TOPIC: "Neurological and Psychological

Disorders"

Submitted by Submitted to
Nazmus Sakib Fahad Imtiaz Rahman
Id: 201811231002 Lecturer
Batch: 31st Department of pharmacy
Department of pharmacy Bangladesh University
Bangladesh University

SUBMITION DATE:
06/07/2021
CONTENTS

1) Insomnia & anxiety

2) Affective disorders

3) Schizophrenia

4) Epilepsy

5) Parkinsonism

6) Alzheimer disease

7) Bipolar disorder

8) ADHD
Insomnia
Insomnia is a common sleep disorder that can make it hard to fall asleep,
hard to stay asleep, or cause you to wake up too early and not be able to
get back to sleep. You may still feel tired when you wake up

Symptoms

Insomnia symptoms may include:

 Difficulty falling asleep at night

 Waking up during the night
 Waking up too early
 Not feeling well-rested after a night's sleep
 Daytime tiredness or sleepiness
 Irritability, depression or anxiety
 Difficulty paying attention, focusing on tasks or remembering
 Increased errors or accidents
 Ongoing worries about sleep

Causes

Insomnia may be the primary problem, or it may be associated with other

conditions.
Chronic insomnia is usually a result of stress, life events or habits that
disrupt sleep. Treating the underlying cause can resolve the insomnia, but
sometimes it can last for years.

Common causes of chronic insomnia include:

 Stress.
 Travel or work schedule.
 Poor sleep habits.
 Eating too much late in the evening.
 Mental health disorders.
 Medications
 Medical conditions
 Sleep-related disorders.
 Caffeine, nicotine and alcohol
The pathophysiology of insomnia

Insomnia disorder is characterized by chronic dissatisfaction with sleep

quantity or quality that is associated with difficulty falling asleep, frequent
nighttime awakenings with difficulty returning to sleep, and/or awakening
earlier in the morning than desired.

Although progress has been made in our understanding of the nature,

etiology, and pathophysiology of insomnia, there is still no universally
accepted model. Greater understanding of the pathophysiology of insomnia
may provide important information regarding how, and under what
conditions, the disorder develops and is maintained as well as potential
targets for prevention and treatment.

The aims of this report are

(1) to summarize current knowledge on the pathophysiology of insomnia

and

(2) to present a model of the pathophysiology of insomnia that considers

evidence from various domains of research.

Working within several models of insomnia, evidence for the

pathophysiology of the disorder is presented across levels of analysis, from
genetic to molecular and cellular mechanisms, neural circuitry, physiologic
mechanisms, sleep behavior, and self-report. We discuss the role of
hyperarousal as an overarching theme that guides our conceptualization of
insomnia.

Finally, we propose a model of the pathophysiology of insomnia that

integrates the various types of evidence presented.
Model of the pathophysiology of insomnia. GABA = γ-aminobutyric acid;
SNP = single-nucleotide polymorphism.

Medication

Benzodiazepine sedatives such as triazolam (Halcion), estazolam,

lorazepam (Ativan), temazepam (Restoril), flurazepam, and quazepam
(Doral) and non-benzodiazepine sedatives such as zolpidem (Ambien,
Intermezzo), eszopiclone (Lunesta), and zaleplon (Sonata) are drugs that
can help induce sleep.
Anxiety
Anxiety is a normal and often healthy emotion. However, when a person
regularly feels disproportionate levels of anxiety, it might become a medical
disorder.

Anxiety disorders form a category of mental health diagnoses that lead to

excessive nervousness, fear, apprehension, and worry

These disorders alter how a person processes emotions and behave, also
causing physical symptoms. Mild anxiety might be vague and unsettling,
while severe anxiety may seriously affect day-to-day living.

an emotion characterized by feelings of tension, worried thoughts and

physical changes like increased blood pressure

Symptoms

 restlessness, and a feeling of being “on-edge”

 uncontrollable feelings of worry
 increased irritability
 concentration difficulties
 sleep difficulties, such as problems in falling or staying asleep

Causes

Possible causes include:

 environmental stressors, such as difficulties at work, relationship

problems, or family issues
 genetics, as people who have family members with an anxiety
disorder are more likely to experience one themselves
 medical factors, such as the symptoms of a different disease, the
effects of a medication, or the stress of an intensive surgery or
prolonged recovery
 brain chemistry, as psychologists define many anxiety disorders as
misalignments of hormones and electrical signals in the brain
 withdrawal from an illicit substance, the effects of which might
intensify the impact of other possible causes
Medications

A person can support anxiety management with several types of

medication.

Medicines that might control some of the physical and mental symptoms
include antidepressants benzodiazepines, tricyclics, and beta-blockers.

Affective disorders
Affective disorders are a set of psychiatric disorders, also called mood
disorders.

The main types of affective disorders are depression and bipolar disorder.
Symptoms vary by individual and can range from mild to severe.

Types of affective disorders & symptoms

Depression
Depression is a medical term that describes ongoing feelings of extreme
sadness and hopelessness.
Bipolar disorder
Bipolar disorder is a mental health condition where a person experiences
extreme shifts in mood.

Causes of affective disorders

Neurotransmitters, or brain chemicals, play a major role in affecting mood.

When they’re imbalanced in some way, or don’t signal properly to your
brain, an affective disorder can be the result. What exactly causes the
imbalance isn’t fully known.

Life events can trigger affective disorders. A traumatic event or personal

loss can cause depression or another affective disorder. Use of alcohol and
drugs is also a risk factor.

There also seems to be a genetic factor. If someone in your family has one
of these disorders, you’re at a greater risk of developing one as well. This
means that they’re hereditary.
Treatments for affective disorders

There are two main treatments for affective disorders: medication and
therapy. Treatment usually involves a combination of both.

There are many antidepressant medications available. You may need to try
several before you find one that helps relieve your symptoms without too
many side effects.

In addition to therapy and medications, supplemental approaches may be

used to help treat some types of depression. These include vitamin D
supplements and light therapy, which is supplied by specialized lamps.

Schizophrenia
Schizophrenia is a serious mental disorder in which people interpret reality
abnormally. Schizophrenia may result in some combination of
hallucinations, delusions, and extremely disordered thinking and behavior
that impairs daily functioning, and can be disabling.

People with schizophrenia require lifelong treatment. Early treatment may

help get symptoms under control before serious complications develop and
may help improve the long-term outlook

Symptoms

 Delusions.
 Hallucinations
 Disorganized thinking (speech).
 Extremely disorganized or abnormal motor behavior..
 Negative symptoms

Pathophysiology

Schizophrenia is a complex disorder involving dysregulation of multiple

pathways in its pathophysiology. Dopaminergic, glutamatergic and
GABAergic neurotransmitter systems are affected in schizophrenia and
interactions between these receptors contribute to the pathophysiology of
the disease. Deficits in acetylcholine muscarinic receptors have been
identified in a sub-group of individuals with schizophrenia. Inflammation has
also been found to play a major role in the development and exacerbation
of psychotic symptoms in schizophrenia. Additionally, evidence from
genetic, post-mortem and animal studies over the past decade has
identified a number of susceptibility factors for schizophrenia, including
neuregulin 1 (Nrg1) and its receptor ErbB4, disrupted-in-schizophrenia-1
(DISK1), dysbindin-1, catechol-O-methyl tranferase (COMT), BDNF, and
Akt. These factors and related pathways interact closely with dopaminergic,
glutamatergic and GABAergic neurotransmitter systems. A key question is
how do these interactions contribute to the pathophysiology of
schizophrenia? More specifically, how do these components interact during
early brain development based on the view of schizophrenia as a
developmental disorder? Therefore, this Research Topic aims to map the
pathophysiology of schizophrenia by illuminating the interactive nature of
specific pathways on different levels of the brain from cellular pathways and
neural circuits to functional deficits.

Treatment

Some potential treatment options include:

 Antipsychotic drugs. These can be for daily use or for less frequent
use if the person opts for injectable medications, which can last up to
3 months between injections (depending on the medication).
 Counseling. This can help a person develop coping skills and pursue
their life goals.
 Coordinated special care. This integrates medication, family
involvement, and education services in a holistic approach.

Epilepsy
Epilepsy is a chronic disorder that causes unprovoked, recurrent seizures.
A seizure is a sudden rush of electrical activity in the brain.
There are two main types of seizures. Generalized seizures affect the
whole brain. Focal, or partial seizures, affect just one part of the brain.
A mild seizure may be difficult to recognize. It can last a few seconds
during which you lack awareness.
Cause

Stronger seizures can cause spasms and uncontrollable muscle twitches,

and can last a few seconds to several minutes. During a stronger seizure,
some people become confused or lose consciousness. Afterward you may
have no memory of it happening.
There are several reasons you might have a seizure. These include:
 high fever
 head trauma
 very low blood sugar
 alcohol withdrawal
Symptoms

The main symptom of epilepsy is recurrent seizures. However, if a person

experiences one or more of the following symptoms, they should seek
medical attention, as it may indicate epilepsy:
 a convulsion with no fever
 short blackouts or confused memory
 intermittent fainting spells, during which they lose bowel or bladder
control, frequently followed by extreme tiredness
 temporary unresponsiveness to instructions or questions
 sudden stiffness for no apparent reason
 sudden falling for no apparent reason
 sudden bouts of blinking without apparent stimuli
 sudden bouts of chewing without any clear reason
 temporarily seeming dazed and unable to communicate
 repetitive movements that seem involuntary
 fearfulness for no apparent reason
 panic or anger
 peculiar changes in senses, such as smell, touch, and sound
 jerking arms, legs, or body, which will appear as a cluster of rapid
jerking movements in babies
Treatment
There is currently no cure for most types of epilepsy.
A doctor may prescribe antiepileptic drugs (AEDs) to help prevent seizures.
If these drugs do not work, some other potential options include surgery,
vagus nerve stimulation, or a special diet.
Pathophysiology
The pathophysiology of epilepsy and seizures is diverse, accounting for the
many different types of seizure disorders. However, one commonality
across epilepsies is a disrupted balance between excitatory (via
glutamatergic signaling) and inhibitory (via GABAergic signaling) drive at
the synaptic level that can result in seizure activity. Early pharmacologic
studies demonstrated that GABAA-receptor antagonists and glutamate-
receptor (NMDA, AMPA, kainate) agonists could elicit seizure activity in
normal animals. Further studies would demonstrate that interictal spikes
commonly observed on EEG recordings from epilepsy patients are
associated with a large depolarization and subsequent flurry of action
potentials in individual neurons. The highly organized structure of cortical
tissue with its laminar cell layers facilitates the flow of normal neuronal
processing, while also providing a structure highly susceptible to abnormal
synchronous activity that can lead to seizure generation. Under normal
circumstances, excitatory synaptic activity is tightly regulated by inhibitory
interneurons; however, genetic mutation, trauma, abnormal development,
or a number of other insults disrupts this regulation allowing cortical
networks to become hyperexcitable.
Partial epilepsies present clinically as any of the partial seizure types and
account for ∼60% of epilepsy patients. The etiology of partial epilepsies is
broad and includes cortical lesions, tumors, developmental malformation,
or acute cortical damage due to trauma or stroke. Trauma-induced epilepsy
is becoming a larger issue as medical advances allow patients to survive
more severe traumas that would have been fatal in previous generations.
Genetics may also play a role in partial epilepsies underlying cortical
malformations or tumor generation.7 In contrast, generalized epilepsies,
accounting for ∼40% of patients, are usually genetic in etiology. Genetic
mutations to ion channels (or channelopathies), including voltage-gated
sodium channels and GABAA receptors, have been identified for many
generalized epilepsies and help guide treatment strategies.
Parkinsonism
Parkinsonism is a disease that occurs when a person has symptoms and
brain dysfunction commonly associated with Parkinson’s disease but also
has other symptoms related to an additional condition or cause.
Symptoms

 difficulty showing facial expressions

 muscle stiffness
 slowed, affected movements
 speech changes
 tremor, especially of one hand
 dementia
 issues with the autonomic nervous system, such as problems with
controlled movements or spasms
 early problems with balance
 rapid onset and progression of symptoms

Treatment

Although there is no cure for Parkinson's disease, medicines, surgical

treatment, and other therapies can often relieve some symptoms

Medicines prescribed for Parkinson's include:

 Drugs that increase the level of dopamine in the brain

 Drugs that affect other brain chemicals in the body
 Drugs that help control nonmotor symptoms

The main therapy for Parkinson's is levodopa, also called L-dopa. Nerve
cells use levodopa to make dopamine to replenish the brain's dwindling
supply.

Other medicines used to treat Parkinson’s symptoms include:

 Dopamine agonists to mimic the role of dopamine in the brain

 MAO-B inhibitors to slow down an enzyme that breaks down
dopamine in the brain
 COMT inhibitors to help break down dopamine
 Amantadine, an old antiviral drug, to reduce involuntary movements
 Anticholinergic drugs to reduce tremors and muscle rigidity
Alzheimer disease
Alzheimer's disease is a progressive neurologic disorder that causes the
brain to shrink (atrophy) and brain cells to die. Alzheimer's disease is the
most common cause of dementia — a continuous decline in thinking,
behavioral and social skills that affects a person's ability to function
independently.

Cause

Alzheimer's disease is thought to be caused by the abnormal build-up of

proteins in and around brain cells. One of the proteins involved is called
amyloid, deposits of which form plaques around brain cells. The other
protein is called tau, deposits of which form tangles within brain cells.

Pathology

The pathology of Alzheimer's disease is characterized, in part, by

extracellular Aβ deposits, commonly referred to as plaques, as well as
intracellular tau protein tangles. The inherently disordered, aggregation-
prone Aβ peptide remains an extremely challenging system to work with.

Medicines

A number of medicines may be prescribed for Alzheimer's disease to help

temporarily improve some symptoms.

The main medicines are:

Acetylcholinesterase (AChE) inhibitors
Memantine
Cholinesterase inhibitors may also improve neuropsychiatric symptoms,
such as agitation or depression. Commonly prescribed cholinesterase
inhibitors include donepezil (Aricept), galantamine (Razadyne) and
rivastigmine (Exelon).
Bipolar disorder
Bipolar disorder, formerly called manic depression, is a mental health
condition that causes extreme mood swings that include emotional highs
(mania or hypomania) and lows (depression).

Symptoms
mania ("the highs")
 Excessive happiness, hopefulness, and excitement
 Sudden changes from being joyful to being irritable, angry, and
hostile
 Restlessness
 Increased energy and less need for sleep
 Drug and alcohol abuse
 Less need for sleep
 Less of an appetite
 Larger sense of self-confidence and well-being
During depressive periods ("the lows"), a person with bipolar disorder may
have:
 Sadness
 Loss of energy
 Feelings of hopelessness or worthlessness
 Not enjoying things they once liked
 Uncontrollable crying
 Insomnia
 Thoughts of death or suicide

Medications
Medications may include: Mood stabilizers. You'll typically need mood-
stabilizing medication to control manic or hypomanic episodes.
Examples of mood stabilizers include lithium (Lithobid), valproic acid
(Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol,
Equetro, others) and lamotrigine (Lamictal).
ADHD
Attention deficit hyperactivity disorder (ADHD) is a brain disorder that
affects how you pay attention, sit still, and control your behavior. It
happens in children and teens and can continue into adulthood. ADHD
is the most commonly diagnosed mental disorder in children.

symptoms

 being unable to sit still, especially in calm or quiet surroundings.

 constantly fidgeting.
 being unable to concentrate on tasks.
 excessive physical movement.
 excessive talking.
 being unable to wait their turn.
 acting without thinking.
 interrupting conversations.

Medications

The number of medications available to treat attention deficit hyperactivity

disorder (ADHD or ADD) is overwhelming at best, and the process for
selecting the best ADHD medication for you or your child, or deciding to
medicate at all, is incredibly personal.
The ADHD medications prescribed to both children (as young as age 6)
and adults are broadly categorized as
Amphetamine
Methylphenidate
Dexmethylphenidate.