EXAM 2 Flashcards
Bipolar 1 is what two things
MDD
Mania
What is mania
Excessive energy/purposeless movement. Restless
What does mania look like in bipolar 1
Little to no sleep
Flight of ideas. Racing thoughts
Reckless behavior with $ and sex
Impulsive (labile mood)
Psychosis (hallucinations/delusions)
Bipolar one is diagnosed how
MDD for 2 weeks
Mania for 1 week
Tx for bipolar
2 things
4 med types
Hospitalization (bipolar 2 doesnt need)
Calm environment
Meds:
-lithium
-anticonvulsants
-antipsychotics
-benzos for sleep
Bipolar 2
What 2 things
Compared to type 1
Has no what vs type 1
4 episodes
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
Bipolar 2 how to diagnose
MDD 2 weeks
Hypomania 4 days
Cyclothymia (2 years needed)
What does thymia mean
What two things it has
What causes a mood episode
Has a strong what component
Thymia=low level/ long lasting
Mild-moderate depression
Hypomania
Stress/sleep precipitate mood episodes
Bipolar has a strong genetic component
Can antidepressants be used to treat bipolar?
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
Lithium (ONLY TRUE MOOD STABILIZER)
Narrow therapuetic index
Hard on what two organs
SE
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
Anticonvulsant meds
Valporic acid
Carbamazepine
Lamotrigine
Valporic acid
SEs
Needs
Get enzymes due to:
Liver
Pancreatitis
GI
Thrombocytopenia
Wt gain
Teratogenic
Need labs monitored
Carbamazepine
Careful with what
SEs
Need what
Careful with heart issues
SEs:
Leukopenia
Thrombocytopenia
SJS
Need labs monitored
Lamotrigine(safest most tolerated)
Risk for what
If miss how many days you have to do what
SEs
Risk for benign rash/SJS
If miss 5 days of meds, need to restart titration
SE:
Tremors
HA
Antipsychotics
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
NMS symptoms
BAD FEvER
Labile bp
Led pipe rigidity
EPS
Acute Dystonia
Psudoparkinsons
Akathesia
Tardive dyskinesia (could be irreversible)
Antidote: benzotropine, diphenhydromine
Hypomania vs mania
Mania need a week
Hypomania needs 4 days
Mania: excessive energy/purposeless movement
Restless
Needs hospitalization
Hypomania: less severe.
Dythmia (persistent depressive disorder)
What it looks like
To diagnose
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
Premenstrual dysphoric disorder
Symptoms
Depressed mood
Anxiety
Mood swings
Decreased interest in activities
Improved mood with end of menses
Seasonal affective disorder (SAD)
When, what
Tx
Nov-April
Lower mood
Tx:
Vit d
Light therapy
SSRI
major depressive disorder
Symptoms
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
MDD need to be present for how long to diagnose
2 weeks
MDD tx
SSRIs take 4-6 weeks
ECT-induced seizures (need informed consent, NPO @ midnight), can cause memory loss
CBT
Therapeutic communication
ECT is good for what
Acutely suicidal
psychotic depression (depression with psychosis diagnosis)
CBT
Manage distored thoughts
Identify dysfunctional patterns of thinking and behaving
Changing automatic thoughts
SSRIs
Vs
SNRIs
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
Schizophrenia positive symptoms
Things were adding on that wouldnt normally be there in a normal person
Delusions
Hallucinations
Alterations in speech
Behavior
Schizophrenia delusions
What is it
Donts
Dos
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)
Schizophrenia hallucinations
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)
Schizophrenia altered speech
-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)
Schizophrenia behaviors
Moods
4 movement things
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
To diagnose schizophrenia you must have what and for how long
Must have at least 2 positive symptoms
(hallucinations, delusions, altered speech, behavior)
Addition to the negative symptoms
Must meet this for 6 months
Schizophrenia negative symptoms
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
Schizoaffective disorder
If pt has schizophrenia and mood disorder (MDD, bipolar)
Anosognosia
Lack of insight
Unable to understand/perceive illness
Controled delusions
Outside forces are contolling actions
Erotomanic delusions
A person of higher status is in love with them (not true)
Grandiose delusions
Inflated sense of self worth
Power or wealth
Somatic delusions
A belief about a dysfunctional body part
Reference delusions
Something happening in the environment is about them
Persecutory delusions
Others are trying to cause harm
Rehabilitation care r/t schizophrenia and pyschosis
Schizophreniform
If 1-6months then its schizophreniform
Schizophrenia tx
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)
Schizophrenia neurotranmittors
Dopamine
Arachnaphobia
Acrophabia
Agoraphobia
Arachnaphobia: fear of spiders
Acrophabia: fear of heights
Agoraphobia: fear of places (going over a bridge)
Panic disorder
Last how long
Four or more of what = diagnosis
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
Seperation anxiety
Anxiety at being seperated from individuals
Symptoms
Ha
Nausea
Sleep disturbance
GAD
Generalized anxiety disorder
How to diagnose
May include what symptoms
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
OCD
Attempts to suppress persistent thoughts or urges that cause anxiety
Can be time consuming
Obesseing about something
Hoarding disorder
Saving items regardless of value
Stress about getting rid of stuff
Body dysmorphic disorder
Attempts to conceal a perceived flaw
Mirror checking or comparing themselves to others
Trichotillomania
Obsessive pulling of the hair
Risk factors to:
OCD
Hoarding disorder
Body dysmorphic disorder
Trichotillomania
Female (except hoarding)
Hyperthyroidism
Adverse effect of meds
Substance induced or withdrawal
How to care for the anxiety and OCD related disorders
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
Anxiety and OCD related disorder MEDS
SSRIs
SNRIs
Beta blockers (propranolol)
Antihistamins
Anticonvulsants (mood stabilizer)
Antianxiety medsL
Benzos (short term) lorazapam, diazapam, alprazolam
Buspirone (long term)
anxiety and OCD r/t disorders
Therapies:
Relaxation
Modeling
Systematic desensitization
Flooding
Response prevention
Thought stopping
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
Benzodiapines concerns
Sedation
Substance abuse
Acute stress disorder
Exposure to traumatic event so what happens right after
Adjustment disorder
Need to adjust causes anxiety
Dissociative disorders
Depersonalized/derealization disorder
Dissociative amnesia
Dissociative fugue
Dissociative identity disorder
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
Risk factors for:
ASD, PTSD, Adjustment d/o, dissociative d/os
Exposure to traumatic event
Exposure to trauma during natural disaster
Exposure to trauma in occupational setting
Living thru traumatic experience of a loved one
PTSD is a RF for what other d/o
Dissociated disorders
Anxiety
Depression
Substance use disorders
RF of ASD and PTSD
Sevverity of trauma
Individuals vulnerabilities
Insufficient tx
RF of Adjusment disorder
Pattern of lifelong difficulty accepting change
Learning pattern of difficulty with social skills or coping
RF of dissociative disorder
Traumatic event
Childhood abuse or trauma
ASD/PTSD symptoms
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
ASD/PTSD behaviors
Agression, irritability, anger
Hypervigilance with heightened startle
Sleep disturbances
Destructive behaviors (suicidal or harming others)
Adjustment disorder symptoms
Depression/anxiety
Changes in behavior (arguing either others, driving erratically)
How to caree for ASD/PTSD and adjustment disorder
Therapeutic relationship
Non-threatinging environment
Asses SI and HI
Anxiety relief:
Music therapy, guided imagery, massage, relaxation, breathing techniques
If child, involve caregiver
How to care for dissociative disorders
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
What meds for adjustment disorder
None
Meds for anxiety disorders and dissociative disorders
2 SSRI
1 SRNI
2 TCAs
2 that effect cardiac
Antidepressants:
Paroxetine and sertraline (SSRIs)
Venaflaxine (SRNIs)
Mirtazapine and Amitriptyline (TCAs)
Prazosin (can cause orthostatic HOTN)
Propranolol: HOTN RISK
Eye movement desensitization and reprocessing (EMDR)
Use
Done with what
Contra indications 5
For PTSD
Done with rapid eye movement
CI:
Sucidal
Psychosis
Severe disociation
Visual issues
On substances
3 therapies for dissociation
Somatic therapy
Hypotherapy
Biofeedback/neurofeedback
What to educate anxiety and dissociative disorder pt on
Relaxation techniques
Avoid caffeine and alcohol
Perform grounding techniques (claping hands) for dissociative disorders
Recovery model r/t mental illness
