Medication for Mental Disorders

Medication for Mental Disorders Mental Disorders: The Medical model Patients appear with a set of symptoms based on which a diagnosis of the disease is made Cure is provided after determining the cause of the disease • Criticism of the model usually the only symptoms of mental disorders are behavioral behaviors are varied and can have many causes model guides much of the current thinking about behavioral disorders Prychoactive drugs are used to control symptoms of mental illness researchers seek to identify chemical imbarance associated with specific mental disorders Classification of Mental Disorders diagnostic and statistical manual of mental disorders, or the DSM-5 -developed by the American Psychiatric Assosciation provides criteria for classifying mental disorders into hundreds of specific diagnostic categories terms and definitions have become Standard for all mental health professionals Mental Disorders • anxiety disorders Characterized by excessive worry, fears, or avoidance anxiety disorders classified under the DSM-5 Specific phobia Social anxiety disorder panic disorder agoraphobia generalized anxiety disorder psychosis a Serious mental disorder involving loss of contact with reality Schizophrenia classified under the DSM-5 Symptoms: 2 or more of the following, including at least one from the first 3: * delusions hallucinations * disorganized speech * disorganized benowior * lack of emotional response interference with Social or occupational function - duration of at least 6 months mood disorders Characterized by depressed or manic symptoms * individuals don't always fit neatly into one of the above categories distinction in the DSM5 is between: *major depressive disorder only depressive episodes #bipolar I disorder ↳ at least one manic episode and possible alternating Periods of depression Early Treatment of Mental Disorders "malaria therapy" introduced in 1917 to treat general paresis, a Syphilitic infection of the nervous system that causes psychosis Fever associated with malaria was thought to improve the condition eliminated by the discovery of antibiotics that could cure syphilis "narcosis therapy" in 1920s depressants were used to induce sleep for a week or more intravenous dose of thiopental Sodium or "truth serum" uses during psychotherapy to help patients express repressed thoughts insulin therapy used to treat Schizophrenia repeated treatments were problematic as the patients became agitated in the few minutes after the drug was administered and before the seizures began. electroconvulsive therapy, or ECT no long-term benefits for schizophrenia Still used to treat Severe depression that does not respond to medication • by the 1950s, paraldehyde, a sedative, was the major drug in use for severely disturbed patients in large mental hospitals Antipsychotics •phenothiazines an early group of drugs used to treat psychosis reduced psycnatic Symptoms without Sedation initially called tranquilizers or neuroleptic drugs now called antipsychotics • following the introduction of drug therapy for schizophrenia, restraints and convulsive therapies were reduced or discontinued in psychiatric hospitals atypical antipsychotics mechanism of action differs from that of phenothiazines all recent antipsychotics are atypical Antipsychotics: Mechanism of Action typical antipsychotics response of the nervous system to repeated administration of dopamine antagonists block D2 dopamine receptors - produce pseudoparkinsonism atypical antipsychotics -referred to as seretonin dopamine antagonists block both D2 dopamine and 5 HT2 A seretonin receptors Produce less pseudoparkinsonism lag time of around 10-14 days, true mechanism of action-unknown Clozapine * risk: produces a deadly suppression of white blood cell production Antipsychotics: Advantages and Side Effects advantages: generally safe do not produce drug dependence difficult to use them to commit suicide •Side effects Some allergic reactions *ex: Jaundice and skin rashes Photosensitivity arangulocytosis, a low white blood cell count pseudoparkinsonism symptoms *ex: tremors, muscular rigidity, a Shulling walk, and a masklike face tardive dyskinesia * most serious complication of drug treatment Antipsychotics: Effectiveness long-term effectiveness appears to be considerably lower than Short-term effectiveness -3/4 of the patients discontinue use by 18 months there is no clear evidence that atypical antipsychotics work better than the conventional drugs use in Children and the elderly "Children: high risk of weight gain and metabolic changes combined with obesity, diabetes, and Cardiovascular problems Elderly significant increase in death risk from Cardiovascular and other problems Antidepressants monoamine oxidase inhibitors ex: phenelzine and tranylcypromine tricyclics ex: amitriptyline, doxepin, amoxapine, desipramine, imipramine, protriptyline, and normrityline Selective reuptake inhibitors ex: Fluoxetine, citalopram, desvenlafaxine, duloxetine, escitalopram, venlafaxine, sertraline, and paroxetine Others ex: bupropion, mirtazapine, and trazodone Monoamine Oxidase, or MAO, Inhibitors • MAO inhibitors iproniazid elfective in treating tuberculosis mechanism of action elevates mood increase the availability of seretonin, norepinephrine, and dopamine by inhibiting their enzymane breakdown limited use because of side effects and tonicity after the normal metabolism of tyramine, a dietary amino acid ex: hypertensive crisis or "cheese reaction" Tricyclic Antidepressants discovery imipramine: a drug that elevated mood resulted from the search for better phenothiazine antipsychotics mechanism of action "increase the availability of seretonin, norepinephrine, and dopamine at the synapse by interfering with their reuptake not effective in au patients, but the depressive episodes are less severe and resolve more quickly Selective Reuptake Inhibitors types of selective reuptake inhibitors SSRIs or selective seretonin reuptake inhibitors SSNRIS or selective seretonin and norepinephrine reuptake inhibitors mechanism of action increase the availability of seretonin or norepinephrine at the synapse by interfering with reuptake can take as long as to weeks to observe effects, while seretonin levers may increase within an hour Safer than tricyclic antidepressants and are less likely to lead to overdose deaths Some unusual violent or Suicidal reactions were reported in the early PADS Electroconvulsive Therapy, or ECT most effective treatment for severe depression best treatment choice in cases with a risk of Suicide can be used in conjunction with drugs Comparison with pharmacotherapy ECT relieves the symptoms of depression faster ECT is more effective than the most effective class of antidepressant drugs