1. Use of Drugs in Mental Health Assoc. professor E. A. Lothe Winter School, Maribor University Maribor, Slovenia, Nov 2015

2. 1.Acquire some basic insight into Mental Health 2.Acquire some basic knowledge of Psycho- farmacological groups of medicines 3.Acquire some basic insight into when, how and why psychofarmacological medication is used – and how this affects the patient 2

3. Goals for this lecture, cont.: The students should Acquire some knowledge on non-medical treatments and significant factors for resilience and recovery. Reflect on use of drugs from ethical and legal perspectives 3

4. Perspectives on mental health Biological Psychic (mental) Psycho-social Cultural Mental suffering can be described as Outside- perspective Vs/ Inside-perspective: That which is experienced by the patient 4

5. Perspectives, cont.: Illness/wellness Symptoms/external and internal Stigma Exclusion/integration 5

6. Some common mental illness diagnoses Psychosis – altered perception of reality Depression – varying degrees of severity Suicidal ideation Anxiety – a number of variables Bipolar variations – affective disorders Eating disorders Susbstance dependency 6

7. Models for treatment of mental illness Hospitalization Outpatient treatment Voluntary vs/coerced treatment Medication Medication-free treatment, examples: Cognitive therapy Trauma treatment Milieu therapy 7

8. Antidepressants Block reuptake of of neurotransmitters (serotonon and norepinephrine) Reduce depression Control anxiety Control obsessions Relieve severe pain Prevent panic attacks Undesirable side effects: nausea, headache, sexual dysfunction, sedation, weight gain, etc. 8

9. Antipsychotic medication Block dopamin receptors Some also block a specific serotonin receptor Relief of psychosis and anxiety Relief of acute mania Undesirable side effects : blurred vision, dry mouth, constipation, tachycardia, sedation, weight gain, ejaculatory difficulty, dizziness. 9

10. Anti-anxiety: Benzodiazepines Facilitate the transmission of the inhibitory neurotransmitter GABA Relief of anxiety Sedation Undesirable side effects: dependence, confusion, memory impairment, motor incoordination. Nausea, headache, dizziness, restlessness. 10

11. Substance abuse and mental health Co-dependency Dual diagnoses Auto-medication Legal substances Illegal substances Dependency-risky prescribed drugs 11

12. Other issues significant for mental health Autonomy Significant relations Hope Resilience Healing and wellbeing Empowerment Coping strategies Recovery 12

13. Good friends pull together 13

14. Relations and their significance for mental health and recovery Issues that promote relations competence Working together : the individual, the family, the social network group and society 14

15. Recovery – healing processes Spontaneous and natural development (without organised treatment) A consequence of treatment interventions (clinical recovery) Recovery in spite of countinued suffering from symptoms and functional disability 15

16. Goals for the nurse Preserve life Build an alliance – important regarding use of drugs Strengthen the patient´s self esteem Encourage the patient in developing the wish to live Assist in dealing with existential crisis 16

17. Nursing tools and actions Multiple different therapies: ex. cognitive, trauma, milieu. Motivate Offer togetherness - share time with Respect Empathy and attentive listening Time and full attention 17

18. The good therapeutic session Building relations Communication –Open invitation –Listening attentively –Listen to the silence and to the affective message Create an alliance for teamwork Use yourself as a tool 18

19. Relevant professional ethical and legal issues for reflection Autonomy vs/paternalism Principle of beneficence Confidentiality Substance legislation 19

20. Suggested reading: Davidson, L et al (2008). Remission and recovery in schizophrenia: practitioner and patient perspectives. Schizophrenia bulletin, vol:34 (1), pp :5 -8 Link BG; Struening EL; Neese-Todd S; Asmussen S & Phelan JC (2001). Stigma as a barrier to Recovery. The Consequences of Stigma for the Self-Esteem of People with Mental Illnesses. Psychiatric Services, vol.52, (12), Dec. http://dx.doi.org/10.1176/appl.ps.52.12.1621 Topor A; Borg M, Di Girolamo S & Davidson L (2011). Not just an individual journey: social aspects of recovery. Int J Soc Psychiatry Jan 20. Townsend, MC (2015). Psychiatric Mental Health Nursing. Concepts of Care in Evidence-Based Practice. Philadelphia, USA, F.A.Davis Co. 20