Professional Documents
Culture Documents
- older antipsychotics
- Typicals divided into basis of
POTENCY
High Potency - 10mg or less
Low Potency - 100mg more sedating
and more anticholinergic side effects than
High Potency
Biological - Antipsychotics
- High Potency cause Acute Movement
Abnormalities : Dystonia,
Akathisia,
Parkinson’s disease like Sx
-3, Olanzapine :
its side effect profile is same as clozapine but
w/ higher incidence of EPS at doses above
20mg/d. Has higher affinity to D2 and 5HT2A
receptors than clozapine and lower affinity to
D1.
Antipsychotics
Olanzapine - effective for positive and
secondary negative sx. It is also effective
maintenance tx for schizophrenia;
4. Quetiapine – effective in acute phase
studies; less EPS, cause more dizziness, dry
mouth and sleepiness than risperidone
5. Amisulpride – the only one w/ effects on D2
and D3 receptors; has a projected optimum
dose in the group of between 400 and 800mg/d ;
Antipsychotics
-6. Ziprasidone :
high 5HT2A and D2 receptor blockade and
high affinity for 5HT2A; also a partial agonist at
5HT1A receptor and potent affinity to D3,
moderate affinity to D4 and exhibit weak
serotonin and noradrenergic reuptake inhibition.
.. Associated w/ greater than 30% decrease in
depressive symptoms.
Linked to QT prolongation
Antipsychotics
-7. Aripiprazole :
partial D2 agonist released in 2002 in USA,
has high affinity for D2 receptors, and moderate
affinity for the 5HT2A.
A partial agonist for 5HT1A
Produce a stabilizing effect on both the
dopaminergic and serotonergic system .
- Has favorable safety and tolerability profile
includes low potential for EPS, weight gain,
prolactin elevation, QT prolongation and
somnolence.
Antipsychotics
Rapid Neuroleptization : administering of
hourly IM doses of dopamine receptor
antagonist medication (e.g. haloperidol) till
marked sedation is achieved.
Maintenance : 1st episode 1-2yrs tx
2nd episode 5 years tx
3rd episode lifetime
Biological - Antidepressants
1. Tricyclic Antidepressants - older group,
used less often than the newer drugs, .
significant unpleasant side effects : sedation,
anticholinergic effects ( dry mouth, constipation,
urinary hesitancy, blurred vision) and orthostatic
hypotension.
The most serious effect is their cardiotoxicity
with a quinidine-like effect of slowing cardiac
conduction as an overdose. TCAs can be fatal.
Biological - Antidepressants
2. Monoamine Oxidase Inhibitors (MAOI) :used
less often than the newer drugs
also cause unpleasant side effects like weight
gain and anorgasmia
Absolute necessity for pxs on MAOI to
maintain a tyramine-free diet to avoid a
hypertensive crisis.
Foods contain tyramine like beer, wine,
cheese , sausages – diet restriction is difficult.
Antidepressants
3. Selective Serotonin Reuptake
Inhibitor (SSRI) : first agents used to tx
depression; Specifically inhibit serotonin
reuptake by presynaptic neurons
Due to safety/ low risk overdose and
well tolerated side effects ;
Antidepressants - SSRI
Indicated : Depression,
Obsessive-Compulsive D/O (OCD),
Panic D/O , Eating D/O
Premenstrual Dysphoric D/O , Chronic
Pain D/O, Paraphilias, and ADD / ADHD
sexual side effects : decreased libido,
delayed ejaculation and trouble reaching
orgasm are common.
It is not toxic; easy to use once a day
dosing.
Antidepressants
depression begins to lift for most people
after 2-4 weeks, longer at continual
medication at therapeutic doses.
Vegetative symptoms improve before
mood symptoms do.
Mirtazapine -(remeron) potent
antagonist of H1 receptors and
moderately potent antagonist of central
presynaptic a1 adrenergic receptors.
Half life 20 to 40 hrs
Antidepressants :
> Px with depression w/ psychotic
symptoms ::: start w/ combination of an
antipsychotic drug and an
antidepressant.
When psychotic symptoms have
resolved the antipsychotic agent can be
stopped and antidepressant can be
continued for several more months…
Biological : Mood Stabilizers
In Bipolar disorder, the mainstay of
pharmacotherapy : Lithium, valproate or
carbamazepine, others (gabapentin,
lamotrigine and topiramate).
Antipsychotic agent is added when there
are psychotic symptoms
Mood Stabilizers (Antimanic)
1. Lithium – 1st line treatment of bipolar I
narrow therapeutic index; requires
medical screening – check BUN and
creatinine Lithium is excreted in kidneys;
serum monitoring needed
Therapeutic index 0.6-1.2mEq/L
Initial side effects: nausea, vomiting, ,
polyuria and diarrhea
Mood Stabilizers
Valproic Acid : used for treatment of acute
manic episode, 1st line tx of bipolar I ;
Dose 20-30mg/kg BW
Therapeutic Level 50-150ug/L
Initial dose 250mg BID
Side effect: alopecia, GI upset, sedation,
weight gain
Monitor liver function, CBC w/ platelets
and serum amylase every 6 months
Mood Stabilizers
3. Carbamazepine :
Approved for acute manic and mixed
episodes of bipolar;
Side effect: sedation, fatigue, dizziness,
blurred vision, nausea
Most common adverse event: nausea,
vomiting, dizziness, sedation, benign rash
Needs baseline assessment CBC w/
platelet
Mood Stabilizers
Drug-Drug: Carbamazepine and
Lamotrigine use concomitantly requires
double dose of lamotrigine to achieve
normal level; sudden stoppage of carba
leads to increase level of lamotrig ->
adverse event
Mood Stabilizers
Other Techniques :
1. systematic desensitization
2. therapeutic graded exposure
3. flooding
4. participant modeling
5. exposure to stimuli in virtual reality
6. assertiveness training
7. aversive training
Behavior Therapy
1. Systematic Desensitization based on
principle of counterconditioning ;
A person overcomes anxiety elicited by a
situation or an obj by approaching feared
situation gradually in psychophysiological
state that inhibits anxiety.
> Steps used: relaxation, hierarchy
construction and desensitization of
stimulus
Behavior Therapy