Psychopharmacology

Psychopharmacology (from Greek psȳkhē, "breath, life, soul" pharmakon, "drug") is the study of drug-
induced changes in mood, sensation, thinking, and behavior.

The field of psychopharmacology studies a wide range of substances with various types of psychoactive
properties. The professional and commercial fields of pharmacology and psychopharmacology do not
mainly focus on psychedelic or recreational drugs, as the majority of studies are conducted for the
development, study, and use of drugs for the modification of behavior and the alleviation of symptoms,
particularly in the treatment of mental disorders (psychiatric medication). While studies are conducted on
all psychoactives by both fields, psychopharmacology focuses primarily on the psychoactive and chemical
interactions with the brain.

Drugs are researched for their physicochemical properties, physical side effects, and psychological side
effects. Researchers in psychopharmacology study a variety of different psychoactive substances that
include alcohol, cannabinoids, club drugs, psychedelics, opiates, nicotine, caffeine, psychomotor
stimulants, inhalants, and anabolic-androgenic steroids. They also study drugs used in the treatment of
affective and anxiety disorders, as well as schizophrenia.
Clinical studies are often very specific, typically beginning with animal testing, and ending with human
testing. In the human testing phase, there is often a group of subjects, one group is given a placebo, and
the other is administered a carefully measured therapeutic dose of the drug in question. After all of the
testing is completed, the drug is proposed to the concerned regulatory authority (e.g. the U.S. FDA), and
is either commercially introduced to the public via prescription, or deemed safe enough for over the
counter sale.
Though particular drugs are prescribed for specific symptoms or syndromes, they are usually not specific
to the treatment of any single mental disorder. Because of their ability to modify the behavior of even
the most disturbed patients, the antipsychotic, antianxiety, and antidepressant agents have greatly
affected the management of the hospitalized mentally ill, enabling hospital staff to devote more of their
attention to therapeutic efforts and enabling many patients to lead relatively normal lives outside of the
hospital. A somewhat controversial application of psychopharmacology is "cosmetic psychiatry" Persons
who do not meet criteria for any psychiatric disorder are nevertheless prescribed psychotropic
medication. The antidepressant Wellbutrin is then prescribed to increase perceived energy levels and
assertiveness while diminishing the need for sleep. The antihypertensive compound Inderal is
sometimes chosen to eliminate the discomfort of day-to-day "normal" anxiety . Prozac in nondepressed
people can produce a feeling of generalized well-being. Mirapex, a treatment for restless leg syndrome,
can dramatically increase libido in women. These and other off-label life-style applications of
medications are not uncommon. Although occasionally reported in the medical literature no guidelines
for such usage have been developed.
Undifferentiated Schizophrenia
The undifferentiated subtype is diagnosed when people have symptoms of schizophrenia that are
not sufficiently formed or specific enough to permit classification of the illness into one of the
other subtypes.

The symptoms of any one person can fluctuate at different points in time, resulting in uncertainty
as to the correct subtype classification. Other people will exhibit symptoms that are remarkably
stable over time but still may not fit one of the typical subtype pictures. In either instance,
diagnosis of the undifferentiated subtype may best describe the mixed clinical syndrome.

How Is It Diagnosed?

Undifferentiated schizophrenia is a difficult diagnosis to make with any confidence because it

depends on establishing the slowly progressive development of the characteristic “negative”
symptoms of schizophrenia without any history of hallucinations, delusions, or other
manifestations of an earlier psychotic episode, and with significant changes in personal behavior,
manifest as a marked loss of interest, idleness, and social withdrawal.

Hallucinations

 Perceptual distortions arising from any of the five senses.

"A false perception, which is not a sensory distortion or misinterpretations but which occurs as
the same time as real perceptions" - (Jaspers)

 Dreams and mental images differ from hallucinations and are often Incomplete,
dependent on will, can be recreated.
 Pseudo-hallucinations.

Causes of hallucinations

 Intense emotions.
 Depression
 Words or short phrases-”kill yourself”
 Suggestions
 Hypnosis
 Motivating instructions
 Disorders of sense organs.
 Glaucoma
 Geriatric clients
  Sensory deprivations.
 Repetitive words and phrases.
 Black patch disease.
 Disorders of CNS.
 Lesions on diencephalon and cortex
 Usually visual.
 Hypnogogic and Hypnopompic
 Organic hallucinations
 Auditory or visual .

Auditory hallucinations

 Elementary or partially or completely organized voices.

 Stimulation of temporal areas.
 Vary in quality ,content.
 Thought echo, second person or third person.
 May be imperative.

Visual hallucinations

 Elementary or partially or completely organized

 Most common in acute organic states
 Extremely rare in schizophrenia.
 sees small animals most often in delirium.
 Often isolated from auditory hallucinations.
 In temporal lobe epilepsy may be experiential.
 Lilliputian hallucinations frequently occur.

Olfactory hallucinations

 Schizophrenics, organic states, temporal lobe epilepsy.

 Uncommon in depressives.

Taste hallucinations

 finds in schizophrenics, organic states.

 can be experienced in Parietal cortex stimulation.

Tactile hallucinations

 finds in Organic states.

 “Cocaine bug.”
 Wind, heat, electrical or sexual sensations.
Special kinds of hallucinations

 Reflex hallucinations
 Extracampine hallucinations
 Autoscopy or phantom mirror image
 Epilepsy ,focal lesions, toxic infective stages
 Parietal lobe disorders
 Negative autoscopy
 Internal autoscopy

Delusions

 False unshakable belief which is out of keeping with the patients social and cultural
background.
 Primary delusions.
 Secondary delusions.

Primary delusions

 A new meaning arises not in connection with other psychopathological event and is not
understandable.       
 Delusional mood: has knowledge of something going on around him but do not know
what it is.
 Delusional perception: attribution of new meaning to a normally perceived object.
 Delusional idea: delusion appears fully formed in the mind.

Secondary delusions

 A delusion which is understandable in terms of persons cultural background or emotional

state.

Treatment

 Antipsychotics
o Typical
o Atypical
o Sedatives / hypnotics

Steps in Management

 Facilitative communication.
 Observation and listening.
 Can talk about hallucination to know about the level of symptoms.
  Talking about hallucination is reassuring and self validating for the patient.
 If left alone, it will overwhelm coping resources.
 Interactive discussions are very helpful.
 Communicate right at the time of hallucination.
 Modulation of sensory stimulation.

Principles

 Eye contact.
 Speak simply but slightly louder.
 Call by name.
 Use touch.

Nurses responsibility

 Don’t argue or reject.

 Try to keep them engaged.
 Encourage to practice some relaxation techniques.
 Use distractions, exercising, hobbies, saying stop.
 Calming by a glass of water or counting.
 Be tactful in approach.
 Do not express approval.
 Acknowledge feelings or fear.
 Reassure and encourage.
 Explain clearly what you are doing and why.
 Maintain consistency.
 Keep communication open and non judgmental.
 Listen understand and respect their feelings

Bipolar disorder or manic-depressive disorder, which is also referred to as bipolar affective

disorder or manic depression, is a psychiatric diagnosis that describes a category of mood
disorders defined by the presence of one or more episodes of abnormally elevated energy levels,
cognition, and mood with or without one or more depressive episodes. The elevated moods are
clinically referred to as mania or, if milder, hypomania. Individuals who experience manic
episodes also commonly experience depressive episodes, or symptoms, or mixed episodes in
which features of both mania and depression are present at the same time.[2] These episodes are
usually separated by periods of "normal" mood; but, in some individuals, depression and mania
may rapidly alternate, which is known as rapid cycling. Extreme manic episodes can sometimes
lead to such psychotic symptoms as delusions and hallucinations. The disorder has been
subdivided into bipolar I, bipolar II, cyclothymia, and other types, based on the nature and
severity of mood episodes experienced; the range is often described as the bipolar spectrum.
Data from the United States on lifetime prevalence varies; but it indicates a rate of around 1% for
bipolar I, 0.5%–1% for bipolar II or cyclothymia, and 2%–5% for subthreshold cases meeting
some, but not all, criteria. The onset of full symptoms generally occurs in late adolescence or
young adulthood. Diagnosis is based on the person's self-reported experiences, as well as
observed behavior. Episodes of abnormality are associated with distress and disruption and an
elevated risk of suicide, especially during depressive episodes. In some cases, it can be a
devastating long-lasting disorder. In others, it has also been associated with creativity, goal
striving, and positive achievements. There is significant evidence to suggest that many people
with creative talents have also suffered from some form of bipolar disorder.[3]

Genetic factors contribute substantially to the likelihood of developing bipolar disorder, and
environmental factors are also implicated. Bipolar disorder is often treated with mood stabilizing
medications and, sometimes, other psychiatric drugs. Psychotherapy also has a role, often when
there has been some recovery of the subject's stability. In serious cases, in which there is a risk of
harm to oneself or others, involuntary commitment may be used. These cases generally involve
severe manic episodes with dangerous behavior or depressive episodes with suicidal ideation.
There are widespread problems with social stigma, stereotypes, and prejudice against individuals
with a diagnosis of bipolar disorder.[4] People with bipolar disorder exhibiting psychotic
symptoms can sometimes be misdiagnosed as having schizophrenia, another serious mental
illness.[5]

The current term "bipolar disorder" is of fairly recent origin and refers to the cycling between
high and low episodes (poles). A relationship between mania and melancholia had long been
observed, although the basis of the current conceptualisation can be traced back to French
psychiatrists in the 1850s. The term "manic-depressive illness" or psychosis was coined by
German psychiatrist Emil Kraepelin in the late nineteenth century, originally referring to all
kinds of mood disorder. German psychiatrist Karl Leonhard split the classification again in 1957,
employing the terms unipolar disorder (major depressive disorder) and bipolar disorder.

Signs and symptoms

Bipolar disorder is a condition in which people experience abnormally elevated (manic or
hypomanic) and, in many cases, abnormally depressed states for periods of time in a way that
interferes with functioning. Bipolar disorder has been estimated to afflict more than 5 million
Americans—about 1 out of every 45 adults.[6] It is equally prevalent in men and women and is
found across all cultures and ethnic groups.[7] Not everyone's symptoms are the same, and there is
no simple physiological test to confirm the disorder. Bipolar disorder can appear to be unipolar
depression. Diagnosing bipolar disorder is often difficult, even for mental health professionals.
What distinguishes bipolar disorder from unipolar depression is that the affected person
experiences states of mania and depression. Often bipolar is inconsistent among patients because
some people feel depressed more often than not and experience little mania whereas others
experience predominantly manic symptoms.