Neuroanatomy

Irene Carmelle S. Tan, MD, DSBPP

The Nervous System
• Central Nervous System
• Brain
• Spinal Cord
• Peripheral Nervous System
• Afferent and efferent system
The Nervous System
• Basis of what persons sense, do, feel, and think (sensory, behavioral,
affective, and cognitive experiences and attributes).
• Organ that perceives and affects the environment and integrates past
and present.
• Sensory systems - create an internal representation of the external
world. A separate map is formed for each sensory modality.
• Motor systems - enable persons to manipulate their environment and
to influence others' behavior through communication
Brain
• Approximately 100,000,000,000 neurons (nerve cells)
• Approximately 1,000,000,000,000 glial cells.
• The basic unit is a neuron. Parts of the neuron
• Soma, or cell body, which contains the nucleus
• Dendrites, which are processes that extend from the cell body and receive
signals from other neurons
• Axon, which extends from the cell body and transmits signals to other
neurons
Cerebral Cortex
• Made up of white matter and gray matter.
• White matter - myelinated axons transporting impulses between the
gray matter and lower brain structures.
• Gray matter - where the nerve cells and synapses reside, that we so
often discuss in mental health treatment.
Brodmann’s Area
• Korbinian Brodmann: Comparative Localization Studies in the Brain Cortex,
its Fundamentals Represented on the Basis of its Cellular Architecture
(1909): divided the neocortex into 52 regions based on:
• Size
• Number
• Density of the cells
• Local connections
• Long tract projections to and from the subcortical regions
• Made up of six layers, with few exceptions
• Pyramidal neurons with their triangular-shaped cell bodies make up
approximately 75% of the cortical neurons.
• The local connections or interneurons are typically inhibitory Gamma-
aminobutyric acid (GABA) neurons.
Prefrontal Cortex
• Front of the motor cortex. This is one of the
anatomic structures that distinguishes humans
from other mammals.
• 29% of the cerebral cortex in humans
(compared with 3.5% in the cat, 7% in the dog)
• Dysfunction in the PFC is implicated as a
possible source of pathology in many
psychiatric disorder: depression, schizophrenia,
anxiety, and attention deficit hyperactivity
disorder (ADHD)
• Four regions of the PFC: dorsolateral,
ventromedial, orbitofrontal and the cingulate
gyrus
Hippocampus

• A folded structure incorporated within

the temporal lobe Essential in the
development of memories
• One of the few locations in the brain
where stem cells reside
• The volume of the hippocampus is
decreased in various psychiatric
disorders: post-traumatic stress disorder
(PTSD) and major depression.
Amygdala
• Lies within the temporal lobe just anterior to
the hippocampus
• Divided into three regions:
• the medial group, the central group, and the
basolateral group.
• The basolateral group, which is particularly
large in humans, receives input from all the
major sensory systems.
• The central nucleus sends output to the
hypothalamus and brain stem regions.
• Links sensory input from cortical regions with
hypothalamic and brain stem effectors
(Amygdala is active when people are anxious
and/or angry)
Hypothalamus
• Small cluster of nuclei makes
• Controls basic functions as eating,
drinking, sleeping, and temperature
regulation
• Receives input from four sources: the
higher cortex, the brain stem, internal
chemoreceptors, and hormonal
feedback.
• Has its own chemoreceptors that
measure glucose, osmolarity, and
temperature
Hypothalamus
• Receives feedback from the steroid
hormones and neuropeptides
• Divided into three zones:
• Lateral zone - controls arousal and
motivated behavior.
• The medial zone - involved with
homeostasis and reproduction.
• The periventricular zone -includes the
suprachiasmatic nucleus, cells that
control the autonomic nervous system
(ANS) and the neurosecretory neurons
that extend into the pituitary
Autonomic Nervous System
• Two branches:
• The sympathetic division:
• Originates in the posterolateral region of
the periventricular zone of the
hypothalamus.
• Controls the fight and flight response
• Plays a prominent role in the physical
symptoms of anxiety, for example, racing
heart.
• Send out their axons from the thoracic and
lumbar regions to preganglionic neurons,
which primarily reside in the sympathetic
chain on either side of the spinal cord.
• Cholinergic and adrenergic
Autonomic Nervous System
• The parasympathetic division:
• Originates in the anterior cells of the same
zone in the hypothalamus.
• Mediate functions that the body performs
in times of calm, forexample, digest food.
• Emerge from the brain stem and sacral
region of the spinal cord.
• Exclusively cholinergic.
• Complicates the treatment of mental
disorders particularly when using the
tricyclic antidepressants. (dry mouth,
tachycardia, and constipation)
Cerebellum
• The cerebellum sits on top of the brain stem, at the back of the skull,
below the cerebral cortex.
• Involved with the coordination of movement,
• Active in sensation, cognition, memory, and impulse control
• Implicated to be playing a role in the pathophysiology of autism,
ADHD, and schizophrenia.
• Supportive structure for the cerebral cortex.
Blood Brain Barrier
• One of the mechanism the brain
uses to maintain a controlled
environment, isolated from the rest
of the body.
• Parts: Astrocytes foot processes,
tight junctions and endothelial
capillary cells
• Few areas of the brain that have gaps
in the BBB: The pituitary gland and
some parts of the hypothalamus
• Active transport mechanisms within
the endothelial cell wall to bring
these essential water-soluble
substances into the brain.
Neuronal Cells and Signaling
Irene Carmelle S. Tan, MD, DSBPP
Neuronal Cells
• The cell body of the neuron is full of the
usual assortment of organelles,
although not in the same proportions as
seen in non-neural cells.
Neuronal Cells – Endoplasmic Reticulum
• Endoplasmic reticulum and
mitochondria are found more
frequently in neurons than in other
brain cells
• Because of the increased need for
protein synthesis and energy.
Neuronal Cells – Ribosome
• The ribosome is the organelle in which
mRNA is translated into proteins.
• attached to the endoplasmic reticulum
(rough ER) or floating freely in the
cytoplasm.
• Once refined, are used by the cell for
structural (e.g., receptors), functional
(e.g., enzymes), or communication (e.g.,
neuropeptides) purposes
Neuronal Cells – Golgi Apparatus
• The Golgi apparatus is where much of
the posttranslation refinement, sorting,
and storage of proteins occurs
• Enables proteins to be appropriately
transported to distant sites within the
cell such as the dendrites.
Neuronal Cells – Mitochondria
• The mitochondria are the energy
generators of the neuron and are
abundant in these cells
• Reflects the active nature of the brain.
• The mitochondria convert adenosine
diphosphate (ADP) into adenosine
triphosphate (ATP)
• It is ATP that the cell uses to perform its
functions.
Neuronal Cells – Dendrites
• The dendrites are the part of the neuron
that sprout off the cell body and look like
tree branches.
• Receive input from other neurons and
relay it to the cell body.
• Dendritic spines - is the postsynaptic
receptor for an incoming signal.
• Dendritic abnormalities are the most
consistent anatomic finding of mental
retardation (reduction in the number and
length of dendritic branches along with
sparse and thin spines).
Neuronal Cells – Axons
• The axon is perhaps the most unique
structure of the neuron.
• Starting at the axon hillock and running
either only a few micrometers or the
length of the spinal cord
• Transmit a signal quickly without
degradation to other neurons or end
organs.
Neuronal Cells – Axons
• Axoplasmic transport enables the neuron to
send material down the microtubules to the
distal ends of the cell.
• The terminal end of the axon forms the
synapse. Here the electrical signal sent
down the axon is converted into a chemical
signal, so that the neuron can communicate
with its neighbor.
• The neurotransmitters that form the basis of
the chemical signal are stored in vesicles
and diffuse across the synaptic cleft to the
receptors on the postsynaptic dendrite
when the vesicles open.
Glial Cells
• The glial cells that make up the rest of the cells in the central nervous
system (CNS) actually outnumber the neurons by 9:1.
• three kinds of glial cells:
1. The microglia are similar to macrophages found in the peripheral tissue. They
respond to injury with a dramatic increase in their numbers and remove cellular
debris from the damaged area.
2. The oligodendrocyte is considered the CNS equivalent of the Schwann cell in the
peripheral nervous system. They are the cells that wrap myelin around the axons of
the neurons and by acting as an electrical insulator greatly increase the speed of
the transmission of the action potential. Complete myelinization of the prefrontal
cortex is delayed until the second and even third decade of life.
3. The astrocyte is the star-shaped cell that fills the spaces between the neurons. It
plays a role in maintaining the blood brain barrier, but other functions include
regulating the chemistry of the extracellular fluid, providing structural support, and
bringing nutrients to the neurons. It also plays in modulating the electrical activity
at the synapse.
Glial Cells
Cell Sgnaling
• All living cells maintain a negative internal electronic charge relative
to the fluid outside of the cell’s roughly -60 mV in a neuron.
• Nerve cells use the depolarization of this charge to signal other
nerves or end organs.
• The neuron first receives signals through the dendrites what are
called postsynaptic potentials.
• Second, the cell sums the incoming impulses and if high enough
sends an impulse down the axon, an action potential.
Cell Signaling
• threshold and all-or-none - The neuron will sum up all the incoming
post synaptic potential at the axon hillock. If the potential has
depolarized to the threshold then an action potential is generated.
• This occurs by the opening of the voltage-gated sodium channels and
the rapid influx of positive ions. Voltage-gated sodium channel is a
protein embedded in the lipid member of the cell.
• The gated nature of the channel means that this type of pore allows a
large and fast influx of the particular ions once the threshold has
been crossed.
Cell Signaling
Cell Signaling
• The arrival of the action potential at the terminal depolarizes the
membrane, which opens the voltage-gated calcium channels.
• The voltage-gated calcium channels are similar to the voltage-gated
sodium channels except they are permeable to Ca2+.
• Consequently, there is a large and rapid influx of Ca2+, which is
required for exocytosis and the release of the neurotransmitter.
Cell Signaling
Neurotransmitters and
Neuronal Tracts
Irene Carmelle S. Tan, MD, DSBPP
Neurotransmitters
• Defined by meeting three criteria:
1. The substance must be stored in the presynaptic neuron.
2. It must be released with depolarization of the presynaptic neuron induced by the
influx of Ca2+.
3. The substance must bind with a specific receptor on the postsynaptic neuron.
• Neurotransmitters differ from hormones by their close physical proximity
of the release to the receptor
• Three basic categories:
1. The classic neurotransmitters
2. Neuropeptides
3. Unconventional neurotransmitters
Classic Neurotransmitter: Amino Acids
• Glutamate
• It is the major workhorse of the brain
• Makes up more than half of the excitatory neurons.
• Do not cross the blood brain barrier.
• Synthesized in the brain from glucose and other precursors.
• Glial cells assist in the reuptake, degradation, and resupply of glutamate for
neurons.
Classic Neurotransmitter: Amino Acids
• GABA and Glycine
• GABA is the major inhibitory transmitter in the brain and is used by
approximately 25% of the cortical neurons.
• Glycine is the other inhibitory amino acid, but is less common.
• GABA puts the brakes on the brain: not enough GABA and one can have
seizures.
• GABA interneuron quiets an overactive neuron.
• Increasing GABAergic activity has been used to treat insomnia, pain, and
anxiety, and to assist in the management of mania.
Classic Neurotransmitter: Monoamine
• Two principle classes of monoamines:
• Catecholamines (DA, NE, and epinephrine)
• Indoleamines (serotonin and melatonin)
• All the monoamines are inactivated and degraded when taken back by the
neuron. (Clinicians often refer to this as the reuptake pump, but
neuroscientists call this the transporter, e.g., the DA transporter.)
• The class of enzymes in the terminal that degrades the neurotransmitters is
the monoamine oxidases (MAOs).
• Consequently, MAO inhibitors cause an increase in catecholamines (e.g.,
DA, NE, and serotonin), by limiting the degradation process, with well-
known benefits for depression and anxiety.
Classic Neurotransmitter: Monoamine
• Dopamine
• DA neurons constitute approximately half a million of the cells in the brain
• Substantia nigra located in the ventral midbrain has primary projections to
the caudate and putamen (collectively called the striatum).
• This pathway is called the nigrostriatal system or mesostriatal system.
• As part of the basal ganglia this pathway is integral to voluntary movement.
• Parkinson's disease is the result of a loss of DA neurons in the substantia
nigra.
• The extrapyramidal side effects due to antipsychotic medications can induce
parkinsonian symptoms by blockade of these neurons.
Classic Neurotransmitter: Monoamine
• Dopamine
• The cells of the ventral tegmental area, also in the ventral midbrain, project
to the nucleus accumbens, prefrontal cortex, amygdala, and hippocampus.
• These innervations, called the mesolimbocortical DA system, are particularly
dense in primates.
• Subdivided to 2 branches:
• mesolimbic (nucleus accumbens, amygdala, and hippocampus)
• mesocortical (prefrontal cortex)
Classic Neurotransmitter: Monoamine
• Dopamine
• The short tracts in the arcuate nucleus of the hypothalamus called the
tuberoinfundibular DA system release DA into the portal veins of the pituitary
gland.
• The synthesis and release of prolactin in the anterior pituitary is inhibited by
this DA.
• Any process that interrupts the action of DA on the prolactin-producing cells
will lead to hyperprolactinemia.
• Antipsychotic medications that block the DA receptor can cause an increase in
prolactin
Classic Neurotransmitter: Monoamine
• Dopamine
• In summary there are 4 tracts:
1. Nigrostriatal tract – controls movement (parkinsonian symptoms)
2. Mesolimbic tract – projects to the limbic system (positive symptoms in schizophrenia)
3. Mesocortical tract – projects to the prefrontal area (negative symptoms in
schizophrenia)
4. Tuberoinfundibular tract – controls prolactin (hyperprolactinemia with the use of
antipsychotic)
Classic Neurotransmitter: Monoamine
• Norepinephrine
• Noradrenergic neurons - contain an additional enzyme in their terminals that
converts DA to NE.
• Approximately 50% of the NE neurons are located in the locus coeruleus.
• Project to virtually every area of the brain and spinal cord.
• Noradrenergic neurons are important in handling danger (Sympathetic
nervous system)
• NE is cleared from the synaptic cleft by a reuptake transporter that is also
capable of taking up DA.
Classic Neurotransmitter: Indoleamines
• Serotonin (5-hydroxytryptamine)
• Synthesized from tryptophan that must be obtained in the diet (grains, meats,
and dairy products are good sources of tryptophan).
• Levels of serotonin in the brain can be lowered significantly with insufficient
dietary tryptophan.
• In the pineal gland there are two additional enzymes that convert serotonin
to melatonin, the other indoleamine.
• Cell bodies are relatively few and reside in the raphe nuclei in the brain stem.
• As with NE, the serotonin neurons project to virtually all areas of the brain.
Classic Neurotransmitter: Indoleamines
• Histamine
• Released from mast cells as part of an allergic reaction in the peripheral tissue
• In the brain, it is involved in arousal and attention.
• Most of the cell bodies start in the tuberomammilary nucleus of the posterior
hypothalamus
• When animals are alert, the histamine neurons are active.
• Histamine neurons are quiet when animals are sleeping.
Classic Neurotransmitter: Indoleamines
• Acetylcholine
• Only small molecule transmitter that is not an amino acid or directly
derived from one.
• Not a monoamine, but is often grouped with these neurotransmitters
due to similar size and distribution.
• Plays a prominent role in the peripheral ANS and is the
neurotransmitter at the neuromuscular junction.
• Projections to the hippocampus that are involved with learning and
memory and are disrupted in Alzheimer's disease.
Neuropeptides
• The neuropeptides are small chains of amino acids, which are
considerably larger than the classic neurotransmitters.
• Initially, the peptide is a large propeptide precursor, which is cleaved
into an active neuropeptide as it is moved from the Golgi apparatus
• Not recycled by the neuron, but are rather broken down by
degradative enzymes (peptidases) on the receptor membrane.
• Examples:
• adrenocorticotropic hormone (ACTH), luteinizing hormone, somatostatin, and
vasopressin
• endorphins and enkephalins
Unconventional Neurotransmitters
• Gas: Nitric Oxide
• Most commonly associated with erectile dysfunction,
• Formed in glutamate neurons when arginine is converted into citrulline and
NO.
• Diffuse (without obstruction) out of the originating cell, through the
extracellular medium and into any neighboring cell that it meets.
• Converts guanosine triphosphate (GTP) into cyclic guanosine monophosphate
(GMP) that acts as a second messenger.
• Send a message to the neighboring cells that signals an increase in activity
Unconventional Neurotransmitters
• Endocannabinoids
• Main active compound of marijuana is tetrahydrocannabinol (THC), which
binds to the cannabinoid receptor and causes the well-known euphoria, calm,
distorted cognition, and munchies
• The cannabinoid receptor 1 (CB1) is widely expressed throughout the brain on
presynaptic terminals.
• calming effect of marijuana.
• activating or blocking the CB 1 receptor for therapeutic reasons such as pain, anxiety, and
nausea are being pursued vigorously.
• Potential for a weight loss treatment
• Rimonabant - selective blocker (antagonist) of the CB1 receptor - facilitate weight loss
• The cannabinoid receptor 2 (CB2) implicated in depressing the immune
system
Receptors and Signaling of
the Nucleus
Irene Carmelle S. Tan, MD, DSBPP
Fast Receptors: Chemical
• Ion channel (also called transmitter-gated ion channel).
• A neurotransmitter or medication stimulates the opening of the pore
inside the receptor and ions rapidly flow into the cell.
• Positive ions (Na+ or Ca2+ )
• Result in an excitatory postsynaptic potential (EPSP)
• Acetylcholine and glutamate
• Negative ions (Cl-)
• Result in inhibitory postsynaptic potentials (IPSPs)
• Gamma-Aminobutyric acid (GABA) and glycine
Amino Acid Receptors
• Mediate most of the fast transmitter-gated channels in the brain.
• The receptors, unlike the transmitter, come in a variety of style a
relationship that is much like feet and shoes.
• ”You only have two feet, but many shoes.”
• Categorized as:
• different classes
• different subtypes within a class
• Examples: Glutamate and GABA receptors
Glutamate
• Three prominent glutamate receptors: N-methyl-D-aspartate (NMDA),
amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA), and
kainate
• NMDA and AMPA receptors, which often coexist on the same
postsynaptic receptor, both allow the rapid entry of Na+ into the cell
that generates the depolarization
• NMDA receptors are unique in that they also allow the entry of Ca2+
that can act as a second messenger inside the cell.
Glutamate
• The NMDA receptor is further unique in that it requires both the
glutamate transmitter and a change in the voltage to open before it
will allow the entry of Na+ and Ca2+.
• This property is due to the presence of Mg2+ ions, which clog the
NMDA receptor at resting voltage.
Gamma-Aminobutyric Acid
• GABA and glycine are the primary inhibitory neurons in the brain
• Too much inhibition causes the brain to slow down even lose consciousness
• Too little inhibition can result in seizures.
• GABA receptor has several other sites where chemicals can modulate
its function. These include ethanol, barbiturates and benzodiazepine.
• Steroid hormones can also modulate GABA receptors which may
explain the psychiatric symptoms that develop at times of drop in sex
hormone levels
Slow Receptors: Metabolic
• G-protein coupled receptor
• Basic style involves three steps:
• A neurotransmitter binds to the receptor.
• The receptor activates the G-protein, which moves along the intracellular
membrane.
• The G-protein activates the effector protein.
• Trigger a process called the secondary messenger cascade
• Examples: cAMP and Adenyl Cyclase
• Examples of Metabolic receptors: serotonin, dopamine,
norepinephrine and histamine receptors
Serotonin Receptors
• The 5-HT1 receptors make up the largest subtype with 5-HT1A, 5-HT1B,
5-HT1D, 5-HT1E, and 5-HT1F.
• 5-HT1A play a prominent role in depression and anxiety. It is an
autoreceptor on the cell body. Stimulation of this receptor reduces
cell firing and curtails the release of serotonin.
• Buspirone (Buspar) is a partial 5-HT1A agonist, which suggests that 5-
HT1A has some role in anxiety.
Serotonin Receptors
• The 5-HT1D receptor is also an autoreceptor but is located on the
nerve terminal at the synapse. The 5-HT1D receptor is stimulated by
the antimigraine drug sumatriptan (Imitrex).
• The 5-HT2A plays an important role in the “atypicalness” of the
second-generation antipsychotic agents (clozapine, risperidone,
olanzapine, etc.).
• Blockade of 5-HT2A decrease in extrapyramidal symptom (EPS) and
greater cognitive improvements.
Serotonin Receptors
• In summary,
• 5-HT1A stimulation – anti-depressant and anti-anxiety.
• 5-HT1D receptor stimulation – anti-migraine
• 5-HT2A antagonism - decrease in extrapyramidal symptom (EPS) and greater
cognitive improvements in patients taking atypical antipsychotics
Dopamine Receptors
• The dopamine receptors are involved in a wide range of functions including
locomotion, cognition, psychosis, and even neuroendocrine secretion.
• Increased D2 receptor antagonism correlates with the therapeutic efficacy
and EPS side effect with the traditional antipsychotics.
• There is great interest in the D2-like receptors (D3 and D4) as possible
alternative sites for antipsychotic agents
• The psychostimulants (cocaine, amphetamine, methylphenidate, etc.) work
in part by blocking the reuptake of dopamine and leaving more dopamine
in the synapse to stimulate the dopamine receptors.
• Augmenting D1 and D2 receptors (agonists) are the mainstay of treatment
for Parkinson's disease.
Dopamine Receptors
• In summary,
• Increased D1 and D2 agonism - treatment for Parkinson's disease
• Increased D2 antagonism - EPS and antipsychotics effects
• D3 and D4 - possible alternative sites for antipsychotic agents
• All Dopamine receptors – site of action of psychostimulants (cocaine,
amphetamine, methylphenidate, etc.)
Adrenergic Receptors
• alpha1 receptor
• play a role in smooth muscle contraction and has been implicated in effecting
blood pressure, nasal congestion, and prostate function.
• Stimulation may synergistically increase the activity of the serotonin neurons
in the raphe nucleus
• alpha2 receptor
• subtypes in the CNS inhibit the firing of the norepinephrine neurons.
• mediate the sedative and hypotensive effects of clonidine.
• decreases sympathetic activity(slows cardiac rhythm and lowers blood
pressure)
Histamine Receptors
• The H1 receptor
• Agonism of H1 receptor may lead to arousal
• Antagonism of H1 receptor may lead to weight gain and sedation
• The H2 receptor
• Antagonism of H2 - used treatment for peptic ulcer disease.
• The H3 receptor
• not clearly understood, but may be involved in appetite, arousal, and
cognition.
Cholinergic Receptors
• Nicotinic receptor
• Cholinergic receptors in skeletal muscle
• Muscarinic receptor
• Cholinergic receptors in the heart
• ACh is important in cognition and memory
• Inhibiting acetylcholinesterase is a treatment for Alzheimer's disease.
Signaling
the
Nucleus
Long-Term Potentiation
• Once a neuron has been exposed to high-frequency stimulation, something
changes, and now a single stimulus will generate a high EPSP.
• LTP demonstrates that neurons can incorporate lasting changes, which is an
essential step to developing memories and skills.
• Both glutamate receptors (NMDA and AMPA) must be operational for the
process to work
• Strengthening of connection between two cells due to more transmitters
and more receptors resulting in a stronger signal.
• Development of new spines on the postsynaptic dendrite in the
hippocampus is a manifestation of learning and memory.
Genetics and Epigenetics
Irene Carmelle S. Tan, MD, DSBPP
Genetics
• Genetics is the DNA code for what a cell can transcribe into specific
types of RNA or translate into specific proteins.
• there are over 20 000 genes in the human genome, it does not mean
that every gene is expressed, even in the brain.
Epigenetics
• Epigenetics is a parallel system that determines whether any given
gene is actually made into its specific RNA and protein, or if it is
instead ignored or silenced.
• If the genome is a lexicon of all protein “words,” then the epigenome
is a “story” resulting from arranging the “words” into a coherent tale.
Molecular Mechanisms of Epigenetics
• In addition, malfunctioning neurons are impacted by inherited genes
that have abnormal nucleotide sequences, which if expressed
contribute to mental disorders.
• Thus, the story of the brain depends not only on which genes are
inherited but also on whether any abnormal genes are expressed or
even whether normal genes are expressed when they should be silent
or silenced when they should be expressed.
• Neurotransmission, genes themselves, drugs, and the environment all
regulate which genes are expressed or silenced, and thus all affect the
story of the brain
Molecular Mechanisms of Epigenetics
• Epigenetic mechanisms turn genes on and off by modifying the
structure of chromatin in the cell nucleus
• The character of a cell is fundamentally determined by its chromatin,
a substance composed of Nucleosomes.
• Nucleosomes are an octet of proteins called histones around which
DNA is wrapped
• Chemical modifications that can do this include not only methylation,
but also acetylation, phosphorylation, and other processes that are
regulated by neurotransmission, drugs, and the environment
Thank you!