Nurs661: PSYCH DIAGNOSIS & MANAGEMENT Review (Combined Review for Exam 2) Graded A

Percentage of patients who experience status epilepticcus due to withdrawing from alcohol - Approx. 3% Percentage of clients that experiences delirium tremens due to alcohol withdraw - Approx. 5% Mechanism of action of Disulfiram (Antabuse) - inhibits aldehyde dehydrogenase Which SSRI is most likely associated with strong withdrawal symptoms? - Paroxetine (Paxil) Withdrawal symptoms of paroxetine (Paxil) include - akathisia, restlessness, GI upset, dizziness, and tingling. Most common side effect from the start of SSRI therapy? - GI upset that generally decreases with time What is the black box warning on SSRIs? - Suicidal ideation Which antidepressant class is most associated with sexual dysfunction? - SSRI What is the most common side effect of MAOIs? - hypertensive crisis What causes hypertensive crisis with MAOIs? - Inhibition of monoamine oxidase A, which leads to increased levels of norepinephrine. This is only problematic when the patient is on another antidepressant without a wash out period, or if the patient ingests a significant amount of tyramine. Potential other side effects of MAOIs - Dizziness, sexual side effects, sedation, headache, fatigue, weakness, tremor, blurred vision, constipation, weight gain, change in appetite, nausea, orthostatic hypotension. What is the standard treatment of neuroleptic malignant syndrome? - Stop the causative agent first. Stop contributory agents. Supportive care, including ICU support, may be necessary. Benzodiazepines should be employed, but the treatment plan may vary based on symptom and presentation. NMS symptoms presents how? - Fever, rigidity, mental status change, and autonomic instability. Serotonin syndrome presents how? - shivering, hyperreflexia, myoclonus, and ataxia Classic triad of symptoms for NMS - HOT, STIFF, and OUT OF IT 1. extreme instability/hyperthermia 2. extreme "lead pipe" muscle rigidity/dystonia 3. extreme mental status change/confusion Treatment for NMS - discontinue neuroleptics, stabilize b/p, hydration, oxygen, cooling blanket Medication treatment for NMS: - dantrolene, amantadine (dopamine agonists), bromocriptine to relieve rigidity, antipyretics Serotonin syndrome mnemonic? - A.R.M.S. Treatment for serotonin syndrome: - antipyretics--stabilizing temp, benzodiazepine or dantrolene--muscle relaxation, beta-blocker--tachycardia, and cyproheptadine -- binds to serotonin and histamine receptors Schizophrenia: hallucinations fluctuate when? - chronic residual phase Which symptoms of schizophrenia respond best to antipsychotic medications? - Positive symptoms What are the risk factors for suicide among those with schizophrenia? - Young, white, male, never married, previous functioning was high pre-disease, history of past suicide attempts, history of alcohol or substance use.