The middle of 20th century identifies a pivotal period in the treatment of persons with mental illness. It was during this time that the phenothiazines were introduced into the United States. Before that time they had been used in France as preoperative medications. As Dr.Henry Laborit of the hospital Bouicaut in Paris stated \u201cit was our aim to decrease the anxiety of the patient\u2019s to prepare them in advance for their postoperative recovery. With these new drugs, Phenothiazines, we were seeing a profound psychic physical relaxation. a real in difference to the environment and to the upcoming operation .It seem to me these drugs must have an application in psychiatry.( Sage, 1984)
Indeed they have had a significant application in psychiatry. Not only have they given many individuals a chance, without which they would have been unable to function, but also they have provided researchers and clinicians with information to study the origins and etiologies of mental illness. Knowledge gained from learning how these drugs work has promoted advancement in understanding how behavioral disorders develop.Dr.Arnold Scheibel,director of the UCLA brain research institute stated \u201cWhen these drugs came out there was a sense of disbelief that we could actually do something substantive for the patients\u2026see them for the first time as sick individuals and not as something bizarre that we could literally talk to (Sage 1984)
Historically, reaction to and treatment of persons with mental illness ranged from benign involvement to intervention some would consider in human. Individuals with mental illness were feared because of common belief associating them with demons or the supernatural. They were looked upon as loathsome and often were mistreated.
Beginning in the late 18th century, a type of \u201cmoral reforms\u201d in the treatment of persons with mental illness considered a break through in the humanization of care, these instutions, however, well intentioned, fostered the concept of custodial care. Clients were ensured the provision of food and shelter but received little or no hope of exchange for the future .As they became increasingly dependent on the institution to fill their need, the likelihood of their return to the family or community diminished.
The early part of the 20th century saw the advent of the somatic therapies in psychiatry. Individuals with mental illness were treated with insulin shock therapy, wet sheets packs, ice baths, electroconvulsive therapy, and psycho-surgery. Prior to 1950, sedatives and amphetamines were the only significant psychotropic medications available. Even these had limited use because of there toxicity & addicting effects. Since the 1950s the development of Psychopharmacology has expanded to include wide spread use of antipsychotic, antidepressant and antianxiety medications, research into how these drugs work has provided an understanding of the etiology of many psychiatric disorders.
Psychotropic medications are not intended to \u201ccure\u201d the mental illness. Most physicians who prescribe these medications for their clients use them as an adjunct to individual or group psychotherapy. Although their contribution to psychiatric care cannot be minimizes, it must be emphasized that psychotropic medications relieve physical and behavioral symptoms. They don\u2019t resolve emotional problems.
Psychopharmacological treatment should be integrated with the principles of psychiatric nursing practice .The psychiatric nurse has a wealth of knowledge and competencies that make the nursing care provided to the people with psychiatric disorders unique in many ways. Following are the role of nurse\u2019s in psychopharmacological treatment of persons with neurobiological illnesses.
brain disorders. However not all patient behavior are treated by drug therapy, not every identified personality trait is a symptom of illness target for the treatment with the drugs. It is essential that through patient baseline assessment, including history, physical and laboratory examination, psychiatric evaluation, sociocultural assessment and a medication history be completed for each patient before any treatment interventions are initiated.
The nurse has an important role in designing a comprehensive treatment program. The most appropriate treatment choices should be individualized for each patient and reflected in the treatment plan. The coordination of treatment modalities is often the primary responsibility of the nurse who works the patient in an ongoing therapeutic alliance as part of the health care team. The nurse is in position to integrate drug treatment with wide range of non pharmacological treatments in a manner that is knowledgeable, safe,effective and acceptable to the patient.
No One on the health care team has a greater daily impact on the patient\u2019s experiences with psychopharmacological agents than the nurse. Nurse administers the medication dose, works out a dosing schedule based on the drug requirements and the patient\u2019s need and preferences and is continually alert for and treats drug effects. This role defines the nurse as a key professional in maximizing therapeutic effects of drug treatment and minimizing side effects in such a way that the patient is a true collaborator in managing the medication regimen.
The nurse has the important role of consistently monitoring the effects of psycho- pharmacological drugs. This includes making standardized measurements of drug effects on baseline target symptoms of illness, evaluating and minimizing side effects, treating adverse reactions and noting the often subtle effects on the patient\u2019s self concept and sense of trust.
A drug should be given within the recommended dose range and for the appropriate amount of time before it can be determined whether the drug has had an adequate therapeutic trial for a particular patient. Therapeutic drug monitoring is important because some drugs have a narrow therapeutic range (such as lithium) ,they can cause sudden serious adverse reactions 9such as neuroleptic malignant syndrome) ,and drugs are often co-administered ,thereby altering drug metabolism and clearance rates.
It is the responsibility of nurse to anticipate these possibilities and prescribe accordingly. The nurse should be vigilant for signs of drug effects that seems inconsistent with what doses prescribed or that are adverse reactions.
The nurse is a pivotal position to educate the patient and family about medications. This includes teaching complex information to the patient so that it can be understood, discussed and accepted. Patients should be informed about each drug prescribed for them. They should be well educated about the expected benefits and potential risks, understand
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