MH 6 & 7

Mental Health II

CHAP 6 - Complementary and Alternative Therapies

CHAP 7 - Psychotherapeutic Drug Therapy

Psychotherapeutic Drug Therapy

  • Definition: Psychotherapeutic drugs are powerful chemicals that produce profound effects on the mind, emotions, and body.
  • Usage: The use of psychotherapeutic drugs has become increasingly common and can be seen in a wide variety of people.

How Psychotherapeutic Drug Therapy Works

  • Mechanism:
    • Psychotherapeutic drugs work by altering the chemical balances within the nervous system.
    • Most drugs alter neurotransmitters and suppress nerve pathways in the frontal lobe and limbic system.
    • Medications aim to create more stable moods but may impair the frontal lobe and limbic system.
  • Nursing Responsibility: It is the nurse's responsibility to recognize therapeutic versus unwanted side effects.

Nervous System Overview

Central Nervous System (CNS)

  • Composition: Composed of the brain and spinal cord.
  • Function: Controls all motor and sensory functions.

Peripheral Nervous System (PNS)

  • Composition: Composed of 31 pairs of spinal cord nerves and 12 pairs of cranial nerves.
  • Divisions: Further divided into motor system and autonomic system.

Autonomic Nervous System (ANS)

  • Function: Regulates vital functions.
  • Divisions:
    • Sympathetic Nervous System: Prepares the body for immediate adaptability under stress (fight or flight response).
    • Parasympathetic Nervous System: Conserves energy and promotes relaxation and maintenance of bodily functions.

Classifications of Psychotherapeutic Drugs

  • Traditional Classes:
    1. Antianxiety agents
    2. Antidepressants
    3. Mood stabilizers
    4. Antipsychotics
  • Newer Classes:
    1. Stimulants
    2. Antiobsessive agents

Antianxiety Medications

  • Definition: Antianxiety agents are drugs that reduce psychic tension associated with stress.
  • Common Drugs:
    • Benzodiazepines:
    • Mechanism: Increase gamma-aminobutyric acid (GABA) activity.
    • Functions: Can induce sleep, prevent seizures, are used pre-operatively, and provide sedation.
    • Characteristics: Fast-acting, metabolized by the liver, and excreted by the kidneys.
  • Side Effects:
    • Fatigue
    • Sedation
    • Dizziness
    • Orthostatic hypotension
  • Usage Note: Not typically prescribed for more than a few months due to risk of dependence.

BuSpar and Other Medications for Anxiety

  • BuSpar:
    • Classification: Different from benzodiazepines (chemical class: Azapirones).
    • Characteristics: Does not cause significant sleepiness or muscle relaxation.
    • Onset: Therapeutic effects are not observed for 3-6 weeks.
    • Safety: Less potential for abuse and overdose.
  • Side Effects: Light-headedness, dizziness, headache, and nausea.
  • Pregabalin (Lyrica): An alternative that can also be used for anxiety.

Antianxiety Medications - Drug Interactions

  • Interactions to Monitor:
    • CNS depressants (including alcohol, which may enhance sedative effects).
    • Digoxin (can increase concentration).
    • Antacids (may interfere with absorption).
  • Nursing Responsibilities:
    • Monitor for adverse effects.
    • Assess the need for medication.
    • Reference: Table 7.2 on page 69 provides more information.

Antidepressant Medication

  • Function: Antidepressants increase certain neurotransmitter activities to alleviate symptoms of depression.
  • Categories:
    • Tricyclic Antidepressants
    • Monoamine Oxidase Inhibitors (MAOIs)
    • Selective Serotonin Reuptake Inhibitors (SSRIs)
    • Atypical Antidepressants
    • Selective Serotonin/Norepinephrine Reuptake Inhibitors (SSNRIs)
    • Reference: Table 7.2 on page 69 for examples.
  • Uses: First treatment option for depression but also applicable to:
    • Bipolar disorders
    • Panic disorders
    • Obsessive-compulsive disorder
    • Enuresis
    • Bulimia
    • Neuropathic pain
    • PTSD
    • Organic mood disorders
    • ADHD
    • Conduct Disorder

Antidepressant Medications - Interactions and Effects

  • Overstimulation Risk: Interaction with other food or drugs that increase the same neurotransmitters can lead to overstimulation of the nervous system.
  • MAOI Interactions: MAOIs have significant interactions, noted in Box 7.2 on page 71, which can lead to:
    • Cardiovascular reactions
    • CNS depression
  • SSRIs: Often regarded as the first choice for treatment, as outlined in Box 7.3 on page 71.
  • Onset of Action: Antidepressants may take 1-4 weeks to achieve full therapeutic effects; side effects may arise immediately.
  • Client Assessment: Regular assessments for changing attitudes and suicidal ideation necessary. Clients must be educated about the importance of continuing medication and potential side effects. Dietary restrictions are crucial for clients on MAOIs.

Mood Stabilizer Medications

  • Lithium:
    • Function: Used to stabilize mood in bipolar disorder.
    • Characteristics: Naturally occurring salt; requires monitoring of salt and fluid intake/excretion due to a narrow therapeutic range.
    • Onset: May take up to 3 weeks for effects, necessitating extra monitoring during this time.
  • Anticonvulsants: Can also be utilized to stabilize moods.
  • Antipsychotics: May be used in conjunction with other medications.
    • Reference: Table 7.4 on page 71 lists other commonly prescribed antimanics.

Antipsychotic Medications

  • Mechanism: All classes of antipsychotic drugs affect the brain and nervous system by altering dopamine levels.
  • Effectiveness: Appear to be more effective for patients exhibiting positive symptoms (e.g., hallucinations).
  • Additional Uses: Can be effective for resistant bipolar disorder, paranoia, and certain movement disorders.
    • Some antipsychotics are prescribed for conditions such as nausea, vomiting, and intractable hiccups.
    • Reference: Table 7.5 on page 72 for commonly prescribed antipsychotic drugs.

Antipsychotic Medications - Interactions and Side Effects

  • Interactions to Consider:
    • Antacids (administer at least 2 hours after antipsychotic medication).
    • Alcohol
    • Antianxiety medications
    • Antihistamines
    • Antidepressants
    • Barbiturates
    • Demerol
    • Morphine
  • Common Side Effects:
    • Extrapyramidal side effects (EPSEs), as detailed in Table 7.7 on page 73.
    • Tardive dyskinesia (TD)
    • Other effects include dry mouth, blurred vision, photophobia, tachycardia, hypotension.
    • Treatment for EPSEs may involve anticholinergics, antihistamines, dopamine agonists, beta-blockers, or benzodiazepines as referenced in Table 7.5 on page 74.

Other Psychotropic Medications

  • Stimulants: Used to treat patients with ADHD, but can also be addictive and misused.

Client Care Guidelines

  • Nursing Responsibilities:
    • Assess the patient thoroughly.
    • Conduct a medication history as outlined in Table 7.9 on page 75.
    • Coordinate care effectively.
    • Administer medications correctly.
    • Monitor and evaluate client responses.
    • Provide education about medications to clients.

Special Considerations

  • Areas of Concern:
    • Adverse reactions to medication
    • Noncompliance with treatment
    • Informed consent considerations

Complementary and Alternative Therapies

  • Types:
    • Allopathic Medicine: Conventional medicine.
    • Complementary Medicine: Used alongside conventional treatments.
    • Alternative Medicine: Used instead of conventional treatments.
    • Integrative Medicine: Combines both conventional and alternative therapies.
    • Holistic Care: Considers the whole person (mind, body, and spirit).

Body-based CAM Therapies

  • Types of Therapies:
    • Ayurveda: Traditional Indian medicine.
    • Homeopathy: Based on the principle of "like cures like."
    • Naturopathy: Focuses on natural remedies.
    • Traditional Chinese Medicine: Incorporates herbal medicine, acupuncture, etc.

Biologically Based Practices

  • Definition and examples:
    • Aromatherapy: Use of essential oils for therapeutic effect.
    • Dietary Supplements: Nutrition-based supplements to improve health.
    • Herbal Products: Botanicals used for medicinal purposes.

Body-based Practices

  • Examples:
    • Chiropractic treatment
    • Chelation (removal of heavy metals from the body)
    • Eye Movement Desensitization and Reprocessing (EMDR)
    • Massage therapy
    • Phototherapy (light therapy)

Energy-based CAM Therapies

  • Mind-Body Medicine: Emphasis on the connection between psychological and physical health.
  • Examples:
    • Expressive therapy
    • Hypnotherapy
    • Meditation
    • Prayer and spiritual healing
    • Energy Medicine: Therapies aimed at manipulating energy fields.
    • Biofield Therapies: Manipulation of energy fields.
    • Electromagnetic Field Therapies: Use of electromagnetic fields to enhance well-being.

CAM Mental Health Therapies

  • Types:
    • Animal-assisted therapy: Incorporates pets to promote emotional healing.
    • Culturally based healing: Draws from traditional practices within specific cultural contexts.
    • Diet and Nutrition: Focus on the impact of diet on mental health.
    • Expressive therapies: Use of creative arts for healing purposes.
    • Pastoral counseling: Integrated faith-based support.
    • Self-help groups: Peer support for shared experiences.
    • Stress reduction and relaxation techniques: Various methods used to manage stress.

Caution with CAM

  • Considerations:
    • Some CAM therapies are new and lack extensive scientific validation.
    • Potential adverse effects from various CAM therapies.
    • Not all drug interactions and side effects are fully understood.