Introduction  Do not force oral medication because of

the danger of aspiration. This is

Psychopharmacology
especially important in stuporous
- Is the study of drugs used to treat
patients.
psychiatric disorders.
 Check drugs daily for any change in
Psychotropic Medication
color, odor & number.
- Medications that affect psychic function
 Bottle should be tightly closed &
behavior or experience.
labeled. Labels should be written legibly
They have significant effect on higher mental
& in bold lettering. Poison drugs are to
functions.
be legibly labeled & to be kept in
separate cupboard.
Psychopharmacological Agent
- Are first line treatment for almost all
PATIENT EDUCATION RELATED TO
psychiatric ailments now a days.
PSYCHOPHARMACOLOGY
 With the growing availability of a wide
 Nurses assess for drug side effects,
range of drugs to treat mental illness,
evaluate desired & make decisions
the nurse practicing in modern
about prn (pro re neta medication)
psychiatric settings needs to have
 Nurses must understand general
sound knowledge of the
principles of psychopharmacology &
pharmacokinetics involved, the benefits
have specific knowledge related to
& potential risks of pharmacotherapy,
psychotropic drugs.
as well as her own role & responsibility.
 Teaching patients can decrease the
incidence of side effects while
increasing compliance with the drug
Psychotropic drug is any drug that has primary
regimen.
effects on behavior, experience, or other
psychological functions (Logman Dictionary of
SPECIFIC AREAS OF EDUCATION INCLUDE
Psychology & Psychiatry)
THE FOLLOWING ….
Psychotropic or psychoactive drugs can also be
1. Discussion of side effects: side effects
defined as chemical that affects the brain &
can directly affect the patient’s
nervous system, after feelings & emotions.
willingness to adhere to drug regimen.
The nurse should always inquire about
These drugs also effect the consciousness in
the patient’s response to a drug, both
various ways. A broad range of these drugs is
therapeutic responses & adverse
used in emotional & mental illness.
responses.
2. Drug interactions: Patients & families
GENERAL GUIDELINES REGARDING RUG
must be taught to discuss of the
ADMINISTRATION IN PSYCHIATRY
addition of over-the-counter, alcohol &
illegal drugs to currently prescribed
 The nurse should not administer any
drugs.
drug unless there is a written order. Do
3. Discussion of safety issues: Because
not hesitate to consult the doctor when
some drugs, such as tricyclic
in doubt any medication.
antidepressants, have a narrow
 All medications given must be charted
therapeutic index, thoughts of self-
on the patient’s case record sheet.
harm must be discussed.
 In giving medication:
 Discuss on abruptly
- Always address the patient by name &
discontinued effects.
make certain of his identification.
 Many psychotropic drugs cause
- Do not leave the patient until the drug
sedation or drowsiness
is swallowed.
concerning use of hazardous
- Do not permit the patient to go the
machinery, driving must be
bathroom to take medication.
reviewed.
- Do not allow one patient to carry
medicine to another.
 If it is necessary to leave the patient to
4. Instructions for older adult
get water, do not leave the tray within
patients: Because older individuals
the reach of the patient.
have different pharmacokinetic
 profile than younger adults, special
instructions concerning side effects
& drug – drug interactions should be
explained.
5. Instructions for pregnant or
breastfeeding patient: as pregnant or
breastfeeding patients have special risks
associated with psychotropic drug
therapy, special instructions should be
tailored for these individuals.

CLASSIFICATIONS OF PSYCHOTROPIC DRUGS

1. Antipsychotic agents
2. Antidepressant agents
3. Mood stabilizing drug
4. Anxiolytics & hypnosedatives
5. Antiepileptic drug
6. Antiparkinsonian drugs

Miscellaneous drug which include

7. stimulants, drugs used in eating

disorders, drugs used in de-addiction,
drugs uses in psychiatry, vitamins,
calcium channel blockers etc.

ANTIPSYCHOTIC AGENTS

Antipsychotic agents are also known as

neuroleptic, major tranquillizers, or
phenothaiazines.

 This group of drugs has major clinical

use in the treatment of psychosis.
Psychosis
- Is a state in which a person’s ability to
recognize reality to communicate & to
relate to others is severely impaired.

MODE OF ACTION

 Antipsychotic agents are thought to

block the dopamine receptors.
 Dopamine is a chemical which is
released in the brain & causes
psychotic thinking.
 Increased production of dopamine
transmits the nerve impulses to the
brainstem faster than normal. This
results in strange thoughts,
hallucination & bizarre behavior.
 Antipsychotics helps in blocking or
reducing the activity of dopamine.
 Antiemetic is another property of
antipsychotic agents. They are also
used in hiccups.
INDICATIONS extrapyramidal symptoms. There are two
Organic psychiatric disorders: varieties of parkinsonia symptoms:
 Delirium
 Dementia a. Akinetic Form -Appears in the first week of
 Delirium tremens administration of antipsychotic drugs. The
 Drug-induced psychosis & characteristics of akinetic form are:
other organic mental Difficulty in masticating movements,
disorders weakness & muscle fatigue.

✔ Functional disorders: b. Agitating Form of parkinsonian Symptoms

• Schizophrenia include:- Tremors at rest, rigidity & mask-like
• Schizoaffective disorders face. Most characteristic features of
 Paranoid disorders parkinsonism are:-
Mood disorders:  Rigidity of muscles
• Mania  Motor retardation
 Major depression with  Salivation
psychotic symptoms  Slurred Speech
Childhood disorders:  Mask like face
 Attention-deficit  Shuffing gait
hyperactivity disorder
 Autism ii. Akathisia:- Akathisia occurs in 50% of all
 Enuresis the patients presenting extrapyrimidal
 Conduct disorder symptoms. The common characteristics:
Restless - walking in place
II. Difficulty in sitting still, or
✔ Neurotic & other psychiatric disorders: strong urge to move about- referred to as
 Anorexia nervosa - Restless leg syndrome generally occurs
 Intractable obsessive-Compulsive after two weeks of treatment. Before
disorder administering anti-parkinson
 Severe, intractable & disabling anxiety medication, anxiety should be ruled
Medical disorders: out.
 Huntington's chorea
 Intractable hiccup iii. Dystonia:- Dystonia occurs in 6% of total
 Nausea & vomiting number of patient's presenting EPS. The
 Tic disorder characteristic features are: rapidly developing
 Eclampsia contraction of muscles of the tongue, jaw, neck
 Heart stroke severe (producing torticollis) & extraocular muscles.
pain in malignancy Combined torticollis & extraocular spasm
tetanus results in an oculogyric crisis in which eyes
looked upward, head is turned to one side.
"Extrapyamidal side effects (EPS), commonly
PHARMACOKINETICS referred to as drug-induced movement
disorders are among the most common adverse
 Antipsychotics when administered
drug etfects patients experience from
orally are absorbed variably from the
dopamine-receptor biocking agents”
gastrointestinal tract, with uneven
blood levels.
iv. Tardive Dyskinesia:-
 They are highly bound to plasma as well
This occur due to abrupt termination or
as tissue proteins. Brain concentration
reduction of the antipsychotic drug after long-
is higher than the plasma
term-high-dose-therapy. Tardive dyskinesia is
concentration.
characterized by involuntary rhythmic,
 They are metabolized in the liver, &
stereotyped movements, protrusion of
excreted mainly through the kidneys.
the tongue, puffing of cheeks, chewing
The elimination half-life varies from
movements, involuntary movements
10 to 24
of extremities & trunk. These symptoms occur
in 3% of patients. Antipsychotics should be
SIDE-EFFECTS
stopped immediately. There is no treatment,
1) Extrapyramidal Symptoms (EPS)
symptoms may appear for years. It is
i Neuroleptic-inducecd pakinsonism- occur in
irreversible.
40% of the patients presenting
 subcutaneously unless specially
V. Neuroleptic Maliqnant Syndrome (NMS):- prescribed as they
This is rare complication of antipsychotic agents cause tissue irritation. These drugs
& is usually fetal. Many develop within hours or should be given deep IM.
after years of continued drug use. Symptoms
include hyperpyrexia, severe muscle rigidity,  Dry mouth may be may be reduced by
altered consciousness, blood pressure changes, encouraging the patient to rinse his or
increased count of W.B.C. symptoms appear her mouth frequently. Give a piece of
suddenly when medication is star is started & lemon or chewing gum. Good oral
can persist for 10-14 days or longer. hygiene should also
Symptomatic treatment is given to patients. be maintained.

2) Autonomic Nervous System:-  Blurred or impaired vision in the patient

Dry mouth, blurred vision, constipation, urinary causes anxiety & annoyance to him. The
hesitance or retention & under rare patient should be encouraged to inform
circumstances paralytic ileus. these symptoms immediately.
3) Cardio-Vascular:-
Tachycardia, orthostatic hypotension &  The patient on antipsychotic drugs may
reversible arrhythmias. have weight gain. Weight record should
4) Blood or Hematopoietic:- be maintained. The patient may be
Agrunulocytosis (marked decrease in leukocytes encouraged on a low salt & planned
system especially with chlorpramozine) caloric diet.
leucopenia, leukocytosis.
 The patient may complain of gastric
NURSE'S RESPONSIBILITY irritation. He should be discouraged to
 Close observation, especially when the take antacid as there will be decreased
antipsychotic are just started. The absorption of antipsychotic drugs.
expected results are reduction in
aggressive hyperactive behavior &  An intake output chart should be
disorganized thoughts. Look for the maintained specially for male patients
possible side-effects. who are confined to bed & have an
enlarged prostate gland. Encourage at
 Extrapyramidal reaction, i.e. least 2500 ml of liquid intake.
Parkinsonism, akinesia, akathisia,
dystonia, & tardive dyskinesia. These
symptoms are reduced/treated with ANTIDEPRESSANTS AGENTS
early observation, reporting & use of
anti-parkinson or anticholinergic DESCRIPTION
medication. I. Antidepressant agents are used in
affective disorders or disturbances
 Observe drowsiness. Medicine should mainly to treat depressive disorders
be administered at bed time. Report if caused by emotional or
the drowsiness persists fora very long environmental stressors.
time. The patient should be advised not
to drive & handle hazardous machinery II. Several groups of affective
while taking antipsychotic drugs. disturbances are treatable by
Observe for sore throat, fever due to antidepressants.
agranulocytosis.
MODE OF ACTION
 Record blood pressure of the patient on Antidepressant drugs are classified Tricyclics
antipsychotic drugs. If the BP is drops Tetracyclics & MAO Inhibitors. Research studies
by 20 to 30 mm of hg in the patient, have shown reduced levels of norepinephrine
immediate reporting & intervention (NE) & serotonin (5-HT) in the space between
should be nerve ending carrying message from one nerve
done. cell to another cause depression.

 Accurate route of medication- Tricyclic antidepressants & MAO inhibitors

antipsychotic drugs are not given increase these neurotransmitters
norepinephrine & serotonin to the synaptic
receptors in the central nervous system.  Chronic pain
Tricyclic inhibitors block the reuptake of NE & 5-  Migraine
HT & MAO inhibitors block the action of  Peptic ulcer disease
MONOamine oxidize in breaking down excess of
NE & 5-HT at the presynaptic neuron. PHARMACOKINETICS

•Antidepressants are highly

lipophilic & protein-bound. The
half-life is long & usually more
than 24 hours.
• It is predominantly metabolized in
the liver.

CONTRAINDICATION
 Antidepressants are given with caution
to patients with cardiovascular disorder
because they cause arrhythmias.
 They increase symptoms of psychosis
& mania in cases of manic-depressive
psychosis.
 Drugs are given with caution to
prevents with liver disorders.

SIDE EFFECTS
1) Autonomic side-effects:
Dry mouth, constipation, cycloplegia,
mydriasis, urinary retention, orthostatic
hypotension, impotence, impaired ejaculation,
delirium & aggravation of glaucoma.
INDICATIONS
 Depression 2) CNS effects:- Sedation, tremor & other
 Depressive episode extrapyramidal symptoms, withdrawal
 Dysthymia syndrome, seizures, precipitation of mania.
 Reactive depression
 Secondary depression 3) Cardiac side-effects:- Tachycardia, ECG
 Abnormal grief reaction changes, arrhythmias,
direct myocardial depression.
 Childhood psychiatric disorders
 Enuresis 4) Allergic side-effects:- Agranulocytosis,
 Separation anxiety disorder cholestatic jaundice, skin rashes, systemic
 Somnambulism vasculitis.
 School phobia 5) Metabolic & endocrine side-effects:-
 Night terrors weight gain
6) Special effects of MAOI drugs:-
 Other psychiatric disorders Hypertensive crises, severe hepatic necrosis,
 Panic attack hyperpyrexia.
 Night terrors
 Generalized anxiety disorder NURSE'S RESPONSIBILITY
 Agrophobia, social phobia  Observation of the side-effects &
 OCD with or without depressior monitoring the changes noted are very
 Eating disorder significant to prevent complications due
 Borderline personality disorder to antidepressant agents.
 Separation anxiety disorder Medical
disorder  Encourage the patient to take medicine
 Post-traumatic stress disorder at bed time due to a sedative effect.
 Depersonalization syndrome Dryness of mouth to decrease.

 Medical disorder
  Give plenty of fluids orally. Lemonade catecholamine activity, thus ameliorating
or chewing gum should be given. A few mania.
sips of water also help the patient.
INDICATION
 Do not give medicine empty stomach as  Acute mania
the patient complains of nausea &  Prophylaxis for bipolar &
vomiting. unipolar mood disorder.
 Schizoaffective
 Accurate recording of intake & output disorder
of the patient should be maintained to  Cyclothymia
check if he has retention of urine.  Impulsivity &
Aggression
 If the patient complains of dizziness or
light headedness he/she should be Other disorders:
encouraged to get up slowly & sit in the - Premenstrual
bed before standing. These symptoms dysphoric disorder
may due to orthostatic hypotension. - Bulimia nervosa
- Borderline
 Accurate recoding of vital signs like B.P. personality disorder
& pulse. - Episodes of binge
drinking
 The nurse should be able to interpret - Trichotillomania
the blood reports specially blood sugar - Cluster headaches
level & W.B.C. count. If the patient
complains of sore throat, fever,
malaise, it should be reported to the PHARMACOKINETICS
physician on duty.  Lithium is readily absorbed with peak
plasma levels occurring 2-4 hours after
MOOD STABILIZING a single oral dose of lithium carbonate.
 Lithium is distributed rapidly in liver &
Mood stabilizers are used for the treatment of kidney & more slowly in muscle, brain &
bipolar affective disorders. Some commonly bone. Steady state levels are achieved
used mood stabilizers are:- in about 7 days.
1. Lithium  Elimination is predominately via tubules
2. Carbamazepine & is influenced by sodium balance.
3. Sodium Valproate Depletion of sodium can precipitate
lithium toxicity.
LITHIUM
DESCRIPTION DOSAGES
 Lithium is an element with atomic Lithium is available in the market in the form of
number 3 & atomic weight 7. the following preparation:
 It was discovered by FJ Cade in 1949, & - Lithium carbonate: 300mg tablet (eg. Licab);
is a most effective & commonly used 400mg sustained release tablets (eg.
drug in the Lithosun-SR).
treatment of mania. - Lithium citrate: 300mg/5ml liquid.
The usual range of dose per day in acute mania
MODE OF ACTION is 900-210Omg given in 2-3 divided doses. The
The probable mechanisms of action can be: treatment is started after serial lithium
 It accelerates presynaptic re-uptake & estimation is done after a loading dose of
destruction of catecholamines, like 600mg or 900mg of lithium to determine the
norepinephrine. pharmacokinetics.
 It inhibits the release of catecholamines
at the
synapse.
 It decreases postsynaptic serotonin
receptor
sensitivity.

All these actions result in decreased

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