Nur 415 Mental Health Exam 3

What Schizophrenia disorders characterized by?
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What Schizophrenia disorders characterized by?
By Psychosis
What is psychosis?
the altered cognition, altered perception, and/ or inability to determine what is or is not real.
When does symptoms of schizophrenia appear? (age)
15 to 25
What do schizophrenia people experience?
Prodromal phase
What psychotic symptoms do people present with schizophrenia?
hallucinations, delusions, and/or disorganized speech or thoughts
Who are more likely to be diagnosed with schizophrenia?
Males. Mostly in urban areas onset 15 - 25
When do women usually have onsets with schizophrenia (age)?
25 - 35, tend to have better prognosis
What diseases associate with Schizophrenia:
Substance use disorder, Anxiety, depression, Suicide, & Physical illness.
Risk factor of schizophrenia
Genetic, neurobiological dopamine theory, environmental stressor (toxins, urban areas with high crime)
What are the phases of Schizophrenia?
Prodromal, Acute, Stabilization, Maintenance or residual
What are the four main assessment symptoms for Schizophrenia?Postive, Negativem Cognitive, AffectivePostive symptoms?Presence of something that should not be present. Positive includes: Hallucinations, Delusions, Paranoia, Disorganized thinking & Bizarre thoughts, behavior or speech. (Presence of problematic behaviors)Negative symptoms?Absence of something that should be present. Inability to enjoy activities, social discomfort, or lack of goal directed behavior, alogia (speaking less). (Absence of healthy behaviors)Cognitive symtoms?Subtle or obvious impairment in memory, attention, thinking, judgement, problem solvingaffective symptomsSymptoms involving emotions and their expression.Types of sensations of hallcuinationssensory experience for which no external stimuli exists. (Auditory, visual, olfactory, gustory, or tactile.)Delusion's?False beliefs despite a lack of evidence to support them. Often persecutory, grandiose, or religious.Clang associationChoosing words based on their sound, often rhyming.Neologism?pt has a different or nonexistent meaning for words, it can be a made up word.Associative looseness?(speach) looseness of association from haphazard and illogical thinking where concentration is poor and they loosely associate their feelings. "I need to get a band-aid. My friend was talking about aids. My friend talks about french fries but how can you trust the French?"Word salad?Most extreme form of associative looseness. Jumble of words that are meaningless to their listener.Echolalia?Pathological repeating of another's words, can be due to inability to generate speech of their own.Outcomes for Schizophrenia in phasesPhase 1 - Acute - safety Phase 2 - Stabilization - focus on patient understanding of illness and treatment Phase 3 - Maintenance - focus on maintaining and increasing symptom controlWhat classes are antipsychotics?First generation & Second GenerationsWhat is first generation antipsychotics?Traditional dopamine (D2 receptor) antagonists known as typical antipsychotics or neuroleptics EX: Aldol (haloperidol)What do First generation meds primary treat for symptomspositive symptoms ( hallucinations, delusion) with little effect on negatives.What is extrapyramidal (EPS) side effects of FGAS?Acute dystonia, Akathisia, pseudoparkinsonism, tardive dyskinesiaWhat Acute dystonia (FGAS)?Sudden, sustained contraction of one or several muscle groups, (head and neck) - can cause anxietyWhat is Akathisia (FGAS)?Motor restlessness that causes pacing and or an inability to stay still or remain in one place.What is pseudoparkinsonism? (FGAS)?Temporary group of symptoms that resemble parkinson disease - tremor, reduced accessory movement.What is tardive dyskinesia? (FGAS)?Persistent EPS involving involuntary rhythmic movements face, eye mouthWhat is a second generation antipsychotic? (SGAs)Serotonin (5-HT2A receptor) and dopamine (D2) receptor antagonists EX: CLozaril (clozapine).What does second gen antipsychotic primary treat?Treat positive and help negative symptoms.. Though improvement in negative and cognitive symptoms is usually less.Meds for second genClozapine, risperidone, olanzapine, quetiapine, ziprasidoneEducation about antipsychotics?Take 2-6 weeks to reach desired effects. Patient - specific dosage adjustment required. Recommended monotherapy - using one medication at a time. Do not abruptly discontinued Discontinuation syndrome: Nausea, dizziness, tremors, insomnia, electric shock like pains, anxiety. Unlikely to be lethal from overdoseSide effect from second gen?Metabolic syndrome, anticholinergic toxcity, neuroleptic malignant syndrome, agranulocytosis, prolonged QT interval, Liver impairment Sexual dysfunction, sedation, seizures, increased mortality older peeps w/ dementiaINFO about long - acting antipsychotics (LAIs)Admin IM Only need to be administered every 2-4 weeks Dosing protocols Downside -Lack of flexibility and PT may feel they have less controlWhat is Anorexia nervosa?Self starvation due to a distorted body image of being overweight Refusal to maintain a minimally normal weight for height and express extreme fear of gaining weight. Loss of intake is rare. Many restrict while some binge-eat and purge.Treatment for anorexia-increase weight gradually -monitor exercise routine -teach healthy eating and exercising -allow client input in choosing healthy foods for meals -Limit activity and decisions if weight is low enough to be life threatening This can require long-term treatment including brief inpatient stays, outpatient therapy, medication. A combination of groups, individual, family therapy can provide the greatest chance of a stressful outcome.What disease associate with Anorexia Nervosa?Bipolar, depressive and anxiety disorders. Obsessive compulsive disorder, alcohol and substance use disorderRisk factor for Anorexia?Neurobiological: altered serotonin function - cause dysregulation of appetite, mood and impulse control in eating disorders Psychological: Learned behaviors has positive reinforcement Environmental: Cultural influence of self-concept and satisfaction with body size.What is present on assessment with a patient with Anorexia?Lanugo- downy hair may be on the face and back. Grows as a physiological or natural response to insulate the body. - Amenorrhea, cool extremities, malnourished, dehydration, electrolyte imbalance Perception of problem, eating habits, history, method used to achieve weight control, values attached to specific shape and weight, mental status and psychological parameters.outcome for anorexiaSmart goals - centered goals, make them with patientPlanning with AnorexiaImmediate medical stabilization - refeeding syndrome may occur - can be lethal.Refeeding syndromemetabolic alterations that may occur during nutritional repletion of starved patientsImplementation with anorexiaAcute care, psychosocial intervention, pharmacological intervention, complementary and integrative therapies, health teaching and health promotionWhat is bulimia nervosa?Repeated episodes of binge eating followed by inappropriate compensatory behaviors such as self-induced vomiting, misuse of laxatives, diuretics, or other medications; fasting, or excessive exercise. (Disturbance in perception of body shape and weightWhat diseases associated with bulimiaMood disorders, depressive or bipolar, alcohol and substance abuseWhat are risk factors for Bulimiarisk in family HX disorder, cycles may have assoc with neurotransmitter - likely to have ADHD, anxiety and low self-esteem, body thin idealWhat to assess for with a PT with bulimiaDo not appear physically or emotionally ill initially, impulse control and compulsivity, parotid gland swelling, dental erosion and caries from vomiting, family relationship chaotic.DX bulimiaCardiac output will decrease, low self-esteem, disturbed body image, ineffective coping, powerlessness, social isolaitonPlaning/TX for bulimia:Prioritize care, address life threatening complications, antidepressants, cognitive behavioral therapy, counseling, health teaching/promotionWhat is binge eating?Individual engages in episodes of binge-eating after which they experience significant distress. Eating large amount of food in a short period of time.Risk factors for binge eatingtends to run in families, hormone irregularities, low self-esteem and body dissatisfaction, reduce coping ability, adverse childhood experiences such as sexual abuse, social pressureAssessment for binge eatingObesity >30 bmiDX binge eatingimbalanced nutrition: more than body requirements, anxiety, chronic low self-esteem, social isolation, ineffective copingPLANNING for binge eatingIncludes the usualy diet and exercise elements for weight loss programs. manage GI issuesTX for Binge eatingOutpatient , SSRIS, Vyvanse (CNS stimulants often used for ADHD) to approve binge eating, bariatric surgery, health teaching/promotion, psychotherapyPICA:Eating substances such as dirt or pain that have no nutritional value. Beings in early childhoodRuminationundigested food being returned to the mouth, then rechewed and re - swallow or spit out. Onset - infant between 3-12 months.Interventions for ruminationRepositioning infants and small children during feeding, improving interactions and making mealtime pleasurable, distracting during this is also helpful. - Family therapy may be needed.Complete sleep cyclestage 1 - light sleep, stage 2- sleep onset, stage 3 - deep sleep, stage 4- very deep sleep, stage 5 - REMSleep Safetysleep loss diminishes safety and results in the loss of lives and property. Can provide impairment to those induced by alcohol consumption.DX sleep disorder/issuePolysomnography (breathing disorders) , Multiple sleep latency test(MSLT) (daytime nap test used to measure sleepiness), Maintenance of wakefulness test (MWT) (Ability to remain awake in a situation conductive sleep) Actigraphy (Apple watch)Hypersomnolence Disorder (sleep)daytime sleepiness. Chronic begins in young adulthood.Narcolepsy disorder (Sleep)Uncontrollable urge to sleep, more in men.Nightmare disorderLong frightening dreams from which people awaken scarred. Can begin in preschoolCataplexySleep paralysis, loss of muscle tone while maintaining consciousness.restless leg syndromesensory movement disorder by an uncomfortable sensation in the legs accompanied by urge to move. - Females tend to be more affected, SSRIS or SNRIs may precipitate restless leg syndrome (causing it or worse, benadryl and dopamine can cause it.)TX for restless legGabapentin or ironSUBSTANCE INDUCED SLEEP DISORDERAlcohol- induce sleepiness, Nicotine - stimulant increasing heart rate and bp, Caffeine - promotes wakefulnessImpactful sleep hygiene practiceGet up and go to sleep at the same time Create a healthy sleep environment Turn off electronics an hr before bed Avoid large, fatty meals prior to sleeping Reduce stress Exercise Limit caffeine Establish a nighttime routineSubstance use disorderpathological use of substance that leads to a disorder of use.four major groupingsImpaired control Social impairment Risky use Physical effects (intoxication, tolerance, and withdrawal)What are DSM 5 criteria psychoactive substancesALCOHOL CAFFEINE CANNABIS HALLUCINOGENS INHALANTS OPIOIDS SEDATIVE HYPNOTIC, AND ANTIANXIETY MEDICATIONS STIMULANTS TOBACCOAddictionIndividuals are unable to continuously abstain from the substance or activity.IntoxicationPeople are in the process of using a substance or excess. May manifest itself in a variety of ways depending on the physiological response of the body to the substance being used.ToleranceNo longer responding to the drug in the way they initially did. Take higher doses for some level of response.WithdrawalSet of physiological symptoms that occur when a person stops using the substance. Specific to the substance being used.What can alcohol and Benzos do to the bodyCan cause seizuresWhy can alcohol cause seizurebecause the body's CNS is depressant, when withdrawal your CNS system gets excited and can cause that seizure.Alcohol withdrawal treatmentBenzodiazepinesCannabiscan cause a negative effect. If you have an underlying diagnosis you're not aware of can enhance and be a negative affect.Disease affecting substance disorderCo-Occurring disorders may include any combination of two or more substance disorders and mental disorders. - MDD, bipolar, anxiety are twice as likely as unaffected to have a substance use disorder.Risk factors for substance abuseBiological - Genetics(40-60% risk.)Identical twins more likely to both have alcohol use problems than fraternal twins. Environmental - (Chronic stressors, poverty, peer influence) Sociocultural (May create some sense of community and belonging for some).HullucinogensProfound disturbance in reality, associated with hallucinations, flashbacks, panic attacks, delirium, mood/anxiety.Intoxication with hallucinogens:Paranoia, impaired judgment, intense perceptions, depersonalization, derealization, "hearing colors or seeing around"PCp drugMedical emergency, violence, impulse, unpredictable, hypertension, tachycardia, ataxia, lack of pain response, seizure.PCP patient safetytalk to these patients cannot be talked down to and may need chemical and physical restraint. May need mechanical cooling for hyperthermia. Monitor: Closely and be careful for yourself as wellWithdrawal PCPNo official withdrawal diagnosis or pattern.TX for PCphallucinogens - talking pt down. PCP: good luck :) need back up and a ton of benzos!InhalantsSolvents for glues, propellants, thinners, fuelsIntoxicationDisinhibition and euphoria, high doses may cause fearfulness, illusions, and A/V hallucinations. Can lead to nausea, nystagmus, depressed reflexes and diplopia. Delirium, dementia, psychosis.Intoxication TX of inhalantsUsually does not require treatment. Coma, cardiac arrhythmias, bronchospasms happen. Monitor on cardiac monitoring and pulse oximetry. May need haldol for prolonged agitation.OpioidsHeroin, prescription drugs - dependence can cause need for larger amounts. Often begin in late teens, early 20'sOpioids intoxicationPsychomotor retardation, drowsiness, slurred speech, altermood, impaired memory, and attention.Opioids withdrawalCOWS scale in hospital to monitorOpioid TXTherapy, METHADONE, BUPRENORPHINE, NALTREXONE, VIVITROLSafety for overdoseNARCAN is used, maintain the airway(breath for them), CPR if no pulse. Mechanical ventilation until stable.Opiate withdrawal timelinelast does, 6-12 hrs (short acting opiates), 30hrs (long-acting opiates), 72 hrs symptoms peak (Nausea,, vomiting, stomach cramps, diarrhea, goosebumps, depression, drug cravings.)Cow scale:for opiate, (pulse, Gi upset, sweeting, flush, chills,SubjectiveWhat they tell youObjectiveWhat you seeVivitrolSobriety maintenance drug. It has potential to develop addictionMethadoneIs used to help addicts during the detox process & manage withdrawal symptoms. It does have the potential to develop addictionSuboxoneIs used as a detox drug for painkiller and heroin detox. Reduces cravings and alleviates withdrawal symptoms.SEDATIVE/HYPNOTIC/ANTIANXIETY drugs:Benzodiazepines, carbamates, barbiturates, barbiturate-like hypnoticsSEDATIVE/HYPNOTIC/ANTIANXIETY intoxicationSlurred speech, incoordination, unsteady gait, nystagmus, impaired thinking, coma potential.SEDATIVE/HYPNOTIC/ANTIANXIETY: withdrawalRebound hyperactivity due to use of CNS depressants so often - agitation, grand mal seizures, psychomotor agitationSEDATIVE/HYPNOTIC/ANTIANXIETY TreatmentGastric lavage, charcoal, careful VS monitoring, keep them awake, monitory airwayalcohol disorderis a sedative, it creates an initial feeling of euphoria. Cluster of behavioral and physical symptoms characterizes alcohol use disorder.Legal intoxication80 to 100 mg ethanol per deciliter of blood (0.08-.10mgdL) Intoxication is based on a number of factors including how quickly alcohol is consumed, quicked makes the rate of blood alcohol higher.Alcohol use disorder withdrawalOccurs after reducing or quitting alcohol after heavy or prolonged use.Signs of withdrawalTremors "shakes," 6-8 hours after last drink. Agitation, lack of appetite, nausea, vomiting, insomnia, impaired cognition, mild perceptual changes, BP increase, HR, TEMP.Withdrawal seizurescan be life-threatening. Begin 12 - 24 hours after the last drink. Seizures are generalized and tonic clonic.What scale to perform with alcohol withdrawalCIWA scale ASAP, seizure precaution, benzosAlcohol withdrawal deliriumDELIRIUM TREMENS - Medical emergency that can result in death of 20% of untreated patients (usually result of medical problems such a pneumonia, renal disease, hepatic insufficiency, or heart failure)When can delirium start with alcohol withdrawalCan happen any time in the first 72 hrs. Delusions, hallucinations may cause unpredictable behavior. (PATIENT SAFETY)Risk for alcohol abuseHepatitis or pancreatitisPrevention goal for alcohol abuse withdrawalusing valium is common. We also use precedex in hospital.alcohol-induced persisting amnestic disorderWERNICKE_KORSAKOFF SYNDROME (memory disorder), blackouts.Side effects of alcohol abuseperipheral neuropathy, alcoholic myopathy, alcoholic cardiomyopathy, esophagitis, gastritis, pancreatitis, alcohol hepatitis, cirrhosis, leukopenia, thrombocytopenia, canerfetal alcohol syndrome (FAS)Leading cause of intellectual disability in the US. Can cause inhibited intrauterine growth, microcephaly, craniofacial malformation, limb and heart defects.Care for substance use disorderDetox, rehabilitation, halfway houses, intensive outpatient therapy/partial hospitalization, outpatient programs, AA, relapse preventioncognitive functionAttention and orientation are basic lower-level cognitive domains. Higher level cognitive domains are more complex.what are neurocognitive disorders?Delirium Mild neurocognitive disorder Major neurocognitive disorder Delirium is short term and reversible. Mild may or may not progress to being major Major diseases are commonly known as dementia, which is progressive and irreversible.DeliriumCommon in hospitalized older patients. Up to 80% of ICU pts and 22% in medical PTS.What can cause DeliriumAlways due to underlying physiological causes that are usually multifactorial and involve a dynamic interplay of factors. (disease, older age, cognitive impairment, polypharmacy, ICU'S, fractures, surgery, stroke, aphasia, vision issues) DELIRIUM IS A MEDICAL EMERGENCY. Increases morbidity and mortality, may have long term consequences.Assessment of deliriumWhen a patient abruptly demonstrates a reduced clarity of awareness of the environment. EX: repeating questions, they are difficult to focus or shift attention, conversation is difficult. Hallucinations or illusions. May try to get up, get dressed and go home Hypervigilance, extraordinary alert, scanning the room with eyes Difficulty sleeping, may be aggressive or scared.Safety for deliriumPatient will remain free of injury. Try to reorient patients when there are periods of clarity by clocks, calendars, maps, white boards. Intervention: Reorientaint, meals keep the same time, news paper, lights onWhat is Alzheimer's?Attacks indiscriminately. Any gender, or baseline intelligence, rich or poor. Usually >65.Risk for alzhemier'sincrease risk with genetics Cardiovascular disease increases risk, also lifestyle such as diabetes, obesity. Head injury & TBI increase Risk Remaining mentally and socially active has been found to be important, as well as a healthy diet. Usually 60 - 80% all have dementia.Mild alzheimers: loses energy, drive and initiative, has issues learning new things. Personality and social behavior remain intact so it may be brushed off.More serve alzheimersAgnosia, Individuals may forget where the toilet is and need to use it and become incontinent.Agnosia is?Unable to identify common object or tasksConfabulationCreation of stories or answers in place of actual memories to maintain self-esteem.PreservationPersistent repetition of a word, phrase or gestureAgraphia?Diminished ability and eventual inability to read or writeAphasiaLoss of language ability. May be unable to find the right wordsApraxiaLoss of purposeful movement in the absence of motor or sensory impairmentHyperoralitythe tendency to taste, chew, and put everything in the mouthHypermetamorphosisurge to touch everythingSundowningbecoming restless and agitated in the late afternoon, evening, or night.Interventions for alzheimer'sPatient centered-care: Shown to decrease agitation in people with dementia living in residential care settings. Education to the family - what can we tell them? Ascertain what is important to the patient, their values and beliefs, as well as their history. Introduce yourself. One direction at a time is slow.Cholinesterase inhibitors is used forDeficiency of acetylcholine has been linked to Alzheimer's medication aimed at preventing its breakdown.Cholinesterase inhibitors drugs areDonepezil and rivastigmineSide of effect of cholinesterase inhibitorweight loss, diarrhea, cause, dizziness, headacheN-Methyl-D-Aspartate (NMDA) Receptor Antagonisttypically added after trying to cholinesterase inhibitors. Regulates glutamate - neurotransmitter involves info processing, storage and retrieval dementiaMed of N-Methyl-D-AspartateMemantineAlzhemiers holistic careUse of essential oils, Have patience with them Monitor for signs of abuse Decreasing stimulation as needed. Try to keep a routine, this can aid in understanding time of day. Work closely with family.Bipolar 1 disorderThe most severe!!!! Marked by shifts in mood, energy, and the ability to function Periods of normal functioning may alternate with periods of illness (high, lows, or combo of both) They have experienced at least one manic episode.What is Mania?Period of intense mood disturbance with persistent elevation. They do not recognize this as problematic and often resist treatment. May lead to psychosis, including hallucinations, delusions, and dramatically disturbed thoughts. May be equal risk for developing anxiety as depression after an episode. Depression and Mania together cna lead to impulsive dangerous behavior including suicidal behavior.Manic symptoms:Decrease need for sleep, racing thoughts, risky behavior, distractibilityDepressionFeeling of worthless, Decrease appetite, suicidal thoughts, extreme sadnessBipolar 2 disorderHave experienced at least one hypomanic episode and at least one major depressive episode.What is hypomania?A low level and less dramatic mania. Tends to be euphoric and functioning. Not usually severe enough to cause serious impairment in occupation or social functioning. Hospitalization is rareCyclothymic disordersymptoms of hypomania alternate with symptoms of mild to moderate depression for at least 2 weeks in adults and 2 weeks in children.Who does bipolar affectAffects men and women equally. Women are more likely to abuse alcohol, commit suicide and develop thyroid disease Women - who experience a severe postpartum psychosis within 2 weeks of giving birth have four times greater change of subsequent conversion to bipolar disorderWhen does cyclothymic disorder usually begin?usually begins in adolescence or early adulthood, There a 15-205 recent someone with it will end up developing Bipolar I or IIWhat disorder affect Bipolar 1Nearly all anxiety disorders are associated with Bipolar I. Substance use disorder is present in more than half, More than half have alcohol use disorder, migraines, metabolic syndrome - higher rate in bipolar IWhat disorder affect bipolar 2anxiety, eating disorders, binge eating, substance disorderRisk factor for bipolarGenetics, neurotransmitters brain , structure, function, neuroendocrine Environmental: children who have genetic and biological risk of developing bipolar disorder are most vulnerable in the bab environment - Childhood events (ACE scares) Psychological: neuroimaging techniques and treatment advancesAssessment for bipolarSpend more time depressed than manic. Often described as having "expansive" mood - elevated and unrestrained expressiveness may have intense feelings of well-bring, being "cheerful in a beautiful world" or becoming " one with god"Assessment for hypomainthere is voracious appetite for social engagement, spending, and activity even indiscriminate sex. May have elaborate schemes to get rich, famous and powerful.Assessment for maniapeople give money, prized possessions, and expensive giftsPressure speachFast, ranging from rapid to frenetic that conveys an inappropriate sense of energy.Circumstantial speechAdding unnecessary details when communicating with others they eventually get to the point.Tangential speechSimilar to circumstantial, but they lose the point they were trying to make and never find it.Loose associationRepresent a disordered way a person is processing information. Thoughts connect looselygrandoise delusionsManifested by a highly inflated self-regard. It is apparent in both ideas expressed and person's behaviors. "I was abducted" "I am the messiah"persecutory delusionsDisturbingly common. People think God is punishing them, the FBI is spying on them.Implementation for bipolarDecreased stimuli Offer finger foods to ensure they are eating, they won't likely want to sit down. Encourage rest.. Frequent high quality fluids. Redirect aggressive behavior Hear and act on legitimate concernsAnticonvulsantsprevent or control seizures (epilepsy) But can be treated for mania and bipolarPharm interventions for BipolarAnticonvulsants, SGAs, Quetiapine (seroquel), and valproateQuetiapinebipolar depression Antidepressants have an increased risk of bringing on manic episodes.LithiumIs a mood stabilizerelectroconvulsive therapy (ECT)Used to subdue manic behavior, esp in patients with treatment-resistant maina and rapid cycling (4+ episodes a year). Far more effective than drug based treatment, but there are risks such as nausea, headache, fatigue confusion, and slight memory loss, which may last minutes to hours.Integrative therapyECT, CBT, family therapy, Interpersonal and social rhythm therapyDSM - 5 classification of depressionMajor depressive disorder Disruptive mood dysregulation disorder Dysthymic disorder Premenstrual Dysphoric Disorder Substance Induced Depression Depression Disorder.What is major depressive disorder?Depressed mood lasting for at least 2 weeks Lack of interest in previously pleasurable activities/inability to feel happy (called Anhedonia) and Anergia (lack of energy and physical passivity)S/S MDDFatigue, sleep disturbance, changes in appetite, feelings of hopelessness, worthlessness, thoughts of death/suicide, inability to concentrate or make decisions, Decrease in physicall activityRisk for MDDdepression increases with losses, health issues, hospitalizations, and when taken from their home.Assessing MDDHamilton Depression Rating scale, Sadpersons sad. Slow thinking, dwelling on their perceived flaws, unable to see strengths, feelings of hopelessness, worthlessness, guilt, anger, and helplessness, psychomotor agitation, change in bowels, belly pain, back pain, eating habits, sleep disturbancesPharm meds for MDDAntidepressants, light therapy, herbs, exerciseWhat is lithium?A mood stabilizerWhat does lithium treat?Treats bipolar disorder & regulars "mood swings" (depression & mania)Therapeutic range for lithium0.6 to 1.2 - 1.5 = toxicPatient education for lithiumDo not restrict sodium or water!! Make sure patient is drinking plenty of fluids to avoid dehydration (TOXICITY), blood drawn often (lithium level 1-2 months)Expected side of effect of lithiumDrowsiness, weight gain!!dry mouth!! How can toxicity occur: Dehydration, Decrease renal function (kidney failure), drug interaction (NSAIDS, diuretic)s/s of toxicity of lithiumGI symptoms (Nausea, vomiting, diarrhea), Confusion, agitation, neuromuscular excitability, ataxiaWhat is valproic acidAnticonvulsant / mood stabilizerWhat is a therapeutic use for valproic acidtreats maniaPatient education for valproic acidDo not abruptly stop the medication, Discontinue gradually to prevent convulsions, take with mealsSide effect of valproic acidNausea, vomiting, diarrhea, heartburnWhat is haloperidol (haldol)is a first generation antipsychoticHaldol (haloperidol) used forhelps diminish positive symptoms of schizophreniaPatient education for FGAeducate that it takes 2- 6 weeks to be effective, adherence is importantSide effect for FGAMALIGNANT SYNDROME, high fever muscle rigidity, alter mental, high bp, high hr, sweating Discontinue and call providerSecond generation antipsychoticAntipsychotics Clozapine (Clozaril), Risperidone (risperdal), Ziprasidone (geodon)Therapeutic use for SGAHelps diminish positive symptoms of schizophrenia & helps negative symptoms as well!Patient education for SGAeducate that it may take 6 - 10 weeks takes effect, exercise to help weight gainSide effect of SGAMalignant syndrome, weight gain, cholesterol, blood sugar,what is SSRIAntidepressantDrugs for SSRISertraline (zoloft), fluoxetine (prozac)Therapeutic use for SSRITreats depression, treats eating disorders All antidepressants can increase suicide risk if patient already has suicide plan or ideation because this med class will increase the energy.Patient education for SSRIDo not combine with MAOisSide effect of SSRISerotonin syndrome: to much serotonin in the brain, sexual dysfunction, stomach issue, swollen weight gainWhat to use other than a SSRI to teats depressionSt johns wartWhat os Monoamine Oxidase inhibitors (MOAI)AntidepressantMeds for MOAIsTranylcypromine, isocarboxazid, phenelzineEducations for MAOISDO NOT EAT FOODS WITH TYRAMINE: aged cheese, fermented meats & liver, sour cream, yogart, take med in morning, take 4 weeks for therapeutic level. DO NOT TAKE WITH SSRI & TCAsside effects of ECTthere are risks such as nausea, headache, fatigue confusion, and slight memory loss, which may last minutes to hours.