ମେଡ଼ିସିନ

Psychotropic drugs

Medications used to treat psychiatric disorders are referred to as Psychotropic drugs. These drugs are commonly described by their major clinical application.

1. Antidepressants
2. Antipsychotics
3. Mood stabilizers
4. Anxiolytics
5. hypnotics
6. cognitive enhancers
7. stimulants

Pharmacological Actions

Both genetic and environmental factors influence individual response to , and tolerability of psychotropic agents. Thus, a drug may not prove effective in many patients with a disorder can dramatically improve symptoms in others. In these cases, identification of characteristics that might predict potential candidates for that drugs become important.

Side effects

Side effects are unavoidable risk of medication treatment. All though it is impossible to have encyclopedic knowledge of all possible adverse effects, psychiatrist should be familiar with the more common adverse effects, as well as those with serious medical consequences.

Side effect considerations include the probability of its occurrence,  its impact on patients’ quality of life, its time course, and its cause. Just as no one drug is certain to produce clinical improvement in all patients, no side effect, no matter how common, occurs in every patients. side effects can result from the same pharmacological action that is responsible for a drugs therapeutic activity or from an unrelated property.

side effects that may occur with psychotropic medications

1. Somnolence – increased sleep, daytime sleepiness
2. Gastrointestinal Disturbances- dry mouth, constipation, nausea,stomach pain, flatulence, diarrhea
3. Movement Disorders – tremor,akathesia, dystonia
4. Sexual Dysfunction – decreased libido, impaired ejaculation and erection
5. Weight gain
6. Glucose changes
7. Hyponatrimia
8. Cognitive impairment- disturbance in capacity to think, absent mindedness
9. Sweating
10. Cardiovascular disturbances
11. Rash -occurs mainly with carbamazepine, valprote, lamotrigine
12. Idiosyncratic and paradoxical drug response

Dosing

Depends on the characteristics of the drug and patient factors
1. Inherited sensitivity
2. Ability to metabolize a drug
3. Concurrent medical disorders
4. Use of concurrent medications
5. History of exposure to previous medications

Duration of Treatment

How long do I need to take the medication?
It is first best to see if the medication works best for him or her and wheather any side effects are acceptable. Any more definite discussion of treatment duration can be held once the degree of success is clear. Psychotropic drugs are not said to cure the disorders they treat but rather help to control the symptoms.
Variables of duration of treatment
1. Nature of the disorder
2. Duration of symptoms
3. Family history of psychiatric illness
4. Patients tolerance of medication
5. Beneficial effects of medication
Early onset, history of multiple past episodes and severity and length of a current episode would make longer, even indefinite, treatment appropriate.

Treatment Phases

1. Initial period of treatment lasts at least several weeks because of delay in therapeutic effects that characterize most classes of psychotropic drugs. Patients should not have unrealistic expectations of an immediate improvement in symptoms. Patients are more likely to experience side effects early in the course treatment. Poor initial reaction to medication is not an indicator of the ultimate outcome of treatment.
2. Continuation and maintenance phase provides clinically and statistically significant protective effects against relapse. Ongoing use of medication, however, doesn’t provide absolute protection against relapse.

Frequency of Visits

Until an unequivocal response to treatment occurs, patients should be seen as frequently as circumstances warrant. The frequency of follow up is determined by clinical improvement and judgment. In severely ill patients, this might mean several times a week/month.
Patients on maintenance treatment, even when stable, need monitoring, but no consensus exists on the frequency of follow-up therapy. Three months is a reasonable interval between visits, but six months may be adequate after long standing treatment.

Reasons of Treatment Failure

1. Patient doesn’t take medicines as advised by psychiatrist
2. Medicines are not taken at an appropriate dosages for a sufficient length of time
3. Patients taking illicit substances ( i.e., cannabis ) or drink excess amount of alcohol
4. Patient taking another drug that may reduce efficacy of psychotropic medication
5. Wrong diagnosis