Neurotransmitters associated disorders

Pharmacology Lithium alters sodium transport in nerve and muscle cells, and effects a shift toward intraneuronal catecholamine metabolism. The specific mechanism in mania is unknown, but it affects neurotransmitters associated with affective disorders. Its antimanic effects may be the result of increases in norepinephrine reuptake and increased serotonin receptor sensitivity. Pharmacokinetics ... 

Tricyclic antidepressants (TCAs) such as amitriptyline and doxepin have been used with some success in the treatment of IBS-related pain (Table 18-5). They modulate pain principally through their effect on neurotransmitter reuptake, especially norepinephrine and serotonin. Their helpfulness in functional gastrointestinal disorders seems independent of mood-altering effects normally associated with these agents. Low-dose TCAs (e.g., amitriptyline, desipramine, or doxepin 10 to 25 mg daily) may help patients with IBS who predominantly experience diarrhea or pain. 

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). 

Some intracellular signal transduction molecules are reduced in schizophrenia. The release of neurotransmitters is regulated by a family of proteins that coordinate vesicular trafficking (see Ch. 9). Of these, the expression of complexin I and II appears to be decreased in prefrontal cortex and subfields of the hippocampal formation, and the ratio of complexin I to complexin II is elevated in the hippocampus [35], SNAP-25 (Synaptosomal Associated Protein, kDa 25) has inconsistently been found to be down-regulated in both these regions. Synapsin expression is also reduced, but more robust decrements have been observed in bipolar disorder (Ch. 55). 

One model of an ionic mechanism of action of Li+ in affective disorders has been proposed, in which the receptors for Li+ are ion channels and cation coenzyme receptor sites, and in which the presence of intracellular Li+ in excitable cells results in the displacement of exogenous Na+ and/or other intracellular cations [13]. It has been suggested that this could lead to a decrease in the release of neurotransmitters alternatively it may be that this intracellular Li+ is altering a preexisting, disease-related electrolyte imbalance [14]. A number of observations of such imbalances in affective disorders have been made depression is associated with elevated levels of intracellular Na+ [15] retention of Li+ is observed in manic-depressive patients prior to an episode of mania [ 16] and Na+/K+ activity is defective during both mania and depression [17]. 

Numerous reports of altered neurotransmitter and hormone functions which have been associated with the affective disorders are reviewed by Levell [142]. It was originally proposed that one or more of the neurotransmitter amines in the brain (norepinephrine, dopamine, serotonin) may be functionally elevated in manic patients and reduced in depressed patients [143]. For instance, an increase in the production of dopamine, observed in a number of case reports, is thought to be the cause of the switch into the manic phase in bipolar patients. For example, Bunney et al. reported an increase in the level of homovanillic acid (HVA), a... 

Although there has been an intensive effort to identify neurotransmitter GPCR variants associated with complex phenotypes, many of the phenotypes associated with these variants are pharmacogenetic. These studies are possibly confounded because recruiting patients with similar symptomatology is not a guarantee that they share the same underlying disorder (3). 

In Parkinson s disease the dopamine-releasing cells are damaged or die, thus reducing the release of dopamine. Loss of the dopamine neurotransmitter contributes to the movement disorders associated with Parkinson s disease. Typically, the loss of dopamine-producing cells in a very specific location in the brain does not become evident until old age, and for a long time Parkinson s disease was thought of as... 

There has been a plethora of linkage and association studies attempting to identify genes for anxiety disorders. The neurotransmitter systems that have been implicated in anxiety disorders include adenosine, adrenaline, noradrenaline, dopamine, serotonin, cholecystokinin, and y-aminobutyric acid (GABA). In... 

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