Psychotropic Medications: Controversies and Nursing Challenges

This essay critically examines the controversies surrounding the use of psychotropic medications, particularly focusing on sedatives, and the challenges registered nurses encounter in their administration within a mental health context. The essay begins by defining psychotropic medications and their therapeutic applications, including analgesics, antipsychotics, and stimulants, while highlighting their impact on mood, perception, and behavior. It then delves into the controversies associated with these medications, such as sedative dependence, paradoxical reactions, and combined drug intoxication, emphasizing the risks of misuse, overdose, and long-term health consequences. The essay further addresses the nursing challenges in administering these medications, particularly within the context of recovery-oriented practice, patient safety, and the need for effective communication. It explores the importance of recognizing patient uniqueness, promoting informed decision-making, and managing issues like patient aggression, inefficient organizational policies, and chemical coping. The essay concludes by summarizing the key issues, emphasizing the need for nurses to balance therapeutic benefits with patient safety and ethical considerations.

Running head: HEALTHCARE
NRSG263 Principles of Nursing: Mental Health
Name of the Student
Name of the University
Author Note

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Introduction- Also referred to as psychopharmaceutical drug or psychoactive
drug, psychotropic medications are chemical substances that are responsible for triggering
alterations in the function of the brain, subsequently leading to variations in mood, perception,
cognition, behaviour or consciousness. These medications might be used recreationally or
medically, with the aim of enhancing performance or altering the consciousness, of a particular
individual (Hagen & Tushingham, 2019). They are often used in the form of entheogens for
spiritual, shamanic, or ritual purpose. Particular categories of psychotropic medications that have
therapeutic values comprise of analgesics and aesthetics, antiparkinsonian drugs, and
anticonvulsant drugs, in addition to medications that are used for the treatment of
neuropsychiatric disorders like antipsychotics, stimulants, anxiolytics and antidepressants
(Aixalá et al., 2019).
Sedative medication acts in the form of a central nervous system depressant, and directly
interacts with the activity of the brain, thereby leading to its deceleration. There are different
types of sedative drugs available; however, the majority of them create an impact on the gamma
aminobutyric neurotransmitter (GABA), which is primarily responsible for initiating
communication between the neurons (Brohan & Goudra, 2017). This essay will critically discuss
the controversy associated with uses of psychotropic medications, and the challenges that
registered nurses have to encounter while administering them.
Controversy associated with the use of psychotropic medication- General anaesthetics
are a type of psychotropic medications that are used for providing relief from pain, by reducing
consciousness, thereby allowing the affected person to be subjected to medical procedure like
operations, without any emotional trauma or physical pain. The subjective experience of pain is
predominantly controlled by endogenous opioid peptides (Patrick, Cooper & Davis, 2017).

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Psychoactive medications have also been found effective for the treatment of borderline
personality disorder, depression, anxiety, and eating disorder. While stimulants have been found
beneficial in the treatment of attention deficit hyperactivity disorder (ADHD), antipsychotics and
mood stabilizers have proven beneficial for the effective management of affective disorder,
bipolar disorder, or severe mania (Furu et al., 2017; Vieta, Arango & Rush, 2018). Sedatives
particularly act by altering communications in the central nervous system, by this means relaxing
the human body by decreasing brain activity. By bringing about an augmentation in their activity
in the central nervous system, these drugs facilitate the GABA neurotransmitter to exert a
stronger impact on the brain. The increased usage of sedative like xanax, valium, and temazepam
has been identified as a matter of great concern all across the nation.
Commonly used sedatives comprise of Phenobarbital, phenobarbital sodium, zolpidem,
hydrocodone, and oxycodone. However, there are several controversies associated with the use
of these medications. Sedative dependence is the primary risk. There are particular classes of
sedatives that bring about physical and psychological dependence of the consumer, when they
are consumed over a prolonged period, at therapeutic dosage. The dependent users who are
continuously subjected to these sedatives gradually demonstrate withdrawal symptoms that range
from insomnia to restlessness to conversations and even death, when not administered in
prescribed amounts (Arunogiri & Lubman, 2016). During psychological dependence the patients
require the drug for their basic functioning, and purchasing and consuming the sedative becomes
the main focus of their lives.
When consumed for recreational purpose, sedative hypnotics have been found to induce
euphoria, subsequently altering the impact of other drugs, however, and its long-term use results
in significant health problems. The most serious adverse effects comprise of drowsiness, poor

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memory, stupor, and psychomotor slowing (Milhorn, 2018). Several psychotropic medications,
particularly benzodiazepines or barbiturates are accountable for majority of the problems with
sedative misuse, owing to their widespread non-medical and recreational usage. Individuals face
difficulty dealing with anxiety, sleeplessness, or stress and become dependent on these drugs.
In addition, particular heroine users also consume them either for supplementing the drug
or as a substitute. Barbiturate overdose has been identified as a significant factor in an estimated
one third of all reported drug associated deaths, which commonly include accidental drug
poisoning and suicide (Suddock & Cain, 2018). Over the long-term, sedative dependence also
results in signs of depression, suicidal ideations, psychosis, seizure, and hypersensitivity.
Research evidences highlight that 51.2% drug-related overdose death in Australia from 2009-14
were directly associated to the use of benzodiazepine, either alone or when combined with other
drugs. Particularly alprazolam and benzodiazepines that have received approval for short-term
management of panic disorder or anxiety have also been implicated in all those drug-related
deaths (Arunogiri & Lubman, 2016).
Severe paradoxical reactions also act in combination with the consumption of sedatives
that result in unexpected health impacts in some people. The paradoxical reactions commonly
comprise of depression, phobia, and aggressiveness with or without suicide ideation and violent
behaviour, in addition to conditions that are frequently misdiagnosed in the form of psychosis
(Lee et al., 2019). In addition, according to the Australian Bureau of Statistics, benzodiazepines
were found to be the most prevalent single substance in overdose, much more than codeine,
fentanyl, and oxycodone. As much as 6 million scripts for this antianxiety medication had been
handed out to the public through Pharmaceutical Benefit Scheme (PBS), excluding private and
hospital scripts, thus highlighting the prevalent usage (Morris, 2019).

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Another controversy is associated with combined drug intoxication, commonly referred
to as multiple drug intakes that leads to death due to polydrug use, or drug overdose often
implicated in cases of polysubstance dependence. Alcohol and sedatives are at times used in
combination for recreational purpose. Taking into consideration the fact that alcohol acts in the
form of a strong depressant, it decreases brain function and leads to respiration suppression
(Boyd et al., 2017). Therefore, a combination of the two substances proves fatal. The long-term
impacts of these medications exert similar consequences on the human brain like alcohol, and
have also been implicated in anxiety, post-traumatic stress disorder, depression, psychosis,
mania, sleep disorder, delirium, neurocognitive disorders, and sexual dysfunction. The
medications are responsible for decreasing the level of neurotransmitters norepinephrine and
serotonin in the brain, thereby affecting fretfulness and mood.
While drugs like benzodiazepines have been found to induce sleep in individuals, when a
person is asleep they disrupt the sleep architecture, by this means decreasing sleep time, and
delaying REM sleep (Manconi et al., 2017). Supplementary evidences have also highlighted that
administration of hypnotics and sedatives must be avoided in individuals diagnosed with
dementia, since they impede the cognitive function. In addition, sedatives have also been found
to be used in the form of date rape drugs. These are administered to guests at different social
gatherings or gullible patrons in bars, with the aim of decreasing the defence of the intended
victims (Donovan, 2016). Hence, it can be stated that there are several controversies associated
with the use of psychotropic medications, particularly sedatives.
Nursing challenges- The major principles of recovery oriented practice in mental health
are pertinent to the national standards. Taking into consideration the perspective of a person
suffering from mental illness, recovery defines obtaining and retaining hope, while

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understanding one's disabilities and strength, increasing participation in active lifestyle,
promoting social identity, personal autonomy, a positive sense of self, and the meaning of life
(Department of Health, 2010). While delivering care to patients suffering from mental illness,
registered nurses are expected to identify uniqueness of each individual, besides empowering
them such that they a are able to make decisions regarding their life choices. Registered nurses
are accountable for learning from and listening to the patients, in addition to protecting their
citizenship, legal, and individual rights.
Not only do they have to support patients in developing and maintaining occupational,
recreational, and vocational activities, but are also expected to remain courteous and respectful
under all situations. Recovery oriented practice is largely dependent on effective communication
with the patients and also requires revaluation of progress at different levels. Within the
contemporary psychiatric inpatient environment, patient safety has been identified as the
cornerstone of nursing care (Department of Health, 2010). Therefore, nurses have the duty to
provide flexible and individualized care, such that it follows all safety measures, in order to
ensure that the care plan poses no health risk to the patients. Nurses have to time and again
administer psychotropic medications for the management of mental illnesses like bipolar
disorder, schizophrenia, depression, and anxiety.
Suicide prevention and risk assessment are central elements of upholding patient safety in
psychiatric care. Not only is the risk of suicide among patients associated with demographic
factors, but also with the overdose of psychotropic medications and sedative dependence amid
the patients. In the absence of definite risk identifiers, the nurses have to constantly monitor the
patients, in relation to their symptoms. This can be accredited to the fact that suicidal tendency
observed amongst patients due to the overdose a psychotropic medication or their previous

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dependence not only threatens health risk of the former, but also takes a toll on the professional
advancement of the nursing practitioners (Sun et al., 2019). Several patients report satisfaction
with the therapeutic impacts of psychotropic medications, since they produce a relaxing effect.
However, nurses face particular challenges when the patients have mixed beliefs regarding the
efficacy of psychotropic medication. It is commonly observed that patients expect instant relief
to their suffering through the administration of the medications, and not observing immediate
changes they demonstrate a less likelihood of showing adherence to the (di Giacomo et al.,
2020). Despite the fact that psychotropic medications is identified as a good booster and induces
sleep in most patients suffering from psychiatric disorders, the nurses always have to maintain a
constant vigilance, to ensure that the medication is not leading to unconsciousness or death of the
patient.
Patients often pose a significant risk of harm to the nursing professionals owing to the
mental illness that they suffer from, in addition to the social and physical environment, and their
interaction with others. Therefore, while administering psychotropic medications, patient
aggression is a domain that the nurse must provide attention, since it is directly associated with
health and safety of both the patient as well as the caregiver (Sherman & Hooker,
2018). However, this needs to be done while maintaining patient dignity and privacy. Under the
circumstances when the nurses are not able to implement the principles of recovery oriented
practice, they demonstrate a failure in averting aggressive incident, which in turn decreases their
capability to address the mental health condition that the patients suffer from.
While administering psychotropic medications, nurses over and over again report about
inefficient organisation policies such as, limited human resource, which in turn slows down the
treatment process, by this means making the patients become aggressive. Poor understanding and

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health literacy amongst family members of patients regarding the medications pose additional
challenges in shared decision making (Sherman & Hooker, 2018). Lack of safe accessories,
absence of non-standard rooms, and non existence of alarms or warning bells make it difficult for
the nurses to inform other healthcare professionals, under circumstances when the psychotropic
medications create unintended effects on the mental strength of the patient.
Nurses often have to encounter particular patients who consume controlled substances
that are generally prescribed for specific mental conditions, in order to obtain other health
benefits like relief from stressful life circumstances, obtaining additional energy or elevating
mood under depressing conditions. Such behaviour demonstrated by patients is also known as
chemical coping, and those who engage in this behaviour repeatedly develop tolerance to the
therapeutic impact, for which the drug had been prescribed, in so doing resulting in dose
escalation (Dev et al., 2019). Furthermore, nurses also encounter challenges in relation to
intentional malingering that encompasses exaggeration of symptoms, resisting access to medical
records, violent behaviour when the prescribed medication dose needs to be decreased, and poor
compliance with the treatment or diagnostic recommendations, thus resulting in conflicts and
disputes with the patient and family members. Furthermore, sudden cessation of the medication
leads to withdrawal symptoms amid patients, and often threatens their emotional wellbeing.
Conclusion- Thus, it can be concluded that, all nursing professionals are entitled with the
responsibility of applying their capabilities and skills for supporting patients suffering from
mental illness, in order to identify and take accountability for own wellbeing and recovery, while
defining their wishes, aspirations, and goals. Sedative tranquilizer typically refers to a
psychotropic medication that decreases excitement or irritability, thereby inducing sedition in a
person. Psychotropic medications are widespread due to their capability of creating an impact on

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emotions, mind, and behaviour. Though there are a range of psychotropic drugs that are used for
the treatment of different mental disorders, they are associated with several controversies. More
than a few instances have been encountered where overdose of these medications have resulted
in sedative dependence, loss of consciousness, or even death of the consumers. In addition, they
are also used for criminal activities. Therefore, while administering psychotropic medications to
patients who pose risk to self or to the health care providers, nursing professionals have to come
across quite a few challenges.

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