2.11 PWB- 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 Fear of future
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)
Increased social isolation may be a contributing factor to suicide in the elderly (Townsend p. 763)
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
http://www.suicidology.org/resources/warning-signs
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. Citalopram (Celexa), Fluoxetine (Prozac), Sertraline (Zoloft), Escitalopram (Lexapro), Paroxetine (Paxil)
SNRI’s
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.
MAO’s
Tricyclic’s
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.
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
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.
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.
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.
Barbiturates not recommended in elderly r/t increased confusion due to long acting drug effects
Types of barbiturates
Phenobarbital
Amobarbital
