Exam 2 Flashcards
1
Q
When obtaining family history- what information would I include on relatives?
A
First degree only, parents, sibs, grandparents and children
2
Q
Risk Factors vs/Protective factors
A
Look up in book- cut out friends or family members who tempt you to drink or use drugs and who affect your mood.
3
Q
Anhedonia
A
inability to feel pleasure
4
Q
Echolalia
A
parrot like repetition of someone else’s words
5
Q
Aphasia
A
inability to understand or express speech
6
Q
avolition
A
lack of motivation
7
Q
clang association
A
rhyming
clang, bang, rang
8
Q
tangenital
A
inability to get to the point of the story
9
Q
neologisms
A
new words that an individual invents
10
Q
CAGE Assessment or alcohol
A
Cut down, annoyed, guilty, eye opener
All questions directed at individual
Have your ever felt annoyed by your friends asking you to stop drinking
11
Q
Example of Psychoeducation in Psychiatric-Mental Health History
A
Anger management, etc
12
Q
When taking medical history what do we need to address prior to addressing the mental health issues
A
Rule out any medical conditions first before focusing on mental health. Could be contributor
13
Q
Syphillis can appear like what mental health illness
A
Schizophrenia
14
Q
CIWA-AR Assessment is for what
A
Probability for alcohol withdrawal, 40% of patients admitted to med surge unit are at risk for alcohol withdrawal
15
Q
Common Lab tests performed and what is RPR
A
CBC, Chem panel for liver and kidney function, comprehensive metabolic panel, thyroid function, folate, RPR- Rapid plasma reagin (tests for syphilis), Urine toxicology, UHCG (pregnant).
16
Q
Suicidal thoughts or attempts screening test
A
CSSRS- Columbia Suicide Severity Rating Scale
17
Q
Disheveled
A
Untidy and disordered
18
Q
Emaciated
A
Abnormally thin or weak
19
Q
Hyperactive behavior could be described as
A
constant activity but also easily distracted
20
Q
Apathetic Attitude
A
Showing or feeling no interest, enthusiasm, or concern
21
Q
Speech is described in 3 categories of a patient
A
Quality Quantity and Rate
22
Q
Monotonous speech describes
A
Quality and think monotone
23
Q
Quantity of speech is labeled as
A
talkative, unspontaneous, normally responsive
24
Q
Rate of Speech
A
Rapid, slow, hesitant, staccato (short choppy sentences), stuttering, pressured
25
Mood is objective or subjective
Subjective
26
Despairing mood
Showing loss of all hope
27
Expansive mood
larger than life behavior, brass or lavish
28
Self contemptuous mood
lack of admiration for oneself
29
If my mood is labile what does that mean
Easily altered or changeable
30
Futile mood
Ineffective, useless, producing no effect
31
Affect can be described as
Within normal range, constricted, blunt, flat
32
Constricted
Range and intensity of expression are reduced
33
Blunted
Persons expression is further reduced
34
Flat Affect
Virtually no signs of expression are present.
35
Affect can be congruent or Incongruent with patients reported _____. Explain
Mood. In line with the mood or incongruent. Doest align so bad mood but appears/acting happy
36
Types of Hallucinations
Auditory, visual, or tactile. Auditory is most common
37
Hallucinations are....
Sensory distortion in the absence of a stimulus
38
Delusions are
Fixed false beliefs that the patient is convinced of and hard to change their mind
39
An illusion is what
A sensory distortion in the presence of a stimulus. Example a child may perceive tree branches at night as if they are goblins
40
Thought disturbance that is called Ideas of reference is what
Misrepresentation of external incident or event that is going on and relates to them but in reality doesn't at all. Thinking that everyone on the bus having a conversation is talking about them
41
Flight of idea thought process
A succession of multiple associations so that thought seems to move from idea to idea often
42
What is circumstantiality
Kind of like tangential except instead of not getting to the point of the story this individual over explains the trivial details which delays getting to the point of the story
43
Looseness of association Throught process
Sentences do not make sense. The words are spoken together but make no sense an we switch from one topic to the next
44
Perseveration
Persistent repetition of the same word or idea to peoples questions
45
Echolalia
Parrot-like repetition of the words spoken by another
46
Neologisms
New words the person invents that have no meaning
47
Word salad thought process
Group of words put together in a random fashion without any logical connection
48
Confabulation memory/cognition
Honest lying. False memories without the intent to deceive
49
Orientation and memory is lost in what order and regained in what order
Time, Place, person (sense of self last to go)
| When regained it goes back and will be regained by person first, then place, then time
50
A patient with schizophrenia hears a person say that people in glass houses should not throw stones, the patient responds by saying because you can break the house. This is an example of
abstract thought
51
The patients mental status examination ends with what
The nurses/psychiatrist's impression of the patients reliability and their capacity to report their situation accurately. Reliability includes estimate of patients veracity
52
What are protective factors in suicide
Preventative methods in both thought and action
(No access to lethal means, easy access to treatment, family friends and community support, support from ongoing healthcare provider relationships
53
The C-SSRS Assessment has how many questions, which ones answered yes require mental health referral vs immediate help
Any yes of the time 6 questions will require a mental health referral, but answering yes to 4, 5, and/or 6 requires immediate help
54
SAFE T consists of what
1. Identify risk factors
2. Identify protective factors
3. Conduct suicide inquiry
4. Determine risk level and implement appropriate interventions
5. Document (risk assessment, interventions, evaluations)
55
Primary main focus for planning and intervention with patient at risk of suicide
Ensure the persons safety, performing those 15 minute checks in an inpatient mental health is huge
56
Crisis Prevention Plan includes 7 steps
1. Identify the upsetting thoughts
2. Write out and review rational responses to this (coping skills)
3. Do things that help feel better for 30 minutes
4. Repeat steps 1-3
5. If the suicide behavior escalates, call someone in support system
6. Cannot reach first person, call second person on list
7. If cannot reach second person and behavior continues call suicide hotline
57
Diagnostic criteria of Schizophrenia
Consists of positive and negative symptoms that prevent the person from functioning in society to best of ability
58
Hallucinations and Delusions are
Positive symptoms
59
Grandiose delusion
Exceptional power
60
Nihilistic Delusion
Patient thinks they are dead
61
Persecutory Delusion
Patient thinks they are being plotted against
62
Somatic Delusion
Person thinks they have a bodily function abnormality
63
Hallucinations involve one of the 5 senses but ____ is the most common
Auditory
64
Alogia
Poverty of thought or speech- mumbling. Negative symptom of Schizophrenia
65
Alterations in speech and bizarre behaviors are positive or negative symptoms of schizophrenia
Positive
66
Negative symptoms of schizophrenia are the _____ of something that usually happens
absence. Anhedonia, avolition, anergia.
67
Should you allow patient to think the hallucinations are real?
No return to reality but ask them about what they are experiencing
68
First generation Anti-psychotic medications used to control what
Positive signs of schizophrenia
69
MOA of First generation anti psychotics
Block dopamine, histamine, AcTh, and norepinephrine receptors in the brain and in the periphery
70
Epidemiology and risk factors for developing schizophrenia
Possible past stressors in childhood or growing up that caused this to happen. Migrant status. Having a family relative diagnosed with schizophrenia makes it 10x more likely someone will be diagnosed.
71
Schizophrenia occurs in what age for males in compared to women
18-25 for males
| 25-35 for females but females have better outcomes
72
Comorbidity of Schizophrenia
Substance use, depression , diabetes, metabolic syndrome, risk for harm, obesity anxiety
73
What is a strength assessment in a mental health assessment
The patients stress and coping mechanisms. What gives hope about the future
74
Nursing Assessment of someone with Schizophrenia
Physical Check to rule out physical ailment causing these symptoms. Look at physical functioning as member of society, nutrition status, then look at the medication adherence and any substance use
75
How long do anti psychotic medications usually take to affect change in symptoms
1-2 weeks
76
How long should patient take anti psychotic medication before considering a change?
6-12 weeks
77
Injectable anti psychotics are a thing? True or false
True, injection every 30 days
78
Psychosocial interventions with Schizophrenic patients
Memory problems- make lists
Executive functioning- simulations to mimic being out in the real world and interacting with people
Behavioral issues- Positive reinforcement of performing their ADLs, focus on motivation and organization
79
In acute phase of schizophrenia, the most important intervention is
Promotion of safety
80
What is schizoaffective disorder
Also known as SAD, has psychosis and mood disturbances. Better outcome than schizophrenic patients. Like being on a emotional roller coaster with someone
81
What is delusional disorder
Delusions for 1 month, no other symptoms
82
Types of disorganized behavior
Disorganized thoughts, speeches or behavior
83
What do you need to show in order to be diagnosed with schizophrenia
Positive and negative symptoms present for at least 1-6 months
84
Developing therapeutic relationship with schizophrenic patient what is important
Approach in calm manner, develop trust, and realize that developing that trust will take time
85
Schizophreniform
Its schizophrenia but only lasts for 6 months or less. has to occur for at least 1 month. In 2/3rds of cases it could lead to schizophrenia
86
Brief Psychotic Disorder
At least one day but less than a month, includes one positive of schizophrenia
87
Bipolar has two poles, what are they
Mania and depression
88
Is there a gene identified for Bipolar
No gene but strong evidence to suggest genetic component
89
Bipolar affects men more than women, true or false
False. It affects them both equally but women are more likely to seek treatment
90
Mania is defined as what, and can it include a state of psychosis?
Very elevated mood for at least 1 week and yes it can include psychosis- hallucinations
91
What is hypomania
4 days duration with the same symptoms as mania but a lighter version. Not extreme enough to have psychosis, warrant hospitalization, and cant still function at work but detrimental to close relationships. Could include mood elevation or irritable mood
92
Mixed episode of Bipolar
Can include both mania and depression at the same time to varying degrees
93
Cyclothymic Bipolar
Switch between hypomanic episode and depressive with rapid cycling
Symptoms have occurred for at least 2 years and without remission for more than 2 months
94
Bipolar 1, is it serious? what are symptom presentation and does it include psychosis
Most serious
One episode of Mania, alternating with one episode of depression
May include psychosis
95
Examples of mania
Inflated self esteem, decreased need for sleep, very talkative, easily distracted, flight of ideas, racing thoughts, too many projects, risky behavior
96
Mania cannot be attributed to other causes, meds, or substances? true or false
true
97
Bipolar 2, is it more serious or common than Bipolar 1? and what does it consist of
It is more common
One or more hypomanic episodes alternating with depressive episodes
There is no full mania or psychosis
Its less serious because its toned down
98
When assessing between Bipolar and depression be sure to ask questions relating to what?
Ask questions relating to the high episodes to prevent misdiagnosis. Major depressive disorder is the most common misdiagnosis
99
What mental health disorder is most commonly associated with suicide?
Bipolar
100
Mania could often be confused for what physiological condition a px is experiencing
Hyperglycemia (agitation)
101
In Bipolar patients always accurately assess what?
Assess suicide risk, doesn't have to be recent
102
For suicide risk assess what things
Px have plan, access to lethal means, acts of deceptiveness relating to doing it
103
Nursing interventions for Bipolar Disorder
```
Clear and concise directions
Recommend boxed breathing
Suicide risk is high
Avoid arguing and debating
Establish routines
Ask lots of open ended questions (Tell me what its like...)
```
104
Dual Diagnosis consists of what?
1. Substance use disorder
w/
2. Depression or bipolar (mental health disorder of some sort)
Alcoholic with depression is dual diagnosis
105
Nursing diagnosis Imbalanced eating
Give them food to eat on the run
106
What is critical for mood disorder patients? This will prevent relapse and bad outcomes
Medication adherence and knowledge on their medications. Also need to know side effects
107
What causes depression
Neurochemical imbalances- serotonin, dopamine , norepinephrine deficiencies
Genetic factors- Inherited variances in alleles and environment can play factor
Hormonal imbalances, stress, circadian rhythms.
108
Can you test neurotransmitter levels?
No, only on autopsy
109
Major depressive disorder is diagnosed by
Must experience 5 or more symptoms for at least 2 weeks
Depressed mood an/or feeling of hopelessness, SI, thinking of death, increased or decreased sleep, weight gain/weight loss, etc.
**Must cause significant dysfunction and this is not related to meds, substances or other mood disorders.
110
When assessing for depression ask about ____ and observe ____. Remember to take notice of the 4 As
Mood, Affect
Anhedonia (Without joy), Anergia (No energy), Apathy (no personality) Avolution (lack of motivation
111
Is major depressive disorder usually diagnosed on its own?
No, typically it goes along with something else, anxiety, personality, schizophrenia, etc
112
What is ECT and why do we utilize it
Electroconvulsive Therapy
Typically used for pxs not responding to antidepressants
Electrodes attached to brain "straightens out tangles"
6-15 treatments
The shock stimulates brain chemistry to correct chemical imbalance of depression
113
Patient care ECT
Same as an operation- remove jewlery, IV, O2
Sedation and muscle relaxant administered
Some short memory impairment, usually have headache afterwards
114
What is CBT (Cognitive Behavioral Therapy)
Therapy to improve problem solving and interpersonal skills with the patient
115
Depression Medications - what they do MOA
SSRIs and tricyclics act by increasing concentration of serotonin/norepinephrine/dopamine by blocking the reuptake of those neurotransmitters
```
Drugs-
TCA
SSRI
SNRI
MAOIs- inhibit monoamine oxidase enzymes that inactivate serotonin/norepinephrine/and dopamine in the body
```
116
Thank TCA stands for
Tricycle antidepressant
117
SSRI stand for
Selective serotonin reuptake inhibitor
118
SNRI
Serotonin and norepinephrine reuptake inhibitor
119
Blackbox warning for anti depressants
Taking these meds prior to age 25 can increase risk of suicide
120
First choice drug for MDD
SSRIs
121
Common side affects of Anti Depressants
weight gain, insomnia, agitation, sexual dysfunction
122
Are SSRIs considered as effective as SSRIs? and what other therapeutic purpose can they serve?
Yes and they can help with pain relief (Neuralgia)
123
SNRI Side effects
Same as SSRIs in addition to stomach pain
124
What was the first antidepressant available
TCAs, can aggravate symptoms with person who has schizophrenia.
125
Common side effects of tricyclics
Blurred vision, anti-cholinergic effects, weight gain, MAJOR ARRHYTHMIAS (EKG)
126
Can I take MAOIs with SSRI's?
No they are contraindicated- you are doubling up on something that will block the enzyme that inactivates serotonin and norepinephrine as well as drug that prevents the reuptake
127
Taking MAOI and SSRI will cause what
Serotonin Syndrome
128
MAOIs are generally the 2nd or third choice for depression due to what, name most common and the most dangerous side effect
Side effects
Insomnia
Hypertensive crisis (Avoid tyramine containing foods)
129
Tyramine containing foods
Caviar, herring, soy sauce, smoked and processed meats, aged cheeses, raisins, beans, pea pods, aged cheeses, MSG and brewers yeast, corned beef, chicken, beef liver, red wines and some beers
130
Citalopram
Celexa- SSRI
131
Fluoxetine
Prozac SSRI
132
Escitalopram
Lexapro SSRI
133
Paroxetine
Paxil SSRI
134
Sertraline
Zoloft SSRI
135
Good drug for generalized anxiety disorder
SNRIs
136
Can you take TCA with SSRIs
Yes, often just increases the effects
137
Carbamazepine and Valproate are what, how do they work
Anticonvulsant drugs that treat mania and seizures.
Calms hyperactivity in the brain, are used for people with rapid cycling (4 or more episodes) of mania and depression within a year
138
What is double depressive disorder
can be in children and adults, persistent depression for 2 years
139
Anticonvulsants can treat depression but also
Bipolar...its manic and depression
140
Isocarboxazid (Marplan), Phenelzine (Nardil), and Tranlycpromine (Parnate)
"I hardly plan to partake"
MAOIs
141
Amitriptyline (Elavil)
TCA
142
Doxepin (Sinequan)
TCA
143
Imipramine (Tofranil)
TCA
144
Nortriptyline (Pamelor)
TCA
145
What drugs can be prescribed for Bipolar
Anticonvulsants, Antipsychotics (mainly second generation due to less side effects), and mood stabilizer drugs
146
First sign of lithium toxicity
tremors especially in the hands
147
Main consideration for lithium
Monitor levels of the drug in system to avoid toxicity
148
Lithium therapeutic range
.6-1.2 mEq/L
149
After starting someone on lithium when do we check their labs
Within 5 days of start, weekly, monthly, 3 month, 6-12 month mark
150
Lithium- fluid status is important
Assess sodium and renal labs, contributor to possible toxicity
151
Anti-psychotics can Treat what
Schizophrenia and Bipolar
152
Why do we ensure adequate salt intake with lithium
Not enough salt, not enough 02, causing toxicity
153
What do we do if the lithium level is too high
Hold dose and call provider
154
Lithium toxicity symptoms
Hand tremors, blurred vision, ataxia, nausea and vomiting
155
Lamotrogine (Lamictal) is what and what is a potential side effect
It is an anti convulsant, steven johnson syndrome (see a rash, call the provider)
156
What should you do with lithium patient if dosage increases or their behavior changes
Draw labs!
157
Take NSAIDS with Lithium?
No! High salt
158
First generation anti-psychotics treat what
Control positive symptoms of psychotic disorders (Schizophrenia)
159
First generation anti-psychotics MOA
Block dopamine, ACTH, histamine and norepinephrine receptors in the brain and periphery
160
Hallucinations can be caused by dopamine hyperactivity in what part of the brain
Trigeminal area
161
First Generation Antipsychotic side effects
Extrapyramidal Adverse Effects, Agranulocytosis, anti-cholinergic effects
162
Command Hallucinations are what
Some non external stimuli that is telling you to do something
163
First Generation anti-psychotics do what MOA
Block dopamine in the basal ganglia, hypothalamus, medulla, and brain stem
164
Which medication treats acute agitation of schizophrenia
Haloperidol (Haldol) First generation anti-psychotic
165
First or Second generation anti-psychotics have more side effects?
FIRST GENERATION!
166
Conventional Antipsychotics are first or second generation
Frist generation
167
Second Generation anti-psychotics are also called
Atypical
168
Second Generation Anti Psychotics treat what symptoms of Schizophrenia
Positive and negative
169
What is first line of treatment med for Schizophrenia or breakthrough episodes
Second generation anti-psychotics
170
MOA of Second Generation anti-psychotics
Blocks SEROTONIN and dopamine, and to lesser extent histamine, norepinephrine, and ACTH
171
Anti-psychotic side effect of Neuroleptic malignant syndrome
Fever, BP, muscle rigidity, life threatening, Stop med and monitor vitals. Wait 2 weeks to resume med or switch
172
Any med that has anti-cholinergic effect should be tapered in both directions?
Yes, Low and slow initially and taper off gradually
173
Anti- convulsants are often utilized to treat ____ _____
Acute mania
174
Serotonin Syndrome symptoms
Confusion, agitation, restlessness, Bp is up , rapid HR, twitchy muscles
175
Neuroleptic Malignant syndrome symptoms
Very high fever and muscle rigidity
176
Mild lithium toxicity symptoms
fine tremors, nausea, and confusion
177
Hypertensive crisis
Elevated BP, Confusion, agitation
178
Off label medication used to treat mania in Bipolar
Antiseizure medications/Anti convulsant
179
What drug is utilized when first line meds are ineffective in treating depression
TCAs
180
What is SAD
Seasonal Affective disorder, people that live in Washington, Depressed because it rains all the time
181
Drug treatment order for Bipolar
Lithium- Anti-seizure/convulsant- then the last choice is an anti-psychotic
182
Second Generation Anti-psychotics do have many less anti-cholinergic and fewer to no EPS but what are some complications of them
Metabolic syndrome, orthostatic hypotension, anti-cholinergic effects and mild EPS
183
What are Extra Pyramidal symptoms and what drugs do they involve
Think voluntary and involuntary muscle twitching, tremors, inability to sit still and it deals with Anti-psychotic medications
184
Third generation Anti-psychotics treat and moa
Treat both positive and negative symptoms the MOA is stabilizing dopamine as both an agonist and antagonist.
185
Third generation Anti-psychotic benefits
Even lower risk of anti-cholinergic effects, diabetes, weight gain, anti-cholinergic, etc
186
Most dangerous side effect of hypertensive crisis associated with which drug
MAOI
187
Potency of Haldol, Loxapine, and Fluphenazine
Haldol- high
Loxapine- medium
Fluphenazine- high
188
Risperidone is what
2nd gen Anti-psychotic
189
Clozapine is what
2nd gen anti-psychotic
190
Olanzipine
Second gen anti-psychotic
191
Aripiprazole is what
Third generation anti-psychotic
192
EPS side effects occur with drugs that block what
Dopamine
193
EPS side effects associated mainly with anti-psychotics, true or false
True
194
EPS side effect of Parkinsonism
Mimics parkinson
195
EPS side effect of dystonic reactions
intermittent spasm of muscles in face and neck, larynx, trunk
196
Akathisia side effect of what meds and what does it look like
Anti psych anti depressant, cant sit still! Psychomotor restlessness
197
Tardive dyskinesia associated side effect of what drugs and what does it look like
Facial tics, involuntary facial movements, smacking lips, tongue thrusting, rapid blinking. Associated with anti psych meds
198
Definition of echopraxia
Purposeful imitation of movements made by others
