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Mental Health Lecture > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Characteristics of ADHD

A

Inappropriate degree of
Inattention
Impulsiveness
Hyperactivity (can also have absence of hyperactivity. This type is called inattentive type, previously was ADD)

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2
Q

Gold standard for treatment of ADHD

A

Medication

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3
Q

When evaluating inattentive type ADHD, what should be focused on?

A

Academic performance
ADLs
Social relationships
Personal perception
(Pts usually have low self esteem)

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4
Q

When evaluating hyperactive-impulse type ADHD (or combined type), what should be focused on?

A

Academic performance
Social skills and relationships
*Impulse control
Behavioral responses
(Focuses more on interpersonal relationships)

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5
Q

What are medications for ADHD used for?

A

Increase attention and task directed behavior
For aggressive behaviors

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6
Q

Psychological therapies for ADHD

A

Parent training in behavior therapy
Cognitive behavioral therapy

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7
Q

Stimulants used to treat ADHD

A

Methylphenidate (Ritaline)
Mixed amphetamine salts (Adderall)
Both cause weight loss and sleep disturbances as side effects

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8
Q

Nonstimulants for ADHD

A

Atomoxetine (Stratera)
No dopamine but doesn’t act as fast (takes 6 weeks)

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9
Q

Alpha 2 adrenergic agonists for ADHD

A

Clonidine
Guanfacine
(Can make pts sleepy)

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10
Q

Medications used to treat aggressiveness in ADHD

A

Antipsychotics

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11
Q

With patients taking medications for ADHD, what needs to be monitored?

A

Vital signs
Assess kidney function
*Need to watch for Tardive dyskinesia

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12
Q

Symptoms of ADHD in adults

A

Poor concentration
Stress intolerance
Antisocial behavior
Outbursts of anger
Inability to maintain a routine

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13
Q

Drug therapy for ADHD in adults

A

Methylphenidate (b/c scared they will abuse adderall/ritaline

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14
Q

Definition of anxiety

A

Apprehension, uneasiness, uncertainty, or dread from *unspecified or *unknown threat

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15
Q

What does mild anxiety look like?

A

Everyday problem-solving leverage
Grasps more information effectively

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16
Q

What does moderate anxiety look like?

A

Selective inattention
Clear thinking hampered
Problem solving not optimal
SNS symptoms begin

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17
Q

What does severe anxiety look like?

A

Perceptual field greatly reduced (less aware of surroundings)
Difficulty concentrating on environment
Confused and automatic behavior
Somatic symptoms increase

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18
Q

What does panic look like?

A

Markedly disturbed behavior - running, shouting, screaming, pacing
Unable to process reality
Impulsivity

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19
Q

Define compensation (defense mechanism for anxiety)

A

Used to counterbalance perceived deficiencies by emphasizing strengths

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20
Q

Adaptive use of compensation

A

A shorter than average man becomes assertively verbal and excels in business

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21
Q

Maladaptive use of compensation

A

Woman drinking alcohol when self esteem is low to temporarily ease her discomfort

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22
Q

Define denial (defense mechanism for anxiety)

A

Escaping unpleasant, anxiety-causing thoughts, feelings, wishes, or needs by ignoring their existence

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23
Q

Adaptive use of denial

A

Someone saying “no I don’t believe you” when someone dies to protect themself from initial grief

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24
Q

Maladaptive use of denial

A

Woman whose husband died 3 years ago still keeps his clothes in her closet and talks about him in the present tense
“No i don’t have a drinking problem”

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25
Q

Definition of projection (defense mechanism of anxiety)

A

Unconscious rejection of emotionally unacceptable features and attributing them to others

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26
Q

Adaptive use of projection

A

There is no adaptive use because this is considered an immature defense mechanism

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27
Q

Maladaptive use of projection

A

A kid saying they’re cold and the parent telling them to put a coat on. Putting their own feelings into something.

A woman who has a suppressed attraction to women not going out to socialize because they’re afraid women will come onto them

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28
Q

Definition of rationalization (defense mechanism of anxiety)

A

Justifying why something is happening

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29
Q

Adaptive use of rationalization

A

An employee says “I didn’t get the raise because my boss doesnt like me”

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30
Q

Maladaptive use of rationalization

A

A man who believes his son was fathered by another man, treating him poorly and justifying it by saying he’s lazy and doesn’t listen when that’s not true

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31
Q

Excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing

A

Agoraphobia

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32
Q

Outcomes for anxiety and fear

A

Self monitors intensity
Uses reduction techinques

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33
Q

Outcomes for difficulty coping

A

Identifies ineffective and effective patterns
Asks for assistance and information
Modifies as needed

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34
Q

Outcomes for impaired socialization and low self-esteem

A

Self-monitors anxiety and desire for avoidance
Uses techniques to reduce anxiety to maintain role performance

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35
Q

Treatments of anxiety

A

Biological: pharmacotherapy:
- Antidepressants
- Anti-anxiety drugs
Integrative medicine
Psychosocial therapies
- Behavioral therapy (EMDR, eye movement, etc.)
- Cognitive behavioral therapy

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36
Q

What should you make sure to ask patients who have anxiety?

A

What their coping mechanisms are

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37
Q

DSM-5 criteria for OCD

A

Obsessions, compulsions, or both
Not due to a substance or condition
Not explained by another psychiatric disorder
Time consuming (over 1 hr per day)

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38
Q

Risk factors for OCD

A

Child abuse and trauma
Post-infectious autoimmune syndrome
Genetics: first-degree relative = twice the risk

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39
Q

Which diseases does OCD frequently have comorbidities with?

A

Anxiety disorders
Eating disorders
Tic disorder

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40
Q

Biological treatments of OCD

A

SSRIs (FDA approved for OCD)
Clomipramine (TCA), Venlafaxine (SNRI)
Some antipsychotics

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41
Q

Psychological therapies for OCD

A

Exposure and response prevention (expose pt to triggers of OCD symptoms)
- first line cognitive-behavioral intervention for OCD behaviors. Shows pt that anxiety does not subside even when ritual is not completed

Flooding
(Expose pt to large amount of trigger to extinguish response)

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42
Q

What can propranolol be given for to help with psychosocial problems?

A

Stage fright

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43
Q

How do SSRIs treat anxiety?

A

Blocks reuptake of serotonin increasing levels in the brain

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44
Q

How do SNRIs treat anxiety?

A

Blocks both serotonin and norepinephrine in the brain

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45
Q

How do noradrenergic drugs treat anxiety?

A

Propranolol - blocks adrenergic receptor activity
Clonidine - stimulates adrenergic receptors

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46
Q

How do benzodiazepines treat anxiety?

A

Binds to benzodiazepine receptors, facilitates action of GABA, slowing neural transmission thus lowering anxiety

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47
Q

How does buspirone (BuSpar) treat anxiety?

A

Functions as a serotonin 5-HT(1A) receptor partial agonist resulting in anxiolytic and antidepressant effects
(Can treat the worry associated with GAD rather than the muscle tension)

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48
Q

Characteristics of PTSD in adults

A

Flashbacks
Avoidance of stimuli associated with trauma
Persistent symptoms of increased arousal (hypervigilance)
Alterations in mood

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49
Q

Outcomes for PTSD

A

Manages anxiety
Experiences enhanced self-esteem
Exhibits an enhanced ability to cope

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50
Q

Pharmacotherapy for PTSD

A

Antidepressants
SSRIs

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51
Q

Psychological therapies for PTSD

A

Components of exposure and/or cognitive restructuring and EMDR therapy

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52
Q

What is ASD?

A

Acute stress disorder
Immediately after a highly traumatic event
Symptoms that persist for 3 days

Diagnosis made within month and if they persist longer than than, resolution or it become PTSD

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53
Q

Treatment for ASD

A

Psychological therapies
- CBT
- Specialized protocols for EMDR therapy

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54
Q

What is adjustment disorder?

A

A milder, less specific version of ASD and PTSD
Precipitated by a stressful event

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55
Q

Symptoms of adjustment disorder

A

All forms of distress: guilt, depression, anxiety, anger

May be combined with other manifestations of distress:
Physical complaints, social withdrawal, impaired occupational function, academic decline

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56
Q

What are dissociative disorders?

A
  • Occur after significant adverse experience/trauma
  • Individuals respond with severe interruption of consciousness (unconscious defense mechanism)
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57
Q

What is dissociative amnesia?

A

Inability to recall important personal information
Often of traumatic or stressful nature

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58
Q

Subtype of dissociative amnesia characterized by sudden, unexpected travel and inability to recall one’s identity

A

Dissociative fugue

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59
Q

Difference between depersonalization and derealization

A

Depersonalization: focus on self: extremely uncomfortable feeling of being an observer of one’s own body or mental process

Derealization: focus on outside world: recurring feeling that one’s surroundings are unreal or distant. Feel like you’re walking around in a fog, bubble, or dream

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60
Q

Disorder with Presence of two or more distinct personality states

A

Dissociative identity disorder

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61
Q

Nursing diagnoses for dissociative disorders

A

Disturbed personal identity
Impaired role performance
Anxiety (specify level)

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62
Q

Phases when planning treatment of dissociative disorders

A

Phase 1: safety, stabilization and symptom reduction
Phase 2: confronting and integrating traumatic memories
Phase 3: identify integration and rehabilitation

63
Q

Biological treatment for dissociative disorders

A

No specific medications
Medications for hyperarousal and intrusive symptoms

64
Q

Psychological therapies for dissociative disorders

A

CBT
Psychodynamic psychotherapy
Exposure therapy
Modified EMDR therapy
Hypnotherapy
Neurofeedback
Ego state therapies
Somatic therapies
Medication

65
Q

What is somatization?

A

Expression of stress through physical symptoms that are often manifestations of psychological and emotional distress
(Anxiety, depression, irritability)

66
Q

4 primary somatic symptom disorders

A

Somatic symptom disorder
Illness anxiety disorder
Conversion disorder
Cognitive factors affecting medical condition

67
Q

Two somatic symptom disorders that are under conscious control

A

Factitious disorder
Malingering

68
Q

What is somatic symptom disorder?

A

Excessive thoughts, anxiety and behaviors around symptoms or health concerns without physical findings or medical diagnosis
- suffering is authentic
- high level of functional impairment

69
Q

Comorbidities with somatic symptom disorder

A

Anxiety disorders
Major depressive disorders

Medical illnesses with higher degree of impairment than expected

70
Q

Important things to remember when treating a pt with somatic symptom disorder

A

Avoid concentrating on psychosocial issues too early and concentrate on current bodily symptoms (but try to avoid unnecessary or repetitive diagnostics)

Focus on development of self-compassion because they tend to focus on internal locus of control (it’s my fault this is happening to me)

71
Q

Treatment of somatic symptom disorder

A

Possible hypnotherapy
CBT in conjunction with medication

72
Q

What is illness anxiety disorder?

A

Fear and preoccupation with having or acquiring serious illness for at least 6 months
Somatic symptoms are absent or mild
Frequent self scanning for signs of illness
*May be care-seeking or care-avoidant
(Either always going to the Dr or avoid going b/c they’re scared)

73
Q

Treatment of illness anxiety disorder

A

Pharmacotherapy
CBT
ECT (very drastic)

74
Q

Important things to remember for treating illness anxiety disorder

A

Discuss illness concerns, but favor other topics
Reassure them that psychiatric care will supplement medical care
Encourage socialization (loneliness associated with illness anxiety disorder)

75
Q

What is conversion disorder?

A

Neurological symptoms in absence of a neurological diagnosis
Presence of deficits in voluntary motor or sensory functions
*La belle indifference versus distress (patients do not seem too concerned with symptoms)

76
Q

Common symptoms of conversion disorder

A

Paralysis
Blindness
Movement and gait disorders
Numbness
Paresthesias
Loss of vision or hearing
Episodes resembling epilepsy

77
Q

Treatment of conversion disorder

A

Provide reassurance and support for pts feelings and beliefs
Encourage socialization
Explore alternative and adaptive coping mechanisms

78
Q

Treatment modalities for conversion disorder

A

Body oriented psychological therapy
Dialectical behavior therapy
Psychodrama
Physical therapy

79
Q

What does psychological factors affecting medical condition mean?

A

Psychological factors can increase risk for medical diseases, magnify them, or interfere with their treatment
Ex: depression can lead to cardiovascular diseases and cancer which can lead to more depression

Stress also affects health

80
Q

Treatment for psychological factors affecting medical condition

A

Teach importance of positive affective responses
Assess childhood experiences
Coping skills
Focus on connections to family, friends, etc.

81
Q

Implementation for somatic symptom disorders

A

Coping skills
Support groups or systems
Focus on strengths and reinforce skills
*promote self-care activities
Assertiveness training

82
Q

What is factitious disorder?

A

Artificially, deliberately, and dramatically fabricate symptoms or self-inflict injury

Goal of assuming a sick role, is a compulsivity
Consciously conceal true nature of illness

83
Q

What is malingering

A

Condition related to factitious disorders
Conscious fabrication of illness or exaggerating symptoms for secondary gain such as insurance fraud, prescription medication, or avoidance of prison or military service

84
Q

Types of anorexia nervosa

A

Restricting type
Binge-eating/purging type

85
Q

Important consideration for treating anorexia

A

Refeeding syndrome p.335

86
Q

Biological treatment for anorexia

A

Pharmacotherapy
Can’t treat anorexia with meds but can treat the symptoms

87
Q

Integrative medicine for anorexia

A

Yoga
Massage
Acupuncture
Bright light therapy

88
Q

Psychological therapies for anorexia

A

Insight-oriented individual therapy
Adolescent-focused therapy
Family therapy
CBT

89
Q

DSM-5 criteria for bulimia nervosa

A

Recurrent episodes of binge eating
Recurrent episodes inappropriate with compensatory behavior
Both occur, on average, at least once a week for 3 months
Self-evaluation is unduly influenced by body shape and weight

90
Q

Difference between anorexia and bulimia

A

With bulimia, it is an egodystonic disorder - the pt knows they shouldn’t be doing it but they do it anyway

91
Q

Physical symptoms of bulimia

A

Appear well: at or near ideal body weight
*Enlarged parotid glands
Dental erosion and caries if pt has been vomiting

92
Q

Emotional and relationship signs of bulimia

A

Impulsivity and compulsivity
Chaotic, no nurturing family relationships
Familial and/or social instability
Difficult interpersonal relationships

93
Q

Biological treatment for bulimia

A

Antidepressants: fluoxetine (Prozac)
Other antidepressants
*Never Wellbutrin for pts who vomit b.c it could induce a seizure

94
Q

Advanced practice interventions for bulimia

A

CBT
Mixed method approach for refractory cases
dialectical behavioral therapy
Interpersonal therapy
Acceptance and commitment therapy

95
Q

Things to remember when implementing treatment for binge eating disorder

A

Binge eating is not about food, it’s about coping with emotion
Help pt track what events triggered an episode
Community or group activities
Use incremental approach in goal setting

96
Q

Biological treatment for binge eating disorder

A

SSRIs (weight tends to return after treatment)
SNRIs
Lisdexamfetamine (lowered relapse risk)
Vivanse to decrease appetite

Surgical intervention: bariatric surgery

97
Q

Psychological therapies for binge eating disorders

A

CBT
Dialectical behavior therapy
Interpersonal therapy

98
Q

Short term consequences of sleep loss

A

Increased stress responsively
Somatic pain
Reduced quality of life
Emotional distress
Mood disorders
Cognitive, memory, and performance deficits
Safety risks

99
Q

Long term effects of sleep loss

A

Cardiovascular disease
Weight related issues
Metabolic syndrome
T2DM
Colorectal cancer
All-cause mortality
Safety issues
Financial burden

100
Q

What occurs during REM sleep?

A

*Reduction and absence of skeletal muscle tone
Results in *Atonia
- Bursts of rapid eye movement
- Myoclonic twitches of facial and limb muscles
- Dreaming
- Automatic nervous system variability

101
Q

What is atonia?

A
  • protective mechanism to prevent physical response to dreams
102
Q

Two processes that regulate sleep

A

Hemostasis process or sleep drive - promotes sleep
Circadian process or circadian drive - promotes wakefulness, influenced by endogenous and exogenous factors

103
Q

Distribution of sleep and wakefulness across the sleep period

A

Sleep continuity

104
Q

Disruption of sleep stages

A

Sleep fragmentation

105
Q

Ratio of sleep duration to time spent in bed

A

Sleep efficiency

106
Q

The time it takes to fall asleep (associated with N1 stage)

A

Sleep latency

107
Q

Homeostatic process that promotes sleep

A

Sleep drive

108
Q

Process that promotes wakefulness

A

Circadian drive

109
Q

Exogenous factors that help set our eternal clock to a 24 hour cycle (“time givers”)

A

Zeitgebers

110
Q

SC nucleus in the hypothalamus that regulates a host of functions

A

Master biological clock

111
Q

Amount of sleep necessary to feel fully awake and sustain normal levels of performance

A

Basal sleep requirement

112
Q

All night test using electrodes to diagnose sleep related disorders and nocturnal seizure disorders

A

Polysomnography

113
Q

Daytime nap test that measures sleepiness in a sleep conducive setting

A

Multiple sleep latency test (MSLT)

114
Q

Test that evaluates ability to stay awake in a situation conducive to sleep

A

Maintenance of wakefulness test (MWT)

115
Q

Test that uses a tracker to record body movement over a period of time to detect sleep patterns

A

Actigraphy

116
Q

How long do adults need to sleep?

A

7-8 hours

117
Q

Characteristic of insomnia disorder

A

Difficulty initiating sleep and maintaining sleep
Early awakening
Results in clinical distress or impairment
Symptoms 3 times per week for 3 months

118
Q

3 factors to assess for insomnia

A

Predisposing factors
Precipitating factors
Perpetuating factors

119
Q

Characteristics of hypersomnolence disorder

A

Excessive daytime sleepiness
Chronic - begins in young adulthood
Impairs social and vocational functioning

120
Q

Symptoms of narcolepsy

A

Uncontrollable attacks of sleep
Disturbed night sleep with automatic behaviors and memory lapses
Cataplexy (atonia while awake)
Hypnagogic hallucinations (dream state while awake)
Not rested regardless of amount of sleep

121
Q

What occurs with non rapid eye movement sleep arousal disorders?

A

Sleep walking (somnambulism)
Sleep terrors

122
Q

What occurs with REM sleep behavior disorder?

A

Pt doesnt have atonia and starts acting out their dreams

123
Q

What should you ask a pt if they may have restless leg syndrome?

A

If the symptoms start late in the evening, at bedtime
If anyone in their family has restless leg syndrome
If they take SSRIs

124
Q

What is the number one treatment for sleep disorders?

A

Aggressive lifestyle management

125
Q

General assessment for pts who have sleep disorders

A

Sleep patterns
2 week sleep diaries
Functioning and safety
- Pittsburgh sleep quality index
- PE worth sleepiness scale

126
Q

List the clusters of personality disorders

A

Cluster A: eccentric (weird)
Cluster B: erratic (wacky)
Cluster C: anxious (worried)

127
Q

Difference between schizophrenia and schizotypal personality disorder

A

With schizotypal personality disorder, the pt can be made aware of their own odd beliefs

128
Q

Characteristics of histrionic personality disorder

A

Excitable, dramatic, often high functioning
Bold external behaviors
No insight into disorder or role in ruining relationships

129
Q

Guidelines for treating narcissistic personality disorder

A

Remain neutral
Role model empathy
Promote a stronger patient self identity

130
Q

Characteristics of avoidant personality disorder

A

Low self esteem
Shyness that increases with age
Preoccupied with rejection, humiliation, and failure, which is why they don’t socialize

131
Q

Individual therapy focuses for pts with avoidant personality disorder

A

Trust building
Assertiveness training

Group therapy to enhance social skills

132
Q

Two most challenging personality disorders

A

Borderline personality disorder
Antisocial personality disorder
(Both are cluster B)

133
Q

Characteristics of borderline personality disorder

A

Severe impairments in functioning
Emotional lability (easily flip from hating to loving someone
Impulsivity
Self destructive behaviors
Antagonism
Splitting; think of someone or something as all good or all bad

134
Q

Important things for treating borderline personality disorder

A

Avoid manipulative behaviors though teamwork and safety

Clear and consistent boundaries
Clear straightforward communication
Respond matter of factor to superficial self injuries

135
Q

Treatment for borderline personality disorder

A

Psychotropics geared toward symptom relief
CBT
Dialectical behavior therapy
Schema focused therapy

136
Q

Characteristics of antisocial personality disorder

A

Antagonistic behaviors
Disinhibited behaviors
Profound lack of empathy
Absence of remorse or guilt

137
Q

Nursing diagnoses of antisocial personality disorder

A

Risk for other directed violence (only one with this)
Impaired impulse control
Impaired social interaction

138
Q

Treatment for antisocial personality disorder

A

No specific meds
Maybe mood stabilizers for aggression
Maybe SSRIs, benzos, or Ritalin

Pts may bond with psychotherapists
CBT, MBT, DBT

139
Q

Single biggest factor for suicide

A

Hopelessness

140
Q

Environmental factors for suicide

A

Family conflict
Low parental monitoring
Clusters of suicides: contagion or copycat

141
Q

Pharmacotherapy for comorbid disorders

A

Lithium for chronic suicidal thoughts
(Need to make sure someone else in household will distribute medication to them)

142
Q

Negatives of lithium

A

Electrolyte imbalances
Frequent blood draws
Toxicity

143
Q

7 stage model of interventions for crisis relief

A

Plan and conduct crisis assessment
Establish rapport and rapidly establish relationship
Identify major problems (last straw or crisis precipitants)
Deal with feelings and emotions (active listening, validation)
Generate and explore alternatives
Develop and formulate action plan (crisis resolution next)
Follow up plan and agreement

144
Q

Types of crisis

A

Maturational
Situational
Adventitious

145
Q

Characteristics of maturational crisis

A

New developmental stage
Old coping skills no longer effective
Leads to increased tension and anxiety

146
Q

Characteristics of situational crisis

A

Arise from events that are extraordinary, external, often unanticipated
Ex: job loss, death, change in financial or marital status, psychiatric or physical illness

147
Q

Characteristics of adventitious crises

A

Natural (epidemics, floods, fires, earthquakes)
Human (one on one violence, terrorism, wars, riots, shootings)
Accidental (airline crashes, structural collapses, etc)

148
Q

Phase 1 of crisis

A

Increased anxiety due to stressor which stimulates usual coping and defense mechanisms

149
Q

Phase 2 of crisis

A

Defense mechanisms fail so threat persists
Anxiety increases, leading to feelings of extreme discomfort
Functioning becomes disorganized and trial and error attempts at problem solving begin

150
Q

Phase 3 of crisis

A

Trial and error attempts fail so anxiety escalates to severe or panic levels
Automatic relief behaviors begin (withdrawal and flight)
Compromising needs or redefining situation may begin

151
Q

Phase 4 of crisis

A

Problem unsolved and coping skills ineffective
Anxiety overwhelms person leading to long term effects

152
Q

Long term effects of crisis

A

Serious personality disorganization
Depression
Confusion
Violence against others
Suicidal behavior

153
Q

Overall outcome we want for pts in crisis

A

To get to pre-crises level of functioning

154
Q

When implementing the nursing process for crises:

A

Patient safety (remove from immediate area)
*Anxiety reduction
Appropriate level of prevention/debriefing (they can’t think straight so need to tell them what to do, be direct with short simple orders)

Mental Health Lecture (5 decks)

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