Psychotherapeutic Drugs

• Psychotherapeutic drugs treat mental and emotional disorders.
• The types of psychotherapeutic drugs are anxiolytic drugs, mood-stabilizing drugs, antidepressant drugs, and antipsychotic drugs.
• Anxiety, affective disorders, and psychotic disorders are examples of mental health disorders.
• Treatment with psychotherapeutic drugs can be an option when emotions significantly impair an individual's daily functions, with psychotherapy and short-term drug therapy utilized, though the exact cause is not fully understood.

Causes of Mental Health Disorders

• Mental health disorders not fully understood, but are possibly linked to biochemical imbalances of neurotransmitters in the brain.
• Neurotransmitters are located in the central nervous system (CNS) and peripheral nervous system (PNS).
• Dopamine, norepinephrine, serotonin, histamine, acetycholine and GABA, sodium, potassium and magnesium have an important role in maintaining health
• Drugs can treat mental illness by stimulating or blocking the release of neurotransmitters.
• Mental health disorders may make individuals susceptible to health problems like cardiometabolic syndrome.
• Patients may self-medicate using tobacco, alcohol, illegal drugs, or unauthorized prescriptions
• Long-standing societal stigma affects care
• Nonpharmacological treatments such as cognitive behavior therapy, drug therapy, exercise, and good nutrition also used.
• Refractory depression may be treated with electroconvulsive therapy (ECT), Vagal Nerve Stimulation, Transcranial magnetic therapy, or deep brain therapy.

Anxiety

• Anxiety is an unpleasant state of dread and fear, based on anticipated or actual past experiences.
• Anxiety may be an exaggerated reaction to imaginary situations or a normal response to stress, and may result from medical illnesses.
• Anxiety disorders include separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder (social phobia), panic disorder, panic attack, agoraphobia, generalized anxiety disorder, and substance- or medication-induced anxiety disorder.

Anxiolytic Drugs

• Anxiolytic drugs reduce anxiety by reducing overactivity in the central nervous system (CNS):
• Benzodiazepines depress activity in the brainstem and limbic system, increase the action of GABA (inhibitory transmitter), and alter levels of serotonin, norepinephrine, and dopamine.
• Examples of benzodiazepines include alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan).
• Buspirone (BuSpar) is a miscellaneous non-sedating, non-habit-forming drug without interactions with selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs).
• Adverse effects of benzodiazepines are an over expression of decreasing CNS activity, sedation, amnesia, hypotension, drowsiness, impaired coordination, dizziness, headaches, nausea, vomiting, dry mouth, and constipation.
• Benzodiazepine overdose can be dangerous, especially when taken with sedatives or alcohol.
• Treatment involves symptomatic and supportive care, and flumazenil.
• Alcohol and CNS depressants together cause death
• Interactions are likely in patients with renal or hepatic compromise.

alprazolam (Xanax)

• Alprazolam is commonly used as an anxiolytic to treat generalized anxiety disorder (GAD), anxiety symptoms, panic disorder, and anxiety associated with depression.
• Adverse effects of alprazolam include confusion, ataxia, headache, and interactions with alcohol, antacids, and oral contraceptives.
• Alprazolam's onset of action is 30-60 minutes, reaching peak plasma concentration in 1-2 hours and has an elimination half-life of 10-15 hours, and duration of action is 6 hours.

diazepam (Valium)

• Diazepam indications include anxiety relief, alcohol withdrawal management, reversal of status epilepticus, preoperative sedation, and skeletal muscle spasm relief adjunct.
• Patients with hepatic dysfunction should avoids the use of diazepam
• Side effects include headache, confusion, and slurred speech and there are interactions with alcohol and oral contraceptives.
• Onset of action is 30-60 minutes, peak plasma concentration in 1-2 hours, elimination half-life is approximately 100 hours, and duration of action is 12-24 hours.

lorazepam (Ativan)

• Lorazepam is an intermediate-acting benzodiazepine
• It is useful intravenously / intramuscularly (dilute) for acutely agitated patients.
• It's used as an infusion for agitated patients undergoing mechanical ventilation and is used to treat / prevent alcohol withdrawal.
• The onset of action is 30-60 minutes, peak plasma concentration in 2 hours, elimination half-life 11-16 hours, and duration of action around 8 hours.

buspirone hydrochloride

• Buspirone has an unknown mechanism of action and is not related to benzodiazepines.
• It has few sedative effects and low dependency potential and should scheduled administered.
• Paradoxical anxiety, blurred vision, dizziness, and headache are some adverse effects.
• The onset of action in 2-3 weeks, reaching peak plasma concentration in 40-90 minutes and has an elimination half-life of 2-3 hours.

Affective Disorders

• Affective disorders, known as mood disorders, have mood changes from mania (high emotions) to depression (low emotions)
• Some patients might experience both mania and depression: bipolar disorder (BPD).
• Depression may cause sadness, emptiness, or irritability, accompanied by somatic and cognitive changes which significantly affect ability to function.
• Major Depressive Disorder is depressed mood, loss of interest/pleasure for over 2 weeks.
• At least 5 symptoms include worthlessness/guilt, anhedonia, fatigue, low motivation, appetite changes, hypersomnia/insomnia, recurrent thoughts of death/suicide.
• Major depression features major sleep disturbances in 80% of patients, and is an undertreated condition.
• Psychosis impairs mental function to the point that activities of daily living is not possible.
• The hallmark of psychosis is loss of contact with reality, examples being Schizophrenia and drug-induced psychoses

Psychotropic Drugs

• Psychotropic drugs are the most prescribed drug in Canada.
• Drug response varies and selection is made through trial and error.
• Patient non-adherence to prescribed regimen is common because of fear on adverse effects and associated stigma.

Mood-Stabilizing Drugs

• Mood-stabilizing drugs treat Bipolar Disorder.
• Dopamine and Norepinephrine/Serotonin facilitate the pathophysiological in BPD.
• Mood stabalizers are effective for maintenance and acute mania.
• Lithium carbonate and lithium citrate are used alongside benzodiazepines, antipsychotic drugs, antiepileptic drugs, and dopamine receptor agonists.

Lithium

• Lithium is a popular treatment for mania.
• It potentiates serotonergic neurotransmission, reduces excitatory (dopamine/glutamate) but enhances inhibitory neurotransmission (GABA).
• Acute mania requires lithium serum level of 1 to 1.5 mmol/L, maintenance between 0.6 and 1.2 mmol/L.
• Toxicity occurs above 1.5 to 2.0 mmol/L (severe reaction above 2.0 mmol/L) causes GI discomfort, tremor, confusion, somnolence, seizures, and possibly death
• Therapeutic lithium levels are best maintained with sodium levels in range (135 to 145 mmol/L).
• The most serious adverse effect is cardiac dysrhythmia (drowsiness, slurred speech, epilepsy-type seizures, choreoathetotic movements, ataxia, and hypotension).
• Long-term lithium causes hypothyroidism .
• Dehydration, sodium imbalance, kidney, and cardiovascular disease may increase lithium toxicity, therefore lithium is contraindicated in patients with these.
• Lithium's therapeutic effect takes 7-14 days to develop with peak plasma concentration reached in 0.5-2 hours.
• Elimination occurs over 18-36 hours, lasting for approximately 2-24 hours.

Antidepressant Drugs

• Antidepressant drugs are the treatment for major depressive disorders; used most by men is 25-44 and women from 25-79.
• They are useful for anxiety disorders, eating/ personality disorders, migraine, chronic pain, sleep disorders, hot flashes, and PMS.
• Increase serotonin, dopamine, and norepinephrine concentrations in the brain.
• Alterations in these concentrations can be caused by depression.
• , Anxiety and depression occur together and reinforce each other increasing potential for suicide, agitation and behavior changes
• Dose optimization is recommended prior change to other drugs.
• Evaluation require immediate action

Antidepressants (First Generation)

• First generation consists of tricyclics, tetracyclics and MAOIs.
• Second-generation consists of SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs) and Miscellaneous drugs.
• Tricyclic antidepressants block neurotransmitter reuptake which causes an accumulation at nerve endings and regulates malfunctioning neurons.
• They are largely replaced by SSRIs yet still can be considered second line drugs for SSRI failures and adjunct therapies in newer-generation antidepressants.
• A common Tricyclic Antidepressants is amitriptyline (Elavil).

Tricyclic Antidepressants: Indications

• Tricyclic Antidepressants are indicated for neuropathic pain, insomnia, childhood enuresis (imipramine), obsessive compulsive disorders (OCDs) (clomipramine), and sometimes, anorexia.
• Adverse effects can include Sedation, impotence, and orthostatic hypotension
• Overdoses are lethal were 70 -80% die before reaching the hospital
• The CNS and cardiovascular systems are affected where death may results from seizures or dysrhythmias and a specific antidote. is not present
• Decreasing drug absorption with activated charcoal, alkalinizing urine and managing seizures and dysrhythmias.
• Basic life support is administered.

Amitriptyline (Elavil)

• Amitriptyline is the oldest, most widely used tricyclic antidepressant.
• Its original indication was for depression, and commonly used to treat insomnia and neuropathic pain,.
• Amitriptyline is not suitable for patience with know drug allergy, pregnancy, and recent myocardial infarction.
• Adverse effects features dry mouth, constipation, blurred vision, urinary retention, and dysrhythmias.
• Onset lasts 7-21 days, peak plasma concentration lasts 2-5 hours, elimination half-life is 13-36 hours and duration of action is 6-12 hours.

Second-Generation Antidepressants

• Second-generation Antidepressants is indicated for depression, BPD, obesity, eating disorders, OCD, panic attacks or disorders, social anxiety disorder, post-traumatic stress disorder, premenstrual dysphoric disorder and neurologic disorder myoclonus.
• If given with similar drugs, binding competition raises the amount of free drugs and increase effects with adverse effects such as insomnia weight gain, and sexual dysfunction.
• Selective serotonin reuptake inhibitors (SSRIs) work by increasing serotonin levels in the brain and regulate mood, sleep, appetite, memory, and social behavior.
• Serotonin carries signals between nerve cells in the brain is reabsorbed by the nerve cells in a process called reuptake.
• SSRIs block reuptake process, increase serotonin concentration available to pass through nerve cells and are the most commonly prescribed type of antidepressant.
• SSRIs includetrazodone (Oleptro®), bupropion (Wellbutrin®) fluoxetine (Prozac®), sertraline (Zoloft®), paroxetine (Paxil®), fluvoxamine maleate (Luvox®) citalopram (Celexa®), escitalopram oxalate (Cipralex®).

fluoxetine (Prozac)

• Fluoxetine is a Prototypical SSRI indicated for bulimia, OCD, panic disorder, and premenstrual dysphoric disorder.
• It is contraindicated in concurrent MAOI therapy patients and with know drug allergy
• Anxeity, dizziness, drowsiness, and insomnia are commonly reported.

mirtazapine (Remeron)

• Mirtazapine Promotes by presynaptic release of serotonin and norepinephrine in the brain causes depression.
• It is used to treat that associated with BPD, sexual adverse effects in male patients with SSRI therapy, and as an appetite stimulant.
• Contraindications include drug allergy and MAOIs.
• Drowsiness, abnormal dreams, dry mouth, constipation, increased appetite, and asthenia are all signs of adverse effects.
• It will interact additively with CNS and cytochrome P-450 CYP inhibitors

bupropion hydrochloride

• The original use of bupropion was for depression.
• It is now indicated as an cessation and as an adjunct antidepressant for patients experiencing sexual adverse effects secondary to SSRI therapy
• Zyban®: is approved for smoking cessation and the first nicotine-free Rx medicine used to treat nicotine dependence.
• The onset of action is from 1-2 weeks and the duration last 1-2 day with approximately 21 hours half-life.

duloxetine hydrochloride (Cymbalta)

• Duloxetine is indicated for depression, generalized anxiety disorder, and pain resulting from diabetic peripheral neuropathy or fibromyalgia, chronic back pain, and osteoarthritis
• With 6 hours to peak concentration the half-life is 12 hours.
• Dizziness, drowsiness, headache, GI upset, anorexia, and hepatotoxicity are all adverse side effects.
• Drug interaction includes alcohol causing Serotonin syndrome, and can worsen glaucoma.

Antipsychotics

• Antipsychotics treats illnesses like Drug-induced psychosis and it will be able to treat schizophrenia (as an adjunct to lithium), BPD, certain movement disorders.
• The first generation is phenothiazines but the second generation is atypical anti psychotics.
• Antipsychotics block dopamine receptors in brain (areas emotion, cognition, motor function) so then dopamine levels are decreased which cause result: tranquilizing effect in psychotic patients
• Positive is (hallucinations, delusions, and conceptual disorganization) and negative symptoms (apathy, withdrawal, poverty speech and catatonia) of schizophrenia.
• Antipsychotics is improving schizophrenia.
• Conventional drugs are less effective in managing negative symptoms but atypical antipsychotics have a better management on them.

Antipsychotic Drugs: Indications

• Indications is Psychotic illnesses most commonly Schizophrenia also include anxiety and mood conditions.
• Adverse effects has significant effect:
  • Agranulocytosis which leads to anemic (CNS is Drowsiness and malignant or extrapyramidal symptoms
• pseudoparkinsonism which be treated by benztropine and hydrochloride.
• Life threatening.
• Akathisia is a acute painful spasms.
• Other affects are insulin and cardio metabolic which affect serum levels.
• haloperidol treats long term psychosis, and is not recommended is conditions are high.
• Given inter muscular and helpful with patient with schizophrenia.

Atypical Antipsychotics

• Atypical Antipsychotics are clozapine, risperidone and olanzapine (Zyprexa) quetiapine (Seroquel) is blocked with serotonin 2 receptor.
• Also include ziprasidone, aripiprazole and asenapine with lurasidone.

Atypical Antipsychotics: Mechanism of Action

• Atypical Antipsychotics block specific receptors example D2 receptors.
• They block the dopamine receptors which is helpful to reduce risks to the patient health safety.
• There is also Clozapine which is a dopamine receptors mesolimbic.
• This also show is no EPS but blood dyscrasias
• Also show the receptor relation which mean which there adeverse reaction affect the effects of the receptors.
• Herbal Products and St. John’s Worth that it also may cause depression a upset stomach or dizzyness

Psychotherapeutic Drugs

• Assessment should include any allergies past medication also ask about the patient level and vital and liver
• Explain to your patiently the side effects and not to abruptly used caution about the potential
• To provide therapy so patient can learn and medication has potential to minimize suicide.
• Antianexty that needs to be monitor so and patient also patient to tell the after procedure and any interaction also for fall risk.
• Patient could develop a decrease and the level.

Nursing Implications

• For therapeutic patient with depression to see their pattern or any suicide actions.
• Less mania and the level that will be 0.6 to 1.2
• Central Nervou system can be reduced and nervous will decreased with nervousness also can use to sedate patient then hypnotic will put them to slept.
• Benzodiazepines relieve anxiety.
• Benzodiazepines are also use to treat insomnia and the GABA

Overdose

• Mild overdose, or if headache
• Dizzy dizzy then can not prescribe alcohol
• Short to act, but patient be side effects the medication also have any allergic medication list , to caution side effects
• Muscle relax also associate skeletal muscle , CNS depressants and action muscle, pain and dizziness.
• Keep bed well to the call

Nursing Application

• Improved with better sleeping patterns.