Literature Review
A thorough review of current research studies related to the question of clinical interest facilitates the process of evidence-based practice validation and the implementation of the project. For this literature review, three articles published in professional journals within the last four years have been identified. The clinical question under discussion is: In individuals with psychotic disorders (including schizophrenia), is the use of two or more antipsychotic medications concurrently more effective than the use of one antipsychotic only? The strengths, weaknesses, and applicability of the studies’ findings will be analyzed and evaluated.
Purpose of Study
The reviewed articles aim at different specific outcomes, all of which are connected to the investigation of patterns in patient outcomes when treating psychoses, including schizophrenia and autism spectrum disorders (ASD) with antipsychotic medications. The study by Wink, Pedapati, Horn, McDougle, and Erickson (2017) targets the identification of the impact of multiple antipsychotics use in patients who are treated for behavioral symptoms of ASD. This research was set at a tertiary care specialty clinic where the effectiveness of the use of several antipsychotic drugs was evaluated as per symptomatic reduction (Wink et al., 2017).
Unlike this article, the study by Castillo and Stroup (2015) aims at a more specific issue of the effectiveness evaluation of long-acting injectable antipsychotics in the treatment of psychotic disorders in comparison to oral antipsychotic medications. The need for such research is validated by the reduced effectiveness of oral drugs due to non-adherence, which might be mitigated with the help of injectable medications (Castillo & Stroup, 2015). The purpose of Castillo and Stroup’s (2015) study is less applicable to the identified clinical question but presents valuable information about the alternative ways of medication intake.
The third article provides the most relevant scope of data due to its precise attention to the issue of polypharmacy in schizophrenia treatment, which is the core element of the clinical question. The purpose of the study by Tesfaye, Debencho, Kisi, and Tareke (2016) is to explore the factors and outcomes of the “frequency of antipsychotic combinations in Amanuel Mental Specialized Hospital” (p. 2). This research most accurately responds to the stated clinical question due to the crucial issues of polypharmacy in comparison to monopharmacy that are considered with high precision.
Methods of Study
The methodology used for the studies contributes to the understanding of how the investigation of the identified issues was conducted and if the findings might be applicable to answering the clinical question. The study by Wink et al. (2017) is longitudinal research that explores the ongoing effects of multiple antipsychotic medication intakes by 1100 patients at the Christian Sarkine Autism Treatment Center located in Indianapolis, IN (Wink et al., 2017). The duration of the study that lasted from July 2004 till April 2012 amplifies the validity of the results and contributes to the applicability of the article to the clinical question investigation. The other two articles provide less duration-oriented data, thus concentrating on the vast presentation of the findings available from different sources.
Indeed, the study by Castillo and Stroup (2015) utilized the method of systematic review and meta-analysis to combine the implications of the vast amount of evidence-based data. These data concern the effectiveness of long-acting injectable antipsychotics on the patients with schizophrenia spectrum disorders (Castillo & Stroup, 2015). Thus, the reference of the study to the findings collected through several decades of antipsychotic drug investigation facilitates the evidential basis of the research. It ensures forming a full picture of the comparative analysis of oral and injectable antipsychotics. Finally, Tesfaye et al. (2016) used a cross-sectional study design at Amanuel Mental Specialized Hospital (AMSH) in Addis Ababa from April to May 2014. The researchers attracted 423 study populations of patients who used several antipsychotics for schizophrenia treatment (Tesfaye et al., 2016). The participants were introduced with pre-tested questionnaires inquiring specific information regarding polypharmacy duration, its impact, and overall outcomes. Thus, the study is of great value for the consideration of possible ways of project implementation for patients with schizophrenia, who are the target population of the clinical question.
Key Findings
The results and overall findings of the analyzed articles are of primary significance due to their immediate factual clinical contribution to the successful implementation of the evidence-based project. The findings of the study by Wink et al. (2017) imply the effectiveness of the combination of two or more antipsychotic medications for patients “diagnosed with autistic disorder and comorbid intellectual disability” (p. 91). Fourteen different types of drugs for psychoses treatment were tested and showed that diverse combinations of two or more medications reduced symptoms and did not cause any adverse effects.
Similarly, the study by Tesfaye et al. (2016) implies positive results of polypharmacy in schizophrenia treatment but demonstrates a more accurate representation of the findings according to patient groups with particular features. For example, patients with a prior history of substance abused were found to be three times more likely to be on antipsychotic polypharmacy (Tesfaye et al., 2016). Also, the study participants who had extrapyramidal side effects were three times more likely to be exposed to using more than one medication. Importantly, the individuals with a long history of treatment by means of monopharmacy demonstrated a higher adherence rate to two or more antipsychotics with ultimate positive symptom reduction results (Tesfaye et al., 2016). The authors of the article validate their findings by comparing the results to those of the prominent US and European studies and claim their consistency with the current research. Therefore, these findings are valuable for clinical question investigation.
As for the article by Castillo and Stroup (2015), their findings imply that no evidence proves the overall effectiveness of injectable antipsychotics in comparison to oral ones. The researchers emphasize the need for patient-specific decision-making regarding the health history, side effects, and preferences of the patients in the choice of antipsychotic drugs (Castillo & Stroup, 2015). However, long-acting injectable medications apply to patients with a high level of relapses and clinical deterioration, as well as non-adherence tendencies. These findings contribute to the understanding of the applicability of particular measures to specific types of patients.
Implications of Nursing Practice
Since psychotic disorders, including schizophrenia, are severe mental issues that adversely affect people’s lives and health quality, it is crucial to eliminate adverse outcomes of the medications and ensure the most effective ways of treatment. The findings of the three reviewed articles provide important evidence-based information concerning the treatment outcomes for mentally ill patients designated within the clinical question. The strengths of the articles are in their articulation of the long-term effects of antipsychotics’ intake in the course of mental illness treatment. Castillo and Stroup’s (2015) article fails to address multiple drugs used simultaneously but justifies the flexibility in the choice of medications in response to patient-specific features. On the other hand, the study by Wink et al. (2017) concentrates on the use of antipsychotics for autism symptoms reduction but succeeds in the validation of positive effects of the combination of several medications. These overall findings might be adjusted to the schizophrenia treatment setting with the allocation of antipsychotics effective for this specific disorder.
The literature review allows for concluding that multiple pharmaceutical interventions provide positive patient outcomes in some specific situations. According to Tesfaye et al. (2016), the patients’ prior incidents of hospitalization, relapses, and the duration of monopharmacy interventions should be precisely considered before prescribing two or more antipsychotics for concurrent use. Therefore, it is important to conduct an analysis of the health history of the patient in treatment, his or her time using one antipsychotic, and the specific features of side effects.
In addition, the patient’s preferences should be taken into account when choosing the type of medications and their combinations. As implied by Castillo and Stroup’s (2015) findings, the experience of the patient in taking specific drugs and their effectiveness is of great importance in psychoses treatment. The resources identified in the articles primarily include medications for psychotic disorder treatment and might be used for the implementation of the treatment plan. The implications of the clinical relevance of the studies might be of general significance for the project due to their specific attention to antipsychotic use. However, the decision-making process will be defined by the patient’s values and preferences with primary concern about the living conditions of the individual and his or her symptomatology.
References
Castillo, G. E., & Stroup, T. S. (2015). Effectiveness of long-acting injectable antipsychotics: a clinical perspective. Evidence Based Mental Health, 18(2), 36-39.
Tesfaye, S., Debencho, N., Kisi, T., & Tareke, M. (2016). Prevalence of antipsychotic polypharmacy and associated factors among outpatients with schizophrenia attending Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. Psychiatry Journal, 6191074, 1-7. Web.
Wink, L. K., Pedapati, E. V., Horn, P. S., McDougle, C. J., & Erickson, C. A. (2017). Multiple antipsychotic medication use in autism spectrum disorder. Journal of Child and Adolescent Psychopharmacology, 27(1), 91-94.