Have you seen Zyprexa, Risperdal, Remeron...make a difference?

Altra, BSN, RN · Aug 12, 2008

I've seen a large number of patients on these meds, and yes they do make a difference, in my experience, in controlling agitation & psychotic s/s. Every patient is different, and these meds are adjuncts to other interventions appropriate for the patient.

Respectfully, I suggest that there's a lot of distance between questioning the effectiveness of specific meds for specific patients and stating, "psychotropic meds are quackery."

dekatn · Aug 12, 2008

When I worked psych these meds were widely used for psychosis and were effective for the most part. You could tell when a pt was non compliant with use. As for the nursing home pt., it was my experience that these meds were prescribed a lot of the time for pt. that weren't clinically psychotic. These people had dementias, a lot of them, in my opinion, acted out due to losing their autonomy, they had no families or friends left. They are put on a schedule according to the nursing home and bathed, fed etc. according to somebody elses' rules, not their own. When they try to resist they are considered "behavior problems" thus the meds are started. There is the chance that giving them these types of meds for the wrong reasons will cause dangerous SE and I am totally against it. I feel a pt. must have a hx of schizophrenia or some type of psychotic disorder in order for these meds to be prescribed. Just because a pt. demonstrates behavior problems isn't reason enough to be prescibed anitpsychotic medications. But, what do I know, "I'm just a nurse".

aprilr · Aug 12, 2008

I work in a psychiatric hospital. I absolutely think that these medications work, on some patients. They may help a person do a complete 180 or they may have no effect at all. Our md's are very good at combining different medications and trying different things for different people. There have been times while working that I have been very thankful for some of these medication!!

SunnyAndrsn · Aug 12, 2008

Risperdal, yes, absolutely it makes it difference. Used liberally? No, I don't think it's being used liberally in our facility. We have 4/72 pts. on this medication.

Remeron--we have more on this one. For two residents, the reason listed is "anorexia". Two refer to it as their sleeping pill. For two more, it does nothing for mood, sleeping, or appetite.

I only have one resident that takes zyprexa, and this resident also takes remeron. Both indications are for mood stabilization. The dx. is bipolar disorder. I don't think this is an effective medication, but since I've not seen this pt. before the zyprexa was prescribed it's difficult to say how effective it is, from my POV.

All of the residents on zyprexa and risperdal have behavior checklists in their MAR to monitor for stabilization, and the nurse on duty fills it in qshift.

These meds are expensive and used liberally in the nursing home. I cannot tell they make any difference in the patients they are used in.
We recently had an inservice where this was discussed, and information was given that these psychotropic meds can aggravate an already compromised mental status and make things worse. The nurse educator added I wish we could get some of these doctors to pay attention to this.
The general consensus around the nursing home (and a psychology professor I just talked to) is that psychotropic meds are quackery. I am interested in becoming a PMHNP but I also have serious doubts about the benefits of most of these medications.
I would appreciate any further insight.

Jo Dirt · Aug 12, 2008

I did not say the use of these medications was "quackery" nor has anyone else I work with, but it doesn't take a rocket scientist to read between the lines and see what they are actually saying.

I know firsthand that without lithium and Prozac, Depakote etc., some people would be unmanageable. Yet, I was taken back when I was talking to a psychology professor at the college I attend who said she does not believe in using psychotropic meds in the elderly because they were very dangerous and did not do any good.

It made me wonder about how many nursing homes she had been in or worked, but I did not say anything.

I also know she is not the only one who feels this way. Even the nurse educator wanted to see if they could do a study and take the patients off their psych meds for just three months to see what a difference it would make.

I understand how psychiatrists can perpetuate some peoples' negative ideas about psychiatry. I went to a psychiatrist who tried to put me on Lamictal (actually, he was going to start with Lamictal and continue to add others when I was established on that.) I am glad I did not continue to go see this doctor. I felt horrible, like I had a lobotomy. I still had my emotions yet I could not express them. I still believe the few months I took the Lamictal permanently altered my brain chemistry.

I feel like mind-altering medications can be beneficial but they are used too liberally. It is a very tricky balancing act but I appreciate what a good psychiatrist can do for someone.

Jo Dirt · Aug 12, 2008

Risperdal, yes, absolutely it makes it difference. Used liberally? No, I don't think it's being used liberally in our facility. We have 4/72 pts. on this medication.
Remeron--we have more on this one. For two residents, the reason listed is "anorexia". Two refer to it as their sleeping pill. For two more, it does nothing for mood, sleeping, or appetite.
I only have one resident that takes zyprexa, and this resident also takes remeron. Both indications are for mood stabilization. The dx. is bipolar disorder. I don't think this is an effective medication, but since I've not seen this pt. before the zyprexa was prescribed it's difficult to say how effective it is, from my POV.
All of the residents on zyprexa and risperdal have behavior checklists in their MAR to monitor for stabilization, and the nurse on duty fills it in qshift.

We have pages and pages of behavior books. 3/4 of the patients are on two or more psych meds (there is one MD at the facility who is the doctor for most of these patients, though, so that might say something.)

BelleKat, BSN, RN · Aug 12, 2008

I know that the atypical antipsychotics don't tend to work as well in the elderly,maybe because they're being given for behavior management and not for actual pychotic features. :twocents:

iwanna · Aug 12, 2008

I know that the atypical antipsychotics don't tend to work as well in the elderly,maybe because they're being given for behavior management and not for actual pychotic features.

Also, we would give these to children and adolescent's for behavior management issues as well. That was part of my job that I totally disagreed with. Sometimes, I believe the adolescents would act out on purpose, so they could feel a buzz from the IM's.

Many times I would question my own morals in doing something that I was so against. e.g giving a child anti-psychotic IM for acting out. When we really needed to address the behavior issue instead of a med, so they will not disrupt the rest of the unit any further.

Personally, I do not like giving these meds to children or the elderly.

However, the anti-psychotics have been a tremendous help with mental illness. It was a good feeling when a pt. would come in(usually result from non-compliance of meds) and leave a totally different person.

Sometimes, though I think these meds are given too freely. I believe a good hx needs to be taken before prescribing theses meds.

Jules A, MSN · Aug 13, 2008

Also, we would give these to children and adolescent's for behavior management issues as well. That was part of my job that I totally disagreed with. Sometimes, I believe the adolescents would act out on purpose, so they could feel a buzz from the IM's.
Many times I would question my own morals in doing something that I was so against. e.g giving a child anti-psychotic IM for acting out. When we really needed to address the behavior issue instead of a med, so they will not disrupt the rest of the unit any further.
Personally, I do not like giving these meds to children or the elderly.
However, the anti-psychotics have been a tremendous help with mental illness. It was a good feeling when a pt. would come in(usually result from non-compliance of meds) and leave a totally different person.
Sometimes, though I think these meds are given too freely. I believe a good hx needs to be taken before prescribing theses meds.

I totally agree that there needs to be a good hx and that it might seem like the meds flow freely in adolescent psych however most of these children can not function without their regular meds and PRNs. Addressing the behavior before they have escalated is the best strategy but once it has happened a PRN is often needed to keep them and the rest of the unit safe. Sadly these are not just run of the mill behavioral issues that are easily modified. I have never gotten the impression that any of my patients have been disruptive in order to get a shot "for a buzz", in fact they usually fight tooth and nail against IMs.

I have seen first hand what can happen when these kids need to be taken off their meds due to abnormal lab values for example. I have a kid in residential treatment who has always been a pleasure to care for. Bright, polite, gets along well with her peers, makes you wonder why she is even living there...until she had to come off two of her meds. It was hard to believe, she became argumentive, refused to do her school work, neglected her ADLs, initiated physical altercations with staff and other patients. Like night and day. I was very glad when she started back on them. I don't know the answer but I do know that for many of the truly mentally ill these meds are a blessing once you find the right combination.

NurseyPoo7 · Aug 13, 2008

I had a pt once in an ALF who had been just been admitted and was already attempting to elope - One dose of Risperdal and she was a perfect angel!

lsyorke, RN · Aug 13, 2008

Zyprexa and Risperdal are not FDA approved for dementia related psychosis, and carry a black box warning for that age group for sudden death.