Drugs Used in Mental

Chapter 32 Antipsychotic and |llness:

Drugs Antimanic
The
psychopharmacological
tropic drugs are those havingagents or psycho in the 1960s.
on psyche (mental primary effects addition. Buspirone is asignificant later
processes) and
treatment of psychiatric disorders. are used for Little attention
During the past 70 years was paid to Cade's
psychiatric treat report in 1949 that
Lithium
ment has witnessed major excitement and mania: its could be used for
changes
advent of drugs which can have due to the in the 1960s and effective use
tary effect in mental specific salu now it has a uniquestarted
place
illnesses. Before 1950s in psychiatry.
psychiatric treatment was mostly confined to like, valproate Interestingly, some antiepileptics
and lamotrigine as
providing atypical antipsychotics are now firstwelllineas drugs
some
which has custodial
care in mental asylums,
in mania and
the patient changed
to aiming at bipolar disorders.
to his restoring
All that could be place in the Categorization of psychiatric disorders is
done beforecommunity. The criteria adopted often not clear cu
less, broad divisions overlap
1952 was in individual patients.
to dope and quieten have to be made, primarily Neverthe
agitated and violent of predominant on the basis
manifestations, to guide the use of drugs. The
patients. The introduction of chlorpromazine
(CPZ) in that year has transformed principal categories are:
of schizophrenics; most of them the lives Psychoses These are severe psychiatric illness with ser
ous distortion of thought,
can now be behaviour, capacity to recognise
rehabilitated to productive life. Reserpine was reality and of perception (delusions and hallucinations). There
discovered soon after. Though it is a powerful is inexplicable
misperception and
may be unable to meet the ordinarymisevaluation; the patient
pharmacological tool to study monoaminergic
(a) Acute and chronic organic brain
demands of life.
systems in brain and periphery, its clinical tive disorders) Such as delirium and syndromes {cogn
use in psychiatry lasted only few years. Next dementia with
chotic features; some toxic or pathological basis can oten psy
came the tricyclic and MAO inhibitor anti be defined. Prominent features are confusion,
depressants in 1957-58 and covered another disorientation,
defective memory, disorganized thought and behaviour.
group of psychiatric patients. Many novel and (b) Functional disorders No underlying cause can be de
atypical antipsychotics, selective serotonin ned; memory and orientation are mostly retained buu enotieA
reuptake inhibitors (SSRIs) and other anti thought, reasoning and behaviour are seriously altered.
depressants have been introduced since the Schizophrenia (split mìnd), ie. splitting of percepäoa
1980s. These are now more frequently used. and interpretation from reality--hallucinations, inability
to think coherently with litle impairment of alerness
Meprobamate (1954) aroused the hope that and intellect.
anxiety could be tackled without producing Paranoid states with marked persecutory or other kinds
of fixed delusions ( false beliefs) and loss of insight
marked sedation. This goal has been realised into the abnormality.
nore completely by the development of Chlor Mood (affective) disorders The primary symptom S
diazepoxide (1957) and other benzodiazepines change in mood state; may manitest as:
 ANTIPSYCHOTIC AND ANTIMANIC DRUGS

sleen.
Mania--clation or irritable mood, reduced psychic indifNerence, emotional quietening with extrapyramidal
and speech, may be
hvperactivity, uncontrollable thoughtbehaviour. symptoms, but without causing ataxia or cognitive impaiment.,)
or
associated with reckless or violent 2. Antimanic (mood stabiliser) used to control
Depression sadness, loss of interest and pleasure.
worthlessness, guilt, physical and mental slowing, melan mania and to break into cyclic affective disorders.
cholia, self-destructive ideation. 3. Antidepressants uscd for minor as well
Acommon fom of mood disorder is bipolar disorder as major depressive illness, phobic states,
with cyclically alternating manic and depressive phases. obsessive-compulsive behaviour, and certain
Two major categories of bipolar disorder are recognized:
Tipe I: Mania episodes only or both manic and depres
anxicty disorders.
sive phases. 4. Antianxiety (anxiolytic-sedative, minor tran
Tne : Cycles ofhypomania alternating with major depression, quilizer) used for anxiety and phobic states.
but no maniaepisodes.
Neuroses These are less serious; ability to comprehend 5. Psychotomimetic (psychedelie. psycho
reality is not lost, though the patient may undergo extreme dysleptic, hallucinogen). They are seldom
suffering. Depending on the predominant feature, it may be used therapeutically, but produce psychosis-like
labelled as: states. Majority of them are drugs of abuse,
(a) Anxiety An unpleasant emotional state associated with e.g. cannabis, LSD.
uneasiness, worry, tension and concern for the future.
Tranquilizer It is an old term meaning "a drug which
(b) Phobic states Fear of the unknown or of some specific reduces mental tension and produees calmness without
objects, person or situations. inducing sleep or depressing mental aculties." Ths ten
(c) Obsessive-compulsive disorder Limited abnormal was used to describe the effects of reserpine or chlorpro
ity of thought or behaviour; recurrent intrusive thoughts or mazine. However, it has been interpreted differentiy by
ritual-like behaviours which the patient realizes are abnor diferent people; some extend it to cover beth chorpro
mal or stupid, but is not able to overcome even on voluntary mazine-like and antianxiety drugs, others feeB that it shoukt
effort. The obsessions generate considerable anxiety and distress. be restricted to the antianxiety drugs only. Their divisior
(d) Reactive depression due to physical illness, loss, blow into major and minor tranquilizers is not just1tied. becuse
to self-esteem or bereavement, but is excessive or dispro the minor tranquilizers' (diazepam-like drugs) are not kss
portionate. important drugs: they are more iequently prescribed and
carry higher abuse liability than the "major ranquihzers
(e) Post-traumatic stress disorder Varied symptoms fol (chlorpromazine-like drugs) The term tranquilizet is,
lowing distressing experiences like war, riots, carthquakes, etc. therefore, best avoided.
() Hysterica! Dramatic symptoms resembling serious physi
cal illness, but situational, and always in the presence of others;
the patient does not feign, but actually undergoes the symptoms, ANTIPSYCHOTIC DRUGS
though the basis is only psychic and not physical, (Neuroleptics)
Pathophysiology of mental illness is not clear, These are drugs having a salutary therapeutic
though some ideas have been formed, e.g. dopa effect in psychoses.
minergic overactivity in the limbic system may be
Involved in schizophrenia and mania, while mono
aminergic(NA, 5-HT) deficit may underlie depres
Sion. Trcatnent is empirical, symptom oriented and CHs
Iiot discase specific. However, it is highly ettective
In many situsions, Depending onthe
H,C H,C H,N
he psycltropic drugs may be primary use, CHLORPROMAZINE
1. Antiachotic grouped into: (aliphatic side chain)

taiquilizer) useful (neuroleptic,

in all types ataractic, major
of functional R(CHaa R-o-o,
psychosis, especially schizophrenia.
(The term Neuroleptic is applied to
peridol-like conventional
which have potent D2 receptor chlorpromazinehalo
untipsychotie subclass of drugs
CH,
THIORIDAZINE TRIFLUOPERAZINE
blocking activity and produce (piperazine side chain)
(piperidine side chain)