Psychotropic Medication

Psychotropic Medication Iowa Psychiatric Society April 2010 Psychotropic-Medication.pptx

I-PART Iowa-Program Assistance Response Team The goal of I-PART is to assist community service organizations and programs to manage the serious behavioral problems of clients enrolled in their programs so that the clients are able to retain their community placements and not be institutionalized, arrested or admitted to jail, or considered for emergency discharge from the community program Psychotropic-Medication.pptx

Contacting I-PART Psychotropic-Medication.pptx

Developmental Disability • A severe, chronic disability that: • Is attributable to a psychological or physical impairment or some combination thereof • Is manifested before age 22 • Is likely to continue indefinitely • Results in substantial functional impairments in three or more major life activities • Reflects the individual’s need for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services that are lifelong or of extended duration and are individually planned and coordinated Psychotropic-Medication.pptx

Diagnostic Criteria for Mental Retardation • Significantly sub average intellectual functioning • An IQ of approximately 70 or below on an individually administered IQ test • Concurrent deficits or impairments in present adaptive functioning • The person’s effectiveness in meeting the standards expected for his or her age by his or her cultural group • Onset before 18 years of age Psychotropic-Medication.pptx

Associated Features of Levels of Mental Retardation Psychotropic-Medication.pptx

Diagnostic Criteria for Autistic Disorder • Qualitative impairment in reciprocal social interaction • Marked lack of awareness of the existence or the feelings of others • No or abnormal seeking of comfort at times of distress • No or impaired imitation • No or abnormal social play • Gross impairment in ability to make peer friendships Psychotropic-Medication.pptx

Diagnostic Criteria for Autistic Disorder -- continued • Qualitative impairment in verbal and nonverbal communication, and in imaginative activity • No mode of communication • Markedly abnormal nonverbal communication • Marked abnormalities in the production of speech • Marked abnormalities in the form or content of speech • Marked impairment in the ability to initiate or sustain a conversation with others, despite adequate speech Psychotropic-Medication.pptx

Diagnostic Criteria for Autistic Disorder -- continued • Markedly restricted repertoire of activities and interests • Stereotyped body movements • Persistent preoccupation with parts of objects or attachment to unusual objects • Marked distress over changes in trivial aspects of environment • Unreasonable insistence on following routines in precise detail • Markedly restricted range of interests and a preoccupation with one narrow interest Psychotropic-Medication.pptx

Guidelines for the Use of Psychotropic Medication Psychotropic-Medication.pptx

1. Definition of Psychotropic Medication • Psychotropic medication is any drug prescribed to stabilize or improve mood, mental status, and / or behavior • Classes of Psychotropic Medication: • Antianxiety • Antidepressant • Antipsychotic • Mood Stabilizers • Stimulant Psychotropic-Medication.pptx

2. Inappropriate Use • Psychotropic medication should not be used: • Excessively • As punishment • For staff convenience • As a substitute for meaningful psychosocial services • In quantities that interfere with an individual’s quality of life Psychotropic-Medication.pptx

3. Multidisciplinary Care Plan Psychotropic medication should be used as part of a coordinated multidisciplinary care plan designed to improve an individual’s quality of life Psychotropic medication alone does not constitute a coordinated multidisciplinary care plan Multidisciplinary team members should not work in isolation Psychotropic-Medication.pptx

4. Diagnostic and Functional Assessment • The use of psychotropic medication should be based on: • a psychiatric diagnosis or • a specific behavioral pharmacological hypothesis if a psychiatric diagnosis is unclear • The use of psychotropic medication should result from psychodiagnostic and functional assessments Psychotropic-Medication.pptx

5. Informed Consent Written informed consent (or documented verbal consent until written consent is obtained) must be obtained from the individual, if competent, or the individual’s guardian, before the use of psychotropic medication Informed consent should be periodically renewed Psychotropic-Medication.pptx

6. Index Measures and Empirical Measurement • Empirical measurement techniques should be used in order to evaluate and monitor the efficacy of psychotropic medication • Index measures should be: • objectively defined • and tracked • Index measures include: • Target behaviors • Signs (observable evidence) • Symptoms (subjective reports of the individual) Psychotropic-Medication.pptx

7. Side Effects Monitoring The individual must be monitored for side effects on a regular and systematic basis, using an accepted methodology which includes the use of standardized assessment instruments Psychotropic-Medication.pptx

8. Tardive Dyskinesia Monitoring If antipsychotic medication or other dopamine-blocking drugs are prescribed, the individual must be monitored for tardive dyskinesia on a regular and systematic basis, using an accepted methodology which includes the use of standardized assessment instruments Psychotropic-Medication.pptx

9. Regular and Systematic Review Psychotropic medication should be reviewed on a regular and systematic basis Regular means at least once every 3 months, and within 1 month of drug or dose changes Systematic means a coordinated procedure between all parties to share, review, document and act on information concerning psychotropic medication and its effects Psychotropic-Medication.pptx

10. Lowest Optimal Effective Dose Psychotropic medication should be reviewed on a periodic and systematic basis to determine whether it is still necessary, and, it it is, whether the lowest optimal effective dose is prescribed Lowest optimal effective dose is the least amount of medication required to improve or stabilize the problem Psychotropic-Medication.pptx

11. Frequent Changes Frequent drug and dose changes should be avoided Psychotropic-Medication.pptx

12. Polypharmacy Psychotropic medication regimens should be kept as simple as possible so as to enhance compliance and minimize side effects Except in unusual cases, polypharmacy is rarely justified, and should be avoided Intraclass polypharmacy is the use of two or more psychotropic medications from the same therapeutic class Interclass polypharmacy is the use of 3 or more psychotropic medications Psychotropic-Medication.pptx

13. Practices to Minimize Long-term use of PRN orders Long-term use of antianxiety medications, especially benzodiazepines Use of long-lasting sedative / hypnotics Long-term use of shorter acting sedative / hypnotics Use of anticholinergic medication in the absence of signs of extrapyramidal side effects Long-term use of anticholinergic medication Use of antipsychotic medication at doses above the typical package insert maintenance range Psychotropic-Medication.pptx

Psychotropic Medication