Adventist Medical Center College – School of Nursing

PSYCHIATRIC-MENTAL HEALTH NURSING

NEUROBIOLOGICAL THEORIES

BRAIN
Central Nervous System

I. Forebrain

1. Cerebrum – is divided into cerebral two hemispheres which makes the most of the
nervous system. The hemispheres are further divided different nervous system
pathways.

A. Cerebral hemispheres – is one of the cerebrum, the part of the brain that controls
muscle functions and also control speech, thought, emotion, reading, writing and
learning.

RIGHT HEMISPHERE LEFT HEMISPHERE

Controls the left side of the body and non- Controls the right side of the body and
dominant in most people. Also called as dominant in most people.
the “creative brain.”
Major Functions: Major Functions:
 Creative thinking  Logical reasoning
 Intuition  Analytical functioning (Reading,
 Artistic ability Writing and Mathematical
 Affect and behavior functions)
 Spatial-perceptual  Comprehension

Lobes of the BRAIN

1. FRONTAL Lobes - controls the organization of thoughts, body movement, memories,
emotional experiences and moral behavior.
Functions: Regulates arousal, focuses attention, enables problem solving and
decision making, speaking, thinking, emotions, judgment, movement
- Also contains Broca’s area – controls the motor function of speech
(Damage - expressive aphasia)
- Insight, judgment, reasoning, concept formation, problem-solving skills,
abstraction, and self-evaluation modulated and affected by the action of
this lobe.
- Often referred to as executive functioning
Alterations: changes in mood and personality, fear and aggressiveness, euphoria
or depression, irritability and apathy

PMHN EVALYN M. LECCIONES,RN,MN,PhD

 Psychiatric disorders related to frontal lobe abnormalities:
 Schizophrenia, Attention Deficit Hyperactivity Disorder (ADHD), Dementia
2. PARIETAL Lobes – control perceptions and interpretations of sensory
information
FUNCTIONS: Touch, Taste, and spatial orientation; calculate, write, recognize
fingers of the opposite hands
Alterations: produces complex sensory deficits including neglect of contralateral
sensory stimuli and spatial relationship.

3. TEMPORAL Lobes - controls sensations .

FUNCTIONS: Smelling, hearing (upper anterior of the lobe), emotional
expression, short term memory (lower part), modulates of mood and
emotion ; (Left temporal lobe) Wernicke’s area – responsible for
receptive speech
ALTERATIONS: Visual aphasia – cannot recognize words in print.
Auditory aphasia – hears word sound but cannot associate
sounds with meaning.
Hippocampus – contributes to memory

4. OCCIPITAL Lobe – controls or coordinated language generation related to functions and

visual interpretation.
FUNCTIONS: Visual reception and interpretation, Language interpretation and
generation
ALTERATIONS: Loss of vision (cortical blindness), visual hallucinations

B. Cerebral Cortex
The outermost part of the brain and is composed of gray matter. If examined visually
it has raised areas called convolutions and grooves between the area. It is further
divided into four major lobes.
a. Gyrus ( gyri-plural) – the convoluted gray matter
b. Sulcus (sulci-plural) – the groove between the gyri
c. Fissure – a deep sulcus

C. CEREBELLUM – center of coordination of movements and postural adjustment.

- Also known as the “little brain”
- It receives and integrates information from all areas of the body such as
muscle, joints, organs and other component of CNS.
- Concerned with the involuntary movement, coordination of movement,
posture and equilibrium.
Alteration: - Malnutrition secondary to alcoholism can lead to degeneration of
cerebellar cortex leading to broad-based, staggering gait, and ataxia
known as anterior lobe syndrome.

PMHN EVALYN M. LECCIONES,RN,MN,PhD

 D. BRAIN STEM – includes the midbrain, pons and medulla oblongata

II. MIDBRAIN
A. Mesencephalon
- Composed of nuclei (red nuclei and substantia nigra) and fiber tracts that
is responsible for reflexes.
Midbrain reflexes :
1. Visual reflex – automatically turning away from a dangerous object when it
comes to a view.
2. Auditory reflex – automatic turning to a sound that is heard
3. Righting reflex – automatic keeping the head upright and maintaining balance.

III. Hindbrain
A. PONS - bridges the gap both structurally and functionally, serving as a primary
motor pathway.
- Forms a link between midbrain and medulla oblongata
- Contains the connections of CN V through VIII
- Center for respiration, skeletal muscle tone
B. Medulla Oblongata – located at the top of the spinal cord, contains vital centers for
respiration and cardiovascular functions.
- Contain nuclei CN IX through XII
- Center for heart rate regulation, BP, respiration
- Reflexes: swallowing, sneezing, coughing, and vomiting
C. Reticular Formation – influences motor activity, sleep consciousness, and
awareness.
- Control cyclic activities such as the sleep – wake cycle also known as
reticular activating system or RAS.
- RAS –serves as screening device that allows individuals to tune out some
stimuli to attend other stimuli
-activated by pain, movement, feedback from the cortex, muscle tone
and stimulant drugs.
- Alteration: - when disruption occurs, person cannot sleep leading to psychosis.
- When RAS is turned off a person is in coma.
D. Basal Ganglia – relays information about movement and coordination from the brain
to the spinal nerves, also known as Extrapyramidal system.
- balances excitatory and inhibitory neurotransmitters
- made up of 3 major nuclei (caudate nucleus,putamen,globus pallidus)

LIMBIC SYSTEM
- is an area of the brain located above the brain system that includes the thalamus,
hypothalamus, hippocampus, and amygdala.
- refers to the structures that functions with it. Center of emotions and motivations.
- This lobe controls the four “F”s and other functions.
The four “F” of the limbic lobe and other major function

PMHN EVALYN M. LECCIONES,RN,MN,PhD

 1. Feeding – the septal area which connects with the hypothalamus.
2. Fight or Flight – compose of amygdala, hypothalamus and midbrain.
3. Fornication or Pleasure – ventral tegmental area (VTA) or also known as the
pleasure center of the brain.
4. Memory functions – Amygdala and hippocampus are key structures for the
transfer of short term memory to long term memory.
5. Emotion and motivations – feeling bout people, institutions and life that affect
behavior.

Structures:
1. Thalamus – regulates sensation, emotion and activity (SEA)
- involves strong emotions (fear or rage), mood and integration of all sensory
inputs except smelling. Considered as the major sensory relay center of the
brain.
2. Hypothalamus – involved in temperature regulation, appetite control, endocrine
function, sexual drive, and impulsive behavior associated with feelings of anger, rage, or
excitement.
- Modulates visceral functions such as:
a. Body temperature regulation
b. Gastrointestinal activity
c. Cardiovascular functions
d. Feeding (food and water intake)
e. Sexual activity
f. Endocrine secretion also known as the Pituitary Portal System.
3. Hippocampus – emotional arousal and memory
- Consolidates recently acquired information about facts and events and eventually
convert it into long term memory.
- Contains large amounts of neurotransmitters
Alteration:
- Surgical removal of hippocampus can lead to inability to form new memories.
- Korsakoff’s syndrome, in which have intact intelligence but cannot form new memory
leading to confabulation.
4. Amygdala – generates emotions from perceptions and thoughts
- Contains many opiate receptors
Alteration:
- Too much stimulation can lead to fear and autonomic responses such as increased heart
rate and release of adrenaline.
- Destruction of amygdala can lead to decrease aggression, tameness, and placidity.

Alteration in Limbic System

- Memory loss that accompanies dementia and poorly controlled emotions and impulses
seen with psychotic or manic behavior.

PMHN EVALYN M. LECCIONES,RN,MN,PhD

NEUROTRANSMITTERS
 are the chemical substances manufactured in the neuron that aid in the transmission of
information from one neuron to another at the synapse.
 these substances either excite or stimulate an action in the cells (excitatory) or inhibit or
stop an action (inhibitory). Videbeck, 2014
 are types of hormones in the brain that that transmit information from neuron to
another neuron. They are made by amino acids.
 control major body functions including movement, emotional response and the physical
ability to experience pleasure and pain.

NEUROTRANSMITTERS:

DOPAMINE
- Control of complex movements, motivation, cognition, and regulation of emotional
responses.
- Excitatory
- Derived from amino acid tyrosine and play role in physical activation.
Functions: Alteration:
- Movement and coordination - Increased : Mania, Schizophrenia
- Emotions
- Decision making ability - Decreased: Depression, Parkinson’s Disease
- Inhibits release of prolactin

NOREPINEPHRINE (noradrenalin)
- Plays a role in changes in attention, learning and memory, sleep and wakefulness, and
mood regulation.
- Excitatory
- Associated with the “fight and flight”
Functions: Alterations:
- Sleep and wake - Increased: Mania, Anxiety states, Schizophrenia
- Mood - Decreased: Depression, memory loss, social withdrawal
- Attention and learning
- Cognition and perception

EPINEPHRINE – known as adrenaline and noradrenaline

- Controls fight or flight
- Excitatory in nature

SEROTONIN (5hT)
- Derived from amino acid tryptophan
- Inhibitory
- Control of food intake or appetite, sleep and wakefulness, temperature regulation, pain
control, sexual behavior(libido) and regulation of emotions (mood).
- Alterations:
PMHN EVALYN M. LECCIONES,RN,MN,PhD
 Increased: contribute to hallucinations, delusions and withdrawn behavior in
Schizophrenia, anxiety states
Decreased: Depression

HISTAMINE
- Mediates in inflammatory and allergic reactions
- Control of gastric secretions, cardiac stimulation, allergic reactions and alertness
- May play role in depression
- Psychotic drugs block histamine, resulting in weight gain, sedation and hypotension.

ACETYLCHOLINE
- Found in the brain, spinal cord and peripheral nervous system, particularly at the
neuromuscular junction of skeletal muscle.
- Both excitatory and inhibitory
- Functions: sleep and arousal, pain perception, coordination and modulation of
movement, memory acquisition and retention.
- Alteration:
Increased: Association with depression
Decreased : Alzheimer’s disease, Huntington’s chorea, Parkinson’s disease, and
Myasthenia Gravis

GLUTAMATE
- Excitatory in nature
- Function: Relay of sensory information
- Alterations: implicated in the brain damage caused by stroke, hypoglycemia, sustained
hypoxia or ischemia and some degenerative diseases (Huntington’s or Alzheimer’s)

GAMMA-AMINOBUTYRIC ACID (GABA)

- Inhibitory
- Major “break system” in the CNS
- A glutamate derivative
- Functions: Interrupts the progression of electrical impulse
- Alterations: Decreased: Anxiety disorder, Huntington’s disorder, epilepsy

CIRCADIAN RHYTHM
 A network of internal clocks that coordinate events in the body
according to a 24-hour cycle. (Stuart)
 the suprachiasmatic nuclei(SCN) considered as the pacemaker of the
circadian rhythm. This nuclei sends message to other parts of the brain
such as hypothalamus thus controlling organ functions leading to
modulation of mood, bod functions and activities.

PMHN EVALYN M. LECCIONES,RN,MN,PhD

BODY DAILY RHYTHMs

TIME (Morning) Body Function Time Body Function

Body temperature (Afternoon)
1:00 AM lowest Increased body
Melatonin and 1:00 PM temperature
growth hormone
the highest
2:00 AM Cortisol begins to 2:00 PM Blood pressure
rise peaks
3:00 AM – 5:00AM Heart and BP begin 3:00 PM – 5:00 Body temperature
to rise, prolactin PM begins to fall,
falls melatonin begins
to rise
6:00 AM Cortisol peaks; 6:00 PM Urinary flow is
insulin is lowest highest
7:00 AM Heart rate 7:00 PM Heart rate falls
continues to rise
8:00 AM Body temperature 8:00 PM Blood pressure
rises falls
9:00 AM Melatonin falls 9:00 PM Pain threshold is
lowest
10:00 AM Norepinephrine 10:00 PM Prolactin rises
rises
11:00 AM – 12:00 Sympathetic 11:00 PM – Growth hormone
Noon nervous increases 12:00 AM rises and immune
until noon cells are at their
peak.
Stuart and Laraia 2005

BRAIN IMAGING TECHNIQUES

Computerized tomography (CT) or Computed axial tomography (CAT)

 Technique:
o X-rays takes cross-sectional images (slices) layer by layer and computer analysis
reconstructs images on a monitor and stores the images in magnetic tape or film.
 Purpose:

PMHN EVALYN M. LECCIONES,RN,MN,PhD

 o Visualize the brain’s soft tissue – to diagnose primary tumors, metastases and
effusions
o Measures accuracy of brain structure (ex. The size of ventricles of the brain)
 Findings:
o Identify various anatomical differences in clients with schizophrenia, organic
mental disorders and bipolar.
o Detect possible lesions, abscesses, areas of infarction or aneurysm.

Magnetic Resonance Imaging (MRI)

 Technique:
o Strong magnetic field, an energy is released and converted to a visual image or
scan.
 Purpose:
o Measures anatomical and biochemical status of various segments of the brain.
 Findings:
o Detects tissue detail and blood flow patterns and tissue changes such as edema,
ischemia, infections, neoplasm, trauma, and other changes such as
demyelination.
o Morphological differences between the brains of clients with schizophrenia and
those of subjects have been noted.

POSITRON EMISSION TOMOGRAPHY (PET)

 Technique:
o Radioactive substance is injected. Detectors relay data to a computer interprets
the signals and produces the image.
o Different colors indicate level of brain activity
o Uses two photons
 Purpose:
o Measure specific brain activity and functioning
 Findings:
o PET measures specific brain functioning such as glucose metabolism, oxygen
utilization, blood flow and particular interest in psychiatry,
neurotransmitter/receptor interaction.

SINGLE PHOTON EMISSION COMPUTED TOMOGRPHY (SPECT)

 Technique:
o Similar to PET, but uses longer-acting radioactive substance and different
detectors.
 Purpose:
o Measure brain activity and functioning
 Findings:
o Measures various aspects of brain functioning
o Has been used to take images of activity or CSF circulation

PMHN EVALYN M. LECCIONES,RN,MN,PhD

ELECTROENCEPHALOGRAPHY (EEG)
 Technique:
o Electrode are placed on the scalp to measure amplitude and frequency of brain
waves.
 Purpose:
o Measures brain electrical activity
 Findings:
o Identifies dysrhythmias, asymmetries, or suppression of brain rhythms. It is used
of epilepsy, neoplasm, stroke, metabolic, or degenerative disease.

PMHN EVALYN M. LECCIONES,RN,MN,PhD