Psychopharmacological Procedures

View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by VCU Scholars Compass Psychopharmacological Procedures HEINZ E. LEHMANN Douglas Hospital and McGill University, Montreal, Canada Of all special fields in medicine, today has grown into a system of internal medicine and psychiatry empirical and rational procedures probably play the most important which can be studied and acquired roles in general medical practice. by anyone who is motivated to do This has always been so, but there so. To acquire knowledge and skill has also always been a gap be of psychopharmacological proce tween the clinical approach to the dures neither calls for particular medical aspects of the total treat assets of temperament or personal ment of a person, and to the psy ity nor dedicated immersion into chiatric aspects. This gap, which esoteric speculations and polysyl for many years has alienated psy labic terminology. chiatry from the other parts of medicine, has only been bridged in What is Psychopharmacology? the last two decades. Since the early 1950's psychiatric thinking Psychopharmacology is a new and practice has moved much closer scientific discipline which was born to general medical procedures, so in the first few years of the second that treatment of many psychiatric half of our century. It is a discipline patients has become more rational, which deals with psychotropic or more understandable and more psychoactive drugs, i.e., drugs practical for the non-specialist. which influence consciousness, If psychiatric treatment today is mood and behavior. Psychopharma a major concern of general medical cology, which has played such an practice, psychopharmacology has important role in bringing psychia been one of the most important fac try back into the fold of general tors in this development. New medicine, is concerned with four and effective pharmacological treat principal aspects of psychotropic ments of various psychiatric dis drugs: 1) indications for, and dos orders have made it possible for age of, psychotropic drugs; 2) side any physician to treat patients who effects and complications of these previously had to be hospitalized drugs and their management; 3) and could be treated only by psy understanding of the mechanisms of chiatrists. In making this claim for action of psychotropic drugs the pharmacotherapy of psychiat through the development of opera ric disorders, I do not wish to im tionally defined and measurable re ply that the fine arts of interview search procedures; 4) development ing, listening and psychological and screening of new substances in understanding are no longer needed this field. The first two of these as by the doctor; they still are and pects primarily concern the clini probably always will be among the cian; the latter two lie more within most important skills of any good the field of the researcher. physician. I simply want to make Following the discovery of chlor the point that psychopharmacology promazine, the first of a group of MCV QUARTERLY 5(3): 151-160, 1969 151 PSYCHOPHARMACOLOGICAL PROCEDURES entirely new drugs for the treat psychiatry is less fortunate than acterized by aimless restlessness and ment of mental disorders, it became other branches of medicine, be autonomic signs of sympathomi clear within a few years that the cause (with very few exceptions) metic (adrenergic) arousal, e.g., new psychotropic drugs had made it lacks objective criteria for diag tachycardia, sweating, increased a tremendous impact on three nosis as well as knowledge about blood pressure, mydriasis. At the areas: 1 ) the public, for whom the etiology of most of the condi same time the patient feels uncom virtually overnight-tranquilizers tions for which a psychiatrist has fortable, unable to relax and became a household word and a to treat his patients. This does not when not only tension but also multimillion-dollar business; 2) re mean that psychiatric diagnosis is anxiety is present-apprehensive search, where the new discipline entirely subjective, but it does mean and threatened in some undefinable of psychopharmacology was estab that practically all psychiatric diag manner. Tense and anxious pa lished in the wake of these discov nosis is based primarily on the ob tients, as a rule, also suffer from eries; 3) treatment, where the new servation of behavioral deviations. insomnia. drugs made possible an almost rev The causes of the major psychoses Perceptual and cognitive disor olutionary new approach to the are still unknown, although a great ders occur mostly in psychotic con therapy for many psychiatric dis deal of promising research is going ditions and indicate impaired con orders. on in this area. The origin of tact with reality. Examples of A number of psychotropic drugs neurotic disturbances is better un symptoms occurring in this cate have, of course, been known and derstood but is also still subject to gory are: hallucinatory perceptions, used by man for a long time. Al controversy between proponents of in one or several sense modalities, cohol, caffeine and certain narcot psychoanalysis, learning theory and without any corresponding objec ics are the oldest psychotropic genetic or other somatic factors. In tive stimulation; delusional ideas, agents known. The discovery of spite of all these theoretical un i.e., false and persistent beliefs their properties has been lost in certainties, we now have a variety which cannot be corrected by ra the dawn of recorded history. But of effective pharmacological treat tional proof that they are un with the advent of scientific medi ments in psychiatry, and even if founded; a generalized thinking cine, systematic research during the their mechanisms of action are not disorder leading to irrational and past century led to the develop always clearly understood, many of bizarre forms of reasoning. ment of anaesthetic drugs and, these treatments have empirically Depression is behaviorally char later, to the introduction of a va proven their worth. acterized either by agitation or, riety of hypnotic and sedative Rather than involve you in the more typically, by psychomotor re agents. Thus, after the empirical problems of psychiatric diagnosis tardation, i.e., a general slowing discovery of intoxicants and stim and classification, I should like to down of all spontaneous and re ulants, medical research discovered discuss the four major symptomatic sponsive activity, an overall in remedies for some of the universal conditions which can be effectively crease of inhibition and reduction ills of mankind, i.e., pain, insomnia treated with psychotropic drugs. of energy output. Most important and anxiety. Effective drugs for These four conditions are: 1 ) psy is the core symptom, a subjective more specific uses in the treatment chomotor excitement; 2) tension background of an all pervasive of mental and emotional disorders and anxiety; 3) depression; 4) per feeling of dejection, pessimism and have been systematically developed ceptual and cognitive disorders hopelessness which not infrequently since two French psychiatrists, De (e.g., hallucinations and delusions). leads to attempted or completed lay and Deniker (1952), adminis Let me briefly define these well suicide. tered chlorpromazine (Thorazine) known behavioral deviations or for the first time to agitated psy mental symptoms. Classification of Psychotropic chotic patients and noted the Psychomotor excitement is char Drugs extraordinary tranquilizing effect of acterized by restless, overactive, this drug. agitated, noisy, boisterous and dis Having thus classified-though inhibited behavior; a feeling of be somewhat roughly-the four prin Pharmacotherapy in Psychiatric ing driven-being under pressure cipal psychiatric conditions which Disorders -with the mood being either one can be effectively treated with psy of aggressive anger or excessive chotropic drugs, let me now give Although the title of my paper elation. Usually, pronounced psy you the brief and simple classifica is "Psychopharmacological Proce chomotor excitement is associated tion of psychotropic drugs which dures," what I really intend to talk with insomnia and sometimes with has been proposed in the report, about is pharmacotherapeutics with clouded consciousness, i.e., confu "Research in Psychopharmacol psychiatric patients. At this point, sion and delirium. ogy," published by a World Health I would like to remind you that Tension and anxiety are char- Organization scientific group 152 H. E. LEHMANN ( 1967). The report distinguishes psychostimulant, he is often ren and affective processes, is still in five categories of drugs. The first dered more tense and sleepless and the experimental stage. category is Neuroleptics-often re may well become more depressed. ferred to as major tranquilizers or Sometimes, but rarely, an ampheta antipsychotics-which are repre mine or Ritalin may be helpful in Therapeutic Applications of sented by the phenothiazines, the the treatment of certain depressive Neuroleptics and Anxiolytic butyrophenones and the thioxan states, but only when the depres Sedatives (Tranquilizers) thenes, as well as by the reser sion is in its very beginning or pine derivatives. The second cat already fading out. During a full States of Excitement egory is Anxiolytic Sedatives blown depression, psychostimulants Effective agents in the treatment often referred to as minor tran are contraindicated. Because physi of acute excitement and

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