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Mental health- 405 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Feeling of apprehension, tension, or uneasiness from anticipation of danger. Source is largely unknown or unrecognized, may be regarded as pathological when it interferes with social and occupational functioning, achievement of goals or emotional comfort.

A

Anxiety

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2
Q

Anxiety can be..

A

Mild: alert, prepared for action, sense sharpen, awareness of environment, promotes optimL growth and creativity
Moderate: focus on immediate concerns, less alert, less attention, may need help with problem solving
Severe: focus is on specific detail, less perceptual field, GI upset, chest pain, must direction is needed

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3
Q

Characterized by recurrent panic attacks, onset is unpredictable and manifested by intense apprehension fear terror or doom, intense physical discomfort.

  • disorganized personality
  • increase in motor activity
  • loss of rational thought
  • frightening and paralyzingly
  • may or may not be associated with agoraphobia
A

Panic disorder

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4
Q

The unstable self identity of an individual with schizophrenia may lead to feelings of unreality
+ symptom of schizophrenia

A

Depersonalization

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5
Q

Suicide assessment questions

A

Directly asking: is she/he thinking of suicide?
-do you have a plan?
-what is the lethality of the plan?
High(gun, jumping, hanging)
Low(cutting, natural gas, overdose)
-do you have the supplies (available means) needed to carry out?
*specify the details

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6
Q

Thought process: hallucinations, paranoid behavior, delusions
Perception: emotionally disconnected, self neglect, socially impaired
Affect- bizarre, grimacing, anxious, depressed, flat
Behavior- incongruent with environment, social isolation, catatonic, paranoid, suspicious, erratic

A

Symptoms exhibited by someone with a thought disorder

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7
Q

Hallucinations can be..

A

Auditory or visual

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8
Q

All events within The environment are referred by the psychotic person to him-herself
Example- “someone is trying to send me a message through the articles, tv and radio”
+symptom of schizophrenia

A

Delusions of reference

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9
Q

” is a classification of psychotic disorders manifested by changes in cognitive, perceptual, emotional,behavioral and social domains of brain functioning “

  • serious persistent brain disease
  • most chronic disabling of the major mental illnesses
A

Schizophrenia definition

-Education

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10
Q

Symptoms: +|-
Cognitive: decreased attention, memory loss, decrease learning, decrease ADLs
Mood: dysphonia, suicidal, hopelessness, irritable, paranoid
Triggers- environment, health, attitudes/behaviors
Hallucination management: talk, distract, music

A

Schizophrenia education

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11
Q

Support group
Mental health center
Call 911 if strong voices are telling you to kill your self and you can’t make them stop

A

Schizophrenia education

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12
Q

Associated with normal brain structures on a CT scab and relatively good responses to treatment with antipsychotics

A

Positive symptoms of schizophrenia

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13
Q

Difficult to treat and less responsive to treatment with antipsychotic vs positive symptoms.
Most destructive bc they leave the patient inert and unmotivated.

A

Negative symptoms of schizophrenia

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14
Q

Respond well to antipsychotics

  • delusions: false, fixed belief
  • hallucinations: false sensory perceptions not based in reality 👂🏻👁
  • disorganized speech: concrete thinking, loose associations, word salad
  • bizarre catatonic behaving
  • illusions
  • depersonalization: unstable self identity- feeling of unreality
A

Positive symptoms

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15
Q

Don’t respond well to antipsychotic Rx

  • more destructive to patient fxn
  • flat/inappropriate affect
  • emotional/social withdrawal: anheclonia
  • poor abstract thinking
  • no spontaneous: avolation
  • poverty Of thought: alogia
A

Negative symptoms

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16
Q

Nursing Dx for patient experiencing hallucinations?

A

Altered/disturbed thought process: delusions

Altered/disturbed sensory perceptions: hallucinations

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17
Q

What is Tardive Dyskinesia?

A 
Irreversible movements "lip smacking", from antipsychotic medications that effect the lips, jaw, tongue, fingers, hands and while body 
-repetitive 
* EPS of antipsychotic meds 
Evaluation tool: AIMS 
-abnormal involuntary movement scale
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18
Q

Persistent depressive disorder
Individual with this describes mood as “down in the dumps”
-NO evidence of psychotic symptoms
-the essential feature is a chronically depressed mood (possibly irritable in children/adolescent)

A

Dysthymia

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19
Q

Therapeutic range of Lithium

A

Acute mania: 1.0-1.5 meql

Maintenance: 0.6-1.2 meql

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20
Q

Therapeutic range of Depakote

A

50-150 mcg/ml

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21
Q

What is Lithium used to treat?

A

Tx and prevention of mania and manic episodes in bipolar disorder

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22
Q

Depakote

-anticonvulsant and mood stabilizer

A

Used to treat manic episodes r/t bipolar and depression, seizures

Prolonged bleeding fine, drowsiness, dizziness, headache, GI upset
-caution in elderly, renal impairment, pregnancy and breastfeeding, liver disease

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23
Q

Dysthymia

A

Persistent depressive disorder, people with this describe their mood as down in the dumps or sad. No evidence of psychotic symptoms. Must manifest for 2 years. The essential feature is a chronically depressed mood

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24
Q

Major depression

A

Characterized by depressed mood, loses interest or pleaser in usual activities, social and occupational functioning impaired for at least two weeks. No history of manic behavior. Cannot be attributed to use of substance or general medical condition .

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25
Q

May last a few weeks- months, associated with hormonal changes, tryptophan metabolism and cell alterations.
Tx- antidepressants and psychosocial therapy
S/S- fatigue, irritability, lose of appetite, sleep disturbances, decreased libido, cannot care for infant

A

Post partum depression

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26
Q

Bipolar 1 disorder

-Mania

A

Stage 1- hypo mania
Stage 2- acute mania
Stage 3- Delerious mania

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27
Q

Stage 1-hypo mania

A

Impairment in social and occupational function, hospitalization not required
-cheerful, easily distracted, increased motor activity, extroverted, superficial

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28
Q

Stage 2- acute mania

A

Intensified symptoms, hospitalization required, euphoria, elation, fragmented thinking, flight of idea, hallucinations, excessive activity, increased energy, increased libido, no sleep, bizarre dress/makeup

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29
Q

Stage 3- Delerious mania

A

Grave form of the disorder, clouding of consciousness, intensified of stage 2, may be psychotic

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30
Q

Mania

Mostly manic symptoms, possible episodes of depression

A

Bipolar 1 disorder

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31
Q

Recurrent bouts of major depression
Episodes of hypo mania
-has not experienced an episode that meets the criteria for mania

A

Bipolar 2 disorder

Depression

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32
Q

Lithium

-mood stabilizer

A

Prevention and Tx of manic episodes of bipolar disorder
Caution in pregnancy and lactation
Elderly, renal disease, urinary retention

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33
Q

Lithium side effects

A

Drowsiness, dizziness, headache, dry mouth, thirst, GI upset, NV, fine hand tremors, hypotension, HR irregularities, polyuria, dehydration

34
Q

Non-pharmacological nursing interventions for patients with General anxiety disorder (GAD)

A

Relaxation exercises-deep breathing, physical exercises, walking, jogging, meditation

CBT-reframe cognition to a positive thought process, interrupt distorted thoughts, talk therapy

35
Q

What medications are used to treat anxiety?

A

Anxiolytics
-benzodiazepines (BZDs)
Targeted S/S- irritability, uneasiness, worry, fear, sense of doom, panic, insomnia
MOA: GABA agonists, potentiate GABA and calm the CNS down=decrease anxiety

36
Q

Alprazolam (Xanax)

Lorazepam (Ativan)

A

Short acting BZD

Short duration

37
Q

Librium
Klonopin
Valium

A

Long acting
Not long term
Can be used for mild-severe anxiety

38
Q

Buspirone (buspar)

A

Very long term anxiolytic
Inhibits the actions of serotonin
Little potential for abuse, good choice in substance abuse patients
Non sedating

39
Q

Presence of obsessions or compulsions or both
Person recognizes that the behavior is excessive or unreasonable but bc the feeling of relief from discomfort it brings, the person continues the act.
-obsessions=intrusive thoughts
-compulsions=repetitive behaviors

A

OCD

40
Q

Implies a relationship with OCD

  • some personality disorders are considered to be less severe versions of particular mental disorders
  • preoccupied with details, rules, lists
  • perfection with tasks
  • devoted to work
A

OCD personality disorder

41
Q

Nursing interventions for OCD

A

Do not prevent the compulsive act unless safe
Build self esteem
Develop rapport with the patient
Encourage and aknowledge acceptable ventilation of feelings

42
Q

Signs and symptoms of Lithium toxicity

-SS appear at levels greater than 1.5

A

Blurry vision, ataxia, tinnitus, NVD
Diluted urine OP, tremors, confusion, giddiness
Decreased LOC, nystagmus, seizure, coma, MI

43
Q

What is serotonin syndrome?

A

A potentially life threatening Syndrome associated with increased serotonergic activity at the 5-HT receptions in the cns and receptors in the Pns
-associated with high doses of an SSRI and concurring use of 2 or more drugs known to potentiate serotonin transmission

44
Q

S/s of serotonin syndrome

A

Fever, tachycardia, hyper and hypotension, anxiety, confused, hallucinations, tremors, rigidity

45
Q

What is neuromalignant syndrome?

A

Rare but life threatening emergency associated with the use of antipsychotic agents

  • associated with dopamine blockage or dopaminergic antagonism in the cns
  • characterize by loc change, rigidity, fever and dysautonomia
46
Q 
Develops 24-48 hours 
Agitated, confused, catatonic 
"Lead pipe rigidity" 
Hyperthermia- defining symptom 
Tachycardia, high BP, tachypnea, sweating
A

S/S of neuromalignant syndrome

47
Q

“A sudden even in ones life that disturbs homeostasis, during which usual coping mechanisms cannot resolve the problem.”

-person becomes non-functional, thoughts become obsessional, behavior is aimed out of relieving anxiety.

A

Crisis

48
Q

Cognitive functions are distorted, emotions are liable, behavior may reflect the presence of psychotic thinking.

A

Crisis

-homeostasis is affected

49
Q

What is mood?

-also called affect

A

Mood is a persuasive and sustained emotion that may have a major influence on a personals perception of the world.
Examples: depression, joy, elation, anger, anxiety
Affect- the emotional reaction addicted with an experience

50
Q

Characterized by recurring panic attacks with unpredictable onset and manifested by apprehension, fear, and feelings of impending doom, intense physical discomfort.

  • symptoms come on unexpectedly
  • doesn’t occur after exposure to situation and not triggered by social situations
  • ❤️palpations, sweating, shaking, sob, chest pain, GI upset
A

Panic Disorder

51
Q

Characterized by persistent, unrealistic and excessive anxiety and worry occurring more days than not for at least 6 months.

  • not associated with caffeine or hyperthyroidism
  • often avoid activities or events that may result in a negative outcome
  • procrastination, impaired decision making
  • chronic with frequent stress relayed exacerbations
  • muscle tension, restless, on edge
A

Generalized anxiety disorder (GAD)

52
Q

Drugs to use for long term treatment of GAD?

A

Buspirone (buspar)

  • long term therapy
  • non addictive
  • inhibits action of serotonin
53
Q

How should someone respond to someone with schizophrenia?

A 
Honestly, respect their personal space 
Short and concise 
Give direction 
Give time to respond 
*do not reinforce hallucinations, use "the voices" not "they" 
*dont argue
54
Q

Dystonia

-EPS

A

Most dramatic and acute of all EPS

  • *dramatic muscle movements
  • sustained muscle contraction, contorting, abnormal posture
  • affects primarily musculature of the head and neck
  • high potency meds
55
Q

Tardive Dyskinesia

-EPS

A

**irreversible
Bizarre facial and tongue movements
-“lip smacking”
-increased risk by long term antipsychotic use
-more common with typical (1st gen) antipsychotics

56
Q

Parkinsonism (Akinesia)

-EPS

A

Looks like PD-decrease dopamine pathway

  • shaky tremors, shuffling gait, drooling, rigidity, cogwheel
  • “pretty shaky”
  • confused with - symptoms of schizophrenia
  • caused by low potency meds
57
Q

Akathisia

-EPS

A

Can’t sit still, restless, fidgeting

  • internal drive/restless
  • often confused with worsening of the disease state but increase antipsychotic meds will make this worse
  • associated with suicide
  • caused by high potency meds
58
Q

With Dysthymic disorder what do you see?

A

Mood is sad or “down in the dumps”

  • no psychotic features
  • chronically depressed mood for at least 2 years**
59
Q

Mood stabilizer: anti manic

A

Lithium

60
Q

Mood stabilizer: anticonvulsant

A 
Valproic acid- Depakote 
Carbamazepine 
Clonazepam 
Lamotrigine 
Topiramate
61
Q

Mood stabilizer: antipsychotics

A

Olanzapam-Zyprexa
Ariprizole- ability
Seroquil
Risperidone- risperdal

62
Q

Three stages
Typically seen in bipolar 1 disorder
-changes in mood, cognition and perception, activity and behavior are present in each stage

A

Mania

63
Q

What is Agoraphobia?

A

“Fear of the marketplace”
Fear of being in open shops and markets
Fear of being separated from a source of security
-escape might be difficult or help may not be available
-provokes fear and aviary
-may be associated with panic disorder

64
Q

Depressive disorders

-affective mood disorders

A

Major depressive d/o- depressed mood, loss of interest, either single episode or recurrent

Dysthymic d/o- mood is down in the dumps or sad, chronically depressed mood for at least 2 years

65
Q

Bipolar Disorders 1&2

Mood disorders

A

Bipolar 1 disorder- individual experiencing a recent manic episode or hx of 1 or more manic episodes
*mania

Bipolar 2 disorder- recurrent bouts of major depression with episode of hypo mania, never experienced a full manic episode
* depression

66
Q

Traits “enduring patterns of perceiving, relaying to and thinking of the environment and oneself that are exhibited in a wide range of social and personal contexts”

  • personality disorders occur when these traits become inflexible and maladaptive
  • Axis 2
A

Personality Disorders

67
Q

Personality Disorder
Clusters A,B,C
Defined by the different behaviors exhibited

A

Cluster A: odd and eccentric

Cluster B: dramatic, emotional, erratic

Cluster C: anxious, fearful

68
Q

Cluster A: odd and eccentric

A

Paranoid PD
Schozoid PD
Schizotypal PD

69
Q

Cluster B: dramatic, emotional, erratic

A

Antisocial PD
Histrionic PD
Narcissistic PD
Borderline PD

70
Q

Cluster C: anxious, fearful

A

Avoidant PD
Dependent PD
Obsessive-compulsive PD

71
Q

Pervasive, persistent, inappropriate mistrust of others
Not psychotic
-Cluster A

A

Paranoid PD

72
Q

Inability to form personal relationships or respond to others in a meaningful way; detachment issues

  • begins in early adulthood
  • Cluster A
A

Schozoid PD

73
Q

Bland/apathetic affect, ideas of reference, depersonalization, odd beliefs, illusions, paranoid ideas

  • cluster A
  • “schizophrenia look a like”
A

Schizotypal PD

74
Q

Exaggerated sense Jr self worth, lack empathy, hypersensitive to the evaluation of others, fantasy about success/power, requires admiration
“Special” sense of entitlement
-arrogant/haughty
-Cluster B

A

Narcissistic PD

75
Q

Colorful, dramatic, extroverted behavior, excitable/emotional people, must be center of attention, sexually provocative, shifty emotions, used physical appeal to attract others, theatrical display of emotions- dramatic, excitable, extroverted
-Cluster B

A

Histrionic PD

76
Q

Socially irresponsible, exploitable, guiltless behavior, disregard the rights of others. Repeats breaking the law, irritable and aggressive, impulses, disregards safety, lack of remorse (conduct disorder before age 15)
-cluster B

A

Antisocial PD

Cluster B

77
Q

Pattern of intense and chaotic relationships with affective unstability and fluctuating attitudes toward people. Impulsive and directly and indirectly self destructive, lack of clear sense of identity
-cluster B

A

Borderline PD

-cluster B

78
Q

A pattern of relying excessively on others for emotional support. Feel helpless when alone, act submissively, fail to act when feelings of dominance surrounds. Excessive need to be taken care of, clingy, need others to be responsible.
-cluster C

A

Dependent PD

Cluster C

79
Q

Extremely sensitive to rejection and may become socially withdrawn, extremely shy and has a strong fear of rejection.
Avoids relationships out of fear of rejection or critisim, wants relationship, shy and lonely
-cluster C

A

Avoidant PD

Cluster C

80
Q 
Difficult expressing emotions, overly disciplined, perfectionist, preoccupied with rules 
All work no play 
Inflexible 
Hoards meaningless items 
Cluster C
A

Obsessive Compulsive PD

Cluster C

Mental health- 405 (4 decks)

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