Psychopharmacology for Therapists

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Psychopharmacology for Therapists

• Antioch University
• Tina Panteleakos, M.A.
• Guest Lecturer
• 10/6/04

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A BRIEF History of Mental Illness

• Out of individuals control (The demons ate my
  soul) Treatment?
• EXORCISM
• Within individuals control (Hes just criminally
  insane) Treatment?
• INSTITUITIONALISM (aka the loony bin)
• Biological-Psychological Interaction Treatment?
• SCIENCE
• Biological factors can affect psychological
  functioning (e.g., hyperthyroidism, steroidal tx
  for lupus, drug abuse)
• Psychological factors can affect biological
  functioning (stress and the hippocampus)
• Its a complex, enmeshed relationship - hopefully
  you would treat the person, not the disorder

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Starter questions

• Why is psychopharmacology important to you?
• Not important (AU requirement)
• General curiosity (Bio 1 was the best college
  class EVER)
• Vested interest (grad school blues)
• Competent therapists are a good thing (people are
  going to come to me for help? Ethics also
  include limitations)
• Knowledgeable therapists are better (why is my
  client involuntarily sticking out his tongue and
  smacking his lips? Oh! Tardive Dyskinesia!)

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Ill Never Tell...unless you sign this
coordination of care form.

• Compliance issues stemming from side effects,
  mood disorders, or personality
• Embarrassing side effects
• Quitting the Xanax cold turkey
• Late-onset side effects
• Previously controlled symptoms re-emerge
• Substance abuse
• The meds just aint working

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A Collaborative EffortWell

• In a Perfect World
• MDs, PAs, NPs would have time to return phone
  calls
• Managed Care Organizations would relax their
  constricted, sphincter-like grip on treatment
  authorizations
• Clients could afford to go to MDs, PAs, or NPs
• Oh what a world we live in
• Therapist. Collaborator. Student. Advocate. All
  before lunch.

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Hypothetical Intake

• 26-year-old, Greek-Mexican, single female prone
  to existential angst complains of insomnia,
  fatigue, and difficulty concentrating. WWUD
• To what extent is there evidence that
  biochemical factors may be contributing to a
  her symptomatology.

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Congratulations!!!

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

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• 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?
• Are you comfortable recommending psychotropic
  medication youve never tried? Why or why not?

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Psychodynamic thoughts on meds

• Generic
• Stigma I must be really sick and/or have no
  willpower
• Therapy cant 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 ability to cope with life is decreased
• Narcissistic Ive never seen individuals with
  significant narcissism stay on meds for long

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THE BRAIN
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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 non-verbal abilities

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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).

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Occipital Lobe

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

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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)

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Cerebellum

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

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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

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The Limbic System
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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.)

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THE NEURON
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What happens when a neurotransmitter falls in
love with a receptor? - You get a binding
relationship!
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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)