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Use of Drugs in Mental Health
Assoc. professor E. A. LotheWinter School, Maribor UniversityMaribor, Slovenia, Nov 2015
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Goals for this lecture:
The students should
1. Acquire some basic insight into Mental Health2. Acquire some basic knowledge of Psycho-
farmacological groups of medicines3. Acquire some basic insight into when, how and
why psychofarmacological medication is used – and how this affects the patient
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Goals for this lecture, cont.:
The students should
• Acquire some knowledge on non-medical treatments and significant factors for resilience and recovery.
• Reflect on use of drugs from ethical and legal perspectives
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Perspectives on mental health • Biological• Psychic (mental)• Psycho-social• Cultural
• Mental suffering can be described as Outside-perspective
• Vs/ Inside-perspective:• That which is experienced by the patient
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Perspectives, cont.:• Illness/wellness• Symptoms/external and internal• Stigma• Exclusion/integration
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Some common mental illness diagnoses
• Psychosis – altered perception of reality• Depression – varying degrees of severity• Suicidal ideation • Anxiety – a number of variables • Bipolar variations – affective disorders • Eating disorders • Susbstance dependency
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Models for treatment of mental illness
• Hospitalization • Outpatient treatment
• Voluntary vs/coerced treatment• Medication• Medication-free treatment, examples:
• Cognitive therapy• Trauma treatment • Milieu therapy
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Antidepressants • Block reuptake of of neurotransmitters (serotonon
and norepinephrine)• Reduce depression • Control anxiety• Control obsessions• Relieve severe pain• Prevent panic attacks
• Undesirable side effects: nausea, headache, sexual dysfunction, sedation, weight gain, etc.
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Antipsychotic medication• Block dopamin receptors• Some also block a specific serotonin receptor
• Relief of psychosis and anxiety• Relief of acute mania
• Undesirable side effects: blurred vision, dry mouth, constipation, tachycardia, sedation, weight gain, ejaculatory difficulty, dizziness.
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Anti-anxiety: Benzodiazepines• Facilitate the transmission of the inhibitory
neurotransmitter GABA• Relief of anxiety• Sedation
• Undesirable side effects: dependence, confusion, memory impairment, motor incoordination.
• Nausea, headache, dizziness, restlessness.
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Substance abuse and mental health
• Co-dependency • Dual diagnoses• Auto-medication
• Legal substances• Illegal substances• Dependency-risky prescribed drugs
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Other issues significant for mental health • Autonomy • Significant relations • Hope • Resilience • Healing and wellbeing• Empowerment • Coping strategies • Recovery
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Good friends pull together
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Relations and their significance for mental health and recovery
• Issues that promote relations competence • Working together:
• the individual,• the family,• the social network group and• society
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Recovery – healing processes
• Spontaneous and natural development (without organised treatment)
• A consequence of treatment interventions (clinical recovery)
• Recovery in spite of countinued suffering from symptoms and functional disability
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Goals for the nurse
• Preserve life• Build an alliance – important regarding use of
drugs• Strengthen the patient´s self esteem• Encourage the patient in developing the wish
to live• Assist in dealing with existential crisis
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Nursing tools and actions • Multiple different therapies: ex.
cognitive, trauma, milieu.
• Motivate • Offer togetherness - share time with• Respect• Empathy and attentive listening• Time and full attention
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The good therapeutic session
• Building relations• Communication
–Open invitation–Listening attentively–Listen to the silence and to the
affective message• Create an alliance for teamwork• Use yourself as a tool
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Relevant professional ethical and legal issues for reflection
• Autonomy vs/paternalism• Principle of beneficence• Confidentiality
• Substance legislation
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Suggested reading:
Davidson, L et al (2008). Remission and recovery in schizophrenia: practitioner and patient perspectives. Schizophrenia bulletin, vol:34 (1), pp :5 -8
Link BG; Struening EL; Neese-Todd S; Asmussen S & Phelan JC (2001). Stigma as a barrier to Recovery. The Consequences of Stigma for the Self-Esteem of People with Mental Illnesses. Psychiatric Services, vol.52, (12), Dec. http://dx.doi.org/10.1176/appl.ps.52.12.1621
Topor A; Borg M, Di Girolamo S & Davidson L (2011). Not just an individual journey: social aspects of recovery. Int J Soc Psychiatry Jan 20.
Townsend, MC (2015). Psychiatric Mental Health Nursing. Concepts of Care in Evidence-Based Practice. Philadelphia, USA, F.A.Davis Co.
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