this presentation help you to understand the anti-psychotic or the drugs that are used in Schizophrenia, bipolar and dementia etc.

1. SADIA
NOREEN
ROLL # 09
ADCP

2. ANTIPSYCHOTIC
DRUGS
(NEUROLEPTICS)

3. 3
SOME DEFINITIONS
• Antipsychotics (also known as neuroleptics or major
tranquilizers) are a class of medication used manage
psychosis (including delusions, hallucinations, or
disordered thought), in particular in schizophrenia and
bipolar disorder, and are increasingly being used in the
management of non-psychotic disorders (ATC code N05A).
The word neuroleptic originates from the Greek
word lepsis ("seizure" or "fit").
– Typical neuroleptic: older agents fitting this
description
– Atypical neuroleptic: newer agents:
antipsychotic efficacy with reduced or no
neurologic side effects

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Medical uses
Schizophrenia
 Bipolar disorder
 Dementia
 Unipolar Depression
 Other

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All neuroleptics are equally
effective in treating psychoses,
including schizophrenia, but differ in
their tolerability.
All neuroleptics block one or more
types of DOPAMINE receptor, but
differ in their other neurochemical
effects.
All neuroleptics show a significant
delay before they become effective.
All neuroleptics produce significant
adverse effects.

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GENERAL CHARACTERISTICS OF
TYPICAL NEUROLEPTICS
The older, typical
neuroleptics are effective
antipsychotic agents with
neurologic side effects
involving the
extrapyramidal motor
system.
Typical neuroleptics
block the dopamine-2
receptor.

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Typical neuroleptics do not
produce a general depression of the
CNS, e.g. respiratory depression
Abuse, addiction, physical
dependence do not develop to
typical neuroleptics.

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Typical neuroleptics are
generally more effective
against positive (active)
symptoms of schizophrenia
than the negative (passive)
symptoms.

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Positive/active symptoms include
thought disturbances, delusions,
hallucinations
Negative/passive symptoms
include social withdrawal, loss of
drive, diminished affect, paucity of
speech. impaired personal hygiene

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THERAPEUTIC EFFECTS OF
TYPICAL NEUROLEPTICS
Relapse, recurrence of symptoms
is common ( approx. 50% within
two years).
Noncompliance is common.
Adverse effects are common.

11. ADVERSE EFFECTS OF TYPICAL
• Anticholinergic (antimuscarinic) side
effects:
– Dry mouth, blurred vision, constipation, urinary
11/02/14
NEUROLEPTICS
retention(release), impotence (power less)
PELTON-C-2 Constellation
Workshop-IID 11

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RECEPTOR BLOCKADE IN THE
BASAL GANGLIA RESULTS IN
EXTRAPYRAMIDAL MOTOR
SIDE EFFECTS (EPS).
DYSTONIA
NEUROLEPTIC MALIGNANT
SYNDROME
PARKINSONISM
TARDIVE DYSKINESIA

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Increased prolactin secretion
(common with all; from
dopamine blockade)
Weight gain (common,
antihistamine effect)
Photosensitivity (v. common
w/ phenothiazines)
Lowered seizure threshold
(common with all)
Leucopenia (rare; w/
phenothiazines)
Retinal pigmentopathy (rare;
w/ phenothiazines

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15. MECHANISMS OF ACTION
OF TYPICAL NEUROLEPTICS
DOPAMINE-2 receptor blockade
in meso-limbic and meso-cortical
systems for antipsychotic effect.
DOPAMINE-2 receptor blockade
in basal ganglia (nigro-striatal
system) for EPS
DOPAMINE-2 receptor
supersensitivity in nigrostriatal
system for tardive dyskinesia

16. LONG LONG TERM TERM EFFECTS EFFECTS OF OF D2
D2
RECEPTOR RECEPTOR BLOCKADE:
BLOCKADE:
Dopamine neurons reduce
activity.
Postsynaptic D-2 receptor
numbers increase (compensatory
response).
When D2 blockade is reduced,
DA neurons start again firing and
stimulate increased no. of receptors
tardive dyskinesia

17. MANAGEMENT OF EPS(extera
pyramidalSymptoms)
oDystonia and parkinsonism: anticholinergic
antiparkinson drugs
oNeuroleptic malignant syndrome: muscle
relaxants, DA agonists, supportive
oAkathisia:( an often distressing sense of inner
restlessness). benzodiazepines, propranolol
oTardive dyskinesia: increase neuroleptic dose;
switch to clozapine

19. GENERAL CHARACTERISTICS OF
ATYPICAL NEUROLEPTICS
Effective antipsychotic agents with
greatly reduced or absent EPS, esp.
reduced Parkinsonism and tardive
dyskinesia
All atypical neuroleptics block
dopamine and serotonin receptors;
other neurochemical effects differ
Are effective against positive and
negative symptoms of schizophrenia;
and in patients refractory to typical
neuroleptics

20. Blockade of alpha-1 adrenergic
receptors
Blockade of muscarinic
cholinergic receptors
Blockade of histamine-1
receptors

21. oSame therapeutic
effectiveness
oSame side effect
profile

22. HYPOTHESIZED MECHANISMS OF
ACTION OF ATYPICAL NEUROLEPTICS
Combination of Dopamine-4 and
Serotonin-2 receptor blockade in
cortical and limbic areas.
Combination of Dopamine-2 and
Serotonin-2 receptor blockade (esp.
risperidone)

25. Antipsychotics
are prescribed one at a time. In
cases in which single antipsychotics
are tried alone, and when one of
those three cases was Clozapine
(Clozapine is usually used only in
patients that have not responded to
other anti-psychotic treatments ) if
possible, then two antipsychotics
may be prescribed at the same
time.

26. •Thank
s