This has long been the focus of fundamental research which this oral will not have time to explore in depth. The subject matter is complex, and although selective effects on CNS proteins appear to offer the most complete explanation, much remains unexplained. Some of the now discounted theories are described briefly here in order to give some context to the continued search for an answer.

This chapter of BASIC Essentials covers information regarding local anesthetics that are essential to know for the American Board of Anesthesiology’s (ABA) BASIC exam. The content covers all of the information that is included in the ABA’s content outline. Highlighted information includes mechanism of action of local anesthetics, pharmacological properties of local anesthetics, comparison of amide and ester local anesthetics, and side effects of local anesthetics.

The cardiovascular pharmacology chapter focuses on therapeutic agents utilized by anesthesiologists in the treatment of a myriad of pathologies encountered in the operating room environment and elsewhere. The chapter provides a succinct outline of major classes of cardiovascular drugs that are an integral part of the practice of anesthesiology. The aim of the chapter is to deliver said material in an easy to read format to those preparing for board examinations and as a review for the practicing anesthesiology resident physician

Paediatric patients differ significantly from adults in the way that drugs affect them, for a number of reasons, including differences in their size, physiology and comorbidities. Developmental changes affecting the absorption, distribution, metabolism and excretion of many anaesthetic drugs, particularly during the first few months of life, profoundly affect both their pharmacokinetics and pharmacodynamics. Drugs discussed are the intravenous induction agents propofol, thiopental and ketamine; the sedatives dexmetetomidine and midazolam; and the opioids morphine, fentanyl and remifentanil, as well as muscle relaxants such as suxamethonium and non-depolarising relaxants. Inhalational anaesthetics are assessed for their usefulness in paediatric practice. Appropriate drug dosages are included and important differences from adult values emphasised.

Psychopharmacology is an integral component of psychiatric treatment and entails the selection, initiation, switching, discontinuation, and possible augmentation of psychotropic medications, as well as monitoring and assessment of symptom improvement. The choice of psychiatric medications should be tailored to a patient’s specific diagnosis, as well as their medical history and other psychiatric comorbidities. Side effects and therapeutic benefit should be assessed early on in treatment, in the event that a patient may benefit from a different medication in the same class, or from a medication with a different mechanism of action. Informed consent and patient education are paramount to ensuring that medication management is a collaborative effort between patient and provider. Safety, adherence, and polypharmacy are also important considerations when it comes to adjusting a psychotropic regimen over time. Advances in psychopharmacology include the potential use of pharmacogenetics as well as compounds such as psychedelics and the repurposing of existing medications.

Psychiatric disorders are complex and multifaceted conditions that profoundly impact various aspects of an individual’s life. Although the neurobiology of these disorders is not fully understood, extensive research suggests intricate interactions between genetic factors, changes in brain structure, disruptions in neurotransmitter pathways, as well as environmental influence.

In the case of psychotic disorders, such as schizophrenia, strong genetic components have been identified as a key feature in the development of psychosis. Moreover, alterations in dopamine function and structural brain changes that result in volume loss seem to be pervasive in people affected by these disorders. Meanwhile, mood disorders, including major depressive disorder and bipolar disorder, are characterized by disruptions in neurotransmitter systems responsible for mood regulation, such as serotonin, norepinephrine, and dopamine. Anxiety and personality disorders also exhibit neurotransmitter dysfunction and neuroanatomical changes, in addition to showing a genetic overlap with mood and psychotic disorders.

Understanding the underlying mechanisms in the pathophysiology of these conditions is of paramount importance and involves integrating findings from various research areas, including at the molecular and cellular levels. This brief overview aims to highlight some of the important developments in our current understanding of psychiatric disorders. Future research should aim to incorporate a comprehensive approach to further unravel the complexity of these disorders and pave the way for targeted therapeutic strategies and effective treatments to improve the lives of individuals afflicted by them.

Among patients with mood disorders, suicidal thinking, planning, and acts are common, particularly during major depressive episodes or mixed episodes. In this chapter, the epidemiology and aetiology of suicidal behaviour in major depressive disorder and bipolar disorder are outlined, followed by the relevant risk factors, and risk assessment of suicide. Finally, the latest evidence on treatments is discussed from a pharmacological, psychological and physical perspective.

There is no consensus for the concept of treatment-resistant depression (TRD). Although some authors argue considering TRD a depression subtype is not supported by evidence, its impact on the individual and society is clear. This chapter discusses the concept of TRD, presents evidence about its neurobiology, pharmacological interventions, and describes drugs currently under investigation. Among the pharmacological strategies to manage TRD, guidelines include increasing the antidepressant dose, switching to another new antidepressant, combining two or more antidepressants, and augmentation of the current medication. Several new components have been investigated for TRD targeting, for instance, the glutamatergic system, inflammatory system, the opioid system, the cholinergic system, dopaminergic system, and neurotrophin signaling. Finally, machine-learning techniques using clinical and neurobiological data provide promising information about treatment outcomes prediction that could change the current approach to a more personalized one.

Colloid fluids are crystalloid electrolyte solutions with a macromolecule added that binds water by its colloid osmotic pressure. As macromolecules escape the plasma only with difficulty, the resulting plasma volume expansion is strong and lasts many hours. The clinically used colloid fluids include albumin, hydroxyethyl starch, gelatin, and dextran.

The plasma volume expansion shows one-compartment kinetics. Marketed iso-oncotic fluids are usually composed so that the infused volume expands the plasma volume by the infused amount. Exceptions include hyperoncotic variants such as 20% albumin.

The main indication for colloid fluid is as second-line treatment of hemorrhage. Because of inherent allergic properties, crystalloid electrolyte fluids should be used when the hemorrhage is small. A changeover to a colloid should be performed only when the crystalloid volume is so large that adverse effects may ensue. The only other clinical indication is that dextran can be prescribed to improve microcirculatory flow.

Almost all patients admitted to psychiatric intensive care units receive pharmacological interventions and medications are often the major treatment intervention. PICU professional staff need to ensure that medication is used safely. This chapter discusses the common medication used in PCUs, their history, evidence base and adverse effects.

Drugs are a part of everyday life and may be defined as any pharmacologically active substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease (1). Whether a drug is a conventional medicine, a herbal remedy, or the caffeine in your coffee, drugs are an integral part of human existence and have been since ancient times. Drugs may be synthetic in origin or naturally derived from plants, animals, or biotechnology. A ‘medicine’ is a drug product containing one or more drugs in a formulation administered for a therapeutic purpose.

This chapter introduces the contents of this volume and provides a critical overview of medieval pharmacology with a focus on the Mediterranean from the ninth/tenth century to the fifteenth. It emphasises the importance of drawing evidence from various cultures (Byzantine, Islamicate, Jewish, Latin) and disciplines (history, art history, manuscript studies, and archaeology) in order to discuss topics of broader significance for the global Middle Ages, such as the transfer of medical and pharmacological knowledge. It also shows how our understanding of medieval pharmacology can be significantly expanded by the study of evidence from other areas, such as alchemy, cooking, diplomacy, magic, religion, and philosophy.

The anonymous early medieval compilers of recipe collections in Latin manuscripts are not often thought of as curious about new medical information. While the stereotype of medieval Latin stagnation in medicine has been countered, recipe compilers remain as recyclers of the ancient past. Close analysis of early medieval medical recipes, however, suggests that we should reconsider this view. This chapter focuses on a series of dental recipes found in related medieval adaptations of the medical portions of Pliny’s Natural History which suggests several changes over time, including a growing attention to precision and quantification, the deployment of a diverse range of new ingredients, and a link between claims of efficacy and ingredients identified as coming from Africa, Arabia, and India. These recipes reveal shifting uses for materia medica described in classical sources and provide insight into new ways that medieval medical writers were interpreting and adapting their source materials.

This chapter will discuss a Latin translation of an Arabic text on the pharmacological uses of the individual body parts of animals. De sexaginta animalibus is placed in the context of its original Arabic genre of works on the useful or occult virtues of animals, minerals, and plants. This is the first detailed scholarly treatment of this text, which has been mentioned in passing by other scholars. It argues that it is a translation of a work on the properties of the body parts of animals by the eleventh-century physician ʿUbaydallāh ibn Bukhtīshūʿ, by comparing the text with the manāfiʿ (usefulness) section from an Arabic Ibn Bukhtīshūʿ bestiary. Other issues covered include the copious use of transliterated Arabic terminology, particularly in regard to the names of the numerous animals themselves and confusion in their identification, the order of the animals (which aids identification of partial copies of the manuscript), cited authorities, and ascribed authorship. The chapter also argues for the existence of two recensions of the text in the manuscript tradition, with a comparison of an entry found in both recensions with the Ibn Bukhtīshūʿ text and ʿĪsā ibn ʿAlī’s Book on the Useful Properties of Animal Parts.

This chapter focuses on a selection of recipes included in Byzantine alchemical and pharmacological compendia that are preserved in manuscripts dating between the fourteenth and the fifteenth centuries: MSS Parisinus gr. 2314, Bononiensis 1808, and Vaticanus gr. 1174. These manuscripts represent important case studies that are compared with similar collections, from late antique medical encyclopaedias to Byzantine alchemical writings and Nicholas Myrepsos’ pharmaceutical handbook. Through an in-depth analysis of the contents and the terminology of these works, I track the transformation of their technical vocabulary, focusing on cross-cultural exchanges between the Byzantine, Arabic, and Latin traditions. Byzantine authors and copyists reshaped and ‘updated’ a long-lasting technical tradition deeply rooted in late antique and early Byzantine writings, which continued to be read and commented on during the Palaiolοgan period, when scholars compiled large selections of formulas and prescriptions belonging to different, yet overlapping fields, such as metallurgy, pharmacology, and cuisine.

Building on our understanding of how suicide emerges and for whom in the United States this occurs, we move into discussions of identification of and intervention for those at risk. The chapter begins with a brief overview of screening to identify those at risk of suicide, and the challenges in the research literature. Comprehensive risk assessments that incorporate multiple sources of information remain essential, and there is a potential role for machine learning in this process. We then summarize biologic (e.g., lithium, electroconvulsive therapy) and psychosocial (e.g., safety planning, cognitive behavioral therapy) promising practices in suicide prevention, as well as the potential role of technology (e.g., telehealth, apps) in suicide interventions. We then highlight community-based interventions (e.g., gatekeeper training, lethal means safety) and the evidence supporting them. At the societal level, state and federal efforts have focused on creating safe environments (e.g., legislation to reduce access to means) and providing economic supports that are promising. Given the complexity of suicide, we highlight the potential benefits of multimodal, multilevel intervention programs.

In this chapter, ComB treatment is introduced within the context of various BFRB treatment approaches that have been reported over past decades. Brief descriptions of psychodynamic, pharmacological, and so-called “alternative treatments” are briefly reviewed, but the emphasis is on behavioral treatments like habit reversal training (HRT) and its variants, that have dominated research and clinical reports for a half century. ComB treatment is introduced, with attention to its derivation from the ComB conceptual model, and its focus on sensory, cognitive, affective, motor, and place (environmental) variables as critical for assessment and for the design of individualized treatment. Technical aspects of ComB treatment, such as the identification of BFRB functions, its presumed mechanisms of action, its flexibility in individualizing the application to each client, and potential advantages over other treatment approaches are described.