Exam 1 Flashcards

1
Q

Mental illness

A

Significant dysfunction in mental functioning, definable diagnosis

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2
Q

Resilience

A

Adaptation
Ability to access resources to promote well-being
Optimism
Mastery
Competence

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3
Q

3 As

A

Anxious
Anger
Aggressive

If you don’t deal with the previous one you might have the next

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4
Q

Protective factors for mental health and well being

A

Things that keep us going such as a family member or pet

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5
Q

Risk factors for mental health and well being

A

Things that make you at risk of killing yourself (engaging in dangerous activity like drinking for a while)

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6
Q

Warning signs for mental health and well being

A

Leads to risk factors, like saying you’re thinking of going back to drinking or saying you started again

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7
Q

Diathesis-stress model

A

Diathesis— biological predisposition like neurotransmitters or viruses during birth can increase risk for schizophrenia
Stress—environmental stress or trauma (outside environment)
Most accepted explanation for mental illness

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8
Q

NAMI and SAMHSA

A

NAMI: Support for patients and families
SAMHSA: people seek to live their full potential (substance abuse mental health society)

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9
Q

2 important components on mental health

A

Mental health is part of overall health
There exists effective mental health treatments

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10
Q

Human genome project

A

Identify genes and sequences, store information and analytic tools, address ethical, legal, and social issues
Most psych disorders result from mutated or defective genes

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11
Q

President’s new freedom commission on mental health

A

Goals for transforming US mental health system
Understanding that mental health is essential to overall health
Mental health care is consumer and family driven
Used to be patient driven and so slow
Early screenings and technology are important

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12
Q

Institute of medicine (IOM)

A

Now called national academy of medicine (NAM)
Improving quality of healthcare for mental and substance use conditions quality chasm series
If you had substance abuse history and mental illness, they wouldnt treat the substance abuse. This report allowed both to happen
Identified treatments and gaps
Highly educated nurses care for diverse populations with chronic conditions

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13
Q

Mental health parity act

A

Parity for mental health just like medicine

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14
Q

Wellstone-domenici party act

A

Based on volume of employees (50), we don’t have to cover mental health costs for substance abuse as well as mental

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15
Q

Patient protection and affordable care act

A

Coverage for everyone

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16
Q

Most common mental illnesses

A

Depression
Generalized anxiety
Panic disorder

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17
Q

3 studies we do for people with mental disorders

A

Natural history of illness (diathesis stress model, environment, did they meet all their milestones)
Diagnostic screening tests
Intervention

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18
Q

Results of mental disorder studies are used to describe the frequency of

A

Mental disorders
Symptoms appearing together (depression with cardiac disease and breast cancer)
Most patients who undergo bypass surgery develop depression

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19
Q

DSM-V

A

Diagnostic manual, categorized. By disorders occurring from youngest to oldest, and disorders related to one another

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20
Q

ICD-10-CM

A

International classification of disorders

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21
Q

Basic vs advanced nursing care

A

Basic: nursing graduate, can seek certification as part of professional development
Advanced: CNS and NP, certification or licensure—therapy, may have prescription privileges

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22
Q

CNS vs NP

A

CNS focuses more on education whereas NP focuses more on medical aspect and prescribing

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23
Q

Psych care in the 1860s

A

Has roots in the asylums before the civil war era

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24
Q

Psych care in the 1950s

A

Private psych/mental hospital—first antipsychotic med (thorazine, chlorpromazine)

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25
Psych care in the 1960s
Medicare and medicaid with no funding of psych care, started to fund it
26
Psych care in 1999
Olmstead decision Deinstutionalization. People would buy homes and turn them into residential treatment places. Not every neighborhood allowed this which lead to homelessness. Shelters were bad so people preferred being on the street
27
Psych care in 2016
Drop in psych hospitals
28
1st psych asylum and 1st psych hospital
500-1500AD (also when mentally ill were sick not posessed) 18th century by dr benjamin rush
29
Enlightenment in the late 18th to early 19th century
Dignity of psych patients upheld Asylum movement
30
Study of mind and mental illness in the late 19th century
Studies and treatment approaches flourished
31
Development of CMHC
Least restrictive alternative evolved
32
CMHC’s act
Patients treated in familiar surroundings Homelessness was linked to deinstitutionalization
33
Least to most restrictive care (11)
PCP Specialty psych providers Patient centered medical homes Community mental health centers Psych home care/personal recovery programs Assertive community treatment Intensive outpatient programs/partial hospitalization Emergency care Crisis stabilization units General and private hospitals State hospitals
34
Patient centered medical homes
Not actually in the home Building with entire healthcare team
35
Psych home care/personal recovery programs
PROS for consistent outpatient treatment but patients not as high functioning Do very well in recovery program 5 days a week, 6-7 hours Nurses go in and out of homes and do assessments to see if patients can stay out of the hospital
36
ACT
Case manager program for patients once they are discharged Nurse becomes case manager and consult with doctor/NP about how patient is doing Someone goes into patient’s environment 2-3 times a week More intensive Usually not admitted to hospital but this method isn’t very common because of low funding
37
Intensive outpatient programs
2-3 days a week 5-6 hours a day
38
Partial hospitalization
5 days a week, 5-6 hours a day for patients who aren’t a danger but aren’t completely well Go from this to intensive outpatient to community clinic to see doc/therapist. Most intensive care after hospital
39
Hospital based consultant model
Consultants (NP or psychiatrist) are called to see whether they should be admitted to inpatient or outpatient psych
40
What to ask with manic bipolar patients
How did you sleep?
41
Psych and medical emergencies
First on scene! DON’T LEAVE THE ROOM!! Seamless transition between you and mental health worker Team comes in and may ask you to step aside but don’t leave CPI needed to deescalation Take valuables away IN FRONT OF PATIENT Code gray
42
Somatic therapy
Patient has pain and we treat them because they are discomforts
43
What does a therapeutic milieu do
Should be purposeful and planned to provide safety Provide interaction and communication among patients and personnel Provide testing ground for new behavior while patients take responsibility for their behavior Provide consistent limit setting Patients stay in the dayroom a lot Tries to mimic the outside world!
44
NPR only + weak milieu - meds
Decompensation when patients don’t receive meds Possibility of decompensation to pre treatment state with bad milieu
45
Meds only
Custodial care only
46
Milieu only
Patient is de-emphasized
47
Meds + NPR - milieu
patient fends for themselves Occurs with lack of leadership (weak head nurse) Many staff avoid patient contact Unit activities have irregular schedule and don’t contribute to overall unit philosophy
48
Meds + milieu - NPR
Ineffective nursing care Other disciplines must make up for ineffective nursing care so pt can improve
49
Anger vs aggression vs violence
Anger is an emotion Aggression is an action in response to anger Violence is full action, came from the person who made them feel that way One leads to the next
50
Limbic system and amygdala
Limbic system is emotions Amygdala mediates anger Helps remember emotions
51
Prefrontal cortex
Executive function, usually altered in psych patients This and the temporal lobe light up when a patient is angry
52
Chemical imbalance in people who imitate others (social learning theory)
Excess dopamine
53
Risk factors of violence
HISTORY OF VIOLENCE Substance use Increasing hyperactivity Verbal abuse, loud voice, silence Possession of weapon Intense eye contact Increased simulation, poor boundaries and structures Cognitive deficits
54
If someone cowers down and tries to look invisible
Possible abuse history
55
Inpatient factors in angry/aggressive patient interventions
Nurses who are respectful and empathetic for patients are more likely to succeed in diffusing situation Confusion/anger r/t behavior of other patients (disputes over food or cigs) Aversive stimulation Over/under stimulation
56
Outpatient factors in angry/aggressive patient interventions
Usually s/s are stabilized so these incidents aren’t common Important for a nurse to stress the need for treatment compliance (meds, program attendance, etc) to avoid relapses and situations
57
Timeline of restraints
Can put them on without order in emergency situation but need order within 30 mins (by 3rd year NP) Skin integrity q15 mins ROM needs to be done in opposites (LA, RL, RA, LL) After 2 hours debrief with patient and renew order Q24 hours debrief for 72 hours (3 chances) Take their word for it, share what you saw if they ask Check nutrition and hydration Circulation in extremities VS Elimination and hygiene Physical and psychological status and comfort
58
Contraindications of restraints
Pregnancy Sleep apnea Fracture Seizure disorder Head injury
59
Nursing responsibilities for seclusion
Must break seclusion q2h Must observe and document q15m Physical needs must be met Monitor BP
60
What to do after incident
OMH incident report Huddle with staff (review incident, what did we do good and bad, plan moving forward)
61
How to confront patient about discrepancies
Perception check: Describe inconsistent or confusing behavior Offer at least 2 possible interpretations Ask for feedback
62
Ethics
The study of philosophical beliefs about what is considered right or wrong in a society
63
Bioethics
Used in relation to ethical dilemmas surrounding healthcare
64
Ethical dilemma
Conflict between two or more courses of action, each with favorable and unfavorable consequences
65
Beneficence
Being kind, merciful, and moral
66
Fidelity
Loyalty
67
Veracity
Honesty
68
Pharmacogenetic testing
Testing is done and we find out a drug may be good for someone but it ends up being contraindicated for them
69
Predictive psych
More for adults, have an ability to make a determination, checking genes, seeing which meds would be good, and then they don’t end up being good
70
Assisted outpatient treatment (Kendra’s law)
Mandates AOT to those having a hard time in rehab and pose a risk to themselves or those in their community
71
Parity law (timothy’s law)
Requires insurance to cover psych and physical health benefits equally
72
Voluntary inpatient admission
Doctor has 3 days to decide whether or not to admit the patient
73
Forms of involuntary inpatient admission
Emergency Community designee 2 physicians certificate (usually seen when going from hospital to state hospital) CPEP
74
Emergency admission
Danger to self or others Person confused or demented Used for observation, diagnosis, and treatment Generally from 24-96 hours Court hearing before discharge or next admission
75
AOT
Similar to ACT Court ordered Been in hospital and was not showing improvement or functioning
76
Due process in involuntary commitment
Writ of habeas corpus (patient can tell nursing staff they want to go to court hearing, nurse tells doctor. Sometimes onsite, sometimes offsite [if offsite, 2 mental health associates go out with them, not nurse]) Least restrictive alternative doctrine
77
Patient rights
Right to treatment Right to refuse UNLESS emergency or court ordered Right to informed consent Rights related to restraint and seclusion Right to confidentiality Implied consent (testing), procedure in the OR is different kind of consent Capacity–ability to make a decision Competency–being able to act on things Psychiatric advance directives (Can’t fill this out while in hospital, has to be before)
78
Types of discharge
Conditional release: Patient leaves with a plan (go to outpatient therapy [doctor, psychiatrist, etc.]) Unconditional release: Someone came in with psychosis due to cannabis, don’t need therapy or meds Release against medical advice (AMA): Possible but rare in psych
79
restraint and seclusion
Least restrictive environment Orders of documentation Safety and assessment In NY if pt is a danger, you can put a patient in restraint and then get order after 30 mins. In any other state you need an order first Department of health, office of mental health, and joint commission If no order, you need to remove the restraints and document it
80
Exceptions to confidentiality
duty to warn potential victim (tarasoff case [I'm gonna kill my neighbor]) Report safety concerns and threats to treatment team and instructor Report elder and child abuse Duty to protect patient (Don't leave suicidal patient alone) Therapist-patient abuse --sexual, misdiagnosis, restraint use (safety)
81
Tort law
Tort is a civil wrong that is done to someone Intentional tort—willful or intentional acts that violate another person’s rights or property Unintentional tort—unintended acts against another that produce injury or harm (very complicated to prove negligence)
82
Standards of nursing care
State Boards of Nursing (only people who can take your license away) Professional Organizations Institutional Policies and Procedures Custom as a Standard of Care (if you do research, you give one group a different standard of care and compare them)
83
Forensic nursing issues at stake
Patient competency Individual’s fitness to stand trial Involuntary commitment Responsibility for a crime Support of victims or perpetrators of crime and violence Collection of evidence!! Provision of health care in prison settings
84
Schizophrenia
Can't function Brain disorder Rare in children Prodromal symptoms in adolescents (starts negative, not being social, sad affect, withdrawal, not doing well in school) In all people there is at least 1 psychotic symptom and difficulty functioning Symptoms HAVE to be present for 6 months and forward
85
Delusional disorder
Can last 1 month or less, altered thinking process, fixed false belief, still able to function though
86
Brief psychotic disorder
Lasts 1 day to less than 1 month Psychotic thinking and presentation (bizarre affect)
87
substance induced psychotic disorders
Cannabis may be good for people with cancer bc pain and nausea but it can cause psychosis
88
Schizpreniform disorder
less than 6 months, all symptoms of schizophrenia. Less occupational, social, and situational dysfunction. No meds or short term med
89
Schizoaffective disorders
2 arms Schizo=schizophrenia Affective: r/t affective domain, usually depression
90
Why are prodromal symptoms seen in schizophrenia in teens
Breaking from support system in late teens to early 20s. Huge transitions, environment plays a role
91
Onset and prognosis of schizophrenia
Late onset usually has better outcomes and less brain abnormality Good prognosis- acute onset, high baseline functioning Less positive prognosis--younger age onset, longer duration between symptoms and treatment, more negative symptoms-
92
DSM-V Criteria for schizophrenia
Two or more of the following for a significant portion of time in 1 month straight: Delusions Hallucinations Disorganized speech–makes no sense to anyone except patient Gross disorganization or catatonia (loss of muscle movement [catalepsy or waxy flexibility]) Negative symptoms (diminished emotional expression or avolition) Continuous disturbance for at least 6 months
93
physical illness in people with schizophrenia
remature death 3.5x higher (very sedentary lifestyle, smoking, unhealthy diet. 2nd generation psychotic meds cause metabolic syndrome so they tend to be overweight, exercise programs available) Polydipsia–excessive thirst, sometimes to get medicine out, electrolyte imbalance!)
94
genetics and schizophrenia
first degree relative with disorder increases risk to 10%, identical twins to 50% and fraternal twins to 15% Virus from mom when born, birth trauma, Genetics thought to account for up to 80% Multiple genes involved Diathesis-stress model
95
dopamine theory
when D2 receptors are blocked reduces symptoms of schizophrenia (1st generation antipsychotics) (blocks dopamine receptors, too much dopamine)
96
biological factors of schizophrenia
Dopamine theory Too little serotonin (depression) Other neurochemicals-- serotonin and dopamine blocked by 2nd generation antipsychotics NMDA receptors and glutamate–glutaminergic synthesis depleted in schizophrenia Acetylcholine–low in patients with schizophrenia
97
brain structure in schizophrenia
Enlarged ventricles or asymmetry Reduced volumes in brain areas Increased fissure sizes Reduced connectivity Decreased blood flow and glucose metabolism frontal lobe Reduced gray matter
98
prenatal factors in schizophrenia
Poor nutrition Hypoxia Viruses-herpes 2, retrovirus Psychological trauma Father older than age 35 Birth in late winter/early spring–seasonal depression
99
stress as a factor in schizophrenia
Increase cortisol interferes with hypothalamic development Often onset during time of stress (what can you identify?) Stressors affect severity and course of disorder Sexual abuse Poverty Migration Toxins
100
Course of schizophrenia
Prodromal symptoms--forewarning one month to more than one year before first psychotic symptoms or manifestation, deterioration, withdrawal and antisocial Recurrent exacerbations with periods of reduced symptoms, usually chronic Focus on management not cure Can somewhat control most symptoms, majority do not respond fully and require ongoing care (in- or outpatient)
101
phases of schizophrenic episode
1. Prodromal-Before acute symptoms 2. Acute--onset or exacerbation of symptoms with loss of function (good prognosis if high function before episode, early intervention!) 3. Stabilization--decreasing symptoms 4. Maintenance--near baseline. Symptoms absent or decreased What settings will individuals be treated in for each of these phases?
102
Assessment of schizophrenia
Are they compliant/cooperative? Do they have judgment? Anosognosia Decreased sensation and confusion (summer clothes in winter) Lab work for THYROID PANEL Imaging if necessary like head trauma r/t episode Speech pattern Monitor those at risk Adherance to treatment is a problem Positive and negative symptoms Cognitive and affective symptoms
103
Positive symptoms
presence of something that shouldn’t be there (hallucinations, delusions, depersonalization, derealization, paranoia, thinking disorder, abnormal movements, bizarre behavior, disorganized speech [associative looseness])
104
Negative symptoms
absence of something that should be there, anhedonia (reduced pleasure), apathy, blunted affect, poverty of thought [alogia], loss of motivation [avolition]
105
Cognitive symptoms
changes/impaired memory, attention issues, illogical thinking, poor problem solving & decision making skills, impaired judgment
106
Affective symptoms
emotions and emotional expression, suicidality, hopelessness, dysphoria
107
Perception vs delusion
Perceptions are hallucinations, delusions are fixed beliefs
108
Depersonalization vs derealization
Depersonalization--feeling of things being unreal or different, not part of self, sense self differently Derealization--feeling that the environment has changed
109
Hallucinations
Sensory perception with no external stimuli, may involve any of the 5 senses, most common is auditory (approx 60% of individuals experience)
110
Illusion
Misinterpretation of a real experience
111
Positive speech symptoms
Looseness of association Clang associations Word salad Neologisms Echolalia Religiosity Magical thinking Paranoia Circumstantiality Tangentiality Alogia Rapid or pressured speech flight of ideas Thought insertion Thought deletion Illogical or bizarre thinking Inattentiveness
112
Clang association
Using words that rhyma or sound similar rather than meaning
113
Circumstantiality vs tangentiality
Circumstantiality is overuse of details but getting to the point Tangentiality is going off topic and never getting to the point
114
Alogia
Poverty of speech reduced volume or spontaneity in speech
115
Rapid or pressured speech
urgent/intense speech, reluctant to allow others to speak
116
Flight of ideas
move rapidly one thought to next, difficult to follow the conversation (looseness of association is not rapid, this is, also there’s no connection)
117
Thought blocking
reduced or abrupt stoppage of thoughts (sorry were you talking to me? Couldn’t hear you over the man in the corner, mind isn’t there)
118
Positive behavioral symptoms
Impaired boundaries Catatonia Motor retardation or agitation Stereotype behaviors (motor behavior with no purpose) Waxy flexibility Echopraxia (mimicking MOVEMENTS) Negativism (does opposite or fails what is asked of them) Impaired impulse control Posturing (unusual positions or expressions)
119
Negative symptoms
Develop over time and most interfere with functioning The seven A’s: Anhedonia–loss of pleasure Avolition–reduce in motivation and goal directed behavior Asociality–not being social? Affective Blunting–reduced affect Apathy Alogia–poverty of speech Affect Thought blocking
120
Types of affect
Blunted–reduced Flat–nothing Constricted–lack of range in affect Inappropriate/incongruent–laughing when someone dies Bizarre–strange faces while talking
121
cognitive symptoms of schizophrenia
Concrete thinking Impaired memory Impaired information processing Impaired executive functioning Anosognosia
122
Why assess affective symptoms in schizophrenia
May herald impending relapse Increases substance use D/O Increases suicide risk Further impair functioning
123
Mental status exam
Affect/mood/how they present themself Cognition SPeech Kinesis Judgment/reality test
124
What mimics schizophrenia
Hypo/hyperthyroid Traumatic brain injury Brain cancer HSV Hep C
125
Command hallucinations
VERY dangerous, can tell patients to hurt themselves or others
126
Nursing diagnoses for positive symptoms
Disturbed sensory perception Risk for self-directed or other-directed violence Impaired verbal communication
127
Phase 1 of schizo
Acute Inpatient Pt safety and medical stabilization
128
Phase 2 of schizo
Stabilization Help patient understand illness and treatment Near end of treatment Being transferred Helping understand their illness and treatment (and how it’s changed) Stabilize meds Control or cope w symptoms May still have delusions but they’re not affecting ADLs
129
Phase 3 of schizo
Maintenance Out of hospital Maintain achievement Prevent relapse Achieve independence, satisfactory quality of life
130
Acute phase interventions for therapeutic milieu
Safety and structure Practicing social skills, stress reduction (very anxious), symptom management Group activities
131
Acute phase interventions for aggressive client
Potential for violence (more to themselves bc depression in schizophrenia) Often response to altered reality tesing Decrease stimulation (move others if needed) Increase observation (DASA is used to assess) Distraction De-escalation
132
Implementation in acute phase
psych, medical, and neuro evaluation Psychopharm treatment Support Supervision and limit setting in milieu Monitor fluid intake (aggressive pts dont eat or drink well) Assess for risk and safety
133
Interventions for hallucinations
Listen and attempt to understand “I don’t hear the voice but I understand you do” Provide reality and convey patient’s reality Safety esp with command hallucinations Focus on here and now Distraction “What is the voice saying to you”
134
Interventions with delusions
Trust them Dont argue or try to talk them out of it Acknowledge their experience Label feelings Empathy Gentle reality orientation—validate what is real Focus on here and now
135
Interventions with health teaching
Involve patient and family as much as possible Symptom management Relapse prevention (who do you call in crisis) Stress management Support groups Substance use avoidance bc of med interaction Sleep!
136
Implementation in stabilization and maintenance phases
Med admin and adherence Relationships w hcp Community based services (how will they get there) Activities and groups
137
First gen antipsychotics
D2 dopamine receptor agonists block altered reality Positive symptoms only
138
First gen adverse effects
Atkinisia, dystonia Looks like a medical emergency, head rolled back and to side, eyes rolled back. Can speak but not swallow Give anti EPS meds (IM not oral)
139
Second gen antipsychotics
Serotonin dopamine antagonists 5hT receptor agonists Positive and negative symptoms Metabolic syndrome and diabetes!!
140
3rd gen antipsychotics
Pretty much same as 2nd but a little different Positive and negative symptoms
141
Short acting injectable antipsychotic
For anger and aggression Works quicker than pill Predominantly for positive symptoms
142
Long acting injectable antipsychotics
See if they tolerate 2nd and 3rd gen well Given for patients so they dont need to take pills every day Compliance is key because they’ll feel well and stop Quick relapse with PO so this is a good choice Positive and negative symptoms
143
Advantages of 1st gen
Treats pos symptoms Less costly Less risk for metabolic syndrome
144
Disadvantages of 1st gen
Anticholinergic side effects: dry mouth, urinary retention, blurred vision, photosensitivity, dry eyes, sexual dysfunction Weight gain, endocrine disturbances, hypotension and postural
145
Tardive dyskinesia
Irreversible, real issue Lip smacking Pill rolling Shuffling gait Tongue stuff Seen in 1st gen
146
EPS
From blockage of D2 receptors in motor centers Extrapyramidal symptoms Acute dystonia Akathisia Pseudoparkinsonism
147
Akathisia
Increased restlessness, looks very anxious
148
Interventions for EPS in 1st gen antipsychotics
Lower the dose Add antiparkinsonian drug Benzos for akathisia Will develop tolerance over time
149
Low potency antipsychotics vs high
Low potency drugs cause increased sedation and high anticholinergic effects, so low EPS High potency drugs cause decreased sedation and anticholinergic effects, so high EPS
150
Tardive dyskinesia interventions for 1st gen antipsychotics
QT prolongation, very sleepy, not given to patients with QT issues already Can treat with valbenazine (ingrezza) and deutetrabenazine (austedo) Reduces severity of symptoms AIMS test
151
Clozaril-serotonin (5-ht2a receptor) and dopamine (d2 receptor)
Second gen antipsychotic
152
Monitoring for second gen antipsychotics
Metabolic syndrome—diabetes so regular fingersticks Agranulocytosis—WBC monitoring very often, patient needs to be VERY compliant Increased risk for cardiovascular disease
153
Which gen of antipsychotics is first line of treatment and why
2nd gen Less EPS/tardive dyskinesia
154
Which 2nd gen antipsychotic does not cause weight gain
Geodon
155
3rd gen antipsychotics
Dopamine system stabilizers May improve positive and negative symptoms and cognitive function Little risk of EPS or tardive dyskinesia
156
Anticholinergic toxicity
potentially life-threatening medical emergency Symptoms-ANS instability, hyperpyrexia without diaphoresis, delirium, and hallucinations
157
neuroleptic malignant syndrome
Acute, life threatening emergency- can be fatal, altered consciousness, muscle rigidity, hyperpyrexia with diaphoresis, hypertension, tachycardia, tachypnea, drooling. Starts as muscle rigidity, very agitated (you think you need meds but the meds are what’s causing it). Cogwheeling to demonstrate what they have. Bend elbow so hand is at shoulder, patient who’s cogwheeling has rigid elbow muscle. ICU or CCU, get them out of psych, too intense for stepdown unit Cooling blanket and bramaline
158
agranulocytosis
monitor for decreased WBC or neutropenia, signs infection Take them off meds
159
Liver impairment is in what antipsychotic
1st generation more-monitor liver function (check this and thyroid before starting anything because those issues could mimic psych stuff)