Psych

• mild
• moderate
• severe
• panic

monamines, amino acids, cholinergics, peptides

dopamine, norepinephrine, seratonin, histamine

gamma-aminobutric acid (GABA)glutamate

acetylcholine

substance P, somatostatin, neurotensin

attention, motivation, pleasure, reward

alterness

obsessions and compulsions

mood

anxiety

• antianxiety and hypnotic drugs
• antidepressants
• mood stabilizers
• anticonvuls
• antsantipsychotic drugs

• bensodiazepines
• short acting sedative hypnotics
• melatonin receptor agonists
• burspirone
• antidepressants

• tricyclic antidepressants
• selective serotonin reuptake
• serotonin - norepinephrine reuptake inhibitors
• serotonin - norepinephrine disinhibitors
• monoamine oxidase inhibitors
• other antidepressants

tiramine free

• lithium
• valproate
• carbamazepine
• lamotrigine
• gabapentin
• topiramate
• oxcarbazepine

monitor closely because of low lethal dose

amount in blood levels, CBC, and liver enzymes

agranulocytosis

• conventional - old block dopamine
• atypical - effects are positive and negative - cause less of the Parkinson's looking SE and EPS

• ADHD
• alzhiemer's disease
• herbal treatments

Parkinson's disease and depression

schizoprenia and mania

norepinephrine (NE)

depression

mania, anxiety states, schizophrenia

serotonin

deppression

anxiety states

GABA

anxiety disorders, schizophrenia, huntington's chorea

reduction of anxiety

acetylcholine

alzheimer's disease, huntington's chorea, parkinson's disease

depression

histamine

depression

movement defects such as - parkinsonian sx, akinesia, akathasia, tardive dyskinesia

• increased prolactin - gynecomastia in men and
• glactorrhea-amenorrhea in women

• clozapine (clozaril)
• resperidone (risperdal)
• quetiapine (seroquell)
• olanzapine (zyprexa)

atypical antipsychotics

• tremor, ataxia, confusion, convulsions
• N/V/D
• arrhythimias
• polyuria, polydipsia, edema
• goiter and hyperthyroidism

• carbamazepine (tegretol)
• valproic acid/valproate (depakote)
• clonazepam (klonopin)

• possibly fatal in 1-2% of pts b/c of potential to suppress bone marrow and induce agranulocytosis
• potential for inducing convulsions in 3% of clients

• drowsiness, sedation, hypersalivation, tachycardia,
• and dizziness

WBC's weekly

motor difficulties, orthostatic hypotension, sedation

sedation and weight gain

hepatic failure, birth defects

liver function tests

• amitriptyline (elavil)
• imipramine (tofranil)
• nortriptyline (pamelor)

blurred vision, dry mouth, tachycardia, constipation, sedation and drowsiness, urinary retention, and esphageal reflux, postural -orthostatic hypotension

dysrhythmias, tachycardia, myocardial infarction, heart block

• fluoxetine (prozac)
• sertraline (zoloft)
• paroxetine (paxil)
• citalopram(celexa)

• Phenelzine (nardil)
• tranylcypromine (parnate)

aged cheeses, pickled or smoked fish, yeast, beer, wine, soy sauce, bologna, liver, lunchmeat, smoked meats, figs, bananas, avocado, sauerkraut, soybean paste

• trazodone (desyrel)
• nefazodone (serzone)
• venlafaxine (effexor)
• mirtazapine(remeron)
• bupropion (wellbutrin)

• trazodone - orthostatic hypotension, priapism in males (painful continuous erectile state unrelated to sexual desires or activity)
• venlafaxine- heightened anxiety, N/V and dizziness, abnormal ejaculation and impotence in males
• mirtazapine - sedation, weight gain, dry mouth and
• constipation; antimuscarinic effects are not as strong with this
• bupropion- headache, insomnia, nausea and restlessness and rarely causes sedation, weight gain, or sexual dysfunction

• benzodiazepines
• buspirone (buspar)

• diazepam (valium);
• clonazepam (klonopin);
• alparazolam (xanax);
• flurazepam (dalmane);
• triazolam (halcion);
• lorazepam (ativan)

• flurazepam and triazolam - hypnotic (sleep inducing) effect
• lorazepam and prazolam - not soporific (sleep producing)

slurred speech, incoordination, unsteady gait, drowsiness, decreased BP; disinhibition of sexual or aggressive drives, impaired judgment, impaired social or occupational function, impaired attention or memory, irritability

cardiovascular or respiratory depression or arrest, shock, coma, convulsions, death

keep awake, induce vomitting, give activated charcoal to aid absorption of drug, VS q 15 min; clear airway - tube, IV fluids, gastric lavage with activated charcoal, frequent VS checks for shock and cardiac arrest after client is stable, seizure precautions, possible hemodiaysis or peritoneal dialysis, flumazenil (romazicon) IV

focus and solve problems with use of open-ended q's, give broad openings, explore and seek clarification,

close off topics, bring up irrelevant topics

calm, willing to listen, recognize distress of pt

past coping mechanisms, help pt to consider alternatives to situations, offer activities that may temporarily relieve tension

• identify anxiety
• anticipate anxiety provoking situations
• use nonverbal language to demo interest
• encourage pt to talk about feelings
• avoid closing off ave of comm that are imp to pt
• clarify
• help pt identify thoughts or feelings before onset of anxiety
• problem solve
• assist in devel alt solutions to prob through role play
• explore behaviors that worked in past
• provide outlets for working of excess enery: walking, exercises

• use firm, short and simple statements
• maintain calm manner
• remain with person in acute severe to panic anxiety
• minimize environmental stimuli; move to quieter setting and stay with client
• use clear and simple statements and repitition
• use low pitched voice, speak slowly
• reinforce reality if distortions occur
• listen for themes in communication
• attend to physical and safety needs when necessary
• SAFETY: physical limits may need to be set
• when a person is constantly moving or pacing, offer high caloric fluids
• assess person's need for meds or seclusion after all other interventions are unsuccessful

• cause sexual dysfunc, insomnia, anxiety, nervousness, let them know what meds you are on for interactions,
• MAOI
• OTC drugs
• ETOH
• liver and reval func tests and CBC's periodically
• rash, hives, rapid HR, sore throat, diff urinating, fever, malaise, anorexia, wt loss, unusual bleeding, initiatvion of hyperactive behavior, severe HA
• D/C abruptly

• begin to work in 7-28 days for; may take 6-8 wks for full effect
• drowsiness, dizziness, and hypotn; after first few weeks
• ETOH
• at bedtime
• take within 3 hrs; otherwise wait for next day
• D/C - will cause N/V, altered HR, nightmares, cold sweat in 2 to 4 days

MAOI's

• 0=none
• 1=mild
• 2=moderate
• 3=disabling
• 4=severe, grossly disabling

• anxious mood
• tension
• fear
• insomnia
• intellectual (cognitive)
• depressed mood
• somatic (sensory)
• somatic (muscular)
• cardio sx
• resp sx
• gastro sx
• genitourinary sx
• autonomic sx
• behavior at interview

emotional conflicts and stressors are dealt with by meeting needs of others

unconscious process of substituting constructive and socially acceptable activity for strong impulses that are not acceptable in their original form

deals with emotional conflicts or stressors by emphasizing the amusing or ironic aspects of conflict or stressor through humor

conscious denial of deisturbing situation or feeling

exclusion of unpleasant or unwanted experiences, emotions or ideas from conscious awareness

transfer of emotions assoc. with a perticular person, object, or situation to another person object or situation that is nonthreatening

overcompensation - unacceptale feelings or behaviors are kep out of awareness b developing opposite behavior or emotion

transforming anxiety on an unconscious level to physical sx that has no organic cause

makes up for an act or communication (compulsive handwashing)

justifying illogical or unreasonable ideas, actions or feelings by developing acceptable explanations

deals with emotional conflict or stressors by indirectly and unassertively expressing aggression towards others.

deals with stress with actions

disruption in the usually integrated fx of consciousness, memory, identity, or perception of environment

attributing neg qualities to self or others

attributing exaggerated positive qualities to others

inability to integrate pos and neg qualities of oneself or others

rejects emotionally unaceptable person features and attributes them to other people

escaping unpleasant realities by ignoring their existance