Mental Health Nursing and substance abuse

Subjective emotional response to a stressor

• Must cause clinically significant distress or impairment in social or other important areas of functioning.
• Chronic, excessive

• Considered the most crippling psychological disorder.
• Positive symptoms: Delusions, hallucinations, abnormal movements
• Negative symptoms: Flat affect, poverty of speech, social withdrawal
• Cognitive symptoms: Memory deficits, attention deficits, language difficulties

• False beliefs that are inconsistent with personal intelligence or cultural background.
• Persecution, grandeur, reference, control or influence, somatic delusion, (nihilistic delusion-sense that everything is unreal)

• Catatonic(inability to move)
• Paranoid (Hallucinations)
• residual(No signs of positive symptoms)
• Schizoaffective disorder (Schizo +bipolar)
• delusional disorder(Delusions)

something is crawling under the skin

Acute intoxication-cardiorespiratory depression or arrest-aspirations.

• Begin up to 4-6 hours after last drink
• Generally starts at 24 hours
• Symptoms last 3-4 days. with some up to 2 weeks.

• Up to 3-4 days.
• Diaphoresis 
• Thirst
• Nausea/vomiting/anorexia
• Gastritis
• Elevated vital signs
• Clammy, pale skin
• Headache
• Visual hallucinations
• Generalized seizures
• Auditory hallucinations, feeling persecuted, increased risk of lethality (self and others)- up to 2 weeks
• insomnia, vivid nightmares
• agitation, fatigue, tremulousness

• onset: 24-48 hours some can be sooner depending on the dependance 
• lasts up to 3-5 days.
• AMS, agitation, fever, diaphoresis, tachycardia, anorexia, hallucinations, hypovolemia/vomiting. can lead to seizures and death.

• manage withdrawal 
• encourage fluids 3000cc
• Mag sulfate for seizure control
• Thiamine to help support, brain, heart and nervous system
• Benzodiazepine used to decrease CNS stimulation. 

Bradycardia, respiratory depression/arrest, pulmonary edema, hypotension, hypothermia, myosis (pin point), pruritus, nausea, dry mouth, constipation.

• Flu-like symptoms
• up to 24 hours
• Methadone: lasts 3-7 days up to several weeks
• Heroin: Onset 6 hours

• Iv fluids
• antiemetics
• alpha adrenergic agents: clonidine, quanfacine-treats tachycardia, lacrimation and diarrhea. 
• Benzo for insomnia and cramps
• Methadone used to tapper patient of the drug and control withdrawal symptoms

Tachypnea, tachycardia, hypertension, hyperthermia, agitation, anorexia, anxiety, tremors and rapid speech

• Stages: crash, withdrawal, extinction
• mild after crash, increases with intensity over 96 hours. lasts from 6-18 weeks
• S&S: lethargy, sleep disturbances, depression, SI, SE: exacerbation.

• Supportive treatment
• droperidol or haldol as a CNS antagonist
• Benzo
• risperdone
• beta-blockers

Acute-Somnolence, agitation, psychosis

• up to 24 hours for short acting
• up to 5 days for long acting
• alleviate over 2-4 weeks
• Symptoms of withdrawal similar to alcohol withdrawal. can be life threatening. Hyperadrenergic manifestations. 

• benzodiazepine tapper over 5-7 days
• Beta-blockers will help control some of the adrenergic symptoms as well.

• Hypertension
• Tachycardia
• Hyperthermia
• Mydriasis
• Seizures
• Stupor
• Respiratory-cardiac depression with high doses
• Acute intestinal ischemia
• Myocardial infarction
• Arrhythmias
• Sudden death

• 24-48 hours onset
• duration is 7-10 days
• Crash: depletion of catacholamines-4 days
• withdrawal at 5-10 days
• Extinction: episodes of intense cravings for months to years
• Not life threatening
• Severe: MI, Acute lung injury
• S&S: anxiety, depression, anhedonia(unable to feel happy or find joy in the things you once found to make you happy), sleep disturbances, increased appetite, psychomotor retardation, hyperprolactinemia, impair color vision.

• Supportive/symptomatic
• fluids
• Benzo

• Acute: Somnolence
• Ataxia
• Nystagmus
• Slurred speech
• Labile emotion
• Depressed myocardial contractility
• Respiratory depression
• Hypothermia

• onset: 6-18 hours
• Duration: 5 days
• Life threatening
• n/v, abdominal cramps, restlessness, anxiety, tremors, insomnia.

• withdrawal can lead to hypotension, hyperreflexia(similar to DT) 
• after 48hours: delirium, seizures, and hyperthermia.

• respiratory support
• fluids
• activated charcoal for intial OD
• vasopressors
• thermoregulation

• Tachycardia
• Hypertension
• Hypertermia
• Hallucinations
• Disinhibition
• Diaphoresis
• Salivation
• Tremors
• Agitation
• Mydriasis (dilation of the pupils)
• Dystonia (dysfunction of muscle tone)
• Confusion
• Seizures

• onset: 8-16 hours
• duration: 5 days
• Life threatening
• S&S: N/V, abdominal cramps, restlessness, anxiety, tremors, insomnia.
• Severe: orthostatic hypotension, hyperreflexia, delirium, hyperthermia, seizures.

• monitor vitals
• supportive care: fluids
• Benzo
• antipsychotics

an unethical breach of human rights no matter the individual or their addictions. Treat people with respect and dignity . We're there to heal not judge.

• a decreased pain threshold-hyperalgesic effect due to a decreased amount of serotonin.
• Substance abusers may require up to 1.5 times the normal dose for pain management.

partial opiate agonists such as pentazocine (Talwin), nalbuphine, (Nubain). these should not be used due to the contraindications of a precipitation of acute withdrawal symptoms and loss of pain control.

• interruption of a persons fundamental aspects of waking consciousness
• ex. Multiple personality disorders.

• Odd or eccentric
• paranoid
• schizoid
• schizotypical

• dramatic, emotional or erratic
• Antisocial
• borderline
• histrionic 
• narcissitic

• anxious or fearful
• Avoidant
• dependent 
• OCD

• Childhood trauma, chaotic environment, physical or sexual abuse
• self mutilation
• impaired social interactions
• disturbed personal identity
• Anxiety
• manipulative
• ASSSSSS......HHOOOOOOLLLLEEEE.....most of the time....

• emotional regulation
• distress tolerance training
• interpersonal effectiveness skills
• mindfulness skills

the behavioral expression of emotion

Fear out of proportion  to the actual danger posed. excessive

recurrent obsessions or compulsions that are severe enough to be time consuming or cause distress.

• associated with events that would be distressing to almost anyone. 
• high level of anxiety
• reexperiencing the events/ flash backs

excess of dopamine

• tactile
• auditory: most common
• visual
• gustatory
• olfactory

• Bipolar I: is more severe episodes of mania and severe depression
• Bipolar II: less severe with episodes of hypomania and some episodes of depression.

• ECT
• CBT
• Exercise 
• and antidepressants

inflexible patterns of relating, perceiving, and thinking serious enough to cause impaired functioning or distress.

Subjective/ Objective opioid withdrawal screening

Drug abuse screening tool

• Inhibitory neurotransmitter
• Also helps to regulate anxiety

plays a critical role in how our brain controls our movements/ cognition. Also associated with the pleasure system of the brain. rewards system.

• aids in regulations of signaling of neurons, believed to play a central role in the CNS.
• Also helps to regulate mood balance.

mobilizes the brain and body for action. part of the fight or flight response. increases arousal and alertness, enhances formation and retrieval of information. also focuses attention.

activates muscles, present in the CNS and PNS. It's also a neuromodulator

• Alcohol
• Benzo/barbs
• Meth
• PCP