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Community Mental Health Nursing > Exam 3 > Flashcards

Exam 3 Flashcards

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1
Q

Bipolar I Disorder

A

Most severe form
Highest mortality rate
At least 1 manic episode

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2
Q

Bipolar II Disorder

A

At least 1 hypomanic episode

At least 1 major depressive episode

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3
Q

Cyclothymic Disorder

A

Alternate with symptoms of mild to moderate depression for at least 2 years

Rapid cycling possible

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4
Q

Epidemiology of Bipolar Disorder

A

Up to 21% of patients with major depression may actually have undiagnosed bipolar disorder

Bipolar I–more common in males

Bipolar II–more common in females

Cyclothymia–usually begins in adolescence or early adulthood

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5
Q

Risk Factors for Bipolar Disorder

A

Biological factors: genetic, neurobiological, neuroendocrine (hypothyroidism)

Psychological factors

Environmental factors

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6
Q

Assessment for Bipolar Disorder

A

Mood

Behavior

Thought processes and speech patterns

Cognitive functioning (decreased attention span, distracted easily)

Speech patterns (pressured speech, circumstantial speech, tangential speech, loose associations, flight of ideas, clang associations)

Thought content (grandiose delusions, persecutory delusions)

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7
Q

Self-Assessment for Bipolar Disorder

A

Manic patient (manipulative, demanding, splitting)

Staff member actions (frequent staff meetings to deal with patient behaviors and staff response, set limits consistently)

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8
Q

Assessment Guidelines for Bipolar Disorder

A 
Danger to self or others
Need for protection from uninhibited behaviors
Need for hospitalization
Medical status
Coexisting medical conditions
Family's understanding
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9
Q

Planning for Bipolar Disorder

A

Medical stabilization

Maintaining safety

Nursing care (managing medications, decreasing physical activity, increasing food and fluid intake, ensuring sleep)

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10
Q

Planning for Acute Manic Phase

A

Medical stabilization

Maintaining safety

In-hospital nursing care

Seclusion, restraint, or ECT may be considered

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11
Q

Implementation for Depressive Episodes

A

Hospitalization for harmful thoughts

Medication concerns about bringing on a manic phase

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12
Q

Implementation for Manic Episodes

A

Hospitalization for acute mania

Communicating strategies and challenges

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13
Q

Lithium Carbonate

A

Mood stabilizer; decreased mania

Therapeutic level: 0.8-1.4
Maintenance blood level: 0.4-1.3
Toxic blood level: 1.5 and above

Takes 10-21 days to get levels stabilized

Give with meals, drink adequate fluids, monitor for weight gain, check renal and thyroid function before giving and monitor those levels throughout due to nephrotoxicity/thyroid toxicity

Contraindications: renal disease, thyroid disorders, brain injury

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14
Q

Lithium Toxicity

A
  1. 5-2.0: mental confusion/sedation, poor coordination/coarse tremors, GI distress
  2. 0-2.5: tinnitus/blurred vision/ataxia, slurred speech/seizures/polyuria, hypotension

Level > 2.5: coma, death

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15
Q

Anticonvulsant Mood Stabilizers

A

Valproate (Depakote)

Carbamazepine (Tegretol)

Lamotrigine (Lamictal)

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16
Q

Other Treatments for Bipolar

A 
ECT
Teamwork and safety
Seclusion protocol
Support groups
Health teaching and health promotion
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17
Q

Persistent Depressive Disorder

A

Formerly known as dysthymia

Low-level depressive feelings through most of each day, for the majority of days

Two or more of the following: decreased appetite, overeating, insomnia or hypersomnia, low energy, poor self-esteem, difficulty thinking, hopelessness

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18
Q

Premenstrual Dysphoric Disorders

A

Symptom cluster in last week prior to onset of a woman’s period; include mood swings, irritability, depression, anxiety, feeling overwhelmed, difficulty concentrating

Symptoms decrease significantly or disappear with the onset of menstruation

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19
Q

Major Depressive Disorder

A

Five or more of the following in a 2 week period: weight loss, appetite changes, sleep disturbances, fatigue, worthlessness or guilt, loss of ability to concentrate, recurrent thoughts of death

PLUS depressed mood or loss of interest or pleasure (anhedonia)

Persistent for 2 weeks to 6 months

Lasts more than 2 years

Recurrent episodes common

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20
Q

Epidemiology of Depression

A

Leading cause of disability in the US

Comorbidities include schizophrenia, personality disorders, eating disorders

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21
Q

Etiology of Depression

A

Biological Factors: genetic, biochemical, alterations in hormonal regulation, inflammatory process

Psychological factors: cognitive theory, learned helplessness

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22
Q

Assessment of Depression

A 
Depressed mood and anhedonia
Anergia
Anxiety
Psychomotor agitation or retardation
Vegetative sides
Chronic pain
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23
Q

Depression Recovery Model

A

Focus on patient’s strengths

Treatment goals mutually developed

Based on patient’s personal needs and values

Planning geared towards patient’s phase of depression, particular symptoms, personal goals

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24
Q

Phases of Depression

A

Acute Phase (6-12 weeks)

Continuation Phase (4-9 months)

Maintenance Phase (1 year or more)

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25
Q

How to Choose an Antidepressant

A 
Symptom profile of the patient
Side-effect profile
Ease of administration
History of past response
Safety and medical considerations
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26
Q

Antidepressants

A

SSRIs (first-line therapy, rare risk of serotonin syndrome)

SNRIs

Tricyclic Antidepressants (anticholinergic adverse reactions)

MAOIs (effective for unconventional depression)

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27
Q

Other Treatments for Depression

A

ECT

TMS

Vagus nerve stimulation

Deep brain stimulation

Light therapy

St. John’s Wort

Exercise

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28
Q

Electroconvulsive Therapy

A

The most effective depression treatment; also used for psychotic illnesses

Used for lengthy depression, delusional depression, schizophrenia with catatonia

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29
Q

Transcranial Magnetic Stimulation

A

Noninvasive

Uses MRI-strength magnetic pulses to stimulate focal areas of the cerebral cortex

Presence of metal is only contraindication

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30
Q

Adverse Reactions to TMS

A

Headache and lightheadedness

No neurological deficits or memory problems, seizures rarely, scalp tingling, discomfort

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31
Q

Vagus Nerve Stimulation

A

Originally used to treat epilepsy

Decreases seizures and improves mood

Electrical stimulation boosts the level of neurotransmitters

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32
Q

Side Effects of Vagus Nerve Stimulation

A

Voice alteration

Neck pain, cough, paresthesia, dyspnea

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33
Q

Deep Brain Stimulation

A

Surgically implanted electrodes in the brain

Stimulates those regions identified as underactive in depression

More invasive than VNS

34
Q

Light Therapy

A

First-line treatment for SAD

Efficacy due to influence of light on melatonin

Effective as medication for SAD

Negative effects include headache and jitteriness

35
Q

St. John’s Wort

A

Flower processed into tea or tablets

Thought to increase serotonin, norepinephrine, anti-dopamine in the brain

Useful in mild to moderate depression

36
Q

Trauma-Related Disorders in Children

A

Posttraumatic stress disorder in preschool children

Reactive attachment disorder

Disinhibited social engagement disorder

37
Q

Comorbidities of Trauma-Related Disorders in Children

A

Learning disorders

Increased stress

38
Q

Biological Factors of Trauma-Related Disorders in Children

A

Genetic: how individuals react to trauma

Neurobiological: trauma dysregulates neural pathways that integrate emotional regulation and arousal; triggers hyperaroused state leading to dissociation; polyvagal theory

Psychological factors: attachment theory

Environmental factors: dependence on adults and systems; external factors that support stress

39
Q

Intervention Stages for Trauma-Related Disorders in Children

A

Stage 1: provide safety and stabilization

Stage 2: reduce arousal and regulate emotion through symptom reduction

Stage 3: catch up on developmental and social skills; develop a value system

40
Q

Interventions for Child with PTSD

A

Establish trust and safety

Use developmentally appropriate language

Teach relaxation techniques

Use art and play to promote expression of feelings

Involve caretakers in 1:1s, unless they are the cause of trauma

Educate child and caretakers about grief process

Assist caregivers in resolving personal distress

41
Q

Posttraumatic Stress Disorder

A

Re-experiencing of the trauma

Avoidance of stimuli associated with trauma

Persistent symptoms of increased arousal

Alterations in mood

42
Q

Acute Stress Disorder

A

Immediately after a highly traumatic event

Symptoms persist for 3 days

Diagnosis made within month

After 1 month: resolution or becomes PTSD

43
Q

Diagnosis of Acute Stress Disorder

A

Alterations in concentration

Anger

Dissociative amnesia

Headache

Irritability

Nightmares

44
Q

Implementation for Acute Stress Disorder

A

Establish therapeutic relationship

Assist to problem solve

Connect person to supports

Collaborate for coordination of care

Ensure and maintain safety

Refer to a licensed mental health provider

Monitor response and/or adherence to treatment

45
Q

Adjustment Disorder

A

Trauma-related disorder in adults

Precipitated by stressful events

Debilitating cognitive, emotional, and behavioral symptoms that negatively impact normal functioning

Responses to stressful event may include combinations of depression, anxiety, and conduct disturbances

46
Q

Dissociative Disorders

A

Occur after significant adverse experiences/trauma

Individuals respond to stress with severe interruption of consciousness

Unconscious defense mechanism

Protects individual against overwhelming anxiety through emotional separation

47
Q

Depersonalization Disorder

A

Focus on self

48
Q

Derealization Disorder

A

Focus on outside world

49
Q

Dissociative Amnesia

A

Inability to recall important personal information

Often of traumatic or stressful nature

Dissociative fatigue

50
Q

Dissociative Identity Disorder

A

Presence of two or more distinct personality states

Each alternate personality has own pattern of perceiving, relating to, and thinking about the self and environment

51
Q

Dissociative Disorders Assessment

A

History

Moods

Impacts on patient and family

Suicide risk

Self-assessment

52
Q

Dissociative Disorders Planning

A

Phase 1: establishing safety, stabilization, and symptom reduction

Phase 2: confronting, working through, and integrating traumatic memories

Phase 3: identity integration and rehabilitation

53
Q

Oppositional Defiant Disorder

A

Angry and irritable mood

Defiant and vindictive behavior

Experience social difficulties, conflicts with authority figures, academic problems

54
Q

Risk Factors for Oppositional Defiant Disorder

A

Genetic component

Numerous neurobiological causes identified

Family dysfunction can play a role

55
Q

Intermittent Explosive Disorder

A

Inability to control aggressive impulses

Adults 18 years or older

Leads to problems with interpersonal relationships, occupational difficulties, criminal difficulties

56
Q

Comorbidities of Intermittent Explosive Disorder

A

Depressive, anxiety, and substance use disorders

Antisocial and borderline personality disorders

57
Q

Risk Factors for Intermittent Explosive Disorder

A

Neurobiological abnormalities

Conflict or violence in family of origin

58
Q

Conduct Disorder

A

Behavior is usually abnormally aggressive

Rights of others are violated and societal norms or rules are disregarded; lack of remorse

59
Q

Complications of Conduct Disorder

A

Academic failure

School suspensions and dropouts

Juvenile delinquency

Drug and alcohol abuse

Juvenile court involvement

60
Q

Personality Disorders

A

Cluster A (Eccentric): paranoid, schizoid, schizotypal

Cluster B (Erratic): borderline, narcissistic, histrionic, antisocial

Cluster C (Anxious): avoidant, dependent, obsessive-compulsive

61
Q

Paranoid Personality Disorder

A

Prevalence: 2% to 4%

Characteristics: may be apparent in childhood, social anxiety in childhood, jealous and controlling as adults, unwillingness to forgive and projection of feelings

62
Q

Treatment of Paranoid Personality Disorder

A

Counteract mistrust by adhering to schedules, avoiding being overly friendly, and projecting a neutral but kind affect

Psychotherapy versus group therapy

Short-term antidepressants

63
Q

Schizoid Personality Disorder

A

Prevalence: nearly 5% of population

Characteristics: symptoms appear in childhood/adolescence, loners, poor academic performance, increased prevalence of disordered family life, avoid close relationships, depersonalization

64
Q

Treatment of Schizoid Personality Disorder

A

Avoid being too nice or friendly, do not try to increase socialization, assess for symptoms the patient is reluctant to discuss, protect against group’s ridicule

Treatment: psychotherapy, group therapy, antidepressants

65
Q

Schizotypal Personality Disorder

A

Prevalence: varies from 0.64 to 4.6% of population

Characteristics: severe social and interpersonal deficits, anxiety in social situations, rambling conversations, paranoia, suspiciousness, anxiety, distrust, intermittent episodes of hallucinations, can be made aware of their own odd beliefs, may be vulnerable to involvement with cults

66
Q

Treatment of Schizotypal Personality Disorder

A

Respect patient’s need for social isolation

Be aware of and intervene appropriately with patient’s suspiciousness

Perform careful diagnostic assessment for symptoms that may need intervention

Withhold judgment or ridicule

Psychotherapy

Low-dose antipsychotics

67
Q

Histrionic Personality Disorder

A

Prevalence: nearly 2% of population

Characteristics: excitable, dramatic, high functioning, bold external behaviors, limited ability to develop meaningful relationships, attention-seeking, self-centered, excessive emotions, may be provocative, no insight into disorder or role in ruining relationship

68
Q

Treatment for Histrionic Personality Disorder

A

Psychotherapy is treatment of choice

Know that seductive behavior is a response to stress

Keep interactions professional and ignore flirtations

Model concrete language

Help patient clarify inner feelings

Teach and role-model assertiveness

69
Q

Narcissistic Personality Disorder

A

Prevalence: 0 to 6%

Characteristics: feelings of entitlement, exaggerated self-importance, tendency to exploit others, weak self-esteem and hypersensitivity to criticism, constant need for admiration, less functional impairment

70
Q

Treatment for Narcissistic Personality Disorder

A

Remain neutral

Avoid power struggles or becoming defensive

Role model empathy

Difficult to treat; patients not likely to seek help

Cognitive-behavioral therapy

Group therapy

Lithium for mood swings

71
Q

Antisocial Personality Disorder

A

Prevalence: 1.1%

Characteristics: antagonistic behaviors, disinhibited behaviors, profound lack of empathy, absence of remorse or guilt

72
Q

Assessment of Antisocial Personality Disorder

A

Patients tend to not answer assessments honestly

Self-assessment

73
Q

Clinical Picture of Borderline Personality Disorder

A

Severe impairments in functioning

Emotional lability

Impulsivity

Self-destructive behaviors

Antagonism

Splitting: inability to view both positive and negative aspects of others as part of a whole

74
Q

Borderline Personality Disorder

A

Prevalence: 1.6%

10% suicide and mortality rate

85% of BPD patients have another mental illness

High genetic association

Separation-individuation factors

75
Q

Assessment for Borderline Personality Disorder

A

Semi-structured interview

Use of MMPI

Self-assessment

76
Q

Treatment of Borderline Personality Disorder

A

Psychotropics geared toward symptom relief

CBT

Dialectical behavior therapy

Schema-focused therapy

77
Q

Avoidant Personality Disorder

A

Prevalence: 2.4%

Characteristics: low self-esteem, shyness that increases with age, feelings of inferiority, reluctance to engage with new people, subject to depression, preoccupied with rejection and failure

78
Q

Dependent Personality Disorder

A

Prevalence: 0.5%

Characteristics: high need to be taken care of, submissiveness, fears of separation and abandonment, manipulating others to take responsibilities, intense anxiety when left alone

79
Q

Treatment of Dependent Personality Disorder

A

Help address current stressors

Set limits

Be aware of strong countertransference

Psychotherapy

80
Q

Obsessive-Compulsive Disorder

A

Prevalence: 2 to 8%

Characteristics: inflexible standards for others and self, constant rehearsal of social responses, excessive goal-seeking, strict standards that interfere with project completion, unhealthy focus on perfection

81
Q

Treatment for Obsessive-Compulsive Disorder

A

Patients tend to seek help for anxiety and depression

Group and behavioral therapy

Clomipramine or fluoxetine for obsessions, anxiety, and depression

Community Mental Health Nursing (4 decks)

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