Classifications in psychopharmacology Medications play a role in the treatment of nearly every psychiatric condition. For the purposes of this course, psychotropic medications are classified into seven broad categories: antidepressants, anti-anxiety agents (also called anxiolytics), antipsychotics and their “partners” anticholinergics Complementary and alternative therapies in mental health Herbals and dietary supplements have gained interest in Western cultures as people search for natural remedies. Many people feel that natural herbal remedies are healthier and safer overall than pharmaceutical drugs. The Food and Drug Administration (FDA) considers herbal supplements, vitamins, and other dietary supplements to be food sources and, as such, only monitors information on the product’s label and does not regulate their manufacturing or usage. This can result in wide variances in the amount of active ingredient that may be available in a certain product; some products have even been found to contain no active ingredients after undergoing laboratory evaluation. Some herbal supplements have been used in the treatment of mental health conditions, as these products are available over the counter in many stores. Patients may seek information available on the Internet and then choose supplements based upon their understanding. The nurse should always assess the use of herbal and other supplements and educate patients about known mechanisms of action, side effects, and possible interactions with pharmaceutical drugs. It is important to review available research regarding supplements and use this evidence when providing patient education. The role of certain natural herbs in the treatment of psychiatric disorders is discussed below. St. John’s wort ( Hypericum perforatum ) is derived from the St. John’s wort plant. It is primarily used to address depression. St. John’s wort is thought to affect serotonin and monoamine oxidase inhibitors in the brain, similar to antidepressants. There are numerous studies that demonstrate reports of drug-to-drug interactions in patients who used St. John’s wort while taking other medications (including prescribed antidepressants), so it is important that the nurse teaches patients not to combine this supplement with other medication, as it may increase the risk for serotonin syndrome. Valerian root ( Valeriana officinalis ) is powdered and taken in a capsule form. It is believed to work on the gamma-aminobutyric acid (GABA) system to alleviate anxiety and treat insomnia. Valerian should not be taken with other central nervous system depressants (especially anesthetics, barbiturates, and benzodiazepines) because it can potentiate their effects. Side effects include headaches, uneasiness, dizziness, and, sometimes, excitability. Kava kava ( Piper methysticum ) is a South Pacific oceanic herb with sedative, analgesic, and mild euphoria-inducing properties. Kava kava may act on GABA in a manner similar to benzodiazepines, and it does have drug-to-drug interaction effects with those products. Side effects of kava kava can include stomach disturbances, dizziness, and a temporary yellowing of the skin. A person with liver impairment or one who is a heavy alcohol user should never use kava kava because it has been linked with hepatotoxicity (Rivers, Xing, & Narayanapillai, 2016). Banned in some European countries, kava kava is still widely available for over the counter or Internet purchase in the United States, Australia, and New Zealand (Rivers et al., 2016). Ginseng ( Panax ginseng ) is a stimulating herb that can produce energy similar to caffeine, meant to result in improved endurance and reduced fatigue. Jitteriness and nervousness can be side effects of this supplement, as can insomnia, hypertension, restlessness, and, possibly, mania. Ginkgo biloba ( Ginkgo biloba ) has gained popularity for its theoretical ability to improve blood flow to the brain to promote alertness, mental sharpness, and memory; to treat fatigue and stress; and to improve endurance. Ginkgo biloba has antioxidant
(used to reverse some side effects), mood stabilizers, sedative- hypnotics, psychostimulants, and miscellaneous medications designed to reduce or prevent alcohol or drug dependence, including nicotine dependence (Stahl, 2021)
properties, reducing free radicals in the body that cause cellular death (Tulsulkar & Shah, 2013). Ginkgo biloba can interfere with blood clotting and reduce platelet action, leading to increases in bleeding times. It may interfere with anticoagulant therapy and should not be taken by patients with circulatory problems who are taking such medications such as Coumadin, Plavix, or aspirin. Side effects of ginkgo biloba include headaches, nausea, vomiting, stomach upset, and, occasionally, skin allergies (Izzo, Hoon-Kim, Radhakrishnan, & Williamson, 2016). Chamomile preparations are often used in Europe to facilitate digestion, ease gas, and decrease cramping (Mahady, Wicks, & Bauer, 2017). It has been shown to be safe for children and is a first line of therapy in Germany for treating sensitive skin infants and young children (Mahady et al., 2017). To address vitamin and mineral needs, a one-a-day multivitamin supplement for adults and a chewable daily supplement for children can be helpful. Iron deficiency is associated with fatigue and oral conditions such as stomatitis. Omega-3 fatty acids (fish oil, flaxseed oil) have shown positive benefits in treating behavioral problems (Bondi et al, 2014; Raine, Portnoy, Liu, Mahoomed, & Hibbeln, 2015). The fat-soluble vitamins A, D, and K can be dangerous in high doses. B-complex vitamins are associated with energy. Given with calcium, vitamin B6 has been shown to reduce premenstrual symptoms (Masoumi, Ataollahi, & Oshvandi, 2016). L-methylfolate (Deplin), a prescription medical food, is a derivative of folic acid (a B vitamin). It is a dietary supplement that has demonstrated effectiveness in enhancing the treatment of depression and is monitored by the FDA (Shelton, Manning, Barrentine, & Tipa, 2013). Massage is the manipulation of the body’s soft tissues to promote circulation and relaxation. There are numerous types of massage techniques, varying from light touch to deep muscle work and from specific to generalized body parts. Swedish massage is meant to provide relaxation and increase circulation; Shiatsu massage, influenced by Chinese medicine, is used by a specialized practitioner who applies pressure to acupoints on the body with the intention of increasing the life flow (or Japanese ki; Halter, 2018). Reflexology, also called zone therapy , is the application of massage or pressure to the hands and feet to alleviate distress in different parts of the body. The theory of reflexology is that all of the body is represented in areas in the hands and feet, and thus stimulating these trigger points can eliminate distress in the related body system(s) https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4624523/). According to traditional Chinese medical theory, acupuncture points are situated along meridians (channels) in the body that align with a vital energy flow, the Qi (Halter, 2018). Illness or distress interrupts the Qi. Acupuncturists insert tiny filiform needles along the meridians to stimulate and readjust the energy flow. Practitioners diagnose which systems in the body are affected based on inspection, auscultation, olfactory senses, palpation, and taking a limited history of symptoms. Side effects to the treatment are generally mild and may include slight headaches, nausea, or pain in certain areas. In the Western hemisphere, a common use of acupuncture is for the treatment of pain (Halter, 2018 (https://www.sciencedirect.com/science/ article/pii/S2213422021000883?via%3Dihub). Hypnosis is a technique that induces a deep relaxation and calm, trance-like state of mind. The patient’s focus of awareness becomes so restricted that external noise and distractions are no
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Book Code: ANCCUS3023
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