Psych ETOH, Schizophrenia

Males & sml

• 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

• BAL
• Tox screen
• UDS - not urinalysis, Not Clean Catch!
• (Urine drug screen)

Ativan

Phenobarbitol

• *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

• ^ Anxiety
• Defensive style developed
• Denial* rationalization, projection

+ Depression, Anxiety, narcissism, low self esteem

• 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

IV B & mag sulfate

mag sulfate ^seizure threshold & body's ability to use vitamin B

Vitamin B in their IV

• Cogentin
• Benadryl
• Artane

1. Agranulocytosis 

2. NMS

3. Jaundice

(Agranulocytosis, and NMS can be fatal treat ASAP)

• Cardiac
• hypotension
• postural hypotension
• tachycardia

• Other
• sexual dysfunction
• weight gain
• photosensitivity
• dematologic changes
• seizures

• Dry mouth
• Dry eyes
• Urinary hesitancy/retention
• Constipation
• Blurred vision
• Photosensitivity
• Ejaculatory inhibition

It is irreversible

• *months --> years after drug therapy
• Tardive Dyskinesia

Ticks, puffing cheeks, lip smacking, tongue thrusting, involuntary movements, speech disturbances.

Tell pt. it is treatable and you will help them.

Call MD.

• 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

• 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

Dopamine receptor blocker

Because dopamine stimulates areas associated with emotions, motor & cognitive functions.

Desired: v aggression, v paranoia, v hallucinations & delusions

• Parnate
• Nardil
• Selegiline
• Marplan (on NCLEX)

• ^ norepinephrine
• ^ # of serotonin receptors

• Depot formulation (aka Deconate)
• PO disintegration waifer

• Weight gain!  100 lbs in 1 year
• +LDL, BGL, Diabetes

• Virus in utero
• Birth complications
• Nutrition
• Stress

• Reduce impact of dopamine
• Block dopamine and hallucinations go away

• CZPPLL
• Celexa
• Zoloft
• Prozac
• Paxil
• Lexapro
• Luvox

• -CRAZIGSS-
• Clozaril
• Reispersal
• Abilify
• Zyprexa
• Ivega
• Geodon
• Solian
• Seroquel
• *Serotonin Dopamine Antagonists*

• Tofranil
• Norprimine
• Elavil
• Amytryptaline
• Sinequon

• Cymbalta
• Desyrel
• Pristiq
• Remeron
• Effexor
• Stratterra
• **CDPRES**

quetiapine/Seroquel- less weight gain

ziprasidon/Goedon - weight neutral *slows heart rate*

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.

Coarse hand tremors, confusion, EEG changes, lack of coordination

• subtype:
• Paranoid-delusional, hallucinations, look & sound normal.  Can flip easily into anger/aggression.

• undifferentitatied:
• Mixture of psychotic symptoms -uncommon-

• residual
• chronic illness - go back to normal almost, just not quite to baseline

• A subtype of schizophrenia
• - incoherent fragmented communication
• - severe perception & thinking disturbances
• - disorganized bizarre speech & behavior
• - very poor hygiene and grooming
• - most regressed of all
• Egosyntonic

• subtype:
• 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"

• Depression & suicide
• Anxiety disorders
• Psychosis - induced polydisia
• Substance abuse
• Violent behavior

• 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

• 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)

• 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

• Hallucinations
• Delusions
• Paranoia
• Bizarre behavior (florid psychotic symptoms)
• *change in self care, unusual eating or sleeping patterns, HA, confusion

• Psychotic process continues to progress
• Remissions & exacerbations
• Focus on med maintenance
• *try to prevent psychosis - it leads to gray matter loss*

Psychotic s/s may decrease over time or become less disruptive -or- may worsen

Focus on relapse prevention

• 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*

• 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.

• Predominantly positive signs
• -Acute onset
• -Age @ onset (the older the better)
• -Work hx: has worked
• -Marital hx: married or close relationship

mild hand tremors

• N/V
• Diarrhea
• Polyuria
• Slurred speech
• Muscle weakness

• Apathy
• Affect - flat, bizarre, inappropriate
• Anergia
• Anhedonia (no interest)
• Avolition (no motivation)
• Poverty of speech
• Isolation
• Poverty of thought
• Thought blocking - stop thinking in middle of though

• 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

• 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