Download Psychopharmacology for the Non-medical Mental Health Clinician

Department of Counseling and Family Therapy
Saint Joseph College
COUN 564
Psychopharmacology for the Non-medical Mental Health Clinician (online)
Credits: 3
Summer 2010
Judith C. Durham, APRN, PhD, LPC.
[email protected]
(860) 716 7266 (cell)
Course Description:
This course will prepare counselors to provide services in conjunction with a
psychopharmacological prescriber. Content will include the merger of psychotherapy and
pharmacotherapy, history, efficacy and present standard of care. Ethical and legal issues for the
non-medical counselor relating to pharmacotherapy will be covered. Numerous case examples
demonstrating appropriate psychopharmacologic management, and strategies for developing a
collaborative relationship with the prescriber will be presented.
Course Objectives:
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Provide the non medical mental health clinician the necessary background in
neuroanatomy and neurophysiology to be able to understand psychopharmacology.
Assist students in developing a clinical perspective into psychotropic drug usage as an
adjunct to other forms of therapy.
Provide students with the major categories of psychotropic medications and the
commonly used drugs within each of those categories.
Provide students with an understanding of the pharmacodynamics and
pharmacokenetics of psychotropic medication to assist clients in monitoring efficacy
and side effects.
Teach students how to form effective working relationships with
psychopharmacological prescribers.
Provide students with an understanding of the role of the FDA in psychopharmacology.
Pre-requsite: A working knowledge and understanding of DSM diagnoses or Successful
completion of COUN 544.
Course Outcomes:
At the completion of this course, students will:
 Possess knowledge of the major categories of psychotropic medications and understand
their psychologic and physiologic reactions within the body.
 Be able to educate clients regarding the side effects and efficacy of medications.
 Be able to advocate for clients with the prescribing individual.
Required Texts:
Bezchlibnyk-Butler, K.Z. & Jeffries, J.J. (2009). Clinical Handbook of Psychotropic Drugs (18th ed.).
Seattle: Hogrefe & Huber Pulb.
Bezchlibnyk-Butler, K.Z. & Virani, A. S. (200?). Clinical Handbook of Psychotropic Drugs for Children
andAdolescents (latest ed.) Seattle: Hogrefe & Huber Pulb.
Sinacola, R.S. & Peters-Strickland, T. (2006). Basic Pharmacology for Counselors and
Psychotherapists. Boston, MA: Pearson Education, Inc.
Course Requirements:
This is an asynchronous on line class clustered into nine (9) learning units (LU). Learning units
must be completed sequentially and spaced over the semester. Each learning unit includes a
lecture (power point format), an assignment and an online discussion. Students must participate in
the course discussion in a manner that demonstrates active engagement with the material.
Sometimes the answers to the questions will be found in the course material, other times students
must look to the web for answers. Students are also expected to read each others posts within the
discussion board and respond thoughtfully.
Assignments must be posted (when so assigned) or placed in the digital drop box as attachments in
MS Word or text format. Professor will be processing email twice a week. However, students are
encouraged to post generic questions in the course conference under the heading of "Questions to
Instructor" in order that all students may benefit from the information as one would in an actual
classroom setting. Please do not email professor with general course questions. Professor will
be responding to the questions in this folder 2-3 times each week, so please do not expect daily
responses.
Students should be comfortable working in an online medium, be able to navigate the web with
relative ease, and be able to send files electronically. Although not absolutely necessary, it is
recommended that students have a DSL or satellite connection. Students must also obtain an SJC email account and check it regularly. All correspondence from Blackboard uses only the SJC email
system.
Following completion of learning Units 5, 6, 7, & 8, students will submit to instructor an analysis
of the posted case examples discussing medication issues, hypotheses regarding
pharmacodynamics, side effect manifestations, and hypothetical discussion with prescribing
physician including treatment recommendations. Paper must be well written and in APA format;
approximately 3-5 pages exclusive of references. Papers are to be posted in the digital drop box. It
is required that students refer to texts, posted course material, as well as online resources to
complete these assignments.
Course Evaluation and Grading
Through the online Discussion and responses formulated to the questions posed by the instructor,
students must demonstrate active engagement with and mastery of the material.
Total points - 40, 5 for each learning unit.
The grading criteria for the Discussion Board is as follows:
1 point for responding to the question.
2 points if your response integrated material from the text or ppt.
and includes appropriate citations.
3 points if your response includes material from the text or ppt.s
or integrates information/research from the Web including appropriate citations and URL.
4 points if your response includes material from the text or ppt.s
and integrates information/research from the Web including appropriate citations and URL.
5 points if you do an especially detailed of the above.
Because this is an asynchronous class, students may work at their own pace in completing the
learning units. However, in order to spread the work load across the summer session, case
analyses will have a due date by which they must be completed, although students may submit
them earlier. Case 1 - June 16: Case 2 – June 30; Case 3 – 15; Case 4 - July 28; Associated
learning units must be completed before the corresponding case analyses. All Black Board
Discussion assignments and case analyses must be completed by July 28. NO exceptions
will be made.
Analyses of case examples must demonstrate comprehension of the material including
appropriate diagnosis, pharmacokinetics, pharmacodynamics, and clinical wisdom. They must also
integrate course readings and material from the internet.
Papers are to be written in APA format, and be 3-5 pages in length excluding references. (Please do
not exceed the 5 page limit.) I recommend that you consult the American Psychological
Association Publication Manual, 6th ed. (2009) (APA). Papers must be well organized, express
concepts in a clear and fluid manner, and develop ideas with enough elaboration and detail to
adequately cover the subject. The proper mechanics of writing (i.e. spelling, punctuation, verb
tense) is a must.
Total Points – 60, 15 for each paper.
15 points: Written using APA style of citations and referencing. Integration of all salient
information from ppt’s. and other posted material, text, and information from web based
sources.
14 points: Written using APA style of citations and referencing. Integration of essential
information from ppt’s. text, and web based information.
13 points: Written using APA style of citations and referencing. Paper is basically accurate,
although some salient information from text, ppt’s or web based sources is missing.
12 points: Not written using APA Style, or essential information from text, ppt’s or web
based sources is missing.
Academic Integrity
Absolute integrity is expected of every student in all academic undertakings. An atmosphere of
academic integrity is inherent in the philosophy of Saint Joseph College and shall be upheld by all
members of this community. Academic integrity is the responsibility a student assumes for honestly
representing all academic work. This responsibility implies the student will in no way either
misrepresent her or his work or unfairly advance her or his academic status and will neither
encourage nor assist another student in so doing. Academic work includes quizzes, tests, mid-term
examinations, final examinations, research projects, take-home assignments, laboratory work, and all
other forms of oral or written academic endeavor. Any breach of the academic integrity policy will be
addressed immediately in accordance with Saint Joseph College guidelines. (2005-2007, Graduate
Catalog, p.8)
Documented Disability: Important Notice to All Students: Saint Joseph College is committed to
ensure the full participation of all students in its programs. Accordingly, if a student has a
documented disability, and, as a result, needs reasonable accommodation(s) to attend, participate,
or complete course requirements, then he or she should inform the instructor at the beginning of
the course. For further information about services through Saint Joseph College for students with
disabilities, contact the Coordinator of Disability Services. To be provided with reasonable
accommodation(s) you must present appropriate full documentation of your disability to the
Coordinator of Disability Services. Please consult with your professor and contact the Coordinator
of Disability Services at 860-231-5366.
Professional Readiness Statement:
The Faculty of the Counselor Education Program
recognize their ethical obligation to monitor the readiness of those wishing to enter the counseling
profession. The Ethical Code of the American Counseling Association (ACA), section F.9.a., holds
that counselor educators are obligated to address personal and professional limitations of students
and supervisees. Section F.9.a. of the ACA Code of Ethics (2006) states:
F.9. Evaluation and Remediation of Students
F.9.a. Evaluation
Counselors clearly state to students, prior to and throughout the training
program, the levels of competency expected, appraisal methods, and timing of
evaluations for both didactic and clinical competencies. Counselor educators provide
students with ongoing performance appraisal and evaluation feedback throughout the
training program.
F.9.b. Limitations
Counselor educators, through ongoing evaluation and appraisal, are aware of and
address the inability of some students to achieve counseling competencies that might
impede performance. Counselor educators 1. assist students in securing remedial
assistance when needed, 2. seek professional consultation and document their decision
to dismiss or refer students for assistance, and 3. ensure that students have recourse in
a timely manner to address decisions to require them to seek assistance or to dismiss
them and provide students with due process according to institutional policies and
procedures.
The Faculty take their ethical responsibilities stated and implied with in the ACA Code of Ethics
seriously. Therefore, the Faculty will function as an educational team to assess and monitor the
presence of any limitations that may impede a student's progress within the program and/or in the
delivery of counseling services. This assessment will address academic and non-academic
(interpersonal functioning) aspects of the student's performance. The Faculty will meet once each
semester to assess each student's progress in academic and personal development domains and
make recommendations regarding specific concerns. If a student discloses personal information to
a Faculty member, that faculty member may share that information with other appropriate faculty.
Such information will only be shared to the extent necessary to assess the student's ability to serve
in the role of a professional counselor. Faculty members may also consult each other if it is
observed that a student behaves in a manner that is inappropriate, unprofessional, and/or raises
questions regarding that student's readiness for the profession. Faculty will address issues of
readiness with individual students as detailed in the 2009-2010 Counselor Education Student
Handbook.
Additional Recommended Texts & Readings:
Coyle, J.T. (2000). Psychotropic drug use in very young
children. JAMA, 283, 1059-1060.
Julien, R. M. (2001). A Primer of Drug Action: A concise
non-technical guide to the actions, uses and side
effects of psychotropic drugs (9th ed.) New York: W.H. Freeman & Co.
King, J. H., & Anderson, S. M. (2004). Therapeutic
implications of pharmacotherapy: Current trends and
ethical issues. Journal of Counseling & Development, 82, 329-336.
Smith, T. (2005). Psychopharmacology & Psychotherapy:
Ethical considerations for the clinical practitioner. TN: Cross Country Education, Inc.
Stahl, S.M. (2004). Essential psychophamacology:
Neuroscientific basis and practical applications, (2nd ed). Cambridge University Press.
Class Outline
Because this is an asynchronous class, students may work at their own pace in completing the
learning units. However, in order to spread the work load across the summer session, case
analyses will have a due date by which they must be completed, although students may submit
them earlier. Case 1 - June 16: Case 2 – June 30; Case 3 – 15; Case 4 - July 28; Associated
learning units must be completed before the corresponding case analyses. All Black Board
Discussion assignments and case analyses must be completed by July 28. NO exceptions
will be made.
Learning Unit 1
Counselors Role in psychopharmacology
Ethical Issues, The Role of the FDA
Diagnosis is essential.
READ: Sinacola, chapt 1 & 4.
Discussion Board Questions:
1. Introductions:
Since this is the first class session and many of you do not know each other, please go to the
discussion section and under the thread "Introductions" introduce yourselves to each
other, adding your clinical experience and exposure to psychotropic medications. Please
also feel free to add any other questions, thoughts or feelings you have regarding
psychiatric medications.
2. What are the ethical issues associated with Counselors discussing medication with
clients? What is the landmark case of Osheroff v. Chestnut Lodge and how does this relate
to counselors responsibility?
3. Hypothesize why one should be cautious in how one talks to an MD prescriber about
medication? What is often most effective in these discussions?
4. What is ‘off label’ prescribing and what are the associated benefits and dangers
Learning Unit 2: Neuroanatomy and neurophysiology, pharmacokinetics and
pharmacodynamics.
Clinical indicators for pharmacologic interventions.
READ: Sinacola, Chapt 2 & 3, and all ppt.s and documents for this LU.
Discussion Board Questions: Learning Unit 2
Respond on the Discussion Board to each of the following:
1. Neurotransmitters are the chemicals responsible for the transmission of all neuronal
messages in the body. In an effort to always achieve homeostasis, when the body
recognizes an increase in neurotransmitters, it down-regulates, or decreases the number of
neurotransmitter receptor sites. Another attempt at maintaining balance is re-uptake.
What is re-uptake and how does that explain what a selective serotonin re-uptake inhibitor
is?
2. Another equally important role in maintaining homeostasis is played by enzymes,
specifically monamine oxidase. Explain the role of monamine oxidase, and therefore why a
monamine oxidase inhibitor would be a useful psychotropic medication.
3. What is Cytochrome P-450? How does it impact pharmacokinetics and the rule of “One
size does not fit all” associated with the new field of pharmacogenetics?
Learning Unit 3: Treatment of Unipolar Depression:
Classical Antidepressants
Monamine Oxidase Inhibitors (MAOI’S)
Tri Cyclic Antidepressants
Second Generation Antidepressants:
SSRIs: Selective Serotonin reuptake inhibitors
Third Generation Antidepressants
SDRIs: Selective Dopamine reuptake inhibitors
SSNRIs: Selective 5-HT & NE reuptake inhibitors
Nonselective cyclic agents
READ: Sinacola, chapt 5, and all ppt.s and documents for this LU.
Discussion Board Questions: Learning Unit 3
1. Patients are usually slowly tapered off their antidepressant medications rather
than having them abruptly discontinued. Why is this? This is less necessary with
drugs such as Prozac which have a longer half life? Why?
2. Discuss why the newer antidepressants such as the SSRI’s and cyclic agents have
a reduced side effect profile in comparison to the older tricyclic agents? What are
typical side effects for SSRI’s and how long do they last?
3. The combination of MAOI’s and many other psychotropic medications, especially
Tricyclic antidepressants causes the same side effects as eating a food containing
tyramine. Why is this? Thus the general protocol is to wait two weeks after
discontinuing another medication before initiating treatment with an MAOI, or to
wait two weeks after discontinuation of an MAOI before initiating treatment with
another medication. Please discuss.
4. Briefly summarize the key elements of the following article. How might you use this
information?
Biology, Meds & Depression- http://www.medscape.com/viewarticle/418726
(you may need to copy and paste these link into your browser after you sign into
Medscape, rather than try to use it as if it is live link.)
Learning Unit 4:Treatment of Bipolar Disorder
Lithium & Mood Stabilizers (Anticonvulsants)
READ: Sinacola, chapt 6, 17 (Ava), and all ppt.s and documents for this LU.
Discussion Board Questions: Learning Unit 4
1. Due to the fact that the therapeutic level and the toxic level for Lithium are very
close, what must become part of the regimen for folks who are treated with LiCo3
(lithium)? How is this done?
2. Why are mood stabilizers added to a typical medication regimen for individuals
with BiPolar disorder? What other disorder with psychotic symptoms often benefit
from the addition of mood stabilizers.?
3. There are times when it is difficult to differentiate between the symptoms of
Lithium toxicity and am impending manic episode. Discuss the similarities and
differences.
Learning Unit 5: Treatment of Psychotic Disorders
Antipsychotics: Typical, Conventional, and Side effects
READ: Sinacola, chapt 8, and all ppt.s and documents for this LU.
Discussion Board Questions: Learning Unit 5
1. Anticholinergic and EPS are the two groups of most frequently occurring and
bothersome side effects experienced by patients taking Typical/Conventional
Antipsychotic medications. Discuss how one of the specific symptoms of either of
these side effect groups can be confounded by a patient’s psychosis making
differential diagnosis difficult.
2. Off-label prescribing is a widespread practice in which a physician prescribes a
drug (or a medical device) for a purpose different from the one for which the drug
has been approved by the Food and Drug Administration (FDA). This practice allows
for greater flexibility in the use of medications, but may also have some associated
problems. What are some of the off label uses of the typical antipsychotic
medications? Discuss some of the potential benefits and difficulties associated with
this practice.
3.What is Tardive Dyskinesia? What are the risk factors associated with developing
it?
First Case exam due following completion of this unit.
Learning Unit 6: Treatment of Psychotic Disorders, con’t.
Antipsychotics: Atypical, Novel, Second Generation, Side effects
READ: Sinacola, Chapt 8 (review) & 17 (Stone), and all ppt.s and documents for this LU.
Discussion Board Questions: Learning Unit 6
1. Which antipsychotic medications are available in the long acting depot injectable
forms? Why might this be helpful?
2. The newer antipsychotic medications give rise to greater patient compliance due
to their reduced side effect profiles (esp. EPS & TD) over the older typical
antipsychotic medications. In addition, they also offer a significant improvement in
terms of symptom relief. Describe the hypothesis for why this is so, and discuss the
symptom reductions.
3. Many patients who receive Medicare, Medicaid, or are under government care
(such as in prisons) are treated with the older typical antipsychotics. Why is this,
and what does it say about who is in charge of prescribing?
4. Of all the newer atypical, novel or second generation antipsychotic medications,
which drug seems to carry the greatest associated risk for weight gain and an
increased risk for diabetes?
Second Case exam due following completion of this unit.
Learning Unit 7: Medicating children & Adolescents
Psychotropic issues with children
READ: Sinacola, Chapt 9, 15 & 16, and all ppt.s and documents for this LU.
Discussion Board Questions: Learning Unit 7
1. Discuss some of the physiologic, developmental, pharmacokinetic and
pharmacodynamic issues associated with medicating children.
2.Which SSRI’s have been approved for use with children and/or adolescents?
3.What other medications have been approved for children and adolescents—list
associated approved age ranges.
Third Case exam due following completion of this unit.
Learning Unit 8: Medicating Anxiety, Sleep Disorders, and the Elderly
Anxiolytic Agents, Sedative Hypnotics, Cognition enhancers
READ: Sinacola, chapt 7, 10, 11, 19 and all ppt.s and documents for this LU.
Discussion Board Questions: Learning Unit 8
1. Benzodiazepines, such as Ativan and Xanax, are more frequently prescribed by
GP’s and Internists rather than Psychiatrists. Why do you think this is, and what is
the problem with this practice?
2. What are some of the physiologic considerations that must be taken into account
when medicating elders? Would it be better for them to have a drug with a long or
short half life? Why?
4. A growing field in psychopharmacology is the group of drugs called cognition
enhancers. Name some of these drugs and discuss how they are hypothesized to
work.
Fourth Case exam due following completion of this unit.
Learning Unit 9: Treating Personality Disorders, Chemical Dependency & Other
Disorders
READ: Sinacola, chapt 12, 13, & 14, chapt 17 (Candy) and all ppt.s and documents for this
LU.
Discussion Board Questions: Learning Unit 9
1. What is the pleasure center, which neurotransmitter is associated with its
activation, and how does this relate to substance abuse?
2. There are several drugs that are used in the treatment of substance abuse. What
are some of these and how do they work? How effective do they seem to be? Why
might they also be used to treat folks with eating disorders?
3. Which groups of medication have been shown to be most effective with folks who
have personality disorders that have an impulsive component? What is the
hypothesis for this?