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mental health exam > m2 recap > Flashcards

m2 recap Flashcards

1
Q

primary, secondary and tertiary care during crisis

A

Primary Care:
- Promote mental health & reduce incidents of crisis
- Teach coping skills (decision making, problem solving, assertiveness, meditation, relaxation, etc.)

Secondary Care: During acute crisis situation
- Safety #1
- Establish plan
- Critical incident stress debriefing (CISD)

Tertiary Care: After severe crisis
- Facilitate optimal level of functioning & reduce further emotional disruptions

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2
Q

restraints

A
  • Emergency use only

MHA
- does not authorize restraining voluntary or informal patients
- Unless it is to avoid harm to self or others
- the person will need to be assessed by a psychiatrist to determine if they meet the criteria for an involuntary admission under the MHA
- If not, all restraints must be discontinued immediately (Chemical restraint?)

Documentation
- must be clearly documented

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3
Q

10 responsibilities with restraints

A
  1. Understanding the person’s behavior
  2. Developing an individualized plan of care to meet the persons needs
  3. Collaborating with the interprofessional team
  4. Evaluating the plan of care and making changes PRN
  5. Using least restrictive restraints
  6. Discussing with the person (or SDM) to ensure informed decisions (about use of restraints in past – what scared the patient – de-escalation techniques that worked?)
  7. Being aware of agency policies
  8. Monitoring and reviewing the continued use of restraints
  9. Being aware that restrain use is a emergency temporary intervention
  10. Documentation
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4
Q

SADPERSONS scale

A

1 point if yes for each

sex (1 for male ) for frmale –> women attempt more, men succeed more)
age
depression
previous attempt
ethanol abuse
rational thinking loss
soial support lacking
organized plan
no spouse
sickness

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5
Q

non suicidal injury and treatment

A

Includes:
- cutting, burning, scratching, hitting, hair picking, biting, etc.
- Self-punishment, alleviate psychic pain, pierce numbness = against dissociation
- Associated with other psychiatric disorders: anxiety, depression, eating disorders, borderline personality disorders.

interventions
- Identification of triggers for self-harming behaviours
- Physical assessment of wounds
- Caring for the wounds
- Therapeutic relationship (establish trust)

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6
Q

MDD

A

Depressed mood and/or a loss of interest or pleasure in nearly all activities
AND 4 or the following 7 additional

symptoms:
1. Disrupted sleep patterns
2. Appetite (weight) changes
3. Poor concentration
4. Loss of energy
5. Psychomotor agitation or retardation
6. Excessive guilt or feelings of worthlessness
7. Suicidal ideation

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7
Q

PDD

A

Depressed mood for most days for at least 2 years AND 2 or more of the following:
- Poor appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration or diffculty making decisions
- Feelings of hopelessness

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8
Q

psychotic depression

A

A person with MDD who experiences hallucinations and/or delusions

Negative, self-critical, self-punishing, self-blaming

May be associated with psychomotor agitation

Reason: Unknown

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9
Q

PPD

A
  • Depression that starts either during pregnancy or any time in the year following the birth of a child (lasts several weeks/months)
  • Tears, anxiety ++, difficulties concentrating, mood swings
  • No ‘typical’ patient (Mother or father, adoptive or biologic)
  • May not enjoy the baby and have frequent thoughts that they are a bad parent
  • Psychotic features: May have SI or HI of harming their baby
  • Sleep deprivation may be a key factor
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10
Q

serotonin syndrome

A

Selective Serotonin Reuptake Inhibitors (SSRIs)
- Risk of suicide early in the treatment
- Serotonin syndrome (muscle hyperrefexivity, tachycardia, hypethermia, confusion, agitation, seizures, death)

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11
Q

ECT

A
  • Mechanism of action unknown
  • Effective treatment for severe depression
  • used for Treatment-resistant depression or so severely ill that rapid treatment is required
  • Several contraindications
  • Appears to be more effecitve in older adults
  • S/E: confusion, disorientation, retrograde amnesia
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12
Q

BPD

types?

A
  • Bipolar disorders correspond to disorders where persons experience periods of depression coupled with periods of extreme euphoria (mania); including some euthymic periods.

Bipolar Disorders
- Bipolar I: one or more manic episodes with a major depressive occurrence
- Bipolar II: periods of major depression accompanied by at least one incidence of hypomania (no psychotic features)
- Milder form: Cyclothymic disorder (no overt mania, no profound depression)

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13
Q

bipolar therapeutic managment

A

lithium carbonate
- Onset 10-21 days (acute phase = LiCO3 supplemented with antipsychotics, antianxiety, and anticonvulsants)
Narrow therapeutic level (~0.6-1.2 mEq/L)
- toxicity at 1.5 and above – importance of monitoring through blood work

Symptoms of toxicity
- N/V, diarrhea, cardiac arrhythmias, blackouts, tremors, seizures.

Carbamazepine
- Combination with antipsychotic / patients who are aggressive / psychotic
- Liver function

Lamotrigine
- Deadly S/E: Stevens-Johnson syndrome
- rash

Valproic acid / divalproex sodium
- drowsiness, dizziness, increase suicidal ideations
- Therapeutic range : 50 – 150 mcg/ml
- Liver function

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14
Q

BPD prioritization of NSG care

acute, contonuation, maintenance phase

A

Acute phase
- Medical stabilization
- Maintaining safety
- Self-care needs

Continuation phase
- Maintain medication adherence
- Psychoeducational teaching
- Referrals

Maintenance phase
- Prevent relapse

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15
Q

Eating vs feeding disorder

A

Eating disorders are not really about food, but rather a socially acceptable coping mechanism gone wrong

Feeding disorders actually are more often the direct result of food preferences or perceived intolerances.

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16
Q

Anorexia

A
  • Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. (Severity of AN is based on BMI).
  • Intense fear of gaining weight or becoming fat, even though underweight..

Subtypes:
- Restricting type (AN-R);
- Binge-eating/purging type (AN-P)

17
Q

AN care

A
  • Immediate medical stabilization is required
  • Inpatient medical management required (nutrition therapy) due to refeeding syndrome
  • Suicidal ideations ?

Pharmacological/Nutritional
- SSRI
- Antipsychotics (chlorpromazine) :
- Atypical antipsychotics (olanzapine):

Psychotherapy
CBT

interventions
- Milieu therapy (structured meal times, weigh-ins, monitoring, etc.)
- Distraction, diversional activities, therapeutic alliance

18
Q

refeeding syndrome

A
  • Caused by rapid refeeding following a long period of fasting (from catabolism to anabolism)
  • Usually presents in first four days, but can present up to two weeks

causes:
Hypophosphatemia
hypomagnesemia
hypokalemia
thiamine deficiency
water retention → edema

19
Q

BN

A
  • Recurrent episodes of binge eating and recurrent inappropriate compensatory behaviour to prevent weight gain
  • Frequency of compensatory behaviours used to specify the level of severity for BN.
  • Binge: eating + Compensatory behaviour: such as self-induced vomiting, misuse of laxatives, diuretics…..
20
Q

BN pysio risks, interventions + psych

A

Physical
- Dental erosion & caries
- Changes in pulse/blood pressure
- Electrolyte disturbance
- Dehydration
- Esophageal tears
- Abdominal pain

interventions
- Observation during and after meal times
- Appropriate exercise patterns

CBT

21
Q

BED

A
  • Recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances
  • Behaviour occurs at least once/wk over 3 months (Frequency of episodes used to specify severity)

must include 3 of the following:
Eating very quickly.
Eating regardless of hunger cues.
Eating until uncomfortably/painfully full.
Eating alone due to embarrassment.
Feelings of self-disgust, guilt or depression.

22
Q

avoidant restrictive food intake disorder

A
  • Restrictive/inadequate eating not due to medical or psychiatric co-morbidity and not attributed to disturbances in the perception of shape and weight

Three common clinical presentations to ARFID
- Lack interest in food or a blunted response to physiological hunger
- Avoidance of eating d/t dislike of smell, taste, texture, temp, or appearance of food; will only eat a narrow range of foods
- Restricting intake as reaction to an upsetting event such as choking

23
Q

PICA

A
  • Persistent eating of nonnutritive substances for at least one month
  • Behaviour is inappropriate to developmental level
  • Behaviour is not a part of a culturally sanctioned practice
  • May cause intestinal damage, blockage or laceration
24
Q

rhumination disorder

A

Rumination Disorder
- Repeated regurgitation of food for at least 1 month
- Regurgitated food may be re-chewed, re-swallowed, or spit out
- Behaviour is not due to medical condition (ex GI)

25
Q

Anorexia athletica and orthorexia

A

Anorexia Athletica
Profound preoccupation with exercise

Symptoms include:
- Compulsive need to exercise
- Prioritizing exercise over work, school and relationships
- Equating self-worth to physical performance
- Rarely being satisfied with one’s physical achievements

Orthorexia
- Problematic preoccupation with “health”
- Relying only on “natural” products
- Finding more pleasure in eating “correctly” or “clean” than actually enjoying food
- Emotional satisfaction when sticking to goals and intense despair when they fail
- Gateway to anorexia nervosa?

26
Q

substance use criteria

A
  1. large amounts or over a longer period of time than intended.

  2. desire or unsuccessful efforts to cut down or control substance use.

  3. A great deal of time is spent in activities necessary to obtain, use, or recover from effects of the substance.

  4. Craving, or a strong desire to use.

  5. failure to fulfill major role obligations at work, school or home.
  6. Continued use despite having persistent social or interpersonal problems caused or exacerbated by the effects of substance

    • Important social, occupational or recreational activities are given up or reduced because of use.

  8. Recurrent use in situations in which it is physically hazardous

  9. Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

  10. Tolerance
  11. Withdrawal,
27
Q

4 C of substance use

A

Compulsive Use
Cravings
Continued Use
- Despite Serious Consequences

Can’t Stop

28
Q

biological and physchological factors to substance use

A

Biology
- Increased reinforcement mechanism of the brain (dopamine)
- Physiological brain changes alter one’s judgement, decision making, learning, memory and behavioural control.
- Use not only for pleasure, but for survival.

Psychological factors
- Substances = Pleasure = Repeated use = Tolerance = Increased use

29
Q

SNC depressors

Sedatives, hypnotics, anxiolytics

A

Synthetic medications that are sedating, induce sleep and reduce anxiety
- Benzodiazepines: diazepam, oxazepam, temazepam, lorazepam
- Flunitrazepam (ruffies, rophies, roachies) which is the ‘date rape’ drug
- GHB is another illegal drug frequently used in the club scene
- Use of these drugs typically co-occurs with alcohol making their use extremely dangerous
- Side effects related to benzodiazepine withdrawal

30
Q

Alcohol withdrawl and pharmacotherapy

minor, immedicate and major withdrawl symtpms

A

Minor withdrawal -
- may include anxiety, nausea and vomiting, coarse tremor, sweating, tachycardia, hypertension, head ache, insomnia – usually resolved within 48-72 hours.

Intermediate withdrawal
- patients experience minor withdrawal symptoms in addition to seizures, dysrhythmias, and/or hallucinations, - patients remain aware of the unreal nature of their auditory or visual hallucinations and remain oriented and alert.

Major withdrawal (delirium tremens)
- severe agitation, gross tremulousness, marked psychomotor and autonomic hyperactivity, global confusion, disorientation and auditory, visual or tactile hallucinations.
- Tends to occur 5 or 6 days after severe untreated withdrawal and sudden death may occur.

pharm
- benzos –> dangerous withdrawl symtpmos
- thiamine –> reduce ataxia
- folic acid –> deificiency so we want to supplement
- supplementation of lost electrolytes -
- disulfram
- nalextrone –> opiod antagonist
- acamprosate –> cravings

31
Q

AA

A

Alcoholics Anonymous (AA)
- Only criterion to join is the “desire to quit drinking”
- Ongoing meetings with hope instilled through others who are no longer drinking
- Focus is on abstinence and the loss of control over the ability to drink
- Success is attained by taking it “one day at a time”

32
Q

opiod overdose risk factors

A

Opioid overdose risk factors
- Decreased tolerance
- Mixing drugs
- Using alone
- Drug quality and potency
- Health status
- Route

32
Q

Cocaine

A
  • Snorted, smoked, or injected
  • Crack cocaine (crystalized): Faster Acting
  • Rapidly crosses the blood-brain barrier
  • Physical effects: alertness and energy and bizarre behaviours potentially leading to violence and potential risk of harm, tachycardia or bradycardia, pupil dilation, hypo or hyper tension, nasal septum destruction, respiratory distress, chest pain, arrhythmias, seizures, coma
  • The high is followed by a significant and intense depressive phase (“the crash”) resulting in irritability fatigue, mood depression, lethargy, abdominal and muscle cramps, dehydration, apathy.
33
Q

amphetamines

A
  • Methamphetamines, amphetamines, methylphenidate, dextroamphetamine and some diet medications.
  • Can be taken orally, snorted, smoked or injected.
  • Act like adrenaline and activate the CNS and peripheral nervous system.
  • Increases alertness, concentration, energy, euphoria… suppreses appetite.
  • Similar presentation as cocaine except for its analgesic effect.
34
Q

hallucinogens

A

3 groups (see Table 18-11):

Indolealkylamines
- (ex: LSD, psilocybin):
- No secondary stimulant effect.

Phenylethylamines
- (ex: mescaline, ecstasy, MDMA)
- Secondary stimulant effect.

Arylcyclohexylamines
- (Dissociative aneasthetics - ex: PCP, Ketamine):
- Secondary depressant effect.

35
Q

cannabis

A
  • Body stores cannabinoids in fat tissue and in the brain causing urine drug screens to remain positive for weeks.
  • May result in the development of psychotic symptoms and the use of cannabis –> recognized as an independent risk factor for the development of schizophrenia and psychosis.
  • Synthetically produced to treatment selected medical conditions/symptoms (e.g., appetite stimulations, pain, MS, nausea)
36
Q

inhalents

A
  • Refers to a group of chemical vapors or gases that when inhaled cause a high.
  • They are not intended for human consumption and typically cause CNS depression.
  • Includes substances such as acetone, felt-tip markers, hobby glue, rubber cement, dry cleaning fluid, paint and nail polish removers, paint thinners, aerosols, chloroform, butane, propane, nitrites.
  • damage to the liver, kidney, lungs, and heart, bone marrow suppression, and cause permanent brain damage.
  • death is not dose dependant
37
Q

substance use Tx

outpatient, intensive OP, healing lodge, medical monitor, medical manage

A

Outpatient treatment:
- usually includes both group and individual sessions totaling fewer than 9 hours/week.

Intensive outpatient treatment (including partial hospitalization):
- Structured programs that include both individual and group sessions totaling greater than 9 hours/week.

Healing Lodge:
- Indigenous treatment approach
- 6-week residential treatment program where the person’s emotional and psychic issues (self-esteem, anger, grief, trauma, etc.) are addressed alongside the substance use disorder.

Medically monitored intensive inpatient treatment (residential):
- organized addiction services, around-the-clock professionally directed evaluation and care.

Medically managed intensive inpatient treatment:
- Most intensive level of care that takes places 24 hours/day in an acute care inpatient unit to medically manage those suffering from severe withdrawal

38
Q

Motivational interviewing and stages of change model

A

MI is a directive, patient-centered style of counseling that helps patients to explore and resolve their ambivalence about changing their behaviors.

MI is based on the stages of change model:
1. Pre-contemplation – person has no intention to quit in the next 6 months
2. Contemplation – person is aware that the 
problem exists and is seriously 
considering making change but has 
not planned to do so.
3. Preparation – person has made a decision 
to quit within the next 30 days.
4. Action – person has quit within the past 6 months and is actively applying cessation skills.
5. Maintenance – person has quit for more than 6 months.

mental health exam (6 decks)

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