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Anggelia puspasari, dr
Pharmacology and theraupetic Departement
Medical Faculty University of Jambi
What is psychosis?
Psychosis is a thought disorder characterized by
disturbances of reality and perception,
impaired cognitive functioning, and inappropriate or
diminished affect (mood).
What Are the Symptoms of a
Psychotic Disorder?
Symptoms of a psychotic disorder vary from
person to person and may change over time.
The major symptoms are hallucinations and
Other symptoms :
Disorganized or incoherent speech
Confused thinking
Strange, possibly dangerous behavior
Slowed or unusual movements
Loss of interest in personal hygiene
Loss of interest in activities
Problems at school or work and with relationships
Cold, detached manner with the inability to express emotion
Mood swings or other mood symptoms, such as depression or mania
Positive and Negative
Psychosis therapy
Medication called antipsychotic
Psychotherapy : cognitive behavioural therapy
(CBT), family therapy
Social support
Drug overview
First generation of antipsychotic
(typical antisychotic)
Antagonist of D2 dopamine receptor than D1
Effect on cholinergic, alfa-1 adrenegik and
histamine receptor.
Pharmacoterapy and adverse effect depend on
that receptor binding.
High potent 1st generation antipsychotic have
greater effect on dopamine receptor, whereas low
potent have greater effect on cholinergic, alfa 1
adrenergic and histamin.
High potent related higher insiden of EPS.
Phenothiazine are direct myocardial depressant.
Thioridazine related to pigmentary retinopathy.
Mechanism of action dopamin antagonis (FGA
Second generation of antipsychotic
(atypical antisychotic)
Antagonist of D1, D2, D4 and D3 receptor, selectivity for
limbic dopamine receptor.
Increased affinity for serotonin receptor
Lower EPS incidense although higher incidense of
hyperglycemia, obesity and DM.
Aripiprazole is dopamine system stabilizer
Clozapine specifis for limbic receptor and not for striate
muscle, low incident of EPS. More effective than other for
management of aggressive behaviour and suicidality. !!!!
Olanzapine and risperidone increased incidense of CV
Ziprasidone and aripiprazole seldom cause weight gain
but ziprasidone more likel to cause QT interval
prolongation than other 2nd generation antipsychotic,
Atypical antipsychotic

Later broadened
Later broadened
to include:
to include:
Originally: Lak of prolactine
Efficacy against
elevation and
Lower risk EPS cognitive and
efficacy for
resistant patient
Neurotransmitter and adverse
Neurotransmitter Adverse effect
D2 antagonist EPS, prolactine
Anticholinergik Blurred vision, urinary
retention, constipation,
dry mouth
Antihistamine sedation
Antiserotonergic Weight gain
Anti alfa 1 adrenergik Orthostatic
hypotension, reflek
Cardinal point of treatment and
Evidence Based Recommendation
Begin at low dose titrate up slowly, provide adjunction
therapi as needed.
Antipsychotic take weeks to achieve the full therapy
Dont decreased abruptly dose to limited EPS in stable
If patient unwilling to take daily medication, depot
injection can be choosen.
Clozapine effective for aggressive behaviour and
suicidality !!!leukopenia.
Olanzapine and risperidone effective for dimentia with
aggressive behaviour.
Cardinal point of treatment and
Evidence Based Recommendation
The Schizophrenia Patient Outcomes Research Team
(PORT) recommended treating first episodes with
antipsychotics other thanclozapine (exception for
refractory symptom) orolanzapine. Both of these
medications are associated with more weight gain,
insulin resistance and dyslipidemia than other
antipsychotics . In addition, clozapine can cause
The Schizophrenia PORT recommended that first-episode
patients receive antipsychotic doses in the lower half of
the recommended dose range . As examples, a first-
episode patient would be treated with 1 to 3 mg of
risperidoneor 10 mg ofaripiprazoledaily. An exception
to this recommendation should be made forquetiapine,
which may require titration to 500 to 600 mg daily.
Cardinal point of treatment and
Evidence Based Recommendation
For patients with schizophrenia who have recovered from
an acute psychotic episode, we suggest that
antipsychotic medication should be continued
indefinitely, even for patients who have achieved
remission from a first psychotic episode. This suggestion
is in accordance with the recommendation of the
Schizophrenia PORT . The lowest effective dose that
achieves therapeutic goals should be used. Patients
should participate in the clinical decision-making
regarding the duration of antipsychotic drug treatment.
Long-acting injectable antipsychotics may be useful for
patients with schizophrenia who experience frequent
relapses due to non-adherence to antipsychotic
medications. They also may be helpful for patients who
will not take oral antipsychotics regularly.
Patient Variable
Geriatric : slow hepatic metabolism and increased
sensitivity to DA.
Pediatric : not reccomended for child under 12
years oldCPZ, Haldol and Thioridazine can be
Pregnancy and lactation : not recomended
especially for first trimester; pregnancy index B
for clozapine.
Goal of treatment
Acute treatment : management of psychotic
apisode or agitation.

Chronic treatment: prevention of relapse and

improvement in psycosocial function
Take home massage
Because the risk of relapse of illness is higher
when antipsychotic medications are taken
irregularly or discontinued, it is important that
people with a psychotic disorder follow a
treatment plan developed in collaboration with
their doctors and with their families. The
treatment plan will involve taking the prescribed
medication in the correct amount and at the times
recommended, attending follow-up appointments,
and following other treatment recommendations.