BY P.M.EMEKA COCP-KFU
Learning Objectives
Define psychosis. How they interact with neurotransmitters. MOA, clinical uses and adverse effects. Recognize the importance of therapeutic effects produced by drugs in the treatment of mood disorders. Describe the side-effects, toxicities and druginteractions for MAO inhibitors. Discuss the roles of lithium in treatment of mood disorders.
Definition
Psychosis is a severe mental disorder in which there is extreme impairment of ability to think clearly, respond with appropriate emotion, communicate effectively, understand reality and behave appropriately.
Psychosis are among the most severe psychiatric disorders, in which there is not only marked impairment of behaviour, but also a serious inability to a. Think coherently. b. Comprehend reality. c. Gain insight into the presence of these abnormalities.
Their etiological basis Psychosis remains unknown, although generally the followings are thought to be proposed causative factors: Genetic, neurodevelopmental, and environmental factors.. Representative syndromes in this category include schizophrenia, brief psychoses, and delusional disorders. Psychotic features also occur in major mood disorders, particularly mania and severe melancholic depression. Psychotic illnesses are characterized by disordered thought processes (as inferred from illogical or highly idiosyncratic communications) with disorganized or irrational behaviour and varying degrees of altered mood that can range from excited agitation to severe emotional withdrawal.
Psychosis
The psychotic disorders include:Schizophrenia (delusions and auditory hallucinations). Manic phase of bipolar (manic-depressive) illness. Acute idiopathic psychotic illnesses. Other conditions marked by severe agitation.
Dopamine Hypothesis
1. Drugs that increase dopamine will enhance or produce positive psychotic symptoms
E.G. Cocaine, amphetamine.
2. All known antipsychotics drugs capable of treating positive psychotic symptoms block the dopamine receptors
Esp..D-2 receptors.
Management of Psychosis
It is very important to recognise and manage psychosis a first time correctly, as delay in diagnosis may adversely affect recovery. If there is an external cause like substance abuse this must be addressed. Remember that psychosis in substance abuse can be part of dual diagnosis.
Antipsychotics
All antipsychotics are considered equally effective
Rationale for determining which medication to use is based on side effect profile
Types of Antipsychotics
1. High potency typical antipsychotics bind to the D2 receptor with high affinity. As a result they have higher risk of extrapyramidal side effects. 2. Low potency typical antipsychotics have less affinity for the D2 receptors but tend to interact with non-dopaminergic receptors resulting in more cardiotoxic and anticholinergic adverse effects including sedation, hypotension.
Clinical Consequences of Dopaminergic D2 Blockade: Extrapyramidal movement disorders Endocrine changes Sexual dysfunction. Possible Clinical Consequences of histamine H1 Blockade: Sedation, drowsiness Weight gain Hypotension. Possible clinical consequences of alpha-1 receptor blockade: Postural hypotension Reflex tachycardia Dizziness. Possible clinical consequences of muscarinic receptor blockade: Blurred vision, Dry mouth, Sinus tachycardia, Constipation Urinary retention, Memory dysfunction.
Classification of Antipsychotics
The original classification of antipsychotics according to their chemical structure.
Treatment involves
Immediate discontinuation of antipsychotic Hydration Maintain vital functions Use bromocriptine and dantrolene.
Clozapine
Mechanism of Action: Weak D1=D2 block. High 5-HT2 block Alpha1, Alpha 2, H1, M1 Clinical Uses: Schizophrenia, as a mood stabilizer low EPS. Side Effects: Agranulocytosis. Do not use with Carbamazepine or other bone marrow suppressors. Sedation, Dizziness, orthostatic hypotension, Hypersalivation, Weight Gain.