Psychiatric Nursing- Mood Disorders Slides

Front 1

TCAs
overview

Back 1

•Can be lethal in overdose
•Can have a 3-4 week delay before therapeutic response.
•No known long term adverse effects.
•Persistent side effects can often be minimized by a small decrease in dose.
•Do NOT cause physical addiction.
•Do NOT cause euphoria, so they have no abuse potential.
•Can be conveniently given once a day.

Front 2

TCAs -Side effects

Back 2

Most side effects are short-term.
•Sedation
•Increased appetite
•Anticholinergic side effects
•Orthostatic hypotension
•Not usually given for patients with history of heart problems, due to possibility of tachycardia, arrhythmia, or heart block.

Front 3

MAO-Is

Back 3

•Very effective medications
•Can be lethal in overdose

Front 4

MAO-Is
•Side effects:

Back 4

•anticholinergic
•cardiovascular: hypotension most common
•Careful patient teaching is absolutely necessary.
•Interaction with tyramine-containing foods or drugs can cause hypertensive crisis.
•Bad drug interactions: SSRIs, Demerol

Front 5

Hypertensive Crisis

Back 5

•Sudden increase in BP
•Explosive headache
•Head and face are flushed, feel “full”
•Stiff neck
•Palpitations, chest pain
•Nausea, vomiting
•Dilated pupils
•Intracranial bleeding
•Heart attack

Front 6

If hypertensive crisis occurs:

Back 6

•Hold next MAO-I dose.
•Do not have patient lie down.
•IM chlorpromazine (Thorazine)
•Manage fever by cooling patient externally.

Front 7

MAO-I -Dietary Restrictions:

Back 7

1 day before, during, and 2 weeks after taking:
Foods to avoid include:
•Cheese, sour cream, yogurt
•Pickled, dried, fermented, smoked or aged fish or meats
•Beer, wine, sherry, liqueurs, cognac
•Liver
•Overripe fruit
•Yeast
•Chocolate
•Caffeine

Front 8

MAO-I: Avoid these:

Back 8

•Narcotics, especially DEMEROL
•Other antidepressants!
•Cold, allergy or hay fever meds
•Weight-reducing pills or stimulants
•Cocaine, amphetamines

Front 9

SSRIs

Back 9

•Relatively safe in overdose
•Treatment effects comparable to other antidepressants, but withoutsignificant anticholinergic, cardiovascular or sedative side effects.
•Prozac -what’s the story
-before depression gets better, energy increased

Front 10

SSRIs -Side Effects
Reported by some patients:
.

Back 10

•GI symptoms:
–Nausea, diarrhea, decreased appetite
•CNS symptoms:
–Headache, dizziness, nervousness, sexual dysfunction.
–SSRIs generally do not cause sedation or weight gain

Front 11

Serotonin Syndrome
•overview

Back 11

Caused when combinations of serotonin-increasing meds interact to make serotonin dangerously high
–Many antidepressants
–Lithium
–Parkinson’s meds
–Demerol, some migraine meds, cold medicine
–Amphetamines, cocaine, LSD, Ecstasy
•Mortality: 11%

Front 12

Serotonin Syndrome
Symptoms:

Back 12

–Agitation, confusion,
–Fever, diaphoresis, nausea, diarrhea
–HR rapid, BP up & down
–Loss of coordination, muscle rigidity, seizures

Front 13

Serotonin Syndrome
Treatment:

Back 13

–Stop the med
–Supportive care of symptoms
•Interventions as symptoms demand
•May include ICU stay, intubation, neuromuscular paralysis to relax muscles and prevent further rhabdymyolysis
•Cooling measures for hypothermia

Front 14

ECT: Nursing Considerations
Before treatment begins

Back 14

Medical clearence, pre amesthia

Front 15

ECT: Nursing Considerations
during

Back 15

-moitor pts vs

Front 16

After treatment

Back 16

post anethsia, swallowing percautions

Front 17

Manic Episode: DSM IV

Back 17

At least 3 of the following must be present to a significant degree for at least 1 week.
•Grandiosity or inflated self esteem.
•Decreased need for sleep.
•Pressured speech
•Flight of ideas or feeling of “thoughts racing”.
•Distractibility.
•Psychomotor agitation or MUCH goal-oriented activity
•Excessive involvement in pleasurable activities with high potential for problems.

Front 18

Hypomanic Episode

Back 18

•Meets most of the criteria for manic episode, but the episode is notsevere enough to:
–result in significant impairment, or to
–require hospitalization

Front 19

Bipolar I Disorder:

Back 19

–One or more manic or mixed episodes, usually with a major depressive episode.

Front 20

Bipolar II Disorder:
–

Back 20

Includes one or two major depressive episodes and at least one hypomanic episode

Front 21

Cyclothymic Disorder
.

Back 21

For at least 2 years:
•The patient has had numerous periods of hypomanic symptoms and numerous periods of depressed mood.
•The patient has never experienced major depression

Front 22

Etiology

Back 22

•Psychodynamic theories
–Family dynamics
–Mania as defense against depression
•Biological theory
–Excessive levels or imbalance in neurotransmitters
•Genetics
Nursing Care -NPR:
•Safety
•Matter-of-fact approach
•Clear, concise directions and comments
•Interrupt if you need to -kindly.
•Set limits calmly, but don’t set unimportant limits.
•Keep assessing your countertransference! Don’t fall in.
•Reinforce reality.

Front 23

Nursing Care -NPR:
•

Back 23

Safety
•Matter-of-fact approach
•Clear, concise directions and comments
•Interrupt if you need to -kindly.
•Set limits calmly, but don’t set unimportant limits.
•Keep assessing your countertransference! Don’t fall in.
•Reinforce reality.

Front 24

Milieu Management
•

Back 24

Meet often with colleagues to defuse conflict and clarify communication.
•Consistency, consistency, consistency.
•Decrease environmental stimuli.

Front 25

Lithium
•

Back 25

A salt.
•Substitutes for sodium, changes neurons’ responses to neurotransmitters.
•1 to 2 weeks for therapeutic response
•Narrow “therapeutic window” -
•maintenance blood levels 0.6 to 1.2.
•blood levels over 1.5 toxic.
•Fluid balance very important.

Front 26

Lithium -Side Effects

Back 26

•ia and polydipsia
•Nausea
•Dry mouth
Polyur•Diarrhea
•Thirst
•Drowsiness
•Mild hand tremor
•Weight gain
•Bloated feeling
•Insomnia
•Dizziness

Front 27

Lithium -Adverse & Toxic Effects
•

Back 27

Diabetes insipidus
•Toxic effects depend on blood level:
–Exacerbation of side effects, increasing to:
–Extreme GI distress,
–Muscular weakness
–Ataxia
–Multiple organ failure at high levels.
•Note patient teaching needs

Front 28

Diabetes insipidus
•

Back 28

Toxic effects depend on blood level:
–Exacerbation of side effects, increasing to:
–Extreme GI distress,
–Muscular weakness
–Ataxia
–Multiple organ failure at high levels.
•Note patient teaching needs