The Practitioner's Guide to Psychoactive Drugs. Questo articolo non è disponibile.The Practitioner's Guide to Psychoactive Drugs

Books, like people, are born, and, if they survive the trauma of birth, mature in response to a changing environment. This volume is no exception. It imme­ diately proved its usefulness to psychiatric clinicians upon its publication six years ago, and it is not surprising to find it now entering a new phase of life in a second edition. The many and significant changes that the reader will find herein reflect not only the rapid growth of knowledge in the field of psy­ chopharmacology but also the editors' wise awareness of the need to incorpo­ rate that knowledge into clinical practice. Important new sections have been added on the management of elderly patients, on the pharmacological approach to those with temporal lobe epilepsy, and on the use of psychoactive medications during pregnancy. The existing clinical sections have been expanded, and the format has been altered to make the volume more practi­ cally useful for the harried clinician. Most important of all, the discussions of individual drugs have been carefully revised to update information about those medications that have stood the test of time and to include those newer pharmacological agents that have appeared on the clinical scene since the publication of the first edition. This last task has been significantly aided by the addition of Dr. Alan J. Gelenberg to the family of editors; his clinical and scientific knowledge nicely complements that of Drs. Bassuk and Schoonover, and its influence is evident throughout.

1. Introduction: The Practice of Pharmacotherapy.- I. Historical Perspective.- II. Current Trends in Psychopharmacology.- A. Definition of Clinical Syndromes.- B. Development of Brain Chemistry Models and New Pharmacological Agents.- C. Pharmacokinetics.- D. Design of Drug Studies.- III. Perspectives on Clinical Practice.- A. Matching Medications with Drug-Responsive Syndromes.- B. Properties of Medication.- C. Attributes of the Clinician.- D. Attributes of the Patient.- E. Pharmacotherapy and Psychotherapy.- IV. General Clinical Guidelines.- A. Patient Evaluation.- B. Principles of Drug Use.- 1. Use Nonbiological Treatments When They Are as Effective as Pharmacotherapy.- 2. Do Not Deny a Patient Appropriate Medication.- 3. Choose the Drug with the Best Risk/Benefit Ratio.- 4. Understand the Pharmacokinetics of Psychotropic Agents.- 5. Learn the Differences between Preparations.- 6. Minimize Drug Use.- 7. Prescribe the Simplest Drug Regimen to Increase Compliance.- 8. Avoid Polypharmacy.- 9. Provide the Most Cost-Effective Treatment.- 10. Exercise Special Care with Medically Ill Patients.- 11. Establish an Ongoing Therapeutic Relationship.- 12. Complete Each Drug Trial.- V. Conclusion.- References.- 2. Depression.- I. Introduction.- A. Psychological Models.- B. Biological Models.- C. Integrative Model.- II. Diagnostic Considerations.- A. Clinical Presentations.- B. Classifications.- C. Biological Diagnosis.- 1. Amine Metabolites.- 2. Cortisol Metabolism.- D. Symptom Profiles and Drug Responsiveness.- III. General Therapeutic Measures.- A. Milieu and Crisis Techniques.- B. Psychotherapy.- C. Electroconvulsive Therapy.- 1. Introduction.- 2. Mechanism of Action.- 3. Indications.- 4. Contraindications and Adverse Reactions.- 5. Technique.- IV. Pharmacotherapy.- A. Heterocyclic Antidepressants.- 1. Chemistry.- 2. Mechanism of Action.- 3. Adverse Reactions.- a. Gastric.- b. Hematological.- i. Leukocytic Effects and Purpura.- ii. Agranulocytosis.- c. Hepatic.- d. Endocrine.- e. Ocular.- f. Cardiovascular.- g. Neurological.- h. Cutaneous.- i. Autonomic.- j. Drug Interactions.- k. Miscellaneous Adverse Reactions.- 4. Precautions for Administration during Pregnancy.- 5. Acute Toxicity.- a. Intoxication Syndromes.- b. Anticholinergic Syndromes.- i. Description.- ii. Anticholinesterase Therapy.- 6. Pharmacokinetics.- 7. Therapeutic Plasma Levels.- 8. Preparations and Dosage.- B. Monoamine Oxidase Inhibitors.- 1. Chemistry.- 2. Mechanism of Action.- 3. Adverse Reactions.- a. Cardiovascular.- b. Autonomic.- c. Gastrointestinal.- d. Neurological.- e. Hepatic.- f. Drug Interactions.- g. Miscellaneous Adverse Reactions.- 4. Contraindications.- 5. Use during Pregnancy.- 6. Toxicity.- 7. Pharmacokinetics.- 8. Preparations and Dosage.- C. Evaluation of the Depressed Patient.- D. Drug Therapy for the Depressed Patient.- 1. Initiating Treatment.- 2. Completing a Medication Trial.- 3. Discontinuing Medication.- 4. Maintenance Therapy for Chronic or Recurrent Depressions.- 5. Depressive Episodes in Bipolar Affective Disorders.- 6. Agitated, Anxious, or Hostile Depressions of Moderate Severity.- 7. Mild Depressions.- 8. Psychotic Depressions.- 9. Depression in Schizophrenic Patients.- 10. “Atypical” Depressions.- 11. Resistant Depressions.- 12. Use of Stimulants for Depression.- V. Conclusion.- References.- 3. Bipolar Affective Disorder and Recurrent Unipolar Depression.- I. Introduction.- II. Manic—Depressive Disorder (Bipolar Affective Disorder).- A. Clinical Presentation.- B. Course of the Illness.- III. General Measures for Treating Manic—Depressive Illness and Recurrent Depressions.- A. Electroconvulsive Therapy.- B. Milieu Therapy.- C. Group Therapy.- D. Psychotherapy and the Therapeutic Relationship.- IV. Pharmacotherapy.- A. General Clinical Considerations.- B. Pharmacokinetics.- C. Adverse Reactions.- 1. Endocrine.- a. Thyroid.- b. Diabetes Mellitus.- 2. Renal.- a. Polydipsia and Polyuria.- b. Diabetes Insipidus.- c. Structural Kidney Damage.- d. Other Kidney Effects.- 3. Hematological.- 4. Cardiovascular.- 5. Cutaneous.- 6. Gastrointestinal.- 7. Central Nervous System and Neuromuscular.- 8. Ocular.- 9. Weight Gain.- 10. Other Adverse Reactions.- 11. Pregnancy.- D. Drug Interactions.- E. Toxicity.- F. Preparations and Dosage.- V. Clinical Applications.- A. Diagnostic Evaluation.- B. Medical Evaluation.- C. Initiating Treatment.- D. Bipolar Affective Disorder.- 1. Acute Manic Episode.- 2. Hypomania.- 3. Maintenance Therapy.- E. Acute Depressive Episode.- F. Recurrent Depression.- G. Schizoaffective Disorder.- H. Other Possible Applications.- 1. Emotionally Unstable Character Disorders.- 2. Premenstrual Tension.- VI. Conclusion.- References.- 4. Psychoses.- I. Introduction.- II. Other Treatments.- A. Nonbiological.- B. Nondrug, Biological.- 1. Electroconvulsive Therapy.- 2. Psychosurgery.- 3. Megavitamin Therapy.- III. Antipsychotic Drugs.- A. Introduction and Terms.- B. Effects on Behavior and the Nervous System.- C. Mechanism of Action.- D. Classes and Chemistry.- E. General Principles of Use.- F. Pharmacokinetics.- G. Adverse Effects and Toxicity.- 1. Neurological.- a. Extrapyramidal Syndromes.- i. Acute Dystonic Reactions.- ii. Akathisia.- iii. Parkinson’s Syndrome.- iv. Tardive Dyskinesia.- b. Sedation.- c. Seizures.- d. Neuroleptic Malignant Syndrome.- 2. Anticholinergic.- a. Peripheral.- b. Central.- c. Serious Toxicity.- 3. Cardiovascular and Respiratory.- a. Hypotension.- b. Cardiac.- 4. Ocular.- 5. Cutaneous.- 6. Hormonal, Sexual, and Hypothalamic Reactions.- 7. Hepatic.- 8. Hematological.- 9. Pregnancy and Lactation.- 10. Withdrawal Reactions.- 11. Overdose.- H. Drug Interactions and Combinations.- I. Laboratory Tests and Monitoring.- J. Clinical Uses of the Antipsychotic Drugs.- 1. Acute Treatment.- 2. Transition and Continuation Therapy.- 3. Maintenance Therapy.- a. Definition.- b. Chronic Schizophrenia.- c. Other Diagnostic Groups.- K. New Drugs.- IV. Conclusion.- References.- 5. Anxiety.- I. Introduction.- A. Anxiety: A Symptom.- B. Symptoms.- 1. Psychological.- 2. Physical.- C. What Anxiety Is Not.- II. Models.- A. Psychoanalytic.- B. Behavioral.- C. Separation Anxiety.- D. Biological.- III. Differential Diagnosis.- A. Medical.- B. Psychiatric.- IV. Primary Anxiety Disorders and Their Treatment.- A. Phobic Disorders.- 1. Agoraphobia.- 2. Social Phobia.- 3. Simple Phobia.- B. Anxiety States.- 1. Panic Disorder.- 2. Generalized Anxiety Disorder.- 3. Obsessive—Compulsive Disorder.- C. Posttraumatic Stress Disorders.- V. Antianxiety Agents.- A. Benzodiazepines.- 1. Chemistry.- 2. Pharmacological Effects and Mechanism of Action.- 3. Kinetics.- 4. Adverse Effects.- 5. Toxicity.- 6. Tolerance, Dependence, and Withdrawal Reactions.- 7: Drug Interactions.- 8. Nonpsychiatric Uses.- B. Other Antianxiety Agents.- 1. Antihistamines.- 2. Barbiturates.- 3. Propanediols.- 4. Propranolol.- 5. Antipsychotic Drugs.- VI. Clinical Use of Antianxiety Agents.- A. Introduction.- B. Evaluating the Patient.- C. Treating Anxiety with the Benzodiazepines.- D. Indications for Using Other Antianxiety Drugs.- E. Discussing Treatment with the Patient.- F. Choosing a Specific Benzodiazepine.- VII. Summary.- References.- Selected Reading.- 6. Insomnia.- I. Introduction.- II. Sleep.- A. Normal.- B. Insomnia.- III. Hypnotic Drugs.- A. Benzodiazepines.- B. Barbiturates.- C. Chloral Derivatives.- D. Piperidinedione Derivatives.- 1. Glutethimide.- 2. Methyprylon.- E. Methaqualone.- F. Ethchlorvynol.- G. Ethinamate.- H. Diphenhydramine.- I. Paraldehyde.- J. Bromides.- K. Tryptophan.- L. Over-the-Counter Drugs.- M. Other Psychotropic Drugs for Insomnia.- IV. Clinical Use of Hypnotics.- V. Summary.- References.- Selected Reading.- 7. Substance Abuse.- I. Introduction and Definitions.- II. Abuse of Opiate Drugs.- A. Classlification.- B. Pharmacology.- C. Acute Effects.- 1. Central.- 2. Peripheral.- D. Tolerance and Physical Dependence.- E. Acute Intoxication and Overdose.- 1. Etiology.- 2. Clinical Manifestations.- 3. Management.- a. General Life-Support Measures.- b. The Use of Naloxone.- c. Other Considerations.- F. Opiate Withdrawal.- 1. Clinical Manifestations.- 2. Management.- a. Detoxification with Methadone.- i. Pharmacology.- ii. Principles of Use.- iii. Clinical Application.- b. The Use of Clonidine in Opiate Detoxification.- c. Neonatal Addiction and Withdrawal.- G. Treatment of Chronic Opiate Abuse.- 1. Medical Complications.- 2. Treatment Approaches.- a. General Considerations.- b. Methadone Maintenance.- i. Background and Theory.- ii. Clinical Application.- iii. Detoxification from Methadone.- iv. l-?-Acetylmethadol (LAAM).- v. Current Issues in Methadone Treatment.- c. The Use of Narcotic Antagonists.- i. Rationale.- ii. Clinical Use.- d. Outpatient Drug-Free Treatment.- e. Therapeutic Communities.- III. Abuse of Central Nervous System Depressants.- A. Introduction.- B. Tolerance and Physical Dependence.- C. Classification.- 1. Barbiturates.- 2. Benzodiazepines.- 3. Other Sedative—Hypnotics.- D. Abuse of CNS Depressants.- E. Acute Intoxication and Overdose.- 1. Etiology.- 2. Clinical Manifestations.- 3. Management.- F. Withdrawal from CNS Depressants.- 1. Clinical Manifestations.- 2. Management.- 3. Mixed Opiate—Sedative Dependence.- G. Treatment of Chronic Sedative Abuse.- IV. Alcohol Abuse.- A. Introduction.- B. Risk Factors in Alcoholism.- C. Pharmacology.- D. Tolerance and Physical Dependence.- E. Acute Intoxication.- 1. Simple Type.- 2. Idiosyncratic “Pathological” Intoxication.- F. Chronic Intoxication.- 1. Peripheral and Central Nervous System Effects.- 2. Effects on Other Organ Systems.- 3. Fetal Alcohol Syndrome.- G. Alcohol Withdrawal.- 1. Minor Abstinence Syndrome.- a. Clinical Manifestations.- b. Management.- 2. Major Abstinence Syndrome (Delirium Tremens).- a. Clinical Manifestations.- b. Management.- 3. Alcoholic Hallucinosis.- H. Treatment of Chronic Alcohol Abuse.- 1. Introduction.- 2. Biological Treatment.- a. Disulfiram.- b. Psychotropic Drugs.- 3. Behavioral Approaches to Treatment.- a. Aversion Therapy.- b. Other Behavioral Techniques.- 4. The Psychotherapies.- 5. Alcoholics Anonymous.- 6. Adjunctive Services.- 7. Summary.- V. Abuse of Central Nervous System Stimulants.- A. Amphetamines and Methamphetamine.- 1. Introduction.- 2. Pharmacology.- 3. Acute Effects.- 4. Tolerance and Physical Dependence.- 5. Patterns of Abuse.- 6. Acute Intoxication.- a. Clinical Manifestations.- b. Management.- 7. Amphetamine Withdrawal.- 8. Amphetamine-Induced Psychosis.- B. Cocaine.- 1. Introduction.- 2. Pharmacology.- 3. Tolerance and Physical Dependence.- 4. Patterns of Abuse.- 5. Acute Intoxication.- 6. Sequelae of Chronic Cocaine Abuse.- C. Treatment of Chronic Stimulant Abuse.- VI. Abuse of Hallucinogenic Substances.- A. Introduction.- B. Classification.- C. d-Lysergic Acid Diethylamide.- 1. Pharmacology.- 2. Tolerance and Physical Dependence.- 3. Acute Intoxication.- D. Adverse Reactions following Use of LSD or Other Hallucinogens.- 1. Panic Reactions.- 2. Toxic Delirium.- 3. Drug-Precipitated Functional Psychosis.- 4. Recurrent Drug Experiences (“Flashbacks”).- E. Sequelae of Chronic Hallucinogen Use.- VII. Phencyclidine Abuse.- A. Introduction.- B. Pharmacology.- C. Acute Intoxication.- D. Phencyclidine Overdose.- E. Phencyclidine Psychosis.- F. Sequelae of Chronic Phencyclidine Use.- VIII. Inhalant Abuse.- A. Introduction.- B. Patterns of Abuse.- C. Acute Intoxication.- D. Sequelae of Chronic Inhalant Use.- E. Treatment Approaches.- IX. Marijuana Use and Abuse.- A. Introduction.- B. Pharmacology.- C. Tolerance.- D. Patterns of Use and Abuse.- E. Acute Intoxication.- 1. Subjective Effects.- 2. Physiological Changes.- 3. Cognitive and Psychomotor Effects.- F. Adverse Reactions following Marijuana Use.- 1. Acute Panic.- 2. Toxic Delirium.- 3. Recurrent Reactions (“Flashbacks”).- G. Sequelae of Chronic Use.- 1. Cannabis Psychosis.- 2. Amotivational Syndrome.- 3. Medical Problems.- H. Potential Medical Uses of Marijuana.- I. Treatment of Chronic Marijuana Abuse.- X. Substance Abuse in Perspective.- Selected Reading.- Opiates.- CNS Depressants.- Alcohol.- CNS Stimulants.- Hallucinogens.- Phencyclidine.- Inhalants.- Marijuana.- 8. Geriatric Psychopharmacology.- I. Introduction.- II. Pharmacokinetic Changes.- A. Absorption and Distribution.- B. Protein Binding.- C. Hepatic Metabolism.- D. Excretion.- III. Adverse Reactions.- A. Central Nervous System.- 1. Sedation.- 2. Confusion.- 3. Extrapyramidal.- 4. Other Central Nervous System Symptoms.- B. Cardiac.- 1. Effects on Blood Pressure.- 2. Effects on Rate, Rhythm, and Contractility.- C. Other Organ Systems.- IV. Clinical Application.- A. Principles of Medication Use.- B. Clinical Use.- 1. Agitated Behavior and Psychotic Thinking.- a. Acute Psychosis or Behavior Problems.- b. Treatment of Extrapyramidal Symptoms.- 2. Dementia.- 3. Anxiety.- 4. Insomnia.- 5. Depression.- 6. Bipolar Affective Disorder.- V. Conclusion.- Selected Reading.- 9. Pediatric Psychopharmacology.- I. Introduction.- II. Psychoses and Severe Behavior Disorders.- A. Introduction.- B. Antipsychotic Drugs.- 1. Principles of Use.- 2. Adverse Effects.- 3. Clinical Application.- III. Tic Disorders.- IV. Depression.- A. Introduction.- B. Heterocyclic Antidepressants.- 1. Principles of Use.- 2. Adverse Effects.- 3. Overdose in Children.- C. Monoamine Oxidase Inhibitors.- V. Bipolar Affective Disorders.- A. Introduction.- B. Lithium.- VI. Enuresis.- A. Introduction.- B. Therapeutic Methods.- VII. School Refusal.- VIII. Anxiety Disorders.- A. Antihistamines.- B. Benzodiazepines.- C. Other Sedative—Hypnotics.- IX. Sleep Disorders.- A. Insomnia.- B. Nightmares.- C. Night Terrors (Sleep Terror Disorder).- D. Sleepwalking (Sleepwalking Disorder).- E. Narcolepsy.- X. Attention Deficit Disorder with Hyperactivity (Minimal Brain Dysfunction).- A. Introduction.- B. CNS Stimulants.- 1. Mechanism of Action.- 2. Types of CNS Stimulants.- a. Methylphenidate.- i. Principles of Use.- ii. Chemistry.- iii. Adverse Effects.- iv. Clinical Application.- b. d-Amphetamine.- i. Principles of Use.- ii. Adverse Effects.- iii. Clinical Application: Children 3 to 5 Years Old.- iv. Clinical Application: Children 6 Years Old or Older.- c. Magnesium Pemoline.- C. Other Drugs Used in the Treatment of Attention Deficit Disorder with Hyperactivity.- D. Diet.- XI. Conduct Disorders.- XII. Anorexia Nervosa.- XIII. “Borderline” Children.- XIV. Conclusion.- Selected Reading.- General.- Psychosis and Severe Behavior Disorders.- Tic Disorders.- Depression.- Bipolar Affective Disorders.- Enuresis.- School Refusal.- Anxiety Disorders.- Sleep Disorders.- Attention Deficit Disorder with Hyperactivity.- Conduct Disorders.- Anorexia Nervosa.- “Borderline” Children.- 10. The Use of Psychotropic Drugs during Pregnancy and Nursing.- I. Introduction.- II. General Therapeutic Approaches: Nonbiological.- III. General Issues Related to Pharmacotherapy.- A. Gross Teratogenesis.- B. Behavioral Teratogenesis.- C. Adverse Effects on the Neonate.- 1. Direct Effects.- 2. Intoxication and Withdrawal Syndromes.- D. Psychoactive Drugs and Lactation.- IV. Emotional Illness during and after Pregnancy.- A. Schizophrenic Disorders.- 1. Phenothiazines.- 2. Antiparkinson Agents.- B. Depressive and Bipolar Affective Disorders.- 1. Heterocyclic Antidepressants.- 2. Lithium.- 3. Electroconvulsive Therapy.- C. Anxiety States.- 1. Benzodiazepines.- 2. Antihistamines—Diphenylmethane Derivatives.- 3. Other Sedative-Hypnotics.- D. Insomnia.- E. Hyperemesis Gravidarum.- F. Ptyalism.- G. Substance Abuse.- 1. Opiates.- 2. CNS Depressants: Barbiturates, Minor Tranquilizers.- 3. Stimulants: Caffeine, Amphetamines, Cocaine.- 4. Marijuana, d-Lysergic Acid Diethylamide, and Phencyclidine.- 5. Alcohol Use and Abuse.- V. Conclusion.- References.- 11. Temporal Lobe Epilepsy.- I. Introduction.- II. Temporal Lobe Epilepsy.- A. Characteristics of Complex Partial Seizures.- 1. Aura.- 2. Complex P...