Psychotherapeutic Drugs

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Chapter 10

• Psychotherapeutic Drugs

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Health Care

• Psychiatrists and psychologists
• National Institute of Mental Health
• http//www.nimh.nih.gov/nimhhome/index.cfm
• Not all cases fit neatly into the aforementioned
  three categories

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Experimental and Clinical Psychopharmacology.

• Web www.apa.org80/journals/pha.html.

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Classification of Mental Disorders

• Diagnostic and Statistical Manual of Mental
  Disorders (DSM-IV) provides criteria and
  classification (p 220-224)
• Anxiety disorders unrealistic worries (i.e.,
  phobias, OCDs, PTSD, GAD)
• Psychosis major disturbance of intellectual and
  social functioning (two types)
• Organic (known cause)or Functional (i.e.,
  schizophrenia)
• Mood disorder depressed symptoms (i.e.,
  dysthmia, bipolar disorder)

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Treatment of Mental Disorders (Before 1950)

• Malaria Therapy (1917)
• Narcosis Therapy (1930s)
• Insulin shock therapy for schizophrenics (1930s)
• electroconvulsive shock therapy

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Treatment of Mental Disorders (Before 1950),
contd

• Induction of convulsions via drugs and electric
  shock ECT (1930-40s)
• Parahyde (sedative), a.k.a. chemical
  straitjacket (1950s)

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Treatment of Mental Disorders (After 1950)

• Anti-psychotics (necroleptic)
• Table 10-1 AP Drugs (p. 227).
• Phenothiazines caused calmness without drowsiness
• Shown to be more effective than placebos
• Discontinuation lead to relapse 75-95 of
  patients within one year

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Treatment of Mental Disorders (After 1950), contd

• Anti-psychotics (necroleptic), contd
• Mechanism of action results from blocking
  dopamine receptors and possibly seratonin
• Are not addictive
• can induce symptoms similar to Parkinsons

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Anti-Depressants

• Monoamine oxidase inhibitors (MAOs), increased
  availability of serotonin, norepinephrine, and
  dopamine. i.e., Nardil, Parnate Table 10-2 (p.
  229).
• Tricyclics (similar to MAOs) (p. 229)
• Selective Seratonin Reuptake Inhibitors (SSRI),
  i.e., Prozac, Paxil (p. 230)

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Mechanisms ofAnti-Depressant Action

• Works by increasing availability of seratonin or
  norepinephrine at respective synapses
• Lag period exists resulting in a two-week
  window for improvements
• Correct theories focus on the reaction of neurons
  to direct effects biochemically

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Lithium

• A salt (lithium chloride)
• Sedative properties identified in animal studies
  (1949)
• Manic patients improved

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Lithium, contd

• Requires 10-15 days before symptoms decrease
• Acts as a mood-normalizing agent for manic
  depression

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Consequences of Drug Treatments for Mental Illness

• Mental hospitals population has decreased since
  1950
• Fig. 10-1 Number of Patients in Nonfederal
  Psychiatric Hospitals, 1946-1998 (p. 237).
• Prescription pad has replaced psychotherapy for
  many psychiatrists
• 1/3 of homeless in the U.S. have some form of
  mental illness

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Our textbook raises an interesting question
Should one be forced to take medication against
ones will? Of course, the answer depends on a
number of variables, such as the severity of the
persons condition and the likelihood that the
person will benefit from the medication. Identify
and list the situations in which one should be
forced to take medication.
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Chapter 10

• Psychotherapeutic Drugs