Using Medication Effectively

1
Using Medication Effectively

• Roberta Walker, LMSW, ACSW
• Director of Staff Development
• Southwest Counseling Solutions
• rwalker_at_swsol.org

2
Illness Management and Recovery (IMR)

• Illness Management and Recovery is a program that
  helps people
• Set meaningful goals for themselves
• Acquire information and skills to develop more
  mastery over psychiatric illness
• Make progress toward personal recovery
• http//www.samhsa.gov/shin or call 1-877-SAMHSA-7.

3
IMR Project Leaders

• Kim Mueser and Susan Gingerich
• Leaders within the Psychosocial Rehabilitation
  movement
• New Hampshire Dartmouth Research Center
• Mary Ellen Copeland
• Author, educator, mental health advocate
• Wellness Recovery Action Plans
• www.mentalhealthrecovery.com

4
Core Ingredients of IMR

• 3-6 months of weekly sessions conducted by
  practitioners
• Educational materials that contain practical
  information and strategies
• Practitioners guide with tips for teaching
  people about mental illness and helping to
  implement strategies

5
IMR Topic Areas

• Recovery Strategies
• Practical Facts about Mental Illness
• Stress-Vulnerability Model
• Building Social Support
• Using Medication Effectively
• Reducing Relapse
• Coping with Stress
• Coping with Problems and Symptoms
• Getting Your Needs Met in the Mental Health System

6
Individual or Group?

• Advantages of individual work
• Material can be fit to the persons needs
• More time can be devoted to individual needs
• Advantages of group work
• Group is a source of feedback, motivation, ideas,
  support and role models
• More economical

7
Structure of an IMR Session

• 1-3 min Informal socializing, identifying
  major issues
• 1-3 min Review of the previous session
• 3-5 min Review homework
• 1-3 min Follow up on goals
• 1-2 min Set agenda
• 30-40 min Teach new material
• 3-5 min Agree on homework assignment
• 3-5 min Summarize progress in current
  session

8
The Evidence for the Practice

• Psycho-education
• Broad based programs to help people to learn
  about mental illness symptoms and treatment
• Psycho-education models alone were found to
  increase the persons knowledge about
  medications, side effects, and managing side
  effects. However, it did not show improvement in
  taking medication as prescribed, improvement in
  symptom management, or reduction in relapse.

9
Cognitive Behavioral Programs

• Cognitive-behavioral programs
• Showed more promising results
• Three CBT methods were analyzed
• Behavioral Tailoring of Medication
• Motivational Interviewing
• Social Skills Training

10
Behavioral Tailoring of Medicine

• Helping people to incorporate medications into
  their daily lives
• Simplifying their medication regimens.
• In 5 studies, all found improvement in taking
  medication as prescribed.

11
Motivational Interviewing

• Connecting the use of medication with the
  persons identified goals
• In 1 study of motivational interviewing, there
  was an improvement in taking medication as
  prescribed, fewer symptoms and relapses, and
  improved social functioning.

12
Social Skills Training

• Improving interactions with doctors and
  discussing concerns.
• Results were less clear in 2 studies, only 1
  showed an improvement in medication knowledge,
  and neither study looked at taking medication as
  prescribed.

13
Education about Medication

• Why is medication recommended as part of a
  recovery plan?
• The effects of medication, including advantages
  and disadvantages
• Strategies for getting the most out of medication

14
Stress Vulnerability Model
Helps
Worsens
Biological Vulnerability to Symptoms
Helps
Stress
Helps
Worsens
15
Why Medication is Recommended

• When people take medication, they usually
• Experience symptoms less often or less intensely
• Concentrate and think more clearly
• Fall asleep more easily and sleep more restfully
• Accomplish more of their goals
• Prevent relapse

16
Explore the Persons Belief System

• People may have strong belief systems about
  medication that affect their decision making
  about medication
• Provide examples to the person about positive and
  negative belief systems
• Describe how belief systems can interfere with
  decision making about medication
• Ask about the persons belief system
• What do you think about taking medication?

17
Benefits of Medication

• Benefits include
• Reducing symptoms during an acute episode
• Reducing the likelihood of a relapse
• Ask if the person remembers a time when stopping
  medication worsened symptoms or caused a relapse

18
Side Effects of Medication

• Side effects vary from person to person
• In most cases, side effects are temporary and
  improve over time
• Some side effects are more serious and long
  lasting, particularly with older drugs

19
Coping With Side Effects
Blurry Vision Constipation Dizziness Drowsiness Dry Mouth
For mild blurry vision, talk to your doctor about reading glasses. Drink 6-8 glasses water daily. Eat high fiber foods. Do light daily exercise. Avoid getting up quickly from a sitting or lying position. Schedule brief naps during the day. Get some mild outdoor activity. Ask your doctor about taking meds in the evening. Chew sugarless gum, suck on hard candy. Take frequent sips of water.
20
Coping with Side Effects
Extreme Restlessness Increased Appetite or Weight Gain Muscle Stiffness Sensitivity to Sun Shakiness or tremors
Find a vigorous activity that you can enjoy, such as gardening, jogging, aerobics, sports, cycling. Emphasize healthy foods in your diet. Cut down on soda, desserts, fast food. Exercise regularly. Try doing regular muscle stretching exercises such as yoga or isometrics. Stay in the shade, use sunscreen and wear protective clothing. Avoid going out in the sunniest time of day. Avoid filling cups to the brim.
21
The Importance of Notifying Staff about Side
Effects

• Medical personnel may recommend
• Reducing the dose of the medication
• Adding another medication for the side effect
• Switching to another medication

22
Medication is complicated

• People respond to medication differently
• There are often delays before medication effects
  begin
• Medication works best as part of an overall
  recovery plan
• Encourage partnership with doctors and nurses

23
Basic Education About Medications

• Four categories of medications
• Antidepressants can reduce symptoms of
  depression, including low mood, poor appetite,
  sleep problems, low energy, poor concentration
• Mood stabilizers can help reduce extremes of
  mood, including mania and depression
• Antipsychotic can reduce symptoms of psychosis
  including hallucinations, delusions, disorganized
  speech or behavior
• Anti-anxiety can reduce anxiety, feeling
  over-stimulated, difficulty sleeping

24
Benefits and Drawbacks

• Ask the person to describe which medications they
  have taken, and the benefits and side effects of
  each of those medications
• Have the person weigh the pros and cons of taking
  medication
• Avoid rushing this process. Ask exploratory
  questions. Dont nag or preach.

25
Encouraging Partnership with Doctors

• Questions to ask your doctor
• How will this medication benefit me? What will
  it help me with?
• How long does it take to work?
• What side effects might I see? Are there long
  term side effects?
• What can be done if I experience side effects?
• Will I need blood tests to make sure that I have
  the right amount in my bloodstream?
• What if the medication doesnt work for me?

26
Behavioral Tailoring Strategies

• Simplify the medication regimen as much as
  possible
• Take medications at the same time each day
• Schedule taking medication into your daily
  routine
• Use cues to help you remember
• Keep the benefits in mind

27
Tips for Common Problems

• The person does not believe he/she has a mental
  illness.
• TIP Focus on symptoms, rather than labels.
• The person has strong beliefs that medications
  are harmful.
• TIP Avoid direct challenges. Try to understand
  the persons point of view and encourage them to
  keep an open mind in the future.

28
Tips for Common Problems

• The person has a misconception based on past
  experiences.
• TIP Acknowledge their past negative experiences
  and then offer new information that might be
  helpful.
• The person has had unpleasant experiences with
  medication.
• TIP Provide accurate info, ask clarifying
  questions, explore pros/cons, explore whether
  medication can help them to achieve their goals