Tiêu đề COMPRE: HANDOUTS - PSYCH (Mr. Arzadon) SC ✅

1 TOPRANK REVIEW ACADEMY - Prof. Kenneth Arzadon, RN Early sign of Schizophrenia: ✓ Neglect of hygiene ✓ Loss of interest in school and work Catatonic stupor – waxy flexibility Catatonic excitability – agitation, restlessness Mood – internal and subjective emotion Affect – external expression of emotion PSYCHIATRIC NURSING COMPREHENSIVE REVIEW PHASE - Prof. Kenneth Arzadon, RN SCHIZOPHRENIA BIOLOGIC THEORY Neuroanatomy: less CSF and brain tissue Neurochemistry: ↑DOPAMINE AND SEROTONIN Social Causation Hypothesis: ↓ income = ↑ stress level Diagnostic Criteria: 2 or more symptom (≥ 1 month) • Hallucinations • Delusions • Disorganized speech • Disorganized behavior • Negative symptoms SIGN AND SYMPTOMS OF SCHIZOPHRENIA POSITIVE Signs (cause: ↑DOPAMINE) Hallucinations – false perception • Auditory (MOST COMMON and MOST DANGEROUS!) • Visual Delusions – false belief o Grandiose – superiority or invulnerability o Persecutory – “to be harmed by others” o Somatic – bodily functions are abnormal o Nihilistic – a part of the body is missing o Erotomania – “a person is in love with her/him.” Ideas of Reference / Referential delusion – giving meaning to events or actions of others o Circumstantiality – fullness of detail o Tangentiality – lack of focus o Looseness of Association - fragmented ideas o Flight of Ideas –jumping from one topic to another o Neologisms – coining of new words o Schizophasia – word salad o Clang associations – rhyming of words o Echolalia – repeating words of others o Palilalia – repeating own words o Verbigeration – repeating phrases NEGATIVE Signs of Schizophrenia (cause: ↑SEROTONIN) Asociality – lack of relationships Avolition – lack of motivation Anhedonia – lack of pleasure Alogia – lack of speech Absence of movement – catatonic stupor Abnormal Affect Flat - no emotion response Blunt - minimal emotional response Restrictive - single emotional response La bile - sudden shift of emotions Inappropriate – emotions don’t match the situation 4As of Schizophrenia (Prof. Eugene Bleuler, 1900’s) Autism – indifference Ambivalence – 2 opposing feelings Associative looseness – fragmented thoughts Abnormal affect Related Disorders: Brief Psychotic Disorder – psychosis (<1 month) Schizophreniform – psychosis (1 – 6 months) Shared Psychotic Disorder (Folie à Deux) - 2 or more people sharing similar delusion
2 TOPRANK REVIEW ACADEMY - Prof. Kenneth Arzadon, RN NEUROLEPTICS / ANTIPSYCHOTICS 1 st generation 2 nd generation 3 rd generation Typical / Conventional MOA: ↓ DOPAMINE Indication: + signs Chlorpromazine Thioridazine Fluphenazine HALOPERIDOL Atypical MOA: ↓ DOPAMINE / SEROTONIN Indication: + / - signs Olanzapine Risperidone Quetiapine Ziprasidone Clozapine Lurasidone Dopamine System Stabilizers MOA: regulates receptors Indication: + signs Aripiprazole Brexpiprazole Depot Treatment / Long Term Injection (LTI) Indication: non-compliance Common cause: side effects, memory problem SIDE EFFECTS OF ANTIPSYCHOTICS Constipation – increase fluid, fiber in the diet Agranulocytosis – Monitor ____________, report any signs of infection (fever, sore throat) Tooth decay – sugarless hard candy or gum Dry mouth – sugarless hard candy or gum to stimulation salivation Orthostatic hypotension – change position gradually Galactorrhea – use cotton underwear Photosensitivity – avoid direct sunlight, use umbrella and sunglasses, apply SPF 25 lotion Arrhythmias – immediately report abnormal heart beat Weight gain – lessen intake of sugary food and beverages Sedation – avoid driving and operating machineries EXTRA PYRAMIDAL SYNDROME Cause: ↓dopamine (1st and 2nd generation neuroleptics) Nursing Action: Notify the physician, DO NOT discontinue to prevent relapse! Intervention: Decrease the dose, shift to another generation NEUROLEPTIC MALIGNANT SYNDROME TARDIVE DYSKINESIA Muscle spasms laryngeal spasms → airway obstruction → DEATH Hyperthermia Hypertension Nursing Action: Discontinue the Medication Treatment: dantrolene, baclofen (muscle relaxants) Prevention: Hydrate the patient Delayed involuntary movements (after 6 months) Tongue protrusion Tongue twisting Teeth grinding Lip Smacking Nursing Action: Notify the physician Treatment: Ingrezza (valbenazine) Prevention: Start with the lowest dose Treatment: Akineton (biperidine) Benadryl (diphenhydramine) Cogentin (benztropine) Dystonia Oculogyric crisis Torticollis Dystonia – uncontrollable muscle spasms Akathisia – restlessness, intense need to move Pseudoparkinsonism – tremors and unstable gait
3 TOPRANK REVIEW ACADEMY - Prof. Kenneth Arzadon, RN Diagnostic criteria: ≥5 symptoms lasting for ≥ 2 weeks which impairs educational, social, and occupational functioning Difficulty thinking Insomnia/Hypersomnia Weight loss/gain (5%) Anhedonia (lack of pleasure) Guilt feeling Anergia (lack of energy) Suicidal thoughts MAJOR DEPRESSIVE DISORDER Exogenous: Loss, self-reproach, self-depreciation Endogenous: ↑ SEROTONIN and NOREPINEPHRINE Defense Mechanism: Introjection Initial Sign: Sleeplessness Hallmark sign: Hopelessness, Helplessness, Worthlessness ANTIDEPRESSANTS MONOAMINE OXIDASE INHIBITOR (MAOI) PARNATE MARPLAN NARDIL ELDEPRYL tranylcypromine isocarboxazid phenelzine selegiline Nursing considerations: Tyramine + MAOI = Hypertension Avoid TYRAMINE-rich foods Frozen, Fermented, Preserved Dried, Pickled, and Overripe Fruits Aged-cheese (Cheddar, Parmesan) TRICYCLIC ANTIDEPRESSANTS (TCA) TROFRANIL ANAFRANIL ELAVIL PAMELOR SINEQUAN imipramine clomipramine nortriptyline amitriptyline doxepin Side effect: ANTICHOLINERGIC stimulation Adverse effect: Tachycardia Sign of toxicity: Bradycardia SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI) ZOLOFT PAXIL LUVOX PROZAC LEXARPO CELEXA sertraline paroxetine fluvoxamine fluoxetine escitalopram citalopram Side effects: Sexual dysfunction (impotence) Gastrointestinal upset (nausea) SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS (SNRI) CYMBALTA EFFEXOR venlafaxine duloxetine Side effect: ↑Blood Sugar ↑ Cardiac Rate ATYPICAL ANTIDEPRESSANTS WELLBUTRIN DESYREL REMERON bupropion trazodone mirtazapine Side effect: Dry mouth, tiredness, dizziness
4 TOPRANK REVIEW ACADEMY - Prof. Kenneth Arzadon, RN a. As prescribed b. Before meals c. With meals d. Morning a. Bedtime b. Early morning c. After breakfast d. Same time each day ANTIDEPRESSANTS Dosage: Start with the lowest dose to prevent dependence and tolerance Best time to take: Morning with meals (some may cause insomnia) Note: time may depend of the side effect reported by the patient Effectivity: _____________________________________ Early indication of effectiveness: increased activity levels TO PREVENT RELAPSE: Continue taking antidepressants for _________________ even the client already feels better. Discontinuing: TAPER! (↓ dose gradually) Shifting: Wait for 5 – 6 weeks (wash-out period) NOTE: DO NOT COMBINE ANTIDEPRESSANTS to prevent serotonin syndrome Electroconvulsive Therapy (Last Resort) Indication: when medications are ineffective, acute suicidal crisis Contraindications: presence of metals (jewelries, pacemaker) Mechanism of Action: unknown (believed to balance neurochemicals in the brain) Frequency: every other day (6 – 15 sessions) Pre-Meds: Succinylcholine (muscle relaxant) Atropine Sulfate (Anti-cholinergic) – to ↓ secretions Methohexital (Anesthesia) Voltage: 75 to 450 Volts Effect: Grand Mal Seizure Duration of seizure: 30 – 60 seconds Side effect: Retrograde Amnesia Nursing Responsibilities BEFORE: NPO post-midnight AFTER: turn the client to the side clean oil from the head reorient the patient DISCONTINUE anticonvulsant Insert bite guard PRIORITY: Assess respiratory status! NOTE: PREGNANCY IMPORTANT REMINDER! PSYCHOTROPICS: Antipsychotics Antidepressants Antimanic Anxiolytics ✓ Begin with the lowest effective dose to prevent tolerance and dependence ✓ DO NOT double dose ✓ DO NOT discontinue anytime ✓ To discontinue: Taper! Decrease dose gradually ✓ Missed dose: catch up? – depends! SEROTONIN SYNDROME signs of hyperstimulation Diaphoresis Elevated temperature Anxiety Diarrhea Clonus Hypertension Agitation Restlessness Tachycardia