Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Running Head: NURSING RELATED TO PSYCHOTROPIC MEDICATION COMPLIANCE Nursing Related to Psychotropic Medication Compliance Samantha Trupp Auburn University 1 NURSING RELATED TO PSYCHOTROPIC MEDICATION COMPLIANCE Abstract Schizophrenia is a mental disease characterized by hallucinations, delusions, disorganized thinking, autism, associative looseness, paranoia, and an improper affect. Pharmacology plays a major role in the treatment of those patients diagnosed with schizophrenia. There are many drugs on the market available to help with the treatment of schizophrenia. The two major classes of drugs used for treatment are conventional antipsychotics and atypical antipsychotics; the atypical drugs tend to have less adverse effects than the conventional category. However, drug compliance is still a major issue in the treatment of schizophrenia. Nursing plays a major role in helping patients stay compliant with their medications. Through interprofessional collaboration, patient education, and psychosocial support nurses have the skills to improve drug compliance among clients with this disease. 2 NURSING RELATED TO PSYCHOTROPIC MEDICATION COMPLIANCE Introduction Overview of Schizophrenia Schizophrenia is defined as an illness that causes a patient to have a distorted reality (Varcarolis & Halter, 2010). According to the Diagnostic and Statistical Manual of Mental Disorders IV-TR (2000) and Varcarolis & Halter (2010), a patient may have delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms such as flat affect. Schizophrenia can be characterized by Bleuler’s four A’s: affect, associative looseness, autism, and ambivalence; affect may be flat or bizarre, associative looseness is illogical speech and impaired reasoning, autism is when a person’s reality is not the norm, and ambivalence is when a person has two opposing emotions towards the same situation (Varcarolis & Halter, 2010). Characteristics of schizophrenia consist of both positive symptoms which include hallucinations, delusions, and paranoia; and negative symptoms which include apathy, depression, mood instability, and poor thought processes (Masand, 2007; Nakanishi, Asuka, Hiroto, Kurita, & Higuchi., 2006; Varcarolis & Halter, 2010). Pharmacology Overview Pharmacological management is a primary treatment for schizophrenia, and medicine is a major contributor in helping to prevent relapse (Masand, 2007; Nakanishi et al., 2006; Varcarolis & Halter, 2010). However, a major issue with schizophrenia treatment is non-adherence to conventional antipsychotic drugs because of adverse side effects such as akathisia, dystonia, seizures, pseudoparkinsonism, and tardive dyskinesia (Jones, Bennentt, Gray, Arya, & Lucas, 2006; Masand, 2007; Varcarolis & Halter, 2010). Newer atypical antipsychotic medications are now available, and these have a much lower incidence of extrapyramidal side effects compared to older psychotropic drugs (Jones et al., 2006; Masand, 2007; Varcarolis & Halter, 2010). Even with these newer drugs compliance is still an issue; therefore, nursing care is important for 3 NURSING RELATED TO PSYCHOTROPIC MEDICATION COMPLIANCE helping patients maintain compliance with medications and for helping them understand why it is important to do so. Current Knowledge Conventional Antipsychotics Antipsychotic drugs generally affect dopamine and serotonin in the brain (Masand, 2007; Varcarolis & Halter, 2010). Schizophrenic symptoms occur because of hyperactivity of dopamine in the brain; conventional antipsychotics block dopamine receptors which decrease the activity of dopamine (Masand, 2007; Varcarolis & Halter, 2010). Some examples of the conventional antipsychotic drugs include Haloperidol (Haldol) and chlorpromazine (Thorazine) (Varcarolis & Halter, 2010). The conventional antipsychotics only stop the positive symptoms (hallucinations, delusions, ect.) of schizophrenia and allow extrapyramidal symptoms (EPS) to occur (Masand, 2007). Along with the extrapyramidal side effects, a serious risk is neuroleptic malignant syndrome which is a medical emergency in which the drug must be discontinued (Varcarolis & Halter, 2010). One benefit of the conventional psychotropic drugs is that they are less expensive than their atypical counterparts (Varcarolis & Halter, 2010). Atypical Antipsychotics Newer generation atypical antipsychotics are now available on the market. Examples of these include clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), and aripiprazole (Abilify); this set of drugs treat both the positive and negative symptoms of schizophrenia (Masand, 2007; & Varcarolis & Halter, 2010). To block the positive and negative symptoms and decrease the risk for EPS, the drugs impair both dopamine and serotonin in the brain (Varcarolis & Halter, 2010). There are two major disadvantages to the atypical antipsychotics. The first, and more common, adverse effect is 4 NURSING RELATED TO PSYCHOTROPIC MEDICATION COMPLIANCE metabolic syndrome; this is characterized by weight gain, altered glucose metabolism, and dyslipidemia which in turn increases the risk for hypertension, diabetes, and heart disease (Masand, 2007; & Varcarolis & Halter, 2010). The second rarer side effect is the risk for potentially fatal agranulocytosis, especially with clozapine (Varcarolis & Halter, 2010). Typically however, atypical antipsychotics have less side effects, which equals a lower chance for the discontinuation of the drug by the patient, which in turn decreases the risk of relapse (Jones, M., et al., 2006; Masand, 2007; Nakanishi et al., 2006). Nursing Care and Medication Adherence Interprofessional Collaboration Nursing care is critical for those taking antipsychotic drugs for schizophrenia. As a health care professional, a nurse must be able to detect, through thorough assessment, when a patient is experiencing unwanted side effects of medication (Jones et al., 2006; Nakanishi et al., 2006). By performing interviews with the patient, the nurse has the ability to detect an issue and then have the physician evaluate the psychotropic drug strength (Nakanishi et al., 2006). This demonstrates the importance of interprofessional collaboration in health care which allows for the best patient outcomes (Jones et al., 2006; Nakanishi et al., 2006). If a patient is treated for adverse effects early he or she may stay compliant with the medication which as noted earlier in the paper, helps prevent a relapse. According to a study done by Nakanishi et al. (2006), collaboration between providers caused patients to have improvements on their Global Assessment of Functioning score which rates a patient’s psychological, social, and occupational ability; furthermore, it also found that acceptance of medication adherence was increased because of interprofessional collaboration. Patient Education 5 NURSING RELATED TO PSYCHOTROPIC MEDICATION COMPLIANCE A second major nursing role in the care of patients who are taking psychotropic drugs for schizophrenia is education. Patients and family members should be educated about what schizophrenia is because understanding is important to a positive treatment outcome (Varcarolis & Halter, 2010). According to Jones et al. (2006), if a nurse builds trust with the client, he or she is more likely to attempt to stay compliant with his or her medications. Compliance is more likely to occur if the patient understands about the drug they are taking (Jones et al., 2006; Nakanishi et al., 2006; Varcarolis & Halter, 2010). To help with medication adherence, nurses should give the patient all the available information possible so that he or she may help decide the treatment plan; this makes the patient feel empowered to help make decisions about his or her health care (Jones et al., 2006). The nurse should also discuss the risks associated with the medications, including the side effects and, just as importantly, the risk of relapse if the patient discontinues the medication (Jones et al., 2006). Nurses should help the patient figure out and understand potential triggers that contribute to potential relapses (Jones et al., 2006; Varcarolis & Halter, 2010). Psychosocial Support Psychosocial support is a third nursing responsibility to help prevent noncompliance with medications. Family members should be supported if their loved one is diagnosed with schizophrenia; this reduces anxiety and allows for the patient to have a better chance of stability in the home, and stability helps prevent relapse (Varcarolis & Halter, 2010). Many times when family members do not have support and understanding of the disease as well as the patient, they may become hostile towards the patient when he or she begins showing symptoms of the disease which in turn leads to tension in the patient’s household and then leads to a greater risk for relapse (Varcarolis & Halter, 2010). Finally, the family must know when to get help for the 6 NURSING RELATED TO PSYCHOTROPIC MEDICATION COMPLIANCE client; nurses must teach them the importance of helping the client adhere to his or her medication plan and must make it known that if their loved one discontinues their medication and relapses, it is merely a part of the illness and not a sign of failure (Varcarolis & Halter, 2010). Advanced Practice Registered Nurses in some locations have the ability to lead cognitivebehavioral therapy, group therapy, and family therapy to help both the family members and the client cope with schizophrenia as a whole and when the client relapses (Varcarolis & Halter, 2010). Conclusion Schizophrenia is a mental disease characterized by many symptoms including hallucinations, flat affect, disorganized thinking, a false reality, and many more (APA, 2000; Masand, 2007; Nakanishi et al., 2006; Varcarolis & Halter, 2010). However, through pharmacological management and supportive care, patients with schizophrenia can control their symptoms and potential relapses (Nakanishi et al., 2006; Varcarolis & Halter, 2010). Nonetheless, medication compliance is a huge issue with antipsychotic drugs because of adverse side effects like extrapyramidal symptoms and weight gain; these interfere with patient’s lives which leads them to stop taking their medications (Jones et al., 2006; Masand, 2007; Varcarolis & Halter, 2010). Nursing care plays a major role in medication adherence. Through careful assessment, interprofessional collaboration, patient education, and psychosocial support it is possible to help a client have better medication compliance (Jones et al., 2006; Nakanishi et al., 2006; Varcarolis & Halter, 2010). With both medication compliance and support from health care professionals like nurses, a patient diagnosed with schizophrenia has the ability to control their disease and consequently increase their quality of life. 7 NURSING RELATED TO PSYCHOTROPIC MEDICATION COMPLIANCE Reference List American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author Jones, M., Bennett, J., Gray, R., Arya, P., & Lucas, B. (2006). Pharmacological management of akathisia in combination with psychological interventions by a mental health nurse consultant. Journal of Psychiatric & Mental Health Nursing, 13(1), 26-32. doi:10.1111/j.1365-2850.2006.00908.x Masand, P. S. (2007). Differential pharmacology of atypical antipsychotics: Clinical implications. American Journal of Health-System Pharmacy, 64S3-S8. doi:10.2146/ajhp060593 Nakanishi, M., Koyama, A., Ito, H., Kurita, H., & Higuchi, T. (2006). Nurses’ collaboration with physicians in managing medication improves patient outcome in acute psychiatric care. Psychiatry & Clinical Neurosciences, 60(2), 196-203. doi:10.1111/j.1440 1819.2006.01486.x Varcarolis, E.M. & Halter, M.J. (2010). Schizophrenia. In J. Ferguson & T. Trautwein (Eds.), Foundations of psychiatric mental health nursing: a clinical approach (pp. 306-343). St. Louis, Missouri: Saunders Elsevier. 8 NURSING RELATED TO PSYCHOTROPIC MEDICATION COMPLIANCE 9