1. ANTI-PSYCHOTIC DRUGS

3. SCHIZOPHRENIA
Two or more of the characteristic symptoms
below are present for at least one-month
period :
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic
behavior
• Negative symptoms, ie, affective
flattening, alogia, or avolition

4. PATHOGENESIS OF SCHIZOPHRENIA
• Dopamine ( DA) – increased
• Serotonin ( 5-HT) – increased
• Glutamate - decreased

7. TYPICAL ANTIPSYCHOTICS
• Block post synaptic D2 receptors in mesolimbic system
High potent Low potent
Less sedating High sedating
More extrapyramidal symptoms Less extrapyramidal symptoms
Low anticholinergic and α blocking side effects More anticholinergic and α blocking side effects
Ex- Trifluperazine, fluphenazine and haloperidol Ex- thioridazine

8. THERAPEUTIC USES
• Schizophrenia
• Drug induced psychosis – drugs like LSD, amphetamines induce psychosis
• Schizo-affective disorders
• Tourette’s syndrome- haloperidol is DOC
• Huntington’s disease
• Anti-emetic – due to D2 blockade in CTZ
• Preanaesthetic – droperidole
• Intractable hiccups- chlorpromazine, haloperidol

9. ADVERSE EFFECTS
CNS
• Sedation , confusional state
• Tolerance develops to sedation and not to antispsychotic effects
ANS
• α- adrenergic blocking postural hypotension, loss of libido,
delayed ejaculation
• Anti-cholinergic s/e dry mouth, constipation, urinary retention

10. ENDOCRINE S/E
• Blockade of D2 in pituitary gland hyperprolactinamia
• Blockade of D2 in meduallry periventricular pathway increase
appetite weight gain

11. EXTRAPYRAMIDAL SYMPTOMS
Due to D2 blockade in limbic system
• Acute muscular dystonia – torticollis, locked jaw, spasms
• Parkinsonism
• Akathisia- irresistible desire to move about
• Malignant neuroleptic syndrome- hyperthermia, rigidity, altered
mental status
• Tardive dyskinesia- purposeless involuntary movements.

12. MISC:
• Jaundice
• Photosensitivity
• Epileptogenic effects
• Corneal opacities
• Olanzapine and clozapine have high risk of precipitating diabetes
• Raised triglyceride level

14. LITHIUM
ACTIONS
CNS:
• on prolonged administration, it acts as a mood stabiliser in bipolar disorder.
• suppresses the episode of mania- taking 1- 2 weeks;
Renal :
• Lithium inhibits the action of ADH on distal tubules in the kidney
• causes a diabetes insipidus like state.

15. Metabolic
• Insulin like effect of glucose metabolism
• Hypothyroidism
Others
• Increase leucocytes
L-leucocytes
I- increased
T- tremors
H- hypothyroidism
I- increased
U-urine
M- mothers should avoid: ebstein anomaly

16. ALTERNATIVES TO LITHIUM
Sodium valproate:
• It acts faster than lithium but slower.
• Better safety profile than lithium
• Uses- Patients with rapid cycling pattern, combination of lithium and valproate may
succeed in cases resistant to monotherapy
Lorazepam + lithium: treatment of choice for acute attack of mania

17. ALTERNATIVES TO LITHIUM
Carbamazepine
• less effective than lithium or valproate in acute mania
• Due to strong enzyme inducing property, CBZ has many drug interactions
Lamotrigine
• prophylaxis of depression in bipolar disorder
Olanzapine is also approved for maintenance therapy of bipolar disorder