Psychopharmacology : BRIEF VIEW

1. PSYCHOPHARMA
COLOGY
Presenter
Ms Neha Bhatt
Ppt By Neha Bhatt

2. INTRODUCTION
 The treatment of psychiatric disorder's in past
constituted mere institutionalization then called the
asylums.
 At that time use of medicines were considered as
ridiculous. The arrival of psychopharmacology in
the last five and a half decades has brought the
treatment of psychiatric disorders in the territory of
scientific medicine.
 Introduction of chlorpromazine in 1952
revolutionized the treatment of psychiatric
disorders . Ppt By Neha Bhatt

3. IDEAL PSYCHOTROPIC DRUG
• Should cure underlying pathology.
• Should benefit all patients suffering from that
disorder.
• No side effects or toxicity.
• Rapid onset of action.
• No dependence or withdrawal symptoms on stopping.
• No tolerance to the drug on longer duration.
• Should not be lethal in overdoses.
• used in both inpatient and outpatient settings
Ppt By Neha Bhatt

4. CLASSIFICATION OF
PSYCHOTROPIC DRUGS
 Antipsychotics.
 Antidepressants.
 Mood stabilizing agents.
 Anti anxiety and hypnotics.
 Anti epileptics.
Antiparkinsonians.
Ppt By Neha Bhatt

5. PHARMACOLOGICAL ACTION
OF PSYCHOTROPIC DRUGS
• Agonist action at a receptor.
• Antagonist action at a receptor.
• Partial agonist action at a receptor.
• Action via second messengers.
• Altered neurotransmitter storage.
• Increased neurotransmitter release.
• Inhibition of neurotransmitter reuptake.
• Inhibition of endogenous metabolism.
Ppt By Neha Bhatt

6. ANTIPSYCHOTICS
Indications:
• organic psychiatric disorders ( delirium, dementia)
• functional disorders (schizophrenia , paranoid
schizophrenia )
• child psychiatric disorders( ADHD , autism, enuresis,
conduct disorder )
• Mood disorder ( mania)
• Neurotic and other psychiatric disorder(anorexia
nervosa )
• medical disorders( eclampsia , sever pain in
malignancy )
Ppt By Neha Bhatt

7. ANTIPSYCHOTICS
Classes of drugs:
• Phenothiazine (CPZ),
• Thioxanthines (Thiothixene),
• Butyrophenones (Haloperidol),
• Di-phenyl-butyl-piperidines (Pimozide),
• Indolic-derivatives (Molindone),
• Di-benzoxa-zepines(loxapine),
• Atypical Antipsychotics ( Clozapine, Amisulpride,
Risperidone, Olanzapine, Quetiapine, Aripiprazole)
Ppt By Neha Bhatt

8. SIDE EFFECTS OF ANTIPSYCHOTICS
• Autonomic side effects: dry mouth, constipation, urinary
retention, impotence, orthostatic hypotension.
• EPSE : parkinsonian syndrome, dystonia, akathesia,
neuroleptic malignant syndrome.
• Other CNS effects: seizures, sedation, depression or
pseudo-depression.
• Metabolic and Endocrine side effect: weight gain,
diabetes, galactorrhea with or without amenorrhea
• Allergic side effects: cholestatic ( obstructive) jaundice,
agranulocytosis.
• Cardiac , Ocular and Dermatological side effects.Ppt By Neha Bhatt

9. ANTI DEPRESSANTS
Indication:
• Depression,
• Child Psychiatric disorders ( ADHD, Enuresis etc.),
• Other Psychiatric disorders ( OCD, PTSD, alcohol
dependence panic attack , etc.),
• Medical
disorders ( chronic
pain, migraine, peptic ulcer disease).
Ppt By Neha Bhatt

10. ANTI DEPRESSANTS
Class of drugs:
–Tricyclic antidepressants
(imipramine,amitriptylline),
–SSRIs (fluoxetine, sertraline),
–Dopaminergic antidepressants ( fluvoxamine )
–Atypical antidepressants (amineptine)
–MAOIs -monoamine oxidase inhibitors ( trazodone)
Ppt By Neha Bhatt

11. SIDE EFFECTS OF ANTI-
DEPRESSANTS
• Autonomic side effects: dry mouth, constipation,
delirium, urinary retention.
• Sexual side effects: impotence .
• CNS effects: sedation, withdrawal syndrome, seizures.
• Cardiac side effects: Tachycardia, Arrhythmias.
• Allergic side effects: Agranulocytosis.
• Metabolic and Endocrine side effects.
• Toxicity
Ppt By Neha Bhatt

12. MOOD STABILIZING DRUGS
Indication:
• acute mania,
• prophylaxis for BPAD,
• neurological disorders,
• seizures,
• schizo - affective disorders
• paroxysmal pain syndrome.
• Class of drugs: Lithium , Valproate, Carbamazepine.
Ppt By Neha Bhatt

13. SIDE EFFECTS OF MOOD
STABILIZERS
• LITHIUM: therapeutic level – 0.6-1.2 mEq/L
prophylaxis – 0.6-1 mEq/L
toxic -- >2 mEq/ L
• Neurological (tremor, muscular weakness, neurotoxicity),
renal (polyuria, polydipsia),
• cardiovascular (T- wave depression: coronary ischemia)
• endocrine (goiter, hypothyroidism, abnormal thyroid
function, weight gain),
• G I effects (nausea, vomiting, diarrhea, metallic taste and
abdominal pain),
• side effect during pregnancy and lactation (teratogenicity,
secreted through milk)
Ppt By Neha Bhatt

14. SIDE EFFECTS COnT.….
•Valproate : nausea, sedation, tremor, weight
gain, thrombocytopenia, menstrual
disturbances, hair loss.
• Most serious but relatively uncommon side
effects include hepatic toxicity, acute
hemorrhagic pancreatitis.
•Dialysis is the management during overdose
Ppt By Neha Bhatt

15. SIDE EFFECTS COnT.…..
• Carbamazepine: diplopia, drowsiness, dizziness,
photosensitivity, hypertension, leucopenia etc.
• The most dangerous side effects include bone
marrow suppression and cardiovascular
collapse
Ppt By Neha Bhatt

16. AnTI AnXIETY AnD HYPnOSEDATIVES
Indication:
• generalized anxiety disorder,
• panic disorder,
• insomnia,
• narcoanalysis,
• premedication in anesthesia etc.
Ppt By Neha Bhatt

17. AnTI AnXIETY AnD HYPnOSEDATIVES
• Classification:
• barbiturates (phenobarbital, thiopentone),
• Non barbiturates,
• Non-benzodiazepine anti anxiety agents(ethanol,
chloral hydrate, propranolol),
• benzodiazepines( midazolam, alprazolam,
diazepam, clonazepam)
Ppt By Neha Bhatt

18. SIDE EFFECTS
• Nausea, vomiting, weakness, epigastric pain,
vertigo, impotence, sedation, dry mouth, irritability,
dis-inhibited behavior, dependence and
withdrawal.
• Commonly abused drugs are from this group
Ppt By Neha Bhatt

19. ANTI EPILEPTICS
• Indication: seizures.
• Drugs: phenytoin sodium, clonazepam,
diazepam, lorazepam, carbamazepine,
valproate sodium, lamotrigine, gabapentin.
Ppt By Neha Bhatt

20. SIDE EFFECTS OF ANTI EPILEPTICS
Phenytoin sodium:
•Delirium, nystagmus, ataxia, incoordination,
dysarthria, hand tremors
•Skin rash, toxic epidermal necrolysis.
•Cerebellar atrophy, peripheral neuropathy,
•Gingival hyperplasia.
Ppt By Neha Bhatt

21. SIDE EFFECTS OF ANTI EPILEPTICS
• Phenytoin sodium:
Ppt By Neha Bhatt

22. ANTI PARKINSONIAN
• Indication: Parkinson's disease, prevent
EPS.
• Class of drugs: THP ( tetrahydropalmatine),
Levodopa and carbidopa, selegiline,
pramipexole.
Ppt By Neha Bhatt

23. SIDE EFFECTS OF ANTI PARKINSONIAN
• THP: Drowsiness, head ache, vertigo, sleep disturbance,
mydriasis with or without photo phobia, blurred vision,
dry mouth.
• Levodopa: hypotension, arrhythmias, nausea, hair loss, G
I bleed, dis orientation and confusion. Chronic use leads
to on/off oscillation, dyskinesia, freezing during
movement, drug resistance.
Ppt By Neha Bhatt

24. Ppt By Neha Bhatt