CHAPTER 21 Drugs and other physical treatments Zhang Lei SIR RUN RUN SHAW HOSPITAL

Aim Grasp Concepts and classification of psychotropic drugs Grasp the indications, contraindications, side effects of antipsychotic drugs, antidepressants, mood stabilizers, anxiolytic and psychostimulants Be familiar with the indications and side effects of electroconvulsive therapy (ECT)

History of physical treatments

Pharmacokinetics of psychotropic drugs Absorption Distribution Metabolism Excretion

Pharmacokinetics of psychotropic drugs Measurement of circulation drug concentrations Pharmacodynamic measures Plasma half-life Drug interactions Pharmacokinetic interactions Pharmacodynamic interactions Drug withdrawal

General advice about prescribing Use well-tried drugs Give an adequate dose Use drug combinations cautiously Dosing and treatment duration What patients want to know Compliance, concordance, and collaboration

Prescribing for special groups Children and the elderly Pregnant women: benefit and risk Anxiolytics and antidepresssants Antipsychotic drugs and mood stabilizers Neonatal toxicity Breast-feeding

What to do if there is no therapeutic response Drug dose? Other drugs? Diagnosis?

The classification of drugs used in psychiatry Antipsychotic: schizophrenia and mania Antidepressant: major depression Mood stabilizer: mania Anxiolytic: anxiety disorder Hypnotic: insomnia Psychostimulant: narcolepsy

Antipsychotic drugs Typical Atypical Chlorpromazine Risperidone Olanzapine Aripiprazole Ziprasidone

Antipsychotic drugs Pharmacology Pharmacokinetics Drug interactions Unwanted effects Contraindications to antipsychotics drugs Antipsychotic drugs and risk of sudden death

Antidepressant drugs SSRI: fluoxetine, fluvoxamine, paroxetine, sertaline, citalopram, escitalopram Mirtazapine Venlafaxine Duloxetine Trazodone Mianserin Reboxetine Buropion

Antidepressant drugs Pharmacokinetics Efficacy of SSRIs in depression Unwanted effects of SSRIs Interactions with other drugs

Mood stabilizing drugs Lithum Carbamazepine Sodium valproate Lamotrigine Gabapetin

Anxiolytic drugs Benzodiazepines Azapirones(buspirone) Antidepressant drugs used for anxiety

Hypnotics Benzodiazepines Zopiclone, zolpidem and zaleplon

Electroconvulsive therapy

Electroconvulsive therapy (ECT): indications 1 severse depressive illness 2 high suicide risk 3 catatonia 4 rufusal of foods and fluids 5 severse manic episode

ECT Mode of action Physiological changes during ECT Unilateral or bilateral ECT Unwanted effects after ECT Memory disorder after ECT Mortality of ECT Technique of administration Anaesthetic procedures

ECT Frequency and number of treatment Prevention of relapse Consent to ECT

Bright light treatment

Neurosurgery of psychiatric disorders Restricted to major depression and obsessive-compulsive disorder that is chronic, treatment refractory and disabling.

Transcranial magnetic stimulation Often used for depressive state In treatment study of OCD, mania and schizophrenia

Trans-cranial magnetic stimulation

Thank you for your attention! 27