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Mental Disorders and Treatment

Introduction

The treatment of severe mental disorders in modern medicine is a feasible task due to the fact that advanced drugs are used not only to block symptoms but also eliminate the root causes of diseases. In psychiatry, long-acting injectable antipsychotics (LAIs) have become widespread, which have the properties of blocking specific receptors or, conversely, stimulating them. In particular, LAIs are often utilized to treat the symptoms of schizophrenia as an acute mental disorder, including a form of paranoid schizophrenia. This work aims to define the effects of LAIs, their work to reduce the positive symptoms of schizophrenia and the impacts on negative symptoms, the types of these drugs, as well as describe the symptoms of pediatric major depressive disorder (MDD) and its psychotherapeutic and pharmacological principles of treatment.

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Reducing the Positive Symptoms of Schizophrenia with LAIs

The advent of LAIs in medicine has provided a breakthrough in addressing mental disorders that have serious effects on the nervous system and patient behavior. As Patel et al. (2020) note, these drugs were discovered in the 1960s, and the authors state that one of their main properties is the ability of the “sustained release of active drug, which reduces the frequency of administration to once or twice monthly” (p. 2). With regard to schizophrenia, drugs of this pharmacological group have the properties of reducing positive symptoms, which are expressed in the distortion of normal body functions. According to Miyamoto and Fleischhacker (2017), antipsychotic medications affect the way information is transmitted between individual cells in the brain. Such drugs work by blocking receptors to reduce communication among groups of cells, thereby reducing the likelihood of positive symptoms of schizophrenia, in particular, delusions and hallucinations. Different LAIs are designed to block various neurotransmitters, and this diversity is critical in addressing schizophrenic symptomatology due to the distinctive causes of its manifestation and the individual nature of each case. Therefore, the value of these drugs comes from their profound effects on brain functions.

Therapeutic Effect of LAIs on the Negative Symptoms of Schizophrenia

The use of LAIs to treat the negative symptoms of schizophrenia is a crucial aspect of the study of these drugs. As such symptoms, Biagi et al. (2017) call a decrease or loss of normal functions and emotional reactions, which manifests itself in a partial or complete loss of cognitive skills. At the same time, as Corigliano et al. (2018) argue, today, there is little research that evaluates the therapeutic effects of LAIs on negative symptoms of schizophrenia, which is a gap. In their study, the authors focus on addressing negative symptoms as one of the essential factors of the treatment of the mental disorder in question and note that the ability of LAIs to increase myelination in the brain has a positive effect on the improvement of patients’ condition (Corigliano et al., 2018). In addition, these medications affect mood and reduce suicidal and other dangerous behaviors, which are also part of the target spectrum. Thus, despite the limited knowledge of LAIs in the context of this problem, the role of these drugs can be regarded as significant in relation to addressing the negative symptoms of schizophrenia.

LAIs Used for the Treatment of Paranoid Schizophrenia

Paranoid schizophrenia is one of the most common forms of this disease. As a rule, this diagnosis is characterized by positive symptoms manifested in patients, in particular, delusions and hallucinations (Diefenderfer, 2017). In the current medical practice, this disorder is treated with highly effective LAIs that are utilized as the main pharmacological medications to address the problem. In her research, Diefenderfer (2017) cites several cases in which patients with paranoid schizophrenia are assessed from the perspectives of their condition and treatment plans with appropriate drugs. Specifically, the author mentions two patients with this disorder and highlights such LAIs as Risperidone microspheres, Olanzapine pamoate, Paliperidone palmitate, and Haloperidol decanoate (Diefenderfer, 2017). The most potent of these drugs is Risperidone microspheres since, according to the provided treatment plans, it can be 12.5 to 50 mg and taken from 3 to 6 days (Diefenderfer, 2017). The weakest one is Olanzapine pamoate (from 150 to 405 mg and approximately 30 days) (Diefenderfer, 2017). These LAIs are common medications used to treat paranoid schizophrenia, a widespread form of this mental disorder.

Symptoms of Pediatric Major Depressive Disorder

Pediatric major depressive disorder (MDD) is a dangerous mental disorder that threatens normal development into adulthood. One of the key problems associated with this condition is that children cannot assess their emotions and feelings objectively due to the lack of life experience, which, in turn, explains the need for adults to pay attention to children’s non-standard behaviors. According to Rice et al. (2017), young patients with MDD are characterized by hanging anxiety, phobias, and periodic panic attacks. These manifestations are typical of preschoolers, while at an older age, a child with MDD shows isolation and indifference in life, loses interest in communication, and does not find pleasure in usual games and entertainments (Rice et al., 2017). Emotional regression is one of the obvious manifestations of pediatric MDD, and timely action is essential for providing target patients with effective care.

Treatment of Pediatric Major Depressive Disorder

The aforementioned pediatric MDD is an issue that can be addressed both psychotherapeutically and pharmacologically with the use of drugs that improve the condition of young patients. Neavin et al. (2018) present treatment programs for this disorder, which are formally developed and approved by the US Food and Drug Administration. In particular, the researchers mention selective serotonin reuptake inhibitors (SSRIs): fluoxetine and escitalopram (Neavin et al., 2018). These drugs are not 100% effective, but clinical trials have shown that, in some cases, they promote remission and reduce MDD symptoms in children. Although these drugs are more commonly used by adults, their use in the pediatric area is acceptable.

At the same time, psychotherapy is a first-line strategy for addressing pediatric MDD. According to Neavin et al. (2018), for this population, “Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT)” are the most common and well-studied approaches (p. 48). One of the main advantages of these types of therapies is an opportunity to perform them in different settings under the supervision of adult specialists involved in psychology, psychiatry, or social work. These interventions can be effective, and the transition to pharmacological treatment may not be necessary.

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Conclusion

The evaluation of the use of LAIs in the treatment of schizophrenia, including its paranoid form, proves that these drugs are potentially effective medications that act on brain receptors by reducing or, conversely, stimulating their activity. LAIs are effective not only in reducing positive symptoms but also as the means of minimizing negative symptoms, such as suicidal behavior. Regarding pediatric MDD, one of the conditions for the timely identification of this disorder in children is constant observation. Fear, anxiety, and emotional regression are the common symptoms of pediatric MDD. Treatment may involve using SSRIs, but initially, psychotherapy is the necessary intervention.

References

Biagi, E., Capuzzi, E., Colmegna, F., Mascarini, A., Brambilla, G., Ornaghi, A., Santambrogio, J., & Clerici, M. (2017). Long-acting injectable antipsychotics in schizophrenia: Literature review and practical perspective, with a focus on aripiprazole once-monthly. Advances in Therapy, 34(5), 1036-1048.

Corigliano, V., Comparelli, A., Mancinelli, I., Montalbani, B., Lamis, D. A., De Carolis, A., Erbuto, D., Girardi, P., & Pompili, M. (2018). Long-acting injectable second-generation antipsychotics improve negative symptoms and suicidal ideation in recent diagnosed schizophrenia patients: A 1-year follow-up pilot study. Schizophrenia Research and Treatment, 2018(4834135), 1-7. Web.

Diefenderfer, L. A. (2017). When should you consider combining 2 long-acting injectable antipsychotics. Current Psychiatry, 16(10), 42-46.

Miyamoto, S., & Fleischhacker, W. W. (2017). The use of long-acting injectable antipsychotics in schizophrenia. Current Treatment Options in Psychiatry, 4(2), 117-126. Web.

Neavin, D. R., Joyce, J., & Swintak, C. (2018). Treatment of major depressive disorder in pediatric populations. Diseases, 6(2), 48. Web.

Patel, M. X., Bent-Ennakhil, N., Sapin, C., di Nicola, S., Loze, J. Y., Nylander, A. G., & Heres, S. (2020). Attitudes of European physicians towards the use of long-acting injectable antipsychotics. BMC Psychiatry, 20(1), 1-11. Web.

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Rice, F., Sellers, R., Hammerton, G., Eyre, O., Bevan-Jones, R., Thapar, A. K., Collishaw, S., Harold, G. T., & Thapar, A. (2017). Antecedents of new-onset major depressive disorder in children and adolescents at high familial risk. JAMA Psychiatry, 74(2), 153-160. Web.

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