ABSTRACT
Abrupt discontinuation of antipsychotic drugs in patients with schizophrenia is associated with earlier, and often more severe, illness episodes than are seen with gradual discontinuation. Antipsychotic drugs can cause various abnormal motor syndromes, but abruptly stopping them has been associated with the seemingly paradoxical development of similar motor syndromes, such as withdrawal dyskinesias, parkinsonian symptoms, dystonias, and neuroleptic malignant syndrome. Dopamine-releasing and dopamine-agonist drugs are used to treat some of the motor syndromes caused by antipsychotic drugs, but their abrupt discontinuation can also be associated with abnormal syndromes. When antipsychotic drugs, lithium, or certain anticonvulsant drugs are used for treatment of bipolar disorder, rapid versus gradual discontinuation is more likely to lead to greater mood instability and manic relapse. If necessary, these medications should be gradually tapered to minimize all types of adverse discontinuation effects. Patients should be educated about the possible adverse effects of abrupt medication discontinuation.
Subject(s)
Anticonvulsants/adverse effects , Antimanic Agents/adverse effects , Antipsychotic Agents/adverse effects , Dopamine Agents/adverse effects , Lithium Carbonate/adverse effects , Psychotropic Drugs/adverse effects , Substance Withdrawal Syndrome/nursing , Akathisia, Drug-Induced/diagnosis , Akathisia, Drug-Induced/nursing , Akathisia, Drug-Induced/prevention & control , Bipolar Disorder/drug therapy , Brain/drug effects , Drug Administration Schedule , Dyskinesia, Drug-Induced/diagnosis , Dyskinesia, Drug-Induced/nursing , Dyskinesia, Drug-Induced/prevention & control , Humans , Nursing Diagnosis , Schizophrenia/drug therapy , Substance Withdrawal Syndrome/diagnosis , Substance Withdrawal Syndrome/prevention & controlABSTRACT
The article describes the management of akathisia by a mental health nurse (MHN) prescriber, working in partnership with the patient. A single-case design was used to evaluate this. It highlights three features: first, MHN can safely prescribe psychiatric medication in combination with concordance therapy. Second, the value base underpinning prescribing practice is partnership, honesty and choice for the patient. Finally, the pharmacological mechanism of antipsychotic medication, which contributes towards akathisia, requires further analysis.
Subject(s)
Akathisia, Drug-Induced/drug therapy , Akathisia, Drug-Induced/nursing , Nurse Clinicians/organization & administration , Psychiatric Nursing/organization & administration , Akathisia, Drug-Induced/etiology , Akathisia, Drug-Induced/psychology , Anti-Anxiety Agents/therapeutic use , Antipsychotic Agents/adverse effects , Benzodiazepines/adverse effects , Diazepam/therapeutic use , Drug Monitoring/nursing , Drug Prescriptions , Humans , Male , Nurse's Role , Nursing Assessment , Nursing Evaluation Research , Olanzapine , Outcome Assessment, Health Care , Patient Compliance/psychology , Professional Autonomy , Psychiatric Status Rating Scales , Psychotherapy, Brief , Schizophrenia/diagnosis , Schizophrenia/drug therapy , Schizophrenia/nursing , Schizophrenic Psychology , Severity of Illness IndexSubject(s)
Antipsychotic Agents/adverse effects , Community Health Nursing/standards , Dyskinesias/etiology , Dyskinesias/nursing , Nursing Assessment/methods , Psychiatric Nursing , Akathisia, Drug-Induced/etiology , Akathisia, Drug-Induced/nursing , Community Mental Health Services/standards , Dyskinesia, Drug-Induced/etiology , Dyskinesia, Drug-Induced/nursing , Dystonia/chemically induced , Dystonia/nursing , Humans , Hypokinesia/chemically induced , Hypokinesia/nursing , Muscle Rigidity/chemically induced , Muscle Rigidity/nursing , Nursing Evaluation Research , Psychiatric Nursing/methods , Psychiatric Nursing/standards , Tremor/chemically induced , Tremor/nursing , United KingdomABSTRACT
Ensuring the safety of patients who receive immunotherapy is an essential element of nursing care. Communicating changes in mental status to the medical team is important feedback for modifying or discontinuing the cycle of immunotherapy. These observations are even more crucial if neuropsychiatric toxicity (NPT) has been exhibited in a previous cycle of treatment. If nurses are aware of associative factors of NPT they can be more alert for emerging cognitive dysfunction. Early intervention will also mean the nurse will take additional measures to ensure patient safety, such as suggesting possible pharmacological alternatives and closer observation, and encouraging family members to help with orientation. The nurse can further assist by helping alleviate the patient's or family's feelings of helplessness by assuring them that the NPT will begin to subside once treatment has been terminated.
Subject(s)
Akathisia, Drug-Induced/etiology , Confusion/chemically induced , Immunologic Factors/adverse effects , Interleukin-2/adverse effects , Substance-Related Disorders/etiology , Akathisia, Drug-Induced/nursing , Akathisia, Drug-Induced/psychology , Confusion/nursing , Confusion/psychology , Family/psychology , Humans , Male , Middle Aged , Substance-Related Disorders/nursing , Substance-Related Disorders/psychologyABSTRACT
Presented are four clinical scenarios of patients receiving narcotics to control pain of various etiologies. In all cases minor adverse effects necessitated intervention so that continued use of these agents was possible. The four cases illustrate common adverse effects, including nausea, vomiting, pruritus, and dysphoria, that may occur during narcotic administration. Management strategies to deal with these and other common non-life-threatening effects of narcotic agents are presented.
