PWB: pysch illness (class 10) Flashcards
psychosocial changes & fears in elderly
loss of family & friends. 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 with anxiety
muscle tension, restlessness, avoidances of activities, excessive worry, procrastination in behavior or decision-making, repeatedly seeking reassurance from others, sleep disturbance, difficulty concentrating “mind goes blank”
non-pharm interventions for anxiety
maintain calm nonthreatening approach. use simple words and brief messages, low stimuli, teach relaxation techniques, stay with the person, be honest keep all promises, provide with glasses, hearing aids, include in decision making, encourage social activities.
risk factors for depression
marital status; single people double risk.
gender: women attempt more than men
age: white males > 80
religion: non-religious higher.
socioeconomic status: highest & lowest higher risk.
ethnicity: 1. caucasion, 2. native americans, 3. african americans, 4. hispanics, 5 asians.
diagnosed mental disorder.
family history.
healthcare workers.
depressive behaviors in older adults
I-ideation
S- substance abuse
P-purposelessnes
A- anxiety
T- trapped
H- hopelessness
W-withdrawal
A-anger
R-recklessness
M- mood changes`
warning signs of suicide
talks about it withdraws from friends or social activites. prepares for death by writing a will, gives away prized possessions, takes unecessary risks, seems preoccupied with death, loses interest in personal appearance, increase alcohol or drug use.
things to consider with antidepressant meds in elderly
can cause confusion, blurred vision, constipation, dry mouth, dizziness, difficulty urinating.
SSRIs
usually 1st line drug tx for depression in elderly r/t less side effects.
(celexa, prozac, zoloft, lexapro, paxil).
SNRI’s
bupropion, remeron, trazodone, cymbalta, effexor.
MAOIs
nardil, marplan, parnate, fatal adverse reactions may occur.
tricyclic
elavil, sinequan, tofranil.
contraindicated in acute recovery phase of post MI and glaucoma.
hyperpyretic crisis and death may occur. hypertensive crisis with clonidine.
side effects: blurred vision, urinary retention, orthostatic hypotension, reduction of seizure threshold, photosensitivity, weight gain.
side effects of SSRIs and SNRIs
insomnia, agitation- avoid caffeine.
headache-analgesics.
weight loss
sexual dysfunction.
serotonin syndrome
change in mental status, restlessness, hyperreflexia, shivering, tremors, diaphoresis, labile BP.
benzodiazepines
least toxic and most effective in elderly for anxiety
benzos
side effects sedations, dizziness, ataxia, dependence.
lorazepam
druge of choice r/t shorter half-life less side effects.
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. causes: unknown may have genetic tendencies.
substance abuse often associated with behiors of bipolar disorder.
bipolar symptoms
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
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 mnemonic
D-distractibility I-indiscretion G-grandiosity F-flight of ideas A-activity increase S-sleep defecit T-talkativeness
schizophrenia
a serious mental illness characterized by incoherent or illogical thoughts, bizarre behavior and speech, and delusions or hallucinations, such as hearing voices.
delusions
false beliefs that are not part of the persons culture and do not change. believing that neighbors can control their behavior with magnetic waves.
hallucinations
things a person sees, hears, smells, or feels that no one else can
voices are the most common type of hallucination in schizophrenia.
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 of face, arms, legs, and neck.)
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 movement.
neuroleptic malignant syndrome
rare but potentially fatal complication of treatment with antipsychotic medications.
onset: hours to years of drug initiaiton. rapid progression of s/s over 24-72 hrs of onset.
manifestations: very high fever hyperpyrexia.
muscle rigidity (lead pipe rigidity)
unstable blood pressure (fluctuations)
rapid deterioration of mental status to stupor to coma.
neuroleptic treatment
discontinue antipsychotic med, monitor vital signs, degree of muscle rigidity, LOC, I&O, lower body temperature-implement cooling measures.
physician may order: dantrolene to treat muscle rigidity, IVF- to manage CV, renal failure potential complications.
