Psychotherapy

Psychiatric Mental Health Drugs Overview

Presentation by: Patti Parker, PhD, RN, ANP, GNP, BC, GS-C

Main Objectives
  • Review and understand the neuro-chemical and physiology that correlates to mental illness.
  • Identify the properties and actions of various medications used to treat psychiatric disorders.
  • Describe the principal indications and anticipated responses to treatments including antipsychotics, antidepressants, anxiolytics, mood stabilizers, and psychostimulants.
  • Compare and contrast common side effects/adverse reactions of psychotherapeutic agents.
  • Review laboratory tests required for evaluation of effects caused by psychotherapeutic agents.
Medication Categories Discussed
  • Anxiolytics
  • Hypnotics
  • Antidepressants
  • CNS Stimulants
  • Antipsychotics
  • Mood Stabilizers
  • Drugs of Abuse

Sub-objectives

  • Identify influence of CYP450 enzymes in medication decision-making.
  • Distinguish a method for medication selection based on neurotransmitter actions and side effect profiles.
  • Differentiate action of traditional and newer antipsychotics on dopamine and serotonin receptors.
  • Discuss benefits of atypical antipsychotics for negative symptoms, cognitive symptoms, anxiety & depression.
  • Discuss the relationship between the potency of older antipsychotics and their side effect profiles.
  • Identify common side effects of SSRIs, TCAs, and MAOIs.
  • Review properties and medications for treating anxiety and insomnia.
  • Compare and contrast drugs used to treat ADHD.
  • Review the neurobiology of addiction and principles of addiction treatment.
  • Explore the action of caffeine and other methylxanthines.
  • Explore the actions and properties of drugs used to treat addiction and substance use disorders.

Clinical Scenarios

Question 1
  • Scenario: James in the ER with unintended overdose of Xanax (Alprazolam).
  • Question: What is the antidote?
    • A) Diazepam
    • B) Ramelteon
    • C) Flumazenil (correct)
    • D) Naloxone
Question 2
  • Scenario: 64-year-old patient with depression and angle closure glaucoma.
  • Question: Which agent should NOT be prescribed?
    • A) Amitriptyline (correct)
    • B) Bupropion
    • C) Mirtazapine
    • D) Sertraline
Question 3
  • Scenario: 10-year-old male with ADHD.
  • Question: Most appropriate management drug?
    • A) Clonidine
    • B) Mirtazapine
    • C) Dextroamphetamine (correct)
    • D) Haloperidol
Question 4
  • Question: Which antipsychotic has the highest sedative potential?
    • A) Aripiprazole
    • B) Quetiapine (correct)
    • C) Haloperidol
    • D) Trazodone
Question 5
  • Scenario: Patient inquiries about effects of LSD.
  • Best response: Exaggerated hallucinations (correct)

Anxiolytics Overview

  • Definition: Anxiety is defined as an unpleasant state of tension, apprehension, or uneasiness, with physical symptoms like tachycardia, sweating, trembling, and palpitations.
  • Mild anxiety is common and does not require therapy.
  • Severe anxiety may necessitate medication and/or psychotherapy.
  • Many anxiolytics exhibit sedating properties; some antidepressants are also indicated for anxiety treatment.
Benzodiazepines
  • Drug Names and Indications:
    • Diazepam (Valium): Anxiety
    • Alprazolam (Xanax): Anxiety
    • Chlordiazepoxide (Librium): Anxiety and ETOH withdrawal
    • Clonazepam (Klonopin): Anxiety
    • Estazolam (Prosom): Sleep
    • Flurazepam (Dalmane): Sleep
    • Lorazepam (Ativan): Anxiety
    • Midazolam (Versed): Procedural sedation
    • Oxazepam (Serax): Anxiety
    • Quazepam (Doral): Sleep
    • Temazepam (Restoril): Sleep
    • Triazolam (Halcion): Sleep
General Considerations
  • Benzos largely replace barbiturates for anxiety and insomnia treatments; generally considered safer and more effective.
  • Considered effective but not always the best choice for anxiety and depression; SSRIs are often preferred.
  • Non-benzodiazepine hypnotics and antihistamines may be preferred for insomnia treatment.
Mechanism of Action
  • Benzodiazepines target gamma-aminobutyric acid (GABAa) receptors, the CNS's primary inhibitory neurotransmitter.
  • GABAa receptors consist of five subunits (alpha, beta, gamma), with different subtypes.
  • GABA binding opens ion channels allowing Cl⁻ ions to flow, resulting in hyperpolarization and decreased neurotransmission.
  • Benzos modulate GABA effects by binding to different sites on GABA receptors.
  • Clinical effects correlate with binding affinity for GABA receptor-Cl⁻ ion channel complexes.
Actions of Benzodiazepines
  • Effects:
    • Reduction of anxiety
    • Sedation/hypnotic effects
    • Anterograde amnesia
    • Anticonvulsant properties
    • Muscle relaxant effects
  • Benzos selectively enhance GABA transmission, inhibiting neuron circuits in the limbic system, producing calmness and sedation. High doses may induce hypnosis.
  • Therapeutic Uses: Treatment of panic, GAD, social anxiety, performance anxiety, other anxiety-related disorders, and related to MDD and schizophrenia. Effective for sleep disorders.
Pharmacokinetics
  • Absorption/Distribution: Lipophilic properties allow rapid absorption post-oral ingestion; penetration throughout the body and CNS.
  • Categorized by duration of action: short, intermediate, and long-acting, correlating to half-lives.