Mental Health FINAL Flashcards
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
What are S/s of Psychosis-Positive Symptoms?
Delusions
Hallucinations
Disorganized thinking
Disorganized/abnormal motor behavior
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)
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)
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
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
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)
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
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
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
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
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%
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
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
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
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
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
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
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
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
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
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
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
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
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?
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?
- Do no harm
- Accept Pt as whole person
- Develop trust
- Explore behaviors & emotions
- Encourage responsibility
- Encourage effective adaptation-crisis intervention
- 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
