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Neurotransmitters
Chemical messengers that transmit signals between nerve cells.
Dopamine (DA)
Regulates pleasure, motivation, and motor control.
Schizophrenia
A disorder characterized by hallucinations and delusions due to excess dopamine.
Parkinson's disease
A disorder resulting from dopamine deficiency.
Antipsychotics
Medications that block dopamine receptors to treat schizophrenia.
Stimulants
Medications that increase dopamine for ADHD treatment.
Serotonin (5-HT)
Involved in mood regulation, sleep, and appetite.
Depression
A disorder associated with serotonin deficiency.
SSRIs
Selective Serotonin Reuptake Inhibitors that increase serotonin.
SNRIs
Serotonin-Norepinephrine Reuptake Inhibitors that also target norepinephrine.
Norepinephrine (NE)
Involved in arousal, alertness, and stress response.
Anxiety
A disorder associated with norepinephrine excess.
Gamma-Aminobutyric Acid (GABA)
An inhibitory neurotransmitter that reduces excitability.
Epilepsy
A disorder associated with GABA deficiency.
Benzodiazepines
Medications that enhance GABA to reduce anxiety.
Glutamate
An excitatory neurotransmitter involved in learning and memory.
Neurotoxicity
Result of glutamate excess linked to Alzheimer's and schizophrenia.
Acetylcholine (ACh)
Involved in memory, learning, and muscle activation.
Alzheimer's disease
A disorder resulting from acetylcholine deficiency.
Cholinesterase inhibitors
Medications that slow cognitive decline in Alzheimer's.
Anxiolytics
Antianxiety medications that reduce anxiety.
Buspirone
A non-sedating, non-addictive anxiolytic that takes 2-4 weeks for full effect.
Monoamine Oxidase Inhibitors (MAOIs)
Prevent breakdown of serotonin, norepinephrine, and dopamine.
Tricyclic Antidepressants (TCAs)
Antidepressants with adverse effects including sedation and weight gain.
Selective Serotonin Reuptake Inhibitors (SSRIs)
First-line treatment for depression and anxiety.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Antidepressants that increase both serotonin and norepinephrine.
First-Generation Antipsychotics (FGAs)
Typical antipsychotics with risk of extrapyramidal symptoms.
Second-Generation Antipsychotics (SGAs)
Atypical antipsychotics with lower EPS risk but higher metabolic side effects.
Third-Generation Antipsychotics (TGAs)
Partial dopamine agonists with fewer side effects.
Lithium
Used for bipolar disorder with a therapeutic range of 0.6 - 1.2 mEq/L.
Toxicity signs of Lithium
Tremors, confusion, vomiting, severe ataxia.
Anticonvulsants
Used for mood stabilization in bipolar disorder.
Sedative-Hypnotics
Medications used for short-term insomnia treatment.
Stimulants
Medications like methylphenidate used for ADHD.
St. John's Wort
Used for depression but can cause serotonin syndrome if combined with SSRIs.
Serotonin Syndrome
Life-threatening condition caused by excess serotonin from SSRIs, SNRIs, MAOIs, or St. John's Wort.
Symptoms of Serotonin Syndrome
Sweating, hyperreflexia, tachycardia, rigidity.
Intervention for Serotonin Syndrome
Discontinue medication, supportive care.
Activation Syndrome
Caused by antidepressants increasing energy levels before mood improves, leading to suicide risk.
Symptoms of Activation Syndrome
Agitation, impulsivity, aggression.
Intervention for Activation Syndrome
Monitor closely, especially in young adults.
Antidepressant Discontinuation Syndrome
Caused by abrupt stopping of SSRIs/SNRIs.
Symptoms of Antidepressant Discontinuation Syndrome
Flu-like symptoms, insomnia, anxiety.
Intervention for Antidepressant Discontinuation Syndrome
Taper medication gradually.
Lithium Toxicity
Mild (1.5-2.0 mEq/L): Nausea, tremors, confusion; Severe (>2.5 mEq/L): Seizures, coma, death.
Intervention for Lithium Toxicity
Stop lithium, IV fluids, dialysis if severe.
Neuroleptic Malignant Syndrome (NMS)
Caused by antipsychotics blocking dopamine.
Symptoms of Neuroleptic Malignant Syndrome
Fever, muscle rigidity, autonomic instability.
Intervention for Neuroleptic Malignant Syndrome
Stop antipsychotic, supportive care.
Extrapyramidal Symptoms (EPS)
Includes dystonia, akathisia, tardive dyskinesia, pseudoparkinsonism.
Intervention for Extrapyramidal Symptoms
Switch to an SGA or use anticholinergic medications (e.g., benztropine).
Motivational Interviewing (MI)
A client-centered approach that enhances motivation to change by exploring and resolving ambivalence.
Engage in MI
Build rapport and establish trust using active listening and open-ended questions.
Focus in MI
Identify the client's priorities and concerns; encourage the client to define the problem in their own words.
Evoke in MI
Help the client explore the importance of change using scaling questions.
Plan in MI
Collaborate on realistic, measurable goals (SMART: Specific, Measurable, Achievable, Realistic, Time-bound).
Evaluation of MI Effectiveness
Client demonstrates increased motivation through verbal affirmations.
Therapeutic Communication
Goal is to establish a supportive nurse-client relationship to improve mental health outcomes.
Nonverbal Strategies in Therapeutic Communication
S.O.L.E.R. Technique: Sit squarely, Open posture, Lean forward, Eye contact, Relax.
Verbal Strategies in Therapeutic Communication
Includes open-ended questions, affirmations, reflections, and summarization.
Cultural Considerations in Therapeutic Communication
Assess cultural factors impacting communication and health beliefs.
Evaluation of Therapeutic Communication
Client expresses feeling understood and supported.
Integrating MI with Therapeutic Communication
Use MI techniques within therapeutic communication to facilitate client-driven change.
Orientation Phase
Establish trust and define the nurse-client relationship.
Identification Phase
The client expresses unmet needs.
Exploitation (Working) Phase
The client and nurse collaborate to achieve goals.
Resolution Phase
Goals are met, and a discharge or transition plan is developed.
Barriers to Trust and Rapport
Certain factors can hinder effective communication and trust-building.
Cultural Sensitivity Techniques
Use culturally sensitive communication techniques (e.g., assessing preferred eye contact norms).
Professional Boundaries
Boundary blurring can interfere with treatment goals.
Transference
Client redirects feelings onto the nurse.
Countertransference
Nurse projects emotions onto the client.
Cultural Maintenance
Support the client in keeping their cultural identity (e.g., respecting spiritual beliefs).
Cultural Negotiation
Help adapt cultural beliefs if they conflict with health outcomes.
Cultural Repatterning
Assist clients in modifying harmful practices while respecting cultural traditions.
Technology in Mental Health Care
Telehealth and electronic health records (EHRs) play a significant role in modern mental health nursing.
Telehealth Access
Almost 50% of mental health patients access care through telehealth.
Clinical Judgment Action Model (CJAM)
Integrates Tanner's Clinical Judgment Model with the Nursing Process to guide decision-making in patient care.
Assessment
Gather relevant data: Mental status exam (MSE), psychosocial assessment, substance use assessment, cultural/spiritual needs.
Safety Concerns
Identify safety concerns (suicide risk, aggression).
Standardized Tools
Use standardized tools (MMSE, Mini-Cog, Montreal Cognitive Assessment).
Analysis
Recognize patterns in symptoms and behaviors.
Prioritizing Care
Prioritize care based on urgency (e.g., suicide risk comes before anxiety management).
Planning
Collaborate with client and interprofessional team to define treatment goals.
SMART Goals
Set SMART goals (Specific, Measurable, Achievable, Realistic, Time-bound).
Example of SMART Goal
Client will report fewer than 3 panic attacks in 14 days.
Evidence-based interventions
Interventions supported by research, such as CBT, motivational interviewing, and psychopharmacology.
Client and family involvement
Engaging clients and their families in care to enhance adherence to treatment.
Medication education
Providing information on medications, relapse prevention, and coping strategies.
De-escalation techniques
Strategies used to calm aggressive clients and prevent escalation of conflict.
Cultural adaptation of interventions
Modifying interventions based on the client's culture, preferences, and literacy level.
Assessment of interventions
Evaluating whether interventions achieved the intended treatment goals.
Care plan modification
Adjusting the care plan as necessary based on ongoing assessments.
Ongoing communication
Maintaining regular communication with the client, family, and treatment team.
Documented progress
Recording progress or challenges to ensure continuity of care.
Clinical Judgment Action Model (CJAM)
A model that promotes structured, patient-centered decision-making to enhance safety and quality of care.
Cultural competence
The ability to understand and effectively respond to the cultural needs of clients in therapeutic settings.
Cultural Formulation Interview (CFI)
A tool to assess how culture influences a client's mental health experience.
Cultural definition of the problem
Understanding how the client perceives their mental health condition.
Cultural perceptions of cause
Exploring if religion, spirituality, or traditional beliefs affect the client's symptoms.
