Clinical Use of Anticonvulsants in Psychiatric Disorders [antikvár]

In recent years there has been a growing interest in the use of anticonvulsant drugs for conditions other than epilepsy. For example, carbamazepine is considered a drug of choice for the treatment of trigeminal neuralgia and related paroxysmal pain syndromes. The value of anticonvulsants in the treatment of somé psychiatric disorders is alsó increasingly recognized. Historically, there has been considerable use of anticonvulsant agents in the treatment of neuropsychiatric patients. Bromides were widely prescribed in the last century, barbiturates in the early part of this century, and more recently there has been extensive use of benzodiazepines. These drugs are effective anticonvulsants, but their clinical use in psychiatry has been restricted to their consideration as sedatives, hypnotics, or minor tranquilizers. In the midpart of the century, psychiatry widely used the seizures of electroconvulsive therapy for treatment of the mood disorders. In retrospect, it now appears that this somatic treatment conveys potent anticonvulsant properties and is perhaps the first widely used anticonvulsant treatment for the major affective disorders. Most recently, carbamazepine and valproic acid have emerged as additional treatment options for the lithium-refractory bipolar patient. The history of carbamazepine is of interest, as the compound was first synthesized for its possible antidepressant properties but discounted for this indication because of its unusual behavioral pharmacological profilé. Its anticonvulsant and antinociceptive properties were then recognized and carbamazepine was introduced in Europe for the management of epilepsy in the early I960s. By the early and mid-1970s, extensive reports suggested that it had "psychotropic" properties in this patient population. These data, as well as its ability to stabilize limbic system excitability, led to the first controlled trials of carbamazepine in the United States and, later, several European countries. Earlier uncontrolled studies had been performed in Japan, suggesting its value in bipolar affective disorder. These data and reports of the possible value of carbamazepine in other conditions, such as episodic dyscontrol and as an adjunct to neuroleptics in schizophrenia, led to a wider series of investigations and to studies of other anticonvulsant agents such as valproic acid and clonazepam in the affective and related disorders. There are now a growing number of studies evaluating the use of a variety of anticonvulsants in several neuropsychiatric conditions. As a consequence, many of these agents have become part of the armamentarium of the practicing psychiatrist as well as neurologists interested in potential