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GENERAL PRINCIPLES IN PSYCHOPHARMACOLOGY

Dr Amaury Delgado-Hernandez ST5 General Adult Psychiatry. GENERAL PRINCIPLES IN PSYCHOPHARMACOLOGY. Dr Amaury Delgado Hernandez ST5 in Genral Adult Psychiatry. 3. PAPER 1 EXAM OF THE RCPSYCH. Basic Psychopharmacology 14 Human Psychological Development 8 Social Psychology 4

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GENERAL PRINCIPLES IN PSYCHOPHARMACOLOGY

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  1. Dr Amaury Delgado-Hernandez ST5 General Adult Psychiatry GENERAL PRINCIPLES IN PSYCHOPHARMACOLOGY

  2. Dr Amaury Delgado Hernandez ST5 in Genral Adult Psychiatry 3

  3. PAPER 1 EXAM OF THE RCPSYCH Basic Psychopharmacology 14 Human Psychological Development 8 Social Psychology 4 Basic Psychological Processes 14 Dynamic Psychopathology 12 Basic Psychological Treatments 8 History of Psychiatry 8 Basic Ethics and Philosophy of Psychiatry 8 Stigma and Culture 8 History and Mental State 12 Descriptive Psychopathology 24 Cognitive Assessment 10 Neurological Examination 10 Assessment 16 Description and Measurement 6 Diagnosis 12 Classification 8 Aetiology 12 Prevention of Psychological Disorder 6 This breakdown is intended as a general guide to the content of Paper 1 and is subject to change Paper 1 pass rate for December 2011= 54.8%

  4. PROGRAMME History of Psychopharmacology Classification Placebo Effect Drug Approval Ethnopharmacology Pharmacokinetics Pharmacodynamics Type of Adverse Reaction Mechanism of side effect

  5. BRIEF HISTORY 1915 Macht and Mora coined the term psychopharmacology when studying opioids 1931 Sen & Bose (Plant Rauwolfia)=Reserpine. 1949 Cade in Australia discovered the use of Lithium compound in mania. 1950-1952 Delay and Deniker antipsychotic properties of Chlorpromazine 1952 Iproniazid anti-tuberculosis with antidepressant effect (mood lifting properties) 1954 First BZD Chlordiazepoxide in Austria Leo Sternbach 1955-1958 Klein TCA (Kuhn) and MAOIs.(Klein) 1958 Janssen synthesised butyrophenone (Haloperidol) 1963 Cheese reaction was proposed by Blackwell. 1970 Fluoxetine tested but not taken until 1987

  6. CLASSIFICATION ACCORDING TO MOLECULES Aliphatic phenothiazines- Chlorpromazine, promazine, triflupromazine Piperidine derivatives- Thioridazine Piperazine derivatives- Trifluoperazine, Fluphenazine, prophenazine, Butyrophenones– Haloperidol, Droperidol Thioxanthenes- Thiothixene, Flupenthixol, Zuclopenthixol Dihydroindoles – molindone Diphenylbutylpiperidine – pimozide (long t1/2) Dibenzoxapine – loxapine Benzisoxazole derivative- risperidone Substituted benzamides- Amisulpride, Sulpiride Dibenzodiazepine - Clozapine Dibenzothiazepine - Quetiapine Thienobenzodiazepine - Olanzapine Benzisothiazole- Ziprasidone Arylpiperidylindole (quinolone) Aripiprazole

  7. CLASSIFICATION ACCORDING TO MOLECULE • Tertiary amines – imipramine, amitriptyline, clomipramine, dothiepin, trimipramine (also venlafaxine) • Secondary amines – desipramine, amoxapine, nortriptyline and protriptyline (also duloxetine) [more potent mg to mg basis; less sedating; more noradrenergic, less antihistaminic or anticholinergic than tertiary] • Hydrazine derivatives - phenelzine, isocarboxazid (greater hepatotoxicity than tranylcypromine, non hydrazine compound) • Aminoketone - Bupropion (amphetamine like) • Azaspironedecanedione Buspirone • Triazolopyridine - Trazodone, nefazodone. • Imidazopyridine - Zolpidem • Pyrazolopyrimidine - Zaleplon • Cyclopyrrolone - Zopiclone

  8. CLASSIFICATION ACCORDING TO MA SSRIs citalopram, paroxetine, fluoxetine, sertraline and fluvoxamine (S enantiomer of citalopram ) -Escitalopram SNRIs – serotonin and noradrenaline reuptake inhibitor venlafaxine, milnacipran, duloxetine NARI – Noradrenaline reuptake inhibitor -reboxetine NaSSA – Noradrenergic and specific serotonergic antagonist – Mirtazepine and mianserin DARI – Dopamine reuptake inhibitor -Bupropion RIMA – reversible inhibitor of Monoamine A oxidase - moclobemide SARI – serotonin antagonist and reuptake inhibitors – nefazodone, trazodone.

  9. PLACEBO “Intervention deliberately used for non-specific psychophysiological treatment effect”. Placebo effect in research: Difference in outcome between placebo and an untreated control group. Nocebo: Placebo that produces significant SE. Placebo sag: The fading of the response with chronic and repetitive administration. Best placebo response (pain and disorders of autonomic sensation Nausea, Bronchial asthma) Psychiatric illness (Placebo Response) Depression 25-60%/ Mania 25% / Schizophrenia 25-50% / Panic Disorders 70% Placebo fails in degenerative and vascular conditions

  10. DRUG APPROVAL

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