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3320 Flashcards

1
Q

Students come into nursing with mental health concern experience

Students belive they are in recovery

Nursing school threatens recovery

Nursing students with mental health feel advantaged

A

Findings

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2
Q

12 determinations of health

A 
Income/status
Social support
Education 
Working condition 
Social environment 
Physical environment 
Coping/personal health
Healthy child develop 
Bio/genetic
Services
Gender
Culture
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3
Q

Recovery CHIME

A 
Connectedness 
Hope and optimism 
Identity
Meaning
Empowerment
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4
Q

Mental health definition

A

“a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”

Not just absence of disease

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5
Q

Mental health and illness are…

A

Relative concepts

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6
Q

A person is mentally healthy when they

A 
Meet basic needs
Assume responsibility for behavior and self growth
Learned to integrate thoughts, feelings, actions
Can resolve conflicts 
Maintain relationships 
Communicate 
Respect others 
Adapts to change
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7
Q

Incidence - new cases

Prevelance - total cases

A

Note

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8
Q 
Promote / prevent
Recovery / rights
Access to services
Disparities / diversity 
First nation's
Lead / collab
A

2009 health commission directives

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9
Q

APA definition of mental disorder

A

A clinically significant behavior in an individual that results in distress or disability woth an increased risk for suffering death, pain or loss of freedom

Not an expected response go a loss such as death of a loved one

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10
Q

Healthy
Reacting
Injured
Ill

A

Model #1

Mental health continuum model

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11
Q

Nature vs nurture

A 
Germ theory (something in environ)
Lead to isolating affected
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12
Q

Psychological ocus in 1952 due to

A

Calming effects of chlorpromazine

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13
Q

Mental health continuum

A

Mental illness refers to disorders diagnose able by DSM-5

Subjective feeling of well being can exist within health and illness

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14
Q

Individual group and environment factors that work together effectively ensuring subjective well being, optimal development and use of mental abilities achievements of goals

A

Optimal mental health

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15
Q

Individual group and environmental factors that conflict producing subjective distress; impairment or underdevelopement of mental ability, failure to achieve goals, destructive behavior

A

Minimal mental health

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16
Q

Optimal health
Minimum health

Absence of MD
Presence of MD

A

Model #2

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17
Q

First highlighted important of mental health

A

EPP report 1988

Framework created in 2009

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18
Q

Genetic predisposition

Stress

A

Dicthesis stress model

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19
Q

4 quadrants

Optimal mental ———-poor mental

Serious illness————no illness

1) max MHD, optimal MH
2) no MHD, optional MH
3) no MHD, min MH
4) max MHD, Min MH (mostly BPD)

A

Flourishing and languishing mental health models (Corey keyes)

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20
Q

Process/outcome of complex cultural systems not independent. Capacity to overcome adversity

Not unaffected my stressors

A

Resilience

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21
Q

Mental health is defined my culture and determined my social norms

A

Note

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22
Q

Feeling good

Low functioning

A

Settling

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23
Q

Feeling good

Functioning well

A

Flourishing

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24
Q

Not feeling good

Low functioning

A

Languishing

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25
Q

Not feeling good

Functioning

A

Striving

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26
Q

Nervous affection (usually woman) where emotion and reflex are exaggerated leads to loss of control

Helped with sexual outlets

Thought to be caused by sexual deprivation

A

Hysteria

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27
Q

Adverse factors

  • Low self esteem
  • Cognitive/emotional immaturity
  • Difficulty communicating
  • Medical illness/ substance use

Protective factors

  • self esteem
  • problem Solving/ stress management
  • communication skills
  • physical health
A

Individual attributes

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28
Q

Adverse factors

  • loneliness/bereavement
  • neglect/family conflict
  • exposure to violence
  • low income
  • difficult schooling
  • work stress
  • no services

Protective factors

  • social support
  • good parenting
  • physical security
  • economic security
  • school achievement
  • success at work
  • basic services
A

Social circumstances

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29
Q

Adverse factors

  • injustice/discrimination
  • social and gender inequality
  • war or disaster

Protective factors

  • social justice
  • equality
  • physical security
A

Environmental factors

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30
Q

Do we need to diagnose to help mental health

A

No

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31
Q

Dsm 5

A

Classifies disorders not people

Also international classification of disease ICD

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32
Q

Mental health affects all

20% will experience a personal concern at some point

33 3% with experience a concern

A

Canadian stats

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33
Q

10-20% affected (most disabling group)

5% male 12% female (12-19) experienced MDD

3.2 million (12-19)

Suicide third highest 4,000 die prematurely

Second highest hospital expenses

1/5 received care

A

Youth stats

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34
Q

5mill use services every year

Woman 25-39 most often

1/4 over 80 overuse

Largest increase 10-14

Boys under 18 more likely

A

More stats

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35
Q

Primitive society

A

Shamans

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36
Q

Medieval (middle ages) 5th - 15th century

A

Western Europe religion dictated
Demonic possession
Inhuman so immune to human discomfort

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37
Q

Early civilization

A

Severe mental illness from disordered physiological condition

Major faith traditions (Christian, Judaism, Islam, Hinduism, Buddhism

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38
Q

First Asylums

A

8th century middle east society with first asylums compassionate peaceful environment

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39
Q

Renaissance 1400-1700

A

Bedlam

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40
Q

18th -19th custodial care

A

Assistance with adls

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41
Q

Dorothea dix

A

Advocate for improved care in public

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42
Q

First asylum in canada

A

Beauport

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43
Q

Salpetriere asylum (France)

Philipe pinel (1802) (Moral therapy)

A

Asylems could cure madness

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44
Q

What are asylems

A

Retreats from society with early intervention and lots of rest would cure

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45
Q

19th C

Alcohol sedatives
Blood worms
Pinning (spin in chair)
Hydrotherapy (forced baths)
Insulin shock (comas)

Mid 20th

ECT
Lobotomy

A

Treatment

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46
Q

Holistic
Individual lost equilibrium with cosmos
Healing at community level

A

Aboriginal

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47
Q 
Colonialism caused more asylems 
Demonic possession (bloodletting, purging, restore humours)
A

Canada

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48
Q

1878 William wundt

A 
Talk therapy 
Psychoanalysis 
Behaviorist
Cognitive science 
Radical therapy (ECT, insulin, lobotomy)
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49
Q 
1950 chlorpromazine
1955 meprobamate (miltown)
1960 choriozepoxide (first anti psychotic)
A

20th psychopharmacology

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50
Q

Nurse pt relationship
Empathetic linkage

Self system (from sulluvans work)
The self is an anxiety system (bio needs from sociocultural)
Nurses help identify needs

A

Hildegard Peplau (1909-1999)

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51
Q

Weir report - change Nursing environ

Nurses and deinstitutionalization

A

Note

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52
Q 
Lived experience 
Value voice
Respect language 
Curiosity 
Personal wisdom
Transparent
Tools that worked
Time used
Change is constant
A

Phil Baker Todal Model

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53
Q

Acculturizstion - adopting new beliefs

Somatizations- distress from physical problems

A

Note

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54
Q

Involuntary admission

A

Suffering from mental
Harm to self or others
Unsuitable as formal pt

A person unfit to stand trial may be detailed in mental facilities

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55
Q

Mental health act (under 16)

A

Informal pt (need consent from other to get tx)

Substitute decision maker

Not mentally capable of consent

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56
Q

Application by physician for psychological assessment

Holding for 72h

Must be seen within 7days before form

A

Form 1

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57
Q

Order of exam

Filled by justice of peace (anyone)

Detection long enough for exam

A

Form 2

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58
Q

Certificate of involuntary admission

Filled by physician

72h from start of detention under form 1

Valid for 2wk

Can contest

A

Form 3

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59
Q

Certificate of renewal

Filled my physician

Before expiration of form 3 or 4

Valid for 30, 60, 90 days

A

Form 4

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60
Q

Involuntary to voluntary

By physician

Whenever

No expiration or renewal

A

Form 5

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61
Q

Order to return

By officer in charge of facilities

Whenever absence becomes known

Expires 1month after becomes known

A

Form 9

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62
Q

Certificate of incompetence

Notice to pt

Physician must inform rights advisor

A

Form 30

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63
Q

Notice to person

Signed by physician

Given when detained under form 1

A

Form 42

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64
Q

Mental health legislation reform

Memory of brain Smith

Provide for early intervention

Community tx orders and new criteria for involuntary admission

A

Brian’s law (2000) bill 68

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65
Q

Community tx orders

For serious reoccurring

Plan of community less restrictive care

Expire 6mo after made

A

Form 45

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66
Q

Right to less restricted care (restraints

Rights to confidentiality

  • duty to warn
  • duty to protect
  • reporting abuse
  • confidentiality of communicable diseases
  • confidentiality after death
A

Patient rights under law

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67
Q

Elements of providing culturally sensitive care

Establish common goals

  • culture preservation
  • accommodation (re-patterning)
A

Self reflection
Cultural knowledge
Facilitate client choice
Communication

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68
Q

Historical trauma

A

Transmission

PTSD of a nation of people

“Cumulative emotional wounding across generations from massive tragedy”

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69
Q

Residential school

A

1870-1950 full scale operation remained open until 1990

Ages 5-15

Denied language, culture

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70
Q

Sixties scoop

Important for NSG: high suicide rate

A

1940s - advocacy for care of aboriginal

1951 - indiact act revised for child welfare

1960 - 1980 : aboriginal taken placed in adoption

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71
Q

Stigma

A

Mark of disgrace

Epidemiological paradox

  • must raise profile of suffering for help
  • perpetuates racist stereotypes
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72
Q

Treating intergenerational trauma

A

Use story telling to instill trust

Uncover contextual ways of

  • explaining the world
  • explaining how and why good and bad things happen (social Det, cultural teaching)
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73
Q

Nurse client relationship

A

Safe, confidential, reliable, consistent

Clear boundaries

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74
Q

Social relationship vs therapeutic

A

Social for friendship, socialization, mutual needs met

Therapeutic focus on pt, personal insight outcome. Nurses needs met outside

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75
Q

Goal and function of nurse pt relationship

A

Facilitate communication of distressing thought

Assist pt with problem solving

Help pt examine self defeating behavior and find alternatives

Promote self care and independence

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76
Q

Nurse pt relationship (Peplau)

A

Orientation: get to know eachother, develops trust (minutes - months)

The working phase: pt examines their difficulty and learns new ways of approaching them

Termination phase: from when issue is resolved to end of relationship (discharge)

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77
Q

CNO

A

Trust - fragile

Professional intimacy

Power - unequal

Respect

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78
Q

Boundaries

Personal space
Location and service of delivery
TX planning and delivery

A

No friendship etc

Can have relationship one year IF

  • would not have negative impact on pt for future
  • not based on trust and professional intimacy
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79
Q

Blurring boundaries

A

Slips into social context

Nurses needs and met by pt

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80
Q

Blurring of roles

Boredom, rescue, overinvolved, overidentify, misuse honesty, anger, help/hopelessness

A

Transference- client displaces onto nurse feelings and behavior related to past

Conterferance- vice versa

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81
Q

Factors that encouraxe client growth and empowerment

A

Genuine

Empathy

Attending

Suspending judgement

Help develop reasourses

Positive regard - attitudes, actions

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82
Q

RNAO client centered care beliefs

A

Respect

Human dignity

Pt expert of own life

Clients as leaders

Pt goals coordinate care

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83
Q

Problem focused approach vs solution focused

A

Past - future

What’s wrong - was right

Blame - progress

Control - influence

Expert knows best - collab

Deficits - resources

Complications - simplicity

Definition - actions

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84
Q

Solution focused is strength based

A

All persons gave strengths

Respect strengths

Motivation increase by focusing on strengths

Focus on helping process
(Not dx, deficits, symptoms, weakness)

Help relationship - collab, mutually

Each person responsible for recovery

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85
Q

5 primary intervention questions

A

Exceptions questions

Miracle questions

Scaling questions

Relationship questions

Coping questions

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86
Q

MSE

A

Systematic assesment

Reflects observations

Finding subjective

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87
Q

MSE ASEPTIC

A 
Appearance 
Speech
Emotion 
Perception 
Thoughts 
Cognition
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88
Q

Mental hygiene

A

Science of establishment and maintenance of health

No official health recommendations for mental health

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89
Q

Default mode network

A

Medial prefrontal cortex to posterior cingulate cortex

More active at rest (task negative)
Mind wandering

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90
Q

Task positive network

A

Attention network

Lateral prefrontal cortex to insula to posterior parietal

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91
Q

Cognitive patterns with DMN (default mode network)

A

Rumination

Self referential (internal narrative)

Mind wandering

Non practical past / future thought

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92
Q

Hyperconnectivity of DMN associated with

A 
MDD
Anxiety 
PTSD 
OCD
phobias 
Stress
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93
Q

DMN and happiness

A

Inversely related

Higher quality of life = decreased connectivity

More resilient

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94
Q

TPN (task positive network)

A

Central executive
Goal orientated activity
Associated with focus state

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95
Q

Dominance of DMN over TPN

A

Associated with depressive states

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96
Q

Decrease DMN

A 
Mental training
Mindfulness 
Meditation 
Mental excersise 
Journaling 
Breathing 
Nature 
Tasanama chant
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97
Q

Kirwan Kriya chant

A

Evidence based

Non symbolic sounds (TA-SA-NA-MA)

Chanting, finger touching, visualize (top of head out)

Decreased intensity then increased to normal

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98
Q

Think thought not about

A

About (worrying, wandering, no solution, distraction)

Through (reflection, concentration, solution, clear and relaxed mind)

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99
Q

Coordinated breathing and walking

A

3 in 4 out

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100
Q 
treat based off diagnosis
balance risk and benefit
treat symptoms
monitoring
compliance
concurrent disorders
social, interpersonal and personality disorders
history of medication use
A

principles of psychopharm

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101
Q

not compliance due to

A

stigma, denial, side effects, delayed onset, cognition, cost, misinformation

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102
Q

medications effect serotonin and NE, some dopamine

clinical response delay of several weeks

all effective depends of mechanism of action and side effects

A

treating depression

onset: initial response 1-2wk (increased apatite, sleep and energy)

peak response: 6-8wk up to 12 (mood, interest)

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103
Q

1987 - fluoxetine (Prozac)

MOA: blocks serotonin reuptake

SE: nausea, diarrhea, anxiety, headache, insomnia, sweating

A

SSRI

for MDD, BPD, PTSD, OCD, PMS, bulimia, smoking cessation

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104
Q

SSRI and sexual dysfucntion

A

decreased libido, anorgasmia, vaginal dryness, ED, delayed erection

m>w

tx: reduce dose, change to non serotonergic (bupropin, mitazapine)

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5
Perfectly
105
Q

SSRI discontinuation syndrome

A

with abrupt stop, depends on medication half-life

flu like, insomnia, n/v/d, imbalance, sensory electric shock sensation, hyperarousal

taper slowly

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106
Q

Serotonin syndrome (life threatening)

discontinue medication, address myoclonus
BP control (propranolol, lorazepam)
A

delirium, agitation, fever, sweating, myoclonus, hyperflexia, tremor, HT, diahhrea, incoordination

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107
Q

SNRI (serotonin NE) uses

A

MDD, anxiety, fibromyalgia, OCD, chronic fatigue, hot flashes, migraine, tension headaches

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108
Q

SNRI side effects

A

dose increase and HT
serotonin syndrome
discontinuation syndrome

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109
Q

SNRI venlafaxine (effexor)

A 
small dose (serotonin)
med dose (NE)
high dose (dopamine)
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110
Q

NDRI (NE, dopamine) uses

A

MDD, BPD, smoking cessation, SAD, chronic fatigue, ADHD, sexual dysfunction

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111
Q

NDRI side effects

A

headache, agitation, seizures, sleep disturbance, decreased apatite/weight loss, sweating

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112
Q

NaSSA (Noradrenaline serotonin specific) uses

MOA: increases NE/A and serotonin

A

MDD, insomnia, weight loss, anxiety, sedative lower dose (tolerance builds)

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113
Q

NaSSA side effects

rare: serotonin syndrome, SIADH, hepatoxicity

A

weight gain

anticholinergic (constipation, urinary retention, dry mouth, blurred vision, drowsy, tachy)

take at bedtime

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114
Q

TCA (tricyclic ad) uses

MOA: block NE and 5-HT reuptake

A

depression, anxiety, pain, migraine, PTSD

115
Q

TCA side effects

narrow therapeutic index

A 
weight gain (blocks histamine)
sedation (blocks histamine)
dizziness (alpha-adrenergic)
orthostatic HT (alpha-adrenergic)
anticholinergic (muscarinic)
cardiac conduction (NA)
116
Q

Anticholinergic Effects

red as beet, dry as bone, blind as bat, mad as hatter, hot as hare, bowel and bladder lose tone, heart goes off alone

A

warm skin, dry mouth, blurred vision, confusion, fever, drowsy, urinary retention, constipation, sinus tachy

ice, candy, increase fluids, laxatives, tears, pilocarpine eye drops, shower daily, talcum powder

117
Q

MAOI

Monoamine oxidase breaks down hormones (5-HT, NE, DA)

A

originally tb med found to decrease depression

first antidepressant

118
Q

MAOI special diet

A

avoid tyramines (aged cheese, wine, beer)

119
Q

MAOI side effects

A

weight gain (orthostatic HT, edema)

rare: SS, HT crisis, teratogenicity

HT crisis- NE not broken down increase BP

120
Q

limitations of MAOI and TCA

A

delay up to 10days
toxic (5-10 therapeutic range)
adverse effects “dumb bomb”
watch for added effects of tramodol, meperidine, dextro

121
Q

SARI (trazodone) (serotonin antagonist and reuptake) uses

A

150mg/day depression
below 150 sedative
not used for PTSD much

122
Q

suicide and antidepressants

A

make more agitated, restless

more likely to commit suicide

123
Q

Mood stabilizers

A 
lithium
valporic acid
lamotrigine
carbamazepine
oxcarbazepine
topimate
124
Q

BPD

A

lithium (toxicity with no sodium diet)
narrow therapeutic (0.8-1.4)
polyuria, goiter

125
Q

Lithium side effects

A

tremors, hypothyroid, weight gain, GI, increased thirst, lethargy

126
Q

lithium toxicity

A

tremor, ataxia, confusion, n/v/d, arrhythmia, poly urea/dipsia, edema, goiter, hypothyroidism, myoclonus, hyperflexia, coma, seizures

127
Q

valproic acid uses and side effects

A

BPD, epilepsy, migraine

sedation, tremor, acne, blood dyscrasias, elevated ammonia, mensural irregularities

128
Q

Lamotrigine uses and side effects

A

BPD, epilepsy, neuropathic pain

rash, ataxia, cognitive slow, sleep disturbance

129
Q

antipsychotics uses and MOA

A

schizophrenia, manic, depression, short term dementia

blocks DA (all)
blocks serotonin (atypical)
130
Q

haldol
loxapine
chlorpromazine
long acting injections (flupenthixol, flupehanzine, haldol, zuclopenthixol)

A

First generation antipsychotics (typical)

older drugs, work well ,cheaper

131
Q

SGA/TGA (second/third atypical)

A

block D2 and 5-HT

less EPS more FGA

may be more effective for negative effects of schizophrenia

132
Q

SGA/TGA side effects

A

weight gain, sedation, hyperglycemia, akathisia, dizzy, photosensitive, agranulocytosis (clozapine), seizure (clozapine)

133
Q

Clozapine (first atypical antipsychotic)

side effects: agranulocytosis, myocarditis, seizures, sialorrhea (drool), metabolic syndrome

other: QT long, arrhythmia, sudden death

A 
1960
came off because agranulocytosis
for tx resistant 
CBC, ECG 
must have 2 other trials first
134
Q

neuroleptic malignant syndrome

tx: stop meds

A

fever, rigid, elevated wbc/ck, change in mental status, autonomic instability (HT, tachy)

135
Q

Acute EPS

A

seen first 3mo
due to blocked DA receptors

parkinsonism (reduce dose, anticholinergic)

dystonia (reduce dose, IM benztropine)

akathisia (reduce dose, propranolol, benzodiazepine)

136
Q

Chronic EPS

A

tardive dystonia (sustained abn posture)

tardive dyskinesia (usu oral-facial)

  • use over 90 days
  • cumulative antipsychotics
  • increased age
137
Q

sedatives anxiolytics

MOA: binds to GABA

A 
short term hypnotic
prevent panic attacks
alcohol withdrawal 
mania
agitation
138
Q

anxiolytics side effects

A

confusion, memory decline, drowsy, withdrawal, dizzy, sleep apnea

hostility, disinhibition (esp elderly)

139
Q

stimulants

A

ADHD, narcolepsy, tx resistant depression

side effects: HT, tachy, insonmia, irritable, headaches, anorexia, child growth slowed

140
Q

stress as kids sensitizes stress in furture

A

note

141
Q

1920s Walter Cannon

Body responds: sympathetic stimulates adrenals, triggers catecholamines (NE, adrenaline)

Increase HR, BP, RR

Body returns in 20-60min

triggers real or imaginary

A

acute stress response: fight or flight

142
Q

GAS: general adaptation syndrome

A

Alarm
resistance
exhaustion

143
Q

human response to prolonged stress feels no control

endocrine and corticosteroids

can cause damage to physical and psychological health

A

Chronic stress response

144
Q

Coping styles

A

health sustaining
life satisfaction
social support
healthy responses

145
Q

Role of oxytocin in bonding

A

increased sensitivity to social cues

if positive/safe (adaptive responses)
if negative/unsafe (distress responses)

146
Q

Stress

A

response to a threat

from pressures in life. releases adrenaline extended releases can cause anxiety, depression etc

147
Q

Anxiety

A

reaction to stress

stress after stressor is gone

fear, impending doom, uneasiness, cause known/not

148
Q

Anxiety responses can be

A

physical
affective (terror, guilt, isolation)
cognitive (flashbacks)
behavioral (restless, inhibition)

149
Q

tensions of daily living, person alert, perceptual field increased

motivated learning, growth, creativity

s/s: restless, irritable, impatient
Relieving: finger tapping, fidgeting

A

anticipation and mild anxiety

150
Q

focus on immediate concerns, narrowing of perceptual field (hears, sees, grasps less)

voice tremor, concentration, pacing, increase VS, frequency, headache

A

moderate anxiety

151
Q

significant reduction of perceptual field

focus on specific details and nothing else

all activity to decrease anxiety focus on self, environment blocked out, sense of dread

inability to process, make decisions, purposeless activity, hyperventilate

A

Severe anxiety

152
Q

sense of terror

unable to do anything

disorganized, no rational thought
unable to communicate or function
terror, dilated pupils, pallor, mute or unintelligent speech, tremors, hallucinations, withdrawal, out of control agitation

A

Panic

153
Q

Distinguishing Anxiety (3 fields)

A

perceptual field
ability to learn
physical/other

154
Q

Contructive means to cope

A

talking
breathing
express feeling
avoid or withdrawal

155
Q

Altruism - dedication to others
Compensation - cover shortcomings
Conversion - anxiety to physical symptom
Denial - Ignore what’s happening

A

identification - associate with a group
introjection - outside world absorbed into self
intellectual - facts not emotion
projection - “what say…what are”

156
Q

Splitting - good or bad
sublimation - mature for immature
suppression - deny feelings
undoing - children, atonement

A

Displacement - feeling onto others
rationalize - justify with other reasons
reaction formation - anxiety thoughts opposite
regression - simple behaviors

157
Q

repression - block memory

dissociation - disrupt function

A

note

158
Q

50% panic
40% GAD
20% phobias
OCD strong link

A

Anxiety theories: Genetic

159
Q

Anxiety theories: biochemical

A

amygdala / hippocampus
sensitivity to CO2
GABA, 5-HT, DA, Epi etc

160
Q

Other anxiety theories

A 
psychodynamic
interpersonal (family)
behavioral
trauma
medical conditions
161
Q

anxious, tension, fear, insomnia, intellecual, depressed, muscular, sensory, CV, respiratory, GI, GU, ANS, behavior

A

Hamilton anxiety rating scale (0-4)

162
Q

difficult to differentiate from worries

excessive worry for more days than not for 6mo

diagnosis of exclusion

A

GAD 4%

NSG - relaxation, awareness of stressors, exercise, CBT, ask questions to dispute illogical thinking, sleep hygiene and avoid stimulants at bed time

163
Q

Intervention for GAD

A

benzodiazepines (no longer because addiction)

SSRI, SSNRI tx of choice

Gabapentin

164
Q

OCD Obsession vs complusions

A

unwanted thoughts that cause anxiety

behaviors to prevent and release anxiety

165
Q

Intervention for OCD

A

harm reduction, accept behaviors

Biological: gauge type and severity (open question “how long to get ready”)

Psych: thought block, present and ask to refrain, relaxation, cognitive restructure

social: SES, explain routine, assist with schedule, recognize rituals

166
Q

OCD tx

A 
CBT
deep brain simulation
SSRI 
Venlafaxine (SNRI) less side effects
Clomipramine (TCA)
167
Q

reexperiencing
avoidance
numbing
heightened arousal

A

PTSD 8% normal 20% cars 80% war

from trauma, fatigue, grief, moral injury

168
Q

PTSD tx

A

psychosocial tx (exposure, coping skills)

SSRI, TCA, antipsychotics, mood stabilizers, service animals

169
Q

similar s/s as PTSD (different duration 1mo)

dissociative symptoms

A

acute stress disorder

170
Q

Abrupt peak in minutes
palpations, sweat, tremble, SOB, chest pain, choking, nausea, depersonalization, derealization
depression and substance use
genetics

A

Panic disorders

can lead to phobias

171
Q

NSG assessment panic disorder

A

determine effects, suicidal assessment, thought patterns

distract, positive talk, CBT, exposure, desensitization

172
Q

panic tx

A

breath, relax, nutrition, physical activity, sleep hygiene

SSRI (First) benzodiazepines

173
Q

emergency care for panic

A 
stay with
reassure
clear directions
minimal stimulation
PRN anxiolytic
venting
174
Q

fear of social
fear of judgement
general/specific

A

Social phobia 14%

specific (10%)

175
Q

caused by substance

BT tx

A

substance induced anxiety

176
Q

anxiety in physical symptoms

A

somatization disorder (W80%, 20% M)

177
Q

impaired physical function de to psychological conflict

“la belle indifference” or distress

A

conversion/functional neuro disorder (2x W)

178
Q

Hypochondriasis/illness anxiety

A

misinterpret physicals sensations

tx; stress management, build trust, distraction, antipsychotics, antidepressants

179
Q

Somatoform vs factitious disorder (Munchausen syndrome)

malingering’s - faking symptoms to benefit

A

should not be confused a person consistently produce physically and psychological symptoms

180
Q

rethink
reboot
reconnect
revitalize

A

note

181
Q

skills for stress management

A 
exercise
relax
lifestyle change
reframe (thoughts)
laughter and humor
memory bank (positive)
182
Q 
trust more
fewer fatal accidents
strong memory
better testing
good friends
not appearing anxious
human race needs more apparently
A

advantages of anxiety

183
Q

schizophrenia is

A

treatable
a neurological disorder
psychosis is one element

184
Q

Epidemiology

A

1% worldwide (no bias yet doctor bias present)

185
Q

Schizophrenia co-morbidity

A

substance use (nicotine, alcohol, cannabis)
anxiety, depression and suicide
physical illness
polydipsia

186
Q

social realities of schizophrenia

A

caregiver stress
stigma and isolation
homelessness

187
Q

Psychological realities of schizophrenia

A 
difficult relating, decisions
affective blunting
decrease stress response and coping
self concept changes
self stigma
188
Q

Creativity and schizophrenia

A

90% higher chance

189
Q

Schizophrenia and dopamine

A 
positive symptoms (overactive mesolimbic)
negative symptoms (mesocortical dysfunction)

both are dopaminergic important role in motivation, cognition and significance of stimuli

190
Q

High levels of D2 receptors impaired grasp of reality, emotional dysregulation

A

mesolimbic

191
Q

reduction of D2 can cause decline in neurocognitive fx, memory, attention, problem solving, social traits

A

Prefrontal cortex

192
Q

Role of glutamate and schizophrenia

A

activated NMDA (forms connections in brain cells, for brain development, learning and memory

low NMDA - schizophrenia later in life?

193
Q

theories of etiology schizophrenia

A

vulnerability stress theory

early causes
vulnerability
drugs
stress and infection

194
Q

Phases of schizophrenia

recovery (maintenance and health promotion)

A 
Prodrome phase 
acute (onset/exacerbation)
Stabilization (diminishing, previous level)
maintenance (at/near baseline)
health promotion
195
Q

Prodromal phase

A

a year before episode
most common symptoms (reduced concentration, reduces motivation, depressed, sleep disturb, anxiety, social withdrawal, suspicious, deteriorating roles, irritable)

196
Q

hallucinations, delusions, racing thoughts, disorganized speech/behavior, disturbed/bizarre behavior

A

positive symptoms

197
Q

Positive symptoms: alterations in perceptions

A

hallucinations (auditory, command, visual)
depersonalization (detach from self)
derealization (detach from surrounding)

198
Q

Positive symptoms: alterations in thought content

A 
delusions 
concrete thinking (literal answers, no abstract thought)
199
Q

clang - rhyme
word salad - meaningless
neologisms - made up words
echolalia - repeating
circumstantiality - explain unneeded detail
flight of ideas
thought insertion
through broadcasting (everyone knows thoughts)
ideas of reference (special significance)

A

Positive symptoms: Alteration in speech (associative looseness)

200
Q 
motor retardation/agitation (slow) (fast)
catatonia (^/v movement)
waxy flexibility (posture maintained)
echopraxia (mimic movements)
boundary impairment (self end other start)
impaired impulse
gesturing/posturing
Automatic obe (robot)
negativism (does opposite)
A

Positive symptoms: Alteration in behavior

201
Q 
avolition (decreased motivation)
affective flattening (decreased expression)
alogia (decreased speaking)
anhedonia (decreased pleasure)
anosognosia (doesn't know ill)
A

negative symptoms

202
Q

assessment for depression

relapse, substances use, increased suicide risk, each psychotic break impair functioning

A

Affective symptoms (symptoms with emotion/expression)

203
Q

difficult attention, memory, information processing, cognitive flexibility, executive functions

A

cognitive symptoms

204
Q

outcomes with schizophrenia

A

1/3 improve
1/3 relapse
1/3 disabled

sustained remission with psychosocial support

205
Q

early detection and schizophrenia

A

earlier better
once symptoms and fear are addressed recovery begins
important to recognize other diseases (Huntington’s, Wilson’s, epilepsy, tumor, encephalitis, meningitis, MS)

206
Q

SPI-A must have 2/9 symptoms

A 
inability to divide attention
thought inference
thought blockage
disturbed receptive speech
disturbed expressive speech
disturbed abstract thinking (concretism)
ideas of reference (subject centrism) 
captivated attention by details of visual field
207
Q

First episode psychosis

A

3% of population
1/3 only have one episode
each acute episode prognosis worsens (toxic storm)
treatable

208
Q

Acute phase intervention

A

self care deficit
prevent water intoxication (polydipsia)
medications

209
Q

FGA-Typical antipsychotics

EPS (extrapyramidal side effects

thorazine, haloperidol, stelazine, loxipine, chlorpromazine

depot-fluphenazine, haldol, flupenthixol, zuclopenthixol

A

traditional (tranquilizer)

first generation (typical)

  • lowers dopamine (D2 antagonist)
  • acute dystonia (sustained contraction) chronic
  • akathesia (restless)
  • psudoparkinsoniasm
  • tardive dyskinesia (invol contractions) chronic
210
Q

SGA- atypical

rispiridone, olanzapine, quintiapine, ziprasidone, amisulpride, clozapine (final choice)

A

block D2 and 5-HT
negative and positive symptoms
minimal EPS or tardive dyskinesia

disadvantage - weight gain, blood monitoring required

se: sedation, hyperglycemia, akathisia, dizzy, photosensitivity

211
Q

Clozapine

A 
SGA
for tx resistant
registration, blood work, ECG, CBC
7 day supply to start
must have two other trial medicines first
212
Q

Clozapine side effects

A 
agranulocytosis
myocardidis
seizure
sialorrea (drool)
weight gain (hyperglycemia)
metabolic syndrome (central obesity, high BP, high TG, low HDL, insulin resistance
213
Q

TGA

aripiprazole (abilify)

A

dopamine stabilizer

improves positive and negative symptoms (little risk of EPS and tardive dyskinesia)

214
Q

iloperidone (fanapt)
lurasidone (latuda)
asenapine (saphris)
paliperidone (invega)

A

newest atypical antipsychotics

215
Q

Dangerous responses to antipsychotics

A

agranulocytosis
anticholinergic toxicity
neuroleptic malignant syndrome

216
Q

anticholinergic toxicity (toxidrome)

blind bat, mad hatter, red beet, dry bone, hot hare, stuffed pipe, myoclonus

A 
blurred vision
confuses, dec. LOC, seizures, delirium, psychosis
flushed, VD, tachy, dysrhythmia
hyperthermia
urinary and bowel retention
217
Q

NMS (FARM)

A

fever
autonomic changes
rigid muscles
mental status changes

218
Q

Adjunts to antipsychotics

A

Anti depressants

mood stabilizers

219
Q

general health of schizophrenia

A

more diabetes
more HIV
higher asthma

modifiable risk factors

220
Q 
1-2% experience (3% in usa)
equal among cultures, ages and genders 
2/3 have family history
6th leading cause of disability
9.2yr off lifespan
A

BPD stats

221
Q

BPS definition

A

shifts in mood, energy and ability to function

75% have concurrent anxiety disorder

222
Q

Mania don’t recognize behavior is problematic

can turn into hallucinations or delusions

A

note

223
Q

BPD 1

A

one or more manic episodes with a major depressive occurrence

224
Q

BPD 2

A

periods of major depression with at least one episode of hypomania
underdiagnosed and usually mistaken for BPD
more common in woman (says slides)
females more depression
males more mania

225
Q

4 changes in 12mo
poor functioning, high reactivity, resist tx
Severe form of BPD

A

rapid cycling

226
Q

depressive and hypomanic episodes don’t meet BP 1/2 criteria
milder form BPD
tend to have irritable hypomanic
substance use to self medicate

A

cyclothymic disorder

227
Q

Mania definition

A

over the top euphoria or irritability

228
Q

Hypomania definition

A

lower level less dramatic mania
at least 4 days
at least 3 manic behaviors
psychosis not present

229
Q

BPD neuroendocrine

A

woman low estrogen (improve with supplement)

HPTA and inflammation

230
Q

BPD neurobio

A

NE, D2, 5HT increase (mania) decrease (MD)
receptor insensensitivity
prefrontal cortex dysfunction on FMRI
grey matter loss

231
Q

Chronic cyclic disorder
mean age onset 21-30
episodes accelerate over time

A

Clinical course BPD

232
Q

initial presentation usually depression
intense range (3h straight)
symptoms reflect developmental stage
maybe mistaken for ADHD or conduct disorders

A

Children BDP considerations

233
Q

abnormalities and cognitive disturbances (confusion)

A

older adults BPD considerations

234
Q

Increase BPD with increase IQ

15-30% genetic

A

note

235
Q

Manic episode priorities

A 
protection
poor judgement, impulsivity
risk taking
supernatural powers
devastation by actions
236
Q

Depressive episode priorities

A

protection of pt
suicidal
self care deficits

237
Q

BDP assesment

A

mood
cognition
thought disturbances
risk assessment (injury, suicide, violence, abuse)

238
Q

psychoses during acute mania

stress and coping (stress trigger, negative coping)

A

BPD thought disturbances

239
Q 
injury prevention 
hospitalization helpful
symptom management and stabilization
antipsychotics or benzodiazepines
serum monitoring (1-2weeks/2months) (3-6weeks/after)
A

BPD acute phase (depression, mania or hypomania onset)

240
Q

lasts 4-9months (2-9mo after acute)
relapse prevention or cycling
continue stabilizers

A

BPD continuation phase

241
Q

prevention
decrease severity of future episodes
medication adherence

A

maintenance phase BPD

242
Q

Nsg assessment BPD

A 
changes in sleep/weight
electrolytes, WBC, thyroid 
use of substances
STI, pregnant
medication adherence
243
Q

encourage rest (min stimulation)
sleep aid
hydration/nutrition
monitor for withdrawal of substances

A

Mania interventions

once mood stabilizes (teaching routine and triggers)

244
Q

600-1200 start (max 1800mg)
supplemented with olanzapine
narrow therapeutic (0.4-1.0mEq/L)
fluid and Na important (low Na increase seizures, dehydration, thiazide diuretics, NSAIDS, ACE inhibitors

A

Lithium carbonate

245
Q

anticonvulsant (BPD, epilepsy, migraine)
better for acute mania (prevent future mania)

SE: dizzy, confusion, hallucination, headache, ataxia, sedation, tremor, acne, blood dyscraias, elevated ammonia, mensural irregularities, PCOS, weight gain, pancreatic, hyper-ammonic encephalopathy

A

divalproex (valproic acid)

broad spectrum
loading dose
liver function needs to be normal

246
Q

Third life antipsychotic

effects estrogen levels

A

tamoxifen

247
Q

n/v/d, fatigue, hyperreflexia, ataxia, delirium, myoclonus, coma, renal impairment

toxicity (arrhythmias, blackouts, tremors, seizures)

contradictions (heart, brain, renal, thyroid issues, graves disease)

A

Lithium toxicity

248
Q

Normal SE of lithium

A 
fine tremors
hypothyroidism
weight gain
GI symptoms
thirst
lethargy
249
Q 
anticonvulsant with mood stabilizing effects 
better with rapid cycling and dysphoria 
for unresponsive to Li
incremental dosing decrease SE
monitor blood and liver function
drug interactions and contraceptives
A

Carbamazepine (tegretol)

250
Q

First line for BPD
for BDP, epilepsy and neuropathic pain

SE: rash, hyponatremia, blood dyscrais, hepatotoxicity, teratogenicity, ataxia, cognitive slow, sleep disturbance

A

Lamotrgine

251
Q

Milieu Method

A

restrains and seclusion

252
Q

education (warning signs, medication adherence, health teaching, weight management

psychotherapy CBT

environment (roommates, peer support)

A

Other nsg interventions

253
Q

persistent depressive disorder (dysthymia)

A

depression most days

254
Q

pre-mensural dysmorphic disorder

A

last week before period

interfere with work and interactions

255
Q

Mood disorders (Affective disorders)

alterations in emotions and mood that result in depression or mania
interfere with life

A

depression (unipolar)
BP (manic depressive)
SAD

256
Q

persuasive and sustained emotion that colors ones perception of the world and how they function in it

A

mood

257
Q

reoccurring disturbances in mood that cause stress and behavioral impairment

alterations in mood not thought or perceptions

A

mood disturbances

258
Q

Mood disorder epidemiology

A 
3million Canadians at some point
2x as many woman
co-occur with other disorders
unrelated to race
culture can influence experience and communication of symptoms
259
Q

changes in apatite, weight, sleep, activity, recurrent thoughts, psychotics features, impaired functioning)
depressed mood 2weeks min
single or reoccurring (20% become chronic)

A

MDD (unipolar depression)

260
Q

Mood disorders behavioral factors

A 
NT
endocrine disorders
family/genetics
psychoimmunology
sleep dysfunction
261
Q

Mood disorders psychological factors

A 
stressful life events 
behavioral factors (cognitive, psychodynamic)
262
Q

Mood disorders social factors

A

support

woman 2x men mood disordersw

263
Q

Biological theory NT dysfunction and mood disorders

A

low 5HT (depression)
D2 (high-mania) (low-depression)
NE (modulated attention)
Acetylcholine and GABA

264
Q

Biological: endocrine dysfunction (hypothalamic-pituitary-adrenal-cortical-axis)(HPAC)

A

depression specifically:
elevated cortisol
malfunction thyroid
dysregulation of GH

265
Q

Diathesis stress model

early signs ^CNS activity CRF
causes sensitization under mild stress

A

biology and life events

psychosocial stressors and interpersonal events can trigger neuro-physical changes in the brain

266
Q

psychological factors

Beck’s triad (negative self, world, future)

A

cognitive theory
persons thoughts drive emotions
negative thoughts perpetuate depression
negative schema in childhood = negativity

267
Q

CBT

A

thought, behaviors and emotions to change perceptions

268
Q

Psychological: stressful events

A

meaning more important than actual event
BP stressful events linked to episodes not future
50-80% don’t develop mood disorders after stress

269
Q

psychological: Behavioral

A

learned helplessness (Sligmans rats and dogs)
linked to lack of control
lack of positive reinforcement (withdrawal)

270
Q

Psychological: psychodynamic

A

depression rooted in deficit of caregiver relationship
adult relations reflect childhood loss
loss triggers depression

271
Q

Brown and Harris social support

A

woman with stressful events
those friend <10% depressed
without >37%

272
Q

Goals of nsg and mood disorders

A 
symptom control
improve occupational/psychosocial function
build coping skills
reduce relapse
safety priority (suicide)
273
Q

nsg assessment mood disorders

A 
MSE
suicide risk
symptoms review
changes 
decreased energy
274
Q

atypical (over eat/sleep)

melancholic (apathy, weight loss, guilt, worse in morning)

psychotic (delusions, hallucinations)

catatonic (nonresponsive)

A

Types of MDD (4/8 total)

275
Q

postpartum (4weeks post, rumination, delusions)

SAD (anergia, hypersomnia, over eat, weight gain)

substance induced

dysthymic

A

Types of MDD (4/8)

276
Q

less likely psychosis
more likely anxiety and somatic
irritable rather than sad
suicide risk (mortality increase through adolescence)

A

nsg assessment MDD children

277
Q 
most don't meet criteria for depression
8-20%
37% in primary care
tx successful yet response slower 
highest suicide rate (over 80)
A

MDD assessment elderly

278
Q

SIGECAPS assessment

A

sleep, interest, guilt, energy, concentration, apatite, psychomotor, suicidal ideation

279
Q

SAD PERSONS - suicide risk assessment

A

sex, age, depression, previous attempts, ETOH/alcohol, rational thinking, social support, organized plan, no spouse, sickness

280
Q

suicide rare <10yo

can they understand the finality of death

A

prepubescent children suicide

281
Q

male 3x more likely
40x more if Inuit
suffocation
20-1 attempts-suicide

A

pre-adolescents suicide

adolescent suicide

282
Q

highest in midlife
single, divorced, widowed
other risk factors
marriage is protective

A

adults suicide

283
Q

parasuicide definition

A

an apparent attempt at suicide not resulting in death

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