This document discusses various psychiatric disorders and their treatment options. It covers depression, bipolar disorder, schizophrenia, anxiety disorders, insomnia, and alcohol abuse. For depression, it describes tricyclic antidepressants, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors as common drug treatments. It also discusses augmentation therapies such as lithium. For bipolar disorder, it defines the characteristics of manic and depressive episodes. The document provides an overview of first and second generation antipsychotic drugs for schizophrenia. It then covers drug classes and options for treating anxiety disorders, insomnia, and alcohol withdrawal and craving.

1. Psychiatric Disorders

2. Definition of Depression Feelings of depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps.

3. Drug used in treament depression Tricyclic Antidepression(TCAs)

4. Monoamine Oxidase Inhibitors MAOIs block the enzyme responsible for the breakdown of certain neurotransmitters such as NE. They are effective for atypical depression (sleeping too much ,increased appetite,weight gain ) They should not be combined with other anti depressants.

5. CON Switching aptient from anther anti depressant to MAOIs (wait 2week) except for fluoxetine 5- 6week) When swiching form MAOIs to anther anti depressant ,2week washout period ,EMSAM,it,is available in pach with (6mg/24h,9mg/24h,12mg/24h).

6. SELECTIVE SEROTONIN REUPTAKE INHIBITORS

7. (Characteristics of( SSRIs

8. Note Because these have potent serotonergic activity,combination with drug effecting serotonin can lead to serotonin syndrom (combination with MAOIs,dextromethorphan ,meperidine ,and other sympathomimetic) these can cause restlessness,tremor,diarrhea...etc

9. Treament -discontinuing the offending agent

10. Adverese Effects GIT Complaints,insomnia,restlessness,headache,and sexual dysfunction(Bupropion&Nefazodone appear to be less likely to cause sexual dysfunction

11. Venlafaxine Deual action (balanced NE&5-HT) At lower dose the effect on serotonin predominates,As dose increased the effect on Nebecomev more Side effect AS SSRIS +mild HT

12. -TrazodoneSSRIS &Blocks 5-HT2A ,it dose not cause anticholinegic or cardiotoxic effects,cuase sedating effect Nefazodone 5-TH2A antgonist ,block 5-HT&NE,liver toxicity as side effect Bupropion the parent drug block dopamine reuptake ,whereas the metabolite block NE reuptake (This class called noradrenalin-dopamine reuptake inhibitors.

13. Mirtazapine Increase in NE&5-HT In the synapse Side effect Sedation,weight gain.constipation Duloxetine Mixed NE/Serotonin reuptake blocker Side effect liver toxicity,increase of B.P

14. Augmention Therapy Augmention regimens include the following -Lithium adding lithium help in the treament resisant depression -Thyroid also adding help in the resistant depression T3 is effective more than T4Buspiron - Seconed generation antipsyotic

15. BIPOLAR DISORER Amanic episode is characterized by at least 1 week of abnormal elevated mood,(irritability,decrease need for sleep,pleasure activities,poor attention) A-bipolar 1(presence of manic episodes +major depressive B-bipolar11(presence of major depression +hypomanic episodes

16. ANTIPSYCHOTIC DRUGS Schizophrenia Positive symptoms: Thought disorders Delusions - Hallucinations - Paranoia Negative symptoms: - Amotivation Social withdrawal Flat affect Poor speech

18. -This class of agents older anti psychotic agents as chlorpromazine was first agents

20. Anti psychotic agent for treatment of schizophrenia by chemical class

21. CONT

22. by potencyFGAS for treatment of SchizophreniaE.G))

24. Risk of dyskinsia is reduce

27. 2-Panic disorder sudden fear

28. 3-Obsessive-compulsive disorder

29. 4-Posttraumatic disorder (Sertaline first-line agent)

30. 5-Social anxitey

32. 2-Antidepressant

33. 3-Buspiron

34. 4-Miscellaneous agents

35. A)B-blcker

36. B)Monoamine oxide inhibitor

37. C)antihistamine( e.g.) hydroxyzine

38. D)Barbiturtes

40. INSOMNIA Insomnia is defined as inabilty to initiate or maintin sleep TYPE OF INSOMNIA Transient,duration 2-3 days ,actue environmental stress . Short term less 3weeks ,continued personal stress. Chronic more 3weeks,psychiatric illenss,medical cause sleep disorder

43. 2-Non barbiturates e.g.(chloral hydrate)limited indication

44. 3-Benzodiazepine

46. BENZODIAZEPINE

47. SIDE EFFECT 1-Tolerance&physical dependence may occur after long periods 2-Residual daytime sedation 3- Rebound insomnia this can occur when the drug is discontinued.

48. NON-BENZODIAZEPINE 1-Zolpidem(Ambien),has sedative&hypnotic effect ,lack of anticovulsant action,lack of muscle relaxant , lower risk of tolerance &withdrwal Half life 1.5-4h ,avoide inrenal &hepatic ptns 2-over-the counter medication as antihistamine 3-non-benzodiazepine tcas

49. ALCOHOL -ABUSE -Treament of actue alcohol withdrawal Benzodiazepine can eliminate many of mamifestation of withrawal Loading dose diazepam ,is given in adose of 10-20 mgevery 1-2 hour until the symptoms of withrawal are alleviated.

51. Benzodiazepine in treament of actue alcohol

52. Nutritional considrtins Thiamine 100mg im to prevent Wernick-Korsakoff syndrome Magnesium, Electrolytes,Vitamins -Fluid iv 5%dectrose soltuion with 0.5normal saline -Hallucinations manage by benzodiazepine,and also seizures

53. -B-blocker help with vital signs &blood pressure ALph –Agonists (e.g clonidine)this agents will help withdrawal symptoms.

54. Chronic therapy Disulfiram thes drug blocks acetaldehyde dehydrogenase -Naltrexone,it reduce alcohol craving -Acamprosate it ,s new drug also ,reduce craving of alcohol.