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)
Characterized by symptoms of anxiety, panic attacks, obsessions and compulsions that develop with use of substance
Substance-induced anxiety disorder
The individuals symptoms of anxiety are the direct physiological result of a medical condition. (hyperthyroidism, pulmonary embolism, or cardiac dysrhythmias)
Anxiety due to a medical condition
Thoughts, impulses, or images that persist and recur and cannot be dismissed from the mind even when the person attempts to do so.
Obsessions
Ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety or prevent an imagined calamity.
Compulsions
Preoccupation with an imagined defective body part resulting in irrational thinking and compulsive behavior.
Body dysmorphic disorder
The accumulation of belongings that may have little or no value in an obsession that prevents some people form leading normal lives.
Hoarding disorder
Trichotillomania
Hair pulling disorder
Dermotillomania
Skin picking disorder
Yale-brown obsessive compulsive scale, hoarding scale self-report, panic disorder severity scale are used for..
Different types of panic/anxiety disorders
The Hamilton Rating scale is used for…
Measuring anxiety
The Fear Questionnaire is used to…
Measure phobias
_____ are the first line of defense in most anxiety and OCD disorders.
SSRIs
Severe emotional inhibition
Reactive attachment disorder
Indiscriminately social behaviors
Disinhibited social engagement disorder
Refers to positive adaptation or the ability to maintain or regain mental health despite adversity
Resilience
The Child Dissociative Checklist is used for…
Assessing children with trama disorders
Trauma symptoms checklist for children, child sexual behavior inventory, and disturbances of attachment interview may be used to ..
Assess children for trauma disorders
Priority nursing diagnosis for children with trauma disorders: (2)
- Risk for impaired parent/child attachment
- Risk for delayed development
Term that means a balance between sympathetic and parasympathetic arousal
Window of Tolerance
Innovative evidence-based therapy used to treat children and adults to help process traumatic memories through a specific eight-phase protocol that allows the person to think about the traumatic event while attending to other stimulation, such as eye movements, audio tones, or tapping.
Eye movement desensitization and reprocessing (EMDR)
ACE
Adverse Childhood Experiences
Persistent re-experiencing of a highly traumatic event that involves actual or threatened death or serious injury to self or others, to which the individual responded with intense fear, helplessness or horror
PTSD
PCL and PC-PTSD
Assessment tools used to screen for PTSD (Primary Care PTSD Screen and PTSD Checklist)
May develop after exposure to a highly traumatic event. Must display 8 of 14 specific symptoms
Acute Stress Disorder
A milder, less specific version of ASD and PTSD. Precipitated by a stressful event that is not severe or traumatic.
Adjustment disorder
An unconscious defense mechanism that protects the individual against overwhelming anxiety through an emotional separation- Occurs after significant adverse experiences/traumas
Dissociative disorders
Dissociative disorders include 3 disorders:
- Depersonalization/derealization disorder
- Dissociative amnesia
- Dissociative identity disorder
Inability to recall important personal information, often of a traumatic or stressful nature. Autobiographical memory is available but not accessible
Dissociative amnesia
Sudden, unexpected travel away from the customary locale and inability to recall one’s identity and information abut some or all of teh past. Precipitated by a traumatic event.
Dissociative fugue
Presence of two or more distinct personality states that recurrently take control of behavior.
Dissociative identity disorder
Somatoform Questionnaire is used for…
Assessment of dissociation
bring the person’s awareness to noticing real things in the present to help counter dissociative episodes.
Grounding Techniques
Findings of PET scan for patient with schizophrenia
Reduced brain activity in frontal lobes
PET scan results for patient with OCD
Increased brain metabolism in frontal cortex
PET scan findings of patient with depression
Decreased brain activity/metabolism in prefrontal cortex
PET scan findings of patient with Alzheimer’s
Hypometabolism in temporal and parietal regions
Neurotransmitters most consistently linked with mental activity: (5)
- Norepinephrine
- Dopamine
- Serotonin
- GABA
- Glutamate
True or False: Depression is caused by an excess of neurotransmitters.
False- Deficiency of norepinephrine and/or serotonin
True or false: Schizophrenia and other thought disorders are associated with excess of neurotransmitters.
True: Dopamine specifically
Drug classification: Benzodiazepines
Antianxiety
Drug class: Z-drugs
Hypnotic
Flurazepam (Dalmane), temazepam (Restoril), triazolam (Halcion), estazolam (Prosom), and quazepam (Doral).
Benzodiazepines (hypnotic)
Benzodiazepines are _______ ________ and may contribute to falls/broken bones, should not be taken in the daytime, and should not be taken with alcohol and other _____ _____
CNS depressants
zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta)
Z-drugs/Hypnotics
Lorazepam (Ativan), alprazolam (Xanax)
Benzodiazepines
Antianxiety and Hypnotic drugs target _______ receptors associated with pain, memory, and mood.
GABA
Ramelteon (Rozerem)
Melatonin receptor agonist
Doxepin (Silenor) use
Treatment of insomnia: difficulty maintaining sleep.
Doxepin (Silenor) contraindications:
Severe urinary retention
MAOIs CNS depressants
Sedating Antihistamines
Buspirone (BuSpar) uses:
Reduces anxiety without sedative properties
*Can use with other CNS depressants- causes insomnia/dizziness
Antidepressants target which neurotransmitters? (2)
Norepinephrine and Serotonin
amitriptyline (Elavil), imipramine (Tofranil), nortiptyline (Pamelor)
TCAs
TCAs lead to _______ ______.
Anticholinergic effects
Overdose of antidepressant _________ can be fatal secondary to cardiac conduction disturbances.
TCAs
fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox)
SSRIs
SSRIs increase levels of _______
Serotonin
TCAs increase levels of ________
Norepinephrine (and sometimes serotonin)
*Also block Histamine causing sedation
Venlafaxine (Effexor), Duloxetine (Cymbalta)
SNRI (Cymbalta- depression, GAD, diabetic neuropathy, fibromyalgia)
SNRIs increase levels of….
Serotonin and Norepinephrine
SNRIs are known to increase _______
BP
SNDIs increase levels of….
Norepinephrine and Serotonin
_______ antidepressants should be given to patients with nausea
SNDIs (antiemetic)
- weight gain, sedation
MAOIs increase levels of ____________.
Most neurotransmitters
MAOIs should be used cautiously because….
Tyramine is present in many food substances and should not be used with other antidepressants
Bupropion (Wellbutrin/Zyban) is used for…
Antidepressant used for smoking cessation
Bupropion (Zyban) is contraindicated in…
Patients with seizure disorder, bulimia, anorexia, or alcohol/sedative discontinuation
Anticonvulsants are _____ antagonist and _____ agonists
Glutamate, GABA
Many anticonvulsants (Valproate (Depakote), Carbamazepine (Tegretol), Lamotrigine (Lamictal)) require frequent __________ _________.
Blood monitoring
Antipsychotic drugs can help symptoms of _______.
Schizophrenia
Antipsychotic drugs target which neurotransmitters?
Dopamine
Antipsychotics can lead to an increase in which hormone?
Prolactin (Signs and symptoms- amenorrhea, galactorrhea, gynecomastia)
Antipsychotics are antagonists of _______ and block ____ receptors
Norepinephrine, histamine
Antipsychotics impair memory because of a blockage of _________.
Acetylcholine
____________ antipsychotics are chosen as first-line treatment of schizophrenia.
Second-generation
__________ increase risk of metabolic syndrome (weight gain, increased blood glucose, increased triglycerides, etc. )
Antipsychotics
Alzheimer’s drugs target _______ and _______.
Acetylcholine (inhibit acetylcholinesterase), Glutamate (decreases levels that destroy neurons)
Namenda, Namenda XR, Memantine all treat…
Alzheimers
St. John’s wort should not be taken with….
Many other medications because it increases metabolism of medications
Patient as a full partner in his care whose values, preferences, and needs are respected.
Patient-centered care
Interactive process between two or more persons who send and receive messages to one another
Communication
Validating the accuracy of the sender’s message is very important and is known as _______.
Feedback
Effective communication in therapeutic relationships depends on nurses’ (3):
- KNOWING the purpose of the message
- COMMUNICATING what is really meant to the patient
- COMPREHENDING the meaning of what the patient is intentionally or unintentionally conveying
Peplau identified two main principles that can guide the communication process during a nurse-patient interview…
- Clarity (ensures that meaning of the message is accurately understood)
- Continuity (promotes connections among ideas)
This is an example of…
The patient is slumped in a chair, puts her face in her hands, and occasionally traps her right foot .
Body behaviors
-Posture, body movements, gestures, gait
The patient grimaces when speaking to the nurse, when alone he smiles and giggles to himself.
This is an example of…
facial expressions
-Frowns, smiles, grimaces, raised eyebrows, pursed lips, licking lips, tongue movements
The patient’s eyes harden with suspicion
This is an example of….
Eye expression/gaze behavior
-Lowering brows, intimidating gaze
the patient talks in a load sing-song voice
This is an example of….
Voice-related behaviors
-Tone, pitch, level, intensity, inflection, stuttering, pauses, silences, fluency
When the patient mentions discharge she becomes pale and her respirations increase
This is an example of….
Observable autonomic physiological responses
-Increase in respirations, diaphoresis, pupil dilation, blushing, paleness
The patient is dressed in a wrinkled shirts, his pants are stained and his socks are dirty. He is unshaven
This is an example of….
Personal appearance
-Grooming, dress, hygiene
The patient is grossly overweight and his muscles appear flabby
This is an example of….
Physical characteristics
-Height, weight, physique, complexion
The ____ and ____ hold the biggest cues on a persons true feelings
Eyes, mouth
Verbal message is referred to as the _____ of the message
Content
Nonverbal behavior is referred to as the ____ of the message
Process
Conflicting messages are known as…
Double or mixed message (different content and process)
Two or more mutually contradictory messages given by a person in power.
Double-bind messages
Useful tools for nurses when communicating with their patients (4)
Silence
Active listening
Clarifying techniques
Questions
Clarifying techniques include…. (4)
Paraphrasing
Restating
Reflecting
Exploring
In other words…. and It seems you are saying…. are examples of….
Paraphrasing
Your life has no meaning? and What kind of meaning is missing? are examples of….
Restating
You looks sad… and I wonder what they are…. are examples of
Reflecting
A means of assisting a patient to better understand their own thoughts and feelings.
Reflecting
Restating in different or fewer words the basic content of a patient’s message
Paraphrasing
Mirroring the patient’s overt and covert messages so the technique may be used to echo feeling as well as content
Restating
Enables the nurse to examine important ideas, experiences, or relationships more fully.
Exploring
Tell me about…. and Give me an example…. are examples of
Exploring
Questions that encourage patients to share information
Open-ended questions
Open-ended questions should be used when…
Establishing rapport with a patient
Beginning of an interview
Help the clinician elicit information
Questions that require a yes or no response and give specific needed information
Close-ended questions
Close-ended questions should be used when….
Initial assessment or intake interview
To ascertain specific results
Questions that start with “what if” and help people articulate, explore, and identify feelings and thoughts
Projective questions
Projective questions should be used….
To help people imagine thoughts, feelings, and behaviors in certain situations
Miracle questions used to identify goals that the patient may be motivated to pursue.
Presupposition questions
Asking a question about what the patient would do if their problem had gone away is an example of a ________ question and help get to the crux of what might be the most important issues in a person’s thinking/life.
Presupposition
Which of these are non-therapeutic techniques?
1- Minimizing feelings
2- Making observations
3- Placing the events in time/sequence
4- Falsely reassuring
5- Attempting to translate into feelings
6- Changing the subject
1, 4, 6
Which of these techniques are therapeutic? 1- Restating 2- Encouraging evaluation 3- Giving advice 4- Giving approval/agreeing 5- Encouraging description of perception 6- Presenting reality
1, 2, 5, 6
Cultural consideration include these four verbal and nonverbal messages
1- Communication style
2- Use of eye contact
3- Perception of touch
4- Cultural filters
A form of cultural bias or cultural prejudice that determines what we pay attention to and what we ignore
Cultural filters
Preparing for a client interview includes (3):
Pace, Setting, Seating
Associated with physical characteristics, such as body movements and postures, facial expressions, eye contact, the way someone holds their head, legs, and shoulders.
Kinesics
The study of personal space and the significance of the physical distance between individuals
Proxemics
0-18in is considered ____ distance
Intimate (in US)- For those we trust
18-40in is considered ______ distance in the US
Personal- Friends/colleagues
4-12 feet is considered _____ distance in the US
Social-Strangers/acquaintances
12feet+ is considered ______ distance in the US
Public- public speaking
Attending behaviors include (3):
Eye contact
Body language
Vocal quality
Written records of a segment of the nurse-patient session taht reflect as closely as possible the verbal and nonverbal behaviors of both patient and nurse.
Process recording
*Useful tool for identifying communication patterns
Characteristics of mania are assessed by: (4)
- Mood
- Behavior
- Thought processes/speech patterns
- Cognitive function
Nonstop physical activity and lack of sleep and food found in mania is…
AN EMERGENCY and can lead to death if not treated.
Primary outcome for acute phase of bipolar:
Injury prevention
Primary outcome for continuation phase (4-9mo) of bipolar
Relapse prevention
The following are examples of outcomes from which phase of bipolar:
- be well hydrated
- Stable cardiac status
- Get sufficient sleep and rest
- Make no attempt of self-harm
Acute
The following are outcomes from which stage of bipolar:
- Knowledge of disease process
- Knowledge of medication
- EDUCATION
- Support groups/therapy
Continuation
Maintenance phase outcomes focus on…
Prevention of relapse and limitation of the severity and duration of future episodes
In which stage of bipolar would you see these outcomes:
- Participation in learning interpersonal strategies
- Participation in psychotehrapy, group therapy, ongoing therapy
Maintenance
Medical stabilization, safety, and hospitalization are usually seen in the _______ phase of bipolar
Acute
Focuses on maintaining adherence to medication regimens and prevention of relapse are seen in the _____ stage of bipolar.
Continuation
Focuses on preventing relapse and limiting the severity and duration of possible episodes is seen in the _____ phase of bipolar
Maintenance
Starting medications for depressive episodes (lithium) and providing safety for manic episodes (hospitalization) are seen in the ______ phase
Acute
Medication adherence is the most important treatment outcomes in the _____ phase
Continuation
Community resources are important in the ____ phase
Maintenance
Start low and go slow is a drug philosophy used for …. .
Older patients
Two major long-term risks of lithium therapy
- Hypothyroidism
- Kidney impairment of ability to concentrate urine
________ drugs are effective for cycling patients, acute mania, rapid cyclers, and dysphoric mania.
Anticonvulsants
_______ is less effective on patients with mixed mania, rapid cycling, and atypical featuers
Lithium
_______ is an anticonvulsant that is the first-line response for bipolar depression
Lamotrigine (Lamictal)
______ is used to subdue severe manic behavior, patients with rapid cycling. Depressive episodes and mania during pregnancy are indications.
ECT- electroconvulsive therapy
Mood stabilizers cause weight gain, risk for diabetes, high blood pressure, dyslipidemia, cardiac problems which are combined known as… .
Metabolic syndrome
APRN treatment for bipolar (2)
CBT
Interpersonal and social rhythm therapy
PET scan of a person with depression shows…
Decreased activity, particularly in the prefrontal cortex.
Beck’s cognitive triad related to depression:
- A negative, self-deprecating view of self
- A pessimistic view of the world
- The belief that negative reinforcement will continue in the future
The outward representation of a person’s internal state of being and is an objective finding based on the nurse’s assessment related to depression.
Affect
Frequent sighing, monotone speaking, and no facial expressions are an example of
Affect
Outcomes of depression focus on a ________ model
recovery
Changes in sleeping, eating, and sexual satisfaction are examples of _______ signs of depression
vegetative
Phase directed at reduction of depressive symptoms and restoration of psychosocial ad work function. Hospitalization may be required and medication and other treatments are initiated
Acute phase: 6-12 weeks
Phase directed at prevention of relapse through pharmacotherapy, education, and depression-specific psychotherapy
Continuation phase: 4-9mo.
Treatment of this phase is directed at prevention of further episodes of depression.
Maintenance phase (1year+)
Since antidepressants take 1-3 weeks to work, ______ is used for patients who are acutely suicidal
ECT- electroconvulsive therapy
Antidepressants increase one or more neurotransmitters including…
Norepinephrine, serotonin, and dopamine
________ and ________ warrant immediate medical attention for patients taking TCAs
Urinary retention, severe constipation
TCAs may affect the… causing serious adverse reactions
heart
*Risk for elderly, cardiac disease
MAOIs can cause increases in… causing serious adverse reactions
Blood pressure
Induces seizures that result in mobilization and activity of neurotransmitters. Decreases suicidal thoughts.
ECT
Procedure where patient is given general anesthetic to induce sleep and seizures are induced with electrical current. EEG monitors brain response and ECG monitors heart response
ECT
A noninvasive treatment modality that uses MRI-strength magnetic pulses to stimulate focal areas of the cerebral cortex. Alternate to antidepressants in pregnant women.
TMS- Transcranial Magnetic stimulation
Headache
Lightheadedness
Seizures
Scalp tingling and discomfort
TMS reactions
Memory deficits
Confusion
Reactions to ECT
Boosts levels of neurotransmitters and improves actin of antidepressants by use of surgical implant of pace-maker device into the left chest wall. Pulses are delivered to this site.
VNS- Vagus nerve stimulation
Treatment whereby electrodes are surgically implanted into specific areas of the brain in order to stimulate regions of underactivity.
DBS- Deep brain stimulation
*Potential for intracranial hemorrhage
First-line treatment of SAD and may also treat MDD or dysphoric disorder
Light Therapy
Mania feels wonderful in the beginning but turns dark and scary as it progresses toward loss of control and confusion
Euphoric mania
Mixed state or agitated depression, depressive symptoms along with mania
Dysphoric mania
Negative effects of light therapy
Headaches
Jitteriness
Flower thought to increase amounts of serotonin, norepinephrine, and dopamine in the brain. As effective as antidepressants in treatment of mild to moderate depression
St. John’s Wort
Dampens activity of hypothalamic-pituitary-adrenocoritcoid (HPA) axis, which is believed to be overly active in depression. More easily accessed, less expensive, and results in fewer side effects than antidepressants
Exercise
APRN treatments for depression
CBT
IPT (interpersonal therapy)
Group therapy
The ______ of the brain plays a role in anxiety disorders.
Amygdala
Neurotransmitters that influence anxiety:
Epinephrine, Norepinephrine, dopamine, serotonin, GABBA
True or false: Decreased amounts of GABA causes people to suffer from anxiety.
True
