Disorders Flashcards
Schizophrenia
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.
Depression
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
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
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
What factors contribute to suicide risk?
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
Dysthymic Disorder
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.
Define the following affects:
- blunted
- flat
- inappropriate
- labile
- restricted or constricted
- 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
What are possible nursing diagnsoses for depressive disorders?
- 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)
Bipolar d/o
- 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
What are:
- mixed episodes
- hypomanic episodes
- rapid cycling
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
What is mania?
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)
Describe the epidemiology of bipolar d/o.
- 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
Anxiety Disorders
Generalized Anxiety D/O
Social Anxiety D/O
Obsessive Complusive D/O
PTSD
Eating Disorders
Anorexia
Buleimia
Personality Disorders
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)
Paranoid personlity d/o
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
Schizoid personlity d/o
- 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
Schizotypal personlity d/o
- 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
Borderline personlity d/o
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
Antisocial personlity d/o
Histrionic personlity d/o
Narcissistic personlity d/o
