Care of the Patient with a Psychiatric Disorder

CARE OF THE PATIENT WITH A PSYCHIATRIC DISORDER

PSYCHIATRIC DISORDERS

  • Neurosis:

    • Definition: Ineffective coping with stress that causes mild interpersonal disorganization.

  • Psychosis:

    • Definition: Out of touch with reality characterized by severe personality deterioration, impaired perception and judgment, hallucinations, and delusions.

ORGANIC MENTAL DISORDERS

Delirium

  • Definition: A rapid change in consciousness occurring quickly over a short time frame.

  • Symptoms:

    • Reduced awareness and attention to surroundings.

    • Disorganized thinking.

    • Sensory misinterpretation and irrelevant speech.

    • Disturbed sleep patterns.

    • Sundowning Syndrome: Increased disorientation and agitation in the evening and nighttime.

  • Treatment: Focused on the problem causing the imbalance.

Dementia

  • Definition: An altered mental state secondary to cerebral disease, which is slow and progressive.

  • Causes:

    • Cerebral disease.

    • Alzheimer’s disease (most common type).

    • Vascular dementia.

  • Symptoms:

    • Impaired memory and judgment.

    • Personality changes.

    • Decreased cognitive function.

    • Impaired orientation.

  • Diagnosis Indicators:

    • Anomia: Inability to remember names of things.

    • Apraxia: Misuse of objects due to failure to identify them.

    • Agnosia: Inability to recognize familiar objects, tastes, sounds, and sensations.

    • Amnesia: Memory loss leading to disorientation like asking, "Who am I? Where am I? Who are you?!"

    • Judgment, Concentration, Attention issues.

  • Aphasia:

    • Inability to express oneself through speech.

Dementia Treatment

  • Medications:

    • For agitation: Lorazepam, Haldol.

    • For dementia: Cognex, Aricept.

  • Nutrition:

    • Finger foods; frequent feedings.

  • Safety Precautions:

    • Remove burner controls at night.

    • Double-lock all doors and windows.

    • Constant supervision (1:1 supervision).

Nursing Interventions for Dementia and Delirium

  • Reality Orientation Techniques:

    • Utilize clocks and calendars.

    • Keep curtains open and lights on during the day.

    • Employ a calm supportive approach.

    • Decrease sensory stimuli.

    • Avoid crowds.

    • Give one instruction at a time, keeping it simple.

    • Use pictures with minimal wording.

    • Limit choices to reduce stress.

    • Maintain consistent staffing where possible.

  • Safety Measures:

    • Low bed position.

    • Side rails up and rails in hallways.

    • Employ chair and bed alarms.

    • Ensure call light and personal articles are within reach.

    • Provide sufficient night light.

SUNDOWNING SYNDROME

  • Definition: The closer it gets to evening and "sundown," the more confused and agitated the client becomes.

THOUGHT PROCESS DISORDERS

Schizophrenia

  • Definition: A psychotic disorder with gross distortion of reality, accompanied by the disturbance of language and communication, social interaction withdrawal, and disorganization of thought, perception, and emotional reactions.

    • Onset: Typically occurs in young adulthood.

    • Symptoms:

    • Hallucinations, illusions, delusions.

    • Inappropriate emotional responses.

    • Inability to relate to others.

    • Self-care deficits.

  • Bizarre, non-reality-based thinking.

Causes:

  • Brain tissue changes.

  • Enlarged brain ventricles and decreased cerebral cortex volume.

  • Excessive dopamine levels (neurotransmitter).

Symptoms Include:

  • Hallucinations and disordered thinking.

  • Apathy and social withdrawal.

  • Flat affect and delusions.

Types of Delusions

  • Grandeur: Belief of having great powers over situations.

  • Ideas of Reference: Belief that events have personal meanings.

  • Persecution: Belief that others intend to harm them.

  • Somatic Delusions: False beliefs regarding body function or image.

  • Thought Broadcasting: Belief that others can perceive one’s thoughts without conveying them.

  • Thought Insertion: Belief that thoughts have been placed in one’s mind.

  • Thought Withdrawal: Belief that thoughts are being removed from one’s mind.

Subtypes of Schizophrenia

  • Paranoid: Hallucinations often contain negative messages, with both grandiose and persecutory delusions.

  • Disorganized: Characterized by flat affect, incoherent speech, and erratic behavior.

  • Catatonic: Rarely initiates movement; tends to mimic others' speech and actions.

  • Undifferentiated: Displays varied symptoms.

  • Residual: Withdrawing continues after positive symptoms dissipate.

Treatment for Schizophrenia

  • Psychotherapies: Must monitor for tardive dyskinesia.

  • Antipsychotic Drug Therapy: Utilization of medications such as Haloperidol, Clozapine, Risperidone.

  • Therapeutic Relationships: Establishing rapport is crucial.

MOOD DISORDERS

  • Also known as affective disorders: Defined by severe and inappropriate emotional responses characterized by prolonged disturbances in mood and associated thought distortions.

  • Key Symptoms:

    • Depression, mania.

  • Causes:

    • Hereditary Factors: Approximately 60% to 80% attributable to genetics.

    • Biological Factors: May be a consequence of inherited traits or environmental influences such as chronic stress or brain trauma.

    • For depression: Insufficiency of norepinephrine and serotonin.

    • For mania: Excess of norepinephrine.

Major Types of Mood Disorders

  • Major Depression: Characterized by prolonged, intense unhappiness, symptoms can include:

    • Apathy, pessimism, anxiety, suicidal thoughts, fatigue, sleep, and appetite disturbances.

  • Bipolar Affective Disorder: Involves mood swings with manic episodes alternating with depressive states, symptoms include:

    • Grandiosity, over-responsiveness to stimuli, insomnia, impaired judgment, irritability.

Symptoms of Depression

  • Characteristics:

    • Exaggerated feelings of sadness, despair, and lowered self-esteem.

    • Displays of neglect in appearance, difficulty focusing, and complaints about physical problems.

    • Disturbed sleeping or eating patterns.

    • Feelings of helplessness, hopelessness, extreme anxiety, or panic.

  • Categories:

    • Unipolar: Major depression lasting more than 2 years.

    • Dysthymic Disorder: Daily moderate depression lasting more than 2 years.

Safety Precautions for Individuals with Depression

  • Remove harmful objects from the vicinity.

  • Implement close observations, preferably 1:1.

  • Establish a written contract for treatment.

  • Encourage meaningful socialization through activities and group discussions.

  • Support self-esteem and promote expression of feelings.

  • Assist participants in decision-making.

  • Assess and meet physical needs: weight monitoring, hygiene, dietary considerations.

ANTIDEPRESSANT MEDICATIONS

Antidepressant Cheat Sheet

Types and Common Generic Names:

  • Tricyclic Antidepressants (TCAs):

    • Examples: Amitriptyline, Doxepin, Imipramine.

  • Selective Serotonin Reuptake Inhibitors (SSRIs):

    • Examples: Citalopram, Fluoxetine, Sertraline, Paroxetine, Escitalopram.

  • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):

    • Examples: Duloxetine, Desvenlafaxine, Milnacipran.

  • Monoamine Oxidase Inhibitors (MAOIs):

    • Examples: Phenelzine, Tranylcypromine, Rasagiline.

Side Effects of Antidepressants

  • Common Side Effects:

    • Tremors, sweating, indigestion, headaches, dry mouth, drowsiness, elevated heart rate, urinary retention.

  • SSRIs:

    • Potential for fatigue, insomnia, sexual side effects, and weight gain.

  • MAOIs:

    • Contraindicated with certain foods and other medications; risk of hypertensive crisis.

ANXIETY DISORDERS

  • Definition: Anxiety is a normal response to stress or perceived threat; a state of apprehension, uneasiness, agitation, uncertainty, and fear driven by anticipated danger.

  • Types of Anxiety Disorders:

    • Generalized Anxiety Disorder: Characterized by high anxiety levels and avoidance behaviors.

    • Panic Disorder: Acute, intense anxiety with physical symptoms.

    • Agoraphobia: Anxiety triggered by specific situations.

    • Obsessive-Compulsive Disorder (OCD): Marked by recurrent intrusive thoughts and compulsive behaviors.

    • Posttraumatic Stress Disorder (PTSD): Response to traumatic events exceeding usual trauma experiences.

Treatment for Anxiety Disorders

  • Panic Disorders:

    • Educate on disorder nature, developing coping strategies, and pharmaceutical interventions to block attacks.

  • PTSD:

    • Treatment through antidepressants, anti-seizure medications, cognitive therapy, behavioral therapy, and immediate debriefing post-trauma.

PERSONALITY DISORDERS

  • Definition: Characterized by inflexible and maladaptive behavior patterns causing significant impairment in functioning.

    • Variations include: Abusive personality, dependent personality, paranoid personality, borderline personality, antisocial personality.

  • Traits:

    • Lack of insight, concrete thinking, inability to comprehend behavior consequences, distorted self-perception, poor impulse control, and inflexible behavior.

EATING DISORDERS

Anorexia Nervosa

  • Criteria:

    • Body weight at or below 85% of normal for age/sex/height, amenorrhea in women, self-imposed starvation, bingeing or purging behaviors, excessive exercise, distorted body image, denial of the problem severity.

Bulimia Nervosa

  • Characteristics:

    • Individuals may present as underweight, normal, or overweight; recurrent binge-eating episodes at least twice per week over three months duration, along with feelings of inadequacy.

Binge-Eating Disorder

  • Attributes:

    • Usually associated with obesity; defined by episodes involving excessive food intake with a perceived loss of control, occurring at least twice a week for six months.

Treatment for Anorexia and Bulimia

  1. Behavioral modifications.

  2. Individual psychotherapy.

  3. Family therapy.

  4. Psychopharmacology:

    • Examples include Fluoxetine (Prozac) and Sertraline (Zoloft).

OVERVIEW OF TREATMENT METHODS

  • Therapeutic Communication: Important for establishing rapport.

  • Electroconvulsive Therapy (ECT): Recommended for unresponsive cases of severe depression, mania, or schizophrenia.

  • Psychopharmacology: Involves the utilization of medications to stabilize mental health conditions.

Electroconvulsive Therapy (ECT)

  • Procedure: ECT involves administering a small electrical current to induce a seizure; may cause temporary memory loss and confusion.

  • Contraindications:

    • Recent myocardial infarction, raised intracranial pressure, aneurysms, recent cerebral infarctions.

  • Preparation for ECT:

    • NPO for 6 to 8 hours before ECT and ensure pre-treatment medications are administered to mitigate secretions and vagal stimulation.

    • Patients should void prior to the procedure and have any removable personal items removed.

Psychopharmacology Categories

  • Antimanic Agents

  • Antipsychotic Agents

  • Atypical Antipsychotic Agents

  • Anti-Anxiety Agents

  • Antidepressants

  • Monoamine Oxidase Inhibitors (MAOIs)

  • Selective Serotonin Reuptake Inhibitors (SSRIs)

  • Other Antidepressants

ALTERNATIVE THERAPIES

  • Increased popularity in natural and herbal medications, not regulated by the FDA.

  • Examples:

    • St. John’s Wort: Treats mild to moderate depression; avoid interaction with MAOIs.

    • Kava: Treats anxiety and insomnia; potential complications with benzodiazepines.

    • Ginkgo Biloba: Used for memory enhancement but may pose risks when combined with anticoagulants.

    • Aromatherapy and Essential Oils: May relieve stress and anxiety but limited efficacy.