what psychotherapists should know about psychiatric medication

What Psychotherapists Should Know About PsychotropicKnow About Psychotropic

Medication

Daniel B. Martinez, M.D.Medical Director

Pilsen Wellness Center, Inc.

The Medical Model

BiologicalP h l i lPsychologicalSociologicalSociological

CulturalCulturalSpiritual

Si l Ph E i i T hSingle Photon Emission Tomography

Images (c) Dr. Amen

N lNormal

Images (c) Dr. Amen

Images (c) Dr. Amen

ENCOURAGE COMPLIANCE!!!ENCOURAGE COMPLIANCE!!!

suntimes, 05

washington.edu

source

D iDopamine

RewardsAttentionMotivationDrivePleasure

Strahl 2000Strahl, 2000

N i h iNorepinephrine

MoodI t tInterestMotivationEnergy

S t iSerotonin

SexConcentrationConcentrationHungerInterestInterestMoodPainSleepp

Cl f M di tiClasses of MedicationsClass: Neurotransmiter: Affects:

Antipsychotics Dopamine Psychosis

Antidepressants SerotoninNorepinephrine

MoodNorepinephrine

Antimanic Polarization of neuron

Mood

Benzodiazepines GABA Anxiety

Have you decided for yourself?

Cl f M di tiClasses of MedicationsClass: Neurotransmiter: Affects:

Antipsychotics Dopamine Psychosis

Antidepressants SerotoninNorepinephrine

MoodNorepinephrine

Antimanic Polarization of neuron

Mood

Benzodiazepines GABA Anxiety

Antipsychotic therapy:Antipsychotic therapy:Historical perspective in the United States

ReserpineChlorpromazine

FluphenazineQuetiapine

Clozapine

ThioridazineHaloperidol

RisperidoneOlanzapine

Quetiapine

Ziprasidone

Aripiprazole

19 0 1960 19 0 1980 1990 2000 20021950 1960 1970 1980 1990 2000 2002

Kaplan HI et al. Kaplan and Sadock’s Synopsis of Psychiatry. 7th ed.1994.Black DW et al. Introductory Textbook of Psychiatry. 2001.

AAntipsychotics

-Major Tranquilizers-Block Dopamine-Block Dopamine -Decrease Psychosis

d k-Induce Parkinsonism

Atypicals and Reported Dangers

Clozaril -Agranulocytosis, SeizuresRespirdal -EPS HyperprolactinemiaRespirdal -EPS, HyperprolactinemiaZyprexa -Weight, Diabetes

d blGeodon -EKG problemsSeroquel -CataractsAbilify -Deaths

A ti h tiAnti-psychotics

Typical (e.g. Haldol)Anticholinergic side effects (thorazine)Anticholinergic side effects (thorazine)Extrapyramidal side effects

Atypical (e.g. Zyprexa and Respirdal)S d ti i ht i di iSedation, weight gain, dizziness, orthostatic hypotension

A tid tAntidepressants

Multimechanism Serotonin

EffexorWelbutrin

ProzacPaxile but

TCARemeron

aZoloftLuvoxRemeron

CymbaltaLuvoxLexaproCelexaCelexa

Selective Serotonin Reuptake Inhibitors

ProzacPaxil

The most common side effects of SSRI medications are: Nausea, diarrhea, Paxil

Zoloftheadache, restlessness, insomnia, anxiety, sexual dysfunction, perspiration, tremor, insomnia,

LuvoxCelexa

perspiration, tremor, insomnia, sleepiness, dry mouth.

Lexapro

A i t Di dAnxiety Disorders

Serotonin Benzodiazepines

ProzacPaxil

ValiumAtivanPaxil

ZoloftLuvox

AtivanXanaxKlonopinLuvox

CelexaLexapro

KlonopinLibrium

Lexapro

Bipolar Disorder MedicationsLithium .6-1.2 mEq/L tremor, N/V, kidney,

thyroid, acne,y , ,sedation

Depakote 50-120ug/ml N/V, wt,sedation,hair loss

Tegretol 6-12 ug/ml sedation, N/V, rash

L k t fLook out for:

Coma, kidney, Heart -Lithium

Liver, Pancreas, Skin, Ovary, Blood-Depakote

Blood, Skin, Liver -Tegretol

Benzodiazepines’ p5 Dangerous Ds

DependenceDependenceDisinhibitionDizzinessDepressionDeficits in Memory

ADHD Treatments

NorepinepherineAnd Dopamine

AdderallVyvanse

DopamineRitaline

ConcertaFocalin VyvanseFocalin

NorepinephrineStrattera

a2-agonist Intunive

Attention Deficit Hyperactivity yp yDisorder

Stimulants (Ritalin, Dexedrine, Adderall, Concerta, Cylert)Cylert)

Blood Pressure Medication (clonidine and Tenex))

WellbutrinTricyclic Anti-Depressants (ImipramineTricyclic Anti-Depressants (Imipramine, Desipramine)

Strattera (atomoxetine)Strattera (atomoxetine)

HHOW ABOUT NATURAL MEDS?

Omega-3DHEADHEASt. John's Wort

lMelatonin

Sun-Times 6/04

Multi-mechanism AntidepressantsEffexor -weight loss, insomnia, nausea, sleepiness, anxiety, decreased appetite. Other side effects include: blurry vision, dizziness, constipation, seizures, changes in blood pressure, decreased energy, sweating, sexualseizures, changes in blood pressure, decreased energy, sweating, sexual dysfunction, dry mouth, yawning.Welbutrin -Nausea, vomiting, sweating, dry mouth, nervousness, constipation dizziness Other side effects include: seizure insomnia motorconstipation, dizziness. Other side effects include: seizure, insomnia, motor tics, rash.Tricyclic Antidepressants -weight gain, weight loss, sleepiness, irritability and aggression dizziness sexual dysfunction changes in breast sizeand aggression, dizziness, sexual dysfunction, changes in breast size, nightmares, stuttering, sensitivity to the sun. Severe side effects include: seizures, irregular heart beats, rash, hallucinations.

R b f l i h i h iRemeron- be careful with weight gain

Serzone – be careful with liver failure

Child Issues

Diagnostic nosology difficult to apply to childrenDiagnostic nosology difficult to apply to children and adolescents.Symptom/Syndrome treatment should be theSymptom/Syndrome treatment should be the focus when there is diagnostic uncertainty.Reconsider the intervention every 6-12 months.Reconsider the intervention every 6 12 months.Start low and go slow.

Figiuring out Prescriptions

Pharmacy Abbreviations

p.o. By mouthi m Intramuscularlyi.m. IntramuscularlyTab tablet

lCap CapsuleLiq LiquidElix Elixer

More Pharmacy Abbreviations

Am morningPm evening (afternoon)Pm evening (afternoon)Hs at bedtimeQ everyPrn as needed

Even more Abbreviations

qD once dailyBid twice dailyBid twice dailyTid three times daily

d f d lQid for times dailyQ6h every six hoursQod every other dayTsp teaspoon (5ml)Tbsp tablespoonTsp teaspoon (5ml)Tbsp tablespoon

(15ml)

MedicationSig. (Directions)Sig. (Directions)

#NumberNumber