improve self-esteem and quality of life for an older adult living with schizophrenia: CBT, functional adaptation skills training (FAST), vocational rehabilitation, and technology communication connection (e.g., it provides reminders for medications and appointments). FAST is a unique treatment approach for schizophrenia that seeks to build necessary life skills that can address social determinant barriers to mental healthcare (Cepla, 2014). For example, an older adult with schizophrenia who lacks personal transportation can be taught how to navigate public transportation. Enhancing transportation for the older adult can address access to care issues and increase resource availability for items such as groceries, clothing, and medications. Psychosocial interventions strengthen the quality of care and life for an older adult living with schizophrenia. Schizophrenia is treated pharmacologically with antipsychotic medications. First- and second-generation antipsychotics are most frequently seen as front-line treatment options, although third-generation antipsychotics are up and coming. Antipsychotic medications are used in patients with schizophrenia because they primarily block dopamine, a known cause of psychotic symptoms, and can alter other neurotransmitters (Sadock et al., 2015). Antipsychotic medications carry a difficult side effect risk profile. Sedation, postural hypotension, anticholinergic effects, extrapyramidal symptoms, and tardive dyskinesia are some of the most concerning side effects of antipsychotic medications (Boyd, 2017). Definition of anticholinergic effects (APA, 2022a): Side effects are characteristic of anticholinergic drugs and are also associated with other agents (e.g., tricyclic antidepressants, monoamine oxidase inhibitors) that exert antagonist effects at muscarinic receptors. They include dry mouth, blurred vision, urinary hesitancy or retention, and constipation. Similar antagonistic effects may occur at nicotinic receptors as well. Depending on the specific receptors involved, these effects may also be called antimuscarinic effects or antinicotinic effects. Definition of extrapyramidal symptoms (APA, 2022d): A group of adverse drug reactions attributable to dysfunction of the extrapyramidal tract, such as rigidity
of the limbs, tremors, and other Parkinson-like signs; dystonia (abnormal facial and body movements); and akathisia (restlessness). Extrapyramidal symptoms are among the most common side effects of the high-potency antipsychotics and have also been reported with the use of other drugs (e.g., SSRIs). Also called extrapyramidal syndrome (EPS). antipsychotics, particularly conventional antipsychotics that act primarily as dopamine- receptor antagonists. It is more common with prolonged use (months or years), and older patients, females, and patients with mood disorders are thought to be more susceptible. Symptoms include tremor; so-called choreoathetoid movements; and spasticity of muscle groups, particularly orofacial muscles and muscles in the extremities. Onset is insidious and may be masked Definition of tardive dyskinesia (TD) (APA, 2022i): A movement disorder associated with the use of by continued use of the antipsychotic, only appearing when the drug is discontinued or the dose lowered. Its incidence is estimated at up to 40% of long-term users of conventional antipsychotics; the incidence is lower with atypical antipsychotics. No effective treatment is known. Older adults need special considerations for medications to treat schizophrenia. Older adults with schizophrenia often need adjustments to medication regimens with lower doses or divided doses throughout the day when possible (Sadock et al., 2015). The AGS releases and continually updates safety criteria to guide the treatment of the older adult population. The AGS (2019) recommends only patients with schizophrenia receive antipsychotic medication, which increases the risk of stroke, diminishes cognitive ability, and contributes to early death. The healthcare worker should investigate all medications being taken by the older adult with acute notation of antipsychotics drugs and their known side effects. Table 6 is a snapshot of antipsychotic medication options and is presented to increase understanding of decreased dose ranges and the comparative difficulty of side effect risk profiles for antipsychotics in older adults.
Table 6. A Snapshot of Decreased Older Adult Dosing and Side Effect Risk Profiles Drug Adult Dosage (mg/day) Geriatric Dosage (mg/day) Sedation Postural Hypotension
Anticholinergic Effects
EPS
TD
Clozaril (clozapine) Olanzapine (Zyprexa) Quetiapine (Seroquel) Risperidone (Risperdal) Haloperidol (Haldol)
300–450
12.5–25
High
Moderate
High
Low
Low
25–50
25
Moderate– high
Moderate
Moderate–high
Low
Low
150–750
50–200
Moderate
Moderate
High
Low
Low
4–16
0.25–1.5
Low
Low
Low
Low
Low
1–15
0.25–0.5
Low
Low
Low
Very high
Yes
Note : Information taken from https://www.Medscape.com Neuroleptic malignant syndrome (NMS) is a life-threatening condition that can happen in response to antipsychotic medications. Early recognition and intervention are the most important things a healthcare worker can do for a patient experiencing NMS. The primary symptoms of NMS are mental status changes, severe muscle rigidity, and autonomic changes (historically presenting with high fever ranging between 101 and 103 degrees Fahrenheit, tachycardia, and fluctuating blood pressure) (Boyd, 2017). Emergency intervention is needed for NMS. The healthcare worker should intervene as workplace
policy dictates to get the patient to appropriate medical care as soon as possible. A delicate balance is needed to lessen problematic schizophrenic symptoms and antipsychotic medication side effect profiles, which can be dangerous to the older adult. The healthcare worker can help assess the older adult with schizophrenia and seek to find interventions and treatments that can be modified if needed. With an individualized plan of care and proactive planning, the healthcare worker can increase the quality of mental health services provided, in turn increasing the quality of life for the older adult living with schizophrenia.
EliteLearning.com/Psychology
Book Code: PYMA2024
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