Chapter 2, page 19 Videbeck 3rd Ed. I. ANTIPSYCHOTIC DRUGS  also known as neuroleptics  used to treat symptoms of psychosis, such as delusions and hallucinations seen in schizophrenia, schizoaffective disorder, and manic phase of bipolar disorder  work by blocking receptors of the neurotransmitter dopamine  examples (table 2.3, p. 30)  Extrapyramidal side effects: o acute dystonia o pseudoparkinsonism o akathisia * although collectively referred to as EPS (extrapyramidal symptoms which are serious neurologic symptoms and are major side effects of antipsychotic drugs), each of these reactions has distinct features * therapy for acute dystonia, pseudoparkinsonism, and akathisia are similar and include the following:  lowering dosage of antipsychotic  changing to a different antipsychotic, or  administering anticholinergic medication o Acute dystonia  includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties  most likely to occur in the first week of treatment, in clients younger than 40 years, in males, and in those receiving high-potency drugs (such as haloperidol and thiothexine)  spasms or stiffness in muscle groups can produce torticollis, opisthotonus, or oculogyric crisis (p.30)  reactions can be painful and frightening to the client  immediate treatment with anticholinergic drug such as diphenhydramine IM or IV usually brings rapid relief * drugs used to treat EPS (table 2.4 p.30) o Pseudoparkinsonism, or drug-induced parkinsonism  often referred to by the generic label of EPS  symptoms resemble those of Parkinson’s disease and include a stiff and stooped posture, mask-like faces, decreased arm swing, a shuffling, festinating gait, cogwheel rigidity, drooling, tremors, bradycardia, and coarse pill-rolling movements of the thumb and fingers while at rest  treated by changing to an antipsychotic drug that has a lower incidence of EPS, or by adding an oral anticholinergic agent o Akathisia  as reported by clients, is an intense need to move about  client appears restless or anxious and agitated often with a rigid posture or gait and a lack of spontaneous gestures.  treated by a change in antipsychotic medication or by the addition of an oral agent (such as beta-blocker, anticholinergic, oor benzodiazepine)

diaphoresis. and monitoring the client periodically for initial signs of TD o Anticholinergic Side Effects  side effects include: orthostatic hypotension. changing medications. dry mouth. unnecessary facial movements are characteristic  once it has developed. may fluctuate from agitation to stupor * all antipsychotics seem to have the potential to cause NMS. blurred near vision. and elevated levels of enzymes (particularly creatinine phosphokinase)  clients with NMS usually are confused and often mute. pseudoparkinsonism. poor nutrition. lip smacking. although decreasing or discontinuing antipsychotic medication can arrest its progression  preventing TD is one goal when administering antipsychotics and this can be done by keeping maintenance dosages as low as possible. but can occur anytime) * dehydration. or  administering anticholinergic medication o Neuroleptic Malignant Syndrome (NMS)  potentially fatal reaction to antipsychotic drugs  major symptoms of NMS are rigidity. but high dosages of high-potency drugs increase the risk (most often occurs in first 2 weeks of therapy or after increase increasing dosage. facial and neck muscles. constipation. and pallor). and other excessive. autonomic instability (such as unstable BP. grimacing. delirium. nasal congestion. dry eyes. each of these reactions has distinct features. and akathisia are similar and include the following:  lowering dosage of antipsychotic  changing to a different antipsychotic. and upper and lower extremities  tongue thrusting and protruding. and decreased memory  Other side effects: . blinking. high fever. photophobia. * therapy for acute dystonia. urinary hesitance or resistance. and concurrent medical illness all increase the risk for NMS  treatment includes immediate discontinuance of all antipsychotic medications and the institution of supportive medical care to treat dehydration and hyperthermia o Tardive Dyskinesia (TD)  syndrome of permanent involuntary movements commonly caused by the long-term use of conventional antipsychotic drugs  symptoms of TD include involuntary movements of the tongue . TD is irreversible.* although collectively referred to as EPS (extrapyramidal symptoms which are serious neurologic symptoms and are major side effects of antipsychotic drugs).

dry mouth 2. and ileus • other common side effects: 1. agitation . 33) 1. weight gain 4. and tachycardia NURSING RESPONSIBILITIES:  inform client of side effects and encourage to report problems instead of discontinuing medication  teach client methods of managing or avoiding unpleasant side effects and maintaining medication regimen: o dry mouth – sugar-free fluids and sugar-free hard candy * client should avoid calorie-laden beverages and candy o constipation – exercise. and psychotic depression  somehow interact with norephinephrine and serotonin which regulate mood. Selective Serotonin Reuptake Inhibitors (SSRI) • have fewer side effects than cyclic compounds • enhanced serotonin transmission can lead to several common side effects: 1. blurred near vision 6. stool softener permissible but avoid laxatives o photosensitivity – sunscreen  client should monitor amount of sleepiness and drowsiness they feel. constipation 3. increase water and bulk-forming foods. agitation. tachycardia • clients may develop tolerance to anticholinergic side effects but these are common reasons of noncompliance ( (esp. urinary retention 4.5. increasing risk for DM II and CVD) o minor cardiovascular adverse effects such as postural hypotension. depressed phase of bipolar disorder. Tricyclic and the related cyclic antidepressants • have more side effects than SSRIs • block cholinergic receptors. arousal. and appetite  divided into 4 groups: examples (table 2. sedation 3. attention. anxiety 2. orthostatic hypotension 2. dry nasal passages 5. more severe. anxiety disorders. ANTIDEPRESSANT DRUGS  primarily used in the treatment of major depressive illness. sensory processing. avoid driving and potentially dangerous activities until response time and reflexes seem normal II. delirium. weight gain and sexual dysfunction) 2. p. palpitations.o increase blood prolactin levels causing breast enlargement and tenderness (both in men and women) o diminished libido o erectile and orgasmic dysfunction o menstrual irregularities o weight gain (obesity common in schizophrenic clients. resulting in anticholinergic effects: 1.

weight gain 4.1. cardiac dysrhythmias • potentially fatal drug interactions with MAOIs: 1. insomnia (sedative –hypnotic or low dosage trazodone) 6. hyperpyrexia 3. SSRI 2. akathisia (treated with beta-blocker) 4. sexual dysfunction • of particular concern with MAOIs is the potential for a lifethreatening hypertensive crisis if client ingests food containing tyramine or sympathomimietic drugs (refer to table 2. opiate derivatives (meperidine) 4. orthostatic hypotension 6. buspirone (BuSpar) 4. 35 regarding food containing tyramine) • increased serum tyramine levels causes: 1. dextromethorpan 5. p. daytime sedation * 2. severe hypertension 2. hand tremor 5. tachycardia 4. diaphoresis 5. sedation * 2. nausea (taking with food lessens nausea) 5.• 3. Other novel antidepressant medication:  nefadozone causes: o sedation o headache o dry mouth o nausea  trazodone o sedation o headache  mirtazapine o sedation  bupropion o loss of appetite o nausea o agitation . sweating * 3. certain cyclic compounds 3. dry mouth 5. cause less weight gain than other antidepressants less common side effects: 1. insomnia * 3. sexual dysfunction (diminished drive or difficulty achieving erection or orgasm) 7. diarrhea 4. tremulousness 6. MAO Inhibitors (MAOIs) • most common side effects: 1. headaches 3.

and treat acute mania  examples: o Lithium  most established mood stabilizer.0 mEq/L. acetylcholine. first-line agent in treating bipolar  normalizes reuptake of serotonin. even OTC drugs without consulting doctor III. and dopamine  serum lithium level 1. o provide a written list of foods to avoid while taking MAOIs o make client aware of serious and fatal drug interactions when taking MAOIs. preventing highs and lows characterizing bipolar illness. with one notable exception: trazodone can cause priapism ( sustained and painful erection) which may result in impotence NURSING RESPONSIBILITIES:  for cyclic compounds: o should be taken at night to lessen side effects o if forgets a dose. MOOD STABILIZERS  used to treat bipolar disorders by stabilizing client’s mood. alert reflexes until sedative effects wear off  for MAOIs: o client should be aware of life-threatening hyperadrenergic crisis if dietary restrictions are not observed. instruct not to take additional medications.  common side effects of lithium therapy: • mild nausea or diarrhea (taking medication with food may help nausea) • anorexia • fine hand tremor (propranolol improves fine tremor) • polydipsia • polyuria • a metallic taste in the mouth • fatigue or lethargy . can take it up within 8 hours after missed dose o client should avoid driving or performing activities requiring sharp. norepinephrine. should be monitored every 23 days  toxicity is closely related to serum lithium levels and can occur at therapeutic doses.o insomnia  venlafaxine o loss of appetite o nausea o agitation o insomnia o dizziness o sweating o sedation  sexual dysfunction is less common but. can take it up within 3 hours after missed dose or omit  for SSRis: o clients should take it first thing in the morning unless sedation is a problem o if forgets a dose.

teratogenic  gabapentin (Neurontin)  topiramate (Topamax) – SE: dizziness.a. and blurred vision. life-threatening toxic epidermal necrolysis o antianxiety agent clonazepam (Klonopin) is occasionally used to treat mania NURSING RESPONSIBILITIES:  for clients taking lithium and anticonvulsants. and alcohol withdrawal  examples (table 2. depression. and rarely. monitor blood levels periodically. lethargy. dialysis may be indicated o some anticonvulsants are effective * and good mood stabilizers:  carbamazepine (Tegretol) * . GABA (major inhibitory neurotransmitter in the brain) o SE:  tendency to cause physical dependence  SE associated with CNS depression ( drowsiness.0 mEq/L. sedation. weight gain.6. and death * when toxic signs occur. sedation. pancreatitis. coma.SE: drowsiness.• weight gain and acne occur later in lithium therapy * lethargy and weight gain difficult to minimize leading to noncompliance  toxic effects: • severe diarrhea • vomiting • drowsiness • muscle weakness • lack of coordination * if symptoms left untreated. poor coordination. dry mouth. ANTIANXIETY DRUGS  also known as anxiolytic drugs  used to treat anxiety and anxiety disorders. and impaired memory or clouded sensorium) . or blurred vision has subsided IV. sedation. Steven-Johnson syndrome. weight loss. hepatic failure. rashes and orthostatic hypotension. posttraumatic stress disorder. discontinue lithium immediately  if lithium levels exceed 3. dry mouth. Depakene) * . and increased incidence of renal calculi  oxcarbazepine (Trileptil)  lamotrigine (Lamictal) – serious rashes requiring hospitalization (esp.SE: drowsiness. p. plasma levels can be checked 12 hours after last dose  encourage client to take medications with meals to minimize nausea  instruct client not to attempt to drive until dizziness. sedation. and hand tremor.37)  benzodiazepines have proved to be the most effective in relieving anxiety and are the drugs most frequently prescribed ( also may be prescribed for their anticonvulsant and muscle relaxant effects o mediate the actions of a. aplastic anemia and agranulocytosis  valproic acid (Depakote. and blurred vision. it worsens and can lead to renal failure. below yrs of age). fatigue. OCD. insomnia. alopecia.

nausea. may complain of next-day sedation or a hangover effect  buspirone is a nonbenzodiazepine often used for the relief of anxiety o acts as partial agonist at serotonin receptors. and possible sedative effects of these drugs when attempting activities such as driving or going to work  inform client never discontinue drug abruptly once started without supervision of physician because benzodiazepines withdrawal can be fatal  . which decreases serotonin turnover o common side effects:  dizziness. and headache * elderly clients may have more difficulty managing the effects of CNS depression. more prone to falls from the effects on coordination and sedation. sedation. slower reflexes. may have more pronounced memory deficit and may have problems with urinary incontinence particularly at night NURSING RESPONSIBILITIES:  make client aware that antianxiety agents are aimed at relieving symptoms such as anxiety or insomnia but do not treat the underlying problems that cause the anxiety  instruct client not to drink alcohol (benzodiazepines strongly potentiate the effects of alcohol)  make client aware of decreased response time.when used for sleep.

pyrazinamide o Anti-asthma . Tegrilol) 200 mg.  Other Medications: o Anithypertensives  nifedipine. o valproic acid 250 mg. o biperiden HCl (Akineton) 2 mg.fluphenazine decanoate 25 mg/ml . o chlorpromazine (Thorazine. o phenytoin (Sodium (Na). Zycloran) 100 / 200 mg.  Anti-parkinsonism o biperiden lactate (Akineton) 5 mg. captopril o Anti-TB  INH. metropolol. Dilantin) 100 mg.haloperidol decanoate 50 mg/ml .Commonly Used Drugs in Psychiatric Ward (Pavilion 5 Unit 3 Big Hall)  Antipsychotic / Neuroleptic Drugs o haloperidol (Serenase. o divalproex Na (Epival) 250 mg. o olanzapine * Short-Acting . Psynor. o risperidone o clozapine o levomepromazine (Nozinan) 100 mg.  Anti-anxiety o hydroxyzine dihydrochloride (Iterax) 25 mg. Serenase. o sertraline (Zoloft) 50 mg. Haldol) 5 / 20 mg.fluphentixol decanoate 25 mg/ml  Anticonvulsants o carbamazepine (Tegretol.  Antidepressants o fluoxetine (Prozac) 20 mg. Psycotil) 5 mg/ml * Long-Acting .haloperidol (Haldol. rifampicin.

 salbutamol o Antipyeretic  paracetamol o Antibiotic  amoxicillin. and disordered thinking (psychosis)  symptoms are divided into two major categories: (refer to table on p. more prominent negative signs. perceptions. page 276 Videbeck 3rd Ed. emotions. is thought of as a syndrome or disease process with many different varieties and symptoms  onset may be abrupt or insidious. and greater cognitive impairment than do . and neglected hygiene  peak incidence of onset: o male – 15-25 years of age o female – 25-35 years of age  usually diagnosed in late adolescence or early adulthood (rarely manifests in childhood)  the diagnosis usually is made when the person begins to display more actively positive symptoms of delusions. and behavior  can’t be defined as a single illness. cloxacillin. loss of interest in school or work. but most clients slowly and gradually develop signs and symptoms such a social withdrawal.  causes distorted and bizarre thoughts. sultamicillin o Antiamoebics  metronidazole o Antihistamine  Diphenhydramine HCl (Benadryl) 50 mg. 276) o positive or hard symptoms/signs  ambivalence  associative looseness  delusions  echopraxia  flight of ideas  hallucinations  ideas of reference  perseveration o negative or soft symptoms  alogia  anhedonia  apathy  blunted affect  catatonia  flat affect  lack of volition  those who develop the illness earlier show worst outcomes that those who develop it later. hallucinations. SCHIZOPHRENIA Chapter 14. movements. younger client display a poorer pre-morbid adjustment. rather. doxycycline. unusual behavior.

but frequently the negative symptoms persist after positive symptoms have abated. those who experience a gradual onset of the disease (about 50%) tend to have both a poorer immediate and long-term course than those who experience a acute and sudden onset approximately 30% of clients with schizophrenia relapse within 1 year of an acute episode the intensity tends to diminish with age. and extremely disorganized behavior o Schizophrenia. 4th edition. however. flat affect. excessive religiosity (delusional religious focus) or hostile and aggressive behavior o Schizophrenia. and behavior o Schizophrenia. family education. over time. incoherence. paranoid type:  characterized by persecutory (feeling victimized or spied on) or grandiose delusions. occasionally. they do not cure the disorder. loose associations. catatonic type:  characterized by marked psychomotor disturbance. social withdrawal. they are crucial to its successful management the more effective the client’s response and adherence to his or her medication regimen. affect. peculiarities of voluntary movement. hallucinations. undifferentiated type:  characterized by mixed schizophrenic symptoms (of other types) along with disturbances of thought. and. family therapy. either motionless or excessive motor activity  motor immobility may be manifested by catalepsy ( waxy flexibility) or stupor  excessive motor activity is apparently purposeless and is not influenced by external stimuli  other features include extreme negativism. Text Revision): o Schizophrenia. the persistence of these negative symptoms overtime presents a major barrier to recovery and improved functioning in the client’s daily life types of schizophrenia according to the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorder. but rarely can the client overcome the effects of many years of dysfunction medication can control the positive symptoms. residual type:  Characterized by at least one previous. and looseness of associations antipsychotic medications play a crucial role in the course of the disease and individual outcomes.       older clients. the better the client’s outcome individual and group therapies. and social skills training can be instituted for clients in both inpatient and community settings . the disease becomes less disruptive to the person’s life and easier to manage. mutism. though not a current episode. disorganized type:  characterized by grossly inappropriate or flat affect. and echopraxia o Schizophrenia. echolalia.

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