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NURS 487 > mental health > Flashcards

mental health Flashcards

1
Q

what permits release of neurotransmitters

A

Conduction in a presynaptic cell permits the release of neurotransmitters

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2
Q

production and release of neurotransmitters can be altered by…

A

The production and release of neurotransmitters can be altered by other chemicals, cell damage, how the neurotransmitters are taken back up by the pre-synaptic cell, etc.

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3
Q

there is competition for different neurotransmitters at…

A

There is competition for different neurotransmitters at the receptor cite

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4
Q

receptor cites are also modified by…

A

Receptor cites are also modified by other chemicals, which can change their ability to receive different neurotransmitters

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5
Q

dopamine

A

Involved in fine muscle movement, integration of thoughts and emotions (pleasure and energy), decision making (motivation)

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6
Q

where is dopamine produced

A

Produced in the Substantia nigra

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7
Q

dopamine has an inverse relationship with…

A

Dopamine has an inverse relationship with gamma-amino butyric (GABA)
Dopamine is excitatory and GABA is calming. Therefore an increase in dopamine means a decrease in GABA

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8
Q

dopamine strives to have a 50/50 balance with…

A

Dopamine strives to have a 50:50 balance with acetylcholine

When this balance is disrupted movement disorders can occur

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9
Q

excess and insufficient dopamine

A

Excess= Mania (symptoms include psychosis, hallucinations, aggression and anxiety)

Insufficiency= Depression and Parkinson’s Disease

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10
Q

norepinephrine

A

Converted from Dopamine

When there is excess dopamine there will be excess norepinephrine

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11
Q

norepinephrine causes changes in…

A

Causes changes in
Mood
Attention
Arousal/energy (stimulates sympathetic nervous system for the fight or flight stress response)

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12
Q

excess and insufficient norepinephrine

A

Excess= mania, anxiety

Insufficiency= depression, anhedonia

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13
Q

serotonin involved in…

A 
Involved in 
Sleep regulation
Hunger
Mood
Pain perception
Aggression
Sexual behavior
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14
Q

excess and insufficient serotonin

A

Excess= anxiety

Insufficiency= Depression

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15
Q

bipolar type 1

A

one or more manic or mixed episodes, usually accompanied by major depressive episodes

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16
Q

bipolar type 2

A

one or more major depressive episodes, usually accompanied by at least one hypomanic episode

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17
Q

bipolar type cyclothymic (rapid cycling)

A

At least two years of numerous periods of hypomanic symptoms that do not meet the criteria for a manic episode and numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode.

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18
Q

bipolar type 1 prevalence

A

Median age of onset is 18 years of age
More common in men
More likely to include legal problems and acts of violence
Most often begins with a depressive episode

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19
Q

bipolar type 2 prevalence

A 
Median age of onset is 18 years of age
Most common form of bipolar disorder
More common in women
More likely to include substance abuse, 
Commonly misdiagnosed as major depressive disorder or personality disorder
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20
Q

bipolar type cyclothymic prevalence

A

Median age of onset is early adulthood

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21
Q

comorbidities for bipolar (mental health diagnoses)

A

Panic attacks, alcohol abuse, social phobia, seasonal affective disorder

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22
Q

comorbidities for bipolar (physical health concerns)

A

Chronic fatigue syndrome, asthma, migraine, chemical sensitivity, hypertension, bronchitis, gastric ulcers

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23
Q

presence of comorbidities in bipolar increases the…

A

Complexity of the treatment
Ability of the patient, and possibly his or her supports to work
Patient’s dependence on others
Patient’s general health care needs

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24
Q

etiology of bipolar: biological factors: genetic

A

Strong Heritability
Increases by 5-10% if a relative has bipolar disorder

Polygenic disease
It has been suggested that there are multiple genes that contribute to the expression of bipolar

Irregularities on chromosomes 13 and 15
Some evidence to suggest that these chromosomes contribute to alterations in thought process

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25
Q

etiology of bipolar: biological factors: neurobiological

A

The proportions of neurotransmitters (Norepinephrine, dopamine, and serotonin are disrupted
The sensitivity of the neurotransmitter receptors are changed
The function of neurotransmitters is linked to hormones
Pre-frontal cortex (impaired executive and cognitive functioning)
Limbic regions of the brain are most severely affected

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26
Q

etiology of bipolar: biological factors: neuroendocrine

A

Hypothalamic-pituitary-thyroid-adrenal (HPTA) axis

Hypothyroidism is known to be associated with depressed mood

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27
Q

etiology of bipolar: biological factors: gender

A

Although there are differences in the prevalence of gender between the types of bipolar, overall the rate of bipolar disorder is relatively equal between men and women
However, women are more likely to be hospitalized
Hospitalization most often occurs between the ages of 40-44

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28
Q

etiology of bipolar: psychological factors: environmental

A

Increased stress
Can be either a significant event or prolonged exposure of less intensity
Once the presentation of bipolar is trigger by a stressful event, the environmental stress is no longer needed to perpetuate the disorder

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29
Q

etiology of bipolar: psychological factors: socioeconomic determinants of health

A

More prevalent in higher socioeconomic classes
Individuals with bipolar achieve higher education as well as higher occupational status than those with unipolar depression
The proportion of individuals with bipolar disorder among creative writers, actors etc is higher than the general public

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30
Q

schizophrenia and other psychotic disorders: DSM V classification identifies this group of disorders as…

A

devastating brain disorders that impact:

Cognition
Language
Emotions
Social behavior
Movement
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31
Q

positive symptoms of psychosis

A

Presence of delusions, hallucinations, overtly disorganized thinking and behaviors
Contribute to poor social functioning
May have sudden onset and improve with antipsychotic medication

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32
Q

negative symptoms of psychosis

A

Absence of thought and behavior patterns that contribute to inappropriate social functioning and poor social functioning
Usually slow onset and worsen over the course of the illness
Examples: withdrawn, alienating/isolating, does not attend to hygiene and other ADLs, unable to make decisions or to follow through on a plan

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33
Q

psychotic disorder prevalence: brief psychotic disorder

A

Occurs in adolescence and across the lifespan
Average onset is in the mid 30s
Twice as common in females
Occurs more frequently in developing countries

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34
Q

psychotic disorder etiology

A

The etiology for brief psychotic disorders may vary depending on the circumstances.
As a result, it is important to complete a thorough assessment of the individuals signs and symptoms, and the context.
Psychosis is evident in changes in mental status and behavior, and can occur as a result of changes in an individuals physical status, major life events, recreational drug use, and environmental changes.

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35
Q

schizophrenia subtypes

A

paranoid, schizoaffective

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36
Q

schizophrenia prevalence

A

Onset is usually late teens and early adolescents
Becomes chronic or recurrent in 80% of individuals who are diagnosed
More common in males (almost 1 ½ x)
Associated with poor functioning before the onset of the disease

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37
Q

schizophrenia etiology: biological factors: genetics

A

Heredity
Polygenic disease
Irregularities on chromosomes 13 and 15

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38
Q

schizophrenia etiology: biological factors: neurobiological

A

Neurotransmitters

dopamine, and serotonin, glutamate

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39
Q

schizophrenia etiology: biological factors: brain structure abnormalities

A

Differences in the size, shape and symmetry of the ventricles
Lower brain volume
Increased cerebrospinal fluid
Slower blood flow to the frontal lobe

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40
Q

schizophrenia etiology: psychological and environmental factors: prenatal stressors

A

Prenatal risk factors include viral infections, poor nutrition, hypoxia, exposure to toxins
Birth complications
Age of parents at conception

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41
Q

schizophrenia etiology: psychological and environmental factors: psychological stressors

A

Prolonged increased stress
Exposure to recreational drugs
Psychological trauma

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42
Q

schizophrenia etiology: psychological and environmental factors: socioeconomic determinants of health

A

Adverse living conditions

Migration

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43
Q

delusional disorder subtypes

A

erotomania
grandiose
jealous
somatic

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44
Q

delusional disorder prevalence

A

Rare to exist on its own
Co-morbidities include: mood disorders, OCD, personality disorders Many individuals can live undiagnosed because their behavior is not noticeably abnormal
Can begin in adolescence
Affects men and women equally

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45
Q

comorbidities of delusional disorder

A

mood disorders, OCD, personality disorders (specifically paranoid, schizoid, avoidant

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46
Q

delusional disorder etiology: neurobiological

A

Asymmetrical temporal lobes
Possible neuro-degenerative component
Sensory alterations in the nervous system associated with cortical changes
Perceptions become linked with an interpretation that has deep emotional significance but no verifiable basis

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47
Q

delusional disorder etiology: socioeconomic determinants of health

A

Influence of early life experiences

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48
Q

what does a good assessment allow a nurse to do?

A

Respect the patient’s experience.
The details help us accurately understand the context and relevance of the patient’s problem.
Makes it easier to identify connections between various assessments
Help the patient see their problem differently and identify their own solutions to resolve the problem.
Increase the patient’s and families buy-in for the treatment plan.

Enables nurses to check their own biases.
Enables nurses to synthesize the assessment data with other nursing knowledge to provide holistic, safe care
Makes it sustainable
Reduce stigma

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49
Q

bipolar areas for assessment

A

MSE

Risk Assessment

Physical Assessment

Family
Evaluation of the quality of the patient’s supports
Increased divorce rates
Increased frequency of hospital admissions

SEDoHs
An inquiry about the patient’s internal and external resources

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50
Q

bipolar assessment: MSE general appearance (depression)

A

grooming = range from disheveled to adequate care of self
dress = may wear same clothing for several days, stay in pajamas, or may get dressed
make up = not wear any
movement: slowed
engagement = difficult to engage and distracted, guarded

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51
Q

bipolar assessment: MSE general appearance (mania)

A

grooming = well groomed
dress = may be well dressed, wear limited clothing, or bright colours
make up = may be grossly overdone
movement = purposeful
engagement = easily engaged and distracted, uninhibited

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52
Q

bipolar assessment: MSE affect and mood (depression)

A 
affect = flat, withdrawn, blunted, teary
mood = low 
congruence = affect and mood will be congruent
appropriateness = affect is usually appropriate to the context
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53
Q

bipolar assessment: MSE affect and mood (mania)

A 
affect = unstable range of emotions (euphoric to angry), labile 
mood = 10/10 
congruence = affect and mood may be congruent
appropriateness = affect is usually not appropriate to the context
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54
Q

bipolar assessment: MSE speech and language (depression)

A 
rate = slow
volume = quiet 
rhythm = may be hesitant, uneven 
vocabulary = may be simple and limited
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55
Q

bipolar assessment: MSE speech and language (mania)

A 
rate = speeded
volume = loud 
rhythm = pressured 
vocabulary = may be expansive and flamboyant
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56
Q

bipolar assessment: MSE thought process (depression)

A

linear = depends on the severity of the depression
goal directed = may have difficulty either finding the words to articulate his/her thoughts or might not be able to concentrate to follow the discussion
may observe = poverty of speech, perseveration

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57
Q

bipolar assessment: MSE thought process (mania)

A

linear = no, the patient will cover multiple topics in a very short time span, and usually dos not complete one topic before moving on to the next
goal directed = may have difficulty either finding the words to articulate his/her thoughts or might not be able to concentrate to follow the discussion
may observe = circumstantiality, tangentiality, loose association, flight of ideas, and perseveration

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58
Q

circumstantiality

A

over-inclusive, indirect, eventually reaches the goal but is delayed

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59
Q

loose association

A

when the patient’s communication is grossly incoherent

60
Q

tangentiality

A

responses from the patient are irrelevant, does not reach the goal of the conversation or topic

61
Q

flight of ideas

A

rapid movement from one idea to another

62
Q

perseveration

A

inability to interrupt a phrase/task/behavior resulting in pathological repetition

63
Q

clang associations

A

stringing together of words that rhyme

64
Q

neologism

A

making up words that do not exist

65
Q

bipolar assessment: MSE thought content (depression)

A

delusions = not usually
risk of harm = presence of suicidal/homicidal ideation and thoughts of self-harm (may include a plan, means and intent)
depressive cognitions = hopeless, helpless, worthless, guilty, and self-deprecatory
anxious cognitions = worried about the future, what others think, that he/she is a burden. in severe depression, the patient may not have anxious cognitions

66
Q

bipolar assessment: MSE thought content (mania)

A

delusions = prevalent
risk of harm = high risk, physical injuries are usually accidental however must also assess for harm that related to impaired insight and judgment that results (poor decision making)
depressive cognitions = no
anxious cognitions = may be preoccupied with tasks, and stressors may include frustration with feeling misunderstood and not being able to acquire the resources needed to accomplish his/her task

67
Q

bipolar assessment: MSE perceptual functioning (depression)

A 
hallucinations = not usually 
illusions = no 
depersonalizations = may occur 
derealization = may occur
68
Q

bipolar assessment: MSE perceptual functioning (mania)

A 
hallucinations = sensory perception may be altered 
illusions = not usually 
depersonalization = not usually 
derealization = not usually
69
Q

bipolar assessment: MSE cognitive functioning (depression)

A

orientation and memory = the degree of impairment increases the more severe the episode
concentration = may decrease as energy decreases
executive functioning = as depression increases thinking becomes more concrete and patients are unable to initiate planning and sometimes even identifying tasks to be completed

70
Q

bipolar assessment: MSE cognitive functioning (mania)

A

orientation and memory = the degree of impairment increases the more severe the episode
concentration = decreases as energy increases
executive functioning = as mania increases thinking becomes more abstract and disorganized, and patients are unable to follow through with planning and implementing tasks

71
Q

bipolar assessment: MSE insight and judgement (mania)

A

Insight (Mania)

Often deny that he/she is experiencing a mental illness
Minimizes impact of his/her behaviors and the consequences

Judgment (Mania)

Resists being controlled

72
Q

bipolar risk assessment: types of risk

A

Suicide
Assess for ideation, plan, intent, means

Homicide
Inquiry about resentment, anger and disappointment

Self harm
Consider the purpose and consequences of the behavior

Harm to others
Direct or indirect

73
Q

bipolar physical assessment: cardiac

A

Changes in electrolyte function related to nutritional intake and stress response

74
Q

bipolar physical assessment: renal

A

Increased risk for toxicity
The patient may still be taking medication but could be dehydrated
Dose of medication is increased
New medications are added

75
Q

bipolar physical assessment: stress response

A

increases in blood pressure, glucose production and ADH further stress the kidneys

76
Q

bipolar physical assessment: reproductive health

A

increased risk of sexually transmitted infections

77
Q

bipolar physical assessment: neurological

A

changes in the balance of serotonin (impacts circadian rhythm), norepinephrine (impacts mood, attention, and stimulates the SNS to engage the flight or fight), dopamine (impactions movement, motivation, and thought process)

78
Q

bipolar family assessment (considerations for the nurses assessment of the patient’s support system)

A

Who is the patient’s family?
Spouse/partner
Dependents

Who assumes the burden of care?
Is it negotiated or assigned
Is it shared

What are the communication patterns?
Passive
Aggressive
Passive-aggressive

79
Q

SEDoHs

A 
Income & social status
Social Support Networks
Education
Employment/working
  conditions
Social Environments
Physical Environments
Health Services
Personal Health Practices/Coping Skills
Healthy Child Development
Biology and Genetic Endowment
Gender
Culture
80
Q

questions to consider with SEDoHs

A

How has the illness contributed to changes within each category?
How may the trajectory of the illness be impacted by current changes in the patient’s SEDoHs?

81
Q

bipolar consequences for patient

A

The patient and support system may have already experienced various consequences of living with bipolar disorder. As part of the nurse’s assessment, these areas should be explored, as they will impact the success of a particular intervention. Examples of common consequences the patient may experience are:

Alienation
Disrupted relationships
Additional health problems
STI
Pregnancy
Addictions
Legal
Impending charges
Financial
Spent all of his/her money
82
Q

bipolar disorder nursing diagnoses

A

risk for injury = excessive energy, poor judgment
ineffective coping = inability to control behaviour, manipulative
risk of violence = loud, hostile, aggressive, demanding behvaiours
interrupted family processes = impulsive behaviour leading to major life changes
impaired social interaction = constantly going from one event/person to another, taunting or provocative behaviours
imbalance nutrition/fluids = failure to eat/drink (too busy)
disturbed sleep pattern = decreased need to sleep/rest

83
Q

schizophrenia assessment

A

MSE

Risk Assessment

Physical Assessment

Family

SEDoHs

*The integration of the assessment for psychotic disorders and schizophrenia focuses largely on understanding the relationship between symptoms, coping, functioning and safety.

84
Q

schizophrenia MSE assessment: general appearance (positive symptoms)

A 
engagement = willing to engage in conversation but may be unmotivated to make changes 
movement = psychomotor agitation, repeated motor behaviors, waxy flexibility, echopraxia
grooming = unable to maintain hygiene and ADLs
dress = eccentric dress
85
Q

schizophrenia MSE assessment: general appearance (negative symptoms)

A 
engagement = apathetic, withdrawn, anergia, anhedonia, avolition 
movement = suporous, psychomotor retardation, comatose
grooming = unable to maintain hygiene and ADLs 
dress = eccentric dress
86
Q

delusional disorder MSE assessment: general appearance

A 
engagement = generally no functionally impairment, as severity of illness progresses, the individual may become more distracted 
movement = no noticeable change 
grooming/dress = self care patterns may be disrupted
87
Q

schizophrenia MSE assessment: affect and mood (positive symptoms)

A 
affect = blunted, anxious, fearful, irritable
mood = may be low due to paranoia
88
Q

schizophrenia MSE assessment: affect and mood (negative symptoms)

A 
affect = blunted, flat 
mood = may be low due to lack of motivation
89
Q

delusional disorder MSE assessment: affect and mood

A 
affect = as the severity of the illness increases the individual may appear anxious 
mood = ------
90
Q

schizophrenia MSE assessment: speech and language

A

for both positive and negative symptoms
speech = alogia (poverty of speech), slow, hesitant, may be quiet
language = poverty of content, vocabulary may vary, will probably not be very fluent, difficulties with comprehension

91
Q

delusional disorder MSE assessment: speech and language

A

generally unaffected

92
Q

schizophrenia MSE assessment: thought process

A

for both positive and negative symptoms

observations = disorganized, range from less goal directed to lack of connection between ideas

93
Q

delusional disorder MSE assessment: thought process

A

generally unaffected

94
Q

schizophrenia MSE assessment: thought content

A

delusions = convinced that what they believe is real, more common with positive symptoms, most common delusions are grandiose and persecutory, concrete thinking
suicide, homicide, self-harm = typically in response to hallucinations, delusions, paranoia, impaired judgement (lack of impulse control), or self-referentiality, assess for concurrent alcohol or substance use
depressive cognitions = loss of close friendships and intimate relationships, increased dependency, slow response to treatment and stigma can increase the individuals sense of hopelessness, helplessness, and shame
anxious cognition = increased anxiety that can result in delusions or be the outcome of a delusion

95
Q

delusional disorder MSE assessment: thought content

A

delusions = convinced that what they believe is real
suicide, homicide, self-harm, depressive cognitions, anxious cognitions = need to assess the individuals impulsivity capacity to act in relationship to the delusion

96
Q

schizophrenia MSE assessment: perceptual functioning

A

hallucinations = most common perceptual disturbance can involve any of the 5 senses, careful assessment is required to distinguish the cause of the hallucination ( psychiatric disorder, drug use, medications, organic causes)
auditory hallucinations typically come from outside the persons head, may be familiar or unfamiliar, supportive or frightening, outward observations may include turning or tilting head or moving lips silently, command hallucinations are voices that direct the individual to take action
other = boundary impairment, depersonalization, derealization, illusions

97
Q

delusional disorder MSE assessment: perceptual functioning

A

hallucinations not present

98
Q

terms to know for delusions

A 
grandiose
Nihilistic 
Persecutory 
Somatic 
Erotomania
Jealousy
99
Q

terms to know for thought process

A 
Loose association
Circumstantially
neologism
Tangential
Word salad
Perseveration
Echolalia
100
Q

terms to know for perceptual functioning

A

Thought insertion
Thought withdrawal
Thought broadcasting
Ideas of reference

101
Q

terms to know for motor behaviour

A 
Rigid 
need to determine if this a result of the illness or side effect of medication
Agitation 
Hypervigilance
Aggression 
Mutism 
Catatonic excitement
a hyperactivity characterized by purposeless activities and abnormal movements such as grimacing and posturing
Waxy flexibility 
Echopraxia
102
Q

family assessment schizophrenia

A

Who are the patient’s supports?
Spouse/partner/close friends
Dependents
Social supports

Who assumes the burden of care?
What is the impact on the support systems?

Is there an acceptance of the diagnosis?
What are the implications ?

103
Q

family assessment delusional disorder

A

interpersonal relationships

104
Q

physical assessment schizophrenia

A 
Endocrine system
Lipid panel
Blood sugar and hormones
Cardiac
Increased BP and pulse
Renal
BUN, GFR, creatinine, urine for protein
Polyuria
Neurological
Movement disorders
105
Q

physical assessment delusional disorder

A

Somatic symptoms
Need to be thoroughly to rule out actual conditions

Medication
Thorough history to assess for adherence and effectiveness related to somatic concerns

Lab and diagnostic tests
Related to somatic concerns

106
Q

SEDoHs schizophrenia

A 
Employment
Income
Housing
Nutrition
Social supports & networks
Personal health practices & coping strategies
Need for health care services
Access to health care services
107
Q

SEDoHs delusional disorder

A

Health Services
Need for health services due to multiple somatic concerns
Social environments
Legal concerns related to acting on delusions
Social Support Networks

108
Q

patient consequences schizophrenia

A 
Alienation from family, friends, and health care providers
Additional health problems
Concurrent disorders
Financial
Inability to maintain employment
Poor physical health
Comorbid diagnoses
109
Q

patient consequences delusional disorder

A 
Difficulties in interpersonal relationships
Additional health problems
Somatic concerns
Legal
Impending charges
110
Q

nursing diagnosis schizophrenia and delusional disorder

A

Nonadherence

Compromised family coping

Delusions

111
Q

signs and symptoms schizophrenia and delusional disorder

A

Stops taking medication

Family is overwhelmed and confused

Disturbed thought process

112
Q

nursing diagnosis schizophrenia

A 
diagnosis = Disturbed sensory perception
Social isolation
Negative self-perception
Lack of motivation
signs and symptoms = Auditory Hallucinations
Command
Uncommunicative
Feels guilty, rejected, lonely, bad or no good
Unable to initiate tasks
113
Q

importance of self reflection

A 
Self awareness
Transference
Counter-transference
Biases
Stigma

Mindfulness
Who you bring to the patient-nurse relationship

114
Q

a personality disorder is…

A

an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture

is pervasive and inflexible

has an onset in adolescence or early adulthood

when maladaptive coping strategies are stable over time

leads to distress or impairment.

115
Q

personality disorders DSM V criteria

A

a pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity, beginning by early adulthood and present in a variety of context, as indicated by five or more of the following:
frantic efforts to avoid real or imagined abandonment
a pattern of unstable and intense interpersonal relationships, altering between extremes of idealization and devaluation
markedly and persistently unstable self-image or sense of self
impulsivity in at least two areas that are potentially self damaging
recurrent suicidal behavior gestures, or threats, or self-mutilating behavior
affect instability due to a marked reactivity of mood lasting a few hours and only rarely more than a few days
chronic feelings of emptiness
inappropriate, intense anger or difficulty controlling anger
transient, stress-related paranoid ideation or severe dissociative symptoms

116
Q

personality disorders cluster a

A

Eccentric behaviors, perceptual distortions, unusual levels of suspiciousness, magical thinking, cognitive impairment
Includes: paranoid, schizoid, and schizotypal personality disorders

117
Q

personality disorders cluster b

A

Respond with dramatic, emotional, or erratic behavior
Difficulties with impulse control, emotional processing and regulation, and interpersonal skills
Includes: antisocial, borderline, histrionic and narcissistic personality disorders

118
Q

personality disorders cluster c

A

Anxious and fearful behaviors, social shyness, rigidity, hypersensitivity, relational dependency
Includes: avoidant, dependent , and obsessive –compulsive personality disorders

119
Q

personality disorders prevalence

A

More frequently seen individuals receiving extensive medical and psychiatric services

Borderline, avoidant, and obsessive-compulsive personality disorders are most common
Borderline personality disorder is most common in women

Affects about 10% of the total population

120
Q

risk factors for personality disorders

A

Childhood neglect and trauma
High corticotrophin-releasing hormone in response to early life stress and emotional reactivity decreases the individual’s overall stress tolerance level.

121
Q

co-morbidities for personality disorders

A

Periods of crisis and illness
Strain already maladaptive coping strategies
Mental health
Mood, anxiety, disordered eating, substance abuse
Other
Homeless, incarcerated

122
Q

personality disorders etiology

A

The etiology of personality disorders in a complex biological and psychosocial phenomena that is influenced by multiple variables. These variables include genetic, neurobiological, neurochemical, and environmental factors.

123
Q

personality disorders etiology: biological factors: genetic

A

Not considered to be associated with particular personality traits
Specifically borderline personality disorder
Potentially hyper responsive amygdala and impairment in the pre-frontal lobe

124
Q

personality disorders etiology: biological factors: neurochemistry

A

neurotransmitters may regulate temperament

125
Q

personality disorders etiology: psychological factors

A

Children learn maladaptive responses
In response to crisis and trauma
As they have been role-modelled
Individuals have a learned way of relating. They continue to relate this way because if feels safe and familiar.

126
Q

personality disorders etiology: environmental factors

A

Family dynamics
Medical history
Supports
Education

127
Q

personality disorders MSE: general appearance

A

Cooperation

Is dependent on the level of trust with the nurse
May not get valid information
Emotionally labile

128
Q

personality disorders MSE: affect and mood

A

Labile
Can range from sweet and kind to irritable, angry, and hostile
Affect and mood may be congruent or incongruent
Affect is often exaggerated and inappropriate for the context

129
Q

personality disorders MSE: speech and language

A

Inflection is intense
Volume may be loud
Emotionally charged
language

130
Q

personality disorders MSE: thought process

A

Goal directed
Fixed on finding ways to get their needs met while staying emotionally safe
Repetitive themes
Negative self-image
A focus on how others have not met their needs

131
Q

personality disorders MSE: thought content

A

Distortions in self-image
An inability to simultaneously hold positive and negative ideas about themselves and others

Fear of separation, abandonment, and intense sensitivity to personal rejection

Disproportionate significance placed on his/her emotions
High risk of self-harm and suicide
Impulsive, often the result of intense emotions
The individual often regrets their actions which perpetuates the cycle of a distorted self-image
*Chronic suicidal ideation

Negative (ineffective over the long term) self-soothing habits
Cutting
Numbing (i.e. with substances)
Promiscuous sexual behavior

132
Q

personality disorders MSE: perceptual functioning

A

May have hallucinations as result of
Stress response
Concurrent diagnosis
Use of drugs

133
Q

personality disorders MSE: cognitive function

A

Difficulties with planning, implementation, and evaluation of their choices and behavior

134
Q

personality disorder MSE: insight

A

Impaired

The individual has difficulty acknowledging and taking personal ownership for their problems

135
Q

personality disorders MSE: judgement

A

Impaired

The individual has difficulty taking responsibility for solving their own problems

136
Q

personality disorders physical assessment: integument

A

There is a significant risk of self-harm, so a thorough skin assessment should be done.
The nurse would look for scars, signs & symptoms of infection, and depth of current cuts.
Accident death is common and occurs as a result of cutting too deep

137
Q

personality disorders family assessment: relationships: attachments

A

Who is in the patient inner circle? Who dies the patient experience the most conflict with? Why?
What activities are most enjoyable for the patient? What activities might the patient avoid? Why?

138
Q

personality disorders family assessment: relationships: boundaries

A

How are the patient’s boundaries rigid? For example, do they use the same coping strategies across diverse situations?
When are the patient’s boundaries flexible? For example, the patient’s boundaries may change if they have met someone for the first time and are trying to make a safe connection.

139
Q

personality disorders family assessment: relationships: support

A

Have the patient’s supports changed? This is common because their support people may be burned out due to the high level of dependency of the patient.

140
Q

personality disorders family assessment: relationships: abuse

A

This can be a recurring trigger and will negatively impact the health trajectory of the patient.

141
Q

personality disorders consequences

A 
Withdrawal
Social isolation
Frustration and anger
Impaired functioning
Increased risk of suicide and self harm
142
Q

personality disorders nursing diagnoses

A

Ineffective coping

Risk for harm

Impaired social interaction

Nonadherence

143
Q

personality disorders signs and symptoms

A

crisis

Withdrawal, depression, anxiety

Difficulties in relationships (seen as manipulative)

Unable to keep medical appointments, frequently arrive late

144
Q

Bipolar disorder and borderline personality disorder share some similar presentations

A

For example, patients with either diagnosis will display similar mood episodes, impaired functioning, high utilization of psychiatric services, high rates of substance use disorders, and increased suicidality.
These commonalities can make it difficult to determine an accurate diagnosis. Collecting detailed assessment data and a longitudinal perspective from the patient and others is critical to identifying the most appropriate diagnosis and treatment options.

145
Q

Based on research and best practice, there are different interventions for bipolar disorder and borderline personality disorder.

A

Bipolar disorder – Treatment is focused on pharmacotherapy first with possible adjunctive psychotherapy. This is because the problem is considered (through trial and error of medication use) to be neurochemical.
Personality disorder – Treatment if focused first psychotherapy. This is because the problem is considered to be in managing the impact of stress and trauma, and the resulting maladaptive coping mechanisms. Adjunctive medication may be used to manage signs of symptoms related to trauma (flashbacks, anxiety, depression, etc.) but are not used to change aspects of a personality or their coping strategies.

NURS 487 (8 decks)

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