Psychotropic medications

In the case of mental illness, new drug therapies have especially been the focus of attention, partly because psychotropic medication has, for a long time, contributed little to the overall cost of treatment, but also because, with the advent of new generations of antipsychotics and antidepressants, healthcare providers are now searching for justification for the use of these much more expensive treatments. 

Pharmacotherapy for PCP-intoxicated patients is delayed. For the first 48 hours of admission we avoid all psychotropic medication,... 

This volume covers topics including cultural perspectives in psychiatric diagnosis and psychopharmacotherapy, differences in pharmacokinetics and pharmacodynamics of psychotropics, pharmacogenetics of ethnic populations, ethnic variations in psychotropic responses, complementary medicines in mental disorders, attitudes towards psychotropic medications, prescribing practices in Asia-Pacific countries, pharmaco-economic implications, integrating theory and practice, and... 

Ethnic differences have been shown to influence response to psychotropic medications. Much of the focus on the explanation for such differences has been on drug-metabolizing (CYP) enzymes of the liver and their sway over pharmacokinetic factors. It is now well recognized that differences in the distribution of polymorphic variants of CYP enzymes exist between different ethnic groups. However, within ethnic groups there are considerable inter-individual variations in drug kinetics, which may not be accounted for solely by genetic variation. Responses to pharmacotherapy are multifaceted and involve the interaction of environmental and... 

Mendoza, R. Smith, M. (2000). The Hispanic response to psychotropic medications. In P. Ruiz, ed., Ethnicity and Psychopharmacology. (Review of Psychiatry Series, Vol. 19, No. 4 J. O. Oldham and M. B. Riba series eds.) Washington, DC American Psychiatric Press, pp. 

Ethnic differences in CYP2D6 have been more thoroughly documented than with the other isoenzyme (Bradford, 2002). Over 70% of Caucasians but only about half of Asians, Sub-Saharan Africans, and African Americans have fully functional CYP2D6 alleles - alleles that code for normal metabolic activity. Approximately 50% of Asian and people of African ancestry have reduced function or nonfunctioning alleles. As a consequence, many older psychotropic medications are metabolized more slowly and plasma levels would be higher. Thus individuals of African and Asian ancestry would have an increased risk of side effects and should receive lower dose for a therapeutic response when compared to Caucasians of European descent (Lin, 2001 Lawson, 2000). 

Bailey, R. K. (2003). Atypical psychotropic medications and their adverse effects a review for the African-American primary care physician. /. Natl. Med. Assoc., 95, 37—-14. 

Kilbourne, A. M. 8c Pincus, H. A. (2006). Patterns of psychotropic medication use by race among veterans with bipolar disorder. Psychiatry Serv., 57, 123-6. 

Sociocultural, illness, and biological factors affect individual attitudes towards psychotropic medications. Health beliefs or explanatory models, particularly causal attributions regarding the illness and the treatment options afforded within such models, exert a profound influence on patients attitudes and behavior regarding medications (Smith, Lin Mendoza, 1993). Such effects can be subtle and can occur during the course of treatment even if there has been initial successful negotiation about the nature of the illness and treatment. In psychiatric illness little research has been leveled at the personal meaning that patients bring to treatment practices such as electro-convulsive therapy (ECT), oral medications, and depot injections, or to the transition between different administrative routes and types of medications. 

Table 10.1 Determinants of attitudes towards psychotropic medications...

The cross-national prescribing database using the same methodology provided a useful and valid comparison of patterns of prescribing psychotropic medications in mental health services in Australia, Thailand, and Malaysia (Ng et al, submitted). The study was carried out in three outpatient mental health centres in North Western Mental Health (NWMH) in Melbourne (September to November 2002), Prince of Songkla University Hospital in Hat Yai (January to March 2003), and Hospital Kuala Lumpur (January to March 2003). The proportions of outpatients treated with a primary diagnosis of a psychotic illness were 91%, 41%, and 75% in the Australian, Thai, and Malaysian samples respectively. Considering psychotropic prescriptions in schizophrenia alone, the majority of patients were prescribed antipsychotics Australia (93.7%), Thailand (92.9%), and Malaysia (97.7%). 

Age-related variations in central nervous system (CNS) neurotransmitter production and receptor sensitivity are the most likely explanations for the pharmacodynamic differences observed between children and adults following administration of psychotropic medications [39a], Children have lower phenobarbital ratios than adults, and the ratio increases with gestational age [40,41]. Conversely, a lower therapeutic range for children has been identified for cyclosporine, phenytoin, and digoxin [42]. 

Psychotropic medications with anticholinergic effects should be avoided because they may worsen cognition. 

Klotz U, Avant GR, Hoyumpa Aet al. (1975) The effects of age and liver disease on the disposition and elimination of diazepam in adult man. J Clin Invest 55(2) 347-359 Kompoliti K and Goetz CG (1998) Neuropharmacology in the elderly. Neurol Clin 16(3) 599-610 Lanctot KL, Best TS, Mittmann N et al. (1998) Efficacy and safety of antipsychotics in behavioral disorders associated with dementia. J Clin Psychiatry 59(10) 550-561 Landi F, Onder G, Cesari M et al. (2005) Psychotropic medications and risk for falls among community-dwelling frail older people an observational study. J Gerontol A Biol Sci Med Sci 60(5) 622-626... 

Snowdon J, Day S, Baker W (2006) Current use of psychotropic medication in nursing homes. Int Psychogeriatr 18(2) 241-250... 

Home hazard assessment and modification Withdrawal of psychotropic medication Nutritional supplements Vitamin D supplements... 

Monoamine Hallucinogens and Concurrent Psychotherapeutic Medications Administration of certain therapeutic psychotropic medications has been shown to alter responsiveness to hallucinogenic drugs. This is not surprising, because they both have actions on monoamine systems, sometimes even the same receptor subtytpes. Tricyclic antidepressants and... 

Should patients be referred to psychiatrists or primary care physicians Our bias is that the referral should almost always be to a psychiatrist. The patient is already seeing a specialist, the therapist, for psychotherapy and deserves the advantage of seeing a specialist for pharmacotherapy. This is not to suggest that certain primary care physicians, physician assistants, or nurse practitioners are not skilled pharmacotherapists. In fact, nonpsychiatric physicians prescribe the majority of psychotropic medications, particularly antidepressants and antianxiety medicines. 

Neurotransmission. This is the most important part of nervous system function for us to understand, both because it serves as the cornerstone of nerve cell signaling, and because it is the process that is modulated by psychotropic medications and... 

First-line GAD treatments include (1) cognitive-behavioral therapy (CBT), (2) antidepressants, (3) buspirone, and (4) benzodiazepines. Treatment selection is determined by the severity of the illness, the presence of any comorbid illnesses, previous patient treatment responses, and patient preference. When treating mild GAD, we recommend eschewing psychotropic medication altogether in favor of CBT. Moderate-to-severe GAD usually requires pharmacotherapy, though combined CBT-pharmacotherapy is highly encouraged. 

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