Abstract
It is estimated that 6% of adults (1 in 17) are diagnosed with a serious and persistent mental illness (SPMI) (http://www.census.gov/popest/national/asrh; Arch Gen Psychiatry. 2005:62[6]:617-627. The defining diagnoses of SPMI consist of 90% schizophrenia, 40% to 50% bipolar disorder, 40% to 50% depression, and 100% dementia (Psychiatric review course, July 21, 2007). The overlay of bipolar disorder or depression and schizophrenia is called schizoaffective disorder. Over the course of a lifetime, a person with bipolar disorder spends approximately 15% of his or her time in a manic state (Psychiatric review course, July 21, 2007). Extended disability for most of the individual's lifetime is the characteristic that makes the illness persistent and serious (J Am Geriatr Soc. 2004:52[12 suppl]:249-257). In 2004, more than 1 million people received care from more than 3,600 hospice organizations in the United States; consequently, it is possible that as many as 54,000 patients nationwide in hospice care could have an SPMI. It is important that hospice nurses be better prepared to care for individuals who fall into this diagnostic category. Having some understanding of medications used to treat mental illness is equally important.