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Psycho pharmacology

Antipsychotics Antidepressants Anxiolytics


Dr.U.P.Rathnakar
MD. DIH. PGDHM

Psychotropic drugs
Psychoses [Schizo,Mania, depression] Severe mental illness Not in touch with reality Hallucinations Delusions Abnormal behaviour Antipsychotics, Antidepressants, Antimanic drugs
Anxiety disorders [Neuroses] Less severe(Extreme suffering) In touch with reality ANXIOLYTICS

Antipsychotics
Classical: 1. Phenothiazines Aliphatic---Chlorpromazine Triflupromazine Piperidine---Thioridazine PiperazineTrifluperazine, Fluphenazine 2. Butyrophenones Haloperidol, Trifluperidol, Penfluperidol, 3. ThioxanthinesFlupenthixol 4. OthersPimozide, Loxapine Atypical Clozapine Risperidone Olanzapine Quetiapine Aripiprazole Ziprasidone

Antipsychotics Chlorpromazine[CPZ]

MOA & Pharmacological actions


Beneficial D2 Blockade ADEs D2 Blockade

Muscarinic block Adrenergic block H1 Block Direct on heart

Beneficial Antipsychotic effect ADEs Extrapyramidal effect Galactorrhoea, Gynaecomastia Anticholinergic Hypotension Weight gain,sedation Arrhythmia

Actions of CPZ
In Normal person: Indifference to surroundings, Psychomotor slowing, Drowsiness, Unpleasant effects Neuroleptic syndrome* In psychotics Reduces irrational behaviour Aggression and agitation Psychotic symptoms Sedation-Tolerance develops

ADEs effects of CPZ

Extrapyramidal effects
1. Parkinsonism 2. Acute muscle dystonia 3. Akathisia 4. Malignant neuroleptic syndrome 5. Tardive dyskinesia Other ADEs Cholestatic jaundice, Agranulocytosis, Myocarditis

Uses of antipsychotics
Psychoses [Scizophrenia] a. Atypical preferred[Less adverse effects, more effective in negative symptoms] Antiemetic Intractable hiccough Mania

Antipsychotics
Classical More action on DA receptors Effective in positive symptoms More adverse effects Atypical Less. More in 5HT Effective in negative symptoms Less ADEs

Antidepressants
MAO-inhibitors Moclobemide Tricyclic antidepressants Imipramine, Amitriptyline, Selective Serotonin Reuptake Inhibitors Fluoxetine, Fluvoxamine Atypical Trazodone, mianserin

Antidepressants ADEs
Anticholinergic effect Sedation Weight gain Postural hypotension Cardiac arrhythmias

No extrapyramidal effects!

Antidepressants- uses
Endogenous depression Obsessive compulsive- neurosis[OCN] Phobias Neuropathic pain Enuresis Migraine

Anxiolytics[Antianxiety]
1. Benzodiazepines[Acts on GABA Rec] Diazepam, Alprazolam, Lorazepam 2. Azapirones Buspirone-Acts on 5HT receptors 3. Betablocker Propranolol [Used in symptoms of anxiety]

Anxiolytics -ADEs
1. Benzodiazepines Dependence, sedation, vertigo, confusional states Flumazenil-effective antagonist available 2. Azapirones Nausea, dizziness, sedation 3. Betablocker Bradycardia, bronchospasm, masking of symtoms of hypoglycemia

Anxiolytics -uses
Benzodiazepines
Anxiolytics, Sedativehypnotics, Anticonvulsants Pre anaesthetic Muscle relaxant

Azapirones [Buspirone]
Anxiolytics,

Beta blockers Syptoms of anxiety[tremors, intestinal motility]

Anxiety

Fight or Flight reaction Fear and worry

Anxiety- Disorder Excessive fear or worry

Anxiolytics -uses
1. Anxiety is normal response 2. It helps in vigilance & drive 3. Require treatment-when performance is affected [Alprazolam, buspirone] 4. Require treatment to control symptoms of anxiety [Betablockers]