Principles of OT in Mental Health - Medications and Treatments

Historical Context
- Until the 1950s, individuals with severe mental health disorders lacked effective medical treatment.
- The introduction of psychotropic medications allowed for the management of symptoms such as hallucinations.
Understanding Signs vs Symptoms
- Signs: Observable characteristics identified by a medical professional, measured through assessments such as body temperature, weight fluctuations, or blood pressure readings.
- Symptoms: Experiences or feelings reported by the client.

Definition
- Psychotropic medications are defined as "mind-changing" drugs that alter brain functions.
OTP Interaction
- Occupational therapy practitioners (OTPs) must observe how these medications impact clients' engagement in daily activities.
Research
- Ongoing investigations aim to identify the most effective and efficient medications.

Impact on Neurotransmitters
- These drugs affect neurotransmitter levels, altering critical brain chemicals such as:
- Dopamine
- Norepinephrine
- Serotonin
Specific Actions
- Medications for schizophrenia target dopamine receptors.
- Antidepressants modify serotonin levels along with other neurotransmitters.
- Medications are primarily administered orally (tablets, capsules, liquids) or through injections to ensure adherence.

Antipsychotic Drugs
- Commonly prescribed for schizophrenia and psychotic disorders.
- Help manage hallucinations and improve reality contact; can reduce aggressive behaviors.
- Adverse Effects
- Discussed are extrapyramidal side effects (EPS) like sunburn, dry mouth, and blurry vision.
- Disadvantages include high costs and difficulty performing activities of daily living (ADLs).
- New Research: Ongoing trials for third-generation antipsychotics address both positive and negative symptoms during acute schizophrenia episodes.
Antiparkinsonian Drugs
- Typically prescribed alongside first-generation antipsychotic medications.
Antidepressant Drugs
- Consist of five classes, each affecting neurotransmitters differently.
- Black Box Warning: Due to the higher risk of suicide among individuals under 25, the FDA mandates warnings on all antidepressants.
- Onset of full effect may take up to three weeks, and certain dietary restrictions are essential (especially for MAOIs).
Mood Stabilizers
- Reduce mood swings and manage mania.
- Lithium, a common mood stabilizer, is toxic and necessitates regular blood monitoring for side effects like neurologic and renal dysfunction.
Anxiolytic Drugs
- Used for anxiety and panic disorders; cause sedation.
- May assist with agitation and alcohol withdrawal symptoms.
ADHD Medications
- Monitor potential side effects, including impaired growth, tics, and increased risk of suicidal thoughts.

Adherence Issues
- Nonadherence rate exceeds 50% within the first year due to feelings of unnaturalness or inconvenience.
- Side effects often deter adherence.
Client Factors
- Conditions such as arthritis, sensory issues, and cognitive challenges affect medication compliance.
- Family opinions on side effects can undermine adherence.

Observing and Reporting Functional Level
- OTPs assess function pre- and post-medication initiation.
- Educate clients on the benefits of medications.
Issues of Adherence
- Clients may alter medication regimens to mitigate side effects or maintain symptom balance.
- Risk of relapse increases with the non-compliance to medical advice.
- OTPs need to observe changes that affect functional abilities and communicate these to medical providers.
Management of Side Effects
- Strategies outlined in Table 8.7 assist clients with side effects.
- Discussions regarding risks of relapse should be facilitated.
Safety Concerns
- Some medications may impair motor skills related to driving.
Medication Education and Management
- The recovery model encourages clients to take charge of their recovery process.

Electroconvulsive Therapy (ECT)
- Incorrectly referred to as "shock therapy"; effectively alleviates severe depression in 80-90% of individuals who do not respond to medications.
- Administered over 8-12 sessions, every other day over several weeks.
Psychosurgery
- Historically utilized procedures like prefrontal lobotomy to relieve severe mental symptoms.
- Gamma radiation surgery is explored for OCD symptom relief.
Somatic Therapies
- Include vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS), and magnetic seizure therapy.
- Bright Light Therapy (BLT): Utilizes controlled UV light exposure for 30-45 minutes daily to treat depression, contraindicated for photosensitive patients.

Kava Kava
- Used to alleviate anxiety.
St. John’s Wort
- Utilized for depression treatment in Europe.
Valerian
- Demonstrated positive effects on insomnia.
Precaution
- Consult with a healthcare provider before initiating any alternative therapies.

Internet Resource Reliability
- Not all online information about medications is trustworthy; clients should consult physicians about their medications.
Box 8.2: Recommended reputable internet sources for drug information.

OTP Professional Qualities
- Should display supportive and nonjudgmental attitudes, cultivate empathy and calmness, establish trust through consistent interactions, and maintain a confident and knowledgeable demeanor.
Signs and Symptoms of Withdrawal
- Medical assessments (blood, urine tests) identify withdrawal states.
- Table 8.8 identifies withdrawal signs and symptoms but emphasizes variability among individuals and co-occurrence of mental disorders during withdrawal.

Initial Evaluation
- Conducted by medical staff encompassing a comprehensive health history, current mental status, neurologic findings, vital signs, substance abuse history, and toxicological reports.
Follow-Up by OTPs
- Evaluates cultural habits, educational backgrounds, living conditions, and social interaction skills among others.

Nutrition and Mealtime
- Establishing meal consistency and nutritious choices aids in forming healthy habits.
- Sensory experiences related to mealtimes (visual, olfactory, gustatory) should be considered as they may overwhelm clients.
Emotional Support
- OTPs assist clients in navigating the range of emotions experienced during detox.
- Encourage connection to social support systems like 12-step programs.

OTPs are responsible for formulating a transition plan that includes community resources, family assistance, and vocational as well as educational pursuits.