Psychopharmacotherapeutics review

Question 1

Define mental health according to the World Health Organization

Answer 1

A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to his or her community

Question 2

What is mental health not?

Answer 2

Mental health is more than the absence of a mental illness

Question 3

Are mental health and mental health problems opposing conditions?

Answer 3

Mental health and mental health problems are not opposing conditions

Question 4

What is a critical component of mental health to understand?

Answer 4

Someone diagnosed with a mental health condition can experience good mental health, while someone without a diagnosed mental illness can experience difficulties at certain times of stress (job loss, housing changes, grief)

Question 5

What is a mental health disorder? How is it defined? What are some other names? Examples?

Answer 5

Results in significant changes in a person’s thinking, emotional state and behavior, and ability to function in social and occupational settings.

Meets defined diagnostic criteria.

Psychiatric diagnosis, Mental illness

Examples: Depression, anxiety, insomnia, bipolar, schizophrenia

Question 6

What is the critical component of mental health disorder?

Answer 6

Meets defined diagnostic criteria

Question 7

What is a mental health problem? How is it defined? What are some other names? Examples?

Answer 7

Broad term that includes mental health disorders and less severe mental health symptoms that do not meet diagnostic criteria but may disrupt personal, social, and occupational functioning.

Experienced and expressed uniquely by individuals.

Poor mental health, Minimal mental well-being

Examples: Stressed, tired, anxious, worried

Question 8

What is the purpose of the Mental Health Services Act?

Answer 8

Purpose: assist people suffering from serious mental illness in receiving treatment

Encourages voluntary receipt of services

Describes what is voluntary and involuntary

Question 9

Define “Voluntary” under the Mental Health Services Act

Answer 9

A person can voluntarily request to be admitted to a mental health centre under the MHSA:

A person may on HIS OR HER OWN REQUEST

a) receive assesment and treatment services

b) With advice and on the on the arrangements of a physician with admitting privileges to a mental health centre, be admitted to a mental health centre

OR

c) Receive other service available pursuant to this ACT

Question 10

Who can make a voluntary request under the MHSA for children?

Answer 10

The admission may be requested by a parent or guardian of the child, or by a mature minor - someone able to make this healthcare decision

For children up to 18 years of age, a parent or guardian can voluntarily admit the child to a mental health centre in order to receive MHSA services with agreement of a physician with admitting privileges to a mental health centre.

However, if the child is a mature minor, the child may have the same health decision-making rights as an adult.

Question 11

What is the only criteria for someone to be voluntarily committed? Does someone require a diagnosis of a mental disorder?

Answer 11

• Only criteria is that the person requires care that can be provided in a mental health centre, and the person consents to the admission
• The person does not have to meet the “mental disorder” definition of the MHSA

Question 12

What are the methods for the initiation of involuntary admission under the MHSA?

Answer 12

Physician or prescribed health professional
–> Examined and Form A completed

Peace officer
–> May apprehend a person without warrant and take a place where he/she may be examined by a physician if the officer has reasonable grounds to believe that the person is: suffering from a mental disorder and likely to cause harm to him/herself or to others or to suffer substantial mental/physical deterioration if he or she is not detained in a mental health centre

Provincial Court Judge
–> May be asked to issue a warrant providing authority to a specified person (usually a peace officer) to apprehend and convey the person to a mental health centre for a psychiatric examination

Question 13

Under the MHSA, what does involuntary refer to?

Answer 13

Where a person needs hospitalization for a mental disorder but it is not possible for them to be admitted voluntarily

Question 14

What are the requirements for an individual to be involuntarily admitted under the MHSA?

Answer 14

2 Form Gs are required before a person is fully involuntarily admitted to a mental health centre

• Forms completed by psychiatrist

Question 15

Who authorizes treatment for involuntary patients under the MHSA? What treatment cannot be authorized?

Answer 15

Mental health treatment for an involuntary patient is authorized by the attending physician under the MHSA

Non-mental health treatment cannot be authorized

Question 16

S.C. is a 40 year old male involuntarily admitted for schizophrenia after addressing concerns about harming other individuals. S.C. is also diagnosed with type 1 diabetes and has not been adherent to there insulin therapy. S.C. is non-adherent to all their medications and states that “medications are only a way for the government to track me.” Under the MHSA, the attending physician may:

a) Only initiate treatment for the diabetes, as S.C. does not meet the criteria for involuntary admission

b) Initiate mental health treatment and administer insulin against the patients wishes

c) Determine S.C. can legally be involuntarily admitted as they are causing personal harm by not adhering to their insulin

d) Determine S.C. can be involuntarily admitted as they are diagnosed with schizophrenia and indicated they may harm others

e) Inititate treatment for S.C. schizophrenia only as insulin cannot be authorized if S.C. is not willing to take the medication

f) D and E are correct actions under the MHSA

Answer 16

F –> D and E are the correct answers

Peace officer
–> May apprehend a person without warrant and take a place where he/she may be examined by a physician if the officer has reasonable grounds to believe that the person is: suffering from a mental disorder and likely to cause harm to him/herself or to others or to suffer substantial mental/physical deterioration if he or she is not detained in a mental health centre

Mental health treatment for an involuntary patient is authorized by the attending physician under the MHSA
Non-mental health treatment cannot be authorized

Question 17

For an involuntary admission under the MHSA, what criteria must be met?

Answer 17

All three criteria must be met including:

1) being found to be a person with a mental health disorder who needs inpatient care

2) not being fully capable of making an admission or treatment decision

3) likely to harm self or others or suffer substantial mental or physical detioration

Question 18

Describe the process for examination, admission and community treatment under the MHSA for voluntary and involuntary admission?

Answer 18

Discharge –> Patients can be made voluntary or form H3 and 4 (put the person under a CTO and defined criteria to meet upon discharge) CTO – need to show once a month with pharmacist to get long acting anti-psychotic (depo)

Question 19

Describe the difference between physical fields of medicine and psychiatry?

Answer 19

Question 20

What is involved in the clinical assessment in psychiatry?

Answer 20

Combination of physical exam & clinical interview

Diagnostic Statistical Manual of Mental Disorders

Currently 5th Edition (DSM-5)
Published by the American Psychiatry Association
Establishes consistent diagnoses

Question 21

List the components of a psychiatric interview?

Answer 21

Patient demographics
–>Name
–>Age
–>Gender
–> Marital status
–> Housing
–> Finance
–> Education

Chief complaint

History of Presenting Illness

Past Psychiatric/Substance Use/Legal History

Medical History

Family Psychiatric history

Social History

Medication History

Risk assessment

Suicide, homicide

Differential Diagnosis

Impression

Treatment Plan

Question 22

Describe the overall concept of a mental status exam?

Answer 22

Observations of patient
–> Throughout the clinical psychiatric interview

Questions about patient’s thoughts, beliefs, perceptions, and cognitions

Creates a picture of the patient

Question 23

A mental status is an analogue of….

Answer 23

Analogue to the physical exam in physical medicine

Question 24

What are the four components of a mental status exam?

Answer 24

Question 25

What tool can a pharmacist use to conduct a suicide risk assessment?

Answer 25

The Columbia Protocol

Question 26

What are the benefits of the columbia protocol?

Answer 26

Question 27

Describe the columbia suicide scale and its respective scoring?

Answer 27

Any yes indicates a need for further care.

If the answer to 4,5 or 6 is YES assist the patient in calling the suicide prevention # or regional crisis #

If they leave the store call 911

Question 28

Describe the current psychotropic nomenclature of medications?

Answer 28

Arbitrarily based on indications the medications were 1st discovered
Antidepressants, antipsychotics, anxiolytics, mood stabilizers, sedatives, stimulants

Flawed and misleading
–>Many drugs have multiple MOAs and are used to manage symptoms of various conditions
Example: antipsychotics used to treat depression, anxiety, and psychosis
–>Differences exist between drugs within current classifications
–>Dose related differences in MOA

Classification system now being questioned by a growing number of psychopharmacologists

Question 29

What are some of the limitations associated with current psychotropic nomenclature?

Answer 29

Outdated
Based on an earlier period of scientific understanding
Does not recognize developments in neuroscience and pharmacology

Does not support clinical decision making
May complicate treatment decisions for HCPs

Inconsistent with other areas of medicine
Classification based on target receptors, enzymes, channels, etc.
e.g. ACE inhibitors, SGLT2 inhibitors

May confuse patients & exacerbate non-adherence
Perplexing when a drug prescribed does not reflect identified diagnosis
e.g. anti-depressant for anxiety

Negatively contributes to stigma

Question 30

When counselling patients on psychotropic medications, a pharmacist should….

Answer 30

Use the mechanism of action to describe the medication

Example: Sertraline

Antidepressant vs. SSRI

Question 31

Briefly describe the role of medication in mental health and substance use care

Answer 31

Medications do not cure mental illnesses, but they can significantly improve symptoms

Medications can reduce the risk of relapse

Medications are only 1 component of mental health and substance use care.

Non-pharm strategies are incredibly important and valuable part of treatment plans.