Anti-Manic-Drugs-Regulating-Mood-Disorders__final.pptx

Most Important and Popular Medications Used in the Treatment of Psychological Disorders and mania

1. Anti Manic Drugs Under super vision Dr/Eman Mahmood Designed By /Ali Abd Al-kareem & Barsoum Ghabrial Fayek

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4. Mania and Bipolar Disorder Mania Mania is a state of heightened energy, euphoria, and impulsivity, often characterized by racing thoughts, poor judgment, and risky behaviors. Bipolar Disorder Bipolar disorder is a mental health condition characterized by alternating periods of mania and depression. Treatment Goals Anti-manic medications are essential for managing the symptoms of mania and preventing future episodes, promoting overall well-being and improving quality of life.

5. Symptoms and Characteristics of Mania 1 Elevated Mood Individuals experiencing mania often feel overly happy, euphoric, and energetic. This can lead to increased talkativeness, impulsivity, and a decreased need for sleep. 2 Racing Thoughts Thoughts may come and go rapidly, making it difficult to focus or complete tasks. This can lead to difficulty concentrating and disorganized speech. 3 Increased Activity People with mania may engage in activities with excessive energy, such as spending sprees, impulsive travel, or risky behaviors. 4 Grandiose Ideas A sense of inflated self-esteem, believing they have special abilities or are destined for greatness. This can lead to unrealistic goals and poor judgment.

6. Causes and Risk Factors of Mania Genetic Predisposition Family history of bipolar disorder or other mood disorders significantly increases the risk of developing mania. Environmental Factors Stressful life events, such as major changes, trauma, or loss, can trigger manic episodes in individuals with a predisposition. Substance Abuse Drug and alcohol abuse can increase the risk of developing mania and worsen existing symptoms. This is due to the effects of substances on brain chemistry and mood regulation. Medications Certain medications, such as corticosteroids and antidepressants, can trigger manic episodes in some individuals.

7. Definition of Anti-Manic Drugs 1 Mood Stabilizers These medications work by balancing the levels of neurotransmitters in the brain, particularly serotonin and dopamine. 2 Reduce Mania Anti-manic drugs are designed to alleviate the symptoms of manic episodes, which include elevated mood, racing thoughts, and impulsive behaviors. 3 Prevent Recurrences They also play a vital role in preventing future manic episodes and promoting long-term mood stability. Anti manic drugs, also known as mood stabilizers, are a class of medications used to treat bipolar disorder and other mood disorders.

8. What are Anti Manic Drugs? Anti manic drugs are medications that help to stabilize mood swings and reduce the severity of manic episodes. They work by influencing the levels of certain neurotransmitters in the brain. 1 Reduce Mania They help to lessen the intensity and duration of manic episodes. 2 Prevent Recurrence They work to prevent future mood swings and stabilize mood overall. 3 Manage Symptoms They help to manage the associated symptoms of mania, such as agitation, irritability, and sleep disturbances.

9. Indications for Use Bipolar Disorder Anti-manic medications are the mainstay treatment for bipolar disorder, helping to manage manic episodes and prevent future occurrences. Schizoaffective Disorder In some cases, anti-manic drugs may be used in combination with antipsychotics to manage the mood symptoms of schizoaffective disorder. Other Conditions Anti-manic medications may be used off-label to treat certain conditions, such as severe agitation or aggression, but their use should be carefully considered and monitored by a healthcare professional.

10. Criteria for Initiating Anti-Manic Treatment Severe Mania Presence of psychosis, hallucinations, or delusions Risk of harm to self or others History of Frequent Episodes Previous episodes of mania that have been difficult to manage High risk of recurrence Functional Impairment Significant disruption in work, relationships, or daily life Inability to perform normal activities

11. Adverse Effects and Monitoring 1 Drowsiness and Fatigue Some anti-manic drugs can cause drowsiness or fatigue. Monitor the patient's alertness and adjust activities as needed. 2 Weight Gain Weight gain can be a side effect of some anti-manic medications. Encourage healthy lifestyle habits and monitor weight regularly. 3 Tremors Tremors are a common side effect of certain anti-manic drugs. The doctor may adjust the dosage or prescribe alternative medications if tremors are severe. 4 Blood Tests Regular blood tests are necessary to monitor for potential side effects, such as changes in liver function or blood cell counts, and to adjust medication dosages if necessary.

12. Potential Side Effects and Monitoring Anti manic drugs can cause a range of side effects, some of which can be serious. Regular monitoring is crucial to manage these potential risks. 5 Weight Gain Some anti manic drugs may increase appetite and contribute to weight gain. 6 Drowsiness Drowsiness is a common side effect, especially during initial treatment. 7 Tremors Lithium, for example, can cause tremors in some patients.

13. Mechanism of Action Neurotransmitter Modulation Anti-manic drugs often work by influencing the activity of neurotransmitters like serotonin, dopamine, and glutamate, which play a crucial role in regulating mood and behavior. Synaptic Transmission These drugs may also affect the process of synaptic transmission, the communication between neurons, by altering the release, reuptake, or receptor binding of neurotransmitters.

14. ‘’Lithium’’ Mechanism of action Involves Several Pathways: Inhibits The Enzyme Inositol Monophosphatase This Leads To Decreased Activity Of Neurotransmitters That Are Often Elevated During Manic Episodes. Inhibition Of  Glycogen   Synthase   Kinase :  These   Actions   Help   Stabilize  Mood  And   Reduce  The  Severity  Of  Manic   Symptoms . Lithium  is  a mood stabilizer commonly used  to   treat  bipolar   disorder ,  including   manic   episodes . 

15. Adverse effects Common adverse effects of lithium include nausea, headache, diarrhea , vomiting , Tremore and Weight gain When concentration of lithium in serum increases to 1.5 mmol/L , toxicity may be induced . This leads to : loss of coordination, drowsiness, weakness, slurred speech and blurred vision. When concentration of lithium in serum increases to 2 mmol/L , this may lead to: chaotic cardiac rhythm and brain-wave activity with seizures  Prolonged use of lithium may damage the body's ability to respond properly to hormone  vasopressin  (ADH) (stimulates water reabsorption) This gives rise to  diabetes insipidus , a disorder characterized by  polyuria  and  polydipsia . 

16. Lithium toxicity can occur when there's too much lithium in the blood, and it can be quite serious. Causes: Lithium toxicity can result from excessive intake, decreased excretion (due to dehydration, low sodium diet, or kidney problems), or interactions with other medications like NSAIDs. Level 1 Serum level 1.5 to 2 Symptoms: blurred vision, ataxia, persistent nausea and vomiting Level of Toxicity lithium

17. Level of Toxicity lithium Management: It's crucial to monitor blood levels regularly and stay hydrated. In cases of severe toxicity, medical intervention is necessary to stabilize the patient and reduce lithium levels. Regular monitoring and communication with a healthcare provider are essential to prevent and manage lithium toxicity Level 2 Serum Level 2 to 3.5 Excessive output of dilute Urine, increased Tremors, muscular irritability, Mental Confusion Level 3 At Serum Level above 3.5 Impaired Consciousness, Seizures, Coma, oliguria, Anuria, Arrhythmia, myocardial infarction lead to death

18. Monitor older adults carefully to prevent toxicity as they may not tolerate the toxicity. Monitor timely the occurrence of hypothyroidism. Weight the patient daily. Check ankles, tibiae, and wrists for edema. Maintain input-output chart. Report early signs of extrapyramidal reactions promptly to physician. Nursing Role Lithium Carbonate

19. Lithium is used to treat and prevent manic episodes in bipolar disorder. It helps stabilize mood and reduce the severity of manic symptoms. Dosage and Administration: It's crucial to take lithium exactly as prescribed by the healthcare provider. Skipping doses or stopping the medication abruptly can lead to relapse or withdrawal symptoms. Monitoring: Patients need regular blood tests to monitor lithium levels and kidney function. This helps prevent toxicity and ensures the medication is at a therapeutic level. Side Effects: Educate patients about common side effects like nausea, diarrhea, tremors, and dry mouth, as well as more severe side effects like lithium toxicity. Encourage them to report any unusual symptoms to their healthcare provider immediately. Lifestyle Adjustments: Advise patients to maintain a consistent salt intake and stay well-hydrated, as changes in sodium levels and dehydration can affect lithium levels in the body. Avoiding Interactions: Warn patients about potential interactions with other medications, especially NSAIDs, diuretics, and certain antibiotics, which can increase the risk of toxicity. Emergency Information: Provide information on what to do in case of an overdose or severe side effects, including emergency contact numbers and the importance of seeking immediate medical attention. By providing comprehensive health education, patients can better manage their condition and reduce the risk of complications Health Education for Lithium as an Antimanic Drug

20. Antipsychotics Antipsychotics Also Known As: Neuroleptics or Major Tranquilizers Antipsychotics are a class of medications primarily used to treat psychosis, which includes symptoms like delusions, hallucinations, and disordered thinking. They are commonly prescribed for conditions such as schizophrenia, bipolar disorder, and severe depression. There are two main types of antipsychotics : Typical (First-Generation) Antipsychotics Atypical (Second-Generation) Antipsychotics These older medications are effective but often have more severe side effects, such as tardive dyskinesia (involuntary movements). These newer medications tend to have fewer side effects and are often preferred for long-term treatment . Common examples of antipsychotics include risperidone, olanzapine, and quetiapine

21. Mechanism of action The mechanism of action of antipsychotics primarily involves blocking dopamine receptors in the brain Dopamine is a neurotransmitter that plays a key role in the transmission of signals in the brain, and its overactivity is associated with symptoms of psychosis, such as delusions and hallucinations Antipsychotics work by blocking dopamine receptors (mainly D2, D3, and D4 subtypes) which helps to reduce these symptoms This is why they are effective in treating conditions like schizophrenia, bipolar disorder, and severe depression

22. Adverse effects Antipsychotics can have a range of side effects. Some common side effects include: Weight gain Drowsiness Dry mouth Blurred vision Constipation Dizziness Restlessness (akathisia)Muscle stiffness (extrapyramidal symptoms) More serious side effects can include: Tardive dyskinesia: Involuntary movements, often of the face and tongue. Metabolic syndrome: Increased risk of diabetes, high cholesterol, and high blood pressure.

23. Perform all baseline tests including platelet count, bleeding time. Monitor keenly client during the dose adjustment and monitor the client for any adverse reactions. Multiple drugs for seizure control increase the risk of hyperammonemia, marked by lethargy, anorexia, asterixis, increased seizure frequency, and vomiting. Report such symptoms promptly to physician. If they persist with decreased dosage, the drug will be discontinued. Do not discontinue therapy abruptly, firstly discuss with Consult physician before you stop or alter dosage regimen because this may lead to loss control over seizures Nursing Role

24. Anticonvulsants Anticonvulsants work through several mechanisms to stabilize neuronal activity and prevent seizures. Seizures occur due to abnormal and excessive electrical activity in the brain, and anticonvulsants aim to reduce this by influencing neurotransmitters, ion channels, and synaptic transmission. Different anticonvulsants use various mechanisms to achieve seizure control. Here's an overview of the primary mechanisms of action: 1. Sodium Channel Inhibition Several anticonvulsants block voltage-gated sodium channels in neurons, stabilizing the inactive state of these channels and preventing repetitive firing of action potentials. This limits the spread of seizure activity. Mechanism : By binding to sodium channels, these drugs prolong the inactivation phase, reducing the excitability of neurons and inhibiting the propagation of seizure activity Mechanism

25. 3. Enhancement of GABAergic Activity Gamma-aminobutyric acid (GABA) is the main inhibitory neurotransmitter in the brain. By enhancing GABA activity, anticonvulsants increase inhibitory effects, reducing neuronal excitability. Mechanism : Benzodiazepines and barbiturates enhance the effect of GABA on GABA-A receptors, increasing chloride ion influx, which hyperpolarizes the neuron, making it less likely to fire. Gabapentin increases GABA release. Tiagabine inhibits GABA reuptake, prolonging its inhibitory effects. Anticonvulsants Mechanism ,con 2. Calcium Channel Inhibition Certain anticonvulsants inhibit T-type calcium channels, which play a role in controlling rhythmic bursts of neuronal firing, particularly in absence (petit mal) seizures. Mechanism : Blocking these calcium channels reduces the neuronal pacemaker activity responsible for generating abnormal electrical discharges in specific types of seizures.

26. 6. Multiple Mechanisms Some anticonvulsants work through a combination of mechanisms, making them effective across a broad spectrum of seizure types. 5. Inhibition of Synaptic Vesicle Proteins (SV2A) Some anticonvulsants act by binding to synaptic vesicle proteins, such as SV2A, which are involved in neurotransmitter release. Mechanism : Levetiracetam binds to SV2A, modulating neurotransmitter release and preventing the synchronization of neuronal firing that leads to seizures. 4. Glutamate Inhibition Glutamate is the major excitatory neurotransmitter in the brain. Some anticonvulsants work by inhibiting glutamate receptors or decreasing glutamate release, thereby reducing excitatory transmission. Mechanism : Topiramate blocks kainate and AMPA receptors, which are subtypes of glutamate receptors, reducing excitatory synaptic transmission. Lamotrigine inhibits the release of glutamate, limiting excitatory activity. Anticonvulsants Mechanism ,con

27. Adverse effects Anticonvulsants can cause various adverse effects, ranging from mild to severe. Here’s a summary of common and serious side effects for major anticonvulsants: Phenytoin : Common : Drowsiness, gum overgrowth, nausea. Serious : Liver toxicity, Stevens-Johnson syndrome, arrhythmias. Valproic Acid : Common : Weight gain, tremors. Serious : Liver failure, pancreatitis, hyperammonemia, birth defects. Carbamazepine : Common : Dizziness, blurred vision. Serious : Aplastic anemia, Stevens-Johnson syndrome. Lamotrigine: Common : Dizziness, headache. Serious : Stevens-Johnson syndrome, meningitis.

28. Levetiracetam: Common : Drowsiness, irritability. Serious : Psychosis (rare). Topiramate : Common : Cognitive impairment, weight loss. Serious : Kidney stones, metabolic acidosis, birth defects. Gabapentin & Pregabalin : Common : Drowsiness, dizziness, edema. Serious : Respiratory depression, suicidal thoughts. Benzodiazepines : Common : Drowsiness, confusion. Serious : Respiratory depression, dependence. Phenobarbital : Common : Lethargy, depression. Serious : Respiratory depression, skin reactions. Ethosuximide : Common : Nausea, dizziness. Serious : Bone marrow suppression, skin reactions. Adverse effects

29. Nursing Role Monitor vital signs timely. Document and monitor input -output chart of the patient. Get all the baseline tests done on periodic basis like CBC, serum electrolytes, LFT, BUN etc. Monitor for the reactions after the drug is given like drowsiness, dizziness, light-headedness, ataxia, gastric upset. Withhold the drug and notify the physician if you notice any of changes like: RBC <4 million/mm, Hct <32%, Hgb <11 g/dL, WBC <4000/mm3, platelet count <100,000/mm3, reticulocyte count <20,000/mm3, serum iron >150 mg/dL. Monitor lithium toxicity. Anticonvulsants Carbamazepine

30. Nursing Role Monitor for any development of rashes and stop the drug immediately. Monitor the plasma levels of lamotrigine when given with any another drug. Also check for any adverse reaction when lamotrigine is used with other anticonvulsants, especially valproic acid. Be aware of drug interactions and closely monitor when interacting drugs are added or discontinued. Anticonvulsants Lamotrigine

31. Toxicity & Management Phenytoin Toxicity: Symptoms : Nystagmus, confusion, coma. Management : Reduce or stop the dose, monitor drug levels, provide supportive care. Valproic Acid Toxicity: Symptoms : Confusion, liver problems, hyperammonemia. Management : Reduce the dose, use L-carnitine, monitor liver function. Carbamazepine Toxicity: Symptoms : Dizziness, ataxia, hyponatremia. Management : Discontinue the drug, use activated charcoal, dialysis in severe cases. Lamotrigine Toxicity: Symptoms : Dizziness, severe skin rash. Management : Immediately stop the drug, supportive care, corticosteroids if needed. Levetiracetam Toxicity: Symptoms : Drowsiness, agitation, severe respiratory depression. Management : Supportive care. Benzodiazepine Toxicity: Symptoms : Drowsiness, respiratory depression, coma. Management : Use flumazenil cautiously, provide supportive care.

32. Contraindications and Precautions Pregnancy Some anti-manic medications may pose risks to the developing fetus. Carefully weigh the potential benefits and risks before initiating treatment. Liver Disease Individuals with liver disease may be more sensitive to the effects of certain anti-manic drugs and may require dose adjustments or close monitoring. Kidney Disease Kidney disease can impact the elimination of anti-manic medications, leading to potential drug accumulation and side effects. Close monitoring and dose adjustments may be necessary. Allergies Individuals with known allergies to specific anti-manic medications should avoid those drugs.

33. Health Education and Adherence 1 Medication Information Ensure the patient understands the purpose, dosage, and potential side effects of their medication. 2 Adherence Encourage the patient to take their medication as prescribed, even if they feel well. This helps to prevent relapse and maintain mood stability. 3 Lifestyle Changes Discuss lifestyle modifications, such as regular exercise, a healthy diet, and stress management techniques, which can complement medication and contribute to overall well-being.

34. Importance of Adherence and Lifestyle Changes Adherence to medication regimens is essential for managing bipolar disorder and maintaining long-term stability. Lifestyle changes can also play a vital role in mood management. Exercise Regular physical activity can help improve mood and reduce stress. Stress Management Techniques like mindfulness, yoga, and deep breathing can help reduce stress levels. Healthy Diet Eating a balanced diet can contribute to overall well-being and mood stability.

35. Considerations for Special Populations Elderly Older adults may be more sensitive to the side effects of anti-manic medications and may require lower doses or more frequent monitoring. Pregnancy Anti-manic medication use during pregnancy should be carefully considered due to potential risks to the fetus. Consult a healthcare professional to weigh the benefits and risks.

36. Considerations in Prescribing Anti Manic Drugs There are several factors to consider when prescribing anti manic drugs, including the patient's individual medical history, any other medications they are taking, and their preferences. Medical History Past medical conditions and allergies must be considered. Drug Interactions Potential interactions with other medications are important to note. Individual Response Each person may respond differently to medication.

37. Antimanic drugs are psychotropic drugs that are used to treat symptoms of mania . Though there are different causes of mania, the majority is caused by bipolar disorder therefore, antimanic drugs are mostly like drugs treating bipolar disorder One purpose of antimanic drugs is to alleviate or shorten the duration of an acute mania. Another objective is to prevent further cycles of mania and maintain the improvement achieved during the acute episode. The mechanism of antimanic drugs has not yet been fully known, it is proposed that they mostly affect chemical neurotransmitters in the brain. However, the usage of antimanic drugs should be consulted with a doctor or pharmacist due to their side effects and interactions with other drugs and food Conclusion

38. References a,b  Britannica, T. Editors of Encyclopaedia (2018, December 7).  Antimanic drug. Encyclopedia Britannica .  https://www.britannica.com/science/antimanic-drug ^ a,b,c,d   Jump up to: a   b   c   d  Torrey, E., & Knable , M. (2002).  Surviving manic depression : A manual on bipolar disorder for patients, families, and providers . New York: Basic Books   Malhi, Gin S.; Outhred , Tim (2016). "Therapeutic Mechanisms of Lithium in Bipolar Disorder: Recent Advances and Current Understanding". CNS Drugs.  30  (10): 931–949.  doi : 10.1007/s40263-016-0380-1 .  PMID   27638546 .  S2CID   5241381 .   Schatzberg , A., & Nemeroff , C. (2017). Lithium. In  The American Psychiatric Association Publishing Textbook of Psychopharmacology  (5th ed., p. 889). Arlington, VA: American Psychiatric Association Publishing.   Malhi, Gin S.; Tanious , Michelle; Das, Pritha; Coulston , Carissa M.; Berk, Michael (2013). "Potential Mechanisms of Action of Lithium in Bipolar Disorder". CNS Drugs.  27  (2): 135–153.  doi : 10.1007/s40263-013-0039-0 .  hdl : 11343/218106 .  PMID   23371914 .  S2CID   26907074 .   Gildengers , Ariel G.; Butters, Meryl A.; Aizenstein , Howard J.; Marron, Megan M.; Emanuel, James; Anderson, Stewart J.;  Weissfeld , Lisa A. ; Becker, James T.; Lopez, Oscar L.; Mulsant , Benoit H.; Reynolds, Charles F. (2015).  "Longer lithium exposure is associated with better white matter integrity in older adults with bipolar disorder" . Bipolar Disorders.  17  (3): 248–256.  doi : 10.1111/bdi.12260 .  PMC   4374042 .  PMID   25257942 7.a.b  Jibson , M., Marder, S., & Friedman, M. (2021). Second-generation antipsychotic medications: Pharmacology, administration, and side effects. Retrieved 10 February 2021, from  https://www.uptodate.com/contents/second-generation-antipsychotic-medications-pharmacology-administration-and-side-effects 8.