PSYCHOPHARMACOLOGY AND WORKING WITH PSYCHIATRY PROVIDERS. Juanaelena Garcia, MD Psychiatry Director Institute for Family Health
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1 PSYCHOPHARMACOLOGY AND WORKING WITH PSYCHIATRY PROVIDERS Juanaelena Garcia, MD Psychiatry Director Institute for Family Health
2 Learning Objectives Learn basics about the various types of medications that are used by psychiatry providers to treat various mental disorders Learn how you can work with psychiatry providers as part of your team
3 Psychiatry providers at IFH Psychiatrists- 4 years medical school after college then 4 years of Psychiatry Residency training Psychiatric Nurse Practitioners-RN s who get advanced training and do special certification in psychiatry Physician s assistants- 3 year training programs, many times affiliated with medical schools, most experience is on the job
4 Psychiatry in an Integrated setting Family practitioners following the IMPACT model of depression care Psychiatry providers working collaboratively with Family practitioners Having family practitioners manage certain cases, increasing access for patients with more complicated psychiatric illness Providing backup and consultation to Family practitioners in their management of psychiatric cases
5 Who can the Family practitioner see and manage New patients/intakes who have not had a history of psychiatric treatment have not had medication trials for depression or anxiety who have been on a regimen of antidepressants and need to be restarted Established patients in psychiatry That have been stable for many months and have had no med changes or adjustments That can have 3 month followup or more Have not had high risk behaviors in 3 months or more, ex suicide, homicide, self injury That are in therapy
6 Who do we want the psychiatrist to see Patients with an extensive psychiatric history, ie multiple hospitalizations and outpatient treatments Patients who are on complicated psychiatric regimens of antipsychotics, mood stabilizers, stimulants, benzodiazepines Actively psychotic Recurrent passive/active suicidal or homicidal ideation or self injury
7 Medication issues that may come up in therapy Side effects Discontinuation of medications Patients who refuse or no longer need medications Monitor in their therapy and refer back to psychiatry provider if symptoms have not improved or worsen
8 Herbal Medications Have chemical effects even though they are herbs Encourage patients to tell their doctor all the medications they are taking including From family members Medication they may have brought in from another country Medication purchased online
9 PSYCHOTROPIC MEDICATION TYPES A small sampling Brand name (Generic name)
10 Antidepressants SSRI s Used also for anxiety, OCD and other conditions, not just depression Prozac (Fluoxetine) Paxil (Paroxetine) Zoloft (Sertraline) Celexa (Citalopram) Lexapro (Escitalopram) The originals Most have generic, covered by plans
11 Antidepressants Dual action medications Serzone (Nefazodone) Remeron (Mirtazapine)-elderly who lose appetite and sleep Effexor XR (Venlafaxine)-anxiety Cymbalta (Duloxetine)-fibromyalgia, pain Viibryd (Vilazodone HCL) Others- Wellbutrin SR, XL (Buproprion)- also for smoking cessation Luvox (Fluvoxamine)- mostly for OCD TCA s (tricyclics) and Neurology- examples are Elavil (Amitryptyline) and Pamelor (Nortryptiline)- diabetic neuropathy Monoamine oxidase inhibitors-dietary restrictions
12 Antidepressant issues with use Discontinuation syndromes Side effects GI Headache Sexual Weight gain
13 Mood Stabilizers Used in Bipolar illness, other conditions with mood instability Examples Lithium carbonate classic bipolar, anti suicide properties Depakote (Valproic Acid)-mixed states Tegretol (Carbamazepine) Trileptal (Oxcarbazepine) Lamictal (Lamotrigine)- bipolar depression Neurontin (Gabapentin)-anxiety and diabetic neuropathy Topamax (Topiramate)- used for weight loss
14 Mood stabilizers issues with use Blood levels Kidney and liver monitoring toxicity
15 Antipsychotics Used for psychotic symptoms in a variety of illnesses Examples First generation- Haldol (Haloperidol) Trilafon (Perphenazine) Prolixin (Fluphenazine) Issues Injectable forms Tardive dyskinesia
16 Antipsychotics Atypicals- Risperdal (Risperidone) Seroquel (Quetiapine) Zyprexa (Olanzapine) Geodon (Ziprasidone) Abilify (Aripiprazole) Clozaril (Clozapine)- blood monitoring Fanapt (Iloperidone) Latuda (Lurasidone)-bipolar depression monotherapy Invega (Paliperidone)
17 Antipsychotics issues with use Atypical issues Expensive Not all formularies cover Metabolic syndrome Weight gain High blood pressure High blood sugar High cholesterol
18 Anti anxiety For symptoms not specific illness Buspar (Buspirone) Hydroxyzine (Atarax) Benzodiazepines- Ativan (Lorazepam) Klonopin (Clonazepam) Valium (Diazepam) Xanax (Alprazolam)
19 Anti anxiety medications- issues with use Benzodiazepines Dependence tolerance Withdrawal Abuse Misuse- xanax Diversion
20 Stimulants For ADD and variants, also augment antidepressant Multiple immediate and long acting preparations, amphetamine salts, combinations Ritalin Concerta Focalin Adderall Adderall XR Methylphenidate
21 Stimulants -issues for use Abuse Diversion Performance enhancement
22 ISTOP law As of 8/27/13, a prescription monitoring program database must be checked before a prescriptions for controlled substances is written Database will show all prescriptions filled, site, method of payment, and prescriber.
23 Sleep aids Desyrel (Trazodone) Restoril (temazepam) The Z drugs Ambien (Zolpidem) Sonata (Zaleplon) Lunesta (Eszopiclone) Issues Tolerance Diversion Abnormal sleep behaviors
24 Questions about your patients meds? Inbasket the psychiatry provider or Psychiatry director
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