Medicines and Drugs to Treat Major Mental Illnesses

Butyrophenones

Haloperidol (Serenace), Trifluperidol (Triperidol), Pimozide (Orap, Mozep)

These are some drugs of this class which are used in the treatment of major mental illnesses. They cause a higher incidence of extrapyramidal symptoms (abvormal movements) than phenothiazines, but the fall in blood pressure is less common. In rare cases, they may affect the, bone marrow to cause a decrease in white blood cells.

The toxicity to the liver is also considerably less. Some reports have indicated that the drug may convert a manic reaction into depression. Pimozide (MOZEP), a sister drug which has similar actions is given in doses of 2 to 5 mg. It has longer duration of action, therefore, is good in maintenance therapy. It may cause a disturbance of heart rhythm. The usual oral dose of haloperidol is 2 to 6 mg per day and of Trifluperidol 0.5 mg per day.

Precautions

It has been reported that most psychotic patients fail to take the drugs regularly. In such cases, fluphenazine decanoate, a long-acting preparation, can be injected at weekly.

Anti-psychotic drugs enhance the effect of respiratory depressant drugs and therefore, sleeping tablets or potent pain relievers like morphine and pethidine should be given cautiously to patients taking these drugs.

These drugs should be used very cautiously in patients with heart or liver diseases.

If the muscle rigidity is troublesome, the dose may be reduced or anti-parkinsoman drug may be administered.

If the treatment is to be stopped, the dose should be reduced gradually to prevent precipitation of severe psychotic reaction due to the drug withdrawal.

If there is any evidence of allergic reactions as characterized by sore throat or fever, the particular drug should be stopped and another substituted.

Those patients who are taking blood pressure lowering agents, antihistaminic and levodopa concurrently should be monitored closely to avoid adverse interactions.

Clozapine (Clopaz, Lozapine, Sizapen, Tab. 25 mg, 100 mg)

It is effective In resistant cases and does no cause extrapyramidal symptoms (abnormal movements). It does not raise prolactin level also. It may decrease white blood cell count( Agranulocytosis in 0.8% cases) and therefore a weekly white cell count is needed to detect any change. It may precIpItate convulsions.

Resperidone (Respidon, Rozidol, Zisper 1 mg, 2 mg, 4 mg)

A potent antipsychotic, useful in acute psychosis. It is least likely to precipitate convulsions. Usual dose is 1 to 4 mg per day. It can, sometimes, cause postural fall in blood pressures.

Olanzapine (Lozap, Oliza, Olapin Tab. 2.5 mg to 20 mg)

It is a broad spectrum antipsychotic and improve positive and negative symptoms in schizophrenia. It can be combined with lithium/sodium valproate for mania.

It causes dry mouth, constipation and weight gain. It is epileptogenic but rise in prolactin level does not occur.

Quetiapine (Quel, Quiticool Seroquin 25 mg to 200 mg), Loxapine (Loxapac 10 mg to 50 mg cap.) and Aripiprazole (Aaprito, Real one 10 mg to 30 mg Tab.) are other agents.

In conclusion, the skill of using these anti-psychotic drugs depends upon the selection of the adequate dosage levels, knowledge of what to expect, and the judgement as to when to stop the therapy or change the drug. Sometimes it may be necessary to combine two drugs to obtain the maximum anti-psychotic action with minimum adverse effects. The anti-psychotic agents should improve the acute symptoms within 48 hours. A demonstrable positive response may take about 3 weeks and the full effect may require 6 weeks to 6 months. It may be necessary to continue the treatment for several years. It has been found that there is a relapse rate of about 30­ 40 per cent after the treatment is stopped.

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