Category Archives: psychiatry

9 Things to Do BEFORE School Starts!

Hey Parents! A successful school year begins before the first day of school. Don’t stress! We have you covered with these 9 simple steps:

1-“Walk-through” the school.

Especially, if this is a new school! Locate their classroom and make notes about the seating arrangement. If your kid goes to several different teachers during the day: walk their entire schedule with them. Noting the arrangement and “feel” for each class. It is suggested to do these things even if it is not a new school because it will at least be new teachers and classrooms.

HELP THEM FIND:

  • Classrooms & homeroom
  • Bathrooms & Lockers 
  • Gym & Cafeteria
  • Nurse’s Office 

Read the rest of this entry

Everyone has an inner RAINBOW

Hey all,

Back in graduate school, I completed my dissertation on Multicultural Identity Development. My chair, Dr. Mark Rosenblatt urged me to create my own minority identity development model. But at that time, it seemed like an overwhelming task and I was too scared of thinking outside the box. So, I attempted to improve someone else’s work. Dr. Pamela Hays had already come up with the very thorough: ADDRESSING Model. Using the word ADDRESSING as a mnemonic, each letter represents a category of social diversity. Here is her work:

Age

Developmental and acquired Disabilities

Religion

Ethnicity

Socioeconomic status

Sexual orientation

Indigenous heritage

National origin

Gender

Like I said, for the time (this was 10+ years ago) it was very inclusive. However, I saw few ways in which it could be expanded to incorporate LGBT+ people. Therefore, for my project, I simply expanded a few items within her existing framework.

Here is Chandler’s LGBT+ Adapted ADDRESSING Model:

Age & Generational influences

Disorders

Disabilities

Religion & spiritual orientation

Ethnicity, race & Culture

Socioeconomic status & education

Sexual identity (see chart)

Ideology

Nationality & Indigenous heritage

Gender identity (see chart)


Also, I expanded the Center for Gender Sanity’s Diagram of Sex and Gender:

Here’s a slightly expanded model, called:
Dr. Chandler’s Complete Sexual Identity Model:

Complete Sexual Identity Model-Dr. Jon Chandler.jpg

You can also see it referenced in this YouTube video, or in the embedded video at the bottom of this post…

For many years after graduation, I was presenting those expanded ADDRESSING & Sexual Identity Models to encourage corporations, agencies, therapists, and individuals to be more inclusive and accepting of diversity all over the country.

Then, a day after presenting at the Southern PFLAG Conference in New Orleans, it hit me. Here I am presenting this wonderful information but highlighting other people’s work. I revisited the idea of coming up with my own model. Once I sat down, I realized it was right in front of me, all along. The categories are similar to Dr. Hays’ work. BUT, I MADE MY OWN MODEL:

Chandler’s RAINBOW Model (of course, that’s the name!)

Race: ethnicity, culture, family structure and spoken/written language(s)

Age and generational influences

Inherent and Acquired Disorders, Diseases and Disabilities: physical, neurological, mental, psychological, emotional, and behavioral

Nationality & Indigenous heritage: immigration status

Belief systems: religion, spirituality, political ideology, how you perceive others, the world and yourself

Orientation: complete sexual identity including: sex, gender identity, gender expression, gender expression attraction, practices, and sexual identity (see chart above)

Work status: socioeconomic status, education, employment/career, class, housing, safety, food security, life experience and income level

There you have it! Chandler’s RAINBOW Model in a nutshell. It is a handy mnemonic to trigger each category of diversity. Further, it is a way to do some much needed introspection about our privileges, biases, and stigmas. Just like with people, when utilized correctly there are no 2 RAINBOW’s alike. Once you’ve had a chance to identify, understand and accept your RAINBOW, you can begin working towards positive changes of accepting other’s RAINBOWs.

Watch my latest training for more information and as always, sharing is caring!!

Dr. Jon Chandler

Your Kid’s a Liar

In today’s political climate, it seems everyone lies. They even have a website to show just how much each presidential candidate actually lies. So, you are probably wondering why people lie and if there is ever a good time to lie? The answer is a little more complicated than you might think. See, none of us are perfect. We cannot expect our children to be, either. If you want your child to be more like Hillary, Barack, and Bernie, and less like Trump, Pence, and Ryan… keep reading.

Liar, Liar Pants on Fire
pinocchio-boypinocchio-girl

First let me say,  ALL kids lie. But everyone lies for different reasons. Yes, there are reasons people lie and if we can figure out the WHY, we can usually nip it in the bud. Some children with ADHD, ODD, and other behavioral disorders lie as a symptom of their disorder. That is not to excuse the behavior, it is just a reality. Their tendency to make mistakes has them thinking they need to cover it up — kids with these issues are especially prone to fibbing. How should you respond when you catch your children in a lie? The most important thing you can do as their parent is to be proactive, not reactive. I’ll expound on this more later. Use the tips below to help your child recognize the importance of telling the truth, and nothing but the truth.

Lying, a mental health symptom?

The impulse to tell lies does not make your kiddo a bad person, nor is it evidence of a character flaw. They are not inherently bad, so don’t start picturing their future jail cell. It can be a byproduct of ADHD, or ODD, or Bipolar Disorder. But as with other symptoms of these disorders, it usually improves with medication. But even with pharmacotherapy, your kid may need some extra coaching to understand the importance of telling the truth.

Make Consequences Clear & Consistent

Some kids tell lies out of feelings of insecurity, concocting fanciful stories in an effort to make themselves seem cooler to other kids. If this is your kid’s reasoning, punishing them could be counterproductive. Instead, make sure they understand what will happen if they get caught in a lie. The downside of telling a lie — even a really small one — may be obvious to us, but kids need to be reminded that lying usually causes more problems than it eliminates.

Teach the 1-2-3 Method

If your kid suffers from any of the disorders we mentioned earlier, they may be prone to blurting out answers to questions. Because they have not thought out the question, the “answer” could range from semi-true to liar-liar-pants-on-fire. Teach them they do not need to be the first one to answer and the answer does not have to be instant. Have them think about the question as they count to 3, “1, one thousand, 2, one thousand, 3, one thousand.” If they come up with the correct, truthful answer, they may answer the question. This is ensuring your kid knows that answering truthfully and accurately is more important than a timely response. 

Be Proactive, not Reactive

If your child says something you know to be untrue, stay calm. Reacting angrily, or with obvious dismay, or disgust, will only make your child feel the need to tell additional lies to defuse the situation. This is actually a survival technique. They fear they are in danger (not that you have beaten them but that they are in trouble) and want to get out as quickly as possible. Be proactive. Give them a free get-out-of-jail card by allowing them another chance to come clean without repercussion.

KidiFact

Give your kid the opportunity to reconsider their answer. Allow them one free get-out-of-jail card with another chance to come clean without consequences. “I’m not sure that’s exactly how things went. Do you want to try again? You get 1 free do-over…” This teaches children to 2nd-guess a misleading answer.

Honesty is Always the Best Policy

You will notice that children often lie to cover up mistakes, or misbehavior. This can be tempting to hand down a bunch of consequences. But working towards increasing positive behavior, studies show, is more reinforcing. Therefore, “catch them being good” and reward them for their honesty. This will make it more desirable to tell the truth, thereby decreasing dishonesty.

Teach Acceptable Lies

Explain the socially appropriate use of very small lies to prevent undue harm to others. For example, if they received a gift they did not like from someone in their class. Ask which response they would most likely give:

A. “Aww man.”
B. “I don’t like that kind of toy.”
C. “Thank you for the thoughtful gift.”

If your child (naturally) picks C, give them a high five! Be sure to explain why that was the correct choice for the situation. If they answer with A or B, explain how the friend’s feelings might be hurt. Furthermore, that it is not harmful to lie to save someone’s feelings in certain social situations. Emphasizing that this is the only acceptable exception.

Let’s Review, when your kid lies:

  1. Stay cool
    -Understandably, it’s hard to stay calm when it seems so easy for your kid to lie. Especially, right to your face!! Rather than taking it personally, remember their behavior is about them, not you! If you constantly lecture, or lose your cool, your child will not feel safe to tell the truth. Recall how their survival instinct kicks in.
  2. Get to the Root of the Problem
    -Lying isn’t the real issue, we all lie for a reason. We may not agree with their reason but we have to understand it made sense to them. Kids with behavioral disorders tend to lie to cover up what they view as shortcomings. They usually have an unwavering desire to be normal. If we can make them feel normal about some of their faults, they will be more honest with us. Additionally, if we can improve their impulse control, they will not feel the “need” to lie.
  3. Level with Them 
    -Say, “Jackson, I know you fibbed because you made a mistake and wanted to cover it up. You might have felt like you were out of control, so you panicked and made up a tall tale. I’m not angry with you – I want to help. Just so you know, your lying does not make me love, or like you any less, but it does mean I will have a hard time trusting you. I’d like to give you a chance to earn it back. But this is a one-time deal.”
  4. Come up with a Safe Word
    -We already talked about how giving a consequence for every lie won’t change things in the long run. Kids do not always know how we are going to respond when they tell us of their errors. If you remain calm and open no matter what your kid says to you, they will likely tell you everything. Even things you probably could have lived your whole life without knowing. LOL. So, in my house we say “Sesame” to signal someone is about to open up and we might not like what comes out.

Page 2-Medical Apps that Save Time & Lives

Take a look at RxP’s 2nd page of apps:

IMG_1267

The following Medical apps are listed:

  • Interactions: UPDATE-Don’t bother, already removed from iPhone!
    • When I started making these reviews, I decided to clean it up a little. So I deleted Interactions and a few other apps. Interactions started out being a pretty easy to use, bare bones, drug interaction check. However, an update (or lack there of) made it where you can only search generic medications. Additionally, I don’t trust that it is entirely accurate in its findings. I wouldn’t even bother with this one. See below:

       

      WebMD

  • WebMD:
    • Now, I’m sure almost everyone (whether you are in the medical field, just curious, or a hypochondriac) has heard of and probably uses WebMD on a regular basis. It’s a great app and comes in handy when a patient tells me they have a rare disease, or medical disorder. Helps the user with Symptom Checker, Med Reminders,  Conditions, Rx, First Aid Info, Local Health Listings, Medical terms, and Tests and Procedures.
    • Also, from the link above you will find every WebMD app available. WebMD Pregnancy & WebMD Baby were particularly helpful when my wife was pregnant and we had our son!
    • **Bonus: They recently teamed up with Walgreens to allow a quick scan of your bottle to refill, or transfer meds to your nearest Walgreens, right inside the app! Of course, you could use the Walgreen’s app for a few more features.

       

  • MDLinx  MDLinx Oncology Articles:
    • I realize Oncology articles, while interesting, seem unrelated to psychology, or medical psychology. However, I decided to download this app in order to learn more information about cancer and their treatments because #CancerSucks. Furthermore, I currently have patients (and friends) in recovery from various forms of cancer. This app provides access to the latest medications, treatments, and trials.
      (Dedicated to my buddy, Scott, who lost his battle to cancer in 2014.)
    • For a bonus, go over to MDLinx.com was extremely helpful when I was studying for the Medical Exam (PEP). It gives you a free, board-like examination to prepare for whatever board you are taking. They are the same makers of The Smartest Doc board prep, just select your specialty and voila! You’re on your way to a few practice tests.
  • Psychiatry: UPDATE: Don’t bother with this one, either.
    • This app is pretty limited. I only realized that after I downloaded it. It wants you to buy the videos? I was initially curious but that is gone, now. I will likely delete this one, as well.

LactMed

  • LactMed:
    • This app has come up recently on the LAMP (Louisiana Academy of Medical Psychologists) listserv. At times during our practice, we have a patient who becomes pregnant, or a new patient comes in with pregnancy-onset depression, or with post-partum depression, or psychosis. Therefore, we have a dilemma of wanting to help the patient maintain, or gain their stability while not endangering the fetus/child. The reality of it is that there just aren’t that many studies done with pregnant women and psychotropic medications. You can guess why that may be… who wants to put their unborn child at risk? That said, the studies that have been conducted have mixed results. Therefore, the FDA assigns a category based on how the medication has been (and if) studied and their effects, see below:
      FDA Preg Categories
    • Therefore, a prescriber has to weigh the risks vs. the benefits (Risk-Benefit Ratio) and analyze the situation with the patient in order to come to a consensus about whether to continue with the current medications, change to “safer” medication(s), or taper off all medication(s). This can apply when the mother is breastfeeding, as well. As some medications will pass through the mother’s milk. LactMed provides a lot of valuable information to assist with the decision process.

       

MangoApp

  • Mango Health:
    • Now, this app is cool. It’s extremely user-friendly so I frequently recommend it to patients to set reminders for their medications. Especially, those who are required to take their medication(s) more than once per day and/or take multiple medications. It uses a “token economy” (a Cognitive Behavior concept) to reward you when you take your meds! Highly effective when dealing with teens and other non-adherent patients.

       

      Stay tuned…

  • Psychiatry Lite
  • NCSBN’s Rx Flashcards
  • Mastering Psychiatry

Medical Apps that Save Time and Lives

Yesterday, I told you about Epocrates. It has been a god-send since I started using it. **See my original post to see what I like and dislike about that particular app**

Today, I want to tell you about a few (okay a lot of) other medical apps I use on a regular basis. Most of them are free, so why not?! Here are some screenshots of my iPhone’s RxP (Rx=Medical Psychologist) Medical App folder.

As you can see, I have collected quite a few. I would say they are pretty much in order of importance from left to right screenshots. Inside each screenshot, I tend to position the apps I use more frequently in the middle and corners. Don’t ask me why, it’s just how my brain works. (And yes, that’s my little boy in my background image. He just turned 1!)

The 1st page (far left screenshot) you will see:

IMG_1199

  • Rx Shortages:
    • This is extremely useful when you are attempting to prescribe a slightly rare medication because you can save yourself  and your patient a lot of time (and money) by making sure there is not a shortage in your area. A little more user-friendly than theFDA Drug Shortage app listed below.

      RxShortages

  • Epocrates:
    • See my previous post about why I use Epocrates on a daily basis.
  • FDA Drug Shortages:
    • Similar to Rx Shortages but shows a slightly different view of drug shortages in your area and is run by FDA. That is both a blessing and a curse, as it is both exhaustive and cumbersome.

      FDA Drug Shortages

  • About Herbs: or Herbal Guide on Google (Disclosure: I have not used, yet!)
    • This used to be a great app but is currently buggy and I can’t even open it, at the moment. Ugh! When it was working, it showed most OTC herbal remedies that can be used for mild (to moderate) mental health issues.
  • MPR:
    • Basic, but user-friendly and free.MPR
  • Formulary: At quick glance there does not seem to be an equivalent Google app (please correct me if I’m wrong.)
    • A very useful app for checking if a particular insurance will approve a medication you are thinking about prescribing. This is extremely important for working with patients with Medicaid! (About 95% of my caseload.) Downfall is that it is not always 100% accurate.

      Drug Shortages

  • MobilePDR:
    • This is a highly useful app and competes with Epocrates pretty well.

      IMG_1207

  • LabGear: (there are a few Lab Value app on Google but I have not tried any.)
    • This is one of the only apps for which I paid. It was a whopping $2.99, or you can bundle it with a few other Medical apps to make each one cheaper. I highly recommend purchasing it as it is invaluable when analyzing Lab Values and explaining them to your patient.

      LabGear

  • PocketRx:
    • This is app is pretty cool. It’s a lot like the MobilePDR, MPR, and Epocrates. However, what I think sets it apart is the ability to have make a “Med Box.” In the med box, you can add your Patient’s medications. It will show you: Interactions, Precautions, and Side Effects. That’s not even the best part! It will also save the profile for later reference. That is a huge time saver!

      Click the Back button to go the Epocrates Review. Or if you’re ready to see the Next page of Medical Apps, press NEXT!

      imagesimgres

Epocrates Medical App Reviewed (you won’t believe the cost…)

In today’s tech-savvy market it’s out of the ordinary if you are not using medical apps in your every day practice. So, I am sure most of you have either seen and/or used the medical/prescribing apps mentioned below. However, just in case you have not and are still grappling with which ones to actually purchase, here is a no-frills review of Epocrates:

Epocrates:

Pros:

  1. Arguably one of the most useful and universal medical apps on the market.
  2. Despite the recent update, still a pretty clean, simple user interface.
  3. New updates = New user-friendly features.
  4. Quickly check interactions right from the medication information page.
  5. Access to Guidelines for nearly all Specialties.
  6. Pill identifier, pill pictures, tables and math equations.
  7. Provides free empirically-based research articles, as well, as FDA Alerts:

Cons:

  1. Empirically-based articles are in all Specialties and currently, there is no way to narrow it down. (see above, but please correct me if I’m wrong.)
  2. Before the most recent update, the interface was a lot cleaner. Now, it seems convoluted, and a bit cluttered (see below).
  3. New Features = More expensive. Some of the more useful features have to be unlocked via purchase. We are not talking about 0.99, 1.99, 0r 2.99 like most apps. It is 174.99/year!! That said, if you are willing to shell out the $, or your company will pay for it, this could be the ONLY app you need.
  4. Guidelines are limited and not all-inclusive. (Specifically, Psychiatry only has 2 available.)
  5. Marketing advertisement pop-ups.

 

Atypical Antipsychotics, or SGAs

Zyprexa

Zyprexa 10mg

AKA: Second-Generation, Atypical Antipsychotics, or simply SGAs.

As mentioned in a previous post, these medications tend to be superior to that of Typical Antipsychotics because they treat BOTH positive and negative symptoms of Schizophrenia Spectrum Disorders.

Q: What the heck are positive vs. negative symptoms of Schizophrenia?

A: Simply put, positive symptoms are psychotic behaviors like:

  • Delusions and paranoia
  • Disordered thoughts and speech
  • Tactile, auditory, visual, olfactory and/or gustatory hallucinations

While negative symptoms are disruptions to normal behaviors and emotions and can sometimes be confused with clinical depression, with symptoms like:

  • Flat, or dull affect (showing no emotion, monotone voice)
  • Lack of pleasure in everyday life
  • Lack of ability to begin and sustain planned activities
  • Speaking little, even when forced to interact


Since both negative and positive symptoms exist within Schizophrenia, the newer, Atypical Antipsychotics are the treatment of choice, here is a list:

  • Aripiprazole (Abilify)
  • Asenapine Maleate (Saphris)
  • Clozapine (Clozaril)
  • Iloperidone (Fanapt)
  • Lurasidone (Latuda)
  • Olanzapine (Zyprexa)
  • Olanzapine/Fluoxetine (Symbyax)
  • Paliperidone (Invega)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)

Common Side Effects:

  • Dry mouth
  • Blurred vision
  • Constipation
  • Dizziness or lightheadedness
  • Weight gain

Sometimes atypical antipsychotics can cause:

  • Problems sleeping
  • Extreme tiredness and weakness. 

With long-term use, atypical antipsychotics can also carry a risk of:

  • Tardive dyskinesia

Though atypical antipsychotics are usually given for Schizophrenia Spectrum Disorders, they have become increasingly popular as an adjunct (or in addition) to an SSRI, or antidepressant. In fact the FDA recently approved Abilify for people who do not respond to antidepressants alone. You’ve all seen the commercials where the Antidepressant and Abilify become friends…?

Abilify

Abilify as an adjunct

Typical Antipsychotics

AKA: First-Generation, Conventional, or Traditional Antipsychotics, Classical Neuroleptics,or Major Tranquilizers. This class of medications is most often utilized in the treatment of psychotic (positive) symptoms during the course of Schizophrenia.

Here is a list of First-Generation Antipsychotics organized by potency:

Low Potency:

  • Chlorpromazine (Thorazine)
  • Chlorprothixene (Taractan)
  • Levomepromazine (Levoprome)
  • Mesoridazine (Serentil)
  • Thioridazine (Mellaril)

Medium Potency:

  • Loxapine (Loxitane)
  • Molindone (Moban)
  • Perphenazine (Trilafon)
  • Thiothixene (Navane) 

High Potency:

  • Droperidol (Inapsine)
  • Flupentixol (Fluanxol)
  • Fluphenazine (Permitil, or Prolixin)
  • Haloperidol (Haldol)
  • Pimozide (Orap)
  • Prochlorperazine (Compro)
  • Trifluoperazine (Stelazine)


Common Side Effects:

  • Extrapyramidal Symptoms (EPS) like:
    • Acute dystonic reactions: muscular spasms of neck (torticollis,) eyes (oculogyric crisis,) tongue, or jaw
    • Akathisia: A feeling of motor restlessness
    • Pseudoparkinsonism: drug-induced parkinsonism (cogwheel rigidity, bradykinesia/akinesia, resting tremor, and postural instability.
    • Tardive dyskinesia: involuntary asymmetrical movements of the muscles, this is a long term chronic condition associated with long term use of antipsychotics and is sometimes irreversible even with cessation of medication.

Anticholinergic medications are used to treat EPS:

  • Anti-Muscarinic agents
    • Atropine
    • Benztropine (Cogentin)
    • Biperiden
    • Chlorpheniramine (Chlor-Trimeton)
    • Dicyclomine (Dicycloverine)
    • Dimenhydrinate (Dramamine)
    • Diphenhydramine (Benadryl, Sominex, Advil PM, etc.)
    • Doxylamine (Unisom)
    • Glycopyrrolate (Robinul)
    • Ipratropium (Atrovent)
    • Orphenadrine
    • Oxitropium (Oxivent)
    • Oxybutynin (Ditropan, Driptane, Lyrinel XL)
    • Tolterodine (Detrol, Detrusitol)
    • Tiotropium (Spiriva)
    • Trihexyphenidyl
    • Scopolamine
    • Solifenacin
  • Anti-Nicotinic agents
    • Bupropion (Zyban, Wellbutrin) – Ganglion blocker
    • Dextromethorphan – Cough suppressant and ganglion blocker
    • Doxacurium – Nondeplorizing skeletal muscular relaxant
    • Hexamethonium – Ganglion blocker
    • Mecamylamine – Ganglion blocker and occassional smoking cessation aid[2]
    • Tubocurarine – Nondeplorizing skeletal muscular relaxant

Buuuuuuuut, there is such thing as “too much of a good thing” since Anticholinergic medications can cause:

Acute Anticholinergic Syndrome:

  • Ataxia-loss of coordination
  • Decreased mucus production in the nose and throat; consequent dry, sore throat
  • Xerostomia, or dry-mouth with possible acceleration of dental caries
  • Cessation of perspiration; consequent decreased epidermal thermal dissipation leading to warm, blotchy, or red skin
  • Increased body temperature
  • Pupil dilation (mydriasis); consequent sensitivity to bright light (photophobia)
  • Loss of accommodation (loss of focusing ability, blurred vision – cycloplegia)
  • Double-vision (diplopia)
  • Increased heart rate (tachycardia)
  • Tendency to be easily startled
  • Urinary retention
  • Diminished bowel movement, sometimes ileus (decreases motility via the vagus nerve)
  • Increased intraocular pressure; dangerous for people with narrow-angle glaucoma
  • Shaking

Possible effects in the central nervous system resemble those associated with delirium, and may include:

  • Confusion
  • Disorientation
  • Agitation
  • Euphoria or dysphoria
  • Respiratory depression
  • Memory problems
  • Inability to concentrate
  • Wandering thoughts; inability to sustain a train of thought
  • Incoherent speech
  • Irritability
  • Mental confusion (brain fog)
  • Wakeful myoclonic jerking
  • Unusual sensitivity to sudden sounds
  • Illogical thinking
  • Photophobia
  • Visual disturbances
    • Periodic flashes of light
    • Periodic changes in visual field
    • Visual snow
    • Restricted or “tunnel vision”
  • Visual, auditory, or other sensory hallucinations
    • Warping or waving of surfaces and edges
    • Textured surfaces
    • “Dancing” lines; “spiders”, insects; form constants
    • Lifelike objects indistinguishable from reality
    • Phantom smoking
    • Hallucinated presence of people not actually there
  • Rarely: seizures, coma, and death
  • Orthostatic hypotension (sudden dropping of systolic blood pressure when standing up suddenly) and significantly increased risk of falls in the elderly population.

**!!GOLDEN NUGGET!!**
A mnemonic for Anticholinergic Syndrome:

  • Hot as a hare (hyperthermia)
  • Blind as a bat (dilated pupils)
  • Dry as a bone (dry skin)
  • Red as a beet (vasodilation)
  • Mad as a hatter (hallucinations/agitation)
  • The bowel and bladder lose their tone and the heart goes on alone (ileus, urinary retention, tachycardia)

The good news is that Acute Anticholinergic Syndrome is completely reversible and subsides once all of the causative agent has been excreted.

  • Physostigmine is a Reversible Cholinergic Agent that can be used in life-threatening cases.
  • Piracetam (and other racetams), α-GPC and choline are known to activate the cholinergic system and alleviate cognitive symptoms caused by extended use of anticholinergic drugs

With all of that going on it is no wonder that most doctors have switched to the Second-Generation, or Atypical Antipsychotics. That’s not to say that the Typicals are not used, at all. It’s just that Atypicals better treated both the positive AND negative symptoms of Schizophrenia Spectrum Disorders.

Selective Serotonin Reuptake Inhibitors, or SSRIs

Serotonin Selective Reuptake Inhibitors, or SSRIs:

  • Citalopram (Celexa)
    • Initial dose: 20mg/day.
    • Maintenance dose: 20 to 40mg/day.
Celexa

Celexa

  • Escitalopram (Lexapro)
    • Initial dose: 10mg/day.
    • Maintenance dose: 10-20mg/day.
Lexapro

Lexapro

  • Fluoxetine (Prozac)
    • Initial dose: 20mg/day.
    • Maintenance dose: 20-60mg/day.
Prozac

Prozac

  • Paroxetine (Paxil, Pexeva, Sarafem)
    • Initial dose: 20mg/day, titrated slowly by 10mg a week.
    • Maintenance dose: 20-50mg/day, as tolerated/needed.
Paxil 20mg

Paxil 20mg

  • Sertraline (Zoloft)
    • Initial dose:
    • Maintenance dose:
Zoloft

Zoloft

Common Side Effects:

  • Nausea
  • Nervousness, agitation or restlessness
  • Dizziness
  • Reduced sexual desire or difficulty reaching orgasm or inability to maintain an erection (erectile dysfunction)
  • Drowsiness
  • Insomnia
  • Weight gain or loss
  • Headache
  • Dry mouth
  • Vomiting
  • Diarrhea

IMPORTANT: Pharmaceutical companies HAVE to list every side effect reported during clinical trails. So, just because a medication lists a certain side effect DOES NOT MEAN YOU will have it. In fact, most people experience very few side effects and with continued use (2 weeks and beyond), most of the initial side effects dissipate, or resolve completely. Additionally, the dosages listed above are FDA approved for treating Depression in an otherwise healthy Adult. For more specific information in treating your symptoms, consult your doctor. 

Serotonin and Norepinephrine Reuptake Inhibitors, or SNRIs

Serotonin and Norepinephrine Reuptake Inhibitors, or SNRIs:

  • Duloxetine (Cymbalta)
    • For Depression: Cymbalta should be administered a total dose of 40mg/day (20mg 2x daily) to 60 mg/day (given either 1x daily or 30mg 2x daily). There is no evidence that doses greater than 60mg/day give additional benefits.
    • 20 mg opaque green capsules imprinted with “Lilly 3235 20mg”
    • 30 mg opaque white and blue capsules imprinted with “Lilly 3240 30mg”
    • 60 mg opaque green and blue capsules imprinted with “Lilly 3270 60mg”
cymbalta

Cymbalta 60mg

  • Venlafaxine (Effexor XR)
    • Immediate release:
      Initial dose: 37.5 mg orally twice a day or 25 mg orally 3 times a day
      Maintenance dose: May increase in daily increments of up to 75 mg at intervals of no less than 4 days
      Maximum dose: (moderately depressed outpatients): 225 mg/day
      Maximum dose (severely depressed inpatients): 375 mg/day
      Daily dosage may be divided in 2 or 3 doses/day
      Extended release, or XR:
      Initial dose: 75 mg orally once daily
      Maintenance dose: May increase in daily increments of up to 75 mg at intervals of no less than 4 days
      Maximum dose (moderately depressed outpatients): 225 mg/day
      Maximum dose (severely depressed inpatients): 375 mg/day
    • EffexorXR 75 and 150mg

      EffexorXR 75 and 150mg

  • Desvenlafaxine (Pristiq)
    • 50 mg 1x daily, with or without food.

      pristiq

      Pristiq 50mg

Common Side Effects:

  • Nausea
  • Dry mouth
  • Dizziness
  • Excessive sweating

Other side effects may include:

  • Tiredness
  • Difficulty urinating
  • Agitation or anxiety
  • Constipation
  • Insomnia
  • Sexual problems, such as reduced sexual desire, difficulty reaching orgasm, or the inability to maintain an erection (erectile dysfunction)
  • Headache
  • Loss of appetite

IMPORTANT: Pharmaceutical companies HAVE to list every side effect reported during clinical trails. So, just because a medication lists a certain side effect does not mean YOU will get it. In fact, most people experience very few side effects and with continued use (2 weeks and beyond), most of the initial side effects dissipate, or resolve completely.

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