Mental Health Flashcards
mentally healthy person
is in contact w/ reality
can relate to ppl and situations in their environment
resolve conflicts w/in a problem-solving framework
psychiatric illness
loss of the ability to responde to the internal and external environment in ways thta are in harmony with oneself or the expectations of society
characterized by thought or behavior patterns that impair functioning and cause distress
right of involuntary admission
- right for informed consent
- right to refuse tx including meds, unless a separate and specific tx is obtained from the court
- lose right if immediate threat to self or others
*
- lose right if immediate threat to self or others
Types of denfense mechanisms
See attached
Need of pt w/ Anxiety
need to decrease stimuli and provide quiet/calm environment
panic d/o
the cause usually cannot be identified
Somatoform d/o
persistant worry or complaints regarding physical illness w/o supportive physical findings
the pt my unconsciously use somatization for secondary gains, such as increased attentention or decreased responsibilities
- Conversion d/o: sudden onset of a physical symptom or a deficit suggesting loss of or altered body function related to psycho conflict or neuro d/o
- Hypochriasis: preoccupaton w/ fears of having a serious illness, no evidence of physical illness
- Somatization d/o: pt has multiple physical complaints involving numerous body systems, it’s psychological
RN to allow a specific time period for the pt to discuss physical complaints b/c pt will feel less threatedend if limited rather than abrupt stopping. avoid responding w/ positive reinforcement about physical complaints
dissociative d/o
- dissociative identity d/o: two or more personalities
- dissociative amnesia: can’t recall important personal information b/c it provokes anxiety
- dissociate fugue: pt assumes new identity in a new environement
Rx for bipolar d/o
traditionally lithium carbonate
- need serium lithium levels!!
- Need stable intake of SODIUM and FLUID (2-3L) to avoid toxicity
valproic acid (depakote)
carbamazepine (tegretol)
these reduce acute manic episodes and for maintenance therapy
olanzapine (Zyprexa)
aripiprazole (abilify)
risperidone (Risperdal)
given for sedative and mood stabilizing effects
**sidenote: RN should avoid power struggles. Just set clear, consistent enforceable limits and the consequences and follow thru
ECT (electroconvulsive therapy)
6 - 12 tx, given 2-3x/wk
Preprocedure
- NPO at least 4h befoe
- baseline VS
- void
- Meds to relax muscles
During procedure
- BP cuff on, IV line and ECG electrodes
- 100% O2 by mask via positive pressure
- BRIEF SEIZURE OCCURS
Postprocedure
- Pt may be confused, frequently reorient the pt
- assess gag reflex before given fluids, meds, food
SSRI’s
antidepressants
citalopram (Celexa)
escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertrraline (Zoloft)
s/e: CNS stimulation, BP changes, dizzy, photosensitivity
- admin w/ snack or meal
- do not stop taking abruptly
- d/c sydnrome: GI distress, behavioral or perceptual oddities, mvmt problems, sleep issues
- notify HCP if priaprism occurs
- monitor liver, kidney and WBC
- serotonin syndrome:
- elevated temp, muscle rigidity, elevated CPK levels
- increased when given with MAOIs
- OTC cold meds increase liklihood
- prevent exposure to sun
- do not take St.John’s wort
TCAs (tricyclic antidepressants)
blocks reuptake of NE (and serotonin)
has anticholinergic effects: dry mouth, difficulty voiding, decr GI mtoitliy, constipation
- may reduce seizure threshold
- reduce effectiveness of antihypertensives
- concurrent use w/ ETOH and antihistamines –> CNS depression
- concurrent use w/ MAOIs –> hypertensive crisis
- CV disturbances like tachycardia/drysrhythmias, ortho hypotension
- prevent exposure to sun
MAOIs
inhibition of MAO increases amines, NE, and serotonin
prescribed when other tx including ECT was not effective for depression
METALLIC TASTE
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)
Selegiline (Emsam)
- Hypertensive crisis –> concurrent use w/ amphetamines, antidepressants, dopamine, epinephrine, levodopa, methyldopa, nasal decongestants. NE foods w/ tyramine
- htn, occipital h/a radiating frontally, neck stiffness/soreness, N/V, clammy skin
ANTIDOTE: phentolamine
Foods to avoid:
- avocados, bananas, eggplant, figs, overripe fruit, papaya
- raisins, red wine
- liver, meat extracts and tenderizers, pickled herring, sausage, bologna, pepperoni, salami
- sour cream, yogurt
- soy sauce, brewer’s yeast
- broad beans
- caffeine, coffee, tea, chocolate
Lithium
mood stabilizer
- therapeutic: 0.6 - 1.2
- mild toxicity: 1.5 mEq/L
- apathy, lethargy, diminished conc, mild ataxia, coarse hand tremors, slight muscle weakness
- moderate toxicity: 1.5 - 2.5
- N/V, severe diarrhea, incoordination, slurred speech, tinnitus, blurred vision
- severe toxicity: >2.5
- nystagmus, DT hyperreflexia, visual/tactile hallucinations, oliguria, anuria, impaired LOC, tonic-clonic seizures or coma leading to death
Need to taper drug!! If missed, can take 2h later only or wait for next dose.
Levels are checked in morning 12h following last dose.
Benzodiazepines
antianxiety, sedative-hypnotic, muscle relaxing and anticonvulsant action
contraindicated in pt w/ acute narrow-angle glaucoma
abrupt w/d can be life-threatening
taper gradually 2-6 weeks
