Mental Health Nursing and substance abuse

  1. Anxiety
    Subjective emotional response to a stressor
  2. Generalized anxiety disorder/Panic disorder
    • Must cause clinically significant distress or impairment in social or other important areas of functioning.
    • Chronic, excessive
  3. Schizophrenia
    • 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
  4. Delusions
    • 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)
  5. Types of Schizophrenia
    • Catatonic(inability to move)
    • Paranoid (Hallucinations)
    • residual(No signs of positive symptoms)
    • Schizoaffective disorder (Schizo +bipolar)
    • delusional disorder(Delusions)
  6. Formication
    something is crawling under the skin
  7. Alcohol Toxicity
    Acute intoxication-cardiorespiratory depression or arrest-aspirations.
  8. Alcohol withdrawl
    • 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.
  9. S&S of alcohol withdrawal
    CIWA (Clinical institute withdrawal assessment of alcohol) is used to assess level of withdrawal and help determine treatment
    • 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
  10. Delirium tremens
    • 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.
  11. Treatments for DT
    • 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. 
  12. Opioid toxicity
    Bradycardia, respiratory depression/arrest, pulmonary edema, hypotension, hypothermia, myosis (pin point), pruritus, nausea, dry mouth, constipation.
  13. Opioid withdrawal
    • Flu-like symptoms
    • up to 24 hours
    • Methadone: lasts 3-7 days up to several weeks
    • Heroin: Onset 6 hours
  14. Opioid treatment
    • 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
  15. Methamphetamine toxicity
    Tachypnea, tachycardia, hypertension, hyperthermia, agitation, anorexia, anxiety, tremors and rapid speech
  16. Methamphetamine withdrawal
    • 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.
  17. Methamphetamine treatment
    • Supportive treatment
    • droperidol or haldol as a CNS antagonist
    • Benzo
    • risperdone
    • beta-blockers
  18. Benzodiazepine toxicity
    Acute-Somnolence, agitation, psychosis
  19. Benzodiazepine withdrawal
    • 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. 
  20. Benzodiazepine treatment
    • benzodiazepine tapper over 5-7 days
    • Beta-blockers will help control some of the adrenergic symptoms as well.
  21. Cocaine toxicity
    • Hypertension
    • Tachycardia
    • Hyperthermia
    • Mydriasis
    • Seizures
    • Stupor
    • Respiratory-cardiac depression with high doses
    • Acute intestinal ischemia
    • Myocardial infarction
    • Arrhythmias
    • Sudden death
  22. Cocaine withdrawal
    • 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.
  23. Cocaine treatment
    • Supportive/symptomatic
    • fluids
    • Benzo
  24. Barbiturates toxicity
    • Acute: Somnolence
    • Ataxia
    • Nystagmus
    • Slurred speech
    • Labile emotion
    • Depressed myocardial contractility
    • Respiratory depression
    • Hypothermia
  25. Barbiturates withdrawal
    • 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.
  26. Barbiturates Treatment
    • respiratory support
    • fluids
    • activated charcoal for intial OD
    • vasopressors
    • thermoregulation
  27. LSD, PCP toxicity
    • Tachycardia
    • Hypertension
    • Hypertermia
    • Hallucinations
    • Disinhibition
    • Diaphoresis
    • Salivation
    • Tremors
    • Agitation
    • Mydriasis (dilation of the pupils)
    • Dystonia (dysfunction of muscle tone)
    • Confusion
    • Seizures
  28. LSD-no real withdrawals, PCP withdrawal
    • 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.
  29. LSD, PCP treatment
    • monitor vitals
    • supportive care: fluids
    • Benzo
    • antipsychotics
  30. Failure to treat pain is what?
    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.
  31. Substance abusers are at greater risk for what in regards to pain?
    • 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.
  32. Avoid the wrong pain management for opiate users
    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.
  33. Dissociative disorder
    • interruption of a persons fundamental aspects of waking consciousness
    • ex. Multiple personality disorders.
  34. Personality disorder: Cluster A
    • Odd or eccentric
    • paranoid
    • schizoid
    • schizotypical
  35. Personality disorder: Cluster B
    • dramatic, emotional or erratic
    • Antisocial
    • borderline
    • histrionic 
    • narcissitic
  36. Personality disorder: Cluster C
    • anxious or fearful
    • Avoidant
    • dependent 
    • OCD
  37. Borderline personality disorder: Axis II
    • Childhood trauma, chaotic environment, physical or sexual abuse
    • self mutilation
    • impaired social interactions
    • disturbed personal identity
    • Anxiety
    • manipulative
    • ASSSSSS......HHOOOOOOLLLLEEEE.....most of the time....
  38. Dialectical behavior therapy
    • emotional regulation
    • distress tolerance training
    • interpersonal effectiveness skills
    • mindfulness skills
  39. Affect?
    the behavioral expression of emotion
  40. Phobias
    Fear out of proportion  to the actual danger posed. excessive
  41. OCD
    recurrent obsessions or compulsions that are severe enough to be time consuming or cause distress.
  42. PTSD
    • associated with events that would be distressing to almost anyone. 
    • high level of anxiety
    • reexperiencing the events/ flash backs
  43. Patho of schizo
    excess of dopamine
  44. Types of hallucinations?
    • tactile
    • auditory: most common
    • visual
    • gustatory
    • olfactory
  45. Bipolar 1 vs 2?
    • Bipolar I: is more severe episodes of mania and severe depression
    • Bipolar II: less severe with episodes of hypomania and some episodes of depression.
  46. Treatments for depression?
    • ECT
    • CBT
    • Exercise 
    • and antidepressants
  47. personality disorders?
    inflexible patterns of relating, perceiving, and thinking serious enough to cause impaired functioning or distress.
    Subjective/ Objective opioid withdrawal screening
  49. DAST
    Drug abuse screening tool
  50. Brief explanation of GABA
    • Inhibitory neurotransmitter
    • Also helps to regulate anxiety
  51. Brief explanation of dopamine
    plays a critical role in how our brain controls our movements/ cognition. Also associated with the pleasure system of the brain. rewards system.
  52. brief explanation of serotonin
    • aids in regulations of signaling of neurons, believed to play a central role in the CNS.
    • Also helps to regulate mood balance.
  53. Brief explanation of Norepinephrine
    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.
  54. brief explanation of Acetylcholine
    activates muscles, present in the CNS and PNS. It's also a neuromodulator
  55. What substances have life threatening withdrawals?
    • Alcohol
    • Benzo/barbs
    • Meth
    • PCP
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Mental Health Nursing and substance abuse
Mental health