• Subject Code : NRSG263
  • Subject Name : Nursing

Principles of Nursing Mental Health

A mental illness is a condition in which an individual is having affected moods and feelings, that might alter the person’s perceptions and thinking as well (Reuben, 2017). These conditions might hamper a person’s ability to relate with the ongoing reality of daily routine in life. Two persons having same diagnosis of mental illness, might be having different experiences altogether, at a same given point of time. The mental illness can affect the individual at any given particular age and is not gender specific as well. The repercussions of it are to be beared by the person as well the family members too. In order to recover from the same a holistic approach is needed to help the patient and their family as well (Vigo, 2016). The person needs to recover in a meaningful way, so that he is normal to carry on with his activities of daily living as well as his work and social life too.

Early interventions in the treatment play a crucial role in defining the progress of the individual and also benefits largely the person’s recovery process that he has to carry on his own. Any mental health related issue is not because of one particular incident, rather it is because of multiple overlapping causes at a same time (Baer, 2019). Some other attributing factors can be genetics, environment of the individual or his choice of lifestyles. Any stressful condition or situation that a person might be subjected to at home or at his work place can act as a trigger as well, for the person to develop these symptoms. This might bring an alteration in the biochemical processes and circuits of brain, that can be directly reflected in person’s behavioural display and attitudes.

There are multiple treatments modalities that are used for the patients having mental illness. Medical management makes up for a major part of the same. Prescribing medication for the purpose of managing these diseases, play a vital role in co-occurring or re-occurring of the disorder. They can help largely in reducing the symptoms and also aid in preventing the symptoms form relapsing in any psychotic disorder. The also assists the healthcare providers in minimizing the effect of other drug abuse on patients and prevents them from developing cravings for abusive substances (Procyshyn, 2019). Taking these medications doesn’t cause substance abuse however, the person still needs to informed about the potential risks and benefits of taking these medications. The drugs have to be strictly administered as per the prescribed dosages by the clinicians (Jones, 2018).

These drugs help in altering the mood of an individual in in a different manner than it is done by a drug. There are multiple drugs that have been tested well before being prescribed to the patients to treat their mental health related issues. These medications are available for a large group of mental health issues such as anxiety disorder, schizophrenia, bi-polar disorder, panic disorder, stress disorder, post-traumatic stress disorder etc. There have been placebo-controlled trials that have proved by due researches that these medications have been effective in reducing the symptoms of the patients by multiple folds (Chen, 2017). Studies have shown that antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs) have been shown to be beneficial in reducing the symptoms of depression by 60 percent (Zaini, 2018). In many of the cases, these medications have also been helpful in achieving complete remission in some of the patients. Although there are multiple psychotherapies in place to treat these individuals, the medical management remains the mainstay of treatment for patients who have profound symptoms or have chronic mental illness or symptoms.

There has been an on-going controversy about the effects of medications in treating mental health related issues. It is ideally safe to prescribe for medication in any mental health problem, as it is one of the effective means to treat the condition. However, as for each of the medication goes, there might be certain side-effects because of the prolonged use of these medications. There have been studies showing that the use of medications like antipsychotic drugs, antidepressants etc., have been shown to actually protect the brain cells from further damage and brain illness (Rief, 2016). They have also been found to improve the overall functioning of the patient suffering from these ailments. There are multiple number of side effects that might come from the use of psychotic medications. Amongst the various classes of the drugs, these side effects can be seen as very common. The span of these side-effects is commonly spread across all classes of drugs. Some of the common side effects can be seen as the patient feeling drowsiness, restlessness, muscle spasms, dry mouth, blurring of vision etc.

Some of these drugs can have long-term side effects including involuntary muscle movement affecting lips, mouths, trunk movements and extremities of the body as arms or legs. The randomized trials conducted in this field reflects on the fact as to how the effect of drug is not properly evaluated before being prescribed. There is a loop-hole in taking the history in detail as well. Some of these patients, might be having a biased-symptoms, as they might be taking some or other psychotic medication before. When these patients are subjected to taking placebo therapy they might go into a wash-out phase, which might disable them to connect with the previous on-going activities and experiences (Grover, 2019). Some of these patients are seen to be having withdrawal symptoms as well. There also has been under-reporting of the symptoms in the patients, regarding these placebo medication therapies given to them. The main effect is brought by the over-use of these medications for a prolonged period of time, without the medication being reconciled to alter the dose or number of times to be taken in a day. This can be one of the major attributing factors in contributing to the alteration in behaviour of the individual taking these medications.

Studies have shown that overuse of psychotic medications in mental disorders can cause the person to develop drug-induced psychosis, due to abuse and intoxication of that drug (Mendrek, 2017). This drug-induced psychosis can be a direct result of the drug being mixing with the blood, causing an adverse reaction in the individuals suffering from mental health related issues. This can also bring about the symptoms in individuals who might be having an underlying possibility of having mental illness. Though a direct relation between drug being taken an onset of psychosis cannot be established, but an individual who is already suffering from the same condition is more prone to develop psychosis, triggered by becoming overly intoxicated. In these cases, the only treatment option is to stop making use of substances that might bring about these changes in individuals. However, doing so can have its own repercussions as it is not the only way out. By refusing the patient these drugs, who are addicted to the same can bring about major withdrawal symptoms in these individuals.

Addiction to these medications can stop an individual from taking these medications any further and thus making the reality a little complicated as observed (Divya, 2019). Withdrawal symptoms in these individuals is more unavoidable due to prolonged use of these medications. These incidences have also shown, forcing an individual to self-medicate themselves in order to silent out their symptoms. The most effective way is to treat the situation through the process of detoxication. Medically supervised detox preventive measures can help these individuals in not only managing their symptoms, but will also assist in tapering off from these medications easily. Upon completion of initial detoxication the issue of psychosis can be easily dealt with. Another major attributing factor causing this harm is the inappropriate prescribing of these medications. While clinicians looking at medication the only way out, might prescribe these drugs rapidly, but it is not the safest way to treat for these disorders. These medications are often being prescribed without duly evaluating the individuals for proper diagnosis.

Due to this factor some of the other drugs that the patient might be taking, might overlap with the functioning of these psychotic drugs, bringing about unwanted clinic signs and symptoms in these individuals. Studies have shown that prescribing medications is an easy resort for physicians as well, rather than being engaged with the patient for longer duration in various therapies (Janus, 2016). On the other hand, there has been evidence-based treatments such as cognitive and behavioural therapies that have been proven to be fruitful in treating these individuals. These reasons can be cumulatively be considered as the contributing factors in bringing about control in the behaviour of patients suffering from mental health related issues, by prescribing them psychotic drugs over other therapies in place for the management of their disease. Clinicians guidelines and integrated-approach is the main key to treat these individuals, rather than opting out for just medication therapy to reduce the symptoms and attain better healthcare outcomes in these individuals (Gjerden, 2017).

The role of nurses in vital in any illness or disorder to manage the condition (Happell, 2016). Psychiatric nurses are having a higher level of expertise at both advanced and generalized practise level. They can have both direct and indirect participation in the care system. They can help in managing these disorders by combine their mental health disciplines with the biopsychosocial knowledge, their competency in pharmacology and their ability to assess the patient on both intrinsic and psychiatric assessment. These psychiatric nurses are an expert in evaluating complex psychiatric issues such as substance abuse, physical, social and mental health needs of an individual (Ewart, 2016). They can help in not only evaluating these individuals, but can also assist in predicting the psychological consequences of the mental illness of the patient.

They also play a crucial role in designing and implementing a patient-centred care model, that will be most appropriate to treat the patient’s condition through a more structured approach and in a holistic manner. They are also well-qualified in participating on a professional front in making best possible use of the treatment modalities to marginalize the effectiveness of the health care system as a whole (McAllister, 2017). One of the main challenges faced by the nurses is the overuse of drugs in patients that are on psychotic medications. Studies have shown that patients are being given more medications to calm their symptoms, as the patients themselves believe that taking these medications is the only resort to treating their symptoms. This drug addiction posses as a main barrier in smooth facilitation of the treatment process. The main motive of misuse of these drugs is convenience. As these drugs can control the symptoms in an instance, they are the preferred choice of treatment mainly by the individuals who are suffering from chronic illness of mental health related issues (Chapman, 2018).

The effects of mainly psychotic drugs can take several days to weeks to wean off and the full effects might also take up to several months to be relieved. In order to stabilize the mental health disorder, it is imperative that a holistic approach is adopted. Before prescribing for drug, a detailed evaluation should be conducted to rule out any medication or personal history of the patient, so as to ensure that no two therapies are overlapping with each other (Muyambi, 2019). Patients that are mainly suffering from mood and anxiety disorders should be considered for tapering off, from their medications so that they don’t develop for any medication addiction. A combined approach of various therapies and treatment modalities should be included in the routine to provide the patient with well-defined care as per the patient’s requirements and needs. The relapse for symptoms should be closely monitored while tapering off the medication, to control the same. The integrated care approach should be inclusive of family and peer group, that can assist largely in smooth facilitation of the disease (Allen, 2017).

References for Principles of Nursing Mental Health

Allen, D. M. (2017). Psychotherapy with borderline patients: An integrated approach. Routledge. United Kingdom.

Baer, R., Crane, C., Miller, E., & Kuyken, W. (2019). Doing no harm in mindfulness-based programs: conceptual issues and empirical findings. Clinical psychology review71, 101-114.

Chapman, S. A., Phoenix, B. J., Hahn, T. E., & Strod, D. C. (2018). Utilization and economic contribution of psychiatric mental health nurse practitioners in public behavioral health services. American journal of preventive medicine54(6),243-249.

Chen, J. J. (2017). Treatment of psychotic symptoms in patients with Parkinson disease. Mental Health Clinician7(6), 262-270.

Divya, M., Arul, B., & Kothai, R. (2019). Drug induced psychiatric disorder-A mini review. International Journal of Research in Pharmaceutical Sciences10(4), 3263-3268.

Ewart, S. B., Happell, B., Platania‐Phung, C., Bocking, J., Griffiths, K., Scholz, B., & Stanton, R. (2016). Embedding a physical health nurse consultant within mental health services: Consumers’ perspectives. International journal of mental health nursing25(4), 377-384.

Gjerden, P., Bramness, J. G., Tvete, I. F., & Slørdal, L. (2017). The antipsychotic agent quetiapine is increasingly not used as such: dispensed prescriptions in Norway 2004–2015. European journal of clinical pharmacology73(9), 1173-1179.

Grover, S., Mehra, A., Chakrabarti, S., & Avasthi, A. (2019). Attitude toward psychotropic medications: A comparison of the elderly and adult patients with affective and psychotic disorders. Journal of Geriatric Mental Health6(2), 38.

Happell, B., Wilson, K., Platania‐Phung, C., & Stanton, R. (2016). Physical health nurse consultant role to improve physical health in mental health services: a carer's perspective. International journal of mental health nursing25(3), 243-250.

Janus, S. I., van Manen, J. G., IJzerman, M. J., & Zuidema, S. U. (2016). Psychotropic drug prescriptions in Western European nursing homes. International psychogeriatrics28(11), 1775-1790.

Jones, E. B. (2018). Practice characteristics of nurse practitioners in mental health and psychiatric settings. Archives of psychiatric nursing32(4), 599-603.

McAllister, S., & McCrae, N. (2017). The therapeutic role of mental health nurses in psychiatric intensive care: A mixed‐methods investigation in an inner‐city mental health service. Journal of psychiatric and mental health nursing24(7), 491-502.

Mendrek, A., & Fattore, L. (2017). Sex differences in drug-induced psychosis. Current opinion in behavioral sciences13, 152-157.

Muyambi, K., Leach, M., Martinez, L., Cronin, K., McPhail, R., Dennis, S., ... & Jones, M. (2019). Rural and metropolitan South Australian mental health workers’ views about nurse prescribing: A thematic analysis. Health & social care in the community27(2), 356-365.

Procyshyn, R. M., Bezchlibnyk-Butler, K. Z., & Jeffries, J. J. (Eds.). (2019). Clinical handbook of psychotropic drugs. Hogrefe Verlag. United KIngdom

Reuben, A., & Schaefer, J. (2017). Mental illness is far more common than we knew. Scientific American Mind28(6), 39-42.

Rief, W., Barsky, A. J., Bingel, U., Doering, B. K., Schwarting, R., Wöhr, M., & Schweiger, U. (2016). Rethinking psychopharmacotherapy: the role of treatment context and brain plasticity in antidepressant and antipsychotic interventions. Neuroscience & Biobehavioral Reviews60, 51-64.

Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis. United States.

Vigo, D., Thornicroft, G., & Atun, R. (2016). Estimating the true global burden of mental illness. The Lancet Psychiatry3(2), 171-178.

Zaini, S., Guan, N. C., Sulaiman, A. H., Zainal, N. Z., Huri, H. Z., & Shamsudin, S. H. (2018). The use of antidepressants for physical and psychological symptoms in cancer. Current drug targets19(12), 1431-1455.

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