Psychopharmacology: Database for Patient and Family Education on Psychiatric Medications
Yoshinao Arai, RN, MN, CNS
Learning Objectives
Glossary
Agonist– A chemical compound (drug or neurotransmitter) that produces a biochemical response when it binds to a receptor. A receptor is a complex molecule located on a cell membrane. When an agonist binds to a receptor, this forms an agonist-receptor complex, and the formation of this complex leads to a biochemical response.
Antagonist – A chemical compound that blocks or reverses the effect of agonists by coupling with a receptor without triggering a physiological response. Antagonists and agonists can bind to a receptor, but they cannot do so at the same time. The degree to which an antagonist dominates an agonist depends on the binding strength and the concentration of the antagonist.
Elimination half-life– Time required to decrease the plasma concentration of a drug by 50%. If the half-life of a drug is shorter than 24 hours, its daily dose needs to be divided into two or three doses a day to maintain steady-state concentration in the body. It takes about five times the half-life for a drug to reach its steady state when a new drug is started or about five half-lives for a drug to be washed out of an individual's system after a drug is discontinued.
Neurotransmitters – Chemical compounds that serve as messengers in the neuronal system. Each neurotransmitter has its specific type of receptors to couple with. Common neurotransmitters for psychopharmacology include dopamine, serotonin, norepinephrine, acetylcholine, and gamma-aminobutyric acid (GABA). Others include oxytocin, growth hormone (GH), calcitonin, angiotensin, insulin, substance P, beta-endorphin, and prolactin.
Potency– A comparative, not absolute, measure of the strength of a drug to produce a response. The higher the potency of a drug, the lower the recommended dose will be to create a given physiological response. For example, a dose of haloperidol (Haldol) of 2 mg is thought to produce the same clinical response (antipsychotic effect) as a dose of chlorpromazine (Thorazine) of 100 mg. The potency of haloperidol is 50 times higher than that of chlorpromazine.
Psychoeducation– Educational intervention with a focus on skills training for managing mental health issues for patients and families to achieve behavioral changes with increased knowledge
Psychiatric medications do not cure psychiatric disorders, but they can alleviate the symptoms caused by the disorders. The medications can minimize the disturbing impact of mental illness on a person's ability to function. The ideal treatment outcome is the removal of all the negative impact of the illness on the person's ability to achieve his or her goals in life. This is the purpose of psychopharmacological interventions when augmented with psychoeducation and rehabilitation. Both pharmacological and nonpharmacological interventions are effective because they work in the brain to adjust its biochemical brain activity. The resulting biochemical changes in the brain enhance the process of psychiatric rehabilitation in a similar manner to that of neurological rehabilitation. To attain the best benefits from psychiatric medication, the person with a psychiatric disability must see how medications can help to eliminate roadblocks in his or her life. This is best accomplished by identifying specific and concrete target symptoms with each individual.
Because people with psychotic symptoms are not aware of the difference between reality and symptoms, it is often difficult for them to see a need for the use of medication. Even if they are aware of their need for medication, it can still be difficult for them to assess a medication's efficacy because they cannot clearly distinguish what is reality and what is a symptom. Medication education, which is usually provided only at the beginning of a particular treatment, is not sufficient. Giving written information about a medication may only make the person feel more anxious. Psychoeducational support should be an ongoing process that helps to maximize the efficacy and safety of the medication regimen. With this support, the people with psychiatric disabilities will be able to value the pharmacological therapies in relation to their life goals.
This chapter provides the essential information on the psychiatric medications and their safety issues (Table 21-1 Summary of Safety Issues on Psychiatric Medications). This can be used in psychoeducational interventions to clarify the value of the medications in terms of the difference they can make in the lives of people with psychiatric disabilities. This information is presented in the following order: