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This is a brief and selective glossary of terms referred to in this web site. The information given is not intended as complete (so many side-effects of a drug will not be mentioned here, for example). I add to this as and when I have time!

Anticholinergics

Often used alongside antipsychotics to try to counter some of the antipsychotic drug ill-effects.

When used with antipsychotics (or with some other drugs with a similar action on dopamine) they may increase the risk for tardive dyskinesia and neuroleptic malignant syndrome. 2, 3

Their side-effects may include blurred vision, sensitivity to light, dry mouth, "stomach upset and constipation ...acute confusion and disorientation".2

The side effects of anticholinergics can mimic psychiatric symptoms, e.g. confusion, excitement, paranoia, agitation, depression, apathy. 3

The side effects of anticholinergics are often under-reported in studies.

Antidepressants

Antidepressants (see here, and here).

There are various different types of antidepressant, including: monoamine oxidase inhibitors (MAOIs), tricyclic, selective serotonin reuptake inhibitors (SSRIs) - more about these here - and serotonin and noradrenalin reuptake inhibitors (SNRIs).

Antipsychotics (neuroleptics)

See more about the limitations here, and the risks here

Also known as neuroleptics.

These tend to be classed into two groups:

1st generation antipsychotics, also known as typicals

E.g. Stelazine, chlorpromazine/Largactil (US Thorazine) and haloperidol (US Haldol).

2nd generation antipsychotics, also known as atypicals

E.g. olanzapine (US Zyprexa), Risperdal/risperidole, and quetiapine/Seroquel, clozapine, Clozaril.

The division into two groups is strongly influenced by marketing objectives, as explained here by Prof Kendall.

Antipsychotic drugs are known to cause tardive dyskinesia.

 

Prochlorperazine - Trade name Stemetil (US Compazine).

This drug is a form of antipsychotic drug (blocking dopamine receptors in the brain) and is sometimes used in lower doses for pregnancy sickness, even though, as stated here “The safety of this medicine during pregnancy has not been established”. This drug can also cause tardive dyskinesia.

Some antidepressants (tricyclics), such as amitryptiline and clomipramine, are similar to the antipsychotics in that they too reduce dopamine.

DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders)

DSM-5 (Version 5 of the Diagnostic and Statistical Manual of Mental Disorders) is published by the American Psychiatric Association (APA). The manual largely comprises descriptive labels that are often assumed to represent specific psychiatric disorders. In the main, these disorders are not discreet entities discovered or supported by independently validated scientific research but are rather ideas borne out of committee consensus.

Although researchers and doctors may find them to be convenient categories and descriptions, they do have a darker side. By giving the impression that so-called psychiatric disorders such as Attention Deficit Hyperactivity Disorder, or childhood/pediatric Bipolar Disorder, for example, are scientifically validated, these descriptions of behaviour (and that is all these terms are) assume an inflated importance and authority and can thus lead to widespread over-diagnosis and the unnecessary use of high risk medications.

Although the DSM manuals are produced by the APA they do have a worldwide influence even though the World Health Organisation's International Classification of Diseases (Currently ICD-10) also has a listing of psychiatric disorders. It is a matter of concern that the DSM is totally unregulated. This means that disorders can be invented, categorised, published and then diagnosed and treated without the necessary scientific evidence to support this. The fact that DSM committee members often have financial ties to drug companies is also a matter of concern.

Writing in the New Scientist, Dr Allen Frances (Chairman of the DSM-IV Task Force) has said: "A petition for independent scientific review [of the basis of DSM-5] endorsed by 56 mental health organisations was ignored. There is no reason to believe that DSM-5 is safe or scientifically sound...The mistake of DSM-5 was to attempt to go beyond current knowledge. Its new disorders...will be a nightmare to the patients who are misidentified and treated unnecessarily."

Metabolic Syndrome

Metabolic syndrome refers to changes that can lead to weight gain, diabetes, elevated cholesterol and high blood pressure.  “All these effects increase the risk of coronary heart disease and other cardiovascular disorders such as stroke”. 1

Neuroleptic Malignant Syndrome (NMS)

See this table here for criteria for guidance in NMS diagnosis.

NMS is a dangerous and potentially lethal effect of antipsychotic drugs and is characterised by muscle rigidity, unstable blood pressure, fever, and altered consciousness that "ranges from agitation to stupor or coma" (source) and other symptoms.

"In most cases, the disorder develops within the first 2 weeks of treatment with the drug; however, the disorder may develop any time during the therapy period." (source)

"The risk of developing NMS has been reported to last for 10–20 days after oral neuroleptics [antipsychotics] are discontinued and even longer when associated with depot [injection] forms of the drugs." (source)

It "is a state in which the individual becomes stiff and feverish. The condition may be fatal if not caught quickly." 2

Paradoxical effects

This is when a drug causes the opposite to the desired effect. This can happen when a person develops a tolerance to a drug, often over time. Thus, a pain killer may cause pain, a sleeping pill lead to insomnia etc.

Psychiatric drug groups (psychotropic drugs) - a brief summary

See Antipsychotics in this glossary

Antipsychotics - also known as neuroleptics (but primarily for marketing purposes, as explained here by Prof Kendall) divided into 2 groups, 'typicals' (1st generation antipsychotics) and 'atypicals' (2nd generation antipsychotics)

Antidepressants (see here, and here)

There are various different types of antidepressant, including: monoamine oxidase inhibitors (MAOIs), tricyclic, selective serotonin reuptake inhibitors (SSRIs) - more about these here - and serotonin and noradrenalin reuptake inhibitors (SNRIs).

Anti-anxiety, sedatives, also known as anxiolytics
Including the benzodiazepines such as diazepam/Valium, lorazepam/Ativan, alprozam/Xanax

Mood stabilisers
e.g.

lithium carbonate (Priadel)

sodium valproate (Epilim)

semisodium valproate (Depakote)

lamotrigine (Lamictal)

gabapentin (Neurontin)

carbamazepine (Tegratol)

Anticholinergics
Often used alongside antipsychotics to try to counter some of the drug ill-effects

Psychostimulants

See more about drugs such as Ritalin and Strattera here

e.g.Ritalin/methyphenidate

atomoxetine (Strattera)

Sleeping pills/Hypnotics

More about sleeping pills here

Tardive Dyskinesia (TD)

Tardive dyskinesia is a movement disorder caused by dopamine receptor-blocking drugs such as neuroleptic (antipsychotic) drugs. Symptoms of this condition might include uncontrollable twitches, jerks and repetitive movements - affecting the face and body (including the arms).

TD often becomes apparent when the antipsychotic drugs are reduced - there is no known cure.

Although strongly associated with the older (first generation antipsychotic drugs) such as Stelazine, chlorpromazine/Largactil (US Thorazine) and haloperidol (US Haldol) it can also result from the newer so-called atypical antipsychotic drugs (such as olanzapine (US Zyprexa), Risperdal/risperidole, and quetiapine/Seroquel. This study (Woods et al 2010) suggests a similar risk for TD with the atypicals as with the conventional antipsychotics.

The likelihood of the onset of TD is usually associated with the use of high doses of antipsychotic drugs and when used for long periods. It can however occur after very little use. The patient information by the makers of Risperdal/risperidole point out that TD can develop “after relatively brief treatment periods at low doses.” (see here).

When anticholinergics are used with antipsychotics the risk for tardive dyskinesia may be increased. 2

Prochlorperazine/Stemetil (US Compazine) is a form of antipsychotic drug (blocking dopamine receptors in the brain) and is sometimes used in lower doses for pregnancy sickness, even though, as stated here “The safety of this medicine during pregnancy has not been established”. This drug can also cause TD.

Metoclopramide - Moxolon (US Reglan) has a number of clinical uses (see here) including as a treatment for nausea and migraines. It is sometimes used with children too. "Metoclopramide seems to be one of the most common causes of TD in adults" and "although we believe that metoclopramide is also an important cause of TD in children, it seems to be under-recognized." The quotes are taken from this poster, which includes a comprehensive list of drugs known to cause TD.

Some antidepressants, such as amitriptyline, are similar to antipsychotics and therefore pose a risk for TD.

This legal claims web site (appropriately for brain and spinal cord injuries) lists a number of medications as having a risk for TD, including Ritalin (widely used with children), the newer antidepressants (SSRIs such as fluoxetine/Prozac, and sertraline/Lustral US Zoloft), the sedative alprazolam/Xanax, and a number of the so-called mood stabilisers (such as carbamazepine/Tegretol) and lithium/Priadel.

 

 

 

References

1 Moncrieff, J. (2008) The Myth of the Chemical Cure. UK: Palgrave MacMillan p115-116

2 Healy, D. (2002) Psychiatric Drugs Explained. UK: Churchill Livingstone

3 Breggin, P. & Cohen. D. 2007 (Update of 1999) Your Drug May Be Your Problem. US: Da Capo Press