精神分裂癥12323課件

精神分裂癥_12323AntipsychoticdrugsSchizophrenia精神分裂癥literaltranslation“splitmind”separateemotionalsidefromintellectualsideemotional&cognitiveprocessesdon'tfunctiontogetheragroupofseveredisorderscharacterizedby:disorganizedanddelusionalthinking（妄想）disturbedperceptionsinappropriateemotions&actionPsychotropicDrugs

抗精神失常藥Classification：antipsychoticdrugs抗精神病藥物neurotropicdrugs神經(jīng)安定劑antimanicdrugs抗躁狂藥物antidepressants抗抑郁藥物anxiolytics抗焦慮藥物Natureofpsychosis/schizophreniaThedopaminehypothesisexcessivedopaminergicactivityplaysaroleinthedisorder.Theenhancementoffunctionof5-HT2DopaminergicSystemsThenigrostriatalpathway(coordinationofvoluntarymovement)Mesolimbic-mesocortical(behavior)Tuberoinfundibular-pituitarysystem(endocrine)

Themedullaoblongata(vomit)Medullary-periventricularpathway(eatingbehavior)AntipsychoticdrugsClassification：Phenothiazin吩噻嗪類(氯丙嗪

chloropromazine)Thioxanthenes硫雜蒽類(chlorprothixene氯普噻噸（泰爾登）)Butyrophenones丁酰苯類(haloperidol氟哌啶醇)OthersAntipsychotic/NeurolepticsPhenothiazin吩噻嗪類chlorpromazine氯丙嗪 (wintermine冬眠靈)

PharmacologiceffectsblockingDA2

、α、

M、5HT2

、

H1receptors

neurolepticeffect(神經(jīng)安定作用)

Blocking

Mesolimbic

systemandmesocortical

D2-R

Moreeffectivefortreatingpositivesymptom

Substantia

nigra-corpusstriatum----extrapyramidaleffects錐體外系反應(yīng)

Node-funnel---endocrinesystemactionpowerfulantiemeticaction鎮(zhèn)吐作用blockingCTZ催吐化學(xué)感受區(qū)D2-R(smalldosage)directlyinhibitingvomitingcenter嘔吐中樞(largedosage)alteringtemperature-regulatingmechanismsdecreasetemperaturenomatternormalorhightemperaturebodytemperaturevarieswiththeenvironment

autonomicNSeffectsblockingα-Rvasodilatation“epinephrinereversal”blockingM-R

atropine-likeaction

endocrinesystemactionincreasingprolactin催乳素secretioninhibitinggonadotropichormone促性腺激素，growthhormone生長激素secretionTherapeuticusesschizophrenia精神分裂癥moreeffectiveintreatingpositivesymptomsseverenauseaandvomitingusefulinthetreatmentofdrug-inducednauseahypothermicanesthesia低溫麻醉andartificialhibernation人工冬眠

chlorpromazine–promethazine–pethidine（氯丙嗪–異丙嗪–哌替啶）Adverseeffectscommonadverseeffects

CNSdepression(drowsiness,indifference)M-Rblock(blurredvision,drymouth)α-Rblock(orthostatichypotension體位性低血壓)extrapyramidalreaction錐體外系反應(yīng)Parkinson'ssyndromakathisia靜坐不能acutedystonia急性肌張力障礙treatedbyantimuscarinicdrugs(artane,安坦)

tardivedyskinesia遲發(fā)性運動障礙treatedbyantidopaminedrugs(clozapine,氯氮平)Neuralantagonistseveresymdromedrug-inducedmindabnormalityconvulsion驚厥andepilepsy癲癇allergicreaction

acutehypogranulocytosis(粒細(xì)胞減少癥)cardiovascularandendocrinesystemreactionacutepoisoning急性中毒Thioxanthenes

硫雜蒽類chlorprothixene

氯普噻噸（泰爾登）Butyrophenones

丁酰苯類haloperidol氟哌啶醇Otherspenfluridol

五氟利多clozapine

氯氮平Clozapine(氯氮平)

BenzodiazepinesPharmacologicaleffectBlocking5-HT,D2receptorStrongefficacy,rapidlyNoextrapyramidalreaction

BlockingH1,MandαreceptorhypogranulocytosisAntimanicdrugsBipolaraffectivedisorder（雙極性情感障礙）Cyclicmanicattacks

（往復(fù)性躁狂發(fā)作）Inhighspirit（情緒高漲）Overactivity（過度活動）Paranoidthoughts（妄想）LithiumCarbonate（碳酸鋰）ClinicaluseBasedontheLi+

treatmentforbipolardisordermanicphaseparticularlyprophylacticLimayblockbothmanicanddepressiveAdverseeffectsGItractnausea,vomiting,diarrheamentalconfusion,tremor,aphasia失語癥,choreoathetosis舞蹈癥,comaManagementofLioverdosage:peritonealdialysis腹膜透析orhemodialysisivNaClAntidepressantsTricyclicantidepressants

三環(huán)類抗抑郁藥（抑制NA

、5-羥色胺再攝?。㎞Areuptakeinhibitor

NA再攝取抑制劑Serotoninreuptakeinhibitor

5-羥色胺再攝取抑制劑OthersTricyclicantidepressants

imipramine丙咪嗪（米帕明）

ActionCNS:inhibitNAand5-HTreuptakenormalindividals:depressanteffectdepression:moodelevation,spiritexcitationTheonsetofthemood-elevationisslow,2~3weeksautonomicnervesystemBlockingM-Reffects:blurredvision,drymouth,constipation,urinaryretentioncardiovascularsystem

lowbloodpressurearrhythmiaClinicalusesdepression

variouskindsespeciallyendogenous，involutionaldepression

enuresis遺尿癥inchildrenolderthansixphobicanxiety

恐懼性焦慮(癥)Adverseeffectsdrymouth,mydrasis,blurredvision,orthostatichypotension體位性低血壓agranulocytosis粒細(xì)胞缺乏癥urinaryretentionocularpressureincreaseContraindicationProstatichypertrophyandglaucoma青光眼NAreuptakeinhibitordesipramine地昔帕明,去甲丙咪嗪

inhibitNAreuptakeselectively

treatmild,moderatedepressionsedationandhypotension

sideeffectisslightcomparedwithimipramine

overdosecancauselowbloodpressure,arrhythmia,drymouth,constipation5-HTreuptakeinhibitorfluoxetine氟西汀,百憂解

inhibit5-HTreuptakeselectively

treatdepression:improveattentionemotionadverseeffects:GItractreaction,tremorriskoflife-threatening“serotonin-syndrome”co-administeredwithMAOinhibitorsMAOinhibitorPhenelzine

苯乙肼

inhibitMAOnonselectively

treatmild,moderatedepression,alsophobicstates恐怖狀態(tài)

sideeffects:orthostatichypotensio