Psychiatric therapy development

Interest in the measurement of intracellular activities centres on transmembrane potentials and on the transport of ions across membranes. For example, lithium salts feature in the treatment of mania, but owing to the analytical problems little has been known of lithium accumulation or about its transport by nerve cell membranes. However, a recently developed microlithium electrode based on a liquid membrane sensor has established [280] an active transport of lithium ions out of Helix aspersa pallial ganglia and that at low external levels there is even less intracellular than extracellular lithium ions. It is therefore difficult to appreciate how lithium could function in an intracellular capacity to alter the neuronal properties in lithium psychiatric therapy [280]. 

Shock Therapy. The early 20th century saw the development of the first effective biological treatments for depression, the shock therapies. The first shock treatments used injection of horse serum or insulin. A major advance in treatment occurred with the advent of electroconvulsive therapy (ECT) in 1934. Although initially used to treat schizophrenia, ECT was soon found to be highly effective for other psychiatric disorders including depression and mania. ECT remained the primary biological psychiatric treatment until the widespread release of psychiatric medications in the 1950s. 

An emerging literature suggests that treatment of psychiatric illness may reduce the risk of developing SUD later in life. The findings are most dramatic for stimulant therapy of ADHD, as several studies have observed decreased SUD rates in children whose ADHD was treated with stimulants, compared to ADHD children who received no such treatment (Biederman et ah, 1999 Toney et ah, 1999 Molina et ah, 1999). There is also preliminary evidence that treatment of bipolar disorder can reduce future substance use (Wilens et ah, 2000). While these findings are encouraging, further research is needed to support the initial data and to... 

Even though the pharmacotherapy of adolescent addictions is a relatively new field, it appears to have a role in the treatment of many youth with SUD. Pharmacological agents have been shown to reduce excessive craving, to reduce associated comorbid psychopathology, and to prevent the future development of SUD in certain at-risk youth. Despite the present lack of empirical evidence, opiate substitution therapy should be considered in youth with heroin addiction. As with all treatments, the expectations, risks, and benefits should be reviewed with the patient and their caretakers. For SUD treatment to be successful, the provider should closely monitor and address the patient s SUD and psychiatric symptoms, treatment compliance, and social stressors. 

The patients in the Zielinski et al. (1993) study developed more severe cardiac complications than did those of Rice et al. (1994). This discrepancy may result from the former study requiring rigorous evaluation of cardiac illness, with strict inclusion criteria, and thus may have involved relatively sicker patients. Nonetheless, even in the Zielinski et al. (1993) study, 38 of 40 cardiac patients completed a course of ECT. Indeed, with proper monitoring and management, patients with cardiac disease can be safely treated with ECT (American Psychiatric Association Task Force on Electroconvulsive Therapy 1990). 

Stahl s Essential Psychopharmacology has established itself as the preeminent source of education and information in its field. This much expanded second edition enlists advances in neurobiology and recent clinical developments to explain with renewed clarity the concepts underlying drug treatment of psychiatric disorders. New neurotransmitter systems, new theories of schizophrenia, clinical advances in antipsychotic and antidepressant therapy, new coverage of attention deficit disorder, sleep disorders, and drug abuse, and a new chapter on sex-specific and sexual function-related psychopharmacology—these are all features of this edition. 

A 32-year-old woman developed irritability, anger, and insomnia after taking oral prednisone (60 mg/day) for a relapse of ileal Crohn s disease (85). The prednisone was withdrawn and replaced by budesonide (9 mg/ day), and the psychiatric adverse effects were relieved after 3 days. A good clinical response was maintained, with no relapse after 2 months of budesonide therapy. 

Respiratory effects of hypoglycemia A 19-year-old woman with diabetes developed hypoglycemia with pulmonary edema (59). This has previously been seen as a complication of insulin shock therapy for psychiatric illnesses. 

No specific treatment programs have been developed for prescription sedative abusers. The problem is so often complicated by abuse of other drugs that it may be more expeditious to enroll the patient in a program designed for alcoholics or opiate-dependent persons. Patients with psychiatric disorders that can be defined, especially those with depression, may be treated with drug therapy specific for the underlying disorder. 

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