FINAL REVIEW OF CRITICAL MENTAL HEALTH CONCEPTS PART 2

MEDICATION FOR DEPRESSION: SSRI

Escitalopram

Fluoxetine, fluvoxamine

Sertraline

Proxetine

Citalopram

Uses:

Depression, anxiety , OCD, Eating disorder

SSRI Side effects

Stomach upset

Sexual dysfunction

Serotonin syndrome:

shivering

hyperreflexia

Increased temp

vital signs instability

encephalopathy

restlessness

sweating

Nursing education for SSRI

Take in AM

May take 4-6 weeks to work

Report increase in suicidal thoughts

SSNRI - Serotonin norepi reuptake inhibitor

Venlafaxine, duloxetine

Uses: depressive episodes, anxiety

Side effects: headache, photosensitivity, agitation, tremors, insomnia, dry mouth, dehydration, constipation, nausea, diarrhea

Nursing education for SNRI

4-6 weeks TO WORK

Don’t mix with/ TCA or MAOI

Tricyclic Antidepressants (TCA)

Amitriptyline

Uses:

Depressive episodes

Bipolar disorder

OCD

Neuropathy

TCA side effects

orthostatic hypotension

Anticholinergic effects

Nursing education TCA

14 day washout—completely taper OFF MAOI before starting TCA or could have Major HTN

2-3 week till full effects

Compliance importance

Very potent—high risk for suicide—death if taken at once

MAOI

Phenelzine

Tranylcypromine

Isocarboxazid

Use:

Depression

MAOI side effects

Orthostatic hypotension

dizziness

blurred vision

constipation

dry mouth

hypertension crisis—report

headache

stiff neck

N/V

fever

dilated pupils

Nursing education for MAOI

4 weeks for the therapeutic level

hypertension crisis—report & seek medical attention

Avoid foods w/ tyramine—

aged cheese, fermented meats, chocolate, caffeinated bev., sour cream, yogurt, beer, wine

Anorexia Nervosa

BMI: less than 18

Hypotension

bradycardia

low tem

no period

skin—fine downy hair

EKG changes

Major cardiac risks

distorted perception

exercise, purging

Bulimia

BMI: normal—slightly

Compensation:

Purge—laxative, vomit, diuretics

non-purge: exercise

Hypokalemia concerns w/ purging

Binging & purging

Binge ONLY

BMI: 30+ overweight

Hypertension issues

Issues caused by being overweight

Somatic symptom disorder

physical symptoms w/ no medical explanation

Medically unexplained

Excessive

Anxiety

Time consuming

Imparing
Chronic

Illness anxiety disorder

misattributes manifestations to a serous illness =obsessive thoughts & fears about illness

Conversion Disorder

significant impairment

deficits in voluntary motor/sensory functions

Clinically unexplained

Abnormality

Nervous system

trigger

Factitious disorder

emotional need for attention

self-injury

can be imposed on others to have relief of responsibility

Nursing interventions for somatic disorders

Safety—patient may be risk to self

Medication reconciliation

Open communication w/ providers

Relaxation techniques/stress management

Suicide precautions for somatic disorder

supervision

documentation—location, mood, quoted statements & behavior

Remove anything that could be used as a weapon or for harm

Plastic only utensils

Check for possible hazards—windows, overhead pipes, non breakaway shower rods

Ensure hands are always visible

Do not assign private room

Door always open

Swallow meds—can overdose by hoarding

Restrict visitors—screen what they bring into room

Bipolar 1

mania episode w/ MDD —one week of manic

Bipolar 2

hypomania w/ MDD

CYCLOTHYMIC

2 years hypomanic w/ minor depression

Manic attack cues

Distractibility

Indiscretion

Grandiosity

Flight of ideas

activity increase

Sleep deficit

Talkativeness

Bipolar intervention focus

Safe environment

Assess for suicide

Decrease stimulation w/o isolation

Rest periods

Outlets for physical activity

Protect from poor judgment/ impulsive behavior

Nursing for Bipolar

Communication—reduce splitting, manipulative behaviors

Consice explanations

Calm & matter of fact

Mood stabilizers: Long-term therapy

Lithium carbonate

levels—narrow range

Side effects:

slight N/V

fatigue

thirst

dry mouth

weight gain

Nursing education for Lithium

Lab follow up—

1-2 months once range is met

more frequent for older adults/changes in dose

Medication adherance

Sedation potential—driving

Water intake to avoid dehydration

Avoid starting a low salt diet

1st gen antipsychotics meds

Chloropromazine

Loxapine

Haloperidol

2nd gen antipsychotic meds

risperidone

clozapine

Antidepressants—SSRI

Fluoxetine to manage MDD episode

Schizophrenia phases: pre-morbid

normal functioning

symptoms not apparent

Schizophrenia—prodromal phase

More tempered form of disorder

can be months —-years for disorder to become obvious

schizophrenia

positive symptoms are not noticeable & apparent

Residual—schizophrenia

periods of remission

negative symptoms may remain

Positive symptoms for schizophrenia

Delusions

anxiety/agitation

hallucinations

auditory *most common

jumbled speech

disorganized behavior

Negative symptoms of schizophrenia

flattened/bland affect

lack of energy

reduced speech

avolition—lack of motivation

anhedonia—lack of feeling joy or pleasure

lack of social interaction

Schizophrenia intervention focus

Assess for command hallucinations—risk for safety

Reality assessment—bring client back to reality

Safety—address clients feelings about hallucinations —don’t aruge with them or pretend to engage w/ hallucinations

Compassionate care

Nursing for schizophrenia

Try to establish trust w/ client

Encourage compliance w/ the meds

Promote self-care

Encourage group activites

Offer therapeutic communication

1st generation antipsychotic meds

chlopromazine

loxapine

haloperidol

Use: positive symp. only

1st gen antispychotic med side effects

EPS: parkinson like symp. , akathesia (restlesssness), dystonia (msucle twitching)

involuntary movements of face, tongue, or limbs, NMS (eps, high fever, & autonomic disturbance), ortho hypotension

2nd gen antipsychotic meds

risperidone, clozapine

use: positve & negative symp.

use: lower risk of TD, EPS, NMS

Increase weight

cholesterol

triglyceride

blood sugar

agranulocytosis—CLozpine only

Nursing education of antipsychotics

check labs —blood suga, LDL, triglycerides

to decrease the risk of gaining weight, advise client about exercise, lower calorie diet, & monitor their weight

Side effects of both generations of anitpsychotic meds

anticholinergic effects

photophobia

photosensitivity

sedation/lethargy

Personality disorders—cluster A

odd or eccentric (weird)

Paranoid-

schizoid don’t desire presence of others, seclusive, detached

Schizotypal—may have some hallucinations/delusions, difficulty relating to other

Cluster B: dramatic or emotional (wired)

Borderline—unstable, manipulative to self/others, fear of neglect

ID disturbance

Dysphoria/emptiness

Emotional instability

Suicide & self-harm

Psychotic/dissociative

Anger

Impulsitiy

Antisocial—cluster B

no care for others, aggressive manipulative, doesn’t follow rules

Histrionic—cluster B

drama queen, overly sexual, attention seeker

Narcisstic—cluster B is

Obssed w/ self

Thinks they are greater than reality

Cluster C—anxious or insecure (worried)

Dependent—need others, very anxious on own

Obseeive compulsive—everyting needs to be perfect, control issues, ridgid

Avoidant—anxious in social situations, avoids socialization but wants close relationships, fear of abandonment

Intervention focus for personality disorders

therapy

Nursing for personailty disorders

safety is priority—high risk for hsk for harm of self

develop therapeutic relationship

respect clients needs while sitll setting limits and consistency

give client choices to improve their feeling of control

antidepressant

personality disorders medications

antidepressants

anxiolytics

antipychotics

mood stablizer