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3400 Mental Health > Final Exam > Flashcards

Final Exam Flashcards

1
Q

mental health assessment for children focuses more on…

A

developmental stages

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2
Q

mental health assessment of child includes…

A

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

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3
Q

methods of collecting data from children

A

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

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4
Q

neurodevelopmental disorders of children

A

intellectual disability, communication disorders, autism spectrum disorders, attention deficit hyperactivity disorder, specific learning disorders, motor disorders, disruptive/impulse-control/conduct disorders

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5
Q

types of disruptive, impulse-control, and conduct disorders

A

oppositional defiant disorder and conduct disorder

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6
Q

intellectual disability

A

can range from mild to moderate to severe to profound

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7
Q

screening and diagnosis of ID in children

A

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

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8
Q

implementation for ID

A

individual/family counseling, appropriate schooling, individualized educational plan, federal individuals with disabilities education act, occupational and behavioral therapies, medications

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9
Q

types of communication disorders

A

language disorders, speech sound disorders, childhood-onset fluency disorder (aka stuttering), social communication disorder

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10
Q

assessing, diagnosing, and implementing with communication disorders

A

delay or speech abnormality is noted; child is referred to speech therapist or school psychologist; speech therapy provided; supportive counseling may be necessary

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11
Q

autisim spectrum disorders

A

present with deficits in social and communication, repetitive patterns of behavior interests or activities; severity based on functional ability

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12
Q

severity of ASDs

A

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

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13
Q

assessment of ASD

A

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

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14
Q

ASD diagnosis

A

most often ages 2-3; diagnosed by child psychiatrist, developmental pediatrician, or pediatric neurologist; the early the diagnosis and interventions = better prognosis

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15
Q

Implementations for ASD

A

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

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16
Q

ADHD symptoms

A

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

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17
Q

ADHD assessment

A

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

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18
Q

Diagnosing ADHD

A

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

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19
Q

ADHD implementation

A

behavior modification therapy, parent training, school accommodations, pharmacological agents to address inattention and hyperactive/impulsive behaviors

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20
Q

specific learning disorders

A

difficulty learning in specific areas such as reading or math; some examples are dyslexia or dyscalculia; onset usually in elementary school

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21
Q

assessment, diagnosis, and implementation of specific learning disorders

A

parents often report the problems, diagnosed via testing, implementations such as tutoring or learning accommodations

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22
Q

motor disorders

A

developmental coordination disorder, tourettes disorder

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23
Q

developmental coordination disorder

A

-delayed coordinated motor skills causing clumsiness, slowness, difficulty with riding a bike, difficulty with handwriting

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24
Q

tourettes disorder

A

motor and vocal tics with early childhood onset; mild to severe spasms that can be embarrassing

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25
Q

assessment, diagnosis, implementation of motor disorders

A

DSM 5 criteria, comprehensive behavioral intervention for tics (CBIT), PT/OT, medications for tremors and tics

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26
Q

disruptive, impulse-control, and conduct disorders

A

oppositional defiant disorder and conduct disorder

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27
Q

oppositional defiant disorder

A

goes beyond normal limit testing of children; symptoms displayed with at least 1 non sibling; need 4 criteria to be met

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28
Q

conduct disorder

A

more severe than ODD; need 3 criteria to be met

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29
Q

assessment, diagnosis, implementation of disruptive, impulse-control, and conduct disorders

A

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)

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30
Q

somatic disorders

A

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

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31
Q

clinical manifestations of somatic disorder

A

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

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32
Q

illness anxiety disorder

A

illness preoccupation with or without symptoms; persistent, high anxiety over health, alarmed body sensations, may or may not seek help; resembles hyperchondriasis

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33
Q

functional neurological disorder

A

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

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34
Q

psychological factors affecting other medical conditions

A

diagnosed when general medical condition is affected by psychological/behavioral factors; factors may precipitate or exacerbate medical condition and interfere with treatment

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35
Q

factitious disorder imposed on self

A

intentional faking of symptoms to assume sick role with no external benefits (i.e. financial gain or avoiding prosecution); pt have medical knowledge

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36
Q

malingering

A

intentionally faking or exaggerating symptoms for benefit

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37
Q

factitious disorder imposed on another

A

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

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38
Q

difference between facticious and somatic disorders

A

somatic = general medical conditions affected by stress or psychological factors; factitious = fabrication of symptoms or self-inflicted injury for sick role

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39
Q

nursing interventions for somatic/factitious disorders

A

establishing rapport, help pt learn to meet needs without resorting to somatization, outpatient psychiatric visits

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40
Q

root cause for developing somatic disorders

A

adverse childhood experiences aka childhood trauma

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41
Q

nursing assessment of somatic disorders

A

childhood trauma, family/workplace dynamics, ability to meet own needs, nature/location/onset/character/duration of symptoms

42
Q

anorexia nervosa

A

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

43
Q

bulimia nervosa

A

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

44
Q

binge eating

A

recurrent episodes of uncontrollable binging without compensatory behaviors; binging induces guilt, depression, embarrassment, and guilt

45
Q

signs and symptoms of anorexia nervosa

A

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

46
Q

signs and symptoms of bulimia nervosa

A

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

47
Q

anorexia nervosa plan

A

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

48
Q

anorexia nervosa and bulimia nervosa interventions

A

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

49
Q

psychotherapy for anorexia nervosa

A

CBT, DBT, Interpersonal psychotherapy, maudsley anorexia nervosa treatment for adults, specialist supportive clinical management therapy, maudsley/family-based therapy, group therapy

50
Q

anorexia nervosa pharmacological interventions

A

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

51
Q

AN and BN diagnoses

A

impaired nutrition, risk for injury, distorted body image, negative self image, low self-esteem, impaired coping process

52
Q

bulimia nervosa pharmacological interventions

A

fluoxetine- SSRI that increases risk of suicide, other antidepressants, mood stabilizers,

53
Q

interventions for binge eating disorder

A

specialized cognitive behavior therapies, guided self-help programs with supportive counseling, obesity management, treat co-occurring psych disorders

54
Q

binge eating disorder interventions

A

fluoxetine, lisdexamfetamine (vyvanse), topiramate (topamax), dasotraline; pharm meds not sole treatment

55
Q

neurocognitive and cognitive disorders

A

delirium, mild neurocognitive disorder, major neurocognitive disorder

56
Q

delirium

A

transient cognitive disorder caused by an underlying physiological disturbance; always secondary to something else

57
Q

mild cognitive disorder

A

person is functioning at a lower level

58
Q

possible causes of delirium

A

medical conditions, substance use, medication or toxin exposure

58
Q

major neurocognitive disorder

A

almost all aspect of brain function are affected; as disease progresses it leaves shell of a once vital functioning human being

59
Q

signs and symptoms of delirium

A

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)

60
Q

interventions for delirium

A

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

61
Q

safety guidelines for pt in delirium

A

never leave pt in acute delirium alone

62
Q

mild neurocognitive disorders

A

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

63
Q

major cognitive disorder aka dementia

A

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

64
Q

alzheimers 4 defense behaviors

A

denial (or covering up), confabulation (making up answers in unconscious manner to maintain self-esteem), perseveration (repeating phrases), avoidance of questions

65
Q

cognitive impairment of alheimers

A

amnesia/memory impairment, aphasia, apraxia (loss of purposeful movement), agnosia (inability to identify objects)

66
Q

stages of alzheimers

A
  1. 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)
67
Q

treatment for alzheimers

A

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

68
Q

cholinesterase inhibitors used for AD

A

razadyne, exelon, ARICEPT, NAMENDA

69
Q

thre clusters of personality disorders

A

cluster A- odd amd eccentric; cluster B- dramatic and unpredictable; cluster C- anxious and fearful

70
Q

cluster A disorders

A

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

71
Q

cluster B disorders

A

dramatic, emotional, attention-seeking, labile, shallow, increase rates of substance use and suicide

72
Q

cluster C disorders

A

anxious, fearful behavior, tense, overcontrolled, depressed

73
Q

paranoid personality disorder (PPD)

A

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

74
Q

schizoid personality

A

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

75
Q

antisocial personality disorder

A

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

76
Q

bordeline personality disorder

A

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

77
Q

narcissistic personality disorder

A

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

78
Q

histrionic personality disorder

A

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

79
Q

avoidant personality disorder

A

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

80
Q

obsessive-compulsive personality disorder

A

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

81
Q

dependent personality disorder

A

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

82
Q

communication guidelines for alzheimers disease

A

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

83
Q

cluster A disorders

A

paranoid, schizoid, schizotypal personality disorder

84
Q

cluster B disorders

A

borderline, narcissistic, histrionic, antisocial personality disorder

85
Q

cluster C disorders

A

avoidant, dependent, obsessive-compulsive

86
Q

treatment modalities for cluster A disorders

A

psychotherapy, group therapy, antianxiety meds, antipsychotics for agitation, antidepressants like wellbutrin for depression, 2nd gen antipsych to improve emotional expressiveness in schizoid

87
Q

schizotypal personality disorder

A

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

88
Q

treatment modalities for cluster B disorders

A

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

89
Q

3 essential therapies for borderline personality disorder

A

cognitive behavioral therapy, dialectical behavioral therapy, schema-focused therapy

90
Q

treatment for cluster c disorders

A

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,

91
Q

two medications approved by FDA for use in children with ASD

A

risperidone and aripiprazole

92
Q

target of risperidone and aripiprazole in children with ASD

A

aggression, deliberate self-injury, temper tantrums, quickly changing moods

93
Q

common side effects of risperidone

A

drowsiness, increased appetite, nasal congestion, fatigue, constipation, drooling, dizziness, weight gain

94
Q

common side effects of aripiprazole

A

sedation, fatigue, weight gain, vomiting, somnolence, tremor

95
Q

more serious side effects of risperidone and aripiprazole

A

neuroleptic malignant syndrome, tardive dyskinesia, hyperglycemia, EPS, diabetes

96
Q

medications given for ADHD

A

CNS stimulants like detroamphetamine, methamphetamine, lisdexamphetamine…etc

97
Q

medications given for tourettes

A

haloperidol, pimozide, atypical antipsychotics, alpha agonisys

98
Q

atypical antipsychotics

A

risperidone, olanzapine, ziprasidone; side effects are weight gain and hyperglycemia

99
Q

atomoxetine and its warnings

A

severe liver damage, sudden death with CNS depressants and atomoxetine in those with cardiovascular disease, worsened psychiatric symptoms with CNS depressants and atomoxetine

3400 Mental Health (8 decks)

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