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CLINICALROLEOFPHARMACISTTOIMPROVEMENTALHEALTHOUTCOMESAMONGVETERANS
JUNEA.GRIFFITH,PharmD,CGP,BCPPTuscaloosaVeteransAffairMedicalCenter
PGY2ResidencyDirectorPsychiatricpharmacypracticeFebruary24,2017
DisclosureStatement
Idonothaveavestedinterestoraffiliationwithanycorporateorganizationofferingfinancialsupportorgrantmoneyforthiscontinuingeducationprogramoranyaffiliationwithanorganizationwhosephilosophycouldpotentiallybiasanypresentation.
ORIdonothaveavestedinterestinoraffiliationwithanycorporateorganizationofferingfinancialsupportorgrantmoneyforthiscontinuingeducationprogram,oranyaffiliationwithanorganizationwhosephilosophycouldpotentiallybiasmypresentation.
OJECTIVES
• UponcompletionofthisCEactivity,pharmacists,nurses,andotherhealthcareprofessionalsshouldbeableto:• Understandthevarioustypesofmentalillnessthatmightgountreated:• AbuseofdrugsandAlcoholtotreatmentalhealthproblems:• NeedofpharmaciststoeducateveteransaboutthecorrectTXofmentalhealthconditions:• TypesofOTCtreatmentsformentalhealth• InteractionswithOTCandconventionalmedications.• Waystoreducethestigmaofmentalhealthdisorders• Identifythevarioustypesofmentalhealthdisordersandknowwhentoreferfortreatment.
OBJECTIVES
• UponcompletionofthisCEactivity,Techniciansandstudentsshouldbeableto:• Understandthevarioustypesofmentalillnessthatmightgountreated;• AbuseofdrugsandAlcoholtotreatmentalhealthproblems;• Needofpharmacists,techniciansandstudentstoeducateeachotherandfamilymembersaboutthecorrectTXofmentalhealthconditions;• TypesofOTCtreatmentformentalhealth;• InteractionsbetweenOTCagentsandconventionalmedications,• Waystoreducethestigmaofmentalhealthdisorders• Identifythevarioustypesofmentalhealthdisordersandknowwhentoreferfortreatment.
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ANXIETYVSDEPRESSION
ANXIETY
SAD
PANIC
GAD
SEPARATION
OCD
PTSD
ANXIETYVSDEPRESSION
• TypesofAnxietydisorders:• SAD– socialanxietydisorder– fearofbeinginpublicplaceswiththepossibilityofbeingembarrassed• GAD– Generalizedanxietydisorder– excessiveanxietyorworryaboutalmosteverythingandconstantworrying• PD– panicdisordercharacterizedbyintensefearthatlastfor5– 10secondsandthensubsides.Notsurewhenitwilloccuragain.• OCD– obsessivecompulsivedisorderswhichischaracterizedbyfearandcontinuousritualstocalmfearsthatmainlyincreasesthefearmore.• Separationanxiety– afraidtobeseparatedfromloveones,orfamilymembersduetofearofsomethingbadhappeningtoloveones.• PTSD– removedfromanxietydisorderinDSMVcriteria,butisstillactuallyananxietytypeofdisorder.
ANXIETYVSDEPRESSION
• TreatmentforanxietyisusuallytheuseofSSRI– SelectiveSerotoninreceptoruptakeinhibitors.• Itinhibitsthereuptakeofserotoninforthereceptorstorepackageitanduseitagain.Insteadthereisaconstantsupplyofserotonininthereceptorsynapticcleft,leadingtoincreasebindingtotheserotoninreceptor.• AnothertypeoftreatmentistheSNRI– Serotoninnorepinephrinereceptoruptakeinhibitors-• Itallowsforserotoninandnorepinephrinetobeavailabletothereceptorsalotlongerandthereforeleadstoincreaseactions.• Thenorepinephrine– dopaminereceptorreuptakeinhibitors–Wellbutrinorbupropion- allowsfornorephinphrineanddopaminetobeavailablealotlongerinthereceptorsynapticcleft.
ANXIETYVSDEPRESSION
• THESAMEAGENTSUSEDTOTREATANXIETYISALSOUSEDTOTREATDEPRESSION.
• WHY?????
• DEPRESSIONischaracterizedbyhaving5ormoreofthefollowingsymptomseverydayforatleast2weeks– depressedmood,irritability,anxiety,tearfulnessandsomaticcomplaints.• AnacronymusedisSIGECAPS
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ANXIETYVSDEPRESSION
• S- sleepdisturbance(insomniaorhypersomnia)• I– Interest(lossof)• G- Guilt(excessive)• Energy(Changesin)• Concentration(impaired)• AppetiteChanges(increasedordecreased)• Psychomotoragitationorretardation• Suicidalideationsoractions• Somaticcomplaints– (GIdisturbances,headaches,musclepain)
CPNPPyschiatricPharmacotherapyreviewpg188 9
ANXIETYVSDEPRESSION
• Ifanxietygoesuntreatedforalongperiodoftime,dependingontheseverityitcanproducedepressionsymptomsnext.• Thatiswhyitisimportanttorecognizedandgettherapyassoonaspossible.• Pillsarenottheonlywaytotreatdepressionandanxiety.• Psychotherapy–• CBT– Cognitivebehaviortherapy– patientaretaughttorecognizedbadthoughtsandlearnhowtochangethoughtprocesses.• ECT– electroconductivetherapy– forseveredepression.
EVALUATIONCASESTUDY
• Awomanis24yearsoldfemale,complainsofchestpain,shortnessofbreathandimpendingdomewhileinacrowdedshoppingcenter,thishasoccurredonmorethanoneoccasionandaftertravellingtotheER.AttheERifwasdeterminedthattheywasnocardiacinvolvement.• 1)Whattypeofanxietydisorderisthiscondition?• a)SocialAnxiety• b)panicdisorder• c)generalizedanxietydisorder• d)separationanxiety
EVALUATIONCASESTUDY
• Aftermanymonthsofthisdisorderthepatienthasstopsocializingwithherfriends,andhasstopleavingthehouseeventobutgroceries.Whattypeofsymptomisthispatientexperiencing?• a)Guilt• b)lossofinterest• c)isolation• d)changesinenergy
• Howwouldthisconditionbetreatedwithwhatagent?• a)SSRIb)Busparc)lorazepamd)St.John’swort
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BIPOLARDISORDER DIAGNOSTICCRITERIA
HYPOMANIC HYPOMANICCRITERIA
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SPECTRUMOFMOODS DIAGNOSTICCRITERIA
BIPOLARDISORDER1OR11
• BIPOLARTERMSusedtobecalledmanicdepressivedisorders.
• Bipolar1– apersonwhohavehadatleastonemanicepisodeinhis/herlifetime.• Bipolar11– mainlycharacterizedbydepressiveepisodeandhypomanicepisode.• Manicischaracterizedbyperiodofloudexpansivemood,withrequirementoflittlesleepandthoughtsofonlyselfpleasurableactivities,thatusuallyrequireeitherhospitalizationorincarceration.• Hypomanicisusuallyperiodofhighexpansivemoodbutnotattheseverityofmanicandrequiringlessneedforsleep.Usuallylasting4-7days,beforecrashingintodepression.
BIPOLAR1OR11
• Mostpatientswithbipolartype11usuallygoestotheirdoctorwhentheyareinadepressiveepisode.• Wheninahypomanicepisode,theyfeelgood,extraenergyandabletodoalotoftasks,butmightnotfinishanyofthemcompletely.• Inthemanicphasic,havelotofracingthoughtsandwanttodoalotofdifferentthings,butmightnevercompleteanything.• Inmanicphasemoreinterestedwiththepleasurableactivities,thanworkorproduction.• Whichusuallyleadtooverspending,extramartialaffairswithmanypartners,gamblinganddoingdrugsandoftenquestionableactivitiesthatmayendupinjailorhospital.• Treatmentisoftencomplex,andusuallyendsupwithalotofnon-compliance.
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TREATMENTOFBIPOLAR1AND11
• DRUGOFCHOICEISLITHIUM.• MOODSTABILIZER– DEPAKOTE,CARBAMAZEPINE,LAMICTAL,• SSRI,SNRI– BUTMUSTBEACCOMPANIEDBYAMOODSTABILIZERONBOARDOTHERWISEITMAYCAUSESWITCHINGTOMANIA• BUPROPIONISTHEONLYANTIDEPRESSANTTHATISLESSLIKELYTOCAUSESWITCHINGTOMANIA.• WHYDOESANTI-EPILEPTICAGENTHELPWITHMOODSTABILIZATION• ITACTUALLYSLOWSDONETHEFASTRACINGTHOUGHTSANDGIVETHEBRAINTIMETOMAKERATIONALDECISIONINSTEADOFBEINGIMPULSIVE.• BIOLARPATIENTSDON’TLIKETHEFEELINGANDISTHEREFORENON-COMPLIANT.
DRUGOFCHOICEFORMANIA
OTHERAGENTSUSEDINTHETREATMENTOFBIPOLARDISORDER
• DEPAKOTE– VALPROICACID• TEGRETOL– CARBAMAZEPINE• TRILEPTAL– OXCARBAZEPINE• LAMICTAL– LAMOTRIGINE– MAINLYFORBIPOLAR11• SECONDGENERATIONANTIPSYCHOTICAGENTS• ABILIFY–ARIPIPRAZOLE• OLANZAPINE-ZYPREXA• RISPERIDONE-RISPERDAL• QUETIAPINE-SEROQUEL
EXPLANATIONSOFMOAOFANTIEPILEPTIC
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EVALUATIONCASESTUDY
• RODNEYISA24YEAROLDMAN,THATWASDIAGNOSEDWITHDEPRESSIVESYMPTOMS,ANDWENTTOHISPCPCOMPLAININGOFNOTBEINGABLETOSLEEPFORAFEWDAYSANDLOWENERGYANDTEARFULMOSTDAYS.HECAN’TEXPLAINWHYHEISSOTEARFUL.HISPCPPRESCRIBEDSERTRALINEFORHIMWITHASLOWGRADUALINCREASEDINDOSE.TWOWEEKSLATER,HEISOUTONTHENEIGHBOURSLAWNSWIMMINGINTHENUDEWITHOUTANYPOOL.THEPOLICEISCALLEDANDHEWASBAKERACTEDTOAPSYCHIATRICWARDFOR3DAYSOBSERVATION.WHATISPROBABBLYRODNEY’SDIAGNOSIS?• A)BIPOLAR1DISORDER• B)BIPOLARCPSYCHOTICFEATURES• C)BIPOLAR11DISORDER• D)DEPESSION
EVALUATIONCASESTUDY
• FROMHISDIFFERENTIALDIAGNOSISWHATMEDICATIONSSHOULDRODNEYBETREATEDWITHATTHISTIME.• A)LAMICTAL• B)PROPRANOLOL• C)LITHIUM• D)ARIPIPRAZOLE• IFRODNEYISTREATEDWITHLITHIUMWHATMONITORINGISNECESSARYFORNEEDEDFORTHISMEDICATION?• A)LITHIUMLEVELIN5DAYS• B)LITHIUMLEVELIN2DAYS• C)LITHIUMLEVELIN2WEEKS• D)LITHIUMLEVELIN6MONTHS
SCHIZOPHRENIA
• COMEONINTHELATETEENTOEARLYTWENTIES• ITCANOCCURREDINMALE:FEMALEEQUALLY,• CANBEDUETOHERIDITARY• AFFECTS1%OFTHEPOPULATION,• ITCANBEDUETOEXPOSUREFROMCANNABISANDMETHAMPHETMINES
CPNP2016-2017PG586
SCHIZOPHRENIA
• TYPESOFSYMPTOMS• POSITIVE• HALLUCINATIONS• DELUSION• MOVEMENTDISORDER• NEGATIVE• LOSSOFINTEREST• LACKOFEMOTIONS• SOCIALWITHDRAWAL• COGNITIVE• PROBLEMSMAKINGDESIONS• MEMORYPROBLEMS
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TREATMENTOFSCHIZOPHRENIA
• USEOFEITHERFIRSTGENERATIONANTIPSYCHOTICAGENTS• Haloperidol• Chlorpromazine• Fluphenazine• Perphenazine• Thorazine• OR• USEOFSECONDGENERATIONANTIPSYCHOTICAGENTS• RISPERIDONE
• ARIPIPRAZOLE
• OLANZAPINE
• CLOZAPINE
TREATMENTOFSCHIZOPHRENIA
• THECHOICETOTREATSCHIZOPHRENIA,NEEDSTOLOOKATTHEENTIREINDIVIDUAL,BEFORECHOOSINGANANTIPSYCHOTICAGENT.• NEEDTOLOOKAT:• MEDICALHX• HEIGHT,WEIGHT,BMI• ALLERGIES• RACE• PREVIOUSUSEOFANTIPSYCHOTICANDWHATWORKED• FAMILYHXANDWHATMEDICATIONWORKEDINTHEPASTINOTHERFAMILYMEMBERS• AGEOFTHEPATIENT.
POSSIBLEADVERSEEFFECTSOFATYPICALANTIPSYCHOTICDRUGS EVALUATIONCASESTUDY
• ASTUDENTISFOUNDWALKINGTHEROADINNEWYORKINTHEDEADOFWINTERINABATHINGSHORTS,WHENASKEDWHATHEISDOINGHESAYSHEISWALKINGTOTHEBEACH.HEWASPICKUPBYTHEPOLICEANDCARRIEDINFOREVALUATION.ITWASDISCOVEREDTHATHEWASINHISJUNIORYEAROFCOLLEGEANDALLOFASUDDENOVERTHELASTSIXMONTHSHEBEGANBEHAVINGWEIRDTOHISCLASSMATES.WHATISONEOFTHEFIRSTBLOODTESTTHATHEHASTOBEDONE?• A)EKG• B)UDS• C)CHEM8• D)CBC
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EVALUATIONSCASESTUDY:
• ISTHEREATESTFORSCHIZOPHRENIA• A)TRUE• B)FALSE
• SAMHASJUSTBEENDIAGNOSEDWITHSCHIZOPHRENIAAFTERAYEAROFCONTINUOUSSYMPTOMS.HEISOVERWEIGHT,ANDISATYPE1DIABETIC.WHICHAGENTWOULDBEAGOODCHOICETOSTARTSAMONANDTOCONTINUEFORCONTINUOUSTHERAPY?• A)OLANZAPINE B)HALDOL• C)ARIPIPRAZOLE D)QUETIAPINE
PERSONALITYDISORDERS
• COMESINTHREEMAINGROUPSANDJUSTADDSTOTHEFURTHERCOMPLICATIONOFDIAGNOSISWITHMENTALHEALTHILLNESS.• CLUSTERA– ODD• CLUSTERB- DRAMATIC• CLUSTERC– ANXIOUSORFEARFUL
PERSONALITYDISORDER• JUSTAFURTHERDEMONSTRATIONOFTHEDIFFERENTTYPESOFPERSONALITIES.
ABUSEOFDRUGSANDALCOHOL
• WHYALCOHOLISTHEMOSTABUSEDRUGALONGWITHNICOTINE• MOSTPEOPLEWITHANXIETYORDEPRESSIVESYMPTOMSDON’TWANTTOADMITTHATSOMETHINGISWRONG• SOINSTEADTHEYBEGINWITHAGLASSOFWINETOLOOSENUP,THENMAYBE2-3ANDBEFOREYOUKNOWIT,THEENTIREBOTTLE.BUTASFARASTHEYARECONCERN,THEYARESTILLINCONTROL.• NICOTINETENDSTOHELPWITHANXIETESANDATTHESAMETIMEADDTOANXIETYIFYOUTRYTOREDUCETHEAMOUNTYOUTAKE.• ITISVERYADDICTIVEANDQUICKLYBECOMEADDICTIVETOTHEPRODUCT.
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ABUSEOFDRUGSANDALCOHOL DURGSOFABUSE
• COCAINECAUSECARDIACPROBLEMS• STROKES• SEIZURES• HEADACHES• DEATH• EXTREMEWEIGHTLOSS• EFFECTSONTHEMENTALCAPACITY
ABUSEOFDRUGSANDALCOHOL
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DRUGSOFABUSE
• DIFFCULTYPAYINGATTENTION• AMOTIVATION• LOSSOFSHORTTERMMEMORY• INCREASEDHEARTRATE• SADNESSORFEARFULNESS• ANXIETYANDPANIC
METHAMPHETAMINEEFFECTSONTHEBODY.
WHATDOESEDUCATIONDOFORVETERANS
• FIRSTWEDOEDUCATIOONALCLASSESON• OPIODSAFETY• CIGARETTECESSATION• SUBSTANCEABUSE• POSTTRAUMATICDISORDER
• THEFOURWEEKSCLASSESSTARTWITH:• ONEWEEKINTRODUCTIONTOSUBSTANCEABUSEORPTSD• 2ND WEEK– SYMPTOMSANDEFFECTSONTHEBODYSYSTEMS• 3RD WEEK- TREATMENTOFEITHERSAORPTSD• 4TH WEEK– LIVINGWITHANDCOPINGWITHADIAGNOSISOFSAORPTSD.
WHATDOEDUCATIONDOFORVETERANS
• MOSTVETERANSLIKETHEFACTTHATTHEYARELEARNINGABOUTTHEMEDICATIONSTHATAREBEINGUSEDANDHOWTHEYWORKTOHELPWITHTHECONDITION.• THESAMEWAYTHATTHEPHARMACISTHASBEENINSTRUMENTALINEDUCATINGTHEPUBLICABOUTDIABETESANDHYPERTENSION.• VETERANSNEEDEDUCATIONABOUTTHEIRSYSMPTOMSANDWHATEFFECTSTHEDRUGSOFABUSEANDTHEDRUGSTHATARECONVENTIONALAGENTSHAVEONTHEIRBODIES.• ONEQUESTIONSARETHEYSUBSTITUTINGONEDRUGOFABUSEFORANOTHERDRUGOFABUSEANDWEDEFINITELYEXPLAINSTHEMECHANISMOFACTIONS• THEYALSOWANTTOKNOWIFTHEYWILLBEABLETOSTOPTHEMEDICATIONANDWHEN.
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WHATDOESEDUCATIONDOFORTHEPUBLIC
• EDUCATIONMAKESTHEVETERANMOREINFORMABOUTBOTHTHECONDITIONANDTHETREATMENTOFTHECONDITIONS• ITMAKESTHEMAWAREOFPOSSIBLESIDEEFFECTSANDWHYTHEIROCCURANDWHATAGENTSMIGHTBEANALTERNATIVEFORTREATMENTOFTHESIDEEFFECTS.• FORSSRIINDUCEDSEXUALSIDEEFFECTS,WECOULDRECOMMENDTALKINGTOTHEYDOCTORSABOUTCHANGINGTHEAGENTTOANOTHERANTIDEPRESSANTSUCHASBUPROPION• ORTAKINGASEROTONERGISTAGONIST– CYPROHEPTADINEABOUT2HRBEFORESEXUALSIDEEFFECT.• THEUSEOFDRUGOFABUSETOTREATPTSDISUSUALLYAOTCEFFECTTOTREATTHEPROBLEM,BUTPRODUCESAWORSEREACTION.
EVALUATION
• VETERANCAMEINTOEMERGENCYROOMCOMPLAININGOFSUICIDALIDEATIONS,WITHAPLANTOJUMPINFRONTOFACAR.COMPLAINSOFHOMELESSNESS,COCAINEANDALCOHOLABUSEANDHEHASNOPLACETOGO,COMPLAINSOFDEPRESSION,LONLINESSANDTEARFULFORPASTMONTH,AFTERWIFEHASLEFTHIM.HISUDSWASPOSITIVEFORCOCAINE,ALCOHOLANDBENZOS.• WHATISTHEMAINCAUSEOFHISDEPRESSION.• A)HOMELESSNESS• B)WIFELEFTHIM• C)DRUGSANDALCOHOL• D)ALLOFTHEABOVE.
EVALUATION
• WHATDIAGNOSISSHOULDHEBETREATEDFORFIRST?• A)ALCOHOLWITHDRAWAL• B)COCAINEWITHDRAWAL• C)DEPRESSION• D)AANDB
WHATISTHEFIRSTAGENTSWILLBEUSEDTOTREATALCOHOLWITHDRAWAL?A) LORAZEPAMB) CLONIDINEC) NAPROXEND) ALLOFTHEABOVE
TYPESOFOTCAGENTSUSEDFORMENTALILLNESS• ST.JOHN’SWORT• CHAMOMILE• LEMONBALM• ROSEMARY• VALERIAN• SAMe• FOLATEANDL-METHYLFOLATE• OMEGA-3FATTYACIDS
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TYPESOFOTCMEDICATIONSFORMENTALILLNESS
• ST.JOHN’SWORT-• Inhibits5-HT,NEandDAtransporter• Alsoweaknon-selectiveinhibitionofMAO• Dose300mgdaily• CaninteractwithotherSSRIorSNRItoproduceSerotoninsyndrome.• Shouldnotbeusedwithotherconventionalagents
• SAMe–• MethyldonorinthesynthesisofdopamineandSerotonin.• Dose– 800-1600mgperdayorIM400mg.• NotregulatedbyFDA• Usedfordepression,veryexpensive.
TYPESOFOTCAGENTSUSEDFORMENTALILLNESS
• OMEGA-3FATTYACIDS–• Containseicosapentaenoicacid(EPA)docosahexaenoicacid(DHA)-• Doserangefrom1– 9gramsperday.• Adverseeffects– GIupset,diarrhea,constipation.• Useformoodstabilizerandasaantidepressant
Magnesiumhydroxide-Helpsregulatecalcium,copper,zinc,potassium,vitamindlevelsUsedforanxiety,insomnia,headache,irritability,HTN,headachesActivatesco-enzymes
OTCAGENTS
• AGENTSTHATCANBEUSEDFORGAD• PASSIONFRUITFLOWER• KAVA• CHAMOMILE• VALERIAN• GINGER• LICORICE
HERBSANDOTCAGENTS
• KAVAROOT–• ADRINKPREPAREDFORUSEINANXIETY,INSOMNIA,• ENHANCEDLIGANDBINDINGTOGABAARECEPTORS• ACTSTOELEVATEMOOD,WELLBEING• KRATOMFOUNDINSPICEANDVARIOUSOTCDRUGS.
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HERBSANDOTCAGENTS
• PASSIONFRUIT– MADEINTOADRINK• SEDATIVEEFFECT• CALMING• CANBEUSEDFORGAD
INTERACTIONBETWEENOTCANDCONVENTIONALMEDICATIONS
• KAVA– CANCAUSELIVEDAMAGEANDLIVERTOXICITY• ST.JOHN’SWORTANDSSRI– MAYLEADTOSEROTONINSYNDROME• SIGNIFICANTINTERACTIONSWITHOTHERANTIDEPRESSANTS• SHOULDNOTUSEST.JOHN’SWORTWITHSSRI’S,TCA,ORMAOI’S• OMEGAFATTYACIDSMAYINTERACTWITHSSRIANDANTICOAGULANTTOINCREASEDTHERISKOFBLEEDING.• PASSIONFLOWERWITHOTHERSEDATIVES,ANTICONVULSANT,TCA,ANDANTICONVULSANT.• CHAMOMILEINTERACTIONWITHWARFARINANDCYCLOSPORINE–• DERMATITIS
INTERACTIONSWITHOTCANDCONVENTIONALMEDICATIONS
• BEWAREOFTHETYPEOFALDULTERANTSINPRODUCTS.• WHETHERITWASTHELEAF,BARK,ORROOTCOULDMAKETHEDIFFERENCEINPOTENCY.• INTERACTIONSWITHCONVENTIONALAGENTS• PLEASEUSEONETYPEOFAGENTSEITHERHERBALORCONVENTIONALTHERAPY• BEWAREOFHERBALAGENTSTHATCUREEVERYTHING,KNOWINGTHATEVERYHERBANDMEDICATIONALWAYSHAVESOMEADVERSEEFFECTS.• BEWAREOFHERBALMEDICATIONSTHATSTATENOADVERSEEFFECTS,MAYBENOTDOINGANYTHINGEITHER.
EVALUATION- CASESTUDY
• APATIENTCOMESTOTHEDRUGSTORECOMPLAININGOFSEVEREANXIETYSINCEBEGINNINGTOTAKEST.JOHN’SWORTABOUTTWOWEEKSAGO.SHEISTAKING3TABLETSADAY,ANDISNOTSLEEPINGASGOODWORSETHANWHENSHEBEGANTAKINGTHEST.JOHN’SWORT.• WHATDOYOUTELLTHISPATIENTTODO?• A)STOPTAKINGTHETABLETS• B)REDUCETHEDOSETO2TABLETSADAY• C)REDUCETHEDOSETO1TABLETADAY• D)STOPTAKINGMEDICATIONFORAWEEKANDTHENRESTARTAGAIN.
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EVALUATION– CASESTUDY
• AVETERANCOMESINTOTHEDRUGSTOREWANTINGSOMETHINGFORSLEEP.HECAN’TSLEEPVERYWELLANDISVERYIRRITABLEINTHEMORNING.WHATDORECOMMENDTOTHISVETERAN?• A)DIPHENHYDRAMNE25MGPOATBEDTIME• B)DOXYLAMINE25MGPOATBEDTIME• C)VALERIANTEAATBEDTIME• D)REFERTOMENTALHEALTHCOUNSELLOR
• TWOWEEKSLATERHECOMESBACKANDCOMPLAINSTHATHEISWAKINGUPWITHNIGHTMARESANDCAN’TGETBACKTOSLEEP,HISIRRITABILITYISWORSE,ANDHISWIFEWANTSTOLEAVEHIM.• A)INCREASEDOSEOFSLEEPAID• B)REFERTOPCPDOCTOR• C)REFERTOMENTALHEALTHDOCTOR• D)RECOMMENDKAVATEA
EVALUATIONCASESTUDY
• VETERANGOESTOHISMENTALHEALTHPHYSCIAN,WHATWOULDYOUEXPECTTHATHISPSYCHIATRISTWOULDGIVETOTHISVETERANFORHISNIGHTMARES?• A)PRAZOSIN• B)ARIPIPRAZOLE• C)SERTRALINE• D)PROPRANOL.• WHATWOULDYOUEXPECTHISPSYCHIATRISTTOGIVEHIMFORHISANXIETY?• A)PRAZOSIN• B)ARIPIPRAZOLE• C)SERTRALINE• D)PROPRANOLOL
EVALUATIONCASESTUDY
• THEVETERANCOMESBACKTOTHEPHARMACYCOMPLAININGOFSTILLHAVINGSUICIDALIDEATIONSAFTER2WEEKSOFTHERAPY.WhatSHOULDTHEPHARMACISTADVICETHEVETERAN?• A)STOPTAKINGMEDICATION• B)CONTACTMENTALHEALTHPHYSICIAN• C)INCREASETHEDOSEOFSERTRALINE• D)CONTINUETAKINGMEDICATIONSASTHEMEDICATIONMAYTAKE6WEEKSTOHAVEANEFFECT.
STIGMA
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QUESTIONSANDANSWERSECTION REFERENCES
• 1)CPNP2016-2017Anxietyandanxietyrelateddisorderspg.1-79.• 2)CPNP2016-2017Bipolardisorderpg.127-181.• 3)CPNP2016-2017;Depression,pg.181-243• 4)CPNP2016-2017;Schizophreniaspectrumandotherpsychoticdisorders,pg.579– 645• www.SAMHSA.gov.Treatmentofmentaldisorders,lastupdated10/27/2015• Collingwood.J.(2016).NaturalandherbalSupplementsforcommonMentalDisorders.Psych.Central.Retrievedfromhttps://psychcentral.com/lib/natural-and-herbal-supplements-for-common-mental-disorders/• Eversole.g.(2017)HerbsforTreatmentofEmotionalandMentalstates,retrievedfromwww.alternativementalhealth.com• FreemanMP,LakeJ,ComplimentaryandAlternativeMedicineinMajorDepressivedisorder:TheAmericanPsychiatricAssociationsTaskForceReport.J.Clinpsychiatry,2010june71(6)669-680.
