Psychia 1

What med is prepared pre-ECT to prevent too much erratic<br>contractions?

Succinylcholine

<20 yrs old [earlier than women; high estrogen delays onset!]

What is the usual onset of schizophrenia in men?

Positive symptoms: <br>Delusions<br>Hallucinations<br>Disorganized speech/behavior<br><br>Negative symptoms<br>Compromised ADLs

Symptoms of schizophrenia

Anhedonia<br>Avolition<br>Alogia <br>Affective flattening<br>Aphasia

What are the negative symptoms of Schizophrenia?

Anhedonia

a negative symptom of schizophrenia wherein there is a lack of interest/motivation

Alogia

= a negative symptom of schizophrenia wherein there is poverty in speech<br>= speaking less d/t brain impairment

Affective flattening

a negative symptom of schizophrenia wherein they exhibit little or no affect in face or voice

Anhedonia

a negative symptom of schizophrenia wherein they are unable to experience pleasure

Associality

a negative symptom of schizophrenia wherein they are unable to form close personal relationships

Somatic Delusion<br>Grandiose Delusion<br>Nihilistic Delusion<br>Delusion of Reference<br>Delusion of Control<br>Paranoid/ Persecutory Delusion

Types of Delusions in Schizophrenics

Somatic

_ delusion is a type of delusion among schizophrenics wherein they insist of having a disease even though they dont"

Schizophrenia [schizo - split; phrenia - mind/person]

= multifactorial major disturbance in thought, emotion, and behavior<br>= aka Dementia praecox<br>= evolution: Dementia praecox &gt; Catatonia &gt; Hebephrenia &gt; Paranoia &gt; ___

Grandiose

_ delusion is a type of delusion among schizophrenics wherein they have exaggerated beliefs related to power/ health"

Nihilistic Delusion

"a type of delusion among schizophrenics wherein they believe that <b><span style=""background-color: rgb(255, 255, 0);"">everything is meaningless</span></b> and <span style=""background-color: rgb(255, 255, 0);""><b>they do not&nbsp;exist at all</b></span>"

Delusion of Reference

"a type of delusion among schizophrenics wherein they&nbsp;believe that <span style=""background-color: rgb(255, 255, 0);""><b>things/events/people are referring to them</b></span>"

Delusion of Control

"a type of delusion among schizophrenics wherein they believe that their <b><span style=""background-color: rgb(255, 255, 0);"">thoughts and feelings</span></b> are being <span style=""background-color: rgb(255, 255, 0);""><b>controlled by outside forces</b></span>"

Paranoid/Persecutory Delusion

"a type of delusion among schizophrenics wherein they believe that <span style=""background-color: rgb(255, 255, 0);""><b>someone is going to harm them</b></span>"

Auditory<br>Visual<br>Tactile<br>Gustatory [taste hallucination]<br>Olfactory [smell hallucination]

5 Types of Hallucinations in Schizophrenics

Auditory hallucination

"<span style=""background-color: rgb(255, 255, 0);""><b>most common and dangerous</b></span> type of hallucination in schizophrenics"

Command hallucination

"<b><span style=""background-color: rgb(255, 255, 0);"">most common</span></b> type of <span style=""background-color: rgb(255, 255, 0);""><b>AUDITORY hallucination</b></span> in schizophrenics"

Crawling sensation

"<b><span style=""background-color: rgb(255, 255, 0);"">most common </span></b>type of <span style=""background-color: rgb(255, 255, 0);""><b>TACTILE </b></span>hallucination"

Word salad <br>Echolalia<br>Palilalia<br>Perseveration<br>Neologism<br>Flight of ideas<br>Concrete association

7 Types of Disorganized Speech in Schizophrenics

Word salad

"= a type of disorganized speech in schizophrenics<br>= <span style=""background-color: rgb(255, 255, 0);""><b>words have no logical meaning</b></span> to each other"

Clang association

"= a type of disorganized speech in schizophrenics<br>= <span style=""background-color: rgb(255, 255, 0);""><b>rhyming of random words</b></span>"

Echolalia

"= a type of disorganized speech in schizophrenics<br>= <span style=""background-color: rgb(255, 255, 0);""><b>echoing, parroting, repeating</b></span> what is heard"

Palilalia

"= a type of disorganized speech in schizophrenics<br>= <span style=""background-color: rgb(255, 255, 0);""><b>echoing own last word</b></span>"

Perseveration

"= a type of disorganized speech in schizophrenics<br>= <span style=""background-color: rgb(255, 255, 0);""><b>same response to all questions</b></span>"

Neologism

"= a type of disorganized speech in schizophrenics<br>= <span style=""background-color: rgb(255, 255, 0);""><b>making own new vocabulary</b></span>"

Flight of ideas

"= a type of disorganized speech in schizophrenics<br>= composed of <span style=""background-color: rgb(255, 255, 0);""><b>fragmented or unrelated ideas</b></span>; full sentences"

Concrete associations

"= a type of disorganized speech in schizophrenics<br>= <span style=""background-color: rgb(255, 255, 0);""><b>literal answers</b></span>"

Waxy flexibility<br>Cataplexy<br>Echopraxia<br>Mutism

4 Types of Disorganized Behavior in Schizophrenics

Waxy flexibility

"= a type of disorganized behavior in schizophrenics<br>= remains in <b><span style=""background-color: rgb(255, 255, 0);"">bizarre, uncomfortable position</span></b> for <span style=""background-color: rgb(255, 255, 0);""><b>very long time</b></span> regardless of discomfort"

Cataplexy

"= a type of disorganized behavior in schizophrenics<br>=&nbsp;<b><span style=""color: rgb(77, 81, 86); background-color: rgb(255, 255, 0);"">sudden, brief loss of voluntary muscle tone</span></b> triggered by strong emotions such as laughter, excitement, anger or fear<br>=<span style=""background-color: rgb(255, 255, 0);""><b> 'helds against gravity' </b></span>posture"

Echopraxia

"= a type of disorganized behavior in schizophrenics<br>= <span style=""background-color: rgb(255, 255, 0);""><b>imitating another’s movement</b></span>"

Mutism

"= a type of disorganized behavior in schizophrenics<br>= <span style=""background-color: rgb(255, 255, 0);""><b>no/very little verbal response</b></span>"

Stage 1: Premorbid [Pre-symptomatic risk]<br>Stage 2: Prodromal [Pre-psychotic prodrome]<br>Stage 3: Onset/Deteriorative [Acute Psychosis]<br>Stage 4: Chronic/Residual [Chronic Illness]

Stages of Schizophrenia

Stage 1: Premorbid

"= stage of schizophrenia wherein patient is <span style=""background-color: rgb(255, 255, 0);""><b>exposed to risk factors</b></span><br>= aka <b><span style=""background-color: rgb(255, 255, 0);"">Pre-symptomatic risk</span></b>"

Stage 2: Prodromal

"= stage of schizophrenia wherein patient <b><span style=""background-color: rgb(255, 255, 0);"">manifests non-specific and non-diagnostic symptoms</span></b> <br>= aka <span style=""background-color: rgb(255, 255, 0);""><b>Pre-psychotic prodrome</b></span>"

Stage 3: Onset/Deteriorative

"= stage of schizophrenia wherein patient already <span style=""background-color: rgb(255, 255, 0);""><b>manifests positive and negative symptoms in 6 months</b></span><br>= aka <b><span style=""background-color: rgb(255, 255, 0);"">Acute Psychosis</span></b>"

Stage 4: Chronic/Residual

"= stage of schizophrenia wherein meds taken by px are taking effect; <span style=""background-color: rgb(255, 255, 0);""><b>s/s are weak and infrequent</b></span><br>= aka <b><span style=""background-color: rgb(255, 255, 0);"">Chronic Illness</span></b>"

Brief Psychotic Disorder<br>Delusional Disorder<br>Schizophreniform<br>Schizoaffective Disorder

Clinical subtypes of Schizophrenia <i>[disorders that are similar to schizophrenia]</i>

Brief Psychotic Disorder

"= a clinical subtype of schizophrenia<br>= <b><span style=""background-color: rgb(255, 255, 0);"">sudden onset</span></b> of psychotic symptoms that may or may not be preceded by severe psychosocial stress<br>= symptoms last at least <b><span style=""background-color: rgb(255, 255, 0);"">1 day up to &lt;1 month</span></b><br>= followed by <b><span style=""background-color: rgb(255, 255, 0);"">remission to Stage 1/premorbid level</span></b><br>= common in <span style=""background-color: rgb(255, 255, 0);""><b>females </b></span>[may follow after childbirth]"

Delusional Disorder

"= a clinical subtype of schizophrenia<br>= <b><span style=""background-color: rgb(255, 255, 0);"">persistently one type of delusion</span></b> lasting at least <span style=""background-color: rgb(255, 255, 0);""><b>1 month</b></span><br>= Hallucinations = not prominent; behavior = not bizarre"

Schizophreniform

"= a clinical subtype of schizophrenia<br>= <span style=""background-color: rgb(255, 255, 0);""><b>identical to schizophrenia</b></span> except that the duration is at least 1 month but <b><span style=""background-color: rgb(255, 255, 0);"">&lt; 6 months</span></b>"

Schizoaffective Disorder

"= a clinical subtype of schizophrenia<br>= Affect → <b><span style=""background-color: rgb(255, 255, 0);"">emotions are affected</span></b><br>= Strong symptoms associated with <span style=""background-color: rgb(255, 255, 0);""><b>mood disorders</b></span><br>= Hallucinations and/or delusions that occur for at least 2 weeks in the absence of a major episode"

Paranoid Schizophrenia<br>Disorganized Schizophrenia<br>Catatonic Schizophrenia<br>Residual Schizophrenia<br>Undifferentiated Schizophrenia

5 Types of Schizophrenia

Paranoid Schizophrenia

"= a type of schizophrenia characterized by <b><span style=""background-color: rgb(255, 255, 0);"">suspicion toward others</span></b> <br>= most prominent manifestation: <span style=""background-color: rgb(255, 255, 0);""><b>Persecutory Delusion</b></span> [believing someone is going to harm them]"

Disorganized Schizophrenia

"a type of schizophrenia characterized by <b><span style=""background-color: rgb(255, 255, 0);"">withdrawal from society</span></b> and <span style=""background-color: rgb(255, 255, 0);""><b>very inappropriate behaviors</b></span>"

Catatonic Schizophrenia

"= a type of schizophrenia characterized by <b>psychomotor agitation or retardation</b><br>= either being <b><span style=""background-color: rgb(255, 255, 0);"">totally still and mute</span></b> or being <b><span style=""background-color: rgb(255, 255, 0);"">hyperactive for no reason</span></b>"

Residual Schizophrenia

"= a type of schizophrenia characterized by <b><span style=""background-color: rgb(255, 255, 0);"">2 or more residual<br>symptoms</span></b>; usually <b><span style=""background-color: rgb(255, 255, 0);"">negative symptoms</span></b><br>= don’t experience hallucinations and delusions anymore, but <span style=""background-color: rgb(255, 255, 0);""><b>negative symptoms may persist</b></span>"

Undifferentiated Schizophrenia

"a type of schizophrenia that is diagnosed when a person <span style=""background-color: rgb(255, 255, 0);""><b>meets the criteria</b></span> for diagnosis for schizophrenia but <b><span style=""background-color: rgb(255, 255, 0);"">cannot be classified into any of the subtypes</span></b>"

Typical antipsychotics [First-generation]

"= dopamine antagonists that <b><span style=""background-color: rgb(255, 255, 0);"">decreases only the positive symptoms</span></b> of schizophrenia<br>= <b><span style=""background-color: rgb(255, 255, 0);"">conventional </span></b>(older); <b><span style=""background-color: rgb(255, 255, 0);"">higher risk for EPS</span></b><br>= ex: Chlorpromazine, Fluphenazine, Perphenazine, Haloperidol<br>= suffix: <span style=""background-color: rgb(255, 255, 0);""><b>-zine and -dol</b></span>"

Atypical Antipsychotics

"=<b><span style=""background-color: rgb(255, 255, 0);""> dopamine + serotonin antagonists</span></b> that <b><span style=""background-color: rgb(255, 255, 0);"">decreases both positive and negative</span></b> symptoms of schizophrenia<br>= unconventional (newer); <b><span style=""background-color: rgb(255, 255, 0);"">lesser risk for EPS</span></b><br>= ex. clozapine, olanzapine, ziprasidone, risperidone<br>= suffix: <b><span style=""background-color: rgb(255, 255, 0);"">-pine &amp; -done</span></b><br>= Exemption: <span style=""color: rgb(0, 170, 0);""><b>Aripiprazole (Abilify)</b></span> - not a PPI!"

Blurred vision<br>Urinary retention<br>Constipation<br>Orthostatic hypotension<br>Photosensitivity<br>Amnesia<br>Nausea<br>Dryness of mouth<br>Apraxia<br>Night discomforts

Side Effects of Antipsychotics [BUCOPANDAN]

"<span style=""background-color: rgb(255, 255, 0);""><b>A</b></span>kathisia <i>[restlessness]</i><br><span style=""background-color: rgb(255, 255, 0);""><b>D</b></span>ystonia <i>[involuntary muscle contraction]</i><br><span style=""background-color: rgb(255, 255, 0);""><b>P</b></span>seudoparkinsonism <i>[tremor, difficulty finishing thoughts, stiff facial muscles]</i><br><span style=""background-color: rgb(255, 255, 0);""><b>T</b></span>ardive dyskinesia <i>[involuntary facial/jaw movements]</i>"

4 Extrapyramidal Symptoms (EPS)

Acute dystonia

"= <b><span style=""background-color: rgb(255, 255, 0);"">earliest EPS</span></b> that can be caused by antipsychotics<br>= occurs <b><span style=""background-color: rgb(255, 255, 0);"">2-4 weeks</span></b> after med is started<br>= appearance of <b><span style=""color: rgb(0, 170, 0);"">torticollis</span></b> [wry neck], <b><span style=""color: rgb(0, 170, 0);"">opisthotonus </span></b>[arching of back and extending of legs], <b><span style=""color: rgb(0, 170, 0);"">oculogyric crisis</span></b> [eyeballs&nbsp;rolling upward]<br>= <span style=""background-color: rgb(255, 255, 0);""><b>second most fatal EPS</b></span>"

Akathisia [makathi sia]

"= <b><span style=""background-color: rgb(255, 255, 0);"">most common EPS </span></b>that can be caused by antipsychotics<br>= inability to sit or stand still<br>= “<b><span style=""background-color: rgb(255, 255, 0);"">Ants in the pants</span></b>” sensation<br>= #1 reason for <b><span style=""background-color: rgb(255, 255, 0);"">drug non-compliance</span></b><br>= DOC: <span style=""background-color: rgb(255, 255, 0);""><b>Propranolol</b></span>"

Propranolol

What is the DOC for Akathisia?

Tardive Dyskinesia

"<img src=""tardive-dyskinesia.jpg""><br>= <b><span style=""background-color: rgb(255, 255, 0);"">manifests after 6 months to 1 year</span></b> of therapy<br>= late onset but <b><span style=""background-color: rgb(255, 255, 0);"">irreversible </span></b>manifestation<br>= <b><span style=""color: rgb(0, 170, 0);"">tongue protrusion, lip smacking,</span></b> and <b><span style=""color: rgb(0, 170, 0);"">facial grimacing</span></b><br>= most effective antidote: <span style=""background-color: rgb(255, 255, 0);""><b>Benztropine</b></span><br>= last option d/t sedative fx: Diazepam (Valium)<br>= other antidotes: Trihexyphenidyl, Diphenhydramine, Amantadine"

Pseudoparkinsonism

"= drug-induced parkinsonism<br>= EPs that is generally <b><span style=""background-color: rgb(255, 255, 0);"">reversible </span></b>and can be treated by stopping the med<br>= <span style=""color: rgb(0, 170, 0);""><b>tremor, cogwheel rigidity, shuffling gait</b></span>"

Neuroleptic Malignant Syndrome<br>Agranulocytosis

2 Adverse Effects of Antipsychotics

Neuroleptic Malignant Syndrome

"= an adverse effect of antipsychotics characterized by distinctive clinical syndrome of mental status change:<br><span style=""color: rgb(0, 170, 0);""><b>&gt; Rigidity of muscles<br>&gt; Fever<br>&gt; Dysautonomia</b></span><br>= most common cause: <b><span style=""background-color: rgb(255, 255, 0);"">Typical antipsychotics (Chlorpromazine)</span></b>"

Chlorpromazine

a typical antipsychotic that may cause the adverse effect of Neuroleptic Malignant Syndrome

Agranulocytosis

"= an adverse effect of antipsychotics wherein the body doesn’t make enough of neutrophils → risk for infection<br>= Initial manifestation: <b><span style=""background-color: rgb(255, 255, 0);"">sore throat</span></b><br>= most common cause: <span style=""color: rgb(0, 170, 0);""><b>Atypical antipsychotics (Clozapine)</b></span><br>= ttt: Hold medication"

Clozapine

an atypical antipsychotic that may cause the adverse effect of Agranulocytosis

Electroconvulsive Therapy (ECT)

"= a <span style=""background-color: rgb(255, 255, 0);""><b>SOMATIC therapy</b></span> for schizophrenia [LAST RESORT!]<br>= duration of shocking: <b><span style=""color: rgb(0, 170, 0);"">0.2-0.8 s</span></b><br>= duration of seizure: <span style=""color: rgb(0, 170, 0);""><b>&lt;&nbsp;1 minute</b></span><br>=<span style=""background-color: rgb(255, 255, 0);""> 6-12 sessions</span> (2-3x a week)<br>= MOA: delivers electrical current to balance neurotransmitters in the brain"

"<b><span style=""background-color: rgb(255, 255, 0);"">Bilateral ECT</span></b> has more memory loss but is more effective; <span style=""background-color: rgb(255, 255, 0);""><b>unilateral ECT</b></span> has less memory loss yet is less effective"

What differentiates Bilateral ECT from Unilateral ECT?

&gt; Atropine sulfate [prevent aspiration]<br>&gt; Succinylcholine [muscle relaxant]<br>&gt; Phenobarbital [tranquilizer]

Before ECT, what meds do we prepare?

Atropine sulfate [minimizes secretion within RT]

What med is prepared pre-ECT to prevent risk for aspiration?

Succinylcholine

What med is prepared pre-ECT to prevent too much erratic contractions?

Respiratory depression

What should we look out for when giving succinylcholine?

Phenobarbital

What med is prepared pre-ECT to induce sleep/deep coma?

NPO for 6-8 hours<br>Half bath only<br>Position: Supine with raised side rails<br>Obtain V/S (check RR)<br><i>*Priority after the procedure: Check RR</i>

How do we prep the px before ECT?

"&gt; <b><span style=""background-color: rgb(255, 255, 0);"">Denial </span></b>- unable to accept the loss<br>&gt; <b><span style=""background-color: rgb(255, 255, 0);"">Anger </span></b>- intense emotion expressing the frustration of not being able to do something<br>&gt; <b><span style=""background-color: rgb(255, 255, 0);"">Bargaining </span></b>- negotiates for more chances<br>&gt; <b><span style=""background-color: rgb(255, 255, 0);"">Depression </span></b>- dwells into the sadness attributed loss<br>&gt; <span style=""background-color: rgb(255, 255, 0);""><b>Acceptance </b></span>- accepts the loss"

Stages of Grieving (Kubler-Ross)

Assist the client to achieve the acceptance of the loss

What is the most important role of the nurse in a grieving patient?

listening, offering self, silence, therapeutic touch, outlet for frustration

How can the nurse help client to accept a loss?

Mood = feeling<br>Emotion = summary of what you feel<br>Affect = outward behavioral expression

What is the difference between mood, emotion, and affect?

Clinical depression <br>Bipolar Disorder

2 DSM-5 Diagnosis of Mood Disorders

Clinical Depression

"= aka <span style=""background-color: rgb(255, 255, 0);""><b>“Common cold” of Psychiatry</b></span><br>= different from regular depression<br>= has 5 clinical types"

Major depressive disorder [MDD]<br>Seasonal affective disorder [SAD]<br>Persistent Depressive Disorder [PeDD]<br>Premenstrual Dysphoric Disorder [PrDD]<br>Substance Induced Depressive Disorder [SIDD]

5 Types of Clinical Depression

Major depressive disorder

"= a clinical depression that has a single or recurrent episode of <b><span style=""background-color: rgb(255, 255, 0);"">unipolar depression of at least 2 wks</span></b><br>= symptoms: depressed mood, insomnia/hypersomnia, indecisiveness, decreased ability to concentrate, anhedonia, weight gain/loss<br>= inability to perform ADLs, increase/decrease in motor&nbsp;activity<br>= most dangerous manifestation: <span style=""color: rgb(255, 0, 0);""><b>Suicidal ideation</b></span>"

Seasonal Affective Disorder

"= a clinical depression that usually <b><span style=""background-color: rgb(255, 255, 0);"">occurs during cold/dark seasons</span></b> [PH: June-Dec]<br>= formerly known as <span style=""background-color: rgb(255, 255, 0);""><b>""Cyclothymic disorder""</b></span><br>= symptoms are the same as MDD"

Light therapy (20-30 minutes/day)

What is the mgmt for Seasonal Affective Disorder?

Persistent Depressive Disorder

"= a clinical depression that only has <b><span style=""background-color: rgb(255, 255, 0);"">3 manifestations of MDD</span></b> mostly present throughout the day; <b><span style=""background-color: rgb(255, 255, 0);"">does not impair ADLs</span></b><br>= <span style=""background-color: rgb(255, 255, 0);""><b>persists for 2 years</b></span><br>= does not need somatic therapy [ECT]"

Premenstrual Dysphoric Disorder

"= a clinical depression that usually occurs among <b><span style=""background-color: rgb(255, 255, 0);"">women in the childbearing age</span></b><br>= happens during the <b><span style=""background-color: rgb(255, 255, 0);"">luteal phase</span></b> of the menstrual cycle<br>= more severe &amp; debilitating than PMS<br>= Exaggerated emotional manifestations: <span style=""color: rgb(85, 170, 0);""><b>irritable, mood swing, overwhelmed feeling</b>&nbsp;</span>"

Hormonal assessment & hormonal therapy

What is the mgmt for Premenstrual Dysphoric Disorder?

Substance-Induced Depressive Disorder

a clinical depression that is related to substance use and withdrawal [alcohol, opioids]

Acute phase

"= phase of depression that lasts bet. <span style=""background-color: rgb(255, 255, 0);"">6-12 mos</span><br>= severe clinical findings<br>= need for hospitalization, first line ttt<br>= assess <span style=""background-color: rgb(255, 255, 0);"">suicide ideation</span>"

Continuation phase

"= phase of depression that starts <b><span style=""background-color: rgb(255, 255, 0);"">after success of ttt and aversion of suicide</span></b><br>= this is where we do <span style=""background-color: rgb(255, 255, 0);""><b>RELAPSE PREVENTION</b></span>"

Maintenance phase

"= phase of depression where we <b><span style=""background-color: rgb(255, 255, 0);"">check for remission</span></b> of manifestations<br>= here we <b><span style=""background-color: rgb(255, 255, 0);"">PREVENT FUTURE EPISODES</span></b> of depression<br>= antidepressants are <span style=""background-color: rgb(255, 255, 0);""><b>LOW-DOSE</b></span><br>= duration: can last months to years [depends on doctor's orders]"

Selective Serotonin Reuptake Inhibitor (SSRI)

"= <b><span style=""background-color: rgb(255, 255, 0);"">FIRST LINE</span></b> of med for depression [lesser side fx, lesser SEDATIVE fx, newest form of antidepressant]<br>= suffix: <b><span style=""background-color: rgb(255, 255, 0);"">-oxetine, -line,&nbsp;-talopram</span></b><br>= prototype: <b><span style=""color: rgb(85, 170, 0);"">Fluoxetine (Prozac)</span></b><br>= other meds: Sertra<b><span style=""color: rgb(85, 170, 0);"">line</span></b> (Zoloft), Ci<b><span style=""color: rgb(85, 170, 0);"">talopram</span></b>, Esci<b><span style=""color: rgb(85, 170, 0);"">talopram</span></b>, Par<b><span style=""color: rgb(85, 170, 0);"">oxetine</span></b><br>= pregnancy <span style=""background-color: rgb(255, 255, 0);""><b>category C</b></span> [can be given as long as benefits outweight the risks]"

Selective Serotonin Reuptake Inhibitor (SSRI)

"= an antidepressant med that <b><span style=""background-color: rgb(255, 255, 0);"">elevates serotonin</span></b> by stopping reuptake/elimination of serotonin<br>= <b><span style=""color: rgb(85, 170, 0);"">takes effect</span></b> within <b><span style=""background-color: rgb(255, 255, 0);"">2-4 weeks</span></b><br>= best given in the AM [can cause <span style=""background-color: rgb(255, 255, 0);""><b>insomnia</b></span>]"

"Sexual dysfunction (low libido) - #1 reason for <span style=""background-color: rgb(255, 255, 0);""><b>drug non-compliance</b></span><br>Insomnia<br>Excessive weight loss"

Side effects of SSRIs

"MAOI + SSRI = leads to <span style=""background-color: rgb(255, 255, 0);""><b>Serotonin syndrome</b></span> &gt; mental confusion, GI symptoms, agitation, hallucination, tremor"

Adverse effects of SSRIs

hold next dose

Priority action for SEROTONIN SYNDROME?

Antidepressant

_ has to be flushed out of system before using another one

Serotonin syndrome

"= characterized by <b><span style=""background-color: rgb(255, 255, 0);"">mental confusion, GI symptoms, agitation, hallucination, tremor</span></b><br>= happens when <span style=""background-color: rgb(255, 255, 0);""><b>MAOI and SSRI</b></span> is taken w/o interval between<br>= mgmt: Hold next dose"

MAOI - Serotonin syndrome<br>Lithium - decreased therapeutic effect of each other<br>Warfarin - severe bleeding<br>NSAIDs - GI bleeding

Drug interactions of SSRIs

lithium

Taking _ with SSRIs decreases both their therapeutic effects.

Warfarin

Taking _ with SSRIs causes severe bleeding.