Files to print out a Condensed Psychopharmacology 2011 booklet
Concurrent use of more than one antipsychotic (antipsychotic polytherapy) is a common practice despite evidence demonstrating increased costs and side effects with no added clinical benefit.
Psychiatric Advance Directives, also called Mental Health Advance Directives in states that recognize them (Figure 1), are legal tools developed prior to a psychiatric crisis, to allow individuals to clearly identify preferences for future mental health treatment. At the time when this document is developed, the individual is competent, autonomous, and able to articulate their wishes.1 The PAD generally contains patient treatment preferences, medical and treatment histories, comorbid conditions of importance for the treating physician or facility, emergency contact information, and history of medication treatment and side effects that may help the treating clinician make informed treatment decisions for the current admission.2 The document may also include identification of a designated healthcare agent charged with communicating the wishes of the person in crisis.3
Atypical antipsychotics have rapidly replaced conventional agents as first-line pharmacologic treatments for psychotic disorders. These drugs may represent an important advance in therapy for mental illnesses, due to a reduced risk of extrapyramidal side effects (EPS) and possible advantages in efficacy compared to conventional agents.
Sexual dysfunction has been reported to occur in approximately 30-70% of patients receiving antidepressant medications. The highest incidence of sexual dysfunction is seen primarily in patients receiving serotonin reuptake inhibitors (SSRIs) where up to 50- 70% of these patients have been shown to have difficulties in sexual functioning.
Evidence for augmentation with atypical antipsychotics for treatment-resistant obsessive compulsive disorder (OCD) is limited. Published data is restricted to open label studies and few small double-blinded studies, mainly with risperidone, olanzapine and quetiapine.1 There is one open-label study with aripiprazole in patients who were not receiving pharmacotherapy for OCD.2 This is a report of the first known case of aripiprazole used as augmentation for treatment-resistant obsessive compulsive disorder.
We report the case of a 33-year old Caucasian female admitted to our facility secondary to an intentional overdose involving ziprasidone, aripiprazole, lamotrigine and alprazolam. Duration of therapy with these agents was not available.
Due to unique diagnostic and treatment issues, many distinctive clinical situations are encountered in treating psychiatric disorders in those with severe-profound developmental disability and co-morbid psychopathology. This report reviews the effects of poly-pharmacotherapy on the measurable behavioral symptoms displayed by a person with severe mental retardation and an eventual diagnosis of rapid cycling bipolar disorder.
A 45-year-old moderately developmentally disabled man diagnosed with Psychosis Not Otherwise Specified (NOS) and Schizoaffective Disorder was referred to the Clinical Pharmacology Service following presentation to a rural emergency room secondary to an order for emergency detention for increasing episodes of aggression toward others and property destruction. Medication at the time of admission included venlafaxine extended release 75 mg, divalproex 1500 mg and risperidone 3 mg total daily doses.
Urinary incontinence (UI) is an embarrassing and distressing adverse effect of antipsychotic agents. Untreated UI may even lead to noncompliance in distressed patients. The incidence of UI and enuresis may be underreported. Although UI associated with antipsychotic use has been recognized, the etiology and optimal treatment strategies have not been fully established.
