What is the ratio of how many people will have a mental disorder at some point in their lives?
1 in 3 people
This part of the ego is impulsive and like a newborn baby "all about me"
This part of the ego tries to control the Id
This part of the ego tries to mediate between the other two
The successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms
Definition of mental health
Maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and interfere with the individual’s social, occupational, or physical functioning.
Definition of Mental Illness
The inability of the general population to understand the motivation behind the behavior. Example: on the news, when someone does something wrong and we don't understand why...
The “normality” of behavior is determined by the culture. One culture practices something that is not normal in another culture
Name the three stages of stress
- 1. alarm
- 2. resistence
- 3. exhaustion
This is one of the three stages of stress when a person is faced with a stressor
This is one of the three stages of stress when a person's body gets prepared to fight or flight (physiological response)
This is one of the three stages of stress when a person experiences continuous stress (PTSD, HTN, HR elevated)
Why are prolonged periods of stress dangerous?
- Promote susceptibility to many diseases:
- Pituitary Gland dysfunctions:
- Increased gluconeogenesis and retention of sodium and water (ACTH)
- Decreased immune and inflammatory responses (ACTH)
- Fluid retention (vasopressin)
- Increased blood pressure (vasopressin)
- Increased serum glucose and free fatty acids (growth hormone)
- Increased the basal metabolic rate (thyrotropic hormone)
- Decreased libido and impotence (gonadotropins)
What determines our adaptation?
the degree to which these thoughts, feelings, and behaviors interfere with an individual’s level of functioning.
A diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness
An Ego Defense Mechanism when a person may be too small to play one sport so they play another one:
An Ego Defense Mechanism when a person refuses to admit that there is a problem (such as addiction).
An Ego Defense Mechanism when a person takes out their feelings on someone else
An Ego Defense Mechanism when a person models after someone else - has a mentor
An Ego Defense Mechanism when a person can't discuss things emotionally, but can discuss intellectually.
An Ego Defense Mechanism when a person integrates others values into their own beliefs
An Ego Defense Mechanism when a person takes themself out of situations and is alone
An Ego Defense Mechanism when a person blames someone for their own feelings (blaming husband for looking at other women, when she is in love with Tommy Lee Jones)
An Ego Defense Mechanism when a person makes excuses for their behavior (addicts)
An Ego Defense Mechanism when a person reacts the exact opposite of how they are feeling
An Ego Defense Mechanism when a person goes back into child-like behavior
An Ego Defense Mechanism when a person involuntarily blocks something out
An Ego Defense Mechanism when a person turns anger into good (like working out when angry)
An Ego Defense Mechanism when a person voluntarily "forgets" to do something (Scarlet O'Hara)
An Ego Defense Mechanism when a person cancels out an inappropriate behavior (sometimes a way of apologizing - man bringing flowers)
Lost touch with reality
What do psychotropic drugs treat?
How many half-lives does it take to get rid of psychotropic drugs?
After using psychotropic drugs symptoms can come back and symptoms may be worse, this is referred to as
What is another name for antipsychotic drugs?
What is the B52 Cocktail for psychosis?
- halidol 5 mg
- ativan 2 mg
What is the mechanism of action for antipsychotic drugs?
Blocks dopamine receptors at post-synaptic sites
What problems with the heart is contraindicated for antipsychotic drugs?
Why are antipsychotics contraindicated in elderly patients?
increases mortality rate in pt's with dementia
What are the adverse effects of Typicals (1st Gen)?
many extrapyramidal side effects because of blocking D2
Name A-Typical (2nd Gen) antipsychotics
- Serroquel (quetiapine)
Name a 3rd generation antipsychotic medication
What is the mechanism of action of Typicals (1st gen)?
potent antagonists (blockers) of D2, D3, and D4
What is the mechanism of action of A-Typicals (2nd Gen)?
- Inhibit reuptake of serotonin
- Weak blockers of D2
What is the mechanism of action of 3rd Gen?
- Dopamine stabilizer
- Self regulates dopamine
What are the adverse effects of A-Typicals (2nd Gen)?
- Weight gain
- Lower incidence of EPS
- Cost concern
What are the common adverse effects of 3rd Gen?
- Cost concerns
What are extrapyramidal symptoms (EPS)?
- acute dystonia
- akathisia (intense need to move)
How do we treat EPS?
- change antipsychotic
- beta blocker
What are symptoms of acute dystonia?
- Acute muscular rigidity
- Difficulty swallowing due to stiff tongue
- Laryngospasms and respiratory difficulties
- Torticollis (twisted head and neck)
- Oculogyric crisis (eyes rolled back in locked position)
- Opisthotonus (tightening of entire body with head rolled back)
- Can be painful and frighteningLikely to occur in clients taking high potency drugs such as Haldol
How do we treat Acute Dystonia?
anticholinergic - IM or IV
What is neuroleptic malignant syndrome?
- Potentially fatal idiosyncratic reaction
- Rigidity, high fever, unstable blood pressure, diaphoresis, delirium, coma
- Confused, often mute, may fluctuate from agitation to stupor
How do we treat Neuroleptic Malignant Syndrome (NMS)?
- d/c med
- treat dehydration
- treat hyperthermia
- give muscle relaxers
- may need to go to ICU
What is Tardive Dyskinesia (TD)?
- Syndrome of permanent involuntary movements
- Most commonly caused by long-term use of typicals
- Pathophysiology is unclear
- Late EPS
- No effective treatment
How do we treat Tardive Dyskinesia (TD)?
- Prevention - watch patient VERY carefully
- TD cannot be reversed
- Do the AIMS scale
- Call MD immediately if you notice symptoms
What are anticholinergic side effects?
- Orthostatic hypotension
- Dry mouth
- Urinary hesitancy or retention
- Blurred vision
- Dry eyes
- Nasal congestion
- Decreased memory
When patients have anticholinergic side effects what do we do?
- Encourage the patient that they may pass within 3-4 weeks.
- If don't clear up then MD may need to change meds
Tons of side effects with all antipsychotics - include?
- Neuroendocrine effects
- Increase blood prolactin levels
- Gynecomastia, breast tenderness in men and women
- Diminished libido
- Erectile or orgasmic dysfunction
- Menstrual irregularities, increased risk for breast cancer
- Weight gain, monitor closely - client may gain 100 lbs.
- Take medication at bedtime
- Anti-seizure medication
- Liver function
- metabolic syndrome
What is the major concern with clozapine (A-Typical)?
When a person is taking clozapine (A-Typical) what must they do that is inconvenient with this med?
- Weekly blood draws for first 6 months is WBC above 3,500 mm
- When med is d/c'd must have WBC Q4W x4W
What are client teaching to manage side effects?
- Drinking sugar-free beverages
- Using sugar-free hard candy to ease dry mouth
- Avoid caloric-laden beverages and candy because they promote dental caries, contribute to weight gain, and do not relieve dry mouth
- To relieve constipation – promote exercise, increase water, high fiber foods
- Use sunscreen due to photosentivity
- Avoid driving if feeling drowsy
What education does the nurse provide when pt is taking antipsychotics?
- Side effects
- Report to healthcare provider rather than stopping medication
- Methods to manage side effects
What are the instructions if a patient misses a dose of their antipsychotic?
- Take the missed dose if it is only 3 or 4 hours late
- If the dose is more than 4 hours overdue or the next dose is due, the client can omit the forgotten dose.