The PSYCH MAP explains a lot of concepts needed in the study of Psychiatric Nursing.

I
hope that this will help you in your study.

The center or the word NORMAL represents a state in which there is equilibrium or the
absence of any problem. If you encounter problems or stressors, you will become
ANXIOUS and your Sympathetic Nervous System SNS will be activated. Epinephrine and
norepinephrine will be released. In severe cases, medications are given. The main
purpose of the medication given for anxiety is to decrease the action of the SNS. GABA
decreases your SNS and further to your left, you will see a list of medications used to
decrease anxiety (VLASTMEVAIB). zepam, zepine and zolam are the common ending
letters of these anxiolytic medications. It will take 3 to 4 weeks until these drugs take
effect. While taking these drugs, you should watch out for anticholinergic effects such as
constipation and urinary retention. It is important to remember that there are safety
precautions when taking these drugs. You should not drive because these drugs can
make you drowsy which means that you should not engage yourself in an activity which
requires alertness (ex. driving, operating a machine). You may also experience
orthostatic hypotension. You should not drink alcohol because it is a depressant and this
will potentiate the effect of the drug. On the other hand, you are also not allowed to
drink coffee. It is a stimulant that counteracts the effect of your anxiolytic drugs, and
besides, you are taking medications to decrease the stimulants causing your anxiety.
Anxiolytic drugs or anti-anxiety drugs may lead to dependence. Withdrawal from these
drugs are done gradually to prevent seizures.

There are lots of theories explaining the cause of SCHIZOPHRENIA. One theory states
that there is an increase in the neurotransmitter DOPAMINE. Dopamine is a
neurotransmitter responsible for cognition and regulation of emotional responses, it is
generally a stimulant. Different kinds of drugs are given to a schizophrenic patient
(SSTTCHAMPZR), these drugs are called Neuroleptics or Antipsychotics. The main action
of these drugs is to decrease Dopamine or its effects. Ldol and azine are the common
ending letters of these drugs. Side effects of these drugs include, agranulocytosis (which
has an early symptom of sore throat) and photosensitivity (use wide brimmed hat). When
Dopamine is severely decreased during the use of neuroleptic drugs, ACETYLCHOLINE –
DOPAMINE balance is affected, when this happens, Pseudoparkinsonism and EPSE will
manifest (NMS fatal). In order to bring equilibrium, two types of drugs are given, the
ANTICHOLINERGIC drugs (AABC) which decreases Acetylcholine and the DOPAMINERGIC
drugs (PLES) which increases the Dopamine. To remember the two types of drugs you
must remember the word CAPABLES.

When norepinephine is increased, there is a distinct period during which, a mood of a

person is constantly elated or persistently high, we consider this to be a manic episode
or MANIA. When this happens, we place the person to be at risk for injury because of
impulsive actions. He is also monitored for nutritional imbalance due to loss of attention
and focus on his own basic needs. Lithium is the drug of choice for mania. A narrow level
of 0.6 to 1.2 meq/L must be maintained. Toxicity is manifested by gastro intestinal
symptoms such as nausea, vomiting and diarrhea (VANDA). To avoid this, give liberal
amount of fluid intake (3L/day). This is also the reason why we don’t combine this drug
with a Diuretic. Diamox (a drug also used for Vertigo) is the antidote for lithium toxicity.
Avoid strenuous activities which may lead to cardiac collapse. Monitor the kidney
function because this drug is nephrotoxic. It takes 2-4 weeks before you see the effects
of this drug.

Serotonin makes us happy. MAO is a substance which decreases the amount of serotonin
present in our body. If serotonin level falls, depression takes place. Depression is a state
in which a person’s mood is persistently low. There are different types of medications
given to people who are depressed. First, the SSRI, this medication aims to inhibit the
reuptake of serotonin in our body which means that the usual serotonin will be made
available in the synapses for a longer period of time. Second is the TCA, this drug works
just like the SSRI except that it has a different target neurotransmitter which is the
norepinephrine. Third is the MAOI, a MAOI inhibits the action of a MAO therefore it
inhibits the breakdown of neurotransmitters. It is important to remember that the effects
of these drugs will take place after a week of continuous medication, as in the case of
MAOI, it can take up to 6 weeks. At these times, we should monitor the patient for
possible suicide because when a patient has just been lifted from depression, he now has
the power to execute the suicidal ideations that has been his mind. Hypertensive Crisis is
the adverse effect of MAOI, this happens when the drug is combined with tyramin rich
food. Pentolamine is given during hypertensive episodes. During the use of
antidepressants, you should monitor for any increase in the intraocular pressure which is
an indication of developing glaucoma. Male sexual function may also be affected.
An ECT may be used while waiting for the therapeutic effects of the antidepressants or if
the patient is not responding to medications. Prior to ECT, short-acting sedatives are
given so the client may sleep (Barbiturates) and a muscle relaxant (Succinylcholine) so
that there would be a less chance of injury due to the rigid effects of seizure
contractions. Best position after ECT is side lying. Check the vital signs, orient the patient
and reassure that memory loss is only temporary. Before giving oral intake, it is
important to check the gag reflex to prevent aspiration. Pregnancy is not a
contraindication to ECT.