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Psychopharmacologic First-Line Strategies in the Treatment of Major Depression and Psychosis: A Survey of Advanced Practice Nurses

Wm. F. Connell School of Nursing, Boston College, 140 Commonwealth Ave., Chestnut Hill, MA, Barbara.Wolfe.1{at}bc.edu

Sandra L. Talley

Yale University School of Nursing, New Haven, CT

Adrian T. Smith

Wm. F. Connell School of Nursing, Boston College, Chestnut Hill, MA

BACKGROUND: Developments in psychopharmacology have led to a broad range of medication choices for prescribing clinicians. Although there have been advances in drug development, less is known about the prescribing strategies used by psychiatric—mental health advanced practice nurses or the extent to which these practices reflect existing practice guidelines. OBJECTIVES: This study examined the prescribing practices of advanced practice nurses attending a psychopharmacology continuing education program. Participants were surveyed about (a) first-line strategies for the treatment of major depression and first-episode psychosis and (b) choices for managing insomnia and the side effect of weight gain. STUDY DESIGN: Participants completed an onsite questionnaire regarding advanced practice characteristics and management of specific clinical situations. RESULTS: The majority of prescribing advanced practice nurses surveyed were psychiatric—mental health specialists. Approximately two thirds (65.9%) of the advanced practice nurses prescribed psychotropic medications, most often for depression. First-choice agents for depression and first-episode psychosis were selective serotonin reuptake inhibitors (97.3%) and atypical antipsychotics (93.9%), respectively. Interventions for insomnia and medication-related weight gain were more varied. CONCLUSIONS: For the advanced practice nurses surveyed, first-line strategies for depression and first-episode psychosis appear consistent with literature and practice guidelines. Future studies and educational offerings would benefit from addressing dosing and switching strategies and optimizing approaches for managing side effects. J Am Psychiatr Nurses Assoc , 2008; 14(2), 144-151. DOI: 10.1177/1078390308316124

Key Words: advanced practice nursing • psychiatric mental health • psychopharmacology • prescribing practices • side effects • selective serotonin reuptake inhibitor • atypical antipsychotic

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