Common Challenges for Clinicians Prescribing Antipsychotics

Discover the critical importance of early identification and intervention in bipolar disorder management as Desiree Matthews, PHMNP-BC, from Monarch community mental health center in Charlotte, North Carolina, sheds light on the hurdles clinicians encounter in diagnosing this complex condition. Uncover the nuances of treatment selection, from mood stabilizers to second-generation antipsychotics, as Nurse Matthews discusses navigating the delicate balance between efficacy and side effects and minimizing adverse effects to optimize patient outcomes in bipolar disorder care.

Find more expert insights on bipolar disorder treatment in our Bipolar Disorder Excellence Forum.

Read the Transcript: 

Psych Congress Network: What are the primary challenges for clinicians working with patients with bipolar disorder? What about challenges for clinicians prescribing antipsychotics in general?

Desiree Matthews, PMHNP-BC: When it comes to treating bipolar disorder, one of the biggest challenges that I find is that oftentimes, by the time they get into my door in community mental health, they've been experiencing symptoms of bipolar disorder for 5, 10, even 15, 20 years. And as we know with the course, if bipolar disorder is not identified early on and is not treated adequately, the ability to treat later on in life becomes very difficult, the longer the illness goes untreated.

So I urge my colleagues and clinicians to really consider actively screening your patients that come in with complaints of depression for history of mania or hypomania. There are some great tools out there, like the mood disorder questionnaire, as well as the rapid mood screener or RMS. These are very helpful tools to screen patients for those historical symptoms that maybe they're not thinking about right now because they're in your office complaining that they're depressed, they can't get out of bed. They're not thinking about those times where they had this elevation, energy, euphoria. They're maybe getting a lot of things done, or so they think. Oftentimes mania and hypomania especially, very much go unreported, so I would say that would be a big challenge, just making the diagnosis.

When it comes to picking and choosing treatment for bipolar disorder, this can be a challenge. When you consider treatment options, we have mood stabilizers including lithium, but these come with limitations. They come with side effects. Many of my patients have essentially voted with their feet and do not really want to take mood stabilizers anymore due to concerns with weight gain, hair loss, sedation, and the need to get labs frequently, like with lithium.

With our second-generation antipsychotic treatments, well, those too come with limitations, weight gain, sedation, the risk of drug-induced movement disorders, and when you consider specifically treatment for bipolar disorder, especially with the depressive episodes, we only have 2 that are FDA approved, and when you consider bipolar 1 depression, we have 5 antipsychotics to choose from, that are FDA approved. So even the shortlist can be a problem because if patients have failed 1 or 2, we might not be left with a lot of room to work with, and that's when really knowing the art of managing side effects and minimizing the side effects is important for your patients.

Desiree Matthews, PHMNP-BC, is a board-certified Psychiatric Mental Health Nurse Practitioner. She received her Bachelor's of Nursing from University at Buffalo and her Master's of Nursing at Stony Brook University. She currently resides in Charlotte, NC, and practices at Monarch, a community mental health center providing telepsychiatry services to adult patients. Clinical interests include the treatment of schizophrenia, bipolar disorder, treatment-resistant unipolar depression, and drug-induced movement disorders, including tardive dyskinesia. She has provided faculty expertise and insight into the development of a clinical screener for TD called MIND-TD.