ERIC Identifier: ED482764
Publication Date: 2003/12
Author: Smith, Robert L.,Garcia, Elda E.
Source: ERIC Clearinghouse on Counseling and Student Services
Psychopharmacology: A Guide for Helping Professionals.
ERIC Digest.
Certain mental disorders are caused by or accompanied by neurochemical
abnormalities. The use of psychotropic medications has dramatically
increased over the past two decades in all age groups, particularly with children. Therefore,
psychopharmacology, the branch of pharmacology dealing with the psychological
effects of drugs, needs to be carefully studied by all helping professionals.
Olfson, Marcus, Weissman, & Jensen (2002) found between 1991 and
1995, the number of 2- to 4 year olds receiving stimulants such as Ritalin or
antidepressants such
as Prozac increased two- to three fold, with even a sharper increase
for Clondidine, which is used to treat insomnia in hyperactive children. The number
of children in the
United States prescribed medications to treat depression, attention-deficit/hyperactivity
disorder (ADHD) or other behavioral conditions nearly tripled between
1986 and 1996.
Dr. Mark Olfson of Columbia University in New York City and colleagues
reviewed surveys of medication use for more than 50,000 people, including about
17,000 children under the age of 18 years in 1986 and 1996. Findings, published
in the May 2002 issue of the Journal of the American Academy of Child and
Adolescent Psychiatry are:
* The number of children taking stimulants such as Ritalin and Adderall,
used to treat
ADHD quadrupled from 6 children per 1,000 in 1986 to 24 per 1,000 in
1996.
* The number of children taking antidepressants such as Prozac or Zoloft,
among
others, rose from 3 children per 1,000 in 1986 to 10 per 1,000 in 1996.
* In 1996, stimulant use was especially common in children aged 6 to
14 years and
antidepressant use was common in children aged 15 to 18 years. (Olfson,
Marcus,
Weissman, & Jensen, 2002)
The increased use of psychotropic medication has been as dramatic for
adolescents,
adults, and particularly the elderly, a clear indication that helping
professionals need to
increase their knowledge base and understanding of psychotropic medications.
This
article addresses: the importance of diagnosis, understanding the basic
psychotropic
medications by name and how they work, an awareness of side-effects/complications,
and the importance of staying current with research in this field.
DIAGNOSIS: A MAJOR ROLE FOR HELPING PROFESSIONALS
Treatment programs to mediate mental health issues are only effective
if there is an
accurate diagnosis. Diagnosis commences long before the beginning of
treatment. This
includes taking a client's history with an emphasis on family of origin.
The standard used for the diagnosis of mental health disorders is the American
Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders
(DSM), but when considering the use of prescriptive drugs diagnosis expands
far beyond the use of the DSM. In conjoint treatment as in the use of psychotherapy
and drugs, clinicians' need to be knowledgeable of: mental health conditions
that warrant consideration of drugs,
medications frequently prescribed for certain disorders, and drug side
effects/problems.
It would also be prudent to be aware of: safe levels of drug dosing,
the drug monitoring process, and psychiatric referrals.
Diagnosis, when psychotropic medication is a consideration, should be
a collaborative
process involving psychiatric and other physicians, the client, the
client's family, and
school based or other health care clinicians. After a comprehensive
diagnostic
evaluation, an individual treatment plan, based on any coexisting mental
and physical
conditions should be selected. Medications should not be considered
as the first or only choice in treatment, but rather as part of a comprehensive
treatment plan when benefits outweigh any risks. Examples of when psychotropic
medications might be considered for children and adolescents follow (Pennsylvania
Department of Public Welfare, Office of Mental Health & Substance Abuse
Services, 2001):
1. The child or adolescent with a psychiatric disorder that is known
to be responsive to psychotropic medication (Schizophrenic, Bipolar Disorder, OCD, ADHD,
Depression).
2. The child or adolescent with a psychiatric disorder that is often
responsive to
psychotropic medication, especially if no improvement occurs through
other
approaches.
3. The child or adolescent for whom a co-occurring or secondary condition
requires
medication.
4. The child or adolescent with symptoms suggestive of a disorder, with
a strong family history of that disorder and positive family response to use of a particular
medication, especially when other interventions are insufficient.
5. The child with an adjustment disorder or acute response to stress,
with symptoms
that are responsive to psychotropic medication such as anxiety following
the death of a
parent.
6. Crisis: An acutely agitated or dangerous child, in need of emergency
assessment
with possible psychiatric hospitalization.
In the United States, one in five children and adolescents suffer from
mental health
problems at any given time, (Healthlink, 2003). The importance of early
and accurate
diagnosis is the key to providing comprehensive treatment. Although
medication is not
considered the first choice of treatment it often becomes part of treatment
along with
counseling. It is therefore important for helping professionals to
enhance their
knowledge base concerning psychotropic medications.
PSYCHOTROPIC MEDICATIONS: A BRIEF OVERVIEW
A number of mental disorders either caused by or accompanied by neurochemical
abnormalities, have been shown to be effectively treated by psychotropic
medications.
Psychotropic medications are referred to as psychiatric medications,
psychoactive
medications, or simply described as prescribed drugs used to stabilize
or improve
mood, mental status, or behavior. Psychotropic medications have two
names; a brand
name or trade name, chosen by the drug manufacturer and a generic name
often
derived from the chemical structure of the drug. The general public
refers to the
psychotropic medication by its brand name, such as Ritalin or Prozac,
while scientific
reports refer to the generic name such as methylphenidate or fluoxetine.
Many generic
names are very similar, such as fluoxetine (Prozac), and fluvoxamine
(Luvox). Both of
these drugs are used as antidepressants. It is important to understand
why one drug
might be preferred over another. For example, both Prozac and Luvox
are considered
antidepressants, they both act on serotonin, and both have mild sedation
qualities. So
why might one of these medications be prescribed over the other? A
number of factors
are considered when determining what drug is be best suited for a client.
The first line of questioning used by psychiatrists is whether the client
or any member of his/her family has a history with the medications being
considered. If it is discovered that either the client or a family member
had success with a particular medication in the past, it is that medication
which is often recommended. However, if there is no such history, other
factors including the client's symptomology and medication tolerance are
considered.
Psychotropic medications are classified by their chemical structure,
their action on the
brain, or their therapeutic action. Major mental illness involves neurochemical
dysfunctions in the subcortical areas of the brain: the limbic system,
basal ganglia,
reticular system and brain stem (Preston, O'Neal, & Talaga, 1997).
Dysfunction in the
brain such as disruption of neurotransmitters can result in a severe
mental health
problem, e.g., major depression. In major depression it has been estimated
that the
neuronal pathways affected represent only about 1 % of the total brain
nerve cells, yet
this condition can be very debilitating for the individual (Preston,
O'Neal, & Talaga,
1997). Not all forms of depression are chemically based, but when physiological
symptoms are present psychotropic drugs, i.e., antidepressant medications,
are quite
effective. Knowledge of the medication's therapeutic action and expected
effect is
valuable information for helping professionals. Table 1 is drawn from
the Mental Health
& Developmental Disabilities Center (2003) and provides examples
of the generic &
brand names, of the most commonly used psychotropic medications and
summarizes
their therapeutic action and intended effect. Helping professionals
should be familiar
with these and other commonly prescribed drugs.
See table at end of digest
PSYCHOTROPIC MEDICATIONS: SIDE EFFECTS
The dramatic increase in the use of psychotropic medications is evident.
Helping
professionals should be knowledgeable of possible side effects when
considering
psychotropic medication. A Health and Safety Alert, Excessive Psychotropic
Medication and Psychotropic Medication Side Effects (2002), describes the
following serious side effects common to most psychotropic drugs:
A. Allergic reaction (difficulty breathing, swelling of lips/face/tongue,
rash or fever).
B. Change in level of alertness (excess sleepiness, insomnia or confusion).
C. Eating problems (nausea, vomiting, weight gain or loss).
D. Change in stool pattern (constipation, diarrhea).
E. Change in heartbeat (slow, fast, irregular) or blood pressure (high
or low).
F. Fainting or dizziness, especially with change in position such as
upon standing.
G. Abnormal posture, movement, or gait.
H. Yellowing of eyes or skin.
I. Unusual bruising or bleeding.
CONCLUSIONS
It is important for helping professionals to identify prescribed medications
(generic and
trade name), their dosage, therapeutic benefits, side effects, and
risks involved, while
remaining familiar with current mental health issues. Helping professionals
can utilize a
number of resources such as electronic sources, textbooks, medical
libraries, courses,
and current research briefs to expand and update their knowledge of
psychopharmacology.
REFERENCES
HealthLink, Medical College of Wisconsin. (2001, Oct.). Children, Mental
Illness and
Medicines. Retrieved on October 4, 2003, from:
http://healthlink.mcw.edu/article/954384940.html
Mental Health & Developmental Disabilities Center (2003). Psychotropic
Medications:
Overview & General Comments. Retrieved October 13, 2003, from:
http://www.npi.ucla.edu/mhdd/INFO/modules/psychotropicmedsoverview.h
tm
Ohio Department of Mental Retardation and Developmental Disabilities,
MUI/Registry
Unit (2002, Mar). Health and Safety Alert: Excessive Psychotropic Medication
and
Psychotropic Medication Side Effects (Information Notice 02-03-08).
Columbus, OH:
Author. Retrieved October 4, 2003, from: http://odmrdd.state.oh.us/ProvidersDoc/2002_Archives/02-03-08.pdf
Pennsylvania Department of Public Welfare, Office of Mental Health &
Substance
Abuse Services. (2001). Possible Clinical Interactions For Psychotropic
Medications for Children and Adolescents. Retrieved October 4, 2003, from:
http://www.dpw.state.pa.us/Omhsas/Guidelines/Ch_Ad_POSSIBLE.asp
Olfson, M., Marcus, S.C., Weissman, M.M. & Jensen, P.S. (2002).
National Trends in the Use of Psychotropic Medications in Children. Journal
of the American Academy of Child and Adolescent Psychiatry, 41, 514-521.
Preston, J., O'Neal, J., & Talaga, M. (1997). Handbook of Clinical
Psychopharmacology for Therapists. Oakland, California: New Harbinger Publications,
Inc.
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Table
==========================================================
==================??
Example Medications and Their Effects??
==========================================================
==================??
Examples (Generic & | Therapeutic | Effect??
Brand Name of Drug) | Action |??
---------------------------------------------------------- ------------------??
Flouxetine (Prozac) | Antidepressants | Elevate mood in people??
Paroxetine (Paxil) | | who are depressed.??
Sertraline (Zoloft) | |??
Imipramine (Tofranil) | |??
---------------------------------------------------------- ------------------??
Clonazepam (Klonapin) | Anti-anxiety | Used to treat anxiety??
Lorazepam (Ativan) | | disorders and reduce??
Buspirone (BuSpar) | | anxiety symptoms.??
---------------------------------------------------------- ------------------??
Carbamazepine (Tegretol) | Mood Stabilizers | Reduce mood swings in??
Lithium (e.g., Lithonate)| | individuals with??
Valproic Acid (Depakene, | | manic-depressive illness.??
Depakote | |??
---------------------------------------------------------- ------------------??
Haloperido (Haldol) | Antipsychotic | Treat psychotic disorders??
Risperidone (Risperdal) | Drugs | such as schizophrenia.??
Olanzapine (Zyprexa) | | Reduce psychotic symptoms??
| | such as hallucinations.??
---------------------------------------------------------- ------------------??
Methyphenidate (Ritalin) | Stimulants | Treat attention -??
Dextroamphetamine | | hyperactivity disorder.??
(Dexedrine) | |??
Pemoline (Cylert) | |??
---------------------------------------------------------- ------------------??
Propanolol (Indural) | Beta Blockers | Treat some forms of severe??
| | aggression.??
---------------------------------------------------------- ------------------??
Naltrexone (RiVea) | Opiate Blockers | Treat some forms of??
| | self-injurious behavior.??
|