Treatment in psychiatry

Treatment in psychiatry

Maha younis
Professor of psychiatry

Treatment in psychiatry

Drug treatment
Non drug treatment –Psychotherapy
Psychosurgery
Electroconvulsive therapy ECT

Drug treatment of psychosis

Psychosis are group of serious psychiatric disorders characterized by thought and perceptual disorder ,the most important and common type is schizophrenia
Psychosis (short ,temporary,sometimes only symptoms ) can be induced also by drugs like
1-Levodopa
2-CNS stimulants : Cocaine ,Amphetamines
Khat
Apomorphine
phencyclidine


Dopamine theory of –schizophrenia
Increased activity of Dopamin -the cause behind discovery of anti-psychotic medications
]ِ ةIncreased activity of the Dopamenergic system dopamine Correlates:
1-Anti-psychotics reduce dopamine synaptic activity
2-they produce parkinson –like symptoms
3-drugs that reduce DA in the limbic system reduce psychosis
Changes in amount of Homovanillic acid (HVA)in plasma ,urine and CSF

Anti-psychotic treatment

In treatment and prevention of all types of psychosis
Neuroleptics
Schizophrenia must be treated with medications for long times as the disease is life long
They are also used in treatment of associated psychotic symptoms with other psychiatric or physical disorders like Alzheimers disease ,Bi-polar disorder ,organic diseases, as anti-emitics,drug addiction

Anti-psychotics

Old anti-psychotics ;1-phenothiazines , 2-Thioxanthines
3-Butyrophenones
4-Chloroprothioexene
5-Haloperidol
6-Droperidol


Anti-psychotics
Newer drugs
Pimozide
Molndone
Loxapine
Clozapine
Olanzapine
Qetiapine
Risperidone
olindone

Anti psychotics

Clinical problems with anti-psychotics includes;
1-failur to control negative effect
2-significant toxicity
3-parkinsone like symptoms
4-Tardive Dyskinesia
5-endocrine effect
6-cardiac effect
7-poor concentration


Mood stabilizers
Bi-polar 1 ,Bipolar 2
Lithium
Valproate
Olanzapine
Anti-convulsants
Carbamazepine
Lamotrgine
Second generation antipsychotics
Clozapine\resperidine
Quetiapine

Mood stabilizers

Lithium
Salt used in treatment of Bi-polar
Very narrow therapeutic window ,1.2
maximum therapeutic plasma level and more than 1.5 toxic symptoms starts to occur
Adverse effect of Lithium
Polydipsia
Hand tremor
Headache
Decreased concentration and memory
Risk of diabetes insipidus and nephrotoxic kidney
hypothyroidism

Mood stabilizers Anti-convulsants

Valproic acid
Carabmazepine
MOA
Adverse effects: weight gain,hair loss ,sedation
Lithium remains the first choice
Drug combination-anti-psychotics+antionvulsants are still commonly used
Quitepine ,olanzapine are the most commonly used anti-psychotics in treatment of Bi-Polar
used

Sedatives ,hypnotic drugs

Normal sleep consists of 4 stages based on 3 physiologic measures ,EEG,elctromyogram,electro nystagmogram
Non –rapid eye movement (NREM)sleep ;70%-&75%
Stage 1.2
Stage 3,4 ;slow waves sleep ,sws
Rapid eye movement(REM)sleep


Pharmacological action
An effective sedatives (anxiolytic)agent should reduce anxiety and exert a calming effect with little or no effect on motor or mental function
A hypnotic drug should produce drowsiness and encourage the onset and maintenance of a state of sleep that as far as possible resembles sleep state

Sedatives and hypnotics

Benzodiazepines: large safety margine doesn’t effect the vital organ when given oraly in overdaose
Barbiturates ; rarely used as sedative nowadays ,older generation cause CNS depression which lead to comma and death will follow at overdoses resembling state of general anesthesia because of respiratory depression and vasomotor depression
Chlordiazepoxide was invented at 1961,dervatives of 1,4 benzodiazepine ,they are basically similar in their phramacological actions ,though some degree of selectivity has been reported

Sedatives

Difference in pharmacokinetic behaviour are more important than difference in profile of activity,selectivety with to 2 types of benzodiazepine receptor may account for these difference
Pharmacological effects
1-reduction of anxiety and aggression; affect the hypocampus and nucleus amygdalae
2-sleep promotion by sedation;
Latency of sleep onset is decresed
Duration of stage 2 NREM sleep is decresed

sedatives

Clinical use ,advantage
1-wide safety margin
2-little effect on REM sleep
Little hepatic microsomal drug-metabolozing enzymes
4-slight physiological and psychological dependence and withdrawal syndrome
5-less adverse effect such as residual drowsiness and incoordination movement
6-anti-convulsants ;they are highly effective against chemically induced convulsions less against electrically induced one
Induce GABA-medicated synaptic syst ems and inhibit excitatory transmission


uses
Muscle relaxation
Act selectively on GABAreceptors by enhancing the response produced by GABA-ergic neurons
Relax contracted muscle in joint disease

Side effects

1-temporary amnesia
2-decrese dosage of anesthesic drugs
Depress respiratory and cardiovascular function

Anti-depressants

depression

It is a common psychiatric disorder characterized by low mood most of the day subjectively and by others
2-diminshed interest in all ,or most of previous activities
3-apetite ,wt changes ;loss or incresed
4-insomnia or hypersommnia
5-decresed concentration and power of discion
Ideas ,thoughts ,images of death ,sucidal thoughts
6-no organic explanation


Anti-depressants





















Anti-depressants

psychosurgery

It is an old treatment before the invention of modern psychiatric medication
Frontoloboctomy
Selective frontotemporal lboctomy
It affect the cognitive function and personality characters
It was indicated in sever types of OCD and psychosis