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What lobe of the brain is involved w/ Schizophrenia?
Frontal...= decr. in abstract reasoning, decision making, socializing, goal planning, insight, motivation
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What MH are assoc. w/ the temporal lobe?
Schizophrenia, depressive disorders, PTSD, ETOHism, Alzheimers...temporal lobes connect w/ limbic system which is our "tmotional brain" that allows expression of emotions (eg. sexual, aggressive, fear...)
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What is the impact of MAOI on neurotransmitter function?
MAOI= Monoamine oxidase inhibitors destroy monoamine oxidase which is an enzyme that destroys nonrepinephrine, epinephrine, dopamine and serotonin...allowing for more of these neurotransmitters at the synapse
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What are the typical antipsychotics?
She Thought Pretty Navels Had Melons
- Stelazine
- Thorazine
- Prolixin
- Navane
- Haldol
- Mellaril
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What are some of the atypical antipsychotics?
Always Remember Clean Giraffes See Zebras
- Abilify
- Risperdal
- Clozaril
- Geodon
- Seroquel
- Zyprexa
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What is the gneral emergency tx for agitated pts?
- -Zydis (PO fizzy tab)
- -Geodon (IM)
- -B-52: Haldol, Ativan, Cogentin
- -any injectible older drugs but watch for EPS
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What is the s/e of Clozaril?
agranulocytosis, pt. must have weekly CBCs
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What is the s/e of Zyprexa?
weight gain, metabolic syndrome
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What is the s/e of Risperdal?
orthostatic hypotension
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What is the s/e of Seroquel?
orthostatic hypotension
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What is the s/e of Geodon?
orthostatic hypotension, dysrhythmias
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What is Abilify?
an atypical....it is a dopamine system stabilizer...in areas of the brain w/ excess dopamine it lowers it, and in areas w/ decr. dopamine it stimulates receptors to raise the dopamine level, acting as a dopamine agonist
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What is an oculogyric crisis?
usually result of typicals, a dystonic reaction when the eyes shoot to the top of the head and the pt. can't bring them down
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What is the tx for a dystonic rxn?
- congentin or benadryl...
- hold the causatory med until consult w/ MD
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When is the highest time of risk for a dystonic rxn?
1-5 days
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What is the time of risk for Pseudoparkinsonism? What is the tx?
- -weeks to months
- -tx is cogentin or symmetrel
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Discuss Cogentin
Cogentin= an Anticholinergic that blocks the EPS of medications, but can cause delirium in the extreme
"hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter"
s/e: dry mouth, blurred vision, hot dry skin and hyperpyrexia, mental statues changes
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Discuss Neuroleptic Malignant Syndrome (NMS)
- -occurs from dopamine blockade...main thing we want to watch for is high fever, but also HTN, incr. muscle tone, sweating, tachycardia, drooling...
- -D/C med, tx in ICU w/ Dantrium and Parlodel
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What is alogia?
poverty of thought
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What is avolition?
lack of motivation
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What is anhedonia?
inability to experience pleasure
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Discuss the positive symptom of Shizophrenia that is negativism/resistance
- active negativism= pt does the opposite
- passive negativism= pt does not perform basic ADLs
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What is the general function of dopamine?
- (dopamine=excitatory)
- -abstract thinking
- -integrationof emotions and thoughts
- -decision making
- -stimulates heart, incr. bloodflow to organs
- -controls muscle movement and coordinations
- -fine muscle movement
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What are the general functions of noradrenaline?
- noradernaline = excitatory
- -selective attention and cognition
- -mood
- -stimulates ANS for Fight or Flight
- -pulse and BP regulation
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What are the general functions of serotonin?
- -serotonin= excitatory
- -mood regulation
- -cognition
- -grooming
- -sexual function
- -panic attacks
- -sleep/wake cycle
- -appetite
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What are the general functions of histamine?
- histamine= excitatory
- -alertness
- -inflammatory response
- -stimulates gastric secretion
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What are the general functions of GABA?
- GABA= inhibitory
- -reduces anxiety
- -reduces excitation
- -reduces agression
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What are the general functions of Glutamate?
- glutamate= excitatory
- -plays a role in learning
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What are the general functions of Acetylcholine?
- -w/ Ach think demintia, Alz....
- a decr. in Ach= decr inhibition, decr memory, euphoria, constipation, tachycardia
-an incr. in Ach =over inhibition, anxiety, depression, diarrhea, bradycardia
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Incr. in Dopamine=
Schizophrenia, Mania
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Decr. in Dopamine=
Parkinsons, depression
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Incr. in norepinephrine=
mania, anxiety, Schizophrenia
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Decr. in norepinephrine=
depression
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Incr. in serotonin=
anxiety, serotonin syndrome (watch for hypertensive crisis!)
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Decr. in serotonin=
depression
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incr in histamine=
hyperactivity, compulsivity, suicidal depression
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decr. in histamine=
sedation, weight gain, hypotension
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incr in GABA=
reduction of anxiety
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decr. in GABA=
mania, anxiety, Schizophrenia
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incr. NMDA/glutamate=
prolonged activation kills neurons
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Decr. NMDA/Glutamate?
Psychosis
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Incr acetylcholine=
depression
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decr Acetylcholine=
Alz disease, huntingtons chorea, parkinsons
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