S

Psychopharmacology

Lecture 14 - Psychopharmochology of Aging

Colorized image of axon button with vessicals of neurotransmitters

http://www.youtube.com/watch?v=CrZXz10FcVM

Gladys Wilson is in the later stages of her experience of dementia - we often step back & let the person go seeing only a shell. This teaches us that everybody can be reached. I felt some discomfort watching initially but had to put that down to my arrogance when I saw the end, please have a look!

https://www.youtube.com/watch?v=rUuO1sL3pwY

Ages of Brain Maturity

Aging Mind

Aging Mind

Environmental Changes

Effects of different housing conditions (8 weeks) on the extracellular concentrations of glutamate and GABA

Dopamine Reduction w Aging

Dopamine – Aging brains have changes in dopamine synth., receptors and binding sites.

Dopamine loss may relate to loss of briain tissue, change in cognative flexability, and postural rigidity.

Specific Systems D2 & D3 - Reductions in anterior cingulate cortex, frontal

cortex, lateral temporal cortex, hippocampus, medial temporal cortex, amygdala, medial thalamus, and lateral thalamus

D1 & D2 – Caudate nucleus and putamen.

Serotonin Reduction w Aging

Decreased levels of serotonin receptors.

Specific Systems: S2 Receptor declines in caudate nucleus, putamen,

and frontal cerebral cortex, decline with age. Decreased binding capscity in frontal cortex (5-HT2) Decreased 5-HHT transporter in the thalamus and

the midbrain.

Glutamate Reduction w Aging

Glutamate reduction is found in normal aging.

Specific Areas: Motor Cortex (Normal Aging) Parietal lobe (Dementia) Basal ganglia (Dementia) Frontal lobe (Normal Aging)

Structural and Functional Changes in Normal Aging

Decreased dendritic arboring (responsible for the majority of loss in brain density with aging).

Brain Area Loss: Insular, Superior parietal gyri, Frontal and temporal cortex, Putamen, Thalamus, and Accumbens.

Neurocognative Changes: processing speed, executive functions, and episodic memory--are seen in healthy aging

Structural brain changes in aging: courses, causes and cognitive consequences. Fjell AM, Walhovd KB. Rev Neurosci. 2010;21(3):187-221. PMID: 20879692.

Benzodiazipines and Elders

Benzodiazipines most common antianxiety medications prescribed for elders: alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin), diazepam (Valium), and temazepam (Restoril)

Elimination and Clearance rates are reduced in elders.

Increased magnitude of sedation, memory, and psychomotor impairment.

Long-term use is contraindicated due to exaserbation of cognitive decline, and increased fall rates.

Psychotropic Medication Use among Older Adults: What All Nurses Need to Know. J Gerontol Nurs. 2009 September; 35(9): 28–38. doi: 10.3928/00989134-20090731-01

Antidepresents

SSRIs – More effective and less severe side-effects.

SSRI - Side-effects include headache, gastrointestinal disturbances, increased sweating, and sexual dysfunction.

TCA’s increase risk of falls, psychomotor retardation, sedation, orthostatic hypotension, anticholinergic effects (e.g. blurred vision and cognitive impairment)

Psychotropic Medication Use among Older Adults: What All Nurses Need to Know. J Gerontol Nurs. 2009 September; 35(9): 28–38. doi: 10.3928/00989134-20090731-01

Atypical Symtpoms of Depression in Elders

Antipsychotic Medicationsfor Elders

Frequently administerd for behavioral desturbances.

Older adults are more at risk for tardive dyskinesia, acute extrapyramidal side effects (EPSEs), and neuroleptic malignant syndrome (NMS).

“U.S. Food and Drug Administration (FDA) have emerged regarding the use of these medications with older adults due to cardiac, cerebrovascular, and mortality risks associated with their use in patients with dementia”

Antipsychotic drugs can cause parkinsonism and lower the seizure threshold, elderly patients with a history of Parkinson's disease or seizure disorders should be monitored closely.

Psychotropic Medication Use among Older Adults: What All Nurses Need to Know. J Gerontol Nurs. 2009 September; 35(9): 28–38. doi: 10.3928/00989134-20090731-01

Behavioral Intervenetions for Behavioral Challenges

Cohen-Mansfield (2005) recommended the following non-pharmacological interventions to prevent or manage disruptive behaviors: Social support and contact (e.g., talking with the person, video or

audiotapes of family members, music therapy, pet therapy, dolls, massage)

Engaging activities (e.g., stimulation, active engagement, and allowing self-stimulation)

Relief from discomfort (e.g., pain, hearing or vision problems, positioning, and addressing activity of daily living needs).

Psychotropic Medication Use among Older Adults: What All Nurses Need to Know. J Gerontol Nurs. 2009 September; 35(9): 28–38. doi: 10.3928/00989134-20090731-01

Anticonvulsants and Lithium

Litium has been commonly prescribed. Due to changes in metabolism and low threashold for lethalitythis medication needs close moitoring.

Anticonvulsnats: Are commonly prescribed and reportedly well tolerated. sedation, tremor, and gait disturbance, were common in bipolar PT presctibed medications. Depacote half-life is prolonged.

Young, R. (2005) Evidence-Based Pharmacological Treatment of Geriatric Bipolar Disorder.