Psychopharmacology Psychopharmacology – A brief introduction– A brief introduction

ObjectivesObjectives

Review general categories of Review general categories of psychiatric disorderspsychiatric disorders

Review classes of psychotropic Review classes of psychotropic medicationsmedications

General principles of treatmentGeneral principles of treatment

Psychiatric DisordersPsychiatric Disorders Psychotic DisordersPsychotic Disorders

Schizophrenia, Schizoaffective DisorderSchizophrenia, Schizoaffective Disorder Mood DisordersMood Disorders

Depression, Bipolar DisorderDepression, Bipolar Disorder Anxiety DisordersAnxiety Disorders

Generalized anxiety disorder, panic disorder, PTSDGeneralized anxiety disorder, panic disorder, PTSD Alcohol and Substance Use DisordersAlcohol and Substance Use Disorders Personality DisordersPersonality Disorders

Cluster A (odd); Cluster B (dramatic); Cluster C (anxious)Cluster A (odd); Cluster B (dramatic); Cluster C (anxious) Adjustment DisordersAdjustment Disorders Cognitive DisordersCognitive Disorders

Delirium, DementiaDelirium, Dementia

Classes of Psychotropic Classes of Psychotropic MedicationsMedications

AntipsychoticsAntipsychotics ConventionalConventional AtypicalAtypical

AntidepressantsAntidepressants SSRIsSSRIs SNRIsSNRIs Tricyclic AntidepressantsTricyclic Antidepressants MAOIsMAOIs OthersOthers

Mood StabilizersMood Stabilizers LithiumLithium AnticonvulsantsAnticonvulsants Atypical antipsychoticsAtypical antipsychotics

Psychotropic MedicationsPsychotropic Medications AnxiolyticsAnxiolytics

AntidepressantsAntidepressants BenzodiazepinesBenzodiazepines Other agentsOther agents

Medications for dementiasMedications for dementias Cholinesterase inhibitorsCholinesterase inhibitors MemantineMemantine

Medications for substance use disordersMedications for substance use disorders Alcohol use disordersAlcohol use disorders Opioid substitution therapiesOpioid substitution therapies Nicotine dependenceNicotine dependence

OthersOthers Medications used to treat “side effects”Medications used to treat “side effects” Medications used for augmentationMedications used for augmentation Sleep aidsSleep aids

Considerations in Choosing Considerations in Choosing Medication(s)Medication(s)

DiagnosisDiagnosis Target symptomsTarget symptoms Severity of symptomsSeverity of symptoms Side effects of medicationsSide effects of medications Drug interactionsDrug interactions ComplianceCompliance Alternatives/adjuncts to medications Alternatives/adjuncts to medications

(psychotherapy, social treatments)(psychotherapy, social treatments)

Psychotic DisordersPsychotic Disorders

Antipsychotics are generally first-lineAntipsychotics are generally first-line ConsiderConsider

Typical vs. atypicalTypical vs. atypical Side effects of the medicationSide effects of the medication Compliance (need for long-acting Compliance (need for long-acting

injectable forms)injectable forms) Need for adjunctive medicationsNeed for adjunctive medications

Antidepressants, sleep aids, side effect Antidepressants, sleep aids, side effect medicationsmedications

Treatment resistance (need for clozapine)Treatment resistance (need for clozapine)

Mood DisordersMood Disorders

DepressionDepression Need to rule out bipolar disorderNeed to rule out bipolar disorder SSRIs generally first lineSSRIs generally first line TCAs and MAOIs are effective medications – side TCAs and MAOIs are effective medications – side

effects limit useeffects limit use Bipolar disorderBipolar disorder

Mood stabilizers are first lineMood stabilizers are first line All choices have significant side effectsAll choices have significant side effects Considerations – “classic mania”, rapid cycling, Considerations – “classic mania”, rapid cycling,

bipolar depression, comorbid medications and bipolar depression, comorbid medications and medical conditionsmedical conditions

Anxiety DisordersAnxiety Disorders

SSRIs, other antidepressants are first SSRIs, other antidepressants are first line choicesline choices

Benzodiazepines – should be used Benzodiazepines – should be used short-term if at all possibleshort-term if at all possible

Many augmentation strategies Many augmentation strategies depending upon diagnosisdepending upon diagnosis

Don’t forget about psychotherapy!Don’t forget about psychotherapy!

Alcohol and Substance Use Alcohol and Substance Use DisordersDisorders

Pharmacology often not consideredPharmacology often not considered AlcoholAlcohol

DisulfiramDisulfiram NaltrexoneNaltrexone AcamprosateAcamprosate

OpioidsOpioids MethadoneMethadone BuprenorphineBuprenorphine

TobaccoTobacco Nicotine replacementNicotine replacement BupropionBupropion VareniclineVarenicline

Personality DisordersPersonality Disorders

No current pharmacologic approaches No current pharmacologic approaches of proven efficacyof proven efficacy

Psychotherapies are first linePsychotherapies are first line Many approachesMany approaches

Antidepressants, antipsychotics, lithium, Antidepressants, antipsychotics, lithium, mood stabilizersmood stabilizers

Some are helpfulSome are helpful

Case discussionCase discussion

Diagnostic thoughts?Diagnostic thoughts? Classes of medications to consider in Classes of medications to consider in

treatment?treatment? Discussion of patient’s current Discussion of patient’s current

treatmenttreatment

QUESTIONS?QUESTIONS?