bh 5, 6

helps pts sleep but not helpful for depression

risk of suicide d/t lifting

• TCA
• MAOI
• SSRI

tricyclic antidepressants

• imipramine
• first antidepressant used

stimulate appetite

• anticholinergic
• no sense of euphoria
• not addicting

• dry mouth
• visual disturbances
• constipation
• decr sweating
• urinary retention
• incr appetite

• elderly
• start low and go slow w dosing

Monoamine oxidase inhibitors

• anticholinergic
• cardiac 
• risk of dependance
• risk of hypertensive crisis

• tachy
• arrhythmias
• cardiotoxicity

• high tyramine foods
• ages, fermented, pickled, smoked
• beer, salami, cheese

Selective serotonin reuptake inhibitors

Prozac

• less s/e than others
• low potential for od
• safe for elderly (still low and slow)

• anticholinergic (not as severe)
• decr sex drive
• cardiovascular effects

• mania w or w/o depression
• pts extremes of mood polarity;
• may feel euporic or depressed;
• may have rapid cycling at times
• crying one moment, euphoric the next

• elevated, expansive, irritable mood
• begins suddenly
• escalates rapid
• last a wk to months
• followed by extreme depression

hx of manic episode

safety

• disturbed speech
• altered social, interpersonal relations
• altered act and appearance

• altered affect
• altered perceptions

lithium carbonate

• bipolar
• takes 7-10 days to begin

• sodium levels/diet
• incr na = decr lith level
• decr na  = incr lith
• need balance 
• maintain consistant na and h20 i&O

nausea, dry mouth, diarrhea, thirst, drowsiness, tremors (lithy shakes), wt gain, polyuria, polydipsia

0.6 - 1.2 mEg/L

draw bld early in the am before first dose and 8-12 h after last dose

n/v/d, drowsy, musc wkness, lack coordination/ataxia, tinnitus, blurred vision

preg

• use matter of fact tone
• clear, concise directions & comments
• limit setting
• reinforce reality
• respond to legitimate complaints
• redirect pts to more healthy act

• used more for suicide than homicide
• incr use by teens

• plan
• intent
• means

• monitor for "sharps" (strings, cans)
• remove all means from reach (pills, guns)
• do not allow wkend passes
• freq observations

contract w pt that they agree if they feel like harming themselves they come and talk to you first

• enhance effects of inhibitory neurotransmitter GABA; 
• depresses cns
• GABA goes up and anx goes down

• Klonopin
• ativan
• valium
• xanax
• librium for detox

• reduce anx
• promote sleep
• relax musc
• prevent seizures
• produce amnesia

flumazenil (Romazicon)

• cns: drowsy, fat, decr coord
• PNS: occ constipation, double vision, hypotension, incont, urin retention

nonspecific, unpleasant, feeling of discomfort w phisiologic and pschy sx that generally result from perception of threat to safety and security (subconscious)

• id cause easily
• consciously recognize

• experiences that are expected as part of normal processes of g&d, for most ind in particular society
• start school, develop relations, new job

less predictable, specific actions are taken only when the threat is eminent or after it occurs

ind recognize acute illnesses/accidents can occur - purchase health insurance but dont know exactly how or when it will happen 

hurricanes and other natural disasters

• +1
• constructive motivator, discuss source of anx, prob solve, accept anx as natural, benefit from it

energetic, fidgeting, muscle tension, good eye contact

slight irritability, feeling challenged, confident

alertness, aware of surrounding, concentration, attentiveness

• +2
• destructive, decr anx-ventilation, crying, exercise, relax techs, refocus attention, relate feelings and behaviors to anx, then use prob-solving techs, give oral meds prn

incr bp, pulse and resp, slight perspiration, startle reflex

motivated to decr anx, incr irritability, decr confidence

difficulty concentrating, tangentiality, loose assocaition

• +3
• decr anx, stimuli and pressure, use kind firm simple directions, use time out (seclusion), five im meds prn

extreme discomfort, feeling of dread, hypersensitivity

extreme musc tension, rapid pacing, reflex responses

distorted perceptions, diff focusing, flight of ideas, disorientation

• +4 
• guide firmly, physically take control, give im meds, order restraints prn

actual flight or fight, suicide attempts, eyes fixed, incoherent

rage, depression, feeling totally drained

word salad, clang associations, neologisms, disorganized perceptions

• health or ability to function
• self-esteem/respect
• self control
• control or power over own life
• status/prestige
• resources (emotional, physical, etc)
• loved ones
• freedom and needs and goals

• subjective experience detected only by obj behaviors 
• emotional pain, apprehension, fearful, sense of powerlessness. warning sign, triggers behaviors, alerts for self defense, contagious, part of a process

pleasure principle, all abt me; unconscious drvie for self-perservation, reproduction, and group association; id is w/o a sense of right and wrong, and ruthlessly insists on immediate satisfaction of impulses and desires; babies are bundles of id

promotes the ind/s satisfactory adjustment in relation to the environment; main funt is to establish an acceptable compromise bw the crude, pleasure seeking id and the inhibitions of the superego; mediator bw id and superego; helps relieve anx

blindly rigid, strictly moralistic and as unrelenting and ruthless; inhibits id

punishes the ind thru feelings of guilt and anx when behavior deviated from strict standards

rewards the ind thru feelings of euphoria and well being

protect ego and relieve anx

• alarm
• resistance
• exhaustion

any stressor that activates the prep for fight/flight; incr in alertness to mobilize resources; level of anx is mild +1, to moderate +2; learning and prob solving; when stressor cont and not resolved...moves to next stage

ind strives to adapt to stress; coping and def mechs use increased; prob solving/learning difficult; moderate +2 to severe +3;

stress that lasts too long; overwhelming; inability to cope; severe +3 to panic +4; defenses are exaggerated; personality disorganized; misperception; reduced orientation; violent, suicidal, immobilized; death w/o intervention

• dilated pupils
• incr resps, sweating, and hr
• any sx of fight or flight

• adaptive
• palliative
• maladaptive
• dysfunctiona;

solves the prob that is causing anx, anx is decreased; pt is objective, rational, and productive; **most effective coping way

temp decr anx but does not solve prob; anx returns; temp relief allows pt to return to prob solving

unsuccessful attempts to decr anx w/o attempting to solve the prob; anx remains

not successful in reducing anx or solving prob; functioning becomes difficult, new probs develop

• relieve anx**
• calm, quiet environment
• ask pts to id how they feel
• encourage to express feelings
• help pt id cause of feelings
• listen for pt expressions of helplessness
• plan and involve pts in act such as walks

nonspecific unpleasant feeling of discomfort w physicologic and psychological sx that generally result from a perception of a threat to safety and security; anx is a sx

patterns of sxs and behaviors in which anx  is either the primary disturbance or a secondary prob that is recognized w the prim sx are removed; has to disrupt adls more days than not over 6 mo

ind experiences the sx of anx cognitively and physically; most common anx d/o, seen w depression, anx or worry is chronic and excessive, can be bt nothing at all; difficulty in controlling anx, habitual worrying way of coping to prevent something bad

intense, irrational fear responses to an external object, act, or situation

fear of being humiliated, scrutinized, or embarrassed in public

fear of being in public or open spaces, places, or situations in which escape might be diff or help might not be available; may not leave home alone

fear of a specific object or situation that is not either 1 of the above; fear of animals, flying, or hts

disorder in which recurrent obsessions (thought) alternate w compulsions (behaviors). both are unwilled

worried abt having, or believe that they have, a serious dis based on the misinterpretation of bodily signs and sensations

existance of two or more identities or personalities that take control of the persons behavior; the host is unaware of the other personailities but the others might be aware of ea other to varying degrees

sudden, unexpected travel away from home or some other location w the assumption of a new identity or a confusion abt ones identity; travel and behavior appear norm; last from a few hrs to several days; rare and unusual follows severe psychosocial stress

loss of mem or the inability to recall important personal info; usually occurs immediately after a traumatic event, one or more episodes of the inability to recall important personal info that is beyond ordinary forgetfulness

development of characteristics sxs (intense fear, helplessness, re-experiencing of events) following exposure to an extreme traumatic stressor; such as war, escaping fire, mva, that maybe a friend/fam member didnt escape

protect ego and relieve anx

unconscious refusal to admit an unacceptable idea or behavior

unconscious and invol forgetting of painful ideas

conscious exclusion from awareness anx-producing feelings, ideas, situations

conscious or uncon attempts to make or prove that ones feelings or behaviors are justifiable

con or uncon, using only logical explanations w/o feelings or an affective component

uncon seperation of painful feelings and emotions from an unacceptable idea, sit, or object

con or uncon attempt to model one self after respected person

uncon incororating values and attitudes of others as if they were your own

con covering up for a wkness by overemphasizing or making up a desirable trait

con or uncon channeling instinctual drives into acceptable activities

a con behavior that is exact opposite of an uncon feeling

con doing something to counteract or make up for a transgression of wrong doing

uncon d/c pent-up feelings to a less threatening object

unco or con blaming someone else for ones difficulties or placing ones unethical desires on someone else

the uncon expression of intrapsychic conflict symbolically thru physical sx

uncon return to a earlier and mroe comfy developmental level

anx accompanies depression

• affect change
• anhedonia
• irritability in kids and young adults
• fatigue
• apathy
• sleep disturbances
• wt changes
• psychomotor changes
• decr/lack of concentration
• inability to make decisions
• feelings of worthlessness/guilt

single white males <24 and >65

decr levels of neurotransmitters, esp serotonin, norepinephrine, and in some cases dopamine

give dexamethasone inj, if depression - urine and bld cortisol levels will not fall, 40% w severe dep fail to suppress any cortisol; not exclusive to the dx of dep

inability to experience pleasure

• no motivation/lack of feeling or interest
• indifferent

retardation or agitation

• used to assess a pt for dep; baseline and cont:
• beck dep inventory
• hamilton rating scale for dep
• zung self rating dep scale

self rating assessment scale; pt w depress will score 50-69; highest possible 80

rule out med or drug induced depre

• accept pt where they are and focus on strength
• reinforce decision making by pts
• respnd to anger therapeutically
• spend time w withdrawn pts
• make decisions for pts in acts for success
• assess for suicide - intent, plan, and means

do not mix, risk for serotonin syndrome

overstimulation of serotonin at synapse, major s/s include hyperthermia, change in loc and musc rigidity

young mania rating scale

safety

may be used alone or in conj w other meds

used as alternate for those that dont respnd to lith; valproates, gabapentin

• sweating
• incr bp - panic - shock = decr bld press
• incr cardiac op