Psych introduction typical antipsychotics

diagnosable syndrome characterized by altered thinking, mood, and/or behavior, and associated with significant distress and/or impaired functioning

• A cluster of symptoms or manifestations that may represent more than one underlying disease/pathology.
• Mental health is diagnosed by syndrome classification as opposed to etiology

symptom cluster that occurs in a specific group, community, or context not recognized as an illness within the culture (e.g. attack of the nerves)

The characteristic ways a cultural group talks about suffering/distress (e.g. "thinking too much")

• self-direction
• individual and person-centered
• empowerment
• holistic
• non-linear
• strengths-based
• peer support
• respect
• responsibility
• hope

• anxiety/stress
• depression/depressive symptoms
• substance misuse and abuse

The stress-diathesis theory, which states that there is a combination between biological or environmental factors and vulnerability.  "Fertile-ground"

• Hildegard Peplau
• Emphasizes interpersonal experiences and healthy relationships.
• Focuses on navigating anxiety during the nurse-patient relationship.

• Orientation: high anxiety; testing trustworthiness of the relationship
• Working: actively working on goals; less anxiety
• Termination/resolution: use of personal styel for "good bye"  (things often seem to end how they started)

• Mindfulness; self-reflection
• See one's own "blind spots" (preconscious)
• Be aware of previously-unconscious aspects of one's self

• My public self (known to self and others)
• My blind spots (known to others but not self)
• My hidden self (known to self but not others)
• My unconscious self (not known to self or others)

• phenothiazines
• butyrophenones

• Dopamine (D2) receptor antagonists
• decreases post-synaptic dopamine in many areas of the brain

• anticholinergic: (key s/e on another slide)
• antiadrenergic: orthostatic hypotension
• cardiac: lengthening of the QT interval
• endocrine: sexual dysfunction, menstrual dysfunction, galactorrhea, gynecomastia
• extrapyramidal: (key s/e on another slide)

• Pseudo-Parkinsonism
• Akethisia: sensation of not being able to sit still
• Acute dystonic reaction: spasms of large muscles can be painful
• Tardive dyskinesia:a difficult-to-treat and often incurable form of dyskinesia, a disorder resulting in involuntary, repetitive body movements.
• Neuroleptic Malignant Syndrome (NMS): medical emergency!

• Norepinephrine
• excitatory NT
• involved in generating, maintinaing mood states, sleep/wake rhythms, flight-of-fight response (anxiety modulation)
• decreased in depressin
•  increased in manic symptoms
• NE (noradrenergic) pathway dysfunction implicated in depression and anxiety

• Serotonin (also ST)
• primarily excitatory NT
• involved in emotions, cognition, sensory perceptions, essential biologic functions (sleep, appetite)
• decreased in depression, insomnia
• increased in mania
• dysfunction implicated in anxiety disorders

• certain psychotropic meds block effects
• side effects of sedation, weight gain, hypotension

• primarily inhibitory NT
• interconnected with other key NTs
• dysfunction associated with anxiety disorders

dysfunction implicated in certain neurodegenerative diseases and schizophrenia

• classic
• conventional
• first-generation

Neuroleptic Malignant Syndrome

• hyperthermia (hyperpyrexia)
• altered consciousness
• wildly fluctuating vital signs
• severe diaphoresis
• drooling

• Similar to flu symptoms with addition of:
• mouth sores
• drop in WBC

potentially life threatening!

• dry mouth
• constipation
• urinary retention
• blurred vision

• Anticholinergic drugs
• Used to manage EPS

• Medical emergency!
• delirium/hallucinations
• severe hypotension
• tachycardia
• extreme agitatation or coma
• flushing
• seizures

• newer
• non-conventional
• second generation

• Bind loosely with D2 receptors
• greater affinity for 5-HT receptor subtypes which indirectly enhances DA production
• lower risk of EPS and tardive dyskinesia

• diabetes
• obesity

note that atypical antipsychotics can result in weight gain and metabolic changes including insulin resistance and reduce insulin secretion

• weight gain
• metabolic changes
• insulin resistance/reduced insulin secretion
• hyperprolactinemia
• erectile dysfunction/gynecomastia
• orthostatic hypotension
• decreased libido

• Clinical Antipsychotic Trials of Intervention Effectiveness
• older medications performed as well as newer ones and were less expensive
• consider s/e when prescribing

• illness-related factors: remission of symptoms, disease features
• medication-related factors: dosing schedule, polypharmacy, expense
• environmental factors: social isolation, unsupportive SOs
• clinician-related factors: poor communication and alliance