The nurse spends several sessions with a patient with paranoid schizophrenia and the patient's family to help them understand the importance of antipsychotic medication in controlling his illness
The patient repeatedly states he isn't sick and the pills make him stiff, and family members say he doesn't think the medication helps him. They indicate that their efforts to promote adherence only lead to a hostile response from the patient. Which options should the nurse discuss with the patient's prescribing provider? Select all that apply. a. Using a long-acting injectable antipsychotic medication
b. Adding medications to reduce the patient's side effects
c. Adding a benzodiazepine such as diazepam (Valium)
d. Tying medication use to meeting the patient's own goals
e. Increasing discussion and problem solving regarding side effects
f. Telling the patient he will get sick without the medicine
A, B, D, E
Medications such as fluphenazine decanoate and haloperidol decanoate are long-acting forms of antipsychotic medication given by injection every 2 to 4 weeks, thus reducing the need for daily medications and struggles that may accompany these. The long-acting injections ensure that the patient maintains a therapeutic drug level, something unlikely when oral medications are taken intermittently. Discussing and addressing the patient's concerns about side effects (some of which can be extremely distressing) conveys interest in the patient and involves him in his treatment, and reducing side effects reduces resistance to the medication. Tying the medication to increasing the chance that the patient will meet his goals provides patient-centered motivation to take the medication (rather than taking it only at the behest of others). Adding a benzodiazepine would reduce anxiety, but that is not the likely cause of this patient's nonadherence. Telling the patient he will get sick without the medication is unlikely to help, because he does not believe he has an illness (anosognosia).
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