Transcript Unit16 - Faculty Sites

Mental Health Nursing II
NURS 2310
Unit 16
Psychiatric/Mental Health
Treatments and
Interventions
Key Terms
Psychotropic medication = affects psychic
function, behavior, or experience; effects
the neuronal synapse, producing changes in
neurotransmitter release and the receptors
they bind to
Neurotransmitter = a chemical that is stored
in the presynaptic neuron and is released by
an electrical impulse through the neuron
Receptor = molecules situated on the cell
membrane that are binding sites for
neurotransmitters
Antianxiety Agents
Used for preoperative sedation and to treat
anxiety disorders, acute alcohol withdrawal,
muscle spasms, and convulsive disorders
 Depresses the CNS; all levels can be affected
 Classes of anxiolytics include antihistamines
(hydroxyzine/Vistaril), benzodiazepines
(alprazolam/Xanax, lorazepam/Ativan), and
miscellaneous agents (buspirone/Buspar)
 Side effects include drowsiness, confusion,
and lethargy; paradoxical excitement or blood
dyscrasias may also occur with use

Effects are increased when used with alcohol,
narcotics, barbiturates, antipsychotics, and
antidepressants; effects are decreased when
used with nicotine and/or caffeine
 Physically and psychologically addicting
 Abrupt withdrawal may be life-threatening;
withdrawal symptoms include depression,
insomnia, increased anxiety, tremors,
vomiting, sweating, convulsions, and delirium
 Exception is buspirone (Buspar), which does
not depress the CNS and has no addiction
potential; has a delayed onset of 10 days – 2
weeks, so cannot be used as a PRN

Antidepressants
Used to treat depressive disorders,
alcoholism, schizophrenia, intellectual
developmental disorder
 Elevates mood and alleviates other symptoms
associated with depression
 May decrease the seizure threshold
 May increase suicide potential (watch for
sudden lifts in mood)
 Side effects common to all antidepressants
include dry mouth, sedation, and nausea;
discontinuation syndrome may occur as a
result of abrupt withdrawal (taper gradually)

Tricyclics
Blocks the reuptake of norepinephrine,
serotonin, and/or dopamine
 Examples: amitriptyline (Elavil),
clomipramine (Anafranil), imipramine
(Tofranil), nortriptyline (Pamelor)
 Side effects specific to tricyclics include
blurred vision, constipation, urinary
retention, orthostatic hypotension, weight
gain, tachycardia, and photosensitivity
 Effects are increased when taken with
buproprion, Haldol, SSRIs, and Depakote

Selective Serotonin Reuptake
Inhibitors (SSRIs)
Blocks the reuptake of norepinephrine,
serotonin, and/or dopamine
 Examples: fluoxetine (Prozac), sertraline
(Zoloft), citalopram (Celexa), paroxetine
(Paxil), escitalopram (Lexapro)
 Side effects specific to SSRIs include insomnia,
agitation, headache, and sexual dysfunction
 Interacts with alcohol (mental/motor skill
impairment); use with buspirone, tryptophan,
lithium, and amphetamines may result in
serotonin syndrome (mental changes)

Miscellaneous Agents

Examples: bupropion (Zyban, Wellbutrin),
mirtazapine (Remeron), trazodone (Desyrel),
venlafaxine (Effexor), duloxetine (Cymbalta)
Monoamine Oxidase Inhibitors
(MAOIs)
Inhibits the release of monoamine oxidase
enzymes that inactivate norepinephrine,
serotonin, and/or dopamine in the body
 Examples: isocarboxazid (Marplan),
phenelzine (Nardil), tranylcypromine
(Parnate)

Use with narcotic analgesics may cause hyperor hypotension, convulsions, coma or death
 Concurrent use of antidepressants,
amphetamines, vasoconstrictors, or foods
containing tyramine may cause hypertensive
crisis (marked increase in blood pressure,
severe occipital headache, palpitations, coma)

– Foods containing tyramine include aged cheese,
smoked/processed meat, chicken, raisins, red
wine, caviar, pickled herring, corned beef, beef
liver, soy sauce, brewer’s yeast, and MSG

Should not be used within 2 weeks of an
adverse agent, or within 5 weeks of Prozac
Mood-Stabilizing Agents
Used to treat bipolar disorder
 Enhances reuptake of norepinephrine and
serotonin, thereby decreasing their levels in
the body (results in decreased hyperactivity)
 Classes of mood-stabilizing agents include
antimanics (lithium carbonate/Eskalith),
anticonvulsants (clonazepam/Klonopin,
valproic acid/Depakote), calcium channel
blockers (verapamil/Isoptin), and
antipsychotics (olanzapine/Zyprexa,
aripiprazole/Abilify, risperidone/Risperdal)

Lithium Carbonate
Very narrow margin between therapeutic and
toxic levels
 Lithium toxicity can be life-threatening
(symptoms include blurred vision, ataxia,
persistent nausea/vomiting/diarrhea,
psychomotor retardation, mental confusion,
seizures, coma, and cardiovascular collapse)
 Fluoxetine, loop diuretics, and decreased salt
intake can increase risk of lithium toxicity;
carbamazepine, Haldol, and methyldopa can
increase risk of neurotoxicity; verapamil may
decrease serum lithium level or result in
lithium toxicity

Antipsychotic Agents
Also called neuroleptics
 Used to treat psychosis and/or increased
psychomotor activity
 Blocks postsynaptic dopamine receptors in
the brain
 Reduces the seizure threshold
 Routine ECG should be completed prior to
initiation due to potential for heart damage
(prolonged QT interval)
 Categorized as typical and atypical

Examples of typical antipsychotics:
haloperidol/Haldol, chlorpromazine/Thorazine,
fluphenazine/Prolixin, and thioridazine/Mellaril
 Examples of atypical antipsychotics:
risperidone/Risperdal, clozapine/Clozaril,
olanzapine/Zyprexa, quetiapine/Seroquel,
ziprasidone/Geodon, and aripiprazole/Abilify
 Side effects common to all antipsychotic
agents include extrapyramidal symptoms
(EPS), dry mouth, blurred vision, constipation,
nausea/GI upset, skin rash, sedation,
orthostatic hypotension, photosensitivity,
amenorrhea, and weight gain

Extrapyramidal Symptoms (EPS)
Pseudoparkinsonism = tremor, shuffling gait,
drooling, rigidity
 Akinesia = muscle weakness
 Akathisia = continuous restlessness and
fidgeting
 Tardive dyskinesia = bizarre facial and
tongue movements, stiff neck, and difficulty
swallowing; all long-term clients are at risk,
and the symptoms are potentially irreversible
even if the medication is discontinued

Dystonia = involuntary muscular movements
or spasms of the face, arms, legs, and neck
 Oculogyric crisis = uncontrolled rolling back of
the eyes; may appear to be seizure activity
*These are medical emergencies that are
treated with IV or IM benztropine (Cogentin)
 Neuroleptic malignant syndrome =
hyperpyrexia (up to 107 degrees), severe
muscle rigidity, tachycardia, stupor/coma;
potentially fatal; treated with Parlodel and
immediate discontinuation of antipsychotic
agent

Use of atypical antipsychotics may cause
hyperglycemia/diabetes; should assess BMI,
blood glucose, and weight regularly
 Agranulocytosis, a potentially fatal blood
disorder in which WBCs drop to extremely low
levels) may occur with use of Clozaril;
baseline WBC count must be completed
before initiation of medication
– WBC count done weekly for first 6 months,
biweekly for next 6 months, and monthly
thereafter
– Supply only given until next test is due

Sedative-Hypnotics
Used to treat anxiety and insomnia
 Causes generalized CNS depression
 Potential for psychological and/or physical
dependence, and may produce tolerance
with chronic use
 Classes of sedative-hypnotics include
barbiturates (secobarbital/Seconal),
benzodiazepines (temazepam/Restoril), and
miscellaneous agents (zolpidem/Ambien,
zaleplon/Sonata, eczopiclone/Lunesta)

Additive effect (CNS depression) when used
with antihistamines, antidepressants,
alcohol, or other CNS depressants
 Should not be used with MAOIs
 Use of barbiturates may decrease the
effectiveness of drugs metabolized by the
liver

Attention-Deficit/Hyperactivity
Disorder (ADHD) Agents
Used to treat ADHD in children and adults
 Increases the levels of neurotransmitters in
the body and stimulates the CNS
 Classes of ADHD agents include
amphetamines (dextroamphetamine
sulfate/Dexedrine), amphetamine mixtures
(dextroamphetamine/Adderall), and
miscellaneous agents
(methylphenidate/Ritalin and Concerta,
atomoxetine/Strattera, buproprion/Wellbutrin)

Tolerance develops rapidly; should not be
withdrawn abruptly
 Should not be used within 14 days of an MAOI
 Side effects common to all ADHD agents
include overstimulation, restlessness,
insomnia, palpitations, tachycardia,
anorexia/weight loss, nausea/vomiting,
constipation, and new/worsened psychiatric
symptoms
 Buproprion is contraindicated in clients with
seizure disorder
 Atomoxetine may cause severe liver damage

Electroconvulsive
Therapy
Involves the induction of a grand mal
seizure through the application of electrical
current to the brain
 Appropriate for the following conditions:

– Acute suicidality
– Severe depression
– Psychotic symptoms
– Psychomotor retardation
– Neurovegetative changes (disturbances in
sleep, appetite, and energy)

Only considered as a final treatment
measure

Side effects and risks:
– Temporary memory loss that lasts
approximately 30 minutes
– Confusion
– Mortality
 2 : 100,000
 Results from heart attack or stroke in already
compromised clients
– Permanent memory loss specific to the
time surrounding treatment
– Brain damage due to oxygenation issues
Psychotherapy
Takes place on a one-to-one basis between
a client and a therapist (APRN, psychiatric
social worker, psychiatrist, psychologist, or
LMHP)
 Various modalities are used based on
condition being treated
– Psychoanalysis

 Client gains insight/understanding about
current relationships/behavior patterns by
confronting unconscious conflicts that surface
in the transference relationship w/therapist
 Includes methods such as free association,
dream analysis, hypnosis, and catharsis
– Assertiveness training
– Interpersonal psychotherapy
 Time-limited therapy developed for the
treatment of major depression
– Reality therapy
 Promotes the conviction that although an
individual is a product of the past, he/she
does not need to continue as its victim
 Based on power (self-empowering),
belonging, freedom, fun, and survival
 Hope is instilled when therapy does not dwell
on past failures, and client is able to look
forward toward a change in behavior
– Relaxation therapy
 Deep-breathing exercises
 Progressive relaxation
 Meditation
 Mental imagery
 Biofeedback
– Cognitive therapy
 Individual is taught to control thought
distortions that are considered to be a factor
in the development and maintenance of
mood disorders
 Goal is to provide symptom relief and identify
dysfunctional patterns of thinking
Behavior Modification
Uses operant conditioning to replace
undesirable behaviors with more desirable
ones through positive or negative
reinforcement
 Positive reinforcement

– rewarding good behavior

Negative reinforcement
– punishing bad behavior

Extinction
– removing the response (i.e. “time-out”)
Alternative/Complementary
Medicine
Alternative medicine = interventions that differ
from the traditional or conventional
biomedical treatment of disease; refers to an
intervention that is used instead of
conventional treatment
 Acupuncture
 Blue light/artificial light treatment
 Lifestyle/dietary changes
 Herbal medicine
 Chiropractic medicine
 Relaxation techniques
 Chelation therapy
Complementary medicine = therapeutic
intervention that is different from, but used in
conjunction with, traditional or conventional
medical treatment.
 Herbal medicine
 Acupressure/Acupuncture
 Diet/Nutrition
 Chiropractic medicine
 Massage
 Therapeutic touch
 Yoga
 Pet therapy