Psychotic disorders are severe mental disorders that cause abnormal thinking and perceptions. People with psychoses lose touch with reality. Two of the main symptoms are delusions and hallucinations. ... Schizophrenia is one type of psychotic disorder. People with bipolar disorder may also have psychotic symptoms.

2. By
Ashok Bhimrao Giri
Pharm D 4th Year

3. Case: A 21 years old male patient b/b relatives to the
hospital with chief complaints of abnormal behavior,
aggressive,irrelvent talk, sleep disturberence.
He has h/o tobacco consumption since 5 years, alcohol
and cannabis since 3 years.
family, social history were not significant. On
psychiatric disorder diagnostic examination, it was
reveals that pt. suffering from brief psychotic disorder
02-Feb-20203©Ashok Giri PharmD

4. Pt.’s Name: A. M
Age : 21yrs Wt. :49 Kg
Gender: Male
C/o: abnormal behavior, aggressive,irrelvent talk,
sleep disturberence, hallucinations or delusions.

5. 1) Medical history : Not significant
2) Medication/ Social/ Family History : Not significant
3) Physical Examination :
a) General condition : Weakly build up (weight: 49 kg)
b) vital sings : PR : 84/min (60-80 beats/min)
BP : 110/70 mmHg (120/80mmHg)
RR : 22/ min (12 to 20/min)
4) Systemic examination :
CVS: S1 & S2 +Ve, no murmur
RS: AEEBS, Clear
P/A: Soft, NT
CNS: Conscious, Oriented 02-Feb-20205©Ashok Giri PharmD

6. a) Biochemical Investigation
* SGOT / AST: 25 U/L (5-40U/L)
(Serum Glutamic Oxaloacetic transaminase / aspartate aminotransferase)
* SGPT: 22 U/L (7-56U/L)
(Serum glutamic pyruvic transaminase/ alanine aminotransferase)
* ALP: 77 IU/L (44-147 IU/L)
(Alkaline Phosphatase)
* BUN : 7.4 mg/dl (5-25 mg/dl)
* Sr. Cr. : 1.1 mg/dl (0.6-1.2mg/dl)
* Bilirubin : Direct: 0.2mg/dl (<0.3mg/dl)
Total : 0.7mg/dl (0.1-1.2mg/dl)
* Protein : Albumin : 3.7g/dl (3.5-5.4g/dl)
Total : 6.8g/dl (6-8.3g/dl)
02-Feb-20206©Ashok Giri PharmD

7. b) Hematology
i. WBC: 4950/mcL (N: 4000-10000/mcL )
ii. RBC: 4.85 millions/mcL (N: 4.5-6.5millions/mcL)
iii. Platelets: 2.24Lakh/mcL (N: 1.5-4Lakh/mcL)
iv. Hemoglobin: 14.3 g/dl (N: 13-16g/dl)
v. RBS: 84 mg/dl (N: 100-180 mg/dl)
02-Feb-20207©Ashok Giri PharmD

8. oAssessment to current Therapy:
Inj. Serenace 5 MG IV OD
Inj. Phenergan 50 mg IV OD
Tab. Olaenz 2.5 mg orally OD
Tab. Arpizol 10 mg orally OD
Tab. Ativan 2 mg Orally OD
Tab. PCM 500 mg orally SOS
 Diagnosis :
Brief Psychotic
Disorder
 Goal of therapy:
1. To improve QoLY of
Pt.
2. Preventing relapse.
3. To reduce severity
of sign & symptoms
4. Decreasing positive
and negative
symptoms
of psychosis. 02-Feb-20208©Ashok Giri PharmD

9. Inj. Serenace 5 MG IV OD
Generic Name: haloperidol
MOA: It tend to block dopamine D2 receptors in the
dopaminergic pathways of the brain.
Indication: brief Psychotic Disorder
Contraindication: Liver cirrhosis, CKD
ADRs: Nausea, Vomiting, dry mouth, dizziness
DI: Scopolamine, Lithium
Std dose: 0.5 – 5 mg/Day
02-Feb-20209©Ashok Giri PharmD

10.  Generic Name: Promethazine
 MOA: Phenothiazine derivative with
antidopaminergic effect: Blocker of mesolimbic
dopamine receptors and alpha-adrenergic
receptors in brain
Antihistaminic effect: H1-receptor blocker
 Indication: DINV
 Contraindication: Pregnancy
 ADRs: Sedation, Confusion, Disorientation,
Blurred vision, Hallucinations, Dystonias,Euphoria
 DI: Dysopyrimide, metrizimide, sotalol
 Std dose: 50 mg/Day
Inj. Phenergan 50 mg IV OD
02-Feb-202010©Ashok Giri PharmD

11. Tab. Olaenz 2.5 mg orally OD
Generic Name: Olanzapine
MOA: It may work by blocking receptors for several
neurotransmitters (chemicals that nerves use to
communicate with each other) in the brain. It binds to
alpha-1, dopamine, histamine H-1, muscarinic, and
serotonin type 2 (5-HT2) receptors.
Indication: Psychotic Disorder, Schizophrenia
Contraindication: Breast ca, DM
ADRs: Dizziness, hypotension, Weight gain, Drowsiness,
muscle spasms, jerky movements, slow movements,Dry
mouth., Weakness.
DI: Apomorphine, bromocriptine
Std dose: Max Dose 20 mg/Day
02-Feb-202011©Ashok Giri PharmD

12. Tab. Arpizol 10 mg orally OD
Generic Name: Aripiprazole
MOA: It functions as a partial agonist at the dopamine
D2 and the serotonin 5-HT1A receptors, and as an
antagonist at serotonin 5-HT2A receptor.
Indication: Psychotic Disorder, Schizophrenia
Contraindication: Obeysity, DM
ADRs: akathisia, anxiety, constipation, dizziness,
headache, insomnia, nausea, and vomiting
DI: Alcohol
Std dose: Max Dose 20 mg/Day
02-Feb-202012©Ashok Giri PharmD

13. Tab. Ativan 2 mg Orally OD
Generic Name: Lorazepam
MOA: It enhance the effects of GABAnergic action
Indication: Psychotic Disorder, Schizophrenia, Bipolar
Contraindication: hypersensitivity to benzodiazepines,
acute narrow-angle glaucoma
ADRs: Drowsiness, dizziness, headache, nausea,
vomiting
DI: Barbiturates, such as Amytal, Fioricet, Butisol,
Estrogen
Std dose: Dose 2-6 mg/Day
02-Feb-202013©Ashok Giri PharmD

14. Generic Name: Acetaminophen
MOA: It inhibits activity of COX enzyme and
show analgesic effect
Indication: Pain, Fever
Contraindication: Liver cirrhosis
ADRs: GI irritation, rashes
DI: warfarin, metoclopramide
Std dose: 40/mg/day (Max Dose 4 g/Day)
Tab. PCM 500 mg orally SOS
02-Feb-202014©Ashok Giri PharmD

15. 1)Discharge medication: Patient not yet discharged.
2)Monitoring parameters:
1. Therapeutic monitoring parameter: SpO2/BP/PR
2. Toxicity monitoring parameter: Sr. Cr/ SGOT/ SGPT
3)Point to Patient:
About disease: Brief psychotic disorder is a sudden, short-term display
of psychotic behavior, such as hallucinations or delusions, which occurs
with a stressful event.
About medication: Take medicines regularly as prescribed.
*About lifestyle modifications (At time of Discharge):
*Talking therapies, Counselling, CBT, Psychoanalytical and
psychodynamic therapies, Music Therapy
*Refrence: https://www.counsellingdirectory.org.uk/psychosis.html
02-Feb-202015©Ashok Giri PharmD

16.  There is no particular diet that need to be followed in case
psychotic disorder.
 However it is better to avoid dairy products, sugar and gluten
rich diet like wheat and refined flour etc.
 Fresh vegetables, fruits, and salads provide enough vitamins,
minerals, and antioxidants which are good to the brain
Dietary Modifications:
02-Feb-202016©Ashok Giri PharmD

17. Drug Interactions:
Serious - Use Alternative
Promethazine and Haloperidol both increases QTc interval.
Avoid or Use alternative
Minor
Lorazepam+ Aripiprazole
Lorazepam+haloperidol
Lorazepam+Olanzapine
Promethazine+Lorazepam
Ref:
I. https://reference.medscape.com/drug-interactionchecker
II. https://www.cochrane.org/CD005146/SCHIZ_haloperidol-plus-promethazine-
psychosis-induced-aggression
02-Feb-202017©Ashok Giri PharmD

18. Thank You
! 02-Feb-202018©Ashok Giri PharmD