Noncompliance and Lithium

Ensuring that patients are taking their prescribed medication is very important, especially in the world of mental health. For those who fail to properly take their medication, sudden mood shifts and adverse reactions can occur due to suddenly stopping and then re-starting the consumption of a given medication. One of the reasons which some patients choose not to take their medications is a fear of no longer being themselves, according to concepts put forward by Young (2014), who states that often patients feel extreme mood shifts from taking meds. The ability to establish a sense of self is extremely important to everyone, but to patients who are experiencing mental illness it becomes an even higher priority.

The extreme risks associated with some who suddenly stop taking Lithium arise both from a sudden, severe recurrence of symptoms from whatever mental illness they are suffering from, in addition to associated withdrawal symptoms. Often the reason patients wish to stop taking Lithium goes beyond a sense of self however, and translates also to no longer wanting to experience the associated side effects of the drug itself. The aforementioned side effects include dizziness, loss of appetite, abdominal pain, dry mouth, tremors, according to facts provided by Adams et al. (2014) and a litany of other side effects that can occur more rarely.

Rates at which serotonin and other neurotransmitter chemicals are secreted and absorbed in the brain are heavily influenced when a person is taking Lithium, and this should be kept in mind when evaluating the potential consequences of sudden, discontinued use. Discontinued use of Lithium should be overseen by a physician therefore in order to prevent these side effects from impacting patients. When serotonin levels are exceedingly low, there is a high risk for patients to suffer from suicidal thoughts, which provides clear necessity for patients to be supervised by doctors. The ideal situation for a patient who has to suddenly discontinue use of Lithium for any reason is to be residing within a treatment center or other facility where they can be supervised.

Patients who are hospitalized for extended periods of time and eventually take medications such as Lithium for the purposes of stabilization prior to release are at a very high risk for wishing to cease taking meds later on. The reason for this is that many patients might not actually see the necessity in taking medication, and they might be taking medication solely for the purposes of being able to leave the hospital. In a treatment setting, patients often have various decisions made for them by medical professionals, and these decisions include which medications they take.

The degree to which antipsychotics aid a patient in overcoming their mood disorder(s) and other ailments often depends heavily upon the degree to which it inhibits other aspects of their life. First generation antipsychotics include the type referred to as neuroleptics, which cause various side effects such as slowed motor functions, slurred speech, slowed mental processing, and foggy thoughts. Included among neuroleptics is the drug Seroquel, which is often prescribed to patients who are experiencing emotional distress and/or having trouble sleeping, although it is not often prescribed exclusively to address insomnia, according to information provided by the Guzman (2018).

Second generation antipsychotics on the other hand possess significant metabolic side effects rather than mental ones, according to the Psychopharmacology Institute (2018), who states that weight gain is the primary factor of concern in second generation psych meds. Instead of facing the possibility of slowed motor functions and thinking, a patient instead faces significant metabolic and digestive side effects. In both cases there are significant tradeoffs for patients looking for relief from mental disorders, although at least with second generation antipsychotics one can retain their mental prowess.

An example of a second generation antipsychotic or atypical antipsychotic is the drug haldol, which possesses significant emotional calming, behavioral changes, and other attributes, while avoiding the mental/physical slowdown associated with first generation antipsychotics. This drug can be prescribed to persons who are attempting to maintain their role within a given profession, and as a result they wish to use medication(s) that are not going to compromise their effectiveness. The ability to continue to live within a reasonable range of behavior after being treated with antipsychotics is at the core of encouraging a patient to accept their treatment.

If a patient can see that their mental and physical activities are limited by the medications they are taking, they are much more likely to resist and eventually refuse the taking of medication, because they feel like they cannot succeed. When a patient feels trapped by the side effects of a medication, there is a significant chance that they will discontinue the use of medication out of desperation. Second generation psych meds therefore present the patient with an appealing option due to the fact that they do not impede the patient from engaging in the more fulfilling activities life has to offer.

The difference between treating chronic and acute pain pertains to the underlying condition itself, an example of this would be the pulling of a tooth versus the existence of a neurological disorder. After a tooth is pulled there will be severe, acute pain in the area of the body where the tooth is removed, but assuming the affected area heals properly, the pain will stop and the use of meds will not be required perpetually. On the other hand, chronic pain such as what is experienced from a neurological (or other) disorder which is suffered from as the result of a person suffering from pain that is not likely to abate on its own.

A drug that is used to treat acute pain is oxycodone, which is a combination of an opioid and tylenol, used to treat acute pain for a short period of time. The challenge with regard to this medication is that it can be extremely addictive and habit forming, hence short term prescriptions often being utilized. This is a drug which people take when it is believed by medical personnel that the pain will stop in a short period of time, or that it will at least lessen and be easier to manage with over the counter remedies (ibuprofen, etc…).

Addressing the available remedies with regard to chronic pain means looking at the underlying cause of the pain itself in addition to stopping the pain, meaning that if a person is suffering from a muscular disorder for instance, addressing the muscular problem is key. Finding the right medication for cutting back on the negative impact of a given condition requires looking at the condition. In the case of a muscular disorder, the use of a muscle relaxer such as flexeril is not a pain reliever in and of itself, but it cuts back greatly on the degree of pain a given patient might be experiencing through a muscular disorder.

One could definitely treat both acute and chronic pain with opioid-derivative medications, however it is a very irresponsible practice given the high likelihood of addiction in addition to failing to treat the underlying condition (in the case of chronic pain). In cases where chronic pain can only be addressed in part due to having an incurable condition, the sparing use of narcotics such as oxycodone is a last resort. Depending on the condition, the use of other forms of therapy outside of medication such as physical therapy and/or other options allows for a reduction in pain.

References

Adams, M., Holland, N., & Urban, C. (2014). Pharmacology for nurses: A pathophysiologic approach (4th ed.). Upper Saddle River, NJ: Pearson Education Inc. 

National Alliance of Mental Illness. (2012). Lithium.

Guzman, F. (2018). First vs second generation antipsychotics. In Pharmacology Institute. Retrieved from https://psychopharmacologyinstitute.com/antipsychotics-videos/first-second-generation-a

Young, J., MD. (2014). Treatment compliance issues in mentally ill adults. Why do some struggling adults stop taking their medication? Psychology Today.