Uncovering the mysteries of psychiatry
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Uncovering the Mysteries of Psychiatry. Nancy Gerrard June 8, 2014. Today’s review:. Alternative treatments for depression 3 new medications Drugs of abuse. OUR clientele. Young adult years have also been called the AGE of INSTABILITY EMERGING ADULTHOOD

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Uncovering the mysteries of psychiatry

Uncovering the Mysteries of Psychiatry

Nancy Gerrard

June 8, 2014


Today s review

Today’s review:

  • Alternative treatments for depression

  • 3 new medications

  • Drugs of abuse


Our clientele

OUR clientele

  • Young adult years have also been called the

  • AGE of INSTABILITY

  • EMERGING ADULTHOOD

  • Children and adolescents increasingly take antidepressants (1/13 on psych meds)

  • Thin line between diagnosing depression and teaching youth to view any emotional upset as pathological

  • NY Times, Iarovici, April 2014


Our clientele1

OUR Clientele

  • Patients I see at the University Health Center:

  • Anxiety

  • Depression

  • Bipolar disorder

  • First episode psychosis

  • Obsessive Compulsive Disorder

  • Eating disorders

  • ADHD

  • Transgender clients


Depression

Depression

Alternative therapies


Depression1

Depression

  • Depressed mood most of day

  • Diminished interest in pleasurable activities

  • Decrease or increase in appetite

  • Insomnia or hypersomnia

  • Psychomotor agitation or retardation

  • Fatigue or loss of energy

  • Feelings of worthlessness or excessive guilt


Depression cont

Depression (cont)

  • Diminished ability to think or concentrate

  • Recurrent thoughts of death, recurrent suicidal thoughts or attempts

  • These symptoms occur nearly every day and they cause clinically significant distress or impairment in social, occupational or other important areas of functioning.


Depression what causes it

Depression – what causes it??

  • Genetics

  • Situational (life events and environmental stress)

  • Personality or temperament

  • Biological/medical factors

  • Drug/alcohol induced


Standard treatment for depression

Standard treatment for depression

  • Therapy

  • Medications

  • Combination of therapy and medication

  • Hospitalization


Medications for depression

Medications for depression

  • Prozac

  • Paxil

  • Zoloft

  • Celexa

  • Lexapro

  • Cymbalta

  • Effexor

  • Pristiq

  • Wellbutrin


Treatments for depression

Treatments for depression

Sleep

Healthy diet

No alcohol or drugs

Limit caffeine use

Get outside for natural light at least 20 minutes per day

Exercise daily

Socialize with positive people


Bright light therapy

Bright light therapy

Hastens the effects of antidepressant drugs

Rapid onset of antidepressant action

Antidepressant effects mediated through eyes

Useful as a nonpharmacological intervention during pregnancy


Bright light therapy1

Bright light therapy

Use a light box with full spectrum light – 10, 000 lux

Time with patient’s circadian phase of melatonin secretion (7.5-9 hrs after evening melatonin secretion

Rare side effects such as: headache, eyestrain, nausea, and agitation


Transcranial magnetic stimulation

Transcranial Magnetic Stimulation

  • Approved for treatment resistant depression

  • Electromagnetic coil placed against scalp and delivers pulses

  • Session is between 30-50 minutes

  • Treatments are 5x week for 4-6 weeks

  • Occasional headache after treatment

  • Some insurance coverage


Alternative treatments

Alternative Treatments

Deep brain stimulation (same as what is used for Parkinsons)

Electroconvulsive therapy (ECT)

Sleep Deprivation (still being studied)


Alternative therapies

Alternative Therapies

  • L- methylfolate or Deplin

  • A form of folate that can cross blood brain barrier

  • 70% of depressed persons have a genetic factor that limits their ability to convert folic acid or folate in food to l-methylfolate.

  • L-methylfolate regulates neurotransmitter production

  • Used as an adjunct to antidepressant medications


Alternative therapies1

Alternative Therapies

  • St John’s wort – antidepressant effects (mild to modest effects)

  • SAMe – possible benefit for depression

  • Omega 3 – possible benefit for depression

  • Melatonin- possible benefit for depression but can improve sleep


Mind body therapies

Mind Body Therapies

  • Psychotherapy

  • Visualization

  • Journaling

  • Meditation

  • Acupuncture


New medications

New Medications


3 new medications

3 New Medications


New medications1

New medications

Fetzima – antidepressant

Works on norepinephrine and serotonin

In same family as cymbalta, pristiq, effexor


New medications2

New medications

Latuda– atypical antipsychotic

Using for mood stabilization, psychosis, adjunct for depression

Same family as Abilify, Geodon, Zyprexa, Seroquel


New medications3

New medications

Brintellex – antidepressant

Works on serotonin but several different receptors involved. Less weight gain and less sexual side effects reported


Drugs of abuse

Drugs of Abuse


Alcohol

Alcohol

  • Most frequently used drug by teens

  • ½ of jr high students drink monthly

  • 14% of teens intoxicated at least 1x in past yr.

  • 8% of teens who drink, drink 5+ drinks


Alcohol1

Alcohol

  • Underage drinking attracts many developing adolescents

  • Peer pressure

  • Increased independence

  • Easy access

  • Increased stress


Alcohol dangers

Alcohol Dangers

  • Lowers attention/car accidents

  • Decreases memory

  • Tend to mix with other drugs – DANGER

  • Intoxication associated with suicides and suicide attempts

  • Males tend to complete less yrs of education if abusing alcohol

  • Drinking increases risk of engage in unsafe sexual practices, or victimization

  • Brain is still developing in adolescents


Students at risk with alcohol

Students at risk with alcohol

  • Family history of alcoholism

  • Genetics

  • Environment

  • Family problems

  • Peers abusing alcohol

  • Psychiatric problems

  • Personality (risk takers)


Marijuana

Marijuana

  • Dried flowers, leaves, stems, seeds from hemp plant Cannabis Sativa which contains THC

  • Most common illicit drug used in US

  • Hand rolled in cigarettes or used in pipes or water pipes (bongs).

  • Can also be mixed in food or brewed as a tea


Marijuana effects on body

Marijuana effects on body

  • THC rapidly passes through lungs into blood which carries chemical to brain and other organs

  • Influences pleasure, memory, thinking, concentration, sensory, and time perception

  • Can affect brain development in young people – affects thinking and memory

  • Increases HR by 20-100% which can last 3 hrs.

  • Increased risk of heart attack


Marijuana effects on body1

Marijuana effects on body

  • High doses of marijuana can cause a temporary psychotic reaction (hallucinations and paranoia)

  • Possible link between marijuana and later development of psychosis

  • Long term marijuana users trying to quit have irritability, sleeplessness, decreased appetite, anxiety, drug craving


Potency of marijuana

Potency of marijuana

  • In 1980, the concentration of THC in marijuana was 4%

  • In 2012, the concentration of THC in marijuana was around 15%


Stimulant abuse

Stimulant abuse

  • Big problem on college campuses

  • Stimulants cannot make you smarter!

  • Persons like to go after the “rush” or the “high” that stimulants can give

  • Also allow to stay awake all night to study

  • Statistics are hard to find for the amount of abuse


Synthetic designer drugs

Synthetic/Designer Drugs


Synthetic designer drugs1

Synthetic/designer drugs

Labeled as not for human consumption

Camouflaged under names such as stain remover, insect repellant

Active ingredients are a moving target

Grown in popularity due to representation as legal and their limited detection by standard tests

May present with s/s that resemble psychiatric disorders such as schizophrenia, anxiety, depression

Longterm consequences relatively unknown


Bath salts

Bath salts

First used in US in July 2010

Cheap ($20-50 per 50mg packet)

Users predominantly young and male

Often coingested with marijuana, alcohol, opiods


Bath salts1

Bath Salts

Contain ingredients similar to ecstasy, methamphetamine, cocaine

Contains cathinone in khat plant

Increase in serotonin, dopamine, norepinephrine


Bath salts names

Bath Salts Names

  • Purple wave

  • Zoom

  • Cloud Nine

  • Lunar Wave

  • White Lightening

  • Scarface

  • Vanilla Sky

  • Bloom


Bath salts2

Bath Salts

  • Cause a surge in dopamine

  • Also surge in norepinephrine


Bath salts3

Bath Salts

Desired effects:

Euphoria

Alertness

Increased sociability

Increased empathy

Intensification of sensory experiences

Sexual arousal


Bath salts4

Bath Salts

Adverse effects

Tachycardia

Hypertension

Hyperthermia/sweating

Mydriasis

Seizures/spasms

Respiratory distress

Death


Bath salts5

Bath Salts

Behavioral side effects

Panic attacks

Agitation

Hallucinations/psychosis/paranoia

Aggression

Self mutilation

Insomnia

Depression


Bath salts6

Bath Salts

May be inhaled, injected, snorted, swallowed , or inserted into rectum or vagina

Effects occur with doses of 2-5mg

Typical dose is 5-20mg

Effects occur 10-20 minutes after ingestion

Desired effects last 2-4 hrs


Bath salts7

Bath Salts

Addiction potential: strong urge to re-dose occurs 20-30” after ingestion

May be 10x more addictive than methamphetamine in rat studies


Bath salts8

Bath Salts

What to look for:

May mimic a psychiatric disorder

Disorientation/agitation

Dilated pupils with nystagmus

Lockjaw and teethgrinding

Rapid, loud, incoherent speech

Emotional, verbal, physical abuse

Negative results on standard urine toxicology but developing new testing


Bath salts9

Bath Salts

Treatment

Mainly supportive

Sedatives (benzodiazepines)

Monitor for respiratory depression

Antipsychotics

Physical restraints may be necessary

Lab work may show elevated liver enzymes

Inderal for BP, tachycardia, tremors, sweating


Molly

Molly

  • Pure form of MDMA or Ecstacy

  • Many more times potent than MDMA

  • Popular

  • Makes it feel as if “everything is right with the world”, euphoria

  • Usually taken as tablet or capsule

  • Surge of serotonin – emotional closeness, sexual arousal

  • Negative: confusion, depression, sleep problems, anxiety


Spice k2

Spice/K2

Synthetic cannabinoids


Spice k21

Spice/K2

Designed to mimic THC (tetrahydrocanninol)

Carry a higher risk of causing psychois

1st appeared in US in 2008

77% of users are male

Inhalation most common route of administration

$10-20 per gram (usual dose is 0.3g)


Spice k22

Spice/K2

What to watch for:

Agitation

Anxiety/Depression

Elevated Blood Pressure/Tachycardia

Hallucinations/Paranoia

Nausea

Seizures

Symptoms may last up to 6 hrs


Spice k23

Spice/K2

Commerical testing is available – formulations change so rapidly that testing quickly becomes obsolete

IV benzodiazepines usually treat

Kidney failure reported in several cases

Possible 3x risk of psychosis

Depression and suicidal ideation may continue

Dependence and withdrawal reported


Salvia

Salvia

Derived from salvia divinroum, a member of the mint family

Works on kappa opiods

Smoke or ingest salvia leaves

Low addiction potential

May have antidepressant effects


Salvia1

Salvia

Desired effects

Relaxation/better mood

Intense psychedelic effects

Hallucinations

Floating feeling, dream like experience

Increase of sensual and aesthetic appreciation

Increased self confidence/insight

Spiritual experience


Salvia2

Salvia

Adverse effects

Racing thoughts

Sleeplessness

Dizziness

Anxiety

Psychosis

Agitation

Sweating/chills

Nausea/vomitting


Synthetic drugs

Synthetic Drugs

  • Website:

  • www. Erowid.org


References

References

  • National Institute of Health, www.nih.gov/ April 2014

  • Saddock & Saddock, Synopsis of Psychiatry, 9th edition, 2003

  • DSM-5, Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association, 2013

  • MedicineNet.com, March 2014

  • NEI Psychopharmacology Congress, 2013

  • Iarovici, NY Times, April 2014


Uncovering the mysteries of psychiatry

Quiz

  • A student with a history of illicit substance abuse is considering trying bath salts as a cheap alternative high that won’t be detectable in standard drug tests. Recent studies indicate:

  • A. it is 10x more addictive

  • B. 5x less addictive

  • C. 10x less addictive


Uncovering the mysteries of psychiatry

Quiz

  • In 2009, what percentage of 16-17 yr olds drove under the influence of drugs/alcohol

  • A. 1.2%

  • B. 3.6%

  • C. 6.3%

  • D. 10.7%


Uncovering the mysteries of psychiatry

Quiz

  • Which of the following statements about adderall (stimulant) is true?

  • A. It can make you smarter

  • B. It can help a person focus, even if they don’t have ADHD

  • C. It causes your body to need less sleep

  • D. None of the above


Uncovering the mysteries of psychiatry

Quiz

  • Alcohol and marijuana are the drugs most abused by teens. What comes next?

  • A. Ecstacy

  • B. Cocaine

  • C. Bath Salts

  • D. Prescription drugs and cough medicine

  • E. Tobacco


Uncovering the mysteries of psychiatry

Quiz

  • What are things dangerous about bath salts?

  • A. Cause paranoia, hallucinations, violent behavior

  • B. Made with cathinones

  • C. May end up in emergency room after taking them

  • D. Contain unknown ingredients

  • E. All of the above


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