Introduction to Drug Treatment

Transcription

1 Introduction to Drug Treatment LPT Gondar Mental Health Group

2 Introduction to Psychiatric Drugs Drugs and Neurotransmitters 5 Classes of Psychotropic medications Mechanism of action Clinical indications Main side effects Prescription in special groups

3 Psychiatric treatment Biological treatments Psychological Social treatments - Medication - ECT

4 Break down (COMT or MAOI) MECHANISM OF ACTION Action Potential Cascade reaction Re uptake process (Recycling)

5 5 Classes of psychotropic medications Anti depressants Anxiolytics Mood stabilisers Anti psychotics Others

6 Anti depressants Re-uptake inhibitors Tricyclic - Nor adrenaline and Serotonin Specific serotonin re uptake inhibitors (SSRI) Newer antidepressants NARI SNRI Monoamine oxidase inhibitors

7 Tricyclic antidepressants Three ringed structure (Tricyclic antidepressants) They work by preventing the reuptake of NA/ SEROTONIN/ They also have affinity for α 1, Histamine and cholenergic receptors Side effects Sedation Anticholinergic side effects Cardiac toxicity

8 Examples of Tricyclic antidepressants Imipramine Amitryptiline Clomipramine Dosulepin Lofepramine Nortriptyline

9 SSRI Functional similarity Highly selective for serotonin Safety Side effects - Less sedating - Fewer anti-muscarinic SE - GI disturbance - anorexia and weight loss - Headache - Sexual dysfunction - Agitation

10 SSRI Examples Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline

11 MAO Inhibitors Older non specific/ irreversible cheese reaction Phenelzine (Nardil); Isocarboxazid, Tranylcypromine New selective / reversible Reaction less intense moclobemide

12 Newer anti depressants Serotonin and NA Reuptake Iinhibition Venlafaxine Duloxetine NA Reuptake Inhibition Reboxetine Presynaptic alpha 2 antagonist Mirtazapine

13 Others antidepressants Trazodone Mianserin

14 How long should it be continued? Acute Phase 8-12 weeks Continue for at least six months following recovery Prophylaxis 2 or more episodes in 5 years First line anti depressants Second mood stabilisers

15 Non responders Evaluate the management strategy Use an antidepressant with a different mode of action. Augmentation Lithium Thyroxin

16 Mania Normal mood variation Depression

17 Mood stabilisers Lithium Carbamazepine Sodium valproate Lamotrigine

18 Lithium Narrow therapeutic range (0.4-1 mmols/l) Side effects 1. Common side effects thirst, poly-uria, tremor, sedation, nausea, diarrhoea, weight gain and mild cognitive impairment 2. Signs of intoxication course tremor, severe vomiting, impairment of consciousness.

19 Clinical use Recurrent bipolar mood disorder treatment and prophylaxis. Schizo affective disorder Depression augmentation of antidepressant effect, prophylaxis recurrent depression Behaviour problems personality disorder Learning disability

20 Lithium Monitoring Lithium levels TFT s U and E s (GFR)

21 Antipsychotics Chlorpromazine Haloperidol Flupenthixol Sulpiride/ amisulpiride Clozapine Olanzapine Risperidone Aripiprazole

22 Mechanism of action Dopamine theory Receptor block Side effects Sedation Anti-cholinergic Extra pyramidal Acute dystonia Akathisia Parkinsonism Tardive dyskinesia Neuroleptic malignant syndrome Typical antipsychotic Atypical antipsychotic

23 Atypical anti psychotics Low EPSE Effect on negative symptoms Weight gain increased Incidence of DM and metabolic syndrome increased

24 Anxiety disorders Generalized anxiety disorder Panic disorder Phobia Simple phobia Agoraphobia Social Phobia Obsessive Compulsive Disorder

25 Anxiety First choice Psychological methods Drugs - Anti depressants - Benzodiazepines only for short term use Treatment of acute anxiety / panic attacks Chronic severe anxiety in addition to psychotherapy.

26 Anxiolytics Benzodiazepines diazepam, lorazepam Anti depressants Buspiron

27 Benzodiazepines GABA- BZ receptor complex Side effects Sedation hang over Memory impairment Motor in coordination Dependence psychological and physical Tolerance Age dependant elimination half life

28 Other anxiety disorders OCD SSRI Agoraphobia (? Antidepressants) CBT is first choice Panic - Antidepressants

29 Other drugs Anti-cholinergics Procyclidine, Benhexine etc Hypnotics/sedatives Anti dementia

30 Special groups Children Elderly Pregnancy Lactation

31 Conclusion Only an introduction Pharmaco-kinetics (general) 5 Classes of Psychotropic medications Mechanism of action Clinical indications Main side effects Prescription in special groups

32 Provided by The Leicester Gondar Link Collaborative Teaching Project This work is licensed under a Creative Commons Attribution-NonCommercial- NoDerivs 3.0 Unported License.