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N401 > EXAM 2 > Flashcards

EXAM 2 Flashcards

1
Q

Bipolar 1 is what two things

A

MDD
Mania

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2
Q

What is mania

A

Excessive energy/purposeless movement. Restless

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3
Q

What does mania look like in bipolar 1

A

Little to no sleep
Flight of ideas. Racing thoughts
Reckless behavior with $ and sex
Impulsive (labile mood)
Psychosis (hallucinations/delusions)

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4
Q

Bipolar one is diagnosed how

A

MDD for 2 weeks
Mania for 1 week

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5
Q

Tx for bipolar
2 things
4 med types

A

Hospitalization (bipolar 2 doesnt need)
Calm environment

Meds:
-lithium
-anticonvulsants
-antipsychotics
-benzos for sleep

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6
Q

Bipolar 2
What 2 things
Compared to type 1
Has no what vs type 1
4 episodes

A

MDD
Hypomania (less severe, dont need hospitalization)

Less need for sleep (5-6)
More directed activity

No PSYCHOSIS (hallucinations/delusions)

4 or more episodes in a year= rapid cycling

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7
Q

Bipolar 2 how to diagnose

A

MDD 2 weeks
Hypomania 4 days

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8
Q

Cyclothymia (2 years needed)

What does thymia mean
What two things it has
What causes a mood episode
Has a strong what component

A

Thymia=low level/ long lasting

Mild-moderate depression
Hypomania

Stress/sleep precipitate mood episodes

Bipolar has a strong genetic component

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9
Q

Can antidepressants be used to treat bipolar?

A

Yes with a mood stabilizer to prevent mania/hypomania.

Used very cautiously for pt with bipolar 1

Risk of triggering flipping into hypomania/mania

SSRIs are used on when pt is stabilized bc it can flip them into a manic state

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10
Q

Lithium (ONLY TRUE MOOD STABILIZER)
Narrow therapuetic index
Hard on what two organs
SE

A

0.6-1.2 is normal
More aggressive tx is 1-1.5

Hard on kidneys and thyroid

SE:
Fine hand tremors
GI distress (nausea)
Thrist
Polyuria
Wt gain
Lethargy

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11
Q

Anticonvulsant meds

A

Valporic acid

Carbamazepine

Lamotrigine

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12
Q

Valporic acid

SEs
Needs

A

Get enzymes due to:
Liver
Pancreatitis

GI
Thrombocytopenia
Wt gain
Teratogenic

Need labs monitored

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13
Q

Carbamazepine

Careful with what

SEs

Need what

A

Careful with heart issues

SEs:
Leukopenia
Thrombocytopenia
SJS

Need labs monitored

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14
Q

Lamotrigine(safest most tolerated)

Risk for what
If miss how many days you have to do what
SEs

A

Risk for benign rash/SJS

If miss 5 days of meds, need to restart titration

SE:
Tremors
HA

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15
Q

Antipsychotics

A

1stgen
EPS/NMS

2ndgen
Ziprasidone and lorasidone (take with food)
Queitapine (wt gain/sedation)
Olanzapine (wt gain)
Risperidone (prolactin and breast issues)
Clozapine (agranulocytosis, NEED LABS)

3rdgen
Aripiprazole (akathesia)

Review on pharm

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16
Q

NMS symptoms

A

BAD FEvER

Labile bp

Led pipe rigidity

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17
Q

EPS

A

Acute Dystonia

Psudoparkinsons

Akathesia

Tardive dyskinesia (could be irreversible)

Antidote: benzotropine, diphenhydromine

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18
Q

Hypomania vs mania

A

Mania need a week
Hypomania needs 4 days

Mania: excessive energy/purposeless movement
Restless
Needs hospitalization

Hypomania: less severe.

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19
Q

Dythmia (persistent depressive disorder)
What it looks like

To diagnose

A

Low mood
Mild-moderate depression (not as severe as MDD)
Long lasting

To diagnose:
Adults - 2 years
Children/adolescents - 1 year

2 or more for the following symptoms:
Appetite change
Sleep change
Low energy
Low self-esteem
Poor concentration
Feelings of hopelessness

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20
Q

Premenstrual dysphoric disorder

Symptoms

A

Depressed mood
Anxiety
Mood swings
Decreased interest in activities

Improved mood with end of menses

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21
Q

Seasonal affective disorder (SAD)

When, what
Tx

A

Nov-April

Lower mood

Tx:
Vit d
Light therapy
SSRI

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22
Q

major depressive disorder
Symptoms

A

Depressed mood / irritable / saddness
Anhedonia (without pleasure)
Isolating
Crying
Numbness
Change in appetite and sleep
Anergia (decreased energy)
Impaired in ADLs
Imparied concentration
Avolition (without motivation)
Anger
Guilt/hopelessness/helplessness (risk for suicide)
Slowed speech

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23
Q

MDD need to be present for how long to diagnose

A

2 weeks

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24
Q

MDD tx

A

SSRIs take 4-6 weeks

ECT-induced seizures (need informed consent, NPO @ midnight), can cause memory loss

CBT

Therapeutic communication

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25
Q

ECT is good for what

A

Acutely suicidal

psychotic depression (depression with psychosis diagnosis)

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26
Q

CBT

A

Manage distored thoughts

Identify dysfunctional patterns of thinking and behaving

Changing automatic thoughts

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27
Q

SSRIs
Vs
SNRIs

A

SSRI: takes 4-6 weeks to work
Citalopram, escitalopram, sertraline, fluvoxamine, paroxatine, fluvoxatine
Black box warning: increase energy=suicidal risk

SNRIs:
Venlafaxin, duloxetine, desvenlafaxine
Increase BP, HR

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28
Q

Schizophrenia positive symptoms

A

Things were adding on that wouldnt normally be there in a normal person

Delusions

Hallucinations

Alterations in speech

Behavior

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29
Q

Schizophrenia delusions

What is it
Donts
Dos

A

Fixed/false belief

Dont:
Aruge with them
Feed it

Do:
Focus on underlying feeling (anxiety)
Focus on reality/present(hi my name is brendon and i am your nurse and we are here to take care of you)

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30
Q

Schizophrenia hallucinations

A

Sensory (auditory most common), visual, tactile

Need to know if it is command hallucinations (voices telling them to do something) for safety

Offer your own perception of reality (i understand you see that but i do not)

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31
Q

Schizophrenia altered speech

A

-Word salad (actual words put together dont make sense)

-Echolalia (pt repeats back after you) (how are you today. Today today today)

-neologism: made up word the pt attaches their own meaning

-flight of ideas

-loose associatation

-clang association (rhyming words)

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32
Q

Schizophrenia behaviors

Moods
4 movement things

A

Agitation
Aggression

Catatonia (reduction in movement)
-healthy body person laying in bed and not doing anything
-need nurse to do ADLs for them

Echopraxia: mimic someones movements
Waxy flexibility: pick up arm then its stuck there till moved
Posturing: standing in position until moved

33
Q

To diagnose schizophrenia you must have what and for how long

A

Must have at least 2 positive symptoms
(hallucinations, delusions, altered speech, behavior)
Addition to the negative symptoms

Must meet this for 6 months

34
Q

Schizophrenia negative symptoms

A

A’s

Affect: flat, inappropriate
Asociality: less socia
Avolition: without motivation
Anergia: without energy
Apathy: no cares to give
Alogia: poverty of speech: sound like a teenager
Anhedonia: without pleasure from things that use to

35
Q

Schizoaffective disorder

A

If pt has schizophrenia and mood disorder (MDD, bipolar)

36
Q

Anosognosia

A

Lack of insight

Unable to understand/perceive illness

37
Q

Controled delusions

A

Outside forces are contolling actions

38
Q

Erotomanic delusions

A

A person of higher status is in love with them (not true)

39
Q

Grandiose delusions

A

Inflated sense of self worth

Power or wealth

40
Q

Somatic delusions

A

A belief about a dysfunctional body part

41
Q

Reference delusions

A

Something happening in the environment is about them

42
Q

Persecutory delusions

A

Others are trying to cause harm

43
Q

Rehabilitation care r/t schizophrenia and pyschosis

A
44
Q

Schizophreniform

A

If 1-6months then its schizophreniform

45
Q

Schizophrenia tx

A

Antipsychotic/Neruoleptic
1st gen: heavy block dopamine (LAIS)
Great risk of EPS
Can cause NMS

2nd gen
Risperidone: prolactin, breast issues
Quetiapine, olanzapine
Lorazidone, ziprasidone (with food)
Clozapine (agranulocytosis, NEED LABS)
ALL cause Wt gain

3rd gen: aripiprazole
Less risk of EPS (akathesia)

46
Q

Schizophrenia neurotranmittors

A

Dopamine

47
Q

Arachnaphobia
Acrophabia
Agoraphobia

A

Arachnaphobia: fear of spiders

Acrophabia: fear of heights

Agoraphobia: fear of places (going over a bridge)

48
Q

Panic disorder

Last how long
Four or more of what = diagnosis

A

Acute anxiety

Last 15-30mins

Four or more of the following:

Palpitations
SOB
Choking or smothering sensation
Chest pain
Nausea
Feeling of depersonalization
Fear of dying or insanity
Chills or hot flashes

49
Q

Seperation anxiety

A

Anxiety at being seperated from individuals

Symptoms
Ha
Nausea
Sleep disturbance

50
Q

GAD
Generalized anxiety disorder

How to diagnose

May include what symptoms

A

Uncontrollable, excessive worry for majority of days over 6 months

May include:
Restlessness
Muscle tension
Avoidance of stressful activity
Increased time and effort needed to prepare for stuff
Procrasination
Sleep disturbances

51
Q

OCD

A

Attempts to suppress persistent thoughts or urges that cause anxiety

Can be time consuming

Obesseing about something

52
Q

Hoarding disorder

A

Saving items regardless of value

Stress about getting rid of stuff

53
Q

Body dysmorphic disorder

A

Attempts to conceal a perceived flaw

Mirror checking or comparing themselves to others

54
Q

Trichotillomania

A

Obsessive pulling of the hair

55
Q

Risk factors to:
OCD
Hoarding disorder
Body dysmorphic disorder
Trichotillomania

A

Female (except hoarding)

Hyperthyroidism

Adverse effect of meds

Substance induced or withdrawal

56
Q

How to care for the anxiety and OCD related disorders

A

Get rapport

Assess for comorbid condition or substance use

Assess suicide risk

Millieu therapy with:
Relaxation techniques (breathing, meditation,guided imag)
Identify defense mechanisms that interfere with recovery
Wait until after acute phase to educate pt
Couseling, group therapy, community resources

57
Q

Anxiety and OCD related disorder MEDS

A

SSRIs
SNRIs
Beta blockers (propranolol)
Antihistamins
Anticonvulsants (mood stabilizer)

Antianxiety medsL
Benzos (short term) lorazapam, diazapam, alprazolam
Buspirone (long term)

58
Q

anxiety and OCD r/t disorders

Therapies:
Relaxation
Modeling
Systematic desensitization
Flooding
Response prevention
Thought stopping

A

Relaxation training

Modeling (when you get the urge to do this, do this instead)

Systematic desensitization (introducing something slowly till phobia goes away)

Flooding: putting it out there fast to get rid of phobia

Response prevention:
Teach new response when they get anxious

Thought stopping: help them to get themselves to stop thinking about it

59
Q

Benzodiapines concerns

A

Sedation

Substance abuse

60
Q

Acute stress disorder

A

Exposure to traumatic event so what happens right after

61
Q

Adjustment disorder

A

Need to adjust causes anxiety

62
Q

Dissociative disorders

Depersonalized/derealization disorder
Dissociative amnesia
Dissociative fugue
Dissociative identity disorder

A

Depersonalized d/o: feeling out of your body or dont feel real

Amnesia: stress so much you cant remember traumatic event

Fugue: type of amnesia, dont know identity or what is going on around you

Identity d/o: having more than one identity

63
Q

Risk factors for:
ASD, PTSD, Adjustment d/o, dissociative d/os

A

Exposure to traumatic event

Exposure to trauma during natural disaster

Exposure to trauma in occupational setting

Living thru traumatic experience of a loved one

64
Q

PTSD is a RF for what other d/o

A

Dissociated disorders

Anxiety

Depression

Substance use disorders

65
Q

RF of ASD and PTSD

A

Sevverity of trauma

Individuals vulnerabilities

Insufficient tx

66
Q

RF of Adjusment disorder

A

Pattern of lifelong difficulty accepting change

Learning pattern of difficulty with social skills or coping

67
Q

RF of dissociative disorder

A

Traumatic event

Childhood abuse or trauma

68
Q

ASD/PTSD symptoms

A

Flashbacks
Night time dreams
Avoidance of things that bring memory back
Avoid thinking of event
Anxiety or depression disorder
Decreased interest in activities
Guilt
Detachment from others
Inability to express emotions (love and tenderness)
Dissociative: amnesia, derealization, depersonalization

69
Q

ASD/PTSD behaviors

A

Agression, irritability, anger

Hypervigilance with heightened startle

Sleep disturbances

Destructive behaviors (suicidal or harming others)

70
Q

Adjustment disorder symptoms

A

Depression/anxiety

Changes in behavior (arguing either others, driving erratically)

71
Q

How to caree for ASD/PTSD and adjustment disorder

A

Therapeutic relationship

Non-threatinging environment

Asses SI and HI

Anxiety relief:
Music therapy, guided imagery, massage, relaxation, breathing techniques

If child, involve caregiver

72
Q

How to care for dissociative disorders

A

Make decisions that can lower stress

Encourage independence

Use grounding techniques like having client clap hands or touch an object

Avoid giving too much info about the past

Teach pt to verbalized negative feelings

73
Q

What meds for adjustment disorder

A

None

74
Q

Meds for anxiety disorders and dissociative disorders
2 SSRI
1 SRNI
2 TCAs
2 that effect cardiac

A

Antidepressants:
Paroxetine and sertraline (SSRIs)
Venaflaxine (SRNIs)
Mirtazapine and Amitriptyline (TCAs)

Prazosin (can cause orthostatic HOTN)

Propranolol: HOTN RISK

75
Q

Eye movement desensitization and reprocessing (EMDR)

Use

Done with what

Contra indications 5

A

For PTSD

Done with rapid eye movement

CI:
Sucidal
Psychosis
Severe disociation
Visual issues
On substances

76
Q

3 therapies for dissociation

A

Somatic therapy

Hypotherapy

Biofeedback/neurofeedback

77
Q

What to educate anxiety and dissociative disorder pt on

A

Relaxation techniques

Avoid caffeine and alcohol

Perform grounding techniques (claping hands) for dissociative disorders

78
Q

Recovery model r/t mental illness

A

N401 (11 decks)

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