Chapter 11: Psychopharmacology
Chapter Overview
The author discusses the basics of neuroanatomy and pharmacodynamics, major classes of mental health
concerns and their corresponding medication options, and the use of psychotropic medications with
special populations. The author highlights the important role of mental health counselors in the
management of their client’s medication.
Key Words
Neuroanatomy – Study of the brain.
Pharmacodynamics – How drugs affect the body
Psychopharmacology – Medications used to treat various mental disorders.
Anhedonia – Loss of interest in previously enjoyable activities.
Multiple Choice Questions
1. Messages transmitted to and from the brain are:
a) Sent from the synapses and passed through the neurons via neurotransmitters.
b) Passed between neurons through neurotransmitters in the synapses.
c) Passed between neurotransmitters by the neurons and stored in the synapses.
d) Stored in the synapses and transmitted by neurons.
e) Stored in the synapses and transmitted by neurotransmitters.
2. What leads to malfunctions in the transfer of messages in the brain?
a) A neuron malfunctions and cannot send messages.
b) A neuron malfunctions and cannot receive messages.
c) A neuron malfunctions and cannot send a complete message.
d) a) and b) only
e) All of the above.
3. What function do agonist drugs perform in the body?
a) They increase the body’s natural response.
b) They decrease the body’s natural response.
c) They eliminate the body’s natural response function.
d) They replace the body’s natural response function.
e) All of the above.
4. Which types of drugs are used to treat anxiety?
a) Drugs that eliminate the body’s natural response to anxiety.
b) Drugs that increase the body’s natural response to anxiety.
c) Drugs that decrease the body’s natural response to anxiety.
d) a) and b) only.
e) All of the above.
5. Which of the following category of drugs is the most commonly used to treat anxiety?
a) Barbiturates
b) Hypnotics
c) Benzodiazepines
d) Nonbenzodiazepines
e) All of the above
6. What is/are the most common concern(s) a counselor will have about a client taking anti-anxiety
drugs?
a) Drug dependency.
b) Withdrawal symptoms.
c) Alcohol consumption.
d) All of the above.
e) None of the above.
7. Depressive symptoms can develop from endogenous and exogenous factors. Which of the
following accurately describes endogenous factors?
a) Genetics, grief, substance abuse, prescription medication.
b) Loss of job, grief, developmental changes, divorce.
c) Genetic, hormonal imbalance, disease, substance use.
d) Genetics, prescription medication, grief, stress.
e) a) and c) only.
8. The brains message malfunctions that lead to depressive symptoms are due to:
a) Some neurotransmitters become depleted or underused.
b) Some neurotransmitters become overactive.
c) Some neurons develop blocks to receiving messages.
d) Some neurons develop blocks to passing on messages.
e) All of the above.
9. There are four classes of antidepressant drugs that act in different ways to relieve depressive
symptoms. Which accurately describes the way in which tricyclic antidepressants work?
a) They prevent the destruction of the neurotransmitters.
b) They prevent the reuptake of selective transmitters into the presynaptic cell.
c) They prevent the reuptake of all transmitters into the presynaptic cell.
d) a) and b) only.
e) All of the above.
10. Which of the following class of antidepressants drugs is most commonly used?
a) Heterocyclic antidepressants.
b) Selective serotonin reuptake inhibitors
c) Tricyclic antidepressants.
d) Monoamine oxidase inhibitors.
e) a) and b) only.
11. Bipolar is characterized by extreme highs and lows in mood disturbance. What factors lead to the
development of the disorder?
a) Environmental stressors.
b) Genetics.
c) Chemical imbalances in the brain.
d) All of the above.
e) None of these, they are not known.
12. A person with Bipolar will usually be treated with a complex mix of drugs that may be adjusted
with mood changes. Lithium is the most common and consistently prescribed drug over the
individual’s lifetime. What are the concerns about the use of Lithium?
a) Lithium has a narrow therapeutic window between benefit and toxicity.
b) It transfers into the bloodstream quickly and so concentration levels are hard to control.
c) It is extremely expensive and so access is limited.
d) Women experience much greater side effects than men.
e) Men experience much greater side effects than women.
13. What are the main distinctive characteristics of psychotic disorders?
a) Inability to perceive and test reality.
b) Day-to–day difficulties in managing life.
c) Problems communicating clearly.
d) a) and b) only.
e) All of the above.
14. Most often a cocktail of drugs is needed to treat the complex mix of symptoms present in
psychotic disorders. Which of the following describes the categories of drugs most often used?
a) Typical and atypical
b) First and second generation anti-psychotics.
c) Tranquilizers and stabilizers.
d) a) and b) only.
e) All of the above.
15. While counselors do not prescribe medication they are the ones who spend the most time with the
client and the opportunity to monitor it. It therefore behooves the counselor to use best practice to
help the client manage his or her medication. Which of the following would NOT be considered best
practice?
a) Understanding when to refer client for medication consultation.
b) Monitor client for drug compliance and side effects.
c) Make dose recommendations to client when side effects are observed
d) Consult with other professionals involved in client’s healthcare.
e) Educate the client about his or medication compliance and side effects.
Activities
1. Multicultural competence and culturally relevant services form the foundation for the way in which
counseling is practiced today. A person’s, or a group’s, experience and history of medication use will be
different and this will play an important role in how the individual responds to medication.
Group activity: Ask each member of the group to select a different cultural population and then research
that group’s attitudes towards psychopharmacology treatment. When considering cultural groups also
bear in mind groups such as socioeconomic, age, education levels and so forth. Then come together as a
group and compare the similarities and differences amongst different populations. What insights are
gained from the comparison? What multicultural competence issues do you see as a result? What sort of
ethical issues does this raise? How might you address these multicultural and ethical issues?
2. Remembering the different types of medication for each disorder and their side effects can be difficult,
especially as a new counselor. However, it is important to have the information at hand so that it can be
accessed easily while working with a client. Often wading through a thick text book is time consuming
and not practical in the moment. Prepare index cards for each disorder with a list of the main classes of
drugs used along with examples of prescription drugs in each class. Also include in each case the side
effects for the drugs. These may be updated regularly as the population you serve and the drugs you deal
with change. Alternatively, design another system that works better for you for capturing the information
and storing it in a way where you could have it at hand when in session with your clients.
3. Communicating effectively with your client’s psychiatrist about issues relating to the client’s
medication use is important. Rambling prose with vague and unnecessary information can not only give
the impression of unprofessionalism, it can lead to serious misunderstandings and frustrations. Equally
insufficient information can also lead to misdiagnosis and time wasting while the relevant information is
retrieved. Think about what information you may need to communicate and how to communicate it in a
succinct and user friendly manner, for example: client’s personal details, symptoms, observations, side
effects, and so forth. Design a form for your use that would prompt you to include all the relevant
information and present it in a logical and user friendly way.
Discussion
1. We all have personal opinions about the use of medication; whether for ourselves, our loved ones, or in
society generally. However, as professional counselors we cannot simply follow our personal beliefs. We
must also consult professional guidelines, scholarly research, and the recommendations of those qualified
to prescribe it. Write an explanation of your position on the use of medication for mental health issues and
the reasons for your point of view. How would you address any differences of opinion you may have with
other mental health professionals you may be working with for your client?
2. Medication compliance is another area of psychopharmacology, especially for chronic disorders where
clients need to take medication for a long time or the life time and serious side effects cannot be avoided.
Discuss how you would address the issue of non-compliance with your client. What is your point of view
about medication compliance? Explore your own history of medication compliance, even for minor
illnesses. How would you feel about having to take strong medications for any disorders you may have
suffered in the past or currently experiencing? Does this influence how you would respond to your client?
If so why?
3. Choose a special population and discuss the challenges and concerns for prescribing and managing
medication for this population. Include in your discussion some of the ethical issues pertinent to the
medication of this population.
Multiple Choice Questions – Answer Key