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PRAGYAN COLLEGE OF NURSING

BHOPAL, M.P.

SUBJECT – MENTAL HEALTH NURSING

TOPIC – NEURO PSYCHIATRIC DISORDER
PAPER PRESENTATION

SUBMITTED TO: SUBMITTED BY:

MRS.JAYA BIJOY MR. ARVIND PATEL
ASSOCIATE PROFESSOR M.Sc. NURSING I YEAR
PRAGYAN COLLEGE OF NURSING
BHOPAL

DATE OF SUBMISSION – 26/08/2019

NEURO PSYCHIATRIC DISORDER

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INTRODUCTION:- “Neuro Psychiatry is a branch of medicine that deals wih mental

disorders attribute to disease of the nervous system.”
“Neuro Psychiatry addresses a clinical problems of cognition and or behavior
caused by brain injury or brain diseases of different etiologies.
It proceded the current disciplines of psychiatry and neurology, which had
common training ,however, psychiatry and neurology have subsequently split a
part and are typically practiced separately. Never the less neuro psychiatry has
become a growing subspeciality og psychiatry and it is also closely related to
the fields of neuro psychology and behavioral neurology.
This special report on
geriatric psychiatric addresses a variety of clinical issues in the rapidly growing
diverse population of older adults with the increases in the population of
adults over age 65 year expected to reach 22% of the general population by
2040, neuropsychiatric disorder of aging will become a challenge for many
practicing health care providers.
This demographic trend has led to an intensive search for effective strategies
to diagnose, treat and prevent mental, cognitive, and physical disorder of
aging.

DEFINATION:- A disturbance of mental function due to brain trauma associated

with one or more of the following: neurocognitive,
psychotic,neurotic,behavioural, or psychophysiologic manifestations or mental
impairement.

Or

“NeuroPsychiatry is a branch of medicine that deals with mental disorders

attribute to diseases of the nervous system.”

Or

“NeuroPsychiatry addresses clinical problems of cognition and or behavior

caused by brain injury or brain diseases of different etiologies.”

NEURO PSYCHIATRIC DISORDERS

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(A) Biological implication of psychiatric disorders:-

Various psychiatric disorders and possible biological influences are
discussed.
Anatomical brain Neuro transmitters Endocrine Genetic link
structures involved involvement involvement

Schizophrenia- frontal Increased Decreased Twin, familial,

cortex, temporal dopamine. prolactin levels. adoption
lobes, limbic system. studies.
Depressive disorder Decreased levels Increased Twin, familial
frontal lobes, limbic of cortisol levels; and adoption
system, temporal norepinephrine, increased studies.
lobes. dopamine and melatonin.
serotonin.
Bipolar disorder Increased levels Elevated thyroid Twin familial
frontal lobes, limbic of hormones. and adoption
system, temporal norepinephrine, studies.
lobes. dopamine and
serotonin.
Panic disorder, limbic Increased levels Elevated thyroid Twin familial
system, mid-brain. of hormones. and adoption
norepinephrine, studies.
decreased
GABA activity
Anorexia nervosa- Decreased levels Decreased levels Twin and
limbic system, of of gonadotropin familial studies.
particularly the norepinephrine, and growth
hypothalamus. serotonin and hormone.
dopamine.
Obsessive compulsive Decreased levels Increased level Twin studies.
disorder limbic of serotonin. of cortisol.
system basal ganglia.
Alzheimer’s diseases Decreased levels Decreased Familial
temporal parietal and of acetylcholine, corticotrophin studies.
occipital regions of norepinephrine, releasing
cerebral cortex. serotonin and hormone.
somatostatin

Types of psychiatric disorder

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o Schizophrenia.
o Depressive disorder.
o Bipolar disorder.
o Panic disorder.
o Anorexia nervosa.
o Obsessive compulsive disorder.
o Alzheimer’s diseases.

Anatomical brain structures involved

Schizophrenia:- Schizophrenia- frontal cortex, temporal lobes, limbic

system.

DEFINITION:- Schizophrenia is a serious mental disorder in which

people interpret reality abnormally .schizophrenia may result in some
combination of hallucinations, delusions, and extremely disordered
thinking and behavior that impairs daily functioning and can be disabling.
People with schizophrenia require lifelong treatment.

American Psychiatric Association

Schizophrenia is a mental disorder that usually appears in late adolescence or early

adulthood.

Characterized by:-
Delusions
Hallucinations
Cognitive difficulties

Symptom of Schizophrenia:-

The symptom are classified in to four categories:-

Positive symptoms:- also known as psychotic symptoms. For example:- delusions

and hallucination.
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Negative symptoms:- these refer to elements that are taken away from the
individual. For example:- absence of facial expression or lack of motivation.

Cognitive symptoms:- these affect the persons though processes they may be
positive or negative symptom for example:- Poor concentration is a negative
symptom.

Emotional symptom:- these are usually negative symptom such as blunted

emotions.

Causes of schizophrenia:-

Genetic Inheritence.
Chemical imbalance in the brain.
Family relationships.
Environmental factors.

Genetic Inheritence:- If there is no history of schizophrenia in a family the

chances of developing it are less than 1%. However, that risk rises to 10% if a
parent was diagnosed.

Chemical imbalance in the brain:- Experts believe that an imbalance of dopamine,

a neurotransmitter, is involved in the onset of schizophrenia other
neurotransmitters such as serotonin, may also be involved.
Family relationship:- There is no evidence to prove or even indicate that family
relationships might cause schizophrenia, however. Some patients with the
illness believe family tension triggers relapses.
Environmental factors:- Although there is no definite proof, many suspect trauma
before birth and viral infections may contribute to the development of the
diseases.
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Pathophysiology:-

Genetic predisposition + Environmental, Social and psychological factors

Neuro developmental abnormalities and target features.

Brain dysfunction, improper balance of chemicals.

Schizophrenia.

Treatment:- Treatment can help relieve many of the symptom of schizophrenia.

The most common schizophrenia medications are:-

 Risperidone.
 Olanzapine.
 Clozapine.
 Haloperidol.

Depressive Disorder

Depressive disorder:- A mental health disorder characterized by

persistently depressed mood or loss of interest in activities, causing
significant impairement in daily life.
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Symptoms:-

 Feeling of sadness, tearfulness, emptiness or hopelessness.

 Angry outbursts, irritability or frustration, even over small matters
 Sleep disturbances, including insomnia or sleeping too much.
 Anxiety, agitation or restlessness.
 Slowed thinking, speaking or body movements.
 Unexplained physical problem, such as back pain or headaches.

Causes:-

 Biological differences.
 Brain chemistry.
 Hormones.

Treatment:-

Treatment modalities for depression:-

 Psychological treatments.
 Organic treatments.

Psychological treatment:-

 Individual psychotherapy
 Group therapy
 Family therapy
 Cognitive therapy

Organic treatment:-
Psychopharmacology

 (TCAs) Tricyclic anti- depressants.

 (MAOI) Monoamine oxidase inhibitors
 Maprotiline.
 Amoxapine
 Mitrazapine.
 ECT ( Electro convulsive therapy).
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Pathophysiology:-

Increase cortisol levels.

Decreased the expression of post synaptic 5 HT receptors in the

hippocampus.

Decrease in5HT NEUROTRANSMISSION.

Depression.

Age:- Childhood, adolescence and involution are the periods most

susceptible to this illness.

Personality:- Anxious personality type, obsessive types personality are most susceptible
to anxiety disorder.

Sex:- Both gender involved equal distribution some point of view it more
in one sex than another.
 Frustation in sexual aim is considered causes of anxiety disorder.
 Physical, psychological, psychosocial stress of a moderate to serve degree
even in well adjusted personalities triggers off the illness.

Treatment:-
Hospitalization is necessary for actual reactions.
Pharmacology:-
Chlordizepoxide, Diazepam, Alprazolam and Meprobamate are most
common anxiolytics.

Small dose of neuroleptics like chlorpromazine, hydrochloride, trifluore.

BIPOLAR DISORDER

Bipolar disorder:- Bipolar disorder, a earlier known as manic depressive

psychosis (MDP), is characterized by recurrent episodes of mania and
depression is the same patient at different times.

These episodes can occur in any sequence. The patient’s with recurrent
episodes of mania (unipolar mania) are also classified here as they are
rare and often resemble the bipolar patient in their clinical features.
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Sub types of bipolar disorder:-

Bipolar I :- Characterized by episodes of severe mania and severe depression.

Bipolar II :- Characterized by episodes of hypomania and severe depression.

Recurrent depressive disorder:-

Recurrent (at least 2) depressive episodes (unipolar depression).

Current episodes in recurrent depressive disorder is specified as one of the
following.
Mild.
Moderate.
Severe with psychotic syndrome.
Severe with psychotic symptoms.
In remission.

Persistent mood disorder:- Persistent disorder symptom which last for more than
2 years but are not severe enough to be labeled as even hyper mania or mild
depression episode.

If the symptoms consist of persistent mile depression , the disorder is called as

dysthymia. If symptom consist of persistent instability of mood between mild
depression and mild elation and the disorder is called as cyclothmia.

Other mood disorder:-

Rapid cycles more than 4 or more/ year.

70-805 of all rapid cycles are women.
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PANIC DISORDER

Panic disorder:- Recurrent anxiety attack that occur at times unpredictable

through certain situation (eg:- driving a car).

Discrete episode of acute anxiety.

Sudden onset, last for a few minutes and is characterized by very severe
anxiety.
Classically symptoms- “out of the blue”.
It can present either alone with agoraphobia.
Levels of anxiety:-

There are four levels.

Mild +
Moderate ++
Severe +++
Panic +++

Symptoms:-
Physical symptoms :-

Motoric symptoms:- Tremors restle onem muscles twitches, fearful facial

expression.
Automatic & Visceral symptom:- palpations tachycardia, sweating, flushes,
dyspnea, hyper-ventilation, Dry mouth, Dizziness, Diarrhea.

Psychological symptoms:-

Cognitive symptom:- poor concenteration , distractibility, hyperarousal.

Perceptual symptoms:- Derealization, depersonalization.
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Affective symptoms:-Diffuse, unpleasant, fearfulness, inability to relax,

irritability.
Other symptoms:- insomnia, increased sensitivity to noise.

cause:- Biological theory

Genetic evidence

15-20 % of first stage degree relatives of patients.

80 % High for monozygotic twins of patients.
20 % High for dizygotic twins of patients.

Biological factors:-

Hereditary, constitution, abnormalities in endocrine disturbance, metabolic and

bio – chemical are not considered most important causes.

Environmental factors:-

Age
Personality
Sex

Age:- Childhood, adolescence and involution are the periods most susceptible to
this illness.

Personality:- Anxious personality type, obsessive type personality are most

susceptible to anxiety disorder.

Sex:- Both gender involved equal distribution some point of view it more in one
sex than another.
Frustation in sexual aim is considered causes of anxiety disorders.
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Physical, psychological, psychosocial stress of a moderate to severe degree even

in well adjusted personalities triggers of the illness.

Treatment:-
Hospitalization is necessary for actual reactions.
Pharmacology:-
Chlordizepoxide, Diazepam, Alprazolam and Meprobamate are most common
anxiolytics.
Psychotherapy:-
Supportive & short term therapy also very useful psychotherapy. Deep
analytical psychotherapy. Deep analytical psychotherapy is needed for chronic
maladjusted personalities.
Abreactive therapies like i.v injection of sodium pentothal, hypnosis helps in
those patients.
Social case work & counselling.
Psycho physiological therapy.

ANOREXIA NERVOSA

Anorexia nervosa:- Anorexia nervosa is a psychological condition and on

eating disorder in which the individual loses more weight than is healthy for the
height and age. The individual will maintain a body weight of 85% or less of
their expected weight.
Symptoms:-
Anorexia nervosa is a complex condition , but the main sign is usually severe
weight loss. The person may also talk about being overweight, although
objective measures, Such as BMI, show that this is not true.

Other physical signs and symptoms resulting from a lack of nutrients

include:-
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Severe loss of muscle mass.

List lessness, fatigue.
Hypotension, blood pressure.
Dizziness.
Dry skin.
 Hypothermia.
 Infertility.
 Insomnia.

Causes:-

No single cause has been identified for anorexia nervosa. It probably happens as
a result of biological, environmental and psychological factors.
The following risk factors have been associated with it:-

Being suspectible to depression and anxiety.

Having difficulty handling stress.
Being excessively worried, afraid or doubt ful about the future.
Having a negative self image.
Having eating problems during early childhood or infancy.
Having had an anxiety disorder during childhood.

Environmental factors:-
Environmental factors may include the hormonal changes that occur during
puberty ,plus feeling of anxiety, stress and low self esteem.
Other environmental factors may include:-
Physical, sexual, emotional or another types of abuse.
Family or other relationship problems.
Being bullied.
A fear of exams and pressure to succeeded.
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A stressful life event, such as bereavement or becoming unemployed.

Biological and Genetic factors:-
Studies have found that some people with eating disorder may have an
imbalance in certain brain chemicals that control digestion, appetite, and hunger
further research is needed to confirm this.
Genetic factors may affect a person’s susceptibility to eating disorder, as they
can run in families. Between 50 and 80% of the risk for anorexia is thought to
be genetic.
Treatment:-
Treatment can involve medication, psychotherapy, family therapy, and nutrition
counselling.
The goals of treatment are:-
To restore body weight to a healthy level.
To treat emotional problems, including low self –esteem.
To address distorted thinking.
To help the patient develop behavioral changes that will persist in the long term.

OBSESSIVE COMPULSIVE DISORDER

Obsessive compulsive disorder (OCD) is an anxiety disorder characterized by

instructive thoughts that produce anxiety, by repetitive behaviours aimed at
reducing anxiety, or by a combination of such thoughts ( obsessions) and
behaviours (compulsions).

Obsessions are defined as unwanted, intrusive, persistent ideas, thoughts,

impulses or images that cause marked anxiety or distress. It is recognized as
irrational and absurd (insight is present). Patient tries to resist against it but is
unable to and failure to resist leads to marked distress.
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Epidemiology:-
It is more common in unmarried males and it is more common from upper
social class and high intelligence. Onset is late third decade. Prevalence of
obsessive compulsive disorder is 2-3 %.
Clinical types:-
ICD 10 Classifies OCD in to 3 clinical subtypes:-
Pre dominantly obsessive thoughts or ruminations.
Pre dominantly compulsive acts.
Mixed obsessional thoughts acts.
Clinical Syndromes:-
Depression is very commonly associated with OCD. Four clinical syndromes
are common in OCD.
Washers.
Checkers.
Pure obsessions.
Primary obsessive slowness.
Washers:-
Obsession is of contamination with dirt, germs, body excretion etc.Compulsion
is washing of hands or whole body repeatedly many times a day.
Examples:- Washing of clothes.
Washing of bathroom/ bedroom, door knobs.
Checkers:-
In this type, individual have multiple doubts, checking repeatedly to remove the
doubt.
Examples:- Door has not been locked.
Kitchen gas has been left open.
Counting of money way no exact etc.
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Pure obsessions:-
It having repetitive intrusive thoughts, impulses or images which are not
associated with compulsive acts. Here, they pre occupation with thoughts.
Primary obsessive slowness:-
More severe obsession and compulsive type. It make absence of anxiety. So, the
individual leads to slowness in daily activities.
Etiological theories:-
Psychodynamics
Biological
Family dynamics.
Neuro transmitters role.
Treatment:-
Medications as treatment include selective serotonin reuptake inhibitors (SSRIs)
such as :-
Paroxetine sertraline, fluoxetine and fluvoxamine and the tricyclic
antidepressants. In particulars clomipramine SSRIs prevent excess serotonin
from being pumped back in to the original neuron that released it.
Alzheimer’s Diseases
Alzheimer’s diseases ( Dementia of Alzheimer’s type,DAT).
This is the common cause of dementia ,seen in about 70 % of all cases of
dementia in USA. It is more commonly seen in women.
Popularly known as “ The Diseases of century.”
Epidemiology:-
The exact prevalence of this diseases in india is not known in united states, its
estimated that the diseases 1.5 to 2 million people and that at least 1 lac of them
die every year.
Etiology:-
The factors which are known to be associated with increased risk for
alzheimer’s diseases are family history, age, history of head trauma and down’s
syndrome.
Genetic factors:-
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The relatives of patient with either presenile or senile dementia have an

increased risk of developing the diseases.
Neuro transmitters:-
The most consistent neuro chemical defect describes in alzheimer’s diseases is a
striking in brain choline acetyl transterase (CAT), the enzyme necessary for the
synthesize of acetylcholine. The decreases CAT correlate with increases in the
severity of cognitive impairement.
Aluminium:-
It play some role in Alzheimer aluminium levels are increased increases of brain
with prominent neuro fibrillary changes. Aluminium also plays an important
role in “Dialysis – Dementia”.
Symptom:-
Early stage ( stage of forgetfulness).
Increased forgetfulness.
Decreased concenteration of tasks.
Problems with word finding.
Not restful sleep.
Changes in eating and sleeping pattern
Decreased social and family interests.

Middle stage (stage of clouded cognitiveness).

Deficits of attention and concenteration.
Slowly of EEG.
Deterioration of dressing ,grooming, cleanliness.
Memory impairement for both recent and remote memory.
Impaired ability to learn new information.
Neurological sign, ataxias, incordination.
Disorientation for time and space.
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Late stage (stage of dementia).

Gross determination of all higher cortical function including solving no food

taking, spastic and rigid extremities with increased deep tendon reflexes gross
urinary and bowel incontinence.

Pathophysiology:-

Alzheimer’s Diseases

Oxidative stress Hyper phosphorylated

Cholinergic
hypothesis Metal ionic Hypothesis
Hypothesis protein hypothesis

\\\\\\
Free radical Metal dyshomeostasis
Reduction in ache. Extracellular proteins
production

Neuronal loss Atrophyn tempofrontal

Cortex

Treatment:--
 To treat what is treat able treating the treatable focuses on the use of the
approx. psychopharmacological agents to relieve the non cognitive,
symptoms, such as depression, agitation, hallucination, delusion and
sleep disturbances.
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At present ,DAT is not a treatable disorder. However recently new drug

like Rigastigmine-1.5 mg/BD To BD/ Day and have been introduced.
 Cerebral Vasodilators, stimulants, hootropics and neuro- peptides are in
the process of being scientifically evaluated.
 The support of patient and the care giver.

Neurotransmitter

INTRODUCTION
Neurotransmitters are endogenous chemicals that enable neurotransmissions
signals a cross a chemical synapses, such as neuromuscular junction, from “
target” neuron, muscle cell, or gland cell.
Neurotransmitter signaling:-
Neurotransmitters are synthesized by neurons and are stored in vesicles, which
typically are located in the axon’s terminal end, also known as the pre synaptic
terminal. The pre synaptic Terminal is separated from the neuron or muscle or
gland cell on to which it impinges by a gap called the synaptic cleft the synaptic
cleft, presynaptic terminal, and receving dendrite of the next cell together from
a junction known as the synapses.
Types of neuro transmitters:-
Different types of neuro transmitters have been identified. Based on chemical
and molecular properties, the major classes of
Neurotransmitters include amino acids, such as glutamate and glycine;
monoamines.

Neurotransmitters Disorder Examples of

disorders
INCREASED DECREASED involving it.
Glutamine Huntington’s, It is also
spinal thought to be
degeneration associated with
and epilepsy. Alzheimer’s
disease whose
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first symptoms
include
memory
malfunctions.
Serotonin Manic state Depression Depression,
Anxiety suicide,
impulsive
behavior and
aggressiveness
all appear to
involve certain
imbalance in
serotonin.

Glycin Spastic motor

movement’s
Substance p Depression Huntington,s
and
Alzheimer’s
diseases.
Somatostatin Huntington’s Alzheimer’s
diseases diseases.
Endorphins and Schizophrenia
Enkephalins
Acetylcholine Depression Alzheimer’s Alzheimer’s
Huntington’s diseases is
Parkinson’s associated with
diseases a lack of
acetylcholine in
certain regions
of the brain.
Dopamine Mania and Parkinson’s The loss of
schizophrenia diseases and dopamine in
depression. certain parts of
the brain causes
the muscle
rigidity typical
of parkinson’s
diseases.
GABA (Gamma Huntington’s, Some drug the
Amino Butyric Anxiety, increase the
Acid) Schizophrenia level of GABA
and Epilepsy. in the brain are
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used to treat
epilepsy and to
certain calm the
trembling of
people
suffering from
Huntington’s
diseases.
Nor epinephrine Mania, anxiety Depression. It plays a role
and in mood
Schizophrenia. disorders such
as manic
depression.

ACETYLCHOLINE

INTRODUCTION:- Acetylcholine is the neurotransmitter used at the neuro

muscular junction in other words, it is the chemical that motor neurons of the
nervous system release in order to activate muscles. This property means that
drugs that affect cholinergic system can have dangerous effects ranging from
paralysis to convulsions.
Definition:- Acetylcholine is a compound which occurs throughout the nervous
sytem, in which it functions as a neurotransmitter.

DOPAMINE

INTRODUCTION:- Dopamine is a brain, dopamine functions as a neuro

transmitter- a chemical release by neurons (nerve cell) to send signals to other
nerve cells. The brain includes several distinct dopamine pathways, one of
which plays a major role in the motivational component of reward motivated
behavior.
Disorders:- Dopamine disorders are mania and Schizophrenia are increased.
Parkinson’s diseases and depression are decreased level.
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Examples:- The loss of dopamine in certain parts of the brain causes the
muscle rigidity typical of parkinson’s diseases.

PARKINSON’S DISEASE

INTRODUCTION:- Parkinson’s disease is a progressive nervous system

disorder that affects movement. Symptoms start gradually, sometimes starting
with a barely noticeable tremor in just one hand. Tremors are common, but the
disorder also commonly causes stiffness or slowing of movement.

In the early stage of parkinson’s diseases, your face may show little or no
expression. Your arms may not swing when you walk. Your speech may
become soft or slurred. Parkinson’s diseases symptom worsen as your condition
progresses over time.

DEFINITION:- Parkinson’s diseases is a chronic progressive neurological

diseases chiefly of later life that is linked to decreased dopamine production in
the substantia nigra and is moved especially by tremors of resting muscles,
rigidity, slowness of movement, impaired balance, and a shuffling gait.

Symptoms:-

Parkinson’s sign and symptoms may include:-

Tremor
Slowed movement (brady kinesia)
Rigid muscles
Impaired posture and balance
Loss of automatic movements
Speech changes.
Writing changes.
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Causes:-
The cause of parkinson’s diseases is un known, but several factors appear
to play a role including:-
Your genes
Environmental triggers.
Researchers have also noted that many changes occur in the brains of people
with parkinson’s disease.
The presence of lewy bodies:- Clumps of specific substances with in brain
cells are microscopic markers of parkinson’s diseases.
These are called lewy bodies.
Alpha- synuclein is found with in lewy bodies:-
Risk factors:-
 Age
 Heredity
 Sex
 Exposure to toxins.

Pathophysiology of parkinson’s diseases:-

Destruction of dopaminergic neuronal cells in the substanti nigra in the

basal ganglia.

Depletion of dopamine stores.

Degeneration of the dopaminergic nigrostriatal pathway.

Imbalance of excitatory (acetylcholine) and inhibiting (dopamine)

neurotransmitters in the corpus striatum
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Impairement of extrapyramidal tracts controlling complex body

movements.

Tremors ,Rigidity, Brady kinesia, Postural changes

Treatment:-
The majority of parkinson’s patient are treated with medications to relieve the
symptoms of the diseases.
Levodopa- blood- brain barrier
Dopamine Agonists.
Anticholinergic medications-
These medications are most useful in the treatment of tremor and muscle
rigidity, as well as reducing medications- induced parkinsonism.
Amantadine- this is an antiviral medication.

GABA (Gamma Amino Butyric Acid)

INTRODUCTION:- Gamma amino butyric acid function neurotransmitter in

the central nervous system, decreasing neuron activity thus preventing them
from over firing. With niacinamide (B3)
And inositol, GABA prevents anxiety and stress related messages from reaching
the motor centers of the brain.
Discovery:- In 1950 Robert and frankel discovered that GABA act as inhibitory
neurotransmitter in human brain.
Function of GABA:-
Relieving anxiety.
Relieving pain
Regulating the release of sex hormones.
Treating ADHD (Attention deficit hyperactivity disorder).
Burning fat.
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Stabilizing blood pressure.

Decrease blood sugar level in diabetics.

Top3 GABA Deficiency symptoms:-

Anxiety & depression.
General uneasy feeling.
Can’t sit long period of time.
Disorders:- Decreased
Huntington’s, Anxiety, Schizophrenia and epilepsy.
Examples of disorder involving it:-
Some drug the increase level of GABA in the brain are used to treat epilepsy
and to calm the trembling of people suffering from Huntington’s diseases.

NOR-EPINEPHRINE

Norepinephrine:- A hormone secreted by certain nerve ending of the

sympathetic nervous system, and by the medulla (center) of the adrenal glands.
A chemical released from the sympathetic nervous system in response to stress.
It is classified as a neurotransmitter , a chemical that is released from neurons.
It is also referred to as a stress hormone.
Plays a role in mood disorders duvh as manic depression.

Side effects:-

Difficulty in breathing.
Swelling of face (lips, tongue or throat).
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Disorders

Increased Decreased

Mania anxiety Depression.

And schizophrenia

Glutamine

Glutamine:- Glutamine is an important amino acid with many functions in the

body. It is a building block of protein and critical part of the immune system.
What’s more , glutamine has a special role in intestinal health your body
naturally produces this amino acid, and it is also found in many foods.

Functions:-

 Protein synthesis, as any other of the 20 protein organic amino acids.

 Lipid synthesis, especially by cancer cells.
 Regulation of acid- base balance in the kidney by producing ammonium.
 Cellular energy, as a source, next to glucose.

Disorders:- Huntington’s, spinal degeneration and epilepsy.

Examples:- It is also thought to be associated with alzheimer’s diseases whose

first symptoms include memory malfunctions.
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SEROTONIN

Serotonin:- serotonin pathways originate from cell bodies located in the pons
and medulla and project to areas including the hypothalamus, thalamus, limbic
system, cerebral cortex, cerebellum, and spinal cord. Serotonin that is not
returned to be stored in the axon terminal vesicles is catabolized by the the
enzyme monoamine oxidase.
Serotonin may play a role in sleep and arousal, libido, appetite, mood,
aggression, pain perception, coordination, and the ability to pursue goal-
directed behavior. The serotoninergic system has been implicated in the
etiology of certain psychopathological conditions including anxiety states
(Murphy & Handlesman, 1991) and mood disorders.
Functions:- Sleep and arousal, libido, appetite, mood aggression , pain
perception, coordination, judgement.
Decreased level :- Depression.
Increased level:- Anxiety states.

GLYCINE

Glycine:- Glycine is a spinal cord and brain stem.

Functions:- Recurrent inhibition of motor neurons.
Implication for mental illness:- Toxic levels:- “Glycine encephalopathy,”
decreased levels are correlated with spastic motor movements.

SUBSTANCE P

Substance p:- substance p was the first neuro peptide to be discovered. It is

present in high concenterations in the hypothalamus, limbic structures, mid-
brain, and brain stem and is also found in the the thalamus basal ganglia, and
spinal cord. Substance p has been found to be highly concenterated in sensory
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fibers and for this reason is throught to play a role in sensory transmission,
particularly in the regulation of pain decreased concenterations have been found
in the substantia nigra of the basal ganglia of clients with Huntington’s chorea.

SOMATOSTATIN

Somatostatin:- somatostatin (also called growth hormone inhibiting hormone)

is found in the cerebral cortex, hippocampus, thalamus, basal ganglia, brain
stem, and spinal cord and has multiple effects on the CNS. It exerts in hibitory
effects on the release of norpine-phrine and stimulatory effects on serotonin. It
stimulates the turn over and release of dopamine in the basal ganglia and
acetylcholine in the brain stem and hippocampus (Davidson, 1991). High
concenterations of somatostatin have been reported in the brain specimens of
clients with huntington’s chorea, and low concenterations in those with
alzheimer’s diseases.

SUPPORTIVE EVIDENCE RELATED RESEARCH

The association between specific neuropsychiatric disturbances in people with

alzheimer’s diseases and dementia with lewy bodies and carer distress.

Abstract
OBJECTIVE:- Neuro psychiatric symptoms (NPSs) are identified as important
care – recipient variables in terms of the impact on carer distress. The aim of
this study was to determine whether specific neuropsychiatric disturbances in
people with alzheimer’s diseases (AD) and dementia with Lewy bodies (DLB)
differentially impact carer distress.
Methods:- This was a cross- sectional study of people diagnosed with AD and
DLB and their primary careers. The relatives ‘stress Scale (RSS) was used to
assess the level of reported distress in careers, and the Neuro - Psychiatrc
Inventory (NPI) was used to assess NPSs . The effect of NPSs on career distress
was analyzed using correlation analysis and partial least squares regression.
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RESULTS:- This study included 159 Participants diagnosed with AD(n=97)

and DLB (n=62), and their primary careers (Spouses and adult children). The
majority of people diagnosed with dementia were women (64.2%) with a mean
age of 75.9 (SD,7.4) years and a mean Mini Mental Status
Examination(MMSE) Score of 23.5 (SD,2.9). The man analysis identified
apathy as the most important NPS contributing to career distress compared to
AD, the explained variance in the DLB group was higher (r2=37.3 Vs r2=
53.7) . In addition, more NPSs were considered clinically important in the DLB
group.

CONCLUSION:- The finding of this study identify apathy as the most

important NPS contributing to career distress among careers of people with AD
and DLB. These findings help us identify the support needs of families dealing
with dementia.

PESENTER’S VIEW ON TOPIC

Presenter’s view on topic neuro psychiatric disorder : - Neuro

Psychiatric disorder is a blanket medical term that encompasses a
broad range of medical condition that involve both neurology and
psychiatry. Common neuro psychiatric disorder include seizures,
attention deficits, cognitive deficits, migraine headaches, depression
and anxiety and others are very depending on the cause (some may be
unknown), may be related to environmental factors, genetic
predisposition and others factors.
Neuro transmitter disorder are generally treat all over the cure.
Neuro psychiatric disorder are specific diseases portion related to
schizophrenia, Alzhemier, neuro transmitter diseases causes and
prevent and treatment care.
 30

CONCLUSION

Neuro psychiatric disorder is a such an approach might improve

genotype – phenol – type correlation across different populations and
lead to identification of reliable genetic markers and novel drug
targets. Integration of these SNPs in literature would further provide
evidence relevant to underlying mechanism’s of genetics based
nosology, pathophysiology and development of new drug for the
treatment of neuropsychiatric disorders.

BIBLIOGRAPHY

Townsend M. (2007), “ Psychiatric mental health nursing”, Jaypee

brothers, New delhi India.
Sreevani R, (2010), 3rd edition, ‘A guide to mental health and
psychiatric nursing, New delhi, Jay pee brothers medical publishers.
Raj, Elakkuvana bhaskara, “ Debers mental health psychiatric
nursing, Emmess medical publishers.