Gardner academy jul_2012,_drug_use_and_abuse-1[1]
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Gardner academy jul_2012,_drug_use_and_abuse-1[1]
- 1. Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health Medications: The Basics David Gardner Denise Rowe
- 2. Declaration We don’t know what you know We don’t know what you do day to day We don’t know what you want to know But…. We know stuff about medication and mental illness Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
- 3. “Top of Mind” Issues Side effects Target Symptoms Time to onset Chance of benefiting/being harmed Interaction with licit and illicit substances Monitoring Tools/resources Case Examples Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
- 4. Med Ed Medication Education for Promoting Mental Wellness A Guide for Young People and Those Who Care for Them http://teenmentalhealth.org/resources/entries/med-ed-bookletd
- 5. Med Ed Passport Covers: - Youth oriented - Uninformative, subtle title Med Ed booklet 5
- 6. Medications for Mental Illness and Symptoms
- 7. aripiprazole Abilify
- 9. Prevailing Attitudes Toward Psychotropic Medication in Young People Email Jun 28, 2012 Dr. Gardner: I got the flyer for the Halifax workshop for teen mental health. I was wondering how you could possibly promote psychotropic drugs for teens. You know the side effects and you also no doubt know that they work no better than a placebo. You also know that many of the studies are funded by pharmaceutical companies and are ghost written and this is passed off as "evidence-based medicine". … I was wondering how you can promote "mental health" as the drugging of children and their possible assault with electroconvulsive shock, and you don't mind getting people of child-bearing age addicted to drugs which can affect the unborn child. How, in all conscience, can you do this? Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
- 10. Antidepressants bupropion citalopram escitalopram fluoxetine paroxetine sertraline Uses Time to See Common Serious Other Effect Side Effects Side Effects • Depression • Improved • Sedation • Thoughts of • Can cause side • Anxiety disorders sleep, appetite, • Headache hurting oneself or effects/ • Obsessive energy: 2-4 • Dizziness suicide withdrawal compulsive weeks • Dry mouth • Abnormal bleeding reaction when disorder • Depressed • Nausea, • Serotonin stopped quickly • Panic disorder mood, loss of vomiting and syndrome • Drug • Eating disorders pleasure, diarrhea interactions • Sleep problems pessimism, • Sweating irritability: 4-8 •Sexual weeks dysfunction • Return of functioning: months Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
- 11. Antidepressants: Common Side Effects Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
- 12. Antidepressants Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
- 13. Antipsychotics Aripiprazole Asenapine Clozapine Iloperidone Olanzapine Quetiapine Risperidone Ziprasidone Uses Time to See Effect Common Serious Other Side Effects Side Effects •Psychosis • Hyperactivity, • Sedation • Severe muscle • Maintenance •Bipolar disorder hostility, agitation • Headache spasms therapy may •Disruptive and aggression: • Dry mouth • Neuroleptic reduce risk of behaviour 1 week • Constipation Malignant relapse disorders • Delusions, • Weight gain Syndrome • Aggression hallucinations: • Sexual •Diabetic •Tourette’s 4-8 weeks dysfunction emergencies • Negative •Movement • Seizures symptoms (eg. problems lack of interest): months Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
- 14. Mood Stabilizers Lithium Valproic Acid Lamotrigine Uses Time to See Effect Common Serious Other Side Effects Side Effects • Bipolar disorder • Acute mania: • Sedation • Blood problems; • Patients will • Agitation 7-28 days • Headache may present as likely be on • Aggression • Antidepressant • Dizziness bleeding or medications long- •Seizures effects: • Nausea, bruising easily term 6-8 weeks vomiting and • Severe skin rash •Mood stabilizers diarrhea with fever can interact with • Weight gain OTCs (e.g. pain • Tremor relievers like • Increased thirst ibuprofen) Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
- 15. Stimulants atomoxetine d-amphetamine methylphenidate modafinil Uses Time to See Effect Common Serious Other Side Effects Side Effects • Attention Deficit • Efficacy can be • Headache • Fast or • Dosing regimen Hyperactivity seen right away • Insomnia pounding heart can be tailored to Disorder (ADHD) with the first • Irritability beat suit the • Aggression dose (within 1 • Nausea, • Weight loss needs/lifestyle of • Help with social hour) vomiting and • Slowed growth each patient interactions • Non-stimulants diarrhea • Tics or abnormal • If reduced used to treat • Decreased movements appetite or ADHD can take appetite • Hallucinations weight loss – longer (2-4 recommend high weeks) calorie snacks or take after meal Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
- 16. Anti-anxiety and Sleep Medications Benzodiazepines (benzo’s) Trazodone Zopiclone Uses Time to See Effect Common Serious Other Side Effects Side Effects • Sleep • Antidepressants: • Sedation • Seizures • Benzo’s can cause • Anxiety 4-8 weeks • Headache • Confusion rebound anxiety/ • Agitation • Benzodiazepines: • Dizziness • Thoughts of withdrawal symptoms • Treat side 1-2 hrs; not • Dry mouth hurting when stopped quickly effects of recommended for • Nausea, oneself or • Avoid driving and antipsychotics long term use vomiting and suicide other activities that diarrhea • Abnormal require quick thinking • Sweating bleeding and reaction • Serotonin syndrome Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
- 17. How do you know if the medication is doing more good than harm? Selection Monitoring Combining Dose adjusting Side effect management Stopping Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
- 18. Symptom Tracker A
- 19. Activity Tracker Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
- 20. Side Effect Tracker Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
- 21. Prescriber Checklist Tool Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
- 22. Issues Worth Discussing Further: •Over sedation / cloudy thinking •Dosing: too high/too low •Addiction to meds / misuse / diversion •MJ, alcohol, other substances of abuse •Lack of effectiveness •Pushing pills (family, health providers, teachers) •Confidentiality •Teacher’s / school’s role •Other
- 23. Resources Medications for Mental Health http://teenmentalhealth.org Search: Med Ed http://heretohelp.bc.ca/ Excellent source for mental illness and drug (prescription and illicit) information First person accounts and blogs Multilingual Timothy E. Wilens. Straight Talk About Psychiatric Medications for Kids, 3 rd edition. Guilford Press: NY; 2009. Kalyna Z. Bezchlibnyk-Butler, et al. Clinical Handbook of Psychotropic Drugs for Children and Adolescents. 2007 Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
- 24. Discussion Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Editor's Notes
- PEI CE day Oct 2007
- PEI CE day Oct 2007 Be Flexible, Be Creative: Some youth may want to use the larger booklet exclusively (at home as well as at all appointments) while other may prefer the passport as their main Med Ed resource. The Med Ed resources should be used in a way that maximizes their value and fits the youth’s preferences and needs. When one of the resources is finished (gets filled up or is damaged or is lost) replace it with a new one. Ideally, keep older completed Med Ed resources in a safe place as they can help to keep a record about medications for that person. These youth-focused resources are not intended to replace appropriate documentation practices by health providers, in patient charts for example.
- Serotonin Syndrome (rapid onset of fever, sweating, problems with reflexes, shaking, problems with balance and movements, and confusion) Health providers should be informed about thoughts of hurting oneself or suicide.
- Med Ed - common SE
- Disruptive behaviour disorders includes: ADHD, ODD and conduct disorder Refer to KT session - later in the afternoon Neuroleptic Malignant Syndrome (stiff muscles, sudden confusion, high fever, irregular blood pressure and heart rate)
- - Is everyone aware of what OTCs are? - medications that you don’t need a prescription for. Importance of talking to the pharmacist to check for interactions.
- Benzos not recommended for > 4-8 wks