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

by Benjamin James Sadock

20.12 Other Substance Use and Addictive

Mood can be defined as a pervasive and sustained emotion or feeling tone that influences a person’s behavior and colors his or her perception of being in the world.

Several trials of a combination of pharmacotherapy and psychotherapy for chronically depressed outpatients have shown a higher response and higher remission rates for the combination than for either treatment used alone.

Fear is a response to a known, external, definite, or nonconflictual threat; anxiety is a response to a threat that is unknown, internal, vague, or conflictual.

This distinction between fear and anxiety arose accidentally. When Freud’s early translator mistranslated angst, the German word for “fear,” as anxiety,

transgender

refer to those who identify with a gender different from the one they were born with (sometimes referred to as their assigned gender).

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who want to have the body of another sex known ...

who feel they are betwee...

gender...

The plasma half-lives of these compounds can be as high as 200 hours in persons whose metabolism is genetically slow. Because the attainment of steady-state plasma concentrations of the drugs can take up to 2 weeks, persons may experience symptoms and signs of toxicity after only 7 to 10 days of treatment with a dosage that seemed initially to be in the therapeutic range.

About 50 to 70 percent of all persons respond within 2 to 3 weeks of initiation. Studies suggest that carbamazepine may be especially effective in persons who are not responsive to lithium (Eskalith), such as persons with dysphoric mania, rapid cycling, or a negative family

history of mood disorders.

The antimanic effects of carbamazepine can be, and often are, augmented by concomitant administration of lithium, valproic acid (Depakene), thyroid hormones, dopamine receptor antagonists (DRAs), or serotonin-dopamine antagonists (SDAs). Some persons may resp...

Carbamazepine is effective in preventing relapses, particularly among patients with bipolar II disorder and schizoaffective disorder, and dysphoric mania.

A subgroup of treatment-refractory patients with acute depression responds well to carbamazepine. Patients with more severe episodic and less chronic depression seem to be better responders to carbamazepine. Nevertheless, carbamazepine remains an alternative drug for depressed persons who have not responded to conventional treatments, including electroconvulsive therapy (ECT).

Carbamazepine helps to control symptoms associated with acute alcohol withdrawal, although benzodiazepines are more effective in this population.

Carbamazepine has been suggested as a treatment for the paroxysmal recurrent component of posttraumatic stress disorder (PTSD). Uncontrolled studies suggest that carbamazepine is effective in controlling impulsive, aggressive behavior in nonpsychotic

ages, including children and elde...

carbamazepine does not appear to cause weight gain.

Most of the adverse effects of carbamazepine are correlated with plasma concentrations above 9 μg/mL.

1 in 125,000 persons treated with carbamazepine.

dyscrasias. Persons should be warned that the emergence of such symptoms as fever, sore throat, rash, petechiae, bruising, and easy bleeding can potentially herald a serious dyscrasia,

Routine hematologic monitoring in carbamazepine-treated persons is recommended at 3, 6, 9, and 12

hepatitis associated with increases in liver enzymes, particularly transaminases,

cholestasis associated with elevated bilirubin and alkaline phosphatase.

persistent elevations more than three times the upper limit of normal indicate the nee...

Hepatitis can recur if the drug is reintroduced to the person and...

Some patients may experience life-threatening dermatologic syndromes, including exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis.

If carbamazepine seems to be the only effective drug for a person who has a benign rash with carbamazepine treatment, a retrial of the drug can be undertaken.

Carbamazepine is occasionally used to treat diabetes insipidus not associated with lithium use.

direct or indirect effects at the vasopressin receptor.

Emergence of confusion, severe weakness, or headache in a person taking carbamazepine should prompt measurement of serum electrolytes.

Carbamazepine use rarely elicits an immune hypersensitivity response consisting of fever, rash, eosinophilia, and possibly fatal myocarditis.

Cleft palate, fingernail ...

microcephaly, and spina bifida in infants may be associated with the maternal use of carbamazepine during pregnancy. Pregnant women should not use carbamazepine unless absolutely necessary. All women with childbearing potential should take 1 to 4 mg of folic acid daily even if ...

Preexisting hematologic, hepatic, and cardiac diseases can be relative contraindications for carbamazepine treatment.

The laboratory examination should include a complete blood count with platelet count, liver function tests, serum electrolytes, and an electrocardiogram in persons older than 40

Serum levels for antimanic efficacy have not been established.

The anticonvulsant blood concentration range for carbamazepine is 4 to 12 μg/mL, and this range should be reached before determining that carbamazepine is not effective in the treatment of a mood disorder.

adding lithium,

Complete laboratory blood assessments may be performed every 2 weeks for the first 2 months of treatment and quarterly thereafter,

It has also been suggested that liver and renal function tests be conducted quarterly,

total WBC count below 3,000/mm3,

erythrocytes below 4.0 × 106/mm3,

neutrophils below 1...

hematocrit less than 3...

hemoglobin less than 11...