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Psychotropic drug
About: Psychotropic drug is a research topic. Over the lifetime, 2309 publications have been published within this topic receiving 54070 citations.
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TL;DR: In this paper, a practical review of the diagnosis and management of angle closure induced by psychotropic agents, including tricyclic antidepressants, antipsychotics and anticonvulsants, is provided.
Abstract: This article provides a practical review of the diagnosis and management of angle closure induced by psychotropic agents, including tricyclic antidepressants, antipsychotics and anticonvulsants. Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors and antipsychotics may trigger angle closure by influencing pupil configuration through adrenergic, anticholinergic, serotonergic or dopaminergic mechanisms. Patients with narrow iridocorneal angles are at risk, and these are more common in people with hypermetropia (near-sightedness), older people and individuals with an Asian background. These patients may benefit from a laser peripheral iridotomy, either prophylactically or to relieve an acute angle-closure episode. An idiosyncratic reaction to medications such as topiramate may lead to angle closure through an alternate mechanism, leading to a uveal effusion. Ophthalmological review may be considered prior to commencing medications in high-risk patients.
2 citations
TL;DR: The efficacy of psychotropic drugs in the treatment of acute episodes can only be evidenced by the reduction of indicators of the severity of the target symptomatology in the controlled drug trials.
Abstract: The pathophysiology of anxiety, affective and schizophrenic disorders is not known. Therefore the efficacy of psychotropic drugs cannot be tested by their effect on the pathophysiology of mental disorders. The efficacy of psychotropic drugs in the treatment of acute episodes can only be evidenced by the reduction of indicators of the severity of the target symptomatology in the controlled drug trials.
2 citations
TL;DR: Protestants, Catholics, and Jews bring differing conceptions of God to the transference phenomenon in individual psychotherapy, and the need for the psychotherapist to be aware of religious factors that influence the course of psychotherapy is sought.
Abstract: While many factors influence the course of therapy, based on empirical evidence a strong case can be made for the importance of religious beliefs influencing the process of transference. During a ten-year period of private psychiatric practice, the senior author saw 353 patients suffering from anxiety and neurotic depression. The form of treatment was individual, dynamic, psychoanalytically oriented psychotherapy with occasional use of psychotropic drugs. Forty percent of the patients who were seen were Catholic; forty percent were Protestant; and twenty percent were Jewish.
2 citations
TL;DR: Cozza et al. as discussed by the authors found that grapefruit juice has an inhibitory effect on the hepatic microsomal enzyme system (i.e., 3A4), which is responsible for 90% of human drug oxidation.
Abstract: Most of us have become acquainted with the cytochrome P450 (or just P450) enzyme system, which is the metabolic pathway for a significant number of psychotropic drugs. This drug-metabolizing system was once referred to as the hepatic microsomal enzyme system (Lehne, 2001), but more precise study has refined our understanding and resulted in a more descriptive designation. The P450 enzymes are oxidase systems, and more than 40 P450 enzyme subtypes have been identified in humans (Cozza & Armstrong, 2001). Six of these enzymes are responsible for 90% of human drug oxidation: 1A2, 3A4, 2C9, 2C19, 2D6, and 2E1 (Cozza & Armstrong; Guengerich, 1997). The P450 enzymes are also responsible for many if not most of the drug-drug interactions that occur (Cozza & Armstrong). Drug-drug interactions cause serious complications to a patient's health, can be deadly, and are largely preventable. A less common yet significant interaction occurs between drugs and certain foods. For example, mixing monoamine oxidase inhibitors (MAOIs) with foods containing tyramine can lead to a deadly hypertensive crisis; combining warfarin (Coumadin) with vitamin K--containing foods (e.g., green, leafy vegetables) promotes clotting-factor synthesis; and eating foods containing vitamin B6 while undergoing levodopa therapy results in increased metabolism of levodopa and its reduced effectiveness (Menke, 1998). Grapefruit juice also causes important food-drug interactions. Grapefruit juice inhibits two of the six major P450 enyzmes--the 3A4 enzyme and, to a lesser extent, 1A2. The specific components of grapefruit juice thought to inhibit 3A4 are psoralen derivatives, the flavonoid derivatives naringenin and naringin, and several other substances (Fuhr, 1998; Fuhr & Kummert, 1995; Fukuda, Guo, Ohashi, Yoshikawa, & Yamazoe, 2000; Malhotra, Bailey, Paine, & Watkins, 2001). Singly, none of the constituents seems profoundly inhibitory, which suggests a complex synergy may be responsible for inhibition of 3A4 and 1A2. The enzyme 3A4 is located in the liver (about 30% of this enzyme), but the majority is found in the gut wall (Bailey, Malcolm, Arnold, & Spence, 1998; Cozza & Armstrong, 2001). More than 100 drugs are metabolized by this enzyme, so any agent that would inhibit 3A4 has the potential to elevate serum levels of those drugs. Table 1 lists some of the categories of drugs metabolized by 3A4. Not all drugs in the categories listed in Table 1 are affected by grapefruit juice. Grapefruit juice has its inhibiting effect on gut wall-3A4 enzymes, hence drugs primarily metabolized by liver-3A4 enzymes are not likely to be affected by grapefruit juice (Fuhr, 1998; Menke, 1998). Following are selected examples of psychotropic agents known to have increased bioavailability when coadministered with grapefruit juice. Anxiolytic Agents Benzodiazepines. There have been contradictory reports on the interaction between grapefruit juice and benzodiazepines. Ozdemir, Aktan, Boydag, Cingi, and Musmul (1998) reported serum levels of diazepam (Valium) increased threefold when given with grapefruit juice. Other studies suggest increases in blood levels of triazolam (Halcion) and midazolam (Versed) when given with this juice (Fuhr, 1998; Hukkinen, Varhe, Olkkola, & Neuvonen, 1995). Kupferschmidt, Ha, Ziegler, Meier, and Krahenbuhl (1995) gave subjects oral or IV midazolam with water or grapefruit juice. Only those drinking grapefruit juice and receiving the drug orally had increased blood levels (~50%). The fact that IV midazolam did not increase in serum concentrations conforms with the information presented above that grapefruit juice only inhibits gut wall 3A4. Of course, IV midazolam would not experience a first-pass reduction. Grapefruit juice does not seem to affect alprazolam levels, and this may be related to its greater bioavailability and subsequent liver metabolism. Buspirone. …
2 citations
01 Jan 1980
TL;DR: The most important psychophysiological changes observed in anxious patients and the effects of benzodiazepines on these parameters are reviewed.
Abstract: The characteristic psychophysiological effects of benzodiazepines are few but important. At therapeutic doses, most of their actions are centrally mediated. Before I review the most important psychophysiological changes observed in anxious patients and the effects of benzodiazepines on these parameters, I would like to spend a few moments on some of the basics of psychophysiology.
2 citations