Main indications for the use of antipsychotics. Is there a cure for schizophrenia? Piperazine derivatives of phenothiazine

Antipsychotics, or antipsychotics, are a group medicines intended for the treatment of psychotic disorders. Medicines of this group of the old generation are characterized by a large number of negative effects. Antipsychotics of the new generation have fewer side effects, but are prescribed mainly by prescription. You can get a prescription at a consultation with a neurologist or psychotherapist.

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Group Description

The first neuroleptic to be used in therapy mental illness, is chlorpromazine. Previously used in treatment medicinal plants- opiates, belladonna, henbane.

Classical antipsychotic drugs are called neuroleptics. Previously, their action was associated with the inevitable manifestation of adverse reactions. With the advent of new generation drugs, a separate subgroup of neuroleptics was identified. They also have some side effects, but they show them much less frequently.

Classification

Antipsychotics are divided according to several parameters. Chemical classification neuroleptics:

• phenothiazine derivatives: Triftazin, Thioridazine;
• thioxanthene: Chlorprothixene;
• butyrophenone: Haloperidol, Droperidol;
• dibenzodiazepine: Clozapine;
• indole: Reserpine, Sulpiride.

The most relevant is the generally accepted classification by generations of antipsychotics, which allows you to choose a drug with the lowest risk for the patient.

The above drugs are used less and less in medical practice, as they have a number of adverse reactions that reduce the quality of life of the patient. New generation drugs do not have such an effect.

New
Active substance	Tradename	Active substance	Tradename
Clozapine	Azaleptin, Azapin, Azaleptol, Leponex	Aripiprazole	Abilify, Arilental, Arip, Ariprazol, Pipzol, Aripradex
Risperidone	Zyris, Ridonex, Rispen, Risperon, Risset, Torendo, Eridon	Azenapine
Olanzapine	Adagio, Zalasta, Zyprexa, Egolanza, Zolafren	Lurasidone
Quetiapine	Gedonin, Kvetiksol, Kvetiron, Kviklein, Ketilept, Seroquel	paliperidone	Invega, Xeplion
Amisulpride	Solex, Solian, Soleron	Sertindol	Serdolect
ziprasidone		Iloperidone

According to the degree of binding to receptors, atypical and typical antipsychotics are distinguished. Atypical ones differ in that they have an affinity not only for dopamine, but also for other receptors, which makes them easily tolerated and mild drugs.

The atypical ones are:

• Ziprasidone.
• Olanzapine.
• Paliperidone.
• Risperidone.
• Quetiapine.
• Azenapine.
• Iloperidone.
• Clozapine.
• Sertindole.

Popular typical antipsychotics:

• Haloperidol.
• Fluphenazine.

It is advisable to consider the effectiveness and mechanism of action on the body for drugs of the old and new generation separately.



Antipsychotics of the old generation




Produced mainly in the form of solutions for injection, some of the drugs - in tablets and capsules. Released strictly according to the prescription, which is confiscated in the pharmacy. For the next purchase of the drug, you must again contact your doctor to obtain a prescription.



Mechanism of action

They show a pronounced antipsychotic effect, blocking the central dopamine receptors in the limbic and mesocortical structures of the brain. Blocking these hypothalamic receptors leads to galactorrhea as a result of increased prolactin production, as well as an antipyretic effect.

Antiemetic properties are due to the inhibition of dopamine receptors in the vomiting center. Interaction with the structures of the extrapyramidal system leads to inevitable extrapyramidal disorders. Antipsychotics of the old generation combine antipsychotic activity and a moderate sedative effect. Slightly block alpha-adrenergic receptors of the autonomic nervous system.

Indications for appointment

Indications for the use of older generation antipsychotics are manifestations psychomotor agitation with diseases and conditions such as:

• psychosis in the manic phase;
• dementia;
• oligophrenia;
• psychopathy;
• schizophrenia in acute and chronic forms;
• alcoholism.

The use of antipsychotics is indicated for hallucinations of various origins, paranoid states and acute psychoses. As part of complex therapy neuroleptics are used for agitation, aggressiveness, behavioral disorders, Gilles de la Tourette syndrome, stuttering. Previously, they were actively used to treat persistent vomiting or hiccups.

Adverse reactions

The following list is typical for the entire list of old generation drugs. The severity and frequency of side effects depends on the dosage regimen and the active substance:

Organ System/Frequency
	-	Tremor, rigidity, excessive salivation, dystonia, restlessness, slowness of movement	confusion, epileptic seizures, depression, drowsiness, agitation, insomnia, headaches
	Nausea, loss of appetite, constipation, digestive disorders	-	-
Endocrine	Prolactinemia, galactorrhea, gynecomastia, amenorrhea	Syndrome of inappropriate vasopressin secretion	Erectile dysfunction, ejaculation
Cardiovascular	Tachycardia, hypotension	hypertension	Ventricular fibrillation and tachycardia, cardiac arrest
Autonomic nervous	Dry mouth, excessive sweating	Blurred vision	urinary retention
Skin covering	-	Edema, skin rashes, urticaria	Dermatitis, erythema multiforme
	-	Jaundice, hepatitis, reversible liver dysfunction	Temperature disturbances, granulocytosis, thrombocytopenia, reversible leukopenia

Cases of sudden causeless death of a patient as a result of cardiac arrest are known. The likelihood of side effects increases with increasing dosage, intravenous administration and in patients with hypersensitivity. The risk also increases for the elderly.

With prolonged treatment or after discontinuation of drugs, symptoms of tardive dyskinesia, such as rhythmic involuntary movements of the tongue, mouth, jaw and face, may develop. The syndrome can manifest itself with increasing doses, switching to other antipsychotics. The use of an antipsychotic in these conditions should be immediately discontinued.

Antipsychotics in this group are associated with neuroleptic malignant syndrome, life-threatening. It is characterized by hyperthermia, imbalance, impaired consciousness, coma.

Symptoms such as tachycardia, high blood pressure, and sweating are early warning signs and herald a hyperthermia attack.

Treatment with neuroleptics should be stopped immediately and seek medical advice. medical care. Antipsychotics of the old generation can also cause subjective feelings of mental dullness and lethargy, paradoxical phenomena of enthusiasm and insomnia.

Contraindications

All representatives of the old generation of antipsychotics are contraindicated in following states and diseases:

• hypersensitivity to the components in the composition;
• diseases of cardio-vascular system;
• liver dysfunction;
• pathology of the urinary system;
• violations of hormonal regulation;
• pathologies of the nervous system with pyramidal and extrapyramidal disorders;
• depression, coma.

Contraindicated in children under 18 years of age and women during childbearing and breastfeeding.

New generation antipsychotics




Drugs representing this group exhibit similar activity and are no less effective. The frequency of side effects is lower, although the list of possible disorders varies from drug to drug.

Pharmacological properties

The mechanism of action is to bind to serotonin and dopamine receptors, adrenoreceptors. Lower affinity for histamine receptors.

One of the main differences from the old generation is that new drugs do not cause a decrease in motor activity, showing the same effectiveness in the symptoms of schizophrenia.

Balanced antagonism to dopamine and serotonin reduces the risk of extrapyramidal side effects, increases healing effect medications for the affective and negative symptoms of schizophrenia and other psychiatric disorders.

The drugs differ in the speed of reaching maximum concentrations. They are achieved in plasma within the first hour of oral administration for most representatives of the new generation of antipsychotics.

Indications for use

Antipsychotics of the new generation are indicated for the treatment of patients with such diseases and conditions:

• acute and chronic schizophrenia;
• productive and negative symptoms of schizophrenia: hallucinations, thought disorders, suspicion, alienation, inhibition of emotions;
• affective disorders in schizophrenia: depression, anxiety, fear;
• various behavioral disorders in patients with dementia;
• outbursts of anger, physical violence, agitation;
• psychotic symptoms.

New generation drugs have a wide spectrum of action with the right choice of dosage and medicinal product. Since neuroleptics of this group have a wide spectrum therapeutic effect, they are used in complex treatment many mental illnesses.

Contraindications

Often, the only contraindication to the use of new generation antipsychotics is known individual hypersensitivity to the active substance or auxiliary components. Most modern antipsychotics are approved for use in children and adolescents under the supervision of a physician, and have been successfully used to treat schizophrenia and aggressiveness in adolescence and childhood.

Certain drugs, such as those based on clozapine, are contraindicated in diseases of the cardiovascular system, as well as in patients with a change in blood counts in the history of the disease. Clozapine, olanzapine and risperidone preparations are prohibited for children.

During pregnancy, representatives of the new generation of antipsychotics are prescribed only under the supervision of the attending physician and, if absolutely necessary, in a hospital.

Side effects

List unwanted effects, which cause neuroleptics of the new sample, is the same for most of them. The severity of manifestations depends on the dosage regimen and the sensitivity of the patient, the response of his body to therapy.

Organ System/Frequency
Hematopoietic system		-	Granulocytopenia, thrombocytopenia, agranulocytosis, purpura, neutropenia
immune	-	Hypersensitivity, allergic reactions	Facial edema, laryngotracheal edema
Metabolism	Increase or decrease in appetite, weight loss	Polydipsia, anorexia, water intoxication	Diabetes mellitus, ketoacidosis, elevated blood cholesterol levels
	Insomnia, lethargy, nervousness	Confusion, sleep disorders, decreased libido	Anorgasmia, depression, mania, affective state
	Drowsiness, dizziness, sedation, tremor, dystonia, speech disorders, restless leg syndrome	Dizziness, lethargy, salivation, balance and attention disorders, myotonia, facial spasm	Malignant neuroleptic syndrome, depressive level of consciousness, inhibition of reactions
organs of vision and hearing	Blurred vision, swelling of the eyelids, swelling of the eyes	Crusting at the edge of the eyelids, lacrimation, decreased visual acuity, itchy eyes	Eye discharge, blurred vision, dry eyes, pain and ringing in the ears
Cardiovascular	Palpitations, hypotension, bradycardia, tachycardia	Blockade of branches of the bundle of His, ECG change	Thromboembolism, deep vein thrombosis, hot flashes, hyperemia
Respiratory	Nasal congestion, nosebleeds, shortness of breath	Pulmonary congestion, wheezing, dysphonia, cough	Moist rales, hyperventilation, wheezing, lung congestion
digestive tract	Nausea, vomiting, constipation, diarrhea, excessive saliva secretion	Pain in the stomach, swelling of the lips	Intestinal obstruction, toothache, fecal incontinence
Skin covering	Dry skin	Seborrhea, itching, rash	Acne, papules and eczema, baldness
Musculoskeletal	Pain in the back, ridge, arthralgia	Pain in the limbs	Pain in the neck and chest
urinary	-	Incontinence or urinary retention	Polyuria, edema
reproductive	-	Menstrual disorders, ejaculation and erection disorders, priapism	Orgasm disorders
General disorders	Fatigue, gait disturbance, facial swelling, thirst	Decrease in body temperature	Decrease in hemoglobin, increase in the concentration of glucose and hepatic transaminases in the blood

If any adverse reactions are detected, you should immediately seek medical help and stop taking the neuroleptic before consulting your doctor. The specialist will cancel the drug if necessary or adjust the dosage.

Conclusion

Antipsychotics are an extensive group of drugs represented by several generations. In recent years, preference has been given to a more modern group atypical antipsychotics thanks to their safety. However, the choice of the drug and its dosing regimen is left to the attending physician, and if necessary, he can prescribe a drug that represents the old generation of antipsychotics.

One of the drugs used in psychiatry are neuroleptics. These funds are prescribed to people who have mental, psychological, neurological disorders. Such diseases are accompanied by aggression, phobia, hallucinations. Clearly, the manifestation of schizophrenia can be viewed from the archives of clinics.

Is there a cure for schizophrenia

To identify symptoms in schizophrenics, there are psychological tests. The most popular is the Luscher test, which is presented as a color table. In the process of choosing certain colors, a certain picture is drawn up and a competent specialist is able to reliably decipher it.

The main action of sedative neuroleptics is to remove the reaction to stimuli, neutralize:

• hallucinations;
• Sense of anxiety;
• aggression;
• paranoia;
• An unreasonable state of anxiety.

A large group of these drugs are divided into sedatives and antipsychomatics. Antipsychotics are used primarily to treat schizophrenia. Such drugs reduce psychotic. Antipsychotics are also divided into typical and atypical types.

Typical are antipsychotics with a powerful therapeutic effect.

They have a good antipsychotic effect. The list of side effects in the elderly is negligible or non-existent.

How to cure schizophrenia

Schizophrenia - chronic illness leading to personality disorder. People aged 16-25 can get sick with schizophrenia. Occasionally, the disease manifested itself in children as young as 5 years of age and in people over 45 years of age.

The progressive stage of schizophrenia is characterized by:

• Associative behavior;
• auditory hallucinations;
• References;
• Closure in yourself.

As a rule, patients with schizophrenia are not prone to aggression. Only the use of psycho can stimulate the manifestation of violence. active substances(alcohol, drugs). Schizophrenia can be caused by acute stress. But this is not the only case of the disease. Any disease of the body can provoke its development.

Therefore, schizophrenia is treated by managing the symptoms.

There is no single answer to the question of whether schizophrenia can be cured completely and forever. Many scientists are fighting for the answer that the disease is curable. But there is certainty that modern methods make it possible to maintain the quality of life. Research into schizophrenia a large number of clinics in Moscow, Novosibirsk, Rostov-on-Don and other cities.

Fundamentals of Schizophrenia Treatment

Every year, new generation drugs appear in the arsenal of doctors. The main part of therapy is the selection of medications. Drugs such as nootropics are used to stimulate the brain, increase cognitive abilities. Below is a list of neuropleeptics recommended by leading experts.

Feedback on them is also positive.

1. Azaleptin. Clozapine is the active ingredient. Does not develop catalepsy, oppression of behavior. In clinical conditions, Azaleptin has a rapid sedative effect. The medicine is well tolerated by patients. The cost is about 200 rubles.
2. galloper- antipsychotic, neuroleptic, antiemetic. Use with extreme caution in patients with cardiovascular pathology, a predisposition to glaucoma, functional disorders liver, and who have epileptic seizures. The price, depending on the form of release, varies from 50 to 300 rubles.
3. Zyprexa zidis round tablets, yellow. A drug that affects a number of receptor systems. Price from 4000 rubles.
4. Clopixol-Akufaz- injection. Is used for initial stage treatment of acute mental, chronic psychosis (exacerbation). The cost of the drug is 2000–2300 rubles.
5. Senorm- drops for oral administration. The active substance is haloperidol. The cost is about 300 rubles.
6. Propazine- tablets, coated with a blue color with splashes and marbling. It has less pronounced side effects. The price is about 150 rubles.
7. Triftazin, solution in ampoules 0.2%. The active substance is trifluoperazine. Blocks dopamine receptors in different brain structures. Compatible with other antipsychotics, tranquilizers and antidepressants. The cost of 10 pieces in a package is 50-100 rubles.
8. Chlorprothixene 50 . Analgesic, antidepressant, antipsychotic, antiemetic, sedative. The average price is 350 rubles.

Schizophrenia is accompanied by a mood disorder. To bring the patient out of this state, normotimics are used. Unlike neuroleptics prescribed for mania, normothymic drugs are used for bipolar affective disorder.

Can schizophrenia be cured?

Has not lost its significance for thirty years domestic drug Phenazepam. This is due to the effectiveness of its properties, which are better realized depending on the dose used and the treatment with hypnosis. There is such a method of treatment as cytokine therapy. Cytokines are protein molecules that carry signals from one cell to another, thereby ensuring the coherence of the actions of the immune system, the processes of restoration of various organs, including the brain.

Together with medications, psychological therapy is prescribed. In this case, the doctor selects an approach to the patient on psychological level, conducts treatment by communication.

It is important to involve family in the process of healing the patient. Such treatment makes it possible to induce certain behaviors in the patient, which will help determine probable causes illness. With the help of cognitive-behavioral psychotherapy, the patient is aware of the symptoms of the disease and strengthens control over them. Most patients can lead a productive life. For such people, occupational therapy programs have been created that act as a recovery for the sick.

Gives a relaxing effect tincture of:

• Chamomile;
• Flowers of prickly hawthorn;
• corollas of motherwort;
• Dried herbs.

Treatment folk remedies It may seem impossible, but there are ways. In the fight against schizophrenia, viburnum bark helps. Don't forget about physical exercises. Running can help you get rid of obsessions hallucinations.

List of non-prescription antipsychotic drugs

In some cases, with the possible development of serious complications, insulin shock therapy is used. essence this method- placing the patient in a coma. Modern supporters of insulin-comatose therapy recommend its forced course, which includes approximately 20 com. First of all, schizophrenia is treated with antipsychotics. Finding such drugs that are dispensed without a doctor's prescription is quite difficult.

But still, there is a small list:

• Etaperazine;
• paliperidone;
• Chlorprothixene.

Etaperzine - available in the form of tablets, has an inhibitory effect on the nervous system. The average cost of the drug is 350 rubles. Paliperidone is effective in the treatment of schizophrenia, schizoaffective disorder, and bipolar disorder. Price from 13 thousand rubles. Chlorprothixene - the drug has a pronounced antipsychotic and sedative effect, enhances the effect of hypnotics and analgesics. The average cost is 200 rubles.

Attack of schizophrenia (video)

In conclusion, it is worth noting that neuroleptics are aimed at suppressing these manifestations. Atypical antipsychotics are a fairly new group of drugs, their effectiveness is not much different from typical ones.

Reserpine
The very first of the neuroleptics was the Rauwolfia alkaloid (Rauwolfia serpentina Benth) reserpine. Rauwolfia is a perennial shrub of the kutrov family (Apocynaceae), grows in South and Southeast Asia (India, Sri Lanka, Java, the Malay Peninsula). Botanical description plants made in the XVI century. German doctor Leonhard Rauwolf. Extracts from the roots and leaves of the plant have long been used in Indian folk medicine. The plant, especially the roots, contains a large amount of alkaloids (reserpine, rescinamine, aimaline, rauwolfine, serpin, serpagin, yohimbine, etc.).
Rauwolfia alkaloids have valuable pharmacological properties. Some of them, especially reserpine and to a lesser extent rescinamine, have a sedative and hypotensive action, others (aymalicin, rauwolfine, serpagin, yohimbine) - adrenolytic. Aymalin renders antiarrhythmic action. Currently, due to relatively low antipsychotic activity and severe side effects, it has given way to more effective modern drugs, but retained its value as an antihypertensive agent.

The main effects of neuroleptics
Antipsychotics have a multifaceted effect on the body. One of their main pharmacological features is a kind of calming effect, accompanied by a decrease in reactions to external stimuli, a weakening of psychomotor arousal and affective tension, suppression of fear, and a decrease in aggressiveness. Their main feature is the ability to suppress delusions, hallucinations, other psychopathological syndromes and have a therapeutic effect in patients with schizophrenia and other mental and psychosomatic diseases.
A number of neuroleptics (phenothiazine and butyrophenone groups) have antiemetic activity; this effect is associated with selective inhibition of chemoreceptor starting (trigger) zones medulla oblongata.
There are neuroleptics, the antipsychotic effect of which is accompanied by a sedative (tizercin, chlorpromazine, propazine, azaleptin, chlorprothixen, sonapax) or an activating (energizing) effect (haloperidol, eglonil, rispolept, stelazin, etaperazine).
Some antipsychotics have elements of antidepressant and normothymic action (chlorprothixene, eglonil, moditen-depot).
These and other pharmacological properties of various neuroleptic drugs are expressed in varying degrees. The combination of these and other properties with the main antipsychotic effect determines the profile of their action and indications for use.

The mechanism of action of neuroleptics
AT physiological mechanisms The central action of neuroleptics is essential for their inhibitory effect on the reticular formation of the brain. Their various effects are also associated with the impact on the occurrence and conduction of excitation in different parts of the central and peripheral nervous system. Of the neurochemical mechanisms of action of neuroleptics, their influence on mediator processes in the brain is the most studied. Currently, a lot of data has been accumulated on the effect of antipsychotics (and other psychotropic drugs) on adrenergic, dopaminergic, serotonergic, GABAergic, cholinergic and other neurotransmitter processes, including the effect on the neuropeptide systems of the brain. Recently, much attention has been paid to the interaction of neuroleptics with dopamine brain structures.
Not only the antipsychotic activity of neuroleptics, but also the main side effect they cause is largely associated with the inhibition of the mediator activity of dopamine. neuroleptic syndrome”, Manifested by extrapyramidal disorders, including early dyskinesia - involuntary muscle contractions, akathisia (restlessness), motor restlessness, parkinsonism(muscle stiffness, tremor), fever. This action is explained by the blocking effect of neuroleptics on the subcortical formations of the brain (substance black and striatum, tuberous, interlimbic and mesocortical regions), where a significant number of dopamine-sensitive receptors are localized. Of the most well-known antipsychotics, noradrenergic receptors are most strongly influenced by chlorpromazine, levomepromazine, thioridazine, for dopaminergic - fluorophenazine, haloperidol, sulpiride.
In all cases of manifestation of specific side effects, a change in the treatment used, the appointment of correctors (nootropics, cyclodol, akineton) are indicated. Usually extrapyramidal correctors side effects(cyclodol, akineton) are always prescribed together with the intake of neuroleptics.
One of the neuroleptics with a pronounced antipsychotic activity, which practically does not cause extrapyramidal side effects and is even able to stop it, is the drug azaleptin, a derivative of piperazinodibenzodiazepine.

Pharmacodynamics of neuroleptics
The influence on central dopamine receptors explains the mechanism of some endocrine disorders caused by neuroleptics, including the stimulation of lactation. By blocking the dopamine receptors of the pituitary gland, antipsychotics increase the secretion of prolactin. Acting on the hypothalamus, neuroleptics also inhibit the secretion of corticotropin and growth hormone.
Most neuroleptics have a relatively short half-life in the body and have a short effect after a single administration. Special drugs of prolonged action have been created (moditen-depot, haloperidol decanoate, clopixol-depot, pyroportyl L4), which have a longer effect.
In the treatment of psychosomatic disorders, eglonil, teralen, frenolon, sonapax, chlorprothixene, and etaperazine are widely used (see below). Drugs, as a rule, are prescribed in small and medium therapeutic dosages. Often, a combination of antipsychotics is used with each other, when in the first half of the day a stimulating antipsychotic (eglonil, frenolon) is given, and in the second - a sedative antipsychotic (chlorprothixen, azaleptin, tizercin).

Indications for the appointment of neuroleptics
Antipsychotics are indicated primarily in the treatment of nosogenic paranoid reactions (delusion of "assigned disease", sensitive reactions), as well as in the treatment of chronic somatoform pain disorder (persistent monomorphic pathological bodily sensations - idiopathic algia).

Rules for prescribing antipsychotics
At the beginning of treatment, more often inpatient, doses of neuroleptic drugs are usually rapidly increased to a certain effective value, which subsequently gradually decreases by 3-5 times, and treatment with neuroleptics becomes supportive, anti-relapse. The tactics of changing dosages is determined strictly individually. Most often, treatment begins with the appointment of an average therapeutic dosage, then, evaluating the effect, the issue of the need to change the dosage is decided. The transition to maintenance doses is carried out after the desired therapeutic effect is achieved.
Supportive (anti-relapse) treatment is best done with long-acting drugs. Of great importance is the choice of the method of administration of the neuroleptic: at the beginning of treatment, it is preferable parenteral administration, which contributes to a more rapid relief of symptoms (intravenous drip, intravenous jet, intramuscular), then they switch to oral intake drugs or to the aforementioned long-acting drugs. With untimely cancellation of treatment, the possibility of recurrence of the disease increases significantly.

Propazine
Propazine by pharmacological properties close to chlorpromazine. Has a sedative effect, reduces motor activity and anxiety. Unlike chlorpromazine, it is less toxic, its local irritating effect is less pronounced, and allergic reactions occur less frequently. Propazine can be used for borderline disorders in patients with somatic pathology in the presence of anxiety, phobic disorders, obsessions, overvalued ideas (in particular, of a hypochondriacal nature). Inside is given in the form of tablets of 25 mg 2-3 times a day, if necessary, the dose can be increased to 100-150 mg per day. The phenomena of parkinsonism when using small doses, as a rule, do not develop, if they do appear, it is necessary to prescribe correctors (cyclodol 2 mg 3 times a day).

Etaperazine
Etaperazine combines an antipsychotic effect with an activating effect and a selective effect on syndromes characterized by lethargy, lethargy, apathy, in particular in atypical depressive states. In addition, etaperazine can be used for neuroses accompanied by fear, tension, and anxiety.
Such conditions are found in the clinic of borderline disorders in somatic diseases, as well as in the presence of somatoform disorders. With the development of pruritus of neurotic origin, etaperazine has a sufficient effect and is used primarily. Etaperazine is better tolerated than chlorpromazine: lethargy, drowsiness, and lethargy are less pronounced. It is used for borderline mental disorders in somatic patients in dosages up to 20 mg per day, correctors are prescribed if necessary.

Triftazin
Triftazin (stelazin) has a noticeable anti-delusional effect, stops hallucinatory disorders. The neuroleptic effect is combined with a moderate stimulating (energizing) effect. It can be used to treat atypical depressive states with obsessive phenomena, with somatoform disorders in combination with tranquilizers and antidepressants. Dosages of the drug usually do not exceed 20-25 mg per day.

Teralen
Teralen (alimemazine) has antipsychotic and antihistamine activity. Compared with chlorpromazine, it has a less pronounced adrenoblocking effect, has a weak anticholinergic activity, which causes a vegetostabilizing effect. Acts as a mild sedative positive effect with senestopathic-hypochondriac symptoms of the borderline register, with psychosomatic manifestations developing against the background of vascular, somatogenic, infectious manifestations, with neurovegetative disorders. Finds wide application in pediatric and gerontological practice, as well as in somatic medicine. Recommended for allergic diseases, especially upper respiratory tract, and at skin itching. It is prescribed orally at 10-40 mg per day; it is administered intramuscularly in the form of a 0.5% solution, drops of a 4% solution are also used (1 drop = 1 mg of the drug).

Thioridazine
Thioridazine (melleril, sonapax) combines an antipsychotic effect with a calming effect without pronounced lethargy and lethargy, there is a moderate thymoleptic effect. Most effective at emotional disorders accompanied by fear, tension, excitement. For the treatment of borderline conditions, including somatic patients, it is used at a dose of 40-100 mg per day. At small doses, an activating and antidepressant effect is manifested. With neurasthenia, increased irritability, anxiety, neurogenic functional gastrointestinal and cardiovascular disorders, 5-10-25 mg are prescribed 2-3 times a day. In cases of premenstrual nervous disorder - 25 mg 1-2 times a day.

Chlorprothixene
Chlorprothixene (Truxal) has a sedative and antipsychotic effect, enhances the effect sleeping pills. The neuroleptic effect is combined with antidepressant. It is used in psychoneurotic conditions in the presence of anxiety, fears. The drug is indicated in the treatment of neurosis, including against the background of various somatic diseases, sleep disorders, skin itching, hypochondriacal subdepressive states. In such cases, the dosage of the drug is 5-10-15 mg 3-4 times a day after meals. Extrapyramidal disorders rarely develop. Does not cause the development of drug dependence, therefore, when psychosomatic disorders can be applied over a long period of time.

Fluanxol
Fluanxol (flupentixol) has an antidepressant, activating, anxiolytic effect. In dosages from 0.5 mg per day to 3 mg per day, it is used for apathetic, asthenic depressive states, with manifestations of anxiety; in this regard, according to recent data, it is preferable to relanium. It is used for psychosomatic disorders with asthenia, subdepression, hypochondriacal manifestations. In dosages up to 3 mg per day, side effects are extremely rare. Fluanxol does not lead to daytime sleepiness and does not impair attention, it can be used in drops.

Eglonil
Eglonil (sulpiride) is characterized as a drug with a regulatory effect on the central nervous system, in which moderate antipsychotic activity is combined with some antidepressant and stimulant effects. It is used in conditions accompanied by lethargy, lethargy, anergy. It is used in patients with somatized, somatoform disorders in the presence of a subdepressive mood background, with treatment of coronary artery disease and skin diseases accompanied by itching. In particular, its use is shown in patients with latent forms of depression, in the structure of which complaints of discomfort in the gastrointestinal sphere predominate, with senestopathic disorders, hypochondriacal personality development in somatic patients.
Its use is also shown in depression with a pronounced cephalgic syndrome, in the presence of sensations of dizziness, migraine headaches. Eglonil also has a "cytoprotective" effect on the gastric mucosa, and therefore it is used for gastritis, gastric ulcer and duodenal ulcer, irritable bowel syndrome, Crohn's disease and "disease of the operated stomach." Usually administered orally at 50 mg, starting with 50-100 mg per day; if necessary, the daily dose is increased to 150-200 mg. The drug is usually well tolerated, but there may be extrapyramidal disorders that require correction, cases of galactorrhea, gynecomastia are described. May be combined with sedative antidepressants.

Neuroleptic (in translation means "neuro" - the nervous system and "leptikos" - able to take) these are antipsychotics that forcibly inhibit the human nervous system and take the leadership of the higher nervous activity man into your own hands.

These medicines are used in the treatment of mentally ill people, to whom, suffering vegetovascular dystonia, have nothing to do with it. That's why VSD treatment neuroleptics should not have the right to exist. Let's look at these drugs in more detail.

The mechanism of action of neuroleptics

As with all psychotropic drugs, exactly where and how neuroleptics act is still unknown. There are only assumptions. According to them, the action of neuroleptics is associated with direct interference in the exchange of biologically active substances in the central nervous system, namely in the brain. They reduce the transmission of nerve impulses to different departments brain, where it is carried out with the help of a substance such as dopamine.

In addition to the necessary impact on the areas of the brain responsible for the onset of psychosis (the limbic system), various areas of the brain and connections of nerve cells with normal activity fall under their action. This is the extrapyramidal system, hypothalamus, pituitary gland. At the same time, their activity is significantly reduced, which leads to a huge list of serious disorders in the body. Violation of the work of dopamine receptors (nerve connections sensitive to dopamine) in the mesocortical system ( middle part cerebral cortex) leads to cognitive dysfunction (cognitive means the mental work of the brain, and dysfunction is a violation normal operation). Simply put, a person turns into a simple, thoughtless and insensitive vegetable. In addition to dopamine receptors, antipsychotics block receptors sensitive to adrenaline, acetylcholine and serotonin.

Antipsychotics classification

The neuroleptics are classified according to chemical composition, according to clinical properties, according to the predominance of a certain type of action. But all these classifications are very conditional, because the effect of the drug depends on many conditions, including individual characteristics each person. I will not give this whole scheme here, especially since it is huge, does not carry any useful information common man and is constantly changing. And scientists do not stop arguing about it to this day.

One pattern has been noticed - the higher the antipsychotic effect, the stronger the side effect of the drug. Based on this, there is a division of antipsychotics into two groups: typical and atypical.

Typical antipsychotics.

Broad spectrum drugs. They affect everything possible structures the brain, in which dopamine, adrenaline, acetylcholine and serotonin are used as a neurotransmitter (a substance for transmitting a nerve impulse). This breadth of influence creates great amount side effects. This group include two subgroups:

1. With a predominance of sedative action.

Cause a pronounced relaxing, sedative, hypnotic and anti-anxiety effect.
List of these drugs:
chlorpromazine (chlorpromazine), sultopride (topral), levomepromazine (tizercin), promazine (propazine), chlorprothixene (truxal), thioridazine (sonapax), neuleptil, frenolon, tizercin.

2. With a predominance of antipsychotic action.

These include drugs:
haloperidol, trifluoperazine (triftazine), droperidol, etaperazine, zuclopenthixol (clopixol), flupentixol (fluanxol), mazheptil, clopixol, chlorprothixene, pyrortil, moditen depot.

Atypical antipsychotics.

These drugs act less on dopamine receptors and more on serotonin receptors. Therefore, they have a less pronounced antipsychotic effect, and more soothing and anti-anxiety. They have less effect on the entire functioning of the brain, as drugs related to typical antipsychotics do.
Over the past decade, completely new neuroleptics of this second group have been invented and registered. Research in this area is ongoing, but drugs are put on the market without a full analysis, which used to be carried out for 5-7 years. Today, this period has been reduced to 1 year.
These are the following drugs:
Quetiapine (Seroquel), Clozapine (Azaleptin, Leponex), Olanzapine (Zyprexa), Risperidone (Rispolept, Risset, Speridan, Torendo), Paliperidone (Invega), Sertindole (Serdolect), Ziprasidone (Zeldox), Aripiprazole (Abilify), Amisulpride ( Solian), sulpiride (eglonil).

The side effect of this group is less than that of typical antipsychotics, but also serious. This is a violation of the release of important hormones, a change in the blood formula, toxic effect on the liver, weight gain, drowsiness, headache. In general, they cause less extrapyramidal and autonomic disorders.

I want to say that a very sharp difference in the predominance of one of its actions has a small amount of neuroleptics. This is the reason why different authors refer to the same drugs different groups. But I think that the information on the classification of neuroleptics is sufficient for the VSDshnik. The main thing is to know which group of psychotropic drugs the drug prescribed for you belongs to and how it can threaten your health.

Side effects of neuroleptics.

Based on the mechanism of action, their ability to block a huge number of nerve receptors, side effects neuroleptics are very complex and diverse.

They call:

Neuroleptic syndrome - extrapyramidal disorders of the type of hypo- (decrease) or hyper- (increase) motor functions skeletal muscles;

Drug dystonia (involuntary contraction and relaxation of muscles);

Medicinal parkinsonism (trembling of hands and head), violation of facial expressions;

Akathisia (to calm down, a person feels the need to constantly move);

Cognitive dysfunction - a violation of the mental activity of the brain, a decrease in intelligence;

Malignant neuroleptic syndrome (NMS) - after treatment with neuroleptics occurs kidney failure, muscle stiffness, fever body, which can lead to death;

Disorder of the autonomic nervous system (drop in blood pressure, tachycardia, decrease in body temperature, disruption of the stomach and intestines);

retention of urine;

Violation of the production of hormones in the pituitary gland (this organ is considered the most important hormonal regulator in the body);

Disorders of sexual function, both in men and women;

Damage to the tissues of the liver and kidneys, and some drugs hit these organs very hard;

visual impairment;

Violation of the blood formula;

Increased risk of oncological diseases;

Violation of the development of the fetus during pregnancy.

As a result of their influence on fat metabolism, the risk of myocardial infarction, stroke, cardiovascular diseases, pneumonia and diabetes. This risk increases with simultaneous reception typical and atypical antipsychotics. Antipsychotics also contribute to weight gain, and a violation of the production of the hormone prolactin causes an increase in the mammary glands. Latest Research suggest that the risk of developing diabetes mellitus is more likely with the use of new atypical antipsychotics.
Special care should be taken when prescribing neuroleptics to children. With long-term treatment of children with neuroleptics, the development and intensification of mental illness is possible.

The neuroleptic is special drug, which is used for various mental disorders. As a rule, such drugs are used to treat neurotic syndromes, psychoses, and the medication can also be used for hallucinations. In addition, antipsychotic drugs are prescribed to prevent the main manifestations of a person's mental illness.

The main effects of the considered drugs

The effects of neuroleptics are multifaceted. Main pharmacological feature- a kind of calming effect, which is characterized by a decrease in response to external stimuli, a weakening of affective tension and psychomotor arousal, suppression of fear, and a decrease in aggressiveness. Antipsychotic drugs can suppress hallucinations, delusions, and other psychopathological symptoms, render therapeutic effect in patients suffering from schizophrenia and other psychosomatic ailments.

Certain drugs of this group have antiemetic activity, this effect of neuroleptics is achieved due to selective inhibition of chemoreceptor trigger (trigger) areas of the medulla oblongata. Some neuroleptics can have a sedative or activating (energizing) effect. A number of these funds are characterized by elements of normothymic and antidepressant action.

The pharmacological properties of various antipsychotic drugs are expressed to varying degrees. The combination of the main antipsychotic effect and other properties determines the profile of their impact and indications for use.

How do neuroleptics work?

Antipsychotics are drugs that depress the brain. The action of these drugs is also associated with the influence on the occurrence and conduction of excitation in various parts of the central and peripheral nervous system. Today, the most studied effect of neuroleptics is the effect on mediator processes in the brain. Scientists have accumulated enough data on the effects of these drugs on adrenergic, serotonergic, dopaminergic, cholinergic, GABAergic and other neurotransmitter processes, which include the effect on the neuropeptide systems of the brain. Particularly much attention has recently been paid to the process of interaction between dopamine brain structures and neuroleptics. When the mediator activity of dopamine is inhibited, the main side effect of these drugs manifests itself, the so-called neuroleptic syndrome develops, which is characterized by extrapyramidal disorders, for example, such as involuntary muscle contraction, akathisia (restlessness), parkinsonism (tremor, muscle stiffness), motor restlessness, fever . This effect is achieved due to the blocking effect of neuroleptics on the subcortical formations of the brain, where a large number of receptors that are sensitive to dopamine are localized.

The manifested side effects of neuroleptics are a reason for correcting treatment and prescribing special correctors (drugs "Akineton", "Cyclodol").

Pharmacodynamics

An antipsychotic is a drug that, by acting on central dopamine receptors, provokes some endocrine disorders, including under their influence, lactation is stimulated. When neuroleptics block the dopamine receptors of the pituitary gland, the secretion of prolactin increases. By acting on the hypothalamus, these drugs prevent the secretion of growth hormone and corticotropin.

Antipsychotics are drugs that have a relatively short half-life in the body and after a single administration they have a short effect. Scientists have created special preparations with a longer action (Moditen-Depot, Geloperidol Decanoate, Piportil L4, Clopixol-Depot). Often neuroleptics are combined with each other: in the first half of the day they take a stimulating drug, in the second - a sedative. In order to stop the affective-delusional syndrome, it is recommended to take antidepressants and antipsychotics in combination.

Indications for use

Antipsychotics are prescribed primarily for the treatment of nosogenic paranoid reactions (sensitive reactions) and in chronic somatoform pain disorder.

Rules for prescribing these drugs

Treatment with neuroleptics begins with the appointment of an average therapeutic dose, then evaluate the effect and decide on the need to change the dose. The dosage of antipsychotics is quickly increased to a certain value, which is subsequently gradually reduced by 3-5 times, and the therapy becomes anti-relapse, supportive. Change the prescribed amount of the drug strictly on an individual basis. Maintenance doses are switched after the desired therapeutic effect is achieved. It is more expedient to carry out anti-relapse therapy with drugs that have a prolonged action. The method of administration of psychotropic drugs has great importance. At the initial stage of treatment, parenteral administration is recommended, in which the relief of symptoms occurs faster (intravenous jet, intravenous drip, intramuscular). Further, it is preferable to take antipsychotics orally. A list of the most effective drugs will be given below.

The drug "Propazine"

This tool has a sedative effect, reduces anxiety and motor activity. The drug is used for borderline disorders in patients with, if there are anxiety, phobic disorders, obsession. Take the medicine inside 2-3 times a day, 25 mg, if necessary - the dose can be increased to 100-150 mg per day. When using small doses, the development of manifestations of parkinsonism, as a rule, is not observed.

The drug "Etaperazine"

The drug has an antipsychotic activating effect and affects syndromes that are characterized by lethargy, lethargy, apathy. In addition, the drug "Etaperazine" is used to treat neurosis, accompanied by tension, fear, anxiety. The daily dose of the drug is 20 mg.

Means "Triftazin"

The drug has a noticeable anti-delusional effect, stops hallucinatory disorders. The drug has a moderate stimulating (energizing) effect. It can be used in the treatment of atypical depressive states with an obsession. For the treatment of somatoform disorders, the drug "Triftazin" is combined with antidepressants and tranquilizers. The dosage of the drug is 20-25 mg per day.

The drug "Teralen"

The drug has antihistamine and neuroleptic activity. Teralen is mild sedative and has a positive effect on synestopathic-hypochondriac signs of the borderline register, with psychosomatic symptoms that develop against the background of infectious, somatogenic, vascular manifestations, with neurovegetative pathologies. It is widely used in gerontological practice and pediatrics. Recommended for use in allergic diseases and skin itching. The drug is taken orally at 10-40 mg per day, intramuscularly used in the form of a 0.5% solution.

Means "Tiridazine"

The drug has an antipsychotic effect with a calming effect, without causing lethargy and lethargy. Also, the drug has a moderate thymoleptic effect. The drug shows the greatest effectiveness in emotional disorders, which are characterized by tension, fear, excitement. In the treatment of borderline conditions, 40-100 mg of the drug is used per day. With such phenomena as neurasthenia, irritability, anxiety, neurogenic functional gastrointestinal and cardiovascular disorders take the medicine 2-3 times a day for 5-10-25 mg. With premenstrual nervous breakdown- 1-2 times a day, 25 mg.

The drug "Chlorprothixen"

The drug has an antipsychotic and sedative effect, enhances the effect sleeping pills. A medication is used for psychoneurotic conditions characterized by fears, anxieties. The use of the drug is indicated for neurosis, including against the background of a variety of somatic ailments, in case of sleep disturbance, skin itching, subdepressive states. The dose of the drug is 5-10-15 mg, take the medicine after meals, 3-4 times a day.

The drug "Flyuanksol"

This remedy has an antidepressant, activating, anxiolytic effect. In the treatment of depressive, apathetic conditions take 0.5-3 mg of medication per day. For the treatment of psychosomatic disorders with subdepression, asthenia, hypochondriacal manifestations daily dose is 3 mg. Fluanxol does not cause daytime sleepiness and does not affect attention.

Means "Eglonil"

The drug has a regulatory effect on the central nervous system, has a moderate antipsychotic activity, which is combined with some stimulating and antidepressant effects. It is used in conditions that are characterized by lethargy, lethargy, anergy. It is used in patients with somatoform, somatized disorders on the background of subdepressive mood and in skin ailments accompanied by itching. This medication is especially indicated for use in patients who have a latent form of depression, senestopathic disorders. It is also recommended to use the drug "Eglonil" for depression with pronounced sensations such as dizziness and migraines. The tool also has a cytoprotective effect on the gastric mucosa, so it is used to treat conditions such as gastritis, peptic ulcer duodenum and stomach, irritable bowel syndrome, Crohn's disease. The recommended dose of the drug is 50-100 mg per day, the daily dose, if necessary, can be increased to 150-200 mg. The drug can be taken in combination with sedative antidepressants.

Side effects of neuroleptics

Like any other medication, negative sides neuroleptics also have, reviews of those who used such drugs indicate the possible development of undesirable effects. Long-term or incorrect use of these drugs can cause the following effects:

All movements accelerate, a person moves for no reason in different directions, usually at high speed. Get rid of settle down, find comfortable position possible only after taking psychotropic drugs.

There is a constant movement of the eyeballs, facial muscles and various parts bodies, grimacing.

Due to damage to the muscles of the face, its features change. A “skewed” face may never return to its normal state, it may remain with a person until the end of his life.

Due to intensive care neuroleptics and depression of the nervous system, severe depression develops, which significantly affects the effectiveness of treatment.

An antipsychotic is a drug that has a direct effect on gastrointestinal tract therefore, during treatment with this medication, discomfort in the stomach, dry mouth may be felt.

Such substances that are part of neuroleptics, such as thioxanthene and phenothiazine, negatively affect human vision.

Atypical antipsychotics

These drugs act more on serotonin receptors than dopamine receptors. Therefore, their anti-anxiety and calming effect is more pronounced than antipsychotic. Unlike typical antipsychotics, they affect brain function to a lesser extent.

Consider the main atypical antipsychotics.

Medication "Sulpiride"

This drug is used to treat conditions such as somatization mental disorders, hypochondriacal, senestopathic syndromes. The drug has an activating effect of action.

The drug "Solian"

The action of this remedy is similar to the previous drug. It is used in conditions with hypobulia, apathetic manifestations, with the aim of stopping

Means "Clozapine"

The drug has a pronounced sedative effect, but does not cause depression. The drug is used in the treatment of catatonic and hallucinatory-delusional syndromes.

Means "Olanzalin"

The drug is used for psychotic disorders and catatonic syndrome. At long-term use this medication may cause obesity.

The drug "Risperidone"

This atypical remedy is used most widely. The drug has an elective effect in relation to hallucinatory-delusional symptoms, catatonic symptoms, obsessive-compulsive states.

Means "Rispolept-consta"

This is a long-acting medication that ensures the stabilization of the well-being of patients. Also, the tool shows high efficiency in relation to acute endogenous genesis.

Medication "Quetiapin"

This drug, like other atypical antipsychotics, acts on both dopamine and serotonin receptors. It is used for paranoid, manic excitement. The drug has an antidepressant and moderately pronounced stimulating effect.

The drug "Ziprasidone"

The agent affects dopamine D-2 receptors, 5-HT-2 receptors, and also blocks the reuptake of norepinephrine and serotonin. This determines its effectiveness in the treatment of acute hallucinatory-delusional, as well as affective disorders. The use of the drug is contraindicated in arrhythmia and the presence of pathologies of the cardiovascular system.

Means "Aripiprazole"

The drug is used for all types of psychotic disorders. The drug contributes to the restoration of cognitive functions in the treatment of schizophrenia.

Means "Sertindol"

The drug is used for sluggish-apathetic conditions, the drug improves cognitive functions, has antidepressant activity. Sertindole is used with caution when cardiovascular pathologies- May cause arrhythmias.

The drug "Invega"

The drug prevents exacerbation of catatonic, hallucinatory-delusional, psychotic symptoms in patients with schizophrenia.

Side effects of atypical antipsychotics

The action of drugs such as Clozapine, Olanzapine, Risperidone, Ariprazol is accompanied by the phenomenon of neurolepsy and significant changes endocrine system, which can cause an increase in body weight, the development of bulimia, an increase in the level of certain hormones (prolactin). In the treatment of the drug "Clozapine" agranulocytosis may also occur. Taking Quetiapine often causes drowsiness, headaches, increased levels of hepatic transaminases, and weight gain.

It is worth noting that today scientists have accumulated enough information indicating that the superiority of atypical antipsychotics over typical ones is not so significant. And their reception is prescribed when, with the use of typical antipsychotics, a significant improvement in the patient's condition is not observed.

Antipsychotic withdrawal syndrome

Like any other drug with psychoactive properties, neuroleptic drugs cause strong psychological and physical addiction. Abrupt withdrawal of the drug can provoke the development of severe aggression, depression. The person becomes too impatient, whiny. There may also be signs of a disease for which antipsychotics were used.

From a physiological point of view, the manifestations during the withdrawal of antipsychotics are similar to the symptoms during the withdrawal of drugs: a person is tormented pain in the bones, he suffers from headaches, insomnia. Nausea, diarrhea and other intestinal disorders may develop.

Psychological dependence does not allow a person to refuse to use these means, because he is tormented by the fear of returning to a gloomy, depressive life.

How to stop taking antipsychotics without disturbing the normal state of health? First of all, you should know that it is contraindicated to use antipsychotics without a doctor's prescription. Only experienced specialist able to adequately assess the patient's condition and prescribe necessary treatment. Also, the doctor will give recommendations on reducing the dose of the medication consumed. The dosage of the drug should be reduced gradually, without causing a strong feeling of discomfort. Next, the specialist prescribes antidepressants that will support emotional condition patient and will prevent the development of depression.

An antipsychotic is a medication that allows you to normalize mental condition person. However, in order to avoid the development of side effects, be sure to follow the doctor's recommendations and do not self-medicate. Be healthy!