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• Psychosis


  A mental disorder involving a loss of contact with reality, may be due to increased 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
• Positive symptoms of schizophrenia


  • Delusion
  • Hallucination
  • Restlessness
  • Talking with own self
• Negative symptoms of schizophrenia

  • Loss of motivation
  • Cognitive impairment
  • Akinesia
  • Mental Depression
  • Social withdrawal
  • Reduced sexual urge
  • Flat affect & Apathy
  • Monotonic Speech
• Neurotransmitter abnormalities in psychosis

  • Dopamine
  • Serotonin
  • Glutamate
• Stages of psychosis


  • 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 psychosis

  • 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
• Typical antipsychotics


  • Phenothiazines
  • Butyrophenones
  • Thioxanthene
• Extrapyramidal symptoms


  • Dystonia
  • Akathisia
  • Pseudoparkinsonism
  • Tardive Dyskinesia
• Tardive dyskinesia


  Complication of typical antipsychotics
• Atypical antipsychotics


  Treat both positive & negative symptoms, decreased EPS, block dopamine & serotonin receptors (5-HT2A), more expensive, second generation agents, first line antipsychotics
• 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
• Thioxanthenes


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


  A thioxanthene antipsychotic
• Butyrophenones


  A class of antipsychotic drugs
• 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
• Droperidol


  May be used alone as a preanesthetic neuroleptic or as antiemetic
• Atypical antipsychotics: ring analogs of phenothiazines

  • Loxapine
  • Clozapine
• Clozapine


  Has proved effective even in chronically ill patients who respond poorly to standard neuroleptics, side effects include severe agranulocytosis, used to reduce suicidal risk
• Olanzapine


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


  An atypical antipsychotic
• Risperidone


  An atypical antipsychotic
• Ziprasidone


  An atypical antipsychotic that can cause/promote arrhythmia
• Aripiprazole


  The newest antipsychotic agent, a dopamine agonist-antagonist with lesser weight gain