Antipsychotic Medication Chronic Mental Disorders

Question: Discuss about the Antipsychotic Medication for Chronic Mental Disorders. Answer: Introduction Non-adherence with antipsychotic medication occurs in all the chronic mental disorders. It is associated to social isolation, stigma, depression, negative thoughts, and cognitive impairment. Non-adherence to medication increments the risk of relapse, re-hospitalization, self-harm, and lowers the quality of life. The problems with non-adherence to antipsychotic medications are not taking the medicines, skipping the medications, not taking the recommended dosages, and in some cases taking excess medication. The interventions to address up the adherence issues require lot of patience and efforts (Simpson et al., 2006). The rationale is to improve the quality of life of the patients and decrease the signs which are the prime responsibility of the nurses as well as the doctors. Interventions to aggravate the adherence are psycho education, psychosocial interventions, antipsychotic injections, reminders, and financial support. The nursing interventions to increase adherence are proved to b e helpful in reducing the signs and symptoms to a larger extent. To help the patient to adhere to the anti-psychotic medications require nursing interventions as well as the support from family (Day et al., 2015). The level of non-adherence to antipsychotic medications is generally seen in antipsychotic disorders like Schizophrenia. Although the non-adherence is more dependent on the level of signs and symptoms. Review of literature Regardless of the discovery of antipsychotic medications, most of the people with psychotic disorders remain unwell. Non-adherence to medication is the major issue. Non-adherence is common to all the psychotic patients all over the world and is the major reason behind repeated hospitalization and relapses. Studies have shown with in the first year of treatment around 50% stops taking the antipsychotic medication and around 75% stops in the next year. Theoretically, it is seen improving adherence improve the effectiveness but, studies show addressing the non-adherence has shown better outcome in patients (Kronish, Edmondson, Cohen, 2012). Many meta-analysis studies show non-adherence is affected by factors like individual, the environment, and the health care services (Coleman et al., 2012). Individual factors are negative thinking about medical treatment, short illness, substance abuse etc. Environmental factors are poor therapeutic relationship, and poor after discharge care. Treat ment factors include medication type, route of administration, and high dose. Other factors are age, ethnicity, marital status, literacy, family, and mood. Systematic review of medication adherence regarding studies conducted from 1980 to 2000 clarifies effective intervention (Barnes et al., 2008). They suggest combining education along with behavioral or motivating approach or support services increase adherence. It has lead to short-term adherence but still the long term- adherence interventions are not successful. Studies say the simple and most successful intervention is to telephone clients to remind them for appointments. Cognitive behavior therapy when added to compliance therapy had been proved fruitful. Compliance therapy consists 4 to 5 sessions including CBT, motivating interviews, psycho education targeting therapeutic relations, and consumers insight. Evidences suggest interventions that are working together, prioritizing person thoughts and beliefs, and focusing on consumers belief about treatment brings about effective adherence (Vrijens et al., 2012). All the findings have solved the short-term adherence but adherence fo r a long period is still unresolved. Observation, analysis, and evaluation Observing the studies of 1980-1999, it can be concluded psychoeducation has little effect on adherence until they are carried out with behavioral and cognitive interventions. In the past decades importance was given to solve the cognitive impairments more. It included SMS reminders, telephonic interventions by nurses and cognitive adaption training. Improved communication technology and to reduce the burden of medical treatment was the focus of study in past decades. Studies after 2000 say community intervention and family intervention brings about a desirable positive adherence in the patients. In this decade client, community nurses, and family were included to increase the adherence to the antipsychotic medications. Providing management training to the nurses and educating the family members about the conditions and medication was studied extensively to get desirable results. The approach was a collective one so as to get better results. On analyzing the studies it can be seen the studies in 1980-1999 was focuses only on client. In this the all the measures were taken only on the consumer to increase adherence. The basis was medication and adherence. In the 2000 decade the focus included client, family, and the nurses. This attempt and approach was more fruitful to the patients as there were not over pressurized and burdened. The approach addressed not only adherence but other aspects also like support, love, and care to the patient (Buckley et al., 2009). Thus, it was difficult to analyze which components were essential to increase adherence. The interventions were not only based on adherence but also on improving the quality of life of the patients. Further, it can be seen that the studies were heterogeneous in design thus drawing out the outcome was difficult. The indirect measures of adherence like self report, doctor report and care giver report were less reliable than the direct measures like electronic records , assay of the medication levels, and pill counts. The subjective reports were overestimating the adherence. Evaluating the researches, some conclusions can be made. First is the interventions that are for long duration and consist of more sessions, and especially the ones that focuses only on adherence seems to provide more successful improvement than the interventions those are for short durations. Second is implementing problem-solving interventions that consists of technical aids ameliorate the adherence even in severe chronic conditions like Schizophrenia. Third is the effects of motivation interviewing in compliance therapy is suitable in providing positive results. Although, the motivation last in the consumers for a short duration (Richardson, McCabe Priebe, 2013). Finally, it appears that the heterogeneity of factors related to non-adherence calls for individually tailored approaches to promote adherence. Evidences show non-adherence results in undesirable poor outcomes so quality work is still to be done in this area. The problem has to be solved on consistent basis. More explora tion and deep interventions that last for a longer period of time are required for such psychotic patients. References Barnes T.R.E., Leeson V.C., Mutsatsa S.H., et al. (2008) Duration of untreated psychosis and social function: 1-year follow-up study of first-episode schizophrenia. The British Journal of Psychiatry 193, 203209 Buckley P.F., Foster A., Patel N.C., et al. (2009) Adherence to Mental Health Treatment. Oxford University Press, Oxford, NY Coleman C.I., Limone B., Sobieraj D.M., et al. (2012). Dosing frequency and medication adherence in chronic disease [Review]. J Manage Care Pharm, 18:527539. Day J.C., Bentall R.P., Roberts C., Randall F., Rogers A., Cattell D., Healy D., Rae P., Power C. (2015). Attitudes toward antipsychotic medication the impact of clinical variables and relationships with health professionals. Arch Gen Psychiatry, 62: 717-724 Kronish I.M., Edmondson D., Li Y., Cohen B.E. (2012). Posttraumatic stress disorder and medication adherence: results from the Mind Your Heart Study. J Psychiatr Res, 46:15951599. Richardson M., McCabe R., Priebe S. (2013). Are attitudes towards medication adherence associated with medication adherence behaviours among patients with psychosis? A systematic review and meta analysis. Soc Psychiatry Psychiatr Epidemiol, 48:649657. Simpson S.H., Eurich D.T., Majumdar SR., et al. (2006). A meta-analysis of the association between adherence to drug therapy and mortality. BMJ; 333:15. Vrijens B,, De Geest S., Hughes D.A., et al. (2012). A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol, 73:69170