Mental health- Able to cope with normal -Excitatory and Inhibatory

stresses of daily life and can work

productively. -Excitatory:

Mental illness- State of imbalance due to  Binds to NICOTINIC RECEPTOR

inability to cope up, characterized by  Skeletal muscle contraction;
thoughts, feelings, and behavior. Unable Increases
to function and stablish personal
relationships. memory

Optimum level of functioning- Doing -Inhibitory:

the best in the important areas of life
(mentally, emotionally, socially, and  Bind to MUSCARINIC RECEPTOR
physically).  Parasympathetic Stimulation

 Coping Mechanism -Increase Acetylcholine= Depression

 Defense Mehanism
-Decrease Acetylcholine= Manic
 Problem solving skills

___________________________________________
______ Serotonin
NEUROTRANMITTERS -Excitatory
___________________________________________ -Happy hormone
______
-Increased= Manic
Dopamine
-Decreased= Depression
-Excitatory

-Reward and pleasure

Norepiniphrine
-Movement initiation and control
-Excitatory (both found in CNS and PNS)
-Increase dopamine = Schizophrenia/
Manic -PNS: Triggers fight or flight response
-Decrease dopamine = Parkinson's/ -CNS: Improves alertness
Depression -Increased= Anxiety/ Manic

-Decreased= Depression
Gamma- Aminobutyric Acid (GABA)

-Inhibitory ___________________________________________
______
-For calming brain activities
SUBSTANCE- RELATED DISORDER
-Increase GABA = Depression
___________________________________________
-Decrease GABA= Anxiety; Manic ______

Acetylcholine Alcohol Use Disorder

-Chronic disease (6 months or more) 3. Thiamine (Vit B1): To prevent Wernick's

characterized by: Encephalopathy

 Compulsive alcohol use 4. IV Dextrose: To prevent hypoglycemia

 Loss of control over intake
 Negative emotional state when not
using
 Physical and Psychological + Karsacoff Syndrome +
dependence on alcohol
-Alcohol-induced memory loss

Behavioral problems: -Vit B1 and B12 deficeincy

 Denial
 Demanding
+ Wernicke's Encelopathy +
 Destructive
 Domineering -Confusion; Ataxia: Eye movement issues

-Vit B1 deficiency
Complications:

+ Alcohol Withdrawal + Management

- Due to norepinephrine rebound Long term management:
- Phase: 1. Aversion therapy
Early signs (6-12 hours from the last - Behavioral therapy
intake) - DOC: Disulfiram (antabuse)
 Tremors
 Nausea and vomiting - MOA: Removes liver's ability to detoxify
 Sweating
 Tachycardia alcohol

Seizure Phase (12-48 hrs from last intake) - Once alcohol is consumend:

Delirium Tremens (48-72 hrs from last  Severe N/V

intake)  Palpitation
 Hypotension, tachycardia,
 Hallucination tachypnea
 Disorientation  Chest pain
 Severe seizure  Elation
 Hypertension  Flu-like symptoms
 May lead to DEATH
-Avoid alcohol- based products:

Medication Management:  Mouthwash

 Facial wash
1. Chlordiazepaxodie (librium): Antianxiety  Hand sanitizer
med, decrease norepi level

2. Lorazepam/ Diazepam: Benzodiazepine 2. Rehabilitation

(antiseizure med) -Group therapy
-Common group: Alcoholic Anonymous  Cardiac problems
 Agitation
-Purpose: Acceptance and develop coping  Insomia
 No appetite
mecahism
-Classic sign: PERFORATED NASAL SEPTUM

2. Cannabis Addiction

-Marijuana: Hallucinogen
___________________________________________
______ -Route: Oral/ Smoke

DRUG RELATED DISORDER -Onset: 15 minutes

___________________________________________ -Duration: 2-4 hours

______
-Classic sign: Bloodshot Eyes
Common substance used:
-SIgns of use: HYPERACTIVE BEHAVIOR

Uppers
3. Opiod Addiction
-Methamphetamine (shabo)
-Prescription: Morphine, Hydrocodone,
-Hallucinogens (Cannabis Sativa), Marijuna
Fentanyl
-Cocaine
-Illegal: Heroin
-Ectasy
-Fast acting relaxant

-Route: Oral/ IV/ Snort/ Smoke

Downers
-Downers: Risk for respiratory depression
-Alcohol
-Antidote: Naloxone (Narcan)
-Barbiturates (makapressure ulcer kay tug
ka

pirmi) ___________________________________________
______
-Heroin
ALZHIMER'S DISEASE
-Opiods
___________________________________________
______

1. Cocain Addiction

-White powder substance -AKA: Senile Dementia

-S/S: -Progressive, irreversible

neurodegenerative
 Cocaine psychosis
 Obvious dilatation of pupils
disorder that causes memory loss, -clutter free environment
cognitive
-install grab bars and low bed height
decline, and behavioral changes

-Exact cause is unknown

2. Promote communication
 Plaques and tangles in the brain
 Decrease acetylcholine -speak slowly and clearly

-use simple words

Early Stage -avoid open-ended question (offer direct

- Forgetfulness limited choices)

-Difficulty with complex task

-Misplacing objects 3. Provide structured routine

-keep consistent daily schedule

Middle Stage -consistent personnel and activities

-Alteration of Activities of Daily Living -calendars and clock must be in the room

-Anterogade Amnesia (difficulty retaining

new information) 4. Medication: Cholinesterase Inhibitors

-Apraxia (inability to practice motor task) -Donepezil (Aricept)

-Agnosia (inability to recognize object) -Rivastigmine (Exelon)

-Aphasia (inability to communicate

effectively)
___________________________________________
-Sundown Syndrome (confusion at night) ______

-Wandering (aimless walking that may ANXIETY DISORDER

lead ___________________________________________
______
to getting loss)
-Characterized by worry, or fear about

situations that are perceived as

Late Stage (terminal) threatening

-Severe forgetfulness and confusion or uncertain

- Requires full time care

Mild Anxiety

MANAGEMENT -Normal and helpful

1. Safety and security -Cognitive sign: Sharpens focus and

-use bed alarms promotes learning

-Physical sign: -Physical sign:

+Slight Increase V/S +Tachycardia and shortness of breath

+Pupillary dilatation +Dizziness, nausea

+Increase alertness +Chest pain, feeling of choking

-Emotional sign: Motivated behavior +Difficulty thinking clearly

-Management: -Emotional signs: Helplessness

+No intervention needed -Management

+Encourage learning and planning +Stay with the patient

+Use calm, reassuring voice

Moderate Anxiety +Reduce environmental stimuli

-Still manageable, but affects +Do not teach new information

concentration

-Cognitive sign: Can focus at task but

easily Panic Anxiety

distracted -Emergency level

-Physical sign: -Cognitive sign: Inability to focus on

anything
+Increase V/S
-Physical signs:
+Muscle tightness
+Inability t communicate
+Sweating
+May scream, run, or freeze
+Narrowed attention span
+Hallucinations
-Emotional sign: Feelings of nervousness
-Emotional sign: Senses of losing control
-Management:
-Management:
+Use short, simple sentences
+Stay with the patient
+Encourage expression of feelings
+Use firm, short, simple phrases
+Teach relaxation technique
+Don't touch unless necessarry

+Remove from stimuli

Severe Anxiety
+Fast acting anxiolytics
-Disrupts daily function

-Cognitive signs: Greatly reduced

perceptive ANXIOLYTICS/ MINOR TRANQUILIZERS

ability -Desered effect: Decrease anxiety

-Problem in anxiety: Increase Norepi, Lorazepam
(ativan)
Decreased GABA

-Classification:
Nursing Management:

1. Best taken before meals (only psyche

Benzodiazipin Non- drug
e
Benzodiazipi taken before meals)
ne
2. Monitor V/S

3. No driving/ operating heavy equipment

Chemical Decrease Dec. Norepi
4. Watch out for: Repiratory Depression
effect Norepi, only
5. Dont stop abruptly; Taper dose
Increase
6. Administer SEPARATELY with other
GABA drugs

Indication Emergency Maintenance ________________________________________

Drug SOMATOFORM DISORDER

________________________________________

Advantage Fast acting Slow acting -Unintentionally experiences physical

Non- symptoms without an organic (medical)

sedative
cause.

-Symptoms represent:
Disadvata Addictive Longer
ge +Unconcious conflict
Sedative Drowsiness
+Stress
Risk for
+Anxiety
withdrawal

Types
Examples Chlordiazepox Buspirone
ide (Librium) Hypochondriasis
Alpidem
Alpraazolam -AKA: Illness anxiety Disorder
(Xanax) Meprobamat
e -Preoccupation with fear of having a
Diazepam serious
(Valium)
illness DESPITE ASSURANCE
Oxazepam
(serax) -Manifestations:
 +Keeps seeking 2nd opinion (doctor 4. Promote coping (stress management;

hopping) relaxation tecjniques)

+Misinterpretation of normal sensation 5. Medication: Antidepressant/ Anxiolytics

+Excessive health- related behaviors

_________________________________________

Body Dysmorphic Disorder FACTITIOUS DISORDER

-Preoccupation with imagined defect in _________________________________________

appearance -Mentally condition wherein a person

intentionally produces symptoms without
-Anxiety relief: ASSURANCE secondary gain

-Manifestation: -Primary gain = Relief from anxiety

+Excessive mirror checking -Secondary gain= Reward

+Frequent cosmetic consultation -Patient reasoning: To assume sick role

and gain attention

-Manifestation:
Conversion Disorder
+Lie about symptoms
- Channelng of an anxious feeling to
symbolic +Manipulates tests

physical symptoms +Induce illness

- Symptoms occur after exposure to

severe
Munchausen Syndrome
stress
-Individual frabricates illness in
-Hallmark sign: La Belle Indifference themselves
(patient
Munchausen Syndrome By Proxy
does not feel concern about the
symptoms) -Caregiver makes another person sick

-Considered as abuse

Management:

1. Build trust and therapeutc relationship Common interchanged with:

2. Acknowledge patient's behavior Malingering

3. Do not make statement that can -Intentionally producing symptoms to have

reinforce secondary gain

physical symptoms (focus on feeling; not

on
Management:
symptoms)
1. Establish therapeutic, non judgemental Super Ego
relationship
-Moral principle
+Avoid direct confrontation (may
become defensive) -Conscience

+Focus on feelings; not the symptom Ego

2. Maintain safety -Reality principle

+Monitor fro self harm; harm ro others -Tries to meet the ID's Need in socially
acceptable ways
3. Avoid reinforcing sick roles

4. Medication: Anxiolytics
___________________________________________
5. Report for possible abuse ______

MAJOR DEPRESSIVE DISORDER

___________________________________________ ___________________________________________
______ ______

MOOD AND AFFECT DISORDER -Persistent feeling of sadness

___________________________________________ -Atleast 2 weeks + Impaired ADL

______
-Hallmark: ANHEDONIA (inability to feel
Theories of Cause pleasure)

MANIA DEPRESSION -Defense mechanism: Introjection

(blaming yourself)
Ne Increase Decrease norepi.,
ur norepi., decrease serotonin -Clinical manifestation:
oc increase
he serotonin +Fatigue
mi
+Anorexia
cal
+Insomia/ Hypersomnia
Ps 1. Increased 1. Increased Super Ego
yc ID +Loss of energy
hol
ogi +Sad feelings/ Suicidal ideation
cal

2. Defense 2. Sense of loss

Mechanism

Nursing Management:

Side note!! 1. Establish therapeutic rapport

ID 2. Encourage verbalization

-Operates PLEASURE principle 3. Promote physical activity as tolerated

-Wants immidiete satisfaction 4. Positive feedback

5. Offer small, frequent feeding -Desired effect: Improve depression
symptoms
6. Promote safety for suicidal ideation
-There should be at least 2 weeks interval
7. WOF: Sudden increase in energy when shifting from one antidepressant to
another.
8. Antidepressant medication
-Never mix 2 antidepressant= Serotonin
9. Electroconvulsant therapy- Resets brain Syndrome (manic)
+Inflicting electrical current to
patient's brain
1. SSRI- First line treatment
+Indicator of effectivesness: Seizure
Effect: Increases serotonin level
+Length: 0.5- 8.0
Side effect:
+Frequency: every 6-12 months
+Decreases clotting ability
+C/I: ICP, fracture, cardiac condition,
pregnant +Sexual dysfunction

+Secure informed consent +GI upset

+NPO 6 hours before procedure Example: (-tine; -pram)

+Dx procedures: Xray, ECG, EEG +(Prozac) Fluoxetine

+Empty the bladder +(Celaxa) Citalopram

+Pre procedural drugs: +(Zoloft) Sertraline

-Atropine: TO reduce oral secretion +(Luvox) Fluvoxamine

-Anectine: Muscle relaxant to +(Paxil) Paroxetine

prevent injury from seizure
-LAG period: 2-4 weeks
+During procedure:

-Client is under general anesthesia

Nursing Management:
-Oxgen administration
1. Never give to pregnant/ lactating
-Ensure safety mother

-Suction equipment at bedside 2. Give in the morning: After meals

+After procedure 3. Avoid:

-Secure airway (priority) +Benzodiazepine

-Sunction secretion +Alcohol

-Reorient the client +Tryptophan: It will be absorbed as

serotonin (Chicken, egg, cheese, fish,
nuts)
ANTIDRESSANT +May lead to serotonin syndrome
 Example:

2. Trycyclic Antidepressant (TCA) - +(PArnate) Tranylcypromine

Second line
+(NArdil) Phenelzine
Only antidepressant without diet
restriction +(MArplan) Isocarboxazid

Effect: Increases norepi. and serotonin

Suffix (-triptylline; -pramine) Nursing Management:

Example: "Pam, Ela, Ana love tofu" 1. Effectivity (2-3 weeks)

+(PAMelor) Nortriptyline 2. Best taken after meals

+(ELAvil) Amitriptyline 3. Avoid TYRAMINE- rich foods (avocado,

banana, aged cheese, soy, preserve foods)
+(ANAfranil) Clomipramine
4. Monitor BP= Risk for hypertensive crisis
+(TOFranil) Imipramine

Nursing Management:

1. Effectivity After 2-3 weeks

2. After meals

3. I and o monitoring

___________________________________________
______
3. Mono-Amine Oxidase Inhibitor
(MAOI)- Third line MANIC DISORDER
Effect: Inc. Norepi., serotonin, dopamine
___________________________________________ -Lithium citrate (cibalith)
______
-Lithium carbonate (Eskalith, litobid,
Elation of more than 7 days + Impaired lithane)
ADL
-Lithium = Electrolyte who will eat sodium
Hallmark: Flight of ideas
-Normal range: 0.6-1.2 mEq/dl
Defense mechanism: Projection
-Therapeutic range: 1.0-1.5 mEq/L
Manifestation:
-Toxic range: >1.5 mEq/L
+Flight of ideas
-Effectivity onset: 10-14 days
+Insomnia

+Distractibility/ demanding
Management:
+Grandiosity
1. Neevr give to pregnant mother
+Energetic (teratogenic)

+Talkative/ Manipulative 2. Best intake: After meals

3. Increase intake of fluid to prevent

toxicity
Nursing Management:
4. Increase sodium (2-3 grams/day)
1. Priority safety and low stimulation
environment 5. Avoid activities that increases
perspiration
2. Set limits on inappropriate behavior
6. Monitr lithium blood levels:
3. Nutrition:
-Timing 12 hours after the last dose
+Finger foods (High in calories, protein,
carbs) -Initially: Every 2-3 days untls
therapeutic level is reached
+Fries, sandwith, biscuit, MILKSHAKE
-Maintenance: every month
4. Activity: Non-competitive (Therapeutic
use of self) 7. WOF signs of toxicity:

+Gardening, delivery of linens, cleaning -Vomitting

+Physical/ motor activities -Anorexia

5. For sleep problem: Warm bath and -Diarrhea

warm milk
-Abdominal cramps
6. Relaxation: Simple painting with guided
numbers -Lethargy (late sign)

Pharmacologic Management: MOOD 8. If toxicity occurs:

STABILIZER
-Hold the next dose the report AP
-To control mania
-Get latest lithium level
Examples:
 -Dialysis as ordered +Delusion

+Insomia

___________________________________________ +Looseness of association

_____
+Ecolalia
SCHIZOPRENIA
+Echopraxia
___________________________________________
______

Theory of cause: Negative Symptoms

-Imbalance dopamine in different brain - Due to decrease dopamine level to

areas mesocortical

☆ Increase dopamine in the -Symptoms that causes a patient to be

mesolimbic pathway non-responding

☆ Decrease dopamine in the +Anhedonia

Mesocortical Pathway
+Alogia
Mesolimbic Mesocortical
+Asocial

Controls pleasure Controls thinking +Avolition (lack ofmotivation)

Regulates emotion Supports judgement +Anergia (lack of energy)

+Affect (flat)
-Unable to cope with life stressors
+Apraxia
-Lack of caregiver
+Waxy flexibility
-OB complication

-Living in Urban (City Living)

Defense mechanism: REGRESSION
-Drug abuse
Nursing Management:
-Head injury
1. Establish trust and rapport

2. Safety precaution
S/S:
3. Symptoms management
-At least 2 or more for 6 months +
impaired ADL 4. Antipsychotic medication
Positive Symptoms- Due to increase
dopamine level in mesolimbic area
Anti Psychotic Medication
Symptopms that causes a patient to be
active: Indication: Schizoprenia and other
psychosis
+Hallucination
Best taken: AFTER MEALS
+Illusion
Classification: +Tachycardia, constipation, urine
retention: monitor and report

+Photosensitivity: Dont expose skin to

Typical Atypical sunlight

Chemical Bloocks Balances

effect dopamine dopamine in
receptor the brain (for Adverse effects:
(pababaon positive and
Extrapyramidal symptoms (EPS)
dopamine) negative
symptoms) -When dopamine is decreased,
acetylcholine increases
Advantage Cheaper Lesser or No
EPS +Pseudoparkinsinsm
More
availabe For both -Pill rolling/ resting tremors
positive and
negative -Muscle ridgidity
symptoms
-Gait problems
Disadvantage Prone for EPS Expensive
+Akathisia
Treats only Less
positive available -Irresistible urge to move
symptoms
Prone for: +Dystonia
Agranulocyto
sis -Involuntary muscle contractions that
Example Haloperidol causes slow repretitive movements:
(Haldol) Torticollis- neck, oculogyric crisis- eyes,
writers clamp- hand fatigues, laryngeal
Thioridazine Risperidone spasm, opisthotonus- archinf og the
(melaril) (Risperdal) back
Chlorpromazi Quetiapine +Tardive Dyskinesia
ne (seroquel)
(Thorazine) -Lip smacking
Clozapine
(clorazil)

Olanzapine Management:
(zyprexa)
1. Hold drug

2. Giive Benztropine (Cogentin)

Side effects:
-Anticholinergic
-Blocks muscarinic receptor=
Anticholinergic side effect -Decreases acetylcholine; Increases
dopamine
+Blurred vision: due to dryness of eyes,
give artificial tears; avoid driving 3. Report to the Physician

+Xerostomia: Give sugarless gum to

promote salivation
+Neurolyptic Malignant Syndrome
 -Muscle rigidity + High grade fever +
Increase BP

Nursing Management:

1.Withhold medication and notify the

doctor

2.Cooling measures (Tepid Sponge Bath;

Antipyretic

+AGRANULOCYTOSIS

- Decrease WBC level = Risk for infection