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Psychiatric Mental Health > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

a behavior is considered to be maladaptive if…

A
  • it is age-inappropriate
  • if it interferes with adaptive functioning
  • if it is misunderstood by others in terms of cultural inappropriateness
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2
Q

Behavior and ____

develop through learning processes or interaction of the environment with an individual’s genetic endowment

A

personality

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3
Q

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

A

behavioral approach to therapy

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4
Q

the principles of behavior therapy are based on what early studies

A

Classical conditioning by Pavlov

Operant conditioning by Skinner

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5
Q

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)

A

classical conditioning

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6
Q

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.

A

unconditioned response

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7
Q

the conditioned response to the previously neutral stimulus

A

conditioned response

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8
Q

unconditioned stimulus

A

eating food

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9
Q

conditioned stimulus

A

sound of the bell

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10
Q

Process by which the fear response is elicited from similar stimuli (all individuals in white uniforms)

A

stimulus generalization

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11
Q

this is an environmental event that interacts with and influences an individual’s behavior

A

stimulus

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12
Q

what is the main difference between classical conditioning and operant conditioning

A

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

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13
Q

operant conditioning was introduced by

A

B.F. Skinner

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14
Q

Assumes that the connection between a stimulus and a response is strengthened or weakened by the consequences of the response

A

operant conditioning

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15
Q

a stimulus that follows a behavior or response is called a

A

reinforcing stimulus

reinforcer

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16
Q

what is the function of a reinforcing stimulus

A

reinforcement

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17
Q

when the reinforcing stimulus increases the probability that the behavior will recur is called a ___ ___

A

positive reinforcer

aka positive reinforcement

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18
Q

Increases the probability that a behavior will recur by removal of an undesirable reinforcing stimulus

A

negative reinforcement

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19
Q

A stimulus that follows a behavioral response and decreases the probability that the behavior will recur.

A

aversive stimulus or punisher

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20
Q

Stimuli that precede a behavioral response and predict that a specific reinforcement will occur
Under an individual’s control

A

discriminative stimuli

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21
Q

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.

A

TRUE

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22
Q

a form of psychotherapy that aims to modify maladaptive behavior patterns by reinforcing more adaptive behaviors

A

behavior therapy

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23
Q

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.

A

shaping

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24
Q

techniques for modifying behavior:

refers to the learning of new behaviors by imitating the behaviors of others.

A

modeling

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25
Q

____ 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.

A

modeling

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26
Q

modeling can result in ___ behaviors as well as adaptive ones

A

maladaptive

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27
Q

in ___ patients may imitate the behaviors of practitioners who are charged with their care

A

modeling

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28
Q

techniques for modifying behavior:
principle states that a frequently occurring response can serve as a positive reinforcement for a response that occurs less frequently.

A

The Premack Principle

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29
Q

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.

A

The Premack Principle

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30
Q

techniques for modifying behavior:

the gradual decrease in frequency or disappearance of a response when the positive reinforcement is withheld.

A

the gradual decrease in frequency or disappearance of a response when the positive reinforcement is withheld.

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31
Q

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.

A

contingency contracting

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32
Q

techniques for modifying behavior:
Developed in the 1950s as a strategy for reinforcing desirable behaviors in long-term hospitalized schizophrenic patients

A

token economy

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33
Q

techniques for modifying behavior:

Type of contingency contracting in which the reinforcers for desired behaviors are presented in the form of tokens

A

token economy

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34
Q

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

A

token economy

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35
Q

what is essential to determine prior to using the token economy technique for modifying behavior

A

determination of items and situations of significance to the client that can be used as reinforcements

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36
Q

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.

A

D.

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37
Q

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.

A

time-out

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38
Q

during time-out the patient is usually ___ so reinforcement from attention of others is absent

A

isolated

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39
Q

reciprocal inhibition is also known as

A

counterconditioning

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40
Q

what is an example of reciprocal inhibition

A

relaxation exercises to an individual who is phobic

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41
Q

techniques for modifying behavior:

an aversion therapy that produces unpleasant consequences for undesirable behavior.

A

over-sensitization

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42
Q

what is an example of over-sensitization

A

giving Antabuse to individuals who wish to stop drinking alcohol

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43
Q

techniques for modifying behavior:

relies on individual’s imagination rather than medication for unpleasant symptoms.

A

covert sensitization

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44
Q

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.

A

covert sensitization

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45
Q

during ___ ___ Mental image is visualized when the individual may succumb to an attractive but undesirable behavior.
Most effective when paired with relaxation exercises.

A

covert sensitization

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46
Q

what is the primary advantage of covert sensitization

A

Primary advantage is individual does not have to perform, but only imagine undesired behaviors.

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47
Q

techniques for modifying behavior:

a technique for assisting individuals to overcome their fear of phobic stimulus.

A

systemic desensitization

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48
Q

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.

A

systemic desensitization

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49
Q

in ___ desensitization The effects of relaxation in the presence of imagined anxiety-producing stimuli transfer to the real situation.

A

systemic

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50
Q

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

A

systemic

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51
Q

this modifying behavior technique is sometimes called implosive therapy

A

flooding

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52
Q

techniques for modifying behavior:

is used to desensitize an individual to a phobic stimulus.

A

flooding

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53
Q

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.

A

flooding

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54
Q

why does flooding raise ethical questions and issues with compliance

A

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

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55
Q

flood is contraindicated in what clients

A

clients for whom intense anxiety would be hazardous such as individuals with heart disease or fragile psychological adaptation

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56
Q 
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.

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57
Q 
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.

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58
Q

relating to the mental processes of thinking and reasoning

A

cognitive

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59
Q

cognitive therapy has its roots in the early 1960’s research on depression conducted by

A

Aaron Beck

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60
Q

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

A

Aaron Beck

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61
Q

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

A

rejection

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62
Q

___ techniques, such as expectancy of reinforcement and modeling, are based in cognitive processes.

A

behavioral

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63
Q

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.

A

cognitive

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64
Q

___ is viewed as shaped by the interaction between innate predisposition and environment

A

personality

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65
Q

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

A

cognitive

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66
Q

since behavior and emotions are intimately linked to thoughts, this approach assumes that behavior and emotions will change as a result changing ones thinking

A

cognitive therapy

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67
Q

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

A

cognitive therapy

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68
Q 
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

A

depression

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69
Q

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.

A

cognitive

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70
Q

cognitive behavior therapy is highly structured and short term lasting from ___ to ___ weeks

A

12-16

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71
Q

if the client doesn’t improve within ___ weeks of therapy a reevaluation of the diagnosis should be made when using cognitive behavior therapy

A

25

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72
Q

how many cognitive behavior therapy principles are there

A

10

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73
Q

principle 1 of cognitive behavior therapy

Based on an ever-evolving formulation of the client and his or her problems in cognitive terms

A

the therapist identifies the event that precipitated the distorted cognition

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74
Q

principle 2 of cognitive behavior therapy Requires a sound therapeutic alliance

A

a trusting relationship between therapist and client must exist for cognitive therapy to succeed

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75
Q

principle 3 of cognitive behavior therapy

Emphasizes collaboration and active participation

A

teamwork between therapist and client is emphasized

they decide what to work on, how often to meet, and homework assignments

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76
Q

principle 4 of cognitive behavior therapy

Is goal oriented and problem focused

A

at the beginning of therapy the client is encouraged to identify what he or she perceives to be the problem

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77
Q

principle 5 of cognitive behavior therapy

Initially emphasizes the present

A

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

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78
Q

principle 6 of cognitive behavior therapy

Is educative, aims to teach patients to be their own therapist, and emphasizes relapse prevention

A

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

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79
Q

principle 7 of cognitive behavior therapy

Aims to be time limited

A

clients often are seen weekly for a couple of months, followed by a number of biweekly sessions

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80
Q

principle 8 of cognitive behavior therapy

Uses structured therapy sessions

A

structure includes

  1. reviewing client’s week
  2. collaboratively setting the agenda for this session
  3. reviewing the previous weeks session
  4. reviewing the previous weeks homework
  5. discussing tis weeks agenda
  6. establishing homework for next week
  7. summarizing this weeks session
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81
Q

principle 9 of cognitive behavior

Teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs

A

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

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82
Q

principle 10 of cognitive behavior

Uses a variety of techniques to change thinking, mood, and behavior

A

techniques from various therapies may be used within the cognitive framework

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83
Q

what are the basic concepts of cognitive behavior therapy

A
  • automatic thoughts

- schemas or core beliefs

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84
Q

Occur rapidly in response to a situation and without rational analysis
Often negative and based on erroneous logic
Beck called these thoughts cognitive errors.

A

automatic thoughts

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85
Q 
these are examples of common \_\_\_ errors 
Arbitrary inference
Overgeneralization
Dichotomous thinking
Selective abstraction
Magnification
Minimization
Catastrophic thinking
Personalization
A

cognitive

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86
Q

the individual automatically comes to a conclusion about an incident without the facts to support it or even despite contradictory evidence

A

arbitrary interference

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87
Q

sweeping conclusions are ___ made on the basis of one incident; an all or northing kind of thinking

A

overgeneralization (absolutistic thinking)

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88
Q

an individual who is using ___ thinking views situations in terms of all or nothing, black or white, or good or bad

A

dichotomous

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89
Q

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

A

selective abstraction

90
Q

exaggerating the negative significance of an even is known as ___

A

magnification

91
Q

undervaluing the positive significance of an event is called ___

A

minimization

92
Q

always thinking that the worst will occur without considering the possibility of more likely positive outcomes is considered ___ thinking

A

catastrophic

93
Q

with ___ the person takes complete responsibility for situations without considering that other circumstances may have contributed to the outcome

A

personalization

94
Q

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

A.

95
Q

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

A

schemas

96
Q

what are the 3 major components of cognitive behavior therapy

A

Didactic or educational aspects
Cognitive techniques
Behavioral interventions

97
Q

this technique of cognitive therapy Prepares the patient to eventually become his or her own cognitive therapist.

A

didactic (educational) aspects

98
Q

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.

A

didactic

99
Q

Strategies in cognitive behavior therapy include recognizing and modifying automatic thoughts and recognizing and modifying schemas.

A

cognitive strategies

100
Q

recognizing automatic thoughts and schemas includes

A

Socratic dialogue
Guided relaxation and behavioral rehearsal
Automatic thought records

101
Q 
Four procedures help the client learn \_\_\_ behavioral strategies that have a positive effect on cognitions.
Activity scheduling
Graded task assignments
Distraction
Miscellaneous techniques
A

adaptive

102
Q

called guided discovery

the therapist questions the client to elaborate the who what when where why and how of his or her situation

A

socratic dialogue

103
Q

___ ___ is aimed at reducing autonomic response to anxiety techniques may include deep breathing, imagery, mindfulness meditation

A

guided relaxation

104
Q

___ ___ often accomplished through role-play, affords the client an opportunity to practice a new way of responding to distressing situations and explore possible outcomes

A

behavioral rehearsal

105
Q

pathological ___ occurs when adaptation is ineffective and the symptoms are significant enough to impair functioning

A

depression

106
Q

Pervasive and sustained emotion that may have a major influence on perception of the world
ex: depression, joy, elation, anger, anxiety

A

mood

107
Q

described as the external, observable emotional reaction associated with an experience

A

affect

108
Q

a flat ___ described the state of a person who lacks emotional expression and is often seen in severely depressed clients

A

affect

109
Q

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.

A

depression

110
Q

the common cold of psychiatry

A

depression

111
Q

this is the most common psychiatric disorder

A

depression

112
Q

research indicates that the incidence of depressive disorder is higher in ___ than it is in ___ by almost two to one

A

women

men

113
Q

true or false: No consistent association between race and depressive disorders have been identified.

A

TRUE

114
Q

depressive disorder that occurs at characteristic times of the year
most common in fall or winter

A

seasonal affective disorder

115
Q

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

A

major depressive disorder (MDD)

116
Q

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

A

severity

117
Q 
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
A

persistent depressive disorder (Dysthymia)

118
Q

diagnosis of dysthymia early onset is made if it occurs before the age of ___ years

A

21

119
Q

diagnosis of dysthymia late onset is made if it occurs at age __ years or older

A

21

120
Q

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

A

premenstrual dysphoric disorder (PMDD)

121
Q

what is the difference between PMDD and typical premenstrual mood changes is what

A

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.

122
Q

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.

A

substance/medications-induced depressive disorder

123
Q

this disorder is characterized by symptoms associated with a major depressive episode that are direct physiological consequence of another general medical condition

A

depressive disorder associated with another medical condition

124
Q

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

A

norepinephrine
serotonin
dopamine

125
Q

it has been found that excessive ___ transmission may also be a predisposing factor in depression

A

cholinergic

126
Q

May play a role in the pathogenesis or persistence of depressive illness
Hypothalamic-Pituitary-Adrenocortical Axis
Hypothalamic-Pituitary-Thyroid Axis
Midbrain disturbance

A

neuroendocrine disturbances

127
Q

in clients who are depressed, the normal system of hormonal inhibition fails, resulting in a hypersecretion of cortisol

A

hypothalamic-pituitary-adrenocortical axis

128
Q

diminished TSH response to administered TRH is observed in 25% of depressed persons

A

hypothalamic-pituitary-thyroid axis

129
Q

___ dysfunction is a main risk factor for causing depression

A

thyroid

130
Q

depressive symptoms that occurs as a consequence of a non-mood disorder or as an adverse effect of certain medications are called ____ depression

A

secondary

131
Q

___ depression may be relate to Medication side effects
Neurological disorders
Electrolyte disturbances
Hormonal disorders
Nutritional deficiencies
Other physiological or psychological conditions
Inflammation

A

secondary

132
Q

what kind of electrolyte imbalances can produce symptoms of depression

A
  • excess sodium bicarb, calcium, potassium

- deficit of magnesium, sodium, potassium

133
Q

depression is associated with dysfunction of the ___ cortex and is commonly observed in both Addison’s and Cushing’s syndrome

A

adrenal

134
Q

Other ___ conditions that may result in symptoms of depression include hypoparathyroidism, hyperparathyroidism, hypothyroidism, and hyperthyroidism

A

endocrine

135
Q

psychosocial theories
Freud presented this theory
A loss is internalized and becomes directed against the ego.

A

psychoanalytical theory

136
Q

“learned helplessness”

A

learning theory

137
Q

The individual who experiences numerous failures learns to give up trying.

A

learned helplessness

138
Q

___ ___ 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

A

learned helplessness

139
Q

theory suggesting that the primary disturbance in depression is cognitive rather than affective

A

cognitive theory

140
Q

what are the 3 cognitive distortions that serve as the basis for depression

A

Negative expectations of the environment
Negative expectations of the self
Negative expectations of the future

141
Q

___ distortions arise out of a defect in cognitive development and the individual feels inadequate, worthless, and rejected by others

A

cognitive

142
Q

cognitive theorists believe that depression is the product of ___ thinking

A

negative

143
Q

this kind of therapy focuses on helping the individual alter mood by changing the way he or she thinks

A

cognitive therapy

144
Q

___ 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.

A

transactional

145
Q

depression symptoms in this age range include

Feeding problems, tantrums, lack of playfulness and emotional expressiveness

A

less than age 3

146
Q

depression symptoms in this age range include

Accident proneness, phobias, excessive self-reproach

A

age 3-5

147
Q

depression symptoms in this age range include

Physical complaints, aggressive behavior, clinging behavior

A

ages 6-8

148
Q

depression symptoms in this age range include

Morbid thoughts and excessive worrying

A

ages 9-12

149
Q

in many depressed children there is a genetic predisposition toward the condition which is then precipitated by a ___ situation

A

stressful

150
Q

a common precipitating factor in childhood depression is what

A

loss

151
Q

what is the focus of therapy with depressed children

A

to alleviate the child’s symptoms and strengthen their coping and adaptive skills with the hope of possibly preventing future psychological problems

152
Q

what other kind of involved therapy is used to help the younger depressed child

A

parental and family therapy

153
Q

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

A

suicide

154
Q 
common symptoms of \_\_\_ among adolescents include 
Anger, aggressiveness
Running away
Delinquency
Social withdrawal
Sexual acting out
Substance abuse
Restlessness, apathy
A

depression

155
Q

what differentiates mood disorder from the typical stormy behavior of adolecence

A

a visible manifestation of behavioral change that last for several weeks is the best clue for a mood disorder

156
Q

what is the most common precipitant to adolescent suicide

A

perception of abandonment by parents of close peer relationship

157
Q

treatment of adolescent depression includes

A

supportive psychosocial intervention

antidepressant medication

158
Q

children and adolescents being treated with antidepressants needs to be closely monitored because this causes an increased risk of ___ thoughts and behavior

A

suicidal

159
Q

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

A

bereavement overload

160
Q

symptoms of __ are often confused with symptoms of neurocognitive disorders or the aging process in the elderly

A

depression

161
Q

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

A

Electroconvulsive therapy (ECT)

162
Q

the severity of depression in the ___ period varies from feeling the baby blues to moderate depression to severe depression with psychotic features

A

postpartum

163
Q

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

A

moderate

164
Q

May last for a few weeks to several months

Associated with hormonal changes, tryptophan metabolism, or cell alterations

A

postpartum depression

165
Q 
symptoms of depression may be described as alterations in \_\_\_ spheres of human functioning which include 
 Affective
Behavioral
Cognitive
Physiological
A

4

166
Q

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

A

transient depression

167
Q 
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
A

mild

168
Q

dysthymia is also called

A

persistent depressive disorder

169
Q

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

A

moderate

170
Q

severe depression is also called

A

major depressive disorder

171
Q

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

A

severe depression

172
Q

what is a short term goal for risk for suicide

A
  • client will seek out staff when feeling urge to harm self

- client will not harm self

173
Q

what is long term goal for risk for suicide

A

client will not harm self

174
Q

nursing diagnosis

vulnerable to self-inflicted life-threatening injury

A

risk for suicide

175
Q

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

A

complicated grieving

176
Q

what are short term goals for complicated grieving

A
  • client will express anger about the loss

- client will identify coping strategies and rational thought patterns in response to loss

177
Q

nursing diagnosis defined as negative self-evaluating/feelings about self or self capabilities

A

low self-esteem

178
Q

nursing diagnosis defined as impaired ability to perform or complete activities of ADLs for self

A

self-care deficit

179
Q

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

A

powerlessness

180
Q

Focus is on interpersonal relations and proceeds through three phases and interventions.

A

individual psychotherapy

181
Q

Focuses on changing “automatic thoughts” that contribute to distorted affect

A

cognitive therapy

182
Q

Electrical currents are applied to the brain, causing a grand mal (generalized) seizure.
Goal is to identify and change dysfunctional patterns of thinking

A

electroconvulsive therapy (ECT)

183
Q

Uses short pulses of magnetic energy to stimulate nerve cells in the brain

A

Repetitive Transcranial Magnetic stimulation (rTMS)

184
Q 
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
A

tyramine

185
Q

what can happen if you eat tyramine containing foods while on MAOIs

A

could cause a life-threatening hypertensive crisis

186
Q

what drugs are used to treat depression

A

tricyclics
selective serotonin reuptake inhibitors (SSRIs)
monoamine oxidase inhibitors (MAOIs)
atypical antidepressants
serotonin norepinephrine reuptake inhibitors (SNRI’s)

187
Q

this kind of treatment for depression involves resolving the symptoms and initiating or restoring adaptive family functioning

A

family therapy

188
Q

this type of treatment for depression involves providing feedback from peers who are having a similar experience

A

group therapy

189
Q 
side effects to \_\_\_ therapy include 
HA
eyestrain 
nausea 
irritability 
photophobia (eye sensitivity to light 
insomnia agitation 
these are all mild and short lived
A

light

190
Q

light therapy and ___ have shown comparable efficacy in studies of SAD treatment

A

antidepressants

191
Q

treatment with light therapy should be continued until until an expected time of spontaneous remission such as the change in ___ to spring or summer

A

season

192
Q

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.

A

mania

193
Q

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.

A

bipolar disorder

194
Q

true or false: mania is still used to describe an abnormal mood state of elation

A

TRUE

195
Q

__ ___ 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.

A

bipolar disorder

196
Q

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

A

hypomania

197
Q

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.

A

Bipolar 1

198
Q

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

A

Bipolar 2

199
Q

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

A

cyclothymic disorder

200
Q

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

A

substance-induced bipolar disorder

201
Q

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

A

bipolar disorder associated with another medical condition

202
Q

biochemical influences studies about bipolar disorder has associated symptoms of mania with a functional excess of what neurotransmitters

A

norepinephrine

epinephrine

203
Q

according to this predisposing factors theory Bipolar disorder clearly results from an interaction between genetic, biological and psychosocial determinants.

A

transactional model of stress and adaptation

204
Q

Disruptive mood dysregulation disorder

A

diagnosis given to youth who were initially diagnosed with ADHD but had atypical symptoms so they created this new diagnosis

205
Q

___ has been identified as the most common comorbid condition in children and adolescents with bipolar disorder

A

ADHD

206
Q

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

A

controlled

207
Q

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

A

hypomania

208
Q

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

A

acute mania

209
Q

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.

A

delirious mania

210
Q

symptoms of manic states can be described according to 3 stages which are

A
  • hypomania
  • acute mania
  • delirious mania
211
Q

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

A.

212
Q

what medications are usually used to treat mania

A

lithium carbonate
anticonvulsants
verapamil
antipsychotics

213
Q

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.

A

lithium

214
Q

what other important information do we need to keep in mind about lithium

A
  • 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
215
Q

what is an adverse effect of antipsychotics

A

agranulocytosis

216
Q

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

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.

217
Q

lithium is a what so anything that depletes sodium will make more receptor sites available and increase the risk for lithium toxicity

A

salt

218
Q

what is the range for lithium in acute mania

A

1-1.5

219
Q

what are the maintenance lithium levels

A

0.6-1.2

220
Q

what are early signs and symptoms of lithium toxicity

A

vomiting and diarrhea

Psychiatric Mental Health (6 decks)

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