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PubMed1986

Emergency psychopharmacology: a review and update.

The emergency area is a difficult site for the practice of careful psychopharmacology. The detailed history taking and collaborative treatment relationship often found in the consultant's office is rarely present. Instead, rapid decisions are made under a variety of pressures, with patients who may be uncooperative and unwilling to be treated. Many emergency patients are concurrently in treatment with a psychotherapist or psychopharmacologist who is available for consultation to the emergency service. When this is possible it is of great potential value, both in arriving more quickly at an appropriate treatment and in preventing a harmful opposition of the patient's treatment resources. For patients who are not currently in another treatment, additional helpful information often may be obtained from friends or family members. This is especially useful in treating patients who are acutely psychotic, unable to communicate, or uncooperative with the emergency interview. Although psychopharmacological approaches properly chosen often yield rapid results, medications are only a part of most emergency treatment plans. Medications are ineffective in a variety of crises and cannot replace careful interviewing of patients and others aimed at understanding the exogenous stress, change in interpersonal relationships, intrapsychic conflict, or biological disorder that precipitated an emergency visit. Furthermore, the decision to treat with medications must include a consideration of the adverse effects that may occur. With these limitations in mind, the area of emergency psychopharmacology can provide powerful assistance to emergency clinicians.

Acute Disease↗

PubMed2002

Psychopharmacological treatment of patients with HIV and AIDS.

Psychopharmacological treatment of patients with HIV/AIDS is an important aspect of managing distress and enhancing quality of life. This article reviews the psychopharmacological management of depression, anxiety, mania, and psychosis in the context of HIV/AIDS, with a discussion of psychotropic-antiretroviral drug interactions. While psychopharmacological management of HIV/AIDS patients may be complex, there is a substantial amount of clinical and research information describing both conventional and novel approaches that are safe and effective.

Acquired Immunodeficiency Syndrome↗

PubMed1984

[Effect of psychopharmacologic therapy on sexual functioning].

Undesirable effects of psychopharmacological treatment on sexual functioning in males and females are summarized in this paper. As the review suggests, all substances used in psychiatric pharmacotherapy might affect sexual functions to a marked extent, a fact which can be explained by different properties of the medication. Review of the literature reveals that the disturbances most frequently provoked by the different substances are diminished sexual interest and ejaculatory impairment. This conclusion can be drawn despite a lack of controlled studies giving indication as to the frequency and practical importance of the effects of psychopharmacological treatment on a patients sexuality. Contrary to expectations, sexual impairment in most of the reports is clearly attributable to a special substance and appears to be independent of the basic psychiatric disturbance. One of the most intriguing results of the review is that considerably fewer reports on the effects of the medication on female sexuality have been published than on male patients. Reports on female patients deal with impaired reproductive functioning, mainly menstrual cycle disturbances. The need for systematic investigation of the effects of psychopharmacological treatment on sexuality is discussed on the basis of the theoretical importance of these effects for the individual patient and in view of the fact that psychotropic medication is frequently prescribed to patients with sexual dysfunctions or deviations without knowledge of the actual effects of the substances on sexual behaviour.

Anti-Anxiety Agents↗

PubMed1996

The diagnosis and psychopharmacological treatment of trichotillomania: a review.

Recently published literature has given rise to two questions: first, can trichotillomania be considered a variant of obsessive-compulsive disorder? and second, are psychopharmacological treatment strategies, in particular serotonin reuptake blockers, effective in the treatment of trichotillomania? The differences between trichotillomania and obsessive-compulsive disorder were too great to answer the former question affirmatively. To answer the latter question, an overview is given of clinical studies on the effects of psychopharmacological treatment of adolescents and adults with trichotillomania. A total of three studies with control groups and seven without were reviewed. The results varied widely and were inconsistent. The conclusion is that no psychopharmacological treatment strategies can be recommended so far.

Adolescent↗

PubMed1994

[Psychopharmacology since 1952].

When chlorpromazine was introduced into psychiatric therapy in 1952 and thus the modern psychopharmacological era was started, the situation in psychiatry was deplorable. The psychiatric hospitals were overcrowded and obsolete, complementary institutions were widely missing. In Germany, even after introducing the neuroleptic era and the beginning of the thymoleptic epoch in 1957, no decisive improvement took place at first. As late as in the 70s successes of psychiatric reform efforts in the sense of humanization became visible, along with modern psychopharmacotherapy making an important contribution to these improvements. With the social attitude towards the mentally ill changing, this contribution became effective. In 1954 the antipsychotic efficacy of Rauwolfia alkaloids was described; in 1958 the butyrophenones, especially haloperidol, were introduced. In 1957 the antidepressive efficacy of imipramine was discovered, in the same year the psychiatric importance of monoaminoxidase inhibitors was defined. In 1949 Cade published his findings on the antimanic effect of lithium salts. As tranquilizers meprobamate (1955) and chlordiazepoxide (1960) were made available. In 1966 clozapine was introduced. Objections to psychopharmacotherapy, which were not always objective, were often raised. The biochemical research in cooperation with psychopharmacology has made progress, yet the target of clarification of the pathophysiology of the main psychoses has not been reached as yet. At present there is considerable resistance towards a further expansion of psychopharmacology, research being hampered by legal reglementation and bureaucracy. This development must be faced. Psychopharmacotherapy is not yet sufficiently effective and safe; it must be improved.

Europe↗

PubMed2000

Psychopharmacology: an update for psychiatric home care.

Psychopharmacology is a critical component of psychiatric home care. Nurses play an important role in medication management for patients who require this intervention. Knowledge of psychopharmacologic assessment, phases of psychopharmacologic treatment, psychobiology, and critical issues related to specific classes of medication is essential in developing a treatment plan with the patient and implementing it. Recent psychobiology research has indicated the importance of neurotransmitters, genetics, and the effect of the immune and endocrine systems. Critical issues related to anxiolytic medications, mood stabilizers, antidepressants, and antipsychotic (neuroleptic) medications are described.

Humans↗

PubMed1999

Psychopharmacology of pediatric posttraumatic stress disorder.

OBJECTIVE: To review the current knowledge of pharmacotherapy in the treatment of Post-traumatic Stress Disorder (PTSD) as it applies to children and adolescents and to provide a rational approach to medication use in Pediatric PTSD. METHOD: The literature on the psychopharmacology of Pediatric PTSD is reviewed. Additionally, literature is reviewed on the neurobiological systems presumptively involved in trauma as well as studies in the pharmacology of adult PTSD, as they pertain to the treatment of Pediatric PTSD. RESULTS: There are too few studies in the current Pediatric PTSD literature to confirm treatment recommendations. Downward extrapolation from the adult literature combined with an understanding of the neurobiology of PTSD and its comorbid conditions may serve as the basis for a rational pharmacotherapy of PTSD in childhood. The effectiveness of targeting pharmacological agents at PTSD symptom clusters and associated comorbid conditions remains to be verified in controlled clinical trials. CONCLUSIONS: The state of psychopharmacology for Pediatric PTSD is in its earliest stages. While there are insufficient numbers of controlled pharmacological trials to make firm recommendations, the field requires a starting point for a rational psychopharmacological approach. Pharmacotherapy may provide symptom relief of both the debilitating primary symptoms and the comorbid conditions in children suffering from PTSD.

Adolescent↗

PubMed1986

Psychopharmacology of schizophrenia: a European view.

This article describes how psychopharmacological therapy is applied in Yugoslavia and other countries in Central Europe. The first part of the article summarizes experience and customary use of psychopharmacological substances in relation to clinical syndromes, course of disease, and dominant symptoms. In the second part of the article, the experience obtained in treatment with combinations of drugs and in prolonged pharmacotherapy of schizophrenia is described. Finally, the last section of the article addresses the social implications of psychopharmacological treatment and presents some of the problems and disadvantages that accompany this form of treatment.

Acute Disease↗

PubMed2005

Ghrelin plasma levels during psychopharmacological treatment.

The mechanisms underlying weight gain induced by psychopharmacological agents are poorly understood. Because the recently discovered enteric hormone, ghrelin, stimulates food intake, we hypothesized that increases in circulating ghrelin levels might mediate the weight gain caused by certain antidepressants and atypical antipsychotic drugs. Fifty-two patients receiving psychopharmacological treatments were included in the study: 16 patients received antidepressants that are not known to induce weight gain, and 13 patients received mirtazapine or trimipramine, which are antidepressants known to lead to weight gain; 6 patients received clozapine and olanzapine, which have the highest liability among the antipsychotics to cause weight gain, and 17 patients received other antipsychotics. Fasting venous blood samples for the measurement of ghrelin were drawn in the morning between 06:00 and 08:00 a.m. in the second week of treatment. Although psychopharmacological treatment induced significant weight changes in the expected directions (most prominent in the clozapine or olanzapine treatment group), ghrelin levels did not differ significantly between groups. Psychotropic drugs with different propensities to induce body weight gain are associated with similar concentrations of plasma ghrelin in psychiatric patients after a short period of treatment.

Antidepressive Agents↗

PubMed2004

Psychopharmacological treatment of depression, anxiety, irritability and insomnia in patients receiving interferon-alpha: a prospective case series and a discussion of biological mechanisms.

We studied 60 patients receiving a 1-year course of interferon (IFN)-alpha therapy for chronic viral hepatitis. Patients underwent psychiatric assessment before starting the IFN-alpha therapy, and monthly throughout the therapy, using the Structured Clinical Interview for the DSM-III-R, the 17-item Hamilton Depression Rating Scale, the Beck Depression Inventory and the Spielberg State and Trait Anxiety Inventory. Five patients had a baseline diagnosis of major depression and 18 (30%) developed an IFN-alpha-induced psychiatric adverse effect; 12 of these 23 patients received psychopharmacological treatment (patients and clinicians jointly decided the need for treatment). Two of the five patients with baseline depression started an antidepressant treatment (paroxetine) together with the IFN-alpha and successfully completed the IFN-alpha therapy. Ten patients received treatment for the IFN-alpha-induced psychiatric adverse effects (depression in five patients, anxiety in two patients, severe irritability in two patients and insomnia in one patient). Depression was treated with paroxetine, amisulpride or levosulpiride; anxiety and insomnia were treated with benzodiazepines; and irritability was treated with thioridazine. Individual response to medications was measured with the Clinical Global Impression scale. Of the patients with IFN-alpha-induced depression, two received paroxetine (one showed a good response), two received amisulpride (one showed a good response) and one did not respond to levosulpiride but responded to paroxetine. The patients experiencing anxiety or insomnia responded well to benzodiazepines. One patient showed a good response, and one a poor response, to thioridazine for irritability. Only one patient interrupted the therapy because of psychiatric adverse effects. Overall, the 12 patients that received psychopharmacological treatment developed less severe psychopathological symptoms during the IFN-alpha therapy compared to the 11 patients who had untreated baseline depression or untreated IFN-alpha-induced psychiatric adverse effects. Thus, psychopharmacological management can successfully treat psychiatric symptoms in patients who are receiving IFN-alpha.

Adolescent↗

PubMed2001

Therapeutic interactions in a medication education group. Using the psychopharmacology RACE.

1. The Psychopharmacology RACE is an interactive, innovative game that emphasizes group teaching about psychiatric medications and disorders at the clients' levels of functioning. 2. Implementation of the Psychopharmacology RACE provides the opportunity to structure a medication group, impart information, and facilitate the development of therapeutic group factors. 3. Interactive group learning with the Psychopharmacology RACE can be a useful tool to enhance learning when clients are unable to read and understand written materials.

Existentialism↗

PubMed2000

[New psychopharmacological approaches in mental health as applied by the Israel Defense Forces].

In the past decade there have been far-reaching developments in psychopharmacology. Previously, only a few classes of medication were at the disposal of psychiatrists, as many had serious side effects that limited their use. Now our psychopharmacological armamentarium has grown considerably, allowing for greater choice of treatment in the military. We review these developments, and discuss the special considerations to be taken into account when treating soldiers with psychiatric medication. We discuss suitable medication for ongoing outpatient treatment, as well as the standard list of medication currently used by units deployed in the field. Advances in psychopharmacologic treatment should enable more soldiers to serve safely in the military with fewer restrictions on their duties.

Humans↗

PubMedDate not supplied

[Evolution, capabilities and limits of psychopharmacology].

Evolution of psychopharmacology is discussed from the viewpoint of the growth of the number of psychotropic drugs, their use and the rate of scientific reports related to them. Power is discussed from the standpoint of economic perspectives, although it is not the only aim. On the other hand, the influence of the psychopharmacological "boom" on the development of the specialty is analyzed. The limits of psychopharmacology achieve their maximum extent when they are combined with the study of psychological, social and cultural factors and determinants and, hence, to other therapeutic methods.

Combined Modality Therapy↗

PubMed1990

[Evaluation of history and clinical oral examination in patients taking psychopharmacologic agents].

The medical history and clinical oral examination of 125 patients taking psychopharmacologic agents as antipsychotic, antianxiety, antidepressant and hypnotic were studied and evaluated. From this study the following findings were assessed. Most patients taking antidepressant (63.4%) and sedative drugs (28.5%). The more frequent oral manifestations in patients who taking psychopharmacologic agents are the xerostomia (47.4%) and the materia alba of the tongue (25.4%). Finally, the limitations and the modifications in dental treatment are relative of kind and duration of receiving of psychopharmacologic agents and of their interaction with dental drugs.

Adult↗

PubMed1989

[Drug therapy of delusional parasitosis. The importance of differential diagnosis for psychopharmacologic treatment of patients with delusional parasitosis].

In 34 patients suffering from delusional parasitosis the relevance of an accurate differential diagnosis with respect to pharmacological treatment was investigated. Under a psychopharmacological therapy of the delusion's additional psychiatric symptomatology in 17 patients (50%) a full remission and in other 5 patients an improvement of the delusional symptoms was observed. The unexpected high recovery-rate is explained by the fact that all of the patients with additional depression showed a reduction also of the delusional symptomatology after a treatment with antidepressants. In contrast to that, patients with organic brain syndromes underlying the delusions had a significant worse outcome, which seems to be caused by the considerable lack of effective psychopharmacological treatment of such states. The results indicate that an accurate psychiatric differential diagnosis is of great importance for the psychopharmacological therapy of patients suffering from delusional parasitosis. In this context the Viennese decision-tree for delusional syndromes is discussed.

Adult↗

PubMed1989

[Psychological symptoms in patients with hearing and equilibrium disorders and possibilities of treatment with psychopharmacologic agents].

The aim of the investigation was to find out in a group of 130 hospitalized men and women, suffering from impaired hearing and equilibrium, the prevalence of psychic symptoms and psychopathological syndromes and symptoms suitable for psychopharmacological intervention. The method of interview and questionnaire SCL-90 was used which makes it possible to extract from quantifiable answers to 90 questions 10 symptoms constructions (dimensions) which roughly correspond with psychopathological syndromes. Psychopathological syndromes which are associated with the basic disease and are suitable for psychopharmacological intervention are in both sexes the following: somatization, depression, anxiety, phobic anxiety, impaired sleep and appetite. The assessed symptoms corresponding to a varying extent to the items of the questionnaire in both sexes are within the mentioned dimensions. In the subsequent stage the authors differentiate psychopathological syndromes and symptoms in acute and chronic ENT disease of the investigated groups. The authors maintain that psychopharmacological drugs influence in a favourable way not only the present mental symptoms in the framework of secondary psychopathology but also the psychosomatic component of the basic disease and thus have a favourable effect on its course. The author recommend some antidepressants, anxiolytics and neuroleptics to be used in small doses.

Adult↗

PubMed1981

Interfaces of psychopharmacology and cardiology--part one.

At least 10% of the American population medically use prescribed psychopharmacological medications; and such psychotropic medications account for approximately 20% of all prescriptions in this country. Furthermore, there is widespread illicit use of psychoactive drugs, including narcotics, psychostimulants, and central nervous system depressants. All of these agents have potent effects on the cardiovascular system and, in addition, may undergo numerous drug-drug interactions with cardiovascular medications. Given the high incidence of both cardiovascular disease and psychoactive drug use in the United States, it is likely that clinicians manage many patients with cardiovascular disease, possible receiving cardiovascular medications, and also needing psychopharmacological interventions. Consequently, the authors have reviewed the pharmacology of the major classes of psychoactive agents: (I & II) Antidepressants (tricyclic antidepressants and monoamine oxidase inhibitors); (III) Lithium Carbonate; (IV) Major Tranquilizers (phenothiazines, thioxanthines, butyrophenones, reserpine); and (V) Minor tranquilizers, Sedatives, and Hypnotics (benzodiazepines and barbiturates) with respect to their cardiotoxicity, cardiovascular side effects, and drug-drug interactions. Management of the cardiovascular complications of psychotropic overdose is discussed, as well as potential therapeutic uses of psychopharmacological medications in patients with cardiovascular pathology.

Analgesics, Opioid↗

PubMed1981

Interfaces of psychopharmacology and cardiology--Part two.

At least 10% of the American population medically use prescribed psychopharmacological medications; and such psychotropic medications account for approximately 20% of all prescriptions in this country. Furthermore, there is widespread illicit use of psychoactive drugs, including narcotics, psychostimulants, and central nervous system depressants. All of these agents have potent effects on the cardiovascular system and, in addition, may undergo numerous drug-drug interactions with cardiovascular medications. Givaen the high incidence of both cardiovascular disease and psychoactive drug use in the United States, it is likely that clinicians manage many patients with cardiovascular disease, possibly receiving cardiovascular medications, and also needing psychopharmacological interventions. Consequently, the authors have reviewed the pharmacology of the major classes of psychoactive agents: (I & II) Antidepressants (tricyclic antidepressants and monoamine oxidase inhibitors); (III) Lithium Carbonate; (IV) Major Tranquilizers (phenothiazines, thioxanthenes, butryophenones, reserpine); and (V) Minor Tranquilizers, Sedatives, and Hypnotics (benzodiazepines and barbiturates) with respect to their cardiotoxicity, cardiovascular side effects, and drug-drug interactions. Management of the cardiovascular complications of psychotropic overdose is discussed, as well as potential therapeutic uses of psychopharmacological medications in patients with cardiovascular pathology.

Adrenergic alpha-Antagonists↗