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