Clinical Literature Review Paper
Clinical Literature Review Paper
Among the conditions that are severely disabling is bipolar disorder. This condition affects up to three percent of the youths worldwide. Therefore, various strategies and interventions have been used to prevent and manage the condition. Current evidence indicates that the use of medications is at the center of mainstay treatment (Yatham et al., 2018). The implication is that individuals living with these conditions need to adhere to the medication regimen for better patient outcomes. However, various factors negatively impact medication adherence among youths with bipolar disorder. Having formulated a PICO statement, the purpose of this current assignment is to write a literature review of articles supporting the PICO and a reflection. The formulated PICO question: Among youth patients with Bipolar Disorder (P), does weight gain due to the use of antipsychotic drugs affect medication adherence?
As earlier indicated, bipolar disorder is a disabling condition and hence has attracted considerable research attention from various stakeholders. As such, various research articles and outputs have been published regarding medication adherence among individuals with bipolar disorder. In one of such outputs, (Edgcomb & Zima, 2018) performed a systematic review and a meta-analysis of research articles that investigate the medication adherence predictors in youths with mental health complications. This review was only carried out for research studies that focused on the psychopharmacologic treatment adherence among youths of at most eighteen years old.
The systematic review includes a total of twenty-eight studies which had a total of 180,870 patients. The meta-analysis indicated that various factors led to the patients adhering to medication. Some of the factors include insight, adherence to psychotherapy, family attitudes towards care, and patient attitudes towards care. On the other hand, nonadherence to the medications was connected to the presence of attention-deficit/hyperactivity disorder, substance use, and the severity of the illness (Edgcomb & Zima, 2018). This article also revealed that medication nonadherence among the youth living with severe mental illness is so prevalent. Among the youths with the conditions, the youths experiencing higher comorbidity and severe illness burden show a greater risk of nonadherence to the anti-psychotic medications.
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Weight gain leads to obesity which can be comorbidity among the youth experiencing bipolar disorder; hence there are possibilities that such individuals may have lower rates of medication adherence. One important aspect of this article is that when the researchers divided the reviewed studies by diagnosis, then it was evident that the complexity of the medication regimen was closely connected to enhanced nonadherence risk among patients with bipolar disorder (Edgcomb & Zima, 2018). This article is of a higher quality. It is a systematic review with meta-analysis, implying that the evidence is strong too. The article is a level I source of evidence; hence it qualifies among the best evidence that supports the research. The findings from this systematic review and meta-analysis can support the formulation of the risk profile for medication nonadherence among youths with bipolar disorder and other mental health conditions.
In another source, Semahegn et al., 2020 conducted a systematic review and meta-analysis focusing on psychotropic medication nonadherence and the connected factors among individuals experiencing major psychiatric disorders. This review included a total of forty-six studies, with ten of the studies focusing on bipolar disorders. From the analysis, the researchers noted that close to half of all the patients considered in the study were non-adherent to their antipsychotic medication. Among the non-adherent patients, up to forty-four patients had bipolar disorders. The systematic review and meta-analysis also revealed various factors connected to nonadherence (Semahegn et al., 2020). These factors include health system factors, treatment or clinical and illness-related factors, inadequate social support, and behaviors exhibited by the patients. It is important to note that out of the reviewed studies, up to five studies revealed that weight gain is a major side effect of using these medications. The weight gain then leads to nonadherence to the medications and well a negative perception of the antipsychotic medications. This source is also a level one source, with the evidence treated as high.
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Reflection
My passion for working with patients led me to the profession, and for a period, I have had various experiences while interacting with the patients, assessing patients, care planning, and when examining the evidence of clinical intervention. One of the experiences is that assessment of mental health patients requires commitment and keenness to accurately diagnose various conditions impacting the patients. In addition, I have also realized that in some instances, you have to rely on the patient’s family members and care providers to get a true picture of what could be happening in a patient’s life (Tristiana et al., 2018). Such steps are key in coming up with appropriate care plans. I have also learned through the interaction with patients that formulating care plans need to consider the patient’s and their families’ views to improve medication adherence and attitude towards using the medications.
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The experiences have contributed to my understanding of the role of mental health nurses. For example, as a mental health nurse, I have to take into account that every mental health patient has unique needs that must be individually attended to and that they should be involved in the care plans as much as possible. In addition, mental health nurses have the role of ensuring that the patients have better outcomes and live lives as normally as possible. These experiences also contribute to my understanding of the role of nursing in planning evidence-based care. For example, a nurse has to use existing evidence in caring for patients. There are various prevention, treatment, and management guidelines that have been formulated from evidence and are to be used as part of evidence-based care planning (Ackley et al., 2019). Indeed, these experiences have all contributed to me as a nurse as I feel I get better with each passing day as I continue interacting with patients. I believe that I am getting better at assessing patients, and I understand the need of my patients better.
References
Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing diagnosis handbook E-book: An evidence-based guide to planning care. Elsevier Health Sciences.
Edgcomb, J. B., & Zima, B. (2018). Medication adherence among children and adolescents with severe mental illness: a systematic review and meta-analysis. Journal of Child and Adolescent Psychopharmacology, 28(8), 508-520. https://doi.org/10.1089/cap.2018.0040.
Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2020). Psychotropic medication nonadherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis. Systematic reviews, 9(1), 1-18. https://doi.org/10.1186/s13643-020-1274-3.
Tristiana, R. D., Yusuf, A., Fitryasari, R., Wahyuni, S. D., & Nihayati, H. E. (2018). Perceived barriers on mental health services by the family of patients with mental illness. Internation https://doi.org/10.1016/j.ijnss.2017.12.003
Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., … & Berk, M. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar disorders, 20(2), 97-170. https://doi.org/10.1111/bdi.12609
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Johns Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal
Article author and year: Edgcomb & Zima, 2018
Strength of Study Design
- Was sample size adequate and appropriate? Yes Yes No
- Were study participants randomized? Yes Yes No
- Was there an intervention? Yes Yes No
- Was there a control group? Yes Yes No
- If there was more than one group, were groups equally treated, except for the
intervention? Yes Yes No
- Was there adequate description of the data collection methods yes Yes No
Study Results
- Were results clearly presented? Yes Yes No
- Was an interpretation/analysis provided? Yes Yes No
Study Conclusions
- Were conclusions based on clearly presented results? Yes Yes No
- Were study limitations identified and discussed? Yes Yes No
Pertinent Study Findings and Recommendations
- Will the results help me in caring for my patients? Yes Yes No
Article author and year: Semahegn et al., 2020
Strength of Study Design
- Was sample size adequate and appropriate? Yes Yes No
- Were study participants randomized? Yes Yes No
- Was there an intervention? Yes Yes No
- Was there a control group? Yes Yes No
- If there was more than one group, were groups equally treated, except for the
intervention? Yes Yes No
- Was there adequate description of the data collection methods yes Yes No
Study Results
- Were results clearly presented? Yes Yes No
- Was an interpretation/analysis provided? Yes Yes No
Study Conclusions
- Were conclusions based on clearly presented results? Yes Yes No
- Were study limitations identified and discussed? Yes Yes No
Pertinent Study Findings and Recommendations
- Will the results help me in caring for my patients? Yes Yes No
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Appendix
Literature review table
| Author, date | Purpose of the study | Population and setting, and sample size (n)b | Methodsc | Findings | Implication for practice | Strength of the evidence (Level I, II, III)/Quality of the evidencea |
| Edgcomb & Zima, 2018
|
To investigate the medication adherence predictors in youths with mental health complications. | The systematic review included a total of twenty-eight studies which had a total of 180,870 patients. | The search methods employed include a systematic literature search in PsycINFO, web of science, and MEDLINE/PubMed. Articles from 1980 to 2017 were included. | -Various factors led to the patients adhering to medication. Some of the factors include insight, adherence to psychotherapy, family attitudes towards care, and patient attitudes towards care.
-Nonadherence to the medications was connected to the presence of attention-deficit/hyperactivity disorder, substance use, and the severity of the illness. |
The findings can support the formulation of the risk profile for medication nonadherence among youths with bipolar disorder and other mental health conditions. | I |
|
Semahegn et al, 2020
|
To examine psychotropic medication nonadherence and the connected factors among individuals experiencing major psychiatric disorders. | The study reviewed a total of forty-six studies, with ten of the studies focusing on bipolar disorders. | The search method conducted included a search on man databases such as google scholar, Web of Science, PsycINFO, CINAHL, Embase, and MEDLINE/PubMed. | – Half of all the patients considered in the study were non-adherent to their anti-psychotic medication.
Among the non-adherent patients, up to forty-four patients had bipolar disorders. – health system factors, treatment or clinical and illness-related factors, inadequate social support, and behaviors exhibited by the patients lead to nonadherence. -weight gain leads to nonadherence to the medications and well a negative perception of the antipsychotic medications |
The factors associated with nonadherence among patients with psychiatric disorders revealed in the study can be prevented through various practice-based interventions. | I |
based on the JHNEBP Evidence Rating Scales (Newhouse, Dearholt, Pugh, & White, 2005)
bFor a systematic review, indicate the setting and number of studies
cFor a systematic review, indicate search methods
Part 1 : Select and evaluate two research articles that answer your PICO question. This narrative part should be no longer than three pages.
Part 2: Complete the Johns Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal each of your articles. Complete the literature table on the last page for the articles you selected, using the Johns Hopkins Appraisal.