Unit 6: Psychopharmacology, Electro Convulsive Therapy, Cognitive

Unit 6: Psychopharmacology, Electro Convulsive Therapy, Cognitive Behavioural Therapy, Neuroplasticity and Legal Considerations (Weeks 11 & 12)Overview Thus far we have reviewed what the major mental illnesses look like, discovered how they are assessed, and considered how mental illnesses impact our daily lives and our nursing practice. In Unit 6 we will consider how mental illness is currently treated and review some supportive therapies. 435 Unit 6 from CNHS AU on Vimeo. Unit Learning Outcomes By the end of Unit 6 you will meet or exceed the following: critically examine five key categories of drugs used extensively in psychiatric mental health settings, including antipsychotics, antidepressants, moods stabilizers, anxiolytics and stimulants. Focus on indications, dosages, side-effects, and precautions; describe common non-pharmacological interventions used to treat mental illness, including electro convulsive therapy (ECT) and cognitive behavioural therapy, focusing on indications, nature of the therapy, side-effects and precautions, explain neuroplasticity and the relationship to mental illness, and examine relevant legalities related to the treatment of people with mental illness. 1. Common Pharmacological Interventions Pharmacological treatment is generally considered the most effective treatment for many psychiatric disorders. Five key categories of drugs used extensively in psychiatric mental health settings are: antipsychotics, antidepressants, moods stabilizers, anxiolytics and stimulants (Austin & Boyd, 2015). Unfortunately, psychotropic medications also frequently produce unpleasant and persistent side effects that discourage compliance. The process of encouraging prescribed medication regimes, as well as prescribing medication that will be effective in managing each client’s unique presentation of symptoms with the least possible side effects, is seldom straightforward. The process becomes even more complex given the limited resources available to many clients, particularly those who are homeless and living with a psychotic disturbance. Required Learning Activity 1 – Common Pharmacological Interventions Read Chapter titled Psychopharmacology and Other Biologic Treatments. Read and Listen to the following power-point on Psychopharmacology The information included in this power point is critical to advancing your understanding the use of pharmacology in mental health treatment, and the role of nurses in monitoring medication efficacy and side effects. Identification and management of side effects and increase adherence to psychiatric medications. Search the AU library journal databases for other research based articles discussing medication adherence and read at least one more current article on this topic. Try putting the search term “medication adherence psychiatric” into the search box. Read – Psychotherapeutic strategies to enhance mediation adherence Compose a forum posting that includes 2 more poignant “aha moments” related to medication adherence in mental health populations and post it in the Unit 6 Medication Adherence in Mental Health Populations Forum. Include the full citation to the additional paper you read with your posting so others can also read the article you discovered. 2. Electro Convulsive Therapy and Cognitive Behavioural Therapy Other interventions in mental health care include electro convulsive therapy (ECT) and cognitive behavioural therapy. ECT is often viewed with apprehension. However, ECT is a safe and effective treatment for depression (Hayne, 2015). Cognitive behavioural therapy is a well-regarded treatment for depression and anxiety disorders. This therapy involves a nurse or other professional working with clients to help them monitor their thoughts, understand how their negative thinking impacts emotions and actions and to learn to replace these irrational or distorted thoughts with more accurate and helpful thinking (Hayne, 2015; Hegadoren & Lasiuk, 2015). Often, particularly when depression is severe, medication and cognitive behavioural therapy will be offered concurrently. Required Learning Activity 2 – ECT and Cognitive Behavioural Therapy Read Chapter titled Cognitive-Behavioural Interventions. Locate and review online credible, current and preferably Canadian online resources (written, audio or visual) that will help you achieve the leaning outcomes related to ECT and Cognitive Behavioural Therapy. HINT – refer to the Open Educational Resources guide and use the AU library as good starting points for your resources discovery. Choose resources that are in a format that appeal to your learning style. Share the best resource you discover in the Sharing Forum. Respond to at least one other student’s posting in the sharing forum after you have reviewed the resource provided by that person. Watch Olive Young Explains Psychosocial Interventions (2014), in which Young discusses the importance of a team approach in determining treatment choices. Reflect on the – How should the decision to use ECT be made in light of the comments made in the video? 3. Neuroplasticity and Mental Illness We are now learning more and more about neuroplasticity. Our knowledge about the amazing ability of the brain provides optimism in regards to treatments for mental illness. The term neuroplasticity refers to the brain’s ability to change its structure and function (e.g. cells can learn new functions) in response to internal pressures (such as changes in electrolytes) and external pressures (such as exercise) (Creamer, 2015). This ability of the brain to adapt and change helps us to understand how individuals can benefit from psychopharmacology (psychiatric medications) and therapy (Creamer, 2015). Required Learning Activity 3 – Neuroplasticity Read Shafer (2016) Neuroplasticity and Clinical Practice: Building Brain Power for Health. Listen to the CBC radio series regarding childhood trauma. It is a fascinating look at childhood trauma and its impact on brain development, childhood behaviour and adulthood health issues (note these can be found on any podcast app if you want to walk or drive and listen) Part 1 All in the Family Part 2; All in the Family Part 2. Seek out other resources that help explain the potential relationship between neuroplasticity and mental illness. Chat with your family about what you learned and assess their reactions. 4. The Legalities As we consider interventions, such as medications, or in some cases, hospitalization, it is important to be aware of legal considerations. This is another layer of the Mental Health Act in Alberta. This provincial statute allows for the involuntary detention and treatment of persons with a mental illness, under certain conditions (pay particular attention to Community Treatment Orders). Required Learning Activity 4 – Mental Health Act In essence, what the Mental Health Act states is that in order to be admitted and detained in a hospital involuntarily, a client must meet all three of the following conditions explained in more detail below: Mental Disorder – The client must have a mental disorder or must apparently be suffering from a mental disorder. A Danger to Self or Others – The client must be in a condition that presents a danger to himself or herself, or to others, or is likely to do so. No Alternative – The client must be unsuitable for admission in any other way. This is generally understood to mean that the client refuses to be admitted voluntarily. Having a mental illness alone is not enough for involuntary detention or admission. If a client is believed to be suffering from a mental illness and appears to be in imminent danger of harming himself or others, then the person can be admitted – either willingly (which then the person is NOT admitted under the Mental Health Act), or unwillingly (by the Mental Health Act). Also, in special circumstances, maintaining a prescribed medication regime is mandated in the Mental Health Act through a Community Treatment Order. Review Mental Health Act or The Alberta Mental Health Act Visit the website of Alberta Mental Health Patient Advocate Office paying particular attention to the stories from Alberta’s mental health community and the responses to the – What does it mean for a person living with mental illness to receive compassion from a family member, friend or colleague? Reflect on the questions: In what way is activating the Mental Health act compassionate? How is it possible to enact the Mental Health Act through a lens of compassion? Contact your study buddy via course mail, telephone or meet on a video conference to discuss your reflections. Required Learning Activity 5 – Crisis Intervention People who are experiencing crises may be anxious, fearful, angry, and potentially aggressive. Understanding how to support the person and competently intervene are essential skills for nurses. Read Crisis and Crisis Intervention and the textbook chapter titled Anger, Aggression, and Violence. Reflect on the following questions: When considering an experience where you witnessed a person was in crisis, what interventions from the readings were implemented? What interventions from the readings would have been useful in this situation? Contact your study buddy to discuss your reflections. Reflection Moment Drug companies research and develop new medications. Much more money and effort is expended to produce new drugs for common disorders rather than rare disorders, such as Tourette’s syndrome (often called “orphan drugs”). What are the ethical and financial dilemmas associated with research designed to produce new drugs? Contact your study-buddy and discuss your reflection moment. You can do this using course mail or make a “date” to chat in real-time video conferencing platform. References Austin, W. (2019). Personality and disruptive, impulse-control, and conduct disorders. In W. Austin and M.A. Boyd (Eds.), Psychiatric & mental health nursing for Canadian practice (4th ed.) (pp. 650-685). Wolters Kluwer. Centers for Disease Control and Prevention. (2020). Adverse childhood experiences (ACEs). https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.html College & Association of Registered Nurses of Alberta (2011, May). Professional boundaries for Registered Nurses: Guidelines for the nurse-client relationship. Author. http://www.nurses.ab.ca/content/dam/carna/pdfs/DocumentList/Guidelines/RN_ProfessionalBoundaries_May2011.pdf Ernstmeyer, K., & Christman, E. (Eds.). (2022). Crisis and crisis intervention in Open RN Nursing Mental Health and Community Concepts. Press Books. University of Regina. Faulkner- Gibson, L., Wong, K., & Austin, W. (2019). Psychiatric disorders diagnosed in children and adolescents. In W. Austin and M.A. Boyd (Eds.), Psychiatric & mental health nursing for Canadian practice (4th ed.) (pp.762-791). Wolters Kluwer Felitti, V. (2019). Origins of the ACE Study. American Journal of Preventive Medicine, 56(6), 787-798. https://doi.org/10.1016/j.amepre.2019.02.011 Forbes, D., & Austin, W. (2019). Neurocognitive disorders: Delirium and dementia. In In W. Austin and M.A. Boyd (Eds.), Psychiatric & mental health nursing for Canadian practice (4th ed.) (pp. 825-858). Wolters Kluwer. Harris, N. B. (2014, September). How childhood trauma affects health across a lifetime [Video]. TEDMED. https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?language=en Hayne, Y.M. (2019). Mood disorders. In W. Austin and M.A. Boyd (Eds.), Psychiatric & mental health nursing for Canadian practice (4th ed.) (pp. 439-479). Wolters Kluwer. Hegadoran, K., & Lasiuk, G. (2019). Anxiety and obsessive-compulsive disorders. In W. Austin and M.A. Boyd (Eds.), Psychiatric & mental health nursing for Canadian practice (4th ed.) (pp. 512-535). Wolters Kluwer. Hennel, L. (2015). Suffering from cancer, Barbi Harris spent her last days sharing her story of life on the street. Calgary Herald. Video http://calgaryherald.com/news/local-news/suffering-from-cancer-barbi-harris-spent-her-last-days-sharing-her-story-of-life-on-the-street Hennel, L., & Sproule, K. (2018). Dignity, at the end of life, for the homeless. https://www.youtube.com/watch?v=4TKLjEOA4IQ Knutson, M. (2007). Recognizing mental illness. Health Vista. http://healthvista.freehosting.net/Webquest/mywebquest/index.htm Metzler, M., Merrick, M. T., Klevens, J., Ports, K. A., & Ford, D. C. (2017). Adverse childhood experiences and life opportunities: Shifting the narrative. Children and Youth Services Review, 72, 141-149. https://doi.org/10.1016/j.childyouth.2016.10.021 Nolen-Hoeksema, S. (2008). What happens when things go wrong: Mental illness Part 1 (lecture @ Yale University). https://www.youtube.com/watch?v=rW79ZwDPKsY Oral, R., Ramirez, M., Coohey, C., Nakada, S., Walz, A., Kuntz, A., Benoit, J., & Peek-Asa, C. (2016). Adverse childhood experiences and trauma informed care: the future of health care. Pediatric Research, 79, 227-233. https://www.nature.com/articles/pr2015197/ Perks, B. (2015). How do we stop childhood adversity from becoming a life sentence? [Video]. YouTube. https://www.youtube.com/watch?v=qp0kV7JtWiE Wilson, J.H. (2019). Schizophrenia. In W. Austin and M.A. Boyd (Eds.), Psychiatric & mental health nursing for Canadian practice (4th ed.) (pp. 402-416-438). Wolters Kluwer. Last updated: January 17, 2023 ©Copyright 2016 Athabasca University For questions, comments or to report broken links, please e-mail: CNHS Web

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