7/5/2011
Declaration Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Medication Use and Abuse D id Gardner David G d Jonathan Melong
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 But…. We know stuff about medication and mental illness
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
“Top of Mind” Issues
Medications for Mental Illness and Symptoms
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
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7/5/2011
Antidepressants: Common Side Effects
Antidepressants Uses
Time to See Effect
Common Side Effects
Serious Side Effects
Other
• Depression • Anxiety disorders • Obsessive compulsive disorder • Panic disorder, • Eating disorders • Sleep problems
• Improved sleep, appetite, energy: 2‐4 weeks • Depressed mood, loss of pleasure, pessimism, irritability: 4‐8 weeks • Return of functioning: months
• Sedation • Headache • Dizziness • Dry mouth • Nausea, vomiting and diarrhea • Sweating
• Thoughts of hurting oneself or suicide • Abnormal bleeding • 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. • Can produce side effects/ withdrawal reaction when stopped quickly
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Antidepressants
Antipsychotics Uses
Time to See Effect Common Side Effects
•Positive symptoms of psychosis (hallucinations and delusions)) • Psychotic illnesses such as schizophrenia, delusional disorders, psychotic depression, mania, and Tourette’s syndrome. • Aggression
• Hyperactivity, hostility, agitation and aggression: 1 week • Delusions, , hallucinations: 4‐8 weeks • Negative symptoms (eg. like a lack of interest in life): months
• Sedation • Headache • Dry mouth • Constipation • Weight gain g g • Sexual dysfunction
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Antipsychotics: Common Side Effects
Serious Side Effects
Other
• Severe muscle spasms. • Neuroleptic Malignant Syndrome (stiff y ( muscles, sudden confusion, high fever, irregular blood pressure and heart rate) • Seizures • Movement Problems
• Although symptoms may resolve in weeks, patients will be on these medications for years or possibly for their entire life to prevent relapse.
Mood Stabilizers Uses
Time to See Effect Common Side Effects
• Bipolar disorder • Acute mania: • Agitation 7‐28 days • Aggression • Antidepressant effects: 6‐8 6 8 weeks weeks
• Sedation • Headache • Dizziness • Nausea, vomiting and vomiting and diarrhea • Weight gain • Tremor • Increased Thirst
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Serious Side Effects
Other
• Blood problems; may present as bleeding or bruising easily. • Severe skin rash Severe skin rash with fever
• Patients will likely be on medications for life • Some mood Some mood stabilizers can interact with medication sold without a prescription (e.g. pain relievers like Advil)
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7/5/2011
Mood Stabilizers: Common Side Effects
Stimulants Uses
Time to See Effect Common Side Effects
• Attention Deficit Hyperactivity Disorder (ADHD) • Aggression • Help with social interactions
• Efficacy can be seen right away with the first dose (within 1 hour) • Non‐stimulants used to treat ADHD can take longer (2‐4 weeks)
• Headache • Insomnia • Irritability • Nausea, vomiting and diarrhea • Decreased appetite
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Other
• Fast or pounding heart beat. • Weight loss • Slowed growth • Tics or abnormal movements • Hallucinations
• If problem with early morning symptoms – other options may be available • If reduced appetite or weight loss – recommend high calorie snacks or take after meal • If swallowing is a problem – some medications can be dissolved in water
Anti-anxiety and Sleep Medications
Stimulants: Common Side Effects Uses
Time to See Effect
Common Side Effects
Serious Side Effects
Other
• Sleep • Anxiety • Agitation • Treat side effects of antipsychotics.
• Antidepressants: 4‐8 weeks • Benzodiazepines: 1‐2 hrs; however they are not recommended for long term use
• Sedation • Headache • Dizziness • Dry mouth • Nausea, vomiting and diarrhea • Sweating
• Seizures • Confused thinking •Thoughts of hurting oneself or suicide • Abnormal bleeding • Serotonin syndrome
• Can produce side effects/ withdrawal reaction when stopped quickly • Activities that require quick thinking and reaction (e.g. driving, bike riding, snowboarding, skateboarding, etc.) can be very dangerous while taking these medications.
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Anti-anxiety & Sleep Medications: Common Side Effects
Serious Side Effects
Symptom Tracker
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
3
7/5/2011
Side Effect Tracker
Activity Tracker
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Can side effects of the medication interfere with school work? Sedation and Drowsiness A common side effects of many drugs that treat mental illnesses. Can vary from slight sedation to some patients sleeping >18 hrs a day
Cognitive Impairment Difficulty concentrating Difficulty paying attention Memory impairment – verbal memory impairment Retrograde amnesia
How do you know if a patient is dose too high/too low? A patient may be dosed too high if…. They are highly sedated – look like a zombie Have problem with movements – moving too slowly, have trouble initiating movement, have abnormal movements, tics F Face shows h littl little to t no emotion ti
A patient may be dosed too low if…. Only have a partial response to the medication – the medication has helped, but only a little
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Are these medications addictive?
Resources
NO! Addiction is when: There is psychological dependence – want the drug even though they don’t need it and/or know that it is harming them. Drug seeking behavior is related to getting “a high”.
Medications can cause physical dependence Body gets used to the medication – abruptly stopping the medication can cause unwanted side-effects. Not unique to drugs that treat mental illness – eg. Beta-blockers
Taking these medications have not been shown to lead to illicit drug use Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
4
7/5/2011
Prescriber Checklist Tool
Role of the Pharmacist When would you call a pharmacist? Side effects D Drug IInteractions t ti Pill identification Indications Time to … benefit/harm… Dosing information
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
School Time Dosing Issues that may arise…
Discussion
Treatment refusal (overt/covert but suspected) Side effects (eg., zombie) Street drugs (eg., high) Responsibility Communications
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
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