Substance Abuse: Cocaine Abuse

Cocaine is a crystalline alkaloid obtained from the leaves of Erythroxylon coca (family Erythroxylaceae) and other species of Erythroxylon, or by synthesis from ecgonine or its derivatives.

Cocaine is a potent central nervous system stimulant, vasoconstrictor, and topical anesthetic, widely abused as a euphoriant and associated with the risk of severe adverse physical and mental effects.

Cocaine: cocaine hydrochlororide (sniffed) free-base cocaine (smoked), crack cocaine (small rocks that are smoked), cocaine that may be injected intravenously

Effect of Substance:

Euphoria, risk taking behavior, feeling of confidence, anorexia, inappropriate sexual behavior, tachycardia, tachypnea, nervousness, hypertension, dilated pupil, agitation, fever, inability to concentrate.

Effect of Withdrawal:
Psychosis, delusion, hallucinations, paranoia, depression, ideas of persecution, aggressiveness, tremor, hypervigilance, insomnia, fatigue, muscle pain, nausea, vomiting, general malaise, suicidal ideation

Treatment:
Detoxification
Drugs: antidepressant, antipsychotic
Charcoal to treat ingested cocaine
Behavior therapy
Psychotherapy
Halfway houses
Day or night hospitalization
Twelve-step support groups

Nursing Intervention:
Maintain and ensure the airway and ventilation
Maintain safety
Monitor and assess patient for using of alcohol and benzodiazepine
Control seizure
Treat hyperthermia
Monitor cardiovascular status
Quiet environment
Encourage patient to express fears and anxiety

Substance Abuse: Benzodiazeipnes

The benzodiazepines are a class of psychoactive drugs with varying hypnotic, sedative, anxiolytic, anticonvulsant, muscle relaxant and amnesic properties, which are mediated by slowing down the central nervous system. The drugs are useful in treating anxiety, insomnia, agitation, seizures, and muscle spasms, as well as alcohol withdrawal. Using of benzodiazepines in long term can cause physical dependence.

Types of Benzodiazepines are Diazepam (Valium) and Lorazepam (Ativan)

Effect of Substance:
Sleepiness and deep sleep, poor coordination, slurred speech, falling, poor thought processes, memory difficulty, weak comprehension, poor judgment, mood swings, constricted pupils, nystagmus, and tachypnea.

Effect of Withdrawal:

Anxiety, rage, insomnia, panic attacks, depression, night-mares, nausea, constipation, diarrhea, shaking, muscle pain, sweating, tachycardia, paresthesia, seizure, and death if combine with alcohol.

Treatment:

• Detoxification
• Drugs: antagonist fumezenil (Romazicon), slowly taper the abused benzodiazepine.
• Behavior therapy
• Psychotherapy
• Halfway houses
• Day or night hospitalization
• Twelve-step support group

Nursing Intervention:

• Maintain safety
• Monitor vital sign and neurologic status and notify physician if abnormal readings
• Monitor for alcohol abuse
• Monitor for dysrhythmias
• Encourage patient to express fears and anxiety, Provide a quiet environment
• Implement seizure precaution

Substance Abuse: Barbiturate

Barbiturates are a group of drugs known as sedative-hypnotics, which generally describes their sleep-inducing and anxiety-decreasing effects.

Person uses barbiturates as abused mostly to reduce anxiety, decrease inhibitions, and treat unwanted effects of illicit drugs. Barbiturates can be extremely dangerous because the correct dose is difficult to predict. Barbiturates are also addictive and can cause a life-threatening withdrawal syndrome.

There are many different kind of barbiturate: Amobarbital (Amytal), pentobarbital (Nembutal), Secobarbital (Seconal), Phenobarbital, and Tuinal

Effect of Subtance:
Sluggish coordination, emotional lability, faulty judgment, aggressiveness, nystagmus, strabismus, diplopia, decreased reflexes, ataxic gait, bradycardia, respiratory depression, stupor, decreased tendon reflexes.


Effect of Withdrawal:
Irritability, anxiety, tachycardia, tachypnea, nausea, tremors, muscle pain, confusion, hallucination, seizures, insomnia, vivid dreaming, coma, death.

Treatment:

• Detoxification
• Drugs: slowly taper the abused barbiturate, sodium bicarbonate (promotes excreation of barbiturates, and activated charcoal for overdose.
• Behavior therapy
• Psychotherapy
• Halfway houses
• Day or night hospitalization
• Twelve-step support groups

Nursing Intervention:

• Maintain airway
• Maintain client safety
• Monitor for alcohol abuse
• Monitor vital signs and neurologic status and notify physician if any abnormal readings
• Orient client to place, person, and time
• Provide a quiet environment with a light switched on
• Control combative behavior
• Encourage patient to express fears and anxiety
• Implement seizures precautions

Substance Abuse: Alcohol Abuse

Alcohol abuse is a psychiatric diagnosis describing the use of alcoholic beverages despite negative consequences. Alcohol abuse is different from alcohol dependence means by the lack of symptoms such as tolerance and withdrawal.

Effect of Substance:
Drunkenness, drowsiness, behavioral changes, poor judgment, coordination difficulty, slurred speech, inappropriate sexual behavior, aggression, memory problems, nystagmus, poor attention span, stupor, coma.

Effect of Withdrawal:
Altered consciousness, agitation, aggressiveness, anxiety, fear, confusion, delusions, disorientation, hallucinations, insomnia, blackouts, profuse sweating, acute psychosis, tachycardia, hypertension, tachypnea, anorexia, nausea, grand mall seizure, abdominal cramps, tremors, and vomiting.

Treatment:

• Detoxification
• Drugs: benzodiazepines, anti-seizure dugs.
• Behavior therapy
• Psychotherapy
• Halfway houses
• Day or night hospitalization
• Twelve-step support groups

Nursing Intervention:

• Maintain client safety
• Orient patient to place, person, and time
• Monitor vital signs and neurologic status, and notify physician if any abnormal value.
• Quiet environment with a light on
• Record intake and output
• Encourage patient to express fears and anxiety

Schizophrenia 1: Definition, Signs, and Symptoms

Schizophrenia is a group of mental disorders characterized by abnormalities in perception, content of thought, and thought processes (hallucinations and delusions) and by extensive withdrawal of interest from other people and the outside world, with excessive focusing on one's own mental life.

Schizophrenia is the most prevalent psychosis, affecting some 2 million Americans. The annual cost of the disease to the U.S. economy is estimated at $65 billion, of which $46 billion reflects lost productivity of patients and their caregivers

The term of schizophrenia was coined by Bleuler, synonymous with and replacing dementia praecox. This disorder disturbances in affect, mood, behavior, and though process.

Signs and Symptoms of Schizophrenia:

POSITIVE SYMPTOMS

• Excess or distortion of normal functions
• Delusions (persecutory or grandiose)
• Conceptual disorganization
• Hallucinations (visual, auditory, or other sensory mode)
• Excitement or agitation
• Hostility or aggressive behavior
• Suspiciousness, ideas of reference
• Pressurized speech
• Bizarre dress or behavior
• Possible suicidal tendencies

NEGATIVE SYMPTOMS

• Diminution or loss of normal functions
• Anergia (lack of energy)
• Anhedonia (loss of pleasure or interest)
• Emotional withdrawal
• Poor eye contact (avoidant)
• Blunted affect or affective flattening
• Avolition (passive, apathetic, social withdrawal)
• Difficulty in abstract thinking
• Alogia (lack of spontaneity and flow of conversation)
• Dysfunctional relationship with others

DISORGANIZED SYMPTOMS

• Cognitive defects/confusion
• Incoherent speech
• Disorganized speech
• Repetitive rhythmic gestures (such as walking in circles or pacing)
• Attention deficits

Diagnostic Characteristics:

• Evidence of two or more of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms
• Above symptoms present for a major portion of the time during a 1-month period
• Significant impairment in work or interpersonal relations, or self-care below the level of previous function
• Demonstration of problems continuously for at least a 6-month interval
• Symptoms unrelated to schizoaffective disorder and mood disorder with psychotic symptoms and not the result of a substance-related disorder or medical condition

Continued to Schizophrenia 2

Bipolar Disorder

Bipolar disorder is an affective disorder characterized by the occurrence of alternating periods of euphoria (mania) and depression.

Signs and Symptoms Of Mania:

• Becomes angry quickly.
• Distracted by environmental stimuli.
• Extroverted personality
• Flights of idea
• Delusional self-confidence.
• Grandiose and persecutory delusions
• Inability to eat or sleep.
• High and unstable affect.
• Inappropriate dress.
• Inappropriate affect.
• Initiation of activity
• Restlessness
• Pressured speech
• Sexually promiscuous
• Unlimited energy
• Urgent motor activity
• Significant decrease in appetite

Signs and Symptoms Of Depression:

• Decreased emotion and physical activity
• Decrease in activities of daily living
• Easily fatigue
• Inability to make decisions
• Introverted personality
• Internalizing hostility
• Lack of initiative
• Lack of energy
• Lack of self-confidence
• Lack of sexual interest
• Withdrawn from groups

Interventions for maniac patients:

• Remove hazardous objects from the environment
• Assess the client closely for fatigue
• Promote sleep
• Provide rest periods
• Provide private room
• Hypnotic or sedative medication as prescribed
• Encourage the patient to ventilate feeling
• Calm and slow interaction
• Encourage patient to focus on one topic during conversation
• Ignore and distract patient from grandiose thinking
• Present reality to patient
• Do not argue with patient
• Provide high-calorie finger foods and fluids
• Reduce environmental stimuli
• Set limits on inappropriate behaviors
• Provide physical activities and outlets for tension
• Avoid competitive games
• Provide gross motor activities such as walking and writing
• Provide structured activities with nurse
• Provide simple and direct explanations for routine procedures
• Supervise the administration of medication

Deal With Aggressive Behavior Patients:

• Assist patient to identify feeling of frustration and aggression
• Encourage patient to talk out instead of acting out
• Assist patient in identifying precipitating events or situations lead to aggressive behavior
• Describe the consequences of the behavior on self and others
• Assist in identifying previous coping mechanism
• Assist in problem solving techniques.

Deal With De-escalation Techniques:

• Maintain safety for the patient, others and self
• Maintain a large personal space and use non-aggressive posture
• Calm in approaching and communicating
• Clear tone of voice, be assertive not aggressive
• Avoid verbal struggles
• Assist the patient with problem-solving and decision making
• Provide the patient with clear option

Deal With Manipulative Behaviors:

• Set clear, consistent, realistic and enforceable limits
• Communicate the expected behaviors
• Be clear with the consequences associated with exceeding limits
• Discuss the patient’s behavior in non-judgmental and non-threatening manner
• Avoid power struggles with the patients

Dissociative Disorder

Dissociative disorder is a group of mental disorders characterized by disturbances in the functions of identity, memory, consciousness, or perception of the environment. It is associated with exposure to an extremely traumatic event.

Dissociative disorder includes dissociative amnesia, dissociative fugue, dissociative identity (multiple personality) disorder, and depersonalization disorder.

Dissociative Amnesia
Dissociative amnesia is the inability to recall important personal information because it is anxiety provoking. Memory impairment may be partial or almost complete.
There are three types of dissociative disorder:

1. Localized: block out all memories about specific period.
2. Selective: recalls some but not all memories about a specific period.
3. Generalized: loss of all memory about past life.

Dissociative Fugue

Dissociative fugue is a disorder in which client assumes a new identity in a new environment. It may be suddenly. The client may drift from place to place and develops few social relationships.

Dissociative Identity (Multiple Personality)
Two or more fully developed distinct and unique personalities exist within the person and may take full control of the client one at a time. This disorder is used as a method of distancing and defending self from anxiety and traumatic experiences. The transition from one personality to the other is related to stress and is sudden.

Depersonalization Disorder
Depersonalization disorder is an altered self perception in which client’s reality is temporally lost or changed. The client will have feelings of detachment and intact reality testing.

Specific Intervention for Dissociative Disorder Client:

• Develop a trust with the client.
• Encourage verbal expression of anxiety and concerns.
• Encourage client to explore methods of coping.
• Orient the client and identity sources of conflicts.
• Focus on the client’s strengths and skills.
• Use stress reduction techniques.
• Allow the client to progress at his or her own pace.
• Plan for individual, group, and family psychotherapy.