Right Medication for the Right Diagnosis, Part 1.Intro-A higher standard of care is needed! QandA
Why do you believe a higher standard of care is needed when it comes to prescribing medications that effect mental functioning?
Medication prescribing is general is a process that is very complex, and in mental health disorders it is even more complex because of the very nature of the mind and its disorders. Secondly more than anywhere else in medicine the personalities and relationships between the prescriber and the patient and their family also play a critical role. Thirdly we are dealing with the most precious organ system of the body the brain, for these reasons a higher standard of care is needed in the prescription of medications that effect the mind. Fourthly the most critical side effects of these medications to understand , be aware of and to look for are psychiatric effects which if negative are adverse effects or side effects. Psychiatric medications cause very helpful good effects and may at the same time cause or bring out undesirable negative effects mentally , emotionally and behaviorally. These must be watched for at all times.
What factors are involved in this process prescribing a medication for mental health reasons?
Generally medications use for mental health problems are very safe and well tolerated but this is dependent on at least six interrelated factors : 1.The right medicine properly prescribed for the 2. right diagnosis and 3. at the right dosage and 4. Prescribed in the right way, appropriately titrated and 5. used in the right manner by the patient, with the 6. right education and counseling occurring in the 7. right mental-emotional environment that involves at the minimum the prescriber, the patient and his family. If any these factors in not appropriate to the problem then treatment failure will occur, new disorders and symptoms may be caused by the treatment, the treatment will fail, or make matters worse, or lead to a less than adequate treatment response.
Will your be covering all of these?
This discussion will focus in on the first two facts the “right medicine for the right diagnosis” . An introduction to this was attempted in the article about why is the person still not getting better after sometimes lengthy treatment. Not getting better with your present treatment. This is an expansion on that discussion, going into specific medications, their classes and representative problems, symptom clusters, and disorders or diagnoses.
How will you approach this here?
For purposes of this discussion we will make a huge assumption that the diagnosis on the biochemical level is mostly correct, and we are dealing with a more classic uncomplicated presentation of symptom complexes and mental health disorders. In real life practice these classic uncomplicated problems tend to be the exception rather than the rule, however one must begin somewhere to start to have some basic understanding of the biochemical fit between a problem and the medication.
Are there some other warnings we need to keep in mind?
Some warnings to keep always in mind. 1. Remember to not confuse the label of the disorder with the targets of the medication management. The more precise and measurable the target behaviors, symptoms, or problems are the more likely one will have a good outcome. 2. Secondly don’t confuse the target problems with the brain chemistry problem the medication is trying to address. 3. Thirdly don’t confuse possible effects or side effect of the medication with symptoms you are trying to get better. This is crucial because all medications can have psychiatric side effects, and for psychiatric medications these are the ones that can cause the most therapeutic and diagnostic confusion.
What do you actually do for the individual patient and how will we proceed?
It try to tailor the medication to the specific brain chemistry that the medication theoretically should address and explain this to the patient; attempts will be made to do the same here. What follows is a highly simplified explanation to help one see the logic involved in appropriate medication management. Remember these are classical uncomplicated representations of the disorders. This will be approached by taking the a representative class of the medicine and the disorders and symptom clusters they usually address. We will start with the simplest class with the most dramatically quick response, the neurostimulants and ADHD, then the class called SSRIs used for stable depressions and anxiety disorders , then the world of most complexity, the mood stabilizers that have three sub classes, consisting of the Atypical and typical neuroleptics, anti convulsants, and in a class by itself Lithium Carbonate.
Are there other medications we should know about?
These will be covered one by one as they apply to specific disorders, and consist of medications such as clonidine, gaunfaciene, propanalol, buspirone, anti histamines such as Benadryl , Atarax , Phenergan, just to name a few.