1. Psychopharmacology Dr. Dawn-Elise Snipes Ph.D., LMHC, CRC, NCC Stephanie Adams LPC Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

2. To identify and define the purpose of 9 types of psychotropic drug classes. To name common side effects and risks of these classes of drugs. To list the five strategies for aiding tobacco users willing to quit (Five A’s) and unwilling to quit (5 Rs). To identify and describe life-threatening syndromes that can develop as a result of taking psychopharmacological medication. To familiarize the counselor with ways to interact with their client’s medical doctor. To educate the counselor in ways to encourage medication compliance in client sessions. Objectives Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

3. Common Antipsychotics: haloperidol (Haldol), loxapine (Loxitane, Daxolin), aripiprazole (Abilify), quetiapinefumarate (Seroquel), risperidone (Risperdal), ziprasidone (Geodon) Two types: traditional and novel/atypical, classified by how they work on the body. Atypical antipsychotics are somewhat less likely to produce neuroleptic malignant syndrome or tardivedyskinesia. Antipsychotics/Neuroleptics Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

4. Generally not advised during first trimester of pregnancy. Side effects of traditional antipsychotics include: tardivedyskinesia (twitching & involuntary muscle movements) neuroleptic malignant syndrome (potentially deadly and rare neurological disorder). Side effects of novel/atypical antipsychotics might include: elevated blood sugar and weight gain. Either can cause drowsiness, restlessness, upset stomach, low blood pressure, reduced enthusiasm or muscle rigidity. Cautions and Side Effects Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

5. Brand names include: Symmetrel, Symadine, Cogentin, Benadryl and Artane. Used to compensate for side effects that result from taking antipsychotics. Side effects might include dry mouth, dizziness, light-headedness, or irritability. It is unclear how it will affect a pregnant woman (Symmetrel & Symadine may produce deformities). Women should discuss with their doctor before use. Antiparkinsonian Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

6. Antimanic drugs focus on reducing hyperactivity, illogical thought and pressured speech, as well as improving sleep and concentration. Can also use antipsychotics such as Abilify, Seroquel, and Risperdol to control symptoms. Can use anticonvulsant medication to curb manic symptoms, though not approved by FDA for this particular use. Most antimanic medication is given multiple times per day. Antimanic Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

7. Lithium, possibly the most well-known antimanic medication, qualifies as Evidence-Based Treatment (EBT) for Bipolar I. Potential danger: lithium toxicity, when too much lithium exists in the blood. Lithium toxicity is characterized by nausea, vomiting, diarrhea, drowsiness, slurred speech, confusion, dizziness, muscle twitching, blurred vision & irritability. Too much or too little fluid intake and too much sweating (decreasing sodium in the body) can reduce effectiveness. Pregnant women who take lithium during the first 3 months of pregnancy risk birth defects. Lithium Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

8. SSRIs are most frequently prescribed, low side effects. Celexa, Lexapro, Prozac, Zoloft, Paxil, Luvox Tricyclics & Quatracyclicsolder and less commonly used. Older Tricyclics are less expensive. Vivactil, Nopramin, Elavil MAO Inhibitors used for “atypical” depressions (oversleeping, panic attacks, phobias) or when nothing else works. Must be extremely careful of food interactions. Marplan, Nardil “Other” kinds of antidepressants include Wellbutrin, Cymbalta & Effexor. Antidepressants Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

9. Usually take 3-4 weeks to show symptom improvement and several months for full effect. Antidepressants also used to treat OCD, social phobia, anxiety disorders. Long-term treatment is essential, 2 years is recommended. Risks of quitting early include medication resistance and decompensation. The Facts on Antidepressants Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

10. SSRIs – sexual side effects (ability and desire), change in appetite, anxiety, agitation, shakiness, insomnia, weight loss or gain, confusion, nervousness. Tri & Quatra – allergic reactions, sexual side effects, heartbeat disturbance, blurred vision, fatigue, kidney failure (Asendin) seizures. MAO – insomnia, fluid retention, high blood pressure, lack of appetite, rapid heartbeat, headache, dizziness. SSRIs have mostly been found to be safe for use during pregnancy, although sometimes withdrawal signs in newborn have been noted. MAO Inhibitors should NOT be used during pregnancy. Side Effects Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

11. Benzodiazapines: work by depressing the CNS, results within days. (Xanax, Klonopin, Valium, Ativan). Beta blockers: impacting the CNS to reduce fight or flight. (Inderal) Other: includes antihistamines, antipsychotics, and other medications that work on the serotonin system. (Lyrica, Seroquel, BuSpar) Most commonly used for anxiety are SSRIs and benzodiazapines. Antianxiety Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

12. Benzodiazapines are relatively difficult to abuse by people without a history of substance abuse, but have potential for physical tolerance, and can be life-threatening when abruptly withdrawn. Use in third trimester of pregnancy can cause infant withdrawal symptoms. Alcohol and benzodiazapines used together may stop breathing and cause death. Many antianxiety medications (beta-blockers, BuSpar, Atarax and Vistaril) are non-addictive. Antianxiety medications can cause depression, lightheadedness, fatigue, heart collapse, confusion, and suppressed breathing among other things. Alcohol in combination with nearly any antianxiety drug can cause major medical issues. Cautions Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

13. Includes forms of amphetamines, going by names such as Ritalin & Adderall. Non-stimulants for ADHD include Wellbutrin, Strattera and Tenex. These are non-addictive and do not cause a high. In addition to use with ADHD, stimulants can also be used for obesity, narcolepsy and occasionally depression. A person taking stimulants risks loss of appetite, nervousness, euphoria, excitability, delayed growth, sleeplessness and more. Potential for tolerance and abuse. Stimulant Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

14. Wide class of drugs that includes Dilaudid, Demoral, Methadone, Morphine, Coedine, Percocet, Percoden, and Darvocet. Used for pain relief. Methadone has been used to treat heroin withdrawal. Risks include stomach upset, tolerance, slowed breathing, vision and cognitive difficulties. Use in pregnant women can cause infant dependence and withdrawal. Narcotic and Opiod Analgesics Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

15. Includes barbiturates (Seconal) benzodiazapines, anticonvulsants, sedating antidepressants and antipsychotics. Used to aid in sleep. “Rebound insomnia” in which abrupt cessation of medication causes insomnia, can occur with medications like Ambien and Sonata (non-benzodiazapines). All hypnotics rapidly develop tolerance and cannot be used for long. For this reason, doctors tend to lean towards antidepressants, anticonvulsants and antihistamines with sedative properties. Hypnotics Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

16. Alcohol withdrawal: benzodiazapines (most common), anticonvulsants and barbiturates. Opiod withdrawal: used in conjunction with sedatives, clonodine (reduces high blood pressure) shows results for mild withdrawal, for major withdrawal methadone or buprenorphine is often successful. Tobacco: Falls into two categories: Nicotine replacement (Nicoderm CQ, Nicorette) or pharmacotherapy. (Chantix) Addiction Treatment Medications Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

17. Brief Counselor Strategies for Tobacco Users Ask about tobacco use and other times they have tried to quit. Advise abstinence. Assess willingness to quit in next 30 days. Assist the effort to quit. Arrange follow-up help. Five A’s Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

18. Brief Counselor Strategies for Tobacco Users Unwilling to Quit Relevance of quitting (Why does it matter to them?) Risks of continued use. Rewards of quitting. (Identify) Roadblocks to quitting. (Use) Repetition Five R’s Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

19. There are a variety of different medications that can be used to help people with mental health and/or addiction issues It is important to ensure that symptoms are not due to substance use or a general medical condition For many people it is helpful to discuss how long they will be on medications and the side effects. Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Summary