Psych

Chapter 2

Serotonin concentrations decrease during REM sleep; therefore, this statement is

accurate. Serotonin is primarily an excitatory, not inhibitory, neurotransmitter that
is diffusely distributed within the cerebral cortex, limbic system, and basal ganglia
of the central nervous system (CNS). The potency of some new medications for
migraine headaches is related to their ability to block, not shunt, serotonin
transmission in the cranial blood vessels. Melatonin is derived from serotonin, not
vice versa.

The cerebellum controls and guides movements, as well as maintains muscle tone.
The cerebrum is composed of the frontal, parietal, occipital, and temporal regions
and contributes to intellectual function, including learning, judgment, reasoning,
and memory. The medulla oblongata controls respiration, gastrointestinal motility,
and circulation. The hippocampus is part of the limbic system.

Symptoms vary widely from individual to individual with frontal lobe syndrome. In
general, after damage to the dorsolateral (upper and outer) areas of the frontal
lobes, the symptoms include a lack of drive and spontaneity. With damage to the
most anterior aspects of the frontal lobes, the symptoms tend to involve more
changes in mood and affect, such as impulsive and inappropriate behavior. The
client’s presentation does not support injury to the parietal, occipital, or temporal
lobes of the brain.

During the acute phase of mania, lithium blood concentrations of 0.8 to 1.4 mEq/L
are usually attained and maintained until symptoms are under control.

Examples of MAOIs are phenelzine and isocarboxazid. Fluoxetine, paroxetine, and

sertraline are examples of selective serotonin reuptake inhibitors.

Agranulocytosis is an acute reaction that causes the individual's white blood cell
count to drop to very low levels and concurrent neutropenia, a reduction in
neutrophils in the blood, to develop. While the remaining options are potential side
effects of antipsychotics, agranulocytosis is both life threatening and specific to
clozapine.
Lithium is considered the first-line treatment for bipolar disorder. Lithium is the
most established mood stabilizer.

Olanzapine is considered an atypical antipsychotic. Haloperidol, thioridazine, and

thiothixene are considered conventional antipsychotics.

Phenelzine is a monoamine oxidase inhibitor. The client needs to avoid foods high
in tyramine, such as tap beers, matured and aged cheeses, dried aged and
fermented meats, broad bean pods, concentrated yeast extract, sauerkraut, and
soy sauce.

Damage to the hippocampus causes short-term memory loss and lack of

motivation. Damage of the nucleus accumbeus does not cause memory loss.
Damage to the thalamus results in obsessive-compulsive behavior or decreased
ability to experience pleasure. Damage to the medulla affects circulation and
respiration.

Acetylcholine is the primary cholinergic neurotransmitter. Biogenic amines include

dopamine, norepinephrine, and serotonin.

Abnormalities of serotonin are involved in mental depression and sleep disorders.

Calcitonin is a hormone produced by the thyroid gland. Melatonin is a peptide
hormone not a neurotransmitter. Parathyroid is a gland that secretes parathyroid
hormone.

PNI examines the relationships among the immune system, nervous system, and
endocrine system and our behaviors, thoughts, and feelings. The passing of mental
illness through the generations, phenotype and genetic sequencing all deal with the
genetic basis for mental illness. Genetic susceptibility suggests that an individual
may be at increased risk for a psychiatric disorder such as due to environmental
influences. In the absence of one specific gene for the major psychiatric disorders,
risk factor assessment is a logical alternative for predicting who is more likely to
experience psychiatric disorders.

Imipramine is a TCA and is associated with sedation, orthostatic hypertension, and

anticholinergic effects such as dry mouth and constipation. The client needs to be
careful with activities because the drug is sedating. The client should change
positions slowly to minimize orthostatic hypotension. Sugarless candies, good oral
hygiene, and frequent rinsing of the mouth are helpful to combat dry mouth. A
high-fiber intake would be appropriate to decrease possible constipation.

f a client is nonadherent and there is a significant decline in functioning,

antipsychotic drugs are most often administered intramuscularly. Antipsychotic
medications are not normally administered by the intravenous or subcutaneous
routes, and oral administration is more challenging when a client is noncompliant
with treatment.

Gamma-aminobutyric acid (GABA), which is found in the brain, inhibits nerve

activity and is important in preventing over excitability or stimulation such as
seizure activity. Acetylcholine, dopamine, and serotonin are not the major inhibitory
neurotransmitter in the CNS.

The most serious and potentially fatal side effect of the typical antipsychotics is
neuroleptic malignant syndrome, characterized by severe muscular rigidity, altered
consciousness, disorientation, dysphagia, elevated creatinine
phosphokinase, stupor, catatonia, hyperpyrexia, and labile pulse and blood
pressure. This life-threatening condition can occur after a single dose of a
neuroleptic; however, it is more common in the first 2 weeks of administration or
with an increase in dose. It can continue for up to 2 weeks after discontinuation of
the medication.
Serotonin syndrome has some overlapping signs and symptoms, but it is
characterized by hyperreflexia rather than rigidity and is usually the result of taking
an MAOI and an SSRI.

Drug antagonists block the actions of everything in the agonist spectrum. These
chemicals bind to and block a receptor, producing no response and preventing
agonists from binding or attaching to the receptor.

The hippocampus, part of the limbic system, controls emotions, memory, and
learning. It is also thought to mediate feelings of aggression, sexual impulses, and
submissive behavior. The midbrain is vital to life. It is the only brain area
maintaining heart and lung function in an otherwise comatose person with no
higher-level capacities. The reticular formation controls sleep and wakefulness and
directs visual and auditory reflexes. The basal ganglia assume motor skills that have
become automatic and also initiate and control activities and muscle tone.

Neurobiologic theories serve as a basis for understanding and administering

pharmacologic agents.

Antidepressants, especially tricyclic antidepressants, can cause cardiac

dysrhythmias.

prescription of clozapine requires weekly blood samples for the first 6 months of
treatment, then every 2 weeks for the next 6 months if the absolute neutrophil
count (ANC) stays normal. If treatment with clozapine continues after 1 year and
the ANC remains normal, the client is then tested monthly for as long as the drug is
taken.

The client’s inability to “sit still” and/or frequent pacing is termed “akathisia,” an
extrapyramidal effect of the antipsychotic medication. Akinesia is slowed
movements. Dystonia involves involuntary muscle spasms that lead to abnormal
postures, especially of the head and neck muscles. Pseudoparkinsonism includes
rigidity, slowed movements, and tremor.

The thalamus and hypothalamus coordinate internal and external responses and
direct information into the cerebral cortex.