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Running Head: NURSING RELATED TO PSYCHOTROPIC MEDICATION COMPLIANCE
Nursing Related to Psychotropic Medication Compliance
Samantha Trupp
Auburn University
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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.
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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
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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
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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
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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
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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.
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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.
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