Cognitive Disorder is a disruption or impairment in higher-level functions of the brain bearing a

devastating effects on the ability of the a person to function in daily life. Cognition is the brain’s
ability to process, retain, and use information (reasoning, judgment, perception, attention,
comprehension, and memory).
General Classifications of Cognitive Disorder:
1. Delirium Disorder
2. Amnestic Disorder
3. Dementia
Amnestic Disorder is characterized by a disturbance in memory that results directly from the
physiologic effects of a general medical condition or the persisting effects of a substance such as
alcohol or other drugs.
Etiology:
1. Physiologic (CVA, head injury, etc)
2. Substance-induced (carbon monoxide, alcholism)
3. Deficiency (Vitamin B12 deficiency)
Dementia is a mental disorder that involves multiple cognitive deficits, primarily memory
impairment and at least one of the following cognitive disturbances.
Symptoms:
1. Aphasia-deterioration of language function (echolalia & palilalia).
2. Apraxia-impaired ability to execute motor function despite intact motor abilities.
3. Agnosia-inability to recognize or name objects despite intact sensory abilities.
4. Disturbance in Executive Functioning-inability to think abstractly and to plan, initiate, sequence,
and complex behavior.
Progressive Stages:
1. Mild – forgetfulness is the hallmark of beginning.
2. Moderate – confusion is apparent along with progressive memory loss.
3. Severe – personality ad emotional changes occur.
Pathologic Etiology:
Alzheimer’s Disease
Vascular Dementia
Pick’s Disease
Creutzfeldt-Jakob Disease
HIV/AIDS
Parkinson’s Disease
Huntington’s Disease
Head Trauma

General Interventions for Dementia

• Promoting Safety from Injury
• Promote adequate sleep, nutrition, hygiene
• Structure environment and routine
• Provide emotional support
• Promote interaction and involvement
• Psychotherapy = “Reminiscence Therapy” – family and client to lament and re-live past
experiences.

Delirium is a syndrome that involves a disturbance of consciousness accompanied by a change in

cognition, usually develops over a short period of time and fluctuates.
Symptoms:
• Difficulty paying attention
• Easily Distracted/disoriented
• Sensory Disturbances (illusions, hallucinations, misinterpretations)
• Sleep-wake Cycle Disturbance
• Psychomotor Activity Changes
• May have experiences of anxiety, fear, irritability, euphoria, apathy

Child and Adolescent Disorders

Psychiatric disorders are not diagnosed as easily in children as they are in adults. Children
usually lack the abstract cognitive skills and verbal skills to describe what is happening. Because
of they constantly are changing and developing, children have no sense of a stable, normal self to
allow them to discriminate unusual or unwanted symptoms from normal feelings and sensations.

General Classifications:
Mental Retardation Learning Disorders Motor Skills Disorder
Communication Dis Pervasive Dev. Dis ADD Beh. Disorder
Feeding/Eating Dis Tic Disorder Elimination Disorder
Other Disorders of Infancy, Childhood, and Adolescence

Mental Retardation essential feature is below average intellectual functioning (IQ less than 70)
accompanied by significant limitations in areas of adaptive functioning such as communication,
self-care, home living, social or interpersonal skills, self direction, academic skills, health and safety.

Degrees of Retardation
Mild Retardation: IQ 50-70 Moderate Retardation: IQ 35-50
Severe Retardation: IQ 20-35 Profound Retardation: IQ less than 20

Learning Disorder is diagnosed when a child’s achievement in reading, mathematics, or written

expression is below that expected for age, formal education, and intelligence. Low self-esteem and
poor social skills are common. Assistance with academic achievements are given through special
education classes.
General Types Of Learning Disorder
Reading Learning Disorder
Mathematics Learning Disorder
Disorder of Written Expression

Motor Skills Disorder also known as Developmental Coordination Disorder is an impairment of

coordination severe enough to interfere with academic achievement or activities of daily living.
It often coexists with communication disorder.
Adaptive Physical Education Program
Sensory Integration Programs
Most cases, the symptoms persist until adulthood and its disease course is so invariable but generally
degenerative.

Communication Disorder is diagnosed when a communication deficit is severe enough to hinder

development, academic achievement, or ADLs including socialization.

General Types Of Communication Disorder

Expressive Language Disorder – involves an impaired ability to communicate through verbal and
sign language.
Mixed Receptive-Expressive Language Disorder – includes the problems of expressive language
along with difficulty understanding (receiving) and determining the meaning and how is the proper
response (expressing).
Phonologic Disorder – involves problems with articulation (forming sounds that are part of speech
and speaking process). Ex. Stuttering

Pervasive Developmental Disorder are characterized by pervasive and usually severe impairment
of reciprocal social interaction skills, communication deviance, and restricted stereotypical behavior
patterns.
General Types
Autistic Disorder – lack spontaneous enjoyment, have apparently no moods or emotional affect, cant
engage in play, little intelligence, most common in boys.
Rett’s Disorder – characterized by the development of multiple deficits after a period of normal
functioning. Rare and exclusively in girls, and persists throughout life.
Asperger’s Disorder – characterized of same symptoms to autism but w/o language or cognitive
delays.

Attention Deficit and Disruptive Behavior Disorder is characterized by inattentiveness,

overactivity, and impulsiveness. (Attention Deficit Hyperactivity Disorder)
 Inattentive Behaviors Hyperactive/Impulsive Behaviors
Misses details Fidgets
Makes careless mistakes Often leaves seat
Difficulty sustaining attention Runs and climbs excessively
Doesn’t seem to listen Can’t play quietly
Doesn’t follow assigned tasks Talks excessively
Difficulty with organization Blurts out answers
Avoids task requiring efforts Interrupts
Often looses things Can’t wait for turn
Easily distracted Intrusive with siblings/classmates
Forgetful of activities

Interventions for ADHD

Ensuring the child’s safety and others
Stop unsafe behavior
Provide close supervision
Give clear directions wit little compromises.
Improve role performance
Give positive feedback for meeting expectations
Manage the environment
Client and Family Education and Support
Listen and encourage verbalization of both
Simplify activities and direction
Feeding and Eating Disorders are persistent natured disorders and are not explained by
underlying medical conditions. Most conditions affect early year of life specifically infants
and early childhood.
General Types
Pica – is persistent ingestion of nonnutritive substances such as hair, cloth, leaves, sand, etc and
common seen in mental retardation.
Rumination Disorder – is the repeated regurgitation and rechewing of food. The regurgitation does
not involve nausea or vomiting.
Feeding Disorder – is characterized by persistent failure to eat adequately or to refuse eating which
results in significant weight loss or failure to gain weight.

Elimination Disorder
General Types
Encopresis – is the repeated passage of feces into inappropriate places, such as clothing or the floor,
by a child who is at least 4 years of age either chronologically or developmentally.
Involuntary encopresis is usually is usually associated with mental or psychological issues that
medicine can’t seem to explain.
Intentional encopresis is often associated with oppositional defiant disorder or conduct disorder.
Enuresis – is the repeated voiding of urine during the day or at night into clothing or bed by a child at
least 5 years of age either chronologically or developmentally.

Substance Abuse
Is defined as using drug in a way that is inconsistent with medical or social norms and
despite negative consequences.
It denotes problems in social, vocational, or legal areas of the person’s life.
Substance Dependence also includes problems associated with addiction such as
tolerance, withdrawal, and unsuccessful attempts to stop using the substance.

INTOXICATION is use of a substance that results in maladaptive behavior.

WITHDRAWAL SYNDROME refers to the negative psychological and physical reactions
that occur when use of a substance ceases or dramatically decreases.
DETOXIFICATION is the process of safely withdrawing from a substance which have
been used for some long time already.
DSM – IV TR lists of 11 Diagnostic Classes Of Substance Abuse
Alcohol Amphetamines
Caffeine Cannabis
Cocaine Hallucinogens
Inhalants Nicotine
Opioids Phencyclidine
Sedatives Hypnotics/Anxiolytics

Alcohol is a central nervous system depressant that is absorbed

rapidly into the bloodstream. Initially the effects are:
- relaxation and loss of inhibitions
- slurred speech
- unsteady gait
- lack of coordination
- impaired attention, concentration, memory and judgment
- blackout.
1. Alcohol withdrawal is usually accomplished with the administration of pharmacological
interventions of benzopdiazepines such as lorazepam (Ativan) and chlordiazepam (Valium).

Methodology used = Fixed-schedule Dosing

Symptom-triggered Dosing

2. Sedatives, Hypnotics, and Anxiolytics are all considered as CNS depressants with
benzodiazepines and barbiturates as the most frequently abused drugs in this
category. Intoxication symptoms include the following:
- slurred speech - impaired attention
- lack of coordination - memory lapses
- unsteady gait - stupor or coma
- labile mood

Tapering is usually accomplished with the administration of pharmacological interventions of

benzopdiazepines such as lorazepam (Ativan) and chlordiazepam (Valium).
Methodology used = Fixed-schedule Dosing
Symptom-triggered Dosing

3. Stimulants are drugs that stimulate or excite the CNS. The DSM IV-TR categorizes
amphetamines, cocaine and other CNS stimulants as having same intoxication and
withdrawal symptoms.

Methamphetamine is particularly dangerous as it is highly addictive and causes psychotic behavior.

Marked DYSPHORIA (unhappiness, restlessness, malaise) is the primary withdrawal symptom
and is accompanied by fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased
appetite, and psychomotor retardation or agitation. Psychotic symptoms also can include suicidal
ideation due to severe depressive experience.

Cannabis sativa is a hemp plant that became well-known for its psychoactive resins the contains
more than 60 substances called cannabinoids, particularly delta-9-tetrahydrocannabinol (THC)
responsible for the psychoactive side-effects.
Effects includes :
- lowered inhibitions - relaxation
- euphoria - increased appetite
- impaired motor coordination
- inappropriate laughter
- impaired judgment
- memory and perception loss and distortion
4. Hallucinogens are substances that distort the user’s perception of reality and produce
symptoms similar to psychosis (visual hallucination and depersonalization). Examples LSD
(lysergic acid diethylamide), Ecstacy, even PCP (phencyclidine) an anesthetic.
 Effects includes :
- increased vital signs - dilated pupils
- hyperreflexia - paranoid ideation
- ideas of reference - depression, anxiety
- sweating, blurred vision - tremor
- unpredictable behavior (belligerence, aggression)

5. Inhalants are substances including anesthetics, nitrates, and organic solvents

(aliphatics & aromatic hydrocarbons) which are all inhaled for their effects. Effects
includes :
- dizziness, nystagmus - slurred speech
- unsteady gait - muscle weakness
- aggressive behavior - tremor, apathy
- unpredictable behavior (belligerence, aggression)
Acute toxicity causes anoxia, respiratory depression, vagal stimulation and dysrhythmias,
bronchospasm, and cardiac arrest.

Nursing Process Applied : Intervention

1. Encourage open expression of feelings.

2. Validate the client’s frustration or anger in dealing with dual problems.
3. Maintain frequent contact with the client even if it is only brief telephone calls.
4. Give positive feedback for abstinence on a day-by-day basis.
5. If drinking or substance use occurs, discuss the events that led to the incident with the client in a
nonjudgmental manner.
6. Discuss ways to avoid similar circumstances in the future.
7. Assess the amount of unstructured time with which the client must cope.
8. Assist the client to plan weekly or even daily schedules of purposeful activities: errands,
appointments, taking walks, and so forth.
9. Writing the schedule on a calendar may be beneficial.
10.Recording a journal of activities, feelings and thoughts may be helpful to the client.
11.Teach clients social skills.
12.Give positive support to the client for appropriate use of social skills.

General Categories of Psychotropic Drugs

Antipsychotic Drugs
Antidepressant Drugs
Mood Stabilizer Drugs
Anxiolytic Drugs
Stimulant Drugs

Efficacy – refers to the maximal therapeutic effect that a drug can achieve.
Potency – refers to the amount of the drug needed to achieve the maximum effect.
Half-Life – refers to the time it takes for half of the drug to be removed from the bloodstream. (Drugs of
shorter half-life may be given 3X or 4X a day; Drugs of longer half-life may be given once a day.)

Pharmacologic Treatment Principles

A medication is selected based on its effect on the client’s target symptoms.
Medications are given in adequate dosaaages for some time before their full effect is realized.
The dosage of medication is often adjusted to the lowest effective dosage for the client.
As a rule, older adults require lower dosages of medications than do younger adult clients to
experience therapeutic effects.
Psychotropic medications often are decreased gradually (tapering) rather than abruptly.
Rebound effect (temporary return of symptoms)
Withdrawal effect (new symptoms due to discontinuation)
Follow up care is essential to ensure compliance to medication regimen.
Medication regimen is often presented simple (dosage, administration and route)
Also known as NEUROLECTICS.
– Used to treat symptoms of Psychosis (delusions & hallucinations).
Indications: Schizophrenia, Schizoaffective Disorder, Manic phase of Bipolar Disorder,
Psychotic Depression, Drug-induced Psychosis, short-term use in Borderline Personality
Disorder.
Mechanism of Action: The major action of all neuroleptics in the nervous system is to block
receptors for the neurotransmitter DOPAMINE.
Side Effects:
Extrapuramidal Symptoms (EPS)
Acute Dystonia – acute muscular rigidity and cramping, still or thick tongue with difficulty of
swallowing, in severe cases: laryngospasm and respiratory distress.
Pseudoparkinsonism – also known as drug-induced parkinsonism (stiff and stooped posture,
mask-like faces, cogwheel rigidity, drooling, tremor, bradycardia.
Akathesia – “intense need to move about”, client appears restless and anxious, rigid posture,
lacks spontaneous gestures.
Other Side Effects:
Neuroleptic Malignant Syndrome – a potentially fatal idiosyncratic reaction to an
antipsychotic drug although with very low incidence rate. Major symptoms include rigidity,
high fever, unstable BP, diaphoresis, pallor, delirium and elevated CPK.
Tardive Dyskinesia – a syndrome of permanent and involuntary movement. Commonly is
caused by the long term use of conventional antipsychotic drugs. Symptoms include
involuntary movement of the tongue, facial and neck muscles, upper and lower
extremities, protruding and lip-smacking, excessive and unnecessary facial movements.
Anticholinergic Side-effects – Includes orthostatic hypotension, dry mouth, constipation,
urinary hesitance or retention, blurred near vision, dry eyes, photophobia, nasal
congestion, and decreased memory.
Warning!
CLOZAPINE – may cause agranulocytosis, potentially life threatening. Must have baseline WBC count,
weekly monitoring and evaluation.
DROPERIDOL, THIORIDAZINE, MESORIDAZINE – may lengthen QT interval, potentially life threatening
causing cardiac dysrhythmias or even cardiac arrest.

Generic Sedati Hypotensi EPS Antichol

Name on on
Conventional ++++ +++ ++ +++
Chlorpromazine ++ +++++ + +
(Thorazine) + + ++++ +++
Trifluoperazine ++++ +++ + ++
Fluphenazine
Thioridazine
++++ ++ + +
Mesoridazine + + ++++ +
Thiothixene +++ + ++++
Haloperidol (Haldol)
Loxapine
Atypical ++++ ++ ++ ++
Clozapine +++ ++ + +
Risperidone ++++ +++ + ++
Olanzapine ++ ++++ + +
Quetiapine +
Ziprasidone
Additional Health Teachings and Interventions
Adherence to the drug regimen.
Monitoring for side effects especially fatal ones.
Management of some unpleasant side effects:
Drinking sugar-free and chewing sugar-free hard candy.
Stool softeners is allowed but should avoid laxatives.
Sunscreens for photosensitivity.
Avoid activities like driving due to unexpected drowsiness.

Antidepressant Drugs
Indications: Used to treat symptoms and in the treatment of Major Depressive Illnesses,
Anxiety Disorders, Depressed Phase of Bipolar Disorder and Psychotic Depression.
Mechanism of Action: The major action somehow is in the interaction of the drug with two
neurotransmitters, Norepinephrine and Serotonin, that regulate mood, arousal, attention, sensory
processing, and appetite.
Four Categories:
Tricyclic and the Related Cyclic Antidepressants
Selective Serotonin Reuptake Inhibitors
Monoamine Oxidase Inhibitors
Atypical and other Antidepressants

Generic Side Effects Nursing Concerns

Name
SSRI Anxiety, agitation, akathesia, *administer in AM if nervous or PM if
Fluoxetine (Prozac) nausea, insomnia, sexual drowsy.
Sertraline (Zoloft) dysfunction, diminished sexual *Monitor for hyponatremia
Paroxetine (Paxil) drive or difficulty achieving *adequate fluid.
Citalopram (Celexa) erection or orgasm... *report sexual difficulties if any.
*administer with food
*check orthostatic blood pressure.
Cyclic Sedation, Orthostatic *administer in AM if nervous or PM if
Amitriptyline Hypotension drowsy.
(Elavil) Anticholinergic Symptoms *Monitor for hyponatremia
Amoxapine Potentially lethal on *adequate fluid.
(Asendin) OVERDOSE. *report sexual difficulties if any.
Doxepin (Sinequan) *administer with food
Imipramine *check orthostatic blood pressure.
(Tofranil)
Desipramine
 Generic Side Effects Nursing Concerns
Name
Atypical Increased blood pressure & *administer in AM if nervous or PM if
Venlafaxine pulse, nausea, vomitting, drowsy.
(Effexor) headache, dizziness, dry *Monitor for hyponatremia
Bupropion mouth, sweating, agitation, *adequate fluid.
(Wellbutrin) weight gain, sexual *report sexual difficulties if any.
Nefazodone dysfunction. *administer with food
(Serzone) *check orthostatic blood pressure.
Mirtazipine
(Remeron)
MAOI Daytime sedation, insomnia, • Assist client to rise slowly.
Isocarboxazid weight gain, dry mouth, sexual • Administer in AM
(Marplan) dysfunction, Hypertensive • Administer with food.
Phenelzine (Nardil) Crisis (due to Tyramine- • Ensure adequate fluids.
Tranylcypromine containing food; very lethal), • Health teachings in medication.
Warning!

NEFAZODONE – may cause lethal condition of Liver Damage which may lead to
failure.
BUPROPION – can cause Seizures and not highly recommended to patients of
opiates, cocaine or stimulant addiction; diabetes or if taking insulin drugs.
TRAZODONE – may cause Priapism (sustained and painful erection) and must
be
stopped immediately that may lead to impotence.
PAROXETINE – most often causes SEDATION compared with others.

Additional Health Teachings and Interventions

SSRI’s should be taken in the morning unless sedation is a problem.
Cyclics are generally taken at night time in a single daily dose.
Cyclics are generally taken at night time in a single daily dose.

Mood Stabilizers
Indications: Used to treat Bipolar Disorder by stabilizing the client’s mood, preventing or
minimizing the highs and lows of the condition, and treating acute episodes of mania.
Included are as following: Lithium and Anticonvulsants.
Mechanism of Action:
Lithium: normalizes the reuptake of some neurotransmitters such as serotonin, norepinephrine,
acetylcholine and dopamine. Also reduces release of norepinephrine through competition with calcium.
Anticonvulsants: (Carbamazepine, Valproic Acid, Gabapentin, Lamotrigine etc.)not yet so clear
but close to have known to increase levels of inhibitory neurotransmitter GABA and the KINDLING
PROCESS. (snowball-like process of increasing the threshold to prevent minor occurrences of minor
mood fluctuations.
Lithium Therapy Advisory
Available in tablets, capsules, liquid and a sustained-released form; no parenteral form.
Usual dosage ranges from 900 to 3,600 mg daily in divided dose.
Monitoring of serum lithium levels is a MUST to assess response to drug & regulation.
1.0 mEq/L is said to be the THERAPEUTIC level.
0.5 mEq/L or less is said to be RARELY THERAPUTIC.
1.5 mEq/L or more is considered TOXIC.
Monitoring of serum lithium levels is to be done every 2 or 3 days while therapeutic level is being
determined and then weekly then after. If the condition as stabilizes, the level may be checked once a
month or less frequently.

Side Effects: Mild nausea or diarrhea, anorexia, fine hand tremor, polydipsia, polyurea, a
metallic taste in the mouth and fatigue or lethargy.
Toxic signs for lithium overdose may lead to real failure, coma and death.

Anticonvulsants Used as Mood Stabilizer

Generic Side Effects Nursing Concerns

Name
Carbamazepine Dizziness, hypotension, ataxia, Assist client to rise slowly. Monitor
sedation, blurred vision, rashes gait and assists as necessary. Report
rashes to physician.
Oxcarbazepine Dizziness, hypotension, ataxia, Provide rest periods. Assist client
sedation, blurred vision, rashes, during movement especially during
tremor, rashes, confusion ambulation. Give with food. Report
rashes to physician.
Divalproex Dyspnea, nystagmus, vomiting, • Monitor gait and movements.
weight gain, hair loss, ataxia, Assist client as necessary.
menstrual changes, dyspepsia. Provide rest period. Establish
balance nutrition.
Gabapentin Hypotension, headache, fatigue, Provide rest periods. Assist client
nausea, vomiting, nystagmus, during movement especially during
coordination, sedation. ambulation. Give with food.

Additional Health Teachings and Interventions

Taking this medication with meals will minimize nausea.
Side effects like dizziness, lethargy must be noted and patients prevented from driving.
Adherence to medication schedule is High priority to properly regulate (especially for lithium therapy)
dosage and effect for long term use.
Pretreatment hematologic baseline data must be obtained. Liver function test at regular intervals for
medication usage at long term prescription.

Warning!
VALPROIC ACID and DERIVATIVES – may cause Hepatic failure resulting in fatality. Can
produce Teratogenic effects (6 months) such as neural tube defects (eg. Spina bifida).
CARBAMAZEPINE – can cause Aplastic Anemia and Agranulocytosis.
LAMOTRIGINE – may cause serious rashes requiring hospitalization including Stevens-Johnson
Syndrome and rarely, life-threatening toxic epidermal necrolysis. Incidence rate is higher to
patients 16 years old and below.
 – Also know as ANTIANXIETY AGENTS.
Benzodiazepines – have proved to be most effective in relieving anxiety and are the drugs most
frequently prescribed. These drugs can also be prescribed for their anticonvulsant and muscle relaxant
effects.
Non-benzodiazepines – less frequently prescribed and is so on case to case basis or as a
professional choice of doctors.
Indications: Anxiety and Anxiety Disorders, Insomnia, OCD, Depression, PTSD, and Alcohol
withdrawal.
Mechanism of Action: Benzodiazepines mediate the actions of the amino acid GABA, the major
inhibitory neurotransmitter in the brain. While Buspirone is believed to exert its anxiolytic effect by
acting as a partial agonist at serotonin receptors which decreases serotonin turnover.

Side Effects: Psychological Dependence to Benzodiazepine.

Additional Health Teachings:
1. Clients need to know that antianxiety agents are aimed at relieving symptoms but not the
underlying problems that cause the anxiety.
2. Benzodiazepines strongly potentiate the effects of alcohol.
3. Clients must be reminded of the decreased response time, slower reflexes, and sedative effects.
No driving.
4. Benzodiazepine withdrawal can be fatal. No abrupt stopping after long term use without the
supervision of the physician.

Anxiolytic Drugs

Generic Speed of Side Effects Nursing Concerns

Name Effect
Benzodiazepines Ranges Dizziness, clumsiness, *avoid other CNS
Diazepam (Valium) from very sedation, headache, depressants.
Chlorazepate fast to fatique, sexual *avoid caffeine & alcohol
Alprazolam intermediate dysfunction, blurred *drink adequate fluids.
Clonazepam
effect vision, dry throat, high *rise/move slowly.
potential for abuse and
dependence.
Non- Ranges Dizziness, restlessness, *take with food.
Benzodiazepines from rapid agitation, drowsiness, *rise/move slowly.
Buspirone to very slow weakness, vomiting, *report persistent &
Meprobamate effect paradoxical excitement recurring side effects.
(equinil) (euphoria).

Stimulant Agents
As the term implies, it has pronounced effects of CNS stimulation.
No caffeine, sugar, and chocolate.
Indications: In the past, they were used to treat Depression and Obesity.
Now, ADHD in children and adolescents, Residual Attention Deficit Disorder in
adults, and Narcolepsy.
Mechanism of Action:
Amphetamines and Methylphenidate act by causing release of the neurotransmitters
(norepinephrine, dopamine, and serotonin) from presynaptic nerve terminals as opposed to having
direct agonist effects on the postsynaptic receptors.

Effects:
 Most common: Anorexia, weight loss, nausea, and irritability.
Less common: Dizziness, dry mouth, blurred vision and palpitations.

Additional Health Teachings and Interventions

Highly addictive.
Taking after meals minimizes anorexia and nausea.
Avoid caffeine, sugar and chocolate.

Warning!

AMPHETAMINES – may result to abuse. Long term use may cause to drug dependence.
METHYLPHENIDATE – can cause marked tolerance and psychic dependence.
PEMOLINE – may cause life-threatening liver failure, which can result in death or require liver
transplantation. Would require additional regulation permit and consent from government
regulating body.

DISULFIRAM
- A sensitizing agent that causes an adverse reaction when mixed with alcohol in the body.
– The agent is used only as DETERRENT to drinking alcohol in persons receiving treatment
program for Alcoholism.
– 5-10 minutes after alcohol ingestion with result to the following symptoms:
- facial and body flushing
- dry mouth, nausea, vomiting
- dizziness and weakness
- In severe cases, chest pain, dyspnea, severe hypotension, confusion and
even death.
– Other side effects would include halitosis, tremor and impotence.
– Can interfere with other drugs like Phenytoin, Isoniazid, Warfarin, Barbiturates, Benzo.

SOMATIC Therapy
ELECTRO-CONVULSIVE THERAPY
~An effective treatment for depression that consists of inducing a grand mal (tonic-clonic)
seizure by passing an electrical current through electrodes that are attached to the temples
 Treatment that consists of inducing a grand mal seizure by passing an electrical current
through the electrodes next to the temporal bone

Indications:
1. Depression
2. Mania
3. Catatonic schizo

Contraindications: (relative) – there is no absolute contraindication to ETC

1. Fever
2. ICP-BRAIN TRUMOR
3. Cardiac
4. TB with history of hemorrhage
5. Recent fracture
6. Retinal Detachment
7. Pregnancy

 Voltage – 70-150 volts

 Length of time applied – 0.5 – 2.0 seconds
 Usual # of tx – 6-12
 Interval of tx – 48 hrs
 Indicators of effective tx- occurrence of generalized tonic-clonic siezure

Patient preparation
 Before the procedure:
 ➢ Consent, Physical Exam (X –ray, ECG,
EEG ), NPO,
➢ Restraints:
➢ Administration of Atropine SO4(secretions)
Anectine (Succinylcholine)Muscle relaxant
Methohexital Na (Brevital) Anesthetic agent

 During the procedure

Observe the patient tonic-clonic contraction
 After the Procedure
➢ Position
➢ Vital signs
➢ Reorient the patient
➢ Common Complications: Memory loss, headache, fracture, apnea
➢ O2
➢
PSYCHOSOCIAL INTERVENTIONS….
Common Psychotherapeutic interventions
1. Remotivation therapy
5 Different Steps
1. Climate of acceptance
2. Creating a bridge to reality
3. Sharing the world we live in
4. Appreciation of the world
5. Climate of appreciation
2. Music therapy
3. Play therapy
4. Group therapy
5. Psychodrama
6. Milieu Therapy
7. Family Therapy
8. Psychoanalysis
9. Hypnotherapy
10.Humor therapy
11.Transactional analysis
12.Behavior modification
13.Aversion therapy
14.Token-economy
15.Gestalt therapy