A Study to Assess the Knowledge Regarding Adverse Effects of Selected Antipsychotic Drugs among the Caregivers of Patients Receiving Antipsychotic Drugs

 

Ms. Sheela S. Ranbhise, Mr. Ashok M. Kamat

Assistant Professor, K.L.E. University’s Institute of Nursing Sciences, Belgaum, Karnataka.

 

ABSTRACT:

A study to assess the knowledge regarding adverse effects of selected antipsychotic drugs among the caregivers of patient receiving antipsychotic drugs.  A non experimental descriptive design with descriptive survey approach was used for the present study. Non Probability sampling by using convenient sampling technique was used to select 30 samples. Data was collected by means of a Standardized Structured Knowledge Questionnaire which was divided into 2 sections which consisted socio-demographic variables and variables to assess the knowledge regarding adverse effects of anti psychotic drugs. The study findings revealed that majority of caregivers 24 (80%) had average knowledge, 5 (16.66%) had good knowledge, 1 (3.33%) had poor knowledge about adverse effects of antipsychotic drugs. There is statistically significant association found between demographic variables with knowledge score regarding adverse effects of antipsychotic drugs at the 0.05 level of significance.

 

 

 

INTRODUCTION:

Medicines have contributed to longer life spans; improved health and better quality of life. Medications are used to treat the symptoms of mental disorders such as schizophrenia, depression, bipolar disorder (sometimes called manic-depressive illness), anxiety disorders, and attention deficit-hyperactivity disorder (ADHD). Sometimes medications are used with other treatments such as psychotherapy. Medications treat the symptoms of mental disorders .They cannot cure the disorder, but they make people feel better so they can function. Many people with mental disorders are treated with psychiatric medications that treat mental disorders. Due to these psychiatric medications many people with psychiatric disorders are living their life happily. Sometimes called psychotropic or psychotherapeutic medications, they have changed the lives of people with mental disorders for the better.¹

 

Antipsychotics are also called tranquilizer and neuroleptic.² Antipsychotics are the branch of medicines that are mainly used to treat psychiatric disorders  such as schizophrenia, mania. They can also be used to treat severe depression and severe anxiety. The term antipsychotic is applied to drugs that reduce psychomotor excitement and control some symptoms of schizophrenia without causing disinhibition, confusion and sleep.³ In the 1990’s, new antipsychotic medications were developed. These new medications are called second generation, or “atypical” antipsychotics. These medications have been available since the mid-1950. They are also called conventional “typical” antipsychotics Some of the more commonly used medications include: Chlorpromazine Haloperidol (Haldol) Perphenazine Fluphenazine. Other atypical antipsychotics were developed. All of them are effective, and none cause agranulocytosis. These include Risperidone, Olanzapine, Quetiapine.

 

In 1952, the drug chlorpromazine has shown a highly great improvement in the treatment of psychiatric disorders such as schizophrenia. The main therapeutics uses of antipsychotics are to cessate hallucinations, delusions, agitations, psychomotor excitement in schizophrenia, organic psychosis or mania.⁴ The indications of antipsychotic drugs are Organic Psychiatric Disorders, Functional Disorders, and Mood Disorders, Childhood Disorders, Neurotic and other Psychiatric disorders and Medical Disorders.⁵

 

Antipsychotic drugs have some adverse effects and most of the people stop taking these drugs due to these adverse effects.  Not more than one antipsychotic to be prescribed to a patient with mental disorders except under unusual circumstances. Among the reasons for this are the increased numbers and harm from adverse effects of the drug when multiple drugs are used. Common (≥ 1% and up to 50% incidence for most antipsychotic drugs) adverse effects of antipsychotics include. Sedation (particularly common in patients on clozapine, olanzapine, quitipine, chlorpromazine and zotepine) Headaches, Dizziness, Diarrhea, Anxiety, Extra pyramidal side effects (particularly common in patients on first-generation antipsychotics).⁶

 

NEED FOR THE STUDY:

Antipsychotic medications are powerful, mind-altering drugs that are prescribed to control psychotic symptoms. A person with psychiatric disorders is unable to differentiate between the reality and his thoughts. The two major symptoms of psychosis are  hallucinations and delusions. A delusion is a fixed false belief.  Hallucinations are sensory perceptions that are not real, e.g., hearing voices, seeing things, feeling bugs on your skin, when no such sensory stimuli are present.⁷

 

Antipsychotic drugs are chemicals that affect the brain and nervous system, alter feelings, emotions and consciousness in various ways and are frequently used therapeutically in the practice of psychiatry to treat a broad range of mental and emotional illness. In the mid 1950s about 500,000 patients were hospitalised in the United States for mental illness. By 1973 that number had fallen to 250,000 largely due to the use of psychoactive drugs^. Psychopharmacology is the “Gold Standard” in the treatment of neuro-biological illness^. However drug therapy is not viewed as a quick fix or miracle pill. It is used to treat specific symptoms of neuro-biological illnesses with significant effectiveness. Side effects and adverse reactions of drug therapy require expertise and sound clinical judgement.⁸  

 

The prevalence of usage of antipsychotic drugs in the USA was reported at 13.9% among individuals aged 40 years and older. Global estimates for 2001 showed that, worldwide, approximately 10 million people suffered from dementia; 8 million are with Parkinsonism 6 million suffering with Alzheimer’s disease and overall 24.3 million people are suffering with neuropsychiatry disorders and 60.1% of all people with dementia lived in developing countries. In India, the prevalence of usage of antipsychotic drugs lies in the range of 1.8 to 3.6% among individuals aged 60 to 65 years. ⁹The treatment of psychiatric disorders in the past had often constituted or institutionalised (i.e. admission in an asylum or mental hospital), sometimes along with the treatment which now seems either ridiculous or fantastic or mostly both. The advent of psychopharmacology in the last 50 years has brought the treatment of psychiatric disorders within the realm of scientific medicine. The duration of treatment with antipsychotic medications depends upon the reason for using the drugs.  Patients with schizophrenia or manic depressive illness may require long-term treatment, i.e., years to decades.  Patients who develop psychosis as a part of a health problem may tolerate dose reduction in four to six weeks following the resumption of normal behaviour.  The value of medication treatment should be re-evaluated every three to six months by comparing the benefit to the side effects and cost.  Medications are continued when the patient exhibits improvement based on self-reports, family reports, or behavioural monitoring. ⁷

 

Dosing ranges for antipsychotic medications depend on the size of the patient, the reason for the medication, health problems, and other features of the patient.  In general, doses recommended for persons with intellectual disability should start at one-half or one-quarter of doses recommended for normal individuals.  Dose adjustments should occur about every week unless there are reasons to more rapidly increase the dose for typical starting doses and maximum doses. ⁷Providing care for a member of the family with mental illness is a progressively overwhelming experience for caregivers. They are the people who are always with the patients and their role is very important. Many of the caregivers are ignorant about the importance of medication, side effects and the continuity of follow-up. They are unprepared to care for their relatives who are just discharged from hospital or who need a long-term treatment and supervised care. ¹⁰Relatives are usually involved in caring for the patients who are receiving antipsychotic drugs. Thus it is essential that all caregivers understand the medication, side effects, precautions and the caregiver’s role. Investigators have proved that educating caregivers on the importance of compliance to antipsychotic drugs, side effects and their role in caring for mentally ill patients can reduce relapse. ¹⁰Caregiver’s stress, burden and sense of being overwhelmed by the care giving roles have been linked to patient’s persistent behavioural problems and caregiver’s perceived or actual inability to handle them. So their role is important in caring for their mentally ill relatives. ¹¹

 

Due to short hospital stay and the involvement of the family in the care of the patient, the contact of the patient with healthcare personnel is minimal. It is the family which stays with the patients for 24 hours of the day helping the patient meet his/her needs. So it is very important that caregivers receive sufficient knowledge as to how to care for their relatives who are on antipsychotic drugs. ¹²

 

STATEMENT OF PROBLEM:

“A study to assess the knowledge regarding the Adverse Effects of Antipsychotic drugs among the Caregivers of patients receiving Antipsychotic drugs admitted in KLE’s Dr. Prabhakar Kore Charitable hospital, Belgaum with a View to Develop Educational Pamphlet.”

OBJECTIVES:

The objectives of the study are:

1.      To assess the knowledge regarding the adverse effects of anti psychotic drugs among the caregivers of patients receiving anti psychotics drugs.

2.      To develop and distribute educational pamphlet regarding adverse effects of antipsychotic drugs among the caregivers of patients admitted in KLE’s Dr. Prabhakar Kore Hospital, Belgaum.

3.      To find out the association between the knowledge scores of the caregivers of patients receiving anti psychotics drugs and the selected socio demographic variables.

 

OPERATIONAL DEFINITIONS:

·        Knowledge: Refers to the level of understanding, or cognitive ability of caregivers.

·        Anti psychotic drugs: Are the type of drugs used to treat the psychotic conditions such as Mania, Depression, Schizophrenia, etc. In the present study the anti psychotic drugs are:

a.       Atypical anti psychotics

Example: clozapine, Risperidone, Quitipine, Olanzapine.

b.      Typical anti psychotics

Example: Chlorpromazine, Haloperidol.

·        Caregivers: Are the relatives of the patients admitted in the KLE’s Dr. Prabhakar Kore Charitable Hospital. They play a vital role in meeting the immediate needs of patients who receive anti psychotic drugs.

·        Educational pamphlet: Refers to the information module for caregivers on adverse effects of anti psychotic drugs by the investigators.

·        Adverse effect: A harmful or abnormal result. An adverse effect may be caused by administration of medication or by exposure to a chemical and be indicated by an untoward result such as by illness or death.

 

HYPOTHESIS:

H_1:  There will be association between the knowledge scores of caregivers regarding adverse effects of antipsychotic drugs and selected socio demographic variables.

 

ASSUMPTION:

Caregivers have some knowledge regarding the anti psychotic drugs.

 

DELIMITATION:

This study is delimited to the patients admitted in psychiatry ward of KLE’s Dr. Prabhakar Kore Charitable Hospital and MRC, Belgaum.

 

RESEARCH METHODOLOGY:

Research Approach:

A descriptive survey approach was adopted in this study.

 

Research Design:

A descriptive design was adopted to carry out the present study.

Research Setting:

The investigator selected KLE’s Dr. Prabhakar Kore Charitable Hospital, Belgaum, Karnataka for the study.

 

Population:

For the present study the caregivers of patients receiving anti psychotic drugs admitted in KLE’s Dr. Prabhakar Kore Charitable Hospital, Belgaum, Karnataka were selected.

 

Sample and Sample Size:

The samples for present study comprised of caregivers of patients receiving anti psychotic drugs, Belgaum, Karnataka. The sample consists of 30 caregivers of patients receiving anti psychotic drugs, Belgaum, Karnataka.

 

Sampling Technique:

Sampling technique adopted for the selection of sample is convenient sampling technique.

 

Description of Tool:

The tool consists of

Section 1: socio demographic data containing 8 items.

Section 2: contains 29 items (multiple choice questions) on anti psychotic drugs.

 

Section 1: demographic data.

This section consists of 8 items for obtaining information about selected demographic factors.

 

Section II: Structured knowledge questionnaire

This section aims to assess the knowledge regarding adverse effects of anti psychotic drugs. It consists of 29 items dealing with anti psychotic drugs its, meaning, definition, indications, contraindications, side effects, complications, management  of the adverse effects. Each item has 4 options with one correct answer. A score ‘1’ is given for the correct answer and a score ‘0’ is given for the wrong answer. Total score is 29.

 

PLAN FOR DATA ANALYSIS:

Experts in the field of nursing and statistics directed the development of data analysis plan which is as follows:

a.       Organization of data on a master sheet.

b.      Tabulation of data in terms of frequencies, percentage, mean, median, mode, standard deviation and range.

c.       Classify the knowledge scores as follows:

·        Poor knowledge                 Mean – SD

·        Average knowledge           Between a and c

·        Good knowledge                Mean + SD

 

RESULTS:

SECTION I:

Distribution of subjects according to sample characteristics

 

TABLE 1: Frequency and percentage distribution of caregivers according to socio demographic variables  n=30

SI.   NO	Socio Demographic variables	Frequency(f)	Percentage (%)
1	Age in years ·         20-29 ·         30-39 ·         40-49 ·         50-59 ·         60 above	8 8 12 2 0	26.7% 26.7% 40% 6.67% 0%
2	Gender ·        Male ·        Female	16 14	53.3% 46.7%
3	Education ·        1-4 (Primary) ·        5-7 (Secondary) ·        8-10 ·        11-12 ·        Diploma ·        PG and Above	1 9 12 8 0 0	3.3% 30% 40% 26.7% 0% 0%
4	Religion ·        Hindu ·        Muslim ·        Christian ·        Others	18 9 3 0	60% 30% 10% 0%
5	Occupation ·         Business ·         Housewife ·         Farmer ·         If any other, specify	1 7 21 1	3.3% 23.3% 70% 3.3%
6	Marital status ·        Married ·        Unmarried ·        Divorced ·        Widow	18 8 4 0	60% 26.7% 13.3% 0
7	Family income ·        < 1000 ·        1000-4000 ·        8000-15000 ·        > 15000	0 4 18 8	0 13.3% 60% 26.7%
8	Relationship with patient ·        Father ·        Mother ·        Spouse ·        Sibling ·        Children ·        If other, specify	4 15 8 1 1 1	13.3% 50% 26.7% 3.3% 3.3% 3.3%

 

Table 1: Reveals that

1.      Majority of caregivers were in the age group of 40-49 years that is 40 (40%) followed by the age of 20-29 years and 30-39 years that is 8 (26.7%) and 8 (26.7%) respectively and then followed by the age group of 50-59 years that is 2 (6.67%) and no caregivers were found to be more than 60 years.

2.      Majority of caregivers were males that are 53.3% and 46.7% of the respondents were females.

3.      Majority of the caregivers were educated up to 8-10^th std that is 12 (40%), followed by 5-7^th std that is 9 (30%), and then followed by 11-12^th std that is 26.7%, and only one respondent was educated up to 1-4^th std that is 1 (3.3%) and respondents were educated up to diploma or PG.

4.      Majority of the caregivers belonged to Hindu religion that is 18 (60%) and followed by Muslim religion that is 9 (30%), and then followed by 3 (10%) of the respondents belonged to Christian religion and no caregivers were found in any other religion.

5.      Majority of the caregivers were farmers by occupation that is 21 (70%), followed by housewife that is 7 (23.3%), then business that is 1 (3.3%).

6.      Majority of the caregivers were married that is 18 (60%), followed by unmarried caregivers that is 8 (26.7%), and then followed by divorced that is 4 (13.3%)

7.      Majority of the caregivers monthly income was between 8000-15000 that is 18 (60%), followed by the monthly income of > 15000 that is 8 (26.7%), and then followed by monthly income of 1000-4000  that is 4 (13.3%).

8.      Majority of the respondents were mothers of patients that is 15 (50%), followed by spouse that is 8 (26.7%), then followed by fathers that is 4 (13.3%), and the other respondents were sibling children that is 1 (3.3%).

 

SECTION II: Findings on knowledge score of caregivers on adverse effects of antipsychotic drugs.

 

TABLE 2: Over all mean, median, mode, standard deviation and range of knowledge scores of caregivers regarding adverse effects of antipsychotic drugs.   n=30 

Area of Analysis	Mean	Median	Mode	Standard Deviation	Range
Pre test (x)	11.9	12.5	14	3.02	12

 

Table 2: Reveals that in the mean was 11.9, median 12.5, mode 14, standard deviation 3.02, range of score was 12.

 

TABLE 3: Distribution of level of knowledge of the caregivers regarding the adverse effects of antipsychotic drugs.

Knowledge score	Frequency (f)	Percentage (%)
Good (14 above)	5	17%
Average (8 to 14)	24	80%
Poor (below 8)	1	3%

 

Figure1: Cylindrical graph showing percentage of knowledge scores of caregivers regarding adverse effects of anti psychotic drugs.

TABLE 3: Reveals that majority of the subjects 24 (80%) had average knowledge, 5 (16.7%) had good

 

SECTION IV: Analysis and interpretation of data to find out an association between the knowledge scores of the caregivers of patients with selected demographic variables.

 

TABLE 4: Findings on knowledge score of caregivers on adverse effects on antipsychotic drugs. n=30 

 

 

P < 0.05, df = degrees of freedom, NS = Not Significant

TABLE 4: Revealed that Chi square value at df (4) for gender was 319.35 was significant, df (8) for age was 4.01, at df (10) for education was 14.19, Chi square value at df (6) for religion was 2.261, df (6) for occupation was 10.81, df (6) for marital status was 3.51, df (6) for family income was 12.53, and at df (10) for relationship with patient was 13.81, was not significant and 1 (3.4%) had poor knowledge.

 

DISCUSSION:

Distribution of samples according to sample characteristics:

In the present study it was found that Majority of caregivers were males that are 53.3%, Majority of the caregivers were educated up to 8-10^th std that is 12 (40%), Majority of the respondents belonged to Hindu religion that is 18 (60%), Majority of the caregivers were farmers by occupation that is 21 (70%), Majority of the caregivers monthly income was between 8000-15000 that is 18 (60%). A similar study was conducted by Ms. Alice T P in 2005 that reveals that most of the caregivers 73.3% were males, among the respondents 43.3% were educated up to high school, majority of the respondents belonged to Hindu religion that is 56.67%, business and agriculture were the common occupations that is 26.6%, with regard to family income 50% had an income below Rs. 1000/- ¹³

 

Assessing the level of knowledge:

In the present study shows that the maximum number of caregivers 24 (80%) had average knowledge, 5 (17%) had good knowledge, 1 (3%) had poor knowledge about adverse effects of antipsychotic drugs.  The similar study was conducted by Mr. Mahesh Gadag among Nursing interns which shows that 35 (58.33%) had average knowledge, 12 (20%) had poor knowledge, 13 (21.66%) had good knowledge. ²⁷

 

CONCLUSION:

The findings of the study have various implications in different areas of nursing that is Nursing Education, Nursing Practice, Nursing Administration and Nursing research. Nursing curriculum should incorporate a vast section on knowledge regarding antipsychotic drugs which helps the students acquire knowledge, skills and attitudes to fulfill their duties and responsibilities in the nursing field. In the hospital or any other set up, nurses play an important role in providing health care. As a part of health care, the nurses can teach the management of extra pyramidal symptoms in the hospital and the educational pamphlet can be distributed among the population. Online learning would be a means of enhancing professional development and certainly be cost effective.

 

REFERENCES:

1.       NIMH · Mental Health Medications Available from http://www.nimh.nih.gov/health/publications/mental-health-medications/ Mental health medications.

2.       BT Basanvanthappa. Psychiatric mental health nursing. New Delhi: 2007, 1^st ed.  P: 650

3.       Dr. (Mrs). K Lalitha. Mental health and psychiatric nursing. Bangalore; P: 173

4.       Stimulant psychosis - Wikipedia, the free encyclopedia Available from http://en.wikipedia.org/wiki/Stimulant_psychosis

5.       R. Sreevani. A Guide to mental health and psychiatric nursing. New Delhi: 2010, 3^rd ed. P: 97

6.       Antipsychotic - Wikipedia, the free encyclopedia Available at http://en.wikipedia.org/wiki/Antipsychotic

7.       Richard E. Powers. Family Guide To Understanding Antipsychotic Medications Prescribed For Persons With Mental Retardation and Developmental Disabilities. 2005 Bureau of Geriatric Psychiatry P.1 Available from http://www.ddmed.org/pdfs/58.pdf

8.       Reddy MV and Chandrashekar CR. Prevalence of mental and behavioural disorders in India. A meta-analysis. Indian J of Psychiatry 1998; 40(2): 149-157.

9.       Pope A, Adams C, Paton C, Weaver T. Assessment of adverse effects in clinical studies of antipsychotic medication. 1998 August 26; Empirical College London 112(9): P 24-26

10.     Ram MS, Xiang MZ, Chan CL, Leff J, Simpson P, Huany MS et al. Effectiveness of psychoeducational intervention for rural Chinese families experiencing schizophrenia and randomised controlled trial 2003 Feb; 38(2):69-75 Available from  http://wellness.fullcoll.edu/newsletter/html.31-40/NL-issue33. html. 2.12.2004.

^11.          P, Somerville J, Williamson I, Warner G, Moore M, Wiles R et al. Randomised control trial of self management leaflets and booklets for minor illness provided by post. British Medical Journal 2001 May 19; 322: 1214-1217

12.     Robbins H, Hundley V and Osman LM. Minor illness education for parents of young children. Journal of Advanced Nursing 2003; 44(3): 238-247

 

 

 

Received on 30.08.2014                Modified on 26.09.2014

Accepted on 10.10.2014                © A&V Publication all right reserved