Anti-psychotics

SUM MARY DRUG TABLE ANTI PSYCHOTIC DRUGS... 

Chlorpromazine had been shown to produce a tranquil state in animals and since it had a similar effect in humans it became known as a major tranquiliser but the term is rarely used today. Sometimes the drugs used to treat schizophrenia are called anti-psychotics but more commonly neuroleptics. Leptic means to activate (take hold of) and in animals these compounds produce a state of maintained motor tone known as catalepsy. This is an extrapyramidal effect and in schizophrenics the neuroleptics can cause a number of extrapyramidal side-effects (EPSs) including Parkinsonism. The new term neuroleptic is unsatisfactory as a description of clinically useful drugs. It really describes a condition (catalepsy) seen in animals and is more indicative of a compound s ability to produce EPSs than to treat schizophrenia. Antipsychotic is more descriptive but could imply a more general efficacy in psychoses than is the case. It would seem more appropriate to call a drug that is used to treat schizophrenia an antischizophrenic just as we use the terms antidepressant or antiepileptic irrespective of how the drug works. Despite such personal reservations, the term neuroleptic will be used in this text. 

Seale, C., Chaplin, R., Lelliott, P. 8cQuirk, A. (2006). Sharing decisions in consultations involving anti-psychotic medication a qualitative study of psychiatrists experiences. Soc. Sci. Med., 62, 2861-73. 

Ziguras, S. J., Klimidis, S., Lambert, T. J. R. Jackson, A. C. (2001). Determinants of anti-psychotic medication compliance in a multicultural population. Community Ment. Health J., 37(3), 273-83. 

At the beginning of the twenty-first century, the century of psychoanalysis may be giving way to that of brain chemistry and neuroscience. Psychotherapy is now supplemented and sometimes even replaced by antidepressants, anti-psychotics, and other pharmaceutical responses to the chemistry of the brain. Neuroscience is beginning to provide physical explanations for cognition, emotion—even subjectivity. At this border of science and our deepest sense of our mental and even spiritual selves, alchemy is again demonstrating its relevance and durability. One final realm in which alchemical tropes became (and remain) common is that of psychedelic drugs.7... 

Use in combination with other drugs (e.g, anti-psychotics, lithium, valproate) for the acute treatment of mania or mixed episodes. Use as a short-term adjunctive sedativehypnotic agent. Binds to the benzodiazepine site and augments the action of GABA/, by increasing the frequency of Cl" channel opening which causes hyperpolarization (a less excitable state) and inhibits neuronal firing. 

Side effects can also occur quickly after a single dose of a medication. For example, some antidepressants (e.g., selective serotonin reuptake inhibitors) can cause nausea, stomach upset, loose stools, and even diarrhea. Likewise, some anti-psychotics (e.g., haloperidol (Haldol)) can cause unpleasant or painful muscle spasms called dystonias. All of these side effects can occur within minutes or hours of taking a single dose of the medication. These side effects are also a result of the direct effects of the medication in the synapse. 

But some feel that by reducing the receptor interactions we may produce less effective medications. In this view, medications with multiple receptor interactions are said to have a rich pharmacology. As we will see in a later chapter, these multiple actions in the synapse appear to be a reason why the newer atypical anti-psychotics have certain advantages over the older antipsychotic medicines. How many receptor interactions are sufficient How many are too many It depends. Certainly, it does no good to interact with a receptor that produces no benefit, but sometimes interacting with two different receptor types in a synergistic manner can produce even greater benefit. 

Antipsychotics. It was recognized some years ago that high potency typical anti-psychotics, that is, haloperidol (Haldol) and pimozide (Orap), were effective in treating OCD patients who had a comorbid tic disorder. The efficacy of these agents, however, is primarily in redncing the tics rather than the core symptoms of OCD. 

Antihistamines. After alcohol, antihistamines are the most commonly self-administered sleep medications. Foremost among these is diphenhydramine (Benadryl), which is also available as a component in a variety of over-the-counter nighttime medications including Tylenol PM and Excedrin PM. Prescription antihistamines like hydroxyzine (Vistaril, Atarax) are also occasionally used to treat insomnia. Finally, it is the antihistamine effect of some antidepressants and anti-psychotics that contribute to their utility as sedative-hypnotics. 

The key has been to avoid using treatments that worsen the disease. In this instance, this means avoiding anticholinergic (acetylcholine-blocking) medications that worsen dementia. As a result, when newer antidepressants such as the SSRIs became available, they quickly replaced the older tricyclic antidepressants because the latter are potent anticholinergics. For the same reason, the low potency anti-psychotics like chlorpromazine (Thorazine) were replaced by the higher potency antipsychotics like haloperidol (Flaldol) and more recently by the atypical antipsychotics. 

Some neuroleptic agents, like cycloindole (497), which has a modified tryptamine structure, and flucindole (498), a difluoro analog of cycloindole, have found use in therapy because of their anti-depressant and anti-psychotic activity (463,464) (Scheme 4.11). 3-Chlorocarbazole (385) (see Scheme 2.102), isolated from female bovine urine, has Diazepam-like activity (354). 

Long-acting benzodiazepines, tricyclic antidepressants, SSRIs, anti-psychotics... 

Patients in whom haloperidol is contraindicated can be treated by intramuscular injection of benzodiazepines, but these can cause respiratory depression or respiratory arrest if given in too high a dose, are contra-indicated in patients with preexisting respiratory depression, and have no specific anti-psychotic effect. 

In the Expert Consensus survey (Rush and Frances, 2000), the respondents identified newer atypical anti-psychotics and anticonvulsants or mood stabilizers as first-line treatments for self-injury. Antidepressants, naltrexone, and conventional antipsychotics were given ratings at least midway or higher on the scale provided. 

ANTI DEPRE ANT/ANTI PSYCHOTIC COMBINATION TREATMENT... 

Lithium, several (but not all) anticonvulsants, and most of the atypical antipsychotic medications are approved by the U.S. Food and Drug Administration (FDA) for the treatment of one of more phases of bipolar disorder. These medications are referred to as mood stabilizers, and they are the foundation of treatment for bipolar disorders. However, the skillful treatment of bipolar disorder requires not only the knowledge of how to prescribe one or more of these medications but also the understanding that some medications are preferred for one phase of the illness but not the other or for long-term use but not necessarily acute use. In this chapter, we first review the clinical use of lithium and the anticonvulsants that are definite or probable mood stabilizers. The general properties of atypical anti-psychotics are reviewed in Chapter 4. In this chapter, we expand on the use of these compounds for the treatment of bipolar disorder. Discussion of the treatment of each phase of bipolar disorder concludes the chapter. 

May, Ph.R A Anti-psychotic drugs and other forms of therapy. In Efron, D.H., Cole, J.O., Levine. J.. Wittenbom, J.R. feds) Psychopharmacology a Review of Progress. US Government Printing Office, Washington, DC, PHS PubL No. 1836, 1968, pp. 1155-1176. 

An example of a potentially important drug interaction is that which occurs when fluvoxamine is given along with theophyllin (Figure 6—13). In that case, the theo-phyllin dose must be lowered or else the blood levels of theophyllin will rise and possibly cause side effects, even toxic side effects such as seizures. The same may occur with caffeine. Fluvoxamine also affects the metabolism of atypical anti-psychotics. 

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