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Adverse Effects of Psychotropic Treatments, An Issue of the Psychiatric Clinics, E-Book

Adverse Effects of Psychotropic Treatments, An Issue of the Psychiatric Clinics, E-Book

Rajnish Mago

(2016)

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Book Details

Abstract

This issue of the Psychiatric Clinics, edited by Dr. Rajnish Mago, will cover a variety of side effects of Psychopharmacotherapy. The topics discussed include principles of evaluation and management; sexual dysfunction; adverse effects on pregnancy due to bipolar medications; metabolic adverse effects of antipsychotics; adverse effects of psychotropic medications on sleep; antidepressants and suicide; and adverse effects of electroconvulsive therapies, among others.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Adverse Effects ofPsychotropic Treatments i
Copyright\r ii
Contributors iii
EDITOR iii
AUTHORS iii
Contents v
Preface: The Neglected Side of Suffering\r v
Adverse Effects of Psychotropic Medications: A Call to Action\r v
Core Concepts Involving Adverse Psychotropic Drug Effects: Assessment, Implications, and Management\r v
Drug-Induced Extrapyramidal Syndromes: Implications for Contemporary Practice\r v
Serotonin Reuptake Inhibitors and Risk of Abnormal Bleeding\r vi
Sexual Dysfunction Due to Psychotropic Medications\r vi
Adverse Effects in the Pharmacologic Management of Bipolar Disorder During Pregnancy\r vi
Adverse Effects of Second-Generation Antipsychotics as Adjuncts to Antidepressants: Are the Risks Worth the Benefits?\r vi
Adverse Effects of Psychotropic Medications on Sleep\r vii
Antidepressants and Suicidality\r vii
Adverse Effects of Electroconvulsive Therapy\r vii
PSYCHIATRIC CLINICS OF\rNORTH AMERICA\r viii
FORTHCOMING ISSUES viii
December 2016 viii
March 2017 viii
June 2017 viii
RECENT ISSUES viii
June 2016 viii
March 2016 viii
December 2015 viii
Preface:\rThe Neglected Side of Suffering ix
Adverse Effects of Psychotropic Medications 361
Key points 361
ADVERSE EFFECTS ARE BOTH COMMON AND BOTHERSOME 362
ADVERSE EFFECTS OFTEN LEAD TO DISCONTINUATION OF TREATMENT 362
ADVERSE EFFECTS ARE CONSIDERED IMPORTANT BY BOTH PATIENTS AND CLINICIANS 362
RATING SCALES FOR ADVERSE EFFECTS ARE INFREQUENTLY USED 363
CAUSAL ATTRIBUTION IS KEY TO IDENTIFYING ADVERSE EFFECTS 364
EXISTING METHODS FOR ASSESSMENT OF ADVERSE EFFECTS HAVE IMPORTANT LIMITATIONS 365
Spontaneous Reporting by Patients 365
Open-Ended Questioning 365
Patient-Rated Scales 365
Clinician-Rated Scales 366
CHANGES IN VITAL SIGNS AND LABORATORY MEASURES CAN BE ADVERSE EVENTS 366
CLINICAL TRIALS DO NOT ADEQUATELY OR CONSISTENTLY REPORT ADVERSE EFFECTS 366
IT IS UNCLEAR HOW EXACTLY TO EDUCATE PATIENTS ABOUT ADVERSE EFFECTS 367
THERE IS LITTLE RESEARCH INTO MANAGEMENT OF ADVERSE EFFECTS 368
RECOMMENDATIONS FOR ASSESSMENT OF ADVERSE EFFECTS 368
RECOMMENDATIONS FOR REPORTING OF ADVERSE EFFECTS 369
RECOMMENDATIONS FOR EDUCATING PATIENTS ABOUT ADVERSE EFFECTS 370
RECOMMENDATIONS REGARDING MANAGEMENT OF ADVERSE EFFECTS 370
SUMMARY 370
REFERENCES 371
Core Concepts Involving Adverse Psychotropic Drug Effects 375
Key points 375
IMPACT OF ADVERSE EFFECTS ON ADHERENCE: ANTICIPATION VERSUS ACTUAL OCCURRENCE 376
PREDICTORS OF ADVERSE DRUG EFFECTS 376
DOSE RELATIONSHIPS 377
NOCEBO EFFECTS 379
ADVERSE EFFECTS VERSUS NATURAL COURSE OF ILLNESS 380
TIME COURSE 380
ADVERSE EFFECT VARIABILITY ACROSS DIAGNOSES 381
PHARMACOGENETICS AND ADVERSE EFFECTS 381
DO ADVERSE EFFECTS INFLUENCE DRUG EFFICACY? 383
RISK-BENEFIT ANALYSES 383
A SYSTEMATIC APPROACH TO EVALUATING SUSPECTED ADVERSE PSYCHOTROPIC DRUG EFFECTS 384
SUMMARY 384
REFERENCES 385
Drug-Induced Extrapyramidal Syndromes 391
Key points 391
INTRODUCTION 391
DYSTONIA 393
Clinical Features 393
Differential Diagnosis 393
Course and Outcome 393
Risk Factors 393
Treatment 394
Pathophysiology 394
PARKINSONISM 395
Clinical Features 395
Differential Diagnosis 395
Course and Outcome 395
Risk Factors 395
Treatment 396
Pathophysiology 396
AKATHISIA 396
Clinical Features 396
Differential Diagnosis 397
Course and Outcome 397
Risk Factors 397
Treatment 397
Pathophysiology 398
CATATONIA 398
Clinical Features 398
Differential Diagnosis 398
Course and Outcome 398
Risk Factors 398
Treatment 399
Pathophysiology 399
NEUROLEPTIC MALIGNANT SYNDROME 399
Clinical Features 399
Differential Diagnosis 399
Course and Outcome 399
Risk Factors 400
Treatment 400
Pathophysiology 400
TARDIVE DYSKINESIA 400
Clinical Features 400
Differential Diagnosis 401
Course and Outcome 401
Risk Factors 402
Treatment 402
Pathophysiology 404
SUMMARY 404
REFERENCES 405
Serotonin Reuptake Inhibitors and Risk of Abnormal Bleeding 413
Key points 413
MECHANISMS OF ABNORMAL BLEEDING ASSOCIATED WITH SEROTONIN REUPTAKE INHIBITORS 414
SITES OF ABNORMAL BLEEDING 414
EVIDENCE OF ABNORMAL BLEEDING: GENERAL ISSUES 414
ANTIDEPRESSANTS THAT INCREASE THE RISK OF ABNORMAL BLEEDING 416
MAGNITUDE OF RISK 417
NONSTEROIDAL ANTI-INFLAMMATORY DRUGS AND THE RISK OF SEROTONIN REUPTAKE INHIBITOR–RELATED BLEEDING 417
ANTIPLATELET/ANTICOAGULANT DRUGS AND THE RISK OF SEROTONIN REUPTAKE INHIBITOR–RELATED BLEEDING 417
PROTON PUMP INHIBITORS AND THE RISK OF SEROTONIN REUPTAKE INHIBITOR–RELATED BLEEDING 418
INTRACRANIAL BLEEDING 418
ABNORMAL BLEEDING ASSOCIATED WITH SURGICAL PROCEDURES 418
ABNORMAL BLEEDING IN WOMEN 420
ABNORMAL BLEEDING ASSOCIATED WITH LIVER DISEASE 421
MANAGEMENT 421
REFERENCES 422
Sexual Dysfunction Due to Psychotropic Medications 427
Key points 427
INTRODUCTION 427
BIOLOGY OF THE SEXUAL RESPONSE: NORMAL AND IN DEPRESSION 428
PATHOPHYSIOLOGY OF ADVERSE EFFECTS 429
Antidepressants and Antipsychotics 429
Mood Stabilizers 430
Benzodiazepines 431
PHARMACOGENETICS OF SELECTIVE SEROTONIN REUPTAKE INHIBITOR–ASSOCIATED SEXUAL DYSFUNCTION 431
MEDICATION-INDUCED SEXUAL DYSFUNCTION 433
Antidepressants 433
Tricyclic antidepressants 433
Selective Serotonin Reuptake Inhibitors 433
Serotonin Norepinephrine Reuptake Inhibiters 437
Mirtazapine 438
Bupropion 438
Other Antidepressants 438
Anticonvulsant Mood Stabilizers 439
Lithium 439
Anxiolytics 439
Antipsychotics 439
Psychostimulants and Atomoxetine 441
TREATMENT OF MEDICATION-ASSOCIATED SEXUAL DYSFUNCTION 441
Waiting for Spontaneous Remission 441
Dose Reduction 443
Drug Holiday 443
Nonpharmacologic Interventions 443
Switching to a Different Antidepressant 443
Bupropion 444
Mirtazapine 444
Vilazodone 445
Vortioxetine 445
Desvenlafaxine 445
Nefazodone 445
Agomelatine 445
Moclobemide 446
Reboxetine 446
Trazodone 446
Tianeptine 446
Selegiline 446
Adding a Medication to Treat Sexual Adverse Effects 446
Bupropion 446
Phosphodiesterase type 5 inhibitors: sildenafil and tadalafil 447
Mirtazapine 447
Buspirone 447
Antihistaminic agents: cyproheptadine and loratadine 447
Amantadine 447
Yohimbine 447
Bethanecol 448
Granisetron 448
Adenosylmethionine 448
Herbals 448
ANTIPSYCHOTICS 448
Lower Incidence of Sexual Dysfunction 448
Adding a Medication to Reverse Sexual Dysfunction 449
SUMMARY 450
REFERENCES 451
Adverse Effects in the Pharmacologic Management of Bipolar Disorder During Pregnancy 465
Key points 465
INTRODUCTION 465
LITHIUM 466
ANTIEPILEPTIC DRUGS 467
Valproic Acid 467
Lamotrigine 468
Carbamazepine 469
ANTIPSYCHOTICS 469
First-Generation Antipsychotics 469
Second-Generation Antipsychotics (Atypical Antipsychotics) 469
DISCUSSION 470
REFERENCES 471
Adverse Effects of Second-Generation Antipsychotics as Adjuncts to Antidepressants 477
Key points 477
INTRODUCTION 478
OVERVIEW OF TREATMENT-RESISTANT DEPRESSION 478
STRATEGIES OF TREATMENT-RESISTANT DEPRESSION: SWITCHING VERSUS ADDING 479
SECOND-GENERATION ANTIPSYCHOTICS: THE NEW STANDARD FOR ADJUNCTIVE THERAPY FOR TREATMENT-RESISTANT DEPRESSION? 480
TOLERABILITY OF ADJUNCTIVE SECOND-GENERATION ANTIPSYCHOTICS THERAPY 481
Short-Term Studies 481
Discontinuation due to adverse events 481
Akathisia 481
Weight gain 482
Longer-Term Studies 482
RECOMMENDATIONS TO MINIMIZE RISK 483
SUMMARY 484
REFERENCES 484
Adverse Effects of Psychotropic Medications on Sleep 487
Key points 487
ANTIDEPRESSANTS 487
SELECTIVE SEROTONIN REUPTAKE INHIBITORS 488
Subjective Effects 488
Antidepressants and Suicidality 503
Key points 503
DEFINITIONS OF SELF-HARM 503
META-ANALYSES OF RANDOMIZED CLINICAL TRIALS 503
WHY IS THERE AN INCREASED RISK FOR SUICIDAL EVENTS FOUND IN THOSE YOUNGER THAN 25? 504
WHAT IS THE CLINICAL SIGNIFICANCE OF SUICIDAL EVENTS? 506
PHARMACOEPIDEMIOLOGIC STUDIES 506
WHY ARE THE FINDINGS OF PHARMACOEPIDEMIOLOGIC STUDIES SO DIFFERENT FROM THOSE OF RCTS? 507
THE BLACK BOX WARNING AS NATURAL EXPERIMENT 508
IN WHOM ARE SUICIDAL EVENTS MOST LIKELY TO OCCUR? 508
HOW CAN CLINICIANS MINIMIZE THE RISK FOR SUICIDAL EVENTS WHEN USING ANTIDEPRESSANTS? 509
Education 509
Close Monitoring During Initiation of Treatment and Dose Changes 509
Strongly Consider Stopping the Antidepressant or Lowering the Dose in the Event of Adverse Effects 509
Rational Dosing 509
Identify and Target Risk Factors for Suicidal Events and Treatment Resistance 510
Try to Achieve as Rapid a Response in Treatment as Possible 510
REFERENCES 510
Adverse Effects of Electroconvulsive Therapy 513
Key points 513
INTRODUCTION 513
GENERAL ADVERSE EFFECTS THAT OCCUR AFTER ELECTROCONVULSIVE THERAPY 514
Nausea 514
Headache 514
Other Musculoskeletal Adverse Effects 514
ADVERSE EFFECTS DUE TO MUSCLE RELAXANTS 514
Prolonged Apnea 514
Malignant Hyperthermia 515
Hyperkalemia 515
Awareness Under Anesthesia 515
SEIZURE-RELATED ADVERSE EFFECTS 515
Prolonged Seizures 515
Tardive Seizures 515
Status Epilepticus 516
Todd Phenomena 516
Postictal Confusional States 516
CARDIAC ADVERSE EFFECTS 517
Asystole 517
Raised Blood Pressure 517
Electrocardiogram Abnormalities 518
Myocardial Infarction 518
Cardiomyopathy 518
RESPIRATORY ADVERSE EFFECTS 518
NEUROLOGIC ADVERSE EFFECTS 518
Electroconvulsive Therapy and Brain Damage 518
COGNITIVE IMPAIRMENT 519
Nonmemory Cognitive Deficits 520
MEMORY LOSS 520
Anterograde Amnesia 521
Retrograde (Including Autobiographical) Amnesia 521
Subjective Memory Loss 521
Moderators of Electroconvulsive Therapy–Induced Amnesia 521
Monitoring Cognitive Adverse Effects 522
Pharmacologic Prevention of Electroconvulsive Therapy–Induced Amnesia 522
EFFECTS OF ELECTROCONVULSIVE THERAPY ON PREGNANCY 523
MISCELLANEOUS ADVERSE EFFECTS 523
COMBINING ELECTROCONVULSIVE THERAPY WITH PSYCHOTROPIC DRUGS 523
MORTALITY RISK WITH ELECTROCONVULSIVE THERAPY 524
IMPLICATIONS FOR INFORMED CONSENT 525
SUMMARY 525
REFERENCES 525
Index 531