Mental Health Book Chapter 8

herbal and alternative therapies

-Kava Kava (root)- reduces anxiety -St. John's wort (an herb)- used in Europe for depression -S-adenosylmethionine (SAMe)- occurs naturally in brain, can help depression -Valerian (herb)- positive effects for insomnia

concerns related to the internet

- misinformation can cause patients to abandon medication for alternative remedy, order fake meds online, or try herbs/remedies that are claimed to help their symptoms with no proof -listen to what patients say about what they find online

Other biological treatments (1)

-ECT (electroconvulsive therapy): electrical shock applied to temples which causes convulsion, relieves severe depression and decreases suicide risk, usually given over several weeks for 8-12 treatments, may cause confusion and memory loss -psychosurgery- older technique where the brain connections are cut (lobotomy), only used today for seizures or depression/violence that will not go away -gamma radiation surgery is experimental technique for OCD

The psychotropic drugs and their side effects: antidepressant drugs (4)

-SNRI side effects: more effective for remission, high blood pressure, sexual side effects, risk of withdrawal problems and overdose -most antidepressant side effects: withdrawal symptoms if stopped quickly, can be used to overdose, sleepy feeling, decreased sexual functioning -all antidepressants take time to work, at least 7-10 days and reach full effectiveness at 3 weeks

Psychotropic Medications

-alter or change the way the brain works -need to know how they work so you know how they will impact someone's occuaptions, how to mointor symtoms -know the classes of drugs, problems for which they are prescribed, and common side effects -psychotropic medicine development is ongoing

How Psychotropic Drugs Work (2)

-antidepressants alter serotonin levels or other neurotransmitters -most drugs are taken orally (tablets, capsules, extended-release capsules) -can be liquid, can be injections -injections can be in depot formulation which last longer and is only needed every few weeks -depot injections increase adherence to medicine plan

The psychotropic drugs and their side effects: antianxiety drugs

-control anxiety for non-psychotic disorders -benzodiazepines can be addicting -sleep medications and antianxiety drugs can decrease alertness and impair driving skills

consumer concerns related to medications (1)

-different effectiveness between brand name and generic -inactive ingredients in drug could be intolerable -time-release drugs could be absorbed differently in different people -adherence (taking medicine as prescribed) can be difficult because: inconvenience, feeling unnatural to take meds, feel medicine is toxic or unhealthy, unpleasant side effects, side effects occurring before effectiveness of drug kicks in, complicated medication schedules, taking a lot of meds, cost of medicine, buy meds online and they are wrong, preference for illegal drugs, start to feel better and think they don't need meds

The role of the OT practitioner: issues related to adherence, and to use of other medications and substances (2)

-discuss medicine-related changes to functional skills with patient and doctor -need to report use of other medicines/substances to doctor, either by encouraging patient to report to doctor or doing it directly

The role of the OT practitioner: management of side effects

-help clients learn to identify, tolerate, and adapt to side effects -patients may consider symptoms worse than the diagnosis -engage client in discussio nand reflection on daily beenfits of drug, dangers of relapse

The psychotropic drugs and their side effects: antidepressant drugs (1)

-increase risk of suicide for people under 25 -often trial different drugs before finding best one -antidepressants can become less effective over time 5 types depending on neurotramsitter effect 1) tricyclics and heterocyclics: block the reuptake of norepinephrine -side effects: dry mouth, blurred vision, consitpation, seizures 2) monoamine oxidase inhibitors (MAOIs): block action of monoamine oxidase

The role of the OT practitioner: observing and reporting functional level

-medicine affects occupational performance and functional skills -OT provides baseline assessment of skills before medicine is started for comparison -helpful to remind patients of functional progress from medicine as they might focus on the negative

The psychotropic drugs and their side effects: antimanic drugs

-mood stabilizing drugs reduce mood swing intensity -prescribed for bipolar with manic symptoms -one type contains lithium, which need sot be monitored through blood test because it is toxic -initial side effects of lithium (2-3 weeks): diarrhea, dry mouth, frequent urniation, drowsiness, fatigue -lasting side effects of lithium: fine hand tremor (can be controlled by drug called propranolol) -signs of lithium overdose: gross bilateral hand tremors and ataxia, jaundice, diarrhea, vomiting -anticonvulsants can also be used (often prescribed with antipsychotics)

consumer concerns related to medications (2)

-nonadherence is more than 50% withing one year -it can take a while for drugs to work or to find the right drug -medicine could stop working or need to be increased -physical and congitive deificits, especially in older people (open the bottles, swallowing, vision, memory) can affect adherence -caregiver/family issues: purposefully mess up meds because they don't like the side effects on their family member, inconvenience of medicine schedule for caregiver,

The psychotropic drugs and their side effects: antiparkinsonian drugs

-often prescribed with first generation antipsychotics because of the possibility for parkinson's symptoms from the antipsychotics -side effects include: dry mouth, blurred vision, dizziness, nausea

The role of the OT practitioner: issues related to adherence, and to use of other medications and substances (1)

-patients might struggle with strict adherence because of everyday life demands (busy and forget to take meds) -OT/OTA can coach people to report life changes and demands to doctor or reach out to doctor directly -negative side effects (bipolar feeling diminished euphoria, increased fatigue) can cause nonadherence and change in occupational performance

The psychotropic drugs and their side effects: psychostimulant drugs

-prescribed for ADD and ADHD -stimulate and increase mental/physical activity, but have the opposite effect on children -side effects: impaired growth, tics, insomnia -can be abused (especially older drugs like dexedrine and ritalin) because they affect dopamine levels and can result in euphoria -adderall is a mix of amphetamine salts, so it can be abused too -side effects of amphetamines: weight loss due to reduced appetite -alternative: strattera, norepepinephrine reuptake inhibitor, doesn't effect dopamine

The psychotropic drugs and their side effects: Antipsychotic drugs (1)

-prescribed for schizophrenia and psychotic disorders -help bring person in contact with reality reducing hallucinations and delusions -help reduce violent and dangerous behaviors of manic episodes or drug use -second generation antipsychotics can be used for mood disorders, even if no psychotic symptoms are present -older antipsychotics, called first generation, do NOT help negative symptoms of schizophrenia -second generation antipsychotics marketed as better at reducing negative symptoms, but does not seem to be true, they do have more tolerable side effects though

The role of the OT practitioner: driving and other safety concerns

-psychotropic meds can be sedating -driving services only offered to 30% of mental health consumers -need to have assessment and intervention for driving fitness ideally

The role of the OT practitioner: medication education and management

-recovery model: person is in charge of their own recovery, including knowledge of their meds and daily medicine routines -need to be able to talk and collaborate with their doctor -psychoeducation groups: medicine management, knowing side effects, gettting medicine, medicine scheduling -teach life skills of keeping a record of drugs you take and reason for them, reading prescription labels, communicating with doctor if you use multiple pharmacies, keeping drugs away from kids, remembering to take meds

The psychotropic drugs and their side effects: Antipsychotic drugs (2)

-second generation (atypical) are more expensive, can require blood monitoring, lead to weight gain, metabolic syndrome (increases risk for heart disease, diabetes, stroke) -side effects for first generation antipsychotics: movement disorders, sensitivity to sun, dry mouth, blurred vision -movement disorders include: parkinsonism (tremors, slow movement, rigidity, impaired balance), dystonia (painful muscle spasms-face neck and jaw commonly), akathisia (motor restlessness), tardive dyskinesia (possibly permanent uncontrollable facial and finger movement)

The psychotropic drugs and their side effects: Antipsychotic drugs (3)

-side effect of second generation: postural hypotension, breast development (gynecomastia if happens in men), lactation, dry mouth, blurred vision, lower chance than first generation for movement disorders -neuroleptic malignant syndrome (NMS): rare but life-threatening side effect of antipsychotics, includes extreme rigidity, fever at 104 or higher, mental obtundation (mental blurring, reduced alertness, diminished relation to pain)

The psychotropic drugs and their side effects: antidepressant drugs (2)

-side effects: take 3 weeks to take full effect, strict dietary rules-no amino acide tyramine (found in aged cheese, wine, beer, yogurt, tea, coffee, avocados, bananas, soy sauce, pickled items, yeast, protein extract, raisins, dates, chocolate 3) target dopamine and norepinephrine system: the only one is Wellbutrin -side effects: has alerting quality, cause anxiety, mess up sleep, no sexual side effects 4) blocks presynaptic receptors for norepinehrine and serotoinin: the only one is Remeron

The psychotropic drugs and their side effects: antidepressant drugs (3)

-side effects: weight gain, sedation, dizziness, minimal sexual side effects 5) selective serotonin reuptake inhibitors (SSRI) and serotonin and norepinephrine reuptake inhibitors (SNRI) bock reuptake of these neurotransmitters -SSRI side effects: sexual dysfunction, less effective over time, serotonin syndrome (can occur when combining this med with others, includes confusion, agitation, shivering, fever, sweating, jerky movement, incoordination) which is a medical emergency

How Psychotropic Drugs Work (1)

-they affect neurotransmitters, changing the level of brain chemicals (commonly target dopamine, norepinephrine, serotonin -neuroleptics (drugs for schizophrenia) target dopamine system -different antipsychotic drugs target specific dopamine receptors -atypical (newer) antipsychotics only affect certain parts of the brain

Other biological treatments (2)

-vagus nerve stimulation (VNS)- stimulator implanted in chest to stimulate vagus nerve, used for seizure treatment -transcranial magnetic stimulation (TMS)- electrical magnetic impulse applied to forehead (mild form of ECT) -magnetic seizure therapy- same as TMS but higher frequencies used to cause seizures -Bright light therapy (BLT)- exposure to UV light for dression