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Drugs for Psychoses & Degenerative Diseases of the Nervous System Chapter 10

Introduction • Disorders associated with emotional, unusual, or bizarre feelings are among the leading causes of mental health problems. • Will cover behavioral/emotional disorders, mood disorders, and psychoses.

Introduction • Most psychoses have no identifiable cause and require long-term drug therapy. • Patients with psychoses often cannot tell what is and is not real. • Delusions, hallucinations, illusions, disorganized behavior, difficulty relating to others.

Introduction • People with psychosis are usually unable to function normally in society without lifelong drug therapy and ongoing visits with a healthcare provider.

Mood Stabilizers • is the major psychosis —characterized by abnormal thoughts and thought processes, disordered communication, withdrawal from other people and the outside environment, and a high risk for suicide.

Mood Stabilizers • Characteristics include: pg. 150 bulleted ▫ Delusions—false beliefs or ideas ▫ Hallucinations— experiencing something that is not really there. ▫ Paranoia—feeling that someone is “out to get” one

Mood Stabilizers • Several theories—positive and negative symptoms help determine type of medication. • Positive—those that add on to normal behavior—hallucinations, delusions, and a disorganized thought or speech pattern. • Negative—those that subtract from normal behavior—lack of interest, motivation, or responsiveness, and lack of pleasure in daily life

Mood Stabilizers • Antipsychotic medication attempts to stabilize client with psychoses— AKA neuroleptics • Conventional antipsychotics • Atypical antipsychotics

Mood Stabilizers • Conventional antipsychotic—Table 10.1 pg. 152. • More effective in treating positive symptoms of schizophrenia • Extrapyramidal side effects—reduce dose may go away • Neuroleptic malignant syndromerare; with dosages; can be fatal • DP—chlorpromazine (Thorazine) pg. 154

Mood Stabilizers • Atypical antipsychotics —Table 10.4 pg. 158 • Treat both positive and negative symptoms of schizophrenia • Fewer side effects • DP—clorozapine (Clozaril) pg. 158.

Parkinsons Disease • Parkinsons disease is a degenerative disorder of the CNS caused by death of neurons that produce the brain neurotransmitter dopamine. • It is characterized by disturbances of muscle movement.

Parkinsons Disease • Symptoms include: ▫ ▫ ▫ ▫

Tremors Muscle rigidity Bradykinesia Postural instability

Parkinsons Disease • Symptoms of Parkinson’s disease result from dysfunction of Dopamine neurotransmitter between various parts of the brain.

Parkinsons Disease • Drug therapy for Parkinson’s symptoms focuses mainly on dopamine and acetylcholine. • Two major drug therapies are levodopa (Larodopa) and benztropine (Cogentin)

Parkinsons Disease • Extrapyramidal symptoms (EPS)— symptoms where muscles become very rigid because of over-medication with anti-psychotics or by lack of dopamine function in the corpus striatium.

Parkinsons Disease • If Extrapyramidal symptoms occur in the health care facility—Benadryl may be given • If untreated can be fatal

Parkinsons Disease • Tardive dyskinesia—a movement disorder often causing involuntary lip and tongue movements and less frequently causing involuntary movements of the trunk and extremities, is observed in client’s who have been given antipsychotic drugs for an extended length of time. • Anticholinergic med’s prescribed concurrently with anti-psychotics to discourage development of tardive dyskinesia or to treat it once it develops.

Parkinsons Disease • Dopaminergic drugs –table 10.6 pg. 161 ▫ Replace dopamine or increase its action in the brain ▫ Drug Profile Levodopa pg. 163.

Parkinsons Disease • Cholinergic blocking drugs—Table 10.7 pg. 164 ▫ Block effect of acetylcholine in CNS ▫ Used in clients who cannot tolerate levodopa ▫ Drug profile— benztropine (Cogentin)– pg. 164

Alzheimers’s Disease • Alzheimer’s Disease ▫ Diagnosis only on autopsy —amyloid plaques & neurofibrillary tangles present ▫ Loss of cholinergic brain function especially in the hippocampus—an area of the brain responsible for learning and memory. ▫ Symptoms pg. 165

Dementia • Dementia is a progressive and permanent loss of brain function. • Two common types of dementia are Alzheimer’s disease and vascular dementia. • Restorative drug therapies for dementia mainly focus on Alzheimer’s disease because this is the most common type of

Alzheimer’s Disease • Alzheimers drugs Table 10.8 pg. 166. • Current medications result in minor improvement of symptoms • Attempt to slow memory loss • Enhance action of acetylcholine in brain • Drug profile—Aricept pg. 167.

Multiple Sclerosis • MS is an autoimmune disorder of the CNS. • Antibodies target and slowly destroy tissues in the brain and spinal cord. • As tissues are damaged, inflammation of nervous tissue causes demyelination, or the loss of myelin, a fatty material that acts as a protective insulator of nerve fibers.

Multiple Sclerosis • Gradually disrupts the ability of the nerves to conduct electrical impulses to and from the brain. • Common s/s: fatigue, heat sensitivity, pain, spasticity (muscle cramps and spasms), cognitive problems, balance and coordination problems, and bowel and bladder symptoms.

Multiple Sclerosis • Two basic strategies for treating MS. • One approach attempts to reduce inflammation and prevent attacks on the nervous system. • The other strategy emphasizes treatments to relieve symptoms. • Drugs used for MS Table 10.9 pg. 169