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NURS 503 > Mental Health in Adults > Flashcards

Mental Health in Adults Flashcards

1
Q

What is the most common class of mental disorders?

A

Anxiety disorders

  • Phobias are the leading cause
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2
Q

What two conditions are often associated with GAD?

A
  • Mixed headache
  • IBS
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3
Q

Common complaints patients present with if you suspect anxiety

A

Worry, anxiety, fear

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4
Q

Anxiety physical complaints

A
  • Fatigue
  • Irritability
  • Cognitive changes
  • Sleep disturbances
  • Other psychiatric illnesses (depression, SUD)
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5
Q

What is the definition of GAD?

A

Excessive anxiety and worry about a number of events or activities

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6
Q

Diagnostic considerations for anxiety

A

Must meet criteria in DSM-5 with symptoms being at a moderate to severe level impacting hygiene, relationships, employment, education

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7
Q

Screening tools that can be used for anxiety

A
  • GAD-7
  • PC-PTSD
  • SPIN
  • PHQ-SADS
  • PHQ-15
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8
Q

Diagnostic tests and labs for anxiety

A
  • Complete physical exam
  • Thorough ROS
  • CBC, CMP, TSH, vitamin B12, electrolytes
  • Toxicology screen
  • ECG (if necessary)
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9
Q

When is a mental health referral indicated for patients with anxiety? To the ED?

A
  • Mental health referral if not responding to first line medications
  • ED referral if at risk for harming themselves or others
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10
Q

Pharmacotherapy management for anxiety

A
  • Antidepressants (SSRIs, SNRIs)
  • Benzodiazepines (acute anxiety)
  • Buspirone (for GAD only)
  • Atypical antipsychotics
    • Monitor for metabolic disorder
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11
Q

When prescribing medications for anxiety, how long should therapy continue?

A

Medications should be continued for at least 6-12 months after symptoms have resolved

  • To avoid relapse
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12
Q

Benzodiazepines should not be prescribed for what disorder?

A

Insomnia

  • Can cause rebound insomnia when benzodiazepine is discontinued
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13
Q

What classification of medication is contraindicated for patients with a history of risk for suicide?

A

TCAs

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14
Q

Common clinical presentation of unipolar depression

A
  • Disinterest
  • Persistent sadness
  • Helplessness
  • Pessimism
  • Worthlessness
  • Guilt
  • Tiredness
  • Confusion
  • Irritability
  • Decreased concentration
  • Diminished hygiene
  • Increased alcohol intake
  • Unexplained weight loss or weight gain
  • Thoughts of death
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15
Q

Common clinical presentation of bipolar disorder

  • Bipolar I
A
  • Mania
  • Hypomania
  • Severe depression
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16
Q

Common clinical presentation of bipolar disorder

  • Bipolar II
A
  • History of hypomania and major depression
  • NO manic episodes
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17
Q

Common clinical presentation of bipolar disorder (general)

A
  • Profound depression
  • Several days of reduced or no sleep without fatigue
  • Mood swings
  • Racing thoughts
  • Irritability and irrationality
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18
Q

Clinical presentation of seasonal affective disorder (SAD)

A

Symptoms associated with bipolar I and II but related to changes in season (especially during fall and winter)

  • Hypomania
  • Mania
  • Depression
  • Carbohydrate craving
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19
Q

If a patient is taking medications for seasonal affective disorder (SAD), when should they wean off their medications?

A

Can wean off during warmer months

20
Q

What is normally the first sign of depression in children/adolescents/adults and older adults?

A

Children, adolescents, adults → irritability

Older adults → cognitive dysfunction

21
Q

Non pharmacologic management of depression and bipolar disorder

A
  • Psychotherapy
  • CBT
  • Family therapy
  • Substance use counseling
  • Promote healthy lifestyle changes
  • SAD → bright light therapy
  • Bipolar → ECT
22
Q

Medications for depression therapy

A
  • SSRIs
  • SNRIs
  • Atypical antidepressants
  • TCAs
  • MAOIs
23
Q

What patient education should be mentioned with MAOI therapy?

A

Avoid foods high in tyramine

  • Aged cheese, sauerkraut, cured meats, draft beer, fermented soy products
24
Q

Indications for immediate referral for patients with substance use disorder

A
  • Withdrawal seizures (from benzodiazepines or alcohol withdrawal)
  • Delirium tremens
  • Overdose
  • Suicidality/homicidality/psychosis
  • Ready for treatment
25
Q

What is tolerance?

A

A person no longer responds to a drug in the way they did at first, so it takes a higher dose of the drug to achieve the same effect as when the person first used it

26
Q

What is dependence and withdrawal?

A

Dependence means that when a person stops using a drug, their body goes through “withdrawal”

  • A group of physical and mental symptoms that can range from mild to life-threatening
27
Q

What substances are considered CNS sedatives?

A
  • Alcohol
  • Barbiturates
  • Benzodiazepines
  • Opioids
28
Q

What substances are considered CNS stimulants?

A
  • Cocaine
  • Amphetamines
29
Q

What substances are considered psychotomimetic and hallucinogens?

A
  • PCP
  • LSD
  • Inhalants
  • Anabolic steroids
  • Injection drug use
30
Q

If a patient presents with acute pain, can the provider prescribe opioids?

A

Yes - start with immediate release opioids

  • Prescribe only for <3 days or 7 days maximum
  • Reevaluate every 3 months
31
Q

How would patients with substance use disorder (SUD) initially present?

A

Behavioral problems appear first

  • Early manifestations of addiction are rarely apparent with routine examination
32
Q

Clinical presentation of CNS sedatives

A
  • Tranquilization
  • Fine lateral or coarse nystagmus
  • Decreased alertness (intoxication)
  • Ataxia
  • Slurred speech
  • Sedation (moderate intoxication)
  • Somnolence
  • Staggering
  • Dysarthria
  • Coma
  • Respiratory depression and death
33
Q

Clinical presentation of opioid addiction

A
  • Euphoria
  • Calmness
  • Sedation
  • Constricted pupils
  • Decreased RR and bowel motility
  • Mildly decreased BP and HR
  • N/V
  • Generalized itchiness
34
Q

Clinical presentation of stimulant use

A
  • Enhanced state of alertness
  • High energy
  • Euphoria
  • Appetite suppression
  • Decreased need for sleep
35
Q

Clinical presentation of hallucinogen use

A
  • Extreme euphoria to severe depression/paranoia/panic or transient psychosis
  • Pupil dilation
  • Tachycardia or HTN
  • Hyperthermic crisis → dry skin, agitation, muscle hypertonicity, seizures
36
Q

Clinical presentation of cannabis use

A
  • Euphoria
  • Relaxation
  • Altered sensory perception
37
Q

Alcohol withdrawal begins __ hours after the patient’s last drink, and can last 1-2 days

A

6-24 hours

38
Q

How soon does delirium tremens occur after alcohol consumption?

A

Occurs within 72-96 hours after last alcohol consumption

39
Q

Signs and symptoms of delirium tremens

A
  • Severe tachycardia
  • Tremor
  • Confusion
  • Hallucinations
  • Agitation
  • Diaphoresis
  • Fever
  • Seizures
40
Q

Screening tools for substance use disorder (SUD)

A

AUDIT and CRAFFT for alcohol

DAST-10 for SUD

41
Q

Lab tests that can be ordered for patients with substance use disorder (SUD)

A
  • CBC, CMP, BUN, creatinine, LFT, glucose, electrolytes
  • Hepatitis panel
  • HIV screening
  • HCG test
  • Thyroid test
  • Drug screening
42
Q

Alcohol abuse lab findings

A
  • AST to ALT ratio of 2:1 → alcohol related liver disease
  • Elevated GGT (most sensitive marker of excessive alcohol use)
  • Elevated MCV
  • Elevated CDT
43
Q

Gold standard medication for alcohol withdrawal

A

Benzodiazepines (based on CIWA score)

44
Q

Medication for opioid overdose

A

Naloxone

45
Q

SSRI and SNRI side effects

A
  • Sexual dysfunction
  • Nausea, diarrhea, constipation
  • Dry mouth
  • Headache
  • Dizziness
  • Insomnia
46
Q

TCA side effects

A
  • Drowsiness, fatigue, sedation
  • Dry mouth
  • Weight gain

NURS 503 (10 decks)

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