ERICDIGESTS.ORG

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.
-----
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.??