Psychopharmacology

A Psychopharmacology Mantra

“Reality is complex, and complexity is our friend” (Ingersoll and Sak)

Psychopharmacology is a rapidly changing field, and therefore it is important to not rely on
memorization; becoming competent in psychopharmacology entails staying current with new
treatments, with a focus on learning concepts and use of the tools available to you.

Scientific Truth and medication cannot erase nonbiological sources of suffering or

help the client to understand the meaning of this suffering.
WORD MAGIC refers to professional groups using words to convey certainty when
there is none eg hypothesis that mental disorders are resultant of a chemical
imbalance.
The Mind-Brain Problem

The Mind-Brain Problem – Explored through two hypotheses:

1. The Epiphenomenon Hypothesis – the mind is a side effect of the brain or the
mind derives from the brain.
2. The Dual-Substance Hypothesis – Belief in a consciousness or external soul that
is separate from the body; the mind and brain are separate therefore client
symptomology must be explored beyond the Medical Model.
An Integrative Approach takes into consideration multiple perspectives.
Faces (Levels) of Truth – complimentary perspectives give us a greater picture of
how to consider and treat individuals within multiple contexts. Failure to consider can
lead to clinician bias. Diamond metaphor (many facets).
Theoretical Perspectives in
Psychopharmacology

1. Medical Model Perspective – helps us to understand the correlation between the parts of the
brain and symptoms of mental / emotional disorders as well as the molecular structure of drugs
using objective, measurable data of individuals.
2. Psychological Perspective – deals with consciousness “the mind”. This perspective considers
the clients’ phenomenological experiences of the world through truthful dialogue and subjective
knowledge of oneself gained through processes such as counseling, psychotherapy, and
meditation.
3. Cultural Perspective – comes from the premise that shared beliefs and worldviews carried
over generations are important considerations in treatment approach and treatment
compliance.
4. Social Perspective – addresses the shared beliefs, policies and laws of social groups and
institutions such as the legal system, FDA, and DEA using measurable and observable data.
Break Out Discussions

o Social perspective - Can / Should a person be medicated against his or her will?
o Psychological Perspective – What might it mean to a person to take a
psychotropic medication?
o Cultural Perspective – How should we interpret and interact with a family who
believes psychotropic medication is spiritually damaging?
o Medical Model Perspective – How might we address a person’s concern
regarding the effects a drug has on an individual’s physiology?
Exploring the Nervous System

The Central Nervous System - VIDEO

o Brain
o Spinal Cord
The Peripheral Nervous System (outside of the brain and spinal cord) - VIDEO
o Somatic – connects with sense receptors and skeletal muscles

 Autonomic – controls involuntary functions related to glands, smooth muscles,

heart and viscera
https://youtu.be/eLIH2gO0g9g
Pharmacologic Terms

Pharmacodynamics is the mechanism for how drugs act on the body.

Pharmacokinetics is the mechanism of how the body reacts to and acts on drugs
introduced into it.
Psychotropic means acting on or moving toward the mind; goal is to get the drug
into CNS.
Brain Anatomy and Functions

https://youtu.be/EeE7Fpg061I
Pharmacodynamics

How drugs act on the body

Anatomy of a Neuron

https://youtu.be/ob5U8zPbAX4
Khanacademy.org
Neurotransmission

https://youtu.be/Tbq-KZaXiL4
Anthropology.net
Neurotransmission

KEY PLAYERS
 Deoxyribonucleic acid (DNA) is a macromolecule, housed in the nucleus of a neuron.
When active it makes ribonucleic acid (RNA) and gives it the genetic code. RNA then
leaves the neuron, attaching to ribosomes to create more proteins as basis for building
other structures in the cell.

 Transporters move things around in and out of the neurons, creating a recycling
program. Transporters pick up a neurotransmitter after it unbinds from a receptor to take
back inside the cell to be stored for later use.
Neurotransmission

KEY PLAYERS CONTINUED

 Enzymes are multifunctional in the neuron, breaking down or putting together
neurotransmitters. They are transported outside of the cell to break down
neurotransmitters in the synaptic cleft and provide energy for the transporters to recycle
the neurotransmitter back to the synaptic cleft.

 Receptors are large protein molecules created in the soma and transported to different
parts of the neuron. They are intra and extracellular, with the binding site for the
neurotransmitter outside the cell.
Process of Neurotransmission

 First messenger effect is the initial binding of a neurotransmitter (excitatory or inhibitory) to the
receptor.
 Second messenger effects are the second messengers that take longer to occur and the effects last longer.
They have a significant impact on neurotransmission by extending and amplifying the cell’s response to
the transmitter.
 Downregulation is the result of a decrease in the creation of receptors, reducing the sensitivity of the
neuron. The outcome of this effect is seen as reduction of symptoms, eg antidepressant-induced
improvement.
 Upregulation is a result of a second messenger effect that increased the synthesis of receptors, thereby
increasing the sensitivity of the neuron. Unwanted effects are called side effects eg tardive dyskinesia
caused by older antipsychotic medications.
Pharmacodynamics
How psychotropic medications affect neurotransmission

 Agonist is a substance that combines with the cell to produce a reaction.

 Antagonist is a substance that combines with the cell to block an action of the agonist.

https://youtu.be/PhfhMBO-w9Q
 Pharmacodynamics

Mechanisms of action with effects on production

 Some drugs act like precursors that increase the amount of precursor material available (agonist action),
correcting a shortage of the neurotransmitter eg Dopamine and its degeneration in Parkinson’s disease.
 Some drugs inactivate enzymes that create neurotransmitters (antagonist action)eg PCPA that inactivates
enzymes that create serotonin, causing insomnia.
 Autoreceptors (located in the membranes of the presnynaptic nerve cells) are only sensitive to the
neurotransmitters or hormones released by the neuron on which the autoreceptor sits. They monitor levels
of neurotransmitters in the synaptic cleft and will send a signal back into the neuron to slow down the
synthesis and release of a neurotransmitter.
 Pharmacodynamics

Mechanisms of action with effects on release of neurotransmitter

 Drugs can inhibit or facilitate exocytosis (the release of neurotransmitter into the synaptic cleft) eg black widow spider
venom will result in acetylcholine to leak out.
 A substance that prevents the release of neurotransmitter from the neuron is botulinum toxin, aka Botox.
 Drugs can imitate a first messenger eg nicotine mimics acetylcholine receptors (nicotinic and muscarinic), causing release
of neurotransmitter and is associated with reinforcing properties of the drug by increasing cell receptors resulting in
tolerance.
 Drugs can interfere with first messenger effects by blocking receptors eg older antipsychotics to block dopamine
receptors and not allowing the dopamine to bind.
Mechanisms of action targeting neurotransmitter deactivation
 Enzyme deactivation is the action that deactivates enzymes that deactivate the neurotransmitters, thereby allowing a drug
to artificially lengthen the amount of time a neurotransmitter influences the synaptic cleft eg MAO inhibitors
 Reuptake inhibition is another action that targets neurotransmitter deactivation, by disabling or slowing down transporter
molecules eg most every antidepressant, except MAO inhibitors.
Neurotransmitters

Neurotransmitters are chemical messengers in the nervous system. They are made from precursor
compounds such as amino acids, glucose, and choline.

What constitutes a neurotransmitter?

A substance must
 Be synthesized in the presynaptic neuron
 Be released from the presynaptic terminal
 Cause excitatory (promotes firing) or inhibitory (prevents firing) signals
 Have some mechanism for removing it from the site of action
Neurotransmitters and Their Functions
Neurotransmitter Function
Acetylcholine (ACh) Enables muscle action, learning
and memory
GABA (gamma- A major inhibitory
aminobutyric acid) neurotransmitter. Known to
“mellow you out” however if
inhibits certain areas in the brain,
it can have opposite effect.
Dopamine Influences movement, learning,
attention, and emotion. Key role
in the pleasure center and
addiction.
Examples of Malfunction
In Alzheimer’s, Ach-producing
neurons deteriorate as ACh rich
tissues degenerate.
Undersupply linked to seizures,
tremors, and insomnia.
Oversupply linked to migraines
(some people avoid MSG in
foods).
Oversupply linked to
schizophrenia. Undersupply
linked to tremors and decreased
mobility in Parkinson’s disease.
Neurotransmitters and Their Functions
Neurotransmitter Function
Glutamate The major excitatory
neurotransmitter; involved in
memory.
Serotonin Affects mood, hunger, sleep, and
arousal.
Norepinephrine Fight/flight chemical;
Synonymous with adrenaline;
Found in CNS, PNS and in the
sympathetic nerves of the ANS.
Example of Malfunction
Oversupply overstimulates the
brain, can trigger migraines and
seizures and result in death of
brain cells (why some people will
avoid MSG, monosodium
glutamate, in foods.
Undersupply linked to
depression. Similar structure to
LSD.
Undersupply can depress mood.
Oversupply increases blood
pressure, dilation of pupils and
air passages in lungs.
Questions and Good night!