Psych/Mental Health Exam 2

Stress

• natural part of life

  • positive experience → helps develop coping skills

  • negative experience → negative mental and physical consequences

• associated with development or exacerbation of symptoms of mental illness

Biologic Perspective of Stress

stressor

• an event, situation, or condition that results in psychological or physical stress

• can be internal or external

acute stress

• intense biophysical reaction to a threatening event

• usually time limited

• “fight or flight”

stress response

• physiological changes → increased HR, increased RR, muscle tension

chronic stress

• ongoing physiologic reaction to events → wear and tear

• maladaptive

• increased risk of illness

Homeostasis

body’s tendency to resist physiologic change and hold bodily functions relatively consistent, well-coordinated, and usually STABLE

Allostasis

dynamic regulatory process that maintains homeostasis through a process of ADAPTATION

Life Events

• events can affect the individual

• relationship between recent life changes + severity of near-future illness

• GREATER RISK OF ILLNESS IF MULTIPLE CHANGES IN SHORT TIME

Peplau’s Levels of Anxiety

mild = first exposed to stressor

• perceptual field → increased awareness, possible hypervigilance

• problem-solving → peak function

• physical characteristics → nail biting, foot tapping, fidgeting to resolve tension

moderate = unable to resolve stress or first exposure

• perceptual field → less concentration

• problem-solving → can problem-solve but cannot learn new things

• physical characteristics → increased VS

severe = stressor perceived as a threat

• perceptual field → distorted, only focus on one thing at a time

• problem-solving → feel no possible solution

• physical characteristics → nausea, impending doom, withdrawal, loud speech

panic = unable to process environment

• perceptual field → dissociation

• problem-solving → disorganized/irrational

• physical characteristics → hallucinations + delusions

Defense Mechanisms

• conscious + unconscious → self-protection + survival, reduce stress + anxiety

• developmental

• adaptive/mature = help to accept situation and make less threatening

• maladaptive/immature = rely on ignoring reality to function

include:

• altruism

• conversion

• compensation

• denial

• dissociation

• displacement

• identification

• intellectualization

• projection

• rationalization

• reaction formation

• regression

• repression

• splitting

• sublimation

• suppression

• undoing

Altrusim

definition:

• transforming feelings and emotions by helping someone who is experiencing something similar

• HELPING OTHERS

adaptive example:

• woman whose son was killed due to drunk driving volunteers at a local group to support other parents who lost their children to drunk drivers

maladaptive example:

• N/A

Conversion

definition

• unconscious process that transforms psychological stress to PHYSICAL symptoms

adaptive example:

• N/A

maladaptive example:

• temporary blindness after seeing partner cheating

Compensation

definition:

• the replacement or creation of strengths in a new area to offset perceived weaknesses

adaptive example:

• a student-athlete who broke their leg has learned how to play chess

maladaptive example:

• a nurse works in geriatrics because she is afraid of pediatrics

Denial

definition:

• dismissing situation as not being real

adaptive example:

• client cannot sleep because worried about deployed son, so they watch a favorite movie to take their mind off it

maladaptive example:

• client diagnosed with cancer thinks the doctor is lying and it isn’t their diagnosis

Dissociation

definition:

• temporary loss of consciousness that affects perception and memory

adaptive example:

• student is taking an exam and feels cold, ignores feeling cold to focus on exam

maladaptive example:

• client cannot recall details about recent car crash or identity

Displacement

definition:

• redirecting unacceptable feelings about stressor onto new target

adaptive example:

• N/A

maladaptive example:

• employee mad at their boss goes home and hits their wife

Identification

definition:

• assuming the characteristics of another individual

adaptive example:

• client experiences flat tire and acts like their parent would

maladaptive example:

• child who witnesses DV begins to harm other kids at school

Intellectualization

definition:

• concealing or abstractly processing emotions by intellectual analysis

adaptive example:

• nurse blocks out emotional aspect of patient care to focus on client needs

maladaptive example:

• client who was sexually assaulted seeks out information on psych development of victims

Projection

definition:

• a person’s painful thoughts are projected onto other people or situations

adaptive example:

• N/A

maladaptive example:

• a child who lies assumes their parent lies consistently as well

Rationalization

definition:

• using reasoning and logic to explain stressor

adaptive example:

• a client feels humiliated during presentation says “the crowd is silent because they are interested in my presentation”

maladaptive example:

• a client after abuse says “this would not have happened if i paid attention to their needs”

Reaction Formation

definition:

• replacement of unacceptable feelings with the opposite

adaptive example:

• a drug addict is often heard teaching others dangers of substance abuse

maladaptive example:

• a client is struggling to express their identity so they start acting the opposite

Regression

definition:

• acting in a way of a previous developmental stage

adaptive example:

• watching a favorite childhood movie after a bad day

maladaptive example:

• bedwetting

Repression

definition:

• avoiding thinking or talking about a stressor

adaptive example:

• client providing eulogy at funeral unconsciously tells a story

maladaptive example:

• client cannot remember abuse as a child but struggles with making secure relationships

Splitting

definition:

• unable to accept a person can have different aspects, only see them as good or bad

adaptive example:

• N/A

maladaptive example:

• a client says a nurse is a “horrible bad person” after they set boundaries

Sublimation

definition:

• feelings and emotions chan

adaptive example:

maladaptive example:

Suppression

definition:

• conscious effort to inhibit or control unwanted thoughts caused by stressor

adaptive example:

• child angry at parent chooses not to let it ruin Christmas

maladaptive example:

• client recovering from surgery states they will pay bills when fully recovered

Undoing

definition:

• an attempt to remove unpleasant thoughts by engaging in opposite behavior

adaptive example:

• a child breaks their sibling’s favorite toy and buys them a new one

maladaptive example:

• a client buys their partner a gift after hitting them

Coping Styles

problem-focused = adjusting or managing the problem causing stress

• ex: starting a project that is due in a week

emotion-focused = coping styles to reduce negative emotions

• ex: leaning on friends during hard times

avoidant = efforts toward diminishing or denying stressful situations to avoid dealing with stressor

• ex: ignoring the stress of finals week by drinking

Psychological, Behavioral, and Physical Manifestations of Stress

psychological:

• anxiety

• irritability

• depression

• panic attacks

• increased sadness

• excessive worry

behavioral:

• substance use

• altered ADLs

• delayed development

• compulsive behaviors

physical:

• increased HR, RR, BP

• body aches

• stomach issues

• chest pain

• exhaustion

• HA

• sexual dysfunction

• weakened immune system

Protective Factors of Stress

• positive self-talk

• social support

• spirituality

• cultural connections

• healthy lifestyle

• hardiness

Risk Factors of Stress

• lack of control

• hopelessness

• negative self-talk

• racism

• ACEs

• poverty

• discrimination

• genetics

• poor social network

• trauma exposure

Adjustment Disorder

DSM criteria:

• occurs 0-3m post-stressful event

• depressed mood

• anxiety

• conduct disturbance

• decreased ADLs

• distress > stressor

• SYMPTOMS SUBSIDE WHEN STRESSOR RESOLVED

meds:

• SSRIs, anxiolytics

treatments/therapies:

• CBT, prolonged exposure therapy, cognitive processing, eye movement desensitization, group therapy, family therapy

Post-Traumatic Stress Disorder (PTSD)

DSM criteria:

• exposure to trauma → witness, learned about, experienced

• intrusive s/s → nightmares, unwanted memories, flashbacks

• arousal s/s → hyperreactive, startled, irritable, risky behavior, poor concentration

• social withdrawal

• negative alterations in cognition or mood

• dissociative s/s → derealization, spacing out, out-of-body, amnesia

• > 1 month after exposure to trauma

meds:

• SSRIs, anxiolytics

treatments/therapies:

• CBT, prolonged exposure therapy, cognitive processing, eye movement desensitization, group therapy, family therapy

Acute Stress Disorder

DSM criteria:

• exposure to traumatic event

• intrusive s/s → memories, flashbacks, nightmares

• dissociative s/s → amnesia, out-of-body, derealization

• arousal s/s → hypervigilance, irritability, difficulty concentrating

• social withdrawal

• decreased ADLs

• 3 days - 1 month post-trauma

meds:

• SSRIs, anxiolytics

treatments/therapies:

• CBT, prolonged exposure therapy, cognitive processing, eye movement desensitization, group/family therapy

Trauma

• any disturbing experience that results in significant feelings of fear, confusion, and dissociation that negatively impacts an individual’s behaviors/ADLs

Crisis

• a situation or event that causes emotional or cognitive stress

Disaster

• an incident or event that could end human life or cause health-related harm, requiring immediate response

Trauma Disorder Etiology + Risk Factors

SINGLE CAUSATIVE FACTOR IS EXPERIENCING/WITNESSING A TRAUMATIC EVENT

• childhood maltreatment

• IPV

• ACEs

• witnessing loss of life

• witnessing loss of limb

risk factors:

• disability

• extreme poverty

• poor social connection

• discrimination

• woman or child

Bowlby’s Attachment Theory

• attachment occurs between caregiver and child during infancy and early childhood

• necessary for survival and brain development

• NEED SECURE RELATIONSHIP FOR TRUST

• secure relationship is a protective factor, build resilience

Polyvagal Theory

1. traumatic event occurs

2. sympathetic nervous system → dorsal vagus nerve

3. ventral vagus nerve → “safety is needed”

4. dysregulated autonomic nervous system

5. FIGHT-FLIGHT-FAWN-FREEZE-FAINT

Parasympathetic Nervous Response

• constricts pupils

• increased salivation

• increased digestion

• relaxes muscles

• slows HR

• slows RR

PARASYMPATHETIC = PARACHUTE TO NORMAL

Sympathetic Nervous Response

• dilates pupils

• decreased salivation

• decreased digestion

• tense muscles

• increased HR

• increased RR

• adrenaline produced

Resilience

• the capacity to withstand stress and catastrophe

• develops over time

• ABILITY TO BOUNCE BACK

• stronger resilience → lower risk of maladaptive outcomes

Universal Trauma Precautions

• acknowledge and assume everyone has experienced trauma

• therapeutic communication

• respect the person

• minimize noise levels

• practice self-care

4Cs

calm- pay attention to how one feels

• adjust tone and volume to client’s level

• calming + grounding exercises

contain- limit the impact of trauma and maintain safety

• provide client space and limit amount of trauma history needed

care- practice self-care and self-compassion

• set boundaries, reflect, take care of yourself

cope- emphasize positive coping skills

• find new ways for client to cope

Nursing Process

analysis of cues

• evidence of helplessness or hopelessness

• client’s insight and judgment

prioritize hypothesis

• risk for self-harm

• risk for harm of others

generating solutions

• client-centered care

• safety promotion

take action

• effective coping strategies

• reduce manifestations

• med admin

PACES

Protective and Compensatory Experiences in Children

DECREASE LIKELIHOOD OF DEVELOPING MENTAL/PHYSICAL ISSUES LATER IN LIFE

• having a hobby

• safe home

• volunteering

• love of parent

• spending time with friends

Generalized Anxiety Disorder (GAD)

DSM criteria:

• excessive anxiety or worry for more days than not for greater than 6 months

• difficult to control worry

• anxiety + worry associated with 3+ of:

  • restlessness

  • fatigue

  • difficulty concentrating

  • irritability

  • muscle tension

  • sleep disturbance

• IMPAIRED ADLs

meds:

• SSRIs, non-benzo anxiolytics (buspirone)

treatments/therapies:

• psychotherapy, CBT, CT, exposure therapy, support groups, relaxation techniques, thought stopping

Panic Disorder

DSM criteria:

• recurrent unexpected panic attacks (surge of fear with 4+ s/s)

  • SOB

  • palpitations

  • sweating

  • shaking

  • choking

  • CP

  • nausea

  • dizziness

  • chills

  • paresthesia

  • fear of dying

  • IMPENDING DOOM

• at least 1 attack is followed by 1+ month of:

  • maladaptive change in behavior r/t attack

  • persistent concern/worry about another attack

meds:

• benzos, small dose SSRI

treatments/therapies:

• psychotherapy, CBT, CT, exposure therapy, support groups, relaxation techniques, thought stopping

nursing interventions:

• NEED MEDICAL CLEARANCE TO RULE OUT CARDIAC

• treatment for panic attack: stay with patient, reassure them, low-stim environment, PRN anxiolytics, clear directions, allow patient to vent feelings

Obsessive-Compulsive Disorder

DSM criteria:

• presence of obsessions and/or compulsions

• obsessions = THOUGHTS, urges, or impulses that are unwanted and the individual attempts to ignore

  • ex: fear of germs, fear of forgetting something, thoughts of harm

• compulsions = repetitive BEHAVIORS that feel driven to perform aimed at preventing an event or anxiety

  • ex: hand-washing, number of repetitions, checking a door is locked

• OBSESSIONS AND/OR COMUPULSIONS CAUSE IMPAIRED FUNCTIONING

terminology:

• good/fair insight = individual knows that beliefs are not true

• poor insight = individual thinks that beliefs are probably true

• absent insight = individual thinks that beliefs are 100% true

meds:

• high dose SSRI, small 3rd gen antipsychotic

treatments/therapies:

• psychotherapy, CBT, CT, exposure therapy, support groups, relaxation techniques, thought stopping

Anxiety Overview

ANXIETY IS A NORMAL HUMAN RESPONSE TO STRESS

• temporary can be motivational

• persistent interferes with function

anxiety = feelings or worry or fear or nervousness when stressed or threatened

Anxiety and Comorbidities

mental disorders:

• mood disorders (MDD, bipolar)

• OCD

• tic disorder

• ADHD

• schizophrenia

• eating disorder

medical conditions:

• PE

• asthma

• MI

• stroke

• cancer

• pain

• IBS

• delirium

Anxiety-Related Disorders

• GAD

• panic disorder

• separation anxiety

• phobias

• agoraphobia

• social anxiety

OCD-Related Disorders

• OCD

• body dysmorphic disorder

• hoarding disorder

• excoriation disorder

• trichotillomania

• substance/med induced OCD

Phobias

• irrational fear of an object, person, or situation that leads to a compelling avoidance

Anorexia Nervosa

DSM criteria:

• restriction of energy intake → LOW BODY WEIGHT

• intense fear of gaining weight or persistent behavior that interferes with weight gain (exercising)

• clinical presentation:

  • THIN

  • dry, brittle nails and skin

  • lanugo hair

  • muscle weakness

  • decreased BP + HR

  • hypothermia

  • amenorrhea

  • dysrhythmias

  • altered GI

labs:

• neutropenia

• anemia

• hypoglycemia

• electrolytes

treatments/therapies:

• acceptance commitment therapy

• behavioral therapy

• cognitive behavioral therapy

Bulimia Nervosa

DSM criteria:

• binge eating episodes AND compensatory purging

• binge eating episodes

  • eating a large amount in 2h

  • feel a lack of control

• compensatory behaviors

  • prevent weight gain

  • laxatives, diuretics, vomiting

• at least 1x a week for 3 months

• clinical presentation:

  • NORMAL WEIGHT

  • dental carries

  • parotid gland enlargement

  • Russell’s sign (scarred knuckles)

  • electrolyte imbalance

  • GI issues

meds:

• SSRI

labs:

• electrolytes

treatments/therapies:

• acceptance commitment therapy

• behavioral therapy

• cognitive behavioral therapy

Binge Eating Disorder

DSM criteria:

• recurrent binge eating episodes

  • eating a lot within 2h

  • loss of control

• at least 1x a week for 3 months

• NO PURGING

• associated with 3+ criteria:

  • eating past full

  • eating when not hungry

  • eating rapidly

  • eating alone r/t embarrassment

  • guilt

  • distress

• clinical manifestations:

  • GI disturbance

  • heart disease

  • HTN

  • DM

  • obesity

  • depression

  • low self-esteem

  • addictive thinking

meds:

• SSRIs

treatments/therapies:

• acceptance commitment therapy

• behavioral therapy

• cognitive behavioral therapy

Healthy Eating

• eating a variety of foods and stop when feeling full

• no obsession over calories

• no restriction of items

Eating Disorder Indicators

• changes in behaviors around food → rituals, secrecy

• obsessions → calorie counting, fixation on weight + shape

• changes in function → illness, low self-esteem

Eating Disorder Warning Signs

• unexplained obvious weight change

• excessive exercising

• fear of fat

• lying about food

• secret eating

Eating Disorder Risk Factors

mental health conditions

• anxiety

• depression

• substance misuse

• suicide

personality disorders

• OCD

• avoidant

• borderline

biologic/genetic

• family tendency

socioeconomic stress

• abuse

• culture

• occupation

• participation in sports

Eating Disorder Complications

• ketoacidosis

• electrolyte imbalance

• osteoporosis

• cardiac dysfunction

• kidney failure

• menstrual cessation

Medical Assessment of Eating Disorders

• labs → glucose, electrolytes, CBC, BUN

• EKG

• DXA

• family data

• SCOFF Tool

  • sick → make yourself sick or vomit after a meal

  • control → worry about loss of control

  • one stone → have you lost more than 14lbs

  • fat → do you think you are fat

  • food → does food dominate your life

Treatment of Eating Disorder

• nutritional engineering

  • safe-paced restoration → 1800cal/day

• avoid refeeding syndrome

  • xs calories too fast

  • cardiovascular decompensation

  • edema, fatigue, weakness, elevated BP, SOB

• monitor meals

  • eat everything on tray

  • watch for smearing or hiding

• daily weights

  • AM before breakfast + after void

• no bathroom for 1hr after meal

• coping skills developed

• medical stabilization

Major Depressive Disorder (MDD)

DSM criteria:

• 5+ of the following criteria must be present over 2+ weeks and represent a change in function… at least 1 is A1/A2

• A1 = depressed mood

• A2 = lack of interest/pleasure… anhedonia

• A3 = significant weight loss or gain

• A4 = sleep disturbance… insomnia or hypersomnia

• A5 = psychomotor changes… slow or fast

• A6 = fatigue, anergia

• A7 = worthlessness/guilt

• A8 = poor concentration

• A9 = thoughts about suicide or death

risk factors:

• family Hx

• old age

• low serotonin, low norepinephrine

• stress

• early trauma

• medical illness

meds:

• SSRI, SNRI, TCA, MAOI, NDRIs

treatments/therapies:

• CBT, ECT, light therapy

Activation Syndrome

• set of manifestations including impulsivity and suicidal ideations that may present after starting an antidepressant

• manifestations = irritability, anxiety, thoughts of suicide, aggression

• can see if misdiagnosis → if patient treated for MDD with SSRI incorrectly, they will be manic

Antidepressant Discontinuation Syndrome (ADDS)

• occurs when discontinue antidepressant suddenly

• manifestations

  • flu-like symptoms

  • depression

  • anxiety

  • brain zaps

• need patient to taper off antidepressant

Bipolar I Disorder

DSM criteria:

• at least one manic episode >7days alternating with major depression

• manic episode = abnormally elevated mood and energy w 3+ of:

  • increased self esteem, grandiosity, risky behavior, euphoria, poor attention, impulsivity, flight of ideas, pressured speech, psychomotor agitation

• specifiers = anxiety, depression, w/ psychotic factors

• high risk for suicide

• labile mood

comorbidities:

• anxiety disorders

• substance use

• hyperthyroid

• DM

meds:

• mood stabilizers, anticonvulsants

treatment of acute mania:

• high calorie, high quality finger foods

• safety

• frequent monitoring

• low-stim environment

• med adherence

• sleep hygiene

s/s mania → DIG FASTER

• D- distractable

• I- impulsive

• G- grandiose

• F- flight of ideas

• A- activity increase

• S- sleep decrease

• T- talkative

• E- euphoria

• R- risky behaviors

Bipolar II Disorder

DSM criteria:

• hypomanic episode followed by major depression

• mostly depression

hypomania = mild mania

meds:

• mood stabilizers, anticonvulsants

nursing education:

• often misdiagnosed as MDD → if given SSRI, watch for mania

Benzodiazepine Anxiolytics

names:

• lorazepam (Ativan)

• alprazolam (Xanax)

used for:

• ACUTE trauma, panic, alcohol withdrawal

side effects:

• sedation

adverse effects:

• addictive

• death with OD

• seizure upon D/C

black box warning:

• DO NOT MIX WITH ETOH

Non-Benzo/Non-Addicting Anxiolytics

name:

• Buspirone (Buspar)

used for:

• long-term anxiety, GAD

side effects:

• dizziness

• drowsiness

• nausea

• HA

• excitement

adverse effects:

• increased digoxin levels

nursing interventions:

• monitor for digoxin toxicity

• split dose

• caution w/ renal or liver impairment

Selective Serotonin Reuptake Inhibitors (SSRIs)

names + doses:

• escitalopram (Lexapro) → 10-20mg/day

• fluoxetine (Prozac) → 20-60mg/day

• sertraline (Zoloft) → 50-200mg/day

• paroxetine, citalopram

used for:

• MDD, anxiety, OCD, PTSD, PMDD, bulimia, binge eatiing

side effects:

• SEXUAL DYSFUNCTION

• increased sweating

• HA

• nausea

• insomnia

• xerostomia

• weight change

• drowsiness

adverse effects:

• SEROTONIN SYNDROME → ocular clonus, myoclonus, hyperreflexia, sweating, shivers, diarrhea, agitation, confusion, elevated temp, elevated BP + HR, pupil dilation

nursing interventions:

• take with food

• report worsening depression, suicidal thoughts, sudden elevated mood/mania

• will take 4-6 weeks to work

black box warning:

• increased suicide risk <24yo

Serotonin Norepinephrine Reuptake Inhibitors (SNRI)

names:

• desvenlafaxine (Pristiq)

• venlafaxine (Effexor)

• duloxetine (Cymbalta)

used for:

• MDD, anxiety, OCD, PTSD, PMDD, bulimia, binge eating

side effects:

• nausea

• HA

• drowsiness

• insomnia

• sexual dysfunction

• HYPERTENSION

• INCREASED SWEATING

• pupil dilation

• xerostomia

adverse effects:

• SEROTONIN SYNDROME → ocular clonus, myoclonus, hyperreflexia, shivering, diarrhea, sweating, agitation, confusion, elevated HR, BP, temp

nursing interventions:

• TAKE WITH FOOD

• report worsening depression, suicidal thoughts, elevated mood/mania

• takes 4-6 weeks to work

black box warning:

• suicide risk <24yo

Norepinephrine Dopamine Reuptake Inhibitors (NDRIs)

name:

• bupropion (Wellbutrin)

used for:

• MDD, smoking cessation

side effects:

• no sexual se

• do not give with seizure disorder, head injury, bulimia → lowers seizure threshold

black box warning:

• suicide risk <24yo

Tricyclic Antidepressants (TCAs)

names:

• amitriptyline (Elavil)

• clomipramine (Anafranil)

used for:

• depression, migraines

side effects:

• seizures, tremors

• orthostatic hypotension

• sedation

• anticholinergic se → xerostomia, constipation, urinary retention

adverse effects:

• serotonin syndrome

• QRS prolonged → arrythmias

• lethal OD

nursing interventions:

• give HS r/t sedation

black box warning:

• suicide risk <24yo

Monoamine Oxidase Inhibitors (MAOIs)

names:

• selegiline (Emsam)

• phenelzine (Nardil)

used for:

• depression, migraines

side effects:

• bad interaction with cold meds

adverse effects:

• serotonin syndrome

• HYPERTENSIVE CRISIS WITH TYRAMINE

• lethal OD

nursing education:

• tyramine free diet → no aged cheeses, cured meats, chocolate, alcohol, tofu, avocado, fermented foods

black box warning:

• suicide risk <24yo

Trazodone

used for:

• depression

• insomnia

side effects:

• SEDATION

adverse effects:

• priapism

black box warning:

• suicide risk <24yo

SLEEP AID

Mirtazapine (Remeron)

used for:

• depression

side effects:

• increased appetite

• weight gain

• sedation

Mood Stabilizers

name:

• lithium (lithium carbonate)

used for:

• bipolar, acute mania, suicidality

side effects:

• N/V/D

• hand tremors

• nephrotoxicity

• hypothyroid

• thirst

• weight gain

adverse effects:

• LITHIUM TOXICITY → levels >1.0, diarrhea, N/V, thirst, polyuria, myalgia, coarse tremors, lethargy, slurred speech

labs/nursing interventions:

• take with food

• effect in 5-7d, max within 3-4wks

• monitor for lithium toxicity

contraindications:

• PREGNANCY, diuretics, bad kidneys, older adults, NSAIDs, thyroid disorder

LMNOP

• Lithium

• Movement → tremors

• Nephrotoxic → thirsty, balance Na

• hypOthyroidism

• Pregnancy → NO WAY

Anticonvulsants

names:

• valproic acid (Depakote)

• carbamazepine (Tegretol)

used for:

• bipolar

side effects:

• VA → N/V/D, pancreatitis, hepatitis, neural tube defects, weight gain, thrombocytopenia

• Carb → vertigo, HA, anemia, leukopenia, thrombocytopenia

VALPRO ate a FOLATE PLaTe

• folate = neural tube defects

• P = pancreatitis… monitor amylase

• L = liver toxic… jaundice, N/V, abd pain

• T = thrombocytopenia… bleed

Special Anticonvulsant

name:

• lamotrigine (Lamictal)

used for:

• bipolar

side effects:

• vertigo, HA, N/V, NO WEIGHT GAIN, sedation

adverse effects:

• steven johnson syndrome → lethal rash… low and slow, watch with abx

nursing interventions:

• pregnancy safe

• good for bipolar II

• take at night