psycho pharmacology ii 13 juni

7/29/2019 Psycho Pharmacology II 13 Juni

1/18

BYDr. Wayan Westa, SpKJ(K)

Dept Of Psychiatry Faculty of Medicine Udayana University/Sanglah Hospital Denpasar


2/18

THERAPY

BIOLOGICAL THERAPY

DRUG THERAPY ELECTRO CONPULSIVE THERAPY SURGICAL THERAPY

PSYCHO THERAPY


3/18

1. Benzodiazephine Receptor Agonists and

Antagonists2. Dopamine Receptor Antagonists (Typical

Anti Psychotic)

3. Serotonin Dopamine Antagonists (Atypical

Antipsychotic)4. Tricyclic and Tetracyclic

5. Selective Serotonin Reuptake Inhibitor (SSRI)

6. Selective Serotonin NorepinephrineReuptake Inhibitors (SSNRI)

7. Lithium


4/18

as sedative hypnotic, althrough other drugs can alsobe classified in this group BarbuturatesBenzodiazepine enchane the activity of the GABAReceptor1. Diazepam (Valium)

2. Lorazepam (Ativan)3. Alprazolam (Xanax)4. Estazolam (Esilgan)5. Clorazepate (Tranxene)6. Clobazam (Frizium)

7. Clonazepam (Riklona)8. EtcBenzodiazepine are drugs of choice for management ofacute anxiety and agitation


5/18

1. Generalized anxiety disorders, adjusmentdisorders

2. Mixed anxiety Depressive Disorders

3. Panic Disorders and Social Phobia :

4. Obsessive Compulsive Disorders5. Postraumatic Stress Disorders

6. Insomnia

7. Bipolar I Disorders (Mania)8. Akathisia

9. Parkinson deseases


6/18

Anxiety, Irritability, Insomnia, ConcentrationDifficultis, Depression, Depersonalization,Increased Sensory Perception, Derealization.

Fatigue, Headace, Muscle Twitching,Sweating, Dizzines, Nausea,

When benzodiazepine are used for shortperiods 1 2 weeks

Benzodiazepine Receptor Antagonist :Flumazenil used to overdosage ofBenzodiazepine.


7/18

Treatment for : Schizophrenia and other psychoticdisorders.Include : Chlorpromazine (Promactil), Thioridazine(Melleril) Haloperidol (Haldol) Trifluoperazine(Stelazine) Fluphenazine (Anatenzol). Also called

typical antipsychosisA new class of antipsychotic agent : The Serotonin Dopamine Antagonist (SDAs)Also called : Atypical anti psychosis : Risperidon(Risperdal) Clozapine (Clozaril) Quetiapine

(Seroquell) Olanzapine (Zyprexa) Ziprasidone,Aripifrazole (Abilify) which has fewer Neurologicalside effect


8/18

1. Primary Psychotic Disorders2. Schizophrenia3. Bipolar Disorders4. Secondary Psychosis Organic Cause5. Severe Agitation and Violent Behavior6. Tourettes Disorders7. Other Psychiatric and Non Psychiatric Indication- Anxiety- Nausea- Emesis- Hiccups- Proritus- Ballismus


9/18

1. Non Neurologicala. Cardiac effects prolong QT and PR Internal

Suddent Deathb. Orthostatic/postural hypotensionc. Hematological effect : Leucopenia, agranulocytosisd. Periferal anticholinergic effect : dry mouth, nausea,

vomiting, blurred vision, constipation urinaryretention, mydriasis pupil

e. Endocrine effect : galactorrhea, amenorrhea,impotence, inhibited Orgasm in women. Sexualadverse effects impotence treated with sildenafil

(viagra)f. Weight gaing. Dermatological effect pigmentation in retinah. Cholestatic jaundice


10/18

2. Neurological effects :

a. Parkinsonism Tremor, Rigiditytreated with anticholinergic agents :Benztropine, (Cogentin) amantadine(Symmetrel) diphenhidramin (Benadryl)

b. Acute Dystonia : torticolis spasmodic,oculogyric crisisc. Acute Akathisia Restlegsless syrodromesd. Tardive dyskinesia

e. Neuroleptic Malignan Syndromes

f. Epileptogenic effect

g. Sedation


11/18

Tricyclic and Tetracyclic Antidepressantstreatment for :

1. Major depressive Disorder2. Mood disorder due to a general medical

condition (secondary Depression)3. Panic disorder with agoraphobia

4. Generalized anxiety disorder5. Obsessive compulcive disorder6. Post traumatic stress disorders7. Eating disorder anorexia nervosa, bulimia

nervosa8. Pain disorder9. Childhood Enuresis


12/18

1. Psychiatric effect : Inducing Maniac episode2. Anticholinergic effect : dry mouth, constipation,

blurred vision, urinary retention3. Sedation : effect anti histamin4. Autonomic effect : Ortostatic hypotension because

an adrenergic blockade5. Cordiac effect : prolong QT internal, depressed ST,

flattenal T Waves6. Neurological : myoclonic, ataxia, tremor7. Dermatological effect: Allergic, Exanthematous

Rashes, agranulositosis8. Wight gain : because blockade of histamine 2 (H2).

Impotence blockade dopamine receptor in tuberoinfundibular tract


13/18

First line agents for treatment of : Depression, Obsesive Compulsive Disorder, PanicDisorder.SSRIs included : Fluoxetin (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Fluvoxamine

(Luvox), Citalopram (Celexa).Therapiute Indications1. Depression2. Suicide3. Depression during pregnancy

4. Depression in the ederly and medically ill5. Chronic depression6. Depression in children

7. Anxiety disorders OCD, Panic, Social Phobia, PTSD, Bulimia, Anorexia, Obesity8. Premenstrual dysphoric disorders9. Premature ejaculation

10. Paraphilia comorbid with depression11. Autistic Disorders12. Attention deficit hyperactive Disorder13. Chronic pain Syndromes14. Psikosomatic Conditions


14/18

1. Sexual disfunction inhibited Orgasm2. Gastrointestinal adverse effect nausea,

dearhea, anorexia, vomiting3. Weight gain

4. Headaches5. CNS adverse effect anxiety, insomnia, severe

vivid dream, nightmare6. Anticholinergic effect : dry mouth, constipation.

Extrapyramidal symptoms : tremor, akatisia

7. Serotonin syndromes : tremor, dearhea, atoxia,myoclonus, hyperthermia, delirium, statusepileticus, coma


15/18

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. Inducedhypertensive crisis. MAOIs include : phenelzine (Nardil) isocarboxazid(Marplan) tranylcypromine (parnate), selegiline (Eldepryl)

Therapuitic Indication1. Depression characteristic by hypersomnia, hyperphagia, anxiety2. Panic with Agoraphobia, Posttraumatic disorder, eating disorder, social

phobia, pain disorder

Precaution and Adverse Reaction1. Orthostatic hypotensia2. Insomnia3. Weight gain4. Oedem5. Sexual disfunction6.

Tyramine induced hypertensive crisis7. Withdrawal : mood desturbances, somatic symptom8. Overdosis : Agitasi, hypertermia, comaReversible Inhibitors Mono Amine Oxidase (RIMAs) Moclobemide

(Aurorix)


16/18

Venlafaxine (Effexor) is an effectiveantidepressant drug that may have a fasteronset of action than other antidepressantdrugs when the dosage is increased rapidly.

Venlafaxine is potent inhibitor of serotoninand norepinephrine and weak inhibitor ofDopamine reuptake

Duloxetine (Cymbalta)


17/18

1. Depressions with melancholic features2. Generalized anxiety disorder3. Obsessive compulsive disorder,

Phobia,ADHDChronic pain syndromes

Precaution and adverse ReactionsThe most cammon reaction are : nausea,

somnolence, dry mouth, dizzines, nervousness,constipation, asthenia, anxiety, anorexia, blurredvision, abnormal ejaculation and orgasm


18/18

psycho pharmacology ii 13 juni

Documents