Thanks to visit codestin.com
Credit goes to www.scribd.com

0% found this document useful (0 votes)
30 views4 pages

Week 2 Problem Identification

Uploaded by

emolotnickson
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
0% found this document useful (0 votes)
30 views4 pages

Week 2 Problem Identification

Uploaded by

emolotnickson
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 4

Running Head: WEEK 1

Week 2 Problem Identification

Student’s Name

Institutional Affiliation
WEEK 2

Week 2 Problem Identification

Problem Statement

Mental illness has been on the rise in the US. It is estimated that nearly one in five US

adults lives with a mental illness (NIMH, 2021). While hospitals have adopted a wide range of

modalities such as psychotherapy, one or more psychotropic medications are prescribed for the

management of mentally ill persons. The use of psychotropic drugs also extends to the elderly

especially among those with dementia. Psychotropic drugs are largely prescribed for problems

with emotions, nerves of mental health. Omnibus Budget Reconciliation Act (OBRA) of 1987

restricted the use of psychotropic medications in residents with long-term care facilities. In 2006.

Center for Medicare and Medicaid Services (CMS) published a guideline on the use of

psychotropic drug therapy outlining specific conditions and noting that the lowest possible dose

should be administered for the shortest period and continually undergo gradual dose reduction.

The goal of GDR is to ensure that patients are free from the unnecessary use of psychotropic

drugs. It also ensures that the use of the drugs is based on the appropriate differential diagnosis

of current behavioral symptoms. However, there is limited research and publication that prohibit

or restrict GDR in some circumstances. This paper thus seeks to answer the research question:

1. For mentally ill persons and the elderly, what risk factors can lead to a relapse after

GDR?

Literature Review

Most healthcare guidelines in the US recommend gradual dose reduction when tapering

to minimize withdrawal symptoms. The CDC recommends a rate of 10 percent per week.

Enough literature seems to agree that this rate of dose reduction is well tolerated by patients who

are tapering their psychotropic drugs. However, a study by Berna et al. (2015) which reviewed
WEEK 3

117 peer-reviewed articles noted that there is limited evidence regarding optimal dose reduction

rates in other clinical settings. Darnall et al. (2018) in a community of experts revealed that

anecdotal reports indicated that patients using long-term opioids were being forced to taper their

dose involuntary. The experts also raised issues with mandated opioid tapers that required

aggressive opioid reduction reductions over a defined period even when that period was an

extended one.

Several studies have also pointed out GDR is not suitable in some situations. Tjia et al.

(2015) noted that abrupt discontinuation or significant dose reduction of psychotropic

medications can cause physiological withdrawal symptoms including disruptive behaviors,

insomnia, nausea, and restlessness. However, the study on Tjia et al. (2005) examined abrupt

discontinuation of dosage among patients receiving high doses for long-duration rather than

those undergoing gradual dose reduction. The authors however noted a need to recognize the

withdrawal symptoms and other negative clinical outcomes when initiating dose reduction. The

findings by Tjia et al. (2019) are supported by Dowell et al. (2019) whose study noted that rapid

dose tapering among physically dependent patients was not recommended since it was associated

with serious withdrawal symptoms, psychological distress, uncontrolled pain, and suicide.

However, the study was concerned with rapid discontinuation. It thus follows that there is a need

to examine the impact of gradual dose reduction among patients under psychotropic medications.

Taking into consideration the recommendation against rapid and abrupt dose reduction, there is a

need to examine under what circumstance GDR is contraindicated even when following

standards and the symptoms that may show up.


WEEK 4

References

Berna, C., Kulich, R. J., & Rathmell, J. P. (2015). Tapering long-term opioid therapy in chronic

Noncancer pain. Mayo Clinic Proceedings, 90(6), 828-

842. https://doi.org/10.1016/j.mayocp.2015.04.003

Darnall, B. D., Juurlink, D., Kerns, R. D., Mackey, S., Dorsten, B. V., & Humphreys, K. (2018).

International Stakeholder Community of Pain Experts and Leaders Call for an Urgent

Action on Forced Opioid Tapering. Pain Medicine, 20(3), 429-433.

https://doi.org/10.1093/pm/pny228

Dowell, D., Haegerich, T., & Chou, R. (2019). No shortcuts to safer opioid prescribing. New

England Journal of Medicine, 380(24), 2285-

2287. https://doi.org/10.1056/nejmp1904190

NIMH. (2021, January). Mental Illness. National Institute of Mental

Health. https://www.nimh.nih.gov/health/statistics/mental-illness

Tjia, J., Reidenberg, M. M., Hunnicutt, J. N., Paice, K., Donovan, J. L., Kanaan, A.,

Briesacher, B. A., & Lapane, K. L. (2015). Approaches to gradual dose reduction of

chronic off-label antipsychotics used for behavioral and psychological symptoms of

dementia. The Consultant Pharmacist, 30(10), 599-

611. https://doi.org/10.4140/tcp.n.2015.599

You might also like