Prescribing Mental Health Medication

by Doran; Christopher M.

• ISBN13: 9780415282222
• ISBN10: 0415282225
• Format: Nonspecific Binding
• Copyright: 2003-08-05
• Publisher: Routledge

Summary

Prescribing Mental Health Medicationis a text for nursing and medical practitioners who are learning how to diagnose and treat mental disorders with medication. Skills-based, it focuses on such key issues as: how to start and stop medication, how to dose, when to change medication, specific illnesses and their medications, special populations and conditions, the management of side effects, practical issues such as monitoring medication with blood levels, and administrative issues such as record-keeping. Special icons used throughout the text highlight clinical tips, advice on how to talk to patients and differences in practice in primary care settings. Based on the author's considerable experience of training nursing and medical staff,Prescribing Mental Health Medicationpresents complex topics in an organized, logical and easily assimilated format. It provides a supportive text for those new to prescribing and a comprehensive source of reference for more experienced practitioners orteachers.

Table of Contents

List of tables	xiv
Preface	xvii
Acknowledgments	xix
A note on the icons used in this book	xx
Part I The Need for this Book	1	(16)
1 General principles of medication management	3	(5)
The scope of the problem	6	(1)
Mental health in the spotlight	6	(2)
2 Myths and truths about mental health medication	8	(9)
Mental health medication is a placebo	9	(1)
Mental health medication is addictive	9	(1)
Mental health medication will change personality	10	(1)
Stop mental health medication as soon as possible	11	(1)
Mental health medication will overcome bad habits	12	(1)
If side effects occur, the medication must be working	12	(1)
Taking medication for depression means weakness	13	(1)
Antidepressants cause suicidal or homicidal thoughts	13	(2)
All antidepressants are alike	15	(1)
Alcohol is prohibited while taking psychotropic medication	15	(1)
Mental health medication will treat alcoholism	16	(1)
A person must be substance-free to be assessed/treated accurately for mental illness	16	(1)
Part II Medication Management Start to Finish	17	(106)
3 The initial prescriptive interview	19	(18)
What to say after "hello"	20	(2)
General issues of history taking	22	(2)
Essentials that must be obtained for medication prescription	24	(1)
Mental status exam	25	(1)
Useful but optional information	26	(1)
Target symptoms	27	(1)
Historical information from others	27	(1)
The medical work-up	28	(1)
The next decision	28	(1)
Assessment and formulation	29	(2)
Length of an initial prescriptive interview	31	(3)
Sample clinician guidelines	34	(3)
4 Helping a patient decide to try medication	37	(8)
Patient issues	37	(2)
Other resistances to psychotropic medication	39	(1)
The use of levers	40	(1)
Reasons that patients take psychotropic medication	41	(2)
The use of metaphor	43	(2)
5 Starting medication	45	(17)
Monotherapy	46	(1)
Overlap and "indications"	46	(1)
What is the target of the medication?	47	(1)
Choosing a starting dose	47	(2)
Loading doses	49	(1)
The art of choosing a medication	50	(3)
Selecting medication in the previously treated patient	53	(1)
The liver-impaired patient	54	(1)
The kidney-impaired patient	55	(1)
How many pills to prescribe?	56	(1)
The five points of education about psychotropics	57	(1)
Other issues to be discussed	58	(1)
Informed consent	59	(1)
Involuntary medication	60	(1)
Education as treatment	60	(1)
The use of placebo	60	(2)
6 Follow-up appointments and strategies	62	(25)
When do I schedule follow-up?	63	(1)
How long does it take?	64	(1)
Inpatient medication follow-up	64	(1)
Preparing for a follow-up	64	(1)
Goals of a follow-up	65	(5)
What is an adequate trial?	70	(1)
Switching and side effects	71	(1)
When changing, gradual is best	72	(2)
Polypharmacy - from the doghouse to the penthouse	74	(3)
Feedback from others	77	(1)
Helping a patient stay on medication - the compliance dilemma	77	(2)
How and when to refer to a mental health specialist	79	(2)
Missed doses	81	(2)
Parenteral medications	83	(1)
Pill facts	84	(3)
7 Medication and psychotherapy	87	(6)
The first session dilemma	88	(1)
Patient's preference	89	(1)
What can medication do?	90	(1)
Who prescribes psychotropic medication?	90	(3)
8 Stopping medication	93	(12)
When to stop	94	(2)
Tapering medications	96	(1)
"When I stopped, I got worse"	97	(2)
Management of discontinuation syndromes	99	(1)
Relapse vs discontinuation syndrome	100	(1)
When to stop medication more quickly	101	(1)
New episode or relapse?	101	(1)
Side effects pass quickly	101	(1)
Unplanned stoppages of medication	102	(3)
9 The long-term patient	105	(18)
Who should receive long-term treatment?	106	(2)
A symptomatic crisis in a stable patient - general principles	108	(1)
"The medicine stopped working" - getting back on TRACCCC	109	(3)
Helping the patient stay well	112	(1)
Missed appointments	113	(3)
When the patient asks for more	116	(1)
Inappropriate requests	116	(1)
Is newer medication better?	117	(2)
Periodic reassessment	119	(1)
Concurrence for a change of medication	119	(1)
Conflicting advice from others	120	(3)
Part III Medicating Special Populations	123	(86)
10 Using medication with children and adolescents	125	(15)
Outdated views of pediatric mental health prescription	125	(1)
The scope of pediatric psychopharmacology	126	(1)
Principles of psychotropic prescription with children and adolescents	127	(1)
Diagnostic and conceptual issues in the prescriptive process	127	(6)
A child's goals differ from those of adults	133	(1)
Parental power struggles over medication	133	(1)
The medical work-up prior to psychotropics	134	(1)
Practical issues in child/adolescent prescription	134	(6)
11 Pregnancy and psychotropics - rewards and risks	140	(19)
Clinician principles for prescribing to the pregnant woman	141	(2)
Working with the fertile woman, prepregnancy	143	(1)
When the patient wishes to get pregnant	144	(1)
While the patient is actively trying to become pregnant	145	(1)
When pregnancy occurs	146	(1)
During pregnancy	147	(1)
Specific conditions and medication groups	148	(3)
Postpartum and lactation	151	(4)
Data will change; the decision process will not	155	(4)
12 Prescribing psychotropics for older patients	159	(11)
Seniors at risk	160	(1)
Non-compliance - a major problem	161	(1)
Principles of psychotropic medication prescription in the elderly	162	(1)
Regular re-evaluation	163	(1)
Senior medication problems - general strategies	164	(2)
Specific psychotropic medication considerations in the elderly	166	(4)
13 Medication of sleep problems	170	(15)
Facts and definitions	171	(1)
Stages of sleep	172	(1)
Evaluating a sleep problem	173	(2)
Principles of treating sleep disorders	175	(1)
Treatment of sleep problems	176	(5)
Special populations	181	(4)
14 Alcohol and mental health medications	185	(10)
Routine warnings in the non-substance abusing patient	186	(1)
Signs of alcohol abuse	187	(1)
Evaluation of the intoxicated and withdrawing patient	188	(1)
Psychotropic medications and dual diagnosis patients	189	(2)
Psychotropics used in the treatment of alcohol use disorders	191	(1)
Psychotropics in treatment of alcohol withdrawal	192	(3)
15 The confused and cognitively impaired patient - medication pitfalls	195	(14)
General principles of dealing with the confused patient	196	(1)
Cognitive disorders - delirium and dementia	196	(4)
Management of delirium and dementia	200	(2)
Medication use in delirium and dementia	202	(4)
Psychiatric diseases that may present with confusion	206	(3)
Part IV Medication Dilemmas and their Clinical Management	209	(96)
16 Psychotropic medications and side effects	211	(39)
During the initial evaluation	211	(3)
Side effect assessment in follow-up visits	214	(1)
How much of a problem is it?	215	(1)
Other issues to consider in evaluating side effects	216	(1)
Changing medication due to side effects	216	(1)
Severity of side effects	217	(1)
Side effects and clinical response	218	(1)
The novice clinician and side effects	218	(1)
Side effects seen most frequently	219	(31)
17 Danger zones - areas of risk with psychotropics	250	(49)
P-450 issues made easy	251	(8)
Serotonin syndrome	259	(3)
Anticholinergic intoxication	262	(4)
Lithium toxicity	266	(3)
QTc interval issues	269	(6)
Extrapyramidal symptoms, neuroleptic malignant syndrome, and tardive dyskinesia	275	(9)
Monoamine oxidase inhibitor reactions	284	(5)
Other potentially dangerous side effects	289	(10)
18 Medication allergies	299	(6)
Identification of allergic responses	300	(1)
Management of allergy symptoms	301	(1)
Other issues of evaluation when allergy is suspected	302	(1)
Stopping the offending medication	302	(1)
What else to do	303	(1)
Pills contain more than just the active ingredient	303	(2)
Part V Competent Clinical Practice	305	(91)
19 Misuse of medication - taking too much and taking too little	307	(16)
How medication misuse presents	310	(1)
Accidental and careless overutilization	310	(2)
Intentional overdose	312	(1)
Serious overdose	313	(1)
Minor overdose	314	(1)
Using too little medication	315	(1)
Fraud and abuse with psychotropic medications	315	(8)
20 "Difficult" medication patients, and how to treat them	323	(24)
Overriding principles of managing difficult patients	324	(3)
The patient who abuses the telephone	327	(1)
The overly anxious patient	327	(2)
The patient preoccupied with side effects and negative reactions	329	(1)
The minimal contact patient	330	(2)
The non-compliant patient	332	(1)
The patient who needs to be in charge	333	(2)
The information overload patient	335	(2)
The "naturalist"	337	(1)
The borderline patient	338	(5)
Consultation and disengagement	343	(1)
The patient is not always the problem	344	(3)
21 Prescription writing and record keeping	347	(10)
The written prescription	347	(2)
Record keeping	349	(1)
Elements of a clinician's prescriptive note	349	(3)
Systems for note taking	352	(1)
Style items in a medication note	352	(1)
Separate medication lists	352	(1)
Ongoing laboratory monitoring	353	(2)
Confidentiality and security of records	355	(2)
22 Serum blood levels of psychotropics	357	(7)
When blood levels help	357	(1)
Instruction to patients	358	(2)
Frequency of blood levels	360	(2)
Using clinical judgment	362	(1)
Where blood levels do not help	362	(1)
Necessary documentation	363	(1)
23 Generic medications	364	(6)
Generic substitution problems	366	(1)
Generic change without the clinician's knowledge	367	(1)
Tips for generic use	368	(1)
Serum blood levels and generic substitution	368	(1)
Mandated generics	368	(2)
24 The telephone and e-mail - mainstays and millstones	370	(9)
Being available by telephone	371	(1)
Telephone appointments	372	(1)
Inappropriate use of the telephone	373	(2)
When a patient calls too much	375	(2)
E-mail and the medication prescriber	377	(2)
25 The pharmacist, the pharmaceutical industry and the clinician	379	(5)
Interacting with the pharmacist	379	(1)
Preauthorization - a fact of American practice	380	(1)
The pharmaceutical industry	381	(2)
Indigent care medication programs	383	(1)
Media advertising and mental health medications	383	(1)
26 Preparing an office for mental health prescribing	384	(5)
Mandatory issues	384	(3)
Optional measures	387	(1)
Periodic re-evaluation of image	387	(2)
27 Keeping current	389	(7)
The Internet and clinicians	390	(3)
The Internet and patients	393	(1)
Practice guidelines	394	(1)
Summary	395	(1)
Appendices	396	(40)
Index	436