Mhgap and Psychotropic Medications PDF

PHARMACOLOGICAL MANAGEMENT FOR MNS CONDITIONS (mhGAP), PSYCHOTROPIC MEDICATIONS CONTENTS 01 Definition of mhGAP 02 Definition of MNS Condition 03 Priority MNS Conditions 04 Psychotropic Medications 05 Nursing Interventions  What is mhGAP? In 2008, the World Health Organization...

PHARMACOLOGICAL MANAGEMENT FOR MNS CONDITIONS (mhGAP), PSYCHOTROPIC MEDICATIONS CONTENTS 01 Definition of mhGAP 02 Definition of MNS Condition 03 Priority MNS Conditions 04 Psychotropic Medications 05 Nursing Interventions  What is mhGAP? In 2008, the World Health Organization (WHO) introduced the Mental Health Gap Action Programme (mhGAP) as a response to the significant disparity between the existing resources and the urgent requirements to tackle the substantial global burden of mental, neurological, and substance use disorders. Through mhGAP, WHO seeks to offer health planners, policymakers, and donors a well-defined and cohesive set of initiatives and programs aimed at expanding the provision of care for mental, neurological, and substance use disorders.  Mental, neurological, and substance use (MNS) disorders are major contributors to morbidity, disability, injury, and premature mortality, and increase the risk for other health conditions. MNS (Mirror Neuron System) conditions refer to disorders or conditions that are associated with abnormalities or dysfunction in the mirror neuron system, a neural network that plays a role in understanding and imitating the actions and emotions of others.  Social Imitation and Languages and Motor Challenges Emphaty Communication Coordination Repetitive Sensory Limited Theory of Mind Behaviors Sensitivities Interests Challenges  Initiated upon diagnosis, these services Early Intervention encompass speech therapy, occupational therapy, physical therapy, and developmental Services interventions, particularly crucial for children. A structured, data-driven approach focusing on behavior modification and Applied Behavior skill development, frequently used for individual with ASD. Analysis (ABA) Specialized therapist work on improving Speech and communication skills, encompassing speech articulation, language comprehension, and Language Therapy non- verbal communication. Occupational therapist address fine motor skills, self care abilities, and Occupational sensory processing, facilitating everyday activities. Therapy  Programs designed to enhance social Social Skills interaction skills, including recognizing social cues, turn-taking, and empathy. Training Tailored education plans, such as Individualized Education Plans (IEPs) or Educational 504 plans, outline necessary accommodations and supports within Interventions educational settings. Aids individuals with sensory sensitivities in Sensory Integration processing and coping with sensory input Therapy through controlled exposure to diverse sensory experiences. Beneficial for individuals experiencing anxiety, obsessive-compulsive Cognitive-Behavioral behaviors, or emotional challenges, helping manage and cope with these Therapy (CBT) emotions.  Empowers parents and caregivers with Parent Training strategies and support for managing behaviors and promoting skills at home. and Support Utilizes technology, like communication devices and Assisstive communication apps on tablets, to support learning and communication. Technology Implemented in educational settings, these Peer-Mediated interventions train peers to interact with individuals with MNS conditions, fostering Interventions social inclusion. Provide opportunities for individuals to engage with peers in community Community-Based settings, enhancing social skills in real- Programs world situations. Priority MNS Condition Depression Psychoses Epilepsy Child and Adolescent Mental and Behavioral Disorder Dementia Disorder due to Substance Use Self-harm/Suicide Other significant Mental Health Complaints  DEPRESSION Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. It affects how you feel, think and behave and can lead to a variety of emotional and physical problems. May have trouble doing normal day-to-day activities. Sometimes may feel as if life isn't worth living.  COMMON PRESENTATIONS Multiple persistent physical symptoms with no clear cause Low energy, fatigue, sleep problems Persistent sadness or depressed mood, anxiety Loss of interest or pleasure in activities that are normally pleasurable PHARMACOLOGICAL INTERVENTION Consider antidepressants Consider the person’s age, concurrent medical conditions, and drug side-effect profile. Start with only one medication at the lowest starting dose. Antidepressant medications usually need to be continued for at least 9-12 months after the resolution of symptoms. Medications should never be stopped just because the person experiences some improvement. PHARMACOLOGICAL INTERVENTION  PSYCHOSES Psychosis affects the way your brain processes information. It causes you to lose touch with reality. You might see, hear, or believe things that aren’t real. Psychosis is a symptom, not an illness. It can be triggered by a mental illness, a physical injury or illness, substance abuse, or extreme stress or trauma. COMMON PRESENTATIONS Marked behavioural changes, neglecting usual responsibilities related to work, school, domestic or social activities. Agitated, aggressive behaviour, decreased or increased activity. Fixed false beliefs not shared by others in the person’s culture. Hearing voices or seeing things that are not there. Lack of realization that one is having mental health problems PHARMACOLOGICAL INTERVENTION Start antipsychotic medication immediately. Prescribe one antipsychotic at a time. Start at the lowest dose and titrate up slowly to reduce risk of side effects. Try the medication at a typically effective dose for at least 4-6 weeks before considering it ineffective PHARMACOLOGICAL INTERVENTION PHARMACOLOGICAL INTERVENTION  EPILEPSY A chronic noncommunicable disorder of the brain, characterized by recurrent unprovoked seizures. Epilepsy may occur in people who have a past history of birth trauma, brain injury (including head trauma and strokes), or brain infections. Two types: Convulsive and non-convulsive Non-convulsive epilepsy has features such as change in mental status while convulsive epilepsy has features such as sudden abnormal movements.  COMMON PRESENTATIONS Convulsive movement or seizures During the convulsion: loss of consciousness or impaired consciousness, stiffness, rigidity, tongue bite, injurym incontinence of urine or faeces After the convulsion: fatigue, drowsiness, sleepiness, confusion, abnormal behaviour, headache, muscle aches, or weakness on one side of the body PHARMACOLOGICAL INTERVENTION PHARMACOLOGICAL INTERVENTION CHILD & ADOLESCENT MENTAL & BEHAVIORAL DISORDERS Developmental Disorders Behavioural Disorders Emotional Disorders CHILD & ADOLESCENT MENTAL & BEHAVIORAL DISORDERS Developmental Disorders Is an umbrella term covering disorders such as intellectual disability as well as autism spectrum disorders. These disorders usually have a childhood onset, impairment or delay in functions related to central nervous system maturation. CHILD & ADOLESCENT MENTAL & BEHAVIORAL DISORDERS Behavioural Disorders Is an umbrella term that includes specific disorders such as attention deficit hyperactivity disorder (ADHD) and conduct disorders CHILD & ADOLESCENT MENTAL & BEHAVIORAL DISORDERS Emotional Disorders Emotional disorders are characterized by increased levels of anxiety, depression, fear, and somatic symptoms.  COMMON PRESENTATIONS Child/adolescent being seen for physical complaints or a general health assessment who has emotional, behavioural or developmental disorders Carer with concerns about the child/adolescent’s difficulty keeping up with peers or carrying out daily activities considered normal for age and their behaviour Teacher with concern about a child/adolescent Community health or social services worker  DEMENTIA Dementia is a chronic and progressive syndrome due to changes in the brain The conditions that cause dementia produce changes in a person’s mental ability, personality, and behaviour. Alzheimer’s disease is the most common cause, however, dementia can be caused by a variety of diseases and injuries to the brain.  COMMON PRESENTATIONS Decline or problems with memory (severe forgetfulness) and orientation (awareness of time, place and person) Mood or behavioural problems such as apathy (appearing uninterested) or irritability Loss of emotional control (easily upset, irritable or tearful) Difficulties in carrying out usual work, domestic or social activities PHARMACOLOGICAL INTERVENTION Antipsychotic medication for behavioural and/or psychological symptoms Provide psychosocial interventions first. If there is imminent risk to a person or carers, consider antipsychotic medication. Follow the principles of: “Start low, go slow” (titrate) and review the need regularly (at least monthly). Use the lowest effective dose. Monitor the person for extrapyramidal symptoms (EPS). Avoid i.v. haloperidol. Avoid diazepam.  DISORDER DUE TO SUBSTANCE USE Disorders due to substance use include both drug and alcohol use disorders and certain conditions including acute intoxication, overdose and withdrawal. ACUTE INTOXICATION Is a transient condition following intake of a psychoactive substance resulting in disturbances of consciousness, cognition, perception, affect, or behaviour.  DISORDER DUE TO SUBSTANCE USE OVERDOSE Is the use of any drug in such an amount that acute adverse physical or mental effects are produced WITHDRAWAL Is the experience of a set of unpleasant symptoms following the abrupt cessation or reduction in dose of a psychoactive substance; it has been consumed in high enough doses and for a long enough duration for the person to be physically or mentally dependent on it.  DISORDER DUE TO SUBSTANCE USE HARMFUL USE A pattern of psychoactive substance use that damages health. Damages may be physical or mental, can lead to health issues like liver disease or depressive disorder, often resulting in social problems in family or work. DEPENDENCE A psychological condition where a person prioritizes using a psychoactive substance. This prioritized use can cause intense cravings and a loss of control, which frequently lead to high levels of substance use and withdrawal.  COMMON PRESENTATIONS Appearing affected by alcohol or other substance Signs and symptoms of acute behavioural effects, withdrawal features or effects of prolonged use Deterioration of social functioning Signs of chronic liver disease Problems with balance, walking, coordinated movements, and nystagmus Emergency presentation due to substance withdrawal, overdose, or intoxication. Person may appear sedated, overstimulated, agitated, anxious or confused  SELF HARM/SUICIDE Self harm is the act of deliberately killing oneself. Self-harm is a broader term referring to intentional self-inflicted poisoning or injury, which may or may not have a fatal intent or outcome. Evaluate for thoughts, plans and acts of self- harm during the initial assessment and periodically thereafter, as required. Attend to the person’s mental state and emotional distress.  COMMON PRESENTATIONS Extreme hopelessness and despair Current thoughts, plan or act of self-harm/ suicide, or history thereof Any of the other priority conditions, chronic pain, or extreme emotional distress PHARMACOLOGICAL INTERVENTION Anti-depressants Mood Stabilizers Anti psychotics may be considered OTHER SIGNIFICANT MENTAL HEALTH COMPLAINTS Other mental health complaints are considered significant when they impair daily functioning or when the person seeks help for them. Other mental health complaints can be due to stress.  COMMON PRESENTATIONS Feeling extremely tired, depressed, irritated, anxious or stressed. Frequently returning with unexplained somatic complaints People with other significant mental health complaints may present with: Symptoms of depression not amounting to depression. Acute stress. PTSD. Bereavement. Medically unexplained somatic symptoms.  PHARMACOLOGICAL INTERVENTION Medication: Some mental illnesses respond well to medication, such as antidepressants and antipsychotics. These medicines change the chemicals in your brain, so you experience fewer symptoms. It’s very important to take medication exactly as your healthcare provider directs. Never stop taking medication for a mental illness without consulting your healthcare provider. Psychotherapy: Talking to a mental health professional can help you work through the challenges of an illness and manage its symptoms. Psychotherapy can be in a one-to-one setting with a healthcare provider or a group setting. Cognitive behavioral therapy (CBT) is a form of psychotherapy. It focuses on helping you change negative behaviors and thought patterns.  PHARMACOLOGICAL INTERVENTION Alternative therapies: Some mental illnesses, such as depression, may improve with alternative therapies. Examples include herbal remedies, massage, acupuncture, yoga and meditation. Talk to your healthcare provider before taking any herbal remedies or supplements. They may affect other medications. Brain stimulation therapies: These treatments change the way nerves and other cells in your brain process chemicals and respond to stimuli. Examples include electroconvulsive therapy and transcranial magnetic stimulation (TMS). PSYCHOTROPIC MEDICATIONS  PSYCHOTROPIC MEDICATIONS A psychotropic describes any drug that affects behavior, mood, thoughts, or perception. It’s an umbrella term for a lot of different drugs, including prescription drugs and commonly misused drugs. PSYCHOTROPIC MEDICATIONS Antidepressants Anti-anxiety medications Stimulants Antipsychotics Mood stabilizers  Antidepressants are a type of psychotropic that doctors may prescribe to treat various mental health disorders, including depression, post-traumatic stress disorder, and generalized anxiety disorder.  Mainly used to treat different types of depression. Among them are major depressive disorder and bipolar disorder. SSRIs are a first-line treatment for depression and a few other mental health conditions  Class of antidepressant drugs used to treat major depressive disorder, anxiety disorders, obsessive– compulsive disorder, social phobia, attention-deficit hyperactivity disorder, chronic neuropathic pain, fibromyalgia syndrome, and menopausal symptom. These drugs are sometimes called dual reuptake inhibitors or dual-acting antidepressants. Monoamine oxidase inhibitors (MAOIs) were the first type of antidepressant developed. They're effective, but they've generally been replaced by antidepressants that are safer and cause fewer side effects.  These are one of the oldest classes of antidepressants still available on the market. They’re reserved for use when newer medications haven’t been effective. Anti-anxiety medications help reduce the symptoms of anxiety, such as panic attacks or extreme fear and worry. Prescription stimulants are medicines generally used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy—uncontrollable episodes of deep sleep. They increase alertness, attention, and energy.  Antipsychotic drugs don't cure psychosis but they can help to reduce and control many psychotic symptoms, including: delusions and hallucinations, such as paranoia and hearing voices. anxiety and serious agitation, for example from feeling threatened.  Doctors prescribe atypical antipsychotics to treat a range of mental health conditions, including schizophrenia, obsessive-compulsive disorder (OCD), and treatment-resistant mania. They may also prescribe atypical antipsychotics off-label for other conditions, such as Tourette's syndrome.  Mood stabilizers are a type of psychiatric drug. They are licensed to be used as part of the treatment for: bipolar disorder. mania and hypomania. In addition to their effectiveness intreating acute mania, many of these medications appear to be useful for prophylaxis against future manic episodes and as adjunctive antidepressants Using effective communication skills allows healthcare providers to deliver good quality care to adults, adolescents, and children with mental, neurological and substance use (MNS) conditions. Create an environment that facilitates open communication Involve the person Start by listening Be friendly, respectful and non-judgemental at all time Use good verbal communication skills Respond with sensitivity when people disclose difficult experiences (e.g. sexual assault, violence or self-harm) Persons with MNS conditions should be treated with respect and dignity in a culturally appropriate manner. As a health care provider, make every effort to respect and promote the will and preference of people with MNS conditions and support and engage them and their carers in the most inclusive way. Persons with MNS conditions are often more vulnerable to human rights violations. Therefore, it is essential that in the health care setting, providers promote the rights of people with MNS conditions in line with international human rights standards, including the UN Convention on the Rights of Persons with Disability (CRPD)* Persons with MNS disorders are at higher risk of premature mortality from preventable disease and therefore must always receive a physical health assessment as part of a comprehensive evaluation. Be sure to take a proper history, including both physical health and MNS history, followed by a physical health assessment to identify concurrent conditions and educate the person about preventive measures. These actions must always be undertaken with the person’s informed consent Assessment of Physical Health Take a detailed history and ask about risk factors. Perform a physical examination. Consider a differential diagnosis. Identify comorbidities. Management of Physical Health Treat existing comorbidities concurrently with the MNS disorder. Refer to/consult with specialists, if needed. Provide education on modifiable risk factors to prevent disease and encourage a healthy lifestyle. Support physical health of persons with MNS conditions. Conducting an assessment for MNS conditions involves the following steps. First, the presenting complaint is explored, then a history is obtained including asking about past MNS issues, general health problems, family MNS history, and psychosocial history. Observe the person (Mental Status Exam), establish a differential diagnosis, and identify the MNS condition. As part of the assessment, conduct a physical examination and obtain basic laboratory tests as needed. The assessment is conducted with informed consent of the person. REFERENCE: https://vetbooks.ir/goodman -and-gilmans-the- pharmacological-basis-of- therapeutics-13th-edition/