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Psychology 317 Chapter 13. Psychotherapeutic Medications. Psychotherapeutic Medications. Psychotherapeutic medications are prescribed to relieve the symptoms of the mentally ill and to improve their functioning.

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psychology 317 chapter 13

Psychology 317 Chapter 13

Psychotherapeutic Medications

psychotherapeutic medications
Psychotherapeutic Medications
  • Psychotherapeutic medications are prescribed to relieve the symptoms of the mentally ill and to improve their functioning.
  • Fewer than 12 countries (US, Italy, Germany, France, Japan, UK, Brazil, Spain, Canada) produce 75% of pharmaceuticals.
  • Psychotherapeutic drugs are drugs that have special or unique effects on the mind and mental functioning.
historical overview
Historical Overview
  • Psychopharmacology began in 19th century and grew rapidly in the 20th century.
  • The term psychopharmacology was first used by David Macht, US pharmacist in 1920.
  • Early mental health treatment was unscientific, varied and included blood letting, hot iron, flogging, revolving chairs, starvation, stoning, and casting out demons.
  • Kraepelin, Pinel, and Esquirol, French, were instrumental in developing and classifying systems of mental illness.
  • They argued scientific understanding and categorization were keys to identifying effective treatments for mental illnesses.
historical overview continued
Historical Overview continued
  • In 1840 Jacques-Joseph Moreau (Paris Hospital) theorize that mental illness could be treated with drugs that produced similar but controllable symptoms.
  • He experimented with cannabis as treatment for depression and mania in mid 1800s. He found it made depressed happy and manic calm/relaxed.
  • During first half of 1900s amphetamine was used to treat depression and narcolepsy; carbon dioxide to treat psychotic and neurotic diseases, psychosurgery, insulin and antihistamine shock to treat psychosis; and ECT/EST to treat depression.
historical overview continued1
Historical Overview continued
  • In 1949 John Cade, Australian, discovered lithium blocked manic phase of manic depression/bipolar disorder.
  • Concerns about toxicity delayed US approval until 1970.
  • In 1950 Paul Charpentier synthesized chloropromazine as anesthetic in general surgery.
  • Henri Laaborit observed it calmed agitated patient in preparation for surgery and he suggested its use in psychiatry.
  • Chloropromazine has become the greatest advance in psychopharmacology as antipsychotic medication.
historical overview continued2
Historical Overview continued
  • A number of drugs were introduced in 1950s including meprobamate, a muscle relaxant as an antianxiety drug and MAOI and tricyclics as antidepressants.
  • Reserpine was next big accidental discovery in 1954. Found to cause symptoms of indifference in patients treated for arterial hypertension.
  • Reserpine effects takes several weeks to appear and patients seemed depressed so it never achieved the popularity of chloropromazine.
epidemiology
Epidemiology
  • About ¼ of US population experience mental disorders annually.
  • Most have symptoms of anxiety, depression and affective disorders or alcohol abuse.
  • Only a minority seek treatment.
  • 2005 Nat Comorbidity Survey Replication of 9,000+ adults 18yrs and older, focused on 4 categories of illness, anxiety (Panic & PTSD) mood disorders (depression & bipolar) impulse-control (ADHD), substance abuse.
epidemiology continued
Epidemiology continued
  • The survey found the following:
    • In US 1:4 adults (26.2%) diagnosed with mental disorders annually and¼ have serious disorder.
    • Most common disorders in past year, anxiety (18%), mood (10%), impulse control (9%), substance abuse (15%).
  • About ½ US adults met criteria for mental illness during their life.
epidemiology continued1
Epidemiology continued
    • About 45% of adults met criteria for 2 mental illness simultaneously, comorbidity.
    • Fewer than ½ get treatment and those who do wait many years to do so.
    • Mental disorders begin showing signs from about age 14 and 75% show sign by age 24.
  • Prevalence rates may be underestimates, because the survey did not include homeless or institutionalized individuals.
epidemiology continued2
Epidemiology continued
  • Less common disorders such as schizophrenia, were not included in the survey.
  • Psychotherapeutic drug use more common in women than men, older individuals, individuals living alone, more educated, with higher income.
  • Abuse of psychotherapeutic drugs is a significant problem.
  • Prescription drugs contribute a large number of emergency room visits and drug related deaths.
epidemiology continued3
Epidemiology continued
  • DAWN (Drug Abuse Warning Network) was formed to monitor drug use (legal & illegal) and it computes annual statistics on morbidity and mortality from drug use.
  • Pychotherapeutic drugs affect neurotransmitter systems.
  • Processes by which they do so are : binding to receptors, agonists, antagonists, release neurotransmitter, block reuptake, change number of receptor sites, or sensitivity of receptors, alter metabolism of ns, and enzyme degradation of ns.
epidemiology continued4
Epidemiology continued
  • Psychotherapeutic drugs can be classified in four groups: antipsychotics, antidepressants, antianxiety agents, mood stabilizers.
antipsychotics see table 13 1
Antipsychotics (See Table 13.1)
  • Also called neuroleptics or major tranquilizers.
  • Used to treat schizophrenia, mania, agitated depression (depression with tension and restlessness), toxic psychosis, emotionally unstable, old age psychosis.
  • Antipsychotics act on the reticular activating system, limbic system, hypothalamus.
  • Antipsychotics block NE, 5-HT and ACH but their primary action is as DA agonist at D2 synapses.
antipsychotics continued
Antipsychotics continued
  • The DA hypothesis is most accepted explanation of the effects of antipsychotics and it is based on the following:
    • Psychosis can be induced by increased levels of DA activity.
    • Most antipsychotic drugs block postsynaptic DA receptors.
  • Side effects of antipsychotic drugs include:
    • Blocking postsynaptic receptors in the extrapyramidal tract in the basal ganglia.
antipsychotics continued1
Antipsychotics continued
  • Parkinson like disorders such as dyskinesia, akinesia, tardive dyskinesia (involuntary movement of trunk, extremities, and mouth, eg. lip smacking)
  • Tardive dyskinesia, is most common side effect & is associated with 2 years plus use.
  • Tardive dyskinesia is more common in women than men
antidepressants
Antidepressants
  • Depression is one of most common psychiatric disorders in US.
  • Depression is one of 2 types: endogenous (symptoms due to genetics), exogenous (reaction to particular situation or event).
  • There are two major groups of antidepressants cyclic antidepressants and MAOIs.
  • Cyclics are prescribed more frequently than MAOIs.
  • Biochemical hypothesis of depression is deficiency in catecholamines and 5-HT.
antianxiety drugs
Antianxiety Drugs
  • First antianxiety drugs were developed as general anesthesia; nitros oxide, and ether.
  • Barbiturate development led to use of depressant in sleeping pills, treatment of anxiety (anxiolytics) and epilepsy
  • Barbiturate use declined with the discovery that it produced rapid development of tolerance, severe withdrawal symptoms, high risk of overdose and high abuse potential.
  • There are several different barbiturate like drugs: nonbarbiturate sedatives, Methaqualone, Quaaludes but all have same undesirable side effects as barbiturates (See Table 13.3).
antianxiety drugs continued
Antianxiety Drugs continued
  • Development of Benzodiazepines revolutionized depressant drug use.
  • Benzodiazepines relieve anxiety without side effects of previous depressants.
  • Benzodiazepines and other depressants influence GABA receptor sites in CNS.
  • Benzodiazepines seem to have more selective anxiolytic effects than other depressants, anxiety relieving doses produce little or no sedation & motor impairment.
  • Benzodiazepines may produce tolerance, dependence and withdrawal but less severe than barbiturates.
mood stabilizing drugs
Mood-stabilizing Drugs
  • Lithium is main drug used to treat mania and bipolar disorders (mood disorders).
  • Lithium blocks mania component of manic –depression and prevents depression component.
  • Bipolar disorder believed related to overactivity of neurotransmitters in brain.
  • Lithium acts by facilitating reuptake of Serotonin and NE and decreasing effect of DA and NE at postsynaptic sites.
  • No drug is totally safe for use during pregnancy.
mood stabilizing drugs continued
Mood-stabilizing Drugs continued
  • Psychotherapeutics should only be used during pregnancy when nondrug therapies (counseling) have failed.
  • Psychotherapeutic drug use during pregnancy is risky for mother and fetus.
  • Fetus at risk for teratogenic, neurobehavioral and toxic consequences from psychotherapeutic drug use during pregnancy.
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