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

2. 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)

3. History of physical treatments

4. Pharmacokinetics of psychotropic drugs
Absorption
Distribution
Metabolism
Excretion

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

6. 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

7. 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

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

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

10. Antipsychotic drugs Typical Atypical Chlorpromazine Risperidone
Olanzapine
Aripiprazole
Ziprasidone

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

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

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

16. Mood stabilizing drugs
Lithum
Carbamazepine
Sodium valproate
Lamotrigine
Gabapetin

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

18. Hypnotics
Benzodiazepines
Zopiclone, zolpidem and zaleplon

19. Electroconvulsive therapy

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

21. 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

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

23. Bright light treatment

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

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

26. Trans-cranial magnetic stimulation

27. Thank you for your attention!27