ELDER TIP A benzodiazepine with a long half-life tends to accumulate in an older patient’s system and may cause oversedation. Benzodiazepines are sometimes given along with opioids to add to the analgesic effect or as a preanesthetic. Remember, if the elderly psychiatric patient is scheduled for surgery, he may take longer to recover from anesthesia if these combinations are used.
Tricyclic antidepressants or higher doses of short-acting benzodiazepines may relieve severe anxiety and panic attacks. Buspirone, an antianxiety drug, causes the patient less sedation and poses less risk of physical and psychological dependence than the benzodiazepines.
Psychotherapy for generalized anxiety disorder has two goals: helping the patient identify and deal with the cause of the anxiety and eliminating environmental factors that precipitate an anxious reaction. In addition, the patient can learn relaxation techniques, such as deep breathing, progressive muscle relaxation, focused relaxation, and visualization.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Delusional disorders:
Treatment
(Handbook of Diseases)
Effective treatment of delusional disorders, consisting of a combination of drug therapy and psychotherapy, must correct the behavior and mood disturbances that result from the patient’s mistaken belief system. Treatment may also include mobilizing a support system for the isolated elderly patient.
Antipsychotic drug therapy
Drug treatment with antipsychotic agents is similar to that used in schizophrenic disorders. Antipsychotics appear to work by blocking postsynaptic dopamine receptors. These drugs reduce the incidence of psychotic symptoms, such as hallucinations and delusions, and relieve anxiety and agitation.
Other psychiatric drugs, such as antidepressants and anxiolytics, may be prescribed to control associated symptoms.
High-potency antipsychotics include fluphenazine, haloperidol, thiothixene, and trifluoperazine. Loxapine, molindone, and perphenazine are intermediate in potency, and chlorpromazine and thioridazine are low-potency agents.
Haloperidol, fluphenazine , and fluphenazine are depot formulations that are implanted I.M. They release the drug gradually over a 30-day period, improving compliance.
Clozapine, which differs chemically from other antipsychotic drugs, may be prescribed for severely ill patients who fail to respond to standard treatment. This agent effectively controls a wider range of psychotic symptoms without the usual adverse effects.
However, clozapine can cause drowsiness, sedation, excessive salivation, tachycardia, dizziness, and seizures as well as agranulocytosis, a potentially fatal blood disorder characterized by a low white blood cell count and pronounced neutropenia.
Routine blood monitoring is essential to detect the estimated 1%to 2% of all patients taking clozapine who develop agranulocytosis. If caught in the early stages, this disorder is reversible.
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Source: Handbook of Diseases, 2003
Personality disorders:
Treatment
(Handbook of Diseases)
Personality disorders are difficult to treat. Successful therapy requires a trusting relationship in which the therapist can use a direct approach. The type of therapy chosen depends on the patient’s symptoms.
Drug therapy is ineffective but may be used to relieve acute anxiety and depression. Family and group therapy usually are effective.
Hospital inpatient milieu therapy can be effective in crisis situations and possibly for long-term treatment for borderline personality disorders. Inpatient treatment is controversial, however, because most patients with personality disorders don’t comply with extended therapeutic regimens; for such patients, outpatient therapy may be more useful.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Anxiety disorder, generalized:
Treatment
(Handbook of Diseases)
A combination of drug therapy and psychotherapy may help a patient with generalized anxiety disorder. Benzodiazepine anxiolytics relieve mild anxiety and improve the patient’s ability to cope. They should be used cautiously, however, because they can be addictive. Buspirone, a nonbenzodiazepine anxiolytic, is an alternative to the benzodiazepines because it causes less sedation and poses less risk of physical and psychological dependence.
Psychotherapy for generalized anxiety disorder has two goals: helping the patient identify and deal with the underlying emotional and psychological issues and eliminating environmental factors that precipitate an anxious reaction. In addition, the patient can learn relaxation techniques, such as deep breathing, progressive muscle relaxation, focused relaxation, and visualization.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Agitation:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Orient the patient with agitation to the unit and its procedures and routines. Provide reassurance and emotional support. Explain the need to reduce stressors and maintain a quiet environment.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Anxiety:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Teach the patient relaxation techniques and practice them with him. Encourage the patient to verbalize his anxiety and listen to him attentively. Help the patient identify and explore coping mechanisms that he used in the past. Work with the patient to identify stressors and guide him in effective coping skills.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Agitation:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Because agitation can be an early sign of many different disorders, monitor the patient's vital signs and neurologic status while the cause is being determined.
▪ Eliminate stressors, which can increase agitation.
▪ Provide adequate lighting, maintain a calm environment, and allow the patient ample time to sleep.
▪ Ensure a balanced diet, and provide vitamin supplements and hydration.
▪ Remain calm, nonjudgmental, and nonargumentative.
▪ Avoid using restraints, unless absolutely necessary, because they tend to increase agitation.
▪ If appropriate, prepare the patient for diagnostic tests, such as a computed tomography scan, skull X-rays, magnetic resonance imaging, and blood studies.
Patient teaching
▪ Orient the patient to the unit and its procedures and routines.
▪ Explain stress-reduction measures.
▪ Offer reassurance and emotional support.
▪ Explain all tests and procedures, the underlying cause, and treatment plan.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Anxiety:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Provide supportive care, as indicated by the patient's signs and symptoms.
▪ Provide a calm, quiet atmosphere.
▪ Administer medications, as ordered, to reduce anxiety.
▪ Treat the underlying cause of the patient's anxiety, if known.
▪ Encourage the patient to express his feelings and concerns.
Patient teaching
▪ Teach the patient anxiety-reducing measures, such as distraction, relaxation techniques, or biofeedback.
▪ Teach the patient coping mechanisms to help control his anxiety.
▪ Explain the underlying causes of his anxiety, if known.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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