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Transcript
Chapter 35 Care of the Patient with a Psychiatric Disorder Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Mental Health Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2 Care of the Patient with a Psychiatric Disorder • The nurse should have basic understanding of the classifications of human responses and treatments for mental illness. • It is important for nurses to be able to interact therapeutically with both the physical and emotional aspects of patient care. Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3 Care of the Patient with a Psychiatric Disorder • Neurosis Ineffective coping with stress that causes mild interpersonal disorganization Remains oriented to reality but may have some degree of distortion of reality manifested by a strong emotional response to the trigger event • Psychosis Out of touch with reality and severe personality deterioration, impaired perception and judgment, hallucinations, and delusions Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4 Involuntary admission • Pg.1135 • Also referred to as “probating” • Carried out by a judge, physician or clinical psychologist • Must prove that the patient is thought to be a danger to himself or others Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5 Organic Mental Disorders • Delirium A rapid change in consciousness that occurs over a short time Causes • Physical illness Fever, heart failure, pneumonia, azotemia, or malnutrition • Drug intoxication • Anesthesia Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6 Organic Mental Disorders • Delirium (continued) Symptoms • Reduced awareness and attention to surroundings, disorganized thinking, sensory misinterpretation, and irrelevant speech • Disturbed sleep patterns • Sundowning syndrome: increased disorientation and agitation during the evening and nighttime Treatment • Focused on problem causing the imbalance Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7 Organic Mental Disorders • Dementia A slow and progressive loss of brain function that is often irreversible Causes • Cerebral disease Alzheimer’s (most common type) Vascular dementia Symptoms • • • • Impaired memory and judgment Personality changes Decreased cognitive function Impaired orientation Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8 Organic Mental Disorders • Dementia (continued) Treatment • Medications Agitation: lorazepam, Haldol Dementia: Cognex, Aricept etc… • Nutrition Finger foods; frequent feedings • Safety Removing burner controls at night Double-locking all doors and windows Constant supervision Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9 Organic Mental Disorders • Dementia and Delirium Nursing interventions • Reality orientation techniques Clock and calendar Curtains open and lights on during the day Calm supportive approach • Decreased sensory stimuli No crowds One instruction at a time; keep it simple Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10 Organic Mental Disorders • Dementia and Delirium (continued) Nursing interventions (continued) • Provide for safety Bed in low position Side rails up Rails in hallways Chair and bed alarms Call light and personal articles in reach Sufficient night light Consistency and simplicity Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11 Organic Mental Disorders • Dementia and Delirium (continued) Nursing interventions (continued) • Adequate nutrition Reduce dining distractions: TV. Encourage snacks: finger foods. Monitor weight. • Self-care support Assist with ADLs as needed. Encourage mobility and other activities that use large muscle groups. Daily routine should be the same time each day. Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12 Thought Process Disorders • Schizophrenia Bizarre, non–reality-based thinking Causes • Brain tissue changes Ventricles of the brain larger than normal Cerebral cortex smaller that normal • Dopamine hypothesis :Excessive dopamine (neurotransmitter) (no longer a hypothesis) Symptoms are individualized but include • • • • Hallucination; disordered thinking (positive behavior) Apathy and social withdrawal (negative behavior) Flat affect (negative behavior) Delusions (positive behavior) Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13 Schizophrenia Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14 Behavior Patterns (page 1140) • Positive behavior patterns: include delusions, hallucinations and disordered thinking which also includes “loose association and concreteness.” Loose association creates conversations that are difficult to follow. Responses may not relate to the question asked. Prognosis is good…fewer structural changes in the brain and better response to medication therapy. Positive behaviors are also considered “excessive.” Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15 Hallucinations • A sensory experience that cannot be corrected by feedback and is not accepted as true by others in culture Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 16 Delusions • • • • • • • Grandeur Ideas of Reference Persecution Somatic Thought broadcasting Thought insertion Thought withdrawal Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 17 Behavior patterns cont’d (page 1140) • Negative behavior patterns: include apathy, social withdrawal, alogia, blunted emotional responses, and anhedonia. Apathy is lack of energy, wants to “sit around and do nothing.” May include an “unkempt” appearance, no desire to “clean up” etc… Social withdrawal is the result of “over stimuli” to the brain. Tend to “withdraw” from contact, isolate. Alogia is a reduced content of speech due to “overload.” Flat affect and anhedonia are terms describing the lack of expressed feelings. See page 1141 Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 18 Thought Process Disorders • Schizophrenia (continued) page 1141 Five subtypes • Disorganized: flat affect, poor prognosis • Paranoid : delusions etc…prognosis good with treatment • Catatonic : stupor etc…prognosis fair • Undifferentiated : delusions, hallucinations etc…prognosis fair • Residual : typical S & S associated with schizophrenia without “gross disorganization,” delusions etc…prognosis poor Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 19 Stages of schizophrenia (page 1141) • Prodromal : may begin in adolescence. Lack of energy, motivation…tend to withdraw. Affect may become blunted, beliefs odd etc… • Prepsychotic : quiet, passive, prefers to be alone. Hallucinations and delusions may occur. Odd behaviors…family members notice • Acute phase: S & S vary widely, looses contact with reality and is unable to function. • Residual phase: similar to prodromal phase, follows the acute phase. Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 20 Thought Process Disorders • Schizophrenia (continued) Treatment • Psychotherapies • Antipsychotic drug therapy: refer to handout (psychotherapeutic medications) • Therapeutic relationship Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 21 Major Mood Disorders: Depression and Bipolar Disorder • Mood Disorders Also known as affective disorders Psychotic disorders characterized by • Severe and inappropriate emotional responses • Prolonged and persistent disturbances of mood and related thought distortions • Other symptoms associated with either depressed or manic states Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 22 Major Mood Disorders: Depression and Bipolar Disorder • Mood Disorders (continued) Cause • Hereditary factors Account for about 60% to 80% • Biologic May be inherited or environmental factors such as prolonged stress or brain trauma o Depression: insufficiency of norepinephrine and serotonin o Mania: excess norepinephrine Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 23 Major Mood Disorders: Depression and Bipolar Disorder • Mood Disorders (continued) Symptoms: Depression • Mood disturbance characterized by exaggerated feelings of sadness, despair, lowered self-esteem, loss of interest, and pessimistic thoughts Neglect of appearance, difficulty concentrating, complaints of physical problems, disturbed sleeping or eating patterns, loss of self-esteem, feelings of helplessness, hopelessness, extreme anxiety or panic Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 24 Depression Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 25 Major Mood Disorders: Depression and Bipolar Disorder • Mood Disorders (continued) Symptoms: Depression • Unipolar Major depression (severe depressive episodes lasting more than 2 years) • Dysthymic disorder Daily moderate depression lasting more than 2 years Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 26 Major Mood Disorders: Depression and Bipolar Disorder • Mood Disorders (continued) Mania • Persistent abnormal overactivity and an euphoric state • Hypomanic When manic symptoms are not severe • Bipolar Manic-depressive • Cyclothymic Involves repeated mood swings of hypomania and depression Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 27 Bipolar Mania Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 28 Major Mood Disorders: Depression and Bipolar Disorder • Mood Disorders (continued) Treatment • Antidepressants Prozac (fluoxetine); Desyrel (trazodone); Elavil (amitriptyline); Effexor (venlafaxine) • Lithium Used to treat bipolar disorders Must be monitored closely Refer to handouts etc. for further information, know symptoms of toxicity and levels • Electroconvulsive therapy (ECT) May be used when drug therapy is ineffective • Psychotherapy Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 29 Anxiety Disorders • Anxiety is a normal response to stress or a threat. • Anxiety is a state of feeling of apprehension, uneasiness, agitation, uncertainty, and fear resulting from the anticipation of some threat or danger. • Signal anxiety A learned response to an event such as test taking • Free-floating anxiety Feelings of dread that cannot be identified • Anxiety trait A learned aspect of personality; anxious reactions to relatively nonstressful events Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 30 Anxiety Disorders • Generalized anxiety disorders are characterized by a high degree of anxiety and/or avoidance behavior. Panic: Acute, intense, and overwhelming anxiety Agoraphobia: High anxiety brought on by possible situation such as people, places, or events Obsessive-compulsive disorder: Recurrent, intrusive, and senseless thoughts and behaviors that are performed in response to the obsessive thoughts Posttraumatic stress disorder (PTSD): Response to an intense traumatic experience that is beyond normal experience Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 31 Mental Health • Agoraphobia Anxiety about being in places or situations where escape may be difficult or embarrassing Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 32 Mental Health • Obsessive – Compulsive Disorder Obsession: • Recurrent and intrusive thoughts that cause marked distress Compulsions: • Repetitive behaviors or mental acts that affect person feels driven to perform in response to obsessive thoughts Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 33 Anxiety Disorders • Treatment Panic disorders • Educate on the nature of the disorder. • Assist to develop better coping mechanisms. • Block attacks pharmaceutically. Posttraumatic stress disorder • Antidepressant or antiseizure medications • Cognitive therapy or behavioral therapy • Debriefing right after the event Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 34 Mental Health • Post-Traumatic Stress Disorder First recognized in war veterans Debilitating condition that follows an extreme traumatic stressor. • Persistent reexperiencing of the traumatic event • Avoidance of stimuli associated with the trauma • Numbing of general responsiveness • Increased arousal, exaggerated startle response, hypervigilance • Flashbacks Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 35 Anxiety • Physical symptoms Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 36 Personality Disorders • Inflexible and maladaptive patterns of behavior or thinking that are associated with significant impairment of functioning. • Characterized by Lack of insight, concrete thinking, poor attention, unable to understand consequences of behavior Distorted self-perception, either hatred or idealizing of self Impaired relationship, projects own feelings onto others, poor impulse control Inflexible behavioral response patterns; cannot handle change Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 37 Personality Disorders • Personality disorders are inflexible, maladaptive patterns of behavior or thinking associated with significant impairment of functioning. Abusive personality Dependent personality Paranoid personality Borderline personality Antisocial personality Lack of insight Concrete thinking Poor attention Inability to understand consequences of behavior Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 38 Personality Disorders Borderline Personality Disorder No self-identity Fears being alone Severe abandonment issues High drama Instigates staff-splitting Requires a high level of structure and consistency Broken record approach Assign to only one staff member Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 39 Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 40 Personality Disorders • • • • • Box 35-3 pg1147 Abusive personality Dependent personality Paranoid personality Borderline personality Antisocial personality Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 41 Nursing Interventions • Refer to handout “ Basic Guidelines for Working with • • • the Mentally Ill Patient” Staff need to be “on the same page” Firmness and consistency Nonjudgmental Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 42 Sexual Disorders • “Normal” sexual behavior is difficult to define because of cultural influences, religious institutions, and a society’s laws, all of which affect an individual’s belief of what is acceptable and unacceptable sexual behavior. Adaptive sexual behaviors • Occur in private between two consenting adults • Satisfying and not forced on each other Maladaptive sexual behaviors • Harmful sexual actions to self or others • May be performed publicly and sometimes without the other’s consent Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 43 Sexual Disorders • Sexual Orientation The preference one chooses for his or her sex partner • Heterosexual Individuals who express their sexuality with members of the opposite sex • Homosexual Individuals who express their sexuality with members of the same sex Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 44 Sexual Disorders • Sexual Dysfunction A disturbance during sexual response May be psychological or physiological • Dyspareunia Painful intercourse • Hypoactive sexual desire • Premature ejaculation Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 45 Sexual Disorders • Paraphilias A group of sexually gratifying activities that are not common to the general public and are illegal in some countries, including the United States • Pedophilia Fondling and/or other sexual activities with a child by an adult • Exhibitionism (flashing) Exposing one’s genitals to unsuspecting people to achieve arousal Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 46 Sexual Disorders • Paraphilias (continued) Voyeurism • Sexual gratification by observing others during intercourse or by viewing another’s genitals Frotteurism • Sexual arousal achieved by rubbing against or touching a nonconsenting individual Fetishism • Using an object, usually an article of clothing, to attain sexual arousal • Usually followed by masturbation Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 47 Sexual Disorders • Paraphilias (continued) Transvestic fetishism • Wearing clothing of the opposite sex (cross-dressing) to obtain sexual gratification Sexual sadism • Sexual arousal by inflicting pain or humiliation on another; spanking, stabbing, or strangulation Masochism • Sexual arousal by receiving mental or physical abuse; punishment necessary to achieve sexual gratification Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 48 Sexual Disorders • Gender Identity Disorder Conflict of biological sex identity and gender perception Person believes he or she was born in the body of the incorrect sex Transsexualism • A persistent desire to have the body of the opposite sex • Biologic sex change Psychological counseling Hormone treatments Major surgical procedures; not reversible Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 49 Sexual Disorders • Therapeutic Interventions Intervention depends on the type or disorder. Most are treated on an outpatient basis. Psychosexual problems can be complex and require the skill of specially educated physicians, nurses, or therapists. Nurses need to be aware of their own attitudes and values about sexual behavior. • Be careful of nonverbal messages. • Quality of nursing judgment and care must not be affected. Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 50 Psychophysiologic Disorders • Psychosomatic illness Physical disorder brought on by a psychological trigger • Implication is that “it’s all in your head.” • Physical signs of emotional distress are very real. • Psychophysical illness More recent term Stress-related problems that can result in physical signs and symptoms Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 51 Psychophysiologic Disorders • Somatization This disorder is characterized by recurrent, multiple, physical complaints and symptoms for which there is no organic cause. An individual’s feelings, needs, and conflicts are manifested physiologically. Diagnosis is made by ruling out any possible physical causes of dysfunctions, any drug or other toxic substance reaction, or mental health problems. It may be referred to as Briquet’s syndrome. Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 52 Somatization Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 53 Eating Disorders • Anorexia Nervosa Severe form of self-starvation that can lead to death Occurs predominantly in adolescent girls of aboveaverage intelligence Intense fear of obesity, bizarre attitudes toward food, and a disturbed self-image Not about food; about self-control and willpower Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 54 Eating Disorders • Anorexia Nervosa (continued) Nursing interventions • Develop a trusting relationship. • Promote better nutrition. Stress-free meal time Frequent small meals • Set limits to decrease manipulation and procrastination behavior. • Encourage to express feelings. • Offer unconditional acceptance of both negative and positive feelings expressed. Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 55 Eating Disorders • Bulimia Nervosa Closely related to anorexia nervosa Episodes of overeating followed by purging • Induced vomiting, laxatives, diuretics, fasting, vigorous exercise Occurs primarily in white females of high-school age, middle- to upper-class and well-educated • Low self-esteem; lack of control • Guilt; anxiety; depression • Physical signs: hoarseness and esophagitis, dental erosion, palate lacerations, weakness or fatigue, electrolyte imbalance Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 56 Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 57 Eating Disorders • Anorexia Nervosa and Bulimia Nervosa Treatment • • • • Behavior modification Individual psychotherapy Family therapy Psychopharmacology Fluoxetine (Prozac) Sertraline (Zoloft) Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 58 Eating Disorders Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 59 Overview of Treatment Methods • Communication and Therapeutic Relationship Psychotherapy • • • • • • • Behavior therapy Cognitive therapy Group therapy Play therapy Hypnosis Psychoanalysis Adjunctive therapies Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 60 Overview of Treatment Methods • Electroconvulsive Therapy (ECT) Treatment for depression, mania, or schizophrenia disorders that do not respond to other treatments A very small amount of electrical current required to trigger a tonic-clonic (grand mal) seizure • Temporary memory loss Last a few hours to a few days • Confusion Lasts a few hours Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 61 Overview of Treatment Methods • ECT (continued) Nursing Interventions • Pre-ECT Informed consent; NPO for 8 hours Baseline vital signs; void prior to treatment All jewelry, glasses, contacts, dentures, and hairpins removed IV line inserted; pre-ECT medications given • Post-ECT Frequent vital signs; warm bath Constant supervision due to confusion Cannot drive themselves home due to use of anesthetics and procedure itself Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 62 Psychopharmacology • Refer to Pharmacological Aspects of Nursing Care Chapter 28 and handouts. • Antidepressants Selective serotonin reuptake inhibitors (SSRIs) • Fluoxetine (Prozac), sertraline (Zoloft), venlafaxine (Effexor), citalopram (Celexa), paroxetine (Paxil) Serotonin syndrome o o Potentially life-threatening condition Occurs due to an interaction between SSRI and another serotonergic agent Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 63 Psychopharmacology • Antidepressants (continued) Tricyclics (tend to cause sedation) • Amitriptyline (Elavil), amoxapine (Asendin), desipramine HCl (Norpramin), imipramine HCl (Tofranil), nortriptyline HCl (Avnetyl, Pamelor) Monoamine oxidase inhibitors (MAOIs) • Phenelzine sulfate (Nardil) • Tranylcypromine sulfate (Parnate) Triazolopyradines • Trazodone (Desyrel) • Bupropion (Wellbutrin) Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 64 Psychopharmacology • Antimanics Stabilizes mood and behavior of a patient with mania Therapeutic blood level required • May take 7 to 10 days to achieve Lithium carbonate (Eskalith, Lithobid) • Monitor for lithium toxicity Serum level above 1.5 mEq/L Nausea, vomiting, diarrhea, drowsiness, muscle weakness, and ataxia Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 65 Psychopharmacology • Antipsychotics Major tranquilizers Treatment of schizophrenia, organic mental disorders with psychosis, and the manic phase of bipolar mood disorder Provide symptomatic control; not a cure Side effects • • • • Postural hypotension Sedation Photosensitivity Autonomic reactions Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 66 Psychopharmacology • Antipsychotics (continued) Side effects • Extrapyramidal symptoms Pseudoparkinsonism Akathisia Dystonias Dyskinesia Tardive dyskinesia • Treatment of extrapyramidal symptoms Reduce or stop the drug, parenteral diphenhydramine, antiparkinson drugs Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 67 Psychopharmacology • Antipsychotics (continued) • • • • • • • Chlorpromazine (Thorazine) Thioridazine HCl (Mellaril-S) Trifuloperazine HCl (Stelazine) Fluphenazine HCl (Prolixin, Permitil) Perphenazine (Trilafon) Thiothixene (Navane) Haloperidol (Haldol) Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 68 Psychopharmacology • Antianxiety Minor tranquilizers Help individuals experiencing moderate to severe anxiety Drugs in this category are commonly abused Examples • • • • • • Alprazolam (Xanax) Busipirone (Buspar) Chlordiazepoxide HCl (Librium) Clorazepate dipotassium (Tranxene) Lorazepam (Ativan) Oxazepam (Serax) Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 69 Alternative Therapies • Use of natural or herbal medications has gained tremendous popularity. • Control and manufacture of these medications do not fall under the laws of the U.S. Food and Drug Administration. Quality and quantity vary from manufacturer to manufacturer. Claims and clinical studies are not always consistent. • Nurse should ask about the use of herbs when obtaining drug history. Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 70 Alternative Therapies • Examples St. John’s wort (Hypericum) • Used for mild depression – may also precipitate mania in a bipolar patient Kava (Piper methysticum) • Used in treating anxiety and insomnia Ginkgo and ginseng • Used to improve memory and boost energy Aromatherapy • Used to enhance or potentiate another remedy Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 71