777 final review Flashcards
Anxiety
Mild- narrow focus, motivational
Moderate- concentration and focus reduces, not able to see things clearly.
Severe- Cannot function, Unable to comprehend surroundings, physical sx, needs concrete directs (“sit Down, Breathe with me!)
Panic-emergency-medication intervention
ANXIETY AGENTS (BENZODIAZAPINE)
Xanax Librium Valium Ativan Klonopin
ANXIETY AGENTS (BENZODIAZAPINE)
TARGET SYMPTOMS Agitation Severe anxiety Fears, phobias Alcohol withdrawal Panic disorder
ANXIETY AGENTS (BENZODIAZAPINE)
SIDE EFFECTS Drowsiness Dizziness Dependence/tolerance Toxicity increases with alcohol use Hypotension Slurred speech Decreased concentration
SUICIDE
Statistics:
High in men, 50 years and older, with high stress such as divorce or loss of job and
Suicide is one of the leading causes of death in adolescents and the elderly
SUICIDE ASSESSMENT
Depressed mood? Low self esteem? Hopelessness, Helpless? Guilt? Specific intent or plan? Realistic?
SUICIDE Assess suicide potential?
Method or means – May people who are n similar situations to you think about not wanting to live…Has that ever happened to you?“ Have you thought about taking your life?”
Specificity - “Do you have specific plan?“
Availability-“Do you have the means available?”
Assess suicide potentiel…protective fx
Lethality?
High risk factors: depression; past suicide attempts; drug abuseisolation/withdrawal; disoriented/disorganized; hostility
Psychosis
PSYCHOSIS: symptom state that refers to the presence of reality misinterpretations, disorganized thinking, and lack of awareness regarding true and false reality.
Psychotic Disorders
Schizophrenia spectrum and other psychotic disorders:
Schizophrenia
Other psychotic disorders
Schizotypal (personality) disorder
Defined by abnormalities in 1 of the following 5 domains
Delusions
Hallucinations
Disorganized thinking
Grossly disorganized or abnormal motor behavior, including catatonia
Negative symptoms
SCHIZOPHRENIA spectrum
Signs and symptoms:
Mood- anxiety, poor self-esteem,
Affect - flat or inappropriate,
Thought - loose associations, delusions, hallucinations, ideas of reference, neologisms, word salad, echolalia
Behavior – isolation, withdrawal, poor level of functioning
SCHIZOPHRENIA spectrum
Positive Symptoms: bizarre behavior
hallucinations, delusions, loose
associations, disorganized thinking
Negative Symptoms: depression
slowed thought, poor spontaneity
flat affect, loss of drive apathy
First Generation Antipsychotic meds
Thorazine
Haldol (deconate)
Navane
Prolixin (deconate)
Dopamine blocker
No antidepressant effect
Less weight gain, cheaper, musculoskeletal side effects, TD, EPS
Second generation MEDICATIONS
Risperdal (Consta) Seroquel Abilify (Maintena) Zyprexa Geodon *Less side affect profile - safer drugs Metabolic Sx- Diabetes
ANTIPSYCHOTIC Meds (Anticholinergic Side Effects)
Drowsiness Hypotension Dry mouth Blurry vision Constipation Decreased urination Photosensitivity Weight gain Amenorrhea Inhibits sexual desire and performance
MEDICATIONS
Antipsychotic
Clozaril
↓ WBC
Agranulocytosis
ANTIPSYCHOTIC SIDE EFFECTS
Extrapyramidal:
Pseudo-parkinsonism – tremors, mask like face, drooling
dystonia (muscle spasm)
akathisia (motor restlessness)
tardive dyskinesia (sometimes irreversible, abnormal, involuntary movements)
NEUROLEPTIC MALIGNANT SYNDROME (NMS)
Rigidity Hyperthermia Elevated CPK Changes in levels of consciousness Hyperthermia Tachycardia Diaphoresis Elevated white count Tachypnea
Anti-Parkinson Medications (Cogentin, Artane, Benadryl)
Treats: Rigidity, stiffness Restlessness (akathisisa) Tremor Muscle spasm in face, neck, back (dystonia) Motor retardation (akinesia)
SIDE EFFECTS OF ANTIPARKINSON Medication
Dry mouth Blurry vision Constipation Decreased urination Confusion Agitation
MEDICATIONS
Anti Anxiety - Benzodiazapine
Valium Librium Xanax Klonopin Ativan
Addictive
Sedating
PERSONALITY DISORDERS , ANTISOCIAL
Inability to delay gratification Inability to conform to norms of society Seeks pleasure Lacks satisfying, fulfilling, interpersonal relationships Lacks capacity for concern over others Does not feel guilt
PERSONALITY DISORDERS , BORDERLINE
Physically self-damaging acts Unstable affect Chronic feeling of emptiness boredom Lack of tolerance for being alone Intense, unstable relationships
Substance Use Disorder (SUDs)
- Failure to fulfill major role obligations
- Physically hazardous situations of use
- Social and interpersonal problems
- Cravings
- Tolerance
- Withdrawal
- Larger amounts/longer time period
- Desire to cut down/control use
- Great amount of time spent to obtain/use/recover
- Activities given up
- Psycholgoical/physical problems
Substance Use D/Os:
Substance-Use D/Os: Use and Induced (10 separate)
1. Alcohol-Use D/Os
2. Caffeine-Use D/Os
3. Cannabis-Use D/Os
4. Hallucinogen- Use D/Os
5. Inhalant-Use D/Os
6. Opioid-Use D/Os
7. Sedative-, Hypnotic-, and Anxiolytic-Use D/Os
8. Stimulant-use D/Os (amphetamine & cocaine use D/O)
9. Tobacco –use D/Os 10. Other (or Unknown) Substance-Related Disorders
Non-Substance-Related D/O (includes one disorder)
Gambling Disorder
Psychoactive Substances
Alcohol Anxiolytics Amphetamines Caffeine Cannabis Cocaine inhalants Hallucinogens Inhalants Nicotine Opioids Phencyclidine (PCP) Sedatives, hypnotics and anxiolytics
SUBSTANCE USE D/O
Alcohol Use D/O
Pathological use that interferes with family, social life, work, health. Addiction is demonstrated by tolerance or withdrawal
Alcohol USE D/O
Symptoms of alcoholic type drinking
Obsessed with getting the drug Increased or decreased tolerance Gulping drinks, Blackouts Drinks alone Use as a medicine Drink or drug more than planned
ALCOHOL WITHDRAWAL
Observe for physical illness or withdrawal:
Occurs 6-48 hours after last drink.
Signs of withdrawal:
8-24 hours after last drink: anxiety, nervousness, irritability, mild tachycardia, hypertension, flushed face, GI upset, insomnia, lasts 48 hours or longer
ALCOHOL WITHDRAWAL
Alcoholic hallucinosis - 12-48 hours after stopping alcohol
Three to five days- DT’s - agitation, diaphoresis, temp above 100, increased pulse and B/P, dilated pupils, muscle spasm, frightening hallucinations, confusion, disorientation, convulsions, coma, death
ALCOHOL WITHDRAWAL
Administer librium or a similar drug (any other anti-anxiety minor tranquillizer) in decreasing amounts
Replace fluid and electrolytes, full diet, thiamine for alcoholics
Lighted room to prevent shadows and perceptual disturbances- well controlled, safe environment
Naltrexone
1st line…Opioid receptor blocker; cuts back craving and ‘reward’ of use
Side effects: Nausea, vomiting, decreased appetite, dizziness. Injection site (if using depot formulation)
Cons: will precipitate withdrawal in those with physiologic dependence on opioids
Disulfiram
great for patients with incredible adherence
Blocks aldehyde dehydrogenase, blocks breakdown of alcohol
With alcohol: flushing, headache, nausea/vomiting, palpitations, shortness of breath
Without alcohol: liver failure, metallic taste, neuropathy
*Must watch LFT’s!
AVOID in: Pregnancy, psychosis, severe heart disease
Topiramate
consider in pts on opioids or who cannot tolerate disulfiram
Potentiates GABA, inhibits glutamate. May reduce cravings Side effects: sedation, decreased appetite, weight loss, dizziness, tremor
Caution in renal disease
Opioids (Heroin, Morphine Oxycontin, Percocet)
Opium, opium derivatives and synthetic substitutes
Sedative/analgesic effect
Relief of pain, diarrhea, and cough relief
Tolerance and physiological and psychological dependence
Induce euphoria, lethargy and indifference to the environment
Opiate withdrawal
anxiety, muscle twitches, hot & cold flashes, restlessness, lacrimation, rhinorrhea, dilated pupils, mild hypertension, yawning, piloerection, perspiration, abdominal cramps-10-15 hours after last use - vomiting, diarrhea, tremors last several days
Withdrawal from Opiates
yawning, rhinorrhea, piloerection, perspiration, lacrimation, mydriasis, tremors (hands), hot & cold flashes (shivering/huddling for warmth), restlessness, vomiting, muscle twitches, diarrhea, abdominal cramps (holding stomach/curled up position), anxiety (range: mild-severe)
Naltrexone forOpioid Use Disorder
Most ideal pharmacologic treatment
Requires detoxification before initiation or severe withdrawal will be precipitated
Risk of OD if medication stopped
In general poor patient compliance (? Better with long-acting injection) but superb treatment for selected patients
Opioid MAT Tx
MEDICATIONS - Opioids
Methadone
Buprenorphine
Methadone Pharmacokineticsand Dosing
Rapidly absorbed Peak Levels in 4 hours t1/2 (half life) =24 hours Metabolized in liver (p450 3A/4) Doses should be individualized but higher doses generally more effective (≈80-120mg)
Buprenorphine
Poor oral bioavailability (give s/l) Slow onset Long duration Slow offset 24- hour half life
Cocaine/ Amphetamines
Activity while intoxcated – mimics mania – hyperactivity, wt loss, hypersexuality
Withdrawal symptoms are depression, anxiety, hypersomnia, anergia, wt gain, paranoia
May treat with antidepressants
SUBSTANCE USE
LSD - makes time pass slowly, causes sounds in color, vivid hallucinations.
PCP - violence, antisocial behavior, hypertension
Nicotine - Benefits of Stopping
Live longer Reduce CV risk after MI by > 1/3 over 5 years Reduce cancer risk Improve lung function Reduce risk of infections Decreased risk for DMII Reduce risk of hip fractures Decrease reproductive disorders Etc.
Smoking reduction vs cessation?
Maybe helpful for heavy smokers-controversial
Smokers often compensate-longer puffs, etc.
Varenicline (Chantix)
A4B2 nicotinic cholinergic receptor (nAChR) partial agonist
Mimics the action of nicotine & prevents withdrawal symptoms
Side effects: GI upset, psychiatric changes
Bupropion (zyban)
Antidepressant that is also a partial agonist at nAChR and inhibitor of dopamine reuptake
Helps reduce withdrawal symptoms.
Tremor, anxiety.
Nicotine Replacement (gum, lozenge, inhaler, patch)
Replaces nicotine, without additives of tobacco. Often used as a combination of patch (long acting ‘basal’ nicotine level) and gum or lozenge for break through cravings.
Anxiety, restlessness, GI upset, tremor, sleep disturbance
SUBSTANCE USE
Other substances:
Inhalants- affects lungs & liver
Cocaine - Red excoriated nostrils – manic like behavior
Barbiturate abuse - sluggish, ataxia, irritability, seizures.
12 step/Alcoholics Anonymous (AA)
A support group for alcoholics
Al-Anon and Al-Ateen are groups for spouses, parents, and teenagers who are involved with alcoholics.
The focus is on helping these non-alcoholics learn to live and work effectively with alcoholics. The underlying belief is that family members often assume the role of enablers or co-alcoholics, perpetuating the alcoholic’s drinking patterns.
As the family attempts to adjust to the alcoholic’s lifestyle, they develop behavioral and emotional problems. Protected by the enabler, the alcoholic is spared the consequences of his or her alcoholism. The alcoholic blames he enabler and the enabler feels guilty and attempts to control family life and the behaviors of the alcoholic, e.g., throwing out liquor, taking the car keys. This does not work. Consequently, enablers feel worthless and helpless because they are unsuccessful in terminating the alcoholism.
NA is Narcotics Anonymous
12 Steps of AA
Cognitive Disorders
Delirium Acute and reversible Sudden onset Signs and Symptoms: Disorientation- speech incoherent Clouding of consciousness Impaired judgment, memory Perceptual impairment- illusions, hallucinations, misinterpretation
Dementia
Chronic and irreversible
Insidious onset
death of neurons
Associated Symptoms:
a. Anxiety-Depression
b. Irritability
c. Shame
d. Decreased control over sexual and aggressive impulses
Dementia
Impairment in: abstract thinking, judgment, impulse control and social conduct Behavior is uninhibited, inappropriate Personal hygiene is neglected Language may or may not be affected aphasia
Personality changes are common
For the most part dementia is PROGRESSIVE, it does not resolve, except in rare instances
Apraxia
Mood is irritable
Difficult comprehending their limitations
Dementia Tx
Support medical treatment and physical status
Provide for adequate nutrition, fluids, rest
Maintain safety factors (lighting, etc)
Foster optimum functioning and independence
Assist with or limit the need to make choice
Use matter of fact attitude with deficits and deterioration - focus on strengths
Eating Disorders
Anorexia (hunger is denied yet there are constant thoughts of food) with weight loss of 25% of total body weight
Distorted attitude toward eating, food, or weight (almost to the point of being delusional)
ANOREXIA - symptoms
Calorie restriction Bulimia - binging Lanugo (fine, downy hair covering body) Amenorrhea and sexual organ atrophy Overactivity Bradycardia Vomiting after meals (patient feels guilty that she ate) Use of laxatives
Bulima
Client- Normal or overweight Binge eating High calorie High Sugar food May be followed by “Purging” Purging- vomiting, enemas, laxatives
Client may have gastric or dental sx evidence of disorder
Client tends to hide the binge eating.
Termination of a binge because of abdominal pain, onset of sleep, interruption by others or self-induced vomiting.
Binge-Eating Disorder
Eating much more rapidly than normal.
Eating until feeling uncomfortably full.
Eating large amounts of food when not feeling physically hungry.
Eating alone because of feeling embarrassed by how much one is eating.
Feeling disgusted with oneself, depressed, or very guilty afterward.
Marked distress regarding binge eating is present.
Attention Deficit Hyperactivity Disorder
Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
Hyperactive-impulsive type
Inattentive type
Combined type
Epidemiology
5% of children, 2.5% of adults
Most frequent psychiatric disorder in childhood
Most cultures
More frequent in males by 2:1 ratio in children and 1.6:1 in adults
Females more likely to have inattentive features
Diagnostic Features
Persistent pattern of inattention and/or hyperactivity-impulsivity
Interferes with functioning or development
Begins in childhood
Manifestations of the disorder present in more than one setting
Symptoms vary depending on setting
