Psychotropic drug

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A psychotropic drug ( plural : psychotropic drugs ) is a psychoactive substance that is used as a medicinal substance . It influences the neural processes in the brain and thereby causes a change in the mental state.

Psychotropic drugs are usually used for the treatment ( psychopharmacotherapy ) of various mental disorders (such as psychoses and depression), but also epilepsy and sleep disorders. Today there are around 120 active ingredients available for this purpose . The effects of most psychotropic drugs were observed by chance in patients - and not discovered through systematic research. Many substances are merely modifications ( analogues ) of the basic chemical structure ( pharmacophore ) of already known active ingredients.

Psychopharmacon is derived from ancient Greek ψυχή psychḗ , " soul ", and ancient Greek φάρμακον phármakon , "medicine". Presumably in 1920 the American pharmacologist David Israel Macht first used this new word in the sense we use today. From around 1950, the term became increasingly widespread in connection with the substances chlorpromazine and imipramine in the psychiatric literature.

history

Modern psychopharmacology was founded by the psychiatrist Emil Kraepelin . In 1883 he published the work on the effect of certain medicinal substances on the duration of simple psychological processes. Kraepelin introduced important methodological innovations such as placebo control and the systematic investigation of dosage variants.

The real breakthrough came in 1949 with the discovery of the anti-manic effects of lithium and in 1952 with the discovery of chlorpromazine for the treatment of psychoses .

In 1957, imipramine was discovered for the treatment of unipolar depression , followed by the discovery of haloperidol in 1958 . From the 1960s onwards, the benzodiazepines were among the best-selling drugs.

classification

The classification of psychotropic drugs can be made according to very different points of view. A classification criterion could, for example, be the similarity in the chemical structure. Most often, however, psychotropic drugs are classified according to their clinical application. The direct practical relevance is advantageous, but has the disadvantage that a number of substances cannot be clearly classified. For example, many benzodiazepine derivatives can be used both as tranquilizers and as sleep aids .

The following groups are classified according to the desired therapeutic effect:

Mechanism of action

General

Almost all psychotropic drugs affect the functions of the brain by influencing the chemical signal transmission at the synaptic gap . Some psychotropic drugs imitate the function of the physiological transmitter and stimulate the receptor of the subsequent nerve cell ( agonist ). Others prevent the physiological transmitter from reaching the receptor by blocking the receptor ( antagonists ). Still others increase the concentration of the physiological transmitter in the synaptic gap by blocking the enzymatic breakdown (enzyme inhibitor) or preventing the transmitter from being absorbed into the original nerve cell once the signal has been transmitted (reuptake inhibitor). As a result, the transmitter is no longer removed from the synaptic gap, which leads to the increase in concentration. A change in the concentrations of the transmitter can also be achieved by influencing the autoreceptors of the excited nerve cell , which are responsible for the amount of the released transmitter or its rate of synthesis .

The functions of the brain mediated by the biogenic neurotransmitters are influenced by inhibition or activation. In order to be able to specifically influence the functions of the brain, it is necessary that psychotropic drugs only influence a few specific processes. This is only possible if either the receptor density differs greatly in the individual brain areas or the psychotropic drug intervenes in a biochemical mechanism that is functionally relevant in one brain area but irrelevant in the other. Even if there is a good knowledge of the molecular pharmacological mechanisms of psychotropic drugs, the clinical effects such as changes in the ability to experience, emotionality, vigilance or motor activity can often only be explained hypothetically. The fundamentals of psychological and psychopathological processes are often still unclear.

Special

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Some mental illnesses are presumably based on changes in the neurotransmitter metabolism, in particular imbalances in the monoamines dopamine , norepinephrine and serotonin . However, there are also neurophysiological changes (e.g. the density and sensitivity of receptors and intracellular structures). It is assumed that these changes are partly the cause (e.g. genetic) and partly the result (e.g. drug consumption) of the respective mental illness, or a mixture of both.

Some psychotropic drug applications are more aimed at normalizing the changed neurotransmitter balance (the "software"), while others are more aimed at readjusting physiological effector structures (the "hardware").

Active ingredient level

Most psychotropic drugs aim to achieve a consistently high level of active ingredient in the body. In order to achieve a steady state , the following points must be observed:

Reasons for strongly deviating plasma levels can be:

  • Non-adherence or refusal or misuse of the drug
  • different drug metabolism, especially in the cytochrome P-450 system due to genetic polymorphisms
  • Induction or inhibition of the cytochrome P450 system due to concomitant drugs or food. This happens particularly often when further psychoactive substances are administered or when further medication is required due to an internal illness
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It is possible to check whether the medication has been correctly dosed by determining the plasma level, which is mainly carried out in the inpatient area for neuroleptics and antidepressants . In this way, patients with a plasma level that is too low can be saved from ineffectiveness of the therapy. Patients with excessively high plasma levels can be protected from intoxication and undesirable side effects. Regardless of this, it should be noted with psychotropic drugs that some patients already react at very low plasma levels, while others only achieve the same desired effect at very high plasma levels.

unwanted effects

As undesirable effects of a psychotropic drug z. B. occur:

  • physical or psychological dependence
  • Tolerance development and habituation effects
  • Influence on sleep behavior
  • Interaction with other drugs
  • Rebound effect
  • Memory problems
  • fluctuating effectiveness
  • Effects on the heart, liver and kidneys
  • Respiratory depression
  • Restriction of driving ability

Application and legal

Common indications for the use of psychotropic drugs are psychosis, depression, epilepsy and sleep disorders.

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In Section 1906 (4) of the German Civil Code (BGB) it is stipulated that if a drug with a sedative effect is administered without the main purpose of administering the drug to cure the patient, a legal approval must be available. In this way, immobilization by means of medication is equivalent to mechanical fixation. Measures involving deprivation of liberty such as bed rails, restraints, room entrapments or sedating medication over a longer period of time require judicial approval by the supervising court. Coercive measures such as drug immobilization by means of psychotropic drugs are only justified if the patient is at risk to himself or to others. This can be the case, for example, with people with dementia who escape from their home or home and wander around disoriented. The medical necessity of prescribing psychotropic drugs must be checked and monitored by a doctor. The nursing staff may administer the medication as directed by a doctor and must document the medication administration on a daily basis.

The medical service of the health insurance companies determined for 2014 that of the 1.1 million dementia patients at the time, 240,000 patients were wrongly treated with psychotropic drugs.

In 2014, the Munich District Court launched the "Munich Initiative, Psychotropic Drugs in Retirement and Nursing Homes". The aim is to provide better information about the "legally and medically responsible use" of sedating drugs and to improve the cooperation between all parties involved.

criticism

Dangers arise when psychotropic drugs are used to immobilize, for example, old people's homes or to cover up normal everyday problems, for example by favoring a potentially fatal infection in the event of prolonged “immobilization”. In addition, it can be problematic if sedatives ( tranquilizers ) reduce the level of suffering necessary for psychotherapy. In the past there were frequent misuse of tranquilizers, which brought psychotropic therapy into public disrepute. More recent studies from the field of drug epidemiology show an increased mortality in older users of psychotropic drugs compared to non-users. The authors therefore recommend long-term studies to clarify this relationship.

A drug report from the health insurance company Barmer GEK in 2012 showed that women were prescribed two to three times more addictive psychotropic drugs than men. In this context, experts rated it as alarming that prescriptions for psychotropic drugs in Germany are increasingly being carried out on private prescriptions and are therefore not fully included in the health insurance statistics.

See also

literature

Introductions

  • Klaus Aktories u. a .: Psychotropic drugs - pharmacotherapy of mental illnesses. In: Klaus Aktories, Ulrich Förstermann , Franz Hofmann , Klaus Starke (eds.): General and special pharmacology and toxicology. 11th, revised edition. Urban & Fischer, Munich / Jena 2013, ISBN 978-3-437-42523-3 , pp. 293–328.
  • Otto Benkert, Hanns Hippius: Compendium of Psychiatric Pharmacotherapy. Springer, Berlin 2010, ISBN 978-3-642-13043-4 . (12th edition, ibid. 2018)
  • Carola Burkhardt-Neumann: Guide to psychotropic drugs. Active ingredients for the soul. Zenit, Munich 2005, ISBN 3-928316-23-0 .
  • Asmus Finzen: drug treatment for mental disorders. Introduction to therapy with psychotropic drugs. 14th edition. Psychiatrie-Verlag, Bonn 2004, ISBN 3-88414-372-7 .
  • Nils Greve, Margret Osterfeld, Barbara Diekmann: Dealing with psychotropic drugs. A patient guide. Balance Buch + Medien, Bonn 2007, ISBN 978-3-86739-002-6 .

history

  • Hans Bangen: History of the drug therapy of schizophrenia. Berlin 1992, ISBN 3-927408-82-4 .
  • Frank Hall: Psychopharmaceuticals - their development and clinical testing: on the history of German pharmaceutical psychiatry from 1844–1952. Kovac, Hamburg 1997.
  • David Healy: The Antidepressant Era. 3. Edition. Harvard University Press, Cambridge 2000.
  • H.-U. Melchert: taking psychotropic drugs. In: H. Hoffmeister, B. Bellach (ed.): The health of the Germans. An east-west comparison of health data. In: RKI booklets. No. 7, Robert Koch Institute, Berlin 1995, ISBN 3-89606-008-2 .
  • Johannes Pantel , Gisela Bockenheimer-Lucius u. a .: Psychotropic drug supply in the nursing home . An interdisciplinary study taking into account medical, ethical and legal aspects. (= Frankfurt publications on health policy and health law ). Lang, Frankfurt 2006, ISBN 3-631-55095-2 .

Reference works for synonyms , INN and systematic names of substances

  • Walter Pöldinger, François Wider: Index Psychopharmacorum. Huber, Bern / Stuttgart / Toronto 1990, ISBN 3-456-81770-3 (English, German, French, Italian, Spanish).
  • Otto Benkert: Pocket Guide Psychotropic Drugs from A to Z. 4th edition. Springer, Berlin / Heidelberg 2017.

Web links

Individual evidence

  1. ↑ Hans Bangen: History of the drug therapy of schizophrenia. Berlin 1992, ISBN 3-927408-82-4 .
  2. ↑ FL Tornatore et al.: Adverse effects of psychotropic drugs. Thieme, Stuttgart / New York 1991, ISBN 3-13-754601-X .
  3. ↑ H. Lüllmann, K. Mohr, M. Wehling: Heart and circulation. In: Pharmacology and Toxicology. Understand the effects of drugs - use drugs in a targeted manner. Georg Thieme Verlag, Stuttgart / New York 2016, pp. 127–170.
  4. ↑ a b Justice in Bavaria
  5. ^ Beta Institute non-profit GmbH: betanet - dementia> measures depriving of liberty - social & law. Retrieved November 15, 2017 .
  6. ↑ Press release 47/2014 - Bavarian State Ministry of Justice. Retrieved November 15, 2017 .
  7. ↑ See also WE Müller: Sedatives as an example for the peculiarities of psychopharmacotherapy in old age. In: Hans Förstl (Ed.): Textbook Gerontopsychiatrie. Thieme, Stuttgart 2002, pp. 220-226.
  8. ↑ Cornelia Krause-Girth: Sham solutions. Psychiatrie-Verlag, Bonn 1989, ISBN 3-88414-099-X . (Critical consideration of the prescription practice)
  9. ↑ On the criticism cf. about also Peter Lehmann: Among psychotropic drugs. Psychotherapy or influence? In: Co'med. Specialist magazine for complementary medicine (BRD). Volume 3, 1997, No. 5, p. 20 f.
  10. ↑ Y. Du, IK Wolf, MA Busch, H. Knopf: Associations between the use of specific psychotropic drugs and all-cause mortality among older adults in Germany: Results of the mortality follow-up of the German National Health Interview and Examination Survey 1998. In: PLoS One. Volume 14, No. 1, Jan 14, 2019, Article e0210695. PMID 30640945
  11. ↑ Hanna Gieffers: Study: Women take more psychotropic drugs than men. In: tagesspiegel.de. June 27, 2012, accessed January 8, 2020 .