# Presentation: 239305

## Mental Health Issues in Job Corps—Reaching Beyond

**How to Help Students on Psychotropic Medications While in Job Corps and When Preparing to Leave Job Corps**
- David Kraft, MD, MPH, Regional Mental Health Consultant
- National Health and Wellness Conference
- May 8, 2003

## Principles of Psychiatric Medications

- Medications are a TOOL to help students control feelings, thoughts, and behavior
- Medications are best when COMBINED with counseling and behavioral techniques

## Principles of Psychiatric Medications (continued)

- Medications take AT LEAST 2 WEEKS to begin to work (except side-effects)
- Medications need to be taken at least ONCE A DAY
- Medications take BETWEEN 1 and 2 WEEKS to stop working, in most cases

## Principles of Psychiatric Medications (continued)

- Major CHANGES in medication should be AVOIDED during Job Corps stay (minimize lost training time)
- Newer medications have FEWER SIDE-EFFECTS
- Newer medications are usually MORE EXPENSIVE

## Common Problems Helped with Psychiatric Medications

- DEPRESSION—especially if chronic, not situational
- ANXIETY states, including panic, phobic and obsessive-compulsive disorders, and general stress not responsive to counseling or behavior techniques

## Common Problems Helped with Psychiatric Medications (continued)

- IMPULSIVE tendencies, especially if explosive and can injure student or others
- FLASHBACKS from earlier traumatic events, especially if disrupt sleep or concentration
- Learning difficulties, especially if Attention Deficit Hyperactivity Disorder is involved

## Obtaining Psychotropic Medications for Students

- Student brings medications from home, and gets from doctor at home
- Student’s health insurance pays for medications while in Job Corps
- Student enrolled in Medicaid at center

## Obtaining Psychotropic Medications for Students (continued)

- Job Corps center provides medications through local pharmacy or government supply house (JC Information Notice   02-18)
- Center physician/psychiatrist applies for patient assist program of specific drug company for each medication

## Helping Students Comply with Taking Medications

- Supply each student a list of medications, when taken, and instructions (if any)
- Ask wellness staff to tailor times of taking medications to minimize interference with learning schedule
- Assist students with ways to remember to take chronic medications, e.g., dispenser, daily reminder, convenient times

## Helping Students Comply with Taking Medications (continued)

- Help students take medications on own, e.g., over weekends or 2-3 days supply at a time (if safe for them to have medications at dorm)
- For addictive and abusable substances (sedatives, hypnotics, stimulants), provide no more than one day’s supply at a time, to minimize risk of other students getting into medications

## Helping Students Comply with Taking Medications (continued)

- Train residential staff in safe use of medications, in order to help students comply with medication regimens
- Educate vocation and education staff, as well as support personnel, concerning the basic principles of using psychotropic medications safely and effectively, to 	support students efforts

## Preparing Students for Life Beyond Job Corps

- Update lists of medications, doses, side-effects, and reason for use
- Help students practice asking their doctors and nurses questions about the medications, and options to care
- Teach students how to keep track of their compliance, as well as changes in their symptoms for which they are being treated

## Preparing Students for Life Beyond Job Corps (continued)

- Help student develop plans to transfer care upon leaving Job Corps, based on where the student is moving to and what services are needed; if possible, schedule appointments with doctors, therapists, etc., before leaving
- Give student written summary of current health and wellness concerns, treatments, present needs, future goals and plans

## Common Medications Used

**DEPRESSION**
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- citalopram (Celexa)
- escitalopram (Lexapro)
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
- Atypical Antidepressants
- buproprion (Wellbutrin SR)
- venlafaxine (Effexor XR)
- Tricyclic Antidepressants (TCAs–older drugs)
- desipramine (Norpramin)
- nortriptyline (Pamelor)
- amitriptyline (Elavil)

## Common Medications Used (continued)

- ANXIETY
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- citalopram (Celexa)
- escitalopram (Lexapro)
- fluoxetine (Prozac)
- fluvoxamine (Luvox)
- paroxetine (Paxil)
- sertraline (Zoloft)
- Atypical Antidepressants
- venlafaxine (Effexor XR)

## Common Medications Used (continued)

- ANXIETY (continued)
- Tricyclic Antidepressants (TCAs–older drugs)
- desipramine (Norpramin)
- nortriptyline (Pamelor)
- amitriptyline (Elavil)
- Benzodiazepines (minor tranquilizers)–[ADDICTIVE, not use with substance abusers]
- clonazepam (Klonopin)
- lorazepam (Ativan)
- diazepam (Valium)
- alprazolam (Xanax)

## Common Medications Used (continued)

- Bipolar Disorders (manic depression)
- Mood Stabilizers
- lithium carbonate (Eskalith)
- divalproate (Depakote)
- carbamazepine (Tegretol)
- Atypical Antipsychotic Agents
- olanzapine (Zyprexa)
- risperidone (Risperdal)
- ziprasidone (Geodon)
- Typical Antipsychotic Agents
- haloperidol (Haldol)

## Common Medications Used (continued)

- Bipolar Depression (Bipolar Type II)–[usually treated with mood stabilizer and antidepressant]
- Mood Stabilizers
- lamotrigine (Lamictal)
- lithium carbonate (Eskalith)
- divalproate (Depakote)
- carbamazepine (Tegretol)
- Atypical Antipsychotic Agents
- olanzapine (Zyprexa)
- risperidone (Risperdal)

## Common Medications Used (continued)

- Impulsive Disorders–[treated according to underlying disorder, if any]
- SSRI & Atypical Antidepressants
- citalopram, escitalopram, fluoxetine, paroxetine, sertraline, venlafaxine
- Mood Stabilizers
- lithium carbonate, divalproate, carbamazepine
- Atypical & Typical Antipsychotic Agents
- risperidone, olanzapine
- haloperidol , thioridazine (Mellaril)
- Adrenergic Agents  [higher doses may help]
- propranolol (Inderal LA, Inderal)

## Common Medications Used (continued)

- ADHD (Attention Deficit Hyperactivity Disorder)
- Selected Antidepressants (SSRI’s, Atypicals, TCA’s)
- buproprion (Wellbutrin SR)
- fluoxetine (Prozac), citalopram (Celexa)
- desipramine (Norpramin)
- SNRI (Selective Norepinephrine Reuptake Inhibitor)–[new]
- atomoxetine (Strattera)

## Common Medications Used (continued)

- ADHD (continued)
- Psychostimulants [easily ABUSED by other students, though “paradoxical” calming effect on ADHD student]
- amphetamine salts (Adderall)
- dextroamphetamine (Dexedrine)
- methylphenidate (Ritalin, Metadate, Concerta)
- pemoline (Cylert)

## Summary

- Encourage students to take medications as prescribed, or consult with wellness center staff if problems
- Support overall goal of student responsibility for behavior, whether or not taking medication

## Summary (continued)

- Discourage students from only using medications “when I remember”—to do any good, most need to be taken at least once a day
- If asked about whether a student should take his/her medication, share your observations of how the medicine may be helping

## Summary (continued)

- Look for ways to make medication compliance easier for students
- Help wellness center staff with ideas about helping students plan for their future

## References

- Mosby’s Drug Consult 2003, Mosby, Inc., St. Louis, MO, 2003.
- Physicians’ Desk Reference 2003, Edition 57, Medical Economics Co., Inc., Montvale, NJ, 2003.
- Psychotropic Drugs Fast Facts, by Maxmen JS, Ward NG, WW Norton & Co., New York, 2002.