substance abuse, nicotine, dependence, depression, suicidal ideation and anxiety

substance abuse can actually lead to schizophrenia*

acute phase- periods of both pos and neg symptoms

maintenance phase- acute symptoms decrease in severity

stabilization phase- symptoms in remission

antipsychotics

(known as tranquilizers or nueroleptics)

Thioxanthens: thiothixene

Butyrophenones: haloperidol

Dihydroindolones: molindone

Dibenzoxazepine: loxapine

Thioridazine, fluphenaziine

Dopamine blockers, new class

clozapine, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, invega

CNS- sedation, delirium

Cardiovascular- orthostatic hypo, syncope, dizziness, ECG changes (particularly mellaril)

Dermatologic- photosensitivity, skin rash, hyperpigmentation, itching, sunburn (especially 1st gen)

GI- dry mouth, constipation

GU- impaired erection, urinary retention

hemato- leukopenia and agranulocytosis (particularly clozaril)

Metabolic/endocrine- 2nd gens for weight gain, metabolic sydrome and diabetes

potentially life threatening, high fever, unstable bp, myoglobinemia.

Given dantrolene to help relax muscles

big adverse effect for all antipsychotics

Will give cogentin or artane(anticolinergics)

It is Involuntary muscle symptoms similar to parkenson's

akanthisia

acute dystonia

involuntary contractions of oral facial muscles

this is permanent

Choreoathetosis( wave like movements of extremities)

redult of antipsychotics

monitor every 6 months to a year

sadness and low energy not severe enough to be diagnosed as a major depressive disorder.

maybe just a few days.

Postpartum disorders

(blues, depression, psychosis)

hormones are thrown out of balance. These can be very serious conditions like depression or psychosis.

psychosis- may lead to bringing harm to a child in belief that the child is trying to harm them.

depression- may not want anything to do with the child but not harming the child.

-changes in appetite or weight, sleep, or psychomotor activity

-decreased energy

-feelings of worthlessness or guilt

-difficulty thinking, concentrating, or making decisions

-recurrent thoughts of death or suicidal ideation, plans or attempts.

who are more vulnerable to major depressive disorders

-acute phase- 6-12 weeks may need hospitalization symptoms of depression are reduced.

Continuation phase- lasting 4 to 9 months prevent relapse through education, meds and psychotherapy

Maintenance phase- includes prevention of future episodes.

safety

milieu therapy

communication

counseling

psychotherapy

medications

Electroconvulsive therapy

transcranial magnetic stimulation

self-care

mixed- cycles alternate between periods of mania, normal mood, depresion, normal mood, mania, and so forth

type 1- manic episodes with at least one depressive episode

type 2- recurrent depressive episodes with at least one hypomanic episode.

genetics

biochemical imbalances

hypothyroidism

neuroanatomical factors

comorbidity- substance abuse, anxiety, eating disorders, adhd

-Persistent elevated mood

-agitation or irritability, intolerance of criticism

-flight of ideas, grandiosity (very full of themselves)

-impulsivity, distractibility

-poor judgement, attention seeking behaviors

-impairment in social functioning, decreased sleep

-Neglect of ADL

-delusions, hallucinations, denial of illness

flat or blunt affect, labile, tearful crying, lack of energy

loss of pleasure... etc.

safety

decrease stimulation

provide client protection

observe escalating behavior

outlets of physical activity

maintenance of self-care

use a calm, matter-of-fact approach

give consice explanations

consistency among staff

avoid power struggles.

men commit suicide 3 times the rate of women

women are 4 times more likely than men to attempt suicide

men, young women, caucasians, being older than 65, separated or divorced

people with psychiatric disorders

isolation, recent loss, lack of support, unemployment, critical life events

being impulsive or erratic, unstable life styles

-do they have a plan

-do they have the means to carry out the plan

-if the person carries out the plan, is it going to be lethal

-has the client made preparations for death

-where and when does the client intend to carry out the plan

-is the intended time a special date or anniversary that has a meaning for the client.

-use an authoritative role

-provide a safe environment

-initiate a no-suicide contract

-creat a support system list

-suspect suicide if client goes from sad and depressed to happy

-document accurately

-check the environment for possible hazards.

block reuptake of neurotransmitters

It is thought that increasing neurotransmitters will correct levels that lead to depression

Amitriptyline, doxepin, imipramine, desipramine, nortriptyline

sedation

dry mouth

constipation, urinary retention

postural hypotension

sexual dysfunction

has to be monitored very closely, watch for potassium and sodium levels. Measured for toxicity, which can be fatal.

slugish, abdominal cramps, delirium, delusional, nausea

highly effective

nardil, parnate, selegiline( skin patch, does not react with tyramine which can cause a hypertensive crisis).

hypertensive crisis (cheese effect)-foods containing thyramine must be avoided

urinary hesitancy

weight gain

sedation

weakness

prozac, paxil, zoloft, luvox, celexa, lexapro

prozac is the only one used for kids.

Effexor, serzone, remeron, cymbalta, pristiq, st. john's wort

sexual dys

anxiety

dizziness

insomina

increased suicidal thoughts in children

serotonin syndrome- restlessness, fever, seizures, abd pain, if severe enough death can occur.