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Drugs for Treating Psychiatric Disorders

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Drugs for Treating Psychiatric Disorders Chapter 13 * * * * St. John's Wort can dangerously interact with other medications, including those used to control HIV. – PowerPoint PPT presentation

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Title: Drugs for Treating Psychiatric Disorders


1
Drugs for Treating Psychiatric Disorders
  • Chapter 13

2
What are Psychotropic Medications?
  • Medications are used to treat the symptoms of
    mental disorders such as schizophrenia,
    depression, bipolar disorder (sometimes called
    manic-depressive illness), anxiety disorders, and
    attention deficit-hyperactivity disorder (ADHD).

3
Side Effects to Psychotropic Drugs?
  • Some people get side effects from medications and
    other people don't
  • Factors that can affect how medications work in
    people include
  • Type of mental disorder, such as depression,
    anxiety, bipolar disorder, and schizophrenia
  • Age, sex, and body size
  • Physical illnesses
  • Habits like smoking and drinking
  • Liver and kidney function
  • Genetics
  • Other medications and herbal/vitamin supplements
  • Diet
  • Whether medications are taken as prescribed.

4
Depression
  • Symptoms
  • Most symptoms, felt most days over 2 weeks
  • Depressed mood most of the day,
  • Markedly diminished interest or pleasure
  • Significant weight loss when not dieting or
    weight gain
  • Insomnia or hypersomnia
  • Psychomotor agitation or retardation
  • Fatigue or loss of energy
  • Feelings of worthlessness or guilt
  • Diminished ability to think or concentrate, or
    indecisiveness
  • Recurrent thoughts of death

5
Depression
  • Most common drugs used
  • Tricyclic antidepressants (TCAs) used mostly in
    the past though no other group of antidepressants
    was been demonstrated as more effective or fast
    working)
  • Elavil, Tofranil, Pamelor
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Celexa, Prozac, Lexapro, Paxil, Zoloft
  • Serotoninnorepinephrine reuptake inhibitors
    (SNRIs)
  • Effexor, Pristiq, Cymbalta, Dalcipran, Meridia
  • Monoamine oxidase inhibitors MAOIs (used rarely)
  • Apresoline, Harmalol, Selegiline, Moclobemide

6
TCAs
Pharmacokinetics
  • Orally (once a day at bedtime to minimize
    unwanted side effects like persistent sedation)
  • 4 days of clinical effect and readily crosses the
    placental barrier
  • Rapidly and almost completely metabolized by
    enzymes located in the liver.
  • Urine
  • Absorption
  • Distribution
  • Metabolism
  • Elimination

7
TCAs
Related Neurotransmitters
  • Therapeutic effects comes from blocking reuptake
    of dopamine, serotonin, and norepinephrine
  • Blockade of ACH receptors results in dry mouth,
    confusion, memory impairments, and blurred vision
  • Blockage of histamine receptors results in
    drowsiness and sedation

8
TCAs
Effects
  • Elevated mood
  • Increased physical activity
  • Improved appetite
  • Improved sleep patterns
  • Reduced morbid preoccupation
  • Clinically effective in the long-term therapy of
    dysthymia
  • Dry mouth
  • Confusion
  • Memory impairments
  • Blurred vision
  • Sedation
  • Cardiac depression
  • Cardiac arrhythmias

9
SSRIs
Related Neurotransmitters
  • Blocks the re-uptake of serotonin
  • Each drug has a different half life

10
SSRIs
Effects
  • Elevated mood
  • Increased physical activity
  • Improved appetite
  • Improved sleep patterns
  • Reduced morbid preoccupation
  • Clinically effective in the long-term therapy of
    dysthymia
  • Sexual dysfunction gt 60
  • Anxiety
  • Agitation
  • Insomnia
  • Rarely suicide

11
SSRIs
Caution!
  • Suicide
  • Serotonin syndrome (most likely to occur when
    SSRIs are combined with each other, other
    antidepressants, or valerian root)
  • - Alterations in cognition, autonomic nervous
    system, and neuromuscular activity which could be
    life threatening.
  • Serotonin Withdrawal Syndrome (occurs in perhaps
    60 of SSRI-treated patients following drug
    removal)
  • - Disequilibrium, gastrointestinal symptoms,
    sensory disturbances (sensation of electric
    shocks), sleep disturbances

12
SNRIs
Related Neurotransmitters
  • Blocks the reuptake of serotonin
  • Blocks the reuptake of norepinephrine

13
SNRIs
Effects
  • Elevated mood
  • Increased physical activity
  • Improved appetite
  • Improved sleep patterns
  • Reduced morbid preoccupation
  • Clinically effective in the long-term therapy of
    dysthymia
  • Dry mouth
  • Dizziness
  • nausea
  • Blurred vision
  • Sedation

14
SNRIs
Caution!
  • Suicide
  • Serotonin syndrome (most likely to occur when
    SSRIs are combined with each other, other
    antidepressants, or valerian root)
  • - Alterations in cognition, autonomic nervous
    system, and neuromuscular activity which could be
    life threatening.
  • Serotonin Withdrawal Syndrome (occurs in perhaps
    60 of SSRI-treated patients following drug
    removal)
  • - Disequilibrium, gastrointestinal symptoms,
    sensory disturbances (sensation of electric
    shocks), sleep disturbances

15
MAOIs
Related Neurotransmitters
  • Breaks down norepinephrine and serotonin
    permanently which means it could be weeks before
    new neurotransmitters are manufactured.

16
MAOIs
Effects
  • Elevated mood
  • Increased physical activity
  • Improved appetite
  • Improved sleep patterns
  • Reduced morbid preoccupation
  • Clinically effective in the long-term therapy of
    dysthymia
  • Potential fatal blood pressure increases when
    mixed with common foods

17
MAOIs
Caution!
  • Death when mixed with common foods like cheese,
    wine, beer, soy, coffee, chocolate
  • Serotonin syndrome (most likely to occur when
    MAOIs are combined with each other, other
    antidepressants, or valerian root)
  • - Alterations in cognition, autonomic nervous
    system, and neuromuscular activity which could be
    life threatening.

18
Wellbutrin (Bupropion)
works on the neurotransmitter dopamine, is unique
in that it does not fit into any specific drug
type.
19
Herbal Remedies for Depression?
  • NIH conducted a clinical trial to determine the
    effectiveness of treating adults who have major
    depression with St. Johns wort.
  • The single-blind study included 340 people
    diagnosed with major depression.
  • 1/3 took the herbal medicine, 1/3 took an SSRI,
    and 1/3 took placebo.

The study found that St. John's wort was no more
effective than the placebo in treating major
depression
20
Bipolar Disorder
  • Depressive Symptoms
  • 5 or more, in same 2 week period
  • Depressed mood most of the day,
  • Markedly diminished interest of pleasure
  • Significant weight loss when not dieting or
    weight gain
  • Insomnia or hypersomnia
  • Psychomotor agitation or retardation
  • Fatigue or loss of energy
  • Feelings of worthlessness or guilt
  • Diminished ability to think or concentrate, or
    indecisiveness
  • Recurrent thoughts of death

21
Bipolar Disorder
  • Mania Symptoms
  • 3 or more, lasting at least 1 week
  • inflated self-esteem or grandiosity
  • decreased need for sleep
  • more talkative than usual or pressure to keep
    talking
  • flight of ideas or subjective experience that
    thoughts are racing
  • distractibility increase in goal-directed
    activity or psychomotor agitation
  • excessive involvement in pleasurable activities
    that have a high potential for painful
    consequences

22
Bipolar Disorder
4 LPR - Laryngopha-ryngeal- reflux
1 in 4 or 5 commits suicide
gt 55 have a history of substance abuse
Must rule out mania caused by antidepressants,
caffeine, herbals, stimulants, corticosteroids,
cough and cold preparation, diet aids, and
hyperthyroid
23
Bipolar Disorder
  • Most common drugs used
  • Lithium
  • 28 of patients discontinue the drug
  • 38 experience recurrences on the drug
  • Only 23 dont have reoccurring episodes
  • Valproic Acid
  • Antipsychotics

24
Lithium a salt
Pharmacokinetics
  • Orally (once daily due to long half life)
  • Peak blood levels reach within 3 hours crosses
    blood-brain barrier incompletely
  • Excreted unchanged by kidneys
  • Urine and skin
  • Absorption
  • Distribution
  • Metabolism
  • Elimination

25
Lithium
Effects
  • Less mania (though not less time to recurrence
    compared to placebo)
  • Reduction in suicidal behaviors
  • Nausea, vomiting, diarrhea, abdominal pain
  • tremor, lethargy, impaired concentration, slurred
    speech, ataxia, muscle weakness
  • Memory loss
  • Weight gain (depressed thyroid)
  • Hallucinations
  • Muscle rigidity, coma, renal failure, cardiac
    arrhythmias, and death

26
Lithium
Caution!
  • Illness course is believed to be worse after
    stopping lithium than having never received the
    drug (including super high suicidal behaviors and
    completions).
  • Low compliance due to side effects, high
    likelihood of relapse, and missing the high
  • High rate of interactions with other drugs
  • About 40 are either resistant to lithium or
    develop side effects that limit its effectiveness

27
Valproic Acid antiepileptic drug
Pharmacokinetics
  • Orally and intravenously for acute mania
  • 90 bound to proteins in blood, 10 may make it
    to the brain (this rises shockingly if too much
    is administered)
  • 95 broken down by liver with metabolites that
    contribute to side effects. Differences between
    peak and trough levels can be extreme
  • Urine
  • Absorption
  • Distribution
  • Metabolism
  • Elimination

28
Valproic Acid
Effects
  • Less mania (though not less time to recurrence
    compared to placebo)
  • Reduction in suicidal behaviors
  • GI upset
  • Sedation
  • Lethargy
  • Hand tremor
  • Alopecia (loss of hair)
  • Metabolic changes in liver
  • Decreased cognitive function
  • Obesity (rarer side effects)
  • Fertility problems in women and masculinization

29
Valproic Acid
Caution!
  • Causes excess ammonia in the blood
    (hyperammonemia) which can lead to brain damage
  • Overdose tremor, stupor, respiratory
    depression, coma, metabolic acidosis and death

30
Antidepressants used in treatment of bipolar
disorder
  • Fluoxetine (Prozac), paroxetine (Paxil), or
    sertraline (Zoloft) are sometimes given to people
    with bipolar disorder
  • CAUTION should not take an antidepressant on its
    own. Doing so can cause the person to rapidly
    switch from depression to mania

31
Atypical Antipsychotics
Related Neurotransmitters
  • Serotonin antagonism

32
Atypical Antipsychotics
Effects
  • Less mania (depending on drug used)
  • More mania (depending on drug used)
  • Sedation (in some drugs)
  • Increased motor activity
  • Agitation
  • Weight gain
  • Extrapyramidal effects
  • Akathesia (sensation of inner restlessness)
  • Tardive dyskinesia (purposeless movements)

33
Schizophrenia
  • Symptoms
  • 2 or more for a sig. portion of time during 1-mo.
    period
  • delusions
  • hallucinations
  • disorganized speech (e.g., frequent derailment or
    incoherence, echolalia)
  • grossly disorganized or catatonic behavior
  • negative symptoms (i.e. affective flattening,
    mental confusion, or lack of initiation/motivation
    )

34
Schizophrenia
1 LPR
10-15 commit suicide
Schizophrenia and the Brain Animation
35
Schizophrenia
  • Most common drugs used
  • Typical Antipsychotics (also called neuroleptics)
  • - Clozapine, Thorazine, Haldol,
  • Atypical antipsychotics
  • Risperdal, Abilify, Seroquel

36
Typical Antipsychotics
Related Neurotransmitters
  • Dopamine receptor blockage

37
Typical Antipsychotics
Effects
  • Less positive symptoms of schizophrenia
  • Worse negative symptomatology of schizophrenia
  • Sedation
  • Extrapyramidal effects
  • Akathesia (sensation of inner restlessness)
  • Tardive dyskinesia (purposeless movements)

38
Atypical Antipsychotics
Related Neurotransmitters
  • Serotonin antagonism

39
Atypical Antipsychotics
Effects
  • Less positive symptoms of schizophrenia
  • Sedation (in some drugs)
  • Increased motor activity
  • Agitation
  • Weight gain
  • Extrapyramidal effects
  • Akathesia (sensation of inner restlessness)
  • Tardive dyskinesia (purposeless movements)

40
Medications for Anxiety Disorders
  • Anxiety disorders include
  • Obsessive compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Generalized anxiety disorder (GAD)
  • Panic disorder
  • Social phobia
  • Fear of open and closed spaces
  • (agoraphobia)
  • Antidepressants, anti-anxiety medications, and
    beta-blockers are the most common medications
    used for anxiety disorders.

41
Generalized Anxiety Disorder
  • Symptoms
  • 3 or more, felt most days over 6mos
  • Feeling wound-up, tense, or restless
  • Easily becoming fatigued or worn-out
  • Concentration problems
  • Irritability
  • Significant tension in muscles
  • Difficulty with sleep

42
Generalized Anxiety Disorder
  • Most common drugs used
  • Buspirone (Buspar)
  • Benzodiazepines ?
  • SSRIs
  • Celexa, Prozac, Lexapro, Paxil, Zoloft
  • SNRIs
  • Effexor, Pristiq, Cymbalta, Dalcipran, Meridia

43
Buspar (buspirone)
Related neurotransmitters
  • unknown (possible serotonin receptor agonist
    possible dopamine antagonist)

44
Buspar (buspirone)
Effects
  • Anxiety remission with less withdrawal symptoms
    than benzos
  • dizziness
  • Headache
  • Lightheadedness
  • nausea
  • Excitement
  • Sweating/clamminess

45
Attention Deficient Hyperactivity Disorder
  • Inattention Symptoms
  • 6 or more, in more than one situation
  • Often does not give close attention to details or
    makes careless mistakes in schoolwork, work, or
    other activities.
  • Often has trouble keeping attention on tasks or
    play activities.
  • Often does not seem to listen when spoken to
    directly.
  • Often does not follow instructions and fails to
    finish schoolwork, chores, or duties in the
    workplace (not due to oppositional behavior or
    failure to understand instructions).
  • Often has trouble organizing activities.
  • Often avoids, dislikes, or doesn't want to do
    things that take a lot of mental effort for a
    long period of time (such as schoolwork or
    homework).
  • Often loses things needed for tasks and
    activities (e.g. toys, school assignments,
    pencils, books, or tools).
  • Is often easily distracted.
  • Is often forgetful in daily activities.

46
Attention Deficient Hyperactivity Disorder
  • Hyperactivity Symptoms
  • Maladaptive in more than one situation
  • Often fidgets with hands or feet or squirms in
    seat.
  • Often gets up from seat when remaining in seat is
    expected.
  • Often runs about or climbs when and where it is
    not appropriate (adolescents or adults may feel
    very restless).
  • Often has trouble playing or enjoying leisure
    activities quietly.
  • Is often "on the go" or often acts as if "driven
    by a motor".
  • Often talks excessively.
  • Impulsivity Symptoms
  • Maladaptive in more than one situation
  • Often blurts out answers before questions have
    been finished.
  • Often has trouble waiting one's turn.
  • Often interrupts or intrudes on others

47
Attention Deficient Hyperactivity Disorder
ADHD animation
http//www.healthcentral.com/adhd/video-39189-47.h
tml
48
Attention Deficient Hyperactivity Disorder
  • Most common drugs used
  • Ritalin?
  • Adderal ?
  • Less common drugs used
  • Methamphetamine ?

49
Special Needs Groups
  • Psychiatric medications are taken by all types of
    people, but some groups have special needs,
    including
  • Children and adolescents
  • Older adults
  • Women who are pregnant or may become pregnant.

50
Children
  • Great care needs to be taken in prescribing
    psychotropic drugs to children
  • FDA indicated that Prozac should never be used in
    children because of brain damage issues
  • Brain is still developing and impacted more
    negatively than in adults

51
Older Adults
  • Often have more medical problems
  • than other groups and tend to take
  • more medications than younger
  • people, including prescribed, over-the-counter,
    and herbal medications.
  • Higher risk for experiencing bad drug
    interactions, missing doses, or overdosing.
  • More sensitive to medications.
  • More likely to experience paradoxical effects

52
Women pregnant or planning
  • Research is inconsistent in determining whether
    antidepressants are safe during pregnancy
  • Some research suggests the use of SSRIs during
    pregnancy is associated with miscarriage or birth
    defects, but other studies do not support this
  • Fetuses exposed to SSRIs during the third
    trimester may be born with "withdrawal" symptoms
    such as breathing problems, jitteriness,
    irritability, trouble feeding, or hypoglycemia
    (low blood sugar).

53
Some medications should not be taken during
pregnancy.
  • Benzodiazepines may cause birth defects or other
    infant problems, especially if taken during the
    first trimester.
  • Mood stabilizers are known to cause birth
    defects.
  • Benzodiazepines and lithium have been shown to
    cause "floppy baby syndrome," which is when a
    baby is drowsy and limp, and cannot breathe or
    feed well.
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