Session 7: Substance Abuse Disorders

Session 7 Substance Abuse Disorders

 

NIAAA is a group that tracks statistics about alcohol use

 

Chronic alcohol use is a CNS depressant, this can lead to increasing depression symptoms in a patient that is chronically using alcohol

 

AUD – alcohol use disorder. (mild, Moderate, Sever)

  • A cluster of cognitive behavioral, and physiological symptoms indicating that the individual continues use even though there are issues arising in the person’s life related to drinking.
  • Criteria groups:
    • Impaired control
    • Social impairment
    • Risky use
    • Pharmacological
  • Severity is defined by how many criteria that the person is completing
  • If a person starts drinking before 15 there is a 50% higher chance to develope AUD
  • DUI – BAC 0.08 g/dl
  • DWAI – BAC 0.05 g/dl
  • UUD – underage drunk driving
  • Implied consent for breathalyzer in colorado and if you refuze there is a 1 year suspension of licence.

 

Medications to help a person to stop drinking (9% of patients with AUD get one of these meds)

  • Disulfiram, Antabuse – discovered on accident and causes person to feel sick with alcohol. It also has a long half life about 2 weeks but a person can drink after 3 days or so. The patient who is required to take this drug may need to take it in front of a healthcare worker 3 times a week for their probation
    • Disulfiram reaction – flushing increased HR, SOB, Nausea and VOM. Side Effects – drowsiness headache, hepatotoxic.
  • Naltrexone – do not feel the good effects of alcohol
  • Acamprosate (campral)
  • Vivitrol – month long injection of naltrexone
  • Topamax – not yet approved for alcohol. Decreases cravings of alcohol.
    • Now commonly used for seizures and migraines

 

Alcohol withdrawal syndrome

  • N/V, tremors, kindling effect (each time the person goes through withdrawal it get worse.), diaphoresis, high BP HR and temp, seizures,
  • CIWA score
  • Can be deadly!
  • Getting a alcohol history is important and is needed to treat the patient.
  • TREATMENT –
    • CIWA Q4h
    • Vitals – B1 often in a “banana bag”
    • Fluids
    • Pharm: Short acting benzodiazepines (lorazepam Ativan, alprazolam Xanax)

 

Opiates – from poppy plant. morphine, heroin, oxycodone

  • Opioids – synthetic opiates
  • Withdrawal can last 72-96 hours and is not usually deadly.
  • OD s/s: excessive CNS depression, respiratory depression, pinpoint pupils
  • Noxalone (Narcan) – is the opiate overdose med to stop symptoms but the H/L is shorter than the heroine H/L so there may need multiple doses.
  • Methadone clinics are used to take a person off of a street drug and hopefully wean them off of opiates in general.

 

Stimulants

  • Cocaine, and crack cocaine.
    • No pharmacological interventions for cocaine use
  • Methamphetamine
    • Extremely addictive,
    • High may last for days
    • Can have “meth mouth” where teeth fall out

 

Cannabis

  • Smoked
  • Adolescence and cannabis, can affect attention, memory, and IQ. This may not improve after succession of use of the drug
  • “Spice” – called an alternative to cannabis, but there are intense side effects: agitation, vomiting, heart attacks, strokes, brain damage, psychosis.

 

Tobacco

  • The leading preventable cause of disease, disability, and death in the US.
  • Contribute to 443,000 deaths year.
  • Stimulant
  • Higher prevalence in the schizophrenia population.
  • Treatments to stop smoking: nicotine replacement, Bupropion, Varenicline tartrate

 

Gambling disorder

  • AA for gamblers exists

 

Nurses and substances

  • Alcohol use is similar to the general population
  • Prescription drugs is higher in professionals almost 7% of population
  • A nurse is required to report suspected use by other healthcare workers.
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Mental Health Session 6: Depression

Session 6 Depressive disorder

 

Depression:

 

  • Persistence of symptoms for at least 2 weeks
  • Anhedonia, Sleep issues, Changes in appetite, Feeling like there is a Grey cloud over you all the time (hopelessness), suicidal thoughts, concentration issues, change in physical activity.

 

  • It is the leading cause of disability in the United States.
  • 6% of adults experience a major depressive episode, and it can be the only time in their life that this happens.
  • Children can get depression.
  • Biological factors
    • There are genetic components
    • Biochemical imbalances of serotonin and norepinephrine
    • HPT axis changes, this will decrease thyroid function and therefore the production of T hormones decreasing energy and metabolism.
  • Cognitive theory – thoughts are greater than emotions
    • Cognitive Triad: Negative view of self, pessimistic view of self, and negative occurrences
  • Nursing assessment of Depressive disorder
    • Affect, thought process, mood, feelings, physical, behaviour, communication, spirituality.
  • Nursing diagnosis
    • Risk for suicide, hopelessness, ineffective coping, self care deficit,
  • Psychopharmacology
    • Antidepressants – (do not give to a patient that has bipolar because it will make the maina worse).
      • SSRI’s are the first drug that is usually prescribed.
        • There is a low side effect profile
      • May take 4-6 weeks to be effective
      • Serotonin syndrome if the med reaches toxic levels.
        • Fever, increased HR, seizure, coma, death,
    • Tricyclic antidepressants –
      • Block histamine, and will make the patient tired
      • Anticholinergic effects
      • 8 weeks to see effect
      • Low Therapeutic index, high chance for MI and other heart issues.
    • MAOIs
      • Neurotransmitter changes
      • Interactions with tyrosine (aged cheese, red wine)
      • Hypertensive crisis if toxic
  • Persistent Depressive Disorder (Dysthymis D/O)
    • Chronic depression for at least 2 years
    • Non medical interventions
      • Transcranial magnetic stimulation (TMS)
      • ECT – medical induced seizures to shock the brain to generate different pathways that are different then the depressive ones that already exist.
  • Premenstrual Dysphoric disorder
    • Depressive symptoms that occur 1 week prior to menses
    • Serotonin meds for this, a small increase in the dose for that week before the period can be very helpful.
  • Disruptive Mood Dysregulation disorder
    • Ages 6-18
    • Outbursts, tantrums, fights, poor school performance
    • R/O medical conditions before diagnosis
  • Non-Pharmacologic treatments for Depressive disorders
    • Electroconvulsive therapy
    • Transcranial magnetic stimulation (Brainsway Deep TMS treatment for depression) not very invasive.
    • Vagus stim
    • Light therapy
    • St. John’s wort
  • Grief – when someone is dealing with loss
    • can turn into depression if not dealt with
    • Should try to treat without meds.
  • Freud psychoanalytic theory
    • Id, Ego, Superego

 

Suicide Assessment

  • Assessment
    • Subjective, objective, overt and covert statements, assessment tools,
    • Scale SAD PERSONS – Sex, age, Depression, previous attempt, ethanol, Rational thought loss, social support, organized plan, No spouse, sickness.

 

  • Command hallucinations are hallucinations that tell the person what to do.
    • Rare and can be very overwhelming and disturbing
  • Protective factors – support group, though process
  • Asking the questions:
    • Have you thought about suicide? This is ideation
    • Hove they ever thought though how they would do it?
    • How would they do it and when did they last think about it?

  • Hard and specific questions need to be asked to help the patient, and your own assessment.

 

Psychiatric pediatric emergency

  • Safety is the highest priority
  • RNs will manage the techs to a 1:1 ratio with the children
  • Try not to use restraints
  • The patients are searched for items that can harm themselves, as well as things like cell phones
  • The patients change into maroon scrubs for identification.
  • M-1 Form a 72 hour hold that requires the hospital to hold the patient for three days and the person cannot leave.
    • This also applies to medication that may need to be used to sedate or calm the patient.
  • The family may be the source of the issue and you may need to focus and support the parents as well.
  • Motivational interviewing is huge in this field.