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The Importance of Medications in Mental Health

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The Importance of Medications in Mental Health
Case Study: The information collected for this paper is drawn from a case study of a 72-year-old white female. After her husband’s passing, she moved into a group home facility so that she could benefit from the services and aid they offered. She was diagnosed with paranoid schizophrenia more than 2 years ago and has been hospitalized five times in the past 2 years. Three of those hospitalizations have occurred in the past year. She also has a history of not complying with health professionals and she has failed to take her prescription medications as directed. She was brought into the gero-psychiatric unit by the police because of complaints of violent, psychotic behavior towards others (Sotiropoulos, Poetter, and Napholz, RN, Ph.D.). Medical compliance is very important to the health and well-being of a patient. The patient’s quality of life is heavily affected by the medications and education of the medications and their illness. In order to attain the quality of life they deserve the health professionals must try to convince the patient that the best way for them to do so is to follow the directions of the doctor.
Gathering Relevant Information For the purpose of this paper, I will assign the name Sally to the patient. Sally was diagnosed as being a paranoid schizophrenic more than 2 years ago. Paranoid schizophrenia is defined as “a chronic mental illness in which a person loses touch with reality (psychosis)” (Mayo Clinic Staff). As time goes by her condition is declining. She denies that she is schizophrenic or that she is in need of treatment or medication. She believes that any form of authority is a conspiracy against her. Her condition is permanent and only with medication and treatment will she show signs of improvement. Over the past 2 years, she has been hospitalized 5 times for unfavorable behavior and 3 times in the last year. This is mainly due to noncompliance with the medical orders. “Medication noncompliance remains a major obstacle in the management of chronic disease” (Kelly and Scott). Sally denies that she needs any medications and while in the group home frequently did not take her prescribed medications. She expresses her desire to be independent and go back to the group home. Nurses and doctors have all tried to make her understand how serious her illness is and could become. They have tried to stress how important it is to stay on her medications and keep up with her treatment. Two days after she arrived at the unit a court hearing was held and it was determined that Sally needed inpatient care. After four days, another court hearing was held and it was ordered that she stay in the hospital for treatment for 30 days. The court ordered this mandatory stay in the hospital to insure that the health professionals would have time to educate Sally on her condition and the medications and treatment needed. Taking this issue to the court shows that the decision makers in her case have listened to what she wanted but disagreed. As a 72-year-old woman, independent is very important to Sally. Loss of independence can lead to depression in seniors. If properly medicated and treated she could return to the group home and have her independence one again. Along with her personal independence, she is also able to pay her own bills and personal expenses. There are many policies psychiatric units have to follow to protect themselves and their patients. Sometimes the court has to step in and approve treatment or require that a patient be held involuntarily. In this case, the court made it mandatory that Sally stay in the unit for at least 30 days to receive medications, treatment, and education. Education of her illness and the medications that she could benefit from are key. Medications such as Chlorpromazine, Haloperidol, Perphenazine, and Fluphenazine could benefit her greatly if she is educated on proper use and the side effects (National Institute of Mental Health). Side effects such as drowsiness, dizziness blurred vision, rapid heartbeat, sensitivity to the sun, skin rashes, and menstrual problems for women are all some reasons why compliance is a problem (National Institute of Mental Health).
Identify the Type of Ethical Problem The major ethical problem in this case is the locus of authority. This is when a “problem arises from an ethical question of who should have the authority to make an important ethical decision” (Purtilo, 60). In this case, Sally was not capable of understanding the severity of her illness and she was acting violent and thought she was being over medicated. In order to confront this issue it is mandatory to go in front of a judge and give reason why the court should give control of a patient’s medical decisions to the health professionals.
Ethical Theories or Approaches to Analyze the Problem Deontology is a theory that states that patients are entitled to respect and health professionals have a duty to provide the best care possible. In this case, the doctors and nurses try to show Sally respect and have a duty to do what they feel is best for her by making it possible for her to receive treatment. This could directly affect her quality of life for the better. The other theory is utilitarianism. This theory states the ends justify the means or that the ratio of benefits to burdens brings about the best outcomes (Purtilo, 92). In association with Sally’s case, this refers to the time that she is required to stay in the unit. Even though she admittedly denies that she needs treatment or medication, the doctors and nurses know that this would benefit her greatly. They do respect her right to autonomy, but if they would let her go home then they would also be causing her harm. The principle of nonmaleficence states that a health professional will do no harm.
Practical Alternatives There are several possibilities for Sally. If she would agree to treatment and agree to take her medications then she would get to go home sooner. However, since she denies being ill then that does not seem to be a very likely possibility. The doctors could appeal to the court and have her found incompetent but with the proper medication and treatment, it is possible that she could live independently once again. The other option is that the court requires her to stay in the unit, for a period of time, to receive treatment and medication. During that time, they could educate her on the specifics of her illness and the medications. They could also educate her on the importance of taking the medications on a regular basis and how to deal with the side effects of the medications.
Complete the Action It is obvious that the court is going to have to intervene in this case. Sally is not in a competent state to understand the seriousness of her condition or to understand the consequences of not complying with treatment. The locus of authority should appeal to the court for approval to do what is best for Sally. Depending on the improvement that she makes over time, it could be possible for her to live on her own.
Process and Outcome After evaluating Sally’s medical history and her behavior when the police brought her to the unit it was obvious to the doctors and nurses that she was going to need more help than what she would agree to. In order to get her the help she needs, they have to appeal to the court to give permission to treat her and educate her. In the time she is with them, they need to take the time to explain to her that her medication is key to her living independently. During this time, they could adjust dosages to fit her best and start her in treatment. If she shows signs of improvement and actively participates then it is possible for her to go home and have a high quality of life.
Conclusion
“Many medical and psychiatric disorders require the prolonged use of maintenance medications to forestall or prevent further deterioration and disability” (Kelly). With the right treatments, people who suffer from schizophrenia can live a high functioning life. They do not have to live with the effects of this mental illness. They can be independent and self-sustaining and live a life that makes them happy.

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