Use of Psychotropic Medications in Older Adults with Dementia!

Size: px
Start display at page:

Download "Use of Psychotropic Medications in Older Adults with Dementia!"

Transcription

1 Use of Psychotropic Medications in Older Adults with Dementia! Deepa Pattani, PharmD, RPh Owner: PrevInteract Health

2 About Me Deepa Pattani, PharmD, RPh with over 13 years of experience as a Pharmacist Practiced in various aspects of pharmaceutical care Licensed to practice in 4 states throughout the country Contact info:

3 Introduction: Dementia Dementia: decline in mental ability severe enough to interfere with daily activities. 2015: million individuals affected worldwide. Alzheimer s dementia accounts for 60-80% of all dementia cases. Vascular dementia: occurs after stroke: 2 nd most common type of dementia. 15 million people provide unpaid care for people with dementia: 18.2 billion hours: $230 billion. Incorrectly labeled senile dementia and not a part of the normal aging process cost to nation: $257 billion

4 Agenda After completion of this activity, the target audience should be able to: Describe different types of dementia and methods of identification. Describe at least 2 classes of psychotropic medications used in the treatment of dementia. Recognize side effects of psychotropic medications vs. symptoms of disease progression. Clinically determine how to screen a patient that may need medications or behavior modifications.

5 Types of Dementia Alzheimer s disease: difficulty remembering. Vascular dementia: impaired ability to make decisions. Dementia with Lewy bodies (DLB): early symptoms: sleep disturbance, visual hallucinations. Mixed dementia: multiple dementia symptoms seen. Parkinson s disease: gait disturbances.

6 Types of Dementia (contd) Frontotemporal dementia: behavior problems & difficulty with language. Creutzfeldt- Jacob disease: rapidly fatal: memory loss, coordination & behavior changes. Huntington s disease: involuntary movements, severe decline in reasoning, depression, mood changes. Normal pressure hydrocephalus: memory loss, loss of bladder control. Wernicke-Korsakoff syndrome: memory loss due to severe thiamine deficiency: alcohol misuse.

7 Treatment No treatment for dementia currently. Medications and non-drug therapy used in combination. Dietary supplements.

8 Psychotropic Medications Antidepressants Anxiolytics, sedatives and hypnotics Stimulants Mood stabilizers Neuroleptics Cognitive enhancers/ stabilizers

9 Psychotropics: Anti-depressants SSRIs: Fluvoxamine, Fluoxetine, Paroxetine, Citalopram, Sertraline, Escitalopram All Ages GI upset Serotonin Syndrome Akathisia Hyponatremia Older Adults Falls/ Hip fractures QTc prolongation (Celexa) Osteoporosis Anticholinergic side effects Increase risk of bleeding (anticoagulants)

10 Anti-depressants (contd) SNRIs Venlafaxine, Duloxetine TCAs Amitriptyline, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline, Protriptyline, Trimipramine MAOIs Isocarboxacid, Phenelzine, Selegiline (oral and patch), Tranylcypromine Misc Mirtazapine, Trazodone, Bupropion.

11 Psychotropics:Anxiolytics SSRIs, SNRIs, TCAs, and MAOIs Benzodiazepines Miscellaneous Buspirone, trazodone Propranolol, clonidine Antihistimines Antiepileptics (AEDs)

12 Psychotropics: Anxiolytics Benzodiazepines Long acting: Chlordiazepoxide, Clonazepam, Diazepam, Flurazepam & Quazepam. Intermediate-acting: Alprazolam, Oxazepam, Lorazepam, Clonazepam. Short-acting: Triazolam, Midazolam, & chlorazepate

13 Anxiolytics: Benzodiazepines Side-effects: FALL risk greatly increased. CONFUSION, CONFUSION, CONFUSION!!! Paradoxical reactions More likely to have withdrawal symptoms (and to have these symptoms misrecognized) Dementia: very hard to differentiate if effects are from BZDs or dementia. (Risk of mis-diagnosis) Depression Misuse

14 Psychotropics: Anxiolytics Miscellaneous Buspirone Trazodone: mild anticholinergic effects, sedation Propranolol, clonidine: hypotension, can potentially address 2 problems with 1 medication Antihistamines: anticholinergic side-effects

15 Psychotropics: Sedative/Hypnotics Benzodiazepines Non-benzodiazepine hypnotics: Falls, confusion, misuse Zolpidem Zaleplon Eszopiclone Melatonin receptor agonist: Ramelteon: well-tolerated Miscellaneous: Trazodone, mirtazapine, and chloral hydrate (effects similar to alcohol)

16 Psychotropics: Stimulants Used for apathy, amotivation, depression Worsen anxiety Buproprion: Anticholinergic properties Methylphenidate: tachycardia, hypertension, confusion, hallucinations

17 Psychotropics: Mood Stabilizers May be useful for impulsivity and irritability Divalproex, valproic acid, valproate: dizziness, falls, elevated liver enzymes, elevated ammonia, weight gain, hair loss. Carbamazepine: blood dyscrasias, elevated liver enzymes, interactions with other medications

18 Psychotropics: Neuroleptics Typical (first generation): Chlorpromazine, thioridazine, trifluoperazine, fluphenazine, perphenazine, prochlorperazine, thiothixene, loxapine, pimozide, haloperidol Atypical (second generation): Clozapine, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole

19 Neuroleptics Appropriate Indication Acute psychotic episode, atypical psychosis, brief reactive psychosis Delusional disorders Schizophrenia, schizo-affective disorder Huntington s disease Mood disorder w/ psychotic features Tourette s syndrome Dementia & delirium with agitated behaviors Short term (< 7 days): hiccups, pruritic, nausea & vomiting Inappropriate Use Agitated behaviors that is not a threat to patient or others Depression without psychosis Anxiety, nervousness Fidgeting, restlessness, wandering Impaired memory Indifference to surrounding, poor self care/hygiene Unco-operativeness, unsociability Insomnia

20 Neuroleptics: cont d Weight gain All Ages Diabetes/ metabolic syndrome Akathesia Sedation Dystonic reactions Older Adults Sudden death (Black Box Warning) EPS, Parkinsonism Cardiac dysrhythmias Anticholinergic effects Hyponatremia Seizures

21 Neuroleptics: Black Box Warning Increased risk of death when used in elderly patients treated for dementia-related psychosis

22 Psychotropics: Cognitive Enhancers Acetylcholinesterase inhibitors Donepezil, galantamine, rivastigmine Side effects: GI, vivid dreams (donepezil) Peripheral cholinergic side effects (cardiac) NMDA antagonist: Memantine GI side-effects, paradoxical agitation

23 Cognitive Enhancers (cont d) FDA approval Alzheimer s disease/dementia Beneficial in vascular dementia, dementia related to Parkinson s disease, and perhaps in some FTD Beneficial in neuropsychiatric symptoms of dementia!

24 Neuroleptics Common side effects: EPS (akathisia, dystonia, pseudoparkinsonism, dyskinesia), sedation, and orthostatic hypotension Long term use of drugs such as Haldol, Risperdal, Zyprexa increase risk of falls by 81%. Recommended to use the smallest possible dose for the shortest duration of action.

25 Drug Selection Appropriate and documented diagnosis associated with medication being prescribed. Document trials of behavioral management. Document assessment of medication s side effects. Document benefit of medication. Documentation of dose reduction trial. Explanation for continued medication.

26 Clinical Decision Making: Side-effect vs. Symptom Management What is the issue/behavior? What might be causing it or contributing to it? Is there a way to quantify or measure the degree of symptomatology (e.g., a screening instrument)? Is it an issue that can be completely or partially addressed without medication?

27 Clinical Decision Making: Side-effect vs. Symptom Management Non-drug symptom management Monitor personal comfort. Avoid being confrontational. Redirect the person's attention (use of art/ music). Create a calm environment. Allow adequate rest Provide a security object. Acknowledge requests, and respond to them. Look for reasons behind each behavior.. Explore various solutions. Don't take the behavior personally.

28 Clinical Decision Making: Sideeffect vs. Symptom Management Supplements used for dementia patients: Ginger Gingko biloba Omega 3 fatty acids Vitamin C Curcumin

29 Clinical Decision Making: Side-effect vs. Symptom Management So, a medication is needed Is there a current medication that can be adjusted to address the behavior? What are the individual s comorbidities and do they prevent the use of any medications? What are the most benign medications that can be used? Are there any side effect profiles that can be useful?

30 Clinical Decision Making: Side-effect vs. Symptom Management Once a medication has been selected: Monitor and document response of symptoms. Monitor and document screening for side effects (e.g., sodium, falls, AIMS). Periodically conduct trials of a decreased dose. Try tapering off the medication to determine if it s still needed.

31

Psychotropic Medication Use in Dementia

Psychotropic Medication Use in Dementia Psychotropic Medication Use in Dementia Marie A DeWitt, MD Diplomate of the American Board of Psychiatry and Neurology, Specialization in Psychiatry & Subspecialization in Geriatric Psychiatry Staff Physician,

More information

ALAMEDA COUNTY BEHAVIORAL HEALTH CARE SERVICES MEDICATION FORMULARY

ALAMEDA COUNTY BEHAVIORAL HEALTH CARE SERVICES MEDICATION FORMULARY ANTIDEPRESSANTS Serotonin Selective Reuptake Inhibitors citalopram 10, 20, 40 mg, 10 mg/5cc $ 0.40 No escitalopram 10, 20 mg $ 2.60 Yes fluoxetine 10, 20 mg, 20 mg/5 ml $ 0.40 Yes fluvoxamine 25, 50, 100

More information

Medications and Children Disorders

Medications and Children Disorders Mental Health Comprehensive Services Providing Family Stability and Developing Life Coping Skills Medications and Children Disorders Psychiatric medications can be an effective part of the treatment for

More information

Introduction to Drug Treatment

Introduction to Drug Treatment Introduction to Drug Treatment LPT Gondar Mental Health Group www.le.ac.uk Introduction to Psychiatric Drugs Drugs and Neurotransmitters 5 Classes of Psychotropic medications Mechanism of action Clinical

More information

Review of Psychotrophic Medications. (An approved North Carolina Division of Health Services Regulation Continuing Education Course)

Review of Psychotrophic Medications. (An approved North Carolina Division of Health Services Regulation Continuing Education Course) Review of Psychotrophic Medications (An approved North Carolina Division of Health Services Regulation Continuing Education Course) Common Psychiatric Disorders *Schizophrenia *Depression *Bipolar Disorder

More information

Guide to Psychiatric Medications for Children and Adolescents

Guide to Psychiatric Medications for Children and Adolescents Guide to Psychiatric Medications for Children and Adolescents by Glenn S. Hirsch, M.D. The following guide includes most of the medications used to treat child and adolescent mental disorders. It lists

More information

Medications for Anxiety & Behavior in Williams Syndrome. Disclosure of Potential Conflicts. None 9/22/2016. Evaluation

Medications for Anxiety & Behavior in Williams Syndrome. Disclosure of Potential Conflicts. None 9/22/2016. Evaluation Medications for Anxiety & Behavior in Williams Syndrome Christopher J. McDougle, M.D. Director, Lurie Center for Autism Professor of Psychiatry and Pediatrics Massachusetts General Hospital and MassGeneral

More information

Psychotropic Medications Archana Jhawar, PharmD, BCPP Clinical Faculty of UIC Pharmacy Practice Clinical Psychiatric Pharmacist Jesse Brown VA

Psychotropic Medications Archana Jhawar, PharmD, BCPP Clinical Faculty of UIC Pharmacy Practice Clinical Psychiatric Pharmacist Jesse Brown VA Psychotropic Medications Archana Jhawar, PharmD, BCPP Clinical Faculty of UIC Pharmacy Practice Clinical Psychiatric Pharmacist Jesse Brown VA Goals of Medications Use least number at lowest dose to get

More information

PSYCHIATRY DRUG ALERTS, VOLUME XXVIII, 2014 INDEX

PSYCHIATRY DRUG ALERTS, VOLUME XXVIII, 2014 INDEX A acamprosate ADHD Generic Methylphenidate Equivalence, 84 Methylphenidate in Pregnancy, 9 Stimulants in Pregnancy, 50 adverse effects Antidepressant-Induced Jitteriness, 94 Antidepressants and Sexual

More information

Overview and Update on Current Psychopharmacological Medications, Including New Medications in Clinical Trials

Overview and Update on Current Psychopharmacological Medications, Including New Medications in Clinical Trials SPEAKER NOTES Overview and Update on Current Psychopharmacological Medications, Including New Medications in Clinical Trials Summarized by Thomas T. Thomas New psychotropic medications are coming on the

More information

Antidepressants. Dr Malek Zihlif

Antidepressants. Dr Malek Zihlif Antidepressants The optimal use of antidepressant required a clear understanding of their mechanism of action, pharmacokinetics, potential drug interaction and the deferential diagnosis of psychiatric

More information

South London and the Maudsley NHS Foundation Trust Medicines Formulary

South London and the Maudsley NHS Foundation Trust Medicines Formulary South London and the Maudsley NHS Foundation Trust Medicines Formulary Medicine Formulations Restrictions Additional Information / Related NICE Technology Appraisal 4.1 Hypnotics and anxiolytics 4.1.1

More information

Behavioral Issues in Dementia. March 27, 2014 Dylan Wint, M.D.

Behavioral Issues in Dementia. March 27, 2014 Dylan Wint, M.D. Behavioral Issues in Dementia March 27, 2014 Dylan Wint, M.D. OVERVIEW Key points Depression Definitions and detection Treatment Psychosis Definitions and detection Treatment Agitation SOME KEY POINTS

More information

Appendix: Psychotropic Medication Reference Tables

Appendix: Psychotropic Medication Reference Tables Appendix: Psychotropic Medication Reference Tables How to Use these Tables These reference tables are designed to provide clinic staff with specific medication related criteria for the Polypharmacy, Cardiometabolic

More information

Objectives. Mental Health Info MEDICATION USE IN ASSISTED LIVING FACILITIES FOR MENTAL HEALTH ISSUES 11/12/2018

Objectives. Mental Health Info MEDICATION USE IN ASSISTED LIVING FACILITIES FOR MENTAL HEALTH ISSUES 11/12/2018 MEDICATION USE IN ASSISTED LIVING FACILITIES FOR MENTAL HEALTH ISSUES Holly Altenberger, PharmD, RPh Director of Pharmacy O Connell Pharmacy holly@oconnellpharmacy.com Objectives At the conclusion of the

More information

Psychopharmacology in the Emergency Room. Michael D. Jibson, M.D., Ph.D. Professor of Psychiatry University of Michigan

Psychopharmacology in the Emergency Room. Michael D. Jibson, M.D., Ph.D. Professor of Psychiatry University of Michigan Psychopharmacology in the Emergency Room Michael D. Jibson, M.D., Ph.D. Professor of Psychiatry University of Michigan Pretest 1. Which of the following conditions is LEAST likely to benefit from emergency

More information

Objectives. Antipsychotics 7/25/2016. LeadingAge Florida 53rd Annual Convention & Exposition

Objectives. Antipsychotics 7/25/2016. LeadingAge Florida 53rd Annual Convention & Exposition Reducing the Use of Antipsychotics in Long Term Care Communities Alan W. Obringer RPh, CPh, CGP Executive Director Senior Care Pharmacy Objectives Recognize the clinical evidence for the need to change

More information

NorthSTAR. Pharmacy Manual

NorthSTAR. Pharmacy Manual NorthSTAR Pharmacy Manual Revised October, 2008 Table of I. Introduction II. III. IV. Antidepressants New Generation Antipsychotic Medications Mood Stabilizers V. ADHD Medications VI. Anxiolytics and Sedative-Hypnotics

More information

Drugs, Sleep & Wakefulness. Brian Koo Reena Mehra MD MS Kingman Strohl MD

Drugs, Sleep & Wakefulness. Brian Koo Reena Mehra MD MS Kingman Strohl MD Drugs, Sleep & Wakefulness Brian Koo Reena Mehra MD MS Kingman Strohl MD Things To Keep In Mind Many drugs effect sleep either causing insomnia or sedation Disruption of sleep and wakefulness may not be

More information

A Brief Overview of Psychiatric Pharmacotherapy. Joel V. Oberstar, M.D. Chief Executive Officer

A Brief Overview of Psychiatric Pharmacotherapy. Joel V. Oberstar, M.D. Chief Executive Officer A Brief Overview of Psychiatric Pharmacotherapy Joel V. Oberstar, M.D. Chief Executive Officer Disclosures Some medications discussed are not approved by the FDA for use in the population discussed/described.

More information

Index. Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) b-adrenergic blockers

Index. Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) b-adrenergic blockers Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) a-adrenergic blockers for PTSD, 798 b-adrenergic blockers for PTSD, 798 Adrenergic

More information

Study Guidelines for Quiz #1

Study Guidelines for Quiz #1 Annex to Section J Page 1 Study Guidelines for Quiz #1 Theory and Principles of Psychopharmacology, Classifications and Neurotransmitters, Anxiolytics/Antianxiety/Minor Tranquilizers, Stimulants, Nursing

More information

Psychopharmacology in the Emergency Room. Michael D. Jibson, M.D., Ph.D. Associate Professor of Psychiatry University of Michigan

Psychopharmacology in the Emergency Room. Michael D. Jibson, M.D., Ph.D. Associate Professor of Psychiatry University of Michigan Psychopharmacology in the Emergency Room Michael D. Jibson, M.D., Ph.D. Associate Professor of Psychiatry University of Michigan Pretest 1. Appropriate target symptoms for emergency room medication treatment

More information

DEMENTIA AND MEDICATION

DEMENTIA AND MEDICATION DEMENTIA AND MEDICATION Dr. Siobhan Ni Bhriain, MRCP, MRCPsych. Clinical Director, Tallaght and SJH MHS, Consultant Old Age Psychiatrist, Chair, DSIDC Steering Committee. SUMMARY OF TODAY S TALK Dementia-definition,

More information

MO Medicaid Foster Care Drugs FY10-FY14

MO Medicaid Foster Care Drugs FY10-FY14 MO Medicaid Foster Care Drugs FY10-FY14 Medicaid (MO HealthNet) Cost of Drugs given to Missouri Foster Care Children by combinations of Age, Gender, Drug Class and Fiscal Year [Raw Data Provided by Missouri

More information

Schedule FDA & literature based indications

Schedule FDA & literature based indications Psychotropic Medication List Recommended dosages are intended to serve only as a guide for children. Recommended doses are literature based. Clinicians should consult package insert of medications for

More information

The use of prescription psychotropic medication in

The use of prescription psychotropic medication in DRUGS AND PHARMACOLOGY Effect of Age on the Profile of Psychotropic Users: Results from the 2010 National Ambulatory Medical Care Survey Donovan T. Maust, MD,* David W. Oslin, MD, and Steven C. Marcus,

More information

Treat mood, cognition, and behavioral disturbances associated with psychological disorders. Most are not used recreationally or abused

Treat mood, cognition, and behavioral disturbances associated with psychological disorders. Most are not used recreationally or abused Psychiatric Drugs Psychiatric Drugs Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally or abused Benzodiazepines

More information

Index. E Elderly and dementia, 2 Epilepsy, 59 Escitalopram, 51, 87 Estazolam, 101 Extrapyramidal symptoms (EPS), 18

Index. E Elderly and dementia, 2 Epilepsy, 59 Escitalopram, 51, 87 Estazolam, 101 Extrapyramidal symptoms (EPS), 18 A Abilify, 143 Absolute neutrophil count (ANC), 29 Acetylcholine (Ach), 14, 15 ACTivities of daily living and cognition (ACTION) study, 167 AD Anti-inflammatory Prevention Trial (ADAPT) study, 156 Adverse

More information

PSYCHIATRIC DRUGS. Mr. D.Raju, M.pharm, Lecturer

PSYCHIATRIC DRUGS. Mr. D.Raju, M.pharm, Lecturer PSYCHIATRIC DRUGS Mr. D.Raju, M.pharm, Lecturer PSYCHIATRIC DRUGS Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally

More information

Psychiatric Illness. In the medical arena psychiatry is a fairly recent field A challenging field Numerous diagnosis

Psychiatric Illness. In the medical arena psychiatry is a fairly recent field A challenging field Numerous diagnosis Psychiatric Illness In the medical arena psychiatry is a fairly recent field A challenging field Numerous diagnosis 12,000,000 children infants through 18 y/o nation wide 5,000,000 suffer severely Serious

More information

Antipsychotics for Dementia Under Control or Over-Prescribed?

Antipsychotics for Dementia Under Control or Over-Prescribed? Antipsychotics for Dementia Under Control or Over-Prescribed? Nathaniel Hedrick, PharmD ProCare HospiceCare, Manager of Clinical Services Learning Objectives Summarize the disease progression and most

More information

Antipsychotic Use in the Elderly

Antipsychotic Use in the Elderly Antipsychotic Use in the Elderly Presented by: Fatima M. Ali, PharmD, RPh, BCPS Clinical Consultant Pharmacist MediSystem Pharmacy, Kingston Originally Prepared by: Nicole Tisi BScPhm, RPh ACPR Disclosure

More information

Judges Reference Table for the March 2016 Psychotropic Medication Utilization Parameters for Foster Children

Judges Reference Table for the March 2016 Psychotropic Medication Utilization Parameters for Foster Children Judges Reference Table for the Psychotropic Medication Utilization Parameters for Foster Children Stimulants for treatment of ADHD Preschool (Ages 3-5 years) Child (Ages 6-12 years) Adolescent (Ages 13-17

More information

Cognitive enhancers PINCH ME. Anticholinergic burden BPSD. Agitation, Aggression and antipsychotics

Cognitive enhancers PINCH ME. Anticholinergic burden BPSD. Agitation, Aggression and antipsychotics Cognitive enhancers PINCH ME Anticholinergic burden BPSD Agitation, Aggression and antipsychotics 2 types Cholinesterase inhibitors licensed for mild to moderate AD Donepezil Galantamine Rivastigmine also

More information

2/12/2016. Drugs and Dementia in the Hospice Patient. Jim Joyner, Pharm.D., C.G.P. Director of Clinical Operations Outcome Resources

2/12/2016. Drugs and Dementia in the Hospice Patient. Jim Joyner, Pharm.D., C.G.P. Director of Clinical Operations Outcome Resources Drugs and Dementia in the Hospice Patient Jim Joyner, Pharm.D., C.G.P. Director of Clinical Operations Outcome Resources 1 Drug Therapy: Targeted at Symptoms Cognitive: Impaired abstract thinking Impaired

More information

Management of Behavioral Problems in Dementia

Management of Behavioral Problems in Dementia Management of Behavioral Problems in Dementia Ghulam M. Surti, MD Clinical Assistant Professor Department of Psychiatry and Human Behavior Warren Alpert Medical School of Brown University Definition of

More information

4/2/13 COMMON CLASSES OF MEDICATIONS. Child & Adolescent Behavioral Medicine & Medication Therapies. Behavioral Medicine & Medication Therapies

4/2/13 COMMON CLASSES OF MEDICATIONS. Child & Adolescent Behavioral Medicine & Medication Therapies. Behavioral Medicine & Medication Therapies Child & Adolescent Behavioral Medicine & Medication Therapies Brian J Cowles, PharmD Associate Professor of Pharmacy Practice Albany College of Pharmacy & Health Sciences; Vermont Campus Behavioral Medicine

More information

Retrospective Drug Use Review for the Use of Psychotropic Medications in Children

Retrospective Drug Use Review for the Use of Psychotropic Medications in Children Retrospective Drug Use Review for the Use of Psychotropic Medications in Children Recommendations Send providers an annual request for additional clinical data for children receiving any of the following

More information

CHILD & ADOLESCENT PSYCHIATRY ALERTS, VOLUME XIV, 2012 INDEX

CHILD & ADOLESCENT PSYCHIATRY ALERTS, VOLUME XIV, 2012 INDEX A Adderall Counterfeit, 31 addiction, internet CBT, 55 ADHD Adjunctive Guanfacine, 11 Counterfeit Adderall, 31 Developmental Trajectory and Risk Factors, 5 Dopamine Transporter Alterations, 14 Extended-Release

More information

Psychobiology Handout

Psychobiology Handout Nsg 85A / Psychiatric Page 1 of 7 Psychobiology Handout STRUCTURE AND FUNCTION OF THE BRAIN Psychiatric illness and the treatment of psychiatric illness alter brain functioning. Some examples of this are

More information

Policy Evaluation: Low Dose Quetiapine Safety Edit

Policy Evaluation: Low Dose Quetiapine Safety Edit Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University 500 Summer Street NE, E35, Salem, Oregon 97301 1079 Phone 503 947 5220 Fax 503

More information

Dementia Medications Acetylcholinesterase Inhibitors (AChEIs) and Glutamate (NMDA) Receptor Antagonist

Dementia Medications Acetylcholinesterase Inhibitors (AChEIs) and Glutamate (NMDA) Receptor Antagonist Dementia Medications Acetylcholinesterase Inhibitors (AChEIs) and Glutamate (NMDA) Receptor Antagonist Medication Dosage Indication for Use Aricept (donepezil) Exelon (rivastigmine) 5mg 23mg* ODT 5mg Solution

More information

Joint Formulary for Psychotropic Medication.

Joint Formulary for Psychotropic Medication. Joint for Psychotropic Medication. This document has been produced in collaboration with the Lancashire Commissioning Support Unit Page 1 Table of Contents Section Page Number Page 2 Definition of categories

More information

Prescriber s Guide. Stahl s Essential Psychopharmacology

Prescriber s Guide. Stahl s Essential Psychopharmacology Stahl s Essential Psychopharmacology Prescriber s Guide FIFTH EDITION With the range of psychotropic drugs expanding and the usages of existing medications diversifying, we are pleased to present this

More information

This document has been produced in collaboration with the Lancashire Commissioning Support Unit

This document has been produced in collaboration with the Lancashire Commissioning Support Unit Joint for Psychotropic Medication. This document has been produced in collaboration with the Lancashire Commissioning Support Unit Date: December 2014. Reviewed August 2016. Next review Date April 2019

More information

Affective or Mood Disorders. Dr. Alia Shatanawi March 12, 2018

Affective or Mood Disorders. Dr. Alia Shatanawi March 12, 2018 Affective or Mood Disorders Dr. Alia Shatanawi March 12, 2018 Affective or Mood Disorders Reactive Depression. Secondary: Medical Neurological Drugs Major (Endogenous) Depression = Unipolar: Depressed

More information

Psychiatric Medication Guide

Psychiatric Medication Guide Psychiatric Medication Guide F O R : N E O N P R I M A R Y H E A L T H C A R E P R O V I D E R S B Y : M I C H E L L E R O M E R O, D O M A Y, 2 0 1 3 Anti-depressants TCA s & MAOI s (Tricyclic Antidepressants

More information

DEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017.

DEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017. DEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017. Introduction. Parkinson's disease (PD) has been considered largely as a motor disorder. It has been increasingly recognized that

More information

Guidelines/Supporting Studies* FDA Label Information Additional Information/Commentsxc` Gene(s)/Level of evidence

Guidelines/Supporting Studies* FDA Label Information Additional Information/Commentsxc` Gene(s)/Level of evidence Drug Gene(s)/Level of evidence Guidelines/Supporting Studies* FDA Label Information Additional Information/Commentsxc` Haloperidol CYP2D6 ( SLC6A5 ( 2D6: DPWG guidelines Reduce dose by 50% in PMs Aripiprazole

More information

BIOLOGICAL TREATMENT IN PSYCHIATRY. PTE ÁOK Dept.of Psychiatry Pécs

BIOLOGICAL TREATMENT IN PSYCHIATRY. PTE ÁOK Dept.of Psychiatry Pécs BIOLOGICAL TREATMENT IN PSYCHIATRY PTE ÁOK Dept.of Psychiatry Pécs 1 SGA effects pharmacokinetic effect chemical strucrure Receptor block D2 5-HT2 α1 H-1 M Selectíve DA (D2D3) antagonists Benzamids Amisulpiride

More information

IMPORTANT NOTICE. Changes to dispensing of some Behavioral Health Medications for DC Healthcare Alliance members

IMPORTANT NOTICE. Changes to dispensing of some Behavioral Health Medications for DC Healthcare Alliance members IMPORTANT NOTICE Changes to dispensing of some Behavioral Health Medications for DC Healthcare Alliance members These changes apply only to members covered under the DC Healthcare Alliance program Alliance

More information

Mood Disorders.

Mood Disorders. Mood Disorders Shamim Nejad, MD Medical Director, Psycho-Oncology Services Swedish Cancer Institute Swedish Medical Center Seattle, Washington Shamim.Nejad@swedish.org Disclosures Neither I nor my spouse/partner

More information

2015 Update on Psychotropics

2015 Update on Psychotropics 2015 Update on Psychotropics Jeffrey T. Apter, M.D. August 2015 Princeton Medical Institute 256 Bunn Drive, Suite 6, Princeton NJ (609) 921-6050 Learning Objectives Upon completion of this session, participants

More information

Richard Heidenfelder M.D. Child, Adolescent and Adult Psychiatry 447 9th Ave San Diego, CA

Richard Heidenfelder M.D. Child, Adolescent and Adult Psychiatry 447 9th Ave San Diego, CA *We are not accepting any New Patients who are currently taking any controlled pain medications *We are *Note: not completion accepting of the any following New Patients paperwork who and Initial are Screening

More information

Pharmacological Treatment of Anxiety & Depressive Disorders

Pharmacological Treatment of Anxiety & Depressive Disorders Pharmacological Treatment of Anxiety & Depressive Disorders Dr Gary Jackson (MB BCh FRCPsych) Consultant Psychiatrist The Priory Hospital Chelmsford Wellesley Hospital Southend-on-Sea Medical Secretary:

More information

Any interventions, where RCTs in PD are not available, are not included in the tables.

Any interventions, where RCTs in PD are not available, are not included in the tables. Tables Interventions where new studies have been published are indicated in bold italics. Changes in conclusions are indicated in italics and are highlighted in yellow. Any interventions, where RCTs in

More information

Insomnia: Updates in Medical Management. Michael Newnam M.D.

Insomnia: Updates in Medical Management. Michael Newnam M.D. Insomnia: Updates in Medical Management Michael Newnam M.D. Sleep Neurobiology Delicate balance of excitatory and inhibitory neurotransmitters that control the switch between wakefulness and sleep Circadian

More information

BRIEF ANTIDEPRESSANT OVERVIEW. Casey Gallimore, Pharm.D., M.S.

BRIEF ANTIDEPRESSANT OVERVIEW. Casey Gallimore, Pharm.D., M.S. BRIEF ANTIDEPRESSANT OVERVIEW Casey Gallimore, Pharm.D., M.S. Antidepressant Medication Classes First Generation Tricyclic Antidepressants (TCAs) Monoamine Oxidase Inhibitors (MAOIs) Second Generation

More information

Chapter 161 Antipsychotics

Chapter 161 Antipsychotics Chapter 161 Antipsychotics Episode Overview Extrapyramidal syndromes are a common complication of antipsychotic medications. First line treatment is benztropine or diphenhydramine. Lorazepam is used in

More information

COMMONLY PRESCRIBED PSYCHOTROPIC MEDICATIONS NAME Generic (Trade) DOSAGE KEY CLINICAL INFORMATION Antidepressant Medications*

COMMONLY PRESCRIBED PSYCHOTROPIC MEDICATIONS NAME Generic (Trade) DOSAGE KEY CLINICAL INFORMATION Antidepressant Medications* COMMONLY PRESCRIBED PSYCHOTROPIC MEDICATIONS NAME Generic (Trade) DOSAGE KEY CLINICAL INFORMATION Antidepressant Medications* Bupropion (Wellbutrin) Start: IR-100 mg bid X 4d then to 100 mg tid; SR-150

More information

Depression in Late Life

Depression in Late Life Depression in Late Life Robert Madan MD FRCPC Geriatric Psychiatrist Key Learnings Robert Madan MD FRCPC Key Learnings By the end of the session, participants will be able to List the symptoms of depression

More information

Katee Kindler, PharmD, BCACP

Katee Kindler, PharmD, BCACP Speaker Introduction Katee Kindler, PharmD, BCACP Current Practice: Clinical Pharmacy Specialist Ambulatory Care, St. Vincent Indianapolis Assistant Professor of Pharmacy Practice, Manchester University,

More information

Anxiolytic, Sedative and Hypnotic Drugs. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia

Anxiolytic, Sedative and Hypnotic Drugs. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Anxiolytic, Sedative and Hypnotic Drugs Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Anxiolytics: reduce anxiety Sedatives: decrease activity, calming

More information

Medications, By Class, in TBI

Medications, By Class, in TBI Medications, By Class, in TBI Generic/Brand Name Drawback Advantage Mood Stabilizers (anti-seizure medications) Carbamazepine (Carbatrol ) (Equetro ) (Tegretol ) Gabapentin (Neurontin ) Lamotrigine (Lamictal

More information

How did we get here? 1876 Methylene Blue. Insecticide 1935 Du Pont Anthelmintic. Garrett McCann, RPh

How did we get here? 1876 Methylene Blue. Insecticide 1935 Du Pont Anthelmintic. Garrett McCann, RPh Polypharmacy, Adverse Effects, and the Importance of Tapering Medications for People with Intellectual and Developmental Disabilities Garrett McCann, RPh How did we get here? 1876 Methylene Blue Insecticide

More information

PSYCHIATRY INTAKE FORM

PSYCHIATRY INTAKE FORM Please complete all information on this form. PSYCHIATRY INTAKE FORM Name Date Date of Birth Primary Care Physician Current Therapist/Counselor What are the problem(s) for which you are seeking help? 1.

More information

BEHAVIORAL PROBLEMS IN DEMENTIA

BEHAVIORAL PROBLEMS IN DEMENTIA BEHAVIORAL PROBLEMS IN DEMENTIA CLINICAL FEATURES Particularly as dementia progresses, psychiatric symptoms may develop that resemble discrete mental disorders such as depression or mania The course and

More information

Treatment Options for Bipolar Disorder Contents

Treatment Options for Bipolar Disorder Contents Keeping Your Balance Treatment Options for Bipolar Disorder Contents Medication Treatment for Bipolar Disorder 2 Page Medication Record 5 Psychosocial Treatments for Bipolar Disorder 6 Module Summary 8

More information

Medicine Related Falls Risk Assessment Tool (MRFRAT)

Medicine Related Falls Risk Assessment Tool (MRFRAT) Medicine Related Falls Risk Assessment Tool (MRFRAT) The Medicine Related Falls Risk Assessment tool (MRFRAT) in Appendix 1 is designed to help identify patients at risk of falls due to their current medicine

More information

Psychiatric Medications. Positive and negative effects in the classroom

Psychiatric Medications. Positive and negative effects in the classroom Psychiatric Medications Positive and negative effects in the classroom Teaching the Medicated Child Beverly Bryant, M.D. Hattiesburg Clinic 9/17/14 Introduction According to the National Survey of Children

More information

Treating Anxiety Disorders. Adil Virani, BSc (Pharm), Pharm D, FCSHP

Treating Anxiety Disorders. Adil Virani, BSc (Pharm), Pharm D, FCSHP Treating Anxiety Disorders Adil Virani, BSc (Pharm), Pharm D, FCSHP Outline! Michelle s Case! Types of anxiety disorders! Goals of therapy! Treatment options and guidelines! Pharmacological options! Benzodiazepines

More information

10/5/2017. BEHAVIORAL and PSYCHOLOGICAL SYMPTOMS in DEMENTIA (BPSD) Dr. Shah MD, MPH Braodlawns Medical Center DISCLOSURE

10/5/2017. BEHAVIORAL and PSYCHOLOGICAL SYMPTOMS in DEMENTIA (BPSD) Dr. Shah MD, MPH Braodlawns Medical Center DISCLOSURE 1 BEHAVIORAL and PSYCHOLOGICAL SYMPTOMS in DEMENTIA (BPSD) Dr. Shah MD, MPH Braodlawns Medical Center DISCLOSURE 2 Dr. Shah has no relevant conflicts with commercial interests to disclose. OBJECTIVES 3

More information

Mental Illness. Doreen L. Rasp, APN, FNP, PMHNP Advanced Behavioral Counseling

Mental Illness. Doreen L. Rasp, APN, FNP, PMHNP Advanced Behavioral Counseling Mental Illness Doreen L. Rasp, APN, FNP, PMHNP Advanced Behavioral Counseling Moodiness Changing Bodies Narcissism Self-Esteem Ignorant Naïve Insecure Self-Centered Independent Adolescence Disorders Affecting

More information

med ed Copyright All rights reserved. No part of this publication can be reproduced without prior written consent of the authors.

med ed Copyright All rights reserved. No part of this publication can be reproduced without prior written consent of the authors. med ed Dr. Andrea Murphy, Assistant Professor, School of Nursing, Dalhousie University; Research Associate, Sun Life Financial Chair in Adolescent Mental Health Dr. David Gardner, Associate Professor,

More information

Anti-Depressant Medications

Anti-Depressant Medications Anti-Depressant Medications A Introduction: This topic may be a little bit underestimated here in Jordan, while in western countries it has more significance. The function of anti-depressants is to change

More information

Professor David Castle. Ms. Nga Tran. St. Vincent s Mental Health Level 2, 46 Nicholson Street, Fitzroy Vic 3065

Professor David Castle. Ms. Nga Tran. St. Vincent s Mental Health Level 2, 46 Nicholson Street, Fitzroy Vic 3065 ARABIIC Professor David Castle Ms. Nga Tran St. Vincent s Mental Health Level 2, 46 Nicholson Street, Fitzroy Vic 3065 (03) 9288 4147 (03) 9288 4751 Psychiatric Medication Information / Arabic 1 Psychiatric

More information

Dealing with a Mental Health Crisis

Dealing with a Mental Health Crisis Dealing with a Mental Health Crisis Information and Resources for First Responders P... PROFESSIONAL WHAT NAMI DOES NAMI Minnesota is a statewide 501(c)(3) grassroots nonprofit organization dedicated to

More information

ANTIPSYCHOTICS IN LONG TERM CARE: Are We Doing More Harm than Good?

ANTIPSYCHOTICS IN LONG TERM CARE: Are We Doing More Harm than Good? ANTIPSYCHOTICS IN LONG TERM CARE: Are We Doing More Harm than Good? STEPHANIE M. OZALAS, PHARMD, BCPS, BCGP VA MARYLAND HEALTH CARE SYSTEM BALTIMORE, MD DISCLOSURES Off-label use of medications will be

More information

Mentoring Session: Participant Cases

Mentoring Session: Participant Cases Handout for the Neuroscience Education Institute (NEI) online activity: Mentoring Session: Participant Cases The Case: 55-year-old patient with depression and anxiety The Question: What to do when antidepressants

More information

Updates in Geriatric Psychiatry

Updates in Geriatric Psychiatry Updates in Geriatric Psychiatry Feyza Marouf M.D. Assistant Psychiatrist, MGH Program Director, Partners Healthcare Geriatric Psychiatry Fellowship Disclosures I have no significant financial relationships

More information

Medicines Formulary BNF Section 4 Central Nervous System

Medicines Formulary BNF Section 4 Central Nervous System Medicines BNF Section 4 4.1 Hypnotics and anxiolytics Chloral Hydrate 500mg/5ml Solution Clomethiazole 192mg Capsules Lormetazepam Tablets Melatonin Capsules Nitrazepam Suspension Nitrazepam Tablets Temazepam

More information

Psychotropic Strategies Handout Package

Psychotropic Strategies Handout Package Psychotropic Strategies Handout Package Psychotropic Strategies Learning Objectives Utilize all clinical information available Assess the patient s overall condition this is essential Basic Principles

More information

Debra Brown, PharmD, FASCP Pharmaceutical Consultant II Specialist. HMS Training Webinar January 27, 2017

Debra Brown, PharmD, FASCP Pharmaceutical Consultant II Specialist. HMS Training Webinar January 27, 2017 Debra Brown, PharmD, FASCP Pharmaceutical Consultant II Specialist HMS Training Webinar January 27, 2017 1 Describe nationwide prevalence and types of elderly dementia + define BPSD Define psychotropic

More information

Pharmacological Treatments for Neuropsychiatric Symptoms in Dementia 3/22/2018

Pharmacological Treatments for Neuropsychiatric Symptoms in Dementia 3/22/2018 Pharmacological Treatments for Neuropsychiatric Symptoms in Dementia 3/22/2018 Mary Ellen Quiceno, MD, FAAN Associate Professor of Neurology UNTHSC Center for Geriatrics 855 Montgomery Street, PCC 4, Ft.

More information

Psychiatric and Behavioral Symptoms in Alzheimer s and Other Dementias. Aaron H. Kaufman, MD

Psychiatric and Behavioral Symptoms in Alzheimer s and Other Dementias. Aaron H. Kaufman, MD Psychiatric and Behavioral Symptoms in Alzheimer s and Other Dementias Aaron H. Kaufman, MD Psychiatric and Behavioral Symptoms in Alzheimer s and Other Dementias Aaron H. Kaufman, M.D. Health Sciences

More information

The Road to Rehabilitation

The Road to Rehabilitation The Road to Rehabilitation Part 6 Mapping the Way: Drug Therapy & Brain Injury Writ ten by Gregory O Shanick, MD Brain Injury Association of America Brain Injury Association of America Creating a better

More information

9/17/2015 DIAGNOSTIC PUZZLES LEARNING OBJECTIVES MENTAL ILLNESS MEDICAL COMORBIDITIES

9/17/2015 DIAGNOSTIC PUZZLES LEARNING OBJECTIVES MENTAL ILLNESS MEDICAL COMORBIDITIES DIAGNOSTIC PUZZLES MENTAL ILLNESS MEDICAL COMORBIDITES SUBSTANCE ABUSE SPECIAL POPULATIONS IMPROVING COMPLIANCE CASE STUDIES LEARNING OBJECTIVES Learner will be able to identify substance abuse and state

More information

Understanding Alzheimer s Disease

Understanding Alzheimer s Disease Understanding Alzheimer s Disease Alzheimer s disease is an irreversible, progressive brain disorder that slowly impacts memory, thinking, skills and, eventually, the ability to carry out the simplest

More information

A Basic Approach to Mood and Anxiety Disorders in the Elderly

A Basic Approach to Mood and Anxiety Disorders in the Elderly A Basic Approach to Mood and Anxiety Disorders in the Elderly November 1 2013 Sarah Colman MD FRCPC Clinical Fellow, Geriatric Psychiatry Mount Sinai Hospital, University of Toronto Disclosure No conflict

More information

HEDIS BEHAVIORAL HEALTH RESOURCE GUIDE

HEDIS BEHAVIORAL HEALTH RESOURCE GUIDE HEDIS BEHAVIORAL HEALTH RESOURCE GUIDE What is HEDIS? 3 HEDIS Reference Guide for Behavioral Health 4 Behavioral Health HEDIS Measures 13 WHAT IS HEDIS? HEDIS (Healthcare Effectiveness Data and Information

More information

USING ANTIPSYCHOTICS TO TREAT THE BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA (BPSD)- WHAT IS THE EVIDENCE?

USING ANTIPSYCHOTICS TO TREAT THE BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA (BPSD)- WHAT IS THE EVIDENCE? USING ANTIPSYCHOTICS TO TREAT THE BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA (BPSD)- WHAT IS THE EVIDENCE? Mugdha Thakur, MD Associate Professor of Psychiatry and Behavioral Sciences Duke University

More information

Disclosure. Objectives: Technician. Objectives: Pharmacist. Diagnostic and Statistical Manual (DSM-V) The Face of Mental Illness 7/25/2015

Disclosure. Objectives: Technician. Objectives: Pharmacist. Diagnostic and Statistical Manual (DSM-V) The Face of Mental Illness 7/25/2015 49th Annual Meeting Psychiatry for the Non-Psychiatry Specialist Jacintha Cauffield, PharmD, BCPS, CDE Associate Professor of Pharmacy Practice Lloyd L. Gregory School of Pharmacy Palm Beach Atlantic University

More information

Depression in Older Adults. Paul Boulware, MD Arizona Neurological Institute April 22, 2012

Depression in Older Adults. Paul Boulware, MD Arizona Neurological Institute April 22, 2012 Depression in Older Adults Paul Boulware, MD Arizona Neurological Institute April 22, 2012 What is it? Major depressive disorder is a syndrome, a collection of symptoms Presentation is variable among individuals

More information

Drug Name Class Examples Mechanism Uses Side Effects Notes Monoamine Oxidase Inhibitors (rarely used)

Drug Name Class Examples Mechanism Uses Side Effects Notes Monoamine Oxidase Inhibitors (rarely used) You have successfully downloaded the list from sharedlist.org You can find here first 1000 rows for free. We do this to prevent fraud and overload of our servers. If your list is more than 1000 rows and

More information

New Patient Questionnaire

New Patient Questionnaire 4 Embarcadero Center, Suite 1400, San Francisco, CA 94111 (415) 926-7774 phone; (415) 591-7760 office@sanfranciscopsych.com New Patient Questionnaire Thank you for trusting San Francisco Psychiatry with

More information

SAMPLE REPORT MENTAL HEALTH DNA INSIGHT LABORATORY INFO. Protected Health Information. SSRIs. TCAs. Other Antidepressants

SAMPLE REPORT MENTAL HEALTH DNA INSIGHT LABORATORY INFO. Protected Health Information. SSRIs. TCAs. Other Antidepressants Test Results Reviewed & Approved by: Laboratory Director, Nilesh Dharajiya,.D. ENTAL HEALTH DNA INSIGHT PERSONAL DETAILS DOB Jan 1, 19XX ETHNICITY Caucasian ORDERING HEALTHCARE PROFESSIONAL Glenn Braunstein.D.

More information

Anxiolytic & Hypnotic Drugs. Asst Prof Dr Inam S Arif

Anxiolytic & Hypnotic Drugs. Asst Prof Dr Inam S Arif Anxiolytic & Hypnotic Drugs Asst Prof Dr Inam S Arif isamalhaj@yahoo.com Anxiolytic & Hpnotic Agents Anxiety: unpleasant state of tension, apprehension or uneasiness, characterised by, tachycardia, sweating,

More information