Jamie Rusch

Psychiatric Medications

› Always been a part of mental health care – Legal or illegal , prescribed or self-administered

› Sedatives played a large role inside institutions› Illegal drugs played a role outside of institutions› Specific drugs became reality after WWII

History

Medications. (n.d.). National Alliance on Mental Illness. Retrieved March 14, 2014, from http://www.nami.org/Template.cfm?Section=About_Medications&Template=/TaggedPgeMental Health Medications. (2008, July 8). National Institute of Mental Health. Retrieved March 13, 2014, from http://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml?utm_source=twitterfeed&utm_medium=twitter.

› 1940s and early 1950s, French company explored sedatives› Discovered chlorpromazine– Relaxed patients but did not make them tired

› Psychiatrists claimed this “straightened out disordered thinking”› Quickly caught on in North America and Europe– Less dangerous than lobotomies or electroconvulsive therapy

History Continued

Medications. (n.d.). National Alliance on Mental Illness. Retrieved March 14, 2014, from http://www.nami.org/Template.cfm?Section=About_Medications&Template=/TaggedPgeMental Health Medications. (2008, July 8). National Institute of Mental Health. Retrieved March 13, 2014, from http://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml?utm_source=twitterfeed&utm_medium=twitter.

› Concept of a “magic bullet” drove research› Laboratory research led to drug boom– Minor tranquilizers for anxiety– Anti-psychotics– Antidepressants– Mood stabilizers– Attention Deficit Disorder medication

History Continued

Medications. (n.d.). National Alliance on Mental Illness. Retrieved March 14, 2014, from http://www.nami.org/Template.cfm?Section=About_Medications&Template=/TaggedPgeMental Health Medications. (2008, July 8). National Institute of Mental Health. Retrieved March 13, 2014, from http://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml?utm_source=twitterfeed&utm_medium=twitter.

› Medications affected how mental illness was treated› Medication availability helped closure of mental institutions› Social impact– Awareness prompted discussion and reduced stigma– Thought of as chemical imbalance– In turn, increased psychiatric drug market

History continued

Medications. (n.d.). National Alliance on Mental Illness. Retrieved March 14, 2014, from http://www.nami.org/Template.cfm?Section=About_Medications&Template=/TaggedPgeMental Health Medications. (2008, July 8). National Institute of Mental Health. Retrieved March 13, 2014, from http://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml?utm_source=twitterfeed&utm_medium=twitter.

› Schizophrenia› Depression› Bipolar Disorder› ADHD

Most Common Disorders at Cherokee Mental Health Institute

› Neurotransmitters- chemicals in the brain that transmit messages to a receiving neuron in the brain

› Too much dopamine in subcortical part (cognition and emotion) of brain

› Not enough dopamine in prefrontal (organization, attention and motivation)

› Abnormal Serotonin, GABA, and glutamate

Schizophrenia-What’s different?

Hoeksema, S. (2013). Abnormal psychology (5th ed). New York, N.Y.: McGrawHill.McKim, W. A., & Hancock, S. D. (2012). Drugs and behavior: an introduction to behavioral pharmacology. (7th ed.). Boston: Pearson.

› Typical antipsychotics (available since 1950s)– Haloperidol– Chlorpromazine– Perphenazine

› Rebalance dopamine,› Improves thinking, mood, organization, hallucinations, and

delusions

Schizophrenia-Medications

Hoeksema, S. (2013). Abnormal psychology (5th ed). New York, N.Y.: McGrawHill. McKim, W. A., & Hancock, S. D. (2012). Drugs and behavior: an introduction to behavioral pharmacology. (7th ed.). Boston: Pearson.Medications. (n.d.). National Alliance on Mental Illness. Retrieved March 14, 2014, from http://www.nami.org/Template.cfm?Section=About_Medications&Template=/TaggedPgeMental Health Medications. (2008, July 8). National Institute of Mental Health. Retrieved March 13, 2014, from http://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml?utm_source=twitterfeed&utm_medium=twitter.

› Atypical antipsychotics (available since 1990s)– Risperidone (Risperdal)– Olanzapine (Zyprexa)– Quetiapine (Seroquel)

› Rebalances dopamine AND serotonin› Improves thinking, mood, behavior, delusions, hallucinations,

motivation

Schizophrenia: Medications

McKim, W. A., & Hancock, S. D. (2012). Drugs and behavior: an introduction to behavioral pharmacology. (7th ed.). Boston: Pearson.Medications. (n.d.). National Alliance on Mental Illness. Retrieved March 14, 2014, from http://www.nami.org/Template.cfm?Section=About_Medications&Template=/TaggedPge.Mental Health Medications. (2008, July 8). National Institute of Mental Health. Retrieved March 13, 2014, from http://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml?utm_source=twitterfeed&utm_medium=twitter.

› Weight gain› Drowsiness› Blurred vision› Rapid heartbeat› Tremors and muscles spasms› Long-term kidney damage and tardive dyskinesia

(uncontrollable muscle movement)

Schizophrenia: Medication Side Effects

Medications. (n.d.). National Alliance on Mental Illness. Retrieved March 14, 2014, from http://www.nami.org/Template.cfm?Section=About_Medications&Template=/TaggedPgeMental Health Medications. (2008, July 8). National Institute of Mental Health. Retrieved March 13, 2014, from http://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml?utm_source=twitterfeed&utm_medium=twitter.

› Inadequate amounts of– Norepinephrine (attention, motivation, pleasure, reward)– Serotonin – Dopamine (Alertness, energy)

Depression

Hoeksema, S. (2013). Abnormal psychology (5th ed). New York, N.Y.: McGrawHill. McKim, W. A., & Hancock, S. D. (2012). Drugs and behavior: an introduction to behavioral pharmacology. (7th ed.). Boston: Pearson.

› Selective serotonin reuptake inhibitors (SSRIs)– Fluoxetine (Prozac)– Sertraline (Zoloft)– Excitalopram (Lexapro)

› Enhance the action of serotonin› Improve sadness, feelings of helplessness and hopelessness,

loss of interest

Depression: Medications (Antidepressants)

McKim, W. A., & Hancock, S. D. (2012). Drugs and behavior: an introduction to behavioral pharmacology. (7th ed.). Boston: Pearson.Medications. (n.d.). National Alliance on Mental Illness. Retrieved March 14, 2014, from http://www.nami.org/Template.cfm?Section=About_Medications&Template=/TaggedPgeMental Health Medications. (2008, July 8). National Institute of Mental Health. Retrieved March 13, 2014, from http://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml?utm_source=twitterfeed&utm_medium=twitter.

› Serotonin and norepinephrine reuptake inhibitors (SNRIs)– Duloxetine (Cymbalta)– Bupropion (Wellbutrin)

› Enhance action of serotonin and norepinephrine› Used less commonly by CMHI medical providers

Depression: Medications (Antidepressants)

McKim, W. A., & Hancock, S. D. (2012). Drugs and behavior: an introduction to behavioral pharmacology. (7th ed.). Boston: Pearson.Medications. (n.d.). National Alliance on Mental Illness. Retrieved March 14, 2014, from http://www.nami.org/Template.cfm?Section=About_Medications&Template=/TaggedPge.Mental Health Medications. (2008, July 8). National Institute of Mental Health. Retrieved March 13, 2014, from http://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml?utm_source=twitterfeed&utm_medium=twitter.

› Headache› Nausea› Sleeplessness› Weight gain› Agitation

Side effects

Medications. (n.d.). National Alliance on Mental Illness. Retrieved March 14, 2014, from http://www.nami.org/Template.cfm?Section=About_Medications&Template=/TaggedPgeMental Health Medications. (2008, July 8). National Institute of Mental Health. Retrieved March 13, 2014, from http://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml?utm_source=twitterfeed&utm_medium=twitter.

› May involve norepinephrine, serotonin, and many others› Lie dormant and then be activated by a life event

Bipolar Disorder

Hoeksema, S. (2013). Abnormal psychology (5th ed). New York, N.Y.: McGrawHill. McKim, W. A., & Hancock, S. D. (2012). Drugs and behavior: an introduction to behavioral pharmacology. (7th ed.). Boston: Pearson.Thase, M., & Sachs, G. (2000). Bipolar depression: pharmacotherapy. Biological Psychiatry, 48(6), 558-572.

› Mood stabilizers– Lithium (manic and depressive episodes)– Depakote

› Antipsychotics› Antidepressants– Controversial

DISCLAIMER: Bipolar is difficult to treat and takes experimenting and different combinations for everyone!!

Bipolar Disorder: Medications

McKim, W. A., & Hancock, S. D. (2012). Drugs and behavior: an introduction to behavioral pharmacology. (7th ed.). Boston: Pearson.Medications. (n.d.). National Alliance on Mental Illness. Retrieved March 14, 2014, from http://www.nami.org/Template.cfm?Section=About_Medications&Template=/TaggedPge.Mental Health Medications. (2008, July 8). National Institute of Mental Health. Retrieved March 13, 2014, from http://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml?utm_source=twitterfeed&utm_medium=twitter.Thase, M., & Sachs, G. (2000). Bipolar depression: pharmacotherapy. Biological Psychiatry, 48(6), 558-572.

› Dry mouth› Slurred speech› Blackouts› Frequent urination› Hallucinations

Bipolar: Medication Side Effects

Medications. (n.d.). National Alliance on Mental Illness. Retrieved March 14, 2014, from http://www.nami.org/Template.cfm?Section=About_Medications&Template=/TaggedPge.Mental Health Medications. (2008, July 8). National Institute of Mental Health. Retrieved March 13, 2014, from http://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml?utm_source=twitterfeed&utm_medium=twitter.

› High amounts of serotonin in the brain– Affects impulsivity

› Dopamine and norepinephrine function abnormally

Attention Deficit Hyperactivity Disorder (ADHD)

Hoeksema, S. (2013). Abnormal psychology (5th ed). New York, N.Y.: McGrawHill.

› Stimulants– Methylphenidate (Ritalin)– Amphetamine (Adderall)

› Nonstimulants– Atomoxetine (Strattera)

› Improve attention through heightened focus› Do the same thing but without addiction risk

ADHD: Medications

McKim, W. A., & Hancock, S. D. (2012). Drugs and behavior: an introduction to behavioral pharmacology. (7th ed.). Boston: Pearson.Medications. (n.d.). National Alliance on Mental Illness. Retrieved March 14, 2014, from http://www.nami.org/Template.cfm?Section=About_Medications&Template=/TaggedPge.

Mental Health Medications. (2008, July 8). National Institute of Mental Health. Retrieved March 13, 2014, from http://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml?utm_source=twitterfeed&utm_medium=twitter.

› Treating mental illness is tricky› It is not like a virus or an infection› Difficult deciding what medications to use› Takes educated trials as well as trial and error› Medications only work when taken properly

Conclusion

› Craighead, W., & Dunlop, B. W. (2014). Combination Psychotherapy and Antidepressant Medication Treatment for Depression: For Whom, When, and How. Annual Review Of Psychology, 65(1), 267-300. doi:10.1146/annurev.psych.121208.131653

› Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association

› Hoeksema, S. (2013). Abnormal psychology (5th ed). New York, N.Y.: McGrawHill. › McKim, W. A., & Hancock, S. D. (2012). Drugs and behavior: an introduction to behavioral

pharmacology. (7th ed.). Boston: Pearson.› Medications. (n.d.). National Alliance on Mental Illness. Retrieved March 14, 2014, from

http://www.nami.org/Template.cfm?Section=About_Medications&Template=/Ta ggedPge› Mental Health Medications. (2008, July 8). National Institute of Mental Health. Retrieved March 13, 2014,

from http://www.nimh.nih.gov/health/publications/mental-health- medications/index.shtml?utm_source=twitterfeed&utm_medium=twitter.

› Moncrieff, J., Cohen, D., & Porter, S. (2013). The Psychoactive Effects of Psychiatric Medication: The Elephant in the Room. Journal Of Psychoactive Drugs, 45(5), 409-415. doi:10.1080/02791072.2013.845328

› Thase, M., & Sachs, G. (2000). Bipolar depression: pharmacotherapy. Biological Psychiatry, 48(6), 558-572.

References