1. Maha younis Professor of psychiatry

2. Drug treatment Non drug treatment –Psychotherapy Psychosurgery Electroconvulsive therapy ECT

3.  Psychosis are group of serious psychiatric disorders characterized by thought and perceptual disorder,the most important and common type is schizophrenia  Psychosis (short,temporary,sometimes only symptoms ) can be induced also by drugs like  1-Levodopa  2-CNS stimulants : Cocaine,Amphetamines  Khat  Apomorphine  phencyclidine

4.  Increased activity of Dopamin -the cause behind discovery of anti-psychotic medications  ] ِ ة Increased activity of the Dopamenergic system dopamine Correlates:  1-Anti-psychotics reduce dopamine synaptic activity  2-they produce parkinson –like symptoms  3-drugs that reduce DA in the limbic system reduce psychosis  Changes in amount of Homovanillic acid (HVA)in plasma,urine and CSF

5.  In treatment and prevention of all types of psychosis  Neuroleptics  Schizophrenia must be treated with medications for long times as the disease is life long  They are also used in treatment of associated psychotic symptoms with other psychiatric or physical disorders like Alzheimers disease,Bi- polar disorder,organic diseases, as anti- emitics,drug addiction

6.  Old anti-psychotics ;1-phenothiazines, 2- Thioxanthines  3-Butyrophenones  4-Chloroprothioexene  5-Haloperidol  6-Droperidol

7.  Newer drugs  Pimozide  Molndone  Loxapine  Clozapine  Olanzapine  Qetiapine  Risperidone  olindone

8.  Clinical problems with anti-psychotics includes;  1-failur to control negative effect  2-significant toxicity  3-parkinsone like symptoms  4-Tardive Dyskinesia  5-endocrine effect  6-cardiac effect  7-poor concentration

9.  Bi-polar 1,Bipolar 2  Lithium  Valproate  Olanzapine  Anti-convulsants  Carbamazepine  Lamotrgine  Second generation antipsychotics  Clozapine\resperidine  Quetiapine

10.  Lithium  Salt used in treatment of Bi-polar  Very narrow therapeutic window,1.2 maximum therapeutic plasma level and more than 1.5 toxic symptoms starts to occur Adverse effect of Lithium Polydipsia Hand tremor Headache Decreased concentration and memory Risk of diabetes insipidus and nephrotoxic kidney hypothyroidism

12.  Valproic acid  Carabmazepine  MOA  Adverse effects: weight gain,hair loss,sedation  Lithium remains the first choice  Drug combination-anti- psychotics+antionvulsants are still commonly used  Quitepine,olanzapine are the most commonly used anti-psychotics in treatment of Bi-Polar  used

13.  Normal sleep consists of 4 stages based on 3 physiologic measures,EEG,elctromyogram,electro nystagmogram  Non –rapid eye movement (NREM)sleep ;70%- &75%  Stage 1.2  Stage 3,4 ;slow waves sleep,sws  Rapid eye movement(REM)sleep

14.  An effective sedatives (anxiolytic)agent should reduce anxiety and exert a calming effect with little or no effect on motor or mental function  A hypnotic drug should produce drowsiness and encourage the onset and maintenance of a state of sleep that as far as possible resembles sleep state

15.  Benzodiazepines: large safety margine doesn’t effect the vital organ when given oraly in overdaose  Barbiturates ; rarely used as sedative nowadays,older generation cause CNS depression which lead to comma and death will follow at overdoses resembling state of general anesthesia because of respiratory depression and vasomotor depression  Chlordiazepoxide was invented at 1961,dervatives of 1,4 benzodiazepine,they are basically similar in their phramacological actions,though some degree of selectivity has been reported

16.  Difference in pharmacokinetic behaviour are more important than difference in profile of activity,selectivety with to 2 types of benzodiazepine receptor may account for these difference  Pharmacological effects  1-reduction of anxiety and aggression; affect the hypocampus and nucleus amygdalae  2-sleep promotion by sedation;  Latency of sleep onset is decresed  Duration of stage 2 NREM sleep is decresed

17.  Clinical use,advantage  1-wide safety margin  2-little effect on REM sleep  Little hepatic microsomal drug-metabolozing enzymes  4-slight physiological and psychological dependence and withdrawal syndrome  5-less adverse effect such as residual drowsiness and incoordination movement  6-anti-convulsants ;they are highly effective against chemically induced convulsions less against electrically induced one  Induce GABA-medicated synaptic syst ems and inhibit excitatory transmission

18.  Muscle relaxation  Act selectively on GABAreceptors by enhancing the response produced by GABA-ergic neurons  Relax contracted muscle in joint disease Side effects  1-temporary amnesia  2-decrese dosage of anesthesic drugs  Depress respiratory and cardiovascular function

20.  It is a common psychiatric disorder characterized by low mood most of the day subjectively and by others  2-diminshed interest in all,or most of previous activities  3-apetite,wt changes ;loss or incresed  4-insomnia or hypersommnia  5-decresed concentration and power of discion  Ideas,thoughts,images of death,sucidal thoughts  6-no organic explanation

28.  It is an old treatment before the invention of modern psychiatric medication  Frontoloboctomy  Selective frontotemporal lboctomy  It affect the cognitive function and personality characters  It was indicated in sever types of OCD and psychosis