Considering Ethnicity and Sex in the Role of Pharmacology in Psychiatric Nursing

     The role of pharmacology is integral in psychiatry. As nurses we encounter clients with mental health issues at all levels of health care from acute to community. With the development of effective medication to treat many psychiatric disorders there has also been an increase in use of medication as a first line of treatment (McCabe, 2004). The readings for this section made me reflect my role as a nurse and how use of psychiatric medication may be optimized for the best treatment of the client in a way that involves much more than simply having an order written by a doctor and hand out pills.

          Intuitively one would imagine that because psychotropic medication is widely used in North America that there has been extensive testing conducted on both men and women to substantiate safety of medication. With my background in psychology it does not come as a surprise to me that historically most medication trials for medications that we continue to use today have been conducted on Caucasian males (Farmer, 2003; Ohlsen & Pilowsky, 2007). Historically, drug research has been conducted on Caucasian men (Farmer, 2003). There are problems associated with this because the results of this research are generalized to the total population which is a diverse group, in terms of gender (Farmer, 2003) and ethnicity (Campinha-Bacote, 2007). I tend to disagree with Farmer’s view that social workers should take a role in suggesting pharmacological routes for clients simply because this is not a social worker’s area of expertise (Farmer, 2003). I think that because doctors and nurses have extensive knowledge about pharmacology they should ideally be the resources when it comes to client’s questions or concerns about medication and medication management. 

     While gender is a fairly clearly defined group biologically, the classification of ethnicity is a murkier because it is more than simply skin colour or one’s country of origin. While I recognize that it is relevant that more attention is being given to the significance ethnic pharmacology, it seems like an incredibly complicated issue because it encompasses biological and environmental factors, is a relatively new area of research and there continues to be controversy about how to define it.

     As defined by Campinha-Bacote (2007), ethnic pharmacology is, “the field of study that investigates the effects of culture, environment, genetics, biopsysiology, and psychosocial factors on the prescribing and metabolism of and response to psychotherapeutic medications” (pp. 27-28). This definition indicates that multiple factors impact the way individuals and ethnic groups process drugs, meaning as nurses because we take on the role of those who administer medication we must be cognizant of more than simply differences in client’s gender or skin colour.

     In terms of researching the effect of medication on ethnically homogenous populations such as Nordic countries or other nations without much international migration, this may be easier to study because group members are very similar. However, in nations like Canada or the United States where there is much immigration and mixing of ethnicities I think these types of effects would be more difficult to connect to a particular ethnic group.

     As discussed by Campinha-Bacote (2007) ethnic pharmacology is a controversial subject mainly because many believe that racial categories are socially defined constructs.  In my experience as a sociologist I tend to shy aware from classifying according to race because these are arbitrary distinctions made by looking at differences in skin colour. Rightfully, there is discussion of caution regarding promotion of particular medications for specific ethnic groups as this may lead to stereotypes or overgeneralization based on characteristics like skin colour while failing to recognize the role of environment or culture (Campinha-Bacote, 2007). I agree with the author that all medical professionals, especially the nurses who are administering the bulk of medication, need to aware of the differing viewpoints and controversies surrounding ethnic pharmacology including differing opinions about what define ethnicity. Vancouver is one of the most ethnically diverse cities in Canada yet in my experience it seems that the psychiatrists that I have worked with do not take into account the ethnicity of the client. I have never heard of ethnicity being discussed in rounds, even those that include the head pharmacist.   

     The McCabe (2004) article helped me examine my role as a nurse who provides medication to clients with various addictions and mental health issues. Only recently have I started to question the amount of medication that is prescribed to clients who present to health care centres with mental health symptoms like low mood or anxiety. In my experience I have found that many clients that I have encountered in detox and in the community are prescribed multiple antidepressants, or anxiety medication without being formally diagnosed by a psychiatrist. I have also found that some clients have continue on antidepressants for months without seeing any benefit. Similarly I find that many clients view the pharmacotherapy as a magic pill that is supposed to cure them, rather than viewing their treatment and recovery in a more holistic way. 

     I agree with McCabe that “psychiatric disorders are about pharmacology,” (pp. 6) because this is the first line of treatment. In some cases, for example clients with schizophrenia or bipolar disorder, medication has definitely made the difference in management of the disorder. Similarly, development of atypical antipsychotics has definitely improved the quality of life of clients with schizophrenia.  I think that McCabe (2004) presents the relationship between nurses, medication and the client as a very intricate relationship that requires the right amount of balance, skill and knowledge on the part of the nurse in order to effectively treat the client.

   

     It came as a surprise to me that the majority of spending by drug companies is now on marketing rather than research and development (McCabe, 2004). I always assumed that because the research and development process is so long and intensive, taking years of clinical trials prior to getting the drug into the market, that this would be the bulk of spending. Since I began nursing I have been more aware of the multitude of drug advertising on American television, often for products that are widely distributed in generic form in Canada.

     I never thought about the actual cost of medication until one shift when I was looking through the drug formulary and I saw the actual price charged for each medication. I noticed that trade name medications, the newer medications that are still patented, are incredibly expensive. For example, I was shocked to discover that one injection of Risperidone Consta (depo risperidone) costs approximately two hundred dollars.     In my experience the generic version of psychotropic medications are often used in the inpatient setting, while newer medication, though they may be more efficacious, are not often covered by private or public drug plans meaning that clients have to pay out of pocket.  I think that I often take for granted the actual cost of medication working inpatient psych and inpatient medical detox because it seems like we have free access to medication which is ultimately covered by provincial healthcare.

References 

Campinha-Bacote, J.(2007). Becoming culturally competent in ethnic psycopharmacology.   

     Journal of Psychosocial Nursing & Mental Health Services, 45(9), 27-33. 

McCabe, S.(2004). The perspective of mystery: Threading the connection between patient and

     nurse. Perspectives in Psychiatric Care, 40(1), 5-12. 

Farmer, R.L. (2003). Gender and Psychotropics: Toward a third wave framework. British Journal

     of Social work, 33(5), 611-623.

Ohlsen, R.I., & L.S. Pilowsky, (2007). Gender and psychopharmacology. In M. Nasser, K. Baistow, & J. Treasure The female body in mind: The interface between the female body and mental health (pp. 238-243