Overview of Psychiatric Pharmacology

Overview of Psychiatric Pharmacology

October 2013

Disclaimer:

• I have no financial ties to any pharmacology concerns.

Objectives

I. Consider the context of treatment.II. An overview of common psychiatric

conditions.III.A brief history of medical treatments for

psychiatric illnesses.IV. Categories of psychiatric medications.V. Principles of treatments

Introductions

• Who am I ?• Who are you?

DSM –IV-TR and DSM -V

• Defining mental illness.• Diagnostic and Statistical Manual of Mental

Disorders –IV-TR offers a descriptive nosology.

• PSYCHOTIC DISORDERS• MOOD DISORDERS• ANXIETY DISORDERS

PSYCHOTIC DISORDERS

• SCHIZOPHRENIFORM DISORDER• SCHIZOPHRENIA’S• DELUSIONAL DISORDERS• PSYCHOTIC DISORDER NOT OTHERWISE

SPECIFIED• SCHIXOAFFECTIVE DISORDER

MOOD DISORDER

• DYSTHYMIA• MAJOR DEPRESSIVE DISORDER• BIPOLAR DISORDER TYPE 1• BIPOLAR DISORDER TYPE 2• BIPOLAR, DEPRESSIVE DISORDER, MOOD

DISORDER(NOT OTHERWISE SPECIFIED)

ANXIETY DISORDERS

• PANIC DISORDERS AND AGROAPHOBIAS• OBSESSIVE COMPULSIVE DISORDERS• PASTTRAUMATIC STRESS DISORDER• GENERALIZED ANXIETY DISORDER • ANXIETY DISORDER NOT OTHERWISE

SPECIFIED

• Consider the issues of : SUBSTANCE DISORDERS PERSONALITY DISORDERS

A BRIEF HISTORY OF SOMATIC TREATMENTS

( OR BAD IDEAS)

CONSIDER THE CONTEXT OF TREATMENT IN 1950 THERE WERE OVER 8000 PATIENTS IN 5

STATE HOSPITALS IN OKLAHOMAIN 1955,4 IN A THOUSAND WERE

INSTITUTIONALIZEDNOW THERE ARE LESS THAN 400 AND ANOTHER

COUPLE OF100 IN CRISIS CENTERS

• 1933: Sakel introduced insulin coma therapy as a treatment for schizophrenia and to treat morphine withdrawal.

• 1934: Von Meduna, a Hungarian physician, gave IM injections of camphor to cure mental illness by seizure, but it was not a reliable enough epileptic agent.

• 1935: Ivan Pavlov and Portuguese neurosurgeon Egas Moniz saw two chimpanzees become imperturbable when their frontal lobes were surgically removed.

• 1935” Egas Moniz performed his first leucotomy on a female patient, destroying connecting fibers from the frontal lobes. Agitation and paranoia were replaced by dullness and apathy.

• 1936: Freeman and his neurosurgeon partner James Watts modify Moniz’s leucotomy and perform the first prefrontal lobotomy on Alice Hammat, a Kansas housewife.

• 1939 through 1945 with the onset of WWII, the US army began to classify psychiatric illnesses systematically.

• 1946: Sallie Lonesco was the first to receive a transorbital lobotomy in Freeman’s Washington D.C. office.

• 1949: Australian physician J.F.J. Cade introduced lithium for psychosis.

• 1949: Moniz wins the Nobel Prize for lobotomy. He also had developed cerebral arteriography.

• In 1952, Henri Laborit, a surgeon in Paris, was looking for a way to reduce surgical shock in his patients by reducing the amount of anesthesia used.

• . He was so struck by the effect of a drug called chlorpromazine (trade name Thorazine).People were much quieter, rather indifferent and he pushed this drug to psychiatrists.

• Thorazine was introduced in the US as an anti nausea drug.

• In 1955 it was repackaged as antipsychotic. Up till then in institutions, only sedatives were offered …and this was more than just a sedative.

• Thorazine is still used though it is not a first choice due to side effects.

• Side effects, Parkinson’s syndrome, led to an understanding of the neurochemistry of psychosis and led to the development of other agents.

Typical antipsychotics

• Chlorpromazine ( Thorazine)• Fluphenazine (Prolixin)• Haloperidol ( Haldol)• Loxapine ( Loxitane)• Pimozide ( Orap)• Perphenazine ( Trilafon)• Thioridazine (Mellaril)• Thiothixene ( Navane)

• Trifluoperazine ( Stelazine)• Prochlorperazine ( Compazine)• Loxapine ( Loxitane)Prolixin ( Fluphenazine) is available in an IM

injection to be given every two weeks.Haldol ( Haloperidol) is available in an IM

injection to be given every four weeks.

New generation antipsychotics

• The first was Clozaril ( Clozapine). It was considered a miracle drug, rather like Thorazine, and like Thorazine it has substantial side effects ….and has been used as a motivating force for the development of new drugs.

• Clozaril( clozapine)• Zyprexa ( olanzapine)• Seroquel ( quetiapine)• Risperdol ( risperidone)• Abilify (ariprprazole)• Fanapt ( iloperidone)• Geodon ( ziprasidone)• Invega ( paliperidone)

• Latuda ( lurasidone)• Saphris ( asenapine)• Risperdol, Invega, Zyprexa and Abilify are all

available in long acting IM injections.