Final Exam Flashcards
what is mental health?
successful performance of mental function, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity
what is the definition of mental illness?
thinking, feeling, mood, ability, to relate to others and daily functioning - a clinical significant behavioral or psychological syndrome experienced by a person and marked by distress, disability, or the risk of suffering disability or loss of freedom
what biological factors can influence mental health
perinatal period, anatomical abnormalities, injuries to the brain
what are the psychological influences on mental health?
self concept, developmental stages, relationships in childhood and adulthood, traumatic events
what are the sociocultural influences on mental health?
drugs, home-environment, housing, school, religion/spirituality, poverty, cultural expectations
what is the diathesis-stress model?
says that there is a biological predisposition (diathesis) and an environmental stress or trauma (stress) that combine to cause mental illness. it is the most widely accepted explanation for mental illness.
what is a major barrier to mental health treatment and recovery?
stigma
what is the nursing process and standards of care committed to?
promoting mental health through assessment, diagnosis, and treatment of human responses to illnesses and disorders
what can RNs do in the mental health feild?
assessment of functioning, case management, medication design and management, medication administration and teaching, crisis intervention, supportive counseling
what are the three stages of Freud’s psychoanalytic theory - describe each
ID - most primitive. focused on getting what we want, it is a natural way to respond and a reflex action that is focused on pleasure
ego - problem solver personality - it is our personality - tests reality
super ego - moral component
what are the three levels of awareness? describe each.
conscious - things that are in our current awareness
preconscious - things that we can bring to the surface of our consciousness pretty easily
unconscious - things that are buried deep in our consciousness
stage of development for infants
trust vs mistrust
stage of development for toddler
autonomy vs shame/doubt
stage of development for preschool age
initiative vs guilt
stage of development for school-age
industry vs inferiority
stage of development for adolescent
identity vs role confusion
stage of development for young adult
intimacy vs isolation
what does interpersonal theory say?
early interpersonal relationships are crucial for personality development and anxiety is an interpersonal phenomenon. states that all behavior is aimed at avoiding anxiety and threats to self esteem
how does interpersonal therapy work?
guides and challenges maladaptive behavior with emphasis on relationship issues. uses the therapist as a “participant observer” and wants the client to assume awareness of dysfunctional patterns and want this to lead to changes in behavior
what does Hildegard Peplau say the difference between the art of nursing and the science of nursing is?
the art of nursing is to provide care, compassion, and advocacy and enhance comfort and well-being; the science of nursing is to apply knowledge to understand the broad range of human problems and psychosocial phenomena and to intervene in relieving the patient’s suffering and promote growth
what is the difference between modeling and shaping?
with modeling, we as the nurse try to model good behavior to the patient; with shaping, we try to teach the patient little by little to change the behavior and reward them along the way
what do you try to do in applied behavioral analysis?
try to get the patient to analyze their behavior
what is systematic desensitization?
expose patient slowly, overtime, to what they are afraid of and pairing with some relaxation exercises
what is aversion therapy?
a more aggressive form of therapy. more focused on keeping you from doing something because it had a negative consequence - like giving Antabuse if they drink.
what do people do with cognitive therapies?
analyze their thinking and try to get them to reframe or rethink their thoughts
what does rational emotive behavioral therapy do?
beliefs about events are the most direct and important cause of how people act and feel. the focus of therapy is refuting irrational beliefs and teaching clients to do analysis of own behaviors
what is the ABCD approach to rational emotive behavior therapy?
antecedent/activating event, belief about the event, consequences of belief, d - refute the false/irrational belief
what are the d-motives in maslow’s hierarchy of needs?
deficiency needs - air, water, and food
what are the b-motives in maslow’s hierarchy of needs?
being needs and esteem needs
what are the different types of leaders?
autocratic leader - wants lots of control
democratic leader - like to reach consensus among the group
laissez-faire leader - hands off leader
what is the difference between group content and process?
group content is what the group talks about and group process is who speaks first and how the communication is handled
what is health?
a state of complete physical, mental, and social well-being
what is universiality?
knowing you’re not the only one who has that problem
what is catharsis?
knowing you can say what you really feel because you’re in a group that can understand what you are saying
what kinds of groups can basic-level RNs lead?
psychoeducational, medication education, health education, symptom management, stress-management, support and self help group
what should you do with the monopolizing member of a group?
redirect them. recognize what they have said, but redirect them back to the topic and remind them that everyone needs a chance to talk
what do you do with the complaining member of a group?
allow them to complain a little bit, but after a while redirect them back to the group and if it still doesn’t get better they may need to be asked to leave
what do you do with the demoralizing member of the group>
may need to pull them out in the middle of the group and talk to them individually
what should you do with the silent member of a group?
allow them a chance to talk. don’t be confrontational, but direct a question toward them. if they don’t want to talk, understand and respect that because some people get a lot out of a group from just sitting there
personal beliefs about the worth of a given idea, attitude, custom, or object
values
study of philosophical beliefs about what is considered right or wrong in society
ethics
ethical questions arising in health care
bioethics
what are the four ethics included in the professional nursing code of ethics?
advocacy, responsibility, accountability, and confidentiality
beneficence
doing good for the patient
autonomy
respecting the rights of others to make their own decisions
justice
distributing care equally among all people
fidelity
faithfulness, maintaining loyalty to the patient
veracity
maintaining truthfulness
where does a statutory law come from?
other nurses
where does regulatory or administrative law come from?
congress
where does common law or judicial decisions come from?
cases that have occurred before
what must be noted in order for a patient to be admitted against their will for a 72 hour hold?
a clear and present danger to self or others
what is due process in civil commitment?
courts have recognized involuntary commitment to a mental hospital is a “massive curtailment of liberty” that requires due process protection, so the least restrictive measure must be used first
what is the difference between a conditional release, an unconditional release, and an AMA?
a conditional release is saying that you are released from the hospital or facility, but must come back for some form of followup treatment, an unconditional release is saying that you are free to go and no other treatment is required, and AMA is a release against medical advice
what are the patient’s rights?
right to treatment, right to refuse treatment, right to informed consent, right to the least restrictive measure for the shortest time
what are the patient’s rights in mental health?
right to treatment, right to refuse treatment, even if a hospital does not specialize in the area of treatment required they must stabilize the patient, right to informed consent, implied consent, right to the least restrictive measure for the shortest amount of time
a wrongful act or infringement of a right leading to a civil legal liability
torts
what elements are necessary to prove malpractice?
you must have a duty to that patient, breach in duty, have to prove that the patient would be okay if it wasn’t for what you did or didn’t do
what are some common negligent acts?
failure to asses/monitor, failure to notify the health care provider, failure to follow orders, failure to follow the 6 rights of medication, failure to do discharge instructions or doing them incorrectly, failure to make sure the patient is safe, failure to follow policies and procedures, failure to properly delegate and supervise
what factors affect communication? what is each?
personal factors - beliefs, moods, cognitive factors, intellectual ability, previous experiences, cultural background
environmental factors - environment in which you are talking with the patient
relationship factors - way you relate to different individuals based on their social status
what are double-bind messages?
saying one thing while you really mean another
what are some non-therapeutic communication techniques?
excessive questioning, giving disapproval or approval, giving advice, don’t ask why, giving false reassurance, changing the subject
should you tell a patient how they are making progress?
no, instead ask them how they feel they are doing with their progress, it needs to be about them
what are the goals of therapeutic relationships?
facilitate communication of distressing thoughts and feelings, assist patients with problem-solving skills, help patient examine self-defeating behaviors and test alternatives, promote self-care and independence, promote dependence
what are necessary behaviors for nurses in a therapeutic relationship?
accountability, advocate for patient, clinical competence, delayed judgement
what is the difference between transferrance and counter transferrance?
transerence is when the patient unconsciously displaces onto the nurse feelings and behaviors related to significant figures in the patient’s past; counter-transference is when the nurse displaces feelings onto the patient that are related to significant figures in the nurse’s past
what are the three phases of Peplau’s model of nurse-patient relationship?
orientation, working, and termination
what occurs during the orientation phase?
when you first meet the patient, establish rapport and parameters of the relationship, confidentiality, terms of termination - you are establishing a structure for them and letting them know what to expect
what factors help the nurse-patient relationship?
consistency, neutral pace, listening, initial impressions - neutral attitude, promoting patient comfort and balancing control, patient factors include trust and active participation
when do somatic symptom disorders usually set in?
at a younger age- usually before 30
what might be a big factor in somatic symptom disorders?
underlying anxiety and depression
are people with somatic symptom disorder faking their symptoms?
no, we might not see them, but they are not making it up. it might just be psychological pain that is manifesting itself physically
the presence of deficits in voluntary motor or sensory function that can be sudden
conversion disorder
what are some common symptoms of conversion disorder?
paralysis, blindness, movement and gaid disturbances, numbness, paresthesia, loss of vision or hearing, episodes resembling epilepsy
what comorbid conditions are common with conversion disorder?
depression, anxiety, personality disorders
who is conversion disorder more common in?
more common in females, people in lower socioeconomic groups, lower education levels, history of severe trauma
how should you assess the symptoms and unmet needs of someone with a somatic disorder?
OLDCARTS, how do they describe these symptoms? are their basic needs being met?
what things should you assess with a patient with a somatic symptom disorder?
symptoms and unmet needs, voluntary control of symptoms (somatic symptom disorder will have no voluntary control), secondary gains, cognitive style, ability to communicate feelings and emotional needs, dependence on medication
what are some basic-level interventions for patients with somatic symptom disorder?
promotion of self-care activities, health teaching and promotion because a lower education level could be why they think the way they do, case management, pharmacological interventions
disorder in which a person deliberately fabricates symptoms of illnesses or self-injury without obvious gains
factitious disorder
what is Münchausen syndrome?
a more severe form of a factitious disorder in which a patient is desperately trying to make themselves or someone else sick and may go so far ast to contaminate lab orders, inject themselves with things, push for treatments
consciously feigning an illness for obvious benefit
malingering
disturbances in the normally well-integrated continuum of consciousness, memory, identity, and perception that is an unconscious defense mechanism that protects a patient from overwhelming anxiety
dissociative disorders
alterations in perception of self. may feel as if they are seeing themselves from a distance, but reality testing is still intact
depersonalization
experience of unreality of surroundings, while reality testing remains intact
derealization
inability to recall important personal information that almost always has to do with trauma. the memories are still there, they are just buried deep
dissociative amnesia
what is dissociative amnesia with fugue?
sudden unexpected travel away from the customary locale and an inability to recall one’s identity and some or all of the past
presence of two or more distinct personality states (usually more than two) that consists of a host and alters
dissociative identity disorder
what biological factors play a roll in dissociative disorders?
think the limbic system and serotonin levels might play a roll
what psychological factors might play a roll in dissociative disorders?
try to avoid or suppress any kind of severe trauma and the more they try to suppress those memories, the more likely they are to dissociate
how should you assess a dissociative disorder?
rule out medical causes, identity and memory, history of head trauma or seizures, underlying depression and anxiety, impact on patient and family, suicide risk
what are some basic level interventions for dissociative disorders?
milieu therapy (calm and quiet, avoid stimulations), health teaching and promotion, pharmacological interventions
what are the c’s of addiction?
continued use despite adverse consequences, loss of control from chronic relapsing brain disorder, cognitive impairment
what is the prevalence of psychiatric comorbidities?
5 or 6 out of every 10 people affected by substance use disorders also are affected by mental health disorders
what medical comorbidities often exist with marijuana abuse?
impaired lung structure, susceptible to infection, possible chromosomal abnormalities, amotivational syndrome, stroke
what are common medical comorbidities with caffeine?
gastric reflux, peptic ulcers, increased intraocular pressure, tachycardia, increased glucose and lipid levels
what biological factors contribute to substance abuse disorders?
hit dopamine centers in their brain and send an explosion of dopamine through their brain which makes them feel good
what are psychological factors that contribute to substance abuse?
lack of tolerance for frustration and pain, lack of success in life, lack of affectionate and meaningful relationships, lack of self-regard and low self-esteem, risk-taking propensity
what sociocultural factors contribute to substance abuse?
social and cultural norms and socioeconomic status
what is crisis?
an acute or time-limited struggle for equilibrium and adaptation that threatens personality organization
what are some examples of crises?
death, job loss, divorce, anything that can impact daily functioning and happens suddenly
what does the outcome of a crisis depend on?
the person’s realistic perception of the event (are they being realistic, over reacting or underreacting), adequate situational supports (crisis interventions), and their adequate coping mechanisms (healthy or unhealthy coping mechanisms)
what are some situational supports for a crisis?
online training - the national child traumatic stress network; the memphis model; financial and familial supports
what are the three types of crisis situations?
maturational, situational, and adventitious
what is a maturational crisis?
you go through a lot of these throughout life and if you don’t progress through them, you regress. Have a lot to do with Erikson’s stages of development. An example would be a person retiring either reaches integrity or regresses to despair.
Do your old coping skills work with a maturational crisis?
no, the person must develop new coping skills, and until that person can develop those new coping skills their defense mechanisms are ineffective.
what do situational crises arise from?
events that are extraordinary, external, and often unanticipated; Ex: death, sudden diagnoses, job loss, accidents, divorce, etc.
what are adventitious crises?
unplanned and accidental - natural disaster, national disaster, crime of violence
what should you assess for first in a crisis situation?
suicidal or homicidal ideations
what things should you assess in a crisis situation?
suicidal or homicidal ideations, perception of precipitating event, situational supports, and personal coping skills
how should you assess a person’s perception of a precipitating event in a time of crisis?
is it realistic; can they define the problem; do they know what is going on; is there something that triggered this; what happened and led up to the crisis; how can we help them out of this situation
how should you assess a person’s situational supports in a time of crisis?
make sure that they are reaching out for help; where are you living?; do you have a home?; who do you live with?; is there anyone at home who can help you?; if they don’t have a support system we need to try and find them one
how should you assess someone’s personal coping skills in a time of crisis?
assess whether they are adequate or inadequate - healthy or unhealthy; ask what do you do to help yourself when you are feeling stressed out? how have you gotten through difficult times in the past?
how should you communicate with someone in a crisis?
avoid false reassurance, avoid platitudes, listen, show interest and concern
what is “vicarious traumatization”
we, as nurses, pick up on things that our patients are anxious about and we become anxious about them as well
what are four common problems in the nurse-patient relationship?
the nurse needs to be needed, the nurse sets unrealistic goals for the patient, nurse has difficulty dealing with the issue of suicide, nurse has difficulty terminating the nurse-patient relationship
what are some outcomes that we want to achieve during a crisis?
appropriate coping skills, decision making, normal level of functioning in role performance, reduces stress level, back to previous level of functioning
what is your priority during a time of crisis?
the crisis situation, if you are working on one, that is all you should be focused on at that time
what are the three levels of nursing care during a crisis? describe each?
primary care - promotes mental health and reduces mental illness to decrease incidence of crisis and prevention of a crisis; secondary care - the event has happened and you are trying to help them through it. acute phase, establishes intervention to prevent prolonged anxiety from diminishing personal effectiveness and personality disorganization; tertiary care - provides support for those who have experienced a severe crisis and are now recovering from a disabling mental state
what is personality disorganization?
where the patient completely breaks down
what does CISD stand for?
critical incidences stress debriefing
what is CISD?
a technique designed to assist individuals in the aftermath of a crisis event - it allows individuals the opportunity to process the event and emotions
how soon after an event does CISD need to occur?
within 24-72 hours after the event
what are the phases of a seven-phase group meeting?
introductory; fact - those who were involved discuss what happened; thought - how did they feel and think about the situation; reaction - let you talk through what the worst phases of the situation were; symptom - people are talking about how it is making them feel in every way; teaching - letting everyone know that their feelings are normal; reentry - reviewing everything and making sure people have the supports and information they need
when should an evaluation of a crisis situation be done?
4-8 weeks after the initial event
when is a crisis intervention successful?
when the individual’s level of anxiety and ability to function has returned to the pre-crisis level. we may not have solved the problem, but we have calmed them down to where they can function as they previously had
primal, not always logical feeling that varies from mild irritation to rage
anger
harsh physical or verbal action reflecting rage, hostility, and potential for destructiveness that can be aimed at self or others
aggression
physical aggression that is unique to humans and is usually out of context of what the stimulus was
violence
how much more likely are individuals with psychiatric disorders to commit violent acts than those who do not have one?
5x more likely
what psychiatric disorders often come with increased risk of violence?
ADHD, ODD, PTSD, dementia, paranoid delusions, personality disorders
what medical/neurological disorders often have an increased risk for violence?
TBI, temporal lobe epilepsy, brain tumor, infections, intoxicated or withdrawing from alcohol/drugs
dysfunctions in what areas of the brain are thought to lead to anger and aggression?
limbic system, amygdala, and temporal lobe dysfunction; serotonin and GABA levels may be decreased as well
what questions should you ask when assessing for anger and aggression?
have you ever though of harming someone else?; have you ever seriously injured another person?; what is the most violent thing you have ever done?
what are some factors for violent outcomes that you should identify before they turn into violence?
angry, irritable affect, hyperactivity, increasing anxiety, verbal abuse, loud voice, history of recent acts of violence, suspicious or paranoia, substance abuse, possession of a weapon, milieu characteristics related to violence
what are some milieu characteristics that are conductive to violence?
loud, overcrowding, staffing not consistent, understaffing
what are your outcome goals for a client experiencing anger or aggression?
remain from injury, manage disease, control triggers
what are your interventions for anger and aggression related to?
the goal of keeping the patient and others safe
what is the most important aspect of helping a client deal with anger and aggression?
the consistency of staff response - the use of well-trained staff skilled in the use of de-escalation techniques
what should you do during the preassaultive stage of the violence cycle?
de-escalation approaches; remain calm with soft, non-judgmental tone; try to find out what is going on and how you can help the patient right now; try to talk the patient through their anger
what is occurring in the assaultive stage of violence and how should the nurse react?
the patient is being violent. have other patients go to their rooms and shut their doors. treat the patient with medications, seclusion, and restraints
what is being done during the post-assaultive stage of violence?
the patient is probably still in seclusion or restraints and is going to need a delicate re-entry back onto the unit
what things should you document about violence?
what was going on - early behaviors and what you did about them; narrative; if there were injuries; if there were injuries, you need to fill out an incident report
what things should you do to avoid catastrophic reactions in a neurocognitively impaired patient?
reality orientation may not work because of the patient’s deficits, so use validation therapy - validate things about them and then use that to distract them; adopt a calm non-hurried manner when responding to agitation/aggression
what things can you do to avoid violence in a neurocognitively impaired patient?
put pictures up around the room, approach patient’s from the front, tell people who you are and smile
what therapy for anger/aggression isused most often in places like prison’s on male forensic patients?
dialectical-behavioral therapy - based on a principle of mindfulness - thinking before you act
what do cognitive-behavioral approaches do for anger/aggression
teach anger management skills
what pharmacological treatments are good for acute aggression?
atypical antipsychotics or high potency typical antipsychotics - haloperidol and Benzodiazapines (Adivan, Lorazepam)
what pharmacological interventions are good for treatments of chronic aggression?
anticonvulsants (carbamazepine); beta blockers (propranolol); lithium carbonate
what is the most helpful tool for a client with aggression?
consistency
what things should you assess for when looking at family functions?
who manages and takes care of the family; boundaries; communication in the family; emotional support/availability; socialization - this determines how we socialize with other members of society
what are families with clear boundaries like?
cohesive, they have good communication, general expectations are firm yet flexible, family members are supported and nurtured, yet offered autonomy
what are families with diffuse or enmeshed boundaries like?
overly involved; not able to define the thoughts and feelings of each individual family member; might lose some autonomy; can be emotionally involved and show warmth or there might be a lot of hostility and meddling; child has more issues becoming an independent person
what are families with rigid or disengaged boundaries like?
there is no flexibility in these families; relationships may be cold and controlling or even withdrawn; individuals may be disengaged from each other, or as a family unit be disengaged from the rest of society; not much negotiation and opportunities for individual development
what is the difference with healthy and unhealthy communication within a family unit?
healthy is clear and easy to comprehend and can help with adapting to stressors; unhealthy is unclear and indirect and could be more passive aggressive
what is the difference with healthy and unhealthy families when it comes to enotional support/ availability?
healthy families show affection and respect for one another; members are allowed to express feelings and don’t repress another person’s feelings; unhealthy families are more angry towards one another and have more conflict
why is socialization within the family unit good to evaluate?
how we socialize with our family members will carry on to how we socialize with the rest of society; we learn how to socialize from our family
what is a family triangle?
when a two person system starts to have tension and they bring in a third person to try and reduce the conflict between them - usually this is a child
how many generations should you look at when assessing multigenerational issues in families. why?
look at 3-4 generations because dysfunctional systems are passed down from generation to generation
what are objective family burdens?
practical problems family members face while caring for someone with a mental illness; symptomatic behaviors like deficit behaviors or intrusive or acting-out behaviors; care-giving (worry a lot about who will care for the mentally ill person); stigma
what are subjective family burdens?
negative emotions that family members experience in response to a loved ones mental illness - grief, fear, guilt, anger
what are iatrogenic family burdens?
burdens caused by a dysfunctional mental health system and by the attitudes and behaviors of some mental health professionals who have outmoded theories about families.
what outcomes do we want with family therapy?
reduced dysfunctional behavior; mobilize family resources, encourage adaptive family problem-solving behaviors, improve communication skills, heighten awareness and sensitivity to other family member’s emotional needs; strengthen ability to cope with major life stressor and traumatic events; improve integration of family system into society
what do traditional family therapies do?
work with the family as a whole, might focus on here and now or the past that is led up to where they are now
what do psychoeducational family therapies focus on?
helping family understand the mental illness, teaching them about side effects, medications, etc
a feeling of apprehension, uneasiness, uncertainty, or dread which results from a real or perceived threat
anxiety
do people with anxiety calm down after the threat resolves?
no, they stay in a constant state of arousal
reaction to a real, specific threat that usually resolves when the situation resolves
fear
what is acute/state anxiety?
anxiety that is temporarily raised because of some sort of outside factor and can be beneficial
what do anxiety disorders tend to develop from?
chronic/trait anxiety
when does anxiety become pathological?
when it affects a patients daily functioning in life
level of anxiety in which the patient has heightened perception and sensory awareness - they see, hear, and grasp more information; they have improved concentration and problem-solving abilities; they have no changes in their verbal ability, but may have some fidgeting
mild anxiety
level of anxiety in which the patient’s perception field narrows and they cannot see, grasp, or hear as much information; they are able to block out unwanted stimuli and focus on the things that are worrying them. they can’t think as clearly, but can still problem solve, just not at an optimal level; they may have vocal tremors or changes in pitch and they have more muscle tension, a pounding heart, more rapid respirations, and somatic problems
moderate anxiety
level of anxiety in which the patient’s perception is greatly reduced and they have trouble processing what is going on around them; they have little ability for problem-solving and learning; speech is loud and rapid; they have more intense somatic complaints like light headedness and dizziness, hyperventilation is possible and they are tachycardic
severe anxiety
level of anxiety in which the patient has no ability to percieve/process anything, and they might start to lose touch with reality; cognition is impossible; they can’t speak at all or what they are saying doesn’t make sense; they are usually either frozen or cannot stop moving
panic level anxiety
what should you do for a patient experiencing severe to panic level anxiety?
reduce environmental stimuli and stay with the patient; try to use gross motor activity to drain the tension, but don’t let them get exhausted; be more simple and direct with your communication and use close-ended questions
what do people with anxiety disorders feel like?
the core of their personality is being threatened, even when no actual danger exists
chronic and excessive worry for 6+ months that interferes with daily functioning and relationships
generalized anxiety disorders
why might generalized anxiety disorder be mistaken for ADHD?
continued high anxiety can cause restlessness, fatigue, depression, poor concentration, sleep disturbances, helplessness, etc.
what is agoraphobia?
fear of being trapped into an unbearable situation within which they cannot escape - they may fear being outside of their home, public transportation, crowded spaces
what is social phobia?
the fear of being embarrassed or scrutinized in front of others; these people don’t like to be around people they don’t know
what are the symptoms of anxiety disorder?
palpitations, tachycardia, sweating, shaking, SOA, choking sensation, chest pain or discomfort, upset stomach/nausea, light headed/dizziness, tingly/faint feeling, derealization, depersonalization, feeling of losing control or going crazy, might think they are dying, chills or hot flashes
how long does a panic attack usually last?
5-20 minutes
what is a panic disorder?
recurrent panic attacks with no medical cause; 1+ month of concern about future attacks and worry about consequences of future attacks; this constant worry may lead to other attacks
recurrent intrusive, ideas, thoughts, and impulses
obsessions
ritualistic behaviors people participate in to control anxiety and thoughts
compulsions
what are two types of OCD?
body dysmorphic disorder and hoarding
what is hoarding often coupled with?
depression
when does acute stress disorder (ASD) occur?
within one month of a traumatic event
what are the symptoms of ASD?
numbless, detachment, drealization, depersonalization, dissociative amnesia
when does ASD turn into PTSD?
when symptoms last longer than one month and are accompanied by functional impairment and stress
when is PTSD considered delayed?
when symptoms do not occur until more than 6 months after an event
what are the s/s of PTSD?
flashbacks, nightmares, sleep disturbances; substance abuse; loss of trust, poor self-esteem - feel “damaged”, difficulty maintaining or building relationships; numbness toward emotions; increased arousal; difficulty with concentration; irritability
what abnormal neurotransmitter levels are seen with anxiety and stress disorders?
they may have too much norepinephrine so they are staying in fight or flight mode; they might have too little serotonin, decreased levels of GABA (benzos help to increase these levels so that the patient calms down and feels good)
what area of the brain shows a decreased size with PTSD?
hippocampus so they have a dysfunction in memories
what individual features of a person can increase the risk for development of an anxiety disorder?
shy and timid people because they are worriers and have a harder time dealing with anger, and people with critical parents
what disorders do anxiety disorders often co-exist with?
depression, substance abuse, eating disorders, personality disorders, and schizophrenia
what things should you look for when assessing for the possibility of an anxiety disorder?
high alcohol/ drug intake, history of barbiturate or benzo dependence, history of frequent somatic complaints, negative outlook, distorted thinking, obsessions or compulsions, history of an eating disorder
how do behavior therapies work to treat anxiety/stress disorders?
they use systematic desensitization and exposure treatment, relaxation techniques and breathing reatraining
what are some common side effects of benzodiazepines?
drowsiness, dizziness, sedation, ataxia, feelings of detachment, irritability or hostility, anterograde amnesia, cognitive slowing with long-term use, tolerance dependency, rebound insomnia/anxiety, rarely nausea, headache, confusion, depression
what are the withdrawal symptoms of benzodiazepines?
agitation, anorexia, hyperactivity, insomnia, irritability, nausea, vomiting, sensitivity to light and sounds, tinnitus, tremulousness, anxiety, dizziness, autonomic arousal, generalized seizures, hallucinations, headache
what medication is used to treat overdoses of benzodiazepines?
flumazenil (Romazicon)
why is there a risk of patients to stop taking buspirone?
it takes several weeks to start working, doesn’t work PRN
what is a disadvantage of using antihistamines to treat anxiety/stress related disorders?
they can lower the siezure threshold, cause anxiety or insomnia in some, and can cause a reverse reaction
what BP meds are good at treating anxiety/stress disorders?
prpranolol and clonidine
what type of anxiety are BP meds good for?
performance anxiety - given to kids a lot
what biological assessments should you make for an anxiety disorder?
substance use, sleep patterns, eating patterns, sexual function and menstrual cycles
what psychological assessments should you make for an anxiety disorder
mood and affect, self esteem, coping strategies
what social assessments should you make for an anxiety disorder
interpersonal relationships, diversional activities, cultural expressions of anxiety
what are the signs and symptoms of an anxiety/stress disorder?
increased heart rate, BP increase, sweating palms, SOA, light headedness, depression, irritability, difficulty focusing, forgetfullness
what outcomes should you look for with anxiety/stress disorders?
free from self harm, reduced anxiety, recognize triggers for anxiety, learn new coping strategies
what interventions should you have for the patient experiencing anxiety?
remain aware of your own feelings, remain calm and patient, establish trust, protect and reassure the client, remain with the client who is experiencing high levels of anxiety, ongoing assessment of anxiety levels and triggers
what are Eugen Bleuler’s 4 A’s of schizophrenia?
affect - emotion that you are showing; associative looseness - communication is jumbled and illogical; autism - not bound to same reality as everyone else; ambivalence - have trouble making decisions
what is the diagnostic criteria for schizophrenia?
two or more of delusions, hallucinations, disorganized speech or behavior, negative symptoms for one month; significan social/occupational dysfunction; signs continue for 6+ months; other psychotic disorders ruled out; no medical cause for psychosis
similar to schizophrenia, but only lasts 1-6 months
schizophreniform
mood disorder at the same time as active symptoms of schizophrenia. high risk of suicide because of altered thoughts coupled with depression
schizoaffective disorder
two or more people sharing the same delusions
shared psychotic disorder
personality disorder that looks a lot like schizophrenia that may be a precurser to schizophrenia
schizotypal personality disorder
nonbizarre delusions for one month, but overall function is not impaired
delusional disorder
psychotic disorder NES
when we don’t know why they are having the psychotic issues
what neuroanatomical features are present in schizophrenia?
lower brain volume, ventricles increase in size, atrophy of the frontal lobe, more CSF, lower metabolism of glucose in the brain, not as much blood flow to the brain
what are positive symptoms of schizophrenia?
indicate a distortion or excess of normal functioning; often occur as the initial symptoms of schizophrenia and may precipitate hospitalization
what are negative symptoms of schizophrenia?
indicate a loss or lack of normal functioning; they develop over time and hinder the person’s ability to endure life tasks such as work and family roles
what are some common positive symptoms of schizophrenia?
command hallucinations, hallucinatoins, delusions, illusions, concrete thinking, associative looseness, personality boundary difficulties (depresonalization and derealization), extreme motor agitation, stereotyped behaviors, autonomic obedience, waxy flexibility, stupor, negativism
what are some common negative symptoms of schizophrenia?
changes in affect, apathy, anhedonia (no pleasure in activities), poor social functioning, poverty of thought
what is the overall goal when treating a patient with schizophrenia?
patient safety and stabilization
how should you communicate with a patient experiencing hallucinations and delusions?
approach in nonthreatening non judgemental manner, id feelings patient is experiencing, clarify reality of patient’s experience, avoid arguing or attempting to reason, interact with patient about concrete reality, distract patient’s attention from hallucinations and delusional beliefs
what is the problem with clozapine (Clozaril)?
it causes agranulocytosis so you want to monitor for s/s of infection
what are the advantages of using clozapine (Clozaril) for treatment of schizophrenia?
effective on both positive and negative symptoms, don’t cause EPS
what are some atypical antipsychotics for schizophrenia?
clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodone), aripiprazole (Abilify)
what are EPS?
extrapyramidal side effects - tardive dyskinesia, acute dystonia, akathisia, psuedoparkinsonism
what is neuroleptic malignant syndrome (a side effect of conventional medications for schizophrenia) manifested by?
altered LOC, rigid muscle tones, diaphoretic, increased temperature, drooling - life threatening
what is the short term treatment for alcohol detox?
benzodiazepines
what are the long-term drugs of choice for treatment of alcoholism?
naltrexone (ReVia), acamprosate (Campral), topirate (Topamax), disulfiram (Antabuse)
what are the pharmacological interventions for opioid addiction?
methadone (Dolophine), LAAM, buprenorphine (Subutex or Suboxone), naltrexone (ReVia), clonidine (Catapres)
what do we want people to realize with a drug/alcohol addiction?
they are powerless over the addiction, their lives are unmanageable, they are not responsible for the disease but they are responsible for their recovery, they can no longer blame others and must face their problems and feelings
what are symptoms of refeeding syndrome that occurs with anorexia nervosa?
cardiac and respiratory failure, delirium, and death
what are pharmacologic treatments for anorexia nervosa?
no FDA approved treatment, but fluoxetine (Prozac) might be used
what drug should you never use to treat bulemia nervosa?
Wellbutrin because of risk of seizures
what medications are used to treat ASD?
no medications are available: risperidone is used for symptoms of aggression, popranolol, and SSRI’s
what pharmacological interventions are used for ADD and ADHD?
methylphenidate (Ritalin or Daytrana), Adderall
what are some common side effects of drugs for ADD and ADHD?
decreased appetite and sleep and increased VS
what alternative phramacological treatments are used to treat ADD and ADHD?
clonidine hypochloride, guafacine HCl, TCAs or Wellbutrin (buproprion HCl)
why should you carefully monitor the medication of children with ADHD and tourette’s?
ADHD medications are CNS stimulants which can increase the severity of tics
what are some pharmacological treatments for Tourette’s disorder?
clonidine HCl and guanfacine HCl are the most effective
