An article in the Journal of Advanced Nursing has asked the big question. Science Daily writes about it here:
Manuela Jarrett, a registered mental health nurse from the Health Service and Population Research Department at the Institute of Psychiatry in London… who co-authored the paper with Professor Len Bowers and Dr Alan Simpson from City University London, carried out a detailed analysis of 14 papers from seven countries, published between 1987 and 2004. These studies included interviews with 543 patients and 263 staff and analysis of 1,165 forms and records from the UK, USA, Sweden, Finland, Germany, Canada and Denmark.
What are they asking?
“While there has been a lot of research into the pharmacological effectiveness of particular medications for quick and effective sedation, the reasons for the compulsory administration of powerful sedative and neuroleptic drugs have not been scrutinised closely or frequently. And there is little evidence that alternatives have been explored.
They want to know – just where is the evidence that says forcing someone to take medication is actually effective? What is the cost/benefit? And what about the alternatives?
I’ve been involved in recent discussions elsewhere about the use of pharmacology for rapid tranquilisation. Now I don’t know if it’s me who has the warped view – but it seems some people (allied professionals) actually believe an IM anti-psychotic will bring about a rapid reduction in psychoses and it is this action that is responsible for calming the recipient. Personally, I’ve always regarded it as just another sedative – that was usually on the form39 – that aids in the reduction of anxiety and agitation – rather than psychotic phenomena. I may be wrong – but I also believe in a strong correlation between levels of stress and anxiety and presence/increase of symptoms (rather than just the ‘symptoms cause stress’ version – tho this obviously remains probable).
So I’ll also ask the question here – does anyone who administers or who has received/taken PRN or top up anti-psychotic in times of a psychotic crisis found it rapidly reduces any positive symptoms – or just sedates a bit more which then reduces stress and ergo the stress related symptoms go.
No comment or experience of the meat of the post but, can’t help but notice that pesky IoP is letting nurses get all upperty again and going out and doing research with real people.
Crippen will be appalled.
And indeed, E will be equally appalled to discover that, contrary to what he’s been repeatedly asserting, nursing research can actually be about important clinical questions.
This is a purely intuitve impression on my part, but I would fall on the “just sedates a bit more which then reduces stress and ergo the stress related symptoms go” side of the argument, though I’d be willing to be convinced otherwise if there’s compelling research evidence for the opposite view.
“The studies showed that patients experienced a range of negative feelings when they received CM, including fear, embarrassment, anger and helplessness. Despite this, many said that they retrospectively agreed with the practice.”
Take that Ted!
One hand washes the other, I reckon. Some (probably genetically inherited) brain dysfunction produces the neurochemistry that leads to the thoughts, which stress and anxiety then do their part to exacerbate.
I’ve had a shot of anti-psychotics in this manner. It worked, although at the time I’d have done anything to avoid it. I’m glad I got it though.
Blissfully, I have no recollection of the event of being rapidly tranquillised or its immediate effects on me (other than to stop me running starkers from the ward at midnight). But I do recall waking up after the short-term sedation had worn off, and I also remember a marked return of anxiety levels as delusions and hallucinations returned. I also remember being offered very little for this, other than more (oral) antipsychotics.
Although without a doubt I needed to be controlled and restrained, I was offered little in the way of emotional support, unless you count being told, military-style, “you’re obviously hallucinating!” as emotional support. It is possible, guys and gals, to be intellectually aware that you are hallucinating but still be confused, frightened and disorientated by the experience.