Gitlin - The psychotherapists guide to psychopharmacology

THE PSYCHOTHERAPISTS GUIDE TO PSYCHOPHARMACOLOGY

Copyright 1990 by The Free Press

A Division of Macmillan, Inc.

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the Publisher.

The Free Press
A Division of Macmillan, Inc.
866 Third Avenue, New York, N.Y. 10022
www.SimonandSchuster.com

Maxwell Macmillan Canada, Inc.
1200 Eglinton Avenue East
Suite 200
Don Mills, Ontario M3C 3N1

Macmillan, Inc. is part of the Maxwell Communication Group of Companies.

Printed in the United States of America

printing number

4 5 6 7 8 9 10

Library of Congress Cataloging-in-Publication Data

Gitlin, Michael J.

The psychotherapists guide to psychopharmacology / Michael J. Gitlin.

p. cm.

Includes bibliographical references.

ISBN 0-02-911781-X

ISBN-13: 978-0-029-11781-1

eISBN-13: 978-1-439-13668-3

1. Psychopharmacology. 2. Psychotherapists. I. Title.

[DNLM: 1. Mental Disordersdrug therapy. 2. Psychotropic Drugspharmacology. 3. Psychotropic Drugstherapeutic use.]

RM315.G57 1990

616.8918dc20

DNLM/DLC

for Library of Congress 90-1734

CIP

To my mother, Beatrice Gitlin, who showed me the value of sensitivity and to the memory of my father, Hyman Gitlin, M.D., who demonstrated the art of being a physician

SECTION ONE

SECTION TWO

SECTION THREE

Mourning

Demoralization

Personality Disorders

Adjustment Disorder with Depressed Mood

Premenstrual Syndrome

Dementia Syndromes

Cyclic Antidepressants

Monoamine Oxidase (MAO) Inhibitors

Lithium

Alprazolam

Electroconvulsive Treatment (ECT)

Light Therapy

Strategies Used in Treatment-Resistant Depressions

Alternative Treatments of Acute Schizophrenia

Diagnosis

Pharmacotherapy

Diagnosis

Pharmacotherapy

Diagnosis

Pharmacotherapy

Diagnosis

Pharmacotherapy

Diagnosis

Pharmacotherapy

Ennresis

Conduct Disorder

Aggressive, Destructive Behavior in Mentally Retarded Children

Diagnosis

Pharmacotherapy

Mood Disorders

Psychotic Disorders

Anxiety Disorders and Insomnia

SECTION FOUR

Panic Disorder

Clinical Uses

Biologic Effects

Techniques for Prescribing

Side Effects

Clinical Uses

Biologic Effects

Techniques for Prescribing

Side Effects

Acute Dystonia

Extrapyramidal Symptoms

Neuroleptic Malignant Syndrome

SECTION FIVE

The Initial Consultation

Working in an Ongoing Split Treatment

ILLUSTRATIONS

TABLES

1-1 Clinical Characteristics That Should Suggest a Psychopharmacological Consultation 12

3-1 Diagnostic Criteria for Major Depressive Episode 37

3-2 Diagnostic Criteria for Major Depressive Episode, Melancholic Type 38

3-3 Diagnostic Criteria for Manic Episode 41

3-4 Medical Disorders That May Cause Depressive Syndromes 51

3-5 Antihypertensives Associated with Depression 54

3-6 Differentiating Pseudodementia (of Depression) from Dementia 58

3-7 Distinguishing Hypomania from Happiness 59

3-8 Psychopharmacological Treatment Options for Depression 61

3-9 Factors Used in Choosing a Specific Cyclic Antidepressant 62

3-10 Factors Used in Deciding to Prescribe a Monoamine Oxidase Inhibitor 65

3-11 Factors Used in Considering a Maintenance Treatment in Unipolar and Bipolar Mood Disorders 72

3-12 Treatments for Mania and Bipolar Disorder 75

4-1 Diagnostic Criteria for Panic Disorder 81

4-2 Medical Disorders and Drugs That May Cause Anxiety Disorders 87

4-3 Advantages and Disadvantages of Antipanic Medications 93

4-4 Medications for Generalized Anxiety 98

4-5 Common Causes of Insomnia 107

5-1 Diagnostic Criteria for Schizophrenia 115

5-2 Diagnostic Distinctions Among Disorders with Both Mood and Psychotic Symptoms 127

5-3 Alternative Treatments of Acute Schizophrenia 133

6-1 Guidelines for Considering Medications in Treating Bulimia 145

6-2 Medications for Attention Deficit Disorder in Adults 148

7-1 Diagnostic Criteria for Borderline Personality Disorder 167

7-2 Medication Strategies for Personality Disorders 172

8-1 Commonly Used Medications in Child and Adolescent Psychiatry 180

8-2 Diagnostic Criteria for Attention-deficit Hyperactivity Disorder 188

8-3 Special Considerations in the Diagnosis and Psychopharmacological Treatment of the Elderly 195

9-1 Disorders for Which Cyclic Antidepressants Are Useful 205

9-2 Effects of Cyclic Antidepressants on Neurotransmitter Systems 209

9-3 Cyclic Antidepressants 212

9-4 Antidepressants for Which Therapeutic Blood Levels Are Established 215

9-5 Common Side Effects of Cyclic Antidepressants 220

9-6 Other Side Effects of Cyclic Antidepressants 221

9-7 Disorders for Which MAO Inhibitors Are Useful 226

9-8 Monoamine Oxidase Inhibitors 227

9-9 Food Restrictions for Patients on MAO Inhibitors 234

9-10 MAO InhibitorsMedications to Avoid 236

9-11 Common Side Effects of MAO Inhibitors 237

10-1 Disorders for Which Lithium Is Useful 242

10-2 Lithium Preparations 246

10-3 Situations in Which Lithium Levels Should Generally Be Checked 248

10-4 Lithium Side Effects 249

10-5 Signs of Lithium Toxicity 253

11-1 Disorders for Which Benzodiazepines Are Useful 263

11-2 Benzodiazepines 269

11-3 Characteristics of Benzodiazepines 270

11-4 Possible Symptoms of Benzodiazepine Withdrawal 275

11-5 Factors Predicting Benzodiazepine Withdrawal Symptoms 276