Tiganov A.S. (under
Psychotropic drugs are medications that affect the human psyche. However, it must be said right away that if, after using such drugs, a person begins to experience seizures that cannot be relieved even with the help of anticonvulsants, then psychotropic drugs must be stopped, otherwise things may end badly.
It should be taken into account that when treating mentally ill people with such medications, the daily dose of such drugs should be significantly higher than the highest doses of psychotropic drugs that are indicated in the Pharmacopoeia. These medications can often cause various kinds side effects, and such side effects are sometimes so dangerous, then the doctor decides to stop taking such medications, and sometimes you even have to prescribe medicines, which eliminate the resulting complications.
It must be remembered that as soon as any kind of side effects occur, the use of psychotropic drugs should be stopped immediately, otherwise yellow liver atrophy may develop, and it may be in acute form, which is extremely dangerous.
If the white blood cell count drops to below 3500 and granulocytes disappear at the same time, then such medications should be stopped immediately. And people who are under the influence of such medications are strongly advised not to stay in direct sunlight for a long time, as there is a serious danger of developing allergic dermatitis; they develop very well when exposed to ultraviolet rays.
Types of psychotropic drugs
We are primarily talking about typical antipsychotics, which have all the properties of this group of medications. If during healing process If psychotropic drugs cause thrombosis and thromboembolism, then treatment with such drugs is stopped immediately, otherwise the situation may worsen greatly. It should be noted that such drugs vary in their degree of impact and intensity, and each product also has its own purpose. It is best to know what the list of psychotropic drugs looks like.
Sleeping pills
Such drugs have widespread, since a person spends more than a third of his life during sleep. Of course, if we take into account sleeping pills, which act very strongly, then a prescription is required to purchase them. Here we are talking, first of all, about time-tested barbiturates. However, there are also many sleeping pills, which can be freely purchased without a prescription.
The fact is that they do not have the strongest psychoactive inhibitory effect on the body, and even with an overdose there should not be significant problems. If a person’s sleep disorders are not the most complex, then such remedies will certainly provide significant support to the body. It is better to talk in more detail about the most common drugs of this type; it should be noted that sleeping pills are very often sold without a prescription.
List of sleeping pills
- Melaxen, which contains melatonin, is what regulates sleep cycles. The main function of such a remedy is to induce a drowsy effect, so that a person falls asleep quite quickly. This drug also has a sedative effect, that is, a calming effect. The product has the following advantages: there is no need to worry about an overdose, since the drug disintegrates very quickly. The sleep here is of a physiological nature, which is clearly positive. There are no sleep disturbances, no nightmares, awakening is normal. It also does not cause a feeling of weakness; it is possible to drive a car. However, there are also disadvantages: it can cause allergies, peripheral edema, and it is not cheap. This drug is well suited for moderate and mild insomnia, and the medicine also perfectly helps adapt to sleep during a sudden change in time zones;
- Donormil is essentially an antihistamine type drug. However, its direct purpose is not to fight allergic reactions, but to counter insomnia and other sleep disorders. This sleeping pill is rightfully considered one of the best of its kind; it can be used by young, healthy people, and there is no need to fear any consequences. The advantages are undoubtedly: the tablet is effervescent, dissolves very quickly, a person falls asleep quickly and sleeps for a long time. However, there are disadvantages: there are side effects common to many antihistamines, namely, dryness appears in the mouth, it is difficult to wake up, and it can also make you sleepy in daytime. And this remedy should not be used by people who have liver problems and who have disturbances during sleep. respiratory process, here sleeping pills are simply irreplaceable;
- Corvalol has been tested by time; it is the only medicine that contains a barbiturate. So such a remedy has significant power, and its low cost ensures popularity that does not fall already long years. It has a mild antispasmodic effect on smooth muscle internal organs, it can be used even in the presence of tachycardia. If we talk about the disadvantages, then we need to mention the strong specific smell that permeates the entire room if such a product is used on a regular basis. Women who are breastfeeding should refrain from taking Corvalol; it is better not to use any sleeping pills in this condition.
A few more popular sleeping pills
- Novo-passit is good because it is made on the basis herbal remedies, a combination type product, has a calming effect and also has an anti-anxiety effect, so it is excellent for sleep disorders. If we talk about the benefits, then this is, first of all, a very quick effect, and if you use syrup, the effect is even faster. Cons: There may be drowsiness during the day, and in cases of overdose there may be a depressed feeling. It should not be used by children, and should not be used by those who suffer from chronic alcoholism;
- Persen-forte is a combination type drug that contains mint, valerian and lemon balm. The action is mild, has a sedative effect, no unpleasant odor No. If we talk about the advantages, then this product is specifically intended for use at night, if a person cannot fall asleep due to nervous excitement, then this remedy fits perfectly. There are also disadvantages, since the product cannot be purchased in liquid form, if a person has biliary tract disorders, then you should not use such a remedy; it is also not needed for children who are not yet 12 years old. You should not use it for a long time, as this can lead to constipation;
- Phytosedan, contains several types medicinal herbs, such as thyme, valerian, oregano. Its effect is very soft, soothing, and what is very important, natural, falling asleep very easily. It should not be used if a woman is expecting a child or is breastfeeding. It can be consumed only in the form of an infusion, and only in a warm form, all this takes time, the product is not available in tablet form, but drugs in tablets are very popular.
It must be said right away that if a person simply cannot sleep because he slept for 10 hours yesterday, then it is better to refrain from taking sleeping pills.
Tranquilizers
Such medications have become widespread in various types of neuroses and conditions close to psychopathic. That is, such means provide significant support when a person experiences fear, panic, is very irritated and his emotionality is not stable. Such drugs are successfully used when a person has psychosomatic disorders.
If we talk about contraindications, then they certainly exist. Tranquilizers should not be taken by elderly people, as well as people with weakened bodies, and children until they are 18 years old. Also, tranquilizers should not be used by pregnant women and those women who are breastfeeding. Tranquilizers should not be used by people who are in a state of alcohol intoxication and also under the influence of drugs. If there is renal or liver failure, then you should also refrain from such drugs. Concluding the conversation about contraindications, it must be said that if you are supposed to do work that requires close attention (for example, driving a car), then you should also abstain here.
It is necessary to take into account that there are many tranquilizers, therefore, you should not rack your brains when choosing drugs, you should consult a doctor who will definitely give the necessary advice. If it comes to the point that a person starts taking tranquilizers, then it is recommended to start with those that have a minimal degree of impact; you should not start treatment with the most powerful drugs, thinking that this will quickly help. When choosing such funds, it is very important to take into account the person’s age and health status. For example, there is such a very strong psychotropic drug as phenazepap, it is often recommended by a person’s family and friends, however, one must take into account that such a drug is very powerful. Because if a person does not really serious problems with the psyche, it is better to use it on initial stage standard sedatives.
Now we need to say one more very important point - many believe that such means are used only by mentally ill and drug addicts. However, this is a completely wrong opinion. Of course, such drugs are very strong, however, they are by no means narcotic. However, in Lately, such products are entering the market under completely new names so as not to traumatize the people’s psyche. For example, today we hear such a name as anxiliotics, if we speak literally, then these are drugs that are ways to suppress feelings of fear and anxiety, and for suppressing neurosis, anti-neurotics have become very popular. However, all these drugs are called tranquilizers, they are also sedatives.
How do tranquilizers work?
Such medications are prescribed to reduce feelings of panic and fear. Now we need to talk about how such drugs differ from other psychotropic drugs, in particular from antipsychotics. The fact is that such means do not in any way affect a person’s consciousness, that is, a person will definitely not become delirious from them. Also, there will be no hallucinations or psychoses, so such remedies can be used safely. However, they can only be used by those people who are mentally healthy, but find themselves in a situation where their mental health needs help. These are very good anti-anxiety sedatives.
If we talk about the mechanism of action of such drugs, it has not yet been fully studied.
Antidepressants
If a person is under the influence of a depressed emotional state, then he should use antidepressants. Such remedies perfectly lift your spirits, create a positive emotional background and are excellent remedies that relieve depression.
It should be noted that there are many such drugs that are available without a doctor’s prescription, however, this does not mean at all that uncontrolled use is possible. If you take antidepressants for a long time, then there may arise Negative consequences. To avoid this, you should always consult your doctor first.
It should be noted that all psychotropic medications can be taken only after a person has consulted with a doctor, who will choose the most appropriate one from the entire list of medications.
It should also be said that you shouldn’t get too carried away with antidepressants; the same should be said about antipsychotics. Even the safest medicine still affects the body, so you should only take it if you really need it.
In the treatment of diseases associated with disorders and changes in the human psyche, a large group of drugs called psychotropic drugs is used. In addition to some medications, a number of substances that can alter consciousness also have psychotropic properties. healthy person and are not used in medicine (alcohol, narcotic substances, hallucinogens).
Psychotropic drugs: mechanism of action
The mechanism of action of drugs that affect the psyche is quite diverse. The main point is the effect of psychotropic drugs on the impulse transmission system in the neurons of the brain and changes in the concentration of certain substances - neurotransmitters (serotonin, dopamine, bradykinins, endorphins, etc.), as well as changes in metabolism different levels central nervous system.
Psychotropic drugs: classification
Like any medications, medications that affect the psyche are divided into several groups. Depending on the effect, all narcotic and psychotropic drugs are divided into:
In the 20th century, some psychiatrists made attempts to identify another group - psychedelics, however this moment These substances are classified as hallucinogenic and are not used in medical practice(LSD, mescaline).
Psychotropic drugs that stimulate the central nervous system
This group is used for diseases that are accompanied by depression of the functions of the central nervous system, such as cerebral stroke, viral encephalitis, These include drugs "Piracetam", " Gamma-aminobutyric acid", "Ginkgo biloba".
and tranquilizers
These medications are used for mental disorders accompanied by increased emotional excitability (valerian, bromine salts, the drug Phenobarbital in small doses). Tranquilizers have greater selectivity of action only on emotional sphere(drug "Sibazon", benzodiazepines).
Antidepressants
These drugs allow you to reduce and level out the symptoms of depression (feelings of melancholy, hopelessness, apathy), which can be the result of objective reasons (unsettled life, everyday problems) or mental disorders (initial These include the drugs "Amitriptyline", "Glaucin", "Azafen" ", "Duloxetine".
Neuroleptics
An important representative of this group of psychotropic drugs is the drug "Aminazin", which is used for psychoses (delirium, visual and auditory hallucinations, increased arousal) to relieve psychotic symptoms. This drug is also used to treat schizophrenia.
Almost all psychotropic drugs are and, if used incorrectly, can cause addiction and dependence. That is why they are classified as strictly controlled drugs and are available only with a prescription. By reading in an encyclopedia or asking your doctor about psychotropic drugs that are available to anyone, you can find out whether you need a prescription to purchase.
Psychotropic drugs - in a broad sense - are all drugs that have a certain effect on the human psyche. These include: sleeping pills, sedatives, psychostimulants or painkillers. IN in the narrow sense- these are drugs that affect the activity of the central nervous system. Psychotropic drugs are divided into three groups: antidepressants, antipsychotics and tranquilizers.
Antidepressants
Based on their tolerability and safety, antidepressants can be differentiated into two groups - 1st and 2nd line drugs. The first of them consisted of thymoleptics belonging to the “new” generations medications. The second - means that have a more pronounced side effect.
Neuroleptics
Neuroleptics - antipsychotic drugs, have a calming effect, weaken or stop hallucinations, delusions, reduce aggressiveness and other manifestations mental disorders.
Tranquilizers
Tranquilizers are medicinal substances that have a calming effect on the central nervous system, eliminate fear, and help to relax. For example, Valium (diazepam), lithium and a hallucinogen, as well as caffeine and the popular psychostimulant drug amphetamine. These funds increase physical strength, endurance, and improve mental performance.
Indications for use
- Depression, psychosis.
- Schizophrenia.
- Phobias (fears), mental stress.
- Decreased performance, loss of strength.
When should psychotropic medications be used?
Psychotropic drugs are used to treat mental disorders. Antidepressants are primarily used to treat depression. They are prescribed if the patient has long time there is lethargy, decline in physical and mental performance in the absence of visual somatic reasons. Antipsychotics are commonly used in the treatment of schizophrenia. Tranquilizers are prescribed if a person suffers from a phobia or severe mental stress. Lithium is prescribed for prophylaxis in the treatment of manic-depressive psychosis. Tablets containing caffeine and amphetamine are used to restore physical strength. Psychostimulants are used to treat hyperactivity syndrome in children.
Advantages and disadvantages
Psychotropic drugs are used to treat severe mental illness(for example, schizophrenia and severe forms depression). The positive effect in the treatment of these diseases is scientifically substantiated and practically confirmed. Psychotropic medications alleviate symptoms of mental illness. However, psychotropic drugs should not be used too often to treat mild mental disorders. Today psychotropic drugs can only be auxiliary, used in conjunction with other (mainstream) psychiatric treatment methods. For example, when treating depression, it is not enough to use only antidepressants; it is necessary to establish the real reason diseases and apply appropriate treatment.
Drug addiction
Most psychotropic substances long-term use cause drug dependence. Overdosing on many medications used to treat depression can cause epileptic seizure. Some antidepressants cause problems heart rate, their use changes blood pressure. Antipsychotics can cause dyskinesia - involuntary movements.
Impaired consciousness
Psychoactive substances have a depressant effect on the central nervous system, causing the development of severe side effects and complications with impaired consciousness, respiratory and circulatory disorders. For example, a person taking sedatives, becomes indifferent, apathetic. Antipsychotics and sedatives block the ability to learn something new and resolve conflicts.
Psychotropic drugs only alleviate the symptoms of mental disorders. With their long-term use, it is possible to develop drug addiction. If any mental disorders, then you need to consult a doctor. Only a specialist can determine their true cause.
Psychotropic drugs are drugs that have a specific therapeutic or preventive effect on mentally ill patients.
Drugs used in different areas of medicine can have one or another effect on mental functions. Signs of excitation or depression of the central nervous system, impaired attention and mental performance, others central effects often reported as side effects when using various medications.
A distinctive feature of psychotropic drugs is their specific positive influence on mental functions, ensuring them therapeutic activity in case of disturbances in the activity of the central nervous system.
The first modern psychotropic drugs were created in the early 50s of the twentieth century. Prior to this, the arsenal of drugs used to treat mental illness was very limited and unspecific. The main drugs used for this purpose were sleeping pills and sedatives, insulin, caffeine; Corazol was used for convulsive therapy of schizophrenia. For neurasthenic disorders, mainly bromides, sedatives of plant origin, and sleeping pills in small (sedative) doses were used.
In 1952, the specific effectiveness of chlorpromazine (aminazine) and reserpine in the treatment of mentally ill patients was discovered. Numerous analogs of aminazine and reserpine were soon synthesized and studied, and it was shown that derivatives of these and other classes of chemical compounds may have beneficial effects in the treatment of schizophrenia and other psychoses, manic syndromes, neurotic disorders, acute alcoholic psychoses and other disorders of the central nervous system.
In 1957, the first antidepressants (iproniazide, imipramine) were discovered. Then the tranquilizing properties of meprobamate (meprotane) and benzodiazepine derivatives were discovered.
A new group of psychotropic drugs, the first representative of which was piracetam, appeared in the early 70s.
The section of pharmacology dealing with the study of substances included in these groups was given a name, and drugs of these types of action began to be called psychopharmacological agents. These funds were combined into a common group.
Currently, psychopharmacological drugs mean a wide range of substances that affect mental functions, emotional condition and behavior. Many of them have found application as valuable medicines in psychiatric and neurological practice, as well as in general somatic medicine. They are prescribed to patients with therapeutic, surgical, oncological and other profiles for the treatment and prevention of borderline mental disorders.
Soon after the discovery of the first psychotropic drugs, an attempt was made to classify them.
In 1967, the Congress of Psychiatrists in Zurich proposed dividing these drugs into two groups: a) antipsychotic substances, used primarily for severe violations activity of the central nervous system (psychosis), and b) tranquilizing substances used for less pronounced dysfunctions of the central nervous system, mainly for neuroses with a state of mental tension and fear. Neuroleptic substances according to this classification include chlorpromazine and other phenothiazine derivatives, reserpine; for tranquilizers - propanediol derivatives (meprotane, etc.) and diphenylmethane derivatives (amizil, etc.).
Neuroleptic substances were originally called. The term (nervous system blocking agents) was proposed to denote substances that cause controlled inhibition of the neurovegetative system and are used for artificial sleep with cooling of the body (hibernation). The term corresponds to the concept. Tranquilizers were also designated as, etc. The Greek word means (from here). The term, or, is associated with the ability of some drugs to have a calming effect in pathological conditions accompanied by fear and emotional tension.
In 1966, a WHO scientific group proposed the following classification for psychotropic drugs:
- A. Neuroleptics, aka, previously designated as large tranquilizers, or; these include derivatives of phenothiazine, butyrophenone, thioxanthene, reserpine and similar substances. These substances have a therapeutic effect in psychosis and other mental disorders. A typical side effect caused by these substances is extrapyramidal symptoms.
- B. Anxiolytic sedatives, previously called, reduce pathological fear, tension, agitation; they usually have anticonvulsant activity and do not cause autonomic or extrapyramidal side effects; may be addictive. These include meprobamate (meprotan) and its analogs, diazepoxide (benzodiazepine) derivatives, including chlordiazepoxide (chlozepid), diazepam (sibazon), etc.
- IN. Antidepressants - substances used in the treatment of pathological depressive states. Sometimes they are also called and. This group includes MAO inhibitors, imipramine (imisin) and other tricyclic antidepressants.
- G. Psychostimulants, which include phenamine and its analogues, caffeine.
- D. Psychodysleptics (hallucinogens), also called. This group includes lysergic acid diethylamide, mescaline, psilocybin, etc.
From the point of view of practical medicine, it is more appropriate to divide psychotropic drugs into the following main groups: a) neuroleptics (antipsychotics); b) tranquilizers; c) sedatives; d) antidepressants; e) mood stabilizers; f) nootropic drugs; g) psychostimulants.
Each of these groups of psychotropic drugs is divided into subgroups depending on the chemical structure, mechanism of action, pharmacological properties And therapeutic use drugs included in these groups.
Psychosomimetic substances, or hallucinogens, which have a strong psychotropic effect, but are not used as medicines, are not included in this classification of psychotropic drugs.
Side effects and complications during treatment with psychotropic drugs Side effects during psychopharmacotherapy, as with the use of many other drugs, are associated with the inability to selectively influence exclusively pathologically altered brain systems. Some of them are directly related to therapeutic effect drugs and occurs in most patients taking this drug. An example is neuroleptic syndrome when using first-generation antipsychotics. Other side effects and complications, which usually occur rarely, are due to the patient’s individual reactions to a particular drug. This section will discuss only the most typical side effects and complications associated with the use of psychopharmacological drugs of various classes. Neuroleptics. The main side effects during treatment with antipsychotics are: neuroleptic syndrome. The leading clinical manifestations of this syndrome are considered to be extrapyramidal disorders with a predominance of either hypo- or hyperkinetic disorders. Hypokinetic disorders include drug-induced parkinsonism, manifested by increased muscle tone, trismus, rigidity, stiffness and slowness of movements and speech. Hyperkinetic disorders include tremor, hyperkinesis (choreiform, athetoid, etc.). Usually in clinical picture in certain proportions there are both hypo- and hyperkinetic disorders. The phenomena of dyskinesia can be paroxysmal in nature. Most often they are localized in the mouth area and are manifested by spasmodic contractions of the muscles of the pharynx, tongue, lips, jaws, but often spread to others muscle groups(oculogyric crises, torticollis, torsion spasm, excitatory motor crises). Along with extrapyramidal disorders, phenomena of akathisia can be observed - a feeling of restlessness, “restlessness in the legs”, combined with tasykinesia (the need to move, change position). IN severe cases akathisia is accompanied by anxiety, agitation, and sleep disorders. A special group of dyskinesias includes tardive dyskinesia(tardive dyskinesia), expressed in involuntary movements of the lips, tongue, face, and less commonly, choreiform movements of the limbs. The very name “tardive dyskinesia” suggests that it occurs after long-term treatment neuroleptics (on average after 2 years). In these cases, there is no correlation with the type of drug, doses and features of treatment for more early stages, including those with previous extrapyramidal disorders. Among the disorders of the autonomic nervous system, the most commonly observed are orthostatic hypotension (it is not recommended to relieve it with adrenaline), sweating, weight gain, changes in appetite, constipation, and diarrhea. Sometimes anticholinergic effects are observed - visual disturbances, dysuric phenomena. Possible functional disorders of the cardiovascular system with changes in the ECG in the form of an increase in the interval Q— T, reduction of the Gili wave, its inversion, tachycardia or bradycardia. Sometimes side effects occur in the form of photosensitivity, dermatitis, skin pigmentation; skin possible allergic reactions. Side effects associated with an increase in prolactin in the blood manifest themselves in the form of dysmenorrhea or oligomenorrhea, pseudohermaphroditism in women, gynecomastia and delayed ejaculation in men, decreased libido, galactorrhea, and hirsutism. IN in rare cases changes in blood sugar levels are observed, as well as symptoms of diabetes insipidus. Severe complications of neuroleptic therapy include general allergic and toxic reactions, hepatitis, pathological changes organ of vision (pathological pigmentation of refractive media, combined with pathological pigmentation of the skin of the hands and face - “skin-eye syndrome”, toxic changes in the retina), blood picture disorders (leukopenia, agranulocytosis, aplastic anemia, thrombocytopenia). Among the mental disorders associated with therapy, anesthetic depression, a painful disturbance of the sense of sleep, delirium are observed (more often it occurs with a sharp change in the doses of antipsychotics in people with organic diseases central nervous system, elderly or children), epileptiform seizures. New generation neuroleptics, compared to traditional derivatives of phenothiazines and butyrophenones, cause significantly fewer side effects and complications. Antidepressants. Side effects related to the central nervous system and the autonomic nervous system include dizziness, tremor, dysarthria, impaired consciousness in the form of delirium, and epileptiform seizures. Possible exacerbation of anxious disorders, activation of suicidal tendencies, inversion of affect, drowsiness or, on the contrary, insomnia. Side effects may include hypotension, sinus tachycardia, arrhythmia, and atrioventricular conduction disturbances. Complications from hematopoietic system are relatively rare. Their clinical signs are depression of function bone marrow, leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia. Dysfunction endocrine system limited by changes in blood sugar (downward trend). When treated with antidepressants, there are also side effects such as dry mucous membranes, impaired accommodation, increased intraocular pressure, hypo- or intestinal atony (constipation), urinary retention. They are more often observed when taking traditional tricyclic antidepressants and are associated with their anticholinergic effect. The use of tricyclic drugs is often accompanied by an increase in appetite and a significant increase in body weight. When using MAO inhibitors simultaneously with food products containing tyramine or its precursor, tyrosine (cheeses, etc.), a “cheese effect” occurs, manifested by hypertension, hyperthermia, convulsions and sometimes leading to death. New generations of antidepressants are better tolerated and safer. It can only be noted that when prescribing serotonin reuptake inhibitors and reversible MAO-A inhibitors, activity disturbances are observed gastrointestinal tract(nausea, vomiting, diarrhea), headaches, insomnia, anxiety. The development of impotence while taking serotonin reuptake inhibitors has also been described. In cases of combination of serotonin reuptake inhibitors with drugs of the tricyclic group, the formation of the so-called serotonin syndrome, manifested by increased body temperature and signs of intoxication. Tetracyclic antidepressants are more likely to daytime sleepiness, lethargy. Tranquilizers. Side effects during treatment with tranquilizers most often include daytime drowsiness, lethargy, muscle weakness, impaired concentration, short-term memory, and a slowdown in the speed of mental reactions. In some cases, paradoxical reactions develop in the form of anxiety, insomnia, psychomotor agitation, and hallucinations. Ataxia, dysarthria, and tremor occur much less frequently. Among the dysfunctions of the autonomic nervous system and other organs and systems, hypotension, constipation, nausea, urinary retention or incontinence, and decreased libido are noted. Signs of depression of the respiratory center may also appear (respiration may stop). Changes in the functions of the visual organs manifest themselves in the form of diplopia and impaired accommodation. Long-term use tranquilizers are dangerous due to the possibility of developing addiction to them, i.e. mental and physical dependence. Nootropics. Side effects during treatment with nootropics are rare. Sometimes nervousness, irritability, elements of psychomotor agitation and disinhibition of drives, as well as anxiety and insomnia appear. Possible dizziness headache, tremor; in some cases, dyspeptic symptoms - nausea, abdominal pain. Stimulants. These drugs have side effects on the central nervous system (tremor, euphoria, insomnia, irritability, headaches, and signs of psychomotor agitation). Disorders of the autonomic nervous system may be observed - sweating, dry mucous membranes, anorexia, as well as disorders cardiovascular activity- arrhythmia, tachycardia, increased blood pressure. When treating patients with diabetes, it should be borne in mind that while taking stimulants, the body's sensitivity to insulin may change. Sexual dysfunction is also possible. It is important to emphasize that long-term and frequent use stimulants can lead to the development of mental and physical dependence. Lithium salts. Side effects or complications when using lithium salts usually occur at the beginning of therapy before a stable concentration of the drug in the blood is established. At correct implementation therapy under the control of lithium levels in the blood and full informing of the patient about the treatment features, side effects rarely interfere with the preventive course. The patient should first of all know about the features of the diet - excluding high intake of liquid and salt, limiting foods rich in lithium - smoked meats, some types of hard cheeses, red wine. The most common side effect that occurs with lithium therapy is tremor. Severe tremor, indicating the neurotoxic effect of lithium, increases with high concentrations of lithium in plasma. Often there are dysfunctions of the gastrointestinal tract - nausea, vomiting, loss of appetite, diarrhea. Weight gain, polydipsia, and polyuria are often observed. Lithium inhibits function thyroid gland, causing hypothyroidism. Usually these phenomena are transient. In severe cases, discontinuation of therapy is indicated. The effects of lithium on the cardiovascular system are similar to those of hypokalemia, but, as a rule, no special intervention is required. Acne, maculopapular rash, and worsening of psoriasis are possible. Cases of alopecia have been reported. With long-term lithium therapy, disturbances in the cognitive sphere may be observed: memory loss, slowing of psychomotor reactions, dysphoria. Signs of severe toxic conditions and drug overdose: metallic taste in the mouth, thirst, severe tremor, dysarthria, ataxia, and with further increase in intoxication - impaired consciousness, fascicular muscle twitching, myoclonus, convulsions, coma. The longer the toxic level of lithium in the blood persists, the greater the likelihood of irreversible changes in the central nervous system, and in especially severe cases, death. Lithium therapy is contraindicated in patients with impaired excretory function kidneys, with cardiovascular diseases(in the stage of decompensation), chronic diseases gastrointestinal tract (stomach ulcer and duodenum etc.), epilepsy, in conditions requiring adherence to a salt-free diet, during pregnancy, in old age. Relative contraindication to the prescription of lithium drugs - dysfunction of the thyroid gland. Anticonvulsants. The most common side effects that occur during treatment with anticonvulsants, in particular carbamazepine, are functional disorders of the central nervous system - lethargy, drowsiness, dizziness, ataxia. Hyperreflexia, myoclonus, and tremor can be observed much less frequently. The severity of these phenomena decreases significantly with a gradual increase in doses. They usually disappear during therapy. Sometimes side effects such as nausea, vomiting, constipation or diarrhea, and decreased appetite are observed; possible development of hepatitis. Severe and rare (1 case in 20,000) complications of carbamazepine therapy include suppression of white blood cells. This drug should be used with caution in patients with cardiovascular pathology (it can reduce intracardiac conduction), with glaucoma, adenoma prostate gland and diabetes. In case of an overdose of carbamazepine, symptoms of drowsiness occur, which can progress to stupor and coma; sometimes there are convulsions and dyskinesia of the facial muscles, functional disorders of the autonomic nervous system - hypothermia, depression of the respiratory and vasomotor centers ( sinus tachycardia, arterial hypo- and hypertension). With pronounced cardiotoxic effects of carbamazepine, atrioventricular block may develop. General principles of treatment for side effects and complications of psychopharmacotherapy With pronounced side effects, the question inevitably arises about the relationship between the positive and negative effects of a particular drug and the advisability of continuing therapy. If the effectiveness of the drug clearly exceeds its undesirable effect, then to improve its tolerability in some cases it is enough to temporarily reduce the dose and then slowly increase it to the therapeutic dose. Sometimes it is advisable to change the regimen and rhythm of taking the drug with redistribution daily dose during the day. Often, additional therapeutic agents are required to relieve side effects. Special therapy is usually carried out in the presence of side effects caused by the use of antipsychotics. To correct the extrapyramidal disorders most characteristic of neuroleptic therapy, anticholinergic drugs are used - trihexyphenidyl (Artane, Cyclodol, Parkopan), bentropine (Cogentin, Tremblex), biperidine (Akineton). Correctors of different pharmacological groups have different features actions, therefore, if the effectiveness of drugs from one group is low, drugs from another group should be prescribed or the form of administration should be changed (oral to parenteral). It must be remembered that corrective therapy should be started after the first signs of side effects occur, but not prophylactically. In some patients, the desired effectiveness of therapy is achieved by combining anticholinergics with tranquilizers with a pronounced muscle relaxant effect (diazepam, lorazepam). A combination of anticholinergics, tranquilizers and β-blockers (propranolol) is indicated in the treatment of akathisia. Special treatment tactics are used for tardive dyskinesia. According to modern ideas, the biological basis of these conditions is an increase in sensitivity and an increase in the density of dopaminergic receptors in the striatum due to their prolonged blockade by neuroleptics. Based on this, it is recommended to reduce the doses of antipsychotics. If the symptoms of tardive dyskinesia increase, then antipsychotics should be discontinued. In these cases, a positive effect is sometimes achieved by prescribing GABA agonists (baclofen, aminalon, picamilon), cholinergic receptor agonists (tacrine, cogitum), and B vitamins. Some features are observed only when orthostatic hypotension is relieved. For this purpose, it is recommended to use α-adrenergic receptor stimulants, for example mezaton. The tremor that appears at high concentrations of lithium in the blood is stopped by reducing the daily dose of the drug. You can use fractional divisions of the daily dose, as well as additionally prescribe antipsychotics. If gastrointestinal disorders occur, lithium tolerability can be improved by reducing doses, split doses of the drug, or taking it immediately after meals. These disorders, as well as weight gain and polydipsia, can also be corrected by prescribing long-acting forms of lithium preparations, which can smooth out sharp fluctuations in concentration medicinal substance in the blood (the latter, according to existing ideas, cause the occurrence of side effects). In case of severe dysfunction of the thyroid gland, lithium therapy is stopped and prescribed hormonal drugs. In case of severe intoxication, lithium preparations should be immediately discontinued and dehydration should be combated; in severe cases, hemodialysis is indicated. Complications during treatment with carbamazepine can also be stopped by reducing doses and preventing their development by gradually increasing the dose. In more severe cases, with an overdose of carbamazepine, you should immediately rinse the stomach, prescribe activated charcoal, and then carry out intensive general medical detoxification measures. Thus, large group side effects of psychotropic drugs do not require special therapy, since their severity decreases with continued therapy at the same doses or with a reduction in doses. This applies in particular to sedative effect and orthostatic disorders. If side effects are significant and it is impossible to cancel therapy or transfer the patient to other drugs, appropriate medications are prescribed. symptomatic remedies and continue treatment under constant medical supervision with monitoring of laboratory parameters.