2/18/2015 ANCY I MSc.

NEUROTRANSMITTERS
By Ancy Kurian
I MSc.(N)

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 OVERVIEW
• Definition & Life-cycle of a neurotransmitter
• Mechanism of Neurotransmitter Action
• Classification Of Neurotransmitters
• Factors influencing - Deficiency/ imbalance/ Malfunctioning
• Neurotransmitters and probable Implications on Mental
Health
• Diagnosis Of Neurotransmitter imbalance
• PSYCHOPHARMACOLOGY
How does drugs alter Neurotransmission
Mechanism of Action Of Drugs
Drugs interfering with Neurotransmission
Drugs that increase/ decrease /mimic Neurotransmitters.
• NURSES CONCERN IN NEUROTRANSMITTER
IMBALANCE

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 DEFINITION

• A chemical released from a nerve ending that

transmits impulses from one neuron (nerve
cell) to another neuron, or to a muscle cell

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 Neurotransmitters (contd…)
• Act as both neurotransmitters and hormones
• Most neurons make two or more neurotransmitters
• 50 or more neurotransmitters have been identified.
• 9 low molecular weight amines that serves as neurotransmitters
egs.Glutamate ,the major fast excitatory transmitter in
mammalian CNS ,
Acetycholine- the excitatory transmitter at the vertebral
junction,
GABA and Glycine ,the major fast inhibitory transmitters in
brain & spinal cord.
• Central nervous system, the peripheral nervous system has only
two: acetylcholine and norepinephrine

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 neuron

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 TYPICAL CHEMICAL SYNAPSE -
STRUCTURE

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 Life Cycle of a Neurotransmitter
1) Synthesis of the transmitter

2) Packaging and storage in Synaptic

vesicles

3) If necessary, transport from the site of

synthesis to the site of release from
the nerve terminal

4) Release in response to an action potential

5) Binding to postsynaptic receptor proteins

6) Termination of action by
diffusion,destruction, or reuptake
into cells
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 MECHANISM OF NEUROTRANSMITTER ACTION

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 Chemical Classification of Neurotransmitters:

Cholinergics - Acetylcholine

Biogenic Amines (modified amino acids) ,involved in

slow synaptic transmission.
• Catecholamines: Dopamine, Norepinephrine (NE), and
Epinephrine
• Indolamines
• Serotonin and Histamine (5-Hydroxytryptamine or 5-HT)

Amino Acids - involved in fast synaptic transmission

and are inhibitory and excitatory in action.
• GABA—Gamma ()-aminobutyric acid
• Glycine , Aspartate ,Glutamate
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 Chemical Classification of Neurotransmitters:
 Neuropeptides
• formed by short chained peptides , slow acting synaptic
transmitters.
• Egs are Substance P , Endorphins and Enkephalins ,
Somatostatin, gastrin, cholecystokinin, oxytocin, vasopressin,
Leutinizing hormone releasing hormone (LHRH)

 Purines
• Adenosine
• ATP

 Gases and Lipids

• Nitric Oxide (NO)
• Carbonmonooxide (CO)
• Cannabinoids

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 Functional Classification
• Excitatory Neurotransmitter- eg;
Glutamate,Aspartate,Adrenaline and
Noradrenaline,Histamine,Nitric Oxide andAcetycholine

• Inhibitory Neurotransmitter–
eg:GABA,Glycine,Adrenaline and
Noradrenaline,Dopamine and Serotonin.

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 CAUSES
( Deficiency, Imbalance / Malfunctioning)

Diet
Food allergies & Environmental Toxins
Chronic stress
sensitivities

Nutritional
Alcohol, Drugs, Candida Deficiencies
Nicotine Genetics Overgrowth
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Neurotransmitter levels and Emotional Health
• Emotional health - combination of attitudes,
personality, support systems, and our brain’s
neurotransmitter levels
• Recognizing changes - important part of
treatment and returning to normal and reducing
our stress.

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 NEUROTRANSMITTERS IN THE CENTRAL NERVOUS SYSTEM
Possible
Neurotransmitter Location Implications for
Mental illness
I. Cholinergics
A. Acetycholine ANS-Sympathetic and parasympathetic Increased levels:
presynaptic nerve terminals; parasympathetic Depression
post-synaptic nerve terminals. Decreased levels :
Alzheimer’s Disease,
CNS- Cerebral cortex ,hippocampus ,limbic
Huntington’s disease,
structures, and basal ganglia. Parkinson’s
Functions : Sleep, Disease
arousal,pain,perception,movement,memory
I. Monoamines
A. Norepinephrine ANS - Sympathetic post-synaptic nerve Decreased levels :
terminals. Depression
CNS – Thalamus, hypothalamus ,limbic system Increased levels :
Mania, Anxiety states,
,hippocampus, cerebellum ,cerebral cortex.
Schizophrenia
Functions: Mood, cognition ,perception
,locomotion ,cardiovascular functioning and
sleep and arousal.
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 NEUROTRANSMITTERS IN THE CENTRAL NERVOUS SYSTEM (contd…)

A. Dopamine Frontal cortex, limbic system ,basal Decreased Levels :

ganglia, thalamus ,posterior pituitary and Parkinson’s disease
spinal cord. and Depression
Functions : Movement and coordination, Increased levels :
emotions ,voluntary judgment ,release of Mania and
prolactin. Schizophrenia

A. Serotonin Hypothalamus ,thalamus, limbic system, Increased levels :

cerebral cortex, cerebellum, spinal cord Anxiety states
Function : Sleep and arousal, libido, Decreased levels :
appetite, mood ,aggression ,pain, Depression
perception, coordination, judgement.

A. Histamine Hypothalamus Decreased levels -

Functions : Wakefulness,pain,sensation Depression
and inflammatory response

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 NEUROTRANSMITTERS IN THE CENTRAL NERVOUS SYSTEM (contd…)
I. Amino Acids
A. Gamma-amino-butyric Hypothalamus, hippocampus, cortex, Decreased levels :
acid(GABA) cerebellum ,basal ganglia, spinal cord, Huntington’s disease,
retina anxiety disorders,
Functions: Slowdown of body activity schizophrenia, and
various forms of epilepsy
A. Glycine Spinal cord and brain stem Toxic levels :”glycine
Functions : Recurrent inhibition of motor encephalopathy”,
neurons decreased levels are
correlated with spastic
motor movements.
C. Glutamate and Asparate Pyramidal cells of the cortex, cerebellum Increased levels :
and the primary sensory afferent systems Huntington’s disease,
,hippocampus. thalamus, hypothalamus, temporal lobe epilepsy,
spinal cord spinal cerebellar
Functions: Relay of sensory information degeneration.
and in the regulation of various motor and
spinal reflexes
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 NEUROTRANSMITTERS IN THE CENTRAL NERVOUS SYSTEM (contd…)

I. NEUROPEPTIDES
A. Endorphins Hypothalamus, thalamus ,limbic structures ,mid brain and Modulation of dopamine
and brain stem; activity by opoid
Enkephalins Enkephalins are also found in the gastro- intestinal tract neuropeptides may
Functions : Modulation of pain and reduced peristalsis indicate some link to the
(enkephalins) symptoms of
schizophrenia
A. Substance P Hypothalamus, thalamus ,midbrain, brain stem, limbic Increased levels :
structures ,basal ganglia and spinal cord ,also found in Depression
gastro-intestinal tract and salivary glands. Decreased levels :
Function: Regulation of pain. Huntington’s disease and
Alzheimer’s disease
A. Somatostatin Cerebral cortex, hippocampus ,thalamus ,basal ganglia, Increased levels :
brain stem and spinal cord Huntington’s disease
Function stimulates release of dopamine ,serotonin Decreased levels :
,norepinephrine and acetylcholine, and inhibits release of Alzheimer's disease
norepinephrine, histamine and glutamate .
Also acts as a neuromodulator for serotonin in the
hypothalamus

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 ALCOHOLISM & NEUROTRANSMITTERS

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 DIAGNOSIS OF NEUROTRANSMITTER IMBALANCE
• Identify the causes

• Identify the symptoms

Symptoms of Neurotransmitter Imbalances or Neurotransmitter
Deficiency

• Diagnostic tests
 Neurotransmitter Testing and Screening using urine samples
Urine test that measures the actual levels of neurotransmitters in
the urine.

 Brain Scans
 Live Studies
 Brain Tissue Assays

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 DRUGS ALTER NEUROTRANSMISSION
• Agonist: A drug that facilitates the effects of a particular
neurotransmitter on the postsynaptic cell.

• Ways that drugs can agonize

• block auto-receptors
• inhibition of reuptake
• inhibition of deactivation
• precursor to neurotransmitter
• stimulate release
• receptor binding etc.

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DRUGS ALTER NEUROTRANSMISSION
• Antagonist: A drug that opposes or inhibits the effects
of a particular neurotransmitter on the postsynaptic
cell.
• Ways that drugs can antagonize
• prevent synthesis
• prevents storage
• block release
• receptor blocker
• stimulates autoreceptors
• Binds at same site neurotransmitter would.
• Binds at different site.

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 (1)DRUGS THAT INTERFER WITH
NEUROTRANSMITTERS (pdf)

(2)DRUGS THAT INCREASE /DECREASE/MIMIC

NEUROTRANSMITTERS (pdf)

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 NURSES’ CONCERN IN NEUROTRANSMITTER
IMBALANCE

• Assessment
• Identify the markers showing adverse effects due to prolonged
use of medications
• Replenishing neurotransmitters
 Diet

 Aminoacid therapy
 Health education
 Rehabilitation

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 NURSING DIAGNOSIS
• Risk for injury related to accelerated motor activity

• Disturbed thought process related to impaired judgement associated with manic

behaviour

• Self-care deficit (unkempt appearance) related to hyperactivity

• Impaired verbal communication –flight of ideas related to accelerated thinking

• Ineffective coping related to elated expressive mood

• Disturbed thought process –grandiosity related to elevated mood

• Ineffective coping related to emotional liability associated with manic behaviour

• Disturbed thought process –related to delusion of grandeur

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 RESEARCH STUDIES
• A 1999 study at Duke University and published in the
Archives of Internal Medicine found that regular
exercise was effective in decreasing symptoms of major
depressive disorder..
• "Journal of Psychiatry & Neuroscience," - exercise also
increases serotonin levels in your brain, leading to
improved mood
• And " exposure to the great outdoors, even on a cloudy
day, can provide enough natural light to raise your
serotonin levels.
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 CONCLUSION

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 THANKYOU
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