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This chapter presents basic information related to functional systems of the brain. It describes the patterns of neural activity and the multiple neurotransmitter system. Disorders of the functional system and the effect of psychotropic drugs on the functional system are also discussed. Of great importance in the operation of the functional systems which determine behaviour is the fact that receptors for transmitters are diverse. There are several subtypes of receptor for each neurotransmitter, and the different subtypes mediate different effects.

This chapter provides a brief account of the diagnosis and treatment of some of the common symptoms found in terminally ill patients. It discusses the causes and recommended treatment for these symptoms, which include anorexia, weight loss, insomnia, and dyspnoea. The chapter also provides a list of essential drugs often given until the last day of life, including morphine, anticonvulsants, and psychotropic drugs.

Nearly all psychotropic drugs act at some point on arousal and sleep systems in the brain. Central nervous system stimulants and depressants are classified according to whether they increase or decrease cortical arousal; anxiolytics and tranquillizers are designated by their effects on emotional arousal; antipsychotic drugs and antidepressants have specialized effects on arousal and sleep systems, and these systems are also affected by a wide range of other drugs from antihistamines to antihypertensive agents. This chapter considers some drugs used therapeutically for their effects on arousal: central nervous system depressants, classed as hypnotics, sedatives, and anxiolytics; and certain stimulants, the sympathomimetic amines and xanthines.

Musical performance can be among the most difficult and demanding of human activities and generally occurs in situations when the personal cost of failure or even suboptimal performance is very high. It is not surprising, therefore, that individuals who earn a living by performing often turn to artificial aids to help them cope either emotionally or physically. The use of ‘psychotropic’ drugs (i.e., drugs that affect the mind and behaviour) has been linked to music certainly for centuries and probably since both were discovered by our ancestors. The question is: can they genuinely help the performer? If the answer to this is yes, we must also ask who might benefit and is there a price to pay? This chapter provides a wide-ranging review of psychotropic drug effects and their implications for musical performance. There is actually very little direct evidence linking the two, but research on drug effects more generally can provide useful clues and practical guidance for the performing musician.

Pregnant women and their fetuses are more likely than ever to be exposed to antipsychotic medications; perhaps to the newer agents in particular. Drugs like clozapine, olanzapine, risperidone, and quetiapine are increasingly used in women of reproductive age for a range of psychiatric and behavioural disorders other than schizophrenia (Buchanan et al. 2009). Reproductive safety data remain surprisingly incomplete and guideline recommendations lend limited support to clinical risk-benefit analyses (Howard 2005; McKenna et al. 2005; NICE 2007). This is a problem not least because the gold standard randomized controlled trial is considered unethical for assessing psychotropic medication use during pregnancy, while other available observational studies are generally underpowered, with biased samples and therefore remain unfit for purpose in a rapidly changing prescribing landscape (NICE 2007). In a UK population approaching 66 million, –3,000–4,000 births per year may be exposed to antipsychotics or other psychotropic medications. This chapter provides a critical summary of current knowledge about potential risks of fetal antipsychotic and antiepileptic drug exposure and proposes how future observational studies might fill crucial gaps in the evidence. Most incident cases of severe mental illness (schizophrenia, related disorders, and bipolar disorder) occur during the reproductive years and most are treated with continuous psychotropic pharmacotherapy (Buchanan et al. 2009). Better care, deinstitutionalization and the use of newer agents with fewer effects on fertility means that women with psychotic disorders maybe increasingly likely to become pregnant (Howard 2005; NICE 2007), while the use of newer ‘atypical’ antipsychotics for other mental disorders common among women of childbearing age is also expanding (McKenna et al. 2005). For these reasons, psychotropic medications is increasingly likely to be prescribed to mothers during pregnancy (Newport et al. 2007). It is surprising then that reproductive safety data for psychotropic agents remains so incomplete (Barnes 2008; Webb et al. 2004) and guideline recommendations lend limited support to women, their partners and their treating clinicians in difficult clinical risk-benefit analyses (NICE 2007). Recent reports conclude that prospective studies are needed which can access unbiased, reliable (large enough) samples of ill mothers exposed to psychotropic medication and take account of key maternal characteristics (e.g. psychiatric diagnosis, smoking, pregnancy weight) in the estimation of risk (Barnes 2008; NICE 2007).

This chapter first considers the emergence of ‘transnational criminology’ — a rapidly developing field that sets out specifically to understand crime and justice beyond national boundaries and, in some instances, to contribute to supranational criminal justice policies. It then turns to the idea of ‘criminal iatrogenesis’: the harmful results of well-intentioned crime control practices. In doing this, the chapter looks in detail at the criminalization of psychotropic drugs as one example among many of how harm-producing crime control models have been exported transnationally even while failing domestically. The final substantive section examines a series of mass murders in Guyana, which provide a vivid illustration of criminal iatrogenesis rooted in the systemic effects of drug prohibition as well as the problems of attempting to understand crime from a transnational and comparative perspective. The chapter concludes with some reflections on the practice of harm production for an emerging global criminology.

Proponents of cognitive neuroenhancement usually ground their argumentation on the assumption that effective neuroenhancers without serious risks and side effects exist or will exist soon. Their argumentation is based on several false assumptions: (1) underestimating the risk of addiction to cognitive enhancers, (2) underestimating psychiatric, cardiovascular, and further medical risks of the drugs currently proposed for cognitive enhancement (e.g., modafinil, methylphenidate), and (3) overestimating the benefits of cognitive enhancers. Although only randomized, double-blind studies could answer the question whether cognitive enhancers are associated with a risk for mental disorders, there are severe ethical objections to such research, particularly because research participants would have to be exposed to significant risks. Therefore, public funding of this research is not justified. However, epidemiological studies on the use of prescription psychotropic drugs for cognitive enhancement might be useful in order to find out more about their effects in real life.

This chapter discusses psychogenic pruritus, which encompasses a heterogeneous group of diagnoses and is not just a diagnosis of exclusion. Psychogenic pruritus can be classified as pruritus precipitated and/or created by conscious behavioural response to underlying psychopathology and as pruritus initiated through unconscious pathological mental processing. The phenomenology and pathogenesis of psychogenic pruritus are discussed, and the authors also provide differential diagnosis for psychogenic pruritus. They furthermore consider whether psychogenic pruritus should stop during sleep or not, and study therapy and psychotropic drugs as ways to treat it.

The 1972 Vienna Convention on Psychotropic Drugs created frameworks both for an effort to control the international trade in psychedelic drugs and for an exemption for communities (imagined exclusively as indigenous) where those drugs were used for traditional religious purposes in a largely unadulterated state. The exemption was well suited to the legal environment in the United States but made little sense in Mexico, where peyotism had long been seen as a vice, much like alcoholism. The treaty, however, set the stage for a new generation of activists and scholars to reposition peyotism as a right within the larger right to indigenous self-determination. This chapter traces the emergence of that claim in Mexico, and in particular the role that concerns over peyotism played in this shift. Even as self-determination became the guiding ethos of the INI, federal officials continued to treat peyotists as children, incapable of governing their own affairs. This tension came into high relief in 2009, when the Mexican government issued a series of mining concessions that many believed would do irreparable ecological damage to Wirikuta, the desert where the peyote grows.

This chapter begins by supporting the shared view that suffering is intrinsically evil and its alleviation ought to be a high moral priority. However, since the alleviation of suffering is inherently only a prima facie duty, the core reflection centers on trying to understand the limits to our obligation to alleviate suffering. Our ethical thinking about suffering is informed by two related matters. First, we cannot know how to alleviate suffering unless we know the good we seek in its remediation. Second, it is the relationship between the goods we prioritize and the powers we use that markedly influences our ethical priorities about how to approach human suffering. Using psychotropic drugs as an example, the chapter addresses our proclivity to evaluate suffering in light of powers we are capable of, which puts at risk our sensitivity to the meaning of suffering in the human experience. In closing, the chapter outlines two ways that our priorities are disoriented to suffering in the human experience.

This introductory chapter explores the prevailing attitudes in India regarding the use of psychopharmaceuticals, especially in the neologism, moner khabar, or “mind food.” The efficacy of psychopharmaceuticals, especially of antidepressants, has long been the subject of controversy. Moner khabar was coined with the intention of making psychotropic drugs acceptable to those hesitant to take them. However, the author notes that although the parallels between food and psychopharmaceuticals were strongly established in one hospital, not all psychiatrists were equally ready to simplify—or dissimulate—psychiatric models for their lay clients. Indeed, in the hundreds of consultations that were witnessed, psychiatrists' explanations of disease etiologies and drug effects were either absent or kept to a bare minimum.