Mental Health and Medication

Introduction
Patient displays symptoms of acute schizophrenia that requires use of anxiolytics, antidepressants, mood stabilizers, and antipsychotics, specifically neuroleptics. Use of two or more neuroleptics in combination with the other medications can lead to health problems like obesity, diabetes mellitus, renal diseases, hyponatremia, and thyroid disorders among other diseases (Correll, Detraux, De Lepeleire, & De Hert, 2015). The central issue regarding use of four different medication types is often progressive decline of quality of life for those taking it. This plan of care is aimed at promoting improved quality of life and perhaps treatment alternatives and medication choices that will reduce likelihood of symptoms, but still maintain high efficacy.
Rationales for Specific Prescription Medications
Use of the four medication types: anxiolytics, antidepressants, mood stabilizers, and antipsychotics for schizophrenia has become a common treatment modality. It is not rare to see patients prescribed all at the same time. That is because schizophrenia affected how an individual thinks, feels, and acts. Often people with schizophrenia have hallucinations. They can be auditory or visual, and may prevent the individual from seeing the world in a normal way. Aside from the hallucinations, those with schizophrenia can experience delusions, jumbled speaking or thinking, strange posture and other random and odd movements (Fernández, 2016). The medications help a patient deal with these symptoms so they can function normally in society.
Delusions and hallucinations experienced by those with schizophrenia require use of antipsychotics. This class of medication works on the dopamine and serotonin chemicals in the brain (Fernández, 2016). However, often this class of medication does not work well and there is no first-line antipsychotic drug suitable for everyone (Burcu et al., 2017). Such a treatment modality may not be the best treatment option, but can be the only option for those experiencing strong hallucinations. Drugs like Seroquel have been used with side effects to achieve around 20% reduction in psychotic symptoms and potential for development of diabetes and other chronic health problems (Burcu et al., 2017). Although drugs like Clozapine has seen effectiveness in long-term studies (Lee, Kim, Lee, & Kwon, 2018).
Antidepressants are another common treatment modality that causes side effects like weight gain, obesity, and thyroid issues. However, they have demonstrated to be useful in treating negative symptoms. “More often, trials on somewhat persistent negative symptoms evaluate add-on strategies to ongoing antipsychotic treatment. Such trials, mostly on modern antidepressants, have demonstrated some efficacy” (Möller, 2015, p. 567). Therefore, they along with antipsychotics, may be a useful treatment option for those severely affected by schizophrenia. For example, Clonazepam is a sedative and anxiolytic often used a common treatment option for those with anxiety and schizophrenia. Although it can be habit forming, it has been used for years with reasonable effectiveness (Lee, Kim, Lee, & Kwon, 2018). The same can be said of mood stabilizers like lithium.
Lithium has been used with varying efficacy for a long time as a mood stabilizer. Some of the major side effects associated with the drug are weight gain and hypothyroidism. “Among mood stabilizers, lithium has not been associated with relevant lipid abnormalities, although lithium?induced hypothyroidism can lead to weight gain and changes in lipid profile” (Correll, Detraux, De Lepeleire, & De Hert, 2015, p. 119). Although, the weight gain often is modest. Lithium and Klonopin or Clonazepam are treatment options with decent efficacy that does not produce severe side effects in most people, therefore becoming a decent treatment modality, even if combined.
Needs Related to Medications, Health Condition, Lifestyle, Genomics and other Factors
Patient suffers from seizures, epileptic fits, and bipolar disorder. The mood stabilizers and anxiolytic can help with these specific health conditions. As for lifestyle needs, medications were altered in the past to help her deal with proper regulation of her menstruation. Lamotrigine has been proven to allow for treatment of bipolar disorders as well as regulation of menstruation. “Menstrually-entrained mood fluctuation is present in women treated for bipolar disorder to a greater degree than in healthy controls. Lamotrigine may be of use in mitigating this fluctuation” (Robakis et al., 2015, p. 175). Because these medications in combination with the others can lead to weight gain and diabetes, lifestyle needs must be addressed like weight maintenance and quality of life.
Specific Goals, Plan and Recommendations
Research has proven that patients with schizophrenia can follow lifestyle changes that ameliorate the potential side effects of medications. “Patients with schizophrenia are capable of adhering to a diet and fitness program and successfully lose weight, regardless to taking typical or atypical medications” (Amiaz, Rubinstein, Czerniak, Karni, & Weiser, 2016, p. 112). If the patient follows a diet and workout plan consistently, she will have better health outcomes than not following one. Although people with schizophrenia are believed to suffer from multiple side effects due to multiple medications, it has been shown they can follow healthy preventative measures that allow them to lose weight, maintain physical health, and continue taking medications (Amiaz, Rubinstein, Czerniak, Karni, & Weiser, 2016). This is why the specific goal, plan, and recommendation for the patient is to adopt a sound eating plan that includes fresh produce and quality meats and eggs that can allow for nutritive support while taking medications. Along with the eating plan, a consistent workout program involving cardio and weight training will be implemented, because exercise has been shown to improve physical health and mood in people with schizophrenia (Amiaz, Rubinstein, Czerniak, Karni, & Weiser, 2016).
Follow up Plan of Care
To assess if patient has been maintaining a positive lifestyle change that includes a change in daily diet and workout program, monthly calls will be made to check on progress along with bi-monthly doctor visits. Things like weight and blood pressure will be measured during these visits. Bi-annual visits can include blood tests to measure any potential signs of malnutrition and hormone imbalance. If patient fails to maintain a healthy weight and appears to have malnutrition, corrective actions will be taken like change in medication and patient education, along with referral to physical therapy. Physical therapy has shown to be an effective treatment modality that helps reduce psychological distress and state anxiety (Vera-Garcia, Mayoral-Cleries, Vancampfort, Stubbs, & Cuesta-Vargas, 2015). Additionally, strength and aerobic exercises can further improve health-related quality of life. If the patient cannot do this on her own, a physical therapist will be able to help her adhere to the protocol.
Conclusion
In conclusion, steps can be taken into improve the quality of life for patients like the one described here. Schizophrenia often becomes a complex order to treat due to the use of multiple medications and the serious side effects that may come with them like obesity and diabetes. The plan of care aims to reduce use of medications that increase the likelihood of symptoms and adopt sound self-care methods to properly cope with any metabolic issues that can arise. Although mental illness is a daunting task to improve, solutions do arise from the use of both medication and lifestyle changes leading to potentially positive health outcomes.
References
Amiaz, R., Rubinstein, K., Czerniak, E., Karni, Y., & Weiser, M. (2016). A Diet and Fitness Program Similarly Affects Weight Reduction in Schizophrenia Patients Treated with Typical or Atypical Medications. Pharmacopsychiatry, 49(03), 112-116. doi:10.1055/s-0035-1569416
Burcu, M., Zito, J. M., Safer, D. J., Magder, L. S., DosReis, S., Shaya, F. T., & Rosenthal, G. L. (2017). Concomitant Use of Atypical Antipsychotics With Other Psychotropic Medication Classes and the Risk of Type 2 Diabetes Mellitus. Journal of the American Academy of Child & Adolescent Psychiatry, 56(8), 642-651. doi:10.1016/j.jaac.2017.04.004
Correll, C. U., Detraux, J., De Lepeleire, J., & De Hert, M. (2015). Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry, 14(2), 119-136. doi:10.1002/wps.20204
Fernández, S. G. (2016). Adherence to antipsychotic medication in bipolar disorder and schizophrenia patients: a systematic review. European Neuropsychopharmacology, 26, S434. doi:10.1016/s0924-977x(16)31412-2
Lee, T. Y., Kim, M., Lee, J., & Kwon, J. S. (2018). T223. REAL WORLD EFFECTIVENESS OF ANTIPSYCHOTIC DRUGS IN PATIENTS WITH SCHIZOPHRENIA: A 10-YEARS RETROSPECTIVE STUDY. Schizophrenia Bulletin, 44(suppl_1), S203-S203. doi:10.1093/schbul/sby016.499
Möller, H. (2015). Pharmacological treatment of primary negative symptoms in schizophrenia. European Archives of Psychiatry and Clinical Neuroscience, 265(7), 567.
Robakis, T. K., Holtzman, J., Stemmle, P. G., Reynolds-May, M. F., Kenna, H. A., & Rasgon, N. L. (2015). Lamotrigine and GABAA receptor modulators interact with menstrual cycle phase and oral contraceptives to regulate mood in women with bipolar disorder. Journal of Affective Disorders, 175, 108-115. doi:10.1016/j.jad.2014.12.040
Vera-Garcia, E., Mayoral-Cleries, F., Vancampfort, D., Stubbs, B., & Cuesta-Vargas, A. I. (2015). A systematic review of the benefits of physical therapy within a multidisciplinary care approach for people with schizophrenia: An update. Psychiatry Research, 229(3), 828-839. doi:10.1016/j.psychres.2015.07.083