1. Introduction to mental Health Nursing

Introduction to mental Health Nursing

1. Psycho pharmacology
Psychological therapies: Therapeutic community, Psycho therapy- individual,
Psycho-analytical, Cognitive and supportive, Family, Group, Behavioral, Play, Psycho-
drama, Music, dance, Recreational and light therapy, Relaxation therapies: yoga,
medication, bio feedback.
Alternative system of medication
Occupational therapy, Physical therapy: electroconvulsive therapy
Geriatric considerations
Role of nurse in above therapies.

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2.  Patients suffering from physical illnesses are given specific
treatment because the causes are specific and the signs and
symptoms are also specific.
In a psychiatric setting
 The treatment may not be so specific and most patients
are given more than one treatment.
These treatment methods vary from patient to patient.
Some patients do not want treatment and may not
cooperate with the doctors and nurses.
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3.  Some do not realize that they are ill and may actively resist
all forms of treatment.
The nurse has an extremely important role to play in the
treatment of the mental ill.
 She is the one who has closer contact with the patient
than any other members of the hospital team.
 She also has a greater opportunity to get to know him and
report on his improvement.
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4.  Psychopharmacology is the study of drugs used to treat
psychiatric disorders.
 It discusses many psychoactive medications that alter
synaptic transmission in the brain in certain and specific ways.
 Medications that affect psychic function, behavior or
experience are called psychotropic medications.
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5.  They have significant effect on higher mental functions.
 Psychopharmacological agents are first line treatment for
almost all psychiatric ailments now a days.
 With the growing availability of a wide range of drugs to
treat mental illness, the nurse practicing in modern psychiatric
settings needs to have a sound knowledge of the
pharmacokinetics involved, the benefits and potential
risks of pharmacotherapy, as well as her own role and
responsibility.

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6.  Several terms used in discussions of drugs and drug
therapy are important for nurses to know.
 Efficacy refers to the maximal therapeutic effect that a
drug can achieve.
 Potency describes the amount of the drug needed to
achieve that maximum effect.
 Drugs that activate receptors are termed agoinist, and
those that block are termed antagonists.
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7.  Half-life is the time it takes for half of the drug to be
removed from the bloodstream. Drugs with a shorter half-
life may need to be given once a day.
Psychotropic Drugs alter Synaptic Activity by
 Modifying the reuptake of a neurotransmitter into the
presynaptic neuron.
 Activating or inhibiting postsynaptic receptors.
 Inhibition of enzyme activity.
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8. Biological theories Suggest that
Many of the psychiatric disorders are caused by
dysregulation (imbalance) in the complex process of brain
structures communicating with each other through
neurotransmission.
Psychosis involves excessive dopamine and serotonin
dysregulation. Antipsychotic drugs block dopamine from the
receptor site.
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9. Mood disorders results from disruption of normal
patterns of neurotransmission of nor-epinephrine, serotonin
and other transmitter antidepressants block the reuptake of
nor-epinephrine or serotonin and regulate the areas of the
brain that manufacture these chemicals.
Anxiety to be a dysregulation of GABA and other
neurotransmitters. Benzodiazepines enhance the effects of
GABA.
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10.  The nurse should not administer any drug unless there is a
written order. Do not hesitate to consult the doctor when in
doubt about any medication.
 All medications given must be charted on the patient’s case
record sheet.
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11. While giving medication,
• Always address the patient by name and make certain of
his identification.
• Do not leave the patient until the drug is swallowed.
• Do not permit the patient to go to the bathroom to take
medication.
• Do not allow one patient to carry medicine to another.
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12.  If it is necessary to leave the patient to get water, do not
leave the tray within the reach of the patient.
 Do not force oral medication because of the danger of
aspiration. This is especially important in stuporous patients.
 Check drugs daily for any change in color, odor and
number.
 Bottles should be tightly closed and labeled. Labels should
be written legibly and in hold lettering.
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13.  Poison drugs are to be legibly labeled and kept in separate
cupboard.
 Make sure that an adequate supply of drugs is on hand, but
do not overstock.
 Make sure no patient has access to the drug cupboard.
 Drug cupboards should always be kept locked when not in
use.
 Never allow a patient or worker to clean the drug cupboard.
 The drug cupboards keys should not be given to patients.
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14. Nurses assess for drug side effects, evaluate desired
effects of medication. Thus, nurses must understand general
principles of psychopharmacology and have specific
knowledge related to psychotropic drugs.
Teaching patient cab decrease the incidence of side
effects while increasing compliance with the drug regimen.
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15. Specific area of education include the following:
1. Discussion of side effects: Side effects can directly affect
the patient’s willingness to adhere to the drug regimen.
The nurse should always inquire about the patient’s
response to a drug, both therapeutic responses and
adverse responses.
2. Discussion of safety issues: Because some drugs, such as
tricyclic antidepressants, have a narrow therapeutic index,
thoughts of self harm must be discussed.
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16. 3. Drug interactions: Patients and families must be taught to
discuss the effects of the addition of over-the-counter
drugs, alcohol and illegal drugs to currently prescribed
drugs.
4. Instructions for older adult patients: Because older
individuals have a different pharmacokinetic profile than
younger adults, special instructions concerning side effects
and drug-drug interactions should be explained
interactions should be explained.
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17. 5. Instructions for pregnant or breastfeeding patients:
As pregnant or breastfeeding patients have special risks
associated with psychotropic drug therapy, special
instructions should be tailored for these individuals. Teaching
patients about their medications enables them to be mature
participants in their own care and decreases undesirable side
effects. Furthermore, effective teaching can reduce
noncompliance (Box 5.2)
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18. Side effects

Illness (suspiciousness)

Emotional dulling

Busy lifestyle

Cognitive slowing Duration of treatment

Sexual dysfunction

Denial of need

Interference with work Fear of becoming addicted

Inability to use alcohol or other recreational drugs

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19. 1.Antipsychotics
2.Antidepressants
3.Mood stabilizing drugs
4.Anxiolytics and hypnosedatives
5.Antiepileptic drugs
6.Antiparkinsonian drugs
7.Miscellaneous drugs which include drugs used in eating
disorders, de-addiction, child psychiatry, vitamins, calcium
channel blockers, etc 19 Mr.Anilkumar Jarali

20. Antipsychotics are those psychotropic drugs which are
used for the treatment of Psychotic symptoms.
These are also known as neuroleptics, major
tranquilizers, D2-receptor blockers and anti-schizophrenic
drugs.
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21. Classification of antipsychotic drugs
I. Typical Antipsychotics / Conventional antipsychotics
1.Phenothiazines : Chlorpromazine, Thioridazine
2.Thioxanthenes : Flupenthixol
3.Butyrophenones : Haloperidol
4.Diphenylbutyl : Pimozide
5.Piperidines : Penfluridol
6.Indolic derivatives: Molindone
7.Dibenzoxazepines: Loxapine
II. Atypical antipsychotics: Clozapine , Risperidone , Olanzapine
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22. Mechanism of Action
Antipsychotic drugs block D2 receptors in the mesolimbic
and mesofrontal systems (concerned with emotional reactions).
Sedation is caused by alpha-adrenergic blockade.
Antidopaminergic actions on basal ganglia are responsible for
causing EPS (extra pyramidal Symptoms).
Atypical antipsychotics have antiserotonergic
(5-hydroxytryptamine or 5-HT) antiadrenergic and
antihistaminergic actions. These are therefore called as serotonin-
dopamine antagonists.
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23. Pharmacokinetics
Antipsychotics when administered orally are absorbed variably
from the gastrointestinal tract, with uneven blood levels. They are highly
bound to plasma as well as tissue proteins. They are metabolized in the
liver, and excreted mainly through the kidneys. The elimination half-life
varies from 10 to 24 hours.
Most of the antipsychotics tend to have a therapeutic window.
If the blood level is below this window, the drug is ineffective. If the
blood level is higher than the upper limit of the window, it results in
toxicity or the drug is again ineffective.

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24. Indications
Organic Psychiatric Disorders
Delirium
Dementia
Delirium tremens
Drug-induced psychosis and other organic mental disorders
Functional Disorders
Schizophrenia
Schizoaffective disorders
Paranoid disorders

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25. Mood Disorders
Mania
Major depression with psychotic symptoms
Childhood Disorders
Attention-deficit hyperactivity disorder
Autism
Enuresis
Conduct disorder
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26. Neurotic and other Psychiatric Disorders
Anorexia nervosa
Intractable obsessive-compulsive disorder
Severe, intractable and disabling anxiety
Medical Disorders :
Huntington’s chorea, Intractable hiccough , Nausea and
vomiting , Tic disorder , Eclampsia, Heat stroke , Severe pain
in malignancy, Tetanus
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27. Adverse Effects of Antipsychotic Drugs
I. Extrapyramidal symptoms (EPS):
Neuroleptic-induced parkinsonism:
Acute dystonia:
Akathisia :
Tardive dyskinesia
Neuroleptic malignant syndrome:
II. Autonomic side-effects:
III. Seizures
IV. Sedation
V. Other effects

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28. I. Extrapyramidal symptoms (EPS):
These are serious neurologic symptoms and major side
effects of antipsychotic drugs. Blockade of D2 receptors in
the midbrain region of the brain stem is responsible for the
development of EPS. Conventional / typical antipsychotic
drugs cause a greater incidence of EPS than do atypical
antipsychotic drugs.
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29. 1. Neuroleptic-induced parkinsonism:
Symptoms include rigidity (stiffness), tremors, bradykinesia,
stooped posture (curved), drooling, akinesia, ataxia, etc. the
disorder can be treated with anticholinergic agents.
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30. 2. Acute dystonia:
Dystonic movements result from a slow sustained
muscular spasm that lead to an involuntary movement.
Dystonia can involve the neck, jaw, tongue and the entire body
(opisthotonus).
There is also involvement of eyes leading to upward lateral
movement of the eye known as oculogyric crisis.
Dystonia can be prevented by anticholinergics,
antihistaminergic, dopamine agonists, beta-adrenergic
antagonists, benzodiazepines, etc.
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31. 3. Akathisia :
Akathisia is a subjective feeling of muscular discomfort that
can cause patients to be agitated, restless and feel generally
dysphoric. Akathisia can be treated with propranolol,
benzodiazepines and clonidine.
4. Tardive dyskinesia:
It is a delayed adverse effect of antipsychotics. It consists of
abnormal, irregular choreoathetoid movements (chorea - irregular
contractions, athetoid - twisting and writhing) of the muscles of
the head, limbs and trunk. It is characterized by chewing, sucking,
grimacing and perioral movements.
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32. 5. Neuroleptic malignant syndrome:
This is a rare but serious disorder occurring in a small
minority of patients taking neuroleptics, especially high-potency
compounds. The onset is often, but not regularly in the first 10
days of treatment. The clinical picture includes the rapid onset
(usually over 24-72 hours) of severe motor, mental and
autonomic disorders.
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33. II. Autonomic side-effects:
Dry mouth
Constipation,
Cycloplegia – paralysis of the ciliary muscle of the eye
Mydriasis – dilation of the eye
Urinary retention
Orthostatic hypotension
Impotence and impaired ejaculation.
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34. III. Seizures
IV. Sedation
V. Other effects
 Agranulocytosis (especially for clozapine)
 Sialorrhea or increased salivation (especially for clozapine)
 Weight gain
 Jaundice
 Dermatological effects (contact dermatitis, photosensitive
reaction)
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35. Nurse’s Responsibility for a Patient Receiving Antipsychotics
 Instruct the patient to take sips of water frequently to relieve dryness
of mouth.
 A high-fiber diet, increased fluid intake and laxatives if needed, help
to reduce constipation.
 Advise the patient to get up from the bed or chair very slowly.
 Differentiate between akathisia and agitation and inform the
physician. Administer antiparkinsonian drugs as prescribed.
 Observe the patient regularly for abnormal movements.
 Take all seizure precautions.

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36.  Patient should be warned about driving a car or operating machinery
when first treated with antipsychotics.
 Advise the patient to use sunscreen measures (use of full sleeves,
dark glasses, etc) for photosensitive reactions.
 Teach the importance of drug compliance, side-effects of drugs and
reporting if too severe, regular follow-ups. Give reassurance and reduce
unfounded fears and anxieties.
 A patient receiving clozapine is at risk for developing
agranulocytosis.
 Seizure precautions should also be taken as clozapine reduces seizure
threshold.

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