Ch. 8 Psychotherapeutic Drugs

Question 1

are psychological disorders also biological disorders?

Answer 1

the medical model of psychological disorders has supporters and detractors
FOR
- medicine can treat symptoms
- disorder risk is often hereditary
- this approach is destigmatizing
AGAINST
- there aren’t diagnostic biological markers for mental disorders
- reduces attention to environmental and personal factors
- medication might pre-empt using other strategies

Question 2

what is a psychotherapeutic drug?

Answer 2

any drug that is used to treat a mental disorder. some disorders are treated with drugs routinely; others not so much.
some disorders respond very well to drugs; some do not.
all of these drugs have potential side effects. costs and benefits should be weighed, not necessarily just financial.

Question 3

how has medication made a difference?

Answer 3

before the 1960s, patients might be institutionalized for life. laws passed in the 1970s changed approach to institutionalization. these are changes that have been good for some people, but not everyone. lifetime institutionalization is now rare.

Question 4

what are the issues with psychotherapeutic drugs?

Answer 4

• potential for teratogenic effects
• anticholinergic effects initially
• palliative; controls symptoms, but cannot sure a disorder
• side effects
• “off-label” prescriptions; using a drugs for something it isn’t approved for, insurance may not cover it

Question 5

what is the research of psychotherapeutic drugs?

Answer 5

• often discovered by accident
• carefully evaluate how data is controlled; a high dropout rate in the drug group should be scrutinized
• statistical significance doesn’t necessarily mean clinical significance

Question 6

what are antipsychotics?

Answer 6

drugs that reduce some symptoms of psychotic disorders.
schizophrenia is the usual target for antipsychotics. changes in the DSM-5 have effectively placed disorganized symptoms in a separate category. schizophrenia often presents with cognitive symptoms that aren’t very responsive to antipsychotics.

Question 7

what are the positive (present) symptoms of schizophrenia?

Answer 7

hallucinations, delusions, disorganized speech, disorganized behavior

Question 8

what are the negative (absent) symptoms of schizophrenia?

Answer 8

flat or inappropriate affect, withdrawal, poverty of speech (mute)

Question 9

what are the two types of antipsychotics?

Answer 9

traditional (first gen) and atypical (second gen)

Question 10

what are traditional antipsychotics?

Answer 10

antipsychotics that block D2 receptors.
extrapyramidal side effects: Parkinson-like symptoms, sedation, shuffling, restlessness
- tardive dyskinesia
- anticholinergic symptoms
- works well in reducing hallucinations and delusions
- many patients don’t respond to them
- not lethal in overdose but there is a rare, possibly lethal, reaction called malignant neuroleptic syndrome
- sometimes used off-label as antihistamines or anti-nausea drugs

Question 11

what do atypical antipsychotics do?

Answer 11

• post 1990s
• blocks several dopamine and serotonin receptors
• some decrease in negative as well as positive symptoms
• calming effects
  side effects
• sedation
• weight gain
• increased risk of diabetes type II with some drugs
• some extrapyramidal effects, less severe than with traditional drugs

Question 12

what are the issues with antipsychotics?

Answer 12

both categories gave equally mediocre compliance rates. repository injections can get around compliance issues. traditional drugs are more of a “known” entity and less expensive. atypical drugs often work for non-responders of traditional drugs.

Question 13

what are the symptoms of depression?

Answer 13

• depressed mood OR feeling numb
• crying
• guilt
• feeling hopeless
• loss of interests and motivation
• symptoms must be present for at least two weeks
• more common in women
• mild to moderate depression can respond to external treatments

Question 14

anti-depressants

Answer 14

• placebo-controlled trials almost always have a placebo effect
• placebos often work at first, but lose effectiveness
• all anti-depressants carry a black-box warning that reflects concerns about children and adolescents
• effects usually emerge in 2-6 weeks
• anti-depressants (particularly SSRIs) are often used to treat anxiety disorders as well
• have anticholinergic effects

Question 15

what are the categories of anti-depressants?

Answer 15

MAO-inhibitors, tricyclic anti-depressants, SSRIs, and “miscellaneous”

Question 16

MAO-inhibitors

Answer 16

inhibit the enzyme that breaks down monoamines; an old category but still used occasionally

Question 17

what foods should be avoided when taking MAO-inhibitors due the possibility of a “hypertensive” crisis?

Answer 17

• aged cheese
• cured meats or smoked or processed meats
• fermented cabbage
• soy sauce, fish sauce, and shrimp sauce
• improperly stored or spoiled foods
• yeast-heavy items
• certain beans
• alcoholic beverages, especially beer on tap and red wine
• some other foods with modest amounts of tyramines may be eaten in small quantities

Question 18

what are the consequences of eating certain foods on MAO-inhibitors?

Answer 18

• headache
• nausea
• vomiting
• sweating
• fast heartbeat
• dilated pupils
• hemorrhagic stroke and possibly death

Question 19

what are tricyclic (Elavil, Tofranil) antidepressants?

Answer 19

an old category of anti-depressants, named for their chemical structure. TCAs work by inhibiting reuptake of monoamines. these drugs are used for many other reasons, some off-label. first-time user will likely gain weight and have anticholinergic effects.
there are some rare but serious side effects such as serotonin syndrome and malignant neuroleptic syndrome. major issue with TCA is that they are lethal in overdose.

Question 20

what are SSRIs (Prozac, Zoloft, Paxil)?

Answer 20

SSRIs are anti-depressants that block serotonin reuptake. they are much safer in overdose than TCAs. side effects include anxiety, insomnia, nausea, and sometimes weight gain. sexual dysfunction is also commonly reported. there is a clear withdrawal syndrome described for SSRIs.

Question 21

what are the “next generation” drugs?

Answer 21

wellbutrin (bupropion): unique; blocks dopamine reuptake. sometimes used for smoking cessation and ADHD. increases energy
esketamine (spravato): really unique; currently used only for treatment-resistant depression. given in-clinic in spray form for 1 or 2 times/week. works pretty quickly, but not currently intended for long-term use

Question 22

what are the mania symptoms of bipolar disorder?

Answer 22

• the person is very “up”, euphoric or “high”
• a lot of energy and activity
• impulsiveness and overindulgence is common
• little to no sleep
• “mixed” episodes are possible

meds are called “mood stabilizers”; antipsychotics may be in order. the original treatment is lithium salt.

Question 23

what are the mechanism of action and therapeutic index of bipolar?

Answer 23

mechanism of action is very unclear, but it does alter the internal workings of the neuron. it has a narrow therapeutic index, which leads to several issues. it is cleared by the kidneys without being metabolized. side effects include tremor, thirst, nausea, and weight gain. risk of suicide greatly increases if the patient abruptly quits lithium.

Question 24

what are anticonvulsants?

Answer 24

they are the first-order treatment now for bipolar disorder. many effective drugs have been around for years and are not under patent and used off-label. side effects include drowsiness and fatigue, nausea, dizziness, and serious rash.

Question 25

anti-anxiety drugs (anxiolytics)

Answer 25

different drugs are used for different forms of anxiety. some anxiety disorders are successively treated with SSRIs. drugs that are used to treat anxiety are often hypnotics (used to induce sleep). earliest drugs include chloral hydrate and paraldehyde; neither is dispensed in the U.S.

Question 26

what drugs were more problematic than they appeared at first?

Answer 26

meprobamate, methaqualone, and barbiturates. all have effects at the GABA receptor complex, interact with alcohol, are potentially lethal, and have abuse liability.

Question 27

benzodiazepines

Answer 27

receptors at GABA receptor complex. less lethal than others, still interacts with alcohol, still has dependence and abuse potential. can cause sleepiness, cognitive slowing and “fogginess”, and memory problems.