Introduction about mental health nursing.pptx

Mental Health Nursing

1. Unit: 5 Treatment modalities and therapies used in mental disorders 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.

2. INTRODUCTION 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.

3. Contu….. 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.

4. PSYCHOPHARMACOLOGY 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 .

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. Contu…..

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. Contu…..

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. Contu…..

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. Contu…..

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. Contu…..

10. General Guidelines regarding Drug Administration in Psychiatry 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.

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. Contu…..

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. Contu…..

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. Contu…..

14. Patient Education related to Psychopharmacology 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.

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. Contu…..

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. Contu…..

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) Contu…..

18. Box 5.2: Common reasons for patients not taking medication as prescribed 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

19. Antipsychotics Antidepressants Mood stabilizing drugs Anxiolytics and hypnosedatives Antiepileptic drugs Antiparkinsonian drugs Miscellaneous drugs which include drugs used in eating disorders, de-addiction, child psychiatry, vitamins, calcium channel blockers, etc Classification of Psychotropic Drugs

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. ANTIPSYCHOTICS

21. Classification of antipsychotic drugs I. Typical Antipsychotics / Conventional antipsychotics Phenothiazines : Chlorpromazine, Thioridazine Thioxanthenes : Flupenthixol Butyrophenones : Haloperidol Diphenylbutyl : Pimozide Piperidines : Penfluridol Indolic derivatives: Molindone Dibenzoxazepines: Loxapine II. Atypical antipsychotics: Clozapine , Risperidone , Olanzapine Contu…..

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. Contu…..

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. Contu…..

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

25. Mood Disorders Mania Major depression with psychotic symptoms Childhood Disorders Attention-deficit hyperactivity disorder Autism Enuresis Conduct disorder Contu…..

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 Contu…..

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 Contu…..

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. Contu…..

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. Contu…..

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. Contu…..

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. Contu…..

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. Contu…..

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. Contu…..

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) Contu…..

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. Contu…..

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. Contu…..