Atypical antipsychotic medications: Pharmacological profiles and psychological implications.

Advances in psychopharmacology and the development of new antipsychotic medications may represent increased opportunities for psychologists to provide expanded psychosocial services to patients with schizophrenia. The new agents, referred to as the atypical antipsychotics, are as efficacious as the older conventional antipsychotics but demonstrate a more favorable side effect profile. Preliminary data suggest improvements in cognitive deficits and negative symptoms typically associated with schizophrenia, which may enhance long-term outcome. Psychologists may be increasingly called on to provide psychosocial services to this population, thereby requiring that they have a sound working knowledge of the pharmacological and psychological properties of these agents. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Aripiprazole: A novel antipsychotic with dopamine stabilizing properties.

Notes that research in the field of psychopharmacology continues to focus on the development of antipsychotic agents that represent significant improvements over currently available agents in terms of side-effect profiles and efficacy. Several different lines of research have emerged, some of which capitalize on advances already attained with atypical or second-generation antipsychotics (SGAs), while others work towards identifying novel pharmacological targets around which to develop new agents. Although activity at serotonin receptors was a focus in the development of SGAs, dopamine remains the primary neurotransmitter of interest. One strategy has been to develop compounds that interact with dopamine receptors in ways that are different from those demonstrated by currently available agents. This approach has met with some experimental and clinical success, and has produced at least one agent--aripiprazole--which was recently approved for use in the US. Biochemical analysis has indicated that, as a potent partial D? agonist, aripiprazole works as an agonist at the presynaptic D? autoreceptors and as an antagonist at the postsynaptic D? receptors. It also exerts antagonist effects--like those of the atypical agents--at the 5-HT2A receptor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The emerging role of glutamate as a new pharmacologic target.

Neurotransmitters serve as functional substrates for receptor signaling, as well as dynamic mediators of psychotropic drug activity. Identifying dysregulations in specific neurotransmitter systems has greatly contributed to increased understanding of the pathophysiology of various disorders. Several primary neurotransmitters have received the greatest attention as they relate to neuropsychiatric disorders--namely, acetylcholine, and the biogenic monoamines (norepinephrine, dopamine, and serotonin). In addition to these 'classic' neurotransmitters, various amino acids, such as gamma-aminobutyric acid (GABA), glutamate, aspartate, and glycine, have also been identified as having neurotransmitter properties within the central nervous system (CNS). The excitatory amino acid glutamate, the most prevalent neurotransmitter in the CNS and a primary mediator of excitatory synaptic transmission, has begun receiving attention. Clinicians will benefit from this overview of glutamate's neurobiology, pharmacological activity, and suspected involvement in the pathophysiology of various disease states. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Selective serotonin reuptake inhibitor discontinuation syndrome: Understanding, recognition, and management for psychologists.

Psychologists increasingly provide psychotherapeutic services to patients receiving concomitant pharmacotherapy. Ongoing experience with the relatively new selective serotonin reuptake inhibitors and other atypical antidepressants has revealed a discontinuation syndrome that emerges following abrupt or tapered withdrawal from these agents. The syndrome has both somatic and psychological characteristics, which tend to be mild and transient but can also be more distressing and become temporarily debilitating. Psychologists need to be aware of the potential for these events, as they are in an optimal position to collaborate with physicians and other prescribing clinicians to prevent or manage this syndrome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structural family versus psychodynamic child therapy for problematic Hispanic boys.

Structural family therapy, psychodynamic child therapy, and a recreational control condition were compared for 69 six-to-twelve-year-old Hispanic boys who presented with behavioral and emotional problems. The results suggest that the control condition was significantly less effective in retaining cases than the two treatment conditions, which were apparently equivalent in reducing behavioral and emotional problems as well as in improving psychodynamic ratings of child functioning. Structural family therapy was more effective than psychodynamic child therapy in protecting the integrity of the family at 1-year follow-up. Finally, the results did not support basic assumptions of structural family systems therapy regarding the mechanisms mediating symptom reduction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ziprasidone: Pharmacological and clinical profile of the newest atypical antipsychotic.

Notes that ziprasidone is the 5th atypical antipsychotic to be approved by the Food and Drug Administration for the treatment of schizophrenia. Since 1989, when the first atypical agent was introduced to the US market, clinical use of these compounds has progressed to the point that several atypical agents are considered first-line treatment for schizophrenia. This article reviews pharmacological and clinical aspects of ziprasidone to familiarize clinicians who will encounter its use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cholinesterase inhibitors: Current pharmacological treatments for Alzheimer's disease.

Examines the use of cholinesterase inhibitors (ChEIs) for the pharmacological treatment of Alzheimer's disease (AD). Topics discussed include: (1) the pathophysiology of AD and the cholingergic hypothesis, (2) the development of the cholinesterase inhibitors, and (3) current issues and future directions for research and use of ChEIs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reboxetine: Refocusing on the role of norepinephrine in the treatment of depression.

Despite recent advances, there remains considerable impetus to formulate and develop agents that are more effective in the treatment of depression. There has been a resurgence of interest in the role of norepinephrine (NE) in depression, amidst emerging data that specific subtypes of depression may exist, some of which may involve primary serotonergic dysfunction, whereas others may involve dysregulation in NE and other neurotransmitters systems. Reboxetine, a new NE-selective antidepressant, represents the next class of agents in the evolution of pharmacological treatment for depression. Results from several studies indicate that patients treated with reboxetine demonstrate significant improvement in social functioning. The potential to exert positive effect on social functioning, particularly as it relates to sustained remission of depression, is an important finding and warrants further investigation in longer term studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

St. John's Wort (Hypericum Perforatum): Practical considerations based on the evidence.

Reviews the available data on hypericum perforatum, an herbal remedy known as St. John's wort commonly used for psychological and psychiatric symptoms, such as anxiety, depression, cognitive dulling, and insomnia. Specifically, data regarding hypericum's efficacy, tolerability, and potential for interactions is examined. It is hoped that this review will allow clinicians to draw their own conclusions regarding this herb and provide them with information for educating and guiding discussions with patients. It is noted that the ethical, legal, and practice issues related to psychologists recommending—or even discussing—the use of herbal preparations remain complex, and that psychologists should be aware that this is not a risk-free area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Overview of the drug approval process.

Reviewed a database sponsored by the National Institutes of Health (NIH) that lists all clinical trials currently underway indicated that there are at least 400 investigational drugs in various stages of development for central nervous system (CNS) disorders, such as major depression, schizophrenia, Alzheimer's disease, and social anxiety disorder (NIH, 2002). Of the 65 new drugs approved in 2001, 10 were drugs for (CNS indications (S. Briggs et al., 2002). Given this level of activity, psychologists might benefit from an overview of the drug development process that would further their understanding of the dynamics involved in bringing a drug into the market. (PsycINFO Database Record (c) 2010 APA, all rights reserved)