Psychopharmacology

Dr. Altaf Qadir Khan

Professor of Psychiatry
Ameeruddin Medical College/PGMI
Lahore
Barbiturates
Anxiolytic
Antidepressant
Alcohol like withdrawal
Abrupt withdrawal is dangerous
Seizures leading to sudden death
Cannabis
Cannabis sativa
Marihjuana resins
Tetrahydrocannabinol (THC)
Effects
Mood
Expectations
Social settings
Adverse effects
Mental illness
Tolerance
Cannabis
Aesthetic experiences
Distortion of perception
Red eyes
Dryness of mouth
Tachycardia

No teratogenecity
Anxiety
Paranoid ideations
Acute confusional state
Amphetamines
ADHD
Narcolepsy
Effects
Mood
Over-talkativeness
Insomnia
Dryness of lips
Increased heart rate & blood pressure
Amphetamine
Cardiac effects
Cardiac arrhythmia
Hypertension
Cardio-Vascular Accident
Circulatory collapse
Amphetamine induced psychosis
Withdrawal syndrome (Crash)
Cocaine
CNS effects
Excitement
Euphoria
Grandiose thinking
Impaired judgement
Sexual disinhibition
Paranoid ideations
Aggressive behavior
Formication (Cocaine bugs)
Cardiac effects
MDMA
Methylene-Dioxy-Meth-Amphetamine
Positive mental state
Euphoria
Sociability
Intimacy
Loss of appetite
Tachycardia
Bruxism
Sweating
LSD
Lysergic acid diethylamide (Psychedelic)
Potent mood changing chemical
Marketed as enhancer of psychotherapy and psychiatric
illnesses i.e. depression and alcohol
CIA use the drug for mind control and chemical warfare
Tested the drug on young servicemen and students
The counterculture of the 60s
The American dream
Inhalants
Chemicals found in such household products
 Aerosol sprays, cleaning fluids, glue, paint, paint thinner, nail
polish remover and petrochemical fuel
Short-term
 Anosmia
 Arrhythmias
Long-term
 Muscle wasting
 Reduced muscle tone and strength
Other treatments
Bright light therapy
 Phototherapy (1000 – 2500 lux)
Transcranial Magnetic Stimulation
Deep brain stimulation
Vagus nerve stimulation (VNS(
Psychosurgery
Sub-caudate tractomy
Anterior cingulotomy
Capsulectomy
 Alcohol
Dr. Altaf Qadir Khan
Professor of Psyhiatry
Ameeruddin Medical College/PGMI
Lahore
ICD-10 Clinical description
A cluster of physiological, behavioural and cognitive
phenomena in which the use of a substance or a class of
substances takes on a much higher priority for a given
individual than other behaviours that once had greater value.
A central descriptive characteristic of the dependence
syndrome is the desire (often strong, sometimes
overpowering) to take psychoactive drugs (which may or may
not have been medically prescribed), alcohol or tobacco.
The return to substance use after a period of abstinence may
lead to a more rapid reappearance of other features of the
syndrome than occurs with non-dependent individuals
Abuse vs Dependence
Substance abuse is characterized by people who engage in
behaviours that are high risk, dangerous and generally are
considered unsafe

A dependence on alcohol or drugs differs from this as the

behaviours are linked to physical or psychological need for the
substance
DSM V
Alcohol abuse and alcohol dependence are no longer
diagnosed

Alcohol use disorder:

Mild
Moderate
Severe
DSM V
Had times when you ended up drinking more, or longer, than
you intended?
More than once wanted to cut down or stop drinking, or tried
to, but couldn’t?
More than once gotten into situations while or after drinking
that increased your chances of getting hurt (such as driving,
swimming, using machinery, walking in a dangerous area, or
having unsafe sex)?
Had to drink much more than you once did to get the effect
you want? Or found that your usual number of drinks had
much less effect than before?
DSM V
Continued to drink even though it was making you feel
depressed or anxious or adding to another health problem? Or
after having had a memory blackout?
Spent a lot of time drinking? Or being sick or getting over
other aftereffects?
Continued to drink even though it was causing trouble with
your family or friends/
Found that drinking - or being sick from drinking – often
interfered with taking care of your home or family? or caused
job troubles? Or school problems?
DSM V
Given up or cut back on activities that were important or
interesting to you, or gave you pleasure, in order to drink?
More than once gotten arrested, been held at a police station,
or had other legal problems because of your drinking?
Found that when the effects of alcohol were wearing off, you
had withdrawal symptoms, such as trouble sleeping,
shakiness, restlessness, nausea, sweating, a racing heart, or a
seizure? Or sensed things that were not there?
Alcohol dependence
Sub-types A and B
Type A
Late onset
Few childhood risk factors
Relatively mild dependence
Few alcohol related problems
Little psychopathology
Alcohol dependence
Sub-types A and B
Type B
Early onset of alcohol related problems
Many childhood risk factors
Severe dependence much psychopathology
A strong family h/o alcohol abuse
Frequent polysubstance abuse
Long h/o alcohol treatment
Lot of severe life stresses
Others
Early stage problem drinkers
Affiliative drinkers
Schizoid isolated drinkers

Gamma alcohol dependence

Wernicke-Korsakoff syndrome
An alcohol amnestic syndrome characterized by confusion and
severe impairment of memory especially for recent events, for
which the patient compensates by confabulation
Typically encountered in patients with long-term alcoholism,
delirium tremens may precede the syndrome, and Wernicke
syndrome often coexists with it.
It results from severe acute deficiency of thiamine (Vitamin
B1) whilst Korsakoff’s psychosis is a chronic neurologic sequela
of Wernicke’s encephalopathy
.
Delirium tremens

Wernicke’s encephalopathy

Korsakoff syndrome
Investigations
Gamma-glutamyl transpeptidase
MCV
Others
Uric acid
Triglycerides
AST
ALT