The Interplay Between Psychotropic Medication & In-Patient Rehabilitation

Generally, in-patient rehab in a skilled nursing facility revolves around the 3 disciplines of therapy which is vital not only in the healing process, but also necessary, in order to establish a viable payor source under Medicare guidelines and regulations.

Pharmacology plays an important role in the clinical protocol for every patient, since there will often be a correlation between the drugs a patient is receiving and the patients ability to progress in therapy.

For this reason, nursing and rehab facilities expend a great deal of time and effort into medicine reconciliation in order to ensure that the drugs help and not hamper a successful therapy regimen.

One of the most difficult challenges of a rehab facility is in the proper treatment of a rehab patient who must concurrently be on psychotropic medications.

Antidepressants and Psychotropic Medications

Psychotropic drugs are prescribed to treat a variety of mental health issues by changing or balancing the amount of chemicals in the brain called neurotransmitters.

In many instances, patients with mental health issues will show improvement when neurotransmitters like dopamine, serotonin and norepinephrine are increased or decreased.

In general, the use of antidepressant drugs increases significantly in treating nursing home residents. The use of selective serotonin reuptake inhibitors (SSRIs) largely replaced tricyclic medications, due to a pre-conceived notion or perception by clinicians of their greater safety.

Side Effects

Much has been said and written regarding the negative side effects of these drugs on the patient, including the issue of over-sedation.

In fact, CMS (Centers for Medicare and Medicaid) has issued strict guidelines regarding the importance of clinical review and monitoring of psychotropic medications in older adults.

Among their requirements, is the gradual tapering of psychotropic drugs unless it is deemed to be clinically contraindicated and harmful to the global wellbeing of the individual.

Nurses are instructed to carefully monitor the length of time a patient has received a medication and dosage reduction or reasons for continuing the medication must be justified and meticulously documented.

Potentially adverse Impact of Psychotropic Medication on In-patient therapy

However, much less is understood or discussed regarding the interplay of antipsychotic meds and its effect on in-patient rehabilitation.

It is an established fact that in certain instances psychotropic drugs also tend to have an adverse effect on the ability of the patient to successfully participate in therapy, especially when given in large doses which sometimes causes lethargy and weakness.

Think about it this way, if your loved one is overmedicated or over-sedated, what are the chances that they will be ready to really get into their therapy? Slim indeed.

Solution

What this all amounts to, is the need to create an awareness about what you (and the rehab facility) are looking to accomplish with the in-patient stay of your loved one.

To be clear, if a patient requires anti-psychotic meds, they should not be deprived of it (in fact, it could be dangerous to completely eliminate these drugs while the patient is receiving therapy).

However, our extensive research at Regency Nursing and Rehabilitation Centers of NJ, has led us to conclude that in most cases a targeted and patient-centered therapy program, with a mindful approach to properly integrate and balance the anti-psychotic meds, will help ensure that the patient does well in therapy without sacrificing their emotional and psychological wellbeing.