Mental Health Exam 1 Flashcards
What are possible causes of schizophrenia
Genetics
Biochemical
Viral
Environmental factors
What are the types of schizophrenia
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Disorganized type- seen in homeless, withdrawn from society, inappropriate social behaviors
Catatonic type- withdrawn ( mute, comatose, not eating, staring @ wall) excited ( constant movement, incoherent speech)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
What are the 5 types of hallucinations
Auditory- hearing things no one else can Visual- seeing things that aren't there Tactile- feeling bugs are on them Gustatory- taste Olfactory- smell
Echopraxia
Imitating movements of others
Echolalia
Repeating words spoke
What are positive symptoms of schizophrenia
Hallucinations/ delusions
Content of thought
Form of thought
Perception
What are the negative symptoms of schizophrenia
Affect Apathy Anhedonia Anergia Decreased social interaction Posturing
What are nursing diagnosis related to schizophrenia
Risk for violence; self directed or others directed
Disturbed thought process
Social isolation
Disturbed sensory perception
What are nursing interventions for the patient with schizophrenia
Avoid touching without warning especially when agitated
Do not reinforce hallucinations
Offer distraction
What are contraindications of typical antipsychotics
Parkinson’s disease, liver, renal or cardiac insufficiency
Uncontrolled seizure disorder
What does typical antipsychotics target
Positive symptoms
What is the prototype typical antipsychotic
Chlorpromazine ( Thorazine)
What are other typical antipsychotics
Haldol
Fluphenazine
Perphenazine
What is the prototype atypical antipsychotic
Risperidone ( risperdal)
What does atypical antipsychotics target
Positive and negative symptoms
What is the action of typicals
Blocks dopamine
What is the action of atypicals
Blocks serotonin and to some degree dopamine
What are contraindications of atypicals
Severely depressed people
Elderly ppl with dementia related psychosis
What are commonly used atypical antipsychotics
Olanzapine ( Zyprexa) Quetiapine ( seroquel) Aripriprazole ( Abilify) Ziprasidone ( Geodon) Clozapine ( clozaril)
What is given to ppl who don’t adhere to treatment of schizophrenia
Long acting IM meds are the medical regime
What are potential side effects of all antipsychotics
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
What are medications reverse EPS
Antichloinergics such as benztropine ( cogentin) and trihexphenidyl ( Artane)
Antihistamines such as diphenhydramine ( Benadryl)
Tardive dyskinesia is typically seen when
Seen after months to years of prolonged use of antipsychotic
What are clinical manifestations of Tardive dyskinesia
Bizarre facial and tongue movements
Stiff neck
Difficulty swallowing
IREVERSIBLE
What is NMS
NEUROLPETIC MALIGNANT SYNDROME
Rare but life threatening
Typically seen soon after initiation of antipsychotics
What are clinical manifestations of NMS
Muscle rigidity Very high fever Tachycardia Tachypnea BP instability,diaphoresis Changes in LOC
WHAT is treatment for NMS
Immediately stop antipsychotics
Monitor VS
IV fluids
I&O
What is metabolic syndrome
It is seen with atypicals
It causes the pt to gain wt and as a result new onset diabetes occurs
What is a side effect assoc with antipsychotics
Anticholinergic effects such as dry mouth, constipation, photophobia, urinary retention.
What is a major side effect to watch out for with antipsychotics such as clozaril
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.
What is the definition of bipolar
A mood disorder manifested by cycles of mania and depression
What is the prevalence of bipolar
It occurs equally between males and females
Avg onset is early 20’s
Genetic predisposition
If a person is dehydrated who also takes lithium, what will happen to there lithium levels
They will go up
If a person has excessive fluid in there body and also takes lithium, what will happen to there lithium levels
Lithium levels will go down
What is bipolar 1
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
What is bipolar 2
Distinguished by bouts of MMD with hypo mania
doesn’t reach mania
What are nursing diagnosis for bipolar disorder
- Risk for injury
- Risk for violence; self directed or others directed
- Imbalanced nutrition; less than body requirements
- Disturbed thought process
- Insomnia
What are nursing interventions during the manic/ acute phase
Safety
Self care
Communication
For a person with bipolar, what type of foods should be offered
Finger foods because they can’t sit down long enuf to eat
What are medications for bipolar disorder
Lithium carbonate
What are contraindications of lithium carbonate
Cardiac or renal disease
Dehydration, sodium depletion
What are side effects of lithium carbonate
Margarine between therapeutic levels and toxic levels is very low
What is the therapeutic range of lithium
0.6-1.2
When do levels of lithium become toxic
Above 1.5
What are clinical manifestations of lithium toxicity from 1.5 - 2.0
Blurred vision, ataxia,tinnitus, fine hand tremors, persistent N/V
Severe diarrhea
What are clinical manifestations of lithium toxicity with levels from 2.5-3.5
Excessive output of dilute urine, increasing tremors, mental confusion
What are clinical manifestations of lithium toxicity above 3.5
Decreased LOC Anuria MI Seizures Coma, death
Is lithium toxicity lethal
Toxicity can be lethal
What is patient education of lithium carbonate
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)
What class of drugs is also used to treat bipolar disorder
Anticonvulsants
Name a anticonvulsant drug
Valproic acid ( depakote)
What are contraindications of valproic acid ( depakote)
Liver disease
Pregnancy
What are side effects of valproic acid ( depakote)
GI upset,hepatotoxicity, prolonged bleeding time
What is lab work that must be monitored while on valproic acid ( depakote)
LFTs ( AST,ALT)
Platelet count
Valproic acid serum levels
What is valproic acid used to treat
Bipolar disorder
What are treatment modalities of bipolar disorder
Individual therapy
Group therapy
Family therapy
ECT
What is the definition of schizophrenia
Psychotic disorder that affects thinking, behavior, emotions,and the ability to perceive reality.
What does serotonin regulate
Sleep cycle
Appetite
Mood regulation
Circadian rhythm
What medications have a side effect of depression
Hormone replacement therapy
Antibiotics such as sulfa drugs, tetracycline
Steroids, prednisone
What is SAD
Seasonal affective disorder
It occurs during winter months
Mood lightens in the spring ( some ppl may require light therapy to relieve the depression)
What is MDD
Major depressive disorder
Characterized by depressed mood or loss of interest in usual activities
Symptoms last at least 2 weeks
What is subjective data of a depressed person
Anergia, anhedonia, anxiety,fatigue
Somatic complaints, loss of appetite
Sleep disturbances
Negative thoughts
What is objective assessment data of a depressed person
Affect, disheveled appearance
Slowed physical movements
Socially isolated,
Slowed thought process and speech patterns
What are nursing diagnosis related to depression
Risk for suicide
Social isolation
Self care deficit
Imbalanced nutrition; less than body requirements
What types of therapies are there for depressed patients
Cognitive behavior therapy; it helps the person realize and change negative thoughts
Group therapy, depression support groups
Individual therapy
When should a person expect to experience relief of depression after taking depression meds
Relief is not immediate, may take 2-4 weeks to reach full therapeutic levels
Do antidepressants carry a black box warning
YES
All antidepressants carry a FDA black box warning for increased risk of suicide in children and adolescents
Do antidepressants increase risk of suicide
As antidepressants take effect the mood begins to lift, giving the patient more energy. Suicide risk increases as the level of depression decreases.
What are meds for depression
TCAs
SSRIs
MAOIs
Atypical antidepressants
What are TCAS
Tricyclic antidepressants
Blocks the reuptake of norepinephrine and serotonin in the synaptic space
What were the first antidepressants used
TCAs
What is the prototype TCAs
Amitriptyline ( Elavil)
What are side effects of TCAs
Orthostatic hypotension
Anticholinergic effects
Sedation
Decreased seizure threshold
What is pt education regarding TCAs such as Amitriptyline
Educate to take at bedtime
Use cautiously in someone with seizure disorder
What are SSRIs
Blocks the reuptake of serotonin
MOST PRESCRIBED ANTIDEPRESSANT
Used to treat depression and anxiety
What is the prototype SSRI
Fluoxetine ( Prozac)
What are side effects of fluoxetine ( Prozac)
Sexual dysfunction
CNS stimulation
Changes in weight
Serotonin syndrome
What is pt education regarding fluoxetine ( Prozac)
Can make a person feel more alert, take in am
May cause decreased libido
What is serotonin syndrome
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
What meds affect serotonin levels
Obviously SSRIs Warfarin Beta blockers Theophylline MAOIs
What are symptoms of serotonin syndrome
Mental confusion Fever Hallucinations Diaphoresis Abdominal pain with diarrhea
What are MAOIs
Blocks MAO in the brain thereby increasing norepinephrine, dopamine,and serotonin
What is the prototype MAOI
Phenelzine ( Nardil)
What are side effects of MAOIs
Serotonin syndrome
Hypertensive crisis
What are foods to avoid while taking phenelzine
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
What are foods that contain tyramine
Aged cheese, figs, yogurt, raisens, pepperoni,
What are atypical antidepressants
They are an alternative to SSRIs
They also help combat nicotine addiction
Blocks the reuptake of dopamine
What is the prototype atypical antidepressant
Bupropion ( Wellbutrin)
What are side effects of atypical antidepressants
Weight loss!
Seizures!
Anticholinergic effects!
What is the definition of anxiety
Apprehension, uneasiness, or tension
What are the different types of anxiety disorders
Panic disorder Phobias Generalized anxiety disorder OCD Compulsions
What is panic disorder
Characterized by recurrent panic attacks
What symptoms may a person experience during a panic attack
Heart palpitations, sweating
Trembling, shaking, chest pain
GI distress, SOB,
Fear of loosing control, fear of dying
What are phobias
A person fears a specific object or situation
Give examples of phobias
Social phobia ( also called social anxiety disorder) Agoraphobia- fear of going outside
Multiple others such as fear of water, heights, marriage, animals etc…..
What is generalized anxiety disorder
Persistent and excessive worry and anxiety
What is OCD
Presence of obsessions, compulsions or both
What are obsessions
Recurrent or persistent thoughts that are experienced as intrusive and stressful
What are compulsions
Repetitive ritualistic behavior
What is desensitization
Gradually introducing the person to the phobia
What are meds for anxiety disorders
Benzodiazepines ( Lorazepam, Ativan )depresses CNS, works immediately
Atypical anxiolytics ( buspirone, buspar) better for long term control of anxiety relief
Antihistamines ( diphenhydramine) ( hydrozyzine, vistaril)
SSRIs
What are contraindications of benzodiazepines such as lorazepam
Do not use with other CNS depressants
Pregnancy, glaucoma,
Elderly and those with a history of drug abuse
What are nursing considerations of benzodiazepines such as lorazepam
It can cause physical and psychological dependence, drowsiness, confusion,orthostatic hypotension with dizziness
Blurred vision
Benzodiazepines are prescribed for PRN use
What are contraindications of atypical anxiolytics such as buspirone ( buspar)
Breastfeeding
Concurrent use of MAOIs can cause hypertensive crisis
What are side effects of atypical anxiolytics
Dizziness
Headache
Agitation
When will therapuetic effects occur with atypical anxiolytics
It may take up to 2 weeks for anxiety symptoms to diminish
What is Paxil
A SSRI
