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PsychopharmacologyPsychopharmacology

Khalid Bazaid, MB BS, FRCPCKhalid Bazaid, MB BS, FRCPCAssistant ProfessorAssistant Professor

Child & Adolescent PsychiatristChild & Adolescent PsychiatristDepartment of PsychiatryDepartment of Psychiatry

College of MedicineCollege of MedicineKing Saud UniversityKing Saud University

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OutlinesOutlines

The role of psychotropic medications in the mental The role of psychotropic medications in the mental health and its therapeutic indicationshealth and its therapeutic indications

Identify specific cautions to be aware of the various Identify specific cautions to be aware of the various psychotropic medicationspsychotropic medications

Discuss the adherence to medication treatmentDiscuss the adherence to medication treatment

Overview Psychotropic Medications ClassificationsOverview Psychotropic Medications Classifications

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The aim is learn how to choose a psychotropic drug that is more:

• Less toxic • Effective • Better-tolerated• The most targeted therapeutic agents

PsychopharmacologyPsychopharmacology

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Use of psychotropic medicationsUse of psychotropic medications

Relieve or reduce symptoms/signs of dysfunctional Relieve or reduce symptoms/signs of dysfunctional thoughts, moods, or actions of mental illnessthoughts, moods, or actions of mental illness

Improve client’s functioningImprove client’s functioning

Increase compliance to other therapiesIncrease compliance to other therapies

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Psychotropic DrugsPsychotropic Drugs

Focus of all mental activity is the CNS (brain)Focus of all mental activity is the CNS (brain)

Origin of psychiatric illness caused by many factors:Origin of psychiatric illness caused by many factors:– GeneticsGenetics– Neurodevelopment factorsNeurodevelopment factors– Endocrinologic e.g. HypothyroidismEndocrinologic e.g. Hypothyroidism– Autoimmune system (infections)Autoimmune system (infections)– DrugsDrugs– Psychosocial experiences, stressors … etc.Psychosocial experiences, stressors … etc.

To date …Theories behind use of psychotropic drugs To date …Theories behind use of psychotropic drugs focuses on neurotransmitters and their receptorsfocuses on neurotransmitters and their receptors

Psychotropic drugs act by modulating neurotransmittersPsychotropic drugs act by modulating neurotransmitters

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Therapeutic Effects of Therapeutic Effects of Psychotropic MedicationsPsychotropic Medications

Do not “cure”Do not “cure” Relieve or decrease Relieve or decrease

symptomssymptoms Prevent or delay return Prevent or delay return

of S/Sof S/S Cannot be used as the Cannot be used as the

sole treatment for sole treatment for disordersdisorders

Need informed consent Need informed consent before startingbefore starting

Are broad spectrum and Are broad spectrum and have effects on a large have effects on a large number of S/Snumber of S/S

Initial effects are Initial effects are sedative in naturesedative in nature

May take weeks for May take weeks for effects to be seeneffects to be seen

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Reasons for Non- adherence:Reasons for Non- adherence:

Medications are Medications are expensiveexpensive

Unpleasant side effectsUnpleasant side effects

Feel better and decide Feel better and decide no longer needno longer need

Stigma associated with Stigma associated with having a mental illness having a mental illness and taking medicationsand taking medications

Paranoia or fears about Paranoia or fears about medication usage medication usage particularly additionparticularly addition

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Encouraging Compliance to Encouraging Compliance to Medication RegimenMedication Regimen

Follow-up appointments With client to verify that client Follow-up appointments With client to verify that client understands:understands:

the purpose, proper administration, intended effects, side and the purpose, proper administration, intended effects, side and toxic effects of, and how to treat problems associated with toxic effects of, and how to treat problems associated with medicationsmedications

Appropriate lab tests must be conducted to prevent Appropriate lab tests must be conducted to prevent complications and assure correct levels of drugscomplications and assure correct levels of drugs

Encourage clients to participate in medication groupsEncourage clients to participate in medication groups

Can use injections of antipsychotics which will last Can use injections of antipsychotics which will last from 2-4 weeks if clients are non-compliantfrom 2-4 weeks if clients are non-compliant

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Efficacy of Psychotropics with Efficacy of Psychotropics with Children & ElderlyChildren & Elderly

Use with great caution Use with great caution

Start Start low and go slowlow and go slow for both elders and for both elders and childrenchildren

Children are faster metabolizer whereas elders Children are faster metabolizer whereas elders have decrease liver & renal functionhave decrease liver & renal function

Risk of injuries and falls with elderlyRisk of injuries and falls with elderly

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Client & Family TeachingClient & Family Teaching

Purpose of the meds Purpose of the meds and benefits, side and benefits, side effects and how to effects and how to treat SEtreat SE

What S/S indicate a What S/S indicate a toxic effect, and how toxic effect, and how to treat, and whom to to treat, and whom to call.call.

Specific instructions Specific instructions about how to take the about how to take the medicationsmedications

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Psychotropic Medications Psychotropic Medications ClassificationsClassifications

Antipsychotics Antipsychotics (Neuroleptics)(Neuroleptics)

Mood StabilizersMood Stabilizers

AntidepressantsAntidepressants

Anxiolytics Anxiolytics (antianxiety)(antianxiety)

SedativesSedatives

HypnoticsHypnotics

PsychostimulantsPsychostimulants

Antihistamines, Antihistamines, antimuscarinics, antimuscarinics, dopamine agonistsdopamine agonists

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AntipsychoticsAntipsychoticsNEUROLEPTICS / MAJOR TRANQUILIZERSNEUROLEPTICS / MAJOR TRANQUILIZERS

Block D2 receptors in the mesolimbic Block D2 receptors in the mesolimbic system system

Not addictiveNot addictive Treat all psychoses & psychotic symptomsTreat all psychoses & psychotic symptoms

Schizophrenia Disorders

Bipolar disorder

Major Depression with psychotic features

Tourette’s Syndrome

Delirium, Dementia, and Delusions

Control of intractable hiccups

Aggressive behavior

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ANTIPSYCHOTIC DRUGSANTIPSYCHOTIC DRUGSNEUROLEPTICS / MAJOR TRANQUILIZERSNEUROLEPTICS / MAJOR TRANQUILIZERS

Mechanism of actionMechanism of action In typical antipsychoticsIn typical antipsychotics

– Blockage of D2 – receptors in: Blockage of D2 – receptors in: Nigro-strial (psychiatric tract)Nigro-strial (psychiatric tract) Substantia Nigra (Neurological tract)Substantia Nigra (Neurological tract) Tubero-infundibular tract (Endocrine tract)Tubero-infundibular tract (Endocrine tract)

In atypical antipsychotics:In atypical antipsychotics:– Blockage of 5HT2A/D2 receptorsBlockage of 5HT2A/D2 receptors

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ANTIPSYCHOTIC DRUGSANTIPSYCHOTIC DRUGSSide effects (Side effects (hinthint))

High Potency typical antipsychotics: High Potency typical antipsychotics: NeurologicalNeurological side effects side effects

e.g. Haloperidole.g. Haloperidol

Low Potency typical antipsychotics: Low Potency typical antipsychotics: otherother side effectsside effects

e.g. Chlorpromazinee.g. Chlorpromazine

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ANTIPSYCHOTIC DRUGSANTIPSYCHOTIC DRUGSNeurologic Side effectsNeurologic Side effects

Due to D2 blockadeDue to D2 blockadeParkinsonian syndromeParkinsonian syndrome– Position & gaitPosition & gait

– ApathyApathy

– DroolingDrooling

– Fine tremorFine tremor

– Staring eyesStaring eyes

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ANTIPSYCHOTIC DRUGSANTIPSYCHOTIC DRUGSNeurologic Side effectsNeurologic Side effects

Due to D2 blockadeDue to D2 blockade– Parkinsonian Parkinsonian

syndromesyndrome– Akathesia (Motor Akathesia (Motor

restlessness)restlessness) Subjective feelings of restlessnessSubjective feelings of restlessness Objective signs of restlessnessObjective signs of restlessness Feelings of anxiety, inability to relax, Feelings of anxiety, inability to relax,

jitteriness, pacing, rocking motions jitteriness, pacing, rocking motions while sitting, rapid alterations of while sitting, rapid alterations of position.position.

More in middle aged womenMore in middle aged women

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ANTIPSYCHOTIC DRUGSANTIPSYCHOTIC DRUGSNeurologic Side effectsNeurologic Side effects

Due to D2 Due to D2 blockadeblockade– Parkinsonian Parkinsonian

syndromesyndrome– Akathesia (Motor Akathesia (Motor

restlessness)restlessness) Brief or prolonged muscle contraction Brief or prolonged muscle contraction

leading to abnormal movements or leading to abnormal movements or postures e.g. postures e.g. Occulogyric crises, Occulogyric crises, tongue protrusion, torticollis, tongue protrusion, torticollis, laryngeal pharyngeal dystonias and laryngeal pharyngeal dystonias and dystonic Posturesdystonic Postures

Early onset, more in young men and Early onset, more in young men and high doses of typical neuroslepticshigh doses of typical neurosleptics

Acute dystoniaAcute dystonia

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ANTIPSYCHOTIC DRUGSANTIPSYCHOTIC DRUGSNeurologic Side effectsNeurologic Side effects

Due to D2 blockadeDue to D2 blockade– Parkinsonian Parkinsonian

syndromesyndrome– Akathesia (Motor Akathesia (Motor

restlessness)restlessness) Involuntary choreiform, athetoid or Involuntary choreiform, athetoid or

rhythmic movements of the tongue, rhythmic movements of the tongue, jaw, trunk or extremitiesjaw, trunk or extremities

More with long term typical neuroleptic More with long term typical neuroleptic treatment, old age, female sex, mood treatment, old age, female sex, mood disorder, cognitive disorders.disorder, cognitive disorders.

– Acute dystoniaAcute dystonia– Tardive DykinesiaTardive Dykinesia

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ANTIPSYCHOTIC DRUGSANTIPSYCHOTIC DRUGSNeurologic Side effectsNeurologic Side effects

Due to D2 blockadeDue to D2 blockade– Parkinsonian syndromeParkinsonian syndrome– Akathesia (Motor Akathesia (Motor

restlessness)restlessness) Muscular rigidity, , Hyper-thermia , Akinesia, Muscular rigidity, , Hyper-thermia , Akinesia,

mutism, obtundation & agitation, sweating, mutism, obtundation & agitation, sweating, tachycardia, Hypertension.tachycardia, Hypertension.

Increased WBC, increased CPK, liver Increased WBC, increased CPK, liver enzymes, and plasma myoglobulin. enzymes, and plasma myoglobulin. Myoglobulinuria, may occur and may lead to Myoglobulinuria, may occur and may lead to renal failure.renal failure.

Symptoms evolve in 1-3 days & may last 10-14 Symptoms evolve in 1-3 days & may last 10-14 days.days.

May occur at any timeMay occur at any time More common in young menMore common in young men Mortality:Mortality: 20% - 30%( higher with depot) 20% - 30%( higher with depot)

– Acute dystoniaAcute dystonia– Tardive DyskinesiaTardive Dyskinesia– Neuroleptic malignant Neuroleptic malignant

syndromesyndrome

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ANTIPSYCHOTIC DRUGSANTIPSYCHOTIC DRUGSOther Side effectsOther Side effects

Muscarenic (anti-cholenergic):Muscarenic (anti-cholenergic):– dry mouthdry mouth

– ConstipationConstipation

– Blurred vision, urinary retentionBlurred vision, urinary retention

– Precipitation of narow angle glucomaPrecipitation of narow angle glucoma

Alpha–1–adrenergic blockade:Alpha–1–adrenergic blockade:– Orthostatic hypotensionOrthostatic hypotension

– ImpotenceImpotence

– Impaired ejaculationImpaired ejaculation

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ANTIPSYCHOTIC DRUGSANTIPSYCHOTIC DRUGSOther Side effectsOther Side effects

CNS Side effects:CNS Side effects:– SedationSedation

Metabolic / Endocrine Side Metabolic / Endocrine Side effects:effects:

– weight gainweight gain– Increased BS & lipidsIncreased BS & lipids– GalactorrheaGalactorrhea– AmenorrheaAmenorrhea

Allergic Side effectsAllergic Side effects– Cholestatic jaundiceCholestatic jaundice– AgranulostasisAgranulostasis

Cardiac side effects: Cardiac side effects: – EKG changesEKG changes– ArrythmiasArrythmias

Occular Side effectsOccular Side effects::– Corneal OpacitiesCorneal Opacities– Retinitis pigmentozaRetinitis pigmentoza

Dermatological Side effectsDermatological Side effects::

– PhotosensitivitiesPhotosensitivities– Metallic discolorationMetallic discoloration– Contact dermatitisContact dermatitis

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Antipsychotics-Long acting Antipsychotics-Long acting preparationpreparation

Can be given be given as an IM injection Can be given be given as an IM injection (depot preparations) if have difficulty (depot preparations) if have difficulty taking oral meds.taking oral meds.

Can use lower doses when given IM, so Can use lower doses when given IM, so less risk of tardive dyskinesialess risk of tardive dyskinesia

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AntidepressantsAntidepressants Treatment of depressive moods, including Treatment of depressive moods, including

bipolar disease bipolar disease

4 categories:4 categories:– Tricyclics (TCA)Tricyclics (TCA)– MAOI’sMAOI’s– SSRI’SSSRI’S– Atypical AntidepressantsAtypical Antidepressants

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Major Indications for Major Indications for AntidepressantsAntidepressants

Major Depressive Major Depressive disorderdisorder

Bipolar depressionBipolar depression Anxiety disorders:Anxiety disorders:

Panic disorderPanic disorder Obsessive-CompulsiveObsessive-Compulsive Phobic disordersPhobic disorders

PTSDPTSD

Substance AbuseSubstance Abuse Chronic PainChronic Pain Tourette’s DisorderTourette’s Disorder ADHDADHD Eating disordersEating disorders Sleep disordersSleep disorders MigrainesMigraines EnuresisEnuresis

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Antidepressant DrugsAntidepressant Drugs

TricyclicsTricyclics- Amitriptyline, Imipramine- Amitriptyline, Imipramine

SSRI’sSSRI’s- Fluoxetine, Sertraline- Fluoxetine, Sertraline

MAOI’sMAOI’s- Phenelzine , Tranycypramine - Phenelzine , Tranycypramine

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Atypical AntidepressantsAtypical Antidepressants

Inhibits reuptake of Inhibits reuptake of serotoninserotonin::

desyrel (Trazodone)desyrel (Trazodone)

Norepinephrine Dopamine Norepinephrine Dopamine Reuptake Inhibitor (NDRI)Reuptake Inhibitor (NDRI): : Wellbutrin (Bupropion)Wellbutrin (Bupropion)

Serotonin Norepinephrine Serotonin Norepinephrine Reuptake InhibitorReuptake Inhibitor-(SNRI): -(SNRI): Effexor (venlafaxine)Effexor (venlafaxine)

Cymbalta (duloxetine)Cymbalta (duloxetine)

Increases release of Increases release of serotonin & norepinephrine: serotonin & norepinephrine: Remeron (Mirtazapine)Remeron (Mirtazapine)

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Atypical AntidepressantsAtypical Antidepressants

Trazodone:Trazodone:alternative to TCA’s, may cause orthostatic hypotension, alternative to TCA’s, may cause orthostatic hypotension, sedation, and priapism in malessedation, and priapism in males

Remeron:Remeron: causes sedation, weight gain, dry mouth, constipationcauses sedation, weight gain, dry mouth, constipation

Wellbutrin Wellbutrin (zyban): rarely causes sedation, weight Gain, (zyban): rarely causes sedation, weight Gain, or sexual dysfunctionor sexual dysfunction– Used for smoking cessation. Most common S/E are headaches, Used for smoking cessation. Most common S/E are headaches,

insomnia & nauseainsomnia & nausea– May lower seizure thresholdMay lower seizure threshold

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Atypical Antidepressants:Atypical Antidepressants: Serotonin Norepinephrine Reuptake Serotonin Norepinephrine Reuptake

Inhibitor (SNRI)Inhibitor (SNRI)

SNRI-blocks uptake of SNRI-blocks uptake of serotonin and norepinephrineserotonin and norepinephrine

Drugs include Drugs include EffexorEffexor & & CymbaltaCymbalta

Good for clients with anxiety Good for clients with anxiety

S/E:GI, sexual dysfunction, S/E:GI, sexual dysfunction, insomnia, agitationinsomnia, agitation

Skipping 1 dose can Skipping 1 dose can cause withdrawal S/Scause withdrawal S/S

Very effective in Very effective in treating severe treating severe depressiondepression

Cymbalta is effective in Cymbalta is effective in treating somatic treating somatic symptoms e.g. painsymptoms e.g. pain

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ANTIDEPRESSANT DRUGSANTIDEPRESSANT DRUGSSide effectsSide effects

HETEROCYCLICS: HETEROCYCLICS: – Muscarenic (anti-cholenergic):Muscarenic (anti-cholenergic):

Dry mouthDry mouth ConstipationConstipation Blurred vision, urinary retentionBlurred vision, urinary retention Precipitation of narow angle glucomaPrecipitation of narow angle glucoma

Alpha–1–adrenergic blockade:Alpha–1–adrenergic blockade:– Orthostatic hypotensionOrthostatic hypotension

– ImpotenceImpotence

– Impaired ejaculationImpaired ejaculation

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ANTIDEPRESSANT DRUGSANTIDEPRESSANT DRUGSSide effectsSide effects

DeliriumDelirium Coma seizuresComa seizures AgitationAgitation HallucinationsHallucinations Severe hypotensionSevere hypotension Supra-ventricular Supra-ventricular

tachycardiatachycardia FlushingFlushing MydriasisMydriasis Dry skinDry skin HyperthermiaHyperthermia Decreased bowel sounds.Decreased bowel sounds.

Central anti-cholenergic syndrome:Management Stop HCA immediately Physostigmine

(anticholinesterase inhibitor) 1-2 mg IV or IM every 20 – 60 minutes, until improvement occurs

Cardiac monitoring and life support (physostigmine may lead to severe BP drop and bronchial constriction)

Benzodiazepines may be used.

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ANTIDEPRESSANTSANTIDEPRESSANTSSide effectsSide effects

HETEROCYCLICS: HETEROCYCLICS: SSRI:SSRI:

– have a much better side effect profile:have a much better side effect profile: AgitationAgitation Sexual problems Sexual problems Stomach upset Stomach upset Hypersomnia/insomniaHypersomnia/insomnia

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ANTIDEPRESSANTSANTIDEPRESSANTSSide effectsSide effects

HETEROCYCLICS: HETEROCYCLICS: SSRI: SSRI: MAOI:MAOI:

– Cardiovascular (orthostatic hypotension, tyramine Cardiovascular (orthostatic hypotension, tyramine hypertensive crisis)hypertensive crisis)

– Sexual (Impotence & delayed ejaculation)Sexual (Impotence & delayed ejaculation)– Neurologic (insomnia, seizure& euphoria)Neurologic (insomnia, seizure& euphoria)– Hepatic: (Cholestatic reaction).Hepatic: (Cholestatic reaction).

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ANTIDEPRESSANTSANTIDEPRESSANTSSide effectsSide effects

HETEROCYCLICS: HETEROCYCLICS: SSRI: SSRI: MAOI: MAOI:

– Interaction:Interaction:– Diet:Diet:

Aged cheesePickled herriagRaisinAlcoholChicken liverBeansFigsYeast productsChocolate

AmphetaminesDecongestants & nasal sprays (Ephedrine….)Epinephrine (local anesthesia)Aldomet

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MOOD STABLIZERSMOOD STABLIZERS

Lithium CarbonateLithium Carbonate Sodium ValproateSodium Valproate CarbamazepineCarbamazepine LamotrigineLamotrigine TopiramateTopiramate ClozapineClozapine

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MOOD STABLIZERSMOOD STABLIZERS

Used in the treatment of Manic (Bipolar) Used in the treatment of Manic (Bipolar) disorder, and in some forms of depressiondisorder, and in some forms of depression

Drugs used: Lithium and Antiepileptic DrugsDrugs used: Lithium and Antiepileptic Drugs

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LithiumLithium

Mechanism of action Mechanism of action unknownunknown

Alters electrical Alters electrical conductivityconductivity – potential threat to all potential threat to all

body functions that body functions that are regulated by are regulated by electrical currentselectrical currents

Can cause polyuria and Can cause polyuria and polydipsa due to Na and polydipsa due to Na and K alterationsK alterations

Has the lowest Has the lowest therapeutic index of all therapeutic index of all psych drugspsych drugs

Have to monitor blood Have to monitor blood levels levels

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LITHIUM CARBONATELITHIUM CARBONATESide effectsSide effects

NeurologicalNeurological: Tremor (50%), weakness, cog-wheeling: Tremor (50%), weakness, cog-wheeling RenalRenal: Occur in 10-50 % e.g. polyuria, polydipsia, nephrogenic : Occur in 10-50 % e.g. polyuria, polydipsia, nephrogenic

D.I., nephrotic syndrome, (tubular changes with chronic use D.I., nephrotic syndrome, (tubular changes with chronic use and high levels)and high levels)

CardiacCardiac: Similar to those of hypokalimia e.g. U-wave and T-: Similar to those of hypokalimia e.g. U-wave and T-wave depressionwave depression

EndocrineEndocrine: Goiter, hypothyroidism, abnormal thyroid functions : Goiter, hypothyroidism, abnormal thyroid functions (30-40%)(30-40%)

DermatologicalDermatological: Acne, exacerbation of psoriasis ), hair loss.: Acne, exacerbation of psoriasis ), hair loss. Pregnancy and lactationPregnancy and lactation: Teratogenicity (level in milk=30-100% : Teratogenicity (level in milk=30-100%

of maternal blood level)of maternal blood level) ToxicityToxicity: (seizures, delirium, cerebellar signs, coma) occurs in : (seizures, delirium, cerebellar signs, coma) occurs in

blood level= 1.2 – 2 mEq/l. Lethal levels above that.blood level= 1.2 – 2 mEq/l. Lethal levels above that.

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Signs & Symptoms of Lithium Signs & Symptoms of Lithium ToxicityToxicity

Fine hand tremors that Fine hand tremors that progress into coarse progress into coarse tremorstremors

Mild GI upset Mild GI upset progressing to progressing to persistent upsetpersistent upset

Slurred speech and Slurred speech and muscle weakness muscle weakness progressing to mental progressing to mental confusionconfusion

Severe ToxicitySevere Toxicity: : – decrease level of decrease level of

consciousness to consciousness to stupor and finally stupor and finally comacoma

– Seizures, severe Seizures, severe hypotension, severe hypotension, severe polyuria with dilute polyuria with dilute urineurine

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Contraindications for LithiumContraindications for Lithium Renal diseaseRenal disease

Cardiac diseaseCardiac disease

Severe dehydrationSevere dehydration

Sodium depletionSodium depletion

Brain damageBrain damage

Pregnancy or lactationPregnancy or lactation

Use with caution in the elderly or clients with diabetics, thyroid Use with caution in the elderly or clients with diabetics, thyroid disorders, urinary retention, and seizuresdisorders, urinary retention, and seizures

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Sedative/Hypnotic DrugsSedative/Hypnotic Drugs Anxiolytic and hypnoticAnxiolytic and hypnotic

Can lead to tolerance and dependencyCan lead to tolerance and dependency

Use for short termUse for short term

Drugs usedDrugs used

benzodiazepines:benzodiazepines: Dalmane, Restoril, Halcion Dalmane, Restoril, Halcion

Non-benzodiazepines:Non-benzodiazepines: Ambien, Sonata, Lunestra Ambien, Sonata, Lunestra

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BenzodiazepinesBenzodiazepines Valium, Xanax, Ativan , Valium, Xanax, Ativan ,

Librium, LexotanilLibrium, Lexotanil

Dalmane, Halcion (used as Dalmane, Halcion (used as sleep aides-short term) sleep aides-short term)

Used for anxiety disorders, Used for anxiety disorders, ETOH withdrawal, muscle ETOH withdrawal, muscle spasm, sedation, insomnia, spasm, sedation, insomnia, and epileptics/seizuresand epileptics/seizures

Risk of dependency Risk of dependency

Avoid ETOHAvoid ETOH

Causes sedation-Causes sedation-don’t drive!!don’t drive!!

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BenzodiazepinesBenzodiazepines Side EffectsSide Effects

– Drowsiness, confusion, sedation, and lethargyDrowsiness, confusion, sedation, and lethargy

Toxic EffectsToxic Effects– Respiratory depression esp. with ETOH use!Respiratory depression esp. with ETOH use!

ContraindicationsContraindications– Combination with other CNS depressantsCombination with other CNS depressants– Renal or hepatic dysfunction (may use Ativan)Renal or hepatic dysfunction (may use Ativan)– History of drug abuse or addictionHistory of drug abuse or addiction– Depression and suicidal tendenciesDepression and suicidal tendencies

TeachingTeaching– Use short term due to risk of drug dependencyUse short term due to risk of drug dependency– Avoid ETOH and other CNS depressantsAvoid ETOH and other CNS depressants– Can impair ability to driveCan impair ability to drive– Sudden D/C of benzodiazepines might cause withdrawal s/sSudden D/C of benzodiazepines might cause withdrawal s/s

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Non-benzodiazepine AnxiolyticNon-benzodiazepine Anxiolytic

BuSpar (Buspirone)BuSpar (Buspirone) Reduces anxiety without strong sedative-hypnotic propertiesReduces anxiety without strong sedative-hypnotic properties Not a CNS depressantNot a CNS depressant Takes 2 weeks to feel effects Takes 2 weeks to feel effects No potential for addictionNo potential for addiction Side EffectsSide Effects

– Dizziness, dry mouth, nervousness, diarrhea, headache, excitementDizziness, dry mouth, nervousness, diarrhea, headache, excitement

Toxic EffectsToxic Effects– Lethal dose is 160-550 times the daily recommended doseLethal dose is 160-550 times the daily recommended dose

ContraindicationsContraindications– Use with caution in PG womenUse with caution in PG women– Nursing mothersNursing mothers– Clients with renal or hepatic diseaseClients with renal or hepatic disease– Anyone taking MAOsAnyone taking MAOs

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Questions after lecture?Questions after lecture?

Please e-mail (kbazaid@ksu.edu.sa) or call Please e-mail (kbazaid@ksu.edu.sa) or call (01 467 1717)(01 467 1717)

Interested in learning more about child and Interested in learning more about child and adolescent psychiatry?adolescent psychiatry?– Arrange to attend OPD Arrange to attend OPD – Consider an elective rotation during internship or Consider an elective rotation during internship or

otherwiseotherwise