In short understanding about psychosis and mania.

1. CENTRAL NERVOUS SYSTEM
Prathamesh K. Rawool
F.Y.M.Pharmacy
Department Of Pharmacology

2. PSYCHOSIS

3. 1.These are severe psychiatric illness with
serious distortion of thought, behaviour,
capacity to recognise reality and of perception
(delusions and hallucinations).
2.There is inexplicable misperception and
misevaluation; the patient is unable to meet
the ordinary demands of life.

4. CLASSIFICATION OF ANTIPSYCHOTIC DRUGS
Note : 2nd Generation are having high risk of metabolic side effects

5. MECHANISM OF ACTION:
All anti psychotics (except clozapine-
like atypical) have potent dopamine
D2 receptor blocking action.
Antipsychotic potency has shown
good correlation with their capacity
to bind to D2 receptor.
Phenothiazines and thioxanthenes
also block Dl, D3 and D4 receptors,
but there is no correlation with
antipsychotic potency.
Action is blocked by agents which
increase dopamine level.
( Levodopa , Bromocriptine)

6. PHARMACOLOGICAL EFFECTS
1. CNS : reduces irrational behaviour, agitation and
aggressiveness and controls psychotic symptomatology.
Disturbed thought and behaviour are gradually normalized,
anxiety is relieved. Hyperactivity, hallucinations and
delusions are suppressed. lowers seizure threshold and can
precipitate fits in untreated epileptics
2. CVS: hypotension, High dose can cause depress rate.

7. 3. Local Anaesthetic : Chlorpromazine is potent a local anaesthetic a s
procaine. However it is not used for this purpose because of its irritant
action. Others have weaker membrane stabilizing action.
4. Endocrine : Neuroleptics consistently increase prolactin release by
blocking the inhibitory action of DA on pituitary lactotropes. This may
result in galactorrhoea and gynaecomastia.

8. ADVERSE EFFECTS
1. CNS: Drowsiness, lethargy, mental confusion, increased
appetite, wt. gain.
2. CVS: Postural hypotension, palpitation, inhibition of
ejaculation and cardiac arrhythmias.
3. Dry mouth, blurring of vision.
• Extrapyramidal Effects:
1. Parkinsonism : Rigidity, Tremor.
2. Akathisia : Restlessness, irrestible desire to move around.
3. Acute Dystonia : Uncontrol muscle spasm mostly over
face, tongue, neck.

9. RECENT ADVANCES
1. Nuplazid (pimavanserin) : Nuplazid (pimavanserin) is
thought to exert it's effect through a combination of inverse
agonist and antagonist activity at serotonin 5-HT2A
receptors and to a lesser extent at serotonin 5-HT2C
receptors.
USES: Schizophrenia, mania, anxiety, antiemetic, organic
brain syndrome

10. MANIA

11. SALIENT FEATURE OF MANIA
1.Inappropriate elation and irritability.
2.Severe insomnia, Increase talking
speed.
3.Increase energy, Poor judgement
4.Inappropriate social behaviour.

12. DRUGS USED IN MANIA: MOOD STABILIZER
1. Lithium
2. Carbamazepine
3. Valproic Acid
4. Lamotegrine

13. MECHANISM OF ACTION
•Effect on Electrolyte : Compete with NA+ .
•G-Protien Coupled Receptor : Decrese Receptor
Mediated actvation.
•Neurotransmitter: Decrease realease of DA and
NE/NA.
•GABA : Increase GABAActivity (Inhibitory).

14. ADVERSE EFFECTS
1. Acute Toxicity
2. Renal Impairment
3. Edema (NA+ retention)
4. Nausea and Vomiting

15. THANK YOU !