Mental Health FINAL Flashcards by Alayna Johnson

Change in the brain that disrupts a person’s interpretation and/or experience of the world secondary to complex neurobiological changes

Hallucinations, delusions, and/or disorganized thinking are hallmark characteristics

Psychosis

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What are S/s of Psychosis-Positive Symptoms?

Delusions

Hallucinations

Disorganized thinking

Disorganized/abnormal motor behavior

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Visual (seeing things)

Auditory (hearing voices)

Tactile (feeling things touch your skin)

Olfactory (smelling things, or not smelling the same things as others)

Gustatory experiences (tasting things)

Hallucinations (positive sign)

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What are Psychosis-Negative Symptoms?

Alogia (reduction in quantity of words spoken)

Affective blunting (emotional expressions don’t show outwardly)

Asociality (reduction in social initiative due to decreased interest in forming close relationships with others)

Anhedonia (reduced experience of pleasure)

Avolition (reduced goal-directed activity due to decreased motivation)

Anosognosia (unaware of their own mental health condition or they can’t perceive their condition accurately)

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Typical agents: Blocks action of dopamine in the brain
* Ex: Halperidol (Haldol)

Atypical agents: Blocks serotonin receptors & dopamine receptors
* Ex: Aripiprazole (Abilify), Olanzapine (Zyprexa),Quetiapine (Seroquel)

Use:
* Treat psychoses associated with mental illnesses (schizophrenia, mania, psychotic depression, psychotic organic brain syndrome)

Side effects:
* Peripheral Nervous System Effects (PNS)
* Constipation, urinary retention, urinary hesitation
* Dry mouth, nasal congestion
* Blurred vision, photophobia
* Hypotension or orthostatic hypotension
* Tachycardia, sedation, weight gain.

Anti Psychotic Agents

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Drug induced condition that produces serious, irreversible side effect of long-term antipsycholtic meds

Produces involuntary, repeated movements of the muscles of the face, trunk, arms, and legs

Facial movements are usually affected first with protrusion of the tongue, puffing of cheeks or tongue in cheek, lip smacking, puckering

Elderyly women w/ stroke hx & young men taking large doses of high-potency antipsych. meds (haloperidol) are at risk
* Younger men may be prescribed prophylactic antiparkinsonian drugs

Interventions:
* Soft food diet
* Suction ready
* Education on S/s
* Routine assessments
* Prevent injury

Tardive Dyskinesia

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unpredictable / potentially fatal extrapyramidal side effect of antipsychotic medications (EPSE - dystonia, akathisa)

Must be recognized and treated quickly
* Neurologic emergency

Occurs in men more than women.
* Can affect all individuals of all ages.

Death occurs from respiratory or kidney failure, aspiration pneumonia or pulmonary emboli

Usually associated with high-potency antipsychotics or other dopamine altering drugs
* Development can occur suddenly after a single dose or years after drug treatment

S/s:
* Elveated temp (103 degress+)
* Change in LOC
* Rigid muscles (rapid onset)
* Tremors
* Resp. difficulty, pnemonia
* Inability to speak
* Tachycardia, rapid change in BP, labored RR
* Increases perspiration (diaphoresis)
* Increased WBC
* Possible kidney failure, UTI

Interventions:
* Monitor Vitals
* Report sudden fever, change in BP, or sudden change in LOC
* monitor during Tx (Onset can be rapid or gradual)

Neuroleptic Malignant Syndrome (NMS)

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What are S/s related to Anticholinergic Effects?

Dry mouth, hot feeling

Blurred vision

Urinary retention

Photophobia

Tachycardia more serious side effect and can cause sudden death.

Blind

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The nurse is caring for a patient who is in the process of sliding into schizophrenia. Her patient is withdrawn, lacks energy, and has little motivation. The patient is in what phase?

A) Prodromal
B) Prepsychotic
C) Acute
D) Residual

A) Prodromal

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Develops in people who have experienced or witnessed a traumatic event

Can become emotionally numb, extremely alert/guarded, or easily startled
* May have difficulty adjusting & coping

S/s:
* Intrusive thoughts, distressing dreams
* Fear, helplessness
* Flashbacks, emotional response
* Feel removed/detached from others
* Ability to feel emotions is reduced, anxiety
* Believes life will be short & wonders why they survived

Ex:
* War, military combat, bombs
* Violent assult, rape, torture
* Burglary, destruction of home
* Natural disaster, terrorist activities
* Witnessing assult or death

PTSD

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What are 3 types of coping mechanisms?

Psychomotor (Physical):
* Efforts to cope directly w/ the problem
* Ex: Confrontation, fighting, running away, negotiating

Cognitive (Intellectual):
* Efforts to neutralize threat by changing meaning of problem
* Ex: Making comparisons, subsituting rewards, ignoring, changing values, problem-solving behaviors
Affective (Emotional):
* Actions taken to reduce emotional distress
* No effor to problem solve
* Ex: Denial & suppression

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0.05% - 1 or 2 alcoholic drinks (0.5-1oz):
* Slowed judgement / reaction time
* More socially at ease
* Unable to do complicated tasks
* Rise in blood pressure

0.10% - 3 or 4 alcoholic drinks (1.5oz):
* Debth perception altered
* Voluntary motor actions clumsy
* Effected eye movement & focus
* Slower reaction time, judgement & control decreased

0.20% - 5+ alcoholic drinks (2.5 or more oz):
* Entire motor area of brain effected
* May want to lie down
* Staggers
* Angered easily, may weep, shout, or fight

0.30% - 6+ alcoholic drinks (3 or more oz):
* Confused, unresponsive to most stimuli
* May be in stupor
* Lose ability to control involuntary responses
* Decreased HR, BP, & RR

0.40% to 0.50% - 7+ alcoholic drinks (3.5 or more oz):
* Comatose
* Medulla severely depressed
* Death d/t resp. failure
* Death if alc. limit rises too quickly
* Fatal at 0.50% w/o medical attention

Blood alcohol content (BAC)

Helpful tip: Legal level 0.08%

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What should be assessed when triaging a suicidal pt?

Suicide Ideation (SI):
* Client talks about wanting to be dead or thoughts of death
* Imagines AIDS or other serious illnesses
* Seems gloomy or brooding (unhappiness)

Hx of past suicide attempts:
* Client has tried to end own life in the past
* Possible family Hx of suicide

Existence of suicide plan:
* More detailed suicide plan
* More likely to carry out act

Avalibile items to carry out plan:
* What weapons are availible?
* How difficult will it be to obtain weapons?

Substance use or abuse:
* Suicide rates are higher in those who abuse substances

Level of despair:
* Ask about future (despair high = hope low)

Ablility to control behavior:
* Inpatient hospitilization

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How do you treat victims of violence?

Ensure safety

DO NOT leave client alone

Explain all procedures simply, & ensure cooperation before proceeding

Show respect

Allow client to be in as much control as possible

Care plan developed on type of abuse, & resources availible

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Inability to sit still
* Side effect to extrapyramidal side effects (EPSE)

S/s:
* Nervous / nervous energy
* jittery
* Assaltive behavior if in one spot

Best Tx is to reduce dose of antipsychotic meds

Akathisia

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Characterized by involuntary , abnormal skeletal muscle movement
* Side effect to extrapyramidal side effects (EPSE)

Usually seen as jerking motion
* interfers w/ ability to walk and perform other voluntary movements

Dyskinesia

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Dopamine med - Antidepressant

Examples:
* Aripiprazole (Abilify)
* Brexpiprazole (Rexulti)
* Clozapine (Clorzaril)
* Olanzapine (Zyprexa)
* Quetiapine (seroquel)
* Bupropion (Wellbutrin)

S/s:
* Agitiation w/ bupropion
* Sleepiness, dizziness
* Sexual dysfunction
* Weight loss, anorexia
* Monitor weight & GI symptoms

Atypical

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Don’t react to things happening nearby or may react in ways that seem unusual

Impaired communication, unusual movements or lack of movement, and behavior abnormalities are the most striking features of this condition

S/s:
* Ridgid posture
* Echopraxia (mimics movements)
* Mute
* Echolalia (Echos others)
* Malnutrition, dehydration (fails to eat/drink)
* Fair prognosis

Catatonic Schizo

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Disoriented speech, thinking, w/ flat or inapproriate behaviors
* Early onset

S/s:
* Distorted facial expressions
* Giggles or cries out
* Loosely organized hallucinations/delusions
* Unable to perform ADLs
* Poor prognosis

Disorganized schizo

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Believes someone/something is out to get them
* late onset

S/s:
* Auditory hallucinations
* High anxiety
* Complex delusions & grandeur (belives they are special/better than others)
* Suspicious, guarded, hostile, angry, violent
* Suicidal, withdrawn
* Prognosis good w/ Tx

Paranoid schizo

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Free of psychosis but still has negative s/s of the disorder
* Had at least 1 acute episode of schizo

S/s:
* Withdrawn
* Emotional changes
* Disorganized thinking, odd behavior
* Poor prognosis

Residual Schizo

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Rapid change intopics w/ rapid flow of speech
* Speech disturbance associated w/ schizo

Example: “The sky is blue. The dog is dead, & I have 2 eyes.”

Flight of ideas

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Expressing belief that some events have special personal meaning
* Speech disturbance associated w/ schizo

Example: “ The united states are sendin satelites into space to spy on me”

Ideas of Reference

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Thinking characterized by speech that moves from one unrelated idea to the next
* Speech disturbance associated w/ schizo

Example: “I’m hungry but the desert has no rain so it’s cold outside”

Loose associations

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Refusal to speak Speech disturbance associated w/ schizo

Mutism

**Words or expressions invented by the individual** * Speech disturbance associated w/ schizo **Example: "The Ispy is not happy when the fulgari is green"**

Neologism

**Rapid, forced speech** * Speech disturbance associated w/ schizo **Example: "I must prepare. There is no time to waste. Can't talk now"**

Pressure speech

**Random, jumbled set of words that have no connection or relationship to one another** * Speech disturbance associated w/ schizo **Example: "Hot happies are spying on me but no men have short feet"**

Word salad

What are 4 theories relating to psychosis? ## Footnote Morrison pg 371

**Possession Theory:** * Believes that the thoughts in their mind are not their own **Biopyschosocial model status:** * States schizo is a result of a combination between physical, psychological, & social factors **Stress/disease/trauma model:** * **Looks at effects of stress on the individual,** especially during prenatal period * *Viural infections & severe malnutrition* during pregnancy contribute to development of schizo **Sociocultural theories:** * *Considers effects of enviornment on psychosis* * **Poverty, homeless, unstable family, cultural differences, ect.**

**Most commonly used for anxiety** * Less likely to interact w/ other drugs or cause overdose * PO, IV, IM **Example of drug:** * Lorazepam (Ativan) * Diazepam (Valium) * Alprazolam (Xanax) Use: * **Sedation, drowsiness** * Muscle relaxant * Antianxiey, anticonvulsant * *Reduce hepatic function* **Therapeutic outcome: Decreased anxiety** Interventions: * Record baseline for anxiety * **Record baseline for vitals** * Check for Hx of blood dyscrasias or hepatic disease * **Determine if pregnant or breastfeeding (Not administered during first trimester, Do not breastfeed)**

Benzodiazepine

**Class: Opiate** * PO, IM Blockes the effects of opioids by competeing for binding sites at opiate receptors Use: * **Diminishes or eliminates opiate & alcohol cravings** * *Must be used w/ other therapies ( support groups or behavior therapy)* **Theraputic outcomes:** * *Improve adherence w/ substances & alcohol* Interventions: * Perform basline neuro assessment *(A&O, bilateral hand grip, motor functioning)* * Monitor vitals * **Check labs for hepatotoxicity (elevated belirubin, AST,ALP, & PT)** * *Monitor for GI sympotoms before and after* * *Obtain baseline liver function tests* before initiating tx & repeat for 6 months * **7-10 day minimum for opioids to leave system, collect UA so ensure non in system**

Naltrexone

**Used to treat alcoholism** * Used w/ other rehab therapies * PO *When ingested before consumption of alc. an unpleasent reaction occurs* * N/V, dizziness * Blurred vision * Confusion * Sweating * Throbbing headache *Blocks metabolism of alc. called acetaldehyde* **Avoid all alc. products:** * *Mouthwash, rubbing alc.* * sleeping aids, *cough / cold products* * *Aftershave lotion* * Certain sauces & vinagers **Interventions:** * Perform basline neuro assessment *(A&O, bilateral hand grip, motor functioning)* * Monitor vitals * **Check labs for hepatotoxicity, UA (elevated belirubin, AST,ALP, & PT)** * *Monitor for GI sympotoms before and after* * *Obtain baseline liver function tests* **Adverse effects:** * Hives, puritus, rash * **Hepatotoxicity (jaundice, N/V/A, hepato/splenomegaly)** * Drug interactions (warfarin, phenytoin,benzos, ect.)

Disulfiram

Describes certain settings/enviornments designed to help clients replace inappropriate behaviors w/ more effective personal/ psychosocial skills Therapeutic tools include the use of eye contact, facial expressions, body movement, and other nonverbal behaviors

Therapeutic communication (milieu)

What are the 7 Principles of Mental Health Care?

1. Do no harm 2. Accept Pt as whole person 3. Develop trust 4. Explore behaviors & emotions 5. Encourage responsibility 6. Encourage effective adaptation-crisis intervention 7. Provide consistency

Energy exchanged between 2 people **A flow that moves patients toward constructive ways of thinking & effective ways of coping** Characteristics: * Acceptance * Rapport * Genuineness * Therapeutic use of self Components (*think TEACH*): **T** = Trust * Assured belief that others are capable of assisting in times of distress **E** = Empathy * Ability to walk a mile in anothers shoes **A** = Autonomy * Ability to detect & control one activities & density **C** = Caring * Energy that allows caregivers to unconditionally accept all people, even when they are most unlovable **H** = Hope * Expectation of acheiving a future goal * *Consists of 6 demensions - affective, affiliative, behavioral, cognitive, temporal, & contextual*

Therapeutic relationship

A Pt w/ seasonal affective disorder (SAD) may be treated successfully w/ which of the following body-based practices? A) Acupuncture B) Phototherapy C) Chelation D) Eye movement desensitization

B) Phototherapy

The absence of disparties / **avoidable differences among socioeconomic & demographic groups / geographical areas in health status** & health outcomes such as *disease, disability, or morality* Ex: * **Lack of health insurance** & high health care costs * **Language barriers, Lack of transportation** * Provider / Pt communication * **Biased clinical decidion making** * Pt's mistrust & refusal * Unequal pain management, palliative care & breast cancer screening * **Unequal early / adequate prenatal care, & recommended immunizations**

**HRSA** "Health disparties" / "Health equity"

**Ineffective emotional states**, ranging from deep depression to excited elation * AKA - " **Affective disorder** " (Affective means emotions) Disturbance in the emotional dimension of human functioning

Mood disorder

**Increase certain neruotransmitter activities** Divided into categories based on chemical formula: * **Tricyclic, atypical** * *Selective seretonin / norepinephrine reuptake inhibitor* (**SSRI/SSNRIs**), *monoamine oxidase inhibitor* (**MAOIs**) **Use**: * Bipolar, panic disorders * OCD, ADHD * Enuresis (bed wetting), bulimia * Neuropathic pain, conduct disorders in children *Require 1- 4 weeks before relief is noted* S/s: * **Hypertensive crisist** * *Headache, stiff neck, palpitations* (**toxicity**) * *Dry mouth, nose, & eyes, urinary retention, sedation* (**Anticholergic reactions**) Interventions: * **Report any behavior / physical changes** * Protect from falls (postural hypotension) * **Repost S/s of toxicity** * *Monitor kidney / liver function*

Antidepressant medications

Why do antidepressants interact w/ other drugs?

They block the destruction of specific major transmitterrs * higher levels of these chemicals circulate through the body

What are 3 interactions w/ monoamine oxidase inhibitors (MAOIs)?

**Anticholergic reactions**: * *Dry mouth*, blurred vision * Decreased tearing, *urinary hesitancy / retention* * Constipation, excessive sweating **Hypertensive crisis**: * Throbbing, **radiating headache, stiff neck** * **Palpitations**, chest tightness, **severe HTN, tachycardia** * *Dilated pupils*, sweating **CNS depression**: * **Change LOC**, disorientation, confusion, agitation * Sedation, **hallucinations**, low seizure threshold

What are side effects of Selective seretonin / norepinephrine reuptake inhibitors (SSRI/SNRIs)?

Dry mouth N/V/D/C/A/H Change in alertness Increased sweating Urinary & visual disturbances Dizziness, Fatigue, weakness, tremor

What are some dietary interactions w/ monoamine oxidase inhibitors (MAOIs)?

AVOID: * Beer/ ale, red wines, sherry wines, liqueurs,cognac (**Alcohol**) * **Aged cheese**, sour cream (**Dairy**) * **Avocados**, **bananas**, fava & broad beans, canned figs, & overriped fruit (**fruits/vegs**) * **Pickled/smoked/ tenderizer**, bologna, ck/beef, liver, dried fish, **salami meats**, **sauasages** (***salami meats***) * Large amounts of caffeinated **coffee, tea, or cola** * **Chocolate**, licorice, soy sauce, *yeast*

What should you instruct a pt to avoid when prescribed monoamine oxidase inhibitors (MAOIs)?

AVOID: * prescription & OTC nasal sprays, sinus decongestions, cold/allergy/hay fever remides * Inhalants for asthma * Weight loss pills, pep pills, stimulants, local anesthetics * Illicit drugs: Cocaine, any amphetamine (uppers), & narcotics

An **emotional state in which a person has an elevated, expansive, & irritable mood** accompanied by a loss of identity, increased activity, & grandiose thoughts & actions Seen in Bipolar disorders * Bipolar 1 & 2 * Cyclothymic disorders Can last 3 months * If allowed to continue, delirium & death from exhaustion may result - eventually depression phase begins again Hospitalization breaks the cycle

Mania

Feeling of sadness, disappointment, & despair Classified into depressive episodes, depressive disorders, & dysthymia on time & recurring behavior patterns Whole body illness that involves emotional, physical, intellectual, social, & spiritual disorders

Depression

Exaggerated sense of cheerfullness begins cycle the progresses to unstable "high of mania" * Behaviors become more impaired Still able to engage in daily living activities

Hypomania

**Episodes of major depression alternating w/ episodes of mania** * *More severe* Delusions, & hallucinations can occur

Bipolar 1

**Associated w/ hypomanic moods that do not progress to full manic states**, and are shorter than type 1 Often results in 1-2 weeks of severe lethargy, withdrawl, & melancholy, followed by several days of elevated ir irritable mood, constant activity, & risky decision making

Bipolar 2

Introduction of a controlled grand mal seizure by passing an electrical current through the brain **Works by raising the levels of the neurotransmitter norepinephrine** (lower in people w/ depression) * Tx 2-3x/week, takes about 15 min, 6-12 treatments over several weeks (*out pt/ or in Pt*) **Used only on clients w/ severe, long-lasting depression after attempts to stabilize the mood** w/ various medications & therapies have failed **Common side effects**: headache, confusion on awakening from the tx, short term amnesia, clients mood improves rapidly

Electroconvulsive Therapy (ECT)

Electroconvulsive Therapy (ECT) is not prescribed for what type of clients?

Recent MI/Heart attack Heart disease High/low BP Stroke CHF **Why**: Tx lowers BP and slows HR

What Pt education & nursing interventions would you implement for Electroconvulsive Therapy (ECT)?

NPO 8 hours before treatment Consent forms signed, remind client that confusion and memory loss are common after treatment Baseline vital signs Cardiac, BP, & O2 monitoring begins Short acting muscle relaxants, sedatives, an anesthetics agents admin. IV EEG

**Prolonged action of norepinephrine, dopamine, & serotonin by blocking reuptake** **Use**: * *Antidepressants*, *phantom limb pain* * Chronic pain, post herpetic neuralgia * Periphreal neuropathy **Adverse**: * *Blurred vision, constipation, dry mouth/nose/throat* (**common**) * *Parkinsonian, seizure activity, tachycardia* (**severe**) * *HF, dysrhythmias, suicidal actions* (**severe**) Drugs: * Amitriptyline (Elavil) * Clomipramine (Anafranil) * Doxepin (Silenor)

Tricyclin Antidepressants (TCA)

**Blocks metabolic destruction of norepinephrine, dopamine, & serotonin neurotransmitters** **Used when tricyclic antidepressant therapy is unsatisfactory** **Avoid tyramine (pickled foods, yeast, nuts, processed meats ect), ages cheese, wine/alcohol** * *causes HTN crisis* **Used for**: * Atypical depression * Panic disorder, & some phobias **adverse reaction**: * **Orthostatic Hypotension** * Restlessness, agitation * Blurred vision, constipation, urinary retention * **Dry mucosa of mouth, throat, & nose** * **Malignant HTN (Severe)** Drugs: * Phenelzine (Nardil) * Tranylcypromine * Selegiline (Emsam)

monoamine oxidose inhibitor (MAOIs)

**Inhibits reuptake & destruction of seritionin** from synaptic cleft, **prolonging action of neurotransmitter** **Use**: Widley w/ antidepressants **Adverse**: * Restlessness, agitation, anxiety * Insomnia, sedative effects * GI effects, suicidal actions

Selective serotonin reuptake inhibitors (SSRIs)

**antidepressant** medications **used to treat major depressive disorder, anxiety disorders, social phobia, chronic neuropathic pain, ect.** * PO Drug example: * **Drug**: Venlafaxine (Effexor) Works by helping to restore the balance of certain natural substances (serotonin and norepinephrine) in the brain S/s: * Confusion, mood swings * Blurred vision, headache * Tiredness, sleep changes * Brief feelings similar to electric shock.

Serotonin and norepinephrine reuptake inhibitors (SNRI)

Moderate depression for *2 years or more* S/s of depression Negative POV of the world Behavior example: * Chronically sad, major depressive episode * Self critical

Dysthymia

**Antimanic** * **Naturally occuring salt** * *Once Pt is no longer manic, the need for drug drops dramatically* Interaction between the level in the blood & common table salt Theraputic level: **0.6-1.2 mEq/L (MV-250)** * *Always be aware of level prior to admin* **Actions**: * Replaces intracellular & intraneuronal sodium * Stabilizes neuronal membrane * Reduces release of norepinephrine & increase uptake of tryptophan * Exact action unknown **Uses**: * **Mania** * Prevention of recurrent cycles **Premedication assessment labs, electrolytes, glucose, BUN/Cr, UA, thyroid function**

Lithium

What are side effects and interventions of Lithium?

Side effects: * Abd. discomfort, **N/D/A**, soft stool, **cramps** * *Edema (feet especially)* * *Hair loss, hypothyroidism* * Muscle weakness, fatigue * **Polyuria** (can progress to diabetes insipidus), * **Thirst, tremors**, weight gain Interventions: * **Give Lithium w/ food or milk** * Reassure s/s are temporary * Check salt restrictions w/ Dr. * **Obtain thyroid function test** * *Monitor I/O (report if >3000Ml/24 hr)* * Encourage to quench thirst, *eliminate caffeine* * *Moderatly restrict calories, reassure weight gain is common*

What are S/s of lithium toxicity?

**Mild - Blood serum level 1.5mEq/L** * Apathy, *sluggishness/drowsines* /lethargy * **Diminished concentration, mild incoordination** * Muscle weakness, muscle twitches, **course hand tremor** **Moderate - Blood serum level 1.5-2.5mEq/L** * N/V/D, Apathy * **Slurred speech, blurred vision, tinnitus** * sluggishness/drowsiness/lethargy, *muscle weakness* * **Irregular tremors**, ataxia, frank muscle twitching **Severe - Blood serum level 2.5mEq/L** * Irregular muscle tremors * **hyperactive deep tendon reflexes** * *Oliguria, dereased urine O/P* * **Severe LOC changes, hallucinations** * **Grandmal seizures, coma, death**

**Anticonvulsants - PO/ IV** *Decreases seizures* **Use**: * Simple/complex/absent/ mixed sizures * **Manic Bipolar episodes**, ADHD, *Schizo*. Side effects: * N/V/D/C/A, Rash * Sedation **Adverse**: * Coma * SI * Hepatotoxicity Interventions: * Assess seizure disorder & mental status * Blood studies (**Hct, HB, RBC, PT/PTT, platelets**)

Valproic Acid (Depakene)

**Antidepressant - PO** * **SSRI** *Potent inhibitor of neuronal serotonin & norepinephrine uptake* *Use: Prevention/Tx of **major depression*** **Adverse**: * SI, SJS * Tachycardia * Angioedema **Interventions**: * Mental status * Blood studies (**CBC, WBC, Cardiac enzymes**)

Venlafaxine (Effexor XR)

**Antipsychotic - PO/IM** Exact mech. unknown **Uses**: * schizo., bipolar disorder * **Mania, major depressive disorder** **Adverse**: * Seizures * SI * Tachycardia, agranulocytosis **BBW: assess mental status before use** **Interventions**: * Take BP, RR, & HR Q4h during initial tx

Aripirazole (Abilify)

What population is most at risk for anxiety?

Non-Hispanic whites Lower income

Related to a child's development level Problems associated w/ anxiety in childhood compulsions * Phobia * Separation anxiety * Overanxious disorder * Avoidant disorder (refuse to cope)

Anxiety in childhood

Ineffectively cope w/ anxiety often express themselves inappropriately * Cutting * Burning * Substance abuse, ect Many initial symptoms of schizo & other psychoses begin in adolescence

Anxiety in Adolescence

Handle anxiety by using earlier established coping mechanisms Several mental health problems may result if not successfully Developmental tasks: * Establishing a career & family * Numerous stressors

Anxiety in Adulthood

Must be long-standing Inappropriate or extreme reactions Commonly follows a loss or traumatic even * Nightmares * N/V * Sleep disturbances

Separation Anxiety

Individual's anxiety is broad, long-lasting & excessive * Worried & anxious often

Generalized Anxiety Disorder

Recurrent & persistent thoughts, impulses or images that are intrusive or inappropriate & cause marked anxiety or distress **(Obsession)** Repetitive behaviors or mental acts that the person feels drive to perform in response to an obsession or according to rules that must be applied rigidly **(Compulsions)** * *Hand washing, ordering, checking* **(Behavior)** * *Praying, counting, repeating* **(Mental acts)** Signs: * Fear of contamination * Repeated unwanted ideas * Aggressive impulse * Persistent sexual thoughts * Thoughts that you might cause other harms

Obsessive-Compulsive Disorder (OCD)

What are signs of compulsion?

Constant checking Constant counting Repeatedly cleaning 1+ objects Repeatedly washing hands Constantly checking the stove or door locks Arrange items to face a certain way

What are consequences of anxiety?

Mild-mod anxiety Severe anxiety to panic, panic Can lead to injury to self or others (suicide d/t impulsivity) Death if not managed

**Unavoidable part of life** * To become unable to find, To misplace * To fail to keep, win or gains * To have taken from one by accident, separation, or death Emotional reactions & resultant behaviors are learned from childhood observations & experiences Characteristics: * Actual or potential state * Temporary or permanent * Expected or unexpected * Sudden or gradual * **Maturational or situational** * Depends on value, importance, and significant of the loss

Nature of **Loss**

Losses outside the individual Example: * Repossession of a car * Death of a parent, pet, ect.

External losses

Losses that involve some part of oneself * Example: Loss of limb

Internal losses

What are various behaviors associated w/ the developmental reaction stages to loss?

**Preschoolers:** Cannor understand permanent loss **School-age:** Feel God or the Devil took loved one * *Children between ages 9-10 perceive loss as adults do* **Adults:** Facing loss are able to perceive events more abstractly

A method of resolving losses & healing or recovering Healing process that encourages individuals to continue on after loss Stages: * Denial * Yearning * Depression & identification * Acceptance & recovery

Grieving Process

Allows individuals to prepare for an impending loss Examples: * A divorce * Terminal Illness * Loss of body part

Anticipatory Grief

Mental health problem can result when the grieving process is prolonged or impairs functioning over time **Bereavement-Related Depression:** * Loss felt so intensely that feelings of despair & loss worthlessness overwhelm the patient **Complicated Grief:** * Persistent yearning for a deceased person * Therapeutic interventions involve listening, providing emotional support, & refering to appropriate resources

Unresolved Grief

Which of the following is a persistent yearing for a decreased person that often occurs w/o signs of depression? A) Complicated grief B) Bereavement-related depression C) Anticipatory grief D) Mourning

A) Complicated grief

The patient has come to the hopsital because of poor appetite, insomnia, inability to concentrate on work tasks, & hostile moods. The patient lost her husband 1 month ago, & sincehis death, she has become isolated from her friends as well. The patient's condition is known as what? A) Mourning B) Complicated Grief C) Bereavement-related depression D) Anticipatory Grief

C) Bereavement-related depression

Last stage of growth & development * Can occur suddenly or gradually Remains unchanged, but attitudes, beliefs, & behaviors surrounding death vary as the individuals who practice them By age 12, children are aware that death is irriversible * *Sibling of dying child needs extra attention * **Terminal Illness**: * Condition in which outcome is death * Grieving occurs * Responsiveness & preparation * Meaning of death to the individual * Coping mechanisms used throughout life * Dx of illness or condition is received w/ disbelief & shock

Dying process

What are the stages of dying & the stages are simplified into what 3 basic phases?

**Stages:** 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance **3 basic phases:** 1. Resistance 2. Working 3. Acceptance

A patient is terminally ill. She has been given a diagnosis of pancreatic cancer & less than 6 months to live. She has been experiencing denial, anger, & bargaining. The patient is at what stage of dying? A) Resistance B) Working C) Personal D) Acceptance

A) Resistance

**Distrust & suspiciousness** **See others motives as threatening or malevolent (Intending to do harm)** May interact in odd or distant ways **Untrusting/ unforgiving, friend or enemy** **Preceives attack (Quick response)** Jealous, scheming, secretive May be emotionally cold or distant **Threats are percieved**

Paranoid **Cluster A - Odd/Eccentric**

**Detached, Neither enjoys or desires close relationships** Emotionally cold & distant, **sexually indifferent** Absorbed in own thoughts and feelings **Indifferent to criticism/ praise** **Neither enjoys or desires close relationships** Takes pleasure in few activities

Schizoid **Cluster A - Odd/Eccentric**

**Constricted (Inappropriate)** affect **Lack of close friends** *Ideas of reference* **unusual/odd thinking/behavior** **Paranoid, eccentric behavior/appearance, anxiety** *Rule out disorders* (Psychotic/developmental)

Schizotypal **Cluster A - Odd/Eccentric**

Disregards/violations rights of others **Ignore rules/ laws** of acceptable behaviors **Impulsive, irresponsible, aggressive, belligerent, reckless, temper** Feels no remorse for behaviors Often reffere to as **psychpaths or sociopaths** * Rely on deceit & manipulation * Hallmark is lack of conscience

Anti-social **Cluster B - Dramatic/Emotional/ Erratic**

**Unstable** *emotions, moods, & behavior, emptiness* **Identity Disturbance** Stormy interpersonall relationships, **abandonment** Unpredictable, self - destructive, **suicidal** Dissociate / paranoid symptoms

Borderline **Cluster B - Dramatic/Emotional/ Erratic**

Excessive emotional expression & attention seeking behaviors **P**: Proactive (seductive) behavior **R**: Relationshps (misinterpreted) **A**: Attention seeking **I**: Influenced easily **S**: Style of speech (showy, lacks detail) **E**: Emotions (change rapidly, showy) **M**: Made up (draw attention to self) **E**: Emotions exaggerated (theatrical)

Histrionic **Cluster B - Dramatic/Emotional/ Erratic**

**Believes they are special & unique** Preoccupied w/ fantasies (*unlimited success, power, beauty, ideal love, brilliance*) **No empathy** or concern for other people or animals **Conceited** (*Grandiose sense of self importance*) Exploits interpersonal relationships **Envious, entitled**

Narcissistic **Cluster B - Dramatic/Emotional/ Erratic**

**Negative self view** *Embarassment* (potential) *Rejection*, certainty **Intimate relationships, new interpersonal relationships** Gets around occupational activity

Avoidant **Cluster C -*Anxious/Fearful***

Excessive need to be cared for/ **nurtured**, **resulting in clinging/ companionship**, submissive behaviors, **requires much reassurance & attention** Expressing disagreement, life responsibility, **exaggerated fear** Helpless & uncomfortable when left *alone*

Dependant *(Fearful)*

*Loses point of activity, ability to perform tasks* **Worthless objects, miserly, stubborn** *friendships excluded* Inflexible over conscientious Reluctant to delagate

Obsessive compulsive *(Fearful)*

**Characterized by odds or strange behaviors** * **Group A** Find it difficult to relate to others or socialize comfortably *Often live in isolation & interact only when necessary* **Clusters include**: * Paranoia * Schizoid * Schizotypal

Eccentric Cluster

**Characteristic is dramatic behavior** * **Group B** Often overly emotional, w/ unpredictable thinking & behaviors Associated w/ dramatic quality in the way these individuals live & conduct their lives Clusters: * Antisocial * Borderline * Histrionic * Narcissistic

Erratic Cluster

Characteristic is anxiety * **Group C** Cluster: * **Avoidant personality**: Fear of rejection & humiliation * **Dependent personality**: Associated w/ separation & abandonment * **Obsessive-compulsive personality**: Uncertain about future

Fearful Cluster

What diagnostic tests relate to personality disorders?

CBC Thyroid function test Screening for HIV & other STD/STI's CT, X-ray

T/F - spirituality is not universal

False - spirituality is universal

What is the difference between Serotonin & Dopamine?

**Serotonin**: * Neurotransmitter (happy hormone) * Helps w/ sleep, emotions, & remembering **Dopamine**: * Neurotransmitter * Helps w/ determination, obsession, & pleasure * Pleasure receptors

A**ntipsychotic** * 1st generation - **Typical** *Treats schizo, tourettes & controls motor movement* S/s: * Spasms of face, neck, & tongue * **High fever, sweating, change LOC, muscle tremor (NMS)** **HOLD medication if s/s of NMS occur** * *Assess first then report to HCP*

Haloperidol

An individual does not maintain normal body weight d/t intense fear of becoming fat * *One of most common/ dramatic eating disorders* * **Life threatening** **People concerned w/ apperiance (High risk):** * Models * Athletes * Flight attendants Often weigh self 3-4x/day, measures body parts, & frequently looks in the mirrior to check for areas of fat **Death usually results from dehydration, loss of critical muscle mass, electrolyte imbalance, or suicide** *Monitor frequently for physical or mental changes *

Anorexia Nervosa

Occurs in anorexia nervosa **Imbalance in fluids & electrolytes that can lead to cellular dysfunctions & life threatening complications (HF)** in individuals w/ little or know nutritional intake *Monitor frequently for physical or mental changes *

Refeeding syndrome

Binge eating by use of inapproriate methods to prevent weight gain * **Occurs more commonly** Often found in young, white middle/ upper class women or those w/ an increase of anxiety, depression, & drug abuse Binge lasts 1-2 hours , & is followed by feeling of guilt & attemps to get ride of the food consumed * Eat in private * Feel out of control & eat in frenzy state **Purging**: * Attemot to rid GI tract & body of unwanted food * **Most common behavior is vomiting & use of diuretics/laxitives** **Non-Purging**: * Does not purge after binge * Uses inapproprate ways to gain weight (fasting between binges & excercising excessively

Bulima

**Result of too many calories consumed or not enough burned** * Excess body weight * *Have larger fat cells* Classified as: * **Mildly**: 20% - 40% above normal * **Moderatley**: 41% - 100% above normal * **Severely (Morbidly)**: More than 100% above normal *Commonly struggle w/ feelings of helplessness, worthlessness, or suicide* * Eats to relieve pain * Replace social interactions w/ comfort of foods

Obesity

How would you medically treat an obese patient?

**Highest priority is to stabilize existing medical condition** **Second priority is to reestablish normal nutrition & eating habits** to resolve psychological/emotional issues related to eating behaviors * Nutrients administered via IV Parenteral nutrition (PN) - severe weight loss **Daily weights**, *administer supplements*, monitor vitals **Monitor for refeeding syndrome** *Observe for secret anoretic or bulimic behaviors* **Focus on teaching about good nutrition & assist on developing appropriate eating habits** * **Goal**:*Assist client in identifying & coping w/ problems leading to inappropriate eating behavior*

What happends to the body as we sleep?

Body conserves energy Metabolic rate slows Workload on heart decreases Muscles relax

What criteria is needed in order to Dx bulimia?

1. Recurring episodes of binge eating 2. Binging followed by recurring inapproriate behaviors to prevent weight gain 3. Eating binges at least 2x/week for at least 3 months 4. Excessive emphasis placed on body shape & weight in determining self-esteem

T/F: Dreams help gain insight, solve problems, work through emotional reactions & prepare for the future

True

**Overwhelming need to eat nonfood items** * Lasts for more than 1 month * Still eats & enjoys **Nonfood items include:** * Clay * Laundry starch * Insects * Leaves * Pebbles Cause can be traced to vitamins, minerals, or calorie deficiency

Pica

Abnormalities of physical mechanisms that regulate sleep & wakefulness Include: * Insomnia * Hypersomnia * Narcolepsy * Breathing & circadian rhythem sleep disorder * REM sleep * Restless leg syndrome

Dyssomnias

**Disorder of falling asleep or maintaining sound sleep** * *Most common dyssomnias* Associated w/ increased physical & mental alertness at night & sleepiness during the day Contributes more anxiety about sleep * The harder you try, the more difficutly it becomes to fall asleep **Chronic**: * Leads to decreased well-being during waking hours * Accompanied by a lack of energy or motivation, decreased attention span. & poor concentration * General worsening moods & emotional reactions

Insomnia

**Uncommon condition in which an individual has repeated attacks of sleep** Onset of disorders often follow change in a persons sleep-wake schedule, or very stressful event Periods of sleepiness are described as irresistable Individuals fall asleep for about 10-20 minutes in any situation whether it is appropriate to sleep or not * Occurs 2-6x/day * Some can "fight off" sleep attacks, where others plan naps to manage condition

Narcolespy