Introduction
Effective measures to address negative and positive symptoms in psychiatric patients with treatment-resistant schizophrenia (TRS) are an important issue in mental health nursing. TRS is characterized by the absence of adequate symptom-related responses to at least two first-line non-clozapine antipsychotic medications (Kane et al., 2019). Being associated with the persistence of diverse symptoms, including delusions, hallucinations, and psychosis, resistance to appropriately administered antipsychotics complicates the disorder’s course, resulting in patients’ suffering and psychiatric nurses’ risks of facing patient aggression. This paper discusses advancements in the identified problem by summarizing one quantitative study devoted to clozapine’s effects on TRS patients.
Summary
Sample and Data Sources
In their study published in the Nordic Journal of Psychiatry, Verma et al. (2020) explore the effects of clozapine, the most well-known atypical antipsychotic agent, on adult TRS patients’ perceived life quality, social and other types of functioning, and disability levels. The sample was comprised of 52 patients with TRS served by a multi-professional tertiary referral center in India (Verma et al., 2020). The inclusion criteria were the confirmed diagnosis of schizophrenia as per DSM-IV, TRS diagnosed as per Kane’s criteria, age between 18 and 65, receiving no clozapine therapy, and the absence of comorbid conditions, including intellectual/developmental disabilities, addiction disorders, and organic mental syndrome (Verma et al., 2020). Regarding data sources, Verma et al. (2020) collected patients’ baseline and post-intervention scores, using more than ten psychiatric assessment tools, including the Functioning Assessment Short Test and the Indian Disability Evaluation Scale. Some scales developed specifically for schizophrenic patients were applied as well.
Inferential Statistics’ Usage and Findings
The researchers used one type of the t-test to make inferences regarding clozapine’s ability to promote health improvement and independence in individuals with TRS within a three-month time frame. Having collected each participant’s scores on all scales prior to and twelve weeks after the start of clozapine therapy (doses had been chosen by patients’ primary psychiatrists individually), Verma et al. (2020) implemented the paired t-test to determine the presence of differences between the two sets of observations. Correlated or paired t-tests are commonly performed to evaluate hypotheses by drawing comparisons between repeated observations or multiple tests conducted in one research subject (LoBiondo-Wood et al., 2019). Using the selected inferential statistic, Verma et al. (2020) calculated paired t-test values, such as t-scores and z-scores, for all assessment tools and each scale’s dimensions. The analysis of the scores produced multiple findings regarding the effects of clozapine therapy, such as significant increases in patient-perceived life quality, functioning, and cognitive insight and reductions in four psychopathology dimensions, disease severity, and the manifestations of compulsions.
The Study’s Purpose
The selected study aimed to expand the existing knowledge regarding the uses of clozapine in adult inpatient and outpatient populations with schizophrenia that display insufficient responses to common non-clozapine pharmaceutical treatment options. More specifically, its purpose was to provide further support for the idea of clozapine as the best therapy agent for individuals with TRS by addressing the remaining knowledge gaps regarding the drug’s influences on functioning levels, disability levels, and life quality in that population (Verma et al., 2020). The study achieved its purpose by producing evidence-based takeaways linked to the aforementioned points.
The Study’s Value to the Topic
The study is valuable in terms of addressing the issue of caring for individuals with TRS and determining medication administration practices that would stabilize such patients’ mental condition without serious adverse effects. On the one hand, it demonstrates clozapine therapy’s ability to improve these individuals’ functioning and independence while addressing both positive and negative psychopathology and promoting increases in patient-reported life quality (Verma et al., 2020). On the other hand, the study offers statistics on the drug’s common side-effects, including obstructed defecation, increases in BMI and blood pressure, and waist circumference growth, and relatively rare adverse outcomes, such as metabolic syndrome and elevated HDL cholesterol levels (Verma et al., 2020). Therefore, the source could be used to evaluate the pros and cons of clozapine administration in TRS patients depending on an individual’s anamnesis and different symptoms’ severity.
Inferential Statistics and the Study’s Application to EBP
The use of inferential statistics definitely strengthens the article’s application to mental healthcare EBP. Paired t-tests’ ability to give rise to high-quality predictions explains their relevance to nursing EBP (Doucette, 2017; LoBiondo-Wood et al., 2019). As opposed to descriptive statistics, inferential ones provided the researchers with assistance in producing clinically meaningful takeaways regarding clozapine’s most likely effects in the general population with TRS. The use of the paired t-test for every individual clinical parameter helped to evaluate the drug’s impacts on the scores separately, which can support the evidence-based selection of treatment options in TRS depending on the most bothersome symptoms (Verma et al., 2020). Notably, the researchers’ conclusions regarding clozapine in TRS are consistent with recommendations in the updated version of the American Psychiatric Association’s (2021) schizophrenia management guideline. Aside from the paired t-test, the researchers calculated unpaired t-values to exclude the risks of drastic socio-demographic differences between those who did and did not complete the three-month therapy (Verma et al., 2020). Thus, inferential tests supported the project’s EBP-related potential by shedding light on the sample’s representativeness of the general population diagnosed with TRS.
Conclusion
Finally, the reviewed article uses the paired sample t-test to expand the knowledge base regarding clozapine’s role in addressing practice issues peculiar to caring for psychiatric patients with TRS. The dependent sample t-test supported the assessment of individual changes associated with clozapine administration, whereas the unpaired t-test helped to guarantee the findings’ transferability. Apart from that, the study’s value for the practice problem refers to its success in addressing persistent knowledge gaps.
References
American Psychiatric Association. (2021). The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia (3rd ed.). APA Publishing.
Doucette, L. (2017). Quantitative methods and inferential statistics: Capacity and development for librarians. Evidence-Based Library and Information Practice, 12(2), 53-58.
Kane, J. M., Agid, O., Baldwin, M. L., Howes, O., Lindenmayer, J. P., Marder, S., Olfson, M., Potkin, S. G., & Correll, C. U. (2019). Clinical guidance on the identification and management of treatment-resistant schizophrenia. The Journal of Clinical Psychiatry, 80(2), e1-e9.
LoBiondo-Wood, G., Haber, J., & Titler, M. G. (2019). Evidence-based practice for nursing and healthcare quality improvement. Elsevier.
Verma, M., Grover, S., & Chakrabarti, S. (2020). Effectiveness of clozapine on quality of life and functioning in patients with treatment-resistant schizophrenia. Nordic Journal of Psychiatry, 1–10.