Discussion 4: Prescriptive Practice in Psychiatric Nursing


Reply to classmates. Compare your answer (see attach) to that of your classmate to produce some interesting dialog. Your response should include evidence of review of the course material through proper citations using APA format. Classmate post:  As a future provider, I view psychiatric medication as one component of a vast and complex mental health care framework. Not all clients suffering from mental illness will benefit from chemical intervention, although many individuals do experience positive outcomes from the use of medication (Deegan, et al., 2017). Braslow & Marder (2019) posit that politics and economic circumstances contributed to the “current infatuation” with psychotropic medicine. However, in my experiences, I have seen lives positively influenced, and possibly saved, with the use of pharmacotherapy. There is inconsistent data in the literature pertaining to the efficacy of psychopharmacology and psychotherapy integration (Lee, Hearon, & Otto, 2017). One advantage of incorporating psychotherapy with psychotropic medication management is that the clinician is able to gain valuable information from the client and engage in a more meaningful interaction (Kamenov, et al., 2017). Psychotherapy may also help the client to develop useful skills that they can practice after their treatment is final. When applied, those strategies can be key in the prevention of relapse (Guidi & Fava, 2020). Pharmacotherapy alone would not be likely to result in the client possessing those mitigating skills (Weitz, et al., 2017). According to Cuijpers, et al. (2020), “combined treatment is the best option in moderate depression, and in routine clinical care it would be better to consider psychotherapy as the first choice when only one treatment is offered to a patient.” Research data provides evidence suggesting that there are few disadvantages of combined psychotherapy and pharmacotherapy, particularly for the treatment of depression (Guidi & Fava, 2020). Some clinicians may feel burdened by the duration of patient visits compared to brief, quick medication management appointments, resulting in an inability to see a larger number of clients (Kamenov, et al., 2017). Rozenthal, et al. (2018) report that approximately 5% of mono psychotherapy patients later complain of detrimental effects allegedly caused by psychiatric treatment. As for the benefits of psychotherapy combined with medication prescribed by the same health care provider, some experts insist that this approach is superior to all other options. Salzman, Glick, & Keshavan (2010) assert, “Part of the art is understanding the patient’s life experience rather than simply listing symptoms that become targets for medication treatment.” It is crucial for the prescriber to understand where the client is coming from in their specific context (Salzman, et al., 2010).  Intuitively, spending time getting to know the patient and building a therapeutic rapport will result in an enhanced, trusting partnership (Salzman, et al., 2010).     References Braslow, J. T., & Marder, S. R. (2019). History of psychopharmacology. Annual Review of Clinical Psychology, 15, 25-50. https://doi.org/10.1146/annurev-clinpsy-050718-095514 Cuijpers, P., Noma, H., Karyotaki, E., Vinkers, C. H., Cipriani, A., & Furukawa, T. A. (2020). A network meta‐analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry, 19(1), 92-107. https://doi.org/10.1002/wps.20701 Deegan, P. E., Carpenter-Song, E., Drake, R. E., Naslund, J. A., Luciano, A., & Hutchison, S. L. (2017). Enhancing clients’ communication regarding goals for using psychiatric medications. Psychiatric Services, 68(8), 771-775. https://doi.org/10.1176/appi.ps.201600418 Guidi, J., & Fava, G. A. (2020). Sequential combination of pharmacotherapy and psychotherapy in major depressive disorder: A systematic review and meta-analysis. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2020.3650 Kamenov, K., Twomey, C., Cabello, M., Prina, A. M., & Ayuso-Mateos, J. L. (2017). The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression: a meta-analysis. Psychological Medicine, 47(3), 414-425. https://doi.org/10.1017/S0033291716002774 Rozental, A., Castonguay, L., Dimidjian, S., Lambert, M., Shafran, R., Andersson, G., & Carlbring, P. (2018). Negative effects in psychotherapy: commentary and recommendations for future research and clinical practice. BJPsych Open, 4(4), 307-312. https://doi.org/10.1192/bjo.2018.42 Salzman, C., Glick, I., & Keshavan, M.S. (2010). The 7 Sins of psychopharmacology. Journal of Clinical Psychopharmacology, 30(6), 653-655. https://doi.org/10.1097/JCP.0b013e3181fb53c2 Weitz, E., Kleiboer, A., van Straten, A., Hollon, S. D., & Cuijpers, P. (2017). Individual patient data meta-analysis of combined treatments versus psychotherapy (with or without pill placebo), pharmacotherapy or pill placebo for adult depression: a protocol. BMJ Open, 7(2), e013478. http://dx.doi.org/10.1136/bmjopen-2016-013478

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