Pushpendra kumar

Pushpendra kumar

Content of talk
Introduction Main cause Pharmacological effect Pharmacokinetic effect Adrs Interaction Use

Psychoses

Psychosis (from the Greek "psyche", for mind/soul, and - "-osis", for abnormal condition) means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality".

A/ (Gelder, Mayou & Geddes 2005) That the term psychosis is not sufficient as some illnesses grouped under the term "psychosis" have nothing in common. classification : 1. cognitive disorder (acute and chronic organic brain syndrome i.e. delurium and dementia .) 2. functional disorder(i.e. schizophrenia,paranoid states,)

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Organic conditions are primarily medical or pathophysiological, whereas, functional conditions are primarily psychiatric or psychological. Psychiatric Functional causes of psychosis include the following: brain tumors drug abuse amphetamines, cocaine, marijuana, alcohol[8] among others brain damage schizophrenia, schizophreniform disorder, schizoaffective disorder, brief psychotic disorder

6.bipolar disorder (manic depression) 7.severe clinical depression 8.severe psychosocial stress 9. sleep deprivation 10.some focal epileptic disorders especially if the temporal lobe is affected 11.exposure to some traumatic event (violent death, etc.) 12.abrupt or over-rapid withdrawal from certain recreational or prescribed drugs

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Affective disorder Mania Depression Manic-depressive (bipolar disorder)

General Population Risk for Psychosis

% of population

General

Population

At risk group Psychosis group

Vulnerability to Psychosis

Mania

When someone is in a manic "high," he may be overactive, overtalkative, and have a great deal of energy. He will switch quickly from one topic to another, as if he cannot get his thoughts out fast enough; his attention span is often short, and he can easily be distracted. Often, he shows poor judgment in these ventures. Mania, untreated, may worsen to a psychotic state.

Causes

What is the cause of manic depression? Genetic Factor Abnormal Brain Activity Neurotransmitters Infectious Agents Like Viruses Super-fast Biological Clock

Types/Common Terms

Bipolar I- Most severe, obscures normal functioning, hospitalization common Bipolar II- Hypomanic,Full manic episodes rare. Depression often still severe Cyclothymia- Milder form of BP II, Bipolar Spectrum Disorder Rapid Cycling- 4 or more episodes in a 12 month period,may not be permanent

Effects:

Estimated 1 out of 4-5 commit suicide from inadequate or no treatment Onset of illness around 25 yrs old and untreated, often results in loss of approx. 9 yrs of life, 14 yrs of activity, 12 of normal health Prime candidates for lifetime treatment express at least 2 episodes of mania

Mania vs. Depression:Treatment options

Manic Episode- anti-psychotics (ex. Zyprexa), or benzodiazepines (sedating) Depressive Episode- temporary coadministration with antidepressants As a whole- mood stabilizers, classicallyLithium. Anti-epileptics are also currently being used ( Tegretol, Depakote, Neurontin, Lamictal)

Antimanic drugs
Lithium Widely recommended treatment for Bipolar Disorder 60-80% success in reducing acute manic and hypomanic states However issues in non-compliance to take medication, side effects, and relapse rate with its use are being examined in terms of being the best option

History

1920s- used as a sedative, hypnotic, and anti-convulsant 1940s- investigated as a salt substitute for heart disease patients -How did this work out? - Poorly- many people died from toxicity - The Doctors decided that maybe it wasnt such a good idea

History Cont.

1949- experiments with animals led to lethargy, and use for acute mania. The logic was simply to make them too tired to run out and repaint the entire house, have wild sex and go shopping This is where non-compliance fits in (seen in up to 50% of patients) the patient feels they are being robbed of their fun by taking meds, so they give them up.

More On Non-compliance

Other reasons patients refuse meds: -weight gain - less energy, productivity - feel disease has resolved, no longer need medication Relapse rate is high regardless of withdrawal being gradual or acute, suicide risk back up episodes are often worse than original symptoms, so treatment is often life-long

So where does this leave us?

Since its discovery, Lithium has been found to be superior to placebo In recent years though, efficacy is being questioned: -Long term results not as good as expected -28% discontinue use, 38% experience relapse on the drug *Even so, it is widely prescribed, demonstrates considerable efficacy, and reduction in mortality risks

Pharmacokinetics:

Peak blood levels reached in 3 hrs, fully absorbed in 8 hrs Absorbed rapidly and completely orally Efficacy correlates with blood levels Crosses blood-brain barrier slowly and incompletely Usually taken as a single daily dose

Kinetics Cont.

Approx. 2 wks to reach a steady state within the body of oral dose excreted in 18-24 hrs,rest within 1-2 wks Recommended .75-1.0 mEq/L, optimum would be .5-.7 mEq/L, with 2 mEq/L displaying toxicity Metabolized b/f excretion

Important:

Because of its resemblance to table salt, when Na+ intake is lowered or loss of excessive amounts of fluid occurs, blood levels may rise and create intoxication

Pharmacodynamics

No psychotropic effect on non-Bipolars Affects nerve membranes, multiple receptor systems and intracellular 2nd messenger impulse transduction systems. Interacts with serotonin Potential to regulate CNS gene expression, stabilizing neurons w/ associated multiple gene expression change.

Action and mechanism

Side Effects and Toxicity

Relate to plasma concentration levels, so constant monitoring is key Higher concentrations ( 1.0 mEq/L and up produce bothersome effects, higher than 2 mEq/L can be serious or fatal Symptoms can be neurological, gastrointestinal, enlarged thyroid, rash, weight gain, memory difficulty, kidney disfunction, cardiovascular Not advised to take during pregnancy, affects fetal heart development

Combination Therapy

Combination therapy with Lithium and antiepileptics may demonstrate better protection against relapse, greater therapeutic efficacy, and studies support this as a rule vs. an exception

Illegal Drug Use

More than 55% of Bipolar patients have a history of drug abuse Some abuse might occur before the first episode, or after diagnosis Used by some as a way to self-medicate

If Lithium Doesnt Work

40% of Bipolars are resistant to lithium or side effects hinder its effectiveness Therefore, we must consider alternative agents for treatment Carbamazepine (Tegretol) Valproic Acid (Depakote) Gabapentine Topiramate Lemotriagine

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Hallucinogens

The term "hallucinogen" is a misnomer because these drugs do not cause hallucinations at typical doses. Hallucinations, strictly speaking, are perceptions that have no basis in reality, but that appear entirely realistic. . Deliriants, such as diphenhydramine and atropine, may cause hallucinations in the proper sense .

Pharmacological classification
Psychedelics (5-HT2A receptor agonists)

Tryptamines

Lysergamides Amphetamines

Phenethylamines

Piperazines

Cannabinoids (CB-1 receptor agonists) Dissociatives

NMDA receptor antagonists -Opioid receptor agonists

Deliriants (anticholinergics)