Psychopharmacology for Psychopharmacology for TherapistsTherapists

Antioch UniversityAntioch UniversityTina Panteleakos, M.A.Tina Panteleakos, M.A.

Guest LecturerGuest Lecturer10/6/0410/6/04

A BRIEF History of Mental A BRIEF History of Mental IllnessIllness

Out of individual’s control (The demons ate my Out of individual’s control (The demons ate my soul) Treatment?soul) Treatment? EXORCISMEXORCISM

Within individual’s control (He’s just criminally Within individual’s control (He’s just criminally insane) Treatment? insane) Treatment? INSTITUITIONALISM (aka the loony bin)INSTITUITIONALISM (aka the loony bin)

Biological-Psychological Interaction Treatment?Biological-Psychological Interaction Treatment? SCIENCESCIENCE

Biological factors can affect psychological functioning (e.g., Biological factors can affect psychological functioning (e.g., hyperthyroidism, steroidal tx for lupus, drug abuse)hyperthyroidism, steroidal tx for lupus, drug abuse)

Psychological factors can affect biological functioning Psychological factors can affect biological functioning (stress and the hippocampus)(stress and the hippocampus)

It’s a complex, enmeshed relationship - hopefully you It’s a complex, enmeshed relationship - hopefully you would treat the person, not the disorderwould treat the person, not the disorder

Starter questions…Starter questions… Why is psychopharmacology important to Why is psychopharmacology important to youyou??

Not important (AU requirement)Not important (AU requirement) General curiosity (Bio 1 was the best college class EVER)General curiosity (Bio 1 was the best college class EVER) Vested interest (grad school blues)Vested interest (grad school blues) Competent therapists are a good thing (people are going Competent therapists are a good thing (people are going

to come to to come to meme for help? –Ethics also include limitations) for help? –Ethics also include limitations) Knowledgeable therapists are better (why is my client Knowledgeable therapists are better (why is my client

involuntarily sticking out his tongue and smacking his involuntarily sticking out his tongue and smacking his lips? Oh! Tardive Dyskinesia!)lips? Oh! Tardive Dyskinesia!)

““I’ll Never Tell...unless you sign I’ll Never Tell...unless you sign this coordination of care form.”this coordination of care form.” Compliance issues stemming from side Compliance issues stemming from side

effects, mood disorders, or personality effects, mood disorders, or personality ““Embarrassing” side effectsEmbarrassing” side effects Quitting the Xanax cold turkeyQuitting the Xanax cold turkey Late-onset side effectsLate-onset side effects Previously controlled symptoms re-Previously controlled symptoms re-

emergeemerge Substance abuseSubstance abuse The meds just ain’t working…The meds just ain’t working…

A Collaborative Effort…A Collaborative Effort…Well…Well…

In a Perfect WorldIn a Perfect World MDs, PAs, & NPs would have time to return MDs, PAs, & NPs would have time to return

phone callsphone calls Managed Care Organizations would relax Managed Care Organizations would relax

their constricted, sphincter-like grip on their constricted, sphincter-like grip on treatment authorizationstreatment authorizations

Clients could afford to go to MDs, PAs, or Clients could afford to go to MDs, PAs, or NPsNPs

““Oh what a world we live in…”Oh what a world we live in…” Therapist. Collaborator. Student. Advocate. Therapist. Collaborator. Student. Advocate.

All before lunch. All before lunch.

Hypothetical IntakeHypothetical Intake

26-year-old, Greek-Mexican, single 26-year-old, Greek-Mexican, single female prone to existential angst female prone to existential angst complains of insomnia, fatigue, and complains of insomnia, fatigue, and difficulty concentrating. WWUDdifficulty concentrating. WWUD ““To what extent is there evidence that To what extent is there evidence that

biochemical factors may be contributing biochemical factors may be contributing to a [her] symptomatology.”to a [her] symptomatology.”

Congratulations!!!Congratulations!!!

You’ve just been nominated for “the You’ve just been nominated for “the Therapist General” for the U.S. The New Therapist General” for the U.S. The New York Times is requesting an in depth York Times is requesting an in depth interview regarding your stance on interview regarding your stance on therapy and psychotropic medication. therapy and psychotropic medication. The journalist kindly gave you a copy of The journalist kindly gave you a copy of her questions so you may prepare. her questions so you may prepare. Complete “quick write answers” for the Complete “quick write answers” for the following questions:following questions:

Who uses (ingests) psychotropic Who uses (ingests) psychotropic medication?medication?

Are there certain circumstances in which Are there certain circumstances in which individuals should be required to take individuals should be required to take psychotropic medication? If yes, describe psychotropic medication? If yes, describe such situations. If no, why not?such situations. If no, why not?

Which is more effective to treat depression Which is more effective to treat depression in adults – medication or talk therapy?in adults – medication or talk therapy?

Should children be prescribed psychotropic Should children be prescribed psychotropic medication? Why or why not?medication? Why or why not?

Are you comfortable recommending Are you comfortable recommending psychotropic medication you’ve never psychotropic medication you’ve never tried? Why or why not?tried? Why or why not?

Psychodynamic thoughts on Psychodynamic thoughts on medsmeds

GenericGeneric Stigma – I must be really sick and/or have no Stigma – I must be really sick and/or have no

willpowerwillpower Therapy can’t helpTherapy can’t help Meds are addictive (AA)Meds are addictive (AA)

PersonalPersonal OCPD: focus on the side effectsOCPD: focus on the side effects Anxiety: feel better, but change causes anxiety/fearAnxiety: feel better, but change causes anxiety/fear Paranoid: worried they are going to lose controlParanoid: worried they are going to lose control Depressed: ability to cope with life is decreasedDepressed: ability to cope with life is decreased Narcissistic: I’ve never seen individuals with Narcissistic: I’ve never seen individuals with

significant narcissism stay on meds for longsignificant narcissism stay on meds for long

THE BRAINTHE BRAIN

Frontal LobeFrontal Lobe

The frontal lobe is The frontal lobe is considered our emotional considered our emotional control center and is control center and is tantamount to our tantamount to our personality, as well as personality, as well as performing logic & performing logic & reasoningreasoning Left lobe is typically involved Left lobe is typically involved

in controlling language in controlling language related movementrelated movement

Right lobe involved in non-Right lobe involved in non-verbal abilitiesverbal abilities

Parietal LobeParietal Lobe

Two main functions:Two main functions: Integrates sensory Integrates sensory

information to form a information to form a single perception single perception (cognition). (cognition).

Constructs a spatial Constructs a spatial coordinate system to coordinate system to represent the world represent the world around us (integrates around us (integrates visual input). visual input).

Occipital LobeOccipital Lobe

The occipital lobes The occipital lobes are the center of are the center of our visual our visual perception system. perception system.

Temporal LobeTemporal Lobe

The temporal lobes The temporal lobes are involved in the are involved in the primary organization primary organization of sensory input of sensory input

The temporal lobes The temporal lobes are highly associated are highly associated with memory skills with memory skills Left: verbal materialLeft: verbal material Right: non-verbal Right: non-verbal

matierical (music & matierical (music & drawings)drawings)

CerebellumCerebellum

Involved in the Involved in the coordination of coordination of voluntary motor voluntary motor movement, balance movement, balance and equilibrium and equilibrium and muscle tone. and muscle tone.

Brain StemBrain Stem

Plays a vital role in Plays a vital role in basic attention, basic attention, arousal, and arousal, and consciousness. All consciousness. All information to and information to and from our body from our body passes through the passes through the brain stem on the brain stem on the way to or from the way to or from the brain brain

The Limbic SystemThe Limbic System

A few structures of the limbic A few structures of the limbic systemsystem

HippocampusHippocampus - at the core of the temporal lobes - at the core of the temporal lobes and controls the more primitive pleasure stimuli and and controls the more primitive pleasure stimuli and aversion stimuli pathways and associations, also aversion stimuli pathways and associations, also involved in the formation of long-term memoryinvolved in the formation of long-term memory

AmygdalaAmygdala - mediates both inborn and acquired - mediates both inborn and acquired emotional responses (such as fear and agression)emotional responses (such as fear and agression)

FornixFornix – an axon tract that interconnects the – an axon tract that interconnects the hyptholamus and the hippocampushyptholamus and the hippocampus

HypothalamusHypothalamus - controls the autonomic nervous - controls the autonomic nervous system and regulates blood pressure, heart rate, system and regulates blood pressure, heart rate, hunger, thirst, and sexual arousal; connected to the hunger, thirst, and sexual arousal; connected to the pituitary gland and thus regulates the endocrine pituitary gland and thus regulates the endocrine system. (Not all authors regard the hypothalamus as system. (Not all authors regard the hypothalamus as part of limbic system.) part of limbic system.)

THE NEURONTHE NEURON

What happens when a What happens when a neurotransmitter falls in love with a neurotransmitter falls in love with a

receptor? - You get a binding receptor? - You get a binding relationship!relationship!

Some neurotransmitters…Some neurotransmitters…

TransmitterTransmitter Derived fromDerived from Site of SynthesisSite of Synthesis

AcetylecholineAcetylecholine CholineCholine CNS, parasymp. CNS, parasymp. nervesnerves

Serotonin (5-Serotonin (5-HT)HT)

TryptophanTryptophan CNS, enteric cells, CNS, enteric cells, gutgut

GABAGABA GlutomateGlutomate CNSCNS

HistamineHistamine HistidineHistidine hypothalamushypothalamus

EpinephrineEpinephrine TyrosineTyrosine Adrenal medulla, CNS Adrenal medulla, CNS cellscells

NorepinephrineNorepinephrine TyrosineTyrosine CNS, sympathetic CNS, sympathetic nervesnerves

DopamineDopamine TyrosineTyrosine CNS, (limbic CNS, (limbic system)system)