dilemma regarding antipsychotics

CarryThatWeight, BSN · May 25, 2012

I worked in mental health for two years. It is tough because it is a field with lots of gray areas, and not a lot of black and white. There are people for whom meds are absolutely the answer; others for whom meds are part of the answer; and others that don't respond to meds at all. Some need meds for life, others for a short term. Basically, there is no solution across the board for mental health. I do not think psych is a good area for you if you have a moral issue with antipsychotics. One thing you must realize is that unmedicated schizophrenics and manic phase bipolars are not only unstable, they can be dangerous to self and others. Antipsychotics are a necessary method of treatment for many patients.

dirtyhippiegirl, BSN, RN · May 25, 2012

I'm purely approaching this topic as a former psychiatric patient (many times over!) -- not as a psych nurse, although I have given anti-psychotics to brain damaged and acutely withdrawing (booze) individuals as a nurse.

In the world of mental illness, treatment tends to be very black or white. (Perhaps even a bit...borderline? lol) You will find studies relevant to both sides of the problem -- to medicate, or not to medicate. You just have to realize that both sides have an agenda and both sides will skew statistics to fit that agenda. Your original post cited an article from a website that is obviously very, very anti-medication/"traditional" psych treatment. Yet you'll find just as many pro-medication studies from big pharm that have been refuted, etc.

I will note that, at least from a patient perspective, you will very rarely meet a psych patient who is doing well on anti-psychs. Why? Because they wouldn't be in an inpatient setting if they were stable, productive members of society.

evanpatten · May 25, 2012

Thank you both for your responses! I definitely agree that something can work great for one person and not at all for another, especially with psych disorders, unfortunately. I know from personal experience that it's a lot of trial and error.

I think it's something I'll do more reading about. For the record, I'm by no means anti-medication for psych disorders; it's just that this information on antipsychotics in particular - which looks pretty legit - is both scary and sad to me :/

Anyhow, thank you.

Whispera, MSN, RN · May 25, 2012

The article was written in 2003 and examines the use of the first generation antipsychotics. These drugs have huge flaws that are recognized. That's why second and third generation antipsychotics were developed and why more are being developed. I don't think we can base our thinking on an article about 50 years of antipsychotic medication when it discusses only the flawed medications. I wonder what an article written 50 years in the future will say.

I'm a prescriber. I avoid prescribing the medications discussed in the article. I've also had patients who take newer antipsychotics tell me the medications have saved their lives in that they can feel "normal."

It's a huge quality of life thing. Bipolar and schizophrenic patients live in emotional chaos that's beyond what most people can even imagine. They lose jobs, family, sometimes everything. They live in the overwhelmingly bizarre and often can't overpower it on their own, or even with the help of therapists and loved ones. They kill themselves. Without antipsychotic medications that can help (and I agree, other things can be as- or more-effective, depending on the person), their suffering is intense, and so is the suffering of those who love them. To throw the option of medication out the window seems illogical at the least, and even cruel.

The sickest of the sick (and others) relapse, no matter what treatment they experience. To not give medications when appropriate, because there's a risk of relapse, also seems illogical.

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....

NutmeggeRN, BSN · May 25, 2012

Interesting article in Boston Globe recently- while addresing seniors/dementia also discusses use/over use of psychtropic meds

Nursing home residents with dementia often given antipsychotics despite health warnings - The Boston Globe

Finding alternatives to potent sedatives - The Boston Globe

After you read the articles if you can read the discussion forum...

elkpark · May 25, 2012

This is the kind of question I have seen a lot of students struggle with when I've taught psychiatric nursing. One of the things that is different about psych nursing (and psychiatry in general) from many other medical and nursing specialties is that there is so much clinical and ethical "grey area." While, in much of medicine and nursing, there is at least one "right," "good" answer or choice for most situations (and several wrong/bad answers), in psych, you often find yourself in situations where there is no "good" answer or option, and the question is which is the "least bad" of the available options.

I also agree with Whispera's point about doing the best we can with what we have to work with at our given point in history. When I have heard students (or colleagues) over the years talking about how ignorant or barbaric or dangerous various medications or treatments were in the past (and it's particularly easy to take that position when looking at the history of psychiatric tx!), I always try to remind people that the individuals at the time were offering people the best tx available at the time, with good intentions -- sure, in hindsight, from our vantage point today, a lot of older medications and treatments seem backward and indefensible, but, 50 or 100 years from now, people will be looking back at us and we'll be the ones who seem (in retrospect) crude and ignorant and barbaric.

If someone isn't comfortable with a high degree of ambivalence and "shades of grey" in your job, psychiatric nursing probably isn't a good specialty to choose.

Long Term Care Columnist / Guide · May 25, 2012

It's a huge quality of life thing. Bipolar and schizophrenic patients live in emotional chaos that's beyond what most people can even imagine. They lose jobs, family, sometimes everything. They live in the overwhelmingly bizarre and often can't overpower it on their own, or even with the help of therapists and loved ones. They kill themselves. Without antipsychotic medications that can help (and I agree, other things can be as- or more-effective, depending on the person), their suffering is intense, and so is the suffering of those who love them. To throw the option of medication out the window seems illogical at the least, and even cruel....
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....

Thank you for this post. No one who's ever had a serious mental illness can possibly know the kind of hell we go through when we don't have medications to take the edge off the insanity. I'm not a huge fan of antipsychotics either, based on the weight gain, somnolence and other adverse effects I've seen in others, but they are a lifesaver for those who need them and shouldn't be denied just because a minority of specialists think the risks outweigh the benefits.

azure42 · May 25, 2012

In a former life, I was an out patient case manager working with SMI (severely mentally ill) clients. I can pretty much assure you that your perspective will change with regards to psychotropic medications.

I had my reservations in the beginning as well, although it didn't take very long before I changed my mind.

Once you see an individual with Schizoaffective Disorder or Paranoid Schizophrenia decompensate from baseline, into full blown psychosis, and back to baseline?

...I'm willling to bet you'll be all about those meds.

Simply Complicated · May 25, 2012

All I can say, is reading articles and stories is totally different from working day to day with these patients. I completely agree with what Whispera said. Many times, maybe the med, with side effects and all that go with it seem like a horrible thing to do to someone.. but the other option, how they often become WITHOUT the medications is much worse. Also, like Whispera said, there are a lot of newer meds out there. Once you experience a severely psychotic decomenstated schizophrenic, the possibility of the antipsychotics causing a relpase later won't seem like a big deal.. when you need to treat the NOW.

If you have a moral reserve to things like this, psych is probably not the place for you. Psych is very very grey, it's totally different than dealing with medical patients. You can't be judgemental, you really have to put your own opinions and moral feelings aside. It requires being adaptable, realizing that each person will have their own thing that works for them. Some people excel in psych, others really should not be working there.

Also, you mentioned working LTC and giving out plenty of antipsychotics. It really depends on if you choose to work geri-psych or a more acute care facility. There's a big difference there as well. What makes you interested in psych?

kids · May 25, 2012

Anyway, I'm struggling because I think psychiatric nursing would be a good fit for me, but from what I can tell, a huge part of the job would be administering antipsychotics, and I don't know how comfortable I'd be with that.

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 a as much sense as going to work in an abortion clinic when you oppose abortion.

As for the reliability of the source you linked you need to consider the source that posted it: http://psychrights.org/index.htm

From their home page:

...public interest law firm whose mission is to mount a against forced psychiatric drugging and electroshock in the United States akin to what Thurgood Marshall and the NAACP mounted in the 40's and 50's
on behalf of African American civil rights. The public mental health system is creating a huge class of chronic mental patients through forcing them to take ineffective, yet extremely harmful drugs.

And you need to look at the background of the author. Robert Whittaker is a writer with ZERO health care training or education or even research for that matter. He is very well known for his blogs, books and articles against modern psychiatric treatment.

http://en.wikipedia.org/wiki/Robert_Whitaker_(author)

Long Term Care Columnist / Guide · May 25, 2012

If it weren't for modern psychiatric treatment, the world would be a much poorer (and sadder) place.....because many of the talented people who entertain us, educate us, and care for us would be dead.