Exam 1 Flashcards
Hans Selye
- defined stress
- state manifested by a specific syndrome that consists of all the nonspecifically induced changes within a biologic system*
(combo of symptoms has come to be known as FIGHT OR FLIGHT syndrome…the SYSTEM)
Selye’s general adaptation syndrome
- Alarm reaction stage (fight or flight syndrome)
- Stage of resistance (use physiological responses of 1st stage as defense in attempt to adapt to stressor)
- Stage of exhaustion (body responds to prolonged exposure to stressor/adaptive energy depleted/diseases of adaptation may occur)
fight or flight syndrome of symptoms
***used to preserve life
-occur in response to psychological/emotional stimuli jsut as they do to physical stimuli
psychological stressors
**not resolved as rapidly as physical stressors
sympathetic NS activation
- dilate pupils
- norep/epi released
- bronchioles dilate/respiration increased
- increased HR and BP
- increase sweat secretions
- increase ureter motility/bladder muscle contracts/sphincter relaxes
adaptation (stress as ENVIRONMENTAL event)
return to homeostasis
**preservation of individual integrity/timely return to equilibrium
stress as environmental event
- creates change in life pattern of individual, requires significant adjustment in lifestyle and taxes available personal resources
- can be POSITIVE or NEGATIVE change
measuring stress
- Miller and Rahe Recent Life Changes Questionnaire (RLCQ) completed considering life stressors within 6 month or year period
- high score places individual at greater susceptibility to physical/psychological illness
critique of life changes questionnaire
-does not consider individual’s perception of event
- also fails to consider:
- cultural variations
- individuals coping strategies
- available support systems
stress as a transaction
-between individual and environment (relationship between internal variables and external variables)
precipitating event
-stimulus arising from internal or external environment and perceived by individual in specific manner
cognitive appraisal vs cognitive response
- appraisal: evaluation of personal significance of event
- response: primary appraisal and secondary appraisal
3 types primary appraisals
(1) irrelevant
(2) benign-positive
(3) stress appraisals (a. harm/loss OR b. threat OR c. challenge)
secondary appraisal
**happens when stress occurs (stress appraisal)
-assessment of skills, resources, knowledge that person has to deal with it
predisposing factors
*strongly influence whether response is adaptive or maladaptive
Types:
- genetic influences
- past experiences
- existing conditions
Hobfoll
- conservation of resources theory
- as existing conditions (lack of resources) exceed person’s perception of adaptive capabilities, individual experiences stress in present but also becomes more vulnerable to effects of stress in future because of “WEAKER RESOURCE RESERVOIR TO CALL ON TO MEET FUTURE DEMAND”
maladaptation
-occurs when individual’s physical or behavioral response to change in his/her internal or external environment results in disruption of individual integrity/persistent disequilibrium
coping strategies adaptive when:
- protect individual from harm
- strengthen individual’s ability to meet challenging situations
list of adaptive coping strategies
- awareness
- relaxation
- meditation
- interpersonal communication
- problem-solving/decision-making
- pets
- music
two major responses to psychological adaptation to stress
- anxiety
- grief
Hippocrates
-theorized mental illness was caused by irregularity in interaction of four body fluids (blood, black bile, yellow bile, phlegm)
Middle Ages
-mental illness and witchcraft and supernatural
Middle Eastern
-perceive mental illness as medical problem
Benjamin Rush
-father of American psychiatry
Dorothea Dix
-system of state asylums established
emergence of psychiatric nursing
1873
*Graduation of Linda Richards
National Mental Health Act of 1946
- provided funds for education of psychiatrists, psychologists, social workers, and psychiatric nurses
- also anti-psychotic meds introduced
6 indicators that are a reflection of mental health
- positive attitude toward self
- growth, development, and ability to achieve self-actualization (successful achieves tasks within each level of development)
- integration (maintaining balance among life processes; ability to respond to environment & development of philosophy of life)
- autonomy
- perception of reality (also includes respect of needs for others)
- environmental mastery (satisfactory role within society; life offers satisfaction to individual at this level)
Horwitz
- cultural influences affecting individuals view of mental illness:
- Incomprehensibility (inability of general population to understand motivation behind behavior)
- Cultural relativity (normality of behavior is determined by culture)
transactional model of stress and adaptation
defines mental illness as :
*maladaptive responses to stressors from internal/external environment evidenced by thoughts, feelings, and behaviors that are incongruent with local and cultural norms and interfere with individuals social, occupational, physical functioning
anxiety
- low levels are adaptive and can provide motivation required for survival
- may be unaware of source by accompanied by uncertainty/helplessness
when does anxiety become a problem
-when individual is unable to prevent their response from escalating to level that interferes with ability to meet basic needs
Peplau’s 4 levels of anxiety
- mild (seldom problem, sharpens everything, heightens awareness)
- moderate (perceptual field begins to diminish, need help w/ problem solving)
- severe (perceptual field diminishes greatly; dread/horror/confusion/insomnia; difficulty completing even simplest tasks; all behavior aimed at relieving anxiety)
- panic (most intense state; no awareness of environment; misconceptions)
mild anxiety
- coping mechanisms
- sleeping/yawn/eating/daydreaming/cursing/pacing/etc
mild-to-moderate anxiety
- Freud & the ego as reality component of personality, governing problem solving/rational thinking
- as level of anxiety increases, strength of ego is tested and energy is mobilized to confront threat
- defense mechanisms (maladaptive use of promotes disintegration of ego)
repression
involuntarily blocking ones feelings or emotions (can’t remember)
identification
-increase self-worth by becoming someone they admire
reaction formation
-exaggeration to complete opposite of reality
intellectualization
-avoid actual expressions of emotions by employing logic
husband moves for job; wife sad; she explains to parents all the advantages of moving
sublimation
-rechanneling of energy that is unacceptable into activities that are constructive
(mom takes anger of death of son in drunk driving accident into making a campaign against drunk driving)
introjection
- integrating beliefs and values of another individual into one’s own ego structure
- kid says “dont cheat, its wrong” parents beliefs/values
suppression
“i dont want to think about that right now” (voluntary blocking)
isolation
separating thought or memory from feeling
girl explains rape attack without any emotion
projection
alcoholic blames wife for drinking problems
displacement
transfer of feelings from one target to another that is more neutral or less threatening
moderate-to-severe anxiety
-anxiety at this level that remains unresolved over an extended period of time can contribute to number of psychological disorders (can affect course of almost every other major disease pathology like pulmonary or cardiac or GI)
**measurable pathophysiology can be demonstrated
severe anxiety
- extended periods of severe repressed anxiety can result in psychoneurotic behavior patterns
- neurosis
neurosis
- no longer considered a separate category of mental disorder
- differentiates from more serious levels of psychosis
neuroses are
psychiatric disturbances characterized by excessive anxiety that is expressed directly or altered thru defense mechanisms
**appears as symptom such as obsession, compulsion, phobia, or sexual dysfunction
common characteristics of ppl with neuroses
- aware they are experiencing distress
- aware behaviors are maladaptive
- unaware of possible psychological causes of the distress
- feel helpless to change their situation
- experience no loss of contact with reality
psychoneurotic responses to anxiety:
- anxiety disorders (disorders in which characteristic features are symptoms of anxiety and avoidance behavior)
- somatic symptom disorders (characteristic features are physical symptoms for which no evident organic pathology)
- dissociative disorders (the characteristic feature is a disruption in the usually integrated functions of consciousness, memory, identify, or perception of environment)
panic anxiety
-at this extreme level, individual not capable of processing what is happening in environment and may lose contact with reality
**psychosis
psychosis
-significant thought disturbance in which reality testing is impaired, results in delusions/hallucinations/disorganized speech/catatonic behavior
characteristics of ppl with psychoses
- exhibit minimal distress
- unaware their behavior is maladaptive
- unaware of psychological problem (ANOSOGNOSIA)
- exhibit flight from reality into less stressful world or one in which attempting to adapt
ex. schizophrenia, schizoaffective, delusional disorders
loss
- any situation that creates change for individual can be identified as a loss
- failure can also be perceived as a loss
mourning
period of characteristic emotions and behaviors
- sadness
- guilt
- anger
- helplessness
- hopelessness
- despair
five stages of grief response
- Denial (shock and disbelief)
- Anger (envy and resentment toward individuals not affected by loss)
- Bargaining (bargain made in an attempt to reverse or postpone loss)
- Depression (sense of loss is intense, sadness/depression prevails)
- Acceptance (feeling of peace regarding loss that has occurred)
guilt
lengthens grief reaction
bereavement overload
-another event before done w/ 1st grief
prolonged grief response
- intense preoccupation with memories of lost entity for many years after loss
- denial and anger stage characteristics manifested
delayed or inhibited grief response
-fixed in denial stage of grieving
distorted grief response
- fixed in anger stage of grieving (turns anger inward on self and consumed with despair)
- may culminate in pathological depression
OOP
order of protection
definition of abuse
no federal definition
cycle of battering
(1). tension-building (name-calling & yelling)
Triggering Event Occurs
(2). Acute Battering Incident
(3). Honeymoon
**Lenore Walker
TN abuse (for OOP)
- violence
- threats of violence
- malicious damage of property including pets
- holding against will
- placing in fear
- stalking
- sexual assault
*stalking & sexual assault are non-relational (don’t have to be blood relative or reside together)
Cobra Characteristics
*Jacobson & Gottman
- cool/methodical/humiliation
- entitled
- decreased BP and HR during arguments/beatings
- increased attention/concentration
- hx of physical/sexual abuse during childhood
- drug/alcohol user
DANGEROUS TO LEAVE IN SHORT RUN
Cobra ideology
- violence if unavoidable part of life
- doesnt fear abandonment & will not be controlled (I will find another victim)
“you were lucky to have me”
Pit Bull Characteristics
- emotions quickly boil over
- increased BP/HR
- insecure/ over dependent on mate
- motivated by FEAR OF ABANDONMENT
- denies woman’s experience
***MORE DANGEROUS TO LEAVE IN LONG RUN
Pit Bill ideology
- Denial PLUS isolation make make woman doubt her sanity
- tends to become stalker/cant let go (OJ Simpson)
leave average of…
…7 times
Jacquelyn Campbell
-femicide research (Femicide Risk Study)
**study shows victims didn’t accurately perceive their risk of being killed and need for validated assessment tool
*20 item validation tool (Danger Assessment Tools)
Femicide Risk Study results
**identify risk factors for IP femicide
-HALF of victims did not accurately perceive risk that perpetrator was capable of killer her
20 Item Danger Assessment Tool
-10 yes of 20 indicated HIGH DANGER
combo of factors that increases risk of being killed
- abuser lacks employment
- abuser access to firearm
- threatens to kill
- threats w/ weapon
IF the abuser:
- is controlling
- is unemployed
- threatens to kill
- there is a stepchild in the home
*warn of extreme danger and need for shelter
Ann Burgess
*if stalking question is answered YES stalking interventions should be included in safety planning
ACE study
Dr. Vincent Felliti and Robert Anda
10 item questionnaire used in primary care
3 stalking patterns of pursuit (Burgess)
- open in their attempts to contact ex-partner; when this fails they contact others and discredit partner
- positive emotion of love changes to negative emotions of hate
- go underground and become nonrevealing (anonymous)
*period of ambivalence before they go public again and public display of stalking is when they can become very violent
TN reporting statutes for health care practitioners
-TN requires reporting if injury appears to be caused by gun, knife, firearm, or other deadly weapon or practitioner believes injury resulted from act of violence, burn or injury from meth lab, female genital mutilation, and strangulation
if answer “YES” to violence in relationship, next steps are…
- Danger Assessment
- safety planning
- report according to state requirement
central pattern of injuries
*look for patterns of injury around face and tunk rather than extremities (50% in head and neck region)
- central (proximal) injury is often more intentional and tx delayed
- accidental trauma more distal
3 major classifications of pattern injury
1- blunt force
2-sharp force
3-thermal
blunt force pattern injuries
- contusion (most common pattern injury)
- abrasion
- laceration
linear contusion patterns
-baseball bat, fingers, hand-slaps
circular contusions
- 0-1.5 cm
* fingertip pressure (grab marks)
semi-circular contusions
human bite marks
pattern abrasions
MOST COMMON: fingernail scratches
LESS COMMON: ligature marks from rope
bite mark 5 & 6
5-partial avulsion (of tissue, moderate forensic evidence)
6-complete avulsion (scalloping can indicate teeth but low forensic significance
bruises and colors and age
-red (0-2 days)
-blue/purple (2-5 days)
-Green (5-7 days)
-yellow (7-10 days)
-brown (10-14 days)
2-4 weeks…no evidence
pattern laceration
- edges of incised wound will be sharply demarcated vs laceration where edges rounded/bridges form, etc.)
- ex.: pattern laceration from baseball bat would be linear and wave like and have characteristic of crushed skin edges and torn skin
sharp-force pattern injuries
TWO TYPES: incised wound (longer than it is deep) or stab wound (deeper than it is wide)
nonfatal strangulation
-risk factor for lethal violence
Strangulation
may be the ultimate power and control mechanism in Lenore Walker’s cycle of violence
3 forms of strangulation
- hanging
- ligature
- manual
brain death from strangulation occurs in…
…4 minutes
hyoid bone fracture
-may close off airway in matter of hours
occlusion caused by pressure
- carotid–11 lbs to occlude and 10 seconds then unconscious
- jugular vein–4.4 lbs to occlude then 10 second to unconscious
- trachea–33 lbs to occlude or fracture
point of no return
*Dr. Luis Pena
***after 50 seconds of O2 deprivation due to continuous strangulation, victims rarely recover (bounce back reflexes become inoperative)
dysphonia
hoarseness (can be permanent from strangulation)
**laryngeal nerve damage
dysphagia or odynophagia
dys–difficult to swallow
-odyno–painful to swallow
breathing changes
-due to laryngeal fracture/swelling
when struggling to breathe…
…air is swallowed and distends the stomach
hallmark injury for strangulation
-look behind hair and ear
blanched areas of neck
-where fingers were
subconjunctival hemorrhage
blood red eyes
*confluent capillary rupture in sclera portion of eyes
petechia
*if there is petechia on the skin surface, there is petechia in the brain
medical tx for strangulation
- airway surveillance
- neuro assessment
- suicide precautions
four phases of death thoughts (before loss of consciousness)
1-disbelief
2-realization
3-primal
4-resignation (thoughts of children)
coup vs countre-coup injury
- coup–head stops suddenlt and brain rushes forward and hits inside of skull and rubs against ridges inside skull
- countercoup injury–brain bounces of primary surface and impacts off opposite side of skull (damaged by ridges inside of skull)
(CLOSED HEAD INJURIES)
diffuse axonal injury
-axons (output fibers of neurons) are twisted, stretched, or severed, and can’t be seen easily (caused by TBI)
concussion/mTBI (mild)
**not typically visible w/ standard brain imaging techniques
(1) LOC for less than 30 minutes
(2) loss of memory for events before or after injury resolves w/in 24 hrs
(3) alteration of consciousness (confusion, disorientation, or dazed feeling)…resolves w/in 24 hrs
concussion/mTBI symptoms
- headache
- dizziness/balance/coordination probs
- cognitive deficits
- fatigue/insomnia
- emotional changes (irritability & depression…70% develop anxiety and 14% panic)
moral behavior
conduct that results from serious critical thinking about how individuals ought to tx others (way person interprets basic respect for others)
values
-personal beliefs about what is important and desirable
values clarification
process of self-exploration by which ppl identify and rank their own personal values (helps see why some choices made over others)
utilitarianism
“greatest-happiness principle”
*actions are right to the degree they tend to promote happiness and are wrong as they tend to produce reverse of happiness (most good for most ppl) ….based on outcome
kantianism
**DIRECTLY OPPOSED TO UTILITARIANISM
- decisions made out of respect for moral law
- decisions and actions are bound by sense of duty (NOT based on outcome)
Christian ethics
do unto others as you would have them do unto you
*all decisions about right and wrong should be centered in love for God and in treating others w/same respect/dignity
natural law theories
- do good and avoid evil
- self-evident and determined by human nature (we inherently know difference between good and bad)
ethical egoism
- what is right and good is what is best for individual making the decision
- what is to his or her advantage (consideration for only individual)
ethical issue vs ethical dilemma
- not all ethical issues are ethical dilemmas
- dilemma–arises when no clear reason to choose one action over another
ethical dilemma
- make a choice between two equally unfavorable alternatives
- create great deal of emotion
ethical principles
fundamental guidelines that influence decision making
(1) autonomy
(2) beneficence
(3) nonmaleficence
(4) veracity
(5) justice
autonomy
- arises from Kantian view of persons as autonomous with right to decide own destiny
- not case w/: children, comatose individuals, and ppl w/ severe mental illness
beneficence
one’s duty to benefit or promote good of others
*sometimes can take importance over autonomy (when patient a danger to self or others)
nonmaleficence
- do not harm either intentionally or unintentionally
* includes acting carefully to avoid harm
justice
- right of individuals to be treated equally and fairly regardless of race, gender, marital status, medical diagnosis, social standing, economic level, or religious belief
- all HEALTHCARE resources ought to be distributed equally
veracity
-one’s duty to always be truthful (med error? report it.)
model for making ethical decisions
(1) Assessment (data)
(2) Problem Identification (identify conflicts)
(3) Planning (explore benefits and consequences)
(4) Implementation (act on patients decision)
(5) Evaluation (evaluate outcomes)
Nurse Practice Act
- defines legal parameters of professional and practical nursing
ex. education/scope of practice/suspension of licensure
statutory law
- enacted by legislative body
ex. nurse practice acts
common law
- derived from decisions made in previous cases
- can differ state to state
civil law (within statutory and common law)
-protects private and property rights of individuals and businesses
- Torts (violation of civil law in which individual has been wronged) ex. malpractice and negligence acts
- Contract violations (fails to fulfill an obligation and thus has breached contract)
criminal law
provides protection from conduct deemed injurious to public welfare
doctrine of privileged communication
-grant certain professionals privileges under which they may refuse to reveal info about and communication with clients
**applies to psychiatrists and attorneys (law cannot force disclosure)
exception: duty to warn
informed consent, nursing duties 3 major elements
- knowledge
- competency
- free will
Patient Self-Determination Act of 1991
restraints/seclusion (except in emergency)
emergency commitments
- time-limited
- court hearing for individual schedules w/in 72 hrs (probable cause hearing)
mentally ill person in need of tx
-last longer than emergency commitments
Involuntary Outpatient Commitment (IOC programs)
-those who dont meet criteria for involuntary hospital tx (but are still dangerous)
**prevent violence rather than waiting for it to happen (Kendras Law)
negligence
accidental
malpractice
specialized form of negligence (caused only by professionals)
defamation of character
(from breach of confidentiality)
- libel (written form) –>BE careful with charting objectively
- slander (verbal)
assault vs battery
- assault (verbal…fear and apprehension that he or she will be touched without consent)
- battery (actual contact)
Peplau nursing roles:
(1) stranger
(2) resource person
(3) teacher
(4) leader
(5) surrogate
(6) technical expert (#1 respected profession)
(7) counselor
therapeutic use of self
- use one’s personality consciously and in full awareness in attempt to establish relatedness and to structure nursing intervention
- nurses must possess: self-awareness, self-understanding, and philosophical belief about life/death/human condition
values clarification
**one process by which you gain self-awareness
- beliefs
- attitudes (negative stigma against mentally ill)
- values (action oriented/action producing…only when belief is acted on does it become a value)
Johari Window
-tool used to increase self-awareness, divided into 4 quadrants (aspects of self)
- open or public self
- the unknowing self (others see, you don’t)
- private self
- unknown self
enhances therapeutic relationship
- trust
- rapport
- respect
- genuineness
- empathy
nursing interventions that promote trust
BE DEPENDABLE!!!
for patients who think concretely
empathy
understand from pt’s point of view
aspects of environment that communicate messages
- territoriality
- density
- distance
4 kinds of distance in interpersonal interactions
- intimate distance (closest space individuals allow between selves and others)
- personal distance (distance for personal in nature, ex. close conversations with friends)
- social distance (conversation with strangers)
- public distance (distance speaking in public or yelling at someone)
SOLER
*nonverbal behaviors designated as facilitative skills for attentive listening
S: Sit Squarely facing patient O: Observe Open posture (uncrossed arms/legs) L: Lean forward toward patient E: Establish Eye contact R: Relax
motivational interviewing
- meet patient where they are at not where nurse THINKS they should be at
- can decrease defensive pt responses (made for substance abuse patients)
feedback
- specific rather than general
- descriptive rather than evaluative
- imparts info rather than offering advice
assistance w/ problem-solving during crisis period
- preserves self-esteem
- promotes growth (w/ resolution)
crisis…
…disturbs homeostasis
phase 1 in development of crisis
-individual exposed to precipitating stressor (anxiety increases, previous prob-solving techniques employed)
phase 2 in development of crisis
- when previous prob-solving techniques do not relieve stressor, ANXIETY increases further
- feelings of confusion and disorganization
phase 3 in development of crisis
-all possible resources (both internal & external) are called on to resolve prob and relieve discomfort
phase 4 in development of crisis
-if resolution does not occur in previous phases the tension mounts beyond further threshold or its burden increases overtime to breaking point
**MAJOR DISORGANIZATION OF INDIVIDUAL OCCURS OFTEN W/ DRASTIC RESULTS
whether individuals experience crisis in response to stressor is based on three factors
1- individual’s perception of event
2-availability of situational supports
3-availability of adequate coping mechanisms
Class 1: Dispositional Crisis
acute response to external situational stressor
Class 2: Crises of Anticipated Life Transitions
-normal life cycle transition that may be anticipated but over which individual may feel lack of control
Class 3: Crises Resulting From Traumatic Stress
- precipitated by unexpected, external stressor over which individual has little or no control and from which he or she feels emotionally overwhelmed and defeated
ex. 9/11, gatlinburg fires, shootings, etc.
Class 4: Maturational/Developmental Crises
- in response to situation that triggers emotions related to unresolved conflicts in one’s life (deals with failed attempts to master developmental tasks associated w/ transitions in life cycle)
ex. baby born, mother dx w/ cancer, 2 years of marriage
Class 5: Crises Reflecting Psychopathology
-emotional crisis in which preexisting psychopathology has been instrumental in precipitating crisis or in which psychopathology significantly impairs/complicates adaptive resolution
Class 6: Psychiatric Emergencies
- general functioning has been severely impaired and individual is rendered incompetent or unable to assume personal responsibility for his/her behavior
ex. : acute suicide risk, drug OD, rxs to hallucinogens, acute psychoses, uncontrollable anger, alcohol intoxication
***many of these turn into 911 calls by individual/fam/witness
three factors important in identifying extent of risks
- past hx violence
- client dx (substance abuse, single most important, schiz, bipolar, major depressive, personality dx)
- current behaviors
prodromal syndrome
- anxiety and tension
- verbal abuse/profanity
- increasing hyperactivity
specific behaviors with prodromal syndrome
- rigid posture
- clenched fist/jaws
- grim/defiant affect
- talking rapid, raised voice
- arguing/demanding
- use of profanity/threats
- agitation/pacing
- pounding/slamming
disasters
- overwhelm local resources & threaten fxn/safety of community
- leave victims with: damaged sense of safety/well-being AND emotional traumas
behavioral responses to disaster in adults:
- anger
- disbelief
- sadness
- anxiety
- fear
- sleep disturbances
- increase in alc/caffeine/tobacco use
responses to disaster in children
- separation anxiety
- nightmares
- probs w/ concentrating
interventions w/ client who has experienced traumatic event
(1) maintain anxiety at manageable level
(2) encourage free expression about spiritual issues
(3) assistance to deal w/ emotional rxns in individually appropriate manner
(4) promotion of activities to improve community fxning
thorazine
-became basis for research in bio factors in mental health
**anti-emetic that had effect on decreasing features of schiz
central NS
*Brain
(1) forebrain
(2) midbrain
(3) hindbrain
(4) nerve tissue
peripheral NS
(1) afferent system
(2) efferent system
forebrain
- cerebrum
- diencephalon
**decision-making
midbrain
- mesencephalon
* less complex fxns (switchboard/sends incoming info somewhere)
hindbrain
- pons
- medulla
- cerebellum
**most primitive (sleep, BP, etc)
nerve tissue
- neurons
- synapses
- neurotransmitters
**interprets all sensory data and issues commands
afferent system (PNS)
- somatic sensory neurons
- visceral sensory neurons
(move sensory info from periphery up to CNS)
efferent system (PNS)
-somatic NS that travels FROM brain to periphery
{somatic/visceral motor neurons}
- somatic nervous system {somatic motor}
- autonomic nervous system (sympathetic and parasympathetic NS) {visceral motor}
cerebral cortex
-outer layer of diencephalon
forebrain (cerebrum) is…
…most advanced part of brain
-interprets info received from MIDBRAIN and DECIDES what must happen (processor)
R & L hemisphere forebrain (cerebrum)
separated by corpus callosum
R-creative (associated w/ affect)
L-logic/prob solving
each hemisphere contains…
frontal, parietal, temporal, and occipital lobes (total of 8)
frontal lobes
-voluntary body movement and executive functions
thinking, judgement, expression of feelings, laughing/crying etc.
parietal lobes
-LANGUAGE recognition (L hemis)
temporal lobes
-manages hearing (L lobe coordinates w L parietal), SHORT term memory and sense of smell
occipital lobes
-visual reception and interpretation
frontal lobes and schiz
decreased activity in frontal lobes with schizo patients
forebrain (diencephalon)
- relay center for most sensory input from PNS
- directs autonomic, endocrine, motor function control/affects homeostasis & perception of senses
a. thalamus
b. hypothalamus
c. limbic system
thalamus
- integrates ALL sensory input EXCEPT smell prior to being sent to cortex
i. e. maintain body fxns on cruise control
hypothalamus
*controls autonomic nervous system (part of peripheral nervous system) i.e. flight/fight/freeze
- manages: appetite/body temp/BP/sleep cycle
- regulates pituitary glands
limbic system
**EMOTIONAL brain (aggression, fear, joy, anger, sexuality, love, social)
key components:
- amygdala (FEAR detector and determines threat level)
- hippocampus (ability to learn new things, converting short term mem into long term mem)
midbrain (mesencephalon)
- REFLEX (provides emergency safety workaround)
- integrated visual, auditory, and balance reflexes between one side of brain to other
**(EYE MOVEMENT biggest one)
*sleep/wake cycles and alertness
midbrain location
-extends from pons to hypothalamus
pons (hindbrain)
- *respiration center
* *associated w/ sleep/dreaming
medulla (hindbrain)
- connects spinal cord and pons (creating brainstem)
* responsible for HR/respirations/reflexes (VITAL CENTERS)
cerebellum (hindbrain)
- connects brainstem thru bundles of fiber tracts
- concerned w/ INVOLUNTARY movement (muscle tone/coordination and maintains posture)
major categories of NTs
- cholinergics
- monoamines
- amino acids
- neuropeptides
cholinergics
- acetylcholine (insufficient amount=dementia or Parkinsons)
- support activity of ANS’s parasympathetic division
monoamines
- norepinephrine (fight or flight)
- dopamine (inhibits release of prolactin, increased=mania or schiz and decreased=depression/Park)
- serotonin (decreased=depression, increased=anxiety)
- histamine (decreased=depression, increased=anxiety)
*regulates emotions, arousal, & memory
amino acids
- inhibitory amino acids (GABA, slow body activities; decreased=anxiety, schiz, epilepsy)
- excitatory amino acids (glutamate=learning mem/reflex)
**common with nerve meds
neuropeptides
- opioid peptides/endorphins
- substance P (regulate pain)
- somatostatin
- *endorphins/control pain
- *produced in pituitary gland (NATURALLY occur in body)
Parkinson’s
decreased dopamine
decreased glutamate
schizophrenia
increased glutamate
Huntington’s , anxiety, depressive
posterior pituitary
*neurohypophysis
ADH
oxytocin
anterior pituitary
*adenohypophysis
- growth hromone
- TSH
- Adrenocorticotropic hormone
- prolactin
- gonadotropic hormones
- melanocyte-stimulating hormone
increased levels T hormones (decreased TSH secretion)
- insomnia
- anxiety
- emotional lability
decreased levels T hormones (increased secretion TSH)
- fatigue
- depression
adrenocroticotropic (ACTH)
stimulates secretions of cortisol in RESPONSE TO STRESS
- increased: mood dx/psychosis
- decreased: depression, apathy, fatigue
MSH
melanocyte stimulating hormone (release stimulated by onset of DARKNESS)
- *stimulates secretion of melatonin
- increased levels=depression (anergia, loss of energy)
circadian rhythms
hypothalamus
**ppl in N latitudes, HIGH MSH and HIGH melatonin production
L-tryptophan
induces sleep (serotonin precursor functioning as effective sedative-hypnotic to induce sleep in clients who have sleep-onset issues)
- warm milk
- chicken/turkey
- cheese
- peanuts
GABA
INHIBITS postsynaptic excitation which disrupts the electrical impulse movement causing DECREASE in body activity
*benzodiazepines (Ativan, Xanax, Valium) enhance GABA producing a calming effect
genetics and dxs
- schiz
- bipolar
- MDD
- anorexia nervosa
- panic dx
- somatic symptom dx
- antisocial personality
schizophrenia NT hypothesis
- dopamine hyperactivity
- decreased glutamate
- decreased prolactin
depressive dx hypo
- decreased norepinephrine
- decreased dopamine
- decreased serotonin
- thyroid hyposecretion
bipolar dx hypo
-increased norep and dopamine in acute mania & elevated thyroid hormones
**FRONTAL LOBE (cant make rational decisions)
panic attacks
-GABA reduced and increased norep
**LIMBIC SYSTEM
alzheimers
decreased acetlycholine, norep, serotonin
*Temporal, parietal, occipital; hippocampus
antidepressants action
-block reuptake serotonin/norep (keep more NTs in synapse)
antipsychotics action
-block specific NT receptors (dopamine)
benzodiazepinesaction
stimulate release of GABA
psychostimulants action
-release norep, serotonin, and dopamine
**enhanced mental alertness/focus
antidepressants NT
-affects:
INCREASE:
- norep
- serotonin
- dopamine
antipsychotics NT
*dopamine
benzodiazepines NT
DEPRESS CNS
*GABA
psychstimulants
STIMULATE CNS
- norep
- dopamine
Buspar
exception of action of antianxiety (most antianxiety depress CNS)
- **doesnt work RIGHT away has to build up in system
- **acts on serotonin (does not act on CNS)
1st antidepressant drug
MAOI (isoniazid) used to tx TB
tricyclics vs SSRIS
SSRIs=less anticholinergic impact
atypical antipsychotics
-increase availability of dopamine and serotonin
atypical SSRIs
wellbutrin, remeron, desyrel
common SNRIs
- pristiq
- cymbalta
- fetzima
- effexor
Serotonin Syndrome with antidepressants
- Buspar
- St Johns wort
MAOI be careful of
HTN crisis
antidepressants and antiepileptics
-lower seizure threshold
diabetics and antidepressants
-can cause hypoglycemia if taken w/ antidiabetics
Verapamil
- mood stabilizer
- anticonvulsant meds
- calcium channel blocker
w/ lithium
***HYDRATION
-but overhydration can lessen effects
**anything that depletes sodium will make more receptor sites available and increase risk for lithium toxicitiy
lithium toxicity numbers
elderly: greater than 1.2
adults: greater than 1.5
early and late symptoms lithium toxicity
early: vomiting/diarrhea
later: ABOVE 2.0 tremors, sedation confusion
3.5 or above lithium
delirium, seizures, coma, death
therapeutic range for lithium
Acute mania: 1.0-1.5
Maintenance: 0.6-1.2
antipsychotics action
-decrease dopamine levels
some antipsychotics used for
tx of bipolar mania
typical antipsychotics
- Haldol (acute psychosis)
- risperdal
**Block dopamine receptors
atypical antipsychotics
-Latuda, Geodon, Vraylar, Rexulti, Seroquel, Clozaril, Abilify
- *weaker dopamine antagonists
- *less side effects/don’t hang around as long
atypical antipsychotics baseline
***GLUCOSE (can increases)
do not use antipsychotics
w/ other CNS depressants or if patient CNS depressed
Artane
CANNOT BE GIVEN IM
clozaril
lower seizure thershold
AND
agranulocytosis
**antipsychotic
antiparkinson agents
anticholinergic
*counteract extrapyramidal symptoms
sedative hypnotics
valium, phenobarbital
Rozerem *Remelteon)
NOTz controlled sedative/hynpotic and doesnt produce tolerance/dependency
ADHD agents increase
-norep, dopamine
