The Role of Forensic Nurses in the Assessment of Psychotic Disorders

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Psychotic disorders include things like loss of reality, hallucinations and delusions, and deteriorating ability to function socially. Because of the variety in characteristics and symptoms of psychotic disorders, the treatment of them is highly individualized and usually involves a combination of different therapies (both drug and non-drug).

The ultimate goal of treatment as outlined by Clayton and Stock in Basic Pharmacology for Nurses is to “restore behavioral, cognitive, and psychosocial processes and skills to as close to baseline levels as possible so that the patient is reintegrated into the community.” The treatment appears to be difficult and complex due the individuality of each persona’s psychosis as well as their reactions to treatment (drug and non-drug).

There are several classes of drugs that are used in the treatment of psychotic disorders: antipsychotic agents, benzodiazepines, beta-adrenergic blocking agents, anti-parkinsonian agents, and anticholinergic agents can all play a role in treating psychosis.

Most antipsychotic agents adjust the seratonin or dopamine uptake or release in the body. There is more to psychotic disorders than dopamine and seratonin levels, however, and there is not enough known about the specific way these drugs are relieving psychotic symptoms. This can account for some of the variety in therapeutic responses to the antipsychotic drugs.

Once specific drug selected for a patient, simply getting that patient to take the drug can sometimes be a huge trial. This is due to many of the patients being out of touch with reality and not believing that they need any sort of treatment. Many patients will pretend to swallow the medication, and spit them out later. This is an interesting detail to consider as a nurse administering these medications. It becomes imperative to ensure that the patient has indeed swallowed the pills, and not just ““cheeked them”” as Clayton and Stock point out.

Overall, there are a great many things to consider as a nurse involved in the assessment process of someone with psychosis. Observations and monitoring are critical in assessing for adverse drug effects. Patient history is important in determining the effectiveness of the treatment method and drug for therapy.

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