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Nursing - Bloomberg > 372: Mental Health > Flashcards

372: Mental Health Flashcards

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1
Q

Principles of Milieu Therapy

A
  1. Fundamental respect for individuals
  2. Communication opportunities
  3. Autonomy reinforced
  4. Socialization facilitated
  5. Part of unit management
  6. Responsibility and accountability
  7. Peer pressure to reinforce rules
  8. Team approach
  9. Group discussions and temporary seclusion’s
  10. Nurses promote these goals
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2
Q

Mental health exam (ABC STAMP LICKER)

A 
Appearance 
Behaviour 
Cooperation 
Speech
Thought process & content
Affect
Mood
Perception 
LOC
Insight
Cognition
Knowledge 
Endings 
Reliability
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3
Q

Tardive Dyskinesia

A

Involuntary movements of face and arms/legs related to Antipsychotic medications

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4
Q

Akathisia

A

Subjective feelings of muscular tension secondary to antipsychotic or other meds, causing restlessness, pacing, repeated sitting and standing

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5
Q

Lutheran’s Recovery Model (HSSE RCR)

A
  1. Hope
  2. Security
  3. Support and managing symptoms
  4. Empowerment
  5. Relationships
  6. Coping
  7. Recovery education
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6
Q

Personal medicine

A

RECOVERY + RESILIENCE

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7
Q

What are the principles of informed consent?

A
  1. Nature of treatment
  2. Expected benefits
  3. Material risks and side effects
  4. Alternative courses of action
  5. Consequences of not having treatment
  6. Respond to requests for additional info
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8
Q

What is the test for capacity to consent?

A
  1. UNDERSTAND information RELEVANT to decision

2. APRECIATE reasonable foreseeable CONSEQUENCES for decision or lack there of

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9
Q

What is the SDM Hierarchy? (CARS PB RP)

A
  1. Court-appointed guardián
  2. Attorney for personal care
  3. Representative by CCB
  4. Spouse, common law partner
  5. Parents + children
  6. Brothers + sisters
  7. Relatives by blood, marriage, adoption
  8. Public Guardian or trustee
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10
Q

What are the rules of emergency treatment without consent for an incapable person?

A
  1. There is an emergency
  2. Delay obtaining decision will prolong pts suffering and put at risk of serious bodily harm
  3. Treatment may continue until SDM is found
  4. If pt regains capacity, they decide
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11
Q

Rules for emergency treatment without consent for apparently capable person

A
  1. There is an emergency
  2. Required communication cannot happen due to language barrier or disability
  3. Reasonable steps have been taken to enable communication without success
  4. Delay by enabling communication will prolong suffering or risk serious bodily harm
  5. No reason to believe the person does not want treatment
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12
Q

Form 1

A
  1. MD must examine
  2. Conclusions may be based on combination of personal data and observations
  3. May sign within 7 days of exam
  4. Valid for 7 days
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13
Q

Form 2

A
  1. Justice of peace may sign Form 2
  2. Directs police to apprehend and take the person for Form 1 exam
  3. Anyone may request
    4? Valid for 7 days
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14
Q

Form 3

A
  1. Valid for 14 days (including date of signature)
  2. Must be preceded by examination
  3. Signed regarding: voluntary or informal pts, detained on Form 1 and still within 72 hours
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15
Q

Form 4

A
  1. Only if pt is already on Form 3 or 4 extension

2. First form = 1 month, second = 2 months, third = 3 months, etc

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16
Q

Transference

A

Client’s unconscious projection of attitudes and feelings from past relationships onto therapist/nurse

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17
Q

Countertransference

A

Therapist/nurse unconsciously and inappropriately displaces feelings related to significant figures onto patient

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18
Q

Core interviewing skills for motivational interviewing

A
  1. Open questioning
  2. Affirm
  3. Reflect
  4. Summarize
  5. Informing and advising
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19
Q

What are the 3 components of crisis?

A
  1. Precipitating/stressful event
  2. Perception of event
  3. Usual coping methods/supports
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20
Q

What are the 3 components that resolution from a crisis depends on?

A
  1. Realistic perception of event
  2. Adequate supports
  3. Adequate coping mechanisms
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21
Q

What is the ABC Model of Cognitive-Behavioural Therapy (CBT)?

A
  1. Activating event
  2. Beliefs that leads to emotions and behaviours
  3. Consequences
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22
Q

Cognitive conceptualization

A

Links between thoughts, feelings, and behaviours

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23
Q

Dialectical Behaviour Therapy (DBT)

A

CBT + Mindfulness

  1. For people with BPD and suicidality
  2. Emphasis on awareness of thoughts and actively shaping them
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24
Q

Intersectionality

A

Theory which seeks to examine socially and culturally constructed categories interact to manifest as inequalities in society

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25
Q

Ideological hegemony

A

Situation where a particular ideology is pervasively reflected throughout society, culture/organization. Located in all social institutions and permeates cultural ideas and social relationships.

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26
Q

Social constructionism

A

Our realities are shaped through our experiences and interactions with others

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27
Q

Goffman’s Oseas in social identity

A

Self-constructed notion of identity works from perspective of individual to society.

Identity is a product of interaction between self and others in social environment

Damage to social identity = stigma

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28
Q

What are Goffman’s key points on social identity?

A
  1. A process
  2. Negotiated
  3. Situational and contextual
  4. Involves membership in group
  5. Embeddedness of categories
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29
Q

What are the 5 faces of oppression?

A
  1. Exploration
  2. Marginalization
  3. Powerlessness
  4. Cultural imperialism
  5. Violence
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30
Q

Cultural relativism

A

Principle of regarding the beliefs, values, and practices of a culture from the viewpoint of that culture itself, rather than be judged against another

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31
Q

Syndemic

A

Two or more afflictions interacting synergistically to contribute to excess burden of disease in a population

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32
Q

Syndemic Theory

A

Individual endémics sustained in populations because of harmful social conditions and injurious social connections

33
Q

Engulfment

A

Degree to which individuals define themselves by their illness

34
Q

What is associated with high engulfment levels?

A
  1. Hopelessness
  2. Depression
  3. Low self-esteem
  4. Lack of self-efficacy
  5. Decreased social adjustment
35
Q

Cultural determinism

A

Who we are is determined by our culture

Perpetuates stigmatization and marginalization

36
Q

Structural determinism

A

Societal factors structure processes and outcomes

Limit access to resources which could potentially improve SES

37
Q

Relative poverty

A

Social conditions that serve to create realities of poverty in a given time and place

Can’t have what the larger community regards as minimum necessary for decency

38
Q

What are the barriers to accessing health care for homeless people? (SIMA)

A
  1. Structural - transit, resources, etc
  2. Individual - memory, fear, etc
  3. Material - lack of ID, insurance, etc
  4. Attitudinal - prejudice, stigma, discrimination
39
Q

What are the 6 principles for WHO Mental Health Action Plan 2013-2020

A
  1. Universal health coverage
  2. Human rights
  3. Evidence-based practice
  4. Life-course approach
  5. Multi sectional approach
  6. Empowerment of persons with mental disorders and psychosocial disabilities
40
Q

Risk factors for schizophrenia

A
  1. Traumatic delivery
  2. Maternal malnutrition
  3. Exposure to toxins
  4. Hypoxia
  5. In uteri exposure to influenza virus
  6. Late winter or early spring births
41
Q

Residual schizophrenia

A

Negative symptoms continue
2+ positive symptoms
No prominent delusions, hallucinations, disorganized speech, or catatonic behaviours

42
Q

Delusions of reference

A

Behaviour of others refers to oneself

43
Q

Delusions of control

A

False belief that ones will, thoughts, or feelings are being controlled by external factors

  1. Thought insertion
  2. Thought withdrawal
  3. Thought broadcasting
44
Q

Negative symptoms of schizophrenia

A

Hypostimulation of D1 receptors

45
Q

Alogia

A

Poverty of thought and speech

46
Q

Avolition

A

Unable to start task, lack of motivation

47
Q

Anhedonia

A

Inability to experience enjoyment

48
Q

Extrapyramidal side effects

A
  1. Tardive Dyskinesia
  2. Pseudo-parkinsonian symptoms
  3. Extreme muscle spasms
  4. Restlessness/akathisia
  5. Weakness
  6. Muscle fatigue
  7. Slowed movements

ariprazole

49
Q

Pseudo-Parkinsonian symptoms

A

Rigidity, mask-like facial expression, stiff gait

50
Q

Neuroleptic malignancy Syndrome

A

Serious rxn to neuroleptic drugs and dopamine blockage

  1. ⬆️ temperature
  2. Labile BP
  3. Elevated CPK (creatinine phosphokinase from muscle damage d/t rigidity)
  4. Altered LOC
  5. Rigidity
  6. Diaphoresis
  7. Tachycardia
51
Q

What is the treatment for neuroleptic malignancy Syndrome?

A
  1. Discontinue meds
  2. Keep cool
  3. Hydrate well
52
Q

Second generation antipsychotics

A

(+ and - symptoms)

  1. Clozapine
  2. Risperidone
  3. Olanzapine
  4. Quetiapine
  5. Ziprasidone
  6. Ariprazole (Abilify)
53
Q

Types of delusions

A
  1. Persecutory
  2. Grandiose
  3. Somatic
  4. Religious
  5. Guilt
  6. Jealous
  7. Erotomanic
54
Q

First generation antipsychotics (+ve symptoms only)

A
  1. Chlorpromazine
  2. Thioridazine
  3. Trifuouperazine
  4. Thiothixene
  5. Perphenazine
  6. Piportil
  7. Loxapine
  8. Haloperidol
  9. Fluphenazine
55
Q

Cyclothymic

A

Alternating depressing and hypomania, not severe enough to be bipolar

56
Q

Dysthymic

A

Low degree of depression, but hx of depressive character low mood lasting period of 2 or more years with moderate depression symptoms

57
Q

Atypical affective Disorder

A

Symptoms not Sever enough to fit other categories of major affective disorders

58
Q

Biological theory of causes of depression

A

Alterations in dopamine, NE, 5HT in areas that regulate appetite, sleep, and emotional processes

Higher risk for disrupted circadian rhythms

59
Q

Behavioural-Social Learning Theory of depression

A

Reciprocal interaction between cognitive, behavioural, and environmental influences.

Stress disrupts involvement with others. Amount/quality of positive reinforcement reduced increase in negative self-evaluation and evaluation of the future.

60
Q

Interpersonal Theory of depression

A

Interpersonal difficulties seems as antecedents and consequences of depression

Children: neglect, abuse, rejection, loss of parent, disharmony of family

Adults: separation, divorce, marital problems, losses, absence of supportive social relationships

61
Q

Cognitive Theory of depression (Aaron Beck)

A

World view based on false belief about self, future, and the world

Negative view considered distortion of reality

62
Q

Learned Helplessness Theory (Seligman) of depression

A

Pt feels have no influence over their environment.

Feelings of helplessness, powerlessness, hopelessness, passivity, susceptibility to depression

63
Q

Diathesis-Stress Model of depression

A

Stressful events trigger neurophysical and neurochemical changes in the brain

Some people are predisposed to depression

64
Q

Risk factors for depression

A
  1. Women > men
  2. 20-50 years old
  3. Family hx of depression, bipolar, or alcoholism
  4. Recent life stressors
  5. Personality: shy, insecure, worrisome, internalized feelings, not assertive, difficulty managing stress
65
Q

Electroconvulsive Therapy (ECT)

A
  1. Used to treat mania, paranoid and catatonic schizophrenia
  2. Effective in pregnant women and safe in all trimesters
  3. Given 2-3 times a week for 6-12 treatments
  4. Vitals monitored q15min until stable
  5. Loss of memory - return in 2 weeks
  6. Temporary headaches
66
Q

What are the signs and symptoms of PTSD? (DREAMS)

A
  1. Detachment
  2. Re-experiencing the event
  3. Emotional effects (distress, numbing)
  4. Avoidance
  5. Medication (self-medication)
  6. Sympathetic hyperactivity (hyper aroused)
67
Q

Interventions for PTSD

A
  1. CBT
  2. Desensitization
  3. Trauma-informed Care
  4. Self-soothing techniques
  5. Psychotherapy
  6. Relaxation techniques
  7. Medications: anxiolytics, antidepressants
68
Q

What are signs and symptoms of Borderline Personality Disorder (BPD)?

A
  1. Impulsive behaviours
  2. Destructive behaviours
  3. Mood: negative affect, intense anger, etc
  4. Unstable interpersonal relationships
  5. Self-image instability
  6. Intense fear of abandonment
  7. Antagonistic
  8. “Splitting” (all or nothing, good/bad)
69
Q

Antisocial Personality Disorder

A
  1. Conduct Disorder in early childhood
  2. Antagonistic, disinhibited behaviours
  3. Lack of appropriate emotional response
  4. Lack of remorse
  5. Finds pleasure and enjoyment in others’ vulnerabilities
70
Q

Dissociative Identity Disorder

A
  1. 2+ alters with unique identity, feelings, memories
  2. R/t extreme trauma, esp childhood sexual abuse
  3. Rare and difficult to diagnose
71
Q

Principles of Trauma-Informed Care

A
  1. Physical and psychological safety
  2. Trustworthiness and honesty among providers and clients
  3. Collaboration and power balance
  4. Empowerment for clients to make treatment decisions
  5. Voice and choice for clients to express differences
  6. Resilience and ability to grow & recover
  7. Inclusiveness
  8. Cultural and gender awareness
72
Q

Disease model of addiction

A

Considers addiction a disease, but doesn’t consider social/environmental factors

73
Q

Epigenetics Theory of addiction

A

Genes that can be “switched on” in response to stress

74
Q

Neurobiology Theory of addiction

A

Mesolimbic areas of the brain (feelings, cognition, behaviours)

75
Q

System Structures of addiction

A

Moving beyond disease and talking about the environment (SODH)

76
Q

Reinforcing role of dopamine in addiction

A
  1. Dopamine overstimulation by substance
  2. Pathways and DA receptions down-regulate after repeated exposure
  3. Increased stimuli needed to signal pleasure via DA receptors
  4. Results in dependence on substance
77
Q

What are the 4 categories of benzodiazepine discontinuation?

A
  1. Symptom recurrence or relapse
  2. Rebound
  3. Pseudo withdrawal
  4. Withdrawal
78
Q

Motivational interviewing skills (OARSI)

A 
O = ask OPEN questions 
A = use AFFIRMATIONS 
R = REFLECT what your pt is saying
S = SUMMARIZE 
I = INFORM and advise
79
Q

Stages of change model

A
  1. Pre contemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance

Nursing - Bloomberg (52 decks)

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