MH2 Mental Health Document Analysis

Running Head: MH 0
mental health
[Document subtitle]
MARCH 24, 2020
[Company name]
[Company address]

MH 1
Table of Contents
Introduction...........................................................................................................................................2
Controversy.......................................................................................................................................2
Challenges.........................................................................................................................................4
Conclusion.............................................................................................................................................4
References.............................................................................................................................................4

MH 2
Introduction
Sedatives are a kind of prescription medicine that slows down a person’s brain
activity. They are classically used to make the person feel more comfortable or relaxed.
Clinicians usually prescribe sedatives to address conditions like worry and sleep disorders.
They similarly use them as common anesthetics (Sheehan et al., 2017). Sedatives are also
called controlled substances. This indicates their manufacturing and sales are controlled.
Sedatives work through adapting certain nerve communications in the central nervous system
(CNS) to the user's brain (Wassink et al., 2015). Precisely, sedatives make the brain's
neurotransmitter named gamma-aminobutyric acid (GABA Trusted Source) function
overtime. GABA is accountable for slowing down the brain. Through increasing its level of
activity in the CNS, sedatives permit GABA to create a much robust effect on brain activity.
It is significant to be cautious when using these medicines to avoid dependence and
addiction. The use of sedatives is not recommended by different investigators. In different
parts of the world use of sedatives is controversial as it can cause multiple health issues
(Rankin, 2015). this particular assignment will discuss the controversy of the application od
psychotropic drugs to control behaviors and the challenging aspects for experienced nurses
while administrating them to the patient will be discussed.
Controversy
A psychotropic defines any medication that affects an individual's behavior, mood,
judgments, or awareness. It is a combined term for different medicines, counting prescription
drugs and usually misused medicines. Psychotropics are an extensive category of medications
that treat several different health conditions (Westbury et al., 2019). Whereas psychotropic
medications can help control a person's emotions and his or her mood, they can similarly
sometimes unfavorably impact their emotions. For instance, a user might have a difficult time
crying when he or she truly feels unhappy. They function through adjusting stages of brain

MH 3
substances, or neurotransmitters, like dopamine, gamma-aminobutyric acid (GABA),
different norepinephrine’s, and serotonin (Partridge, Lucke & Hall, 2014). Psychotropic
medicines for example antipsychotics, different anti-depressants, mood stabilizers counting
anti-epileptic drugs and lithium, the anti-anxiety medicines including benzodiazepines, many
psycho-stimulants, the beta-adrenergic blockers, and the opioid antagonists are used
extensively among individuals with intellectual disabilities and other mental health issues in
countries like Australia (del Carmen Panini et al., 2017). The degree of usage of these
medicines varies between 32 per cent and 85 per cent; some of these investigations have
stated the degree of antipsychotic application alone. These medicines are used in adding to
the current high use of medicine for physical difficulties. These medicines are used for both
psychological illness and also problematic (challenging) behavior without a license
(Karanges, Stephenson & McGregor, 2014).
Psychotropic medications transformed the management of mental disorders and
associated behavioral and symptoms. They allowed numerous individuals to be treated
deprived of chronic hospitalization. Though, medications have different side effects and
similarly introduce the problem of likely addiction. Long-standing use can be challenging.
Almost 50 percent of Australian grownups – closely 7.3 million individuals aged 16 to 85 –
will have a mental disease at some stage in their lifetime (Ćurković et al., 2016). Furthermore,
almost 600,000 young individuals aged between 4 and seventeen are exaggerated by a
clinically important mental health issue every year (Ford et al., 2017). The mental disease
significantly disturbs how an individual think, behaves and cooperates with other individuals.
Specifically, in 1949, in the Australian counselor John Cade exposed the anti-manic
characteristics of lithium and presented it for psychiatric management of people with bipolar
disorder. It was not accepted as a medicine until the late 1970s. Chlorpromazine usage for
schizophrenia issues followed in the year of 1953. Such a studied decrease in symptoms had

MH 4
never been understood before (del Carmen Panini et al., 2017). Tricyclic medications, for
example, Tofranil, were presented for the management of depression in the 1950s. In the year
of 1987 Fluoxetine, also recognized as presented and became extensive and controversial
management for depression. It has its place to a class of antidepressants that improve
serotonin levels. Its usage raises queries about whether individuals must expect to
continuously be happy. Australian investigations also show that between 60 per cent and 97%
of grownups and between 25 per cent and 50% of kids treated in a mental health unit obtain
prn psychotropic drugs (Ćurković et al., 2016). Different Australian investigations have
evaluated the use of numerous antipsychotics, a practice not usually recommended,
representing that on normal 35% of individuals with serious or problematic to treat
psychological illness were prescribed several antipsychotics (Ford et al., 2017). Around 14-
20 Individuals taking more than 1 antipsychotic were similarly more probable to be
prescribed doses above the maximum suggested antipsychotic dose (Ford et al., 2017)
These sedatives are often used to manage behaviors and symptoms of some health
issues like Dementia, COPD, and bipolar disorder. Behavioral and mental symptoms of
dementia (BPSD) comprise a variety of non-cognitive signs, for example, apathy, anxiety,
sadness, agitation, aggression, misunderstandings and hallucinations, itinerant, incontinence,
changed eating habits, sensual disinhibition, shouting, hoarding, recurrent questioning, and
sleeping issues (Sahed & Chaufton, 2017). Reduced strength antipsychotics are occasionally
prescribed to manage BPSD but create only restricted benefits and are linked with an
augmented risk of stroke and death, in addition to other severe opposing events for example
sedation, extrapyramidal negative impacts, dehydration, falls, chest contaminations and
enhanced cognitive deterioration (Willemse et al., 2016). Patients can be affected with
difficult and occasionally vicious behavior in a variety of healthcare settings. Difficult or
Challenging behavior is distinct as any non-verbal, spoken or bodily behavior which makes it

MH 5
problematic to deliver good care securely. It can comprise grabbing, biting, punching, or self-
harm. The patient might not be conscious of their movements (Lapane et al., 2016). The
aging people are at specific risk for drug-associated adverse events. Elderly patients in
overall, and individuals with dementia in specific, are additionally sensitive to medicine
adverse effects, counting anticholinergic impacts, orthostatic hypotension, increased sedation,
parkinsonism, the tardive dyskinesia, and intellectual impairment compared to younger
individuals with dementia or without dementia (Westbury et al., 2019). They are similarly
particularly prone to falls, and medications that cause sedation, postural hypotension or other
different extrapyramidal symptoms. There are several investigators recommended using other
different therapies like cognitive behavioral therapy with these drugs as there is a lack of
evidence about the efficacy of psychotropic alone top mage behavior and symptoms of
mental health issues. it has been also reported that by applying different lifestyle
modifications one can also avoid the mental health issues and the use of psychotropic drugs
such as performing daily exercises, earing healthy food, and avoid the consumption of
alcohol and drugs (Brett et al., 2017).
Challenges
Nurses are the core member of the health care team assigned to treat a patient with a
mental health issue or other physical problem. Nurses have multiple skills necessary to
provide health care services and develop a healthy environment for the patient. They are
responsible to perform different takes during their shifts such as assessment, medicine
administration, discharge planning, etc. psychiatric nurses are the one who is specialist in
providing mental health serviced to a patient with mental illness. Providing health care
services to a mentally ill person is not easy takes and different nurses reported issues and
challenges while assessing and administrating drugs (Otsuka, Hamahata & Abe, 2020).
According to the national mental health policy, Australia Individuals with mental health

MH 6
difficulties and mental illness possess rights and responsibilities to be knowledgeable about
and involved in the decisions about their treatment. People's rights to evocative community
contributions and to consent to or refuse the treatment must be protected and dignity,
confidentiality, and respect protected (Valdovinos et al., 2017). Following these policy
guidelines become difficult for nurses when providing the psychotropic drug to the patient
with a significant risk of self-harm. The nurse has to receive a filled consent form from the
patient or their family members. In case there is no family member available, it becomes
difficult for them to obtain it (Grace et al., 2015). Most of the patients with increased risk of
self-harm refuse to provide a consent form and do not provide complete support in the
treatment process. involving the patient in the decision-making process about the treatment is
also difficult for nurses as they often refuse it. There is another challenge for nurses that the
patient with an increased risk of self-harm is already depressed and stressed, so there is a
probability that might become dependent or addictive to the drug. Which can be legal and
ethical issues for nurses. Before administrating the drugs to the patient, nurses need to assess
the patient for any allergies or other health issues that can hinder the recovery process
(Shafiekhani, Mirjalili & Vazin, 2018).
To assess the patient nurses are required to develop a therapeutic relationship with the
mentally ill patient and their families, which can be difficult. The researcher conducted
surveys in the nursing department identified that most nurses feel exhausted, angry and
helpless in developing a therapeutic association with the client (Cavanagh & Edelstein,
2017). This is because the patient with an increased risk of self-harm does not take part in the
process and often avoid discussing their problems with the other individuals or staff.
Psychotropic medications are usually administered to elderly patients to manage behavior and
different psychiatric symptoms. Age-associated deviations for example altered absorption,
changed distribution, altered hepatic metabolism, abridged renal excretion, and changed

MH 7
neurophysiology all disturb pharmacokinetics and pharmacodynamics (Kormelinck et al.,
2019). Non-adherence is another major challenge reported by nurses while providing care to
the patient with self-harm risk. Certain psychiatric diseases can also increase the risk for a
person being non-adherent to medicine. the degree of non-adherence to medicine is
uppermost among younger patients diagnosed with schizophrenia, in addition to bipolar
disorder (Schulz, 2019). According to participants of different studies conducted among
nurses, after caring for a mentally ill person and putting energy into serving the patient
recover, the diseased person's relapses can be faced as a "downfall" and can cause a feeling of
insufficiency about endorsing recovery. In place of involving patients in a close relationship,
the nurses attempted to make a borderline between themselves and the mentally ill patient.
While administrating the drug a patient can be aggressive. aggression is the hostile behavior
of mentally ill patient which pose a threat of attack (Nagesh, Kishore & Raveesh, 2016). It is
a larger group of difficult behaviors: non-verbal, spoken or physical movements which make
it problematic to administer drugs to the person. However, effective communication can be a
key to resolving such issues and help nurses to provide the drug safely. it is central to starting
an association with the patient and preventing or calming distress (Shafiekhani, Mirjalili &
Vazin, 2018).
The health care providers must follow the principles of trauma informed care while
administrating sedatives to the patients with mental health issues. There are some trauma
principles associated with trauma informed care such as safety, transparency and
trustworthiness, choice, collaboration and mutuality, and empowerment. Safety includes
creating environment where individuals can feel safe (culturally, emotionally, and physically)
In addition to as an awareness of a person’s discomfort. Transparency principle discusses
about providing the individuals with correct information about their health and treatment.
Another principle is choice which indicate that the healthcare approach must honors an

MH 8
individual’s dignity. Collaboration and mutuality allow the health care workers to develop a
healthy relationship with the client and include them in decision making. Empowerment
allow the health care providers to identify patient’s strength (Hamberger, Barry & Franco, 2019).
Conclusion
Sedative is a medicine that calms a diseased person, easing agitation and allowing
sleep. Sedatives generally work by modulating signals within the central nervous system.
Examples of these drugs include antidepressants, psychoactive drugs, etc. however there are
different oppose the use of sedatives as they cause multiple health issues. psychotropic drugs
affect behavior, mood, thoughts, and awareness of individuals. Some of the psychotropic
drugs like anti-depressants, opioid antagonists are extensively used in different healthcare
settings of Australia and there are several cases of adverse effects have been reported. The
psychotropic drugs were not accepted as a medicine until 1970 in Australia. While
administrating these drugs experience multiple challenges such as aggressive behavior of
patients can harm them, patients refusing the treatment choices, etc. nurses often feel
exhausted and helpless while administrating the drug to the patient with self-harm as they are
not adhering to the treatment. After providing the drug to the patient, there is a possibility that
he or she might develop addiction or dependency issues which may pose ethical issues.
Nurses also reported that the patient often refuses to provide consent form which is necessary
before providing any kind of medication or treatment to the patient. Patients dependent to
these medications must undergo medically administered decontamination as the dose must be
slowly tapered off. Inpatient or the outpatient counseling can benefit the individual
throughout this process. the health care professional must also follow the principles of trauma
informed care such as safety of the patient, transparency, choice in the treatment,
collaboration, and empowerment.

MH 9
References
Brett, J., Karanges, E. A., Daniels, B., Buckley, N. A., Schneider, C., Nassir, A., & Pearson,
S. A. (2017). Psychotropic medication use in Australia, 2007 to 2015: Changes in
annual incidence, prevalence and treatment exposure. Australian & New Zealand
Journal of Psychiatry, 51(10), 990-999.
Cavanagh, C., & Edelstein, B. (2017). Challenging Behavior. Encyclopedia of
Geropsychology.
Ćurković, M., Dodig-Ćurković, K., Petek Erić, A., Kralik, K., & Pivac, N. (2016).
Psychotropic medications in older adults: a review. Psychiatria Danubina, 28(1), 0-
24.
del Carmen Panini, A., Teves, M. R., Giraudo, E., Garraza, M. H., & Calderón, C. P. (2017).
Psychotropic medication use in the elderly. In Psychiatry and Neuroscience Update-
Vol. II (pp. 293-306). Springer, Cham.
del Carmen Panini, A., Teves, M. R., Giraudo, E., Garraza, M. H., & Calderón, C. P. (2017).
Psychotropic medication use in the elderly. In Psychiatry and Neuroscience Update-
Vol. II (pp. 293-306). Springer, Cham.
Ford, A. C., Luthra, P., Tack, J., Boeckxstaens, G. E., Moayyedi, P., & Talley, N. J. (2017).
Efficacy of psychotropic drugs in functional dyspepsia: systematic review and meta-
analysis. Gut, 66(3), 411-420.
Grace, F. C., Meurk, C. S., Head, B. W., Hall, W. D., Carstensen, G., Harris, M. G., &
Whiteford, H. A. (2015). An analysis of policy levers used to implement mental
health reform in Australia 1992-2012. BMC health services research, 15(1), 479.

MH 10
Hamberger, L. K., Barry, C., & Franco, Z. (2019). Implementing trauma-informed care in
primary medical settings: evidence-based rationale and approaches. Journal of
Aggression, Maltreatment & Trauma, 28(4), 425-444.
Karanges, E. A., Stephenson, C. P., & McGregor, I. S. (2014). Longitudinal trends in the
dispensing of psychotropic medications in Australia from 2009–2012: Focus on
children, adolescents, and prescriber specialty. Australian & New Zealand Journal of
Psychiatry, 48(10), 917-931.
Kormelinck, C. M. G., Van Teunenbroek, C. F., Kollen, B. J., Reitsma, M., Gerritsen, D. L.,
Smalbrugge, M., & Zuidema, S. U. (2019). Reducing inappropriate psychotropic drug
use in nursing home residents with dementia: protocol for participatory action
research in a stepped-wedge cluster randomized trial. BMC psychiatry, 19(1), 298.
Lapane, K. L., Hume, A., Ulbricht, C., & Gambassi, G. (2016). Safety of psychotropic drugs
in the elderly. In Pharmacovigilance in Psychiatry (pp. 285-297). Adis, Cham.
Nagesh, H. N., Kishore, M. S., & Raveesh, B. N. (2016). Assessment of adherence to
psychotropic medications in a psychiatric unit of district hospital. National Journal of
Physiology, Pharmacy, and Pharmacology, 6(6), 581.
Otsuka, S., Hamahata, A., & Abe, M. (2020). BPSD and the challenges faced by
nurses. Working with Older People.
Partridge, B., Lucke, J., & Hall, W. (2014). Over-diagnosed and over-treated: a survey of
Australian public attitudes towards the acceptability of drug treatment for depression
and ADHD. BMC psychiatry, 14(1), 74.
Rankin, D. C. (2015). Sedatives and tranquilizers. Veterinary Anesthesia and Analgesia: The
Fifth Edition of Lumb and Jones, 196-206.

MH 11
Sahed, I., & Chaufton, A. (Eds.). (2017). Psychotropic Drugs, Prevention and Harm
Reduction. Elsevier.
Schulz, P. (2019). Opportunities and challenges in psychopharmacology. Dialogues in
clinical neuroscience, 21(2), 119.
Shafiekhani, M., Mirjalili, M., & Vazin, A. (2018). Psychotropic drug therapy in patients in
the intensive care unit–usage, adverse effects, and drug interactions: a
review. Therapeutics and clinical risk management, 14, 1799.
Sheehan, R., Strydom, A., Morant, N., Pappa, E., & Hassiotis, A. (2017). Psychotropic
prescribing in people with intellectual disability and challenging behaviour.
Valdovinos, M. G., Schieber, E., McMahon, M., Beard, L., Wilkinson, A., & Carpenter, J.
(2017). Adverse side effects of psychotropic medication and challenging behavior:
pilot work assessing impact. Journal of developmental and physical
disabilities, 29(6), 969-982.
Wassink, G., Lear, C. A., Gunn, K. C., Dean, J. M., Bennet, L., & Gunn, A. J. (2015, April).
Analgesics, sedatives, anticonvulsant drugs, and the cooled brain. In Seminars in
Fetal and Neonatal Medicine (Vol. 20, No. 2, pp. 109-114). WB Saunders.
Westbury, J., Gee, P., Ling, T., Kitsos, A., & Peterson, G. (2019). More action needed:
Psychotropic prescribing in Australian residential aged care. Australian & New
Zealand Journal of Psychiatry, 53(2), 136-147.
Westbury, J., Gee, P., Ling, T., Kitsos, A., & Peterson, G. (2019). More action needed:
Psychotropic prescribing in Australian residential aged care. Australian & New
Zealand Journal of Psychiatry, 53(2), 136-147.

MH 12
Willemse, B. M., De Jonge, J., Smit, D., Dasselaar, W., Depla, M. F., & Pot, A. M. (2016). Is
an unhealthy work environment in nursing home care for people with dementia
associated with the prescription of psychotropic drugs and physical
restraints?. International psychogeriatrics, 28(6), 983-994.