Appendix: A Proposed Approach to Nosology © Ronald B. David, MD While the practice of medicine has experienced major technological advances in recent years, nosologic systems (e.g., International Classification of Diseases – 10 and the Diagnostic and Statistical Manual – IV of the American Psychiatric Association) present at times a confusing array of diagnostic possibilities. Many diseases/disorders may even be represented in more than one place in the diagnostic system. Lack of a comprehensive framework leads to diagnostic confusion in the clinical, teaching, and often in the research setting. Clearly, organization and orderliness are needed to better discriminate between entities. Webster's International Dictionary defines nosology as the branch of medical science that deals with the orderly classification of diseases. My purpose is to propose such a system. This system will submit a priori that if a disease/disorder exists, there must also exist features which discriminate it from similar entities. It is clinically derived by expert opinion, categorical and multi-dimensional. Where the state of the art permits, discriminators have been empirically validated.
Mifa.org.auhelping families & friends find better ways Psychiatric medications finding the appropriate medication and • possible side effects and what should The experience of mental illness can have dosage, and in talking through concerns be done if they occur; a profound impact upon people's work, about side effects. • how long will it be necessary to take the family and social lives, as well as on Medications have both desired effects confidence and self-esteem.
(eg reducing symptoms) and undesired • sources of information about this Most people need assistance in rebuilding effects commonly called side effects (eg medication (eg. internet sites, their lives after experiencing mental drowsiness). The aim is for each person to illness. Ideally, treatment involves find a medication that is tolerable and has Looking up medications in medical biological (medical), psychological and the least number of side effects while it texts, drug texts, or on the internet social components. Whilst medications effectively reduces symptoms. Adherence can be overwhelming and alarming. are the cornerstone of treatment for most to a medication is much more likely when Many possible effects are listed, but mental illnesses, they are not sufficient it is clear that the benefits of taking the not necessarily in order of importance in themselves to lead people to recovery. medication outweigh the costs. Changes or frequency of occurrence and the Instead, medications will alleviate or ease in medications and/or in dosage need to benefits of the medication may not symptoms for most people, providing be achieved in partnership between the be well presented. Discussing concerns a window of opportunity to begin the person taking the medication and the with the doctor or a health professional journey to recovery.
doctor to find optimum outcomes.
can be helpful.
The ongoing use of medications will New medications are becoming It is also important to remember also assist in stabilising symptoms and available regularly, so it is worth that people may experience more preventing relapse.
pursuing the search for a medication that has the most benefit and the least than one diagnosable and treatable This guide may not be all encompassing side effects for a particular person.
condition and may be prescribed a as new medications or ‘brands' may be combination of medications. marketed. If you are unsure about a A feature of most psychiatric medications Before starting or changing any psychiatric particular medication, check with your is that they may only begin to have a medication it is important that the doctor doctor or pharmacist. beneficial effect after several weeks. This can cause frustration and confusion knows whether the person: General guidelines and
about whether the medication is working • has a particular active medical condition; precautions in relation
adequately or is in fact the right one. • is taking any other prescription or to psychiatric medication
It is best to be patient and communicate non-prescription medicines including well with the doctor about the suitability complementary or herbal treatments; Finding the right medication – persist! of the medication.
• is smoking, consuming alcohol or In searching for the right medication, It is useful to request information about: it is important to understand that both • the name of the medication, what it is symptoms and diagnoses can change • is breastfeeding, pregnant or planning supposed to do, and when it should over time. Typically then, a person will be to become pregnant.
begin to take effect; prescribed a variety of medications. It is It is important to take all medications
important that the person who is taking • how the medication is to be as directed, not just on an as
the medication understands what that taken ie. daily, with food etc; needed basis. Most medications for
particular medication is aiming to achieve. • any food, drinks, other medicines and mental illnesses do not work when taken Similarly the person plays an active role activities the person should avoid while irregularly, and extra doses can cause in partnership with the treating doctor in taking this medication; unnecessary side effects.
Any unusual feeling may be a side effect and should be Long-term injectables reported to the doctor. After taking a medication for some time, (often used for people under a Community Treatment Order) people will be better able to identify which feelings go with Common brand names the medication and which do not. However, if a person is still flupenthixol decanoate experiencing discomfort or is worried or afraid, speaking with the fluphenazine decanoate doctor can provide reassurance and alert the doctor that a review haloperidol decanoate of medication may be required. Describe side effects in detail to zuclopethixol decanoate the doctor before changing or stopping any medication. Some possible side effects and precautions Medications for psychosis Side effects include constipation, dry mouth, blurred vision, dizziness (especially after standing up quickly), difficulty in urinating, General information rapid heart rate, weight gain, allergic reactions, impaired alertness, Medications for pyschosis are called ‘antipsychotics'.
drowsiness or sedation, breast enlargement and/or tenderness, Psychosis is a condition in which the functioning of a person's and a change in menstrual cycle for women. Breast enlargement/ brain is severely disrupted, affecting their thoughts, perceptions, engorgement or tenderness can also occur in men.
emotions and behaviour. A person experiencing psychosis These medicines can also cause movements such as motor will have confused thoughts and speech, and difficulty in restlessness, tremor, muscle stiffness or rigidity and muscle jerking, also eye rolling and other involuntary body movements. These are Antipsychotic medications are used for treating schizophrenia, managed with a range of side-effect medications (see below).
schizophreniform psychosis, schizoaffective disorder, substance- Long term use of these medicines can result in tardive dyskinesia induced psychosis and other conditions where psychotic symptoms which is a syndrome of involuntary movements, especially around (ie. hearing voices, hallucinations, confused thinking or delusional the mouth. The involuntary movements include lip puckering, ideas) are present. chewing movements and tongue protusion, involuntary leg jiggling, Interactions between prescribed medications and other drugs such or movement of neck, trunk, or pelvis. Contact your doctor as alcohol and illicit drugs is often unpredictable. Report to the if you are experiencing any of these symptoms.
doctor if illicit drugs are being used.
Atypical antipsychotic medications The medication may take a few weeks to work so it is important for people to continue with the treatment even when they think it may not be working. A medication should be taken for at least Common brand names three weeks before a change is considered, unless severe, adverse reactions necessitate discontinuation. Maximum improvement may take several months. Clozaril,Clopine Other medications may be prescribed with the antipsychotic to assist with the treatment of additional symptoms or side effects.
Typical (Conventional) antipsychotic medications Long-term injectables Common brand names Common brand names Risperdal Consta Some possible side effects and precautions Side effects include weight gain, drowsiness, sleep disturbance and change in eating patterns, dizziness, excess saliva, and agitation.
For clozapine, there are a number of serious side effects requiring close monitoring during treatment. Regular blood tests will be taken to check for signs of the serious (but infrequent) blood condition agranulocytosis (decrease in number of white blood cells that can lead to serious infection and death). Some heart conditions can also develop and monitoring for these will be done also. At certain dosages, seizures may also occur. Medications for side effects Commonly experienced side effects are thirst, nausea, stomach (also called anticholinergic medications or antiparkinsonian agents) upset, weight gain, slight shaking, swollen ankles and passing a lot of urine. If any of the following symptoms are noticed General information contact your doctor immediately: severe shaking, blurred vision, These are used to treat the involuntary muscle effects drowsiness, weakness, twitching, diarrhea, vomiting, slurred of antipsychotic medications. Many involuntary symptoms speech or impaired concentration. Lithium can affect the kidneys and thyroid gland. Blood tests will monitor for any changes in • loss of facial expression; thyroid or kidney function.
• lack of drive to initiate movement; Carbamazepine is an epilepsy medication found to be effective • feelings of restlessness in the muscles – can't stay still; in managing mania and preventing recurrence of mania and • muscle stiffness or rigidity; depression. The right dose is determined by response to treatment • muscle jerks or spasms.
and checking the level of drug in the body (bloodtest).
Common brand names Common side effects tend to occur at the start of treatment and decrease in severity over time. These include drowsiness, dry mouth, blurred vision, nausea, mild dizziness, ringing in the ears Benztrop, Cogentin Side effects of these medications can include dry mouth, blurred If any of the following uncommon side effects are experienced vision, constipation, drowsiness, difficulty in urinating and contact your doctor urgently: skin rash, hives or itching, sore worsening of glaucoma.
throat and flu-like symptoms, severe diarrhea, unusual bruising or bleeding, or yellow skin or eyes (jaundice). Medications for mood disorder If the dose of carbamazepine is too high the following symptoms can be experienced: severe nausea, vomiting, shaking, clumsiness, General information irritability, restlessness or agitation, confusion or changes in vision. Mood disorders are sustained abnormal emotional states that Contact your doctor immediately if you experience any of these disrupt people's lives. Feelings that range from depression and sadness to elation and excitement are often the experience of Sodium Valproate is an epilepsy medication found to be effective people who suffer a mood disorder.
for treating acute mania and recurrences of mania or depression. Mood stabilizers are medications that relieve the symptoms of The right dose is determined by response to treatment and mood chages such as mania and severe depression. They also checking the level of drug in the body (blood test). prevent the recurrence of mania and depression in bipolar disorder when taken regularly over an extended period of time. Common side effects early in treatment are mild stomach cramps, The main medicines used are lithium carbonate and a range of nausea and vomiting, mild diarrhoea, headache, weight gain, drugs first marketed to treat epilepsy. change in menstrual cycle, trembling of hands or arms, drowsiness or rash.
It is important to take the medication regularly as it can take a few weeks to notice the benefit. Often side effects are noticed Uncommon side effects requiring urgent medical attention include before the benefit of the drug.
severe stomach cramps, unusual bruising or bleeding, changes in vision, spots before eyes, confusion, lethargy, vomiting, swollen Each medicine has its own particular precautions. Blood tests are face, yellow eyes or skin (jaundice), hair loss or change in hair required with each to check that the dose is effective and texture, and persistent fever or sore throat. to monitor for problems specific to each medication. When the dose of sodium valproate is too high the following Common brand names symptoms may be experienced: Severe dizziness, severe drowsiness and racing heart beat. Contact your doctor immediately if you lithium carbonate Lithicarb, Quilonum SR experience any of these symptoms.
sodium valproate Other antiepileptic drugs have been used in bipolar disorder. You should request specific information on these medications from Some possible side effects and precautions your doctor or health care professional when they are prescribed Lithium carbonate is a simple element found in nature, (see drug information contact at end of leaflet).
some mineral waters and in the human body. At the right dose, determined by blood monitoring, lithium treats the symptoms of mania and helps prevent recurrence of manic and depressive symptoms.
Medications for depression Some possible side effects and precautions Side effects can include constipation, dry mouth, weight gain, General information blurred vision, difficulty in urinating, dizziness (especially after These are used for treating symptoms of depression, such as standing up suddenly), sleepiness/sedation, rapid heart rate, persistent sadness, hopelessness, poor appetite, insomnia, lack arrhythmias. Rarely, behavioural complications such as mania or of energy, difficulty in concentrating and diminished interest psychosis, seizure in susceptible patients.
in usually pleasurable activities.
Tricyclic antidepressants may increase the frequency of seizures with It will take a few weeks before noticing any improvement in people who experience epilepsy, and episodes of seizures may occur symptoms although some side effects may be experienced. The for those who are not diagnosed with epilepsy. medications may need to be taken for some time to improve mood and maintain the improvement.
Tricyclic medication may interfere with the rhythm of the heart, especially when taken in overdose. Selective serotonin reuptake inhibitors (SSRI) are most commonly prescribed because of their safety and tolerability. If these Other side effects such as worsening of glaucoma, and difficulty do not work then other antidepressant medications may be passing urine should be closely monitored by the treating doctor. tried. Special precautions may need to be followed when changing Individuals who suddenly cease tricyclic medication may experience from one antidepressant to another as combining antidepressant withdrawal symptoms such as nausea and headaches. medications can result in serious reactions. Monoamine oxidase inhibitors (MAOI's) Selective serotonin re-uptake inhibitors (SSRIs) Common brand names Common brand names Arima, Aurorix, Genrix, Maosig Cipramil, Celapram, Talam, Talohexal Genrix, Fluohexal, Lovan, Some possible side effects and precautions Faverin, Luvox, Movox The most serious adverse reaction seen with MAOIs is critically Aropax, Oxetine, Paxetine raised blood pressure often caused by eating tyramine-rich foods (strong flavoured foods or foods needing an aging process to bring out the flavour). This is particularly a risk with phenelzine and Some possible side effects and precautions tranylcypromine. Always consult your doctor or pharmacist before Side effects can include nausea, vomiting and diarrhoea taking ANY prescribed or non-prescribed medicine including those especially early in treatment, insomnia or increased sedation obtainable from the supermarket or health food store.
(particularly in young patients), abnormal dreams, headache, palpitations, yawning, rash, sweating, anxiety, restlessness, If taken with certain food and medications, MAOI can produce sexual dysfunction, bruising.
a severe reaction (critically raised blood pressure), which may rarely cause stroke or death. Individuals who suddenly cease SSRI medications may experience discontinuation symptoms such as nausea, headaches, Other side effects can include insomnia, dizziness, dry mouth, insomnia and flu-like symptoms. When treatment begins with a MAOIs, it is extremely important to discuss the restrictions on both diet and medication (prescription and Common brand names non-prescription) with the doctor.
Anafranil, Clomipramine, Dothep, Prothiaden Melipramine, Tofranil Other antidepressants Common brand names Common brand names Avanza, Mirtazon, Remeron Kalma, Xanax Alprax Atenex, Ducene, Valium Efexor, Efexor XR Alepam, Murelax, Serapax Some possible side effects and precautions Temaze, Euhypnas, Normison Mianserin and Mirtazapine can cause sedation, weight gain, dry mouth, dizziness, weakness and, very rarely serious blood Some possible side effects and precautions changes. The doctor will monitor for any changes especially Side effects can include drowsiness, dizziness, fatigue, in the first 12 weeks of treatment (bloodtest).
irritability, difficulty in coordinating movements, dependence Reboxetine is a specific noradrenaline reuptake inhibitor with long term use, may precipitate seizures in susceptible antidepressant. Common side effects include dry mouth, nausea, individuals, paradoxical reactions such as acute rage, excitement insomnia, racing heartbeat, difficulty urinating.
or stimulation may occur rarely.
Venlafaxine is a selective inhibitor of both serotonin and As with all medications, take as directed. These drugs have high noradrenaline (SNRI). It has a side effect profile similar to the potential for misuse and dependence. Do not increase the dose SSRIs. As the dose increases there may be increase in blood or suddenly stop taking them without discussion with your doctor.
pressure. The doctor will monitor this. When stopping venlafaxine Withdrawal reactions, including restlessness, nervousness, a discontinuation syndrome similar to that with SSRIs may be confusion, weakness, anxiety and convulsions can be caused by sudden discontinuation. Medications for anxiety disorders (also called anxiolytic medications) Further information about psychotropic medications may also be obtained from the Psychotropic Drug Advisory Service at the General Information Victorian Mental Health Research Institute on 03 9389 2920.
The anxiety disorders are a group of illnesses, each characterised by persistent feelings of high anxiety. There are feelings of Other information lines include: continual or extreme discomfort, tension with fear of panic attacks, Medicines Line (NSW) 1300 888 763 (Mon-Fri 9am-6pm) usually without discernible cause.
Consumer Adverse Medicine Events Line (NSW) 1300 134 237 These medications are used for the whole range of anxiety (Mon-Fri 9am-6pm) disorders, including social anxiety disorder, social phobia, Queensland Medications Helpline (QLD) Freecall 1800 632 763 generalised anxiety disorder, post traumatic stress disorder and panic disorder with or without agoraphobia. They are also useful in helping to manage agitation. Some are used to help people to Mental Illness Fellowship of Australia Antidepressant medications, particularly the SSRIs, clomipramine, Mental Illness Fellowship Victoria venlafaxine and mirtazapine (see medications for depression above) are used to treat a range of anxiety disorders without Mental Health Research Institute the tolerance and dependence problems associated with benzodiazepines (Valium and drugs like it). Reboxetine may also National Alliance of the Mentally Ill (NAMI) (USA) be used in the treatment of panic disorder.
Alprazolam is used for the treatment of panic disorder with or without agoraphobia. Temazepam is prescribed to help with sleeping Clobazam is used, short-term, for acute anxiety. Diazepam and Clonazepam are also used as anti-epileptic/seizure medications.
Occasionally Clonazepam may be used for agitation.
Mental Illness Fellowship of Australia Mental Illness Fellowship of Mental Illness Fellowship Victoria ARAFMI (Tas) Inc 08 8221 5072 www.mifa.org.au Sth Australia Inc 03 8486 4200 www.mifellowship.org Launceston 03 6331 4486 Mental Illness Fellowship Nth Qld Inc 08 8378 4100 www.mifsa.org Schizophrenia Fellowship of NSW Inc Moonah 03 6228 7448 07 4725 3664 www.mifnq.org.au Mental Health Carers NT 02 9879 2600 www.sfnsw.org.au Schizophrenia Fellowship of Qld Inc Mental Illness Fellowship of WA Inc 07 3358 4424 www.sfq.org.au 08 9228 0200 www.mifwa.org.au
Colorado Teacher-Authored Instructional Unit Sample Comprehensive Health Unit Title: Personal Choices INSTRUCTIONAL UNIT AUTHORS Adams 12 Five Star School District Pam Gibble Tracy Schreiber Molly Huffman Dave Derby Berthalina Kinsel BASED ON A CURRICULUM OVERVIEW SAMPLE AUTHORED BY Adams 12 Five Star School District