Use of Medication

Test review

• Stages of change• Substance-related disorders:

– know the difference between use and induced disorders

– be able to describe abuse and dependence

• Medications:– Important terms– Stepwise treatment– Your role re: meds– Reasons why clients discontinue meds

Important terms

• Pharmacotherapy-treatment with medication

• Psychotropics-drugs that affect mental functioning

• Neuroleptics-antipsychotic meds

• Psychoactive-drugs with acute effects on mood, thought, behavior

General issues

• For some disorders, medication is a core part of treatment.

• Meds treat the symptoms, they don’t cure the disorder.

• Psychotropics don’t typically cause physiological dependence.

• Meds are approved for specific disorders.• They are often used “off-label.”• Stepwise treatment is preferred.

Stepwise Treatment

1. Nonpharmacological approaches first

2. Medications with low abuse potential

3. Varied treatment approaches are complementary, not competitive…this and that, as opposed to this or that.

Your role

• Document clearly and consicely• Describe sx, side effects, difficulties cx is

experiencing. • Give information, not recommendations• Talk with cx about their meds

– Educate– Ask about how it is helpful– Consistency– Reasons why they missed meds

Why do clients dc medication?

1. Side effects are unpleasant

2. Sx diminish or go away

3. Sx are familiar and possible pleasant

4. Life is too disorganized to keep track

5. Preference for nonprescribed drugs

6. Limited or no improvement

7. Rebellion, aka autonomous

Antidepressants• Tricyclics

• Monoamine Oxidase Inhibitors (MAOIs)

• SSRIs or SRIs

• SNRIs-effexor, cymbalta

Special considerations-antidepressants

• Gradual increase in blood level=gradual reduction of sx.

• Sometimes a reduction of side effects.

• Discontinuation syndrome with 6 weeks or more use & abrupt discontinuation.

• Serotonin syndrome-restless, extreme nervousness, tremor, confusion

Antimanics

• Lithium

• Anticonvulsants-tegretol, depakote, etc.

Special considerations

• Blood tests are required to monitor lithium level

• Therapeutic dose is close to toxic dose

Antipsychotics• Traditional• Atypical or novel

Special considerations• Gradual increase in effect• Medication for side effects• Tardive dyskinesia• Blood tests required for some

Anxiolytics • Benzodiazepines• “Other”-buspirone• SSRIs-luvox (ocd), paxel (gad), zoloft (ptsd)

Special considerationsBenzos are addictiveBenzos can be taken “prn” and have immediate

effect.“Other” includes buspirone, which builds up in

system over time.

Stimulants

• Ritalin

• Adderall

Special considerations

• Stimulants may be abused

• Non stimulants (SNRIs) are sometimes used for ADHD

Too many meds?