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Neuroanatomy and Neurophysiology: A Comprehensive Guide for PMHNP Exam Preparation, Exams of Nursing

University of Louisville Nursing

A detailed overview of neuroanatomy and neurophysiology, essential for understanding the nervous system's structure and function. It covers key concepts like the neuron, brain regions, and neurotransmitters, highlighting their relevance to psychiatric disorders and psychopharmacological treatment. Particularly useful for pmhnp exam preparation, offering a comprehensive foundation in the subject.

Typology: Exams

2024/2025

Available from 03/12/2025

nursejulie 🇺🇸

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PMHNP Psychopharm Exam 16 2024

THE NERVOUS SYSTEM - All human thoughts, feelings, and actions are seated in and start

with actions of the

nervous system.

Necessary for the PMHNP's role functioning is an understanding of the following basic

neuroanatomy and physiology:

* Neurodeficits that underlie psychiatric disorders

* Actions of and client responses to psychopharmacological treatment agents

The nervous system's primary function is to transfer and exchange information.

The Neuron ("Nerve Cells") - The basic cellular unit of the nervous system

The microprocessor of the brain responsible for conducting impulses from one part of the

body to another

Components of the neuron:

* Cell body: Also known as soma; made up of the nucleus and cytoplasm within cell

membrane

* Stem or axon: Transmits signals away from the neuron's cell body to connect with other

neurons and cells

* Dendrites: Collect incoming signals from other neurons and send the signal toward the

neuron's cell body

Nervous System - Composed of two separate, interconnected divisions:

* Central nervous system (CNS)

** Composed of the spinal cord and the brain

*Peripheral nervous system (PNS)

** Composed of the peripheral nerves that connect the CNS to receptors, muscles, and glands

** Includes the cranial nerves just outside the brain stem

** Comprises the somatic nervous system and the autonomic nervous system:

***Somatic nervous system: Conveys information from the CNS to

skeletal muscles; responsible for voluntary movement

*** Autonomic nervous system: Regulates internal body functions to

maintain homeostasis; conveys information from the CNS to smooth

muscle, cardiac muscle, and glands; responsible for involuntary

movement; divided into the sympathetic nervous system and the

parasympathetic nervous system:

**** Sympathetic nervous system: The excitatory division; prepares the body for stress (fight

or flight); stimulates or increases activity of

organs

**** Parasympathetic nervous system: Maintains or restores energy;

inhibits or decreases activity of organs

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PMHNP Psychopharm Exam 16 2024

THE NERVOUS SYSTEM - All human thoughts, feelings, and actions are seated in and start with actions of the nervous system. Necessary for the PMHNP's role functioning is an understanding of the following basic neuroanatomy and physiology:

Neurodeficits that underlie psychiatric disorders
Actions of and client responses to psychopharmacological treatment agents The nervous system's primary function is to transfer and exchange information. The Neuron ("Nerve Cells") - The basic cellular unit of the nervous system The microprocessor of the brain responsible for conducting impulses from one part of the body to another Components of the neuron:
Cell body: Also known as soma; made up of the nucleus and cytoplasm within cell membrane
Stem or axon: Transmits signals away from the neuron's cell body to connect with other neurons and cells
Dendrites: Collect incoming signals from other neurons and send the signal toward the neuron's cell body Nervous System - Composed of two separate, interconnected divisions:
Central nervous system (CNS) ** Composed of the spinal cord and the brain *Peripheral nervous system (PNS) ** Composed of the peripheral nerves that connect the CNS to receptors, muscles, and glands ** Includes the cranial nerves just outside the brain stem ** Comprises the somatic nervous system and the autonomic nervous system: ***Somatic nervous system: Conveys information from the CNS to skeletal muscles; responsible for voluntary movement *** Autonomic nervous system: Regulates internal body functions to maintain homeostasis; conveys information from the CNS to smooth muscle, cardiac muscle, and glands; responsible for involuntary movement; divided into the sympathetic nervous system and the parasympathetic nervous system: **** Sympathetic nervous system: The excitatory division; prepares the body for stress (fight or flight); stimulates or increases activity of organs **** Parasympathetic nervous system: Maintains or restores energy; inhibits or decreases activity of organs

NEUROANATOMY AND THE BRAIN - Brain tissue is categorized as either white matter or gray matter.

White matter is the myelinated axons of neurons. *Gray matter is composed of nerve cell bodies and dendrites; it is the working area of the brain and contains the synapses, the area of neuronal connection. Outermost surface of the brain: Structured to contain grooves and dips of corrugated wrinkles within the brain tissue that provide anatomical landmarks or reference points
Functions to increase brain's surface area ** Increases working area and cell communication area
Grooves and dips named by size and depth ** Sulci: Small shallow grooves ** Fissures: Deeper groves extending into the brain
Gyri are the raised tissue areas.
Distinct anatomical areas of brain ** The brain is subdivided into the cerebrum and the brainstem. Cerebrum - Largest part of the brain, which is divided into two halves, the right and left cerebral hemispheres
Left hemisphere: Dominant in most people; controls most right-sided body functions
Right hemisphere: Controls most left-sided body functions
Normal functioning requires effective coordination of two hemispheres.
Both hemispheres connected by a large bundle of white matter, the corpus callosum, an area of sensorimotor information exchange between the two hemispheres Cerebrum Frontal lobe: - Frontal lobe: Largest and most developed lobe. Functions include:
Motor function: Responsible for controlling voluntary motor activity of specific muscles
Premotor area: Coordinates movement of multiple muscles
Association cortex: Allows for multimodal sensory input to trigger memory and lead to decision-making
Seat of executive functions: Working memory, reasoning, planning, prioritizing, sequencing behavior, insight, flexibility, judgment, impulse control, behavioral cueing, intelligence, abstraction
Language (Broca's area): Expressive speech
Personality variables: The most focal area for personality development
Problems in the frontal lobe can lead to personality changes, emotional, and intellectual changes Cerebrum Temporal lobe: - Temporal lobe; functions include:
Language (Wernicke's area): Receptive speech or language comprehension
Primary auditory area
Memory
Emotion
Integration of vision with sensory information
Problems in the temporal lobe can lead to visual or auditory hallucinations, aphasia, and amnesia

Plays a role in movement initiation; complex motor functions with association connections
Functions in learning and automatic actions such as walking or driving a car
Contains extrapyramidal motor system or nerve tract
Functions in involuntary motor activities (e.g., muscle tone, posture, coordination of muscle movement and common reflexes)
Many psychotropic medications can affect the extrapyramidal motor nerve track, causing involuntary movement side effects
Contains both the caudate and the putamen
Problems in the basal ganglia can lead to bradykinesia, hyperkinesias, and dystonia. Brainstem - Brainstem
Made up of cells that produce neurotransmitters
Includes the midbrain, pons, medulla, cerebellum, and reticular formation **Midbrain: Houses the ventral tegmental area and the substantia nigra (areas of dopamine synthesis) ** Pons: Houses the locus ceruleus (area of norepinephrine synthesis) ** Medulla: Together with the pons, contains autonomic control centers that regulate internal body functions ** Cerebellum: Responsible for maintaining equilibrium; acts as a gross movement control center (e.g., control movement, balance, posture) *** Each hemisphere of cerebellum has ipsolateral control (same side of body). *** Problems with the cerebellum can lead to ataxia (uncoordinated and inaccurate movements). *** Romberg test is important for detecting deficiencies in cerebellar functioning. ** Reticular formation system: The primitive brain *** Receives input from cortex; an integration area for input from post sensory pathways *** Innervates thalamus, hypothalamus, and cortex *** Regulation functions include: **** Involuntary movement **** Reflex **** Muscle tone **** Vital sign control **** Blood pressure **** Respiratory rate **** Critical to consciousness and ability to mentally focus, to be alert and pay attention to environmental stimuli NEUROPHYSIOLOGY AND THE BRAIN Two classes of cells are in the nervous system: glia and neurons. - Two classes of cells are in the nervous system: glia and neurons.
Glia: Structures that form the myelin sheath around axons and provide protection and support

Neurons: Nerve cells responsible for conducting impulses from one part of the body to another NEUROPHYSIOLOGY AND THE BRAIN Components of a neuron include: - Components of a neuron include:
Cell body: Also known as soma; made up of the nucleus and cytoplasm within the cell membrane
Dendrites: Receive information to conduct impulse toward the cell body
Axon: Sends or conducts information away from cell body NEUROPHYSIOLOGY AND THE BRAIN Synapse or synaptic cleft - Synapse or synaptic cleft—The connection site and area of communication between neurons where neurotransmitters are released
The synapse converts an electrical signal (action potential) from the presynaptic neuron into a chemical signal (neuron transmitter) that is transferred to the postsynaptic neuron.
Neurotransmitters are released at the synaptic cleft as the result of an electrical activity (action potential).
The two phases of an action potential are: ** Depolarization: The initial phase of the action potential (an excitatory response), when sodium and calcium ions flow into the cell; and ** Repolarization: The restoration phase (an inhibitory response), when potassium leaves the cell or chloride enters the cell.
Problems in either the structure or chemistry of the synapse interrupt normal flow of impulses and stimuli, which then contribute to symptoms commonly seen in psychiatric disorders. NEUROPHYSIOLOGY AND THE BRAIN Neurotransmitters: - Neurotransmitters: Chemicals synthesized from dietary substrates that communicate information from one cell to another.
The neurotransmitter will be released from the presynaptic neuron, cross the synapse, and then bind to a specific receptor on the postsynaptic neuron.
Specific criteria must be met for a molecule to be classified as a neurotransmitter (see Table 5-1).
Categories of neurotransmitters: Monoamines, amino acids, cholinergics, neuropeptides NEUROPHYSIOLOGY AND THE BRAIN Monoamines: "Biogenic amines"—dopamine, norepinephrine, epinephrine,serotonin - Monoamines: "Biogenic amines"—dopamine, norepinephrine, epinephrine, serotonin Dopamine: Known as a catecholamine; produced in the substantia nigra and the ventral tegmental area; precursor is tyrosine; removed from the synaptic cleft by monoamine oxidase (MAO) enzymatic action
Four dopaminergic pathways: Mesocortical, mesolimbic, nigrostriatal, tuberoinfundibular (see Chapter 10) Norepinephrine: Also known as a catecholamine; produced in the

Neurotransmitter Acetylcholine - NEUROTRANSMITTER Acetylcholine Decrease *Alzheimer's disease *Impaired memory Increase *Parkinsonian symptoms Neurotransmitter Dopamine - NEUROTRANSMITTER Dopamine Decrease *Substance abuse *Anhedonia *Parkinson's disease Increase *Schizophrenia *Psychosis Neurotransmitter Norepinephrine - NEUROTRANSMITTER Norepinephrine Decrease *Depression Increase *Anxiety Neurotransmitter Serotonin - NEUROTRANSMITTER Serotonin Decrease *Depression *Obsessive-compulsive disorder, anxiety disorders *Schizophrenia Neurotransmitter γ-Aminobutyric acid (GABA) - NEUROTRANSMITTER γ-Aminobutyric acid (GABA) Decrease *Anxiety disorders

Neurotransmitter Glutamate - NEUROTRANSMITTER Glutamate Increase *Bipolar affective disorder *Psychosis from ischemic neurotoxicity or excessive pruning Decrease *Memory and learning difficulty *Negative symptoms of schizophrenia Neurotransmitter Opioid neuropeptides - NEUROTRANSMITTER Opioid neuropeptides Decrease *Substance abuse Neurotransmitter Details Dopamine - NEUROTRANSMITTER Dopamine RECEPTORS D1-like D2-like GENERAL FUNCTION Thinking Decision-making Reward-seeking behavior Fine muscle action Integrated cognition SYMPTOMS OF DEFICIT Mild: *Poor impulse control *Poor spatiality *Lack of abstractive thought Severe: *Parkinson's disease *Endocrine alterations *Movement disorders SYMPTOMS OF EXCESS Mild: *Improved creativity

Reduces aggression Reduces anxiety Reduces excitation SYMPTOMS OF DEFICIT Irritability Hostility Tension and worry Anxiety Seizure activity SYMPTOMS OF EXCESS Reduced cellular excitability Sedation Impaired memory Neurotransmitter Details Serotonin - NEUROTRANSMITTER Serotonin RECEPTORS 5HT1a 5HT1d 5HT 5HT2a 5HT 5HT GENERAL FUNCTION Regulation of sleep Pain perception Mood states Temperature Regulation of aggression Libido Precursor for melatonin SYMPTOMS OF DEFICIT Irritability Hostility Depression Sleep dysregulation Loss of appetite Loss of libido SYMPTOMS OF EXCESS Sedation Increased aggression

Hallucinations (rare) Neurotransmitter Details Acetylcholine - NEUROTRANSMITTER Acetylcholine RECEPTORS Nicotinic Muscarinic GENERAL FUNCTION Attention Memory Thirst Mood regulation REM sleep Sexual behavior Muscle tone SYMPTOMS OF DEFICIT Lack of inhibition Decreased memory Euphoria Antisocial action Speech decrease Dry mouth, blurred vision, constipation SYMPTOMS OF EXCESS Over-inhibition Anxiety Depression Somatic complaints Self-consciousness Drooling Extrapyramidal movements Neurotransmitter Details Glutamate - NEUROTRANSMITTER Glutamate RECEPTORS AMPA MNDA GENERAL FUNCTION Memory Sustained automatic functions SYMPTOMS OF DEFICIT

Decreased memory STRUCTURAL IMAGING - Provides evidence of size and shape of anatomical structures Computed tomography (CT): - Computed tomography (CT): Provides a three-dimensional view of the brain structures; differentiates structures based on density; provides suggestive evidence of brain-based problems but no specific testing for psychiatric disorders

Advantages: Widely available, relatively inexpensive
Disadvantages: Lack of sensitivity, cannot differentiate white matter from gray matter; cannot view structures close to the bone tissue; underestimation of brain atrophy; inability to image sagittal and coronal views FUNCTIONAL IMAGING - Technique that measures function of areas of the brain and bases the resulting assessment on blood flow; may use radioactive pharmaceuticals to cross the blood-brain barrier; mainly used for research Common functional imaging tests include: - Common functional imaging tests include: *EEG and evoked potentials testing: Least expensive tests that convey information on electrical functioning of the CNS *Magnetoencephalography (MEG): Similar to the EEG but detects different electrical activities; often used in a complementary fashion with EEG testing *Single photon emission computed tomography (SPECT): Provides information on the cerebral blood flow; limited availability; expensive but less than positron emission tomography *Positron emission tomography (PET): Provides images of the brain when positron-emitting radionuclei interact with an electron; expensive procedure that requires extensive resources and support team Combined structural and functional imaging - The newest imaging; attempts to examine structure in conjunction with function; currently mainly used for research Available tests include: - Available tests include: *Functional MRI (fMRI) *Three-dimensional, event-related functional MRI (3fEMRI) *Fluorine magnetic spectroscopy *Dopamine D2 receptor binding

Genetic Counseling - * Genetic counseling is a communication process used when a client has a genetic risk and often involves offering a test that could provide information about the genetic status of the person and possible implications for the family. *A genetic counselor is someone whose primary role is to offer information and support to people concerned about an illness that may have a genetic basis. *A referral to a genetic counselor may be needed when a client is anticipating a pregnancy and concerned for the health of the fetus. GENOMICS Family History, Family Tree, or Pedigree - Family History, Family Tree, or Pedigree *Tool in determining likelihood of genetic disorder in family, inheritance patterns, and risk of recurrence in family members *Surgeon General recommended that families know their family history (U.S. Department of Health and Human Services, n.d.) *Pedigree symbols in drawing a family tree indicate male, female, marriage, divorce, adoption, twins, pregnancy, consanguinity (relatives having children), conditions *Family history starts with current family and moves back to grandparents. *Autosomal-dominant conditions may be present in more than one generation and in up to 50% of offspring when one parent is affected (e.g., Marfan syndrome). *Recessive conditions appear only in one generation, affecting people who have two copies of a faulty gene, one from each (unaffected) parent (e.g., hemochromatosis, cystic fibrosis).

X-linked disorders are caused by faulty genes on an X chromosome (e.g., fragile X syndrome, color blindness). *Risk assessment is based on inheritance patterns and may be by percentage of risk. Genetic Terms - Chromosomes are structures of DNA (deoxyribonucleic acid) in the nucleus of cells; there are normally 46 total (23 pairs) in humans. DNA is made up of two twisted, paired strands, composed of sugars linked by four nucleotide bases—adenine (A), thymine (T), cytosine (C), and guanine (G)—specifying the amino acids that make proteins. A is always paired with T and G is always paired with C. Genes are a sequence of DNA that cause human characteristics to be passed to the next generation; genes direct the production of proteins. Messenger RNA (mRNA) codes for an amino acid. The Human Genome Project mapped the entire nucleotide sequence of the human genome in

The genome is a complete set of DNA.

*Genetic testing or profiling helps identify the presence of gene variants that may help determine dosing of medication (e.g., CYP450 test of CYP4502D6, CYP450 2C19, and methylene tetrahydrofolate reductase [MTHFR] genes—see Chapter 7 for further information on pharmacokinetics). Testing for presence of HLA-B1502 allele, an inherited variant of HLA-B gene, is required by the FDA in people of Asian descent prior to prescribing the anticonvulsant carbamazepine due to risk of Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN). CASE STUDY 1 Ms. Franklin is a 24-year-old sales clerk. She has a strong family history of mental illness and is worried that she may experience some problems in her life because of her family history. She presents to her local primary care provider complaining of the following symptoms:

Hyperalertness
Increased startle response
Concern that people are staring at her and watching what she eats
Decreased appetite
Difficulty falling asleep Ms. Franklin is trying to determine if these experiences are the beginning of a mental illness. She wants to have a brain scan done to determine the answer. She also is getting married soon and wants to know what the risk is that her future children will experience mental illness, because she believes it runs in her family. In working with Ms. Franklin, the PMHNP must consider many issues.

Are the symptoms described by Ms. Franklin consistent with a psychiatric disorde - ANSWERS TO CASE STUDY DISCUSSION QUESTIONS Case Study 1
More assessment would be needed to determine whether Ms. Franklin's symptoms are consistent with a psychiatric disorder, but they may be consistent with an anxiety or mood disorder.
Most psychiatric illnesses have been shown to have, in part, a genetic link and therefore, do tend to run in families.
Ms. Franklin's symptoms are consistent with excessive levels of norepinephrine.
No. There is insufficient data to warrant the cost of a brain scan at this time.
Yes, the risk of Ms. Franklin's children developing psychiatric disorders can be determined but only if Ms. Franklin meets criteria for an actual psychiatric illness. Once this is determined, the genetic risk to her children can be identified through the use of such things as concordant rate tables. CASE STUDY 2 Joel is an 18-year-old college freshman who developed psychotic symptoms necessitating a brief hospitalization at his university's medical center. Joel is given haloperidol (Haldol) 5 mg IM with lorazepam (Ativan) 1 mg IM and diphenhydramine (Benadryl) 50 mg IM upon admission and is started on risperidone (Risperdal). One day after admission, Joel presents to the nurses' station complaining of a painful "stiff neck" and "thick tongue."
What is the best description of Joel's presentation?
What is the best explanation for Joel's presentation?
Which neurotransmitters are involved in Joel's presentation?

How should the PMHNP address this scenario?
In formulating diagnostic conclusions about Joel, what should the PMHNP consider? - Case Study 2
Joel's presentation is consistent with acute dystonia.
Both haloperidol and risperidone are high-potency D2 antagonists. Although Joel received prophylactic diphenhydramine, adding risperidone, particularly with aggressive dosing, increases the risk of extrapyramidal side effects.
CNS dopamine (DA) and acetylcholine (ACH) have a reciprocal relationship. As DA receptors are antagonized by antipsychotic medication, acetylcholine levels increase, giving rise to extrapyramidal side effects. This is particularly true of first-generation antipsychotics, but also of high-potency second-generation agents.
Administer diphenhydramine or benztropine (Cogentin) IM immediately and hold subsequent doses of risperidone until dystonia completely resolves. Resume risperidone at a lower dose along with an oral anticholinergic medication. Adjust the dose of the antipsychotic as indicated. If Joel continues to experience extrapyramidal side effects, switching to a lower-potency antipsychotic may be necessary.
Joel may have experienced a sentinel episode of schizophrenia. Joel's symptoms may also have been substance-induced.

Neuroanatomy and Neurophysiology: A Comprehensive Guide for PMHNP Exam Preparation, Exams of Nursing

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PMHNP Psychopharm Exam 16 2024