Concurrent Disorders

Is defined as a condition in which a person has both a substance abuse problem and a diagnosable psychiatric illness.

The Three Main Psychiatric Disorders

Schizophrenia:

literally means ‘split-mind’, but the mind is not physically split, nor do they have a split or multiple personalities It is a major mental illness, characterized by being cut off from a sense of reality.  Symptoms may include catatonia, hallucinations, voices, feelings of persecution, paranoia and delusional thinking.

Types of Antipsychotic Medications:

First Generation: significantly reduce hallucinatory and delusional behaviour, but are less effective in social withdrawal, apathy and disorientation.

Chlorpromazine (thorazine), haloperidol (Haldol), trifluperazine (Stelazine)

Second Generation: atypical antipsychotic medications, they offer a complete treatment without the Parkinson’s-like side effects. No undesirable movement difficulties (tardive dyskenesia), but each one has its undesirable effect such as blood disease (agranulocytosis), weight gain (seroquel) or diabetes (risperdal)

Quetiapine (seroquel), risperidone (Risperdal), ziprasidone (Geodon)

Third Generation: no risks for Parkinson’s-like side effects, tardive dyskenesia, agranulocytosis, weight gain or diabetes.

Aripiprazole (Abilify)

Bipolar Affective Disorder (Manic Depression)

Characterized by mood swings back and forth between depression and mania.

Mania: a mood disorder characterized by agitation, sleeplessness, irritability, bursts of energy, impulsiveness and feelings of grandeur. Usually treated with lithium carbonate, but is effective for only 50% of people.

Valproate (Depakote), also second generation antipscychotic and antidepressant drugs combined.

Major Depression

an emotional state far beyond ordinary feelings of sadness, grief or remorse. Drugs used to treat this are called antidepressants.

Types of Antidepressant Medications:

First Generation: key factor is in the inhibition of the monoamine oxidase enzyme (MAO), and are called MAO inhibitors.  Need to have strict dietary regulation as they inhibit MAO everywhere in the body.  No foods or drinks that are derived from fermentation (tyramine).Tricyclic drugs can cause elevated or irregular heart rates.

Tranylcypromine (Parnate), selegiline (Eldepryl), phenelzine (Nardil)

Second Generation: SSRI or selective serotonin reuptake inhibitors slow down the reuptake of serotonin from its synaptic receptors.  The net effect is to prolong the action of serotonin.  Some side effects are agitation, nausea, sexual dysfunction.

Citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), escitalopram (Lexapro).

Third Generation: affects the activity of serotonin like SSRIs, but also noreponephrine. Mirtazepine (Remeron), venlafaxine (Effexor).

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