5,6,11

• Psychosis


  A mental disorder involving a loss of contact with reality, may be due to increased level of dopamine in the brain
• Two broad forms of psychosis

  • Hallucination - hearing, seeing and feeling things that are not existing
  • Delusion - holding unusual belief that are not shared by other people
• Psychotic Disorders


  • Schizophrenia
  • Manic Phase of Bipolar Illness
  • Acute Idiopathic Psychotic Illness
• Schizophrenia


  The most common psychotic disorder, perception, thinking, communication, social functioning, and attention are altered, characterized by a clear sensorium but a marked thinking disturbance
• Symptoms of Schizophrenia


  • Positive - delusion, hallucination, restlessness, and talking with own self
  • Negative - loss of motivation, cognitive impairment, akinesia, mental depression, social withdrawal, reduced sexual urge, flat affect & apathy, and monotonic speech
• Neurotransmitter Abnormalities in Schizophrenia

  • Dopamine
  • Serotonin
  • Glutamate
• Stages of Schizophrenia


  • Prodromal - unhygienic, loss interest in work, gradual
  • Acute - full blown of psychotic behavior, with + or - symptoms
  • Stabilization - symptoms gradually lessen
  • Stable - disappearance of symptoms
• Psychosis


  A mental disorder involving a loss of contact with reality
• Psychosis


  • May be due to the increased level of dopamine in the brain
• Two broad forms of psychosis

  • Hallucination
  • Delusion
• Hallucination


  Hearing, seeing and feeling things that are not existing
• Delusion


  Holding unusual belief that are not shared by other people
• Psychotic disorders


  • Schizophrenia
  • Manic Phase of Bipolar Illness
  • Acute Idiopathic Psychotic Illness
• Schizophrenia


  • The most common psychotic disorder
  • Perception, thinking, communication, social functioning, and attention are altered
  • Characterized by a clear sensorium but a marked thinking disturbance
• Symptoms of schizophrenia


  • Positive symptoms: delusion, hallucination, restlessness, and talking with own self
  • Negative symptoms: loss of motivation, cognitive impairment, akinesia, mental depression, social withdrawal, reduced sexual urge, flat affect & apathy, and monotonic speech
• Neurotransmitter abnormalities in schizophrenia

  • Dopamine
  • Serotonin
  • Glutamate
• Stages of schizophrenia


  • Prodromal: unhygienic, loss interest in work, gradual
  • Acute: full blown of psychotic behavior, with + or - symptoms
  • Stabilization: symptoms gradually lessen
  • Stable: disappearance of symptoms
• Risk factors for schizophrenia

  • Environmental factors
  • Genetics
  • Poverty
  • At birth
  • Stress
  • Birth on winter
  • Drug abuse
• Two major types of antipsychotic drugs

  • Typical
  • Atypical
• Typical antipsychotics


  • Treat positive symptoms
  • Block Dopamine receptors only
  • Increased Extrapyramidal Symptoms (EPS)
  • Cheaper
  • Conventional/first-generation agents
• Examples of typical antipsychotics

  • Phenothiazines
  • Butyrophenones
  • Thioxanthene
• Extrapyramidal symptoms


  • Dystonia: sustained contraction of muscles leading to twisting, distorted postures (occurs after few hours or days of tx)
  • Akathisia: motor restlessness (days to weeks of tx)
  • Pseudoparkinsonism: weeks to months of initial tx
  • Tardive dyskinesia: may be irreversible, months or years of tx; involuntary movements, usually of the tongue, lips, neck, trunk and limbs

  
• Atypical antipsychotics


  • Treat both positive & negative symptoms
  • Decreased EPS
  • Block dopamine & serotonin receptors (5-HT2A)
  • More expensive
  • Second generation agents
  • First line antipsychotics
• Examples of atypical antipsychotics

  • Loxapine
  • Clozapine
  • Risperidone
  • Sertindole
  • Olanzapine
  • Quetiapine
  • Aripiprazole
• Complications of atypical antipsychotics

  • Abdominal fat
  • Hypertension
  • Hyperlipidemia
  • Diabetes
  • Insulin Resistance
• Actions of antipsychotics


  • Antipsychotic effects
  • Extrapyramidal effects
  • Antiemetic (except Aripiprazole)
  • Anticholinergic
• Phenothiazines


  Have a tricyclic structure in which two benzene rings are linked by a sulfur and a nitrogen atom
• Types of phenothiazines


  • Aliphatic - Chlorpromazine
  • Piperazine - Fluphenazine, Prochlorperazine
  • Piperidine - Thioridazine
• Chlorpromazine


  First phenothiazine compound introduced in therapy, used to treat intractable hiccups

  
• Phenothiazine drugs


  • Promazine
  • Triflupromazine
  • Thioridazine
  • Prochlorperazine
  • Mesoridazine
  • Perphenazine
  • Fluphenazine
• Thiothixene


  Differs from the phenothiazine system by replacement of the N-H moiety with a carbon atom doubly bonded to the propylidine side chain
• Butyrophenone drugs


  • Haloperidol
  • Droperidol
• Haloperidol


  A potent antipsychotic useful in schizophrenia and in psychoses associated with brain damage, frequently chosen to terminate mania and often used in therapy for Gilles de la Tourette
• Atypical antipsychotic drugs


  • Loxapine
  • Clozapine
  • Olanzapine
  • Quetiapine
• Clozapine


  Has proved effective even in chronically ill patients who respond poorly to standard neuroleptics, but has severe side effects of agranulocytosis and agranulocytosis

  
• Olanzapine


  A more potent antagonist at D2 and 5-HT2A receptors, can induce weight gain, type 2 diabetes & hyperlipidemia
• Other atypical antipsychotic drugs

  • Risperidone
  • Ziprasidone
  • Aripiprazole
• Aripiprazole


  Newest antipsychotic agent, dopamine agonist-antagonist with lesser weight gain
• Cholinergic antagonists


  Agents that bind to cholinoceptors (muscarinic or nicotinic) and prevent the effects of acetylcholine (ACh) and other cholinergic agonists
• Anticholinergic agents


  Also known as antimuscarinic agents or parasympatholytics, selective blockers of muscarinic receptors