PSYCH

• Mental health


  A state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability
• Mental illness


  Disorders that affect mood, behavior, and thinking, such as depression, schizophrenia, anxiety disorders, and addictive disorders. Often cause significant distress or impaired functioning or both. Individuals experience dissatisfaction with self, relationships, and ineffective coping. Daily life can seem overwhelming or unbearable. Individuals may believe that their situation is hopeless.
• Theories of Psychopathology


  1. Psychoanalytic theories

  2. Developmental theories

  3. Interpersonal Theories

  4. Humanistic theories

  5. Behavioral Theories
• Id, Ego, Superego


  Components of personality described by Sigmund Freud
• Maslow's Expanded Hierarchy of Needs


  • Includes self-transcendence, which involves altruistically helping others to achieve self-actualisation. Transcendence refers to the very highest and most inclusive or holistic levels of human consciousness, behaving and relating, as ends rather than means, to oneself, to significant others, to human beings in general, to other species, to nature, and to the cosmos.
• Transference and Countertransference


  Concepts described by Sigmund Freud
• Psychopharmacology


  The study of drugs used to treat mental disorders
• The 3 main classes of synthetic drugs used as sedatives and hypnotics are benzodiazepines, barbiturates, and nonbenzodiazepines-nonbarbiturate drugs
• Benzodiazepines


  Produce many therapeutic effects including sedation before anesthesia, sleep inducement, relief of anxiety and tension, skeletal muscle relaxation, and anticonvulsant activity. Bind to cell receptors enhancing the effects of GABA, the inhibitory neurotransmitter.
• Nonbenzodiazepines


  Buspirone is the first antianxiety drug in this class. Advantages include less sedation, no increase in CNS depressant effects when taken with alcohol or sedative-hypnotics, and lower abuse potential.
• Barbiturates


  Have many clinical indications including daytime sedation, hypnotic effects for insomnia, preoperative sedation and anesthesia, relief of anxiety, and anticonvulsant effects. Bind to cell receptors and stimulate the effects of GABA, the inhibitory neurotransmitter.
• Nonbenzodiazepines-Nonbarbiturates


  Act as hypnotics for treatment of simple insomnia. Offer no special advantages over other sedatives.
• Sedatives and hypnotics


  • Amobarbital
  • Butabarbital
  • Mephobarbital
  • Pentobarbital
  • Phenobarbital
  • Secobarbital
• Low doses of sedatives and hypnotics


  • Depress sensory and motor cortex in the brain, causing drowsiness
• High doses of sedatives and hypnotics


  • May cause respiratory depression and death because of its ability to depress all levels of CNS
• Barbiturates


  Sedatives and hypnotics with the suffix -arbital
• Adverse drug reactions of sedatives and hypnotics


  • Drowsiness, sedation
  • Lethargy
  • Headache
  • Depression
• Sedatives and hypnotics taken with Valproic acid

  May increase barbiturate levels
• Sedatives and hypnotics taken with MAOIs


  Inhibit the metabolism of barbiturates, increasing their sedative effects
• Sedatives and hypnotics taken with acetaminophen


  Increases the risk of liver toxicity
• Nonbenzodiazepine-nonbarbiturate sedatives and hypnotics


  • Chloral hydrate
  • Eszopiclone
  • Ramelteon
  • Zaleplon
  • Zolpidem
• Nonbenzodiazepine-nonbarbiturate sedatives and hypnotics


  Act as hypnotics for treatment of simple insomnia, offer no special advantages over other sedatives
• Mechanism of action of nonbenzodiazepine-nonbarbiturate sedatives and hypnotics


  • Isn't fully known, however they produce depressant effects similar to barbiturates
• Uses of nonbenzodiazepine-nonbarbiturate sedatives and hypnotics


  • Treatment for simple insomnia
  • Sedation before surgery
  • Sedation before EEG studies
• When used with other CNS depressants, additive CNS depression occurs, resulting in drowsiness, respiratory depression, stupor, coma, or death
• Lithium carbonate


  Commonly used drug for its mood stabilizing property, most often used for long-term treatment of bipolar disorder
• Mechanism of action of lithium carbonate


  • Exact mechanism is unknown, may regulate catecholamines release in the CNS by increasing NE and serotonin uptake, reducing the release of NE from the synaptic vesicles, and inhibiting NE action in the postsynaptic neuron
• Therapeutic range of lithium carbonate

  0.6 -1.2 mEq/L
• Lithium carbonate toxicity levels


  • Mild: 1.5 - 2 mEq/L, Moderate: 2-3 mEq/L, Severe: >3 mEq/L
• Symptoms of lithium carbonate toxicity


  • Confusion
  • Blurred vision
  • Diarrhea
  • Tinnitus
  • Slurred speech
  • Coma
  • Convulsions
  • Excessive urination
  • Excessive thirst
  • Tremors/ataxia
• Classifications of antidepressant medications


  • SSRI
  • SNRI
  • MAOI
  • TCA
• Selective serotonin reuptake inhibitors (SSRIs)


  Inhibit the neuronal reuptake of the neurotransmitter serotonin
• Uses of SSRIs


  • Major depressive disorders
  • Obsessive-compulsive disorder
  • Treatment for bulimia
  • Social anxiety disorder
  • Severe depression
• SSRI medications


  • Citalopram
  • Duloxetine
  • Escitalopram
  • Fluoxetine
  • Fluvoxamine
  • Paroxetine
  • Sertraline
  • Venlafaxine
  • Vilazodone
• Adverse drug reactions of SSRIs


  • Anxiety
  • Insomnia
  • Somnolence
  • Palpitations
  • Various rashes
  • Sexual dysfunction
  • Nausea
  • Dry mouth/thirst
• SSRIs may take 4 - 6 weeks to take effect thus needs good compliance
• Take SSRI medication in the morning
• SSRIs have a black-box warning for suicide risk
• Taper down SSRI dosage slowly over several weeks to avoid discontinuation syndrome
• 3 S's of SSRI


  • Serotonin syndrome
  • Sexual dysfunction
  • Stomach distress