Mood stabilizers schizophrenia

This chapter will explore the various drug treatments for psychotic disorders, with special emphasis on schizophrenia. Such treatments include not only conventional antipsychotic drugs but also the newer atypical antipsychotic drugs, which are rapidly replacing the older conventional agents. We will also take a look into the future at the drugs under development for psychosis, especially schizophrenia. Mood stabilizers for bipolar disorders were covered in Chapter 7. 

Post R (2000). Psychopharmacology of mood stabilizers. In PF Buckley and JL Waddington (eds), Schizophrenia and Mood Disorders (pp. 127-154). Butterworth-Heinemann, Oxford, UK. 

Although this is an area in which research is burgeoning, definite evidence of the effectiveness of EFAs in the treatment of mental disorders is lacking. There are some controlled trials of varying methodological quality in adult patients with schizophrenia, and unipolar and bipolar depression, with conflicting results (Fenton et ah, 2000 Maidment, 2000). The most encouraging trial is a preliminary study of 30 patients with bipolar disorder. It found that EFAs concurrent with mood stabilizers reduced the rate of recurrence of episodes (Stoll et al., 1999). 

Certain disorders may require combined therapy. For example, SA-bipolar type may best respond to the addition of mood stabilizers, and BZDs may be useful adjuncts for agitated psychoses. Conversely, some mood disorders may require augmentation with antipsychotics (e.g., delusional depression). Unfortunately, except for schizophrenia, most other psychotic conditions have not been systematically studied to determine the optimal use of these agents. 

It is also possible that there may not be a strict isomorphism between personality disorders and other diagnostic entities. Thus, a personality disorder may be a psychological condition that only exists in patients who have a major psychiatric disorder, such as schizophrenia, atypical depression, or social phobia. One example is mania, which can present with interpersonal behaviors such as attacking people s weaknesses, sensitivity to division, and manipulative behavior with staff. This syndrome disappears completely, however, when the patient undergoes treatment with a mood stabilizer. 

Atypical antipsychotic drugs (AADs), in addition to their application as a first-line treatment in schizophrenia, are also effective mood stabilizers. AADs are successfully used in unipolar and bipolar mood disorders, either as solo treatment or as adjuncts to SSRIs (Blier et al., 2005 Kennedy et al., 2001 Kennedy and Lam 2003 Papakostas et al., 2007 Simon and Nemeroff 2005 Tremblay and Blier 2006 Uzun et al., 2005). It has been suggested that the beneficial effect of AADs as adjuncts to SSRIs is explained, at least in part, by their ability to... 

Addition of a mood stabilizing anticonvulsant such as valproate, carbamazepine, or lamotrigine may be helpful in both schizophrenia and bipolar mania... 

Keywords Major depressive disorder Biopolar disorder Schizophrenia Mood disorders Biogenic amine hypothesis Learned helplessness Antidepressant drugs Mood stabilizers Dopamine hypothesis Antipsychotic drugs... 

Trade names Abilify (Bristol-Myers Squibb) Abilitat Indications Schizophrenia Category Antipsychotic Mood stabilizer Half-life 75-94 hours... 

Hudson CJ, Lin A, Cogan S, Cashman F, Warsh JJ. The niacin challenge test Chnical manifestation of altered transmembrane signal transduction in schizophrenia Biol Psychiatry 1997 41 507-513. Ikonomov OC, Manji HK. Molecular mechanisms underlying mood stabilization in manic-depressive ill-... 

Psychiatrists prescribe antipsychotics to treat mental illnesses that cause patients to experience marked breaks with reality (psychosis). The most common of such disorders is schizophrenia, which is a chronic, disabling, persistent, and severe brain disease that sigpiificantly impairs brain functioning and affects 1 percent of the world s population, including 3 million people in the United States alone. Antipsychotic medications are referred to as typical or atypical. Psychiatrists prescribe anxiolytics (antianxiety medications) to treat anxiety disorders, which include panic disorder, generalized anxiety disorder, specific phobias, obsessive-compulsive disorder, social anxiety disorder, and posttraumatic stress disorder. Psychiatrists prescribe antidepressants and mood stabilizers to treat the symptoms of mood disorders, the most common and severe of which are major depression and bipolar disorder. 

Maes M, Goossens F, Scharpe S, Calabrese J, Desnyder R, Meltzer HY (1995) Alterations in plasma prolyl endopeptidase activity in depression, mania, and schizophrenia effects of antidepressants, mood stabilizers, and antipsychotic drags. Psychiatry Res... 

Click ID, Bosch J, Casey DE. A doubleblind randomized trial of mood stabilizer augmentation using lamotrigine and valproate for patients with schizophrenia who are stabilized and partially responsive. J Clin Psychopharmacol 2009 29(3) 267-71. 

The role that dopamine plays in regulating mood and emotional stability can be at least partially grasped by examining dopamine s role in schizophrenia and drug addiction. Schizophrenia is a disorder characterized by delusions, hallucinations, withdrawal from external reality, and emotional unresponsiveness. The dopamine theory of schizophrenia, proposed in 1965, attributes the disorder to elevated brain concentrations of dopamine or to a hypersensitivity of dopaminergic receptors, especially the D2 and D4 receptor subtypes. Several drugs used to treat schizophrenic patients bind to D2 and D4 receptors and block the dopaminergic response. 

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