Exam 1 Flashcards
clinical epidimiology
a broad field examines health and illness at the population level
comorbid condition
presence of two or more disorders
incidence
conveys information about risk of contracting a disease; refers to number of new cases in healthy population within given time period (usualy annually)
prevalence
describes total number of cases new and existing in given population during specific time period
diagnostic and statistic manual of mental disorders, 5th edition (DSM-5)
publication of american psychiatric association to identify disorders based on specific criteria
cultural competence
adjusting practices to meet pt cultural beliefs, practices, needs, preferences
mental health
state of wellbeing in which individuals reach own potential to cope with normal stressed of life, work productively, and contribute to community
mental health continuum
one end is mental health and the other is mental illness; everyone falls somewhere on the continuum and can shift along
mental illness
refers to all psychiatric disorders that have definable disorders manifested in significant dysfunctions (ex. impaired ability to think = alzheimers)
recovery
process of change through which individuals improve their health and wellness, live self directed life, and strive to reach full potential
resilience
ability and capacity for people to secure resources they need to support their well-being; how we over come things
stigma
belief that the overall person is flawed characterized by shunning disgrace and shame; negative stereotype that leads to attitude or belief that causes one to view person in certain way (ex. mentally ill pt is dangerous)
diathesis stress model
most accepted explanation for mental illness; diathesis = biological predisposition; stress = environmental stress or trauma
epidimiology
quantitative study of distribution of diseases/mental disorders in human populations
superego
develops between ages 3-5 and represents moral component of personality; resides inn conscious, preconscious, and unconscious level of awareness (allows for sense of guilt or pride)
id
present at birth; totally unconscious and impulsive; source of drive instincts reflexes and needs; lacks ability to problem solve
ego
develops within the first few years of life; resides in conscious, preconscious, unconscious levels of awareness; it is the problem solver and reality tester
unconscious
includes all repressed memories, passions, and unacceptable urges; exerts powerful but unseen effect on the conscious (trauma is an example)
preconscious
material that can be retrieved easily through conscious effort
conscious
contains all material a person is aware of at any one time such as perceptions, memories, thoughts, fantasies, feelings
mental health parity act
1996- US insurers must offer same benefits at same level coverage for mental illness as for other conditions
mental disorders with strong biological influences
schizophrenia, bipolar, major depression, obsessive compulsive and panic disorders, PTSD, autism, anorexia nervosa, attention deficit. hyperactivity disorder
factors that can affect mental health
biological/hormones/genetic, spirituality/religion, culture/regional differences, family/friends/community, personality traits, health practices and beliefs, environmental experiences, economics, impaired parenting, psychosocial stressors, negative influences
DSM-5 and cultural accomodations
discusses cultural variations for each clinical disorder, describes culture-bound syndromes, outline assist clincians in evaluating and reporting impact of an individuals cultural context
outpatient psych mental heath care
primary care providers. specialty psychiatric care providers, pt-centered health/medical homes, community clinics, psychiatric home care, assertive treatment, intensive outpatient programs, partial hospitalization programs, telephone crisis, telepsychiatry
role of nurse in outpatient setting
strong problem-solving and clinical skills, promoting recovery and continuation of treatment, knowledge of community resources, flexibility, autonomy, cultural competence
settings for inpatient care
crisis stabilization/observational units, general hospital and private hospital, state hospital
entry to acute inpatient care
direct admission on referral, ED or crisis service, voluntary or involuntary (sect.12)
Pt rights
hospitalized pt retain rights as citizens, pt need for safety needs to be weighed against pt rights, mental health facilities have written statements of pt rights and applicable state laws, pt have the rights to decline meds unless court ordered
CNS
brain and spinal cord
PNS
cranial nerves, spinal nerves, autonomic nervous system
akithisia
side effect of antipsychotic causes body to move and be restless
brain consists of
3lbs and 100 billions neurons; forebrain- cerebrum, diencephalon; midbrain- mesencephalon; hindbrain- pons, medulla, cerebellum
neurons are composed of
cell body, axons, dendrites
classes of neurons
afferent, efferent, interneurons
parasympathetic nervous system
stimulates flow of saliva, slows HR, constricts bronchi, stimulates peristalsis and secretion, stimulates release of bile, contracts bladder
sympathetic nervous system
dilates pupil, inhibits saliva, increases HR, dilates bronchi, inhibits peristalsis and secretion, conversion of glycogen to glucose, secretion of adrenaline and noradrenaline, inhibition of bladder contraction
neurotransmitters
play important role in human emotions and behaviors and are target for mechanism of action in many psychotropic meds; released from of neuron across synapse and received by dendrites of next neuron
insufficient transmission
insufficient degree of transmission caused by deficient release or neurotransmitters from presynaptic cell or by decrease in receptors on postsynaptic
excessive transmission
may be due to excessive release of a transmitter or increased receptor responsiveness (occurs in schizophrenia)
psychiatric illness is…
related to number of factors such as genetics, neurodevelopmental factors, drugs, infection, psychosocial experience
psychiatric illness results in
alteration in neurotransmitters and are the target of psychotropic drugs
functions of the brain
maintenance of homeostasis, regulation of autonomic nervous system and hormones, control of biological drives and behavior, cycle of sleep and wakefulness, circadian rhythm, conscious mental activity, memory, social skills
neuroimaging used for
picking up electrical activity in the brain; examples of test are computed tomography (CT), magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), positron emission tomography (PET), single photon emission computed tomography (SPECT)
increased neurotransmitter: dopamine
scizophrenia, mania
decreased neurotransmitter: dopamine
parkinsons, depression
increased neurotransmitter: serotonin
anxiety states
increased neurotransmitter: norepinephrine
anxiety states
decreased neurotransmitter: epinephrine
depression
decreased neurotransmitter: serotonin
depression
increased neurotransmitter: histamine
depression and anxiety
monoamine neurotransmitters
dopamine, norepinephrine, serotonin, histamine
amino acid neurotransmitters
gamma-amino butyric acid (GABA), glutamate
increased neurotransmitter: GABA
reduction of anxiety, schizophrenia, mania
decreased neurotransmitter: GABA
anxiety disorders, schizophrenia, mania, huntington chorea
glutamate amino acid neurotransmitter
major mediator of excitatory signal in the central nervous system; involved in most aspects of normal brain function, cognition, memory, learning
cholinergic neurotransmitter
acetylcholine
increased neurotransmitter: acetylcholine
depression
decreased neurotransmitter: acetylcholine
alzheimers, huntington chorea, parkinsons
peptides-neuromodulator neurotransmitters
substance P, somatostatin, neurotensin
substance p
regulation of mood and anxiety, role in pain management
increased neurotransmitter: somatostatin
huntington disease
decreased neurotransmitter: somatostatin
alzheimer
neurotensin
decreased levels in spinal fluid of pt with schizophrenia
types of psychotropic drugs
antianxiety, anti-depressants, mood stabilizers, anti-convulsants, anti-psychotics, ADHD agents, alzheimer agents, herbal supps
Antidepressants
monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitor (SNRIs), serotonin-norepinephrine disinhibitors (SNDIs), Norepinephrine-dopamine reuptake inhibitors (NDRIs), Serotonin antagonist/reuptake inhibitors, Selective norepinephrine reuptake inhibitor
Monoamine oxidase inhibitors (MAOIs)
drugs that increase concentration of monoamines by inhibiting action of monoamine oxidase
MAOIs precaution
avoid tyramine found in OTC meds, beer, wine, aged cheese, organ meats, avocados; dietary restriction must be maintained 2 weeks after stopping MAOIs
TCA
increase norepinephrine; side effects: anticholinergic- cant pee cant see cant spit cant shit (amitriptylene, nortriptyline)
TCA precaution
inability to pee can lead to potential infection
SSRIs
increases serotonin; side effects: fewer anticholinergic effects than TCAs, N/V, sexual dysfunction, can cause serotonin syndrome (fluoxetine, sertraline, paroxetine)
SNRIs
increases serotonin and norepinephrine; side effects: fewer anticholinergic effects (venlafaxine and duloxetine)
SNDIs
increase serotonin and norepinephrine; usually combined with SSRIs to augment efficacy or counteract serotonergic side effects (mirtazapine)
NDRIs
do not act on serotonin system; inhibit nicotinic acetylcholine receptors to reduce addictive effects (bupropion)
SARIs
not first choice for antidepressant treatment, but useful for insomnia; side effects: can cause priapism (trazodone)
NRIs
treat ADHD when stimulants are not tolerated but no significant antidepressant effects (atomoxetine)
Anxiolytics or anti-anxiety
benzodiazepines
anxiety medications
diazepam, clonazepam, alprazolam, lorazepam; should only be used short term; not first choice for anxiety but first choice for panic disorder; lorazepam/alprazolam not soporific at lower doses
insomnia medications
flurazepam, triazolam
non benzodiazepine anxiolytics
buspirone, z-hypnotics, melatonin-receptor agonist
buspirone
anxiolytic with less potential for dependence
z-hypnotics
short acting sedative and hypnotic sleep agents; provide sedative effects without the antianxiety, anticonvulsant, or muscle relaxant effects of benzos
melatonin-receptor agonist
hypnotic drug that acts similar to melatonin; thought to regulate circadian rhythm
mood stabilizer
lithium: stabilizes depression and mania (bipolar); very narrow therapeutic range, has potential for toxicity; titrate from low dose up to desired amount but monitor BUN and creatinine for kidney function
toxicity of lithium
tremor, ataxia, confusion, convulsions, N/V
anticonvulsant mood stabilizers
valproate- very effective in managing impulsive aggression (monitor LFT and enzymes-liver), carbamazepine- administered for acute mania, lamotrigine- administered for maintenance therapy (watch for Steven Johnson)
off-label mood stabilizers
oxycarbazepine, gabapentin, topiramate
first-generation antipsychotic drugs
chlorpromazine (thorazine), fluphenazine (prolixin), haloperidol (haldol); all treat positive symptoms of schizophrenia
positive symptoms of schizophrenia treated by first gens
delusions (paranoia), hallucinations (visual, auditory, tactile, gustatory, olfactory), illusion (morphing of something)
adverse/extrapyramidal side effects of first-gen antipsychotics
dystonia- muscle stiffness, akathisia- restlessness, tardive dyskinesia- lip-smacking (irreversible),drug induce parkinsonism- shuffling gait, drooling, neuroleptic malignant syndrome- muscle stiffness/wasting (life-threatening), orthostatic hypotension (non-reversible)
how to treat reversible side effects of 1st gen antipsychotics
mainly cojentin, sometimes diphenhydramine (benadryl), propanolol, dantroline
2nd generation atypical antipsychotic drugs
fewer extrapyramidal side effects; target negative side effects and positive side effects of schizophrenia
ex of 2nd gen antipsychotics
clozapine, quetiapine, olanzapine, aripiprazole
positive symptoms vs negative symptoms schizophrenia
+ = symptoms added to pt such as hallucinations or illusions; - = absence of normal behaviors like anhedonia
anhedonia
lack of pleasure or enjoyment or interest
why choose second gen antipsychotics
much lower risk of EPS but still possible; 2nd gen can cause metabolic syndrome
metabolic syndrome
increased weight, increased blood glucose, increased triglyceride levels, insulin resistance
best treatment for most psychiatric problems
combination of medication and psychotherapy
importance of talk therapy
based on psychotherapy (freud) and found to change brain chemistry in similar ways as medication
therapeutic relationships…
needs of pt are identified and explored, clear boundaries established, problem-solving approaches taken, new coping skills developed, behavioral change encouraged
professional and ethical boundaries
maintaining prolefessional role helping meet patients goals and never personal goals of nurse
legal boundaries
pt rights to confidentiality; breach of confidentiality i a common law tort which is a civil wrong; results in lawsuit for monetary compensation and/or loss of license
over-involvement increases risk of…
boundaries being crossed- relationship becomes personal (RN needs being met); boundary violations- reversal of roles (RN needs met and pt needs not met); sexual misconduct (physical or verbal)
peplaus nurse pt relationship
- preorientation phase 2. orientation phase 3. working phase 4. termination phase
preorientation phase
prepare for your assignment; research pt HX, recognize own thoughts and feeling about meeting pt; anticipate and set ground rules prior to first meeting
orientation phase
establishing rapport; parameters of relationship, formal or informal contract; confidentiality; terms of termination (begin talking abut end); initial interview takes place
working phase
maintaining relationship, gather further data; promote patients problem-solving skills; self-esteem and use of language; facilitate behavioral change; overcome resistant behaviors; evaluate problems and goals; promote practice and expression of alternative adaptive behaviors
termination phase
summarize goals and obj. achieved; discuss ways for pt to incorporate new coping strategies learned; review situation of relationship and exchange memories
factors promoting patient growth
empathy (not sympathy), genuineness, positive regard, SOLER
empathizing with someone is…
aiming to understand the feeling of the patient which is therapeutic not pittying or feeling sorrow for pt
SOLER
s- sitting at comfortable angle and distance; O- open posture arms and legs uncrossed; L- leaning forward from time to time, looking genuinely interested, listen attentively; E- eye contact without staring; R- remaining relatively relaxed
components of nonverbal communication
physical appearance and dress, body movement and posture, touch (be very careful), facial expressions, eye behavior, vocal cues or paralanguage
active listening
listen to pt verbally and nonverbally, SOLER
transference
occurs when client unconsciously displaces to the nurse feelings formed towards a person from his or her past
countertransference
refers to nurses behavior and emotional response to client. Responses maybe related to unresolved feelings toward significant other from nurses past or may be generated in response to transference feelings on part of client
process recordings
written reports of verbal interactions with clients used to improve communication technique
therapeutic communication techniques
using silence, accepting, giving recognition, offering self, giving broad openings, offering general leads, placing the even in time or sequence, making observations, encouraging description of perceptions, encouraging comparison, restating, reflecting, focusing, exploring, seeking clarification and validation, presenting reality, voicing doubt, verbalizing the implied, attempting to translate words into feelings, formulating plan of action
non-therapeutic communication techniques
giving reassurance, rejecting, giving approval or disapproval, agreeing/disagreeing, giving advice, probing, defending, requesting an explanation, indicating the existence of an external source of power, belittling feelings expressed, making stereotyped comments, using denial, interpreting, introducing an unrelated topic
preexisting conditions impacting communication
values/attitudes/beliefs, culture/religion, social status, gender, age/developmental level, physical impairments (glasses/hearing aids), environment of transaction (territoriality/density/distance), personal space
clinical epidemiology studies
the natural history of a disorder/disease (if no interventions occurred, the studies of diagnostic screenings, and observational and experimental studies of interventions used to treat individuals with said disorder/symptoms
