Mental Health Intro

• 1. Cognition, volition (free will) and/or emotional processes
• 2. Judgment
• 3. Capacity to recognize reality or control behavior
• 4. Ability to fx effectively at work, home

• Interference with social/occupational functioning (school work & attendance in children)
• Impairment in ADLs

• 1. goal oriented
• 2. present oriented
• 3. disclosure to help pt
• 4. knowledge and skill required
• 5. client-directed

• 1. self-respect
• 2. understanding

• usually dominant
• responsible for language
• mathematical ability
• problem-solving

• musical skills
• recognition of faces
• spacial relationships
• TWO SIDES CONNECTED BY CORPUS CALLOSUM

• motivation
• speech
• mood and emotional experience

Act as the synaptic interface-from axon to dendrite, and sometimes within the neuron.

• 1. Amino acids-glutamate (excitatory) and GABA (inhibitory)
• 2. Neuromodulators-monoamines, catecholamines (norepinephrine, dopamine), indolamine (5HT, seratonin)
• 3. acetycholine
• 4. Peptides (endorphins)
• 5. Epinephrine

• client adherance
• rationale for PRNs
• patient and family teaching

• receive sensory stimulation
• emotional expression generated here

Messenger chemicals produced by the brain which allow the transmission of signals from one neuron to the next (the receiving cell) across synapses.

• "Adrenalin" for the brain
• Secreted by the adrenal glands-fight or flight
• Secreted in response to stress, arousal
• present in the brain while adrenalin is in the rest of the body
• regulates alertness, tension, stress

• regulates mood, anxiety and pain
• has an effect on appetite, sleep, sexual behavior
• When inhibit reuptake, more serotonin in synapse, so more gets over to receiving cell

• influences emotional behavior and cognition (thought)
• regulates motor activity/movement
• regulates endocrine activity, especially lactation

When dopamine is down, men and women will lactate, develop gynecomastia

When dopamine is increased in the limbic system, psychosis increases.

• major inhibitor transmitter SO
• decreased GABA means increased anxiety
• associated with emotional balance, sleep, anxiety

• benzos
• hypnotics
• anticonvulsants

• 1. sedation
• 2. anti-seizure
• 3. anti-nausea
• 4. pre-op

• non-benzo antianxiolytic
• beta-blocker
• can be used for extrapyramidal SE
• can also be used for social phobia, panic attacks, PTSD, migraine HAs

• SSRI used to treat depression
• also used to treat OCD and/or social anxiety disorder (long term)

ambien, trazadone

• amitryptyline
• protriptyline
• clomipramine
• desipramine
• imipramine
• doxepin

• Anticholinergic (dry mouth, blurred vision, postural hypotension, constipation/urinary retention)
• EPS
• cardiac
• photosensitivity

• dangerous in overdose
• admin in small doses

• 2+ weeks to have full effect
• don't give with MAOIs
• admin at hs
• don't stop abruptly
• use sunscreen
• increase fiber in diet

• fluoxetine/prozac
• citolopram
• escitalopram
• fluvoxamine (OCD)
• paroxetine
• sertraline

• anxiety
• insomnia
• tremors
• weight changes

• don't prescribe with MAOIs-can cause serotonin syndrome (HTN crisis)
• watch for suicidal ideation at beginning of prescription
• can reduce seizure threshold
• renal and hepatic

• taper when d/cing
• don't take with MAOIs or some OTCs
• watch for dizziness
• don't take with ETOH

• effexor
• serozone and trazadone (desyrel)
• wellbutrin (smoking cessation)
• zyban

• lithium
• anti-convulsants: tegretol, depakote, lamictal

• GI/N&V
• diarrhea
• EPS
• tremor
• polyuria
• cardiac (arrhthymias, circulatory collapse)
• weight gain

• narrow therapeutic index
• 0.6-1.4 mEq/L with 1.6 toxic
• draw levels 8 hrs past last dose

• drink 2-3 L a day
• adequate NaCl intake
• report S/E (GI sx or fever, thirst, dehydration)
• taper off slowly

• phenothiazines:
• -thorazine/chlorpromazine
• -mellaril/thioridazine
• -stelazine/trifluoperazine
• -prolixin/fluphenazine
• -trilafon/perphanzine
• Butyrophenones:
• -haldol-haloperidol
• Loxitane, Navane, Moban

• clorazil/clozapine
• zyprexa/olanzapine
• risperdal/risperidone
• abilify/aripiprazole
• seroquel/quetiapine
• geodon/ziprasidone

• psychotic thinking
• delusions
• hallucinations
• disorganized speech/behavior
• exaggerated language/behavior
• IMPROVES WITH AGE
• BOTH ATYICAL AND TYPICAL ANTI-PSYCHOTICS TREEAT POSITIVE SYMPTOMS

• A dimnution or loss of normal fx including:
• -flat affect
• -alogia (restricted thought/speech)
• -apathy (lack of goal directed behavior)
• -anhedonia (inability to experience pleasure)
• -impaired attention
• -emotional withdrawal
• IMPROVES WITH AGE
• USE ATYPICAL MEDS, TYPICALS DO NOT WORK WELL!

• incoherence
• loose associations
• impaired attention
• impaired information processing
• SYMPTOMS WORSEN WITH AGE

• akathisia (fidgeting, foot tapping)
• Parkisonism (pill rolling, tremor, cog-wheel rigidity, impaired gait)
• dystonia (involuntary muscle movements, eyes rolled back)
• Tardive dyskinesia (involuntary facial movements)

• anticholirnergics
• photosensitivity
• orthostatic hypotension
• weight gain
• grand mal seizures
• increased prolactin levels
• Neuroleptic Malignant Syndrome (NMS)
• -extreme form of EPS

• rare form of EPS
• Symptoms: fever, tachycardia, severe muscle rigidity, "lead pipe rigidity", tremor, incontinence, increased CPK, renal failure
• Risk factors: age under 20, over 60, African American, high neuroleptic dose or potency, hx of CNS disease or DD, sometimes abrupt withdrawal of Parkinsons meds
• TX: Stop neuroleptics, reduce fever, maintain hydration, correct electrolyte imbalance, administer dopamine agonist
• 80% OF PATIENTS MAY RESTART MEDS W/IN 3 WEEKS, 33% RISK REOCCURENCE

Dopamine blocking agents