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Mental Health
Vocab - Chapter 22 Substance-Related and Addictive Disorders.
| Question | Answer |
|---|---|
| Addiction | chronic medical condition -Addiction is a chronic medical condition with roots in the environment, neurotransmission, genetics, and life experiences |
| Intoxication | in the process of using a substance to excess |
| Tolerance | takes a higher dose to achieve the initial level of response |
| Withdrawal | symptoms that occur when a person stops using a substance |
| Psychiatric comorbidity | Any combination of two or more substance use disorders and mental disorders -Treat both at the same time |
| The major neurotransmitters involved in developing substance use disorders are | The opioid, catecholamine (especially dopamine), and Gamma-aminobutyric acid (GABA) systems. The dopaminergic neurons in the ventral tegmental area (VTA) are especially important in the sensation of reward. |
| Caffeine - Most widely used psychoactive substance in the world Behavioral Symptoms of Intoxication | CNS Stimulant restlessness nervousness excitement agitation rambling speech inexhaustibility |
| Caffeine - Physical Symptoms of Intoxication | flushed face diuresis gastrointestinal disturbance muscle twitching tachycardia cardiac arrhythmia |
| Excessive use of Caffeine is associated with many psychiatric problems like | bipolar disorders eating disorders sleep disorders. |
| Cannabis (Marijuana) - Third most commonly used psychoactive drug in the United States after alcohol, and illicit drugs Cannabis (Marijuana) Intoxication | Cannabis intoxication heightens users’ sensations Experience brighter colors, see new details in common stimuli, and time seems to go more slowly In higher doses, they experience depersonalization and derealization. |
| Cannabis (Marijuana) - Physical Symptoms of Intoxication | Motor skills are impacted for 8 to 12 hours. Conjunctival injection (red eyes from vessel dilation) Increased appetite Dry mouth Tachycardia Hallucinations with intact reality testing may occur, or auditory, visual, or tactile illusions may occur in the absence of delirium. |
| Hallucinogens causes | Cause a profound disturbance in reality |
| Hallucinogens are associated with | Flashbacks Panic attacks Psychosis delirium mood and anxiety disorders. They are both natural and synthetic substances |
| Hallucinogens are found in | Plants and mushrooms |
| Hallucinogens are commonly divided into two broad categories: | Classic hallucinogens (LSD) and Dissociative drugs |
| Hallucinogen Behavioral Symptoms of Intoxication | Paranoia impaired judgment intensification of perceptions depersonalization, and derealization Illusions hallucinations and synesthesia (e.g., hearing colors or seeing sounds) are particularly prominent with this type of intoxication. |
| Hallucinogen Physical Symptoms of Intoxication | Pupillary dilation tachycardia sweating palpitations blurred vision tremors, and incoordination. |
| Hallucinogen Intoxication Treatment | -Treatment for hallucinogen intoxication includes talking the patient down. This refers to reassurance that the symptoms are caused by the drug and that the symptoms will subside. -In severe cases, an antipsychotic such as: Haloperidol (Haldol) or a Benzodiazepine such as diazepam (Valium) can be used in the short term |
| Phencyclidine (PCP) Behavioral intoxication | -PCP intoxication is a medical emergency that can result in dangerous and violent side effects. -People under the influence of this drug can be belligerent, assaultive, impulsive, and unpredictable. |
| Phencyclidine (PCP) Physical intoxication | Nystagmus (involuntary eye movements) Hypertension Tachycardia Diminished response to pain, Ataxia (loss of voluntary muscle control), Dysarthria (unclear speech), Muscle rigidity Seizures Coma, and Hyperacusis (sensitivity to sound). Hyperthermia and seizure activity may also occur. |
| Phencyclidine Intoxication Treatment | Cannot be talked down and may require restraint A calming medication such as a benzodiazepine (Lorazepam) may be administered intramuscularly or intravenously. Mechanical cooling may be necessary for severe hyperthermia. |
| Inhalants are: | Solvents for glues and adhesives Propellants Thinners Fuels |
| Inhalants causes: | Small doses of inhalants result in disinhibition and euphoria. High doses can cause fearfulness, illusions, auditory and visual hallucinations, and a distorted body image. |
| Inhalants Behavioral intoxication | Apathy, diminished social and occupational functioning, impaired judgment, and impulsive and aggressive behavior |
| Inhalants Physical intoxication | Nausea, Anorexia, Nystagmus (the quick, involuntary movement of the eyes) Depressed reflexes, and Diplopia (double vision) High doses and long exposure can lead: to stupor, unconsciousness, and amnesia. Delirium, dementia, and psychosis are also serious side effects from inhalant use |
| Inhalants Treatment | -Inhalant intoxication usually does not require any treatment. -Serious and potentially fatal responses such as coma, cardiac arrhythmias, or bronchospasm do happen. -A psychotic response can be induced by inhalant intoxication. -This self-limiting (a few hours to a few weeks) problem may require careful use of an Antipsychotic: Haloperidol (Haldol) to manage severe agitation. |
| Opioid Use Disorder - Heroin and prescription (Pain reliever) Drugs cravings: | Cravings result in larger amounts, longer periods of use, increasing tolerance to its effects |
| Opioid Overdose causes: | Death usually due to respiratory arrest CNS Depressant |
| Opioid Intoxication | Opioid Intoxication: Bradycardia (slow pulse) Hypotension (low blood pressure) Hypothermia (low body temperature) Sedation Miosis (pinpoint pupils) Hypokinesis (slowed movement) Slurred speech Head nodding Euphoria Analgesia (pain-killing effects) Calmness |
| Opioid Overdose Treatment: | Treatment for an overdose begins with promoting breathing by: Aspirating secretions inserting an airway and mechanical ventilation. Naloxone (Narcan), a specific opioid antagonist can be given intranasally, intramuscularly, subcutaneously, or intravenously. Duration of action for naloxone is short Increased respirations and pupillary dilation should happen quickly Too much naloxone may produce withdrawal symptoms |
| Opioid Withdrawal Symptoms | Classic symptoms of withdrawal are: lacrimation (watery eyes) rhinorrhea (runny nose) pupillary dilation, and yawning. Opioid Withdrawal: Tachycardia (fast pulse) Hypertension (high blood pressure) Hyperthermia (high body temperature) Insomnia Mydriasis (enlarged pupils) Hyperreflexia (abnormally heightened reflexes) Diaphoresis (sweating) Piloerection (gooseflesh) Increased respiratory rate Lacrimation (tearing), yawning Rhinorrhea (runny nose) Muscle spasms & Pain ABD Cramps N/V/D |
| Opioids like Morphine, heroin, and methadone withdrawal symptoms begin: | Begins 6 to 8 hours after the last dose following a period of at least a week of use It reaches intensity during the second or third day and then subsides during the next week. |
| Opioids like Meperidine (Demerol) withdrawal symptoms begin: | Begins within 8 to 12 hours from abstinence and lasts about 5 days. |
| Opioid Withdrawal Treatment | -Clonidine (Catapres), an alpha agonist antihypertensive, is often used to reduce the symptoms of opioid withdrawal. Clonidine eases sweating, hot flashes, watery eyes, and restlessness. This drug also decreases anxiety and may even shorten the detox process. -Buprenorphine is an opioid partial agonist. Like opioids, it produces effects such as euphoria or respiratory depression, but these effects are weaker than those of drugs such as heroin and methadone -Lofexidine (Lucemyra), another alpha agonist |
| Opioid Maintenance Treatment | Continued abstinence is the goal of maintenance therapy: Methadone (Dolophine, Methadose) - It is used to decrease the painful symptoms of opiate withdrawal Suboxone is a combination of two drugs - buprenorphine and naloxone -Naltrexone (ReVia), is an opioid antagonist that prevents intoxication. - prevents opioid drugs from producing rewarding effects such as euphoria. An injectable long-acting form of naltrexone, Vivitrol, is given intramuscularly once a month. |
| Sedative, Hypnotic, and Antianxiety Medication Use Disorder are: | Benzodiazepines Benzodiazepine-like drugs Carbamates Barbiturates Barbiturate-like hypnotics |
| Sedative, Hypnotic, and Antianxiety Medication Overdose: | -gastric lavage -Overdose treatment includes gastric lavage, activated charcoal, and careful vital sign monitoring. -Patients who are awake after overdosing should be kept awake to prevent a loss of consciousness. -If unconscious, an intravenous fluid line should be established. -An endotracheal tube may be required to provide a patent airway, and mechanical ventilation can be used if necessary. |
| Sedative, Hypnotic, and Antianxiety Medication Withdrawal symptoms: | -Gradual reduction to prevent seizures Withdrawal: Autonomic hyperactivity Tremor Insomnia Psychomotor agitation Anxiety and Grand mal seizures |
| Stimulant Use Disorder are: | Amphetamine-type, Cocaine, Crack, Meth, Bath Salts CNS Stimulant |
| Stimulant Withdrawal treatment | -Group and individual therapy -Possible diazepam for agitation -1 to 2 weeks’ cocaine withdrawal requires no inpatient care; no drugs reduce symptoms -Depression treatment once withdrawal is complete (e.g., bupropion) |
| Tobacco (Nicotine Addiction) | Craving, persistent and recurrent use, and tolerance are all symptoms of tobacco use disorder. Dependence happens quickly. Cigarettes are the most commonly used tobacco product. |
| Tobacco is | is distressing |
| Tobacco Withdrawal treatment: | Bupropion The antidepressant bupropion (Zyban) reduces the cravings for nicotine and withdrawal symptoms. or Varenicline Varenicline (Chantix) is a nicotinic receptor partial agonist that mimics the effects of nicotine, thereby reducing cravings and withdrawal. It also partially blocks the nicotine receptors, which blunts the effect of nicotine if smoking is resumed |
| Alcohol Use Disorder causes | Sedative with the initial euphoria CNS Depressant |
| Alcohol Severity based on the number of DSM-V symptoms | Mild: 2–3 Symptoms Moderate: 4–5 Symptoms Severe: 5 or more symptoms |
| Alcohol Comorbidity | Bipolar disorders, schizophrenia, antisocial personality disorder, major depressive disorder |
| Binge Drinking | refers to drinking too much alcohol quickly. For women, this amount is four or more drinks within 2 hours; for men, this amount is five or more drinks within 2 hours. |
| Heavy Drinking | is characterized by drinking too much, too often. Eight or more drinks in a week constitute heavy drinking in women. Men who drink more than 14 drinks in a week are considered heavy drinkers. |
| Alcohol intoxication | 80 or 100 mg ethanol per deciliter of blood (mg/dL). Often expressed as 0.08 to 0.10 g/dL. |
| Alcohol withdrawal | The classic sign of alcohol withdrawal is: Tremulousness, commonly called the shakes or the jitters, which begins 6 to 8 hours after alcohol cessation ( After the last drink has occurred) Shakiness Nausea/Vomiting Loss of Appetite Depression Fatigue |
| Mild to moderate alcohol withdrawal includes | Agitation lack of appetite nausea, vomiting insomnia impaired cognition and mild perceptual changes. Both systolic and diastolic blood pressure increases, as does pulse and body temperature. Chlordiazepoxide (Librium) is useful for tremulousness and mild to moderate agitation. |
| Alcohol withdrawal and Psychotic symptoms | Psychotic and perceptual symptoms may begin in 8 to 10 hours. Increase: Blood Pressure, Temperature, Anxiety, Rapid breathing, mood swings If your patient is undergoing withdrawal to the point of psychosis, it should be considered a medical emergency because of the risks of unconsciousness, seizures, and delirium. -The benzodiazepines lorazepam (Ativan) or chlordiazepoxide (Librium) can be given either orally or intramuscularly and tapered over the following 5 to 7 days. |
| Alcohol withdrawal seizures | Withdrawal seizures may occur within 12 to 24 hours after alcohol cessation. These seizures are generalized and tonic-clonic. Additional seizures may occur within hours of the first seizure. -Diazepam (Valium) given intravenously, is a common treatment for withdrawal seizures. |
| Alcohol Delirium | Alcohol withdrawal delirium, also known as delirium tremens (DTs), is a medical emergency that can result in the death in 20% of untreated patients, medical problems such as pneumonia, renal disease, hepatic insufficiency, or heart failure. -Alcohol withdrawal delirium may happen anytime in the first 72 (3 days)hours. ***Serious physical illnesses such as hepatitis or pancreatitis may increase the likelihood of alcohol withdrawal delirium. *** |
| Alcohol withdrawal delirium symptoms | Autonomic hyperactivity may result in Tachycardia Diaphoresis Fever Anxiety insomnia, and hypertension Delusions and visual and tactile hallucinations are common in alcohol withdrawal delirium. -Oral diazepam (Valium) may be useful in the symptomatic relief of acute agitation, tremor, impending or acute DTs, and hallucinosis. -Chlordiazepoxide (Librium) may keep your patient out of danger. However, once delirium appears, intravenous lorazepam (Ativan) is used to treat these severe symptoms. |
| Wernicke-Korsakoff syndrome | The pathophysiological connection between the two problems is a thiamine deficiency Wernicke’s encephalopathy is characterized by altered gait, vestibular dysfunction, confusion, and several ocular motility abnormalities (horizontal nystagmus, lateral orbital palsy, and gaze palsy). These eye-focused signs are bilateral but not necessarily symmetrical. Sluggish reaction to light and anisocoria (unequal pupil size) are also symptoms. May progress into Korsakoff’s syndrome (worsening symptom) |
| Fetal alcohol syndrome | Resulting in microcephaly, craniofacial malformations, and limb and heart defects. As adults, affected individuals tend to have a short stature. |
| AUDIT: | Alcohol use disorders identification test |
| CAGE: | 4 questions to identify alcohol abuse |
| CAGE-AID: | Same questions as CAGE but adds drug use to alcohol |
| T-ACE: | Tolerance, Annoyance, Cut down, Eye-opener |
| Nursing Process: Assessment | Codependence is a cluster of behaviors originally identified through research involving the families of alcoholic patients. People who are codependent often exhibit overly responsible behavior—doing for others what others could just as well do for themselves. |
| Nursing Process: Planning | Identifying problem Setting a goal Determining the interventions that will accomplish the goal |
| Nursing Process: Implementation | Promoting safety and sleep: first-line interventions Reintroduce good nutrition and hydration Support for self-care (hygiene) Exploring harmful thoughts and spiritual distress |
| Nursing Process: Evaluation | Assessing the effectiveness of the treatment plan Using objective data to check whether nursing actions addressed the patient’s symptoms Measuring the changes in the patient’s behaviors for progress toward meeting stated goals |
| Treatment Modalities: Pharmacotherapy for Alcohol: Disulfiram (Antabuse) | Generic (Brand Name): Disulfiram (Antabuse) Uses: Maintenance, relapse prevention, aversion therapy Implications for the Therapeutic Process: -Physical effects when alcohol is used: Intense nausea and vomiting, headache, diaphoresis (sweating), flushed skin, dyspnea (respiratory difficulties), and confusion. -Avoid all alcohol and substances such as cough syrup and mouthwash containing alcohol |
| Treatment Modalities: Pharmacotherapy for Alcohol: Naltrexone (Vivitrol—injectable, ReVia, Depade—oral) | Generic (Brand Name): Naltrexone (Vivitrol—injectable, ReVia, Depade—oral) Uses: Withdrawal, relapse prevention, decreases pleasurable feelings and cravings Implications for the Therapeutic Process: -Oral or long-acting (once a month) injectable form. Nausea usually goes away after first month; headache, sedation. -Pain at injection site, patient needs to be opiate free 10 days before initiation of medication. |
| Treatment Modalities: Pharmacotherapy for Alcohol: Acamprosate calcium (Campral) | Generic (Brand Name): Acamprosate calcium (Campral) Uses: Relapse prevention Implications for the Therapeutic Process: -Begin taking on the fifth day of abstinence from alcohol. -Tablets are taken three times a day. -Side effects include diarrhea, gastrointestinal upset, appetite loss, dizziness, anxiety, and difficulty sleeping. -Contraindicated in patients with renal impairment. |
| Treatment Modalities: Pharmacotherapy for Alcohol: Benzodiazepines (lorazepam [Ativan], chlordiazepoxide [Librium], diazepam [Valium]) | Generic (Brand Name): Benzodiazepines (lorazepam [Ativan], chlordiazepoxide [Librium], diazepam [Valium]) Uses: Withdrawal Implications for the Therapeutic Process: -Sedation decreased anxiety, and blood pressure. -Use CIWA-AR scale to assess dose according to agency policies. -Assess for seizures that could lead to delirium tremens (DTs). If not treated, coma and ultimately death. |
| Treatment Modalities: Pharmacotherapy for Alcohol: Anticonvulsants (Tegretol) Barbiturates (phenobarbital) | Generic (Brand Name): Anticonvulsants (Tegretol) Barbiturates (phenobarbital) Uses: Withdrawal Implications for the Therapeutic Process: -Older treatments still used today. Other treatments have proven more effective and safer. -Assess for seizures that could lead to delirium tremens if not treated, coma, and ultimately death. |
| Treatment Modalities: Pharmacotherapy for Alcohol: Clonidine (Catapres) | Generic (Brand Name): Clonidine (Catapres) Uses: Mild to moderate withdrawal Implications for the Therapeutic Process: Alpha-agonist antihypertensive agent. -Give every 4–6 h as needed. Side effects dizziness, hypotension, fatigue, and headache. |
| Psychotherapy | Cognitive behavioral therapy and motivational interviewing are commonly used evidence-based therapies. |
| Cognitive behavioral therapy | helps patients explore thinking patterns so that the core belief system and any irrational core beliefs can be identified. The positive and negative consequences of alcohol use are explored. Patients learn to self-monitor their cravings and challenge these cravings realistically. |
| Motivational interviewing | is an approach based on the transtheoretical or stages of change theory. It has gained popularity in its use as a brief, long-term, and supplementary intervention, particularly in the treatment of substance use disorders. It uses a person-centered approach to strengthen motivation for change. |
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