We had 2 psychiatrists, 5 psychologists, 1 psychotherapist, 4 physiotherapists and a whole lot of nurses of all sorts and colors, as well as a therapist, neurologist, optometrist, gynecologist, masseur and a swarm of nurses; a mountain of antidepressants, neuroleptics and all that, all colors, and even a car of correctors, decaliter tea, a box of coloring, half a liter of compote, art therapy and two walks a week. It’s not that it was all so necessary in depression, but once began to come out of it, then go in his passion to the end. The only thing that bothered me was the General despondency. There is no one in the world more helpless and irresponsible and depraved than a person in deep depression. But I knew we’d be cured soon enough.
Jokes jokes, but the hospital where I was laying, to the disease really came comprehensively. On admission, I gave blood and urine, I had a cardiogram. And after 2 weeks, everything was repeated to track changes in the course of treatment. Nurses often checked patients ‘ blood pressure, and the doctor was interested not only in your mental state, but also in your chair. Chair, by the way, one of the most pressing problems in the treatment of psychiatric hospitals. Diarrhea and constipation are the eternal companions of psychotropic drugs. It came to some madness: it happened that a crowd of girls suffered from intestinal obstruction for weeks, and to tell about this delicate problem to their doctor, the poor sufferers were embarrassed. It is very important to understand the following: the last thing you should think about in hospitals, and in any, is constraint. Constipation, nausea, urinary retention, rash – all this is worth talking to the doctor.
There is a standard set of specialists and examinations that all patients undergo. These are General and biochemical blood tests, urinalysis, ECG. Blood is given for viral hepatitis B and C, as well as for RW (syphilis). Patients are examined by a neurologist, therapist, optometrist, gynecologist. Further, if necessary, depending on the pathology or the recommendations of the attending physician or key specialists, the patient is advised by a surgeon, endocrinologist, dentist, ENT, infectionist, physiotherapist. Additionally, CT (computed tomography), MRI (magnetic resonance imaging), x-ray, encephalography, hormone tests, specific urine tests, etc. in The absence of any ECG pathologies, General and biochemical blood tests, urine tests are repeated once a month. This is done to monitor the patient’s condition and track the effects of drugs on the main systems. Psychotropic drugs, like all other drugs, have a number of side effects. We know which drugs can have a negative impact on certain organs and systems more often than others. For example, one atypical antipsychotic most frequently affects the blood condition (can reduce the number of white blood cells, which in turn can lead to complications), in connection with which the patients receiving the drug, renting common blood test every 10 days.
Here it is worth mentioning the difference between side effects and complications. Side effects we foresee, for us they are somehow theoretically expected, but complications – this is what the doctor does not expect and that should warn. Typical neuroleptics often cause an increase in the level of prolactin, which in turn can lead to galactorrhea, menstrual irregularities and so on. A number of drugs more often than others cause undesirable changes in the ECG, in such cases, monitoring occurs more often. Do not forget about the individual sensitivity, the characteristics of the body, the presence of somatic diseases. Therefore, patients see the neurologist and therapist. A number of drugs can not be taken with glaucoma and other pathologies of the organs of vision, so the ophthalmologist looks at patients. Plus, without the consent of these three specialists and the EEG (electroencephalogram), we can not give permission to conduct the ECT procedure. Accordingly, depending on the results of examinations, patients are prescribed additional somatic drugs. As specialized (for example, for the treatment of hypertension, diabetes), and a wider range. In situations where the patient is ill somatically, ranging from SARS, ending with intestinal disorders and allergic reactions, also carried out specialized somatic treatment after consultation with relevant specialists, taking into account the correction of psychotropic with the therapy.
Despite the variety of procedures, the most important aspect in the treatment of mental disorders remained the selection of medicines.
In psychiatry, used the following drug groups: neuroleptics, antidepressants, normotimiki, anxiolytics and hypnotics, psychostimulants and nootropics. Most often, most drugs are combined with each other (for example, antidepressant + neuroleptic) and in addition, correctors are prescribed to reduce side effects.
There is a common myth that antidepressants and neuroleptics are addictive and that, “sowing”, the body will no longer be able to fight not only with depression, but even with “household” sadness. Here it is necessary to understand that the drugs of these groups are prescribed in psychiatry in the presence of certain disorders, when the subtle system of the psyche fails. Neurotransmitters begin to be produced either in larger or in smaller quantities, or for one reason or another, neurotransmitters can not have their direct effect on the receptor, etc. In such cases, these drugs perform their function. Either they normalize the number of neurotransmitters or help them perform their function. Accordingly, when the body is all right, he absolutely does not need any additional substances. Antidepressants don’t work without depression. And these groups of drugs do not cause addiction (unlike, for example, tranquilizers).
1) Neuroleptics (aka antipsychotics) – the largest group of drugs. They are divided into two groups: antipsychotics of the first generation (typical) and antipsychotics of the second generation (atypical). The main mechanism of their action is associated with exposure to dopamine receptors. These receptors are involved in the development of acute mental States. Directly blocking these receptors causes primary antipsychotic and secondary sedative action. Unfortunately, exposure to dopamine receptors causes extrapyramidal disorders (motor disorders: stiffness in the body, tremor, muscle contraction, eye rolling, etc.). To resolve adverse effects with the preservation of the main primary action of antipsychotic drugs, use proofreaders.
Antipsychotics are prescribed not only in the presence of acute psychotic conditions, where they play a major role. In bipolar affective disorder (BAR), obsessive-compulsive disorder (OCD), somatoform and other disorders in small doses, neuroleptics are used for symptomatic treatment. Do not cause addiction.
2) Antidepressants. Used in the treatment of depression, but the range of their actions is very wide. These are anxiety phobic disorders and OCD. The principle of operation of antidepressants is the effect on neurotransmitters: serotonin, noradrenaline, rarely dopamine. Depending on what neurotransmitter and in what ratio they affect, antidepressants are divided into groups. The most well-known and widely used are selective serotonin reuptake inhibitors (SSRIs). Each group of antidepressants and each drug in General have their main and side effects. Depending on the nature of depression (anxiety, sadness, etc.) are prescribed different drugs. Do not cause addiction. But they can cause withdrawal syndrome with abrupt or incorrect withdrawal of the drug. If you cancel them gradually – there will be no withdrawal syndrome.
3) Normotimiki – stabilizers sentiments. The main drug here are antiepileptic drugs, which, in addition to the anticonvulsant effect, have a stabilizing effect. Due to the fact that the annotation to these drugs primarily indicates the treatment of epilepsy, patients are often frightened by the appointment of these drugs. It is worth reading the summary in full to see that the application written their effects in the treatment of BAR and mood swings.
There are two polar States: depression and mania. The cure for depression is an antidepressant, and when mania is chosen normotimic (mania-stabilizer). In addition, the normotimic is aimed at equalizing the emotional level and/or removes the constant “mood chatter” and irritability.
Also normotimiki include preparations of lithium. Their mechanism of action is to regulate affective manifestations (rapid response, rapid transition from one emotional state to another).
4) Tranquilizers (they are anxiolytics and hypnotics). Their main effect is anti-anxiety. The vast majority of tranquilizers are derivatives of benzodiazepines. Their effect is by acting on the benzodiazepine receptors, which are located only in one GABAergic system. They are quickly absorbed after ingestion, thereby causing a rapid anti-anxiety effect. Hypnotics-anxiolytics have a powerful soporific effect. The main problem of this group of drugs is drug dependence. Therefore, they are prescribed courses, strictly observing the rules, otherwise their excessive intake can lead to substance abuse.
5) Psychostimulants – psychotropic drugs that have a stimulating effect: increase the level of wakefulness, increase efficiency, reduce drowsiness and fatigue. The mechanism of action is associated with the ability to influence energy metabolism in brain tissue by activating cellular metabolism. They are not widely used, because with their regular use there is a high risk of developing substance abuse (addiction), in addition, they can cause psychomotor agitation and stimulate the development of psychotic disorders.
6) Nootropics – drugs that have a positive effect on cognitive function, memory, increase the resistance of the brain to adverse conditions (eg, hypoxia) and increased stress. But unlike psychostimulants, they do not have a direct stimulating effect. They affect the GABAergic system, increase metabolism and enhance the work of neurotransmitters (dopamine, norepinephrine). Used in the treatment of dementia (incl. Alzheimer’s disease), the consequences of impaired cerebral circulation after traumatic brain injury, intoxication, reduced concentration, etc.
Correctors are anticholinergic drugs of Central action that stop extrapyramidal (motor) disorders caused by taking neuroleptics (tremor, stiffness in muscles, restlessness, etc.).