UNIT 19 Psychotropic Agents

Key Terms Adrenergic Affective Anticholinergic Anxiolytic Bioavailability Catecholamine Dopamine Endogenous Extrapyramidal Limbic system Norepinephrine Orthostatic hypotension Serotonin Tyramine

Causes of Mental Illness Exact causes unknown Contributing factors Genetics Environment Drugs Biochemical changes

Stress Common stressors Money Illness School Peer pressure Birth Death Crime Relationships (continues)

Stress Financial costs 14% of all occupational disease claims are stress related Approximately $34 billion annually (continues)

Stress Physical costs Immune system dysfunction Cancer Hypertension Heart disease Ulcers Migraine headaches

Common Stressors for the Older Adult Increased cost of living Decrease in income Health problems Loneliness/death of spouse Loss of physical or mental abilities

Ways to Reduce Stress Make a budget Take control over situations Get help Healthy lifestyle Find time for yourself Think positive, but be realistic Emotional fitness Get a pet (continues)

Ways to Reduce Stress Discussion Questions: What are some ways that you use to reduce stress? What could you do to help patients deal with stress?

Symptoms of Stress in Children Vary with age Toddlers: inactivity, stomachaches School-age: decline in school, refusal to take part in activities Adolescents: withdrawal, change in sleep or eating habits, frequent thoughts of suicide (continues)

Symptoms of Stress in Children Warning! Suicidal thoughts seen frequently in adolescents, occasionally in school-age children. School-age child may not realize permanence of death. May want to “visit Grandma in heaven” May consider suicide to punish parents (continues)

Symptoms of Stress in Children Discussion Questions: How should you respond if a child talks about suicide? How should you respond if a teenager talks about suicide?

Psychotropic Drugs Affect psychic function, behavior, or experience Antianxiety (anxiolytic) Antidepressant Antimanic Antipsychotic (neuroleptic)

Benzodiazepines Most widely prescribed for anxiety Suppress response to conflict or aggression May cause physical and psychological dependence Did you know? Many of the generic names for benzodiazepines end in –am. This may help you to recognize these drugs when you encounter them.

Antidepressants Indicated when depression interferes with ability to function properly Affective disorder: disturbance of mood, with manic or depressive syndrome

Symptoms of Depression Helplessness Worthlessness Guilt and sadness Sleep changes Weight or appetite changes Loss of interest/pleasure in activities Restlessness or irritability Thoughts of death

Antidepressant Agents SSRIs SNRIs TCAs MAOIs Lithium carbonate Atypical antipsychotics Miscellaneous drugs (continues)

Antidepressant Agents Did you know? Tofranil (imipramine hydrochloride) is used to treat bedwetting in children. (continues)

Antidepressant Agents Warning! FDA has requested additional suicide warnings on labels for Lexapro Luvox Remeron Wellbutrin Effexor Celexa Prozac Paxil Zoloft

SSRIs Block reabsorption of serotonin Includes Prozac, Zoloft, and Luvox Contraindicated for use with MAOIs Potentially fatal reactions

SNRIs Inhibit the reuptake of serotonin and norepinephrine Includes Effexor Warning! Serotonin syndrome can result in patients taking triptans and SSRIs or SNRIs concomitantly. Careful observation is warranted. Common symptoms include restlessness, hallucinations, coma, loss of coordination, nausea, vomiting, diarrhea, fast heartbeat, rapid changes in blood pressure, increased body temperature, and overactive reflexes.

Tricyclic Antidepressants Three-ring (tricyclic) structure Raise the levels of norepinephrine and serotonin More likely to relieve endogenous depression Includes Tofranil and Pamelor Adverse actions include anticholinergic and alpha-adrenergic blocking activities, orthostatic hypotentions

MAOIs Block breakdown of norepinephrine and serotonin Numerous contraindications Must follow strict diet Effects last for 2 weeks after discontinuance Includes Nardil and Parnate (continues)

MAOIs Warning! Patients taking MAOIs must be monitored for signs of hypertensive crisis. If marked hypertension develops, drug should be discontinued and measures should be taken to reduce blood pressure.

Antimanic Agents Bipolar disorder Lithium commonly used for treatment Three types Manic Depressive Mixed

Lithium Does not produce sedation Alters sodium transport Used for prophylaxis and treatment Contraindications Renal disease Cardiovascular disease Severe dehydration Pregnancy Severe debilitation

Laboratory Testing for Lithium Lithium levels Monthly during maintenance Two to three times weekly during acute manic phase Warning! Inform patient and family of signs of lithium intoxication. If signs are present, discontinue medication and contact physician.

Antipsychotic Agents Include Risperdol and Zyprexa Adverse effects Drowsiness Dry mouth Constipation Urinary retention Blurred vision Dizziness EPS

EPS Appear to be dose related Includes Dystonia Akathisia Pseudo-Parkinsonism Tardive dyskinesias

Patient Teaching or Antipsychotic Agents Avoid UV rays Balanced diet Adequate fluids Avoid alcohol and CNS depressants Take as ordered