Antipsychotic Drugs-1
Antipsychotic Drugs-1
Antipsychotic Drugs-1
ANTIPSYCHOTIC DRUGS
Antipsychotic drugs are drugs used to control manifestations of Psychosis. Psychosis is a
mental illness in which the mind is separated from reality.
Manifestations of Psychosis:
I- Hallucinations: - Perception without an external stimulus. Patient sees or
hears things that don’t exist.
II- Delusions: - False beliefs. They may be paranoid (suspicion), persecutory
(Patient believes people are against him) or Grandiose (Patient believes he is a
genius or a messenger from God).
III- Incoherent (meaningless) speech.
IV- Abnormal behavior: - Aggression and Agitation.
Classification of Antipsychotics
I- Typical Antipsychotics: - They are Dopamine antagonists. They include:
1- Phenothiazines e.g. Chlorpromazine.
2- Butyrophenones e.g. Haloperidol.
II- Atypical Antipsychotics: - They are 5-HT and Dopamine antagonists:
1- Resperidone.
2- Clozapine.
3- Olanzepine.
2) Blockade of M-receptors.
Side effects: - Dry mouth, blurred vision, retention of urine, constipation.
3) Blockade of Alpha-receptors.
Side effects: - Postural hypotension and reflex tachycardia.
III- Miscellaneous effects:
- Cardiotoxicity, Leucopenia.
- Convulsions.
- Corneal and lens opacities.
- Cholestatic jaundice.
Atypical Antipsychotics
They have the following advantages:
I- Less central side effects (more selective on the Mesolimbic system), less
Parkinsonism, less Akathisia, less Dystonia, and less Tardive dyskinesia.
II- More efficacy (due to 5-HT antagonism):
- Effective in resistant cases of Schizophrenia.
- Effective against negative symptoms (typical Antipsychotics are only
effective against positive symptoms).
Atypical Antipsychotics include:
- Resperidone.
- Clozapine; reserved for refractory cases due to high incidence of fetal
agranulocytosis (requires weekly monitoring of white blood cells).
- Olanzepine; similar to Clozapine but no agranulocytosis.
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Lithium carbonate
- Lithium (Li) is a monovalent cation similar to Na+.
- It is mainly used as a prophylactic maintenance therapy for Manic-depressive
disorder.
Manic-Depressive disorder:
- It is a chronic disorder characterized by attacks of Mania alternating with attacks of
Depression.
- During the Manic phase, there are euphoric and psychotic symptoms
(Hallucinations, Delusions, Agitation).
- Increased catecholamine activity has been shown to be associated with mania.
The beneficial effects of Lithium in Bipolar Manic-depression are:
- Mood stabilizer: - Reduces mood swings.
- Anti-Manic effect: - Decreases the Manic behavior during the manic
phase (Antipsychotics are added to Lithium for rapid control of acute
mania).
Mania
Mood stabilizers Lithium + Antipsychotics
Depression Lithium
Antidepressants Valpraote Alternative mood stabilizers
Carbamazepine in cases of Li+ toxicity or
Ineffectiveness.
Fig: Manic-depressive disorder.