psychopharm: psychologist role working with medical teams

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Psychopharmachology

Lecture 6 – Working with Medical Providers Cont.

Talking to Your Client About Medications

Assessment: Assess beliefs, fears and worries about medications. Assess side effects duration, intensity and frequency.

Look up side effects, consult with a provider and develop plan to minimize their impact.

Address Concerns: Normalize and use as opportunity to develop increased self

acceptance. Support client to discuss concerns with clinician. (Clinical goal:

Healthy boundaries and assertiveness). Support cleint to research normal and high risk side effects and

empower them to understand their treatment.

Develop Interventions to Minimize Impacts of Side Effects

Collaborative Care

Collaborative Care is a diverse set of healthcare protocols that incorporate health, behavioral health and substance abuse services into primary care treatment.

Three Models: The shifted outpatient clinic, The consultation liaison model, and The attached-mental health professional model.

The Attached mental health model: Behavioral Health professionals are attached to a primary care practice and are a part of extended care services.

Date of download: 10/21/2012

Copyright © American Psychiatric Association. All rights reserved.

From: Anxiety Disorders and Comorbid Medical Illness

Focus. 2008;6(4):467-485.

Number of 30-Day Role Impairment Days Associated With Comorbid DSM-III-R Mental Disorders Among NCS-R Respondents With Chronic Physical Disorders

Figure Legend:

Activation of CRF1 signaling pathways and IBS-like manifestations, which can be blocked by CRF1 receptor antagonists.

Psychological Impacts of Medical Diagnosis

Core beliefes about medical condition.

Change in cognitions: Self, world, future.

Adjustment to the medical diagnosis.

Chronic psychological strain.

Adjustment to Medical Diagnosis

Grief Stages: 1. Deniel and Isolation, 2. Anger, 3. Bargining, 4. Depression and 5. Acceptance.

Developing Adaptations: Living with a chronic illness or dissability requires adapting life and building tools to make our life a good life for us.

Understanding diagnosis and how to work with it: Often medical information is confusing and overwhelming. Psychologists can be invaluable to catch missunderstandings and develop realistic apprasials of current abilities.

Dealing with Ablism: Bigotry is real. It impacts how safe we feel with each other. However developing a positive identity can support the transformation of an impediment to a stregnth.

Physiological Impacts of Diagnosis

Impacts of diagnosis on stress response: Asthma, COPD, Diabetes, and chronic pain.

Impacts of diagnosis on mood: Lack of exercise, impacts concentration, impacts cognitive functioning.

Impacts of diagnosis on sleep, eating, breathing, self-care and other basic functions. (Aleostatic load)

Impacts of diagnosis on ability to do things one enjoys and have ease daily living.

Impacts of diagnosis on cognitive functions (Thoughts, cognitions, awareness, delirium or dementia).

Social Impacts of Disease

Change in ability to socialize through reduced energy, focus, stamina and ability.

Poor understanding of disease by friends and family (get over it, or poor them).

Change in physical appearience.

Change in role in family system.

Change in ability to engage sexually or romatically.

Tammy Duckworth, a disabled Iraq War veteran who was elected to represent the 8th congressional district of Illinois in the U.S. House of Representatives.

Vingette

Medication of the Week Presentation

Describe a medication briefly,

Describe what it is used to treat

Describe its side effects

Describe other relivent information.

Case Discussion

Identify clinical cases for case consult at end of training that have a pharmachologcial and a health component of care.

We will have 30 min for case consultation starting at 3:30.

Pharmacological Interventions a Dissorder

Based Approach

Detailed and clear diagnosis as route to best possible treatment (Differential diagnosis and co-morbidity).

Symptoms cluster to dissorder if you treat the main causes you treat the dissorder.

Dissorder Based treatment matches the diagnosis with proper treatment protocol. Depression – CBT, SSRI. Seizure dissorder – Neurontin (or other

anticonvulsent), identifing prodromals, safety planning, increased self-care and stress reduction.

Pharmacological Interventions a Symptom

Based Approach Identify core symptoms effecting paitient (e.g. sleep,

lack of hunger, lethargy, social anxiety, impulsivity, irritability, difficulty concentraiting).

Consider bodily system driving the symptom and its context to assess ways to possibly address symptom (e.g. chronic pain leading to nocturnal rousals - long acting pain medication at night combined with tricyclic).

Consider psychopharacological intervention to reduce symptoms impact on quality of life.

Psychologists as Pharmacology Consultant

Psychologists have begun to realize just how valuable psychopharmacological training can be.

Psychopharmacological training for psychologists is the new face of psychology.

It can prepare the psychologist to (a) Collaborate with physicians in order to craft the right

psychopharmacological regimen for their mutual patients. (b) Recognize which symptoms are likely to benefit from the use

of medications. (c) Examine possible drug–drug interactions. (d) Make sure that the prescription decisions being made are

actually in the best interest of the patient.

Psychologists as Pharmacology Consultant

Prescribing (Louisianna, New Mexico, Navey) Significant post graduate training.

Colaborating – Actively engage with support and dialog about paitient care and medication selection.

Providing Information – Discuss medication information, identify client concers, support adherence, identify side effects and communicate concerns with providers.

Discussion

Working with Medical Providers

People become doctors to help. Medical providers want their patients to do well.

Basic Prinicipals of Clinical Consult with Medical Provider: Listen to the consulting question. Be cofortalble with the limits of your knowledge but speak

the providers language. They are the provider you “make a recommendation for a

medication evaluation.” Be focused and direct. Say concerns in 3 sentenses or less. Give suggestions through questions.

Psychologist Role in Medical Collaboration

Psychologist Role in Medical Collaboration: Develop clinical team and facilitate communication. Support secure attachment between client and health

provider. Support client to be assertive with questions and needs. Provide direct understanding of impact of medical

intervention on client (side effects, medication complience and changes in condition).

Provide neuanced understanding of psychological conditions for medical providers.

Support treatment adherence and know when treatment is not working and urge team to change treatment.

Working with Psychiatrists

Psychologists see their cleints more often then psychiatrists and our input can be vital.

Many issues require a tag team approach working from both angles (e.g. medication adherence, moving from pre-contemplative to contemplative).

Keep medical explinations on the radar.

Important: Building clinical relationship, recognizing and accepting higherarchy, one down position, effective questions and listen well.

Good statement: “I have been noticing ___ have you noticed it?” and follow, “what do you think about it?”

Good questions: What would help your work? What would you like the client to know about their medcations?

Working with Primary Care Physiscians

Psychologists see paitients more oftenthan PCP.

Psychologists can communicate about psychological symptoms and support neuanced decisions about psychopharmacological treatment.

Develop the collaboration with individual providers.

Build care team. Identify the appropraite range of services. Keep members informed. Address concerns. Be willing to call for team meetings.

Support attachment between medical provider and their patients.

Working With Nursing Staff

Nursing staff are the backbone of the organization. They make everything happen. Many medical errors are caught by nurses.

Nurses in some areas prescribe with a physician supervisor.

Nursing as a culture tends to be practical, direct and results focused.

Nurses provide a large amount of direct information and are integral to patient care.

Defference to their knowledge and expertise as well and seeking their input can increase you knowledge and efficacy as well as your direct impact on patients.

Types of Nurses and Their Training

CNA Certified Nursing Assistant - The education and experience for a CNA is limited, therefore so are the job responsibilities (not considered a nurse).

A Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN): Perform all job duties of a CNA, plus more in-depth care, such as administering medications, injections, starting Ivs, develop patient care plans. LPNs/LVNs cannot fill doctor's orders directly, they must take their orders from higher level nurses.

A Registered Nurse (RN) can perform all tasks of CNAs, LPNs, and LVNs and can take orders directly from doctors. They also operate medical equipment, administer IVs, give medications and injections, assist in surgery, administer care plans and sign off another nurse's work.

Master of Science in Nursing (MSN) programs, RN to MSN programs, and graduate specialty diploma programs are available, as well as PhD doctorates for students who wish to pursue advanced nursing work and/or research.

Advanced Practical Registered Nurse (APRN) specializes in certain types of complex nursing care.

Discussion

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CasCase Consultation

Closing Questions

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