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CHAPTER 21 Drugs and other physical treatments

CHAPTER 21 Drugs and other physical treatments. Zhang Lei SIR RUN RUN SHAW HOSPITAL. Aim. Grasp Concepts and classification of psychotropic drugs Grasp the indications, contraindications, side effects of antipsychotic drugs, antidepressants, mood stabilizers, anxiolytic and psychostimulants

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CHAPTER 21 Drugs and other physical treatments

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  1. CHAPTER 21Drugs and other physical treatments Zhang Lei SIR RUN RUN SHAW HOSPITAL

  2. Aim • Grasp Concepts and classification of psychotropic drugs • Grasp the indications, contraindications, side effects of antipsychotic drugs, antidepressants, mood stabilizers, anxiolytic and psychostimulants • Be familiar with the indications and side effects of electroconvulsive therapy (ECT)

  3. History of physical treatments

  4. Pharmacokinetics of psychotropic drugs • Absorption • Distribution • Metabolism • Excretion

  5. Pharmacokinetics of psychotropic drugs • Measurement of circulation drug concentrations • Pharmacodynamic measures • Plasma half-life • Drug interactions • Pharmacokinetic interactions • Pharmacodynamic interactions • Drug withdrawal

  6. General advice about prescribing • Use well-tried drugs • Give an adequate dose • Use drug combinations cautiously • Dosing and treatment duration • What patients want to know • Compliance, concordance, and collaboration

  7. Prescribing for special groups • Children and the elderly • Pregnant women: benefit and risk • Anxiolytics and antidepresssants • Antipsychotic drugs and mood stabilizers • Neonatal toxicity • Breast-feeding

  8. What to do if there is no therapeutic response • Drug dose? • Other drugs? • Diagnosis?

  9. The classification of drugs used in psychiatry Antipsychotic: schizophrenia and mania Antidepressant: major depression Mood stabilizer: mania Anxiolytic: anxiety disorder Hypnotic: insomnia Psychostimulant: narcolepsy

  10. Antipsychotic drugs • Typical • Chlorpromazine • Atypical • Risperidone • Olanzapine • Aripiprazole • Ziprasidone

  11. Antipsychotic drugs • Pharmacology • Pharmacokinetics • Drug interactions • Unwanted effects • Contraindications to antipsychotics drugs • Antipsychotic drugs and risk of sudden death

  12. Antidepressant drugs • SSRI: fluoxetine, fluvoxamine, paroxetine, sertaline, citalopram, escitalopram • Mirtazapine • Venlafaxine • Duloxetine • Trazodone • Mianserin • Reboxetine • Buropion

  13. Antidepressant drugs • Pharmacokinetics • Efficacy of SSRIs in depression • Unwanted effects of SSRIs • Interactions with other drugs

  14. Mood stabilizing drugs • Lithum • Carbamazepine • Sodium valproate • Lamotrigine • Gabapetin

  15. Anxiolytic drugs • Benzodiazepines • Azapirones(buspirone) • Antidepressant drugs used for anxiety

  16. Hypnotics • Benzodiazepines • Zopiclone, zolpidem and zaleplon

  17. Electroconvulsive therapy

  18. Electroconvulsive therapy (ECT): indications 1 severse depressive illness 2 high suicide risk 3 catatonia 4 rufusal of foods and fluids 5 severse manic episode

  19. ECT • Mode of action • Physiological changes during ECT • Unilateral or bilateral ECT • Unwanted effects after ECT • Memory disorder after ECT • Mortality of ECT • Technique of administration • Anaesthetic procedures

  20. ECT • Frequency and number of treatment • Prevention of relapse • Consent to ECT

  21. Bright light treatment

  22. Neurosurgery of psychiatric disorders • Restricted to major depression and obsessive-compulsive disorder that is chronic, treatment refractory and disabling.

  23. Transcranial magnetic stimulation • Often used for depressive state • In treatment study of OCD, mania and schizophrenia

  24. Trans-cranial magnetic stimulation

  25. Thank you for your attention! 27

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