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Hallucinogenic Agents
Published in Frank A. Barile, Barile’s Clinical Toxicology, 2019
Lysergic acid diethylamide (LSD) does not occur naturally but is a semi-synthetic preparation of d-lysergic acid (Figure 16.1). Discovered by A. Hoffman in 1943 during the course of experiments directed toward the synthesis of stimulants (analeptics), LSD produces opposing actions of powerful central stimulation with slight depression. Although it has no legitimate medical use today, the colorless, odorless, and tasteless compound is the most powerful psychotropic agent known, whose experimental value has proved it to be a model for psychosis.* The substance is available “on the street” in liquid, powder, and microdot dosage† forms, with 20 to 25 μg as an effective oral dose.
Emergency Management of Suicidal Behavior
Published in R. Thara, Lakshmi Vijayakumar, Emergencies in Psychiatry in Low- and Middle-Income Countries, 2017
Lakshmi Vijayakumar, Vinayak Vijayakumar
Underlying psychiatric disorders should be treated aggressively, always bearing in mind the therapeutic margin of the psychotropic agent prescribed (Nicholas and Golden 2001). Prescribing medications to suicidal patients is always a cause for concern as there is a fear that the drugs might be used to attempt suicide. However, if the signs and symptoms warrant the use of medications, the patient should not be denied the benefits of medication (Goldney 2002). Antidepressants are necessary for the treatment of depressive patients. Electroconvulsive therapy is also recommended if rapid results are required, as in the case of patients at high risk of suicide. Mood stabilizers and antipsychotic medication are useful in the treatment of bipolar patients and those with psychotic depression. Lithium is also recommended for use in patients with a high risk of suicide independent of any specific diagnosis (Raja 2009). In patients with schizophrenia and schizoaffective disorder, clozapine has been proven to be effective in reducing attempts at and completion of suicide.
Opioids and Psychological Disorders
Published in Barry Stimmel, Opiate Receptors, Neurotransmitters, & Drug Dependence: Basic Science-Clinical Correlates, 2014
After the introduction of methadone for the maintenance treatment of heroin addicts,34 large numbers of subjects were treated with methadone and substantial numbers of addicts appeared to have had prior psychological problems.35 McKenna described the significant psychotropic effects of methadone in emotionally disturbed patients.9 Three representative case studies were described with different psychological problems including mania, depressive psychosis, agitated depression, and paranoid schizophrenia. He states that for these subjects methadone was a “primary psychotropic agent to interrupt their psychotic symptoms.” The three subjects all experienced periods of intense anxiety, depression, self-doubt and subsequently found symptomatic relief with an opiate. Methadone provided for them a sense of self-esteem previously lacking and also gave them a new energy or zest for life which allowed them to pursue relationships without their previous handicaps of fear, doubt, and imminent failure. Each subject made repeated attempts to become drug free but they became psychotic during or shortly after these attempts and returned to opiate use to abolish or attenuate their psychotic disturbances. “None of these patients took opiates for the attainment of a high. They were not victims of peer pressure for their addiction, but were actively seeking any substance to relieve their painful psychological problems. They were specific in their drug of choice and were not deterred by threats of criminal prosecution.”9
Why lithium should be used in patients with bipolar disorder? A scoping review and an expert opinion paper
Published in Expert Review of Neurotherapeutics, 2022
Gaia Sampogna, Delfina Janiri, Umberto Albert, Filippo Caraci, Giovanni Martinotti, Gianluca Serafini, Alfonso Tortorella, Alessandro Zuddas, Gabriele Sani, Andrea Fiorillo
As a consequence, several clinical guidelines or practice recommendation papers consider lithium the first treatment choice when suicidal risk is high. According to the VA/US Department of Defense Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide ‘lithium alone (among patients with bipolar disorder) or in combination with another psychotropic agent (among patients with unipolar depression or bipolar disorder) may be offered to patients in order to decrease the risk of death by suicide .’ Lithium may be maintained together with another mood stabilizer even when as monotherapy it failed to prevent mood episodes if the risk of suicide is high: in that case, it will reduce the risk of suicide while another compound will contribute to the long-term stabilization of the patient [70].
Antipsychotic treatment patterns in Alzheimer’s disease patients with agitation: a cohort study using the UK clinical practice research datalink
Published in Current Medical Research and Opinion, 2022
Cam Thanh Tran, Martin Bøg, Shuk-Li Collings, Michelle Johnson, Nawab Qizilbash, Stefan Lind, Ross A. Baker, Kristian Tore Jørgensen
The study provides a better understanding of recent AP use in a large representative sample of AD patients with agitation, other NPS and no NPS in the UK. A significant proportion of AD patients have prescribed at least one AP agent, split equally among atypical and typical APs. Atypical APs were much more likely to be prescribed for AD patients with agitation than those with other NPS and no NPS. A majority of AD patients with agitation were still on antipsychotics at six months, while the NICE guideline in the UK recommends reassessment of the need for APs every six weeks due to the increased risk of stroke and myocardial infarction with atypical APs. This suggests that there is an unmet need for more efficacious long-term APs or other treatment options to control agitation in AD patients. A majority of AD patients with agitation and other NPS have prescribed at least one other psychotropic agent, including benzodiazepines. More than half of all AD patients with agitation had a history of falls. Therefore, there is a need for further research to investigate whether APs, particularly those with sedative properties, and benzodiazepines affect the risk of future falls in AD patients with agitation.
Remote digital monitoring of medication intake: methodological, medical, ethical and legal reflections
Published in Acta Clinica Belgica, 2021
Wim Van Biesen, Johan Decruyenaere, Katerina Sideri, Julian Cockbain, Sigrid Sterckx
The introduction of tracking devices may also impact society in other ways. The mere presence of tracking devices may at some future time curtail our autonomy and serve to both discipline individual bodies and to regulate behaviors deemed to be a threat to society for whatever reason. It is probably no coincidence that the first drug available in this category is a psychotropic agent. Furthermore, tracking devices might be used to achieve optimal disease management through surveillance and discipline, with the final aim to reduce the financial burden of non-compliance on healthcare systems, and serve to further marginalize and differentiate ‘at-risk groups’ because of their unwillingness or inability to conform [36]. Furthermore, there is a risk that patient profiling based on medication tracking devices will lead to cherry-picking by healthcare providers and insurers, with only low-risk patients having access to health insurance and healthcare. There is thus a need for a strict and close regulation and/or oversight by an independent body, in order to protect patient and public safety and best interests. Such a regulation should ensure that the technology can be used optimally in situations where it could be of benefit, and at the same time safeguard against its use in conditions where it would be negative or even detrimental. Exploration on how this can be most optimally organized should be the subject of further research.