Psychopharmacologic Treatment of Anxiety

Integration and Synthesis: Cognitive Behavioral Therapies Within the Biological Paradigm

1. In today's managed care environments, where more emphasis is placed on cost-effective management of patients, the role of medications along with psychotherapy is becoming an accepted standard for psychiatric care. 2. Blind acceptance of the biological model tends to trivialize cognitive behavioral and psychoeducational interventions and casts doubt on the outcome of rehabilitation and retraining. 3. For complete and comprehensive care of patients, psychiatric nursing should embrace both biological and behavioral paradigms and view them as complementary rather than competitive.

The Placebogenic Phenomenon: Art in Psychiatric Nursing

1. Nearly half of all orders for psychotropic medications are written "as needed" (PRN); therefore, the nurse must assume a vital function in the assessment, use, and evaluation of medication. 2. Placebo agents are known to have an effectiveness rate between 30% and 50%. Nurses and other health professionals severely underestimate the magnitude of this effect. 3. The patient's perception of the medication experience, beliefs, degree of trust, expectation, and the psychosocial context in which medications are used, contribute to agent effectiveness. 4. The nurse's personal beliefs, nonverbal cues, anticipation, and interpersonal style can influence effectiveness of agents in relieving symptoms; likewise, by understanding and increasing various interpersonal skills, professionals can enhance effectiveness of psychotropic agents.

The Undertreatment of Anxiety: Overcoming the Confusion and Stigma

1. The patient, the nurse, and organizational variables all interact in a dynamic and complex manner, which all have an impact on decisions about intervention. 2. The numbers and variety of agents ordered as PRN indicate the responsibility for treatment placed by physicians on nurses and their reliance on appropriate and accurate nursing assessment. 3. Much of the stigma surrounding symptoms of anxiety and their treatment is based not only on the nature of the illness, but on the perceptions and beliefs concerning the use of anti-anxiety agents.