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112 Cards in this Set
- Front
- Back
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DSM IV-TR Definitions of substance
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DSM-IV uses the term “SUBSTANCE” to encompass drugs of abuse, medication or a toxin
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Substance Abuse definition
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A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one or more of the following:
*FAILURE TO FULFILL MAJOR OBLIGATIONS *USE WHEN PHYSICALLY HAZARDOUS *RECURRENT LEGAL PROBLEMS *RECURRENT SOCIAL OR INTERPERSONAL PROBLEMS |
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Substance Dependence (Addiction/Alcoholism)
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Three or more of the following, occurring at any time in the same 12 month period:
*TOLERANCE *WITHDRAWAL *LARGER AMOUNTS TAKEN OVER A LONGER PERIOD THAN WAS INTENDED *PERSISTENT DESIRE OR UNSUCCESSFUL EFFORTS TO CUT DOWN *TIME SPENT IN OBTAINING THE SUBSTANCE, USING THE SUBSTANCE OR RECOVERING FROM ITS EFFECTS *IMPORTANT SOCIAL, OCCUPATIONAL OR RECREATIONAL ACTIVITIES GIVEN UP OR REDUCED BECAUSE OF SUBSTANCE USE *CONTINUED USE DESPITE KNOWLEDGE OF ADVERSE CONSEQUENCES |
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tolerance is defined as either:
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*a need for markedly increased amounts of the substance to achieve intoxication or the desired effect OR
*markedly diminished effect with continued use of the same amount of substance |
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withdrawal manifested by either
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*the characteristic withdrawal syndrome for the substance
*the same substance is taken to relieve or avoid withdrawal symptoms |
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Substance Withdrawal -Definition
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*Physiological, behavioral, cognitive, and affective symptoms that occur after reduction or discontinuance of a drug that has been used heavily over a long period of time.
*Symptoms specific for each drug |
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Chemical Dependence
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*Complex, chronic, progressive
*If untreated, can be fatal *Also psychological, sociological, and spiritual aspects *Most who are chemically dependent are poly-drug users |
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Dual Diagnosis
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*Presence of substance abuse with current psychiatric disorder
*Three possibilities: – Two independent disorders occur together – Substance abuse caused the mental disorder – Person with mental disorder self-medicates to feel better |
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Behavioral Characteristics of Substance Abuse
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*Lack of Control
*Decreased inhibitions *Higher risk for violence *Social isolation *Absenteeism *Interpersonal problems *Altered lifestyle |
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Affective Characteristics of substance abuse
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*Drugs may be used to
– Overcome boredom or depression – Manage stress, anxiety – Decrease negative feelings & increase positive feelings *Emotionally labile |
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Cognitive Characteristics of substance abuse
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*Low self-esteem
*Grandiose thoughts *Blackouts (alcohol) *Confabulation *Paranoid thinking (w/ meth and cocaine) *General decline in cognitive ability *Use of defense mechanisms |
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Defense Mechanisms of substance abuse
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*Denial
– Facts – Implications – Change – Feelings *Projection projecting or blaming our own inadequacy on others *Minimization *Rationalization |
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Effects on Family in substance abuse
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*Substance abuse affects all members
*Especially bad if abuser is parent *Power struggles lead to dysfunctional family system *Abuser may abandon old friends for new (drug users) or become isolated *Financial problems *Ineffective communication problems |
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Family Roles
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Codependent
Hero Scapegoat Clown Lost Child |
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Codependency
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*A relationship in which a non-substance-abusing-partner remains with a substance abuser
*Relationship is dysfunctional *Non-abuser/over-responsible, abuser/under responsible *Operate out of fear, resentment, helplessness, and hopelessness *Try to control the users behavior *Enabling—facilitates substance dependence |
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hero
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*often oldest child
*becomes the competent caretaker *works on making the family function |
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Scapegoat
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*acts out at home, in school, and in community
*child takes focus off the alcoholic parent by getting into trouble and becoming the focus of conflict in family *behavior may also be a way to draw attention to family in unconscious attempt to seek help |
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lost child
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*tries to avoid conflict and pain by withdrawing physically and emotionally
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clown/mascot
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*often the youngest child
*ties to ease family tension with comic relief used to mask his or her sadness |
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Examples of Enabling
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*Rescuing
– ex. posting bail *Taking over – ex. assuming responsibilities *Attempting to control – ex. pouring out alcohol *Covering up – calling in sick for him/her *Denying – ex. believing, promises *Justifying – ex. agreeing with rationalizations *Avoiding – Using food, work, medications to escape *Enduring – Keeping feelings inside, allowing fear to immobilize *Blaming – Criticizing, lecturing, threatening, accusing |
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What makes addict stop using?
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*addict/alcoholic will get help when he or she wants to. The thing that will make him or her want to stop is PAIN
*"hitting bottom" |
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Children of Alcoholics
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*1 out of 8 Americans
*Dysfunctional family roles *Family acts as if nothing is wrong *Children learn to “keep the secret” *Repress feelings *Learn to please parent and serve their needs *Expected to be perfect *Don’t expect reliability in relationships *Learn to distrust |
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Adult Children of Alcoholics
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*Deny stress of dysfunctional family
*Denial is frequent defense mechanism *Expect relationships to be based on power, violence, deceit, misfortune *Have difficulty expressing emotions *May repeat pattern by becoming addicted or marrying addict *Need to change/control environment *Deny powerlessness *Try to solve problems alone-do not succeed *Blame themselves *Obsessive attempt to cover feelings of inadequacy, anxiety, fear of abandonment |
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Impaired Health Professionals
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*About the same as general population
*Shame and guilt magnified *Before 1982, fired, censured or suspended by BON *Now have Intervention Project for Nurses (IPN) |
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CAGE Questionnaire
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C Have you ever felt like you should cut down?
A People have annoyed you by criticizing your drinking? G Have you ever felt bad or guilty about your drinking? E Have you ever taken a drink in the morning as an “eye-opener”? |
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Alcohol: Effects on Body
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*every cell affected
*cardiovascular (damage to heart muscle, cause cardiomyopathy & CHF) *peripheral neuropathies *blackouts *organic brain disorders (korsokoff's syndrome, wernicke's encephalopathy) *digestive system *alcoholic dimentia *cirrhosis (disease of liver) *esophageal varices/rupture *pancreatitis *gastritis/ulcer/GI bleeding *inflammatory process with malapsorption *nutritional abnormalities (vit B, Mg, thiamine deficiency) *prolong use cause tolerance & dependence |
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korsakoff's syndrome
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*Amnesia seen in chronic alcoholics
*Short-term memory loss *Inability to learn new skills *Usually disoriented *May present with delirium and hallucinations and confabulate to conceal condition *Caused by degeneration of thalamus as a result of deficiency of B vitamins, especially *Thiamine and B12 deficiency |
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Wernicke’s encephalopathy
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*Inflammatory, hemorrhagic, degenerative condition of brain
*Characterized by lesions in several parts of brain: hypothalamus, mammillary bodies, tissues surrounding ventricles and aqueducts *Symptoms: double vision, involuntary and rapid eye movements, lack of muscular coordination, mild or severely decreased mental function *Caused by thiamine deficiency *Seen with chronic alcoholism *May coexist with Korsokoff’s syndrome |
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Alcohol: Intoxication and Overdose
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*Slurred speech, incoordination, unsteady gait, nystagmus, impairment in memory and attention, stupor
*Coma *Respiratory depression *Aspiration |
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Alcohol: Overdose Priority Interventions
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*Maintain airway/have resuscitation equipment available
*Monitor breathing pattern *IV line patent *Blood alcohol levels (remember tolerance when interpreting results) *Assess and monitor LOC *Obtain history R/T abuse and recent intake (especially other drugs) |
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Alcohol Withdrawal Syndrome (AWS)
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*headache, fullness in head
*orientation and clouding of sensorium *Develops within hours to a few days of last alcohol intake (usually 6-8 hours) *Autonomic hyperactivity – Sweating – Increasing pulse rate and B/P *Increased hand tremor *Insomnia *Nausea, vomiting *Auditory, visual, tactile hallucinations and illusions (alcohol withdrawal delirium-formerly DTs) *Psychomotor agitation *Anxiety *Seizures |
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Alcohol Withdrawal Delerium (formerly D[elerium]T[remor]s)
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*Usually occurs on day 2 or 3 but may be as late as 14 days after last drink
*Confusion, disorientation, hallucinations *Tachycardia *Hypertension or hypotension *Extreme tremors *Agitation *Diaphoresis *Fever *Death may result from cardiovascular collapse or hyperthermia |
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AWS Nursing Interventions
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*Monitor VS
*Alcohol withdrawal protocol *Maintain patent IV *Administer medications as ordered *Rehydrate, reorient, reassure *Maintain calm environment *Avoid restraints, if possible *Stay with patient for safety and reassurance *Monitor and assess symptoms for worsening/improvement *Delerium or hallucinations should be reported immediately |
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AWS: Pharmacologic Interventions - Benzodiazepines
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*Benzodiazepines are the preferred drugs to use in alcohol withdrawal
*Decrease symptoms and prevent seizures – Chlordiazepoxide (Librium) – most common – Diazepam ( Valium ) – Ozazepam ( Serax) – Lorazepam ( Ativan) |
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AWS: Nursing Interventions - Benzodiazepines
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*Monitor
– BP and P – Tremors – State of anxiety/agitation *Dosage determined by symptoms *Medications given as needed and titrated downward over 5 days |
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Adjuncts to Benzodiazepines in Alcohol Withdrawal
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*Carbamazepine (Tegretol)– reduces risk of seizures
*Clonidine- reduce autonomic nervous system responses to withdrawal, adrenergics (centrally acting), antihypertensive *Beta blockers- reduce autonomic nervous system responses and may reduce craving *Antipsychotic medication |
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Drugs Used to Maintain Abstinence From Alcohol
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*Disulfiram (Antabuse)
*Naltrexone (ReVia) *Acamprosate (Campral) *acetaldehyde if ETOH is ingested *Reaction occurs in 5-10 min and lasts 30 min to several hours |
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Disulfiram (Antabuse)reaction
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*Causes very unpleasant effects if alcohol is ingested while on this drug.
*Not used much anymore *occurs in 5-10 min and lasts 30 min to several hours – Nausea – Copious vomiting – Flushing – Palpitations – Headache – Sweating – Thirst – Chest pain – Hypotension – Weakness – Blurred vision |
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Disulfiram (Antabuse) dangers
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– Marked respiratory depression
– Cardiovascular collapse – Dysrhythmias – MI – CHF – Convulsions – Death |
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Disulfiram (Antabuse)special considerations
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*Patients must be carefully chosen
*Informed consent essential *Patient teaching very important: – Must avoid products containing alcohol >Sauces and other foods cooked with alcohol >Cologne, after shave lotion, liniments applied to the skin >Cough syrups and other OTC preparations containing alcohol - Cannot drink or use alcohol for 2 weeks after stopping the drug – Should carry identification information concerning their status |
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Naltrexone (ReVia)
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*An opioid antagonist
*Prevents pleasurable effects of opioids *Patient must go through withdrawal before taking this drug *Decreases craving *Will precipitate withdrawal in someone who is dependent on opioids *If a person taking this drugs needs opioids, it will require a much higher dose |
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Acamprosate (Campral)
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*Reduces unpleasant feelings brought on by abstinence
*Treatment should include psychosocial support |
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Other Drugs Used in the Treatment of Alcohol Abuse
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*B vitamins
– thiamine – Folic acid – B 12 *Multivitamins *Fluid replacement *Antibiotics |
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Intervention for substance abusers
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*Confronting the drinker/drug user, in a loving and emphatic manner, with the objective evidence of his or her drinking/using and the consequences
*Offer assistance in obtaining treatment *give consequences for not seeking treatment |
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Sedatives/Hypnotics/Antianxiety Agents
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*Benzodiazapines
*Barbiturates |
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Barbiturates
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– Seconal (secobarbital)
– Nembutal (pentobarbital) – Amytal (amobarbital) – Tuinal (amobarbital & secobarbital) – Phenobarbital – Quaaludes |
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Benzodiazapines
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– Valium (diazepam)
– Librium(chlordiazepoxide) – Xanax (alprazolam) – Halcion (triazolam) – Ativan (lorazepam) |
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Sedatives/Hypnotics/Antianxiety Agents: Mode of Administration
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– Oral
– Can be used IV |
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Sedatives/Hypnotics/Antianxiety Agents: Site of action
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– Enhance action of GABA in limbic system
– May cause significant CNS depression |
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Sedatives/Hypnotics/Antianxiety Agents: effects
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– Drowsiness, sedated appearance
– Lack of coordination – Euphoria – Labile emotions – Irritability, anxiety – Impaired attention – Working memory loss |
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Intoxication and Overdose
Sedatives/Hypnotics/Antianxiety Agents |
*Same potential problems as alcohol
*Synergistic effect with other CNS depressants including alcohol |
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Priority interventions
Intoxication and Overdose Sedatives/Hypnotics/Antianxiety Agents |
– Manage airway
– Monitor for respiratory depression/arrest – Support vital functions – Lavage/activated charcoal – Dialysis for drugs with longer half-lives and no antidotes |
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Antidote for benzodiazapines: Anexate, Romazicon (flumazenil)
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– Reverses CNS depression
– Monitor for withdrawal symptoms – If symptoms occur, larger doses may be required because of tolerance |
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Withdrawal
Sedatives/Hypnotics/Antianxiety Agents |
*Dangerous
*Symptoms same as for alcohol ***Seizures can occur*** *Can have delirium *May use same drug or different CNS depressant and taper off gradually *Monitor for same symptoms as in ETOH withdrawal |
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Designer Drugs: Rohypnol (flunitrazapam)
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– Street names: roofies, forget pills, R2
– Small white tablet that is tasteless and odorless in a drink – “Date rape” drug, sedative-hypnotic effect with muscle relaxation, blackouts, amnesia – Used to render rape victims unconscious – Causes short-term memory loss – May cause respiratory depression, aspiration, or death – May be addictive – Withdrawal seizures may occur – Klonopin (clonazepam) sold as “roofies” |
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Designer Drugs: GHB (gamma-hydroxybutyrate)
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– Street names:G-riffic, Grievous Bodily Harm, Liquid G
– Euphoric, sedative and anabolic effects – Sometimes used by body builders and at gyms and fitness centers – Rapid acting CNS depressant – Occurs naturally in body – Has been associated with sexual assault – Clear liquid, odorless, and tasteless – Can lead to unconsciousness, coma, seizures or death esp. when combined with ETOH – Can cause breathing difficulties when used with alcohol and/or other depressants – When combined with amphetamines, increased seizure risk – May be withdrawal symptoms |
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Opioids
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– morphine
– heroin – codeine – Dilaudid(hydromorphone hcl) – Percodan (oxycodonex2/asa) – Demerol (meperidine hcl) – Methadone – oxycodone – Percocet (oxycodone/apap) – Vicodin (hydrocodone/apap) |
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Opioids Mode of Administration:
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– Oral, injection, IV
– Smoking, inhalation |
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Opioids Site of Action:
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Attach to same opiate receptors in brain as endorphins, enkephalins, dynorphins
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Effects of opioids
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– Brief, intense sensation—rush or thrill
– Followed by longer-lasting high, calmness – Sedated appearance, motor retardation – Slurred speech, decreased awareness – impaired attention span – Reduction of instinctual drives – Euphoria, pleasure, relaxation – Depress respiration – Suppress coughs – Inhibit GI motility – Continued use decreases production of endorphin and enkephalin—results in low pain tolerance during withdrawal |
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Complications with opioid use
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– Poisoning from heroin
– Heroin more potent – Risk for hepatitis, HIV infection, AIDS if using needles – Liver problems – Malignant hypertension – Strokes – Kidney failure |
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opioid Overdose symptoms
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*Clammy skin
*Shallow respirations *Pinpoint pupils (may be dilated with hypoxia) *Death from respiratory depression or irreversible pulmonary edema |
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Drugs Used to Treat Opioid Overdose
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*Lasix for pulmonary edema
*Naloxone (Narcan)is an opioid antagonist |
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Naloxone (Narcan)
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*An opioid antagonist
*Reverses effects of opioid overdose *Usually has to be readministered because it has short half life *If too much given, patient may go into withdrawal |
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Opiate Withdrawal
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*elevated resting pulse rate
*sweating, chills, flushing *restlessness *dilated pupil *bone or joint aches *runny nose or tearing *nausea, vomiting, diarrhea (GI upset) *tremors *yawning *anxiety or irritability *gooseflesh skin *flu like symptoms |
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Drugs Used To Assist In Withdrawal From Opioids
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*Methadone
*Buprenorphine *Clonidine |
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Methadone
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*potent narcotic, usually for heroin withdrawal
*Modifies drug using behaviors *Prevents the reinforcing pleasurable effects of street drugs *Highly addicting |
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Buprenorphine (Subutex, Suboxone)
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*Sublingual
*Used for withdrawal and maintenance of abstinence *Alleviates craving *Reduces use of illicit drugs *Low abuse potential *Safer than methadone *Can prevent opioid- induced euphoria *Withdrawal is milder |
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Central Nervous System Stimulants
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*Cocaine
*Amphetamines |
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cocaine: mode of administration
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– Smoking (brain delivery rate similar to IV)
– Inhalation (addictive, causes erosion of nasal mm and may cause perforated septum) – Injection – IV |
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Cocaine reaction
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*High in 2-3 minutes, may last 20-30 minutes
*Higher potential for addition with crack (purified chips). *can be inhaled, smoked or injected. Most efficient method of delivery. *Takes 6-7 seconds to reach brain |
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Site of Action: cocaine
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– CNS STIMULANT
– Binds to DA transporters resulting in accumulation of DA – Intense feeling of euphoria – Research animals will self-administer, often overdose, and die *dopamine makes people feel good |
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Effects: cocaine
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– Uniquely addicting
– Positive reinforcement thru euphoria, increased energy, mental alertness, increased self-confidence, sexual arousal – Tension, fatigue, shyness disappear – Talkative, playful – Judgment may be impaired – May become AGGRESSIVE/VIOLENT – PARANOIA – Negative reinforcement – Rebound dysphoria, or “crash” – Progressive tolerance of positive effects – Intensified negative effects |
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Complications from cocaine
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*Vasoconstriction (sympathomimetic effects cause severe hypertension, elevated HR, stroke, MI, dysrhythmias)
*Seizures (CNS stimulation cause hypertension, stroke, MI) – Decreased glucose utilization in frontal cortex – Loss of sense of smell – Perforated nasal septum – Pulmonary damage – Hepatitis |
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Space-basing
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*crack cocaine with PCP (angel dust)
*May lead to panic, terror, violent, uncontrollable behavior |
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Speedballing
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cocaine mixed with heroin and injected IV
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Withdrawal symptoms of cocaine
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*Severe craving
*Depression *Fatigue, irritability *Vivid, unpleasant dreams |
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cocaine overdose symptoms
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– Euphoria, grandiosity, anger, combativeness, impaired judgment
– Tachycardia, cardiac arrhythmias, elevated BP – Perspiration, chills – Nausea, vomiting – Seizures, respiratory depression – Hyperpyrexia (extremely high temp) – Death |
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treatment of cocaine overdose
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– May have to ventilate
– Lidocaine or propranolol IV (dysrhythmias) – Acetomenophen or Dantrium (hyperthermia) – Hydralazine or nitroprusside (HTN) – Diazepam or phenobarbital (seizures) |
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Overview - Elements of Recovery
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*Abstinence – life long
*Detox if needed *Diet *Exercise *Overcome denial *Face/explore feelings *Learn about the illness of addiction *Learn new behavior patterns *Learn new ways of communicating and relating *Relapse prevention *Support |
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Recovery Model
(12-step programs) |
*Chemical dependence is a chronic, progressive, often fatal disease
*Responsibility for recovery is on client *Recovery is a life-long, day-to-day process *Support comes from peers with same addiction *Deeply spiritual |
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substance abuse physical assessment integrity of skin and scalp
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– Bruising
– Spider angiomas – Dermatitis – Diaphoresis (sign of impending withdrawal) – Dependent edema |
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substance abuse physical assessment head
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– Fractures
– Puffy face with flushed cheeks and nose |
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substance abuse physical assessment eyes
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– Icterus aka jaundice (hepatitis or cirrhosis)
– Nystagmus (Wernicke’s encephalopathy) |
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substance abuse physical assessment ears
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signs of trauma
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substance abuse physical assessment mouth
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– Signs of trauma, infection
– Lip peeling (B deficiencies) – Condition of teeth |
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substance abuse physical assessment neck
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– Visible pulsations (cardiomyopathy-inflamed heart, CHF)
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substance abuse physical assessment chest
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– Pneumonia, TB
– Gynecomastia (cirrhosis) |
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substance abuse physical assessment abdomen
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– Bulging flanks(love handles) (ascites- is an accumulation of fluid in the peritoneal cavity)
– Enlarged liver (hepatitis or cirrhosis) – Anorexia, N&V, fever, liver tenderness (early signs of hepatitis) – Pale stools, dark urine, jaundice (later signs of hepatitis) – Dilated veins at umbilicus, GI bleeding, hemorrhoids (portal hypertension) – Vomiting bright red blood (esophageal varices secondary to portal hypertension) |
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substance abuse physical assessment neurologic status
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Neurologic status
– LOC, cognitive function, motor function – Orientation – Long-term memory loss (Korsakoff’s) – Impaired abstract thinking, judgment, personality changes (alcoholic dementia) – Ataxia (lack of coordination), nystagmus, confusion (Wernicke’s encephalopathy) |
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Diagnosis of substance abuse
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*Determine:
– client’s view of substance abuse – Client’s attitude about addicts – Client’s concept of disease – Client’s treatment goal – Reason treatment sought |
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Nursing interventions for substance use treatment
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Help client overcome denial:
*Help client identify negative consequences of drug use *Connect life problems to drug dependence *Avoid “supporting” denial –Use one-day-at-a-time approach –Listen and give active support –Identify client’s strengths and abilities –Teach relapse prevention –Help client make short-term and long-term goals –Encourage physical fitness –Dietary management |
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Nursing interventions for impulse control training
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– Part of relapse prevention
– Help client identify and express feelings – Help them see how drugs were used to avoid pain of emotions – Encourage to identify high-risk situations – Help to identify internal/external cues (HALT) – Help identify previously successful techniques – Help anticipate and plan for problem situations – Encourage them to plan a daily schedule – Have clients identify early warning signs of impending relapse – Acknowledge that slips will occur – 9-15 months required to adjust to no drugs – Lifelong vulnerability to relapse – Recovery is total abstinence from all drugs |
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Nursing Interventions
(Behavioral: Coping Assistance) |
*Refer to Support Groups:
>Self-help groups >Group therapy *Spiritual Support >Facilitate client’s use of meditation, prayer *Hope Instillation >Emphasize client’s worth and dignity >Encourage to “let go” of the past |
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Nursing Interventions
(Behavioral: Patient Education) |
*Learning Facilitation
>Teach about the illness >Ask about parents’ use of alcohol, nicotine, other substances >Educate them about their influence on children |
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Nursing Interventions
(Family: Life Span Care) |
*Family Support, Family Therapy
>Chemical dependency is a family disease >Abstinence affected by family process >Provide relapse prevention education to identify triggers and coping strategies >Help co-dependent members talk about feelings >Help them learn to respect themselves >Help them identify co-dependent behaviors |
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Other Nursing Interventions
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– Empower them to give up co-dependent behavior
– Equalize power in adult relationships by helping them develop list of responsibilities – Utilize family support groups (Al-Anon) – Assess and modify role behaviors and communication patterns |
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Adjunctive Medications for EPS’s
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• Inderal (propranolol) - counteract akathisia
• Benadryl (diphenhydramine) - counteract akathisia, treat dystonia • Congentin (benztropine)- counteract akathisia, treat dystonia • Parlodel (bromocriptine)- may be used to help halt DA blockage in neuroleptic malignant syndrome • Symmetrel (amantadine) • Akineton (biperiden) • Parsidol (ethopropacine) • Disipal, Norlex (orphenadrine) • Kemadrin (procyclidine) • Artane (trihexyphenidyl) • Dantrium (dantrolene) • Inderal (propranolol) • Visken (pindolol) |
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Clozapine (Clozaril)
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Advantages
May be most effective; especially for negative symptoms and cognitive deficiencies Does not cause movement disorders May lower the risk of drug and alcohol abuse Side effects Agranulocytosis (in at least 1% of patients) Drowsiness, dizziness, drooling Seizures (in 1-5% of patients) Muscle weakness Weight gain Diabetes Rapid withdrawal may lead to psychosis |
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Risperidone (Risperdal)
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Advantages
Outperforms conventional drugs No seizures or drooling Movement disorders uncommon Side effects Dizziness Drowsiness Dry mouth Rapid heartbeat Some movement disorders at high doses Weight gain Diabetes |
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Olanzapine (Zyprexa)
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Advantages
Outperforms conventional drugs Overall low rate of side effects No seizures or drooling Movement disorders uncommon Can be injected for gradual absorption (up to one month) Side effects Dizziness Drowsiness Dry mouth Substantial weight gain Diabetes |
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Quetiapine (Seroquel)
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Advantages
Similar to Risperidone and Olanzapine, but little risk of dry mouth or dizziness Side effects Drowsiness Substantial weight gain Diabetes Occasional movement disorders Cataracts reported in animals given high doses |
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Ziprasidone (Geodon)
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Advantages
No movement disorders Apparently little weight gain May be helpful for depression and anxiety Side effects headaches Nausea Drowsiness Dizziness Rash Can slow electrical conduction through the heart |
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Conventional (>20) antypsychotic drugs
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Advantages
Well known; proven effective for positive symptoms Cause less weight gain and diabetes than novel drugs Some can be injected for gradual absorption (long lasting effects) (Haldol Decanoate, Prolixin Decanoate – IM slow release every 2-6 weeks) Side effects Constipation Dry mouth Blurred vision Dizziness Movement disorders (some have high incidence) Little effect on negative symptoms |
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older/typical/conventional psychotic drugs
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• Tindal (acetophenazine)
• Thorazine (chlorpromazine)- oldest, very sedating • Proxilin, Permitil (fluphenazine) • Serentil (mesoridazine) • Trilafon (perphenazine) • Mellaril (thioridazine) • Stelazine, Suptazine (trifluoperazine) • Vesprin (triflupromazine) • Haldol (haloperidol) –used for agitation • Moban (molindone) • Taractan (chlorprothixene) • Navane (thiothixene) • Loxitane (loxapine) • Orap (pimozide) |
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catatonic type schizo
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*Non movement (motor immobility)
*Excessive motor activity catatonic exitement *Extreme negativism *Peculiar movements waxy flexibility (body part stays where it is left) *Echolalia saying the same word or echopraxia repeated movement |
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paranoid type schizo
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Delusions false fixation
• Organized around a theme • Persecutory someone’s out to get them • Grandiose think they are famous Hallucinations Anger Argumentativeness Violence due to paranoia |
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disorganized type schizo
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*Fragmented delusions or hallucinations
*Disorganized behavior magical thinking • Odd behaviors (mannerisms) • Extreme social withdrawal *Disorganized speech thought pattern disorganized *Flat, inappropriate, or silly affect |
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undifferentiated type schizo
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*psychotic symptoms
*mixed schizophrenic symptoms |
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residual type schizo
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*older pts
*Absence of prominent delusions/hallucinations •Emotional blunting •Social withdrawal •Eccentric behavior •Illogical thinking •Loose associations |
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Benzodiazepines
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Ex: Xanax, Valium, Ativan, Librium, Centrax
*antianxiety medications *produce calming effect *CNS depression, skeletal muscle relaxation, antinconvulsant properties SIDE EFFECTS: *syngergistic effect with alcohol *fatigue *dizziness *psychomotor impairment *potential for addiction |
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Azaspirones
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Buspar (buspirone)
*DOC for long-term treatment of antianxiety medications *don't tranquilize or sedate *have mild antidepressant effects SIDE EFFECTS *no potential for dependence *drowsiness *dizziness *headache *nervousness |
