Exam 4 Flashcards
a behavior is considered to be maladaptive if…
- it is age-inappropriate
- if it interferes with adaptive functioning
- if it is misunderstood by others in terms of cultural inappropriateness
Behavior and ____
develop through learning processes or interaction of the environment with an individual’s genetic endowment
personality
the basic assumption of this approach is that problematic behaviors occur when there has been inadequate learning and therefore can be corrected through the provision of appropriate learning experiences
behavioral approach to therapy
the principles of behavior therapy are based on what early studies
Classical conditioning by Pavlov
Operant conditioning by Skinner
Introduced by Russian physiologist Pavlov in his experiments with dogs
Found dogs salivated when presented with food (unconditioned response)
Learned dogs salivated when food came into view (conditioned response)
classical conditioning
an unlearned response that occurs naturally in reaction to the unconditioned stimulus.
For example, if the smell of food is the unconditioned stimulus, the feeling of hunger in response to the smell of food is the unconditioned response.
unconditioned response
the conditioned response to the previously neutral stimulus
conditioned response
unconditioned stimulus
eating food
conditioned stimulus
sound of the bell
Process by which the fear response is elicited from similar stimuli (all individuals in white uniforms)
stimulus generalization
this is an environmental event that interacts with and influences an individual’s behavior
stimulus
what is the main difference between classical conditioning and operant conditioning
classical conditioning focus is on behavioral responses elicited by specific objects or events
operant conditioning additional attention is given to the consequences of the behavioral response
operant conditioning was introduced by
B.F. Skinner
Assumes that the connection between a stimulus and a response is strengthened or weakened by the consequences of the response
operant conditioning
a stimulus that follows a behavior or response is called a
reinforcing stimulus
reinforcer
what is the function of a reinforcing stimulus
reinforcement
when the reinforcing stimulus increases the probability that the behavior will recur is called a ___ ___
positive reinforcer
aka positive reinforcement
Increases the probability that a behavior will recur by removal of an undesirable reinforcing stimulus
negative reinforcement
A stimulus that follows a behavioral response and decreases the probability that the behavior will recur.
aversive stimulus or punisher
Stimuli that precede a behavioral response and predict that a specific reinforcement will occur
Under an individual’s control
discriminative stimuli
True or false: with discriminative stimuli The individual can discriminate between stimuli and choose according to the type of reinforcement they have come to associate with a specific stimulus.
TRUE
a form of psychotherapy that aims to modify maladaptive behavior patterns by reinforcing more adaptive behaviors
behavior therapy
In ____ the behavior of another, reinforcements are given for increasingly closer approximations to the desired response.
Shaping is an effective way of modifying behavior for tasks a child has not mastered on command.
shaping
techniques for modifying behavior:
refers to the learning of new behaviors by imitating the behaviors of others.
modeling
____ occurs in various ways.
Children imitate the behavior patterns of their parents, teachers, friends, and others.
Adults and children alike model many of their behaviors after individuals observed on television and in movies.
modeling
modeling can result in ___ behaviors as well as adaptive ones
maladaptive
in ___ patients may imitate the behaviors of practitioners who are charged with their care
modeling
techniques for modifying behavior:
principle states that a frequently occurring response can serve as a positive reinforcement for a response that occurs less frequently.
The Premack Principle
techniques for modifying behavior:
If you want someone to do more of a behavior, they must do that behavior before they are permitted to do “fun” stuff.
Getting to do the “fun” stuff becomes a reinforcement for accomplishing the desired behavior change.
The Premack Principle
techniques for modifying behavior:
the gradual decrease in frequency or disappearance of a response when the positive reinforcement is withheld.
the gradual decrease in frequency or disappearance of a response when the positive reinforcement is withheld.
techniques for modifying behavior:
a contract is drawn up among all parties involved.
Positive and negative reinforcers for performing the desired behaviors, and aversive reinforcers for failure to perform, are stated explicitly in the contract.
contingency contracting
techniques for modifying behavior:
Developed in the 1950s as a strategy for reinforcing desirable behaviors in long-term hospitalized schizophrenic patients
token economy
techniques for modifying behavior:
Type of contingency contracting in which the reinforcers for desired behaviors are presented in the form of tokens
token economy
techniques for modifying behavior
Contemporary settings and therapy uses __ ___ as behavior modification
More often used to promote behavior change in children
Effective behavior modification strategy for children on the autism spectrum
token economy
what is essential to determine prior to using the token economy technique for modifying behavior
determination of items and situations of significance to the client that can be used as reinforcements
The nurse is encouraging a child, diagnosed with autism, to verbalize needs. Which nursing intervention reflects the behavior therapy of shaping?
A. The nurse provides no rewards to the child to encourage independence.
B. The nurse rewards the child regardless of speech improvement.
C. The nurse rewards the child at the conclusion of the therapy.
D. The nurse rewards the child incrementally as improvement in speech occurs.
D.
techniques for modifying behavior:
an aversive stimulus or punishment during which the client is removed from the environment where the unacceptable behavior is being exhibited.
time-out
during time-out the patient is usually ___ so reinforcement from attention of others is absent
isolated
reciprocal inhibition is also known as
counterconditioning
what is an example of reciprocal inhibition
relaxation exercises to an individual who is phobic
techniques for modifying behavior:
an aversion therapy that produces unpleasant consequences for undesirable behavior.
over-sensitization
what is an example of over-sensitization
giving Antabuse to individuals who wish to stop drinking alcohol
techniques for modifying behavior:
relies on individual’s imagination rather than medication for unpleasant symptoms.
covert sensitization
techniques for modifying behavior:
this technique is
Under client’s control; can be used whenever required.
Individual learns to visualize nauseating scenes and a mild feeling of nausea through mental imagery.
covert sensitization
during ___ ___ Mental image is visualized when the individual may succumb to an attractive but undesirable behavior.
Most effective when paired with relaxation exercises.
covert sensitization
what is the primary advantage of covert sensitization
Primary advantage is individual does not have to perform, but only imagine undesired behaviors.
techniques for modifying behavior:
a technique for assisting individuals to overcome their fear of phobic stimulus.
systemic desensitization
It is systemic with a hierarchy of anxiety-producing events the individual progresses through during therapy.
Desensitization procedures occur in the therapy setting with relaxation exercises.
Therapy continues until the patient demonstrates ability to progress through the entire hierarchy with manageable anxiety.
systemic desensitization
in ___ desensitization The effects of relaxation in the presence of imagined anxiety-producing stimuli transfer to the real situation.
systemic
in ___ desensitization: Patients who are not successful in extinguishing phobic reactions through imagery may require:
Real-life desensitization
Exposure to hierarchy of steps in real-life situation
Relaxation exercises
systemic
this modifying behavior technique is sometimes called implosive therapy
flooding
techniques for modifying behavior:
is used to desensitize an individual to a phobic stimulus.
flooding
in ___ the patient is “flooded” with a continuous presentation until the phobic stimulus no longer elicits anxiety.
Believed to produce results faster than systematic desensitization
Some therapists report more lasting behavior changes with systemic desensitization.
flooding
why does flooding raise ethical questions and issues with compliance
there are questions raised about the ethics of encouraging patients to endure prolonged fear and psychological discomfort and clients may avoid this type of therapy for that reason
flood is contraindicated in what clients
clients for whom intense anxiety would be hazardous such as individuals with heart disease or fragile psychological adaptation
A patient diagnosed with alcoholism has been prescribed disulfiram (Antabuse). The nurse recognizes this as which type of behavior therapy? A. Overt sensitization B. Flooding C. Reciprocal inhibition D. Systemic desensitization
A.
A patient diagnosed with alcoholism has been prescribed disulfiram (Antabuse). The nurse recognizes this as which type of behavior therapy? A. Overt sensitization B. Flooding C. Reciprocal inhibition D. Systemic desensitization
A.
relating to the mental processes of thinking and reasoning
cognitive
cognitive therapy has its roots in the early 1960’s research on depression conducted by
Aaron Beck
trained in the Freudian psychoanalytic view of depression as “anger turned inwards”
observed a common theme of negative cognitive processing in thoughts and dreams of depressed clients
Aaron Beck
A number of theorists have taken from and expanded upon Beck’s original concept with the common theme of ___ of the passive listening used in psychoanalysis in favor of active, direct dialogues with clients
rejection
___ techniques, such as expectancy of reinforcement and modeling, are based in cognitive processes.
behavioral
The model for ___ therapy is based on an individual’s cognition, or an individual’s personal cognitive appraisal of an event and the resulting emotions or behaviors.
cognitive
___ is viewed as shaped by the interaction between innate predisposition and environment
personality
whereas some types of therapy is directed toward improvement in coping strategies or adaptiveness of behavioral response, ___ therapy is aimed at modifying distorted cognitions about a situation
cognitive
since behavior and emotions are intimately linked to thoughts, this approach assumes that behavior and emotions will change as a result changing ones thinking
cognitive therapy
this is a type of psychotherapy based on the concept of pathological mental processing
the focus is on the modification of distorted cognitions and maladaptive behaviors
cognitive therapy
cognitive therapy was originally used to treat \_\_\_ but now is used to treat all of these conditions Depression Panic disorder Generalized anxiety disorder Substance use disorders Personality disorders Schizophrenia Couple’s problems Bipolar disorder Illness anxiety disorder Somatic symptom disorder
Social phobia
Obsessive-compulsive disorder
Posttraumatic stress disorder
Eating disorders
depression
these are the goals of ___ behavior therapy
Monitor his or her negative, automatic thoughts.
Recognize the connections between cognition, affect, and behavior.
Examine the evidence for and against distorted automatic thoughts.
Substitute more realistic interpretations for these biased cognitions.
Learn to identify and alter the dysfunctional beliefs that predispose him or her to distort experiences.
cognitive
cognitive behavior therapy is highly structured and short term lasting from ___ to ___ weeks
12-16
if the client doesn’t improve within ___ weeks of therapy a reevaluation of the diagnosis should be made when using cognitive behavior therapy
25
how many cognitive behavior therapy principles are there
10
principle 1 of cognitive behavior therapy
Based on an ever-evolving formulation of the client and his or her problems in cognitive terms
the therapist identifies the event that precipitated the distorted cognition
principle 2 of cognitive behavior therapy Requires a sound therapeutic alliance
a trusting relationship between therapist and client must exist for cognitive therapy to succeed
principle 3 of cognitive behavior therapy
Emphasizes collaboration and active participation
teamwork between therapist and client is emphasized
they decide what to work on, how often to meet, and homework assignments
principle 4 of cognitive behavior therapy
Is goal oriented and problem focused
at the beginning of therapy the client is encouraged to identify what he or she perceives to be the problem
principle 5 of cognitive behavior therapy
Initially emphasizes the present
resolution of distressing situations that are based in the present usually leads to symptom reduction so it it is better to start with current problems and delay shifting attention to the past
principle 6 of cognitive behavior therapy
Is educative, aims to teach patients to be their own therapist, and emphasizes relapse prevention
client is taught about the nature and course of their disorder, about the cognitive model and about the process of his or her own behalf
principle 7 of cognitive behavior therapy
Aims to be time limited
clients often are seen weekly for a couple of months, followed by a number of biweekly sessions
principle 8 of cognitive behavior therapy
Uses structured therapy sessions
structure includes
- reviewing client’s week
- collaboratively setting the agenda for this session
- reviewing the previous weeks session
- reviewing the previous weeks homework
- discussing tis weeks agenda
- establishing homework for next week
- summarizing this weeks session
principle 9 of cognitive behavior
Teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs
through gentle questioning and review of data, the therapist helps the client identify his or her dysfunctional thinking, evaluate the validity of the thoughts, and devise a plan of action
principle 10 of cognitive behavior
Uses a variety of techniques to change thinking, mood, and behavior
techniques from various therapies may be used within the cognitive framework
what are the basic concepts of cognitive behavior therapy
- automatic thoughts
- schemas or core beliefs
Occur rapidly in response to a situation and without rational analysis
Often negative and based on erroneous logic
Beck called these thoughts cognitive errors.
automatic thoughts
these are examples of common \_\_\_ errors Arbitrary inference Overgeneralization Dichotomous thinking Selective abstraction Magnification Minimization Catastrophic thinking Personalization
cognitive
the individual automatically comes to a conclusion about an incident without the facts to support it or even despite contradictory evidence
arbitrary interference
sweeping conclusions are ___ made on the basis of one incident; an all or northing kind of thinking
overgeneralization (absolutistic thinking)
an individual who is using ___ thinking views situations in terms of all or nothing, black or white, or good or bad
dichotomous
referred to as mental filter
conclusion that is based on only a selected portion of evidence usually negative evidence
focus on failure instead of the success that occurred
selective abstraction
exaggerating the negative significance of an even is known as ___
magnification
undervaluing the positive significance of an event is called ___
minimization
always thinking that the worst will occur without considering the possibility of more likely positive outcomes is considered ___ thinking
catastrophic
with ___ the person takes complete responsibility for situations without considering that other circumstances may have contributed to the outcome
personalization
A patient diagnosed with severe depression states, “When I wasn’t invited to my niece’s wedding, it was obvious that the in-laws did not think I was good enough to be included.” The nurse understands that this automatic thought is an example of which common cognitive error?
A. Arbitrary inference
B. Overgeneralization (absolute thinking)
C. Dichotomous thinking
D. Personalization
A.
Structures that contain the individual’s fundamental beliefs and assumptions
Develop early in life from personal experience and identification with significant others
These concepts are reinforced by further learning experiences and, in turn, influence the formation of beliefs, values, and attitudes.
May be adaptive or maladaptive, general or specific, and positive or negative
schemas
what are the 3 major components of cognitive behavior therapy
Didactic or educational aspects
Cognitive techniques
Behavioral interventions
this technique of cognitive therapy Prepares the patient to eventually become his or her own cognitive therapist.
didactic (educational) aspects
during ___ aspects The therapist provides information about cognitive behavior therapy and provides assignments to reinforce learning.
A full explanation about the correlation between distorted thinking and clients’ mental illness is provided.
didactic
Strategies in cognitive behavior therapy include recognizing and modifying automatic thoughts and recognizing and modifying schemas.
cognitive strategies
recognizing automatic thoughts and schemas includes
Socratic dialogue
Guided relaxation and behavioral rehearsal
Automatic thought records
Four procedures help the client learn \_\_\_ behavioral strategies that have a positive effect on cognitions. Activity scheduling Graded task assignments Distraction Miscellaneous techniques
adaptive
called guided discovery
the therapist questions the client to elaborate the who what when where why and how of his or her situation
socratic dialogue
___ ___ is aimed at reducing autonomic response to anxiety techniques may include deep breathing, imagery, mindfulness meditation
guided relaxation
___ ___ often accomplished through role-play, affords the client an opportunity to practice a new way of responding to distressing situations and explore possible outcomes
behavioral rehearsal
pathological ___ occurs when adaptation is ineffective and the symptoms are significant enough to impair functioning
depression
Pervasive and sustained emotion that may have a major influence on perception of the world
ex: depression, joy, elation, anger, anxiety
mood
described as the external, observable emotional reaction associated with an experience
affect
a flat ___ described the state of a person who lacks emotional expression and is often seen in severely depressed clients
affect
Alteration in mood expressed by sadness, despair, and pessimism
there is a loss of interest in usual activities and somatic symptoms may be evident
Changes in appetite, sleep patterns, and cognition are common.
depression
the common cold of psychiatry
depression
this is the most common psychiatric disorder
depression
research indicates that the incidence of depressive disorder is higher in ___ than it is in ___ by almost two to one
women
men
true or false: No consistent association between race and depressive disorders have been identified.
TRUE
depressive disorder that occurs at characteristic times of the year
most common in fall or winter
seasonal affective disorder
Characterized by depressed mood
Loss of interest or pleasure in usual activities
Symptoms present for at least 2 weeks
No history of manic behavior
Cannot be attributed to use of substances or another medical condition
major depressive disorder (MDD)
diagnosis of MDD will also identify the ___ of severity of symptoms (mild, moderate, or severe) and whether there is evidence of psychotic, catatonic, or melancholic features
severity
individuals with this mood disturbance have symptoms similar to and kind of milder than MDD describe their mood AS Sad or “down in the dumps” No evidence of psychotic symptoms Essential feature is a chronically depressed mood for Most of the day More days than not At least 2 years
persistent depressive disorder (Dysthymia)
diagnosis of dysthymia early onset is made if it occurs before the age of ___ years
21
diagnosis of dysthymia late onset is made if it occurs at age __ years or older
21
Characterized by:
Markedly depressed mood, excessive anxiety, mood swings, decreased interest in activities during the week prior to menses, improving shortly after the onset of menstruation, and becoming minimal or absent in the week postmenses
premenstrual dysphoric disorder (PMDD)
what is the difference between PMDD and typical premenstrual mood changes is what
a matter of intensity and frequency of symptoms
PMDD symptoms interfere with ability to function socially, at work, or school; recurrent for majority of menstrual cycles.
the symptoms of this disorder are Considered the direct result of physiological effects of a substance (drug of abuse, medication, toxin exposure)
The depressed mood is associated with intoxication or withdrawal from several substances or adverse side effects from many different medications.
substance/medications-induced depressive disorder
this disorder is characterized by symptoms associated with a major depressive episode that are direct physiological consequence of another general medical condition
depressive disorder associated with another medical condition
it has been hypothesized that depressive illness may be related to a deficiency of the neurotransmitters ___, ___, and ___ at functionally important receptor sites in the brain
norepinephrine
serotonin
dopamine
it has been found that excessive ___ transmission may also be a predisposing factor in depression
cholinergic
May play a role in the pathogenesis or persistence of depressive illness
Hypothalamic-Pituitary-Adrenocortical Axis
Hypothalamic-Pituitary-Thyroid Axis
Midbrain disturbance
neuroendocrine disturbances
in clients who are depressed, the normal system of hormonal inhibition fails, resulting in a hypersecretion of cortisol
hypothalamic-pituitary-adrenocortical axis
diminished TSH response to administered TRH is observed in 25% of depressed persons
hypothalamic-pituitary-thyroid axis
___ dysfunction is a main risk factor for causing depression
thyroid
depressive symptoms that occurs as a consequence of a non-mood disorder or as an adverse effect of certain medications are called ____ depression
secondary
___ depression may be relate to Medication side effects
Neurological disorders
Electrolyte disturbances
Hormonal disorders
Nutritional deficiencies
Other physiological or psychological conditions
Inflammation
secondary
what kind of electrolyte imbalances can produce symptoms of depression
- excess sodium bicarb, calcium, potassium
- deficit of magnesium, sodium, potassium
depression is associated with dysfunction of the ___ cortex and is commonly observed in both Addison’s and Cushing’s syndrome
adrenal
Other ___ conditions that may result in symptoms of depression include hypoparathyroidism, hyperparathyroidism, hypothyroidism, and hyperthyroidism
endocrine
psychosocial theories
Freud presented this theory
A loss is internalized and becomes directed against the ego.
psychoanalytical theory
“learned helplessness”
learning theory
The individual who experiences numerous failures learns to give up trying.
learned helplessness
___ ___ predisposes individuals to depression by imposing a feeling of lack of control over their life situations
they become depressed because they feel helpless
they have learned that whatever they do is futile
learned helplessness
theory suggesting that the primary disturbance in depression is cognitive rather than affective
cognitive theory
what are the 3 cognitive distortions that serve as the basis for depression
Negative expectations of the environment
Negative expectations of the self
Negative expectations of the future
___ distortions arise out of a defect in cognitive development and the individual feels inadequate, worthless, and rejected by others
cognitive
cognitive theorists believe that depression is the product of ___ thinking
negative
this kind of therapy focuses on helping the individual alter mood by changing the way he or she thinks
cognitive therapy
___ model recognizes the combined effects of genetic, biochemical, and psychosocial influences on an individual’s susceptibility to depression
No single theory or hypothesis exists to substantiate a clear-cut explanation for depressive disorder.
Evidence continues to mount in support of multiple causation.
transactional
depression symptoms in this age range include
Feeding problems, tantrums, lack of playfulness and emotional expressiveness
less than age 3
depression symptoms in this age range include
Accident proneness, phobias, excessive self-reproach
age 3-5
depression symptoms in this age range include
Physical complaints, aggressive behavior, clinging behavior
ages 6-8
depression symptoms in this age range include
Morbid thoughts and excessive worrying
ages 9-12
in many depressed children there is a genetic predisposition toward the condition which is then precipitated by a ___ situation
stressful
a common precipitating factor in childhood depression is what
loss
what is the focus of therapy with depressed children
to alleviate the child’s symptoms and strengthen their coping and adaptive skills with the hope of possibly preventing future psychological problems
what other kind of involved therapy is used to help the younger depressed child
parental and family therapy
depression is a major cause of suicide among teens with ___ as the second leading cause of death in the 15-24 year old age group
suicide
common symptoms of \_\_\_ among adolescents include Anger, aggressiveness Running away Delinquency Social withdrawal Sexual acting out Substance abuse Restlessness, apathy
depression
what differentiates mood disorder from the typical stormy behavior of adolecence
a visible manifestation of behavioral change that last for several weeks is the best clue for a mood disorder
what is the most common precipitant to adolescent suicide
perception of abandonment by parents of close peer relationship
treatment of adolescent depression includes
supportive psychosocial intervention
antidepressant medication
children and adolescents being treated with antidepressants needs to be closely monitored because this causes an increased risk of ___ thoughts and behavior
suicidal
occurs when individuals experience so many losses in their lives that they are not able to resolve one grief response before aonther begins and is a common reasons for why the elderly experience depression
bereavement overload
symptoms of __ are often confused with symptoms of neurocognitive disorders or the aging process in the elderly
depression
this may be considered the treatment of choice for the elderly individual who is an acute suicidal risk or is unable to tolerate antidepressant medications but confusion is more pronounced in the elderly with this treatment
Electroconvulsive therapy (ECT)
the severity of depression in the ___ period varies from feeling the baby blues to moderate depression to severe depression with psychotic features
postpartum
symptoms of ___ postpartum depression have been described as depressed mood varying from day to day, more bad days than good, worsening toward evening
fatigue
irritability
loss of appetite
sleep disturbances
loss of libido
concern about inability to care for infant
moderate
May last for a few weeks to several months
Associated with hormonal changes, tryptophan metabolism, or cell alterations
postpartum depression
symptoms of depression may be described as alterations in \_\_\_ spheres of human functioning which include Affective Behavioral Cognitive Physiological
4
Symptoms at this level of the continuum are not necessarily dysfunctional
subsides quickly and individual is able to refocus on other goals
Affective: The “blues”
Behavioral: Some crying
Cognitive: Some difficulty getting mind off of one’s disappointment
Physiological: Feeling tired and listless
transient depression
Symptoms of \_\_\_ depression are identified by clinicians as those associated with normal grieving Affective: Anger, anxiety Behavioral: Tearful, regression Cognitive: Preoccupied with loss Physiological: Anorexia, insomnia
mild
dysthymia is also called
persistent depressive disorder
Symptoms associated with dysthymic disorder or ___ depression
Affective: Helpless, powerless
Behavioral: Slowed physical movements, slumped posture, limited verbalization
Cognitive: Retarded thinking processes, difficulty with concentration
Physiological: Anorexia or overeating, sleep disturbance, headaches
moderate
severe depression is also called
major depressive disorder
Includes symptoms of major depressive disorder and bipolar depression
Affective: Feelings of total despair, worthlessness, flat affect
Behavioral: Psychomotor retardation, curled-up position, absence of communication
Cognitive: Prevalent delusional thinking, with delusions of persecution and somatic delusions; confusion; suicidal thoughts
Physiological: A general slow-down of the entire body
severe depression
what is a short term goal for risk for suicide
- client will seek out staff when feeling urge to harm self
- client will not harm self
what is long term goal for risk for suicide
client will not harm self
nursing diagnosis
vulnerable to self-inflicted life-threatening injury
risk for suicide
Defined as a disorder that occurs after the death of a significant other in which the experience of distress accompanying bereavement fails to follow normative expectations and manifests in functional impairment
complicated grieving
what are short term goals for complicated grieving
- client will express anger about the loss
- client will identify coping strategies and rational thought patterns in response to loss
nursing diagnosis defined as negative self-evaluating/feelings about self or self capabilities
low self-esteem
nursing diagnosis defined as impaired ability to perform or complete activities of ADLs for self
self-care deficit
nursing diagnosis defined as the lived experience of lack of control over a situation, including a perception that one’s actions do not significantly affect an outcome
powerlessness
Focus is on interpersonal relations and proceeds through three phases and interventions.
individual psychotherapy
Focuses on changing “automatic thoughts” that contribute to distorted affect
cognitive therapy
Electrical currents are applied to the brain, causing a grand mal (generalized) seizure.
Goal is to identify and change dysfunctional patterns of thinking
electroconvulsive therapy (ECT)
Uses short pulses of magnetic energy to stimulate nerve cells in the brain
Repetitive Transcranial Magnetic stimulation (rTMS)
you do NOT want to eat foods (which include the following) containing \_\_\_ while on MAOIs cheese wine beer chocolate sodas coffee tea sour cream smoked and processed meats beef or chicken liver Caviar Raisins Pickled herring Yeast products Broad beans Soy sauce Cold remedies Diet pills
tyramine
what can happen if you eat tyramine containing foods while on MAOIs
could cause a life-threatening hypertensive crisis
what drugs are used to treat depression
tricyclics
selective serotonin reuptake inhibitors (SSRIs)
monoamine oxidase inhibitors (MAOIs)
atypical antidepressants
serotonin norepinephrine reuptake inhibitors (SNRI’s)
this kind of treatment for depression involves resolving the symptoms and initiating or restoring adaptive family functioning
family therapy
this type of treatment for depression involves providing feedback from peers who are having a similar experience
group therapy
side effects to \_\_\_ therapy include HA eyestrain nausea irritability photophobia (eye sensitivity to light insomnia agitation these are all mild and short lived
light
light therapy and ___ have shown comparable efficacy in studies of SAD treatment
antidepressants
treatment with light therapy should be continued until until an expected time of spontaneous remission such as the change in ___ to spring or summer
season
An alteration in mood that may be expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, racing thoughts, and accelerated speech.
It can occur as part of the psychiatric disorder bipolar disorder, as part of some other medical conditions, or in response to some substances.
mania
in 1980 the American Psychiatric Association adopted the term ___ __
identified by a “…period of mood elevation and excitation” as a defining characteristic replacing the term “mania” because descriptions of people as “maniacs” was considered stigmatizing.
bipolar disorder
true or false: mania is still used to describe an abnormal mood state of elation
TRUE
__ ___ is characterized by mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy.
Delusions or hallucinations may or may not be part of clinical picture.
Onset of symptoms may reflect seasonal pattern.
bipolar disorder
A somewhat milder form of mania is called ___; it is not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization and no psychotic features
hypomania
Diagnosis of this type of bipolar disorder requires that the patient:
Is experiencing a manic episode or has a historyof one or more manic episodes
May have also experienced episodes of depression
Diagnosis is further specified by the current or most recent behavioral episode.
Bipolar 1
diagnosis of this type of bipolar disorder requires that the patient:
Presents with symptoms (or history) of depression or hypomania
Has never met criteria for full manic episode
Has never had symptoms severe enough to cause impairment in social or occupational functioning or to necessitate hospitalization
Bipolar 2
diagnosis of this type of bipolar disorder
requires that the patient:
Has a chronic mood disturbance, lasting at least 2 years
Has numerous periods of elevated mood that do not meet the criteria for a hypomanic episode; or
Has numerous periods of depressed mood of insufficient severity or duration to meet criteria for a major depressive episode; and
Is never without the symptoms for more than 2 months
cyclothymic disorder
diagnosis of this type of bipolar disorder
requires that the patient:
Has a mood disturbance as the direct result of physiological effects of a substance
Has a mood disturbance that involves elevated, expansive, or irritable moods with inflated self-esteem, decreased need for sleep and distractibility
substance-induced bipolar disorder
diagnosis of this type of bipolar disorder
requires that the patient:
Has an abnormally and persistently elevated, expansive, or irritable mood and excessive activity or energy as the direct physiological consequence of another medical condition
Has a mood disturbance causing clinically significant distress or impairment in social, occupational, or other areas of functioning
bipolar disorder associated with another medical condition
biochemical influences studies about bipolar disorder has associated symptoms of mania with a functional excess of what neurotransmitters
norepinephrine
epinephrine
according to this predisposing factors theory Bipolar disorder clearly results from an interaction between genetic, biological and psychosocial determinants.
transactional model of stress and adaptation
Disruptive mood dysregulation disorder
diagnosis given to youth who were initially diagnosed with ADHD but had atypical symptoms so they created this new diagnosis
___ has been identified as the most common comorbid condition in children and adolescents with bipolar disorder
ADHD
Because stimulants can exacerbate mania it is suggested that medication for ADHD be initiated only after bipolar symptoms have been ___ with a mood stabilizing agent
controlled
what is this manic stage
Mood
Cheerful and expansive; underlying irritability surfaces rapidly
Cognition and Perception
Exalted; ideas of great worth and ability; flighty thinking; heightened perception of environment; easily distracted
Activity and Behavior
Increased motor activity; perceived as extroverted; lacks depth of personality for close friendships
hypomania
what is this manic stage
Mood
Continuous “high”; subject to frequent variation
Cognition and Perception
Flight of ideas; distractibility becomes all-pervasive
Activity and Behavior
Psychomotor activity is excessive; sexual interest increased
Inexhaustible energy; may go for days without sleeping
acute mania
what is this manic stage
Mood
Very labile; panic-level anxiety may be evident
Cognition and Perception
Clouding of consciousness; extremely distractible and incoherent
Activity and Behavior
Psychomotor activity is frenzied; exhaustion, injury to self or others, and eventually death could occur without intervention.
delirious mania
symptoms of manic states can be described according to 3 stages which are
- hypomania
- acute mania
- delirious mania
In the initial stages of caring for a client experiencing an acute manic episode, what should the nurse consider to be the priority nursing diagnosis?
A. Risk for injury related to excessive hyperactivity
B. Disturbed sleep pattern related to manic hyperactivity
C. Imbalanced nutrition, less than body requirements, related to inadequate intake
D. Situational low self-esteem related to embarrassment secondary to high-risk behaviors
A.
what medications are usually used to treat mania
lithium carbonate
anticonvulsants
verapamil
antipsychotics
important information to keep in mind when taking __
Take the medication regularly.
Do not drive or operate dangerous machinery.
Do not skimp on dietary sodium and maintain appropriate diet.
Know pregnancy risks.
Carry identification noting taking lithium.
Be aware of side effects and symptoms of toxicity.
Notify physician if vomiting or diarrhea occur.
Have serum lithium level checked every 1 to 2 months.
lithium
what other important information do we need to keep in mind about lithium
- important that they maintain a normal intake of salt and fluids
- should be taken on a full stomach
- causes weight gain (reason for noncompliance)
- low calorie diet and increase exercise
- avoid caffeine or caffeine products
what is an adverse effect of antipsychotics
agranulocytosis
A client who is prescribed lithium carbonate is being discharged from inpatient care. Which medication information should the nurse teach this client?
A. Do not skimp on dietary sodium intake.
B. Have serum lithium levels checked every 6 months.
C. Limit fluid intake to 1,000 mL of fluid per day.
D. Adjust the dose if you feel out of control.
A.
Patients taking lithium should consume a diet adequate in sodium and drink 2,500 to 3,000 mL of fluid per day.
Lithium is a salt and competes in the body with sodium.
If sodium is lost, the body will retain lithium with resulting toxicity.
Maintaining normal sodium and fluid levels is critical to maintaining therapeutic levels of lithium and preventing toxicity.
lithium is a what so anything that depletes sodium will make more receptor sites available and increase the risk for lithium toxicity
salt
what is the range for lithium in acute mania
1-1.5
what are the maintenance lithium levels
0.6-1.2
what are early signs and symptoms of lithium toxicity
vomiting and diarrhea
