1. Psychiatric Medications
Milwaukee Police Crisis Intervention Team
Psychiatric Medications

2. Major Mental Illness Mood Disorders Thought Disorder
Depression
Bipolar Disorder
Thought Disorder
Schizophrenia
Psychosis
Personality Disorder
Anxiety Disorders
Obsessive Compulsive Disorder

3. Holistic Approach

4. Some medications can work can work differently for different people.
Effectiveness
Bipolar Disorder 80%
Major Depression 65%
Schizophrenia 60%
Some medications can work can work differently for different people.

6. Neurotransmitters Dopamine- pleasure and rewards
Serotonin – feelings of well being
Norepinephrine – stress hormone feelings of arousal

7. Antidepressants Take 4 to 6 weeks to work
Suicide risk increases in first few weeks
Can precipitate a manic episode

8. Selective Serotonin Reuptake Inhibitors (SSRI’s)
Celexa
Prozac
Luvox
Paxil
Lexapro
Zoloft

10. SSRI’s Less lethal in overdose Can cause sleepiness or insomnia
(30xdaily dose – minimal or no symptoms, tremor, nausea, vomiting, drowsiness)
(>75xdaily dose – decreased LOC, EKG changes, seziures)
Most fatalities occurred when combined with other medications or alcohol
Can cause sleepiness or insomnia
Side effects include: weight gain, tremors, sexual dysfunction
Serotonin Syndrome: Too high a dose or a combination with other meds (St. John’s Wort, migraine meds)

11. Atypical Antidepressants
Wellburtrin
Desyrel
Effexor
Remeron
Cymbalta

12. Tricyclic Antidepressants (TCA’s)
Older Medications
Side effects include dry mouth, blurred vision, constipation, urinary retention
High lethality in overdose (30 day supply) – cardiac problems
2 weeks supply enough to cause considerable toxicity.
Imipramine (Tofranil), amitriptyline (Elavil), doxepin (Senequan)

13. Monoamine oxidase inhibitor (MAOI’s)
Monoamine oxidase deactivates the neurotransmitters
Used for treatment resistant depression
Nardil, Parnate
Problems with certain foods containing tyramine (sausage, cheeses, imported beers, sauerkraut) can cause very high blood pressure and stroke

14. MAOI Patch Emsam (selegiline)
At lowest strength (6mg), can be used without dietary restrictions
Patch changed once per day

15. Mood Stabilizers (Lithium)
Treatment of choice for bipolar disorder
Naturally occurring salt
10-21 days to take effect, 1 to 2 weeks to reach therapeutic levels
10% have no response
Small window between therapeutic dose and toxic

16. Lithium (cont.)
Long term risk of kidney impairment and hypothyroid disorder
Side effects include weight gain, acne, tremors. SE’s increase with toxicity levels, which can lead to death.
Caution with vomiting, diarrhea, dehydration, exercise

17. Mood stabilizers – Anticonvulsants
Tegretol, Depakote, Lamictal
Side effects include insomnia, drowsiness, dizziness

18. Antipsychotic Older medications: Cheap
Low potency (more sedating and less movement disorders): Thorazine, Mellaril
High potency (less sedating and more movement disorders): Haldol, Prolixin

19. Intramuscular injection medications for schizophrenia
Haldol
Prolixin
Risperdal
Zyprexa
Geodon

20. Movement Disorders Involuntary movements Lack of movements
Parkinson-like symptoms
Tardive Dyskinesia

21. Atypical Antipsychotics
Newer, more expensive, works on more symptoms, better side-effect profile
Clozaril, Risperdal, Zyprexa, Seroquel, Abilify, Geodon
Some cause weight gain and diabetes

22. Neuroleptic Malignant Syndrome
Potentially fatal
Can occur in the first week of drug therapy
Severe muscle rigidity, catatonia, fever, altered consciousness
Requires emergency treatment

23. Other antipsychotics side effects
Problems with temperature regulation (risk for heat stroke)
Sun sensitivity

24. Anxiety Disorders
Generalized Anxiety Disorder: excessive worry, discomfort
Panic Disorder
Obsessive Compulsive Disorder

25. Anxiety Medications Can sometimes be treated with antidepressants
Short acting Benzodiazepines: Xanax, Valium, Librium, Ativan
Buspar: Longer acting anxiety med

26. Milwaukee Police CIT
Questions?