Psychotropic Medications Definition
The use of benzodiazepines and hypnotics should be avoided, or their use should not exceed 30 days if possible (Carr, 2005; Voyer and Martin, 2003). When benzodiazepines are prescribed, it is best to avoid older medications (such as diazepam or chlordiazepoxide [Librium®]), which are more likely to build up and cause toxicity. Preferred anxiolytic and hypnotic medications as well as dosage guidelines and serious side effects are listed in Table 1. A systematic review of the published and unpublished literature on the use of atypical antipsychotics in patients with Alzheimer`s disease revealed a number of dangerous side effects. Poly pharmacy. Keep psychotropic medications as simple as possible to improve adherence and minimize side effects. Table 2 — Guidelines for the use of psychotropic drugs. Minimization practices. Minimize the following practices: (i) long-term use of PRN prescriptions (if necessary); (ii) long-term use of anxiolytic benzodiazepines such as diazepam; (iii) the use of long-acting calming hypnotic drugs such as chloral hydrate; (iv) long-term use of shorter-acting tranquilizing hypnotics such as temazepam (Restoril); (v) administration of anticholinergics such as benztropine without evidence of EPSE; (vi) long-term use of anticholinergics; (vii) high-dose antipsychotics; (viii) Use of phenytoin, phenobarbital and primidone as psychotropic substances. Anti-anxiety medications include beta-blockers, which help treat physical symptoms of anxiety, including increased heart rate, nausea, sweating, and tremors. The importance of clinical examination and monitoring of psychotropic medications in older adults cannot be overstated. Given the CMS guidelines (day 329 E), which prescribe gradual rejuvenation of psychotropic medications unless clinically contraindicated, nurses should carefully monitor how long a patient has received a medication.
The dose reduction or the reasons for continued treatment should be carefully documented. Although psychotropic medications are often prescribed to treat behavioral disorders and psychiatric symptoms, it is imperative that a comprehensive assessment of care be done to identify other possible causes of disruptive behavior, such as delirium, pain, fatigue, hunger, incontinence, and infection. Non-pharmacological interventions such as reminiscence, activity therapy, and pet therapy should be studied extensively (Kerber et al., 2008). When psychotropic drugs are administered, the lowest possible dose should be used, usually one-third to one-half of the usual dose of younger individuals, with a slow titration upwards (Carr, 2005). Close monitoring of adverse reactions and documentation of pharmacological and non-pharmacological interventions, including their effectiveness, are essential. Table 3 lists psychotropic and antiepileptic drugs by class, generic name and age-recommended dosage for people with developmental disabilities. Table 4 presents the most common indications and side effects for different classes of drugs. A comprehensive review of psychotropic drug use among people with developmental disabilities can be found in the following sources (Aman & Singh, 1991; Ellis et al., 1996; Singh, Ellis & Singh, 1994).
Among the psychotropic drugs available for pediatric use, antipsychotics have been heavily criticized. Antipsychotics are used to treat mental disorders such as psychosis, schizophrenia and bipolar disorder. These drugs can be divided into two classes: (1) first-generation antipsychotics, which were discovered in the 1950s, and (2) second-generation antipsychotics, which were introduced in the 1990s. Second-generation antipsychotics were marketed as safer remedies because they had reduced side effects common to first-generation drugs, such as extrapyramidal symptoms. This has led to the predominant use of second-generation antipsychotics not only for approved indications (e.g., schizophrenia, psychosis), but also for off-label conditions and symptoms (e.g., ADHD). However, several clinical trials and post-marketing pharmacoepidemiological studies have examined the risk of second-generation antipsychotics and reported that children taking these drugs have a higher risk of weight gain (Sporn et al., 2007), cardiometabolic syndrome (Correll et al., 2009) and type 2 diabetes (Sohn et al. 2015). An interesting example is ayahuasca, an infusion of the banisteriopsis vine and other plants whose combined β-carbolines and indole alkaloids produce the hallucinogenic effects that Amazonian shamans use in healing rituals.
However, the effects of ayahuasca go beyond psychoactivity. For example, it is antiparasitic, both because of the action of β-carbolines and because of the strong emetic and laxative effect (ejection of worms) of the infusion. This antiparasitic effect is important for populations that use ayahuasca, as the lowland tropics are home to many intestinal and other parasites. To divert some of the attention to psychoactivity, one could argue that the type and intensity of psychotropic visions that healers manipulate by adding plants could be indicators that healers use to determine the therapeutic efficacy and dose of ayahuasca for a variety of disorders. From this point of view, ayahuasca could also be understood as a means of administration for a long list of plant adjuvants, which is facilitated, among other things, by the inhibition of monoamine oxidase by β-carbolines. In other words, in some traditional therapies, antiparasitic and other effects are the main target, and psychoactivity is mainly used as a dose marker. Geriatric nurses can access information about the use of psychotropic medications in older adults from a variety of sources. The value of this article is that it provides an easily accessible source of critical information about psychotropic medications that all geriatric nurses need to improve their knowledge and care practices. Psychotropic medications carry a risk of neurotoxic side effects. The occurrence of neurotoxic effects can potentially reduce medication adherence. Some side effects can be treated symptomatically by the use of additional drugs such as anticholinergics (antimuscarinics). Some side effects of rebound or withdrawal, such as the possibility of sudden or severe onset or recurrence of psychosis in antipsychotic withdrawal, may occur if medications are interrupted or stopped too quickly.
[17] Although much of the literature on the use of psychotropic medications in older adults focuses on their use in nursing homes and among residents with dementia, the use of psychotropic medications in older adults with and without dementia is fairly common in all settings (community, assisted living, acute and psychiatric units, and nursing homes). Psychotropic medications are more common among seniors living in the community than in other age groups. For example, seniors living in the community are 7 to 18 times more likely to be psychotropic drugs than middle-aged adults (Voyer & Martin, 2003). Smith, Buckwalter, Hyunwook, Ellingrod and Schultz (2008) noted research suggesting that between 35% and 53% of assisted living residents receive one or more psychotropic medications, and Voyer and Martin (2003) found that more than half of community-dwelling seniors admitted to nursing homes receive psychotropic medications within 2 weeks of admission. In a study of older adults with dementia in nursing homes and geriatric care units, Pitkala, Laurila, Strandberg and Tilvis (2004) found that 87% of patients were taking one psychotropic drug, 66% two, 36% three, and 11% four or more. Informed consent. The written declaration of consent must be obtained from the person, if capable, or from the person`s guardian prior to the use of psychotropic drugs and must be renewed regularly. Kalashnik et al. (1995), the International Consensus Conference on Psychopharmacology established guidelines for the use of psychotropic drugs in persons with intellectual and other developmental disabilities (see Table 2). The following sources were used in the development of the guidelines: (i) regulation (e.g., Health Care Financing Administration, 1992); (ii) accreditation (e.g., Joint Commission on Accreditation of Healthcare Organizations, 1995); (iii) professional (e.g., American Psychiatric Association Committee on Research on Psychiatric Treatments, 1992); iv) litigation (e.g., Wyatt v. Stickney, 1972); (v) legislation (e.g.
the Civil Rights of Persons in Institutions Act of 1981); and (vi) proclamations and declarations (e.g., United Nations Assembly, “Declaration on the Rights of Persons with Mental Disabilities”; see Beyer, 1988; Kalashnik et al., 1995; Singh et al., 1992). The guidelines are supported by experts in the field of developmental disabilities and serve as a model for appropriate application. A stimulant is a drug that stimulates the central nervous system and increases arousal, alertness and endurance. Stimulants are used in psychiatry to treat attention deficit hyperactivity disorder. Because drugs can be addictive, addicted patients are usually closely monitored or treated with a non-stimulant. Psychopharmacology studies a wide range of substances with different types of psychoactive properties. The professional and business fields of pharmacology and psychopharmacology generally do not focus on psychedelic or recreational drugs, and therefore the majority of studies are conducted on psychiatric drugs.
