Management

Antipsychotic agents (also called neuroleptics) are primarily used in treatment. These medications are used to treat acute psychotic episodes and to maintain patients in remission or with chronic illness. Antipsychotic medications are discussed in Chapter 11. Combinations of several classes ol medications are often prescribed in severe or refractory cases. Psychosocial treatments, including stable reality- Positive and Negative Symptoms of Schizophrenia Negative symptoms Affective flattening...

Eating Disorders

Eating disorders are characterized by disturbances in eating behavior and an overconcern with body image or size. Although eating disorders are classified into two discrete diagnostic categories in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), many symptoms overlap. The principal diagnostic distinction is based on ideal body weight. When abnormal eating behavior causes body weight to fall below a defined percentage of expected body weight, a diagnosis of...

Alcohol Dependence

Alcohol abuse becomes alcohol dependence when effects on one's life become more global and tolerance and withdrawal symptoms develop. The alco-holically dependent patient drinks larger amounts over longer periods of time than intended, spends a great deal of time attempting to obtain alcohol, and reduces participation in or eliminates important social, occupational, or recreational activities because of alcohol. In alcohol dependence, there also is a persistent desire or unsuccessful ef forts...

Anxiol

The medications discussed in this chapter have anxiolysis in common. Although benzodiazepines have a wide variety of clinical applications (e.g., as preanesthetics, in the treatment of status epilepticus, as muscle relaxants, and in the treatment of insomnia) and other medications (e.g., antidepressants) are of utility in treating some forms of anxiety, the benzodiazepines are uniquely effective for the rapid relief of a broad spectrum of anxiety symptoms. Buspirone is a novel medication that,...

Therapeutic Monitoring

A similar dosage range is used for seizure and bipolar disorders, although the drug is not FDA approved for this use. The drug is excreted renally and unchanged. < cuan M fle* aB o-KCHBepcMH MyCAUfl 3T fpoHT. py > There is no clinically available assay for serum gabapentin. Mood stabilizers are indicated for the treatment 2. They work by unknown but likely varied Efficacy varies according to the subtype of bipolar Mood stabilizers have serious toxicities, so patients require regular...

Biphasic Mood Disorder

Mood disorders are among the most common diagnoses in psychiatry. Mood is a persistent emotional state (as differentiated from affect, which is the external display of feelings). There are three major categories of mood disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition unipolar mood disorders (major depressive disorder, dysthymic disorder), bipolar mood disorders (bipolar I disorder, bipolar II disorder, and cyclothymic disorder), and mood disorders...

Mechanism of Action

The mechanism of action of gabapentin in bipolar disorder and in seizure disorders is unknown. Gabapentin inhibits induced seizures in rats and mice. Although it is structurally related to the neurotransmitter GABA, it has no binding affinity to the GABA receptor or to any other known brain receptors. 300 mg bid-tid 250 mg bid-tid 100 mg bid-tid 25-50 mgqhs2 300 mgqd 150 mg bid 900-1500mg day 1000-2500 mg day 600-1200 mg day 300-500 mg day 900-1800 mg day 600-1200 mg day ' Dosages are generally...

Miscellaneous Disorders

Miscellaneous disorders does not refer to any official Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) classification but rather to psychiatric diagnoses not covered elsewhere in this book. Generally, these diagnoses are either less common, less understood, or less frequently the focus of psychiatric practice than the disorders previously covered. Although many of these disorders are not uncommon, they seldom come to psychiatric attention for a variety of reasons...

Phototherapy

Antidepressants are used commonly in medical and psychiatric practice. As a class, antidepressants have in common their ability to treat major depressive illness. Most antidepressants are also effective in the treatment of panic disorder and other anxiety disorders. Some antidepressants effectively treat obsessive-compulsive disorder (OCD) and a variety of other conditions (see indications below). The most commonly prescribed antidepressants are listed in Table 12-1. Antidepressants are...

Buspirone

Buspirone is a novel medication that appears to act as an anxiolytic via its action as an agonist at the serotonergic 5HT receptor. In addition, it has some D2 antagonist effects, although with unclear clinical significance. Unlike the benzodiazepines, it does not work rapidly a period of several weeks of sustained dosing is required to obtain symptomatic relief. Buspirone has no GABA receptor affinity and is therefore not useful in treating benzodiazepine or alcohol withdrawal. It is not a...