PSYCHOPHARMOCOLOGY PRESENTERDR PRATEEK MODERATORDR ANIL KAKUNJE PSYCHOTROPIC DRUGS

PSYCHOPHARMOCOLOGY PRESENTER-DR. PRATEEK MODERATOR-DR. ANIL KAKUNJE

PSYCHOTROPIC DRUGS 1. 2. 3. 4. 5. Antipsychotics Antidepressants Mood stabilising drugs Anti anxiety Alcohol and other drugs of dependence + others 6. Antiparkinsonian drugs 7. Drugs used in dementia

• Psychotropic drugs acts on neurotransmitter via actions on • Neurotransmitter receptors • Storage • Release • Reuptake and Metabolism

Ideal Psychotropic Drug 1. Should cure the underlying pathology causing the disorder or symptom. 2. Should benefit all the patients suffering from that disorder. 3. Should have no side-effects or toxicity in therapeutic range. 4. It should have rapid onset of action.

5. Should be no dependence on the drug and no withdrawal symptoms on stopping the drug. 6. It should not be lethal in overdoses 7. It can be given in both inpatient and out patient settings

• • • ANTIPSYCHOTICS DRUGS Schizophrenia Schizoaffective disorder Acute psychosis Delusional disorder Delirium , Dementia, Delirium tremens

• • Pharmacokinetics- Well absorbed by Oral Intramuscular Intravenous injections.

CLASSIFICATION

• MECHANISM OF ACTION- Antidopaminergic activity of these drugs. • Antipsychotic drugs block D 2 -receptors • SIDE EFFECTS- Autonomic side effects include dry mouth, constipation , cycloplegia, urinary retention, mydriasis, delirium, orthostatic hypotension,

• Extra pyramidal side effects-Parkinsonism tremors, akathisia , acutedystonia, rabbit syndrome , neuroleptic malignant syndrome, tardive dyskinesia, seizure, sedation.

• ANTIDEPRESSANTS • Isoniazid (INH) was first antidepressant - 1951. • INDICATIONS • Depression • Depressive episode (major depression, endo genous depression) • Depressive episode with melancholia • Depressive episode with psychotic features (with antipsychotics or ECTs)

• Dysthymia (with psychotherapy) • Atypical depression (e. g. MAO inhibitors) • Secondary depression (e. g. in hypothyroidism, Cushing’s syndrome) • Abnormal grief reaction • Child Psychiatric Disorders • Enuresis (with or without behavior therapy) • School phobia

• • Separation anxiety disorder (in children) Somnambulism Night terrors Other Psychiatric Disorders Panic attacks (e. g. SSRIs) Agoraphobia Social phobia OCD (e. g. clomipramine, SSRIs)

• Generalized anxiety disorder (e. g. SSRIs) • Nicotine dependence (e. g. bupropion is used for treatment of craving) • Alcohol dependence (e. g. fluoxetine sometimes used for treatment of craving) Medical Disorders – • Chronic pain (in low doses, e. g. amitriptyline, duloxetine) • Migraine (as an adjuvant)

CLASSIFICATION

SIDE EFFECTS

MOOD STABILISERS • Treatment of Bipolar disorder • Acute management and maintenance treatment • Cyclothymia and impulse aggression • First line mood stabilisers are sodium valproate, Lithium and carbamazepine

ANTI ANXIETY DRUGS • Benzodiazepines –Indications 1. Generalized anxiety disorder 2. Panic disorder, agoraphobia, and school phobia 3. Agitated depression 4. Short-term treatment of insomnia 5. Nocturnal enuresis, somnambulism 6. Nightmares

7. Treatment of alcohol and other drug withdrawal syndromes 8. Antipsychotic-induced akathisia 9. Narcoanalysis or abreaction (IV diazepam)

CLASSICATION

MECHANISM OF ACTION

NEWER DRUGS 1. 2. 3. 4. Buspirone Zopiclone Zolpidem Zalpelon

OTHER DRUGS USED IN PSYCHIATRY • Anticraving agents like accamprosate, baclofen for alcohol deaddiction. • Deterrents like disulfiram which produce adverse drug reaction in the body. • Drugs used in treatment of dementia like donepezil , memantine.

THANK YOU