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LONG BEACH, Calif. – Patients take antipsychotics when they aren't delusional, antihypertensives when they don't have high blood pressure, and stimulants when they're already wired up by attention-deficit/hyperactivity disorder (ADHD). Is it any wonder, psychiatric nurses asked at a conference here, why patients are confused?

The solution, the speakers said, is to overhaul how types of drugs are named.

The current naming system "is confusing for everyone. It does not accurately describe how we use the medications and how they work, and it doesn't give us the information that we need to make the best treatment decisions," said Lyons Hardy, PMHNP, of Virginia Commonwealth University in Richmond, in a presentation at the annual meeting of the American Psychiatric Nurses Association. "Obviously, our naming system has some room for improvement."

Hardy and co-presenter Erin Ellington, DNP, PMHNP-BC, of the University of Missouri-Kansas City, urged colleagues to rely on so-called Neuroscience-based Nomenclature (NbN), which was developed by a task force of the American College of Neuropsychopharmacology and other neuropsychopharmacology organizations. The NbN guidelines' stated aim is to move from "a disease-based classification ... to a pharmacologically driven classification, in order to shift from symptoms to mechanisms, from disease to pharmacology."

Under NbN, the focus is on dividing 130 drugs into nine mechanisms of action. Methylphenidate (Ritalin) is defined as a neurotransmitter releaser instead of a stimulant, fluoxetine (Prozac) is a reuptake inhibitor instead of an antidepressant, and clonazepam (Klonopin) is an enzyme modulator instead of a tranquilizer, sedative, or benzodiazepine.

According to Hardy, the current naming system leads to poor communication between medical providers and patients, "which to be associated with poor treatment, adherence, and poor outcomes."

For example, he said, a patient may ask, "Why are you giving me an antidepressant for anxiety?" Or, he said, a parent may be mystified about why their child is being prescribed the tranquilizer clonidine, which is classified as an antihypertensive. "They go to the pharmacy and get information about the blood pressure medication that you have given to their child. Even though you have done your education [with them] beforehand, they get a little nervous, a little panicky, and they call you and start asking questions."

Patients can also wonder why they're being prescribed a second-generation medication instead of a better-sounding first-generation alternative or an antidepressant for a non-depressive condition such as migraines or neuropathy, according to Hardy's presentation.

Then there's the wide category of so-called mood stabilizers. "Can anybody give a good definition of what a mood stabilizer is?" Ellington asked the audience. "Please, anybody?"

Under NbN, she said, antipsychotics -- a type of mood stabilizer -- aren't lumped together based on when they were released (first vs second generation) or as typical or atypical types. "The atypicals work very differently depending on which one it is that we're looking at, but they're all still kind of categorized as atypicals."

Under NbN, the second-generation antipsychotic aripiprazole (Abilify) is categorized as a receptor partial agonist, and the atypical antipsychotic risperidone (Risperdal) is a receptor antagonist.

Adopting NbN should improve communication, Hardy said. And "theoretically, making things clear for patients should lead to better outcomes."

According to Hardy, several journals have adopted NbN, including The Lancet, JAMA Psychiatry, Biological Psychiatry, Neuropsychopharmacology, CNS Spectrums, European Psychiatry, and Clinical Psychopharmacology and Neuroscience.

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