Find out Factors Due to George Had Stopped Taking the Medicines

Question: Discuss about the Study of George Undergoing a Treatment. Answer: Introduction This essay is based on the case study of George, who is was addicted to cannabis and was undergoing a treatment. He was being treated with specific doses of risperidone, but it has been found that George had stopped taking the medications due to some factors. This essay aims to focus on the factors due to which George had stopped taking the medicines. This essay will also focus on the possible nursing interventions and the evidence based practices that have to be adopted to reduce the factors that are preventing George to take the proper medications. Apart from the pharmacological management, this essay would also concentrate on the holistic care of approach taken up by the nurses to care for the psychotic patients. Cannabis is drugs that are also known as marijuana are often used by people for the recreational use other than the medical uses. Excessive use of such drug can lead to mental disorders. They can show irritability, restlessness, withdrawal symptoms when not taking the drug. Cannabis dependence may occur when the brain adapts a large part of the drug and reduces the production of its own neurotransmitters (Volkow et al., 2014).It becomes an addiction when the person can no longer stop the usage of the drugs. Addiction may hamper many aspects of the life including the personal and the professional life. Proper and timely medications along with holistic approach of care from the family and the care givers can bring back the persons life to the normal. This essay focuses on the care interventions that would improve the quality of life of these people. Doses of Risperidone (n=21) are often prescribed as medications to the patient suffering from cannabis disorder. Risperidone is normally used to treat Schizophrenia, schizo-affective disorder. Factors Anti psychotic medicines like risperidone reduces the severity of the serious mental illnesses, and can help in the improvement of the outcome of the patient. Discontinuation of the treatments of the serious mental disorders might increase the risk of relapse. There are certain factors that lead to the nonadherence to treatments and medications, and it is important to understand the factors before adopting any interventions (Machielsen, Veltman, van den Brink de Haan, 2017). It was found that poor insight was the main reasons for non adherence to treatment in almost 56.5 of the studies. Other factors are the substance abuse, which has been found in almost 36% of the studies, negative attitude towards the medication in 30% of the studies and cognitive impairment in 13.45 of the studies (Kane, Kishimoto Correll, 2013). The main reason that has been found behind the discontinuation of the medicine is the negative attitude towards the medicine.( Kane, Kishimoto Correll, 2013) Another important factor is that people having drug addiction have a tendency to get rid of any sorts treatments that would part them away from the drug, as it becomes very difficult for them to stay away from the drug, even if they want to. Few studies have provided with the evidences that cannabis widrawal has lead to serious clinical adverse condition (Machielsen, Veltman, van den Brink de Haan, 2017). Sudden widrawal from the drug might lead to irritability, anxiety, depressions, troubled sleep, insomnia, loss of focus and feeling of low esteem, sometimes even suicidal. The cannabis consumers would face some consequences in the early stage of the treatment- like headaches, which will ultimately weaken and fade away. The addicted ones would face strong cravings for the drugs. Many users suffer from strong sweating and chills, the discomfort and the cravings can trigger strong relapse (Noto et al., 2015). People who are addicted often fear of these traumatic symptoms of the drug widrawal, and often refrain them from taking the antipsychotic medications. An important reason directly associated with voluntary nonadherence was a negative attitude toward medication, a mediator of effects of insight and therapeutic alliance. Substance abuse was the only reason which associated with involuntary nonadherence,(Noto et al., 2015) regardless of type and stage of the disorder. It has been found that poor acceptance of early medications and hostility and un-cooperativeness at the first admission was found to be the key mediator of the non adherence to treatment. A patient can be unaware of the severity of his own clinical conditions. Better awareness of the illness and the medications can decrease the negativity of the patient towards the medication. Further, another reason that cannot be overlooked is the side effects of Risperidone (Bayl et al., 2015).Major side effects related to Risperidone is- display of aggressive behavior, anxiety, agitation, difficulty in speaking or swallowing, loss of balance , problems with memory, muscular spasms, p roblems with urination, restlessness, twitching and twisting body movements and more. (Machielsen et al., 2017). It was mentioned in the report that George was taking the medication and has stopped it suddenly, which can give us an indication , that George might have been suffering from such a condition that George actually thought of discontinuing the medicine. Few studies have revealed that these psychotic medicines have impacted badly on the brain and have caused cognitive impairment (Jalbert et al., 2017). This can be a reason for the non adherence to the medications. Therefore, George might have been suffering from any of these factors, that he had stopped the usage of the medicines. As per the case study, George had discontinued the uptake of the medicines, which may be due to the factors discussed above. Partial or complete discontinuation of the medications may lead to many negative outcomes. It can cause relapse of the persistent symptoms, psychosis, even attempts to suicide. It has also been found that lack of adherence to the medications has led to hospitalization of the patient with critical conditions. According to (Morrison, Meehan Stomski, 2015), nonadherence to the medication during the first week after the discharge has got a high risk of re-hospitalization within a month of discharge. Nursing interventions There are several support strategies to address the problem that George is facing on discontinuation of the medical treatment. There are several therapeutic support services that can provide counseling to the patient, in this case George. There are several therapies that can identify the motivational and the cognitive barriers that are responsible why George had discontinued the intake of Risperidone. The cognitive and behavioral therapy involves the negative beliefs about the medication. This involves motivational interviewing, where all ambivalence regarding the side effects of the medication are cleared, and perceptions are addressed which involves the importance of taking medication and confidences are provided to stick to the treatment regimen. (Zullig, Peterson Bosworth, 2013). Cognitive adaption trainings are given which involves the environmental supports and the cues to compensate for the cognitive impairment that can cause memory problems that can involve pillboxes, alarms, activity checklists. Support system also accessibility of the medicines, arrangement of the transportation to the pharmacies. (Zullig, Peterson Bosworth, 2013). A medication management program must focus on the importance of the interactions that are required to improve the adherence rates of the medications. Interactions lead to client participation in therapeutic programs. The actual reasons behind the non adherence have to be recognized. The interventions that can be taken up as a medication management approach- Assessment of the mental health The initial assessment of the mental status of the client is very important for taking the decisions to carry out the effective treatments. A baseline assessment of the symptoms is necessary before the administration of any psychotropic medications. In this case the mental health of George had to be assessed before choosing any course of treatment for him. A scale such as KMV scale can be assessed (Kardas, Lewek Matyjaszczyk, 2013). Assessment of the adverse effects of medicine This case study provides with the information that George had been under the dosage of risperidone. Therefore it is essential for a nurse to assess the severity of this drug in George (if he is facing any side effects).Sometimes side effects go undetected because the patients might not share the complications they are facing with the nurses, or sometimes the nurses just overlook the symptoms. There are several neuroleptic side effect scales in order in order to get an accurate picture of the side effects and how they affect the lives of the patients. (Haddad, Brain Scott, 2014) has identified that this scale is particularly useful as it can be used by the health care staffs without any such special training, and only takes between 5-20 minutes to complete ensuring that it can be included in on-going nursing. The side effects can be managed by consulting with the doctor and switching to other pharmacological doses. In critical cases, an independent psychiatrist and a nurse might work together in partnership for the betterment of a particular patient (Department of Health). The supplementary nurse prescribers can adjust the doses of medicines according to the conditions. As per (Kane, Kishimoto Correll, 2013) mental health nurses have an expanding role in the management of the patients like George. Mental health nurses can look for the symptoms of side effects in George such as constipation, dry mouth and weight gain. Nurses can apply psychotropic medications in George, which can help to improve the adherence to medication regimen. (Kane, Kishimoto Correll, 2013) Compliance therapy is a therapy that involves a cognitive behavioral intervention, and has adapted techniques from psycho education and the motivational interviewing. This therapy involves the open discussion about the pros and cons of taking the medications and the modes of the treatment. It has been found that patients often are not consulted, before making the decisions related to the modes of treatment (Zullig, Peterson Bosworth, 2013). A positive therapeutic relationship with the individual who prescribes medicines can be a key component to increase the adherence of George to the medicine. According to (Bauml et al., 2016) education is the main component of the of the compliance therapy. George should be given a proper education regarding the illness and the importance of taking medicines. George might have stopped medications, may be out of lack of proper knowledge. Again, as per (Kane, Kishimoto Correll, 2013) healthcare professionals might not share everything with George, with the fear that he might stop taking the medicines, after hearing the pros and cons of using the medicines. (Kardas, Lewek Matyjaszczyk, 2013). had said that one of the side effects of using psychotropic medication is sexual dysfunction, addressing this problem mental nurse should discuss everything freely with the clients regarding the side effects of the medications and all possible ways how these side effects can be diminished (Morrison, Meehan Stomski, 2015). According to (Haddad, Brain Scott, 2014) support service interventions can also be provided like adherence therapy, electronic messages, motivational strategies, cognitive behavioral strategies. (Misdrahi et al., 2014) has said that it is the duty of a nurse of mental health to Provide George a support to stop the intake of the cannabis. A proper nurse should strengthen the coping skills of individuals. The patient should be taught new ways to prevent anxiety. George could take part in rehabilitation program, to facilitate growth and development (Zullig, Peterson Bosworth, 2013). Recent researches (Jalbert et al., 2017) have provided with the evidence that youths who maintain active involvement in the community are less likely to be engaged in the usage of drugs. According to (Jalbert et al., 2017), schools and communities can play an important role to engage young people in order to prevent the usage of drugs (Misdrahi et al., 2014). The above essay provides with an idea that the mental health nurses play the lead role in assisting the patients to manage their treatments effectively. Thus it can be said that all these interventions can bring about a change in George's life and bring him back to the normal life, convince him to undergo proper treatments and take medicines accordingly. It is the duty of the nurses to understand the factors that affects an individual's decision to take the medications and working together in addressing the factors. 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