Advances in drug treatment have revolutionised the practice of psychiatry over the past six decades. Drugs provide a degree of stability and control in the lives of those suffering from schizophrenia, a chronic debilitating illness with impact so profound that it accounts for 2-3% of UK national health spending. Similarly, the impact of medication in alleviating the burden on individuals, their families and society of depression, which has a lifetime prevalence of up to I in 6 of the population, is substantial. Psychotropic drugs greatly improve the prognosis of other common conditions such as anxiety disorders, attention deficit/hyperactivity disorder and bipolar affective disorder. In this chapter the following drug groups are considered
• Antipsychotics ('neuroleptics')
• Mood stabilisers
• Drugs for anxiety and sleep disorders
• Drugs for attention deficit/hyperactivity disorder
Writing prescriptions is easy, understanding people is hard. (Franz Kafka, 1883-1924)
In 1940 psychotropic medication was limited to chloral hydrate, barbiturates and amphetamine. By contrast, the modern-day formulary lists almost 100 psychotropic drugs, with efficacious treatment available for the vast majority of psychiatric diagnoses and in all phases of life. Psychotropic medication has been a key factor in accelerating the closure of Victorian 'asylums' such that the psychiatric inpatient population is now a tiny fraction of its 1954 peak of 148,000 in England and Wales.
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