Drugs and other physical treatment of mental disorders Prof.ZHAO Jing-ping 1
1 Drugs and other physical treatment of mental disorders Prof. ZHAO Jing-ping
General considerations Drug therapy chemical therapy ECT electroconvulsive therapy) ·Mental surgery ·Insulin coma therapy Physical treatment are always combined with psychological treatment
2 General considerations • Drug therapy ( chemical therapy ) • ECT ( electroconvulsive therapy) • Mental surgery • Insulin coma therapy • Physical treatment are always combined with psychological treatment
1.Introduction of psychotropic drugs Drugs be called psychotropics: -which act at a particular site in the CNS -which have effects mainly on mental symptoms,normalized abnormal mental (psychological)function
3 1. Introduction of psychotropic drugs • Drugs be called psychotropics: – which act at a particular site in the CNS – which have effects mainly on mental symptoms, normalized abnormal mental (psychological) function
Classification of psychotropics According to their principal actions ·Antipsychotics ·Antidepressants Antimanic drugs (mood stabilizers) Antianxiety drugs (anxiolytics) Stimulants (psychotomimetics) 4
4 Classification of psychotropics • According to their principal actions • Antipsychotics • Antidepressants • Antimanic drugs（mood stabilizers） • Antianxiety drugs（anxiolytics） • Stimulants（psychotomimetics）
Advise patients The likely initial effects of the drug (e.g.drowsiness or dry mouth) The delay before therapeutic effects appear The likely first signs of improvement ·Common side effects ·Any serious effects Any restrictions while drug is taken(e.g.not driving or operating machinery How long the patient will need to take the drug
5 Advise patients • The likely initial effects of the drug (e.g.drowsiness or dry mouth) • The delay before therapeutic effects appear • The likely first signs of improvement • Common side effects • Any serious effects • Any restrictions while drug is taken(e.g. not driving or operating machinery • How long the patient will need to take the drug
2.Antipsychotic drugs Drugs can reduce psychomotor excitement and control psychotic (schizophrenic) symptoms ·neuroleptic ·major tranquillizer 6
6 2. Antipsychotic drugs • Drugs can reduce psychomotor excitement and control psychotic （schizophrenic） symptoms • neuroleptic • major tranquillizer
Mechanism of action Antipsychotic (dopaminergic receptor antagonism):reduce hallucinations,delusions, thought disorders。 Sedation (block noradrenergic receptor): reduce agitation and psychomotor excitement. Unwanted effects (side effects): antidopaminerdic action an basal ganglia (EPS), anticholinergic and antiadrenergic actions
7 Mechanism of action • Antipsychotic （dopaminergic receptor antagonism）：reduce hallucinations，delusions， thought disorders。 • Sedation（block noradrenergic receptor）： reduce agitation and psychomotor excitement。 • Unwanted effects（side effects）： antidopaminerdic action an basal ganglia（EPS）， anticholinergic and antiadrenergic actions
Indications for antipsychotics Schizophrenia:acute and maintain treatment (prophylaxis) Schizoaffective disorder: Mania:acute treatment Psychotic depression:acute treatment Schizophreniform disorders
8 Indications for antipsychotics • Schizophrenia：acute and maintain treatment（prophylaxis） • Schizoaffective disorder： • Mania：acute treatment • Psychotic depression：acute treatment • Schizophreniform disorders
List(Classification)of antipsychotics Conventional(first generation)AP -Phenothiazines:chlorpromazine,perphenazine, trifluperazine -Thioxanthines:chlorprothixene -Butyrophenones:haloperidol -Substituted benzamide:sulpiride Newer agents(second generation,atypical): clozapine,risperidone,olanzapine,quetiapine
9 List(Classification) of antipsychotics • Conventional(first generation) AP – Phenothiazines：chlorpromazine，perphenazine， trifluperazine – Thioxanthines：chlorprothixene – Butyrophenones：haloperidol – Substituted benzamide：sulpiride • Newer agents(second generation, atypical)： clozapine，risperidone，olanzapine，quetiapine
Administration and dosage lower titration,gradually increasing dose (1-2w) treatment dose (acute):4-8w stabilization treatment:after improvement,keep treatment dose for 4-8w maintenance treatment:use 1/2 or 1/4 treatment dose to prevent recurrence (continuous over 2 years) lower dose in children,elderly,brain damage o
10 Administration and dosage • lower titration，gradually increasing dose（1-2w） • treatment dose（acute）：4-8w • stabilization treatment：after improvement，keep treatment dose for 4-8w • maintenance treatment：use 1/2 or 1/4 treatment dose to prevent recurrence（continuous over 2 years） • lower dose in children，elderly，brain damage