Who is most likely to use/abuse substances?
Males & sml
What are the detox stages of alcohol?
- 1. First 6-8 hours:
- onset of tremors, tachy, ^ B/P, n/v, vivid dreams
- 2. 6-48 hours: onset of hallucinations, seizures
- 3. 48-72 hours: onset of delirium tremors
*Life threatening, up to 10% still die ^B/P, tachy, ^ temp, hallucinations, delusions, restlessness, fluctuating LOC
What 3 things do you obtain from the pt. during an alcoholism assessment?
- Tox screen
- UDS - not urinalysis, Not Clean Catch!
- (Urine drug screen)
What is given to a person detoxing from alcohol?
What is the etiology of alcoholism?
- *no single cause all are a reason
- - Genetic - parent uses
- - Endorphin deficiency
- - GABA deficiency (braking action)
- - Psych: Intolerance to pain & frustration decreased self esteem, ^ risk taking
- - Socio: ethnic groups
What are the psychological changes in someone addicted to alcohol?
- ^ Anxiety
- Defensive style developed
- Denial* rationalization, projection
+ Depression, Anxiety, narcissism, low self esteem
What is Wernicke Korsakoff Syndrome?
- encephalopathy, also called "wet brain", caused by vitamin B deficiency secondary to alcohol abuse, decreased muscle coordination.
- s/s: wide based gait, ataxia, confusion, coma, death, vision
Tends to be permanent
How do you treat Wenicke Korakoff's syndrome?
IV B & mag sulfate
mag sulfate ^seizure threshold & body's ability to use vitamin B
What do patient going through alcohol withdrawal always need?
Vitamin B in their IV
What antiparkinson meds help with EPS and are generally ordered with antipsychotics?
What are adverse reactions to antipsychotics?
(Agranulocytosis, and NMS can be fatal treat ASAP)
What are other s/e of standard neuroleptics/antipsychotics?
- postural hypotension
- Othersexual dysfunction
- weight gain
- dematologic changes
What anticholinergic symptoms are s/e of standard neuroleptics/antipsychotics?
- Dry mouth
- Dry eyes
- Urinary hesitancy/retention
- Blurred vision
- Ejaculatory inhibition
Why is Tardive Dyskinesia a bad sign?
It is irreversible
What are late reactions/signs of EPS from antipsychotic meds?
- *months --> years after drug therapy
- Tardive Dyskinesia
Ticks, puffing cheeks, lip smacking, tongue thrusting, involuntary movements, speech disturbances.
What do you do if your patient shows early s/s of EPS?
Tell pt. it is treatable and you will help them.
What are early signs of EPS from antipsychotic meds?
- 1st 60 days
- Acute dystonia - severe spasms of muscles of tongue, face, neck, or back
- Pseudoparkinsonism - rigidity, tremors, salvation, shuffling gate, mask like face
- Akathisia - most common, motor reslessness, pacing
What are some standard neuroleptics?
What are long-acting antipsychotics? How long? How are they given? Why are they given?
- Long acting:
- Haldol-D, Prolixin-D
- (last 2-4 weeks, given IM z-track)
- Standard antipsychotics: "Hal Mel & Stella met Thor in the Navy"
- thorazine, haldol, mellareil, stelazine, navare
Given when compliance is just not there
What neurotransmitters do antipsychotics work on?
What is the desired effect?
Dopamine receptor blocker
Because dopamine stimulates areas associated with emotions, motor & cognitive functions.
Desired: v aggression, v paranoia, v hallucinations & delusions
What are some MAOI's?
- Marplan (on NCLEX)
What neurotransmitters does lithium affect?
- ^ norepinephrine
- ^ # of serotonin receptors
What are 2 unique routes of Risperdone/visperdal?
- Depot formulation (aka Deconate)
- PO disintegration waifer
What is unique s/e about atypical antipsychotics Zyprexa/onalzapine?
- Weight gain! 100 lbs in 1 year
- +LDL, BGL, Diabetes
What are some hypothesis of the etiology of schizophrenia?
- Virus in utero
- Birth complications
What do antipsychotics do when used for schizophrenia?
- Reduce impact of dopamine
- Block dopamine and hallucinations go away
What are some SSRI's
What are some atypical antipsychotics that work on both positive & negative symptoms of schizophrenia?
What neurotransmitters do they affect?
- *Serotonin Dopamine Antagonists*
What are some tricyclic drugs (TCA)?
What are some SNRI's?
What are the benefits of Seroquel/quetiapine & Goedon/ziprasidone?
quetiapine/Seroquel- less weight gain
ziprasidon/Goedon - weight neutral *slows heart rate*
What are is schizophrenia recognized?
Typically adolescents, when the prefrontal cortex turns on and begins to develop.
The brain malfunctions in communicating between areas which are governed by the prefrontal cortex.
What are advanced signs of toxicity of lithium?
Coarse hand tremors, confusion, EEG changes, lack of coordination
What is Paranoid Schizophrenia?
- Paranoid-delusional, hallucinations, look & sound normal. Can flip easily into anger/aggression.
- Mixture of psychotic symptoms -uncommon-
- chronic illness - go back to normal almost, just not quite to baseline
What is disorganized shizophrenia?
- A subtype of schizophrenia
- - incoherent fragmented communication
- - severe perception & thinking disturbances
- - disorganized bizarre speech & behavior
- - very poor hygiene and grooming
- - most regressed of all
What is catatonic schizophrenia?
- Mute but can hear
- -Extreme withdrawal
- -Mute, appear comatose
- -Waxy flexibility, move them and they stay
- -Client aware of environment but unable to respond
- -Able to hear & remember
- -Extreme agitation - extreme hyperactivity & excitement almost "manic state"
What are some schizo associated symptoms?
What are common disorder often found in people with schizophrenia?
- Depression & suicide
- Anxiety disorders
- Psychosis - induced polydisia
- Substance abuse
- Violent behavior
How do you communicate to a hallucinating client?
- Avoid touch
- Don't get too close too quickly
- ask directly about hallucinations
- do not react as if they are real
- assist pt. to differentiate between inner vs. outer stimuli
What are good interventions to use with a hallucinating client?
- Use radio/music
- Use thought stopping tech. ie:rubber bands
- journal. argue with voices
- Positive affirmation tapes "disease will go into remission"
- Avoid "white noise", fans, static blowers
- TMS - transcranial magnetic stimulation
- (magnetics stimulate weak electric currents)
What are the prepsychotic or prodromal phase s/s?
- Anxiety obsession/compulsions
- Difficulty concentrating
- Difficulty sleeping
- Attaching symbolic meaning to symptoms
- Loneliness & isolation
- Preoccupation w/ metaphysical, religious or sexual theme
- Hopelessness sense of rejection or self-hatred
- Slow onset 2-3 years
What happens in phase 1?
- Bizarre behavior (florid psychotic symptoms)
- *change in self care, unusual eating or sleeping patterns, HA, confusion
Describe phase 2 - "early years" maintenance.
- Psychotic process continues to progress
- Remissions & exacerbations
- Focus on med maintenance
- *try to prevent psychosis - it leads to gray matter loss*
Describe phase 3 - "long term stabilization"
Psychotic s/s may decrease over time or become less disruptive -or- may worsen
Focus on relapse prevention
What is the difference between Positive & Negative symptoms of schizophrenia?
- Positive signs are delusions & hallucinations - classic signs
- *meds work well with + signs*
- Negative signs - deficits in emotions/emotional responses.
- *meds do not work well w/ negative signs*
What are positive signs?
- clang association, echoialia, word salad
- Delusion: grandeur, persecution/paranoid somatic, etc.
- Associative looseness: thought patterns are vague, fragmented, unfocused
- Concrete thinking: can't think abstractly "those in glass houses", no concepts or generalization.
- Hallucination loss of boundaries: depersonalization, bizarre behavior, derealization.
What are good prognosis of schizophrena?
- Predominantly positive signs
- -Acute onset
- -Age @ onset (the older the better)
- -Work hx: has worked
- -Marital hx: married or close relationship
What are s/s of lithium @ therapeutic level?
mild hand tremors
What are early s/s of lithium toxicity?
- Slurred speech
- Muscle weakness
What are the Negative s/s of schizophrenia?
- Affect - flat, bizarre, inappropriate
- Anhedonia (no interest)
- Avolition (no motivation)
- Poverty of speech
- Poverty of thought
- Thought blocking - stop thinking in middle of though
What are poor prognosis of schizophrenia?
- Predominantly negative s/s
- Slow insidious onset
- Age @ onset: younger is worse
- Work hx: Poor, no jobs
- Marital hx: Never, no close relationships
- Hx of substance abuse
How are BAL's r/t behavior?
- 0.05 = change in mood/judgement
- 0.10 = clumsy "legal intoxication in most states"
- 0.20 = v function of brains, entire motor area
- 0.30 = confusion/stupor
- 0.40 = coma
- 0.50 = Death r/t respiratory depression