Disorders Flashcards

1
Q

Schizophrenia

A

Definition: characterized by a breakdown of thought processes and by a deficit of typical emotional responses.[

Symptoms:

  • delusions,
  • hallucinations, and
  • disorganized thinking
  • significant social or vocational dysfunction

Negative and Positive Symptoms:

Positive symptoms are those that most individuals do not normally experience but are present in people with schizophrenia. They can include delusions, disordered thoughts and speech, and tactile, auditory, visual, olfactory and gustatory hallucinations, typically regarded as manifestations of psychosis. Hallucinations are also typically related to the content of the delusional theme.[20] Positive symptoms generally respond well to medication.[20]

Negative symptoms are deficits of normal emotional responses or of other thought processes, and respond less well to medication.[8] They commonly include flat or blunted affect and emotion, poverty of speech (alogia), inability to experience pleasure (anhedonia), lack of desire to form relationships (asociality), and lack of motivation (avolition). Research suggests that negative symptoms contribute more to poor quality of life, functional disability, and the burden on others than do positive symptoms. People with prominent negative symptoms often have a history of poor adjustment before the onset of illness, and response to medication is often limited.

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2
Q

Depression

A

Definition: mood disorder characterized by feelings of sadness, hopelessness, and worthlessness, accompanied by a lack of interest in previously enjoyed activities.

Etiologies: Psychological, social, and biological factors—including genetic predisposition, CNS disorders (e.g., stroke, Parkinson’s disease), hormonal changes (e.g., those occurring during menopause), life stressors, and ineffective coping strategies—contribute to the onset of depression. Depression negatively affects quality of life, impairs performance (e.g., of ADLs, in work and/or school), and increases the risk for substance abuse and suicide.

Signs and Symptoms:

when a patient has had a depressed mood and loss of interest almost every day for most of the day for at least 2 weeks, accompanied by 4 or more of the following symptoms:

  • Apetite: significant unintentional change in body weight;
  • Sleep: hypersomnia or insomnia;
  • Energy: fatigue;
  • Guilt: feelings of guilt and worthlessness;
  • Psychomotor retardation: psychomotor changes;
  • Concentration: impaired cognition; and
  • Suicidal Ideation: recurrent thoughts of suicide and death

Risk Factors:

  • Prior episode of depression
  • Family history of depressive d/o
  • Lack of social support
  • Stressful life event
  • Current substance use
  • Medical comorbidity
  • Economic difficulties
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3
Q

Explain the hypotheses for causes of MDD

  • Genetic
  • Neurobiologic Hypothesis
    • Neuroendocrine and Neuropeptide Hypotheses
    • Psychoneuroimmunology
  • Psychological Theories
    • Psychodynamic Factors
    • Behavioural Factors
    • Developemental Factors
  • Social Theories
    • Family Factor
    • Social Factor
A

Genetic

Neurobiologic Hypothesis: MDD is caused by dysregulation or deficiency in CNS of neurotransmitters NE, DO, and SE or their receptors. Based on the observation that some pharmacologic agents eleveated mood, with their primary MOA being alteration of neurotransmitter levels

  • **Neuroendocrine and Neuropeptide Hypotheses: **MDD is often associated with alteration to the:
    • hypothalamic-pituitary-adrenal axis,
    • hypothalamic-pituitary-thyroid axis,
    • hypothalamic-growth hormone axis,
    • hypothalamus-pituitary-gonadal axis
  • Psychoneuroimmunology: cytokines, chemical messengers between immune cells, signal the brain and serve as mediators between immune and nerve cells

Psychological Theories

  • Psychodynamic Factors: early lack of love, care, warmth, protection, with resultant anger, guilt and helplessness; avoidant coping style, distorted negative beliefs and thoughts about self, environment and future (Freud)
  • Behavioural Factors: MDD is result of severe reduction in rewarding activities or an increase in unpleasant events
  • Developemental Factors: results from loss of parent (death/seperation) or via emotionally unavailable

Social Theories

  • Family Factors: maladaptive circular patterns in family interactions lead to onset of depression in family members
  • Social Factors: traumatic life events including loss of an important relationship or role in life; social isolation, deprivation and financial stress are risk factors. Women between 35-45yr have greatest number of MDD hospitalizations
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4
Q

What factors contribute to suicide risk?

A

SAD PERSONS

  • sex (male)
  • age (
  • history of depression
  • previous attempts
  • ETOH abuse
  • lack of rationale thought
  • lack of support network
  • organized plan
  • no spouse (men)
  • sickness
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5
Q

Dysthymic Disorder

A

Definition: milder but more chronic form of MDD

Signs and Symptoms:

An individual diagnosed with persistent depressive disorder (dysthmia) needs to meet all of the following criteria:

  • Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years.
  • Presence, while depressed, of two (or more) of the following:
    • Poor appetite or overeating
    • Insomnia or Hypersomnia.
    • Low energy or fatigue.
    • Low self-esteem.
    • Poor concentration or difficulty making decisions.
    • Feelings of hopelessness.
  • During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the above symptoms for more than 2 months at a time.
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6
Q

Define the following affects:

  • blunted
  • flat
  • inappropriate
  • labile
  • restricted or constricted
A
  • blunted: reduced intensity of emotional expression
  • flat: absent or nearly absent affective expression
  • inappropriate: discordant affective expression accompanying speech content or ideation
  • labile: varied, rapid, and abrupt shifts in affective expression
  • restricted or constricted: mildly reduced in rance and intensity of emotional expression
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7
Q

What are possible nursing diagnsoses for depressive disorders?

A
  • Risk for self-directed violence (risk for suicide)
  • Disturbed thought processes
  • Chronic low self-esteem
  • Spiritual distress
  • Impaired social interaction
  • Disturbed sleep pattern
  • Self-care deficit (Imbalanced nutritiion, disturbed sleep pattern, bathing/hygeine, constipation)
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8
Q

Bipolar d/o

A
  • Distinguished from depression by occurence of mania or hypomania (ie., mildly manic)

Types:

  • BP I: one or more manic episodes with a major depressive ocurrence
  • BP II: periods of major depression acompanied by at least one incidence of hypomania
  • cyclothymic d/o: periods of hypomania and depression that do not meet criteria for a major depressive episode
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9
Q

What are:

  • mixed episodes
  • hypomanic episodes
  • rapid cycling
A

mixed episodes: meet criteria for both manic and major depressive episodes are met and present for at least 1 wk; usually exhibit high anxiety, agitation, and irritability

hypomanic episodes: same criteria as with hamic episode except that the time crtierion is at least 4 days, rather than 1 wk, and there is no marked impairment in social or occupational functioning is present

rapid cycling: can occur in BP I and II; 4 or more episodes of MD, mania, mixed mania or hypomania in any combination in a 12 mnth period

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10
Q

What is mania?

A

DSM Criteria (must have 3 or 4 if irritable):

  • inflated self-esteem or grandiosity,
  • decreased need for sleep,
  • being more talkative or having pressured speech,
  • flights of ideas or racing thoughts,
  • distractibility,
  • increase in goal-drected activity or psychomotor agitation
  • excessive involvement in risky pleasurable acitivities

Other descriptions:

  • an abnormally and persistently elevated, expansive or irritable mood for duraction of at least 1 wk (or less if hospitalized)
  • euphoria, a state of elation experienced as a heightened sense of well-being
  • decreased inhibition
  • impulsivity
  • distractibility
  • decreased attention/concentration
  • expansive mood
  • overvalue importance
  • lack of restraint in expressing emotions
  • alterations between euphoria and irratibility (lability of mood)
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11
Q

Describe the epidemiology of bipolar d/o.

A
  • age of onset = 21 to 30 yrs
  • in children associate with intense rage (unprovoked rage episodes lasting 2 to 3 hrs; irritability and emotional lability)
  • BP II: 5%greater in females than males
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12
Q

Anxiety Disorders

A

Generalized Anxiety D/O

Social Anxiety D/O

Obsessive Complusive D/O

PTSD

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13
Q

Eating Disorders

A

Anorexia

Buleimia

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14
Q

Personality Disorders

A

10 of them:

Cluster A (odd-eccentric):

  • paranoid (suspcious)
  • schizoid (asocial)
  • schizotypal (eccentric)

Cluster B (dramatic-emotional)

  • borderline (unstable)
  • antisocial (aggrandizing)
  • histrionic (attention seeking)
  • narcissistic (egotistic)

Cluster C (Anxious-Fearful)

  • avoidant (withdrawn)
  • dependent (submissive)
  • obsessive compulsive (conforming)
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15
Q

Paranoid personlity d/o

A

Features:

  • mistrust of others
  • desire to avoid relationships in which one is not in control or loses power
  • suspicious, guarded, hostile
  • consistently mistrustful of others’ motives, even with relatives and close friends
  • unforgiving, hold grudges
  • typical emotional response is with anger and hostility
  • may hold prviate hopes of being understood, feel powerless, fearful and vulnerable
  • persistent ideas of self-importance and tendancy to be rigid and controlled
  • blind to their unattractive behaviours
  • hypercritical and attribute these characteristics to others
  • extremely sensitive

Etiology:

  • genetic disposition for irregular maturation
  • excessive limbic and sympathetic sysem reactivity

PharmacoTherapy: use SE-DO anatoginsts

  • risperidone
  • olanzapine
  • quetiapine
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16
Q

Schizoid personlity d/o

A
  • expressive impassive and interpersonally unengaged
  • unable to experience joyful/pleasurable aspects of life
  • introverted, reclusive, distant, aloof, apathetic, emtionally detached, difficulties making friends
  • uninterested in social activities
  • interests are directed at objects, things and abstractions
  • Nursing dx: impaired social interactions and chronic low self-esteem
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17
Q

Schizotypal personlity d/o

A
  • pattern of social and interpersonal deficits
  • no close friends aside from 1st-degree relatives
  • odd beliefs, inconsistent with cultural norms, ideas of reference, delusions, circumstantial thinking, metaphorical thinking/speech
  • moood: constricted or inappropriate,
  • excessive social anxieties that do not diminish with familiarity
  • avoidant behaviour patterns
  • if psychotic: totally disoriented and confused, posturing, grimacing, giggling, peculiar mannerisms, rambling speech, hallucinations, bizarre delusions
  • regressive acts: bed wetting, consume food in an infantile manner or ravenously
  • socially isolated and dependent on family or institutions

Etiology:

  • neurodevelopemental: oxygen depreivation,
  • cognitive deficits in left hemisphere and impaired cholinergic responsivity
  • difficulty with short-term memory and verbal learning

Dx:

  • Impaired perception
  • Social isolation
  • ineffective coping
  • low self-esteem
  • impaired social interactions
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18
Q

Borderline personlity d/o

A

Definition:

  • a pervasive pattern of instability of interpersonal relationships, self-image, affects and marked impulsivity
  • begins in early adulthood
  • present in various contexts
  • have difficulty regulating mood, developing sense of self, maintaining relationships, relative-based cognition, avoiding destructive behaviour
  • soap opera life, one drama after another

Three subgroups:

  • Depressed
  • Impulsive
  • Psychotic
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19
Q

Antisocial personlity d/o

A
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20
Q

Histrionic personlity d/o

A
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21
Q

Narcissistic personlity d/o

A
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22
Q

Avoidant personlity d/o

A
23
Q

Dependent personlity d/o

A
24
Q

Obsessive Compulsive personlity d/o

A
25
Q

Childhood Disorders

A
26
Q

Pervasive Developemental D/O (aspbergers)

A
27
Q

Tic D/O

A
28
Q

Terretes D/O

A
29
Q

ADD/ADHD

A
30
Q

Conduct D/O

A
31
Q

Explain the etiological theories for bipolar d/o.

A

Chronobiologic theories

  • sleep disturbance is an important aspect of depression and mania

Sensitization and kindling theory

  • repeated affective epidsodes might be accompanied by the preogressive alteration of brain synapses that lower the threshold for future episodes

Genetic factors

  • highly heritable

Psychological and social theories

  • mania is an attempt to overcompensate for depressed feelings
32
Q

What are possible nursing diagnoses for biploar disorder?

A

Pyschological

  • Disturbed sensory perception
  • Disturbed thought processes
  • Defensive coping
  • Risk for suicide
  • Risk for violence
  • Ineffective coping

Social

  • Ineffective role performance
  • Interupted family processes
  • Impaired socoial interaction
  • Impaired parenting
  • Compromised family coping
33
Q

Which psychological interventions are used for bipolar disorder?

A

Pharmacotherapy

Psychoeducation

CBT

Individual interpersonal therapy

Adjunctive therapies (e.g., trt of substance abuse)

34
Q

What medicaitons are associated with weight gain?

A

Divalproex sodium

lithium

antidepressants

olanzapine

35
Q

What factors make patients more vulnerable to relapses of bipolar manic and depressive episodes?

A
  • High rates of non-adherance to medicaiton therapy
  • Obesity
  • Marital conflict
  • Seperation
  • Divorce
  • Unemployment
  • Underemployment
36
Q

What are specific goals used to prevent relapse of bipolar symptoms?

A
  • Medication adhereance
  • Decrease number and length of hospitalizations
  • Enhance social and occupational functioning
  • Improving quality of life
  • Increase pt and family’s acceptance of d/o
  • Reduce suicide risk
37
Q

What is normal anxiety?

A

3 parts:

1) Physiologic arousal
2) Cognitive processes: decide if threat should be approached or avoided
3) Coping strategies

  • appropriate for situation
  • realistic intensity and duration for situation
  • followed by relief behaviours that reduce or prevent more anxiety
  • can be dealt with without repression
  • can be used by pt to identify underlying cause of anxiety
  • maintain allostasis
38
Q

What is allostasis?

A

adapative processes that maintain homeostasis through productions of brain and periphereal stress-related chemicals

39
Q

What are symptoms of anxiety?

A

Physical

  • Sympathetic: Heart racing or palpitiations
  • Increased BP
  • Rapid breathing
  • Shortness of breath
  • Pressure in chest
  • Lump in throat
  • Choking sensation
  • Increased reflexes
  • Startle reaction
  • Eyelid twitching
  • Insomnia
  • Unsteadiness
  • Flushed/pale
  • Sweating
  • Hold/cold
  • Loss of appetite
  • Vomiting diarrhea
  • Dilated pupils
  • Pressure to urinate

Affective

  • Edgy
  • Impatient
  • Uneasy
  • Nervous
  • Wound up
  • Anxious
  • Fearful
  • Apprehensive
  • Scared
  • Frightened
  • Alarmed

Cognitive

  • Dazed
  • Object blurred/distant
  • Unreal
  • Self-conciousness
  • Hypervigiliance
  • Cannot recall important things
  • Difficulty concentrating/attending
  • Fear of losing control/unable to cope
  • Fear injury/death
  • Fear going crazy/negative eval.
  • Frightening visual images
  • Repetitive fearful ideaition

Behavoural

  • Inhibited
  • Tonic immobility
  • Flight
  • Avoidance
  • Impaired coordination
  • Restlessness
  • Postural collapse
  • Hyperventilation
  • Jumpy/jittery
40
Q

Descrive the epidemiology of anixety d/o

A
  • Most common mental health issue in Canada
  • More often in women than men
  • Relationship between anxiety and atopic disorders (e.g., hives, asthma)
41
Q

What is generalized anixety d/o?

A

Definition: extensive, persistant, pervasive worries.

  • amount of time spent worrying
  • degree of control over worrying
  • impact on social, occupational and personal functioning

onset often in early life

**Etiology: **

  • genetic vulnerability
  • childhood adversity
  • environmental stressors
  • dysregulation of NT systems
42
Q

What is Obsessive Compulsive d/o?

A

Definition: severe ovsessions and/or compulsions that interfere with normal daily routines

5 Diagnostic Criteria:

  • A: Presence of obsessions or compulsions
  • B: Pt recognizes that thoughts and actions are unreasonable or excessive (does not apply to children)
  • C: Thoughts and rituals cause severe disturbance in daily routines and are time consuming (taking >1hr per day to complete)
  • D: Thoughts/behaviours are not a result of another axis I d/o
  • E: Thoughts/behaviours are not result of substance or medical condition

Epidemiology:

  • age of onset = early 20s to mid-30s
43
Q

Define obessions and compulsions

A

obessions: create anziety because they are not under pts control and are inconguent with pt usual pattern of thought

  • persistant thoughts, images, impulses that are intrusive and inappropriate, causing marked anxiety
  • are not simply excessive fretting over real-life situations
  • person tries to ignore or suppress the thoughts or to neutralize thoughts by some other action
  • person understands that thoughts are products of his or her own mind

compulsions: behaviours that are performed repeatedly in a ritualistic fashion with the goal of preventing or relieving anxiety and distress caused by obsessions

  • repititive in that the person feels that her or she must perform them because the thoughts or because of rules that must be rigidly followed
  • actions performed to reduce stress or to prevent a catstrophe from occuring
44
Q

What is posttraumatic stress d/o?

A

Epidemiology:

  • 8% of population
  • more women
  • prevalence varies with type of trauma: 20% with car accident, 80% after POW experience

3 Core Symptom Clusters:

  • reexperiencing: recurrent nightmares, flashbacks, extreme stress upon exposure to an events or image that resembles the traumatic event
  • avoidance: avoid discussing event or situations that remind them of the event
  • heightened arousal: difficulty sleeping, irritability, poor concentration, exergerated startle response and hypervigilence

Risk Factors:

  • prior dx of depression or acute stress d/o
  • being female
  • preexisting personality d/o
  • duration and intensity of trauma involved
  • environemntal issues
  • coping style
  • low self-esteem
  • previous traumatic events
45
Q

What is acute stress d/o?

A

Definition: same three symptom as PTDSD but has difference duration,

  • symptoms emerge 2-4 days after trauma and last up to 1 mnth
  • experience dissociative symptoms (numbing, detachment, a reduction of awareness of one’s surrounding, derealization, depersonalization or disassociative amnesia

considered to me failed recovery rather than immediate psychopathological processes….person will recover with ASD

46
Q

What is social phobia?

A

Definition: persistent fear of social or performance situations in which embarassment might occur

  • onset = early adolescence
  • two types: general and specific (e.g., eating, speaking)
47
Q

What are personality, personality traits, and personality d/o?

A

Personality:

  • complex pattern of characteristics, outside a persons awareness, that compose that persons pattern of percieving, feeling, thinking, coping and behaving
  • emerge from biologic disposition, psychological experiences, and environmental situations

Personality Treat:

  • prominent aspects of personality exhibited in wide range of social and personal contexts

Personality Disorder (10 seperated into three clusters)

  • enduring pattern of inner experience and behaviour
  • deviates from expected by culture,
  • inflexible and pervasive
  • onset in adolescence or early adulthood
  • stable with time
  • leads to distress and impairment
48
Q

What are the big Five personality traits?

A

OCEAN

Openness

Conscientiousness

Extraversion

Agreeableness

Neuroticism

49
Q

How/where do behaviour patterns of personality d/o manifest themselves?

A
  • cognition: ways of percieving and interpreting self/others/events
  • affectivity: range, intensity, lability, and propriatieness of emotional responses
  • interpersonal functioning
  • impulse control
50
Q

What determines the severity of a disorder?

A
  • tenuous stabliity: lack resiliency under subjective stress, exagerrated emotional response, cannot cope emotionally with normal stressful situations, do not easliy learn coping skills and may be overwhelmed when new difficulties arise
  • adaptive inflexibility: rigidity in interactions with others, achievement of goals and coping with stress
  • trapped in rigid and inflexible patterns of behaviour that are self defeating: produces vicious cycles of behaviours that are self-defeating,
51
Q

Desribe the following characteristics of borderline personality d/o:

  • affective instability,
  • identity disturbances,
  • unstable interpersonal relationships
  • cognitive dysfunction
  • dysfunctional behaviours
A

**affective instability: **rapid and extreme shift in mood, erratic emotional responses to situations, intense sensivitiy to criticism/percieved slights

**identity disturbances: **

  • identity diffusion = person lacks aspects of personal identity or when personal identity is poorly developed
  • no sense of their own identity or direction
  • 4 factors that are disturbed:
    • role absorption (narrowly defining self within a single role)
    • painful incoherence (distressed sense of internal disharmony)
    • inconsistency (lack of coherence in thoughts, feelings, and actions)
    • lack of comittment

**unstable interpersonal relationships: **

  • extreme fear of abandonment
  • history of unstable, insecure attachments
  • restrict themselves to relationships in which they feel in control
  • distance themselves from groups and rarely use social supports
  • reluctant to share feelings, even if married or have a supportive extended family
  • they do not want to burden anyone, fear rejection
  • persons with childhood trauma are 4x more likely to have a personality d/o

cognitive dysfunction:

  • dichomotous thinking
  • disorganized thinking, irrevelent bizarre notions and vague or scattered thought connections as well as delusions and hallucinations
  • dissociation = thoughts and ideas are split off from conciousness, decrease memory of traumatic event

dysfunctional behaviours:

  • impaired problem solving = fail to engage in active problem solving, solicit help from others in helpless/hopeless mann, rarely take suggestions
  • impulsivity = actions are unpredictable, difficulty in delaying gratification
  • gambling, buying, eating, sex, physically and verbally aggressive
  • self-injurious behaviour = 43% to 67% of BPD engage in self harm/suicide
    • compulsive self-injury = daily (trichillomania)
    • episodic = to ilicit emotion, relieve tension and can trrigger pleasure centres
    • repetitive = “cutter”
52
Q

What are the risk factors for BPD?

A
  • physical and sexual abuse (55-80%)
  • parental loss and seperation
53
Q

What are the etiologic theories for BPD?

A

Biological

  • no genetic component
  • BPD have a smaller amygdala, consistent with increased exposure to cortisol
  • limbic system and frontol lobe = impulsive ness, parasuicide, and mood disturbance
  • decrease in SE and increase in apha-adrenergic receptor sites related to irratibility and impulsiveness
  • increase in DO=pyschotic states

Psychological

  • Psychoanalytic
    • Seperation-individuation
    • projective identification
  • Biosocial
    • emotional vulnerability
    • emotional dysregulation
    • invalidating environment
  • Maladaptive Cognitive Processes
    • maladaptive schemas