W1-Prescriptive Practice in Psychiatric Nursing

Post#2 Prescriptive Practice in Psychiatric Nursing by Kathryn Sutherland

In this discussion board post, this author will be comparing the TED Talk on Toward a New Understanding of Mental Illness held by Thomas Insel and the NY Times Article, Mind Over Meds by Danial Carlat. I will be discussing my own viewpoint of psychiatric medication, the advantages and disadvantages of being a psychopharmacologist versus a psychotherapist, and what the research states on integrating the two. I will be utilizing evidence-based sources, in addition to my own experience, to support my ideas.

Insel, a psychiatrist, and neuroscientist, delivered a very powerful message in his TED Talk regarding mental health disorders or as he would say - ‘brain disorders’. Insel described and made the link that early detection and intervention leads to optimal patient outcomes of several life-altering disorders such as leukemia, cardiovascular disease, and AIDS. Insel was alluding to a future of mental health where brain pathophysiology will be so well known that detection and intervention will have a much larger role in treatment. The main takeaway point Insel described with mental health is that the disease begins long before the behavior is often observed. He believes that the sooner debilitating diseases are discovered, such as schizophrenia, bipolar disorder, and borderline personality disorders the sooner treatment can begin and suffering can end (TED, 2013).

In his NY Times Article, Mind Over Meds, Carlat describes the long evolution of psychiatric medication prescribing from the days where psychiatrists would perform therapy with their clients to now the more frequent, 20-minute med management visits. Carlat speaks to the process in which med students are trained: allow the patient to describe their problems, match a diagnosis and prescribe a medication to treat their symptoms. Rarely today, do psychiatrists have training (or are willing) to do both (​​Carlat, 2010). When comparing the TED talk to the NY Times article, both Insel and Carlat attempt to pin mental health conditions on a biological basis that are caused and subsequently “fixed” in the brain. For Insel, he believes detection of neuropathways can do this and for Carlat, he describes the fix is with medication (​​Carlat, 2010; TED, 2013).

In overviewing the learning material for this week, I began to think deeply regarding the use of medication in the promotion of patient well-being. From my own experience working on an inpatient trauma unit and on a residential unit for borderline personality disorder, I think that there is certainly a place for medication and it is used best when in combination with some sort of psychotherapy. Some individuals lack the skills necessary to regulate their emotions to the point where they can begin to engage in therapy or treatment. This can become treatment interfering and subsequently detrimental to progress. In my own opinion, there is certainly a need, for medication when prescribed appropriately. It is also essential to take into consideration each and every factor for each specific care.

In one interesting article, by Hadjipavlou et al., (2015) the authors reviewed the place of psychotherapy in current psychiatric practice. The largest impediment to medication prescribers engaging in psychotherapy today with clients is the time constraint put on them by insurance companies (Hadjipavlou, 2015). As Carlat had described, insurance companies want to pay, lower hourly wages to providers other than MDs for the therapy aspect of patient care. As a result of this time constraint put on by insurance companies, medication prescribers are engaging in therapy less and it is a trend we continue to see today (​​Carlat, 2010).

One of the major advantages of being the sole provider who prescribes only psychopharmacological agents to patients is you get to be the expert in one specific thing. The sole focus is on only treating the symptoms and assessing for progress on this one specific intervention. However, when only prescribing medication, this individual misses being able to learn and treat the entire client. Additionally, it can be problematic if both the therapist and prescriber are not on the same page with treatment. It can also become a hazard as there may be inconsistencies in the patient reports which are influential to treatment. This phenomenon is what is known as split mental health care (Skodol, 2021).

Being able to perform psychotherapy and prescribe meds also comes with its advantages and disadvantages. A disadvantage would be that need to focus both on the ins and outs of therapy and learning the specific tecnqhuies could take away from the focus of the medication prescribing. Personally, I like to talk and get to know my patients. Carlat describes the type of therapy he engages with his clients in as supportive therapy, like talking to a friend and giving encouraging problem-solving suggestions (​​Carlat, 2010). As a future psychiatric mental health nurse practitioner (PMHNP) I cannot imagine myself not being in this type of role in addition to prescribing medication.

Carlat describes the importance and the need for psychotherapy and supports his claims with evidence-based research in the article. This raises the question, should medication prescribers be the ones to perform psychotherapy? Research has shown that there are major communication gaps if there is more than one provider which has led to patient dissatisfaction in care. At the present moment, however, there is no clinical research or rigorous data analyses comparing outcomes of split and integrated mental health treatment (Skodol, 2021). In my opinion, an individual who is both responsible for medication and psychotherapy is in a much better position to understand and address all aspects of the client.

References

​​Carlat, D. (2010, April 23). Mind over Meds (Published 2010). The New York Times - Breaking News, US News, World News and Videos. https://www.nytimes.com/2010/04/25/magazine/25Memoir-t.html

Hadjipavlou, G., Hernandez, C. A., & Ogrodniczuk, J. S. (2015). Psychotherapy in Contemporary Psychiatric Practice. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 60(6), 294–300. https://doi.org/10.1177/070674371506000609

Skodol, A. (2021, August). Collaboration between prescribing physicians and psychotherapists in mental health care. UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/collaboration-between-prescribing-physicians-and-psychotherapists-in-mental-health-care?search=Collaboration%20between%20prescribing%20physicians%20and%20psychoth

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TED. (2013, April 16). Thomas Insel: Toward a new understanding of mental illness [Video]. YouTube. https://www.youtube.com/watch?v=PeZ-U0pj9LI