PSYCHIATRIC NURSING

• Acute Dystonia: twisted head and neck, spasms or stiffness in muscle
• Major categories of psychotropic medications

  • Antipsychotics
  • Antidepressants
  • Antianxiety/antipanic
  • Stimulants
  • Mood stabilizers
• In classical economic theory, 'rational' means that economic agents are able to consider the outcome of their choices and recognise the net benefits of each one
• Pseudoparkinsonism symptoms include a stiff, stooped posture, masklike facies, decreased arm swing, a shuffling, festinating gait (with small steps)
• Opisthotonus: eyes rolled back in a locked position
• Treatment for Pseudoparkinsonism includes changing antipsychotic medication or adding an oral anticholinergic agent
• Treatment for Akathisia includes changing antipsychotic medication or adding an oral agent such as a beta-blocker, anticholinergic, or benzodiazepine
• Symptoms of Tardive Dyskinesia include tongue-thrusting and protrusion, lip-smacking, blinking, grimacing, and other excessive, unnecessary facial movements
• Other side effects of antipsychotic drugs include Neuroleptic Malignant Syndrome (NMS) with symptoms like rigidity, high fever, unstable blood pressure, delirium, and elevated enzyme levels
• Anticholinergic side effects include orthostatic hypotension, dry mouth, constipation, urinary retention, blurred near vision, dry eyes, photophobia, nasal congestion, decreased memory
• Psychotropic medications

  Reduce or eliminate symptoms of psychosis (delusions and hallucinations) by affecting the brain chemical called dopamine
• Side effects of antipsychotic drugs

  • Extrapyramidal Symptoms (EPS)
• Torticollis: tightness in the entire body; arched head, back & neck
• Treatment for Acute Dystonia

  Rapid relief is brought about by immediate treatment with anticholinergic drugs such as Intramuscular benztropine mesylate (Cogentin) or Intramuscular or intravenous diphenhydramine (Benadryl)
• Cogwheel rigidity, drooling, tremor, bradycardia, coarse pill-rolling movements of the thumb and fingers while at rest are symptoms of pseudoparkinsonism
• Akathisia is an intense need to move about. The client appears restless or anxious and agitated
• Treatment for Anticholinergic side effects

  Drink sugar-free fluids, eat sugar-free hard candy, avoid
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• Treatment for Tardive Dyskinesia

  Decrease or discontinue the antipsychotic medication, keep maintenance dosages as low as possible, consider using Clozapine
• Treatment for Neuroleptic Malignant Syndrome

  Immediate discontinuance of all antipsychotic medications, supportive medical care until the client’s physical condition is stabilized
• Tardive Dyskinesia is a syndrome of permanent, involuntary movements, most commonly caused by the long-term use of typical antipsychotics
• Clozapine side effects can occur up to 24 weeks after the initiation of therapy
• Antidepressants are used for treating depression
• Treatment for anticholinergic side effects

  1. Drink sugar-free fluids and eat sugar-free hard candy

  2. Avoid calorie-laden beverages and candy

  3. Increase intake of water and bulk-forming foods

  4. Exercise

  5. Use sunscreen & wear protective clothing

  6. Rising slowly from a sitting or lying position
• Monoamine oxidase inhibitors (MAOIs)


  • A less common variety of antidepressant drugs, often a last option with complex, treatment-resistant depression
• AVOID while on MAOIs

  • Aged cheese
  • Sauerkraut
  • Cured meats
  • Draft beer
  • Fermented soy products such as miso, tofu or soy sauce
  • Wine
  • All forms of beer
• How SSRIs work

  Ex. Prozac (fluoxetine), Zoloft (sertraline)
• Stimulants

  • Prescribed to people with attention-deficit hyperactivity (ADHD)
  • Ex. Ritalin (methylphenidate)
• Types of crisis

  • Developmental/Maturational Crisis
  • Situational Crisis
• A crisis is an overwhelming reaction to a threatening situation in which a person’s usual problem-solving strategies fail to resolve the situation resulting in a state of disequilibrium
• Side effects of TCAs

  • Dry mouth
  • Blurred vision
  • Constipation
  • Urinary retention
  • Drowsiness
  • Increased appetite
  • Weight gain
  • Drop in blood pressure
  • Light-headedness
  • Increased sweating
• Selective serotonin reuptake inhibitors (SSRIs)


  • These medications gradually increase the amount of serotonin, a neurotransmitter, in the brain
• Client teaching & medication for antipsychotic drugs

  • If you forget a dose of antipsychotic medication, take it if the dose is only 3 to 4 hours late, if more than 4 hours, omit the forgotten dose
• Clozapine Side Effects: Agranulocytosis characterized by fever, malaise, ulcerative sore throat, and leukopenia
• Anticholinergic side effects

  • Orthostatic hypotension
  • Dry mouth
  • Constipation
  • Urinary retention
  • Blurred near vision
  • Dry eyes
  • Photophobia
  • Nasal congestion
  • Decreased memory
• Complications of MAOIs

  • Hypertensive crisis
• Antianxiety/Antipanic medications

  • Used to treat a variety of chronic and acute anxiety issues, from generalized anxiety to panic attacks
  • Ex. Ativan (lorazepam), Valium (diazepam), Xanax (alprazolam)
• Tricyclics (TCAs)


  • Increases serotonin & norepinephrine in the brain
• Side effects of SSRIs

  • Nausea
  • Nervousness
  • Agitation or restlessness
  • Dizziness
  • Reduced sexual desire/difficulty reaching orgasm/inability to maintain an erection
  • Insomnia
  • Drowsiness
  • Weight gain or loss
  • Headache
  • Dry mouth
  • Vomiting & diarrhea
• Mood stabilizers

  • Used to treat intense, repeated shifts in a person's mood, common for those experiencing bipolar, schizophrenia, or borderline personality
  • Ex. Lithium Carbonate