Psychology 317 Chapter 13

1. Psychology 317 Chapter 13 Psychotherapeutic Medications

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. Epidemiology continued • Psychotherapeutic drugs can be classified in four groups: antipsychotics, antidepressants, antianxiety agents, mood stabilizers.

13. 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.

14. 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.

15. 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

16. 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.

17. 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).

18. 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.

19. 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.

20. 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.