PsychoPharmacology Course

HISTORY

Presenter: Novlette Mattis-Robinson

(MPH/HP/HE, BPharm. RPh.)

Participants should be able to:

explain how psychiatric illnesses were handled
in the past
describe

current treatment strategies

employed in mental illnesses
identify

neurotransmitters found in the CNS

describe

the role of the various

neurotransmitters in the management of
psychiatric disorders

Prior to Psychotropic agents, management /

treatment of mentally challenged included;
Tortured in an attempt to drive out the
demon
Isolation (hidden cellars)
Jails
Home for the insane
Physical restraints e.g. Tranquilizer chair
Shock therapy
Drugs barbiturate, paraldehyde, chloral
hydrate

Treatment of psychotic conditions

revolutionized in early 1950s

Discovery of first antipsychotic agent

in 1952

Drug Chlorpromazine (typical agent)

Drug success, resulted in a variety of
structurally diverse antipsychotic drugs

Resulted in decline of hospitalized patients.

Discovery of Atypical antipsychotics in the

late 1980s

First Atypical Clozapine (approved and

marketed in the US in 1990)

Atypicals shown to be more effective in

managing negative symptoms of
schizophrenia

 Antipsychotic

drugs do not provide

permanent cure

Used

in conjunction with supportive

therapy

Many

cases resumption to function

in community versus prolonged or
permanent hospitalization

New trends also exist for antidepressants

Mostly Tricyclics used in earlier times

1950s

Selective Serotonin Reuptake Inhibitors

introduced in the 1970s now prescribed
more frequently

 Serotonin

and Norepinephrine
Reuptake Inhibitors- 1990s

Generally,

newer drugs show

evidence of fewer side effects
and less frequent dosing and
greater cost

Non-dopamine approach

Glutamatergic agents : e.g., Glycine

Cholinergic agents : e.g., Achesterase

Inh./nicotinic receptor modulator

Neuroprotective targets : e.g., COX-2

inhibitors or antioxidants (anti-apoptotic)

Other
Trancranial Magnetic Stimulation (TMS) versus
Electroconvulsive Therapy (ECT) - depression

 Brain
The

and spinal cord;

human brain highly complex

structure and is hailed the most
complex object in the universe
organ of the mind

 Responsible

for consciousness,
behaviour, memory, recognition,
learning and more highly developed
attributes such as imagination,
abstract reasoning, and creative
thought.

Serves

also, to coordinate vital

regulatory functions such as HR, BP,
respiration, salivary and gastric
secretions, muscular activity and
body temperature.

 Functions

depends on :
Action of certain neuronal agents
(neurotransmitters) located in
the brain and peripheral tissues
Neurotransmitters

exert their
action by interacting with
specific receptors

 Communication

in CNS occurs via

nerve impulses and
neurotransmitters

Neurotransmitter (NT) - a
chemical substance synthesized and
stored primarily in nerve terminals
until released by a nerve impulse.

The Neurotransmitter
is released from nerve ending
diffuses across synaptic cleft
interacts with suitable receptors
produces its effect (s)
Metabolized / deactivated
see example of Adrenergic neuron

Norepinephrine
Dopamine
Serotonin
Gamma Amino Butyric acid
Acetylcholine
Histamine
Glycine
Aspartate and Glutamate

Neurotransmitters Implications
Norepinephrine

Sensory perception and sleep pattern

Dopamine

Arousal and dreaming ; flight or fight

hormone

Gamma Amino
Butyric acid
(GABA)

Responsible for emotion, cognition

and motor function

Serotonin (5HT)

Eating , sleeping, sexual behaviour and

memory alteration

Others: Acetylcholine Cognitive function

The scientific study of the

actions of drugs and their
effects on mood, sensation,
thinking, and behavior.

Pharmacotherapy plays significant role in

approaches to the management of
psychiatric illnesses.
Reduces or alleviates symptoms
Allow client/patient an opportunity to participate
more easily with other types of therapy
Modifies behaviour temporarily (biochemical
changes)

Psychotherapy actions of drugs

(exogenous agents) reflect various
blockade or stimulating actions at
receptors of endogenous
neurotransmitters e.g.,
Dopamine
Serotonin
Norepinephrine
Acetylcholine

Effects of Pharmacotherapy depend on the

nature and directions of the effects
Additive
Potentiative
Antagonistic

Choice of psychotropic agents is influenced

by how clients symptoms match with
therapeutic advantages

From restraints to pharmacologic agents

Newer agents being discovered

The central nervous system the mind

Neurotransmitters in the CNS

Pharmacotherapy as support not a

cure.

Rang and Dale : Pharmacology , 2nd Ed. Churchhill

Harvey, Richard .A; Champe Pamela C. etal : Pharmacology

2nd , Lippincotts Wiliams & Wilkin, 1992

Craig, Charles R.; Stitzel, Robert E. : Modern pharmacology,

4th ed, Library of Congress Cataloging Publication Data,
1994

Dipiro, Joseph T. etal: Pharmacotherapy; A Pathophysiologic

Approach, 6th ed ; Mcgraw- Hill, medical publishing
Division , 2005

ttp://pubs.acs.org/subscribe/journals/mdd/v04/i05/html/05ti
meline.html

Other internet online reviews

Lectures Notes Dr. Delmore Tyrell Updated By N.

Mattis-Robinson June 2014