Psychtropic Drugs - Restrictive and coercive practices in mental health care

Running head: PSYCHTROPIC DRUGS
Restrictive and coercive practices in mental health care
Name of the Student:
Name of the University:
Author Note:

PSYCHTROPIC DRUGS1
Introduction
According to Muir-Cochrane & Gerace (2017), psychotropic drugs such as sedatives to
control the behavioral symptoms is a subject of debate and has been argued as a coercive
approach with severe ill-effects on the patient. Sedatives are one of the five groups of
psychotropic drugs that reduce the functioning of the brain and make the person feel relaxed.
They are widely prescribed by healthcare professionals for anxiety disorders. These
tranquilizers suppress the central nervous system (CNS) and are also termed as CNS
depressants (Allison & Moncrieff, 2014). At significant doses, these drugs may be associated
with adverse effects such as slow reflexes, slurred speech and staggering gait. Moreover, the
administration of these drugs for prolonged periods has demonstrated the dependency of the
patients on these medications. However, sedatives and tranquilizers are critical medications
for the treatment of maximum mental disorders (Innes & Sethi, 2013). Due to these reasons,
the use of sedatives for mental health treatment faces worldwide controversy. This essay
critically argues the use of sedatives to control behaviors with relevant evidence, its impact
and the challenges faced by registered nurses to administer these medications to the
consumers with mental health disorders posing significant self-harm and to others as well.
Discussion
Sedatives in pharmacological management
Psychotropic medications are known to be useful options for the management of behavioral
symptoms, specifically, if the observed behavior is of a psychiatric origin such as psychosis
or in cases where the behavior puts the patient or others around them at high immediate risk.
According to the guidelines of NICE, patients or their caregivers may have the right to make
informed decisions related to their care. However, if someone lacks the minimum capacity to

PSYCHTROPIC DRUGS2
make proper decisions, the safeguards stated in the Mental Capacity Act 2005 have to be
followed. Irrespective of the route chosen, the medication should have a rapid onset of action,
exhibiting an effect that lasts for only a few hours. The term ‘rapid tranquillization’ is used
by NICE to define medicines used parenterally to decrease the risk of harm and for
minimizing aggression and violence (Nice.org.uk, 2020). These medications are commonly
called the sedatives and are administered intramuscularly. The most prescribed drugs include
benzodiazepine lorazepam and the usual antipsychotic haloperidol, and both of these drugs
have clear evidence demonstrating efficacy. Theoretically, Benzodiazepines can cause
significant sedation and may result in respiratory depression, which may be reversed by
intravenous flumazenil (Calver et al., 2010). Lorazepam, on the other hand, is short-acting
with extremely unlikely respiratory depression on prescribed doses. Thus, Lorazepam is
considered a safer first-line drug in comparison to the other, longer-acting, benzodiazepines,
such as diazepam (Rahimi et al., 2016). It is expected that the use of psychotropic sedative
medication reduces the adverse behavioral symptoms such as agitation and will considerably
decrease after the patients move into the community.
Impact of sedative medications
The clinical consequences of patients acutely intoxicated with sedatives are similar to those
of alcohol intoxication. Psychiatric features involve disturbed attention, labile mood,
inappropriate behavior, and impaired judgment. Physical symptoms are decreased reflexes,
nystagmus, and unsteady gait. As the dosage increases, specifically beyond the developed
tolerance of the patient, progressively more dysfunctions can be observed in judgment and
brain functioning (Schumacher et al., 2017). It is also stated that the prolonged use of
sedatives like benzodiazepines may worsen underlying depression and anxiety. Another study
demonstrated that benzodiazepines accounted for about 30% of deaths caused by
pharmaceutical agents, and 75% of overdose-induced deaths were unintentional. A common

PSYCHTROPIC DRUGS3
adverse effect associated with sedatives is the dependency on the drug, followed by
withdrawal symptoms. It is argued that the unconsented/consented use sedatives to manage
agitation can lead to addiction to the drug wherein the individual fails to function normally
without the drug. This addiction or dependency is believed to end with withdrawal
symptoms, which forms a significant point of the controversy along with the coercive nature
of the practice (Ries et al., 2014).
There is a growing public concern regarding the use of sedatives and psychotropic drugs in
patients for the management of problem behavior. Some of the probable reasons for this
increasing concern include poly-pharmacy and the use of higher doses than recommended of
antipsychotics, prolonged use without regular reviews, associated ill-effects which could
cause severe harm, and inappropriate concomitant intake of drugs to counter ill-effects and
the practices of administering these drugs as highly coercive (Iaboni et al., 2016; Cross et al.,
2016. The proposed benefits along with the associated side-effects and coercive nature of
these practices, are the fundamental basis of the controversy regarding the use of sedative
medications.
Government regulations
The government regulates the systematic and safe method of administering acute sedation
when de-escalation of behavioral symptoms has been unsuccessful. This ct indicates that
acute sedation can be a clinically appropriate treatment approach when consumers exhibit
extreme agitation, threaten violence, are violent in reality and pose considerable danger to
themselves or others. Acute sedatives must only be prescribed after attempting to manage the
behavioral disturbances with de-escalation methods and oral medication has been
unsuccessful (Health.nsw.gov.au, 2020). The objectives of the managing acute behavioral,
psychiatric emergencies include to calm the person and thereby managing extreme aggression