Central nervous system disorders depression

Ethanol (ethyl alcohol) has central nervous system depressant properties and is widely used to relieve anxiety and produce sedation. Although some medical practitioners occasionally prescribe an alcoholic beverage for relieving minor anxiety and inducing sleep, individuals frequently self-medicate with ethanol. Many individuals who abuse alcohol may have started using it to relieve symptoms of central nervous system disorders, such as anxiety and depression. 

Chlorpromazine Blockade of D2 receptors >> 5 2 receptors .-Receptor blockade (fluphenazine least) muscarinic (M)-receptor blockade (especially chlorpromazine and thioridazine) Hx-receptor blockade (chlorpromazine, thiothixene) t central nervous system (CNS) depression (sedation) t decreased seizure threshold t QT prolongation (thioridazine) Psychiatric schizophrenia (alleviate positive symptoms), bipolar disorder (manic phase) nonpsychiatric antiemesis, preoperative sedation (promethazine) pruritus Oral and parenteral forms, long half-lives with metabolism-dependent elimination Toxicity Extensions of effects on a - and M- receptors blockade of dopamine receptors may result in akathisia, dystonia, parkinsonian symptoms, tardivedyskinesia, and hyperprolactinemia... 

Prescription medications such as pain relievers, central nervous system (CNS) depressants (tranquilizers and sedatives), and stimulants are highly beneficial treatments for a variety of health conditions. Pain relievers enable individuals with chronic pain to lead productive lives tranquilizers can reduce anxiety and help patients with sleep disorders and stimulants help people with attention-deficit hyperactivity disorder (ADHD) focus their attention. Most people who take prescription medications use them responsibly. But when abused—that is, taken by someone other than the patient for whom the medication was prescribed or taken in a manner or dosage other than what was prescribed—prescription medications can produce serious adverse health effects, including addiction. 

Central Nervous System Disorders. Clinicians should be cautious when using topically applied central nervous system stimulants such as cyclopentolate. High concentrations of these drugs in normal children, and occasionally in adults, have resulted in transient central nervous system effects. The use of topical P-blockers for treatment of glaucoma has been associated with central nervous system side effects, including depression, fatigue, weakness, confusion, memory loss, headaches, and anxiety. 

The antiemetic and antivertigo dru are contraindicated in patients with known hypersensitivity to these dru, diose in a coma, or those with severe central nervous system (CNS) depression. In general, these dni are not recommended during pregnancy, lactation, or for uncomplicated vomiting in young children. Metoclopramide is contraindicated in patients with a seizure disorder, breast cancer, pheochromocytoma, or gastrointestinal obstruction. Prochlorperazine is contraindicated in patients with bone marrow depression, blood dyscrasia, Fbrkinson s... 

This atrophy can be attributed to net reduction of overall neural activation, which triggers catabolic processes within the muscle fibers. Causes indude supra-segmental central nervous system disorders, experimental de-afferentation of LMNs, general illnesses, cast on a limb, arthritic joint pains, and psychosocial factors, such as depression or interminable television. 

Neurochemical theories for the affective disorders propose that there is a link between dysfunctional monoaminergic synapses within the central nervous system (CNS) and mood problems. The original focus was the neurotransmitter noradrenaline, or NA (note noradrenaline is called norepinephrine, or NE, in American texts). Schildkraut (1965) suggested that depression was associated with an absolute or relative deficiency of NA, while mania was associated with a functional excess of NA. Subsequently, another monoamine neurotransmitter 5-hydroxytryptamine (5-HT), or serotonin, was put forward in a rival indoleamine theory (Chapter 2). However, it was soon recognised that both proposals could be reconciled with the available clinical biochemical and pharmacological evidence (Luchins, 1976 Green and Costain, 1979). 

In this rapidly evolving field, the detection of PDE enzymes in the central nervous system (CNS) has stimulated interest in exploring potential applications of PDE inhibitors for treating CNS disorders such as Alzheimer s disease and other cognitive malfunctions, depression, anxiety, and schizophrenia. This review will focus on these therapeutic opportunities as well as new developments in the medicinal chemistry and biology associated with selected members of the PDE family, in particular PDEs 2, 4, 9, and 10. There have been a number of other reviews in this field in the past year that have covered selected individual PDE enzymes and potential pharmacologic applications of PDE inhibitors in CNS disorders [3,7,8]. 

Symptoms of exposure May cause weakness, confusion, depression of central nervous system, dyspnea, weak pulse, and respiratory failure. May irritate eyes and mucous membranes. Contact with skin may cause burns and dermatitis. Chronic effects may include gastrointestinal disorders, nervous disorders, tremor, confusion, skin eruptions, oliguria, jaundice, and liver damage (NIOSH, 1997 Patnaik, 1992). 

Substance-Induced Anxiety Disorder. Numerous medicines and drugs of abuse can produce panic attacks. Panic attacks can be triggered by central nervous system stimulants such as cocaine, methamphetamine, caffeine, over-the-counter herbal stimulants such as ephedra, or any of the medications commonly used to treat narcolepsy and ADHD, including psychostimulants and modafinil. Thyroid supplementation with thyroxine (Synthroid) or triiodothyronine (Cytomel) can rarely produce panic attacks. Abrupt withdrawal from central nervous system depressants such as alcohol, barbiturates, and benzodiazepines can cause panic attacks as well. This can be especially problematic with short-acting benzodiazepines such as alprazolam (Xanax), which is an effective treatment for panic disorder but which has been associated with between dose withdrawal symptoms. 

As with research on drugs for the treatment of disease, an understanding of the mechanism by which mind-altering drugs operate is fundamental to the development of new chemicals to treat mental disorders, such as Parkinson s disease, schizophrenia, and depression. Scientists now understand that many abnormal mental conditions are the result ofbiochemical imbalances— an excess or deficiency of essential chemicals in the central nervous system—that can be ameliorated or cured by treatment with natural or synthetic drugs. 

Exposed individuals with evidence of central nervous system depression or seizures should be evaluated for the presence of some other underlying disorder. Diazepam or phenobarbital may be administered to alleviate seizures. Supplemental oxygen can also be administered. If pulmonary edema occurs, conventional therapy should be considered. Additional information regarding the treatment of individuals exposed to cresols may be obtained from Bronstein and Currance (1988), Haddad and Winchester (1990), and Stutz and Janusz (1988). 

Nearly all central nervous system depressants have some capacity to suppress seizures by virtue of their depressant activity on the brain and spinal cord. Clonazepam and diazepam are two benzodiazepines that depress epileptiform activity and are used in the treatment of epilepsy and seizure disorders (see Chapter 32). 

Hollander E, Schiffman E, Cohen B, et al Signs of central nervous system dysfunction in obsessive-compulsive disorder. Arch Gen Psychiatry 47 27-32, 1990b Hollander E, Mullen L, DeCaria CM, et al Obsessive compulsive disorder, depression, and fluoxetine. J Clin Psychiatry 52 418-422, 1991 Hollander E, De Caiia CM, Nitescu A, et al Serotonergic function in OCD. Arch Gen Psychiatry 49 21-28, 1992... 

Disadvantages of the benzodiazepines include the risk of dependence, depression of central nervous system functions, and amnestic effects. In addition, the benzodiazepines exert additive central nervous system depression when administered with other drugs, including ethanol. The patient should be warned of this possibility to avoid impairment of performance of any task requiring mental alertness and motor coordination. In the treatment of generalized anxiety disorders and certain phobias, newer antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are now considered by many authorities to be drugs of first choice (see Chapter 30). 

---