1.PsychopharmachologyLecture 2 Pharmacodynamics, Pharmacokenetics,Stress and Emotions in the Brain S

2. Pharmacokenetics andPharmacodynamicsS Pharmacokenetics What the body does to the drug.S Pharmacodynamics What the drug does to the body. 3. Inside the CellS Biovisions Project HarvardS Research in the biological sciences often depends on thedevelopment of new ways of visualizing important processesand molecules. Indeed, the very act of observing and recordingdata lies at the foundation of all the natural sciences. The sameholds true for the teaching and communication of scientificideas; to see is to begin to understand. The continuing questfor new and more powerful ways to communicate ideas inbiology is the focus of BioVisions at Harvard University.S http://multimedia.mcb.harvard.edu/ 4. Pharmacokenetics - ADMES Absorbtion (A) How the body takes in the drug(stomach, lungs, patches, intestines).S Distribution (D) How the body is transported throughout the body.S Metabolism (M) How the body transforms themedication and for many psychiatric medicaitons thisoccures in the liver.S Excretion (E) How the body eleminates the medication. 5. Paxil Pharmacokenetic DataBioavailability Completely absorbed fromGI, but extensive first-pass metabolism in theliver; Tmax 4.9 (with meals) to 6.4 hours(fasting)Protein binding: 9395%Metabolism: Extensive, hepatic (mostlyCYP2D6-mediated)Half-life: 24 hours (range 365 hours)Excretion:64% in urine, 36% in bile 6. Vingette GeorgeADMEGeorge is a 75 year old Mexican American came into theclinic with slurred speech and staggering. He recently steppeddown from directing a family run business.George had been treated for difficulty sleeping in the last twoweeks. He reported that the first time he took the medicationhe slept and was groggy but felt less anxious.Since that time he reports he was feeling better (no anxiety)but in the last two days he became more and more disorentedand now does not feel safe driving. 7. Neurobiology of Affect RegulationHPA-Axis and ThalamusS Hypothalamus Pituitary Adrenal--axis (HPA--axis): Is made up of the hypothalamus, pituitary gland, and adrenal cortex. Its main task is to mobilize a powerful energetic defense when a person is threatened and to return to rest when the threat is gone. The HPA--axis triggers cortisol secretion.S Thalamus: Is a relay station for the brain.It plays a role in modulating levels of arousal. A damagedthalamus can result in acoma. The thalamus may be the seat of human consciousness. 8. Neurobiology of Affect RegulationHPA-Axis and ThalamusS Hypothalamus Pituitary Adrenal--axis (HPA--axis): Is made up of the hypothalamus, pituitary gland, and adrenal cortex. Its main task is to mobilize a powerful energetic defense when a person is threatened and to return to rest when the threat is gone. The HPA--axis triggers cortisol secretion.S Thalamus: Is a relay station for the brain.It plays a role in modulating levels of arousal. A damagedthalamus can result in acoma. The thalamus may be the seat of human consciousness. 9. Thalmus and Hypothalmus 10. HPA AxisHypothalamicpituitaryadrenal axis 11. Neurobiology of Affect Regulation HippocampusS Thehippocampus Is found in the medial temporal lobe.S The three major theories used to explain hippocampusfunctioning are that the hippocampus is involved in: behavioral inhibition, declarative memory consolidation, and sense of place. In those with PTSDhippocampus declines have been noted.S Dissociative Identity Disorder (DID), one study found a 26%decline compared with controls. 12. Neurobiology of Affect Regulation HippocampusS Thehippocampus Is found in the medial temporal lobe.S The three major theories used to explain hippocampusfunctioning are that the hippocampus is involved in: behavioral inhibition, declarative memory consolidation, and sense of place. In those with PTSDhippocampus declines have been noted.S Dissociative Identity Disorder (DID), one study found a 26%decline compared with controls. 13. Hippocampus 14. Neurobiology of AffectRegulation - The InsulaS The insula is a part of the limbic cortex.S The insula has been postulated to be involved in the felt experience of introceptive cues from the body, viscera, app etite, and addiction and plays a role in the integration of bo dy sensation of the primary emotions (such as anger, sadness, happiness, and disgust).S It has connections with the amygdala and the orbital frontal cortex through connections with the thalamus. 15. Insular Cortex 16. Neurobiology of Affect RegulationCingulate GyrusS The cingulate gyrus is often referred to as the limbic cortex.S At three to nine months of development, the infant grows the ability to modulate social engagement through immobility and w ithdrawing (noradrenalin) and active protection through fight/flight (dopamine), monitors internal and external behavior, attends to mistakes, and modulates behavior for more successful outcomes.S The anterior is discussed here and is related to autonomic homeostasis, reward anticipation; heart rate, decision- making, emotions, and modeling the emotions of others.S It plays a central role in integration of bottom up and top down neural 17. Cingulate Cortex 18. Neurobiology of AffectRegulation: the AmygdalaS The Amygdala is often knownas the fear center of the brain.S Although it could be better conceptualized as a smokedetector. It notices changesin the insula, and other limbic structures.S The amygdala is involved in classical conditioning andemotional memory. Likely involved in flash bulb memories. 19. Amygdala 20. Neurobiology of Affect Regulation Basal Ganglia Septal NucleusS Basal Ganglia (BG): Iscentral to the modulation of movement, emotional set, anticipation of movement, eye movement, motivation, andreward.S Septal Nucleus: Plays a role in pleasure, relaxation and rest.It has an inhibitory effect of cortisol. In rat pups, a damagedseptal nucleus leads to increased aggression and loss ofmaternal behaviors. 21. Neurobiology of Affect Regulation Basal Ganglia Septal NucleusS Basal Ganglia (BG): Iscentral to the modulation of movement, emotional set, anticipation of movement, eye movement, motivation, andreward.S Septal Nucleus: Plays a role in pleasure, relaxation and rest.It has an inhibitory effect of cortisol. In rat pups, a damagedseptal nucleus leads to increased aggression and loss ofmaternal behaviors. 22. Basal Ganglia 23. Basal Ganglia 24. Neurobiology of Affect RegulationOrbital Frontal CortexS Orbital Frontal Cortex:emotion and reward area of the prefrontal cortex.S This is likely the most abstract area of emotional processing.S It is also the last to mature.S It reaches full maturity in the early twenties.S It is involved in decision making and expectation. 25. Neurobiology of Affect RegulationOrbital Frontal CortexS Orbital Frontal Cortex:emotion and reward area of the prefrontal cortex.S This is likely the most abstract area of emotional processing.S It is also the last to mature.S It reaches full maturity in the early twenties.S It is involved in decision making and expectation. 26. Frontal Cortex 27. Emotion Regulation 28. Brain Structures and Mental HealthS Group Activity.S Devide up into groups.S Look at the brain structures and their functions.S Identify as a group possible menal health conditions thatmaybe associated with the brain areas and why. 29. Autonomic Nervious System 30. Autonomic Responses 31. Stress Reactions 32. Tracking the Stress Response 33. Receptor Actions 34. Major Areas to AssessS Axis IIS Substance Abuse/Drug SeekingS Medical ConditionsS Primary and secondary gain. 35. Medical Illnesses ChecklistS Sudden onset out of the blueS Older then 55 yrsS PT Taking multiple medicationsS No family hx of similar MH dx.S Hallucinations or illusions (visual)S Looks ill, poor vitals, fever or weekness 36. Role PlaysS Form groups of two.S One person is the clinician, one the client.S You have a 10 min session.S 5 minuet debriefing 37. Closing Questions