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2003-09

ERIC Digest
A Guide for Helping Professionals
Robert L. Smith and Elda E. Garcia clinicians. After a comprehensive diagnostic evaluation, an individual treatment plan, based on any coexisting mental and physical conditions Certain mental disorders are caused by or accompanied by should be selected. Medications should not be considered as the first or neurochemical abnormalities. The use of psychotropic medications only choice in treatment, but rather as part of a comprehensive treatment has dramatically increased over the past two decades in all age groups, plan when benefits outweigh any risks. Examples of when psychotropic particularly with children. Therefore, psychopharmacology, the branch medications might be considered for children and adolescents follow of pharmacology dealing with the psychological effects of drugs, needs (Pennsylvania Department of Public Welfare, Office of Mental Health to be carefully studied by all helping professionals. & Substance Abuse Services, 2001): Olfson, Marcus, Weissman, & Jensen (2002) found between 1991 1. The child or adolescent with a psychiatric disorder that is known to and 1995, the number of 2- to 4 year olds receiving stimulants such as be responsive to psychotropic medication (Schizophrenic, Bipolar Ritalin or antidepressants such as Prozac increased two- to three fold, with Disorder, OCD, ADHD, Depression).
even a sharper increase for Clondidine, which is used to treat insomnia 2. The child or adolescent with a psychiatric disorder that is in hyperactive children. The number of children in the United States often responsive to psychotropic medication, especially if no prescribed medications to treat depression, attention-deficit/hyperactivity improvement occurs through other approaches.
disorder (ADHD) or other behavioral conditions nearly tripled between 3. The child or adolescent for whom a co-occurring or secondary 1986 and 1996. Dr. Mark Olfson of Columbia University in New York condition requires medication.
City and colleagues reviewed surveys of medication use for more than 4. The child or adolescent with symptoms suggestive of a disorder, 50,000 people, including about 17,000 children under the age of 18 years in with a strong family history of that disorder and positive family 1986 and 1996. Findings, published in the May 2002 issue of the Journal response to use of a particular medication, especially when other of the American Academy of Child and Adolescent Psychiatry are: interventions are insufficient.
• The number of children taking stimulants such as Ritalin and 5. The child with an adjustment disorder or acute response to stress, Adderall, used to treat ADHD quadrupled from 6 children per with symptoms that are responsive to psychotropic medication 1,000 in 1986 to 24 per 1,000 in 1996.
such as anxiety following the death of a parent.
• The number of children taking antidepressants such as Prozac or 6. Crisis: An acutely agitated or dangerous child, in need of emergency Zoloft, among others, rose from 3 children per 1,000 in 1986 assessment with possible psychiatric hospitalization. to 10 per 1,000 in 1996.
• In 1996, stimulant use was especially common in children aged 6 In the United States, one in five children and adolescents suffer to 14 years and antidepressant use was common in children aged from mental health problems at any given time, (Healthlink, 2003). 15 to 18 years. (Olfson, Marcus, Weissman, & Jensen, 2002) The importance of early and accurate diagnosis is the key to providing comprehensive treatment. Although medication is not considered the The increased use of psychotropic medication has been as dramatic first choice of treatment it often becomes part of treatment along with for adolescents, adults, and particularly the elderly, a clear indication counseling. It is therefore important for helping professionals to enhance that helping professionals need to increase their knowledge base and their knowledge base concerning psychotropic medications. understanding of psychotropic medications. This article addresses: the importance of diagnosis, understanding the basic psychotropic medications Psychotropic Medications: A Brief Overview
by name and how they work, an awareness of side-effects/complications, and the importance of staying current with research in this field.
A number of mental disorders either caused by or accompanied by neurochemical abnormalities, have been shown to be effectively treated Diagnosis: A Major Role for Helping Professionals
by psychotropic medications. Psychotropic medications are referred to as psychiatric medications, psychoactive medications, or simply described Treatment programs to mediate mental health issues are only effective as prescribed drugs used to stabilize or improve mood, mental status, or if there is an accurate diagnosis. Diagnosis commences long before the behavior. Psychotropic medications have two names; a brand name or beginning of treatment. This includes taking a client's history with an trade name, chosen by the drug manufacturer and a generic name often emphasis on family of origin. The standard used for the diagnosis of mental derived from the chemical structure of the drug. The general public health disorders is the American Psychiatric Association's Diagnostic and refers to the psychotropic medication by its brand name, such as Ritalin Statistical Manual of Mental Disorders (DSM), but when considering or Prozac, while scientific reports refer to the generic name such as the use of prescriptive drugs diagnosis expands far beyond the use of the methylphenidate or fluoxetine. Many generic names are very similar, DSM. In conjoint treatment as in the use of psychotherapy and drugs, such as fluoxetine (Prozac), and fluvoxamine (Luvox). Both of these drugs clinicians' need to be knowledgeable of: mental health conditions that are used as antidepressants. It is important to understand why one drug warrant consideration of drugs, medications frequently prescribed for might be preferred over another. For example, both Prozac and Luvox are certain disorders, and drug side effects/problems. It would also be prudent considered antidepressants, they both act on serotonin, and both have mild to be aware of: safe levels of drug dosing, the drug monitoring process, sedation qualities. So why might one of these medications be prescribed and psychiatric referrals.
over the other? A number of factors are considered when determining Diagnosis, when psychotropic medication is a consideration, should what drug is be best suited for a client. The first line of questioning used be a collaborative process involving psychiatric and other physicians, by psychiatrists is whether the client or any member of his/her family has the client, the client's family, and school based or other health care a history with the medications being considered. If it is discovered that either the client or a family member had success with a particular medication C. Eating problems (nausea, vomiting, weight gain or loss).
in the past, it is that medication which is often recommended. However, if D. Change in stool pattern (constipation, diarrhea).
there is no such history, other factors including the client's symptomology and E. Change in heartbeat (slow, fast, irregular) or blood pressure medication tolerance are considered. (high or low).
Psychotropic medications are classified by their chemical structure, their F. Fainting or dizziness, especially with change in position such action on the brain, or their therapeutic action. Major mental illness involves as upon standing.
neurochemical dysfunctions in the subcortical areas of the brain: the limbic G. Abnormal posture, movement, or gait.
system, basal ganglia, reticular system and brain stem (Preston, O'Neal, & H. Yellowing of eyes or skin.
Talaga, 1997). Dysfunction in the brain such as disruption of neurotransmit ers I. Unusual bruising or bleeding.
can result in a severe mental health problem, e.g., major depression. In major depression it has been estimated that the neuronal pathways affected represent Conclusions
only about 1 % of the total brain nerve cells, yet this condition can be very debilitating for the individual (Preston, O'Neal, & Talaga, 1997). Not all It is important for helping professionals to identify prescribed forms of depression are chemically based, but when physiological symptoms medications (generic and trade name), their dosage, therapeutic are present psychotropic drugs, i.e., antidepressant medications, are quite benefits, side effects, and risks involved, while remaining familiar effective. Knowledge of the medication's therapeutic action and expected with current mental health issues. Helping professionals can utilize effect is valuable information for helping professionals. Table 1 is drawn a number of resources such as electronic sources, textbooks, medical from the Mental Health & Developmental Disabilities Center (2003) and libraries, courses, and current research briefs to expand and update provides examples of the generic & brand names, of the most commonly their knowledge of psychopharmacology. used psychotropic medications and summarizes their therapeutic action and intended effect. Helping professionals should be familiar with these and other commonly prescribed drugs: HealthLink, Medical College of Wisconsin. (2001, Oct.). Children, Table 1: Example Medications and Their Effects Mental Illness and Medicines. Retrieved on October 4, 2003, from: Examples (Generic & Therapeutic
Brand Name of Drug) Action
Mental Health & Developmental Disabilities Center (2003). Fluoxetine (Prozac) Elevate mood in people Paroxetine (Paxil) who are depressed.
Psychotropic Medications: Overview & General Comments. Sertraline (Zoloft)Imipramine (Tofranil) Retrieved October 13, 2003, from: http://www.npi.ucla.edu/mhdd/ Clonazepam (Klonapin) Used to treat anxiety disorders Lorazepam (Ativan) and reduce anxiety symptoms.
Buspirone (BuSpar) Ohio Department of Mental Retardation and Developmental Disabilities, Carbamazepine (Tegretol) Mood Stabilizers Reduce mood swings in Lithium (e.g., Lithonate) individuals with manic- MUI/Registry Unit (2002, Mar). Health and Safety Alert: Excessive Valproic acid (Depakene, depressive illness. Psychotropic Medication and Psychotropic Medication Side Effects Haloperidol (Haldol) Treat psychotic disorders such (Information Notice 02-03-08). Columbus, OH: Author. Retrieved Risperidone (Risperdal) as schizophrenia. Reduce October 4, 2003, from: http://odmrdd.state.oh.us/ProvidersDoc/ Olanzapine (Zyprexa) psychotic symproms such as Methyphenidate (Ritalin) Treat Attention-Hyperactivity Dextroamphetamine Pennsylvania Department of Public Welfare, Office of Mental Health Pemoline (Cylert) & Substance Abuse Services. (2001). Possible Clinical Interactions Propanolol (Indural) Treat some forms of severe For Psychotropic Medications for Children and Adolescents. Retrieved October 4, 2003, from: http://www.dpw.state.pa.us/ Naltrexone (RiVea) Treat some forms of self-injurious Psychotropic Medications: Side Effects
Olfson, M., Marcus, S.C., Weissman, M.M. & Jensen, P.S. (2002). National Trends in the Use of Psychotropic Medications in The dramatic increase in the use of psychotropic medications is evident. Children. Journal of the American Academy of Child and Adolescent Helping professionals should be knowledgeable of possible side effects when Psychiatry, 41, 514-521.
considering psychotropic medication. A Health and Safety Alert, Excessive Psychotropic Medication and Psychotropic Medication Side Effects (2002), Preston, J., O'Neal, J., & Talaga, M. (1997). Handbook of Clinical describes the following serious side effects common to most psychotropic Psychopharmacology for Therapists. Oakland, California: New Harbinger Publications, Inc.
A. Allergic reaction (difficulty breathing, swelling of lips/face/tongue, rash or fever).
B. Change in level of alertness (excess sleepiness, insomnia or ERIC Digests are in the public domain and may be freely reproduced and disseminated. This publication was funded by the U.S.
Department of Education, Of fice of Educational Research and Improvement, Contract No. ED-99-CO-0014. Opinions expressed in this report do not
necessarily refl ect the positions of the U.S. Department of Education, OERI, or ERIC/CASS.
For information on other ERIC/CASS products and services, please call toll-free (800) 414-9769 or (336) 334-4114 or fax (336) 334-4116 or write ERIC/CASS, School of Education, University of North Carolina at Greensboro, Greens boro, NC 27402.

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AUTOIMMUNITY, AUTOIMMUNE DISEASES Prof dr Gergely Péter Semmelweis University Central Laboratory of Immunology The etiology of autoimmune diseases is unknown. They are diseases of variable clinical picture and prognosis, their common feature: autoreactivity (autoreactive T cells, autoantibodies) plays a pivotal role in their pathogenesis. Features: • Variable clinical picture and prognosis, even within one disease (spontaneous remissions) • In the majority: Female predominance (e.g., in SLE 9:1) • They frequently appear as „overlap" e.g. Sjögren's syndrome, mixed connective tissue disease (MCTD).

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