Introduction to PharmacologySchedule of DrugsBlood / Brain BarrierCNS NeurotransmittersMood DisordersWhat Defines Depression?…continuedMedicationsHow they workWhy was there a need for a new generation?Vocational ImplicationsACCOMMODATIONS FOR DEPRESSIVE DISORDERBipolar DisorderBipolarSlide 15Medications for BipolarSide Effects of Bipolar MedicationsSlide 18AccommodationsSchizophreniaSlide 21Slide 22“Positive Symptoms”Slide 24“Negative Symptoms”Slide 26Slide 27Slide 28AccommodationsAnxietySlide 31Slide 32Medications for AnxietySide EffectsVocational LimitationsSlide 36As a counselor…Introduction to Pharmacology October 3, 2006Schedule of DrugsDeveloped in 1970 by the DEA to aid in the regulation of controlled substances.Drugs are placed on 1 of 5 “schedules” in accordance with 1) accepted medical use and 2) abuse / addiction potential.A schedule 1 drug (crack, heroin, marijuana) has no accepted medical use and is considered to have a high abuse / addiction potential. Whereas a schedule 5 drug (cough syrup) is widely accepted for medical use and is considered to have a little to no abuse / addiction potential.Schedule 2 and 3 drugs are ones typically used to treat psychosis and mood disorders. For these drugs, you need a prescription to have then in your possession.Blood / Brain BarrierBBB is semi-permeable Protects the brain from “foreign substances” in the blood that may injure the brain.Protects the brain from hormones in the rest of the body.Maintains a constant environment for the brain.CNS Neurotransmitters4 Main ClassesAcetylcholine (excitation)Monoamines*** (inhibition) Norepinephrine Dopamine SerotoninAmino Acids (excitation / inhibition) GABA Glycine Glutamate AspartatePeptides (excitation) Substance P Enkephalins***Monoamines are implicated in mood disorders, psychosis and anxiety. These neurotransmitters are found in the limbic system, a part of the brain associated with the the regulation of sleep, appetite, and emotional responses.Mood DisordersThere are two major types of mood disorders: Depressive Disorders and Bipolar DisordersDepression affects females approximately 2x more than malesMost common psychological disorder in the U.S.What Defines Depression?AFFECTIVE – depressed mood, feelings of sadness, dejection, and excessive/prolonged mourning, feelings of worthlessness, and a loss of joy for livingBEHAVIORAL – social withdrawal, lowered work productivity, low energy levels is the dominant behavioral symptom…continuedCOGNITIVE – feelings of futility, emptiness, and hopelessness, profound pessimistic beliefs about the future, disinterest, decreased energy, and motivation towards work and life in generalPHYSIOLOGICAL – change of appetite, weight change, constipation, sleep disturbance, menstrual abnormalities, and lack of libidoMedications3 classes of meds for depressionTricyclics - effect norepinephrine - include Elavil, Emitrip, Pertofrane, and JanimineMAO inhibitors - effect norepinephrine - include Marplan, Nardil, Parnate2nd Generation of medications (including SSRIs) - effect seretonin - include Wellbutrin, Prozac (SSRI), Zoloft (SSRI), and Paxil (SSRI)How they workTricyclics and SSRI work the same, but for a different monoamine (norepinephrine and serotonin respectively). Each 1) prevents the reuptake in the synapse allowing the neurotransmitter more time to be absorbed into the second neuron and 2) increases the number of receptor cites the neurotransmitter can be absorbed through.MAO inhibitors prevent the MAO enzyme from breaking norepinephrine down; allowing it to remain in the synapse.Why was there a need for a new generation?Tricyclics can cause dry mouth, excessive sweat, blurred vision, sexual dysfunction.MAO inhibitors have less effects, but can damage the liver, cause severe low blood pressure, or be fatal. So they are not prescribed nearly as much as tricyclics.SSRI can cause a person to become nervous, angry, or weak; however the side effects last a shorter amount of time. SSRI usually take 2 weeks to build up effective levels whereas tricyclics and MAO inhibitors take approx. 4 weeks. Furthermore the side effects of SSRIs usually last a shorter time.Vocational ImplicationsClient exhibits decreased motivation for work productivityClient exhibits decreased energyBoth lead to employee loss of time at workSleep disturbance can also cause absenteeism Cognitive difficulties, i.e. concentration, memory, decision-makingCan be associated with other illnesses (cancer, diabetes, cardiac problems)Side effects from medicationACCOMMODATIONS FOR DEPRESSIVE DISORDERFlexibility in work scheduleTime for treatment (medical/psychological)Reduction of workload during active stage of disorderBipolar DisorderAffects approximately 1.2% of the population.Characterized by mood shifts from depression to mania.BipolarSymptoms for a manic episode include elevated persistence, irritability, grandiosity, decreased need for sleep, distractibility, and social/occupational impairmentUsually accompanied by:psychosis – altered mental state (auditory and visual hallucinations)delusions – believing something about yourself that is not true (ability to fly)BipolarBipolar can easily be misdiagnosed as schizophrenia and depression because of the similar symptoms one can have.Remember a person with bipolar disorder is unlikely to seek treatment while in the manic phase unless Baker Acted (committed).A typical cycle for Bipolar ranges from several weeks to a several months. No one is depressed, then manic in one or two days.Medications for BipolarPeople with bipolar usually take a medication to even out their mood.Lamictal and Tegretol are most commonly used. Lithium is the old “standby” medication, but not that common anymore. Why would med compliance be more difficult in a person who is in a manic phase of his disorder?Side Effects of Bipolar MedicationsHeadacheFatigueDrowsinessDizzinessBlurred visionJoint achesVocational ImplicationsVery similar to depression, but during stages of mania:Work relationship difficultiesConcentration difficultiesLack of focus or attentionSide effects to medicationAccommodations Similar modifications for a person with depressive disordersSchizophreniaGroup of disorders characterized by severely impaired cognitive processes, personality disintegration, affective disturbances, and social withdrawal4 main types of schizophrenia: paranoid, disorganized, catatonic, and residualApproximately 1% of the