Psychiatric Nursing Bullets

A. Psychiatric Drugs
1. Psychiatric drugs (Psychotropic agents) are given after meals.
2. Psychotropic agents must be tapered (gradually stopped) to discontinue.
3. Benzodiazepines (antianxiety drugs) ends with -pam or –am.
-addicting, causes habituation (habit-forming).
4. Non-benzodiazepines are not habit-forming or addicting.
5. Most common anxiolytics are diazepam (Valium) & lorazepam (Ativan).
6. Drug of Choice(DOC) for status epilepticus: Diazepam (Valium); 2nd DOC: Barbiturates (-ital)
7. Diazepam is commonly prescribed and can cause SEDATION therefore SAFETY is the priority.
8. DOC for alcohol withdrawal: 1st: Chlordiazepoxide (Librium); 2nd: Chlorazepate (Tranxene);3rd:
Valium
9. DOC for Generalized Anxiety Disorder: Buspirone (Buspar) 🡪non-benzodiazepine
10. DOC for OCD: SSRI: Fluvoxamine (Luvox); TCA: Clomipramine (Anafranil)
11. Antidote for Anxiolytic Overdose (OD): flumazenil (Romazicon)
12. Haloperidol (Haldol) is the most potent typical neuroleptic (antipsychotic), Chlorpromazine
(Thorazine) is the oldest.
13. Antipsychotics generally ends with –zine or –xene.
14. Conventional or Typical neuroleptics (e.g. Haldol and Thorazine) can treat positive sx and cause
more EPS.
15. Atypical neuroleptics (Clozapine [Clozaril]) can treat both positive & negative sx but are primarily
used because of lesser EPS risk.
16. Clozapine (Clozaril) can cause Agranulocytosis (low WBC) characterized by sore throat & fever.
Client is required to have CBC every 7 days or every week.
17. Common SE: PHOTOSENSITIVITY. Apply Sunblock & wear protective clothing when outdoors.
18. Benztropine (Cogentin) & Diphenhydramine (Benadryl) are drugs usually given to decrease EPS.
19. DOC for Dystonia: Diphenhydramine (Benadryl)
20. Beta-blocker used to treat Akathisia “Ants in the Pants”: Propranolol (Inderal)
21. NMS is an adverse reaction to neuroleptics. DOC: dantrolene (Dantrium); 2nd: bromocriptine
(Parlodel)
22. Tardive Dyskinesia is the only EPS that is irreversible.
23. Anti-EPS drugs are also Anticholinergics (DRY effects) except for amantadine
(Symmetrel)🡪dopaminergic.
24. TCA antidepressants are the most effective antidepressants but are 2nd line drugs because of its many
cardiovascular SE’s. Remember, TCA’s end with –il.
25. SSRI’s are most recommended because it’s safe to use and with lesser cardiovascular SE’s.
26. MAOI’s (Parnate, Nardil, Marplan) should not be given along with Tyramine-rich foods e.g.
Avocado, Alcohol, Banana, Beans (FAVA), Cheese (except for cream and cottage), Caviar, Chianti,
Soy Sauce, Salami
27. MAOI + Tyramine = Hypertensive Crisis; DOC: PHENTOLAMINE (REGITINE); 2nd:
Nitroprusside (Nipride)
28. SSRI’s contains “x” or “z” in its brand name.
29. Watch out for suicide 2 weeks after the antidepressant therapy or if the patient feels better.
30. DOC for Mania: LITHIUM CARBONATE (Eskalith, Lithotabs, Lithobid, Lithonate);Li citrate
(Cibalith)
31. 2-3 gms of salt and 3 L of fluids per day is recommended for clients under Lithium therapy.
32. Vomiting and persistent Diarrhea are early signs of Lithium Toxicity. Therapeutic range: 0.5-1.5
mEq/L
33. Acetazolamide (Diamox) and Mannitol (Osmitrol) are antidotes for Lithium toxicity.
34. Cognex and Aricept are drugs used to treat dementia.
35. Methylphenidate (DOC: Ritalin, Concerta), pemoline (Cylert), amphetamine (Adderall),
dextroamphetamine (Dexedrine) 🡪 stimulant drugs for ADHD. SE: AGI (Anorexia, Growth
suppression, Insomnia)

B. Personality and it’s Components

1. a. ID – “Pleasure Principle” b. EGO – “Reality Principle” c. SUPEREGO – “Moral
Principle”
2. a. Conscious – “Here & Now” b. Preconscious – “Watchman of the Mind” c. Unconscious –
“Storehouse of Memories”
3. Weak Ego = ANXIETY
C. Treatment Modalities
1. Psychotherapy = Therapy of Choice (TOC) for PD’s
Psychotherapy (also called talk therapy) refers to a variety of treatments that aim to help a person identify
and change troubling emotions, thoughts, and behaviors. Most psychotherapy takes place one-on-one with
a licensed mental health professional or with other patients in a group setting.
2. Crisis Intervention: GOAL: Return the client in the pre-crisis state.
Crisis intervention is an immediate, short-term response to mental, physical, emotional and behavioral
distress. It is not a long-term option like psychotherapy or similar treatments. The goal is to restore the
person's functioning to before the crisis and reduce the opportunity for long-term trauma
3. CRISIS: when conventional coping skills failed to relieve the anxiety. Self-limiting: 4-6 weeks
4. Systemic Desensitization: gradual exposure to feared object/event. TOC for: PHOBIA &
PTSD/ASD
5. Milieu therapy or Therapeutic Environment: Priority: Client’s safety
6. Play therapy is best for less than 5 years old; Psychodrama is best for adults.

D. Anxiety & Anxiety Disorders

1. Anxiety: “Fear of the Unknown”, “Mother of all Mental Disorders”

Fear of the unknown refers to anxiety around unpredictable situations or events. It can also link to things
that people find unfamiliar or strange.Anxiety is at the root of many, if not all, of our psychological
disorders. It is, physically, a kind of fear response, involving the activation of the sympathetic nervous
system, in response to a dangerous situation.
2. LOW GABA is the primary neurotransmitter that causes Anxiety. Gamma-aminobutyric acid
The most important function of GABA is in our brain. When GABA levels get too low, it's difficult for
the body to relax after a stress-induced neurotransmitter release. Low GABA activity leads to anxiety,
depression, insomnia, and mood disorders. GABA is a natural brain relaxant that makes us feel good.The
role of the inhibitory neurotransmitter GABA has long been regarded as central to the regulation of
anxiety and this neurotransmitter system is the target of benzodiazepines and related drugs used to treat
anxiety disorders.
3. Neurosis: appears normal and is found amongst normal people. Psychosis: is characterized by
delusions and hallucinations and are therefore institutionalized.
4. Mild Anxiety: “Motivating Force” and is desirable. Perceptual field is broad and organized.
5. Moderate Anxiety: Perceptual field is either NARROWED or SELECTIVE INATTENTION. Learning
is possible.
6. Severe Anxiety: Perceptual field is greatly decreased. Learning does not take place. Best time to
give PRN anxiolytics.
7. Panic Anxiety: Perceptual field is disrupted/distorted reality. “FIGHT OR FLIGHT RESPONSE”
8. NEVER LEAVE the client alone, STAY with the client, SAFETY is the Priority.
9. PHOBIA: irrational fear. Accdg. to the National Epidemiology Center of the DOH, Specific Phobia is
the leading Mental Disorder in the Philippines accounting to about 15% out of 35% of Mental
Disorders in the country.
10. Defense Mechanism (DM) in Phobia: DISPLACEMENT
11. OCD: Obsession –intrusive thoughts; Compulsion – rituals. Strong Superego, History of strict
Toilet Training.
People with OCD may experience unwanted and intrusive thoughts, which causes them to repeatedly
perform ritualistic behaviors and routines. These unwanted and persistent thoughts are called obsessions
and the rituals are called compulsions. Some of the most common examples of OCD rituals
include: Walking a certain way. Performing a repetitive activity, such as locking, unlocking, and relocking
a door.
12. DM in OCD: UNDOING
13. Flashback is a characteristic of clients with PTSD/ASD.
14. Generalized Anxiety D/O (GAD): Diagnostic Criteria: Must persist for at least 6 months.
15. DM in Somatoform D/O: CONVERSION
16. Hypochondriasis: characterized by a belief that one has a serious disease. “Doctor Shoppers”
17. DM in Dissociative D/O: DISSOCIATION –splitting of the awareness.
18. Dissociative Identity Disorder (DID) aka Multiple Personality D/O. History of abuse during
childhood.

E. Schizophrenia
 1. Eugene Bleuler coined the word Schizophrenia (SPLIT MIND).
The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eugen
Bleuler. Paul Eugen Bleuler first used the term "schizophreniegruppe", on April 24, 1908, during a lecture
at a meeting of the German Psychiatric Association in Berlin. The word schizophrenia translates as "split
mind"

2. Nsg. Dx: “Altered thought process.” – PRIORITY nsg dx

3. Delusion – false, fixed belief. Nsg dx is the same with schizophrenia.
Delusional disorder is a type of mental health condition in which a person can’t tell what’s real from
what’s imagined. There are many types, including persecutory, jealous and grandiose types. It's treatable
with psychotherapy and medication.
4. Hallucination – false sensory perception w/o a stimulus. Most common: Command Auditory
5. Illusion -false sensory perception w/ a stimulus.
6. Causal Neurotransmitter: Increased DOPAMINE
7. Negative Sx usually start with the letter “A”: Apathy, Avolition, Blunt/Flat Affect, Alogia, Anhedonia
8. Positive Sx: Hallucinations, Delusions, Associative Looseness (Loose associations)
9. DM in Disorganized/Hebephrenic schiz: REGRESSION
10. DM in Paranoid schiz: PROJECTION. NOTE: Nutrition: SEALED FOODS or CLIENT
PREPARES OWN FOOD.
11. DM in Catatonic schiz: REPRESSION “Mother of all Defense Mechanism”
12. Schizophreniform: S/Sx of schizophrenia for more than 1 month but less than 6 months.

F. Mood Disorders
1. Depression is common in the ELDERLY r/t an experience of actual/possible LOSS. “ANGER turned
INWARDS.”
Depression is a common problem among older adults, but clinical depression is not a normal part of aging.
2. Diagnostic Criteria: ANHEDONIA –lack of pleasure from formerly enjoyed activities.
Anhedonia is the inability to feel pleasure. It's a common symptom of depression as well as other mental health
disorders. The symptoms of anhedonia include:

Decreased pleasure in daily activities.

Reduced interest in hobbies or things you used to enjoy.

3. Causal Neurotransmitter: LOW SEROTONIN, LOW NOREPINEPHRINE

4. “ALL DEPRESSED ARE POTENTIALLY SUICIDAL!”
5. Risk of suicide is highest 2 weeks after antidepressant therapy or if the client is feeling better.
6. Priority Nsg Dx: “High risk for Self-directed Violence.”
7. ECT is effective for the treatment of depression and works faster than antidepressants.
8. Atropine is given before ECT to reduce secretions and the risk of aspiration.
9. Succinylcholine (Anectine) a muscle relaxant used before ECT to prevent injuring the client during
Sz activity.
10. Valium or a Barbiturate (-ital drugs e.g. Brevital) for sedation.
11. AFTER ECT, REMAIN WITH CLIENT UNTIL HE’S ALERT. Then, reorient to person, time,
place.
12. Mania: high levels of NOREPINEPHRINE and SEROTONIN
13. Finger foods high in calorie, CHON, and electrolytes are best for manic clients. (e.g. peanut butter
sandwich)
14. Avoid NSAIDs if the client is on Li therapy.

G. Personality Disorders
1. Cluster A: Paranoid PD, Schizoid, Schizotypal
2. PARANOID – suspicious, main issue is DISTRUST. SCHIZOID – aloof, distant, introvert, loner.
SCHIZOTYPAL – weird, odd, eccentric
3. Cluster B: BORDERLINE PD – unstable, suicidal; HISTRIONIC – dramatic, erratic;
ANTISOCIAL –rule breaker, truancy (lakwatsa), petty crimes; NARCISSISTIc – strong sense of
importance, grandiose sense of importance
4. Cluster C: AVOIDANT –fears rejection and criticism; DEPENDENt – needs someone to make
decisions for him; OCPD – preoccupied with detail, standards, rules, perfectionists; PASSIVE-
 AGGRESSIVE PD – uses Reaction formation (plastic, hypocrites), express anger thru
procrastination, inefficiency
5. TOC: PSYCHOTHERAPY

H. Eating Disorders
1. Refusal to eat is the major problem in anorexia nervosa.
2. Weight loss of >15% from Ideal Body Weight (IBW) is a characteristic of Anorexia Nervosa.
Weight is <85% of IBW.
3. Body Mass Index = Weight (kg)
Height (m2)
4. Amenorrhea and Lanugo are symptoms of Anorexia nervosa. Anorexics are also
PERFECTIONISTS.
5. Binge-Purge Cycle is the main problem in Bulimia nervosa.
6. Dangerous Complication: HYPOKALEMIA r/t to vomiting or purging behaviors.
7. Bulimia is characterized by a near normal weight, binge-purge cycle,& dental/enamel erosion due to
vomiting.
8. Priority Nsg. Dx: “Altered Nutrition: less than body requirements.”
9. STAY with the client during meals.
10. Weight gain indicates effective nursing intervention.

I. Pervasive Developmental Disorders

1. Safety and Nutrition (finger foods) should be prioritized for ADHD.
2. Impulsiveness, Hyperactivity, and Inattention are hallmark signs of ADHD.
3. Ritalin and Dexedrine are drugs commonly administered for ADHD.
4. Onset of ADHD is before the age of 7 years.
5. Autism: self-preoccupation, child has his own world.
6. Provide helmet for autistic children, head-banging is common.
7. Autism is common in boys and is diagnosed between 2 – 3 years of age.
8. Mental retardation is an IQ of <70.
9. MILD mental retardation: IQ of 50 – 70; IMBECILE
10. MODERATE mental retardation: 35 – 49 IQ; MORON
11. SEVERE mental retardation: 20 – 34 IQ; IDIOT
12. PROFOUND mental retardation: IQ of <20

J. Elderly Psych Problems

1. Parkinson’s disease results from decreased dopamine and increased level of acetylcholine due to
degeneration of the substantia nigra.
2. Tremors (pill rolling and resting), Rigidity (cog wheel), & Shuffling gait are common symptoms of
Parkinson’s.
3. L-dopa is the DOC for Parkinson’s disease.
4. Alzheimer’s disease is due to decreased acetylcholine (Ach) and Cognex or Aricept is usually
administered to improve memory.
5. Altered thought process is the priority nursing diagnosis for AD.
6. Confabulation (filling in of gaps with made up stories) is commonly seen in AD, the most common
type of dementia.

K. Substance abuse and Dependence

1. Alcohol is a CNS depressant and the most widely abused drug in ALL CATEGORIES.
2. Marijuana is the most widely used ILLICIT drug.
3. Wernicke’s-Korsakoff’s Syndrome are neurologic complications of alcoholism resulting from Vit.
B1 (thiamine) deficiency. Treatment: 100 mg Thiamine IM
4. Disulfiram (Antabuse) is used for alcoholism, Aversion Therapy. Client must be alcohol free 12 H
before the therapy is started.
5. Narcotic or pioid overdose cause pupil constriction (unique characteristic of opioids).
6. Yawning indicates brain hypoxia and is common in heroin withdrawal. Flu-like symptoms is also a
withdrawal symptom of heroin.
7. Perforated nasal septum is a physical complication of cocaine, a stimulant.
8. Hallucination, Pica, Blood-shot eyes are common manifestations of a person using marijuana.
9. Treatment of Narcotic Overdose (OD): Naloxone (Narcan), Naltrexone (ReVia)
10. Drug for Narcotic Withdrawal and Detoxification: Methadone
11. Ecstasy is also known as Methylene DioxyMethAmphetamine (MDMA).
12. Cocaine, a stimulant, is also called CRACK or COKE.
13. Cocaine is the second widely used illicit drug after marijuana.
14. Amphetamine is called “shabu” in the Philippines. It is a stimulant and may be taken orally, by
injection, snorting, or smoking.

MKD