Nursing Assignment Help on Drug-Induced Psychosis

1. Introduction

According to the World Health Report (WHO, 2001), mental disorders affect one in four people worldwide at some point or the other in their lifetime. It is so common today that across nations, mental health issues are the fastest increasing encumbrance to the healthcare industry (Staniulienė, et al., 2013). Studies abound on the subject. However, the focus of the current essay is on the case of Ben, a compulsory patient diagnosed with drug-induced psychosis and undergoing treatment in a hospital setting. The following discussions not only explore the specific nature of Ben’s mental illness, but also evaluates the recovery strategies that can be adopted by the Mental Health Nurse (MHN) towards Ben in the context of the legislative rigour imposed by the Victorian Mental Health Act 2014. For an MHN, there are both legal and emotional challenges in treating a mentally-ill psychotic patient and this essay attempts to identify some of those.

 

 

2. The Case Overview

2.1 The Disorder

Ben suffers from drug-induced psychosis and is a compulsory patient under the Victorian Mental Health Act 2014. A few questions that obviously arise are: (i) what is psychosis and in particular, what is drug-induced psychosis, (ii) what is meant by a compulsory patient, (iii) what is Ben’s demographics — age, ethnicity, social habits, etc. (iv) what is Ben’s health history and family background and finally, (v) what is the Act referred to here.

While Ben’s demographics, family background and health history is not known for better analysis of the MHN’s role, it can certainly be said that Ben’s illness is in a critical state, whereby he has been ordered to be treated by law. According to the Victorian Mental Health Act 2014, a compulsory patient is one who is subject to either an assessment order, or court assessment order or temporary treatment order or a treatment order. Therefore, by all means, Ben’s condition is acute and he needs attention.

Termed also as ‘thought disorders’, psychosis generally means a mental state where one loses connection with reality or demonstrates a distorted sense of reality, without any consciousness (General Practitioner Booklet, 2007; National Drug Strategy, 2009). Characterised by delusions, hallucinations, loss of motivation, anxiety, affective blunting, violent behaviours, speech disturbance, etc., psychosis leads to complete social disability (Psychosis and Substance Use Booklet, 2011).

Sometimes one or some of these symptoms can arise in persons taking stimulant drugs like cannabis, cocaine, amphetamines, hallucinogens, opioids, nicotine, sedatives, etc. (Caton, Samet & Hasin, 2000; What is Stimulant-Induced…). That is called drug-induced psychosis. It is immaterial what drugs Ben was addicted to or what were the manifestations of his disorder; what is more important is the recovery approaches and potential challenges of the MHM towards his treatment.

2.2 The Recovery Approach

There are two main approaches to the recovery of psychotic patients like Ben — medicines and psychotherapy. From the medicinal approach, MHN can use medicines, especially antipsychotics like pimozide, clozapine, chlorpromazine, haloperidol and amisulpride (Psychotic Disorders; National Drug Strategy, 2009). In psychotherapy, the MHN can hold one-to-one motivational interviews with patient, counsel and educate him, ask for caregiver interventions, support from patient’s family and other support groups.

Drug-induced psychosis is generally first-episode and acute psychosis, which is one of the commonest psychiatric emergencies (Byrne, 2007). Hence, Ben is a compulsory patient. The MHN responsible for Ben’s care need to integrate both pharmacotherapy and psychotherapy to effectively recover Ben from his illness. According to the General Practitioner Booklet (2007), most young adults will recover completely, although around 10-20% of patients need continued care after the first-episode acute psychosis. Recovery also depends, to a large extent, on patient or his family’s cooperation to treatment, which includes compliance to doctor’s instructions, prescribed medicines.

It is not known if Ben’s case is an early detection, but if it is, chances of recovery is high (National Drug Strategy, 2009). Unfortunately, two-thirds of mentally ill people never seek professional help (WHO, 2001). Ben, evidently, falls into this category — he has been ordered a treatment, he did not seek it himself. Nevertheless, he can still fully recover if he cooperates with the MHN.

3. The Victorian Mental Health Act 2014

It is common to treat psychosis and persons having mental disorders with a sense of exclusion from the ‘normal’. According to Funk, Drew & Baudel (2015), globally there are many mentally-ill people who are deprived of their human rights. They are discriminated and abused physically, sexually and emotionally. Sometimes, they are even ridiculed publicly. WHO (2001) felt that a lot of its responsibility lies with the governments. Laws are needed to do away with these inhuman acts and disgraceful behaviours. Unfortunately, there are still 25% of countries worldwide that do not have a mental health legislation (WHO, 2001). Some do. The Victorian Mental Health Act 2014 is one such law, setting the limits of behaviour towards mentally-ill people generally and in hospital settings.

Often faced with neglect and fearing ridicule, mentally-affected people refrain from seeking help, even when treatments are available. Ironically, if they did seek help early, or if the general attitude towards them was positive, there would have been far less mental health cases to be handled and discussed across the world today. Left with little choice, governments like the Government of Victoria established the laws around mental health, that protects their rights and dignity, as well as raising awareness on the legal parameters of mental health-related issues, the tribunals, the administrative parameters, the treatment guidelines, etc. Since Ben is a compulsory patient under the Victorian Mental Health Act 2014, the MHN responsible for his recovery must comply to the standards laid out in the legislation, while applying pharmacotherapy and psychotherapy.

4. Challenges to Mental Health Nurses

Mental health nurses have a dual role to perform — one, as a trained nursing support in the care of patients and two, as practice professionals of the healthcare industry as a whole. Both these roles need balancing together and a medical health practitioner cannot afford to favour any one over another. Morse & Procter (2011) studied that MHNs can positively impact the health outcomes of a psychotic patient.

In trying to focus too much on the effectiveness of MHN’s roles on the recovery of patients, people often tend to overlook that they are humans too and it is immensely difficult dealing with mental health patients, especially those like Ben, suffering from acute psychosis. The challenges to the role of an MHN are mainly legal and emotional.

4.1 Legislative

According to the Victorian Mental Health Act (2014), a mental health service provider must comply to the mental health principles while providing mental health services. “A person must have regard to the mental health principles in performing any duty or function or exercising any power under or in accordance with this Act.“

While some principles are reasonably feasible to follow in all circumstances, some principles may pose a challenge to the MHN on duty. For example, Section 15 (right to communicate) of the Act mentions that hospital staff should assist an inpatient to communicate lawfully with any person as it is a patient’s right, unless according to Section 16 (restrictions of right to communicate), an authorised psychiatrist directs the staff “in writing” that restriction to communicate should apply for the wellbeing of the patient. And even if such restriction is applied, the staff must notify the patient and his family before applying such restriction (Section 17). Although from the theoretical and legal perspectives it makes sense, adhering to such a formal method of applying restrictions may not be practically possible if the patient’s psychotic behavioural symptoms suddenly intensify and the MHN visibly feels that the patient is unfit to communicate. An authorised psychiatrist may not be immediately available to impose a restriction in writing. Even then, according to law, the MHN may not be able to restrict the patient and therefore, feel challenged.

Most of the important decisions are bound by law to the authorised psychiatrist. But practice often varies from theory and it can pose serious challenges for the MHNs. Legal reliefs, if any, for other health practitioners like the MHN, are limited to urgent medical treatments only, and only if they meet certain situational criteria as specified in Section 77.  Ben being an acute psychotic patient, the MHN responsible for care must be cognizant of her legal limitations during his treatment.

4.2 Emotional

Caring for distressed patients like Ben can be emotionally demanding and stressful for the MHN. The study by Staniulienė,et. al., (2013) show that nurses across countries felt strong emotions while caring for such patients. MHNs have varied range of experiences with mentally-ill patients having high-levels of distress. They also experience multiple emotional quandaries parallel to the patients’ cognitive dissonance.

MHNs are sometimes afraid of patient aggression and hostility in hospital settings. As per one survey in the UK, an estimated 70% of MHNs in psychotic patient care have been assaulted at least once in their entire career (Needham, et. al., 2005). Ben’s MHN may also feel fear of safety for everyone around and herself while trying to deal with his acute psychotic behaviour. She may feel worried about crossing her professional and legal limits in the heat of the situation and be held up by law for doing so. Fear anxiety is a big challenge for MHNs.

Another emotional challenge for MHNs is overcoming the sense of loss of a relationship. Close association with patients through interviews and counselling and other nursing care techniques often lead nurses to naturally develop a connection to patients. When that patient has to be coercively treated or restricted otherwise, the MHN feels emotionally torn between personal choices and professional duties.  Sometimes however, coercive interventions emerge as the only choice as all efforts to descale the patient’s condition fails. But restraints of this kind, for many MHNs, are a personal and professional failure and result in their frustrations (Staniulienė,et. al., 2013).

Since treatment for psychosis entails listening to the patient’s story, acknowledging their beliefs, understanding their personal failures and getting inside their world for delivering better nursing care, there are obvious trusts and alliances at work (Freeman, 2002). MHNs get emotionally connected for better or worse and is often challenged to keep emotions out of their professional liabilities.

5. Conclusion

The above discussions point to the criticality of an MHN’s role in psychotic patient care. Not only are there legal and emotional considerations in applying the recovery strategies towards a compulsory patient like Ben, but also a personal commitment towards the recovery of the patient. Recovery strategies available to Ben’s MHN mainly comprise pharmacotherapy (medicines, electroconvulsive or neural) or  psychotherapy (cognitive behavioural therapy or CBT, family-oriented therapy, interpersonal therapy, counselling, etc) or both, as prescribed by the doctors and psychiatrists. And in applying any or all of these, the MHN is faced with legislative and emotional challenges which they take time to recover from. Therefore, it can be argued that the recovery strategies in psychosis, be it drug-induced or otherwise, ironically have the potential to drive the MHN to further distress.

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6. References

1. “Psychotic Disorders“, PsychGuides.com. http://www.psychguides.com/guides/psychotic-disorders/
2. “What is Stimulant-Induced Psychosis?” Dual Diagnosis.Org, Foundations Recovery Network. http://www.dualdiagnosis.org/drug-addiction/psychosis/
3. Byrne, Peter (2007). Managing the acute psychotic episode, British Medical Journal (BMJ), Vol.334, Issue: 7595, pp:686-692.
4. Caton, Carol; Samet, Sharon and Hasin, Deborah (2000). When Acute-Stage Psychosis and Substance Use Co-Occur: Differentiating Substance-Induced and Primary Psychotic Disorders, Journal of Psychiatric Practice, Vol.6, pp:256-266.
5. Freeman, Jacqueline (2002). The nurse’s role in managing psychosis, Nursing Times, Vol.98, Issue: 39, p.40.
6. Funk, Michelle; Drew, Natalie and Baudel, Marie (2015). Dignity in Mental Health, World Federation for Mental Health, 2015 Issue, Section 2, WHO. Retrieved from: http://wfmh.com/wp-content/uploads/2015/09/WMHD_report_2015_FINAL.pdf on April 18, 2016.
7. General Practitioner Booklet (2007). “The Early Diagnosis and Management of Psychosis“, Orygen Youth Health, Melbourne, Australia. http://oyh.org.au/sites/oyh.org.au/files/gp_manual.pdf
8. Morse, M and Procter, N (2011). Review: exploring the role of mental health nurse-practitioner in the treatment of early psychosis, Journal of Clinical Nursing, 20(19-20):2702-11. DOI: 10.1111/j.1365-2702.2010.03574.x
9. National Drug Strategy (2009). Australia Government. http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/FE16C454A782A8AFCA2575BE002044D0/$File/m717.pdf
10. Needham, I., Abderhalden, C., Halfens, R.J.G., et al. (2005) The impact of patient aggression on carers scale: Instrument derivation and psychometric testing. Scandinavian Journal of Caring Sciences, Vol.19, pp: 296-300. DOI: 10.1111/j.1471-6712.2005.00344.x
11. Psychosis and Substance Use Booklet (2011). National Drug & Alcohol Research Centre, Department of Health and Ageing, Government of Australia. https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/NDARC_PYCHOSIS_FINAL.pdf
12. Staniuliene, V. , Chambers, M. , Kantaris, X. , Kontio, R. , Kuosmanen, L. , Scott, A. , Rebelo Botelho, M. , Zanotti, R. and Välimäki, M. (2013) The feelings and thoughts of mental health nurses concerning the management of distressed and disturbed in-patients: A comparative qualitative European study. Open Journal of Nursing, 3, 426-436. doi: 10.4236/ojn.2013.36058.
13. Victorian Mental Health Act 2014, Government of Victoria, http://www.legislation.vic.gov.au/domino/web_notes/ldms/pubstatbook.nsf/f932b66241ecf1b7ca256e92000e23be/0001F48EE2422A10CA257CB4001D32FB/$FILE/14-026aa%20authorised.pdf
14. World Health Organization (2001), http://www.who.int/whr/2001/media_centre/press_release/en/