Psychosis abnormal condition of the mind Signs and

• Psychosis: abnormal condition of the mind Signs and symptoms • • Hallucinations Delusions Thought disorder Lack of insight The word psychosis was first used by Ernst in 1845

What are antipsychotis? • Neuroleptic drugs • The term antipsychotic is applied to a group of drugs used to treat psychosis

Classification 1. Phenothiazines Chlorpromazine, Thioridazine, Fluphenazine 2. Butyrophenones Haloperidol , Penfluridol 3. Thioxanthines Thiothixene 4. Atypical neuroleptics Clozapine, Olanzapine, Risperidone 5. Other Heterocyclics Reserpine, Loxapine

CHLORPROMAZINE PHARMACOLOGICAL ACTIONS 1. CNS a) Normal individuals indifference to surroundings paucity of thought emotional quietening tendency to sleep

b) In a psychotic patient ↓irrational behavior, agitation ↓ aggressive behavior normalize disturbed thought relieve anxiety suppress hyperactivity sedation lower seizure threshold

MOA • POTENT D 2 RECEPTOR BLOCKER • Blockade of Dopaminergic actions in the temporal & pre-frontal areas constituting the limbic system & in mesocortical areas is responsible for its antipsychotic action

2. ANS α adrenergic blocking activity Anticholinergic property 3. Local anaesthetic potent local anaesthetic 4. CVS postural hypotension reflex tachycardia 5. Endocrine ↑ prolactin level ↓ GH & Gonadotropin levels

Pharmacokinetics • • • Unpredictable oral absorption IM/IV : consistent effect High plasma protein bound Half life: 18 -30 hours Excretion : urine & bile

Adverse Effects CNS • Drowsiness, lethargy, mental confusion • Aggravation of seizures ANS • postural hypotension, palpitation • Dry mouth, constipation, urinary hesitancy

Adverse Effects Endocrine • Amenorrhea, infertility • Gynecomastia, galactorhoea

Adverse Effects Extrapyramidal Disturbances 1. Parkinsonism tremor, rigidity, akinesia, gait Treatment: Benzhexol, Amantadine

Adverse Effects Extrapyramidal Disturbances 2. Acute muscular dystonias muscle spasms, torticollis, locked jaw common in children (girls) Treatment: Benzhexol, Promethazine

Adverse Effects Extrapyramidal Disturbances 3. Akathesia restlessness, feeling of discomfort desire to move about

Adverse Effects Extrapyramidal Disturbances 4. Malignant Neuroleptic Syndrome rigidity, immobility, tremor, fever semiconsciousness fluctuating BP Treatment: Dantrolene IV

Adverse Effects Extrapyramidal Disturbances 5. Tardive Dyskynesia involuntary facial & limb movements common in elderly women

Adverse Effects miscellaneous • • Weight gain Increased blood sugar Blue pigmentation of skin Skin rashes, urticaria, dermatitis

Therapeutic Uses 1. PSYCHOSES a) Schizophrenia b) Mania 2. ANXIETY 3. ANTIEMETIC