The Case of Carlos (page 347) 

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Psychopharmacology for Mental Health Professionals: An Integrative Approach (2nd Edition)

R. Elliott Ingersoll

Carl F. Rak

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Title: Psychopharmacology for Mental Health Professionals: An Integrative Approach (2nd Edition)

Author: R. Elliott Ingersoll, Carl F. Rak

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BEGIN CONTENT

i

Psychopharmacology FOR MENTAL HEALTH PROFESSIONALS AN INTEGRATIVE APPROACH

2nd Edition

R. Elliott Ingersoll

Cleveland State University

Carl F. Rak

Cleveland Psychoanalytic Center

CENGAGE

Learning*

Australia – Brazil – Mexico – Singapore – United Kingdom – United States

ii

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CENGAGE Learning

Psychopharmacology for Mental Health Professionals: An Integrative Approach, Second Edition

R. Elliott Ingersoll and Carl F. Rak

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© 2016, 2006 Cengage Learning

WCN: 01-100-101

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To my students from the Clinical Counseling, School Counseling, Clinical Psychology and School Psychology programs at Cleveland State University. You’ve all kept me believing in and improving this work as we used early drafts in our classes — thank you so much! Also to my co-author Carl. This would not have happened without your extensive clinical experience and friendship.

–R.E.I.

This edition is dedicated to Timothy Dugan MD, greatest of friends, mentor, and counselor on this endeavor. Tim is a passionate child and adult psychoanalyst and psychiatrist practicing in the Boston area.

To Elliott Ingersoll, my lead author, this is your dream endeavor and this second edition is so much better because of you. Thanks!

–C.F.R.

vi

Contents

PART ONE

An Overview of the New Edition 1

What Is an Integrative Approach? 1

1 Introduction 3

Encouragement to the Reader 3

A Mantra 3

Scientific Truth and the Acceleration of Knowledge 4

Chapter One: Section Two 6

Everybody Is Right (About Something): The Many Faces of Truth 6

The Medical Model Perspective 7

The Psychological Perspective 8

The Cultural Perspective 9

The Social Perspective 9

Psychophamiacology and Magical Thinking 10

Moving On: What We Know, What We Do Not Know 11

The Case of Lawrence 11

The Mind-Brain Problem 12

The Epipheuoincnon Hypothesis 13

The Dual-Substance Hypothesis 14

The Layout of This Book 15

Part One 15

Part Two 15

Part Three 15

Study Questions and Exercises 16

2 Introduction to the Nervous System, Neurons, and Pharmacodynamics 17

Introduction 17

Section One: An Overview of Physiology Relevant to Psychophamiacology 17

A Few Basics 17

Section Two: Exploring the Central Nervous System 19

Exploring the Brain Stent 19

Exploring the Midbrain 20

vii

The Cerebellum 20

Exploring the Dienccphalon 20

Exploring the Limbic System 22

Exploring the Telencephalon 22

Section Three: An Overview of Neurons and Glial Cells 23

The Basic Anatomy of a Neuron 24

Glial Cells 25

The Blood-Brain Barrier 26

Section Four: Types of Neurotransmitters 27

Glutamate (Glu) 28

Gamma-Aminobutyric Acid (GABA) 28

Acetylcholine (Ach) 28

Monoamine Neurotransmitters 29

Dopamine (DA) 29

Norepinephrine (NE) 29

“It’s Creek to Me” 29

Serotonin (5-HT) 29

Reality Is Complex and 30

Section Five: The Story of Neurotransmission 31

Neurotransmission: The Team Players 31

Deoxyribonucleic Acid (DNA) 31

Transporters 31

Enzymes 32

Receptors 32

Back to Neurotransmitters 32

Ions 32

Ion Channels 33

A View Within the Cell 33

The Process of Neurotransmission 33

First-Messenger Effects 33

Second-Messenger Effects 35

A Quick Review 35

What Happens When Neurotransmitters Bind to Receptors? 36

What Happens to the Released Neurotransmitter? 36

Section Six: Pharmacodynamics or How Psychotropic Medications Affect

Neurotransmission 36

Agonism and Antagonism 37

Mechanisms of Action with Effects on Production 37

Mechanisms of Action with Effects on Release of Neurotransmitter 38

Mechanisms of Action Targeting Neurotransmitter Deactivation 39

Summary 39

Case of Colleen 40

Class Exercise: The Psychodramatic Neuron 40

Study Questions and Exercises 41

3 Pharmacokinetics: How the Body Acts on Psychotropic Medications 42

Section One: Drug Absorption 42

Routes of Administration 42

viii

Oral Administration 43

Inhalation 43

Injection 43

Transdermal Administration 44

Rectal Administration 44

Mucus Membrane (transmucosal) Administration 44

Section Two: Getting to the Bloodstream 44

Cell Membrane Permeability 44

Section Three: Drug Distribution 46

Section Four: Drug Binding and Types of Tolerance 47

Types of Tolerance 48

Section Five: Elimination of Drugs 49

The Renal System 50

The Liver and Drug Metabolism 50

Other Factors Affecting Pharmacokinetics 50

Case 51

4 Psychological, Social, and Cultural Issues in Psychopharmacology 52

Section One: Adherence and Compliance with Medication Regimens 52

Client Reactions to the Medical Model of Mental Illness 53

Compliance and Adherence 55

Reasons that Clients May Not Comply 55

The Medication Won’t Work 56

I Should Feel Good Right Away 56

My Depression Is Incurable 56

Trouble with Routines, or Inconvenience 56

Medication as Evidence of an Undesirable Self 57

Misinformation 57

Other Issues 58

Section Two: Talking to Clients about Medications: Know and Educate

Thyself 59

Specific Supervision Issues 60

Assessment 61

Monitoring 62

Advocacy 62

Summary 63

Section Three: Ethno-Psychopharmacology: Group Differences in Response to

Psychotropic Agents 64

Sex Differences 64

Racial Differences 66

A Focus on the Cultural Perspective 68

Shared Belief Systems Regarding Psychopharmacology: Multicultural

Variables 68

Discrimination and Oppression 69

Case Study: The Case of Rafael 70

Case 70

A Meeting of Subcultures: Collaboration with Prescribing Professionals 71

Conditions of the Relationship 72

ix

Confidentiality Issues 72

Confrontation Issues 72

Transference and Counter transference Issues 72

Section Four: Social Institutions and Their Impact on Psychotropic Medications 72

The Food and Drug Administration 73

Pharmacoeconomics 73

The Power of Pharmaceutical Companies 73

Pharmaceutical Company-Sponsored Research 74

Pharmaceutical Companies and Direct-to-Consumer Advertising 75

The Subculture of the Pharmaceutical Industry 76

The Drug Enforcement Agency 77

Conclusion 78

Summary 79

Study Questions and Exercises 79

PART TWO

Introduction 81

5 The Antidepressant Era 82

Section One: The Current Impact of Antidepressants 82

Major Depressive Disorder (MDD) 83

Comorbidity of Depression and Anxiety 84

Antidepressant Efficacy 84

Section Two: Theories of Antidepressant Action 84

Amine Theory 85

The Discovery of Reuptake Inhibition 87

Downregulation Theory 87

Neurotransmitter Receptor Hypothesis 89

Section Three: The Neurotrophic/Plasticity Hypothesis and New Theories of Antidepressant Action 89

Newer Hypotheses and Theories 91

The Emerging Science of the Role of Signaling Pathways in Depression 91

Toward an Integrative Theory of Antidepressant Action 92

Section Four: Overview of First-Generation Antidepressant Medications 93

The Role of Vegetative Symptoms 93

Monoamine Oxidase (MAO) Inhibitors 94

Common Side Effects of MAOIs 94

Inhibition of MAO A and Tyramine Intolerance 95

Contraindications for MAOI Therapy 95

Newer MAO Inhibitors 96

The Case of Allan 96

Tricyclic Antidepressants 97

Side Effects of TCAs 97

Tricyclic Derivatives 98

x

Benefits and Drawbacks to TCAs and TCA Derivatives: A Summary 99

The Case of Rita 99

Section Five: Second Generation Antidepressants: Selective Serotonin Reuptake Inhibitors 100

A Bit More History 100

Mechanism of Action 102

Common Side Effects 102

Antideprcssant-Induccd Sexual Dysfunction 103

Do Antidepressants Induce Dependence? 104

Psychological and Cultural Issues with SSR Is 105

Cases Involving SSRI Medication 106

The Case of Linda 106

The Case of Jack 106

Section Six: Third-Generation Antidepressants 107

Bupropion / Welllmtriu: A Norepinephrine-Dopamine Reuptake Inhibitor 108

Mirtazapinc/Rcincron: A Serotouin-Norcpinephrine Antagonist 109

VenlafaxineEffexor: A Serotonin-Norepinephrine Reuptake Inhibitor 109 Desvenlafaxine/Prestiq 109

Rcboxctinc/Edrouax: A Selective Noradrenergic Reuptake Inhibitor 110 Brintellix/Vortioxetine 110

Milnacipran/Savella 111

Duloxctine/Cymbalta: A Newer Serotonin-Norepinephrine Reuptake Inhibitor 111

Into the Future: Ketamine 111

Summary Points About Antidepressants 112

Case of Joshua 113

Antidepressants in Older Clients 113

Section Seven: Focus on Psychological, Cultural, and Social Perspectives 114 Psychological Perspectives 114

Different Perspectives on the Placebo Problem 115

Other Treatments for Depression 116

A Problem Case: The Case of Alex 116

When to Recommend Medication Evaluation 116

The Culture of Pharmaceutical Companies: Are Newer Antidepressants Medical Innovations or “One-Trick Ponies”? 117

Summary 118

Study Questions and Exercises 119

6 The Age of Anxiety 120

Section One: Overview of Anxiolytic Medication and the Construct of Anxiety 121

The Construct of Anxiety 122

The Case of Marcia122 Theories of Anxiolytic Action 123

Section Two: The Central Nervous System: Anxiety, Brain Circuits, Brain Structures,

and Neurotransmitters 123

A Hypothesized Braking System 124

Neurotransmitters Involved in Anxiety 124

xi

Section Three: Central Nervous System Depressants 125

Barbiturates 126

Mechanisms of Action 126

Common Side Effects 127

Tolerance and Dependence 127

Barbiturates and Overdose 128

The Case of Francis 128

Nonbarbituratc Alternatives: Mother’s Little Helpers 128

Meprobamate 129

The Quaalude Years 129

The Case of John 130

Benzodiazepines 130

Some Anxiolytic History 130

Varieties of Benzodiazepine Compounds 131

2-Keto Compounds 131

7-Nitro Compounds 131

3-1 Iydroxy Compounds 132

Triazolo Compounds 132

Im idazo Compounds 132

Pharmacokinetics 132

Mechanisms of Action 132

Side Effects 133

Tolerance and Dependence 133

Overdose Potential 134

The Case of Jennifer 134

The Case of Sherry 134

The Case of William 135

Section Four: Nonbenzodiazepine Alternatives 136

Hypnotics 136

Buspirone: A Unique Anxiolytic 137

Mechanisms of Action 131

Side Effects and Dosing 138

Tolerance, Dependence, and Overdose 139

The Case of Meredith 139

Section Five: Newer Approaches to Anxiolytic Medications 140

The Case of Starr 141

Section Six: SSR1 Treatment of Anxiety 141

The Case of Katrina 142

The Case of Nicole 142

The Case of Rhonda 142

Section Seven: Anxiolytic Therapy by Diagnosis 143

Generalized Anxiety Disorder 143

Pharmacological Treatments for GAD 144

Psychological Treatments for GAD 144

Panic Disorder 145

Social Anxiety Disorder and Specific Phobias 145

Social Anxiety Disorder 146

xii

Section Eight: Focus on Psychological, Cultural, and Social Issues 146

Psychological Issues 146

Anxiety Disorders: Myth or Reality 146

Cultural Issues 148

Social Issues 149

Summary 149

7 Antipsychotic Medications: The Evolution of Treatment 150

The Current Impact of Antipsychotics 150

Section One: Schizophrenia 151

The Spectrum of Symptoms in Schizophrenia 151

Section Two: Theories of Neuroleptic Action from the Medical Model Perspective 153

The Dopamine Hypothesis of Schizophrenia 153

The Case of Colin 154

The Case of Ethel 155

Side Effects of Neuroleptic Medication 156

The Four Primary Dopamine Pathways in the Brain 157

The Mesolimbic Pathway 157

The Mesocortical Pathway 157

The Nigrostriatal Dopamine Pathway 157

The Tuberoinfundibular or Hypothalamic Pathway 158

Allergic Reactions to Neuroleptics 158

Anticholinergic Effects of Neuroleptics 158

Blurred Vision 158

Dry Mouth 159

Constipation 159

Urinary Retention 159

Withdrawal Reactions 159

Cardiovascular Side Effects from Neuroleptics 159

Dermatological Side Effects from Neuroleptics 159

Endocrinological Side Effects of Neuroleptic Medications 160

Weight Gain 160

Extrapyramidal Symptoms Caused by Neuroleptic Medication 160

Early-Onset Extra pyramidal Symptoms 160

Late-Onset Extra pyramidal Symptoms 161

Neuroleptic Malignant Syndrome 162

Agents to Treat Extra pyramidal Side Effects 162

The Case of Teana 164

The Case of Maurice 164

Uses and Efficacy of Neuroleptic Medications 164

Section Four: Clozaril: The Prototype for Atypical Antipsychotics 166

The Case of Bonnie 166

A New Era 167

Placebo Versus Active Control Trials 168

Mechanisms of Action 168

Clozapine/Clozaril Side Effects 169

Agranulocytosis 169

xiii

Autonomic Side Effects of Clozapine 171

Cardiovascular Side Effects 171

Metabolic 171

Neurological Side Effects 172

Extrapyramidal Side Effects 172

Section Five: The Serotonin/Dopamine Antagonists 172

The Specter of Side Effects 173

Risperidone/Risperdal 175

Olanzapine /Zyprexa 175

Quetiapine/Seroquel 176

Ziprasidone/Geodon 178

The Case of Melanie 178

Section Six: Newer Agents 179

Amisulpride/Solian 179

Lurasidone/Latuda 179

Iloperidone/Fanapt 179

Asenapine/Saphris 180

Aripiprazole/Abilify 180

Section Seven: Focus on Other Perspectives 181

Psychological Considerations 181

Dealing with Ambivalence About Taking Medication 182

Issues from the Cultural Perspective 183

The Culture of Stigma 183

Social Issues 184

Pharmacoeconomics 184

Efficacy and Compliance 184

Whom Do We Trust? 185

Summary 186

8 Mood Stabilizers 187

Section One: Mood Misnomers 187

Section Two: Bipolar I Disorder 190

Symptoms in Bipolar I Disorder 191

Section Three: Some History on Mood Stabilizers 192

Developments Down Under 192

Section Four: Lithium: The Prototypical Mood Stabilizer 195

Theories of Lithium Action 196

Lithium and Neurotransmission 196

The Amine Theory Revisited 196

Lithium’s Ionic Impact on Neurotransmitter systems 197

Dopamine 197

Glutamate and NMDA Receptors 197

GABA 197

Lithium’s Effect on Second-Messenger Systems 198

Lithium and Circadian Rhythms 198

xiv

Side Effects of Lithium 198

CNS Side Effects of Lithium 198

Neuromuscular Side Effects of Lithium 199

Gastrointestinal Side Effects of Lithium 199

Endocrine Side Effects of Lithium 200

Renal Side Effects of Lithium 200

Demiatologic Side Effects of Lithium 200

Sexual Side Effects of Lithium 200

Lithium Toxicity 200

Lithium and Aggression 202

Lithium Cases 202

The Case of William 202

The Case of Lincoln 203

The Case of Kelly 204

Section Five: Anticonvulsants as Mood Stabilizers 204

Carbamazepine/Tegretol 205

Mechanisms of Action in Carbamazepine /Tegretol 205

Ion Channel Effects of Carbamazepine/Tegretol 205

Carbamazepine/Tegretol’s Effects on Neurotransmission 206

Efficacy of Carbamazepine/Tegretol in Bipolar Disorder 206

Side Effects of Carbamazepine/Tegretol 206

Dermatologic Side Effects of Carbamazepine/Tegretol 206

Endocrine Side Effects of Carbamazepine/Tegretol 207

Gastrointestinal Side Effects of Carbamazepine/Tegretol 207

Hematologic Side Effects of Carbamazepine/Tegretol 207

Hepatic Side Effects of Carbamazepine/Tegretol 207

Neurologic Side Effects of Carbamazepine/Tegretol 207

Psychiatric Side Effects of Carbamazepine/Tegretol 208

Teratogenic Side Effects of Carbamazepine/Tegretol 208

Oxcarbazepine/Trileptal 208

The Case of Molly 208

The Case of Roger 208

Valproic Acid 209

Mechanism of Action 209

Efficacy of Valproate in Bipolar I Disorder and Aggression 209

Side Effects of Valproate 210

Cardiovascular Side Effects of Valproate 210

Demiatologic Side Effects of Valproate 210

Endocrinologic Side Effects of Valproate 210

Gastrointestinal Side Effects of Valproate 211

Hematologic Side Effects of Valproate 211

Hepatic Side Effects of Valproate 211

Neurologic Side Effects of Valproate 211

Teratogenic Side Effects of Valproate 211

The Case of Jose 211

The Case of Beverly 212

Section Six: Newer Anticonvulsants as Mood Stabilizers 212

Lamotrigine/Lainictal 212

xv

Mechanism of Action of Lamotrigine/Lamictal 213

Side Effects of Lamotrigine/Lamictal 213

Preliminary Conclusions About Lamotrigine/Lamictal for Bipolar I Disorder 213 Topiramate /Topamax 214

Gabapcntin/Nenrontin 214

Section Seven: Atypical Antipsychotics as Mood Stabilizers 214

General Conclusions on Mood Stabilizers 215

Section Seven: Issues from Other Perspectives 215

Psychological Issues 216

Bipolar Illness and Creativity 216

The Case of Robert 216

Compliance with Mood Stabilization Therapy 217

Section Eight: Issues from the Cultural and Social Perspectives 218

The Gabapentin Controversy: Corruption in Corporate Culture 218

The Role of the Law in Pharmaceutical Company Regulation 220

The Social Costs of Bipolar Disorder 220

Conclusion 221

Summary 221

PART THREE

Newer Issues 223

9 Medicating Children 224

Section One: Perspectives, Dilemmas, and Future Paradigms 224

The Complex State of Therapy 224

The Explosion of Psychotropic Medication Prescriptions for Children and

Adolescents 226

The Case of Phillip 227

Analysis of Phillip’s Case 228

The Medication of Children and the Federal Laws 228

FDA Modernization Act 229

The Best Pharmaceuticals for Children Act 229

Child and Family Services Improvement Act 230

A Word on Cross-Cultural Perspectives 230

Psychological Perspectives of Children and Adolescents 231

Opposition to the Current Trend of Medicating 231

An Overview of Pediatric and Adolescent Psychopharmacology 232

Developmental Issues 234

Developmental Lines 235

Developmental Pharmacology 235

Section Two: Stimulant Medication 237

Some History 238

Mechanisms of Action in Amphetamines 239

ADHD Diagnosis and Assessment 240

ADHD Efficacy, Effectiveness, and Conundrum 242

Section Three: ADHD and Combined Interventions 242

xvi

ADHD and Comorbidity 244

Atomoxetine, a Nonstimulant 245

Section Four: Mood Stabilizers and Bipolar I Disorder in Children 246

The Case of Nicole 249

Section Five: Children and Antipsychotic Medication 250

Section Six: Antianxiety Medications and Children and Adolescents 252

School Issues, Anxiety, and Children 254

Section Seven: Antidepressants and Children and Adolescents 255

Tricyclic Antidepressants in Children 255

SSRIs in Children 256

The Placebo Problem 258

Conclusion 258

Summary 259

10 Herbaceuticals 260

The Behavior of Herbaceutical Use 261

Section One: Psychological Issues 262

Why Do People Take Herbaceuticals? 262

Mistrust of Traditional Western Medicine 262

Belief That Natural Products Are Safer Than Drugs 263

Acceptance of Anecdotal Testimony About Efficacy 263

Section Two: Issues of Culture 263

Section Three: Issues from the Social Perspective 264

Legal Issues 264

Section Four: Problems in Studying Medicinal Plants 264

Differences Between Herbs and Drugs 266

Section Five: Examining Better Known Herbaceuticals with Application for Psychiatric Problems 267

St. John’s Wort 267

Mechanism of Action 267

Efficacy of St. John’s Wort 268

Side and Interaction Effects of St. John’s Wort 268

Kava 269

Mechanism of Action 269

Efficacy of Kava as an Anxiolytic 269

Side Effects and Advene Reactions 270

Ginkgo Biloba 270

Mechanisms of Action 270

Efficacy of Ginkgo 270

Valerian Root 271

Mechanisms of Action 271

Efficacy of Valerian 271

Side and Adverse Effects 271

Ephedrine 271

Mechanisms of Action 272

Adverse Effects 272

Other Herbaceuticals 273

Passion Flower and Hops 273

Melatonin 273

xvii

Section Six: An Integrative View of Marijuana 273

A Brief History of Marijuana Use 273

A Medical Model Perspective on Marijuana 274

Delta-9- Tetrahydrocannabinol 274

Physiological Effects of THC 275

The Issue of Cannabis Dependence and Withdrawal 275

Is Cannabis a “Gateway” Drug? 276

Proposed Medical Uses for Cannabis 277

Adverse Effects 278

Respiratory Problems 278

Cardiovascular Side Effects 278

Psychiatric Effects 278

Drug Interactions 278

Infection from Contaminated Crop 279

Impairment of Motor Skills 279

Problems in Pregnancy 279

Marijuana from the Psychological Perspective 279

Changes in the Senses 280

Marijuana from the Cultural Perspective 281

Social/Legal Perspectives on Marijuana 282

Conclusions 283

Summary 283

Study Questions and Exercises 283

11 Pharmacotherapy of Alcohol and Drug-Related Disorders 285

Section One: Brief Historical Sketch of Pharmacological Treatments for Patients

Experiencing Drug and/or Alcohol-Related Concerns 285

Pharmacological Treatment of Alcoholism 286

Pharmacological Treatment of Opioid Dependence 287

Section Two: Current Statistical Impact of Drug and Alcohol Abuse/Dependency

and Terminology 289

Section Three: Pharmacological Treatment of Individuals with Alcohol-Use

Disorden 292

Disulfiram Treatment 293

Naltrexone Treatment 294

Acamprosate Treatment 295

Combined Pharmacotherapy 296

Additional Pharmacotherapies for Alcohol-Use Disorders 296

Section Four: Pharmacotherapy of Individuals Diagnosed with Severe

Opioid Dependence 297

Methadone Maintenance Treatment (MMT) 298

Naltrexone Pharmacotherapy 300

Buprenorphine Treatment 301

Buprenorphine/Naloxone Treatment (Bup/Nx) 302

Section Five: Cultural Considerations for Treating Patients, Pharmacologically,

with Substance-Use Disorders 303

Stigmatization of Substance-Use Addiction and Treatment 304

Multicultural Competent Practice and Advocacy 304

A Problem Case: The Case of Carlos 305

xviii

Clinical Recommendations 306

Summary 307

Study Questions and Exercises 307

12 Drug-Assisted Psychotherapy 308

Introduction 308

What Do Psilocybin and MDMA Do? 308

Hallucinogen Terminology Over Time 309

The Subjective Effects of Psilocybin 309

The Subjective Effects of MDMA 310

Clinical Research with Psilocybin and MDMA 310

A Note About Psychoactive Biota Use Among Indigenous People 310

A Short History of MDMA 311

The Nature of Early Drug-Assisted Psychotherapy Research 311

Set and Setting 312

Psilocybin-Assisted Psychotherapy in Brief 312

MDMA-Assisted Psychotherapy for Post-Traumatic Stress Disorder

The First Randomized Controlled Pilot Study 313

Long-Term Follow-Up Study 314

Healthy Volunteer Research 314

The Use of MDMA and Hallucinogens in Clinical Training 315

Mechanisms of Action 316

Potential Mechanisms of Action in Psilocybin-Assisted Psychotherapy 316

Potential Mechanisms of Action in MDMA for PTSD 317

The Psychotherapy in MDMA-Assisted Psychotherapy 317

Is It the Drug, the Psychotherapy, or Both? 319

Clinical Effect without Psychotherapy 320

Between Psychopharmacology and Psychotherapy 320

Risks Versus Benefits 321

Safety of Psilocyin and other Classical Hallucinogens 321

Safety of MDMA 322 Dependency 322

Risks Associated with Psychotherapeutic Use 323

The Future of Psychedelic Research 323

The Future of MDMA Research 323

The Future of Psilocybin Research 324

Legal Status of MDMA and the Classical Hallucinogens 325

13 Psychotropic Medication and the Elderly 326

Introduction: The New Old Age 326

Section One: DSM-5 Changes to Delirium and Dementia 327

Neurocoguitive Disorders (NCDS) 321

Major and Mild NCDs 321

Etiological Subtypes 328

Medications for Alzheimer’s Disease and Parkinson’s Disease 328

xix

Can Alzheimer’s Disease Be Prevented? 328

Acetylcholinesterase Inhibitors 329

Section Two: The State of Psychosocial Interventions for Elderly Clients 332

Section Three: Phamiacologic Treatment of Dementia: From the 20th Century

and into the 21st Century 335

Commonly Prescribed Psychotropic Medications in Elderly Population 336

Depression 336

Anxiety 336

Psychosis/Agitation 337

Section Four: Aging and Assisted Living 339

Section Five: Side Effects Peculiar to the Elderly 339

Psychotropic Side/Adverse Effects in Elderly Clients 340

Glossary 342

References 350

Name Index 393

Subject Index 406

xx

Preface

These early years of the 21st century are a time of great opportunity for nonmedical mental health professionals. For the first time since the inception of the mental health fields we have excellent research on how to treat many mental health symptoms like depression and anxiety. Perhaps more importantly, the lay public is learning what many of us in mental health fields have known for years: we don’t know what causes mental disorders and when medications work; we don’t fully understand why medications work. There is no support for the …