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Mental Health > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Currently known as mood dysregulation disorder
Have extreme highs such as exaggerated euphoria/excitedness or manic episodes to extreme lows such as severe/suicidal depression or anger
There are family tendencies with this and it starts to occur in late teens/early adults
Genetics plays a large role in this disorder (80-90+% can develop this disorder from family) the rate may be 5-10 times higher for those who have a relative with this

A

Bipolar disorder

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2
Q

Periods of abnormally and persistently elated, expansive, or irritable moods
These don’t let people sleep
They usually begin suddenly and last from a few days to a few months
The individual has no insight to the fact that they are sick
Has abrupt mood changes from happy to irritable

A

Manic episodes

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3
Q

Mood disorder characterized by one or more week-long manic episodes resulting in excessive activity and energy

A

Bipolar 1 disorder

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4
Q

Hallucinations, delusions, and dramatically disturbed thoughts that many occur during manic episodes

A

Psychosis

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5
Q

This type of bipolar disorder experiences psychosis

A

Bipolar 1 disorder

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6
Q

In this bipolar disorder, manic episodes may alternate with major depression or a mixed state of agitation and depression

A

Bipolar 1 disorder

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7
Q

Mood disorder characterized by low level mania (hypomania) alternate with profound depression or major depressive episodes rather than manic episodes

A

Bipolar 2 disorders

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8
Q

Unlike manic, psychosis is never present in …

A

Hypomanic (bipolar 2)

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9
Q

Its very hard to maintain employment and social connections with this disorder
The median onset age is 18

A

Bipolar 1

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10
Q

If someone comes into the hospital in a manic state what should be done?

A

Sedation to keep them from hurting themselves or others

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11
Q

What are some things you should do/look for in a manic patient

A

Make sure they are in appropriate clothes
-if not, because manic women usually wear less than they should..give her some clothes
Promote sleep so they wont stay up all night

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12
Q

This does not cause impairment of social or occupational functioning
The median onset age is 20

A

Bipolar 2

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13
Q

4 or more hypomanic episodes alternating with depression in a 12 month period

A

Rapid cycling

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14
Q

First line therapy for bipolar disorders

A

Lithium

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15
Q

Symptoms of hypomania alternating with symptoms of mild to moderate depression for at least 2 years in adults and 1 year in children
Might be difficult to distinguish from bipolar 2

A

Cyclothymic disorder

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16
Q

Accelerated speech or pressured speech, tangential or vague, can be vulgar or sexual, continuously flowing with abrupt changes from topic to topic that are usually based on understandable associations or play on words

A

Flight of Ideas

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17
Q

The flight of ideas may give way to _____, the stringing together of words because of their rhyming sounds without regards to their meaning

A

Clang association

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18
Q

Inflated self regard, feeling superior to others, apparent in the person’s behavior and their expressed ideas
Very common

A

Grandiosity

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19
Q

When treating a bipolar patient, frequent staff meetings are important because patients will try to …

A

Manipulate staff/staff splitting by saying that one nurse is letting the patient do something that another nurse wont
*Consistency among staff is imperative if the limit setting is to be carried out effectively

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20
Q

One of the main ways to treat a patient with bipolar disorder

A

Limit setting (lights out after 11pm, patients will exhaust themselves, another good reason to sedate them)

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21
Q

What kind of diet should a manic patient be on?

A

High caloric finger foods or protein drinks: milkshakes, sandwiches, fruit
Monitor intake&output
Offer fiber

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22
Q

What is refocus?

A

A program children go on when the doctor thinks that the child does not understand their issue

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23
Q

During this phase, planning focuses on injury prevention, medically stabilizing the patient while maintaining safety and the hospital is usually the safest environment for accomplishing this

A

Acute phase

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24
Q

During this phase (which lasts 4-9 months) planning focuses on maintaining adherence to the medication regimen and prevention of relapse

A

Continuation phase

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25
Q

During this phase, planning focuses on preventing relapse and limiting and severity and duration of future episodes

A

Maintenance phase

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26
Q

These drugs are the first line of treatment for a person with bipolar disorder experiencing an acute depressive episode, when depressive episodes have psychotic features, a second generation antipsychotic may be added to the medication regimen

A

Lithium & lamotrigine (Lamictal)

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27
Q

Treatment with what type of drug is not recommended for bipolar patients

A

Antidepressants (could send them into a manic episode)

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28
Q

These medications are given for severe manic episodes

A

Lithium & valproate (Depakote)

and a second generation antipsychotic such as olanzapine (Zyprexa) or risperidone (Risperdal)

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29
Q

This drug is effective in treatment of bipolar 1 acute and recurrent mania and depressive episodes, it inhibits 80% of acute manic and hypomanic episodes within 10-21 days

A

Lithium (Li+)

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30
Q

These can be used to prevent exhaustion, coronary collapse, and death until lithium reaches therapeutic levels

A

Antipsychotics or benzodiazepines

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31
Q

How long does it take lithium to reach therapeutic levels in the blood

A

7-14 days or longer

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32
Q

Recommended range of lithium

A

0.8-1.5

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33
Q

Lithium levels should be measured at least ____ days after beginning lithium therapy and after any dose change

A

5 days

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34
Q

Lithium blood levels should be drawn..

A

In the morning, 8-12 hours after last dose

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35
Q

What are 2 major long term risks of lithium therapy

A

Hypothyroidism

Impairment of the kidneys ability to concentrate urine

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36
Q

Anticonvulsant drugs approved for the treatment of mood disorders

A

valproate (Depakote) - can injure liver
carbamazepine (Tegretol)
lamotrigine (Lamictal) - can develop a rash due to steven johnson syndrome

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37
Q

Which drug do you need to seek immediate medical attention if a rash appears?

A

lamotrigine (Lamictal) due to steven johnson syndrome

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38
Q

Antianxiety drugs useful for acute mania in patients resistant to other treatments

A

clonazepam (Klonopin)

lorazepam (Ativan)

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39
Q

Used to subdue severe manic behavior (bipolar1, mania and major depression) especially in patients with treatment resistant mania, and patients with rapid cycling

A

Electroconvulsive therapy (ECT)

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40
Q

Lithium is effective in treating

A

Elation, grandiosity, and expansiveness
Flight of ideas
Irritability and manipulation
Anxiety

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41
Q

To a lesser extent, lithium is effective in treating

A 
Insomnia
Psychomotor agitation
Threatening or assaultive behavior
Distractibility
Hypersexuality
Paranoia
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42
Q

Lithium is a salt, what does this mean for a patients salt intake

A

It should not be limited or overindulged in

Keep it normal

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43
Q

Why should you be aware of dehydration when taking lithium

A

Because when you are dehydrated, you are hyponatremic (too little salt) and since lithium is a salt, this will cause lithium to build up because your body wants salt

dehydration, fever, infection, and people who are out in the sun are also risk factors for lithium toxicity

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44
Q

If lithium is not at therapeutic levels its very dangerous and can become

A

Toxic

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45
Q

What side effect will occur with lithium toxicity

A

Coarse tremors, toxicity can kill you, might have to have hemodialysis if toxicity occurs

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46
Q

How long can someone be on lithium

A

Possibly a lifetime

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47
Q

What is a common side effect of lithium

A

Fine hand tremors, polyuria, mild thirst, mild nausea, general discomfort, and weight gain

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48
Q

Side effects with early signs of toxicity

A

N/V/D, thirst, lethargy, polyuria, slurred speech, muscle weakness

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49
Q

Advanced side effects of toxicity

A

Coarse hand tremors, confusion, sedation, GI upset, muscle hyperirritability, incoordination

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50
Q

Severe side of effects of toxicity

A

Ataxia (loss of full control of body movements), giddiness, graphic changes, blurred vision, clonic movements, large output of dilute urine, seizures, stupor, severe hypotension, coma, death secondary to pulmonary complications

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51
Q

What should you remember about lithium in older patients

A

Start low, stay low

Its toxic to older adults at much lower levels

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52
Q

Mood stabilizers can cause..

A

Weight gain & metabolic problems

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53
Q

What do we know about a relapse of bipolar disorder

A

A relapse can come out of the blue

Alcohol and drugs, even just a tiny amount, can cause a relapse

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54
Q

The leading cause of disability in the U.S.

A

Depression

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55
Q

People with this disorder have a history of one or more major depressive episodes, they have no history of manic or hypomanic episodes because would qualify them as bipolar

A

Major depressive disorder

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56
Q

One of the most common mental disorders affecting approx. 13 million adults annually in the U.S.
It is characterized by a persistently depressed mood lasting for a minimum of 2 weeks, children tend to be more irritable

A

Major depressive disorder

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57
Q

Severe depression may include..

A

Psychotic features

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58
Q

Facials expressions

A

Your affect

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59
Q

Having no energy

A

Anergia

60
Q

Having no pleasure

A

Anhedonia

61
Q

Occurs when feelings of depression persist consistently for at least 2 years
It is a chronic depressive syndrome present on most days throughout the whole day

A

Dysthymic disorder

62
Q

Major depressive disorder symptoms interfere with most..

A

social and occupational functioning

63
Q

Children and adolescents are effected between the ages 13-18 and they display their depression by..

A

Being irritable, possibly quiet, possibly acting out, being aggressive, their grades will go down, and they will probably self mutilate

64
Q

The risk for depression in the elderly increases as..

A

their health deteriorates

65
Q

Co-morbidly, depression usually us accompanied with the psychiatric disorder of..

A

Anxiety and anxiety disorders

66
Q

Factors that put someone at risk for depression

A

Medical illnesses (HEART DISEASE, hypothyroidism, anxiety, cancer)
Stressful life events (job loss, loss of family/friend, loss of abilities)
Postpartum (females)
Being unmarried
Being on substances

67
Q

What are key findings to look for in a depressed patient

A

Anergia
Anhedonia
Anxiety
Sluggish or the opposite
Vegetative findings
Somatic complaints of GI, malaise, head or back aches)
Psychomotor agitation (pacing) or retardation (slow)

68
Q

What are vegetative findings found in subjective data

A 
BESS: changes in...
Bowel habits (hyper or constipated)
Eating habits
Sleep disturbances
Sex desire (lack of)
69
Q

Assessment of a depressed patient should start with a..

A

Self assessment:
do you have realistic expectations for yourself
do they have realistic expectations of themselves
AND DONT FEEL WHAT THE PATIENT IS FEELING

70
Q

In depressed patients there is ALWAYS an assessment for…

A

Suicide

71
Q

What will a depressed patients affect look like

A 
Feelings of hopelessness and despair
Posture is poor
Facial expressions convey sadness or possibly flat
Possibly weeping
Might not make eye contact
Monotoned
72
Q

What will a depressed patients thought processes be like

A

Judgement is poor
Indecisive
Memory and concentration is poor

73
Q

What will a depressed patients mood look like

A

Feeling worthless, guilt, hopeless, anger

Reflects a low self esteem

74
Q

What are some possible nursing diagnosis for depressed patients

A 
RISK FOR SUICIDE
Hopelessness
Ineffective coping
Social isolation
Spiritual distress
Self care deficit
75
Q

What does the recovery model base recovery on..

A

Focus on patient’s strengths
Treatment goals are mutually agreed upon and developed
Based on patient’s specific needs (if she lost her husband, base her treatment around her kids)
Include the patient in on their treatment

76
Q

Planning for the patient is always based on..

A

Patient’s phase of depression
Their specific symptoms
Their personal goals
*Safety is always the highest priority

77
Q

What are the 3 phases of treatment and what is it important to know about them

A
  • Important to know that the first year is the hardest and they can always back within that first year
    1. Acute phase: reducing depressive symptoms and restoring social and work functions (6-12 weeks)
    2. Continuation: prevention of relapse through medicine, education, and specific therapies (4-9 months)
    3. Maintenance: preventing further episodes, medication may be phased out or continued (1 year or more)
  • It takes 2-3 weeks at least for antidepressants to work
78
Q

The first line therapy for most types of depression

A

SSRIs (selective serotonin reuptake inhibitors)

79
Q

SSRIs have relatively low side effects compared to..

A

Tricyclics (older antidepressant)

80
Q

SSRIs and SNRIs have low suicide attempts compared to..

A

Tricyclics which have very high potential for lethality with overdose (we would rather them overdose on an SSRI/SSNI)

81
Q

What is the biggest potential toxic effect with an SSRI

A

Serotonin syndrome

82
Q

The risk of serotonin syndrome is greatest when..

A

mixed with second serotonin enhancing agent such as an MAOI

**a patient should discontinue all SSRIs for 2-5 weeks before starting and MAOI

83
Q

Effects of serotonin syndrome

A 
Abdominal pain
Fever
Diarrhea
Tachycardia
Increased BP
Sweating 
Altered mental state
Irritable
Hostile
Mood changes
High fever
84
Q

What are 5 specific SSRIs

A 
Lexapro
Celexa
Prozac
Zoloft
Paxil
85
Q

What are some long term side effects with SSRIs

A

Weight gain

Sexual dysfunction

86
Q

What is the main toxic complication with TCAs (tricyclics)

A

Heart complications: MIs, heart blocks, tachycardia. dysrhythmias, heart palpitations

87
Q

Diet recommendations for patients on tricyclics

A

High fiber

88
Q

A specific TCA drug

A

Elavil

89
Q

Besides heart complications, what other effects can happen with TCAs

A

Anticholinergic effects (fight of flight)

  • tachycardia
  • dry mouth
  • blurred vision
  • esophageal reflux
  • URINARY RETENTION**needs immediate attention
  • SEVERE CONSTIPATION**needs immediate attention
90
Q

What should you know about wellbutrin

A

Antidepressant
Atypical
Do not take after 5pm
May cause weight loss
**Avoid giving to at risk seizure patients
**Only antidepressant that does not decrease sex drive (may even increase it)

91
Q

Why are MAOIs not given as a first line defense against depression

A

There are specific dietary restrictions that if not followed can cause someone to go into a hypertensive crisis
**because of this, BP has to be monitored the first 6 weeks of treatment involving an MAOI

92
Q

What are 3 MAOI drugs

A

Nardil
Parnate
Emsam (patch)

93
Q

What is the specific dietary restriction with MAOIs

A

Food/drinks containing tyramine: fish, salami, cheese, wine, sauerkraut, yeast, avocados, beans

94
Q

You should not start another drug for 2 weeks with this medication and you need to have a level

A

MAOIs

95
Q

If you develop a headache with this medication go to the ER immediately

A

MAOIs

96
Q

What drugs are given with electroconvulsion therapy

A

A general anesthetic (barbituate)

A muscle paralyzing agent (succinylcholine)

97
Q

What happens during an ECT

A

Short seizures are induced
Usually 2-3 treatments a week for a total of 6-12 treatments
Short term memory loss is expected but it gets better
Patients usually have 70-90% remission/recovery

98
Q

Helps people reconstruct their negative thought patterns and behaviors

A

Cognitive behavioral therapy

99
Q

Focuses on working through personal relationships that may contribute to depression, modeling

A

Interpersonal therapy

100
Q

Therapy done with the patient and the family

A

Time limited focused psychotherapy

101
Q

What features accompany major depressive disorders

A 
Psychotic features
Melancholic features: not happy 
Atypical features
Catatonic features: purposeless movement
Postpartum onset
Seasonal features: treated with light therapy
102
Q

What should you check for in someone having ECT

A

a gag reflex

103
Q

Apprehension, uneasiness, uncertainty, or dread from real or perceived threats, not very productive, and not rational

A

Anxiety

104
Q

A reaction to a specific danger

A

Fear

105
Q

Occurs in the normal experience of everyday living, allows for sharp focus, good for test taking

A

Mild anxiety

106
Q

Perceptual field narrows and some details are excluded from observation, the patient could have selective inattention as well

A

Moderate anxiety

107
Q

When only certain things in the environment are heard or seen unless pointed out

A

Selective inattention

108
Q

Perceptual field is greatly reduced, a person may focus on particular scattered details, difficulty noticing whats going on in the environment, learning and problem solving not possible, trembling, heart pounding, hyperventilation, impending dread or doom

A

Severe anxiety

109
Q

The most extreme level of anxiety and results in disturbed behaviors, pacing, running, shouting, screaming, or withdrawal losing touch with reality

A

Panic

110
Q

Automatic coping styles protecting people from anxiety and maintaining self image by blocking feelings, conflicts, and memories

A

Defense mechanisms

111
Q

What is the defense mechanism: reaction formation

A

when unacceptable feeling or behaviors are controlled and kept out of awareness by developing the opposite behavior or emotion
-a recovering alcoholic talks about how alcohol is gross and evil (good use of it)

112
Q

What is the defense mechanism: splitting

A

the inability to integrate the positive and negative qualities of oneself or others, its either all good or all bad
-a women values her significant other until she finds out they have flaws (bad use of it)

113
Q

What is the defense mechanism: denial

A

involves escaping unpleasant, anxiety causing thoughts, feelings, wishes, or needs by ignoring them
-someone has died and the person says, I dont believe you

114
Q

What is the defense mechanism: displacement

A

the transference of emotions associated with a particular person, object, or situation to another nonthreatening person, object, or situation
-child yells at teddy bear after being bullied on the bus

115
Q

What is the defense mechanism: intellectualization

A

a process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feelings and emotions
-a mans farm has been destroyed by a tornado but he leads his child to safety

116
Q

What is the defense mechanism: projection

A

refers to the unconscious rejection of emotionally unacceptable features and attributing them to others
-emotions about a situation usually cause you to reject others as well, similar to displaced emotion

117
Q

What is the defense mechanism: rationalization

A

consists of justifying illogical or unreasonable ideas, actions, or feelings by developing an acceptable explanation, making excuses
-I didnt get the raise because my boss doesnt like me

118
Q

What is the defense mechanism: regression

A

reverting to an earlier, more primitive and child like pattern of behavior
-4 yr old with a new baby brother will temporarily start sucking this thumb or wanting a bottle

119
Q

Exhibiting developmentally inappropriate levels of concern over being away from someone by fear of being away from them forever

A

Separation Anxiety Disorder

120
Q

A sudden onset of extreme apprehension or fear usually associated with doom, takes place in panic disorders

A

Panic attacks

121
Q

An intense, excessive anxiety of fear about being in places or situations that escape might be difficult or embarrassing or help might not be available
-the feared places are avoided

A

Agoraphobia

122
Q

Characterized by severe anxiety or fear provoked by exposure to a social or performance situation that could be evaluated negatively

  • fear of saying something foolish
  • not being able to answer classroom questions
  • looking awkward while eating
A

Social anxiety disorder

123
Q

The key feature in this disorder is worry, people will anticipate disaster, they are restless, irritable, and experience muscle tension
*lasts for 6 months or longer

A

Generalized anxiety disorder

124
Q

Characterized by symptoms of anxiety, panic attacks, obsessions and compulsions developing with the use of substances
also develops in a month with stopping the substance

A

Substance induced anxiety

125
Q

Anxiety directly the result of a medical condition, most commonly hyperthyroidism, PE, cardiac dysrhythmias, chemo, not being able to live a normal life/perform ADLs

A

Anxiety due to medical conditions

126
Q

What should you always do when your patient is having a panic attack

A

STAY WITH YOUR PATIENT

  • just stay quiet, no music, just be with them
  • focus on one thing at a time
127
Q

Thoughts, impulses, or images that persist and reoccur

-germs are the thought

A

Obsession

128
Q

Ritualistic behaviors a person feels driven to perform in an attempt to reduce anxiety
-handwashing is the compulsion

A

Compulsions

129
Q

Can be a personality or anxiety disorder
Exists along a continuum
Can be things like “did I lock the door, shut the garage”
Mild forms are rewarded in society

A

Obsessive compulsive disorders

130
Q

This is a chronic disorder, difficult to treat/response to treatment is limited
When a person fixates on a defective part of their body, they can be seen in extensive cosmetology surgeries
Men tend to focus on body build, women on hips, thighs, butt
Most likely no one is going to see what the victim sees

A

Body Dysmorphic Disorder

131
Q

Prevents people from living normal lives, so much clutter it makes homes unsafe, affects both genders

A

Hoarding disorder

132
Q

Linked to symptoms of OCD
Occurs as early as 1 year old, more often in children
Referred to as trichtotillomania & dermotillomania
The pain reduces the anxiety
The habit is irresistible to the individual

A

Hair pulling & skin picking

133
Q

Most common form of psychiatric disorders in the US affecting 40 million, about 18% of the population

A

Anxiety disorders

134
Q

Suggests that unconscious childhood conflicts are the basis for future symptoms development of anxiety

A

Psychodynamic theories

135
Q

Frued & Sullivan*

A

Things happen early on in live that cause problems that people just cant over come once they are older, anxiety is linked to needs that werent met

136
Q

Teaching and physical practice of activities to decrease anxious or avoidant behavior

A

Behavioral therapy

137
Q

Ways to cope with behavioral theories that anxiety is related to a specific stimuli (what are some behavioral therapies)

A 
Modeling
Systemic desensitization
Relaxation training
Flooding
Response prevention
Thought stopping
138
Q

Therapy based on distortions in a persons thoughts, usually very exaggerated and what can make this better

A

Cognitive therapy and cognitive restructuring is used

139
Q

Too little of this neurotransmitter relates to anxiety

A

GABA

140
Q

2nd line of defense for anxiety

A

Benzodiazepines, they allow GABA to stay in the brain

141
Q

First line of defense for anxiety and what is their benefit compared to benzos

A

SSRIs such as Paxil, they have a secondary benefit of treating comorbid depressive disorders

142
Q

This disorder most people see flashbacks
They avoid stimuli associated with the trauma
They experience a persistent numbing of responses
They experience persistent symptoms of increases arousal

A

Post traumatic stress disorder

143
Q

A person experiencing these levels of anxiety can still solve problems, they can be talked out or talked down from their anxiety

A

Mild to moderate

144
Q

A person experiencing these levels of anxiety are unable to solve problems and wont know whats happening, medication will most likely have to be used

A

Severe to panic

145
Q

What are side effects of benzodiazepines

A 
Respiratory depression
Addiction/dependence
Sedation
Ataxia (cant control body)
Decreased cognitive functions
*dont give to people who have substance abuse issues or women pregnant or breast feeding
146
Q

Name 6 benzodiazepines

A 
BuSpar: must be taken daily, non addictive, takes 2-4 weeks to reach full effect
Librium
Xanax
Ativan
Klonopin
Valium

Mental Health (4 decks)

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