1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 05Psychopharmacology

2. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychopharmacology and Mental Illness Study of the changes that occur as drugs interact with chemicals in the brain –Symptomatic treatment do not cure or resolve the underlying problem –Not a cure, but it can allow a person with mental illness to function in society

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychotropic Drugs Neurotransmitters—chemical messenger proteins –Presynaptic compartment –Synaptic cleft –Postsynaptic receptor –Reuptake Enhance or decrease the brain’s ability to use neurotransmitter Lipid solubility –Major determinant of the drug’s molecular infusion into the brain tissue

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lipid Solubility Drugs such as alcohol, heroin, and diazepam have high lipid solubility and are readily absorbed into the cerebral cells through the blood-brain barrier –Increases potential for abuse

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Link Between Specific Neurotransmitters and Mental Disorders Pg. 72 Table 5.1

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Classification of Drug Agents Antianxiety agents Antidepressants Mood-stabilizing (antimanic) agents Antipsychotic agents Antiparkinson (anticholinergic) agents

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Antianxiety Agents (Anxiolytics) Counteract of diminish anxiety Indications for use –Anxiety and anxiety disorders –Acute alcohol withdrawal –Skeletal muscle spasms –Convulsive and seizure disorders –Neuropathic pain –Preoperative sedation

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Antianxiety Agents (Anxiolytics) Benzodiazepines – most end in “-pam” Contraindications –CNS depressant, sedation –Increased sensitivity in adults –Addictive tendencies possible

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing ProcessAntianxiety Agents Nursing diagnoses(Pg. 74) Nursing interventions(Pg. 75) Client and family teaching –Drowsy –Fatigued –Loss of Coordination –Slurred Speech

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Antidepressants Used in treatment of depression –Elevate mood –Increase physical activity and mental alertness –Improve appetite and sleep –Restore interest in activities

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Antidepressants (Cont.) Three types –Monoamine oxidase inhibitors (MAOIs) –Tricyclic antidepressants (TCAs) –Serotonin-specific reuptake inhibitors (SSRIs)

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Monoamine oxidase inhibitors (MAOIs)

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Trycyclic Antidepressants (TCAs)

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Selective Serotonin Reuptake Inhibitors

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Effects of Antidepressant Drugs Not immediate; Can take up to 6-8 weeks Must be taken continuously for several weeks before the client feels better Close observation necessary for clients with suicidal tendencies

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Antidepressant Drugs Indications for use –Major depression –Dysthymic and bipolar disorders –Childhood disorders –Obsessive-compulsive disorders –ADHD –Panic disorder –Chronic pain

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Antidepressant Drugs Contraindications Hypersensitivity, Pregnant, Lactating Acute period following an MI Hx: Urinary retention, BPH, glaucoma, asthma, hepatic or renal disease

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing ProcessAntidepressants Nursing diagnoses(Pg. 78) Nursing interventions(Pg. 78) Outcome evaluation(Pg. 78) Client and family teaching(Pg. 78)

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Mood-Stabilizing Agents (Antimanic) Lithium carbonate Anticonvulsants Calcium channel blocker

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lithium Naturally occurring metallic salt, similar to sodium carbonate Not metabolized by body Excreted by kidneys Adequate renal functioning

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Mood-Stabilizing Agents Indications for use –Manic episodes associated with bipolar disorder –Bipolar maintenance therapy –Migraine headaches –Schizoaffective disorder Contraindications –Anticonvusants and CCB should not be used together –Bone Marrow Suppression –MAOI within 14 days

22. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing ProcessMood-Stabilizing Agents Nursing diagnoses(Pg. 79) Nursing interventions(Pg. 79) Outcome evaluation(Pg. 80) Client and family teaching(Pg. 81)

23. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Antipsychotic Agents Used to treat serious mental illness –Bipolar affective disorder –Depressive and drug-induced psychosis –Schizophrenia –Autism

24. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Antipsychotic Agents (Cont.) Noncompliance issues –Lack of insight about the need for continued treatment –Adverse side effects

25. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Antipsychotic Agents (Cont.) Indications for use –Acute and chronic psychosis –Mania –Dementia-induced psychosis –Intractable hiccups –Control of tics and vocal disturbances Contraindications Extrapyramidal side effects –Antiparkinson agents – Cogentin or Artane

26. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing ProcessAntipsychotic Agents Nursing diagnoses(Pg. 82) Nursing interventions(Pg. 83) –AIMS assessment scale Outcome evaluation(Pg. 85) Client and family teaching(Pg. 85)

27. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Extrapyramidal Side Effects Block dopamine – causing irritation of the CNS resulting in involuntary movements Signs & Symptoms –Akathisia, Dystonia, Tardive dyskinesia, Drug- induced parkinsonism, Neuroleptic malignant syndrome Nursing interventions Treatment – immediate medical intervention; Antiparkinson Agents

28. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Psychotropic drugs do not provide a cure for mental illness.

29. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: Psychotropic drugs do not provide a cure for mental illness, but they can allow the person with mental illness to function in an adaptive role within society. They can also provide symptomatic relief.

30. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Antidepressants must be taken continuously for several weeks before therapeutic effects are evident.

31. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: The effects of antidepressant drugs are not immediate. They must be taken continuously for several weeks before the client feels better.

32. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins