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final psych portion Flashcards

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1
Q

what is the continuum of eating experiences?

A

manifestations of eating disorders overlap significantly and thus may be viewed holistically with a continuum of eating experiences

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2
Q

binge eating

A

episodes of uncontrolled, ravenous eating of large amount of food within discrete periods of time usually followed by guilt and purging behaviour

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3
Q

body image

A

self-perception of one’s body

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4
Q

body image distortion

A

the individual perceives their body disparately from how the world or society views it

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5
Q

dietary restraint

A

cognitive effort to restrict food intake for the purpose of weight loss or prevention of weight gain

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6
Q

drive for thinness

A

intense physical and emotional process that overrides all physiological body cues

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7
Q

interoceptive awareness

A

sensory response to emotional and visceral cues, such as hunger

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8
Q

maturity fears

A

feeling overwhelmed by adult responsibilities

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9
Q

purging

A

compensatory behaviour to rid oneself of food already eaten by means of self-induced vomiting or use of laxatives, enemas or diuretics

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10
Q

psychological characteristics relating to eating disorders

A

difficulty expressing anger, low self-esteem, body dissatisfaction, powerlessness, obsessiveness, compulsiveness, non-assertiveness, cognitive distortion

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11
Q

what are some common eating disorder warning signs?

A

constant dieting even when thin, rapid unexplained weight loss/gain, laxative or diet pill use, obsession with calories, food or nutrition, compulsive exercising, hoarding high-calorie food, going to the bathroom right after meals

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12
Q

anorexia nervosa

A

life-threatening eating disorder characterized by refusal to maintain body weight appropriate for age, intense fear of gaining weight, a severely distorted body image and refusal to acknowledge the seriousness of weight loss

severity determined by BMI

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13
Q

psychological characteristics specific to anorexia nervosa

A
  • decreased interoceptive awareness
  • sexuality conflict/fears
  • maturity fears
  • ritualistic behaviours
  • perfectionism
  • dietary restraint
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14
Q

anorexia - restricting type

A

restricts dietary intake

the person does not binge or purge

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15
Q

anorexia - binge eating/purging type

A

during the current episode of AN, the person engages in binge eating and purging behaviours

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16
Q

typical age of onset of anorexia nervosa

A

14-16 years, highest incidence rates for females 15-19 years

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17
Q

muscle dysmorphia

A

eating disorder generally seen in men who obsess on over-exercising or building muscle mass

higher rate in jobs or professions that demand thinness or large muscular bodies

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18
Q

risk factors of anorexia nervosa

A
  • sports that emphasize leanness
  • personal trauma
  • abuse
  • interpersonal distrust
  • family systems
  • lack of assertiveness
  • fear of expressing feelings
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19
Q

can you be certified under the mental health act for eating disorders?

A

the patient will ONLY be certified for MEDICAL REASONS

otherwise, VOLUNTARY on eating disorders unit OR outpatient

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20
Q

BMI

A

body mass index

“normal” - 18.5-24.9
anorexia - under 16
overweight - 25-29.9
obesity - 30 +

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21
Q

when would you be admitted for an eating disorder?

A
  1. MEDICAL: less than 75% than ideal weight, severe dehydration
  2. STARVATION: electrolyte imbalance, syncope, seizures, bradycardia, cardiac BMI under 16
  3. PSYCH: suicidal, psychosis, OCD, family dysfunction, decreased daily functioning
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22
Q

nursing interventions for anorexia nervosa

A
  1. building trust and establish a therapeutic alliance
  2. psychoeducation
  3. weight restoration (start low and go slow)
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23
Q

what is refeeding syndrome

A

rare but potentially fatal condition that can occur during refeeding of malnourished individuals

due to the metabolic and hormonal changes that occur due to aggressive nutritional rehab

can cause severe electrolyte imbalances

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24
Q

who is at risk for refeeding syndrome?

A
  • any pt resulting in rapid weight loss of 15-20% over 3-6 months
  • 10 days of low intake or starvation
  • pts receiving enteral or parenteral feeds
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25
Q

manifestations of refeeding syndrome

A

hyperglycemia, fluid retention, dysrhythmias, heart failure, respiratory failure, anemia, delirium, weakness

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26
Q

how can we prevent refeeding syndrome?

A
  • start low and go slow when increasing kcal intake
  • MONITOR pt presentation closely
  • adjust fluid, electrolyte, vitamin, and mineral requirements based on lab work
  • provide thiamine and complete multivitamin
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27
Q

bulimia nervosa

A

eating disorder characterized by recurrent episodes of binge eating and compensatory behavior to avoid weight gain through purging methods or non purging methods such as fasting or excessive exercise

binge eating and compensatory behaviours occurring on average once a week for 3 months

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28
Q

psychological characteristics specific to BN

A
  • impulsivity
  • boundary problems
  • limit-setting difficulties
  • dietary restraint

binging and purging often occur in private (secret) and are typically of average weight making it difficult to identify the problem

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29
Q

physical assessment findings of someone with bulimia nervosa

A
  • loss of dental enamel
  • chipped, or moth eaten teeth appearance
  • increased dental caries
  • scars on dorsum of hand
  • menstrual irregularities
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30
Q

lab findings from someone with bulimia nervosa

A
  • fluid and electrolyte imbalances
  • metabolic alkalosis (from vomiting) or metabolic acidosis (from diarrhea)
  • mildly elevated serum amylase levels
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31
Q

the binge-purge cycle

A
  1. hunger
  2. binge eating
  3. shame, humiliation, failure
  4. dieting or purging
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32
Q

bulimia nervosa and hospitalization

A

less likely than those with anorexia nervosa to be hospitalized

dehydration, electrolyte imbalance, depression, suicidality

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33
Q

priority care issue for bulimia nervosa

A

suicidality or self-harm due to impulsivity

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34
Q

binge eating disorder

A

eating disorder characterized by frequent consumption of very large amounts of food, coupled with feelings of being out of control, ashamed and disgusted by the behaviour and experience high body dissatisfaction

  • more common than AN and BN
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35
Q

psychological characteristics of BED

A
  • negative mood
  • self-deprication
  • social insecurity
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36
Q

risk factors for BED

A
  • low self-esteem
  • weak therapeutic alliances
  • low mastery and clarification
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37
Q

what should we assess for in binge eating disorder pts?

A
  • current BE patterns & triggers
  • associated symptoms of gastric distress
  • physical mobility, activity and sleep patterns
  • cognitive distortions & knowledge gaps
  • symptoms of comorbid psychiatric disorders
  • MSE & risk
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38
Q

what are the priority care issues for BED?f

A

comorbid obesity, depression and anxiety can contribute to cardiac and other health crises

  • also risk of type 2 diabetes in presence of obesity
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39
Q

nursing interventions for BED

A
  • building the therapeutic relationship
  • psychotherapy (addressing cognitive distortions with CBT)
  • encourage clients to record intake, binges and emotions associated
  • pharmacological intervention for weight loss (Vyvanse)
  • establishing health sleep and coping patterns
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40
Q

pica

A

persistent eating of non-nutritive, non-food substances over a period of at least 1 month

inappropriate to developmental level of individual and not supported culturally or socially

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41
Q

rumination disorder

A

repeated regurgitation of food over a period of at least 1 month, food may be re-chewed, re-swallowed or spit out

does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, or binge eating disorder

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42
Q

avoidant/restrictive food intake disorder (ARFID)

A

eating or food disturbance as manifested by persistent failure to meet appropriate nutritional/energy needs

  • significant weight loss
  • significant nutritional deficiency
  • dependence on enteral feeding or oral nutritional supplements
  • marked interference with psychosocial functioning

*** differs from AN: the person LACKS the drive for thinness or body image disturbances

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43
Q

purging disorder

A

recurrent purging behaviour to influence weight or shape in the absence of binge eating

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44
Q

night eating syndrome

A

recurrent episodes of night eating after awakening from sleep or excessive food consumption after the evening meal

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45
Q

personality traits

A

persistent patterns of perceiving, thinking, feeling and behaving that shape the way in which a person responds to the world

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46
Q

temperament

A

recognizable, distinctive, and relatively stable pattern of individual differences that are evident early on in life

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47
Q

what are the 5 key traits of personality

A

O.C.E.A.N

Openness to experience
Conscientiousness
Extraversion
Agreeableness
Neuroticism

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48
Q

personality disorder

A

a diagnosis when the perceptions, emotions, cognition and behaviours of an individual substantially deviate from cultural expectations in a persistent and inflexible way causing distress or impairment

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49
Q

personality disorder traits

A

underlying thoughts, feelings and behaviours that may be intermittent and interfere interpersonally without obvious impairment

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50
Q

what is required for a diagnosis of a personality disorder?

A

behaviours and characteristics must persistently occur to such an extent that they interfere with functioning (socially and occupationally)

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51
Q

what are some common features of personality disorders?

A
  • impaired metacognition
  • maladaptive emotional response
  • impaired self-identity and interpersonal functioning
  • impulsivity and destructive behaviours
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52
Q

Cluster A personality disorders

A

ODD/ECCENTRIC

  • paranoid personality disorder
  • schizoid personality disorder
  • schizotypal personality disorder
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53
Q

Cluster B personality disorders

A

Cluster B personality disorders
DRAMATIC/UNPREDICTABLE

  • antisocial personality disorder
  • borderline personality disorder
  • histrionic personality disorder
  • narcissistic personality disorder
54
Q

Cluster C personality disorders

A

ANXIOUS/FEARFUL

  • avoidant personality disorder
  • dependent personality disorder
  • obsessive-compulsive personality disorder
55
Q

treatment for cluster A PDs

A

if they are content, can maybe just let them be!

psychotherapy is most effective
can use antidepressants or antipsychotics if there are overlap of symptoms

56
Q

treatment for cluster B PDs

A

counseling and therapy (DBT)
medications may be used to treat specific symptoms but not the disorder itself

57
Q

borderline personality disorder (BPD)

A

characterized by affective instability, identity disturbances, unstable relationships, cognitive dysfunctions, impulsivity, self-injurious behaviours, risk for suicide

58
Q

what are the 6 behavioural patterns seen in BPD

A
  1. emotional vulnerability
  2. self-invalidation
  3. unrelenting crisis
  4. inhibited grieving
  5. active passivity
  6. apparent competence
59
Q

nursing interventions for BPD

A
  • management of medications
  • regular sleep patterns
  • nutrition
  • safety measures
  • cognitive strategies
  • limit setting
  • community resources
60
Q

all or nothing thinking

A

only seeing things in black or white, with no shades of grey

“If I don’t get a perfect evaluation, I am a failure”

61
Q

overgeneralizatio

A

the assumption that one error/problem means a lifetime of the same error/problem

“If I lose this job, I will never succeed in making a living”

62
Q

mental filter

A

filtering out the good things that happen and retaining only the negative

“When I received that award, I could see that Jane didn’t think I deserved it”

63
Q

magnification/minimization

A

over exaggeration of fears, imperfections, or errors

“There is absolutely no way I could have passed that exam, I’ve totally blown the course”

64
Q

jumping to conclusions

A

concluding things that are not justified based on available evidence

“I saw Peter yawn during my presentation, everyone was bored”

also includes mind reading/fortune telling

“my coworker didn’t say hello to me today because she’s starting to dislike me”

65
Q

labelling

A

putting a negative label on yourself or others, a way to believe that no one can change

“My roommate is a slob, I have to keep everything tidy”

66
Q

personalization and blame

A

making yourself feel responsible for things out of your control

“It is my fault our team lost the game. If only I hadn’t dropped the ball in the first half”

67
Q

should/must statements

A

thinking only in terms of “should” or “must”

“I must make no mistakes during the skill laboratory, no matter what”

68
Q

discounting the positive

A

refusing to credit the positive aspects of situations

“John said that I looked great today. He must think I look terrible most days”

69
Q

emotional reasoning

A

believing something must be true because one “feels” it so strongly, ignoring any evidence to the contrary

“I know I’ve had people in my life who say I’m a good person, but it’s hard to believe because I feel like I’m so bad”

70
Q

treatment for cluster C PDs

A
  • best treated in group therapy (typically in community)
  • CBT used to deal with cognitive distortions, emotional reasoning and personalization
  • strength-based approach
  • psychotropic medications (anxiolytics and antidepressants) may be used in conjunction with therapy to treat depression, anxiety and sleep disturbances
71
Q

difference between signal signs and signal symptoms

A

SIGNAL SIGNS: observable behaviours and styles of interaction which may prompt the interviewer to look further

SIGNAL SYMPTOMS: client’s reported complaints of symptoms typically associated with a personality disorder

72
Q

paranoid personality disorder

A

DISTRUST, SUSPICION

Heightened sense of fear and vulnerability

Tx: psychotherapy

73
Q

schizoid personality disorder

A

SOCIAL DETACHMENT, EMOTIONAL RESTRICTION

Anxiety due to forced contact with others

Tx: CBT, group therapy

74
Q

schizotypal personality disorder

A

ODD BELIEFS, SOCIALLY ISOLATIVE

odd interpretation of illness, anxiety because of forced contact with others

Tx: psychotherapy, CBT, group therapy

75
Q

antisocial personality disorder

A

DISREGARDS RIGHTS OF OTHERS

anger, entitlement masking fear

Tx: psychoanalytic therapy, CBT

76
Q

histrionic personality disorder

A

EXCESSIVE ATTENTION-SEEKING BEHAVIOUR, EMOTIONALITY

threatened sense of attractiveness and self-esteem

Tx: psychotherapy

77
Q

narcissistic personality disorder

A

GRANDIOSITY, NEED FOR ADMIRATION, LACK OF EMPATHY

anxiety caused by doubts of personal adequacy

Tx: psychotherapy

78
Q

avoidant personality disorder

A

SOCIAL INHIBITION D/T FEAR OF REJECTION OR HUMILIATION

heightened sense of inadequacy, low self esteem

Tx: psychoanalytic therapy, CBT, group therapy

79
Q

dependent personality disorder

A

EXCESSIVE NEED TO BE TAKEN CARE OF, SUBMISSIVE AND CLINGING BEHAVIOUR

fear of abandonment, helplessness

Tx: psychotherapy, CBT, DBT, group therapy

80
Q

obsessive compulsive personality disorder

A

PREOCCUPATIONS WITH ORDERLINESS, PERFECTION, CONTROL

fear of losing control of bodily function and emotions

Tx: CBT

81
Q

psychoanalytic therapy

A

“talk therapy” with focus on uncovering and resolving unconscious emotions and memories

82
Q

what is the first line tx for BPD?

A

DBT

83
Q

self-care and personality disorders

A

effective in reducing distress, improve resilience and physical health, and improved coping with stressors

can help reduce common symptoms of cluster A, B and C personality disorders such as mood changes, impulsive behaviour, anxiety and irritability

84
Q

what are the five core elements of mindfulness?

A
  1. attention & awareness
  2. present-centeredness
  3. external events
  4. cultivation
  5. ethical mindedness
85
Q

acceptance based treatments

A

learning to be open to reality and acknowledge things as they are

acknowledging the feeling, experience or situation then identifying ways to cope, experience or change the feeling/situation

86
Q

CBT

A

psychotherapy focused on identifying, analyzing and ultimately changing the habitually inflexible and negative cognitions about oneself, others and the world

intersection of thoughts, emotions and behaviours

87
Q

what are the 3 levels of cognition

A
  1. CORE BELIEFS (ones view of self, others and the world)
  2. INTERMEDIATE BELIEFS (attitudes, rules, or expectations and assumptions that influences one’s perception, affect and behaviours)
  3. AUTOMATIC THOUGHTS (initial and most superficial response)
88
Q

DBT

A

combines cognitive and behavioural strategies in which patients actively formulate treatment goals to change the target behaviours

89
Q

describe the stages of DBT

A

PRE-TREATMENT: orient to DBT

STAGE 1: commitment, safety and stability (focus on life-threatening, quality of life interfering, or therapy interfering behaviours)

STAGE 2: symptom reduction (trauma/PTSD, eating disorders, anxiety disorders, mood disorders)

STAGE 3: regulating emotions through acceptance and change (low self-esteem, relationship difficulties, problem-solving, inadequate quality of life)

90
Q

self-harm

A

self-inflicted actions that cause damage to body tissue

91
Q

suicidal ideation

A

thoughts, ideas and feelings about wanting to die and how to die

92
Q

suicidal plan

A

plan or plans to die by suicide

93
Q

suicidal behaviour

A

any self-inflicted behaviours with the intent to die

94
Q

suicide attempt

A

self-destructive behaviour that did not result in death but had the expectation of death

95
Q

suicide

A

completion of death by self

96
Q

5 types of abuse

A

physical, emotional, sexual, child abuse, elder abuse

97
Q

criminal code

A

IMMEDIATE RISK - 911

when you suspect a crime has occurred, might occur or someone is exhibiting behaviour that indicates a lack of wellbeing and unpredictability

98
Q

adult guardianship act

A

NEGLECT/ABUSE

when you are concerned an adult is being abused, neglected or is self-neglecting and unable to seek support/assistance on their own due to:
- physical restraint
- physical handicap
- illness, disease, injury

99
Q

public guardian and trustee

A

FINANCIAL LEGAL RISK

you have reason to believe that an adult is not capable of managing his or her financial and legal affairs and there is imminent risk to his or her assets

100
Q

who are vulnerable groups for abuse?

A
  • people with a mental disorder
  • LGBTQ2+
  • people in care
  • multicultural, immigrants and visible minorities
  • children & youth
  • intimate partners
  • older adults
  • indigenous people
  • people with disabilities
101
Q

women abuse

A

domestic abuse, spousal abuse, or intimate partner abuse

102
Q

stalking/harassment

A

crime of intimidation which causes distress and/or fear

103
Q

battering

A

repeated physical or sexual violence with the intent of coercive control

104
Q

rape & sexual assault

A

any form of non consenting sexual activity

105
Q

abuse against men

A
  • men and women report relatively equal rates of spousal violence
  • men 3.5x more likely to experience kicking, biting, hitting or being hit with something
  • less likely to seek support services
106
Q

what is the age of consent in canada?

A

16

107
Q

what is the age of consent for someone in a relationship of authority, trust or dependency?

A

18

108
Q

cycle of abuse

A

PHASE 1) tension building

PHASE 2) violence erupts

PHASE 3) remorse ensues

109
Q

why do women stay in violent relationships?

A
  • economic or financial dependence
  • societal, cultural or religious expectation
  • fear of retaliation
  • mental health problems
  • history of trauma and abuse
  • traumatic bonding
110
Q

what is the role of an RPN when working with someone who has been abused or suspected to have been abused?

A

ASSESS
SAFETY
DUTY TO REPORT

provide resources, can’t force anyone who is a competent adult to get help if no imminent risk

111
Q

who does the duty to report apply to?

A

children, older adults or adults with impaired decision making skills

112
Q

what is “car 86”

A

emergency service

police and ministry of child and family development together

113
Q

what are some possible indicators of abuse

A
  • vague information about cause of issue
  • delay between occurrence of injury and seeking of tx
  • inappropriate reactions of significant other or family
  • denial or minimization
  • discrepancy between history and physical examination findings
114
Q

can you contact the police if you suspect abuse?

A

if they are a competent adult, you can only contact police if they agree to it

115
Q

priority nursing interventions for a pt suffering from abuse

A

INFORM, provide resources if they are accepting, explain importance of having a “to-go” bag, book a follow up appt

116
Q

sexual health

A

a state of physical, emotional, mental and societal well-being related to sexuality

117
Q

sexuality

A

encompasses [assigned] sex, gender identity and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction

118
Q

sexual orientation

A

who we are attracted to

119
Q

gender identity

A

one’s sense of being male or female (or outside of that)

120
Q

gender expression

A

how one outwardly shows one’s gender

121
Q

gender diverse

A

gender roles/expression that do not match social and cultural expectations

122
Q

binary model of gender

A

classification of sex and gender into two distinct (male or female) categories

outdated

123
Q

spectrum model of gender

A

acknowledges a spectrum of gender and is not limited to male and female

124
Q

spectrum model 2.0 of gender

A

goes beyond the spectrum model and acknowledges outside of/beyond male/femaleness

125
Q

gender dysphoria

A

discomfort or distress that is caused by a discrepancy between their gender identity and gender assigned at birth

significant distress and impairment in social, occupational or other important areas for at least 6 months

126
Q

treatment options for gender dysphoria

A
  • individual therapy/counselling
  • education/resources (social, legal or medical affirmation)
  • family/couples therapy
  • support groups
127
Q

puberty blockers

A

GnRH used to suppress puberty to prevent secondary sex characteristics to develop

requires a long lasting and intense pattern of gender dysphoria

128
Q

hormone therapy

A

need to be the age of majority in Canada (18)

either estrogen (male to female) or testosterone (female to male)

129
Q

what are some procedures not covered by MSP?

A

facial procedures, pectoral implants, hair reconstruction or restoration, liposuction or lipofilling, voice surgery

as well as supportive garments, travel/accomodation for surgeries, other travel expenses

130
Q
A

concepts 4 (4 decks)

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