Question | Answer |
Psychosis | The inability to distinguish reality from imagination |
Schizophrenia | -Delusions
-Hallucinations
-Disorganized speech
-Disorganized catatonic behavior |
Common Myths about Schizophrenia | -does NOT mean split personality
-are NOT unusually prone to violence
-NOT caused by family dysfunction |
DSM-IV Diagnostic Criteria: Schizophrenia | 2 or more of the following during a 1 month period: Delusions, Hallucinations, Disorganized speech, Grossly disorganized/Catatonic behavior, Negative Symptoms |
Schizophrenia Subtypes | -Paranoid:Delusions of persecution/grandeur
-Disorganized:Regressed,silly,inappropriate behav
-Catatonic:motor immobility, stupor,excessive purposeless motor activity |
Schizophrenia Subtypes | -Undifferentiated:indicate schizophrenia but fail to meet criteria
-Residual:no active symptoms, continues neg. symptoms |
Other Psychotic Disorders | -Schizophreniform Disorder: hallucinates
-Schizoaffective Disorder: most popular,hard time determining if depression or schizo
-Delusional Disorder
-Brief Psychotic:happens once or twice and never happens again
-Substance induced: cocaine/alcohol |
Schizophrenia Etiology | -Is a combination of inherited genetic factors and nongenetic factors
-Is NOT a single disease but a syndrome involving neurobiochemical and neuroanatomical abnormalities with strong genetic links |
Schizophrenia: Genetics | -Overall risk: 1%
-One parent: 10x higher
-Both parents: 50% higher
-Identical twins: 50%
-Fraternal twins: 10-15% |
Schizophrenia: Nongenetic Risk Factors | -Birth and pregnancy complications (difficult birth, lack of O2, overmedication)
-Stress may precipitate in a vulnerable person |
Schizophrenia: Neuroanatomical | -Decreased cerebral and cranial size
-Lowered numbers of cortical neurons
-Decreased volume of brain-reduced brain activity in the frontal lobe. |
Dopamine Hypothesis | -Increase in dopamine receptors in the brain's basal ganglia
-Typical antipsychotics reduced or eliminated positive symptoms by dopamine receptor blockage |
Comorbidity | -Substance Abuse Disorders
-Nicotine Dependence
-Depressive Symptoms
-Anxiety Disorders
-Physical Illness (DM, obesity, vision, dental, HTN)
-Polydipsia (Can lead to water intoxification) |
Schizophrenia: Potential Early Symptoms | -Withdrawn from others
-Depressed
-Anxious
-Phobias
-Obsessions and Compulsions
-Difficulty concentrating
-Preoccupation with self |
Symptoms of Schizophrenia | -Positive: reflects an excess or distortion of normal function, add something to personality
-Negative: Reflects a lessening or loss of normal function, take something away |
Positive Symptoms | -Delusions (religious, ideas of reference,persecution,grandeur, somatic)
-Hallucinations
-Looseness of association
-Echolalia
-Concrete thinking
-Tangentiality
-Neologisms
-Circumstantiality
-Clang assoc
-Word salad |
Positive Symptoms: Alterations in Behavior | -Extreme motor agitation
-Catatonia
-Stereotyped Behavior (do what see someone else doing)
-Waxy flexibility (make movement and once start they can't stop)
-Automatic obedience (no matter what anyone says, do behavior) |
Negative Symptoms | -Poverty of speech - limited
-Affective blunting
-Anhedonia
-Social withdraw
-Apathy
-Avolition - no goals
-Poor grooming
-Attentional Impairment
-Anergia |
Outcome Criteria | 1) Acute phase: stabilization of symptoms
2) Stabilization phase: prevent relapse
3) Return to previous level of functioning |
Communication Guidelines | -Auditory hallucinations most common
-Assess if suicidal/homicidal
-Avoid arguing about delusions
-Don't pretend to understand associative looseness1 |
Typical Antipsychotics | -Chlorpromazine HCL, Thoridazine, Fluphenazine, Thiothixene, Haloperidol
-Block dopamine
-Tx of pos symptoms, not neg
-Higher incidence of EPS |
Side Effects of Typical Antipsychotics | -Sedation
-Orthostatic Hypotension
-Alt. in sex
-Increase appetite
-Decrease tolerance to alcohol/sedatives
-Seizures
-Galactorrhea/Amennorhea
-Gynecomastia
-Jaundice, Agranulocytosis
-NMS |
Neuroleptic Malignant Syndrome | -Hyperthermia
-Muscular rigidity (stiffness)
-Altered Consciousness
-Autonomic dysfunction: HTN, tachycardia, diaphoresis, incontinence
-Stop drug and treat symptoms |
Treatment of NMS | -Withdraw med
-Cooling blankets, antipyretics
-Dantrolene - muscle relaxer
-Bromocriptine - dopamine receptor agonist
-Benzodiazepines - relieve anxiety and reduce bp, tachycardia |
EPS: Acute | -Pseudoparakinsonism (resting tremor, mask like face, shuffle) -Acute Dystonia (intermittent/fixed abnormal, posture of eyes,face,tongue,trunk)
-Akathasia (motor restlessness, pacing, rocking,shifting, subjective sense of not being able to sit still) |
EPS: Late | -Tardive Dyskinesia (abonrmal dyskinetic face, mouth, jaw, movements of extremities)
-Tardive dystonia (sustained postures in face, eyes, tongue)
-Tardive akathsia (unabative sense of subjective/objective restlessness |
Anticholinergics | -Benztropine, Trihexphenidyl, Diphenhydramine
-Side effects: dry mouth,blurred vision, decrease lacrimation,mydrasis,photphobia, constipation, urinary hesitancy/retention |
Atypical Antipsychotics | -Blocks D2 receptors(low) and serotonin blockage (high)
-Less incidence of EPS
-Effective in treating both of the pos and neg symptoms
-Risperidone,Olanzapine,Quetiapine,Siprasidone,Apriprazole,Clozapine, Paliperidone |
Atypical Antipsychotics: Side Effects | -Weight gain
-Glucose dysregulation -DM
-Hypercholesterolemia
-HTN
-Decreased self esteem
-Sedation
-Agranulocytosis (clozapine)
-Cardiac arrhythmias
-Caution with ALL:risk of mortality in elderly is used for dementia |
Common Problems associated with SPMI | -Housing
-Social network and supports
-Finances and benefits
-Education
-Employment
-Transportation
-Stigma/Discrimination
-Nonadherence to Medication Regimen
-Comorbid medical conditions
-Coexisting substance abuses |
Why don't clients take their medications? | -Poor insight
-Side effects
-Substance abuse
-Inadequate discharge planning/ lack of knowledge
-Poor therapeutic alliance w/ treating clinician
-Attitude about taking med for rest of their life |
Beautiful Minds Can Be Reclaimed | -Almost 1/2 of people sig. improve/recover
-Mid 1950s: meds not enough, psychosocial rehab helps, requires community system after d/c
-Results are lasting |
Old Treatment Model | -Maintenance - hopelessness - Entitlements, Staying out of hosp |
New Treatment Model | -Rehabilitation - Recovery - Self-sufficiency - Employment - Community reintegration |
Recovery and Rehabilitation | -Recovery: what clients do
-Rehabilitation: what hcp do
-Each of us is/has been recovering
-Use this as base for empathy |
Recovery | -A personal process of overcoming the negative impact of a psychiatric disability despite its continued presence
-Recovery from consequences of the illness can be more difficult than recovery from the illness itself |
Recovery involves recovery from: | -Stigma
-Institutionalization
-Effects of poor/wrong tx
-Lack of opportunities for self-determination
-Neg. side effects of unemployment
-Crushed dreams
-No and/or miseducation about illness |
Community Resources | Adult outpatient services provide: -Long term mental health tx
-Response to crisis calls
-Evaluation of walk-ins for possible psychiatric services
-Many have dual-dx tx programs
-Psychiatric nurses make home visits |
Community Resources: Psychosocial rehab | -Daily structure to promote socialization and vocational skills
-May be consumer-driver and involve a "clubhouse" atomostphere |
Community Resources: Case Manager | -Coordinates services
-Provides psychosocial services
-Acts as advocates for clients |
Community Resources: Community Outreach Programs | -Team approach used to find the mentally ill where they may be
-Connect these clients to services available to meet their needs
-Outreach workers are advocates in all areas of client needs |
Topics for Education | -Information about illness
-Information on meds and methods of improving adherence
-Principles of management and tx
-Stress management for family members
-Improvement of functioning in all family members |
Psychiatric Comorbidity | -50% of people with SMI have substance use disorder
-Suicide risk is 3 to 4 times higher in substance abusers |
Common examples of dual disorders | -Major depression disorder
-Alcohol with panic disorder/depression
-Alcoholism and polydrugism with schizophrenia
-Substance abuse with personality disorder |
Alcohol and CNS | -Wernike's encephalopathy
-Korsakoff's psychosis |
Alcohol and GI | -Esophagitis
-Pancreatitis
-Gastritis
-Hepatitis
-Cirrhosis of liver |
Alcohol and Pregnancy | -Fetal Alcohol Syndrome |
Alcohol and Cardiovascular | -MI
-CVA |
Alcohol and Infections | -TB
-HIV
-Bacterial endocarditis
-Asbecesses |
Alcohol and Respiratory | -Perforated septum
-Sinusitis
-CA |
Alcohol and Long term use | -TB
-Accidents
-Suicide
-Homicide |
Medical Comorbidities: Cocaine, Crack, Narcotics (Heroin), PCP | -IV - infections, sclerosed veins, AIDS, hepatitis, endocarditis, cardiac arrest, coma, seizures, PE
-Intranasal - sinusitis, perforated septum
-Smoking - Resp. problems |
What is Addiction? | -Loss of control of substance consumption
-Substance use despite associated problems
-Tendency to relapse |
Biological Theory | -Alcohol abuse 3-4 times more likely if parents alcoholic
-Effects on neurotransmitters (alcohol on gaba, amphetamines on dopamine) |
Psychological Theory | -View abuse of substances a defense against anxious impulses form of oral regression (dependency) or self medication for depression |
Sociocultural Theory | -Women diagnosed with less substance abuse
-NO SINGLE CAUSE OF SUBSTANCE ABUSE |
Substance Abuse | One or more in 12 mo
-Inability to fulfill major work, home, school
-Hazardous situations while impaired
-Recurrent legal issues
-Continued use despite recurrent social and interpersonal problems |
Substance Dependence | 3 or more in 12 mo
-Tolerance/Withdrawal
-Substance taken in larger amts for longer period
-Unsuccessful desire to cut down
-More time obtaining,using substance
-Reduction/Absence of social/work
-Continued use despite physical/psychological problem |
Synergistic Effect | -Refers to the intensification or prolongation of the effect of two or more drugs occurring when taken together
Ex: Alcohol + Benzo = extremely drowsy |
Antagonistic Effect | -Refers to the weakening or inhibiting the effect of one drug by using another
-Heroin OD and get narcan to block receptors |
Tolerance and Withdrawal | -Tolerance: need for higher and higher amounts to obtain the desired effect
-Withdrawal: Occurs after a long period of continued use so stopping or reducing results in physical and psychological signs and symptoms |
Blackouts | -Periods of amnesia during which the person appears to function normally but later does not recall the events that transpired
-Frequent blackouts can be sign of alcohol dependence/addiction |
CNS Depressants | -Alcohol
-Barbiturates
-Benzo
-Sedatives |
CNS Depressants: Intoxification | -Slurred speech
-Uncoordinated -Ataxia
-Drowsy
-Decreased BP
-Decreased inhibitions (risk)
-Impaired judgment |
CNS Depressants: OD | -CV depression/arrest
-Coma
-Shock
-Convulsions
-Death |
CNS Depressants: Treatment of OD | -Induce vomiting
-Charcoal
-Clear airway
-IV fluids
-Seizure precautions
-Romazicon IV |
CNS Depressants: Withdrawal | -N/V
-Tachycardia
-Diaphoresis
-Anxiety
-Tremors
-Insomnia
-Grand mal sz
-Delerium |
CNS Depressants: Withdrawal Tx | -Tiltrated detox with similar drug
-Abrupt withdrawal can lead to death
-Only withdrawal that can truly be deadly |
Alcohol Withdrawal | -Associated with severe morbidity and mortality unlike withdrawal from other drugs
-Develop w/in a few hours after cessation (2-8h)
-Peak at 24-48h after stop using
-Disappear rapidly after peak |
Alcohol Withdrawal Symptoms | -Anxiety
-Anorexia
-Insomnia
-Hand Tremor
-"Shaking Inside"
-N/V
-Vivid nightmares
-Illusions
-Sweating
-I HR/BP
-Psychomotor agitation
-Grand mal seizures |
Alcohol Withdrawal Delirium Tremens | -Medical Emergency - 10% mortality
-Peak 48-72h
-lasts 2-3d
-Altered consciousness
-Changes in cognition - memory/ language impairment,disorientation
-Perceptual Disturbances - hallucinations, illusions
-Fever
-I pulse, BP, diaphoresis
-Seizur |
CNS Stimulants | -Cocaine
-Crack
-Amphetamines
-Caffeine
-Nicotine
-Accelerate normal body function
-Dependence develops rapidly
-Highs followed by deep depression |
CNS Stimulants: Signs of Abuse | -Pupil dilation
-Dryness oronasal
-Excessive motor activity
-Tachycardia
-I BP
-Twitching
-Insomnia
-Anorexia
-Grandiosity
-Impaired judgment
-Paranoid thinking
-Hallucinations
-Hyperpyrexia
-Convulsions
-Death |
Cocaine, Crack Intoxication | -Dilated pupils
-Dryness of oronasal cavity
-Excessive motor activity
-N/V
-Insomnia
-Grandiosity
-Impaired judgment
-Euphoria |
Amphetamine Intoxication | -Paranoid
-Delusions (may last for months)
-Psychosis
-Hallucinations
-Panic level anxiety
-Potential for violence |
CNS: Overdose | -Resp. Distress
-Ataxia
-Fever
-Convulsions
-Coma
-Stroke
-MI
-Death |
CNS: Tx of Overdose | -Antipsychotics
-Medical management of fever, convulsions, resp. distress and CV systems |
CNS: Withdrawal | -Depression
-Paranoia
-Craving
-Lethargy
-Anxiety
-Insomnia
-N/V
-Sweating
-Chills |
CNS: Tx of Withdrawal | -Antidepressant
-Dopamine agonists
-Bromocriptine |
Marijuana (Cannabis Sativa) | -From Indian hemp plant
-THC active ingredient
-Depressant/Hallucinogenic
-Usually smoked
-Desired effects euphoria, detachment,relaxation
-Long term:lethargy,anhedonia, trouble concentrating,loss of memory,D motivation
-OD&w/drawal rare |
Opiates | -Opium
-Heroin
-Demerol
-Morphine
-Codeine
-Methadone
-Fentanyl |
Opiates: Intoxication | -Constricted pupils
-D resp.
-Drowsiness
-D BP
-Slurred speech
-Psychomotor retardation
-Initial euphoria followed by dysphoria
-Impaired attention, judgment, memory |
Opiates: OD | -Possible dilation of pupils
-Resp. Depression/arrest
-Coma
-Shock
-Convulsions
-Death |
Opiates: OD Tx | -Narc antagonist (Narcan) |
Opiates: Withdrawal | -Feels like bad flu
-Insomnia
-Irritability
-Runny nose
-Panic
-Sweating
-Cramps
-N/V
-Fever
-Chills |
Opiates: Withdrawal Tx | -Methadone: synthetic opiate
-Clonodine
-Buprenophine: Treat symptoms |
Hallucinogens:LSD, Mescaline, Psilocybin | -Trip: slowing of time, lightheadedness, images in intense colors, visions in sound
-BAD trip: severe anxiety, paranoia, terror, distortions in time and distance |
Hallucinogens: Phencyclidine Piperidine | -PCP, angel dust, horse tranquilizer, peace pill
-Route significant: Oral(1h);IV, sniffing,smoking (5 min)
-Symptoms:blank stare, ataxia, musc. rigidity, violence
-High dose:hyperthermia,chronic jerk of extrem. HTN, renal fail
-Suicidal Ideation |
Long term use of Hallucinogens | -Result in dulled thinking, lethargy, loss of impulse control, poor memory, and depression |
Flashbacks | -Transitory recurrence of perceptual disturbance caused by a person's earlier hallucinogenic drug when he or she is in a drug free state
-Examples: Club drugs - ecstasy, GHB, Rohypnol, LSD
-Can happen with any drug but more common w/ hallucinogen |
Hallucinogens: Intoxication and OD | -Dilated pupils
-Tachycardia
-Sweating
-Palpitations
-Tremors
-Uncoordinated
-I temp, resp, pulse
-Paranoid
-Anxiety
-Depression/SI
-Synesthesia
-Depersonalization
-Hallucinations
-Bizarre behavior
-Labile
-Violent |
Hallucinogens: Tx | -Minimal Stimuli
-Manage symptoms |
Inhalants | -Volatile Solvents: spray paint, glue,cigarette lighter fluid, propellant gases used in aerosols, room deodorizers, anesthetics |
Inhalants: Intoxication/OD | -Excitation followed by drowsiness
-Disinhibition
-Lightheaded
-Agitation
-Enhancement of sexual pleasure
-Giggling, laughter
-Damage to nervous system
-Death |
Inhalants: Tx | -Support affected systems (mostly nervous system)
-B12 and folate |
Club Drugs | -Ecstasy (adam, yabba, XTC)
-3,4 methylenedioxy-methamephetamine
-Ketamine |
Club Drug: Effects | -Euphoria
-I energy
-I self-confidence
-I socialability
-Psychedelic effects
-Dehydration
-Fever
-Rhabdomyolysis
-Acute renal failure
-Hepatotoxicity
-CV collapse
-Depression
-Panic attacks
-Psychosis
-Death |
Date Rape Drugs | -Flunitrasepam (Rohypno) or Roofies
-GHB-y-Hydroxybutyric acid
-Rapidly produce: disinhibition, relaxation of voluntary muscles, retrograde amnesia
-Alcohol synergistic drug |
Asst. Guidelines | -Most important Question: When did you last drink/use?
-In last year have you ever drunk or used drugs more than you meant to?
-Have you felt you wanted or needed to cut down on your drinking or drug use in the last year? |
Asst. Psychological Changes | -Denial (Hallmark sign)
-Depression
-Anxiety
-Dependency
-Hopelessness
-Low self esteem |
Quick Screening Tools (CAGE) | -C - cut down on drug/drinking use?
-A - annoyed with criticism
-G - guilty about use
-E - early morning (eye opener) to get day started
-Yes, sometimes or often to 2+ of these and they may have a problem |
BAL | -Blood Alcohol Level
-Legal limit in OH = .08
-How many drinks? 1 or 2
-Lethal BAL = .5 |
Defense Mechanisms | -Denial
-Rationalization
-Projection |
Planning | -Abstinence is the safest tx goal for addicts |
Codependency | -Cluster of behaviors that prevents one individual from taking care of his or her own needs due to preoccupation with another who is addicted to a substance |
Enabling Behaviors | -Supporting the clients physical or psychological dependence on the drug
-Encouraging denial by agreeing the clt uses drugs socially
-Ignoring clues to possible dependency
-Demonstrating sympathy for client's reasons for abusing substances and preachi |
Dual Diagnosis | -Coexistence of a substance abuse disorder and a mental health disorder
-Can be more difficulty accurate assessments, setting priorities, determining appropriate treatment interventions and planning patient's discharge |
Relapse Cycle | -Reemerging Psychiatric Symptoms
-Ineffective coping strategies
-Increased anxiety
-Substance abuse
-Adverse consequences
-Attempted abstinence
-Psychiatric symptoms reappear |
Epidemiology | -Overall chance of a substance disorder in a patient seeking psychiatric treatment is 1 in 2
-Highest occurrence: Antisocial Personality Disorder, Bipolar, Schizophrenia, Mood |
Effects of drugs on mental illness | -Alcohol (increase SI)
-Cocaine
-Amphetamines
-Marijuana (heighten paranoia)
-Opiates (Increase SI) |
Basic Premises | -Mask or cause psychiatric symptoms or may mimic:substance use,w/drawal
-Substance can initiate/exacerbate psychiatric disorder
-Psychiatric&subsatnce use disorders can exist independently
-Psychiatric behaviors can mimic alcohol/other drug problems |
4 Manifestations of Dual Diagnosis | -Primary mental illness w/subsequent substance abuse
-Primary substance abuse disorder w/ psychopathologic sequelae
-Dual primary diagnosis (both @ same time)
-Common Etiology |
Barriers to Treatment | -Nature of substance abuse
-Counter transference - become frustrated with patients
-Misunderstandings about and the stigmatization
-Health Hazards |
Mood | -A pervasive and sustained emotion that when extreme can markedly color the way the individual perceives the world
-A prolonged emotional state that affects a persons life and personality |
Affect | -The external manifestation of feeling or emotion which is manifested in facial expression, tone of voice, and body language
-How an individual presents feelings and mood |
Major Depressive Disorder Characteristics | -Symptoms interfere with usual functioning
-Severe emotional, cognitive, behavioral,and physical symptoms
-Hx of one or more major depressive episodes
-No hx of manic or hypomanic episodes
-At least 60% can expect to have 2nd episode |
MDD - DSM-IV-TR Criteria
-Change in previous functions
-Symptoms cause clinically significant distress or impair social, occupational or other important areas of functioning | -5+ occur nearly every day in 2 wk period:Depressed,anhedonia,wt loss/gain,Insomnia/hypersomnia,anergia,motor activity,guilt,indecisiveness,death SI |
MDD Subtypes | -Psychotic (voices, delusions)
-Catatonic
-Melancholic
-Postpartum onset (4wks after birth)
-SAD
-Atypical: hypersomnia,overeating -seen in young ppl |
MDD Proposed Subtypes | -Premenstral dysphoric disorder
-Mixed anxiety-depression
-Recurrent brief depression
-Minor depression |
Dysthymic Disorder | -Chronic depressive syndrome
-Present for most of the day
-More days than not
-At least 2 years
-Hosp. rare
-Early age of onset, still able to function |
Depression Epidemiology | -Leading cause of disability in the US
-More common in Females
-Prevalence unrelated to: ethnicity, edu, income, marital status
-Dominates symptom in adolescents- irritability
-Depression in elderly - major problem |
Depression Comorbidity | -Schizophrenia - go on schizo drugs and relieve symptoms but realize they'll have to be on them for the rest of their life and become depressed
-Substance abuse
-Eating disorders
-Anxiety disorders
-Personality disorders
-Medical disorders - fibromya |
Depression Etiology | -Biological:genetic,biochemical(serotonin, NE), Alt. in hormonal regulation, Diathesis-stress model
-Psychological:Beck's Triad (neg.view of self, world, future), learned helplessness |
Depression Recovery Model | -Focus on patient's strengths
-Treatment goals mutually developed
-Based on patient's personal needs and values
-Optimistic attitude |
Three Phases in Treatment and Recovery | -The acute phase (6-12wks): psychiatric mngt and initial tx
-The continuation phase (4-9mos): tx continues to prevent relapse
-The maintenance phase (1+yrs):continuation of antidepressants to prevent relapse;edu=relapse prevention |
Basic Level Interventions: Depression | -Counseling and communication
-Health teaching and health promotion
-Promotion of self-care activities
-Milieu therapy |
Advanced Practice Interventions | Psychotherapy
-Cognitive Behavioral Therapy (most common)
-Interpersonal Therapy
-Time-Limited focused psychotherapy
-Behavior Therapy (coping and social skills)
Group Therapy:important in maintenance phase |
Antidepressants: SSRIs | -First line therapy
-Indications: Depression and dysthymic disorder
-Adverse Reactions: sleep disturbance, agitation, N/V
-Toxic Effects: Serotonin Syndrome - tachycardia, HTN, irritability, vascular shock |
New Atypical Antidepressants | -SNRI: Effexor and Cymbalta
-NRI - Vestra
-Serotonin Receptor Antagonist/ Agonist - Nefazodone
-NDRI - Wellbutrin |
TCAs | -Neurotransmitter: NE and Serotonin
-Indications: Depressive Disorders
-Adverse Effects: anticholinergic effects, orthostatic hypotension
-Contraindications: MAOIs, MI, pregnancy, seizures, glaucoma |
MAOIs | -Neurotransmitter: block MAO, I serotonin and NE
-Indications: depression, anxiety
-Adverse Effects: I BP, could result in sz or stroke
-Interactions: Food (tyramine)
-Contraindications: stroke, sz, other drugs |
Other Treatments for Depression | -Electroconvulsive Therapy (ECT)
-Indications
-Transcranial magnetic stimulation
-Vagus Nerve Stimulation
-Light therapy
-St. John's wort
-Exercise |
ECT | -Use of electrically induced sz for the tx of severe depression
-Indications:Elderly,non responsive to drug therapy
-80% effective
-Contraindications:severe cardiac disease,HTN,lesions of brain/spinal cord
-Side Effects:memory loss transient,confusion |
ECT Procedure | -6-12txs over 3-4wks
-Admin. anticholinergic
-Prebreathe O2
-Anesthetic
-Air way w/ventilator assist
-bilaterlly,unilaterally
-Musc contraction
-Tonic/Clonic phase(barely noticeable)
-Spontaneous breathing w/in 60-120 sec
-Regain consciousnes |
Complementary Therapies | -St. John's Worst
-Most prevalent in Germany
-As effective as antidepressants in reducing sx
-Not as effective in returning to functionality
-CAUTION: blocks certain metabolic pathways used in rx of other disease |
Depression: Promote Physical Activity | -Release energy
-Increase feelings of well being
-Increase feelings of control and accomplishment
-Walking, jogging, swimming, aerobics, weight lifting |
Phototherapy | -Exposure to bright artificial broad spectrum light for a prescribed period each day
-Usually in the morning before sun comes up
-Usually for 30 minutes
-Client must face the light |
Bipolar Disorder | -Bipolar I Disorder: spans whole spectrum
-Bipolar II Disorder: hypomania to sever depression
-Cyclothymia: hypomania to mild depression |
Epidemiology | -Bipolar I more common in males
-Bipolar II more common in females
-Cyclothymia usually begins in adolescence or early adulthood |
Etiology | -Biological Factors: genetic, neruobiological, neuroendocrine (adrenal, pit, thyroid)
-Psychological factors - drug use
-Environmental factors - upper socioeconomic status, higher incidence |
Self-Assessment | -Manic Patient: manipulative, aggressively demanding, splitting (see things black and white) |
Bipolar: Assessment | -Mood:overenergetic,agitation, very high,think indestructible, anger
-Behavior:hyperactive,poor attention span,indiscriminant spending,sexually indiscreet
-Flight of ideas,clang associations,gradiosity
-Disorganized racing thoughts |
Bipolar: Outcomes Identification | -Acute Phase:Stabilization, prevent injury
-Continuation Phase:relapse prevention,education
-Maintenance Phase: goal limit relapse occurrence and limit periods out of normal |
Bipolar: Planning | -Acute Phase: Medical stabilization, maintaining safety, self-care needs
-Continuation Phase: maintain, medication adherence, psychoeducational teaching, referrals
-Maintenance phase: prevent relapse |
Bipolar: Lithium Carbonate | -Levels: Therapeutic:0.8 - 1.4; Maintenance:0.4 - 1.3; Toxic: 1.5 - 2.0
-Contraindications: Kidney Disease
-Relapse: w/in wks of stopping drug, need to be on it for lifetime
-Watch salt, electrolytes |
Bipolar: Anticonvulsant | -Valproate-can use with Li
-Carbamazepine - can use with Li, used for rapid cycling
-Lamotrigine |
Bipolar Pharmacological Interventions | -Antianxiety: Clonazepam, Lorazepam
-Atypical Antipsychotics: Olanzapine, Risperidone |
Bipolar: Other Treatments | -Electroconvulsive Therapy: can be used for mania or depression
-Milieu management
-Support groups
-Health teaching and health promotion |
Sleep Disorders | -Sleep Deprivation: not getting an optimal amount of sleep every night
-Leads to: chronic fatigue, memory problems, energy deficits, mood difficulties, feeling out of sorts |
Consequences of Sleep Loss | -Excessive sleepiness
-Serious enough to: impact social, vocational functioning, increase risk for accident/injury
-Comorbidity: sleep apnea - HTN, HF - fewer antibodies can't fight infection, obesity, diabetes; addiction |
Sleep Requirements | -Varies from individual to individual; most adults require 7-8h each night
-Long sleepers: require more than 10h each night
-Short sleepers: can function effectively on few than 5h per night |
Normal Sleep Cycle | -Complex interaction b/w CNS and environment
-Non-REM sleep:composed of 4 stages, peaceful, restful
-REM Sleep: reduction and absence of skeletal muscle tone,bursts of REM, myoclonic twitches of facial and limb musc, dreaming, ANS variability |
Regulation of Sleep | -Complex interaction b/w 2 processes: homeostatic process or sleep drive promotes sleep; Circadian process or circadian drive promotes wakefulness
-Influenced by endogenous factors (neurotransmitters, hormones) or exogenous factors (light and dark) |
Sleep Disorders | -Dyssomnias: problems in initiating or maintaining sleep
-Parasomnias: unusual or undesirable behaviors that intrude into sleep or occur at the threshold b/w waking and sleeping |
Dyssomnias | -Primary insomnia
-Primary hypersomnia
-Narcolepsy
-Breathing-related sleep disorders
-Circadian rhythm disorders
-Dyssomnias not otherwise specified (restless leg syndrome) |
Primary Insomnia | -Most common sleep complaint
-Difficulty with sleep initiation
-Sleep maintenance
-Early awakening
-Non-refreshing nonrestorative sleep |
Dx of Primary Insomnia | -Medical and Psychiatric Hx
-Sleep-wake behavior during 24h period
-Impact on daytime function
-Rating Scale: Pitt. sleep quality index
-2 wk sleep diary
-Polysomnography measures: sleep fragmentation, prolonged sleep latency, decreased sleep effici |
Sleep Hygiene | -Conditions and practices that promote continuous and effective sleep
-Bed used only for sleep
-Sleep ritual
-Reduce stimuli |
Pharmacological Interventions:Primary Insomnia | -Benzo (promote sleep, crisis/short term therapy)
-Sonata, Ambien, Lunesta (Atypical): less addcitive, longer term
-Antidepressants - sedative effects
-Barbiturates - short term
-Antihistamines |
Herbals: Pharmacological Interventions | -Melatonin
-Appears to be helpful in treating insomnia in older adults and insomnia r/t circadian rhythm disruption
-Risks: Not FDA approved
-Forms: Natural from pineal glands of animals- risk of virus; Synthetic - no risk of virus |
Parasomnias | -Unusual or undesirable behaviors or events
-Occur during: sleep/wake transitions, certain stages of sleep; arousal from sleep |
Sleep Disorders related to other mental disorders | -Insomnia related to another mental disorder
-Hypersomnia related to another mental disorder: major depressive disorder, anxiety disorder, schizophrenia |
Other Sleep Disorders | -Sleep disorders due to a general medical condition
-Substance-induced sleep disorders
-In both sleep disorders, sleep disturbances maybe: insomnia, hypersomnia, parasomnia, combination |
Relaxation Therapies | -Hyponosis
-Meditation
-Deep breathing
-Progressive muscle relaxation |
Nonpharmacological Interventions for Sleep Disorders | -Stimulus control: decrease neg. associations b/w the bed and bedroom
-Sleep restriction: limiting sleep creates a mild sleep deprivation
-Sleep hygiene |