University of Nizwa College of Pharmacy and Nursing School of Pharmacy

Slides:



Advertisements
Similar presentations
conventional antipsychotic drug
Advertisements

Psychopharmacology: Anti-psychotic Medications
Drugs Used to Treat Schizophrenia
 incidence  characteristics  causes?  treatments?
Intro to Psychopharmacology Caitlin Stork, MD. Besides dopamine blockade... ReceptorEffect of Blockade Acetylcholine (muscarinic; M1) Anticholinergic.
Schizophrenia and Antipsychotic Treatment Stacy Weinberg 3 April 2007.
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 31 Antipsychotic Agents and Their Use in Schizophrenia.
Schizoaffective Disorder What is it? How does it affect the person diagnosed? How is it dealt with? What is it? How does it affect the person diagnosed?
The Treatment of Psychotic Disorders By: Siva Dantu.
for the Psychiatry Clerkship is proud to present And Now Here Is The Host... Insert Name Here.
for the Psychiatry Clerkship is proud to present And Now Here Is The Host... Insert Name Here.
Major Depressive Disorder Presenting Complaints
Psychotic disorders.
Antipsychotic Medications in the Primary Care Practice Angelo Potenciano, M.D.
Following Frank Patients with Chronic Mental Illness John R. Hall MD Te Roopu Whitiora Maori Mental Health Service.
Antipsychotic drugs. Anti-psychotic drugs The CNS functionally is the most complex part of the body, and understanding drug effects is difficult Understanding.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 16Psychopharmacology.
CASE 7 CASE 7 CHEN,CHUN-HUANG(ALEX). Juanita is 45 years old and has been admitted at the Half Way Center(a psychiatric center) for seven time.She had.
ANTIPSYCHOTIC. What do antipsychotics treat?  Psychotic Disorders (Psychosis) Abnormal Thinking and Perceptions Loss of Contact with Reality Delusions.
Clinical Toxicology & Pharmacology, Newcastle Mater Misericordiae Hospital Neuroleptic Malignant Syndrome Recognition, Risk factors and Management.
ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS Anti schizophrenic drugs Neuroleptic drugs Major tranquilizers.
Pharmacotherapy in Psychotic Disorders. Antipsychotic drugs Treat the symptoms of the disorder Do not cure schizophrenia Include two major classes: –
Pharmacotherapy in Psychotic Disorders. Antipsychotic drugs Treat the symptoms of the disorder Do not cure schizophrenia Include two major classes: –
Schizophrenia Overview. Schizophrenia is the most severe and debilitating mental illness in psychiatry and is a brain disorder.
Schizophrenia Chapter 14. Louis Wain cat This cat, like many painted during that period, is shown with abstract patterns behind it. Psychologists have.
Schizophrenia characterized by positive and negative symptoms –positive symptoms – those that can be observed; ex. hallucinations –negative symptoms –
*a group of severe brain disorders in which people interpret reality abnormally *may result in hallucinations, delusions, and disordered thinking and.
Antipsychotic agents By S.Bohlooli PhD.
The term schizophrenia comes from two Greek words that mean splitting apart of mental functions. “Split mind“ U-Ajwbok&sns=em.
ANTIPSYCHOTICS Katy and Zoë. Psychosis Mental disorder with a broad range of symptoms. Patients ‘lose touch with reality’ and present with: hallucinations.
Schizophrenia Pathogenesis is unknown. Onset of schizophrenia is in the late teens - early ‘20s. Genetic predisposition -- Familial incidence. Multiple.
By David Gallegos Period 7.  What are the Causes and Symptoms of Schizophrenia ?  How do people who have Schizophrenia live with it and how is it treated?
ATYPICAL ANTIPSYCHOTICS FIRST GENERATION ANTIPSYCHOTICS.
بسم الله الرحمن الرحيم Dr: Samah Gaafar Hassan Al-shaygi.
Drugs Used for Psychoses Chapter 18 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Schizoaffective, Delusional and Other Psychotic Disorders Chapter 17.
BIPOLAR DISORDER, DR GIAN LIPPI CONSULTANT PSYCHIATRIST UNIVERSITY OF PRETORIA & WESKOPPIES HOSPITAL FORENSIC UNIT MANAGEMENT GUIDELINES.
TM The EPEC-O Project Education in Palliative and End-of-life Care - Oncology The EPEC TM -O Curriculum is produced by the EPEC TM Project with major funding.
PSYCHOTIC DISORDER Mental Health First Aid By Mental Health Commission of Canada, 2010.
Management of Geriatric Psychiatric Disorders Arash Mirabzadeh Psychiatrist University of Social Welfare and Rehabilitation Sciences.
At the end of the lecture, students should:  List the classification of antipsychotic drugs used in schizophrenia.  Describe briefly the mechanism of.
Chris Allred NS 215 ?id= &page=1&CMP=O TC-RSSFeeds0312.
抗精神失常药 PHARMACOLOGY OF ANTIPSYCHOTIC DRUGS (NEUROLEPTICS)
Psychiatric Treatment
Antipsychotic Agents and Their Use in Schizophrenia
Central Nervous System
11 Drugs for Psychoses.
Treatment of psychotic disorders
PRESENTED BY Heena Parveen, M.Pharmacy(Pharmacology), CP&PT. PRESENTED BY Heena Parveen, M.Pharmacy(Pharmacology), CP&PT.
Antipsychotic-Induced Dysphagia
PRESENTED BY Heena Parveen, M.Pharmacy(Pharmacology), CP&PT. PRESENTED BY Heena Parveen, M.Pharmacy(Pharmacology), CP&PT.
ِِAntipsychotic Drugs
Antipsychotic Agents and Their Use in Schizophrenia
Spinrad/Psychology Antipsychotic Drugs.
Clinical pharmacology of antipsychotic agents
Pharmacodynamics: How do antipsychotic medications work?
School of Pharmacy, University of Nizwa
Clinical Pharmacokinetics
PSYCHOSES.
School of Pharmacy, University of Nizwa
PHARMACOTHERAPY - I PHCY 310
Antipsychotics: chemistry and pharmacokinetics
Antipsychotic (Neuroleptic) Drugs
University of Nizwa College of Pharmacy and Nursing School of Pharmacy
Neuroleptic drugs.
Antipsychotic Agents & Schizophrenia
Antipsychotic Drugs (Neuroleptics, Major Tranquillisers)
PHARMACOTHERAPY - I PHCY 310
Antipsychotics.
Topic Discussion By Alexandria Brown
Presentation transcript:

University of Nizwa College of Pharmacy and Nursing School of Pharmacy PHARMACOTHERAPY - I PHCY 310 Lecture -12 Psychiatric Disorders “Schizophrenia” Dr. Sabin Thomas, M. Pharm. Ph. D. Assistant Professor in Pharmacy Practice School of Pharmacy University of Nizwa

Course Outcome Upon completion of this lecture the students will be able to Describe pathophysiology, diagnosis, and therapeutic choices including non-pharmacologic and pharmacologic treatments for schizophrenia, Explain the different phases of treatment in schizophrenia.

Psychosis is brain disorder in which there is loss of contact with reality, affecting the ability to think, feel, perceive and act. Investigations 1- History - Withdrawal from usual activities with friends and family - Rapid fluctuations in mood (emotional lability) - Unreasonable suspiciousness - Unusual or bizarre behavior - Hallucinations - Difficulties in thinking or expressing thoughts 2- Clinical rating scales to monitor the psychotic event - Clinical Global Impression Scales for Severity (CGI-S) - Clinical Global Impression Scales for Change (CGI-C) - Global Assessment of Functioning (GAF)

Pathophysiology Schizophrenia is usually a lifelong psychiatric disability. Psychosis may result from hyper- or hypo activity of dopaminergic processes in specific brain regions. This may include the presence of a dopamine (DA) receptor defect. Schizophrenic patients with abnormal brain scans have higher whole blood 5-HT concentrations, and these concentrations correlate with increased ventricular size. Clinical presentation Symptoms of the acute episode may include the following: being out of touch with reality; hallucinations (especially hearing voices); delusions (fixed false beliefs); ideas of influence (actions controlled by external influences); disconnected thought processes (loose associations); ambivalence (contradictory thoughts); flat, inappropriate, or labile affect; autism (withdrawn and inwardly directed thinking); uncooperativeness, hostility, and verbal or physical aggression; impaired self-care skills; and disturbed sleep and appetite.

Therapeutic Choices Nonpharmacologic Choices - Medication adherence - Family psychoeducation - Assessment of postpsychotic depression and suicidality Pharmacologic Choices There are two major classes of antipsychotics:Selection of an antipsychotic should be based on (1) the need to avoid certain side effects, (2) concurrent medical or psychiatric disorders, and (3) patient or family history of response. First-generation (typical) antipsychotics (FGAs): e.g., fluphenazine, trifluoperazine, chlorpromazine, haloperidol, and pimozide. Second-generation (atypical) antipsychotics (SGAs): e.g., aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone, and paliperidone. Paliperidone is the active metabolite of risperidone, and it is not metabolized by the liver. Therefore it has less drug-drug interactions compared to other antipsychotics.

INITIAL THERAPY The goals during the first 7 days are decreased agitation, hostility, anxiety, and aggression and normalization of sleep and eating patterns. In general, titrate over the first few days to an average effective dose. After 1 week at a stable dose, a modest dosage increase may be considered. If there is no improvement within 3 to 4 weeks at therapeutic doses, then an alternative antipsychotic should be considered. IM antipsychotic administration (e.g., ziprasidone 10 to 20 mg, olanzapine 2.5 to 10 mg, or haloperidol 2 to 5 mg) can be used to calm agitated patients. Intramuscular (IM) lorazepam, 2 mg, as needed in combination with the maintenance antipsychotic may actually be more effective in controlling agitation than using additional doses of the antipsychotic.

STABILIZATION THERAPY During weeks 2 and 3, the goals should be to improve socialization, selfcare habits, and mood. Improvement in formal thought disorder may require an additional 6 to 8 weeks. Most patients require a dose of 300 to 1,000 mg of CPZ equivalents (of FGAs) daily or SGAs in usual labeled doses. Dose titration may continue every 1 to 2 weeks as long as the patient has no side effects. If symptom improvement is not satisfactory after 8 to 12 weeks, a different strategy should be tried.

MAINTENANCE THERAPY Medication should be continued for at least 12 months after remission of the first psychotic episode. Continuous treatment is necessary in most patients at the lowest effective dose. Antipsychotics (especially FGAs and clozapine) should be tapered slowly before discontinuation to avoid rebound cholinergic withdrawal symptoms.

If partial or poor adherence is an issue, a long-acting or depot injectable antipsychotic should be considered (e.g., risperidone microspheres, haloperidol decanoate, fluphenazine decanoate). Only clozapine has shown superiority over other antipsychotics for the management of treatment-resistant schizophrenia. Propranolol, pindolol, and nadolol have been used for antiaggressive effects. ADVERSE EFFECTS Autonomic Nervous System: Anticholinergic (ACh) side effects include impaired memory, dry mouth, constipation, tachycardia, blurred vision, inhibition of ejaculation, and urinary retention.

Central Nervous System Extrapyramidal System Dystonias are prolonged tonic muscle contractions, with rapid onset (usually within 24 to 96 hours of dosage initiation); they may be life threatening (e.g., pharyngeal-laryngeal dystonias). Pseudoparkinsonism akinesia, bradykinesia, tremor, rigidity, postural abnormalities Tardive Dyskinesia abnormal involuntary movements Sedation and Cognition Seizures Thermoregulation Hyperpyrexia can lead to heat stroke

Neuroleptic Malignant Syndrome Symptoms develop rapidly over 24 to 72 hours and include body temperature exceeding 38°C (100.4°F), altered level of consciousness, autonomic dysfunction (tachycardia, labile blood pressure, diaphoresis, tachypnea, urinary or fecal incontinence), and rigidity. Laboratory evaluation frequently shows leukocytosis, increases in creatine kinase (CK), aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and myoglobinuria.