Transcript Commonly Used Medications for Psychiatric Symptoms

Building Your Mental Health
Toolbox
Christina O’Neill MSW
 Common Psychiatric Symptoms
 Common Psychiatric Diagnosis
 Commonly Used Medications
 Quick Guide to Suicide Assessment
 Case Management tools
Common Psychiatric Symptoms
(Identifying What You Are Seeing)
Psychosis:
collection of symptoms that make it difficult for a person to
connect with reality. Can include positive symptoms such as delusions,
hallucinations, disorganized speech/ behavior or negative symptoms such as
catatonic behavior, psychomotor retardation, lack of speech, social
withdrawal.
Delusions:
belief or impression that is firmly maintained despite being
contradicted by what is generally accepted as reality or rational argument.
Hallucinations:
an experience involving the apparent perception of
something not present; they can be auditory, visual or sensory. Audio
hallucinations will sometime consist of “voices” and they can have a
command component in which they might instruct the person to do
something.
Mania:
(or hypomania- similar behavior lasting shorter amount of time
and usually not as extreme). Inflated self-esteem/ grandiose thinking,
decrease need for sleep/ flight of ideas/ pressured talking/
distractibility/excessive involvement in pleasurable activities with potential
for negative outcome.
Additional Symptoms can include: Extreme Agitation/ Irritability, Disorganization,
Ideas of reference, Tic’s/ Repetitive behaviors, Poor impulse control, Self Harm, Paranoid
Thinking
Common Psychiatric Diagnosis
Psychiatric diagnosis are made by observing a collection of symptoms- these definitions are not
meant to be all inclusive as there are many exceptions to the rules- these are simply meant to
give you a basic understanding of the diagnosis
Bipolar:
Mood Disorder characterized by having episodes of mania,
hypomania, depression or combination of both (mania and depression).
Episodes of severe mania can resemble a psychotic state. Subtypes:
Bipolar I (1 or more manic episode- sometimes with a depressive
episode) and Bipolar II (1 or more depressive episode and at least 1
hypomanic episode).
Major Depression:
Depressed mood, episode lasts more than 2
weeks, disruptive to lifestyle (diminished pleasure, sleep/ eating
disturbances, diminished capacity to concentrate or think).
Schizophrenia:
Psychotic disorder characterized by having
episodes lasting a significant period of time (1 month or more
untreated) of delusions/ hallucinations/ disorganized speech or
behavior. Schizophrenia can also manifest with negative symptoms to
include cationic behavior, delayed speech/ actions, flat affect. Subtypes
include paranoid, disorganized, and catatonic.
Common Psychiatric Diagnosis
(continued)
Schizoaffective disorder:
Schizophrenic type psychotic features
are present for a significant amount of time (1 month or more untreated)
concurrent to manic, major depressive or hypomanic episodes.
Generalized Anxiety Disorder:
Excessive anxiety or worry that
is hard to control (occurs more days than not for at least 6 months) that
cause significant disturbance in ones functioning and include some of the
following symptoms: restless / on edge feelings, easily fatigued, difficult
concentrating, irritability, muscle tension, sleep disturbance.
Personality disorders:
Enduring patterns of inner experiences and
behaviors that deviate from the social norm that are pervasive/ inflexible
over a length of time that lead to distress or impairment. Main Subtypes
include: Borderline, Antisocial, Narcissistic, Dependent, Histrionic, Paranoid,
Obsessive- Compulsive, Avoidant, Schizotypal (cognitive/ perceptual
distortions, eccentric behavior), Schizoid (detachment from social
relationships, restricted range of emotion).
Commonly Used Medications for
Psychiatric Symptoms
(Most of medications listed by brand name for easy recognition instead of generic name)
Things to remember:
Antipsychotics/ Neuroleptics: Zyprexa,
Seroquel, Risperdal, Haldol, Geodon, Clozaril (also
called -clozapine -not to be confused with
clonazepam/Klonopin), Abilify, Latuda, Invega,
Saphris.
Antidepressants: Zoloft, Prozac, Celexa, Paxil,
Wellbutrin, Effexor, Cymbalta, Remeron, Viibryd,
Lexapro, Amitriptyline, trazadone
Mood Stabilizers: Depakote, Tegretol,
Lithium, Neurontin, Lamicatal, Trileptal
*ADHD: (these will test positive on UA) Vyvance,
Concerta, Adderall, Ritalin, Strattera
*Benzodiazepines: (these will test positive on
UA) Ativan (Lorazepam), Klonopin (clonazepam),
Valium (Diazapam), Xanax (alprazolam), Librium
Non Benzodiazepine Anxiety Meds:
Vistaril (antihistamine), Propranolol, Inderal,
Atenolol (beta blockers/ blood pressure meds)
Alcohol Abuse: Campral, Naltrexone, Antibuse
Heroin/Opiate abuse: Suboxone, methadone
Medication is meant to treat the
symptoms, not the diagnosis, so
different meds could be used for
different reasons.
Some antipsychotic meds are
used in low doses for anxiety and
sleep.
Some of the mood stabilizers are
also seizure medications.
* Most will show up positive on
Drug UA’s
Quick Guide to Suicide Assessment
Risk Factors (in no way all-inclusive)
 *Mental health diagnosis*
 *Recent loss/ separation*
 Age (45 years or older)
 Stressors
 Sex (men more lethal/ women
more often)
 Access to weapons
 Substance use/ *Alcohol*
 *Impulsive*
 *Significant depression*
 Lack of insight
 High anxiety
 Trauma
 Financial woes
 *Lack of social support*
 Hopelessness
 Chronic illness
 *Family hx of suicide*
 *Recent hospitalization*
 *Prior attempts*
 *Command hallucinations*
Questions to ask:
Goal is to assess for low/ moderate/ imminent risk of suicide- if there is imminent risk send
person to an emergency room/ crisis clinic for evaluation.
 Assess for Ideation:
(to get the conversation started)

Are you having suicidal thoughts? (Ask for specifics, how long, what kind, plan
specific or generalized wish to not exist?).

For how long? Have these thoughts increased in frequency or intensity?

Are they fleeting thoughts/ intrusive thoughts/ chronic thoughts/ daydream
thoughts?

How do the thoughts make you feel? (Scared, angry, calm, happy, peaceful?)

What do you have to live for? (What are the barriers to suicide? Religion/ family/
job…)
 Asses for Plan:
hospital/clinic)
(If the answer to all three is YES-send to

Do you have a plan/ What is your plan? (Ask specifics if they have them- how,
where, date/ time, with what)

Access to plan? (Do they have pills/ garage/ weapon/ etc.?)

Does plan have lethal intent?
Other factors/ Questions to consider:
(if you still need
more facts to make a decision on client’s safety risk)

Command Hallucinations? (voices telling them to hurt self- very dangerous)

History of suicide in family?

Prior attempts? (Is this episode different than prior attempts? How/ why?)

Poor impulse control? (alcohol/ bipolar/ young age/ personality disorder)

Recent change in affect? (used to be depressed now happy, used to be happy now hopeless)

Too calm? (Often very calm after they have made final decision)

Unable to talk about future?

Lacks working alliance with treatment team/ assessor/ clinician. Won’t tell you what’s going
on.

Won’t contract to be safe/ safety plan (see ideas below)?

Did they tell anyone? What support systems do they have?

Fears of any consequences?

Chronic self-punishment/ self-criticalness/ self-dislike/ self-worthlessness thoughts?

Have they made arrangements for after their suicide?

Suicide scale: 1=lowest 10=highest (ask them where they are on a scale 1-10. gives idea
how intense thoughts are)
What Next? Safety Planning/ Contract
to be Safe (not all inclusive/ just some ideas)

Have client make a list of four support people. (Identifying people that they
can reach out to / contact before they take any action). Can any of these
people stay with you today/ tonight/ next few days?

Create a list of five things you can do to soothe and distract yourself from
suicidal/ self-injurious thoughts/ feelings. How can you stay safe? What
can help keep you busy for next few days to get through this part? (Coping
skills and activities)

List at least 4 positive or strength based self-talk statements that you can
use when difficult feeling arise. List four things you have to stay alive for
(my child, my dog, my church, etc).

List 2 goals for the upcoming day/week/month/year. (Future orientated).

Take Action Steps: Contract to tell someone before you harm self. Have
someone else help distribute your meds. Remove dangerous objects from
home. Stay with family/ friend.

Provide client crisis line numbers, nearest hospital if they become unsafe
later, therapy references.
Case Management: Looking at
the Big Picture When Working
with Mental Health Clients
Community Safety vs Perfect Compliance
 Primary goal is to interact with supervision staff in a
meaningful way
 Failure to Comply often results in the defendant either being in community with
no supervision (active warrant situation) or taking a jail bed (bad for client/
expense for jail).
 Leveling the Playing Field
 What are barriers to compliance (resources/ understanding/ability)
 Make expectations realistic and manageable (look at strengths and limitations)
Case Management Tools
Solution Focused approach concentrating on motivation and
goal setting vs problem behaviors and arrest
Techniques:
(AND SOME EXAMPLES)

Move one step at a time, small steps can lead to big changes.

Create a non threatening positive environment

Homework assignments: impulse control techniques, breathing
exercises

Removing the mystery: go to court room while empty, explain what
happens next

Give tips for deescalating/ interacting with public or police

Meet them where they are at: look for other successful areas of their
lives to parallel/ set realistic goals.

If something is working do more of it/ if not working do
something different

Exception to the problem: “I see you made it to court today on timehow did you organize your morning different than usual?”

Understanding Motivation: You must have had a good reason for
doing this- can you tell me about it?