A BASIC INTRODUCTION TO PSYCHOPHARMACOLOGY
(Copyright 2005, Salvatore Cullari)
NOTE: The material in this course is made up of numerous sources including many of those listed in the bibliography and internet sites (which are listed at the very end), my own experience and numerous psychopharmacology courses I have taken over the years. However, as all of you know, this field is changing so rapidly that it is often difficult or impossible to keep up with new developments. In this vein, if you have any new thoughts, suggestions, reading materials or internet sites, please send them to me.
This information is presented without charge. However, please do not copy, market or duplicate any of this material in any manner without my written permission.
Unit I: The “Basic” Basics
absolute refractory period
The time when another action potential cannot be set off no matter how much current you inject.
Decrease in spike firing rate with time.
A neurotransmitter that connects nerves to muscles. Also active at other synapses in CNS/ANS.
A spike in membrane voltage caused by opening and closing of Na and K channels. This is the
signal that is conducted down the axon to transmit information to other neurons.
active (excitable) membrane
Membranes that have voltage-sensitive channels
An axon, neuron or tract that brings information in towards the central nervous system
Hyperpolarization after an action potential
A drug that will activate a particular receptor and opposite of antagonist
The building blocks of peptides and proteins. Some amino acids also serve as neurotransmitters
A kind of glutamate receptor that mediates excitatory (depolarizing) signals. The channel
conducts both Na+ and K+.
A nucleus involved in emotional and sexual behavior. Part of the limbic system
The study of structures in biology. Contrasted with physiology.
A drug that will block a particular receptor, opposite of agonist
Loss of language skills following brain damage.
One of many areas for higher cortical processing of vision. This one mediates the visual
perception of motion.
artificial neural network (ANN)
Networks of simple units that do complex things due to their connectivity. The computer
science/engineering approach to computational neuroscience.
An area of cortex that does not receive primary sensory (or give off primary motor) information;
some of these areas are thought to be involved in integrating or associating different types of
associative long term potentiation
Increased strength in a weakly stimulated synapse with strong activation in a nearby synapse.
This has been shown to occur in some areas of hippocampus
Glial cells that are involved in nutritive support for neurons and in maintaining concentrations in
the extracellular space.
A neural mechanism that permits brain function to be focused on a particular sensory stream.
autonomic nervous system (ANS)
A section of the nervous system innervating organs.
The axon is classically regarded as the output side of the neuron. In vertebrates, axons may be
myelinated. Conduction of signals down the axons is due to action potentials which are
self-regenerative signals that propagate by saltatory conduction. A myelinated axon is shown at
the bottom of this picture.
A branch of an axon.
The initial part of the axon. This may be where action potentials start in some neurons.
The end of an axon. There is usually a synapse here.
A large nuclear complex rostral (anterior) to the thalamus. Involved in motor activity, planning,
The brain somehow has to bind together information about a single object that is processed in
different places. For example a visual image is taken apart so that motion, color, shape and other
aspects can be separately analyzed, yet somehow one has a unitary percept of what's being seen.
The area in which one cannot see because light rays fall on the optic disk. The optic disk has no
photoreceptors. Somehow this blindness is ignored by the brain, an act of completion
A barrier that keeps bad stuff floating around in the blood from getting into the brain.
bouton en passant
(= synaptic bouton) A synapse that is not at an axon terminal but is just a swelling as the axon
passes by a dendrite.
The part of the CNS within the skull
The part of the CNS between the thalamus and the spinal cord
An equation that describes how voltage attenuates along an electrical cable. Originally proposed
by Lord Kelvin to describe the reduction of telegraph signals from Europe to North America, it is
also used to describe attenuation of membrane voltage down a passive neural membrane such as
a passive dendrite.
A chemical amplification process where the product of one enzyme (or a second messenger)
augments the rate of another enzyme which creates a large amount of another messenger
controlling yet another enzyme. A few such steps can turn a relatively small chemical signal into
a large number of signaling molecules.
Computerized axial imaging. An imaging method that recreates 2 dimensional cross sections
using transforms of x-ray conductance through tissue. Also called CT scan.
The big "horses tail" of nerves at the base of the spinal cord.
The tail side of the body. In the brain this is toward the back (posterior) and in the spinal cord it's
towards the bottom (inferior).
Hebb hypothesized that cell assemblies (groups of simultaneously active neurons) could
represent perceived or remembered objects.
Synonym for soma
central nervous system (CNS)
The brain (including retina and brainstem) and spinal cord
A complex movement control center at the caudal end of the brain overlying the brainstem.
Grey matter at the surface of the brain
cerebrospinal fluid (CSF)
The fluid that bathes the CNS and lies inside the ventricles
A synapse where information is conveyed by the diffusion of a neurotransmitter across the
synaptic cleft to bind to and activate receptors on the other side
The ability of the brain to organize complex multi-part information into a single remembered
object. An example is seen in remembering a telephone number -- it is hard to remember as a
collection of digits but chunking into a set of 3 followed by a set of 4 makes it easier
Different neurotransmitters released at a single synapse.
The ability of the nervous system to ignore inconsistencies or gaps in incoming information to
construct a complete story. Neglect syndromes may be in part caused by excessive completion.
The speed of spike (action potential) conduction along an axon
Putative process whereby memories are moved from temporary storage in hippocampus to more
permanent storage in cerebral cortex
The other side. Most of the brain innervates contralateral structures. Opposite of ipsilateral.
contralateral neglect syndrome
A very odd syndrome often seen after strokes affecting the non-dominant hemisphere. The
patient may deny that the contralateral side of his body belongs to him or her.
Multiple inputs coming into one neuron
The vertical plane that runs from left to right (or lateral to medial) and up to down (ventral to
dorsal). An example would be the coronal plane running from ear to ear
The large white matter that connects the two hemispheres
(aka pyramidal tract) A tract of that starts in motor cortex and goes down to the spinal cord.
Responsible for some aspects of fine motor control.
A limited period of time when a particular aspect of brain development is sensitive to a change in
the external environment
Movement of charge. In a wire this represents a wave of electrons moving but in living tissue
current is carried by ions. current I is measured in Amperes (amps).
Holding a steady current in a neuron and watching how the voltage responds.
A map of the cerebral cortex that distinguishes areas according to anatomical differences such as
the prominence of a particular cortical layer.
The contiguous fluid inside a cell that lies outside the organelles.
the hypothesis that a single neuron has only one transmitter that is given off at all its synapses.
Although this has turned out to be wrong in part (see co-transmitters), it seems to still hold true
that major neurotransmitters such as glutamate and GABA are not coexpressed by a single
slow waves (< 4 Hz) of the EEG seen in deep sleep
Cellular extensions from the soma. They are generally fatter and shorter than axons and are never
myelinated. Dendrites were classically thought to be electrically passive but it now appears that
many are active. Dendrites are classically regarded as the input side of the cell. Again this is not
always the case. Note the apical dendrites at the top of the picture and the basal dendrites to the
A spiny excrescence off the side of a dendrite. Often the site of an excitatory synapse. Has
specialized internal structures presumed related to its signal carrying function.
The full set of dendrites that belong to a neuron.
Change in membrane potential positive from the resting membrane potential. This is usually
associated with excitation of the cell.
The tendency of particles at a high concentration to move to places where they are not so
Removal or reduction of inhibitory action in a neural circuit.
Multiple outputs coming from one neuron
The cerebral hemisphere that controls language. This is the left hemisphere in most people.
The back side of the body. For the CNS this would be posterior in the spinal cord and superior
(up) in the brain.
The potential felt by ions of a particular type. This depends on the difference between the current
membrane potential and the Nernst potential corresponding to the concentration difference across
An axon, neuron or tract that takes information out away from the CNS.
A mechanism for allowing an animal to deliver small electric currents to activate a particular spot
in its own brain.
A gap junction connection between cells that allows direct current flow that can thereby pass
electrical signals from one cell to another.
A balance between diffusive force in one direction and a membrane potential gradient in the other
direction. The membrane potential where this occurs is the Nernst potential.
A recording of electrical signals from the brain made on the skin of the head.
A peptide neurotransmitter that is active at the same location where opium or morphine acts.
enteric nervous system
The nervous system that runs the gut. It can function on its own even after being completely
disconnected from other parts of the nervous system.
A brain disorder where repeated seizures occur.
The Nernst potential that produces electrochemical equilibrium for a particular ion.
excitatory postsynaptic potential (EPSP)
Depolarization of the postsynaptic membrane potential due to synaptic action. Nominally
Release of material from a cell due to fusion of a vesicle with the cell membrane. This is how
neurotransmitters are released into the synaptic cleft.
The outside of cells.
The ability of incoming excitatory signals to produce a transient increased excitability. Generally
shorter in duration as compared to potentiation.
The central part of the retina that has the most acute vision
The notion that increases in spike frequency are an important part of the code of the nervous
system. Also called rate coding.
The most anterior lobe of the brain. Thought to play a role in initiative and planning.
functional magnetic resonance imaging (fMRI)
A technique for imaging physiological activity using magnets and radio waves
The major inhibitory neurotransmitter in the CNS
ganglion (plural, ganglia)
A collections of neurons lying outside the CNS
An ion channel that connects two cells together.
The ability of channels to be opened or closed either by membrane potential (voltage-gated) or by
the arrival of a neurotransmitter or other chemical (ligand-gated)
The most common type of neuron in the nervous system. These cells play roles in support,
hormone release, and balancing extracellular concentrations. Two important types are astrocytes
An amino acid that is the major excitatory neurotransmitter in the central nervous system.
grandmother cell theory
The theory that the brain codes involves specific neurons that stand for specific things in the
world -- ie a neuron that lights up when grandma is seen, heard, smelled or touched
Brain volumes made up of cell bodies such as cerebral cortex, basal ganglia and thalamus. Looks
grey when you cut open a brain.
gyrus (Plural: gyri)
The cerebral hemispheres are folded; gyri are the ridges.
A nonassociative learning form leading to decreased behavioral responses to repeated stimulation
A synapse that that increases in strength when both the presynaptic and postsynaptic neurons are
active at the same time.
A cortical area in the temporal lobe. This area is involved in declarative memory (memory for
A set of equations that describe the evolution of the action potential by taking account of changes
in conductance of voltage-sensitive sodium and potassium channels.
The horizontal plane is horizontal with the person in the anatomical position. it runs rostral
(front) to caudal (back); medial to lateral (also left to right).
An inherited movement disorder characterized by dance-like movements.
Change in membrane potential negative from the resting membrane potential. This is usually
associated with inhibition of the cell.
Study of biological tissue that has been taken out of the organism. (means "in glass")
Study of biological tissue in the intact organism. (means "in life")
Closing of an ion channel with time.
inhibitory postsynaptic potential (IPSP)
Neurotransmitter-induced postsynaptic potential making the postsynaptic neuron less likely to
fire action potentials
For a neuron to connect up synaptically with something
Combination of incoming signals in a neuron or neuronal unit.
A neuron with axons that only project locally. In the cortex many of these appear to be
The inside of a cell.
An animal without a spine. Can be divided into squishies (clam, octopus, leech) and crunchies
(insect, limulus, lobster).
A charged atom. The most important ions in the nervous system are Na+,K+,Cl-,Ca++. The
superscript tells you what type of charge it is and whether it is monovalent (one +) or divalent
An protein that lies in the cell membrane (integral membrane protein) that has a hole that allows
ions to pass from one side of the membrane to the other. Most of these ion channels are selective,
only allowing passive of certain ions and not letting others through. Picture: Diagrams
On the same side of the midline or body, opposite of contralateral.
Towards the side. For example, the ears are lateral to the brain.
lateral geniculate nucleus (LGN)
An area of the thalamus that relays information from the retina.
Storage of new information in a biological or artificial system.
An ion channel which opens and closes depending on the arrival of some chemical -- usually
either a neurotransmitter or second messenger
A set of interconnected brain structures that may be involved in emotion (see Papez circuit).
The horseshoe crab, an animal whose visual mechanisms have been heavily studied. Picture
The architecture of membranes in living things. Can be understood by thinking of a soap bubble.
Soaps are amphoteric: one end is fatty and the other end is ionic. This allows them to clean: one
end sticks to grease (hydrophobic = hates water) and the other end sticks to water (hydrophilic =
loves water). In a soap bubble all the hydrophilic ends stick out and the hydrophobic ends point
inward and interact to form a membrane. A lipid bilayer is like 2 soap bubbles one inside the
other with the inner one's hydrophilic heads sticking in to the cytoplasm.
long term potentiation (LTP)
A persistent strengthening of synaptic strength that may be the neural analogue of the Hebb
synapse. NMDA receptors are involved in this process.
long-term depression (LTD)
A persistent weakening of synaptic strength.
magnetic resonance imaging (MRI)
A technique for imaging the anatomy of the brain using magnets and radio waves.
An area in the nervous system where some aspect of the sensory world is represented. This may
be topographic as in vision or touch or may represent some other aspect of the stimulus as in a
tonotopic (frequency-oriented) map for hearing. Maps are not always continuous, they may be
patchy or scattered.
Towards the middle. For example, the nose is medial to the cheeks.
The ability of the membrane to store charge by keeping positive and negative charge separated on
opposite sides of the membrane. Diagram
The inverse of membrane resistance. The ease with which a particular ion can move across the
membrane. Conductance, g is measured in Siemens S. (See Ohm's law)
The voltage drop across a membrane. Specifically, the difference in force that a charge would
feel at opposite sides of the membrane. This term is synonomous with membrane voltage or
membrane polarization. One speaks of membrane voltage or potential being changed in a
depolarizing (more positive) or hyperpolarizing (more negative) direction. (see resting membrane
Measurement of the difficulty that a charge has moving from one side of the membrane to the
other. Resistance R is measured in Ohms. Resistance is related to current and voltage by R=V/I,
Ohm's law. Resistance = 1 / conductance
Storage of information.
A small glass tube tapered toward the tip that can be inserted into neurons to allow intracellular
recording. Slightly bigger microelectrodes may be made of different materials and used in
extracellular recording. Picture
10-6 meters. A neuron soma may be 5-30 microns in diameter.
10-3 seconds. A typical action potential duration is 1-2 ms.
10-3 volts. A typical neuron resting membrane potential is about -75 mV.
Cortical areas that control movement
The insulation that is wrapped around axons by oligodendroglia which permits faster conduction
velocity by saltatory conduction.
Contralateral neglect syndrome
An equation for calculating the equilibrium potential of a particular ion
The equilibrium potential for a particular ion. This is the potential that balances out the chemical
diffusive gradient to produce electrochemical equilibrium.
A bundle of axons in the peripheral nervous system. Nerves run to muscles and from sensory
organs in the periphery.
The principal information carrying element of the nervous system. These can differ widely in
shape and connectivity. Most neurons have a soma, dendrites and an axon. Two important
neuron types are pyramidal cells and inhibitory interneurons. Generic neuron picture
The concept put forth by Cajal that suggested that neurons are separate cells. This was contested
by Golgi's reticular hypothesis that suggested that the nervous system was just one big
The lipid bilayer that separates the outside from the inside of a neuron.
Peptides (short sequences of amino acids) that serve as neurotransmitters
Study of how drugs alter neural function
Areas where numerous dendrites and axons come together making connections.
A chemical released across a chemical synapse to communicate from one neuron to another.
A type of glutamate receptor that provides a more prolonged time course of excitation than does
AMPA and appears to be responsible for triggering long term potentiation.
node of Ranvier
A gap in the myelin sheath where action potentials can be generated. The jumping of the action
potential from one node to the next is saltatory conduction
The cerebral hemisphere that doesn't control language. This is the right hemisphere in most
people. It is thought to play a role in spatial tasks.
A collection of cell bodies in the central nervous system. Also, an organelle that is responsible
for reproduction in a cell.
The rearmost cortex where the primary visual area lies.
V=IR (voltage equals current times resistance); since g=1/R can also write I=gV
the sense of smell
These cells directly provide the myelin sheath wrapping that provides insulation for axons.
The crossing point for the optic nerves (which are not really nerves) coming from the retina.
The cell has an anatomy too. Organelles are the organs of the cell and include stuff for making
energy, for reproducing and for making proteins.
An area of visual cortex with neurons that respond primarily to line segments seen on the retina
that have a particular angle with the horizontal
A set of interconnections within the limbic system that were proposed (by Papez) to form the
The idea that calculation in the brain involves many paths working in parallel simultaneously
(opposite of serial processing)
The large middle region between occipital and frontal lobes. Houses language in the dominant
hemisphere and spatial functions in the non-dominant hemisphere. Has many areas of association
A movement disorder featuring tremor, rigidity, reduced movement (except for the tremor) and
tendency to fall. Associated with loss of dopaminergic neurons in the substantia nigra.
Membranes that lack voltage-sensitive channels. Voltage in such membranes is governed by the
Synonym for soma
peripheral nervous system (PNS)
The nervous system that lies outside of the brain and spine.
A transient response to a continuing stimulus, opposite of tonic.
The study of functional interactions in biology. Contrasted with anatomy.
Changes in neural connectivity
positron emission tomography (PET)
A technique for imaging physiological activity using radioactive substances. Picture.
Backwards, depending on the position in the CNS corresponds to either caudal or dorsal.
The part of a synapse on the receiving side
postsynaptic potential (PSP)
Change in voltage in the postsynaptic membrane caused by activation at that synapse.
The part of a synapse on the transmitting side
primary sensory cortex
An area of cortex that receives sensory information directly from the thalamus or other
primary visual cortex
The primary sensory area for vision
Monkeys, apes and people
sensation of movement in muscles and joints
a neurological condition where specific faces can't be recognized
Closer to the center of the body, opposite of distal
A characteristic neuron of the cortex that has a cell body shaped like a pyramid which gives off a
large apical dendrite.
"realistic" neural network
Networks of neurons simulated to be relatively close to the real thing. The quotes around realistic
are necessary because the complexity of neurons makes it impossible to accurately simulate them
at this time. A neurophysiological approach to neural networks.
The receptive field of a neuron are the union of all those locations where stimulation will activate
that neuron. For touch this could be an area of skin while for vision this would be the area
(visual field) that this neuron "sees"
A site on a cell membrane where a chemical can bind. Most receptors are highly selective, they
will only bind a particular type of chemical and not others. Receptors are the site where the
neurotransmitter binds on the postsynaptic membrane.
Axon collaterals that come back and synapse either on the same neuron or on the same type of
neuron that they come from
A stereotyped closed stimulus-response loop
relative refractory period
A period during which a repeated neuron stimulation must be increased in order to generate
another action potential
resting membrane potential
The membrane potential that a neuron will remain at in the absence of stimulation of activity. It is
determined by a complex function that takes into account relative permeabilities of different ions
and their respective Nernst potentials. Usually somewhere near -75 mV.
reticular activating system
An area of brainstem that causes arousal or wakening when stimulated. Damage to this area can
The head side of the body. In the brain this is toward the front (anterior) and in the spinal cord
it's towards the top (superior). Opposite of caudal.
The vertical plane that runs from front to back and up to down. Mid-sagittal would be the plane
that runs through the middle of the nose.
The jumping of an action potential from one node of Ranvier to the next in a myelinated axon.
An intracellular chemical that transmits a message between one place and another. In many cases
a neurotransmitter activates a receptor that then secondarily relays the information to open an ion
channel or activate another series of chemicals.
A psychophysics term for a neural pathway for a particular sense or aspect of a sense.
The cell body of a neuron. This is where most of the metabolic activity of the neuron is centered.
It has the organelles for producing energy and creating proteins. In the classical view, signals
generally pass through the soma on the way from the dendrite (input) to the axon (output). The
soma is in the middle of this picture
space constant (lambda)
The distance along a passive dendrite for a fixed voltage to decline by 1/e (~37%)
Adding up of synaptic potentials arriving at different places on one cell
An action potential
The frequency at which spikes occur. Usually between 5-100 Hz in most cell types.
A specialized area with particularly high concentrations of voltage-gated ion channels that is the
first to generate an action potential.
The part of the central nervous system that lies in the spine
The "resting" firing of a neuron when not being stimulated.
A maneuver that can activate a sensory receptor.
sulcus (pl. sulci)
The cortex is a folded 2-dimensional sheet. The infoldings are sulci.
The nonlinear adding together of multiple synaptic inputs.
Synapses are the connections between neurons. Some are electric but in vertebrates most are
chemical, involving the diffusion of a chemical messenger from one side (presynaptic) to the
other (postsynaptic) across the synaptic cleft.
The region separating the presynaptic and postsynaptic membranes at chemical synapse
The sending of information across the synapse, usually by means of release and reception of a
Organelles found in the presynaptic cell that store and release neurotransmitter
A lobe of the brain lying mostly inferior (ventral) and pointing forward (rostral-ward) from
below the major fissure. The auditory area and hippocampus (memory area) are in the temporal
Adding together of postsynaptic potentials arriving one after another at a synapse
The end of an axon
A bunch of axon branches at the end of an axon
A poison that comes from the puffer fish and blocks voltage-sensitive sodium channels.
Allegedly used in the voodoo religion for creating zombies.
A large collection of nuclei that forms the major entry point for most sensory systems to the
brain. It is also involved in sleep.
An activation level that causes a neuron or neural analog to pass from a quiescent to an excited
state. In the case of a neuron this would be the voltage where an action potential would be
time constant (tau)
The amount of time it takes a fixed voltage to die off by 1/e (~37%)
A sustained response to a continuing stimulus, opposite of phasic
A bundle of axons that run together in the CNS
The belly side of the body. For the CNS this would be anterior in the spinal cord and inferior
(down) in the brain.
Large cavities in the brain containing fluid
An organelle that can store a chemical, keeping it from floating loose around the cytoplasm. See
A measure of the force that a charge experiences due to an electric field. Symbol: V, units: volts,
(also called potential)
Holding a steady voltage in a neuron and watching how the current responds.
Synonym for Voltage-sensitive channel
An ion channel that opens or closes in response to changes in membrane potential.
Brain volumes made up of axons going from one place to another. Looks white when you cut
open a brain.
Common Medical Abbreviations
ABG Arterial blood gas
ABO A system of classifying blood groups
a.c. Before meals
ACE Angiotensin converting enzyme
ACTH Adrenocorticotropic hormone, corticotropin
ADH Antidiuretic hormone
ADL Activities of daily living
ad lib As desired
Afib Atrial fibrillation
AFL Atrial flutter
AIDS Acquired immunodeficiency syndrome
ALT Alanine aminotransferase (formerly SGPT)
AST Aspartate aminotransferase (formerly SGOT)
ANA Antinuclear antibody
A&P Anterior and posterior
ARDS Adult respiratory distress syndrome
ASHD Atherosclerotic heart disease
AV Arteriovenous, atrioventricular
b.i.d. Twice a day
BLS Basic life support
BMR Basal metabolic rate
BP Blood pressure
BPH Benign prostatic hypertrophy
bpm Beats per minute
BSA Body surface area
BUN Blood urea nitrogen
BX, Bx Biopsy
C Celsius, centigrade, complement
CA, Ca, ca Cancer, carcinoma
CAB Coronary artery bypass
CAD Coronary artery disease
CAV Cytoxan, adrimycin, and vincristine
CBC Complete blood count
CC, C.C. Chief complaint
cc Cubic centimeter
CCU Coronary care unit
CEA Carcinoembryonic antigen
CHF Congestive heart failure
CK Creatine kinase
Cl Chloride, chlorine
CLL Chronic lymphocytic leukemia
CNS Central nervous system
CO Carbon monoxide, cardiac output
CO2 Carbon dioxide
COPD Chronic obstructive pulmonary disease
CPK Creatine phosphokinase
CPR Cardiopulmonary resuscitation, C-reactive protein
C&S Culture and sensitivity
CSF Cerebrospinal fluid
CT Computed tomography
CTS Carpal tunnel syndrome
CVA Cerebrovascular accident
D&C Dilatation and curettage
DIC Disseminated intravascular coagulation
DIFF, diff Differential blood count
dl Decliter (100 ml)
DM Diabetes mellitus
DNA Deoxyribonucleic acid
DO Doctor of osteopathy
DP Dorsalis pedis
DPT Diphtheria, pertussis, and tetanus (toxoids/vaccine)
DSA Digital subtraction angiography
D/W Dextrose in water
DX, Dx, dx Diagnosis
ECF Extracellular fluid
ED Emergency department
ENT Ear, nose, and throat
ERA Estroadiol receptor assay
ESR Erythrocyte sedimentation rate
FBS Fasting blood sugar
FDA Food and Drug Administration
FSH Follicle-stimulating hormone
ft Foot, feet, (measure)
FUO Fever of undetermined origin
g, gm Gram
GFR Glomerular filtration rate
GP General practitioner
G6PD Glucose-6-phosphate dehydrogenase
gt, gtt Drop, drops
GTT Glucose tolerance test
GYN, gyn Gynecology
HCG Human chorionic gonadotropin
HCI Hydrochloric acid, hydrochloride
HDL High-density lipoprotein
HDN Hemolytic disease of the newborn
HGH Human growth hormone
HI Hemagglutination inhibition
HLA Human leukocyte antigen
HR Heart rate
h.s. At bedtime, hour of sleep
Hz Hertz (cycles per second)
IABP Intra-aortic balloon pump
ICF Intracellular fluid
ICS Intercostal space
ICU Intensive care unit
IgA Immunoglobulin A
IHSS idiopathic hypertrophic subaortic stenosis
I&O Intake and output
IPPB Intermittent positive-pressure breathing
IU International unit
IUD Intrauterine device
IVP Intravenous pyelogram
IVU Intravenous urography
JRA Juvenile rheumatoid arthritis
kcal Kilocalorie (food calorie)
17-KGS 17-ketogenic steriods
KO Keep open
KUB Kidneys, ureters, and bladder
LAD Left anterior descending (coronary artery)
LBBB Left bundle branch block
LDH Lactate dyhdrogenase
LDL Low-density lopoprotein
LE Lupus erythematosus
LH Luteinizing hormone
LUQ Left upper quadrant
LV Left ventricle
m Meter, minim
MCH Mean corpuscular hemoglobin
MCHC Meancorpuscular hemoglobin concentration
MCV Mean corpuscular volume
MD Medical doctor, muscular dystrophy
mm Millimicron (nanometer)
m g Microgram
MI Myocardial infarction
m l Microliter
m m Micrometer, micron
m mol Micromole
mol wt Molecular weight
m Osm Micro-osmole
MRI Magnetic resonance imaging
MS Multiple sclerosis, morphine sulfate
MSH Melanocyte-stimulating hormone
MUGA Multigated acquisition (scanning)
N Nitrogen, normal (strength of solution)
NaCl Sodium chloride
ng Nanogram (millimmicron)
NGT Nasogastric tube
NPO Nothing by mouth
Ob-GYN Obstetrics and gynecology
OTC Over the counter (a drug that can be obtained without a prescription)
P Phosphorus, pressure, pulse
PaCO2 Partial pressure of carbon dioxide in arterial blood
PaO2 Partial pressure of oxygen in arterial blood
Pap Papanicolaou smear
p.c. After meals
PCO2 Partial pressure of carbon dioxide
PO2 Partial pressure of oxygen
Perrla Puplis equal, round, react to light and accommodation
pg Picogram (micromicrogram)
pH Hydrogen ion concentration
PID Pelvic inflammatory disease
PMS Premenstrual syndrome
P.O. By mouth
PPD Purified protein derivative (of tuberculin)
ppm Parts per million
p.r.n. As needed, whenever necessary
Pro time Prothrombin time
psi Pounds persquare inch
PT Physical therapy
PTCA percutaneous transluminal coronary angioplasty
PTH Parathyroid horomone
PVC Premature ventricular contraction
q.d. Every day
q.h. Every hour
q2h Every 2 hours
q4h Every 4 hours
q.i.d. Four times a day
R Respirations, roentgen
RA Rheumatoid arthritis
RAIU Radioactive iodine uptake
RBBB Right bundle branch block
RBS Red blood cell
RCA Right coronary artery
RF Rheumatic fever, rheumatoid factor
Rh Rhesus blood factor
Rh neg. (Rh-) Rhesus factor negative
Rh pos. (Rh+) Rhesus factor positive
RLQ Right lower quadrant
RN Registered nurse
RNA Ribonucleic acid
R/O Rule out
ROM Range of motion (of joint)
RUQ Right uper quadrant
SaO2 Systemic arterial oxygen saturation (%)
SBE Subacute bacterial endocarditis
S.C., SQ, subq Subcutaneous
sed rate Sedimentation rate
SGOT Serum glutamic-oxalacetic transaminase (see AST)
SGPT Serum glutamic-pyruvic transaminase (see ALT)
SI Internation System of Units
SIADH Syndrome of inappropriate antidiuretic hormone
SIDS Sudden infant death syndrome
SLE Systemic lupus erythmatosus
SOB Short of breath
sp gr Specific gravity
S&S Signs and symptoms
STD Sexually transmitted disease
T Temperature; thoracic, to be followed by number designating specific thoracic vertebra
T&A Tonsillectomy and adenoidectomy
T&C Type and crossmatch
TIA Transient ischemic attach
TIBS Total iorn-binding capacity
t.i.d. Three times a day
TMJ Temporomandibular joint
TPA Tissue plasminogen activator
TPN Total parenteral nutrition
TPR Temperature, pulse, respirations
TSH Thyroid-stimulating hormone
URI Upper respiratory infection
USPHS United States Public Health Service
VDRL Veneral Disease Research Laboratory (test for syphilis)
Vfib Ventricular fibrillation
VS Vital signs
VSD Ventricular septal defect
VT Ventricular septal defect
VT Ventricular tachycardia
UTI Urinary tract infection
WBC White blood cell
WHO World Health Organization
*abbreviations should have a line above
Common Abbreviations In Psychopharmacology
a.c. before meals
ADD attention deficit disorder
ADHD attention deficit hyperactivity disorder
bid twice a day
CNS central nervous system
DNRI dopamine norepinephrine reuptake inhibitor
EPS extrapyramidal side effects
ER extended release
FDA Food and Drug Administration
GABA gamma-aminobutyric acid
GAD generalized anxiety disorder
hs at sleep/at night
HCA heterocyclic antidepressant
i one unit or pill (ii = two, iii = three)
mEq/L milliequivalents per liter
MAOI monoamine oxidase inhibitor
NMS neuroleptic malignant syndrome
OCD obsessive-compulsive disorder
OTC over the counter
p.c. after meals
PO by mouth
prn as needed
q every (or with)
qd once a day; daily
qod every other day
qid four times a day
SR sustained release
SSRI selective serotonin reuptake inhibitor
SNRI serotonin norepinephrine reuptake inhibitor
STAT Immediately (right away)
TCA tricyclic andi-depressant
TD tardive dyskinesia
tid three times a day
T 1/2 half-life
tpk time to peak concentration
WBC white blood count
XR extended release
New Drug Development
I. Preclinical Research
III. Clinical Trials
IV. Phase IV evaluations
I. Preclinical Research
Drug synthesis or extraction
Establish efficacy and toxicity
Toxicity-use animals, bacteria
Teratogenicity and mutagenicity
Use non-human species or human tissue
Institutional Review Board (IRB) oversight
II. Application to Food and Drug Administration (FDA)
Preclinical data are submitted
Apply to perform clinical studies for investigational new drug (IND)
(or new use for previously approved drugs)
Upon approval, clinical studies begin
III. Clinical Trials
Each phase addresses different question
All trials must be reviewed and approved by IRB
At least yearly reports must be sent to both FDA and IRB
Phase I Trials
new drug is given to a small group (20-100)
healthy volunteers (usually male, almost never children)
Sometimes patient volunteers are used (especially for rare or difficult to treat disorders)
Questions for phase I: safety (most important); safe dose range; identify side effects
Phase II Trials
Drug is given to larger group of persons (100-500)
Subjects include persons with the disease or condition
Questions for phase II:
Efficacy and dose response relationship
What type of patients is drug appropriate for (age, sex, condition)
Frequency of dose for optimal benefit
Further evaluation of safety
New indications for previously approved drugs
Phase III Trials
Drug is given to large group of persons (1,000 to 5,000)
Subjects usually limited to patient population indicated for the drug
Questions for Phase III
Monitor side effects
Compare to other common treatments
Determine safe dosage
Efficacy for sub-groups of patient population
Upon completion and approval of Phase III, submit new drug application (NDA) to FDA
If drug is approved, Phase IV begins
IV. Phase IV evaluations
Data is collected after drug is marketed
New adverse reactions are identified (as we have seen recently, it may take years for some to appear)
Full description of adverse effects
Identify risk factors
New patient characteristics may be identified
Further studies of most effective dosage
Optimal duration of treatment
Comparison to other drug treatment
Study Design During Clinical Trials
May be problems with random selection and assignment
Does sample represent larger population?
Are control and treatment groups identical?
Referring physician as middleman becoming less common
Chemically inert substance
Used as a comparison to compare true drug effect (pharmacological) from non-specific
May not be practical or ethical - e.g., patients with AIDS
Sham injection - Equivalent of placebo in animal studies
Open label vs double blind
Subject and evaluator both know identity of drug
Advantages: Relatively inexpensive; easy to recruit subjects; simple design
Disadvantages: Demand characteristics and observer bias
Appropriate dosage forms for placebos
Best to use capsules
Encapsulation is most likely to hide differences between drug and placebo
Taste and size is the same
Can easily be blinded with blister packs
AB/BA design or some variant
Subject gets one treatment then switched to second drug and/or placebo after washout period
Advantages of Cross-Over Design
Large sample size not required - therefore easier to recruit for study
Reduced within-subject variability
Good for Phase I trials
Disadvantages of Cross-Over Design
Risk of carryover effect - Must ensure that washout is long enough
Requires a stable condition
Not generally useful with neurodegenerative and many psychiatric conditions
As disease or condition progresses may negate therapeutic effect or tolerance may develop
Double Blind Studies
Neither subject nor evaluator knows identity of drug
Employs placebo or another similar drug
Sometimes employs similarly acting known drug, e.g., TCA when determining effect of SSRI
Advantages of Double-Blind design
Negates demand characteristics and experimenter bias
Disadvantages of Double-Blind Studies
More expensive and harder to design
More prone to error in dispensing
More difficult to recruit subjects (e.g., subjects may not want to risk possibility of getting only placebo)
Subjects may still determine identity of drug (e.g., taste side effects, lack of beneficial effects)
Determination of Efficacy of Clinical Trials in Psychopharmacology: Problems & Issues
e.g., Ham-D; Brief Psychiatric Rating Scale, -
Cognitive measures (memory recall, etc.)
Potential problems with psychometrics of scales and training of raters
Determination of Safety of Clinical Trials in Psychopharmacology
Interviews and rating scales
e.g., AIMS, DOTES
Laboratory measures and other diagnostic procedures
e.g., liver function tests, EKG
Efficacy vs Clinical Significance
Differences on rating scales may mean little in terms of actual real life functioning level
e.g., a few points on MMSE with the use of a cognitive enhancer may be statistically significant, but produce very little change in day-to-day behaviors
This is an issue for both treatment and clinical trials
Adverse reactions and/or lack of perceived efficacy may be contributory
Self-selected subjects (e.g., via internet) may be more motivated than physician referred
Issues related to Informed Consent and Duty to Inform
Is the patient competent and free to consent?
Special populations – severely mentally ill, demented, children
Need to explain in a language subject understands the potential adverse reactions and risks (what, how, when, how severe, how often?)
Duration of Studies
Usually too short (6-8 weeks) to determine effect and toxicity of drug over the long term - e.g., Relapse with antidepressants, serotonin “poop-out;” Tardive dyskinesia (TD), etc.
When is the end point of study reached?
When toxicity ensues??
Must be explained to patient when she/he consents
Problems with Large Scale Clinical Studies
Very expensive to mount
May require underwriting from other sources (government; other or larger pharmaceutical companies)
Requires considerable expertise in design
Record keeping and confidentiality required - Especially problematic when sharing data across the internet - requires secure codes
Becoming increasingly international in scope
Requires knowledge of regulations in other countries
Funding For Clinical Trials and Marketing
Requires enormous sums
Biotech and other start-up companies or academia do not have resources
Drugs with presumed market of < 20,000
Summary of Drug Development
>$800 million required to develop one drug (drug companies spent more than 33 billion dollars, approximately 18% of their sales, for R & D in 2003).
Only one of 5000 to 10,000 conceptualized drugs are actually marketed
Only 30 % of marketed drugs recoup costs of R & D
Time from initial development to patent approval long (>14 years)
Competition with generic companies
Only 12 year between patent approval and generic approval; often not enough time to recoup development and marketing costs
75% of experimental drugs fail during clinical trials
Intellectual property not respected in many countries (e.g., China and Viagra)
Current Categories for Drug Use in Pregnancy
Category : Description
A: Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities.
B: Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate and well-controlled studies in pregnant women.
Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus.
C: Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in pregnant women.
No animal studies have been conducted and there are no adequate and well-controlled studies in pregnant women.
D: Studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk.
X: Studies, adequate well-controlled or observational, in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. The use of the product is contraindicated in women who are or may become pregnant.
Controlled Drug Schedules
A controlled (scheduled) drug is one whose use and distribution is tightly controlled because of its abuse potential or risk. Controlled drugs are rated in the order of their abuse risk and placed in Schedules by the Federal Drug Enforcement Administration (DEA). The drugs with the highest abuse potential are placed in Schedule I, and those with the lowest abuse potential are in Schedule V. These schedules are commonly shown as C-I, C-II, C-III, C-IV, and C-V. Some examples of drugs in these Schedules are as follows:
Schedule I — drugs with a high abuse risk. These drugs have NO safe, accepted medical use in the United States. Some examples are heroin, marijuana, LSD, PCP, and crack cocaine.
Schedule II — drugs with a high abuse risk, but also have safe and accepted medical uses in the United States. These drugs can cause severe psychological or physical dependence. Schedule II drugs include certain narcotic, stimulant, and depressant drugs. Some examples are morphine, cocaine, oxycodone (Percodan®).
Schedule III, IV, or V — drugs with an abuse risk less than Schedule II. These drugs also have safe and accepted medical uses in the United States. Schedule III, IV, or V drugs include those containing smaller amounts of certain narcotic and non-narcotic drugs, anti-anxiety drugs, tranquilizers, sedatives, stimulants, and non-narcotic analgesics.
Some examples are acetaminophen with codeine (Tylenol® No.3), paregoric, hydrocodone with acetaminophen (Vicodin®), diazepam (Valium®), alprazolam (Xanax®), propoxyphene (Darvon®), and pentazocine (Talwin®), methylphenidate (Ritalin®), and dextroamphetamine (Dexedrine®).
(1) Schedule I.
(A) The drug or other substance has a high potential for abuse.
(B) The drug or other substance has no currently accepted medical use in treatment in the United States.
(C) There is a lack of accepted safety for use of the drug or other substance under medical supervision.
(2) Schedule II.
(A) The drug or other substance has a high potential for abuse.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.
(C) Abuse of the drug or other substances may lead to severe psychological or physical dependence.
(3) Schedule III.
(A) The drug or other substance has a potential for abuse less than the drugs or other substances in schedules I and II.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States.
(C) Abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence.
(4) Schedule IV.
(A) The drug or other substance has a low potential for abuse relative to the drugs or other substances in schedule III.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States.
(C) Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in schedule III.
(5) Schedule V. -
(A) The drug or other substance has a low potential for abuse relative to the drugs or other substances in schedule IV.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States.
(C) Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in schedule IV.