مكانيسم‌هايي كه داروها موجب درمان اختلالات روان‌پزشكي مي‌شوند

2. مكانيسم‌هايي كه داروها موجب درمان اختلالات روان‌پزشكي مي‌شوند • مكانيسم اصلي (حال حاضر): تاثير بر Neurotransmission است. • Neurotransmission: آزاد سازي يك واسطه نروني(نروترانسميتر) و اتصال آن به نرون گيرنده در نرون بعدي و ايجاد تغييرات در آن. • كليه ارتباطات در مغز ناشي از تعامل ميان نرون‌ها است. • اين ارتباط به صورت انتقال پيام‌هاي الكتريكي است. • انتقال پيام الكتريكي از يك نرون به نرون ديگر توسط در اتصال دهنده‌هاي شيميايي انجام مي‌شود.

3. Psychopharmacology : history “if we understand what is broken, it should be possible to fix it.”  Despite that the chemical pathology of psychiatric and psychosomatic diseases near the end of the 20th century is still rudimentary, many excellent medications are now available. How were these drugs found and developed?

4. psycho tropics Medications used to treat psychiatric disorders are referred to as psychotropic. other names: (Neuroleptics, tranqualizers) In us every 6 women and 14 men use a psychoropics. Understanding of how the brain works led to : more effective, less toxic, better tolerated, specifically targeted agents.

5. classification:psycho tropics 2 According to: Clinical application: antidepressants, antipsychotics, mood stabilizers, anxiolytics, hypnotics, cognitive enhancer, stimulants Structure: tricyclics Mechanism: monoamine oxidase inhibitors History: traditional, first generation Uniqueness: atypical

6. Depression: biological Hypotheses Serotonin: functional or absolute deficiency in serotonin (Sr) Catecholamine: functional or absolute deficiency in Norepinephrine (NEP), dopamine, Permissive hypothesis: diminished Sr gives permission for a superimposed NEP deficiency Beta adrenergic hypothesis: increased beta-adrenergic receptor sensitivity

7. Antidepressant:Classification • Tricyclicantidepressants (TCA) • MAO inhibitors • Second/third generation or atypical ADs • Selective serotonin reuptake inhibitors (SSRIs) • others

8. Tricyclic Antidepressants • Amitriptyline HCl • Coated tablet 10mg, 25mg; scored F.C. tablet 50mg,100 mg • Clomipramine HCl • Coated tablet 10mg, 25mg, 50mg, 75mg • Desipramine HCl • Coated tablet 25 mg • Nortriptylline • Tablet 10mg, 25mg • Imipramine • Coated tablet 10mg, 25 mg, 50mg; injection 25mg/2ml • Doxepin • Capsule 10mg, 25mg; F.C. tablet 10mg, 25 mg

9. Selective Serotonin Reuptake Inhibitors (SSRIs) • Fluoxetine • Capsule 1mg, 20mg • Fluvoxamine • Tablet 50mg, 100mg • Citalopram • Tablet 20mg, 40 mg • Sertralin: 50, 100 • Paroxerin:

10. Other Antidepressants • TrazodoneTablet 50mg • MaprotilineTablet 25mg, 75mg • BupropionTablet 75mg • VenlafaxineTablet 37.5mg, 75mg, 150mg

11. Benzodiazepines (BZDs) • AlprazolamTablet 0.5 mg, 1 mg • ClonazepamTablet 1mg, 2mg • LorazepamTablet 1mg, 2mg injection 2mg/ml, 4mg/ml • OxazepamTablet 10mg • FlurazepamCapsule 15mg • DiazepamTablet 2mg, 5mg 10mg;injection 5mg/ml • ClordiazepoxideTablet 5mg, 10mg • MidazolamSyrup 2mg/ml, injection 5mg/ml

12. Anti- Psychotic Medication • Anti- psychotic medication is used to control psychosis • Psychological treatments are more effective when medication is taken as well • Medication is only ONE PART of a comprehensive package of care that aims to help keep a person stable and to live as normal a life as possible • Anti- psychotic medications are MOST EFFECTIVE at controlling POSITIVE SYMPTOMS (hallucinations, delusions) - less effective at treating negative ones (apathy, withdrawal etc)

13. Therapeutic guideline • Antipsychotics have revolutionized treatment of schizophrenia • Two major group: • Dopaminantagonista (Das): (haloperidol, perphenazine, trifluoperazine, fluphenazine, thioridazine, chlorpromazine,…) • Serotonin Dopamine Antagonists: ( risperidone, olanzapine, clozapine,quetiapine,…)

14. Mood stabilizers Indications: Bipolar, cyclothymia, schizoaffective, impulse control and intermittent explosive disorders. Classes: Lithium and anticonvulsants Which you select depends on what you are treating and again the side effect profile.

15. I. Lithium • 1st medication for manic-depressive disorder • Discovered by Cade in Australia • Neurotoxic if overdose – thus serum level monitoring needed • Common side-effects: polyuria & polydipsia, hand tremor • Toxic side-effects: neuroleptic malignant syndrome (+ haloperidol) • ?controversy as 1st line treatment (especially in primary care)

16. Lithium- how to use it 1st medication for manic-depressive disorder Before starting :Get baseline creatinine, TSH and CBC. In women check a pregnancy test During the first trimester is associated with Ebstein’s anomaly 1/1000 (20X greater risk than the general population) 􀂾 Monitoring: Steady state achieved after 5 days Check 12 hours after last dose. Once stable check q 3 months and TSH and creatinine q 6 months. 􀂾 Goal: blood level between 0.6-1.2

17. Lithium toxicity • Mild- levels 1.5-2.0 see vomiting, diarrhea, ataxia, dizziness, slurred speech, nystagmus. • Moderate: 2.0-2.5 nausea, vomiting, anorexia, blurred vision, clonic limb movements, convulsions, delirium, Syncope • Severe: >2.5 generalized convulsions, • oliguria and renal failure

18. Various anti-epileptics • valproate (divalproex) - esp. mania/mixed • carbamazepine /oxcarbazepine - esp. mania/mixed • lamotrigine - esp. BP-D/rapid cycling • topiramte - mania/mixed, esp. rapid cycling • Gabapentine/pregabalin - analgesic & ?anxiolytic effect