PSYCHO

PHARMACOLOGY
bY
Dr. Alit Aryani SpKJ
Dept Of Psychiatry Faculty of Medicine Udayana University/
Sanglah Hospital Denpasar

BIOLOGICAL THERAPY

THERAPY

DRUG THERAPY
ELECTRO CONVULSIVE
THERAPY
SURGICAL THERAPY

PSYCHO THERAPY

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Benzodiazephine Receptor Agonists and

Antagonists
Dopamine Receptor Antagonists (Typical Anti
Psychotic)
Serotonin Dopamine Antagonists (Atypical
Antipsychotic)
Tricyclic and Tetracyclic Antidepresant
Selective Serotonin Reuptake Inhibitor (SSRI)
Selective Serotonin Norepinephrine
Reuptake Inhibitors (SSNRI)
Lithium

Benzodiazephine Receptor
Agonists and Antagonists
Benzodiazepine are sometimes classified as sedative hypnotic,
althrough other drugs can also be classified in this group
Barbiturates
Benzodiazepine the activity of the GABA Receptor
1. Diazepam (Valium)
2. Lorazepam (Ativan)
3. Alprazolam (Xanax)
4. Estazolam (Pro Som, Esilgan)
5. Clorazepate (Tranxene)
6. Clobazam (Frizium)
7. Clonazepam (Riklona)
8. Etc
Benzodiazepine are drugs of choice for management of acute anxiety
and agitation
Mechanism of action GABA. NT

Therapiutic Indication
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Anxiety generalized anxiety disorders, adjusment disorders with

anxietas
Mixed anxiety Depressive Disorders Alprazolam
Panic Disorders and Social Phobia : Alprazolam, Clonazepam,
Antidepressant Paroxeline, Sertraline also been approved
Obsessive Compulsive Disorders and Postraumatic Stress Disorders
Clonazepam
Insomnia : Flurazepam, Estazolam, Temazepam, Triazolam
Depression : alprazolam has anti depressant effect equal to the
Tricyclic drugs
Bipolar I Disorders (Mania) Clonazepam is effective for maniac
episodes as an adjuvant to lithium
Akathisia : benzodiazepines Diazepam also effective. The first line
drug for akathisia propranolol (Inderal)
Parkinson desease effective with Zolpidem dosages 10 mg 4
time/daily

Withdrawal Symptoms of
Benzodiazepine
Anxiety,

Irritability, Insomnia, Fatigue,

Headace, Muscle Tevitching, Sweating,
Dizzines, Concentration Difficultis, Nausea,
Depression, Depersonalization, Increased
Sensory Perception, Derealization.
When benzodiazepine are used for short
periods 1 2 weeks
In moderate dosages No significant tolerance,
dependence or withdrawal effects.
Benzodiazepine Receptor Antagonist : Flumazenil
used to overdosage of Benzodiazepine.

Dopamine Receptor Antagonists

(DAs)
They

are high affinity Antagonist of Dopamin

Receptors.
Treatment of : Schizophrenia and other
psychotic disorders.
Include : Chlorpromazine (Promactil),
Thioridazine (Melleril) Haloperidol (Haldol)
Trifluoperazine (Stelazine) Fluphenazine
(Anatenzol).
Also called typical antipsychosis

: The Serotonin Dopamine

Antagonist (SDAs)
A new class of antipsychotic agent
Also called : Atypical anti psychosis :
Risperidon (Risperdal) Clozapine (Clozaril)
Quetiapine (Seroquell) Olanzapine (Zyprexa)
Ziprasidone, Aripifrazole (Abilify) which has
fewer Neurological side effect

Therapiutic Indications
1.
2.
3.
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7.

Primary Psychotic Disorders

Schizophrenia
Bipolar Disorders
Secondary Psychosis Organic Cause
Severe Agitation and Violent Behavior
Tourettes Disorders
Other Psychiatric and Non Psychiatric Indication
Anxiety
Nausea
Emesis
Hiccups
Ballismus

Adverse Reactions
1. Non Neurological
a. Cardiac effects prolong QT and PR Internal Chlorpromazine
b. Suddent Death
c. Orthostatic/postural hypotension adrenergic pressor agents
such as metazaminal (Aramine) and Norepinephrine a drugs of
choice in the treatment
d. Hematological effect : Leucopenia, agranulocytosis
e. Periferal anticholinergic effect : dry mouth, nose, blurred vision,
constipation urinary relention, mydriasis, nausea vomiting
f.
Endocrine effect : galactorrhea, amenorrhea, impotence, inhibited
Orgasm in women. Sexual adverse effects impotence treated with
sildenafil (viagra) has been successful
g. Weight gain
h. Dermatological effect pigmentation in retina
i.
Jaundice obstructive / cholestatic jaundice

2. Neurological adverse effects :

a. Neurological Induced Parkinsonism Tremor,
Rigidity treated with anticholinergic agents :
Triheyphenidil, diphenhidramin
b. Acute Dystonia : torticolis spasmodic in neck,
oculogyric crisis
c. Acute Akathisia Restlegsless syndromes
d. Tardive dyskinesia treated by GABA drugs,
Dopaminergic Agonist
e. Neuroleptic Malignan Syndromes
f.
Epileptogenic effect
g. Sedation Blockade of histamine tipe I Receptor

Tricyclic

and Tetracyclic Antidepressants

depression, panic, PTSD, OCD, eating
disorders and panic syndrome.
Therapiutic Indications
1. Major depressive Disorder
2. Mood disorder due to a general medical
condition (secondary Depression)
3. Panic disorder with agoraphobia
4. Generalized anxiety disorder
5. Obsessive compulcive disorder
6. Eating disorder anorexia nervosa, bulimia
nervosa
7. Pain disorder
8. Childhood Enuresis

Precaution and adverse

Reaction
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Psychiatric effect : Inducing Maniac episode

Anticholinergic effect : dry mouth, constipation, blurred
vision, urinary retention
Sedation : effect anti histamin
Autonomic effect : Ortostatic hypotension because an
adrenergic blockade
Cardiac effect : prolong QT internal, depressed ST, flattenal
T Waves
Neurological : myoclonic, atexia, tremor
Allergic, dermatological effect : Exanthematous Rashes,
agranulositosis
Weight gain : because blockade of histamine 2 (H2).
Impotence blockade dopamine receptor in tubero
infundibular tract

Selective Serotonin Reuptake

Inhibitors (SSRI)
First line agents for treatment of : Depression, Obsesive Compulsive Disorder, Panic
Disorder.
SSRIs included : Fluoxetin (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Fluvoxamine
(Luvox), Citalopram (Celexa).
Therapiute Indications
1. Depression
2. Suicide
3. Depression during pregnancy
4. Depression in the ederly and medically ill
5. Chronic depression
6. Depression in children
7. Anxiety disorders OCD, Panic, Social Phobia, PTSD, Bulimia, Anorexia, Obesity
8. Premenstruil dysphoric disorders
9. Premature ejaculation
10. Paraphilia
11. Autistic Disorders
12. Attention deficit hyperactive Disorder
13. Chronic pain Syndromes
14. Psikosomatic Conditions

Precaution and Adverse

Reactions
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Sexual disfunction inhibited Orgasm

Gastrointestinal adverse effect nausea, dearhea,
anorexia, vomiting
Weight gain
Headaches
Central Nerrous System adverse effect anxiety,
insomnia, severe vivid dream, nightmare
Anticholinergic effect : dry mouth, constipation,
sedation. Extrapyramidal symptoms : tremor, akatisia
Serotonin syndromes : tremor, dearhea, atoxia,
myoclonus, hyperthermia, delirium, status epileticus,
coma

Mono Amine Oxidise Inhibitor

(MAOI)
Are higly effective antidepressants, by inhibiting degradation of biogenic amines
serotonine, dopamine, norapinephrine. But less frequently used because of the dietory
precuations that must be followed to used avoid tyramine induced hypertensive crisis.
MAOIs include : phenelzine (Nardil) isocarboxazid (Marplan) tranylcypromine (parnate),
selegiline (Eldepryl)
Therapuitic Indication
1. Depression characteristic by hypersomnia, hyperphagia, anxiety
2. Panic with Agoraphobia, Posttraumatic disorder, eating disorder, social phobia, pain
disorder
Precaution and Adverse Reaction
3. Orthostatic hypotensia
4. Insomnia
5. Weight gain
6. Oedem
7. Sexual disfunction
8. Tyramine induced hypertensive crisis
9. Withdrawal : mood desturbances, somatic symptom
10. Overdosis : Agitasi, hypertermia, coma
Reversible Inhibitors Mono Amine Oxidase (RIMAs) Moclobemide (Aurorix)

Serotonin Norepinephrine
Reuptake Inhibitor (SNRI)
Venlafaxine (Effexor) is an effective
antidepressant drug that may have a faster
onset of action than other antidepressant
drugs when the dosage is increased rapidly.
Venlafaxine is potent inhibitor of serotonin
and norepinephrine and weak inhibitor of
Dopamine reuptake
Duloxetine (Cymbalta)

Therapiutic Indications
1.

2.
3.

Depressions with melancholic features 200 mg

venlafaxine/day may respond in 2 weeks
Generalized anxiety disorder dosage 75 to 225 mg/day
Other indication : obsessive compulsive disorder,
agora phobia, social phobia, attention dificit
hyperactivity disorder, chronic pain syndromes

Precaution and adverse Reactions

The most cammon reaction are : nausea, somnolence,
dry mouth, dizzines, nervousness, constipation,
asthenia, anxiety, anorexia, blurred vision, abnormal
ejaculation and orgasm

Thank You