Drugs for Psychoses

1
Drugs for Psychoses Degenerative Diseases of
the Nervous System

• Chapter 10

2
Introduction

• Disorders associated with emotional, unusual, or
  bizarre feelings are among the leading causes of
  mental health problems.
• Will cover behavioral/emotional disorders, mood
  disorders, and psychoses.

3
Introduction

• Most psychoses have no identifiable cause and
  require long-term drug therapy.
• Patients with psychoses often cannot tell what is
  and is not real.
• Delusions, hallucinations, illusions,
  disorganized behavior, difficulty relating to
  others.

4
Introduction

• People with psychosis are usually unable to
  function normally in society without lifelong
  drug therapy and ongoing visits with a healthcare
  provider.

5
Mood Stabilizers

• is the major psychosischaracterized by abnormal
  thoughts and thought processes, disordered
  communication, withdrawal from other people and
  the outside environment, and a high risk for
  suicide.

6
Mood Stabilizers

• Characteristics include pg. 150 bulleted
• Delusionsfalse beliefs or ideas
• Hallucinationsexperiencing something that is not
  really there.
• Paranoiafeeling that someone is out to get one

7
Mood Stabilizers

• Several theoriespositive and negative symptoms
  help determine type of medication.
• Positivethose that add on to normal
  behaviorhallucinations, delusions, and a
  disorganized thought or speech pattern.
• Negativethose that subtract from normal
  behaviorlack of interest, motivation, or
  responsiveness, and lack of pleasure in daily
  life

8
Mood Stabilizers

• Antipsychotic medication attempts to stabilize
  client with psychosesAKA neuroleptics
• Conventional antipsychotics
• Atypical antipsychotics

9
Mood Stabilizers

• Conventional antipsychoticTable 10.1 pg. 152.
• More effective in treating positive symptoms of
  schizophrenia
• Extrapyramidal side effectsreduce dose may go
  away
• Neuroleptic malignant syndrome-rare with
  dosages can be fatal
• DPchlorpromazine (Thorazine) pg. 154

10
Mood Stabilizers

• Atypical antipsychoticsTable 10.4 pg. 158
• Treat both positive and negative symptoms of
  schizophrenia
• Fewer side effects
• DPclorozapine (Clozaril) pg. 158.

11
Parkinsons Disease

• Parkinsons disease is a degenerative disorder of
  the CNS caused by death of neurons that produce
  the brain neurotransmitter dopamine.
• It is characterized by disturbances of muscle
  movement.

12
Parkinsons Disease

• Symptoms include
• Tremors
• Muscle rigidity
• Bradykinesia
• Postural instability

13
Parkinsons Disease

• Symptoms of Parkinsons disease result from
  dysfunction of Dopamine neurotransmitter between
  various parts of the brain.

14
Parkinsons Disease

• Drug therapy for Parkinsons symptoms focuses
  mainly on dopamine and acetylcholine.
• Two major drug therapies are levodopa (Larodopa)
  and benztropine (Cogentin)

15
Parkinsons Disease

• Extrapyramidal symptoms (EPS)symptoms where
  muscles become very rigid because of
  over-medication with anti-psychotics or by lack
  of dopamine function in the corpus striatium.

16
Parkinsons Disease

• If Extrapyramidal symptoms occur in the health
  care facilityBenadryl may be given
• If untreated can be fatal

17
Parkinsons Disease

• Tardive dyskinesiaa movement disorder often
  causing involuntary lip and tongue movements and
  less frequently causing involuntary movements of
  the trunk and extremities, is observed in
  clients who have been given anti-psychotic drugs
  for an extended length of time.
• Anticholinergic meds prescribed concurrently
  with anti-psychotics to discourage development of
  tardive dyskinesia or to treat it once it
  develops.

18
Parkinsons Disease

• Dopaminergic drugs table 10.6 pg. 161
• Replace dopamine or increase its action in the
  brain
• Drug Profile Levodopa pg. 163.

19
Parkinsons Disease

• Cholinergic blocking drugsTable 10.7 pg. 164
• Block effect of acetylcholine in CNS
• Used in clients who cannot tolerate levodopa
• Drug profilebenztropine (Cogentin) pg. 164

20
Alzheimerss Disease

• Alzheimers Disease
• Diagnosis only on autopsyamyloid plaques
  neurofibrillary tangles present
• Loss of cholinergic brain function especially in
  the hippocampusan area of the brain responsible
  for learning and memory.
• Symptoms pg. 165

21
Dementia

• Dementia is a progressive and permanent loss of
  brain function.
• Two common types of dementia are Alzheimers
  disease and vascular dementia.
• Restorative drug therapies for dementia mainly
  focus on Alzheimers disease because this is the
  most common type of dementia.

22
Alzheimers Disease

• Alzheimers drugs Table 10.8 pg. 166.
• Current medications result in minor improvement
  of symptoms
• Attempt to slow memory loss
• Enhance action of acetylcholine in brain
• Drug profileAricept pg. 167.

23
Multiple Sclerosis

• MS is an autoimmune disorder of the CNS.
• Antibodies target and slowly destroy tissues in
  the brain and spinal cord.
• As tissues are damaged, inflammation of nervous
  tissue causes demyelination, or the loss of
  myelin, a fatty material that acts as a
  protective insulator of nerve fibers.

24
Multiple Sclerosis

• Gradually disrupts the ability of the nerves to
  conduct electrical impulses to and from the
  brain.
• Common s/s fatigue, heat sensitivity, pain,
  spasticity (muscle cramps and spasms), cognitive
  problems, balance and coordination problems, and
  bowel and bladder symptoms.

25
Multiple Sclerosis

• Two basic strategies for treating MS.
• One approach attempts to reduce inflammation and
  prevent attacks on the nervous system.
• The other strategy emphasizes treatments to
  relieve symptoms.
• Drugs used for MS Table 10.9 pg. 169