1

مكانيسم هايي كه داروها موجب درمان اختالالت روان پزشكي مي شوند

بر bull تاثير حاضر( )حال اصلي مكانيسم Neurotransmissionاست

bullNeurotransmission واسطه يك سازي آزاد در گيرنده نرون به آن اتصال و نروني)نروترانسميتر(

نرون بعدي و ايجاد تغييرات در آننرون ها bull ميان تعامل از ناشي مغز در ارتباطات كليه

استاين ارتباط به صورت انتقال پيام هاي الكتريكي استbullانتقال پيام الكتريكي از يك نرون به نرون ديگر توسط bull

در اتصال دهنده هاي شيميايي انجام مي شود

Psychopharmacology historyldquoif we understand what is broken it should be possible to fix itrdquo

Despite that the chemical pathology of psychiatric and psychosomatic diseases near the end of the 20th century is still rudimentary many excellent medications are now available

How were these drugs found and developed

psycho tropicsMedications used to treat psychiatric disorders are referred to as psychotropic other names (Neuroleptics tranqualizers)In us every 6 women and 14 men use a psychoropicsUnderstanding of how the brain works led to more effective less toxic better tolerated specifically targeted agents

classificationpsycho tropics 2 According to Clinical application antidepressants antipsychotics mood stabilizers anxiolytics hypnotics cognitive enhancer stimulantsStructure tricyclicsMechanism monoamine oxidase inhibitorsHistory traditional first generationUniqueness atypical

Depression biological Hypotheses

Serotonin functional or absolute deficiency in serotonin (Sr)Catecholamine functional or absolute deficiency in Norepinephrine (NEP) dopaminePermissive hypothesis diminished Sr gives permission for a superimposed NEP deficiencyBeta adrenergic hypothesis increased beta-adrenergic receptor sensitivity

AntidepressantClassification

Tricyclic antidepressants (TCA)

MAO inhibitors

Secondthird generation or atypical ADs

Selective serotonin reuptake inhibitors(SSRIs)

others

Tricyclic Antidepressants Amitriptyline HCl

Coated tablet 10mg 25mg scored FC tablet 50mg100 mg Clomipramine HCl

Coated tablet 10mg 25mg 50mg 75mg Desipramine HCl

Coated tablet 25 mg Nortriptylline

Tablet 10mg 25mg Imipramine

Coated tablet 10mg 25 mg 50mg injection 25mg2ml Doxepin

Capsule 10mg 25mg FC tablet 10mg 25 mg

Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine

Capsule 1mg 20mg Fluvoxamine

Tablet 50mg 100mg Citalopram

Tablet 20mg 40 mg Sertralin 50 100

Paroxerin

Other Antidepressants

Trazodone Tablet 50mg

Maprotiline Tablet 25mg 75mg

Bupropion Tablet 75mg

Venlafaxine Tablet 375mg 75mg 150mg

Benzodiazepines (BZDs)bull Alprazolam Tablet 05 mg 1 mg

bull Clonazepam Tablet 1mg 2mg

bull Lorazepam Tablet 1mg 2mg injection 2mgml

4mgmlbull Oxazepam Tablet 10mg

bull Flurazepam Capsule 15mg

bull Diazepam Tablet 2mg 5mg 10mginjection 5mgml

bull Clordiazepoxide Tablet 5mg 10mg

bull Midazolam Syrup 2mgml injection 5mgml

12

Anti- Psychotic Medicationbull Anti- psychotic medication is used to control psychosis bull Psychological treatments are more effective when medication

is taken as wellbull Medication is only ONE PART of a comprehensive package of

care that aims to help keep a person stable and to live as normal a life as possible

bull Anti- psychotic medications are MOST EFFECTIVE at controlling POSITIVE SYMPTOMS (hallucinations delusions) - less effective at treating negative ones (apathy withdrawal etc)

Therapeutic guidelinebull Antipsychotics have revolutionized

treatment of schizophreniabull Two major group Dopamin antagonista (Das) (haloperidol

perphenazine trifluoperazine fluphenazine thioridazine chlorpromazinehellip)

Serotonin Dopamine Antagonists( risperidone olanzapine clozapinequetiapinehellip)

Mood stabilizers Indications Bipolar cyclothymiaschizoaffective impulse control andintermittent explosive disorders

bullClasses Lithium and anticonvulsantsbull Which you select depends on what youare treating and again the side effectprofile

I Lithiumbull 1st medication for manic-depressive disorderbull Discovered by Cade in Australiabull Neurotoxic if overdose ndash thus serum level

monitoring neededbull Common side-effects polyuria amp polydipsia hand

tremorbull Toxic side-effects neuroleptic malignant

syndrome (+ haloperidol)bull controversy as 1st line treatment (especially in

primary care)

Lithium- how to use it1st medication for manic-depressive disorder

Before starting Get baseline creatinine TSHand CBC In women check a pregnancy test bullDuring the first trimester is associated withEbsteinrsquos anomaly 11000 (20X greater risk thanthe general population)1048766 Monitoring Steady state achieved after 5 days Check 12 hours after last dose Once stable check q 3 months and TSH and creatinine q 6months

1048766 Goal blood level between 06-12

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

مكانيسم هايي كه داروها موجب درمان اختالالت روان پزشكي مي شوند

بر bull تاثير حاضر( )حال اصلي مكانيسم Neurotransmissionاست

bullNeurotransmission واسطه يك سازي آزاد در گيرنده نرون به آن اتصال و نروني)نروترانسميتر(

نرون بعدي و ايجاد تغييرات در آننرون ها bull ميان تعامل از ناشي مغز در ارتباطات كليه

استاين ارتباط به صورت انتقال پيام هاي الكتريكي استbullانتقال پيام الكتريكي از يك نرون به نرون ديگر توسط bull

در اتصال دهنده هاي شيميايي انجام مي شود

Psychopharmacology historyldquoif we understand what is broken it should be possible to fix itrdquo

Despite that the chemical pathology of psychiatric and psychosomatic diseases near the end of the 20th century is still rudimentary many excellent medications are now available

How were these drugs found and developed

psycho tropicsMedications used to treat psychiatric disorders are referred to as psychotropic other names (Neuroleptics tranqualizers)In us every 6 women and 14 men use a psychoropicsUnderstanding of how the brain works led to more effective less toxic better tolerated specifically targeted agents

classificationpsycho tropics 2 According to Clinical application antidepressants antipsychotics mood stabilizers anxiolytics hypnotics cognitive enhancer stimulantsStructure tricyclicsMechanism monoamine oxidase inhibitorsHistory traditional first generationUniqueness atypical

Depression biological Hypotheses

Serotonin functional or absolute deficiency in serotonin (Sr)Catecholamine functional or absolute deficiency in Norepinephrine (NEP) dopaminePermissive hypothesis diminished Sr gives permission for a superimposed NEP deficiencyBeta adrenergic hypothesis increased beta-adrenergic receptor sensitivity

AntidepressantClassification

Tricyclic antidepressants (TCA)

MAO inhibitors

Secondthird generation or atypical ADs

Selective serotonin reuptake inhibitors(SSRIs)

others

Tricyclic Antidepressants Amitriptyline HCl

Coated tablet 10mg 25mg scored FC tablet 50mg100 mg Clomipramine HCl

Coated tablet 10mg 25mg 50mg 75mg Desipramine HCl

Coated tablet 25 mg Nortriptylline

Tablet 10mg 25mg Imipramine

Coated tablet 10mg 25 mg 50mg injection 25mg2ml Doxepin

Capsule 10mg 25mg FC tablet 10mg 25 mg

Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine

Capsule 1mg 20mg Fluvoxamine

Tablet 50mg 100mg Citalopram

Tablet 20mg 40 mg Sertralin 50 100

Paroxerin

Other Antidepressants

Trazodone Tablet 50mg

Maprotiline Tablet 25mg 75mg

Bupropion Tablet 75mg

Venlafaxine Tablet 375mg 75mg 150mg

Benzodiazepines (BZDs)bull Alprazolam Tablet 05 mg 1 mg

bull Clonazepam Tablet 1mg 2mg

bull Lorazepam Tablet 1mg 2mg injection 2mgml

4mgmlbull Oxazepam Tablet 10mg

bull Flurazepam Capsule 15mg

bull Diazepam Tablet 2mg 5mg 10mginjection 5mgml

bull Clordiazepoxide Tablet 5mg 10mg

bull Midazolam Syrup 2mgml injection 5mgml

12

Anti- Psychotic Medicationbull Anti- psychotic medication is used to control psychosis bull Psychological treatments are more effective when medication

is taken as wellbull Medication is only ONE PART of a comprehensive package of

care that aims to help keep a person stable and to live as normal a life as possible

bull Anti- psychotic medications are MOST EFFECTIVE at controlling POSITIVE SYMPTOMS (hallucinations delusions) - less effective at treating negative ones (apathy withdrawal etc)

Therapeutic guidelinebull Antipsychotics have revolutionized

treatment of schizophreniabull Two major group Dopamin antagonista (Das) (haloperidol

perphenazine trifluoperazine fluphenazine thioridazine chlorpromazinehellip)

Serotonin Dopamine Antagonists( risperidone olanzapine clozapinequetiapinehellip)

Mood stabilizers Indications Bipolar cyclothymiaschizoaffective impulse control andintermittent explosive disorders

bullClasses Lithium and anticonvulsantsbull Which you select depends on what youare treating and again the side effectprofile

I Lithiumbull 1st medication for manic-depressive disorderbull Discovered by Cade in Australiabull Neurotoxic if overdose ndash thus serum level

monitoring neededbull Common side-effects polyuria amp polydipsia hand

tremorbull Toxic side-effects neuroleptic malignant

syndrome (+ haloperidol)bull controversy as 1st line treatment (especially in

primary care)

Lithium- how to use it1st medication for manic-depressive disorder

Before starting Get baseline creatinine TSHand CBC In women check a pregnancy test bullDuring the first trimester is associated withEbsteinrsquos anomaly 11000 (20X greater risk thanthe general population)1048766 Monitoring Steady state achieved after 5 days Check 12 hours after last dose Once stable check q 3 months and TSH and creatinine q 6months

1048766 Goal blood level between 06-12

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

Psychopharmacology historyldquoif we understand what is broken it should be possible to fix itrdquo

Despite that the chemical pathology of psychiatric and psychosomatic diseases near the end of the 20th century is still rudimentary many excellent medications are now available

How were these drugs found and developed

psycho tropicsMedications used to treat psychiatric disorders are referred to as psychotropic other names (Neuroleptics tranqualizers)In us every 6 women and 14 men use a psychoropicsUnderstanding of how the brain works led to more effective less toxic better tolerated specifically targeted agents

classificationpsycho tropics 2 According to Clinical application antidepressants antipsychotics mood stabilizers anxiolytics hypnotics cognitive enhancer stimulantsStructure tricyclicsMechanism monoamine oxidase inhibitorsHistory traditional first generationUniqueness atypical

Depression biological Hypotheses

Serotonin functional or absolute deficiency in serotonin (Sr)Catecholamine functional or absolute deficiency in Norepinephrine (NEP) dopaminePermissive hypothesis diminished Sr gives permission for a superimposed NEP deficiencyBeta adrenergic hypothesis increased beta-adrenergic receptor sensitivity

AntidepressantClassification

Tricyclic antidepressants (TCA)

MAO inhibitors

Secondthird generation or atypical ADs

Selective serotonin reuptake inhibitors(SSRIs)

others

Tricyclic Antidepressants Amitriptyline HCl

Coated tablet 10mg 25mg scored FC tablet 50mg100 mg Clomipramine HCl

Coated tablet 10mg 25mg 50mg 75mg Desipramine HCl

Coated tablet 25 mg Nortriptylline

Tablet 10mg 25mg Imipramine

Coated tablet 10mg 25 mg 50mg injection 25mg2ml Doxepin

Capsule 10mg 25mg FC tablet 10mg 25 mg

Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine

Capsule 1mg 20mg Fluvoxamine

Tablet 50mg 100mg Citalopram

Tablet 20mg 40 mg Sertralin 50 100

Paroxerin

Other Antidepressants

Trazodone Tablet 50mg

Maprotiline Tablet 25mg 75mg

Bupropion Tablet 75mg

Venlafaxine Tablet 375mg 75mg 150mg

Benzodiazepines (BZDs)bull Alprazolam Tablet 05 mg 1 mg

bull Clonazepam Tablet 1mg 2mg

bull Lorazepam Tablet 1mg 2mg injection 2mgml

4mgmlbull Oxazepam Tablet 10mg

bull Flurazepam Capsule 15mg

bull Diazepam Tablet 2mg 5mg 10mginjection 5mgml

bull Clordiazepoxide Tablet 5mg 10mg

bull Midazolam Syrup 2mgml injection 5mgml

12

Anti- Psychotic Medicationbull Anti- psychotic medication is used to control psychosis bull Psychological treatments are more effective when medication

is taken as wellbull Medication is only ONE PART of a comprehensive package of

care that aims to help keep a person stable and to live as normal a life as possible

bull Anti- psychotic medications are MOST EFFECTIVE at controlling POSITIVE SYMPTOMS (hallucinations delusions) - less effective at treating negative ones (apathy withdrawal etc)

Therapeutic guidelinebull Antipsychotics have revolutionized

treatment of schizophreniabull Two major group Dopamin antagonista (Das) (haloperidol

perphenazine trifluoperazine fluphenazine thioridazine chlorpromazinehellip)

Serotonin Dopamine Antagonists( risperidone olanzapine clozapinequetiapinehellip)

Mood stabilizers Indications Bipolar cyclothymiaschizoaffective impulse control andintermittent explosive disorders

bullClasses Lithium and anticonvulsantsbull Which you select depends on what youare treating and again the side effectprofile

I Lithiumbull 1st medication for manic-depressive disorderbull Discovered by Cade in Australiabull Neurotoxic if overdose ndash thus serum level

monitoring neededbull Common side-effects polyuria amp polydipsia hand

tremorbull Toxic side-effects neuroleptic malignant

syndrome (+ haloperidol)bull controversy as 1st line treatment (especially in

primary care)

Lithium- how to use it1st medication for manic-depressive disorder

Before starting Get baseline creatinine TSHand CBC In women check a pregnancy test bullDuring the first trimester is associated withEbsteinrsquos anomaly 11000 (20X greater risk thanthe general population)1048766 Monitoring Steady state achieved after 5 days Check 12 hours after last dose Once stable check q 3 months and TSH and creatinine q 6months

1048766 Goal blood level between 06-12

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

psycho tropicsMedications used to treat psychiatric disorders are referred to as psychotropic other names (Neuroleptics tranqualizers)In us every 6 women and 14 men use a psychoropicsUnderstanding of how the brain works led to more effective less toxic better tolerated specifically targeted agents

classificationpsycho tropics 2 According to Clinical application antidepressants antipsychotics mood stabilizers anxiolytics hypnotics cognitive enhancer stimulantsStructure tricyclicsMechanism monoamine oxidase inhibitorsHistory traditional first generationUniqueness atypical

Depression biological Hypotheses

Serotonin functional or absolute deficiency in serotonin (Sr)Catecholamine functional or absolute deficiency in Norepinephrine (NEP) dopaminePermissive hypothesis diminished Sr gives permission for a superimposed NEP deficiencyBeta adrenergic hypothesis increased beta-adrenergic receptor sensitivity

AntidepressantClassification

Tricyclic antidepressants (TCA)

MAO inhibitors

Secondthird generation or atypical ADs

Selective serotonin reuptake inhibitors(SSRIs)

others

Tricyclic Antidepressants Amitriptyline HCl

Coated tablet 10mg 25mg scored FC tablet 50mg100 mg Clomipramine HCl

Coated tablet 10mg 25mg 50mg 75mg Desipramine HCl

Coated tablet 25 mg Nortriptylline

Tablet 10mg 25mg Imipramine

Coated tablet 10mg 25 mg 50mg injection 25mg2ml Doxepin

Capsule 10mg 25mg FC tablet 10mg 25 mg

Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine

Capsule 1mg 20mg Fluvoxamine

Tablet 50mg 100mg Citalopram

Tablet 20mg 40 mg Sertralin 50 100

Paroxerin

Other Antidepressants

Trazodone Tablet 50mg

Maprotiline Tablet 25mg 75mg

Bupropion Tablet 75mg

Venlafaxine Tablet 375mg 75mg 150mg

Benzodiazepines (BZDs)bull Alprazolam Tablet 05 mg 1 mg

bull Clonazepam Tablet 1mg 2mg

bull Lorazepam Tablet 1mg 2mg injection 2mgml

4mgmlbull Oxazepam Tablet 10mg

bull Flurazepam Capsule 15mg

bull Diazepam Tablet 2mg 5mg 10mginjection 5mgml

bull Clordiazepoxide Tablet 5mg 10mg

bull Midazolam Syrup 2mgml injection 5mgml

12

Anti- Psychotic Medicationbull Anti- psychotic medication is used to control psychosis bull Psychological treatments are more effective when medication

is taken as wellbull Medication is only ONE PART of a comprehensive package of

care that aims to help keep a person stable and to live as normal a life as possible

bull Anti- psychotic medications are MOST EFFECTIVE at controlling POSITIVE SYMPTOMS (hallucinations delusions) - less effective at treating negative ones (apathy withdrawal etc)

Therapeutic guidelinebull Antipsychotics have revolutionized

treatment of schizophreniabull Two major group Dopamin antagonista (Das) (haloperidol

perphenazine trifluoperazine fluphenazine thioridazine chlorpromazinehellip)

Serotonin Dopamine Antagonists( risperidone olanzapine clozapinequetiapinehellip)

Mood stabilizers Indications Bipolar cyclothymiaschizoaffective impulse control andintermittent explosive disorders

bullClasses Lithium and anticonvulsantsbull Which you select depends on what youare treating and again the side effectprofile

I Lithiumbull 1st medication for manic-depressive disorderbull Discovered by Cade in Australiabull Neurotoxic if overdose ndash thus serum level

monitoring neededbull Common side-effects polyuria amp polydipsia hand

tremorbull Toxic side-effects neuroleptic malignant

syndrome (+ haloperidol)bull controversy as 1st line treatment (especially in

primary care)

Lithium- how to use it1st medication for manic-depressive disorder

Before starting Get baseline creatinine TSHand CBC In women check a pregnancy test bullDuring the first trimester is associated withEbsteinrsquos anomaly 11000 (20X greater risk thanthe general population)1048766 Monitoring Steady state achieved after 5 days Check 12 hours after last dose Once stable check q 3 months and TSH and creatinine q 6months

1048766 Goal blood level between 06-12

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

classificationpsycho tropics 2 According to Clinical application antidepressants antipsychotics mood stabilizers anxiolytics hypnotics cognitive enhancer stimulantsStructure tricyclicsMechanism monoamine oxidase inhibitorsHistory traditional first generationUniqueness atypical

Depression biological Hypotheses

Serotonin functional or absolute deficiency in serotonin (Sr)Catecholamine functional or absolute deficiency in Norepinephrine (NEP) dopaminePermissive hypothesis diminished Sr gives permission for a superimposed NEP deficiencyBeta adrenergic hypothesis increased beta-adrenergic receptor sensitivity

AntidepressantClassification

Tricyclic antidepressants (TCA)

MAO inhibitors

Secondthird generation or atypical ADs

Selective serotonin reuptake inhibitors(SSRIs)

others

Tricyclic Antidepressants Amitriptyline HCl

Coated tablet 10mg 25mg scored FC tablet 50mg100 mg Clomipramine HCl

Coated tablet 10mg 25mg 50mg 75mg Desipramine HCl

Coated tablet 25 mg Nortriptylline

Tablet 10mg 25mg Imipramine

Coated tablet 10mg 25 mg 50mg injection 25mg2ml Doxepin

Capsule 10mg 25mg FC tablet 10mg 25 mg

Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine

Capsule 1mg 20mg Fluvoxamine

Tablet 50mg 100mg Citalopram

Tablet 20mg 40 mg Sertralin 50 100

Paroxerin

Other Antidepressants

Trazodone Tablet 50mg

Maprotiline Tablet 25mg 75mg

Bupropion Tablet 75mg

Venlafaxine Tablet 375mg 75mg 150mg

Benzodiazepines (BZDs)bull Alprazolam Tablet 05 mg 1 mg

bull Clonazepam Tablet 1mg 2mg

bull Lorazepam Tablet 1mg 2mg injection 2mgml

4mgmlbull Oxazepam Tablet 10mg

bull Flurazepam Capsule 15mg

bull Diazepam Tablet 2mg 5mg 10mginjection 5mgml

bull Clordiazepoxide Tablet 5mg 10mg

bull Midazolam Syrup 2mgml injection 5mgml

12

Anti- Psychotic Medicationbull Anti- psychotic medication is used to control psychosis bull Psychological treatments are more effective when medication

is taken as wellbull Medication is only ONE PART of a comprehensive package of

care that aims to help keep a person stable and to live as normal a life as possible

bull Anti- psychotic medications are MOST EFFECTIVE at controlling POSITIVE SYMPTOMS (hallucinations delusions) - less effective at treating negative ones (apathy withdrawal etc)

Therapeutic guidelinebull Antipsychotics have revolutionized

treatment of schizophreniabull Two major group Dopamin antagonista (Das) (haloperidol

perphenazine trifluoperazine fluphenazine thioridazine chlorpromazinehellip)

Serotonin Dopamine Antagonists( risperidone olanzapine clozapinequetiapinehellip)

Mood stabilizers Indications Bipolar cyclothymiaschizoaffective impulse control andintermittent explosive disorders

bullClasses Lithium and anticonvulsantsbull Which you select depends on what youare treating and again the side effectprofile

I Lithiumbull 1st medication for manic-depressive disorderbull Discovered by Cade in Australiabull Neurotoxic if overdose ndash thus serum level

monitoring neededbull Common side-effects polyuria amp polydipsia hand

tremorbull Toxic side-effects neuroleptic malignant

syndrome (+ haloperidol)bull controversy as 1st line treatment (especially in

primary care)

Lithium- how to use it1st medication for manic-depressive disorder

Before starting Get baseline creatinine TSHand CBC In women check a pregnancy test bullDuring the first trimester is associated withEbsteinrsquos anomaly 11000 (20X greater risk thanthe general population)1048766 Monitoring Steady state achieved after 5 days Check 12 hours after last dose Once stable check q 3 months and TSH and creatinine q 6months

1048766 Goal blood level between 06-12

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

Depression biological Hypotheses

Serotonin functional or absolute deficiency in serotonin (Sr)Catecholamine functional or absolute deficiency in Norepinephrine (NEP) dopaminePermissive hypothesis diminished Sr gives permission for a superimposed NEP deficiencyBeta adrenergic hypothesis increased beta-adrenergic receptor sensitivity

AntidepressantClassification

Tricyclic antidepressants (TCA)

MAO inhibitors

Secondthird generation or atypical ADs

Selective serotonin reuptake inhibitors(SSRIs)

others

Tricyclic Antidepressants Amitriptyline HCl

Coated tablet 10mg 25mg scored FC tablet 50mg100 mg Clomipramine HCl

Coated tablet 10mg 25mg 50mg 75mg Desipramine HCl

Coated tablet 25 mg Nortriptylline

Tablet 10mg 25mg Imipramine

Coated tablet 10mg 25 mg 50mg injection 25mg2ml Doxepin

Capsule 10mg 25mg FC tablet 10mg 25 mg

Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine

Capsule 1mg 20mg Fluvoxamine

Tablet 50mg 100mg Citalopram

Tablet 20mg 40 mg Sertralin 50 100

Paroxerin

Other Antidepressants

Trazodone Tablet 50mg

Maprotiline Tablet 25mg 75mg

Bupropion Tablet 75mg

Venlafaxine Tablet 375mg 75mg 150mg

Benzodiazepines (BZDs)bull Alprazolam Tablet 05 mg 1 mg

bull Clonazepam Tablet 1mg 2mg

bull Lorazepam Tablet 1mg 2mg injection 2mgml

4mgmlbull Oxazepam Tablet 10mg

bull Flurazepam Capsule 15mg

bull Diazepam Tablet 2mg 5mg 10mginjection 5mgml

bull Clordiazepoxide Tablet 5mg 10mg

bull Midazolam Syrup 2mgml injection 5mgml

12

Anti- Psychotic Medicationbull Anti- psychotic medication is used to control psychosis bull Psychological treatments are more effective when medication

is taken as wellbull Medication is only ONE PART of a comprehensive package of

care that aims to help keep a person stable and to live as normal a life as possible

bull Anti- psychotic medications are MOST EFFECTIVE at controlling POSITIVE SYMPTOMS (hallucinations delusions) - less effective at treating negative ones (apathy withdrawal etc)

Therapeutic guidelinebull Antipsychotics have revolutionized

treatment of schizophreniabull Two major group Dopamin antagonista (Das) (haloperidol

perphenazine trifluoperazine fluphenazine thioridazine chlorpromazinehellip)

Serotonin Dopamine Antagonists( risperidone olanzapine clozapinequetiapinehellip)

Mood stabilizers Indications Bipolar cyclothymiaschizoaffective impulse control andintermittent explosive disorders

bullClasses Lithium and anticonvulsantsbull Which you select depends on what youare treating and again the side effectprofile

I Lithiumbull 1st medication for manic-depressive disorderbull Discovered by Cade in Australiabull Neurotoxic if overdose ndash thus serum level

monitoring neededbull Common side-effects polyuria amp polydipsia hand

tremorbull Toxic side-effects neuroleptic malignant

syndrome (+ haloperidol)bull controversy as 1st line treatment (especially in

primary care)

Lithium- how to use it1st medication for manic-depressive disorder

Before starting Get baseline creatinine TSHand CBC In women check a pregnancy test bullDuring the first trimester is associated withEbsteinrsquos anomaly 11000 (20X greater risk thanthe general population)1048766 Monitoring Steady state achieved after 5 days Check 12 hours after last dose Once stable check q 3 months and TSH and creatinine q 6months

1048766 Goal blood level between 06-12

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

AntidepressantClassification

Tricyclic antidepressants (TCA)

MAO inhibitors

Secondthird generation or atypical ADs

Selective serotonin reuptake inhibitors(SSRIs)

others

Tricyclic Antidepressants Amitriptyline HCl

Coated tablet 10mg 25mg scored FC tablet 50mg100 mg Clomipramine HCl

Coated tablet 10mg 25mg 50mg 75mg Desipramine HCl

Coated tablet 25 mg Nortriptylline

Tablet 10mg 25mg Imipramine

Coated tablet 10mg 25 mg 50mg injection 25mg2ml Doxepin

Capsule 10mg 25mg FC tablet 10mg 25 mg

Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine

Capsule 1mg 20mg Fluvoxamine

Tablet 50mg 100mg Citalopram

Tablet 20mg 40 mg Sertralin 50 100

Paroxerin

Other Antidepressants

Trazodone Tablet 50mg

Maprotiline Tablet 25mg 75mg

Bupropion Tablet 75mg

Venlafaxine Tablet 375mg 75mg 150mg

Benzodiazepines (BZDs)bull Alprazolam Tablet 05 mg 1 mg

bull Clonazepam Tablet 1mg 2mg

bull Lorazepam Tablet 1mg 2mg injection 2mgml

4mgmlbull Oxazepam Tablet 10mg

bull Flurazepam Capsule 15mg

bull Diazepam Tablet 2mg 5mg 10mginjection 5mgml

bull Clordiazepoxide Tablet 5mg 10mg

bull Midazolam Syrup 2mgml injection 5mgml

12

Anti- Psychotic Medicationbull Anti- psychotic medication is used to control psychosis bull Psychological treatments are more effective when medication

is taken as wellbull Medication is only ONE PART of a comprehensive package of

care that aims to help keep a person stable and to live as normal a life as possible

bull Anti- psychotic medications are MOST EFFECTIVE at controlling POSITIVE SYMPTOMS (hallucinations delusions) - less effective at treating negative ones (apathy withdrawal etc)

Therapeutic guidelinebull Antipsychotics have revolutionized

treatment of schizophreniabull Two major group Dopamin antagonista (Das) (haloperidol

perphenazine trifluoperazine fluphenazine thioridazine chlorpromazinehellip)

Serotonin Dopamine Antagonists( risperidone olanzapine clozapinequetiapinehellip)

Mood stabilizers Indications Bipolar cyclothymiaschizoaffective impulse control andintermittent explosive disorders

bullClasses Lithium and anticonvulsantsbull Which you select depends on what youare treating and again the side effectprofile

I Lithiumbull 1st medication for manic-depressive disorderbull Discovered by Cade in Australiabull Neurotoxic if overdose ndash thus serum level

monitoring neededbull Common side-effects polyuria amp polydipsia hand

tremorbull Toxic side-effects neuroleptic malignant

syndrome (+ haloperidol)bull controversy as 1st line treatment (especially in

primary care)

Lithium- how to use it1st medication for manic-depressive disorder

Before starting Get baseline creatinine TSHand CBC In women check a pregnancy test bullDuring the first trimester is associated withEbsteinrsquos anomaly 11000 (20X greater risk thanthe general population)1048766 Monitoring Steady state achieved after 5 days Check 12 hours after last dose Once stable check q 3 months and TSH and creatinine q 6months

1048766 Goal blood level between 06-12

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

Tricyclic Antidepressants Amitriptyline HCl

Coated tablet 10mg 25mg scored FC tablet 50mg100 mg Clomipramine HCl

Coated tablet 10mg 25mg 50mg 75mg Desipramine HCl

Coated tablet 25 mg Nortriptylline

Tablet 10mg 25mg Imipramine

Coated tablet 10mg 25 mg 50mg injection 25mg2ml Doxepin

Capsule 10mg 25mg FC tablet 10mg 25 mg

Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine

Capsule 1mg 20mg Fluvoxamine

Tablet 50mg 100mg Citalopram

Tablet 20mg 40 mg Sertralin 50 100

Paroxerin

Other Antidepressants

Trazodone Tablet 50mg

Maprotiline Tablet 25mg 75mg

Bupropion Tablet 75mg

Venlafaxine Tablet 375mg 75mg 150mg

Benzodiazepines (BZDs)bull Alprazolam Tablet 05 mg 1 mg

bull Clonazepam Tablet 1mg 2mg

bull Lorazepam Tablet 1mg 2mg injection 2mgml

4mgmlbull Oxazepam Tablet 10mg

bull Flurazepam Capsule 15mg

bull Diazepam Tablet 2mg 5mg 10mginjection 5mgml

bull Clordiazepoxide Tablet 5mg 10mg

bull Midazolam Syrup 2mgml injection 5mgml

12

Anti- Psychotic Medicationbull Anti- psychotic medication is used to control psychosis bull Psychological treatments are more effective when medication

is taken as wellbull Medication is only ONE PART of a comprehensive package of

care that aims to help keep a person stable and to live as normal a life as possible

bull Anti- psychotic medications are MOST EFFECTIVE at controlling POSITIVE SYMPTOMS (hallucinations delusions) - less effective at treating negative ones (apathy withdrawal etc)

Therapeutic guidelinebull Antipsychotics have revolutionized

treatment of schizophreniabull Two major group Dopamin antagonista (Das) (haloperidol

perphenazine trifluoperazine fluphenazine thioridazine chlorpromazinehellip)

Serotonin Dopamine Antagonists( risperidone olanzapine clozapinequetiapinehellip)

Mood stabilizers Indications Bipolar cyclothymiaschizoaffective impulse control andintermittent explosive disorders

bullClasses Lithium and anticonvulsantsbull Which you select depends on what youare treating and again the side effectprofile

I Lithiumbull 1st medication for manic-depressive disorderbull Discovered by Cade in Australiabull Neurotoxic if overdose ndash thus serum level

monitoring neededbull Common side-effects polyuria amp polydipsia hand

tremorbull Toxic side-effects neuroleptic malignant

syndrome (+ haloperidol)bull controversy as 1st line treatment (especially in

primary care)

Lithium- how to use it1st medication for manic-depressive disorder

Before starting Get baseline creatinine TSHand CBC In women check a pregnancy test bullDuring the first trimester is associated withEbsteinrsquos anomaly 11000 (20X greater risk thanthe general population)1048766 Monitoring Steady state achieved after 5 days Check 12 hours after last dose Once stable check q 3 months and TSH and creatinine q 6months

1048766 Goal blood level between 06-12

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine

Capsule 1mg 20mg Fluvoxamine

Tablet 50mg 100mg Citalopram

Tablet 20mg 40 mg Sertralin 50 100

Paroxerin

Other Antidepressants

Trazodone Tablet 50mg

Maprotiline Tablet 25mg 75mg

Bupropion Tablet 75mg

Venlafaxine Tablet 375mg 75mg 150mg

Benzodiazepines (BZDs)bull Alprazolam Tablet 05 mg 1 mg

bull Clonazepam Tablet 1mg 2mg

bull Lorazepam Tablet 1mg 2mg injection 2mgml

4mgmlbull Oxazepam Tablet 10mg

bull Flurazepam Capsule 15mg

bull Diazepam Tablet 2mg 5mg 10mginjection 5mgml

bull Clordiazepoxide Tablet 5mg 10mg

bull Midazolam Syrup 2mgml injection 5mgml

12

Anti- Psychotic Medicationbull Anti- psychotic medication is used to control psychosis bull Psychological treatments are more effective when medication

is taken as wellbull Medication is only ONE PART of a comprehensive package of

care that aims to help keep a person stable and to live as normal a life as possible

bull Anti- psychotic medications are MOST EFFECTIVE at controlling POSITIVE SYMPTOMS (hallucinations delusions) - less effective at treating negative ones (apathy withdrawal etc)

Therapeutic guidelinebull Antipsychotics have revolutionized

treatment of schizophreniabull Two major group Dopamin antagonista (Das) (haloperidol

perphenazine trifluoperazine fluphenazine thioridazine chlorpromazinehellip)

Serotonin Dopamine Antagonists( risperidone olanzapine clozapinequetiapinehellip)

Mood stabilizers Indications Bipolar cyclothymiaschizoaffective impulse control andintermittent explosive disorders

bullClasses Lithium and anticonvulsantsbull Which you select depends on what youare treating and again the side effectprofile

I Lithiumbull 1st medication for manic-depressive disorderbull Discovered by Cade in Australiabull Neurotoxic if overdose ndash thus serum level

monitoring neededbull Common side-effects polyuria amp polydipsia hand

tremorbull Toxic side-effects neuroleptic malignant

syndrome (+ haloperidol)bull controversy as 1st line treatment (especially in

primary care)

Lithium- how to use it1st medication for manic-depressive disorder

Before starting Get baseline creatinine TSHand CBC In women check a pregnancy test bullDuring the first trimester is associated withEbsteinrsquos anomaly 11000 (20X greater risk thanthe general population)1048766 Monitoring Steady state achieved after 5 days Check 12 hours after last dose Once stable check q 3 months and TSH and creatinine q 6months

1048766 Goal blood level between 06-12

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

Other Antidepressants

Trazodone Tablet 50mg

Maprotiline Tablet 25mg 75mg

Bupropion Tablet 75mg

Venlafaxine Tablet 375mg 75mg 150mg

Benzodiazepines (BZDs)bull Alprazolam Tablet 05 mg 1 mg

bull Clonazepam Tablet 1mg 2mg

bull Lorazepam Tablet 1mg 2mg injection 2mgml

4mgmlbull Oxazepam Tablet 10mg

bull Flurazepam Capsule 15mg

bull Diazepam Tablet 2mg 5mg 10mginjection 5mgml

bull Clordiazepoxide Tablet 5mg 10mg

bull Midazolam Syrup 2mgml injection 5mgml

12

Anti- Psychotic Medicationbull Anti- psychotic medication is used to control psychosis bull Psychological treatments are more effective when medication

is taken as wellbull Medication is only ONE PART of a comprehensive package of

care that aims to help keep a person stable and to live as normal a life as possible

bull Anti- psychotic medications are MOST EFFECTIVE at controlling POSITIVE SYMPTOMS (hallucinations delusions) - less effective at treating negative ones (apathy withdrawal etc)

Therapeutic guidelinebull Antipsychotics have revolutionized

treatment of schizophreniabull Two major group Dopamin antagonista (Das) (haloperidol

perphenazine trifluoperazine fluphenazine thioridazine chlorpromazinehellip)

Serotonin Dopamine Antagonists( risperidone olanzapine clozapinequetiapinehellip)

Mood stabilizers Indications Bipolar cyclothymiaschizoaffective impulse control andintermittent explosive disorders

bullClasses Lithium and anticonvulsantsbull Which you select depends on what youare treating and again the side effectprofile

I Lithiumbull 1st medication for manic-depressive disorderbull Discovered by Cade in Australiabull Neurotoxic if overdose ndash thus serum level

monitoring neededbull Common side-effects polyuria amp polydipsia hand

tremorbull Toxic side-effects neuroleptic malignant

syndrome (+ haloperidol)bull controversy as 1st line treatment (especially in

primary care)

Lithium- how to use it1st medication for manic-depressive disorder

Before starting Get baseline creatinine TSHand CBC In women check a pregnancy test bullDuring the first trimester is associated withEbsteinrsquos anomaly 11000 (20X greater risk thanthe general population)1048766 Monitoring Steady state achieved after 5 days Check 12 hours after last dose Once stable check q 3 months and TSH and creatinine q 6months

1048766 Goal blood level between 06-12

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

Benzodiazepines (BZDs)bull Alprazolam Tablet 05 mg 1 mg

bull Clonazepam Tablet 1mg 2mg

bull Lorazepam Tablet 1mg 2mg injection 2mgml

4mgmlbull Oxazepam Tablet 10mg

bull Flurazepam Capsule 15mg

bull Diazepam Tablet 2mg 5mg 10mginjection 5mgml

bull Clordiazepoxide Tablet 5mg 10mg

bull Midazolam Syrup 2mgml injection 5mgml

12

Anti- Psychotic Medicationbull Anti- psychotic medication is used to control psychosis bull Psychological treatments are more effective when medication

is taken as wellbull Medication is only ONE PART of a comprehensive package of

care that aims to help keep a person stable and to live as normal a life as possible

bull Anti- psychotic medications are MOST EFFECTIVE at controlling POSITIVE SYMPTOMS (hallucinations delusions) - less effective at treating negative ones (apathy withdrawal etc)

Therapeutic guidelinebull Antipsychotics have revolutionized

treatment of schizophreniabull Two major group Dopamin antagonista (Das) (haloperidol

perphenazine trifluoperazine fluphenazine thioridazine chlorpromazinehellip)

Serotonin Dopamine Antagonists( risperidone olanzapine clozapinequetiapinehellip)

Mood stabilizers Indications Bipolar cyclothymiaschizoaffective impulse control andintermittent explosive disorders

bullClasses Lithium and anticonvulsantsbull Which you select depends on what youare treating and again the side effectprofile

I Lithiumbull 1st medication for manic-depressive disorderbull Discovered by Cade in Australiabull Neurotoxic if overdose ndash thus serum level

monitoring neededbull Common side-effects polyuria amp polydipsia hand

tremorbull Toxic side-effects neuroleptic malignant

syndrome (+ haloperidol)bull controversy as 1st line treatment (especially in

primary care)

Lithium- how to use it1st medication for manic-depressive disorder

Before starting Get baseline creatinine TSHand CBC In women check a pregnancy test bullDuring the first trimester is associated withEbsteinrsquos anomaly 11000 (20X greater risk thanthe general population)1048766 Monitoring Steady state achieved after 5 days Check 12 hours after last dose Once stable check q 3 months and TSH and creatinine q 6months

1048766 Goal blood level between 06-12

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

12

Anti- Psychotic Medicationbull Anti- psychotic medication is used to control psychosis bull Psychological treatments are more effective when medication

is taken as wellbull Medication is only ONE PART of a comprehensive package of

care that aims to help keep a person stable and to live as normal a life as possible

bull Anti- psychotic medications are MOST EFFECTIVE at controlling POSITIVE SYMPTOMS (hallucinations delusions) - less effective at treating negative ones (apathy withdrawal etc)

Therapeutic guidelinebull Antipsychotics have revolutionized

treatment of schizophreniabull Two major group Dopamin antagonista (Das) (haloperidol

perphenazine trifluoperazine fluphenazine thioridazine chlorpromazinehellip)

Serotonin Dopamine Antagonists( risperidone olanzapine clozapinequetiapinehellip)

Mood stabilizers Indications Bipolar cyclothymiaschizoaffective impulse control andintermittent explosive disorders

bullClasses Lithium and anticonvulsantsbull Which you select depends on what youare treating and again the side effectprofile

I Lithiumbull 1st medication for manic-depressive disorderbull Discovered by Cade in Australiabull Neurotoxic if overdose ndash thus serum level

monitoring neededbull Common side-effects polyuria amp polydipsia hand

tremorbull Toxic side-effects neuroleptic malignant

syndrome (+ haloperidol)bull controversy as 1st line treatment (especially in

primary care)

Lithium- how to use it1st medication for manic-depressive disorder

Before starting Get baseline creatinine TSHand CBC In women check a pregnancy test bullDuring the first trimester is associated withEbsteinrsquos anomaly 11000 (20X greater risk thanthe general population)1048766 Monitoring Steady state achieved after 5 days Check 12 hours after last dose Once stable check q 3 months and TSH and creatinine q 6months

1048766 Goal blood level between 06-12

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

Therapeutic guidelinebull Antipsychotics have revolutionized

treatment of schizophreniabull Two major group Dopamin antagonista (Das) (haloperidol

perphenazine trifluoperazine fluphenazine thioridazine chlorpromazinehellip)

Serotonin Dopamine Antagonists( risperidone olanzapine clozapinequetiapinehellip)

Mood stabilizers Indications Bipolar cyclothymiaschizoaffective impulse control andintermittent explosive disorders

bullClasses Lithium and anticonvulsantsbull Which you select depends on what youare treating and again the side effectprofile

I Lithiumbull 1st medication for manic-depressive disorderbull Discovered by Cade in Australiabull Neurotoxic if overdose ndash thus serum level

monitoring neededbull Common side-effects polyuria amp polydipsia hand

tremorbull Toxic side-effects neuroleptic malignant

syndrome (+ haloperidol)bull controversy as 1st line treatment (especially in

primary care)

Lithium- how to use it1st medication for manic-depressive disorder

Before starting Get baseline creatinine TSHand CBC In women check a pregnancy test bullDuring the first trimester is associated withEbsteinrsquos anomaly 11000 (20X greater risk thanthe general population)1048766 Monitoring Steady state achieved after 5 days Check 12 hours after last dose Once stable check q 3 months and TSH and creatinine q 6months

1048766 Goal blood level between 06-12

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

Mood stabilizers Indications Bipolar cyclothymiaschizoaffective impulse control andintermittent explosive disorders

bullClasses Lithium and anticonvulsantsbull Which you select depends on what youare treating and again the side effectprofile

I Lithiumbull 1st medication for manic-depressive disorderbull Discovered by Cade in Australiabull Neurotoxic if overdose ndash thus serum level

monitoring neededbull Common side-effects polyuria amp polydipsia hand

tremorbull Toxic side-effects neuroleptic malignant

syndrome (+ haloperidol)bull controversy as 1st line treatment (especially in

primary care)

Lithium- how to use it1st medication for manic-depressive disorder

Before starting Get baseline creatinine TSHand CBC In women check a pregnancy test bullDuring the first trimester is associated withEbsteinrsquos anomaly 11000 (20X greater risk thanthe general population)1048766 Monitoring Steady state achieved after 5 days Check 12 hours after last dose Once stable check q 3 months and TSH and creatinine q 6months

1048766 Goal blood level between 06-12

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

I Lithiumbull 1st medication for manic-depressive disorderbull Discovered by Cade in Australiabull Neurotoxic if overdose ndash thus serum level

monitoring neededbull Common side-effects polyuria amp polydipsia hand

tremorbull Toxic side-effects neuroleptic malignant

syndrome (+ haloperidol)bull controversy as 1st line treatment (especially in

primary care)

Lithium- how to use it1st medication for manic-depressive disorder

Before starting Get baseline creatinine TSHand CBC In women check a pregnancy test bullDuring the first trimester is associated withEbsteinrsquos anomaly 11000 (20X greater risk thanthe general population)1048766 Monitoring Steady state achieved after 5 days Check 12 hours after last dose Once stable check q 3 months and TSH and creatinine q 6months

1048766 Goal blood level between 06-12

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

Lithium- how to use it1st medication for manic-depressive disorder

Before starting Get baseline creatinine TSHand CBC In women check a pregnancy test bullDuring the first trimester is associated withEbsteinrsquos anomaly 11000 (20X greater risk thanthe general population)1048766 Monitoring Steady state achieved after 5 days Check 12 hours after last dose Once stable check q 3 months and TSH and creatinine q 6months

1048766 Goal blood level between 06-12

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

Lithium toxicity

bull Mild- levels 15-20 see vomiting diarrheaataxia dizziness slurred speechnystagmusbull Moderate 20-25 nausea vomitinganorexia blurred vision clonic limbmovements convulsions deliriumSyncopebull Severe gt25 generalized convulsionsbull oliguria and renal failure

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

Various anti-epileptics bull valproate (divalproex) - esp maniamixedbull carbamazepine oxcarbazepine - esp

maniamixedbull lamotrigine - esp BP-Drapid cyclingbull topiramte - maniamixed esp rapid cyclingbull Gabapentinepregabalin - analgesic amp

anxiolytic effect

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19

• Slide 1
• مكانيسمzwnjهايي كه داروها موجب درمان اختلالات روانzwnjپزشكي ميzwnjشوند
• Psychopharmacology history
• psycho tropics
• classificationpsycho tropics 2
• Depression biological Hypotheses
• AntidepressantClassification
• Tricyclic Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Other Antidepressants
• Benzodiazepines (BZDs)
• Anti- Psychotic Medication
• Therapeutic guideline
• Mood stabilizers
• I Lithium
• Lithium- how to use it
• Lithium toxicity
• Various anti-epileptics
• Slide 19