An antipsychotic (or neuroleptic) is a tranquilizing psychiatric medication primarily used to manage psychosis (including delusions or

hallucinations, as well as disordered thought), particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics,
known as typical antipsychotics, was discovered in the 1950s. Most of the drugs in the second generation, known as atypical
antipsychotics, have been developed more recently, although the first atypical antipsychotic, clozapine, was discovered in the 1950s
and introduced clinically in the 1970s. Both generations of medication tend to block receptors in the brain's dopamine pathways, but
antipsychotic drugs encompass a wide range of receptor targets.
A number of harmful and undesired (adverse) effects have been observed, including lowered life expectancy, weight gain, enlarged
breasts and milk discharge in men and women (hyperprolactinaemia), lowered white blood cell count (agranulocytosis), involuntary
repetitive body movements (tardive dyskinesia), diabetes, an inability to sit still or remain motionless (akathisia), sexual dysfunction, a
return of psychosis requiring increasing the dosage due to cells producing more neurochemicals to compensate for the drugs (tardive
psychosis), and a potential for permanent chemical dependence leading to psychosis much worse than before treatment began, if the
drug dosage is ever lowered or stopped (tardive dysphrenia).
Temporary withdrawal symptoms including insomnia, agitation, psychosis, and motor disorders may occur during dosage reduction of
antipsychotics, and can be mistaken for a return of the underlying condition.[1]HYPERLINK
"http://en.wikipedia.org/wiki/Antipsychotic" \l "ite_note-Moncrieff-2006-1" [2]
The development of new antipsychotics with fewer of these adverse effects and with greater relative effectiveness as compared to
existing antipsychotics (efficacy), is an important ongoing field of research. The most appropriate drug for an individual patient requires
careful consideration.
Common conditions with which antipsychotics might be used include schizophrenia, bipolar disorder and delusional disorder.
Antipsychotics might also be used to counter psychosis associated with a wide range of other diagnoses, such as psychotic
depression. However, not all symptoms require heavy medication and hallucinations and delusions should only be treated if they
distress the patient or produce dangerous behaviors. [7]
Antipsychotics are associated with a range of side effects. It is well-recognized that many people stop taking them (around two-thirds
even in controlled drug trials) due in part to adverse effects.[16] Extrapyramidal reactions include acute dystonias, akathisia,
parkinsonism (rigidity and tremor), tardive dyskinesia, tachycardia, hypotension, impotence, lethargy, seizures, intense dreams or
nightmares, and hyperprolactinaemia.[17] Some of the side-effects will appear after the drug has been used only for a long time.
The most serious adverse effect associated with long-term antipsychotic use is lowered life expectancy. T

A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by intense and sustained mood shifts,
typically bipolar disorder. Used to treat bipolar disorder,[1] mood stabilizers suppress swings between mania and depression. Mood
stabilizing drugs are also used in borderline personality disorder.[2] and Schizoaffective Disorder.

The term "mood stabilizer" describes an effect, not a mechanism. More precise terminology is used to classify these agents.
Drugs commonly classed as mood stabilizers include:

Anticonvulsants
Many agents described as "mood stabilizers" are also categorized as anticonvulsants. The term "anticonvulsant mood stabilizers" is
sometimes used to describe these as a class.[3] Although this group is also defined by effect rather than mechanism, there is at least a
preliminary understanding of the mechanism of most of the anticonvulsants used in the treatment of mood disorders.
Valproic acid (Depakene), divalproex sodium (Depakote), and sodium valproate (Depacon, Epilim) – Available in extended
release form. This drug can be very irritating to the stomach, especially when taken as valproic acid. Liver function and CBC
should be monitored.
Lamotrigine (Lamictal) – Particularly effective for bipolar depression. The patient should be monitored for signs and symptoms
of Stevens-Johnson syndrome, a very rare but potentially fatal skin condition.
Carbamazepine (Tegretol) – CBC should be monitored, as carbamazepine can lower white blood cell count. Therapeutic drug
monitoring is required. Carbamazepine was approved by the US Food and Drug Administration as a bipolar disorder treatment
in 2005, but had been widely used previously.
Oxcarbazepine (Trileptal) – Oxcarbazepine is not FDA approved for bipolar disorder. Still, it appears to be effective in about
one half of patients with bipolar disorder and be well tolerated.[4]
Gabapentin (Neurontin) is not FDA approved as a treatment for bipolar disorder. Randomized controlled trials suggest that Gabapentin
is not an effective treatment, but many psychiatrists continue to prescribe it, reportedly because of positive but "low quality" literature
reviews.[5] Topiramate (Topamax) is not FDA approved for bipolar disorder either, and a 2006 Cochrane review concluded that there is
insufficient evidence on which to base any recommendations regarding the use of topiramate in any phase of bipolar illness.[6]

The extrapyramidal system can be affected in a number of ways, which are revealed in a range of extrapyramidal symptoms (EPS),
also known as extrapyramidal side effects (EPSE), such as akinesia (inability to initiate movement) and akathisia (inability to remain
motionless).
Extrapyramidal symptoms (EPS) are various movement disorders such as acute dystonic reactions, pseudoparkinsonism, or akathisia
suffered as a result of taking dopamine antagonists, usually antipsychotic (neuroleptic) drugs, which are often used to control
psychosis.
THERAPEUTIC COMMUNICATION IN PSYCHIATRIC NURSING
This page was last updated on 27/7/2010

INTRODUCTION

* The nurse-client relationship is the foundation on which psychiatric nursing is established.

* The therapeutic interpersonal relationship is the process by which nurses provide care for clients in need of psychosocial
intervention.
* Mental health providers need to know how to gain trust and gather information from the patient, the patient's family, friends and
relevant social relations, and to involve them in an effective treatment plan.
* Therapeutic use of self is the instrument for delivery of care to clients in need of psychosocial intervention.
* Interpersonal communication techniques are the “tools” of psychosocial intervention.

THERAPEUTIC NURSE-CLIENT RELATIONSHIP

* Therapeutic relationships are goal- oriented and directed at learning and growth promotion.

Therapeutic Use of Self

* Definition - ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure
nursing interventions.
* Nurses must possess self-awareness, self-understanding, and a philosophical belief about life, death, and the overall human
condition for effective therapeutic use of self.

Requirements for Therapeutic Relationship

* Rapport
* Trust
* Respect
* Genuineness
* Empathy

Phases of a Therapeutic Nurse-Client Relationship

* Pre-interaction phase
* Orientation/Introductory Period
* Working
* Termination

INTERPERSONAL COMMUNICATION

* Interpersonal communication is a transaction between the sender and the receiver. Both persons participate simultaneously.
* In the transactional model, both participants perceive each other, listen to each other, and simultaneously engage in the process of
creating meaning in a relationship, focusing on the patients issues and assisting them learn new coping skills.
* Both sender and receiver bring certain preexisting conditions to the exchange that influence the intended message and the way in
which message is interpreted.

CONTEXT OF THERAPEUTIC COMMUNICATION

Values, attitudes, and beliefs.

* Example: attitudes of prejudice are expressed through negative stereotyping.

Culture or religion

* Cultural mores, norms, ideas, and customs provide the basis for ways of thinking.

Social status

* High-status persons often convey their high-power position with gestures of hands on hips, power dressing, greater height, and
more distance when communicating with individuals considered to be of lower social status.

Gender

* Masculine and feminine gestures influence messages conveyed in communication with others.
Age or developmental level

* Example: The influence of developmental level on communication is especially evident during adolescence, with words such as
“cool,” “awesome,” and others.

The environment

* Territoriality, density, and distance are aspects of environment that communicate messages.
o Territoriality - the innate tendency to own space
o Density - the number of people within a given environmental space
o Distance - the means by which various cultures use space to communicate

Proxemics: Use of Space

* Intimate distance - the closest distance that individuals allow between themselves and other
* Personal distance -the distance for interactions that are personal in
nature, such as close conversation with friends
* Social distanc - the distance for conversation with strangers or acquaintances
* Public distance - the distance for speaking in public or yelling to someone some distance away

Nonverbal Communication: Body Language

Components of nonverbal communication

* Physical appearance and dress

* Body movement and posture
* Touch
* Facial expressions
* Eye behavior
* Vocal cues or paralanguage

THERAPEUTIC COMMUNICATION TECHNIQUES

* Using silence - allows client to take control of the discussion, if he or she so desires
* Accepting - conveys positive regard
* Giving recognition - acknowledging, indicating awareness
* Offering self - making oneself available
* Giving broad openings - allows client to select the topic
* Offering general leads - encourages client to continue
* Placing the event in time or sequence - clarifies the relationship of events in time
* Making observations - verbalizing what is observed or perceived
* Encouraging description of perceptions - asking client to verbalize what is being perceived
* Encouraging comparison - asking client to compare similarities and differences in ideas, experiences, or interpersonal relationships
* Restating - lets client know whether an expressed statement has or has not been understood
* Reflecting - directs questions or feelings back to client so that they may be recognized and accepted
* Focusing - taking notice of a single idea or even a single word
* Exploring - delving further into a subject, idea, experience, or relationship
* Seeking clarification and validation - striving to explain what is vague and searching for mutual understanding
* Presenting reality - clarifying misconceptions that client may be expressing
* Voicing doubt - expressing uncertainty as to the reality of client’s perception
* Verbalizing the implied - putting into words what client has only implied
* Attempting to translate words into feelings - putting into words the feelings the client has expressed only indirectly
* Formulating plan of action - striving to prevent anger or anxiety escalating to unmanageable level when stressor recurs

THERAPEUTIC COMMUNICATION AND PROBLEM-SOLVING

Goals are often achieved through use of the problem-solving model:

* Identify the client’s problem.

* Promote discussion of desired changes.
* Discuss aspects that cannot realistically be changed and ways to cope with them more adaptively.
* Discuss alternative strategies for creating changes the client desires to make.
* Weigh benefits and consequences of each alternative.
* Help client select an alternative.
* Encourage client to implement the change.
* Provide positive feedback for client’s attempts to create change.
• Help client evaluate outcomes of the change and make modifications as required.
•
LISTENING TO THE PATIENT

* To listen actively is to be attentive to what client is saying, both verbally and nonverbally.

Several nonverbal behaviors have been designed to facilitate attentive listening.

* S – Sit squarely facing the client.

* O – Observe an open posture.
* L – Lean forward toward the client.
* E – Establish eye contact.
* R – Relax.

Process Recordings

* Written reports of verbal interactions with clients

* A means for the nurse to analyze the content and pattern of interaction
* A learning tool for professional development
* How do I give a Patient Feedback

Feedback is useful when it

* is descriptive rather than evaluative and focused on the behavior rather than on the client
* is specific rather than general
* is directed toward behavior that the client has the capacity to modify
imparts information rather than offers advice.

Nontherapeutic Communication Techniques

* Giving reassurance - may discourage client from further expression of feelings if client believes the feelings will only be
downplayed or ridiculed
* Rejecting - refusing to consider client’s ideas or behavior
* Approving or disapproving - implies that the nurse has the right to pass judgment on the “goodness” or “badness” of client’s
behavior
* Agreeing or disagreeing - implies that the nurse has the right to pass judgment on whether client’s ideas or opinions are “right” or
“wrong”
* Giving advice - implies that the nurse knows what is best for client and that client is incapable of any self-direction
* Probing - pushing for answers to issues the client does not wish to discuss causes client to feel used and valued only for what is
shared with the nurse
* Defending - to defend what client has criticized implies that client has no right to express ideas, opinions, or feelings
* Requesting an explanation - asking “why” implies that client must defend his or her behavior or feelings
* Indicating the existence of an external source of power - encourages client to project blame for his or her thoughts or behaviors on
others
* Belittling feelings expressed - causes client to feel insignificant or unimportant
* Making stereotyped comments, clichés, and trite expressions - these are meaningless in a nurse-client relationship
* Using denial - blocks discussion with client and avoids helping client identify and explore areas of difficulty
* Interpreting - results in the therapist’s telling client the meaning of his or her experience
* Introducing an unrelated topic - causes the nurse to take over the direction of the discussion

CONCLUSION

* Effective communication is the core skill in mental health care in primary care settings.
* Self-awareness and ability to collaborate with other health care providers are also skills that will facilitate accurate inquiry into the
patient's true concerns and the context in which they occur.