Nursing

Major Depressive Disorder (MDD) Schizophrenia

Intervention
Assess for psychotic symptoms,
Assess for mood, affect, suicidal ideation,
Assessment including delusions, hallucinations
and level of energy.
, and disorganized speech.
Ensure patient safety by preventing
Monitor for suicidal ideation and
harm
Patient Safety ensure environmental safety to prevent
from delusions or hallucinations (e
harm.
.g., protective environment).
Use clear and simple
Therapeutic
Use active listening, offer validation, and communication, avoid arguing
Communicati
avoid minimizing the patient's experience. with delusions, and provide a calm,
on
non-judgmental approach.
Administer antipsychotics (e.g., sec
Medication Administer antidepressants (e.g., SSRIs, S
ond-generation antipsychotics)
Administratio NRIs) as prescribed, and monitor for side
and monitor for side effects (e.g.,
n effects.
EPS).
Cognitive Encourage therapy (e.g., cognitive-
Behavioral Encourage CBT to help the patient identify behavioral therapy), but be
Therapy and change negative thinking patterns. mindful of the patient's cognitive
(CBT) deficits.
Encourage physical activity and Encourage structured routines to
Activity and
engagement in structured activities to reduce anxiety and help the patient
Engagement
improve mood. focus on goal-oriented activities.
Educate family
Educate family members about depression, about schizophrenia, its
Family
symptoms, and the importance symptoms, medication adherence,
Education
of supportand therapy adherence. and how to manage symptoms at
home.
Educate the patient and family
about the importance
Psychiatric Educate the patient and family about the
of antipsychotic medications and
Medications role of medications in managing depression
their potential side
Education and possible side effects.
effects (e.g., weight
gain, sedation).
Monitor for extrapyramidal
Monitoring Monitor for serotonin syndrome (in symptoms (EPS), neuroleptic
for Side SSRIs), sedation, weight gain, and other malignant syndrome,
Effects side effects of antidepressants. and metabolic side effects of
antipsychotics.
Encourage social skills
Encouraging Encourage participation in support
training, family therapy,
Social groupsand fostering relationships with
and community-based support to
Support supportive family and friends.
improve social functioning.
Nutrition and Encourage a balanced diet to promote Ensure adequate nutrition and
 Nursing
Major Depressive Disorder (MDD) Schizophrenia
Intervention
hydration, as antipsychotics can
Hydration physical and emotional well-being.
cause weight gain and dry mouth.
Promote regular sleep routines and
Educate on healthy sleep habits and the
educate on techniques to
Sleep Hygiene importance of regular rest to manage
manage sleep disturbances due to
symptoms of depression.
psychosis or medication.
Be prepared to intervene
Develop a crisis intervention plan in case
Crisis during psychotic crises (e.g., when
of worsening symptoms or suicidal
Intervention the patient is unable to distinguish
thoughts.
reality).

1. Mental Health Disorders

 Mood Disorders:
o Major Depressive Disorder (MDD): Symptoms include prolonged sadness,
anhedonia, weight changes, suicidal thoughts.
o Bipolar Disorder: Alternating periods of mania (elevated mood, grandiosity) and
depression.
o Cyclothymic Disorder: Chronic mood swings not severe enough for full manic or
depressive episodes.
 Anxiety Disorders:
o Generalized Anxiety Disorder (GAD): Excessive worry, restlessness, muscle
tension.
o Panic Disorder: Sudden attacks of intense fear or discomfort.
o Phobias: Specific (e.g., heights, animals) or social phobia (social situations).
 Obsessive-Compulsive Disorder (OCD): Recurrent, persistent thoughts (obsessions)
and repetitive behaviors (compulsions).
 Post-Traumatic Stress Disorder (PTSD): Intrusive memories, avoidance, negative
mood, hyperarousal after a traumatic event.
 Psychotic Disorders:
o Schizophrenia: Delusions, hallucinations, disorganized speech/behavior, negative
symptoms (e.g., lack of motivation, flattened affect).
o Schizoaffective Disorder: Symptoms of schizophrenia + mood disorder.
 Neurocognitive Disorders:
o Dementia: Gradual cognitive decline (e.g., Alzheimer’s disease).
o Delirium: Acute confusional state, often reversible.

2. Suicide Risk and Prevention

 Risk factors: History of depression, substance abuse, previous attempts, chronic illness,
family history.
  Warning signs: Verbal statements (e.g., "I want to die"), withdrawal, giving away
possessions.
 Interventions: Establish rapport, ensure safety, stay with the patient, create a safety plan.

3. Medications in Psychiatry

 Antidepressants:
o SSRIs (e.g., fluoxetine, sertraline): First-line treatment for depression, anxiety.
o SNRIs (e.g., venlafaxine, duloxetine): For depression and anxiety.
o TCA (e.g., amitriptyline): Older class, more side effects, used for depression and
neuropathic pain.
o MAOIs (e.g., phenelzine): Used for resistant depression; requires dietary
restrictions (avoid tyramine).
 Antipsychotics:
o Atypical Antipsychotics (e.g., risperidone, olanzapine): First-line for
schizophrenia, fewer extrapyramidal side effects.
o Typical Antipsychotics (e.g., haloperidol, chlorpromazine): Used in acute
psychosis, higher risk of extrapyramidal symptoms (EPS).
o NMS (Neuroleptic Malignant Syndrome): Rare, but life-threatening side effect
(fever, rigidity, altered mental status, autonomic dysfunction).
 Mood Stabilizers:
o Lithium: Used for bipolar disorder, requires regular blood monitoring (toxicity
signs: tremor, confusion, ataxia).
o Anticonvulsants (e.g., valproate, lamotrigine): Used for bipolar disorder,
especially in rapid cycling.
 Anxiolytics:
o Benzodiazepines (e.g., diazepam, lorazepam): Short-term treatment for anxiety,
risk of dependence.
o Buspirone: Non-habit-forming anxiolytic for GAD.

4. Therapeutic Approaches

 Cognitive Behavioral Therapy (CBT): Focuses on changing negative thought patterns.

 Dialectical Behavior Therapy (DBT): Developed for borderline personality disorder,
emphasizes emotional regulation, distress tolerance, interpersonal effectiveness.
 Group Therapy: Helps with social skills, interpersonal issues, and support.
 Electroconvulsive Therapy (ECT): Used for severe depression, especially when other
treatments fail.

5. Personality Disorders

 Cluster A (Odd/Eccentric):
o Paranoid Personality Disorder: Distrust, suspicion.
o Schizoid Personality Disorder: Detachment from social relationships, limited
emotional expression.
o Schizotypal Personality Disorder: Social anxiety, odd beliefs.
  Cluster B (Dramatic/Emotional):
o Antisocial Personality Disorder: Disregard for others' rights, often associated
with criminal behavior.
o Borderline Personality Disorder: Instability in relationships, self-image,
impulsivity, often accompanied by self-harm.
o Histrionic Personality Disorder: Excessive emotionality, attention-seeking.
o Narcissistic Personality Disorder: Grandiosity, need for admiration, lack of
empathy.
 Cluster C (Anxious/Fearful):
o Avoidant Personality Disorder: Social inhibition, feelings of inadequacy.
o Dependent Personality Disorder: Submissive, need for reassurance.
o Obsessive-Compulsive Personality Disorder: Preoccupation with orderliness,
perfectionism.

6. Substance Use and Addictive Disorders

 Alcohol Use Disorder: Symptoms include craving, tolerance, withdrawal, and continued
use despite negative consequences.
o Detox and medications (e.g., disulfiram, naltrexone).
 Opioid Use Disorder: Treatment with methadone or buprenorphine, naloxone for
overdose.
 Caffeine, Nicotine, and Marijuana: Can lead to dependence; withdrawal symptoms
vary.
 Other Addictions: Gambling, internet gaming disorder.

7. Child and Adolescent Psychiatry

 Autism Spectrum Disorder (ASD): Persistent deficits in social communication and

restricted/repetitive behaviors.
 Attention-Deficit/Hyperactivity Disorder (ADHD): Inattention, hyperactivity,
impulsivity; treatment with stimulants (e.g., methylphenidate).
 Oppositional Defiant Disorder (ODD): Pattern of angry/irritable mood, argumentative
behavior.
 Conduct Disorder: Aggressive behavior, violation of rules and others’ rights.

8. Legal and Ethical Issues in Psychiatry

 Informed Consent: Ensuring the patient understands treatment and risks.

 Confidentiality: Legal and ethical responsibility to protect patient privacy.
 Involuntary Admission: Criteria for involuntary admission and treatment, usually based
on risk to self or others.

Key Nursing Interventions:

 Building rapport: Establish trust, be empathetic, nonjudgmental.

 Safety: Always ensure patient safety, especially in suicidal or psychotic states.
  Medication Adherence: Educate patients on medication side effects and importance of
adherence.
 Crisis Intervention: Immediate support during acute psychiatric crises, such as
psychosis or suicidal ideation.

1. Antidepressants

 SSRIs (Selective Serotonin Reuptake Inhibitors)

o Examples: Fluoxetine (Prozac), Sertraline (Zoloft), Escitalopram (Lexapro)
o Important Notes:
 First-line treatment for depression and anxiety.
 Takes 2–4 weeks to see therapeutic effects.
 Can cause sexual dysfunction, insomnia, and weight changes.
 Risk of Serotonin Syndrome (e.g., agitation, confusion, fever, tremor)
when combined with other serotonergic agents.
o Nursing Interventions:
 Monitor for suicidal ideation, especially in young adults.
 Educate the patient about potential side effects and the time needed for
therapeutic effects.
 Advise the patient to avoid alcohol.
 Assess for signs of serotonin syndrome.
 SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)
o Examples: Venlafaxine (Effexor), Duloxetine (Cymbalta)
o Important Notes:
 Effective for both depression and anxiety.
 Can raise blood pressure, particularly at higher doses.
 Discontinuation syndrome if stopped abruptly (e.g., dizziness, nausea).
o Nursing Interventions:
 Monitor blood pressure regularly.
 Taper the dose gradually when discontinuing.
 Educate on avoiding abrupt discontinuation.
 TCAs (Tricyclic Antidepressants)
o Examples: Amitriptyline, Imipramine
o Important Notes:
 Older class, used for depression, anxiety, and chronic pain.
 High risk of overdose (cardiac arrhythmias).
 Anticholinergic effects (dry mouth, constipation, blurred vision, urinary
retention).
o Nursing Interventions:
 Monitor ECG in patients with a history of heart problems.
 Educate on managing anticholinergic effects (e.g., sucking sugar-free
lozenges).
 Caution with the elderly due to increased risk of side effects.
 MAOIs (Monoamine Oxidase Inhibitors)
 o Examples: Phenelzine (Nardil), Tranylcypromine (Parnate)
o Important Notes:
 Reserved for treatment-resistant depression.
 Requires strict dietary restrictions (avoid tyramine-rich foods, e.g., aged
cheese, cured meats) to prevent hypertensive crisis.
o Nursing Interventions:
 Educate the patient on dietary restrictions.
 Monitor for signs of hypertensive crisis (severe headache, high blood
pressure, chest pain).
 Monitor for dizziness and hypotension.

2. Antipsychotics

 Atypical Antipsychotics
o Examples: Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel)
o Important Notes:
 First-line treatment for schizophrenia and bipolar disorder.
 Risk of metabolic syndrome (weight gain, hyperlipidemia, diabetes).
 Lower risk of extrapyramidal side effects (EPS) compared to typical
antipsychotics.
o Nursing Interventions:
 Monitor weight, blood glucose, and lipid levels regularly.
 Educate about lifestyle changes to manage weight gain (exercise, healthy
eating).
 Assess for signs of EPS (e.g., tremors, rigidity, restlessness).
 Typical Antipsychotics
o Examples: Haloperidol (Haldol), Chlorpromazine (Thorazine)
o Important Notes:
 Used in acute psychosis and agitation.
 Higher risk of EPS and tardive dyskinesia (involuntary movements,
particularly in the face and mouth).
o Nursing Interventions:
 Monitor for EPS and tardive dyskinesia.
 Administer anticholinergic drugs (e.g., benztropine) as ordered to manage
EPS.
 Encourage adherence to prescribed dose to avoid relapse.
 Neuroleptic Malignant Syndrome (NMS) (side effect of antipsychotics)
o Symptoms: High fever, muscle rigidity, altered mental status, autonomic
dysregulation (e.g., tachycardia, labile blood pressure).
o Nursing Interventions:
 Immediate discontinuation of antipsychotic medication.
 Provide supportive care (hydration, cooling measures, monitoring vitals).
 Administer medications to treat symptoms (e.g., dantrolene for muscle
rigidity).

3. Mood Stabilizers
  Lithium
o Important Notes:
 Used for bipolar disorder (manic episodes).
 Requires regular blood level monitoring (therapeutic range: 0.6–1.2
mEq/L).
 Toxicity can occur if levels exceed 1.5 mEq/L (signs: tremor, confusion,
ataxia).
o Nursing Interventions:
 Monitor serum lithium levels regularly (especially after changes in
dosage).
 Maintain consistent fluid intake (dehydration can increase lithium levels).
 Educate patients about early signs of toxicity (e.g., tremors, vomiting,
diarrhea).
 Avoid NSAIDs (e.g., ibuprofen) which can increase lithium levels.
 Anticonvulsants (e.g., Valproate, Lamotrigine)
o Important Notes:
 Used for mood stabilization in bipolar disorder.
 Valproate is hepatotoxic and requires liver function tests.
 Lamotrigine can cause life-threatening rash (Stevens-Johnson Syndrome)
in some patients.
o Nursing Interventions:
 Monitor liver function tests regularly for valproate.
 Educate about the importance of reporting any rashes immediately (for
lamotrigine).
 Assess for signs of valproate toxicity (e.g., sedation, tremor, confusion).

4. Anxiolytics

 Benzodiazepines
o Examples: Diazepam (Valium), Lorazepam (Ativan), Clonazepam (Klonopin)
o Important Notes:
 Short-term use for anxiety, panic attacks, and insomnia.
 Risk of dependency, tolerance, and withdrawal symptoms.
 Can cause sedation, dizziness, and impaired coordination.
o Nursing Interventions:
 Limit use to short-term (2–4 weeks) to avoid dependence.
 Educate the patient not to mix with alcohol or other CNS depressants.
 Monitor for signs of overdose (e.g., drowsiness, confusion, respiratory
depression).
 Buspirone
o Important Notes:
 Non-habit forming medication for Generalized Anxiety Disorder (GAD).
 Takes 2–4 weeks to achieve therapeutic effects.
 No sedative effects or risk for dependence.
o Nursing Interventions:
 Educate the patient that it takes time to work.
  Monitor for side effects such as dizziness, nausea, or headache.

5. Other Medications in Psychiatry

 Cognitive Enhancers
o Example: Donepezil (Aricept), Rivastigmine (Exelon)
o Used for: Alzheimer’s disease and other dementias.
o Important Notes:
 May help improve cognitive function or delay worsening symptoms.
 Side effects: Nausea, diarrhea, bradycardia.
o Nursing Interventions:
 Monitor for gastrointestinal side effects.
 Assess heart rate regularly.

General Nursing Interventions Across All Psychiatric Medications:

 Assess for side effects, adverse reactions, and therapeutic response.

 Educate patients and families about the medication regimen, potential side effects, and
the importance of adherence.
 Monitor for signs of medication toxicity (especially with mood stabilizers like lithium).
 Provide safety measures to prevent accidents (e.g., from sedation or dizziness).
 Support patients emotionally during treatment, especially for chronic conditions like
schizophrenia or bipolar disorder.
 Encourage regular follow-up visits for ongoing monitoring of medication effectiveness
and side effects.

Anxiety Disorders

 Generalized Anxiety Disorder (GAD):

o Excessive worry about multiple aspects of life (e.g., work, health, family).
o Symptoms include restlessness, fatigue, difficulty concentrating, muscle tension,
and sleep disturbance.
 Panic Disorder:
o Recurrent, unexpected panic attacks (e.g., rapid heart rate, sweating, chest pain,
dizziness).
 Medications:
o SSRIs (Fluoxetine, Sertraline)
o SNRIs (Venlafaxine)
o Benzodiazepines (Alprazolam, Lorazepam) for short-term relief.
o Buspirone (non-habit forming anxiolytic).
 Nursing Interventions:
o Therapeutic Communication: Encourage the patient to talk about their anxiety
and fears. Use calming techniques.
 o Monitor for Overuse of Benzodiazepines: Use them sparingly, as they can be
habit-forming.
o Relaxation Techniques: Teach deep breathing exercises, progressive muscle
relaxation, and grounding techniques.
o Cognitive Behavioral Therapy (CBT): Support the patient in engaging in CBT
to challenge and reframe irrational thoughts.

5. Obsessive-Compulsive Disorder (OCD)

 Symptoms:
o Obsessions: Recurrent, intrusive thoughts or urges (e.g., fear of contamination).
o Compulsions: Repetitive behaviors or mental acts (e.g., washing, checking)
performed to reduce anxiety caused by obsessions.
 Medications:
o SSRIs (Fluoxetine, Sertraline)
o Clomipramine (TCA)
 Nursing Interventions:
o Non-Judgmental Approach: Approach the patient with empathy and avoid
reinforcing rituals.
o Gradual Exposure: Help the patient gradually reduce compulsive behaviors
through exposure therapy.
o Medication Adherence: Encourage adherence to the prescribed medication
regimen.
o Supportive Therapy: Educate patients and families about the chronic nature of
the disorder and the need for long-term management.

6. Post-Traumatic Stress Disorder (PTSD)

 Symptoms:
o Flashbacks, nightmares, and intrusive thoughts related to a traumatic event.
o Hypervigilance, irritability, emotional numbing, and avoidance of trauma-related
reminders.
 Medications:
o SSRIs (Sertraline, Paroxetine) for symptom management.
o SNRIs (Venlafaxine) for mood and anxiety symptoms.
 Nursing Interventions:
o Safety: Ensure a safe environment, especially during flashbacks or intrusive
memories.
o Cognitive Behavioral Therapy (CBT): Promote participation in therapy to
process trauma.
 o Education: Teach the patient and family about trauma responses and coping
strategies.
o Grounding Techniques: Help the patient use grounding techniques to reduce
flashbacks or dissociation.

7. Substance Use Disorders

 Symptoms:
o Craving for the substance, inability to control use, neglect of responsibilities,
withdrawal symptoms.
o Tolerance development, physical dependence, and persistent desire to cut down
use.
 Medications:
o Disulfiram (Antabuse) for alcohol cessation (causes nausea and vomiting when
alcohol is consumed).
o Methadone and Buprenorphine for opioid dependence.
o Naltrexone for alcohol and opioid dependence.
 Nursing Interventions:
o Monitor for Withdrawal: Be aware of withdrawal symptoms (e.g., anxiety,
tremors, seizures).
o Education: Provide information about the effects of substance use and benefits of
quitting.
o Support Group Referrals: Encourage participation in AA (Alcoholics
Anonymous) or NA (Narcotics Anonymous).
o Motivational Interviewing: Use non-confrontational techniques to enhance
motivation for treatment and recovery.

8. Personality Disorders

 Borderline Personality Disorder (BPD):

o Characterized by unstable relationships, mood swings, impulsivity, and fear of
abandonment.
 Antisocial Personality Disorder (ASPD):
o Disregard for others' rights, manipulation, and impulsivity.
 Medications:
o Antidepressants (SSRIs) for emotional regulation.
o Antipsychotics (Risperidone, Olanzapine) for mood stabilization.
o Mood stabilizers (Lamotrigine, Valproate) for mood swings.
 Nursing Interventions:
o Therapeutic Communication: Establish trust and boundaries, which are key in
managing BPD.
o Crisis Intervention: Help manage emotional crises, particularly in BPD patients.
o Cognitive Behavioral Therapy (CBT): Encourage participation in therapy to
improve coping strategies.