ANTOPSYCHOTICS ANTIDEPRESENT DRUGD ANTIANXIETY DRUGS HALLUCINATION.pptx

1. Rajkumari Lodhi
Assistant Professor
Department of Pharmacology
Bhopal Madhya Pradesh
ANTIPSYCHOTICS, ANTIDEPRESSANT DRUGS
,ANTIANXIETY DRUGS ANTIMANIC DRUG,
HALLUCINATIONS
Subject:-pharmacology-I
Semester:- 4th

2.  Psychosis is a thought disorder characterized by disturbances of reality and perception, impaired cognitive
functioning, and 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.
 Substances that can induce psychotic symptom These includes;
1. Levodopa
2. CNS stimulants
A. Cocaine
B. Amphetamines
C. cathinone, methcathinone
3. Apomorphine
4. Phencyclidine
And other Alcohol , Cannabis (Marijuana) ,
ANTIPSYCHOTICS, ANTIDEPRESSANT DRUGS ,ANTIANXIETY DRUGS
ANTIMANIC DRUG, HALLUCINATIONS

3. Schizophrenia
It is a thought disorder.
The disorder is characterized by a divorcement from reality in the mind of the person
(psychosis).
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

4. Symptoms
1. Positive Symptoms
 Hallucinations, delusions, paranoia, excited motor behaviour.
2. Negative Symptoms
 Slow thought or speech, social withdrawal, extreme inattentiveness or lack of motivation to interact with
the environment.
Antipsychotic Medications (APMs)
 Used to treat manifestations of psychosis and other psychiatry disorders
 Precise mechanism of action is unknown, however APMs blocks several populations of dopamine (D2,
D4) receptors in the brain.
 The newer APMs also block serotonin (5-HT2) receptors, a property that may be associated with increased
efficacy.
 APMs also variably blocks central and peripheral cholinergic, histamine and alpha receptors

5. Classification of antipsychotic drugs
• PHARMACOLOGICAL CLASSIFICATION – FIRST-GENERATION ANTIPSYCHOTIC (low potency)
• Chlorpromazine
• Prochlorperazine
• Thioridazine –
FIRST-GENERATION ANTIPSYCHOTIC (high potency)
• Fluphenazine (Modecate)
• Haloperidol (Haldol)
• Pimozide
• Thiothixene
• Zuclopenthixol (Clopixol)
SECOND GENERATION ANTIPSYCHOTIC
• Aripiprazole
• Asenapine
• Clozapine
• Iloperidone
• Lurasidone
• Paliperidone
• Risperidone
• Ziprasidone

6. Division of APMs based on receptor blockade There are three (3) main groups;
 Pure D2 antagonist: Typical APMs (low and high potency).
 D2-5HT2 antagonist: Risperidone
 Multireceptor antagonist:
a. Clozapine - D2, D4, 5HT2
b. Olanzapine - D2, D4, 5HT2
c. Quetiapine - D2, D4, 5HT2
d. Ziprasidone - D2, D4, 5HT2
e. Aripiprazole - D2, D4, 5HT2

7. General Adverse effects of APMs
 Weight gain (olanzapine)
 Sedation – due to antihistamine activity
 Hypotension – effect is due to alpha adrenergic blockade. It is most common with
low potency APMs
 Anticholinergic symptoms – dry mouth, blurred vision, urinary retention,
constipation, etc
 Endocrine effects – gynecomastia, galactorrhea, amenorrhea, due to blockade of
tuberoinfundibular tract
 Hematological problems such as agranulocytosis with atypical APMs (clozapine as
the most problematic agent).

8. Antidepressant drugs
 Drugs that are used to relieve or prevent psychic depression.
 Work by altering the way in which specific chemicals, called neurotransmitters, work in our brains (i.e. in
the case of depression, some of the neurotransmitter systems don’t seem to be working properly).
 They increase the activity of these chemicals in our brains
TYPE OF DEPRESSION :
 Major depression
 Chronic depression (Dysthymia)
 Atypical depression
 Bipolar disorder/Manic depression
 Seasonal depression (SAD)

9. Major depression
 More disabling Symptoms must last for at least two weeks and impair one’s ability to interfere with a
person's ability to work, sleep, study, eat, and enjoy once-pleasurable activities.
 Chronic depression – less disabling than major depression, but symptoms can last longer, sometimes
being unhappy for two years. More common in women, affects 11 million people.
 Atypical depression, rather than the other two, is characterized less by pervasive sadness and more by
overeating, oversleeping, sensitivty to rejection
 Bipolar/manic depression
I – episode of mania with or without depression. Bipolar
II – episode of depression with episode of hypomania or mania.
 Seasonal depression (SAD) – often occurs where winters are short or there is a big change in the
amount of sunlgiht, and often treated with light therapy.

10. SYMPTOMS:
 Empty moods
 loss of pleasure in usual activities
 feelings of helplessness, guilt, or worthlessness
 crying, hopelessness,
 fatigue or decreased energy
 loss of memory, concentration, or decision-making capability
 restlessness, irritability
 sleep disturbances
 change in appetite or weight
 thoughts of suicide or death, or suicide attempts
Classification
 Tricyclic Antidepressants (TCAs)i. NA+5-HT reuptake inhibitor
- Imipramine
- Trimipramine
- Amitriptyline
 Predominantly NA reuptake inhibitors
- Desipramine
- Nortriptyline
- Reboxetine

11.  Selective Serotonin reuptake inhibitors(SSRIs)
- Citalopram
- Escitalopram
- Fluoxetine
- Paroxetine
- Sertraline
 5-HT / NE Reuptake Inhibitors (SNRIs)
- Duloxetine
- Venlafaxine
 Atypical Antidepressants
- Buproprion
- Mirtazapine
- Nefazodone
- Trazodone
 Monoamine Oxidase Inhibitors
- Phenelzine
- Selegiline
- Tranylcypromine

12. MECHANISM OFANTIDEPRASSAT DRUGS
 Biogenic amine theory of depression and mania proposes that:
 Depression is due to a deficiency of monoamines such as norepinephrine and serotonin, at certain sites in
the brain
 Mania is caused by an overproduction of these neurotransmitters
 Antidepressants potentiate, either directly or indirectly, the actions of norepinephrine and/or serotonin in
the brain
 The amine theory of depression and mania is too simplistic to explain.
 Decreased reuptake of neurotransmitters is only an initial effect which may not be directly responsible for
the antidepressant effects.

13. Adverse effects
 Headache
 Sweating
 Anxiety
 GI effects (nausea, vomiting, diarrhea)
 Weakness and fatigue
 Sexual dysfunction
 Changes in weight
 Sleep disturbances (insomnia)
COMPLICATIONS OF UNTREATED DEPRESSION
•Panic attacks
•Anxiety
•Physical pain
•Weight gain or weight loss
•Relationship problems
•Social isolation and loneliness
•Self-harm
•Alcohol- and drug abuse
•Eating disorders
•Other mental health issues
•Suicidal thoughts and suicide

14. Antianxiety drugs
Anxiety
 Anxiety It is an emotional state, unpleasant in nature, associated with uneasiness (a fear
that seems to arise from a unknown source), discomfort and concern or fear about some
defined or undefined future threat.
 Some degree of anxiety is a part of normal life. Treatment is needed when it is
disproportionate to the situation and excessive.
 Some psychotics and depressed patients also exhibit pathological anxiety.
 The physical symptoms of severe anxiety are similar to those of fear (such as sweating,
trembling, and palpitations) and involve sympathetic activation.

15. Antianxiety drugs Classification
 Benzodiazepines: Diazepam, Chlordiazepoxide, Oxazepam, Lorazepam, Alprazolam, Clonazepam,
Flurazepam
 Azapirones: Buspirone, Gepirone, Ispapirone
 Sedative: Hydroxyzine
 Barbiturates: Amobarbital, Pentobarbital, Phenobarbital, Thiopental
 β blocker: Propranolol

16. Benzodiazepines (BZDs)
• Benzodiazepines act preferentially on midbrain
. BZDs act by enhancing presynaptic/postsynaptic inhibition through a specific BZD receptor which is an
integral part of the GABAA receptor-Cl- channel complex (GABA receptor has five or more span the
postsynaptic membrane).
• Benzodiazepines modulate GABA effects by binding to a specific, high-affinity site located at the interface
of the α subunit and the γ2 subunit
• Binding of GABA to its receptor triggers an opening of a chloride channel, which leads to an increase in
chloride conductance. Benzodiazepines increase the frequency of channel openings produced by GABA
(influx of chloride ion cause hyperpolarization).

17. Anti-anxiety drugs acts on GABA receptor and they open the chloride channel and
extend the penetration of chloride channel through it, chloride channel are
responsible for the negative charge inside cell, after some time negativity got
balanced due to presence of potassium ion, and thus the normal physiology of body
maintain by the continuous polarization and depolarization process.
However, when GABA channels are open by antianxiety drug, the penetration of
chloride channel increases inside cell and when negativity increases it also increases
polarization, but this generated polarization is comparatively longer than normal
polarization, thus this is also called hyperpolarization
Hyperpolarized condition delays the depolarization state and these moves the
postsynaptic potential away from action threshold and inhibit the action potential. .

18. Antimanic drug
 Antimanic drug, any drug that stabilizes mood by controlling symptoms of mania, the abnormal
psychological state of excitement.
 Mania is a severe form of emotional disturbance in which a person is progressively and inappropriately
euphoric and simultaneously hyperactive in speech and locomotor behaviour.
 This is often accompanied by significant insomnia (inability to sleep), excessive talking, extreme
confidence, and increased appetite.
 As the episode builds, the person experiences racing thoughts, extreme agitation, and incoherence,
frequently replaced with delusions, hallucinations, and paranoia, and ultimately may become hostile and
violent and may finally collapse.
 In some persons, periods of depression and mania alternate, giving rise to bipolar disorder.

19. Bipolar I Bipolar II
 high self-esteem  Changes in appetite or weight, sleep, or
psychomotor activity
 little need for sleep  decreased energy
 increased rate of speech (talking fast)  feelings of worthlessness or guilt
 flight of ideas  trouble thinking, concentrating, or making
decisions
 getting easily distracted  thoughts of death or suicidal plans or attempts
 An increased interest in goals or activities
 psychomotor agitation (pacing, hand
wringing, etc.)
 increased pursuit of activities with a high
risk of danger

20. Available drugs
 Lithium Carbonate (Li) – sedative in animals in 1949
 Alternative Drugs:
 Carbamazepine
 Sodium Valproate
 Lamotrigine
 Topiramate
 Atypical anyipsychotics
 Olanzapine
 Risperidone
 Aripiprazole
 quetiapine etc

21. Pharmacological action- CNS
 No acute effects in bipolar and normal person
 Neither sedative nor euphorient
 But, on prolong administration – stabilizes mood in bipolar disorder
 In acute mania
 gradually suppresses episodes (1 – 2 weeks)
 continued treatment prevents cycle of mood changes
 Reduced sleep time normalized
MOA:
1. Effects on Electrolyte and ion transport
2. Effects on Neurotransmitters
3. Effects on 2nd Messenger generation

22. Antimanics
 The most effective antimanic medications, which are used primarily for bipolar disorder,
are the simple salts lithium chloride or lithium carbonate.
 Although some serious side effects can occur with large doses of lithium, the ability to
monitor blood levels and keep the doses within modest ranges makes.
 it an effective treatment for manic episodes, and it can also stabilize the mood swings of
the patient with bipolar disorder.
 Lithium has a gradual onset of action, taking effect several weeks following initiation of
treatment. The precise mechanism of its action is not known.

23. CNS
 Prolonged administration acts as mood stabilizer in bipolar disease.
 In acute mania , it gradually suppress episode taking 1-2 weeks ; continuedT/t prevent cyclic mood changes
. Proposed
MOA
 Lithium by inhibits several important enzyme in conversion of IP 2 to IP 1 & conversion of IP to inositol.
Antimanics.
 Causes depletion of second messenger source PIP2 (phosphatidyl inositol biphosphate)& therefore reduce
release of IP3 & DAG & its effects (activation of protein kinase c , mobilization of intracellular ca 2+).
Antimanics.
 Before therapy , such activity might be greatly increased in mania.
 Lithium could cause a selective depression of overactive circuits.

24. Hallucinations
If you're like most folks, you probably think hallucinations have to do with seeing things
that aren't really there.
But there's a lot more to it than that. It could mean you touch or even smell something
that doesn't exist.
There are many different causes.
It could be a mental illness called schizophrenia, a nervous system problem
like Parkinson's disease, epilepsy, or of a number of other things.
If you or a loved one has hallucinations, go see a doctor. You can get treatments that help
control them, but a lot depends on what's behind the trouble.
There are a few different types.

25. Common Causes of Hallucinations
Hallucinations most often result from:
Schizophrenia
More than 70% of people with this illness get visual hallucinations, and 60%-90% hear
voices. But some may also smell and taste things that aren't there.
 Parkinson's disease. Up to half of people who have this condition sometimes see
things that aren't there.
 Alzheimer's disease. and other forms of dementia, especially Lewy body
dementia. They cause changes in the brain that can bring on hallucinations. It may be
more likely to happen when your disease is advanced.

26.  Migraines. About a third of people with this kind of headache also have an "aura," a type of
visual hallucination. It can look like a multicolored crescent of light.
 Brain tumor. Depending on where it is, it can cause different types of hallucinations. If it's in
an area that has to do with vision, you may see things that aren't real. You might also see
spots or shapes of light. Tumors in some parts of the brain can cause hallucinations of smell
and taste.
 Charles Bonnet syndrome. This condition causes people with vision problems like macular
degeneration, glaucoma, or cataracts to see things. At first, you may not realize it's a
hallucination, but eventually, you figure out that what you're seeing isn't real.
 Epilepsy. The seizures that go along with this disorder can make you more likely to have
hallucinations. The type you get depends on which part of your brain the seizure affects.

27. Hearing Things (Auditory
Hallucinations)
You may sense that the sounds are
coming from inside or outside your mind.
You might hear the voices talking to each
other or feel like they're telling you to do
something. Causes could include:
•Schizophrenia
•Bipolar disorder
•Psychosis
•Borderline personality disorder
•Posttraumatic stress disorder
•Hearing loss
•Sleep disorders
•Brain lesions
•Drug use
Hearing Things (Auditory
Hallucinations)
You may sense that the sounds are
coming from inside or outside your mind.
You might hear the voices talking to each
other or feel like they're telling you to do
something. Causes could include:
•Schizophrenia
•Bipolar disorder
•Psychosis
•Borderline personality disorder
•Posttraumatic stress disorder
•Hearing loss
•Sleep disorders
•Brain lesions
•Drug use

28. Seeing Things (Visual Hallucinations)
•See things others don’t, like insects crawling on
your hand or on the face of someone you know
•See objects with the wrong shape or see things
moving in ways they usually don’t
Sometimes they look like flashes of light. A rare type
of seizure called "occipital" may cause you to see
brightly colored spots or shapes. Other causes include:
•Irritation in the visual cortex, the part of your brain
that helps you see
•Damage to brain tissue (the doctor will call this
lesions)
•Schizophrenia
•Schizoaffective disorder
•Depression
•Bipolar disorder
•Delirium (from infections, drug use and withdrawal,
or body and brain problems)
•Dementia
•Parkinson’s disease
•Seizures
Smelling Things (Olfactory Hallucinations)
You may think the odor is coming from something
around you, or that it's coming from your own body.
Causes can include:
•Head injury
•Cold
•Temporal lobe seizure
•Inflamed sinuses
•Brain tumors
•Parkinson’s disease
Tasting Things (Gustatory Hallucinations)
You may feel that something you eat or drink has an
odd taste. Causes can include:
•Temporal lobe disease
•Brain lesions
•Sinus diseases
•Epilepsy

29. THANK YOU