Clinical Psychopharmacology

Jining Medical University

zhaijinguo

zhaijinguo@yahoo.com.cn

Chapter 1 Introduction

Definition

Psychotropic drugs 精神药物 Psychoactive drugs 精神活性药物 Psychopharmaceutical drugs 精神药物 Psychotherapeutic drugs 精神病治疗药

Psychotropic drugs ： Drugs with high affinity for central nervous system, which alter the cognition, emotion and behaviors of individuals.Psychotherapeutic drugs ： Drugs which can be used to adjust abnormal nervous biochemical process, treat psychiatric symptoms, improve pathological thought, mood, and behaviors, prevent relapse and recurrence, promote social function, increase the quality of life of patients.

Definition

精神药物：对 CNS 有高度亲和力，能改变个体认知、情感和行为的药物。精神治疗药物：对紊乱的大脑神经化学过程进行调整，达到控制精神症状，改善和矫正病理思维、心境和行为，预防复发，促进社会适应能力恢复，提高病人生活质量的药物。

Definition

Psychoactive substanceSubstances with psychotropic action, such as alcohol, nicotine, cocaine and heroin, which are characterized as social or addictive products and have no generally recognized therapeutic applications .

Clinical psychopharmacology is the discipline of exploring interaction between psychotherapeutic drugs and ill individual, especially CNS. 规律

Explore clinical mechanisms of action and rule of psychotherapeutic drugs, direct the use of drugs reasonably in clinical practice, treat and prevent mental disorders efficiently, provide evidences for the study of etiology, pathophysiology of mental disorders and exploitation of new drugs.

Clinical psychopharmacology

临床精神药理学（ Clinical psychopharmac

ology ） ：是研究精神药物与患病个体，特别是中枢神经系统相互作用的学科。

探讨精神药物的临床作用机制和规律，指导临床合理用药，对精神障碍进行有效的防治，为精神障碍的病因学、病理生理学研究提供线索，为新药开发提供依据。

Clinical psychopharmacology

Clinical psychopharmacology

Clinical psychopharmacology is the study of psychotherapeutic drugs. The goal of clinical psychopharmacology is to apply information about drugs and their mechanisms of action to develop safer, more effective treatment and eventually curative and preventive measures for a host of psychiatric disorders.

Classification of psychotherapeutic drugs

Antipsychotics

Antidepressants

Mood stabilizers

Anxiolytics and sedatives

Psychostimulants

Cognition enhancers

Antipsychotics For the symptomatic treatment of schizop

hrenia and states of agitation occurring in other psychiatric syndromes. Neuroleptics, antischizophrenic drugs, major tranquillizers.Chlorpromazine, haloperidol, clozapine,

olanzapine, risperidone, asenapine .

Major tranquilizers （ neuroleptics ）

Minor tranquillisers （ benzodiazepines ）

Antidepressants For the treatment of depression and other

depressive syndromes. Thymoleptics ( 抗抑郁剂 ) TCAs , SSRIs, MAOIs

Mood stabilizers （ antimanic drugs ） For the treatment of mania or hypomania, mixed

states of mania and depression or rapid cycling between mania and depression.

For preventing the recurrence of mania and depression.

Not to induce diversion.Lithium carbonate ， valproate ， carbamazepine, lamotrigine

Anxiolytics For the treatment of states of anxiety and tension of varied origins. Sedatives, hypnotics , minor tranquillizers Benzodiazepines ， azaperone.

Psychostimulants are medications that can increase drive a

nd performance. Their most frequent use is in attention deficit hyperactivity disorder (ADHD) and in narcolepsy （发作性睡病） . They are also called stimulants. Amphetamine, methylphenidate （ ritalin ） , caffeine.

Cognition enhancers are substances that, especially in the elde

rly, may have a beneficial effect on cognitive functions without inducing general stimulation. nootropic drugs 促智药 donepezil 多奈哌齐

Names of drugs

Chemical Name 化学名Generic Name 通用名 (nonproprietary name )Trade Name 商品名 3-[2-[4-(6- 氟 -1 ， 2- 苯并异恶唑 -3- 基 )-1- 哌啶基 ] 乙基 ]-6 ， 7 ， 8 ， 9- 四氢 -9- 羟基 -2-甲基 -4H- 吡啶并 [1 ， 2-a] 嘧啶 -4- 酮

How to Get and Interpret the Data of psychotropic drugs

Systematic overview and meta analysisRCT--randomized controlled trialsOpen-label studiesCase reportsIndividual opinion of experts

Evidence-Based MedicineEVIDENCE

Evidence grade

low

high

cohort study

case report

Evidence pyramid

Systematic overview and meta analysis

randomized controlled trial

case control study

Series of case analysisClinical summary

Individual opinions

Before centuries :plant extracts and naturally occurring substances .19~20th centuries: sedatives --chloral hydrate and the barbiturates .1930s~1950s:biological treatment :ECT, insulin.1931 :two Indians use Rauwolfia( 萝芙木 ) to reduce symptoms of psychosis. Second half of the 20th century: chemotherapy as a major treatment for mental disorders.

The history of psychopharmacology

The history of psychopharmacology

In 1952 John Delay and Pierre Deniker reported the effectiveness of chlorpromazine in treating severe agitation and psychosis.

The discovery of chlorpromazine marked the beginning of modern psychopharmacology .1952: iproniazid( 异丙异烟肼 ) was found to elevate mood. 1957 : MAOIs. 1957: benzodiazepines were found to produce sedative, muscle relaxant, and anticonvulsant properties. 1958: haloperidol -- Paul Janssen.1980s:atypical antipsychotics and new antidepressants.2000: new antipsychotics and new antidepressants.

The history of psychopharmacology

The history of psychopharmacology

Pharmaceutical industry influence

Positive

Negtive

Combined Pharmacotherapy and Psychotherapy

Pharmacotherapy

Psychotherapy

Combined therapy

Cost of treatment

Cost of drug

Cost of treatment

Cost-benefit analysis

Cost-effectiveness analysis

Ethnic and Cultural Perspectives in Psychopharmacology

RaceCultureConventional ideaLifestyle Socio-demographic factors

Therapeutic attitudeCompliance Effectiveness