Psychiatry

Psychiatric nursing

interpersonal process (core)

therapeutic self (tool) (acceptance) task: self awareness

Mental illness

disturbance of thought, feelings and behaviors

Risk

poverty

abuse

heredity

Major Psychotic Signs and Symptoms

Altered sensory perception

hallucination - no stimuli

illusion - with stimuli

best response: acknowledge the feelings of the patient

Altered thought process (belief) (language)

delusion

grandeur

false or unusual belief about one's greatness. A person may believe, for
instance, that they are famous, can end world wars, or that they are
immortal

Psychiatry 1
 persecution

harm

control

false belief that another person, group of people, or external force

controls one's general thoughts, feelings, impulses, or behavior

religion

preoccupied with religious subjects that are not within the expected
beliefs for an individual's background, including culture, education, and
known experiences of religion.

ideas of reference

is the false belief that irrelevant occurrences or details in the world

relate directly to oneself ("you are talking about me")

echolalia

repeated words (autism)

word salad

mix words

neologism

coining new words

clang association

rhyming words

alogia

refers to a poverty of speech

tangentiality

tendency to speak about topics unrelated to the main topic of

discussion

circumstantiality

delay in getting to the point because of the interpolation of unnecessary

details and irrelevant remarks

flight of ideas

person starts talking and they sound jittery, anxious, or very excited

loose association

patient's responses do not relate to the interviewer's questions, or one

paragraph, sentence, or phrase is not logically connected to those that
occur before or after.

dissociation

detached from normal function. Disconnecting from one's thoughts,

feelings, memories or sense of identity.

Psychiatry 2
 nihilistic

belief that self or anything is not real

Inappropriate affect (mood)

blunt

difficulty in expressing their emotions, characterized by diminished facial

expression,

flat

It is a lack of showing emotion characterized by an apathetic and

unchanging facial expression and little or no change in the strength, tone, or
pitch of the voice.

anhedonia

inability to feel pleasure

apathy

lack of feeling, emotion, interest, or concern about something

ambivalence

opposing feelings

is the experience of having an attitude towards someone or something that

contains both positively and negatively valenced components

labile

severe mood swings and with intense emotional reactions

Motor disturbances

echopraxia

repeats movements

waxy flexibility

person remains in a position for an unusually long time after someone else
places him or her in a position

Memory disturbances

Amnesia

anterograde

forgets recent or immediate events

common in alzheimer's

retrograde

forgets distant pasts

Confabulation

made-up stories fill in any gaps in memory

Psychiatry 3
 Defense Mechanisms
Ego defense mechanism - protect self against anxiety

denial

failure to accept reality

displacement

shifting emotions to something less threatening

projection

involves taking our own unacceptable qualities or feelings and ascribing

them to other people (blaming)

you see yourself to other people

a cheating spouse who suspects their partner is being unfaithful

substitution

replace unattainable goal into something attainable

business man who has been angry over certain events of the day may
redirect his energies into games, gardening or any other manual work

sublimation

channeling unacceptable behavior into something acceptable

You feel an urge to be unfaithful to your partner. Rather than act on these
unacceptable urges, you channel your feelings into doing projects around
the yard.

symbolization

uses an object/behavior that represents another

reaction formation

acting opposite to what you truly feel

undoing

attempts to erase a wrong doing

repression

involuntary forgetting events

suppression

voluntary forgetting events

identification

conscious patterning of behavior

adopting the behavior of a person who is more powerful and hostile towards
them

introjection

Psychiatry 4
 unconscious patterning of behavior

person internalizes the ideas or voices of other people-often external

authorities

for approval

rationalization

excuse

justifies unacceptable behavior

intellectualization

explains in details (through books or science)

compensation

compensates for a perceived lack

regression

go back to previous growth and development in times of anxiety

Schizophrenia
cause

unkown

biologic cause

high dopamine

population who has schizophrenia

1%

freud's cause

child abuse (weak ego)

social factor

single mom

vitamin deficiency

B1, B6, B12

Criteria (1-3 major) (PT MUST MEET 2 OR MORE CRITERIA) (AT LEAST 1
MAJOR)

hallucination (1month)

delusion (+)

disorganized speech

disorganized behavior

negative symptoms

avolition

Psychiatry 5
 lack of motivation or ability to do tasks

anergia

no energy

asocial

dont have the mood to talk to people

anhedonia

cannot appreciate pleasure

apathy

no emotions

alogia

lack of speech

blunt

delayed response but with facial expression

flat

no expression

classifications of s/sx

positive

major symptoms

absent to a mentally healthy person

hallucination

delusion

illusion

bizarre behavior

agitation

POOR HYGIENE

INSOMNIA

AMBIVALENCE - state in which you lack certainty or the ability to make

decisions.

schizophrenia

paranoid

address nutrition(sealed) and safety

catatonic

hyper

stupor (waxy flexibility)

Psychiatry 6
 should always address circulation (open communication)

disorganized

thought

behavior

attend to physiologic needs

schizoaffective disorder

schizophrenia + mania

others: delusional disorders, shared psychosis, postpartum psychosis (1month

after birth)

admission management

involuntary admission

danger to self or others

grave disability (basic needs)

cant sign consent

cant refuse treatment

no HAMA

pt must be admitted within 48-72h

Antipsychotics/Neuroleptics
Typical (ZINE)

old

manages positive signs and symptoms

increase risk of developing EPS

haloperidol, thiotexane

Atypical (PINE) (DONE)

latest drugs

manages positive and negative signs and symptoms

still develops EPS but has a lower risk of developing it

clozapine (clozaril) - most effective antipsychotic drug in the world

Side effects

expected

photosensitivity - sunblock, sweater, umbrella

dry mouth + constipation - give candy and have a low residue diet

Psychiatry 7
 weight gain (increase in appetite)

hypotension - teach the client to move slowly or get up slowly

EPS - decrease dopamine

anti EPS drugs

cogentin

benadryl

akineton

artane

tardive dyskinesia

irreversible

tounge twitching

lip smucking

report use of anticholinergics

discontinue and give bromocriptine

pseudoparkinsonism

1st sx: tremors (reversible symptom)

2nd sx: rigidity

3rd sx: bradykinesia

4th sx: akinesia

pizza symptom

akineton

dystonia

dysphagia

neck rigidity

pupillary paralysis

give cogentin/benztropine

akathisia

restless and irritable, inability to sit still

cogentin, artane, biperidine

dopaminergics (increases dopamine)

to prevent further symptoms of EPS

sinemet (levodopa + carbidopa)

amantadine (symmetrel)

avoid eating foods rich in vit B6 (pyridoxine)

Psychiatry 8
 Toxic side effects

NMS (Neuroleptic malignant syndrome)

management

hold the medication

cover the patient with blanket

notify HCP

1st: elevated temperature (cardinal sign)

2nd: rigidity or muscle problems

3rd: decrease LOC

elevated vital signs

give dantrolene, parlodel

Agranulocytosis

1st: sore throat (see MD ASAP)

Leukopenia

check CBC

Hepatotoxic

hold medication

Oral

tablet form

assess the if the patient swallowed the drug

liquid form

the nurse should wear gloves because it causes contact dermatitis

IM

given q 2ks or 4 wks

decanoates

Serotonin syndrome

super high serotonin

caused by medications that are high in serotonin like SSRI, MAOI, st john's wort
and narcotics

wait for 2 weeks to administer another medication that is high in serotonin

s/sx

decrease LOC

muscle problems

Psychiatry 9
 increase in VS

Contraindicated medications during pregnancy

isotretinoin

ACE inhibitors

tetracyclines (doxy)

lithium

0.5-1.5

before taking lithium, check for renal function

do not administer if patient has low sodium, dehydration and renal failure

instead of lithium use valproic acid, carbamazepine or any antipsychotics

hold the drug if toxicity happens and administer with either mannitol, diamox
and theophylline

phenytoin (dilantin)

anti-convulsant

SE: Gingival hyperplasia (decrease folic acid)

hirsutism

osteoporosis

rash

management

Oral care

soft bristle toothbrush

gargle with NSS or water

increase folic acid

increase calcium

methotrexate

MAOI

parnate

marplan

nardil

SELEGILINE

avoid foods rich in tyramine

SSRI

(tine)

prozac

Psychiatry 10
 zoloft

paxil

lexapro

can cause sex problems

Psychotropics
avoid alcohol

avoid caffeine

avoid activities requiring concentration (safety)

GI irritants (give after meals except anxiolytics)

hepatotoxic

Mood Disorders
primary problem is affect or feelings

Types

unipolar

depression

bipolar

2 mood disorder

mania

Causes

loss

biologic cause (serotonin and norepinephrine)

chronic illness

substance abuse

Depression

hopeless + helplessness

loss of zest in life

decrease appetite but to some, increase in appetite

sleep (insomnia) (hypersomnia)

low self esteem (suicidal ideation) (identify self worth) (know their present
plans) (question with direct statements like where, when, how, are you)

Types

major depression

Psychiatry 11
 acute (2wks or more)

severe depression

suicidal

management

antidepressants (2-4 wks) (patient with the highest suicidal risk)

(less than 2 wks) (increases energy if less than 2 wks)

electroconvulsive therapy

if the patient is highly suicidal

if antidepressants are not responding

best management of depression is ECT

indication

highly suicidal

major depression

bipolar disorder

mania

schizophrenia

management

consent

if pt is not capable, let the nearest kin sign the consent

if no nearest kin, court will sign the consent

70-150 volts

6-12 times ECT to get the effect

can be performed atleast 4-8 hours or 3 times a week

(interval)

patient must experience generalized seizure (tonic clonic

seizure)

contraindications

increase intracranial pressure

trauma

stroke

meningitis

patient has pacemaker

hold ECT

if patient has fever

increase BP

Psychiatry 12
 fracture

present respiratory problem

present cardiac problem

transplants

not contraindicated

pregnant (less than 100V)

liver problem

kidney problem

preparations

same with pre op preparations (GA)

pre ect meds

atropine sulfate - safety

succinylcholine (anectine) - muscle relaxant

methohexital Na (breuital) -anesthesia

patient is alseep prior ECT

SE

pt will have temporary memory loss

headache

asleep after ECT

muscle weakness

nursing responsibilities

airway

raise side rails

orient the patient

monitor VS and LOC

dysthymic depression

chronic (2yrs or more)

less severe depression

suicidal

management

no antidepressants

psychotherapy - to let the pt ventilate

let the patient ventilate

postpartum depression

Psychiatry 13
 after 1wk

low serotonin

DNOS (depression not otherwise specified)

cause is unknown

less than one week

seasonal depression

winter

march 30

Suicide

priority is to stay with the patient

characteristics

S - sex (attempt - female) (complete - male)

A - age (18-27yo) (40yo and above)

D - depression (helplessness or hopelessness)

P - previous history of suicide

E - ethanol or drugs

R - rational thinking loss

S - support system is absent

O - organized plan of suicide

N - no significant others

S - sickness (terminal)

types

threat

gesture

attempt

complete

risk

unsuccessful suicide - pt must sign a contract promising to never commit

suicide again. give emergency hotlines to patient

age (18-27yo) (above 40yo)

sex - increase attempt (female)

chronic illness

substance abuse

signs

Psychiatry 14
 sudden mood changes

gives priced belongings

verbalizes ideation

will

low self esteem

prevention

safety

stay with the patient

unscheduled rounds

remove pointed objects

ask direct questions

Anxiety Disorder

subjective response to presence of threat

cause

GABA is low

high dopamine

high norepinephrine

high serotonin

heredity

social factors

familial factors

previous live experiences

levels

mild (alert anxiety)

highest in learning

high perception

individual is alert

normal tensions is daily living

s/sx

increased VS

dilated pupils

sweating or diaphoresis

moderate (apprehension anxiety)

selective inattention

Psychiatry 15
 decreased perception (decreased awareness)

learning

can still cope

s/sx

GI signs and symptoms (LBM, constipation)

severe (fight or flight response) (free floating anxiety)

confused

pupil is constricted

impaired awareness

feeling of impending doom

they cannot cope and needs somebody to help them cope

s/sx

heart and lungs signs and symptoms

palpitation

hyperventilation, dyspnea, shortness of breath

panic (disorganized)

disorganized thought and behavior

danger to self or other people

danger is death

goal is to decrease the level of anxiety

give anxiolytics (priority)

pupil is dilated

doom

s/sx

pt may become exhausted

heart and lung symptoms

management

safety

decrease stimulant (bring pt to a quiet environment)

communicate with the patient (make a simple commands or

instructions) (should have a tone of authority)

if there is a need to restrain the patient, you may do so.

if mechanical (check restrain q 1hr to 2hr to check for circulation)

tie the restraints to the bed frame and lower the bed.

Psychiatry 16
 if leather (check q 30mins for safety)

chemical (medication is also a restraint)

isolation is the least restrictive restraint

chemical is the most restrictive restraint

instruct the patient to do relaxation techniques (DBE)

verbalization

mild or moderate - encourage the pt to verbalize

severe or panic - talk to the patient with direct, specific and simple
words. ask patient with questions that are answerable with yes or no

betablockers (if patient has palpitations) (priority)

anxiolytics (benzodiazepine) (zipam,zolam) (buspar responds after 2 wks)

librium and transine (used to manage s/sx of alcohol wothdrawal)

antidote: flumazipine

do not use or administer with kava and valerian root

kava and clonazepam together is hepatotoxic

kava and valerian root

for anxiety

for depression

for insomnia

increases CNS depression if pt take it with anxiolytics

buspar

does not cause dependence

effective after 2-4 wks

common anxiolytics (pam)(lam)

buspirone (buspar)

librium

tranxene

most common SE: dizzines

antidote of anxyolitics: FLUMAZENIL (ROMAZICON)

Phobia

irrational fear of a certain specific object

types

agoraphobia

Psychiatry 17
 public

social phobia

intense anxiety or fear of being judged, negatively evaluated, or

rejected in a social or performance situation

xenophobia - fear of strangers

simple phobia

any phobia that is very specific

tanakophobia - fear of leaving a dying patient

management

systematic dysensitization

image

video

expose to object

always encourage to do DBE in each step

PTSD

related to previous experiences

develops 3 months or 6 months after the event

reexperience of events (flashbacks and will experience panic and palpitations)

(nrsg dx: severe anxiety)

patient develops conversion

patient will have nightmares

patient will develop depression

management

cognitive therapy

aims to correct a wrong belief

flooding therapy

sudden exposure to a fake scenario

Generalized Anxiety Disorder

pt worries on simple things

lasts for 6 months or more

s/sx

always have tension

increase VS

restless

always have headaches

Psychiatry 18
 disoriented or confused

slurred speech

management

promote safety

encourage DBE

encourage the patient to verbalize

betablockers if patient experiences palpitations

Nursing Diagnosis

if mild or moderate - ineffective coping

severe or panic - severe anxiety

Obssessive Compulsive Disorder

presence of obssession and compulsion

compulsion is an uncontrolled ritual

goal is to control or limit rituals but do not stop

nursing diagnosis - severe anxiety

management

group therapy - min of 6 max of 12

support group

members should have the same case

some members should have recovered from OCD

nurse is a facilitator and should create a therapeutic environment

all patients should be a leader

medication

antidepressant (clomipramine)

(SSRI) (decreases libido)

Lithium

0.5-1.5

diet

regular sodium - 2-3g per day

increase fluids: 2-3L per day

avoid excessive perspiration

avoid nsaids

avoid thiazides (decreases sodium)

Psychiatry 19
 toxic effects

diarrhea (1st sign)

muscle problems

Antidote: diuretics, mannitol, diamox, terbutaline

SE

GI signs and symptoms

depression

Somatoform Disorder
pain of a patient with no physiologic cause

overexaggerates their signs and symptoms

defense mechanism - repression, displacement, regression

cause

stress - pt is not aware that the pain is caused by stress

types

psychogenic pain disorder

consistent pain for minimum of 3 months

somatization

pt complains of several pain

hypochondriasis

goal - limit diagnostic procedures

pt complains of severe or serious pain (DR SHOPPERS) (because of

mistrust)

conversion

common symptom - blindness, paralysis and La belle indifference (A

condition in which the person is unconcerned with symptoms caused by a
conversion disorder. A naive, inappropriate lack of emotion or concern for
the perceptions by others of one's disability, usually seen in persons with
conversion disorder.)

caused by a previous traumatic experience

malingering

creates signs and symptoms

pt claims that he/she is ill

secondary gain ex: to avoid certain tasks

manchausen syndrome

Psychiatry 20
 by proxy (others) - child or relatives deliberate creation of signs and
symptoms (primary and secondary gain)

management

avoid focusing on the patient complaint (divert the attention of the patient)

encourage the pt to talk about events that happened in the past

matter of fact

set limits (should be firm and consistent)

attend to all physiologic needs but not to all requests

DO NOT REINFORCE SECONDARY GAIN

Eating Disorders
cause

belongs to a very strict family (perfectionist)

heredity

social factors

mass media

characteristics of both anorexia and bulimia

obsessed with weight

obsessed with food

perfectionist

abdominal problems

exercise

abuses laxatives and diuretics

depression - suicidal

Anorexia Nervosa

denial

pt purge

odd behavior - slow eating, hides the food, puts the food in the trash

hypothermia

amenorrhea

lanugo

poor nutrition

thin

wt loss

Psychiatry 21
 dry + scaly skin

hair is brown and brittle

Bulimia Nervosa

pt is aware

binge eating - social factors

purge - enamel erosion

stained teeth

prone to dental carries

rupture of esophagus

near normal weight

exercise - orthorexia nervosa

rumination syndrome - pt purge, then chew, then swallows the food

nursing diagnosis

imbalanced nutrition less than body requirements

body image disturbance

self esteem disturbance

ineffective individual coping

management

cognitive therapy (used to challenge or correct a wrong belief)

behavioral modification therapy (improves behavior)

build trust and rapport

contract (+behavior)

set limits (should be firm and consistent)

token of economy (rewards and punishments)

involve patient with meal plan

weigh the patient daily

monitor the patient while eating

monitor the patient 1-2hrs after eating

antidepressants

Alcohol withdrawal

C - confused or disoriented

H - hallucinations

I - increase VS and irritable

T - tremors

Psychiatry 22
 S - sweating (1st) and seizure (last)

management

lorazepam

librium

tranxene

delirium tremens

alcohol reaches your brain

korsakoff's

deficiency of thiamine and niacin

s/sx

amnesia signs and symptoms

confabulation

memory disturbances

management

thiamine and niacin IM for 1 month

if intrinsic factor has returned, give it in oral form

wernicke

deficiency of thiamine

s/sx

eye problems

nystagmus

opthalmoplegia

ataxia

management

thiamine IM

aversion therapy

introduce painful stimuli to prevent other stimuli

before aversion therapy, pt must accept that he or she is alcoholic

disulfiram (antabuse) - avoid alcohol substances within 12H prior

do not take substances that has alcohol after 2 wks of last intake of
disulfiram

SE: severe GI symptoms (headache, nausea, vomiting and abdominal

pain), tachycardia, flushed skin, decreased BP and dyspnea

avoid

cold remedies (elixir)

Psychiatry 23
 fruit extracts

fermented

skin products

aftershave

Al anon - group of wives of alcoholics

blood alcohol level of alcoholic pt -0.1%

Narcotic/opiates abuse

heroine (methadone progam)

oxycodone

hydrocodone

morphine

demerol

narcan

naltroxene

signs and symptoms

constricted pupils

downer symptoms

cns depression

decrease rr

piloerection

these drugs causes euphoria

if patient just took narcotics, they will experience constipation

withdrawal

sweating and yawning

GI symptoms

coryza symptoms (runny nose, teary eyes)

diarrhea

increase VS

pupil is dilated

Domestic Violence
rape

forcible insertion of penis or object into vagina, mouth and anus

cause

Psychiatry 24
 power - musculinity

anger - revenge

sadism

types

acquaintance rape

rapist is someone you know

incest

incest is a relative within the bloodline

statutory rape

rape to a victim with consent (sex with 14yo and below)

blitz rape

rapist is someone you do not know

accessory rape

someone who cannot give consent is raped

date rape

social media

RTS (rape trauma syndrome)

trauma experienced by the victim after rape

victim is very disorganized

immediately after the rape, patient is in denial

patient doesnt want to talk about the rape

the day after the rape, the victim tells the whole story about the rape without
emotions - denial

high anxiety (fear of death)

management

preserve evidence

safety (stay with the patient)

proper documentation

proper referral

report to supervisor

supervisor will report to the police

identify support system

child abuse

1st: assess the child

Psychiatry 25
 2nd: obeserve parent child behavior

2rd: report to the supervisor

emotional

physical

neglect

sexual

most common site is buttocks and thighs

characteristics

injuries at different stages

aloof

unequal hair length

nightmare

knowledge of sex

depression - powerlessness

management

safety

what to call

where to go

shelter

family therapy

play therapy

battered wife syndrome

characteristics of abuse husband

low self esteem

belongs to a violent family

abused

immaturity

poor parenting

phases

tension building - verbal

acute battery - physical harm

denial

co dependence

dependence

Psychiatry 26
 honeymoon - undoing

Developmental Disorders
ADHD, autism, MR

cause

pregnancy complication

heredetary

stress, nutrition, environment

characteristics

poor social interaction

ADHD

boys (7yo)

I - impulsive

H - hyperactive (fidgets) (language) may lead to tourette's (3-5%) (involuntary

movements and speech and may remain present until they grow old)

I - inattention (easily distracted)

management

safety

nutrition (increase calories)

behavioral modification therapy

promote trust and rapport

contract (+behavior)

structure activity

allow to play

teach the patient to relax (DBE)

CNS stimulants

methylphenidate (ritalin)

take it in the morning

increases focus of the patient

SE: wt loss and growth retardation

ritalin - causes insomnia, increase VS, weight loss and growth delays

Autism

2-3 yo

common in boys

Psychiatry 27
 child is unresponsive

poor social interaction

poor eye contact

not cuddly

echolalia

loves to spin objects

do not give balls to avoid tantrums

give blocks

loves music

provide helmet (patient may do headbang)

management

safety

nutrition

behavior modification

build trust and raport with the patient

contract (+behavior)

set limits

set a good example

repitition

refer with resources

Personality Disorders
Borderline

more on female

self mutilating

manipulative

projection

intense relationship

never have successful relationship

splitting

sexually provocative

impulsive

priority is SAFETY

Psychiatry 28
 Schizoid

last to catch up with fashion

solitary

odd

Schizotypal

magical thinkers

Antisocial

break laws

no remorse

Narcissistic

exagerrated love of self

Histrionic

attention seeker

Passive agressive

back fighter

OCPD

perfectionist

has decision conflict

Dependent

depends on others

Avoidant

inferiority complex

Dissociative identity disorder

alternate personalities

response to abuse or trauma

not aware of alter personality

has memory gaps

lost of time

switch identities (stress/trauma)

Delirium vs Dementia
Delirium

adult

subacute or subacute

Psychiatry 29
 reversible

cause

substance abuse

threat

illness

liver

kidney

signs and symptoms

C - confusion

H - hallucination

visual

tactile

I - increase VS, irritable

T - tremors

S - sweating (first sign of delirium) seizure (last sign of delirium)

management

safety (priority)

anxiolytics

diazepam

librium (chlordiazipoxide)

tranxene (chlorazipate dipotassium)

Dementia

elderly

chronic

ivversible

progressive, degenerative disease of elderly

cause is unknown but can be caused by lesions in the brain

other causes

alzhiemer's (age)

organic factors (stroke)(trauma to the brain)

certain illness or hx of infections to the brain

signs and symptoms

memory disturbances

amnesia

Psychiatry 30
 anterograde amnesia - forgets recent events

retrograde amnesia - forgets distant event

confabulation

management

safety (priority)

orient

Alzhiemer's Disease

senile plaque deposition in the brain (cerebral cortex)

neurofibrillary tangles

decrease in acetylcholine

lifespan: 2-20yrs (10yrs is the average lifespan)

diagnostic procedure

early stage

PET scan

confirmatory procedure

autopsy

classic signs

Aphasia

expressive

partial loss of the ability to produce language

USE PICTURES

receptive

hard for a person to understand spoken or written language

USE LOW PITCH TONE

Anomnia

difficulty naming

Agnosia

difficulty recognizing people and objects

Apraxia

slow movements

stages of alzheimer's

1st stage: forgetfulness (HALLMARK)

Psychiatry 31
 poor judgement

orient patient

2nd stage: difficulty performing complex task (orient patient)

3rd stage: active stage

confabulation

recollecting of the past (allow the patient to talk about the past)
(prevents depression) (post old pictures in the wall)

insensitive to the weather

lucid interval

triggered by familiar stimuli

short awareness

sundown syndome (wandering at night)

cause

not well lighted room or dark room

fatigue

management

lock the door (above or below eye level)

4th stage: end stage (1yr)

immobility (check for pneumonia and bed sores)

forgets everything

management

safety (priority)

provide structured or daily routine

nutrition

orient the patient

socialize

assist with activities in daily living

cholinergics

slows progression of the disease

SE: dehydration

tacrine

donazepil

do not remind the forgetfulness of the patient

Psychiatry 32
 no innovative

Antidepressants
effective after 2-4 weeks

MAOI

increases serotonin and norepinephrine

Parnate (tranylcypromine)

Nardil (phenelzine)

Marplan (isocarboxacid)

Selegiline (ensam)

give AM

SE: insomnia

instruct the patient to avoid foods rich in thyramine because it can lead to
hypertensive crisis

avocado

banana

papaya

beer

liver

food rich in preservatives (packed goods)

soya (soy sauce)

yogurt

aged cheese

swiss cheese

cheddar cheese

mozzarella cheese

TCA

ends with pramine or tryptilyne

trazodone

increases level of norepinephrine

SE: anticholinergic side effects

dry mouth

constipation

decrease BP

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 avoid TCA if patient has glaucoma because anticholinergics increases IOP
(TCA has anticholinergic side effects)

imipramine - for pt with enuresis

SSRI

ends with ine but doesnt end with pine

ends with pram

increases serotonin

floxetine (prozac)

sertraline (zoloft)

paroxetine (paxil)

fluvoxamine

venlafaxine

escitalopram

citalopram

vilazidone

SE: sex problems

St John's wort

herbal antidepressant

half - life: 2 wks

wait 2 wks before shifting antidepressants or it will lead to hypertensive crisis

Anxiolytics/Benzodiazepine
zepam/zolam

to decrease anxiety

muscle relaxants

buspirone (2wks before it effects the pt)

librium (chlordiazeoxide)

chlorazipate dipotassium (tranxene)

antidote: flumazeril

side effects

dizzines (most common)

headache

Psychiatry 34
 nausea

vomiting

drowsiness

clumsiness

danger

addiction/dependence

CNS depression (decreases RR)

Psychiatry 35