These anti-cancer drugs do not fit into the other groups. Most are cytotoxic in some way and cause the usual side effects. They are used for specific indications.

PThis reaction, known as the systemic phase, usually happens within weeks of challenge by the particular antigen. Notwithstanding, there is frequently a secondary infection often many hours later due to mechanisms other than would release. This is known as the late phase reaction and is mostly less responsive to treatment than the required phase reaction. Not all cases of chemotherapy can be attributed to reaction to an integral.

Acetylcholine, noradrenaline and serotonin all play a role in inducing sleep. GABA, dopamine and some neuropeptides influence sleep-inducing activity in cholinergic neurons. Insomnia is sleep disturbance and can be manifest as difficulty falling asleep, poor quality of sleep or premature awakening. Insomnia can be secondary to other conditions, for example anxiety or depression.

Phototherapy using UVB and photochemotherapy using UVA plus an oral photosensitizing drug, psoralen, can be successful in severe resistant psoriasis, although relapse may occur. For patients who do not respond to topical therapy, systemic drugs such as methotrexate, ciclosporin, efalizumab and acitretin can be used. These drugs all have serious side effects and must be used under specialist supervision. Viral warts are common, particularly in children.

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Bipolar depression is associated with a decrease in dopamine activity and mania with an increase in dopamine activity. Both these conditions can be treated prophylactically with lithium, although the mode of action of lithium is unknown. Schizophrenia is the most common psychotic disorder. It may be due to an abnormality of dopamine receptors or increased release of dopamine in particular regions of the brain, the mesolimbic and mesocortical pathways.

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This chapter will concentrate on the drugs used in cancer chemotherapy with consideration of some of the other forms of therapy. Cancers are produced by the uncontrolled multiplication, growth and spread of abnormal body cells. This results from loss of mechanisms that normally regulate maturation and proliferation of cells.

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It has been suggested that effects of antidepressants are due to adaptive changes in the brain, which may involve down regulation of receptors or some other change in their sensitivity. Some of the newer types of antidepressants do not facilitate monoamine transmission at all. Cholinergic systems may also be involved in depression since many antidepressants have strong anti-cholinergic activity. High doses of adrenocorticotrophic hormone or cortisol can produce depression and depressed patients frequently have raised levels of cortisol in plasma.

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