Psychopharmacology Demystified

130 Pages·2010·19.851 MB·English

by  Leonard Lichtblau

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Leonard Lichtblau,
PhD
Associate Professor
Department of Experimental and Clinical Pharmacology
College of Pharmacy
University of Minnesota
Australia • Brazil • Japan • Korea • Mexico • Singapore • Spain • United Kingdom • United States
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Psychopharmacology Demystifi ed, © 2011 Delmar, Cengage Learning
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Leonard Lichtblau
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FLAME has many meanings. It can be a brilliant light, a streak of
color, an intense passion, or a sweetheart. Bobbi, my late wife, was all
of these to me. She was the flame whose radiance lit up my life and
allowed me to see the world. She was my first and only sweetheart, a
woman full of life and overflowing with passion, both to be right and
to do right. She was a role model of what humanity is supposed to be
about. She both loved life and lived life.
When I met her, so long ago, at age 21, she had a shock of pure
white hair running along her brow, a sign of where God’s tears of joy
landed upon her, seeing how beautiful she was. My Bobbi brought
lightness into every room she entered and into every life she touched.
Without Bobbi’s support and her confidence in me, this project
would not have happened. It is to her memory that I dedicate this
book. Bobbi’s flame shone brightly but oh so briefly upon the world
and we are all a little less for her absence today.
Bobbi Lichtblau (1950–2007)
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
TABLE OF
CONTENTS
Preface / vii Retrograde Messengers .................................. 16
Acknowledgments / ix Unusual Messengers ..................................... 17
Reviewers / xi Neurotrophins ............................................. 17
Information Gathering 17
...................................
CHAPTER 1:
CHAPTER 2:
NEUROANATOMY AND
NEUROPHYSIOLOGY / 1 PHARMACOTHERAPY
OF DEPRESSION / 21
Introduction 2
..................................................
Terms ........................................................2 Diagnosing Depression ................................. 22
The Nervous System 3 Battling Depression 22
...................................... ......................................
The Structure of the Nervous System .....................4 The Four Rs: Recovery, Remission,
The Brain .....................................................4 Response, and Recurrence .............................. 22
Classification Systems ......................................5 Biologic Psychiatry ...................................... 23
The Brainstem ...............................................5 Monoamine Oxidase Inhibitors (MAOIs) ................ 24
The Cerebellum .............................................6 Tricyclic Antidepressants (TCAs) ........................ 24
The Diencephalon ..........................................7 Sources of Depression ................................. 24
The Limbic System .........................................7 Multistep Processes ...................................... 25
The Cerebrum ...............................................8 Brain-derived Neurotrophic Factor (BDNF) and Stress ... 25
Frontal Lobe .................................................8 Pharmacokinetics ......................................... 26
Parietal Lobe ................................................9 Limitations of MAOIs and TCAs ......................... 26
Temporal Lobe ..............................................9 Selective Serotonin Reuptake Inhibitors (SSRIs) ....... 27
Occipital Lobe ...............................................9 Norepinephrine Reuptake Inhibitors (NRIs) ............. 28
Basal Nuclei (Basal Ganglia) ..............................9 Selective Serotonin and Norepinephrine Reuptake
Neurophysiology Overview ............................ 10 Inhibitors (SNRIs) ......................................... 28
Information Exchange ................................... 10 Delay in Symptom Relief ................................. 30
Receptors .................................................. 11 BDNF’S Role .............................................. 30
Neurotransmitters 12 Depression: Past and Present 32
........................................ ........................
Acetylcholine (ACh) ....................................... 12
Biogenic Amines: Norepinephrine (NE), CHAPTER 3:
Dopamine (DA), and Serotonin (5-HT) .................. 12 PHARMACOTHERAPY
Amino Acid Neurotransmitters ........................... 14 OF BIPOLAR DISORDER / 37
The Complex Brain 15
.......................................
Neuropeptide Messengers ............................... 15 Bipolar Mood Disorder .................................. 38
Multiple Releases ......................................... 16 Bipolar Categories ........................................ 39
Neuronal Messengers .................................... 16 Bipolar I Subtypes ........................................ 39
v
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vi TABLE OF CONTENTS
Bipolar II (Figure 3-2, G) ................................. 41 CHAPTER 6:
Cyclothymia (Figure 3-2, H) .............................. 41 ANXIOLYTIC–SEDATIVE–HYPNOTIC
Depression Therapies .................................... 41
DRUG PHARMACOTHERAPY / 77
A Pharmaceutical Inventory 42
...........................
Lithium ..................................................... 42 Anxiety ...................................................... 78
Anticonvulsants ........................................... 42 Pharmacotherapy of Anxiety ............................. 78
Antipsychotics ............................................. 43 Insomnia .................................................... 82
Electroconvulsive Therapy (ECT) .................... 43 Pharmacologic Management of Insomnia .............. 82
Potential Role of BDNF 43 Evolving Drug Options 83
................................. ..................................
Molecular Biology Basics ................................. 43
BDNF Variants ............................................ 45 CHAPTER 7:
Tailoring Treatment ....................................... 45 NEUROBIOLOGY OF ADDICTION / 87
CHAPTER 4: Statistics .................................................... 88
Addiction ................................................... 90
ANTIPSYCHOTIC
Terms 90
........................................................
PHARMACOTHERAPY / 51
Narcotic .................................................... 90
Introduction ................................................ 53 Drug Dependence ........................................ 90
Neuroanatomy and Neurophysiology ............... 54 Tolerance .................................................. 90
Mesolimbic Pathway (ML) ................................ 54 Psychoactive Drugs ....................................... 90
Mesocortical Pathway (MC) .............................. 55 Drug Abuse ................................................ 90
Nigrostriatal Pathway (NS) ............................... 55 Opioids, Anxiolytics, and Stimulants ............... 91
Tuberoinfundibular Pathway (TI) ......................... 55 Opioids ..................................................... 91
Antipsychotics ............................................. 56 Anxiolytic–Sedative–Hypnotics .......................... 93
Antipsychotic Drugs and Brain Dopamine Psychostimulants ......................................... 95
Pathways .................................................... 57 Selective Abuse ........................................... 97
Nigrostriatal Pathway ..................................... 57 Opioids ..................................................... 97
Mesocortical Pathway .................................... 58 Alcohol and Anxiolytic–Sedative–Hypnotics ............ 97
Tuberoinfundibular Pathway .............................. 58 Psychostimulants ......................................... 98
Mesolimbic Pathway ...................................... 58 Issues of Comorbidity .................................. 98
Putting It Together: Part I ............................... 58 The Substrate of Addiction ............................ 98
Adverse Drug Effects .................................... 58 Abstinence Initiation .................................. 100
Drug Interactions .......................................... 59 Opioids ................................................... 100
Pharmacokinetics ......................................... 59 Nicotine .................................................. 102
Putting It Together: Part II .............................. 60 Alcohol ................................................... 102
Genes, BDNF, and Schizophrenia 60 Stimulants ............................................... 102
....................
Antipsychotics and BDNF ................................ 61 The Meaning of Addiction ............................ 103
CHAPTER 5:
Answer Key 106
..............................................
COGNITIVE ENHANCERS / 65
Index 113
.......................................................
No Magic Pill 67
...............................................
Attention Deficit Hyperactivity Disorder
(ADHD) 67
......................................................
Alzheimer’s Disease (AD) 69
..............................
Cholinesterase (AChE) Inhibitors ........................ 70
BDNF and AD ............................................. 73
Acetylcholine (ACh) in ADHD and AD 73
..............
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PREFACE
T
he preface of a textbook is where the author gives you PEDAGOGICAL ELEMENTS
his or her lofty, dignified and, often, altruistic reasons for
writing the book they hope you will purchase. My reasons are,
This book does not fit the standard definition or composi-
by contrast, mundane and uncomplicated; I accepted a chal-
tion of a textbook. Unlike traditional pharmacology and
lenge or bet and lost (or won, actually).
psychology texts, it does not offer identically organized
Three years ago my colleague Merrie Kaas, DNSc, RN,
chapters with consistent section headers. Each chapter in
CS, and I, in the University of Minnesota School of Nursing,
this textbook stands on its own, with a unique je ne sais quoi
had two months to prepare an online psychopharmacology
(that’s French for a pleasing characteristic that is difficult
course for advanced practice nursing students, and I wouldn’t
to describe—and it makes me sound so clever). Moreover,
stop whining about the limited choices of textbooks we could
Psychopharmacology Demystified is not filled with copious
use for the course. What bothered me to no end was that
quantities of pharmacokinetic and pharmacodynamic fac-
the available psychopharmacology texts were either weighty
toids or with exhaustive lists of every drug used to treat ev-
tomes written by MD-PhDs for MD-PhDs or they were writ-
ery disease or illness (If you are looking that level of detail,
ten by authors who seemed to think that impugning the intel-
purchase Delmar’s Nurse’s Drug Handbook.)
ligence of their potential audience (rhymes with mummies)
Instead, Psychopharmacology Demystified is filled with
would get students to flock to college bookstores and shell
s tories (read about the first bad acid-trip) and fun-facts (carbon
over hard-earned cash for overly simplified explanations of
monoxide is a neurotransmitter; the first clinically useful anti-
truly complex phenomena.
depressants were developed by the Allies from leftover chemi-
What was needed, I felt, was a book that communicated
cals used by the Germans to fuel the rockets that showered over
our current understanding of mental illnesses and the drugs
England during WW II). The stories are designed to capture
used to treat those illnesses, but written using language intel-
your attention and keep you reading through the tedious mate-
ligible by college-educated students pursuing a career in nurs-
rial (Sorry, I can’t entirely eliminate it). Each chapter begins
ing and/or clinical psychology. On top of that, it should be
with a quote (because I love quotes) and often with a personal
FUN to read. Fed up, Merrie challenged me to put up or shut
vignette, written by a patient or family member (to remind you
up and write my own content if I thought I could do better.
that, although the book focuses on illnesses and drugs, ulti-
This book is the result of that challenge.
mately it is about people.) This book is written for you—the
For each section of the psychopharmacology course, I
student—the one who needs to use the information. You may
was responsible for assembling the scientific evidence sec-
find that this book is a little like its author, rumpled, disheveled,
tions while Merrie addressed the other essential elements
irreverent, and fun to be around (LOL).
that allow mental health professionals to make rational treat-
A word of warning: Don’t buy this textbook if all you
ment decisions for the patient, and to maximize the chance
want are the answers. You won’t find them here. I believe an
of a successful therapeutic outcome (Model for Psychophar-
exceptional textbook and a first-class higher education is one
macotherapeutic Management, developed by Merrie Kaas).
that not only gives you some answers, but more importantly, it
The course was a tremendous success and I was encouraged
gives you new questions. But don’t panic! Answers and ratio-
by our students to assemble my contributions into a text-
nales are provided for all end-of-chapter review questions and
book and get it published. So, voila, Psychopharmacology
are located in the Answer Key at the back of the book.
Demystified, at your service.
vii
Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
viii PREFACE
“Model for Psychopharmacotherapeutic Management” developed by Merrie Kaas.
Patient Context Scientific Evidence
Treatment Options
Legal and Cost Benefit Situational Issues
Ethical Standards
Patient/Clinician Decision
Treatment Plan
Treatment Outcomes
So, if you actually have gotten this far and read this entire Len Lichtblau, PhD
Preface, and perhaps enjoy the book, please send me an e-mail Associate Professor
([email protected]) and let me know. I’ll even write back to you. College of Pharmacy and School of Nursing
Enjoy! 1 University of Minnesota
1“Human salvation lies in the hands of the creatively maladjusted.” —Martin Luther King Jr.
Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.