Chapter 027

Drug Therapy for Psychiatric Problems
Psychiatric Disorders
Include affective or emotional instability,

behavioral problems, and cognitive dysfunction
or impairment
Can be biologic or psychologic
Major depression, generalized anxiety disorder,
bipolar disorder, schizophrenia
Major psychiatric illnesses
Depression
Anxiety
Psychosis
Copyright 2016 Elsevier Inc. All Rights Reserved.
Issues Related to Drug Therapy

for Psychiatric Problems
Before:
Complete list of patients current drugs

Establish baseline vital signs
Assess risk for falls
Assess IV site for patency
Assess mental status, suicidal thoughts
After:
Monitor blood pressure abnormal heart rhythms

Monitor for dizziness, drowsiness
Reassess mental status
Issues Related to Drug Therapy

for Psychiatric Problems (Cont.)
Patient teaching:
Take drugs exactly as prescribed, immediately

report side effects
Keep follow-up appointments
Avoid activities requiring alertness
Change positions slowly
Avoid alcohol
Tell about drugs before surgery
Wear a medical alert bracelet
Depression
Involves body mood, and thoughts

Interferes with ability to function normally,
causes pain/suffering
Depressive disorders
Major depression: May occur once/several times

Dysrhythmia: Symptoms arent disabling
Bipolar disorder: Untreated can progress to
psychosis
Treatment: Counseling, psychotherapy,

antidepressants
Cycle of Depresion
{Insert Fig 27-2}
Review of Related Physiology

and Pathophysiology
May be caused by an imbalance of

neurotransmitters
When levels decrease, neurons may be less
able to communicate
Use of drugs can improve symptoms
Selective serotonin reuptake inhibitors (SSRIs), and

tricyclic antidepressants (TCAs)
SSRIs work by increasing the amount of

serotonin in the brain; TCAs inhibit reuptake of
norepinephrine, dopamine, and serotonin
Neurotransmitters
{Insert Fig. 27-3}
How SSRIs Work
Figure 27-4. Selective serotonin reuptake inhibitor drugs increase the amount
of serotonin in the brain by blocking reuptake of neurotransmitters by neurons.
Antidepressant Drugs
Intended responses:
Correct depression
Decrease symptoms of depressed mood
Side effects: Drowsiness, dizziness, fatigue,

insomnia, GI upset, impotence, lethargy, sedation,
blurred vision, dry eyes
Adverse effects:
TCAs: Cardiac effects
NDRIs: Seizures, neutropenia, liver failure/toxicity,
increased suicidal thoughts in
children/adolescents/young adults
10
10
Administering Antidepressant
Drugs
Check before:
Check after:
Ask about family history of depression, usual bowel

movements, diet
For TCAs, ask about smoking
Mental status to determine response and watch for side
effects
Patient teaching:
Are not a cure, take 1-8 weeks for symptoms to improve

Discontinue gradually
Frequent mouthwashes can decrease dry mouth
11
11
Life Span Considerations

for Antidepressant Drugs
Pediatric:
Pregnancy and breastfeeding:
Risk of increased suicidal thoughts in depressed children

Fluoxetine may cause unusual excitement, restlessness,
irritability, trouble sleeping
Venlafaxine may slow growth and weight gain
SSRIs not tested; avoid paroxetine in pregnancy
Some pass through breast milk
Older adults:
May require lower doses, especially with kidney disease or

liver failure
12
12
Anxiety
Apprehension, fear, worry; can occur without cause

Common anxiety disorders
Panic disorders: Intense feelings of fear or doom

Generalized anxiety disorder: Excessive anxiety daily for 6
months
Phobic disorders: Persistent/recurrent fears of certain
objects/situations
Obsessive-compulsive disorder: Compulsive actions
Post-traumatic stress disorder: Exposure to death or neardeath experiences
Treatment depends on cause

13
13
Review of Related Physiology

and Pathophysiology
Physical and emotional symptoms occur

Causes and factors include mental
conditions, physical conditions, or the effects
of drugs
Mild anxiety is a common and requires no
treatment
Moderate-to-severe anxiety is a symptom of
psychiatric disorders
Treated with antianxiety drugs

14
The Circle of Anxiety
Figure 27-5. The circle of anxiety.

15
15
Antianxiety Drugs
Benzodiazepines, SSRIs have milder side

effects
Benzodiazepines reduce alcohol withdrawal;

increase the inhibitory actions of GABA in the
brain
SSRIs affect the action of the neurotransmitter
serotonin
Bispirone increases norepinephrine metabolism to
relieve anxiety
16
16
Antianxiety Drugs (Cont.)
Intended responses:
Anxiety is relieved, symptoms of anxiety are
decreased
Improved sense of well-being improved
Side effects:
Benzodiazepines: CNS effects
Nervousness, irritability, difficulty concentrating, heart
rate and blood pressure changes
Adverse effects: Seizures and coma,

hallucinations, heart failure, insomnia, confusion
17
Administering Antianxiety Drugs
Check before:
History of drug dependencies
Check after:
Assess gait for steadiness
Monitor level of anxiety
Assess/ monitor for suicidal ideation
Patient teaching:
Take exactly as prescribed; avoid alcohol and
sleeping pills
Wean off the drugs gradually
Dont take benzodiazepines with antacids
18
18

for Antianxiety Drugs
Pediatric:
Benzodiazepines: Sensitive to effects; side effects

more likely
Clonazepam may cause decreased mental/
physical growth
Benzodiazepines should not be used or taken while
breastfeeding
Older adults:
More sensitive to effects; greater risk for side effects

Monitor for respiratory depression, use low doses
19
19
Psychosis
Loss of contact with reality

Common symptoms: Illusions, delusions,
hallucinations
Treatment:
Psychologic therapies
Antipsychotic drugs
Hospital care may be needed to ensure safety

Many symptoms controlled with long-term
treatment
20
20
Antipsychotic Drugs
Produce tranquilizing effect, help relax CNS

All antipsychotic drugs tend to block dopamine
receptors in the dopamine pathways in the brain
Major tranquillizers, lithium carbonate,
thiothixene
Should not be used on a whim
Intended responses:
Signs/symptoms of psychosis decreased, behavior

and schizophrenic behavior are improved, suicidal
thoughts decreased
21
21
Antipsychotic Drugs (Cont.)
Side effects
Sedation, drowsiness, dizziness, lethargy

restlessness, insomnia, GI upset
Adverse effects
Several life-threatening effects, neuroleptic

malignant syndrome
Neutropenia
Risk of death in those with dementia
22
Administering Antipsychotic
Drugs
Check before:
Monitor fluid intake and urine output

Baseline weight
Orientation, mood, behavior, suicidal thoughts
Check after:
Daily weight, intake and output

Bowel function
Reassess mental status and watch for sedation
Give with food if GI upset develops
23
23
Administering Antipsychotic
Drugs (Cont.)
Patient teaching:
Prescriber may start dose low and gradually

increase
Teach about side effects and adverse effects
Importance of psychotherapy
Avoid alcohol and other CNS depressants
Monitor bowel function and increase activity
Take drugs with food if GI upset occurs
Use sunscreen and wear protective clothing/hats
24

for Antipsychotic Drugs
Pediatric:
Side/adverse effects more likely

Avoid taking during pregnancy or breastfeeding
Avoid taking lithium during pregnancy/breastfeeding
Older adults:
More sensitive to effects; side/adverse effects more

likely
Start with lower doses, especially with renal
insufficiency; can cause rapid blood pressure falls
25
25

Chapter 027

Enviado por

Dados do documento

Título original

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

Chapter 027

Enviado por

Direitos autorais:

Formatos disponíveis

Drug Therapy for Psychiatric Problems

Include affective or emotional instability,

Copyright 2016 Elsevier Inc. All Rights Reserved.

Issues Related to Drug Therapy

Complete list of patients current drugs

Monitor blood pressure abnormal heart rhythms

Issues Related to Drug Therapy

Take drugs exactly as prescribed, immediately

Copyright 2016 Elsevier Inc. All Rights Reserved.

Involves body mood, and thoughts

Major depression: May occur once/several times

Treatment: Counseling, psychotherapy,

{Insert Fig 27-2}

Copyright 2016 Elsevier Inc. All Rights Reserved.

Review of Related Physiology

May be caused by an imbalance of

Selective serotonin reuptake inhibitors (SSRIs), and

SSRIs work by increasing the amount of

{Insert Fig. 27-3}

Copyright 2016 Elsevier Inc. All Rights Reserved.

How SSRIs Work

Side effects: Drowsiness, dizziness, fatigue,

Copyright 2016 Elsevier Inc. All Rights Reserved.

Ask about family history of depression, usual bowel

Are not a cure, take 1-8 weeks for symptoms to improve

Copyright 2016 Elsevier Inc. All Rights Reserved.

Life Span Considerations

Pregnancy and breastfeeding:

Risk of increased suicidal thoughts in depressed children

May require lower doses, especially with kidney disease or

Copyright 2016 Elsevier Inc. All Rights Reserved.

Apprehension, fear, worry; can occur without cause

Panic disorders: Intense feelings of fear or doom

Treatment depends on cause

Review of Related Physiology

Physical and emotional symptoms occur

Treated with antianxiety drugs

The Circle of Anxiety

Figure 27-5. The circle of anxiety.

Benzodiazepines, SSRIs have milder side

Benzodiazepines reduce alcohol withdrawal;

Copyright 2016 Elsevier Inc. All Rights Reserved.

Antianxiety Drugs (Cont.)

Adverse effects: Seizures and coma,

Administering Antianxiety Drugs

History of drug dependencies

Copyright 2016 Elsevier Inc. All Rights Reserved.

Life Span Considerations

Pregnancy and breastfeeding:

Benzodiazepines: Sensitive to effects; side effects

More sensitive to effects; greater risk for side effects

Loss of contact with reality

Hospital care may be needed to ensure safety

Produce tranquilizing effect, help relax CNS

Signs/symptoms of psychosis decreased, behavior

Copyright 2016 Elsevier Inc. All Rights Reserved.

Antipsychotic Drugs (Cont.)

Sedation, drowsiness, dizziness, lethargy

Several life-threatening effects, neuroleptic

Copyright 2016 Elsevier Inc. All Rights Reserved.

Monitor fluid intake and urine output

Daily weight, intake and output

Prescriber may start dose low and gradually