Daniel Castellanos, MD Medical Director, South Florida
Behavioral Health Network SFBHN Psychotropic Medications Training
2014
Slide 2
None Nada Yoktur Keiner nenhum Aucun Nessuno Gralnik &
Castellanos Nov 2013
Slide 3
This training about psychotropic medications was developed for
clinicians to help them make informed decisions and monitor
consumers who are prescribed these medications. This training
reviews expectations for the safe and effective use of psychotropic
medications in the State of Florida. Disclaimer The author and
SFBHN have used reasonable care and skill in compiling the content
of this training. However, we accept no responsibility or liability
for any inaccuracy or errors and omissions, or for any damage or
injury to persons or property arising out of the accessing or use
of any of the materials contained in this presentation and material
accessed from it. Individual prescribers are responsible for their
prescribing practices. Specific questions about medications should
be consulted with the prescriber. 3 Psychotropic Medications
Training 2014
Slide 4
Recognize common mental health disorders in children &
adolescents. Identify effective treatment options for these mental
health disorders. Identify the names and indications for use of
commonly prescribed psychotropic medications. Recognize how
psychotropic medications are used. Recognize common psychotropic
medication side effects. Identify your responsibilities in the
treatment process. Identify what to do if you have concerns about
the psychotropic medications prescribed to consumers whose care you
are involved with. 4 Psychotropic Medications Training 2014
Slide 5
Psychotropic medications (sometimes called psychotherapeutic
medications) are used to treat emotional and behavioral health
symptoms and psychiatric disorders. They affect mood, thoughts,
behaviors, and how a person processes information and perceives his
or her surroundings. 5 Psychotropic Medications Training 2014
Slide 6
Psychotropic medication must not be used as a method of
discipline or control for any consumer. Psychotropic medications
are not to be used instead of or as a substitute for identified
therapy or behavioral interventions and supports required to meet a
consumers mental health needs. 6 Psychotropic Medications Training
2014
Slide 7
The FDA observes that accepted medical practice includes
medication use that is not reflected in approved medication
labeling. This is called off label use. Many psychotropic
medications that are not FDA approved for a specific use can be
used off label to appropriately manage different and difficult
problems. Off label psychotropic medication use may be justified
when the benefits of treatment outweigh the risks. Without
treatment, these consumers could at times suffer serious or
dangerous consequences. 7 Psychotropic Medications Training
2014
Slide 8
General population: About 20% of children in the general
population have some form of a mental health disorder.
Approximately 40% of youth have co-occurring disorders. Foster
care: The national range of children in foster care that have
significant mental health problems is 23-80% In Miami-Dade and
Monroe Counties during FY 2011-2012, approximately 82% of children
in foster care had a diagnosable Axis I mental health disorder.
Even when compared to children in similar social class and
demographics, foster children are at greater risk for mental health
problems. 8 Psychotropic Medications Training 2014
Slide 9
General population: About 20% of children in the general
population have some form of a behavioral health disorder.
Approximately 40% of youth have co-occurring disorders. Foster
care: The national range of children in foster care that have
significant behavioral health problems is 23-80% Even when compared
to children in similar social class and demographics, foster
children are at greater risk for behavioral health problems. 9
Psychotropic Medications Training 2014
Slide 10
The most common disorders in children and adolescents include:
Anxiety Disorders Disruptive Behavior Disorders (ADHD, Oppositional
Defiant Disorder, Conduct Disorder) Depressive Disorders (Major
Depressive Disorder and Persistent Depressive Disorder/ FKA
Dysthymic Disorder) Substance Use Disorders (mainly adolescents).
Schizophrenia is not commonly found in childhood. 10 Psychotropic
Medications Training 2014
Slide 11
Psychotropic Meds Training 2014 Source: www.nami.org
Slide 12
Mental health matters at every stage of life and requires an
integrated continuum of services ranging from prevention to
recovery. Mental health can be improved: With earlier
identification and intervention. With improved access to services
at the right time. By establishing best practices and improving
standards of care. By coordinating mental health care across
school, medical and community environments. 12 Psychotropic
Medications Training 2014
Slide 13
The Treatment Plan is a tool that helps coordinate, monitor and
guide treatment interventions. The Treatment Plan: Should be
developed based on the best available evidence. Involves a
continuous process that is updated on a regular basis and as
needed. Defines target problems that will be the focus of
treatment. Defines the plan to monitor the child, short and long
term. 13 Psychotropic Medications Training 2014
Slide 14
A multitude of interventions may be indicated in helping
children in out of home care. Treatment may involve: Therapy
Educational interventions Structure Medications REMEMBER:
Psychotropic medications should only be used as one part of a
comprehensive treatment plan. 14 Psychotropic Medications Training
2014
Slide 15
Many kinds of psychotherapies exist. There is no
"one-size-fits-all" approach. Some therapies have been
scientifically tested more than others. The goal is to utilize more
Evidenced-Based therapies. Sometimes psychotherapy alone may be the
best treatment for a person, depending on the illness and its
severity. Sometimes, psychotherapy is combined with medications.
The kind of psychotherapy a child receives depends on his or her
needs. 15 Psychotropic Medications Training 2014
Slide 16
16 Psychotropic Medications Training 2014
Slide 17
The classes of psychotropic medications to be reviewed are:
Stimulants and Other Medications Used to Treat ADHD Antidepressants
Antipsychotics Mood stabilizers Anxiolytics Miscellaneous:
Antihistamine Medications Medications used to Treat Side Effects of
Antipsychotics Remember: Not all medications your consumer is
taking may be covered here. 17 Psychotropic Medications Training
2014
Slide 18
18 Psychotropic Medications Training 2014 Stimulants &
Other Medications Used to Treat ADHD SFBHN Psychotropic Medications
Training
Slide 19
Stimulants and other medications are commonly used to treat
Attention-Deficit/Hyperactivity Disorder (ADHD). Symptoms of ADHD
interfere with functioning at school, work and in daily living and
may include: Short attention span. Inability to stay still. Being
impulsive. 19 Psychotropic Medications Training 2014
Slide 20
FDA MaxFDA Approved for ADHD Generic NameBrand Nameper
dayChildren & AdolAdults Mixed Amphetamine saltsAdderall40 mg
Yes No Mixed Amphetamine salts XRAdderall XR30 mg Yes
ClonidineCatapres *0.4 mg No MethylphenidateDaytrana Patch30 mg Yes
No Methylphenidate ER Concerta Metadate CD Ritalin LA Quillivant XR
72 mg 60 mg Yes DextroamphetamineDexedrine40 mg Yes No
DexmethylphenidateFocalin20 mg Yes No Dexmethylphenidate XRFocalin
XR30 mg Yes Guanfecine ERIntuniv *4 mg Yes No Clonidine ERKapvay
*0.4 mg Yes No MethylphenidateRitalin60 mg Yes No
AtomoxetineStrattera *100 mg Yes GuanfecineTenex *4 mg No
LisdexamphetamineVyvanse70 mg Yes BupropionWellbutrin SR/XL*300
mgNo 20 SFBHN Psychotropic Medications Training 2014
Slide 21
Groups: Stimulants: Usually first line/choice meds Controlled
substances Amphetamine based Methylphenidate Non-stimulant
medications: NOT controlled substances Atomoxetine Clonidine,
clonidine ER & guanfecine, guanfecine ER Others (typically off
label) 21 Psychotropic Medications Training 2014
Slide 22
What does it mean that stimulants are controlled substances by
DEA (Schedule II)?: One prescription supply only (usually one
month) No refills Cannot be called in or faxed to the pharmacy
(Paper prescription is needed) Potential for abuse 22 Psychotropic
Medications Training 2014
Slide 23
Examples of stimulants (DEA Schedule II controlled substances):
Mixed Amphetamine salts: Adderall , Adderall XR Methylphenidate:
Ritalin , Daytrana Patch Methylphenidate ER: Concerta , Metadate CD
, Ritalin LA Quillivant XR Dextroamphetamine: Dexedrine
Dexmethylphenidate: Focalin , Focalin XR Lisdexamphetamine: Vyvanse
23 Psychotropic Medications Training 2014
Slide 24
Decreased appetite Stomachaches Headaches Trouble falling
asleep Irritability Higher blood pressure and heart rate
Jitteriness Being too quiet Tics Problems with growing 24
Psychotropic Medications Training 2014
Slide 25
Rare, Unexpected, Serious Psychosis/Mania Cardiovascular Risks
(May include sudden cardiac death, dizziness, chest pain, stroke
and arrhythmias in persons with serious pre-existing heart
problems). Skin rashes Dependence 25 Psychotropic Medications
Training 2014
Slide 26
Nonstimulants: Atomoxetine (Strattera ) - Side Effects: Stomach
aches Increased liver enzymes Suicidal behaviors Clonidine,
clonidine ER/Kapvay & guanfecine, guanfecine ER/Intuniv - Side
Effects: Tiredness Sedation Headaches Stomach aches Lowering of
blood pressure 26 Psychotropic Medications Training 2014
Slide 27
27 Psychotropic Medications Training 2014
Slide 28
Time (hours) 0510 0 15 20 Mean plasma levels (ng/mL) 5 10
Methylphenidate Concerta Adderall XR Vyvanse Effective
concentration SFBHN Psychotropic Medication Training 2014
Slide 29
FDA MaxFDA Approved for ADHD Generic NameBrand Nameper
dayChildren & AdolAdults Mixed Amphetamine saltsAdderall40 mg
Yes No Mixed Amphetamine salts XRAdderall XR30 mg Yes
ClonidineCatapres *0.4 mg No MethylphenidateDaytrana Patch30 mg Yes
No Methylphenidate ER Concerta Metadate CD Ritalin LA Quillivant XR
72 mg 60 mg Yes DextroamphetamineDexedrine40 mg Yes No
DexmethylphenidateFocalin20 mg Yes No Dexmethylphenidate XRFocalin
XR30 mg Yes Guanfecine ERIntuniv *4 mg Yes No Clonidine ERKapvay
*0.4 mg Yes No MethylphenidateRitalin60 mg Yes No
AtomoxetineStrattera *100 mg Yes GuanfecineTenex *4 mg No
LisdexamphetamineVyvanse70 mg Yes BupropionWellbutrin SR/XL*300
mgNo 29 SFBHN Psychotropic Medications Training 2014
Slide 30
30 Psychotropic Medications Training 2014 Antidepressants SFBHN
Psychotropic Medications Training
Slide 31
Antidepressants are used in consumers to treat: Depressive
disorders Anxiety disorders Obsessive-Compulsive Disorder (OCD)
other conditions. 31 Psychotropic Medications Training 2014
Slide 32
Child & Adolescent- Only 2 antidepressants are FDA approved
for the treatment of major depressive disorder in children and
adolescents: fluoxetine (Prozac; 8 17 yo) escitalopram (Lexapro; 12
17 yo) 32 Psychotropic Medications Training 2014
Slide 33
Generic NameBrand Name FDA Max per day FDA Approved for Major
Depression VortioxetineBrintellix 20 mg Adults CitalopramCelexa 60
mg Adults DuloxetineCymbalta 60 mg Adults VelanfaxineEffexor 225 mg
Adults Venlafaxine XREffexor XR 225 mg Adults SelegineEmsam patch
12 mg Adults FetzimaLevomilnacipran CR 120 mg Adults
EscitalopramLexapro 30 mg Children & Adol (12-17); Adults
FluvoxamineLuvox 300 mg No Fluvoxamine CRLuvox CR 300 mg No
ParoxetinePaxil, Pexeva 50 mg Adults Paroxetine CRPaxil CR 62.5 mg
Adults DesvenlafaxinePristiq 400 mg Adults FluoxetineProzac 60 mg
Children & Adol (8-17); Adults MirtazapineRemeron 45 mg Adults
FluoxetineSerafem 80 mg No DoxepinSilenor 6 mg No VilazodoneViibryd
40 mg Adults BupropionWellbutrin 450 mg Adults Bupropion
SR/XLWellbutrin SR/XL 400 mg(SR) / 450(XL) Adults SertralineZoloft
200 mgs Adults SFBHN Psychotropic Medications Training 2014
Slide 34
Generic NameBrand Name FDA Max per day FDA Approved for Major
Depression ClomipramineAnafranil 200 mg (children/adol) 250 mg
(adults) No DoxepinSinequan300 mgAdults TrazodoneDesyrel300
mgAdults AmitryptilineElavil300 mgAdults NortryptilinePamelor200
mgAdults ImipramineTofranil300 mgAdults 34 SFBHN Psychotropic
Medications Training 2014
Slide 35
Anxiety Disorders: Antidepressant medications have an
anti-anxiety effect. Some of these medications are considered first
line medications (off label) in the treatment of anxiety disorders
in children and adolescents. Obsessive Compulsive Disorder (OCD):
Certain antidepressants are FDA approved for the treatment of OCD
in children and adolescents: clomipramine (Anafranil) fluoxetine
(Prozac) fluvoxamine (Luvox) sertraline (Zoloft). 35 Psychotropic
Medications Training 2014
Slide 36
Antidepressant medications can be effective in the treatment of
other disorders. In ADULTS Certain antidepressants are FDA approved
for the treatment of: Bulimia Nervosa Generalized Anxiety Disorder
Obsessive Compulsive Disorder (OCD) Panic Disorder Premenstrual
Dysphoric Disorder (PMDD) Posttraumatic Stress Disorder (PTSD)
Social Anxiety Disorder (FKA Social Phobia) 36 Psychotropic
Medications Training 2014
Child, Adolescents & Young Adults- A boxed warning is used
by the FDA to alert doctors and patients that special care should
be exercised when using antidepressants: Antidepressants increased
the risk compared to placebo of suicidal thinking and behavior
(suicidality) in children, adolescents, and young adults in
short-term studies of major depressive disorder (MDD) and other
psychiatric disorders. REMEMBER: Children, adolescents & young
adults (< 24 yo) taking an antidepressant should be monitored
for new or worsened suicidal thoughts and behaviors. Talk to the
doctor or the prescriber if this happens. 40 Psychotropic
Medications Training 2014
Slide 41
SSRIs FDA Category C pregnancy precaution: no adequate and
well-controlled studies in humans to determine the effect of the
SSRI on the fetus. Research findings on the effects of
antidepressants on the growing baby are mixed and inconclusive.
Even though most risks found by researchers have been low, the
potential risk of a rare heart and lung condition known as
persistent pulmonary hypertension of the newborn (PPHN) has been
identified. Antidepressants should be used during pregnancy only if
the potential benefit justifies the potential risk to the fetus.
Psychotropic Medication Training 2014
Slide 42
Generic NameBrand Name FDA Max per day FDA Approved for Major
Depression VortioxetineBrintellix 20 mg Adults CitalopramCelexa 60
mg Adults DuloxetineCymbalta 60 mg Adults VelanfaxineEffexor 225 mg
Adults Venlafaxine XREffexor XR 225 mg Adults SelegineEmsam patch
12 mg Adults FetzimaLevomilnacipran CR 120 mg Adults
EscitalopramLexapro 30 mg Children & Adol (12-17); Adults
FluvoxamineLuvox 300 mg No Fluvoxamine CRLuvox CR 300 mg No
ParoxetinePaxil, Pexeva 50 mg Adults Paroxetine CRPaxil CR 62.5 mg
Adults DesvenlafaxinePristiq 400 mg Adults FluoxetineProzac 60 mg
Children & Adol (8-17); Adults MirtazapineRemeron 45 mg Adults
FluoxetineSerafem 80 mg No DoxepinSilenor 6 mg No VilazodoneViibryd
40 mg Adults BupropionWellbutrin 450 mg Adults Bupropion
SR/XLWellbutrin SR/XL 400 mg(SR) / 450(XL) Adults SertralineZoloft
200 mgs Adults SFBHN Psychotropic Medications Training 2014
Slide 43
43 Psychotropic Medications Training 2014
Slide 44
Generic NameBrand Name FDA Max per day FDA Approved for Major
Depression ClomipramineAnafranil 200 mg (children/adol) 250 mg
(adults) No DoxepinSinequan300 mgAdults TrazodoneDesyrel300
mgAdults AmitryptilineElavil300 mgAdults NortryptilinePamelor200
mgAdults ImipramineTofranil300 mgAdults 44 SFBHN Psychotropic
Medications Training 2014
Slide 45
45 Psychotropic Medications Training 2014 Antipsychotics SFBHN
Psychotropic Medications Training
Slide 46
These medications may improve: Psychotic symptoms (eg,
hallucinations, delusions, impaired reality, disorganized thinking,
etc). Bipolar mood changes, such as manic episodes; bipolar
depression less so. Depression, as an adjunct to antidepressants.
Irritability, associated with autism spectrum disorder. Agitation
or aggression. 46 Psychotropic Medications Training 2014
Slide 47
Antipsychotic medications are FDA approved to treat:
Schizophrenia spectrum & other psychotic disorders Bipolar and
related disorders Major Depressive Disorder (augmentation) Autism
Spectrum Disorder (irritability): Aripiprazole (Abilify)
Risperidone (Risperdal) Acute treatment of agitation: Aripiprazole
(Abilify) Loxitane (Adasuve#) - Inhaler Olanzapine (Zyprexa)
Ziprasidone (Geodon) 47 Psychotropic Medications Training 2014
Slide 48
The following antipsychotic medications are FDA approved for
the treatment of schizophrenia in adolescents 13-17 years:
aripiprazole (Abilify) haloperidal (Haldol; 3-17 yo) olanzapine
(Zyprexa) quetiapine (Seroquel) risperidone (Risperdal). 48
Psychotropic Medications Training 2014
Slide 49
The following antipsychotic medications are FDA approved for
the treatment of acute manic or mixed episodes associated with
Bipolar I Disorder in youngsters 10-17 years: aripirprazole
(Abilify) olanzapine (Zyprexa; 13-17 years only) quetiapine
(Seroquel) risperidone (Risperdal). 49 Psychotropic Medications
Training 2014
Slide 50
The following antipsychotic medications are FDA approved for
the treatment of the symptomatic treatment of irritability
associated with children and adolescents with autistic disorder:
aripiprazole (Abilify) risperidone (Risperdal) 50 Psychotropic
Medications Training 2014
Slide 51
Generic NameBrand Name Schizophrenia (13-17 yo) Bipolar I
Disorder (10-17 yo) Autism Spectrum Disorder (6-17 y0)
AripiprazoleAbilify OlanzapineZyprexa (13-17) QuetiapineSeroquel
RisperidoneRisperdal HaloperidalHaldol (03-17) SFBHN Psychotropic
Medications Training 2014
55 Bipolar Depression Mania Maintenance Euthymia/Baseline
Hypomania D MDD Psychotropic Medications Training 2014
Slide 56
Generic NameBrand Name Major Depressive Disorder (Augmentation)
Bipolar Depression Agitation- Acute Treatment AripiprazoleAbilify
LoxapineAdasuve ZiprasidoneGeodon LurasidoneLatuda
QuetiapineSeroquel Quetiapine + Fluoxetine Symbyax
OlanzapineZyprexa SFBHN Psychotropic Medications Training 2014
Slide 57
Most antipsychotics are associated with decreased appetite and
weight loss.
Slide 58
Slide 59
Drowsiness Dizziness Dry mouth Blurred vision Constipation
Stiffness Restlessness Drooling Rapid heartbeat Sensitivity to the
sun Skin rashes Increased appetite and weight gain Menstrual
problems 59 Psychotropic Medications Training 2014
Slide 60
Rare, unexpected, serious Enlargement of breasts in males
Galactorrhea (flow of milk from the breast when not pregnant)
Dangerous drop in white blood cells (clozapine). Seizures
(clozapine) Tardive dyskinesia (TD; potentially irreversible
involuntary movements) Neuroleptic malignant syndrome (NMS;
increased temperature, muscular rigidity, altered mental state,
changes in kidney functioning). 60 Psychotropic Medications
Training 2014
Slide 61
QT prolongation (changes in hearts electrical activity): May
prolong QT interval and may be associated with arrhythmia and
sudden death. Use with caution in children and adolescents with
cardiovascular problems. 61 Psychotropic Medications Training
2014
Slide 62
Metabolic Changes: Atypical antipsychotic drugs have been
associated with metabolic changes that may increase cardiovascular/
cerebrovascular risk, such as: heart disease stroke diabetes These
metabolic changes include: Increased blood sugar (hyperglycemia)
Increased lipids (dyslipidemia) Weight gain 62 Psychotropic
Medications Training 2014
Slide 63
63 Psychotropic Medications Training 2014
Slide 64
FDA Category C pregnancy precaution Antipsychotics are
associated with increased gestational weight & diabetes and
with increased risk of preterm birth. Findings in relation to
malformations are inconclusive. Potential risk for abnormal muscle
movements (extrapyramidal signs or EPS) and withdrawal symptoms in
newborns whose mothers were treated with these drugs during the
third trimester of pregnancy. Clozapine is considered a Category B
medication. Psychotropic Meds Training 2014
Generic NameBrand NameFDA Max per day FDA Approved for
SchizophreniaMania/Bipolar Haloperidal Haldol 60 mg Child &
Adol (3-17) Adults No HaloperidalHaldol Decanoate*300 mg/moAdultsNo
LoxapineLoxitane250 mg Child & Adol (12-17) Adults No
ThioridazineMellaril800 mgAdultsNo ThiothixeneNavane60 mg Child
& Adol (12-17) Adults No Pimozide Orap 10 mgNo Fluphenazine No
current brand name exists 40 mgAdultsNo FluphenazineProlixin
Decanoate*75 mg/2 wksAdultsNo TrifluoperazineStelazine80 mg Child
& Adol (6-17) Adults No ChlorprmazineThorazine2,000 mg Child
& Adol (1-17) Adults No PerphenazineTrilafon64 mgAdultsNo 66
SFBHN Psychotropic Medications Training 2014 Approved for use in
Tourette's Disorder * Long acting injection
Slide 67
67 Psychotropic Medications Training 2014 Mood Stabilizers
SFBHN Psychotropic Medication Training
Slide 68
Mood stabilizers are medications used to treat bipolar disorder
with or without an antipsychotic. Many antiepileptic medications
(medicines for seizures) can work as mood stabilizers.
Interventions for bipolar disorder are not necessarily directed at
curing the disorder but at optimally managing it over time. The
outcome is better when treatment is continuous rather than on and
off over time. 68 Psychotropic Medications Training 2014
Slide 69
Generic NameBrand NameFDA Max per day FDA Approved for Bipolar
Disorder Divalproex/Valproic AcidDepakote/Depakene*60 mg / kgAdults
LithiumEskalith / Lithobid*1,800 mgAdults
LamotrigineLamictal0.15-3.0 mg / kgAdults GabapentinNeurontin1,800
mgNo CarbamazapineTegretol / Equetro* 1,000 mg children; 1,200 mg
adults Adults TopiramateTopamax5-9 mg / kgNo
OxcarbazapineTrileptal1,800 mgNo 69 Psychotropic Medications
Training 2014
Slide 70
Excessive thirst Frequent urination Nausea Fine hand tremor
Muscles twitches Acne Itching, rash EKG changes Weight gain. 70
Psychotropic Medications Training 2014 O
Slide 71
Rare, unexpected, serious Blackouts Loss of coordination
Seizures Slurred speech Fast, slow, irregular, or pounding
heartbeat. Hallucinations Changes in vision Swelling of the eyes,
face, lips, tongue, throat, hands, feet, ankles, or lower legs.
Hypothyroidism. 71 Psychotropic Medications Training 2014
Slide 72
Changes in weight Nausea Stomach pain Vomiting Anorexia Changes
in appetite. Vomiting Diarrhea Constipation Skin rash Increased
suicidal thoughts and behaviors. Rare, unexpected, serious Liver or
pancreatic damage Polycystic ovarian syndrome (PCOS). 72
Psychotropic Medications Training 2014
Slide 73
Headaches Dizziness Diarrhea Rash Pruritus (itchiness) Negative
mood adverse reactions Sleep changes Increased suicidal thoughts
and behaviors. Rare, unexpected, serious Liver or pancreatic damage
Steven Johnson Syndrome: A serious, potentially fatal allergic
reaction that leads to a skin rash and sores in the mouth.
REMEMBER: If a consumer develops a rash while taking Lamotrigine
(Lamictal) immediately contact the doctor. 73 Psychotropic
Medications Training 2014
Slide 74
Mood stabilizers may effect the metabolism, liver, kidneys, and
thyroid. Consumers taking Valproic acid / divalproex sodium
(Depakote), Lithium or Carbamazepine (Tegretol/Equetro) should have
routine blood work to make sure the dose is safe and effective.
Levels are usually checked in the morning before the medication is
given to the consumer. 74 Psychotropic Medications Training
2014
Slide 75
The FDA has issued a warning for all of the mood stabilizers
listed previously EXCEPT lithium. This warning alerts people to the
increased risk of suicidal thinking and behavior REMEMBER:
Consumers taking any mood stabilizer (except lithium) should be
monitored for new or worsened suicidal thoughts and behaviors. Talk
to the doctor or prescriber if this happens. 75 Psychotropic
Medications Training 2014
Slide 76
Caution should be exercised when Consumers with pre-existing
medical problems are prescribed a mood stabilizer in which there
may be an interaction. Examples: lithium in persons with renal,
cardiovascular or thyroid problems divalproex (Depakote) in persons
with liver problems topiramate (Topamax) in consumers with
glaucoma. 76 Psychotropic Medications Training 2014
Slide 77
Category C: No adequate and well-controlled studies in humans
to determine the effect of the SSRI on the fetus. Lamotrigine
(Lamictal) Gabapentin (Neurontin) Oxcarbazepine (Trileptal)
Category D: There is positive evidence of human fetal risk based on
adverse reaction data from investigational or marketing experience
or studies in humans, but potential benefits may warrant use of the
drug in pregnant women despite potential risks. Lithium (Eskalith,
Lithobid) Valproate/divalproex (Depakote) Topiramate (Topamax)
Carbamazepine (Tegretol) Psychotropic Meds Training 2014
Slide 78
Generic NameBrand NameFDA Max per day FDA Approved for Bipolar
Disorder Divalproex/Valproic AcidDepakote/Depakene*60 mg / kgAdults
LithiumEskalith / Lithobid*1,800 mgAdults
LamotrigineLamictal0.15-3.0 mg / kgAdults GabapentinNeurontin1,800
mgNo CarbamazapineTegretol / Equetro* 1,000 mg children; 1,200 mg
adults Adults TopiramateTopamax5-9 mg / kgNo
OxcarbazapineTrileptal1,800 mgNo 78 SFBHN Psychotropic Medications
Training 2014
Slide 79
79 Psychotropic Medications Training 2014 Anxiolytics &
Other Anti-Anxiety Medications SFBHN Psychotropic Medications
Training
Slide 80
Generic NameBrand NameFDA Max per day FDA Approved for Anxiety
LorazepamAtivan10 mgAdults BuspironeBuspar *60 mgAdults
ClonazepamKlonopin4 mgAdults ChlordiazepoxideLibrium 300 mg (IV/IM)
Adults DiazepamValium40 mgAdults AlprazolamXanax6 mgAdults 80 SFBHN
Psychotropic Medications Training 2014
Slide 81
Anxiolytics or anti-anxiety medications and antidepressants are
the most commonly used medications for anxiety disorders.
Benzodiazepines (BZs) are a group of anxiolytic medications that
work differently than antidepressant medications: BZs generally
start working more quickly. BZs help improve situational anxiety
but are less effective in preventing or maintaining anxiety under
control. The effects of BZs usually do not last for a full day. BZs
are classified as controlled substances (Schedule IV). BZs can
result in dependence. 81 Psychotropic Medications Training
2014
Slide 82
What does it mean that benzodiazepines are controlled
substances by DEA (Schedule IV)?: Can be written with refills if
appropriate Can be called in or faxed to the pharmacy Potential for
abuse. 82 Psychotropic Medications Training 2014
Slide 83
Examples of Benzodiazepines (DEA Schedule IV controlled
substances): Lorazepam: Ativan Clonazepam:Klonopin
Chlordiazepoxide: Librium Diazepam:Valium Alprazolam:Xanax 83
Psychotropic Medications Training 2014
Slide 84
Buspirone (Buspar) is an anti-anxiety medication that is not a
benzodiazepine and: Unlike benzodiazepines typically takes at least
two weeks to begin working. Usually should be taken 2 3 times per
day. Is not classified as a controlled substance. Has little
scientific support for its use in children and adolescents. 84
Psychotropic Medications Training 2014
Slide 85
Tiredness Drowsiness Dizziness Unsteadiness when walking Upset
stomach Blurred vision Headache Confusion Memory problems
Nightmares Depression Increased suicidal thoughts and behaviors
(clonazepam/Klonopin, clorazepate/Tranxene). 85 Psychotropic
Medications Training 2014
Slide 86
Rare, unexpected, serious Respiratory depression (Dose
dependent, with more severe effects occurring with high doses).
Disinhibition Hypomania in persons with depression Blood dyscracias
(abnormality of blood cells) Liver problems Seizures (withdrawal).
86 Psychotropic Medications Training 2014
Slide 87
Generic NameBrand NameFDA Max per day FDA Approved for Anxiety
LorazepamAtivan10 mgAdults BuspironeBuspar *60 mgAdults
ClonazepamKlonopin4 mgAdults ChlordiazepoxideLibrium 300 mg (IV/IM)
Adults DiazepamValium40 mgAdults AlprazolamXanax6 mgAdults 87 SFBHN
Psychotropic Medications Training 2014
Slide 88
88 Psychotropic Medications Training 2014 Misc Meds SFBHN
Psychotropic Medications Training
Slide 89
Antihistamine medications, or antihistaminics, primary
indication is to treat allergies. These medicines are also
contained in certain cold remedies. Partly because of their
relatively safe side effect profile, sometimes these medications
are used off-label for the management of agitation and aggression.
89 Psychotropic Medications Training 2014
Slide 90
Drowsiness Excitability (Especially in young children) Dry
mouth Increased appetite Itchiness Headaches Diarrhea Constipation
Weight gain. Rare, unexpected, serious Shakiness (Usually with
higher doses) Seizures (Usually with higher doses) Dangerous drop
in white blood cells. 90 Psychotropic Medications Training
2014
Slide 91
Generic NameBrand NameFDA Max per day FDA Approved for
Agitation & Insomnia DiphenhydramineBenadryl100 mgNo
HydroxyzineVistaril400 mgNo 91 SFBHN Psychotropic Medications
Training 2014
Slide 92
These medicines can be useful to treat certain side effects
secondary to antipsychotic use. Side effects that could be helped
with these meds: Muscle stiffness/rigidity Muscle spasms of the
back, neck and eyes Drooling 92 Psychotropic Medications Training
2014
Generic Name Brand Name FDA Max per day FDA Approved to help
side effects of Antipsychotics TrihexyphenidylArtane15 mgAdults
BenztropineCogentin6 mgAdults SFBHN Psychotropic Meds Training
2014
Slide 95
95 Psychotropic Medications Training 2014
Slide 96
What is true informed consent: A joint decision-making process
in which the individual, to the extent of his/her capacity, is
involved in discussions about his/her health care to improve
long-term outcomes and to foster trust and a better clincian-
consumer relationship. Engaging individuals helps: Empower them
Encourages their active involvement in the decisions that affect
their lives Improves adherence Is more likely to have improved
health outcomes. 96 Psychotropic Medications Training 2014
Slide 97
Continuous process: With the individual Family, caretakers or
other important people involved are the mediators. Information must
be presented at age, intellectually and developmentally appropriate
level and language There is no substitute for informed individuals.
97 Psychotropic Medications Training 2014
Slide 98
What is the name of the medicine? Is it also called by other
names? What do we know about how it helps other individuals who
have a similar condition? How will the medicine help me? How long
before I see if I get better? When will it work? What are the side
effects or reactions which commonly can happen with this
medication? Can I get addicted to this medicine? Can it be abused?
What is the recommended dosage or amount to take? How many times a
day do I take the medicine? Are there any blood or other tests
(e.g. heart tests, blood test, etc.) which need to be done before I
begin taking the medicine? Will any tests need to be done while I
take the medicine? 98 Psychotropic Medications Training 2014
Slide 99
Will a psychiatrist or other prescriber be checking to see how
I am doing with my medicine and make changes if needed? How often
will I go for appointments and who will do it? Are there
interactions or bad reactions between this medicine and other
medicines (prescription and/or over-the-counter) I am taking? Are
there any activities that I should avoid while taking the medicine?
Should I take any special care for other activities? How long will
I need to take this medicine? How will the decision be made to stop
this medicine? What do I do if a problem comes up (e.g. if I become
sick, doses are missed, or if I get side effects or bad reactions)?
99 Psychotropic Medications Training 2014
Slide 100
100 Psychotropic Medications Training 2014 Monitoring for
Possible Side Effects or To See if the Psychotropic Medication is
Helping
Slide 101
Monitoring for possible side effects or see if the psychotropic
medication is helping: Use common sense! It may sound basic Always
know if a child is being prescribed medications. Understand what
the specific medication is supposed to help with. You need to know
what the medicine is supposed to be doing to be able to monitor if
it is helping. 101 Psychotropic Medications Training 2014
Slide 102
Obtain regular feedback from the caregiver or any other person
involved in the childs life, such as the childs teacher and/or
other school personnel. Examples include: Has the child shown any
changes? Is the child even taking the medication? Ask the child how
they are feeling both physically and emotionally. Remember if not
sure - Discuss with a supervisor. 102 Psychotropic Medications
Training 2014
Slide 103
103 Psychotropic Medications Training 2014
Slide 104
Use common sense! Report concerns or questions of possible side
effects to the childs physician. This may require some persistence.
Insist on a call back. Make yourself available for a call back.
Schedule a new appointment if needed. 104 Psychotropic Medications
Training 2014
Slide 105
As with all medical issues, if an emergency is suspected call
911 or arrange for the child to go to the nearest emergency
department. If you are not sure what to do = ACT! Discuss with a
supervisor. Call the doctor. 105 Psychotropic Medications Training
2014
Slide 106
Clinicians should be aware: Was an evaluation completed before
initiating medication treatment? Has the prescriber provided
feedback about the diagnosis and educated the individual (and
possibly family and others) regarding the individuals disorder and
the treatment and monitoring plan? Has the individual provided
consent before initiating medication treatment and at important
points during treatment? 106 Psychotropic Medications Training
2014
Slide 107
Has the individual been engaged in the process? Has the child
provided assent (if appropriate)? Has the assent and consent
discussion focused on the risk and benefits of the proposed and
alternative treatments? Have I reported concerns or questions of
possible side effects to the individuals physician? 107
Psychotropic Medications Training 2014
Slide 108
Assisting Consumers who are being prescribed psychotropic meds:
Use common sense! It may sound basic Always know if a consumer is
being prescribed medications. Understand what the specific
medication is supposed to help with. You need to know what the
medicine is supposed to be doing to be able to monitor if it is
helping. 108 Psychotropic Medications Training 2014
Slide 109
Obtain regular feedback from the consumer and any other person
involved in the consumers life (as appropriate). Examples include:
Has the consumer shown any changes? Is the consumer even taking the
medication? Ask the consumer how they are feeling both physically
and emotionally. Remember if not sure Consult with the prescriber;
discuss with a supervisor. 109 Psychotropic Medications Training
2014
Slide 110
Use common sense! Can it wait??? Encourage the consumer to
contact the prescriber with concerns or questions: This may require
some persistence. Insist on a call back. Make themselves available
for a call back. Schedule a new appointment if needed. Consider
reporting directly to the prescriber concerns or questions of
possible side effects. 110 Psychotropic Medications Training
2014
Slide 111
As with all medical issues, if an emergency is suspected call
911 or arrange for the consumer to go to the nearest emergency
department. If you are not sure what to do = ACT! Discuss with a
supervisor. Call the doctor. 111 Psychotropic Medications Training
2014
Slide 112
Medications can be an important part of treatment for some
emotional and behavioral disorders. Psychotropic medications should
only be used as one part of a comprehensive treatment plan. Ongoing
evaluation and monitoring by a physician is essential. Each
clinician is also an important part of the monitoring process.
Informed decision making is important. 112 Psychotropic Medications
Training 2014
Slide 113
APPROPRIATE use of medications is the key. Taking too much or
too little of a medication can have undesired consequences! It is
very important to take medications as prescribed. Consumers should
never add or stop a medication without consulting the prescribing
doctor. 113 Psychotropic Medications Training 2014