Final Exam Flashcards
mental health assessment for children focuses more on…
developmental stages
mental health assessment of child includes…
presenting problem, medical and developmental issues, family HX, physical exam, ACE score, and mental status assessment; important to consider self harm, sexual activity, suicidal thoughts, and substance use in adolescents
methods of collecting data from children
interview, testing, observing, interacting, HX from parents/caregivers, questions toward life at home and school, games, drawings, puppets, free play, observations among other children caregivers adolescents and siblings, freedom to describe current problems
neurodevelopmental disorders of children
intellectual disability, communication disorders, autism spectrum disorders, attention deficit hyperactivity disorder, specific learning disorders, motor disorders, disruptive/impulse-control/conduct disorders
types of disruptive, impulse-control, and conduct disorders
oppositional defiant disorder and conduct disorder
intellectual disability
can range from mild to moderate to severe to profound
screening and diagnosis of ID in children
severe cases can show signs of almond shaped eyes and short stature; children screened during well-child exams; diagnosis confirmed with blood, DNA, brain scans, IQ testing, and failure to meet developmental milestones
implementation for ID
individual/family counseling, appropriate schooling, individualized educational plan, federal individuals with disabilities education act, occupational and behavioral therapies, medications
types of communication disorders
language disorders, speech sound disorders, childhood-onset fluency disorder (aka stuttering), social communication disorder
assessing, diagnosing, and implementing with communication disorders
delay or speech abnormality is noted; child is referred to speech therapist or school psychologist; speech therapy provided; supportive counseling may be necessary
autisim spectrum disorders
present with deficits in social and communication, repetitive patterns of behavior interests or activities; severity based on functional ability
severity of ASDs
level 1aka high functioning autism- noticeable social deficit but language and speech are normal; level 2 aka autism- noticeable deficit in verbal and nonverbal social and communication skills; level 3 aka severe autism- social deficits are severe with communication being limited and needs-based
assessment of ASD
observe for social and emotional deficits like bonding with parents, dislike of cuddling, poor eye contact, lack of interaction with peers; child with autism may not understand jokes/sarcasm; may not adhere to social norms; delays in communications; rigid routines; ritualized behaviors and interest may be present
ASD diagnosis
most often ages 2-3; diagnosed by child psychiatrist, developmental pediatrician, or pediatric neurologist; the early the diagnosis and interventions = better prognosis
Implementations for ASD
speech therapy to help with delay and language skills; OT to help with sensory or stimming issues; PT to help with strength/coordination; psych NP or MD for medication management; school support for tutoring or smaller classroom environment
ADHD symptoms
problems with concentrating causing careless mistakes, difficulty remaining focused, easily distracted; may avoid tasks that require mental effort; tend to be messy and misplace items; fidgeting or running or climbing when not appropriate; may interrupt or talk excessively; may show as restlessness internally in adults
ADHD assessment
high level of fidgeting; difficulty paying attention in class, fidgeting and getting out of seat in class, talking at inappropriate times, inconsistent/messy assignments; nurse may avoid pt repeatedly sent to office for disruptive behavior
Diagnosing ADHD
primary care can diagnose and treat if uncomplicated; if symptoms do not improve then refer to psych NP or MD; questionnaires like vanderbilt assessment scales used to identify and measure progress of treatment
ADHD implementation
behavior modification therapy, parent training, school accommodations, pharmacological agents to address inattention and hyperactive/impulsive behaviors
specific learning disorders
difficulty learning in specific areas such as reading or math; some examples are dyslexia or dyscalculia; onset usually in elementary school
assessment, diagnosis, and implementation of specific learning disorders
parents often report the problems, diagnosed via testing, implementations such as tutoring or learning accommodations
motor disorders
developmental coordination disorder, tourettes disorder
developmental coordination disorder
-delayed coordinated motor skills causing clumsiness, slowness, difficulty with riding a bike, difficulty with handwriting
tourettes disorder
motor and vocal tics with early childhood onset; mild to severe spasms that can be embarrassing
assessment, diagnosis, implementation of motor disorders
DSM 5 criteria, comprehensive behavioral intervention for tics (CBIT), PT/OT, medications for tremors and tics
disruptive, impulse-control, and conduct disorders
oppositional defiant disorder and conduct disorder
oppositional defiant disorder
goes beyond normal limit testing of children; symptoms displayed with at least 1 non sibling; need 4 criteria to be met
conduct disorder
more severe than ODD; need 3 criteria to be met
assessment, diagnosis, implementation of disruptive, impulse-control, and conduct disorders
parenting classes and management training to create limit setting; treatment is long term usually several hours per week; therapy consist of problem solving, social skills, impulse control, developing empathy, medication to treat coexisting conditions (ADHD or anxiety)
somatic disorders
psychological distress expressed as physical symptoms without known organic source; physical symptoms offer method to indicate distress when verbal communication is rare; more prevalent in women; usually diagnosed in children who have experienced traumatic event
clinical manifestations of somatic disorder
physical symptoms such as distress, impaired functioning, obsession with health concerns, seeking medical relief; pain is predominant symptom; disorder persists longer than 6 months and is on continuum from mild to severe
illness anxiety disorder
illness preoccupation with or without symptoms; persistent, high anxiety over health, alarmed body sensations, may or may not seek help; resembles hyperchondriasis
functional neurological disorder
chronic or brief symptoms of altered voluntary motor/sensory function; findings indicate symptoms does not align with anatomy, physiology, or known disease; symptoms are inconsistent at different times
psychological factors affecting other medical conditions
diagnosed when general medical condition is affected by psychological/behavioral factors; factors may precipitate or exacerbate medical condition and interfere with treatment
factitious disorder imposed on self
intentional faking of symptoms to assume sick role with no external benefits (i.e. financial gain or avoiding prosecution); pt have medical knowledge
malingering
intentionally faking or exaggerating symptoms for benefit
factitious disorder imposed on another
fabrication of symptoms/injury imposed on another person usually a child or dependent victim; perpetrator is often parent/caregiver; motive is to receive attention and nurturing
difference between facticious and somatic disorders
somatic = general medical conditions affected by stress or psychological factors; factitious = fabrication of symptoms or self-inflicted injury for sick role
nursing interventions for somatic/factitious disorders
establishing rapport, help pt learn to meet needs without resorting to somatization, outpatient psychiatric visits
root cause for developing somatic disorders
adverse childhood experiences aka childhood trauma
nursing assessment of somatic disorders
childhood trauma, family/workplace dynamics, ability to meet own needs, nature/location/onset/character/duration of symptoms
anorexia nervosa
intense fear of weight gain; distorted body image, restricted cal with very low BMI; can be restricting or binge eating and purging; risk for cardiac issues
bulimia nervosa
recurrent episodes of uncontrollable binging followed by compensatory mechanisms like vomiting, laxatives, diuretics, or exercise; self-image influenced by body image; risk for cardiac and electrolyte issues
binge eating
recurrent episodes of uncontrollable binging without compensatory behaviors; binging induces guilt, depression, embarrassment, and guilt
signs and symptoms of anorexia nervosa
terror of weight gain; preoccupied with thoughts of food; view self as fat even when emaciated; odd handling of food (cut into small bites, pushing food around plate); possibility for rigorous exercise plan; possible self induced vomiting laxatives or diuretics; judge self by weight; control food intake to feel power to overcome feelings of helplessness
signs and symptoms of bulimia nervosa
binge eating behaviors, compensatory mechanism after eating, hx of anorexia nervosa, depressive signs and symptoms, problems with interpersonal relationships and self concept and impulsive behaviors, increased levels of anxiety, possible comorbid substance use disorder
anorexia nervosa plan
physiologic stabilization through nutritional plans, weight restoration; following stabilization psychotherapy, nutritional education, continued medical monitoring, medications, modify pt distorted eating behaviors, assist in changing beliefs about weight and body image
anorexia nervosa and bulimia nervosa interventions
acknowledge emotional and physical difficulty, assess for SI, monitor physiological status, weight pt consistently, monitor pt during/after meals, recognize pt distorted views without minimizing perception of pt, educate about harms of low weight, work with pt to identify strengths; encourage to keep journal
psychotherapy for anorexia nervosa
CBT, DBT, Interpersonal psychotherapy, maudsley anorexia nervosa treatment for adults, specialist supportive clinical management therapy, maudsley/family-based therapy, group therapy
anorexia nervosa pharmacological interventions
fluoxetine- SSRI that is sometimes prescribed once weight has been stabilized to treat depression and OCD symptoms (SSRI increase risk of suicide); olanzapine- atypical antipsychotic to help wiht weight gain, change obsessive thinking
AN and BN diagnoses
impaired nutrition, risk for injury, distorted body image, negative self image, low self-esteem, impaired coping process
bulimia nervosa pharmacological interventions
fluoxetine- SSRI that increases risk of suicide, other antidepressants, mood stabilizers,
interventions for binge eating disorder
specialized cognitive behavior therapies, guided self-help programs with supportive counseling, obesity management, treat co-occurring psych disorders
binge eating disorder interventions
fluoxetine, lisdexamfetamine (vyvanse), topiramate (topamax), dasotraline; pharm meds not sole treatment
neurocognitive and cognitive disorders
delirium, mild neurocognitive disorder, major neurocognitive disorder
delirium
transient cognitive disorder caused by an underlying physiological disturbance; always secondary to something else
mild cognitive disorder
person is functioning at a lower level
possible causes of delirium
medical conditions, substance use, medication or toxin exposure
major neurocognitive disorder
almost all aspect of brain function are affected; as disease progresses it leaves shell of a once vital functioning human being
signs and symptoms of delirium
cognitive and perceptual changes- illusions which are errors in perception and interpretation of real sensory stimuli, hallucinations which are false sensory stimuli of visual and tactile; physical needs- wandering, falling, hypervigilence, change in sleep-wake cycle, change in autonomic responses; mood and physical behaviors- dramatic fluctuations, labile moods (quick changing)
interventions for delirium
know and treat underlying cause, orient pt, sensory stimulation via engagement, pain control, implement early mobility, maintain O2 sat, maintain hydration and nutritional status, assess elimination, promote rest/sleep, ignore insults and acknowledge when pt upset, antipsychotic/antianxiety when needed
safety guidelines for pt in delirium
never leave pt in acute delirium alone
mild neurocognitive disorders
mild cognitive impairment excludes dementia or age-related memory impairment: memory impairment ins main symptom, does not interfere with general cognitive functioning, does not interfere with ADLs and socialization; mild dementia: more than one cognitive domain affected, interferes with navigation of daily life
major cognitive disorder aka dementia
general term for decline in mental ability severe enough to interfere with daily life, usually develops more slowly than delirium, can be primary or secondary, alzheimers is subtype of major neurocognitive disorder an most common cause of dementia, assessments/interventions all similar for pt with dementia
alzheimers 4 defense behaviors
denial (or covering up), confabulation (making up answers in unconscious manner to maintain self-esteem), perseveration (repeating phrases), avoidance of questions
cognitive impairment of alheimers
amnesia/memory impairment, aphasia, apraxia (loss of purposeful movement), agnosia (inability to identify objects)
stages of alzheimers
- mild- forgetfulness and possible depression; 2. moderate- confusion, memory gaps, self-care gaps, apraxia, labile mood; 3. mod.-severe- unable to identify familiar objects or people, advanced agnosia and apraxia; 4. late- end-stage, agraphia (inability to write), hyperorality (obsession with oral sensations), hypermetamorphosis (need to touch/hoard all objects in sight)
treatment for alzheimers
pharmacological is cholinesterase inhibitors that prevent breakdown of acetylcholine and stimulate nicotinic receptors to release more acetylcholine, delay and prevent symptoms from worsening for limited time period, SSRI for depression, trazodone or mirtazapine for increasing sleep or decreasing agitation
cholinesterase inhibitors used for AD
razadyne, exelon, ARICEPT, NAMENDA
thre clusters of personality disorders
cluster A- odd amd eccentric; cluster B- dramatic and unpredictable; cluster C- anxious and fearful
cluster A disorders
aka schizotypal personality disorder; odd, eccentric, suspicious, cold, withdrawn, isolative; resembles schizophrenia but does not meet criteria for inpatient; no hallucinations; paranoid; may later develop schizophrenia
cluster B disorders
dramatic, emotional, attention-seeking, labile, shallow, increase rates of substance use and suicide
cluster C disorders
anxious, fearful behavior, tense, overcontrolled, depressed
paranoid personality disorder (PPD)
a cluster A disorder that does not meet inpatient requirement needs; pervasive, persistent, inappropriate suspiciousness, and distrust; may be hostile, irritable, angry; suspect others of exploiting or deceiving; reads into situations and perceives them as attacks; pimozide (1st gen antipsych.) can be used to reduce paranoid ideation
schizoid personality
cluster A that does not meet inpatient requirements; unable to establish relationships with others; eccentric, isolated, take pleasure in few activities; usually flat affect; no psychosis; may invest large amounts of time into mathematics or astrology; may later develop schizophrenia
antisocial personality disorder
cluster B disorder; disregard for and violation of others rights; lack remorse; entitlement; persistent lying, deception, and conning for profit/pleasure; can be charming and engaging; manipulative and irresponsible behavior; risky activities to feel alive; more common in men; ex the joker
bordeline personality disorder
cluster B disorder; pt are manipulative and try to staff split; unstable self image and impulsivity; maladaptive behaviors; desperately seek relationships to avoid feelings of abandonment; poor anger control
narcissistic personality disorder
cluster B disorder; grandiose sense of self importance; preoccupation with fantasies of unlimited success; arrogant and haughty behavior; require excessive admiration; lack empathy for others; exploit others to meet own needs; envious of others success; believe others are envious of them
histrionic personality disorder
cluster b disorder; purposeful actions unlike in mania; excessive emotionality and attention seeking; manipulative; inappropriate/sexually seductive/provocative; sudden emotional shifts and lability; use of physical appearance for attention; highly suggestible
avoidant personality disorder
cluster C disorder; hypersensitive to criticism or rejection, avoid socialization situations; may view self as socially inept or unappealing; no personal risk for fear of embarrassment; feelings of inadequacy causing inhibition in new interpersonal relationships
obsessive-compulsive personality disorder
cluster c disorder; preoccupation with orderliness and mental and interpersonal control at expense of openness of efficiency; pattern of perfection and inflexibility; can interfere with task completion; financially stingy; difficulty parting with objects even if worthless
dependent personality disorder
cluster C disorder; excessive need to be taken care of; soliciting caretaking by clinging and being submissive; difficulty making everyday decisions without excessive advice, difficulty initiating projects d/t lack of confidence; fearful of disagreement; fear of being left alone
communication guidelines for alzheimers disease
identify self, call person by name at beginning of convo, speak slowly, use short simple words and phrases, maintain face to face contact, 1-2 arms lengths away when talking, one piece of info at a time, reinforce reality but do not argue, happy thoughts
cluster A disorders
paranoid, schizoid, schizotypal personality disorder
cluster B disorders
borderline, narcissistic, histrionic, antisocial personality disorder
cluster C disorders
avoidant, dependent, obsessive-compulsive
treatment modalities for cluster A disorders
psychotherapy, group therapy, antianxiety meds, antipsychotics for agitation, antidepressants like wellbutrin for depression, 2nd gen antipsych to improve emotional expressiveness in schizoid
schizotypal personality disorder
strange and unusual; magical thinking, odd beliefs, inappropriate affect, similar brain dysfunction as in schizophrenia, social anxiety and paranoia, lesser degree of psychotic symptoms; treated with low-dose antipsychotic agents like risperidone or olanzapine; antianxiety and antidepressants
treatment modalities for cluster B disorders
psychotherapy (histrionic), group therapy (antisocial), MBT and DBT as form of CBT (antisocial, narcissistic, borderline), lithium (narcissistic), antidepressants and antianxieties when needed, antipsychotics if delusional symptoms
3 essential therapies for borderline personality disorder
cognitive behavioral therapy, dialectical behavioral therapy, schema-focused therapy
treatment for cluster c disorders
avoidant personality- individual and group therapy to provoke and manage anxiety provoking situations; antianxiety agents, beta-adrenergic to reduce CNS, antidepressants like SSRIs and SNRIs; dependent personality- psychotherapy and CBT, antianxiety and antidepressants for symptoms (TCA for panic); OCD- group therapy and behavioral therapy, colmipramine and/or fluoxetine to reduce obsessions, anxiety, and depression,
two medications approved by FDA for use in children with ASD
risperidone and aripiprazole
target of risperidone and aripiprazole in children with ASD
aggression, deliberate self-injury, temper tantrums, quickly changing moods
common side effects of risperidone
drowsiness, increased appetite, nasal congestion, fatigue, constipation, drooling, dizziness, weight gain
common side effects of aripiprazole
sedation, fatigue, weight gain, vomiting, somnolence, tremor
more serious side effects of risperidone and aripiprazole
neuroleptic malignant syndrome, tardive dyskinesia, hyperglycemia, EPS, diabetes
medications given for ADHD
CNS stimulants like detroamphetamine, methamphetamine, lisdexamphetamine…etc
medications given for tourettes
haloperidol, pimozide, atypical antipsychotics, alpha agonisys
atypical antipsychotics
risperidone, olanzapine, ziprasidone; side effects are weight gain and hyperglycemia
atomoxetine and its warnings
severe liver damage, sudden death with CNS depressants and atomoxetine in those with cardiovascular disease, worsened psychiatric symptoms with CNS depressants and atomoxetine
