—  brain disease that can severely disturb a person’s ability to think, feel and relate to others and the environment.

Exampels of—  Mental  Health

Exampels of—  Mental  Illness

Theories of Mental Health

Psychoanalytical

—  “nurture or inorganic”

Freud believed mental illness was due to ineffective parent-child relationship. 

 Endured an unknown situation early in life.

Person cannot be held responsible for behaviors.

Theories of Mental Health

Psychobiological- 

“nature or organic”

Product of genetic, physical or neuro-chemical malfunction in the brain.  No definitive cause- 

Neurotransmitters

—  Chemical messengers that transmit thought from one cell to the next- allowing the brain cells to “talk to each other.” 

Depression, Lifelessness, Moods, Irritability, Sleeplessness, Anxiety/panic, Brain Fog, Stress damage

—  Neurotransmitter

Can either........

—  Neurotransmitter

“Feel Good” or excitatory type 

Norepinephrine, Dopamine, Acetylcholine, Endorphins

—  Neurotransmitter

Inhibitory type 

GABA

—Neurotransmitter Hormonal Type

Serotonin, Melatonin, Oxytocin

Anxiety

—  Uncomfortable feeling of dread, in response to prolonged periods of stress.

Anxiety

Four levels

◦     “impending doom”

—  Neurotransmitters

linked to

Anxiety

Anxiety Theories

Psychoanalytical

—  conflict was repressed but emerged in adulthood.

Anxiety Theories

Biological – 

bodies response to stress

  “fight or flight”

Symptoms of Anxiety

—  DSM-IV lists 18 symptoms- must show 6 or more

Restlessness, Fatigue, Sleep disturbance, Feeling on edge, Fearful, Shakes, Muscle aches, Palpitation, Dry mouth, Nausea, Vomiting, Hot flashes, Chills, Polyuria, Difficulty swallowing, Panic. Shortness of breath, Chest tightness

Anxiety

Symptoms can mimic 

diabetes, cardiac problems, medications, electrolyte imbalance,  and physical trauma .

Types of Anxiety-

—  General Anxiety Disorder- GAD

Excessive worry or severe stress

Types of Anxiety-

Panic Disorder

Extreme fear that cannot be controlled

Types of Anxiety-

Phobia

  Irrational fear

Types of Anxiety-

Obsessive-Compulsive Disorder- OCD

Obsession= repetitive thoughts, urge or emotion

Compulsion= repetitive action that may appear purposeful.

Types of Anxiety-

Post-Traumatic Stress Disorder-PTSD

◦     “Actual or threatened” traumatic event

Anxiety-Treatment

—  Meds-

◦    Benzodiazepines

◦    Antidepressants

Anxiety-Treatment other:

Psychotherapy, Relaxation therapy, Biofeedback, Hypnosis

Nursing Considerations for Anxiety

—  Maintain calm milieu. Establish trust.  Listening.   Maintain open communication.  Observe for signs of suicidal thoughts.         Document changes in behavior.  Encourage activities

Mood Disorders or Affective Disorders

Deff.

People experience extreme changes in mood (emotions) and affect (outward expression of mood).

—  Abnormal excess or inhibition of NT that control mood, thought, and pain.

Mood Disorders or Affective Disorders

is seen in what groop of people?

—  both sexes, all ethnic groups and socioeconomic groups.

People of all age groups develop depressive disorders

—  Neurotransmitters

linked to 

Mood Disorders or Affective Disorders

Serotonin

Norepinephrine

Mood Disorders or Affective Disorders

Theories

Psychoanalytical

People who have suffered loss will develop depressions.

  Unable to succeed

–  Associated with unresolved anger

Mood Disorders or Affective Disorders

Theories       Biological

Chemical imbalance and genetic links

Neurochemical depletion- serotonin, norepinephrine

Connection with female hormone

Mood Disorders or Affective Disorders

Theories   Cognitive-

Altered perception of events- “Awfulize”

Maladaptive thinking

Mood Disorders or Affective Disorders

Frequently occurring S/S:

Types of Mood Disorders

Depression/Major/Dysthymia

Bipolar Depression

Melancholia

Depression:

Major Depression

Patient shows symptoms longer and stronger

Displays behavioral and physical symptoms

Dysthymic Depression

Severe depression lasting >2 yrs in adults, >1 yrs in children.

Symptoms not as severe as major depression

Bipolar Disorder

Depression with both extreme mania   and depression

Alternating or “cycling” from one pole to the next.

Bipolar Disorder

Manic- 

out of control, feel on top of the world

Bipolar Disorder

Hypomania-

Melancholia- “Empty Nest Syndrome”

Affects people over age 45

Woman affected more frequently

Somatic symptoms more common

Mood Disorders or Affective Disorders

Treatment

Lithium, Antidepressants, Psychotherapy, Electroconvulsive therapy (ECT), Light therapy (SAD), *Herbal supplements-St. Johns Wart, Ginco, SAM. Acupuncture. Biofeedback/hypnosis

Types of Mood Disorders

Nursing Considerations

Patience, Honesty, Consistency. Monitor drug effects and lab levels. Encourage activity. Nutrition. Communication

Schizophrenia- “Split Mind”

Disturbance in thinking and emotional reactions and between their reality and society’s reality.  Very distractible, have difficulty focusing on one topic for a long time.

◦     Is not curable but treatable

—  Neurotransmitters

Linked with

Schizophrenia- “Split Mind”

What Illegal drugs can mimic schizophrenia symptoms

–  Methamphetamine, LSD, Mescaline

Schizophrenia- “Split Mind”

Theories Psychoanalytic- “Nurture”

Revert to anal stage- leaves people in the adolescent and young adult years.

Schizophrenia- “Split Mind”

Theories Biological 

Genetics- elevated levels of dopamine in the brain or the brain overreacts to dopamine. 

–  Accounts for 50% of patients with schizophrenia

Schizophrenia- “Split Mind”

Socioeconomic factors

High numbers of diagnosed cases among people of lower socioeconomic levels.

Schizophrenia- “Split Mind”

Onset 

between age 16- 35 common.

◦     Onset in males before females (>5yrs)

◦     Rare in young children

Schizophrenia- “Split Mind”

Insidious onset

quiet and withdrawn, change in personality or social functioning

Schizophrenia- “Split Mind”

S/S

Poor social functioning. Low self esteem. Highly intelligent. Delusions- false beliefs. Hallucinations- false sensory perceptions. Illusions- mistaken perceptions of reality

Schizophrenia- Bleuler’s “4 As”

—  Associative disturbance

—  Affect

—  Autism

—  Ambivalence

—  Associative disturbance

◦     Make up words-

◦     Rambling from topic to topic

◦     Words out of context with conversation

—  Affect

◦     Flat or blunted affect- rarely show s/s emotions

◦     Outward expression does not match the mood expressed

◦     Exaggerated affect

—  Autism

◦     Emotional detachment

◦     Preoccupation with self

—  Ambivalence

◦     Opposite feelings about a person or situation at the same time.

◦     “Love/Hate relationship”

“Word Salad”. Unusual behavior and facial contortions. Bizarre speech and incoherent. Inappropriate emotions to the situation. Auditory hallucinations. More severe form of schizophrenia. Poor prognosis

Types of Schizophrenia-Catatonic Schizophrenia

Motor activity disturbed. Vacillate between extreme muscle rigidity and agitation. Symptoms can change quickly. Catatonic Stupor- rigid state.

Echolalia, Echopraxia

repetition of actions

Schizophrenia

Nursing Considerations

Monitor drug effects. Never reinforce hallucinations, delusions, or illusions. Never whisper or laugh when the patient cannot hear the whole conversation. Avoid placing person in competitive or embarrassing situations. Trust, consistency. Milieu. Communication- keep it simple, brief and clear

Schizophrenia

Treatment

—  Medications

◦    decrease dopamine level.

side effects off set with anticholinergic medications

Schizophrenia

Treatment other

Schizophrenia

Treatment other

Schizophrenia

Treatment Supplements

- niacin (B3) - turkey, peanut butter, whole grains, salmon, beef. Used to help lower behaviors of schizophrenia.

Antidepressant Medications

Newer Meds: 

—  SSRI’s (Selective Serotonin Reuptake Inhibitors)

—  SSNRI’s

—  SSDNRI’s

Antidepressant Medications

Older Meds:

—  Tricyclic (TCA’s)

—  Monoamine Oxidase Inhibitors (MAOI’s)

Antidepressant Medications

Basic Mechanisms of Action

Selective Serotonin Reuptake Inhibitor (SSRI):

Blocks reuptake of serotonin – more available for action at receptors

Antidepressant Medications

Basic Mechanisms of Action

Tri-cyclic Antidepressants (TCA): 

Blocks the reuptake of serotonin, norepi, cholinergic and adrenergic receptors

Antidepressant Medications

Basic Mechanisms of Action

Monoamine Oxidase Inhibitor (MAOI): 

Blocks monoamine oxidase – enzyme that breaks down norepi & serotonin (and tyramine)

Antidepressant Medications

SSRI’s

—  Prozac - Fluoxetine

—  Zoloft - Sertraline

—  Celexa - Citalopram

—  Lexapro - esCitalopram

—  Paxil - Paroxetine

Antidepressant Medications

Selective Dopamine /Serotonin/Norepinephrine Reuptake Inhibitor

—  Buproprion (Wellbutrin)

Side Effects of Antidepressants

GI side effects

Side Effects of Antidepressants

Sexual

—  Sexual dysfunction- delayed orgasm

Side Effects of Antidepressants

CNS

Agitation, dizziness, fatigue, headache, anxiety, insomnia, tremors , —  Yawning

Side Effects of Antidepressants

Effexor

Side Effects of Antidepressants

Wellbutrin

—  SEROTONIN SYNDROME

Signs and Symptoms

 sweating, chills, nausea, vomiting, diarrhea, restlessness, myoclonus, insomnia, agitation, and possibly delirium

—  SEROTONIN SYNDROME

Treatment:

◦    Stopping the drug and call the physician

◦    Institute supportive measures

Tricyclic Antidepressants

—  Amitriptyline (Elavil)

—  Clomipramine (Anafranil)

—  Doxepin (Adapin, Sinequan)

—  Imipramine (Tofranil)

—  Desipramine (Norpramin)

—  Nortriptyline (Pamelor)

Monoamine Oxidase Inhibitors

—  Isocarboxazid (Marplan)

—  Phenelzine (Nardil)

—  Tranylcypromine (Parnate)

—  *Selegiline (Eldepryl)

MAOI Reactions

Severe headache, stiff neck, sweating, nausea, vomiting, HTN

Encourage pt to wear an allergy bracelet and/or info in wallet 

MAOI Restricted Foods

Pickled or smoked foods (herring)

Aged cheese- cause 80% of hypertensive crises

Soy sauce. alcohol- beer and wine (esp sherry, red wines)

Liver, lima beans, aspartame*

ANXIOLYTIC MEDICATION
Benzodiazepines

—  Alprazolam (Xanax)

—  Chlordiazepoxide (Librium)

—  Clonazepam (Klonopin)

—  Diazepam (Valium)

—  Lorazepam (Ativan)

—  Oxazepam (Serax)

Benzodiazepine uses:

Alcohol Withdrawal, Phobias, Mania, Panic disorder, Anxiety, Insomnia, Convulsions

Shorter acting benzodiazepines with

strong effects.... 

are more addictive due to rapid highs and lows

E.g.. Xanax 

Ataxia. Dizziness, drowsiness. Erectile dysfunction. Disinhibition

Tolerance increases

is life threatening - similar to alcohol and barbiturate withdrawal

occurs with abrupt cessation or increased time between dosing

Mood Stabilizers/Bipolar Disorder

Medications

—  Lithium carbonate=Eskalith

—  Carbamazepine=Tegratol

—  Gabapentin=Neurontin

—  Valproate sodium/Valporic acid=Depakene/Depakote

—  Lamotrigine=Lamictal

—  Topiramate=Topamax

Mood Stabilizers/Bipolar Disorder

Medications Side effects

◦     Sedation, calming, Dizziness

Hypotension,  Bone marrow suppression

Blood –aplastic anemia,thrombocytopenia, leukopenia

Hepatitis,  SIADH, Rash- Stevens-Johnson

Monitoring Lithium Levels

= narrow therapeutic window:

  Lab range 0.5 – 1.5

Levels drawn - 12 hr after last dose

Takes 5 days for dose change to stabilize level

Lithium  Acute Side effects

  thirst, nausea, urination, +fine hand tremor

Lithium  Chronic Side effects

◦     urination, weight, hair loss, acne, cognitive impairment.

◦     Hypothyroidism

Coarse hand tremor, vomiting & diarrhea, blurred vision, drowsy, slurred speech, confusion, coma, seizure

LIFE THREATENING 

Antipsychotic Medications

Exert most effects by 

Antipsychotic Medications

USED FOR...

Acute Psychotic Disorder Bipolar Disorder- acute & prophylactic. Aggressive behavior, Agitation, Impulsivity, Self injury. Tourette’s syndrome. Chronic psychotic disorders. Hiccups,Obsessive-Compulsive Disorder. Schizophrenia prophylaxis. Parkinson’s disease (psychotic episodes). Cocaine Withdrawal. Emesis (neuroleptics are potent anti-emetics)

TYPICAL Antipsychotics

druges

—  Phenothiazines-Thorazine, Mellaril, Serentil, Trilafon, Stelazine, Prolixin

—  Thioxanthene-

—Navane

—  Butyrophenone-Haldol

ATYPICAL Antipsychotics

—  Clozaril, Risperdal, Zyprexa, Seroquel, Geodon, Abilify

Side Effects of Typical Antipsychotics

Hepatic, EKG changes, seizures, hematologic

Dermatitis, photosensitivity, ↑Prolactin levels

Neuroleptic Malignant Syndrome (NMS)

Weight gain. Sexual dysfunction. EPS

Insomnia

Characteristics of Atypical Antipsychotics

Less EPS(Extrapyramidal symptom) and side effects

Zyprexa, Seroquel, Risperdol- increased risk of hyperglycemia.

—  Also used in mood stabilization

Extrapyramidal symptom

S/S

Dystonia-head turned muscel cramp

Akathisia-restlessness

Parkinsonia-shufling and "pill rolling"

Treatment of Extrapyramidal symptom

Anticholinergics-Benzotropine (Cogentin),Trihexphenidyl (Artane)

Antihistamine-Diphenhydramine (Benadryl)

Antiviral- Amantadine (Symmetrel)

Anticholinergic Adverse Reactions

Mad as a hatter (unresponsive)

Red as a beet (red skin)

Hot as a hare (febrile)

Dry as a bone (dry)

Blind as a bat (dilated pupils)

TARDIVE DYSKINESIA

Abnormal Involuntary Movement

Tends to occur after months/years of meds

No treatment, only management options

TARDIVE DYSKINESIA

Treatment

change meds, treat s/s

Benzodiazepines or mood stabilizers may reduce TD

Neuroleptic Malignant Syndrome (NMS)

Neuroleptic = Antipsychotic drugs

Generally the -↑ dose, ↑ occurrence rate

Neuroleptic Malignant Syndrome (NMS)

mortality rate 

High mortality rate 14-30%   (potentially fatal)

—  Early recognition essential

Neuroleptic Malignant Syndrome (NMS)

Treatment:  

Neuroleptic Malignant Syndrome (NMS)

 Signs/Symptoms

Muscle rigidity. Fever. Tachycardia. Sweating . Tremor. Incontinence. Stupor. Leukocytosis. ↑ CPK        Renal failure

More common in high potency drugs and dehydrated patients