Use of Drugs in Mental Health

Assoc. professor E. A. LotheWinter School, Maribor UniversityMaribor, Slovenia, Nov 2015

Goals for this lecture:

The students should

1. Acquire some basic insight into Mental Health2. Acquire some basic knowledge of Psycho-

farmacological groups of medicines3. Acquire some basic insight into when, how and

why psychofarmacological medication is used – and how this affects the patient

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Goals for this lecture, cont.:

The students should

• Acquire some knowledge on non-medical treatments and significant factors for resilience and recovery.

• Reflect on use of drugs from ethical and legal perspectives

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Perspectives on mental health • Biological• Psychic (mental)• Psycho-social• Cultural

• Mental suffering can be described as Outside-perspective

• Vs/ Inside-perspective:• That which is experienced by the patient

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Perspectives, cont.:• Illness/wellness• Symptoms/external and internal• Stigma• Exclusion/integration

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Some common mental illness diagnoses

• Psychosis – altered perception of reality• Depression – varying degrees of severity• Suicidal ideation • Anxiety – a number of variables • Bipolar variations – affective disorders • Eating disorders • Susbstance dependency

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Models for treatment of mental illness

• Hospitalization • Outpatient treatment

• Voluntary vs/coerced treatment• Medication• Medication-free treatment, examples:

• Cognitive therapy• Trauma treatment • Milieu therapy

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Antidepressants • Block reuptake of of neurotransmitters (serotonon

and norepinephrine)• Reduce depression • Control anxiety• Control obsessions• Relieve severe pain• Prevent panic attacks

• Undesirable side effects: nausea, headache, sexual dysfunction, sedation, weight gain, etc.

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Antipsychotic medication• Block dopamin receptors• Some also block a specific serotonin receptor

• Relief of psychosis and anxiety• Relief of acute mania

• Undesirable side effects: blurred vision, dry mouth, constipation, tachycardia, sedation, weight gain, ejaculatory difficulty, dizziness.

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Anti-anxiety: Benzodiazepines• Facilitate the transmission of the inhibitory

neurotransmitter GABA• Relief of anxiety• Sedation

• Undesirable side effects: dependence, confusion, memory impairment, motor incoordination.

• Nausea, headache, dizziness, restlessness.

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Substance abuse and mental health

• Co-dependency • Dual diagnoses• Auto-medication

• Legal substances• Illegal substances• Dependency-risky prescribed drugs

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Other issues significant for mental health • Autonomy • Significant relations • Hope • Resilience • Healing and wellbeing• Empowerment • Coping strategies • Recovery

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Good friends pull together

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Relations and their significance for mental health and recovery

• Issues that promote relations competence • Working together:

• the individual,• the family,• the social network group and• society

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Recovery – healing processes

• Spontaneous and natural development (without organised treatment)

• A consequence of treatment interventions (clinical recovery)

• Recovery in spite of countinued suffering from symptoms and functional disability

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Goals for the nurse

• Preserve life• Build an alliance – important regarding use of

drugs• Strengthen the patient´s self esteem• Encourage the patient in developing the wish

to live• Assist in dealing with existential crisis

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Nursing tools and actions • Multiple different therapies: ex.

cognitive, trauma, milieu.

• Motivate • Offer togetherness - share time with• Respect• Empathy and attentive listening• Time and full attention

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The good therapeutic session

• Building relations• Communication

–Open invitation–Listening attentively–Listen to the silence and to the

affective message• Create an alliance for teamwork• Use yourself as a tool

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Relevant professional ethical and legal issues for reflection

• Autonomy vs/paternalism• Principle of beneficence• Confidentiality

• Substance legislation

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Suggested reading:

Davidson, L et al (2008). Remission and recovery in schizophrenia: practitioner and patient perspectives. Schizophrenia bulletin, vol:34 (1), pp :5 -8

Link BG; Struening EL; Neese-Todd S; Asmussen S & Phelan JC (2001). Stigma as a barrier to Recovery. The Consequences of Stigma for the Self-Esteem of People with Mental Illnesses. Psychiatric Services, vol.52, (12), Dec. http://dx.doi.org/10.1176/appl.ps.52.12.1621

Topor A; Borg M, Di Girolamo S & Davidson L (2011). Not just an individual journey: social aspects of recovery. Int J Soc Psychiatry Jan 20.

Townsend, MC (2015). Psychiatric Mental Health Nursing. Concepts of Care in Evidence-Based Practice. Philadelphia, USA, F.A.Davis Co.

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