M. Catalina Melo, M.D.

Antipsychotics: -first generation -atypical or second generation Antidepressants: -tricyclics -SSRI’s & SNRI’s -Others (wellbutrin, remeron, nefazodone, trazodone, viibryd) -MAO Inhibitors Mood Stabilizers: -Lithium -Anticonvulsants

Anxiolytics and Hypnotics: -Benzodiazepines -Buspar -Antihistamines (benadryl, vistaril) -Sleep agents (ambien, lunesta, sonata, melatonin) Stimulants and Cognitive enhancers: -Amphetamines, methylphenidate, strattera, provigil -Aricept, Namenda, Reminyl, Exelon

-> D2 Receptors Antagonists * Chlorpromazine=Thorazine * Thioridazine=Mellaril * Fluphenazine=Prolixin (injection) * Perphenazine=Trilafon * Trifluoperazine=Stelazine * Thiothixene=Navane * Haloperidol=Haldol (inj) * Pimozide=Orap

* EPS, TD (haldol) * Sedation * Orthostatic hypotension * NMS * leukopenia (low white blood cell count) * Constipation * Urinary retention, dry mouth, blurry vision * Galactorrhea, breast enlargement * Skin pigmentation (mellaril) * Seizures (increases risk)

EPS (Extrapyramidal Symptoms): inability to move, akathisia (restlessness), acute dystonia, tremor, difficulty with gait, mouth/tongue tremor. Tardive Dyskinesia : rapid repetitive movements. * Neuroleptic Malignant Syndrome: confusion, fever, muscle rigidity.

->5HT2A and 5HT2C Serotonin Blockeade Clozapine= Clozaril Risperidone= Risperdal (consta inj) Olanzapine= Zyprexa Quetiapine= Seroquel Ziprasidone= Geodon Aripiprazole= Abilify Paliperidone= Invega (sustenna inj) Asenapine= Saphris Iloperidone= Fanapt Lurasidone= Latuda

Sedation (seroquel +++) Weight gain (zyprexa, clozaril+++) Metabolic changes (zyprexa, seroquel, clozaril) EPS, TD Risks if pregnancy Constipation, dry mouth Irritability Changes in blood cells (clozaril needs blood counts regularly)

Psychotic Disorders: Schizophrenia, Schizoaffective Disorder, Schizophreniform Disorder, depression with psychosis, drug induced and other organic psychosis. Acute mania Maintenance of Bipolar Illness Tourette’s Syndrome and other tic disorders Treatment-Resistant Depression: Abilify and Seroquel Other uses (not FDA): personality disorders, chronic aggression, OCD. Psychosis and Bipolar illness in Children and adolescents.

Lithium= Eskalith, Lithobid Valproic acid = Depakote, Depakene, ER Carbamazepine= Tegretol, Equetro, Carbatrol, XR Lamotrigine = Lamictal Oxcarbamazepine= Trileptal Gabapentin= Neurontin Topiramate= Topamax

Thirst/ Increased Urination Tremor Weight gain Nausea, diarrhea Acne Fatigue Thyroid abnormalities Toxicity: severe tremor, confusion, seizures Interactions with Diuretics, NSAID’s, lisinopril

-> Increases GABA transmission Gastrointestinal Low platelet count Tremor Sedation Weight gain Alopecia

-> Blocks sodium channels Dizziness, uncoordination Double vision G.I. upset Tremor Decreased white blood cells Rash * Interactions with other drugs

Lamotrigine : no weight gain. RASH. Neurontin: used for pain. Somnolence. Topiramate : migraine prophylaxis. Weight loss, memory deficits, sedation, osteoporosis. *ALL: Neonatal complications and fetal malformations. Neurological side effects.

Bipolar Illness type I and II (prophylaxis) Acute mania Cyclothymia Schizoaffective Disorder Aggression Personality Disorders with unstable affect Alcohol Abuse (+/-) Anxiety Chronic pain syndromes

Fluoxetine= “Prozac” Paroxetine= “Paxil, Paxil CR, Pexeva” Citalopram= “Celexa” Sertraline= “Zoloft” Fluvoxamine= “Luvox” * Duloxetine= “Cymbalta” Venlafaxine= “Effexor, Effexor ER, XR” Desvenlafaxine= “Pristiq” Vilazodone= “Viibryd”

Nausea and decreased appetite Increased sweating Tremor Headaches Sleep changes (quantity, quality, dreams) Sexual dysfunction* Diarrhea/constipation Bruxism HTN (SNRI’s)

Tricyclics: sedation, hypotension, dry mouth, blurry vision, constipation, cardiac toxicity. Bupropion “Wellbutrin”: low appetite, headaches, seizures. Mirtazapine “Remeron”: increased appetite, somnolence. Nefazodone: Liver damage. Trazodone: somnolence, priapism. MAO (-): rarely used due to dietary limitations. Viibryd: newest antidepressant. No sexual side effects?

Major Depressive Disorder Dysthymic Disorder Panic Disorder Social Anxiety Disorder Generalized anxiety Disorder PTSD (zoloft) OCD (fluvoxamine), Impulse Control Disorders Bulimia Nervosa Personality Disorders (BPD)

Neuropathic Pain, Fibromyalgia Insomnia Enuresis (imipramine) ADHD (Wellbutrin) Smoking cessation (Wellbutrin)

Alprazolam= “xanax” Clonazepam= “Klonopin” Diazepam= “Valium” Lorazepam= “ativan” Temazepam= “restoril” Zolpidem= “Ambien” Eszopiclone= “Lunesta” Buspirone= “Buspar” Hydroxyzine= “Vistaril” Side Effects: sedation, memory deficits, incoordination, dependence, coma in OD (BZD).

Atomoxetine= Strattera Methylphenidate = ritalin, focalin, concerta, daytrana. Amphetamines = dexedrine, adderall, vyvanse. Modafinil = Provigil. (Narcolepsy). *Uses: ADHD, narcolepsy, treatment resistant depression. *Side Effects: Cardiac, insomnia, irritability, G.I.

-> Acethylcholinesterase inhibitors Donepezil= “Aricept” Galantamine= “Reminyl” Memantine= “Namenda” Rivastigmine= “Exelon” Side Effects: G.I., insomnia, mood changes.

“All things are poison, and nothing is without poison” Patients with a psychiatric diagnosis have a higher incidence of co-existent medical problems, therefore are at higher risk of pharmacological interactions Most patients do not take medications as prescribed Providers forget to ask about the use of CAM Birth Control Substance Abuse Epocrates.com Erowid.org

High risk of depression, anxiety and substance abuse: women Attempted suicide: high rate in US Latino high school students Higher rate of mental illness: US born and long-term residents

Less than 10% with a Dx seek services Largest uninsured group in the US Research on Evidence based treatments tested mainly on white populations Over-reliance on family and religion Low socio-economic status: 2-3 times more likely to have a mental illness Poor Health overall

Stigma of mental illness and Psychiatry care Being an “Illegal alien” Lost in Translation: 1% of APA members are Hispanic Gender roles Different Hispanic cultures/ countries Over-representation in the criminal and Juvenile justice systems