Transcript EVOLUTION OF A PSYCHIATRIST – PERSONAL EXPERIENCE

By: Dr. M. M. O. Okonji
FRCPsych. (UK)
Consultant Psychiatrist
Evolution of a Psychiatrist –
Personal Experience
1. Why the medical school
2. Why psychiatry of all the disciplines
3. Diagnosis and Treatment with time
a) Classification
b) Mental health service delivery

Institutions

Community

Primary healthcare

Mental healthcare financing
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Development of Drugs in General Medicine
 Identification of molecular pathology leads to
intervention methods.
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Schematic of HIV/CD4 Cell Interaction
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Development of Drugs in General Medicine
(Cont.)
 The treatment regime comprises a combination of ARV
medication which fall into four major classes – NRTIS
(Nucleotide Reverse Transcriptase Inhibitors)
 NNRTIS – Non Nucleotide Reverse Transcriptase Inhibitors
 PI – Protease inhibitors
 Entry inhibitors
 Each medication within its respective class acts to
inhibit the replication process of HIV at distinct point in
its viral life cycle
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DEVELOPMENT OF DRUGS IN PSYCHIATRY
 Serendipitous discovery of the first neuroleptic
ushered in the modern era of psychiatry.
 1950 Chlorpromazine was synthesised originally
as antihistamine / antihelmenthic was found to
be sedative and antipsychotic.
 Dopamine hypothesis was inferred and believed
to play an important action of antipsychotic drugs
 Antipsychotic
increase
turnover
of
brain
dopamine
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Development of Drugs in Psychiatry (Cont.)
 The greater the DA receptor binding affinity of
antipsychotic, the greater the clinical potency.
 The drugs developed following this hypothesis are
called Typical Antipsychotics. More than 30
compounds between 1950-1970.
 Between 30-40% of patients are not responsive
 More important, they are ineffective against negative
symptoms and neurocognitive deficits.
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Development of Drugs in Psychiatry (Cont.)
 The challenge of dopamine hypothesis comes from
primary two lines of evidence:
 Dopamine hypothesis does not account for negative
symptoms
 Dopamine hypothesis does not account for
nonrecognitive deficits.
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Development of Drugs in Psychiatry (Cont.)
 In 1970’s: atypical antipsychotics developed on the
basis of reduced extrapyramidal side effects in
animal models (Thioridazine and Sulpiride).
 1980’s: Clozapine rediscovered with recognition of
broader efficacy compared with other antisychotics
 1990’s: New generation atypical antipsychotics act
through multiple neurotransmitter
addition to dopamine.
Evolution of a psychiatrist – personal experience
systems
in
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Severity
Limitations of Efficacy of
Antidepressant Drugs
C
B
A
Time
Comparison of efficacy of two active drugs (A, B) and a placebo with time
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Limitations of Efficacy of Antidepressant Drugs
 Side effects are a problem
 No accurate prediction of response
 Two or more weeks before beginning of
effective response
 15-20% of patients fail to respond to any
treatment
 Tendency for active drugs to be equipotent
in any investigations
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Future of psychiatry – which direction?
 The future of psychiatry will most likely
depend on developments in molecular
neuroscience.
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The Genome Project
 The human genome project involved the
sequencing of DNA in human.
 The human genome consists of 3 billion
genes with three million gene variations or
polymorphisms.
 There are coding and non-coding genes.
Humans have only 23,000 genes.
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MOLECULAR BASIS OF GENEENVIRONMENT INTERACTION
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HOW ENVIRONMENT INFLUENCE
GENE EXPRESSION IN THE BRAIN
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Schematic illustration of gene-environment interactions
ENVIRONMENTAL INPUTS
• Sensory inputs
• Psychotropic drugs
• Psychological stressors
PROTEINS
• Neurotransmitter
metabolism
• Receptors
• Ion channels
• Intracellular regulatory
systems
• Transcription factors
• Learning (including psychotherapy)
• Toxins
• Viruses
PHENOTYPE
(functional
properties)
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Thank You !!