T4 MENTAL HEALTH #4

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T4 MENTAL HEALTH #4
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T4 MENTAL HEALTH #4
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  1. PSYCHOANALYSIS
    • Classical Psychoanalysis is a therapeutic process of Assessing unconscious thoughts/feelings & resolving conflict through talking to an analyst for many sessions over months to years
    • Defense Mechanism & Past Relationships are a common focus for Therapy
  2. PSYCHOTHERAPY
    A trusting relationship is developed between client & therepist to explore clients problems
  3. COGNITIVE BEHAVIORAL THERAPY
    • Type of Psychotherapy , based on Cognitive model, which focuses on client thoughts & behaviors to solve current problems
    • Used to treat depressions, anxiety, eating disorders, & other problems that can be improved by changing the client's attitudes toward life experiences
    • Therapy is time limited, active, structured, & directive - helps people identify distorted thoughts (bad beliefs about themselves) & to evaluate wether those thoughts ( cognitions) are realistic

    • Types of Behavioral Therapy
    • Modeling - the therapist or others serve as role Models for the Clients, who learns improved behavior by imitation
    • Operant Conditioning - rewards are given for Positive behavior (positive reinforcement such as grooming
    • Systematic Desensitization - type of behavior modification used to lessen the phobias of a specific client
    • Aversion therapy - A maladaptive behavior is paired with a Punishment or unpleasant stimuli to change the behavior

    • Group Therapy
    • Group Norm - the way the group behaves during sessions, & overtime, provides structure & support for the group

    • Focus & Goals of Therapies
    • Group
    • Focus on helping individuaks develop more functional & satisfying relations within a grup setting (group members support each other)
    • Goals vary but generally clients discover that members share same common feelings, experiences, & thoughts; experience positive behavior changes as a result of group interaction & feedback
  4. STRESS
    The effects of stressors is cumulative at any given time
  5. COGINITIVE-BEHAVIORAL METHODS FOR STRESS MANAGEMENT
    • Cognitive Reframing - Client looks at irrational thoughts in more realistic light & restructures the thoughts in more positive way
    • Priority Restructuring - client learns to prioritize differently to decrease number of stressors; the client may delgate tasks to others rather than doing everything himself
    • Assertiveness Training - Client learns to communicate in a more assertive (not aggressive) manner in order to decrease psychological stressors; When you keep telling me what to do, i feel angry & frustrated. I need to try making my own decisions
  6. ELECTROCONVULSIVE THERAPY
    • Electroconvulsive Therapy - (ECT) is an alternative somatic treatment that has been in use for 60 years & is still administered to 100,000 clinets each year in the U.S.
    • Although some studies have shown 80% of severely depressed clients improve, other studies indicate high relapse rate
    • Side Effects: Temporaty memory loss & confusion

    • Indications for ECT
    • Severe Depression
    • - Not Responsive to Pharmacologic Tx
    • - Actively suicidal & in need of Rapid response

    • ECT Procedure
    • - Severe hypertension should be controlled before the procedure, since a short period of Hypertension occurs after ECT is performed
    • - Prior to Tx, an anticholinergic, such as Atropine Sulfate is given to dry up oral secretions
  7. ANXIOLYTICS (ANTIANXIETY):
    • Benzodiazepines
    • Withdrawal > likely when drug is taken for 3 months or more & abruptly discontinued; Taper

    • Non-Barbiturate
    • Buspirone (BuSpar)
    • - No Potention for Abuse
    • - Does not result in sedation

    • Non-Barbiturates, Non-Benzodiazepine
    • Buspirone (BuSpar)
    • - Take Medication withFood
    • - Effects may take several weeks
    • - Not used on a PRN basis, taken routinely

    • Benzodiazepines:
    • - Flumazenil (Romazicon) for IV toxicity; have rescucitation equipment available (antidote)
  8. SEDATIVES & HYPNOTICS
    • Child may experience withdrawal symptoms in the postnatal period
    • Zolpidem (Ambien) may cause memory loss or amnesia; person may not remember getting out of bed, driving or eating

    Symptoms of Barbiturate withdrawal syndrome appear 12-20 hrs after the last dose; anxiety irritability, increase heart & respiration rate, muscle pain; nausea, tremors, hallucinations, confusion, & seizures, & death

    • Nonbenzodiazepines:
    • Zolpidem (Ambien) Zaphelon (Sonata) Eszopiclone (Lunesta) Trazodone (Desyrel)
    • - Food decreases the absorption of the drug; advise client to take on an empty stomach
  9. TRICYCLIC ANTIDEPRESSANTS
    • Generalized A/R: anticholinergic effects (sedation, dry mouth, visual disturbances, urinary retention), constipation, Photosensitivity, Orthostatic hypotension
    • Doxepin (Sinequan) is contraindicated in clients with Glaucoma or Tendency for Urinary Retention (older men with BPH)
    • Used cautiously in Cardiac, hepatic, or renal disease, hyperthyroid disease, history of seizures, narrow angle glaucoma, urinary retention, and risk of suicidal ideation or behavior (very lethal in overdose)
    • Clomipramine (Anafranil) is associated with gynecomastia (men & women)
    • The TCA's must be tapered when discontinuing the medication
  10. SEROTONIN SELECTIVE REUPTAKE INHIBITORS (SSRIs)
    • SSRIs may cause weight gain; encourage regular exercise, & healthy low calorie diet
    • Serotonin Syndrome begins 2-72 hours after starting Tx: Mental confusion, agitation, anxiety, hallucinations, hypreflexia; fever restlessness, tremors; notify the PCP & stop the medication
    • Do not use within 2 weeks of stopping an MAOI antidepressant
  11. MONOAMINE OXIDASE INHIBITORS (MAOIs)
    • Neuromuscular A/R: Orthostatic Hypotension, dizziness, vertigo, headache blurred vision
    • Hypertensive Crisis: occur when foods containing Tyramine are eaten; headache nausea; increase heart rate & B/P

    • Foods Containing Tyramine
    • - Aged Cheese, sour cream, yogurt
    • - Beef or Chicken livers, pickled herring, fermented meats (Bologna, hot dogs, pepperoni, dried fish)
    • - Undistilled alcoholic beverages (beer, ale, red wine, especially Chianti & Sherry)
    • - Caffeinated Beverage (coffee, tea, colas), chocolate
    • - Avocado, bananas, fava beans, figs, raisins, sauerkraut, yeast extracts, soy sauce
  12. ATYPICAL ANTIDEPRESSANTS
    • The smoking cessation product is bupropion (Wellbutrin, Zyban)
    • NeuroMuscular System A/R: Seisures (Bupropion)
    • Trazodone (Desyrel) may cause an uncommon but potentially serious a/r: Priapism, a Persistent, painful erection of the Penis
    • If Priapism occurs the drug is discontinued immediately
  13. NURSING INTERVENTIONS FOR CLIENTS ON ANTIDEPRESSANT DRUGS
    • Avoid prolonged exposure to sunlight or sunlamps because exaggerated reaction to the ultraviolet light may occur (Photosensitivity)
    • Response to Antidepressant medications is not Rapid, it can take a number of weeks for the drugs to take effect (10 days to 4 weeks)
    • The Nurse should monitor the client for Suicidal Ideation or Behavior when the antidepressant becomes effective; they now have energy
    • SSRIs should be adminsitered in the morning
    • Inspect client's oral cavity to be sure the drug was swalloed
  14. ANTIPSYCHOTIC DRUGS
    • Used to treat Acute & Chronic Psychosis
    • Generalized A/R: Sedation, headache, hypotension, dry mouth, nasal congestion, urticaria, Photophobia, Photosensitivity
    • Changes in psychotic behaviors may not be seen for days or weeks, although adverse reactions may occur before then

    • ExtraPyramidal Syndrome (EPS)
    • Symptoms: Parkinson-like symptoms akathisia (restless movements), dystonia (facial grimacing & twisting of the neck into unnatural positions
    • Typically the primary health care provider prescribes Trihexyphenidyl (Artane), Biperiden (Akineton), or Benzotropine (Cogentin)

    • Tardive Dyskinesia (TD)
    • - Symptoms: Rhytmic, Involuntary movements of the tongue, face, mouth, or jaw & sometimes the etremities
    • - Tongue may protrude and there may be chewing movements, mouth puckering, or facial grimacing
    • - Drug Therapy must be discontinued

    • Neuroleptic Malignant Syndrome
    • - Rare reaction characterized by a combination of Extrapyramidal effects, Hyperthermia & autonomic disturbance
    • - Potentially fatal; immediate discontinuation of Drug

    • Atypical Antipsychotic: Clozapine (Clozaril)
    • - May cause agranulocytosis (bone marrow suppression): monitor weekly WBC
    • - May Cause seizures, weight gain, excessive salivation, tachycardia, no EPS
    • - High Incidence of Anticholinergic side effects

    • Nursing Interventions for Clients on Antipsychotic Medications
    • - Offer frequent sips of water to prevent dry mouth
    • - Assist client in/out of bed or chair, & supervise all ambulation if orthostatic hypotension occurs
    • - Drugs may cause extreme drowsiness & sedation; administer at bedtime to minimize risk of injury
    • - Instruct client to avoid exposure to the sun
    • - Depot Preparations may be used for clients with difficulty maintaining medications regimen: Medications are adm. IM on an outpatient basis every 1-3 weeks; drugs inc: fluphenazine (Prolixin) Decanoate; haloperidol (Haldol) decanoate, perphenazine (Trilafon) decanoate
  15. MOOD STABILIZERS
    • Lithium Carbonate, Valproic acid (Depakote), carbamazepine (Tegretol)
    • Used in the Tx of Bipolar disorders to control episodes of acute Mania & to help prevent the return of Mania Depression acloholism bulimia schizoprenia
    • Most common A/R of Lithium: Tremors, Nausea, Vomiting, Thirst, & Polyuria.
    • Monitor Plasma Lithium Levels during Tx at initiation, monitor every 2-3 days & then every 1-3 mos: 0.6-1.2 mEq/L is desirable
    • - Initial Tx: 0.8-1.4 mEq/L
    • - Maintenance: 0.4-1.0 mEq/L
    • - Levels > 1.5 mEq/L --> toxicity
    • Lithium is contraindicated in Clients with hypersensitivity to tratrazine, renal or Cardiovascular disease, sodium delpletion; dehydration, & in clients recieving diuretics
    • Monitor for signs of Lithium Toxicity: Diarrhea, vomiting, Nausea, drowsiness, muscle weakness, incoordination
    • Clients on Lithium need to Increase fluid intake to 3000 ml/day
    • Lithium is excreted as a salt, so add extra salt to food
    • Take Lithium with food or after meals to prevent stomach upset
    • Sun exposure --> to dehydration --> toxicity
    • avoid caffeine (coffee tea or chocolate)
    • Lithium may cause renal toxicity monitor I&O, daily weights baseline kidney function test(BUN, Crt)
  16. MOOD STABILIZERS DRUGS
    • Vaproic Acid (Depakote)
    • - May cause nausea , vomiting, indigestion: take drug with food
    • - Should not be used by those pregnant or nuirsing; need to use contraception
    • - Regular serum levels are necessary due to drug toxicity
    • Carbamazepine (Tegretol)
    • - Should not be taken with MAOIs & should not be used by those pregnant or nursing
    • - Regular serum levels are necessary due to drug toxicity
  17. MEDICATIONS FOR COGNITIVE DISORDERS:
    • Alzheimer's Disease:
    • - Estrogen therapy for women may prevent Alzheimer's disease but does not decrease effects of existing dementia

    • Cholinesterase Inhibitors:
    • Donepezil (Aricept)
    • - increase availability of acethylcholine at cholinergic synapses
    • Memantine (Namenda)
    • - Block Entry of Calcium into nerve cells slowing down brain cell death
  18. MEDICATIONS FOR ATTENTION DEFICIT HYPERACTIVITY DISORDERE (ADHD)
    • CNS Stimulants:
    • - Can Cause tolerance, physical dependence, & risk for abuse
    • Methyphenidate (Ritalin)
    • - Monitor VS, height, weight, growth & behavior
    • Atomoxetine (Strattera)
    • - Monitor VS, height, weight, growth, & behavior

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