Addiction & Withdrawal
A patient with alcohol use disorder has AST levels twice as high as ALT. What does this lab pattern suggest?
chronic alcohol use?
- An AST:ALT ratio of approximately 2:1 is commonly associated with chronic alcohol-related liver injury
A patient started on an SSRI reports increased agitation, sweating, and tremors after adding St. John’s Wort. What condition is suspected?
Serotonin syndrome
- Combining serotonergic agents increases serotonin to toxic levels. Symptoms include hyperreflexia, agitation, diaphoresis, and autonomic instability. This is a medical emergency.
This therapy focuses on restructuring negative thought patterns.
Cognitive Behavioral Therapy (CBT)
- CBT targets cognitive distortions contributing to mood disorders.
A patient presents with depressive symptoms. The nurse plans to administer the GAD-7. What is the purpose of this tool?
Screen for generalized anxiety disorder severity
- The GAD-7 is a clinical screening tool used to assess the severity of anxiety symptoms. It helps determine whether monitoring, referral, or treatment is indicated
Low serotonin and norepinephrine are most associated with this mood disorder subtype.
What is major depressive disorder?
A patient receiving methadone maintenance therapy becomes drowsy with a respiratory rate of 8/min. What is the priority intervention?
Administer naloxone
- Respiratory depression is life-threatening. Naloxone reverses opioid effects. Airway and breathing are priority
A patient taking lithium reports nausea, tremors, and confusion. The lithium level is 1.8 mEq/L. What is the priority action?
Hold the lithium and notify the provider
- Therapeutic range is 0.6–1.2 mEq/L. Levels above 1.5 indicate toxicity. Neurologic symptoms signal worsening toxicity that can lead to seizures.
This treatment is indicated for severe depression with psychotic features and rapid symptom relief is required.
Electroconvulsive Therapy (ECT)
- ECT is effective for treatment-resistant or psychotic depression.
Flat affect is characterized by what?
Minimal emotional expression
- Common in severe depression or schizophrenia.
This neurotransmitter is linked to reward and motivation.
Dopamine
- Central to addiction and pleasure pathways.
A patient withdrawing from alcohol reports tremors, anxiety, and diaphoresis 6 hours after last drink. What is the priority nursing action?
Assess using CIWA-Ar and prepare to administer a benzodiazepine
- Assessment using CIWA-Ar determines severity and medication need. Treating early prevents life-threatening complications. Benzodiazepines enhance GABA activity and are first-line treatment.
A patient taking an MAOI eats aged cheese and develops a severe headache and hypertension. What is occurring?
Hypertensive crisis
- Tyramine-containing foods with MAOIs cause excessive norepinephrine release, leading to severe hypertension
Temporary memory loss after ECT is classified as what?
An expected side effect
- Short-term confusion and memory impairment are common and transient.
A patient scores 16 on the GAD-7. What does this indicate?
Severe anxiety that requires treatment
- A score of 15 or higher indicates severe symptoms that warrant evaluation and likely intervention
This neurotransmitter increases alertness and energy.
Norepinephrine
- Low levels are linked to fatigue in depression.
A patient with long-term benzodiazepine use abruptly stops taking the medication and develops tremors, anxiety, and tachycardia. What is the priority concern?
Risk for seizures
- Benzodiazepine withdrawal can be life-threatening due to CNS hyperexcitability. Abrupt cessation removes GABA enhancement, leading to seizure risk
A depressed patient reports improved energy but continues to express hopelessness after 2 weeks on an SSRI. Why is this concerning?
Increased suicide risk
- Energy improves before mood. Patients may now have the motivation to act on suicidal thoughts. Close monitoring is essential during early treatment
This therapy uses magnetic stimulation to target mood centers in the brain
Transcranial Magnetic Stimulation (TMS)
- TMS stimulates the prefrontal cortex to improve depression.
Before diagnosing major depressive disorder, what medical condition must be ruled out?
Hypothyroidism
- Thyroid dysfunction mimics depressive symptoms. Test medical causes before psychiatric diagnosis
Alcohol enhances this neurotransmitter, leading to CNS depression.
GABA
- Alcohol potentiates inhibitory GABA activity
A patient treated for alcohol withdrawal suddenly develops severe hypertension, agitation, and hallucinations 48 hours after last drink. What complication is occurring?
Delirium tremens
- DTs typically occur 48–72 hours after cessation and are life-threatening due to autonomic instability. This requires ICU-level monitoring and aggressive benzodiazepine treatment
A patient taking TCAs has a widened QRS on EKG. What complication is likely?
Cardiac arrhythmia
- TCAs block sodium channels and can cause lethal arrhythmias
Prescription digital therapeutics primarily aim to address what healthcare gap?
Limited access to mental health providers
- PDT expands treatment access, especially in underserved areas.
A patient with depressive symptoms reports fatigue and weight changes. Before attributing this to a mood disorder, what needs to be done first?
Rule out underlying medical conditions
- Mood changes may be secondary to thyroid dysfunction, vitamin deficiencies, chronic pain, or hormonal imbalance. Medical causes must be assessed before confirming psychiatric diagnosis
Excess dopamine in the mesolimbic pathway contributes to what symptoms?
Psychotic symptoms
- Hallucinations and delusions are dopamine-mediated