Psych introduction typical antipsychotics

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Psych introduction typical antipsychotics
2015-06-22 13:53:00
Basic principles, typical antipsychotics
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  1. Define mental disorder
    diagnosable syndrome characterized by altered thinking, mood, and/or behavior, and associated with significant distress and/or impaired functioning
  2. What is a syndrome?
    • 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
  3. What is a cultural syndrome?
    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)
  4. What is a cultural idiom of distress?
    The characteristic ways a cultural group talks about suffering/distress (e.g. "thinking too much")
  5. What are the 10 fundamental components of recovery?
    • self-direction
    • individual and person-centered
    • empowerment
    • holistic
    • non-linear
    • strengths-based
    • peer support
    • respect
    • responsibility
    • hope
  6. What are the top 3 mental health issues in the general population?
    • anxiety/stress
    • depression/depressive symptoms
    • substance misuse and abuse
  7. This theory has an overarching framework for explaining and targeting hypothesized causes of mental illness
    The stress-diathesis theory, which states that there is a combination between biological or environmental factors and vulnerability.  "Fertile-ground"
  8. Who is the mother of psychiatric nursing and what two points are most important for her theory of practice?
    • Hildegard Peplau
    • Emphasizes interpersonal experiences and healthy relationships.
    • Focuses on navigating anxiety during the nurse-patient relationship.
  9. What are the developmental stages of 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)
  10. Enahancing self-awareness requires this.
    • Mindfulness; self-reflection
    • See one's own "blind spots" (preconscious)
    • Be aware of previously-unconscious aspects of one's self
  11. The Johari Window has these four areas
    • 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)
  12. Classifications of typical antipsychotics
    • phenothiazines
    • butyrophenones
  13. Mechanism of action of typical antipsychotics
    • Dopamine (D2) receptor antagonists
    • decreases post-synaptic dopamine in many areas of the brain
  14. Side effects of typical antipsychotics
    • 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)
  15. Extrapyramidal side effects (EPS)
    • 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!
  16. What is NE?
    • 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
  17. What is 5-HT?
    • 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
  18. Discuss histamine in mental health
    • certain psychotropic meds block effects
    • side effects of sedation, weight gain, hypotension
  19. Discuss GABA in mental health
    • primarily inhibitory NT
    • interconnected with other key NTs
    • dysfunction associated with anxiety disorders
  20. Discuss glutamate in mental health
    dysfunction implicated in certain neurodegenerative diseases and schizophrenia
  21. Typical antipsychotics are also referred to as:
    • classic
    • conventional
    • first-generation
  22. What does NMS stand for?
    Neuroleptic Malignant Syndrome
  23. Signs and symptoms of neuroleptic malignant syndrome
    • hyperthermia (hyperpyrexia)
    • altered consciousness
    • wildly fluctuating vital signs
    • severe diaphoresis
    • drooling
  24. Symptoms of agranulocytosis
    • Similar to flu symptoms with addition of:
    • mouth sores
    • drop in WBC

    potentially life threatening!
  25. Key anticholinergic side effects
    • dry mouth
    • constipation
    • urinary retention
    • blurred vision
  26. Antidyskinesic medications
    • Anticholinergic drugs
    • Used to manage EPS
  27. Signs and symptoms of anticholinergic toxicity
    • Medical emergency!
    • delirium/hallucinations
    • severe hypotension
    • tachycardia
    • extreme agitatation or coma
    • flushing
    • seizures
  28. Atypical antipsychotics are also referred to as:
    • newer
    • non-conventional
    • second generation
  29. Characteristics of atypical antipsychotics
    • Bind loosely with D2 receptors
    • greater affinity for 5-HT receptor subtypes which indirectly enhances DA production
    • lower risk of EPS and tardive dyskinesia
  30. People with schizophrenia have higher rates of these comorbidities
    • diabetes
    • obesity

    note that atypical antipsychotics can result in weight gain and metabolic changes including insulin resistance and reduce insulin secretion
  31. What are the common side effects of atypical antipsychotics?
    • weight gain
    • metabolic changes
    • insulin resistance/reduced insulin secretion
    • hyperprolactinemia
    • erectile dysfunction/gynecomastia
    • orthostatic hypotension
    • decreased libido
  32. What is CATIE and the overall results?
    • Clinical Antipsychotic Trials of Intervention Effectiveness
    • older medications performed as well as newer ones and were less expensive
    • consider s/e when prescribing
  33. Reasons for treatment nonadherence
    • 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