Psychopharmacology

Psychopharmacology in Psychiatry

Objectives

Objectives: At the end of this session you should be able to:

• Identify general pharmacologic strategies
• Discuss antidepressants including indications for use and side effects
• Describe mood stabilizers including indications for use and side effects
• Review antipsychotics including how to choose an antipsychotic and side effects
• Identify anxiolytic classes and indications for use

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General Pharmacology Strategies

General Pharmacology strategies

Indication: Establish a diagnosis and identify the target symptoms that will be used to monitor therapy response.

Choice of agent and dosage: Select an agent with an acceptable side effect profile and use the lowest effective dose. Remember the delayed response for many psych meds and drug-drug interactions.

• Establish informed consent: The patient should understand the benefits and risks of the medication. Make sure to document this discussion including pt understanding and agreement. In fertile women make sure to document teratogenicity discussion.

• Implement a monitoring program: Track and document compliance, side effects, target symptom response, blood levels and blood tests as appropriate.

• Management: Adjust dosage for optimum benefit, safety and compliance.

• Use adjunctive and combination therapies if needed

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Psychopharmacology

• Antidepressants

  • Tricyclics (TCAs)
  • Monoamine Oxidase Inhibitors (MAOIs)
  • Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
  • Novel antidepressants

• Mood stabilizers & Anticonvulsants -

Indications: Bipolar, cyclothymia, schizoaffective, impulse control and intermittent explosive disorders. Classes: Lithium, anticonvulsants, antipsychotics - Which you select depends on what you are treating and again the side effect profile. - Mood Stabilizers - Lithium - Valproic acid - *Anticonvulsants - Carbamazepine (Tegretol) - Lamotrigine (Lamictal)

cases

• Antipsychotics

• Agents for EPS

  • Anxiolytics
  • Benzodiazepines

Take home points

Take home points

• Be clear on the diagnosis you are treating and any comorbid diagnoses when you are selecting an agent to treat- often can get 2 birds with 1 stone!
• Select the agent based on patients history, current symptom profile and the side effect profile of the medication- there is no one correct answer in most cases.
• Monitor for efficacy and tolerance and adjust as indicated.
• If the patient does not improve step back, rethink your diagnosis and treatment plan!
• Keep an eye on drug-drug interactions