Psychiatric Bullets Flashcards
Suicide is
the act of deliberately killing oneself.
- Self-harm is
a broader term referring to intentional
self-inflicted poisoning or injury, which may or may not have a fatal intent or outcome.
Suicide: Risk Assessment
SAD PERSONS
Sex=male
Age= <19;>45
Depressed/Hopelessness
Previous Attempt or Psychiatric Care
Excessive Alcohol/Drug Use
Rational Thinking Loss
Separated/Divorced/Widowed
Organized/Serious Attempt
No social support
Stated future intent
0-4: Low
5-6: Medium
7-10: High
Suicide Precautions:
- DO NOT LEAVE THE PERSON ALONE!
- INITIATE A NO-SUICIDE CONTRACT
- Nurse Role: Authoritative-to help patient stay safe
- No sharps! (Anything you think of that can be used to hurt yourself)
- Identification of “triggers”
- Substance abuse treatment
- ECT/CBT
- Avoid Isolation (Activate Psychosocial Support); Support System List
- DO NOT GUILT TRIP THE PATIENT!
Electroconvulsive Therapy (ECT)
MOA
Dose
- An electrically inducing grand mal seizure used to treat serious mental disorders. This type of therapy is usually considered only if a patient’s illness has not improved after other
treatments (such as antidepressant medication or psychotherapy) are tried, or in cases where rapid response is needed. - MOA: Unknown
● Guilty: ECT serves as punishment for atonement of sins
● Depressed: causes memory loss
● Manic: resets pattern of brain activity - Dose: administered for .5-2 seconds causing a 30-60 seconds seizure; 2-3x/week for 6-12 treatment sessions delivered via: bilateral or VnilateRal (V=Vertex, unilateral)
Common Side Effects: ECT
Epigastric Issues
Cramps/Muscle Aches
Transient Memory Loss=reorient
ECT: Nursing Responsibilities
● Pre-Op:
- Consent, CP/Bone Clearance
- Prepare: cardiac monitor, oxygen
- Pre Meds:
A. Succinylcholine (Muscle relaxant, can cause Malignant Hyperthermia)
B. Atropine Sulfate (Minimize secretions and Postictal bradyarrhythmia, PSSS Management)
C. Methohexital (anesthetic, monitor RR)
- Pt Prep: NPO 6-8 hrs prior, empty bladder and bowel, no jewelries, contact lenses, dentures
● Intra-Op:
- Safety, Airway, Oxygenation, Circulation
● Post-Op:
- Airway, VS, Safety (posticteric sleep [5-10 mins]), GCS (patient usually alert after 1 hour and can resume normal activities)
Phobia
Fear cued by the presence or anticipation of a specific object or situation, exposure to which provokes an immediate anxiety response or panic attack even
though the subject of the fear is unreasonable. The phobic stimulus is avoided or endured with marked distress
Phobia types and causes
Types: Agoraphobia, Social Phobia (Social Anxiety Disorder) and Specific
- Cause: Psychoanalytical-Fear of aggression from same-gender parent and displace it onto something safer and more neural (phobic stimulus); repression and symbolization and direct learning or imitation,
Phobia Treatment:
Systematic Desensitization-AKA graduated exposure therapy.
- Identification of an anxiety inducing stimulus hierarchy
- Learning of relaxation or coping techniques
- React towards and overcome situations in the established hierarchy of fears.
● Goal: learning how to cope and overcome the fear in each step of the hierarchy
Somatoform Disorders def
- Freud: People can convert unexpressed emotions into physical symptoms
Somatoform Disorder types
- Somatization Disorder: multiple physical symptoms
- Pain Disorder: Physical pain unrelieved by analgesics
- Hypochondriasis: Preoccupation with fear that one has a serious illness (disease conviction) ex: headache=brain tumor; clients with this disorder misinterprets bodily sensations or functions
- Body Dysmorphic Disorder: Imagined or exaggerated defect in physical appearance
- Conversion Disorder: Unexplained, sudden deficit in sensory or motor function (blindness)
- Factitious Disorder: A person intentionally produces or feigns physical or psychological symptoms solely to gain attention (ex. Manchausen’s Syndrome)
Alzheimer’s/Dementia (6 A’s)
amnesia
apraxia
agnosia
aphasia
anomia
aceytcholine
Dementia mgmt
DO NOT EXPOSE TO THE UNFAMILIAR!
Environmental Modifications
Manage sensory deficits
Eliminate choices
Never neglect the carer
Tasks that are simple and easy
Integrate to community (tx approach)
Arrange routinary activities
Dementia MEDICAL MGMT
As much as possible, medical management is the LAST RESORT for treatment.
Medical Mgt: NARC
Memantine (Namenda)=monitor kidney function, can cause constipation
Donepezil (Aricept)= monitor liver/kidney function, can cause syncope, seizures
Galantamine (Reminyl)=monitor ECG, give with meals
Tacrine (Cognex)=causes dizziness, orthostatic hpn
