PSYCHIATRIC NURSING

 MENTAL HEALTH – balance in a persons internal life and adaptation to reality

 Mental ILL Health – state of imbalance characterized by a disturbance in a persons
thoughts, feelings and behavior
 Poverty and abuses are major risk factors
 Psychiatric nursing – interpersonal process whereby the professional nurse
practitioner ,through the therapeutic use of self(art) and nursing theories
(science), assist clients to achieve psychosocial well being.
 Core of psych nursing – interpersonal process – human to human
relationship(both for mentally healthy and ill)
 Mental hygiene – measures to promote mental health , prevent mental illness and
suffering and facilitate rehabilitation…….(and if necessary find meaning in these
experiences)
 Main tool – therapeutic use of self
 It requires self-awareness
 Methods to increase self-awareness:
– Introspection ,Discussion, Experience, Role play

Neurosis
 any long term mental or behavioral d/o in which contact with reality is retained the
condition is recognized by the patient as abnormal. Essentially features anxiety or
behavior exagerrated designed to avoid anxiety
 ( anxiety d/o ; hysteria to conversion d/o,amnesia,fugue,multiple
personality and depersonalization- dissociative d/o
 ;oc d/o)
 Result of inappropriate early programming(psychoanalysis little value)
 Benefits from Behavior Therapy
Psychosis
 Mental or behavioral disorder wherein patient looses contact with reality
 Presence of delusions, hallucinations,severe thought disturbances,alteration of mood,
poverty of thought and abnormal behavior
 (schizophrenia , major disorder of affect ( mania – depression), major paranoid
states and organic mental disorder
 Benefits from psychoanalysis and antipsychotics

Common Behavioral Signs and Symptoms

 Disturbances in perception
o Illusion- misinterpretation of an actual external stimuli
o Hallucinations – false sensory perception in the absence of external stimuli

 Disturbances in thinking and speech

 neologism – coining of words that people do not understand
 Circumstantiality – over inclusion of inappropriate thoughts and details
 Word salad – incoherent mixture of words and phrases with no logical sequence
 Verbigeration – meaningless repetition of words and phrases
 Perseveration – persistence of a response to a previous question
 Echolalia – pathological repetition of words of others
 Aphasia – speech difficulty and disturbance
o Expressive , receptive or global
 Flight of ideas- shifting of one topic from one subject to another in a somewhat related
way
 Looseness of association-incoherent ,illogical flow of thoughts(unrelated way)
 Clang association – sound of word gives direction to the flow of thought
 Delusion – persistent false belief,rigidly held
 Delusions of grandeur- special /important in a way
 Persecutory-threatened
 Ideas of reference-situation/events involve them
 Somatic- body reacting in a particular way
 Magical thinking – primitive thought process thoughts alone can change events
 Autistic thinking – regressive thought process-subjective interpretations not
validated with objective reality

 Disturbances of affect
 Inappropriate – disharmony between the stimuli and the emotional reaction
 Blunted affect – severe reduction in emotional reaction
 Flat affect – absence or near absence of emotional reaction
 Apathy – dulled emotional tone
 Depersonalization – feeling of strangeness from one’s self
 Derealization – feeling of strangeness towards environment
 Agnosia – lack of sensory stimuli integration

 Disturbances in motor activity

 Echopraxia – imitation of posture of others
 Waxy flexibility – maintaining position for a long period of time
 Ataxia – loss of balance
 Akathesia – extreme restlessness
 Dystonia- uncoordinated spastic movements of the body
 Tardive dyskenisia – involuntary twitching or muscle movements
 Apraxia – involuntary unpurposeful movements

 Disturbances in memory
 Confabulation – filling of memory gaps
 Déjà vu – 2nd time-like feeling
 Jamais vu- not having been to the place one has been before
 Amnesia – memory loss (inability to recall past events)
 Retrograde-distant past
 Anterograde – immediate past
 Anomia – lack of memory of items
Dynamics of Human Behavior
 Personality – integration of systems and habits representing anindividuals
characteristic adjustment to his environment expressed through behavior
 Individualistic, unique, predictable(stability and consistency)
 Determinants: psychological,cultural, biological ( not inhereted) and familial

Analysis
 Potential support systems or stressors
 Potential risk factor
 Satisfaction of human needs
– Physiological(oxygen , fluids, nutrition, temp.,elimination,shelter,rest,sex)
– Safety and security(physical and psychological)
– Love and belongingness
– Self esteem
– Self –actualization
 3 divisions of the mind
 Conscious – focussed on awareness

 Subconscious – recalled at will

 Unconscious – never recalled / largest part

Learning – change in behavior through – insight , relearning and remotivation

Theories of personality development

Freuds psychosexual theory

 Libido – inner drive
 Parts of body –focus of gratification
 Unsuccesful resolution - fixation
 Structures of personality
– Id – pleasure principle-instinct

– Ego – controls action and perception –reality principle

– Superego – moral behavior - conscience

 0-18 m0s ;oral – mouth – trust and discriminating

 18 mos. – 3 years ; anal – bowels – holding on or letting go
– Negativism and toilet training age
 3 -6 years phallic ; genitals –exploration and discovery ( inc. sexual tension)
– Gender identification and genital awareness
– Oedipus and Electra complex //
– Castration anxiety and penis envy
 6-12 years –latency (quiet stage) sexual energy diverted to play.
Institution of superego…control of instinctual impulses
 12 – young adult – genital ; reawakening of sexual drives –relationships
– Sexual maturation
– Sexual identity ,ability to love and work

Psychosocial – Erickson
developmental milestones
//delay
0-12mos; TRUST
1-3y AUTONOMY
3-6 INITIATIVE
6-12 INDUSTRY
12-18 IDENTITY
18-25 INTIMACY
25-60 GENERATIVITY
60 and above EGO INTEGRITY

PIAGET’S COGNITIVE THEORY

 0-2 SENSORIMOTOR
 REFLEXIVE
 IMITATIVE REPETITIVE BEHAVIOR
 SENSE OF OBJECT PERMANENCE AND SELF SEPARATE FROM ENVT.
 TRIAL AND ERROR RESULTS IN PROBLEM SOLVING
  2-7Y PRE-OPERATIONAL
 SELF-CENTERED,EGOCENTRIC
 CANNOT CONCEPTUALIZE OTHER’S VIEW
 ANIMISTIC THINKING
 IMAGINARY PLAYMATE – SYMBOLIC MENTAL REPRESENTATION –
CREATIVITY
 2-4 PRE-CONCEPTUAL (PRE-LOGICAL)
 4-7 INTUITIVE (UNDERSTANDING OF ROLES)
 7-12Y CONCRETE OPERATIONAL
 LOGICAL CONCRETE THOUGHT
 INDUCTIVE RESAONING (SPECIFIC TO GENERAL)
 CAN RELATE ,PROBLEM SOLVING ABILITY
 REASONING AND SELF-REGULATION
 12-ABOVE FORMAL OPERATIONAL THOUGHT
 Abstract thinking
 Separation of fantasy and fact
 Reality oriented
 Deductive reasoning
 Apply scientific method

 Kohlberg – MORAL DEVELOPMENT/ THINKING/ JUDGEMENT

 PRE-CONVENTIONAL (0-6)
– PUNISHMENT AND OBEDIENCE
– OBEDIENCE TO RULES TO AVOID PUNISHMENT
 CONVENTIONAL ( 6-12 )
– MUTUAL INTERPERSONAL EXPECTATIONS,RELATIONSHIPS AND
CONFORMITY
– SOCIAL SYSTEM AND CONSCIENCE MAINTENANCE
– BEING GOOD IS IMPORTANT SELF RESPECT OR CONSCIENCE
 POST –CONVENTIONAL (12 – 18 Y)
 PRIOR RIGHT OR SOCIAL CONTRACT
 UNIVERSAL ETHICAL PRINCIPLE
 ABIDE FOR COMMON GOOD
 RATIONAL PERSON-VALIDITY OF PRINCIPLES-AND BECOME
COMMITTED TO THEM INNER CONTROL OF BEHAVIOR
UNDERSTANDING THE EQUALITY OF HUMAN RIGHTS AND DIGNITY OF
HUMAN BEINGS AS INDIVIDUALS

DEFENSE MECHANISMS
• unconscious intrapsychic adoptive efforts to resolve emotional conflict and cope
•
with anxiety automatic
•
pathology is determined by the frequency of use

• examples of DEFENSE MECHANISMS

• DENIAL – failure to acknowledge an intolerable thought , feeling, experience or reality
DISPLACEMENT – redirection of emotions or feelings to a subject that is more
•
• acceptable or less threatening
PROJECTION – attributing to others one’s feelings, impulses , thought or wishes
•
UNDOING – an attempt to erase an act , thought , feeling or desire
COMPENSATION – an attempt to overcome real or imagined shortcoming

 SYMBOLIZATION – a less threatening object or idea is used to epresent another

 SUBSTITUTION – replacing desired , impractical , unattainable object with
one that is acceptable
 INTROJECTION – a form of identification in which there is a taking into
oneself the characteristic of another(love object)
 REPRESSION – unacceptable thoughts is kept from awareness(unconscious)
 SUPPRESSION- consciously putting a disturbing thought or incident out of awareness
 REACTION FORMATION - expressing attitude directly opposite to unconscious wish or
fear
 REGRESSION – returning to an earlier developmental phase in the face of stress
 DISSOCIATION – detachment of painful emotional conflicts from consciousness
 CONVERSION – emotional problems are converted into symptoms
 FANTASY – conscious distortion of unconscious feelings or wishes

 IDENTIFICATION – conscious patterning of one’s self from another person

 INTELLECTUALIZATION - over use of intellectual concepts by an
individual to avoid expression of feelings
 RATIONALIZATION – justifying ones actions which are based on other motives
 SUBLIMATION - rechanneling of unacceptable instinctual drives with one hat is
aceptable
NURSE – PATIENT RELATIONSHIP
• SULLIVANS THEORY ON INTERPERSONAL RELATIONSHIP – DEVELOPED
BY PEPLAU INTO NURSE- PATIENT RELATIONSHIP
• SERIES OF INTERACTION BETWEEN THE NURSE AND PATIENT IN WHICH
THE NURSE ASSISTS THE PATIENT TO ATTAIN POSITIVE BEHAVIORAL
CHANGE
• T RUST
• R APPORT
• U NCONDITIONAL POSITIVE REGARD
• S ETTING LIMITS
• T HERAPEUTIC COMUNICATION
PHASES
• PRE-INTERACTION – SELF – AWARENESS
• ORIENTATION PHASE – DEVELOP A MUTUALLY ACCEPTABLE CONTACT
• WORKING – IDENTIFICATION AND RESOLUTION OF THE PATIENT’S
PROBLEMS
• TERMINATION – ASSIST PATIENT TO REVIEW WHAT HE HAS
LEARNED AND TRANSFER HIS LEARNING TO HIS REL. W/
OTHERS
WHEN TO TERMINATE NPR
• GOALS ACCOMPLISHED
• EMOTIONALLY STABLE
• GREATER INDEPENDENCE
• ABLE TO COPE WITH ANXIETY, LOSS , FEAR AND
SEPARATION COMMON
PROBLEMS - NPR
• TRANSFERENCE – DEVELOPMENT OF EMOTIONAL ATTITUDE + OR –
TOWARDS THE NURSE
• RESISTANCE – DEVELOPMNET OF AMBIVALENT FEELINGS
TOWARDS SELF – EXPLORATION
• COUNTER – TRANS FERENCE – TRANSFERENCE AS EXPERIENCED BY THE
NURSE
PRINCIPLES OF CARE
• ACCPETS PATIENT AS UNIQUE WITH INHERENT VALUE AND WORTH
• PATIENT IS VIEWED AS HOLISTIC HUMAN BEINGS WITH
INTERDEPENDENT AND INTERRELATED NEEDS
• FOCUS ON STRENGTHS AND ASSETS
• NON – JUDGEMENTAL ASSISTANCE TOWARDS COPING
• EXPLORE THE PATIENTS BEHAVIOR AND THE NEED IT IS DESIGNED
TO MEET AND THE MESSAGE IT IS COMMUNICATING
LEVELS OF INTERVENTION
• PRIMARY – INTERVENTIONS AIMED AT THE PROMOTION OF MENTAL
HEALTH AND LOWERING THE RATE OF CASES BY ALTERING THE
STRESSORS
• SECONDARY – INTERVENTIONS THAT LIMIT THE SEVERITY OF THE
DISORDER
– CASE FINDING AND PROMPT Tx
• TERTIARY – REDUCING THE DISABILITY AFTER A DISORDER
– PREVENTION OF COMPLICATION AND ACTIVE PROGRAM OF
REHABILITATION
 CHARACTERISTICS OF A PSYCHIATRIC NURSE-major roles of a
nurse - socializing agent and patient advocate

• EMPATHY- ability to see beyond outward behavior and sense accurately another
persons inner experience
• GENUINENESS/CONGRUENCE – ability to use therapeutic tools appropriately
• UNCONDITIONAL POSITIVE REGARD - respect
THERAPEUTIC COMMUNICATION
• CLARIFICATION
• LIMIT SETTING
• EMPATHETIC / ENCOURAGE EXPRESSION
• ANSWERS NEEDS
• REFLECTIVE AND INSIGHTFUL
THERAPEUTIC COMMUNICATION
• FOCUS ON FEELING TONE ,NEEDS ,MOTIVATION
• MUST HAVE CONSISTENCY AND IS NON JUDGEMENTAL
• CRITERIA OF SUCCESSFUL COMMUNICATION – FEEDBACK ,
APPROPRIATENESS, FLEXIBILITY AND EFFICIENCY
TECHNIQUES OF COMMUNICATION
• TO INITIATE A CONVERSATION –
– giving broad openings
– giving recognition / acknowledgement
• TO ESTABLISH RAPPORT
– GIVING INFORMATION
– USE OF SILENCE
• TO GATHER INFORMATION
– FOCUSING
– VALIDATING
– REFLECTING
– RESTATING
• TO CLOSE A CONVERSATION
– summarizing

TYPES OF PSYCHOTHERAPIES

REMOTIVATION THERAPY
• TREATMENT MODALITY THAT PROMOTES EXPRESSION OF
FEELINGS THROUGH INTERACTION FACILITATED BY DISCUSSION OF
NEUTRAL TOPICS
• STEPS :
climate of acceptance
creating bridge to reality
sharing the world we live in
appreciation of works of the world
climate of appreciation

MUSIC THERAPY
• INVOLVES USE OF MUSIC TPO FACILITATE EXPRESSION OF
FEELINGS,FACILITATE RELAXATION AND OUTLET OF TENSION
PLAY THERAPY
enables patient to experience intense emotion in a safe environment with the use of play
children express themselves more easily in play. revealing as reflection of child’s
situation in the family
provide toys and materials – facilitate interaction – observe and help child
resolve problems through play
 Group therapy
• Treatment modality involving three or more patients with a therapist to relieve
emotional difficulties, increase self – esteem, develop insight , LEARN NEW
ADAPTIVE WAYS TO COPE WITH STRESS and improve behavior with
• others( RELATIONSHIP WITH OTHERS CAN BE WORKED THROUGH)
IDEAL 8 – 10 MEMBERS
• MILIEU THERAPY
CONSISTS OF TREATMENT BY MEANS OF CONTROLLED
•
MODIFICATION OF THE PATIENTS ENVIRONMENT , FACILITATE
• POSITIVE BEHAVIORAL CHANGE
• INCREASE PATIENTS AWARENESS OF FEELINGS, INCREASE
SENSE OF RESPONSIBILITY AND HELP ETURN TO
COMMUNITY
•
clients plan social and group interaction
• token programs , open wards and self medication
•
• FAMILY THERAPY
• A METHOD OF PSYCHOTHERAPY WHICH FOCUSES ON THE TOTAL
FAMILY AS AN INTERACTIONAL SYSTEM
PROBLEM IS A FAMILY PROBLEM
• focus on sick members behavior as source of trouble / symptom serve a function for the
• family
members develop sense of identity
• points out function of the sick member for the rest of the family

PSYCHOANALYTIC
• focuses on the exploration of the unconscious, to facilitate identification of the
patients defenses
ANXIETY RESULTS BETWEEN CONFLICTS OF ID AND EGO(DEFENSE
MECHANISMS FORM TO WARD OFF)
BECOMES AWARE OF UNCONSCIOUS THOUGHTS AND
FELINGS.UNDERSTAND ANXIETY AND DEFENSES
HYPNOTHERAPY
VARIOUS METHODS AND TECHNIQUES TO INDUCE A TRANCE
STATE WHERE PATIENT BECOMES SUBMISSIVE TO
INSTRUCTIONS
BEHAVIOR MODIFICATION
A THERAPEUTIC INTERVENTION INVOLVOING THE APPLICATION
OF LEARNING PRINCIPLES IN ORDER TO CHANGE MAL-ADAPTIVE
BEHAVIOR PSYCHOLOGICAL PROBLEMS ARE A RESULT OF
LEARNING
DEFICIENCIES CAN BE CORRECTED THROUGH LEARNING

• OPERANT CONDITIONING
– USE OF REWARDS TO EINFORCE POSITIVE BEHAVIOR
– PERCEIVED AND SELF REINFORCEMENT BECOMES MORE
IMPORTANT THAN EXTERNAL
• DESENSITIZATION
– SLOW ADJUSTMENT OR EXPOSURE TO FEARED OBJECTS(USED IN
PHOBIAS)
 – PERIODIC EXPOSURE,UNTIL UNDESIRABLE BEHAVIOR DISAPPEARS OR
LESSENS
• AVERSION THERAPY - EXAMPLE OF BEHAVIOR MODIFICATION IN
WHICH PAINFUL STIMULUS IS INTRODUCED TO BRING ABOUT AN
AVOIDANCE OF ANOTHER
STIMULUS WITH THE END VIEW OF FACILITATING
BEHAVIORAL CHANGE OTHER THERAPIES
TOKEN ECONOMY-REWARDING DESIRED BEHAVIOR
COGNITIVE THERAPY – SHORT TERM STRUCTURED THERAPY –ORIENTED
TOWARDS PRESENT PROBLEMS ABD SOLUTIONS – AMIN FOCUS OF
DEPRESSIVE DISORDERS HUMOR THERAPY – TO FACILITATE EXPRESSION
AND ENHANCE INTERACTION ACTIVITY THERAPY – GROUP INTERACTION
WHILE WORKING ON A TASK TOGETHER
PSYHCHOPHARMACOLOGIC AGENTS

I. ANTI-PSYCHOTICS

SUB-CLASSIFICATIONS
PHENOTHIAZINES NON-PHENOTHIAZINES

Chlorpromazine (Thorazine) Clozapine ( Clozaril)

Fluphenazine (Prolixin) Haloperidol ( Haldol)
Perphenazine ( Trilafon) Olanzapine ( Zyprexa )
Prochlorperazine (Compazine) Risperidone ( Risperdal)
Thioridazine ( Mellaril) THIOXANTHENES
Triflouperazine (Stelazine) Thiothixene ( Navane)
MOA
- antagonizes dopamine in the CNS and also blocks
Cholinergic, Histaminic, Serotogenic, Adrenergic
neurotransmitters
- ( anticholinergic, antihistaminic, anti-emetic ) blocks activity of the CNS
receptors and sympathetic nervous
system

INDICATION
- formerly called major tranquilizers / neuroleptics.
used to relieve psychotic symptoms( delusions ,
hallucinations
and looseness of association)of schjizophrenia, mania and
psychotic depression and organic mental disorders
- acute management of agitation and hyperactivity

SIDE/ ADVERSE EFFECTS:

 ANTICHOLINERGIC EFFECTS
 (EPS)EXTRAPYRAMIDAL SYMPTOMS
– PSEUDOPARKINSONISM-tremor , mask like facies drooling , restlesssness
– AKATHISIA- restlessness,and anxiety
– DYSTONIA-grimacing , torticollis ,oculogyric crisis, intermittent muscle spasms
- TARDIVE DYSKINESIA-lip smaking and tongue and mouth

 (NMS) NEUROLEPTIC MALIGNANT SYNDROME*

- hyperthermia, and severe EPS -muscular rigidity, tremors,
trismus, choreiform movements,autonomic instability
/hyperactivity
and alterations in LOC

 SEIZURES HEPATOTOXICITY*
ORTHOSTATIC HYPOTENSION
PHOTOSENSITIVITY and
HYPERSENSITIVITY ENDOCRINE
DISORDERS

DYSCRASIAS *
AGRANULOCYTOSIS – sorethroat,chills,fever,malaise
LEUKOPENIA

CONTRAINDICATIONS AND SPECIAL PRECAUTIONS:

C/I : hypersensitivity , glaucoma , convulsive d/o , pregnancy and lactation, elderly
clients
NURSING CARE GUIDELINES:

C- antipsychotics, neuroleptics, major tranquilizers

H- decreased overt or positive manifestations of psychosis
E- p.c.
C- rise slowly
avoid sunlight
Report –sorethroat,fever,muscular rigidity
Reduced psychomotor agitation and insomnia – 1 week
Reduction of hallucinations, delusions and thought disorder takes 6-8 weeks for full
therapeutic effect

BP and temperature
K – monitor blood levels
Seizures, NMS and EPS
L.F.T.’s
CBC with differential

medical management :
NMS – Bromocriptine or Amantadine( dopamine
agonist) and Dantrolene (Dantrium)
muscular relaxant
Dystonia – Diphenhydramine,Benztropine , Diazepam,
Lorazepam Pseudoparkinsonism – Antiparkinsonian,
Anticholinergic
Akathisia – Anticholinergic, Benzodiazepines, Beta-
blockers,Clonidine Tardive dyskinesia – early referral-dose
reduction , no anticholinergics

II. ANTI-PARKINSONIAN AGENTS

CLASSIFICATIONS

2 TYPES :

1.) DOPAMINERGIC DRUGS

MOA: enhance dopaminergic activity
slows deterioration of dopaminergic nerve cells
Increasing dopamine

Carbidopa – Levodopa ( Sinemet)

Amantadine ( Symmetrel)
Bromocriptine Mesylate ( Parlodel)
Levodopa ( Larodopa)
Pergolide Mesylate ( Permax)
Ropinirole(Requip)
Tolcapone ( Tasmar)

2.) ANTI-CHOLINERGIC AGENTS

MOA:inhibit relative excess in cholinergic activity, symptomatic relief
Decrease signs and symptoms ( tremors,rigidity, drooling promote
optimal levels of motor function (gait, posture and speech )

Trihexypheiedil ( Artane)
Biperiden Hydrochloride ( Akineton)
Benztropine Mesylate ( Cogentin)
Diphenhydramine Hydrochloride
(Benadryl)

Misc. agent
INDICATIONS: Selegiline ( Eldepryl)
For management of anti psychotic induced EPS- pseudoparkinsonism
SIDE AND ADVERSE EFFECTS
Anticholinergic Effects Blurring of vision, constipation, 3D’s and
orthostatic hypotension, sorethroat*
Headache, photosensitivity, drowsiness, CHF and halluciantions

CONTRAINDICATIONS AND SPECIAL PRECAUTION

Glaucoma, tachycardia, HPN, Cardiac D/O, asthma, duodenal ulcer
 NURSING CARE GUIDELINES
C- dopaminergic or anti-cholinergic
H- decrease tremors and rigidity in 2-3 days
E- p.c.
C- avoid sudden position change
Avoid Vit. B6 and CHON rich foods- dec. absorption of medication
Avoid alcohol-increases sedative effects
K- check BP- orthostatic hypotension
drugs not withdrawn abruptly

III. ANTI DEPRESSANTS

COMMON
TYPES
MONO AMINE
TRICYCLICS OXIDASE SELECTIVE SEROTONIN
INHIBITOR REUPTAKE
S INHIBITORS

Imipramine(Tofranil) Citalopram ( Celexa)

Amitriptryline ( Elavil) Flouxetine (Prozac)
Clomipramine (Anafril) Paroxetine ( Paxil)
Doxepin ( Sinequan) Sertraline ( Zoloft)
Nortryptyline ( Aventyl) Fluvoxamine (Luvox)
Tranylcypromine (Parnate)
Isocarboxazid ( Marplan)
Phenelzine (Nardil)

Mechanism of
Action

Prolongs the action Blocks the

of norepinephrine metabolic
Dopamine destruction of
Serotonin by neurotransmitters by Inhibits reuptake and
blocking the the enzyme mono- destruction of
reuptake of this amine oxidase serotonin to prolong its
CNS STIMULANTS
neurotransmitters action
Ritalin ( Methylphenidate)
Amphetamine ( Benzedrine)

Increases levels of neurotransmitters

in the brain thereby increasing CNS
activity and decreasing
hyperactivity.

INDICATIONS
effective in management and treatment of depression and related mood and
depressive disorders
such as:
Obsessive compulsive ,Eating d/o,Obesity,Bipolar disorder,Panic d/o
SIDE EFFECTS AND ADVERSE REACTIONS:

TCA’S MAOI SSRI CNS Stimulants

Cardiac arrhythmias, Hypertensive crisis Tremors, decreased Growth suppression,
Liver and
palpitations,orthostatic cardiovascular libido, NAVDA insomnia
Nervousness,
hypotension disease insomnia,
Constipation,Sedation, Weight gain drowsiness
anticholinergic effects Sexual dysfunction anxiety
Confusion photosensitivity
Bone marrow
depression

CONTRAINDICATIONS AND SPECIAL PRECAUTIONS

TCA’S MAOI SSRI CNS Stimulants

Hypersensitivity, liver Hypertension same
Cardiovascular
disease , glaucoma disease
and Liver disease

NURSING CARE GUIDELINES

C- anti-depressants
H- decreased signs and symptoms of depression(increased appetite and sleep
E – p.c.

TCA’S MAOI SSRI CNS Stimulants

C-
2-3 wks initial effect 2-3 initial 2-3 initial Give in AM , not
3-6 wks full
therapeutic 3-4 full ther. Effect 3-4 full ther. effect beyond 2 pm
6 hours before
effect Avoid foods rich in bedtime
tyramine –leads to
Emphasize
compliance hypertensive crisis
( processed,preserved
Avoid citrus juice – and
decrease absorption fermented )
K-
Monitor BP, HR and
ECG
Monitor BP and food
items

IV. ANTI – MANIC

EXAMPLES

Lithium Carbonate ( Eskalith,

Lithane, Quilinium –R,
Lithionate)

Carbamazepine (Tegretol )
MOA
Exact mechanism unknown , alters the level of norepinephrine and other neurotransmitters

INDICATIONS
• Treatment of acute mania and for prophylaxis of recurrent manic and depressive
episodes in bipolar disorder
SIDE AND ADVERSE EFFECTS
NAVDA Nephrotoxicity*
Fine tremors leading to coarse tremors Cardiac toxicity*
Thirst Hyperthyroidism – Thyroid Crisis*
Nystagmus
 CONTRAINDICATIONS AND SPECIAL PRECAUTION
Cardiovascular disease , renal disease, clients on low sodium diet and on diuretic
therapy, brain damage, pregnancy and lactation
NURSING CARE GUIDELINES

C- mood stabilizer – anti manic

H- decrease hyperactivity/manic episodes
Initial effect – 10-14 days
Full therapeutic effect 3 -4 weeks
E- after meals with milk or food
C- antipsychotics given with lithium for immediate
management of manic episodes.
Diet – Na 6-10 grams a day; fluids- 3 liters per day
Avoid caffeine , diuretics and activities that increase perspiration

K- monitor for untoward signs and symptoms

Monitor serum level at least once a month(A.M. 12
hours after the last dose
maintenance dose - .5 – 1.2 mEq / L
acute level – 1.5 mEq / L
level for the elderly .4 – 1.0 mEq / L
Antidote for toxicity – Mannitol (Osmitrol) or Acetazolamide (Diamox)

V. ANTI ANXIETY
CLASSIFICATION:
BENZODIAZEPINES AZASPIRONES NON-BENZODIAZEPINE
Miscellaneous agents
Alprazolam ( Xanqax)
Chlordiazepoxide ( Librium) Hydroxyzine ( Vistaril)
Clorazepate ( Tranxene) Meprobamate ( Equanil)
Diazepam ( Valium) Buspirone
Lorazepam ( Ativan) (Buspar)
Oxazepam ( Serax)

MOA: depresses Reticular Activating system and reduces anxiety by stimulating the
action of an inhibitory neurotransmitter called GABA
INDICATIONS; treatment of anxiety disorders and for short term relief of
symptoms of Anxiety; selective medications effective for
skeletal muscle relaxation, pre
and post-op sedation, seizure control.

SIDE AND ADVERSE EFFECTS

Sedation and Dizzinees,drowsiness and dry mouth
Paradoxical reactions*(hallucination and delusions),CNS depression*
Addison’s disease , Dependency*, hepatotoxicity*

CONTRAINDICATIONS AND SPECIAL PRECAUTION

Glaucoma, hypersensitivity, liver and kidney
dysfunction, psychoses, elderly , pregnancy and lactation
NURSING CARE GUIDELINES

C- anxiolytics, minor tranquilizers

H- decrease anxiety
E- a.c. – food delays absorption
C- rise slowly
Avoid caffeine and alcohol

K- monitor CBC, LFT’s,

report sorethroat, jaundice, weakness and fever