ch 1 Flashcards
shift from institutional care in hospitals to community care
deinstitutionalization
DSM is used for
describe all mental disorders and outline diagnostic criteria
managed care is used to purposely control the balance of
expenditure of funds and quality of care
a state of overall wellbeing and stability
mental health
mental illness
a behavioral or psychological pattern that causes distress or disability in an individual
psychotropic drugs effect
mood, behavior and thinking
is mental health considered lack of mental illness
no, it is a state of emotional, physical, social and psychological wellness
dynamic and ever changing due to external factors
3 purposes of DSM
- standardized nomenclature is established
- present defining characteristics that differentiate specific diagnosis
- to assist in finding the underlying causes of disorders
Aristotle and mental health
believed was determined by “humors” or the amounts of blood and bile in the body determined if mental illness was present
who created the concept of asylums in 1790s
William Tuke and philippe pinel
who opened 32 state hospitals in the US to offer asylum
dorthea dix
first drugs to be developed to treat mental illness
chlorpromazine (antipsychotic) and lithium (antimanic)
supplemental security income
mentally ill able to have source of income due to disability
__% Americans 18yr+ have a mental illness
18.6%
mental illness is leading cause of disability 15-44yr in US and Canada T/F
true
negative side effect of deinstitutionalization
revolving door effect
do planned hospital stays contribute to the revolving door effect?
no-> pt with severe and persistent mental illness may show signs of improvement during an unplanned stay but are not stabilized when released
is funding for community health centers congruent between states
no it varies by state and areas depending on funding
medicare covers
65+ and over
medicaid covers
people with disabilities
mental health parity act
eliminated annual and lifetime dollar amounts for mental health care for companies with more than 50 employees
first American psychiatric nurse
linda richards
first psych textbook published when and by who
in 1920 by harriet bailey
nursing theorist that supported interpersonal relationships with nurse and client
peplau
nursing theorist that focused on clients psychosocial needs and strengths
june mellow
who develops standards of care for nurses
american nurses association
intense need to move about, restless movement, cannot remain still
akathisia
anticholinergic side effects
cant see
cant pee
cant poop
cant spit
neuroleptics
antipsychotic drugs used to treat psychosis
anxiolytic drugs
used to treat anxiety
black box warning
highlighted box that indicates warning about life threatening side effects
depot injection
slow release injectable form of antipsychotic medication for maintenance therapy
NT in control of movements, motivation, cognition
dopamine
dystonia
extrapyramidal side effect to antipsychotic meds
acute muscular stiffness, stiff tongue, in severe cases respiratory difficulties and laryngospasm
maximal therapeutic effect a drug can reach
efficacy
most prevalent NT in CNS
epinephrine and norep
epinephrine plays a role in
attention, learning and memory, sleep, and mood regulation
extrapyramidal s/s
side effects of antipsychotics
dystonia
pseudoparkinsonism
akathisia
snowball effect of when a minor seizure seems to build up into more frequent
kindling process
limbic system includes
thalamus
hypothalamus
hippocampus
amygdala
mood stabilizing drugs are used for
bipolar
possibly fatal reaction to antipsychotic drug
neuroleptic malignant syndrome
post injection delirium/sedation syndrome
cluster of s/s from accidental intravascular injection of alanzapine
slurr speech
confusion
altered gait
serotonin syndrome
caused by combo of serotonin enhancing drugs that will cause agitation sweating fever tachy hypotension hyperreflexia
most common combo of serotonin drugs that cause serotonin syndrome
MAOI and SSRI
tardive dyskinesia
late onset side effect of antipsychotic
involuntary movements such as lip smacking, tongue protrusion, chewing etc
lobe that controls organization, body movement, memories, emotions and moral behavior
frontal lobes
abnormalities in the _____ result in schizophrenia, ADHD and dementia
frontal
lobe that interprets sensations of taste and touch, assists in spatial organization
parietal
center for smell, hearing, memory and emotional expression is interpreted in what lobe
temporal
lobe that assists in coordination language, visual interpretation-depth perception
occipital
center for coordination or movements and postural adjustments
cerebellum
lack of dopamine in cerebellum
parkinsons
bottom of brainstem that controls breathing and cardio functions
medulla
the pons serves as the ____ pathway
primary motor pathway
midbrain connects the pons with cerebellum and controls most of the ____ systems
reticular activating systems and extrapyramidal system
extrapyramidal system function
relays info about movement and coordination from brain to spinal cord
norep producing area in the brain
locus coeruleus
locus coeruleus is associated with
stress, anxiety and impulsive behavior
thalamus system regulates
activity, sensation and emotion
part of limbic system in control of appetite, temperature control, sex drive and impulsive behavior
hypothalamus
part of limbic system associated with memory
hippocampus and amygdala
neurotransmission
NT communicate with other neurons
MAO function
breaks down NT in synapses when they are not reuptaked
dopamine is synthesized by
tyrosine
dopamine excess is seen in
schizophrenia
antipsychotics work to block dopamine receptors
excess norep is seen in what disorder
anxiety
serotonin is derived from
tryptophan
is serotonin excitatory or inhibitory
inhibitory
decreased ACH is present in what diseases
alzheimers and myasthemia gravis
high glutamate can cause
severe brain damage, seen in strokes, hypoglycemia, hypoxia
inhibitory NT that modulates other NT
GABA
used exp with benzos to reduce anxiety and induce sleep
CT vs MRI
CT is multiple Xrays that can visualize soft tissues
MRI shows more tissue detail and blood flow. used to measure size and thickness
PET and SPECT are mainly used for
research, pt performs cognitive functions and is observed.
SPECT is single photon and takes shorter time
drugs take longer to reach effect and require lower dosages in elderly T/F
true
how do antipsychotics work
block receptors of dopamine
antipsychotics main use
schizophrenia, acute manic, psychosis
is the antipsychotic- clozapine known to have higher or lower instances of extrapyramidal effects
lower
dopamine stabilizing drug
aripiprazole
commonly causes HA, N/V
what depot injection has the possibility of causing post injection delirium
zyprexa
nursing duties after depot injection
monitor for 3 hours post for sedation syndrome
first gen or second gen antipsychotics more likley to cause EPS
first gen
when is geodon contraindicated
when pt has hx for QT prolongation, recent MI, or uncompensated heart failure
dystonia is more likely in what kind of pt
first week of tx
under 40
pt receiving haloperidol or thiothixene
pt is experiencing severe EPS s/s, what treatment is possible
anticholingeric drugs such as benztropine IM or benadryl
treatment of EPS s/s of akathisia
add a B-blocker, anticholinergic or benzo
s/s of neuroleptic malignant syndrome
pt usually confused and mute, usually first two weeks of starting the drug pale unstable BP diaphoresis high creatine
tx for neuroleptic malignant syndrome
stop immediately
tool used to assess for tardive dyskinesia
abnormal involuntary movement tool
increased prolactin levels when n antipsychotic drugs causes
weight gain
breast enlargement
decreased libido
weight gain is most commonly seen with what antipsychotic
clozapine and olanzapine
what 3 antipsychotics may lengthen the QT interval and lead to life threatening effects
droperidol
thioridazine
mesoridazine
clozapine’s deadly side effect nurses must watch for
agranulocytosis
pt misses an antipsychotic med
can take it if its within 3-4hours-> omit if not
antidepressants act on what 2 NT
norep and serotonin
life threatening possible side effects of taking MAOI
HTN crisis if pt ingests tryamine
many drug interactions
lethal if OD
first choice for depression
SSRI
drugs effective fro OCD
SSRI and clomipramine
MAOI’s commonly prescribed for pt who is highly suicidal
no
most established mood stabilizer
lithium
serious side effect of lamotrigine
serious rashes, higher risk in younger children
signs of lithium toxicity
severe diarrhea, vomiting, drowsiness, muscle weakness
most effective drug class for anxiety
benzo’s
-> never discontinue abruptly!
where do amphetamines act on the cell
presynaptic terminals
client teaching for stimulants
take after meals
no caffeine, sugar
why is disulfiram used
produced negative side effects when ingested with alcohol
why is disulfiram used
produces negative side effects when ingested with alcohol
extrapyramidal system is controlled where
midbrain
a drug induced movement disorder would be induced where
D2 receptors in midbrain
4 functions of dopamine
complex movements, motivation, cognition, regulation of emotional response
schizophrenia has high/low dopamine
high
antipsychotics block receptors
is norep increased or decreased in anxiety disorder
increased
what meds function to increase the function of gaba
benzo
what meds function to increase the function of gaba
benzo
tardative dyskinesia is most likely seen with what kind of antipsychotics
conventional/first gen
weight gain is most common side effect with what kind of antipsychotics
second gen:
clozapine
olanzapine
what to do if suspect neuroleptic malignant syndrome (side effect of antipsychotics)
stop meds!
what antipsychotic can cause deadly agranulocytosis
clozapine
what antidepressants cause anticholingeric side effects
TCA
what antidepressants cause anticholingeric side effects
TCA
when should TCA’s be given
at night
examples of mood stabilizaera
valpronic acid carbamazepine gabapentin topiramate oxcarbazepine lamotrigine
how are valpronic acid and topiramate known to work for mood stabilization
increase GABA
what two anticonvulsants are thought to stop the kindling process
valpronic acid and carbamazepine
lithium side effects
Nausea
diarrhea
anorexia
fine hand tremor
lithium severe side effects
severe diarehha and vomitting, weakness
= toxicity (over 3)
when must blood tests be taken when on lithium
within 12 hours of last dose
biggest side effect with benzos
physical dependence
