This presentation is meant for Crisis Intervention Team (CIT) training.

1. Signs and Symptoms of Mental Illness in Adults
Franklin County Crisis Intervention Team Training Course
Columbus Police Academy

2. Teaching Team
 David Kasick, MD
 Associate Professor of Clinical Psychiatry and Behavioral Health
 Director of Consultation-Liaison Psychiatry
 Douglas Misquitta, MD
 Assistant Professor of Clinical Psychiatry and Behavioral Health
 Director, Forensic Psychiatry Fellowship Program
 Evita Singh, MD
 Clinical Instructor, Department of Psychiatry and Behavioral Health
 Laura Taylor, DO
 Clinical Instructor, Department of Psychiatry and Behavioral Health

3. Successful Crisis Intervention Requires a Team Approach
“Patient”
“Client”
“Consumer”
Law
Enforcement
Family
&
Friends
Psychologists
Social
Workers
Nurses
Religious
Clergy
Counselors
&Therapists
Psychiatrists
ER &
Primary
Care
Physicians

4. CIT: “It’s more than just training”
 Law enforcement & other first responders are key partners
 ~10% of police calls involve active mental illness
 Front lines of the crisis care system
 Intervention during crisis impacts outcomes
 Collection and documentation of “behavioral evidence”
 Helps guide further diagnosis and treatment
 Further augmentation of officer safety

5. What are Mental Illnesses?
 Biological diseases affecting the brain
 Depression, Bipolar Disorder, Schizophrenia, Dementia, Anxiety Disorders, Personality
Disorders, Substance Use Disorders
 Many others…
 Impact on feelings, thinking, and behavior
 Vary widely in:
 Age of onset
 Duration
 Symptoms
 Some of the most common medical conditions in the United States
 Often occur in episodes
 Are highly treatable

6. What Psychiatrists Do:
 Medical Doctors (MDs & DOs):
 Physicians specializing in behavioral and emotional aspects of brain functioning & illness
 Additional training after medical school in diagnosis and treatment of mental illnesses
 Distinguishing mental illness syndromes from other medical causes of behavior change
 “Biologic” treatments: prescribe medications and other medical treatments
 “Psychosocial” treatments: psychotherapy = “talk therapy” & other change strategies
 Overlaps with many other medical specialties
 Neurology: structural brain & nervous system disorders – “hardware”
 Collaboration with Primary Care/Family Medicine, Internal Medicine, OBGYN, many
others…

7. Mental Illnesses Cause:
 Distress
 Signs = objective observations
 Symptoms = subjective experiences
 Impairment
 In social, occupational, or other areas of functioning (disability)
 Sustained problems outside of normal human experiences (e.g. grief)
 Increased risk
 Suffering, death, pain, or loss of freedom
 Dysfunction
 Behavioral, psychological, or biological

8. The Biopsychosocial Model:
Factors Impacting Mental Illness
Biologic
Factors
Genetics
Physical Medical Illnesses
Medications
Substance Use
Head/Brain Injuries
Psychological
Factors
History of abuse
Past losses/traumas
Personality Traits
Coping Skills
Social Factors
Relationships
Family Support
Financial
Education/Occupation
Religious/Spiritual

9. What is the Impact of Mental Illness?
 Very common medical conditions in U.S.:
 Depression: 20.9 million (9.5%)
 Bipolar Disorder: 5.7 million (2.6%)
 Schizophrenia: 3 million (1%)
 Anxiety Disorders: 40 million (18%)
 Often co-exist with other serious health problems
 Persons with serious mental illness are now dying up to 25 years earlier than the general population1
 Smoking, obesity, substance abuse, and inadequate access to medical care
 Over 15% of the burden of disease in the United States
 More than the disease burden caused by all cancers
 Increase costs and healthcare spending
 Depression is the leading cause of disability worldwide2
 Increased vulnerability
 Poverty, homelessness, incarceration, unemployment, social isolation
1“Morbidity and Mortality in People with Serious Mental Illness”, National Association of State Mental Health Program Directors, October 2006
2 World Health Organization Depression Fact Sheet 2012

10. How are diagnoses made?
•Can be challenging to
diagnose
•Require interpretation of
patterns behavior over
time
•No single blood test or x-ray
can make a diagnosis
•We’ve all been fooled
•Malingering: a
preponderance of
“secondary gain”

11. Other medical problems capable of affecting
behavior
 Seizures
 Traumatic Brain Injuries
 Brain tumors
 Strokes
 Multiple Sclerosis
 Cerebral Palsy
 Diabetes
 Thyroid Disease
 Infectious Diseases
 Syphilis, HIV, meningitis
 Autoimmune Disorders
 Lupus
 Metabolic problems
 Liver or kidney disease
 Shifts in blood sodium and calcium
levels
 Toxic illnesses
 Lead poisoning
 Respiratory illness/ Low oxygen levels
 Sudden blood pressure changes
 Prescription Medications

12. Substance Abuse, Intoxication, and Withdrawal
 Commonly co-exists with many mental illnesses
 Complicates the appearance of symptoms
 Complicates accurate diagnosis
 “Dual Diagnosis”
 Profound affects on behavior:
 Amphetamines, Cocaine
 LSD, PCP, MDMA
 Alcohol
 Barbiturates
 Benzodiazepines
 Ketamine
 Khat
 Anticholinergic Drugs
 Cannabis
 Inhalants

13. Signs and Symptoms of Behavioral Crisis
 Appearance and attitude  Unable to focus, distracted, not making choices
 Motor activity  apathetic, lethargic, withdrawn, perplexed -or- agitated, excessive energy
 Speech  too slow/inaudible -or- rapid, loud, uninterruptable
 Mood and affect  sad, tearful, crying -or- elevated, euphoric, intense
 Thinking and perceptions  lethal thoughts, paranoia, delusions, hallucinations
 Orientation  confused about name, location, situation, lacking awareness
 Memory  unable to remember important personal information
 Judgment  lacking appreciation or concern for the consequences of actions
 Insight  not understanding the risks/dangerousness of current behavioral state
 Impulse control  inability to maintain predictable behavior or suppress irrational action

14. Emergency symptoms: Suicidal or Homicidal Ideation
 May occur in any of the disorders
 At any time
 Are the among the most dangerous and concerning symptoms
 Generally warrants emergency evaluation
 May exist separately or together
 Asking about suicide
 Does not encourage someone to do it

15. Case Examples
Common Mental Health Crisis Presentations You’re Likely to Encounter
 Problems with diminished or excessive mood and energy
 Major Depressive Disorder
 Bipolar Disorder
 Problems with psychosis and thinking
 Schizophrenia
 Delusional Disorder
 Problems with personality and coping skills
 Borderline Personality Disorder
 Sudden problems with awareness and behavior with an underlying medical cause
 Delirium
 Chronic problems with declining memory, thinking, and behavior
 Dementia

16. Mood and Energy Problems: Depression
 A family member calls dispatch and asks for a well-being check on their loved one, Tim.
 The caller indicates that Tim has not been acting like himself for several weeks and made a
comment about “being ready to be done with it all” yesterday and has not answered his door since.
 The caller said that Tim goes through these episodes a couple of times a year but they seem to be
getting worse.
 When officers arrive at the home, Tim is slow to answer the door. He appears to have not
showered for several days and has dark circles under his eyes.
 He is slow to answer questions and is quiet in his speech. He makes little eye contact with the
officers. When asked about the comment to his family member he says “they always make a big
deal of nothing.” He said he has an appointment with his therapist that afternoon.
 From the doorway, officers observe numerous pill bottles and a half-empty bottle of vodka on the
kitchen table behind him.

17. Major Depressive Disorder
 Low mood, sadness, emptiness, tearful, or discouragement
 Loss of interest, pleasure, and enjoyment
 Weight loss (perhaps gain)
 Insomnia (perhaps hypersomnia)
 Agitation or sluggishness in motor behavior
 Fatigue or loss of energy
 Feelings of worthlessness or excessive guilt
 Difficulty thinking and concentrating
 Recurrent thoughts of death/suicide
 At least five present for two weeks

18. Mood and Energy Problems: Bipolar Disorder
 A McDonald’s manager calls 911 to report a woman causing a disturbance in the parking lot.
 She was reportedly running back and forth between the cars in the drive through line, knocking on
windows and proclaiming that she would buy lunch for everyone present, for the “glory of God!”
 Upon arrival, officers observe her loudly and rapidly blurting sexually provocative comments into the
drive through speaker while distractedly yelling at someone on her cell phone.
 She becomes very irritable as the officers approach, telling them that she owns all of the
businesses on the street. She stares intensely at one of the officers and begins repeatedly
shrieking “Customer appreciation!”
 Officers are later able to make contact with family members who report that she has not slept in
several days after returning from an out-of-town business trip and losing her “meds.”

19. Bipolar Disorder
 Manic episodes –four or more for one week or longer
 Abnormally elevated, expansive, or irritable mood
 Grandiose inflated self-esteem
 Decreased need for sleep
 Talkative
 Many fast ideas all at once, racing thoughts
 Distractible
 Multiple concurrent goals
 Excessive sex, spending, or high risk behavior
 Depressive episodes
 Recurrent periods of depression also occur in bipolar disorder
 “Manic Depression” = old name

20. Video example: Manic behavior (1:20)
 Appearance and attitude
 Motor activity
 Speech
 Mood and affect
 Thinking and perceptions
 Orientation
 Memory
 Judgment
 Insight
 Impulse control

21. Psychosis and Thinking Problems
 An individual’s loss of contact with external reality
 Delusions
 Hallucinations
 Behaviors
 Unable to differentiate what is real from what is not real
 Problems providing for basic needs

22. Hallucinations
 Sensory perceptions
unrelated to external
stimuli
 Auditory
 Visual
 Tactile
 Smells/Tastes
http://jonkeegan.com

23. Delusions
 Firmly held false beliefs
 Maintained despite obvious evidence or proof to the contrary
 Not based in reality
 Logic and arguing generally do not help
 Beliefs not accepted by an individual’s societal or cultural
peers
 Often impossible (bizarre)
 Sometimes possible, but improbable (non-bizarre)

24. Psychosis Case Example: Schizophrenia
 A man in his late twenties calls the dispatcher reporting that his neighbor has a microwave device
aimed at his bedroom which the neighbor is using to intentionally disrupt the man’s sperm
production.
 Officers arrive at the caller’s home and observe that he has the windows covered with black paper
and has moved his bed to the basement “to preserve my sperm so I can repopulate the world after
the culling.”
 The man says his neighbor is a part of a covert group that is trying to stop him in his efforts to save
the world and he knows this because he intercepts their communications which say that he is a
“pervert” and “a failure”.
 He tells you that he has been hearing voices which told him to “get rid of the neighbor’s dog,” which
is part of the conspiracy, and has been leaving out antifreeze for the animal to drink.
 He asks for your help in dealing with his neighbor noting that he has “tried everything to handle this
the right way.”

25. Schizophrenia
 A complex brain disease: “disconnected mind”
 Recurrent psychosis
 Delusions, Hallucinations
 Loss of normal behaviors
 Well organized thinking and speech
 Emotional responsiveness
 Verbal expression
 Personal motivation
 Enjoyment
 Social drive
 Attention to the environment
 Decline in functional capacity and integration of brain functions
 Social functioning
 Occupational functioning
 Cognitive problems
 Thinking, memory, planning, problem solving, organizing

26. Are the voices real?
 Auditory hallucinations are
common in schizophrenia
 Stimulation/misfire of the
auditory cortex
 Brain perceives these
discharges as external sounds
 “Can you hear things other
people can’t hear?”

27. Video example: Disorganized thinking
 Appearance and attitude
 Motor activity
 Speech
 Mood and affect
 Thinking and perceptions
 Orientation
 Memory
 Judgment
 Insight
 Impulse control

28. Psychosis Case Example: Delusional Disorder
 A female local TV news anchor reports that she has been having escalating stalking behavior from
a man with whom she has only had limited interaction.
 She states it started a few months ago with a very positive letter from the man saying how much he
appreciated her work on the news. He then sent a glowing letter to her boss. In response she
sent him an autographed photo of herself.
 He then began sending letters weekly telling her how much he valued the time they had together
when she was on air and that he could tell she was a good person.
 His letters then began to speak of his knowing that she was truly in love with him and that he could
tell by the way she smiled at him during the broadcast.
 The letters continued on this way until a week ago when her co-anchor had congratulated her about
her engagement on-air.
 At that point his letters turned angry and accusatory, accused her of cheating on him and
threatening her fiancé for “getting between us.”

29. Delusional Disorder
 Presence of delusional beliefs, but absence of other psychotic symptoms (hallucinations, thinking
problems)
 Delusional Themes
 Reference:
 The questions on Jeopardy were written with me in mind
 Grandiosity:
 Oprah Winfrey consults with me about her business decisions and clothing
 Persecution:
 People are breaking into my apartment and moving my things around
 The FBI has wired my house to listen to my thoughts
 Somatic:
 My internal organs were stolen and a skin suit was stapled to me
 I am infested with lice
 Erotomanic:
 Taylor Swift is in love with me

30. Video example: Delusional thinking (0:45)
 Appearance and attitude
 Motor activity
 Speech
 Mood and affect
 Thinking and perceptions
 Orientation
 Memory
 Judgment
 Insight
 Impulse control

31. Personality Disorders
 Patterns of inner experiences and behavior that deviate markedly from expectations of the individual’s culture
 Ways of perceiving and interpreting self, others, and events
 Range, intensity, and lability of affect and appropriateness of emotional response
 Interpersonal functioning
 Impulse control
 Pervasive and inflexible across a broad range of situations
 Leads to distress or impairment
 Present from early adulthood
 Not better explained by another mental illness

32. Case Example: Borderline Personality Disorder
 You are working in a new neighborhood with your new partner, Officer Jones, and are called for a domestic dispute
to an address that your partner knows very well.
 A female caller told dispatch that her boyfriend was threatening her but dispatch could clearly hear the woman telling
someone “you will be sorry for saying you’re going to leave me” and “I’m going to get you arrested!”
 Officer Jones reports that the woman at the address has been transported to the emergency room on several
occasions in the past for reporting suicide attempts by overdoses on small amounts of Tylenol or sleeping pills.
 When you arrive at the home a woman in her mid-twenties answers the door and says everything is fine now, and
that it was all a misunderstanding.
 She is clutching a teddy bear, and bats her eyelashes at you saying it was “just a lover’s quarrel.” She then
whispers “You poor thing, you have to work with Officer Jones. He is the worst, isn’t he! You must be a saint!”
 You can see several healed horizontal scars on her forearms. When you and your partner go to leave she winks at
you when no one else is looking.

33. Borderline Personality Disorder
 Borderline Personality Disorder
 Pervasive instability in moods, interpersonal relationships, self-image, and
behavior
 Emotional intensity problems
 Dramatic relationships
 Fears of abandonment
 Feelings of emptiness and unstable self image
 Cutting, plagued by anxiety and guilt
 Can have stress induced “psychotic” symptoms

34. Excited Delirium Case
 Patrol officers are requesting additional cars to respond to a naked man who has used
his bare hands to break the window of a candy store.
 When you arrive he is sweating profusely and screaming incoherently. Despite 10
police officers being present and being in a confined space, he continues to run and try
to elude officers.
 At one point 3 officers briefly have him on the ground but he is able to push all of them
off.
 He is tased by a fellow officer but still tries to run and has to be taken down by 5
officers.
 He repeatedly screams “Do it!” and other profane comments but doesn’t appear to be
aware of where he is or what is happening around him.
 You later learn from his family that he had ingested “bath salts” earlier in the evening.

35. Delirium
 Sudden, rapid, severe change in brain function
 Develops over hours to days
 Disturbance of consciousness and thinking
 Not aware of surroundings
 Unable to focus
 Quick changes between mental states http://www.scottcamazine.com
ne.com

36. Delirium
 Delirium is caused by an underlying medical problem or substance
 Can include prescription drugs or illicit drugs
 Delirium can produce any behavioral symptom:
 Hallucinations and agitation are frequently encountered
 Can range from lethargic to hyperactive motor behaviors
 “Excited Delirium”
 Goal: Identify and treat the underlying medical problem

37. ALERT
RELAXED ATTENTIVE
VIGILANTSOMNOLENT
“NORMAL” AWARENESS
COMA
EXTREME
EXCITEMENT
HYPERSOMNOLENT
OBTUNDED
STUPOROUS
HYPERVIGILANT
DISTRACTIBLE
HYPERAROUSED
Delirium always includes impairment of awareness

38. Video example: Excited Delirium

39. “Excited Delirium”
 Red flags:
 Bizarre, violent, paranoid
 Subject continues to fight, even while
restrained
 Resists with super strength
 Taser or sprays have little effect
 Multiple officers needed to cuff and
restrain
 Overheated
 Sweating/hyperthermic
 Elevated risk for in-custody death
 Multiple disturbance calls
 Naked, male
 Threatening, yelling
 Breaking windows
 Not communicating
 Grossly incoherent, disoriented
 Hallucinating
 May be related to abnormal brain
dopamine signaling*
*2009 Mash et al. Brain biomarkers for identifying excited delirium as a cause of sudden death.

40. “Excited Delirium” Management
 Call for medics early
 Monitor airway at all times
 Monitor for sudden changes
in consciousness
 Disposition: ER
 Cocaine? PCP? Bath
Salts?
 Heart Disease?
 Head injury?
 Respiratory Disease? http://www.flickr.com/photos/rollingsmoke/3292614896/

41. Dementia
 The local library has called about an elderly man who will not leave even though closing time
passed an hour ago.
 They said he was pleasant when he came in late that morning, smiling to the other patrons and
engaging in small talk with the staff.
 He didn’t read any books or look at materials, instead was wandering from person to person. It
became apparent that he was unable to remember conversations he had had with staff just a few
minutes earlier.
 As evening came his pleasant demeanor became more agitated and when staff told him it was
closing time he insisted that he was just waiting for his wife to come out of the restroom, despite
there being no evidence that he was there with anyone.
 When a staff person tried to gently take his arm to lead him to the desk to call for someone to pick
him he grabbed her hair and pulled it violently.

42. Dementia
 Gradual decline in:
 Memory and ability to think
 Social and occupational functioning
 Often develops over years
 Language disturbances
 Problems with speaking, word finding/recall
 Diminished motor skills
 Problems dressing, eating, operating tools, driving
 Failure to recognize objects
 Can’t remember names, places, names of object
 Easily becomes lost
 Unable to plan for the future or organize information
 Problems with anticipating risk, managing medications, bills

43. Common Behavior Problems in Dementia
 Memory problems
 Temper outbursts
 Demanding or critical behavior
 Night awakening
 Hiding things
 Communication difficulties
 Suspiciousness
 Making accusations
 Poor mealtime behavior
 Daytime wandering
 Poor hygiene
 Incontinence
 Difficulty with cooking
 Problems driving
 Problems smoking
 Inappropriate sexual behavior
 Physical violence
 Delusions or hallucinations
 Hitting or assaults
Adapted from Rabins et. al 1982

44. Video application exercise:
What crisis behaviors do you see?
 Appearance and attitude
 Motor activity
 Speech
 Mood and affect
 Thinking and perceptions
 Orientation
 Memory
 Judgment
 Insight
 Impulse control

45. Red flag situations
 Medical emergencies
 Life threatening medication side effects
 Elevated body temperature (especially in hot weather)
 Dehydration
 Tremor, muscle stiffness, confusion, speech changes, seizures
 Agitation, elevated anxiety
 Drug interactions and drug withdrawal
 Prescription drugs + illicit drugs
 New medication interactions
 Watch for alcohol, benzodiazepine, barbiturate withdrawal
 Monitor for delirium
 Accidental overdoses
 Patients can become confused about what to take

46. Thank You

49. Supplemental Information

50. Violence and Mental Illness
 Attributable risk (to the mentally ill) of violence in the general
population has been estimated to be 3% to 5%
 A small fraction of total violent acts
 Serious mental illness is a minority of the population (~6%-10%)
 Be aware of negative stereotypes perpetuated in the media
 Often linked with substance abuse
 Most people who are violent are not mentally ill
 Most people who are mentally ill are not violent
Choe, et. al. Psychiatric Services 59:153-164, 2008
Swanson JW. Mental disorder, substance abuse, and community violence: an epidemiological approach. In Monahan J, Steadman HJ, eds. Violence and
mental disorder: developments in risk assessment. Chicago: University of Chicago Press, 1994:101-36.

51. Violence and Mental Illness
 Violence rates are higher during active episodes
 Periods of crisis
 Around time of inpatient hospitalization
 History of violence is best predictor of future violence
 Treatment markedly reduces events of violence
 Up to 54% for up to 50 weeks after hospital discharge
 Victims often known to the individual
 Family victims 51%
 Friend victims 35%
 Stranger victims 14%

52. Victimization among people with mental illness
 Much more likely to be victimized
 25% -35% of severely mentally ill vs. 3% in general population
 Patients in community treatment
 Chicago neighborhood, 1997-1999
 Comparison to the general population, are more likely to be:
 Victims of Property Crime: 4x
 Personal Theft: 50x
 Victims of Violent Crime: 11x
 Rape: 23x
 Assault: 18x
 Teplin et al, Arch Gen Psychiatry. 2005 August; 62(8): 911–921.

53. Suicidal Behavior
 In the United States in 2016, suicide was the:
 10th leading cause of death overall
 The national suicide rate has been steadily increasing since 2006
 2rd leading cause of death in ages 10-14
 2nd leading cause in ages 15-24
 2nd leading cause in ages 25-34
 4th leading cause in ages 35-44
 5th leading cause in ages 45-54
 In adults, suicide deaths outnumber homicides
 Individuals with prior attempts have increased risk of completion
National Center for Health Statistics (NCHS), National Vital Statistics System
U.S. Centers for Disease Control and Prevention

54. Suicidal Behavior
 Suicide Deaths
 4 male : 1 female
 Suicide Attempts
 3 female : 1 male
 Depression is the most common mental illness in people
who die by suicide

55. Methods of Suicide Completion
 In the general U.S. population in 2011:
 Firearms: 50.6%
 Hanging/Suffocation: 25.1%
 Poisoning: 16.6%
 Other Methods: 7.7%
 Men tend to use more violent means
 Compared to women

56. Medications
 Medications can be extremely helpful
 All have potential side effects
 Some immediate, some can occur over time
 Best managed through regular physician follow-up
 Target: reduction or remission of symptoms
 Can prevent recurrence or relapse
 Can facilitate more effective problem solving skills as individuals
work to address solve psychosocial problems

57. Medications
 Medications can be grouped into several basic categories
 Grouped by how they work and what they are used for
 Medications are often prescribed across categories
 It’s not always possible to know the illness based on what medications have been prescribed
 Multiple formulations available
 Short acting vs. long acting
 Some antipsychotics come in long acting injections given every 2-4 weeks
 Treatment failures:
 Drugs and alcohol
 Cost and access problems

58. Medication categories
 Antidepressants
 Depression, Anxiety Disorders, Eating Disorders
 Mood Stabilizers
 Bipolar Disorder, Impulse Control Problems
 Antipsychotics
 Schizophrenia, mood disorders, anxiety disorders, delirium

59. Medication categories
 Anti-anxiety medication
 Stimulants
 Sleep medications
 Treatment of addiction
 Medications to treat side effects

60. Antidepressants
 Depression
 Mood Disorders
 Anxiety Disorders
 OCD
 PTSD
 Panic Disorder
 Social Phobia
 Specific Phobia
 Generalized Anxiety
 Eating Disorders
 Prozac
 Paxil
 Zoloft
 Celexa
 Lexapro
 Effexor
 Wellbutrin
 Remeron
 Cymbalta
 Luvox
 Elavil
 Doxepin
 Trazodone

61. Antidepressants
 Possible side effects
 Sexual inhibition
 Anxiety
 Headache
 Increased blood pressure
 Upset stomach
 Tremor
 Poor memory
 Mania

62. Mood Stabilizers
 Bipolar Disorder
 Mood Disorders
 Impulse Control Disorders
 Lithium
 Depakote
 Tegretol
 Trileptal
 Lamictal
 Topamax

63. Mood Stabilizers
 Possible side effects
 Toxic blood levels
 Sedation
 Rash
 Weight gain
 Upset stomach
 Tremor
 Slurred speech
 Unsteady walking
 Liver, kidney, thyroid problems

64. Antipsychotics
 Schizophrenia
 Psychotic Disorders
 Mood Disorders
 Anxiety Disorders
 Delirium
 Haldol
 Thorazine
 Prolixin
 Trilafon
 Clozaril
 Risperdal
 Seroquel
 Zyprexa
 Geodon
 Abilify
 Invega

65. Antipsychotics
 Possible side effects
 Frozen face
 Stiff/Locked Muscles/Neck
 Shuffling gait
 Slurred speech
 Tremor
 Drooling
 Blurred vision
 Sedation
 Abnormal involuntary movements
 Tardive Dyskinesia

66. Anti-anxiety
 Xanax
 Valium
 Ativan
 Klonopin
 Buspar
 Inderal
 Vistaril
 Uses:
 Anxiety Disorders
 Possible side effects:
 Sedation
 Unsteady
 Forgetful
 Slurred speech
 Addiction

67. Stimulants
 Ritalin
 Adderall
 Strattera
 Concerta
 Focalin
 Provigil
 Dexedrine
 Vyvanse
 Uses:
 ADHD
 Narcolepsy
 Possible side effects
 Insomnia
 Nervousness
 No appetite
 Tremor
 Mania
 Addiction

68. Other Medications
 Sleep Medications
 Ambien
 Lunesta
 Rozerem
 Trazodone
 Sonata
 Treatment of Side Effects
 Cogentin
 Artane
 Benadryl
 Addiction Medications
 Campral
 Naltrexone
 Chantix
 Methadone
 Suboxone