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.
Specializes in Home Care, Primary care NP, QI, Nsg Adm.
Anti-psychotics and mood stabilizing medications definitely have their place in the treatment of appropriate psychiatric disorders, however, approximately 30% of patients will be resistant to these medications.
In the nursing home setting many other factors can and do influence a patients behavior besides dementia. Lack of intimate contact, changes in their normal environment, diet, chronic dehydration, medication cocktails, chronic diseases, etc. It seems that a more thoughtful approach beyond slamming an elderly patient with an anti-psychotic that can have undesirable side effects and are quite costly is appropriate. Again, it is nurses questioning the validity and necessity of these medications.
Zyprexa and Risperdal are not FDA approved for dementia related psychosis, and carry a black box warning for that age group for sudden death.
When are we going to acknowledge that just BEING in that age group is a "black box" warning for death?
I have seen risperdal help a lot for dementia-related behavior. And when the frontal lobes are atrophied and inactive what results is psychotic behavior.
Remeron, I've seen mostly used to stay dementia. Doesn't work.
Zyprexa doesn't work for much, as far as I have ever seen, except acutepsychotic episodes in young people whose conditions have not progressed to chronicity. Same with Abilify.
I have seen risperdal help a lot for dementia-related behavior. And when the frontal lobes are atrophied and inactive what results is psychotic behavior.
This scares me so bad. I have significant frontal lobe damage from when a horse fell on me when I was 13. No telling what will happen if I make it to old age.
I did not read ALL of the other threads, so excuse me if I am repeating something. My nephew is eight and is on risperdal for extreme ADHD and it is the only thing that works. He is also on something else in combination with it, but for some reason it has slipped my mind. I know that you were asking about it for its labled use, but just had to add this in. Anyways, it is very effective in managing his ADHD which is so severe that he has been kicked out of 2 schools.
I did not read ALL of the other threads, so excuse me if I am repeating something. My nephew is eight and is on risperdal for extreme ADHD and it is the only thing that works. He is also on something else in combination with it, but for some reason it has slipped my mind. I know that you were asking about it for its labled use, but just had to add this in. Anyways, it is very effective in managing his ADHD which is so severe that he has been kicked out of 2 schools.
It is nice to read success stories. We have quite a few kids on it also with varying results. I hope your nephew continues to do well.
I was wrongly prescribed an antipsychotic. I've never wanted to hurt myself before in my life, but thanks to a WHOLE 5-minute evaluation on my mental state at the time, I was given a dangerous drug that made my body and mind crazy. Thanks for the thorough investigation to the psychiatrist (I repeat, 5 minute session). Just because you overdose on an antidepressant you're treated like an animal with no feelings or thoughts. This is my random sampling of one time in a psych ward.
Specializes in Home Hlth, Psych, Nsg Hm, Plasma Med Sup.
Remeron (mirtazapine) - Nursing 2010 Drug Handbook, still does not list the off-label uses, and this is the most used drug handbook (but not necessarily the best). Many patients of all ages (even those in late teen years, a black box warning age group) have found this effective after trying many other anti-depressants which came up lacking.
In addition to being effective for the labeled use, it has helped many with anxiety, insomnia, and anorexia. It even works great for anorexic animals, ask your vet!
Great comments by all, and as always, a very helpful learning experience.
I have seen these drugs make a big difference for a number of patients but they were all truly mentally ill to begin with. One thing that seems to get a little confused is dementia and psychosis. We have a few LOLs in the acute psych facility that I work at that are are (in my humble opinion) simply aging and are taking on some of the characteristics of early dementia. When put on anti-psychotics they not only not improve they begin to further decomensate d/t the side effects of these potent drugs on this population. I think in general these drugs do not have a place in a nursing homes unless the patient really is mentally ill and alzheimers/dementia is ruled out.
Saifudin
234 Posts
Anti-psychotics and mood stabilizing medications definitely have their place in the treatment of appropriate psychiatric disorders, however, approximately 30% of patients will be resistant to these medications.
In the nursing home setting many other factors can and do influence a patients behavior besides dementia. Lack of intimate contact, changes in their normal environment, diet, chronic dehydration, medication cocktails, chronic diseases, etc. It seems that a more thoughtful approach beyond slamming an elderly patient with an anti-psychotic that can have undesirable side effects and are quite costly is appropriate. Again, it is nurses questioning the validity and necessity of these medications.