TREATMENT MODALITIES in PSYCHIATRIC NURSING

A.Pharmaco / Drug Therapy

1. Minor tranquilizers / Anxiolytics

Common Indication: Anxiety Disorders

Example:

- Diazepam (Valium)

- Oxazepam (Serax)

- Chlordiazepoxide (Librium)

- Chlorazepate Dipotassium (Tranxene)

- Alprazolam (Xanax)

C – anti anxiety; muscle relaxant

H – decreased anxiety, adequate sleep

E – best take before meals, food in the stomach

C – delays absorption

K – avoid driving, intake of alcohol and caffeine containing foods, since it alters the effect of the drug

 

2. Trycyclic Antidepressants

Indication : Depression

Examples:

- Imipramine (Tofranil)

- Amitripyline (Elavin)

C – Tricyclic; anti depressants

H – increased appetite; adequate sleep

E – best given after meals

C – therapeutic effects may become evident only 2-3 weeks of intake

K – check the BP, it causes hypotension; check the heart rate, it causes cardiac arithmias

 

3. Anti depressants – MAO inhibitors

Example:

- Tranylcypromide (Parnate)

- Pheneizine (Nardil)

- Isocarboxazid (Marplan)

• antidepressants (MAO inhibitors)

• increased appetite; adequate sleep

• best taken after meals

• report headache; it indicates hypertensive crisis

• avoid tyramine containing foods because toxic when taken with MAO inhibitors, like avocado, banana, cheddar and aged cheese, soysauce and preserved foods.

• It takes 2-3 weeks before initial therapeutic effects become noticeable.

• Monitor the BP. There should be at least a two week interval when shifting from one anti depressant to another.

 

4. Anti Manic Agent:

- cause augmentation of serotonin function in the CNS preventing increase nerve impulse transmission.

Examples:

- Lithium Citrate (Cibalith)

- Lithium Carbonate (Eskalith, Lithane, Lithobid)

• anti manic, decreased hyperactivity

• best taken after meals

• increase fluid intake (3L / day) and sodium intake (3gm / day). Avoid activities that increase perspiration.

• It takes 10-14 days before therapeutic effect becomes evident.

• Antipsychotic is administered during the first 2 weeks to manage the acute symptoms of Mania until Lithium takes affect.

• Monitor serum level

• Nausea, anorexia, vomiting, diarrhea and abdominal cramps indicate lithium toxicity.

• Mannitol is administered if toxicity occurs.

 

5. Major tranquilizers / Anti psychotics

Indication: Schizophrenia

Examples:

- Haloperidol (Haldol)

- Prochioperazine (Comazine)

- Fluphenazine (Prolixin)

- Chlorpromazine (Thorazine)

• anti psychotics

• decreased delusions, hallucinations and looseness of association.

• Best taken after meals

• Report elevated temperature and muscle rigidity (it indicates neuroleptic malignant syndrome)

• Check the BP, the drug causes hypotension

• Assess for akathisia, usually described by patients as I feel I have ants in my pants.

• Assess Tardive Dyskinesia, initially manifested by tongue witching or lip smacking

• Check the CBC, drugs cause leucopenia

 

B.Psychotherapy - is also known as talk therapy because its basic rule is to make client to talk about anything that enters his mind and not to hold back. Freud said that the goal of therapy is simply to make the unconscious conscious.

 

C.Electro convulsive therapy

• It requires a consent.
• Usually given at 70 – 159 volts for about 0.5 – 2 seconds
• It takes 6 – 12 treatments with at least 48 hours interval to notice the effect
• Indicator of effectiveness : tonic – clonic seizure

 

Indications of Use:
a. depression
b. Mania
c. Catatonic Schizophrenia

 

Contraindications (not absolute):
a. fever
b. increased ICP
c. cardiac conditions
d. TB with history of hemorrhage
e. Unhealed fracture
f. Pregnancy

 

Before the procedure:
a. diagnostic procedures like X-ray, ECG
b. drugs given – Atrophine sulfate (decrease secretion), Anectine (relax muscles), Methohexital Na (anesthetic)

 

During the procedure:
- observe for tonic-clonic seizure

 

After the procedure:
a. postion
b. check vital signs
c. re-orient client

 

Watch out for complications:
- memory loss, headache, apnea, fracture, respiratory depression