Psychotropic drugs – a group of drugs that affect mental processes, affecting mainly the higher nervous activity. Psychotropic drugs are classified according to clinical action and divided into three groups: 1) antipsychotics (see), 2) antidepressants (see), 3) psychotomimetic drugs (see).
Mental disorders accompanied by delirium, hallucinations, intense anxiety or fear, as well as conditions with a predominance of arousal — catatonic, manic, states of altered consciousness, etc., are treated primarily with neuroleptics. Mental disorders, manifested by inhibition, primarily various depressive syndromes, are treated with antidepressants.
Since a significant number of mental disorders usually combine the phenomena of arousal and inhibition, in practice, more often use the combined treatment with antipsychotics and antidepressants. The dose ratio varies depending on the change in the mental state of the patient.
It must be remembered that in the treatment of psychotropic drugs of the mentally ill, the dosages used significantly exceed the higher daily doses of psychotropic drugs specified in the Pharmacopoeia.
Psychotropic drugs often cause side effects, in some cases so severe that they have to stop treatment and use medicines that eliminate the complications that have developed. Side effects that occur most often in the first two to four weeks after the start of treatment. Vegetative disorders: dry mouth or increased saliva; dry skin or, on the contrary, excessive sweating; nausea, constipation, diarrhea; decrease or increase in body temperature; drop in blood pressure; increased or slowing pulse; sharp narrowing or dilation of the pupils; urination disorders.
Most of these disorders disappear by itself. Reducing blood pressure easily leads to a sharp drop in blood pressure when rising from a prone position, so the first weeks of treatment with psychotropic drugs should avoid sudden changes in body position and bed rest for an hour after taking the medicine.
With prolonged urinary retention, bladder catheterization is performed, and treatment is temporarily canceled.
Endocrine disorders are manifested as menstrual disorders and lactorrhea in women; reduced potency in men. These phenomena do not require special treatment. Occasionally, thyroid function disorders or Itsenko – Cushing’s syndrome (see Itsenko – Cushing’s disease) require discontinuation of treatment.
Liver function disorders. Manifest headache, nausea, vomiting, pain in the liver. In the serum increases the content of bilirubin. It is necessary to immediately stop treatment with psychotropic drugs, as the development of acute yellow liver atrophy is possible.
Leukopenia and agranulocytosis. Occur most often in women. Develop gradually. The fall in the number of leukocytes below 3500 with the simultaneous disappearance of granulocytes requires the immediate cessation of treatment with psychotropic drugs. Side effects that appear at various times after the start of treatment. Allergic phenomena are more common in the form of dermatitis – eczema, exanthema, erythema, urticaria. Rarely there is angioedema, allergic conjunctivitis, allergic arthritis. Skin allergic dermatitis often occur with the additional action of ultraviolet light. Therefore, patients during treatment with psychotropic drugs are not recommended to be in the sun.
Neurological disorders can manifest akinetikorigidnym syndrome (see. Parkinsonism) or a variety of hyperkinesis (see.) – then isolated, then generalized, resembling chorea (see). Oral hyperkinesis often occurs in elderly patients – smacking and sucking movements of the lips, involuntary contractions of the masticatory muscles. Sometimes there is a cramp gaze. To prevent the development of neurological disorders, antiparkinsonian drugs are usually prescribed at the beginning of psychotropic treatment. Occurrence of thrombosis and thromboembolism during psychotropic treatment requires the immediate cessation of treatment.
Convulsive seizures that occur despite the use of anti-convulsant drugs, require the abolition of treatment with psychotropic drugs.
Mental disorders. Most often they are found in the form of akathisia, i.e., anxiety states accompanied by the need for movement and in the disorder of night sleep.
Psychosis develops much less frequently – various states of stupefaction, depression, transient hallucinatory and hallucinatory-delusional disorders.
Contraindications to the use of psychotropic drugs are diseases of the liver, kidneys, gastric ulcer and duodenal ulcer, severe forms of hypertension and atherosclerosis, allergic diseases, diabetes, blood diseases, organic diseases of the central nervous system.
Psychotropic drugs (Greek. Psyche — soul, mental properties; tropos – direction) —a group of medicinal substances that influence mental processes by preferentially influencing higher nervous activity.
General principles of classification Since 1950, after synthesizing largactil (synonym: chlorpromazine, aminazine), psychotropic drugs quickly found application in psychiatric practice. A new section of pharmacology has emerged – psychopharmacology (see). To date, there are more than 150 psychotropic drugs, differing in their action and belonging to the most diverse groups of chemical compounds.
The basis of the classification of psychotropic drugs currently laid clinical effect of the drug.
Psychotropic drugs are divided into three large groups: 1) sedative, sedative action (synonym: tranquilizers, neuroleptics, neuroplegics, psycholeptics); 2) stimulating, stimulating action (synonym: antidepressants, analeptics, psychotonics) and 3) remedies that cause mental disorders (synonym: hallucinogens, psychotomimetics, psychodysleptic substances). This division is relative, since many psychotropic drugs have a different effect depending on the characteristics of the psychopathological state, the dosage, the duration of use and other causes; there are also psychotropic drugs of mixed action.
The drugs of each of these groups differ in the intensity of action (at equivalent dosages). Some of them are able to eliminate hallucinations, delusions, catatonic disorders and have antipsychotic effects, others have only a general sedative effect. In this regard, the group of neuroplegics (neuroleptics) is divided into large and small tranquilizers. Similarly, we can talk about the big and small antidepressants.
Characteristics of individual drugs In psychiatric practice, doses are often used that exceed the doses indicated in the pharmacopoeia, many times. They are indicated in this article as the maximum.
Large tranquilizers. The most commonly used “large” tranquilizers (the list is compiled in order of decreasing strength of action within each chemical group) include the following drugs (the synonyms are shown in parentheses): Phenothiazine derivatives 1. Mazeptil (thioproperazine, thiopromezine, thioperazine, sulfamidophenothiazine, vactin, vontil, cephalmine). The usual daily dose – 5-60 mg; max. 200 mg.
2. Lyogen (flufenazine, fluorophenazine, flumazin, prolixin, permitil, sevinol, moditen). The usual daily dose, 5-10 mg; max. 20 mg.
3. Triftazin (see) (stelazin, trifluoroperazine, trifluromethylperisan, terflusin, ekasin, ekosvinil, iatroneural). The usual daily dose of 5-40 mg; max, 100 mg.
4. Aminazin (see) (chlorpromazine, largaktil, plegomazin, megaphen, torazin, gibernal, contamin, fenaktil). The usual daily dose is 25-600 mg; max. 1000 mg.
5. Levomepromazine (nozinan, methoxylymepromazine, methotrimeprazine, sinogan, veraktil, dedoran, neurocyl, neuractyl, neosin, nirvan, tizertsin). The usual daily dose is 25–400 mg; max. 800 mg.
6. Stemetil (Tementil, Meterazin, Compazin, Prochlorperazine, Prochlorpemazine, Ne-Filed, Wildal, Noramin). The usual daily dose of 20-100 mg; max — 200 mg.
7. Dartal (Dartalan, thiopropazate). The usual daily dose — 5–60 mg; max. 100 mg.
8. Frenolon. The usual daily dose – 30-60 mg; max allowed is 100 mg.
9. Eperapasin (see) (trilaphone, perphenazine, decentan, chloroperphenazine, phenacin, chloriprosine). The usual daily dose – 10-120 mg; max. 300 mg. 10. Melleril (Mallaril, Malorol, Thioridazin). The usual daily dose is 75 – 400 mg; max, 1000 mg.
I. Mepazin (see) (pekazin, pakatal, paktal, lakumin). The usual daily dose – 25-350 mg; max. 700 mg. 12. Propazin (see) (Promazin, Sparin, Verofen, Talofen, Alofen, Lyranol, neurolephil, Protaktil, Prazin, Sediston, Centractil). The usual daily dose – 25-800 mg; max. 2000 mg. 13. Diprazin (see) (protazine, promethazine, proazazmine, atosil, fargan, phenergan, procyte, promesinemide, tiergan, tanidil, vallergin, giberna-ergigan). The usual daily dose of 150-200 mg; max. 300 mg.
Rauwolfia alkaloids 1. Reserpine (see) (raunatin, serpazil, serpin, sedarapine, serpiloid, serfin, serpazole, sandril, raunorin, raunova, raused, rausedin, reserpoid, reperpex, rivasin, roxinoid, quiescin, cristoserpine, esperasper), rivasin, roxinoid, kvesitsin, cristoserpine, esperserap) The usual daily dose of 0.25 to 15 mg; max. 50 mg.
2. Deserpidine (harmony, kanestsin, roundormin, recanescine). The usual daily dose is 0.25-5 mg; max. 10 mg.
Butyrophenone derivatives 1. Triperidol. The usual daily dose of 1.5-2 mg; Max. – 6.5 mg.
2. Haloperidol (haloperidine, haldol, serenas). The usual daily dose is 3 to 10 mg; max. 20 mg.
3. Haloanison (sedalant). The usual daily dose is 75-130 mg; max. 320 mg.
Thioxanthene derivatives Taraktan (Truksal, Fruksal, Chlorprotixen, Protixen, Thioxanthen, Tarazan). The usual daily dose is 50 to 500 mg; max. 1000 mg.
Small tranquilizers The most common small tranquilizers (in part, this is a small antidepressant) include the following drugs.
Benzodiazepine derivatives 1. Librium (Elenium, chlordiazepoxide, metaminodiazepoxide). The usual daily dose – 5-30 mg; max. 100 mg.
2. Valium (diazepam). The usual daily dose of 10-40 mg; max. 80 mg.
Glycol and glycerol derivatives Meprotan (see) (andaksin, meprobamate, miltown, equanil, sedazil, tranquiline, urbil, harmony). The usual daily dose – 200-400 mg; Max. – 3000 mg.
Hydroxyzine derivatives Atarax (wistarin, atarazoid, hydroxyzin, trans-Q). The usual daily dose – 25-100 mg; max, 400 mg.
Benactizine derivatives 1. Amizil (see) (dimitsil, benaktizin, valladan, difemin, kafron, lucidil, nervaktil, nervakton, nutinal). The usual daily dose – 8-12 mg; max. 25 mg.
2. Frankvel (azacyclonol, frenoton, parakatan, psychozan, calmeran). The usual daily dose is 50–200 mg; max, add. – 500 mg.
Large and small tranquilizers constitute the main group of psychotropic drugs – neuroplegic agents.
More detailed pharmaco-clinical characteristics of the above listed group drugs – see. Neuroplegic agents.
Antidepressants. The most commonly used psychoanaleptic drugs (antidepressants) are as follows.
Amitriptyline derivatives 1. Triptizol (saroten, triptanol, elavil, laroksil, horizon). The usual daily dose is 75–200 mg; max. 350 mg.
2. Nortriptilin (noritren, nortrilen, avent). The usual daily dose is 100-150 mg; max. – 250 mg.
Iminobenzyl derivatives 1. Imizin (see) (imipramine, melipramine, tofranil). The usual daily dose – 25-300 mg; max. 400 mg.
2. Surmontil (Trimeprimin, Trimepromin). The usual daily dose – 25-300 mg; max. 400 mg.
Monoamidoxidase inhibitors (IMAO) (incompatible with iminobenzyl and phenothiazine derivatives; if necessary, take a pause between preparations for at least 2 weeks; exclude cheese, cream, meat extracts, beer, dry wine from the patients diet!). 1. Iprazid (see) (marsilide, marsalid, iproniazid). The usual daily dose – 25-150 mg; max. 200 mg.
2. Niamide (nialamide, niamidal, nuredal). The usual daily dose is 75-200 mg; max. 400 mg.
3. Transamin (see) (Parnate, tranylcypromine). A usual daily dose – 5 – 30 mg; max. 50 mg.
4. Phelazine (phelazine, narde, nardezin, cavodil, sinevral). The usual daily dose is 15-75 mg; Max. – 150 mg.
5. Benazid (isocarboxazid, marplan). The usual daily dose — 20-40 mg; max. 80 mg.
6. Katron (fenizin, feniprazin, katroniazid, kavodil). The usual daily dose, 3-12 mg; max. 25 mg.
7. Indopan. The usual daily dose of 5-20 mg; max. 30 mg.
The now-used amphetamine derivatives (decedril, fenamin, pervitin, and phenatin) and the derivatives of diphenylmethane (pyridrol, centedrin, phenidate) are also rarely referred to small antidepressants.
As antidepressants, substances belonging to neuroleptics, such as nozinan, taraktan, frenolon, are widely used.
Psychotomimetics. Substances that cause mental disorders include mescaline, lysergic acid diethylamide, psilocybin, sernil. In clinical practice, they are not used; serve for experimental psychopathological research. See also Psychotomimetics.