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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Anti Maniac Drugs

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