This chapter discusses psychopharmacology and the nursing process for various drug classes. It provides background on how psychotropic drugs work and historical perspectives. For different drug classes like antidepressants, mood stabilizers, antipsychotics, and others, it outlines indications, mechanisms of action, side effects to monitor, nursing diagnoses, and important assessment factors like interactions and contraindications. The goal is to safely and effectively manage clients' medication regimens.
Neurobiology of depression- recent updatesSantanu Ghosh
The document summarizes recent updates in the neurobiology of depression. It discusses various areas of the brain implicated in depression and mechanisms of neuroplasticity. It also covers the roles of neurotrophins like BDNF, microRNAs, stress hormones, inflammation, and the gut microbiota in depression pathophysiology. While monoaminergic systems are important, the conclusion states that depression involves multiple brain systems and regulators of central nervous function that require further study.
This document provides an overview of Acute and Transient Psychotic Disorder (ATPD). It discusses the history and evolution of ATPD from early descriptions in the late 19th century to its inclusion as a diagnostic category in ICD-10 in 1992. The document outlines the ICD-10 diagnostic criteria for ATPD and reviews several landmark studies that helped establish ATPD as a separate diagnostic category from schizophrenia and affective disorders. It also discusses cultural variants of brief psychotic episodes and debates around classifying certain culture-bound syndromes as ATPD.
This was a lecture in the course "Significant Medical Conditions in Seniors" presented at Peer Learning in Chapel Hill, NC, USA in 2016 by Michael C. Joseph, MD, MPH.
This document discusses various psychopharmacological agents used to treat psychiatric conditions including antipsychotics, antidepressants, mood stabilizers, and benzodiazepines. It provides details on the classification, mechanisms of action, indications, and adverse effects of typical and atypical antipsychotics, tricyclic and SSRI antidepressants, lithium and anticonvulsants used as mood stabilizers. It emphasizes the importance of monitoring serum lithium levels and describes the management of lithium toxicity as an emergency. The document aims to inform psychiatrists and other medical professionals about appropriate pharmacotherapy options for different psychiatric diagnoses.
This document provides information on the pharmacology of second generation antipsychotics. It discusses the history and development of antipsychotic drugs from chlorpromazine to clozapine. It describes the mechanisms of action of atypical antipsychotics including their effects on serotonin and dopamine receptors. The document classifies antipsychotics and examines the pharmacology of individual drugs like clozapine, risperidone, and olanzapine, covering their indications, mechanisms, side effects and interactions.
1) Post-traumatic stress disorder (PTSD) is caused by exposure to highly stressful or dangerous events and symptoms must last over a month.
2) It has been referred to by different names in different eras reflecting traumatic events of those times like shell shock or combat stress syndrome.
3) PTSD is associated with changes in neurobiology including increased noradrenergic activity and alterations in the hippocampus and amygdala.
4) Symptoms include re-experiencing the traumatic event, avoidance of trauma-related stimuli, and increased arousal and anxiety.
This document outlines psychotropic medications used to treat mental health conditions such as depression, bipolar disorder, and anxiety. It defines psychotropic medications as psychiatric drugs that affect brain chemistry. Common medications are discussed for each condition, along with their dosages, side effects, and nursing considerations. The document emphasizes that pregnant and breastfeeding women should discuss risks and benefits of psychotropic medication with their doctors, as limited research exists on effects during pregnancy and breastfeeding.
Neurobiology of depression- recent updatesSantanu Ghosh
The document summarizes recent updates in the neurobiology of depression. It discusses various areas of the brain implicated in depression and mechanisms of neuroplasticity. It also covers the roles of neurotrophins like BDNF, microRNAs, stress hormones, inflammation, and the gut microbiota in depression pathophysiology. While monoaminergic systems are important, the conclusion states that depression involves multiple brain systems and regulators of central nervous function that require further study.
This document provides an overview of Acute and Transient Psychotic Disorder (ATPD). It discusses the history and evolution of ATPD from early descriptions in the late 19th century to its inclusion as a diagnostic category in ICD-10 in 1992. The document outlines the ICD-10 diagnostic criteria for ATPD and reviews several landmark studies that helped establish ATPD as a separate diagnostic category from schizophrenia and affective disorders. It also discusses cultural variants of brief psychotic episodes and debates around classifying certain culture-bound syndromes as ATPD.
This was a lecture in the course "Significant Medical Conditions in Seniors" presented at Peer Learning in Chapel Hill, NC, USA in 2016 by Michael C. Joseph, MD, MPH.
This document discusses various psychopharmacological agents used to treat psychiatric conditions including antipsychotics, antidepressants, mood stabilizers, and benzodiazepines. It provides details on the classification, mechanisms of action, indications, and adverse effects of typical and atypical antipsychotics, tricyclic and SSRI antidepressants, lithium and anticonvulsants used as mood stabilizers. It emphasizes the importance of monitoring serum lithium levels and describes the management of lithium toxicity as an emergency. The document aims to inform psychiatrists and other medical professionals about appropriate pharmacotherapy options for different psychiatric diagnoses.
This document provides information on the pharmacology of second generation antipsychotics. It discusses the history and development of antipsychotic drugs from chlorpromazine to clozapine. It describes the mechanisms of action of atypical antipsychotics including their effects on serotonin and dopamine receptors. The document classifies antipsychotics and examines the pharmacology of individual drugs like clozapine, risperidone, and olanzapine, covering their indications, mechanisms, side effects and interactions.
1) Post-traumatic stress disorder (PTSD) is caused by exposure to highly stressful or dangerous events and symptoms must last over a month.
2) It has been referred to by different names in different eras reflecting traumatic events of those times like shell shock or combat stress syndrome.
3) PTSD is associated with changes in neurobiology including increased noradrenergic activity and alterations in the hippocampus and amygdala.
4) Symptoms include re-experiencing the traumatic event, avoidance of trauma-related stimuli, and increased arousal and anxiety.
This document outlines psychotropic medications used to treat mental health conditions such as depression, bipolar disorder, and anxiety. It defines psychotropic medications as psychiatric drugs that affect brain chemistry. Common medications are discussed for each condition, along with their dosages, side effects, and nursing considerations. The document emphasizes that pregnant and breastfeeding women should discuss risks and benefits of psychotropic medication with their doctors, as limited research exists on effects during pregnancy and breastfeeding.
This document provides an overview of delirium, including its definition, history, epidemiology, predisposing factors, etiology, pathophysiology, and management. Delirium is characterized by an acute decline in consciousness and cognition, particularly impaired attention. It has been described since Hippocrates' time. It commonly occurs in elderly hospitalized patients, with prevalence rates as high as 80% in intensive care units. Predisposing factors include older age, dementia, sensory impairment, and medical comorbidities. Delirium has many potential causes including infections, medications, metabolic disturbances, and neurological disorders. The pathophysiology is complex and likely involves imbalances in several neurotransmitter systems such as acetylcholine, dopamine
The document provides an overview of mood stabilizers, including their definition, classification, mechanisms of action, and side effects. It defines mood stabilizers as medications that decrease vulnerability to manic or depressive episodes without exacerbating current symptoms. Common mood stabilizers are lithium, anticonvulsants like valproate and carbamazepine, and atypical antipsychotics. These medications impact neurotransmitter systems and signaling pathways in the brain to achieve their mood stabilizing effects, but can also cause side effects like tremors, weight gain, thyroid and kidney issues.
This document provides an overview of drug therapy for depression. It discusses the following key points:
1. It classifies antidepressants into groups including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs).
2. It describes the mechanisms of action and effects of these drug classes, with TCAs and SSRIs increasing monoamine neurotransmitter levels by inhibiting reuptake, while MAOIs inhibit the breakdown of monoamines.
3. It notes advantages of SSRIs over TCAs including less cardiotoxicity, fewer anticholinergic side effects, and less risk of interactions,
Depression is the leading cause of disability world wide and is a major contributor to the overall global burden of diseases .At its worst depression can cause suicide .
There are effective psychological and pharmacological treatments for depression
The document discusses dissociative (conversion) disorders, which involve a loss of normal integration of memories, identity, and bodily control. It describes various types classified under F44, including dissociative amnesia, fugue, stupor, motor disorders, and convulsions. Nursing priorities for patients include providing a safe environment, promoting insight into anxiety relationships, and supporting adaptive coping skills and participation in therapeutic activities.
Psychotic disorders involve hallucinations and/or delusions where the person loses contact with reality. Schizophrenia is a type of psychosis characterized by disturbances in thought, emotion and behavior. It affects about 1% of the population and usually develops in early adulthood. Symptoms include delusions, hallucinations, disorganized speech and behavior. Treatment involves antipsychotic medications and psychosocial support. Prognosis depends on several factors but schizophrenia generally involves long-term impairment.
This document discusses the differentiation between lethal catatonia and neuroleptic malignant syndrome (NMS). Both conditions can involve motor abnormalities and hyperthermia. Catatonia is associated with mental disorders while NMS occurs due to antipsychotic medications. They share some symptoms but catatonia typically involves excitement before hyperthermia, while NMS involves rigidity before hyperthermia. Both can be treated effectively with benzodiazepines, dantrolene, or electroconvulsive therapy. It can be difficult to distinguish the two conditions in some cases.
SCHIZOPHRENIA:
slide 1: A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
slide 14: Types:
• Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations (hearing voices that don't exist) but relatively normal intellectual functioning and expression of emotions. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and can be argumentative.
• Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh inappropriately for no apparent reason, make illogical statements, or seem preoccupied with their own thoughts or perceptions. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
• Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types, but not enough of any one of them to define it as another particular type of schizophrenia.
• Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no "positive" symptoms (such as delusions, hallucinations, disorganized speech, or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes.
Catatonic Schizophrenia
This type of schizophrenia includes extremes of behavior, including:
Catatonic excitement - overexcitement or hyperactivity, in which the patient may mimic sounds (echolalia) or movements (achopraxia) around them.
Catatonic stupor - a dramatic reduction in activity in which the patient cannot speak, move or respond. Virtually all movements stops.
Conclusion
It is clear now, through the use of genetic linkage studies and microbiology, that schizophrenia does indeed have a biological explanation. However, the biological explanation is only part of the story. A yet unknown combination of intense stress, sociocultural situations, and cognitive processes may lead to the actual onset of schizophrenia aided by natural precursors. The most compelling explanation seems to be that a genetically inherited biological abnormality gives rise to hallucinations/delusions as a result of intense stress and eventually leads to other negative symptoms in reaction to the hallucinations/ delusions. At any rate, the current understanding of schizophrenia explains that the symptoms, however easily identifiable, are the result of a complex interaction between nature and nurture that can be treated adequately through the use of atypical anti psychotic drugs and psychotherapy.
This document discusses psychotropic drug categories and antipsychotic drugs. It summarizes that antipsychotic drugs work by blocking dopamine receptors and are used to treat symptoms of psychosis. It lists common antipsychotic drugs and their dosages and side effects, which include extrapyramidal symptoms like acute dystonia, pseudoparkinsonism, akathisia, and tardive dyskinesia. It provides information on treating side effects and educating clients on antipsychotic medication management.
The document discusses substance use disorders and provides information on various substances of abuse including alcohol, opioids, cannabis, cocaine, amphetamines, and lysergic acid diethylamide (LSD). It covers terminology, classifications, etiology, effects of acute intoxication and withdrawal, complications, treatments, and diagnostic criteria for substance use disorders involving these classes of drugs.
This document provides an overview of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) in veterans presented by three experts from Rutgers Robert Wood Johnson Medical School. It describes the brain regions involved in PTSD, risk factors, symptoms, diagnosis, and treatment options. A case study is presented of a veteran diagnosed with PTSD and TBI who experienced intrusive thoughts, nightmares, and social detachment two years after a traumatic brain injury from a mortar explosion during deployment in Iraq.
The document provides an overview of the neurobiology of obsessive compulsive disorder (OCD). It discusses the definition and diagnostic features of OCD, as well as basic neuroanatomy involving structures like the basal ganglia, prefrontal cortex, thalamus, and limbic system. Neurophysiology concepts around the serotonergic system are also reviewed. The document examines the etiology and pathophysiology of OCD, including potential genetic and neurobiological factors. Neuroimaging and other studies implicate abnormalities in the anterior cingulate cortex, orbitofrontal cortex, basal ganglia, and thalamus. The role of neurotransmitters like serotonin, dopamine, and glutamate in the neurobiology of OCD is also explored
This short presentation demonstrates important adverse effects of common anti-psychotic medications in clinical practice and how to effectively manage the adverse events.
1. The document outlines guidelines for treating schizophrenia in three phases: acute, stabilization, and stable.
2. During the acute phase, treatment focuses on ensuring safety, comprehensive assessment, and prompt treatment of psychotic symptoms. Antipsychotics are the primary treatment.
3. The stabilization phase aims to achieve sustained symptom remission and transition patients successfully into the community with continued support.
4. During the stable phase, treatment focuses on managing side effects, monitoring adherence, and identifying relapse risk factors to prevent recurrence of psychosis. Continued medication is emphasized for long-term prevention of relapse.
Treatment resistant schizophrenia is defined as lack of satisfactory improvement despite trials of two antipsychotics for adequate duration and dose. Around 20-30% of schizophrenia patients are considered treatment resistant. Clozapine is currently the treatment of choice for such patients, though combination and augmentation strategies with other agents have limited evidence. Definitive treatment guidelines recommend establishing treatment resistance before trials of clozapine or other strategies for treatment resistant schizophrenia.
The document provides an overview of non-pharmacological management in psychiatry including psychotherapies, brain stimulation methods, and neurosurgery/deep brain stimulation. It discusses various types of psychotherapies such as psychoanalysis, cognitive behavioral therapy, rational emotive behavioral therapy, dialectical behavioral therapy, group psychotherapy, family therapy, and couples therapy. It also covers brain stimulation methods like electroconvulsive therapy and transcranial magnetic stimulation.
This document discusses the development and properties of various atypical antipsychotic drugs. It provides chemical structures and names for common atypical antipsychotics like clozapine, risperidone, olanzapine, quetiapine and ziprasidone. It summarizes the pharmacokinetics, therapeutic indications, side effects and dosing for these drugs. The document also discusses differences between first and second generation antipsychotics and adverse effects of antipsychotic treatment.
This document discusses antipsychotic medications. It begins by defining psychotic disorders like schizophrenia and their symptoms. It then describes the dopamine, serotonin, and glutamate hypotheses for the causes of schizophrenia. The rest of the document summarizes different classes of antipsychotic medications, including their mechanisms of action, uses, and side effects. It covers both typical/first generation antipsychotics like chlorpromazine as well as atypical/second generation antipsychotics like clozapine, risperidone, and quetiapine.
This document provides an overview of delirium, including its definition, history, characteristics, epidemiology, risk factors, causes, pathophysiology, clinical features, diagnosis, differential diagnosis, course and prognosis, and treatment. Some key points covered include:
- Delirium is defined as an acute impairment of attention, consciousness, and cognition that fluctuates in severity.
- Risk factors include older age, medical illnesses, cognitive impairment, and polypharmacy.
- Causes include infections, withdrawal, toxins/drugs, hypoxia, and metabolic disturbances.
- The pathophysiology is not fully understood but may involve neurotransmitter imbalances and blood-brain barrier disruption.
- Diagnosis involves
The patient, a 53-year-old man with bipolar disorder treated with lithium carbonate, presented with loose stool, nausea, fatigue, and loss of energy over the past two days. His lithium level was found to be 3.17 mmol/L, above the therapeutic range of 0.50-1.20 mmol/L, indicating lithium toxicity. He was admitted and treated supportively with IV fluids and discontinuation of lithium. His lithium level decreased to 0.68 mmol/L after 4 days and he was discharged to psychiatric care after one week.
Major Depressive Disorder is characterized by one or more episodes of depression without a history of mania. Its etiology is complex with several factors like genetics, environment, and biology contributing. Symptoms include decreased levels of neurotransmitters like serotonin and norepinephrine. Treatment involves pharmacological therapies like SSRIs, TCAs, and MAOIs to reduce symptoms as well as psychotherapy. The goals are to reduce acute symptoms, facilitate a return to normal functioning, and prevent future episodes. Treatment is conducted over acute, continuation, and maintenance phases.
This document discusses the treatment of depression with antidepressant medications. It covers the stages of acute, continuation, and maintenance treatment. It describes the mechanisms of action and side effect profiles of different classes of antidepressants including tricyclic antidepressants, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, and serotonin-norepinephrine reuptake inhibitors. Factors to consider in choosing an antidepressant and ensuring patient adherence are also discussed.
This document provides an overview of delirium, including its definition, history, epidemiology, predisposing factors, etiology, pathophysiology, and management. Delirium is characterized by an acute decline in consciousness and cognition, particularly impaired attention. It has been described since Hippocrates' time. It commonly occurs in elderly hospitalized patients, with prevalence rates as high as 80% in intensive care units. Predisposing factors include older age, dementia, sensory impairment, and medical comorbidities. Delirium has many potential causes including infections, medications, metabolic disturbances, and neurological disorders. The pathophysiology is complex and likely involves imbalances in several neurotransmitter systems such as acetylcholine, dopamine
The document provides an overview of mood stabilizers, including their definition, classification, mechanisms of action, and side effects. It defines mood stabilizers as medications that decrease vulnerability to manic or depressive episodes without exacerbating current symptoms. Common mood stabilizers are lithium, anticonvulsants like valproate and carbamazepine, and atypical antipsychotics. These medications impact neurotransmitter systems and signaling pathways in the brain to achieve their mood stabilizing effects, but can also cause side effects like tremors, weight gain, thyroid and kidney issues.
This document provides an overview of drug therapy for depression. It discusses the following key points:
1. It classifies antidepressants into groups including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs).
2. It describes the mechanisms of action and effects of these drug classes, with TCAs and SSRIs increasing monoamine neurotransmitter levels by inhibiting reuptake, while MAOIs inhibit the breakdown of monoamines.
3. It notes advantages of SSRIs over TCAs including less cardiotoxicity, fewer anticholinergic side effects, and less risk of interactions,
Depression is the leading cause of disability world wide and is a major contributor to the overall global burden of diseases .At its worst depression can cause suicide .
There are effective psychological and pharmacological treatments for depression
The document discusses dissociative (conversion) disorders, which involve a loss of normal integration of memories, identity, and bodily control. It describes various types classified under F44, including dissociative amnesia, fugue, stupor, motor disorders, and convulsions. Nursing priorities for patients include providing a safe environment, promoting insight into anxiety relationships, and supporting adaptive coping skills and participation in therapeutic activities.
Psychotic disorders involve hallucinations and/or delusions where the person loses contact with reality. Schizophrenia is a type of psychosis characterized by disturbances in thought, emotion and behavior. It affects about 1% of the population and usually develops in early adulthood. Symptoms include delusions, hallucinations, disorganized speech and behavior. Treatment involves antipsychotic medications and psychosocial support. Prognosis depends on several factors but schizophrenia generally involves long-term impairment.
This document discusses the differentiation between lethal catatonia and neuroleptic malignant syndrome (NMS). Both conditions can involve motor abnormalities and hyperthermia. Catatonia is associated with mental disorders while NMS occurs due to antipsychotic medications. They share some symptoms but catatonia typically involves excitement before hyperthermia, while NMS involves rigidity before hyperthermia. Both can be treated effectively with benzodiazepines, dantrolene, or electroconvulsive therapy. It can be difficult to distinguish the two conditions in some cases.
SCHIZOPHRENIA:
slide 1: A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
slide 14: Types:
• Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations (hearing voices that don't exist) but relatively normal intellectual functioning and expression of emotions. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and can be argumentative.
• Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh inappropriately for no apparent reason, make illogical statements, or seem preoccupied with their own thoughts or perceptions. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
• Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types, but not enough of any one of them to define it as another particular type of schizophrenia.
• Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no "positive" symptoms (such as delusions, hallucinations, disorganized speech, or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes.
Catatonic Schizophrenia
This type of schizophrenia includes extremes of behavior, including:
Catatonic excitement - overexcitement or hyperactivity, in which the patient may mimic sounds (echolalia) or movements (achopraxia) around them.
Catatonic stupor - a dramatic reduction in activity in which the patient cannot speak, move or respond. Virtually all movements stops.
Conclusion
It is clear now, through the use of genetic linkage studies and microbiology, that schizophrenia does indeed have a biological explanation. However, the biological explanation is only part of the story. A yet unknown combination of intense stress, sociocultural situations, and cognitive processes may lead to the actual onset of schizophrenia aided by natural precursors. The most compelling explanation seems to be that a genetically inherited biological abnormality gives rise to hallucinations/delusions as a result of intense stress and eventually leads to other negative symptoms in reaction to the hallucinations/ delusions. At any rate, the current understanding of schizophrenia explains that the symptoms, however easily identifiable, are the result of a complex interaction between nature and nurture that can be treated adequately through the use of atypical anti psychotic drugs and psychotherapy.
This document discusses psychotropic drug categories and antipsychotic drugs. It summarizes that antipsychotic drugs work by blocking dopamine receptors and are used to treat symptoms of psychosis. It lists common antipsychotic drugs and their dosages and side effects, which include extrapyramidal symptoms like acute dystonia, pseudoparkinsonism, akathisia, and tardive dyskinesia. It provides information on treating side effects and educating clients on antipsychotic medication management.
The document discusses substance use disorders and provides information on various substances of abuse including alcohol, opioids, cannabis, cocaine, amphetamines, and lysergic acid diethylamide (LSD). It covers terminology, classifications, etiology, effects of acute intoxication and withdrawal, complications, treatments, and diagnostic criteria for substance use disorders involving these classes of drugs.
This document provides an overview of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) in veterans presented by three experts from Rutgers Robert Wood Johnson Medical School. It describes the brain regions involved in PTSD, risk factors, symptoms, diagnosis, and treatment options. A case study is presented of a veteran diagnosed with PTSD and TBI who experienced intrusive thoughts, nightmares, and social detachment two years after a traumatic brain injury from a mortar explosion during deployment in Iraq.
The document provides an overview of the neurobiology of obsessive compulsive disorder (OCD). It discusses the definition and diagnostic features of OCD, as well as basic neuroanatomy involving structures like the basal ganglia, prefrontal cortex, thalamus, and limbic system. Neurophysiology concepts around the serotonergic system are also reviewed. The document examines the etiology and pathophysiology of OCD, including potential genetic and neurobiological factors. Neuroimaging and other studies implicate abnormalities in the anterior cingulate cortex, orbitofrontal cortex, basal ganglia, and thalamus. The role of neurotransmitters like serotonin, dopamine, and glutamate in the neurobiology of OCD is also explored
This short presentation demonstrates important adverse effects of common anti-psychotic medications in clinical practice and how to effectively manage the adverse events.
1. The document outlines guidelines for treating schizophrenia in three phases: acute, stabilization, and stable.
2. During the acute phase, treatment focuses on ensuring safety, comprehensive assessment, and prompt treatment of psychotic symptoms. Antipsychotics are the primary treatment.
3. The stabilization phase aims to achieve sustained symptom remission and transition patients successfully into the community with continued support.
4. During the stable phase, treatment focuses on managing side effects, monitoring adherence, and identifying relapse risk factors to prevent recurrence of psychosis. Continued medication is emphasized for long-term prevention of relapse.
Treatment resistant schizophrenia is defined as lack of satisfactory improvement despite trials of two antipsychotics for adequate duration and dose. Around 20-30% of schizophrenia patients are considered treatment resistant. Clozapine is currently the treatment of choice for such patients, though combination and augmentation strategies with other agents have limited evidence. Definitive treatment guidelines recommend establishing treatment resistance before trials of clozapine or other strategies for treatment resistant schizophrenia.
The document provides an overview of non-pharmacological management in psychiatry including psychotherapies, brain stimulation methods, and neurosurgery/deep brain stimulation. It discusses various types of psychotherapies such as psychoanalysis, cognitive behavioral therapy, rational emotive behavioral therapy, dialectical behavioral therapy, group psychotherapy, family therapy, and couples therapy. It also covers brain stimulation methods like electroconvulsive therapy and transcranial magnetic stimulation.
This document discusses the development and properties of various atypical antipsychotic drugs. It provides chemical structures and names for common atypical antipsychotics like clozapine, risperidone, olanzapine, quetiapine and ziprasidone. It summarizes the pharmacokinetics, therapeutic indications, side effects and dosing for these drugs. The document also discusses differences between first and second generation antipsychotics and adverse effects of antipsychotic treatment.
This document discusses antipsychotic medications. It begins by defining psychotic disorders like schizophrenia and their symptoms. It then describes the dopamine, serotonin, and glutamate hypotheses for the causes of schizophrenia. The rest of the document summarizes different classes of antipsychotic medications, including their mechanisms of action, uses, and side effects. It covers both typical/first generation antipsychotics like chlorpromazine as well as atypical/second generation antipsychotics like clozapine, risperidone, and quetiapine.
This document provides an overview of delirium, including its definition, history, characteristics, epidemiology, risk factors, causes, pathophysiology, clinical features, diagnosis, differential diagnosis, course and prognosis, and treatment. Some key points covered include:
- Delirium is defined as an acute impairment of attention, consciousness, and cognition that fluctuates in severity.
- Risk factors include older age, medical illnesses, cognitive impairment, and polypharmacy.
- Causes include infections, withdrawal, toxins/drugs, hypoxia, and metabolic disturbances.
- The pathophysiology is not fully understood but may involve neurotransmitter imbalances and blood-brain barrier disruption.
- Diagnosis involves
The patient, a 53-year-old man with bipolar disorder treated with lithium carbonate, presented with loose stool, nausea, fatigue, and loss of energy over the past two days. His lithium level was found to be 3.17 mmol/L, above the therapeutic range of 0.50-1.20 mmol/L, indicating lithium toxicity. He was admitted and treated supportively with IV fluids and discontinuation of lithium. His lithium level decreased to 0.68 mmol/L after 4 days and he was discharged to psychiatric care after one week.
Major Depressive Disorder is characterized by one or more episodes of depression without a history of mania. Its etiology is complex with several factors like genetics, environment, and biology contributing. Symptoms include decreased levels of neurotransmitters like serotonin and norepinephrine. Treatment involves pharmacological therapies like SSRIs, TCAs, and MAOIs to reduce symptoms as well as psychotherapy. The goals are to reduce acute symptoms, facilitate a return to normal functioning, and prevent future episodes. Treatment is conducted over acute, continuation, and maintenance phases.
This document discusses the treatment of depression with antidepressant medications. It covers the stages of acute, continuation, and maintenance treatment. It describes the mechanisms of action and side effect profiles of different classes of antidepressants including tricyclic antidepressants, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, and serotonin-norepinephrine reuptake inhibitors. Factors to consider in choosing an antidepressant and ensuring patient adherence are also discussed.
The document discusses various psychotropic medications used in psychiatry including:
1. Antipsychotics such as first-generation antipsychotics which are dopamine receptor antagonists and second-generation antipsychotics which are serotonin-dopamine antagonists or partial dopamine agonists.
2. Antidepressants which include MAOIs, TCAs, SSRIs, SNRIs, and others.
3. Mood stabilizers indicated for bipolar disorder.
4. Benzodiazepines which are commonly used as anxiolytics.
5. Anticholinergic drugs which are primarily used to treat medication-induced movement disorders.
This document provides information on psychoactive drugs used to treat psychiatric conditions. It defines psychoactive drugs as substances that act on the central nervous system, altering brain function and resulting in changes in perception, mood, consciousness, and behavior. The document then summarizes several classes of psychoactive drugs - antipsychotics, antidepressants, mood stabilizers, anxiolytics, stimulants, and depressants - listing their indications, mechanisms of action, side effects, and nursing responsibilities for each.
This document summarizes different classes of antidepressants and mood stabilizers. It discusses how antidepressants like SSRIs, SNRIs, and TCAs work to block neurotransmitter reuptake in the brain. It provides examples of common medications in each class and their indications and side effects. Mood stabilizers discussed include lithium, anti-convulsants like carbamazepine, valproate, and lamotrigine which are used to treat bipolar disorder.
Antidepressants work by blocking the reuptake of serotonin and norepinephrine in the brain. They are used to treat conditions like depression, chronic pain, and family history of depression. Common types include SSRIs, SNRIs, and tricyclics. Side effects may include dry mouth, constipation, blurred vision, and weight gain. Mood stabilizers like lithium and anticonvulsants are used to treat bipolar disorder and prevent manic episodes. Lithium requires blood monitoring due to risk of toxicity. Side effects can include tremors, nausea, weight gain, and decreased thyroid function.
This document summarizes different classes of drugs used to treat depression, including SSRIs, SNRIs, TCAs, MAOIs, and atypical antidepressants. It describes the mechanisms of action, therapeutic uses, examples of drugs, and potential adverse effects for each class. Key points covered include that SSRIs work by inhibiting serotonin reuptake and it takes 4-6 weeks to see effects, TCAs also inhibit norepinephrine reuptake and are used for depression with accompanying pain, and MAOIs non-selectively inhibit MAO enzymes and their use requires avoiding foods high in tyramine to prevent dangerous interactions.
This document discusses various psychotropic medications including their classifications, mechanisms of action, indications, side effects and nursing implications. It covers antianxiety agents, sedative-hypnotics, mood stabilizers, antipsychotics, antidepressants and ADHD medications. Nurses must understand how to properly administer these medications and monitor for both therapeutic effects and potential adverse reactions. Psychotropic medications can help relieve symptoms but do not cure the underlying mental illness.
Schizophrenia is a complex psychiatric disorder characterized by disorganized thoughts, delusions, hallucinations, inappropriate affect, and impaired social functioning. The exact causes are unknown but likely involve genetic, brain chemical, environmental, and family history factors. Brain imaging shows enlarged ventricles and decreased cortical size, particularly in the left temporal lobe. Symptoms include positive symptoms like hallucinations, negative symptoms like loss of interest, and mood symptoms. Treatment involves pharmacological therapy with antipsychotics and non-pharmacological approaches like therapy, social skills training, and vocational rehabilitation.
Substance abuse - Signs and Symptoms & Treatment over dependence CLINICAL TOX...Dr. Ebenezer Abraham
This topic is taken from the Pharm.D (Doctor of Pharmacy) 4th Year, Subject (Clinical Toxicology) which describes the signs and symptoms and treatment over dependence of SUBSTANCE ABUSE
Recent advancements have been made in antidepressant drugs. Vilazodone was approved in 2011 and targets the serotonin transporter and 5-HT1A receptors. Levomilnacipran was approved in 2013 and potently inhibits the reuptake of serotonin and norepinephrine. Desipramine, a tricyclic antidepressant, is under investigation and selectively blocks the reuptake of norepinephrine while also inhibiting serotonin reuptake. Escitalopram was approved in 2002 and causes an increase in serotonin levels by preventing its reuptake. These drugs demonstrate improved mechanisms of action for the treatment of depression.
David studied neurological disorders like Parkinson's disease and schizophrenia to gain a wider understanding of involved drugs and their targets. He summarized information on major depressive disorder (MDD) and the antidepressant drug Citalopram. MDD is a common mental illness associated with reduced quality of life and increased suicide risk. Citalopram is a selective serotonin reuptake inhibitor used to treat MDD by increasing synaptic serotonin levels. However, some patients do not respond to SSRIs and they have a delayed onset of action leading to discontinuation of treatment for many. Combining SSRIs with 5HT receptor antagonists may improve efficacy and reduce discontinuation.
This document discusses antidepressants and mood stabilizing drugs. It begins by defining affective disorders like major depressive disorder and bipolar affective disorder. It then discusses the causes, symptoms, and statistics of depression. The remainder of the document focuses on different classes of antidepressant drugs including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs). It describes the mode of action, examples of drugs, side effects, drug interactions, and therapeutic uses for each class.
Pharmacological treatment of schizophreniajoanna1956
This document discusses the pharmacological treatment of schizophrenia. It covers the classification and clinical use of antipsychotics, the development of typical and atypical antipsychotics, their mechanisms of action and side effect profiles. It summarizes key studies on the effectiveness of typical versus atypical antipsychotics and provides recommendations from the 2009 PORT treatment guidelines for using antipsychotics to treat acute episodes and as maintenance therapy for multi-episode and first-episode schizophrenia. Alternatives to antipsychotic medication like the Soteria paradigm are also discussed.
This document discusses antipsychotic drugs and their mechanisms and uses. It covers the dopamine hypothesis of schizophrenia and how antipsychotics work by blocking dopamine receptors. It describes the differences between typical and atypical antipsychotics, with atypicals having less motor side effects and effects on negative symptoms. The document outlines adverse effects of antipsychotics and provides clozapine as an example of an atypical drug, noting its superior efficacy but risks of side effects requiring blood monitoring.
Antipsychotic : Dr Rahul Kunkulol's Power point preparationsRahul Kunkulol
This document discusses the treatment of psychosis and schizophrenia with a focus on antipsychotic drugs. It begins by classifying psychiatric disorders and defining psychosis. Schizophrenia is described as a particular type of psychosis characterized by disturbances in thinking. The dopamine theory of schizophrenia is explained, which posits that psychosis is related to increased dopamine activity in the brain. Older antipsychotics are dopamine antagonists that can cause neurological side effects like tardive dyskinesia. Atypical antipsychotics have fewer side effects. Lithium is discussed as the drug of choice for treating mania in bipolar disorder.
Depression is caused by a deficit of neurotransmitters like norepinephrine and serotonin in the brain. Antidepressants work by inhibiting the reuptake of these neurotransmitters, increasing their availability. Tricyclic antidepressants like imipramine were the first developed but have more side effects. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are now preferred as they are more tolerable while still effective. Antidepressants are used to treat major depression, obsessive-compulsive disorder, anxiety disorders, neuropathic pain, premature ejaculation, and other conditions. The choice of antidepressant depends on individual factors and side effect profiles.
Effective treatment in depression and anxietyHarsh shaH
The document discusses mechanisms, types, symptoms, and treatment approaches for anxiety and depression. It provides details on specific medications including SSRIs (fluoxetine, fluvoxamine, paroxetine, sertaline, citalopram, escitalopram), paroxetine, escitalopram, desvenlafaxine, dosages, indications, mechanisms of action, efficacy, adverse effects, and warnings/precautions for safe use. Combination therapy with escitalopram and L-methylfolate is also rationale given their complementary mechanisms for enhancing neurotransmitter production and treatment response.
Similar to 2107 psychopharmacology townsend_5th_edition_spring_2013 (20)
2. Psychiatric Mental Health Nursing, 5th Edition
Historical Perspectives
Before 1950, sedatives and amphetamines
were the only significant
psychotropic drugs available.
Since the 1950s,
psychopharmacology has expanded
to include antipsychotic, antidepressant, and
antianxiety drugs.
Psychotropic drugs are intended to be used as
an adjunct to individual or group
psychotherapy.
3. Psychiatric Mental Health Nursing, 5th Edition
How Do Psychotropics Work?
Neurotransmitters
– Chemicals that are stored in the axon terminals
of the presynaptic neuron.
– An electrical impulse through the neuron
stimulates its release into the synaptic cleft,
which in turn determines whether another
electrical impulse is generated.
4. Psychiatric Mental Health Nursing, 5th Edition
How Do Psychotropics Work? (cont.)
Receptors
– Molecules situated on the cell membrane that are
binding sites for neurotransmitters.
5. Psychiatric Mental Health Nursing, 5th Edition
How Do Psychotropics Work? (cont.)
Reuptake
– The process of neurotransmitter inactivation by
which the neurotransmitter is reabsorbed into the
presynaptic neuron from which it had been
released.
6. Psychiatric Mental Health Nursing, 5th Edition
How Do Psychotropics Work? (cont.)
Antidepressants
– Block reuptake of neurotransmitters
Antipsychotics
– Block dopamine and other receptors
Benzodiazepines
– Facilitate transmission of GABA
Psychostimulants
– Increase release of neurotransmitters
7. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antianxiety Agents
Background Assessment Data
Indications: anxiety disorders, anxiety
symptoms, acute alcohol withdrawal,
skeletal muscle spasms, convulsive
disorders, status epilepticus, and
preoperative sedation
Action: depression of the CNS
Contraindications/Precautions
– Contraindicated in known hypersensitivity; in combination with
other CNS depressants; in pregnancy and lactation, narrow-
angle glaucoma, shock, and coma
– Caution with elderly and debilitated clients, clients with renal or
hepatic dysfunction, those with a history of drug abuse or
addiction, and those who are depressed or suicidal
8. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antianxiety Agents (cont.)
Background Assessment Data (cont.)
Interactions
– Increased effects when taken with alcohol,
barbiturates, narcotics, antipsychotics,
antidepressants, antihistamines,
neuromuscular blocking agents, cimetidine, or
disulfiram
– Decreased effects with cigarette smoking and
caffeine consumption
9. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antianxiety Agents (cont.)
Nursing Diagnosis
Risk for injury
Risk for activity intolerance
Risk for acute confusion
10. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antianxiety Agents (cont.)
Planning/Implementation
Monitor client for these side effects
– Drowsiness, confusion, lethargy; tolerance;
physical and psychological dependence;
potentiation of other CNS depressants;
aggravation of depression; orthostatic hypotension;
paradoxical excitement; dry mouth; nausea and
vomiting; blood dyscrasias; delayed onset (with
buspirone only)
Educate client/family about the drug
Outcome Criteria/Evaluation
11. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antidepressants
Background Assessment Data
Indications: dysthymic disorder;
major depression; depression
associated with organic disease,
alcoholism, schizophrenia, or
mental retardation; depressive phase of bipolar disorder;
and depression accompanied by anxiety
Action: increase concentration of norepinephrine and
serotonin in the body, either by blocking their reuptake by
the neurons (tricyclics, tetracyclics, SSRIs) or by inhibiting
the release of monoamine oxidase (MAOIs)
12. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antidepressants (cont.)
Background Assessment Data (cont.)
Contraindications/precautions
– Contraindicated in known hypersensitivity (SSRIs, MAOIs,
tricyclics); acute phase of recovery from myocardial
infarction; angle-closure glaucoma (tricyclics); and
concomitant with MAOIs (SSRIs and tricyclics).
– Caution with elderly or debilitated clients; clients with
hepatic, cardiac, or renal insufficiency; psychotic clients;
clients with benign prostatic hypertrophy; and those with
history of seizures (tricyclics, MAOIs).
13. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antidepressants (cont.)
Background Assessment Data (cont.)
Interactions (with tricyclics)
– Increased effects of tricyclics with bupropion, cimetidine,
haloperidol, SSRIs, and valproic acid
– Decreased effects of tricyclics with rifamycin, carbamazepine,
and barbiturates
– Hyperpyretic crisis, convulsions, and death can occur with MAO
inhibitors
– Hypertensive crisis can occur with clonidine
– Decreased effects of levodopa and guanethidine
– Potentiation of pressor response with direct-acting
sympathomimetics
14. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antidepressants (cont.)
Background Assessment Data (cont.)
Interactions (MAOIs)
– Hypertensive crisis with amphetamines, methyldopa, levodopa,
dopamine, epinephrine, norepinephrine, reserpine,
vasoconstrictors, or foods with tyramine
– Hypertension, hypotension, coma, convulsions, and death with
narcotic analgesics
– Additive hypotension with antihypertensives
– Additive hypoglycemia with antihyperglycemic agents
– Potentially fatal reactions with other antidepressants,
carbamazepine, cyclobenzaprine, maprotiline, furazolidone,
procarbazine, or selegiline (avoid use within 2 weeks of each
other)
15. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antidepressants (cont.)
Background Assessment Data (cont.)
Interactions (SSRIs)
– Toxic, sometimes fatal, reactions have occurred with
concomitant use of MAOIs
– Increased effects of SSRIs with cimetidine, L-tryptophan, and
lithium
– Concomitant use of SSRIs may increase effects of hydantoin,
tricycle antidepressants, benzodiazepine, beta-blockers,
carbamazepine, clozapine, haloperidol, phenothiazine, St.
John’s wort, sumatriptan, sympathomimetics, tacrine,
theophylline, and warfarin.
– Concomitant use of SSRIs may decrease effects of buspirone
and digoxin
– Serotonin syndrome can occur with concurrent use of other
drugs that increase serotonin
16. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antidepressants (cont.)
Nursing Diagnosis
Risk for suicide
Risk for injury
Social isolation
Constipation
17. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antidepressants (cont.)
Planning/Implementation
Monitor client for the following side effects
– May occur with all chemical classes
• Dry mouth, sedation, nausea
• Discontinuation syndrome
– Most commonly occur with tricyclics
• Blurred vision, constipation, urinary
retention, orthostatic hypotension, reduction
of seizure threshold, tachycardia,
arrhythmias, photosensitivity, weight gain
18. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antidepressants (cont.)
Planning/Implementation (cont.)
Side effects (cont.)
– Most commonly occur with SSRIs
• Insomnia, agitation, headache, weight loss, sexual dysfunction,
serotonin syndrome
– Most commonly occur with MAOIs
• Hypertensive crisis
– Miscellaneous side effects
• Priapism (with trazadone)
• Hepatic failure (with nafazodone)
Educate client/family about drug
Outcome Criteria/Evaluation
19. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Mood-Stabilizing Agents
Background Assessment Data
Indications: prevention and
treatment of manic episodes
associated with bipolar disorder
Examples: lithium carbonate, clonazepam,
carbamazepine, valproic acid, lamotrigine, gabapentin,
topiramate, verapamil, various antipsychotics
20. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Mood-Stabilizing Agents
(cont.)
Background Assessment Data (cont.)
Action
– Lithium enhances the reuptake of norepinephrine and
serotonin in the brain, lowering levels in the body and
resulting in decreased hyperactivity
– The role of anticonvulsants, verapamil, and antipsychotics
in the treatment of bipolar mania is not fully understood.
Interactions
Contraindications/precautions
21. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Mood-Stabilizing Agents
(cont.)
Nursing Diagnosis
Risk for injury
Risk for self-directed or
other-directed violence
Risk for activity intolerance
22. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Mood-Stabilizing Agents
(cont.)
Planning/Implementation
Monitor for side effects of lithium
– Drowsiness, dizziness, headache
– Dry mouth; thirst; GI upset; nausea/vomiting
– Fine hand tremors
– Hypotension; arrhythmias, pulse irregularities
– Polyuria; dehydration
– Weight gain
– Potential for toxicity
23. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Mood-Stabilizing Agents
(cont.)
Planning/Implementation (cont.)
Lithium Toxicity
– Therapeutic range: 1.0–1.5 mEq/L
– Initial symptoms of toxicity include
• Blurred vision, ataxia, tinnitus, persistent nausea and
vomiting, and severe diarrhea
– Ensure that client consumes adequate
sodium and fluid in diet
24. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Mood-Stabilizing Agents
(cont.)
Planning/Implementation (cont.)
Monitor for side effects of anticonvulsants
– Nausea and vomiting
– Drowsiness; dizziness
– Blood dyscrasias
– Prolonged bleeding time (with valproic acid)
– Risk of severe rash (with lamotrigine)
– Decreased efficacy with oral contraceptives (with
topiramate)
25. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Mood-Stabilizing Agents
(cont.)
Planning/Implementation (cont.)
• Monitor for side effects of verapamil
– Drowsiness; dizziness
– Hypotension; bradycardia
– Nausea
– Constipation
26. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Mood-Stabilizing Agents
(cont.)
Planning/Implementation (cont.)
• Monitor for side effects of antipsychotics
– Drowsiness; dizziness
– Dry mouth; constipation
– Increased appetite; weight gain
– ECG changes
– Extrapyramidal symptoms
– Hyperglycemia and diabetes
27. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Mood-Stabilizing Agents
(cont.)
Planning/Implementation (cont.)
Educate client and family
about the medication
Outcome Criteria/Evaluation
28. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antipsychotics
Background Assessment Data
Indications: Treatment of acute and
chronic psychoses; selected agents
are also used as antiemetics in the
treatment of intractable hiccoughs and for control of tics
and vocal utterances in Tourette’s disorder
Actions: Unknown; thought to block postsynaptic
dopamine receptors in the basal ganglia, hypothalamus,
limbic system, brainstem, and medulla. Newer
antipsychotics may block action on receptors specific to
dopamine, serotonin, and other neurotransmitters.
29. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antipsychotics (cont.)
Background Assessment Data (cont.)
Contraindications/precautions
– Contraindicated with known hypersensitivity; with CNS
depression; when blood dyscrasias exist; in clients with
Parkinson’s disease; or those with liver, renal, or cardiac
insufficiency
– Caution with elderly, debilitated, or
diabetic clients or those with
respiratory insufficiency, prostatic
hypertrophy, or intestinal obstruction
Interactions
30. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antipsychotics (cont.)
Background Assessment Data (cont.)
Interactions
– Additive anticholinergic effects with
other drugs that produce these
properties
– Additive hypotensive effects with beta-blockers
– Decreased absorption of antipsychotics with antacids and
antidiarrheals
– Decreased effectiveness of antipsychotics with
barbiturates
– Additive CNS depression with alcohol, antihistamines,
antidepressants, sedative-hypnotics, and anxiolytics
31. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antipsychotics (cont.)
Nursing Diagnosis
Risk for other-directed violence
Risk for injury
Risk for activity intolerance
Noncompliance
32. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Antipsychotics (cont.)
Planning/Implementation
Monitor client for these side effects
– Anticholinergic effects, nausea, GI upset, skin rash,
sedation, orthostatic hypotension, photosensitivity,
hormonal effects, ECG changes, reduction of seizure
threshold, agranulocytosis (especially with clozapine),
hypersalivation (with clozapine), extrapyramidal symptoms
(EPS), tardive dyskinesia, neuroleptic malignant syndrome
(NMS), hyperglycemia and diabetes
Educate client/family about drug
Outcome Criteria/Evaluation
34. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process:
Antiparkinsonian Agents
Background Assessment Data
Indications: treatment of
parkinsonism of various causes,
including degenerative, toxic,
infective, neoplastic, or drug-induced
Action: work to restore the natural balance of
acetylcholine and dopamine in the CNS
36. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process:
Antiparkinsonian Agents (cont.)
Background Assessment Data (cont.)
Contraindications/precautions
– Contraindicated in known hypersensitivity;
angle-closure glaucoma; pyloric, duodenal, or
bladder neck obstructions; prostatic hypertrophy;
or myasthenia gravis
– Caution with hepatic, renal, or cardiac
insufficiency; elderly and debilitated clients; those
with a tendency toward urinary retention; those
exposed to high environmental temperatures
37. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process:
Antiparkinsonian Agents (cont.)
Background Assessment Data (cont.)
Interactions
– Additive anticholinergic effects and potentially fatal
paralytic ileus with other drugs that possess these
properties
– Concurrent use with haloperidol or phenothiazine may
result in decreased effect of the antipsychotic and
increased incidence of anticholinergic side effects.
– Additive CNS effects with CNS depressants
38. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process:
Antiparkinsonian Agents (cont.)
Planning/Implementation
Monitor client for these side effects
– Anticholinergic effects, nausea, GI upset,
sedation, dizziness, exacerbation of
psychoses, orthostatic hypotension
Educate client/family about drug
Outcome Criteria/Evaluation
39. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Sedative-
Hypnotics
Background Assessment Data
Indications: short-term management
of various anxiety states and treatment of
insomnia
Action: depression of the CNS
Contraindications/precautions:
contraindicated in known hypersensitivity;
caution advised with clients with hepatic
dysfunction, severe renal impairment, those
who are suicidal, and those who have been
addicted to drugs
40. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Sedative-
Hypnotics (cont.)
Background Assessment Data (cont.)
Interactions
– Additive CNS depression with alcohol, antihistamines,
antidepressants, phenothiazine, or other CNS
depressants
– Barbiturates decrease effectiveness of drugs metabolized
by the liver
– Adverse effects when taken with MAOIs
41. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Sedative-
Hypnotics (cont.)
Nursing Diagnosis
Risk for injury
Disturbed sleep pattern
Risk for activity intolerance
Risk for acute confusion
42. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: Sedative-
Hypnotics (cont.)
Planning/Implementation
Monitor client for side effects:
– Drowsiness, confusion, lethargy;
tolerance; physical and psychological
dependence; potentiation of other
CNS depressants; aggravation of
depression; orthostatic hypotension; paradoxical
excitement; dry mouth; nausea and vomiting; blood
dyscrasias
Client/family education
Outcome Criteria/Evaluation
43. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: ADHD Agents
Background Assessment Data
Indications: ADHD in children
and adults
Action: The CNS stimulants increase levels of
norepinephrine, dopamine, and serotonin in the CNS.
Atomoxetine inhibits the reuptake of norepinephrine and bupropion
blocks the neuronal uptake of serotonin, norepinephrine, and
dopamine. The exact mechanism by which these drugs produce
therapeutic effects in ADHD is unknown.
44. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: ADHD Agents (cont.)
Background Assessment Data (cont.)
Contraindications
– CNS Stimulants: Contraindicated in clients with
hypersensitivity to sympathomimetic amines; clients with
advanced arteriosclerosis, symptomatic cardiovascular
disease, hypertension, hyperthyroidism, glaucoma, agitated
or hyperexcitability states; clients with a history of drug abuse;
clients during or within 14 days of receiving therapy with
MAOIs; in children younger than 3 years of age; and
in pregnancy
45. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: ADHD Agents (cont.)
Background Assessment Data (cont.)
Contraindications
– Atomoxetine and bupropion: Contraindicated in clients
with hypersensitivity to the drugs; in concomitant use with,
or within 2 weeks of using MAO inhibitors.
– Atomoxetine: In clients with narrow-angle glaucoma
– Bupropion: In clients with known or suspected seizure
disorder; acute phase of MI, and in clients with bulimia or
anorexia nervosa
46. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: ADHD Agents (cont.)
Background Assessment Data (cont.)
Precautions:
– CNS Stimulants: Caution with lactating clients;
psychotic children; clients with Tourette’s disorder,
anorexia, or insomnia; elderly, debilitated, or asthenic
clients; and clients with history of suicidal or homicidal
tendencies
– Atomoxetine & Bupropion: Caution in clients with
urinary retention; hepatic, renal, or cardiovascular
disease; suicidal clients; pregnancy and lactation; and
elderly and debilitated clients.
Interactions
47. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: ADHD Agents (cont.)
Nursing Diagnoses
Risk for injury
Risk for suicide
Imbalanced nutrition, less
than body requirements
Disturbed sleep pattern
Nausea related to side effects of atomoxetine or
bupropion
Pain related to side effect of headache with atomoxetine
or bupropion
Risk for activity intolerance
48. Psychiatric Mental Health Nursing, 5th Edition
The Nursing Process: ADHD Agents (cont.)
Planning/Implementation
Monitor client for these side effects
– Overstimulation, restlessness, insomnia, palpitations,
tachycardia, anorexia, weight loss, tolerance, physical and
psychological dependence, nausea and vomiting, constipation,
potential for seizures (bupropion)
Educate client/family about drug
Outcome Criteria/Evaluation