PCN-527 Topic 8: Short Answer Questions

Introduction 

Substance abuse has become a national crisis as it has given rise to cases of mental health problems especially among adolescents and teenagers. Some of the common mental disorders are psychosis and depression that may lead to suicide of not treated on time. It is therefore important for the doctor to make a correct diagnosis on the type of disorder the patient is suffering from as a misdiagnosis could lead to serious problems. There are various medications used to treat mental disorders and it is up to the doctor to determine the best one for his patients in consideration of the side effects of each medication (Correll, Detraux, De Lepeleire, & De Hert, 2015).

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Topic 8: Short Answer Questions

1. Discuss the similarities and differences of the three generations of antipsychotic medications. 
Doctors use antipsychotic medications to treat psychiatric conditions such as schizophrenia and bipolar. First generation antipsychotics which are considered typical reduce anxiety and alter an individual’s state of mind; examples are haloperidol and chlorpromazine. Second generation antipsychotics are considered a typical as the block serotonin receptors such as 5-HT2A that are known to bring about schizophrenia. First and second generation antipsychotics possess D2 antagonism which is credited for antipsychotic efficacy. Third generation antipsychotics such as Aripiprazole are also dopamine agents though partially. Notable differences in first and second generation antipsychotics are that patients using first generation antipsychotics exhibit extrapyramidal effects, dry mouth, sedation, and neuroleptic malignant symptoms whereas second generation antipsychotics are said to cause type 2 diabetes, increase in weight, and elevation of lipid levels in the patient (Tung and Procyshyn, 2007).

2.  How do the current antipsychotics work on the brain?

Antipsychotics treat psychological health conditions such as acute mania, psychosis, and altered behavioral problems. An individual is said to have psychosis when they start to lose contact with reality where they have fantasies and unrealistic dreams; some patients suffering from mental health conditions hear voices that are really not there. Antipsychotics are used to decrease neurotransmissions, which are responsible for how information is delivered in the brain, by decreasing dopamine. Dopamine is a key neurotransmitter that affects the mental health of an individual. In the initial stages after commencing antipsychotic medication, the patient’s symptoms reduce but they are not completely gone as they are relegated to the back of their minds. The symptoms rake time to go away but through the mediation of plasticity and new learning, they eventually go away (Kapur, Agid, Mizrahi, & Li, 2012).

3. Discuss the similarities and differences between the three generations of medications to treat depression.

First generation antidepressants (FGAs) cause side effects that are intolerable to the patients, they are also harmful in case there is an overdose or if the patient combines them with other medications; they are recommended when patients do not respond to other antidepressants. FGAs have serious food and drug interactions that may lead to headache, confusion, high blood pressure, nausea and vomiting, seizures, and even death.

Second generation antipsychotics (SGAs) are often the first choice of treatment for depressed individuals as they increase the amount of serotonin in the brain by blocking its reuptake by nerve cells; they also have less side effects. Third Generation Antipsychotics (TGAs) improve efficacy and bring change faster than other antidepressants with greater safety reported in comparison with other medications (Drugabuse.gov, 2014).

4. How do the current medications to treat depression work on the brain?

The brain and the spinal cord make up the central nervous system (CNS) that is in charge of emotions, activity, and thoughts. The functions of the central nervous system are controlled by neurotransmitters that travel between various brain regions through nerve cells known as neurons. Receptors are other neurotransmitters that operate on nerve cells; they generate effects that affect emotions, memory, appetite, muscle movement and other body functions (Harmer, Duman, and Cowen, 2017). Antidepressants work the same way by increasing the concentration of the brain neurotransmitters. Tricyclic antidepressants (TCAs) increase serotonin and norepinephrine concentrations but others may increase serotonin more than norepinephrine and vice versa. Monoamine oxidase inhibitor antidepressants (MAOIs) function by blocking the breakdown of monoamine neurotransmitters by keeping the concentration of the brain of neurotransmitters at levels that improve the mood of the patient.

5. Describe three medications that are used to treat substance use disorders.

Buprenorphine reduces withdrawal symptoms that are brought about by opioid addiction and drug cravings without generating the side effects that come with addiction. The drug acts through activation and blockage of opioid receptors in the brain which is known as partial opioid agonist. Its administration is sublingual in a standalone formulation (Subutex) in combination with an agent naloxone. (Drugabuse.gov, 2014). Another drug used to treat substance use disorders is methadone that prevents symptoms that come about with withdrawal through activation of brain receptors as a full opioid agonist. Methadone is mostly used in treating opioid dependence in adults and it is available in legalized methadone treatment centers. Naltrexone is the other drug that is used to prevent relapses in adults after detoxication from opioids. It functions by blocking the receptors in the brain as an opioid antagonist by reducing the feeling that the patient feels after withdrawal from opioids (Tung and Procyshyn, 2007).

6. What medications may be risky to prescribe someone who has a substance use disorder?  Why are they risky?

There are medications that a doctor may not prescribe to a patient with a history of substance abuse; such medicines include pain relievers, muscle relaxers, and stimulants. The drugs are not recommended as they may lead to a relapse on the part of the patients as they may produce a’ high’ that comes with substance use; this is because some of them have small quantities of opium or other narcotics as ingredients. The drugs may also lead to a new addiction by the individual (Drugabuse.gov, 2014).

7. Describe the importance of the DSM in diagnosing and treating mental illnesses and substance use disorders.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), is a tool that directs physicians on diagnosis of mental illnesses. It states that a person is considered to be abusing substances when their continued use leads to health problems or causes them to abandon their responsibilities. DSM accommodates regular communication among health care providers to determine moderate, mild, or severe illness based on the met criteria; it does not treat substance use problems or mental conditions but helps in proper diagnosis of the same an incorrect diagnosis can hinder proper treatment. The tool also helps healthcare provider code diagnostics for insurance purposes. There have been cases where a metal condition has persisted or worsened as a result of the wrong diagnosis hence emphasis on the importance of the DSM tool (Telles-Correia, Saraiva, and Gonçalves, 2018).

8. Identify some adverse side effects of at least two commonly prescribed medication for treating psychiatric disorders

Different medications react differently to different people depending on the severity of the symptoms. Antidepressants can cause side effects that include high blood pressure, headaches, nausea and vomiting, seizures, confusion, and death. Antipsychotic medications are

Known to cause side effects such as drowsiness, dry mouth, or Tardive Dyskinesia, which is a disorder that causes unintentional movement of body muscles. Buspar and Xanax treat panic or anxiety disorders and their side effects include dizziness, impaired coordination, dysphoria, and memory impairment. It is important for the physician to take a detailed medical history of the patient to avoid some of the side effects like high blood pressure as a patient who already has it could lose their lives after taking the medication. The patient should also be advised to go back to the health center if the side effects are intolerable (Correll, Detraux, De Lepeleire, & De Hert, 2015).

Conclusion

Mental disorders as a result of substance abuse are treated by various medications. One might a medication without success but it is advisable to try another type until you find the one that suits you. Patients taking antidepressants should be carefully monitored as there are cases where antidepressants increase the risk of suicide.

References

Correll, C. U., Detraux, J., De Lepeleire, J., & De Hert, M. (2015). Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World psychiatry : official journal of the World Psychiatric Association (WPA), 14(2), 119–136. doi:10.1002/wps.20204

Drugabuse.gov. (2014). Addiction Medications. [online] Available at: https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/evidence-based-approaches-to-treating-adolescent-substance-use-disorders/addiction-medications 

Harmer, C. J., Duman, R. S., & Cowen, P. J. (2017). How do antidepressants work? New perspectives for refining future treatment approaches. The lancet. Psychiatry, 4(5), 409–418. doi:10.1016/S2215-0366(17)30015-9

Kapur, S., Agid, O., Mizrahi, R., & Li, M. (2012). How antipsychotics work-from receptors to reality. NeuroRx : the journal of the American Society for Experimental NeuroTherapeutics, 3(1), 10–21. doi:10.1016/j.nurx.2005.12.003

Telles-Correia, D., Saraiva, S., & Gonçalves, J. (2018). Mental Disorder-The Need for an Accurate Definition. Frontiers in psychiatry, 9, 64. doi:10.3389/fpsyt.2018.00064Tung, A. and Procyshyn, R. (2007). How Antidepressant and Antipsychotic Medications Work | Here to Help. [online] Heretohelp.bc.ca. Available at: http://www.heretohelp.bc.ca/visions/medications-vol4/how-antidepressant-and-antipsychotic-medications-work

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