Anxiolytics, Antidepressants and Antipsychotics 2
Bipolar Disorder
Manic Phase
Depressive Phase
1st line- Anti-psychotics (Haliperidol, RIsperidone, Olanzapine)
Sodium Valporate
Lithium- delayed action in acute mania
Electroconvulsive Therapy
Don't use anti-depressants and stimulants and some OTC medication such as cold remedies as they precipitate mania
Antidepressants used in combination with mood stabilizers. SSRI are less likely to result in mania compared to TCA.
Anti-psychotics used alone or with an anti-depressant. QUETIAPINE
LAMOTRIGINE- Used in severe depression
Prevent Relapse Treatment
Lithium, Valporate, Anti-psychotics (OLANZOPINE, QUETIAPINE, ARIPIPRAZOLE), CARBAMAZEPINE, LAMOTRIGINE and Anti-depressants
LITHIUM
Treatment and prophylaxis of mania, bipolar disorder, recurrent depression and self-harming behaviour
Narrow therapeutic window
Slow onset of action- usually takes 7-14 days to work
Renal excretion - kidneys
S.E- tremors, GIT, renal, coma
MOA- Mimics Na+ in tissues by entering through the Na+ channels and accumulating in the cell. It won't be pumped out through the Na+/K+ ATPase pump so there will be partial loss of K+ cell depolarisation
It inhibits IMPase which is the rate-limiting enzyme in inositol recycling. So the phosphatidyl inositol pathway is blocked and inositol phosphate is hydrolysed to free inositol
Mood stabilising drug as it can reduce both manic and depressive symptoms in bipolar disorder
Toxicity S.E- Thyroid disorders, hair loss, mild cognitive impairment, acne and weight gain
Toxicity symptoms are metallic taste, thirst from polyuria, weight gain and oedema and causes of toxicity include intentional overdose or reduced drug excretion. When conc >1.5
Patient counselling- Regular fluid intake, full compliance and regular monitoring essential and avoid crash diets
Anti-psychotics
First generation (typical) anti-psychotics
D2 receptor antagonist
To treat the positive symptoms such as hallucinations
CHLORPROMAZINE, FLUPHENAZINE, FLUPENTIXOL, HALOPERIDOL
Effect over 2-4 weeks
Depot (slow-acting) anti-psychotics are used for poor adherence such as the decanoate derivatives- haliperidol decanoate
Extrapyramidal SE- Acute symptoms such as dystonias, Parkinsons and Akathisia. Tardive Dyskinesia
Other S.E- Behavioural (apathy, inhibition of aggression, reduced initiative), Cardio (orthostatic hypotension), increased levels of prolactin, neuroepileptic malignant syndrome
Other S.E- sedation, weight gain, seizures, temperature regulation, skin problems, sexual dysfunction, blood dyscrasis and visual impairment
Second generation (atypical) anti-psychotics
Greater affinity for the serotonin receptors compared to the dopamine receptors
For the treatment of the negative symptoms
Less anti-cholinergic S.E and lower risk of cardiotoxicity
No effect on prolactin levels except for RISPERIDONE, AMISULPRIDE
OLANZAPINE and RISPERIDONE increases the risk of stroke in elderly with dementia
OLANZAPINE results in weight gain, obesity and hypertension
Also causes metabolic disorders such as diabetes, hyperlipidemia and glucose intolerance
CLOZAPINE- It is a weak D2 and marked 5-HT2, Muscarinic, alpha 1 and H1 antagonist and used with patients who are unresponsive and treatment resistant.
S.E of CLOZAPINE- Increased risk of agranulocytosis, myocarditis, intestinal obstruction and hypersalivation
Patients with schizophrenia are likely to smoke but the hydrocarbons in cigarette smoke induce the cytochrome P450 enzymes which decreases the serum levels of the anti-psychotic medication. The levels of CLOZAPINE are the most affected so when the patient stops smoking, the CLOZAPINE levels increase and so there will be an increased risk of seizures. The CLOZAPINE levels need to be monitored.