Psychiatric Disorders, Diseases, and Drugs

Schizophrenia

Most people associate schizophrenia with “madness” (Pinel, 2009, p. 456). Schizophrenia begins in early adulthood with common symptoms of delusions, hallucinations, incoherent thought, odd behavior, and inappropriate affect. Symptoms lasting one month, with two occurrences need to be present for a schizophrenia diagnosis. A Child with a parent or sibling who has schizophrenia is 10% more likely to inherit the disorder. Several genes have been linked with schizophrenia. Early experiences which alter neurodevelopment can also have an impact on developing schizophrenia. Factors and experiences such as early infections, birth complications, toxins, autoimmune reactions, stress, and traumatic injury can contribute to the potential development of schizophrenia.

Theories

The dopamine theory states schizophrenia “is caused by too much dopamine and that anti-schizophrenic drugs exert their effects by decreasing dopamine levels” (Pinel, 2009, p. 458). The person with schizophrenia creates realities that are untrue and twisted as a coping mechanism. Excessive dopamine in the brain leads to auto-intoxication and results with schizophrenia. Dopamine is believed to inhibit human functionality; overproduction of dopamine causes misfiring of circuits in the brain, causing a split state of mind.

Drugs that remedy or lessen effects

A wide variety of drugs have been researched to determine if they reduce the symptoms of schizophrenia. Classes of anti-schizophrenic drugs include: phenothiazines (chlorpromazine), butyrophenones (haloperidol), and neuroleptics (both chlorpromazine and reserpine). Chlorpromazine was the first anti-schizophrenic drug used in the early 1950s; it “was developed by a French drug company as an antihistamine” (Pinel, 2009, p. 458). An American psychiatrist later found reserpine, the active ingredient in the snakeroot plant, to be a helpful treatment to those with schizophrenia. According to Pinel (2009, p. 459), “Haloperidol was one of the most potent anti-schizophrenic drugs of its day.” Neuroleptics such as clozapine are also widely used to treat schizophrenia patients.

How these drugs help

The drug, chlorpromazine, was found to have a calming effect on schizophrenic patients and reduced the severity of the symptoms. Chlorpromazine binds receptors without activating them and blocks the dopamine from activating them while increasing the dopamine release. Similar to chlorpromazine, reserpine breaks down the synaptic vesicles and decreases the brain of dopamine. Haloperidol also reduces symptoms of schizophrenia by reducing the dopamine in the brain. Neuroleptics reduce the propensity to violent behavior, ceasing the delusions and hallucinations.

Negative side effect associated with these drugs

Chlorpromazine agitates schizophrenic patients who are emotionally blunted. Reserpine is no longer used “because it produces a dangerous decline in blood pressure at the doses needed for the treatment” (Pinel, 2009, p. 458). Reserpine may also contribute to mental depression and suicide. Neuroleptics, such as clozapine, can produce a severe blood disorder and movement disorders. It also takes several weeks to alleviate symptoms of schizophrenia with the use of neuroleptics.

Depression

According to Pinel (2009, p. 463), “Depression is often divided into two categories:” reactive depression (the death of a loved one) and endogenous depression (no apparent cause). Those with depression often fall into despair and cannot experience pleasure, oftentimes interfering in their personal and professional lives. Genetic factors contribute to psychological disorders; there is a sixty percent chance of inheriting depression among parents and siblings with depression. However, Pinel (2009) states, there is no particular gene that is found responsible for depression (Berton & Neslter, 2006).

Theories

Two theories surround depression; the monoamine theory and the diathesis-stress model. The monoamine theory states “depression is associated with underactivity at serotonergic and noradrenergic synapses” (Pinel, 2009, p. 465). Autopsy studies show an increase of norepinephrine and serotonin receptors in the brain. The diathesis-stress model is based around stress being the insinuator of depression, along with a biological susceptibility. Interaction with stressors in life can increase the depression affects in some patients. Many believe depression is caused by both biological indifferences and stressful events.

Drugs that remedy or lessen effects

Antidepressants are commonly used for depression; these include selective serotonin-reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). Fluoxetine (Prozac) was the first SSRI to be developed and is widely used to treat depression. Paxil, Zoloft, Luvox, Celexa, and Lexapro are all SSRIs and were modeled after Prozac’s structure.Other medications include tricyclic antidepressants, bupropion (Wellbutrin), and monoamine oxidase inhibitors.

How these drugs help

Selective serotonin-reuptake inhibitors (SSRIs) “block the reuptake of serotonin from the synapses” (Pinel, 2009, p. 464). A similar class of drugs, selective norepinephrine-reuptake inhibitors, was introduced to “block the reuptake of more than one monoamine neurotransmitter” (Pinel, 2009, p. 464). Cymbalta, Remeron, Effexor, and Wellbutrin are considered SNRIs. Tricyclic antidepressants block the reuptake of both serotonin and norepinephrine, thus increasing their levels in the brain. They are safer alternatives to Monoamine oxidase inhibitors (MAOIs). Monoamine oxidase inhibitors (MAOIs) increase the levels of serotonin and norepinephrine in the brain.

Negative side effect associated with these drugs

Each class of depression medication carries many side effects, some are low risk and others are high risk. Selective serotonin-reuptake inhibitors (SSRIs) can cause dizziness, headaches, insomnia, jittery feelings, nausea, low sex drive, and the inability to achieve orgasm (WebMD, 2011). Effexor and Wellbutrin can cause blurred vision, strange dreams, constipation, drowsiness, dizziness, and nausea. Sedation can occur with the use of Remeron; an increase in blood pressure and fatigue can occur with Cymblata. Caution must be used when using monoamine oxidase inhibitors (MAOIs); serious side effects can result with certain food interactions. Any side of effects of chest pain, headache, nausea, and stiff neck are dangerous and must seek medical attention.

Mania

“Mania is an affective disorder characterized by overconfidence, impulsivity, distractibility, and high energy” (Pinel, 2009, p. 463). Mania can become full-blown, with conversation jumping from topic to topic, acting before thinking, and overconfidence to complete too many tasks at one time. Mania is not a disorder alone, but rather a bipolar disorder which moods cycle between highs and lows.

Theories

Genes are said to be the initial cause of mania (bipolar disorder). However, many scientists cannot agree on which gene it is that attributes to bipolar. (Bromwell, 2009). A child with a mother who has bipolar is more likely to inherit the genes for bipolar disorder. Bipolar is a complicated disorder; various types of bipolar disorder have been found. Some people believe psychological factors, such as focusing too much on environmental stressors, trigger bipolar disorder. The true cause of bipolar is still unknown.

Drugs that remedy or lessen effects

Lithium is a simple metallic ion used to block mania and is considered a mood stabilizer. The therapeutic effects of lithium were seen later when it functioned as a mood stabilizer (Pinel, 2009). Lithium is also commonly prescribed to patients with bipolar disorder. Other medications used to treat mania include monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, lithium, and selective serotonin-reuptake inhibitors (SSRIs). A new group of medications, anticonvulsants, are being used to treat mania and bipolar.

How these drugs help

Lithium is the most commonly used drug to stabilize mood swings. Mood stabilizers are also widely used to manage mood swings. Mood stabilizers are effective at blocking rapid transition of mania to depression (Pinel, 2009). Anticonvulsant medication is used for people who cycle rapidly over the course of hours or days. Depakote was approved for use in 1995 for manic-depression.

Negative side effect associated with these drugs

Lithium works for only some patients; some patients have no benefit from using lithium. Common side effects of lithium include nausea, hand tremors, irregular heartbeat, confusion, kidney changes, and underactive thyroid. Side effects associated with the use of anticonvulsants include memory impairment, confusion, disturbed vision, dizziness, and lowering of the white blood cell count. Depakote is an anticonvulsant which can cause anxiety, double vision, and liver dysfunction.

Anxiety Disorder

Fear is normal, but when it becomes severe enough to disrupt normal activities it becomes an anxiety disorder. Pinel (2009) states that a persistent fear can cause anxiety, with physical stress reactions such as high blood pressure, rapid heartbeat, sleep problems, nausea, and even difficulty breathing.

Theories

Anxiety disorders are classified into five groups: generalized anxiety (GA), phobic anxiety (PA), panic disorders (PD), obsessive-compulsive disorders (OCD), and posttraumatic stress disorder (PTSD). Anxiety is often triggered by stressful events and people tend to focus on particular situations or objects which create stress. Although “no specific genes have been linked to anxiety disorders (Gordon & Hen, 2004),” there is a significant genetic component to inheritability (30 – 50%). It is also noted that particular experiences can affect anxiety disorders.

Drugs that remedy or lessen effects

Pinel (2009, p. 467) states, “Three categories of drugs are effective against anxiety disorders: benzodiazepines, serotonin agonists, and anti-depressants.” Common benzodiazepines include Librium and Valium. Busprirone is a serotonin agonist that is widely used in treating anxiety. Antidepressant drugs are also used for anxiety.

How these drugs help

Anxiety, like depression, involves emotional responses which are heightened during stress. Anti-psychotics (antidepressants), such as SSRIs are effective in reducing anxiety and evening out mood swings. Antipsychotics are often used in combination with Lithium. Serotonin agonists, such as buspirone, are widely used in the treatment of anxiety disorders to relax muscle tension. Benzodiazepines help reduce irritability, overactivity, and insomnia.

Negative side effect associated with these drugs

Benzodiazepines are highly addictive and thus, should be for only short-term use. They can also cause sedation, tremors, nausea, and disruption of motor activity. Increased agitation, irritability, and anxiety can occur with the use of anti-anxiety drugs. Some of these drugs can cause mania, rage, impulsive behavior, and hallucinations (Helpguide.org, 2011). Buspirone can cause headaches, nausea, and insomnia.

Tourette Syndrome

Tourette syndrome begins in early childhood, effecting 0.7% of the population. Sudden eye blinking, head movements, or “tics (involuntary, repetitive, stereotyped movements or vovalizations)” (Pinel, 2009, p. 469) are common symptoms of Tourette syndrome. Physical motor tics include touching objects, hopping, hitting, or twirling of hands; verbal tics include swearing, barking, loud sounds, and repeating words.

Theories

Strong evidence links Tourette syndrome to heritability but other factors may play an important role. Tourette syndrome is a disease for the young and lacks any connection to a particular gene. This disease is linked to problems in the brain, particularly with the nerve cells. Patients with Tourette syndrome tend to have smaller caudate nuclei (Pinel, 2009, p. 470) and activity in the prefrontal cortex and caudate nuclei increases when tics are suppressed.

Drugs that remedy or lessen effects

Tics are usually treated with neuroleptics (receptor blockers), however other medications involved in the treatment of tics include anti-seizure medication, blood pressure medication, botulinum toxin injections, and dopamine blockers (risperidone, haloperidol and pimozide). Deep brain stimulation has also shown improvement for tics. Behavioral treatments are also used for Tourette syndrome.

How these drugs help

Medications can reduce tics but cannot stop them completely from occurring. Clonidine and guanfacine can be used to reduce hypertension. The best treatment for Tourette syndrome is the use of behavior therapy. Supportive family and friends can also reduce the occurrences of tics.

Negative side effect associated with these drugs

Neuroleptics can cause weight gain, sedation, tremors, and parkinsonian-like symptoms. Medication research is still being conducted for those with Tourette syndrome including brain images, neuropathology, and clinical trials.

References

A.D.A.M. (2011). National Center for Biotechnology Information. U.S. National Library of Medicine. Major Depression. Retrieved December 3, 2011 from ncbi.nlm.nih.gov

A.D.A.M. (2011). National Center for Biotechnology Information. U.S. National Library of Medicine. Gilles de la Tourette syndrome. Retrieved December 4, 2011 from ncbi.nlm.nih.gov

Association of Physicians of Great Britain and Ireland. (2011). Neuroleptics reconsidered. Oxford Journals. DOI: 10.1093/qjmed/hcl049. Retrieved December 3, 2011 from qjmed.oxfordjournals.org

Bromwell, M. A. (1999). Biological Theories of Manic-Depression. Retrieved December 4, 2011 from serendip.brynmawr.edu

Helpguide.org (2011). Anxiety Medication. Retrieved December 4, 2011 from helpguide.org

National Institute of Neurological Disorders and Stroke. (2011). Tourette Syndrome Fact Sheet. Retrieved December 4, 2011 from ninds.nih.gov

Pinel, J. P.J. (2009). Biopsychology (7th ed.). Pearson Education, Inc.

Psych Central. (2011). Medications for Mania and Bipolar Disorder. Retrieved December 4, 2011 from psychcentral.com

Reserpine. (2011). Retrieved December 3, 2011 from drugs.com

Royal College of Psychiatrists. (2011). Medications for mania. Retrieved December 3, 2011 from rcpsych.ac.uk

The Dopamine Theory. (n.d.). Retrieved December 3, 2011 from pages.slc.edu

WebMD, LLC. (2011). Drugs to Treat Depression. Retrieved December 3, 2011 from webmd.com