CPPS 306 Drug Therapy For PSychosis

What is neurosis

A class of funtional mental disorders inovlving distress with niehter delusions nor hallucinations, whereby behaviour is not outside socially accepted norms

• Maladaptive learned behaviour

What is psychosis

Severe froms of psychiatric disorders, during ehich hallucinations, delusions and impaired insight may occur

• Loss of contact with reality (lack of realit testing

• Disruption of the brain funciton

• Neurochemical imbalance induced by:

  • Drugs/chemicals

  • Neurodegeneration

  • Genetic and environmental factors

What are neuroleptics? Name and compare the two types

Neuroleptics = antipsychotic drugs

Typical antipsychotics (relative potency in mg):

Atypical antipsychotics (relative potency high-low)

Name the typical antipsychotics

Name the atypical antipsychotics

Which type of antipsychotic drugs have lower rsik of extrapyramidal side effects

Atypical

In describing mental disorders, especially schizophernia, symptoms can be divided ____ + ____ + ____

Cognitive control

Positive Symptoms

Negative Symptoms

What is the key difference between positive and negative symptoms in schizophrenia?

Positive symptoms = are experiences or behaviours that are added to normal functioning (excess or distortion)

Negative symptoms = normal thoughts, emotions, or behaviours that are reduced or absent (loss of functions)

What are positive symptoms of schizophrenia, and give one example

Positive symptoms are symptoms that most individual do not normally experience and reflect an excess or distortion ofnormal brain function

• Hallucinations - an experience that is ADDED to normal functioning

What are negative symptoms of schizophrenia, and give one example

Negative symptoms are symptoms that are not present or are diminished compared to healthy individuals and reflect a loss of normal brain function

• Affective flattening, reduction in normal emotional expression

True or false:Anti-schizophernia drugs are dopamine D2 antagonists

True

What do DA receptor over stimulation mimic?

Szhiophernia

• Amphetamine psychosis

• Psychosis as an adverse effect of therapy in Parkinson’s Disease

Compare and contrast how DA antagnoiist affects positive vs negative symptoms

DA antagnoist reduce positive but NOT negative, symptoms of schizophernia

What are they key principles for the rational use of antipsychotics?

• DONT combine antipsychotics

• All antipsychotics are equally effective

• Atypical = same efficacy, better side-effect profile

• Choose a drug the patient or family has responded to before

• Duration: minimum 6 months, often lifelong

What are long acting antipsychotic preparations and when are they used?

• Long-Acting antipsychotics are deep IM injections give on an outpatient basis (in and out the same day) for patients with schizophrenia who relapse because they do not consistently take oral antipsychotics

What is haloperidol?

Typical Antipsychotics (high potency)

• Blocks D1 and D2 dopamine receptors

• Has only dopamine related side effects:

  • Extrapryamidal symptoms, hyperprolacinemia, anti-emetic, tardive dyskinesia

Chlorpromazine, what is it

Typical antipsychotic (low potency)

• DA antagonist: affect extrapyramidal system (most important), pituitary, chemoreceptor drugs and can elicit tardive dyskinisia (TD)

• Weak a-adregernic antagonist (postural hypotension)

• Muscarinic + histamine antagonist

What is Clozapine

Atypical antipsychotics

• D1, D2, 5HT antagonist

• Effective onboth positive and negative symptoms

• Little to no extrapyramidal symptoms but weight gain

• Causes BONE MARROW suppression produces granulocytosis and death

Which atypical antipsychotic drugs requires mandatory weekly blood testing

Clozapine

What is risperidone

Atypical Antipsychotics

• D2 and 5-HT2 antagonist

• at optimal doses, reduces positive and negative symptoms with little or no EPS or other

  side effects

What is olanzapine

What is Quetiapine

What is aripiprazole

What is Pimavanserin

Which atypical antipsychosis is the most common and why

Quetiapine because its cheaper!!

What are the use of atypical antipsychotics been linked to?

• Weight gain

• Hyperglycemia

• Lipid abnormalities

  • Increased risk of metabolic syndrome

What are extrapyramidal motor symptoms (EPS)

• Acute dystonia

• Akathisia

• Pseydoparkinsonism

• Peroral tremor

• Neuroleptic malignant syndrome

• Tardive Dyskinesia

What is acute distonia

A extrapyramidal motor symptoms (EPS)

• Spasms of tongue, face, neck and back muscles (torticollis)

What is akathisia

extrapyramidal motor symptoms (EPS)

• Inability to remain motionless (very distressing)

change drug or dose - lower potency

What is pseudoparkinsonism?

extrapyramidal motor symptoms (EPS)

• Bradykinesia, rigidity, variable tremor, shuffling gait

What is perioral tremor

extrapyramidal motor symptoms (EPS)

Rabbit-like movements of mouth and face

What is neuroleptic malignant syndrome

extrapyramidal motor symptoms (EPS)

• Due to massive DA block; increased incidence with high potency and depot neuroeptics

• Fever, muscle rigidity, unstable blood pressure, lactic acidosis,shock and dehydration

What are treatments for Neuroleptic malignant syndrome

Stop the drug, hydrate, cool, dantrolene, bromociptine

What is Tardive Dyskinesia

extrapyramidal motor symptoms (EPS)

• Repetitive, painless, involuntary, tic-like movements of face, eyelids, motuh, tongue, extremities or trunk

• Frequent appears after long term or high dose use of antipsychotic drugs