Suicidality and risk factors
The major factor(s) contributing to the rising suicide rate in men.
Substance use disorders, aggression, hopelessness, emotion-focused coping, social isolation, and lack of purpose in life have been associated with suicidal behavior in men
You should avoid these types of foods when taking an MAOI
What are tyramine-rich foods. (aged cheese, beer, red wine).
Some MAOIs: Isocarboxazid, phenelzine, selegiline, tranycypromine
What happens if they take an MAOI and eat tyramine rich foods?
Differences between 1st gen and 2nd gen antipsychotics
1st gen: Heavily focused on dopamine receptors aka dopamine receptor antagonists
example: Thorazine (Chlorpromazine) hits H2 (Histamine), D2 (Dopamine), and M1 receptors (Muscarinic) (The H2 and M1 are related to its anti-emetic effects, D2 is also indicated here)
2nd gen: Broader target hits both dopamine and serotonin, has fewer/less severe side effects, less likely to have EPS etc.
example: Olanzapine (Zyprexa) hits 5-HT2 (serotonin) and D2 (Dopamine)
List some of the main neurotransmitters involved in depression
What are serotonin, dopamine, norepinephrine
These things should be included in the documentation of suicide risk
What are presence or absence of suicidal thoughts, intent, plan, availability of means, any denial, and use of substances 6 hours before the assessment
The therapeutic window for Lithium is??
1-1.5 mEq/L for acute and 0.6-1.2 mEq/L for chronic
Medications we can expect to administer to a patient with parkinsonism
What is an anticholinergic
We do this because taking a medication that artificially lowers Dopamine effectively causes a rise in acetylcholine, leading to the symptoms we see.
What are some things you may want to educate a patient with insomnia on?
The first thing we want to do is instruct them to keep regular bedtimes and rising times. We may want to encourage stimulus control (not watching tv before bed etc)
This is the priority assessment for depressed patients
What is suicide risk assessment and or assessing for thoughts of self harm
We have a patient on lithium who is working out and sweating profusely, this might be a concern
What is Lithium toxicity. We need to recommend to our patient, when sweating a lot they should INCREASE their salt intake. Hyponatremia can lead to lithium toxicity.
"Hot as a hare, blind as a bat, mad as a hatter, dry as a bone"
Anticholinergic crisis
Signs and Symptoms of Anticholinergic Crisis Neuropsychiatric signs: confusion; recent memory loss; agitation; dysarthria; incoherent speech; pressured speech; delusions; ataxia; periods of hyperactivity alternating with somnolence, paranoia, anxiety, or coma Hallucinations: accompanied by “picking,” plucking, or grasping motions; delusions; or disorientation Physical signs: nonreactive dilated pupils; blurred vision; hot, dry, flushed skin; facial flushing; dry mucous membranes; difficulty swallowing; fever; tachycardia; hypertension; decreased bowel sounds; urinary retention; nausea; vomiting; seizures; or coma
Describe narcolepsy
an overwhelming urge to sleep. Can happen at inappropriate times (driving a car, working, etc)
This psychotic disorder includes a mood disorder and there places the patient at higher risk for suicide
What is schizoaffective disorder
This is the therapeutic range for divalproex sodium (Depakote)
What is 50-150 ng/mL
Describe the difference between Disulfiram (Antabuse) and Naltrexone
Antabuse: Is an adjunct therapy....it causes severe symptoms with even small amounts of alcohol
Naltrexone: Helps eliminate cravings
What is a major potential contributor to substance abuse disorder?
Genetics.
A person with bipolar disorder is more at risk for suicide when experiencing this/these symptoms
What are depression and or mania
These are side effects in Lithium toxicity
<1.5 mEq/L
Mild side effects
Metallic taste in mouth
Fine hand tremor (resting)
Nausea
Polyuria
Polydipsia
Diarrhea or loose stools
Muscular weakness or fatigue
Weight gain
Edema
Memory impairments
1.5–2.5 mEq/L
Moderate toxicity
Severe diarrhea
Dry mouth
Nausea and vomiting
Mild to moderate ataxia
Incoordination
Dizziness, sluggishness, giddiness, vertigo
Slurred speech
Tinnitus
Blurred vision
Increasing tremor
Muscle irritability or twitching
Asymmetric deep tendon reflexes
Increased muscle tone
Look at table 22.1 for more details
note: a fine tremor is a possible normal side effect
What medication is administered during an opioid overdose
Naloxone
note: be mindful of the difference between Naltrexone and Naloxone, both are opioid antagonists but Naloxone is the one used during an overdose
This life-threatening pulmonary issue can happen with clozapine
What is a pulmonary embolism.
s/s: DIB, chest pain, hemoptysis, sense of impending doom etc.