Paranoid pts and meds

[Scarlettz, BSN, RN]

For the most part, many of my patients take their medications. However, I have one woman who has refused her Seroquel a couple of times because it was not the same shape/color as it was last time. It is hard to explain to her that they come in different shapes/colors because she gets agitated about it and I don't want to argue with her. I can't really show her the name of the pill, because it has the generic name on the wrapper vs. the brand name that she knows.

From now on I make sure I pick the pill that is round and white whenever I can. But, what do you do when this happens? Just let it go? Or, what do you say to them?

[Davey Do]

I tend to be straightforward with the Patients with whom I work.

Rote memory: "A delusion is a false fixed belief in spite of evidence to the contrary".

The delusional process is an symptom of Mental Illness. By not accepting your medication due to your paranoid delusion is treatment non-compliance. Until you make a decision to follow treatment protocol, your symptoms will continue and you will remain here as an Inpatient. Your symptoms of psychosis will allow the Doctor to legally order forced meds. You may also be court ordered to continue to be an Inpatient until the Treatment Team deems your mental status to be stable.

That's the gist. This approached is tempered to the Patient's cognitive and psychological status.

[A&Ox6, MSN, RN]

On an outpatient basis, it can be helpful to give the client a few pictures of the seroquel variations. As an aside, many psych patients do not know their medications by name, only by appearance. This can make compliance even more difficult when they receive different brands.

[margin261]

I don't know if this would work with psych pts, but it has worked with some elderly pts I've had that were reluctant to take their meds in the hospital bc it didn't look their pills at home.

There is an app from drugs.com called pill identifier- you just put in the numbers &/or letters that are imprinted on the pill and it shows you what the pill is. (Works great for pills found in the bed or on the floor too)

It probably depends on their level of paranoia as to whether this will convince them

[psych308]

I don't know what resources or time you have available at your facility, but in the times that this has happened to me, I've been lucky enough to take time to educate and reassure the patient. I usually do this by:

1. Acknowledging their fears ("I understand that this pill looks different than what you take everyday and that this makes you worried")

2. Explaining the reason for the difference ("In this facility, we use generic brands because they cost less for the hospital, which means sometimes the pill or package looks different. It's like buying Aquafina instead of Dasani--both are still water, just different brands")

3. Showing them the package and a reference ("This says Quentiapine--that is the generic name for the brand name Seroquel. See how this website says they're the same?")

For most of my patients, this has been enough. I find that this works a lot better than explaining noncompliance or saying "just trust me" or whatever.

[MMC.RN]

When I have a patient who is refusing due to paranoia I acknowledge their feelings first and foremost and I attempt to reason with them. I always open the packages in front of them and will show them their MAR as well if need be. I also utilize a drug handbook that we have and will show them pictures. I do this a lot, especially since there are constant med changes on some patients. Of course, we have the actively psychotic patients often who you can't reason with no matter what. Reasoning will sometimes work for me and sometimes it's a bust. Fortunately, most of our patients have OTT so we can use IM injections if they refuse psych meds.