Module 6 - Nervous System 2

Disorders of the CNS

ANS - involuntary control over vital functions of the cardiovascular, respiratory, and genitourinary system.

CNS - responses include thinking, emotions, or movement.

Disease states occur when neurons do not communicate effectively.

Anxiety Disorders

A generalized feeling of worry, fear, or uneasiness about a perceived threat.

Treatment options:

• Disorder specific cognitive behavioural therapy (CBT).

• Stress-reduction techniques, mindfulness, biofeedback.

• Physical activity, healthy diet, sleep hygiene.

• Mood-disorder drugs - longer-term treatment, but slow onset.

• Anxiolytics (e.g., benzodiazepines) - for generalized anxiety over short-term.

Benzodiazepines

CNS depressants - slows neuronal activity in the brain.

Can lose efficacy with repeated use.

Insomnia

A sleep disorder is a disturbance in the normal pattern, quality, or quantity of sleep.

• Sleep-onset insomnia: inability to fall asleep within a reasonable time.

• Sleep-maintenance insomnia: frequent awakenings with an inability to fall back asleep.

• Sleep-offset insomnia: early morning awakenings.

• Nonrestorative insomnia: persistent sleepiness during the day, despite adequate sleep.

• Chronic insomnia: lasting at least 30 days or more and affecting daytime functioning.

Z-Drugs

Zopiclone, eszopiclone, zolpidem.

MOA: benzodiazepine receptor agonists (GABA).

Common adverse effects: bitter taste, dry mouth.

Dual Orexin Receptor Antagonist (DORA)

Lemborexant

MOA: Antagonists at orexin receptors.

Adverse effects: minimal.

Other Drugs for Insomnia

• Doxepin, mirtazapine, trazodone

  • Antidepressant used due to sedative properties.

  • May be beneficial if associated with a mood disorder.

• Quetiapine

  • Antipsychotic commonly used due to sedative effect.

  • Not recommended for insomnia in the absence of comorbidities.

• Cannabis

  • Benefits are unclear.

  • Use should be limited to comorbidities such as pain,

Mood Disorders

A persistent disturbance in emotion that impairs ability to effectively deal with ADLs.

Examples: major depressive disorder, bipolar disorder.

Depression

Sad or despondent mood out of proportion to actual life events.

Non-Pharmacological Treatment of Depression

Cognitive-behavioural therapy (CBT) and other psychotherapies are a first line treatment option with or without drug therapy.

Antidepressants

MOA - enhance mood by increasing NTs in the synaptic cleft.

Examples: SRRIs, Tricyclic antidepressants.

General approach: Start with a low dose, slow onset, tapering important upon discontinuation.

Common Adverse Effects when Initiating

H - headache

A - anxiety, agitation, or anticholinergic

N - nausea

D - diarrhea or dizziness

S - sleep disturbance

Common Withdrawal Symptoms

F - flu-like

I - insomnia

N - nausea

I - imbalance

S - sensory disturbances

H - hyperactivity

Psychosis

A characteristic of some types of mental illness in which a client has lost contact with reality

• Delusions - ideas and beliefs that are not founded in reality.

• Hallucinations - seeing, hearing, or feeling something that is not there.

• Illusions - distorted or misleading perceptions of something that is not real.

• Paranoia - tendency toward irrational distrust.

Schizophrenia

A type of psychosis in which clients exhibit diverse symptoms over time, including ↓ self-care and ↓ social/occupational function.

Neuroleptic Malignant Syndrome (NMS)

Severe, life-threatening motor syndrome caused by any dopamine-depleting drug.

Antipsychotics (AP)

Uses: schizophrenia, other psychotic disorders, bipolar disorder, depression, PTSD, delirium, borderline personality disorder

First generation antipsychotics (FGAs) - typical/conventional AP

Second generation antipsychotics (SGAs) - atypical AP

Third generation antipsychotics (TGAs) - atypical AP

Clozapine

Proven efficacy for treatment-resistant schizophrenia.

Reserved for treatment-resistant schizophrenia due to the risk of serious adverse effects:

• Myocarditis - inflammation of the heart muscle.

• Constipation

• Agranulocytosis - low neutrophil count (white blood cell).