Exam II Flashcards
_____ is refusing to admit reality or what is really occurring
Denial
I.e. Alcoholic denies having a problem because they can still function or man puts plate at table for dead spouse
_____ is attributing one’s own unacceptable qualities or feelings and attributing them to another
Projection
I.e. Spouse angry at SI for not listening when they are the one not listening
_____ is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image (can’t view positive/negative as a whole)
Splitting
I.e. Pitting two people against one another
_____ is avoiding conscious experience of the emotion through impulse action
Acting out
I.e. Instead of feeling sad or angry a person gets drunk
_____ is the transformation of emotion into bodily symptoms
Somatization
I.e. Woman feels body aches and pains when husband goes out of town
_____ is reverting to an earlier more primitive and childlike pattern or behavior that may or may not have been previously exhibited.
Regression
Child wets bed after parents divorce
_____ _____ is taking up the opposite feeling, impulse, or behavior in order to reduce anxiety
Reaction formation
I.e. Treating someone you don’t like in a friendly manner to hide true feelings
_____ is the process in which the focus is on the intellectual component rather than the emotional or stressful emotion
Intellectualization
I.e. Person given terminal diagnosis, instead of expressing sadness they focus on all possible fruitless medical procedures
_____ is the unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness.
Repression
I.e. Child can’t remember abuse from parents
_____ is transference of emotions associated with a particular person, object, or situation to another non-threatening person, object, or situation
Displacement
I.e. Man gets angry at work and comes home and kicks dog
_____ is explaining an unacceptable behavior or feeling in a rational or logical manner
Rationalization
I.e. Didn’t get job because boss was playing favorites
_____ is avoiding emotional distress through an altered state of consciousness
Dissociation
I.e. Person can’t remember a block of time and doesn’t remember what happened
_____ is an attempt o take back an unconscious behavior or thought that is unacceptable or hurtful
Undoing
I.e. Send flowers after fight
_____ is a dedication to meeting the needs of others and gratification from the response of others
Altruism
I.e. Woman gives money to charity to help the homeless
_____ is counterbalance perceived deficiencies by emphasizing strengths
Compensation
I.e. Person who can’t cook but instead is very organized
_____ is pointing out funny or ironic aspects of a situation to express feelings
Humor
I.e. Uses self-deprecating humor to put others at ease
_____ converts unacceptable impulses into more acceptable impulses
Sublimation
I.e. A person with extreme anger goes t gym to box
_____ is the conscious removal of unwanted information out of awareness
Suppression
I.e. Elderly man caring for a dying spouse who feels chest pain ignores it so he can take care of her
_____ is the unconscious modeling of one’s self upon another persons character and behavior
Identification
I.e. 15 year old thinks she needs to act like her 21 year old sister by engaging in drinking and partying like her
What are the five principles of motivational interviewing?
Express empathy, Develop discrepancy, Avoid argumentation, Roll with resistance, Support self-efficacy
What are the signs of resistance?
Arguing,
Interrupting,
Ignoring,
Denying
Challenging, discounting and hostility are considered _____
Arguing
Talking over or cutting off are signs of _____
Interrupting
Inattention, not answering, not responding, and sidetracking are considered _____
Ignoring
Blaming, disagreeing, making excuses, claiming impunity, minimizing, being pessimistic, reluctance, and unwillingness to change are _____
Denying
What is CAGE and what does it stand for?
Screening for alcoholism
Has anyone asked you to Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt bad or Guilty about your drinking?
Have you ever had a drink first thing in the morning to get rid of hangover or steady your nerves (Eye opener)?
Stages of change
Precontemplation, Contemplation, Preparation, Action, Maintenance, Relapse
In _____ there is no intention of changing behavior
Precontemplation
In _____ a person is aware a problem exists but has no commitment to action
Contemplation
In ______ there is an intent to take action
Preparation
In the _____ stage a person is active in modifying their behavior
Action
In the _____ stage change is sustained and new behaviors replace old behaviors
Maintenance
In the ______ stage a person falls back into old patterns of behavior
Relapse
Intrusive thoughts, apprehension, uncertainty, dread and autonomic responses relating to the future is _____
Anxiety
_____ is a function of worry or thoughts about the past
Depression
Anxiety is most prevalent among which age group?
30-44
Which race and gender have higher prevalence of anxiety?
Non-Hispanic whites,
Female
What are the risk factors for anxiety?
Medical conditions,
Environment (culture, trauma),
Genetics (twins)
What are the brain structures affected by anxiety?
Amygdala, GABA
_____ occurs when a person feels anxiety about a situation such as the marketplace, bus station, or crowds, whereby the person perceives escape could cause embarrassment and/or be difficult
Agoraphobia
_____ is a problem that manifest with an abrupt, unexpected feeling of discomfort whereby cognitive and/or autonomic responses manifest
Panic
_____ is a persistent, recurrent thought, impulse, or image that causes distress or anxiety. A _____ is a repetitive behavior (handwashing, checking) and/or thought that a person uses to diminish, neutralize, or word off an obsession
Obsession,
Compulsion
This group of conditions is characterized by excessive worry and anxiety that occurs more days than not for a minimum of six months. The problem is chronic, symptoms may fluctuate and are exacerbated by stress.
Generalized anxiety disorder
This disorder causes problems with concentration, irritability, restlessness, sleep disturbances, and/or muscle tension may occur
What are medical conditions associated with anxiety?
Cancer, COPD, dysrhythmias, encephalitis, heart failure, hyperthyroidism, hypoglycemia, pneumonia, vestibular dysfunction, vitamin B 12 deficiency, Pheochromocytoma
What are the three phases of stress response?
Alarm (reaction to stress),
Resistance (organism performs self repair and stores energy),
Exhaustion
What are the benzodiazepine medications used for panic disorder, GAD, and social anxiety disorder?
Alprazolam (Xanax),
Lorazepam (Ativan),
Clonazepam (Klonapin)
Side effects include dizziness and sedation, alcohol is contradicted, potential for abuse
What are the SSRI medication is used for anxiety, OCD, panic attacks, GAD, PTSD, and social anxiety?
Sertraline (Zoloft), Citalopram (Celexa), Paroxetine (Paxil), Fluvoxamine (Luvox), Escitalopram (Lexapro)
Side effects are nausea, diarrhea, lightheadedness, sexual dysfunction
Which SNRI medications are used for performance anxiety, GAD, and social anxiety disorder?
Venlafaxine (Effexor)
Side effects include hypertension, nausea, diarrhea, lightheadedness, and sexual dysfunction
Which tricyclic medications are used for panic attacks, panic disorder, and GAD?
Imipramine (Tofranil)
Potential side effect is being jittery
Which MAOI medication is used to treat phobic disorder, GAD and social anxiety disorder?
Phenelzine (Nardil),
Tranylcypromine (Parnate),
Isocarboxazid (Marplan),
Selegiline (Eldepryl)-patch
Cancel side effects include insomnia, hypotension, and weight gain. A diet low in Tyramine reduces the risk for hypertensive crisis.
Which anticonvulsants are used for the treatment of social anxiety disorder, resistant panic disorders, and PTSD?
Gabapentin (Neurontin)-social anxiety disorder,
Divalproex (Depakote)-resistant panic disorders,
Topiramate (Topamax)-PTSD,
Lamotrigine (Lamictal)-PTSD,
Levetiracetam (Keppra)
Cognitive behavioral therapy is effective for which anxiety disorders?
In children/teens-
Separation anxiety disorder, OCD, phobias, and PTSD,
In adults-
Panic disorder, agoraphobia, social phobia, OCD, and PTSD
heightened senses, mild restlessness, sleeplessness, feelings of increased alertness and arousal are common in which level of anxiety?
Mild
Deep breathing, reassurance, relaxation techniques are good interventions
Voice tremors appear, Pitch changes, muscle tremors, facial twitches, shakiness, increase muscle tension, narrowed focus of attention, selective attentiveness, butterflies in stomach, slight increase in heart and respiratory rate (respirations mid 20s, heart rate low 100s) are present in which level of anxiety?
Moderate
Interventions include coaching, refocusing, and teaching; use
simple directions; deep breathing exercises
Communication difficult to understand, inability to relax, increased motor activity, fearful look, inability to focus, Rochen concentration, severely impaired learning, impaired judgment, easily distracted, tachycardia, hyperventilation, headache, dizziness, nausea, markedly increased vital signs (tachycardia 110-120s) are evident in which level of anxiety?
Severe
Interventions include firm redirection and consideration of medication
Pounding headache, trembling, loss of coordination, inability to learn, feeling of impending doom, hallucinations, delusions, palpitations, choking, chest pain, parasthesia, diaphoresis, dilated pupils, and loss of control are signs of which level of anxiety?
Panic
Interventions are primarily medication
St. John’s wort is helpful in treating _____ and _____
Depression, anxiety
_____ disorder is indicated with exaggerated and rigid traits that cause dysfunction with relationships.
Personality
Personality disorders associated with emotional, social, and occupational disability. It is often occurring with other psychiatric disorders.
Personality disorder traits are present from infancy but emerge during ____ ?
Adolescence
What are the risk factors for personality disorder?
Genetics, environment, childhood neglect, childhood trauma (harsh, erratic discipline; alcoholic parents; physical and sexual abuse)
Which cultural groups are more at risk for personality disorder?
Native and African-Americans, young adults, low socioeconomic status, divorced, separated, widowed, never married
What are the common traits with personality disorder?
Self identity and self direction, lack of empathy and intimacy, perception of nothing wrong, issues with interpersonal relationships and socialization (fear of rejection, lack of trust, fault finding)
What are the primitive/immature defenses for personality disorder ?
Attempt to control inner chaos, ambivalence and poor impulse control, Blurred personal boundaries, needs are experienced as rage, sexuality and dependency confused with aggression
What are the characteristics of borderline personality disorder?
Emotionally labile, fear of separation/rejection, impulsive and self-destructive, interpersonal difficulties, antagonistic, inability to forgive, no guilt, Engages in splitting behavior
What is the treatment plan for borderline personality disorder?
Work on affect/ behavior,
Mindfulness,
Medication (anticonvulsants for mood),
Low dose antipsychotics and omega 3
What are the characteristics of antisocial personality disorder?
Antagonistic (deceitful, manipulative for personal gain), Impulsive, Risk taking, Takes no responsibility, Not capable of intimacy, Lack of empathy
_____ personality disorder usually coexists with other mental illness, is associated with self-mutilization, and is a disruption from normal separation
Borderline
Those with _____ personality disorder are often referred to as sociopaths. They are associated with criminal activity and have lowered levels of serotonin and dopamine.
Antisocial
What is the treatment plan for antisocial personality disorder?
Typically involuntary admission for risk-taking behaviors, setting boundaries and realistic choices,
support,
off label meds for mood
What are the risk factors for antisocial personality disorder?
Inconsistent parenting/discipline,
Abuse/neglect
Higher incidence in African-American,
Environment
What are typical manipulative behaviors used by those with personality disorders?
Arguing or begging, Using flattery or seductiveness, Instilling guilt and clinging, Constant attention seeking, Pitting one person against another, Frequent disregard for rules, Constant engagement in power struggles, Exhibiting angry, demanding behaviors
What are the interventions for impulsive behavior for those with personality disorder?
Identify and discuss what proceeds impulsive acts,
Explore effects on self and others,
Recognize cues,
Identify triggers,
Discuss alternative behaviors,
Teach or refer the patient for coping skills training (i.e. Anger management, assertiveness skills)
What assessments are necessary for personality disorders?
- Assess for suicidal and homicidal thoughts,
- Determine whether the patient has a medical disorder or another psychiatric disorder,
- Consider ethical, cultural, social backgrounds,
- Assess for recent and important losses,
- Evaluate for strong negative emotions,
- Assess for substance-abuse
_____ is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences
Addiction
What are the acute effects of cannabinoids such as marijuana and hashish?
Euphoria, relaxation, slow reaction time, distorted sensory perception, impaired balance and coordination, increased heart rate an appetite, impaired learning and memory
What are the health risks of cannabinoids such as marijuana and hashish?
Anxiety, panic attacks, psychosis, cough, frequent respiratory infections, possible mental health decline, addiction
What are the acute effects of opioids such as heroin and opium?
Euphoria, drowsiness, impaired coordination, dizziness, confusion, nausea, sedation, feeling of heaviness in the body, slowed or arrested breathing
What are the health risks of opioids such as heroin and opium?
Constipation, endocarditis, hepatitis, HIV, addiction, fatal overdose
What are the acute effects of stimulants such as cocaine, amphetamines, methamphetamine?
Increased heart rate, blood pressure, body temperature, metabolism, feelings of exhilaration, increased energy, mental alertness, tremors, reduced appetite, irritability, anxiety, panic, paranoia, violent behavior, psychosis
What are the health risks of stimulants such as cocaine, amphetamines, methamphetamine?
Weight loss, insomnia, cardiac or cardiovascular complications, stroke, seizures, addiction
For cocaine: nasal damage from snorting
For methamphetamine: severe dental problems
What are the acute effects of the club drug MDMA (Ecstacy)?
Mild hallucinogenic effects, increased tactile sensitivity, empathetic feelings, lowered inhibition, anxiety, chills, sweating, teeth clenching, muscle cramping
What are the health risks of the club drug MDMA (Ecstacy)?
Sleep disturbances, depression, impaired memory, hypothermia, addiction
What are the acute effects of the club drug Flunitrazepam (roofies)?
Sedation, muscle relaxation, confusion, memory loss, dizziness, impaired coordination
Health risk: addiction
What are the acute effects of the club drug GHB (liquid Ecstacy, liquid X)?
Drowsiness, nausea, headache, disorientation, loss of coordination, memory loss
Health risks: unconsciousness, seizures, coma
What are the acute effects of dissociative drugs (Ketamine-Special K)?
Feelings of being separated from one’s body and environment, impaired motor function, analgesia, impaired memory, delirium, respiratory depression and arrest, death
Health risks: anxiety, tremors, numbness, memory loss, nausea
What are the acute effects of dissociative drugs (PCP-Angel Dust)?
Feelings of being separated from one’s body and environment, impaired motor function, analgesia, psychosis, aggression, violence, slurred speech, loss of coordination, hallucinations
Health risks: anxiety, tremors, numbness, memory loss, nausea
What are the acute effects of hallucinogens (LSD)?
Altered states of perception and feeling, hallucinations, nausea, increased body temperature, increased heart rate, increase blood pressure, loss of appetite, sweating, sleeplessness, numbness, dizziness, weakness, tremors, impulsive behavior, rapid shifts in emotion
What are the Health risks of hallucinogens (LSD)?
Flashbacks, hallucinogen persisting perception disorder
What are the acute effects of anabolic steroids?
None
What are the Health risks of anabolic steroids?
Hypertension, blood clotting and cholesterol changes, liver cysts, hostility and aggression, acne,
- in adolescents: premature stoppage of growth,
- in males: prostate cancer, sperm production, shrunken testicles, breast enlargement
- in females: menstrual regularities, development of beard and other masculine characteristics
What are the acute effects of inhalants?
Stimulation, loss of inhibition, headache, nausea or vomiting, slurred speech, loss of motor coordination, wheezing
What are the health risks for inhalants?
Cramps, muscle weakness, depression, memory impairment, damage to cardiovascular and nervous systems, and consciousness, sudden death
What neurotransmitter is craved buy those with addiction?
Dopamine
What are the signs and symptoms of uncomplicated or mild to moderate alcohol withdrawal?
Restlessness, irritability, lack of appetite, tremor, insomnia, impaired cognitive functions, mild perceptual changes
What are the signs and symptoms of severe alcohol withdrawal?
Obvious trembling of the hands and arms, sweating, elevated pulse (above 100), elevated blood pressure (greater than 140/90), nausea (sometimes with vomiting), hypersensitivity to noises and light, brief periods of hearing and seeing things that are not present, fever greater than 101°F
What are the medical complications of alcohol withdrawal?
Infections, hypoglycemia, G.I. bleeding, undetected trauma, hepatic failure, cardiomyopathy with an effective pumping, pancreatitis, encephalopathy
What are the signs and symptoms of opioid withdrawal?
Tachycardia, hypertension, hyperthermia, insomnia, Mydriasis (enlarged pupils), Hyperreflexia, diaphoresis, piloerection (goosebumps), increased respiratory rate, lacrimation (tearing), yawning, rhinorrhea, muscle spasms, abdominal cramps, nausea, vomiting, diarrhea, bone and muscle pain, anxiety
What are the signs and symptoms of short term stimulant intoxication?
Increased energy, decreased appetite, mental alertness, increased heart rate/pressure, dilated pupils
What are the signs and symptoms of long term stimulant intoxication?
Irregular heartbeat, chest pains, increased risk of heart attack, panic attacks, depression, delusions/hallucinations, skin sensation (cocaine bugs)
What are the signs and symptoms of stimulant withdrawal?
Depression, hypersomnia (or insomnia), fatigue, anxiety, irritability, poor concentration, psychomotor retardation, increased appetite, paranoia, drug craving
What are the five As for alcohol abuse intervention?
- Assess alcohol consumption with a brief screening tool,
- Advise clearly and specifically about effects of alcohol consumption,
- Agree on goals for reducing use or abstinence
- Assist in developing motivation, self-help skills, and supports
- Arrange follow-up, repeat counseling, or specialty referral
What does the acronym FRAMES stand for?
Feedback, Responsibility, Advice, Menu, Empathic, Self efficacy
Which medications are used for alcohol withdrawal?
Carbamazepine (Atretol, Tegretol), phenobarbital, diazepam (Valium), naltrexone (vivitrol)
Which neurotransmitter regulates reward and feelings of pleasure?
Dopamine
Which neurotransmitter signals craving after a dopamine crash
Glutamate
Which neurotransmitter regulates motor, emotion, motivation, and cognition?
Acetylcholine
Which neurotransmitter regulates arousal, attention, mood, and stress response?
Norepinephrine
Red flags to identifying addiction…
Appearance older than stated age, Undernourished, Failure of standard doses of sedatives to have therapeutic effect, Cognitive deficits, Withdrawal symptoms
What is the emergency management for opiate overdose?
Naloxone
Restores respiratory function by blocking opiate receptors
What are the nursing considerations when administering naloxone during potential opiate overdose?
Potential for violence attributable to panic and fear as consciousness is restored
When do signs of delirium tremens typically occur with acute alcohol withdrawal?
6-9 hours after last drink
What medications are administered for alcohol withdrawal?
Naltrexone (Vivitrol)-also reduces cravings,
Nalmefene (Selincro),
Acamprosate (Campral)
Disulfiram (Antabuse)-aversion therapy, makes sick when combined with alcohol
Which medications are administered to treat opiate withdrawal?
Methadone (Dolophine),
Buprenorphine (Butrans)-higher dosage, less side effects,
Clonidine (Catapres)-antihypertensive,
Suboxone (Buprenorphine/Naloxone)-combination drug, reduces potential abuse of Buprenorphine
Which medications are administered for nicotine withdrawal?
Nicotine (Habitrol, Nicoderm, Nicotrol)-gum or patch,
Bupropion (Aplenzin)-non-nicotine replacement, reduces cravings
What are the primitive/narcissistic defense mechanisms?
Denial,
Projection,
Splitting
What are the immature defense mechanisms?
Somatization,
Acting out,
Regression
What are the neurotic defense mechanisms?
Reaction formation, Intellectualization, Repression, Displacement, Rationalization, Dissociation, Undoing
What are the mature defense mechanisms?
Altruism, Compensation, Humor, Sublimation, Suppression, Identification
_____ is a medically managed inpatient program with 24 hour medical coverage while the patient’s body clears itself of drugs.
Detox
_____ programs are available as medically managed and medically monitored inpatient programs. The have 24 hour staff and can be for short or long term recovery of biomedical or psychiatric conditions.
Rehabilitation
These facilities offer residential treatment in a substance free communal or family environment. Residents typically live here but work outside the home.
Halfway houses
This intensive form of outpatient programming is for patients who do not require 24 hour care. Treatment in psychotherapy and educational groups on at least 3 days per week for a minimum of 10 hours per week is typical.
Partial hospitalization
This type of care is highly structured with scheduled treatment groups and at least one individual session regularly. Participants attend at least 3 days per week from 5-10 hours per week
Intensive outpatient
This type of care is highly structured with a mix of individual and group therapy consisting of not more than 5 hours per week.
Outpatient treatment
_____ is the total inability to recognize reality
Psychosis
_____ are fixed, false beliefs. Such as ‘you’re all army men coming to get me’.
Delusions
______ is seeing (visual) or hearing (auditory) things that are not there. Such as ‘look at all those bugs crawling up the wall’ or ‘grandpa (deceased) said we can’t go there’
Hallucinations
_____ schizophrenia is a result of a major stressor and lasts about a month followed by full recovery.
Brief
_____ is the form of schizophrenia that lasts less than 6 months
Schizophreniform
______ disorder is a form of schizophrenia that is most common and co-exists with a mood/affect disorder
Schizoeffective
What is the primary biological factor of schizophrenia ?
Heredity
Which neurotransmitters are effected in schizophrenia ?
Increased dopamine and glutamate
What are the brain abnormalities associated with schizophrenia?
Enlarged ventricles/fissures,
Reduced connectivity,
Low rate blood flow
What are the psychological and environmental factors relating to schizophrenia ?
Prenatal stressors/birth complications,
Increased cortisol (impedes hypothalamic development),
Trauma/abuse,
Environment (toxinx, poverty, crime)
What are the phases of schizophrenia ?
Prodromal/Pre-psychotic,
Phase I - Acute,
Phase II - Stabilization,
Phase III - Maintenance
A person presents as socially awkward, lonely, depressed, with anxiety, phobias, obsessions, dissociation and compulsions in which phase of schizophrenia ?
Prodromal/Pre-psychotic
May appear for a month or more than a year before first psychotic break
This phase of schizophrenia presents with disruptive symptoms (hallucinations, delusions, apathy, withdrawal) and results is loss of functional abilities.
Phase I - Acute
Increased care or hospitalization may be required.
This phase of schizophrenia has symptoms diminishing and the level of functioning is returning to baseline.
Phase II - Stabilization
May require partial hospitalization or care in a residential crisis center or group home
This phase of schizophrenia has the patient returned to baseline (or nearing) functioning. Symptoms are diminished or absent and the level of functioning is good enough for the patient to live in the community.
Phase III - Maintenance
_____ schizophrenia symptoms include hallucinations, delusions, bizarre behavior, paranoia, abnormal movements, gross errors in thinking.
Positive
_____ schizophrenia symptoms include the absence of something that should be present. Such as hygiene, motivation, ability to experience pleasure.
Negative
_____ symptoms of schizophrenia include subtle changes in memory, attention or thinking. There is an inability to set priorities and make decisions (executive functioning)
Cognitive
_____ symptoms of schizophrenia involve emotions and their expressions. Such as suicidality, hopelessness, dysphoria, depression, or hostility.
Affective
Alterations in speech such as clang associations, word salad, neologisms, and echolalia are ______ symptoms of schizophrenia
Positive
Thought blocking, thought insertion, thought deletion, religiosity, paranoia, flight of ideas and magical thinking are all ______ symptoms of schizophrenia
Positive
Perceptual changes such as depersonalization, derealization, delusions, and hallucinations are _____ symptoms of schizophrenia
Positive
Hallucinations can be visual, command or auditory (auditory being the most common)
Movement/Behavior alterations such as catatonia, echopraxia (mimicking movements), negativism (failing to do what’s asked of them), impaired impulse control, repeated movements, gesturing/posturing, and boundary impairment are all _____ symptoms of schizophrenia
Positive
Flat/Blank affect, lack of emotion, labile mood (fluctuating), and restricted/constricted affect are all ______ symptoms of schizophrenia
Negative
Difficulty with executive functioning such as attention, memory, information processing and cognitive flexibility are _____ symptoms of schizophrenia
Cognitive
Nursing considerations for Phase I - Acute schizophrenia
Patient safety,
Medical stabilization,
Safety/stabilization strategies
Nursing considerations for Phase II - Stabilization schizophrenia
Help patient understand illness and treatment,
Stabilize medications,
Control/cope with symptoms
Nursing considerations for Phase III - Maintenance schizophrenia
Maintain achievements/relapse prevention,
Achieve independence,
Skills training,
Monitoring
_____ generation antipsychotics target positive symptoms of schizophrenia
First
They are cheaper
Side effects include anticholinergic side effects, extra pyramidal side effects, tardive dyskinesia (involuntary movements), Weight gain, sexual dysfunction, endocrine disturbances
_____ generation antipsychotics target positive and negative symptoms of schizophrenia and is a 5HT2A/D2 agtagonist (targets serotonin/dopamine)
Second
Requires blood monitoring for one year
Caution: CVD, lipademia, diabetes, metabolic syndrome
_____ is the most used high potency first generation antipsychotic
Haloperidol (Haldol)
_____ is the most used low potency first generation antipsychotic
Chlorpromazine (Thorazine)
___, ___, ____, are common second generation antipsychotics
Quetiapine (Seroquel),
Risperidone (Risperdal),
Aripiprazole (Abilify)
_____ is the most used medium potency antipsychotic
Ioxaine (Loxitane)
What are the adverse reactions to first generation (conventional/typical) antipsychotics?
Extra pyramidal symptoms (EPSs):
Akathisia (restlessness of body)
Acute dystonia (involuntary repetitive muscle contractions)
Pseudoparkinsons (reactions that mimic Parkinson's, depleted
dopamine)
Tardive Dyskinesia (TD): involuntary movement
Neuroleptic Malignant Syndrome (NMS):
FARM - Fever greater 103,
Autonamic instability,
Rigidity of muscles,
Mental status change (delirium)
Agranulocytosis: dangerous leukopenia
Anticholinergic effects
Orthostasis
Lowered seizure threshold
Weight gain
Sexual dysfunction
Endocrine disturbances
autonomic instability, deliriumWhat are the adverse reactions to second generation (atypical) antipsychotics?
More expensive
Minimal (less than 1st gen) extra pyramidal side effects (EPSs)
Tardive Dyskinesia
Metabolic syndrome (weight gain, dyslipidemia, altered glucose
metabolism
Increased risk for diabetes, HTN, CVD
Agranulocytosis (specifically with Clozapine, required 1yr blood
Monitoring)
What are the treatments for Extra Pyramidal Symptoms (EPSs)?
Lower dosage of antipsychotics, Antiparkinson drugs (Cogentin, Benadryl)
What are the third generation antipsychotics?
Aripiprazole (Abilify) - often still considered 2nd gen
Little risk of EPS or TDK, Unlikely to have significant metabolic effects, hypotension, little anticholinergic effects
Safer but less effective (hit or miss)
What are the adjunct therapies for antipsychotic medications for co-morbidity?
Antidepressants,
Lithium,
Benzodiazepines,
Clonazepam
What is the timeframe for antipsychotic medications to have full effect ?
2-4 Weeks
