Exam 2 Flashcards
*Best treatment for PTSD
-SSRI medications
-Paroxethine and Sertaline
-Short Term Benzodiazephines
-Prazosin for nightmares
-Mood stabilizers and antipsychotics
*Symptoms of PTSD
Re-experiencing the the traumatic event example getting flash backs
· Constantly at a high level of stress or startle
· Numbing of responsiveness like avoidance or indifference
· Disturbed sleeping patterns because of nightmares
· Amnesia to certain aspects of the trauma
*What is depersonalization and derealization?
-Depersonalization is focus on self. Feeling like your body does not belong to you or feeling like you are outside of your and sometimes feeling like something is wrong with your body
-Derealization is focus on the outside world Feeling like you do not know your surroundings or the world is not real and feeling disconnected from people
*What are the different dissociative disorders?
-Dissociative identity disorder is having two or more separate personalities and switching between them
-Depersonalization-derealization disorder
- Dissociative amnesia a persons inability to remember or recall detailed information about their life
How are dissociative disorder treated?
First we establish safety and stabilization
· Then we confront and work though traumatic experiences
· Finally we use rehabilitation
· We can also use meds
· * CBT, psychodynamic psychotherapy, exposure therapy,
· modified EMDR therapy, hypnotherapy, neurofeedback,
· ego state therapies, somatic therapies
Review Joint Commission regulations on restraints in your ATI
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*What is timing for restraints for 5-7 year olds adolescents? Adults?
-8 year or younger limit is 1hr
- 9 to 17 limit is 2hr
-18+ limit is 4hr
Provide examples of negative symptoms and positive symptoms
Positive symptoms are symptoms shouldn’t be present. Ex: hallucinations, delusions, paranoia, alteration in speech.
Negative symptoms are the absence of essential human qualities like social discomfort, apathy, Anhedonia (inability to enjoy activities).
It shows the outward expression of the person’s internal emotional state
*Major acronyms like SIGECAPS, SOLER, DIGFAST, What do they stand for?
Depression: SIGECAPS
S- Sleep changes
I- Interest (loss)
G- Guilt (worthless)
E- Energy (lack)
C- Cognition/ Concentration
A- Appetite
P- Psychomotor
S- Suicide/Death
SOLER: non verbal communication
S- Sit squarely
O- Open posture
L- Leaning
E- Eye contact
R- Relaxed
DIG FAST: Primary symptoms of a Mania attack
D-Distractibility
I-Indiscretion
G- Grandiosity
F-Flight of Ideas
A- Activity Increase
S-Sleep Deficit
T-Talkativeness
Signs of lithium toxicity
N/V, dizziness, diarrhea, and abdominal pain
*How to treat lithium toxicity
stomach pumping
Lithium Levels
Therapeutic level: 0.8-1.4 mEq/L
Maintenance blood level: 0.4 to 1.3 mEq/L
Toxic Blood level: >1.5 mEq/L
*What are the potential long-term effects of lithium use?
Kidney and thyroid gland issues.
How often should lithium levels be checked?
Every 3 to 6 months
A major side effect of desryl (Trazodone) is priapism. What instructions should you provide patients regarding this serious side effect?
Go to the hospital if the erection lasts longer than four hours
What classes do each of these groups of medications fall under
a. sertraline, paroxetine, escitalopram, citalopram, fluoxetine,
b. duloxetine, venlafaxine, desvenlafaxine
c. haloperidol, Chlorpromazine
d. olanzapine, Risperidone, ziprasidone, quetiapine, , Clozaril or clozapine
e. alprazolam, clonazepam, lorazepam diazepam
f. amphetamines, methylphenidate
g. parnate, nardil
h. donepezil
i. bupropion
j. mirtazepine
A. SSRI’s
B. SNRI’s
C. First- Generation (Conventional) Antipsychotics
D. Atypical/ Second Generation Antipsychotics
E.Benzodiazepines (Anxiety)
F. Psychostimulants/CNS Stimulants
G. MAOIs
H. Cholinesterase Inhibitors
I. Atypical Antidepressants
J. Antidepressants
A second-generation antipsychotic is a second generation antipsychotic because of the 5HT 2A receptor activity? What does that mean?
They also target dopamine D2 receptor
Which antipsychotic is most likely to cause agranulocytoses? Why does it matter?
Clozapine
What are the As of schizophrenia…ie alogia, anhedonia, anergia etc.?
affective flattening, alogia, anhedonia, asociality, and avolition
What are extrapyramidal side effects (EPS)?
Acute Dystonia- Last hours to 5 days and it cause spasm of the tongue, neck, face, & back
Parkinsonism- last 5-30 days and it causes tremors, shuffling gait, drooling, stooped posture, instability
Akathesia- Last 5-60 says and it casues Compulsive, repetitive motions, agitation
Tarditive Dyskinesia- Last months to years and causes lip-smacking, worm-like tongue movement, “fly-catching”.
Of the antipsychotic medications, which are more likely to cause weight gain, Galacteria or lactation, QT prolongation, cataracts?
Thioridazine
If you have a patient who received a haloperidol injection 24 hours ago, what side effects should you look for?
Chest pain, trouble breathing, fast heartbeat, or chills
*What is ECT and when is it used?
-ElectroConvulsive Therapy is a therapy used to treat depression specific Psychotic illness, which involves passing a mild electric current through your brain, causing a short seizure “induce seizure”
-Uses:-
*Severe malnutrition, exhaustion, and dehydration due to lengthy depression or when a person is a danger to themselves or others and medication will take days/week to become effective
Delusional depression
*Schizophrenia with catatonia
*Failure of previous medication trials/medication aren’t working
*What is the main side effect of ECT?
Nausea, headaches, fatigue, myalgia, confusion and slight memory loss.
*Who is a good candidate for ECT?
A client with depression and other major psychiatric/mental health disorders such as schizophrenia and bipolar disorders
How do you prepare patients for ECT?
Explain the procedure
Several test done such as blood urine tests, ECG/EKG, imaging tests on the skull, brain and spine
Fast before the procedure (food 8hr & liquids 2hrs)
Remove all type of accessories
Medication stopped or reduce accordingly to the provider
Anesthesia and other preparations
Electrodes placement
*What is Transcranial Magnetic Stimulation (TMS)?
Is a non invasive method to treat depression, it uses MRI- strength magnetic pulses to stimulate focal areas of the cerebral cortex.
*When is TMS used and how is it different from ECT?
ECT:
*Is the most effective
Safer than meds with certain medical conditions
Uses electric current
SE: *possibilities of neurological deficits or memory problems
*Seizures are possible
May cause nausea
Suitable for severe cases of depression, *when nothing has worked and there is an immediate risk of suicide
TMS:
Noninvasive
Uses MRI-strength magnetic pulses
SE: *no neurological deficits or memory problems
*Seizures are rarely
May cause headache and lightheadedness
*Suitable for a pt with mild, moderate or severe depression
Be prepared to prioritize actions based on presenting actions based on presenting symptoms
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How is capacity different from competence?
Capacity involves a person’s ability to make informed decisions and provide informed consent
Competence is a legal term and a process that speaks to determining the capability of a person to act on his or her own behalf or have the mental capacity to participate in legal proceedings
You have a patient taking Cymbalta, which vital sign would cause you to hold this medication?
a. Resting HR of 56,
b. B/P 180/100,
c. Temp 100.0,
d. Respiratory Rate 20
B
Talking in circles and including more detail than you asked for is …………. speech
Circumstantial Speech
Not answering a simple question _____________ speech
Tangential Speech
