Psychosis manic depression

Indications Psychosis, manic-depressive disorders Category Antipsychotic, phenothiazine Muscarinic antagonist Half-life initial 2 hours terminal 30 hours Clinically important, potentially hazardous interactions with alcohol, antihistamines, arsenic, chlorpheniramine, dofetilide, epinephrine, evening primrose, guanethidine, mivacurium, quinolones, sparfloxacin... 

In clinical psychiatric terms, the affective disorders can be subdivided into unipolar and bipolar disorders. Unipolar depression is also known as psychotic depression, endogenous depression, idiopathic depression and major depressive disorder. Bipolar disorder is now recognised as being heterogeneous bipolar disorder I is equivalent to classical manic depressive psychosis, or manic depression, while bipolar disorder II is depression with hypomania (Dean, 2002). Unipolar mania is where periods of mania alternate with periods of more normal moods. Seasonal affective disorder (SAD) refers to depression with its onset most commonly in winter, followed by a gradual remission in spring. Some milder forms of severe depression, often those with an identifiable cause, may be referred to as reactive or neurotic depression. Secondary depression is associated with other illnesses, such as neuro-degenerative or cardiovascular diseases, and is relatively common. 

Bipolar disorder A group of affective disorders characterised by alternating periods of pathologically elevated moods, followed by severely reduced moods. Previously known as manic depression, or manic depressive psychosis. 

Rowntree, Nevin and Wilson have also examined the effects of D.F.P. in schizophrenia and manic depressive psychosis.4 D.F.P. dissolved in peanut oil was administered by intramuscular injection to seventeen cases of schizophrenia and nine cases of manic depressive psychosis. Their findings suggest that D.F.P. may be of therapeutic value in some manic patients if given in repeated small doses and gradually cut down after improvement has been obtained. 

Antipsychotics or neuroleptics are used for intervention in patients with severe and chronic psychosis of an organic as well as induced nature. These drags are used for controlling manic phases in manic-depressive psychosis such as relieving anxiety, fear, excitement associated with somatic diseases, controlling aggression, tics, and other unequal conditions. 

In psychiatric practice, promazine is used in minor cases of psychomotor excitement in schizophrenics, in paranoid and manic-depressive conditions, for neurosis, alcoholic psychosis, and others. It is sometimes used in anesthesiological practice. The most common synonyms are propazine, trilafon, sparine, permitil, and others. 

Psychiatric patients Schizophrenic or paranoid patients may exhibit a worsening of psychosis with TCA therapy, and manic-depressive patients may experience a shift to a hypomanic or manic phase this may also occur when switching antidepressants and withdrawing them. In overactive or agitated patients, increased anxiety or agitation may occur. Paranoid delusions, with or without associated hostility, may be exaggerated. Reduction of TCA dosage and concomitant antipsychotic therapy may be necessary. 

Activation of psychosis or mania Antidepressants can precipitate manic episodes in bipolar manic depressive patients during the depressed phase of their illness and may activate latent psychosis in other susceptible patients. 

Thomsen, P.H., Moller, L.L., Dehlholm, B., and Brask B.H. (1992) Manic-depressive psychosis in children younger than 15 years a register-based investigation of 39 cases in Denmark. Acta Psychiatr Scand 85 401 06. 

Hucker, S.J. (1975) Pubertal manic depressive psychosis and mental subnormality—a case report. Br J Ment Subnormality 21 34-37. 

Linter, C.M. (1987) Short-cycle manic-depressive psychosis in a mentally handicapped child without family history. Br J Psychiatry 151 554-555. 

Jensen S, Plaetke R, Holik J, et al Linkage analysis of the Dj dopamine receptor gene and manic depression in six families. Hum Hered 42 269-275, 1992 Jeste DV, Eastham JH, Lacro JP, et al Management of late-life psychosis. J Clin Psychiatry 57 [suppl 3) 39-45, 1996... 

Lenox RH, Manji HK Lithium, in The American Psychiatric Press Textbook of Psychopharmacology. Edited by Nemeroff C, Schatzberg A. Washington, DC, American Psychiatric Press, 1995, pp 303-349 Lenox RH, Watson DG Lithium and the brain a psychopharmacological strategy to a molecular basis for manic-depressive illness. Chn Chem 40(2 309-314, 1994 Lenox RH, Watson DG, Patel J, et al Chronic lithium administration alters a prominent PKC substrate in rat hippocampus. Brain Res 570 333-340, 1992 Lenzi A, Lazzerini F, Grossi E, et al Use of carbamazepine in acute psychosis a controlled study. J Int Med Res 14 78-84, 1986 Leonard BE Commentary on the mode of action of benzodiazepines. J Psychiatr Res 27 (suppl 1) 193, 1993... 

Nasrallah HA, Varney N, Coffman JA, et al Opiate antagonism fails to reverse post-ECT cognitive deficits. J Clin Psychiatry 47 555-556, 1986 Nasrallah HA, Coffman JA, Olson SC Structural brain-imaging findings in affective disorders an overview. J Neuropsychiatry Clin Neurosci 1 21-26, 1989 Naylor GJ, Smith AHW Defective genetic control of sodium-pump density in manic depressive psychosis. Psychol Med 11 257-263, 1981 Naylor GJ, McNamee HB, Moody JP Erythrocyte sodium and potassium in depressive illness. J Psychosom Res 14 173-177, 1970 Naylor GJ, McNamee HB, Moody JP Changes in erythrocyte sodium and potassium on recovery from depressive illness. Br J Psychiatry 118 219-223, 1971 Naylor GJ, Dick DAT, Dick EG, et al Lithium therapy and erythrocyte membrane cation carrier. Psychopharmacologia 37 81-86, 1974 Naylor GJ, Smith AHW, Dick EG, et al Erythrocyte membrane cation carrier in manic-depressive psychosis. Psychol Med 10 521-525, 1980... 

Despite this favorable result, lithium was hardly considered as a psychopharmaceutical for many years. There were a variety of reasons for this. Firstly, mania is not a very common psychosis and there is spontaneous remission in many cases. There were thus not so many occasions where lithium treatment was indicated. Secondly, lithium salts were considered to be toxic because for some time they had been given in excessive doses to patients with heart failure and in this way, had led to a number of fatalities (Cade, 1970). Thirdly, a few years after Cade s first publication psychiatrists attention had been claimed by chlorpromazine and the subsequent neuroleptics and antidepressants, thus explaining why lithium almost fell into oblivion. It was onl> in the 1960s that it once more attracted some interest, after the Danish psychiatrist Mogens Schou had shown that lithium salts were not only useful in the manic phase of manic depressive illness but also could prevent depressive episodes in patients suffering from bipolar psychoses. 

In the treatment of manic depressive psychosis (treatment of mania). 

Baastrup PC. The use of lithium in manic-depressive psychosis. Compr Psychiatry 1964 5 396-408. 

Baastrup PC. Lithium-behandling of mani-depressiv psykose en psykoseforebyggende behandlingsmade (Lithium treatment of manic-depressive psychosis a procedure for preventing psychotic relapses). Nordisk Psykiatrisk Tiddskrift 1966 20 441-450. 

Takezaki H, Hanaoka M. The use of carbamazepine (Tegretol) in the control of manic-depressive psychosis and other manic, depressive states [Japanese]. Sheishin-lgaku 1971 13 173-183. Okuma T, Kishimoto A, Inoue K, et al. Anti-manic and prophylactic effects of carbamazepine on manic-depressive psychosis. Folia Psychiatr NeurolJpn 1973 27 283-297. 

McKay AP, Tarbuck AF, Shapleske J, et al. Neuropsychological function in manic-depressive psychosis evidence for persistent deficits in patients with chronic, severe illness. Br J Psychiatry 1995 167 51-57. 

Although the usefulness of the atypical antipsychotics is best documented for the positive symptoms of schizophrenia, numerous studies are documenting the utility of these agents for the treatment of positive symptoms associated with several other disorders (discussed in Chapter 10 see Fig. 10—2). Atypical antipsychotics have become first-line acute and maintenance treatments for positive symptoms of psychosis, not only in schizophrenia but also in the acute manic and mixed manic-depressed phases of bipolar disorder in depressive psychosis and schizoaffective disorder in psychosis associated with behavioral disturbances in cognitive disorders such as Alzheimer s disease, Parkinson s disease, and other organic psychoses and in psychotic disorders in children and adolescents (Fig. 11—52, first-line treatments). In fact, current treatment standards have evolved in many countries so that atypical antipsychotics have largely replaced conventional antipsychotics for the treatment of positive psychotic symptoms except in a few specific clinical situations. 

Profound mood-stabilizing effects of the atypical antipsychotic drugs were observed once their antipsychotic effects were documented. These effects on mood appear to be quite independent of their effects on positive symptoms of psychosis. The most dramatic story may be how impressive the atypical antipsychotics are turning out to be for the treatment of bipolar disorder (Fig. 11 — 53). Although the best documented effect of these drugs is to reduce psychotic symptoms in the acute manic phase of bipolar disorder, it is clear that these agents also stabilize mood and can help in some of the most difficult cases, such as those marked by rapid cycling and mixed simultaneous manic-depressed states that are often nonresponsive to mood... 

CONTROL OF MANIC EPISODES IN MANIC-DEPRESSIVE PSYCHOSIS USING LITHIUM... 

High concordances between identical twins and first-degree relatives are reported for schizophrenia and manic depressive psychoses. There is evidence of simple dominant and possibly X-linked inheritance of manic depressive psychosis in some families, but the extent to which the total incidence is mutationally maintained is not clear. 

At another psychopharmacology conference held in the United States in 1962, it was suggested that antidepressants strike almost specifically at the governing mechanisms of affectivity which are disturbed in manic depressive psychosis (Flugel 1966, p. 495). Their specificity of action was again contrasted with stimulants ... 

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