Introduction to Drug Treatment LPT Gondar Mental Health Group www.le.ac.uk
Introduction to Psychiatric Drugs Drugs and Neurotransmitters 5 Classes of Psychotropic medications Mechanism of action Clinical indications Main side effects Prescription in special groups
Psychiatric treatment Biological treatments Psychological Social treatments - Medication - ECT
Break down (COMT or MAOI) MECHANISM OF ACTION Action Potential Cascade reaction Re uptake process (Recycling)
5 Classes of psychotropic medications Anti depressants Anxiolytics Mood stabilisers Anti psychotics Others
Anti depressants Re-uptake inhibitors Tricyclic - Nor adrenaline and Serotonin Specific serotonin re uptake inhibitors (SSRI) Newer antidepressants NARI SNRI Monoamine oxidase inhibitors
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
Examples of Tricyclic antidepressants Imipramine Amitryptiline Clomipramine Dosulepin Lofepramine Nortriptyline
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
SSRI Examples Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline
MAO Inhibitors Older non specific/ irreversible cheese reaction Phenelzine (Nardil); Isocarboxazid, Tranylcypromine New selective / reversible Reaction less intense moclobemide
Newer anti depressants Serotonin and NA Reuptake Iinhibition Venlafaxine Duloxetine NA Reuptake Inhibition Reboxetine Presynaptic alpha 2 antagonist Mirtazapine
Others antidepressants Trazodone Mianserin
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
Non responders Evaluate the management strategy Use an antidepressant with a different mode of action. Augmentation Lithium Thyroxin
Mania Normal mood variation Depression
Mood stabilisers Lithium Carbamazepine Sodium valproate Lamotrigine
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.
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
Lithium Monitoring Lithium levels TFT s U and E s (GFR)
Antipsychotics Chlorpromazine Haloperidol Flupenthixol Sulpiride/ amisulpiride Clozapine Olanzapine Risperidone Aripiprazole
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
Atypical anti psychotics Low EPSE Effect on negative symptoms Weight gain increased Incidence of DM and metabolic syndrome increased
Anxiety disorders Generalized anxiety disorder Panic disorder Phobia Simple phobia Agoraphobia Social Phobia Obsessive Compulsive Disorder
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.
Anxiolytics Benzodiazepines diazepam, lorazepam Anti depressants Buspiron
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
Other anxiety disorders OCD SSRI Agoraphobia (? Antidepressants) CBT is first choice Panic - Antidepressants
Other drugs Anti-cholinergics Procyclidine, Benhexine etc Hypnotics/sedatives Anti dementia
Special groups Children Elderly Pregnancy Lactation
Conclusion Only an introduction Pharmaco-kinetics (general) 5 Classes of Psychotropic medications Mechanism of action Clinical indications Main side effects Prescription in special groups
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