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Major mental disorders caused by disorders of brain structure and function are...

Schizophrenia, Major Depressive Disorder, Bipolar Disorder

What approaches are used to Improve outcomes for those with mental disorders?

Active involvement of client
Psychotropic medications
Trusting therapeutic relationship
Cognitive and behavioral therapies

Genetics of Mental Illness

Genetic component to major mental illnesses
Several genes may be necessary to cause psychiatric disorders
Genetic counseling based on statistical risks
Identification of specific genes that reliably increase risk for mental illness

What is the purpose of Psychopharmacology

- Improve or stabilize mood, normalize thinking, reduce anxiety, or allow for sleep
Critical part of effective treatment
Do not ―cure‖ but help to stabilize the disorder

To ensure the client's best outcomes what should the nurse do?

Understand their disease process and treatment plan
Active, participative role in treatment
Social support system
Safe and healthy place to live where basic needs met
Healthy coping and problem-solving skills
Appropriate psychotropic medications
Therapeutic relationship with healthcare providers

What are Phases Of Medication Treatment

Stabilization and Maintenance

Explain the nursing actions during stabilization phase

Stabilization phase
◦Assess client's symptoms and response to drug
◦Obtain lab tests, observe for adverse effects
◦Educate client

Explain the nursing actions during the maintenance phase

Maintenance phase
◦Ongoing assessment of drug effects
◦Assess for long-term side effects
◦Continue client education (focus on medication management at home, treating side effects and importance of continuing therapy when symptoms improve)

What are some nursing diagnosis for psychobiology and psychopharmacology

- Deficient Knowledge, Medication Management

Ineffective Therapeutic Regimen Management

List desired outcomes

Client will be able to state name of mental disorder by discharge
Client will list medications taken before discharge
Client will state basic target effects of medications before discharge
List possible side effects and when to notify physician and whether to continue medications before discharge
Express feelings about medications
List resources for help or information

List Interventions for Deficient Knowledge, Medication Management

Determine current knowledge level
Teach expected effects and side effects
Use clear simple terms
Reinforce with printed information
Encourage questions
Provide several learning opportunities
Teach when client can concentrate and cooperate

list nursing interventions for Ineffective Therapeutic Regimen Management

Ask how they take medications at home
Teach skills needed to follow treatment plan
Help to develop personalized medication plan
Discuss problem-solving issues

How should the nurse evaluate?

Evaluate outcome related to drug therapy
Document response to drug therapy
Careful teaching if peak effects not reached by discharge
In long-term care, evaluate
◦Extent of target effects achieved
◦Presence of side effects and adverse effects

Explain Discharge Considerations

Resources to call for problem solving
◦Outpatient appointments
◦Phone numbers for pharmacy, emergency advice, physicians, Alliance for the Mentally Ill

Emphasize need to take medications regularly for extended period of time
◦Do not discontinue when they feel better

Expected side effects and how to relieve them

What are the side effects of antidepressants and what do they do?

These drugs act on brain neurotransmitters by increasing the availability of one or more mood neurotransmitters (Serotonin, epinephrine, and dopamine) to increase the clients mood and lessen the depression

- Constipation
- Increase Heart Rate
- Dry mouth

What are the adverse effects of antipsychotic drugs?

Extrapyramidal Symptoms: abnormal involuntary movements: dyskinesia - akathisia - dystonia (muscle rigidity) - pseudoparkinsonism (stiffness;tremors;shuffling gait) - Tardive Dyskinesia (late-onset movement disorder)

- Weight gain
- Orthostatic hypotension (2nd & 3rd), seizures
- Photosensitivity
- Endocrine, anticholingeric
- Cardiac side effect (Tachycardia)

Typical/ 1st generation Antipsychotic actions and SE

Dopamine antagonist that blocks D2 receptor sites and decrease DA activity - Used to decrease positive Sx but not so much negative - (Haldol, Prollxin)

- Increase weight
- EPS (give anticolingeric)
- Tachycardia
- risk for hypotension
- seizures
- decrease anti-coagulation

Atypical/2nd Generation antipsychotics action and SE

Serotonin-dopamine antagonist that tx psychosis and more effective tx of negative Sx - (Risperdal + Zyprexa+ Seroquel + Clozapine) *Best for those not responding to typical (1st).

- non-compliance
- C: fatal agranulocytosis (monitor WBC for 1st 6 months then q 2wks)
- Increase weight (essp. Zyprexa)
- sedation
- orthostatic hypotension
- hypergycemia (DM)
- hypersalvation,
- risk fir seizures
- EPS (esp. Risperdal)

3rd generation Antipsychotics actions and SE

Dopamine stabilizer: It decrease DA when it's high and maintains a nor level + stabilizes mood - (Aripiprazole (Abilify))

- fewer EPS compared to 2nd
- akathisia
- weight gain
- less sedation
- orthostatic hypotension
- N/C

PSYCHOTROPIC AGENTS (used for depression)

Medications effective for all types of depression
No one single medication works for everyone
Takes 2-6 weeks for full effect
Drug chosen because side effects are helpful
All but one only given orally
Most act on serotonin and norepinephrine
A few act on dopamine

Selective serotonin reuptake inhibitors (SSRIs)

class of antidepressant drugs that work specifically on increasing availability of the neurotransmitter serotonin by interfering with its reuptake [Celxa - Prozax - Zoloft]

- sedation/agitation
- H/A - dizziness - tremors
- sexual dysfunction (decrease libido, anoragnism)
- GI affects (decrease appetite, N, diarrhea, constipation), dry mouth

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

antidepressants, that increase DA, examples include: venlafaxine (Effexor), and duloxetine (Cymbalta) Monitor BP

- Increase BP
- Insomia / Sedation
- H/A
- N - decrease appetite
- sweating
- sexual dysfunction

Norepinephrine and dopamine reuptake inhibitors (NDRI)

Increase NE & DA by blocking their reuptake and increasing neurotransmission [Bupropion (Wellbutrin)]

- Dry mouth / anorexia / N
- sweating / tremors / insomnia
- H/A and agitation

Tetracyclic antidepressants (NaSSA)

These drugs have effects on both norepinephrine and serotonin, enhancing brain levels of these neurotransmitters [Mirtazapine (Remeron)]

Constipation px & orthostatic hypotension

- hypotension
- dry mouth / constipation
- increase appetite / weight gain
- sedation / dizziness / abnorm dreams / confusion
- UTI / flu-like Sx
- seizures (rare)

Combined serotonin antagonists and reuptake inhibitors (SARs)

They act by antagonizing serotonin receptors such as 5-HT2A and inhibiting the reuptake of serotonin, norepinephrine, and/or dopamine. [Trazodone (Desyrel) / Nefazodone (Serzone)]

Constipation px & orthostatic hypotension

- sedation / fatigue / dizziness / hypotension
- H/A / lack of coordination / tremor
- N/V
- blurred vision / dry mouth
- syncope
- Priapism: painful erection(Trazdone)
- liver damage (Nefazodone)

Selective norepinephrine reuptake inhibitors (NRI)

Increase NE and can also increase DA in frontal cortex
[Reboxetine (Edronax)]

orthostatic hypotension

- anticholinergic effects
- insomia / anxiety
- sexual dysfunction (impotence)
- hypotension

Tricyclic antidepressants (TCA's)

antidepressants block the reuptake of the neurotransmitters, SE and NE, making more of these chemicals available in the brain.
*orthostatic hypotension, constipation)

- sedation / othostatic hypotension
- weight gain and anticholinergic effects

Monoamine oxidase inhibitors (MAOI's)

Antidepressant medications that affects brain and GI. Stops removal of NE, SE, and DA from the brain. Rarely used as 1st choice d/t many serious dietary SE

hypertensive crisis: throbbing H/A, sense of spreading or pounding heart, and stiff neck *Hold meds, take VS, and notify Doc*

Tx: 1 CCB oral/Sublingual

what are anticholinergic effects

- dry mouth & eyes / dry warm skin and/or flushing
- blurred vision (may produce or exacerbate glaucoma) ask about hx of glaucoma
- increased heart rate
- difficulty emptying our bladder / constipation
- headaches / confusion

The *reason why many clients stop taking TCA's meds

What antidepressants should the nurse take cautions if person is suicidal?

TCA's are fetal in OD so the healcare team needs to assess depression degree and consider another such as...

SSRI's b/c they have a low potential for abuse and like all antidepressants they don't cause euphoria/physical dependency

-- However they are highly protein bound and if mix w/TCA, TCA toxicity can occur --

What occurs when SSRI's are given In combination w/MAOI's, St. John's Wart (herbal antidepressant) or tryptophan (AA in food)


-- change in MS / agitation or restlessness / muscle spasm / hyperreflexia / diaphoresis / shivering / tremors / diarrhea / abd cramps / N / lack of coordination and H/A

What occurs when SSRIs are taken w/Lithium? antipsychotics?

Potential lithium toxicity

EPS increased w/antpsychotics

What foods should be avoided when taking MAOI's?

AA tyramine containing:
Aged cheeses (except cottage, cream, ricotta, & processed cheese slices)
- Preserved Meats (sausage, pepperoni and salami, lunch meats, canned ham, pickled herring, & dried fish)
- Liver & other organ meats
- Soy sauce, yeast, or protein extract (concentrated) products
- Broad bean (fava bean) pods, sauerkraut, banana peels
-Tap (draft) beer or unpasteurized beer - Some wines, red wine

What drugs should be avoided when taking MAOI's?

SSRI's -- TCA's --- meperdine (Demerol) -- CNS depressents (anesthetic agents) sympathomimetics (stimulants/decongestions like OTC cold, allergy, and wight loss remedies), methylphenidate (Ritalin), bronchodilators, and some antihyertensive

**Death in OD**

Lithium (action, precautions, and SE)

- Tx manic bipolar
- Toxic effect on renal function (have baseline kidney+thyroid function)
- Labs need to be done q 2 months
- narrow therapeutic index -- bld needs to be checked 12 hrs after last dose
- Nurse needs to maintain Na +F&E intake (Lithium is a salt)

- weight gain / N
- sedation
- fine hand tremor
- rash / hair loss / acne
- memory problems / feeling of mental dullness
- leukocyotosis

Valproate/ depakote (action, precautions, and SE)

- Anticonvulsant that is used to tx manic bipolar -- mood stabilizer

*Get baseline liver function test and monitor liver and platelet count throughout use of med*

- sedation, tremor, dizziness,m ataxia, H/A, constipation, constant weight gain,

Lithium Toxicity

coarse tremors, ataxia, slurred speech, hypotension, V, sedation, diarrhea, irregular pulse

*DC Immediately*
Dehydration can cause toxicity


Most widely prescribed drugs in the world
Used for wide variety of conditions
Insomnia, alcohol withdrawal
Skeletal muscle relaxation, acute management of seizures
Severe agitation, social phobia
Generalized anxiety disorder, and panic disorder


Target symptoms are insomnia and sleep disorders

Insomnia - difficulty falling asleep, staying asleep, or awakening too early

Match duration of action with client's sleep problem

Elderly, children, and people with brain damage at increased risk of paradoxical response


Overdosages of benzodiazepines alone are rare unless combined with another CNS depressant

Additive CNS depression with alcohol, TCAs, MAOIs, anticonvulsants, antihistamines, antipsychotics, or other CNS depressants


Rarely used
Secobarbital and pentobarbital

Other drugs are more effective and safer
Cause dependence, tolerance, and dangerous

withdrawal syndromes
Dangerous overdosage
Fatalities combined with alcohol and other CNS depressants

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