W10: NEUROPSYCHIATRIC DISORDERS

• Psychiatric disorders


  A broad range of problems that disturb a person's thoughts, feelings, behavior or mood. Also referred to as "mental illness," and "mental health conditions"
• Psychiatric disorders can significantly affect a person's ability to perform at work or school, or maintain healthy social relationships
• Examples of psychiatric disorders

  • Generalized anxiety disorder, PTSD, major depressive disorder, bipolar disorder, schizophrenia, borderline personality disorder, anorexia nervosa, binge eating disorder, borderline and personality disorder
• Symptoms of psychiatric disorders

  • Trouble sleeping, feeling sad or down, excessive fears, withdrawal from friends and activities, mood changes, detachment from reality, suicidal thinking, extreme fatigability, confused thinking or worries, eating problems, etc.
• Treatment for psychiatric disorders

  Combination of healthy lifestyle practices, psychotherapy and medications to treat chemical imbalances in the brain
• Sleep disorders


  Conditions that disturb your normal sleep patterns
• Major types of sleep disorders

  • Insomnia, sleep apnea, restless leg syndrome (RLS), hypersomnia, circadian rhythm disorders, parasomnia
• Insomnia is the most common sleep disorder
• Insomnia


  Being unable to fall asleep and stay asleep
• Types of insomnia

  • Short-term insomnia (acute), Long-term insomnia (chronic), Primary insomnia, Secondary insomnia
• Symptoms of insomnia


  • Sleepiness during the day, Fatigue, Grumpiness, Problems with concentration or memory
• Causes of insomnia


  • Stress, Noise, light, or temperature, Changes to sleep schedule, Genes, Mental health issues, Medications, Pain and discomfort at night, Caffeine, tobacco, or alcohol use, Hyperthyroidism and other endocrine problems, Sleep apnea or restless leg syndrome, Pregnancy, Alzheimer's disease and other types of dementia, ADHD, PMS and menopause
• Pharmacotherapy for insomnia


  Use of medications to treat insomnia
• Benzodiazepine sedatives used to treat insomnia


  • Triazolam (Halcion), Estazolam, Lorazepam (Ativan), Temazepam (Restoril), Flurazepam, Quazepam (Doral)
• Benzodiazepine sedatives


  • Drowsiness, Light-headedness, Confusion, Unsteadiness (especially in older people, who may fall and experience injuries), Dizziness, Slurred speech, Muscle weakness, Memory problems, Delirium, especially in older people, Behavioral changes, Risk of dependence
• Nursing responsibilities for benzodiazepine sedatives

  • Do not take with alcohol, These drugs can be addictive, Take this drug exactly as prescribed by the doctor, These drugs can cause morning sleepiness and dizziness, Do not stop taking this drug abruptly, Educate patient on its adverse effects and advise to report adverse effects to the health care provider, These drugs should be stored in a locked storage/medicine cabinet, Assist the patient in going to the bathroom/toilet especially the older people who are prone to accidents and falls
• Non-benzodiazepine hypnotics used to treat insomnia


  • Zolpidem, Zaleplon, Eszopiclone
• Non-benzodiazepine hypnotics


  • Enhance sleep spindles, Used to treat insomnia
• Side effects of non-benzodiazepine hypnotics

  • Metallic taste in the mouth, Dry mouth, Feeling sleepy at daytime
• Nursing responsibilities for non-benzodiazepine hypnotics

  • Advise not to drink alcohol or caffeine while on zolpidem, Assess for allergic reaction, Report any serious allergic reaction to the doctor, Not safe for pregnant and lactating mothers, Consult the doctor before using this drug if with mental health problem, alcohol and drug problems, This is taken 1 hour before bedtime, Swallow zolpidem tablet whole with a glassful of water, Can be taken with or without food, Obtain lab test result (kidney and liver function test) before initial administration of this drug, If the patient forgot to take zolpidem, leave out the missed dose
• Ramelteon - used to treat insomnia


  • Dizziness, tiredness, daytime drowsiness, May sleep walk, sleep talk or eat while not fully awake, Mental and mood changes, Depression, Thoughts of suicide, Decreased sexual desire, Missed menstrual periods, Nipple discharge, Difficulty becoming pregnant
• Nursing responsibilities for Ramelteon


  • Can be taken with or without food, 30 minutes before bedtime, Do not break the tablet before taking it, Report any serious side effects such as changes in mood or feelings of depression, or the insomnia worsens to the health care provider, Do not take with alcohol, Tell the doctor right away if the patient experiences sleep walking, sleep talking and eating when not fully awake, Assess breathing of patient before giving this drug, Advise the patient not to drive or use machinery that needs alertness, If pregnant, consult first with the doctor before taking this drug, Do not stop taking this drug abruptly, Do not take this drug with other products that cause drowsiness such as opioid, cough relievers
• Suvorexant - CNS depressant used to treat insomnia


  • Unusual dreams may occur, Daytime drowsiness, Mental/mood changes (depression or suicidal thoughts), Temporary weakness of the legs, Sleep paralysis, Rare: sleep walk, sleep talk, eating and having sex while not fully awake
• Nursing responsibilities for Suvorexant

  • Taken by mouth 30 minutes before bedtime, Can be taken with or without food, but it may take longer to work if you take it with or right after a meal, Do not take a dose of this drug unless you have time for a full night's sleep of at least 7 hours, Do not take with alcohol, If this drug is used for a long time, it may not work as well, Report to the doctor any serious side effects including mental and mood changes like depression and thoughts of suicide, Monitor the patient closely for sleep paralysis
• Lemborexant - a Schedule IV substance with sedative properties, a CNS depressant used to treat insomnia


  • Nightmares/unusual dreams, Tiredness, Daytime drowsiness, Mental/mood changes (depression, hallucinations, thoughts of suicide), Temporary weakness of the legs, May cause sleep paralysis, May cause "sleep-driving", May sleepwalked, prepared/eaten food/made phone calls or had sex while not fully awake
• Nursing responsibilities for Lemborexant

  • Taken by mouth at bedtime, Can be taken with or without food, Do not take with alcohol, Avoid eating grapefruit or drinking grapefruit juice, May cause addiction, Take this drug exactly as prescribed by the doctor, Regular monitoring of patient especially at night, Assess first the patient for muscle weakness disorder, lung problems, liver problems, sleep disorder, breathing problems, mental/mood problems, personal or family history of substance abuse before using this drug, Watch carefully the patient especially the elderly for possible falls, Pregnant women should consult first their doctor before using this drug, Should not be mixed with opioid and cough reliever drugs
• Doxepin - used to treat anxiety or depression, used to treat insomnia, a tricyclic antidepressant

  • Drowsiness, Dry mouth, Dizziness, Headache, Tiredness, Blurred vision, Constipation, Trouble urinating, Heartburn that doesn't go away, Mental/mood changes (anxiety, agitation, confusion), Shaking, Severe stomach/abdominal pain, Severe dizziness, Fast/irregular heartbeat, Fainting, Seizures, Eye pain/swelling/redness/widened pupils/vision changes (seeing rainbows around lights at night)
• Nursing responsibilities for Doxepin

  • Taken by mouth, usually 1 to 3 times daily or as directed by the doctor, Do not stop taking this drug without a doctor's order, It may take up to 3 weeks before this drug will take its full effect, Report any adverse effects of this drug to the doctor, To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position, Eat dietary fiber, exercise, and drink enough water in case of constipation
• Melatonin sleep aid supplement

  • Headache, Dizziness, Nausea, Daytime drowsiness, Vivid dreams or nightmares, Short-term feelings of depression, Irritability, Stomach cramps, Diarrhea, Constipation, Decreased appetite, Urinary incontinence at night, Increased risk of falls, Increased risk of seizures, Confusion or disorientation, Mood swings, Reduced alertness
• Nursing responsibilities for melatonin


  • Advise patient not to drive or use machinery within five hours of taking melatonin, Melatonin can interact with some types of medicine, Pregnant women should consult first with their doctor before taking this supplement, Those with bleeding disorders, depression, hypertension, seizure disorders, transplant recipients should check first with their doctors if it is safe for them to take this supplement, Melatonin might lower blood sugar levels, Melatonin can increase the activity of the immune system, Remind those who are taking anticoagulants not to combine melatonin with anticoagulants
• Anxiety


  A feeling of worry, unease, or nervousness that varies from mild to severe
• Causes of anxiety


  • Environmental stressors, Genetics, Medical factors, such as symptoms of a different disease, effects of medication, Brain chemistry, Withdrawal from an illicit substance
• Symptoms of anxiety


  • Restlessness, and feeling of being "on-edge", Uncontrolled feelings of worry, Increased irritability, Concentration difficulties, Sleep difficulties, such as problems in falling or staying asleep
• Pharmacotherapy for anxiety

  Use of medications to treat anxiety
• Antidepressants (Serotonin Reuptake Inhibitors - SSRIs) used to treat anxiety

  • Fluoxetine (Prozac), Citalopram (Celexa)
• Side effects of SSRIs

  • Fatigue, Nausea, Sexual dysfunction, Agitation, Drowsiness, Weight gain, Diarrhea, Insomnia, Nervousness, Headaches, Dry mouth, Increased sweating, SSRI withdrawal (Extreme depression, Fatigue, Irritability, Anxiety, Flu-like symptoms, insomnia)
• Nursing responsibilities for SSRIs

  • Antidepressants can make depression worse rather than better in some people. Monitor patient closely for changes in behavior, mood, and suicidal thoughts, Assess patient for allergies, Limit drug access if patient is suicidal to decrease the risk of overdose to cause harm, Establish suicide precautions for severely depressed patients, Suggest that the patient use barrier contraceptives to prevent pregnancy while taking this drug
• Being "on-edge"


  Uncontrolled feelings of worry
• Symptoms of being "on-edge"

  • Increased irritability
  • Concentration difficulties
  • Sleep difficulties, such as problems in falling or staying asleep
• PHARMACOTHERAPY FOR ANXIETY


  • ANTIDEPRESSANTS (SEROTONIN REUPTAKE INHIBITORS ) SSRI
  • BENZODIAZEPINES
  • BETA-BLOCKERS
  • BUSPIRONE