Download 2. Literatures related to antidepressive drugs.

Rajiv Gandhi University of Health Sciences, Karnataka
SYNOPSIS
FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1
Name of the Candidate
GEETHU GOPI
Name of the Institution
Diana College of Nursing
2.
No. 68, Chokkanahalli,
Jakkur Post, Bangalore – 64
3.
Master of Science in Nursing
Course of Study and Subject
Mental Health Nursing.
4.
.10.5.2012
Date of Admission to Course
Assess the knowledge and practice of staff
5.
nurses
Title of the Topic
regarding
the
management
of
mentally ill patients with anti depressive
drugs at selected hospitals, Bangalore,
Karnataka
1
6. Brief resume of the intended work:
Introduction
A sound mind is in a sound body is a saying to which most people are familiar. Man is a
psychological being and have to fulfill his physical, spiritual, social and environmental
needs. The disturbance in any of these area affects the health and people. People use
various methods to cope with their health problems. When the individual is not able to
cope with health, may lead to mental illness and ultimately he or she needs assistance
from the health personnel2.
When a person is not able to make balance between integrated body, mind, spirit and
environment , it is considerd as mentally ill person. There are many type of mental
illness in which depression is one of the most common mental disorder. It is known that
the prevalence of depression among people younger than 20yrs of age has increased
world wide18.
Depression is the most common psychiatric disorder.Depression is a chronic and
recurrent disorder characterized by one or more depressive events with atleast 2 weeks of
depressive mood or loss of interest in most activities , accompanied by atleast for
additional depressive symptoms. These symptoms include persistent pessimism , guilty,
difficulty in concentrating, hopelessness, decreased sexual desire, insomnia and appetite
loss. It is known that the prevalence of depression among people younger than 20 yrs of
age has increased world wide.The incidence In women is twice that in men7
Two types of treatment have been used to treat this population; psychotherapy and
therapy withpsycho pharmacology. Psycho pharmacology is a gold standard in the
treatment of neurobiological illness. The drugs which have significant effect on mental
functions are called psychotropic drugs. Psychopharmacology is the one of the most
active areas of research and development in clinical medicine. The biological therapies
mainly employed in psychiatry are pharmacological agents15
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Anti depressive drugs are one of the psychotropic drugs. It is used either alone or
combination with other
medications. This drugs elevate mood and alleviate other
symptoms with moderate to severe depression. Anti depressive drugs are widely used in
all part of the world. There are a wide variety of anti depressive drugs are available to
treat mentally ill patients. Anti depressive drugs are very effective in treating
depression.TCAs, Serotonin specific reuptake inhibitors, Mono amine oxidase inhibitors,
Atypical inhibitors are some kind of anti depressive drugs11.
Nurses have various functions and most important is the responsibility to administer
medications. This responsibility includes pharmacological knowledge concerning
medications and their practice with the medication18.
The nurse must have a wealth of knowledge and competencies that make the nursing
care provided to people with mental disorders unique in much way. The nurse’s role
includes patient assessment, coordination of treatment modalities, drug administration
and monitoring drug effect. The co ordination of treatment modalities is often primary
responsibility of the nurse. This role defines the nurse as a key professional in
maximizing therapeutic effect of drug treatments and minimizing side effects. The nurse
is in a pivotal position to manage the mentally ill patient with anti depressive drugs.2.
6.1. Need for the study
Mental illness are medical conditions that disrupt a person’s thinking, feeling,
mood,ability to relate to others and daily functioning. Mental illness is maladjustment in
living. Mental illness are universal affecting people in all countries, individual of all
ages. It is caused by predisposing factors like genetic, biological and socio cultural
factors20.
Depression is one of the most kind of mental illness. Depression is the most common
disturbance of mood. It is a pathological mood disturbance characterized by feelings,
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attitudes and believes the person has about self and his environment. The prevalence of
depression increase with age. A review of epidemiological studies revealed that
depression affects 32% young and 13% community dwelling old people. Depression
impairs quality of life & increase morbidity & mortality among mentally ill patient.12
World widely illness has increased to 63%. In that 45% suffer from mental illness where
13% suffer from depression. According to WHO rate of depression found to be 14.6% in
developed countries and 11.1% in developing countries. In India 6.5% prevalence of
serious mental disorder in which 35.9% of people have depression. The world bank has
ranked depression as fifth in illness burden among women and seventh among men. The
UN health agency predicted that by the year 2020, depression would jump to be the
second greatest cause of death and disability world wide. This shows the magnitude of
problem related to depression15.
Patient with depression should be offered both treatment with antidepressant
&environmental therapy .Anti depressive drugs are most effective way to treat
depression. Anti depressive drugs are used either alone or combination with other
medications. There are many side effects for anti depressive drugs. Prolonged use of anti
depressive drugs can impaire the patient’s ability to communicate., sleep problems, poor
appetite, poor memory etc. so the nurses have to look after patients for side effects1.
The rapid growth of an ever changing society and consumer demand in the practice due
to the advancement in bio technology is a challenge to the health professionals. The
knowledge and skills of health professionals have an effect of health care. Care of
mentally ill patients are carried out mainly by the nurses. Mostly the drug administration
is dealt by the nurses. So it is necessary to have enough knowledge and practice about
the management of mentally ill patient with anti depressive drugs20
Overdose of anti depressants can be life threatening. Health professionals such as nurses
are the important persons who is more dealing with management of patients. so this is
necessary to have a good knowledge and practice among staff nurses who are dealing
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with the management of patient with anti depressive drugs. There are only a few studies
done on the knowledge and practice of nurses dealing with management of patients with
antidepressive drugs8
It is well known that anti depressant drugs have serious side effects. It is the nurse’s
role to administer medication as prescribed, handle the side effects and teach the
family about the side effects of drugs. Although the curriculum in nursing includes
about psychopharmacology and the nurses role, it is essential to reinforce the
knowledge to staff nurses who are handling patients who are treated with anti
depressive drugs. Hence, the need to teach the nurses about anti depressant drugs
which in turn will help them to care for the patients in the hospital and the in a better
way9.
Hence the investigator keeping the above view in mind felt to undertake this study
among staff nurses who have a key function in managing patients with anti depressive
drugs..
6.2. Review of literature
The review of literature entails systemic identification, selection, critical analysis and
reporting of existing information in relation to the problem of interest.
The purpose of review of literature is to obtain comprehensive knowledge and in depth
information about nurses knowledge and practise of nurses regarding management of
patients with anti depressive drugs. Thus literature review will help in developing a
broad conceptual context into which research problem will fit. (15)
The review of literature is presented under the following subheadings:
1.Literatures related to mentally ill patients.
2. Literatures related to patients with antidepressive drugs.
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3. Literatures related to knowledge and practice among nurses regarding antidepressive
drugs.
1. Literatures related to mental illness.
A survey revealed that mental disorder has been characterized as a clinically significant
behavioral or psychological pattern that occurs in an individual and is usually associated
with distress, disability or increased risk of suffering.13
A study reported that nearly half of people are affected with psychiatric disorders in their
lifetime for either an anxiety disorder (28.8), mood disorders (26.8), impulse- control
disorder (24.8%), or substance use disorder (14.6%). Actual lifetime prevalence rates for
mental disorders are estimated to be between 65% and 85%.7
A study found that approximately one in four people are affected with mental disorder in
their lifetime, which mainly included mood disorders, anxiety disorder or alcohol
disorder. Study also showed that 27% of adults are affected by at least one mental
disorder in a year.23
A study on mental illness showed that numerous factors are responsible for development
of mental disorder. The causes may include genetic studies, indicates gene play
important role in development of mental disorder, environmental stressors, traumatic
brain injury, abnormal functioning of neurotransmitter system and social influences have
been found to be important cause of mental disorder. Indicates responsible factors for
causation of mental illness are factors like predisposing factors, precipitating factors and
perpetuating factors.19
A study describes the common signs and symptoms of mental disorder. It includes
disturbance in motor behavior, disturbance of thought, language and communication,
disorder of perception and emotions, disturbance of consciousness, disturbance in
attention, disturbance of memory and disturbance in biological function22
6
A study on mentally ill patients revealed that number of treatment modalities such as
psychotherapy which include behavior therapy, relaxation therapy, group therapy, family
therapy etc. psychiatric medications like antidepressants, antipsychotics, mood
stabilizing drugs etc and somatic therapies like electro convulsive therapy & psycho
surgery10
2. Literatures related to antidepressive drugs.
A study conducted on anti depressant treatment revealed that it protects against stress
induced neurohistological and restore functional neuroplasty in stressed organisms and
there by presumably facilitates adaptation through learning and memory mechanisms.16
A study conducted on use of anti depressants showed that antidepressants increase level
of prolactin and may promote the growth of mammary tumor cells, there has been
concern that use of these drugs may increase the risk of breast cancer14.
A study conducted on the side effects of anti depressants revealed that sexual
dysfunction is a widespread side effect of antidepressants in mentally ill patients because
of the prolonged use.6
A study conducted on anti depressants and its side effects indicated that amitriptyline,
mirtazapine, and paroxetine were associated with a greater risk of weight gain. In
contrast, some weight loss occurs with fluoxetine and bupropion, although the effect of
fluoxetine appears to be limited to the acute phase of treatment. Other compounds have
no transient or negligible effect on body weight in the short term. However, the effect of
each antidepressant may vary greatly depending on an individual's characteristics and
generally became more evident in the long term to a variable degree across compounds.21
A survey conducted on antidepressants showed that a well described discontinuation
syndrome occurs with the selective serotonin reuptake inhibitors, common symptoms
including dizziness headache, nausea, and lethargy. Rare anti depressant discontinuation
syndromes includes extrapyramidal syndromes and mania5.
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3. Literatures related to knowledge and practice among nurses regarding
management of patients with anti depressive drugs
A survey was conducted on sample of gerontological nurses from different work settings
on their knowledge of anti depressive drugs. Results indicated that the use of anti
depressive drugs within the psychiatric hospital setting was substantial, with 43.7% of
patients receiving antidepressive drugs, for an average length of time of 1.8 years.
Nursing staff participants from all three work settings revealed a number of significant
knowledge gaps, particularly with regard to appropriate indications for anti depressive
drugs with older persons and the side-effects of antidepressive drugs4
A Study was conducted on attitudes and knowledge of gerontological nurses toward anti
depressive drugs shows that gerontological nurses surveyed in that 42percent felt
involved in anti depressive drug- related decisions; 86% felt they should be involved.
Nurses favored subjective drug assessment techniques. They were aware of potential of
anti depressive drugs to interfere with cognition, but many failed to identify series of
bogus side effects. Most regard training on drugs as in adequate.3
A study was done to examine the knowledge of nurses about anti depressants in public
hospital units were selected for the study. Results shows that nurses selected more
indication anti depressants. For agitation majority of nurses viewed both antidepressants
(60%)
effective. Junior staff both nursing and medical had less knowledge of
pharmacological alternatives to this13.
A study conducted on the knowledge of nurses
in regard to using antidepressant
medication and proposes actions such that nurses contribute to a safe and effective
antidepressant therapy showed that Even after receiving instruction concerning the
antidepressant treatment before its administration, the majority of users (cII1=0.07, p>
0.05) still had doubts about its use. Fluoxetine was the most prevalent antidepressant.
Actions to improve knowledge concerning the use of antidepressant medications, their
side and therapeutic effects, seem to be necessary and relevant10.
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6.3 Statement of the problem
A study to assess the knowledge and practice of staff nurses regarding management
of mentally ill patients with antidepressive drugs at selected hospitals, Bangalore,
Karnataka.
6.4. Objectives of the study
1.To assess the knowledge of staff nurses regarding management of mentally ill patients
with anti depressive drugs
2.To assess practice of staff nurses regarding management of mentally ill patients with
anti depressive drugs.
3.To associate knowledge and practice of staff nurses regarding management of mentally
ill patients with antidepressive drugs
4.To find out the association between the knowledge and their selected demographic
variables
5.To find out the association between the practice and their selected demographic
variables
6.5 Operational definitions
1. Assess: - it refers to the Statistical measurement of knowledge of nurses regarding
management of patients with antidepressive drug
2. Knowledge:-Refers to the response of participants regarding antidepressants which is
measured by structured questionnaire method
3. Practice: - It refers to the ability of the participants regarding handling antidepressive
drugs
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4. Staff nurses: - Refers to the person who aids in the rehabilitation and care of a
diseased or mentally ill patient.
5. Mentally ill patients:-Refers to the patients admitting in selected hospitals Bangalore.
1.6. Antidepressive drugs:-It refers to the drugs which are provided to the achievement
of physical and psychological dimensions of a depressed patient.
6.6 Hypotheses
H1. There is no significant association between knowledge and practice of staff nurses
regarding management of mentally ill patients with anti depressive drugs.
H2. There is no significant association between knowledge of staff nurses regarding
management of patients with anti depressive drugs and their demographic variables.
H3.
There is no significant association between practice of staff nurses regarding
management of patients with anti depressive drugs and their demographic variables.
6.7 Assumptions
1. The staff nurse may have some knowledge regarding the management of patient with
anti depressive drugs
2. The staff nurse may have some practice regarding the management of patient with anti
depressive drugs
6.8 Limitations:
The study is limited to staff nurses:Working in the psychiatric unit.
Who are willing to participate in the study.
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7. Materials and methods:
7.1 source of data
Data will be collected from staff nurses working in the
psychiatric units of selected hospitals.
7.2 Method of data collection
Research design
Descriptive design.
Setting
Psychiatric wards of selected hospitals.
Population
Staff nurses working in psychiatric ward.
Samples
Staff nurses working in psychiatric wards at selected
hospitals Bangalore.
Sample size
Sampling technique
50 Sttaff nurses
Simple random sampling- lottery method will be used
to select staff nurses.
Inclusion criteria
Staff nurses who are:
Available at the time of study.
Willing to participate in the study.
To communicate in English.
Exclusion criteria
Staff nurses who are:
Not available at the time of study.
Not willing to participate in the study.
Not working in the psychiatric units.
Tool
Structured questionnaire, check list.
Data collection
Prior to data collection, permission will be obtained
from the concerned authority and the selected staff
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nurses. After obtaining the consent from the selected
staff nurses, data will be collected by the researcher
herself by using questionnaire and check list.
On the first day, socio demographic data will be
collected using structured questionnaire. Knowledge
level and practice will be assessed using questionnaire
and check list.
Data
analysis,
data The collected data will be organized by:
presentation
Descriptive statistics
Frequency distribution, percentage, mean and
standard deviation will be used to assess the
demographic variables.
Inferential statistics
Chi-square test will be used to determine the
association between knowledge and practice of
staff nurses and their selected demographic
variables.
Analyzed data will be presented in the
form of tables, diagrams, graphs based on the findings.
7.3 Does the study require any investigation of intervention to be conducted on
patients or other humans or animals? If so describe briefly?
Yes. The study will be conducted among staff nurses working in psychiatric units.
12
7.4 Has ethical clearance has been obtained from your institution in case of 7.3?
Yes. Ethical clearance will be obtained from the ethical committee of Diana College of
nursing, Bangalore. Permission will be obtained from the Principal, Diana College of
Nursing, Bangalore. Permission will be obtained from the administrative heads of
selected hospitals in Bangalore. Informed consent will be obtained from the participants
of the study.
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Ethical Committee:
A study to assess the knowledge and
practice
Title of the topic
of
staff
nurses
regarding
management of mentally ill patients with
anti depressive drugs at selected hospitals,
Bangalore, Karnataka.
Name of the Candidate
Course of the Study and Subject
Ms. Geethu Gopi
M.Sc. (N) 1st year.
Mental Health Nursing.
Name of the guide
Prof. Kalaiselvi
Head of the Department
Department of Medntal HealthNursing,
Diana College of Nursing,
Bangalore – 64.
Ethical committee
Approved
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Members of Ethical committee:
1. Prof. Veda vivek
Principal and HOD
Department of Community Health Nursing
Diana College of Nursing, Bangalore – 64.
2. Prof. Elizabeth Dora
Head of the Department
Department of Child Health Nursing
Diana College of Nursing, Bangalore – 64.
3.Prof. Kalai Selvi. S.
Head of the Department
Department of Psychiatric Nursing
Diana College of Nursing, Bangalore – 64.
4. Prof. Rangappa
Biostatistician GKVK,
Jakkur International Airport Road,
Bangalore.
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8. List of references
1. Ann J Zwimmer. Basic psychology for nurses in India. 1st edition. NewDelhi. BI
publications pvt lmtd. 2009.p 193
2. Antai –otong, “Psychiatric nursing” WB Saunders publications, chapter 2
3. Adriana Inocenti and Claudia Maria. “A study on knowledge of nurses regarding anti
depressants””
3. Bimla Kapoor. Text book of Psychiatric nursing .1st edition. New Delhi. Kumar
publishing house 2009, p272-275
4. Chittaranan and Sanay Kumar rao,” a survey on the chemical imbalance and anti
depressants”
5. Coogan P F, A study on the use of anti depressants”
6. D S Baldwin, “A survey conducted on the side effects of anti depressant drugs”
7. Kessler RC, “life time prevalence and age of onset distribution of mental disorders in
the national co morbidity survey replication
8. Lalitha 2007 “Mental health and Psychiatric nursing” 1st edition VMG books and
publications
9. Mary ann Boyd. Psychiatric nursing contemporary practice 2nd edition Philadelphia
Lippincott company. 2008 p 921
10. Mashour GA, Psychosurgery, past, present, future. Pg; 409-419
11. Morry Lopeez, global burden of disease, world health forum Cambridge, Harvard
university 2009 pg 189-192
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12. National family health survey, sponsored by WHO
13. NIMH ( national institute of mental health), teachers guide; information about mental
illness and the brain
14. Pamela L Lindsey, “A study on the place bo effect of anti depressant drugs
15.Park “ a text book of Preventive and social medicine 19th edition
16. Peter M Hadded, a study on the discontinuation syndrome of anti depressant drugs,
2010
17. Polit and Hungler B P “Nursing research; principles and methods”, Philadelphia.
Chapter 1
18. Rachel A Lewis, Columbia University of psychiatric faculty practice Newyork
19. R Sreevani “A guide to mental health and psychiatric nursing” 2nd edition Jaypee
publication, chapter 1.
21. Seritti andMandelli, Anti depressants and body weight a comprehensive review
22. S Nambi. Psychiatry for nurses 2nd edition N.Delhi. Jypee brothers company; 2008
p153
23. Stuart and Sundeen, “ Principles and practice of nursing”, Mosby’s publication;
Philadelphia. Chapter 1.
24. Wittchen H U , Size and burden of mental disorders- a critical review approach of 27
studies.
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9.Signature of candidate
This study is feasible and relevant
10. Remarks of the guide
Prof. Kalaiselvi
Head of the Department
11.Name and designation of guide
Department of Mental Health Nursing,
Diana College of Nursing,
Bangalore – 64.
Signature
Prof. Kalaiselvi
Head of the Department
HOD
Department of Mental Health Nursing,
Diana College of Nursing,
Bangalore – 64.
Signature
The topic selected for the candidate is researchable
and feasible and forwarded for needful action
12. Remarks of the Principal
Signature
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