As AJN‘s June issue CE article on antipsychotic medications makes clear, the history of the treatment of mental illness provides many cautionary tales:

Theories about the causes of mental illness have included the belief that a person is possessed by spirits, demons, or the devil; that she or he has a weakness of character; or that the person had a “refrigerator” mother, someone whose coldness led to the child developing insanity. Those with mental health issues were treated with . . . therapies that are now considered to be questionable and inhumane: being chained . . . in institutions . . . and put into insulin-induced comas; having a lobotomy; being subjected to malarial therapy, exorcism, and prayer; being placed into ice water baths . . .

Images courtesy of the estate of Bryan Charnley. Full image caption below.

In the past century, as our understanding of various aspects of mental illness has increased (there’s still a long way to go), so has the range of available treatments, from psychotherapy to a constantly expanding arsenal of first- and later-generation drugs, many with substantial adverse effect profiles. The use of psychotropic medications continues to increase in the United States:

“It’s been estimated that approximately 20% of adults are taking at least one type of psychotropic medication, an increase of 22% from 2001 to 2010 . . . .” And “adults are not alone—between 2005 and 2010, more than 6% of adolescents reported using psychotropic medications within the past month.”

As author Donna Sabella points out, these drugs are most often prescribed by primary care providers and family physicians, often without concomitant psychotherapy or monitoring by a psychiatrist. In this age of polypharmacy, nurses need to know about these drugs as they know about any other types of commonly prescribed drug:

Because nurses are now caring for people of varying ages, and with varying diagnoses, who are taking these types of medications, they need to develop a working knowledge of the agents available and know when it’s appropriate to prescribe them for mental health disorders as well as for disorders unrelated to mental health.

“Antipsychotic Medications,” the first article in a series on commonly used psychotropic medications for the treatment of mental illness, reviews the mechanisms of action, adverse effects, and contraindications of first-generation typical and second-generation atypical antipsychotics. Drug interactions, potential for abuse, and alternative or complementary therapeutic options are all part of the picture.

As Sabella writes:

“What nurses should do when caring for a person taking antipsychotics is what we do for those taking any class of medications: assess the patient’s response and look for adverse reactions.”

For a broader context, see also this month’s editorial, “How Will We Care for the Mentally Ill?”

(Image caption: Diagnosed with schizophrenia as a young man, British painter Bryan Charnley began his final work, the Self Portrait Series, while experimenting with decreasing doses of his antipsychotic medications. At left is what he called a “conventional portrait”; at right is “an extremely complicated picture as I feel I am closing in on the essential image of my schizophrenia.” The 17 self-portraits depict his mental state over the six months before his death by suicide in July 1991 at the age of 42. Images courtesy of the estate of Bryan Charnley.)wa