Psychopharmacology by Disorders

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Psychopharmacology by Disorders

• Depression

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Psychopharmacology

• Neurons Synapses
• Neurotransmitters
• Catecholamines (Dopamine, Norepi, Epiph)
• Monoamine(Catecholamines serotonin)
• Amino Acids (Gaba, glycine, glutamates)
• Neuropeptides(hormones, endorphines)
• Pharmacokinetics drug administration and
  absorption
• Drugs Treatment

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Terminology

• Drug Names
• Trade Name given by pharmaceutical Co.
• Generic Name- chemical name
• Black Box warning risk of serious side
  effects (ie. Suicide)
• All depression meds for children

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Depression

• Amine hypothesis Depress is caused by
• Lack of excitatory transmitters
• Inability process excitatory tranmitters
• Abundance of inhibitory
• Deficits serotonin (5-HT) or norepinephrine
• Drug effects 2 to 3 weeks, not immediate
• Cognitive reaction to biological changes

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AntidepressantsTricyclics

• Blocks reuptake of NE, DA, 5-HT
• Enhances inhibition of brain stem to spinal cord
  Blocks pain
• NEJM 75 pain relief amitriptyline, 61
  desiprimine and 48 fluoxetine
• 14-21 days response, max effect 4th week

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Monoamine Oxidase Inhibitors

• Inhibits action of MAO which is an enzyme to
  breakdown NE, 5-HT
• Used for unresponsiveness to TRIs
• Used less frequently due to interaction with
  other substances (e.g. wine cheese)

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MAO

• Drugs Foods to Avoid
• Over the counter cold and sinus, stimulants,
  cheese, yogurt, caffeine, wine, beer, cream,
  chicken liver.

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Tetracyclic SSRI (2nd generation)

• Serotonin specific, less toxic, fewer side
  effects than 1st gen (trycyclics)

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Other SSRIs sometimes used for depression
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Link to NIMH

• http//www.nimh.nih.gov/publicat/NIMHmedicate.pdf

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Children
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Anxiety

• Define normal vs. abnormal
• Anxiolytics (ANGK-see-oh-LIT-ick)
• Drugs used to relieve or prevent anxiety
• 70 sedative / benzodiazepines
• DSM-IV
• High variance in anxiety classification
  (generalized, panic, phobia, etc.)
• Genetic to Conditioned Experience

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Risks

• Anxiety comorbid with other conditions
• Benzo reduced impulse control
• Depression low control Suicide risk
• Addiction or Dependency
• Over prescribing anti-anxiety meds.
• Cover up underlying problems
• Reduce anti-anxiety mgmt through therapy
• Sudden discontinuation may create reversal
  effects (strokes, seizure, panic)

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Etiology

• Heightened arousal
• Decrease in GABA or abundance of norepinephrine
• GABA most abundant inhibitory NT
• Overactive limbic or RASystm
• 5-HT works as opponent to NE in brain stem
  (prozac, zoloft, luvox). Accounts for success of
  anti-depressants in treating OCD.
• 5-HT inhibits species specific behavior.
• Benzo inhibit Amygdala

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ADHD

• DSM-IV (ADHD Inattentive, Hyperactive, Combined,
  NOS)
• 6 of 9 symptoms
• Genetic contribution, extreme of normal
  variation.
• Delay of reinforcement
• Dopamine Reduction methylphenidate decreases
  reuptake of DA.

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Stimulant Meds
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Psychotic

• DSM IV Catatonic, Disorganized, Paranoid,
  Residual, Undifferentiated.
• Positive and negative symptoms
• DA hypothesis-overactivity of DA in mesolimbic
  system
• Genetic, prenatal viral exposure, stress

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• Phenothiazines DA 1 and DA 2, 4-6 weeks effect
  (Mellaril, Thorazine, Prolixin, Stelazine,
  Vesprin)
• Butyrophenones (Haldoperidol (Haldol)) more
  effective but high extrapyramidal ef.
• 2nd generation
• Clozaril (DA, 5-HT), Risperdal (?DA, 5-HT),
  Serlect, Zyprexa
• Safer, less side effects