Psychoactive Medications: Uses, Types, and Treatments

Posted on Jan 20, 2025 in Medicine & Health

Psychoactive Medications

1. Benzodiazepines

Most used for sleep induction (fast-acting, short-term): Zolpidem, Lormetazepam, Loprazolam.

Anxiolytics: Alprazolam (Trankimazin) is addictive; Bromazepam (Lexatin), Lorazepam (Orfidal, Idalprem), Clorazepate (Tranxilium), Diazepam (Valium), Halazepam (Alapryl), Ketazolam (Sedotime).

Types of Insomnia

  • Insomnia conciliation: Multiple causes. Use sleep inducers.
  • Fragmented sleep: Use long-acting BZD, not sleep inducers.
  • Waking up early: Characteristic of depression. Treat with ATD, not BZD.

BZD antidote: Flumazenil (Anexate) 0.2-0.3 mg IV over 15 seconds, max 1-2 mg. IV infusion: 0.1-0.4 mg/h for recurring effects.

2. Antidepressants

SSRIs are the preferred choice. Tricyclics have more serious side effects, often managed by psychiatrists.

ATD-Tricyclics: Imipramine, Clomipramine.

SSRIs: (more side effects but less severe) Fluoxetine, Paroxetine, Sertraline, Escitalopram (mild anxiolytic, useful in the elderly). All SSRIs cause initial nausea and decreased libido.

Indications: Depression, anxiety, impulse control disorders, eating disorders, chronic pain, sleep disorders. (Drugs causing depression: Anti-inflammatories, hormones, steroids, anticancer).

3. Antipsychotics

Classic: Haloperidol.

Atypical: Clozapine, Olanzapine, Risperidone, Quetiapine, etc.

4. Eutimizantes

For bipolar disorder: Lithium (decreases manic phases, toxic, levels 0.5-1.3, long-term thyroid effects) and antiepileptics.

5. Treatment of Alzheimer’s

Donepezil, Galantamine, Rivastigmine, Tacrine.

Psychotic Disorders

Ideas of overestimation (emotionally charged, subjective perception) and delusions (primary, false, logically irrefutable). Delusion contents: self-reference, prejudice, jealousy, religious megalomania, fantastic, guilt, hypochondriasis.

Types of Psychotic Disorders

  • Acute and transient psychotic disorder
  • Persistent delusional disorder
  • Schizophrenia
  • Schizotypal disorder
  • Schizoaffective disorder

Symptoms of Psychotic Disorders

  1. Perceptual and auditory hallucinations: Pseudo-hallucinations, visual, olfactory, and gustatory hallucinations.
  2. Thought disorders.
  3. Language disorders: Neologisms, echolalia, stereotypes, impoverished speech.
  4. Mood and affect disorders: Inappropriate emotional response, emotional isolation, post-psychotic depressions.
  5. Psychomotor disorders: Catatonic manifestations (restlessness, bizarre postures, negativism, automatic obedience, mutism, stupor).

Schizophrenia

Positive symptoms: Hallucinations, delusions, disorganized behavior, disorganized thinking, affective incongruity.

Negative symptoms: Affective flattening, alogia (poor content of thought, language, blocking, increased latency), apathy, anhedonia, impaired concentration and attention.

Types of Schizophrenia

  • Paranoid (affecting thought, delusions)
  • Disorganized (early onset, immature personality)
  • Catatonic
  • Undifferentiated
  • Residual

Information for Patients and Family

Mental illness symptoms can include anxiety and unusual behavior. Early detection is important to avoid relapses. Medication is essential, especially for relapse prevention. Agitation or behavior may require evaluation for admission. Reduce stress, avoid discussing delusions, and avoid confrontation or criticism.

Prognosis

Depends on pre-adaptation, marital status, family support, number and duration of episodes, expression of emotions, treatment compliance (better in females), and timing of symptoms (hebephrenic has a worse prognosis).