Pharmacology (Psychosis and Mania)
Pharmacology (Psychosis and Mania)
Pharmacology (Psychosis and Mania)
◦ Doses used are often higher than those required for maintenance treatment
of stable patients.
◦ Thus, one should be familiar with one member of each of the three
subfamilies of phenothiazines, a member of the thioxanthene and
butyrophenone group, and all of the newer compounds—clozapine,
risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole
Parenteral Preparations
◦ Well-tolerated parenteral forms of the high-potency older drugs
haloperidol and fluphenazine are available for rapid initiation of
treatment as well as for maintenance treatment in noncompliant
patients.
◦ Distinguished from its less severe form, hypomania, by the fact that
hypomania, by definition, does not result in functional impairment or
hospitalization, and is not associated with psychotic symptoms.
Mania
◦ Genetic studies of bipolar disorder have yielded several loci of interest
associated with disease risk and predictors of treatment response.
◦ Pharmacodynamics
◦ Directly inhibits two signal transduction pathways
◦ It both suppresses inositol signaling through depletion of intracellular
inositol and inhibits glycogen synthase kinase-3 (GSK-3), a
multifunctional protein kinase.
◦ GSK-3 is a component of diverse intracellular signaling pathways.
◦ These include signaling via insulin/insulin-like growth factor, brain
derived neurotrophic factor (BDNF), and the Wnt pathway
Effects on Electrolytes and Ion Transport
◦ Lithium is closely related to sodium in its properties. It can substitute for
sodium in generating action potentials and in Na + -Na + exchange
across the membrane.