2.4 psychotic disorders

antipsychotic

• also called as neuroleptics or major tranquilizers

psychosis

• Mental disorder which involves breakdown of personality

• the presence of delusions

• various types of hallucinations

• usually auditory or visual but sometimes tactile (touch) or olfactory (smell)

schizophrenia

• Is a psychotic disorder characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour

• positive symptoms: mesolimbic system

  • delusions

  • hallucinations

  • thought disorder

• negative: mesocortical

  • withdrawal from social contacts

  • flattening of emotional responses EMOTIONLESS

mesoCORTIcal

• konting dopamine = negative symtoms

mesoliMbic

maraming dopamine= positive symptoms

neuroleptics

• antischizophrenic drugs, antipsychotic drugs, or major tranquilizers.

• Most antipsychotics are nonselective in action, meaning, they block other receptors such as alpha adrenergic, histamine, and serotonin receptors in addition to dopamine receptor.

typical antipsychotics

• MOA: Block D2 receptors

• Additional effects: antiHAM

• Histamine blockade: sedation

• Alpha 1 blockade: Failure to ejaculate, orthostatic hypotension (leading to syncope)

• Muscarinic blockade: Urinary retention, constipation, blurred vision, xerostomia

• Use: Major use for positive symptoms only

typical antipsychotics (traditional) - chlorpromazine

fluphenazine

typical antipsychotics (traditional) - chlorpromazine

trifluoperazine

typical antipsychotics (traditional) - chlorpromazine

thioridazine

typical antipsychotics (traditional) - chlorpromazine

perphenazine

typical antipsychotics (traditional) - butyrophenones

haloperidol

typical antipsychotics (traditional) - butyrophenones

droperidol

typical antipsychotics (traditional) - thiothixenes

Thiothixene

typical antipsychotics (traditional) - thiothixenes

Chlorprothixene

typical antipsychotics (traditional) - Diphenylbutyrylpiperidine

Pimozide

typical antipsychotics (traditional) - Dibenzoxazepines

Loxapine

typical antipsychotics (traditional) - Dihydroindolone

Molindone

Phenothiazine - azine (typical antipsychotics)

• Alipathic - “-promazine ”, Chlorpromazine

• Piperazine - “-phenazine”, Fluphenazine

• Piperidine - “-ridazine”, Thioridazine

butyrophenones - peridol (typical antipsychotics)

• Haloperidol, Droperidol

• For manic phase

• Haloperidol is the DOC for phencyclidine overdose and is clinically used also in Huntington’s disease and Tourette’s syndrome.

thioxanthenes - thixene (typical antipsychotics)

thiothixene

potency (typical antipsychotics)

• Butyrophenones = Piperazines > Piperidine > Thioxanthenes > Alipathic

• Increasing potency = Increasing D2 affinity, decrease HAM affinity

Atypical Antipsychotics

MOA: Block 5HT receptor, partial blockade of D2 receptor

• Use: For negative symptoms

• Advantage: Less binding to DA = less EPS

• Clozapine - the only atypical antipsychotic without EPS effect

• Efficacy:

• Positive symptoms: 1st gen = 2nd gen

• Negative symptoms: 2nd gen > 1st gen

• Examples: Clozapine, Onlanzapine, Loxapine, Risperidone, Paliperidone, Ziprasidone, Quetiapine, Amivulpride, Molindone, Aripiprazole

atypical antipsychotics 2nd gen

Dibenzodiazepine

• Clozapine (prototype atypical antipsychotic)

Atypical Antipsychotics (2nd Generation)

Olanzapine

Atypical Antipsychotics (2nd Generation)

Risperidone – benzisoxazole

Atypical Antipsychotics (2nd Generation)

Quetiapine – dibenzothiazepine

Atypical Antipsychotics (2nd Generation)

Sertindole – phenylindole

Atypical Antipsychotics (2nd Generation)

Sulpiride – Benzamide

Atypical Antipsychotics (2nd Generation)

Asenapine

Atypical Antipsychotics (2nd Generation)

Paliperidone

Atypical Antipsychotics (2nd Generation)

Ziprasidone

Atypical Antipsychotics (2nd Generation)

Zotepine

Atypical Antipsychotics (2nd Generation)

Aripiprazole

Atypical Antipsychotics (2nd Generation)

Cariprazine