This document provides an overview of psychotherapeutic medication. It begins by defining mental illness and providing demographic statistics. It then discusses the history of treatment, including early abusive practices and the development of electroconvulsive therapy. The document outlines several mental disorders like anxiety, mood disorders, and psychosis. It provides details on diagnosis and specific medications used to treat various disorders. The document notes challenges like dual diagnosis, non-compliance, and the increased societal impacts of widespread medication use.

1. Chapter 10
Psychotherapeutic medication
Goldberg

2. What percentage of
people with a
mental illness seek
professional help?
A. 90%
B. 55%
C. 40%
D. 10%
90%
55%
40%
10%
0%
25%
71%
4%

3. Mental Illness
 The National Alliance
on Mental Illness
defines mental
illnesses as: “medical
conditions that disrupt
a person’s thinking,
feeling, mood, ability
to relate to others and
daily functioning”

4. Demographics
 10-15% of the general population receive
drugs for emotional problems each year
 43% of people with mental disorders reside
in the US and Europe
 1 in 3 Americans suffer from a mental
disorder
 Antidepressants are the medication most
frequently used by people aged 18–44

5. Early Treatment of Mental
Disorders
 Before 1950, people
with mental illness
were subjected to
abysmal treatment
 Depression was
treated with
amphetamines; other
types of mental
illnesses were
treated with
sedatives

6. History
 Electroconvulsive therapy (ECT), first developed in
1938, was used to treat depression and psychosis
 Electrical activity in the brain is temporarily
interrupted and a seizure within the brain is triggered
 Many patients experienced adverse cognitive effects
 Despite concerns, ECT is still a treatment option

7. Disorders
 Anxiety disorders
 Obsessive-compulsive
disorders
 Mood disorders
 Depression
 Mania/Bipolar
 Psychosis

8. Diagnosis of Mental Disorders
 DSM-5 criteria
 Clinically significant distress or impairment in social,
academic (occupational) or other important areas of
functioning
 Not attributable to the physiological effects of a
substance or another medical condition
 Dual-diagnosis
 VERY QUICK OVERVIEW – YOU WILL NOT BE ABLE
TO DIAGNOSE ANYONE, EVEN YOURSELF!

9. It is important to rule out substance use
as a cause of symptoms because
A. Patients could be lying
about their use of
drugs
B. Intoxication can
resemble some
symptoms of mental
disorders
C. A patient can’t be
diagnosed with both
mental illness and
substance abuse
Patientscould
belying
...
Intoxication
can
resem
bl...
A
patientcan’tbe
diag...
0%
8%
92%

10. How are you keeping up?
A. Great, this makes
sense.
B. Pretty well, but I’m
going to need to
do some reading.
C. Michelle, I’m lost.
Great,thism
akessense.
Pretty
w
ell,butI’m
going...
M
ichelle,I’m
lost.
71%
0%
29%

11. Disorders with Anxiety
Symptoms
 Anxiety Disorders
 Panic Disorder
 Social Anxiety
 Phobias
 Obsessive
Compulsive Disorder
 Post-traumatic Stress
Disorder
Treatment often
includes
use of sedative-
hypnotic
drugs

12. Anxiety Videos
 Panic Attack:
http://digital.films.com/PortalViewVideo.a
spx?xtid=6788
 OCD:
http://digital.films.com/PortalViewVideo.a
spx?xtid=41357

13. Medications for Anxiety
 Long-acting benzodiazepines

14. Most people have a phobia of
some sort
A. True
B. False
True
False
83%
17%

15. Repeatedly washing one’s hands is
an example of an obsession.
A. True
B. False
True
False
77%
23%

16. People with panic
disorder alter their
behavior to avoid
another panic attack
A. True
B. False
True
False
0%
100%

17. Mood Disorders
 Major Depression
 Manic Episodes
 Bipolar Disorder

19. Depression
 Depressed mood most of the day, nearly every day
 Diminished interest or pleasure in activities
 Disturbances in appetite
 Disturbances in sleep
 Psychomotor agitation or retardation
 Fatigue/loss of energy
 Feelings of worthlessness/
guilt
 Diminished ability to
concentrate
 Recurrent thoughts of
death

20. Mood Disorder Videos
 Manic episode:
http://youtu.be/p9hbXPVaOuk
 Depressive episode:
http://digital.films.com/PortalViewVideo.a
spx?xtid=41085#

21. Before giving antidepressants to
children:
A. The medications were
tested for effectiveness
B. The medications were
tested for safety
C. The medications were
not tested on children
Them
edicationsw
erete...
Them
edicationsw
erete...
Them
edicationsw
ereno...
0%
73%
27%

22. Medications for Mood Disorders
 Antidepressants
 Monoamine Oxidase Inhibitors
 Tricyclic Antidepressants
 Selective Serotonin Reuptake Inhibitors
 Electroconvulsive therapy (not
medication)
 Mood stabilizers

23. Video
 Depressive episode:
http://digital.films.com/PortalViewVideo.a
spx?xtid=41085#
 http://www.halfofus.com/video/scott/

24. Anti-depressant
Medications
 Monoamine oxidase inhibitors (MAOIs)
 Tricyclic antidepressants
 Selective serotonin reuptake inhibitors
(SSRIs)
 Serotonin and norepinephrine reuptake
inhibitors (SNRIs)
 Atypical antidepressants that do not fall
into one of the above categories

25. SSRIs
 Selective serotonin reuptake
inhibitors (SSRIs)
 Antidepressant medications that increase the
concentration of serotonin in the brain
 Reduce aggressive and violent behavior
 Adverse effects include sexual dysfunction,
increase in weight, and altered sleep patterns
 Not much more effective than placebos

26. Although antidepressants
are only slightly more
effective than placebos,
most patients feel they help.
A. True
B. False
True
False
0%0%

27. Manic Episode
 Inflated self-esteem
 Decreased need for sleep
 Talkative
 Flight of ideas
 Distractibility
 Increase in goal-directed activity
 Excessive involvement in risky behavior

28. Video
 http://youtu.be/p9hbXPVaOuk

29. A manic episode can resemble:
A. Being drunk
B. Being high on
marijuana
C. Being high on
cocaine
BeingdrunkBeinghigh
on
m
arijuanaBeinghigh
on
cocaine
4%
96%
0%

30. Medications for Bipolar
Disorder/Manic Episode
 Lithium
 Effective for acute mania and prevents
recurrence
 Maximal benefit is achieved in one to two weeks
 Effective for unipolar depression not responsive
to other antidepressant drugs
 The therapeutic window is small – three to four
times the therapeutic level can cause grave
consequences
 Chlorpromazine
 Fewer toxic side effects

31. Non-compliance with med
schedules is a problem with lithium
because
A. Patients are
hallucinating
B. Patients like the feeling
of a manic episode
C. It takes several months
for the dose to reach
therapeutic threshold
Patientsarehallucinating
Patientslikethe
feeling..
Ittakesseveralm
onthsf..
0%
15%
85%

32. Psychosis
 Psychosis
 Severe mental condition marked by loss of contact with
reality
 Organic psychoses
 Have physical causes such as excessive drug use, brain
infections, metabolic or endocrine disorders, brain tumors,
and neurological diseases
 Functional psychoses
 Have no known or apparent cause (e.g. schizophrenia)

33. Schizophrenia
 Psychosis
• Delusions
• Hallucinations
• Disorganized Speech
• Disorganized Behavior
• Negative Symptoms

34. The number of children taking
antipsychotic drugs has increased
in the US. In Europe:
A. Rates have slightly
increased as well
B. Rates have remained
the same
C. Rates have decreased
D. Rates have increased
at an alarming rate,
doubling the numbers
Rateshaveslightlyincre...
Rateshaverem
ained
the...
Rateshavedecreased
Rateshaveincreased
ata...
23% 23%
31%
23%

35. Psychosis is
A. Blunting of
emotional
expression
B. A loss of touch
with reality
C. Always marked by
hallucinations
Bluntingofem
otionalex...
A
lossoftouch
w
ith
reality
Alw
aysm
arked
byhalluc...
0%
15%
85%

36. Video
 Schizophrenia:
http://digital.films.com/PortalViewVideo.a
spx?xtid=11024#
 Schizophrenia:
http://digital.films.com/PortalViewVideo.a
spx?xtid=42758
 4 patients
https://www.youtube.com/watch?v=bWa
Fqw8XnpA 7:12

37. Antipsychotic Drugs
 Antipsychotic drugs (neuroleptics) used
particularly for schizophrenia
 Pharmacologically different from other
sedative-hypnotic drugs
 They block dopamine
 Four to six weeks for maximum
effectiveness

38. Antipsychotic Drugs
 Absorbed erratically
 Sometimes given by injection so the drug
can be released slowly into the
bloodstream
 Build up in fatty areas of brain and lungs,
and cross the placenta to affect the fetus

39. Antipsychotic Drugs
 Patients almost always show improvement,
but a small percentage gets worse
 Improvement is most rapid during the first
several weeks of treatment
 Although many people taking antipsychotic
drugs relapse, it appears that these drugs
reduce violent behavior

40. Side Effects
 Parkinsonism
 tremor, slow movement, impaired speech or
muscle stiffness — especially resulting from the
loss of dopamine
 Tardive dyskinesia
 Motor disorders such as involuntary repetitive
facial movements, lip smacking, involuntary
movement of trunk and limbs, and twitching

41. Which is not true of
antipsychotic drugs?
A. Takes 4-6 weeks for max
effect
B. Side-effects are mild and
easily reversed
C. They are absorbed
unevenly
D. They block dopamine
Takes4-6w
eeksform
ax...
Side-effectsare
m
ild
and...
Theyare
absorbed
unevenly
Theyblockdopam
ine
8%
4%
19%
69%

42. Dual Diagnosis
• Two or more
co-existing
mental
illnesses
• Common
Example:
• Substance
Use Disorder
& Depression

43. Increased Medication Use =
Consequences for Society
 Number of hospitalizations decreased
 Lack of outpatient services
 Psychiatrists spend much time
prescribing/managing medications
 Civil Rights issues around hospitalization
 Non-compliance with medication regimen
 Jail
 Homelessness

44. Psychotherapeutic Drug Abuse
• 7 million Americans
• Unintentional poisoning deaths
increased by 84% (1999-2004)