Studying teens on psychiatric medications—What do they
think?
Ground-breaking MSASS study by Floersch investigates
patient perspective
December 7, 2005
| For more information: Susan Griffith 216-368-1004
A spoonful of sugar makes the medicine go down. Whoa, not so fast! What does
the young patient think, asks Jerry Floersch from the Mandel School of Social
Sciences at Case Western Reserve University.
Floersch plans to find out when he begins questioning teen patients and their
parents in a clinical study on how they “make sense” of the use
and impact of medications for mental disorders on their everyday lives.
He has received a five-year, $700,000 mentored grant from the National Institute
of Mental Health (NIMH) for the research project, “Adolescent and Parent
Subjective Experience of Psychotropic Treatment.”
Little is known about how the patient or the parent understands the personal
experiences, both social and psychological, associated with the medications
for mental health conditions such as attention deficit, anxiety and bi-polar
disorders, according to Floersch, associate professor of social work at the
Mandel School.
The grant from NIMH is an award that recognizes a clinical scientist who has
branched into an unexplored field of research. While much is known about the
drugs and how they work physically, he will investigate how the adolescent
patient personally handles the whole spectrum from the diagnosis, management
of the illness, interactions with friends to cultural and religious practices
that might impact the treatment of the illness—and the patient’s
adherence to the medication as prescribed.
With the study’s impact in both the medical and anthropological arenas,
Floersch will collaborate with his mentors Robert Findling, director of the
Division of Child and Adolescent Psychiatry at University Hospitals of Cleveland
and Janis Jenkins, professor of anthropology in the College of Arts and Sciences
and professor of psychiatry in the Case School of Medicine.
The one drug fits all may not be working for many people, according to Floersch.
One concern for Floersch is the increasing use of a battery of drugs to treat
a wide range of mental conditions with drugs known to work for adults but off-labeled
prescribed for children.
“By reminding the larger community that children are not small adults,
off-label use patterns have sent many advocates, clinicians and researchers
clamoring for child-centered efficacy test,” reported Floersch in the
journal article for Psychiatric Medication Issues for Social Workers, Counselors
and Psychologist.
A gap can often exist between the “desired” effects the doctor
wants in response to the patient’s symptom and the patient reaction or “actual” experience
with the drugs, including all sorts of messages and expectations from parents,
teachers, friends and peers about use of the medications.
“Take an aspirin,” he said, “and the expectation is that
15 minutes later the headache is gone.”
With all the television messages for psychiatric drugs, people can have some
of those similar expectations with their psychiatric medications, he explained.
Today’s youth are getting some messages that there is a pill for every
worry, sleepless night or moment of unfocused attention, according to Floersch.
Youth, their parents and the medical community have responded with use of psychotropic
treatments increasing three-fold over the past decade for children between
the ages of 4 and 18 as more of these drugs become safe for use by young people.
Meanwhile youth prescribed medications do not always take the medicine as
directed, potentially minimizing their effectiveness. Youth also have been
known to share their medications with friends, who have self-diagnosed their
symptoms or want a quick fix to focus or get out of a bad mood.
He wants to understand whether adherence issues are related to an assertion
for independence or an avoidance of negative side effects.
The outcome of studying 75 youth between the ages of 12 and 18 who have been
prescribed antipsychotic medications is to design a reporting tool to gather
personal narratives about the patient’s experiences and help doctors
and social workers assist in the teen patient’s ability to learn how
to independently manage their illness and function as healthy individuals.
Similar tools exist to analyze the experiences of adults on medications,
such as the Subjective Experience Medication Instrument and Drug Attitude Inventory,
but these diagnostics need to be adapted for use with adolescents.
“The long-term goal is to develop instruments and practices that clinician,
family members and adolescents can use to help them make sense and master their
particular medication experience,” he said.
Floersch added that this is just the beginning of looking into this medical
and social issue that is becoming increasingly important as more youth take
medications to alleviate mental conditions.
About Case Western Reserve University
Case is among the nation's leading research institutions. Founded in 1826
and shaped by the unique merger of the Case Institute of Technology and Western
Reserve University, Case is distinguished by its strengths in education, research,
service, and experiential learning. Located in Cleveland, Case offers nationally
recognized programs in the Arts and Sciences, Dental Medicine, Engineering,
Law, Management, Medicine, Nursing, and Social Work. http://www.case.edu.
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