C H A P T E R 2 2
Psychotherapeutic agents
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CRITICAL THINKING SCENARIO
Antipsychotic drugs
THE SITUATION
B.A., a 36-year-old, single, professional woman, was
diagnosed with chronic schizophrenia when she was in
high school. Her condition has been well controlled with
chlorpromazine
(Largactil)
and she is able to maintain
steady employment, live in her own home and carry on a
fairly active social life. At her last evaluation, she appeared
to be developing bone marrow suppression and her doctor
decided to try to taper the drug dosage. As the dosage was
being lowered, B.A. became withdrawn and listless, missed
several days of work and cancelled most of her social
engagements. Afraid of interacting with people, she stayed
in bed most of the time. She reported having thoughts of
death and paranoid ideation about her neighbours that she
was beginning to think might be true.
CRITICAL THINKING
What care interventions are appropriate at this time?
What supportive measures might be useful to help B.A. cope
with this crisis and allow her to function normally again?
What happens to brain chemistry after long-term therapy
with phenothiazines?
What drug options should be tried?
Are there any other options that might be useful?
DISCUSSION
Schizophrenia is not a disorder that can be resolved simply
with proper counselling. B.A., an educated woman with a
long history of taking phenothiazines, realises the necessity
of drug therapy to correct the chemical imbalance in her
brain. She may need a high-potency antipsychotic to return
her to the level of functioning she had reached before
experiencing this setback. Her knowledge of her individual
responses can be used to help select an appropriate drug
and dosage. Her experiences may also facilitate her care
planning and new drug regimen.
B.A. will need support to cope with problems at
work—from her inability to go in to work, to coping with
feelings about not meeting her social obligations, to finding
the motivation to get up and become active again. She
might do well with behaviour modification techniques that
give her some control over her activities and allow her to
use her knowledge and experience with her own situation
to her advantage in forming a new medical regimen.
She may need support in explaining her problem to her
employer and her social contacts in ways that will help her
avoid the prejudice associated with mental illness and will
allow her every opportunity to return to her regular routine
as soon as she can.
Because it may take several months to find the drug or
drugs that will bring B.A. back to a point of stabilisation, it is
important to have a consistent, reliable healthcare team in
place to support her through this stabilisation period. She
should have a reliable contact person to call when she has
questions and when she needs support.
CARE GUIDE FOR B.A.: ANTIPSYCHOTIC/
NEUROLEPTIC DRUGS
Assessment: History and examination
Allergies to any of these drugs; CNS depression; CV disease;
pregnancy or breastfeeding; myelography; glaucoma;
hypotension; thyrotoxicosis; seizures
Concurrent use of anticholinergics, barbiturate anaesthetics,
alcohol, pethidine, beta blockers, adrenaline,
noradrenaline
CV: blood pressure, pulse, orthostatic blood pressure
CNS: orientation, affect, reflexes, vision
Skin: colour, lesions, texture
Respiratory: respiration, adventitious sounds
GI: abdominal examination, bowel sounds
Laboratory tests: thyroid, liver and renal function tests, FBC
Implementation
Give drug in evening; do not allow person to chew or crush
sustained-release capsules.
Provide comfort and safety measures: void before dosing;
raise side rails; provide sugarless lozenges, mouth care;
institute safety measures if CNS effects occur; position
person to relieve dyskinesia discomfort; taper dosage
after long-term therapy.
Provide support and reassurance to help person cope with
drug effects.
Teach person about drug, dosage, adverse effects,
conditions to report and precautions.
Evaluation
Evaluate drug effects: relief of signs and symptoms of
psychotic disorders.
Monitor for adverse effects: sedation, dizziness, insomnia;
anticholinergic effects; extrapyramidal effects; bone
marrow suppression; skin rash.
Monitor for drug–drug interactions as listed.
Evaluate effectiveness of teaching program.
Evaluate effectiveness of comfort and safety measures.
TEACHING FOR B.A.
• The drugs that are useful for treating schizophrenia are
called antipsychotic or neuroleptic drugs. These drugs
affect the activities of certain chemicals in your brain and
are used to treat certain mental disorders.
