NURS 4500: Unit 2 Mood Disorders Notes PDF

NURS 4500: Unit 2 Notes Marla Valencia Mood Disorders (19 Items – 38%) Objectives Notes Define mood Definition of Mood Mood refers to a person’s emotional state or prevailing feelings...

NURS 4500: Unit 2 Notes Marla Valencia Mood Disorders (19 Items – 38%) Objectives Notes Define mood Definition of Mood Mood refers to a person’s emotional state or prevailing feelings over time. Signs of mood: Euphoria (elevated mood) vs. Anhedonia (inability to feel pleasure, associated with depression). Examine Major Depressive Disorder (MDD): Persistent feelings of differences sadness, hopelessness, loss of interest, sleep/appetite between major disturbances, anergia (low energy), and increased risk of suicide. depressive Bipolar Disorder (BPD): Alternating episodes of depression disorder and and mania. Mania is characterized by hyperactivity, little need Bipolar Disorder for sleep, grandiosity, impulsivity, possible delusions/hallucinations. Key Difference: Presence of at least one manic episode in BPD. Review across the Children & Adolescents: Genetic predisposition, lifespan situations environmental stressors (bullying, financial stress, school that can be issues), difficulty articulating emotions. associated with Adults: Common in high-stress professions, relationship mood disorders. struggles, and life transitions. Older Adults: Increased risk due to chronic illnesses, loss of loved ones, and isolation. Prenatal & Postpartum: Maternal stress impacts fetal development and increases long-term risk of neuropsychiatric disorders. Discuss Depression Assessment: assessments, o Sleep disturbances (too much or too little) behaviors and o Loss of interest in activities risks associated o Overwhelming sadness, guilt, or hopelessness with these two o Appetite changes disorders o Suicidal thoughts (screen for safety, especially in first 3 months of symptoms) Nursing Assessment: o Family relationships, support systems o Substance use screening o Coping skills and strengths  o Physical health conditions that may contribute to mood disorders o Social determinants: financial status, access to healthcare Review treatment Medication: options for each o Antidepressants: SSRIs, SNRIs, TCAs, MAOIs, disorder atypical antidepressants TCAs (Amitriptyline): Older class with more side effects. SSRIs (Paroxetine): First-line treatment; takes weeks to take effect. SNRIs (Duloxetine, Venlafaxine): Can lower BP; pre- assessment is required. MAOIs (Phenelzine): Avoid tyramine (risk of hypertensive crisis). Atypical (Trazodone): Often used for insomnia; avoid caffeine. NDRIs (Bupropion): Used for depression and smoking cessation. Mood Stabilizers: Lithium, valproic acid, lamotrigine, carbamazepine Lithium: Enhances norepinephrine and serotonin reuptake, reducing hyperactivity. o Monitor sodium intake, hydration (2- 3L/day), kidney function, and therapeutic drug levels. o Signs of toxicity: N/V/D, mental confusion, seizures, MI (therapeutic range 0.5-1.5 mEq/L, concern above 1.8, toxicity above 2.0). Anticonvulsants (Depakote, Lamictal, Carbamazepine, Valproic Acid): o Monitor for liver function and side effects (e.g., Lamictal can cause severe rash).  Antipsychotics: Used for severe mania or treatment-resistant depression Electroconvulsive Therapy (ECT): o Used for treatment-resistant depression, catatonia, or severe mood disorders. o Requires informed consent, pre-oxygenation, anticholinergic (atropine) administration, and sedation (propofol). o Involves a controlled seizure to reset neurotransmitters. Combination Therapy: o Medication, psychotherapy, social support o Medications alone do not resolve underlying behavioral patterns o Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT) Nursing Interventions Prioritize safety: Monitor for suicidal/homicidal ideation, remove hazardous objects. Promote nutrition: Offer small, frequent meals. Encourage structured sleep patterns (avoid daytime naps, reinforce circadian rhythm). Use therapeutic communication: Open-ended questions like “Tell me more” instead of “Why?” Support medication adherence: Educate patients on the importance of continuing meds even when feeling better. Implement combination therapy: Medications alone will not immediately resolve symptoms; therapy and social support are crucial. Analyze side Side Effects of Medications effects of each class of SSRIs (e.g., Paroxetine): Takes weeks to work, side effects medications include nausea, weight gain, sexual dysfunction. SNRIs (e.g., Duloxetine, Venlafaxine): Can lower blood pressure; pre-assessment needed.  TCAs (e.g., Amitriptyline): Sedation, weight gain, dry mouth, cardiac effects. MAOIs (e.g., Phenelzine): Avoid tyramine-rich foods to prevent hypertensive crisis. Atypical Antidepressants (e.g., Trazodone): Used for sedation; avoid caffeine. Lithium: Narrow therapeutic range (0.6–1.2 mEq/L); toxicity at >1.8 mEq/L. o Signs of toxicity: N/V/D, tremors, confusion, blurred vision, MI risk. o Requires regular monitoring of sodium levels and kidney function. Highlight priority Priority Nursing Interventions & Teaching nursing interventions to Safety First: Continuous monitoring for suicidal/homicidal include teaching ideation. with medications. Medication Education: o Importance of adherence o Avoid sudden discontinuation o Report adverse effects (e.g., lithium toxicity symptoms) Support Independence: Encourage ADLs, small frequent meals, circadian rhythm regulation. Therapeutic Communication: Open-ended questions (“Tell me more,” “What is that like?”). Avoid “why” questions. Environmental Safety: Remove breakable items, strings, or other potential hazards.  Schizophrenia (19 Items – 38%) Objectives Notes Apply Nursing Assessment: Process to the o Observe for positive symptoms (hallucinations, Care and delusions, illusions). Management of o Identify negative symptoms (flat affect, apathy, poor Clients with self-care, poverty of speech). Schizophrenia o Assess cognitive symptoms (memory issues, impaired judgment, difficulty making decisions). o Ask open-ended questions (e.g., “Tell me more about the voices. What are they saying?”) to evaluate severity and risk of harm. o Recognize command hallucinations, which increase risk of self-harm or violence. o Assess for safety concerns (e.g., command hallucinations, self-harm risk). o Evaluate medication adherence and side effects. o Monitor nutritional status, hygiene, and overall self-care. Diagnosis: o Risk for self-harm or harm to others. o Impaired thought processes. o Social isolation. o Impaired social interaction due to withdrawal or associative looseness. o Self-care deficit. o Nonadherence to medication due to paranoid delusions. Planning: o Establish short-term and long-term goals (e.g., medication adherence, participation in therapy). o Develop interventions based on symptoms (e.g., communication strategies for hallucinations, reinforcement for self-care activities). o Acute Phase (Hospitalized Care) § Ensure safety: Reduce stimuli, monitor hallucinations/delusions, prevent self-harm. § Establish trust: Use simple, direct communication. § Administer antipsychotics as prescribed. o Maintenance & Stabilization Phase (Long-Term Management) § Medication adherence: Many clients resist due to paranoia or side effects. § Psychotherapy: Cognitive behavioral therapy (CBT) and group therapy when feasible. § Family education & support: Crucial for relapse prevention.  § Community resources: Housing programs, employment support, case management. Implementation: o Use therapeutic communication: "Tell me more about the voices. What are they saying?" o Administer medications as prescribed, monitor for side effects (EPS, metabolic syndrome, NMS). o Provide education on medication adherence and symptom management. o Encourage participation in therapy and support groups. o Promote family involvement and psychoeducation. Evaluation: o Reduced hallucinations and improved reality-based thinking. o Improved medication adherence and symptom management. o Increased social interaction and self-care abilities. Differentiate Positive Symptoms (Beyond the Personality): Positive, Negative, o Hallucinations: sensory perceptions without external and Cognitive stimuli (auditory, visual, command hallucinations) Symptoms o Delusions (false fixed beliefs) o Illusions (misinterpretation of stimuli) o Disorganized thinking (associative looseness, word salad) Negative Symptoms (Taking Away from Personality): o Flat affect (little emotional expression) o Apathy (lack of motivation) o Anhedonia (inability to feel pleasure) o Poverty of speech (one-word answers, minimal speech) o Social withdrawal, lack of motivation for self-care Cognitive Symptoms: o Poor problem-solving skills o Impaired memory and concentration o Inability to plan or organize thoughts o Associative looseness (disconnected thoughts) Verbalize Pharmacologic Treatment Treatment Options and First-Generation (Typical) Antipsychotics (treat positive Role/Impact on symptoms) Family o Haloperidol (Haldol), Chlorpromazine (Thorazine) o High risk for extrapyramidal symptoms (EPS) (dystonia, akathisia, tardive dyskinesia)  o May cause neuroleptic malignant syndrome (NMS) (life-threatening) o "Beers Criteria": Avoid in elderly (can worsen dementia) Second-Generation (Atypical) Antipsychotics (treat positive & negative symptoms) o Clozapine (Monitor WBC for agranulocytosis, flu-like symptoms indicate risk for sepsis) o Risperidone, Olanzapine (Zyprexa), Quetiapine (Seroquel) o Risk for metabolic syndrome (weight gain, diabetes, cardiovascular risks) Third-Generation Antipsychotic o Aripiprazole (Abilify) o Lower risk of EPS and metabolic side effects o Black Box Warning: Increased mortality in dementia patients, suicidal ideation in young adults Managing Side Effects EPS Treatment: Benztropine (Cogentin) to reduce dystonia and tardive dyskinesia Metabolic Syndrome Monitoring: Monitor weight, blood sugar, cholesterol Orthostatic Hypotension: Educate about slow position changes Impact on Family & Long-Term Care Family support & education reduces relapse rates Encourage community programs for stable housing, job support Nonadherence is common due to paranoia or severe side effects—family plays a key role in ensuring treatment adherence EPS Management: o Benztropine (Cogentin) to reduce symptoms like dystonia, akathisia. o Monitor for tardive dyskinesia, parkinsonism-like symptoms. Non-Pharmacological Treatments: o Psychotherapy, CBT, family therapy, community support. o Group therapy (if symptoms allow participation). Examine How Phases of Schizophrenia: Other Concepts o Prodromal Phase: Early signs (anxiety, withdrawal, are Connected intrusive thoughts) 1 month – 1 year before psychotic episode. o Acute Phase: Psychotic symptoms, hospitalization often required. Comorbidities and Lifespan Considerations: o Clients with schizophrenia have a 15% shorter lifespan due to lifestyle factors, medication side effects (cardiovascular risk, diabetes), and social determinants (housing instability, access to care). Differences Between Delusions, Illusions, and Hallucinations: o Hallucinations: Sensory perceptions without external stimuli (auditory, visual, command hallucinations). o Illusions: Misinterpretation of real stimuli (e.g., a shadow mistaken for a person). o Delusions: Fixed false beliefs, resistant to reasoning. Neuroleptic Malignant Syndrome (NMS): o Life-threatening reaction to antipsychotics (fever, muscle rigidity, altered mental status). Metabolic Syndrome: o Risk with atypical antipsychotics, requires monitoring for obesity, cardiovascular issues, and diabetes. Case Study: Applying RN Clinical Judgment KT, a 25-year-old, admitted with schizophrenia, found wandering downtown talking to themselves. Police brought them in due to inappropriate behavior. o Assessment: § Auditory hallucinations, disorganized speech, poor hygiene, underweight, homeless. o Nursing Actions: § Assess safety risk (command hallucinations?). § Administer prescribed medications and monitor for side effects. § Provide psychoeducation on symptom management and adherence. § Collaborate with social work for housing and support resources.  Foundations of the Psychosocial Concept (11 Items – 22%) Objectives Notes Influences on Mental Health: Social Factors: o COVID-19 effects: Lack of socialization led to non-verbal behaviors, deterioration in mental health. o Pediatric impact: Children became detached but simultaneously more connected via technology. Discuss factors that Environmental Factors: impact the o Seasonal depression due to lack of sunlight. psychosocial concept. o Home life stressors, including food insecurity and unstable housing. Stress Level: o Individuals have unique stress thresholds and coping mechanisms. o Chronic stress can contribute to mental health deterioration. Medical Influences: o Thyroid Disorders: § Hypothyroid: fatigue, weight gain § Hyperthyroid: anxiety, palpitations Mental Health o A state of well-being where individuals can cope with stress, work productively, and contribute to their community. Delineate Mental Mental Illness Health from Mental o A condition that disrupts thinking, feeling, mood, ability to relate Illness to others, and daily functioning (NAMI definition). Concept of a Spectrum o Mental health and illness exist on a continuum rather than as distinct categories. Connection to physical health: Mental illness can impact sleep, appetite, energy levels, and immune function. Role of the Brain and Neurotransmitters: Neurological Basis of Mental Health: o Brain chemistry and neurotransmitters regulate mood, cognition, and behavior. o Imbalances in dopamine, serotonin, and norepinephrine can contribute to conditions like depression and anxiety. Endocrine System and Mental Health: o Thyroid Dysfunction: § Hypothyroidism: Fatigue, weight gain, depression. Hyperthyroidism: Anxiety, palpitations, restlessness  Role of the Brain & Neurotransmitters: o Reflect on neuroanatomy: Brain function influences mental well- being. o Neurotransmitter imbalances impact mood, cognition, and behavior. Analyze conceptual Maslow’s Hierarchy of Needs: connections. o Mental health influences and is influenced by basic needs (food, safety, love/belonging, self-esteem, self-actualization). o Unmet physiological and safety needs can contribute to stress and mental illness. Grief and Loss: Recognizing stages of grief (denial, anger, bargaining, depression, acceptance) is essential for providing support. Keep in Mind When Caring for Yourself and Others: o Mental and physical health are intertwined. Assessment & Safety: o Active listening and observation o Identifying psychosocial risks and needs Client-Centered Care: o Collaborating with clients and families o Developing individualized care plans Examine key roles of Self-Awareness in Nurse-Client Relationship: the Registered Nurse o Understanding personal biases o Maintaining professional boundaries Collaboration: o Integral in forming an optimal care plan with the healthcare team Professional/Legal/Ethical Considerations: o Adhering to HIPAA and maintaining patient confidentiality. o Ethical considerations: Informed consent, autonomy, and advocating for least restrictive interventions.  Mental health influences physical health: o Chronic stress impacts the immune system and increases disease risk. Verbalize the o Depression and anxiety contribute to cardiovascular disease. connections between Physical health influences mental health: mental and overall o Medical conditions (thyroid disorders, chronic pain) affect mental health. well-being. Holistic Nursing Approach: o Addressing both physical and psychosocial needs to provide comprehensive care. Addressing Stigma: o Promoting mental health awareness and normalizing discussions about mental illness. o Challenging misconceptions and stereotypes in healthcare and the community. Improving Mental Health Care: o Enhancing accessibility to mental health resources. o Integrating mental health care into primary care settings. o Encouraging self-care and resilience-building strategies for both patients and healthcare providers. Nursing Assessment: Focus on key psychosocial priorities. (11 Items – 22%) Objectives Notes Signs vs. Symptoms: o Signs: What the observer (MD, RN, etc.) sees o Symptoms: What the client reports Purpose of Mental Status Exam: o Assess changes in intellect, thought, mood, and affect o Evaluate progress vs. decline o Use a numeric scale (0-10) to assess mood and depression levels o Carefully integrate mental health questions into physical assessments General Assessment: Observe psychomotor movements (pacing, picking at Discuss key priorities of things in the air) the psychosocial nursing Note hygiene and cleanliness (avoid personal bias) assessment. Assess responsiveness to questions Emotion: Mood vs. Affect: o Mood = Patient’s self-report of emotional state o Affect = Emotional tone perceived by the observer Look for incongruency (e.g., patient reports sadness but is laughing) Types of Mood Deviations: o Dysphoric (irritable, depressed) o Euphoric (manic states) o Lability (rapid mood changes, seen in BPD) o Emotional incontinence (extreme variation, inappropriate expression) Experience & Perception: Hallucinations: False sensory perceptions without external stimuli o Types: Auditory, visual, tactile, olfactory, gustatory o Not always a sign of psychosis (e.g., hypnagogic hallucinations) Delusions: False beliefs despite objective proof otherwise  o Example: Believing one is the President of the U.S. Illusions: Misperceptions of real external stimuli Thinking: Do not correct patient’s beliefs; document objectively Assess speech patterns (rate, coherence, logical flow) Common thought disturbances: o Thought blocking: Sudden breaks in thought (seen in schizophrenia) o Flight of ideas: Rapid, disconnected thoughts (seen in mania) o Loosening of associations: Shifting between unrelated topics o Perseveration: Repetitive speech or behaviors Suicide Risk Assessment (Adapted from Columbia SSRS): o Have you wished you were dead or wished you could go to sleep and not wake up? o Have you actually had any thoughts of killing yourself? o Have you been thinking about how you might kill yourself? Integrate evidenced based o Have you had these thoughts and had some tools to screen clients at intention of acting on them? risk for safety issues o Have you started to work out or worked out the (Suicide, Violence) details of how to kill yourself? o Do you intend to carry out this plan? o Have you ever done anything, started to do anything, or prepared to do anything to end your life? o How long ago did you do any of these? Violence Risk Assessment: o Broset Violence Checklist as part of RN shift assessment o Observe signs of escalating agitation (shouting, pacing, clenched fists, threats)  Cultural and Linguistic Considerations: Examine how culture as Language barriers may impact patient expression and well as language can accurate assessment impact assessment. Stigma surrounding mental health varies across cultures Ensure culturally competent care and use interpreters when needed Impact of Adverse Childhood Events (ACEs): o Trauma affects coping, behaviors, and actions o Patients with past trauma may have heightened Discuss trauma informed stress responses nursing care Keys to Trauma-Informed Care: o Provide a non-shaming and welcoming environment o Use validated tools for assessment o Keep safety in mind at all times  Legal and Ethical Issues in Psychiatric Nursing (9 Items – 18%) Objectives Notes Legal and Ethical Considerations Nurse Practice Act: Defines the legal role of nurses in psychiatric care. Civil vs. Criminal Commitment: Discuss the o Civil Commitment: Legal process by which individuals Commitment with severe mental illness are court-ordered into Process treatment. o Criminal Commitment: When individuals with mental illness commit crimes and are placed in treatment rather than incarceration. Duty to Warn (Tarasoff Law): Requires mental health professionals to warn potential victims of a patient's credible threat of violence. HIPAA & Confidentiality: Patient information must remain confidential except when legally mandated to disclose (e.g., danger to self/others). Voluntary Commitment: Patient agrees to hospitalization and can request discharge unless deemed a danger. Example: Ralph, 53 years old, found threatening the public, voluntarily admitted instead of jail. Rights: o Right to refuse medication (unless deemed incompetent). o Right to participate in treatment decisions. Delineate between Voluntary Involuntary Commitment: & Involuntary commitments Patient is hospitalized without consent due to risk to self or others. Legal Justifications: o Psychiatric emergency. o Danger to self or others. o Grave disability (unable to meet basic needs). Levels of Involuntary Commitment: o Emergency hold (24-72 hours for evaluation). o Short-term commitment (court-ordered, usually 90 days, periodic review required). Ethical Considerations: Right to Least Restrictive Treatment: Patients should receive care with the least amount of restriction necessary. Right to Refuse Treatment: o If a patient refuses medication, notify the provider. o Document refusal and any manifestations requiring intervention. Explore nurses Coercion vs. Autonomy: decision making o Example of coercion: Hiding medication in applesauce process related to without patient consent. use of confinement o Ethical dilemma: Balancing safety and patient rights. and restraints Nurse's Role in Crisis Situations: Assessment and De-escalation: o Observe behavior changes (e.g., verbal outbursts, physical aggression). o Use verbal de-escalation techniques. o Offer medication voluntarily before considering restraint. Intervention Steps: 1. Get help and move the patient to a safer location. 2. Call security if needed and attempt de-escalation: § "Ralph, I’m worried about your safety. Can I offer you something? Do you need your medication?" 3. Seclusion or Restraint as Last Resort: § Requires provider order. § Seclusion: Confining the patient to a controlled environment to prevent harm. § Restraints: Physical or chemical methods used when the patient is a direct threat. Restraints and Seclusion Guidelines: Used only when other measures fail. Monitor patient safety: o Q15 min checks in psych units. o Minimum hourly assessment for circulation, breathing, and distress.  o Document all interventions taken before resorting to restraints. Professional Boundaries: Nurses should not engage in personal relationships with patients unless initiated by the patient. Commitment Issues and Legal Considerations: Competency vs. Incompetency: o Competent patients retain legal decision-making abilities. o Incompetent patients may require court-appointed guardians. Legal Charges Related to Psychiatric Care: o Failure to follow least restrictive measures. o Improper use of restraints. o Neglect or abuse. Hierarchy of Restrictions (Least to Most Restrictive): 1. Emotional or verbal restrictions 2. Inability to use money or control resources 3. Restricting what the client eats, smokes, etc. 4. Restriction of movement as it relates to space (seclusion, unit restrictions) 5. Restriction of body positioning/movement (seclusion or restraint use) Know Standards of Care: o Understand institutional protocols. o Follow legal and ethical guidelines. Teach the Patient: o Provide education with appropriate interpreters if needed. o Document all patient education provided. Follow-Up with Delegated Care: o Ensure interventions are completed. o Document care objectively. o Ensure follow-up is arranged. Recognize and Respond to Cues: o Assess patient behavior and intervene early. o Prevent escalation through timely interventions. Consistently Use All Steps of the Nursing Process: o Assess, diagnose, plan, implement, and evaluate care appropriately.  Anxiety Disorders (6 Items – 12%) A crisis occurs when an individual is exposed to a stressor (situational, financial, life transition, traumatic event) that Define a crisis? overwhelms their ability to cope. Anxiety increases, and if coping attempts fail, the situation escalates into a crisis. Example: Loss of a loved one leads to anxiety, which may snowball uncontrollably, causing physical symptoms like GI distress, palpitations, and difficulty breathing, culminating in an acute exacerbation (crisis). Crisis reactions are culturally bound. The goal in nursing is to assist the client with psychological solutions and return them to their pre-existing level of function. Assess: Identify stressors, assess anxiety level, recognize ineffective coping. Diagnose: Determine risk for crisis based on symptoms and history. Plan: Develop interventions focused on comfort, safety, and therapeutic environment. How does crisis relate to the Implement: Apply interventions such as medication nursing process? (benzodiazepines like diazepam), low-level oxygen therapy, a soothing voice, dimmed lighting, and active listening. Evaluate: Assess the patient’s response to interventions and modify as needed. Phases in the Development of a Crisis 1. Exposure to a stressor (situational, financial, life transition, traumatic event) leads to anxiety. 2. Anxiety Increases, and the individual attempts to cope. 3. Failure to Cope results in a crisis situation. Example: o Loss of a loved one → Anxiety increases → Inability to manage anxiety → Physiological symptoms (GI distress, palpitations, difficulty breathing) → Acute crisis.  Cultural Considerations: Reactions to stress vary across cultures. What is the (RN) response to Ensure patient safety and comfort. crisis? Provide a therapeutic environment. Utilize pharmacologic interventions if necessary (e.g., benzodiazepines for acute management). Encourage coping strategies and support. Use therapeutic communication techniques. Refer to counseling, therapy, or support groups if appropriate. Understand types of Anxiety Understand Types of Anxiety Disorders Anxiety is an disorders emotional process, while fear is a cognitive response to a perceived threat. Disorders arise when anxiety persists for 3-6 months and disrupts ADLs (work, school, eating, sleeping). Types of Anxiety Disorders: Generalized Anxiety Disorder (GAD) – Characterized by excessive worry and three or more symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance) lasting 3-6 months. Panic Attacks vs. Panic Disorder – Panic attacks are severe episodes of anxiety lasting 15-30 minutes, with symptoms like palpitations, tremors, SOB, chest pain, and nausea. Panic disorder involves recurrent panic attacks with no known trigger. Obsessive-Compulsive Disorder (OCD) – Persistent obsessions (thoughts) and compulsions (behaviors) that interfere with daily life. Post-Traumatic Stress Disorder (PTSD) – Triggered by trauma (military service, abuse, accidents, disasters), causing flashbacks, nightmares, anxiety, and substance use. Phobias – Intense, irrational fears that can impact lifestyle and behavior, leading to avoidance and social isolation. Nursing care of clients with Assessment: Identify the type and severity of anxiety disorders. anxiety disorder. Interventions: o Create a calming environment (dim lights, reduce stimulation). o Utilize behavioral techniques (positive reframing, cognitive behavioral therapy, exposure therapy, breathing exercises, distraction, assertiveness training). o Use pharmacologic management as needed: § First-line medications: SSRIs (Citalopram, Fluoxetine, Sertraline) – take 3-6 weeks for effect. § Acute pharmacologic management: Benzodiazepines (Lorazepam, Alprazolam, Clonazepam) – monitor for CNS depression and respiratory issues. § Other medications: Buspirone (long-term management), Propranolol (for physiological symptoms), Hydroxyzine and Diphenhydramine (for sedation and relaxation). o Avoid false reassurance; validate patient concerns. o Encourage psychotherapy and support groups (CBT, EMDR, group/milieu therapy). Additional Considerations in Anxiety Treatment Complications: o Serotonin Syndrome: Caused by excessive serotonin (SSRIs + MAOIs/St. John’s Wort); symptoms include high fever and severe muscle rigidity. o Hypertensive Crisis: MAOIs interact with tyramine-containing foods. o Orthostatic Hypotension: Tricyclic antidepressants (TCA) can cause falls and sedation. Combination Therapy is Best: o Cognitive and psychotherapy + medication provides the most effective treatment. o Lifestyle changes (exercise, meditation, smoking cessation) play a role in management.  Substance Use Disorder (5 items – 10%) -addiction is a brain disease: MRI imaging shows that the brain of an addict is different from a non-addict -concepts for addiction of substance: safety (are they getting clean needles, are they selling themselves or their children’s body to pay for the drug), homeostasis (withdrawal can cause life- threatening like seizures and uncomfortable), think about how we label people who have a substance-use problem because often times nobody addressed the root of their root, we don’t know if the problem is the substance or their mental illness), environment (family history like their mom is an alcoholic and then themselves are an addict too) Care of the client with substance related disorders -substance use is a national health problem -key: illegal substance is hard to know what’s inside it -substance use doesn’t dispose to one culture -Individuals die from overdose or chronic disorders derived from substance use Substance Related Disorders: What are potential KEYS to development -genetic link -environmental impact -friend groups -children in an alcoholic household are more likely to develop that -coexisting BPD, ptsd, major depression, may use substance initially to cope and may develop an addiction Substances commonly abused: -meth: stimulants; highly addictive, you can tell a meth user, they age immensely because of high, they don’t sleep, don’t eat, teeth rotten, lose weight -opioid: -coton: long term chronic pain; usually for cancer patient -codon: short acting acute pain relief -alcohol: short term and long term consequences -keep controlled substance with lock and key because children may experiment with that -Percocet (oxy + Tylenol) – don’t add more acetaminophen > liver failure -bath salts -computer cleaner -don’t be naïve, educate teenagers, be aware of short and long term effects since they’re unknown -mixing different pills, puffs, snort -airway problems, dysrhythmias Alcohol Withdrawal can begin within 4-36 hr after the last use of the substance -tremors, diaphoresis, n/v Severe withdrawal – delirium, tremors, frequent vs, thiamine deficiency > neuro complications, supplement thiamine -significant intake: people can die through alcohol poisoning and alcohol withdrawal -as a nurse, monitor intake of substances of both prescribed and non-prescribed, sometimes patients underreport, “ask about the substances for safety, I’m not going to report to the police this is about protecting your health -intoxicated: impaired -severe intoxication = can aspirate and die