NR546 Psychopharmacology Week 1

Neuroanatomy

Central Sulcus

Separates frontal lobe from parietal lobe

Frontal Lobe

Associated with movement, intelligence, abstract thinking, etc.

Cerebellum

coordination

Occipital Lobe

Primary visual area

Sensory cortex

pain, heat, and other sensations

Motor cortex

movement

Hippocampus

involved in both memory and anxiety

Thalamus

sensory organ and motor command processing

Striatum

complex motor actions; links cognition to motor actions

Basal ganglia

Voluntary motor movements

Corpus Callosum

controls communication between brain hemispheres

White Matter

Nerve fibers that connect various regions to make functional circuits

Grey Matter

Nerve cells and dendrites

Brain Tissue

Made of grey and white matter

Nucleus Accumbens

Reward circuit, reinforces addictive behaviors

Parietal Lobe

Keeps us alert to what is going on around us

Temporal Lobe

Object identification and auditory signals

Amygdala

Emotional regulation and perception of odors

Limbic System

Circuits associated with pleasure and reward

Wernicke's Area

Speech comprehension

Broca's Area

Speech

Framework for Improving Medication/Treatment Adherence

1. Diagnosis: confirm dx and explain biological determinants

2. Pharmacological Treatment: discuss medications and expectations/goals

3. Medication Education: Mechanism of action, timeline, duration of trx, side effects, lifestyle modifications

4. Monitoring: Short- and long-term goal discussion and measures

5. Adherence Reinforcement: Social, familial, and clinician support

Informed consent

Clients have the right to receive enough information to make decisions about treatment. They must also be informed about potential risks associated with medications. Clients have the right to refuse treatment and cannot be forcibly medicated in non-emergencies. However, clients can be forcibly medicated if they are violent toward themselves or others and when less restrictive methods have failed.

Compliance

A court order may be issued for a client to receive treatment against their wishes if they are considered a danger to themselves or others. Examples include clients with schizophrenia or sex offenders. Guardians can also provide consent for clients who have limited cognitive capabilities or are incompetent to make decisions. Ultimately, PMHNPs are responsible for being knowledgeable about their state laws and abiding by them.

Off-label prescribing

Some clients may benefit from the unapproved use of a drug for symptom management. For example, many selective serotonin reuptake inhibitors (SSRIs) are used to treat anxiety and obsessive-compulsive disorder but are not Federal Drug Administration (FDA) approved for use in this disorder. Off-label prescribing potentially raises ethical and legal concerns; the PMHNP must remain up to date with the latest recommendations for off-label prescribing.

Lifespan considerations: Pediatrics

Heightened drug sensitivity, greater individual variation, higher risk of adverse effects

Lifespan considerations: Pregnancy/Breastfeeding

Certain drugs can cause birth defects if taken while baby is in-utero; certain drugs can transfer to baby through breast milk or affect milk production; risk to baby versus benefit to mom analysis

Lifespan considerations: Older adults

Aging affects absorption, distribution, metabolism, and elimination of drugs; lower doses may be needed; increased risk of drug interaction due to comorbid conditions/medications

PMHNP Considerations for prescribing

- Symptoms are primary consideration

- Age

- Physical health

- Previous response to trx

- Lifestyle