Schatzberg 8th: Manual of Clinical Psychopharm
Chapter Section
2: Dx and
Classification
General Principles
SSRIs
SNRIs
5HT2R Antagonists
Bupropion
3:
Mirtazepine
Antidepressants
Vilazodone
Vortioxetine
TCAs
MAOIs
Selective and reversible MAOIs
Norepi Reuptake inhibitors
Novel Agents
General Principles
4: Antipsychotics
x
2nd gen
1st gen
LAIs
Adjunctive Tx of negatiive and cognitive Sx
Alternatives
Novel Agents
General Principles
Lithium
Anticonvulsants
5: Mood
Antipsychotics
Stabillizers Benzos
Ca2+ Channel blockers
Omega-3
Benzos
Antidepressants
Anticonvulsants
6: Antianxiety Antipsychotics
Agents
6: Antianxiety
Agents Noradrenergic Agents
Antihistamines
Buspirone
Novel Agents
Insomnia
Benzos
Non-benzos
7: Hypnotics
Antihistamines and others
Others
Dual Orexin Receptor Antagonists
Amphetamine
Uses of stiimulants
Combinations
Psychosis
8: Stimulants
Use Vs Abuse
Atomoxetine
Guanfacine
Others
Depression
9: Augmentation
Biipolar
of Tx Resistance Schizophrenia
Agitation/Violencce
Depression/Suicidality
10: Emergency Psychosis
Dept. Severe Anx
Catatonia
Referrals
Drug testing
Stimulants
Opiates
Sedatines/Hypnotics
11: Substance Benzos
Use Disorders Alcohol
Nicotine
Cannabis
Hallucinogens
PCP
Pregnancy
Pediatrics
12: Special
Geriatrics
Situations ID
Medical stuff
cal Psychopharmacology
Notes
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•"Atypical" refers to increased 5HT/DA ratio which may account for greater sx control and dec
•D2 recept binding goal: 60-80%; Higher than this increrases risk of EPS without increased sx
-Haloperidol 2-5 or 2.5-6mg/day = 60-80% D2 blockade
-Olanzapine 10-20mg/day
-Risperidone 2-6 mg/day
•SGAs may bid less tightly or for briefer periods, thus resulting in less EPS
•European CUtLASS trials and meta analysis shows similar efficacy with onlly modest benefit
•SGAs have more mood stabilizing/elevating effects, thus approved for bipolar/MDD/suicidlity
• Clozapine causes akathisia but does not progress to mre EPS
•IM SGAs cause less dystonia/parkinsoniism than IM Haldol but have more akithisia
•for aucute psychosis, fastest titration = risp, aripip, olanz in orally disintigrating tablets. Que
•Early tx (esp. of olanz vs haldol) of psychosis likely neuroprotective against grey matter loss
•Possible evidence that omega-3 and cognitive training that prevent full expression of schizop
•In the absence of undesirable side effects, it is always difficult to be sure whether a shift to a
continuing the original drug for a longer period. Pragmatically, 2 weeks without response in m
or with detectable but quite inadequate im- provement generally forces the clinician to make
-Consider switching to another med at significantly reduced equivalent dose
•Plasma levels generally unhelpful for antipsychotics; exceptions: Haldol 4-26 ng/mL and Cloz
•Consider augmenting antipsychotics with Li+ or antidepressant (shown to be helpful in SCZ
•Weight gain: Geodon < Abilify < risp < olanz/clozaril
•Kane study: 10% normall dose fluphenazine decanoate = better symptom control, functiona
worth the tradeoff?)
•In depressed bipolar: antipsyhcotics are faster, more effective than Li+ or valproate
•EPS MUCH more likely in uni/bipolar depression, so avoid 1st gen antipsychotics or DOCUME
•For combat veterans, SGAs helpful with agitation, hypervigilance, flashbacks, sleep
•In elderly dementia patients, 2.5-7.5 mg olanzapine (or simiilar dose risp) better than quetia
-Tradeoff is 1.7x all-cause mortality rate on SGAs. Assess on case by case basis