Lecture Notes: Mental Health and Medication Management

Stevens-Johnson Syndrome and Lamotrigine

• Limictrine (Lamotrigine): Can cause Steven Johnson's syndrome, a serious skin reaction.

Depression

• Symptoms: Sleeping more, anhedonia (loss of pleasure).
• Suicidal Thoughts: Assess the plan and intent to act.

Medication Management

• Fluoxetine Use: "Mood is so much better, I stopped taking it."
  • Action: Assess suicide risk, monitor anxiety and vitals, notify doctor.
• Fluoxetine for Autism Disorder: Decreases anxiety and increases peer interaction.
• Medications for Hopelessness and Anxiety: Fluoxetine.
• Phenelzine (MAOI) Discharge Teaching:
  • Avoid tyramine-rich foods.
  • Monthly BP checks.
  • Monitor OTC meds and sleeping habits.
• Selegiline (MAOI) Adverse Effects: Hypertensive crisis.
• Lithium:
  • Toxicity above 1.5 requires seizure precautions and fluids.
  • Teach to maintain salt intake and fluids, manage weight (may gain 5lbs in the first week).
• Clozapine (2nd Gen Antipsychotic): Monitor WBC.
• Sertraline Discharge Teaching:
  • Weight gain.
  • Takes 2-4 weeks for therapeutic effect.
  • Monitor for suicidal thoughts.

Oppositional Defiant Disorder (ODD)

• Long-term Goals:
  • CBT and medications.
  • Safe environment.
  • Consistent limits and expectations.
  • Follow through with consequences.
  • Include activities.

Alcohol Withdrawal

• Symptoms: Nystagmus, altered gait, confusion, sluggishness.
• Treatment: Administer tyramine.

Anorexia and Purging

• Weight Gain Struggles: Monitor bathroom use.

Hypertension

• Effect on Sexual Health: Decreases sex drive, avoid Viagra.

Hostility

• Approach: Calm demeanor.

Anxiety Disorders

• Agoraphobia:
  • Treatment: Exposure therapy.
  • Note: No medication.
• Panic Attack Reduction:
  • Deep breathing.
  • Dim lights.
  • Stay and walk with the person.

Factitious Disorder

• Characteristics:
  • Demands specific treatments.
  • Limited family interaction.
  • Knowledgeable about medical jargon.

Abuse and Safety

• Questions to Ask:
  • "Are there guns in the house?"
  • "Have they ever hurt you?"
  • "Do you have resources?"

Substance Use Disorders

• Disulfiram: Stops alcohol consumption.
• Lorazepam: For detox with symptoms of bugs crawling and diaphoresis.
• Amphetamine Overdose: Monitor BP.

Mental Health Disorders

• Bipolar Disorder (Manic Phase):
  • Vulgar behavior requires boundary setting and limits.
• Borderline Personality Disorder:
  • Priority interventions: Monitor self-injurious behaviors and suicide risk.
• Conversion Disorder:
  • Symptoms relieve anxiety, present neurological issues (e.g., blind, deaf).
• Somatic Symptom Disorder: Often seen as hypochondriasis.

Schizophrenia

• Childhood Events: Triggers and genetics can affect onset.
• Symptoms Management: Improvement with symptom control.
• Command Hallucinations: Ask the patient what they are hearing.
• Neologism: Use of made-up words.
• Restlessness: May be Extra-Pyramidal Symptoms (EPS).

Conduct Disorder

• Behavioral Example: Pulling on a dog's ear for fun.
• Disruptive Child: Conversation and timeout in a calm, quiet area.

Electroconvulsive Therapy (ECT)

• Pre-ECT:
  • NPO, hold meds.
  • Teach about possible short-term memory loss.
• Post-ECT:
  • Monitor for memory loss, increased temperature, and pain.

Professional Boundaries

• Crossing Boundaries: Giving advice, inappropriate physical closeness (e.g., sitting on bed).

Other Treatments

• ACT Team:
  • For rural areas.
  • Similar to home health, involves monthly medication scheduling.
• Vagal Nerve Stimulation (VNS): No memory loss reported.