Thursday, 31 May 2012

Zuclopenthixol acetate for acute schizophrenia and similar serious mental illnesses

Zuclopenthixol acetate is a tranquilliser and sedative that calms people down and helps them sleep.

People with schizophrenia or other mental health problems often hear disturbing voices or see distressing things (which are called delusions, hallucinations and psychosis). Such experiences can be frightening and may lead people to be aggressive or show violent behaviour toward themselves or other people. Tranquilising drugs are medications that help people to sleep or calm down, and help stop aggressive or disorganised behaviour. Tranquillisers should not have to be used often and also have few unwanted side-effects, such as pain at the injection site or uncontrolled shaking of the head and hands. Zuclopenthixol acetate is said to possess all these properties.

Read the full summary here:

From a service user perspective (SUPER), the experience of hearing voices, being manic and seeing things can be confusing, frightening and sometimes terrifying.  It may be difficult for people to grasp what is ‘real’ and what is ‘delusion’.  People may have racing thoughts, which make you feel dizzy and something similar to vertigo.  Even your own thoughts and words may not seem to be your own, as voices or thoughts can sometimes feel as if they are inserted into your mind somehow by an outside force or person. 

If people’s voices are shouting at them, putting them down, being derogatory or abusive, then it is perhaps not surprising that people become aggressive and sometimes violent.  After all, if someone shouted at you in the street, many people would just shout back!  This is what it is like for people who hear voices or see things: it is like someone shouting straight into your ear and never going away. 

It may come as little surprise, then, that many people choose to shout back at their goading voices and this can be taken as being aggressive and violent.  No one can hear the voice, the verbal abuse or what the voice is saying, so an aggressive response to hearing an internal voice can seem to come from nowhere.  A service user that I met some time ago would often walk along the hospital corridors, screaming back at her voices.  She would sometimes hit herself violently on the head, as if trying to physically knock the voices out of her mind.  This was seen as aggression and unexplained violence by onlookers, but left me with mixed feelings of pity, consternation and fear.

Unfortunately, some people may become very aggressive or violent towards others.  They may have panic attacks or be in emotional turmoil.  Sometimes sedatives and tranquillisers are necessary to help people calm down (and some people even ask for them to help them cope). 

The use of these sedatives is never ideal, and the use of forced or coerced injection is a horrible experience, which is degrading both to the person being injected and unpleasant for the nurse doing the injection.  Forced injection can feel like a violation.  It can break the trust between the person with mental health problems and nurses.  Nurses want to provide therapy and care but at the same time have to deal with sometimes violent and aggressive behaviour, meaning that nursing work also has an element of social control.  This care/ control dichotomy (or split) is a catch- 22, with no clear winners or losers.  Nurses want to foster and build therapeutic relationships with people.  But all the time it takes to build up feelings of trust and intimacy can be broken in an instant, when force is used to restrain or inject the person.

In a mental health unit, with lots of beds and people, there is increased potential for friction and conflict between people.  I was unfortunate enough to witness the forced injection of sedatives on two occasions: the first time involving a young girl called ‘B’ who was trying to cut herself with the shards of a broken bottle; and the second time a man called ‘R’ who was violently kicking the door of the nurse station and shouting abuse at staff.  With the catch- 22 of care/ control, the use of sedatives could perhaps be said to be necessary but never ideal or therapeutic in the long term.

Seclusion, where an aggressive or violent individual is kept in their room is also far from ideal.  But seclusion may be better than the injection of sedatives and tranquillisers.  At the same time, nurses have a duty of care toward the individual and some people request tranquilisers to calm down.  The review suggested that zuclopenthixol acetate may result in less forced injections, where someone may need to be restrained so as to have the injection to calm down.  Low doses of the drug (as low as 25mg) may be just as good and effective as higher doses (up to 100mg).    

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