use of drugs in mental health assoc. professor e. a. lothe winter school, maribor university...

Use of Drugs in Mental Health

Assoc. professor E. A. LotheWinter School, Maribor UniversityMaribor, Slovenia, Nov 2015

Goals for this lecture:

The students should

1. Acquire some basic insight into Mental Health2. Acquire some basic knowledge of Psycho-

farmacological groups of medicines3. Acquire some basic insight into when, how and

why psychofarmacological medication is used – and how this affects the patient

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Goals for this lecture, cont.:

The students should

• Acquire some knowledge on non-medical treatments and significant factors for resilience and recovery.

• Reflect on use of drugs from ethical and legal perspectives

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Perspectives on mental health • Biological• Psychic (mental)• Psycho-social• Cultural

• Mental suffering can be described as Outside-perspective

• Vs/ Inside-perspective:• That which is experienced by the patient

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Perspectives, cont.:• Illness/wellness• Symptoms/external and internal• Stigma• Exclusion/integration

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Some common mental illness diagnoses

• Psychosis – altered perception of reality• Depression – varying degrees of severity• Suicidal ideation • Anxiety – a number of variables • Bipolar variations – affective disorders • Eating disorders • Susbstance dependency

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Models for treatment of mental illness

• Hospitalization • Outpatient treatment

• Voluntary vs/coerced treatment• Medication• Medication-free treatment, examples:

• Cognitive therapy• Trauma treatment • Milieu therapy

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Antidepressants • Block reuptake of of neurotransmitters (serotonon

and norepinephrine)• Reduce depression • Control anxiety• Control obsessions• Relieve severe pain• Prevent panic attacks

• Undesirable side effects: nausea, headache, sexual dysfunction, sedation, weight gain, etc.

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Antipsychotic medication• Block dopamin receptors• Some also block a specific serotonin receptor

• Relief of psychosis and anxiety• Relief of acute mania

• Undesirable side effects: blurred vision, dry mouth, constipation, tachycardia, sedation, weight gain, ejaculatory difficulty, dizziness.

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Anti-anxiety: Benzodiazepines• Facilitate the transmission of the inhibitory

neurotransmitter GABA• Relief of anxiety• Sedation

• Undesirable side effects: dependence, confusion, memory impairment, motor incoordination.

• Nausea, headache, dizziness, restlessness.

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Substance abuse and mental health

• Co-dependency • Dual diagnoses• Auto-medication

• Legal substances• Illegal substances• Dependency-risky prescribed drugs

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Other issues significant for mental health • Autonomy • Significant relations • Hope • Resilience • Healing and wellbeing• Empowerment • Coping strategies • Recovery

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Good friends pull together

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Relations and their significance for mental health and recovery

• Issues that promote relations competence • Working together:

• the individual,• the family,• the social network group and• society

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Recovery – healing processes

• Spontaneous and natural development (without organised treatment)

• A consequence of treatment interventions (clinical recovery)

• Recovery in spite of countinued suffering from symptoms and functional disability

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Goals for the nurse

• Preserve life• Build an alliance – important regarding use of

drugs• Strengthen the patient´s self esteem• Encourage the patient in developing the wish

to live• Assist in dealing with existential crisis

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Nursing tools and actions • Multiple different therapies: ex.

cognitive, trauma, milieu.

• Motivate • Offer togetherness - share time with• Respect• Empathy and attentive listening• Time and full attention

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The good therapeutic session

• Building relations• Communication

–Open invitation–Listening attentively–Listen to the silence and to the

affective message• Create an alliance for teamwork• Use yourself as a tool

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Relevant professional ethical and legal issues for reflection

• Autonomy vs/paternalism• Principle of beneficence• Confidentiality

• Substance legislation

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Suggested reading:

Davidson, L et al (2008). Remission and recovery in schizophrenia: practitioner and patient perspectives. Schizophrenia bulletin, vol:34 (1), pp :5 -8

Link BG; Struening EL; Neese-Todd S; Asmussen S & Phelan JC (2001). Stigma as a barrier to Recovery. The Consequences of Stigma for the Self-Esteem of People with Mental Illnesses. Psychiatric Services, vol.52, (12), Dec. http://dx.doi.org/10.1176/appl.ps.52.12.1621

Topor A; Borg M, Di Girolamo S & Davidson L (2011). Not just an individual journey: social aspects of recovery. Int J Soc Psychiatry Jan 20.

Townsend, MC (2015). Psychiatric Mental Health Nursing. Concepts of Care in Evidence-Based Practice. Philadelphia, USA, F.A.Davis Co.

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