CMA 8 student's response

QUESTION: As a PMH-APRN, you may have clients who use integrative therapies in conjunction with the conventional therapies prescribed by the health care provider. Identify issues that are important to assess, and discuss how you would ask about the use of these non-conventional practices.

Posts are a minimum of 250 words, scholarly written, APA formatted (with some exceptions due to limitations in the D2L editor), and a minimum of 2 references (which may include the course textbook). Reply to at least one classmate's initial discussion post by Friday at 11:59 PM ET.

STUDENT’S POST:

As a future psychiatric-mental health advanced practice registered nurse (PMH-APRN), I would assess a client’s use of integrative therapies as part of a complete medication and health history. Important information includes the type of therapy or product used, the reason for using it, the dose or frequency, the duration of use, the source of the product, and the qualifications of any practitioner involved. I would also ask about perceived benefits, adverse effects, and whether the client has changed or stopped a prescribed medication or psychotherapy because of the nonconventional practice. Supplements and herbal products require particular caution because “natural” does not mean risk-free, product potency and purity may vary, and some ingredients can alter the effects or metabolism of psychiatric medications. For example, St. John’s wort may increase serotonin-related effects when combined with antidepressants and may alter medication concentrations by inducing drug-metabolizing enzymes.

 Similarly, ginkgo biloba may increase bleeding risk when combined with selective serotonin reuptake inhibitors or other medications that affect clotting, so I would assess for unusual bruising, nosebleeds, or gastrointestinal bleeding and consult the prescriber before continued use (Souza-Peres et al., 2023). Valerian, kava, melatonin, and other products with sedating properties may increase drowsiness, impaired coordination, or respiratory risk when used with benzodiazepines, sleep medications, sedating antipsychotics, alcohol, or opioids. Products marketed for energy, weight loss, or mood enhancement may contain stimulating ingredients that worsen anxiety, insomnia, agitation, mania, psychosis, blood pressure, or heart rate. Therefore, I would specifically assess the complete ingredient list, brand, dose, frequency, and timing of every vitamin, mineral, botanical, tea, tincture, gummy, powder, or over-the-counter product and consult a pharmacist or reliable interaction resource before recommending continued use. Additional concerns include possible interactions with psychotropic medications, additive sedation, changes in mood or cognition, effects on liver or kidney function, product contamination, inaccurate labeling, and risks related to pregnancy, medical conditions, substance use, mania, psychosis, or suicidal thoughts (Souza-Peres et al., 2023).

I would ask about integrative therapies in a respectful and nonjudgmental manner because clients may not disclose their use if they expect criticism. I might begin by normalizing the discussion: “Many people use herbs, vitamins, meditation, acupuncture, cannabis-derived products, spiritual healing, or other approaches along with prescribed treatment. What practices or products do you use to support your health?” I would then ask open-ended follow-up questions, such as, “What do you use it for?” “What benefits or unwanted effects have you noticed?” “How often do you use it?” and “Who recommended it?” I would invite the client to bring the product or a photograph of its label to the next appointment so that the ingredients can be reviewed. This approach respects the client’s cultural values and autonomy while allowing me to identify safety concerns (Balneaves et al., 2021).

If I identify a concern, I would explain the specific risk rather than dismiss the practice. For example, I could say, “I understand that improving your sleep is important to you. Let us review this product together to determine whether it can be used safely with your medications.” I would use shared decision-making to consider safer options, appropriate monitoring, and the client’s treatment goals (Thomas et al., 2021). With the client’s consent, I would also coordinate care with the prescribing clinician, primary care provider, pharmacist, and integrative practitioner. I would document the therapy, education provided, the client’s response, and the follow-up plan. Overall, routine and culturally responsive assessment helps preserve the therapeutic relationship while promoting safe, coordinated psychiatric care.

References

Balneaves, L. G., Watling, C. Z., Hayward, E. N., Ross, B., Taylor-Brown, J., Porcino, A., & Truant, T. L. O. (2022). Addressing complementary and alternative medicine use among individuals with cancer: An integrative review and clinical practice guideline. Journal of the National Cancer Institute, 114(1), 25–37. https://doi.org/10.1093/jnci/djab048

Souza-Peres, J. V., Flores, K., Umloff, B., Heinan, M., Herscu, P., & Babos, M. B. (2023). Everyday evaluation of herb/dietary supplement–drug interaction: A pilot study. Medicines, 10(3), Article 20. https://doi.org/10.3390/medicines10030020

Thomas, E. C., Ben-David, S., Treichler, E., Roth, S., Dixon, L. B., Salzer, M., & Zisman-Ilani, Y. (2021). A systematic review of shared decision-making interventions for service users with serious mental illnesses: State of the science and future directions. Psychiatric Services, 72(11), 1288–1300. https://doi.org/10.1176/appi.ps.202000429