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Pharmacological treatment of mental health problems.

Pharmacological treatment of mental health problems. Sammy Ohene Faculty of Psychiatry Pre-conference workshop @ 9th AGSM, GCPS Accra, November 27, 2012. PRE TEST Answer each question True or False. Chlorpromazine was discovered before Phenobarbitone .

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Pharmacological treatment of mental health problems.

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  1. Pharmacological treatment of mental health problems. Sammy Ohene Faculty of Psychiatry Pre-conference workshop @ 9th AGSM, GCPS Accra, November 27, 2012

  2. PRE TESTAnswer each question True or False • Chlorpromazine was discovered before Phenobarbitone. • Haloperidol has similar chemical structure to Thioridazine but different from Chlorpromazine • Risperidone is superior to Haloperidol in efficacy in treatment of Mania. • Venlafaxine is a pure SSRI. • Most bipolar patients require a single drug during an episode of mania.

  3. Introduction • Treatment of mental disorders is determined among other factors by knowledge and beliefs about causes. The following preceded drug therapy: • Exorcism – “demon possession” • Sacrifices – “ affliction of gods” • Prayers/fasting -- ‘spiritual illness’ • Convulsive therapy • Behavior therapy, psychotherapy,

  4. Drug treatment ISAAC NEWTON (GRAVITY) AND THE FALLING APPLE

  5. “ Discoveries“ in early 1950s • Antipsychotic effect of antihistamine drug, chlorpromazine, (CPZ) observed during testing on schizophrenic patients. • Antidepressant action of antituberculosis drug iproniazid noted. Effect found to be due to inhibition of MAO,

  6. Psychopharmacological actions are based on biological theories of psychiatric disorders. • In both cases the discoveries came before the neurobiological basis of their actions were found. • Antipsychotic action of CPZ and conventional antipsychotics due to D2 receptor blockade in mesolimbic pathways of brain.

  7. Progress! • Increasing knowledge in neurosciences with greater understanding of actions of more neurotransmitters have led to discovery of many more effective psychoactive drugs. • In clinical practice, most psychoactive drugs used act on dopamine, serotonin, noradrenaline, acetylcholine, glutamate and GABA neurotransmitters.

  8. Principles of psychoactive drug use. • To reverse observed dysfunctions in mental health problems. • Prevent mental disorders or recurrence where possible. • Minimise or reduce severity of symptoms. • Restore function to or as close as possible to normal with minimal side effects.

  9. IMPORTANT NOTES! • ALMOST ALL MENTAL HEALTH PROBLEMS ARE A CULMINATION OF, OR RESULT IN MULTIPLE FACTORS THAT AFFECT THE INDIVIDUAL AND HIS ENVIRONMENT. • A HOLISTIC BIOPSYCHOSOCIAL APPROACH TO MANAGEMENT IS OFTEN THE MOST REWARDING. • DO NOT “THROW PILLS AT PROBLEMS”!!!

  10. Deciding on drug treatments for mental health problems. For each condition, consider the following: • Effectiveness and target symptoms. • Initiation of treatment • Continuation/stabilization phase • Duration of treatment • Side effects • Adjunct drugs ? • Special populations- children, elderly, pregnant, comorbidities

  11. PSYCHOSES- Schizophrenia, delusional disorders, others. • ANTIPSYCHOTICS Atypicals- risperidone,olanzapine,quetiapine,ziprasidone,aripiprazole Conventional Haloperidol, chlopromazine, fluphenazine, sulpiride, Anticholinergics? Antidepressants?

  12. BIPOLAR DISORDER • Mood stabilizers Lithium, Valproate, Carbamazepine, Lamotrigine • Antipsychotics • ? Antidepressants

  13. DEPRESSIVE DISORDERS (UNIPOLAR) • Antidepressants- SSRIs, SNRIs,NDRIs,TCAs, etc fuoxetine, paroxetine, duloxetine, venlafaxine, imipramine, amitryptiline etc • ?Antipsychotics

  14. General Anxiety Disorder • Antidepressants – SSRIs, bupropion • Anxiolytics/sedatives • B-blockers

  15. PANIC DISORDER • SSRI • Anxiolytics • B-blockers

  16. Obsessive Compulsive Disorder (OCD) • SSRIs

  17. PHOBIC CONDITIONS • SOCIAL PHOBIA SSRIs • SPECIFIC PHOBIA ( Flying phobia) Diphenhydramine

  18. Post Traumatic Stress Disorder (PTSD) • SSRIs • Anxiolytics

  19. DEMENTIA • Anticholinestrases- - Memantine, Donepezil, Tacrine, Rivastigmine, Galantamine • Antidepressants ? • Antipsychotics? Caution with atypicals

  20. SLEEP DISORDERS • NARCOLEPSY • PRIMARY INSOMNIA

  21. ALCOHOL ABUSE • Dependence - Naltrexone • Withdrawal – Benzodiazepines, Vit-B1,B6, B12 • Prevention- Disulfiram, Naltrexone • Psychosis - Antipsychotics

  22. OPIATES • Methadone (opiate full agonist) • Buprenorphine (opiate partial agonist)

  23. COCAINE • Methylphenidate • Imipramine ?

  24. A. D. H. D. • Atomoxetine • Methylphenidate • Tricyclics? • Anticonvulsants? Lithium??

  25. IATROGENIC CONDITIONS • Acute dystonia:- anticholinergics( benztropine, benzhexol), diphenhydramine • Akathisia: propranolol • Pseudoparkinsonism- anticholinergics

  26. PRACTICE POINTS • Choice of drug • Effectiveness • Compliance potential • Side effects • Oral vrsparanteral • Availability • Cost • Monotherapyvrs. Combination

  27. Practice points contd. • Techniques of administration • Adequate dosing vrs. treatment response • Long acting preparations • How long do you treat? • Treatment resistance

  28. DILEMMAS • Duration of drug treatment in acute psychosis • Evidence based Treatment guidelines vrs. Reality • When do you begin drug treatment? • What if patient accepts illness but wants no medication? • Forced administration. • Spiritual care and medication

  29. Drug treatment and stigma • “PRN administration • Allergic reactions!

  30. THE FUTURE OF PSYCHOPHARMACOLOGY. • The ‘IDEAL” antipsychotic drug. What would be its features? • Designer drugs tailored to a particular individual by virtue of specific information on genetic make up. • Gene manipulation to fit predicted drug response? • Ketamine- new wonder drug in treatment-resistant depression?

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