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MENTAL HEALTH > Mental Health Exam 1 > Flashcards

Mental Health Exam 1 Flashcards

1
Q

What are possible causes of schizophrenia

A

Genetics
Biochemical
Viral
Environmental factors

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2
Q

What are the types of schizophrenia

A

Paranoid type- These ppl can b prone to violence, thinks someone is out to get them
FBI, POISONED
Disorganized type- seen in homeless, withdrawn from society, inappropriate social behaviors
Catatonic type- withdrawn ( mute, comatose, not eating, staring @ wall) excited ( constant movement, incoherent speech)
Undifferentiated- has schizophrenia but doesn’t fit into the above categories

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3
Q

What are the 5 types of hallucinations

A 
Auditory- hearing things no one else can
Visual- seeing things that aren't there
Tactile- feeling bugs are on them
Gustatory- taste 
Olfactory- smell
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4
Q

Echopraxia

A

Imitating movements of others

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5
Q

Echolalia

A

Repeating words spoke

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6
Q

What are positive symptoms of schizophrenia

A

Hallucinations/ delusions
Content of thought
Form of thought
Perception

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7
Q

What are the negative symptoms of schizophrenia

A 
Affect
Apathy
Anhedonia
Anergia
Decreased social interaction
Posturing
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8
Q

What are nursing diagnosis related to schizophrenia

A

Risk for violence; self directed or others directed
Disturbed thought process
Social isolation
Disturbed sensory perception

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9
Q

What are nursing interventions for the patient with schizophrenia

A

Avoid touching without warning especially when agitated
Do not reinforce hallucinations
Offer distraction

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10
Q

What are contraindications of typical antipsychotics

A

Parkinson’s disease, liver, renal or cardiac insufficiency

Uncontrolled seizure disorder

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11
Q

What does typical antipsychotics target

A

Positive symptoms

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12
Q

What is the prototype typical antipsychotic

A

Chlorpromazine ( Thorazine)

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13
Q

What are other typical antipsychotics

A

Haldol
Fluphenazine
Perphenazine

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14
Q

What is the prototype atypical antipsychotic

A

Risperidone ( risperdal)

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15
Q

What does atypical antipsychotics target

A

Positive and negative symptoms

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16
Q

What is the action of typicals

A

Blocks dopamine

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17
Q

What is the action of atypicals

A

Blocks serotonin and to some degree dopamine

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18
Q

What are contraindications of atypicals

A

Severely depressed people

Elderly ppl with dementia related psychosis

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19
Q

What are commonly used atypical antipsychotics

A 
Olanzapine ( Zyprexa)
Quetiapine ( seroquel)
Aripriprazole ( Abilify)
Ziprasidone ( Geodon)
Clozapine ( clozaril)
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20
Q

What is given to ppl who don’t adhere to treatment of schizophrenia

A

Long acting IM meds are the medical regime

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21
Q

What are potential side effects of all antipsychotics

A

EPS-
Pseudoparkinsonism- tremor, shuffling gait, drooling,rigidity ( because of lowered dopamine)
Akathisia- restlessness
Akinesia-muscle weakness
Dystopia- spasms & stiffness of neck, face, arms, or legs ( usually happens @ the start of antipsychotic tx.
Oculogyric crisis- rolling back of eyes

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22
Q

What are medications reverse EPS

A

Antichloinergics such as benztropine ( cogentin) and trihexphenidyl ( Artane)

Antihistamines such as diphenhydramine ( Benadryl)

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23
Q

Tardive dyskinesia is typically seen when

A

Seen after months to years of prolonged use of antipsychotic

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24
Q

What are clinical manifestations of Tardive dyskinesia

A

Bizarre facial and tongue movements
Stiff neck
Difficulty swallowing

IREVERSIBLE

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25
Q

What is NMS

A

NEUROLPETIC MALIGNANT SYNDROME
Rare but life threatening
Typically seen soon after initiation of antipsychotics

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26
Q

What are clinical manifestations of NMS

A 
Muscle rigidity
Very high fever 
Tachycardia
Tachypnea
BP instability,diaphoresis
Changes in LOC
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27
Q

WHAT is treatment for NMS

A

Immediately stop antipsychotics
Monitor VS
IV fluids
I&O

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28
Q

What is metabolic syndrome

A

It is seen with atypicals

It causes the pt to gain wt and as a result new onset diabetes occurs

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29
Q

What is a side effect assoc with antipsychotics

A

Anticholinergic effects such as dry mouth, constipation, photophobia, urinary retention.

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30
Q

What is a major side effect to watch out for with antipsychotics such as clozaril

A

Agranulocytosis
Before initiation, a baseline WBC count and absolute neutrophil count is drawn.
WBC must be at least 3500
WBC AND ABSOLUTE NEUTROPHIL ARE DRAWN WEEKLY FOR 1ST 6 MONTHS THEN WEEKLY AFTERWARDS.

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31
Q

What is the definition of bipolar

A

A mood disorder manifested by cycles of mania and depression

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32
Q

What is the prevalence of bipolar

A

It occurs equally between males and females
Avg onset is early 20’s
Genetic predisposition

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33
Q

If a person is dehydrated who also takes lithium, what will happen to there lithium levels

A

They will go up

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34
Q

If a person has excessive fluid in there body and also takes lithium, what will happen to there lithium levels

A

Lithium levels will go down

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35
Q

What is bipolar 1

A

Full blown manic episodes
Interferes with Q day functioning, can become severely depressed when they crash, often cycle between ups and downs
Can be seasonal
Should be in hospital

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36
Q

What is bipolar 2

A

Distinguished by bouts of MMD with hypo mania

doesn’t reach mania

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37
Q

What are nursing diagnosis for bipolar disorder

A
  1. Risk for injury
  2. Risk for violence; self directed or others directed
  3. Imbalanced nutrition; less than body requirements
  4. Disturbed thought process
  5. Insomnia
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38
Q

What are nursing interventions during the manic/ acute phase

A

Safety
Self care
Communication

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39
Q

For a person with bipolar, what type of foods should be offered

A

Finger foods because they can’t sit down long enuf to eat

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40
Q

What are medications for bipolar disorder

A

Lithium carbonate

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41
Q

What are contraindications of lithium carbonate

A

Cardiac or renal disease

Dehydration, sodium depletion

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42
Q

What are side effects of lithium carbonate

A

Margarine between therapeutic levels and toxic levels is very low

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43
Q

What is the therapeutic range of lithium

A

0.6-1.2

44
Q

When do levels of lithium become toxic

A

Above 1.5

45
Q

What are clinical manifestations of lithium toxicity from 1.5 - 2.0

A

Blurred vision, ataxia,tinnitus, fine hand tremors, persistent N/V
Severe diarrhea

46
Q

What are clinical manifestations of lithium toxicity with levels from 2.5-3.5

A

Excessive output of dilute urine, increasing tremors, mental confusion

47
Q

What are clinical manifestations of lithium toxicity above 3.5

A 
Decreased LOC
Anuria
MI
Seizures
Coma, death
48
Q

Is lithium toxicity lethal

A

Toxicity can be lethal

49
Q

What is patient education of lithium carbonate

A

Drink 2-3 L of water daily ( by not drinking enuf, they can raise lithium levels)
Maintain a sufficient level of Na, ( not more not less)
Avoid use of NSAIDs
Use diuretics cautiously ( because of loss of Na)

50
Q

What class of drugs is also used to treat bipolar disorder

A

Anticonvulsants

51
Q

Name a anticonvulsant drug

A

Valproic acid ( depakote)

52
Q

What are contraindications of valproic acid ( depakote)

A

Liver disease

Pregnancy

53
Q

What are side effects of valproic acid ( depakote)

A

GI upset,hepatotoxicity, prolonged bleeding time

54
Q

What is lab work that must be monitored while on valproic acid ( depakote)

A

LFTs ( AST,ALT)
Platelet count
Valproic acid serum levels

55
Q

What is valproic acid used to treat

A

Bipolar disorder

56
Q

What are treatment modalities of bipolar disorder

A

Individual therapy
Group therapy
Family therapy
ECT

57
Q

What is the definition of schizophrenia

A

Psychotic disorder that affects thinking, behavior, emotions,and the ability to perceive reality.

58
Q

What does serotonin regulate

A

Sleep cycle
Appetite
Mood regulation
Circadian rhythm

59
Q

What medications have a side effect of depression

A

Hormone replacement therapy
Antibiotics such as sulfa drugs, tetracycline
Steroids, prednisone

60
Q

What is SAD

A

Seasonal affective disorder
It occurs during winter months
Mood lightens in the spring ( some ppl may require light therapy to relieve the depression)

61
Q

What is MDD

A

Major depressive disorder
Characterized by depressed mood or loss of interest in usual activities
Symptoms last at least 2 weeks

62
Q

What is subjective data of a depressed person

A

Anergia, anhedonia, anxiety,fatigue
Somatic complaints, loss of appetite
Sleep disturbances
Negative thoughts

63
Q

What is objective assessment data of a depressed person

A

Affect, disheveled appearance
Slowed physical movements
Socially isolated,
Slowed thought process and speech patterns

64
Q

What are nursing diagnosis related to depression

A

Risk for suicide
Social isolation
Self care deficit
Imbalanced nutrition; less than body requirements

65
Q

What types of therapies are there for depressed patients

A

Cognitive behavior therapy; it helps the person realize and change negative thoughts
Group therapy, depression support groups
Individual therapy

66
Q

When should a person expect to experience relief of depression after taking depression meds

A

Relief is not immediate, may take 2-4 weeks to reach full therapeutic levels

67
Q

Do antidepressants carry a black box warning

A

YES

All antidepressants carry a FDA black box warning for increased risk of suicide in children and adolescents

68
Q

Do antidepressants increase risk of suicide

A

As antidepressants take effect the mood begins to lift, giving the patient more energy. Suicide risk increases as the level of depression decreases.

69
Q

What are meds for depression

A

TCAs
SSRIs
MAOIs
Atypical antidepressants

70
Q

What are TCAS

A

Tricyclic antidepressants

Blocks the reuptake of norepinephrine and serotonin in the synaptic space

71
Q

What were the first antidepressants used

A

TCAs

72
Q

What is the prototype TCAs

A

Amitriptyline ( Elavil)

73
Q

What are side effects of TCAs

A

Orthostatic hypotension
Anticholinergic effects
Sedation
Decreased seizure threshold

74
Q

What is pt education regarding TCAs such as Amitriptyline

A

Educate to take at bedtime

Use cautiously in someone with seizure disorder

75
Q

What are SSRIs

A

Blocks the reuptake of serotonin
MOST PRESCRIBED ANTIDEPRESSANT
Used to treat depression and anxiety

76
Q

What is the prototype SSRI

A

Fluoxetine ( Prozac)

77
Q

What are side effects of fluoxetine ( Prozac)

A

Sexual dysfunction
CNS stimulation
Changes in weight
Serotonin syndrome

78
Q

What is pt education regarding fluoxetine ( Prozac)

A

Can make a person feel more alert, take in am

May cause decreased libido

79
Q

What is serotonin syndrome

A

Can become life threatening
May begin 2-72 hours after initiation of tx
It is a side effect that can occur while taking meds concurrently that affect serotonin levels

80
Q

What meds affect serotonin levels

A 
Obviously SSRIs
Warfarin
Beta blockers
Theophylline
MAOIs
81
Q

What are symptoms of serotonin syndrome

A 
Mental confusion
Fever
Hallucinations 
Diaphoresis
Abdominal pain with diarrhea
82
Q

What are MAOIs

A

Blocks MAO in the brain thereby increasing norepinephrine, dopamine,and serotonin

83
Q

What is the prototype MAOI

A

Phenelzine ( Nardil)

84
Q

What are side effects of MAOIs

A

Serotonin syndrome

Hypertensive crisis

85
Q

What are foods to avoid while taking phenelzine

A

Foods that contain tyramine because tyramine is already found in MAOIs. If you eat foods that have tyramine, tyramine levels will rise leading to hypertensive crisis

86
Q

What are foods that contain tyramine

A

Aged cheese, figs, yogurt, raisens, pepperoni,

87
Q

What are atypical antidepressants

A

They are an alternative to SSRIs
They also help combat nicotine addiction
Blocks the reuptake of dopamine

88
Q

What is the prototype atypical antidepressant

A

Bupropion ( Wellbutrin)

89
Q

What are side effects of atypical antidepressants

A

Weight loss!
Seizures!
Anticholinergic effects!

90
Q

What is the definition of anxiety

A

Apprehension, uneasiness, or tension

91
Q

What are the different types of anxiety disorders

A 
Panic disorder
Phobias
Generalized anxiety disorder
OCD
Compulsions
92
Q

What is panic disorder

A

Characterized by recurrent panic attacks

93
Q

What symptoms may a person experience during a panic attack

A

Heart palpitations, sweating
Trembling, shaking, chest pain
GI distress, SOB,
Fear of loosing control, fear of dying

94
Q

What are phobias

A

A person fears a specific object or situation

95
Q

Give examples of phobias

A 
Social phobia ( also called social anxiety disorder)
Agoraphobia- fear of going outside

Multiple others such as fear of water, heights, marriage, animals etc…..

96
Q

What is generalized anxiety disorder

A

Persistent and excessive worry and anxiety

97
Q

What is OCD

A

Presence of obsessions, compulsions or both

98
Q

What are obsessions

A

Recurrent or persistent thoughts that are experienced as intrusive and stressful

99
Q

What are compulsions

A

Repetitive ritualistic behavior

100
Q

What is desensitization

A

Gradually introducing the person to the phobia

101
Q

What are meds for anxiety disorders

A

Benzodiazepines ( Lorazepam, Ativan )depresses CNS, works immediately
Atypical anxiolytics ( buspirone, buspar) better for long term control of anxiety relief
Antihistamines ( diphenhydramine) ( hydrozyzine, vistaril)
SSRIs

102
Q

What are contraindications of benzodiazepines such as lorazepam

A

Do not use with other CNS depressants
Pregnancy, glaucoma,
Elderly and those with a history of drug abuse

103
Q

What are nursing considerations of benzodiazepines such as lorazepam

A

It can cause physical and psychological dependence, drowsiness, confusion,orthostatic hypotension with dizziness
Blurred vision
Benzodiazepines are prescribed for PRN use

104
Q

What are contraindications of atypical anxiolytics such as buspirone ( buspar)

A

Breastfeeding

Concurrent use of MAOIs can cause hypertensive crisis

105
Q

What are side effects of atypical anxiolytics

A

Dizziness
Headache
Agitation

106
Q

When will therapuetic effects occur with atypical anxiolytics

A

It may take up to 2 weeks for anxiety symptoms to diminish

107
Q

What is Paxil

A

A SSRI

MENTAL HEALTH (17 decks)

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