Psychopharmacology for Psychopharmacology for TherapistsTherapists

Why is psychopharmacology important to Why is psychopharmacology important to youyou??

Your client’s presenting problem is difficulty Your client’s presenting problem is difficulty attaining an orgasm. attaining an orgasm.

Your client reports fatigue, isolation, weight gain, Your client reports fatigue, isolation, weight gain, and suicidal ideationsand suicidal ideations

Your client is involuntarily sticking out his tongue Your client is involuntarily sticking out his tongue and smacking his lipsand smacking his lips

Competent therapists are a good thing Competent therapists are a good thing (Ethics also include limitations)(Ethics also include limitations)

You, of course, can not prescribe You, of course, can not prescribe medicationsmedications

You can not recommend stopping, You can not recommend stopping, reducing or increasing medicationsreducing or increasing medications

You can not suggest any herbal You can not suggest any herbal treatments or vitaminstreatments or vitamins

However, you can recommend the However, you can recommend the client talk to their doctor about the client talk to their doctor about the above itemsabove items

Why Coordinate with MDsWhy Coordinate with MDs

You see client more often and can track You see client more often and can track symptoms and side effectssymptoms and side effects

You will know more about triggers and You will know more about triggers and stressors (separating medicine issues from stressors (separating medicine issues from stress reactions or personality traits)stress reactions or personality traits)

To ensure you are working on the same To ensure you are working on the same pagepage

To help the client advocate for them To help the client advocate for them selvesselves

Helping the client advocateHelping the client advocate

Bob Tauber’s handoutBob Tauber’s handout Skills Training IssuesSkills Training Issues

Locating a doctor who matches youLocating a doctor who matches you What to reportWhat to report Writing down a list of questionsWriting down a list of questions Family as advocates and symptom monitorsFamily as advocates and symptom monitors Self-education: books, reputable web sites, Self-education: books, reputable web sites,

information packagesinformation packages Assertiveness and Role playAssertiveness and Role play

A Few of the Therapeutic A Few of the Therapeutic IssuesIssues

Compliance issues stemming from side effects, Compliance issues stemming from side effects, mood disorders, or personality mood disorders, or personality

Who am I now that I am better? Embracing the full Who am I now that I am better? Embracing the full selfself

Emotional developmentEmotional development Separating symptoms from normal moods and Separating symptoms from normal moods and

addressing the fears that accompany normal addressing the fears that accompany normal nervousness, sadness, etc.nervousness, sadness, etc.

New skills for getting needs metNew skills for getting needs met Coping with “Embarrassing” side effectsCoping with “Embarrassing” side effects Previously controlled symptoms/side effects re-Previously controlled symptoms/side effects re-

emerging and the hopelessness and fear that followsemerging and the hopelessness and fear that follows Substance abuseSubstance abuse Response vs remissionResponse vs remission The meds just ain’t working…The meds just ain’t working…

Additional ConcernsAdditional Concerns StigmaStigma Reactions from othersReactions from others Cultural ConstraintsCultural Constraints Health Care CoverageHealth Care Coverage FinancesFinances

MedicationsMedications Blood workBlood work Transportation Transportation

What if my client doesn’t want What if my client doesn’t want to see the psychiatrist or take to see the psychiatrist or take

meds?meds? Are you making progress without meds?Are you making progress without meds? In not, consider:In not, consider:

Talking openly about diagnosis and optionsTalking openly about diagnosis and options Help cl. Gather informationHelp cl. Gather information Have pt. see psychiatrist for consultHave pt. see psychiatrist for consult Encourage cl. To fill prescription so it is Encourage cl. To fill prescription so it is

available “if needed”available “if needed” See the psychiatrist togetherSee the psychiatrist together Recruit familyRecruit family Limits around therapy Limits around therapy

What does the Psychiatrist What does the Psychiatrist want to know?want to know?

Symptoms (includes possible side effects)Symptoms (includes possible side effects) Over the last two weeks how was: mood, Over the last two weeks how was: mood,

anxiety, sleep, appetite, energy, anxiety, sleep, appetite, energy, concentration, irritability, delusions, concentration, irritability, delusions, hallucinations, speech/thought rate, Mental hallucinations, speech/thought rate, Mental Status ExamStatus Exam

ResponseResponse Does the patient seem to be doing better on Does the patient seem to be doing better on

medication? (give it 2-6 weeks before judging)medication? (give it 2-6 weeks before judging)

Let’s look at a few questionsLet’s look at a few 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?

Why would clients be resistant to using Why would clients be resistant to using medications?medications?

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: Focus is here and now and bleak futureDepressed: Focus is here and now and bleak future 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********Moving on to the brain*************************Moving on to the brain*****************

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)