UNIT-VI. BIO-PSYCHO AND SOCIAL THERAPIES

(a).Psychopharmacology-Definition, Classification of drugs antipsychotic, antidepressants, sedative, antianxiety, anti parkinson.

PSYCHOPHARMACOLOGY

Definition: Psychopharmacology is the study of medicine used for the treatment of mental disorders. Medicines that affect mental function, behavior or experience are called psychotropic medicines.

CLASSIFICATION OF PSYCHOTROPIC DRUGS

(Classification of Psychotropic Drugs)

•Antipsychotic drugs

•Antidepressants drugs

•Anxiolytic drugs

• Mood stabilizer drugs

•Stimulants drugs

•Depressants drugs

ANTI-PSYCHOTICS DRUGS

*Antipsychotic drugs are also called major tranquilizers or neuroleptics or anti-schizophrenic drugs.

*Antipsychotic drugs are used to treat thought process and psychotic disorders.

Classification Of Anti-Psychotic Drugs

1.Typical Antipsychotic (First Generation Antipsychotic)

• 2. Atypical antipsychotic (second generation antipsychotic)

1. Atypical Antipsychotic (First Generation Antipsychotic)

*Effective for positive symptoms of schizophrenia like hallucinations, aggression and delusions.

• Haloperidol

*Chlorpromazine

• Fluphenazine
• Pimozide

*Trifluperazine

*Chlorprothiazine

• Dapiczole

*All these drugs are typical or first generation antipsychotic drugs.

•2. Atypical Antipsychotic (Second Generation Antipsychotic)

*Effective for negative symptoms of schizophrenia like alogia, apathy.

*Clozapine

• Olanzapine
• Aripiprazole

*Risperidone

*Acenapine

• Ziprasidone

*All these drugs are called atypical or second generation anti-psychotic drugs.

Mechanism Of Action

(Mechanism of Action)

*Work as antidopaminergic drugs that block the D2 receptor of the dopamine pathway in the brain, meaning that the dopamine released from the pathway has less effect. Increased release of dopamine in the mesolimbic pathway is linked to psychotic experience.

Indication Of Anti-Psychotics Drugs

*Schizophrenia

*Bipolar disorders

*Mania

*Psychotic depression

*Delusional disorders

*PTSD (Post Traumatic Stress Disorders)

*OCD (Obsessive Compulsive Disorders)

*Postpartum psychosis

*Anxiety

*Insomnia

• Autism
• Tourette syndrome

*Asperger syndrome

*Acute brain syndrome

Contraindication Of Anti-Psychotic Drugs

*History of severe allergy

*Comatose state

• Hypersensitivity
• Liver, kidney and heart disease

*Do not combine with alcohol, barbiturates, narcotics.

Side Effect Of Anti-Psychotic Drugs

•EPS (Extra Pyramidal Symptoms)

*EPS is seen due to long time use of antipsychotic drugs.

*EPS includes akathisia, pseudoparkinsonism, acute dystonia, tardive dyskinesia, and akinesia.

Akathisia:

• It is a movement disorder in which the person cannot stand or sit properly.
• Pseudoparkinsonism:
• Clinical features of parkinsonism such as rigidity, tremors, weakness and fatigue are seen.
• Acute dystonia:

*This includes involuntary muscle contractions such as neck spasm (torticollis). Dystonia affects more than one body part and sometimes affects the entire body.

Tardive dyskinesia:

• Uncontrolled and involuntary muscle movements are seen, in which tremors (shaking) occur in the body.

•NMS(Neuroleptic Malignant Syndrome):

*Neuroleptic malignant syndrome (NMS) is a life threatening neurological emergency associated with the use of antipsychotic (neuroleptic) agents and is characterized by mental status changes, fever and rigidity.

*EPS is mostly caused by side effects of haloperidol and fluphenazine.

*Anticholinergic medicine benzotropine is useful for treatment of EPS.

*Other Side-Effect

• Dry mouth

•Dizziness

• Tachycardia
• Hypotension

•Blurred vision

• Constipation

•siezure

• Diabetes mellitus

Tremor

• Stiffness

•Sexual dysfunction

• Lethargy

Nursing Responsibility

*To check patient’s vital sign before and after administering medication.

*Physiological and psychological assessment before giving medication.

*Maintain weight chart of patient.

*Giving instructions to the patient to intake more water so that dry mouth does not occur.

*Ask the patient to take high fiber diet so that constipation can be prevented.

*Assess the side effects of the medication and ask the patient to tell about the discomfort caused by it.

*Assessment of tremors, rigidity and muscle movement.

• If it is not safe to use during pregnancy, be careful and it is also excreted from breast milk.

ANTIDEPRESSANTS DRUGS

*Antidepressants drugs are also called mood elevators or thymoleptic drugs. Which is used to treat the patient of depression. Antidepressants are used for the treatment of many types of affective disturbance.

Indication Of Antidepressant Drugs

• Depression

*Depressive episodes

• Dysthymia
• Reactive depression

*Secondary depression

*Abnormal grief reaction

•Childhood Psychiatric Disorders

• Enuresis

*Separation anxiety disorder

*Somnambulism (sleep walking)

*School phobia

• Other psychiatric disorders

*Panic attack

*Agoraphobia, Social phobia

*Depression with or without OCD

*Eating disorders

*Borderline Personality Disorder

*Post Traumatic Stress Disorder

*Depersonalization syndrome

Classification Of Antidepressants Drugs

1.SSRIs(Selective Serotonin Reuptake Inhibitors) Antidepressants.

2.TCAs (Tricyclic Antidepressants).

3.MAOI(Mono-Amine Oxidase Inhibitors).

1.SSRIs(Selective Serotonin Reuptake Inhibitors) Antidepressants.

*SSRIs work by inhibiting serotonin reuptake so that the serotonin level in the synapse increases which acts as a mood elevation in the patient.

• Fluoxetine
• Fluvoxamine

*Sertraline

*Citalopram

• Acetalopram

All these drugs are SSRI antidepressants.

Mechanism Of Action Of SSRIs (Mechanism of Action)

*Selective serotonin reuptake inhibitors (SSRI) are a type of medicine used as antidepressants. It inhibits the serotonin reuptake transporter (SERT) protein, which transfers serotonin (5-hydroxytryptamine or 5-HT) from the synaptic cleft to the presynaptic axon terminal. Therefore, SSRIs increase serotonin levels in the synaptic cleft.

2.TCAs (Tricyclic Antidepressants)

• Tricyclic antidepressants are the oldest class of antidepressants. TCAs are the first generation antidepressant medications. It is used sparingly because its side effects are very high.
• Imipramine

*Amitriptyline

• Clomipramine

*Dazipramine

• Nortriptyline

*Doczepine

All these drugs are TCAs antidepressants.

Mechanism Of Action Of TCAs

*TCAs (tricyclic antidepressants) block the reuptake of neurotransmitters such as serotonin and norepinephrine.

MAOIs ((mono-amine oxidase inhibitors).

*It is an antidepressant type of medicine, MAOIs are used when other antidepressant medications are ineffective.

*Isocarboxazide

*Phenelzine

*Celegiline

• Tranylcypromine

All of these medications are MAOIs antidepressants.

Mechanism Of Action Of TCAs

• It blocks the mono amine oxidase enzyme which breaks down some neurotransmitters like dopamine, serotonin, nor epinephrine and improves the person’s mood.

Contraindication Of Antidepressants Drugs

• SSRIs

*Pregnancy

*Children

• Liver disease

*seizure

•TCAs

*elderly person

*Pregnancy

• Glaucoma
• Cardiac disease

*Parkinson’s disease

• MAOIs

*Hypertension

*Cerebrovascular disease

*CHF (Congestive Heart Failure)

• Liver disease

Side Effect Of Antidepressants

• Dry mouth

•Weight gain or loss

•Sexual problems

•Agitation

• Head one

•Skin rash

• Constipation

•anxiety

• Confusion

•Dizziness

• Tremors
• Seizures
• Stroke
• Hepatitis

•Nozia

• Diarrhea
• Insomnia
• Anorexia

•Blurred vision

• Drowsiness
• Confusion

Nurse’s Responsibility

• Observing side effects and monitoring changes is very important to prevent complications due to antidepressant medication.

*Giving instructions to the patient to take more fluid intake so that dry mouth does not occur.

*Patient’s weight chart should be maintained and small frequent diet should be given.

• Do not give medicine on empty stomach as the patient complains of nosia and vomiting.
• Suicidal tendency should be assessed and prescribed medicine should be given and its side effects should be explained.

*Maintain intake output chart of patient.

*If the patient complains of dizziness, he should be made to slowly get up and sit on the bed before standing up. These symptoms may be due to orthostatic hypotension.

*Blood pressure and pulse should be monitored at regular intervals

ANXIOLYTIC DRUGS

*Anxiolytic medicines are known as sedatives or hypnotics and antienzymatic medicines.

*These drugs relieve anxiety and induce sleep.

Indication Of Anxiolytics

•anxiety

• Insomnia

•Phobic neurosis

•Preoperative sedation

Mechanism Of Action

*These drugs increase the level of GABA (gamma amino butyric acid) in the brain. GABA is an inhibitory neurotransmitter. It reduces the neuronal activity of the brain, due to which the anxiety level decreases.

Classification Of Anxiolytic Drugs

1. Benzodiazepines :

• Benzodiazepines are currently the first line drug of choice for anxiety and insomnia. If benzodiazepines are used continuously for more than 6 months, dependency may occur.

*Common benzodiazepines medications include diazepam, clonazepam, alprazolam and chlordiazepoxide.

2. Barbiturates :

*Barbiturates are rarely prescribed. They are used when benzodiazepines and non-benzodiazepines fail and are useful for short term treatment of severe insomnia.

*Phenobarbital, Butalbital and Primidone are barbiturates medicines.

3.Azapirones:

*Azapirones are a group of medicines that work on the 5-HT1A receptor and are used to treat generalized anxiety disorders (GAD).

*Buspirones are drugs of the common azapirones group.

4. Sedatives Antihistamines

*It is also used as a primed before anesthesia or for sedation after anesthesia due to its sedative properties.

*Hydroxyzine is a sedative antihistamine.

Side-Effect Of Anxiolytics Drugs

• Confusion

*Depression

*Dizziness

*Muscle weakness

• Memory loss

*Hypotension

*Low heart rate

*Blurred vision

*Insomnia

*Hallucinations

• Toxicity

*Slurred speech

*Disorientation

Contraindication Of Anxiolytics

• Hypersensitivity

*Myasthenia gravis

*Sleep apnea

• Liver disease

*Pregnancy and breast feeding

*Alcohol and drug abuse history

*Shock and Coma

Nurse’s Responsibility

*Monitoring patient response to therapy and observing side effects of drugs.

• Do not change the doses of drugs without consulting a doctor.

*Do not use drugs in combination with CNS depressants like alcohol etc.

• Asking the patient to avoid caffiene will provide safety to the patient.
• To assess the toxicity of drugs.

MOOD STABILIZER

• Mood stabilizer drugs are also called anti-manic drugs. These drugs are used for the management and treatment of mood disorders like mania and bipolar.

Classification Of Mood Stabilizer

1.Lithium Carbonate :

*Lithium carbonate is the oldest and well known mood stabilizer. Lithium carbonate is the drug of choice for mania and is effective for the treatment of bipolar disorder.

Mode Of Action Of Lithium

• At the neuronal level, lithium decreases dopamine and glutamate but increases inhibitory (GABA) neurotransmission, which is helpful in stabilizing mood and preventing manic episodes.

Indication Of Lithium

• Mania

•Bipolar disorders

•Schizoaffective disorders

• Recurrent depression
• Mood disorders

Contraindication Of Lithium

• Allergies

•Severe kidney disease

•Severe heart disease

•Hypothyroidism

•Severe dehydration

Side Effects Of Lithium

•hand tremors

• Increased urination

•Weight gain

•Nozia

• Vomiting
• Kidney problems
• Thyroid problems

•Low sodium level

Toxicity

*Lithium has a therapeutic value of 0.6 to 1.2meq/L. If the level of lithium increases in the blood, then toxicity occurs.

2. Anticonvulsants:

*Some anticonvulsants are mood stabilizers medications.

•Valporic acid

• Lamotrigine

•Carbamazepine

Nurses Responsibility

*To monitor vital signs specially monitor pulse and blood pressure.

• To assess the level of lithium toxicity in the patient.

*If the level of lithium in blood exceeds 2 meq/L, symptoms like vomiting, severe diarrhoea, albuminuria and hypotension are seen.

*Ask patients on lithium therapy to take a high sodium diet.

*Lithium has a teratogenic effect (harms the fetus) in the ante-natal mother.

STIMULANTS

*Psychoactive drugs that temporarily improve physical and mental function.

*Stimulants are widely used as prescription medicine as well as over-the-counter (illegally).

• Prescribe stimulants : amphetamine, ephedrine, caffeine, nicotine etc.

*illicit (illegal) stimulants: cocaine, crack cocaine, methamphetamine

Mechanism Of Action

*Resolved around increased catecholamine levels and agonist activity on adrenergic receptors.

*Caffeine has a unique action that works as an inhibitor on the adenosine receptor.

Indication

(indication)

*Attention Deficit Disorder.

*Chronic lethargy.

*Morbid obesity.

*Narcolepsy.

*Neonatal apnea

*Prolonged depression

*Cognitive disturbance

Side-Effect

side effect)

• Stomach upset
• Head one

*Hypertension

*insomnia

*Irritability

• Weakness
• Tremors

*Anorexia

*Nozia

• Vomiting

*cramps

Nurses Responsibility

*Level of dependency and abuse should be monitored during therapy.

*To monitor vital signs specially monitor pulse and blood pressure.

*Monitoring patient response to therapy and observing side effects of drugs. * Weight chart and intake