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
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v
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 …
