PSYCHOPHARMACOLOGY muscles) causing the extrapyramidal

syndrome and other side effects.

Medication management is a crucial issue that
greatly influences the outcomes of the treatment for
many clients with mental disorder.
The following sections discuss several
categories of drug used to treat mental disorders
(psychotic drugs): antipsychotics, antidepressants,
mood stabilizer, anxiolytics, and stimulants.
A. SOMATIC THERAPIES
Psychotropic Drugs
Characteristics:
 Use to modify behavior
 Affect the Central Nervous System and
Autonomic Nervous System.
 Do not cure mental illness but must relieve it’s
symptoms.
Types
 Antipsychotic Drugs- Otherwise known
“ataractic” “neuroleptic”, major tranquilizer
(addictive effects), “psychic energize”
General Considerations
1. Calms an excited client without producing
impairment of motor function sleep.
2. Antipsychotics have a high therapeutic index
and can be given a high dose with minimal
risk.
ACIU (Acute Crisis Intervention Unit)-
RAPID TRANQUILIZER
3. They are not addicting, and patient do not
develop tolerance to their psychotic effect.
4. Use of antipsychotic during pregnancy is not
recommended. -because of teratogenic
effect.
Indication
1. For treatment of the following illness :
a. Acute psychotic symptoms of
schizophrenia, organic brain syndrome
with psychosis. (Accidents,
structural damage)
b. Manic phase of manic- depressive
illness
2. For treatment of the following symptoms:
a. Agitation (can result to rage)
b. Rage
c. Overactivity to sensory stimuli
d. Hallucinations, delusions
e. Paranoia
f. Vertigo
Mechanism of Actions
1. It blocks the post synaptic dopamine receptor
in the limbic system, hypothalamus and the
cerebral cortex. (Dopamine- cognition,
motivation (highly motivation), motor complex
(strong) D1 & D2 -receptors
2. It also block the dopamine receptor in the
basal ganglia (involuntary movement of
Chemical Classes of Antipsychotic
1. Phenothiazine
a. Taurausine
Administration
1. Daily dose is increased every 1-4 days until
symptoms improve.
- Depends on weight of patient
2. Available in oral tablet or IM injection.
- Should not be taken on an empty
stomach.
- Should be on TIME.
- IM- rage, (nagwawala)
- Haldol- robot, akinesia, protruded
tongue, observe BP
3. If the clients’ symptoms are unresponsive after
adequate time (6 weeks) another class may be
tired.
Contraindications
1. In the client with severe Central Nervous
System depressions due to excessive alcohol
or narcotic use; brain damage, trauma
2. Patients with Parkinson’s disease-brain is not
producing dopamine (levodopa)
3. Clients with allergic response to one of the
psychotic drugs.
4. Clients with blood dyscrasias
5. Clients with acute narrow-angle glaucoma
because it can cause increased Intracranial
Pressure.
6. Clients with prostatic hypertrophy because
they are a risk of urinary retention.
Side Effects
 Sedation
 Orthostatic Hypotension
- everyday check BP
-Sitting, Lying, Standing [OH]
 Seizure
-PSYCHOMOTOR
-PETIT MAL- Absence seizures, are
brief, usually lasting less than 20
seconds.
-GRAND MAL- A tonic-clonic seizure,
causes a loss of consciousness and
violent muscle contractions. (Absence
Of Respirations)
- 15 mins of seizure may cause
permanent damage
 Depression of the Hypothalamic functioning
symptoms:
o Increase appetite
o Weight gain
o Amenorrhea
o Galactorrhea (in women)
o Gynecomastia (in men)
o False positive pregnancy test
 Anticholinergic side effects symptoms:
 Blurred vision
 Constipation
  Urinary Retention or hesitancy sit still or just to keep moving sensation, leg
 Nasal Congestion aches
 In Geriatrics pts. “Atropine Psychosis” may Tardive Dyskinesia
occur marked by:
o Hyperactivity  Bizarre, involuntary, stereotyped, and rhythmic
o Agitation movement of the face and neck: it is
o Confusion characterized by facial grimaces, excessive
o Flushed skin blinking, frowning, lip smacking or sucking and
o Sluggishly reactive pupil tongue thrusting.
 It is considered as a long-term effect of
 Dermatologic Side Effect
antipsychotic therapy. Symptoms usually occur
o Systemic Dermatosis may occur 2 to 8
after a maintenance dose is discontinued or
weeks after treatment; there is
reduced. Theres no known cure for Tardive
localized rash on face, neck, and
Dyskinesia.
chest that usually cleans without
treatment. ANTIPARKINSONNIAN DRUGS
o Contact Dermatitis may develop when
Examples:
touching the drug photosensitivity.
 Hematologic & Cardiovascular Effect  Benztropine (Congentin)
o Agranulocytosis may occur within 3-  Biperiden (Akineton)
8 weeks after treatment. Symptoms  Trihexyphenidyl (Artane)
contribute a medical emergency:  Diphenhydramine (Benadryl)
Fever, Malaise, sore throat,
leukopenia  Indicated for patient treated with psychotic
o Treatment: D/C of drug, reverse except, when history is prolonged.
isolation, anttibiotics  This is not administered until there is clear
Extra Pyramidal Syndrome evidence of EPS.
EPS- disease refers to a motor disorder often
Acute Dystonic Reactions- associated with pathological dysfunction in
basal ganglia.
 rapid
onset  This drug should not withdraw abruptly.
of  This drug decreases perspiration. Place the
severe patient in a cool environment to prevent heat
stroke.
muscles contractions Side Effects
bronchospasm (usually for
the tongue, face, and neck),  Dizziness -Dry mouth
extraocular crisis producing  Headache -Weight gain
torticollis, Opisthotonos and  Blurred vision
oculogyric crisis.  Memory impairment
 Symptoms may occur dramatically, frightening and Indications
physically painful. They occur within 5 days of
treatment. Children and young adults are not high For the treatment of endogenous depressions.
risk. Also known for treatment of.
 Anxiety
Parkinson Syndrome
 Enuresis (Urinary incontinence)
 Akinesia  Panic attack
(absent  Phobias
or slow  Hyperactivity in children
Mechanism of Action
Tricyclic Antidepressants (TCA) blocks the
reuptake of Norepinephrine and Serotonin at the
presynaptic neuron.
movement)
 Small step gait
 Muscle stiffness General Considerations
 Bilateral fine tremors
 This drug should not be withdrawn abruptly.
 Pill rolling motion of fingers
 TCA and MAOI’s are not stimulants, will not
Female and Geriatric patient are more likely to produce euphoria and non-addicting.
experience this syndrome.  Response to TCA and MAOI’s may not occur
Akathisia up to 3 wks after the 1st dose
 Give SSRI (Selective Serotonin Reactive
 Restlessness (pacing fidgeting, shifting, Inhibitor) - antidepressants in the treatment of
shifting weight from foot to foot, can’t stand or
 major depressive disorder, anxiety disorders, e) May administered concurrently with
and other psychological conditions. Antipsychotic drugs during the acute manic
episodes to manage behavioral and psychotic
ANTI DEPRESSANTS DRUGS/ MOOD ELEVATOR manifestation.
THREE CLASSIFICATIONS: f) Therapy may begin with 300 mg. TID

a) Tricyclic Antidepressants (TCA) Contraindications

b) Non-Tricyclic Antidepressants (Non-TCA’s)  Elderly or Debilitated Phase
c) Monoamine Oxidase Inhibitors (MAOI’s)  Thyroid or Renal Disease
d) Selective Serotonin Reuptake Inhibitors (SSRI)  Epilepsy
Administration  Severe dehydration or sodium depletion
 Brain damage or Cardiovascular disease.
In most cases, small dose (25 mg) of TCA
are administered several times a day. Adverse Side Effects
This drug should be discontinued gradually.  Nausea, abdominal discomfort, diarrhea or soft
stools
Contraindications
 Tremors, ranging from fine to coarse
 With TCA or Non TCA’s  Thirst
o DV Disease  Weight gain
o History of seizure  Muscle weakness and fatigue
o Narrow Angle Glaucoma  Hair loss
o Schizophrenics may experience
LITHIUM TOXICITY
increased psychotic symptoms if
given. - a lethal side effects which occur when
 With MAOI’s ingested lithium cannot be detoxified and
o Cardiovascular Disease excreted by the kidneys.
o Age over 60 - occurs when serum level exceeds to 2.0
o Liver Disease mEq/L
 Constipation - Sign and Symptoms
a. In mild (serum level about 1.5 mEq/L)
 Dry Mouth
- Slight apathy
 Difficulty Voiding
- Lethargy
 Blurred Vision - Diminished concentration
 Sedation - Mild ataxia
 Anxiety, Restlessness, Irritability - Muscle weakness
 Hypomania - Hand tremors
 Seizure - Slight muscle twitching
 Weight Gain b. In Severe toxicity (serum level above
 Decreased Libido 2.5 mEq/L)
- Severe diarrhea
Anti Manic Drugs
- Nausea and vomiting
Lithium Carbonate - Visual and Tactile
Hallucination
Indication for use
- Grand mal seizure
1. Acute manic and Hypomanic episodes - Coma
2. Long term of prophylactic treatment of Bipolar - Death
Disorder.
ANTIANXIETY (Anxiolytic) and Sedative Hypnotics
Mechanism of Action
Indications
 The exact mechanism of action is unclear. 1. For the treatment of anxiety and sleep disorder
 They interfere with Norepinephrine, Dopamine, 2. Alcohol and drugs withdrawal, preoperative
Serotonin metabolism. medications, muscle relaxants or
 They alter sodium transport in nerves and anticonvulsant agents.
muscles cells.
General considerations
General Considerations
1. Continued use can lead to emotional and
a) Route of administration: Oral physical dependency; withdrawn symptoms
b) Prior to Lithium therapy may appear with abrupt discontinuation of
- A patient must undergo laboratory therapy.
procedures specifically renal function
and thyroid function Categories
c) Lithium can augment the effects of Anti- a) Lorazepam (Ativan)
depressants. b) Chlordiazepoxide (Librium)
d) Carbamazepine (Tegretol) and Valproic Acid c) Chlorazepate (tranxene)
are used to treat bipolar disorder. d) Diazepam (Valium)
 e) Oxazepam (Serax) HALLUCINOGENS are substances that distant the
users perception of reality and produce symptoms
Administration
similar to psychosis (visual hallucination and
i. Given orally and IM. depersonalization). Examples LSD (lysergic acid
ii. All benzodiazepine should be tapered. diethylamide) Ecstasy. Even PCP (phencyclidine) an
iii. Sedative-hypnotic benzodiazepine typically are anesthetic. Effects includes:
given at bedtime.
 Increased vital signs
iv. Sedative hypnotic therapy generally as not
effective after 28 days or so.  Hyperreflexia
 Ideas of reference
Contraindications  Sweating, blurred vision
v. Benzodiazepine should not be given in  Dilate pupils
patients with history of alcohol and drug  Paranoid ideation
abuse because of possibility of cross  Depression, anxiety
tolerance and increase risk of abuse.  Tremor
vi. Hepatic insufficiency  unpredictable behavior
vii. Pregnancy and lactating mother.
Drug Use Nursing
Consideration
Lorazepam Alcohol Monitor v/s,
(Ativan) withdrawal dizziness,
drowsiness
Chlordiazepoxide Alcohol Monitor v/s,
(Librium) withdrawal dizziness,
drowsiness
Disulfiram Maintain Caution clients
(Antabuse) abstinence from with the adverse
alcohol
Methadone Maintain Caution clients
(dolophine) abstinence from with the adverse
heroin effect
(vomiting).
Levomethadyl Maintain Cant be taken
(ORLAAM) abstinence from on consecutive
OPIATES doses. Follow
as medically
ordered
Naltrexone Blocks the Take with food
(ReVia, Trexan) effects of or milk. May
opiates. cause
Reduces headache,
alcohol craving. restlessness,
irritability

Inhalants are substances including anesthetics,

nitrates, and organic solvent (aliphatics and aromatic LITHIUM THERAPY
hydrocarbon) which are all inhaled for their effects.
Antidote: Mannitol, Aminotyline, Dialysis
Effects includes:
Serum Level Symptoms Interventions
 Dizziness, nystagmus (repetitive,
uncontrolled eye movements) 1.5-2 mEq/L Nausea
 Unsteady gait
 Aggressive behavior
 Unpredictable behavior
 Slurred speech
 Muscle weakness
 Tremor, apathy (loss of feeling) Drug of Choice for Specific Symptom

Acute toxicity causes anoxia, respiratory Target Symptoms Drug of Choice

depression, vagal stimulation and dysrhythmias, Aggression/
bronchospasm, and cardiac arrest. Impulsivity
Affective Aggression Lithium; Anticonvulsants; -slurred speech
(normal) low dose Antipsychotics
-unsteady gait
Predatory Antipsychotics; lithium -lack of coordination
(hostility/cruelty)
-impaired attention, concentration, memory,
Organic-like Aggression Cholinergic agonists
and judgement
(donepezil)
Ictal Aggression Carbamazepine; Dipen -black out
hydantoin;
Alcohol Withdrawal is usually accomplished with the
Benzodiazepines
administration of pharmacological interventions of
Mood Dysregulation
benzodiazepines such as lorazepam (Ativan) and
Emotional Lability Lithium/
chordiazepam (Valium)
Carbamazepine/
Atypical Depression Antipsychotics Methodology used= fixed-schedule dosing
MAOI’s, SSRIs,
Symptom-triggered dosing
Emotional Detachment Antipsychotics
SSRIs, Atypical Sedatives, Hypnotics, and Anxiolytics are all
Antipsychotics considered as CNS Depressants with Benzodiazepine
Anxiety and barbituates
Chronic Cognitive SSRI’s Stimulants are drugs that stimulate or excite the CNS.
The DSM IV-TR categorizes amphetamines, cocaine
Chronic Somatic
and other CNS stimulants as having some intoxication
Severe Anxiety and withdrawal symptoms. Methamphetamine is
particularly dangerous as it is highly adjective and
causes psychotic behavior.
Marked Dysphoria (unhappiness,
SUBSTANCE ABUSE restlessness, malaise) is the primary withdrawal
symptoms and is accompanied by fatigue, vivid and
Using drug in a way that is inconsistent with unpleasant dreams, insomnia or hypersomnia,
medical or social norms and despite negative increased appetite, and psychomotor retardation or
consequences. agitation. Psychotic symptoms also can include
It denotes problems in social, vocational, or suicidal ideation due to severe depressive
legal areas of the person’s life. experience.
Substance Dependence also includes Cannabis Sativa is a hemp plant that became well
problems associated with addiction such as tolerance, known for its psychoactive re
withdrawal and unsuccess useful of substance to stop AME SCALE EPS,NMS,
the abuse.
INTOXICATION is use of a substance that
results in maladaptive behavior.
WITHDRAWAL SYNDROME refers to the
negative psychological and physical reactions that
occur when use of a substance ceases or dramatically
decreases.
DETOXIFICATION is the process of safely
withdrawing from a substance which have been used
for some long time already. ( for 72 hours)
DSM- V List if 11 Diagnostic Classes of Substance
Abuse
Alcohol Amphetamines
Caffeine Cannabis
Cocaine Hallucinogens
Inhalants Nicotine
Opioids Phencyclidine
Sedatives Hypnotics/ Anxiolytics
Alcohol is a central nervous system depressant that is
absorbed rapidly into the bloodstream. Initially the
effects are:
-relaxation and loss of inhibition