Mental Health Targeted Case Management Training
Lesson 19
Psychotropic Medications
The goal of this lesson is to familiarize the case managers with the types of
psychiatric medications, the side effects, and adverse reactions.
1. Why psychiatric medications? Psychiatric disorders are caused by a
dysfunction in the brain’s chemistry, more specifically, neurotransmitters
such as: norepinephrine, epinephrine, dopamine, and serotonin. In many
cases, psychiatric medications can help by affecting the number or activity
of these neurotransmitters and/or the brain receptors on which they act.
2. Side effects are the number one reason why people discontinue their
medications and the number one reason people are re-admitted to a
psychiatric unit.
3. Adverse reactions are detrimental responses from an FDA-approved
medication that is unintended or unexpected when given in accepted
doses.
4. Psychiatric medications, drug classification and purpose:
a. Anti-psychotic/ Neuroleptic/ Psychotropic – Reduce psychosis
b. Anti-depressants – Elevate mood
c. Anti-anxiety – Reduce anxiety / Panic
d. Mood stabilizing – Reduce Mania
e. Anticonvulsant – Reduce Seizures
f. Central Nervous System Stimulants – Reduce symptoms of ADHD
5. Anti-Psychotic / Neuroleptic / Psychotropic: Typically used to reduce
psychosis, the symptoms of Schizophrenia (delusions, hallucinations,
disorganized speech, flat / inappropriate affect).
a. Medication Trade Name and Generic Name:
1) Thorazine / Chlorpromazine
2) Mellaril / Thioridazine
3) Prolixin (Deconate) / Fluphenazine
4) Trilafon / Perphenazine
5) Loxitane / Loxapine
6) Navane / Thiothixene
7) Stelazine / Trifluoperazine
8) Serentil / Mesoridazine
9) Moban / Molindone
10) Haldol (Deconate) / Haloperidol
11) Risperdal* / Risperidone
12) Zyprexa* / Olanzapine
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13) Seroquel* / Quetiapine
14) Abilify* / Aripiprazole
15) Geodon* / Ziprasidone**
16) Clozaril* / Clozapine**
(Note: * New medications – don’t have adverse reactions of EPS, akathisia, etc.).
b. Common Side Effects:
1) Drowsiness
2) Light headedness, heart racing
3) Drop in blood pressure on standing
4) Nasal congestion
5) Constipation
6) Dry mouth / extreme thirst
7) Blurred vision
8) Skin reactions, rash, hives
9) Weight gain and increase appetite
10) Alteration of body heating mechanism
11) Reduced seizure threshold
12) Sensitivity to light (sunburn)
13) Salivation**
14) Sweating**
15) Urinary hesitancy**
16) Alterations in body temperature**
c. Adverse Reactions:
1) Extrapyramidal Syndrome (EPS) – Fine tremors
2) Akathisia – Motor restlessness, pacing
3) Dystonias – Peculiar involuntary muscle movements (tics /
twitching).
4) Tardive Dyskinesia – Late appearing abnormal movements
of mouth, limbs.
5) Neuroleptic Malignant Syndrome – Pipe-like rigidity, High
fevers.
6) Heart rhythm abnormalities**
7) Drop in white blood cell count, requires bi-weekly blood
tests**
6. Anti-Psychotic Medications: Typically used to alleviate / reduce the
adverse reactions (i.e., ESP, akathisia, dystonia) caused by the use of
anti-psychotic mediations.
a. Medications – Trade Name and Generic Name:
1) Cogentin / Benztropine
2) Benedryl / Diphenhydramine
3) Artane / Trihexyphenidyl
4) Symmetrel / Amantadine
b. Common Side Effects:
1) Euphoria
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2)
3)
4)
5)
6)
7)
8)
Psychosis
Blurred vision
Constipation
Urinary retention
Dry mouth
Decreases sweating / temperature control
Aggravates other movement disorders
c. Adverse Reactions:
1) None listed.
7. Anti-Depressants – Typically used to elevate mood, including symptoms
of depression such as persistent sadness, feelings of hopelessness, guilt,
worthlessness, pessimism, and decreased energy, loss of interest in
activities, sleep disturbance, and poor concentration.
a. Medications – Trade Name and Generic Name:
1) Anafranil / Clomipramine
2) Asedin / Amoxapine
3) Celexa* / Citalopram
4) Desyrel / Trazadone
5) Effexor* / Venlafaxine
6) Elavil / Amitriptyline
7) Lexapro* / Escitalopram Osalate
8) Ludiomil / Maprotiline
9) Luvox* / Fluroxamine
10) Marplan (MAOI) / Isocarboxazid
11) Nardil (MAOI) / Phenelzine
12) Norpramin / Desipramine
13) Pamelor / Nortryptyline
14) Parnate (MAOI) / Tranylcypromine
15) Paxil* / Paroxetine
16) Prozac* / Fluoxetine
17) Remeron* / Mirtazapine
18) Serzone* / Nefazodone
19) Sinequan / Doxepin
20) Surmontil / Trimiyramine
21) Tofranil / Imipramine
22) Vivactil* / Protriptyline
23) Welbutrin* / Bupropion
24) Zoloft* / Sertraline
(Note: Newer medications)
b. Common Side Effects:
1) Nausea
2) Vomiting
3) Dry mouth
4) Confusion / impaired concentration
5) Agitation
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6) Weakness
7) Drowsiness
8) Fatigue
9) Headache
10) Dizziness
11) Rash
12) Sweating
13) Blurred vision
14) Sleeplessness
15) Tremor
16) Side effects for several of the newer anti-depressants
include:
a) Decrease in sex drive
b) Change in blood pressure
c) Seizures
d) Nightmares
c. Adverse Reactions:
1) MAOI – Monoamine Oxidase Inhibitor
2) Ingestion of certain foods may produce a significant
increase in blood pressure.
8. Anti-anxiety Medications: Typically used to reduce the symptoms of
anxiety (restlessness, feeling keyed up or on edge, difficulty concentrating
or mind going blank, irritability, muscle tension, sleep disturbance) and
panic (palpitations, pounding heart, accelerated heart rate, sweating,
trembling, sensations of shortness of breath, feeling of choking, chest pain
or discomfort, nausea or abdominal distress, dizziness, fear of losing
control, chills or hot flashes).
a. Medications Trade Name and Generic Name:
1) Aptiva* / Lorazepam
2) Buspar / Buspirone
3) Klonopin* / Clonazepam
4) Librium* / Chordiazepoxide
5) Serax* / Oxazpam
6) Tranxene / Clorazepate
7) Valium* / Diazepam
8) Vistaril / Hydroxyzine Pamoate
9) Xanax* / Alprazolam
(Note: *Benzodiazepine: Medications from this chemical class are used for their central nervous
system properties including sedation, facilitation of sleep and general anesthesia).
b. Common Side Effects:
1) Stomach upset
2) Constipation
3) Diarrhea
4) Vomiting
5) Confusion
6) Depression
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7) Drowsiness
8) Fatigue
9) Dizziness
10) Disorientation
11) Headache
12) Changes in heart rate
13) Itching / rash
14) In addition, benzodiazepines may cause:
a) Slurred speech
b) Hear growth
c) Change in sex drive
d) Fever
e) Yellowing of skin or eyes
c. Adverse Reactions:
1) Patients on long-term or high dosage of benzodiazepines
may have withdrawal symptoms if therapy is suddenly
stopped.
9. Mood Stabilizing Medications: Typically used to reduce the frequency
and intensity of manic episodes / symptoms such as inflated self-esteem,
decreased need of sleep, more talkative than usual or pressure to keep
talking, racing thoughts, distractibility, and increase in goal-directed
activity, and excessive involvement in pleasurable activities that have a
high potential for painful consequences.
a. Medications – Trade Name and Generic Name:
1) Depakote* / Divalproex
2) Neurontin* / Gabapentin
3) Tegretol* / Carbamazepine
4) Lamictal / Lamotrigine
5) Lithium (Eskalith, Lithane, Lithobid) / Lithium Carbonate
(Note: *Medications also used to treat epilepsy and seizures)
b. Common Side Effects:
1) Stomach cramps
2) Indigestion
3) Weakness
4) Tiredness
5) Clumsiness
6) Drowsiness
7) Depression
8) Unusual bruising
9) Abnormal vision
10) Unusual eye movements
11) Weight gain or loss
c. Common Side Effects of Lithium include:
a) Nausea
b) Vomiting
c) Diarrhea
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d)
e)
f)
g)
h)
i)
j)
k)
l)
Thirst / dry mouth
Increased urination
Lethargy
Fine had tremors
Muscle weakness
Drowsiness
Weight gain
Decrease in blood pressure
Hair loss
d. Adverse Reactions:
1) Liver dysfunction
2) Lamictal: Serious and life-threatening allergic reaction
(rash, hives, difficulty breathing, swelling of the mouth /
face / tongue).
3) Adverse Reactions to Lithium include:
a) Persistent nausea, vomiting and diarrhea
b) Coarse hand tremor
c) Metal confusion
d) In-coordination
e) Vertigo
f) Stupor
g) Unsteady gait
h) Large urine output
i) Seizures or convulsions
e. Lithium Considerations:
1) Lithium decreases sodium reabsorption
2) Essential to maintain a normal diet, including adequate salt
and fluid intake.
3) Periodic blood tests must be performed (Therapeutic range
is .5 to 1.5).
4) Blood samples should be drawn 12 hours after the
previous dose (i.e., before morning dose).
10. Anticonvulsant Medications: Typically used in the treatment of seizures.
a. Medication Trade Name and Generic Name:
1) Dilantin / Phenytoin
2) Felbatol / Felbamate
3) Lamictal* / Lamotrigine
4) Mysoline / Primidone
5) Neurontin / Gabapentin
6) Phenobarbital* / Phenobarbital
(Note: * These medications should not be stopped abruptly, doses should be tapered off over 2-3
weeks).
b. Common Side Effects:
1) Fever
2) Rash
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3) Slurred speech clumsiness
4) Swelling
5) Confusion
6) Dizziness
7) Sleeplessness
8) Nervousness
9) Tremors
10) Headache
11) Nausea
12) Constipation
13) Joint pain
14) Drowsiness (only side effect listed for Phenobarbital)
c. Adverse Reactions:
1) Phenobarbital: Do not stop medication suddenly.
Withdrawal symptoms may be severe and may cause
death.
2) Withdrawal Symptoms include:
a) Anxiety
b) Muscle twitching
c) Tremor of hand and fingers
d) Progressive weakness
e) Dizziness
f) Visual problems
g) Nausea
h) Vomiting
11. Central Nervous System Stimulants:
a. Medication Trade Name and Generic Name:
1) Ritalin, Ritalin SR (Concerta –long acting Ritalin) /
Methlphenidate
2) Adderall (Adderall XR – long acting) / Amphetamine
Mixture
3) Strattera / Atomoxetine
4) Dexedrine / Dextroamphetamine
5) Cylert / Pemoline
6) Desoxyn / Methamphetamine
b. Common Side Effects:
1) Ritalin / Strattera / Cylert / Desoxyn:
a) Skin rash
b) Dizziness
c) Headache
d) Blood pressure changes
e) Decreased appetite
f) Nausea
g) Nervousness
h) Fever
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2) Dexedrine Adderall:
a) Blood pressure elevation
b) Anorexia
c) Restlessness
d) Palpitations
e) Insomnia
f) Tachycardia
g) Dry mouth
h) Diarrhea
i) Phonic tics
c. Adverse Reactions:
1) May be potentially addicting
2) May impair physical coordination
3) May mask symptoms of fatigue
12. Miscellaneous Medications:
a. Medications Trade Name and Generic Name:
1) Re Via / Naltrexone
2) Antabuse/ Disulfiram
3) Dalmane / Flurazepam
4) Aricept / Conepezil
b. Common Side Effects:
1) Re Via:
a) Nausea, vomiting
b) Stomach cramps / pain
c) Appetite loss
d) Diarrhea
e) Constipation
2) Antabuse:
a) Drowsiness, fatigue
b) Psychotic reaction
c) Rash, acne
d) Metallic or garlic-like aftertaste
e) Impotence
3) Dalmane:
a) Nausea, vomiting, diarrhea
b) Heartburn
c) Constipation, stomach pain
d) Nervousness, talkativeness
e) Apprehension, irritability
4) Aricept:
a) Nausea, vomiting, diarrhea
b) Sleeplessness, fatigue
c) Muscle cramps
d) Appetite loss
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e) Headache
f) Weight loss
c. Medication Use:
1) Re Via – Used to aid in the treatment of addiction
2) Antabuse – Used to aid in the treatment of addiction
3) Dalmane – Used to aid in the treatment of insomnia
4) Aricept – Used to aid in the treatment of mild to moderate
dementia of Alzheimer’s disease.