Blook 1 ECG Program

week 6

Psychiatry and -
Psychopharmacology
Prepared By
Dr. Manal H. Abo Elmagd

2024-1445H
 Learning Objectives:

• Identify the definition of mental disorder.

• Identify the purpose of ECT.
• Identify classification of psychiatric medication
• Discuss common examples for each drug
group.
• Identify Side effects for each group.
• Discuss nursing intervention to the client for
client receiving psychiatric medications.
 World Health Organization definition of
health

• The World Health Organization defines health as a state of

complete physical, mental, and social wellness , not merely the
absence of disease or infirmity. This definition emphasizes health
as a positive state of well being.

• People are in a state of emotional, physical, and social well being

fulfill life responsibilities, function effectively in daily life, and are
satisfied with their interpersonal relationships and themselves.
 Mental Health and Mental Illness

▪ People who can carry out their roles in society and whose
behavior is appropriate and adaptive are viewed as healthy.

▪ Conversely those who fail to fulfill roles and carry out

responsibility or whose behavior is inappropriate are viewed
as ill.

Page. 25
 What is Psychiatry ?

➢Psychiatry is the medical specialty devoted to:

➢ Diagnose
➢Prevent
➢ Treat mental disorders.

➢Treat maladaptation's related to mood, behaviour,

cognition, and perceptions.
 Definition of Mental Disorder

➢A syndrome characterized by clinically significant

disturbance in an individual's cognition, emotion regulation, or
behavior that reflects a dysfunction in the psychological,
biological, or developmental processes underlying mental
functioning.

➢ Mental disorders are associated with significant subjective

distress or impairment in social, occupational, or other
important activities.
 Mental illness/ disorder
Mental illness includes disorders that affect mood, behavior,
and thinking, such as:
❖Mood disorder
❖ depressive disorder
❖schizophrenia,
❖anxiety disorders,
❖ addictive disorders/ substance abuse disorder.
• The following are associated with person suffer from
Mental disorders :
• Significant distress or impaired functioning or both
• Individuals experience dissatisfaction with self, relationships,
• Individuals’ ineffective coping.
• Daily life can seem overwhelming or unbearable.
• Individuals may believe that their situation is hopeless.
Factors contributing to mental illness
 Schizophrenic Disorder
▪Definition: Severe psychotic disorder characterized by
distortions (malformation) of reality and disturbances in
thought, language, feeling and withdrawal from social
contact.
▪Schizophrenia usually is diagnosed in late adolescence or
early adulthood.
▪ The peak incidence of onset is 15 to 25 years of age for
men and 25 to 35 years of age for Women
▪ The life time prevalence of schizophrenia is about 1% .
Page. 589
 Schizophrenic Disorder

• Most clients slowly and gradually develop signs and

symptoms such as social withdrawal, unusual behavior,
loss of interest in school or work, and neglected hygiene.

• The diagnosis of schizophrenia usually is made when the

person begins to display more actively positive
symptoms of delusions, hallucinations, and disordered
Page. 591- 592
thinking (psychosis).
 Mood disorders

▪Mood disorders, also called affective disorders,

are pervasive alterations in emotions that are
manifested by depression, mania, or both.

▪They interfere with a person’s life, plaguing him or

her with drastic and long-term sadness, agitation,
or elation. Accompanying with self-doubt, guilt,
and anger alter life activities especially those that
involve self-esteem, occupation, and relationships.
Major Depressive disorder

• Major depressive disorder typically involves 2 weeks

or more of a sad mood or lack of interest in life
activities, with at least four other symptoms of
depression such as anhedonia and changes in weight,
sleep, energy, concentration, decision-making, self-
esteem, and goals.
• Major depression is twice as common in women.
 Anxiety disorders

•Anxiety disorders are diagnosed when anxiety no longer

functions as a signal of danger or a motivation for needed
change.
•However, it becomes chronic and permeates major
portions of the person’s life, resulting in maladaptive
behaviors and emotional disability.
•Anxiety disorders are more prevalent in women, people
younger than 45 years of age, people who are divorced or
separated, and people of lower socioeconomic status.
What the psychiatric interview

• On the psychiatric interview :

• Proper interview techniques and skills.
• Sufficient psychiatric history.
• Standard “Mental State Examination”.

• To assess and appropriately refer psychiatric

patients in the primary care settings.
 Treatment modalities in psychiatry:

•Treatment modalities in psychiatry

Physical therapy :
• 1) Pharmacotherapy,
• 2) Electroconvulsive therapy
Psychological:
• Behavioral, cognitive, supportive psychotherapy
and others.
Electro convulsive therapy is somatic therapy
 Definition of ECT
• Electroconvulsive therapy (ECT) is a type of somatic
treatment in which electric current is applied to the brain
through electrodes placed on the temples.
• The current is sufficient to induce a grand mal seizure,
from which the desired therapeutic effect is achieved.
• The duration of the seizure should be at least 25 seconds
• Usually administered every other day, for three times per
week; most clients need 6 to 12 sessions
Electroconvulsive therapy ECT Procedure Purposes

1. Electroconvulsive therapy (ECT) produces biochemical changes in

the brain

2. ECT is primarily used in the treatment of severe depression and

very hyperactive manic clients.

3. ECT is effective for individuals who are extremely suicidal

4. ECT is effective in the treatment of acute psychoses and catatonia

and schizophrenia.
 ECT Team

• Psychiatrist
• Anaesthetist
• Trained nurses
• Nursing aids
• ECT assistant
Physical restrain used as a therapeutic tool
for control patient movement such as :

1- Seclusion Room 2- Physical restrain

 Part two
10-12 pm

Psychopharmacology
Psychopharmacology
P.70

• Medication management is a crucial

issue that greatly influences the
outcomes of treatment for many clients
with mental disorders.
• Nurses should understand how drugs
work; their side effects, and
interactions; and the nursing
interventions required to help clients
manage medication regimens.
Classification of Psychotropic Medication

• 1. Antipsychotic

• 2. Antidepressant.

• 3. Mood stabilizer.

• 4. Antianxiety/Anxiolytic.
 1. Antipsychotic drugs p.72

➢These are also known as Neuroleptics.

• These are used to treat symptoms of psychosis, such as

delusions and hallucinations seen in schizophrenia and
schizoaffective disorder.
 Indications p.72

• Antipsychotic drugs are the primary medical treatment for

the following:
❖Schizophrenia.
❖Psychotic episodes of acute mania.
❖Psychotic depression.
❖Drug-induced psychosis.
❖Clients with dementia who have psychotic symptoms.
❖Short-term therapy with antipsychotics may be useful for
transient psychotic symptoms, such as those seen in some
persons with borderline personality disorder.
 Side Effects of Antipsychotic Drugs p.76

❖ Extrapyramidal side effects includes:

• Extrapyramidal Symptoms (EPS) are serious neurologic
symptoms that are the major side effects of antipsychotic
drugs, which include:
A. Acute Dystonia.

B. Pseudo parkinsonism.

C. Akathisia.

D. Tardive Dyskinesia.
 A. Acute Dystonia P. 77

▪ Acute Dystonia: acute muscular rigidity and cramping, a

stiff or thick tongue with difficulty swallowing, and, in
severe cases, laryngospasm and respiratory difficulties.

❖Spasms or stiffness in muscle groups can produce:

▪ Torticollis (twisted head and neck).

▪ Oculogyric crisis (eyes rolled back in a locked position).

 B. Pseudo parkinsonism P.77

Pseudo parkinsonism:
• Characterized by symptoms like those of parkinsonism and
include a stiff, stooped posture, masklike facies,
decreased arm swing, a shuffling, drooling, tremor,
bradycardia, and coarse pill-rolling movements of the
thumb and fingers while at rest.
 C. Akathisia P.77

• Akathisia: The client appears restless or anxious and

agitated, often with a rigid posture or gait and a lack of
spontaneous gestures.
 D. Tardive Dyskinesia P.77

• Tardive Dyskinesia: The symptoms include involuntary

movements of the tongue, facial and neck muscles, upper and
lower extremities, and truncal musculature.
• Tongue thrusting and protruding, lip smacking, blinking,
grimacing.
 Other Side Effects of Antipsychotic drugs P.81

• Obesity—excess weight, increased body mass index (BMI).

• Increased blood pressure.

• High blood sugar level.

• High cholesterol level.

 Part three :
12-2 pm

Psychopharmacology
Antidepressant & antianxiety
 2- Antidepressant Drugs P. 84

❖ Antidepressant Drugs classification

• These are divided into four groups:

1. Tricyclic and the related cyclic antidepressants
2. Selective serotonin reuptake inhibitors (SSRIs)
3. Monoamine Oxidase Inhibitors (MAOIs)
4. Other Antidepressants drugs
 Indication P.84

• Antidepressant drugs indication:

• Major depressive illness.
• Anxiety disorders.
• The depressed phase of bipolar disorder.
• Psychotic depression.
 Side Effects of Cyclic Antidepressants P. 88

a) Anticholinergic effects such as dry mouth, constipation, urinary

hesitancy or retention, dry nasal passages, and blurred near vision.

b) More severe anticholinergic effects such as agitation, delirium,

and ileus may occur, particularly in older adults.

c) Other common side effects include orthostatic hypotension,

sedation, weight gain, and tachycardia.
Side Effects of Selective Serotonin Reuptake Inhibitors
p. 87

• Enhanced serotonin transmission can lead to several

common side effects such as:
• Anxiety
• Agitation
• Akathisia or motor restlessness.
• nausea
• Insomnia
• weight gain
 Side effects of (MAOIs) P. 88

• The most common side effects of MAOIs include:

• Day-time sedation
• Insomnia
• Weight gain
• Dry mouth
• Orthostatic hypotension
• Sexual dysfunction
• Sedation and insomnia are difficult to treat and may necessitate
a change in medication.
 Side Effects of (MAOIS) Cont. P. 88

• A particular concern with MAOIs is the potential for a

life-threatening hypertensive crisis if the client
ingests food containing tyramine.
• The symptoms of this crisis are:
• Severe hypertension.
• Hyperpyrexia.
• Tachycardia.
• Diaphoresis.
• Cardiac Arrhythmias.
 3. Mood Stabilizers P.91

• Mood stabilizing drugs are used to:

• Treat bipolar disorder by stabilizing the client’s mood,
preventing recurrent attack of bipolar illness.
• Treat acute episodes of mania.
❖Lithium is the most established mood stabilizer
 Side Effects of Mood Stabilizers P. 92

❖Common side effects of lithium therapy include:

Mild nausea or diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, a
metallic taste in the mouth, and fatigue or lethargy. Weight gain and acne
are side effects that occur later in lithium therapy; both are distressing for
clients.
❖Toxic effects of lithium are:
Severe diarrhea, vomiting, drowsiness, muscle weakness, and lack of
coordination. Untreated, these symptoms worsen and can lead to renal
failure, coma, and death. When toxic signs occur, the drug should be
discontinued immediately.
 4. Antianxiety Drugs (Anxiolytics) P. 94

• Antianxiety drugs, or anxiolytic drugs indications:

➢To treat anxiety and anxiety disorders.
➢ Insomnia.
➢Obsessive-compulsive disorder (OCD).
➢Depression.
➢Post-traumatic stress disorder.
➢Alcohol withdrawal.
➢Benzodiazepines → most effective in relieving anxiety and are the
drugs most frequently prescribed.
 Side Effects Benzodiazepines P.96

• One chief problem encountered with the use of

benzodiazepines is their tendency to cause physical
dependence.

➢This can lead to overuse or abuse of these drugs.

• The other side effects most commonly reported with
benzodiazepines such as drowsiness, sedation, poor
coordination, and impaired memory.
The most common nursing diagnosis and
intervention to the client for client
receiving psychiatric medications.
1- Intervention for the side effect of (sedation, drowsiness
and dizziness.)

1. Instruct client not to drive or operate dangerous machinery when

taking the medication.

2. Provide safety measures to client to minimize the injuries like

raising side rails, adequate lighting.

3. Adequate and continuous monitoring of client after the drug is

given to the client.
2- lack of knowledge related to medication
regimen.
• Interventions:
1. Assess client’s level of knowledge regarding the medication Sid
effect
2. Assess client’s level of anxiety and readiness to learn. Learning
does not take place beyond moderate level of anxiety.
3. Determine method of learning most appropriate for client (e.g.,
discussion, question and answer, use of audio or visual aids, oral
or written method). Level of education and development are
important considerations as to methodology selected.
4. Include significant others, if possible. Lifestyle changes often
affect all family members.
 Nursing implications for psychiatric medications

❖The plan of care should include monitoring for the following side
effects:
❖Dry mouth
• Offer the client sugarless candy, ice, frequent sips of water.
• Strict oral hygiene is very important.
❖ Sedation
• Request an order from the physician for the drug to be given at bedtime.
• Request that the physician decrease the dosage or perhaps order a less
sedating drug.
• Instruct the client not to drive or use dangerous equipment when
experiencing sedation.
❖ GI upset; nausea/vomiting
• Administer medications with meals to minimize GI upset.
 Nursing implications for psychiatric medications

❖Blurred vision
• Offer reassurance that this symptom should subside after a few
weeks. Instruct the client not to drive until vision is clear.
❖Constipation
• Order foods high in fiber; increase fluid intake if not
contraindicated; and encourage the client to increase physical
exercise, if possible.
❖Urinary retention
• Instruct the client to report hesitancy or inability to urinate.
• Monitor intake and output.
 Nursing implications for psychiatric medications

• Orthostatic hypotension
• Instruct the client to rise slowly from a lying or sitting position.
• Monitor blood pressure (lying and standing) frequently, and
document and report significant changes.
• Avoid long hot showers or tub baths.
❖Insomnia; agitation
• Administer or instruct client to take dose early in the day.
• Instruct client to avoid caffeinated food and drinks.
• Teach relaxation techniques to use before bedtime.
 Client/Family Education

1- Advise client receiving long-term therapy not to quit taking the

drug abruptly. Abrupt withdrawal can be life threatening.

2- The nurse informs clients taking psychiatric medication about the

types of side effects that may occur and encourages clients to report
such problems to the physician instead of discontinuing the
medication.

3- Clients should monitor the amount of sleepiness or drowsiness

they feel.
4- Clients should be caution when driving or performing activities
requiring sharp, until sedative effects can be determined.

5- The client should not attempt to drive until dizziness, lethargy,

fatigue, or blurred vision has subsided.

6- For clients taking lithium and the anticonvulsants, monitoring

blood levels periodically is important.

7- Taking these medications with meals minimizes nausea.

 Thank you
• Reference:
▪ Psychiatric – Mental Health Nursing 8th edition.
Chapter 2, Page: 54- 97

• Pocket of Psychiatric Nursing 10th Edition page.

Unit 4- Psychotropic medications, Page: 406- 510