Psychosocial

Mood state characterized by diminished interestin normal activity, fatigue, feelings of sadness and impaired concentrationnearly every day.

chronic depression – at least 2 or more years.  Most common psychiatric disorder

(pshychodynamic, cognitive, biochemical) – anger directed inward, loss of self esteem. learned world view, negative belief systems, dysfunctional thinking, neurotransmitter imbalance (dopamine,norepinephrine, epinephrine), thyroid dysfunction, medication side effects. 

• To diagnose, must have one of the 1st two, and 5 or more of the following:
• *Depressed mood most of the day, nearly every day
• *Markedly diminished interest/pleasure in almost all activities (anhedonia)
• -Weight loss/gain (>5%)
• -Insomnia/hypersomnia
• -Psychomotor agitation/retardation
• -Fatigue/loss of energy
• -Lack of concentration/indecisiveness nearly every day
• -Excessive guilt or feelings of worthlessness·
• -Recurrent thoughts of death/suicide ideation without a plan or attempt

TSH r/o hypothyroidism, BMP, CBC, LFTs UA, VDRL,B12

May need to refer (ex:hallucination,delusions).  Mild depression = therapeutic communication – encourageverbalization of feelings, fears, losses & cognitive errors inthinking.  Categories of feelings (mad,sad, glad, afraid, ashamed).  Supportstages of grief: Denial, anger, bargaining, depression, acceptance (DABDA).

SSRI, Tricyclics, MAOIs

most commonly prescribed (paxil, prozac, zoloft,celexa, luvox) d/t low overdose danger, fast sx response, no posturalhypotension

Trycyclics cause anticholinergic effects = dry mouth, constipation

increased side effects and high overdose potential 

wine+cheese = hypertensive crisis

increased side effects and high overdose potential

Anxiety – unpleasant feeling of dread, apprehension, tension resulting from unexpected threat to one’s own feeling of self esteem or well being.

emotionally learned response to stress (cognitive behavioral therapy works well).

excessive worries re: life circumstances

morbid dread of harmlessobjects/situations.  May lead toagoraphobia

repetitive thoughts (obsessions) and behaviors (compulsions)

for at least 6 months after a sever trauma/eventperceived as a threat to ones integrity. Sx= flashbacks, nightmares & intrusive thoughts

r/o hyperthyroid, serum drug analyses, glucose, ECG (normal)

• Benzodiazepines – most commonly used (lorazepam, xanax)
• Antihistimines – for those with COPD or potential for abuse
• Beta blockers – reduces tachycardia, palpitations and breathlessness
• Trycyclics & MAOIs – beneficial for panic attacks, less effective for generalized anxiety
• Buspirone (buspar)–only antianxiety med that’s not a tranquilizer – takes 3-4 weeks to reach full therapeutic effect
• Assess coping mechanisms, therapeutic communication, relaxation, focus responsibility on the patient, Patient education: reassurance, medications, etc

most common in adolescents, elderly (>65) and white males >45 years old, hx of substance abuse.  Hopelessness = a common predicting variable, men>women.

“suicidal” - Sex, Unsuccessful attempts, Identified family hx, chronic illness, depression,drug abuse, drinking, age of patient, lethalmethod available

hospitalization with psychotherapy, antipsychotics – caution with low therapeutic medications (lithium) – expect weight gain in atypical antipsychotics.  Elderly – interventions focus on loneliness & medical disability

10% of population, ETOH = most common drug intoxicant, cause= genetics, alterations in opiate receptors, neurotransmitter alterations, psychosocial

• Have you ever felt you should cut down on your drinking?
• Have people annoyed you by criticizing your drinking?
• Have you ever felt bad or guilty about your drinking?
• Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?

be direct with patient – I’m concerned about alcoholism, tell pt disease is treatable, refer to alcohol anonymous

Cerebral function

• O orientation to place/time
• R recognition (repeat 3 objects
• A attention (serial 7s
• R recall 3 objects 5 minutes later
• L language
• 2 indentify names of 2 objects (clock and chair)
• 3 follow a 3-step command (take paper, fold in half, put on table)
• R reading (read statement to yourself & do what it says – do not say it out loud)
• W writing – write a sentence
• D drawing – copy a design

• maximum=30,
• no cognitive impairment  24-30 (avg-27), delirium/dementia 18-23
• mild (0-7 severe) 

sudden, transient onset of cloudedsensorium.  Any age, often associated witha physical stressor

gradual mmemory loss, decreased intellectualfunction over age 60.  Alzheimers – mostcommon cause.

Drugs,emotional disorders, metabolic/endocrine, eye/ear disorders, nutrition, tumors, infection,arteriosclerosis

difficulty with speech

inability to perform a previously learned task

inability to recognize an object (paper clip) – test with sterognosis

• multiple cognitive effects with both memory impairment and 1 or more of the following:  --Aphasia – difficulty with speech
• -Apraxia – inability to perform a previously learned task
• -Agnosia – inability to recognize an object (paper clip) – test with sterognosisInability to plan, organize, sequence and make abstract differences
• -Inability to plan, organize, sequence and make abstract differences

forgetfulness

r/o other causes: CBC, electrolytes, glucose,BUN, CT, LFTs, B12, VDRL, CT/MRI to r/o tumors

neuro consult.  Meds to increase availability of acetylcholine (acetylcholinesterase inhibitors) – aricept, razadyne, Exelon (prescribed w/ namenda to improve thinking and ADLs), refer family for counseling