Brain Disorders and the Effect of Drugs

1. Brain Disorders and the Effect of Drugs October 15, 2012

2. Concussion • Description: minor injury resulting from impact with the head • Cause: trauma • Symptoms: confusion, drowsiness, headache, loss of consciousness (sometimes), memory loss, nausea, vomiting, flashing lights, “lost time”, convulsions, muscle weakness, coma, unequal pupils, unusual eye movements, walking problems • Treatment: hospitalization for severe cases; rest for the duration of the healing period (may be days, weeks, or months)

3. Contusion • Description: bruise of the brain tissue – small blood vessel bleeds inside the brain • Cause: trauma • Symptoms: headache, confusion, sleepiness, dizziness, loss of consciousness, nausea, vomiting, seizures, difficulty with coordination and movement, difficulty with memory, vision, speech, hearing, managing emotions, and thinking – symptoms depend on the location in the brain • Treatment: medication to stabilize blood pressure, supply sodium, and decrease carbon dioxide in the blood; rest – usually contusions heal on their own

4. Cerebral Edema • Description: excess water in the brain • Cause: hypertension, brain cancer, altitude sickness, drug intoxication, hypothermia, stroke, cardiac arrest, excessive water intake, trauma • Symptoms: headache, loss of coordination (ataxia), weakness, decreasing levels of consciousness, disorientation, loss of memory, hallucinations, psychotic behavior, coma, death • Treatment: mannitol, diuretics, surgical decompression

5. Cerebrovascular Accidents • Description: stroke • Cause: lack of blood supply via block or hemorrhage • Symptoms: depend on part of the brain affected, but may include sudden-onset face weakness, arm drift, abnormal speech, numbness, reduction in sensory/vibratory sensation, flaccidity, spasticity, hyperreflexia, altered senses, eyelid drooping, balance problems, altered breathing and heart rate, inability to turn head to the side, weakness in tongue, difficulty with speaking and comprehen-sion, memory deficits, loss of consciousness, headache, vomiting • Treatment: surgery to remove clot, break down clot with medication, treat cause of bleeding, rehab and therapy

6. Paralysis • Description: loss of function in one or more muscles • Cause: trauma/damage to the nervous system, infection; temporary paralysis occurs during REM sleep • Symptoms: inability to move affected muscles; may be flaccid (relaxed) or spastic (tightening) • Treatment: helping patient adapt to life with paralysis

7. Ataxia • Description: loss of coordination in voluntary muscle movements – dysfunction of the cerebellum, primarily • Cause: lesions in the CNS, alcohol, prescription drugs, mercury, radiation poisoning, vitamin B12 deficiency, spinal disorders, inherited disorders, Arnold-Chiari malformation (obstructs flow of CSF) • Symptoms: inability to control voluntary muscles • Treatment: physical and occupational therapy

8. Alzheimer’s Disease • Description: loss of brain function that worsens over time – one of the TERRIBLE THREE • Cause: unknown; factors may include age, family history, inherited genes, long-term high blood pressure, history of head trauma; brain cells are destroyed, leading to loss of brain mass. • Symptoms: difficulty in emotional behavior, personality, language, memory, perception, thinking, and judgment – usually appears first as forgetfulness; difficulty performing more than one task at a time, difficulty solving problems, forgetting recent events or conversations, taking loner to perform more difficult activities, getting lost on familiar routes, change in sleep patterns, delusions, depression, agitation, difficulty reading or writing, becoming anti-social, poor judgment, incontinence, swallowing problems • Treatment: no cure – managing symptoms, family support, and medication

9. Parkinson’s Disease • Description: disorder of the brain leading to muscle malfunction – one of the TERRIBLE THREE • Cause: unknown; risk factors include age and family history – nerve cells releasing dopamine, which helps control muscle movement, are slowly destroyed, leading to loss of muscle function. • Symptoms: slow blinking, constipation, difficulty swallowing, drooling, balance and walking problems, expressionless face, muscle aches and pains, movement problems (including starting, continuing, stopping movements, especially FINE movements of the hands), rigid or stiff muscles, tremors, slowed/quiet speech, low blood pressure, anxiety, confusion, dementia, depression, fainting, hallucinations, memory loss • Treatment: no cure – L-dopa based medication, good nutrition, exercise, therapy, support, lots of rest

10. Huntington’s Disease • Description: inherited disorder in which nerve cells in certain parts of the brain waste away – one of the TERRIBLE THREE • Cause: DOMINANT genetic defect on chromosome 4 – specific DNA sequence is repeated more than it should be • Symptoms: behavioral disturbances, hallucinations, irritability, restlessness, paranoia, psychosis, abnormal movements of face, head, limbs, slow, uncontrolled movements, unsteady gait, dementia including disorientation, confusion, loss of judgment and memory, personality and speech changes, difficulty swallowing, speech impairment • Treatment: no cure – dopamine blockers to control movements, therapy

11. Multiple Sclerosis • Description: autoimmune disease affecting the brain and spinal cord • Cause: immune system attacks and damages the myelin sheaths of neurons – this causes nerve signals to slow down or stop; may be viral, mutation in the gene, or environmental • Symptoms: loss of balance, muscle spasms, numbness, problems moving and walking, problems with coordination and small movements, tremors, weakness, constipation, difficulty beginning to urinate, strong and frequent need to urinate, double vision, eye discomfort, vision loss, facial pain and muscle spasms, decreased attention span, poor judgment, memory loss, difficulty reasoning and solving problems, depression, vertigo, fatigue • Treatment: no cure – medications to control the immune system (suppress it), steroids, urinary medication, muscle movement medication, therapy, healthy lifestyle, exercise, support

12. Locked-In Syndrome • Description: patient is aware and awake but cannot move or communicate, except the eyes • Cause: damage to the lower brain and brainstem only – trauma, diseases of circulatory system, medication overdose, stroke or brain hemorrhage • Symptoms: complete paralysis except the eyes • Treatment: no cure – stimulation of muscle reflexes with electrodes, computer technology to help communication

13. Meningitis • Description: infection of the meninges • Cause: bacterial or viral infections, chemical irritation, drug allergies, fungi, tumors • Symptoms: fever and chills, mental status changes, sensitivity to light, severe headache, stiff neck, agitation, decreased consciousness, poor feeding/irritability in children, rapid breathing, unusual posture, convulsions • Treatment: antibiotics, IV fluids to treat swelling, shock, seizures

14. Toxoplasmosis • Description: infection due to a parasite • Cause: Toxoplasma gondii from blood transfusions, organ transplants, careless cat litter handling, eating contaminated soil, raw or undercooked meat • Symptoms: enlarged lymph nodes, headache, fever, muscle pain, sore throat, confusion, blurred vision, seizures, behavioral changes (rats no longer afraid of cats!) • Treatment: antimalarial drugs and antibiotics – the disease may return for those with weak immune systems

15. Lyme Disease • Description: bacterial infection spread through the bite of the blacklegged tick • Cause: Borrelia burgdorferi carried by ticks – they pick it up when they bite mice or deer with Lyme disease • Symptoms: body-wide itching, chills, fever, ill-feeling, headache, light-headedness, fainting, muscle pain, stuff neck, paralysis, weakness in the face, muscle pain and swelling, heart problems, numbness, speech problems • Treatment: antibiotics, pain medication

16. Herpes • Description: viral disease responsible for oral and genital herpes, resulting in painful blisters • Cause: Herpes Simplex Virus Types 1 and 2 (sexually-transmitted infection) • Symptoms: infection of skin or mucosa, damage to the eye and brain, cognitive deficits, may contribute to Alzheimer’s disease, may cause bell’s palsy (paralysis of the face) – HOWEVER, many people are asymptomatic • Treatment: no cure – some medications help prevent breakouts (Valtrex)

17. Rabies • Description: deadly viral infection affecting the brain and nervous system • Cause: Rhabdoviridae virus family • Symptoms: anxiety, stress, tension, drooling, convulsions, excitability, loss of feeling and muscle function, low fever, muscle spasms, numbness, tingling, pain at bite site, swallowing difficulty • Treatment: clean the wound; preventative vaccine can be administered within 14 days, but within 3 days is best—3-5 shots must be given over a period of 28 days; there is no treatment for symptoms. Death will occur without the vaccine.

18. Dyslexia • Description: brain does not properly recognize and process certain symbols • Cause: problem in areas of the brain that help interpret language; may be genetic • Symptoms: difficulty determining the meaning of a simple sentence, recognizing written words, rhyming; disorder may lead to behavior problems in school, loss of self-esteem, persistent reading problems • Treatment: remedial instruction, private tutoring, special classes

19. Tourette Syndrome • Description: affected individuals make repeated, quick movements or sounds they cannot control, called tics • Cause: possibly genetic, may be involved with neurotransmitters not functioning or over functioning • Symptoms: arm thrusting, eye blinking, jumping, kicking, repeated throat clearing, sniffing, shoulder shrugging – only FEW patients yell curse words • Accompanying conditions may include: anger, ADHD, impulses, OCD, poor social skills • Treatment: antiseizure medications, blood pressure medication, Botox injections, dopamine blockers

20. Epilepsy • Description: brain disorder with repeated seizures over time • Cause: stroke, dementia, trauma, infections, congenital brain defects, tumors, abnormal vessels in the brain, medications • Symptoms: Absence (petit mal) seizures, generalized tonic-clonic (grand mal) seizures, partial (focal) seizures • Treatment: surgery, antiseizure medication

21. Bipolar Disorder • Description: individual ranges from very good or very irritable mood and depression – mood swings between “mania” and “depression” may be very quick • Cause: unknown, may be genetic • Symptoms: periods of mania or high energy to major or minor depression, easily distracted, little need for sleep, poor judgment and temper control, reckless behavior and lack of self control, very elevated mood, highly involved in activities, easily upset, daily low mood or sadness, difficulty concentrating, eating problems, fatigue, feeling worthless, loss of pleasure in once enjoyed activities, thoughts of death and suicide • Treatment: mood stabilizing medication, antiseizure drugs, antipsychotics, anti-anxiety drugs, anti-depression medications, electroconvulsive therapy, transcranial magnetic stimulation

22. Autism • Description: developmental disorder affecting the brain’s normal development of social and communication skills; usually appears during the first 3 years of life • Cause: unknown; abnormal biology and chemistry in the brain • Symptoms: difficulty with pretend play, social interactions, and all forms of communication; overly sensitive to various stimuli, unusually distress without routines, repeated body movement, unusual attachments to objects, cannot maintain conversation, communicates with gestures rather than words, slow/absent language development • Treatment: applied behavior analysis, medication, therapy

23. Psychological Disorders • Schizophrenia • Description: mental disorder in which the patient cannot distinguish between reality and what is not real • Cause: unknown—possibly genetic • Symptoms: trouble concentrating and sleeping, bizarre behavior, hallucinations, lack of emotion, delusions, anxiety, paranoia, childlike behavior, unresponsiveness • Treatment: antipsychotic medications • Dissociative Identity Disorder • Description: at least two distinct and relatively enduring identities/personalities control a person’s behavior • Cause: unknown – may be trauma, stress, or hypnosis-induced • Symptoms: lapses in attention, easily distracted, daydreaming, dissociative disorders, depression, headaches • Treatment: no clear agreement among psychiatrists, but mostly consists of therapy

24. Obsessive-compulsive disorder • Description: anxiety disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations, obsessions, or behaviors that make them feel like they have to do something. • Cause: unknown, but could include head injury, infections, or family history • Symptoms: obsessions/compulsions not related to medical illness, drug use, but cause major distress or interfere with every day life. Could include checking and rechecking actions, excessive counting, excessive fear of germs, compulsion to repeatedly wash hands • Treatment: medications (antidepressants involved with serotonin) and therapy • Impulses are similar to OCD, but may include… • Kleptomania (stealing) • Pyromania (fire starting) • Trichotillomania (pulling hair out) • Dermatillomania (picking at the skin)

26. Effect of Drugs on the Brain • Drugs are chemicals and they work by interfering with the brain’s communication system • Some drugs activate neurons by mimicking brain chemicals, some drugs cause neurons to release large amounts of natural neurotransmitters, and some reward the brain’s pleasure center—this usually leads to addiction • Rewards are triggered by dopamine, a specific neurotransmitter in the brain that is in charge of movement regulation, emotion, cognition, motivation, and pleasure feelings

27. Brain’s Pleasure Circuit • Our brains are programmed to repeat life-sustaining and rewarding activities • Drugs stimulate this reward center and teaches us that we should do it again and again without thinking • Some drugs can release 2-10x the amount of dopamine that usual rewards do • Sometimes this occurs IMMEDIATELY • Effects last longer than natural dopamine release • This causes a strong effect than normal rewarding behaviors, such as eating and sexual activity

28. Brain Damage • Repeated drug use can lead to brain damage • Drugs cause mass amounts of dopamine to be released • After a while, the brain will not respond as readily to the dopamine (it gets worn out, so to speak) • The ability to experience any pleasure is reduced • This is why abuses feel flat, lifeless, and depressed • Only drugs will make them feel pleasure again

29. Dopamine isn’t the only chemical in the brain that is stimulated during drug use • Regardless of the chemical being altered, it causes the brain to respond less readily to that chemical when the abuser is not using drugs

30. Caffeine • Description: stimulant; world’s most widely consumed psychoactive drug; legal and unregulated; increases acetylcholine, epinephrine, dopamine, serotonin, norepinephrine, and glutamate • Origin: plant • Short-term effects: wakefulness, faster and clearer thoughts, increased focus, better body coordination, possible increased sports endurance (high doses can have the opposite effect), sleep disruption, diuretic, dehydration, may help or hurt anxiety disorders • Long-term effects: addiction, nervousness, irritability, restlessness, insomnia, headaches, heart palpitations • Overdose: death @ 80-100 cups of coffee for an average adult OR 2 grams (pills)

31. 2 grams = 2000 mg

32. Nicotine • Description: stimulant AND relaxant; increases dopamine; decreases dopamine, norepinephrine, and serotonin • Origin: plant • Short-term effects: euphoria, relaxation, activates sympathetic NS, alertness, sharpness, calmness, reduces appetite, raises metabolism, increases blood pressure and heart rate, mild laxative • Long-term effects: cancer, birth defects (during pregnancy only), hypertension • Overdose: 30-60 mg for adults – about 1 mg is in one cigarette • Interesting fact: nicotine itself isn’t highly addictive, but other chemicals in tobacco make it addictive!

33. Alcohol • Description: ethanol; depressant • Origin: fermentation of yeast, sugars, and starches • Short-term effects: impair brain function and motor skills – difficulty walking, blurred vision, slurred speech, slow reaction time, impaired memory, blackouts • Long-term effects: cancer, stroke, liver disease, addiction/dependence, memory lapses, nerve damage, heart damage, brain shrinkage • Overdose: .28 BAC – 21 standard drinks in 6 or fewer hours. A normal drink is .6 oz. pure ethanol (12 oz. beer, 8 oz. malt liquor, 5 oz. wine, 1.5 oz 80-proof spirits or liquor) – overdose would be 12.6 oz pure ethanol.

35. Marijuana • Description: active ingredient is THC; psychoactive drug, most used illicit drug in the world; mix of stimulant, depressant, and hallucinogen • Origin: plant • Short-term effects: increased heart rate, increased appetite and food consumption, lowered BP, impairment of short-term and working memory, psychomotor coordination, concentration, pain reliever • Long-term effects: dependence, affects intelligence, memory, respiratory functions, and is possibly related to mental disorders (schizophrenia, psychosis, depersonalization disorder, depression); use before age 18 is linked to decreased intelligence, attention, and memory—quitting did not appear to reverse these effects • Overdose: 75 kg for an average male—21 cigarettes of maximum THC potency—not known to cause death, but can cause feelings of paranoia/fear, nausea, vomiting, increased heart rate, hallucination, disorientation • Interesting fact: THC can be DETECTED weeks to months after a SINGLE administration!

37. Methamphetamine • Description: stimulant, related to amphetamine; long-lasting and toxic; crosses the blood-brain barrier • Origin: synthetic • Short-term effects: increases wakefulness and physical activity, rapid heart rate, irregular heart beat, increased BP and body temperature, euphoria, enhanced self-esteem and increased libido, anorexia, hyperactivity, dilated pupils, flushed skin, excessive sweating, restlessness, dry mouth, headache, diarrhea, constipation, blurred vision, dizziness, numbness, tremors, acne, pallor, irritability, aggressiveness • Long-term effects: lung damage when smoked, mood disturbances, violent behavior, anxiety, confusion, insomnia, dental problems, infectious diseases (injections), convulsions, heart attack, stroke, addiction, repetitive and obsessive behaviors, paranoia, hallucinations, hair pulling, seizures, psychosis, death • Overdose: 50 mg pure for a non-tolerant user (common dose is 10-30 mg)

38. Cocaine • Description: stimulant • Origin: plant • Short-term effects: appetite suppressant, anesthetic, increased alertness, well-being, euphoria, energy and motor activity, competence, increased athletic performance, anxiety, paranoia, restlessness, constricted blood vessels, dilated pupils, headaches, abdominal pain, nausea, involuntary tooth grinding, dehydration, dry mouth • Long-term effects: tremors, convulsions, increased body temperature, itching, tachycardia, hallucinations, delusions, hyperthermia, high blood pressure, insatiable hunger, aches, insomnia/oversleeping, lethargy, persistent runny nose, depression, suicidal ideations, decreased serotonin and dopamine, bronchospasms, chest pain, lung trauma, sore throat, asthma, hoarse voice, shortness of breath, nasal cartilage degradation, increases risk of developing rare autoimmune or connective tissue diseases, kidney disease, renal failure, stroke, addiction • Overdose: 20 mg IV, 500 mg nasal/oral (normal 2 mg IV, 50 mg nasal/oral)

39. Heroin • Description: often used as a pain killer in its LEGAL form; depressant • Origin: plant • Short-term effects: euphoria, ambition, nervousness, relaxation, sleepiness, warm skin, dry mouth, wakeful/drowsy states, cloudy mental function, slow breathing – to the point of respiratory failure • Long-term effects: infection of heart lining and valves, liver disease, kidney disease, pulmonary (lung) complications, skin infections and abscesses • Overdose: 75-375 mg (5-20 mg normal)

40. Psychedelic mushrooms • Description: hallucinogen • Origin: fungus • Short-term effects: disorientation, lethargy, euphoria, joy, depression, anxiety, paranoia, hallucinations, regression to primitive/childlike thinking, pupil dilation, changes in heart rate, blood pressure, stretch reflex, nausea, tremors, slowed time perception, panic, violence, aggression, homicidal/suicidal attempts, psychosis, convulsions, depersonalization disorder • Long-term effects: flashbacks and recurring hallucinations, even when not consuming the drug • Overdose: Mostly unknown, possibly 2000x the normal dose—2,000 - 10,000 g (normal 1-5 g)

41. LSD • Description: lysergic acid; hallucinogen • Origin: synthetic • Short-term effects: altered thinking processes, hallucinations, altered sense of time, pupil dilation, reduced appetite, numbness, weakness, nausea, hypo- or hyperthermia, elevated blood sugar, goosebumps, increase in heart rate, jaw clenching, perspiration, saliva production, mucus production, sleeplessness, tremors, metallic taste, temporary confusion, impaired memory and attention span, panic attacks, psychosis • Long-term effects: anxiety, delusions, significant changes in outlook, personality, and emotions, flashbacks, HPPD (hallucinogen persisting perception disorder) • Overdose: 300 mg (normal 0.2-1 mg)

42. Ecstasy • Description: MDMA; psychoactive drug • Origin: synthetic • Short-term effects: euphoria, alteration of consciousness, diminished aggression, diminished fear, mood lift, improved self-confidence, involuntary eye movements, intensification of all body senses, mental imagery, auditory and visual distortions, hyperactivity, increased energy, alertness, motivation, decreased pain sensitivity, difficulty concentrating, teeth grinding, jaw clenching, lack of appetite, dry mouth • After-effects: anxiety, paranoia, depression, irritability, fatigue, impaired attention and focus, dizziness, vertigo, loss of appetite, diarrhea, constipation, insomnia, aches and pains, exhaustion, jaw soreness – result of low serotonin! • Long-term effects: increased depression and anxiety, even after quitting; short- and long-term verbal memory impairment, impairment of functioning in general, brain damage, possibly cause of Parkinson’s disease, decreases in learning, memory, attention, mood, and decision making • Overdose: 4000 – 6000 mg (normal 100-150 mg)