Essential psychopharmacology最新文献

The smoking rate for patients with schizophrenia reaches as high as 90% in clinical samples, 70% for patients with bipolar disorder, and 40% to 50% for patients with major depression and anxiety disorders. Because it is a significant health hazard, smoking should be aggressively discouraged, and, in this group of patients, a combination of behavioral therapy and pharmacotherapy currently offers the best option. Nicotine provides a number of benefits, including anxiety relief, increased alertness, and improved cognitive functioning. It alters a wide range of central nervous system neurotransmitters. Unfortunately, nicotine readily establishes physiological dependence. In cessation efforts, transdermal nicotine patches and nicotine gum are helpful adjuncts. The primary FDA approved non-nicotine pharmacotherapy agent is bupropion (Zyban). Studies summarizing the effectiveness (or lack thereof) of other (off-label) agents, such as tricyclic antidepressants, MAO-Inhibitors, SSRIs, and clonidine, are cited.

Treatment-resistant depression (TRD) is not uncommon; 29% to 46% of patients with depression who are treated with antidepressants fail to respond fully. Dr. Papakostas discusses various augmentation strategies, focusing particular on a possible role for the newer atypical antipsychotics. Their complex neuropharmacological actions suggest such efficacy. One chart review and a number of open-label studies have been encouraging, but 2 double-blind, placebo controlled-studies have offered contradictory results. Considering the side-effect profiles of these drugs, a careful risk/benefit assessment is always required. While routinely used for psychotic depression and panic reactions in depressive disorders, their value as augmenters in TRD awaits further study.

Schizotaxia is a stable syndrome of neuropsychological deficits and negative symptoms found in relatives of schizophrenic patients. These may represent special vulnerability to schizophrenia. Five areas of deficit are enumerated and suggestions as to the potential value of pre-illness interventions are discussed.

Medications are commonly used in the elderly population. Because of a variety of treatments now available, many disease states now have very effective treatment. As a result, our elderly patients often take multiple medications. Due to various changes that occur, the elderly are at increased risk of adverse drug effects and drug toxicity potentially resulting in serious complications. Some medications have a greater potential to cause harm and these should be made aware to those who prescribe to elderly patients. Some of these medications should not be used if at all possible, while others, if used, need to be used with great caution, watching carefully for signs of problems. This article describes a variety of medications which have an increased potential for causing harm in elderly patients and gives alternatives of safer medications consideration.

Objective measures of attention, concentration, and motor activity can be used effectively in the assessment and differential diagnosis of bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD) in children. Children with BD were evaluated using actigraphy and the McLean Motion Analysis Test (M-MAT), and the results were compared with age- and gender-matched ADHD and normative data. Actigraphy indicated decreased sleep efficiency and duration with BD, with a longer latency and increased nocturnal activity. Using M-MAT clinicians were able to detect cognitive impairment and activation in children with mania, and worse-than-normal scores on measures of attention and increased levels of activity and impulsiveness in children with BD. Thus, objective measures of attention and activity can be of assistance in the differential diagnosis of ADHD and BD.

Drs. Alam and Janicak briefly review the current indications and problems associated with the use of atypical antipsychotics in schizophrenia treatment. When called for, they may be augmented by mood stabilizers, such as lithium; antidepressants; benzodiazepines (for rapid tranquillization during agitated psychotic episodes); and stimulants, even nicotine, to improve cognition. Even though extrapyramidal side effects are less frequent and less intense that those seen with traditional antipsychotics, they do occur; the authors spell out the attributes of those patients who are most vulnerable. Clinicians should also look for weight gain and the risk of activating or aggravating type 2 diabetes in patients, as well as cardiac risk involving prolongation of the QTc interval. Because, despite of modern approaches to treatment, 80% of patients end up rehospitalized and only 1 in 3 can be said to have a good level of socialization, active measures must be taken to ensure continuity of care, monitoring for prodromal symptoms, early intervention, and psychosocial rehabilitation.