Psychiatry

Bipolar Disorder

increase in serotonin → Mania

increase in norepinephrine → inc BP

Bipolar Disorder

restless, irritable, demanding, manipulative, unable to sleep

Restless in bipolar patient

risk for injury directed to others

Unable to sleep in bipolar

provide calm environment
soothing music
warm bath

warm milk

activity for bipolar patient

non competitive:
painting with colors
delivery of linens

First line of medication for Bipolar Disorder

Lithim

Normal value of lithim

0.6-1.2 meq/dl

What to watch out for in taking lithim

L - level: 0.6.1.2
I - increase urination: inc OFI
T - toxicity: corse tremors, kidney damage
H - hand: fine tremors (side effect)
I - increase OFI
U- upset stomach
M - maintain Na level 135 - 145

2nd line of medication for bipolar

Carbamazepine - Tegretol

Carbamazepine - Tegretol WOF

Myelosuppression - increase WBC → risk for infxn

Major Depression

last for 2 weeks

Dysthymia

last 2 years or more

Functional Depression

depression during solitude

Post part um depression

normal if last 30 days. >30 days = post partum psychosis

Seasonal affective disorder

winter fall depression

Anti Depressant

Tricyclic Antidepressant
Serotonin Selective Reuptake Inhibor
MAOI

TCA

“praning and tililing”
-pramine - triptyline

Tofranil, Elavil, Anapranil, Nortriptyline

SSRI

-xamine, -xetine- pram

Prozac (fluoxetine), Zoloft (sertraline), Paxil, Escitalopram

Side effect of SSRI

sexual dysfunction

MAOI

-promine, - phenelzine, - isocarboxazid

parnate, marplan, nardil

What to avoid when taking MAOI?

tyramine rich food:
processed food, aged food → can lead to HTN crisis

Schizophrenia

dopamine imbalance

Positive symptoms of Schizophrenia

-tion - tion
-sion -sion
-nia - nia
-echo -echo

Hallucination, loss of association
Delusion, Illusion
Insomnia, catatonia
Echolalia, echopraxia

Catatonia

waxy flexibility
WOF: circulatory problem

Echolalia

repitition of words

Echopraxia

repitition of action

Negative Symptoms of Schizophrenia

6 As
Anergia - lack of energy
Avolition - lack of motivation
Alogia - inability to speak
Affect is flat
Anhedonia - no pleasure
Asocial - rejecting friends

Antipsychotic Medication

Typical: Old generation
Atypical: New generation

Typical antipsychotic drug

Haloperidol
Chlorpromazine

Atypical antipsychotic medication

“OSCAR”

respiredone (respiredal)
seroquel (quetiapine)
aripriprazole (abilify)
clozapine (clozaril)
olanzepine (zyprexia)

Priority in Depression

Suicide prevention

Suicidal Ideation

“Have you been thinking about suicide?

Suicidal plan

“What is your plan for suicide?”

Serotonin Syndrom

Hyperthermia, muscle rigidity, tremor

ECT

Maintain NPO pre op
Voided pre op

Short-acting anesthetics and muscle relaxants
monitor vital signs, ECG, and airwat
Confusion and short term memory loss is common

SSRI

Fluoxetine
Sertraline

TCA

Nortryptilline
Amitriptylline

MAOI

Phenelzine
Isocarboxazid

Anxiety

Excessive and presistent worry

Signs of Anxiety

Palpitations, agitation, sweating

4 levels of anxiety

Mild, moderate, severe, panic

Mild Anxiety

Able to problem solve

Severe and Panic

priority is safety
stay with the client
dec environmental stimuli
Fast acting anxiolytics

Mild to moderate

Prevent escalation of anxiety
expression of feelings

breathing techniques
assist in problem solving

Management for Anxiety

Identify triggers
relaxation techniques
cognitive behavioral therapy

Fast-acting, short term, acute anxiety

Benzodiazepine
diazepam, midazolam

Long term, long acting, chronic anxiety

SSRI (fluoxetine, sertraline)
Buspirone

Phobia

fear

Exposure therapy

management for phobia

Obssessive compulsive disorder

obssession and compulsion

Obsession

persistent, unwanted thoughts

compulsion

repetitive behaviors

Management for OCD

do not interrupt during ritual, can inc anxiety