Exam 3 SG

Question 1

Grandiosity Symptoms

Answer 1

• Experienced by Bipolar Disorders with elevated self-esteem, larger than life feelings of superiority and invulnerability.

Question 2

Phenelzine (Nardil): Drug class, toxicity and nursing considerations

Answer 2

• Monoamine Oxidase Inhibitor Agents
• Prescribed as third line agents after SSRIs and tricyclic antidepressants
• Toxicity: headaches and palpitations
• Do NOT use within 14 days of taking SSRIs.
• Avoid anticholinergics, anesthetics, amphetamines, appetite suppressants, nasal decongestants, anti-HTN, CNS depressants (including alcohol), sympathomimetics, and cyclic and newer antidepressants because these may increase hyperpyretic crises, seizures, HTN episodes, or serotonin syndrome. Some OTC cough and cold medications contain sympathomimetics. Consult with the pharmacist when purchasing OTC medicines when taking MAOIs.
• Oral selegiline (Eldepryl) has been helpful with refractory depression

Question 3

Suicidality: Psychological Factors

Answer 3

o Self-directed aggression/self-destruction
o Death as atonement for wrongdoings
o Death as a way to recapture lost love object
o Suicidal death as a secondary result of the major depressive process
o Suicidal ideation and parasuicidal as an abandonment anxiety
o Response to helplessness, hopelessness, guilt, and diminished self-esteem
o Suicide serves as a way to end painful feeling states
o Cognitive rigidity: inability to identify problems and solutions
o Perturbation: determination of an individual’s level of distress and rated on scale of 1 to 9

Question 4

Five Level of Suicidal Behavior

Answer 4

(1) Suicidal ideation: Direct or indirect thoughts
(2) : Suicidal threats: Direct verbal or written messages of intent
(3) : Suicidal gestures: Actions resulting in minor injury, no intention to die
(4) : Suicidal attempts: Serious actions with intention to die
(5) : Successful suicides: Deaths of persons who had conscious intent to die

Question 5

Risk Factors: SADPERSONS

Answer 5

Sex: Male
Age: <19 or >45 years
Depression or hopelessness
Previous attempts or psychiatric care
Excessive alcohol or drug use
Rational thinking loss	Separated/divorced/widowed
Organized or serious attempt
No social supports
Stated future intent

Question 6

Manic Episode

Answer 6

•Abnormally and persistently elevated, expansive or irritable mood for at least 1 week.
•At least 3 of the following symptoms must be present:
•Emotional Symptoms
o Excessively and persistently elevated, expansive, or irritable mood
• Cognitive Symptoms
o Thoughts of inflated self-esteem and grandiosity
o Thought-flow disturbance with racing thoughts and flight of ideas
• Behavioral Symptoms
o Increased talkativeness
o Decreased need for sleep
o Increased goal-directed behavior or agitation
o Excessive involvement in activities thought to be pleasurable, risky, or even dangerous
• Social Symptoms
o Increased sociability and sexuality
o Intrusive, interruptive, and disruptive during conversations or activities
o Fluctuations between euphoria and anger
• Perceptual Symptoms
o Distractibility
o Hallucinations

Question 7

Manic Episode Emotional Symptoms

Answer 7

Excessively and persistently elevated, expansive, or irritable mood

Question 8

Manic Episode Behavioral Symptoms

Answer 8

o Increased talkativeness
o Decreased need for sleep
o Increased goal-directed behavior or agitation
o Excessive involvement in activities thought to be pleasurable, risky, or even dangerous

Question 9

Manic Episode Social Symptoms

Answer 9

o Increased sociability and sexuality
o Intrusive, interruptive, and disruptive during conversations or activities
o Fluctuations between euphoria and anger

Question 10

Manic Episode Perceptual Symptoms

Answer 10

Distractibility

Hallucinations

Question 11

Adjustment disorder

Answer 11

Occurs with a specific psychosocial stressor that can be identfied.
Reactions that occur as a response to a stressor.
Acute case, 3 months,
Chronic case, 6 months.
Symptoms occur as a result of hard time coping or reaction is stronger than expected.

Question 12

Adjustment disorder with depressive symptoms

Answer 12

• Anhedonia, depressed mood and sadness, diminished ability to think, concentrate or make decisions, recurrent thoughts of death, excessive self-worthlessness and guilt, significant weight loss or gain or change in appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, sleep disturbances, withdrawal from family and social interactions, problems at work as a result of the inability to organize, initiate or complete work, financial problems.

Question 13

Adjustment disorder signs and symptoms

Answer 13

Symptoms, such as stress, feeling sad or hopeless, and physical symptoms that can occur after you go through a stressful life event. Symptoms occur because you are having a hard time coping. Your reaction is stronger than expected for the type of event that occurred.

Question 14

Personality disorders

Answer 14

• Pattern is manifested in two or more of the following areas:
o Cognition
o Affectivity
o Interpersonal function
o Impulse control
• Enduring pattern is inflexible and pervasive across a broad range of personal and social situation.

Question 15

3 Types of Personality disorders

Answer 15

Cluster A - Weird
Cluster B - Wild
Cluster C- Worried

Question 16

Cluster A - Weird

Answer 16

o Difficulty relating to others, isolate themselves and are unable to socialize comfortably.
o Paranoid, schizoid, schizotypal personality disorders

Question 17

Paranoid Personality Disorder

Answer 17

Pervasive distrust and suspicion of others and their motives
Unjustified belief that others are trying to harm or deceive you
Unjustified suspicion of the loyalty or trustworthiness of others
Hesitancy to confide in others due to unreasonable fear that others will use the information against you
Perception of innocent remarks or nonthreatening situations as personal insults or attacks
Angry or hostile reaction to perceived slights or insults
Tendency to hold grudges
Unjustified, recurrent suspicion that spouse or sexual partner is unfaithful

Question 18

Schizoid Personality Disorder

Answer 18

Lack of interest in social or personal relationships, preferring to be alone
Limited range of emotional expression
Inability to take pleasure in most activities
Inability to pick up normal social cues
Appearance of being cold or indifferent to others
Little or no interest in having sex with another person

Question 19

Schizotypal Personality Disorder

Answer 19

Peculiar dress, thinking, beliefs, speech or behavior
Odd perceptual experiences, such as hearing a voice whisper your name
Flat emotions or inappropriate emotional responses
Social anxiety and a lack of or discomfort with close relationships
Indifferent, inappropriate or suspicious response to others
“Magical thinking” — believing you can influence people and events with your thoughts
Belief that certain casual incidents or events have hidden messages meant only for you

Question 20

Cluster B Symptoms

Answer 20

Characterized as the “dramatic” and “emotional”
Overly emotional or unpredictable thinking or behavior
Permiscous/impulsive
Antisocial, borderline, histrionic, narcissistic disorders

Question 21

Antisocial Personality Disorder

Answer 21

Disregard for others’ needs or feelings
Persistent lying, stealing, using aliases, conning others
Recurring problems with the law
Repeated violation of the rights of others
Aggressive, often violent behavior
Disregard for the safety of self or others
Impulsive behavior
Consistently irresponsible
Lack of remorse for behavior

Question 22

Borderline Personality Disorder

Answer 22

Impulsive and risky behavior, such as having unsafe sex, gambling or binge eating
Unstable or fragile self-image
Unstable and intense relationships
Up and down moods, often as a reaction to interpersonal stress
Suicidal behavior or threats of self-injury
Intense fear of being alone or abandoned
Ongoing feelings of emptiness
Frequent, intense displays of anger
Stress-related paranoia that comes and goes

Question 23

Histrionic Personality Disorder

Answer 23

Constantly seeking attention
Excessively emotional, dramatic or sexually provocative to gain attention
Speaks dramatically with strong opinions, but few facts or details to back them up
Easily influenced by others
Shallow, rapidly changing emotions
Excessive concern with physical appearance
Thinks relationships with others are closer than they really are

Question 24

Narcissistic Personality Disorder

Answer 24

Belief that you’re special and more important than others
Fantasies about power, success and attractiveness
Failure to recognize others’ needs and feelings
Exaggeration of achievements or talents
Expectation of constant praise and admiration
Arrogance
Unreasonable expectations of favors and advantages, often taking advantage of others
Envy of others or belief that others envy you

Question 25

Cluster C - Worried

Answer 25

Characterized as the “anxious” and “fearful”

Avoidant, dependent, obsessive-compulsive disorders

Question 26

Avoidant Personality Disorder

Answer 26

Too sensitive to criticism or rejection
Feeling inadequate, inferior or unattractive
Avoidance of work activities that require interpersonal contact
Socially inhibited, timid and isolated, avoiding new activities or meeting strangers
Extreme shyness in social situations and personal relationships
Fear of disapproval, embarrassment or ridicule

Question 27

Dependent Personality Disorder

Answer 27

Feeling the need to be taken care of
Submissive or clingy behavior toward others
Fear of having to provide self-care
Lack of self-confidence, requiring excessive advice and reassurance from others to make even small decisions
Difficulty starting or doing projects on your own due to lack of self-confidence
Difficulty disagreeing with others, fearing disapproval
Tolerance of poor or abusive treatment, even when other options are available
Urgent need to start a new relationship when a close one has ended

Question 28

Obsessive-compulsive Personality Disorder

Answer 28

Preoccupation with details, orderliness and rules
Extreme perfectionism, resulting in dysfunction and distress when perfection is not achieved, such as feeling unable to finish a project because you don’t meet your own strict standards
Desire to be in control of people, tasks and situations, and inability to delegate tasks
Neglect of friends and enjoyable activities because of excessive commitment to work or a project
Inability to discard broken or worthless objects
Rigid and stubborn
Inflexible about morality, ethics or values
Tight, miserly control over budgeting and spending money

Question 29

Freud’s psychosexual stage

Answer 29

Oral
Anal
Phallic 
Latency
Genital

Question 30

Freud’s Oral Stage

Answer 30

o Ability to relate to others without excess dependency or jealousy.
o Do not complete show lack of trust, self-centered, dependent and jealous.
o Paranoid, Borderline or Histrionic Personality Disorder

Question 31

Freud’s Anal Stage

Answer 31

o Ability to manage ambivalence
o Do not complete shows difficulty making decisions, withhole friendship or share
o Antisocial, Borderline, Histrionic or Dependent Personality Disorder

Question 32

Freud’s Phallic Stage

Answer 32

o Ability to master impulses and gains a beginning sense of relating to other people in the environment
o Do not complete shows inability to resolve conflict.
o Multiple psychiatric disorders, particularly those involve the superego function of guilt.

Question 33

Freud’s Latency Stage

Answer 33

o Repasses the libidinal (sexual) drive and turns attention towards learning and industry.
o Experience too much or too little ability to develop inner control
o Lack of inner control: borderline personality disorder
o Excess of inner control: Obsessive-Compulsive Disorder

Question 34

Freud’s Genital Stage

Answer 34

o Opportunity to rework earlier issues that the individual has not resolved.
o Do not complete shows compromised sense of self and ability to relate to others
o Whole range of personality disorders.

Question 35

Milieu Therapy

Answer 35

Recreate a community setting on these units so that the patient is able to interact with other patient peers to identify and problem-solve issues that occur when relating to others.

Question 36

Adolescent Suicide RF

Answer 36

Previous suicide attempt
History of psychiatric disorders
History of physical/sexual abuse
Exposure to violence

Question 37

Asperger’s Disorder

Answer 37

Language and cognition are unaffected
Will have sustained social impairment, and restricted repetitive patterns
Obsessed with one field of area
Motor skills are poorly developed
More likely to live independently
Diagnosis at 7/8

Question 38

Reactive Attachment Disorder

Answer 38

Occur in kids who experiences pronounce parental physical and emotional abuse or neglect or who are institutionalize or who exposed to extreme poverty.

Question 39

Reactive Attachment Disorder Clinicals

Answer 39

Feeding difficulties
Failure to gain weight
Detached and difficult to comfort
Shows inhibited or disinhibited type

Question 40

Reactive Attachment Disorder Inhibited

Answer 40

Unable to socially interact in accordance with his or her developmental level due to lack of healthy bonding and intimacy
Fails to initiate or respond to social cues

Question 41

Reactive Attachment Disorder Disinhibited

Answer 41

Lacks appropriate boundaries and is unable to differentiate between strangers and safe attachment relationship

Question 42

Assessing progression of eating disorders

Answer 42

involves sensitivity, thoroughness, and sharp observation skills.
First impressions set the tone for the entire treatment experience
Assess for co-occuring disorders

Question 43

Eating disorder Etiology

Answer 43

Genetic
Serotonin abnormality
Diet, Fitness and Fashion industry
Women's movement
Peer pressure
Perfectionism,
Social insecurity
Affective insecurity
Interoceptive deficits- inability to accurately identify and respond to bodily cues
Alexithymic - difficulty naming and expressing emotions
Low self-esteem
Immaturity 
Compliance
Sense of ineffectiveness 
Interpersonal distrust
Enmeshment
Poor conflict resolution
Separation and individuation

Question 44

Eating Disorder Epidemiology

Answer 44

Sex ratio: Female
Age of onset: before 20 years old
Cross-cultural: no differentiation in racial, ethnic, or socioeconomic group in US
Mortality: higher than any mental illness
Commonly diagnosed with depression

Question 45

Anorexia Nervosa Behavioral & Physical Symptoms

Answer 45

Self-starvation 
Compulsive behaviors regarding food
May use laxative/diuretics, excessive exercise & vomiting
Wearing baggy clothes
Weight loss 15% below ideal 
Amenorrhea
Bradycardia, subnormal body temperature
Cachexia, sunken eyes, dry skin
Lanugo on face
Constipation 
Cold sensitivity

Question 46

Anorexia Nervosa Psychological Symptoms

Answer 46

Denial of seriousness of low weight
Body image disturbance
Irrational fear of weight gain
Constant striving for perfect body
Self-concept unduly influenced by shape & weight
Preoccupation with food, cooking
Delayed psychosexual developement (little interest in sex, relationships)

Question 47

Bulimia Nervosa Behavioral & Physical Symptoms

Answer 47

Recurrent episode of binge eating
Purging behavior to compensate
Self-induced vomiting, use of laxatives, diuretics, enemas, fasting & excessive exercise
Fluid & electrolyte imbalances
Hypokalemia, alkalosis, dehydration, idiopathic edema,
Cardiovascular: hypotension, dysrhythmia, cardiomyopathy
Endocrine: hypoglycemia, menstrual dysfunction
GI: constipation, diarrhea, gastroparesis, esophageal reflux, esophagitis, esophageal tears, dental enamel erosion, parotid gland enlargement

Question 48

Bulimia Nervosa Psychological Symptoms

Answer 48

Body image disturbance
Persistent over concern with weight, shape, proportions
Mood swings, irritability
Self-concept unduly influenced by weight

Question 49

External (Situational) crisis

Answer 49

Occurs when a specific, external event, such as job loss, disturbs one’s psychologic equilibrium.

Question 50

Coping with stressor

Answer 50

Manifests as fight-or-flight reactions or freeze reactions
Denial is common during crisis
Usually individual’s interpretation of crisis is based on the individuals perception of the event, prior learning, memory and previous outcomes to similar situations.

Question 51

Internal (Subjective) crisis

Answer 51

Triggered by subjective perception of threat to one’s well-being that may not be obvious to the outside observer.
It results from a threat to a deeply held belief or value.

Question 52

Psychiatric Emergency

Answer 52

Involves a sudden and serious psychologic disturbance that results in a behavioral state that requires intervention to prevent a life-threatening or psychologically damaging consequence.

Question 53

3 Categories of Psychiatric Emergency

Answer 53

Life-threatening behavior
Life-disrupting behavior,
Life-impairing behavior

Question 54

Life-threatening behavior

Answer 54

threatened or attempted suicide; individuals at high risk for suicide, assault, homicidal thoughts or actions, other violent acts toward the self or others; drug overdose (intentional or unintentional); acute psychoses caused by psychopathology, drug-induced intoxication, or psychosis; and uncontrollable anger.