Transcript Psychotropic Medication

Psychotropic Medication
Iowa Psychiatric Society
April 2010
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I-PART
1.
2.
Iowa-Program Assistance Response Team
The goal of I-PART is to assist community
service organizations and programs to manage
the serious behavioral problems of clients
enrolled in their programs so that the clients are
able to retain their community placements and
not be institutionalized, arrested or admitted to
jail, or considered for emergency discharge
from the community program
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Contacting I-PART
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Developmental Disability
1.
2.
3.
A severe, chronic disability that:
a.
Is attributable to a psychological or physical
impairment or some combination thereof
b.
Is manifested before age 22
c.
Is likely to continue indefinitely
Results in substantial functional impairments in three
or more major life activities
Reflects the individual’s need for a combination and
sequence of special, interdisciplinary, or generic care,
treatment, or other services that are lifelong or of
extended duration and are individually planned and
coordinated
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Diagnostic Criteria for Mental Retardation
1.
2.
3.
Significantly sub average intellectual functioning
a.
An IQ of approximately 70 or below on an
individually administered IQ test
Concurrent deficits or impairments in present
adaptive functioning
a.
The person’s effectiveness in meeting the
standards expected for his or her age by his
or her cultural group
Onset before 18 years of age
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Associated Features of Levels of
Mental Retardation
Level of Mental
Retardation
IQ Range
Percentage of
Mentally
Retarded
Population
Highest
Expected Level
of Academic
Achievement
Approximate
Mental Age
Mild Mental
Retardation
50 to 69
85%
6th Grade
11
Moderate
Mental
Retardation
35 to 49
10%
2nd Grade
7
Severe Mental
Retardation
20 to 34
3%
Survival Words
4
Profound
Mental
Retardation
Less than 20
2%
Directions,
Colors
2
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Associated Features of Levels of
Mental Retardation
Level of Mental
Retardation
Appearance
Probable
Employment
Situation
Expected Level of
Self-Care
Level of Support
Required to
Function
Successfully
Mild Mental
Retardation
Do Not “Look”
Different From NonDisabled Peers
Competitive
Settings
Perform Self-Help
Skills
Independently
Intermittent
(Episodic Need)
Moderate Mental
Retardation
May or May Not
“Look” Different
From Non-Disabled
Peers
Modified
Competitive
Settings
Perform Self-Help
Skills with Minimal
Assistance
Limited (Needed
for Specific
Periods of Time)
Severe Mental
Retardation
“Look” Different
From Non-Disabled
Peers
Modified
Competitive or
Non-Competitive
Setting (Sheltered
Workshop)
May Master Very
Basic Self-Help
Skills
Extensive
(Needed Regularly
for an Extended
Period of Time)
Profound Mental
Retardation
“Look” Different
From Non-Disabled
Peers
Non-Competitive
Setting (Sheltered
Workshop)
May Develop Very
Basic Self-Help
Skills
Pervasive (LifeLong, Intense
Need)
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Diagnostic Criteria for Autistic Disorder
1.
Qualitative impairment in reciprocal social
interaction
a. Marked lack of awareness of the existence or
the feelings of others
b. No or abnormal seeking of comfort at times
of distress
c. No or impaired imitation
d. No or abnormal social play
e. Gross impairment in ability to make
peer friendships
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Diagnostic Criteria for Autistic Disorder -- continued
2.
Qualitative impairment in verbal and nonverbal
communication, and in imaginative activity
a.
No mode of communication
b.
Markedly abnormal nonverbal
communication
c.
Marked abnormalities in the production of
speech
d.
Marked abnormalities in the form or
content of speech
e.
Marked impairment in the ability to initiate or
sustain a conversation with others, despite
adequate speech
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Diagnostic Criteria for Autistic Disorder -- continued
3.
Markedly restricted repertoire of activities and
interests
a. Stereotyped body movements
b. Persistent preoccupation with parts of objects
or attachment to unusual objects
c.
Marked distress over changes in trivial
aspects of environment
d. Unreasonable insistence on following
routines in precise detail
e. Markedly restricted range of interests and a
preoccupation with one narrow interest
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Guidelines for the Use of Psychotropic Medication
1.
Definition of Psychotropic
Medication
8. Tardive Dyskinesia Monitoring
2.
Inappropriate Use
9. Regular and Systematic review
3.
Multidisciplinary Care Plan
10. Lowest Optimal Effective Dose
4.
Diagnostic and Functional
Assessment
11. Frequent Changes
5.
Informed Consent
12. Polypharmacy
6.
Index Measures and Empirical
Measurement
13. Practices to minimize
7.
Side Effects Monitoring
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1. Definition of Psychotropic Medication
1.
2.
Psychotropic medication is any drug prescribed
to stabilize or improve mood, mental status,
and / or behavior
Classes of Psychotropic Medication:
a.
Antianxiety
b.
Antidepressant
c.
Antipsychotic
d.
Mood Stabilizers
e.
Stimulant
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2. Inappropriate Use
1.
Psychotropic medication should not be used:
a.
Excessively
b.
As punishment
c.
For staff convenience
d.
As a substitute for meaningful
psychosocial services
e.
In quantities that interfere with an
individual’s quality of life
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3. Multidisciplinary Care Plan
1.
2.
3.
Psychotropic medication should be used as
part of a coordinated multidisciplinary care plan
designed to improve an individual’s quality of
life
Psychotropic medication alone does not
constitute a coordinated multidisciplinary care
plan
Multidisciplinary team members should not
work in isolation
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4. Diagnostic and Functional Assessment
1.
2.
The use of psychotropic medication should be
based on:
a.
a psychiatric diagnosis
or
b.
a specific behavioral pharmacological
hypothesis if a psychiatric diagnosis is
unclear
The use of psychotropic medication should result
from psychodiagnostic and functional assessments
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5. Informed Consent
1.
2.
Written informed consent (or documented
verbal consent until written consent is
obtained) must be obtained from the
individual, if competent, or the individual’s
guardian, before the use of psychotropic
medication
Informed consent should be periodically
renewed
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6. Index Measures and Empirical Measurement
1.
2.
3.
Empirical measurement techniques should be used in
order to evaluate and monitor the efficacy of
psychotropic medication
Index measures should be:
a.
objectively defined
b.
and tracked
Index measures include:
a.
Target behaviors
b.
Signs (observable evidence)
c.
Symptoms (subjective reports of the individual)
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7. Side Effects Monitoring
1.
The individual must be monitored for side
effects on a regular and systematic basis,
using an accepted methodology which
includes the use of standardized
assessment instruments
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8. Tardive Dyskinesia Monitoring
1.
If antipsychotic medication or other
dopamine-blocking drugs are prescribed,
the individual must be monitored for
tardive dyskinesia on a regular and
systematic basis, using an accepted
methodology which includes the use of
standardized assessment instruments
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9. Regular and Systematic Review
1.
2.
3.
Psychotropic medication should be reviewed
on a regular and systematic basis
Regular means at least once every 3
months, and within 1 month of drug or dose
changes
Systematic means a coordinated procedure
between all parties to share, review,
document and act on information concerning
psychotropic medication and its effects
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10. Lowest Optimal Effective Dose
1.
2.
Psychotropic medication should be
reviewed on a periodic and systematic
basis to determine whether it is still
necessary, and, it it is, whether the lowest
optimal effective dose is prescribed
Lowest optimal effective dose is the least
amount of medication required to improve
or stabilize the problem
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11. Frequent Changes
1.
Frequent drug and dose changes
should be avoided
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12. Polypharmacy
1.
2.
3.
4.
Psychotropic medication regimens should be
kept as simple as possible so as to enhance
compliance and minimize side effects
Except in unusual cases, polypharmacy is
rarely justified, and should be avoided
Intraclass polypharmacy is the use of two or
more psychotropic medications from the same
therapeutic class
Interclass polypharmacy is the use of 3 or more
psychotropic medications
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13. Practices to Minimize
1.
2.
3.
4.
5.
6.
7.
Long-term use of PRN orders
Long-term use of antianxiety medications, especially
benzodiazepines
Use of long-lasting sedative / hypnotics
Long-term use of shorter acting sedative / hypnotics
Use of anticholinergic medication in the absence of
signs of extrapyramidal side effects
Long-term use of anticholinergic medication
Use of antipsychotic medication at doses above the
typical package insert maintenance range
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