Exam 2 Flashcards
Treatment of psychiatric disease with psychotropic drugs often causes a disturbance in _________.
movement
A component of major psychiatric disturbance is an alteration is _______ experience.
Sensory
Hormones associated with anxiety are….
CRH, corticotropin and cortisol
*Normal negative feedback mechanism to bring these levels down does not respond properly
The fluctuation of various physiological and behavioral parameters over a 24-hour period.
Circadian rhythms
A basic, meandering stream of consciousness that can flow from thoughts of future responsibilities, memories, fantasies, and so on.
Conscious mental activity
Jumble of unrelated words
Word salad
The ability to retain and recall past experiences
Memory
Make interpersonal relationships Nerve cells that conduct electrical impulses
Neurons
Three actions carried out by neurons
- Respond to stimuli
- Conduct electrical impulses
- Release neurotransmitters
A chemical substance that functions as a neuromessenger
Neurotransmitter
MAO
Monoamine Oxidase- Destructive enzyme of monoamine neurotransmitters (norepinephrine, dopamine, serotonin)
Affects fine muscle movement, emotions and thoughts, decision making, and stimulation of sex, thyroid, and adrenal hormones
Dopamine (DA)
Affects mood, attention, arousal, and fight or flight response to stress.
Norepinephrine (NE)
Affects sleep, hunger, mood, pain, aggression, and sexual behavior
Serotonin (5-HT)
Affects alertness, inflammatory response, and stimulation of gastric secretions
Histamine
Decrease of this neurotransmitter is associated with depression and Parkinson’s disease
Increase is associated with schizophrenia and mania
Dopamine
Decrease of this neurotransmitter is associated with depression, increase is associated with mania, anxiety states ,and schizophrenia.
Norepinephrine
Decrease of this neurotransmitter is related to depression and increase is related to anxiety states
Seratonin
Decrease of this neurotransmitter is related to sedation and weight gain
Histamine
This neurotransmitter plays a role n inhibition, reduces aggression, excitation and anxiety.
GABA
Decrease in this neurotransmitter can result in anxiety disorders, schizophrenia, mania, huntington’s disease while increase may cause reduction of anxiety.
GABA
This neurotransmitter is excitatory and plays a role in learning and memory.
Glutamate
Decrease in this neurotransmitter can result in psychosis, neurotoxicity, and Alzheimer’s disease while increase can improve cognitive performance in behavioral tasks
Glutamate
This neurotransmitter plays a role n learning and memory, regulates mood (mania, sexual aggression) and stimulates the parasympathetic nervous system
Acetylcholine (ACh)
Decrease in this neurotransmitter can cause Alzheimer’s disease, Huntington’s disease, or Parkinson’s disease while increase can cause depression.
Acetylcholine
Pathways that play a crucial role in emotional status and psychological function
Limbic system (Mesocoritcal pathways or mesolimbic pathways)
Part of the brain involved in formulating goals, planning, initiating actions, decision making, insight, motivation, and social judgement
Frontal Lobe
Part of the brain that regulates skeletal muscle coordination and contraction and maintains equilibrium (Thought Processes)
Cerebellum
Part of the brain that controls sensory and motor function
Parietal lobe
Part of the brain that controls vision
Occipital lobe
Part of the brain that controls auditory
Temporal lobe
Part of the brain that controls balance, heart rate, respirations, coughing/swallowing/sneezing, blood pressure maintenance, and vomiting
Medulla Oblongata
A recording of electrical signals from the brain made by hooking up electrodes to the subjects scalp. Used to show the state a person is in.
EEG (electroencephalograph)
A series of x-ray images taken of the brain and a computer analysis produces slices providing a precise 3D-like reconstruction. Used to detect abnormalities and detect schizophrenia.
CT (Computerized axial tomography)
A magnetic field applied to the brain that provides 3D visualizations of the brain’s structure in sectional images. Used to detect edema, ischemia, infection etc. and can detect schizophrenia
MRI (Magnetic resonance imaging)
Radioactive substance injected and travels through the brain and shows up as bright spots on the scan. Can detect glucose metabolism, oxygen utilization, blood flow, and neurotransmitter-receptor interaction. Diagnoses schizophrenia and other disorders
PET (Positron-emission tomography)
Neurotransmitters most consistently linked to mental activity (5)
- Norepinephrine
- Dopamine
- Serotonin
- GABA
- Glutamate
Refers to the biochemical and physiological effects of drugs on the body
Pharmacodynamics
Refers to the actions of the person on the drug (how it is absorbed, transformed, distributed, excreted etc.)
Pharmacokinetics
Targets of benzodiazepines
GABA-A receptors
____ receptors coupled to calcium and/or potassium channels are associated with pain, memory, and mood.
GABA-B
Diazepam, clonazepam, and alprazolam are examples of:
Benzodiazepines
Flurazepam (Dalmane), temazepam (Restoril), triazolam (Halcion), estazolam (Prosom), and quazepam (Doral) produce a ______ effect and are used to treat _____.
Sedative, Insomnia
Lorazepam (Ativan) and alprazolam (Xanax) can treat _____ and do not produce a sleep response .
Anxiety
Benzodiazepines, Doxepin, Buspirone, Melatonin receptor agonists, short-acting sedative-hypnotic sleep agents and antidepressants are all used to treat ______.
Anxiety
TCAs, SSRIs, SNRIs, SNDIs, MAOIs, and others are all used to treat _______.
Depression
Lithium is a known _____ _______.
Mood stabilizer
Valproate, carbamazepine, lamotrigine, and others are all ___________ dugs.
Anticonvulsant
First-generation, second-generation (clozapine, risperidone, quetiapine), and third-generation are all ________ drugs.
Antipsychotic
Potentiate or promote activity of GABA by binding to a specific receptor on the GABA-A receptor complex.
Benzodiazepines
Drugs that treat anxiety are aimed at _____ receptors.
GABA
Have sedative effects without the anti-anxiety, anticonvulsant, or muscle relaxant effects.
Short-acting sedative-hypnotic sleep agents (“Z-drugs”)
Actions of these drugs include three hypothesis (Monoamine hypothesis, monoamine receptor hypothesis, and increased production of neurotropic factors)
Antidepressants
Heterocyclic antidepressants that can cause lethal overdose
TCAs (Tricyclic antidepressants)
Antidepressants that are the first line of action in depression and have little side effects and low chance for lethal overdose. They increase Seratonin levels
SSRIs (Selective serotonin reuptake inhibitors)
Medications that increase serotonin and norepinephrine.
SNRIs (Serotonin-norepinephrine reuptake inhibitors)
Drugs that increase norepinephrine and Seratonin but also block histamine.
SNDIs (Serotonin-norepinephrine disinhibitors)
Antidepressant drugs that affect levels of norepinephrine, epinephrine, dopamine, and serotonin
MAOIs (Monoamine oxidase inhibitors)
A mood stabilizer in patients with bipolar
Lithium
Represents the ratio of the lethal dose to the effective dose, a measure of overall drug safety in regards to the possibility of overdose or toxicity
Therapeutic index
A mood disorder characterized by at least one week-long manic episode that results in excessive activity and energy.
Bipolar 1 disorder
Disorder marked by low-level mania (hypomania) alternating with profound depression
Bipolar 2 disorder
Disorder with symptoms of hypomania that alternate with symptoms of mild to moderate depression for at least 2 years in adults (1yr in children)
Cyclothymic disorder
At least 4 mood episodes in a 12-month period
Rapid cycling
First line of therapy for bipolar disorder
Lithium (for those in depressive state)
Mood disorder questionnaire (MDQ)
Used to assess and screen for bipolar disorder (not to definitively diagnose)
A nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations or plays on words.
Flight of ideas
The stringing together of words because of their rhyming sounds, without regard to their meaning
Clang associations
Primary nursing diagnosis for person with bipolar
Risk for injury (for patient in acute mania to prevent exhaustion and death from cardiac collapse)
Therapeutic range for lithium is between _____ to ____ mEq/L, maintenance range is between _____ to ___mEq/L, and levels should not exceed ____ mEq/L.
0.8- 1.4, 0.4- 1.3, 1.5
Fine hand tremors, polyuria, and mild thirst along with mild nausea, general discomfort, and weight gain are _________ of lithium and seem at ___ to ___ mEq/L- Interventions
expected side effects, 0.4- 1.0
Symptoms may persist or subside, weight gain can be helped with diet and exercise
Nausea, vomiting, diarrhea, thirst, polyuria, lethargy, slurred speech, muscle weakness, and fine hand tremor are _______ of lithium and are seen at ____ mEq/L- Interventions
Early signs of toxicity, 1.5,
Medication withheld, levels measured, dosage reevaluated
Course hand tremor, persistent GI upset, mental confusion, muscle hyperirritability, ECG changes, incoordination, and sedation are _______ of lithium and seen at ___ to ____ mEq/L- Interventions
Advanced signs of toxicity, 1.5- 2.0
-Depending on severity, medication is withheld OR hospitalization is indicated.
Ataxia, giddiness, serious ECG changes, blurred vision, clonic movements, large output of dilute urine, seizures, stupor, sever hypotension, coma are ____ of lithium, seen at levels of ___ to ___ mEq/L- Interventions
Severe toxicity, 2.0-2.5
-Hospitalization with hastened excretion and administered emetic if patient is alert.
Convulsions, oliguria, and death occur when lithium levels reach above ___mEq/L- Interventions
2.5
Hospitalization with hastened excretion, administered emetic, and hemodialysis.
Fatigue, sleep disturbances, changes in appetite, feelings of hopelessness or worthlessness, persistent thoughts of death/suicide, and inability to concentrate or make decisions are all symptoms of…
Major Depressive Disorder (MDD)
Occurs when feelings of depression persist consistently for at least 2 years.
Dysthymic disorder
Relates to children between 6-18yrs that have frequent temper tantrums resulting in verbal or behavioral outbursts out of proportion to the situation
Disruptive mood dysregulation disorder
Refers to a cluster of symptoms that occur in the last week prior to the onset of a woman’s period. Symptoms include discomfort, emotional symptoms similar to depression that interfere with the ability of a woman to work and interact with others.
Premenstrual dysphoric disorder
Applies when symptoms of a major depressive episode arise as a result of prolonged drug or alcohol intoxication or as a result of withdrawal.
Substance-induced depressive disorder
Can be the result of changes that are directly related to certain illnesses (kidney failure, Parkinson’s disease, Alzheimer’s disease)
Depressive disorder associated with another medical condition
Beck depression inventory, hamilton depression scale, zung depression scale, and geriatric depression scale
Assessment tools to assess type and severity of depression
The patient health questionnaire-9
Depression assessment tool that highlights predominant symptoms seen in depression, easy to use, 91% accuracy.
Risk for suicide includes the following symptoms:
Severe hopelessness Overuse of alcohol Recent loss/separation History of past and serious suicide attempts Acute suicide ideation
Highest priority nursing diagnosis for depression
Risk for suicide
Universal human experience and most basic of emotions. feelings of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat
Anxiety
Occurs in the normal experience of everyday living and allows an individual to perceive reality in sharp focus. Problem solving becomes more effective. May have slight discomfort, restlessness, irritability, mild tension-relieving behaviors.
Mild anxiety
Anxiety in which perceptual field narrows and person demonstrates selective inattention, ability to think clearly is hampered, but learning and problem solving can still take place at a less optimal level.
Moderate anxiety
Signs and symptoms include tension, pounding heart, increased pulse, increased respiratory rate, perspiration, and mild somatic symptoms, voice tremors and shaking may be noted.
Moderate anxiety
Anxiety level in which attention is scattered or focused on one detail, problem solving is impossible.
Severe anxiety
Signs and symptoms of this level of anxiety include: feelings of dread, confusion, purposeless activity, sense of impending doom, more intense somatic complains, diaphoresis, withdrawal, loud and rapid speech, and threats/demands
Severe anxiety
Level of anxiety in which person is unable to attend to the environment, focus is lost, disorganized and irrational reasoning.
Panic level of Anxiety
Signs and symptoms of this level of anxiety include: Experience of terror, immobility or severe hyperactivity/flight, unintelligible communication/inability to speak, somatic complains (numbness, tingling, shortness of breath, dizziness, chest pain, nausea, trembling, chills, overheating, palpitations), severe withdrawal, hallucinations or delusions.
Panic level of anxiety
_______ use of defense mechanisms help people lower anxiety to achieve goals in acceptable ways
Adaptive
________ use of defense mechanisms occurs when one or several are used in excess, particularly the overuse of immature defenses
Maladaptive
__________ and _________ are always healthy coping mechanisms
Sublimation and altruism
People who exhibit developmentally inappropriate levels of concern over being away from a significant other.
Separation anxiety
Used to counterbalance perceived deficiencies by emphasizing strengths
- Adaptive: A shorter-than-average man becomes assertively verbal and excels in business
- Maladaptive- An individual drinks alcohol when self-esteem is low to temporarily diffuse discomfort
Compensation
The unconscious transformation of anxiety into a physical symptoms with no organic cause
- Adaptive: NONE
- Maladaptive: man becomes blind after seeing his wife flirt with other men
Conversion
Involves escaping unpleasant, anxiety-causing thoughts, feelings, wishes, or needs by ignoring their existence
- Adaptive: man reacts to death of a loved on by saying “I don’t believe you”
- Maladaptive: woman whose husband died 3yrs ago still keeps his clothes in the closet and talks about him in present tense
Denial
The transference of emotions associated with a particular person, object, or situation to another nonthreatening person, object, or situation
- Adaptive: A child yells at his teddy bear after being bullied at school
- Maladaptive: A child is unable to acknowledge fear of his father and becomes fearful of animals
Displacement
Is a disruption in consciousness, memory, identity, or perception of the environment that results in compartmentalizing comfortable or unpleasant aspects of oneself.
- Adaptive: An art student is able to mentally separate herself form a noisy environment to become absorbed in her work
- Maladaptive: As a result of an abusive childhood, a woman perpetually disconnects from reality
Dissociation
Attributing to oneself the characteristics of another person or group. Done consciously or unconsciously
- Adaptive: 8yr old girl dresses like her teacher and puts together a pretend classroom for her friends
- Maladaptive- Young boy thinks a neighborhood pimp with drugs and money is someone to look up to.
Identification
A process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feeling and emotion into the processing
- Adaptive: Despite the fact that a man has lost his farm to a tornado, he analyzes his options and leads his child to safety
- Maladaptive: a man responds to the death of his wife by focusing on the details of day care and operating the household rather than processing the grief with his children
Intellectualization
Refers to the unconscious rejection of emotionally unacceptable features and attributing them to others
- Adaptive: NONE (Considered an immature defense mechanism)
- Maladaptive: A woman who has repressed an attraction to other women refuses to socialize as a fear that other women will make homosexual advances toward her.
Projection
When unacceptable feelings or behaviors are controlled and kept out of awareness by devolving the opposite behavior or emotion
- Adaptive: recovering alcoholic talks of the evils of drinking
- Maladaptive: Woman who has an unconscious hostility towards her daughter is overprotective and hovers over her to protect her from harm,.
Reaction formation
Consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener.
- Adaptive: An employee says: I didn’t get a raise because the boss doesn’t like me
- Maladaptive: A man who thinks his son was fathered by another man excuses his malicious treatment of the boy by saying he is lazy and disobedient when that is not the case.
Rationalization
Reverting to an earlier, more primitive and childlike pattern of behavior that may or may not have been previously exhibited.
- Adaptive: A 4yr old with a new baby brother starts sucking his thumb and wanting a bottle temporarily
- Maladaptive: A man who loses a promotion starts complaining to others, hands in sloppy work, misses appointments, and comes in late
Regression
An unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness
- Adaptive: A man forgets his wife’s birthday after a fight
- Maladaptive: A woman is unable to enjoy sex after having pushed out awareness of a traumatic sexual incident from childhood
Repression
The inability to integrate the positive and negative qualities of oneself or others into a cohesive image
- Adaptive: NONE (pathological defense)
- Maladaptive: A 26yr old woman initially values her acquaintances yet invariably becomes disillusioned when they turn out to have flaws
Splitting
An unconscious process of substituting mature and socially acceptable activity for immature and unacceptable impulses.
- Adaptive: a woman who is angry with her boss writes a short story about a heroic woman
- Maladaptive: None- always constructive
Sublimation
The conscious denial of a disturbing situation or feeling. (student not paying rent until after exam studied for an entire week)
- Adaptive: Business woman preparing to make an important speech is told that morning her husband wants a divorce. Puts incident aside until after speech.
- Maladaptive: Woman who feels lump in her breast before leaving for 3-week vacation puts information in back of mind until returning from vacation
Suppression
Most commonly seen in children, when a person makes up for an act or communication.
- Adaptive: after flirting with her male secretary, a woman brings her husband tickets to a concert he wants to see
- Maladaptive: A man with rigid, moralistic beliefs and repressed sexuality is driven to wash his hands to gain composure around attractive women
Undoing
Sudden onset of extreme apprehension or fear, usually associated with feelings of impending doom
Panic attack
Intense, excessive anxiety or fear about being in places or situations where escape might be difficult, particularly in wide open places.
Agoraphobia
Persistent, irrational fear of a specific object, activity, or situation that leads to a desire for avoidance or actual avoidance of the object, activity, or sitaution.
Specific phobia
Severe anxiety or fear provoked by exposure to a social or performance situation that could be evaluated negatively by others.
Social anxiety disorder
Excessive worry which is out of proportion to the true impact of events or situations
Generalized anxiety disorder (GAD)
