Medicines to Treat Mental Health Issues

Medicines to Treat Mental Health Issues

  • Professor: Emilio Badoer, School of Health and Biomedical Sciences, RMIT University
  • Email: emilio.badoer@rmit.edu.au

Overview of Lecture Structure

  • Sections: Each section has specific learning outcomes highlighted at the beginning.
  • Revision Questions: Provided for feedback and to help gauge understanding and connect learning to the outcomes.

Lecture Topics

  • Focus Areas:
    • Epilepsy
    • Parkinson’s Disease
    • Depression
    • Anxiety and Sleep Disorders
    • Psychoses
    • Dementia

Section I: Treatment of Seizures (Focus on Epilepsy)

  • Reading Reference: Chapter 23 in Pharmacology in Nursing, Edition 4.
Learning Outcomes for Epilepsy
  • Discuss symptomatology of epilepsy.
  • Describe types of seizures.
  • Explain mechanisms of action of anti-epileptic drugs.
  • Discuss medication indications and adverse effects.
  • Identify drug interactions.
Epilepsy Overview
  • Definition: A chronic disorder characterized by recurrent episodes of seizures.
  • Diagnosis: More common in children and the elderly.
  • Causes: Can include genetics, stroke, CNS trauma, and infections.
  • Seizure Types:
    • Partial Seizures: Begins in one area of the brain, localized symptoms without loss of consciousness.
    • Generalized Seizures: Involves both hemispheres, includes loss of consciousness and muscle spasms.
    • Absence Seizures: Seen in children; brief staring episodes without awareness.
Status Epilepticus
  • Definition: Continuous seizures lasting over 5 minutes; a medical emergency.
  • Causes: Can result from untreated epilepsy, stroke, tumors, infections, or hypoglycemia.
General Treatment Guidelines for Epilepsy
  • Is there a likelihood of seizure recurrence or severity?
  • Start treatment with a single drug at low doses; titrate as needed.
  • Consider adding a second drug if seizures are uncontrolled.
  • Gradually withdraw any drug if discontinuation is necessary.
Overview of Pharmacological Therapy for Epilepsy
  • Antiseizure agents act on various neurotransmission sites.
  • Mechanisms of Action:
    • Inhibition of sodium channels to reduce neuronal excitability.
    • GABA neurotransmission modulation to increase inhibitory signal.
    • Calcium channel function inhibition.
Example Antiseizure Drugs
  • Carbamazepine: Indicated for partial seizures; common adverse effects include drowsiness and dizziness.
  • Phenytoin (Hydantoins): Indicated for tonic-clonic seizures, mortality risk if not monitored properly.
  • Ethosuximide (Succinimides): Mainly for absence seizures, adverse effects include nausea and ataxia.
  • Valproate: Inhibits GABA breakdown, increasing its levels; various adverse effects including potential liver damage.

Section II: Treatment of Parkinson's Disease

  • Reading Reference: Chapter 22 in Pharmacology in Nursing, Edition 4.
Learning Outcomes for Parkinson's Disease
  • Discuss symptomatology of PD.
  • Describe drug mechanisms and pharmacological therapy indications and effects.
Parkinson’s Disease Overview
  • Definition: Progressive disorder, prevalent in older adults, defined by a deficiency of dopamine.
  • Symptoms: Tremors, bradykinesia, muscle rigidity, postural instability.
Pharmacological Treatment Overview
  • Levodopa (L-DOPA): Main treatment, prescribed with carbidopa to enhance effectiveness without crossing the blood-brain barrier.
  • Adverse Effects: Include dyskinesias, anxiety, and hypotension, often worsening over time.
  • Adjunct Therapies: Include dopamine agonists and enzyme inhibitors to enhance treatment effects, protect dopamine levels.

Section III: Treatment of Depression

  • Reading Reference: Chapter 19 in Pharmacology in Nursing, Edition 4.
Learning Outcomes for Depression
  • Discuss symptomatology, mechanisms of action, drug indications, and adverse effects.
Depression Overview
  • Symptoms: Profound sadness, changes in appetite and sleep, fatigue, feelings of guilt.
  • Causes: Life events, medications, or may be idiopathic (30% without external causes).
Antidepressant Types
  • SSRIs: Such as fluoxetine, increase serotonin levels by blocking reuptake.
  • SNRIs: Such as venlafaxine, affecting both noradrenaline and serotonin levels.
Adverse Effects and Drug Interactions
  • Common effects include nausea, dizziness, and risk of hypertensive crises with specific antidepressants.
  • Bipolar Disorder Treatment: Focused on mood stabilizers like lithium, effective within a narrow therapeutic window.

Section IV: Treatment of Anxiety Disorders

  • Reading Reference: Chapter 18 in Pharmacology in Nursing, Edition 4.
Learning Outcomes for Anxiety and Psychoses
  • Explore mechanisms of treatment, symptomatology, and pharmacological responses.
Anxiolytics and Sedatives
  • Benzodiazepines: Widely prescribed for various anxiety disorders, sleep issues, and muscle spasms.
  • Mechanism: Enhance GABA receptor function, leading to increased inhibitory effects on neuronal activity.
Antipsychotic Treatment
  • Schizophrenia: Characterized by positive and negative symptoms; treated with antipsychotics aiming to reduce positive symptoms quickly.
  • Common agents include olanzapine and risperidone, but they have significant side effects.
Polypharmacy in the Elderly
  • High prevalence of multiple medications, requiring careful monitoring to avoid adverse effects.