Psychopharmacology for Therapists

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Psychopharmacology for Therapists
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Why is psychopharmacology important to you?

• Your clients presenting problem is difficulty
  attaining an orgasm.
• Your client reports fatigue, isolation, weight
  gain, and suicidal ideations
• Your client is involuntarily sticking out his
  tongue and smacking his lips

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

• You, of course, can not prescribe medications
• You can not recommend stopping, reducing or
  increasing medications
• You can not suggest any herbal treatments or
  vitamins
• However, you can recommend the client talk to
  their doctor about the above items

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Why Coordinate with MDs

• You see client more often and can track symptoms
  and side effects
• You will know more about triggers and stressors
  (separating medicine issues from stress reactions
  or personality traits)
• To ensure you are working on the same page
• To help the client advocate for them selves

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Helping the client advocate

• Bob Taubers handout
• Skills Training Issues
• Locating a doctor who matches you
• What to report
• Writing down a list of questions
• Family as advocates and symptom monitors
• Self-education books, reputable web sites,
  information packages
• Assertiveness and Role play

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A Few of the Therapeutic Issues

• Compliance issues stemming from side effects,
  mood disorders, or personality
• Who am I now that I am better? Embracing the
  full self
• Emotional development
• Separating symptoms from normal moods and
  addressing the fears that accompany normal
  nervousness, sadness, etc.
• New skills for getting needs met
• Coping with Embarrassing side effects
• Previously controlled symptoms/side effects
  re-emerging and the hopelessness and fear that
  follows
• Substance abuse
• Response vs remission
• The meds just aint working

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Additional Concerns

• Stigma
• Reactions from others
• Cultural Constraints
• Health Care Coverage
• Finances
• Medications
• Blood work
• Transportation

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What if my client doesnt want to see the
psychiatrist or take meds?

• Are you making progress without meds?
• In not, consider
• Talking openly about diagnosis and options
• Help cl. Gather information
• Have pt. see psychiatrist for consult
• Encourage cl. To fill prescription so it is
  available if needed
• See the psychiatrist together
• Recruit family
• Limits around therapy

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What does the Psychiatrist want to know?

• Symptoms (includes possible side effects)
• Over the last two weeks how was mood, anxiety,
  sleep, appetite, energy, concentration,
  irritability, delusions, hallucinations,
  speech/thought rate, Mental Status Exam
• Response
• Does the patient seem to be doing better on
  medication? (give it 2-6 weeks before judging)

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Lets look at a few questions

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

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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 Focus is here and now and bleak future
• Narcissistic Ive never seen individuals with
  significant narcissism stay on meds for long
• Moving on to the brain

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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)