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Primary Care 1 > Mental Health > Flashcards

Mental Health Flashcards

1
Q

Somatic symptoms of depression

A

headache, bachache, back problems, chronic pain. May also have changes in cognition and unable to perform every day activities

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2
Q

Dysthymic disorder

A

chronic form of MDD. Seen more commonly in the older adult and is associated with symptoms of MDD but lasts for more than 2 years. Related to those who are socioeconomically and educationally disadvantaged

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3
Q

MDD

A

five or more of the following presented most of the day or nearly every day for a minimum of 2 consecutive weeks: depressed mood, loss of interest in pleasure of doing things, insomnia or hypersomnia, changes in appetite or weight, psychomotor retardation, low energy, poor concentration

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4
Q

s/s Dysthmia

A

two years with depressed mood - need two or more: decrease appetite, insomnia or hypersomnia, low energy, poor self esteem, poor concentration, hopelessness

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5
Q

clinical red flags of depression

A

insomnia, fatigue, chronic pain, recent life changes and stressors, fair or poor health, unexplained physical symptoms

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6
Q

patho of depression

A

neurotransmitter availability, drug classes work to increase the amount of brain serotonin, norepinephrine or dopamine. cortisol the stress hormone will increase in people with depression

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7
Q

treatment recc depression age 18-29

A

avoid SSRIs d/t suicidal risk

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8
Q

> 65 treatment depression

A

avoid SSRIs d/t suicide risk

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9
Q

stress v anxiety

A

stress - caused by a stressor. anxiety - exists after stressor is gone

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10
Q

anxiety disorder

A

anxiety is excessive or occurs in absence of a stressor or interferes with persons functioning

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11
Q

type of anxiety disorders

A

panic disorders, specific phobias, social phobias, social anxiety disorder, OCD, PTSD, GAD

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12
Q

panic attack

A

recurrent, unexpected panic attacks followed by a 1 month persistent concern about having another. symptoms can resemble an acute cardiac event with sweating, palpitations, SOB, choking sensation, chest pain, nausea and lightheadedness

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13
Q

specific phobia

A

persistent irrational fear of a particular object, place or situation referred to as a phobic stimulus. will seek treatment when the fear interferes with daily routine, occupation and social functioning. tx w exposure therapy

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14
Q

social anxiety disorder

A

refers the the fear of social performance situations like public speaking, fear of being judged or humiliated, different than being shy, they are self reinforcing as the embarrassment leads to poor performance

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15
Q

OCD

A

obsessions like repetitive intrusive thoughts, compulsions like ritualistic behaviors. thoughts lead to anxiety that is relieved by ritualistic behavior. will avoid situations assoc w the obsession. helpless in interrupting the cycle.

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16
Q

PTSD

A

follows a traumatic event, does not have to be personally witnessed or experienced to have a traumatic event, may have anxiety related to an event made known by someone else, s/s depression, anxiety, sleep disturbances, sexual dysfunction, psychosis. intense re-experiencing through traumatic memories is most common w flashbacks

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17
Q

acute stress disorder

A

if s/s appear a month after the test. if unresolved it can progress to PTSD

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18
Q

GAD

A

uncontrolled anxiety over a period of 6 months. s/s restlessness, fatigue, trouble concentrating, irritable, difficulty sleeping, muscle tension. may have unexplained physical symptoms. linked to heart disease, GI and pain disorders

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19
Q

patho GAD

A

combo of neurobiotic, genetic and environmental factors. underactive serotonergic system, overactive noradrenergic system, dysregulation of cortisol, and inhibitory neurotransmitters. early childhood trauma is a significant environmental factor in developing anxiety

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20
Q

anxiety assessment

A

cbc, chemistry, thyroid, ua, urine drug screen, possibly EEG, LP, HIV testing, somatic s/s like headache or sleep disturbance may relate to anxiety, ask about abuse, review current meds including alcohol or drugs, may be r/t caffeine, abusive drugs, OTC meds. ask about suicide. depression with 50% of those w anxiety

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21
Q

cardiovascular s/s that can lead to anxiety

A

PE, MI, CHF, dysrhythmia

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22
Q

Endocrine leading to anxiety

A

hyper/hypothyroid, hypoglycemia, pheochromocytoma, hyperadrenocorticism

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23
Q

metabolic disorder leading to anxiety

A

b12 deficiency, porphyria

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24
Q

respiratory disorders leading to anxiety

A

hyperventilation, copd, pneumonia

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25
Q

neuro disorders leading to anxiety

A

encephalitis, vestibular disturbances, neoplasm

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26
Q

SSRI for anxiety

A

celexa, lexapro, prozac, luvox, paxil, zoloft

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27
Q

lifetime prevalence of alcohol use disorder

A

18.6%

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28
Q

substance use disorder percentage of population

A

10.9%

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29
Q

percentage of population who smokes cigarettes

A

20%

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30
Q

percentage of lifetime nonmedical use of narcotics

A

14%

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31
Q

number of deaths from substance abuse each year

A

1 in 4

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32
Q

problematic pattern of substance abuse

A

2 of the following in the last 12 months: taking the substance longer or more amount than intended, desire or unsuccessful effort to cut down, great deal of time spent on activities to obtain or use, craving, and recurrent use resulting in failure to fulfill role requirements at work, school or home, use despite these problems, giving up social or work activities because of use, using even though hazardous,

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33
Q

severity based on number of those symptoms of substance abuse

A

mild: 2-3
moderate: 4-5
severe: 6 or more

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34
Q

risk factors for relapse

A

co-occurring psychiatric problems, sustained sleep difficulties, poor social support for recovery, low motivation for recovery, high levels of personal stress or high stress reactivity, history of multiple prior treatments with a relapse

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35
Q

clinical factors suggesting need for more intensive treatment

A

continued use of alcohol or drugs early in treatment, ongoing self reported substance craving, people close to the pt who support substance abuse, low motivation to stop after several weeks, spending time in places with people who increase the risk like being in a bar and not drinking

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36
Q

moral model

A

attribute addiction to personal weakness, a lack of character or willpower. substance use is personal choice, any negative consequences are the individuals fault. social scorn, isolation and punishment are imposed

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37
Q

behavioral model

A

addiction is a habit that is overlearned through observation, interactions, treatment is behavioral approoaches like cognitive, behavioral and relapse prevention

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38
Q

twelve step model

A

alcohol and drug addiction is an illness of the mind and body with devastating consequences. AA says alcoholism is a spiritual malady. AA was predicted on the idea of one alcoholic helping another, has sought to induce psychic change in those afflicted with alcoholism through a spiritual program of action as set forth in the 12 steps. Spirituality not religion

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39
Q

Disease model

A

medical model for substance use disorders views addiction as a disease. disease of the brain with genetic, developmental, biological and environmental influences that undermine voluntary control

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40
Q

bio-psycho-social-spiritual-model

A

combines several models including behavioral, disease and 12 step. the most adaptive approach for nurses to use.

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41
Q

chronic care model

A

conceptual foundation for addiction. includes continuing contact over time between patient and provider, interventions to promote pt self mgmt, links to pt oriented community resources and use of patient data to monitor progress and guide intervention

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42
Q

continuing care model

A

recognition that addiction is often chronic or relapsing has led to gradual evolution of clinical management to continuing care. treatment with an understanding that the disease will wax or wane over time. flexible. draws on a full range of treatment in different settings. good for moderate or severe substance abuse.

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43
Q

components of continuing care model

A

customization, flexibility, teaching self mgmt, link to other support, measuring pt over time

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44
Q

SBIRT

A

screening, brief intervention, referral to treatment. screening: briefly assess the extent of alcohol or substance abuse. brief intervention a 5-15 min discussion about avoiding reducing or discontinuing substances, refer to addictions treatment.

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45
Q

cognitive behavioral therapy

A

good for those w substance abuse. relapse prevention will identify cognitive, behavioral and environmental risk factors for relapse - goal is to select and rehearse coping responses for these risk factors

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46
Q

pharmacotherapy substance abuse

A

opioid agonist medication like methadone or buprenorphine for those with opioid use disorders. vivitrol or campral for alcohol abuse disorder

47
Q

mutual self help groups

A

like 12 step AA. focus is on helping group members to achieve and maintain abstinence from alcohol and drugs where the group members help one another

48
Q

self mgmt skills

A

patient has to develop confidence in goal setting, identification of barriers to reach their goals, development of plans to overcome barriers, self monitoring of status and symptoms and coping with stressors

49
Q

schizophrenia

A

chronic or recurrent psychosis. impaired social and occupational functioning. symptoms of hallucinations, delusions, disorganized speech, negative symptoms of flat affect, impaired cognition, poor attention, memory and executive functions. these symptoms with social/occupational dysfunction for 6 months is a dx.

50
Q

positive s/s schizophrenia

A

reality distortion symptoms of hallucinations and delusions as disorganized thoughts and behavior. hallucinations, delusions, disorganization

51
Q

negative s/s schizophrenia

A

absence of normal process. decreased expressiveness, apathy, flat affect, and lack of energy

52
Q

neuro disturbances in schizophrenia

A

impairments in sensory integration, motor coordination and sequencing. right-left confusion, agraphesthesia (draw letter in palm) astereognosia (object identified by touch) these are usually stable and unrelated to medication

53
Q

metabolic disturbances schizophrenia

A

schizophrenia is associated with diabetes, hyperlipidemia, and hypertension. antipsychotic meds cause metabolic issues like weight gain and dm. often usually are sedentary and smokers. schizophrenia is associated w insulin resistance.

54
Q

diagnosis of schizophrenia

A

need delusions, hallucinations, disorganized speech, and negative s/s with social/occupational dysfunction for 6 months

55
Q

rule out schizoaffective disorder if

A

no major depressive, manic, or mixed episodes have occurred with the active phase symptoms. or if there has been it has been brief relative to the duration of the active periods. the disturbance is not due to a substance or medical condition (if it were related to a substance/med it would be schizoaffective)

56
Q

schizophrenia and smoking

A

over 70 percent of those w schizophrenia smoke. death from lung cancer twice as likely. less likely to get smoking cessation education. may use nicotine to reduce s/s of schizophrenia

57
Q

obesity and schizophrenia

A

42% are obese. d/t inactivity, diets, antipsychotic meds increasing obesity, specifically Zyprexa. Risperdal and Seroquel are atypical antipsychotics w/ similar metabolic side effects

58
Q

dm and schizophrenia

A

2-3x more likely to develop as antipsychotics and weight gain lead to metabolic syndrome due to a link of excess body fat

59
Q

cvd and schizophrenia

A

rate of cvd doubles with schizophrenia due to smoking, obesity, inactivity, hyperlipidemia. some antipsychotics adversely affect lipid profiles

60
Q

schizophrenia med adverse effects

A

hyperprolactinemia, qt prolongation, myocarditis

61
Q

hyperprolactinemia

A

side effect of all atypical antipsychotics, as well as risperdal and amisulpride. this is a suppression of dopamine indirectly increases pituitary prolactin production and may present with menstual irregularity, amenorrhea, or galactorrhea in women and gyneocomastia in men. may promote growth of breast and prostate tumors

62
Q

myocarditis w/ clozapine

A

unexplained fatigue, dyspnea, tachypnea, fever, chest pain, s/s CHF and ST abnormalities and t wave inversions. if suspected, EKG WBC and troponin levels. if found, stop clozapine and urgent refer to cardiac

63
Q

nicotine with antipsychotics

A

interferes with the metabolism of the antipsychotics need to monitor effect of these meds more closely if smoking

64
Q

weight monitoring on antipsych

A

waist circumference and BMI measured frequently in first 3-6 months of starting treatment. if increased, provide counseling on diet and exercise

65
Q

bipolar

A

distruption of mood, energy, sleep, cognition and behavior. need pharmacotherapy to minimize risk of suicide. characterized by episodes of mania, hypomania, and major depression.

66
Q

presentation of bipolar

A

mania, hypomania, major depression, some may remit and become euthymic, others transition immediately from depression to mania. mood onset is usually depression. labile mood may come before depression w anxiety, irritability, aggressive

67
Q

Mania

A

abnormally elevated irritable and labile mood. unusually good, euphoric mood with disinhibition, disregard to social boundaries, relentless pursuit of stimulation and social activities. Increased energy and goal directed activity. decreased need to sleep. manic speech w flight of ideas. difficult to interrupt. dramatic gestures. hospitalization to prevent harm

68
Q

hypomania

A

changes in mood, behavior, sleep, cognition similar to mania but less severe. self esteem inflated but not delusionaly grandiose. can have flight of ideas but thought form is more organized. can lead to productivity.

69
Q

major depression

A

dysphoria, slowing in pace, speech is slow and soft, interest is minimal, appetite diminished, can be agitated

70
Q

mixed features

A

bipolar w symptoms of the opposite polarity has manic and hypomania - also has at least 3 of the following: depressed mood, diminished interest, psychomotor retardation, low energy and excessive guilt

71
Q

medical psych hx

A

screen all pts who present w depression for past manic or hypomanic episodes. use mood disorder questionnaire to screen for mania.

72
Q

common conditions for manic symptoms

A

head injuries, MS, CNS tumors, HIV, syphillus

73
Q

substances that can induce a manic episode

A

stimulants, corticosteroids, sympathomimetics, decongestants, caffeine and antidepressants

74
Q

substances that can lead to depressed mood

A

cns depressant, alcohol, benzos

75
Q

high genetic component to family hx in this psych disorder

A

bipolar disorder, onset is usually late in adolescence or young adulthood with a distinct change in behavior

76
Q

suicide question to ask

A

do you feel like killing yourself? … hurting yourself is self harm not suicide. if admit to thoughts need to assess for active plan, substance use, access to lethal means, determine the patients contract for safety possibly send to er

77
Q

refer to psych

A

strong indication for bipolar to improve pharm therapy and decrease risks

78
Q

treatment and medication for BPD

A

maintenance medication to prevent manic and hypomanic symptoms, reduce depression symptoms. address all metabolic syndrome side effects from meds. three classes: mood stabilizers, second generation antipsychotics and antidepressants

79
Q

mood stabilizers

A

mainstay for BPD decrease liklihood of manic and hypomanic symptoms. need contraception due to congenital abnormalities. lithium and valproate cause weight gain.

80
Q

s/s lithium toxicity

A

delirium, mental status changes, tremor, ataxia, diarrhea, vomiting, highly sedated

81
Q

meds that increase lithium plasma level

A

NSAIDs, ace, thiazide diuretics. caffeine, high dietary sodium. need to avoid heavy exercise, or low sodium

82
Q

valproic acid

A

indicated for acute mania and mania prevention. boxed warning for hepatic failure within first 6 months. can cause life threatening pancreatitis so look for s/s

83
Q

lamotrigine (lamictal)

A

maintenance treatment. can lead to severe skin rashes leading to hospitalization. may need higher dose of med if on oral contraceptive

84
Q

second gen antipsychotics

A

also known as atypical antipsychotics for acute mania or maintenance. assoc w hyperglycemia or DKA. risk for weight gain, DM and metabolic syndrome. order w caution in diabetics. need baseline FBG. assess BMI, waist circum, BP, lipids

85
Q

Abilify

A

for acute mania or maintenance. good for DM, CAD for low weight gain. increased risk for suicide in young adults

86
Q

Latuda

A

contraindicated in those w liver disease, heart disease, hyperlipidemia, MI. risk for suicide.

87
Q

Zyprexa

A

monotherapy for mania, mixed and maintenace. Alcohol increasing absorption and makes more sedated. More weight gain than SGA peaking at 9 months

88
Q

Seroquel

A

first line for BPD and maintenance. moderate risk for weight gain and suicide.

89
Q

Geodon

A

adjunct to lithium and valproic acid for maintenance. can lead to QT interval elongation. not for any pt with cardiac dysrhytmias

90
Q

Antidepressants

A

not good for bipolar. may be ok with depressive episodes with a mood stabilizer. tricyclics and SNRIs only after SSRI or Wellbutrin tried and failed d/t high risk to cause mania. Only zyprexa-prozac is supported for bipolar 1

91
Q

The prevalence of GAD in the pediatric population is approximately

A

15%

92
Q

manifestations of postpartum depression

A

Thoughts of harming themselves or fear of harming their babies, Changes in appetite or weight. (DOES NOT effect decisions about breast feeding vs.bottle feeding)

93
Q

these symptoms would most directly guide the NP to a diagnosis of GAD

A

excessive, age-inappropriate uncontrollable worrying

94
Q

Postpartum depression is largely undetected and untreated and routine screening is not standard (t or f)

A

true

95
Q

when assessing adolescent GAD, this category of peer influence is the most important

A

evidence of bullying

96
Q

Older adults are less likely than younger individuals to seek help for mental health issues. (t or f)

A

true

97
Q

Older adults are reported to more frequently seek outpatient help and to less frequently be hospitalized for mental illness (t or f)

A

true

98
Q

Older adults with mood or affective disorders are at less risk for suicide than younger individuals. (t or f)

A

false

99
Q

Symptoms of bipolar disorder in older adults are often milder than those in younger individuals. (t or f)

A

true

100
Q

usefulness of GGT in screening for alcohol abuse

A

GGT is a biomarker that is altered in the presence of alcohol consumption, GGT is a more sensitive indicator of alcohol abuse than AST or ALT, GGT may help provide a differential diagnosis between alcohol misuse and non-alcohol-related liver disease

101
Q

club drugs

A

used to increase extraversion and heighten mood

102
Q

What is one factor likely to enhance success of a nurse-led initiative to improve postpartum depression screening by obstetric providers?

A

Establishing face-to-face contact with physicians
and identifying a physician champion in an obstetric
practice.

103
Q

MDMA

A

acts as a stimulant and a psychedelic

104
Q

Risk factors for postpartum depression

A

difficulty with conceiving, multiparity, low income, previous history of depression

105
Q

Withdrawal symptoms from MDMA

A

depression, fatigue, difficulty concentrating.

106
Q

Combining GHB with alcohol can result in

A

respiratory arrest.

107
Q

One characteristic of flunitrazepam is that it

A

peaks at 2 hours.

108
Q

Ketamine is a controlled substance on Schedule____

A

III

109
Q

Manic episodes are diagnosed with the significant presence of at least three of these groups of symptoms.

A

Grandiosity, increased self-esteem, pressured speech, psychomotor agitation, racing thoughts

110
Q

Ketamine overdose is usually treated with what?

A

mechanical ventilation and cardiovascular support.

111
Q

methamphetamine causes?

A

activation of the sympathetic nervous system

112
Q

common parenting styles associated with GAD in adolescents?

A

over controlling, highly critical

113
Q

Methamphetamine is associated with ?

A

psychotic-like effects that can continue long after discontinuation

Primary Care 1 (6 decks)

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