Exam 2 Flashcards

Question

Monoamine oxidase inhibitors

Answer 1

Came out in 50s, first to come out Effective for unconventional depression Breaks down neurotransmitters (dopamine, norepinephrine, and serotonin) Monoamine oxidase breaks them down so they can’t attach and get synapse connection to make them feel better. MAOIs prevent the breaking down Used to be first-line therapy but not anymore because of cardiac effects Now it’s a last resort. It’s good if you can commit to diet

Answer 2

agitation, sleep disturbance, tremor, sexual dysfunction (causes med inherence), headache, autonomic effects

Answer 3

serotonin syndrome!! Abdominal pain, diarrhea, increased BP, HR, temp; delirium, muscle spasm, irritable, may lead to shock/death caution when use 2 antidepressants or herbal supplement (Esp. MAOI) Washout period between two antidepressants (2 weeks)

Answer 4

Therapeutic dose reached 2-8 weeks (will have some effect sooner)

Answer 5

anticholinergic, postural hypotension, tachycardia

Answer 6

cardiac rhythm, heart block, MI (lots of elderly pts got this med, cardiac effects seen. Doesn’t happen with everyone but still serious

Answer 7

MAOI, barbiturates, disulfiram, oral contraceptives and estrogen, alcohol, antihypertensives (clonidine, reserpine)

Answer 8

Cardiac issues but tiny amounts help with back pain (neuropathic response instead of antidepressant

Answer 9

Adhere to a restrictive diet of foods and drugs (tyramine free) Tyramine involved which can cause HTN crisis, can’t eat pickled foods, herrings, pickles, chocolate, aged cheeses/wines/beers

Answer 10

Those individuals with atypical depressions, all other meds and nothing worked for them (hypersomnia and overeating, anxiety disorders)

Answer 11

orthostatic hypotension, weight gain, cardiac rhythm changes, insomnia, fatigue, anticholinergic

Answer 12

hypertensive crisis (tyramine), need to monitor vital signs Don't use MAOIs if you have cardiac history and can't adhere to diet

Answer 13

Have to go to an esketamine center where licensed practitioners administer the nasal spray. Pt comes in, kind of like OR setup, monitored for HTN every 30 mins. Someone has to drive them home. Used for people with acute suicide, helps very much with symptoms no food 2 hrs before and no liquid 30 mins before treatment

Answer 14

high BP, dissociation, dizziness, vertigo, sedation, numbness, anxiety, and feeling drunk, out of body experience with ketamine so esketamine isnt as bad, they feel outward though

Answer 15

twice weekly for 4 weeks, tapering once a week for 4 weeks, week 9 and after once every week or two

Answer 16

Zulresso antidepressant 1st and only FDA approved med for ppd- schedule II drug Neuroactive steroid 60 hour IV infusion. It is a one time infusion

Answer 17

hypoxia, excessive sedation, and potential LOC. patients are continuously monitored

Answer 18

inconclusive some preterm esp with bipolar manic phase congenital malformations MAOI and TCA SSRI in first trimester some risk

Answer 19

black box warning suicidal risk, despite less prescriptions suicide increased. What are the implications? Ages 15-25, brain doesn’t stop growing until 25 Weren’t being given these because of black box and ended up suiciding even more, so they put it back

Answer 20

Polypharmacy and metabolism issues

Answer 21

Electroconvulsive Therapy Mini OR setup, bilateral (less confusion) or unilateral (more confusion but quicker recovery). Electrodes used

Answer 22

most common depression up to 90% remission, suicidal thoughts, psychotic disorders, failure to respond to meds Informed consent (6-8 treatments from this consent), education for patient and family

Answer 23

anesthetic (barbiturate (brevital) and muscle paralyzing agent (Succinylcholine), EEG and EKG monitoring, brief seizure induced via electrodes (uni- or bilateral)

Answer 24

confusion (will last some period of time or never goes away), headache, memory deficits (can get better or maybe wont) If MAOI doesn't work this is the last resort

Answer 25

PACU certified nurse needs to watch pt When anesthesia lets pt go to next level of care, they go to PACU so they need PACU certified nurse, psych doesn't have this

Answer 26

Transcranial Magnetic Stimulation For those unresponsive to other treatments, pregnancy, outpatient, electrode deliver magnetic pulses, noninvasive Good if they don’t want ACT Strong magnet but not as strong as MRI, literally just under it Looking at cerebral cortex, results within 2 weeks

Answer 27

electrical stimulation boosts neurotransmitters, implanted in chest (surgical procedure) and attached to vagus nerve in neck, treatment-resistant depression

Answer 28

implanted electrodes in underactive brain areas, device (stabilizer) in chest wall, also works for parkinson’s

Answer 29

first line treatment for Seasonal Affective Disorder (SAD) Very specific bulb, lux bulb Useful for when we fall back, darker early, not out as much Depressed for the 6 months until spring Sometimes people just use this or they supplement with meds

Answer 30

increases serotonin, norepinephrine and dopamine Careful with serotonin syndrome!!

Answer 31

increases serotonin, decrease HPA axis (thought to be overly active in depression) 30-45 minutes a day, 5 days a week. For mild to slightly mild-moderate depression If you’re in the middle or severe-moderate depression, it won’t work for you

Answer 32

improved screening, reduce depression incidence and increase treatment options and compliance (75% people with depression will receive treatment)

Answer 33

Ideation, intent, and plan

Answer 34

Need to confiscate the gun and report it to the state. Local authorities come to you and take the gun so the hospital/whatever place doesn’t deal with it

Answer 35

Highest risk 2 days before admission, 2 days after admission, and 2 days after discharge 2 days after discharge, they have some energy and the meds haven’t kicked in yet

Answer 36

Thinking about killing oneself

Answer 37

Suicide successfully resulting in death

Answer 38

Self-injury directed to the surface of the body to induce relief from a negative feeling/cognitive state or to achieve a positive mood state Suicide can happen by accident SUICIDE IS NOT THEIR INTENT

Answer 39

Active duty service members THEY HAVE ACCESS TO A GUN! FEELING HOPELESS AND HELPLESS

Answer 40

Males more often successfully suicide, females attempt more Increase in 50-75. Most common in adolescents 10-34 White people decreased in religious and ppl married with CHILDREN Increased in professionals Half have a physical illness PRIOR ATTEMPTS AND LETHAL PLAN

Answer 41

having access to the means such as a gun, jumping off a building, purposeful crash maybe, jumping out of a car and into a river could be, carbon monoxide poisoning yes, etc), loss Pills and hanging may not be lethal (hanging is lethal if done correctly but usually it’s not)

Answer 42

immediate risk of suicide Often talking or writing about death, dying, or suicide Making comments about being hopeless, helpless, or worthless Expressions of having no reason for living: no sense of purpose in life Saying things like “it would be better if I wasn’t here” or “I want out” Increased alcohol and/or drug misuse (drinking + reckless behavior) Withdrawal from friends, family, and community!! Reckless behavior or more risky activities, seemingly without thinking Dramatic mood changes (pt came in depressed, showing a little lift/happiness only after like 4 days. Negative thinking is still a problem, be worried) Talking about feeling trapped or being a burden to others

Answer 43

characteristics that make it more likely that an individual will consider, attempt, or die by suicide Previous attempt(s) BIGGEST RISK FACTOR A history of suicide in the family Substance use (people come into ED, feel very suicidal, sober up, and say they would NEVER want to kill themself, then they are let home) Mood disorders (depression, bipolar disorder) Access to lethal means (ex. Keeping firearms in the home) Losses and other events (ex. The breakup of a relationship or a death, academic failures, legal difficulties, financial difficulties, bullying) History of trauma or abuse (I can go to the safehouse, but someone did that and died so I’d rather stay here) Chronic physical illness including chronic pain Exposure to the suicidal behavior of others

Answer 44

Talking to friends or hearing of it on social media Let two suicidal people talk but if they start talking about which means is better, etc., stop their communication A little negativity is fine though because they can be rearranged to positive comments and helping them learn and move forward They watch movies and TV and we may think “wow why are we letting them watch that?” We can’t stop what they do when they go home. If they love to watch these crazy shows, they will do that at home, too. Better to allow them to watch it here and see what they do with it.

Answer 45

Effective mental healthcare; easy access to a variety of clinical interventions Strong connections to individuals, family, community, and social constitutions Marriage, having children Problem-solving and conflict resolution skills

Answer 46

Have you ever felt that life was not worth living? Have you been thinking about death recently? Do you ever think about suicide? Have you ever attempted suicide? Do you have a plan for ending your life? If so, what is your plan for suicide

Answer 47

Ask about risk factors, ask about protective factors, conduct suicidal inquiry (how they’re feeling, their thoughts on suicide, behavior, plan), then we determine level of risk and document it

Answer 48

Attempt within last 24 months Attempt was not initiated in delirium or confusion Attempt was not undertaken for a religious or political objective

Answer 49

change in mood, caution increase energy after treat with antidepressants, give away possessions (to specific people or to the masses)

Answer 50

Came out from VA hospital Brings lots of tools used in psychiatry Questions are very specific, they all ask about living. One of the final questions is “what do you feel you would live for?/what do you live for?” (protective factor) Thinking about death recently: What about death? Thoughts about where you want to die or actually killing yourself Thinking about suicide/attempted suicide: Is there a definite plan?

Answer 51

Using a gun Jumping off a high place Hanging Poisoning with carbon monoxide Staging a car crash

Answer 52

Cutting wrists Inhaling natural gas Ingesting pills

Answer 53

"This is the worst thing someone can do" It WILL come across so this is the only option you feel like you have? Are you open to hearing anything else I might be able to say to you? Might be open but feel like this is the only option. Them being open leads to many things we can do

Answer 54

Question their intent Persuade against it Refer them

Answer 55

Very involved piece of paper that gets patients involved in their own plan. Tells them if they’re feeling suicidal, talk to somebody They will approach the nurse and the nurse has to stop what they’re doing. If the nurse can pull them down, great! If not, find somebody else like the doctor If they’re home, have three people to consult. If you’re the third person, you’re the call before 911. Go over this before they come in, in case they have suicidal ideation while they’re in the hospital Copies of plan go to involved family members

Answer 56

Psychosocial interventions-Safety Plan Psychobiological interventions (meds like SSRIs) Safety and teamwork Health teaching and health promotion Case management Documentation of care Postvention for survivors of completed suicide (Refer them to support groups which can exist in the facility, may have to research outside)

Answer 57

Use (and count) plastic utensils. No private room; keep the door open at all times. Jump-proof and hang-proof bathrooms. Lock doors to non-patient areas. Monitor for and remove potentially harmful gifts. In the patient's presence, assess belongings and search patients for harmful objects. Ensure that patients do not bring or leave harmful objects

Answer 58

Deliberate non-suicidal bodily harm Intent to feel relief, not to kill themselves. They want positive relief Cut, carve, bite, burn, skin picking Last more than a year and repeated alleviate psychic pain or numbness Risk factors- family depression, non-heterosexual, personality disorder (BPD), anxiety, substance use They feel euphoric after self-harming. Bad coping habits

Answer 59

Limit setting for safety Developing self-esteem Discovery of motive and its role Discovering self-control Replacement with coping skills Entering maintenance phase

Answer 60

Most severe form Highest mortality rate of the three At least one manic episode that lasted a week or more May alternate with depressed moods and agitation, periods of symptom-free Delusions, hallucinations, depression, mania Breakthrough symptoms without a manic episode. Have to figure out if it’s depression or bipolar Mania and depression

Answer 61

Happens for around 4 days At least 1 hypomanic episode Not so irritable Most times they present hypomania and then depression shows later At least 1 major depressive episode Hypomania alternating with severe depression (make sure it's not major depressive) Not as much sleep deprivation, famous ppl

Answer 62

Alternate with symptoms of mild to moderate depression for at least 2 years (adults) 1-year children Irritable hypomanic episodes Rapid cycling, may even occur in one day, 4 mood episodes in 12 months (also seen in bipolar 1) More severe Hypomania is more irritable in this than bipolar II Partial hospital or intensive outpatient may be recommended by doctor but not preferred bc they get transferred to hospital fast, need to be danger to self or others

Answer 63

4 mood episodes in 12 months

Answer 64

Substance/medication-induced bipolar and related disorder Bipolar and related disorder due to another medical condition (HYPERTHYROIDISM and renal function studies if they’re suspected bipolar bc lithium is bad for kidneys)

Answer 65

Occurs in 4% of population 2% in children and adolescents Usual onset late teens - early 20s Gender differences (equal rates, a little more men in bipolar I have legal and violent issues during mania, bipolar II with women and substance abuse/suicide attempts usually in manic phase because they have energy,careful with meds because it could give them the energy they need to suicide, 2-2-2 rule) Children (make sure it isn't ADHD)

Answer 66

At least 50% of individuals with bipolar disorder have a comorbid psychiatric disorder–biggest one right now is substance (peer pressure of feeling different, self medicating and now they don't want proper meds bc it makes them feel blank and gets rid of mania) Higher rates of some physical disorders with Bipolar I Panic is common in bipolar I because of disorientation and realizing you’re different from others Chronic fatigue common in manic phase, 90% heritable (from parents, grandparents, etc)

Answer 67

Biopsychosocial approach Biological: genetic, neurobiological, neuroendocrine Prefrontal cortex (can’t operate the way they want or think clearly) Cognitive replacing Psychological Environmental

Answer 68

See dysfunction in prefrontal cortex (executive decision making, personality expression, social behavior) Dysfunction in the hippocampus (memory) Dysfunction in the Amygdala (Memory of what happened, decision making based on memory, emotion with memory, amygdala in charge of remembering anger and emotions)

Answer 69

Early identification and tx. is key! Mood (lability, euphoria, inappropriateness based on situation, irritable, angry, poor boundaries, wanting to call the President, grandiose situations) Behavior (hypersexual, extreme spending, sleep probably not. If not sleeping but goal directed, probably also not eating) Thought processes and speech patterns (similar to schizophrenia, hallucinations, grandiosity, delusions, alterations in perception) Cognitive functioning (impaired concentration, rule out ADHD in young person) Self-assessment (not best bc they can lie)

Answer 70

Pressured speech Circumstantial speech Tangential speech Loose associations Flight of ideas Clang associations

Answer 71

Grandiose delusions Persecutory delusions

Answer 72

Unusual dress, hyperactive or “busy” behavior Excessive engagement in pleasurable activities (like excessive buying, sexual acting out)

Answer 73

Rapid and “pressured speech” (speech that is hard to interrupt)

Answer 74

Feeling “on top of the world” or be angry and irritable Mood can be “labile” (changes rapidly) Is it congruent?

Answer 75

possible hallucinations

Answer 76

Orientation Little insight (understanding) of having an illness Judgment impaired and can lead to painful consequences Impulsive; can act aggressively Ability to concentrate is impaired Easily distractible

Answer 77

Suicidal or homicidal hx. & current thoughts Intent and presence of a plan

Answer 78

Distractibility and easy frustration Impulsivity, Irritability, Irresponsibility and erratic uninhibited behavior Grandiosity Flight of ideas Activity increased with weight loss and increased libido Sleep is decreased Talkativeness-excessive

Answer 79

Danger to self or others Need for protection from uninhibited behaviors Need for hospitalization–very vulnerable based on behavior Medical status Coexisting medical conditions Family’s understanding Risk for injury Risk for violence (other or self) Ineffective coping

Answer 80

Manipulative, charming, rizz, could be best friend before delusions, once everything is resolved they’re still you’re best friend, might think this is borderline personality disorder but it’s not Demanding Splitting, so charming you’ll think they have borderline personality disorder

Answer 81

Frequent staff meetings to deal with patient behavior and staff response Set limits consistently

Answer 82

Prevent injury because they’re all over the place

Answer 83

Relapse prevention, they don’t think they’re sick. Stop taking meds after about 3-4 weeks because they feel good and then bottom out.

Answer 84

Limit severity and duration of future episodes Stay on meds consistently Breakthrough periods can happen even on meds, stressful situations happen in life

Answer 85

Medical stabilization Maintain safety Nursing care

Answer 86

Managing meds, decreasing physical activity, usually need to go to court and get mandated treatment. Medicate PRN against will, document, set limits to decrease activity, finger foods so they use less energy Increasing food and fluid intake (protein drink) Ensuring at least 4 to 6 hrs. of sleep per night Intervening so that self-care needs are met. Seclusion, restraint, or electroconvulsive therapy (ECT) may be considered during the acute phase

Answer 87

Hospitalization for suicidal, psychotic, or catatonic signs Medication concerns about bringing on a manic phase Could see a manic episode with certain antidepressants based on chemical composition of patients Could have psychotic episodes

Answer 88

Hospitalization for acute mania (bipolar I disorder) Communicating challenges and strategies

Answer 89

don’t know what’s wrong and they don’t want to lose elated feeling during mania, during depression they can’t even get out of bed Short and direct verbiage, can’t take so much information in but can put it out

Answer 90

Lithobid Therapeutic: 0.8-1.2 mEq/L Toxic: 1.5+ Maintenance: 0.6-0.8 MONITOR RENAL AND THYROID Predominantly for bp1 Make sure they actually have bipolar and not depression First line of defense, then next mood stabilizer, then add antipsychotic and/or depakote Sometimes provider doesn’t even want their levels up to 1.2 Takes 3 days to 3 weeks to work If while they’re on lithium they’re still moving too fast, we can add an antipsychotic or depakote

Answer 91

Mood Stabilizers valproate (Depakote) carbamazepine (Tegretol) lamotrigine (Lamictal): bad rash, 5 weeks into therapy, d/c it Valproic acid may also work, on aggressive piece quicker and antipsychotic Levels of vap acid: 50-100, also known as depakote/depakene (2nd line of defense) Benzo is next line of defense if they don't want antipsychotic or anticonvulsant (not a good option bc drug abuse) Tegretol: levels are 6-12

Answer 92

clonazepam and lorazepam

Answer 93

Atypicals-second generation- olanzapine (zyprexa) and risperidone (risperdol) Typicals-first generation- chlorpromazine and loxapine (inhaled) Calms them down quickly, works quick for aggression, takes a while for psychosis

Answer 94

Omega-3 fatty acids, works well especially if pt is tx resistant or a rapid cycler ECT for rapid cycling (succ as muscle relaxant, atropine for secretions) safety precautions with mania because of grandiosity (in everyone’s face) or suicidal Health teaching and promotion Advanced practice: CBT, interpersonal therapy

Answer 95

Most prescribed 900-1800mg daily in 2-4 divided doses, max 2400 daily

Answer 96

mood stabilizer

Answer 97

addresses neurotransmitters

Answer 98

Safety/Prevent exhaustion (trazodone or benzos, traz is an antidepressant but makes u sleepy, rest periods, decrease stimulation even tho they want stimulation) Set expected outcomes (will sleep 4-6h a night) Safety/hydration and food intake (monitor I/Os, finger foods) Impulse control (sedatives, avoid stimulation, limits, 1-1 if violent, least restrictive, go to room if they're not safe)

Answer 99

Give sedative meds to facilitate sleep Promote rest periods even when patient can not sleep Decrease environmental stimulation

Answer 100

Patient will rest/sleep at least 4-6 hours per night

Answer 101

Monitor intake and output Offer finger foods and foods with good nutritional value Patient is easily distractible so verify actual intake Patient will eat and drink enough throughout the day Patient will not show signs of dehydration

Answer 102

Give sedative meds to lessen hyperactivity Monitor interpersonal interactions for intrusiveness Help patient to avoid stimulating milieu activities like group Set firm and consistent limits on unsafe behaviors “One on one supervision” if violence Have patient go to room if acting in an unsafe manner Use restraints if ALL other “least restrictive measures” have been tried Recognize and intervene quickly with escalating behavior (de-escalation techniques should be utilized)

Answer 103

Symptoms of depressive, manic, and mixed episodes Supports self-efficacy and treatment adherence Medications, SE, ways to lessen SE, toxic effects, when to report, importance of compliance Lithium toxicity Relapse prevention Self-help strategies for family (support groups like NAMI), talk about experience, not the patient

Answer 104

Elevated or expansive and irritable mood accompanied by changes in activity and energy

Answer 105

Emotional dysregulation Enduring pattern of inner experience and behavior deviating from expectations of individual’s culture Leads to distress and impaired functioning Long duration, onset adolescence or early adulthood Inflexible traits, pervasive If diagnosed under age 18, must have symptoms for 1 year (except antisocial which is only adults)

Answer 106

Biological: genetic, neurobiological Psychological Environmental Diathesis-stress model

Answer 107

(odd, eccentric): Paranoid, Schizoid, Schizotypal, 5.7% prevalence

Answer 108

(dramatic, emotional, erratic): Antisocial, Borderline, Histrionic, Narcissistic, 1.5% prevalence

Answer 109

(anxious, fearful) : Avoidant, Dependent, Obsessive-Compulsive, 6.0% prevalence

Answer 110

Clinical presentation: distrust and suspicious of others Easily experiences shame and humiliation Struggles with personal relationships Defense mechanism of projection

Answer 111

Distraction Give them space (they want to be alone bc they dont trust others) You often dont see them in groups Let connection and trust develop

Answer 112

Clinical presentation: detachment from social relationships, restricted emotional expression, lifelong pattern of social withdrawal Aloof, introspective, No desire for social or sexual relationships Generally well functioning, untroubled by their oddness

Answer 113

Don’t force them to go to group therapy, they wouldn’t enjoy it

Answer 114

Clinical presentation: discomfort in close relationships, cognitive and perceptual distortions, eccentric behavior Odd beliefs, magical thinking, Fear social interaction, do not blend in with crowds

Answer 115

Individual psychotherapy

Answer 116

Clinical presentation: excessive emotionality and attention seeking Lack self worth so depend on others’ attention for well-being Dramatic, Excitable, overly charming or seductive React poorly to criticism or disapproval

Answer 117

Limit setting Don’t defend yourself, reinforces their behaviors

Answer 118

Clinical presentation: grandiosity, need for admiration, lack of empathy Sense of entitlement Controlling, intolerant

Answer 119

Usually only come into the hospital when in trouble with the law Don’t want to be in the group, think there’s nothing wrong with them They’re mean to people in the group cause they’re above the group Limit setting, daily expectations

Answer 120

Often referred to as sociopaths Diagnosed in adults, symptoms in mid teens to early 20s Antagonistic, manipulative, hostile, risky behaviors, impulsive, irresponsible, often legal issues, substance use, seek own gratification, disregard needs of others, lack intimacy, Profound lack of empathy, absence of remorse/guilt, disregard for rules and responsibilities More common in men (3%)

Answer 121

Biological Environmental Cultural

Answer 122

Psychiatric setting often court ordered, avoid legal system, often disruptive on unit, may be co-occurring depression, anxiety Assessment-Patients do not tend to answer honestly Medical setting for injuries Self-assessment

Answer 123

Risk for other-directed violence Defensive coping Impaired social interaction Ineffective health maintenance

Answer 124

Safety-- limit setting, observation, boundaries, consistency, consequences for actions, documentation, therapeutic listening and communication, empathy, communicate expectations, don’t argue or bargain, monitor for aggression, physical outlets, identify anger triggers, “stop and think”, positive reinforcement p. 461 Medications-- based on symptoms not diagnosis, mood-stabilizing medications

Answer 125

Instability in emotional regulation, emotional lability (extremes), impulsivity, lack identity or self image, unstable mood and relationships, overreact Separation and abandonment Self-destructive (self soothing with cutting, burning, numbing with substances) Promiscuity Suicidality Antagonism Splitting (primary defense)

Answer 126

1.6% population, 10% mortality 85% co-occurring mental illness, 50% substance abuse --what are the implications of this?

Answer 127

Biological: familial risk factor, hyperactive amygdala, impaired prefrontal cortex Cognitive: early abandonment, Mahler’s separation-individuation, rapprochement phase (18-24 months)

Answer 128

MMPI-Minnesota Multiphasic Personality Inventory Assess for self-harm, impulsivity, intense feelings, abandonment, idealization of others, suicidality, extreme mood changes, risky behaviors History of abuse Self-assessment

Answer 129

Medications--anticonvulsants mood stabilizers, antipsychotics (low doses), Naltrexone(Vivitrol) for self-injurious behaviors

Answer 130

Self-mutilation Risk for suicide Risk for self- and/or other-directed violence Impaired social interaction Disturbed personal identity Ineffective coping

Answer 131

CBT DBT schema-focused

Answer 132

Clinical presentation: social inhibition, feeling inadequate, hypersensitive to negative comments Avoid others unless feel liked Often associated with anxiety disorders

Answer 133

Do not force these people to go to group

Answer 134

Clinical presentation: submissive and clinging behavior, excessive need to be taken care of Lack self confidence

Answer 135

Limit setting Setting expectations

Answer 136

Clinical presentation: preoccupied with rules, details order, schedules Perfectionism Rigid, controlling, cautious

Answer 137

Would not do well in group therapy because nobody fits their schedules Complex social relationships Exposure therapy does not work here