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CLINICAL PHARMACOLOGY 2003 (PART 21A)

Advances in drug treatment have revolutionised the practice of psychiatry over the past six decades. Drugs provide a degree of stability and control in the lives of those suffering from schizophrenia, a chronic debilitating illness with impact so profound that it accounts for 2-3% of UK national health spending. Similarly, the impact of medication in alleviating the burden on individuals, their families and society of depression, which has a lifetime prevalence of up to I in 6 of the population, is substantial. . | 19 SECTION 4 Psychotropic drugs SYNOPSIS Advances in drug treatment have revolutionised the practice of psychiatry over the past six decades. Drugs provide a degree of stability and control in the lives of those suffering from schizophrenia a chronic debilitating illness with impact so profound that it accounts for 2-3 of UK national health spending. Similarly the impact of medication in alleviating the burden on individuals their families and society of depression which has a lifetime prevalence of up to I in 6 of the population is substantial. Psychotropic drugs greatly improve the prognosis of other common conditions such as anxiety disorders attention deficit hyperactivity disorder and bipolar affective disorder. In this chapter the following drug groups are considered Antidepressants Antipsychotics neuroleptics Mood stabilisers Drugs for anxiety and sleep disorders Drugs for Alzheimer s dementia Drugs for attention deficit hyperactivity disorder Writing prescriptions is easy understanding people is hard. Franz Kafka 1883-1924 In 1940 psychotropic medication was limited to chloral hydrate barbiturates and amphetamine. By contrast the modern-day formulary lists almost 100 psychotropic drugs with efficacious treatment available for the vast majority of psychiatric diagnoses and in all phases of life. Psychotropic medication has been a key factor in accelerating the closure of Victorian asylums such that the psychiatric inpatient population is now a tiny fraction of its 1954 peak of 148 000 in England and Wales. DIAGNOSTIC ISSUES Older classifications of psychiatric disorder divided diseases into psychoses and neuroses . The term psychosis is still widely used to describe a severe mental illness with the presence of hallucinations delusions or extreme abnormalities of behaviour including marked overactivity retardation and catatonia usually accompanied by a lack of insight. Psychotic disorders therefore include schizophrenia severe forms of depression and mania.