Antipsychotic Medication and the Physical Health Problems of the Patient With Mental Illness
More and more attention is now being given to the mental disorders especially in U.S. And due to this increase in attention an increase has also been noticed in the treatment of these mental health issues (Zuvekas, 2005). About 30% of the total U.S. population that is between the ages of 18-52 is being affected by mental health issues which make up a large part of the public health problem (Kessler et al., 2005; Narrow et al., 2002). The risk of morbidity and smaller life expectancy is very high in the patients who suffer from the mental health issues (Millar, 2008; Skodol, 2008). It has been observed from numerous researches that the chances of suffering from various health issues such as diabetes, cardiovascular disease and hypertension are a lot more for the patients suffering from schizophrenia (Millar, 2008; Sharif, 2008). 4 and 6 Also, the patients who have mental disabilities live a low quality life and the social and personal burden of their disease increases even more due to a lot of functional impairments (Cotter, 2007; Ostacher et al., 2008).
The main method of treating the mental illnesses is prescription medication. This treatment method is also being given a lot of importance with regards to managing the mental health issues. There are also a number of other mental conditions like mood disorders, bipolar disorder and dementia which are treated with the help of these antipsychotics (Glick et al., 2001; Katzung, 2007). Although there do exist some disagreements but generally the atypical antipsychotics are considered to have the same levels of effectiveness as the typical antipsychotics but the extrapyramidal side effects associated with them are far less (Duggan, 2005; Kapur and Remington, 2001; Stahl, 2002).
The cost of atypical antipsychotics can be as much as 4-10 times the cost of the typical antipsychotics. This fact raises the question regarding the cost-effectives of these particular drugs (Daumit et al., 2003; Martin et al., 2001). There are some people who have put forward the arguments regarding atypical antipsychotics that they help in reducing the universal expenses of schizophrenia as these drugs provide the patients with better social functioning and adherence along with fewer consultations and hospitalizations (Mark et al., 2002). With regards to the cost saving aspect of atypical antipsychotics, there are still a lot of controversies (Duggan, 2005).
With the increase in the rate of diagnosis of the mental health issues the use of antipsychotic medication to treat these conditions has risen as well. It was noted that as compared to 1991 in the year 2001 5.5 million more patients were given the prescription medication to treat the mental health issues. A large portion of this increased medication use from 1991 to 2001 can be attributed to the consumption of the atypical antipsychotic medications that was observed to have gone through an average annual increase of 44% in the new users. There are some factors which can be held responsible for this increase in the use of the atypical antipsychotic medications like the problems that these medications market themselves to be able to treat such as pervasive developmental disorder, obsessive-compulsive disorder, and depression (Fountoulakis et al., 2004).
With the increase in the popularity of these antipsychotic medications a very steep increase has been noticed in their expenditure as well (Zuvekas, 2005; Jano et al., 2007). It was calculated that about 2.1 million Americans were given the antipsychotic treatment which increased its expenditure from about $0.5 billion in 1996 to $3.1billion in 2001 (Zuvekas, 2005; Huskamp, 2005). From 1996 to 2001 there has been an average increase of 77% in the expenditures associated with the antipsychotic medications. In 2003 the total expenditures for the antipsychotic were about $2.82 billion and the atypical antipsychotic agents were responsible for 93% of this amount (Aparasu and Bhatara, 2006).
Focus question and rationale
The morbidity and mortality rates of the cardiovascular disease are a lot more for the people who suffer fromserious mental illness (SMI) as compared to the rest of the population. The SMI patients are also more prone to the non-insulin-dependent diabetes, some kinds of cancers (Dixon et al., 1999), infectious diseases, respiratory diseases and HIV infection (Cournos et al., 2005). According to an estimate the life expectancy of the people who suffer from schizophrenia gets reduced by about 10 years (Newman and Bland, 1991). With regards to the universal increase in the occurrence of the chronic diseases in the low, middle and high-income countries there is an immediate need for these high mortality and morbidity rates to be considered seriously.
The demand for nurses in the mental health field is very high. This high demand places us in a very positive position strategically speaking as; the nurses can play a very important role in the physical as well as mental well-being of the patients who suffer from SMI. For this reason the focus question in this study is going to be: Antipsychotic medication (Clozapine, Olanzapine and others) and the physical health problems such as cardiovascular diseases (CVD), weight gain, diabetes (type 2) and Obesity that are suffered by the patients who have mental illnesses.
Antipsychotics are the type of drugs which are prescribed very often to the people who suffer from intellectual disability. These drugs are usually given to the patients for many years and quite often they are prescribed for reasons other than what they are officially licensed for (i.e. not to treat the psychotic disorders but to rather ease the behavioral issues de Kuijper et al., 2010, Stolker et al., 2002, Tobi et al., 2005 and van SchrojensteinLantman-de Valk et al., 1995). An occurrence of 32.2% (n = 763) was found for the usage of antipsychotics in the population (N = 2373) which lived in the residential areas.
It was noted that majority of the people from among these 763 have been consuming the antipsychotics for many years. The people who had used these medications for less than a year made up 1% of the total population, the ones who used it for 1-5 years made up 12%, the ones using it for 5-10 made up 8% and about 78% of them had been taking these drugs for many years (de Kuijper et al., 2010).
There are some neurological side effects that can affect the extrapyramidal system and are associated with the prolonged use of the antipsychotics and these side effects (Matson and Mahan, 2010 and Stone et al., 1989). Some of these extrapyramidal symptoms can include parkinsonism, tardive dyskinesia, and tardive akathisiaand this can result in distressful feelings as well as secondary morbidity like muscle weakness and aching. Some of the other side effects associated with the long-term usage of antipsychotics are the metabolic symptoms like glucose dysregulation, weight gain, dyslipidemia (Bhuvaneswar et al., 2009, McKee et al., 2005 and Newcomer, 2007).
Also, hormonal dysregulation especially with regards to the increase in the levels of lactotrophic hormone prolactin and ultimately a decrease in the levels of the sex hormones can take place as well with the usage of the antipsychotics. Decrease in the levels of the sex hormones can result in low bone density; disturb the metabolism of bone, loss of calcium bone as well as an increase in the occurrence of osteoporosis (Bhuvaneswar et al., 2009 and Misra et al., 2004).
The extent of side effects of different antipsychotics varies largely. The first thing to be taken into consideration here is that the kind of antipsychotic being used plays a very important role in the extent of side effects which can occur. The factors that are associated with and responsible for the side effects caused by the various antipsychotics are serotonin 5-hydroxytryptamine 2C (5-HT2C), dopamine D2 and D3 as well as histamine H1 receptor affinity, all of these factors are responsible for causing low tardive dyskinesia's risk (Fodstad et al., 2010 and Matson et al., 2010) whereas, the risk of metabolic dysregulation and weight gain is really high in comparison to the usual antipsychotics (Deng et al., 2010, McKee et al., 2005, Newcomer, 2007 and Reynolds and Kirk, 2010). Also, the antipsychotics particularly the atypical antipsychotics (risperidone, paliperidone, and amisulpiride) have a very obvious link with prolactin's higher levels (Bushe et al., 2008a and Holt and Peveler, 2011).
The usage of antipsychotics and the side effects associated with them differ from person to person. Genetics can also be a reason for this difference in the manner that different people react to these drugs (Lencz & Malhotra, 2009). For instance it has been seen through the studies that in the people suffering from schizophrenia a single nucleotide polymorphism (SNP) of the dopamine D2 receptor gene rs1800497 (presence of the A allele); ( Guzey et al., 2007 and Liou et al., 2006) and of the dopamine D3 receptor gene SNP rs6280 (also presence of the A allele); ( Al Hadithy et al., 2009, Rizos et al., 2009 and Woo et al., 2002) has been noticed to have a link…