Transcript Psychopharmacology for Therapists

Psychopharmacology for
Therapists
Why is psychopharmacology important to you?



Your client’s presenting problem is difficulty attaining an
orgasm.
Your client reports fatigue, isolation, weight gain, and
suicidal ideations
Your client is involuntarily sticking out his tongue and
smacking his lips
Competent therapists are a good thing
(Ethics also include limitations)




You, of course, can not prescribe
medications
You can not recommend stopping,
reducing or increasing medications
You can not suggest any herbal
treatments or vitamins
However, you can recommend the client
talk to their doctor about the above items
Why Coordinate with MDs




You see client more often and can track
symptoms and side effects
You will know more about triggers and stressors
(separating medicine issues from stress
reactions or personality traits)
To ensure you are working on the same page
To help the client advocate for them selves
Helping the client advocate


Bob Tauber’s handout
Skills Training Issues
Locating a doctor who matches you
 What to report
 Writing down a list of questions
 Family as advocates and symptom monitors
 Self-education: books, reputable web sites,
information packages
 Assertiveness and Role play

A Few of the Therapeutic Issues










Compliance issues stemming from side effects, mood
disorders, or personality
Who am I now that I am better? Embracing the full self
Emotional development
Separating symptoms from normal moods and addressing
the fears that accompany normal nervousness, sadness,
etc.
New skills for getting needs met
Coping with “Embarrassing” side effects
Previously controlled symptoms/side effects re-emerging
and the hopelessness and fear that follows
Substance abuse
Response vs remission
The meds just ain’t working…
Additional Concerns





Stigma
Reactions from others
Cultural Constraints
Health Care Coverage
Finances



Medications
Blood work
Transportation
What if my client doesn’t want to
see the psychiatrist or take meds?


Are you making progress without meds?
In not, consider:







Talking openly about diagnosis and options
Help cl. Gather information
Have pt. see psychiatrist for consult
Encourage cl. To fill prescription so it is available “if
needed”
See the psychiatrist together
Recruit family
Limits around therapy
What does the Psychiatrist want to
know?




Symptoms (includes possible side effects)
Over the last two weeks how was: mood,
anxiety, sleep, appetite, energy, concentration,
irritability, delusions, hallucinations,
speech/thought rate, Mental Status Exam
Response
Does the patient seem to be doing better on
medication? (give it 2-6 weeks before judging)
Let’s look at a few questions





Who uses (ingests) psychotropic medication?
Are there certain circumstances in which
individuals should be required to take
psychotropic medication? If yes, describe such
situations. If no, why not?
Which is more effective to treat depression in
adults – medication or talk therapy?
Should children be prescribed psychotropic
medication? Why or why not?
Why would clients be resistant to using
medications?
Psychodynamic thoughts on meds

Generic




Stigma – I must be really sick and/or have no willpower
Therapy can’t help
Meds are addictive (AA)
Personal
OCPD: focus on the side effects
 Anxiety: feel better, but change causes anxiety/fear
 Paranoid: worried they are going to lose control
 Depressed: Focus is here and now and bleak future
 Narcissistic: I’ve never seen individuals with significant
narcissism stay on meds for long
********Moving on to the brain*****************

THE BRAIN
Frontal Lobe

The frontal lobe is
considered our emotional
control center and is
tantamount to our
personality, as well as
performing logic & reasoning


Left lobe is typically involved
in controlling language related
movement
Right lobe involved in nonverbal abilities
Parietal Lobe

Two main functions:


Integrates sensory
information to form a
single perception
(cognition).
Constructs a spatial
coordinate system to
represent the world
around us (integrates
visual input).
Occipital Lobe

The occipital lobes
are the center of our
visual perception
system.
Temporal Lobe


The temporal lobes
are involved in the
primary organization
of sensory input
The temporal lobes
are highly associated
with memory skills


Left: verbal material
Right: non-verbal
matierical (music &
drawings)
Cerebellum

Involved in the
coordination of
voluntary motor
movement, balance
and equilibrium and
muscle tone.
Brain Stem

Plays a vital role in
basic attention,
arousal, and
consciousness. All
information to and
from our body passes
through the brain stem
on the way to or from
the brain
The Limbic System
A few structures of the limbic system




Hippocampus - at the core of the temporal lobes and
controls the more primitive pleasure stimuli and aversion
stimuli pathways and associations, also involved in the
formation of long-term memory
Amygdala - mediates both inborn and acquired emotional
responses (such as fear and agression)
Fornix – an axon tract that interconnects the hyptholamus
and the hippocampus
Hypothalamus - controls the autonomic nervous system
and regulates blood pressure, heart rate, hunger, thirst, and
sexual arousal; connected to the pituitary gland and thus
regulates the endocrine system. (Not all authors regard the
hypothalamus as part of limbic system.)
THE NEURON
What happens when a neurotransmitter falls in love
with a receptor? - You get a binding relationship!
Some neurotransmitters…
Transmitter
Derived from
Site of Synthesis
Acetylecholine
Choline
CNS, parasymp. nerves
Serotonin (5-HT)
Tryptophan
CNS, enteric cells, gut
GABA
Glutomate
CNS
Histamine
Histidine
hypothalamus
Epinephrine
Tyrosine
Adrenal medulla, CNS cells
Norepinephrine
Tyrosine
CNS, sympathetic nerves
Dopamine
Tyrosine
CNS, (limbic system)