psych- somatic disorders, addictive disorders

transtheoretical stages of change theory

precontemplation, contemplation, preparation, action, maintenance

care continuum for substance abuse

detox, rehab, halfway house, other housing, partial hospitalization, intensive outpatient treatment, outpatient treatment, AA, relapse prevention

implementation

achieve psychological stability, provide an empathetic, supportive environment, promoting safety and sleep, reintroduce good nutrition and hydration, support for self care, exploring harmful thoughts and spiritual distress

screening tools

SBIRT, AUDIT, CAGE, CAGE- AID, T-ACE

alcohol systemic effects

peripheral neuropathy, alcoholic myopathy, cardiomyopathy, alcoholic hepatitis, cirrhosis of the liver, esophagitis, gastritis and pancreatitis, leukopenia, thrombocytopenia, cancer

alcohol minor withdrawal symptoms ( 6-8 hours)

n,v, shaky, jitters, HA, mild perceptual changes

alcohol moderate withdrawal symptoms (8-10 hr)

psychotic and/ or perceptual symptoms begin (hallucinations), can lead to seizures, delirium or unconsciousness

alcohol severe withdrawal symptoms (12-24 hr)

seizures (generalized and tonic- clonic

delirium tremens

medical emergency; causes physiologic problems; delusions and hallucinations; pts are danger to self

tobacco cessation

patches, lozenges, gum, hypnosis, bupropion, varenicline

disulfiram (antabuse)

only for AUD. used in adjunct to treatment of chronic alcoholism

antabuse action

blocks enzyme involved in processing alcohol which creates severe discomfort and is a deterrent to drinking

antabuse se

severe n, v, chest pain, tachycardia, flushing, dizziness

antabuse nursing

never use with any alcohol containing products, carefully check labels of all liquid medications, avoid breathing fumes of paints, stains, stripping compounds

naltrexone

first line treatment for OUD and AUD.

naltrexone action

binds to the endorphin receptors and blocks effects of opioids

naltrexone po

reduced tolerance for opioids, taking the same or even a lower dose of opioids used in the past can cause OD

naltrexone AUD- must have withdrawn from alcohol

reduces alcohol cravings and amount of alcohol consumed, must maintain sober

IM naltrexone- vivitrol q 28 days

must wait at least 7 days from last opioid use for short acting and 10-14 after long acting

methadone

long acting full opioid agonist and schedule 2 controlled medication. helps achieve and sustain recovery

methadone nursing

taken daily for >12 months, medically monitored daily, low dose for pregnancy, can also be addictive

buprenorphine

1st opioid use disorder medication that could be prescribed in the dr’s office. makes it easier for people to seek treatment

buprenorphine route

buprenorphine/ naloxone sublingual films (suboxone), buprenorphine extrende release injection (sublocade)

addiction

inability to consistently abstain from a substance or activity

intoxication

under the influence, varying levels

tolerance

builds up. higher doses required for effect

withdrawal

physiological symptoms occur when a person stops using

advanced practice interventions

psychotherapy or consultation, holistic approach, cognitive behavioral therapy

caffeine intoxication s/s

restlessness, nervousness, flushed feeling, GI upset, tachycardia

caffeine withdrawal s/s

HA, drowsiness, irritability, poor concentration

cannabis intoxication s/s

heightened senses, depersonalization, derealization, delirium

cannabis withdrawal s/s

irritability/ anger, restlessness, anxiety, gi upset, fever, chills

cannabis treatment

abstinence, ssri’s

hallucinogen intoxication s/s

paranoia, impaired judgement, derealization, pupil dilation, tachycardia, tremors

hallucinogen withdrawal s/s

re- experiencing s/s, can last weeks, mnths, yrs

hallucinogen treatment

reassurance of safety, benzodiazepines, restraints

inhalants intoxication s/s

disinhibition, euphoria, illusions, hallucinations, nystagmus, n, v, decreased reflexes

opioid intoxication s/s

constricted pupils, drowsiness, slurred speech, impaired memory and attention, psychomotor retardation, respiratory arrest

opioid withdrawal s.s

mood dysphoria/ anxiety, n, v, d, diaphoresis, hyperreflexia

stimulants intoxication s/s

elated, euphoric, hypervigilant, anxious, dilated pupils, wgt loss, seizures, chest pain, arrhythmias

stimulants withdrawal s/s

tiredness, insomnia, vivid nightmares, depression, suicidal, paranoia, irritability

stimulants treatment

inpatient (amphetamines), outpatient (cocaine), antipsychotics, diazepma

somatization

expression of stress through physical s/s that are often manifestations of psychological and emotional distress

somatic symptom disorder

>6 months, excessive thoughts, anxiety and behaviors around symptoms or health concerns, high level of functional impairment, often resistant to seeking psychiatric assistance

illness anxiety disorder (hypochondriac)

preoccupation with having serious illness for >6m, high anxiety about health, excessive health related behaviors or maladaptive avoidance

conversion disorder

presence of deficits in voluntary motor or sensory functions

conversion disorder s/s

paralysis, blindness, movement and gait disorders, numbness, paresthesia, loss of vision or hearing, episodes resembling epilepsy

factitious disorder

psychiatric disorders in which people consciously pretend to be ill to get emotional needs met

malingering factitious disorder

Conscious fabrication of illness or exaggerating symptoms for secondary gain such as insurance fraud, prescription medication, avoidance of prison or military service

factitious disorder by proxy

Rare condition wherein a person intentionally causes or perpetuates the illness of a loved one. Most commonly parent to child

psychoanalytic theory- freud

psychogenic complaints of pain, illness, or loss of physical function is a cover up for conflicted feelings and/or unwelcome experiences

behavioral theories

communication of helplessness, attention seeking

cognitive theories

negative, distorted, catastrophic thoughts, focus on body sensations and misintherpret their meaning, responding with excessive alarm

cognitive reframing

questioning client to determine other potential causes of feared disease