Week 8: Psychopharmacology (Chapter 12)
Psychiatric disease
Classification
Psychiatric manifestations of medical conditions
Primary psychiatric conditions:
o Psychoses (schizophrenia, manic depression, bipolar disease)
Lost insight; not aware of illness
Radical loss of touch with reality
Delusion (cognitive): unshakeable belief in something untrue which cannot be
explained by cultural beliefs
Hallucination (sensory): sees, hears, smells, tastes, feels things that don’t exist
outside their mind.
o Neuroses (anxiety, phobias, psychological depression)
Awareness
Severe forms of ‘normal’ emotional experiences
Psychoses
Causes
Psychological causes: schizophrenia
General medical causes: neurosyphilis, HIV/AIDS, neurodegenerative disease
Drug-induced: cocaine, amphetamine and LSD (directly causes psychosis temporarily), alcohol,
cannabis (does not directly cause psychosis but can trigger for genetic predisposition for
schizophrenia – permanent)
Classification
Positive symptoms:
o Any change in behaviour or thoughts such as hallucinations/delusions
Negative symptoms:
o Withdrawal or lack of social function e.g. reduction in speech, impaired attention, flat
emotion.
Characterisation
Lost insight, but not confused (clear consciousness, fully orientated)
Disorders of mood and thought
Often affect young patients
Caused by a primary psychotic disorder (no underlying medical condition)
Often complain of auditory (not visual) hallucinations
Have disordered belief system (delusions)
Treatment (non-pharmacological)
Resistant chair, insane asylum, strait jacket
Shock therapy:
o Fever therapy (malaria-induced fever) to treat neurosyphilis (not functional against
schizophrenia as it is not bacteria-induced)
o Insulin induced coma and convulsion (low blood glucose, seizure, low consolidation of
memory)
o Psychosurgery; prefrontal lobotomy
, Remove prefrontal lobe (higher brain functions – ethics, morality, imagination)
Drugs
No curative drugs – just management
Neuroleptics reduce symptoms of psychoses
Drugs given to calm patients when acutely psychotic and for chronic therapy to prevent relapse
Drugs are given in long-acting depot preparations
Lithium salts are used to stabilise manic depressives
Benzodiazepines
In widespread use (and abuse), commonly used as hypnotic
Activation of GABA receptors, increasing its affinity for its site on GABA-activated Cl - channels
Shift of GABA log dose-concentration curve to lower concentrations
Enhancement of neuroinhibitory actions of GABA = causes CNS depression
Lipid soluble, well absorbed in gut, readily distributed into the brain
E.g. diazepam (Valium), chlordiazepoxide, temazepam
Uses:
o Short-term sedation
o Pre-operative medication
Psychiatric disease
Classification
Psychiatric manifestations of medical conditions
Primary psychiatric conditions:
o Psychoses (schizophrenia, manic depression, bipolar disease)
Lost insight; not aware of illness
Radical loss of touch with reality
Delusion (cognitive): unshakeable belief in something untrue which cannot be
explained by cultural beliefs
Hallucination (sensory): sees, hears, smells, tastes, feels things that don’t exist
outside their mind.
o Neuroses (anxiety, phobias, psychological depression)
Awareness
Severe forms of ‘normal’ emotional experiences
Psychoses
Causes
Psychological causes: schizophrenia
General medical causes: neurosyphilis, HIV/AIDS, neurodegenerative disease
Drug-induced: cocaine, amphetamine and LSD (directly causes psychosis temporarily), alcohol,
cannabis (does not directly cause psychosis but can trigger for genetic predisposition for
schizophrenia – permanent)
Classification
Positive symptoms:
o Any change in behaviour or thoughts such as hallucinations/delusions
Negative symptoms:
o Withdrawal or lack of social function e.g. reduction in speech, impaired attention, flat
emotion.
Characterisation
Lost insight, but not confused (clear consciousness, fully orientated)
Disorders of mood and thought
Often affect young patients
Caused by a primary psychotic disorder (no underlying medical condition)
Often complain of auditory (not visual) hallucinations
Have disordered belief system (delusions)
Treatment (non-pharmacological)
Resistant chair, insane asylum, strait jacket
Shock therapy:
o Fever therapy (malaria-induced fever) to treat neurosyphilis (not functional against
schizophrenia as it is not bacteria-induced)
o Insulin induced coma and convulsion (low blood glucose, seizure, low consolidation of
memory)
o Psychosurgery; prefrontal lobotomy
, Remove prefrontal lobe (higher brain functions – ethics, morality, imagination)
Drugs
No curative drugs – just management
Neuroleptics reduce symptoms of psychoses
Drugs given to calm patients when acutely psychotic and for chronic therapy to prevent relapse
Drugs are given in long-acting depot preparations
Lithium salts are used to stabilise manic depressives
Benzodiazepines
In widespread use (and abuse), commonly used as hypnotic
Activation of GABA receptors, increasing its affinity for its site on GABA-activated Cl - channels
Shift of GABA log dose-concentration curve to lower concentrations
Enhancement of neuroinhibitory actions of GABA = causes CNS depression
Lipid soluble, well absorbed in gut, readily distributed into the brain
E.g. diazepam (Valium), chlordiazepoxide, temazepam
Uses:
o Short-term sedation
o Pre-operative medication
