Psychomotor (mental energy) retardation/agitation: bad memory, can’t collect thoughts, not organized Altered nutrition: Increase (agitate) / decrease (retard) intake Sleep disturbances: Insomnia, hyper-insomnia (not sleeping for days) Decreased libido: Lack of interest and activity Poor personal hygiene: Unkept, disheveled, sloppy Substance abuse: Alcohol, drugs, nicotine abuse Decreased physiologic processes: Lethargy, circulation, perfusion, elimination, physical pain, discomfort Physical discomfort: Pain Nursing Diagnosis Potential for self-harm Altered thought process Disturbance in self-esteem Impaired verbal communication Self-care deficits Altered nutrition Sleep pattern disturbance Activity deficit Non-Compliance Altered family processes
Goals (always correcting back to normal) The patient will be: Free from self-harm / injury Maintain nutrition, hydration and elimination Balance between rest and activity Express emotions Communicate with others Maintain hygiene Participate in activities Decrease in psychotic features Antidepressants Manipulation of neurotransmitters: Norepinephrine, serotonin, dopamine Blocking the re-uptake of neurotransmitters. Increases emotional energy Inhibiting neurotransmitter break-down: won’t take up and absorb Reducing stimulation of beta-adrenergic receptors: by norepinephrine Metabolized by hepatic system Excreted by renal system Therapeutic effects of Antidepressants Correct back to normal Elevate mood: increase emotional energy and expression Increase and organize thought processes: Increase attention, concentration, memory. Animate behavior: Physically active, in lobby or day room not in bedroom Improved sleep and appetite: Appear rested, increase in weight if loss evident Initial response: 7-10 days Full therapeutic effects: 4-6 weeks See table for Antidepressant medications Tricyclics – MAOI’s - SSRI’s – SNRI’s – Atypical antidepressants SSRI Dis-Continuation Syndrome Occurs with abrupt discontinuation: Withdraw effect. Needs to be taken at the same time daily. Causes: Nausea, anxiety, restlessness, dizzy, lethargic with headache. Requires tapered withdrawal – gradually decreasing dose to get off. Serotonin Syndrome
Over-abundance of serotonin: toxic effect Occur in interaction with other antidepressants: MAOI’s SSRI’s, St John Wort, LSD, ecstasy, diet pills S/E: Diaphoresis, tachycardia, change in mental status, labile BP, headache, ataxia, diarrhea, overactive reflexes, restlessness Electroconvulsive Therapy (ECT) Indicated when other antidepressants are not effective Can be used as 1 st line treatment: Acute/Suicidal psychotic features, vegetative state Contraindication: ICP, Cardiac conduction disorders, stroke, CVA, MI, brain mass/lesion Action: Increase levels of circulating neurotransmitters > esp. Norepinephrine Improvement in 6-12 treatments Requires informed consent Pre-procedural preparation: D/C medications that reduce seizure threshold (antianxiety, anticonvulsant) Baseline EKG
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- Spring '18
- Major depressive disorder, Antidepressant