antipsychotics

CHAPTER 25: DRUG THERAPY FOR PSYCHIATRIC PROBLEMS

PSYCHIATRIC DISORDERS

Psychiatric disorders encompass various conditions affecting emotional stability, behavior, and cognitive function. These disorders can arise from biological or psychological causes.

Types of Psychiatric Disorders
  • Major Depressive Disorders
  • Generalized Anxiety Disorder
  • Bipolar Disorder
  • Schizophrenia
Major Psychiatric Illnesses
  • Depression
  • Anxiety
  • Psychosis

ISSUES RELATED TO DRUG THERAPY FOR PSYCHIATRIC PROBLEMS

Understanding proper medication management is crucial. The following teaching priorities are essential for patients on psychiatric medications:

  1. Adherence to Prescription: Take medications exactly as prescribed.
  2. Report Side Effects: Immediately inform healthcare providers about any adverse reactions.
  3. Follow-Up Appointments: Keep all scheduled follow-up visits.
  4. Position Changes: Change positions slowly to avoid dizziness.
  5. Avoid Alcohol: Alcohol can interfere with the efficacy of medications.
  6. Pre-Surgery Notifications: Inform healthcare providers about current medications before surgery.
  7. Wearing a Medical Alert Bracelet: This informs others of medication-related health conditions.

DEPRESSION

Depression is a multifaceted disorder characterized by disturbances in body, mood, and thought processes. It severely interferes with daily functioning, leading to significant pain and suffering.

Types of Depressive Disorders
  • Major Depression: Presents itself as a single episode or multiple episodes throughout life.
  • Bipolar Disorder: If untreated, this can progress to psychotic experiences.
Treatment for Depression

Typical treatments include:

  • Counseling and Psychotherapy: Engaging in talk therapy to address underlying issues.
  • Antidepressants: Utilization of pharmacological interventions.
Causes of Depression

Depression can be attributed to neurochemical imbalances, particularly involving neurotransmitters. When neurotransmitter levels decline, neurons struggle to communicate effectively, leading to symptoms.

Pharmacological Options

Drugs can alleviate symptoms, including:

  • Selective Serotonin Reuptake Inhibitors (SSRIs): These work by increasing serotonin levels in the brain.
  • Tricyclic Antidepressants (TCAs): They inhibit the reuptake of norepinephrine, dopamine, and serotonin.

ANTIDEPRESSANT DRUGS

Intended Responses
  1. Correct depressive symptoms.
  2. Decrease symptoms of depressed mood.
Side Effects

Common side effects include:

  • Nausea/Vomiting
  • Weight Gain
  • Diarrhea
  • Drowsiness
  • Sexual Dysfunction
Adverse Effects
  • TCAs: Can induce cardiac effects.
  • Increased risk of suicidal thoughts in children, adolescents, and young adults.
  • Allergic reactions and serotonin syndrome.
Administering Antidepressant Drugs

When prescribing antidepressants, healthcare providers should:

Check Before Administration
  • Inquire about family history of depression.
  • Assess usual bowel movements and fluid intake.
  • Investigate diet and possible interactions, such as with St. John's wort.
  • For TCAs, inquire about smoking habits.
Check After Administration
  • Reassess mental status and watch for side effects or adverse reactions.
  • Monitor for any suicidal thoughts.
Teaching Priorities
  1. Understanding Treatment Duration: Patients should be informed that these medications are not a cure and may take 1 to 8 weeks to exhibit improvement.
  2. Gradual Discontinuation: Stopping medication should be a gradual process.
  3. Oral Health: Frequent mouthwash use may alleviate dry mouth side effects.

LIFE SPAN CONSIDERATIONS FOR ANTIDEPRESSANT DRUGS

  • Pediatric: Increased risk of suicidal thoughts with antidepressants; specific drugs like fluoxetine may cause agitation or sleep issues; venlafaxine could affect growth and weight.
  • Pregnancy and Lactation: SSRIs generally lack substantial testing; paroxetine is advised against during pregnancy due to potential risks. Some SSRIs can transfer to infants through breast milk.
  • Older Adults: These patients may need lower doses, particularly in cases of renal or hepatic impairment.

ANXIETY

Anxiety encompasses feelings of apprehension, fear, and worry, which can occur without a specific cause. It manifests in several common anxiety disorders:

Common Anxiety Disorders
  1. Panic Disorder: Characterized by acute feelings of fear or doom.
  2. Generalized Anxiety Disorder: Involves excessive anxiety lasting for at least six months.
  3. Phobic Disorders: Persistent fears of specific objects or situations.
  4. Obsessive-Compulsive Disorder (OCD): Involves compulsive behaviors.
  5. Post-Traumatic Stress Disorder (PTSD): Triggered by exposure to traumatic events.
Treatment of Anxiety

Treatment strategies vary based on causation:

  • Mild Anxiety: Considered normal and typically requires no intervention.
  • Moderate to Severe Anxiety: Associated with psychiatric disorders and may necessitate treatment through medications.

ANTIANXIETY DRUGS

Types of Anti-Anxiety Medications
  1. Benzodiazepines: Increase GABA’s inhibitory action, sometimes used in alcohol withdrawal contexts.
  2. SSRIs: These have milder side effects compared to benzodiazepines and primarily affect serotonin levels.
  3. Buspirone: Enhances norepinephrine metabolism to alleviate anxiety.
Intended Responses of Anti-Anxiety Drugs
  • Relief of anxiety symptoms.
  • Improvement in overall sense of well-being.
Side Effects
  • Benzodiazepines: Associated with central nervous system (CNS) effects.
  • Buspirone: Can cause dizziness and drowsiness.
Adverse Effects
  • Benzodiazepines: May lead to seizures or comas.
  • Buspirone: Risks include hallucinations and heart failure. Specific drugs like clonazepam may lead to suicidal ideation.
Administering Anti-Anxiety Drugs
Check Before Administration
  • Evaluate history of drug dependency.
Check After Administration
  • Assess the patient’s gait for steadiness.
  • Monitor anxiety levels and evaluate for suicidal ideation.
Teaching Priorities
  1. Medication Adherence: Use medications exactly as directed.
  2. Avoidance of Alcohol: Avoid combined use with alcohol and sleeping pills.
  3. Weaning Off: Gradually decrease dosage when stopping treatment.
  4. Avoid Mixing: Advise against taking benzodiazepines with antacids due to potential interactions.

LIFE SPAN CONSIDERATIONS FOR ANTIANXIETY DRUGS

  • Pediatric: Increased sensitivity to medication effects in children; side effects are more pronounced.
  • Pregnancy and Lactation: Benzodiazepines should be avoided, while it's advisable to steer clear of SSRIs during pregnancy.
  • Older Adults: Often have heightened sensitivity to effects and a greater risk for side effects; closer monitoring for respiratory depression is necessary, and dosage should generally be lower.

PSYCHOSIS

Psychosis is defined as a significant loss of contact with reality, marked by symptoms such as illusions, delusions, and hallucinations. Treatment typically includes:

  1. Psychologic Therapies
  2. Antipsychotic Medications
  3. Possible Need for Hospital Care: In certain cases, hospitalization might be necessary to ensure the patient's safety.
Treatment Goals for Psychosis
  • Effective long-term management of symptoms with appropriate medication.

ANTIPSYCHOTIC DRUGS

Function and Mechanism

Antipsychotic medications are designed to produce a tranquilizing effect and relax the CNS by blocking dopamine receptors in the brain's dopamine pathways. It is critical that these drugs should not be used impulsively.

Intended Responses
  1. Reduction in signs and symptoms of psychosis.
  2. Improvement in behavior and symptoms related to schizophrenia.
  3. Decrease in suicidal thoughts.
Side Effects of Antipsychotics
  • Common side effects include sedation, drowsiness, dizziness, lethargy, restlessness, insomnia, and gastrointestinal upset.
Adverse Effects

Potential serious adverse effects include:

  • Tardive Dyskinesia
  • Neuroleptic Malignant Syndrome
  • Neutropenia: Associated with clozapine and prochlorperazine.
  • Myocarditis: Specifically linked to clozapine.
  • Increased Mortality Risk: Notable with quetiapine and risperidone, especially in patients with dementia.
  • Lithium Toxicity: A critical concern within psychiatric management.