mental health volume 2

Ketamine

A substance acting as a glutamate receptor antagonist in the treatment of psychiatric disorders.

Glutamate

An excitatory neurotransmitter involved in various brain functions.

Persecutory

Related to a feeling of being harassed or persecuted.

Antagonist

A substance that inhibits the action of another; used in the context of medications.

Mania

A state of abnormally elevated or irritable mood, arousal, and/or energy levels.

Hypnagogic

Pertaining to the state immediately before falling asleep.

Hallucination

A perception in the absence of an external stimulus that has qualities of real perception.

Psychosis

A severe mental disorder characterized by a disconnection from reality, including delusions and hallucinations.

Schizophrenia (Etymology)

Derived from Greek: 'Schizo' (To split) and 'Phrenia' (Mind).

Schizophrenia (Epidemiology)

Affects approximately 0.45% of adults; 2/3 of affected individuals do not receive appropriate medical treatment; life expectancy is reduced by 10-20 years.

Schizophrenia (Age of Onset)

Males: Ages 18–25; Females: Ages 25–30 (often with less severe symptoms).

Schizophrenia (Symptoms)

Disorganization and discord in thought, mood, and behavior; altered perception of reality.

Schizoid Personality Phase

The first phase of schizophrenia, characterized by secretiveness, isolation, and lack of interest in socialization.

Prodromal Phase (Schizophrenia)

The second phase of schizophrenia, characterized by mood changes (anxiety, depression, mood swings), sleep disturbances, irritability, impaired role functioning, and eccentric behavior.

Active Phase (Schizophrenia)

The third phase of schizophrenia, characterized by the exhibition of positive symptoms.

Positive Symptoms (Schizophrenia)

Actual disease symptoms, including hallucinations, illusions, depersonalization, bizarre behavior, agitation, catatonia, and autism.

Illusions

Misinterpretations of real external stimuli.

Depersonalization

Feeling detached from oneself.

Bizarre Behavior

Unusual actions that do not conform to social norms.

Agitation

Increased motor activity, often without purpose.

Catatonia

Immobility or excessive movement in response to sensory stimuli.

Autism (Schizophrenia Symptom)

Social withdrawal from reality.

Negative Symptoms (Schizophrenia)

Reflect a diminished capacity to cope with life, including blunt or flat affect, anhedonia, avolition, impoverished speech, substance use, depression, and violent behavior.

Blunt or Flat Affect

Reduced expression of emotions.

Anhedonia

Inability to feel pleasure from activities.

Avolition

Lack of motivation for self-care and daily tasks.

Impoverished Speech

Limited amount of spontaneous conversation.

Paranoid Schizophrenia

Characterized by suspicion and delusions, auditory hallucinations, and hostile behavior.

Disorganized Schizophrenia

Characterized by indifference to social norms and inappropriate emotional responses; often diagnosed in adolescence.

Undifferentiated Schizophrenia

Symptoms do not fit criteria for other types; generally less severe psychotic symptoms.

Catatonic Schizophrenia

Exhibits two forms: Catatonic Stupor (immobility, lack of facial expressions) and Catatonic Excitement (agitated, impulsive behavior).

Rule of Quarters (Schizophrenia Prognosis)

Describes the prognosis of schizophrenia: 25% recover fully, 25% show significant improvement with residual symptoms, 25% have a chronic course, and 25% experience poor outcomes.

Determinants of Schizophrenia Prognosis

Early onset correlates with poorer outcomes; support systems, family history, marital status, and compliance with medication are crucial.

Schizoaffective Disorder

Requires the presence of primary positive symptoms of schizophrenia and episodes of mood disorders (either Major Depressive Disorder or Bipolar Disorder); chronic and disabling.

Antipsychotic Medications (Schizophrenia Treatment)

Crucial for treatment; may include time-released pills. Anticholinergic drugs may be needed to combat side effects.

Long-acting Injectables (LAI)

Antipsychotic medications administered every 2–4 weeks; used for non-compliant patients.

Allopurinol (Schizophrenia Treatment)

Shows promise in reducing both positive and negative symptoms in resistant schizophrenia cases.

Electroconvulsive Therapy (ECT)

A treatment method that changes levels of neurotransmitters affecting mood and cognition.

Psychotherapy (Schizophrenia Treatment)

Includes social skills training and coping skills development.

High Potency Antipsychotics

Medications like Haloperidol (Haldol) and Fluphenazine (Prolixin), characterized by prevalent extrapyramidal side effects.

Moderate Potency Antipsychotics

Medications like Loxapine (Loxitane) and Perphenazine (Trilafon).

Low Potency Antipsychotics

Medications like Chlorpromazine (Thorazine) and Thioridazine (Mellaril), characterized by prevalent anticholinergic side effects.

Anticholinergic Reactions (Side Effects)

Symptoms include dry mouth, blurred vision, urinary retention, constipation, and hypotension.

Extrapyramidal Side Effects (EPS)

Movement disorders resulting from blocking dopamine pathways, including akathisia, dystonia, tardive dyskinesia, and neuroleptic malignant syndrome.

Akathisia

A side effect of antipsychotics characterized by restlessness.

Dystonia

A side effect of antipsychotics characterized by abnormal muscle contractions.

Neuroleptic Malignant Syndrome

A serious condition characterized by muscle rigidity, hyperthermia, and changes in levels of consciousness as a side effect of antipsychotics.

Tardive Dyskinesia

An irreversible involuntary movement disorder caused by long-term use of neuroleptic drugs; characterized by uncontrollable movements of the face and limbs.

Nursing Care for Patients with Schizophrenia

Assess for non-compliance, identify knowledge deficits, monitor side effects, encourage safety/ADLs, build trusting relationships, provide reality orientation, manage hallucinations by refocusing, combat oral dryness, and emphasize medication compliance.

Addiction

A chronic condition characterized by compulsive substance use despite harmful consequences.

Tolerance (Substance Abuse)

The need for increased amounts of a substance to achieve the same effect.

Withdrawal (Substance Abuse)

Unpleasant symptoms experienced when reducing or stopping substance use.

Relapse (Substance Abuse)

The return to substance use after a period of abstinence.

Substance Dependency (Criteria)

Requires three or more symptoms for at least one month: tolerance, withdrawal, desire to cut down, significant time spent, reduction of activities, and continued use despite problems.

Alcohol Abuse (Characteristics)

Central Nervous System depressant leading to relaxation, slurred speech, and impaired coordination.

Long-term Effects of Alcohol Abuse

Cardiomyopathy, cirrhosis, hepatitis, and Wernicke-Korsakoff Syndrome (linked to thiamine deficiency).

Wernicke-Korsakoff Syndrome

A condition linked to thiamine deficiency from chronic alcohol abuse, including memory loss and confusion.

MAST (Michigan Alcohol Screening Tool)

An assessment tool used to evaluate alcohol use patterns.

CAGE Questions

An assessment tool for alcoholism: Cut down? Annoyed? Guilty? Eye-opener?

Alcohol Detoxification

Usually lasts 4-6 hours after the last drink, with symptoms such as anxiety, tremors, and withdrawal seizures. Nursing care includes managing symptoms and nutritional support.

Delirium Tremens (DTs)

Severe alcohol withdrawal symptoms including seizures, hallucinations, and agitation.

Post-Detox Treatment (Alcohol)

Use of medications like Antabuse (to deter drinking) and Naltrexone (to decrease cravings), along with therapy support.

Cannabis (Marijuana)

Active ingredient is Tetrahydrocannabinol (THC). Symptoms include hallucinations, anxiety, increased appetite, and short-term memory impairment. Detectable in urine for 3-4 days, blood for 3-4 weeks.

Cocaine

A stimulant causing immediate dependence, hallucinations, and increased heart rate.

Opiates

Highly addictive drugs leading to severe consequences like respiratory depression and overdose crisis.

Narcan (Naloxone)

The antidote for opiate overdose.

Hallucinogens

Drugs (e.g., LSD, PCP) that alter perceptions of time and reality; cause intense visual and auditory hallucinations.

Anxiolytics (Abuse)

Commonly abused benzodiazepines and barbiturates with sedating effects, leading to impaired cognition and decision-making capabilities.

Support Groups (Drug Abuse)

Programs like Narcotics Anonymous that provide physiological care, therapy, and coping skill development.

Personality Disorders

Patterns of interpersonal behavior that may cause social and occupational difficulties. Diagnosed typically in childhood or adolescence with traits resulting in manipulation and difficulties in relationships.

Cluster A Personality Disorders (Odd/Eccentric)

Includes Paranoid (distrustful), Schizoid (withdrawn), and Schizotypal (eccentric beliefs).

Cluster B Personality Disorders (Dramatic/Erratic)

Includes Borderline (unstable self-image), Narcissistic (grandiosity), Antisocial (manipulative), and Histrionic (attention-seeking).

Cluster C Personality Disorders (Anxious/Fearful)

Includes Obsessive-Compulsive (perfectionism), Dependent (excessive need for support), and Avoidant (sensitivity to negative evaluation).

Borderline Personality Disorder (Characteristics)

Common in females, with patterns of intense emotions, unstable relationships, impulsivity, mood swings, and self-harm.

Interventions (Borderline Personality Disorder)

Cognitive Behavioral Therapy (CBT), safety contracts, and anger management.

Dependent Personality Disorder (Characteristics)

Characterized by a lack of self-confidence and a preoccupation with fears of being abandoned.

Interventions (Dependent Personality Disorder)

Encourage autonomy and decision-making.

Narcissistic Personality Disorder (Characteristics)

Exhibits grandiosity, a need for admiration, and lacks empathy.

Interventions (Narcissistic Personality Disorder)

Teach coping skills, direct communication, and healthy relationships.

Antisocial Personality Disorder (Characteristics)

Marked by a disregard for others and impulsive behavior; high risk of criminal behavior.

Interventions (Antisocial Personality Disorder)

Protect others, manage anger, and set enforcement limits.

Paranoid Personality Disorder (Characteristics)

Features include chronic hostility, jealousy, and projection of insecurities onto others.

Interventions (Paranoid Personality Disorder)

Focus on cognitive-behavioral therapies to help develop trust and flexibility.

Dissociative Identity Disorder (Multiple Personalities)

Often a result of severe childhood trauma; characterized by two or more distinct identities affecting behavior.

Nursing Care for Personality Disorders

Essential for the patient to accept the need for help first; employ therapeutic communication and paternalization techniques.

Eating Disorders

Involve chronic disruptions in eating behaviors due to emotional issues; major forms include Anorexia Nervosa and Bulimia Nervosa.

Anorexia Nervosa

An eating disorder characterized by an intense fear of gaining weight, leading to significant weight loss. Symptoms include cardiac issues, amenorrhea, and skin problems.

Bulimia Nervosa

An eating disorder characterized by binge eating followed by compensatory behaviors (vomiting, laxatives) while typically remaining at a normal weight.

Complications (Bulimia Nervosa)

May lead to dental problems, electrolyte imbalances, and neurological deficits.

Nursing Care for Eating Disorders

Focus on nutritional counseling, monitoring weight, providing IV support as needed, and encouraging therapy addressing underlying emotional issues.

Sexual Disorders

Include dysfunction related to interest, arousal, and pain; gender dysphoria is also noted. Treatment typically involves hormone therapy and psychotherapy.

Crisis Intervention

A temporary state of emotional imbalance that occurs in five phases (Pre-Crisis, Impact, Crisis, Adaptive, Post-Crisis). Goals include ensuring safety, diffusing anxiety, and returning to a pre-crisis functioning level.

Phases of Crisis Intervention

1. Pre-Crisis, 2. Impact, 3. Crisis, 4. Adaptive, 5. Post-Crisis.

Therapeutic Milieu

An environment designed to support recovery with a focus on safety, structure, and regulated behavior. Goals are to improve behavior, build self-esteem, and teach coping skills.