N4E3

therapeutic milieu

the clients environment is organized to assist him to control problematic behavior and use various adaptive skills in coping with self, others, and environment

• focus on social relationships and activities

• can co-exist in many settings

actual or anticipated loss

the death of a loved one, losing a job, a serious injury resulting in a disability, or a natural disaster destroying your home, while "anticipated loss" could refer to grieving the future loss of a loved one diagnosed with a terminal illness, preparing for the eventual retirement from a job, or knowing a relationship is likely to end soon. 

major depressive disorder

• lasts at least 2 weeks

• mild —→ severe

• sleeping issues, weight change, feelings of worthlessness and hopelessness, recurrent thoughts of death

• causes impairment in social or occupational functioning

disruptive mood Dysregulation disorder

children and adolescents 6-18 years old

• differentiates between children with irritability and episodic bipolar disorder

persistent depressive disroder

• feelings of depression nearly all the time

• often begins in childhood

This is LESS severe than regular depression. People can continue with ADLs but feel chronically sad, still go day-to-day

premenstrual dysphoric disorder

symptoms occur before/during menstruation

• this type of feeling improves when the female moves out of menstruation

ECT/EST

pulses of electrical energy passed through the brain- sufficient to cause a seizure (gran maul- tonic clonic)

• used for serious, life - threatening mood disorders

MEDICATIONS: given to reduce secretions, cause anesthesia, and prevent seizure related injuries

side effects for ECT

primarily memory deficits

ECT nurse responsibility

• signed consent, no education on procedure

• NPO 8 hours prior

• have client empty bladder

• loose, non-restrictive clothing

• offer support

• vitals, documentation

milieu management

• specific types of verbal techniques

• helps client gain insight into causes of depression

medications for depression

tricyclic antidepressants

• take 2-4 weeks for a response

• must be tapered off

• adverse effects: dry mouth, constipation, difficulty passing urine, orthostatic SE , SEDATION

• can help with: improving appetite, and weight.

• is FATAL in overdose (do not give to suicidle patients)

SSRI

• tx of choice for depression

• 4-6 weeks to see effects

• generally safe in overdose

• DO NOT ABRUPTLY WITHDRAWL (headache, vivid dreams, insomnia, confusion)

• take in MORNING with food

serotonin syndrome

Serotonin syndrome occurs when the levels of a chemical in your brain called serotonin become too high. It's usually triggered when you take an SSRI in combination with another medicine (MAOI or st johns wart)

serotonin syndrome s/s

mental status change, agitation, hyperreflex, hypertension, fever, sweating, nausea, headache

tx: discontinue, in severe patients may require muscle relaxants

apathy syndrome related to SSRI

Apathy syndrome, also known as SSRI-induced apathy, is a collection of symptoms that can occur when taking selective serotonin reuptake inhibitors (SSRIs). SSRIs are commonly used to treat depression.

Symptoms Loss of motivation, Lack of curiosity, Anergy, and Decreased emotional responsiveness.

SSRI withdrawal syndrome

do not stop abruptly, can cause lethargy, dizziness, nausea, anxiety, and agitation

SSRI examples

citalopram, escitalopram, fluoxetine, paraoxetine, sertraline

MAOI examples

marplan, nardil, parnate

MAOI

strictly reserved for patients who are not response to other medications

• orthosatis hypertension is a common effect

• numerous drug interactions

what foods do patients on these medications avoid

tyramine - leads to dangerous hypertension

(beer, wine, mature cheese, sour cream, yogurt, processed meat)

psychosis

disruptive mental state where the client struggles to distinguish the external world from the internal perception

• can not distinguish between what is real and what is not

• have impaired communication

• can occur in many diagnosis

positive symptoms of schizophrenia

Positive symptoms refer to excesses or distortions of normal function caused by overactivity of dopamine in the brain.

• hallucinations, delusions, loose associations, word salad,

negative symptoms of schizophrenia

Negative symptoms refer to a loss or reduction of normal functions, often linked to decreased dopamine activity in certain brain regions.

• absense of what should be there

• blunted affect, social withdrawal, poor insight

• lack of social skills

anergia

abnormal lack of energy

anhedonia

Anhedonia is a symptom characterized by a reduced ability to experience pleasure or interest in previously enjoyable activities

alogia

Alogia, also known as poverty of speech, is a condition that makes it hard for someone to speak.

avolition

a lack of motivation or the inability to start or continue goal-directed activities

does positive or negative symptoms have better prognosis?

positive - negative last longer

schizoaffective disorder

schizophrenic symptoms are dominate but accompanied by major depressive or manic symptoms (affective)

brief psychotic disorder

all psychotic disturbances that last less than 1 month are not related to a mood disorder, medical condition, or substance abuse

delusional disorder

similar to schizophrenia but do not meet criteria for schizophrenia

Milieu management

• Maintain a secure and predictable environment

• Set clear rules and expectations

• Monitor for self-harm or aggressive behaviors

• Allow patients to participate in decision-making

• Promote responsibility for self-care and daily routines

• Empower patients to set personal goals

• non stimulating environment

suspicious patients

be matter of fact,

do not laugh or whisper

be consistent and maintain eye contact

antipsychotics (traditional)

most effective on positive symptoms

significant adverse effects (photosensitivity, decreased sweating,

antipsychotics, 2nd generation (atypical)

increased effectiveness on negative symptoms

little to no risk of EPS or TD

antipsychotics, third generation

most effective on negetive symptoms

side effects of traditional

Orthostatic hypotension

• constipation, nv

• photosensitivity

• sexual dysfunction, menstral dysfunction

• extrapyramidal side effects

extrapyramidal side effects

• Parkinson like symptoms:

• Dystonia (Acute Muscle Spasms) 🦴

• Oculogyric crisis (upward eye deviation)

• Akathisia (Restlessness & Urge to Move) 🏃‍♂

• Parkinsonism (Tremors & Rigidity) 🧓

• Tardive Dyskinesia (Late-Onset Involuntary Movements) 👄

Dystonia

Acute Muscle Spasms) 🦴

• Torticollis

neck twisting

Oculogyric crisis

upward eye deviation

Akathisia

• Intense inner restlessness, pacing, inability to sit stil

Parkinsonism (Tremors & Rigidity) 🧓

• Symptoms mimic Parkinson’s disease:

  • Tremors, rigidity, bradykinesia (slow movement), shuffling gait

Tardive Dyskinesia

• Involuntary, repetitive movements (lip smacking, tongue rolling, blinking

neuroleptic malignant syndrome

NMS is a rare but serious adverse reaction to antipsychotic medications. It is characterized by a triad of symptoms: 

fever, muscle rigidity, and altered mental status, tachycardia. 

neuroleptic malignant syndrome

dentroline or dopamine antagonist

anticholinergic side effects

• Dry mouth (xerostomia)

• Blurred vision (due to pupil dilation)

• Urinary retention

• Constipation

• Increased heart rate (tachycardia)

• Flushed skin (redness & warmth)

• Decreased sweating (anhidrosis), leading to overheating

akathisia

Akathisia is a movement disorder characterized by an intense, uncontrollable urge to move.

akinesia

Akinesia refers to the inability to voluntarily move one's muscles and limbs.

managment if EPS and TD

• lowest dose of antipsychotics

• vitamin E

• benadryl, cogentin, vistril

• benzos

haldol (haloperidol)

HIGH potenency (first generation)

2nd generation

clozapine, rispiridone, olanzapine, quetiapine (-PINE and -DONE)

Better for negative symptoms

third generation

Aripiprazole (abilify)

dystonia

sudden and expected muscle spam in neck, face, and mouth

·      Understand MAOI’s and food interactions/teaching r/t Rx·      Understand MAOI’s and food interactions/teaching r/t Rx

o   Interacts with TYRMAINE (aged cheeses, smoked meats, chocolate, overripe fruits, fermented foods)

 

·      Review definition of EPS. Which meds most likely to cause these? How is this treated?

Extrapyramidal symptoms (EPS) are drug-induced movement disorders that include symptoms like tremors, rigidity, and bradykinesia, often caused by antipsychotic medications. Treatment typically involves the use of anticholinergic drugs or beta-blockers.