Building a Strong Foundation Through Neurobiology

In this interview from the NP Institute annual meeting in Orlando, Florida, Co-Chair Andrew Penn, MS PMHNP, discusses the importance of neurobiological foundations in everyday prescribing. He explains how a deeper understanding of mechanisms of action can help clinicians make smarter treatment decisions, even with new or off-label medications. Watch now to gain practical insights that will strengthen your clinical reasoning and improve patient communication.

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Andrew Penn, MS, PMHNP: I am Andrew Penn. I'm a psychiatric nurse practitioner and a clinical professor at the University of California San Francisco School of Nursing. I'm also a member of the Psych Congress Steering Committee.

Psych Congress Network: Could you explain why the first session at NP Institute 2025 focused on neurobiology and how that information lays the foundation for further learning?

My first session at NP Institute this year was about the foundational knowledge that we need as nurse practitioners in neurobiology. This is understanding things like neurotransmitters and receptors, networks in the brain. For a lot of people, they got this [education] in school, of course, so for many people, this is a refresher. But, what I found throughout the 20 years of my career is that I'm always learning a new layer of this information. There will be moments where things just suddenly click for me. For [some of our attendees], I'm sure some of the information that I presented was familiar, but for many, maybe it wasn't. The value of learning this kind of information is that it helps you to understand how these medications and treatments that we use actually work.

One of the things that distinguishes an advanced practice nurse from a staff nurse is a staff nurse knows which medications are used to treat a condition and what side effects might be. An advanced practice provider (APP) should really understand why they work and why they cause side effects. In order to understand that, you need to understand the mechanism of action and also the other effects that happen that we often call side effects. But because receptors for many of these drugs and many of these neurotransmitters exist in other parts of the body, besides the central nervous system, they can occasion some of these side effects like gastrointestinal distress, et cetera. So, by understanding where these things work and how they work, you can then map that knowledge onto drugs that haven't even come out yet, the things that'll come out in the future. Once you have these foundations in place, then it's a lot easier to slot that new information into your existing knowledge.

Psych Congress Network: What are some common misconceptions about how psychiatric medications work that you want to see corrected among frontline prescribers?

Penn: One of the things I wanted to get across in my session was understanding how medications work allows us a better understanding of what we're actually treating. By that I mean we're not just matching a drug to a disease state. We need to understand what that drug does once it gets inside the body. That also helps to make more sense out of these drugs that often don't stay within their category.

A good example of that would be dopamine-blocking and serotonin 2A-blocking drugs, also commonly called atypical antipsychotics. Now, a good example of that is that we use these in the treatment of mood disorders, both bipolar and now increasingly as an adjunct for unipolar mood disorders. Now, if you just think of them as treatments for psychosis or treatments for schizophrenia, it's going to be harder for practitioners to explain, "why do we use this drug in this condition?" Because a patient might go home and Google one of these medications and say, do you think I have schizophrenia? And I say, "no, no. I know that you have depression. But the reason why we're using this medication is that it increases signaling on a dopamine receptor, that's going to help to alleviate your mood." It's important to understand how these medications work in order to not get trapped by these disease state categories, which they're sometimes organized into.

Andrew Penn, MS, PMHNP, is a clinical professor in the University of California, San Francisco, School of Nursing, where his teaching has received the UCSF Academic Senate Distinction in Teaching Award, among other recognitions. He works as a psychiatric/mental health nurse practitioner, treating veterans at the San Francisco Veterans Administration Hospital. As a researcher, he collaborates on psychedelics studies of psilocybin and MDMA in the Translational Psychedelics Research (TrPR) lab at UCSF. A leading voice in nursing, he is a cofounder of the Organization of Psychedelic and Entheogenic Nurses (OPENurses.org), advocating for the perspective of nurses in psychedelic therapy, he has published on psychedelics in the American Journal of Nursing, Frontiers in Psychiatry, The Journal of Humanistic Psychotherapy, and JAMA. An internationally invited speaker, he has lectured at SXSW, Aspen Health Ideas Festival, TEDx, the Singapore Ministry of Health, and Oxford University and can be found at Andrewpennnp.com.