Mental Health #8

Front 1

How many people with serious mental illness have a substance use disorder at some point in their lives?

Back 1

Approximately 50% of people

55% of schizophrenic clients and 62% of bipolar clients had a comorbid substance use disorder

Front 2

clients with comorbid mental illness or dual diagnosis often experience more..?

Back 2

experience more severe and chronic medical, social, and emotional problems. Because they have 2 or more disorders they are vulnerable to both substance abuse relapse and worsening of psychiatric problems.

Front 3

Substance abuse relapse leads to

Back 3

psychiatric decompensation, and worsening of psychiatric problems often leads to substance abuse relapse.

Front 4

Examples of common dual disorders are:

Back 4

Common examples of dual disorders include the combination of major depression with cocaine addiction, alcohol addiction with general anxiety disorders, alcoholism and polydrug addiction with schizophrenia, and borderline ppd with episodic polydrug abuse

Front 5

What is the most prevalent of the substance abuse disorders?

Back 5

Alcohol abuse.
Therefore, alcohol related medical problems are the comorbidities most commonly seen in medical settings. Alcohol can effect all organs, in particular the
CNS: Wernicke’s encephalopathy and Korsakoff’s psychosis (lack of vit B).
GI system (esophagitis, gastritis, pencreatitis, alcoholic hepatitis, and cirrhosis of the liver.

Front 6

Effects of cocaine users:

Back 6

experience extreme weight loss and malnutrition, MIs, and stroke

Front 7

IV drug users have severe...?

Back 7

infections and sclerosing of veins.

Front 8

Intranasal users have..?

Back 8

sinusitis and perforated nasal septum

Front 9

Biological Theory of chemical dependency:

Back 9

Substance use problems seem to run in families. Alcoholism is 3-4 times more likely to occur in children of alcoholic parents than in children of non-alcoholic parents

Front 10

Biological theories of chemical dependancy:

Back 10

It has been demonstrated more recently that alcohol and drug use has specific effects on selected neurotransmitter systems.
1. Opiods:
2. Alcohol and CNS depressants:
3. Cocaine and amphetamines:

Hint 10

1. Opiods: act on opioid receptors
2. Alcohol and CNS depressants: act on GABA receptors. This findings help to explain the addictive and cross tolerance effects that occur when the use of alcohol is combined with use of barbiturates and benzodiazepines
3. Cocaine and amphetamines: act on the dopamine system.

Front 11

Psychological Theories of chemical dependacy:
Although no known addictive personality type exists, associated psychodynamic factors have been identified, including the following:

Back 11

lack of tolerance for frustration and pain,
lack of success in life,
lack of affectionate and meaningful relationships,
low self-esteem,
lack of self-regard,
risk taking propensity.

Front 12

Psychodynamic Theories view substance use as a? (3)

Back 12

defense against anxious impulses,
a form of oral regression (dependency),
or self-medication for depression

Front 13

Persons who are polysubstance abusers are more likely to report..?

Back 13

Persons who are polysubstance abusers are more likely to report an unstable childhood and self-medication than are persons who abuse alcohol.

Front 14

What therapy focuses on positive reinforcement effects of drug-seeking behavior?

Back 14

Behavioral therapy

Front 15

What is a need for higher doses to achieve the desired effect?

Back 15

Tolerance

Front 16

What occurs after a long period of continued use, so that stopping or reducing use results in specific physical and psychological s/s?

Back 16

Withdrawal

Front 17

Phenomenons frequently associated with substance abuse are (5)

Back 17

Tolerance
Withdrawal
flashbacks,
synergistic effects,
antagonistic effects.

Front 18

What are transitory recurrences of perceptual disturbance caused by person’s earlier hallucinogenic drug use when he/she is in a drug-free state

Back 18

Flashbacks

Front 19

Flashbacks can be experienced as:

Back 19

visual distortions,
time expansion,
loss of ego boundaries
intense emotions

Front 20

Flashbacks are typically like what?

Back 20

Often flashbacks are mild and pleasant, but other times individuals experience repeated recurrences of frightening images or thoughts.

Front 21

What drugs taken together have serious synergistic effects and intensify or prolong effects of drug?

Back 21

1. alcohol and benzodiazepine,
2. alcohol and opiate
3. alcohol and barbiturates

Taking two of these drugs results in far greater CNS depression than the simple sum of the effects of each drug.

Front 22

Many people combine drugs to weaken or inhibit the effect of one of the drugs (I.e. for antagonistic effects).

What is an example of this?

Back 22

1. Cocaine with heroin(speedball). Heroin (CNS depressant) is meant to soften the intense letdown of withdrawal from cocaine (CNS stimulant).

Front 23

What is an opiate antagonist that is often given to people who have overdosed on heroin to reverse respiratory and CNS depression?

Back 23

Naloxone (Narcan)

Front 24

Assessment:Current alcohol and/or other drug problems can be detected by asking two questions that are easily integrated into a clinical interview, which are:

Back 24

1. In the last year, have you ever got drunk or used drugs more than you meant to?
2. Have you felt you wanted or needed to cut down on your drinking or drug use in the last year?

Ask specific questions. Specific names of drugs, route, quantity, time of last use, and usual pattern of use.

Front 25

Assessment: Responses that serve as red flags indicating the need for further assessment are:

Back 25

1. rationalizations (“you’d use dope to if. . . );
2. automatic responses as if the question were predicted,
3. slow, prolonged responses, as if the person were being careful about what to say.

Front 26

If the person is not able to provide a drug hx assess for indications for substance abuse, such as:

Back 26

1. dilated or constricted pupils,
2. abnormal v/s,
3. needle marks,
4. tremors, and
5. alcohol on the breath.

Front 27

Assessment: There is a consistent and significant association between alcohol and/or drug use and ..what?

Back 27

the occurrence of injury.

significant association between alcohol and/or drug use and the occurrence of injury.

Front 28

Substance abuse can go undetected in those who are:

Back 28

1. depressed,
2. suicidal, or
3. anxious unless a thorough hx is taken.

Front 29

Assessing the psychological changes: Certain psychological characteristics are associated with substance abuse, like:

Back 29

1. denial,
2. depression,
3. low self-esteem,
4. dependency, and
5. hopelessness.

It is often hard to determine which comes first, psychological changes or substance abuse

Front 30

Some people self-medicate to cope with psychiatric symptoms. For these people, symptoms of psychological difficulty.... do what?

Back 30

For these people, symptoms of psychological difficulty remain, even after months of abuse.

Front 31

Assessment: Substance abusing people are threatened on many levels in their interactions with nurses.
How are they? #1

Back 31

1. They are acutely aware that not all nurses are equally willing to care for addicted people, and in fact, many clients have experienced instances of rejection in past encounters with nursing personnel.

Front 32

Assessment: Substance abusing people are threatened on many levels in their interactions with nurses.
How are they? #2

Back 32

2. Substance abusers may be anxious about recovering because to do so they must give up the substance they think they need to survive.

Front 33

Assessment: Substance abusing people are threatened on many levels in their interactions with nurses.
How are they? #3

Back 33

3. Addiction is a chronic relapsing condition. In fact, relapse is one of the criteria for diagnosing addiction. Most addicts tried recovery at least once before and have experienced relapse. As a result, many become discouraged about their chances of ever succeeding.

Front 34

Assessment: Substance abusing people are threatened on many levels in their interactions with nurses.
how? --Summary of all three

Back 34

1. past rejection of care from nurses.
2. they think they need the substance to survive.
3. They have tried and failed before, and are discouraged.

Front 35

These three concerns have what kind of effect on the patient?

Back 35

These concerns can threaten the addict’s sense of security and sense of self, increasing anxiety levels.

Front 36

How do addicts protect themselves from these feelings?

Back 36

To protect against these feelings, the addict establishes a predictable defensive style with various defense mechanisms (3), thought processes (2), and behaviors (3) like:

Hint 36

1. Defense mechanisms: denial, projection, rationalization
2. thought processes: all or non thinking, selective attention.
3. behaviors: conflict minimization and avoidance, passivity, and manipulation.

Front 37

Substance abuser is not able to give up these defenses until:

Back 37

Substance abuser is not able to give up these defenses until more functional coping styles are learned.

Front 38

Assessing s/s of intoxication:

Back 38

CNS depressant drugs please see text (table 27-2, pg. 553). Withdrawal rxns to alcohol and other CNS depressants are associated with severe morbidity and mortality, unlike withdrawal from other drugs.

Front 39

Alcohol withdrawal: The early s/s of withdrawal develop within ?

Back 39

a few hours after cessation or reduction of alcohol (ethanol) intake.

Front 40

Alcohol withdrawal: The early s/s of withdrawal peak after?

Back 40

24-48 hours and then rapidly and dramatically disappear, unless the withdrawal progresses to delirium.

Front 41

Alcohol withdrawal: the person may appear...?

Back 41

The person may appear hyper-alert, jerky movements, experience illusions, hallucinations, shakiness, grand mal seizures.

Front 42

Alcohol withdrawal: what kind of environment can the nurse create for the addict that will be therapeutic?

Back 42

1. A kind, warm and supportive environment by the nurse can decrease anxiety and provide a sense of security.
2. Orient them to time and place.
3. Encourage family members to stay with them (one at a time).

Front 43

Alcohol withdrawal: If a person is argumentative, hostile, or demanding it is often because of ?
What can the nurse do?

Back 43

Often because of deep-seated anxiety and shame. The nurse can help relief and give hope by demonstrating an accepting attitude.

Front 44

This is considered a medical emergency and can result in death even if treated.

Back 44

Alcohol Withdrawal Delirium

Front 45

Death from Alcohol Withdrawal Delirium is usually due to?

Back 45

due to
1. sepsis,
2. MI,
3. fat embolism,
4. peripheral vascular collapse,
5. electrolyte imbalance, and
6. aspiration pneumonia.

Front 46

The state of delirium usually peaks in?

Back 46

peak 2-3 days (48-72 hours) after cessation or reduction of intake (although it can occur later) and lasts 2-3 days.

Front 47

Alcohol withdrawal s/s

Back 47

1. anxiety, insomnia, anorexia, and delirium
2. Tachycardia, diaphoresis, High BP
3. Fluctuating level of consciousness (ranging from hyperexcitablity to lethargy)
4. Delusions, paranoid, agitated behavior and fever of 100F). They need immediate medical action.

Front 48

CNS stimulants (please see text pg. 555, table 27-4). All stimulants accelerate the normal functioning of the body and affect the CNS. Common s/s of stimulant abuse include:

Back 48

1. dilation of the pupils,
2. dryness of the oronasal cavity, and
3. excessive motor activity.

Front 49

When a person who has ingested a stimulant experiences:

Back 49

1. chest pain,
2. irregular pulse and has a
3. hx of heart problems need to be taken to ER immediately.

Front 50

Chemically Impaired Nurse. Nurses have a WHAT% higher rate of chemical dependency than the general population.

Back 50

32-50%

Front 51

Estimates of proportion of practicing nurses who are chemically dependent range from ??%.

Back 51

range from 10-20%.

Front 52

Chemically Impaired Nurse: What behaviors would they have?

Back 52

1. Often they will volunteer to work additional shifts to be nearer to the source of drug.
2. They may spend a lot of time in the bathroom.
3. When they are on duty more clients may complain that their pain is not relieved.

Front 53

Chemically Impaired Nurse: Intervention is the responsibility of who?

Back 53

responsibility of the manager and the administration. However, the co-workers need to document the dates and specific times. Some state boards allow them to avoid disciplinary action if they seek tx.

The aim is to:

Hint 53

The aim is to protect pts and to keep the nurse in active practice maybe with limitations.

Front 54

Chemically Impaired Nurse:
The aim of tx is?

Back 54

The aim of tx is self-responsibility. Safe detox and referral to an inpatient and outpatient chemical dependency program. Please see the communication guidelines in text, pg. 562.

Front 55

A useful tool for helping the resistant addict develop a willingness to change in tx is known as

Back 55

substance-abuse intervention.
Table 27-4, pg. 563.

The concept behind this is that addiction is a ...?

Hint 55

progressive illness and rarely goes into remission without outside help.

Front 56

Relapses are common during the person’s recovery. The goal of relapse prevention is to ?

Back 56

To help the client learn from these situations so sobriety can be lengthened. Relapse can result in renewed and refined effort toward change.

Front 57

Other addict-recovery programs include:

Back 57

1 self help groups (AA),
2. Al-Anon, Alateen,
3. Twelve step programs (views alcoholism as a disease),
4. outpatient drug-free programs and
5. employee assistance programs.

Front 58

Psychopharmacology: Alcohol withdrawal tx. Not all people who stop drinking require management. It depends on:

Back 58

1. llength of time and the amount the client has been drinking,
2. prior hx of withdrawal complications,
3. overall health status.

Front 59

Psychopharmacology: Alcohol withdrawal tx:
Medication should not be given until ?

Back 59

the s/s of withdrawal are seen. See text, pg. 568, table 27-9.

Front 60

What is an agent used for narcotic addiction-is sometimes used in the tx of alcoholism, especially for those with high levels of ??

Back 60

Naltrexone (Trexan, Revia)
--for those with high levels of craving and somatic symptoms

Front 61

Naltrexone works by

Back 61

Works by blocking opiate receptors, thereby interfering with the mechanism of reinforcement and reducing or eliminating the alcohol cravings.

Front 62

(Antabuse) Disulfiram works by?

Back 62

creates unpleasant physical effects when alcohol is consumed: facial flushing, swaeting, throbbing h/a, neck pain, tachycardia, respiratory distress, serious decrease in BP, & n/v.

Most effective in early recovery.

Front 63

What is a synthetic opiate that blocks the craving for and effects of heroin?

Back 63

Methadone (Dolophine)

How often does it need to be taken?

Hint 63

It has to be taken every day, is highly addicting, and when stopped produces withdrawal.

Front 64

For methadone to be effective, the client must:

Back 64

the client must take a dose that will prevent withdrawal symptoms, block drug craving, and block any effects of illicit use of short-acting narcotics.

Should include counseling and job training.

Front 65

Methadone is the only medication currently approved for the tx of ?

Back 65

tx of the pregnant opioid addict.

Front 66

Other Tx for Opioid Addiction:

Back 66

Please read text, pg 569 on LAAM, Naltroxone, and Clonidine.
Please see workbook pgs. 233-256.