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What 4 things does a mentally ill person have impairment in?
- 1. Cognition, volition (free will) and/or emotional processes
- 2. Judgment
- 3. Capacity to recognize reality or control behavior
- 4. Ability to fx effectively at work, home
What is the definition of a disorder/syndrome?
- Interference with social/occupational functioning (school work & attendance in children)
- Impairment in ADLs
What are 5 aspects of a therapeutic relationship?
- 1. goal oriented
- 2. present oriented
- 3. disclosure to help pt
- 4. knowledge and skill required
- 5. client-directed
What are two essential components of therapeutic communication?
- 1. self-respect
- 2. understanding
What is the left side of the brain used for?
- usually dominant
- responsible for language
- mathematical ability
What is the nondominant side of the brain used for?
- musical skills
- recognition of faces
- spacial relationships
- TWO SIDES CONNECTED BY CORPUS CALLOSUM
What purpose doe the frontal lobes serve?
- mood and emotional experience
What is the purpose of neurotransmitters?
Act as the synaptic interface-from axon to dendrite, and sometimes within the neuron.
What are the 5 classes of neurotransmitters?
- 1. Amino acids-glutamate (excitatory) and GABA (inhibitory)
- 2. Neuromodulators-monoamines, catecholamines (norepinephrine, dopamine), indolamine (5HT, seratonin)
- 3. acetycholine
- 4. Peptides (endorphins)
- 5. Epinephrine
What are some considerations when it comes to psychotropic medications?
- client adherance
- rationale for PRNs
- patient and family teaching
What is the fx of the limbic system of the brain?
- receive sensory stimulation
- emotional expression generated here
What are neurotransmitters?
Messenger chemicals produced by the brain which allow the transmission of signals from one neuron to the next (the receiving cell) across synapses.
What is epinephrine and norepinephrine?
- "Adrenalin" for the brain
- Secreted by the adrenal glands-fight or flight
- Secreted in response to stress, arousal
- present in the brain while adrenalin is in the rest of the body
- regulates alertness, tension, stress
What is serotonin?
- regulates mood, anxiety and pain
- has an effect on appetite, sleep, sexual behavior
- When inhibit reuptake, more serotonin in synapse, so more gets over to receiving cell
What is dopamine?
- influences emotional behavior and cognition (thought)
- regulates motor activity/movement
- regulates endocrine activity, especially lactation
How does dopamine affect lactation?
When dopamine is down, men and women will lactate, develop gynecomastia
How does dopamine affect psychosis?
When dopamine is increased in the limbic system, psychosis increases.
What is GABA (gamma amino-butyric acid)?
- major inhibitor transmitter SO
- decreased GABA means increased anxiety
- associated with emotional balance, sleep, anxiety
What meds activate GABA?
What are 4 other reasons anxiolytics are used?
- 1. sedation
- 2. anti-seizure
- 3. anti-nausea
- 4. pre-op
What is inderol/propranolol?
- non-benzo antianxiolytic
- can be used for extrapyramidal SE
- can also be used for social phobia, panic attacks, PTSD, migraine HAs
What is luvox/fluoxamine used for?
- SSRI used to treat depression
- also used to treat OCD and/or social anxiety disorder (long term)
What are two examples of sedative hypnotics?
What are examples of tricyclics?
What are common SE of tricyclics?
- Anticholinergic (dry mouth, blurred vision, postural hypotension, constipation/urinary retention)
What are some cautions when administering tricyclics?
- dangerous in overdose
- admin in small doses
What is patient teaching with tricyclics?
- 2+ weeks to have full effect
- don't give with MAOIs
- admin at hs
- don't stop abruptly
- use sunscreen
- increase fiber in diet
What are some examples of SSRIs (selective serotonin reuptake inhibitors)?
- fluvoxamine (OCD)
What are common SE of SSRIs?
- weight changes
What are cautions with SSRIs?
- don't prescribe with MAOIs-can cause serotonin syndrome (HTN crisis)
- watch for suicidal ideation at beginning of prescription
- can reduce seizure threshold
- renal and hepatic
What patient teaching would you include with SSRIs?
- taper when d/cing
- don't take with MAOIs or some OTCs
- watch for dizziness
- don't take with ETOH
What are examples of non-SSRIs?
- serozone and trazadone (desyrel)
- wellbutrin (smoking cessation)
What are examples of mood stabilizers?
- anti-convulsants: tegretol, depakote, lamictal
What are common SE of mood stabilizers?
- cardiac (arrhthymias, circulatory collapse)
- weight gain
What are cautions when it comes to Li+?
- narrow therapeutic index
- 0.6-1.4 mEq/L with 1.6 toxic
- draw levels 8 hrs past last dose
What patient teaching should be included with mood stabilizers?
- drink 2-3 L a day
- adequate NaCl intake
- report S/E (GI sx or fever, thirst, dehydration)
- taper off slowly
What meds are included in typical antipsychotics?
- Loxitane, Navane, Moban
What are atypical antipsychotics?
What are positive symptoms of psychosis?
- psychotic thinking
- disorganized speech/behavior
- exaggerated language/behavior
- IMPROVES WITH AGE
- BOTH ATYICAL AND TYPICAL ANTI-PSYCHOTICS TREEAT POSITIVE SYMPTOMS
What are negative symptoms?
- A dimnution or loss of normal fx including:
- -flat affect
- -alogia (restricted thought/speech)
- -apathy (lack of goal directed behavior)
- -anhedonia (inability to experience pleasure)
- -impaired attention
- -emotional withdrawal
- IMPROVES WITH AGE
- USE ATYPICAL MEDS, TYPICALS DO NOT WORK WELL!
What are cognitive problems associated with schizophrenia?
- loose associations
- impaired attention
- impaired information processing
- SYMPTOMS WORSEN WITH AGE
What are extrapyramidal symptoms?
- akathisia (fidgeting, foot tapping)
- Parkisonism (pill rolling, tremor, cog-wheel rigidity, impaired gait)
- dystonia (involuntary muscle movements, eyes rolled back)
- Tardive dyskinesia (involuntary facial movements)
What are other SE of anti-psychotics
- orthostatic hypotension
- weight gain
- grand mal seizures
- increased prolactin levels
- Neuroleptic Malignant Syndrome (NMS)
- -extreme form of EPS
What is Neuroleptic Malignant Syndrome?
- rare form of EPS
- Symptoms: fever, tachycardia, severe muscle rigidity, "lead pipe rigidity", tremor, incontinence, increased CPK, renal failure
- Risk factors: age under 20, over 60, African American, high neuroleptic dose or potency, hx of CNS disease or DD, sometimes abrupt withdrawal of Parkinsons meds
- TX: Stop neuroleptics, reduce fever, maintain hydration, correct electrolyte imbalance, administer dopamine agonist
- 80% OF PATIENTS MAY RESTART MEDS W/IN 3 WEEKS, 33% RISK REOCCURENCE
How do neuroleptic drugs work?
Dopamine blocking agents