“Psychiatric medication”的意思、由来-开放百科全书

A psychiatric medication is a licensed psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. Usually prescribed in psychiatric settings, these medications are typically made of synthetic chemical compounds. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, therefore lowering the cost of mental health care.^[1]^[2]^[3]^[4] The recidivism or rehospitalization of the mentally ill is at a high rate in many countries and the reasons for the relapses are under research.^[5]^[6]^[7]^[8]

History

Several significant psychiatric drugs were developed in the mid-20th century. In 1948, lithium was first used as a psychiatric medicine. One of the most important discoveries was chlorpromazine, an antipsychotic that was first given to a patient in 1952. In the same decade, Julius Axelrod carried out research into the interaction of neurotransmitters, which provided a foundation for the development of further drugs.^[9] The popularity of these drugs have increased significantly since then, with millions prescribed annually.^[10]

The introduction of these drugs brought profound changes to the treatment of mental illness. It meant that more patients could be treated without the need for confinement in a psychiatric hospital. It was one of the key reasons why many countries moved towards deinstitutionalization, closing many of these hospitals so that patients could be treated at home, in general hospitals and smaller facilities.^[11]^[12] Use of physical restraints such as straitjackets also declined.

As of 2013, the 10 most prescribed psychiatric drugs by number of prescriptions were alprazolam, sertraline, citalopram, fluoxetine, lorazepam, trazodone, escitalopram, duloxetine, bupropion XL, and venlafaxine XR.^[13]

Administration

Psychiatric medications are prescription medications, requiring a prescription from a physician, such as a psychiatrist, or a psychiatric nurse practitioner, PMHNP, before they can be obtained. Some U.S. states and territories, following the creation of the prescriptive authority for psychologists movement, have granted prescriptive privileges to clinical psychologists who have undergone additional specialised education and training in medical psychology.^[14] In addition to the familiar dosage in pill form, psychiatric medications are evolving into more novel methods of drug delivery. New technologies include transdermal, transmucosal, inhalation, and suppository supplements.^[15]

Research

Psychopharmacology studies a wide range of substances with various types of psychoactive properties. The professional and commercial fields of pharmacology and psychopharmacology do not typically focus on psychedelic or recreational drugs, and so the majority of studies are conducted on psychiatric medication. While studies are conducted on all psychoactive drugs by both fields, psychopharmacology focuses on psychoactive and chemical interactions within the brain. Physicians who research psychiatric medications are psychopharmacologists, specialists in the field of psychopharmacology.

Adverse and withdrawal effects

Psychiatric medications carry risk for adverse effects. The occurrence of adverse effects can potentially reduce drug compliance. Some adverse effects can be treated symptomatically by using adjunct medications such as anticholinergics (antimuscarinics). Some rebound or withdrawal adverse effects, such as the possibility of a sudden or severe emergence or re-emergence of psychosis in antipsychotic withdrawal, may appear when the drugs are discontinued, or discontinued too rapidly.^[16]

Medicine combinations with clinically untried risks

While clinical trials of psychiatric medications, like other medications, typically test medicines separately, there is a practice in psychiatry (more so than in somatic medicine) to use polypharmacy in combinations of medicines that have never been tested together in clinical trials (though all medicines involved have passed clinical trials separately). It is argued that this presents a risk of adverse effects, especially brain damage, in real-life mixed medication psychiatry that are not visible in the clinical trials of one medicine at a time (similar to mixed drug abuse causing significantly more damage than the additive effects of brain damages caused by using only one illegal drug). Outside clinical trials, there is evidence for an increase in mortality when psychiatric patients are transferred to polypharmacy with an increased number of medications being mixed.^[17]^[18]^[19]

Types

Antidepressants

Antidepressants are drugs used to treat clinical depression, and they are also often used for anxiety and other disorders. Most antidepressants will hinder the breakdown of serotonin or norepinephrine or both. A commonly used class of antidepressants are called selective serotonin reuptake inhibitors (SSRIs), which act on serotonin transporters in the brain to increase levels of serotonin in the synaptic cleft.^[21] SSRIs will often take 3–5 weeks to have a noticeable effect, as the regulation of receptors in the brain adapts. There are multiple classes of antidepressants which have different mechanisms of action. Another type of antidepressant is a monoamine oxidase inhibitor, which is thought to block the action of Monoamine oxidase, an enzyme that breaks down serotonin and norepinephrine. MAOIs are not used as first-line treatment due to the risk of hypertensive crisis related to the consumption of foods containing the amino acid tyramine.^[21]

Antipsychotics

Antipsychotics are drugs used to treat various symptoms of psychosis, such as those caused by psychotic disorders or schizophrenia. Atypical antipsychotics are also used as mood stabilizers in the treatment of bipolar disorder, and they can augment the action of antidepressants in major depressive disorder.^[22]

Antipsychotics are sometimes referred to as neuroleptic drugs and some antipsychotics are branded "major tranquilizers".

There are two categories of antipsychotics: typical antipsychotics and atypical antipsychotics. Most antipsychotics are available only by prescription.

Anxiolytics and hypnotics

Benzodiazepines are effective as hypnotics, anxiolytics, anticonvulsants, myorelaxants and amnesics.^[23] Having less proclivity for overdose and toxicity, they have widely supplanted barbiturates.

Developed in the 1950s onward, benzodiazepines were originally thought to be non-addictive at therapeutic doses, but are now known to cause withdrawal symptoms similar to barbiturates and alcohol.^[24] Benzodiazepines are generally recommended for short-term use.^[23]

Z-drugs are a group of drugs with effects generally similar to benzodiazepines, which are used in the treatment of insomnia.

Mood stabilizers

In 1949, the Australian John Cade discovered that lithium salts could control mania, reducing the frequency and severity of manic episodes. This introduced the now popular drug lithium carbonate to the mainstream public, as well as being the first mood stabilizer to be approved by the U.S. Food & Drug Administration.

Besides lithium, several anticonvulsants and atypical antipsychotics have mood stabilizing activity. The mechanism of action of mood stabilizers is not well understood.

Stimulants

A stimulant is a drug that stimulates the central nervous system, increasing arousal, attention and endurance. Stimulants are used in psychiatry to treat attention deficit-hyperactivity disorder. Because the medications can be addictive, patients with a history of drug abuse are typically monitored closely or treated with a non-stimulant.

See also

References

1. ^{{cite book|last1=Rose|first1=Nikolas|title=Historical changes in mental health practice|publisher=Oxford University Press|isbn=9780199565498|chapter-url=http://oxfordmedicine.com/view/10.1093/med/9780199565498.001.0001/med-9780199565498-chapter-002|accessdate=24 April 2016|doi=10.1093/med/9780199565498.003.0012|chapter=Chapter 2 Historical changes in mental health practice|year=2010}}
2. ^{{cite book|last1=Grob|first1=Gerald N.|title=Mental health policy in modern America|publisher=Oxford University Press|isbn=9780199565498|chapter-url=http://oxfordmedicine.com/view/10.1093/med/9780199565498.001.0001/med-9780199565498-chapter-003|accessdate=24 April 2016|doi=10.1093/med/9780199565498.003.0014|chapter=Chapter 3 Mental health policy in modern America|year=2010}}
3. ^{{cite book|last1=Becker|first1=Thomas|last2=Koesters|first2=Markus|title=Psychiatric outpatient clinics|publisher=Oxford University Press|isbn=9780199565498|chapter-url=http://oxfordmedicine.com/view/10.1093/med/9780199565498.001.0001/med-9780199565498-chapter-016|accessdate=24 April 2016|doi=10.1093/med/9780199565498.003.0086|chapter=Chapter 16 Psychiatric outpatient clinics|year=2010}}
4. ^{{cite book|last1=Shaywitz|first1=Jonathan|last2=Marder|first2=Stephen|title=Medication treatment for anxiety, depression, schizophrenia, and bipolar disorder in the community setting|publisher=Oxford University Press|isbn=9780199565498|chapter-url=http://oxfordmedicine.com/view/10.1093/med/9780199565498.001.0001/med-9780199565498-chapter-022|accessdate=24 April 2016|doi=10.1093/med/9780199565498.003.0109|chapter=Chapter 22 Medication treatment for anxiety, depression, schizophrenia, and bipolar disorder in the community setting|year=2010}}
5. ^{{cite journal | doi = 10.1186/1471-244X-14-161 | pmid=24888262 | pmc=4059735 | volume=14 | pages=161 | title=The frequency of rehospitalization and associated factors in Colombian psychiatric patients: a cohort study | journal=BMC Psychiatry| year=2014 | last1=Jaramillo-Gonzalez | first1=Luis Eduardo | last2=Sanchez-Pedraza | first2=Ricardo | last3=Herazo | first3=Maria Isabel }}
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10. ^{{cite web|last=Martin|first=Emily|title=Resources on the History of Psychiatry|url=https://www.nlm.nih.gov/hmd/pdf/historypsychiatry.pdf|publisher=National Library of Medicine|accessdate=6 May 2013|last2=Rhodes|first2=Lorna A.}}
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12. ^{{cite journal|last1=Eisenberg|first1=Leon|authorlink=Leon Eisenberg|last2=Guttmacher|first2=Laurence|title=Were we all asleep at the switch? A personal reminiscence of psychiatry from 1940 to 2010|journal=Acta Psychiatrica Scandinavica|date=August 2010|volume=122|issue=2|pages=89–102|doi=10.1111/j.1600-0447.2010.01544.x|pmid=20618173}}
13. ^Top 25 Psychiatric Medication Prescriptions for 2013 Author John M. Grohol, Psy.D..Psych Central.
14. ^{{cite web | last = Murray | first = Bridget | title = A Brief History of RxP | publisher = APA Monitor | date = October 2003 | url = http://www.apa.org/monitor/oct03/rxp.html | accessdate = 11 April 2007 }}
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16. ^{{cite journal|last=Moncrieff|first=Joanna|date=23 March 2006|title=Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse|journal=Acta Psychiatrica Scandinavica|volume=114|issue=1|pages=3–13|issn=1600-0447|url=http://www3.interscience.wiley.com/journal/118626311/abstract|archive-url=https://archive.today/20130105081330/http://www3.interscience.wiley.com/journal/118626311/abstract|dead-url=yes|archive-date=5 January 2013|accessdate=3 May 2009|doi=10.1111/j.1600-0447.2006.00787.x|pmid=16774655}}
17. ^Michael S Ritsner (2013) "Polypharmacy in Psychiatry Practice, Volume I: Multiple Medication Use Strategies"
18. ^Michael S Ritsner (2013) "Polypharmacy in Psychiatry Practice, Volume II: Use of Polypharmacy in the "Real World""
19. ^Otto Benkert, Wolfgang Maier, Karl Rickels (2012) "Methodology of the Evaluation of Psychotropic Drugs"
20. ^{{cite journal | last = Schatzberg | first = A.F. | year = 2000 | title = New indications for antidepressants | journal = Journal of Clinical Psychiatry | volume = 61 | issue = 11 | pages = 9–17 | pmid = 10926050}}
21. ^{{cite journal| author =Stephen M. Stahl, M.D.| title =A Review of the Neuropharmacology of Bupropion, a Dual Norepinephrine and Dopamine Reuptake Inhibitor| publisher =Journal of Clinical Psychiatry; 6(04) 159-166 2004 PHYSICIANS POSTGRADUATE PRESS, INC| year = 2004 | url = http://www.psychiatrist.com/pcc/pccpdf/v06n04/v06n0403.pdf | accessdate =2006-09-02 |display-authors=etal}}
22. ^¹²{{cite book|author= Stahl, S. M. | title=Stahl's Essential Psychopharmacology: Neuroscientific basis and practical applications| publisher=Cambridge University Press | year=2008}}
23. ^¹{{cite journal|last=Ashton|first=Heather|title=Guidelines for the rational use of benzodiazepines. When and what to use|journal=Drugs|date=July 1994|volume=48|issue=1|pages=25–40|doi=10.2165/00003495-199448010-00004|pmid=7525193}}
24. ^{{cite journal |vauthors=MacKinnon GL, Parker WA |title=Benzodiazepine withdrawal syndrome: a literature review and evaluation |journal=Am J Drug Alcohol Abuse |volume=9 |issue=1 |pages=19–33 |year=1982 |pmid=6133446 |doi= 10.3109/00952998209002608|url=}}