Mental health articles

Two examples of antipsychotic medication

Olanzapine (Zyprexa)

This may cause some signs of drowsiness or tiredness, with tendency towardsweight gain in the long term. However, there is a low risk associated with EPSE.Clozapine (Clozaril)

According to Gillam, clozapine should not be used initially as the first drugof choice in first-episode psychosis. Gillam, however, reports success in treatment resistance; when other forms of medication and intervention have had little or nopositive effects, he claims it possesses a resistance to sedation/drowsiness. However,it can reduce the production of white blood cells; leading to a low white cell count(agranulocytosis), which ultimately lowers the body’s resistance to fight infection,making a person more susceptible to illness. Therefore, early detection is vital and regular blood tests and medication may be reviewed or discontinued. The reportedside effects of most antipsychotic medication are:

• sedation and drowsiness

• lack of motivation

• akinesia – stiffness, lack of movement

• dyskinesia – abnormal movement, usually tremors of the hands or arms thatrange from fine to severe tremor but may also affect facial muscles

• tardive dyskinesia – late-onset dyskinesia, involuntary abnormal movements ofthe face and mouth, such as protrusion of the tongue and chewing movements,which may last for several years after stopping taking the medication

• dystonia – a slow movement or extended spasm in a group of muscles

• akathesia – complaints of restlessness accompanied by movements such as,rocking from foot to foot, pacing and being unable to sit still

• orthostatic hypotension – low blood pressure occurs when the person stands up

• dry mouth, constipation

• blurred vision

• urinary retention, urinary incontinence

• skin problems – irritation, rashes

• agranulocytosis – low white cell count

• weight gain

• Neuroleptic Malignant Syndrome – unusually high temperature and flu-likesymptoms, with muscle rigidity, requires rapid medical intervention as may befatal.

These unpleasant side effects impact negatively on people with schizophreniaand can lead to them not taking their medication. Norman and Ryria  usethe term ‘psychoeducation’ to describe improving service users’ knowledge aboutthe benefits and side effects of medication. It is an essential part of the role of thepractitioner to improve the knowledge not only of the person with schizophreniabut also of their family and therefore allow them to make informed choices abouttheir treatment.

Petit-ZeMan et al. demonstrate that weight gain is one of the mostsignificant reasons for a service user not taking their medication as they find thisweight gain distressing. Facilitation of weight control and overall holistic careis the way forward. Meiklejohn  refers to the physical health in mediumsecure units as being one of the most neglected areas in clinical practice. Thisview can be extended to other areas providing health care. Meiklejohn recommends direct focus on physical health as ‘a matter of routine’ and that health care practitioners require training in this area in order to be able to offer healthpromotion advice as a matter of course.

Hannigan and Coffey report on theories which confirmed that peoplewith schizophrenia were able to predict a relapse in their own mental health. Thesepersonal predictions, referred to as ‘prodromal signs’, alert the service user to the possibility of relapse. They differ from their usual and normal routines; behaviourbegins to marginally change from their usual rhythm of life, for example insomnia,increasing levels of anxiety and high or low expressed emotion (extremes of mood)can all be indications of an impending psychotic episode. Recognition of these subtlechanges in personal behaviour is the first stage of promoting insight. The personis encouraged to experience a certain level of control over their individual wellbeingand feel empowered to act on their personal findings. A quick response canminimise the impact of a psychotic episode. Gillam  recommends an ‘earlywarning clinic’ for people with schizophrenia to assist one another in identifyingand promoting insight and responsibility for themselves.

One mental health promotion strategy could be an advance directive. This is avehicle that empowers the person with schizophrenia to move quickly to report signs of deterioration. An advance directive is written by the service user and is facilitatedby the mental health practitioner. Family members or carers are identified, plusactions the service user wishes to be put into place should they become too ill tomake decisions for themselves. This advance directive allows theservice user, when they are lucid and insightful, to recommend particular personalactions and particular contact persons whom they trust to take care of their home,finances and personal issues. It is not a legally binding document. It can be altered,particularly if the service user becomes so debilitated that they require a formalsection of the Mental Health Act 1983 or are detained for treatment.

The advance directive is still a relatively new concept and more needs to be learnt.Rashid refers to these advance statements as ‘living wills’, and there aremany ethical, legal and administrative issues to explore. These relapse preventionplans (also known as ‘relapse signatures’) need to be tailored to each person. This is a further movement towards partnership and collaboration: theservice user and their mental health practitioner can set realistic plans to be put intooperation when they are unwell and unable to make decisions about their care andaffairs. This is a positive step away from the paternalistic care that many peoplewith schizophrenia have experienced.

Tags: antipsychotic，medication