This document discusses the treatment of psychiatric disorders through pharmacotherapy, psychotherapy, and somatic treatments. It focuses on the role of medications in treating various conditions like mood disorders, schizophrenia, anxiety, sleep disorders, substance use disorders, and others. It provides details on specific drug classes and examples used to treat each condition. It also covers electroconvulsive therapy (ECT) and discusses what it is, how it works, when it may be used, potential side effects, and the ECT administration and recovery process. Psychotherapies are also mentioned as important treatment options.

1. Psychopharmacology
Dr. Sujit Kumar Kar, MD (Psy)
Additional Professor of Psychiatry
King George’s Medical University, Lucknow, U.P

2. Are psychiatric disorders treatable?

3. Treatment of psychiatric disorders
Pharmacotherapy
(drug treatment)
Psychotherapy
(Counselling)
Somatic
treatment (ECT,
TMS, etc)

4. How old is
drug
treatment in
psychiatry?

5. Role of medications in treatment of mood
disorders
Antidepressants (TCAs
and newer
antidepressants)
Useful for
depression
Mood stabilizers
(lithium, valproate,
lamotrigine,
Carbamazepine)
Useful for bipolar
affective disorder
Benzodiazepines
(Diazepam,
clonazepam,
lorazepam)
For controlling
anxiety, agitation
and ensuring sleep
Antipsychotics
(Additional mood
stabilizing property)
For controlling
agitation, mood
stabilization

6. Role of medications in treatment of
Schizophrenia and other psychotic illnesses
Antipsychotic medications (Control the core
psychotic symptoms)
• Typical : Haloperidol, Chlorpromazine
• Atypical: Olanzapine, Risperidone, Quetiapine, Aripiprazole
Benzodiazepine (ensures sleep and reduces
agitation)

7. Role of medications in treatment of Anxiety
disorders
Medications
with anxiolytic
property
Antidepressants
Benzodiazepines
Buspirone
Propranolol
Short term anxiety control:
Benzodiazepines, Propranolol
Long term anxiety control:
Antidepressants
Caution: Long term use of
benzodiazepines cause
dependence

8. Role of medications in treatment of Sleep
disorder
• Benzodiazepines (clonazepam, lorazepam, nitrazepam)
• Non-benzodiazepine hypnotics (zopiclone, zolpidem,
trazodone)
Insomnia
• Modafinil
• Traditional psychostimulants- amphetamines and their
derivatives
Hypersomnia
• Benzodiazepines
Parasomnia

9. Role of medications in treatment of
Neurocognitive disorders
Delirium
• Anti-psychotics for agitation
Dementia
• Cholinesterase inhibitors (e.g. donepezil, rivastigmine, galantamine),
Memantine (NMDA antagonist)
Amnestic disorders
• treat the underlying cause, Benzodiazepine (for anxiety)

10. Role of medications in treatment of
Substance use disorder
Alcohol Use disorder
• Benzodiazepines- diazepam , oxazepam,
chlordiazepoxide, lorazepam (for withdrawal
symptoms)
• Thiamine (nutritional substitution)
• Disulfiram (deterrent)
• Acamprosate, Naltrexone (for craving)

11. Role of medications in treatment of
Substance use disorders
Opioid use disorder
Methadone,
Buprenorphine (for
substitution)
Naloxone (antagonist)
Cannabis
Anti-psychotics (for
cannabis induced
psychosis),
Benzodiazepines (for
agitation and sleep)
Nicotine
Nicotine replacement
therapy, Bupropion,
Varenicline
Benzodiazepine and
other Sedative-
hypnotic use disorder
Replacement therapy

12. Role of medications in treatment of
psychosexual disorder
In Pre-mature ejaculation (to retard ejaculation)
TCAs, some SSRI
In erectile dysfunction
PDE-5 inhibitors-
sildenafil, tadalafil,
vardenafil

13. Role of medications in treatment of
Childhood psychiatric disorder
Anti-psychotics
Low dose- for
irritability
Stimulants Methylphenidate
Non-stimulants:
Atomoxetine
Clonidine
FOR ADHD

14. Conclusion
Most psychiatric
disorders are
treatable
Long term
treatment is
required
Adherence to
treatment &
regular follow up
is key to success
(favorable)
Some
medications
require regular
monitoring
Side effects of
the medications
need to be
monitored
regularly

15. Thank you

16. ELECTROCONVULSIVE
THERAPY &
PSYCHOTHERAPIES

17. Treatment of Psychiatric Disorders
Pharmacological treatment
(Pharmacotherapy
Psychological treatment (Psychotherapy)
Somatic treatment (e.g., ECT & Other
biological treatments)

18. ECT
Aim of the lecture
What
Why When
How

19. ECT
What
Brain stimulation/ Neuromodulation
treatments
• Electroconvulsive
therapy (ECT)
• Transcranial magnetic stimulation
(TMS)
• Transcranial direct current
stimulation (tDCS)
• Vagus nerve stimulation (VNS)
• Deep brain stimulation (DBS)
• Magnetic seizure therapy (MST)
• Others: Sonic, Thermal,
Chemical, Photic stimulation

20. ECT
What
• Cognitive
• Cardiovascular
• Musculoskeletal
• Respiratory
• Ocular
• Anesthesia related
• Headache
Side effects

21. How it
works?
Multiple mechanisms
• ECT:
• Neurotransmitter
correction
• BBB permeability
• Changes brain metabolic
activity
• Increasing BDNF
• Cortisol suppression
• Neuroplastic effect

22. ECT
Why
If conventional treatment don’t work
Serious side effects to drugs
Rapid response required
Choice of the patient
To augment the treatment

23. ECT
When
Indications Contraindications
Mood disorders
Schizophrenia
Suicidal behavior
Catatonia
ICSOL
Recent AMI
Retinal detachment
Dental dislocation
Recent stroke
Pregnancy
There is no absolute
contraindication

24. ECT
◦ Precautions
◦ Administration
◦ Recovery care
◦ Monitoring

26. https://link.springer.com/referenceworkentry/10.1007/978-3-540-69960-6_171

27. https://www.nature.com/articles/s41380-018-0054-0

28. https://www.sciencedirect.com/science/article/abs/pii/S1878875016309950

29. Types of PSYCHOSURGERY
Lobectomy
Tractotomy
Deep Brain Stimulation

31. Considerations
in
psychosurgery
Risks & Benefits
Psychopathology
Resistance

32. Queries &
Feedback
◦ You may contact me at
Email: drsujita@gmail.com