!Mental Disorders!
Schizophrenia
Most common type of psychosis. Can be debilitating and prevent individuals from functioning in society.
Characteristics
Hallucinations, paranoia, delusions, speech abnormalities, and affective problems.
Bipolar Disorder (Manic Depression)
involves extremes of depression alternating with hyperactivity and excitement.
Condition may reflect a biochemical imbalance followed by over compensation on the part of neurons and their inability to reestablish stability.
Narcolepsy
disorder may reflect problems with stimulation of the brain of the brain by the reticular activating system (RAS) or problems with response to that stimulation.
Characterized by daytime sleepiness and sudden periods of loss of wakefulness.
Attention deficit disorder
usually diagnosed in school-aged children but can occur in adults. Girls are usually diagnosed later than boys.
Characterized by an inability to concentrate on one activity for longer than a few minutes and a state of hyperkinesis.
Antipsychotic and Neuroleptic Drugs
Essentially are dopamine receptor blockers that are used to treat disorders that involve thought processes. (Because of their neurological ARs, also called Neuroleptic drugs).
Notes to consider:
psychotherapeutic agents are used in children, often in combination with other CNS drugs, but long term effects are not known.
The doses in children are often higher than in adults
Lithium does not have an established pediatric dose and should not be ordinarily used in children. If it is, the dosage should be calculated by child's age and weight, and should be adjusted to maintain a level between 0.8 and 1.2 mEq/L. Pt's using lithium should be encouraged to drink plenty of fluids and maintain salt intake. Monitor serum lithium levels.
Positive Symptoms: Symptoms that add to normal behavior
Negative Symptoms: Symptoms that subtract from normal behavior.
Two Classes:
Typical Antipsychotics
Atypical Antipsychotics
ACTION: Typical Antipsychotic medications block dopamine receptors, preventing stimulation of the postsynaptic neurons by dopamine. Typical Antipsychotics suppress the RAS, limiting stimulation coming into the brain. R/T their dopamine receptor site blocking actions, they also have anticholinergic, antihistamine, and alpha-adrenergic blocking effects.
INDICATION:
schizophrenia and manifestations of other psychotic disorders such as hyperactivity, combative behavior, and severe behavioral problems in children; Also some for bipolar disorder.
ACTION:block both dopamine and serotonin (5HT) receptors (dual action may help alleviate some of the unpleasant neurological effects and depression associated with the typical antipsychotics)
INDICATION: same as previously mention on that side <
Contraindications In Typical and Atypical Antipsychotics:
Underlying CNS depression, circulatory collapse, parkinsons disease, coronary disease, severe HoTN, prolonged QT interval.
ADVERSE REACTIONS:
Sedation, weakness, tremors, drowsiness, extrapyramidal effects, dry mouth, nasal congestion,
Extrapyramidal Effects: (Dystonia, Akathisia, Pseudoparkinsonism, Tardive dyskinesia).
DRUG-DRUG Interactions:
antipsychotics and beta blockers could increase effects of both drugs.
Antipsychotics and alcohol combination increases CNS depression risk.
Antipsychotic-anticholinergic combinations lead to increase anticholinergic effects.
Thioridazine and ziprasidone.
PROTOTYPE: chlorpromazine (generic)
IND: management of manifestations of psychotic disorders, relief of preoperative restlessness, adjunctive treatment of tetanus, acute intermittent porphyria, severe behavioral problems in children, and CONTROL OF HICCUPS, nausea, and vomiting.
Acts: Previously stated.
ARs: Drowsiness, insomnia, vertigo, extrapyramidal symptoms, orthostatic HoTN, photophobia, blurred vision, dry mouth, nausea, vomiting, anorexia, urinary retention, photosensitivity.
PROTOTYPE: clozapine (Clozaril)
IND: management of severely ill pts with schizophrenia who are unresponsive to standard drugs; * reduction of recurrent suicidal behavior in pts with schizophrenia or schizoaffective disorders.
ACTION: as stated in chain of chart.
ARs: drowsiness, sedation, seizures, dizziness, syncope, headache, techycardia, nausea, vomiting, fever, neuroleptic malignant syndrome.
NOTE: do not stop drug abruptly, urine may be pink/reddish brown, fluids and ice chips should be heavily encouraged.
Other atypical antipsychotics:
aripiprazole (Abilify)
quetiapine (Seroquel)
risperidone (Risperdal)
ziprasidone (Geodon)
Other Typical Antidepressants:
haloperidol (Haldol)
Drugs for Bipolar Disorder (manic depression):
aripiprazole (Abilify) (a atypical antipsychotic) is for acute manic and mixed episodes of bipolar disorder.
quetiapine (Seroquel) (an atypical antipsychotic) is adjunct or monotherapy for treatment of manic episodes associated with bipolar disorder.
ziprasidone (Geodon) (an atypical antipsychotic) is also for acute manic and mixed episodes of BD.
Lithium (Standard antimanic drug) is a Prototype drug for treating manic episodes of BD and maintenance treatment of BD. Many ARs, not normally used in children, level should be maintained between 0.8-1.2mEq/L
IMPORTANT LITHIUM NOTE: Give with food or milk to alleviate GI upset.