Download - Anti Maniac Drugs
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Pushpendrakumar
Pushpendra kumar
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Content of talk
IntroductionMain cause
Pharmacological effect
Pharmacokinetic effect
Adrs
Interaction
Use
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Psychoses
Psychosis (from the Greek "psyche", formind/soul, and - "-osis", for abnormal
condition) means abnormal condition of the
mind, and is a generic psychiatric term for a
mental state often described as involving a
"loss of contact with reality".
http://en.wikipedia.org/wiki/Greek_languagehttp://en.wikipedia.org/wiki/Psychiatryhttp://en.wikipedia.org/wiki/Realityhttp://en.wikipedia.org/wiki/Realityhttp://en.wikipedia.org/wiki/Psychiatryhttp://en.wikipedia.org/wiki/Greek_language -
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A/ (Gelder, Mayou & Geddes 2005)
That the term psychosis is not sufficient as someillnesses grouped under the term "psychosis"
have nothing in common.
classification :1. cognitive disorder (acute and chronic organic
brain syndrome i.e. delurium and dementia .)
2. functional disorder(i.e.schizophrenia,paranoid states,)
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Organic conditions are primarily medicalor pathophysiological, whereas, functionalconditions are primarily psychiatric or
psychological. Psychiatric
1. Functional causes of psychosis include thefollowing:
2. brain tumors3. drug
abuse amphetamines, cocaine, marijuana, alcohol[8]among others
4. brain damage5. schizophrenia, schizophreniform
disorder, schizoaffective disorder, brief psychoticdisorder
http://en.wikipedia.org/wiki/Pathophysiologyhttp://en.wikipedia.org/wiki/Brain_tumorhttp://en.wikipedia.org/wiki/Amphetamineshttp://en.wikipedia.org/wiki/Cocainehttp://en.wikipedia.org/wiki/Marijuanahttp://en.wikipedia.org/wiki/Alcoholismhttp://en.wikipedia.org/wiki/Brain_damagehttp://en.wikipedia.org/wiki/Schizophreniahttp://en.wikipedia.org/wiki/Schizophreniform_disorderhttp://en.wikipedia.org/wiki/Schizophreniform_disorderhttp://en.wikipedia.org/wiki/Schizoaffective_disorderhttp://en.wikipedia.org/wiki/Brief_psychotic_disorderhttp://en.wikipedia.org/wiki/Brief_psychotic_disorderhttp://en.wikipedia.org/wiki/Brief_psychotic_disorderhttp://en.wikipedia.org/wiki/Brief_psychotic_disorderhttp://en.wikipedia.org/wiki/Schizoaffective_disorderhttp://en.wikipedia.org/wiki/Schizophreniform_disorderhttp://en.wikipedia.org/wiki/Schizophreniform_disorderhttp://en.wikipedia.org/wiki/Schizophreniahttp://en.wikipedia.org/wiki/Brain_damagehttp://en.wikipedia.org/wiki/Alcoholismhttp://en.wikipedia.org/wiki/Marijuanahttp://en.wikipedia.org/wiki/Cocainehttp://en.wikipedia.org/wiki/Amphetamineshttp://en.wikipedia.org/wiki/Brain_tumorhttp://en.wikipedia.org/wiki/Pathophysiology -
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6.bipolar disorder (manic depression)
7.severe clinical depression
8.severe psychosocialstress
9. sleep deprivation
10.some focal epileptic disorders especially ifthe temporal lobe is affected
11.exposure to some traumatic event (violent
death, etc.)
12.abrupt or over-rapid withdrawal from certain
recreational or prescribed drugs
http://en.wikipedia.org/wiki/Bipolar_disorderhttp://en.wikipedia.org/wiki/Clinical_depressionhttp://en.wikipedia.org/wiki/Psychosocialhttp://en.wikipedia.org/wiki/Stress_(medicine)http://en.wikipedia.org/wiki/Sleep_deprivationhttp://en.wikipedia.org/wiki/Epileptichttp://en.wikipedia.org/wiki/Temporal_lobehttp://en.wikipedia.org/wiki/Withdrawalhttp://en.wikipedia.org/wiki/Withdrawalhttp://en.wikipedia.org/wiki/Temporal_lobehttp://en.wikipedia.org/wiki/Epileptichttp://en.wikipedia.org/wiki/Sleep_deprivationhttp://en.wikipedia.org/wiki/Stress_(medicine)http://en.wikipedia.org/wiki/Psychosocialhttp://en.wikipedia.org/wiki/Clinical_depressionhttp://en.wikipedia.org/wiki/Bipolar_disorder -
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Affective disorder
1. Mania
2. Depression
3. Manic-depressive
(bipolar disorder)
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General Population Risk for Psychosis
General
PopulationAt risk group
Psychosis
group
Vulnerability to Psychosis
%
ofpopulation
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Mania
When someone is in a manic "high," he maybe overactive, overtalkative, and have a greatdeal of energy.
He will switch quickly from one topic toanother, as if he cannot get his thoughts outfast enough; his attention span is often short,and he can easily be distracted. Often, heshows poor judgment in these ventures. Mania,untreated, may worsen to a psychotic state.
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Causes
What is the cause of manic depression?
Genetic Factor
Abnormal Brain Activity Neurotransmitters
Infectious Agents Like Viruses
Super-fast Biological Clock
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Types/Common Terms
Bipolar I- Most severe, obscures normal
functioning, hospitalization common
Bipolar II- Hypomanic,Full manic episodes rare.
Depression often still severe Cyclothymia- Milder form of BP II, Bipolar
Spectrum Disorder
Rapid Cycling- 4 or more episodes in a 12month period,may not be permanent
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Effects:
Estimated 1 out of 4-5 commit suicide from
inadequate or no treatment
Onset of illness around 25 yrs old and untreated,
often results in loss of approx. 9 yrs of life, 14yrs of activity, 12 of normal health
Prime candidates for lifetime treatment express
at least 2 episodes of mania
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Mania vs.
Depression:Treatment options
Manic Episode- anti-psychotics (ex. Zyprexa),
or benzodiazepines (sedating) Depressive Episode- temporary co-
administration with antidepressants
As a whole- mood stabilizers, classically-Lithium. Anti-epileptics are also currentlybeing used ( Tegretol, Depakote, Neurontin,Lamictal)
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Antimanic drugs
Lithium
Widely recommended treatment for BipolarDisorder
60-80% success in reducing acute manic andhypomanic states
However issues in non-compliance to takemedication, side effects, and relapse rate with its
use are being examined in terms of being thebest option
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History
1920s- used as a sedative, hypnotic, and
anti-convulsant
1940s- investigated as a salt substitute for
heart disease patients
-How did this work out?- Poorly- many people died from
toxicity
- The Doctors decided that maybe itwasnt such a good idea
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History Cont.
1949- experiments with animals led to lethargy,and use for acute mania.
The logic was simply to make them too tired to
run out and repaint the entire house, have wildsex and go shopping
This is where non-compliance fits in (seen in upto 50% of patients)
the patient feels they are being robbed of theirfun by taking meds, so they give them up.
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More On Non-compliance
Other reasons patients refuse meds:
-weight gain
- less energy, productivity
- feel disease has resolved, no longer needmedication
Relapse rate is high regardless of withdrawalbeing gradual or acute, suicide risk back up
episodes are often worse than originalsymptoms, so treatment is often life-long
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So where does this leave us?
Since its discovery, Lithium has been found tobe superior to placebo
In recent years though, efficacy is beingquestioned:
-Long term results not as good as expected-28% discontinue use, 38% experience
relapse on the drug
*Even so, it is widely prescribed, demonstratesconsiderable efficacy, and reduction in mortalityrisks
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Pharmacokinetics:
Peak blood levels reached in 3 hrs, fully
absorbed in 8 hrs
Absorbed rapidly and completely orally
Efficacy correlates with blood levels
Crosses blood-brain barrier slowly and
incompletely
Usually taken as a single daily dose
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Kinetics Cont.
Approx. 2 wks to reach a steady state within the
body
of oral dose excreted in 18-24 hrs,rest within
1-2 wks Recommended .75-1.0 mEq/L, optimum would
be .5-.7 mEq/L, with 2 mEq/L displaying toxicity
Metabolized b/f excretion
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Important:
Because of its resemblance to table salt, when
Na+ intake is lowered or loss of excessive
amounts of fluid occurs, blood levels may rise
and create intoxication
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Pharmacodynamics
No psychotropic effect on non-Bipolars
Affects nerve membranes, multiple receptor
systems and intracellular 2nd messenger impulse
transduction systems. Interacts with serotonin
Potential to regulate CNS gene expression,
stabilizing neurons w/ associated multiple geneexpression change.
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Action and mechanism
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Side Effects and Toxicity
Relate to plasma concentration levels, soconstant monitoring is key
Higher concentrations ( 1.0 mEq/L and up
produce bothersome effects, higher than 2mEq/L can be serious or fatal
Symptoms can be neurological, gastrointestinal,enlarged thyroid, rash, weight gain, memory
difficulty, kidney disfunction, cardiovascular Not advised to take during pregnancy, affects
fetal heart development
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Combination Therapy
Combination therapy with Lithium and anti-
epileptics may demonstrate better protection
against relapse, greater therapeutic efficacy,
and studies support this as a rule vs. anexception
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Illegal Drug Use
More than 55% of Bipolar patients have a history
of drug abuse
Some abuse might occur before the first
episode, or after diagnosis Used by some as a way to self-medicate
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If Lithium Doesnt Work
40% of Bipolars are resistant to lithium or sideeffects hinder its effectiveness
Therefore, we must consider alternative agents
for treatment1. Carbamazepine (Tegretol)
2. Valproic Acid (Depakote)
3. Gabapentine
4. Topiramate
5. Lemotriagine
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Hallucinogens
The term "hallucinogen" is a
misnomer because these drugs donot cause hallucinations at typical
doses.
Hallucinations, strictly speaking,
are perceptions that have no basisin reality, but that appear entirely
realistic.
. Deliriants, such as
diphenhydramine and atropine,
may cause hallucinations in the
proper sense .
http://en.wikipedia.org/wiki/Hallucinationhttp://en.wikipedia.org/wiki/Diphenhydraminehttp://en.wikipedia.org/wiki/Atropinehttp://en.wikipedia.org/wiki/Atropinehttp://en.wikipedia.org/wiki/Diphenhydraminehttp://en.wikipedia.org/wiki/Hallucination -
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Pharmacological classification
Psychedelics (5-HT2A receptoragonists) Tryptamines
Lysergamides
Phenethylamines
Amphetamines Piperazines
Cannabinoids (CB-1 receptor agonists)
Dissociatives
NMDA receptor antagonists -Opioid receptor agonists
Deliriants (anticholinergics)
http://en.wikipedia.org/wiki/Psychedelic_drughttp://en.wikipedia.org/wiki/5-HT2A_receptorhttp://en.wikipedia.org/wiki/Agonistshttp://en.wikipedia.org/wiki/Tryptaminehttp://en.wikipedia.org/wiki/Ergolinehttp://en.wikipedia.org/wiki/Phenethylaminehttp://en.wikipedia.org/wiki/Amphetaminehttp://en.wikipedia.org/wiki/Piperazineshttp://en.wikipedia.org/wiki/Cannabinoidshttp://en.wikipedia.org/wiki/Dissociative_drughttp://en.wikipedia.org/wiki/NMDAhttp://en.wikipedia.org/wiki/%CE%9A-Opioid_receptorhttp://en.wikipedia.org/wiki/%CE%9A-Opioid_receptorhttp://en.wikipedia.org/wiki/Delirianthttp://en.wikipedia.org/wiki/Anticholinergichttp://en.wikipedia.org/wiki/Anticholinergichttp://en.wikipedia.org/wiki/Delirianthttp://en.wikipedia.org/wiki/Delirianthttp://en.wikipedia.org/wiki/%CE%9A-Opioid_receptorhttp://en.wikipedia.org/wiki/%CE%9A-Opioid_receptorhttp://en.wikipedia.org/wiki/%CE%9A-Opioid_receptorhttp://en.wikipedia.org/wiki/%CE%9A-Opioid_receptorhttp://en.wikipedia.org/wiki/NMDAhttp://en.wikipedia.org/wiki/NMDAhttp://en.wikipedia.org/wiki/Dissociative_drughttp://en.wikipedia.org/wiki/Dissociative_drughttp://en.wikipedia.org/wiki/Cannabinoidshttp://en.wikipedia.org/wiki/Cannabinoidshttp://en.wikipedia.org/wiki/Piperazineshttp://en.wikipedia.org/wiki/Piperazineshttp://en.wikipedia.org/wiki/Amphetaminehttp://en.wikipedia.org/wiki/Amphetaminehttp://en.wikipedia.org/wiki/Phenethylaminehttp://en.wikipedia.org/wiki/Phenethylaminehttp://en.wikipedia.org/wiki/Ergolinehttp://en.wikipedia.org/wiki/Ergolinehttp://en.wikipedia.org/wiki/Tryptaminehttp://en.wikipedia.org/wiki/Tryptaminehttp://en.wikipedia.org/wiki/Agonistshttp://en.wikipedia.org/wiki/5-HT2A_receptorhttp://en.wikipedia.org/wiki/5-HT2A_receptorhttp://en.wikipedia.org/wiki/5-HT2A_receptorhttp://en.wikipedia.org/wiki/Psychedelic_drug -
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