Psychopharmacology

Question 1

Antidepressants

Answer 1

Tricyclic Antidepressants (TCAs)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)

Question 2

Tricyclic antidepressants

Answer 2

E.g. amitriptyline, lofepramine
Not first line medications, more often used for neurological pain and helping people sleep
Inhibit 5-HT (serotonin) and NA uptake
-produces therapeutic effect
-side effects of 5-HT makes you drowsy (antihistamine)
Block of M1, H1, alpha1 receptors produces side effects
-side effects: changes to BP
-side effects of H1 (antihistamine) makes you drowsy
-side effects of M1: dry mouth

Question 3

Selective serotonin reuptake inhibitors

Answer 3

E.g. fluoxetine, sertraline, citalopram.  
Inhibit 5-HT uptake
-produces therapeutic benefit
-depression
-OCD, Panic, anxiety
Produces side effects
-nausea
-early increased anxiety
Well tolerated and good first line treatments

Question 4

Serotonin and noradrenaline reuptake inhibitors

Answer 4

E.g. venlafaxine
Inhibit 5-HT and NA (and DA) uptake
-produces therapeutic effect
-produces side effects (similar to SSRI)
Better tolerated than TCAs and ? more effective than SSRIs for severe depression

Question 5

Anxiolytics/ hypnotics

Answer 5

Benzodiazepines e.g. diazepam & lorazepam
-relieve anxiety immediately, good for short term use
-S/E’s - very few except dependency
“Z-drugs” – Zopiclone
-used as hypnotics due to shorter half lives
Pregabalin
Antidepressants are the drugs of choice for treating anxiety but take longer to work

Question 6

Antipsychotics

Answer 6

Typicals/first generation antipsychotics
-e.g. Haloperidol
Atypicals/second generation antipsychotics
-e.g. Olanzapine and Risperidone

Question 7

Atypical antipsychotics- core pharmacology

Answer 7

D2 and SHT2A (adrenergic) receptor

-supposed to have effects on positive and negative symptoms of schizophrenia

Question 8

Mood stabilisers - lithium

Answer 8

Narrow therapeutic index
Renal and thyroid dysfunction
Teratogenic
Interaction with other drugs (e.g. NSAIDs)

Question 9

Mood stabilisers - valproate

Answer 9

Not for women of child bearing potential due to teratogenicity

Question 10

Clinical use of drugs in psychiatry: fundamental principles

Answer 10

Assessment of risk/benefits
Consideration of costs
Full discussion with patient
Informed choice by patient
Repeated monitoring and re-assessment
Integration with other treatments

Question 11

Non-pharmalogical approaches

Answer 11

Electroconvulsive Therapy (ECT)
Phototherapy: seasonal affective disorder
Psychological Therapies
-behavioural Therapy
-cognitive Therapy
-family Therapy
-sex & Relationship Therapy
-art Therapy
Social Interventions: 
-occupational Therapy: Daily living skills training
-finance, Accommodation, Employment
Rehabilitation
-for chronic mentally ill
-maximise potentials & minimise disabilities

Question 12

Typical antipsychotics

Answer 12

E.g. haloperidol
Block D2 receptors
-Therapeutic effects
-EPSEs
Also antagonise histamine, NA and acetylcholine receptors causing side effects