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CV487 > Class 5: Mental Health > Flashcards

Class 5: Mental Health Flashcards

1
Q

Positive symptoms of pyschosis

A

-Delusions, hallucinations, disorganized thinking and behaviors
-Poor social functioning
-Sudden onset improved with antipsychotic medication

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2
Q

Negative symptoms

A

-Absence of thought and behavior patterns contributing to inappropriate social functioning
-Slow onset that worsens

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3
Q

Delusions

A

-aThought content, fixed false beliefs
-Cannot be corrected by reasoning or evidence

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4
Q

Examples of delusions

A

-Grandiose, persecutory, somatic & nihilistic
-GPSN

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5
Q

Nihilistic

A

Belief that they’re dead

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6
Q

Persecutory

A

Being watched

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7
Q

Somatic

A

aBodily function

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8
Q

Disorganized thinking

A

Illogical speech, impaired reasoning, loose associations

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9
Q

Abnormal motor behaviour

A

-Agitation, aggression (perceived or toward others), catatonic excitement, echopraxia, hypervigilance, mutism, rigid (could be r/t medications), waxy flexibility

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10
Q

Echopraxia

A

Imitating others behaviors

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11
Q

Catatonic excitement

A

Hyperactivity of purposeless activities and abnormal movements such as grimacing and posturing

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12
Q

Waxy flexibility

A

Posture held in an unusual position

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13
Q

Brief pyschotic disorder criteria rules

A

-2 or more of the following, presenting for 1 month. At least one of these needs to be: Delusions, hallucinations or disorganized speech
-Episode lasts at least 1 day but less than 1 month with a return to a normal level of functioning

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14
Q

Brief psychotic disorder criteria manifestations

A

Catatonic behaviour, delusions, disorganized speech and behavior, hallucinations

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15
Q

Brief psychotic disorder etiology

A

Can result from changes in physical status, major life events, drug use, and environmental changes

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16
Q

Prevalence of brief psychotic disorders

A

Onset in the mid 30s, can occur at any age, twice as common in females, more common in developing countries

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17
Q

Delusional disorder criteria rules

A

-1 or more delusions over 1 month
-Delusion criterion for schizophrenia has not been met, if hallucinations are present they are not prominent or r/t delusion
-Function is not markedly impaired

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18
Q

Subtypes of delusional disorder

A

-Jealous, somatic, erotomania (sexual), & grandiose
-JSEG

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19
Q

Delusional disorder prevalence

A

-Rarely exists on its own, comorbidities include: Mood disorders, OCD, and personality disorders (specifically paranoid, schizoid, avoidant)
-Can begin in adolescence

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20
Q

Delusional disorder may go..

A

Undiagnosed because behavior is not noticeably abnormal

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21
Q

If delusions are…

A

Somatic, individuals risk unnecessary medical investigations and legal interventions

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22
Q

Neurobiological etiology of delusional disorder

A

-Asymmetrical temporal lobes, possible neuro-degenerative component
-Sensory alterations in the nervous system associated with cortical changes
-Perceptions linked with an interpretation that has deep emotional significance but no verifiable basis

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23
Q

SDOH + delusional disorder etiology

A

Early life experiences

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24
Q

Schizophrenia criteria rules

A

-2 or more of the following over a 1 month period. Must include delusions, hallucinations, or disorganized speech
-Lasts >1 month >6 months

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25
Q

Schizophrenia manifestations

A

Delusions, disorganized speech and behavior, negative symptoms, and hallucinations

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26
Q

Phase I (acute) assessment of schizophrenia

A

-Onset of illness, loss of function abilities
-Florid, disruptive symptoms (positive or negative)

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27
Q

Phase II (stabilization) assessment of schizophrenia

A

-Period of wellness
-Move from acute care to community-based services, still require supervision

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28
Q

Phase III (maintenance) assessment of schizophrenia

A

Progress in not a linear

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29
Q

Prevalence of schizophrenia

A

-Late teens/ early adolescents
-Becomes chronic in 80% of individuals who are diagnosed, poor functioning before onset of disease
-More common in males, except in later onset

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30
Q

Early onset of schizophrenia

A

Early onset ( 18-25 yrs.): Increased brain abnormality & increased apathy

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31
Q

Later onset of schizophrenia

A

Later onset (25-35 yrs.): More likely to be female, less structural brain abnormality

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32
Q

Schizophrenia genetic etiology

A

-Heredity, polygenic disease, irregularities on chromosomes 13 and 15
-Rate increases by 10 x if you have a first degree relative with schizophrenia

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33
Q

Schizophrenia neurobiological etiology

A

-Neurotransmitters; dopamine, and serotonin, glutamate
-Dopamine & serotonin; based on the use of use of conventional antipsychotics
-Glutamate; involved in neural communication, memories, learning, regulation, CNS maturation
-GSD

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34
Q

Schizophrenia brain structure abnormalities + etiology

A

-Differences in structure of the ventricles
-Lower brain volume, increased CSF, decreased blood flow to the frontal lobe

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35
Q

Schizophrenia comorbidity + etiology

A

Obesity & diabetes

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36
Q

Schizophrenia etiology + prenatal risk factors

A

Viral infections, poor nutrition, hypoxia, toxins, birth complications, age of conception

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37
Q

Schizophrenia etiology + psychological stressors

A

-Prolonged increased stress results in aHypothalamus development
-Recreational drugs increase dopamine
-Trauma
-PRT

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38
Q

Schizophrenia etiology + SDOH

A

Adverse living conditions, migration

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39
Q

Across the lifespan considerations + children & adolescents

A

-Look for patterns
-Consider if the difficulties are r/t developmental tasks (i.e. exploration with drugs, alcohol, and sex; seeking autonomy)

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40
Q

Across the lifespan considerations + older adults

A

Presence of additional factors may increase patients’ stress and potential for secondary concerns

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41
Q

Delusional disorder general appearance + engagement

A

-No functional impairment, may become more distracted as it progresses

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42
Q

Delusional disorder general appearance + grooming & dress

A

Disrupted self-care

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43
Q

Delusional disorder affect

A

Anxiety with progression of illness

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44
Q

Delusional disorder thought content + delusions

A

Fixed false beliefs

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45
Q

Delusional disorder thought content + suicide, homicide, self-harm, depressive & anxious cognitions

A

Assess impulsivity to act in relation to the delusion

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46
Q

Schizophrenia general appearance positive & negative symptoms + engagement

A

-Positive: Engage in conversation but unmotivated to change
-Negative: Apathetic, withdrawn, anergia, anhedonia, avolition

47
Q

Anergia

A

Lack of energy

48
Q

Anhedonia

A

Inability to feel pleasure

49
Q

Avolition

A

Lack of motivation

50
Q

Schizophrenia general appearance positive & negative symptoms + movement

A

-Positive: Psychomotor agitation, repeated motor behaviours, waxy flexibility, & echopraxia
-Negative: Stuporous, psychomotor retardation, comatose

51
Q

Schizophrenia general appearance + grooming

A

Poor maintenance of hygiene & ADLs

52
Q

Schizophrenia general appearance + dress

A

Eccentric dress

53
Q

Schizophrenia affect positive & negative symptoms

A

-Positive: Blunted, anxious, fearful, irritable
-Negative: Blunted, flat

54
Q

Schizophrenia mood positive & negative symptoms

A

-Positive: Low d/t paranoia
-Negative: Low d/t lack of motivation

55
Q

Schizophrenia speech

A

Alogia (poverty of speech), slow, hesitant, quiet

56
Q

Schizophrenia language

A

Poverty of content, variable vocabulary, not fluent, troubles comprehending

57
Q

Schizophrenia thought process

A

Disorganized, range from less goal directed to lack of connection between ideas

58
Q

Schizophrenia thought process + range from goal directed to lack of connection between ideas

A

Loose associations, circumstantiality, tangentiality, neoglisms, echolalia, word salad

59
Q

Loose associations

A

Interrupted thoughts

60
Q

Circumstantiality

A

Inclusion of unnecssary details

61
Q

Echolalia

A

Repeating of another’s words (often seen in catatonia and neurological disorders)

62
Q

Schizophrenia thought content + delusions

A

-Fixed false beliefs, more common with positive symptoms
-Delusions are usually grandiose & persecutory
-Concrete thinking

63
Q

Schizophrenia thought content + suicide, homicide, & self-harm

A

-In response to hallucinations, delusions, paranoia, impaired judgement, or self-referentiality
-Assess for alcohol or substance use

64
Q

Schizophrenia thought content + depressive cognitions

A

-Relationship breakdowns
-Dependency
-Slow response to tx & stigma can increase sense of hopelessness, helplessness & shame

65
Q

Schizophrenia thought content + anxious cognitions

A

Increase anxiety can be the outcome or result of a delusion

66
Q

Concrete thinking

A

We use a similarity test where we ask patients what is similar between two objects (i.e. an apple and an orange). Improves the ability to understand concepts such as love and belonging, , problem solving processes, time, and consequences

67
Q

Self-referentiality

A

Belief that neutral or everyday occurrences carry special meaning

68
Q

Schizophrenia perceptual functioning + hallucinations

A

-Most common disturbance
-Assess to distinguish the cause of the hallucination
-Auditory hallucination outward observations: Turing/tilting head or moving lips silently

69
Q

Schizophrenia perceptual functioning + other

A

Boundary impairment, depersonalization, derealization, illusions

70
Q

Boundary impairment

A

Impaired ability to differentiate between his/her own space and what is his/her own things

71
Q

Derealization

A

False perception that the environment has changed (bigger/smaller, a familiar environment has become unfamiliar)

72
Q

Perceptual functioning

A

-Thought insertion, withdrawal, broadcasting
-Ideas of reference

73
Q

Assessment of delusional disorder

A

-Somatic symptoms
-Medications
-Lab and diagnostic tests r/t somatic concerns

74
Q

Assessment of schizophrenia

A

-Lipid panel, glucose and hormones
-Increased BP&HR, movement disorders
-BUN, GFR, creatinine, urine for protein
-Polyuria (significantly decreased Na+ levels)

75
Q

Family assessment of delusional disorder

A

Quality of relationships

76
Q

Family assessment of schizophrenia

A

-Who assumes the burden of care?
-Is there an acceptance of the diagnosis?

77
Q

SDOH influence on delusional disorder

A

-Health Services; need for health services due to multiple somatic concerns
-Social environments; legal concerns related to acting on delusions

78
Q

SDOH influence on schizophrenia

A

-Need for health care services & access
-Personal health practices & coping strategies
-Employment

79
Q

Consequences of illness on patient well-being in delusional disorder

A

-Difficulties developing relationships
-Additional health problems, somatic & legal concerns
-Family is overwhelmed and confused

80
Q

Consequences of illness on patient well-being in schizophrenia

A

-Isolation, family is overwhelmed and confused
-Additional health problems
-Financial; inability to maintain employment

81
Q

NANDA for schizophrenia & delusional disorder

A

-Non-adherence with treatment plans and medications
-Compromised coping/alienate from others
-Delusions

82
Q

S&S of schizophrenia & delusional disorder + NANDA

A

-Stops taking medication
-Loneliness, disturbed thought process

83
Q

NANDA for schizophrenia

A

Disturbed sensory perception, social isolation, negative self-perception, lack of motivation

84
Q

NANDA S&S for schizophrenia

A

-Auditory Hallucinations (command), uncommunicative
-Feels guilty, rejected, lonely, bad or no good
-Unable to initiate tasks

85
Q

Personality disorder

A

-Pattern of inner experience and behavior that deviates markedly from their cultural expectations
-Patterns of coping and relating are pervasive and inflexible
-Onset in adolescence or early adulthood
-Overtime, stable maladaptive coping strategies lead to distress and inability to adapt to new situations

86
Q

Personality disorder definition

A

-Pattern of unstable relationships, self-image, and affects
-Marked impulsivity
-Begins by early adulthood
-Indicated by 5 or more common findings

87
Q

Personality disorder manifestations (1-4)

A
  1. Frantic effort to avoid real or imagined abandonment
  2. Patter of unstable relationships alternating between extremes of idealization & devaluation
  3. Unstable self-image or sense of self
  4. Impulsive in at least 2 areas that are self-damaging
88
Q

Personality disorder manifestations (5-9)

A
  1. Recurrent suicidal behaviour, gestures, threats, or self-mutilatation
  2. Affective instability d/t reactivity of mood
  3. Chronic feelings of emptiness
  4. Inappropriate, intense & difficult to control anger
  5. Transient, stress-related paranoid ideation or dissociative symptoms
89
Q

Cluster A personality disorder

A

-Eccentric behaviors, perceptual distortions, unusual levels of suspiciousness, magical thinking, cognitive impairment
-Includes: paranoid, schizoid, and schizotypal personality disorders
-A=Atypical..

90
Q

Cluster B personality disorders

A

-Respond with dramatic, emotional, or erratic behavior
-Difficulties with impulse control, emotional processing and regulation, and interpersonal skills
-Includes: antisocial, borderline, histrionic and narcissistic personality disorders
-B=bad=mad!

91
Q

Cluster C personality disorders

A

-Anxious and fearful behaviors, social shyness, rigidity, hypersensitivity, relational dependency
-Includes: avoidant, dependent , and obsessive –compulsive personality disorders
-C=Careful/cautious/caring

92
Q

Personality disorder prevalence

A

-Often in those receiving extensive medical and psychiatric services
-Borderline, avoidant, and obsessive-compulsive personality disorders are most common
-BPD most common in women
-~ 10% of the total population

93
Q

Personality disorder risk factors

A

-Childhood neglect and trauma
-High corticotropin-releasing hormone in response to early life stress and emotional reactivity decreases the individual’s overall stress tolerance level

94
Q

Personality disorder comorbidities

A

-Periods of crisis and illness; strain already maladaptive coping strategies
-Mental health; mood, anxiety, disordered eating, substance abuse
-Other; homeless, incarcerated

95
Q

Personality disorder etiology

A

Multifactorial

96
Q

Personality disorder genetic factors

A

Potentially hyper responsive amygdala and impairment in the prefrontal lobe

97
Q

Personality disorder neurochemistry etiology

A

Neurotransmitters may regulate temperament

98
Q

Personality disorder pyschological factors + etiology

A

-Children learn maladaptive responses in response to crisis and trauma, as they have been role-modeled, and/or in a way of relating that feels familiar

99
Q

Personality disorder environmental factors + etiology

A

Family dynamics, PMH, supports, education

100
Q

General appearance of personality disorders + cooperation

A

-Dependent on the level of trust with the nurse, may not get valid information

101
Q

General appearance of personality disorders + affect & mood

A

-Labile
-Affect and mood can be the same or different
-Affect is exaggerated and inappropriate for the context

102
Q

Speech & language in personality disorders

A

Intense inflection, loud volume, emotional language

103
Q

Thought process in personality disorder

A

-Goal directed; find ways to get their needs met while staying emotionally safe
-Repetitive themes; negative self-image, focus on how others have not met their needs

104
Q

Thought content of personality disorder

A

-Distortions in self-image; inability to simultaneously hold positive and negative ideas about themselves and others
-Fear of abandonment and sensitivity to personal rejection
-Significance placed on emotions, high risk of self-harm
-Regrets actions which perpetuates distorted self-image
-*Chronic suicidal ideation, negative self-soothing habits

105
Q

Perceptual function in personality disorder

A

May have hallucinations as result of the stress response, concurrent diagnosis or use of drugs

106
Q

Cognitive function in personality disorder

A

Difficulties with planning, implementation, and evaluation of their choices and behavior

107
Q

Insight + personality disorder

A

Impaired, difficulty acknowledging and taking personal ownership for their problems

108
Q

Physical assessment of personality disorder

A

Integument; risk of self-harm

109
Q

Family assessment of personality disorder

A

Relationships, boundaries, support, abuse

110
Q

Relationship assessment in personality disorder

A

-Attachments
-What activities are most enjoyable for the patient? What activities might the patient avoid? Why?

111
Q

Boundary assessment in personality disorder

A

-Do they use the same coping strategies across diverse situations?
-When are the patient’s boundaries flexible?

112
Q

Consequences of well-being in personality disorder

A

-Withdrawal, social isolation, frustration and anger, impaired functioning, risk of suicide and self harm

113
Q

NANDA for personality disorder

A

-Ineffective coping
-Risk for harm
-Impaired social interaction
-Nonadherence

114
Q

NANDA S&S for personality disorder

A

-Crisis, withdrawal, depression, anxiety
-Difficulties in relationships (seen as manipulative)
-Unable to keep medical appointments, frequently arrive late

CV487 (15 decks)

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