Psychotic Disorders for Field

8/14/2019 Psychotic Disorders for Field

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Psychotic DisordersPsychotic Disorder Definition:

Disorder characterized by loss of contact with reality, marked disturbances of thought & perception &

bizarre behavior.

Types :1) Schizophrenia

-Psychotic symptoms ( P! usually lasts for up to " months

2) Schizophreniform disorder

-P lasts for # $ month but %" months

! Schizoaffective disorder

- 'istory of DD ) now P at least for * weeks+! Drug abuse disorders

- Drug induced psychosis

! Maor depression !ith Psychotic features.- imultaneous occurrence of depressive symptoms ) Psychotic symptoms

"! Dementia.- loss of cognitive functions.

Schizophrenia Def :

Psychiatric disorder with delusional beliefs & 'allucinations

Preva"ence :

- round $- of the population- en ( early */0s ! & 1omen ( late */0s! e2ually affected.

#ause :- 3enetic abnormalities

- $iochemica" factors %&'cessive Dopamine ( D)

- 4rain tructural abnormalities

- Psychological stress & lower social class- 5amilial relationship

Types:

$! Paranoid schizophrenia.

-eg: Patients think that somebody is going to kill him.

*! 6atatonic schizophrenia

-eg: Patients motion is disturbed! Disorganised chizophrenia

-eg: Patients thoughts & language is changes.

+! 7ndifferentiated chizophrenia-eg: Mix of above 4 types .

! 8esidual chizophrenia

-eg: Symptoms !hich remain after the treatment.


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Symptoms :

1) Positive Symptoms

- ddition of e9tra behavior to the patient0s present personality- eg 'allucinations , delusions etc

2) *egative Symptoms

- 8emoval of some e9isting behavior from the patient0s personality.- eg: ;motional flatness or lack of e9pression,

+) #ognitive symptoms

- Cognition is the act or process of thinking, perceiving, and learning

,) ggressive symptoms

-


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Path!ay Drug &ffect #onse0uences

$! esolimbic 4locked Positive symptoms*! esocortical 4locked ?egative symptoms

! ?igrostriatal 4locked ovement disorder(;P!

+!


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a"operido" ( S&*3M )

- 'aloperidol is a butyropherone derivative- ntipsychotic properties are particularly effective in the management of hyperactivity, agitation, a

mania.

- ;ffective neuroleptic also possesses antiemetic properties- 'as a marked tendency to provoke e9trapyramidal effects

M3


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T5P4#6 *T4PS5#3T4#S

$. >lanzapine.

*. 8isperidone.

. 6lozapine.+. Euetiapine.

. Fiprasydone

". ripiprazole

T5P4#6 D78S

erotonin Dopamine ntagonist

ore effective on negative symptoms

Aess risk of causing ;9trapyramidal symptoms ( ;P !

Aess risk of causing


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D3PM4*& PT95S

esolimbic esocortical


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36&*; #ategory : ntipsychotic

M3:

>leanz is a thienbenozodiazepine atypical antipsychotic

>leanz demonstrates a broad pharmacological profile across a number of receptor systems.

>leanz has affinity for :

-Dopamine (D$, D*, and D+!,

-erotonin ('< *C*6!,

-'istamine ('$!,

-drenergic ($! receptors.

4ndications:

>leanz is indicated for the treatment of schizophrenia. >leanz is effective in maintaining the clinical improvement during continuation therapy in pati

who have shown an initial treatment response.

Dosage and dministration:

>lanzapine should be administered on a once-a day schedule without regard to meals, gener

beginning with to $/ mg initially, with a target dose of $/ mgCday within several days.

5urther dosage ad=ustments, if indicated, should generally occur at intervals of not less than $ we

Daily dosage may subse2uently be ad=usted on the basis of individual clinical status within the ra

of -*/ mg daily.

n increase to a dose greater than the routine therapeutic dose of $/ mgCday, i.e. to a dose o

mgCday or greater, is recommended only after appropriate clinical reassessment.

Elderly patients:

lower starting dose ( mgCday! is not routinely indicated but should be considered for those " over when clinical factors warrant.

Patients with hepatic and/or renal impairment:

lower starting dose ( mg! may be considered for such patients.


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# marc igh"ights/

Indication dependance ( Psychiatrist )

Rank Indications Preference Indication Oleanz

1 Schizophrenia 39%Schizophrenia 60%

2 Psychosis 22%

3 Depression 21%Depression 26%

3 Manic Depression 5%

4 Bipolar Depression 6%

Bipolar Disorder 10%5 Bipolar mood disorder. 2%

6 Bipolar aec!i"e disorder. 2%

# $!hers 4% $!her co eis!in& condi!ions 4%

"he #ommunication for $lean% !ill be based on the above indication.

"he thrust for each indication !ill be as per the se'uence

#ommunication 3bective :

@st Aine therapy in chizophrenia.

s an essentia" choice in Psychotic depression/

lso the drug of choice in acute & maintenance treatment of 4ipolar disorder


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S4;3D3*#"ass:ntipsychotic

M3: 8isperidone is a benziso9azole derivative

8isperidone0s antipsychotic activity is attributed to its antagonist activity at both

- Dopamine (D* subtype! and- erotonin ('


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S4;3P4*

#"ass : ntipsychotic/

M3/

6lozapine is a novel atypical antipsychotic drug.

Differs from other antipsychotic medications by its profile of binding to dopam

receptors and its effects on various dopamine mediated behaviours.

@t does interfere with the binding of dopamine at D$, D*, D and D

'as a high affinity for the D+ receptor.

@t is also preferentially more active at limbic than at striatal dopaminergic recept


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Special patient groups: @n patients with a history of seizures, those suffering f

cardiovascular, renal or hepatic disorders, the initial dose should be $*. mg given on the

day and dosage increase should be slow and in small increments.

# M# igh"ights:

SIZOPIN

Indication dependance ( Psychiatrist )

Rank Indications Preference Indication Oleanz

1 Schizophrenia '3%Schizophrenia 100%

2 Psychosis 1#%

6lozapine has a well - defined & role in the mangement of chizophrenia.

>nly reason for the restricted use of 6lozapine is the problem of granulocytosis.

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Psychotic Disorders for Field