Review Article: Psychopharmacologic Treatment in Neurological Practice

Abstract

Colorado 80262.Numerous medications are currently available to treat behavioral disturbances that are commonly encountered in neurological practice. This paper reviews psychopharmacotherapy of depression, mania, anxiety, agitation, and psychosis. The effects of commonly used psychotropic agents in neurological patients, particularly those who are elderly, are emphasized. DepressionDiagnosis At any given time, 4-6% of men and twice as many woman are clinically depressed; the lifetime risk of depression is approximately 12% for men and 25% for women (1). Depression is typically manifested by a disturbance in mood (depressed, irritable, and/or anxious), thinking (helplessness, hopelessness, negativism, suicidal thoughts, self-blame, lowered self-esteem, psychomotor slowing), and vegetative function (appetite and weight change, sleep disturbance, diurnal and seasonal variation in mood). Not infrequently, neurological illnesses and/or the medications used to treat them cause depression. For example, 50-70% of patients with left hemisphere strokes develop clinical depression (2-5). Anticonvulsants, tranquilizers, and corticosteroids are common causes of depression in neurological patients (6,7). Right hemispheral dysfunction, diffuse brain disease, and some personality disorders might interfere with the ability to express emotion directly so that depressed mood is &dquo;masked&dquo; by other complaints.Most common among these are disturbances of social functioning (e.g., marital problems, frequent job changes, personality deterioration, chronic insomnia), behavior (e.g., disheveled appearance, hostility, substance abuse, catatonia, agitation, failure to recover as expected from neurological illness), thinking, (e.g., negativism, noncompliance, pseudodementia, physical complaints, expression of a wish to die), or affect (e.g., inappropriate or labile affect) (3,7,8).