2. • Etiology:
• Not known
• Strong but incomplete genetic pre-
disposition
• (1st degree relatives – 10%)
• (2nd monozygotic twin – 50%)
• suicide is about 10% cases
3. • Symptoms:
• 1.Positive symptom: (result from
Neurochemical Abnormality)
• Increase do paminergic transmission
Respond well to Rx
• Delusions often paranoid in nature:
cann’t be rectified by reasoning
4. • Hallucinations:
• They may be
• Visual
• Auditory
• Tactile (CD Canine bugs)
•
5. • c) Thought disorder
• Wild train of thoughts
• Draw irrational conclusion with the feeling
that thoughts are inserted or withdrawn by
an outside agency.
• Usually not like to be interfered, flight of
ideas from one thought to other thought.
• Broadcast of ideas.
• d) Abnormal stereotypical behavior,
6. • 2. Negative Symptoms:
•
• Result from brain atrophy
• Don’t respond / less responsive to R x
• Emotional blunting.
• Poor Socialization
• Cognitive deficit (Dementia)
• more irritable.
7. • Neurochemical Basis:
• 1) Dopamine Theory (Hypothesis by
Carlson awarded noble prize in
year 2000)
• Dopamine hyperactivity in mesolimbic
and mesocortical pathway & amygdale
positive symptoms of schizophrenia.
• Proof:
• Dopamine agonists – produce these
symptoms of schizophrenia e.g. central
8. • 2) Glutamate Theory
– Glutamate and DA exert excitatory and
inhibitory effects respectively on GABA ergic
striatal neurons which project to thalamus and
constitute “sensory Gate”
– Glutamate or DA disables the gate and
uninhibited sensory input reaches the cortex.
– Glutamate NMDA (N-methyl deaspartate)
recep antagonists:
• Phencyclidine
9. • 3) 5 – HT Theories:
• 5 – HT dysfxn
• LSD & 5-HT2 Receptors agonists produced
schizophrenia like syndrome.
•
• Mostly of Anti-psychotics in addition to
affect dopamine also back serotonin
receptors.
10. • 4) Current views:
• Combination of DA hyperactivity with 5-
HT & glutamate dysfxn.
11. • 1) Nigrostriatal Pathway:
• 75% of dopamine in brain
• 2) Mesolimbic mesocortical pathway:
• Projects from neurons near S.N to
limbic system & Neocortex
• Behaviorial effects
• Hyperactivity leads to schizophrenia.
• 3) Tuberoinfundibular (Tubrohypophy
Scal) Pathway:
12. • 4) Medullary Perventricular Pathway:
• From neurons of Motor Nucleus of Vagus
___ Periventricular nuclei
• Eating behavior
• Satiety center ____ Bolimia Nervosa
• Appetite Cetre _____ Anorexiz Nervosa
• 5) Incertohypothalamic Pathway:
• From medial zone incerta to
hypothalamus & Amygdala.
13. • 5) Incertohypothalamic Pathway:
• From medial zone incerta to
hypothalamus & Amygdala.
• Sexual drive, Microvasculatory function
and temperature regulation.
• 6) Many local Dopaminergic Neurons in
olfactory cortex & retina:
• 7) Dopaminergic transmission in
periphery:
14. Classification of Antipsychotic
Drugs
A: Classical / Typical Antipsychotics.
I. Phenothiazine Derivatives
a. Aliphatic compounds
Chlorpromazine
Promazine.
b. Piperazine Compounds:
Procholorperazine
Perphenazine
Fluphenazine
Trifluperazine
c. Piperidine Compounds:
Thioridazine
Mesoridazine
20. • B) Atypical Neuroleptics:
• Their mechanism of action is different
from anti-psychotics
• Loxapine
• Clozapoine (Clozanl) ___ A/E: Cause
agranulocyctosis ___ Bone marrow
depression
21. • Risperidone ____ commonly used D2 5HT2 selective
activity for D4 receptors
• Olanzapine __ Disadv: cause agranulocytosis
• Ziprasidone(patients resistant to other drugs. Also Rx of negative
effects)
• Sulpirdie (D2 selective)
• Remazopride
• Remoxipride
• Pimozide (D2 selective) long acting indole
• Quetiapine
• Aripiprazole
22. II. Butyrophenone Derivatives
Haloperidol Droperidol
III. Thioxanthenes
Thiothixene Flupenthixol
IV. Rauwolfia Alkalois
Reserpine
28. Ph. Actions
• a) PTS:
• No loss of intellectual functions and
performance (clear sensorium)
• Alteration of deranged thought process
• Emotional quietening
• Psychomotor slowing
• Antagonism of behavior eff. of amphetamine
• Decreased paranoid idea
• Decrease initiative
• Decrease aggressiveness
29. • b) NORMAL (NON -PSYCHOTICS)
• unpleasant feelings due to
• Sleepiness, restleseness
• Autonomic effects : b/c of muscarinic
blockade
• unpleasant feelings due to
• Sleepiness, restleseness
• Autonomic effects : b/c of muscarinic
blockade
31. • ) DECREASE SEIZURE THRESHOLD:
• Convulsive potential
• High dose: cause convulsion cause
seizure in patients of epilepsy
• Aggrevate epilepsy
• If anti-epilepsy is taken by epilepsy potent,
he has to increase the dose
• Potentiate cause of seizure latent epilepsy
patient
33. • a) ANTICHOLINERGIC
• b) ADRENOCEPTORS BLOCKADE
• Orthostatic hypotension
• Less less with halo oeriod of flupenthixol
and eluphenazine and other non
phenothiazines except clozapine
• c) WEAK GANGLIONIC BLOCKADE:
• Both symp and P/symp ganglionic
blockade . Non blockade cz transmission
34. B: PERIPHERAL EFFECTS
1. Effect on ANS
2. Effect on CVS
3. Quinidine like anti-arrhythmic effect on heart
4. Miscellaneous
– LA effect
– Renal effects
– Effect on Liver
– Antihistaminic action
– Skeletal muscle relaxant effect
35. • v) RESP. CONTROL:
• Depressant effect
• No permanent effect in N individual
• No prominent effect in psychotic pt having
N respiration
• But if he suffers from resp. diseases such
as Asthama them resp. depression
36. • vi) ENDOCRINE EFFECT:
• hyper prolactinemia and inflextility DA,
control prolactin (check its release),if block
hyper prolactinemia manifested by
Gynecomastia in infertility in male and
female
• ix) ANTIEMETIC ACTION:
• Because of DA recep blockade in CRTZ.
Useful in drug induced vomiting and other
vomiting except motion sickness and
37. • x) TEMP. REGULATION:
• Dopaminergic transmission to
hypothalamus is blocked. Temperature
regulation is lost person because
poikelothermic
38. • xiii) SK.MUSCLES:
• in high doses themselves cause
convulsion and spasm
• 2) CVS
• -ve isotropic effects more thioridazine
cause death in young children
• Decrease stroke volume and decrease
CO
• Decrease TPR and alpha adrenergic
41. 5. Endocrinal effects
6. Hypothermia / Hyperthermia
7. Dermatitis
8. Opacities in lens and cornea
9. Blood Dyscrasias
10. Drug Interactions
42. Therapeutic Uses
A. Treatment of Psychiatric patient
1. Schizophrenia
2. Organic Psychosis
3. Bipolar depression
B. Nausea & vomiting
C. Alcoholic hallucinition
D. Intractable Hiccough
43. • NEUROLEPTIC POISONING:
• Can be homicidal less common suicidal
less chances occure in extreme of
disease.
• Rarely fatal except thio & mesoridazine
duer jto cacdio depressive neuro
musculal, excitability. Convulsions.
• Pt. comatosed.
• Hypothermia, miosis, deep
• Tendon reflexes.
• Tachycacdia
• Thioridazine.
45. • PIPERIDINE DERIVATIVE:
• THIORIDAZINE:
– Block D2,x-1 & 5HT-2
– More potent anti muscacinics
• Extrapyramidal (packinsonian) symptoms
duer jto blockade of D2 and balance is
disturbed, in this case balance is notr
distubedf when cholinergicx activity es.
– Sinilac B.A (2s-30%)
– More cacdiotoxic
46.
47. – More macked occulax eff.
• Deposit in retina browning of vision.
• Picture res emble that of retinitis
pigmentosa pt.
• Potency—related to dose.