Psychosis preparation

Chapter 78 Puerperal psychosis Preparation Assessment Management Take-home message Further reading Resources... 

The prescribing physician should be notified immediately if tics or psychosis (usually paranoia) develop. The medication should always be stopped when psychosis occurs. We once said the same about tics, but recent research suggests that stimulants may not worsen tics. Methylphenidate is now available in a controlled-release preparation (Concerta), which can be prescribed once daily. One key advantage to once-daily dosing is not pharmacological, but rather that it avoids the stigma children may experience when they need to go to the school nurse s office to receive their afternoon dose. Focalin is the active isomer of methylphenidate. 

The 2004 Practice Guideline for the Treatment of Patients With Schizophrenia recommends indefinite maintenance treatment for patients who have had at least two episodes of psychosis within 5 years or who have had multiple previous episodes (Lehman et al. 2004). Maintenance therapy should involve the lowest possible doses of antipsychotic drugs, and patients should be monitored closely for symptoms of relapse. If the patient is compliant with treatment, oral medications are usually sufficient. However, if the patient s treatment history suggests that the patient may not reliably take daily oral medication, a long-acting depot preparation may be indicated. 

Chemicals known as piperazines have industrial applications worldwide, and it is legal to purchase bulk quantities of these chemicals on the Internet for this purpose. By changing chemical groups added to the basic piperazine skeletal structure, different chemicals can be formed that vary considerably in their industrial, medical, and mind-altering properties. Piperazine citrate and related compounds destroy intestinal worms, making these chemicals useful in both medical and veterinary preparations. Other medicinal and mind-altering qualities of piperazines are being exploited as possible treatments of depression, psychosis, Alzheimer s disease, and tumors. 

A 27-year-old US Marine developed a frank psychosis with ideas of reference and some paranoid ideation. He had been taking two preparations containing Ma huang, although the duration of use was unclear. 

Phenothiazine cholinesterase inhibitors. Synthetic derivatives of phe-nothiazine are well-tolerated drugs against a variety of human ailments from psychosis to cancer. A number of synthetic N-10-carbonyl phenothiazine derivatives, with cholinesterase inhibitory activity, were tested for interaction with a variety of neurotransmitter receptor systems. Phenothiazines can be prepared without significant neurotransmitter receptor interactions while retaining high potency as cholinesterase ligands for treatment of AD [165],... 

Liquid, bp 46.5°C. Pure gas reputedly has a pleasant odour but industrial preparations smell foul. Solvent used in rubber and rayon industries. Explosive poisonous by all routes. Acute toxicity - euphoria, restlessness, mucous membrane toxicity, nausea, vomiting, convulsions. Chronic exposure psychosis, tremor, polyneuropathy lower limb weakness and parasthesiae. Dermal contact may cause burning sensation, erythema and exfoliation. 

Korean traditional preparations Thirty-one naturally occurring substances used to treat psychosis in Korean traditional medicine were subjected to in-vitro CNS screening assays using crude plant extracts. In-vitro assays revealed several CNS receptor selectivities and affinities. More constituents had strong binding affinities with monoamine receptors than other CNS receptors. Controlled animal studies are needed to elucidate specific behavioral effects of different preparations. 

Roberge RJ et al Dextromethorphan- and pseudoephedrine-induced agitated psychosis and ataxia oase report. J Emerg Med 1999 17(2) 285-288. [PMID 10195488] (A 2-year-old developed irritability, psyohosis, and ataxia after being overmedicated with a combination OTC oough preparation.)... 

The technology was rapidly adapted to the preparation of metabolites of other sophisticated pharmaceutical entities. Scheme 29.17 shows the products obtained fiom two other compounds (IX and X) under investigation for the treatment of psychosis. The hydroxy and desmethyl derivatives shown were difficult to synthesize by conventional orgaitic chemistry methods. 

Chapter 23 First episode psychosis fFEPf Preparation Assessment Management What if... ... 

Rehabilitation ( rehab ) Complex, severe and enduring mental illness (usually psychosis) Long stay, e.g. one to two years Occupational therapy focus Thorough preparation and meatment before discharge, often to supported accommodation... 

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