MANAGING CHALLENGES IN PRESCRIBING FOR THE INTELLECTUALLY DISABLED INTELLECTUAL DISABILITY AND RESEARCH BECOME A BEHAVIORAL SUPPORT SUPER H.E.R.O.
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1 BECOME A BEHAVIORAL SUPPORT SUPER H.E.R.O. 1 November 10, 2016 Wyndham Indianapolis West 2 MANAGING CHALLENGES IN PRESCRIBING FOR THE INTELLECTUALLY DISABLED Presenter Elizabeth L. McGee, PMHNP-BC, FNP, MS 3 INTELLECTUAL DISABILITY AND RESEARCH
2 4 INTELLECTUAL DISABILITY AND DRUG RESEARCH 5 INTENTIONALLY LEFT BLANK 6 PRESCRIBING FOR INTELLECTUALLY DISABLED PRINCIPLES GOALS
3 7 PRIMUM NO NOCERE 8 GOALS OF TREATMENT 9 PRIMER ON PSYCHOACTIVE MEDICATIONS
4 10 DISCLAIMER OFF LABEL USE 11 ANTIDEPRESSANT AND ANTIANXIETY MEDICATIONS 12
5 13 SSRI S SELECTIVE SEROTONIN REUPTAKE INHIBITOR SSRI Selective serotonin reuptake inhibitor
6 16 17 Citalopram (Celexa) Escitalopram(Lexapro) Fluoxetine(Prozac) Fluvoxamine(Luvox) Paroxetine(Paxil) Sertraline(Zoloft) 18
7 19 SRNI S Serotonin Reuptake Norepinephrine Inhibitor 20 Duloxetine(Cymbalta) Venlafaxine(Effexor) Desvenlafaxine(Pristiq) 21 OTHER ANTIDEPRESSANTS TRICYCLICS AND MAO S OLDIES CAN BE GOODIES
8 TRICYCLICS 22 AMITRIPTYLINE(ELAVIL) CLOMIPRAMINE(ANAFRANIL) DESIPRAMINE(NORPRAMIN) DOXEPIN(SINEQUAN) IMIPRAMINE(TOFRANIL) NORTRIPTYLINE(PAMELOR) 23 MONOAMINE OXIDASE INHIBITORS Selegiline(Emsam) 24 Isocarboazid(Marplan) Phenelzine(Nardil) Tranylcypromine(Parnate)
9 OTHER ANTIDEPRESSANTS ANXIOLYTIC MEDICATIONS 25 BUPROPRION(WELLBUTRIN) MIRTAZAPINE(REMERON) NEFAZODONE(SEROZONE) TRAZODONE(OLEPTO) 26 ANTIANXIETY MEDICATIONS BENZODIAZAPINES 27 ALPRAZOLAM(XANAX) CLONAZEPAM(KLONOPIN) DIAZEPAM(VALIUM) LORAZEPAM(ATIVAN)
10 OTHER ANXIOLYTIC MEDICATIONS 28 BUSPIRONE(BUSPAR) CLONIDINE(CATAPRESS PRAZOSIN(MINIPRESS) PROPRANOLOL (INDERAL) 29 ANTIPSYCHOTICS 30 TYPICALS ATYPICALS
11 31 TYPICAL ANTIPSYCHOTICS Haldol(haloperidol) Loxitane(loxapine) Mellaril(thioridazine) Moban(molindone) Navane(thiothixene) Prolixin(fluphenazine) Serentil(sesoridazine) Stelazine(trifluoperazine) 32 ATYPICAL ANTIPSYCHOTICS Apiprazole(Abilify) Clozapine(Clozaril) Olanzapine(Zyprexa) Palperidone(Invega) Quetiapine(Seroquel) Risperidone(Risperdal) DEMENTIA MEDICATIONS 33 DONEPEZIL (ARICEPT) GALANTAMINE/ER (RAZADYNE ER) MEMANTINE/ER (NAMENDA)
12 34 DONEPEZIL(ARICEPT) GALANTAMINE(RAZADYNE/ER) MEMANTINE(NAMENDA/ER) MEMANTINE ER/DONEPEZIL (NAMZARIC) RIVASTIMINE(EXELON) MOOD STABILIZERS 35 CARBAMAZEPINE(TEGRETOL) 36 LAMOTRIGINE(LAMICTAL) LITHIUM(LITHOBID) OXCARBAZEPINE(TRILEPTAL) VALPROIC ACID(DEPAKOTE/KENE)
13 37 VIGINETTES YOU ARE WORKING WITH A THIRTY-FOUR YEAR OLD ID CLIENT. EVERYDAY HE WALKS TO WORKSHOP HE PICKS UP EVERY ITEM HE SEES ALONG THE WAY. AT TIMES HE COMES TO WORK LUGGING A LARGE GARBAGE-TYPE BAG BEHIND HIM. HE GETS VERY UPSET AND CAN BECOME AGGRESSIVE WITH STAFF IF THERE IS AN ATTEMPT TO REMOVE ITEMS OR TAKE THE BAG. 38 *IS THIS SOMETHING TO TREAT WITH MEDICATION? *WHAT DIAGNOSIS/ES MIGHT BE CONSIDERED? *WHAT WOULD BE GOALS OF MEDICATION TREATMENT? *IF TREATING WITH MEDICATION WHAT ONES MIGHT BE HELPFUL? YOU HAVE BEEN ASKED TO CONSULT ON A FORTY NINE YEAR OLD ID CLIENT WHO HAS BEEN DISPLAYING UNCHARACTERISTIC BEHAVIORS. SHE HAS BECOME WITHDRAWN SOCIALLY, NO LONGER ENJOYS FAVORITE ACTIVITIES LIKE HORSE BACK RIDING, PAINTING AND MAKING NEW RECIPES. SHE ALSO SEEMS TO HAVE SOME ANXIETY AND GETS EXASPERATED TRYING TO TALK ABOUT HER FEELINGS. THESE SYMPTOMS HAVE BEEN OCCURRING FOR MONTHS AND ARE WORSENING. STAFF IS STUMPED AND HAS ASKED FOR ASSISTANCE FROM THE B.C. 39 *WHAT ARE SOME POSSIBLE DIAGNOSES FOR THESE SYMPTOMS? *DO THESE SYMPTOMS SUGGEST TREATMENT WITH MEDICATIONS? *WHAT MEDICATIONS MIGHT BE CONSIDERED?
14 YOU ARE ASSIGNED A CLIENT WITH ID WHO SEEMS TO HAVE THE POTENTIAL TO DO MORE THAN THEY ARE IN ALL DOMAINS. YOU NOTE DIAGNOSES OF SEIZURE DISORDER, POOR APPETITE, ECZEMA WITH SKIN PICKING AND MIGRANES. THE MEDICATION LIST WITH INDICATIONS IS AS FOLLOWS: 40 Cyproheptadine (appetite stimulation); dipenhydramine (puritis); Keppra (seizure disorder); Topiramate (migranes) *What are your impressions? *What might be some options for this client? *Would this patient benefit from seeing a psychiatrist/psychiatric NP? 41 The Future of Psychiatry OPTOGENETICS BRAIN INTERFACES GENETIC TESTING VIRTUAL REALITY PHONE APPLICATIONS 42 OPTOGENETICS
15 43 OPTOGENETICS 44 BRAIN-MACHINE INTERFACES 45 IMPLANTABLES
16 46 BRAIN PACEMAKER 47 GENETIC TESTING 48
17
18 52 53 HEAD OF TECHNOLOGY FORMER HEAD OF NIH 54 DEPRESSION LEADING CAUSE OF DISABILITY WHAT IF THERE WAS AN APP
19 55 Americans with mental health challenges: **die years earlier on average (NAMI,Vahabzadeh) **those with profound ID lose >20 percent life expectancy IMPROVING MENTAL HEALTH CARE IMPROVES WELLBEING OF SOCIETY 56 OPTOGENETICS 57
20 58 CONTACT INFORMATION: CITED REFERENCES UPON REQUEST
475 Child & Adolescent Psychopharmacology p.1
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