School of Nursing and Health Studies University of Miami School of Nursing Coral Gables, Florida. School of Nursing Philadelphia, Pennsylvania JoAnn Marrs, PhD, RN, FNP, BC Professor and RODP Clinical Coordinator East Tennessee State University.
Psychiatric Nursing for Advanced Practice
Part I
Chapter 1
Nonverbal communication can provide insight necessary for patient clinical assessment and diagnosis, particularly in patients who are significantly impaired by psychiatric illness. Elicit by asking the patient questions such as, "How have you been most days?" Write the mood in the patient's own words.
Chapter 2
The treatment of personality disorders presents an unusual challenge because many of the maladaptive characteristics that caused the patient pain and suffering are fundamental components of the personality structure. Substance abuse disorders require clinicians to wear many hats and address many different aspects of the patient's experiences.
Chapter 3
The ego begins as a fragile subsection of the id with the goal of satisfying the id. The ego is the executor and arbiter, directing and balancing the demands of the id and superego.
Part II
Chapter 4
In the CNS capillaries, P-glycoprotein pumps drugs back into the blood, thereby limiting their access to the brain. It is connected to all areas of the brain, especially the frontal cortex, which is It is a group of nuclei located at the base of the forebrain and strongly connected to the cerebral cortex, thalamus and other areas.
The hippocampus belongs to the limbic system that forms the inner edge of the cortex. Intensity of response produced. chemicals in the body that the drug binds to to produce effects).
Chapter 5
Theoretically, there may be several hundred neurotransmitters based on. the amount of genetic material in the neurons. The following six neurotransmitter systems are the main targets of psychotropics. neurotransmitter = serotonin) originating primarily in the raphe nuclei of the reticular formation that extends from the medulla to the midbrain. neurotransmitter = norepinephrine) originating in the locus coeruleus. neurotransmitter = dopamine) originating primarily in the ventral tegmental area. neurotransmitter = acetylcholine) one of them. most important neurotransmitters in the autonomic nervous system Glutamatergic neurons. neurotransmitter = glutamate) an amino acid transmitter synthesized by the brain from glucose and other nutrients for motor activity GABAergic neurons. neurotransmitter = gamma-aminobutyric acid [GABA]) an inhibitory amino acid neurotransmitter which is synthesized from glutamate in the brain and reduces the activity of nerve cells. BDNF, brain-derived neurotrophic factor; CNS, central nervous system; GI, gastrointestinal; PNS, peripheral nervous system.
Beta2 Lungs, brain, skeletal muscle Excitatory: bronchial relaxation, vasodilation, smooth muscle relaxation Beta3 Adipose tissue Excitatory: stimulation of effector cells. AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor; CNS, central nervous system; NMDA, N-methyl-D-aspartate receptor.
Chapter 6
They travel through the portal vein first to the liver and then through the heart and into the general circulation. Oral administration results in more variable drug absorption and drug bioavailability. ability than other routes of administration. also known as the first-pass effect) refers to the inactivation of an orally administered drug by liver enzymes shortly after absorption from the gastrointestinal tract and before the drug reaches the general circulation. Enterohepatic recirculation refers to the cyclic movement of orally administered drugs from the gastrointestinal tract to the liver, then packaged in bile and secreted into the small intestine, and then reabsorbed in the liver.
The term plateau refers to the steady drug levels reached in the body with continuous drug administration. Because of the unique pharmacodynamic properties of psychiatric drugs (eg, . . . antidepressants), it is possible that there is a significant delay in therapeutic response even after a plateau drug level is reached.
Chapter 7
People who attempt suicide more than once and later complete the act tend to be. Certain traits can serve as warning signs that a patient may escalate toward physically violent behavior. If the patient is known to be schizophrenic or bipolar and is most likely in a psychotic or manic state, an antipsychotic should be used.
If the diagnosis is unclear or the result of drug or alcohol intoxication, lorazepam, a benzodiazepine, is most often given. If the patient will not voluntarily submit to this evaluation, a request for an emergency medical evaluation is obtained from a judge, justice of the peace, or police officer.
Drug selection table for Psychiatric Emergencies
Antipsychotics and sedatives are usually chosen, but should be slowly titrated in the elderly and chosen to target the symptom. It should be borne in mind that the use of benzodiazepines in the elderly may worsen confusion and delirium. Serotonin syndrome is a potentially life-threatening syndrome associated with increased serotonergic activity in the central nervous system (CNS), such as by the combination of a selective serotonin reuptake inhibitor and a monoamine oxidase inhibitor (MAOI).
Most commonly occurs with concomitant use of serotonergic drugs, with drugs that disrupt the metabolism of serotonin, including MAOIs, or with antipsychotics or other dopamine antagonists. Mad in America: Bad Science, Bad Medicine, and the Continued Mistreatment of the Mentally Ill.
Part III
Chapter 8
Another mental health disorder, such as depression or drug abuse (alcoholism .. or drug abuse), increases the risk of developing delirium. QTc interval greater than 450 msec or 25% over baseline warrants a cardiology consultation and reduction or discontinuation of the medication. Persons with delirium are more likely to have a fall in the hospital or other events. which will delay discharge and result in more expensive hospital stays.
Although dementia is far more common in the geriatric population, it can occur at any stage of adulthood. The focus of the treatment is to improve the quality of life for the individual and the care staff by maintaining functional capacity and by supporting remaining intellectual abilities, mood, behavior and social support networks such as the Swedish Council for Technology Assessment in Healthcare (http://www.sbu.se/da/) .
Drug selection table for Dementia and alzheimer’s Disease
Drug selection table for major Depressive Disorders
Drug selection table for generalized anxiety Disorder
Chapter 9
Signs and symptoms will vary with individuals/substances used, but include sudden weight loss/gain. Alcohol withdrawal is a life-threatening condition that can lead to alcohol withdrawal delirium, tonic-clonic seizures, and in some cases, death. Electrolytes (and glucose if indicated as symptoms of Wernicke's, only after .. thiamine is given first), folic acid and magnesium supplements can also be given.
Naltrexone (Revia, Vivitrol, oral or intramuscular [IM]) or acamprosate. Campral) is given to reduce cravings.
Drug Selection Table for Managing Substance Abuse
Drug Selection Table for Substance Dependence
Drug Selection Table for Substance Dependence (continued)
Chapter 10
Lorazepam (Ativan) or diazepam (Valium) can be used if the person has a very high level of anxiety or insomnia. Both the patient and the family must be educated about the disease and the possible adverse effects of the medication. If there is doubt that a symptom is a delusion, a diagnosis of delusional disorder should not be made.
However, recent studies have not confirmed that atypical drugs are better than conventional antipsychotics in the treatment of delusional disorder. Also, the evidence suggests no difference in improvement between atypical and conventional antipsychotics in the treatment of patients with delusional disorder.
Drug Selection Table for Delusional Disorder
This is especially true as the family often feels the impact of the disorder the most. Delusions or hallucinations for at least 2 weeks can be seen in moodiness. The CAGE (clumsy, upset, guilty, and eye-opening) questionnaire is useful in determining alcohol consumption in patients with schizoaffective disorder.
Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), asenapine (Saphris), and paliperidone (Invega) are effective in treating global psychopathology and positive symptoms of schizophrenia spectrum disorders, including schizoaffective disorder. Any SSRI can be used for depressive symptoms, but the most evidence available is for fluoxetine (Prozac).
Drug Selection Table for Schizoaffective Disorder
The identical twin of a person with schizophrenia has the highest risk (40%–65%) of developing this disorder. Women are found to be particularly susceptible to acute worsening of symptoms in the postpartum period. Atypical (second generation) antipsychotic drugs are suggested to be used as. a first-line treatment of schizophrenia due to their fewer side effects than conventional or typical antipsychotic medications.
ECT, in combination with antipsychotic medication, may be considered. patients with schizophrenia who do not respond to antipsychotics. A good therapeutic alliance is likely to help patients with schizophrenia remain in therapy, increase adherence to treatments, and have positive outcomes at 2-year follow-up evaluations.
Drug Selection Table for Schizophrenia
Reported recurrence rates range from 10% to 60%; approximately 20% to 30% of patients with schizophrenia can lead somewhat normal lives, 20% to 30% continue to experience moderate symptoms, and 40% to 60% of them remain significantly impaired throughout their lives. Mental Health Web site at http://www.nimh.nih.gov/health/ publications/schizophrenia/index.shtml. It is important that patients tell health care providers about all medications, including over-the-counter medications, prescription medications, vitamins, minerals, and herbal supplements that patients are taking.
It is important for mental health care providers to regularly monitor their physical conditions. It is dose-dependent and all second-generation antipsychotics (APS) are more likely to cause extrapyramidal symptoms extrapyramidal symptoms (EPS) in patients who are not antipsychotic-naïve.
Drug Selection Table for Schizophreniform Disorders
Chapter 11
- SIG E CAPS Depressed mood
For example, people with depression are four times more likely to develop a heart attack than those without a history of the disease. 15 to 44 years and the world's leading cause of disability for adolescents and adults. Having another mental health disorder, such as substance abuse (alcoholism or drug abuse), or a sleep disorder can increase your risk of developing MDD.
At least five of the following symptoms were present for at least 2 weeks in Stress management and lifestyle changes such as regular exercise have been reduce depression, are essential for ongoing prevention.
Drug Selection Table for Major Depressive Disorder
Patients with bipolar II disorder have one or more MDEs, with at least one hypo-. Sixty-one percent of patients diagnosed with bipolar I disorder and 48% of. patients diagnosed with bipolar II disorder also have co-existing substance use disorders. The most common substance use disorder appears to be alcohol abuse/. Lifetime prevalence of alcohol abuse/dependence is 49% of men and 29% of. women diagnosed with bipolar spectrum disorders.
Approximately one-third of patients with bipolar disorder also have cluster B. borderline, narcissistic, antisocial, and histrionic personality disorder).
Drug Selection Table for Bipolar Disorders
The occurrence of a cyclothymic disorder after the age of 65 is rare and cautions the practice. Drug interactions or side effects that may cause mood symptoms (e.g., baclofen, bromide, bromocriptine, captopril, cimetidine, corticosteroids, cyclosporine, disulfiram (Antabuse), hydralazine, isoniazid, levodopa, methylphenidate (Ritalin), metrizamide, procarbazine, procyclidine (Kemadrin)). This means that the mood symptoms come out of nowhere with little external provocation.
Drug Selection Table for Cyclothymic Disorder
