Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry QUOTES

1 " Psychotropic drugs have also been organized according to structure (e.g., tricyclic), mechanism (e.g., monoamine, oxidase inhibitor [MAOI]), history (first generation, traditional), uniqueness (e.g., atypical), or indication (e.g., antidepressant). A further problem is that many drugs used to treat medical and neurological conditions are routinely used to treat psychiatric disorders. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

2 " The issues of antidepressant-associated suicide has become front-page news, the result of an analysis suggesting a link between medication use and suicidal ideation among children, adolescents, a link between medication use and suicidal ideation among children, adolescents, and adults up to age 24 in short term (4 to 16 weeks), placebo-controlled trials of nine newer antidepressant drugs. The data from trials involving more than 4.4(K) patients suggested that the average risk of suicidal thinking or behavior (suicidality) during the first few months of treatment in those receiving antidepressants was 4 percent, twice the placebo risk of 2 percent. No suicides occured in these trials. The analysis also showed no increase in suicide risk among the 25 to 65 age group. Antidepressants reduced suicidality among those over age 65. Following public hearings on the subject, in October 2004, the FDA requested the addition of “black box” warnings—the most serious warning placed on the labeling of a prescription medication—to all antidepressant drugs, old and new. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

3 " Medications used to treat psychiatric disorders are commonly referred to as psychotropic drugs. These drugs are commonly described by their major clinical application, for example, antidepressants, antipsychotics, mood stabilizers, anxiolytics, hypnotics, cognitive enhancers, and stimulants. A problem with this approach is that these drugs have multiple indicators. For example, selective serotonin reuptake inhibitors (SSRls) are both antidepressants and anxiolytics, and the serotonin-dopamine antagonists (SDAs) are both anxiolytics and mood stabilizers. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

4 " selective serotonin reuptake inhibitor (SSRI) and serotonin–norepinephrine reuptake inhibitors (SNRIs) are now used as primary treatments, with benzodiazepines used as adjuncts. Benzodiazepine abuse is rare, usually found in patients who abuse multiple prescription and recreational drugs. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

5 " The complex interplay of the emotions, however, is far beyond the understanding of functional neuroanatomists. Where, for example, are the representations of the id, ego, and and the superego? Through what pathway are ethical and moral judgments shepherded? What processes allow beauty to be in the eye of the beholder? These philosophical questions represent a true frontier of human discovery. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

6 " it is often best if benzodiazepine agents are used in conjunction with psychotherapy and when alternative agents have been tried and proven ineffective or poorly tolerated. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

7 " The fact that all benzodiazepines are lipid soluble to varying degrees means that benzodiazepines and their active metabolites bind to plasma proteins. The extent of this binding is proportional to their lipid solubility. The amount of protein binding varies from 70 to 99 percent. Distribution, onset, and termination of action after a single dose are thus largely determined by benzodiazepine lipid solubility, not elimination "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

8 " half-life. Preparations with high lipid solubility, such as diazepam and alprazolam, are absorbed rapidly from the GI tract and distribute rapidly to the brain by passive diffusion along a concentration gradient, resulting in a rapid onset of action. However, as the concentration of the medication increases in the brain and decreases in the bloodstream, the concentration gradient reverses itself, and these medications leave the brain rapidly, resulting in fast cessation of drug effect. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

9 " For patients being seen for supportive psychotherapy or medication management, answering the question, especially if it is not very personal, such as “Do you watch football?,” is quite appropriate. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

10 " administration of medications more frequently than the elimination half-life leads to drug accumulation, medications such as diazepam and flurazepam accumulate with daily dosing, eventually resulting in increased daytime sedation. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

11 " administration of medications more frequently than the elimination half-life leads to drug accumulation, medications such as diazepam and flurazepam accumulate with daily dosing, eventually resulting in increased daytime sedation. Some benzodiazepines (e.g., oxazepam) are conjugated directly by glucuronidation and are excreted. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

12 " more than 120 hours. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

13 " Zolpidem, zaleplon, and eszopiclone are rapidly and well absorbed after oral administration, although absorption can be delayed by as long as 1 hour if they are taken with food. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

14 " Because insomnia may be a symptom of a physical or psychiatric disorder, hypnotics should not be used for more than 7 to 10 consecutive days without a thorough investigation of the cause of the insomnia. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

15 " The rapid metabolism and lack of active metabolites of zolpidem, zaleplon, and eszopiclone avoid the accumulation of plasma concentrations compared with the long-term use of benzodiazepines. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

16 " The benzodiazepine hypnotics differ principally in their half-lives; flurazepam has the longest half-life, and triazolam has the shortest. Flurazepam may be associated with minor cognitive impairment on the day after its administration, and triazolam may be associated with mild rebound anxiety and anterograde "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

17 " dysfunction and weight gain. However, the SSRIs are still often preferred because they target common comorbid conditions, such as depression or obsessive-compulsive disorder (OCD). Benzodiazepines and SSRIs can be initiated together to treat acute panic symptoms; use of the benzodiazepine can be tapered after 3 to 4 weeks after the therapeutic benefits of the SSRI have emerged. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

18 " Clonazepam has been shown to be an effective treatment for social phobia. In addition, several other benzodiazepines (e.g., diazepam) have been used as adjunctive medications for treatment of social phobia. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

19 " Chronic catatonia does not respond as well to benzodiazepines. The definitive treatment for catatonia is electroconvulsive therapy. "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry

20 " frequently associated with bipolar disorder than with schizophrenia "

― , Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry