Overmedication

Last updated

Overmedication is an overutilization of medication wherein a patient takes voluntarily, or is prescribed, unnecessary or excessive medications. While not strictly a medical condition, common symptoms may include: slurred speech, drowsiness, confusion, and poor motor skills. Hence it is a risk factor for falls, especially among the elderly. [1] Children with behavior problems are also at risk of overmedication, with parents wanting an easy fix, and drug companies and doctors often obliging.

Contents

Overmedication in the elderly

A report in 2018 by Human Rights Watch, found that every week in American nursing homes, around 180,000 residents are given antipsychotic drugs who do not have the diagnosis for which the drugs are approved. Most of these people have behavioral issues or some form of dementia. The drugs are often administered without informed consent. The reason these drugs are administered is for the sedative effect, which makes the patients docile and easier to manage. [2]

Overmedication in children

The overmedication of children has dramatically risen with those between the ages of 2 and 5 years old who are being prescribed atypical antipsychotics for bipolar disorders, developmental disabilities, ADHD, and behavior disorders. [3] Drug companies have benefited considerably with profits made in sales for drugs such as stimulants for hyperactive children, with half a million children in the United States receiving medication. [4] [ obsolete source ] Children have become more involved with technology resulting in less play time outside and less time spent with parents. The long hours children spend with technology has impacted their attachment development, sensory and motor development, along with socialization skills, in return causing behavioral and psychological disorders and learning disabilities being diagnosed by psychotropic medication. [5]

If parents monitor their child's behavior and regulate their environment, it can help to prevent any future affective disorders. Medication is often prescribed to these children; however, it alone will not teach a child to create more valuable relationships at home or in the community. Other forms of intervention can be applied to supplement the effects of medication therapy and teach the child self-regulatory behaviors and healthy coping skills. [6] The increase of psychiatric medication of children may be a result of the declining support for caregiving, leading to psychopathology in which drugs are oftentimes the go to method of treatment. [3] Families do not always have knowledge regarding or the means to pursue other methods of intervention such as one-on-one therapy with the child, family therapy and parenting counseling that can teach effective parenting strategies to meet their child's specific needs. There is debate that healthcare professionals have been put under pressure to perform proficiently causing the influence of piecemeal polypharmacy. [7]

Overprescription

A related issue is overprescription, which occurs when doctors give prescription drugs to patients who do not need them. Antibiotics are a common example, [8] as were narcotic painkillers. [9] Aggressive marketing by drug companies is sometimes cited as a reason for overprescription. [10]

Undiagnosing medical conditions to prevent overprescribing

Some diagnoses do not hold important clinical implications. These conditions do not require treatment. When they are treated, there is the potential for harm but little potential for benefit. The ERASE algorithm can help clinicians to Evaluate diagnoses through the consideration of Resolved conditions, Ageing normally and Selecting appropriate targets to Eliminate unnecessary diagnoses and associated medicines. [11] Undiagnosing relies on accurate and comprehensive medical records to inform a thorough review of diagnoses. [12]

Medication overuse headaches

Medication overuse headaches, also known as rebound headaches, are caused by the overuse of pain-relieving drugs for headaches, such as migraine headaches.

See also

Related Research Articles

<span class="mw-page-title-main">Insomnia</span> Inability to fall or stay asleep

Insomnia, also known as sleeplessness, is a sleep disorder where people have trouble sleeping. They may have difficulty falling asleep, or staying asleep for as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, irritability, and a depressed mood. It may result in an increased risk of motor vehicle collisions, as well as problems focusing and learning. Insomnia can be short term, lasting for days or weeks, or long term, lasting more than a month. The concept of the word insomnia has two possibilities: insomnia disorder and insomnia symptoms, and many abstracts of randomized controlled trials and systematic reviews often underreport on which of these two possibilities the word insomnia refers to.

<span class="mw-page-title-main">Psychiatric medication</span> Medication used to treat mental disorders

A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. These medications are typically made of synthetic chemical compounds and are usually prescribed in psychiatric settings, potentially involuntarily during commitment. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, thereby lowering the cost of mental health care. The recidivism or rehospitalization of the mentally ill is at a high rate in many countries, and the reasons for the relapses are under research.

<span class="mw-page-title-main">Risperidone</span> Antipsychotic medication

Risperidone, sold under the brand name Risperdal among others, is an atypical antipsychotic used to treat schizophrenia and bipolar disorder. It is taken either by mouth or by injection. The injectable versions are long-acting and last for 2–4 weeks.

<span class="mw-page-title-main">Polypharmacy</span> Use of five or more medications daily

Polypharmacy (polypragmasia) is an umbrella term to describe the simultaneous use of multiple medicines by a patient for their conditions. Most commonly it is defined as regularly taking five or more medicines but definitions vary in where they draw the line for the minimum number of drugs. Polypharmacy is often the consequence of having multiple long-term conditions, also known as multimorbidity. An excessive number of medications is worrisome, especially for older patients with many chronic health conditions, because this increases the risk of an adverse event in those patients.

<span class="mw-page-title-main">Prochlorperazine</span> Medication for nausea, psychosis, and anxiety

Prochlorperazine, formerly sold under the brand name Compazine among others, is a medication used to treat nausea, migraines, schizophrenia, psychosis and anxiety. It is a less preferred medication for anxiety. It may be taken by mouth, rectally, injection into a vein, or injection into a muscle.

Child psychopathology refers to the scientific study of mental disorders in children and adolescents. Oppositional defiant disorder, attention-deficit hyperactivity disorder, and autism spectrum disorder are examples of psychopathology that are typically first diagnosed during childhood. Mental health providers who work with children and adolescents are informed by research in developmental psychology, clinical child psychology, and family systems. Lists of child and adult mental disorders can be found in the International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10), published by the World Health Organization (WHO) and in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association (APA). In addition, the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood is used in assessing mental health and developmental disorders in children up to age five.

Oppositional defiant disorder (ODD) is listed in the DSM-5 under Disruptive, impulse-control, and conduct disorders and defined as "a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness". This behavior is usually targeted toward peers, parents, teachers, and other authority figures. Unlike conduct disorder (CD), those with ODD do not show patterns of aggression towards people or animals, destruction of property, theft, or deceit. One half of children with ODD also fulfill the diagnostic criteria for ADHD.

Toxic encephalopathy is a neurologic disorder caused by exposure to neurotoxic organic solvents such as toluene, following exposure to heavy metals such as manganese, as a side effect of melarsoprol treatment for African trypanosomiasis, adverse effects to prescription drugs, or exposure to extreme concentrations of any natural toxin such as cyanotoxins found in shellfish or freshwater cyanobacteria crusts. Toxic encephalopathy can occur following acute or chronic exposure to neurotoxicants, which includes all natural toxins. Exposure to toxic substances can lead to a variety of symptoms, characterized by an altered mental status, memory loss, and visual problems. Toxic encephalopathy can be caused by various chemicals, some of which are commonly used in everyday life, or cyanotoxins which are bio-accumulated from harmful algal blooms (HABs) which have settled on the benthic layer of a waterbody. Toxic encephalopathy can permanently damage the brain and currently treatment is mainly just for the symptoms.

In medicine, patient compliance describes the degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to other situations such as medical device use, self care, self-directed exercises, or therapy sessions. Both patient and health-care provider affect compliance, and a positive physician-patient relationship is the most important factor in improving compliance. Access to care plays a role in patient adherence, whereby greater wait times to access care contributing to greater absenteeism. The cost of prescription medication also plays a major role.

<span class="mw-page-title-main">Attention deficit hyperactivity disorder controversies</span>

Despite the scientifically well-established nature of attention deficit hyperactivity disorder (ADHD), its diagnosis, and its treatment, each of these has been controversial since the 1970s. The controversies involve clinicians, teachers, policymakers, parents, and the media. Positions range from the view that ADHD is within the normal range of behavior to the hypothesis that ADHD is a genetic condition. Other areas of controversy include the use of stimulant medications in children, the method of diagnosis, and the possibility of overdiagnosis. In 2009, the National Institute for Health and Care Excellence, while acknowledging the controversy, states that the current treatments and methods of diagnosis are based on the dominant view of the academic literature.

Mental disorders are classified as a psychological condition marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological and often social functioning of the individual. Individuals diagnosed with certain mental disorders can be unable to function normally in society. Mental disorders may consist of several affective, behavioral, cognitive and perceptual components. The acknowledgement and understanding of mental health conditions has changed over time and across cultures. There are still variations in the definition, classification, and treatment of mental disorders.

Tourette syndrome is an inherited neurodevelopmental disorder that begins in childhood or adolescence, characterized by the presence of motor and phonic tics. The management of Tourette syndrome has the goal of managing symptoms to achieve optimum functioning, rather than eliminating symptoms; not all persons with Tourette's require treatment, and there is no cure or universally effective medication. Explanation and reassurance alone are often sufficient treatment; education is an important part of any treatment plan.

Bipolar disorder in children, or pediatric bipolar disorder (PBD), is a rare and controversial mental disorder in children and adolescents. PBD is hypothesized to be like bipolar disorder (BD) in adults, thus is proposed as an explanation for periods of extreme shifts in mood called mood episodes. These shifts alternate between periods of depressed or irritable moods and periods of abnormally elevated moods called manic or hypomanic episodes. Mixed mood episodes can occur when a child or adolescent with PBD experiences depressive and manic symptoms simultaneously. Mood episodes of children and adolescents with PBD deviate from general shifts in mood experienced by children and adolescents because mood episodes last for long periods of time and cause severe disruptions to an individual's life. There are three known forms of PBD: Bipolar I, Bipolar II, and Bipolar Not Otherwise Specified (NOS). Just as in adults, bipolar I is also the most severe form of PBD in children and adolescents, and can impair sleep, general function, and lead to hospitalization. Bipolar NOS is the mildest form of PBD in children and adolescents. The average age of onset of PBD remains unclear, but reported ages of onset range from 5 years of age to 19 years of age. PBD is typically more severe and has a poorer prognosis than bipolar disorder with onset in late-adolescence or adulthood.

Attention deficit hyperactivity disorder management options are evidence-based practices with established treatment efficacy for ADHD.

Prescription cascade is the process whereby the side effects of drugs are misdiagnosed as symptoms of another problem, resulting in further prescriptions and further side effects and unanticipated drug interactions, which itself may lead to further symptoms and further misdiagnoses. This is a pharmacological example of a feedback loop. Such cascades can be reversed through deprescribing.

Child and adolescent psychiatry is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the pediatric population.

<span class="mw-page-title-main">Depression in childhood and adolescence</span> Pediatric depressive disorders

Depression is a mental disorder characterized by prolonged unhappiness or irritability, accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, loss of appetite, loss of engagement. low self-regard/worthlessness, difficulty concentrating/indecisiveness, or recurrent thoughts of death or suicide. Depression in childhood and adolescence is similar to adult major depressive disorder, although young sufferers may exhibit increased irritability or behavioral dyscontrol instead of the more common sad, empty, or hopeless feelings seen with adults. Children who are under stress, experiencing loss, or have other underlying disorders are at a higher risk for depression. Childhood depression is often comorbid with mental disorders outside of other mood disorders; most commonly anxiety disorder and conduct disorder. Depression also tends to run in families. In a 2016 Cochrane review cognitive behavior therapy (CBT), third-wave CBT and interpersonal therapy demonstrated small positive benefits in the prevention of depression. Psychologists have developed different treatments to assist children and adolescents suffering from depression, though the legitimacy of the diagnosis of childhood depression as a psychiatric disorder, as well as the efficacy of various methods of assessment and treatment, remains controversial.

<span class="mw-page-title-main">Disruptive mood dysregulation disorder</span> Medical condition

Disruptive mood dysregulation disorder (DMDD) is a mental disorder in children and adolescents characterized by a persistently irritable or angry mood and frequent temper outbursts that are disproportionate to the situation and significantly more severe than the typical reaction of same-aged peers. DMDD was added to the DSM-5 as a type of depressive disorder diagnosis for youths. The symptoms of DMDD resemble those of attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), anxiety disorders, and childhood bipolar disorder.

<span class="mw-page-title-main">Deprescribing</span> Medical condition

Deprescribing is described as a patient-centred process to taper or stop medications with the intention to achieve improved health outcomes by reducing exposure to medications that are potentially either harmful or no longer required. Deprescribing is important to consider with changing health and care goals over time, as well as polypharmacy and adverse effects. Deprescribing can improve adherence, cost, and health outcomes but may have adverse drug withdrawal effects. More specifically, deprescribing is the planned and supervised process of intentionally stopping a medication or reducing its dose to improve the person's health or reduce the risk of adverse side effects. Deprescribing is usually done because the drug may be causing harm, may no longer be helping the patient, or may be inappropriate for the individual patient's current situation. Deprescribing can help correct polypharmacy and prescription cascade.

<span class="mw-page-title-main">Prescription drug addiction</span> Medical condition

Prescription drug addiction is the chronic, repeated use of a prescription drug in ways other than prescribed for, including using someone else’s prescription. A prescription drug is a pharmaceutical drug that may not be dispensed without a legal medical prescription. Drugs in this category are supervised due to their potential for misuse and substance use disorder. The classes of medications most commonly abused are opioids, central nervous system (CNS) depressants and central nervous stimulants. In particular, prescription opioid is most commonly abused in the form of prescription analgesics.

References

  1. ↑ "3. Adverse Effects of Overmedication | ATrain Education". www.atrainceu.com. Retrieved 2022-07-01.
  2. ↑ ""They Want Docile": How Nursing Homes in the United States Overmedicate People with Dementia". 2018-02-05.{{cite journal}}: Cite journal requires |journal= (help)
  3. 1 2 "The overmedication of our youth: An interview with Brent Dean Robbins, PhD". Society for Humanistic Psychology Newsletter. April 2012.
  4. ↑ Gittelman, Martin (1979). "Introduction: Refining Diagnosis and Behavioral Intervention: Key to Preventing Overmedication". International Journal of Mental Health. 8 (1): 3–9. doi:10.1080/00207411.1979.11448816. JSTOR   41350662.
  5. ↑ Rowan, Cris (2010). "Unplug—Don't Drug: A Critical Look at the Influence of Technology on Child Behavior with an Alternative Way of Responding Other Than Evaluation and Drugging". Ethical Human Psychology and Psychiatry. 12: 61. doi:10.1891/1559-4343.12.1.60. S2CID   58689722.
  6. ↑ Luvmour, Josette (2011). "Nurturing Children's Well-Being: A Developmental Response to Trends of Overdiagnosis and Overmedication". Journal of Humanistic Psychology. 51 (3): 350–368. doi:10.1177/0022167810386958. S2CID   146359625.
  7. ↑ Zakriski, Audrey L.; Wheeler, Elizabeth; Burda, Jeffrey; Shields, Ann (February 2005). "Justifiable Psychopharmacology or Overzealous Prescription? Examining Parental Reports of Lifetime Prescription Histories of Psychiatrically Hospitalized Children". Child and Adolescent Mental Health. 10 (1): 16–22. doi:10.1111/j.1475-3588.2005.00111.x. PMID   32806815.
  8. ↑ Thompson, Dennis (5 December 2016). "U.S. Doctors Still Over-Prescribing Drugs: Survey". WebMD.
  9. ↑ Mozes, Alan (25 March 2016). "Nearly All U.S. Doctors 'Overprescribe' Addictive Narcotic Painkillers: Survey". WebMD.
  10. ↑ Franklin, Cory (20 June 2011). "America's epidemic of over-prescribing". The Guardian.
  11. ↑ Page, Amy; Etherton-Beer, Christopher (May 2019). "Undiagnosing to prevent overprescribing". Maturitas. 123: 67–72. doi: 10.1016/j.maturitas.2019.02.010 . PMID   31027680.
  12. ↑ Hosking, Sarah M.; Etherton-Beer, Christopher; Page, Amy T. (1 July 2019). "Undiagnosing: Correcting the medical record to prevent over-intervention". Case Reports in Women's Health. 23: e00133. doi:10.1016/j.crwh.2019.e00133. PMC   6664263 . PMID   31384565.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.