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PSYCHOTHERAPEUTIC AGENTS
They are used to treat psychoses- perceptual and
behavioral disorders
MENTAL DISORDER AND THEIR CLASSIFICATION
They are thought to be cause by some inherent dsyfunction of the brain.
It leads to abnormal thought process and responses
Some theories attribute these disorders to chemical imbalance in the brain
Kinds of Mental disoder
1. Schizoprenia-( Splitting of the mood).it is mental illness characterized by impairments in perception or expression of reality. This include hallucination,paranoia, delusions, speech disoder, and affective problems.
2. Mania,it is associated bipolar disorder The two extreme mood states of mania
(ranging from euporia or unpleasant mood) and depression(felling of sadness)
KINDS OF MENTAL DISORDER3.NACROLEPSY- it is characterized by irrestable
attacks of sleep (sleep attacks) occuring daily over at least 3 months with cratalepsy(breif episodes abrupt loss of muscle tone) and hallucination or sleep paralysis at the beginning or end of sleep.
4. Attention-defecit disorder- it is characterized by an inability to concentrate on one activity for longer than few minutes and states of hyperkinesis. (frequent in school children) they manifest inattentiveness, over activity, and impusiveness. This children are restless, distructible, recless, and distruptive. Treatment include few simple rules,and Firm limits, Avoid fatigue, Regular routine, and structured invironment.
ANTIPSYCHOTIC/NUEROLEPTIC DRUGS They are also called nueroleptics or
major tranquilizers. Most common side effects is dizziness They are indicated for schizophrenia,
organic brain syndrome with psychosis and delusional disorder (disorder of thinking)
They are essentially dopamine receptor blockers used to treat disorders of thought process.
CLASSIFICATION OF ANTIPSYCHOTICS1. Traditional Antipsychotics High- potencyFlephenanezine (prolixin)Haloperedol (Haldol)Thiothixene (Navane)Triflurperazine(Stelazine)Moderate-PotencyPerphenazine (trilafon)Loxapine( Loxitane)Molidone(Moban)LOW-POTENCYChloropromazine (Thorazine)Thioridazine (Mellaril
CLASSIFICATION OF TRADITIONAL ANTIPSYCHOTICS
Introduced in 1950 Chlorpromazine was the first
antipsychotic developed Thioridazine (mellaril) is therapeutic in
children with severe behavioral problems marked by Combativeness.
Fluphenazine deconeate (prolixin deconeate is the long acting form (injectable) of prolixin; last 2-3 weeks
CLASSIFICATION OF TRADITIONAL ANTIPSYCHOTICS
Parenteral Haloperadol alone or in combination with benzodiazephine Lorazepam( ativan) is used to help aggressive or psychiatric patients stay in control
Haloperedol is along acting form and can be given at 2-4 weeks intervals or longer. This is used for individuals who struggle compliance
ACTION/Traditional antipsychotics
Potent antagonist of dopamine (D2, D3,D4 ) receptors
Extrapyramidal side effects are caused by the blocking of D2 receptors
Side effects/ Traditional antipsychotics Low-potency drugs: more intense High-potency drugs: more
extrepyramidal effects Thioridazine (mellaril) has maximum
upper limit of 800 mg/day because of possible pigmentary retinopathy (decrease visual acuity,impairs night vision, and pigmented deposits in the fundus
ATYPICAL ANTIPSYCHOTICS
CLORAZAPINE (CLORAZIL) PISPERIDONE (Resperdal) Olanzapine (Zyprexia) Quelopine (Seroqoun) Ziprasidone (Geodon)
Classification/Atypical antipsychotics Inodtroduced in 1990 Reduced or no risk for EPSEs: Blockade of 5-HT2 prevents D2 Blockage Increase effectiveness in treating negative and
cognitive symtoms: dopamine is increase. Minimal risk of TD Tardive dyskinesia a
streotyped involuntary movements, lip smacking, tonque protrusion, chewing,blinking, grimacing, Choeriform movements of limbs and tongue and foot tapping.
Classification of Atypical antipsychotic drug Absence of prolactin level elavations. Clozapine is the first truly new
antipsychotics Respiridone is the most frequently
prescribe antipsychotics. Available in injection form(long acting)
Olanzapine is available in injectable form and form and is proven in treating acute mania and bipolar disorder
ACTION/Atypical Antipsychotic drugs
Blocks dopamine receptors but are weak blocker of D2= Low incidence of extrapyramidal side effects
Blocks 5-HT2 receptors thus liberates dopamine
Side effects Clozapine: agranulocystosis( Nuetrophil
< 500/mm3) dose related seizures, exessive salavation, and myocarditis
Respiridone: orthostatic hypotension, sedation, appetite stimulation, insomia,agitation,headache, and rhinitis in higher doses it can cause EPSEs and hyperprolactinemia
Olanzapine has similar side effects with respiridone
New Generation of Antipshotics Aripipazole (Abilify) Introduced in 2002 This is dopamine system stabilizers
(stabilizes dopamine output) Increase/Decreases dopamine if
levels are high/low Controls sysmtoms without sides
effects of other antipsychotics.
SIDE EFFECTS OF ANTIPSYCHOTICS
Sedation- provide safety the patient
Side effects of Antipsychotic CAN CAUSE EXTRAPYRAMIDAL EFFECTS
Dystonia- acute mascular regidity, Torticollis-contracted position of the neck Oculogyric crisis contracted position of the
eyes upward Writer’s Clamp- fatigue spasm affecting
the hand Laryngeal-Pharyngeal Spasm- life
treatening Opisthothonus- arching of the back
Consideration in patient with Dystonia Occurs in males and in those receiving
High potency drugs (haloperedol and thiothexine)
Painful and freightening to the client Immediate treatment with Anticholinergic
drugs,such as IM benztropine meesmylate (Cogentin)or IM or IV. Diphenhydramine (benadryl), usually brings rapid relief.
Stay with the client and offer reassurance and support.
Endce Parkinsonism/Side effect of antipsychotic drug Tremor, shuffling/festinating gait,
drolling, cogwheel regigity Stiff, stopped posture, mask-like
faces, decrease arm swing, Bradycardia, coarse pill rolling
movements of the tumb and fingers while at rest
Nursing consideration of patient who has Enduce Psuedoparkinsonism
Symtom may appear 1-5 days following initiation of antipsychantichotic medication
Occurs most often in women, the elderly, and dehydrated clients
Treated by shifting to an antipsychotic medication with lower incidence of EPSEs or by adding an anticholinergic agent or amatadine (symmetrical), a dopamine agonist.
NURSING CONSIDERATION for AKATHESIA as EPSEs of Antipaychotic drugs
Akathesia is a continous restlessness, fidgeting, jittery fellings, and nerousness.
Most common EPSE and respond poorly to treatment
Major reason why patient taking medications
Treatment by change in antipsychotic medication or by adding an oral agents such as beta-blocker, anticholinergic, or benzodiazepine
Akinesia/Bradykinesia
Akinesia- absence of movement Bradykinesia- slowed movement Weakness, fatigue, painful
muscles, and anergia They respond to anticholinergic
Pisa syndrome an EPSEs
Leaning torwards one sides Consideration would include Older individual are more
succeptable to this side effect Higher doses of antiparkinsonian
drugs may be helpul and maintain saftey
Orthostatic hypotension an EPSEs after taking antipsychotic drug
Occurs more often in adults meanwhile accomodation occurs in a few weeks in younger individuals
Instruct the client to rise slowly from lying or sitting position (dangle feet first) and provide support stockings
Monitor BP at each shift and before giving medication
Hold the medication if there is a rise by 30 beats or 30mmHg( from lying to sitting to standing position)
Hormonal effects with used of anti psychotic drugs EPSEs Decrease libido Retrograde ejaculation and
gynecomastia(MEN) Amenorrhea (women) Weight gain Provide an explanation of effects and
reassurance of reversibility of sexual dysfunction
Instruct patient to continue contraception Weigh the client daily, Provide high calorie-
controlled diet and exercise