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81 Cards in this Set
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The primary risk factors for depression are |
History of Prior episode of depression family history of depressive disorder especially in first-degree relatives history of suicide attempts or family history of suicide member of the LGBT community lesbian gay bisexual transgender female gender age 40 years or younger postpartum. Chronic medical illness absence of social support negative stressful life events active alcohol or substance abuse history of sexual abuse |
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What are the common symptoms of depression |
Mood of sadness Despair and emptiness negative pessimistic thinking loss of ability to experience pleasure in life (anhedonia) low self-esteem apathy low motivation and social withdrawal excessive emotional sensitivity irritability and low frustration tolerance insomnia or hypersomnia disruption (mild to severe) and concentration or ability to make decisions suicidal ideation excessive guilt indecisiveness |
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When assessing someone for depression what is the most priority |
Assess for suicide ideation |
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What is the difference between persistent depressive disorder (dysthymia) and major depressive disorder |
Persistent depressive disorder is much less severe and longer an episode. major depressive disorder shorter and most severe |
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What are the steps of assessing someone for depression |
Always evaluate the patient's risk of suicide or harm to others assess if depression is primary or secondary to another disorder so evaluate is the patient is psychotic has used drugs or alcohol if co-occurring comorbid medical conditions are present if the patient has a history of cor-ocurrent psychiatric disorder such as eating disorder borderline personality disorder anxiety disorder. If patient has a history of depression determined therapies used previously that were effective assess support systems family and significant others and the need for information and referrals assess for any events that might have triggered a depressive episode include a psychosocial assessment that includes cultural belief and spiritual practices related to mental health and treatment determine if the depression is affecting the patient beliefs and practice |
Have you ever gone through or felt anything like this before what seemed to help you at that time with whom do you live whom do you trust to foam do you talk when you are upset has anything happened recently to upset you have you had any major changes in your life have you had any recent losses job divorce loss of partner child moving away deaths how do you view depression have you tried taking any over-the-counter remedies such as herbs to help with your depression do you find Solace and spiritual activities or a place of worship such as church temple or mosque |
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How do you communicate with someone with depression |
Give the patient time to reply withdrawn patient may be unable to speak just sitting with a patient inside lights may be a valuable intervention makeup salvations such as pictures on the wall or wearing new shoes you simple concrete words listen for covert message and ask about suicide plans avoid platitude such as things will look up or everything's gets down once in awhile |
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What are the selective serotonin reuptake inhibitors (SSRI) most popular type of antidepressants |
Citalopram (Celexa) escitalopram (Lexapro) fluoxetine (Prozac) fluvoxamine (Luvox) paroxetine (Paxil) Sertraline (Zoloft) |
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Dual action reuptake Inhibitors serotonin and norepinephrine (SNRI) |
Duloxetine (Cymbalta) venlafaxine (Effexor) desvenlafaxine (Pristiq) |
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Tricyclics antidepressants |
Amitriptyline (Elavil) Doxepin (sinequan) desipramine (norpramin) imipramine (tofranil) Nortriptyline (Pamelor) clomipramine (anafranil) |
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Monoamine oxidase inhibitors (maois) |
isocarboxiazid (Marplan) Phenelzine (nardil) tranylcypromine (parnate) Selegiline (eldepryl) ANSAM transdermal patch |
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What are the list of food that can counteract with monoamine oxidase inhibitors |
Food that are high in tyramine such as avocados figs or overripe bananas fermented meat smoked cured aged spoiled meat sausages fermented bologna pepperoni salami are dried sausages pickled herring smoked salmon lung fish dried pickled or cured fish fish that is fermented smoked all cheese especially hard cheeses yeast extract beers some Wine soup that contains protein extract shrimp paste soy sauce chocolate fava beans ginseng caffeinated beverages |
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What is electroconvulsive therapy used |
ECT is used for people with treatment-resistant depression which exists one pharmacological intervention fail or when the side effects are too uncomfortable |
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When is electroconvulsive therapy may be indicated |
When there is a need for a rapid definitive response when a patient is suicidal or homicidal the patient is in extreme agitation or stupor the patient develops a life-threatening illness because of refusal of food and fluids the patient has a history of poor drug response a history of good ECT response or both standard medical treatment has no effect |
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What are the potential adverse reaction of ECT |
Confused and disoriented |
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What is bipolar 1 disorder |
At least one episode of persistent or elevated expensive or irritable mood Mania and at least one clearly recognizable episode of major depression it is marked impairment in Social and occupational functioning maybe psychosis and hospitalization may be warranted |
Severe depression to Mania or vice versa |
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Bipolar II disorder |
Presents with recent severe and prolonged periods of depression that alternate with brief. Of hypomanic episode often these brief periods of hypomania may be missed however a decreased need for sleep and a lot of daytime fatigue are the red flag for hypomania primarily in women |
Severe depression to hypomania |
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Hypomania |
A less severe and less intense form of Mania in may only lasted 4 days in most cases |
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Cyclothymic disorder |
Presents with hypomanic episodes alternating with persistent depressive episode dysthymia for at least two years duration 1 year in children individual with cyclothymia tend to have irritable hypomanic episodes |
Depression to hypomania |
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Bipolar disorder unspecified |
Disorders with bipolar features that do not meet criteria for any of the previously specified disorders they can still cause the stress and disruption in the individuals work social and private life they are not a distinct bipolar disorder and are noted as other specified |
Don't really know what's going on or which form of bipolar it is |
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Bipolar Mania |
Everything is hyperverbal speech Non-Stop high energy they don't sleep they can become grandiose constantly moving not focusing so dizzy that they don't hydrate and eat |
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Pressured speech |
Non-stop unusually loud seemingly driven and usually hard to interrupt attentive listener can keep up with the changes even though Direction changes constantly |
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Flight of ideas |
A nearly continuous flow of accelerated speech with abrupt changes among topics that are usually based on understandable associations or a play on words puns speech is rapid verbals and circumstantial including minute in unnecessary details |
Example how are you doing kid no kidding around I'm going home home sweet home home is where the heart is the heart of the matter is I want out and that ain't hey hey Doc get me out of this place |
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Clang associations |
The stringing together of words because of their rhythmic sounds without regard to their meaning |
Cinema 1 & 2 last row row row row your boat don't be a Cutthroat cut your throat get your goat go out and vote and so I wrote |
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Grandiosity |
Inflated self-regard exaggerated their achievements or importance state that they know famous people will believe that they have great powers |
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What is important to assess in someone with bipolar disorder |
Dehydration cardiac status to prevent cardiac collapse poor sleep may lead to exhaustion need for hospitalization to stabilize the individual medical exam to determine whether Mania is primary bipolar disorder or cyclothymia was secondary to a co-occurring conditions such as abuse of a drug or substance or toxins exposure or it could occur in medical condition such as brain disease certain infection including HIV and endocrine disorders assess whether the patient is in danger to self assess the patients and families understanding of bipolar disorder |
To assess if patient is in danger to self assess for manic behaviors can be exhaustive to the patient to the point of death patient me not eat or sleep often for days at a time poor impulse control may result in harm to self or others poor judgment inappropriate sexual activity uncontrolled spending protect the patient in Mania from bankruptcy |
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Some interventions for acute Mania are |
Use firm and calm approach use short and concise explanations or statements remain neutral avoid power struggles and value judgements be consistent and approach and expectations have frequent staff meetings to plan consistent approaches and to set agreed on limits with other staff decide own limits to patient and simple concrete terms with consequence here and act on legitimate complaints for Madeira direct energy into more appropriate and constructive channels |
John come with me eat this sandwich John do not yell or keep Peter if you cannot control yourself will help you or the seclusion room will help you feel less out of control and prevent harm to yourself and others |
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Structure in a safe milieu for acute Mania |
Maintain low level of stimuli and patience environment oh way from Bright Lights loud noises and people provided structured solitary activities with nurse or aide provide frequent high calorie fluids provide frequent rest redirect violent Behavior through physical exercise walking when warranted in acute Mania use antipsychotic and seclusion to minimize physical harm via Physician's order observe for signs of lithium toxicity protect patient from giving away money and possessions hold valuables and Hospital safe until rational judgment returns |
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Nutrition for acute mania |
Monitor intake output in vital signs of for frequent high calorie protein drinks and finger food examples and witches fruit milkshakes frequently remind patient to eat |
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Sleep intervention for acute Mania |
Encourage frequent rest periods during the day keep patient in areas of low stimulation at night provide warm baths soothing music and medication when indicated giving patient caffeine |
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Hygiene interventions for acute Mania |
Supervised choice of clothes minimize flamboyant and bizarre dress example garish stripes with plaids and loud and matching colors give simple step-by-step reminders for Hygiene in stress |
Example here is your razor shave the left side or the right side here is your toothbrush with toothpaste on the toothbrush |
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Elimination intervention for acute Mania |
Monitor bowel habits of fluids and foods that are high in fiber evaluate need for laxatives encourage patient to go to the bathroom |
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Lithium carbonate |
Effective in the treatment of mania and depressive episode any prevention of your current Mania and depressive episode |
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what are the side effects of lithium |
Fine hand Tremor polyuria and Mild thirst mild nausea and general discomfort weight gain |
Therapeutic level of lithium is <0.4 to 1 mEq/L |
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What are the early signs of lithium toxicity the Advanced Signs of toxicity in severe sign of toxicity |
Early signs- (<1.5) nausea vomiting diarrhea thirst polyuria slurred speech muscle weakness Advanced Signs- (1.5 to 2) coarse hand Tremor persistent gastrointestinal upset mental confusion muscle hyperirritability electroencephalographic changes incoordination severe toxicity- (2 to 2.5) Ataxia seriously EEG changes blurred vision clonic movements large output of diluted urine tinnitus blurred vision seizures stupor severe hypotension, death is usually secondary to pulmonary complications (>2.5)- symptoms May progress rapidly, cardiac dysrhythmia peripheral circulatory collapse proteinuria oliguria and death |
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Other mood stabilizer medication are ( anticonvulsant) |
Divalproex Depakote lamotrigine Lamictal carbamazepine Tegretol |
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What nursing diagnosis would you use for someone with bipolar |
Risk for injury |
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What are the three neurotransmitters that someone with schizophrenia might have |
Dopamine hypothesis serotonin and glutamate |
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What are the positive symptoms of someone with schizophrenia |
Hallucination delusions bizarre behavior paranoia also known as flori psychotic symptoms they are the ones that capture attention catatonia formal thought disorder |
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What are the negative symptoms of schizophrenia |
Apathy lack of motivation anhedonia poor thought processes blunted or flat affect poverty in speech social withdrawal |
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What are the cognitive symptoms of someone with schizophrenia |
They are the most belligerent symptoms impairment in memory disruption and social learning inability to reason solve problems of focus attention |
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What are the mood symptoms of someone with schizophrenia |
Depression anxiety demoralization suicidality agitation excitability |
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Associative looseness |
Thinking becomes haphazard illogical and Confused |
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neologism |
Made up words that have special meaning for the person for example I was going to tell him the mannerologies of his Hospitality just won't do |
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Echolalia |
Repeating of another's word by imitation and is often seen in people with catatonia |
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Echopraxia |
Mimicking the movements of another which is also seen in catatonia |
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Clang Association |
Meaningless rhythmic Awards Austin and forceful manner example on the track have a Big Mac or get the sack |
May be sending someone with both bipolar and schizophrenia what cognitive disorder such as Alzheimer's for hiv-related dementia |
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Word salad |
Used to identify a jumble of words that is meaningless to The Listener and perhaps to the speaker as well |
Example I think out for my mother for this to hell I want how long is Road these little said three hills Hopper board share the appetite of the Christmas spread within 3 round moons the devil will be washed away |
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Hallucinations |
Sensory perceptions for which no external stimulus exist when that occurred there are vivid and clear with the full force of impact of normal perception |
Types are auditory visual olfactory gustatory tactile |
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Illusions |
May interpret wires as snake |
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Command hallucinations |
Assess because voices may come into person to herself or others |
Example a patient my state that the voices are saying jump out of the window or take a nap and kill your child |
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What are the serious side effects of Geodon |
ECG changes QT prolongation not to be used with other drugs known to prolong QT interval no propensity for weight gain diabetic ketoacidosis dyskinesia mns may occur |
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Tardive dyskinesia |
Usually appear after prolonged treatment is more serious and is not always reversible consists of involuntary tonic muscular spasm that typically involve the tongue fingers toes and neck trunk or pelvis frequently seen in women and older patients. Early signs are constant lip-smacking |
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Acute dystonia |
Severe spasm of the muscles of the tongue head and neck fixed upward deviation of the eyes and severe back spasm that Arch the trunk forward and thrust the head and lower limb backward |
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Akathisia |
Interval restlessness and external restlessness pacing of fidgeting |
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Pseudo parkinsonian |
Stiffening of muscular activity in the face body arms and legs |
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Neuroleptic malignant syndrome |
It's a medical emergency usually occur early in the course of therapy but has been reported in people after 20 years of treatment it is characterized by decreased level of Consciousness greatly increased muscle tone and autonomic dysfunction including hyperpyrexia labile hypertension tachycardia tachypnea diaphoresis and drooling treatment consists of early detection discontinuation of the antipsychotic agent management of fluid balance rejection of temperature and monitoring for complication |
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Agranulocytosis |
I'm not adverse to side effect of first-generation antipsychotic medication which can be fatal involving the liver |
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Treatment for neuroleptic malignant syndrome include |
Antiparkinsonian drugs especially centrally acting anticholinergic such as Cogentin Benadryl stop all new electric medication PolloDel can relieve muscle reduce and muscle fever dantrium Mary just muscle spasm cool body to reduce fever maintain hydration with oral and IV fluids correct electrolyte imbalance dysrhythmia should be treated small doses of Heparin may decrease possibility of pulmonary emboli early detection increases patient chance of survival |
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Illness anxiety disorder formerly known as hypochondriasis |
Preoccupied with having or eventually developing a serious illness may or may not present with somatic symptoms and if they do the symptoms are usually mild they to exhibit high level of anxiety and alarm about their health lasting at least six months avoid Medical Care |
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Conversation Disorder (also called functional neurobiological symptoms disorder) |
Present with one or more symptoms of impaired motor or sensory function the deficit causes significant distress to the patient and impaired Social or occupational functioning symptoms are weakness or paralysis abnormal movements swallowing or speech difficulties seizures or attacks sensory loss or anesthesia or symptoms involving the sense of lightness or loss of smell the symptoms are not voluntarily controlled or created patients may be highly distressed or showing lack of emotional concerns known as La Belle indifference |
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Factitious disorder imposed on self also known as Munchausen syndrome |
Factitious disorder imposed on self is the deliberate fabrication of symptoms or self-injury without obvious external reward or gain |
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Malingering |
Intent to receive reward or gain through the fabricated of exaggerated symptom malingerers attempt to receive an obvious gain example being continued visit to a chiropractor when the next rain has been resolved in order to inflate an insurance claim |
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Factitious disorder imposed on another Munchausen by proxy |
Same criteria as factitious disorder except the deliberate fabrication or symptoms or injury is imposed upon another person of the in a child or dependent victim |
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Depersonalization derealization disorder |
The person is not feeling like they're in their body it's very mild it is characterized by recurrent periods of feeling unreal detached outside of the body numb dreamlike or distorted sense of time of visual perception |
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Dissociative amnesia disassociative amnesia with fugue |
The ability to recall specific information about the self usually over dramatic nature the memory impairment may be selected for the traumatic event or a particular time period or generalized for the entire life history it is related to a traumatic incident and if it's accompanied with fuge where the patient flees from their normal life to another location and start a new life gradually over time memories of the original life may be triggered |
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Dissociative identity disorder formerly multiple personality disorder |
Most severe of disassociative disorder include disruption of identity by two or more distinct personalities States the disruption and identity involve discontinuity in the sense of self Alton Nation in affect Behavior memory and functioning patients loose time meaning they do not have memory of periods of time ranging from minutes to weeks during the periods of lost time and alter personality will be in control of the host person the patient is often unaware of the other personality Behavior obtaining psychological treatment |
Each personality alter has its own pattern of Personality perception and memories |
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Alcohol withdrawal |
Early signs of ritual develop within a few hours after cessation or reduction of alcohol and take the peak after 24 hours to 48 hours and then rapidly and dramatically disappear unless the withdrawal progresses to alcohol withdrawal delirium |
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Signs and symptoms of alcohol withdrawal |
Hyper alert manifest jerking movement and irritability startled easily and experience subjective distress often described as shaking inside early symptoms of rituals appear 7 to 48 hours after cessation alcohol intake and continue for 5 to 7 days early symptoms of withdrawal include intense Tremors cramps vomiting and creases and heart rate blood pressure and temperature and in some individuals Grand mal seizures particularly and people with history of seizures |
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Alcohol withdrawal delirium |
It is considered a medical emergency and can result in death even if treated that is usually result of sepsis myocardial infarction fat embolisms peripheral vascular collapse electrolyte imbalance aspiration pneumonia or suicide delirium usually picks two to three days after cessation of reduction of intake all the way can occur later and lasts 2 to 3 days hallucination so terrifying in addition to anxiety insomnia anorexia and delirium |
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Features of alcohol withdrawal delirium include |
Autonomic hyperactivity tachycardia diaphoresis elevated blood pressure severe disturbance disorientation clouding of consciousness perceptual disturbances illusion visual tactile hallucinations fluctuating levels of consciousness ranging from hyperexcitability to lethargy delusion paranoid agitated behaviors in fever temperatures of 100 to 103 |
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Antabuse |
used after an alcohol-free sober for a number of months to demonstrate his or her ability to remain abstinent patient teaching explain to the individual that when this drug is mixed with alcohol it can cause violent reaction such as pounding in the chest a drop in blood pressure nausea vomiting facial flushing and potentially death |
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Re Via, Vivitrol |
Reduces the desire Pleasant Feeling High by blocking the release of endorphins related to alcohol opiate intake also block the drug craving it is much more effective in those with a family history of alcoholism the dose is once a day. Risk it should not be used by a patient who is also using opiates such as heroin also cause nausea abdominal pain constipation dizziness headache anxiety and fatigue |
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Campral |
Helps by Ritu Singh some of the unpleasant symptoms of abstinence such as and anxiety tension and dysphoria which can also cut down on the craving of the risk diarrhea and decrease libido was found to be effective in treating alcohol dependence and relapse related symptoms of insomnia anxiety dysphoria craving headaches and or pain in individual with a co-occurring substance use disorder |
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If someone is intoxicated with opiates what are the effects |
Oxycodone physical heroin constricted pupils Demerol decrease respiration morphine drowsiness codeine decrease blood pressure methadone slurred speech hydromorphone psychomotor retardation fentanyl psychological perceptual fentanyl analogue initial Euphoria followed by dysphoria and impairment of attention judgment and memory |
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Opiates overdose effect |
Triad symptoms, respiratory distress respiratory arrest pinpoint pupils possible dilation of pupils as a result of anoxia cardiac arrest and death shock convulsions death |
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Possible opiates overdose treatment |
Narcan too quickly reversed central nervous system depression |
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Date rape drugs Rohypnol |
Drugs used to facilitated sexual assault rape also known as roofies which is a fast acting benzodiazepine they are odorless tasteless and colorless mix easily with drinks and can result in unconscious in a matter of minutes victim becomes amnesia |
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Date rape drugs Ketamin |
A dissociative anesthetic that can also be slipped into an unsuspected individuals drink without detection because it is also induced Amnesia it is also used in the commission of sexual assault or rape alcohol potentiates the effect of these drugs |
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Assessment guidelines for someone with drug intoxication |
Clarified the presenting signs and symptoms are not due to physical accident or condition identify the specific name of the drug route quantity time of last used in usual pattern of abuse assess for a severe a major withdrawal syndrome assess for an overdose from a drug or alcohol that warrants immediate medical attention assess the patient for suicidal thoughts or other self-destructive Behavior evaluate the patient for any physical complications related to substance use disorder explore the individuals interest in taking action to address his or her drug or alcohol abuse disorder assess the patient and family for knowledge of Community Resources for alcohol and drug treatment |
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Self help group for patient in 12-step program Alcohol Anonymous |
A 12-step program that were subsequently developed for many types of addiction this program offer the behavioral cognitive and dynamic structure needed in recovery |
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Smart recovery self management and Recovery training |
Enhancing and maintaining motivation to abstain coping with urges problem-solving managing thoughts feelings and behaviors lifestyle balance balancing momentary and injuring satisfaction |
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