Review Exam 1 - Mental Health Notes

Psych Review Exam #1 Rights of the Patient with Mental Illness 1. Patients have the right to refuse medication unless they pose a danger to themselves or others 2. The right to the least restrictive treatment (seclusion  restricted to an area even if the doors are open. If isolated for more than 30mins is considered seclusion) 3. The right to be released/discharged if not dangerous to self or others  If the patient wants to leave the facility (self-discharge), as a nurse, you first need to talk to the patient to find out why they want to leave the facility (you need to assess objective and subjective data). Then, you call the Dr. to report what the patient wants and to inform him about your observation of the patient current mental status as well as the reason why the patient wants to leave (you need to collect the info first). As an RN, you cannot let the patient go even if it is their will because the person may be dangerous to himself and/or others (i. e; may commit suicide)  Legally, the person can request to be discharged (they need to have been voluntarily admitted); however, if the person has a court order (Baker acted), they have to stay in the hospital and will not be allowed to leave under any circumstances unless capable to Ethical Dilemmas When faced with ethical dilemmas there is no right or wrong answer. It is important to have some sense of your own believes, values, moral, attitudes to come out with a solution. Gather subjective and objective information to help you make an ethical decision Ex. A 95 y/o pt is very ill and wants to see his son who has not seen for 30 years before he dies. You call the son who refuses to see his father, what would you say to the patient? TAKING NO ACTION IS CONSIDERED AN ACTION TAKEN Ethics: the science that deals with the rightness and wrongness of actions Values: ideals or concepts that give meaning to the individual’s life Moral Behavior: conduct that result from serious critical thinking about how individuals ought to treat others (moral behaviors are based on values) Model for Making Ethical Decisions 1. 2. 3. 4. 5. Assessment (Before making a decision, you need to gather data (subjective & objective) Problem Identification Plan Implementation Evaluation Stress – Symptoms, Responses, Adaptive/Maladaptive Behavior Anxiety and Grief have been described as the two major, primary psychological response patterns to Stress Adaptation is determined by the extent to which the thoughts, feelings, and behaviors interfere with an individual’s functioning Bad behaviors related to the thoughts and feelings in not socially accepted, but if the feelings and thoughts are put into words, it is accepted as a good behavior Anxiety: is a diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness. Very common in our society Adaptive Behavior  Exercise  Breathing Techniques  Relaxation (music, read) Maladaptive Behavior  Smoking, Overeating  Sleeping too Much or too Little  Drinking Anxiety – Symptoms at Mild, Moderate, Severe and Panic Levels Peplau’s Four Level of Anxiety 1. Mild It is good because it motivates, rarely a psychological or physical problem. Learning is enhanced. It is adaptive  Restlessness, irritability  May remain superficial with others  Rarely experienced as distressful  Motivation is increased 2. Moderate  Your perceptual field diminishes. Learning still occurs, but not at optimal ability. Decreased attention span. Decreased ability to concentrate, part of the room may not be noticed  Increased restlessness  Increased heart rate, respiration rate and perspiration  Gastric discomfort, increased muscular tension  Increase in speech rate, volume and pitch  A feeling of discontent, someone talking may not be heard 3. Severe  Your perceptual field is greatly diminished that only extraneous details are perceived or fixation on a single detail may occur. May notice an event when attention is directed by another  Extremely limited attention span  Unable to concentrate or problem solve  Effective learning cannot occur  Headaches, dizziness, nausea, trembling, insomnia, palpitations, tachycardia, hyperventilation, urinary frequency, diarrhea  Feelings of dread, loathing and horror 4. Panic  Unable to focus on even one detail within the environment. Misperception of the environment, common perceived detail may be elaborated and out of proportion  Learning cannot occur, unable to concentrate  Unable to comprehend even simple directions  Dilated pupils, labored breathing, severe trembling, sleeplessness, palpitations, diaphoresis and pallor, muscular incoordination, immobility or purposeless hyperactivity, incoherence or inability to verbalize  Terror, bizarre behavior, including shouting, screaming, running about wildly, clinging to anyone or anything from which a sense of safety and security is derived. Hallucinations, delusions, extreme withdrawal into self Grief: is the subjective state of emotional, physical, and social responses to the loss of a valued entity; the loss may be real or perceived Elisabeth Kubler-Ross Five Stages of Grief 1. 2. 3. 4. 5. Denial Anger Bargaining Depression Acceptance Defense Mechanisms At the mild to moderate level, the Ego calls on defense mechanisms for protection, such as… Compensation is the covering up of a real or perceived weakness by emphasizing a trait one considers more desirable Ex. A handicapped boy who is unable to participate in sports compensates by becoming a great scholar Denial  is the refusal to acknowledge the existence of a real situation or the feelings associated with it Displacement  is the transferring of feelings from one target to another that is considered less threatening or neutral Ex. A boy who is teased and hit by the class bully on the playground comes home after school and kicks his dog Identification  is an attempt to increase self-worth by acquiring certain attributes and characteristics of an individual one admires Ex. The young son of a famous civil rights worker adopts his father’s attitudes and behaviors with the intent of pursuing similar aspirations Intellectualization  is an attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis Ex. A man whose brother is in ICU spends his visiting hours discussing with the RN tests results, and making reasonable determination about what might have caused his brother to end up in ICU Introjection  is the internalization of the beliefs and values of another individual such that they symbolically become a part of the self to the extent that the feeling of separateness or distinctiveness is lost Ex. A psychiatric client claims to be the Son of God, drapes himself in sheet and blanket, “performs miracles” on other clients, and refuses to respond unless addressed as Jesus Christ Isolation  is the separation of a thought or a memory from the feeling tone or emotions associated with it (sometimes called emotional isolation) Ex. A young woman describes being attacked and raped by a street gang. She displays an apathetic expression and no emotional tone Projection  projecting your feelings onto someone else, placing blame on others Ex. A businessperson who values punctuality is late and blames the secretary for not reminding him Rationalization  having an excuse, explanation to justify an unacceptable feeling or behavior Ex. A woman is turned down for a secretarial job after a poor performance on a typing test. She claims, “I’m sure I could have done a better job on a word processor hardly anyone uses electric type writers anymore” Reaction Formation  is the prevention of unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behavior Ex. A person that does not like kids and becomes a pre-k teacher Regression  going back to a previous time Ex. Toilet trained toddler, after a new sibling begins to wet the bed Repression  is the involuntary blocking of unpleasant feelings and experiences from ones awareness Ex. A woman cannot remember being sexually assaulted when she was 15 years old Sublimation  take a potentially negative situation and turn it into something positive, productive Ex. Angry at boss and want to hit him in the face, but instead goes home and hit a tennis ball Suppression  is the voluntary blocking of unpleasant feelings and experiences from one’s awareness Ex. A young woman who is depressed about getting divorce tells you “I just don’t want to talk about it, there’s nothing I can do anyways” Undoing  believing that by doing something right it will undo the wrong already done Stages of Development / Personality Development – Freud, Erickson, Piaget, Maslow Psychoanalytic Theory – Freud Freud believed that basic character was formed by age 5 years. He organized the structure of the personality into three major components  Id  pleasure seeker at the expense of anyone or anything, instant gratification, is what I want and I want it now, low tolerance level. Id-driven behaviors are impulsive and may be irrational. Social and cultural acceptability are not considered, “if it feels good, do it”  Ego  rational, balance, mediator between the id and the superego. An effort is made to delay gratification and to satisfy societal expectations  Superego  conscience, feeling guilty, the perfection principle. Behaviors are uncompromising and rigid. They are based on morality and society’s values. Behaviors strive for perfection. Violation of the superego’s standards generates guilt and anxiety in an individual who has a strong superego. Development of Personality by Freud  Oral Stage (birth to 18 months)  Behavior is directed by the id, and the goal is immediate gratification of needs. The focus of energy is the mouth, with behaviors that include sucking, chewing, and biting. The infant feels a sense of attachment and is unable to differentiate the self from the person who is providing the mothering. Relief from anxiety through oral gratification needs  Anal Stage (18 months to 3 years)  The major task is gaining independence and control, with particular focus on the excretory function. When toilet training is strict and rigid, the child may choose to retain the feces, becoming constipated. Toilet training that is more permissive and accepting attaches the feeling of importance and desirability to feces production. The child becomes extroverted, productive, and altruistic  Phallic Stage (3 to 6 years)  The focus of energy shifts to the genital area. Discovering the differences between genders results in a heightened interest in the sexuality of self and others. The interest may be manifested in sexual self exploratory or groupexploratory play. Identification with parent of same sex, development of sexual identity, focus on genital organs  Latency Stage (6 to 12 years)  The focus now is shifted from egocentrism to more interest in group activities, learning, and socialization with peers. The preference is for the same-sex relationships, even rejecting members of the opposite sex  Genital Stage (13 to 20 years)  The maturing of the genital organs results in a reawakening of the libidinal drive. The focus is on relationships with members of the opposite sex and preparations for selecting a mate Theory of Psychosocial Development – Erikson Is based on the influence of social processes on the development of the personality Stages of Development  Trust vs Mistrust (birth to 18 months)  The major task is to develop a basic trust in the mothering figure and learn to generalize that to others. The infant learns to trust when basic needs are met consistently  Autonomy vs Shame and Doubt (18 months to 3 years)  The major task is to gain selfcontrol and independence within the environment. Autonomy is achieved when parents encourage and provide opportunities for independent activities  Initiative vs Guilt (3 to 6 years)  The goal is to develop a sense of purpose and the ability to initiate and direct one’s own activities. Initiative is achieved when creativity is encouraged and performance is recognized and positively reinforced  Industry vs Inferiority (6 to 12 years)  The major task is to achieve a level of selfconfidence by learning, competing, performing successfully, and receiving recognition from significant others, peers, and acquaintances. Achievement of the task results in a sense of satisfaction and pleasure in the interaction and involvement with others. Industry is achieved when encouragement is given to activities and responsibilities in the school and community, as well as those within the home, and recognition is given for accomplishment  Identity vs Role Confusion (12 to 20 years)  The goal is to integrate the tasks mastered in the previous stages into a secure sense of self. Parents should be available to offer support when needed but should gradually relinquish control to the maturing individual in an effort to encourage the development of an independent sense of self  Intimacy vs Isolation (20 to 30 years)  The objective is to form an intense, lasting relationship or a commitment to another person, a cause, an institution, or a creative effort. The intimacy goes far beyond the sexual contact between two people. It describes a commitment in which personal sacrifices are made for another, whether it be another person or, if one chooses a career or other type of cause to which the individual elects to devote his or her life  Generativity vs Stagnation (30 to 65 years)  The major task is to achieve the life goals established for oneself while also considering the welfare of future generations. Generativity is achieved when the individual expresses satisfaction with this stage in life and demonstrates responsibility for leaving the world a better place on which to live  Ego Integrity vs Despair (65 years to death)  The goal is to review one’s life and derive meaning from positive and negative events, while achieving a positive sense of self Cognitive Development – Piaget Is based on the premise that human intelligence is an extension of biological adaptation, or one’s ability for psychological adaptation to the environment He identifies four stages of development that are related to age, demonstrating at each successive stage a higher level of logical organization than at the previous stage  Sensorimotor (birth to 2 years)  With increased mobility and awareness, development of a sense of self as separate from the external environment, the concept of object permanence emerges as the ability to form mental images evolves  Preoperational (2 to 6 years)  Learning to express self with language, development of understanding of symbolic gestures, achievement of object permanence  Concrete Operations (6 to 12 years)  Learning to apply logic to thinking, development of understanding of reversibility and spatiality, learning to differentiate and classify, increased socialization and application of rules  Formal Operations (12 to 15+ years)  Learning to think and reason in abstract terms, making and testing hypotheses, capability of logical thinking and reasoning expand and are defined, cognitive maturity achieved Maslow’s Hierarchy of Needs Maslow emphasized and individual’s motivation in the continuous quest for self-actualization. An individual’s position within the hierarchy may reverse from a higher level to a lower level based on life circumstances Maslow describes self-actualization as being “psychologically healthy, fully human, highly evolved, and fully mature”. 1. Self-Actualization: the individual possesses a feeling of self fulfillment and the realization of his or her highest potential 2. Self-Esteem/Esteem of Others: the individual seeks self-respect and respect from others, works to achieve success and recognition in work, and desires prestige from accomplishment 3. Love and Belonging: needs are for giving and receiving of affection, companionship, satisfactory interpersonal relationships, and identification with a group 4. Safety and Security: needs at this level are for avoiding harm, maintaining comfort, order, structure, physical safety, freedom from fear, and protection 5. Physiological Needs: basic fundamental needs include food, water, air, sleep, exercise, elimination, shelter, and sexual expression Role of the Psychiatric Nurse vs an ARNP Nurses: can do counseling, teaching, advocating ARNP: can provide psychotherapy, admits and discharges pts, able to prescribe meds Therapeutic Communication (Feedback, Silence, Empathy) vs Non Therapeutic Communication Techniques Therapeutic Communication Techniques  Using Silence: it allows the client to take control of the discussion, if he or she desires. The nurse can be silent, or the patient or both  Accepting: conveys positive regard  Giving Recognition: acknowledging, indicating awareness  Offering Self: making oneself available  Giving Broad Openings: allows client to select the topic of conversation  Offering General Leads: encourages client to continue  Placing the Event in Time or Sequence: clarifies the relationship of events in time  Making Observations: verbalizing what is observed or perceived  Encouraging Description of Perceptions: asking client to verbalize what is being perceived  Encouraging Comparison: asking the client to compare similarities and differences in ideas, experiences, or interpersonal relationships  Restating: lets client know whether an expressed statement has or has not been understood  Reflecting: directs questions or feelings back to client so that they may be recognized and accepted  Focusing: taking notice of a single idea or even a single word  Exploring: delving further into a subject, idea, experience, or relationship  Seeking Clarification and Validation: striving to explain what is vague and searching for mutual understanding  Presenting Reality: clarifying misconceptions that client may be expressing  Voicing Doubt: expressing uncertainty as to the reality of client’s perception  Verbalizing the Implied: putting into words the feelings the client has expressed only indirectly  Formulating a Plan of Action: striving to prevent anger or anxiety from escalating to an unmanageable level the next time the stressor occurs  Empathy: Ex. I see you may be having a difficult time (don’t feel bad for the person, don’t show sympathy)  Feedback: it is based on perception of the other person’s behavior or action, it is not evaluative, and it is therapeutic  Feedback is useful when is descriptive rather than evaluative and focused on the behavior rather than on the client  It’s specific rather than general  It’s directed towards behavior that the client has the capacity to modify  Imparts information rather than offers advice  It’s well timed  Another therapeutic technique is to help the person put their thoughts/experiences into feeling as oppose to telling them what to do Nontherapeutic Communication Techniques  Giving Reassurance: may discourage clients from further expression of feelings if client believes the feelings will only be belittled  Rejecting: refusing to consider client’s ideas or behavior  Giving Approval or Disapproval: implies that the nurse has the right to pass judgment on the “goodness” or “badness” of client’s behavior  Agreeing/Disagreeing: implies that the nurse has the right to pass judgment on whether client’s ideas or opinions are “right” or “wrong”  Giving Advice: implies that the nurse knows what is best for client and that client is incapable of any self-direction  Probing: pushing for answers to issues the client does not wish to discuss causes client to feel used and valued only for what is shared with the nurse  Belittling Feelings Expressed: causes the client to feel insignificant or unimportant  Making Stereotyped Comments, Clichés, and Trite Expressions: these are meaningless in a nurse-client relationship  Using Denial: blocks discussion with the client and avoids helping him or her identify and explore areas of difficulty  Interpreting: results in the therapist’s telling client the meaning of his or her experience  Introducing an Unrelated Topic: causes the nurse to take over the direction of the discussion Biological Theories of Disease Neurotransmitters play an important role in human emotions and behavior, and are the target for the mechanism of action in many psychotropic medications Depressive Disorders: they manifest with decreased levels of norepinephrine, dopamine, and serotonin Implications for Psychiatric Illness Individuals become more susceptible to physical illness following exposure to a stressful stimulus or life event Evidence exists to support a correlation between psychosocial stress and the onset of illness If an individual has experienced stress for a long period of time, there is a decreased resistance to diseases, as the immune system is suppressed Levels of Care Within the Healthcare Community (Interventions at Each Level) Primary prevention • Primary prevention is defined as reducing the incidence of mental disorders within the population • It is focused on targeting groups at risk and providing educational programs Ex. Doing counseling before getting married • The services are offer in settings that are convenient to the public such as churches, schools, colleges, community centers, YMCA and YWCA, workplace of employee organizations, meeting of women’s group, health fairs and community shelters Secondary Prevention • It deals with reducing the prevalence of psychiatric illness by shortening the course (duration) of the illness • It is accomplished through early identification of problems and prompt initiation of effective treatment and referrals • There is already an existing problem and you do interventions to prevent that it gets worst Ex. If a couple is married and are having marital problems, you recommend counseling • Services can be offered for the followings: o Ongoing assessments on individual at risk for illness exacerbation  during home visits, day care, in community health centers o Provision of care for individuals in whom illness symptoms have been accessed  individual or group counseling, medication administration, education and support during periods of high stress---crisis intervention, staffing rape crisis centers, suicide hotlines, homeless shelters, shelters for abuse women, mobile medical health units o Referrals for treatment of individuals in whom illness symptoms have been accessed: support groups, community mental health centers, emergencies services, psychiatrist or psychologist, and day or partial hospitalization. Tertiary prevention • Reducing the residual defects that are associated with severe and persistent mental illness • It is accomplished by preventing complications of the illness and promoting achievement of each individual’s maximum level of functioning Ex: A person has chronic mental illness and you do rehabilitation so that the condition does not get worst • Nursing in tertiary prevention focus on helping clients learn or relearned socially appropriate behaviors so that they may achieve a satisfying role within the community. • At this level, you also do teaching and referrals---look at samples on pg 749 • Nursing care at the tertiary level of prevention can be administer on an individual or group basis and in a variety of settings such as inpatient hospitalization, day and partial hospitalization, group home or halfway house, shelters, home health care, nursing homes, and community mental health centers. Roles of the Nurse in Various Levels of Care in the Community Case Manager: is the nurse responsible for negotiating with multiple health care providers to obtain a variety of services for the client. The case manager coordinates the person care across the entire spectrum of what is happening in the community Case management has been shown to enhance the client’s functioning by increasing ability to solve problems, improving work and socialization skills, and endeavoring to diminish dependency on others Role of the Nurse in Psychiatry • The role of the psychiatry nurse is to assist the client’s successful adaptation to stressors within the environment • Goals are directed toward change in thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms The Role of Legal Implication Nursing Process Related to Patient’s with Mental Illness The nursing process is the same for mentally ill patients, there is only some differences on how you do the assessment, in which you focus on psychological and social factors, observation of the client and his/her environment, subjective/objective data. The patient is more looked in a holistic way. You also assess for spirituality, learning needs, suicidal thoughts. The most important assessment is to diagnose the level of risk which requires priority, as it can be a lifethreatening potential During the assessment process is when The Mental Status Examination is done Standard 1. Assessment Standard 2. Diagnosis Standard 3. Outcomes Identification Standard 4. Planning Standard 5. Implementation  Standard 5A. Coordination of Care  Standard 5B. Health Teaching and Health Promotion  Standard 5C. Milieu Therapy  Standard 5D. Pharmacological, Biological, and Integrative Therapies  Standard 5E. Prescriptive Authority and Treatment  Standard 5F. Psychotherapy  Standard 5G. Consultation Standard 6. Evaluation Phases in the Nurse-Client Therapeutic Relationship - What Occurs in Each Phase, Nursing Interventions/Actions Pre Interaction Phase: This is before you meet your client. This phase is about collecting information previous to see the client to make sure you know as much as possible about him/her. Obtain information from the chart, significant others or other health team members. The downfall is that you can have preconceived judgments about the patient. Examine one’s own feelings, fears, and anxieties about working with a particular client. The nurse needs to be aware of how these preconceptions may affect her ability to care for individual clients Orientation (introductory) Phase: • • • • • • • • Creates an environment for trust and rapport Establish contract for intervention Gather assessment data from the patient (objective/subjective) Identify client’s strengths and weaknesses Formulate nursing diagnoses Set mutually agreeable goals Develop a realistic plan of action Explore feelings of both client and nurse Interactions may remain on a superficial level until anxiety subsides. Several interactions may be required to fulfill the tasks associated with this phase Working Phase: • • • • • Maintain trust and rapport Promote client’s insight and perception of reality Use problem-solving model to work towards achievement of established goals Overcoming resistance behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues Continuously evaluate progress toward goal attainment  Transference: occurs when the client unconsciously displaces (or “transfers”) to the nurse feelings formed toward a person from the past  This feelings toward the nurse may be triggered by something about the nurses appearance or personality characteristics that remind the client of the person  Transference can interfere with the therapeutic interaction when the feelings being expressed include anger and hostility. Anger towards the RN can be manifested by uncooperativeness and resistance to the therapy  In case of transference the nurse should work with the patient in sorting out the past from the present, and assist the patient into identifying the transference and reassign a new and more appropriate meaning to the current nurse-patient relationship. The goal is to guide the patient to independence by teaching them to assume responsibility for their own behaviors, feelings, and thoughts, and to assign the correct meanings to the relationships based on present circumstances instead of the past  Countertransference: it refers to the nurse’s behavioral and emotional response to the client  These responses may be related to unresolved feelings toward significant others from the nurse’s past or they may be generated in response to transference feelings on the part of the client. The nurse may be completely unaware or only minimally aware of what’s happening  In case of countertrasnference the nurse should be assisted by other staff members to identify her feelings and behaviors and recognize the occurrence of the phenomenon. Termination Phase: • Therapeutic conclusion of relationship occurs when:  Progress has been made towards attainment of the goals  A plan of action for more adaptive coping with future stressful situations has been established  Feelings about termination of the relationship are recognized and explored (the client may feel sad & feel a loss & show behaviors and as a result transference can occur  The RN should use therapeutic closure, by establishing the reality of the separation and resist being manipulated into repeated delays by the patient Cultural Differences and Appropriate (nursing) Interventions/Responses (i.e. Communication, Dietary, etc. Do not assume that all individuals who share a culture or ethnic group are the same. This is stereotyping and should be avoided. A. Communication: How to communicate with someone who does not speak your language and you do not have a translator? o Use body language such as nonverbal communication (hand gestures) o Use simple terms when communicating especially if they have little understanding of the language B. Diet:  Respect cultural differences in regards to food. Ex: special food accommodation. You need to find out dietary preferences (may possibly allow family members to bring food for the patient specially kids) C. Meds  Be sensitive to each cultural perspective of health care practitioner and needs in medication (i. e., folk medicine, healer, curanderos etc.). You may need to bring this people to help the client collaborate with the treatment) D. Strive to gain pt’s trust. Do that by understanding and accommodating to pt’s culture Anti-Anxiety Medications – Neurotransmitter, Side Effects, Patient Education: A) Benzodiazepines: increases GABA neurotransmitter (in limbic system) which decreases excitability; therefore, reducing anxiety B) They are CNS depressant Limbic system = “the emotional brain”, plays an important role in the regulation of human and emotional behaviors, feelings. It is associated with feelings of fear and anxiety, anger, rage, and aggression; love, joy, and hope; and with sexuality and social behaviors        Most of them end in “pam”. Ex: clonazepam, diazepam, oxazepam, *lorazepam (most common), prazepam, alprazolam Work rapidly, approx. 20 to 30mins In order for a person to be detoxified from substances like benzos or alcohol, the pt needs to be given benzo and slowly tapered him/her off of it They should only be used as short term treatment as they are addictive and you can build tolerance The antidote is Romazicone ( ex: pt is at the E.R, semi unconscious, rn finds empty bottle of xanax. Pt must be given antidote Contraindicated in pregnancy, narrow angle glaucoma, shock and coma Caution w/ depressed bc CNS depressants ( like benzo) can exacerbate s/s of depression Side Effects        Dizziness Orthostatic Hypotension (rise slowly from sitting or lying position) Drowsiness, confusion, lethargy ( instruct not to drive, or operate machinery) Tolerance/ dependence (instruct short term use preferred) Aggravating s/s in depressed pts Paradoxical effect Dry mouth, s/s sore throat, fever, malaise, easy bruising (report asap) Benzodiazepine teaching:       Not to stop abruptly due to a high risk for seizure, rebound symptoms (the person may experience more aggravated symptoms from what they had before—the mental illness will come back worse than it was). Take as ordered They work better for short term use They are addictive and you can build tolerance The antidote is Romazicome Don’t take it during pregnancy Paradoxical effects    Paradoxical Effect is when a particular substance does the opposite of what is supposed to do Ex. Coffee an stimulant put you to sleep instead of causing hyperactivity Do not mix with alcohol, narcotics, antidepressants, cimetidine, antihistamines, antipsychotics (it causes CNS depression) bc it increases effects of benzos. They can cause orthostatic hypotension. Caution w/ home remedies like kava, valeria which increases the effects too Stimulants (i.e., coffee) will decrease its effect and any CNS depressant (i.e., alcohol) will enhance the effect B) BuSpar: Although its action is unknown, it is believed to produce its desire effects through interactions with serotonin, dopamine, and other neurotransmitter receptors            Does not causes DEPENDANCE Not a CNS depressant Delayed onset; lag time of 10 days to 2 weeks in order for it to start working. Pt should continue to take BuSpar. MUST ADVICE PT ABOUT LAG TIME. Relief is usually evident within 10 to 14 days Not recommended for prn use because of its delayed therapeutic onset Avoid CNS suppressants like in Benzos Grapefruit juice increases action of BuSpar Caffeine consumption and cigarette smoking can decrease its effect Administer with food always Possibility of aggravating symptoms in depressed patients Said in class: “how do you know that it is effective = by observing the patient less agitated/anxious, and by the patient’s report of being less anxious” Cannot be stopped abruptly as the withdrawal symptoms can be life threatening Note: the person may be very anxious and not show being excited but rather will be very calm and quiet. As a result, you must ask the patient if they feel that their anxiety level has decreased Side Effects: Life threatening: CVA, CHF, MI   Incoordination, tremors, insomnia, paresthesia, Chest pain, stomach discomfort, headache