dilemma regarding antipsychotics

tothepointeLVN, LVN · May 25, 2012

Try working psych see if you like it. If not move on. I wouldn't base your position on that article alone. The patients themselves can usually tell you if they think the medications have helped their life long term.

Kooky Korky, BSN, RN · May 25, 2012

Give Psych a try if you want to. Decide how you feel about anti-psychotics after working in Psych for a year or so. Best wishes.

Simply Complicated · May 26, 2012

Give Psych a try if you want to. Decide how you feel about anti-psychotics after working in Psych for a year or so. Best wishes.

I think a lot of people can tell in the first month if psych is for them or not, lol.

evanpatten · May 26, 2012

Thank you all for your responses. A few things I want to respond to; first, that article mentioned that atypical antipsychotics work in the same way as the first generation ones, by blocking D2 dopamine receptors which could ultimately lead to greater risk for psychosis and altered brain structures. From what I've seen on NIMH's website, it seems that atypical antipsychotics aren't much more effective in treating schizophrenia, they just have a lower risk of leading to tardive dyskinesia but have MORE issues associated with metabolic problems (obesity, diabetes). That's just the impression I've gotten from several of their articles; I don't have any experience to back that up. I'm trying to learn.

That being said, I am glad antipsychotics are helpful for some people! Again, I WANT this to be the case. I don't want to be "against" these medications.

>>>>>"Even if the medications have some or a large part in relapse, sometimes having a time of normalcy is better then living in overwhelming chaos always...."

I think that is a good thing for me to keep in mind.

>>>>>"Going to work in psych nursing when you're not comfortable administering anti-psychotics makes a as much sense as going to work in an abortion clinic when you oppose abortion."

Yes, I know that. That's what drove me to make the original post, and why this is a struggle; I basically wanted to hear convincing evidence about why in other people's experience, treatment with antipsychotics has been seen to be a good option for some patients. My problem is that I don't have enough real-world experience to go on, but other people here do.

Another poster asked why I wanted to go into psych; I thought it was the most interesting area we studied in school, and it was the most interesting to me at clinicals. I have a lot of empathy for psych patients and would love to be there as a support person for them. Part of this has to do with my own family history and personal experience; bipolar and depression both run in my family, and I myself have major depression, and I understand to some extent what it's like to have the stigma of being "mentally ill." I'm actually on effexor for my depression, and I thank God that I was finally put on effexor (after a couple years of trying other anti-depressants that did nothing). In some ways it's a nasty medication too, but I know that for me it has been totally worth it, and I hope that other people have had the same experience with antipsychotics. I don't have an agenda in terms of this stuff, just that people get the best treatment.

elkpark · May 26, 2012

I'm actually on effexor for my depression, and I thank God that I was finally put on effexor (after a couple years of trying other anti-depressants that did nothing). In some ways it's a nasty medication too, but I know that for me it has been totally worth it, and I hope that other people have had the same experience with antipsychotics.

I've been in psychiatric nursing for over 25 years, and I can assure that many people have had the same experience with antipsychotics.

albymangel · May 26, 2012

I'm a Credentialed Mental Health Nurse and for the lady 2years I have not administered any antipsychotics so there are other option

algebra_demystified · May 28, 2012

I have a little over three years' experience as a psychiatric nurse. In my opinion, antipsychotics are useful for managing psychosis. At the same time, they are used to treat many other conditions that could be better managed by talk therapy and community integration techniques rather than using antipsychotics as sedatives.

I definitely endorse the idea that there are other options.

I think that schizophrenics are regarded as more of a danger to others than they actually are. Sometimes they are psychotic, sometimes they engage in hostile and agitated shows of fear. That doesn't necessarily mean that anyone is going to be attacked. When I communicate with a decompensated and acutely psychotic schizophrenic, I've found that listening and being an emotional wet blanket has very good results. However, in order to perform that intervention, I have to have time.

I wish hospitals added up the cost of antipsychotic medications (seroquel, anyone?) vs the cost of an hour of a psychiatric nurse's time and figured that analysis into staffing vs prescribing.

newtinmpls, BSN, RN · May 28, 2012

My answer is "it all depends". I've seen patients come in psychotic, struggling, violent & dangerous and then a month later are chuckling over the "weird things I used to think." I've also seen patients who don't respond successfully to anything. Antipsychotics are one (of many) tools. They aren't "the answer" they aren't even a whole answer; they are just one tool to utilize to help people that are in a very unique kind of pain.

Dian

greenbeanio · Jun 2, 2012

To put it simply, if you don't agree with the standard treatment modalities utilized by a specialty, it's NOT a "good fit" no matter how much you want it to be.
Going to work in psych nursing when you're not comfortable administering anti-psychotics makes as much sense as going to work in an abortion clinic when you oppose abortion.

I don't necessarily agree. Before I even considered nursing as a career, I had an experience as a patient that has really stayed with me. I had spent years using nothing but alternative healing and then suddenly I was a patient on a L&D unit in a life-and-death situation. I felt very helpless and scared in a system whose values and practices were alien and antithetical to mine, until I was assigned to a nurse who "got" where I was coming from and talked with me in terms of herbs and natural therapies. It was such a relief to be cared for by someone who spoke my language!

Now, as a psych nurse on a medical-model oriented inpatient psych unit, I do still struggle with the ethics of handing out some of the meds I hand out, knowing what I know about them. On the other hand, I am convinced there is a place for me there since I am the one who takes every opportunity to talk with my patients about what they can do for themselves - aka non-medication alternatives - in addition to the meds. I take my cues from the patients, and when I sense discomfort around or resistance to taking psych meds, I do not badmouth the psych meds but simply focus their attention on what they can do of their own initiative.

As part of this discussion we talk about regulating the sleep-wake cycle, exercise, diet, hydration, stress-reduction techniques, CBT techniques, etc. We talk, but I also use handouts and what is the most effective of all is demonstration. It's not easy to fit into a busy schedule, but I see that as my ethical responsibility.

I think it is empowering to the patients to know that it's not ALL about meds, and that meds can be a helpful "crutch" to get them on their feet enough to be able to do all the things they need to do to regain balance and health.

greenbeanio · Jun 2, 2012

In my opinion, antipsychotics are useful for managing psychosis. At the same time, they are used to treat many other conditions that could be better managed by talk therapy and community integration techniques rather than using antipsychotics as sedatives.

I once asked a doctor why a particular patient was on an antipsychotic when he had no sxs of psychosis, just severe depression. He said it was because the insurance companies wanted them out so fast that there wasn't enough time for the antidepressants to really kick in and the antipsychotics can reduce anxiety enough to let the antidepressants be more effective. He also said this was a short-term use of antipsychotics with the assumption that the outpatient prescriber will taper and discontinue them.

Anyone else ever hear this?

tothepointeLVN, LVN · Jun 2, 2012

Yeah I've personally experienced this. Inpatient they'll often go up on the doseage on everything you are taking till either it gets you through the hump or you stop complaining then your outpatient dr tapers it all down. It can sometimes take years to taper everything off. I find a small prn dose of an anti psych can be more effective for anxiety than a benzo without the dependence and tolerance issues. I really think they need to rename the drug classification as antipsychotic doesn't seem to cover all the possible benefits. There's not a lot of talk therapy going on inpatient. Honestly its more of a keep you safe hotel.

Overall I've taken a wide range of psych meds. Not all are bad and for most the side effects are tolerable when you get the right fit. Could I have survived without meds? Sure but my quality of life would have been pathetic. I certainly would never have been stable enough to become a nurse.