The presence of catatonia was confirmed with Pedro’s score of 14 on the Bush–Francis Catatonia Rating Scale with accompanying findings of staring, autonomic instability, mutism, and withdrawal. A lorazepam challenge was instituted. Pedro was started on 4 mg of lorazepam over 24 hours, with changes in his catatonic state observed and documented. Considering his persistent fever, tachycardic state, catatonia, recent low adherence to antipsychotic medications, and subsequent elevation of creatinine kinase levels, Pedro was finally diagnosed with neuroleptic malignant disorder (NMS). MANAGING SCHIZOPHRENIA, THEN NEUROLEPTIC MALIGNANT DISORDER (NMS)
Pedro was started on a bromocriptine regimen, and his antipsychotics were temporarily discontinued pending the evaluation of his clinical response to bromocriptine. Pedro was also started on psychopharmacology with a routine class of cognitive-behavioral therapy in an attempt to modify his drug use behavior and help his long history of schizophrenia, panic, and anxiety attacks. The clinical plan was to thoroughly evaluate the risks and benefits of restarting his antipsychotic medications after his NMS resolved. Pedro’s cases argues for a need for drug use stewardship in psychiatry with a principal focus on the integration of nondrug psychotherapy in patients with confirmed cases of neurological disorders. Self-Assessment Quiz Question #1 1. Which of the following describes the reason for Pedro’s scarred memory and his episodes of panic attacks and paranoia? a. Early-life social trauma
Self-Assessment Quiz Question #3 3. Which of the following characterized Pedro’s therapy for schizophrenia? a. Wrong diagnosis
b. Poor drug adherence c. Inactive medication d. Wrong drug selection
Self-Assessment Quiz Question #4 4. In Pedro’s therapy plan, what was IV haloperidol reserved for?
a. Agitation b. Psychosis c. Insomnia d. Diabetes
Self-Assessment Quiz Question #5 5. Which psychotherapy method can be identified in Pedro’s therapy plan? a. Cognitive-behavioral therapy b. Group discussion
b. Sexual abuse c. Drug abuse d. Neglect
Self-Assessment Quiz Question #2 2. Which psychoactive drug kickstarted Pedro’s psycho- behavioral woes? a. Diazepam b. Fluphenazine c. Methamphetamine d. Haloperidol
c. Meditation d. Cryotherapy
PSYCHOPHARMACOLOGY: PREHISTORIC TIMES TO MODERN CLINICAL MEDICINE In an updated description generally adopted by different healthcare institutions today, the American Society of Clinical Psychotherapy has defined psychopharmacology as the study of the use of medication in the treatment of mental disorders. In its comprehensive practice form, psychopharmacology explores a combination of psychology—the scientific study of behavior and pharmacology—the scientific study of drug action in human biology. Primarily, psychopharmacology evaluates the effects of drugs on behavior, charting a new field of therapeutic interventions complementing the clinical efforts of psychiatry and neuroscience in healthy living. To examine the effects of drugs on behavior, neurotransmitters, receptors, and other sites of drug action in the body (Sheffler et al., 2022). Combining the clinical evidence from these two parameters as it relates to specific drugs helps psychopharmacologists understand the optimal method of designing and executing clinical intervention in psychiatry. Although psychopharmacology as a medical field only recently received a huge research interest, humans have used psychoactive drugs since time immemorial. The early psychoactive substances were initially identified and used for their behavior-modulating effects despite a weak understanding of their mechanism of action. In retrospect, the history of the development of psychopharmacology from 1950 to the present can be classified into four different eras: 1. Psychopharmacology: Mid-nineteenth century to 1950
psychopharmacologists are interested in pharmacokinetics and the pharmacodynamic parameters as they relate to specific drugs. Pharmacokinetics is a term that describes how a drug is absorbed by the body, distributed through the body in fluids and compartments, metabolized by special organs, and excreted in different forms. Pharmacodynamics, on the other hand, examines the molecular interaction between the drug and the various Psychopharmacology: Mid-Nineteenth Century to 1950 Before 1950, the practice of psychopharmacology was primarily focused on the trialed use of sedatives and hypnotics derived from animal and plant sources. Bromides, chloral hydrates, hyoscine, sulfonal, and plant-derived narcotics were the substances revered for mood-altering and mood-modulating behavior. The clinical use of these substances was limited, as the population primarily traded these substances for recreational purposes. However, with time, hyoscine and chloral hydrate were introduced into clinical practice.
2. Modern psychopharmacology: 1950–1964 3. Forging disease specificity: 1964–1988 4. Late 1980s to the present
The early documentation on this integration into clinical practices explored the physiological effects of hyoscine on test subjects. Describing the effects of hyoscine in this context, Thomas Drapes reported (Mauger, 2020): “It is incomparably superior to the older sedatives, such as morphine and chloral, and none of the newer ones, in my opinion, approach it in value as a remedy for
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