Chapter 4 - Psychopharmacology in the medically ill

Summary

Most psychotropics are highly protein bound and are influenced by fluctuations in protein levels. Specific drug-binding proteins include albumin and globulin, which generally bind to acidic (e.g. valproic acid) and basic (e.g. tricyclic antidepressant) psychotropic drugs, respectively. Although anticonvulsants are used in psychiatry for stabilization of bipolar disorder, alcohol withdrawal, and aggression, medically ill patients may also receive these drugs during treatment for epilepsy, neuropathic pain, and migraines. Lithium has multiple systemic effects and can precipitate or exacerbate underlying medical illness. Antidepressant use within the psychiatric setting has greatly expanded to include treatment of eating disorders, premenstrual dysphoric disorder, chronic aggression and impulsivity, and impulse control disorders. The serotonin antagonist reuptake inhibitor (SARI) trazodone is commonly used for sleep because of sedating properties. Antipsychotics are also used at times as antinauseants and for the treatment of refractory hiccups. Psychostimulants improve depression and fatigue in the medically ill.