Nervous System and Psychiatric Disorders

Introduction

Nervous system and psychiatric diseases include many complicated disorders involving nerve transmission, neurotransmitters, mood and behavior, and sensory and motor impulse disturbances. The medical specialty of neurology diagnoses and treats nervous system disorders. Psychology and psychiatry diagnose and treat psychiatric diseases. Some nervous system and psychiatric diseases are difficult to diagnose in early stages and may cause severe impairment and long term damage if left untreated. Many medications are available to treat these disorders, but a combination of psychotherapy and behavioral therapy produce the best results in treating behavioral disorders. 

 

Nervous System Disorders and Treatments

Because the nervous system is so complex and fragile, it's vulnerable to various disorders. Nervous system disorders may be caused by functional impairments, brain tissue degeneration, vascular abnormalities, trauma, or infections.

Aging plays a role in decreased nerve signal reception and conduction. This results in varying degrees of decreased vision, hearing, muscle coordination, confusion, and weakness. Some of the common symptoms of nervous system disorders include tremors, blurred vision, paralysis, irritability, change in respiration and pulse, restlessness, and speech difficulties.

 

Parkinson's disease is a slowly degenerative disease caused by shrinking levels of the neurotransmitter dopamine. It may result from the loss of dopamine-producing neurons in the brain.

 

Dopamine is a neurotransmitter vital for the normal functioning of posture control, physical support, and voluntary movement.

Causes of Parkinson's disease are unknown, and there's no cure. Medications are used to relieve symptoms of the disease. 

The following are four hallmark signs of Parkinson's disease:

1. Resting tremor (shakiness in hands and feet)

2. Muscular stiffness or rigidity 

3. Slowing of movements (bradykinesia)

4. Impaired postural reflexes (the most debilitating because it increases the risk of falls)

 

The following medications are used to relieve Parkinson's disease symptoms:

• Levodopa/Carbidopa (Sinemet)
• Entacapone (Comtan)
• Entacapone/Levodopa/Carbidopa (Stalevo)
• Benztropine (Cogentin)
• Rasagiline (Azilect)

 

Alzheimer's disease (AD) is characterized by loss of memory, poor judgment, and general withdrawal from daily life. The exact causes of this disease are unclear. This disease can be traumatic for family members because the patient's personality changes. One important fact about AD is that it's not a normal process of aging. Early warning signs of Alzheimer's disease include memory loss, difficulty performing familiar tasks, speech impairment, disorientation, and significant mood or behavior changes. 

The following medications are commonly used to treat Alzheimer's disease:

• Donepezil (Aricept)
• Rivastigmine (Exelon)
• Galantamine (Razadyne)
• Memantine (Namenda)

 

Multiple sclerosis (MS) is caused by an inflammation of the myelin sheath that covers the nerve pathways in the brain and spinal cord. Once the myelin sheath is damaged, nerves are unable to conduct impulses appropriately. Causes of MS are unknown, but some believe a virus is responsible. MS is more common in women than men and occurs more frequently between the ages of 15 and 45. Although steroids and muscle relaxants may help, there's no effective treatment for MS. The symptoms of MS are tingling, numbness, and weakness affecting certain areas of the body. It may also result in loss of balance, poor coordination, shaking or tremors, muscle spasticity, difficulty in speaking clearly, and bladder dysfunction.

The following medications are commonly used to treat MS:

• Glatiramer (Copaxone)
• Interferon beta-1a (Avonex)
• Interferon beta-1b (Betaseron)
• Azathioprine (Imuran)
• Cyclophosphamide (Cytoxan)
• Mitoxantrone (Novantrone)
• Diazepam (Valium), baclofen (Lioresal), and tizanidine (Zanaflex) are used to decrease symptoms of spasticity. 

 

Meningitis is an inflammation of the meninges due to an infection. The infection often results from an invasion of bacteria or viruses. Because there are many forms and degrees of meningitis, treatment is tailored to the type of bacterium or virus causing the disease as well as the severity of the infection. 

The symptoms of meningitis are fever, nausea, vomiting, stiff neck, inability to tolerate bright light, a deep red or purplish skin rash, drowsiness, and even unconsciousness in severe cases. Meningitis is very difficult to treat with antivirals or antibiotics due to the inability of many medications to cross the blood-brain barrier. Patients often require high doses of antivirals and antibiotics to treat meninges. 

Meningitis Treatment

The following antibiotics and antivirals are effective against meningitis when used with a combination of two to three medications given in high doses:

• Ceftriaxone (Rocephin)
• Cefotaxime (Claforan)
• Vancomycin (Vancocin)
• Meropenem (Merrem)
• Acyclovir (Zovirax)
• Ganciclovir (Cytovene)

Myasthenia Gravis

Myasthenia gravis is a rare disease that causes weakness in certain skeletal muscle groups due to faulty transmission of nerve impulses to those muscles. Symptoms include muscular weakness (initially facial), drooping eyelids, double vision, and difficulty talking and swallowing.

Myasthenia Gravis Treatment

The following medications are effective in treating myasthenia gravis:

• Neostigmine (Prostigmin)
• Pyridostigmine (Mestinon)

 

Tension headaches (or headaches in general) are probably the most common medical complaint. Headaches can be caused by stress, lack of sleep, dehydration, a side effect effect of medications, or environmental factors.

A migraine is an episodic headache that's accompanied by nausea, vomiting, and sensitivity to light and sound. It's one of the most severe and debilitating types of headache. Migraines are known to be caused by a sequence of changes as a result of neural dysfunctions.

Tension Headache

The following medications are used in treating the common headache:

• Acetaminophen (Tylenol)
• Acetaminophen with caffeine (Excedrin)
• Butalbital and aspirin (Fiorinal)
• Butalbital and Acetaminophen (Fioricet)
• Acetaminophen, Isometheptene, and Dichloralphenazone (Midrin)
• Ibuprofen (Motrin)

Migraine

The following medications are commonly used to treat acute attacks as well as prevent future migraine attacks:

• Sumatriptan (Imitrex)
• Eletriptan (Relpax)
• Zolmitriptan (Zomig)
• Topiramate (Topamax)
• Ergotamine (Ergostat)

 

A stroke is known as a cerebrovascular accident or CVA. A seizure disorder is generally known as a convulsion.

1. A stroke is a sudden onset of a neurological deficit in the blood vessels that supply blood to the brain. The cause of the stroke can be due to a blood clot (thrombus) or bleeding (hemorrhage) in any part of the brain. When a blood clot or thrombus clogs a blood vessel in the brain, it results in a lack of oxygen to the affected area, causing an ischemic stroke. In other cases, various factors such as increased pressure and trauma can cause the blood vessels to burst open in the brain, causing a hemorrhagic stroke. 

It's very important to distinguish these two types of strokes to choose an appropriate treatment. Common signs and symptoms of stroke include blurred vision, speech impairment, partial paralysis, dizziness, memory loss, and fainting. Hemorrhagic stroke often requires blood transfusions and immediate surgical intervention to stop the bleeding.

2. The following medications are commonly used to treat ischemic stroke:

• Dipyridamole (Persantine)
• Ticlopidine (Ticlid)
• Heparin sodium (Heparin)
• Enoxaparin sodium (Lovenox)
• Warfarin sodium (Coumadin)
• Alteplase (TPA)—Treats acute and severe ischemic stroke and must be administered within the first one to two hours of the onset of stroke symptoms for the best clinical outcome.

3. A seizure disorder is generally known as a convulsion. It's the disease of involuntary contraction or a series of contractions by voluntary muscles. Any irritation of the nerves can lead to seizures. Such irritations may cause infectious diseases such as meningitis and encephalitis. 

There are many types of seizures, but regardless of the form, the seizure is caused by communication problems among the brain's nerve cells. This breakdown in communication results in a temporary disturbance of the brain's impulses. Patients may temporarily lose consciousness and have jerky movements in the skeletal muscles. 

4. The following seizure medications are commonly used:

• Phenytoin (Dilantin)
• Carbamazepine (Tegretol)
• Levetiracetam (Keppra)
• Phenobarbital (Luminal)
• Primidone (Mysoline)
• Lamotrigine (Lamictal)
• Gabapentin (Neurontin)
• Tiagabine (Gabitril)
• Valproic acid (Depakote)

 

Psychiatric Disorders and Treatments

Depression is a mood disorder that involves great sadness, despair, dejection, and feelings of hopelessness. Common symptoms of depression include lethargy, sleeplessness, lack of interest, isolation, and lack of motivation. Depression is caused by a decrease in the function of neurotransmitters (NTMs) responsible for controlling mood. Serotonin, norepinephrine, and dopamine are the main NTMs involved in many psychiatric disorders, including depression. Suicide is the most serious outcome of depression.

Medications that are used to treat depression (antidepressants) also increase the risk of suicide. Generally, lethargy and lack of motivation are the first symptoms to respond to antidepressants, which can lead to carrying out the suicidal thoughts. All antidepressants are required to include a warning of increased suicidal risk associated with their use. Medications are used in conjunction with non-pharmacologic therapies such as behavioral therapy, light therapy, and electroconvulsive therapy (ECT) to improve the outcome. Many medications are available to treat depression.

 

Antidepressant Medications

Drug Class                                                                      

Selective Serotonin Reuptake Inhibitors (SSRIs)

Tricyclic Antidepressants (TCAs)

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)

Other

Mechanism of Action

Increase serotonin levels at the synaptic cleft.

Increase both serotonin and norepinephrine levels at the synaptic cleft.

Increase serotonin and norepinephrine levels by blocking reuptake 

Generic Name

Citalopram, Escitalopram, Fluoxetine, Paroxetine, Sertraline

Amitriptyline, Nortriptyline, Clomipramine, Desipramine, Imipramine

Venlafaxine, Desvenlafaxine, Duloxetine 

Trazodone

Bupropion 

Mirtazapine 

Brand Name

Celexa

Lexapro

Prozac

Paxil

Zoloft

Elavil

Pamelor 

Anafranil

Norpramin

Tofranil

Effexor

Pristiq

Cymbalta

Desyrel

Wellbutrin

Remeron

 

Anxiety is believed to be caused by abnormal levels of neurotransmitters such as serotonin, norepinephrine, and gamma-aminobutyric acid (GABA). Extreme anxiety, fear, or terror may result in panic disorder. 

Everyone experiences some level of anxiety during stressful or fearful situations. It's the body's normal reaction. When it becomes excessive and starts affecting daily routines, it becomes a disease. Anxiety often co-exists with depression and is more common in women than men.

Obsessive Compulsive Disorder (OCD) is a form of anxiety. Patients suffering from OCD become anxious and obsessive in performing certain tasks over and over in a certain order, such as hand-washing, arranging items in a certain way, or performing daily tasks in a specific order.

Anxiety Symptoms

Common symptoms of anxiety include agitation, tiredness, headache, stomach ache, restlessness, difficulty breathing, vomiting, excessive fear, and worry.

Anxiety Treatment

Even though benzodiazepine class of medications listed below are the mainstays for treating anxiety, antidepressants and sedatives are also beneficial in treatment.

• Alprazolam (Xanax)
• Clonazepam (Klonopin)
• Diazepam (Valium)
• Lorazepam (Ativan)
• Clorazepate (Tranxene-T)
• Temazepam (Restoril)

 

Bipolar disorder is a mood disorder similar to depression. Patients experience episodes of both mania and depression at various points in their lives. It affects both men and women equally and generally becomes apparent in patients in their twenties. Bipolar disorder is managed with a combination of pharmacologic and nonpharmacologic therapies.

The following medications, called mood stabilizers, are used to treat bipolar disorder and are also commonly used to treat seizures:

• Lithium (Eskalith)
• Valproic acid (Depakote)
• Carbamazepine (Carbatrol, Tegretol)
• Lamotrigine (Lamictal)
• Oxcarbazepine (Trileptal)
• Topiramate (Topamax)
• Levetiracetam (Keppra)

Schizophrenia is a psychiatric disorder characterized by false beliefs, confused thinking, hallucinations, and reduced social engagement. It affects men and women equally. The exact causes of schizophrenia are unknown, but it's believed to be associated with abnormal levels of the neurotransmitter dopamine. Patients may suffer "positive symptoms" of delusion and hallucinations or "negative symptoms" such as social withdrawal, lack of interest, and reduced expression. It's a chronic, debilitating disorder that's very difficult to manage and requires a lot of emotional support from patients' family and friends.

The following medications are commonly used to treat schizophrenia:

• Haloperidol (Haldol)
• Fluphenazine (Prolixin)
• Clozapine (Clozaril)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Aripiprazole (Abilify)

Attention deficit hyperactivity disorder (ADHD) is more common in children younger than seven to eight years old. It's a neurobehavioral developmental disorder that involves lack of attention and increased hyperactivity. Three main behavioral symptoms include the inability to pay attention, impulsivity, and hyperactivity. Neurotransmitters that are believed to play an important role in ADHD are dopamine and norepinephrine. 

The following medications, or central nervous system stimulants, are commonly used to treat ADHD:

• Amphetamine salt combo (Adderall)
• Dexmethylphenidate (Focalin)
• Dextroamphetamine (Dexedrine)
• Methylphenidate (Ritalin)

Insomnia is a medical term used to describe the behavioral disorder of difficulty falling asleep, inability to stay asleep, and restlessness. Insomnia affects approximately 30–40 percent of the United States population. Various diseases and medications can cause varying degrees of insomnia. It's important to develop a routine before going to bed to help relax the body and avoid sleep disturbances.

The following medications are used to treat insomnia:

• Zolpidem (Ambien)
• Eszopiclone (Lunesta)
• Zaleplon (Sonata)
• Trazodone (Desyrel)
• Amitriptyline (Elavil)
• Quetiapine (Seroquel)

 

Key Points

• Nervous system disorders may be caused by functional impairments, brain tissue degeneration, vascular abnormalities, trauma, or infections.
• Parkinson's disease is a slowly degenerative disease caused by shrinking levels of the neurotransmitter dopamine.
• Causes of Parkinson's disease are unknown, and there's no cure.
• Panic disorders and OCD are types of anxiety.
• All antidepressants increase the risk of suicide, so close monitoring and supervision of patients during initial treatment of antidepressants is imperative.