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PSYCHOPHARMACOLOGY & PSYCHOTHERAPY IN PSYCHIATRY

FRILYA RACHMA PUTRI

PSYCHOPHARMACOLOGY
ANTI PSYCHOTIC ANTI CHOLINERGIC ANTI ANXIETY ANTI MANIC ANTI DEPRESSANT

ANTI PSYCHOTIC

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

KEY DOPAMIN PATHWAYS (1)


Mesolimbic pathway
Hyperactivity on this pathway is associated with positive symptoms of schizophrenia

Mesocortical pathway
Deficit in dopamine in this pathway is associated with negative and cognitive symptoms of schizophrenia

KEY DOPAMIN PATHWAYS (2)


Nigrostiatal pathway
Part of extrapyramidal system and controls motor movement Blockade of D2 receptors causes:
deficiency in dopamine in this pathway and thus movement disorder such as Parkinsons disease hyperkinetic movement such as tardive dyskinesia

KEY DOPAMIN PATHWAYS (3)


Tuberoinfundibular pathway
Increased neuronal activity of this pathway inhibits prolactin release Blockade of D2 receptor increases prolactin release and causes:
galactorrhea amenorrhea

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

TYPICAL ANTI PSYCHOTICS (FIRST GENERATION)


Chlopromazin Perphenazine Trifluoperazine Fluphenazine Thioridazine Haloperidol Pimozide

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

ATYPICAL ANTI PSYCHOTICS (SECOND GENERATION)


Clozapine Olanzapine Quetiapine Zotepine Risperidone Aripiprazole

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

ANTI CHOLINERGIC

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

ANTICHOLINERGIC
Anticholinergics block the actions of the nerve transmitter acetylcholine. Long term of usage: cognitive deterioration Anticholinergics fall into two categories:
Antimuscarinic block the effects of parasympathetic autonomic nervous system and are often called parasympatholytic drugs. Antinicotinic less able to stimulate muscle contraction

The prototype of these agents is atropine.

ANTICHOLINERGIC AGENT (1)


Artane (trihexyphenidyl hydrochloride)
which exerts a direct inhibitory effect on the parasympathetic nervous system. It also exhibits a direct spasmolytic action and weak mydriatic, antisialogogue and cardiovagal blocking effects.

Benztropine mesylate
It possesses both anticholinergic and antihistaminic effects as therapeutically significant in the management of parkinsonism

ANTICHOLINERGIC AGENT (2)


Diphenhydramine hydrochloride Procyclidine hydrochloride
a synthetic antispasmodic compound useful for the symptomatic treatment of parkinsonism (paralysis agitans) and extrapyramidal dysfunction.

Biperiden
an analog of trihexyphenidyl. it is approved for the treatment of parkinsonism and has greater pharmacological anticholinergic activity than trihexyphenidyl.

ANTI ANXIETY

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

Quoted from: www.uic.edu/classes/pcol/pcol331/dentalpharmhandouts2006/lecture49.pdf

ANTI MANIC

ILLUSTRATION CASE
Man, 30 years old, with clinical features:
1 week of profound mood disturbance, characterized by elation, irritability, or expansiveness. The following symptoms: Grandiosity, diminished need for sleep, excessive talking or pressured speech, racing thoughts or flight of ideas, clear evidence of distractibility, increased level of goal-focused activity at home, at work, or sexually, excessive pleasurable activities, often with painful consequences.

Mechanism of action AM

Psychiatric Uses of Lithium


Historical Gouty mania Well established (FDAapproved):
Manic episode Bipolar maintenance therapy Major depressive disorder
Acute depression (as an augmenting agent) Maintenance therapy

Schizoaffective disorder

Evidence of benefit in particular groups


Schizophrenia Aggression (episodic), explosive behavior self-mutilation Conduct disorder in children and adolescents Mental retardation

Reasonably well established


Bipolar disorder Depressive episode Bipolar II disorder Rapid-cycling bipolar I disorder Cyclothymic disorder

Nonpsychiatric Uses of Lithium


Historical Gout and other uric acid diatheses Lithium bromide as anticonvulsant Neurological Epilepsy Headache (chronic cluster, hypnic, migraine, particularly cyclic) Mnire's disease (not supported by controlled studies) Movement disorders Huntington's disease Levodopa-induced hyperkinesias

Adverse Effects of Lithium


Neurological Benign, nontoxic: Dysphoria, lack of spontaneity, slowed reaction time, memory difficulties Tremor: Postural, occasional extrapyramidal Toxic: Course tremor, dysarthria, ataxia, neuromuscular irritability, seizures, coma, death Miscellaneous: Peripheral neuropathy, benign intracranial hypertension, myasthenia gravis-like syndrome, altered creativity, lowered seizure threshold Endocrine Thyroid: Goiter, hypothyroidism, exophthalmos, hyperthyroidism (rare) Parathyroid: Hyperparathyroidism, adenoma Cardiovascular Benign T-wave changes Sinus node dysfunction Renal Concentrating defect Morphological changes Polyuria (nephrogenic diabetes insipidus) Reduced GFR Nephrotic syndrome Renal tubular acidosis Dermatological Acne, hair loss, psoriasis, rash Gastrointestinal Appetite loss, nausea, vomiting, diarrhea Miscellaneous Altered carbohydrate metabolism, weight gain, fluid retention

Potential Correlates of Response to Valproate


Diagnosis-Related Factors
Diagnosis of bipolar disorder [vs. schizoaffective or schizophrenia disorder] Dysphoric [or mixed mania] Bipolar II disorder

Comorbid psychiatric diagnosis Comorbid alcohol abuse Comorbid anxiety and panic attacks Comorbid migraine

ANTI DEPRESSANT

Mechanism of Action (1)

Mechanism of Action (2)

PSYCHOTHERAPY
It is a form of therapy with psychological ways to emotional problems, which is trained by professional in relationships with the patient. Goal:
Remove, modify or retard symptoms. Mediate disturbed behavior patterns Support the growth and development of positive personality.

PYCHOTHERAPIES
Supportive psychotherapy Reconstructive psychotherapy Reeducative psychotherapy

Supportive Psychotherapy
Goal: to strengthen existing defense mechanism, extending proprietary control mechanism with newer and better, improvements & more adaptif Method: guidance, reassurance, environmental manipulation

Reconstructive Psychotherapy
Goal: to develop and strengthen creative potency of person, with or without reaching insights of conflict imaginable. Method: behavioral therapy, group therapy, family therapy, etc.

Reeducative Psychotherapy
Goal: the achievement of insight to unconscious conflicts, with an effort to achieve structural changes in a person's character. Method: Freudian Psychoanalysis and Non Freudian analytic psychotherapy-oriented and dynamic.

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