Antipsychotics, Antidepressants

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Antipsychotics, Antidepressants

• Barbara S. Hays, RN
• Winter, 2006

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Psychosis

• Thought disturbances
• Out of touch with reality

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SCHIZOPHRENIA

• GROUP of mental disorder
• Disordered thought processes
• Psychotic features
• Disrupted interpersonal relationships
• DISTURBANCES in
• Thought processes
• Affect, mood
• Behavior

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Affective disorder of schizophrenia

• Flattened, blank
• Blunted
• Inappropriate, incongruous

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Affective disorder of schizophrenia

• Flattened, blank
• Blunted
• Inappropriate, incongruous

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Autism of schizophrenia

• Retreats into self
• Stereotypical behaviors like hair twirling
• May forget to feed, bathe, dress body
• Own language (neologisms)

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• Illusions
• Delusions
• Hallucinations

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Atypical antipsychotics to treat schizophrenia
(Easy p 459, 60)

• Block dopamine receptors (less than the
  typicals do) and seratonin receptors
• Clozapine (Clozaril)
• Resperidone
• Fewer extrapyramidal tract side effects

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Typical Antipsychotics(Easy p 462)

• Thorazine (chlorpromazine)
• Prolixin (Fluphenazine)
• Mellaril (Thioridazine)
• Stelazine (Trifluoperazine)

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Typical antipsychotics

• THORAZINE especially
• After dopamine in CNS
• Anticholenergic, adrenergic blocking effect
• EPS, pseudoparkinsonism
• Tardive dyskinesias (can become permanent)
• Orthostatic hypotension
• Photosensitivity
• Agranulocytosis (report sore throat/fever STAT!)

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THORAZINE

• Extrapyramidal tract side effects (EPSs)
• Acute dystonias
• Torticolis
• Occulaogyral crisis
• Ajastgesua (restless legs, etc)

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THORAZINE

• pseudoParkinsonism from decreased dopamine
• Artane
• Cogentin
• Tardive dyskinesias (long term, hi doses)
• PERMANENT
• Facial grimaces
• Tongue movements

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Other ANTIPSYCHOTICS

• PROLIXIN (fluphenazine)
• HALDOL (haloperidol) anticholinergic effects
  dry mouth, orthostatic hypotension, etc.
• give with Cogentin to reduce s/es

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Affect MEDICATIONS

• Antidepressants (Easy p 441 459)
• SSRIs
• MAO inhibitors
• Tricyclics
• Atypicals

• Mood stabilizers (Easy p 456)

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DEPRESSION

• Theories
• Freud
• Biologic

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S/S DEPRESSIONSilvestri p 947 (box 61-2)

• Sense of inadequacy and helplessness
• Maybe unresolved grief
• Psychomotor retardation
• Vegetative signs
• Weight loss
• Constipation
• Early morning awakening

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Care of DEPRESSED client

• Simple, structured activities
• One-on-one (maybe with nurse)
• Watch for suicide when energy level on the rise
• Assess degree of risk
• Find out if has lethal plan

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Selective Seratonin Reuptake Inhibitors (Easy p
441)

• PROZAC (fluoxetine)
• PAXIL (paroxetine)
• ZOLOFT (sertraline)
• EFFOXOR (seratonin norepinephrine)
• ELAVIL (seratonin norepinephrine)
• DONT GIVE WITH MAOIS

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MonoAmineOxidase Inhibitors

• PARNATE is prototype
• Parnate-cheese reaction -- increased
  catecholamines HTN, CVA
• Aged, fermented things
• Blue cheese
• Chianti wine
• DC at least 2-5 weeks prior to beginning SSRIs

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TRICYCLIC antidepressants (Easy p 448)

• Block reuptake of norepinephrine into peripheral
  adrenergic nerves see increased sympathetic tone
• Takes 2-4 weeks to see results
• Uses
• Depression
• Phobic attacks
• bedwetting

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TOFANIL (imipramine)Prototype Pro p 450

• Potentiates effects of seratonin and
  norepinephrine
• Arrhythmias
• Constipation
• Avoid concurrent use with MAOIs (stop MAOI 2
  weeks before starting Tofranil)

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Elavil (amipriptyline)

• Take daily at bedtime
• Anti-cholinergic effect
• Dry mouth (hard candy, sugarless gum)
• constipation

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Other Antidepressants/Anxiolytics

• BARBITURATES (ital) (Easy p 430)
• CNS depressants
• Dont withdraw suddenly
• BENZODIAZEPINES (pam, plam ) (Easy p 437)
• Valium
• Xanax
• Ativan
• Avoid ETOH combination effect

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BIPOLAR (old term manic depressive)

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BIPOLARsilvestri p 947

• Psychotic at both extremes

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MOOD STABILIZERS(Easy p 456 459)

• LITHIUM CARBONATE
• Therapeutic blood level 0.8 1.2 mEq/l
• Toxic level 1.5 - 2

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MOOD STABILIZERS

• LITHIUM CARBONATE (a natural salt)
• Chops off both ends of bipolar
• Hard on kidneys over time
• Take with food, milk, to decrease GI upset