Shararah, I am so glad you mentioned the moral distress involved with administering SGAs as a nurse. It made me consider how moral distress plays a part in the settings you have worked in (where an MD prescribes and an RN administers) compared to my clinical site and similar settings (where the prescriber also administers the injection --- we don’t have RNs). I have definitely experienced moral distress at my clinical site, as I am following several TAY patients who are on oral or LAI SGAs with subsequent severe weight gain. My supervising psychiatrist is officially prescribing these medications, but I am administering them and will soon be prescribing them.
Under the psychiatrist’s supervision, I’ve also been starting patients on Metformin, ordering labs for metabolic monitoring, tracking patients’ weight, and trying my best to offer practical nutrition and wellness counseling. I have seen significant improvements in some patients’ psychotic and/or mood symptoms, but I am now witnessing severe weight gain and metabolic disturbances. In my clinical setting, the SGAs that are currently causing these side effects are clozapine, aripiprazole, and palliperidone.
Like you, I hope to use SGAs that are more likely to be weight-neutral when treating children and adolescents. Unfortunately, our choices are limited. I still hear people say aripiprazole is weight neutral, but that hasn’t been my experience and it doesn’t seem to be supported in the literature, particularly for children and adolescents (Goltz & Rice, 2017).
I think the issue of SGAs and metabolic disturbances will continue to create moral distress and challenge us to be astute providers who approach patient care holistically with an emphasis on wellness and prevention.
References:
Goltz, J. S., & Rice, T. R. (2017). Commentary: A Randomized, Double-Blind, Placebo-Controlled Trial of Metformin Treatment of Weight Gain Associated with Initiation of Atypical Antipsychotic Therapy in Children and Adolescents. Frontiers in Psychiatry,8. doi:10.3389/fpsyt.2017.00059
Vázquez-Bourgon, J., Pérez-Iglesias, R., Foz, V. O., Pinilla, P. S., Martínez, Á D., & Crespo-Facorro, B. (2017). Long-term metabolic effects of aripiprazole, ziprasidone and quetiapine: A pragmatic clinical trial in drug-naïve patients with a first-episode of non-affective psychosis. Psychopharmacology,235(1), 245-255. doi:10.1007/s00213-017-4763-x