Psych introduction typical antipsychotics
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Define mental disorder
diagnosable syndrome characterized by altered thinking, mood, and/or behavior, and associated with significant distress and/or impaired functioning
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
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)
What is a cultural idiom of distress?
The characteristic ways a cultural group talks about suffering/distress (e.g. "thinking too much")
What are the 10 fundamental components of recovery?
- individual and person-centered
- peer support
What are the top 3 mental health issues in the general population?
- depression/depressive symptoms
- substance misuse and abuse
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"
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.
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)
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
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)
Classifications of typical antipsychotics
Mechanism of action of typical antipsychotics
- Dopamine (D2) receptor antagonists
- decreases post-synaptic dopamine in many areas of the brain
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)
Extrapyramidal side effects (EPS)
- 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!
What is NE?
- 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
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
Discuss histamine in mental health
- certain psychotropic meds block effects
- side effects of sedation, weight gain, hypotension
Discuss GABA in mental health
- primarily inhibitory NT
- interconnected with other key NTs
- dysfunction associated with anxiety disorders
Discuss glutamate in mental health
dysfunction implicated in certain neurodegenerative diseases and schizophrenia
Typical antipsychotics are also referred to as:
What does NMS stand for?
Neuroleptic Malignant Syndrome
Signs and symptoms of neuroleptic malignant syndrome
- hyperthermia (hyperpyrexia)
- altered consciousness
- wildly fluctuating vital signs
- severe diaphoresis
Symptoms of agranulocytosis
- Similar to flu symptoms with addition of:
- mouth sores
- drop in WBC
potentially life threatening!
Key anticholinergic side effects
- dry mouth
- urinary retention
- blurred vision
- Anticholinergic drugs
- Used to manage EPS
Signs and symptoms of anticholinergic toxicity
- Medical emergency!
- severe hypotension
- extreme agitatation or coma
Atypical antipsychotics are also referred to as:
- second generation
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
People with schizophrenia have higher rates of these comorbidities
note that atypical antipsychotics can result in weight gain and metabolic changes including insulin resistance and reduce insulin secretion
What are the common side effects of atypical antipsychotics?
- weight gain
- metabolic changes
- insulin resistance/reduced insulin secretion
- erectile dysfunction/gynecomastia
- orthostatic hypotension
- decreased libido
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
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
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