PSYCHIATRIC NURSING

COPING AND ADAPTATION

MENTALLY HEALTHY INDIVIDUAL
ATTITUDE OF SELF ACCEPTANCE
AUTONOMY
ABILITY TO ABSTRACT,TRUST ,COPE WITH STRESS
ACCURATE SELF PERCEPTION
AWARENESS OF SELF
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
Illusion- misinterpretation of an actual external stimuli
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
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 ones 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
Dj 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
superegocontrol of instinctual impulses
12 young adult genital ; reawakening of sexual drives relationships

Sexual maturation
Sexual identity ,ability to love and work

0-12mos;
1- 3y
3- 6
6- 12
12-18
18-25
25-60
60 and above

Psychosocial Erickson
developmental milestones //delay
TRUST
AUTONOMY
INITIATIVE
INDUSTRY
IDENTITY
INTIMACY
GENERATIVITY
EGO INTEGRITY
PIAGETS 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 OTHERS 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 ones 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

IDENTIFICATION conscious patterning of ones self from another person

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

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 PATIENTS 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

CLARIFICATION

FOCUS ON FEELING TONE ,NEEDS ,MOTIVATION

UNCONDITIONAL POSITIVE REGARD - respect

THERAPEUTIC COMMUNICATION
LIMIT SETTING
EMPATHETIC / ENCOURAGE EXPRESSION
ANSWERS NEEDS
REFLECTIVE AND INSIGHTFUL
THERAPEUTIC COMMUNICATION
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 childs 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 impr ove 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.
SUB-CLASSIFICATIONS
PHENOTHIAZINES

ANTI-PSYCHOTICS

NON-PHENOTHIAZINES

Chlorpromazine (Thorazine)
Fluphenazine (Prolixin)
Perphenazine ( Trilafon)
Prochlorperazine (Compazine)
Thioridazine ( Mellaril)
Triflouperazine (Stelazine)

Clozapine ( Clozaril)
Haloperidol ( Haldol)
Olanzapine ( Zyprexa )
Risperidone ( Risperdal)
THIOXANTHENES
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
blood levels

K monitor

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
Selegiline
( Eldepryl)
INDICATIONS: For
management
of anti psychotic induced EPS- pseudoparkinsonism
SIDE AND ADVERSE EFFECTS
Anticholinergic Effects Blurring of vision, constipation, 3Ds 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
TRICYCLICS

MONO AMINE OXIDASE

INHIBITORS

SELECTIVE SEROTONIN
REUPTAKE INHIBITORS

Imipramine(Tofranil)
Amitriptryline ( Elavil)
Clomipramine (Anafril)
Doxepin ( Sinequan)
Nortryptyline ( Aventyl)

Citalopram ( Celexa)
Flouxetine (Prozac)
Paroxetine ( Paxil)
Sertraline ( Zoloft)
Fluvoxamine (Luvox)
Tranylcypromine (Parnate)
Isocarboxazid ( Marplan)
Phenelzine (Nardil)

Mechanism of
Action

Prolongs the action

of norepinephrine
Dopamine
Serotonin by
blocking the
reuptake of this
CNS STIMULANTS
neurotransmitters

Blocks the
metabolic
destruction of
neurotransmitters by
the enzyme monoamine oxidase

Inhibits reuptake and

destruction of
serotonin to prolong its
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:

TCAS
Cardiac arrhythmias,
palpitations,orthostatic
hypotension
Constipation,Sedation,
anticholinergic effects
Confusion
Bone marrow depression

MAOI
Hypertensive crisis
Liver and cardiovascular
disease
Weight gain
Sexual dysfunction
photosensitivity

SSRI
Tremors, decreased
libido, NAVDA
Nervousness, insomnia,
drowsiness
anxiety

CNS Stimulants
Growth suppression,
insomnia

CONTRAINDICATIONS AND SPECIAL PRECAUTIONS

TCAS
Hypersensitivity, liver
disease , glaucoma

MAOI
Hypertension
Cardiovascular disease
and Liver disease

SSRI
same

CNS Stimulants

NURSING CARE GUIDELINES

C- anti-depressants
H- decreased signs and symptoms of depression(increased appetite and sleep
E p.c.
TCAS
C2-3 wks initial effect
3-6 wks full therapeutic
effect
Emphasize compliance
Avoid citrus juice
decrease absorption

MAOI

SSRI

CNS Stimulants

2-3 initial
3-4 full ther. Effect
Avoid foods rich in
tyramine leads to
hypertensive crisis
( processed,preserved and
fermented )

2-3 initial
3-4 full ther. effect

Give in AM , not
beyond 2 pm
6 hours before bedtime

KMonitor 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
Fine tremors leading to coarse tremors
Thirst
Nystagmus

Nephrotoxicity*
Cardiac toxicity*
Hyperthyroidism Thyroid Crisis*

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

Alprazolam ( Xanqax)
Chlordiazepoxide ( Librium)
Clorazepate ( Tranxene)
Diazepam ( Valium)
Lorazepam ( Ativan)
Oxazepam ( Serax)

NON-BENZODIAZEPINE
Miscellaneous agents

Hydroxyzine ( Vistaril)
Meprobamate ( Equanil)
Buspirone
(Buspar)

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*
Addisons 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, LFTs,
report sorethroat, jaundice, weakness and fever