PSYCHOPHARMACOL

OGY

Presented By :
Mr.Jayesh Patidar
Professor
H.O.D. Psychiatric Nursing
 DEFINITION :-
PSYCHOPHARMACOLOGY
is the study of drug-induced
changes in mood, sensation, thinking, and behavior.

PSYCHOACTIVE DRUGS
may originate from natural
sources such as plants and animals, or from
artificial sources such as chemical synthesis in the
laboratory
 CLASSIFICATION
ANTIPSYCHOTIC

ANTIMANIC ANTIPARKINSOMINA

PSYCHOPHARMACOLOGY

ANTAABUSE
ANTIDEPRESIVE

ANXEOLYTIC
 ANTIPSYCHOTIC (NEUROLAPATIC DRUGS)

TYPICAL ANTIPSYCHOTIC ATYPICAL ANTIPSYCHOTIC

• CHLORPROMAZINE • ARIPIPRAZOLE (ABILIFY)

(THORAZINE) • OLANZAPINE (ZYPREXA)
• HALOPERIDOL (HALDOL) • QUETIAPINE (SEROQUEL)
• PERPHENAZINE (TRILAFON) • RISPERIDONE (RISPERDAL)
• THIORIDAZINE (MELLARIL)
• THIOTHIXENE (NAVANE)
 DOSES –
Class Trade Name Dose Mg
>Phenothiazines Laragactil 300-
1500
>Thioxanthenes Flupenthixol 3-40
>butyrophenoes Haloperidol 5-100
>PIPERIDINES Flumap 20-60
>Diphenylbutyl Pimozide 4-20
> Atypical Risperidone 0.5-50a
INDICATIONS :-
• SCHIZOPHRENIC DISORDERS
• MANIA
• ACUTE BRAIN SYNDROME
• PARANOID DISORDERS
• ORGANIC DEMENTIA
• IMPAIRED COMMUNICATION, INABILITY TO
RELATE TO OTHERS, DELUSION HALLUCINATIONS
AND INABILITY TO IDENTIFY REALITY,
DISORDERED THINKING AN EMOTIONAL
WITHDRAWAL
• AUTISM
• CONDUCT DISORDER
 MODE OF ACTION
Block D2 receptors in brain mesolimbic and
misofrontal

Sedation is caused by alfa adrenergic blockage

Anti dopaminergic action on basal ganglia is

responsible for causing EPS
 CONTRA­INDICATIONS
• Children under three year’s age,
• Comatose patients,
• Patients with drug hypersensitivity and bone
marrow depression.
• Antipsychotic agents should be used cautiously in
patients with history of epilepsy
> pregnancy
>Parkinson's disease
>peptic ulcers
SIDE-EFFECTS

• CENTRAL NERVOUS SYSTEM

EXTRA PYRAMIDAL SYMPTOMS
>AKATHESIA
>PARKINSONISM,
>ACUTE DYSTONIA,
>TARDIVE DYSKINESIA
>NEUROLAPATIC MALIGNANT SYNDROME
Parkinsonism (40%)
(i) AKINETIC FORM –
> Appears 1st week CHARACTERISTICS :
>Difficulty in masticating movements, weakness and
muscle fatigue.
(ii) AGITATING FORM –
> Tremors at rest, rigidity and mask-like face.
CHARACTERISTIC :
(i) Rigidity of muscles
(ii) Motor retardation
(iii) Salivation
(iv) Slurred speech
(v) Mask-like face

TREAT WITH ANTICHOLINERGIC DRUG

AKATHISIA: (50%)
characteristics :
Subjective feeling of muscular weakness
Restless "walking in place."
Difficulty in sitting still, or strong
Urge to move about -referred to as "Walkies & Talkies“.
Generally occurs after 2nd weeks .
Treat with propranolol and benzodiazepines

ACUTE DYSTONIA: ( 6% )
characteristic :
Rapidly developing contraction of muscles of the tongue,
jaw, neck and extra ocular muscles.
• Treat with ANTICHOLINERGIC and benzodiazepines
OCULOGYRIC CRISIS-
>eyes look upward, head is turned to one side.
>Dystonia is painful and gives a frightening experience to the
patient.
> Dystonia occurs within a few minutes of
giving medicine or after several hours

• NEUROLAPATIC MALIGNANT SYNDROME

(NMS):
>RARE BUT SERIOUS
May develop hours or after years. >Symptoms include
severe muscle rigidity, altered consciousness, blood
pressure increased count of W.B.C, stiffness of muscles of
throat and chest.
>Symptoms appear suddenly 10-14 days or longer.
Other system are also involve -
> AUTONOMIC NERVOUS SYSTEM
SEIZURES
SEDATIONS
OTHER

>HEPATIC SIDE-EFFECTS

Liver toxicity occurs in 0.5% of cases presenting EPS.

It is a hypersensitivity reaction and not dose dependent. Onset of
symptoms is within the first one month of treatment. Symptoms may
be fever, chills, nausea, malaise, purities and jaundice
 ROLE OF THE NURSE.
• Close Observation
• Extra pyramidal reaction
• High fiber diet
• Observe drowsiness
• Record blood pressure
• Accurate route of medication
• Dry mouth (Water)
• 'Blurred or impaired vision
• An intake output chart
• Reassurance to relatives
• Seizure precaution
 ANTIDEPRESSANTS
• Also called as mood elevator

• GRIEF REACTION
• PATHOLOGICAL GRIEF
• DEPRESSION
• ENURESIS
• SCHOOL PHOBIA
• PANIC ATTACK
• AGITATED INVOLUTIONAL DEPRESSIVE SYNDROMES
• OCD
• PERSOLALITY DISORDER
MODE OF ACTION
Reduced nor epinephrine (NE) and serotonin (5-HT)
(neurotransmitters) nerve endings

TCA and MAO inhibitors increase neurontransmitters ( nor epinephrine

and serotonin to CNS)

Tricycles inhibitors block the reuptake of NE and 5-HT at nerve

terminals and increase at recepter sites.
CONTRAINDICATIONS
• Cardio­vascular disorders because they cause
arrhythmias.
• They increase symptoms of psychosis and mania in
cases of manic-depressive psychosis.
• Drugs are given with caution to patients with liver
disorders
CLASSIFICATION OF ANTIDEPRESSANTS
1) TRICYCLES ANTIDEPRESSANTS(TCA)
AMIPRAMINE- 75-300mg/day
2) SELECTIVE SEROTONIN REUPTAKE INHIBITORS
(SSRIs)
FLUOXETINE -10-80 mg/day
3) DOPAMINERGIC ANTIDEPRESS
FLUVOXAMINE- 50 mg/day
4) ATYPICAL ANTIDEPRESSANTS
AMINEPTINE- 100-400 mg/day
5) MONOAMINE OXIDASE INHIBITORS (MAOIs)
TRAZODONE- 150 mg/day
SIDE EFFCTS OF ANTIDE­PRESSANT DRUCS

1) CNS - Drowsiness, sedation, delusion, hallucination,

EPS,Taradive dyskinesia
2) ANS - dry mouth, urinary retention,
constipation, dilated pupils
3) CVS - Postural hypotension, Tachycardia
4) G.I - Nausea, vomiting, loss of appetite, jaundice.
5) Endocrine - Galactorrhca ,Gynecomastia, hyperglycemia
and hypoglycemia.
6) Allergic rash
NURSE'S ROLE
1) Observation side-effects and monitoring changes.
2) To take medicine at bed time ( sedative effect)
3) Give plenty of fluids . (Lemonade or chewing gum)
4) Do not give medicine empty stomach
5) recording of I/O chart maintained ( retention of urine)
6) To relieve constipation plenty of fluids and roughage
7) complains of dizziness. Pt encouraged to get up slowly and sit
before standing (orthostatic hypotension) s
8) Accurate recording of vital signs like B.P. and Pulse.
9) Interpret the blood reports specially blood sugar level and W.B.C.
count.
10) If the patient complains of sore throat, fever, malaise, it should be
reported . These symptoms may be due to agranulocytosis or hyper-
glycomia.
ANTIMANIC AGENTS
• Antimanic agents are also called MOOD
STABILIZERS.
Lithium treatment of choice for the manic phase of
the bipolar disorders, mania or manic depression.
It has also been tried the treatment of depressive
and schizoaffective disorder.
• INDICATION-
The major use of an antimanic agent is for
treatment of mania and recurrent manic episodes
MODE OF ACTION-

• The specific biochemical mechanism of action unclear.

• Anatimanic agents produce many neurochemical changes
in the area of brain.
• changes may affect nor epinephrine and serotonin
• CNS involved in emotion.
• Decrease activity of the nerve impulse, resulting in
depression or increase in the nerve impulse, causing mania.
• Lithium maintaining the sodium concentration in the brain,
thereby regulating the mood swings as well as impulse
along the nerve cells.
CONTRA- INDICATIONS
1) Renal impairment
2) sodium depletion or receiving diuretics (diuretics
are the drugs which increase urine output.)
3) cardio-vascular
4) Pregnant woman can have fetal anomalies.
5) Patients with hypothyroidism would require
monitoring of their dose for hypothyroidism also
Lithium –
>Atomic number 3 and atomic weigh
>Discovered by FJ CADE in 1949
INDICATIONS
Acute mania
Prophylaxis for bipolar and-unipolar mood Disorder.
Schizoaffective disorder
Impulsivity and aggression

Other disorders:
Premenstrual dysphonic disorder
Bulimia nervosa
Borderline personality disorder
Episodes of binge drinking
Cluster headaches
 PHARMACOKINETICS
Lithium is readily absorbed with peak
plasma levels occurring 2-4 hours after a single oral dose of
lithium carbonate.
> Lithium is distributed rapidly in liver and kidney and more
slowly in muscle, brain and bone.
> Steady state levels are achieved in about 7 days.
> Elimination is predominantly via kidneys. Lithium is
reabsorbed in the proximal tubules and is influenced by
sodium balance.
> Depletion of sodium can precipitate lithium toxicity.
MECHANISM OF ACTION
It accelerates presynaptic re-uptake and des­truction of
catecholamine, like norepinep-hrine
• It inhibits the release of catecholamine at the
synapse.
• It decreases postsynaptic serotonin receptor
Sensitivity.
• All these actions result in decreased catecholamine
activity, thus ameliorating mania.
DOSAGE
300mg tablets (e.g. Licab)
400mg (e.g. Lithosun-SR)
300mg/5ml liquid Lithium citrate
range of dose/day in acute mania
900-2100 mg given in 2-3 divided doses.
• BLOOD LITHIUM LEVELS
Therapeutic levels - 0.8 - 1.2 mEq/L (for treatment of acute
mania)
Prophylactic levels = 0.6 - 1.2 mEq/L (for prevention of
relapse in bipolar disorder)
Toxic lithium levels > 2.0 mEq/L
 SIDE EFFECTS
Neurological:
Tremors, muscular weakness, seizures, neurotoxicity
(delirium, abnormal involuntary movements, seizures)
Renal:
Polyuria, tubular enlarge­ment, nephritic syndrome.
Endocrine:
Abnormal thyroid function, goiter and weight gain.
Side-effects during pregnancy and lactation;
Increased incidence of
Epstein’s anomaly (distortion and down­ward displacement of
tricuspid value in right ventricle) when taken in first trimester.
Secreted in milk and can cause toxicity in infant.
Signs and symptoms of lithium
toxicity (level >2.0 mEq/L)
Ataxia
Coarse tremor (hand),
Nausea and vomiting ,
Impaired memory
Impaired concentration
Nephrotoxicity
Muscle weakness
Convulsions,
Muscle twitching,
Lethargy,
Confusion,
Coma
 MANAGEMENT OF LITHIUM TOXICITY
> Discontinue the drug immediately.
>For significant short-term ingestions, residual
gastric content should be removed by induc­tion
>If possible instruct the patient to ingest fluids.
>Assess serum lithium levels, serum electro­lytes,
renal functions, ECG as soon as possible.
>Maintenance of fluid and electrolyte balance. In a
patient with serious manifestations of Lithium
toxicity, hemodialysis should be Initiated.
CONTRAINDICATIONS OF LITHIUM USE
• Cardiac, renal, thyroid or neurological
dysfunctions
• During first trimester of pregnancy and
Lactation
• Severe dehydrator
• Hypothyroidism
• History of seizures
NURSE'S RESPONSIBILITIES FOR A PATIENT
RECEIVING LITHIUM

• The pre-lithium work up

 CARBAMAZEPINE
• Tegretol, Mazetol, Zeptol and Zen Retard

Indications
• Seizures-complex partial seizures, GTCS, seizures due to
alcohol withdrawal.
• Psychiatric disorders- rapid cycling bipolar disorder, acute
depression, impulse control disorder, aggression, psychosis
with epilepsy, schizoaffective disorders, borderline persona­
lity disorder, cocaine withdrawal syndrome.
• Paroxysmal pain syndromes - trigeminal neuralgia and
phantom limb pain.
DOSAGE & MECHANISM OF ACTION

• daily dose is 600-1800 mg orally, in divided doses.

• Its mood stabilizing mechanism is not clearly

established. Its anticonvulsant action may however
be by decreasing synaptic transmission in the CNS.
 SIDE EFFECTS
Drowsiness, confusion, headache, ataxia, hyper­
tension, arrhythmias, skin rashes,
nausea, vomiting, diarrhea, dry mouth,
abdominal pain, jaundice, hepatitis, oliguria,
leucopenia, thrombocytopenia, bone marrow
depression leading to a plastic anemia.
Nurse's Responsibilities
>drug may cause dizziness and drowsiness advise
him to avoid driving and other activities requiring
alertness.
>Advise patient not to consume alcohol when he is
on the drug.
>Emphasize the importance of regular follow-up
visits and periodic examination of blood count and
monitoring of cardiac, renal, hepatic and bone
marrow functions.
Sodium Valproate (Encoraie chrono, valparirt,
Epilsx, Epival)
• INDICATIONS
>Acute mania,
>Bipolar disorder
>Schizoaffective disorder
> Other disorders like
bulimia nervosa, obsessive- compulsive
disorder, agitation and PTSD.
MECHANISM OF ACTION

The drug acts on gamma-amino butyric acid

(GABA) an irdlibitory amino acid
neurotransmitter. GABA receptor activation serves
to reduce neuronal excitability.
DOSAGE
The usual dose is 15mg/kg/day with a maxi­mum of
60 mg/kg/day orally
SIDE EFFECTS
• Nausea, vomiting, diarrhea, sedation, ataxia,
dysarthria, tremor, weight gain, loss of hair,
tluombocytopenia, platelet dysfunction.
Nurse's Responsibilities
1) Explain to the patient to take the drug immediately
after food to reduce GI irritation union.
2) Advise for regular follow-up , periodic
examination of blood count, hepatic and thyroid
function. Therapeutic serum level of valproic
acid is 50-100 micrograms/ml.
ANXIOLYTICS (ANTI-ANXIETY DRUGS) AND HYPNOSEDATIVES
(minor tranquilizers)
BENZODIAZEPINE GROUP CLASSIFICATION-

1) Barbiturates Example- phenobarbetal

2) Non-barbiturate Example- ethanol

3) Benzodiazepines:
drugs of first choice in the treatment of
anxiety, and treatment of insomnia.

a) Very short-acting:
Midazolam
b) Short-acting:
Lorazepam (Afivan, Larpose)
Alprazolam (Restyl, Trika)
c) Long-acting:
Diazepam (Vilium,Calmpose),
Clonazepam (Lonazep)
INDICATIONS FOR BENZODIAZEPINES
> Anxiety disorders
> Insomnia
> Depression
> Panic disorder and social phobia
> Post- traumatic stress disorder
> Bipolar I disorder
> Other psychiatric indications include alcohol
withdrawal, substance-induced and psy­chotic
agitation
 MECHANISM OF ACTION

Benzodiazepines bind to specific sites

GABA receptors and increase GABA level

GABA is an inhibitory neurotransmitter(Calming effect on

CNS)

Reducing anxiety
 SIDE EFFECTS
>Nausea
>Vomiting
>weakness
>blurring of vision
>body aches,
>epigastric pain
>diarrohea,
>dry mouth,
>impairment of driving skills
>dependence and withdrawal s/s
NURSE'S RESPONSIBILITY IN THE
ADMINISTRATION OF BENZODIAZEPINES
• Administer with food (gastric irritation)
• Take medication as directed.
• Abrupt withdrawal cause insomnia, seizures.
• Explain about adverse effects & advise him to avoid
activities that require alertness.
• Avoid alcohol or any CNS depressants, also instruct him
not to take any OTC medications,
• If IM administration is give deep IM. For IV don’t mix
with any other drug. Give slow IV as respiratory or cardiac
arrest can occur.
• monitor vital signs during IV administration. Prevent
extravasa­tions since it can cause phlebitis and venous
thrombosis.
ANTIPARKINSONIAN AGENTS
• Anticholinergic drugs& antihistamines have their
primary use as treatments for medication-induced
movement disorders, particularly neurolapatic-
induced Parkinsonism, acute dystonia and.
medication-induced tremor.
>Anticholinergics
>Trihexyphenidyl
>Benztropine
>Biperiden
>Dopaminergic Agents
• Trihexyphenidyl (Artane, Trihexane, Trihexy,
Pacitane)
• INDICATIONS
Drug-induced Parkinsonism
• Mechanism of Action
Increasing the release of dopamine from
presynaptic vesicles, blocking the re-uptake of
dopamine into presynaptic nerve terminals or by
exerting an agonist effect on postsynaptic
dopamine receptors.
• 1-2 mg per day orally Maximum dose up to 15
mg/day in divided doses.
SIDE EFFECTS
>Dizziness, nervousness, drowsiness
>weakness, headache
>confusion,blurred vision,
>tachycardia, orthostatic hypotension
>urinary retention
>decreased sweating
 NURSE'S RESPONSIBILITIES
> Assess Parkinson a and extra pyramidal symptoms.
Medication should be tapered gradually.
> Caution patient to make position changes slowly to
minimize orthostatic hypotension.
> Instruct the patient about frequent rinsing of mouth and
good oral hygiene.
> Caution patient that this medication decreases perspiration,
and over-heating may occur during hot weather.
Anti abuse Drugs
• It is an important drug in this class and is used to
ensure abstinence in the treatment of alcohol
dependence. Its main effect is to produce
• person who ingests even a small amount of alcohol
while taking disulfiram
Drugs Used in Child Psychiatry
CLONIDINC
• INDICATIONS
> Control of withdrawal symptoms from upioius
> Tourette's disorder
> Control of aggressive or hyperactive behavior in children
> Autism
• MECHANISM OF ACTION
> Alpha 2 - adrenergic receptor agonist. .
> The agonist effects of clonidine on presynaptic
Decrease in the amount of neurotransmitter released from me presynaptic nerve
terminals. This decrease serves generally to reset the sympathetic tone at a lower
level and to decrease arousal.

DOSAGE
• Usual starting dosage is 0.l mg orally twice a day; the dosage can be
raised by 0.3 mg a day to an appropriate level.
SIDE EFFECTS
• Dry mouth, dryness of eyes, fatigue, irritability,
sedation, dizziness, nausea, vomiting, hypotension
and constipation.

NURSE'S RESPONSIBILITY
• Monitor BP, the drug should be withheld if the
patient becomes hypertensive.
THANK YOU