2.11 Psychological Well Being, Psych Illness Flashcards
Psychosocial Changes & Fears in Elderly
Loss of family & friends = loneliness & isolation Physical & functional changes Major life changes Health Problems Decreased hearing, vision, taste. Fear of future Loss of independence Fixed incomes healthcare costs Age discrimination
Psychosocial Changes & Fears in Elderly
Major life changes
Major life changes:
Death of spouse
Children grown don’t visit as much
Can’t perform physically they way they used to
Physical changes= incontinence, decreased hearing lead to avoidance of activities once enjoyed)
No longer working feel worthless not needed anymore
Behaviors Associated with Anxiety in Older Adult
Muscle tension
Restlessness
Avoidance of activities
Excessive worry
Procrastination in behavior or decision-making
Repeatedly seeking reassurance from others
Sleep disturbance
Difficulty concentrating “mind goes blank”
Non-Pharmacological Interventions for Anxiety & Isolation
Maintain calm nonthreatening approach to person (provides feeling of security)
Use simple words and brief messages.
Low stimuli
Teach relaxation techniques (deep breathing, meditation, exercise)
Stay with the person
Be honest keep all promises
Provide with glasses, hearing aids
Include in decision making as appropriate
Encourage social activities (eat in dining room, attend events)
Risk Factors for Depression & Suicide
Marital Status (single people double risk of suicide)
Gender (women attempt suicide more men succeed more)
Age (white males >80 years highest risk of all gender, age, and races)
Religion (non-religious higher risk)
Socioeconomic status (highest & lowest higher risk)
Ethnicity (#1 Caucasians, #2 Native Americans, #3 African Americans, #4 Hispanic,#5Asian)
Diagnosed mental disorder
Family history of suicide (not genetic)
Healthcare workers
Depressive Behaviors in Older Adult
Insomnia or oversleeping Low energy increased fatigue Restlessness or irritability Worthlessness/ hopelessness Poor concentration Difficulty making decisions Withdrawal from activities Threats of hurting self Appetite changes
Depressive Behaviors in Older Adult
IS PATH WARM
I- Ideation
S- Substance Abuse
P- purposelessness
A- Anxiety
T- Trapped
H- Hopelessness
W- Withdrawal
A- Anger
R- Recklessness
M- Mood changes
Warning Signs of Suicide
Be concerned if someone you know:
Talks about committing suicide
Withdraws from friends or social activities
Prepares for death by writing a will and making final arrangements
Gives away prized possessions
Takes unnecessary risks
Seems preoccupied with death and dying
Loses interest in his or her personal appearance
Increases alcohol or drug use.
Sudden change in behavior- depressed happy increase energy levels
Nursing Interventions for Suicidal Patient
Ask- “have you thought about killing yourself?” “Do you have a plan or method?” Create safe environment Formulate verbal contract Close observation irregular rounds Encourage expression of feelings Admin meds carefully- observe Identify causative factors Encourage verbalization of feelings Identify resources Provide expressions of hope “ I know you feel you cannot go on, but I believe things can get better for you. It is ok if you don’t see that now”.
Things to Consider with Antidepressant Meds in Elderly
Antipsychotic, antidepressant, & antihistamine meds produce anticholinergic effects: Confusion Blurred vision Constipation Dry mouth Dizziness Difficulty urinating
Elderly & dementia patients are at increased risk for these effects.
Medications for Depression in Elderly
Teach: Antidepressants take 2-8 wks, depending on med, for therapeutic effects to be seen
Classifications: SSRI’s- usually 1st line drug tx for depression in elderly r/t less side effects. SNRI’s MAO’s Tricyclic’s
Medications for Depression in Elderly
Selective Serotonin Reuptake Inhibitors
Selective Serotonin Reuptake Inhibitors (SSRIs) Citalopram (Celexa) Fluoxetine (Prozac) Sertraline (Zoloft) Escitalopram (Lexapro) Paroxetine (Paxil)
Medications for Depression in Elderly
Others
Others: Heterocyclics and Serotonin-Norepi Reuptake Inhibitors (SNRIs)
Heterocyclics:
Bupropion (Wellbutrin)
Mirtazapine (Remeron)
Trazodone.
SNRIs: Duloxetine (Cymbalta) Venlafaxine (Effexor) Fatal effects may occur with MAOIs. Increased risk of liver injury with alcohol. Altered effects of coumadin.
Medications for Depression in Elderly
Monoamine Oxidase Inhibitors (MAOIs)
Monoamine Oxidase Inhibitors (MAOIs)
Pheneizine (Nardil)
Isocarboxazid (Marplan)
Tranylcypromine (Parnate)
Fatal adverse reactions may occur with concurrent use of all other antidepressants. (Not within 2 weeks of each other)
Hypertensive crisis with vasoconstrictors, stimulants.
Hypotension with antihypertensives, diuretics or spinal anesthesia.
Hypoglycemia with insulin and oral hypoglycemics.
Hypertensive crisis with foods or products containing high tyramine.
Medications for Depression in Elderly
Monoamine Oxidase Inhibitors (MAOIs)
tyramine
HIGH levels: Smoked and processed meats (salami, bologna, pepperoni, summer sausage, caviar, corned beef, chicken or beef liver, soy sauce, brewer’s yeast, MSG).
Moderate levels: Beer, white wine, coffee, colas, tea, hot chocolate, meat extracts such as bouillon, chocolate.
Side effect:
Hypertensive crisis
Medications for Depression in Elderly
Tricyclic’s
Tricyclic’s
Amitriptyline (Elavil)
Doxepin (Sinequan)
Imipramine (Tofranil)
Contraindicated in acute recovery phase post MI and glaucoma
Hyperpyretic crisis (fever), seizures, and death may occur with MAOIs.
Hypertensive crisis with clonidine.
Medications for Depression in Elderly
Tricyclic’s
Side effects
Side effects: Blurred vision (subsides after a few weeks) Urinary retention Orthostatic hypotension Reduction of seizure threshold Photosensitivity Weight gain
Side effects of SSRIs and SNRIs:
Insomnia, agitation: NI- Administer in am, avoid caffeine, relaxation techniques
Headache- Analgesics
Weight loss
Sexual dysfunction
Serotonin syndrome (occurs minutes to hours of taking meds) Change in mental status, restlessness, hyperreflexia, shivering, tremors, diaphoresis, labile BP. Discontinue immediately.
**Don’t give 2 SSRI or SNRI’s together to decrease risk of serotonin syndrome
Anxiety Medications
Should not be used routinely or prolonged periods.
Benzodiazepines least toxic & most effective in elderly.
Anxiety Medications
Benzo’s
Benzo’s: Side effects: sedations, dizziness, ataxia, dependence
Diazepam (valium)
Alprazolam (Xanax)
Lorazepam (Ativan)- drug of choice r/t shorter half-life less side effects.
Barbiturate’s not recommended in elderly r/t increased confusion due to long acting drug effects
Types of barbiturates
Types of barbiturates
There are many different barbiturates. The primary difference among them is how long their effects last.
The effects of some of the long-acting drugs may last up to 2 days. Others are very short-acting. Their effects last only a few minutes.
Barbiturates can be injected into the veins or muscles, but they are usually taken in pill form.
The street names of commonly abused barbiturates describe the desired effect of the drug or the color and markings on the actual pill.
Phenobarbital, Amobarbital,
Bipolar Disorder AKA Manic Depressive
What Is Bipolar Disorder?
What Is Bipolar Disorder?
Mood swings from profound depression to extreme mania
Effects ability to carry out day-to-day activities
Onset late teens to early adult usually before age 25
Causes: Unknown may have genetic tendencies
Substance abuse often associated behaviors of Bipolar Disorder
Bipolar Symptoms
Mania
Mania Elevated mood / irritability Psychotic features may be present Excessive motor activity Racing thoughts Impulsive Poor sleep Engages in high risk activity Unrealistic beliefs in abilities
Bipolar Symptoms
Depression
Depression Loss of interest in activities Sadness for long period of time Change in eating, sleeping, or other habits Hopelessness Difficulty concentrating & decisions Feeling tired or slow Thoughts of death or suicide attempts.
Bipolar Outcome Criteria
Important to monitor effectiveness of interventions:
Exhibits no physical injury
Not exhibiting signs of physical agitation
Accepts responsibility for behaviors
No manipulation of others for own gratification
Interacts appropriately with others
Increase focus on activities
Sleeps 6-8 hours without medication.
Schizophrenia
Greek “skhizo” (split) and “phren” (mind)
A serious mental illness characterized by incoherent or illogical thoughts, bizarre behavior and speech, and delusions or hallucinations, such as hearing voices. Schizophrenia typically begins in early adulthood.
Schizophrenic Behaviors Delusion
Delusions
false beliefs that are not part of the person’s culture and do not change.
believing that neighbors can control their behavior with magnetic waves.
Schizophrenic Behaviors Hallucinations
Hallucinations
Things a person sees, hears, smells, or feels that no one else can
“Voices” are the most common type of hallucination in schizophrenia. Many people with the disorder hear voices.
NI for Hallucinations & Delusions & Aggression
Do not touch patient if you have to warn patient before. Touch may be considered threatening and elicit an aggressive response.
Convey attitude of acceptance. Encourage patient to share content of the hallucination/voices.
Speak quietly and calmly
Recognize behaviors that precede aggression & intervene prior to behavior.
Ask if they are hearing voices. “what do the voices tell you” (important to determine risk of injury to patient or others)
Overly friendly cheerful behavior creates suspiciousness “why are you being so cheerful? You must be out to get me” type reactions.
NI for Hallucinations & Delusions & Aggression
Attempt to distract the patient from the hallucination thru interpersonal interactions and explaining situation in attempt to bring back to reality.
Do not argue or deny the belief. “I believe you are hearing the voices but I do not hear them”
Develop trust
Avoid laughing, whispering, or talking quietly where the patient is
Provide food in closed containers and meds in packages for suspicious patients
Assertive matter-of-fact approach (do not respond well to friendly overly cheerful attitude)
Bipolar & Schizophrenia Treatment
see chart
Extrapyramidal Side Effects (EPS) of Antipsychotics
Extrapyramidal symptoms:
Pseudoparkinsonism (tremor, shuffling gait, drooling, rigidity). May appear 1-5 days of initiation.
Akinesia (muscular weakness)
Akathisia: (Continuous restlessness and fidgeting).
Dystonia: (involuntary muscular movements (spasms) of face, arms, legs, and neck).
http: //www.youtube.com/watch?v=Gjiy1rDZpp8
http: //www.youtube.com/watch?v=9WH3HPTChkQ severe dystonia
Oculogyric crisis (uncontrolled rolling back of the eyes)
Tardive dyskinesi
Tardive dyskinesia:
Bizarre facial and tongue movements, stiff neck, and difficulty swallowing.
Symptoms are potentially irreversible.
Drug should be stopped at the first sign; tongue movements.
Pill rolling, facial grimacing, eye blinking, pelvic rocking or involuntary hip movements.
http://www.youtube.com/watch?v=fLwZQBJs8fI
Neuroleptic Malignant Syndrome
Rare but potentially fatal complication of treatment with antipsychotic medications. (typical vs atypical antipsychotics)
Onset: hours to years of drug initiation
Rapid progression of s/s over 24-72 hours of onset.
Neuroleptic Malignant Syndrome Manifestations
Manifestations: Very high fever (hyperpyrexia) Muscle rigidity (lead pipe rigidity) Unstable blood pressure (fluctuations) Rapid deterioration of mental status, stupor, coma
Neuroleptic Malignant Syndrome Treatment
Treatment:
Discontinue antipsychotic med IMMEDIATELY!
Monitor vital signs, degree of muscle rigidity, LOC, I&O
Lower body temperature- implement cooling measures
Physician may order:
Dantrolene (skeletal muscle relaxant) to treat muscle rigidity.
IVF- to manage CV, renal failure potential complications.
