Susan Swedo, Chief of Pediatrics and Develop-
mental Neuropsychiatry at the National Institutes of
Mental Health, has studied the relation of strepto-
coccal bacteria and obsessive-compulsive disorder
(OCD) in children. In a 1999 study of 28 children with
OCD, Swedo replaced their blood plasma, which had
high levels of Streptococcus antibodies, with healthy
donor plasma. In 1 month, the incidence of tics had
decreased by 50% and other OCD symptoms had been
reduced by 60% (Washington, 1999). Studies such as
this are promising in discovering a link between in-
fection and mental illness.THE NURSE’S ROLE IN RESEARCH
AND EDUCATION
Amid all the reports of research in these areas of
neurobiology, genetics, and heredity, the implica-
tions for clients and their families are still not clear
or specific. Often reports in the media regarding new
research and studies are confusing, contradictory, or
difficult for clients and their families to understand.
The nurse must ensure that clients and families are
well informed about progress in these areas and
must also help them to distinguish between facts and
hypotheses. The nurse can explain if or how new re-
search may affect a client’s treatment or prognosis.
The nurse is a good resource for providing informa-
tion and answering questions.PSYCHOPHARMACOLOGY
Medication management is a crucial issue that greatly
influences the outcomes of treatment for many clients
with mental disorders. The following sections will dis-
cuss several categories of drugs used to treat mental
disorders (psychotropic drugs): antipsychotics, an-
tidepressants, mood stabilizers, anxiolytics, and stim-
ulants. Nurses should understand how these drugs
work; their side effects, contraindications, and inter-
actions; and the nursing interventions required to
help clients manage medication regimens.
Several terms used in discussions of drugs and
drug therapy are important for nurses to know. Effi-
cacyrefers to the maximal therapeutic effect that a
drug can achieve. Potencydescribes the amount of
the drug needed to achieve that maximum effect.
Low-potency drugs require higher dosages to achieve
efficacy, whereas high-potency drugs achieve efficacy
at lower dosages. Half-lifeis the time it takes for
half of the drug to be removed from the bloodstream.
Drugs with a shorter half-life may need to be given
three or four times a day, but drugs with a longer half-
life may be given once a day. The time that a drug
needs to leave the body completely after it has been
discontinued is about five times its half-life (Maxmen
& Ward, 2002).
The U.S. Food and Drug Administration (FDA)
is responsible for supervising the testing and mar-
keting of medications for public safety. These activi-
ties include clinical drug trials for new drugs and
monitoring the effectiveness and side effects of med-
ications. The FDA approves each drug for use in a
particular population and for specific diseases. At
times, a drug will prove effective for a disease that
differs from the one involved in original testing and
FDA approval. This is called off-label use.An ex-
ample is some anticonvulsant drugs (approved to
prevent seizures) that are prescribed for their effects
in stabilizing the moods of clients with bipolar dis-
order (off-label use). The FDA also monitors the oc-
currence and severity of drug side effects. When a
drug is found to have serious or life-threatening side
effects, even if such side effects are rare, the FDA may
issue a black box warning.This means that pack-
age inserts must have a highlighted box, separate
from the text, that contains a warning about the seri-
ous or life-threatening side effect(s). Several psycho-
tropic medications discussed later in this chapter have
black box warnings.28 Unit 1 CURRENTTHEORIES ANDPRACTICEKeeping clients informed