Course Content
Making an Impact on Mental Health
In the United States, one out of every five individuals is afflicted with some form of mental illness. It is also known that about one out of every six from those affected, chronically consume psychotropic medications for their mental condition. Some of these are the very people that frequent the pharmacy and look up to the pharmacist for help and guidance. At times, they walk into the pharmacy feeling isolated and discouraged, wondering if they are supposed to be getting better when all they feel is worse.
How can we make the interaction between these psychiatric patients and the pharmacist more productive? As pharmacists, how can we be sure we are providing exactly what the patient needs? How do we further assess the patient’s needs and include other mental healthcare providers? By solidifying the pharmacist’s confidence through mental health education, we can accomplish this and much more.
The focus of this course is to provide some insight on the most prevalent mental illnesses and offer a guide to help pharmacists deliver mental health first aid to their patients. By recognizing mental illness, helping refer patients to the proper mental healthcare professional, monitoring for drug efficacy and providing mental health education, a pharmacist can make a significant impact on mental health in their community.
What is Mental Health?
Mental Health is the social, emotional, and psychological well-being of an individual. When there is mental health, an individual is aware of their own limitations. This person can function productively, is able to manage routine stresses in life and is capable of making contributions to their own communities. Enjoying mental health also includes having optimistic emotions and moods, being generally satisfied with life, and feeling fulfilled.
Having the ability to recover easily from a crisis is also indicative of desirable mental health. Everyone must go through their ups and downs in life but being able to manage difficult situations is required to demonstrate mental stability. The way a person perceives being in a negative situation is precisely suggestive of just how well they will be able to emerge from it. In today’s world, strong coping mechanisms are essential for mental well-being.
The absence of the ability to handle life’s difficulties, along with the inability to stabilize mood represents mental illness.
Mental Illness refers to the presence of a mental disorder or health condition which involves emotional, cognitive, or behavioral changes. Normally, these produce a disruption of social, occupational, or family activities. At times, the mental state can be so poor that it becomes quite debilitating, rendering the individual dysfunctional.
Although there are many forms of mental illnesses, there are a few that are more prevalent in society and primarily stand out. Some of these include depression, post-traumatic stress disorder, generalized anxiety, obsessive compulsive disorder, attention deficit hyperactivity disorder, eating disorders, schizophrenia, bipolar disorder, substance use disorder, and others.
For an individual, to have a pharmacist help them recognize the signs of mental distress and advise them to pursue professional assistance can be life altering. Sometimes patients do not realize that they can be on the path to better days if only they are willing to acknowledge the problem and seek help to resolve it.
Why is Mental Health Awareness Necessary?
Mental health awareness is the acknowledgment by all that – we care. That we care enough to demonstrate compassion and empathy to those suffering from mental illness; so much so, that we are willing to educate ourselves on the subject and become a partner in promoting and facilitating recovery and stability.
As it stands, it is evident that mental hardships can affect anyone of us at any given time. Knowing how to recognize a problem in others and recommend treatment is paramount to helping them maintain mental health. Learning techniques or behaviors that can be used to help prevent symptomatic escalation is also beneficial.
Everyone has a role to play, from the healthcare providers, nurses, doctors, pharmacists, psychotherapists to those surrounding the patient, family, friends, and caregivers.
Together we must stand as the infallible support the patient can always count on. Hence, Mental Health Awareness is needed to provide the knowledge base required to enable us to make a real difference in the life of a patient with mental illness.
National Alliance on Mental Illness (NAMI)
– is a global organization devoted to offering activism, education, and assistance along with public awareness of mental illness to improve the lives of those suffering from mental conditions. They have designated the month of May the Mental Health Awareness Month. Their current theme, ‘You are not Alone’, underscores their mission to do away with the stigma of mental illness and provide the support and help to those in need.
National Institute of Mental Health (NIMH)
– is the leading legacy devoted to research in mental health. It provides education in mental health subjects, statistics on studies conducted, fact sheets useful for community awareness, and information on mental services helping sites. This institution is under the National Institute of Health (NIH) which reports to the U.S. Department of Health and Human Services (HHS). Both organizations communicate an accurate, trustworthy mental health awareness message abundant in facts and supportive material. Each is also an excellent primary source for mental illness information and available treatments.
The Harm with Stereotyping and Ignoring Mental Illness
There has always been stigma surrounding mental illness. Some people have preconceived ideas that those suffering from a mental illness can be violent, abusive, or just a nuisance. This often leads to stereotyping and the impulse to completely ignore someone with mental illness by just walking away from them and pretending not to notice. Unfortunately, regardless of what stage a person with mental illness may find themselves, if allowed to progress without treatment, the symptoms can worsen, and the person can proceed to a more dangerous phase of the disease. As a result, an already pressing situation can turn into an urgent situation. Especially if the individual is considering some form of self-harm, including suicide.
Equally as concerning would be if the person becomes agitated and homicidal. This again, can result in harm to them, only now, the potential of hazard to those around them as well. For these reasons, it is crucial to be familiar with the signs and symptoms of mental illness and be aware of the existing options designed to address them.
Diagnostic and Statistical Manual of Mental Disorders(DSM-5®)
The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is considered the source of authority for the classification and diagnosis of mental illness. It was produced through the collaboration of hundreds of international experts in all facets of mental healthcare.
The DSM-5 is used by both researchers and clinicians to enhance diagnosis, therapy, and investigation of mental disease. It is meant to provide a concise and objective evaluation of mental symptomology in any setting from inpatient care to outpatient and/or private practice.
There are approximately 297 disorders discussed in the DSM-5 which is divided into three major parts: the diagnostic classification, diagnostic criteria set and its descriptive text. Each section providing extensive information about the mental diseases named. This being a clinician’s primary source for descriptive and diagnostic information on mental diseases, while excluding treatment plans.
Check your Knowledge Question and Scenario 1
Check your Knowledge Question and Scenario 1 – Answers
Question 1 |
Scenario 1 |
A global organization devoted to offering activism, education, and assistance along with public awareness of mental illness to improve the lives of those suffering from mental conditions.
A. National Alliance on Mental Illness (NAMI) B. National Institute of Psychological Disorders C. Centers for Mental Illness D. Mental Health Awareness
|
A 23-year-old college student is waiting for you to give him his flu shot in the private designated area. You walk in and he makes a joke about fear of needles. You approach him with the exposed needle ready to administer the shot. He jumps off the chair and begins hyperventilating. What do you think is happening?
A. The patient prefers standing when getting vaccines. B. He is having a panic attack due to a needle phobia. C. He saw a mouse on the floor. D. The student has asthma.
|
Explanation: NAMI founded in 1979, is the nation’s leading voice in mental health. Currently supports 600 local affiliates and 48 state organizations. |
Explanation: The student is experiencing a panic attack brought on by his fear of needles. The priority should shift to helping him calm down. |
Most Prevalent Mental Disorders
There are many forms of mental illnesses, some of which we will discuss in this course. The following mental conditions represent the most prevalent in society today. Some are suspected to be linked to genetic markers and others can just occur to anyone at any point in their lives, particularly if an individual experiences a serious trauma or loss.
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- Anxiety Disorder
- Attention-Deficit/Hyperactivity Disorder (ADHD)
- Bipolar Disorder
- Eating Disorders
- Major Depression
- Obsessive Compulsive Disorder (OCD)
- Post-Traumatic Stress Disorder (PTSD)
- Schizophrenia
- Substance Use Disorder (Substance Abuse)
- Suicidal Ideation
Anxiety Disorders
Feeling anxious is not uncommon. There are many different reasons why someone may be feeling some anxiety beginning with having to pass an important exam after graduation, getting married in the morning, or flying on an airplane. This transient sense of dread and worry is normally temporary and lasts until overcoming the impending event. For those with anxiety disorders, the uncomfortable feeling can last much longer, and they can have difficulty controlling it.
Some kinds of anxiety disorders include general anxiety disorder, specific phobias, separation anxiety disorder and panic disorder. All of which can be triggered spontaneously by outside causes or manifest without any specific triggers.
These anxiety disorders can be debilitating and cause notable changes at home, work, or school. Occasionally, a person can endure the symptoms without realizing something is probably wrong. Hence it is vital to be familiar with all the signs and symptoms to help address them.
Signs and Symptoms of Anxiety Disorders
This is a list of the most prevalent signs and symptoms of anxiety disorders. Those that suffer from anxiety disorders learn to avoid the things, places and situations that manifest their symptoms and can develop a phobia, further isolating themselves from society.
- Feeling tired easily
- Experiencing sleeping difficulties, either initiating or maintaining sleep
- Being on edge, restlessness
- Having difficulty managing worry
- Irritability
- Tense muscles
- Problems concentrating
A panic attack may cause:
- Difficulty catching breath
- Chest pain
- Sense of something horrible about to take place
- Rapid heart rate
- Heavy perspiration
- Quivering
Treatment Options for Anxiety Disorders
The main treatments options for anxiety disorders are psychotherapy, medication, or a combination of both. The course of treatment must be selected by the doctor and the patient. The best treatment plan is always initiated even though there may be a need to adjust later in either pharmacotherapy or psychotherapy as the care progresses.
Psychotherapy
One of the most popular methods of psychotherapy is Cognitive Behavioral Therapy (CBT). It directs people into alternative ways of thinking, behaving and even responding to anxiety triggering items and situations. CBT helps to teach practical social skills. Both CBT and exposure therapy along with relaxation techniques are often successfully used together.
Pharmacotherapy
Medication is commonly used primarily to subside the symptoms of anxiety disorders. The most widely used classes of drugs include beta-blockers, anxiolytics, and anti-depressants. These may be used together or in combination in a medication regimen.
Depending on severity of symptoms, the patient my benefit from just psychotherapy or medication therapy. At times, it best to initiate a treatment plan that involves both.
Attention-Deficit/Hyperactivity Disorder (ADHD)
This is one of the most prevalent childhood disorders. It has the possibility to remain through the adolescent years and even right through adulthood. It involves a lack of concentration, an inability to focus and maintain attention, along with behavior control issues and excessive hyperactivity.
A reduction or slowing down of development can occur due to disruptions in learning. Severe cases are associated with a decrease in function because of the inability to focus. Besides the hyperactivity and inattention, there can also be impulsivity. Acting before thinking can be very destructive and has the potential of causing significant harm.
Diagnosis of this disorder requires a complete assessment by a licensed clinician, psychologist, or psychiatrist, to determine if there are any other contributing factors before exploring the treatment options available.
Signs and Symptoms of (ADHD)
In ADHD, the main elements to note are the severity, the frequency, and the resulting reduction in function due to the observed signs and symptoms. Most of the behaviors can be viewed as normal but when they become more severe, occur often, and cause notable decreases in function with social, learning, and developmental skills, they are more problematic.
Signs Associated With ADHD
- Make careless mistakes because not paying full attention.
- Seem not to be listening if they are spoken to.
- Can be exceedingly distracted.
- Be easily forgetful about items, tasks, appointments.
- Be prone to misplace items needed for daily activities.
- Have problems with organization and time management.
- Display the inability to sit still.
- Speak incessantly.
- Avoid completing homework, reports, anything requiring intense focus.
- Impulsively interrupt the conversations or activities of others.
Treatment Options for (ADHD)
Currently there is no permanent remedy for ADHD. All treatment options are designed to alleviate the symptoms and improve function. Available treatments include psychotherapy, medication, and behavior training. A combination of therapies are also considered.
Psychotherapy
Behavior therapy is one of the modes of treatments used. It involves having the patient learn to modify their behavior. Patients receive practical support in completing assignments and getting through emotionally challenging times. They also learn to observe their own behavior and self-reward for managing their anger or taking the time to process before acting. Additional psychotherapies used include cognitive behavior therapy, family and marital therapy, parenting skills, stress management, among others.
Pharmacotherapy
Medications must always be tailored to the patient specifically whether it’s for a child or an adult. It always takes time to find what exact drug or dose works best. Optimal therapy can only be reached through trial and error. Certain drugs to consider are stimulants, antidepressants, and some hypertension medications. Further selections depend on involvement of any underlining conditions.
Check your Knowledge Question & Scenario 2
Question 2 |
Scenario 2 |
A manual by the American Psychiatric Association used for the assessment and diagnosis of mental disorders.
A. Mental Disorders from A to Z B. Mental Health Disorder Manual C. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) D. Mental illness Today
Next Slide for answers |
JR is a 62-year-old male whose wife claims he is experiencing severe sadness ever since their dog died three weeks ago. They used to be inseparable. He does not eat much; he won’t watch their favorite shows or take a walk like they used to. She asks for your advice as to what she can do to help him. What should you tell her?
A. “Don’t worry, he will get over it.” B. “The sadness Mr. JR is experiencing may be a form of depression, here are some numbers for mental health services.” C. “Buy a cat, it will last longer.” D. “Mr. JR must go on vacation and have fun.”
|
Check your Knowledge Question & Scenario 2 – Answers
Question 2 |
Scenario 2 |
A manual by the American Psychiatric Association used for the assessment and diagnosis of mental disorders.
A. Mental Disorders from A to Z B. Mental Health Disorder Manual C. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) D. Mental illness Today |
JR is a 62-year-old male whose wife claims he is experiencing severe sadness ever since their dog died three weeks ago. They used to be inseparable. He does not eat much; he won’t watch their favorite shows or take a walk like they used to. She asks for your advice as to what she can do to help him. What should you tell her?
A. “Don’t worry, he will get over it.” B. “The sadness Mr. JR is experiencing may be a form of depression, here are some numbers for mental health services.” C. “Buy a cat, it will last longer.” D. “Mr. JR must go on vacation and have fun.” |
Explanation: The DSM-5 is used for assessing symptoms and determining diagnosis. Because treatment should be tailored to specific patient, treatment options are not discussed. |
Explanation: Based on the symptoms, patient may benefit from either counseling or psychotherapy. Having handy the contact information for mental service providers in the area can save time and show efficiency. |
Bipolar Disorder (Manic-Depressive)
Rapid shifts in mood, focus and energy best describe bipolar disorder (formerly known as manic depression). There are notable changes in concentration which affects activity levels. The three categories are Bipolar I, Bipolar II, and Cyclothymic disorder. All three are characterized by manic episodes, depressive episodes, and hypomanic episodes. Symptoms can manifest anywhere from early childhood to mid or late thirties. There is no cure and requires lifetime management of the symptoms.
Signs and Symptoms
Treatment Options for Bipolar Disorder
The goal of therapy is to help the patient lead a healthy and active life. This is a lifetime illness that requires management of symptoms for the patient to thrive. Recommended treatment options involve the combination of both pharmacotherapy and psychotherapy. Bipolar individuals have a higher risk of thyroid disease, diabetes, cardiovascular disease, suffering from migraines and becoming obese.
Psychotherapy
Psychoeducation and Cognitive Behavior Therapy are some of the treatments used. These are designed to provide support, behavior training and counseling to patients and their families. Therapies also include interpersonal and social rhythm therapy (IPSRT) and family-focused therapy.
Treatment Options for Bipolar Disorder – cont.
Pharmacotherapy
Once again, experimenting with different drugs and doses to optimize therapy is paramount. It may take some time to stabilize the patient and place them on the proper maintenance therapy.
Additionally, patients can become tolerant to certain medications such as Lithium, resulting in the dose or the drug needing to be changed.
Both second-generation antipsychotics and mood stabilizers are included as first line treatment for bipolar disorder. A doctor may usually combine an antidepressant to a mood stabilizer to prevent a depressive episode while trying to avoid a manic episode.
Anxiolytics and sleeping aids may also be part of a treatment plan. Along with medications used to treat any other underlying mental condition the patient may also be suffering. The treatment goal remains to try to improve the patient’s quality of life by helping them lead healthy productive lives.
Note: All psychotropic medications to be reviewed in an upcoming table.
Eating Disorders
There are several common eating disorders which include anorexia nervosa, binge-eating, and bulimia nervosa. These mental illnesses have the potential to be chronic and eventually fatal. Of all mental illnesses, anorexia nervosa is associated with the highest mortality rate.
Whereas severely distorted thoughts or emotions can lead to drastic changes in people’s eating behaviors, public perception may mistakenly view it as just a lifestyle change. When actually this is a very serious disorder. Often, it starts with an unhealthy preoccupation with body shape, weight or food which can be a vital warning sign of these disorders.
Signs and Symptoms:
- Self-esteem primarily influenced by body shape, weight.
Distorted self-body image.
Preoccupation with low body weight (thinness).
Constantly checking the scale for weight.
Severe fear of weight gain.- Extreme body underweight.
- Self-restrictive eating.
Eating Disorders – cont.
Other Signs and Symptoms
These are potential indicators consistent with active disease. More like part of the possible physical consequences manifested due to these eating disorders. Some can be conspicuous but others, require further investigating through active counseling
- Patient may be anemic
- Experiencing muscle wasting or weakness
- Hair and nails may appear thin and brittle
- Skin may appear yellowish and dry
- A film of fine hair throughout the body (lanugo)
- Experiencing severe constipation
- Reduced blood pressure and pulse
- Decreased breathing
- Cardiovascular structural and functional damage
- Brain abnormalities along with multiorgan failure
- Reduction in bodily temperature
- Extreme fatigue, lethargy
- Unable to conceive (infertility)
Treatment Options for Eating Disorders
Although there is the potential for a recovery, it is best achieved when treatment is started in the beginning stages of the disease. As mentioned earlier, this is a serious illness with high risks of severe medical complications and a possibility of suicide.
As with other mental diseases, people with eating disorders can also be suffering from depression, anxiety or have issues with substance abuse.
The therapy usually includes family, group, or individual psychotherapy, along with medical care and observation if required. Nutritional counseling is a significant part of the plan to educate and retrain to establish healthier eating habits. Pharmacotherapy also plays a role in the effort to restore mental wellness to these patients.
Psychotherapy
Besides the individual, family and group therapy, the cognitive behavior therapy can also be used (CBT). Here CBT is useful in teaching a person to recognize inaccurate, distorted beliefs and helps them to work towards modifying these invalid mindsets.
Treatment Options for Eating Disorders – cont.
Pharmacotherapy
Treatment plans for eating disorder patients must be completely tailored for each individual. Because of the large number of symptomatic variables that can be present, the drugs considered for treatment are antipsychotics, antidepressants, mood stabilizers, and anxiolytics.
Other Information
Because of the high mortality rate and the importance for further research, the National Institute of Mental Health is constantly searching for volunteers to join their studies. They welcome both healthy and eating disorder patients to conduct their studies to design better treatment options. Clinical trials are organized all over the country. More information can be obtained from the National Institute of Mental Health’s webpage.
https://www.nimh.nih.gov/health/trials/index.shtml
Eating disorders can be expressed in teens or young adults but may also appear later in life. Both females as well as males are vulnerable to this disease. Although it can be found in females at a higher rate. Those affected can belong to any racial/ethnic group regardless of age or body weight. Contrary to public belief, there is no typical patient.
Major Depression
Depression can affect anyone and is considered to be a common mood illness. The symptoms are often severe and tend to alter the feelings, beliefs, and the way a person conducts themselves in their daily activities. It can disrupt the person’s family, work, sleeping, and even eating habits. A diagnosis of depression must follow the presence of symptoms for at least two weeks in a row.
Depressive episodes can also be linked to other medical conditions such as a diagnosis of cancer. Alternatively, it can be triggered by a medication taken for a different disease. Likewise, substance abuse is often associated with depression, either as a cause or effect.
There are several sub-categories of depression and are basically based on the reason for the development of the disease. These sub-classifications include:
Persistent Depressive Disorder (Dysthymia) –
in this form of depression, the mood of depression must last for two years to be under this category. There could be variations in severity including intervals of alternating low or high periods of depression.
Postpartum Depression – this type of depression involves a new mother that is experiencing severe feelings of sadness, fatigue and anxiety which prevent her from caring for herself or her baby. The symptoms lasting beyond the anticipated “baby blues” period some of the mother’s encounter.
Psychotic Depression – here a person with severe depression also has some type of psychosis. They have extreme feeling of sadness plus they hear voices or report hallucinations.
Seasonal affective disorder – is also referred to as winter depression. It is the cyclic return of sorrow on months when there is less sunlight. People often become socially withdrawn, tend to sleep more and put on pounds.
There are others such as depression associated with bipolar disorder. Depression is known to be part of the experience during episodes of extremely low moods. In the DSM-5, new additions under depressive disorders include disruptive mood dysregulation disorder and premenstrual dysphoric disorder (PMDD).
Depression can be chronic and require life-long treatment. Recognizing the signs and symptoms early can improve the prospects of achieving remission and ensuring a more stable future in a patient’s life.
Signs and Symptoms of Major Depression
The number of symptoms and the severity can vary depending on the individual. A diagnosis of depression requires the presence of low mood accompanied by some of the persistent symptoms listed below. The signs must be observed daily and should have been notable for at least two weeks.
Signs and Symptoms
- Continuous sorrow or anxiety
- Negativity or hopelessness
- Feeling insignificant or worthless
- Anger or irritability
- Guilt or helplessness
- Having low energy or being fatigued
- Restlessness or moving slower
- No interest in what use to be pleasurable activities/hobbies
- Changes in eating/weight
- Preoccupation with death or suicide
- Experiencing body aches without cause
Treatment Options for Major Depression
The treatment of depression includes the use of both psychotherapies and medication. The earlier the treatment is started the higher the chances of success. If therapy and drugs are not able to suppress the symptoms, then other treatment options exist. Electroconvulsive therapy (ECT) along with other brain stimulation treatments represent additional available options.
Psychotherapy
There are many types of psychotherapies available. Patients with depression may benefit from individual therapy, group therapy, family therapy or a combination of each. The key for success is the patient’s commitment to remain consistent not only to attend the session, but to practice what was learned at home. As with all forms of treatment, the family’s involvement is essential.
Pharmacotherapy
Antidepressants provide first line treatment for patients with depression. Depending on the progress, a mood stabilizer may be added to improve results. Anxiolytics are also used to manage existing anxiety and issues with being unable to relax. The selection of care is always very specific to the individuals needs and is based on symptom presentation and treatment goals.
Check your Knowledge Question & Scenario 3
Question 3 |
Scenario 3 |
All of the following are a known type of Depression, except:
A. Persistent Depressive Disorder (Dysthymia) B. Postpartum Depression C. Psychotic Depression D. Affection Deprived Depressive Disorder
Next slide for answers |
MJ is only 21 years old. She walks into the pharmacy with her mom. Mom says ever since MJ became of legal age to drink, she has been abusing alcohol. She drinks at any time of the day and finishes at least one bottle a day. She tells you she wants to stop but doesn’t feel like she can. What should you do?
A. Talk to MJ and only encourage her to quit. B. Tell her mother that the patient is old enough to make her own decisions. C. Ask the mother to wait six months, MJ may stop on her own. D. Give MJ information about Substance Abuse and the different provider options for treatment. |
Check your Knowledge Question & Scenario 3 – Answers
Signs and Symptoms
Question 3 |
Scenario 3 |
All of the following are a known type of Depression, except:
A. Persistent Depressive Disorder (Dysthymia) B. Postpartum Depression C. Psychotic Depression D. Affection Deprived Depressive Disorder
|
MJ is only 21 years old. She walks into the pharmacy with her mom. Mom says ever since MJ became of legal age to drink, she has been abusing alcohol. She drinks at any time of the day and finishes at least one bottle a day. She tells you she wants to stop but doesn’t feel like she can. What should you do?
A. Talk to MJ and only encourage her to quit. B. Tell her mother that the patient is old enough to make her own decisions. C. Ask the mother to wait six months, MJ may stop on her own. D. Give MJ information about Substance Abuse and the different provider options for treatment. |
Explanation: Affection deprived is not an official depressive disorder although being deprived of affection may very well make you feel depressed. |
Explanation: Since mother and daughter inquired together, speak directly to MJ and ask mom for a supportive role. Knowledge is power, so knowing what to do and where to go for help takes care of the first major step towards recovery. |
Obsessive Compulsive Disorder (OCD)
Those suffering from obsessive-compulsive disorder (OCD) tend to have uncontrolled, repetitive thoughts and actions. An example would be to continuously wash hands without cause until producing skin irritation. Often, these obsessive urges cause disruption in a person’s family, work and/or social life. These compulsions can also cause anxiety and become very debilitating.
Signs and Symptoms
Obsessions
- Requiring objects to remain symmetrical or perfectly ordered.
- Entertaining thoughts of aggression against themselves or others.
- Engaging in unwelcome thoughts of religion, sex, or harm.
- Excessively obsessing over microbes and/or contamination.
Compulsions
- Tendency for extreme cleaning/washing
- Repeatedly monitoring things over and over such as alarm on, gas off.
- Incessant counting
- No pleasure from performing rituals constantly.
- Unable to control excessive thoughts or actions.
Treatment Options for Obsessive Compulsive Disorder
As with other mental illnesses, the treatment options include psychotherapy, pharmacotherapy or a mixture of both. Most patient’s symptoms improve but for the most part, this is a chronic condition that requires maintenance therapy.
Psychotherapy
Assessing the patient for other common coexisting mental illnesses such as anxiety, depression or body dysmorphic disorder is a must before committing to a treatment plan. Generally cognitive behavior therapy (CBT) is recommended along with habit reversal training. Another effective option under CBT includes Exposure and Response Behavior (EX/RP). This treatment prevents a patient from responding to an exposure. For example, if the patient is asked to touch a dirty sock, but not allowed to wash their hands.
Other therapies
The FDA has approved the use of Transcranial Magnetic Stimulation (TMS) as an optional extra for OCD. As well as other brain stimulation therapies to be used in conjunction with psychotherapy and medication on patients not responding adequately to the standard therapies.
Treatment Options for Obsessive Compulsive Disorder cont.
Pharmacotherapy
The first line treatment for OCD includes selective serotonin reuptake inhibitors (SRI). They normally take about eight to twelve weeks to begin working. Generally, they are used at higher doses than for depression.
If symptoms persist after initial drug treatment of an SSRI, then an antipsychotic medication is considered as an adjunct. These do require weeks onboard before patient shows symptom improvement. Patients are monitored closely to reach optimal therapy and when making necessary changes, so that to slowly and carefully taper patients down old medications while at the same time tapering up new drugs.
A major component to take into consideration is the fact that both SSRIs and antipsychotics should not be discontinued abruptly. The potential of unwanted side effects exists with sudden termination of these classes of medications.
Post Traumatic Stress Disorder (PTSD)
The term post-traumatic stress disorder refers to a condition that is produced following a disturbing, frightening, or dangerous incident. It applies to the fear and anxiety a survivor of a traumatic event continues to experience well past the time of the episode. Some possible causes of PTSD are man-made or natural disasters, vehicle accidents, military combat, sudden loss of family or friend, personal assault, or assault of a loved one, among others. Symptoms usually appear after three months of the incident but may begin years later. In order to be diagnosed with PTSD, symptoms must be continuous for over one month and severely disrupt relationships or time at work.
Signs and Symptoms
For the diagnosis of PTSD to be determined, the patient must be suffering from at least one re-experiencing symptom, one avoidance symptom, two arousal and reactivity, two cognition and mood symptoms. The next slide best describes each type of symptom.
PTSD – Signs and Symptoms – cont.
Re-experiencing
- Reliving the incident both physically (palpitations, sweat), and mentally (flashbacks).
- Having nightmares about the event.
- Preoccupying with scary thoughts.
Avoidance
- Avoiding places, events, or items that are considered dark reminders of the painful experience.
- Precluding thoughts or feelings associated with the distressing incident.
Arousal and Reactivity
- Becoming easily stunned.
- Experiencing tension or uneasiness.
- Having difficulty controlling rage.
- Having the inability to initiate and maintain restful sleep.
PTSD – Signs and Symptoms – cont.
Cognition and Mood
- Difficulty recalling specific details of the traumatic incident.
- Pessimistic ideas about self or the world.
- Unfounded feeling of self-blame and guilt.
- Uninterested in activities that use to be pleasurable.
A diagnosis of PTSD is concluded if the presence of the symptoms interferes with an individual’s ability to socialize, have meaningful relationships and perform work duties.
Treatment Options for PTSD
As with other mental illnesses, treatment consists of psychotherapy, medications, or both. Again, specific tailoring to a patient’s needs is required for optimal treatment. Mainly because a therapy that is successful for one patient may not necessarily work for another patient. It is recommended for those seeking treatment to select a provider that is experienced with PTSD therapies.
If a person is experiencing PTSD due to a coexisting trauma such as engaging in an abusive relationship or having substance abuse difficulties, these issues must be addressed first. Additionally, if a patient also has panic disorder, depression or feels suicidal, therapy plans should include strategies to stabilize these conditions as well.
For the most part, all mental illnesses seem to have some overlap and share identical psychotherapies and medications. The uniqueness of an individual’s case is ultimately what determines the course of therapy.
Treatment Options for PTSD – cont.
Psychotherapy
Therapy usually involves one-on-one or group sessions. They can last anywhere from six to twelve weeks and maybe even longer. The help and support of family and friends is always encouraged and remains ideal for recovery.
The goal of treatment is to teach the patient about the symptoms and the possible triggers. Equally as important, is to help them cope with these symptoms. One of the most effective therapies is cognitive behavior therapy or CBT. The two specific techniques below are used most frequently.
Exposure therapy –
this tool is used to help people confront and manage their fears. It is the safe and gradual exposure to the trauma experienced through either revisiting the place, looking at imagery, or writing about it.
Cognitive restructuring –
this allows people to reexamine their memories to make better sense of what happened. Providing a more realistic view, in order for the person to stop blaming themselves, feeling guilty or shameful.
Treatment Options for PTSD – cont.
Pharmacotherapy
The most common medication used for PTSD are antidepressants. The symptoms antidepressants target are feelings of sadness, worry, and irritability. There are other drugs used during the treatment of PTSD like medications to help sleep, and anxiolytics to help with anxiety or edginess. Adjunct therapy is used only as needed and only after checking for compatibility with the antidepressant.
Monitoring through the titration process of medications and being aware that for the most part, antidepressants take weeks to reach a therapeutic level is essential for reaching therapy goals.
Recommended Self-help
- Reduce stress by exercising.
- Establish reasonable self-goals for improvement.
- Discuss with family and friends what may trigger symptoms.
- Anticipate symptoms to slowly get better.
- Try to find reassuring people and places.
Check your Knowledge Question & Scenario 4
Question 4 |
Scenario 4 |
A person that obsesses over cleanliness and considers everything around them contaminated, based on known signs and symptoms, is said to be:
A. Suffering from post-traumatic stress disorder (PTSD). B. Experiencing symptoms of obsessive-compulsive disorder (OCD). C. Afflicted with a memory problem. D. Engaged in substance abuse. Next slide for answers |
JJ is a 27-year-old delivery service driver that brings the daily morning drug shipment. He has bruises on his face. You ask him if he is ok. He tears up and confides in you about the fist fight he had yesterday at a bar. He shares that he has a difficult time controlling his temper and keeps remembering the details of the armed robbery he suffered through last year. What can you offer him besides comfort?
A. Tell him that he may be suffering from PTSD and offer information about providers in the area. B. Warn him to control his anger or he may end up in jail. C. Ignore his comments because you are busy. D. Advise him to be happy, today is a better day. |
Check your Knowledge Question and Scenario 4 – Answers
Question 4 |
Scenario 4 |
A person that obsesses over cleanliness and considers everything around them contaminated, based on known signs and symptoms, is said to be:
A. Suffering from post-traumatic stress disorder (PTSD). B. Experiencing symptoms of obsessive-compulsive disorder (OCD). C. Afflicted with a memory problem. D. Engaged in substance abuse. |
JJ is a 27-year-old delivery service driver that brings the daily morning drug shipment. He has bruises on his face. You ask him if he is ok. He tears up and confides in you about the fist fight he had yesterday at a bar. He shares that he has a difficult time controlling his temper and keeps remembering the details of the armed robbery he suffered through last year. What can you offer him besides comfort?
A. Tell him that he may be suffering from PTSD and offer information about providers in the area. B. Warn him to control his anger or he may end up in jail. C. Ignore his comments because you are busy. D. Advise him to be happy, today is a better day. |
Explanation: Obsession with cleanliness is a classic OCD symptom that is consistent with excessive hand washing. |
Explanation: Since JJ had a traumatic experience, he may be suffering from Post-Traumatic Stress Disorder. He would probably benefit from referral to a therapist. |
Schizophrenia
One of the most serious mental illnesses is Schizophrenia. This mental disease affects a person’s thoughts, emotions, and actions. It can often be severe and quite debilitating. This condition causes a person to lose perception of reality. It can create substantial stress for the patient, family, friends, and everyone around them.
Treatment given in a timely, consistent way can be effective. Allowing people with schizophrenia to become independent, have personal relationships, and enjoy school or work.
Signs and Symptoms
Signs of schizophrenia usually occur between the late teen years to the early thirties. Symptoms usually appear earlier in males from late adolescence to early twenties while females may experience their first symptoms in their early twenties to early thirties. The diagnosis often follows the first psychosis episode although there could have been precursor gradual shifts in thought, mood, and social behavior. Younger children can be affected, but this is uncommon.
Schizophrenia Signs and Symptoms – cont.
The symptoms are classified under three more basic categories. They are psychotic symptoms, negative symptoms, and cognitive symptoms. Below is a more complete description of each.
Psychotic symptoms –
a detached view of the world, outside of reality. Patients normally lose perception of senses (visual, hearing, taste, smell, and touch). They may have abnormal thoughts followed by unusual actions. Suffer from hallucinations by hearing voices or report seeing things which are not really there. Delusions may also be present. A person may be paranoid and believe they are being followed. Along with incoherent or disorganized speech, demonstrating thought disorder.
Negative symptoms –
refers to the loss or reduction of stamina or interest in daily activities. Becoming socially withdrawn, and having a difficult time displaying inner feeling. Also, the inability to function normally. Unable to make plans, starting or continuing activities. Really not being able to get enjoyment from anything in life. They often display a ‘flat affect’, or no facial expression and have a diminished urge to speak.
Schizophrenia Signs and Symptoms – cont.
Cognitive symptoms –
this involves issues with focus, attention, and recollection. Some patients are not able to participate in simple activities, engage in a conversation or learn different things. Scheduling and remembering appointments are also a problem. They experience trouble managing the necessary information to make decisions. They are unable to retain learned information to use immediately after. Concentrating and maintaining attention is also problematic.
Treatment Options for Schizophrenia
Psychotherapy
For schizophrenia, the therapies choices are plentiful. Cognitive behavioral therapy (CBT) is the most common, as well as behavioral skills training. Typically, with supported employment and cognitive remediation interventions, the adverse and cognitive signs of schizophrenia can be addressed. Permitting an individual to be more functional and partake further in regular activities.
Psychosocial treatments are useful for individuals with schizophrenia to assist them in learning solid skills to improve management of everyday life. Regular participation, in psychosocial therapy will reduce the probability of decline or hospitalization. It can help them attain their life aspirations like going to college, being able to work and creating and maintaining personal relationships, offering a positive improvement in the patient’s quality of life.
Family education and support is essential in these situations. Depending on the available daily access to the patient, an individual suffering from schizophrenia would greatly benefit from consistent assistance or supervision from a family member or friend.
Treatment Options for Schizophrenia – cont.
Pharmacotherapy
The medications used to decrease the severity and the number of psychotic symptoms are the antipsychotic medications. Daily doses include oral pills, liquids and monthly or bimonthly injections. Clozapine is a drug used for illness resistant to conventional treatment. It does require regular blood tests to identify the presence of a possibly dangerous, but rare side effect. All psychotropic medications will be discussed on an upcoming slide.
There are several side effects associated with standard treatment of schizophrenia. The negative side effects include gaining weight, having dry mouth, feeling restless, or experiencing drowsiness. When these side effects persist, a patient may be tempted to discontinue the medication to great detriment. The reaction resulting from coming off the antipsychotic medication can be severe and may send the patient back to the hospital. These drugs are not meant to be discontinued abruptly. Patients should always consult their physician if they are experiencing an issue with their medication.
Often, a combination of these treatments along with psychotherapy provide an excellent initial treatment plan which can be later fine-tuned to help meet the patient’s specific needs, since schizophrenia is a chronic illness.
Substance Use Disorder
When an individual is unable to manage their use of substances whether legal or illegal, they are said to have substance use disorder (SUD). The substances often involve either alcohol or drugs, or a combination of both. When the signs of abuse are moderate to severe, then the patient has an addiction.
Studies find that approximately 50% of people with substance use disorder (SUD) also suffer from another coexisting mental illness. The most common ones are depression, bipolar disorder, personality disorder, attention-deficit hyperactivity disorder, anxiety disorder, and schizophrenia. They do not seem to have a cause-and-effect relationship. It is not believed that one, the abuse or the mental illness, came as a result of the other and vice versa.
Those with SUD may have some contributing factors. Family members with the same affliction, that suggests a genetic component may be responsible. Stress and trauma are environmental factors that can be present and can also impact the risks of SUD.
Treatment Options for Substance Abuse
Psychotherapy
The options for psychotherapy are ample. Clinicians can opt to select psychotherapy alone for the treatment plan or augment the strategy by using a psychotropic drug. Listed below are five of the most popular methods employed for SUD.
- Cognitive Behavior Therapy (CBT) –
talking to the patient to assist in managing tough situations by having them examine any perceived illogical thoughts and moving them towards shifting their unfavorable behavior.
- Dialectical Behavior Therapy (DBT) –
uses the idea of being mindful and self-accept in order to control or change thoughts of self-harm (suicide, urges or substance use). Patients learn skills to enable them to manage their emotions and helps them decrease self-destructive behavior.
- Assertive Community Treatment (ACT) –
is a multidisciplinary team approach that is person-centered which underscores outreach to the community. It is proven to decrease hospitalizations and improving housing stability.
Treatment Options for Substance Abuse – cont.
- Therapeutic Communities (TC) –
a long-term, inpatient treatment that concentrates on assisting individuals in developing different, more healthier ideals, thoughts, and habits.
- Contingency Management (CM) –
is a type of incentive system for healthy behaviors. It uses vouchers or other rewards to encourage better habits.
Pharmacotherapy
Treatment consists of specific medications targeting nicotine, alcohol, or opioid abuse. For SUD with concomitant mental disease, drugs that can reduce the symptoms associated with those disorders should be included in treatment plan. If depression or anxiety is present, then antidepressants and anxiolytics should be in the drug regimen.
It is important to address the symptoms of all the mental illnesses of a patient at once. For example, if a person that suffers from depression and drinks too much, going to a local AA meeting is not expected to improve the depression. A complete evaluation of all symptoms would reveal any underlining conditions that can be treated concurrently to better improve the patient’s quality of life.
Check your Knowledge Question and Scenario 5
Question 5 |
Scenario 5 |
There are many forms of psychotherapy. One of the most commonly used therapies helps an individual to shift cognitive distortions by training them to change their thoughts, beliefs, or behaviors. Which one of the following best applies to this definition?
A. Mental Behavior Therapy B. Mental Change Challenge Therapy C. Cognitive Behavior Therapy D. Classic Behavior Shift Therapy Next slide for answers |
JR is a 35 years old. He came from Iraq 3 years ago as a refugee. His parents had to stay behind. Every time you see him, he always looks down. He seems to have lost 10-15 lbs. since you first saw him. You ask him how he is feeling. He tells you he is sad and misses his parents. What would be the best course of action?
A. Tell JR everything will get better soon. B. Advise JR to go visit his parents. C. Invite JR to a social event. D. Explain to JR there are people he can talk to if he is feeling sad. Give him information about the signs of depression and refer him to a provider. |
Check your Knowledge Question and Scenario 5 – Answers
Question 5 |
Scenario 5 |
There are many forms of psychotherapy. One of the most commonly used therapies helps an individual to shift cognitive distortions by training them to change their thoughts, beliefs, or behaviors. Which one of the following best applies to this definition?
A. Mental Behavior Therapy B. Mental Change Challenge Therapy C. Cognitive Behavior Therapy D. Classic Behavior Shift Therapy |
JR is a 35 years old male. He came from Iraq 3 years ago as a refugee. His parents had to stay behind. Every time you see him, he always looks down. He seems to have lost 10-15 lbs. since you first saw him. You ask him how he is feeling. He tells you he is sad and misses his parents. What would be the best course of action?
A. Tell JR everything will get better soon. B. Advise JR to go visit his parents. C. Invite JR to a social event. D. Explain to JR there are people he can talk to if he is feeling sad. Give him information about the signs of Depression and refer him to a provider. |
Explanation: Cognitive Behavior Therapy is one of the most popular forms of psychotherapy and it is used for several mental illnesses. |
Explanation: JR says he is sad and seems to have lost weight (loss of appetite). These are some signs of depression. He should be evaluated by a psychotherapist for treatment. |
Suicidal Ideation
The act of suicide is defined as dying due to having taken intentional actions or steps to cause own death. While suicidal ideation refers to the contemplating and planning of suicide. Suicide may also be attempted unsuccessfully; some individuals have survived multiple attempts.
According to the Centers for Disease Control and Prevention (CDC), suicide is one of the top ten leading causes of death in the United States. In their 2019 Leading Causes of Death Report, they identified 48,000 plus people as having taken their own lives. Suicide came in as second leading cause of death in the ten to thirty-four group and fourth leading cause of death in the thirty-five to fifty-four age group. In their report, suicides accounted for more than twice as many homicides for the same time period.
In the statistical survey results of the CDC, the most prominent method of suicide was by firearm (50.5%), followed by suffocation (28.6%), then poisoning (12.9%), with other methods making up the remaining (7.9%). Trends show that suicide rates have been gradually increasing, by 24% from 1999 to 2014, and that males continue to have higher incidents of suicide above their female counterparts.
Signs and Symptoms of Suicidal Ideation
There are both specific and non-specific indicators that someone may be thinking about suicide. In order to eliminate doubt, the best thing to do is ask. This can be a very difficult thing to do but, if you do not ask the person to discuss it, they may never initiate the conversation with anyone.
Specific Signs
- Expressing desire to die or harming themselves.
- Speaking about helplessness, hopelessness, or no purpose for living.
- Actively planning for ways to kill themselves, obtaining pills, purchasing a weapon.
- Feeling trapped with no way out.
- Worried about being a problem to others.
- Engaging in risks that can result in death such as speeding in a car.
- Having thoughts of death or speaking about death frequently.
- Retreating from friends and family.
- Gifting cherished, valuable possessions.
- Bidding farewell to family and friends.
- Making a will and arranging legal affairs.
Signs and Symptoms of Suicidal Ideation – cont.
Non-Specific Signs
- Expressing shame or guilt
- Suffering from intolerable physical or emotional pain
- Increasing alcohol or drug use
- Displaying anxiety or agitation
- Shifting sleeping or eating habits
- Displaying anger and planning vengeance
- Experiencing extreme mood changes from very glad to very sad, vice versa
The act of suicide can be associated with a person of any gender, race, or age. Suicide is a complicated phenomenon with no distinctive means for causation. The reason someone attempts suicide may be linked to various factors. Fortunately, those that are most at risk do tend to display particular signs and symptoms that if detected, can help identify them and secure a better chance of them getting the proper support. Suicidal ideation is also connected to other metal disorders such as depression or substance abuse disorder. It can also be related to chronic medical conditions, like chronic pain, or terminal physical illnesses, as in cancer. Sometimes it can follow a traumatic event, like an assault, accident or natural disaster. There are five specific actions that can be taken if someone is perceived to be suicidal.
Actions to Take if you or Someone you Know has Suicidal Thoughts
Suicidal ideation can happen to anyone for many reasons or for no apparent reason at all. It is important to be familiar with all the signs and symptoms to be able to help somebody in need. Once you realize you are in the presence of someone that seems suicidal, the five measures below are recommended to be completed in that order.
Steps to Take to Help
- Ask –asking is important because it opens the door for further conversation. The question should be clear, “Are you thinking about suicide?”.
- Be there –Follow the question by displaying undivided attention to what ever the individual wants to share about their emotional pain and reasons for wanting to do it.
- Keep them safe –assess if there is immediate danger. Ask the individual if they have a suicide plan. Inquire about access to the method for suicide, like a gun or pills. Find out if they have attempted suicide in the past. Removing them from place and means of suicide is a significant step towards suicide prevention.
Actions to Take if you or Someone you Know has Suicidal Thoughts – cont.
- Help them connect –have the National Suicide Prevention Lifeline’s phone number (800-273-TALK (8255)) and the Crisis Text Line’s number (741741) available if needed. Help the person get in touch with someone in their family or a close friend. Ask if you can contact their spiritual advisor or their therapist if they are seeing one.
- Stay connected –follow up with the person periodically to see how they are doing. Research shows that the risk of suicide reduces when a person is constantly shown care and attention. Evaluate their current status; are they feeling better? Did they stop thinking about suicide? Are they attending regular support activities?
A good way to assist individuals recovering from suicidal ideation is to help them create a safety plan they are comfortable with. It can be written on a colorful board or card and contain the exact steps a person can follow if they are feeling down or suicidal. Starting with the ways they can recognize they are experiencing severe thoughts of suicide and exactly what to do for prevention. The number to the lifeline, or any other person they wish to contact during moments of crisis should also be included.
Most Frequently Used Psychotropic Medications
Classes of Drugs |
Examples of Drugs |
Generally Used for |
Anti-anxiety |
Alprazolam (Xanax) Clonazepam (Klonopin) Diazepam (Valium) Lorazepam (Ativan) |
Anxiety Disorders, Depression with anxiety, Sleep disorders, Panic attacks, Stress |
Antidepressants -Selective serotonin reuptake inhibitors (SSRI)
-Serotonin-norepinephrine reuptake inhibitor (SNRI) |
Paroxetine (Paxil) Sertraline (Zoloft) Citalopram (Celexa) Escitalopram (Lexapro) Fluvoxamine (Luvox)
Duloxetine (Cymbalta) Atomoxetine (Strattera) Venlafaxine (Effexor XR) Desvenlafaxine (Pristiq) |
Major depression, Bipolar disorder, Obsessive compulsive disorder, Eating disorder, Post-traumatic stress disorder (PTSD)
|
Tricyclic antidepressants – (reserved for newer drug resistant mental disease) |
Desipramine (Norpramin) Imipramine (Tofranil) Amitriptyline Nortriptyline (Pamelor) Protriptyline (Vivactil) |
Depression, Panic disorder and (off label use -sleep) |
Most Frequently Used Psychotropic Medications– cont.
Classes of Drugs |
Examples of Drugs |
Generally Used for |
Other antidepressants
|
Bupropoin (Wellbutrin), Mirtazapine (Remeron), Trazodone (Desyrel), Vilazodone (Viibryd), Vortioxetine (Trintellix) |
Depression
|
Mood Stabilizers |
Carbamazepine (Carbatrol, Tegretol, Tegretol XR) Divalproex (Depakote) Lamotrigine (Lamictal) Lithium (Eskalith, Eskalish CR, Lithobid) |
Bipolar Disorder, Depression
|
Stimulants |
Amphetamine (Adderall, Adderall XR) Dexmethylphenidate (Focalin, Focalin XR) Dextroamphetamine (Dexedrine) Lisdexamfetamine (Vyvanse) Methylphenidate (Ritalin, Metadate ER, Methylin, Concerta) |
Attention Deficit Hyperactivity Disorder (ADHD) |
Most Frequently Used Psychotropic Medications– cont.
Classes of Drugs |
Examples of Drugs |
General Used for |
Antipsychotics -Typical -Atypical |
Chlorpromazine (Thorazine) Fluphenazine (Prolixin) Haloperidol (Haldol) Perphenazine (Trilafon) Thioridazine (Mellaril) Aripiprazole (Abilify) Clozapine (Clozaril) Iloperidone (Fanapt) Olanzapine (Zyprexa) Paliperidone (Invega) Quetiapine (Seroquel) Risperidone (Risperdal) Ziprasidone (Geodon) |
Schizophrenia Bipolar Disorder, Depression, Schizophrenia |
Drugs Commonly Used in Substance Abuse Treatment
Treatment plans for those with substance use disorder includes drugs that treat depression, anxiety, sleeplessness, and other symptoms. The drugs listed below can be used to manage the actual substance dependence.
Drugs used for management of substance dependence |
•Naltrexone (Vivitrol) •Buprenorphine (Probuphine, Suboxone) •Disulfiram (Antabuse) •Acamprosate (Campral) •Modafinil (Provigil) •Mirtazapine (Remeron) •Bupropion (Wellbutrin, Zyban) •Gabapentin (Neurontin) •Vigabatrin (Sabril) •Baclofen (Lioresal) •Topiramate (Topamax) |
General Warning Signs of Declining Mental Health
As pharmacists, we tend to be more accessible and interact more with our patients than any other healthcare provider. It is important to recognize the general signs of mental strain early, to be able to make timely recommendations to our patients so that they may start on the road to recovery. Below are the most common warnings that indicate a person could be headed into a decline in mental health.
Signs of Poor Mental Health
- Looking depressed or withdrawn
- Gaining or losing substantial weight
- Engaging in risky behavior
- Experiencing extreme mood shifts
- Drinking alcohol, smoking, or using drugs excessively
- Expressing tremendous fear without obvious reason
General Warning Signs of Declining Mental Health – Cont.
- Having problems focusing
- Worrying or stressing excessively
- Changes in behavior, character, or sleeping patterns
- Complaining of multiple ailments without apparent causes
- Unwilling to carry out regular activities
- Avoids family and friends, social activities
These signs can either be observed or can be learned when having a conversation with the patient. Knowing what to do next is the focus of the next upcoming slides. Training for preparing pharmacists to help in these situations is available and can be lifesaving.
Identify Those with Mental Illness Using Action Plans and Other Tools
As a part of the multidisciplinary health care team, a pharmacist has earned the distinction along with the responsibility to care for those with mental illness. It is not just a matter of dispensing medications, counseling the patients, and hoping everything will be alright. Being a part of the frontline health care group affords the pharmacist the opportunity to participate in the long-term monitoring of those afflicted with mental illness. Since evidence-based studies dictate that approaching challenges with action plans improve the probability of success for any attempted strategy, it is essential to formulate plans to help us better manage our meetings with mental health patients. Besides improving success, following a set of predetermined actions will also help us to expedite the encounter.
It is important to realize that taking the time to go over a few points in your exchange with your patient can significantly increase their chances to improve their situation and possibly save their life. Specific action plan designed to render mental health first aid to someone that seems to be experiencing mental illness is to be discussed later.
What is Mental Health First Aid?
Mental Health First Aid is an education program supported by the National Council for Community Behavioral Healthcare to help identify, understand, and respond to people who are showing signs and symptoms of declining mental health or substance abuse. It is recommended for pharmacists by the American Pharmacists Association (APhA) and the National Community Pharmacists Association (NCPA).
The educational certification program provides a more in-depth view of mental illnesses and substance abuse disorders in the United States. It highlights risk factors and alerting signals related to mental health illnesses, reviews standard treatment plans and creates confidence through education and understanding.
To be certified as a Mental Health First Aider, course participants are taught a 5-step action plan which outlines resources, expertise and abilities needed to help those in a mental health crisis. It includes training on how to help the patient connect with the appropriate mental health care provider, other social health care groups and deliver self-help care.
What is the Role of the Pharmacist in Mental Health First Aid?
Besides their expertise in pharmacotherapy, a pharmacist can offer their knowledge, skills and aptitudes to a multidisciplinary team engaged in caring for an individual with mental illness. There is evidence concluding that inclusion of the pharmacist in the multidisciplinary team is expected to substantially improve drug therapy, resulting in better outcomes for patients with mental illness. Below are specific functions a pharmacist can offer as part of the medical team.
Pharmacist’s contributions
- Pharmacists may primarily help by identifying, resolving, or avoiding problems linked to medications.
- They are instrumental in assisting in making sure drugs are used safely and efficaciously.
- Pharmacists provide extensive medication information to other health care providers and patients.
- They encourage their patients to maintain drug adherence.
- Pharmacists promote prevention of both general and mental health.
- They recommend lifestyle changes and provide community health activities.
The Mental Health First Aid Action Plan – ALGEE
ALGEE is an acronym that outlines the Mental Health First Aid action plan. It details a series of steps that should be taken once you identify a person which seems to be showing signs of mental health distress. It provides an orderly pathway to follow to help the individual suffering from mental illness get the help they need.
ALGEE Action Plan
- Assess the risk of suicide or harm – Identifying signs of suicidal behavior discussed earlier and proactively seeking answers from the individual, are vital to suicide prevention.
- Listen non-judgmentally – Demonstrating patience when communicating with the person and committing to fully listen to what they have to say is paramount.
- Give reassurance and information – Allowing the person to completely discuss what they need to say, followed by statements of encouragement and comfort is recommended. Then providing information regarding what to do or where to go next.
- Encourage appropriate professional help – Strongly urging the person to get professional help insisting there can be better days ahead.
- Encourage self-help and other support strategies – Promoting self-help approaches such as exercising, meditating and other relaxation methods. Advising to join support groups and increasing communications with family and friends.
Supporting Mental Health in the Pharmacy
Pharmacist and the pharmacy staff already play a critical role in supporting patients with mental illness after they have been diagnosed. The Pharmacy team is responsible for ensuring the patient’s pharmacotherapy is properly maintained and monitored.
Primary Objectives
- Checking for drug interactions – Performing drug utilization reviews (DUR) to ensure all of the patient’s medications, for mental health and otherwise, are compatible and can be used together.
- Evaluating all drug side effects – Assuring that other medications the patient is on do not cause additional psychological side effects like depression, anxiety, or suicidal tendencies.
- Promoting patient adherence – Making sure to encourage patient to take all their medications daily and on time. Inquiring about non-adherence issues and quickly resolving them.
- Following-up on efficacy –Asking the patient the right questions to determine if efficacy has been attained. Exploring for the possible cause if drug effectiveness has not been achieved.
Check your Knowledge Question and Scenario 6
Question 6 |
Scenario 6 |
A pharmacist, as part of the multidisciplinary mental health team can check for drug interactions, evaluate for side effects, promote patient adherence and follow-up on efficacy to improve better patient outcomes.
A. True B. False Next slide for answers |
DP is a 57-year-old female. She is an empty nester. Ever since she had her accident last year, she has been struggling with narcotic addiction. She has decided she wants to do something about it and asks for your advice. What can you do?
A. Tell her not to worry about it as long as she has a prescription for her narcotics. B. Explain to her that there are so many organizations available to help her with substance abuse. Provide their contact information. Follow-up with her. C. Contact the doctor that writes for the narcotics and tell him you want to work in collaboration with him to help the patient stop her addiction. D. Both B and C are correct |
Check your Knowledge Question and Scenario 6 – Answers
Question 6 |
Scenario 6 |
A pharmacist, as part of the multidisciplinary mental health team, can check for drug interactions, evaluate for side effects, promote patient adherence and follow-up on efficacy to improve better patient outcomes.
A. True B. False |
DP is a 57-year-old female. She is an empty nester. Ever since she had her accident last year, she has been struggling with narcotic addiction. She has decided she wants to do something about it and asks for your advice. What can you do? A. Tell her not to worry about it as long as she has a prescription for her narcotics. B. Explain to her that there are so many organizations available to help her with substance abuse. Provide their contact information and follow-up with her. C. Contact the doctor that writes for the narcotics and tell him you want to work in collaboration with him to help the patient stop her addiction. D. Both B and C are correct |
Explanation: A pharmacist is a valuable part of the multidisciplinary mental healthcare team. |
Explanation: The patient should be advised to seek help with a substance abuse provider and the physician that writes for the narcotics should be notified the patient is trying to stop taking them. Patient, doctor and pharmacist should work together to increase the probability of success. |
Mental Healthcare Provider Referrals
Once you have noticed the mental illness warning signs displayed by your patient, you can refer them to the appropriate mental healthcare provider. It is a good idea to compile a list of mental healthcare providers available in your area. There are hospitals and local health departments that offer free mental health services for low-income families.
Patients should also be advised to check with their employers to see if they provide EAP or Employee Assistance Program which offers an array of practical mental health services, like cost-free individual or couple’s therapy.
Other Mental Health Provider Options
- Counselors/Therapists (MS or MA) –Provide psychological family and marriage counseling along with other types of psychotherapy. Help patients decrease mental symptoms and improve their thoughts, beliefs, and behaviors to lead better daily lives.
- Social Workers (MSW) –(Social worker with master’s degree) Clinicians with special training to assess a patient’s mental health and help them by employing different therapy styles to resolve daily coping issues.
Mental Healthcare Providers Referrals – cont.
- Psychologists –These professionals are clinicians and experts in counseling. They are trained to assess a patient’s mental health, diagnose, and offer private or group psychotherapy. Some are afforded prescription writing privileges.
- Psychiatrists –This is a licensed medical doctor specialized in mental health illnesses. They can evaluate the patient, prescribe medications, and supervise cognitive behavior therapies (CBT) and other psychotherapies.
Mental Health Facilities
Different types of treatment facilities are available for mental health services. A patient can start with telemedicine. It consists of video or telephone appointments directly with a mental health clinician or provider. This is the most convenient way to get the patient the help they need.
Mental health care is also available on an inpatient or outpatient basis depending on the patient’s condition. Patients with severe mental illness will require confinement in the psychiatric section of a hospital. Those that are able to function independently, and can commit to frequent counseling or regular appointments, can use the outpatient services.
Special facilities are available for people suffering from substance abuse disorder to detoxify. Most detoxification institutions require long-term residency and are also able to provide rehabilitation care.
Mental Health Care Organizations
There are many organizations that offer help and support to those with mental health conditions. It is recommended to have this printed and available to hand out to your patients when needed.
Mental Health Organization (National) |
Contact Information |
Crisis Text Line Type of Assistance: Immediate crisis management (24/7). Helps individual calm down. Mental health care provider referrals. |
Text – Home to 741741 |
National Alliance on Mental Illness Type of Assistance: Support, information, and mental health provider referral. |
info@nami.org 1-800-950-NAMI (6264) |
National Suicide Prevention Lifeline Type of Assistance: 24/7 Access to crisis support, Information and mental health provider referral. |
1-800-273-TALK (8255) |
Substance Abuse and Mental Health Services Administration National Helpline Type of Assistance: Information and support on mental illness and substance abuse, provider referral. |
1-800-662-HELP (4357) |
Psychotropic Pharmacotherapy Management Strategies
The management of psychotropic medications is especially sensitive and requires great care because patient’s drug regimens may experience frequent adjustments of doses or drug changes. The following steps serve as a valuable tool in the proper management of these and all medications.
- Ask patient what medications they take – At drop off, patient should be asked to update their medication profile. A prescription may have been filled elsewhere and getting that information is vital in performing drug utilization reviews. Verify full name, date of birth, and drug allergies too.
- Confirm Auto-refill medications – If a patient is enrolled, at every opportunity you get to speak to your patient, verify the drugs being refilled automatically for that patient. This is an essential task to help avoid therapeutic duplications caused by discontinued medications.
- Evaluate all medications for potential CNS effects – Check each medication for potential central nervous system (CNS) side effects. If a patient is depressed, we wouldn’t want them to be on multiple drugs that may cause depression. In cases of interactions, determine whether the benefits of using the new drug outweigh the risks and notify the provider accordingly.
Pharmacist Participation in Mental Health Awareness
As already established, a pharmacist is part of the mental healthcare multidisciplinary team with the primary tasks of dispensing psychotropic medications to patients and assisting in monitoring their progress.
There are many ways a pharmacist can participate in Mental Health Awareness in their area. Below are several suggestions that can be used by a pharmacist to enhance their role in their community as a mental health care provider and educator.
Holding a Health Fair Featuring Mental Health – Designating a time, like World Mental Health Day (Oct 10), to place a table in the waiting area with information about signs and symptoms of mental illness, where to get help, and other related mental illness information. Be available to answer questions as needed.
Pharmacist Participation in Mental Health Awareness – cont.
Having Mental Health Screenings – Screening tools include Patient Health Questionnaire (PHQ) for depression, World Health Organization – Wellness Index (WHO-5) form, and Mental Health Continuum Short Form (MHC-SF) for mental well-being. They are useful for initial detection of mental decline and to monitor progress of those previously diagnosed.
Organizing a ‘Brown Bag’ Pharmacy Day – Invite patients that take medications for mental illness to bring all their drugs including daily supplements and painkillers inside a brown bag into the pharmacy. This will provide an opportunity to go over the patient’s medications with them and answer any questions or concerns they may have. It can be by appointment or just designate a couple of hours as ‘Brown Bag’ time for walk-ins.
What are the Expectations of a Mental Health First Aid Responder?
?
As a frontline professional, the pharmacist has the unique opportunity to interact with patients more often than any other provider. Pharmacists should be trained to recognize the signs and symptoms of mental illness in order to increase the patient’s chances of being diagnosed early and began the road to recovery.
In review, the following measures should be taken by the pharmacist to provide solid support to both the patient with the mental disorder and their clinician.
- Recognize signs and symptoms of mental illness– Become familiar with the signs and symptoms of the most common mental illnesses.
- Communicate with patient– Be proactive, ask the patient directly how they are feeling, use screening tools if necessary. Make referrals to other mental health providers as required.
What are the Expectations of a Mental Health First Aid Responder? – cont.
- Counsel them on new and refill medications– Ensure patient is informed about their medication. Say the drug name and dose, mention what it is for, how to take it, when to take it, how long will it take to work, and possible side effects. Have them repeat to confirm comprehension.
- Follow up with the patient –Contact the patient to get an update on how they are doing. Ask them how they take their medications and respond to any questions or concerns.
- Plan community outreach – Organize mental illness awareness health fairs. Provide mental illness information and perform free screenings. Discuss the results with participants.
Active Learning
At times, life can be very challenging for all of us. It can also be daunting to tackle the stigma of mental illness. As human beings, we have a moral obligation to love and care for one another. Therefore, it is so important to be familiar with the signs and symptoms of mental conditions, not just for our patients but for ourselves, family, and friends.
I recently came across an interesting book called Signs of Hope: How small acts of love can change your world. It is about a woman that decided to make actual garden signs with sweet messages, some of which read: -You are worthy of love, -Don’t give up, -You are not alone, –You are enough.
In her book, Amy Wolff, shares her own struggles in life. She explains how she chose to focus her time and energy to bringing hope to others and teaches us how small acts of kindness and joy can help reduce anxiety and emotional pain for all of us. Most notably, she reveals some of the stories of those whose lives she has changed through the positive impact of her actions.
Through the link below, you will find more information about the book and its author. This is an important step in learning what little it takes to turn someone’s life around.
https://www.goodreads.com/book/show/54287626-signs-of-hope
Conclusion
The stresses of everyday living can sometimes become overwhelming. Sadly, there are some people who find it difficult to cope with day-to-day pressures. Making yourself available as a pharmacist and fellow human being can literally make a difference between life and death for some.
Reducing the stigma of mental illness through training and education can help build the confidence needed to identify and provide support for declining mental health in our patients. It is important to recognize that as pharmacists, we have a better chance to have multiple, close encounters with them than most providers. So, we must take advantage of this opportunity to proactively interact with our patients and ask the right questions, either individually or through community outreach.
There is no need for anyone to suffer in silence. A multitude of organizations are available to render aid to those who want it. Together we can help reduce the misconceptions of mental illness and provide useful tools and information to minimize the distress of people afflicted with mental disorders and those around them.
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