This document discusses the treatment of psychosis and schizophrenia with a focus on antipsychotic drugs. It begins by classifying psychiatric disorders and defining psychosis. Schizophrenia is described as a particular type of psychosis characterized by disturbances in thinking. The dopamine theory of schizophrenia is explained, which posits that psychosis is related to increased dopamine activity in the brain. Older antipsychotics are dopamine antagonists that can cause neurological side effects like tardive dyskinesia. Atypical antipsychotics have fewer side effects. Lithium is discussed as the drug of choice for treating mania in bipolar disorder.
Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. Learn about the health effects of prescription opioids and read the DrugFacts on Fentanyl, Heroin, and Prescription Opioids.
Opioid-involved overdose deaths rose significantly from 46,802 deaths in 2018 to 49,860 in 2019.
Source: National Vital Statistics System, CDC
Looking for Treatment?
Use the SAMHSA Treatment Locator or call 1-800-662-HELP (4357).
Learn more about:
NIDA's Role in the NIH HEAL Initiative℠
Overdose Death Rates
Benzodiazepines & Opioids
Xylazine in the Illicit Opioid Supply
Opioid Research Findings Funded by NIDA - (PubMed - 2001 to present)
Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. Learn about the health effects of prescription opioids and read the DrugFacts on Fentanyl, Heroin, and Prescription Opioids.
Opioid-involved overdose deaths rose significantly from 46,802 deaths in 2018 to 49,860 in 2019.
Source: National Vital Statistics System, CDC
Looking for Treatment?
Use the SAMHSA Treatment Locator or call 1-800-662-HELP (4357).
Learn more about:
NIDA's Role in the NIH HEAL Initiative℠
Overdose Death Rates
Benzodiazepines & Opioids
Xylazine in the Illicit Opioid Supply
Opioid Research Findings Funded by NIDA - (PubMed - 2001 to present)
a presentation on GABA including its synthesis, storage and degradation, types of receptors, and implications in various neuropsychiatric disorder, and finally a small chart on the drugs acting on GABA system.
Anxiety is an emotional state, unpleasant in nature, associated with uneasiness, discomfort and concern or fear about some defined or undefined future threat. It has several types. the presentation includes pharmacologic approach of anxiety disorder.
A compiled Power point presentation on "Antipsychotic drugs" suitable for Undergraduate level medical students and also PG students in the subject of Pharmacology.
My presentation on neurotransmitter glutamate. References from Comprehensive textbook of psychiatry 9th edition and Stahl's essential psychopharmacology 4th edition.
a presentation on GABA including its synthesis, storage and degradation, types of receptors, and implications in various neuropsychiatric disorder, and finally a small chart on the drugs acting on GABA system.
Anxiety is an emotional state, unpleasant in nature, associated with uneasiness, discomfort and concern or fear about some defined or undefined future threat. It has several types. the presentation includes pharmacologic approach of anxiety disorder.
A compiled Power point presentation on "Antipsychotic drugs" suitable for Undergraduate level medical students and also PG students in the subject of Pharmacology.
My presentation on neurotransmitter glutamate. References from Comprehensive textbook of psychiatry 9th edition and Stahl's essential psychopharmacology 4th edition.
Here is an overview of Antipsychotics,starting from basic pathophysiology of Psychosis and Schizophrenia,breifing the Neuropharmacology and lastly introduction of drugs with special reference to side effects and clincal uses.
Antipsychotics, also known as neuroleptics,[1] are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of other psychotic disorders.[2][3] They are also the mainstay together with mood stabilizers in the treatment of bipolar disorder.[4]
Antipsychotic
Drug class
Zyprexa.PNG
Olanzapine, an example of a second-generation (atypical) antipsychotic
Class identifiers
Synonyms
Neuroleptics, major tranquilizers[1]
Use
Principally: Schizophrenia, Schizoaffective disorder, Dementia, Tourette syndrome, Bipolar disorder, irritability in autism spectrum disorder
Clinical data
Drugs.com
Drug Classes
External links
MeSH
D014150
In Wikidata
Prior research has shown that use of any antipsychotic is associated with smaller brain tissue volumes,[5][6] including white matter reduction[7] and that this brain shrinkage is dose dependent and time dependent.[5][6] A more recent controlled trial suggests that second generation antipsychotics[8] combined with intensive psychosocial therapy[9] may potentially prevent pallidal brain volume loss in first episode psychosis.[10][7]
The use of antipsychotics may result in many unwanted side effects such as involuntary movement disorders, gynecomastia, impotence, weight gain and metabolic syndrome. Long-term use can produce adverse effects such as tardive dyskinesia, tardive dystonia, and tardive akathisia.
Prevention of these adverse effects is possible through concomitant medication strategies including use of beta-blockers. Currently, treatments for tardive diseases are not well established.
First-generation antipsychotics (e.g. chlorpromazine), known as typical antipsychotics, were first introduced in the 1950s, and others were developed until the early 1970s.[11] Second-generation antipsychotics, known as atypical antipsychotics, were introduced firstly with clozapine in the early 1970s followed by others (e.g. risperidone).[12] Both generations of medication block receptors in the brain for dopamine, but atypicals tend to act on serotonin receptors as well. Neuroleptic, originating from Greek: νεῦρον (neuron) and λαμβάνω (take hold of)—thus meaning "which takes the nerve"—refers to both common neurological effects and side
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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- GENE THERAPY
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- ETHICAL CHALLENGES IN LIFE SCIENCES
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. Psychiatric Nosology
(Classification of disease)
• Psychosis
• Cognitive disorders: confusion, disorientation,
memory disturbances and behavioral disorganization
(delirium and dementia)
• Mood disorders
• Anxiety disorders
• Personality disorders
3. Psychosis
• Psychosis is a thought disorder
characterized by :
• Disturbances of reality and perception
• Impaired cognitive functioning
• Inappropriate or diminished affect (mood)
• Psychosis denotes many mental disorders.
Schizophrenia is a particular kind of
psychosis characterized mainly by a clear
sensorium but a marked thinking disturbance.
4. Schizophrenia
• Pathogenesis is unknown.
• Onset of schizophrenia is in the late teens early
twenties.
• Genetic predisposition -- Familial incidence.
• Multiple genes are involved.
• Afflicts 1% of the population worldwide.
• May or may not be present with anatomical
changes.
5. Schizophrenia
• It is a thought disorder.
• The disorder is characterized by a divorcement
from reality in the mind of the person
(psychosis).
• It may involved visual and auditory
hallucinations, delusions, intense suspicion,
feelings of persecution or control by external
forces (paranoia), depersonalization, and there is
attachment of excessive personal significance to
daily events, called “ideas of reference”.
6. Schizophrenia
Positive Symptoms.
Hallucinations, delusions, paranoia, ideas of reference.
Negative Symptoms.
Apathy, social withdrawal, anhedonia (Loss of the
capacity to experience pleasure), emotional blunting,
cognitive deficits, extreme inattentiveness or lack of
motivation to interact with the environment.
These symptoms are progressive and non-responsive to medication.
9. Psychosis Producing Drugs
1) Levodopa
2) CNS stimulants
a) Cocaine
b) Amphetamines
c) Khat, cathinone, methcathinone
3) Apomorphine
4) Phencyclidine
10. Dopamine Theory of Schizophrenia
Many lines of evidence point to the
aberrant increased activity of the
dopaminergic system as being critical in
the symptomatology of schizophrenia.
11. Dopamine Theory of Schizophrenia
Dopamine Correlates:
• Antipsychotics reduce dopamine synaptic activity.
• These drugs produce Parkinson-like symptoms.
• Drugs that increase DA in the limbic system cause
psychosis.
• Drugs that reduce DA in the limbic system
(postsynaptic D2 antagonists) reduce psychosis.
• Increased DA receptor density (Post-mortem, PET).
• Changes in amount of homovanillic acid (HVA), a
DA metabolite, in plasma, urine, and CSF.
12. Dopamine Theory of Schizophrenia
Evidence against the hypothesis
• Antipsychotics are only partially effective in most
(70%) and ineffective for some patients.
• Phencyclidine, an NMDA receptor antagonist,
produces more schizophrenia-like symptoms in non-
schizophrenic subjects than DA agonists.
• Atypical antipsychotics have low affinity for D2
receptors.
• Focus is broader now and research is geared to
produce drugs with less extrapyramidal effects.
13. Dopamine System
There are four major pathways for the dopaminergic
system in the brain:
I. The Nigro-Stiatal Pathway: Voluntary movements
II. The Mesolimbic Pathway.: Behaviour
III. The Mesocortical Pathway: Behaviour
IV. The Tuberoinfundibular Pathway: Prolactin release
20. Antipsychotic treatments
Schizophrenia has been around perhaps, since the
beginning of humankind, however, it was not until
the last century that it was established as a separate
entity amongst other mental disorders.
Many treatments have been devise:
Hydrotherapy:
“The pouring of cold water in a stream, from a height of
at least four feet onto the forehead, is one of the most
certain means of subsiding violent, maniacal excitement
that we have ever seen tried”... wrote an anonymous
physician in the early 1800’s.
21. Antipsychotics treatment
Antipsychotics/Neuroleptics
• Antipsychotics are the drugs currently used in
the prevention of psychosis.
• They have also been termed neuroleptics,
because they suppress motor activity and
emotionality.
** These drugs are not a cure **
• Schizophrenics must be treated with
medications indefinitely, in as much as the
disease is lifelong and it is preferable to
prevent the psychotic episodes than to treat
them.
22. Antipsychotics/Neuroleptics
Although the antipsychotic/neuroleptics are
drugs used mainly in the treatment of
schizophrenia, they are also used in the
treatment of :
– Psychoses associated with depression
– Manic-depressive illness
– Psychosis associated with alzheimer’s disease.
These conditions are life-long and disabling.
30. Antipsychotics/Neuroleptics
• Old antipsychotics
/neuroleptics are D2
dopamine receptor
antagonists.
Although they are
also effective
antagonists at ACh,
5-HT, NE receptors.
Dopamine Synapse
DA
L-DOPA
Tyrosine
Tyrosine
dopamine
receptor
antagonist
D2
31. Antipsychotics/Neuroleptics
• It appears that the specific interaction of
antipsychotic drugs with D2 receptors is
important to their therapeutic action.
• The affinities of most older “classical” agents
for the D2 receptors correlate with their
clinical potencies as antipsychotics.
32. Antipsychotics/Neuroleptics
• Both D1 and D2 receptors are found in high
concentrations in the striatum and the nucleus
accumbens.
• Clozapine has a higher affinity for the D4 receptors
than for D2.
• Recently it has been found that most antipsychotic
drugs may also bind D3 receptors (therefore, they
are non-selective).
33. Antipsychotics/Neuroleptics
• Antipsychotics produce catalepsy (reduce motor
activity).
– BLOCKADE OF DOPAMINE RECPTORS IN BASAL GANGLIA.
• Antipsychotics reverse hyperkinetic behaviors
(increased locomotion and stereotyped behavior).
– BLOCKADE OF DOPAMINE RECPTORS IN LIMBIC AREAS.
• Antipsychotics prevent the dopamine inhibition of
prolactin release from pituitary.
– BLOCKADE OF DOPAMINE RECEPTORS IN PITUITARY.
hyperprolactinemia
36. Antipsychotics/Neuroleptics
• Newer drugs have higher affinities for D1, 5-
HT or -AR receptors.
• NE, GABA, Glycine and Glutamate have
also been implicated in schizophrenia.
37. Antipsychotics/Neuroleptics
The acute effects of antipsychotics do not explain why
their therapeutic effects are not evident until 4-8
weeks of treatment.
Blockade of D2 receptors
Short term/Compensatory effects:
Firing rate and activity of nigrostriatal and
mesolimbic DA neurons.
DA synthesis, DA metabolism, DA release
38.
39. Antipsychotics/Neuroleptics
Presynaptic Effects
Blockade of D2 receptors
Compensatory Effects
Firing rate and activity of nigrostriatal and mesolimbic DA
neurons.
DA synthesis, DA metabolism, DA release.
Postsynaptic Effects
Depolarization Blockade
Inactivation of nigrostriatal and mesolimbic DA neurons.
Receptor Supersensitivity
40. Antipsychotic/Neuroleptics
Clinical Problems with antipsychotic drugs
include:
1) Failure to control negative effect
2) Significant toxicity
a) Neurological effects
b) Autonomic effects
c) Endocrine effects
d) Cardiac effects
3) Poor Concentration
41. Neurological effects
• Acute dystonia- Spasms of muscles of tongue,
neck and face
• Akasthisia – Uncontrolled motor restlessness
• Parkinsonism
• Neuroleptic Mallignant Syndrome
• Rabbit syndrome (perioral tremors)
• Tardive dyskinesia
Piperazines
Butyrophenones
43. Tardive Dyskinesia (TD)
• Repetitive involuntary movements, lips,
jaw, and tongue
• Choreiform quick movements of the
extremities
• As with Parkinson’s, movements stop
during sleep
• No effective treatment
46. Antipsychotic/Neuroleptics
Some antipsychotics have effects at
muscarinic acetylcholine receptors:
• Dry mouth
• Blurred vision
• Urinary retention
• Constipation
Clozapine
Chlorpromazine
Thioridazine
47. Antipsychotic/Neuroleptics
Some antipsychotics have effects at -
adrenergic receptors:
• orthostatic hypotension
Chlorpromazine
Thioridazine
Some antipsychotics have effects at H1-
histaminergic receptors:
• sedation
Risperidone
Haloperidol
48. Antipsychotic/Neuroleptics
Blockade of D2 receptors in lactotrophs
in breast increase prolactin concentration
and may produce breast engorgement
and galactorrhea.
49. Blood Dyscrasias
• Clozapine 1-3 % incidence agranulocytosis
• Monitor WBC weekly
– WBC < 3,000 hold tx, check for infection
– Restart when reach 3,500
– WBC < 2,000 discontinue treatment, do not
rechallange
50. Antipsychotic/Neuroleptics
Neuroleptic Malignant Syndrome
Is a rare but serious side effect of neuroleptic
(antipsychotic) therapy that can be lethal. It
can arise at any time in the course of treatment
and shows no predilection for age, duration of
treatment, antipsychotic medication, or dose.
51. Antipsychotic/Neuroleptics
Neuroleptic Malignant Syndrome
• Occurs in pts. hypersensitive to the Ex.Py. effects of
antipsychotics.
• Due to excessively rapid blockade of postsynaptic
dopamine receptors.
• The syndrome begins with marked muscle rigidity.
• If sweating is impaired, a fever may ensue. The
stress leukocytosis and high fever associated with this
syndrome may be mistaken for an infection.
• Autonomic instability with altered blood pressure and
heart rate is another midbrain manifestation.
• Creatine kinase isozymes are usually elevated,
reflecting muscle damage.
53. XVI. Anti-Manic Drugs
Lithium (Li+) remains the drug of choice for the
treatment and prophylaxis of mania.
• Acute manic episodes are managed with lithium
salts (carbonate or citrate) alone, or in combination
with:
1) Antipsychotics (carbamazepine, similar in
structure to TCAs but not effective in
depression).
2) Valproic acid
3) Calcium-channel blockers (nifendipine,
diltiazem, verapamil).
54. XVI. Anti-Manic Drugs
Li+
• Helps alleviate the depressive phase of
bipolar illness.
• Useful in refractory depression when
added to SSRIs or TCAs, but not a good
antidepressant alone.
55. XVI. Anti-Manic Drugs
Li+
Mechanism of action:
• Does not alter receptor numbers but alters the
coupling of the receptors with their second
messengers by reducing coupling of G-proteins.
• Regulation of -AR and DAR.
• Can reduce release of NTs (5-HT) and affinity of
binding to receptor.
56. XVI. Anti-Manic Drugs
Li+
Mechanism of action (Con’t):
Inhibits breakdown of IP2 to IP1 (during PIP
hydrolysis) => depletion of DAG and IP3 and
[Ca2+] in response to receptor activation (i.e.
from 5-HT2R, 1-AR, muscarinic receptors and
others).
• Alterations in adenylate cyclase and
phospholipase C.