The patient was given a diagnosis of vocal cord dysfunction and was treated with alprazolam and desipramine. Her episodes quickly became milder and less frequent, and she was discharged home with psychiatric follow-up. Vocal cord dysfunction commonly presents as episodes of acute respiratory distress with significant wheezing. Patients are often treated for chronic asthma, sometimes taking steroids for years, and numerous acute presentations result in intubation and even recurrent emergency tracheotomy. Since family practitioners care for many patients who wheeze, it is important for us to be aware of this diagnosis because it can mistakenly lead to long-term use of potentially toxic medicines as well as unnecessary invasive procedures.
Unopposed dopamine is associated with schizophrenia and predatory aggression.
Excess serotonin activity may induce hallucinations. The agonal effect of GABA is to render cells resistant to excitation, while the antagonist effect is severe anxiety. Rational use of psychotropic medication requires familiarity with these central neurotransmitters since psychiatric syndromes are diagnosed by a constellation of symptoms, which represent the observed effects of the actions of the specific neurotransmitters on respective receptor sites. Synapses represent the drug modifiable control points within neuronal networks, and it is here that the psychotropic medications act. Physicians who use psychotropic medications in their practice need to be well versed in this aspect of neurophysiology to maximize the clinical effectiveness, application, and safety of these drugs.