By L. Gunnar. New World School of the Arts. 2019.
A thorough review of their effects and mechanism of action in mental illness would be out of place here buy depakote 500 mg otc medicine 123. Unfortunately generic depakote 250 mg online treatment zenkers diverticulum, the usefulness of these tranquilizers in exploring psychologic processes and in facilitating communication has not been very extensively tested purchase depakote 250mg without a prescription treatment head lice. Yet discount 250mg depakote fast delivery treatment 0 rapid linear progression, for the sake of completeness, and to indicate the directions further research might take, the psychologic actions of these drugs deserve mention. Therefore, the psychopharmacologic actions of only this compound are discussed here. Delay and his associates (38) appear to have been the first to explore chlorpromazine in the treatment of mental illness. They found that the effects of chlorpromazine in patients with manic psychoses were somnolence, decreased responses to external and internal stimuli, pleasant indifference, and decreased spontaneity of speech. Subsequent reports (5, 20, 28, 32, 75, 81, 87, 88, 134) have been in agreement that chlorpromazine is effective in quieting or abolishing severe agitation and psychomotor excitement, whether of manic-depressive, schizophrenic, or toxic origin. Most of these reports agree that the basic disorder in these conditions is not -124- altered by the drug. In the psychoneuroses, chlorpromazine was reported (52, 80) to decrease anxiety and tension temporarily, but to have no specific ameliorative effects on conversion symptoms, obsession, piaobia, depression, or physical pain. A recent, controlled investigation (123) on the effect of chlorpromazine on the communication processes of psychiatric patients has indicated no specific facilitating effect. In normal subjects, the effect of 10 mg of proclorperazine (a phenothiazine derivative) was compared with that of 10 mg of phenobarbital. No specific differences were found on tests of mental performance, hearing, and pain perception, although a decrement in muscular coordination and efficiency occurred under proclorperazine (14). Other phenothiazine derivatives are being extensively investigated at this time in psychiatric practice with the hope of finding one with equal or better therapeutic effects and fewer of the side effects of chlorpromazine, such as Parkinsonism, obstructive jaundice, dermatitis, tachycardia, etc. Reserpine, believed to be the most active of the rauwolfia alkaloids, was identified by Müller et al. Initially the drug was used in the United States for treating high blood pressure (133). From such experiences it was noted that reserpine produced a state of calmness without significant impairment of sensory acuity, muscular coordination, and alertness. Repeated doses of reserpine over long periods of time reduced or -125- abolished hyperactivity, combativeness, destructiveness, insomnia, flight of ideas, etc. The tranquilizing action of reserpine and chlorpromazine appears to be quite similar. This similarity extends to some of the side effects, such as miosis, lowering of blood pressure and body temperature, increase in appetite, nasal congestion, and Parkinson syndrome. Although certain differences in side effects do occur, they do not require our attention here. The literature on the effectiveness of reserpine and chlorpromazine as aids to individual (119) and group (34) psychotherapy is extensive. Whereas there is agreement that the drugs lower anxiety and tension, there are such notable differences of opinion about the aims of psychotherapy and about what constitutes psychotherapy that no definite statement can be made regarding this point. If the reviewer were to add his voice to the disharmonious chorus of viewpoints on this subject, he would, on the basis of impressionistic evaluations only, say that the tranquilizers are of some aid in the psychotherapy of those patients who are so agitated, anxious, and hyperactive that they cannot sit still very long for psychotherapy. However, working out the finer nuances of emotional conflicts of a patient in psychotherapy is precluded when the patient is regularly taking a tranquilizer, because the patient appears to become too insulated against emotional reactions to realize or care that he is responding with feeling in some pertinent way. As with the phenothiazine derivatives, the place of the rauwolfia alkaloids in the potential armamentarium of the interrogation has not been established. Speculatively, the tranquilizers might be of avail in selected informants who are highly agitated and disturbed, and who might yield information in return for the relaxation they experience with such a sedative. On the other hand, less emotionally disturbed informants might strengthen their resolve to retain information under a tranquilizer. Furthermore, tranquilizers in moderate dosage do not notably impair intellectual and sensory functioning. Therefore, their use probably does not contribute to the distortion of factual information produced. Addiction The dependence of the drug addict on the supplier of drugs has figured in speculations regarding the use of drugs to control behavior. The writer is unaware of any actual or alleged utilizations of drugs in this manner for the purposes of interrogation. One of the cardinal criteria of addiction is the occurrence of severe reactions when the drug is withdrawn. Withdrawal syndromes occur with opiates, barbiturates, and, recently, an animal study has made this claim for meprobamates (43). Beyond a minimal dosage and time period, the continuous usage of these drugs produces addiction in almost everyone (72). No demonstrable impairment of cognitive or psychomotor functions has been identified in subjects operating under the maintenance dosage to which they are habituated. Under most of the opiates, the subject is likely to show a keen awareness of a limited segment of reality, a decrease in spontaneity and creativity, a decrease in suggestibility, and an increase in rigidity and compartmentalization of thinking. As with other drugs, the reaction varies widely from individual to individual 50, 131). Information contributed by an addicted source is naturally suspect, since many addicts have gone to great length, fabrication of information being the least of them, to maintain their drug supplies. If a source became addicted as a sequel to the treatment of injuries, the ability of the interrogator to give or withhold the drug would give him a powerful hold on the source. It appears unlikely that this weapon is so unique as to lead an interrogator to create addiction deliberately. An interrogator who would be willing to produce addiction would not hesitate to employ more reliable and instantly effective means for inducing results as unpleasant as withdrawal symptoms. Since the initial reactions of most subjects to drugs of addiction are unpleasant, these drugs would not appear to have a role as positive motivators, except for subjects experiencing pain. Inasmuch as this is an unusual condition, little or no empirical information is available. Other instances of this type of anxiety in neuroses, psychoses, and cerebral insult have demonstrated that it feeds on itself. Specifically, the anxiety increases in something like a geometric progression whenever the source of concern is put to the test and adequate control is indeed found to be wanting, with the mounting anxiety itself contributing to further loss of control. Some persons more than others habitually use the mechanism of control and might presumably attempt to do so in this situation. Small to moderate doses, although affecting the subject, might not alarm him, since the drug effects may be within the range of his ordinary experiences, and since none of the functions which form the basis for his sense of control may have been seriously impaired. Because it is difficult for most persons to succeed in their efforts to relax, the main resultant of any effort presumably is anxiety and arousal. If this is so, the effect of stimulants would be intensified, whereas the effect of sedatives might be counterbalanced to some extent. Here, the question of how massive a dosage of a sedative the subject could counteract would need to be considered. The phenothiazine tranquilizers might be expected to produce a sufficient lack of concern in the subject to prevent his attempting to undo their effect, or, more directly, preclude a state of arousal. Summary and Conclusions Nature of Reviewed Studies A distinction has been made between interviews carried out for psychotherapy and those to obtain factual information. Although there has been considerable speculation regarding the possible use of drugs for the latter purposes, open publications of serious research dealing directly with such cases are scant. The paucity of reported studies on the matter has obliged the reviewer to include related published material of psychopharmacologic studies. When extrapolations are made from published material of this sort, they are presented as hypotheses, and in every instance require testing and validation. The interest of scientists in employing drugs in research transcends an interest in drug effects, per se.
Health workers are thus encour- aged to record and report to the Natonal Pharmacovigilance Centre for any unexpected adverse efects with any medicine to achieve faster recogniton of serious related problems buy generic depakote 500mg on line symptoms 5-6 weeks pregnant. Major Factors Predisposing to Adverse Efects It is well known that diferent patents ofen respond difer- ently to a given treatment regimen buy 500mg depakote with amex medications 126. For example order 250 mg depakote pretreatment, in a sample of 2422 patents who had been taking combinatons of drugs known to interact depakote 500mg otc medications you can give your cat, only 7 (0. Drugs which commonly cause problems in the elderly include hypnotcs, diuretcs, non-steroidal ant-infamma- tory drugs, anthypertensives, psychotropics, digoxin etc. All children, and partcularly neonates, difer from adult in their response to drugs. Some drugs are likely to cause problems in neonates (for example morphine ), but are generally toler- ated in children. Other drugs associated with problems in children include chloramphenicol (grey baby syndrome), antarrhythmics (worsening of arrhythmias), acetylsalicylic acid (Reye’s syndrome etc). Drug Interactons Interactons (see Appendix 6) may occur between drugs which compete for the same receptor or act on the same physiolog- ical system. They may also occur indirectly when a medicine- induced disease or a change in fuid or electrolyte balance alters the response to another medicine. Interactons may occur when one medicine alters the absorpton, distributon, metabolism or eliminaton of another medicine, such that the amount which reaches the site of acton is increased or decreased. When two drugs are administered to a patent, they may either act independent of each other, or interact with each other. Interactons may increase or decrease the efects of the drugs concerned and may cause unexpected toxicity. As newer and more potent drugs become available, the number of serious medicine inter- actons is likely to increase. Remember that interactons which modify the efects of a medicine may involve non-prescripton drugs, non-medicinal chemical agents, and social drugs such as alcohol, marijuana, tobacco and traditonal remedies, as well as certain types of food. Pharmaceutcal Interactons Certain drugs, when added to intravenous fuids, may be inactvated by pH changes, by precipitaton or by chemical reacton. Benzylpenicillin and ampicillin lose potency afer 6-8 hours if added to dextrose solutons, due to the acidity of these solutons. Some drugs bind to plastc containers and tubing, for example diazepam and insulin. The Efect of Food on Medicine Absorpton Food delays gastric emptying and reduces the rate of absorp- ton of many drugs; the total amount of medicine absorbed may or may not be reduced. However, some drugs are pref- erably taken with food, either to increase absorpton or to decrease the irritant efect on the stomach. Pharmacist plays and important role as a connectng link between the physician and patent. Analgesics, Antpyretcs, Non-Steroidal Ant-Infammatory Drugs Analgesics are used to relieve/reduce body pain and antpy- retcs are used to reduce elevated body temperature. Non- opioid analgesics are partcularly suitable for relieveing or management of pain in musculoskeletal conditons whereas the opioid analgesics are more suitable for moderate to severe visceral pain. Neuro- genic pain generally responds poorly to conventonal anal- gesics; treatment can be difcult and includes the use of carbamazepine for trigeminal neuralgia and amitriptyline for diabetc neuropathy and post-therapeutc neuralgia. Non-opioid anal- gesics with litle or no ant-infammatory actvity include paracetamol. Diclofenac Pregnancy Category-B Schedule H Indicatons Acute musculo-skeletal pain; arthrits; gout; spondylits; migraine; post-operatve pain. Dose Oral 100 to 150 mg daily in 2 to 3 divided doses, (max 150 mg/day) maintenance by 50 to 100 mg in divided doses. Instll to eye Post-operatve ocular infammaton: Adult- as sodium (1% w/v), 4 tmes daily startng 24 h afer surgery for up to 28 days. Contraindicatons Porphyria; avoid injectons containing benzyl alcohol in neonates; history of gastric ulcers, bleeding or perforaton. Adverse Efects Injecton site reactons; transient epigastric pain, risk of thrombotc events; toxic epidermal necrolysis; Abnormality in kidney functon. Ibuprofen* Pregnancy Category-C Schedule H Indicatons Pain and infammaton in rheumatc disease and other musculoskeletal disorders including juvenile arthrits; mild to moderate pain including dysmenorrhoeal pain, headache; pain in children; acute migraine atack. Dose Oral Adult- and Child over 12 years- initally 300 to 400 mg 3 to 4 tmes daily, increase if necessary (max. Infant or Child over 3 months- 5-10 mg/kg 3 to 4 tmes/day, Maximum daily dose: 40 mg/kg/day. Intravenous injecton and infusion Neonate- initally by intravenous injecton (over atleast 5 min) 25-100 µg/kg then by contnuous intravenous infusion 5-40 µg/ kg/h. Precautons Renal and hepatc impairment (Appendix 7a); preferably avoid if history of peptc ulceraton; cardiac disease; elderly; pregnancy (Appendix 7c); lactaton (Appendix 7b); coagulaton defects; allergic disorders; interactons (Appendix 6a, 6c, 6d). Dysmenorrhea: 500 mg orally, followed by 250 mg every 6 hours startng with the onset of menses. Children Pain: 14 to 18 years: 500 mg orally followed by 250 mg every 6 hours as needed, not to exceed 7 days. Precautons Hepatc efects: Borderline elevatons of one or more liver functon tests may occur. These laboratory abnormalites may progress, may remain unchanged, or may be transient with contnuing therapy. A patent with symptoms and/or signs suggestng liver dysfuncton, or in whom an abnormal liver test has occurred, should be evaluated for evidence of the development of a more severe hepatc reacton while on therapy. If clinical signs and symptoms consistent with liver disease develop, or if systemic manifestatons occur (e. Anaemia: Patents on long-term treatment should have their hemoglobin or hematocrit checked if they exhibit any signs or symptoms of anaemia. Asthma: Mefenamic acid should not be administered to patents with aspirin sensitve asthma and should be used with cauton in patents with preexistng asthma. Adverse Efects Gastrointestnal experiences including- abdominal pain, constpaton, diarrhoea, dyspepsia, fatulence, gross bleeding/ perforaton, heartburn, nausea, gastrointestnal ulcers, vomitng, abnormal renal functon, bronchospasm, anaemia, dizziness, edema, elevated liver enzymes, headaches, increased bleeding tme, pruritus, rashes, tnnitus. Paracetamol* Pregnancy Category-B Indicatons Mild to moderate pain including dysmenor- rhoeal pain, headache; pain relief in osteoar- thrits and sof tssue lesions; pyrexia including post-immunisaton pyrexia; acute migraine atack. Precautons Hepatc impairment (Appendix 7a); renal impairment; alcohol dependence; lactaton (Appendix 7b); pregnancy (Appendix 7c); overdosage: chapter 7. Adverse Efects Rare but rashes and blood disorders reported; important: liver damage (and less frequently renal damage) following overdosage; dyspepsia. In additon to pain relief it confers a state of euphoria and mental detachment; repeated administraton may cause dependence and tolerance, but this should not be a deterrent in the control of pain in terminal illness. Regular use may also be appropriate for certain cases of non-malignant pain, but specialist supervision is required. In normal doses common adverse efects include nausea, vomitng, constpaton and drowsiness; larger doses produce respiratory depression and hypotension. Codeine is an opioid analgesic much less potent than morphine and much less liable, in normal doses, to produce adverse efects including dependency. Contraindicatons Respiratory depression; obstructve airways disease; acute asthma atack; where risk of paralytc ileus; hypersensitvity; head injury; increased intracranial pressure. Precautons Hepatc impairment (Appendix 7a) and renal impairment; opioids dependence; lactaton; overdosage: chapter 7. Elderly or frail- Acute pain: 5 mg, adjust according to response (not suitable for patents having oedema).