The Treatment Of Schizophrenia In Older Persons Essay Paper

Posted: December 6th, 2022

The Treatment Of Schizophrenia In Older Persons Essay Paper

Prescribing for Older Adults and Pregnant Women

Schizophrenia in Older Adults

In order to minimize drug-related problems in older persons, enhancing medication treatment is a crucial part of their care. Nevertheless, there are many reasons why prescription for elderly people is difficult. First and foremost, elderly persons are more likely than younger ones to have multidrug regimen due to various chronic health conditions, therefore increasing their risk of experiencing unfavorable medication incidents. Additionally, elderly patients are often excluded from pre-market research studies for new medications. As a result, medications and dosages that are authorized for use in elderly people are frequently unsuitable. In addition, variations in pharmacodynamic and pharmacokinetic properties that occur with age highlight the practical necessity of exercising caution when determining prescription choices for elderly people. For the treatment of schizophrenia in older persons, this paper seeks to propose one FDA-approved drug, one non-FDA-approved “off-label” medication, and one nonpharmacological treatment The Treatment Of Schizophrenia In Older Persons Essay Paper.

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The United States Food and Drug Administration has approved the administration of antipsychotic medications in treating schizophrenia in older adult populations. In elderly people suffering from schizophrenia, the medication Seroquel has been certified by the FDA. In contrast to traditional antipsychotics, Seroquel is an atypical antipsychotic medication that is recommended. Atypical antipsychotics are commonly prescribed as they have a decreased likelihood of inducing the sympathomimetic adverse effects that are prevalent with first-generation antipsychotics (Hashimoto et al., 2015). Atypical antipsychotics are available in various doses, but the recommended Seroquel dosage for adults with schizophrenia should start from 50 mg per day.

I choose Tegretol as an off-label medication used for treating elderly schizophrenia. Tegretol is an antiepileptic medication that is beneficial in treating the affective manifestations of schizophrenia and in reducing aggressive behavior in persons with schizophrenia. Its anti-kindling properties may make it a potential therapeutic option for elderly people suffering from persistent schizophrenia. The recommended dosage for this medication is 200-1300 mg/day The Treatment Of Schizophrenia In Older Persons Essay Paper.

The non-pharmacological intervention recommended for older adults with schizophrenia is psychosocial therapy. A long history of research has been conducted on psychosocial interventions aiming at enhancing independent functioning and social skills in schizophrenia. These therapies may be particularly beneficial in elderly patients since a considerable percentage of them fail to respond completely to antipsychotic medications (Cooper et al., 2020). Occupational therapy used in conjunction with independent and interpersonal skills training has been linked to better social performance and self-sufficient living, according to research.

In the field of psychiatry, risk assessment has long been recognized as a critical component of clinical practice. It is particularly important when deciding on the management of schizophrenia in elderly people. The primary aim of risk assessment will be to obtain facts on the efficacy and safety of medicines in elderly patients. Elderly people are at greater risk of experiencing an adverse drug event. This is due to changes in pharmacodynamics and pharmacokinetics that occur with aging, along with concomitant ailments, multidrug regimens, and infirmity in the elderly. As a result, it is critical to deriving insights on the likelihood, rate, and inevitability of unpleasant medication incidents on a continuous basis to make informed decisions. This helps to assure the safety and efficacy of medications for the older adult group (Rochon & Schmader, 2019). Schizophrenia is a long-term illness that has a significant chance of refractory episodes. Clinical problems include prescription of an antipsychotic medication at the highest safe dosage while limiting the likelihood of dose-dependent unfavorable medication reactions. As per EBP practice, healthcare professionals should ensure that patients are started on the minimum efficient dosage of antipsychotic medications, and the dosage is subsequently titrated according to safety and the extent to which patients are able to bear the overt side effects of medications.

It is important to note that medications approved by the FDA as well as those used off-label have upsides and downsides. Atypical antipsychotics like Seroquel work by rebalancing dopamine and serotonin in the brain, which helps patients think more clearly and behave better as a result of this. Although helpful, Seroquel may induce side effects in some people, including dry mouth, dizziness, orthostatic hypotension, constipation, and a sense of sleepiness in the elderly. Furthermore, older individuals with schizophrenia are more prone than non-schizophrenic to acquire diabetes, and using Seroquel or comparable drugs may raise the likelihood. Tegretol is indicated as an antipsychotic drug for treating schizophrenia and other mental illnesses because of its antiepileptic and mood-stabilizing properties. Therapy with approved atypical antipsychotics is often ineffective in alleviating the acute schizophrenia features (Hashimoto et al., 2015). Therefore, Tegretol’s ability to stabilize the mood is critical in keeping the schizophrenia effects from returning once they have subsided. For a large number of persons with schizophrenia, antipsychotic drugs do not provide a meaningful effect. Adjunctive drugs like Tegretol may help amplify the effects of the primary treatment. Despite this, research suggests that Tegretol should not be used frequently in the healthcare context to manage schizophrenia or enhance antipsychotic therapy (Maan et al., 2018). It may bring side effects such as drowsiness, lack of coordination, and headaches.

The American Psychiatric Association’s (APA’s) clinical practice standards are critical in helping healthcare practitioners select healthcare options for schizophrenic patients. Such therapeutic standards for schizophrenia are founded on proven medication and nonpharmacological therapies. In accordance with the guidelines, mentally ill persons like schizophrenics should be treated with an antipsychotic drug, and their efficacy and adverse reactions should be monitored carefully The Treatment Of Schizophrenia In Older Persons Essay Paper.

References

Cooper, R. E., Laxhman, N., Crellin, N., Moncrieff, J., & Priebe, S. (2020). Psychosocial interventions for people with schizophrenia or psychosis on minimal or no antipsychotic medication: A systematic review. Schizophrenia Research, 225, 15-30. https://doi.org/10.1016/j.schres.2019.05.020

Hashimoto, N., Toyomaki, A., Honda, M., Miyano, S., Nitta, N., Sawayama, H., Sugawara, Y., Uemura, K., Tsukamoto, N., Koyama, T., & Kusumi, I. (2015). Long-term efficacy and tolerability of quetiapine in patients with schizophrenia who switched from other antipsychotics because of inadequate therapeutic response—a prospective open-label study. Annals of General Psychiatry, 14(1), 1. https://doi.org/10.1186/s12991-014-0039-6

Maan, J. S., TvH, D., & Saadabadi, A. (2018). Carbamazepine. https://europepmc.org/article/NBK/nbk482455

Rochon, P. A., & Schmader, K. E. (2019). Drug prescribing for older adults. https://www.uptodate.com/contents/drug-prescribing-for-older-adults

To Prepare: Choose one of the two following specific populations: either pregnant women or older adults. Then, select a specific disorder from the DSM-5 to use. Use the Walden Library to research evidence-based treatments for your selected disorder in your selected population (either older adults or pregnant women). You will need to recommend one FDA-approved drug, one non-FDA-approved “off-label” drug, and one nonpharmacological intervention for treating the disorder in that population. Assignment Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women. Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug? Explain whether clinical practice guidelines exist for this disorder, and if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration. Support your reasoning with at least three current, credible scholarly resources, one each on the FDA-approved drug, the off-label, and a nonpharmacological intervention for the disorder.

Mild Neurocognitive Disorder DSM-5 331.83 (G31.84) in the older adult population

Affective brain disease Alzheimer’s accounts for up to 60-80% of causes of Dementia, a common term for a mental deterioration severe enough to interfere with daily life. The most common cause of Dementia is Alzheimer’s disease. Alzheimer’s disease is a distinct illness, and Dementia is not. Dementia is a term used to describe a set of symptoms associated with a loss of memory, reasoning, or other cognitive abilities. There are many different varieties of Dementia, and many different illnesses can cause it. Mixed Dementia is a disorder in which multiple types of Dementia manifest themselves in the brain simultaneously. Alzheimer’s disease is the leading cause of Dementia, accounting for 60 to 80 percent of cases The Treatment Of Schizophrenia In Older Persons Essay Paper.

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In the United States, five FDA-approved drugs (Donepezil, galantamine, rivastigmine, memantine, and donepezil/memantine combo) treat the symptoms of Alzheimer’s disease by temporarily improving cognition. Aricept (Donepezil) is an FDA-approved medicine that is classified into two groups based on the severity of the illness: mild-to-moderate and moderate-to-severe. Cholinesterase inhibitors, such as Donepezil, are used to treat mild to moderate disease (Aricept; also approved for moderate-to-severe disease). According to National Institute on Aging, Aricept, and other medications such as rivastigmine (Exelon) and galantamine (Razadyne) are prescribed to help interrupt or prevent symptoms from getting worse for a limited time, as well as control some behavioral abnormalities. Rabins et al. (2014).

Seroquel is the off-label prescription I picked, but there are others such as antipsychotics, antidepressants, anti-anxiety medications, and mood stabilizers, all of which alter brain function and cause changes in perception, mood, or consciousness.

Vascular: research has shown that the relationship between blood pressure and the progression of Dementia is complex. Although considerable research has linked high systolic blood pressure to an increased risk of Alzheimer’s disease and all-cause Dementia, some investigations have found that a systolic blood pressure of less than 140 mm Hg is also linked to an increased risk. Despite these and other seemingly contradicting findings, the Systolic Hypertension in Europe (SYST-EUR) study found that people taking antihypertensive therapy had a lower incidence of Dementia, Patterson et al. (2018). Lifestyle measures (regular physical and mental activity, moderate alcohol consumption, and avoidance of cigarettes and head injuries) appear to potentially lessen the risk of Dementia. Patterson, and colleagues (2018). Medications: Patterson et al. (2018) found that using estrogen alone or in conjunction with progesterone for the primary goal of lowering dementia risk is not recommended. Headaches, dizziness, and constipation are possible adverse effects, but they are usually relatively transient. Patterson et al. (2018) The Treatment Of Schizophrenia In Older Persons Essay Paper.

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According to Furey and Wilkins (2016), prescribing drugs for “off-label” uses has ethical and legal ramifications. It also makes us think about whether pharmaceutical companies will seek FDA approval for additional indications when medicine has already been approved for use in another ailment.

When considering difficult therapeutic decisions, such as using off-label pharmaceuticals that lack solid evidence that they will help for the disorders for which they were not FDA approved, it is critical to adopt shared decision making. Also, before deciding to utilize an off-label drug, it is essential to consult with a family member or caregiver and the patient. The advantage is that it will work, and the patient will improve, according to Furey and Wilkins (2016).

Neurocognitive Disorder Guidelines, The FDA has licensed three cholinesterase inhibitors—Donepezil, rivastigmine, and galantamine—to treat mild to severe Alzheimer’s disease, which accounts for 60-80% of dementia cases. Rabins and colleagues (2014). New randomized controlled trials of cholinesterase inhibitors and memantine to treat cognitive symptoms of Dementia have been published. This study treated specific dementias (such as Alzheimer’s disease, vascular Dementia, and other dementias) with medications like Aricept (Donepezil). According to the guideline, Donepezil has also been recommended for severe Alzheimer’s disease. Rabins, and colleagues (2014).

Reference

American Psychiatric Association (APA) 2013., Diagnostic and statistical manual of mental

disorders 5^th ed. DSM-5. American Psychiatric Publishing Washington, DC / London, England

Furey, K. & Wilkins, K. (2016). Prescribing “Off-Label”: What Should a Physician Disclose?

AMA J Ethics. 2016;18(6):587-593. DOI 10.1001/journalofethics.2016.18.6.ecas3-1606.

Patterson, et al (2018). Diagnosis and treatment of dementia: 1. Risk assessment and primary

prevention of Alzheimer’s disease. CMAJ 2008; 178:316-21. www.cmaj.ca/cgi/content/full/178/5/548/DC1

Rabins, P.V. et al, (2014). Guide watch (October 2014): Practice guideline for the treatment of

patients with Alzheimer’s disease and other dementias. APA Guideline Watch; https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/alzheimerwatch.pdf The Treatment Of Schizophrenia In Older Persons Essay Paper