mental health final Flashcards
1
Q
two subdivisions of autonomic nervous system
A
sympathetic (fight or flight) and parasympathetic (rest and digest)
2
Q
Dopamine responsible for:
A
movement and depression. pleasure center of brain
3
Q
serotonin responsible for:
A
elevating mood
4
Q
GABA:
A
inhibitory and excitatory
5
Q
epinephrine
A
released with sympathetic nervous system is activated
6
Q
glutamate
A
excitatory NT in brain, traffic cop
7
Q
frontal lobe responsible for:
A
cognition, voluntary movement, executive functioning (lists, checkbook balance, etc)
8
Q
thalamus responsible for:
A
relays motor and sensory activity
9
Q
limbic system responsible for:
A
emotions and memory
10
Q
extrapyramidal system (EPS) responsible for:
A
regulating involuntary movement (affected in parkinson’s)
11
Q
neurotransmitter is:
A
chemical messenger that controls neuron function. selectively causes excitation or inhibition of action potentials
12
Q
4 major neurotransmitters:
A
GABA (always inhibitory).
Monoamines: epi, norepi, dopamine, serotonin.
Acetylcholine: inhibitory in heart, excitatory in muscles.
Glutamate: excitatory, traffic cop.
13
Q
Steps in NT synaptic transmission (five)
A
1) NT synthesized
2) NT stored in synaptic vesicles (presynaptic cleft)
3) synaptic vesicle releases NT
4) NT binds to receptor that will accept it
5) termination of NT after job is done
14
Q
Autonomic nervous system maintains internal ____
A
balance/homeostasis
15
Q
parasympathetic:
A
rest and digest, acetylcholine, cholinergic, muscarinic, parasympathomimetic, sympatholytic, alpha blocker, beta blocker, relaxation
16
Q
sympathetic:
A
fight or flight, adrenergic, anticholinergic, sympathomimetic, parasympatholytic, alpha 1 and 2 receptors, beta 1 and 2 receptors, stimulation
17
Q
what can cause exaggerated effects of NT?
A
too much NT produced or too much released, oversensitivity of receptor, inadequate removal
18
Q
what can cause inadequate effects of NT?
A
deficient synthesis, too little released, insensitive receptor site
19
Q
What is PSYCHOTROPIC?
A
Med that enters CNS
20
Q
pharmacotherapy has effects observed on ___, ___, and ___
A
thought, mood, behavior
21
Q
____ dosage if pt has damage to kidney or liver to avoid toxicity
A
decreased dosage
22
Q
excretion happens in:
A
liver and kidney, sometimes lungs and skin
23
Q
how many half lives to reach steady state and for elimination of most of the drug?
A
4-5 half lives
24
Q
Anti anxiety agents, types of drugs:
A
SSRI, SNRI, Benzodiazepines, Hydroxyzine, Beta blocker, Anticonvulsants
25
SSRI used for
depression, anti anxiety
26
SNRI used for
depression, anti anxiety
27
SSRI keeps more ___ at receptor site
serotonin
28
SNRI keeps more ___ at receptor site
serotonin and norepinephrine
29
Benzodiazepines used for
anti anxiety
30
Benzodiazepines do what:
increases GABA in the brain
31
Hydroxyzine does what:
increases serotonin and is an antihistamine - relaxes patient
32
Beta blocker does what: (propranolol)
stops sympathetic nervous system
33
Gabapentin does what (anticonvulsant):
increase GABA NT in brain
34
What are antipsychotics used for?
schizophrenia, delusional disorders, bipolar disorders, depressive psychoses, drug induced psychoses
35
Two groups of antipsychotics and how they work:
FGA (conventional): block receptors for dopamine in the CNS.
SGA (atypical): produce moderate blockage of dopamine receptors; stronger blockage for serotonin.
36
Risk for FGAs and SGAs:
FGAs: can cause serious EPS
SGAs: higher risk of metabolic effects
37
Schizophrenia positive symptoms:
- hallucinations (altered sense of perception, not pleasant) - one of the senses affected.
- delusions
- disordered thinking
- combativeness
- agitation
- paranoia
38
Schizophrenia negative symptoms:
- social withdrawal
- emotional withdrawal
- lack of motivation
- poverty of speech
- blunted affect
- poor insight
- poor judgement
- poor self care
39
Which schizophrenia symptoms (+/-) respond to antipsychotics (FGA/SGA)?
Both + and - respond to FGA/SGA. If patient at risk for metabolic disorder, will not go on SGA.
40
FGA classified by?
potency (high/low)
41
FGA low potency drug:
chlorpromazine (Thorazine)
42
FGA high potency drug:
haloperidol (Haldol)
43
FGA mechanism of action:
block a variety of receptors within and outside the CNS, block receptors for Ach, histamine, norepi.
44
FGA therapeutic uses:
Schizophrenia, bipolar, prevent emesis
45
Adverse effects of FGA:
```
(in order):
Acute dystonia
Parkinsonianism
Akathisia
Tardive Dyskinesia
```
CAN CAUSE TORSADES DE POINTES
Other: Anticholinergic side effects, orthostatic HoTN, Neuroleptic malignant syndrome, sedation, seizures, sexual dysfunction, dermatologic effects, neuro endocrine effects.
46
Acute dystonia s/s and treatment:
Severe spasm of muscles of back, face, tongue, upward deviation of eyes. can end up with severe laryngospasms.
Occurs within hours/days of first FGA dose.
Medical emergency.
Treatment: ANTICHOLINERGIC MEDICATION
47
Parkinsonianism s/s and treatment:
Drooling, tremors, rigidity, mask like expression.
Occurs within first month of FGA.
Treatment: ANTICHOLINERGIC MEDICATION. Do not give med for Parkinson's - can exacerbate. Will resolve on it's own in a couple months.
48
Akathisia s/s:
Pacing, squirming, moving legs, cannot sit still.
Occurs within two months of FGAs.
49
Tardive Dyskinesia s/s:
Involuntary movement of face, mouth, tongue (slow worm-like movement). Hard time eating, malnourished, involuntary movements of limbs and torso.
FREQUENTLY IRREVERSIBLE.
Occurs on long-term FGAs.
50
Anticholinergic side effects:
increased HR, constipation, urinary retention, orthostatic hypotension
51
Neuroleptic malignant syndrome:
Rare, serious. Fatal without treatment.
Sweating, rigidity, sudden high fever >104, autonomic instability (HR and BP all over the place, unstable).
52
FGA Toxicity:
Typically very safe, OD is rare.
OD causes HoTN, CNS depression, EPS.
Treatment: IV Fluids, alpha-adrenergic agonist, gastric lavage. Emetics not effective.
53
Haloperidol (HALDOL) (FGA high potency)
PO or IM.
Hepatic metabolism. First pass effect. Renal excretion.
Used for schizophrenia and acute psychosis, preferred for Tourette's.
A/EL EPS, gynecomastia, menses irregularities, QT prolongation, cardiac dysrhythmias.
54
Why would FGA be given over SGA?
Increased risk of metabolic disorders: weight fain, diabetes, dyslipidemia
55
SGA Drug:
Clozapine
56
What family drug does Clozapine fall under?
SGA
57
Clozapine used for:
Schizophrenia, levodopa induced psychosis
58
What is the risk of using Clozapine? What are the interventions for this?
Risk of agranulocytosis. Provider needs to try minimum 4 other meds before clozapine will be ordered.
WBC checked daily when starting x1 week.
Weekly WBC x6 months.
If WBC < 3k, interrupt med and will start again when WBC > 3k.
If WBC falls < 2k, never on med again.
59
Clozapine mechanism of action:
Blocks dopamine and serotonin
60
Clozapine pharmacokinetics:
PO, rapid absorption, highly protein bound, hepatic metabolism, renal and fecal excretion.
61
What is Risperidone (Resperdal)?
Depot preparation SGA. Long term formulation for schizophrenia.
Long acting IM injection q3 weeks-1 month.
62
Types of antidepressants:
SSRI, SNRI, Tricyclic, MAOI, Atypical
63
Antidepressants used for:
Used to relieve s/s of depression, can help anxiety.
64
Depression s/s:
Depressed mood, loss of pleasure/interest (anhedonia), insomnia/hypersomnia, anorexia or hyperphasia, mental slowing, LOC, death/suicidal thoughts/behaviors.
65
Diagnosis of depression: s/s must be present _____
nearly every day for at least 2 weeks.
66
Pathophysiology of depression:
Genetics, childhood difficulties, low self esteem.
Monoamine hypothesis of depression: caused by functional insufficiency of monoamine NT.
Nature vs nurture.
67
What is the main concern after a patient begins an antidepressant?
Increased risk of suicidal tendencies. It takes 4-6 weeks for antidepressants to start to work. The medication gives energy to kill self and motivation.
Observe closely for suicidality, worsening mood, behavior change.
68
SSRI drugs:
Fluoxetine, Sertraline, Citalopram
69
SSRI uses:
primarily for major depression.
Other: OCD, bulimia nervosa, PMS dysphoric disorder, PTSD, anxiety.
70
SSRI adverse effects:
Serotonin syndrome w/in 2-72 hours.
Withdrawal s/s: dizziness, headache, nausea, anxiety
May cause neonatal withdrawal
teratogenesis, EPS, bruxism, bleeding disorder, sexual dysfunction, weight gain (not with fluoxetine)
71
Serotonin syndrome:
altered mental status, agitation, disorientation, hallucinations, hyperreflexia, diaphoresis, tremors, fever, death has occured
72
SSRI drug interactions:
MAOIs, warfarin, TCAs, lithium
73
SNRI drug:
Venlaxafine
74
SNRI used for:
Major depression, generalized anxiety disorder
75
SNRI side effects:
nausea, headache, anorexia, nervous, sweating, somnolence, insomnia, weight loss, anorexia, diastolic HTN, sexual dysfunction
76
TCA drugs:
amitriptyline
77
TCA used for:
Major depression, bipolar disorders
other: neuropathic pain, chronic insomnia (Admin in morning), ADD, panic disorder, OCD
78
TCA most dangerous effect:
CARDIAC TOXICITY
79
TCA most common adverse effects:
sedation, orthostatic HoTN, anticholinergic effects
80
TCA Side effects:
Yawngasm, HoTN, seizures
81
TCA toxicity manifestations:
Anticholinergic and cardiotoxic actions:
Dysrhythmias, tachycardia, complete AV block, VTach, VFib
82
What does "-Ase" mean?
Enzyme, breaks down chemicals
83
What does MAOI do?
Monoamine oxidase inhibitor - prevents monoamine oxydase from breaking down Norepi, serotonin, and dopamine.
84
What is MAOI used for?
last choice antidepressant
85
What food is restricted while using MAOI?
any foods rich in Tyramine *** can trigger hypertensive crisis
86
MAOI Med:
Selegeline
87
MAOI used for:
depression, bulimia nervosa, OCD, panic attacks
88
MAOI Adverse effects:
CNS stimulation, orthostatic HoTN, hypertensive crisis from tyramine ingestion
89
Foods rich in tyramine:
bologna, pepperoni, salami, cheeses, beer, wine, soy sauce, chocolate, yogurt
90
How else can Selegeline (MAOI) be given?
PO or Transdermal
91
Atypical antidepressant med:
Buproprion (wellbutrin)
92
Atypical antidepressant used for:
Stimulant and suppresses appetite, will increase libido
| usually taken with SSRI
93
Main drugs given for Bipolar Disorder:
Lithium, Valproic Acid
94
How does lithium work?
Control episodes of acute mania, helps prevent return of mania.
Short half life - 2-3x daily
Can take several weeks to work
Patient will stay on lithium even if mania goes away
95
Lithium interactions:
diuretics, NSAIDs, anticholinergic drugs
96
Lithium therapeutic range:
0.6-0.9 preferred
97
What is trazodone given for?
Help sleep, can cause hangover effect. Smaller doses are better.
98
Who should not take antihistamines?
Children or >65y/o
99
What is sleep hygiene?
Bed and wake at same time. No caffeine after 2pm. Bed used for only sleep and sex.
100
S/s of anxiety:
uncomfortable state with psychologic and physical components
101
s/s of panic disorder:
palpitations, pounding heart, tachycardia, SOB, choking, dizzy, nausea
102
What is the first line drug for panic disorder?
Benzodiazepines
103
What is the dopamine hypothesis?
argues that unusual behavior and experiences can be explained by change in dopamine
104
Anxiety:
feeling of discomfort and apprehension related to fear of impending danger (can be real or imagined)
105
Mild anxiety:
should not be a problem. Prepares people for action. Sharpens senses. Increase motivation. Helps person function at optimal level.
106
Moderate anxiety:
less alert, tension increased. Concentration low. Restless, pacing, increased muscle tension.
107
Severe anxiety:
focuses on one detail of stressor. Poor attention span. HA, heart palp., insomnia, N/V
108
Panic anxiety:
most intense state of anxiety that you can have. Feel like loss of contact with reality, feel like going crazy, losing control. Hallucinations or delusions.
109
Delusion:
fixed, firm, false belief that is incorrect
110
Coping skills can be ____ or _____
adaptive or maladaptive
111
Autonomy:
right to make own decisions
112
Beneficience:
quality of doing good
113
Nonmaleficence:
do no harm
114
Justice:
fair and equal treatment for all
115
Veracity:
honesty
116
Duty to warn:
client poses danger to others, contact police and person of question
117
Child/elder abuse:
report suspicious of child to legal authorities, cannot report elder unless child is involved
118
Informed consent:
right to accept or reject treatment
119
Restraints:
shortest amount of time possible.
Physical or chemical restraints.
seclusion: minimally furnished, alone, unable to leave. meant to deescalate behavior.
Never used for punishment or convenience to staff.
120
Types of hospitalization:
voluntary: self admit.
involuntary: against will. Imminent danger to self, act of suicide/self harm/dangerous to others. homicidal/suicidal tendencies, gravely disabled.
emergency: brought in by police
121
Goals of therapeutic nurse-patient relationship:
self-realization, self-acceptance, self-respect, sense of personal identity, capacity to give and receive love, improved functioning and increased ability to satisfy needs
122
Altriusm:
concern for welfare of others
123
Phases of a relationship:
Pre: prepare
Introductory/orientation: become acquainted, contract for safety
working: therapeutic work accomplished here, maintain trust and rapport
termination: discharge, goals met, evaluate, plan of continuing care
124
Paraverbal includes:
pitch, tone, quality, loudness, intensity, rhythm, cadence
125
Therapeutic outcome:
we want to help the patient living with mental illness to lead a fruitful life that has quality to it
126
Benzodiazepine drugs:
diazepam, lorazepam, alprazolam
127
Benzos used for:
insomnia and anxiety
128
Benzos adverse effects:
CNS depression, anterograde amnesia, sleep driving, paradoxical effects, respiratory depression, abuse
129
Depression is:
alteration of mood expressed by feelings of sadness, despair, pessimism. Loss of interest (anhedonia), somatic symptoms may be present (pain, such as headaches, stomach aches, etc).
Changes in sleep, appetite, and cognition are common.
130
Mood and affect should ____
mood and affect should match
131
Affect:
external, observational reaction associated with an experience
132
Mood:
pervasive and sustained emotion that may have a major influence on the person's perception o the world
133
Incidence of depression based on?
Females 14-22y/o > men up until age 45 then equal.
Lower class more likely.
White people more likely.
Happily married LESS LIKELY.
134
Types of depression:
Major depressive disorder (MDD)
Dysthymia - persistent depression
Premenstrual dysphoric disorder (PMDD)
Substance induced depressive disorder
Season affective disorder disease (SADD)
135
Anhedonia is:
Loss of pleasure or interest
136
[Major Depressive Disorder] Characterized by? Severity levels?
Characterized by depressed mood or anhedonia. Impaired social/occupational functioning.
2 weeks or longer, no history of manic behavior.
s/s cannot be attributed to substances or another medical condition.
Levels: Mild, moderate, severe.
137
[Major Depressive Disorder] How to be diagnosed?
depressed mood or loss of pleasure/interest in activities for 2 weeks or longer, no history of manic behavior and not attributed to substance or another medical condition.
138
Anenergy is:
loss of energy
139
[Major Depressive Disorder] S/S of MDD:
depressed mood, most of the day, nearly every day.
anhedonia.
feelings of worthlessness, inappropriate guilt (can cause self hard/suicidal ideations)
anenergy, weight loss, hypersomnia, insomnia.
lack of concentration, recurrent thoughts of suicide/death.
psychomotor agitation/retardation
140
[Major Depressive Disorder] "SIGECAPS"
```
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicidality
```
141
[Dysthymia] What is Dysthymia?
Similar to MDD, milder symptoms. "down in the dumps."
No psychosis.
Chronically depressed/irritable mood for most of the day, more days than not, for two years
142
[Dysthymia] What is the onset?
Early onset: before 21y/o
| Late onset: after 21y/o
143
[Dysthymia] How is it diagnosed?
Chronically depressed mood or irritable mood in children/adolescents for most of the day, more days than not, for two years, with at least 2 of the following:
poor appetite, insomnia/hypersomnia, fatigue, poor concentration, low self esteem, hopelessness
144
[Substance/Medication Induced Depressive Disorder] What is it?
Direct result of physiological effects of a substance. Clinically significant distress or impairment in social/occupational functioning
145
[Substance/Medication Induced Depressive Disorder] What drug classes can evoke depressed moods?
antihistamines, anticholinergics, anesthetics, beta blockers, coming off cocaine.
intoxication or withdrawal from marijuana can cause depression.
146
[Depression] Other causes:
Electrolyte imbalance, hormonal imbalance, thyroid imbalance (esp. hypothyroidism), cushings disease, huntingtons, MS, parkinson's, stroke, TBI
147
[Depression] Treatment for depression, what is best treatment?
Treatment options: Behavioral therapy, cognitive therapy, lifestyle changes, Electroconvulsive therapy, transcranial magnetic stimulation, light therapy.
148
What is behavioral therapy?
can include cognitive therapy or psychotherapy. Goal: obtain relief of symptoms as quickly as possible.
change thinking pattern, help with lifestyle changes.
149
What is cognitive therapy?
Tries to help the person change their way of thinking.
150
What is electroconvulsive therapy (ECT)?
Induced grand mal seizure through use of electrical current to brain. Alter brain chemistry.
151
Side effects of ECT?
memory loss up to three days. Risk of permanent memory loss.
152
Safety interventions of ECT:
Fall precautions and monitor.
153
ECT pre procedures? During?
Pre: NPO.
| Measure length of seizure during.
154
Who is ideal candidate for ECT?
Patients who are severely suicidal or acutely suicidal with not enough time for antidepressants to work (6 weeks). Also used for associated psychosis. Elderly not eating due to depression. ECT can be tried after failed attempt with antidepressants.
155
What is Transcranial Magnetic Stimulation (TMS)?
non invasive, it stimulates nerve cells in brain.
short pulses of magnetic energy given to brain to stimulate cerebral cortex.
3x a week for 40 mimnutes.
156
What are the procedures for TMS if any? Any side effects?
No NPO needed. Patients can drive themselves.
S/E: tinnitus and headache.
157
What is light therapy?
Used for seasonal affective disorder, typically started in fall/late summer.
10-15 minutes increasing to 30-45 minutes.
158
Interventions/teaching for light therapy:
Do not stare into light. Caution for headache.
159
[Depression] Interventions for depression:
- Ask hard questions.
- Safe environment.
- Contract for safety.
- Observe (sometimes 1:1)
- Med Admin
- 15 minute checks (sometimes 5)
- Express feelings encouraged
- Be accepting and spend time with patient
- Focus on strengths
- Encourage participation and independence
- Encourage recognition of needed change
160
[Generalized Anxiety Disorder] What is GAD?
persistent, unrealistic, and excessive anxiety and worry. All the time for 6 months.
***Not GAD if brought on by drugs or caffeine.
161
[Generalized Anxiety Disorder] What is a phobia?
persistent and irrational fear, compelling desire to avoid the feared stimuli.
162
Agoraphobia:
fear of open spaces, fear of being somewhere unable to escape
163
[Generalized Anxiety Disorder] Social anxiety manifestations:
Patient will not eat in public, speak in public, or go to the bathroom in public.
164
[Anxiety Disorder] Panic attack manifestations:
Increased HR
Dry mouth
Palpitations
Commonly end up in ER thinking they have a heart attack.
165
[Anxiety Disorder] What is Obsessive compulsive disorder?
Anxiety that the only way to alleviate the anxiety is to do the compulsive act.
thought is the obsession, behavior is the compulsion.
166
[Anxiety Disorder] What is trichotillomania?
Hair pulling without realization
167
[Anxiety Disorder] What is hoarding usually caused by?
Loss of family or other
168
[Anxiety Disorder] What are treatments for anxiety?
Cognitive therapy, cognitive reframing, lifestyle changes (diet, exercise, sleep), behavioral therapies.
169
What is cognitive reframing?
help patient stop the automatic thoughts. reframe way of thinking.
170
[Anxiety Disorder]
| What medications help tone down panic attacks? Prevent?
Benzodiazepines / -PAMs to treat.
SSRI/SNRI/Therapy to prevent.
171
[Anxiety Disorder] What is habit reversal training (HRT)?
Typically used for trichotillomania. Patient has to be conscious of their behavior they are substituting with.
Change maladaptive to adapting coping skills.
172
[Anxiety Disorder] What is systematic desensitization?
Slow exposure to fear, each time anxiety becomes less.
173
[Anxiety Disorder] What is flooding (implosion therapy)?
Flood the patient with their phobia to quickly desensitize.
174
[Anxiety Disorder] What is thought stopping?
Stop though immediately, deep breath, "what can help me right now?"
175
[Anxiety Disorder] What is progressive relaxation?
tense up one area then relax, repeat until entire body is done.
176
What is the best approach to a full-on panic attack?
Benzodiazepine is used to ABORT and ATTACK. Ask direct questions and direct verbiage.
177
[Anxiety Disorder] Plan of care for fear:
Discuss phobia object, ability to function near object, reassure safety, discuss reality, desensitize/flood
178
[Anxiety Disorder] Plan of care for OCD ineffective coping:
decrease ritualistic behaviors, allow time for behaviors, structured schedule, limit time gradually, reinforce non-ritualistic behaviors.
179
[Anxiety Disorder] Hazards to monitor for:
firearms, cheeking of medications, suicidal ideations, follow up care, side effects of medications
180
[Bipolar Disorder] What are the two spectrums of bipolar disorder?
Mania and depression
181
[Bipolar Disorder] What is Mania?
alteration in mood, expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, accelerated thinking/speaking.
182
[Bipolar Disorder] What is bipolar disorder?
characterized by mood swings from profound depression to extreme euphoria (mania) with intervening periods of normalcy. may or may not have delusions and hallucinations.
183
[Bipolar Disorder] What is psychosis?
severe mental disorder where thoughts and emotions are so impaired that contact with reality is lost.
184
[Bipolar Disorder] What is hypomania?
milder form of mania. No delusions or hallucinations, no extreme euphoria.
185
[Bipolar Disorder] What is Bipolar I Disorder?
client is experiencing, or has experienced, a full syndrome of manic or mixed symptoms. mania and depression.
distinct period of abnormally/persistent elevated expansive, irritable mood.
186
What is hedonistic interest?
All about themselves
187
[Bipolar Disorder] How to diagnose Bipolar I Disorder?
distinct period of abnormally/persistent elevated expansive, irritable mood lasting at least 1 week and exhibiting 3+ symptoms:
grandiosity, decreased need for sleep, flight of ideas, hedonistic interest, distractability
188
[Bipolar Disorder] MANIC ATTACK: "DIG FAST"
```
Distractability
Indiscretion
Grandiosity
Flight of Ideas
Activity increase
Sleep deficit
Talkative
```
189
[Bipolar Disorder] What is Bipolar II Disorder?
bouts of major depression with episodic occurrence of hypomania, never met the criteria for full manic episode. lasting at least 4 days. NEVER psychosis associated.
190
[Bipolar Disorder] How to diagnose Bipolar II Disorder?
bouts of major depression with episodic occurrence of hypomania, never met the criteria for full manic episode. lasting at least 4 days with 3/4+ of the DIGFAST symptoms.
191
[Bipolar Disorder] What is Cyclothymic disorder?
Chronic mood disturbance, at least 2 year duration. periods of depression, periods of hypomania, but not enough for diagnosis of BP I or II.
Hypomania or depressive at least half the time and not without symptoms for longer than 2 months at a time.
192
[Bipolar Disorder] What is Substance-induced bipolar disorder?
Disturbance of mood (depression/mania) directly resulted of physiological effects of substance (ingestion or withdrawal)
193
[Bipolar Disorder] What are the predisposing factors?
- Genetics
- biochemical influences: excess norepi and dopamine in mania, low serotonin in both mania and depression
- glutamate (excitatory) - mood stabilizers inhibit this
- medication side effects
194
[Bipolar Disorder] S/S in childhood and adolescence?
nondiscrete mood episodes, chronic irritability, temper tantrums, easily set off, defiant, aggressive, hitting, biting, bed wetting as older child, excessively goofy/silly
195
[Bipolar Disorder] What are children/adolescents frequently diagnosed with before BP?
ADHD
196
[Bipolar Disorder] Treatment strategies for children/adolescents?
- Monotherapy (one drug): lithium, divalproex, carbamazepine, SGAs.
- Family interventions. Educate on s/s of manic episode: less sleep, more active, rapid speech.
197
[Bipolar Disorder] Stage 1 Hypomania s/s:
s/s not severe enough to impair social/occupation functioning or require hospitalization.
Expansive mood, rapid flow of ideas, heightened self worth perception, increased motor activity, distracted by stimuli, goal directed activities prove difficult.
*They do not like medication because they feel really good - accomplish a lot with little sleep!
198
[Bipolar Disorder] Stage II Acute Mania s/s:
marked impairment in functioning, usually requires hospitalization.
continuous high, mood variations, flight of ideas, hallucinations, delusions, paranoia, grandiose, excessive motor activity, social/sexual inhibition, little sleep, dress is bizarre.
199
[Bipolar Disorder] Stage III Delirious Mania s/s:
Grave form characterized by intensification of s/s. Rate with use of FGA/SGAs.
Labile mood, panic anxiety, clouding of consciousness, disoriented, frenzied psychomotor, exhaustion, death without intervention
200
[Bipolar Disorder] What should be provided to patient during mania?
High calorie, high protein FINGER foods
201
[Bipolar Disorder] What would be measured for outcomes?
No evidence of injury, no harm to self/others, no signs of physical agitation, well balanced meals, accurate interpretation of environment, hallucination activity ceased, accepts responsibility, no manipulation, appropriate sleep
202
[Bipolar Disorder] Interventions for Impaired Social Interaction:
Set limits on manipulative behaviors, do not argue/bargain/reason with client, provide positive reinforcement
203
[Bipolar Disorder] Client Education:
- Not patient's fault
- Cyclic nature
- S/S to look out for
- Med Adherence and management
- Encourage anger management classes
204
[Bipolar Disorder] Treatment modalities:
Individual Psychotherapy, group therapy, self-help, family therapy, cognitive therapy, ECT
205
What is individual psychotherapy?
regulate sleep, exercise, social rhythms
206
What is group therapy?
After acute phase, discuss issues in lives with others.
207
What is self-help group?
Peer led support
208
What is family therapy?
Resolve symptoms and restore family functioning
209
What is cognitive therapy?
Control thought distortions. Things can have a happy medium.
210
[Bipolar Disorder] What is the Recovery Model?
learning how to...
Safe, dignified, full, autonomous life. Take control, independence.
Recovery is a continuous process.
Prevent and minimize s/s. Cope with side effects.
211
[Bipolar Disorder] When is ECT most effective?
Acute mania with no medication tolerance, failed response to medication, life threatening behavior or exhaustion.
212
[Bipolar Disorder] Medications used for Mania:
Lithium - mood stabilizer
Anticonvulsant - carbamazepine
Verapamil - CCB
213
[Bipolar Disorder] Medications used for depression:
Antidepressants with care (SSRI) - can trigger mania
214
[Bipolar Disorder] Lithium education:
Take regularly. Do not skimp on dietary sodium.
6-8 glasses of water daily.
Notify PCP if vomiting/diarrhea.
Serum lithium checked qFewDays until stabilized, then q1-2 months.
*Fine tremors when starting should go away; if get worse, it could be toxicity.
Keep eye out for confusion, nausea, vomiting, tinnitus.
215
[Bipolar Disorder] Anticonvulsants education:
Do not stop abruptly. Report rash, unusual bleeding, bruising, sore throat, fever, malaise, dark urine, yellow eyes/skin.
Avoid ETOH and OTC meds without consult.
216
[Bipolar Disorder] Calcium channel blocker education:
Do not stop abruptly. Change positions slowly. Report chest pain, irregular heart beat, swelling, mood swings, severe/persistent headache.
217
[Bipolar Disorder] Antipsychotics education:
Do not stop abruptly. Sunscreen. Change positions slowly. Avoid ETOH and OTC meds. take even if feeling well. Report fever, malaise, bruising, rash, nausea, vomiting, twitching, headache, rapid HR, weakness.
218
[Substance Use Disorder] Physical dependence:
need for increasing amount to produce desired effects
219
[Substance Use Disorder] psychological dependence:
overwhelming desire to repeat use of particular drug to produce pleasure or avoid discomfort
220
[Substance Use Disorder] Withdrawal from ____ is medically urgent
ETOH
221
[Substance Use Disorder] What is substance intoxication?
Reversible syndrome of symptoms following excessive use of a substance. Disruption in functioning.
222
[Substance Use Disorder] What is substance withdrawal?
Development of symptoms that occurs upon abrupt reduction or d/c of substance. Symptoms specific to substance used.
223
[Substance Use Disorder] Classes of psychoactive substances:
```
Etoh
Caffeine
Cannabis
Hallucinogens
Inhalants
Opioids
Sedatives/hypnotics (benzos)
Stimulants
tobacco
```
224
[Substance Use Disorder] Psychological factors, developmental influences:
Punitive superego (punish self), fixation in oral stage of psychosexual development
225
[Alcohol Use Disorder] Patterns of use, Phase 1, Prealcoholic phase:
use of ETOH to relieve everyday stress and tensions of life
226
[Alcohol Use Disorder] Patterns of use, Phase 2, Early ETOH Phase:
begins with blackouts, occurs during/following period of drinking. ETOH required by person psychologically.
227
[Alcohol Use Disorder] Patterns of use, Phase 3, Crucial phase:
lost control. Physical dependence evident. S/S of ETOH withdrawal. Needs a drink to alleviate S/S of withdrawal. Common binge drinking. Loses marriage, job, children, self-respect.
228
[Alcohol Use Disorder] Patterns of use, Phase 4, chronic phase:
Emotional and physical disintegration. Intoxicated more often than sober.
229
[Alcohol Use Disorder] Effects of ETOH on the body, Peripheral neuropathy:
lack of B vitamins - Thiamine
pain, burning, tingling, prickly sensations. Treated with admin of B vitamins, esp thiamine. Can reverse in some patients.
230
[Alcohol Use Disorder] Effects of ETOH on the body, Alcoholic Myopathy:
lack of B vitamins - Thiamine
acute: reddish tint to urine, incr. in creat, swelling, pain, eventual kidney failure.
chronic: no swelling, pain. only weakness.
231
[Alcohol Use Disorder] Effects of ETOH on the body, Wernicke's Encephalopathy:
Treated with Thiamine.
Most serious form of thiamine deficiency in ETOH pt:
s/s:
nystagmus, ocular muscle paralysis, somnolence, stupod, ataxia (imbalance)
232
[Alcohol Use Disorder] Effects of ETOH on the body, Korsakoff's psychosis:
confusion, loss of memory, confabulation
233
[Alcohol Use Disorder] Effects of ETOH on the body, Alcoholic cardiomyopathy:
ETOH causes accumulation of lipids on myocardial cells. Enlarged heart, not pumping properly.
s/s:
weight gain, SOB, edema, crackles, decreased urine output, fatigue, HoTN, tachycardia.
234
[Alcohol Use Disorder] Effects of ETOH on the body, Esophagitis:
inflammation and pain in esophagus
235
[Alcohol Use Disorder] Effects of ETOH on the body, Esophageal varices:
takes over by fibrotic cells. Portal HTN pressure on esophagus, pressure on varices, can rupture + bleed out.
236
[Alcohol Use Disorder] Effects of ETOH on the body, Gastritis:
inflammation of stomach lining.
s/s: epigastric distress, nausea, vomiting, distention.
237
[Alcohol Use Disorder] Effects of ETOH on the body, Pancreatitis:
1-2 post binge of ETOH.
s/s: constant severe epigastric pain, fetal position, nausea, vomiting, distention.
LABS: Amylase, lipase. With acute attack: AMYLASE first, then lipase.
Chronic: constant inflammation of pancreas. malnutrition, weight loss, diabetes, steatorrhea (fat with feces).
238
[Alcohol Use Disorder] Effects of ETOH on the body, alcoholic hepatitis:
long term heavy alcohol use.
s/s: RUQ tenderness,
nausea, vomiting, clay colored stool, lethargy, anorexia, high WBC, fever, jaundice, ascites, weight loss.
239
[Alcohol Use Disorder] Effects of ETOH on the body, Cirrhosis:
chronic, long term heavy use.
Widespread damage, replaced with scar tissue.
Men: 4+ in a day, 14 a week.
Women: 3+ in a day, 7 in a week.
240
[Alcohol Use Disorder] What is Leukopenia?
Decreased WBC, prone to infection
241
[Alcohol Use Disorder] What is thrombocytopenia?
low platelet count, responsible for clotting. Easy bruising, petechiae, GI bleeding, bleeding gums.
242
[Alcohol Use Disorder] Effects of ETOH on the body, sexual dysfunction:
short term: enhanced libido,
long term: dysfunction
can cause gynecomastia, sterility, impotence.
243
[Alcohol Use Disorder] Intoxication levels? Death may occur between?
100-200mg/dl for intoxication.
400-700mg/dl for possible death.
withdrawal within 4-12 hours of cessation.
244
[Alcohol Use Disorder] ETOH WITHDRAWAL SYMPTOMS:
```
Nausea
vomiting
malaise
diaphoresis
HoTN
tachycardia
AMS
confusion
```
within 2-3 days, can have severe seizures.
245
[Opioid Use Disorder] Effects on the body:
CNS Depression:
```
Decr. metabolic rate
Decr. muscle activity
constipation
Low BP (CV collapse in high doses)
Respiratory depression/arrect
```
246
[Opioid Use Disorder] Intoxication symptoms:
euphoria, apathy, dysphoria, psychomotor agitation/retardation, impaired judgement.
247
[Opioid Use Disorder] SYMPTOMS OF OPIOID WITHDRAWAL:
```
Dysphoria
muscle aches
nausea
vomiting
lacrimation
mydriasis
piloerection
diaphoresis
cramps
diarrhea
yawning
fever
insomnia
```
