Orientation Manual
Orientation Manual
Orientation Manual
PSYCHIATRIC UNIT
INDEX
SLNO
CONTENT
PAGE NO
SLNO
1-9
17
32-33
10
18
c.
34-35
11-18
19
19
20
37-39
Professional behavior
19
21
20
22
21
23
e. Caring
patients with psychotic
disorders: delusions and hallucination
managment
f. Caring
patients
with
obsessive
compulsive disorder
g. Caring patients with dissociative
disorders
h. Caring children with mental disorders
21
24
i.
41-42
22
25
j.
42
10
22
26
k.
11
24
27
l.
12
27-28
28
46-47
13
28
29
48
14
Psychiatric
nursing
documentation
guidelines
Specific nursing care guidelines
29-30
30
49
31-32
2
3
15
16
31
CONTENT
PAGE NO
35-36
40
40
41
43-45
45-46
50-58
Disturbances of consciousness:
autonomic discharge.
Apathy: dulled emotional tone associated with detachment or
indifference.
Ambivalence: coexistence of two opposing impulses
toward the same thing in the same person at the same
time
Guilt: emotion secondary to doing what is perceived as
wrong.
Impulse control: ability to resist an impulse, drive. or
temptation to perform an action.
Physiological disturbances associated with mood:
Anorexia: loss of or decrease in appetite.
Hyperphagia: increase in intake of food.
Insomnia: lack of or diminished ability to sleep.
o Initial: difficulty in falling asleep.
o Middle: difficulty in sleeping through the night
without waking up and difficulty in going back to
sleep.
o Terminal; early morning awakening.
Hypersomnia: excessive sleeping.
Diurnal variation: mood is regularly worst in the morning,
immediately after awakening, and improves as the day
progresses.
Diminished libido: decreased sexual interest, drive, and
performance (increased libido is often associated with
manic states).
Constipation: inability to defecate or difficulty in defeacating.
Fatigue: a feeling of weariness, sleepiness, or irritability
following a period of mental or bodily activity.
Pica: craving and eating of nonfood substances, such as
paint and clay.
Bulimia: insatiable hunger and voracious eating: seen in
bulimia nervosa and atypical depression.
Disturbances in motor behavior: aspect of the psyche that
includes impulses, motivations, wishes, drives, instincts, and
cravings, as expressed by a person's behavior or motor activity.
Echopraxia: pathological imitation of movements of one
person by another.
Disturbances of perception
Hallucination: false sensory perception not associated with
real external stimuli; there may or may not be a delusional
interpretation of the hallucinatory experience.
Disturbances of memory.
Amnesia: partial or total inability to recall past experiences;
may be organic or emotional in origin.
Anterograde: amnesia for events occurring after a point in
time.
Retrograde: amnesia for events occurring before a point in
time.
Paramnesia: falsification of memory by distortion of recall.
Retrospective falsification: memory becomes unintentionally
(unconsciously) distorted by being filtered through a person's
present emotional, cognitive, and experiential state .
..Confabulation: unconscious filling of gaps in memory by
imagined or untrue experiences that a person believes but
that have no basis in fact; most often associated with organic
pathology.
Deja vu: illusion of visual recognition in which a new situation
ARREVIATIONS
PRACTICE
USED
IN
1. AD - Alzhiemers Dementa
2. VD - Vascular Dementia
3. ADS- Alcohol Dependence Syndrome
CLINICAL
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
AA Alcoholic Anonymous
ADD Attention Deficit Disorder
ADL Activities of Daily Living
ECT Electro Convulsive Therapy
OT Occupational Therapy
GAD Generalised Anxiety Disorder
SSRI Selective Serotonin Reuptake Inhibitors
TCA: Tricyclic Antidepressants
ASD Autism Spectrum Disorder
PDD pervasive development disorder
F01Vascular dementia
F01.0Vascular dementia of acute onset
F01.1Multi-infarct dementia
F01.2Subcortical vascular dementia
F01.3Mixed cortical and sub cortical vascular dementia
F01.8Other vascular dementia
F01.9Vascular dementia, unspecified
F02Dementia in other diseases classified elsewhere
F02.0Dementia in Pick's disease
F02.1Dementia in Creutzfeldt-Jakob disease
F02.2Dementia in Huntington's disease
F02.3Dementia in Parkinson's disease
F02.4Dementia in human immunodeficiency virus [HIV]
disease
F02.8Dementia in other specified diseases classified
elsewhere
F03Unspecified dementia
A fifth character may be added to specify dementia in F00F03, as follows:
.x0 Without additional symptoms
The ICD-10
Classification codes of
Mental
and Behavioral
Disordes
F00-F09
Organic, including symptomatic, mental disorders
F00 Dementia in Alzheimer's disease
F00.0Dementia in Alzheimer's disease with early onset
F00.1Dementia in Alzheimer's disease with late onset
F00.2Dementia in Alzheimer's disease, atypical or mixed
type
F00.9Dementia in Alzheimer's disease, unspecified
10
and dysfunction
F09Unspecified organic or symptomatic mental disorder
F10--F19 Mental and behavioural disorders due to
psychoactive substance use
F10.-Mental and behavioural disorders due to use of alcohol
F11.-Mental and behavioural disorders due to use of opioids
F12.-Mental and behavioural disorders due to use of
cannabinoids
F13.-Mental and behavioural disorders due to use of
sedatives or hypnotics
F14.-Mental and behavioural disorders due to use of cocaine
F15.-Mental and behavioural disorders due to use of other
stimulants, including caffeine
F16.-Mental and behavioural disorders due to use of
hallucinogens
F17.-Mental and behavioural disorders due to use of tobacco
F18.-Mental and behavioural disorders due to use of volatile
solvents
F19.-Mental and behavioural disorders due to multiple drug
use and use of other psychoactive substances
Four- and five-character categories may be used to
specify the clinical conditions, as follows:
F1x.0 Acute intoxication
.00 Uncomplicated
.01 With trauma or other bodily injury
.02 With other medical complications
.03 With delirium
.04 With perceptual distortions
.05 With coma
.06 With convulsions
.07 Pathological intoxication
F1x.1 Harmful use
F1x.2 Dependence syndrome
.20 Currently abstinent
.21 Currently abstinent, but in a protected
environment
.22 Currently on a clinically supervised
maintenance
or
replacement
regime
[controlled dependence]
11
12
13
14
F51.5 Nightmares
F51.8 Other nonorganic sleep disorders
F51.9 Nonorganic sleep disorder, unspecified
F52 Sexual dysfunction, not caused
by organic disorder or disease
F52.0 Lack or loss of sexual desire
F52.1 Sexual aversion and lack of sexual enjoyment
.10 Sexual aversion
.11 Lack of sexual enjoyment
F52.2 Failure of genital response
F52.3 Orgasmic dysfunction
F52.4 Premature ejaculation
F52.5 Nonorganic vaginismus
F52.6 Nonorganic dyspareunia
F52.7 Excessive sexual drive
F52.8 Other sexual dysfunction, not caused by organic
disorders or disease
F52.9 Unspecified sexual dysfunction, not caused by organic
disorder or disease
F53Mental and behavioural disorders
associated with the puerperium,
not elsewhere classified
F53.0 Mild mental and behavioural disorders associated with
the puerperium, not elsewhere classified
F53.1 Severe mental and behavioural disorders associated
with the puerperium, not elsewhere classified
F53.8 Other mental and behavioural disorders associated
with the puerperium, not elsewhere classified
F53.9 Puerperal mental disorder, unspecified
F54Psychological and behavioural factors associated with
disorders or diseases classified elsewhere
F55 Abuse of non-dependence-producing substances
F55.0 Antidepressants
F55.1 Laxatives
F55.2 Analgesics
F55.3 Antacids
F55.4 Vitamins
F55.5 Steroids or hormones
F55.6 Specific herbal or folk remedies
15
16
17
Assisting
10.00-11 am
11.00 am 12.30
Medication
change
administration
based
on
order
12.30- 1.00 pm
Lunch
2.00-3.30 pm
3.30- 4.30 pm
Administ
Assisting
therapy
Presentin
Carrying
4.30- 5.00 pm
Patient visit documentation
5.00 pm
Medication and documentation
8.30-9.00 pm
Medication and documentation
9.30 pm
After 9.30
TIME
8.00-8.30 am
NURSES ACTIVITY
Handing over
Inventory checking
Prayer
8.30- 8.45 am
8.45 -9.00 am
Bed making
Maintenance of patient unit
9.00-9.15 am
Orderly maintenance
collection
9.15- 10.30 am
Rounds
Lights off
drugs
&
report
18
3- 4pm r
o
o
o
o
o
o
o
o
o
o
o
19
14. If the patient is irritable and restless, restrain them and give
PRN medicine according to doctors order
15. If patient is drowsy after giving PRN medication, withhold
the next dose,
16. if the patient is not willing to take food or not able to take
food or medicine consult concern doctor and start IVF.
17. Written consent to be taken from the bystanders.
20
Red
Blue
Black
3.
4.
5.
PREPARATION OF PATIENT UNIT
6.
7.
8.
9.
10.
PATIENT ADMISSION
PROTOCOL
11.
ADMISSION PROCEDURE
Admission to psychiatric inpatient can be either from Psychiatry OPD
or from Casualty
12.
13.
14.
21
ADMISSION COUNSELING
8. Welcome the patient and relatives to the ward
9. Orient the patient and bystanders about their bed , the ward
and ward routines, include nurses station, occupational
therapy room, bath room, drinking water, food facilities,
entertainment activities, doctors visiting time.
10. Explain the minimum duration of stay expected is 1-2 weeks.
Never expect sudden changes because the effect of
medicine will take two weeks time for proper effect.
11. Explain about the details of room rent/ cost of hospital stay
K3 ward :
Single room Rs 720/day;
Double room Rs395/day
Advance for single room-RS 4000/- and
double room Rs 2500/-
22
20.
21.
22.
23.
V.
23
VI.
VII.
VIII.
IX.
24
f.
click the respective medicine to be credited------enter the number of tablets to be credited ----enter
the IPNo---- save.
9. Hand over the medicines to be credited with the bystanders
in the cover with medicine bill /IP NO/name/ward
10. Writing medicine in the medicine cover
25
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
Billing procedure
Take the billing sheet
Write the discharge date. Tick the final bill
If
any
injection/accucheck/gloves/canula/dressing/GOTI/catheter/
nebulization
Isolation charge from ---- to ----Good will diet with date and number of days
Put signature of ward in charge
Send the billing sheet to billing section
Computer discharge procedure
Click patient ---Bed number----click ----- view --- from
admission date ---- any pending cancellation required-----medicine returns if any investigation pending
DOCTORS
ROUNDS
RESPONSIBILITIES
AND
NURSES
Before rounds:
Make sure that all staff members attend main rounds but
one staff nurse will stay in the nurses station to carry out
change in the medication order in the cardex before
giving morning medications and ensure that the new
order/ order change has been carried out .
Keep the newly admitted patients OP Chart ready before
rounds itself.
Check for any pending investigations results, if any--enter in the investigations sheet.
Any abnormal results found, a separate card has to be
mention and put above the order sheet in order to make
sure of doctors notification.
Students has to attend the rounds of their corresponding
patients and they must stand near to that patient with
patient chart
During the time of rounds:
26
Days
Monday and Friday
Wednesday
Tuesday and Saturday
Thursday
Doctors name
SPECIAL INSTRUCTION RELATED TO PROCEDURES IN
Dr. TR John
Dr.Subalakshmi
PSYCHIATRIC UNIT
Dr.Nisha
Never carry thermometer tray for checking temperature,
Dr. Joseph Varghese
carry thermometer in hand with needed cotton to swipe.
Never do any procedures like dressing, nebulization in
After rounds
the bedside; bring the patient to the treatment room, do
Change the order sheet:
the procedures.
Ensure that the order sheet has been draped fully if the
space is inadequate for the next day or any drastic
changes in medicine order
In the order sheet the corresponding psychiatrist and PG
student name has to mention on the top.
Carry out if any consultation / review is advised
immediately after the rounds.
After rounds, rounds book has to be cross checked with
rounds order book,
Any changes in medicine order that has to be started
from 10 clock medicine its self, and carried out medicine
has to be labeled as a small tick mark in red pen for
easy understanding
PSYCHIATRIC NURSING
DOCUMENTATION GUIDELINES
MEDICINE ADMINISTRATION
GUIDELINES
27
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Documentation sample
8am. Mrs. Rosy is conscious, oriented to time and place. Vital
parameters within normal limit. Patient is uncooperative. She is over
talkative but relevant speech. Agitation and Increased psychomotor
activity present. Mood is elated and affect is cheerful. Flight of ideas,
delusions of persecution and grandiosity present .She is having
overeligiousity and excessive praying, singing songs. No
hallucination reported. Poor attention and concentration. Eats
excessive amount of food, normal bowel and bladder movement.
Excessive social interaction with other patients and staff. Personal
hygiene maintained by self; over grooming present. Performs
28
activities
of
daily
living
by
herself.
Sign(signature should be clear
and legible; if student mention the course e.gII PBBSC/IIIBSC)
General documentation guidelines
29
andwho
minor
tranquillizers, are given with hypnotics as needed
hospitalized patients, or those in intensive care units, or postoperative patients, or those
have
to ensure
proper
various systemic medical conditions. Elderly people are more prone to develop delirium.
It has an
acutesleep.
onset and rapid progress
Nurse
should
ensure the safety of the patient by providing
tries to pick up and throwaway. Because of auditory hallucinations to which the patient may be
less stimulating, hazardless environment
responding, he does not reply or gives erratic replies to the examiner's questions.
Nursing care should be done in well ventilated room
Provide soft physical restrain if the patient is very much
NURSING CARE GUIDELINES FOR CARING PATIENTS
exited and pulls out iv line or tube feeding
EXPERIENCING DELIRIUM AND DEMENTIA.
Provide proper attention to his personal needs like bathing
Inform the doctor about the sudden worsening in the
,feeding dressing
patients condition
30
II.
31
III.
32
IV.
33
34
V.
2.
3.
4.
5.
6.
7.
duration)
a. Paranoid
b. Hebephrenic
c. Catatonic
d. Simple
e. Residual
f. Undifferentiated
g. Post schizophrenic depression
Acute psychosis( acute onset of psychotic symptoms with
less than one month duration)
Delusional disorder( 1 or more culturally appropriate
delusions without absence of other psychotic symptoms for
more than 3 consecutive months)
Schizoaffective disorders( presence of schizophrenic
symptoms and affective symptoms occur in the same
episodes
a. Manic type
b. Depressive type
Post partum psychotic disorder( acute onset of psychotic
symptoms within first 6weeks of delivery of a child)
Psychosis unspecified
Schizotypal disorders
FOR
PATIENT
DELUSIONS : Fixed unshakable false belief based on the external reality that cann
reasoning .it occurs due to the dopamine - serotonin deregulation in the brain.
Types of delusions
Paranoid delusions( delusions seen in manic patients/ psychotic patien
reference( others are talking about them) delusions of persecution(others are trying
35
until
the delusions
intensity is reduced rather that
others), delusions of grandeur( he is having extraordinary power/ability), delusions of infidelity(
spouse
is
saying that your husband is loving and caring. Here
unfaithful or having extramarital affair)
triggering
Delusion congruent with depressive mood: nihilistic delusion( patient is dead or worldthe
is going
to factor is the presence of the husband.
o
If
the
patient
is experiencing severe persecutory
end), somatic delusions ( body/ bodily functioning is abnormal), delusions of sin and guilt( they are sinner
delusions and extremely fearful; nurse can reassure
and to be punished) hypochondriacal delusion( he is having serious illness like cancer/AIDS etc)
the patient by saying we are there with you
Other delusion : delusional perception( real perception triggers delusional belief), bizarre delusion
nothing will happen to you are safe in this hospital
no one can enter into the ward without our
Managing patients with delusions
permission.( address and handle their emotional
First and the most important step in managing these patients
component involved in delusion rather than
is establishing good rapport with the patient.
trying to convince that the delusions are unreal)
Nurse need to understand the fact the delusional experience
o Never argue with the patient about the delusion; it
is real for the patient and is caused by the neurochemical
will worsen the patients condition; sometimes the
changes in the brain; even though it may appear to be
patient can become violent.
Carefully monitor the patient if the delusions lead patients to
difficult to belief the existence of delusion however bizarre it
may be.
harm themselves or others.(delusions of infidelity,
Talk to the patient in a calm and non threatening manner as
persecutory, nihilistic, grandiose etc)
Discourage long discussions about irrational thinking,
the patient who is experiencing persecutory delusion may
appear extremely fearful.
instead talk about real events and real people.
Assess the type, and content of the delusion without
Encourage the patients to ventilate their feelings and listen
appearing to probe. Assess how frequently and how intense
to them and make them feel that your are genuinely
is the delusions for the patient.
concerned about the issues and problems of the patients.
Initially you can ask for clarification to confirm the intensity of
Patient reality based conversations are positively reinforced
delusion: e.g. If a patient is saying (looking fearful): they will
and encouraged.
Psycho education to the bystanders: if it is the first
kill me and my family. In response the nurse can seek
clarification in a non threatening manner why do you think
episode of illness, family members are not aware about what
they are trying to kill you?
is happening in the patient and they are not able to
Approach the patient with calmness, empathy and gentle
comprehend the irrational beliefs and statements made by
eye contact.
the patient.
o They may be helpless and may not know how to
The nurse should communicate clearly, directly in simple
sentences.
tackle the patient nor the situation
o Nurse should educate the bystanders that are a
Assess the situation and environmental triggers for
symptom of the illness that they are suffering with
delusional experience. If we identify the triggers nurse can
and the illness occurs due to the neurotransmitter
control or eliminate the triggers to handle the patient.
imbalance.
E.g. If wife is having delusion of infidelity; whenever the wife
o
Reassure the family members that the delusional
sees the husband, she gets aggressive saying that he is a
thinking will reduce as they starts to respond to the
cheat he is having extramarital affair.
o In this situation its better to convince the husband
medication and that will take at least a week to show
reduction in the intensity and severity of symptoms
and tactfully ask him to stay out of the patient vicinity
36
37
VII.
VIII.
FOR
PATIENTS
WITH
38
VIII.
IX.
NURSING
CARE
GUIDELINES
WHILE
CARING
CHILDREN WITH MENTAL DISORDERS.
Mood disorders, psychotic disorders, mental retardation,
conduct disorder, autism , ADHD, brain damage , epilepsy
,unfavorable family situation, problems in schools are the
main reasons of admission in psychiatric unit.
The symptoms will be depending on the development of the
child
Establish good rapport with the child.
Never give an impression to the child that hospital is a form
of punishment, the ward should be maintain with friendly
atmosphere and daily routines should be adjusted according
to the childs need
Follow the routines maximum as like homes and staff should
mingle with the child during play time
Physically remove the child from the scene of quarrel /
arguments
Spent more time with the patients, reassure the patients and
explain about the conditions and the behavior the parents
need to display towards their child.
Sent blood Investigation as per order
39
X.
XI.
40
NURSING
PATIENTS
HYGIENE.
MANAGING
PERSONAL
XII.
Dry mouth: Provide patient with, frequent slips of water. Ensure that
patient practices strict oral hygiene. Advice the patient to take sips of
water frequently. Apply glycerin to lips, if excessively dry or cracked.
Avoid dehydration particularly during work and exercise, exposure to
extreme heat and concurrent use of medication can cause dry mouth
Blurred vision: Explain that this symptom will most likely subside
after few weeks. Advice patient to avoid driving until vision clears.
Clear small items from the pathway to prevent falls
Constipation: Provide food high in fiber e.g vegetables, salads,
leafy vegetables etc. Drink 2-3litres of water until 6pm.Encourage
increase physical activity and fluid intake if not contraindicated.
Assess the patients pattern of daily bowel activity and stool
consistency. Take measures to reduce constipation
Urinary retention: Palpate the patients bladder for urinary retention
.Instruct the patient to report any difficulty in urination, monitor intake
and output. Try applying hot and cold compress over the bladder.
Bring the patient to the toilet and turn on the pipe/ pour some water
over the legs.
Nausea, GI upset: Tablets or capsules may be administered with
food to minimize GI upset. Concentrates may be diluted and
administered with fruit juice ,they should be mixed immediately
before administration
Skin rash: Report appearance of any rash on skin to physician.
Avoid spilling any of liquid concentrate on skin, contact dermatitis
can occur with same medication
41
Photosensitivity Ensure that the patient use sun screen lotion and
use umbrellas while exposing sun light. In form the patient that he
may develop sensitivity to sun light mainly for anti depressants
Sexual dysfunction: Men may report abnormal ejaculation or
impotence.Women may experience delay or loss of orgasms if side
effect become in tolerate, a selection to another antidepressant may
necessary. Amenorrhea offer reassurance of reversibility instruct
patient to continue use of contraception amenorrhea does not
indicate cessation of ovulation
XIII.
NURSING
CARE
GUIDELINES
FOR
PATIENTS
EXPERIENCING EXTRA PYRAMIDAL SYMPTOMS
EPS develops due to the impact of antipsychotics on the dopaminergic (D2) recept
pyramidal tract. Dopaminergic antagonism effect on D2 receptors leads to dopaminer
the extra pyramidal tract leading to acute or chronic movement disorders which are
pyramidal symptoms.
42
43
j.
If
the
patient
is experiencing severe tremors, nausea ,
o Patient should consume dietary sodium the normal
vomiting, ataxia, confusion, slurring of speech **nurse
level, should not put additional salt in the rice, should
avoid too much salty foods e.g. pickle, papad, salted
44
XV.
Hepatic diet (diet that give rest/ minimal work to the liver )patient teaching for ADS patients with deranged LFT.
45
XVI.
46
Anti psychotic
Blocks D2
receptors in the
mesolymbic and
mesofrontal
system.
( concerned
with emotional
reaction)
sedation is
caused by alpha
adrenergic
blockage antdopaminaergic
actions are
responsible for
EPS
Class
Phenothiazines
1.Chlorpromazin
e
Chlorpromazine
Sunprasine (50 mg, 100 mg
Megatil
Tranchlor
Siquil
2.Triflupromazine
3.Thioridazine
4.Trifluoperazine
5.Flufanazine
deconate
Thioxanthenes
1.Fluanxol
Butyrophenones
1.Haloperidol
25
47
Indication
Contraindication
Contraindications of typical
ant psychotics
Or 1 st generation
conventional
Known
hyper
sensitivity
Comatose patients
Blood dyscariasis
Parkinsons disease
Narrow
angle
glaucoma
Liver
renal
or
cardiac insufficiency
Elderly
and
severely ill patients
Prostatic
hypertrophy
Intestinal
obstruction
lactation
Diphenylbutyl
Piperidines
Indolic derivatives
Dibenzoxazepines
Atypical anti
psychotics
Orap
Flumap 20 mg
Palipxr 3 mg
Pimozide
Penfluridol
Molindone
Loxapine
Clozapine
Moban
Loxapac(10 mg, 25 mg. 50 mg)
Respiridon
Resdone ,resperidone (1 mg,
2mg,3 mg,4 mg)
Risnia MD 3mg
Risdone MT (0.5 mg)
Roze 1 mg
Zisper MD
Sizodon
Sycodone
Olazipine
Quetiapine
Aripriprazole
Socalm
Quatan
Quticool
Arpizole 9 5 mg ,10 mg)
48
Contraindication of atypical
ant psychotic
Second
generation
antipsychotics
Hypersensitivity
Severe depression
Dementia
related
psychosis
Lactation
Cardiac
dysarrtymias
Recent MI
Heart failure
Controlled epilepsy
In cardiac hepatic or renal
insufficiency
Ziprasidone
Iloperidone
Zisper
Geodone
flusure ( 4 mg)
Anti
parkinsonian
agents
Mechanism
of
action;
It
acts
by
increase
the
release
of
dopamine from
pre
synaptic
vesicles,
blocking
the
reuptake
of
dopamine
into
presynaptic
nerve terminals
or by excreting
an agonist effect
on post synaptic
dopamine
receptor
Anti cholinergic
Trihexy phenidyl
hydrochloride
(1-15 mg/day)
Benstropine (1-8
mg/day)
Dopaminergic
agents
Biperiden(2-6
mg/dl)
Mono
amino
oxidate type B
inhibitor
Selegiline
Drug
induced
parkinsonism
Drug
induced
extra
pyramidal reactions
Bromocriptine
Carbidopa
levodopa
Syndopa(10 mg0
Syndopa plus (10 mg)
Park met(10 mg)
Neo care (10 mg,50 mg)
Selerin(5 mg)
Selgin (5 mg)
49
Hypersensitivity
Angle
closure
glaucoma
Pyloric
duodenal
/bladder
Pregnancy
and
lactation
Melanoma
C V collapse
Narrow
angle
glaucoma
Paralytic illus.
Chronic pulmonary
disease
Sick
sinus
syndrome
Thyrotoxicosis
Antianxiety
drugs
Depress
subcortical
levels
of
CNS,limbic
system
and
reticular
formation. They
made potentiate
the effect of the
powerful
inhibitory
neurotransmitter
GABA in the
brain, these by
producing
a
calmative effect.
All levels of CNS
depression can
be affected from
mild sedation to
hypnosis
to
coma
SSRI
sblock
reuptake
of
serotonin in to
the presynaptic
nerve
terminals,increa
sing
synaptic
concentration of
serotonin
benzodiazepine
Selective
serotonin
reuptake
inhibitors
Alprazolam (0.56)
Clonazepam(0.520)
Diazepam
Lorazepam (2-6)
Chlordiazepoxide
Escitalopram
Paroxetine
sertaline
Xanax
Klonopin
Valium
Ativan
Sanprazole
Lopez (1mg,2 mg)
Librium(10 mg)
Anxiety disorder
Anxiety symptoms
Acute alcohol with drawl
Skeletal muscle spasm
Convulsive disorder
Status epilepticus
Pre operative sedation
Their use and for periods
greater than 4 months
have not been evaluated
Lexapro
Paxil
Zoloft
50
Hypersensitivity to
benzodiazepines
Pregnancy
Lactation
Narrow
angle
glaucoma
Elder adults
In
depressed
patients
CNS
depression
can
exacerbate
symptoms
Severe
hepatic
insufficiency
Obstructive sleep
apnoea
Amnesia
Abnormal vision
Hepatitis
Anaphylactic
reaction
Diarrhea
Buspridone
Buspridone
does
not
depress
CNS,although t
Its
action
is
unknown,
the
drug
produce
desired effects
through
interaction with
serotonin
in
dopamine and
other
neurotransmitter
receptors.
Buspiridone
Sedative
Sonata
Ambies
Benzodiazepine
Nausea
Drugged feelings
Severe
hepatic
imparement
CNS depression
Drowsinesss
Blurred vision
Pregnancy
Lactation
Diplopia
Buspar
Hypnotics
Depression
Lorazepam
Diazepam
Clonazepam
lopez
Ativan
Restoril
halcion
51
ANTIDEPRESS
ENT
This
drugs
ultimately work
the increase the
concentration of
nonepineprine,s
eratonine, and
dopamine in the
body. this is
accomplished by
blocking
the
reuptake
of
these
neurotransmitter
by the nurone
Tri
cyclic
antidepressent
Imipramine
(75mg/Daily
Fluoxetine
-40 mg)
(20
Escitalopram
Citalopram(20
mg daily)
Monoamio oxidate
inhibitors(MAOIs)
Depression
Depressive episode
Dysthymia
Reactive depression
Secondary depression
Abnormal grief reaction
Childhood psychotic disorder
Enuresis
Separation anxiety disorder
Somnambulism
School phobia
Other psychiatric disorder
Antidep
depsonil
elamin
depsol
Clomipramine
(10 mg -30to 200
mg)
Selective
serotonin
reup
take
inhibitor(SSRIs)
Elavil
Tryptomer
Amitone
anafranil
clonil
Panic attack
Anxiety
Agoraphobia
Social phobia
Barozac
prodep
flutinol
fludac
prosac
Citalo
Topdep
Nexito (10mg,5mg)
Sertaline (25-200
mg)
Daxid (50mg,100mg)
Setalin(25,50,100 mg)
Zosert(25,50 100 mg)
Serenata (50 mg)
Isocarbacid
Marplan
Trazodone (150-
52
Individual
with
hypersensitivity
Acute
recovery
phase followed by
myocardial
infraction
Individual
with
angle
closure
glaucoma
Elderly patients
Hepatic, renal or
cardiac insufficiency
Patient who have
benign
prostate
hypertrophy
Patient with history
of seizures
Atypical
depressants
anti
Antimanic
modulates
the
effects of various
nurotransmitters
such
as
nonepinephrene,serato
nine,dopamine,glut
aminate and gaba
Anti convulsants
100 mg)
Mirnite 15,30,45)
Mirtaz(7.5 ,15,30 mg)
Lithium
carbonate
(300-400)
Carbolith
(300,400,450 mg)
Elcab 300mg
Intalith 150,330,450, mg
Litium 300,400 mg
Lithosum 250,300,400
Carbamizepine
(200-1600 mg)
Carbatol
(100,200,400 mg)
Tegretol (100,200,300,400mg)
Zen (100,200)
Zen retard(200,300,400)
Clonazepam 0.5
-20 mg
Clonotril(.25 ,.5,1,2,mg)
Lonazep (.25,.5,1,2,mg)
Zepam (0.5,1,2,mg)
Valproic acid
These drugs act
on gama amino
beutiric acid an
Sodium valporate
Encornate chrono(200,300,500)
Epilex (200,500 mg)
Epival (200 mg)
53
Acute mania
Prophylaxis for bipolar and unipolar
mood disorder
Schizoaffective disorder
Cyclothymia
Impulsivity and aggression
Other disorder
Premenestral dysphoric disorder
Bulimia nervosa
Borderline personaliy disorder
Episodes of binge drinking
Trichotillomania
Cluster headache
Epilepsy
Trigeminal neuralgia
Bipolar disorder
Resistant schizophrenia
Hypersensitivity
Cardiac, renal,thyroid or
neurological dysfunction
Severe dehydration
History of seizures
Pregnancy and lactation
Urinary retention
Diabetics
Hypersensitivity
Lactation
Caution with elderly
inhibitory amino
acid
neuro
transmitter,
GABA
receptorsactivati
on serves to
reduce neuronal
exitability
Lamotrigine
100-200 mg
Lamictal
Epitic (25,50,100 mg)
Lamipil(25,50,100 mg)
Lamogen (25,50,100 mg)
Alcohol withdrawal
Restless leg syndrome post
therapeutic neuralgia
Petitmal,akinetic
and
myoclonis sezures
Panic disorder
Unlabelled use
Acute manic episode
Uncontrolled leg movement
during sleep
Neuralgia
Gabapentin
900-1800 mg
VITAMINS
Vitamin B1 or
thiamine
Essential
for
normal
functioning
of
nerous tissue .it
is co enzyme in
CHO
metabolism.
Tablet forms
Injections
Rengunate 300 mg
Renjuron 300 mg
Gaba 300 mg
Gabalept (100,300,400 mg)
Neupent AF 900 mg
54
Acute mania,
prophylactic treatment of
bipolar disorderI,
rapid
cycling
bipolar
disorder
Schizoaffective disorder
Seizures
Migraine prophylaxis
Other
Bulimia nervosa
OCD
Agitation
PTSD
DRUG
FOR
DEADDICTION
Disulfuram
Used to ensure
abstinence in the
treatment
of
alchohol
depentance .it is a
aldehydehydogena
ce inhibiter that
interfere
with
mechanism
of
alcohol
and
produce a marked
increase in blood
acetaldehyde
levels.
55
As an aversive conditioning in
treatment of alcohol dependence
Pulmonary
and
cardiovascular
disese
Brain damage
Hepatic disease
Seizures
Poly
drug
dependence