Review of Psychotrophic Medications
(An approved North Carolina Division of Health Services Regulation Continuing Education Course)
Common Psychiatric Disorders *Schizophrenia *Depression *Bipolar Disorder *Anxiety *Attention Deficit Hyperactivity Disorder
General Notes on Psychiatric Treatment
*Medications treat symptoms, not cure disorder *Medications work differently for different people *Side Effects can differ based on the following:
-type of medication -liver/kidney function -sex of patient -genetics -body size -other treatments -physical illness -diet -lifestyle habits -dose of
medication
General Notes Continued….. *Monitoring signs/symptoms every 2 weeks and reassess response at 4-8 weeks & if… -clear response: continue treatment 4-8 weeks until symptoms in remission -partial response: (no side effects) - increase dose and reassess in 4 weeks -no response: (or side effects too great) - change medication to different class,
and reassess in 4-8 weeks
Goal of Remission: no symptoms for 2-6 months
General Notes Continued….. *Treatment Duration
-No one should stop medications abruptly -Acute treatment phase: 6-12 weeks - goal is to decrease symptoms &
find dose that works
-Continuation phase: 6-9 months -Maintenance Therapy considered if: *History of 3+ episodes *Severe Episodes *Psychotic features (hear/see things) *Pt with chronic depression 2-5 years
Schizophrenia
Schizophrenia is a mental disorder that makes it hard to: Tell the difference between what is real and not real; Think clearly; Have normal emotional responses; Act normally in social situations. Treatment with Typical or Atypical Antipsychotics
Schizophrenia Treatment (Typical Antipsychotics)
Brand Generic
Thorazine Chlorpromazine
Haldol Haloperidol
Trilafon Perphenazine
Prolixin Fluphenazine
Clozaril Clozapine
Schizophrenia Treatment (Atypical Antipsychotics)
Brand Generic
Risperdal Risperidone
Zyprexa Olanzapine
Seroquel Quetiapine
Geodon Ziprasidone
Abilify Aripiprazole
Invega Paliperidone
Saphris Asenapine
Latuda Lurasidone
Schizophrenia Treatment Side Effects Typical: physical movement changes varying from tremors and spasms to more severe tardive dyskinesia and pseudoparkinsonism. (involuntary movements) Atypical: Weight gain Both Types: drowsiness, dizziness, blurry vision, rapid heartbeat, sensitivity to sunlight, skin rashes, and menstrual problems in women Clozaril: agranulocytosis (WBC loss)
Schizophrenia Treatment Patient Information
*Takes up to 4-6 weeks to see optimum effects *May be sensitive to weather changes due to decrease in sweat production. *Clozapine - WBC checked on a routine basis
Depression
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods.
Depression Treatment (4 Classes) 1.SSRI - Selective serotonin reuptake inhibitors 2.SNRI - Serotonin-norepinephrine reuptake inhibitors 3.TCA - Tricyclic antidepressants 4.Others
Depression Treatment - SSRI
Brand Generic
Prozac Fluoxetine
Celexa Citalopram
Lexapro Escitalopram
Zoloft Sertraline
Paxil Paroxetine
Depression Treatment - SNRI
Brand Generic
Effexor Venlafaxine
Cymbalta Duloxetine
Pristiq Desvenlafaxine
Depression Treatment - TCA
Brand Generic
Elavil Amitriptyline
Tofranil Imipramine
Sinequan Doxepin
Pamelor Nortriptyline
Depression Treatment - Others
Brand Generic
Remeron Mirtazapine
Desyrel Trazodone
Wellbutrin Bupropion
Depression Treatment - Side Effects Nausea: Bupropion, Mirtazapine, SNRI’s, SSRI’s Agitation: Bupropion, Mirtazapine, SSRI’s Fatigue/Sedation: Bupropion, Mirtazapine, Trazodone, SSRI’s, TCA’s Sexual Dysfunction: SSRI’s, TCA’s, SNRI’s Weight Gain: Bupropion, Mirtazapine, SSRI’s, TCA’s Anticholinergic effects: Bupropion, Mirtazapine, SSRI’s, SNRI’s Hypotension: TCA’s
Depression Treatment - Patient Information
*Reassure Depression is a common condition and can be successfully treated *Consider drug interactions with other treatment, that can cause increased
serotonin and/or dopamine, such as the following: -Clonidine -Birth Control -Beta Blockers -High-dose Steroids -Alcohol -CNS Depressants
Bipolar Disorder
Bipolar disorder is a condition in which a person has periods of depression and periods of being extremely happy or being cross or irritable.
Bipolar Disorder Treatment Mood Stabilizers (or anticonvulsants) alone or in combination with antidepressants)
Brand Generic
Mood Stabilizers Eskalith Lithium Carbonate
AntiConvulsants Depakote Divalproex
Tegretol Carbamazepine
Lamictal Lamotrigine
Trileptal Oxcarbazepine
Bipolar Treatment Common Side Effects
Lithium: loss of coordination, excessive thirst, frequent urination, hallucinations, vision changes, edema
Anticonvulsants: weight gain, dizziness, drowsiness, nausea
Divalproex: females can develop polycystic ovarian syndrome
Lamotrigine: skin rash that can be very severe
Bipolar Treatment - Patient Information
*No cure of Bipolar Disorder, treatment is available and can be successful
*Regular monitoring of drug levels, thyroid level, liver and kidney function is recommended
*Keep regular visits with physicians for side effects monitoring & dose escalations or changes
*Have close family member or friend to help monitor on a daily to weekly basis
Anxiety Disorder
Stress can come from any event or thought that makes you feel frustrated, angry, or nervous. Anxiety is a feeling of fear, unease, and worry. The source of these symptoms is not always known.
Anxiety Disorder Treatment (Benzodiazepines)
Brand Generic
Klonopin Clonazepam
Ativan Lorazepam
Xanax Alprazolam
Valium Diazepam
Librium Chlordiazepoxide
Serax Oxazepam
Benzodiazepine Side Effects
Blurred Vision Upset Stomach
Headache Drowsiness Confusion
Anxiety Disorder - Patient Information
*Buspirone (Buspar) is an alternative option. Has less sedative side effects.
*Beta-Blockers (Propranolol) also an option *High chance of dependence with Benzodiazepines,
therefore these medications should be tapered down instead of being stopped abruptly
Attention-Deficit/Hyperactivity Disorder
Attention deficit hyperactivity disorder (ADHD) is a problem of not being able to focus, being overactive, not being able control behavior, or a combination of these. For these problems to be diagnosed as ADHD, they must be out of the normal range for a person's age and development.
ADHD Treatment
Brand Generic
Methylphenidates Ritalin, Methylin Methylphenidate
Metadate ER, Ritalin SR, Methylin ER
Methylphenidate
Focalin Dexamethylphenidate
Concerta, Metadate CD, Ritalin LA, Daytrana
Methylphenidate
Amphetamines Dexadrine Dextroamphetamine
Vyvanse Lisdexampetamine
Adderall Dextramphetamine / Amphetamine
ADHD Treatment Side Effects *Decreased appetite *Insomnia *Abdominal pain *Headaches *Tics *Cardiac Issues
ADHD - Patient Information *Strattera (Atomoxetine) - also approved for ADHD, but has an increased risk of suicide in children *Long-acting should be taken in the morning to prevent lack of sleep/insomnia *Determine if only needed during school/work or all the time
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