Guide Prescribing Mental Health Medication: The Practitioners Guide (2nd Edition)

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There is no evidence to support the use of SGA medications for major depression, anxiety, or insomnia in children and adolescents. Additionally, based on recent FDA warnings[ 25 ] and the literature review conducted by Panagiotopoulos and colleagues,[ 4 ] it is clear that olanzapine should not be used as a first-line treatment in adolescents. Monitor according to protocol Primary care physicians are in a unique position to identify early signs of cardiometabolic dysfunction related to SGA medications, and are likely to encounter such patients in their practice.

Despite the development of such protocols and tools, attention to these monitoring recommendations has been low in both adults and children,[ 5 , 26 , 27 , 29 ] with some evidence suggesting that children are less likely than adults to receive metabolic screening and monitoring. Monitoring begins with family and personal history taking. The family history should include questions about diabetes type 1, type 2, gestational , hyperlipidemia, cardiovascular disease, schizophrenia, schizoaffective disorder, psychosis not otherwise specified, and bipolar disorder.

The personal history should include questions about smoking, physical activity, screen time e. Monitoring then proceeds with both clinical and laboratory evaluations. Although these medications are less likely than first-generation antipsychotics to cause extrapyramidal side effects, they are associated with an increased risk of metabolic complications. Of increasing concern, SGA medications are being used off-label without the benefit of clear guidelines for indications, dosing, or monitoring. It is thus very important that primary care physicians make themselves aware of the appropriate guidelines for both prescribing and monitoring the use of second-generation antipsychotics in their clinical practice.

Utilization and costs of antipsychotic agents: A Canadian population-based study, Psychiatr Serv ; Aparasu RR, Bhatara V. Antipsychotic prescribing trends among youths, National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Arch Gen Psychiatry ; Metabolic screening in children receiving antipsychotic drug treatment.

Arch Pediatr Adolesc Med ; Trends in antipsychotic prescriptions to children and adolescents in British Columbia, Canada, Ann Clin Psychiatry ; Prescription of antipsychotic drugs by office-based physicians in the United States, Lower risk for tardive dyskinesia associated with second-generation antipsychotics: A systematic review of 1-year studies.

Am J Psychiatry ; Side effects of atypical antipsychotics: Extrapyramidal symptoms and the metabolic syndrome. Harv Rev Psychiatry ; Correll CU. Multiple antipsychotic use associated with metabolic and cardiovascular adverse events in children and adolescents. Evid Based Ment Health ; Increased prevalence of obesity and glucose intolerance in youth treated with second-generation antipsychotic medication.

Can J Psychiatry ; Correll CU, Carlson H. Antipsychotics and diabetes: An age-related association. Ann Pharmacother ; Changes in antipsychotic drug prescribing by general practitioners in the United Kingdom from to A population-based observational study.

Br J Clin Pharmacol ; Primary care use of antipsychotic drugs: An audit and intervention study. Ann Gen Psychiatry ; Trends in prescribing of antipsychotic medications for US children. Ambul Pediatr ; Survey of atypical antipsychotic prescribing by Canadian child psychiatrists and developmental pediatricians for patients aged under 18 years. Can J Psychiatry Epidemiology of medical error.

BMJ ; Diagnostic error—the next frontier for patient safety. JAMA ; New Engl J Med Confirmation bias: Why psychiatrists stick to wrong preliminary diagnoses. Psychol Med ; Medication errors in psychiatry: A comprehensive review. CNS Drugs ; Abilify aripiprazole [product monograph]. US Food and Drug Administration. Global Mental Health is an area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide, [45] although some scholars consider it to be a neo-colonial, culturally insensitive project.

Military psychiatry covers special aspects of psychiatry and mental disorders within the military context. Neuropsychiatry is a branch of medicine dealing with mental disorders attributable to diseases of the nervous system. Social psychiatry is a branch of psychiatry that focuses on the interpersonal and cultural context of mental disorder and mental well-being. In larger healthcare organizations, psychiatrists often serve in senior management roles, where they are responsible for the efficient and effective delivery of mental health services for the organization's constituents.

For example, the Chief of Mental Health Services at most VA medical centers is usually a psychiatrist, although psychologists occasionally are selected for the position as well.

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In the United States, psychiatry is one of the few specialties which qualify for further education and board-certification in pain medicine , palliative medicine , and sleep medicine. Psychiatric research is, by its very nature, interdisciplinary; combining social, biological and psychological perspectives in attempt to understand the nature and treatment of mental disorders. Psychiatric diagnoses take place in a wide variety of settings and are performed by many different health professionals.

Therefore, the diagnostic procedure may vary greatly based upon these factors. Typically, though, a psychiatric diagnosis utilizes a differential diagnosis procedure where a mental status examination and physical examination is conducted, with pathological , psychopathological or psychosocial histories obtained, and sometimes neuroimages or other neurophysiological measurements are taken, or personality tests or cognitive tests administered. Three main diagnostic manuals used to classify mental health conditions are in use today. The ICD is produced and published by the World Health Organization , includes a section on psychiatric conditions, and is used worldwide.

The stated intention of diagnostic manuals is typically to develop replicable and clinically useful categories and criteria, to facilitate consensus and agreed upon standards, whilst being atheoretical as regards etiology. The DSM has attracted praise for standardizing psychiatric diagnostic categories and criteria. It has also attracted controversy and criticism. Some critics argue that the DSM represents an unscientific system that enshrines the opinions of a few powerful psychiatrists.

Individuals with mental health conditions are commonly referred to as patients but may also be called clients , consumers , or service recipients. They may come under the care of a psychiatric physician or other psychiatric practitioners by various paths, the two most common being self- referral or referral by a primary care physician. Alternatively, a person may be referred by hospital medical staff, by court order , involuntary commitment , or, in the UK and Australia, by sectioning under a mental health law.

Persons who undergo a psychiatric assessment are evaluated by a psychiatrist for their mental and physical condition. This usually involves interviewing the person and often obtaining information from other sources such as other health and social care professionals, relatives, associates, law enforcement personnel, emergency medical personnel, and psychiatric rating scales. A mental status examination is carried out, and a physical examination is usually performed to establish or exclude other illnesses that may be contributing to the alleged psychiatric problems.

A physical examination may also serve to identify any signs of self-harm ; this examination is often performed by someone other than the psychiatrist, especially if blood tests and medical imaging are performed. Like most medications, psychiatric medications can cause adverse effects in patients, and some require ongoing therapeutic drug monitoring , for instance full blood counts serum drug levels, renal function, liver function or thyroid function.

Electroconvulsive therapy ECT is sometimes administered for serious and disabling conditions, such as those unresponsive to medication. The efficacy [76] [77] and adverse effects of psychiatric drugs may vary from patient to patient. For many years, controversy has surrounded the use of involuntary treatment and use of the term "lack of insight" in describing patients. Mental health laws vary significantly among jurisdictions, but in many cases, involuntary psychiatric treatment is permitted when there is deemed to be a risk to the patient or others due to the patient's illness.

Involuntary treatment refers to treatment that occurs based on the treating physician's recommendations without requiring consent from the patient. Mental health issues such as mood disorders and schizophrenia and other psychotic disorders were the most common principle diagnoses for Medicaid super-utilizers in the United States in Psychiatric treatments have changed over the past several decades.

Psychiatric Mental Health Medication Overview

In the past, psychiatric patients were often hospitalized for six months or more, with some cases involving hospitalization for many years. Today in most countries, people receiving psychiatric treatment are more likely to be seen as outpatients. Average inpatient psychiatric treatment stay has decreased significantly since the s, a trend known as deinstitutionalization. Psychiatric inpatients are people admitted to a hospital or clinic to receive psychiatric care. Some are admitted involuntarily, perhaps committed to a secure hospital, or in some jurisdictions to a facility within the prison system.

In many countries including the US and Canada, the criteria for involuntary admission vary with local jurisdiction. They may be as broad as having a mental health condition, or as narrow as being an immediate danger to themselves or others. Bed availability is often the real determinant of admission decisions to hard pressed public facilities. European Human Rights legislation restricts detention to medically certified cases of mental disorder, and adds a right to timely judicial review of detention.

People may be admitted voluntarily if the treating doctor considers that safety isn't compromised by this less restrictive option. Some wards are mixed-sex whilst same-sex wards are increasingly favored to protect women inpatients. Once in the care of a hospital, people are assessed , monitored, and often given medication and care from a multidisciplinary team, which may include physicians, pharmacists, psychiatric nurse practitioners, psychiatric nurses , clinical psychologists, psychotherapists, psychiatric social workers, occupational therapists and social workers. If a person receiving treatment in a psychiatric hospital is assessed as at particular risk of harming themselves or others, they may be put on constant or intermittent one-to-one supervision, and may be put in physical restraints or medicated.

People on inpatient wards may be allowed leave for periods of time, either accompanied or on their own. In many developed countries there has been a massive reduction in psychiatric beds since the mid 20th century, with the growth of community care. Standards of inpatient care remain a challenge in some public and private facilities, due to levels of funding, and facilities in developing countries are typically grossly inadequate for the same reason.

Even in developed countries, programs in public hospitals vary widely. Some may offer structured activities and therapies offered from many perspectives while others may only have the funding for medicating and monitoring patients. This may be problematic in that the maximum amount of therapeutic work might not actually take place in the hospital setting. This is why hospitals are increasingly used in limited situations and moments of crisis where patients are a direct threat to themselves or others. Alternatives to psychiatric hospitals that may actively offer more therapeutic approaches include rehabilitation centers or "rehab" as popularly termed.

Outpatient treatment involves periodic visits to a psychiatrist for consultation in his or her office, or at a community-based outpatient clinic. Initial appointments, at which the psychiatrist conducts a psychiatric assessment or evaluation of the patient, are typically 45 to 75 minutes in length. Follow-up appointments are generally shorter in duration, i. The frequency with which a psychiatrist sees people in treatment varies widely, from once a week to twice a year, depending on the type, severity and stability of each person's condition, and depending on what the clinician and patient decide would be best.

Increasingly, psychiatrists are limiting their practices to psychopharmacology prescribing medications , as opposed to previous practice in which a psychiatrist would provide traditional minute psychotherapy sessions, of which psychopharmacology would be a part, but most of the consultation sessions consisted of "talk therapy. The underlying assumption was that psychopharmacology was at least as effective as psychotherapy, and it could be delivered more efficiently because less time is required for the appointment.

Because of this shift in practice patterns, psychiatrists often refer patients whom they think would benefit from psychotherapy to other mental health professionals, e. The earliest known texts on mental disorders are from ancient India and include the Ayurvedic text, Charaka Samhita. The Greeks also created early manuscripts about mental disorders. Greece, Hippocrates wrote that he visited Democritus and found him in his garden cutting open animals. Democritus explained that he was attempting to discover the cause of madness and melancholy.

Hippocrates praised his work. Democritus had with him a book on madness and melancholy. Trepanning was one of these methods used throughout history. The Islamic Golden Age fostered early studies in Islamic psychology and psychiatry, with many scholars writing about mental disorders.

The Persian physician Muhammad ibn Zakariya al-Razi , also known as "Rhazes", wrote texts about psychiatric conditions in the 9th century. Two of his works in particular, El-Mansuri and Al-Hawi , provide descriptions and treatments for mental illnesses. Abu Zayd al-Balkhi , was a Persian polymath during the 9th and 10th centuries and one of the first to classify neurotic disorders. He pioneered cognitive therapy in order to treat each of these classified neurotic disorders. He classified neurosis into four emotional disorders: fear and anxiety , anger and aggression , sadness and depression , and obsession.

Al-Balkhi further classified three types of depression: normal depression or sadness huzn , endogenous depression originating from within the body, and reactive clinical depression originating from outside the body. The first bimaristan was founded in Baghdad in the 9th century, and several others of increasing complexity were created throughout the Arab world in the following centuries.

Some of the bimaristans contained wards dedicated to the care of mentally ill patients, [] most of whom suffered from debilitating illnesses or exhibited violence. The beginning of psychiatry as a medical specialty is dated to the middle of the nineteenth century, [98] although its germination can be traced to the late eighteenth century. In the late 17th century, privately run asylums for the insane began to proliferate and expand in size.

In the Bethel Hospital Norwich was opened, the first purpose-built asylum in England. During the Enlightenment attitudes towards the mentally ill began to change. It came to be viewed as a disorder that required compassionate treatment.

In English physician William Battie wrote his Treatise on Madness on the management of mental disorder. It was a critique aimed particularly at the Bethlem Hospital , where a conservative regime continued to use barbaric custodial treatment. Battie argued for a tailored management of patients entailing cleanliness, good food, fresh air, and distraction from friends and family.

He argued that mental disorder originated from dysfunction of the material brain and body rather than the internal workings of the mind. The introduction of moral treatment was initiated independently by the French doctor Philippe Pinel and the English Quaker William Tuke. Patients were allowed to move freely about the hospital grounds, and eventually dark dungeons were replaced with sunny, well-ventilated rooms. Pinel's student and successor, Jean Esquirol — , went on to help establish 10 new mental hospitals that operated on the same principles.

Although Tuke, Pinel and others had tried to do away with physical restraint, it remained widespread into the 19th century.


At the Lincoln Asylum in England, Robert Gardiner Hill , with the support of Edward Parker Charlesworth , pioneered a mode of treatment that suited "all types" of patients, so that mechanical restraints and coercion could be dispensed with — a situation he finally achieved in In Sergeant John Adams and Dr. John Conolly were impressed by the work of Hill, and introduced the method into their Hanwell Asylum , by then the largest in the country.

The modern era of institutionalized provision for the care of the mentally ill, began in the early 19th century with a large state-led effort. In England, the Lunacy Act was an important landmark in the treatment of the mentally ill, as it explicitly changed the status of mentally ill people to patients who required treatment. All asylums were required to have written regulations and to have a resident qualified physician.

In the United States, the erection of state asylums began with the first law for the creation of one in New York, passed in The Utica State Hospital was opened approximately in Many state hospitals in the United States were built in the s and s on the Kirkbride Plan , an architectural style meant to have curative effect. At the turn of the century, England and France combined had only a few hundred individuals in asylums. However, the idea that mental illness could be ameliorated through institutionalization ran into difficulties.

In the early s, psychiatry made advances in the diagnosis of mental illness by broadening the category of mental disease to include mood disorders , in addition to disease level delusion or ir rationality. For Emil Kraepelin, the initial ideas behind biological psychiatry, stating that the different mental disorders are all biological in nature, evolved into a new concept of "nerves", and psychiatry became a rough approximation of neurology and neuropsychiatry.

By the s, however, the psychoanalytic school of thought became marginalized within the field. Psychopharmacology became an integral part of psychiatry starting with Otto Loewi 's discovery of the neuromodulatory properties of acetylcholine ; thus identifying it as the first-known neurotransmitter.

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In , US president John F. Kennedy introduced legislation delegating the National Institute of Mental Health to administer Community Mental Health Centers for those being discharged from state psychiatric hospitals. Controversy has often surrounded psychiatry, and the term anti-psychiatry was coined by psychiatrist David Cooper in and was later made popular by Thomas Szasz. The basic premise of anti-psychiatry is that: psychiatrists attempt to maliciously classify "normal" people as "deviant;" psychiatric treatments are ultimately more damaging than helpful to patients; and psychiatry's history involves what may now be seen as dangerous treatments, such as the frontal lobectomy commonly called, a lobotomy.

From Wikipedia, the free encyclopedia. Not to be confused with Clinical psychology. See also: Ethical issues in psychiatry disambiguation. Main article: Psychiatrist. This section relies largely or entirely upon a single source. Relevant discussion may be found on the talk page. Please help improve this article by introducing citations to additional sources. August Learn how and when to remove this template message. See also: Diagnostic classification and rating scales used in psychiatry. This section may need to be rewritten to comply with Wikipedia's quality standards.

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Alienist Medical psychology Biopsychiatry controversy Telepsychiatry Telemental health Bullying in psychiatry Psychiatry organizations Psychiatry Innovation Lab Glossary of psychiatry Glossary of medicine. International Journal of Medical Education.

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Retrieved 3 November Molinad and Ahmed Okasha. These practices, in which racial hygiene constituted one of the fundamental principles and euthanasia programmes were the most obvious consequence, violated the majority of known bioethical principles. Psychiatry played a central role in these programmes, and the mentally ill were the principal victims.

Journal of Medical Ethics.

Prescribing Mental Health Medication : The Practitioner's Guide -

Based on the generally accepted definition, we correctly term the utilisation of psychiatry for the punishment of political dissidents as torture. In Corillon C ed. Science and Human Rights. The National Academies Press. Retrieved Over the past two decades the systematic use of torture and psychiatric abuse have been sanctioned or condoned by more than one-third of the nations in the United Nations, about half of mankind.

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Diagnostic Criteria

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