Mental Health part 2 Flashcards
1
Q
reduction in or lack of energy
A
anergia
2
Q
an inability to find meaning or pleasure in existence
A
anhedonia
3
Q
a classification of more recently released antidepressants affecting a variety of neurotransmitters
A
atypical antidepressants
4
Q
a mild to moderate mood disturbance characterized by chronic depression syndrome that is usually present for at least 2 years
A
dysthymic disorder
5
Q
an effective tx for depressio nin which a grand mal seizure is induced by passing an electrical current through electrodes that are applied to the temples. The admin of a muscle relaxant minimizes seizure activity and prevents damage to long bones and cervical vertebrae
A
Electroconvulsive therapy (ECT)
6
Q
the spending of increased time in sleep, possibly to escape from painful feelings; however the incresed sleep is not experienced as restful or refreshing
A
hypersomina
7
Q
inabilty to fall asleep or to stay asleep, early morning awakening or both
A
insomnia
8
Q
a classificati nof antidepressants that inhibit monoamine oxidase, an enzyme that breaks dowm amines such as serotonin and norepinephrine. The use of this necessitates the adoption of a tryamine-free diet bc of potentially fatal interactions
A
Monoamine oxidase inhibitors (MAOI)
9
Q
a pervasive and sustained emotion that, when extreme, can markedly color the way individual perceives the world
A
mood
10
Q
PT may constantly pace, bite their nails, smoke, tap their fingers, or engage in some other tension relieving activity
A
psychomotor agitation
11
Q
slowed and difficult movements to complete inactivity and incontinence
A
psychomotor retardation
12
Q
1st line antidepressants that block the reuptake of serotonin, permitting serotonin to act for an extended period at the synaptic binding sites in the brain
A
selective serotonin reuptake inhibitors (SSRI)
13
Q
drugs that inhibit the reuptake of norepinephrine and serotonin by presynaptic neurons in the CNS, increasing the amount of time norepinephrine and serotonin are available to the postsynaptic receptors
A
tricyclic antidepressants
14
Q
name the 3 types of mood disorders
A
major depressive disorder
dyshymic disorder
postpartum depression
15
Q
the primary alteratio nin depression is what
A
mood, rather than in thought or perception
16
Q
the most common cause of depression is
A
neurobiologic (serotonin & norepinephrine)
17
Q
serotonin does what
A
regulates sleep, apettite, mood
18
Q
low levels of norepinephrine does what
A
no energy, cant concentrate
19
Q
both serotonin and norepinephrine are involved in what
A
perception of pain
20
Q
depression can occur because of medication side effects such as
A
corticosteriods, anti psycotic, anti HTN, anti parkinsons
21
Q
depression can occur because of neurological disorders such as
A
CVA, brain tumor (temporal lobe), alzhiemers
22
Q
depression an occur because of electrolyte disturbances such as
A
excessive amounts of sodium or calcium or a deficit in Mg
23
Q
depression can occur because of nutritional deficiencies such as
A
deficit in B1 (thiamin), zinc, folic acid, niacin
24
Q
what psychosocial event can cause depression
A
reactio nto life events, early life trauma
25
plays a part in the stress response, if you have a major stressor, can deplete norepinephrine stores which causes depression
norepinephrine
26
Sx of depression
mood sadness, despair, emptiness, adhedonia, low self esteem, apathy, low motivation, social withdraw
27
single or recurrant episode, experience pain an dsuffering, does not function normally, Sx persist over a minumial 2 week period
major depressive disorder
28
For DSM what must you hve for major depressive disorder
loss of ability to experience pleasure in life*
depresssed mood, anhedonia, change in weight, psychomotor agitation or retardation, fatigue, anergia, feelings of worthlessness, diminished concentration, recurrent thoughts of death or suicide
*must have this
29
Melancholic features
complete loss of pleasure in life and inability to feel better, feels worse in morning, weight loss, excessive guilt, has psychotic features
30
postpartum onset
within 4 weeks postpartum, delusional thoughts about infant signigy risk of harm to infant
31
catatonic features
exhopraxia, grimacing, sterotyped movements, posturing, negativism, waxy flexibilty, mutism, agitation
32
atypical features
mood reactivity (opp of what is expected), hypersomnia, hyperphagia, leaden paralysis, rejecction sensitivity
33
depressed mood for at least 2 years for more days than not, disorder of chronicity rather than severity
dysthymic disorder
34
S/Sx of dysthymic disorder
chronic sadness, eating too much or too little, difficulty getting to sleep, low energy, decreased pleasure, negative thinking, low self esteem, feelings of worthlessness
35
physical changes of dysthymic disorder
psycomotor agitation/retardation, vegatative signs
36
natural response to death, responsive to social contacts, typically does not need antidepressants
grief
37
an illness, persistent and can worsen, suicidal ideation, responsive to antidepressants
depression
38
Black box warnings
carefully observe for worsening symptoms of depression and suicidal thuoghts
39
nonselective inhibition of norepinephrine and serotonin.
| Ex. Elavil, Sinequan, Anafrail, Pamelor, Norpramin, Asendin
Tricyclic Antidepressants
40
Tricyclic antidepressants
take 10-14 days to become effective, tapper Rx to effective dose
SE: dry mouth, blurred vision, tachycardia, constipation, urinary retention, esophageal reflux, postural orthostatic hypotension, weight gain, can trigger manic episode, agranulocytosis, nightmares
41
when are tricyclic antidepressants given
at night due to sedative effects
42
Tricyclic Toxic effect
cardiovascular: dysrhythmias, MI, Heart block, tachycardia
43
what off brand issue can tricyclic antidepressants help with
migraines
44
what is contraindicated in taking Tricyclic Antidepressants
MAOI, Lethal in overdose
45
selectivley block the reuptake of serotonin (block the reuptake process, leaving a longer period of time for the serotonin to act on the recieving cell)
Ex. Celexa, Lexapro, Prozac, Luvox, Paxil, Zoloft
SSRI, selective serotonin reuptake inhibitors
46
SE of SSRI
HA, N, insomnia, treamors, sexual dysfunction, agitation or sense of restlessness
47
overactivatio nof central serotonin receptors, rare, life threatening, usually happens when taken with MAOI
serotonin syndrome
48
S/Sx of serotonin syndrome
abdominal pain, diarrhea, piaphoresis, hyperreflexia, tachycardia, increase BP, confusion, restlessness, myoclonus (tenseness)
49
blocks the reputake of serotonin and morepinephrine, may be more effective than SSRI
Ex. Effexor, Cymbalta, Remeron
Selective sertotonin Norepinephrine reuptake inhibiotrs (SNRI)
50
SE of SNRI
HTN, N, insomina, dry mouth, sweating, agiataion, HA, sexual dysfunction
51
When take a Rx and abruptly stop, S/Sx: HA, Gi upset, dizziness, flu like Sx, insomina and anxiety
discontinuation syndrome
52
a form of bipolar disorder in which at least one episode of maina alternates with major depression
Bipolar I disorder
53
a form of bipolar disorder in which hypomanic episodes alternate with major depression
Bipolar II disorder
54
the meaningliess rhyming of words often in a foreful manner
clang associations
55
mood swing that alternates btwn hypomania and depressio nbut not major depression
cyclothymia
56
a continucous flow of speech in which the person jumps from one topic to another themes ofthen include grandiose and fantasized evalation of personal sexual prowess, buisness ability, artistic talents and so forth
flight of ideas
57
a mild form of mania marked by elation and hyperactivity, these differ in that they do not cause significant distress or impatis ones work family or social life in an obvious way while manic episodes do
hypomanic
58
exaggerated belief in or claims about ones importance or identity
grandiosity
59
known as a antimanic drug bc it can stabilize the manic phase of a bipolar disorder, it can modify future manic episodes and protect against future depressive episodes
lithium carbonate
60
an unstable elevated mood in which delusion, poor judgement, and other signs of impaired reality testing are evident
mania
61
experiencing four or more mood episodes in a 12 month period
rapid cycling
62
acute often painful sustained contractio nof muscles usually of the head and neck, which typicaly occur from 2-5 days after the introduction of certain antipsycotic Rxs
acute dystonia
63
outward manifestion of a persons feelings and emotions, schizophrenia may cause flat, blunted, inapproptiate or bizarre effect
affect
64
regular rhythmic movements usually of the lower limbs, constant pacing may also be seen, othen noticed in people taking antipsychotic medications
akathisia
65
a disturbance of thinking in which ideas shift form one subejct to another in an oblique or unrelated manner
associative looseness
66
classification of antipsychotic medications, also known as 2nd generation antypsychotics, which interact which sertonin as well as dopamine receptors, they are considered 1st line tx for psychosis and have a low profile for extrapyramidal side effects
atypical antipsychotics
67
meaningless rhyming of words, often in a forceful manner
clang association
68
thinking grounded in immediate experience rather than abstraction
concrete thinking
69
"vioces" that directs the person to take action
command hallucinations
70
original calssification of antipsychotic Rxs also known as typical and 1st generation antipsychotics which work by D2 receptor antagonism, they are effective in tx of positive sx but not negative sx
conventional antipsychotics
71
a false belief held to be true even with evidence to the contrary
delusions
72
repeating of the last words spoken by another, mimicry or imitation of the speech of another person
echolalia
73
mimicry of imitation of the movemenets of another person
echopraxia
74
variety of S/Sx that are often SE of the use of certain psychotic rxs particularly phenothiazines. Three reversible extrapyramidal side effects are acute dystonia, akathisia, and pseudoparkinsonism. A fourth tardive dyskinesia is the most serious and not reversible
extrapyramidal side effects (EPSs)
75
a sense of perception for which no external stimulus exists
hallucinations
76
an error in the perception of a sensory stimulus
illusion
77
absence of something that shoud be present
negative sx
78
a word a person makes up that has meaning only for that person, often part of a delusional system
neologisms
79
rare and sometimes fatal reactio nto high potency neuroleptic drugs, Sx: muscle rigidity, fever, elevated WBC
neuroleptic malignant syndrome (NMS)
80
the presence of something that is not normally present
positive Sx
81
a medication induced temporaty constellatio nof Sx associated with parkinsons disease
pseudoparkinsonism
82
serious and irreversible side effect of the phenothiazines and related Rxs; consists of involuntary tonic muscle spasms typically involving the tongue, fingers, toes, neck or pelvis
tardive dyskinesia (TD or TDK)
83
what type of depression medications are contraindicated in people taking MAOIs
atypical antidepressants
| ex. Wellbutrin, Serzone, BuSpar
84
MAOI
2nd line agent, beneficial for those who do not respond to other antidepressants or ECT
85
inhibits the enzyme which normally breaks down serotonin, dopamine and norepinephrine, also inhibits the breakdown of tyramine in the liver
MAOI antidepressant
| Ex. Nardil, Parnate, Marplan
86
Problem with MAOI
results in increase of Tyramine level which can lead to HTN crisis, CVA, death
MUST restrict intake of Tyramine
87
Food restrictions with Tyramine
avocados, fermented veggies/meats, aged cheese, bananas, meat tenderizer, caffeinated drinks, beer and ale, chocolate, ginsing
88
HTN crisis Tx
Medical emergency
Procardia, Adalat
VS Q10-15 minutes
89
Transdermal selegiline (emsam)
inhibits monoamine oxidase in CNS, avoids breakdown of tyramine in liver,
90
can St. Johns wort be used for depression
yes
91
electroconvulsive therapy
used for major depression with psychotic sx, tx resistant depression, usually 3x week for 8-10 txs, informed consent required, NPO night prior
92
seasonal affective disorder
depression followed by mania (summer=mania, winter=depression)
93
Tx for seasonal affective disorder
2-3 hours of bright light /day within 3-4 days feel better
94
Maternity or baby blues
mildest form of postpartum, sx peak btwn postpartum days 3 and 5, resolve spontaneously within 24-72 hours, Tx supportive care and reassurance
95
Postpartum psychosis
most severe impairment, sx: hallucinations and delusions that focus on infant dying or being divine or demonic, places mother at highest risk of infanticide or suicide
96
postpartum depression
Sx: must be present for more than 2 weeks, dysphoric mood or anhedonia, delusions, recurrent thoughts of death or suicide, anxiety of child's health
97
what is the cause of postpartum depression
link btwn rapid drop in hormones after delivery and depression
98
a brain disprder that affects a persons thinking, language, emotions, social behavior, and ability to perceive reality accurately
schizophrenia
99
age of onset of schizophrenia
late adolescence or early adulthood
100
the onset and relapse of schizophrenia almost always related to
stress
101
etiology of schizophrenia
genetics, excess levels of dopamine (drug use {cocaine, Ritalin, levodopa}) early brain injury, use of street drugs
102
what anatomical abnormalities are found in schizophrenia
ventricular enlargement, smaller cortex, temporal cortex, hippocampus. slightly larger right hemisphere, lower than normal overall activity in the left hemisphere
103
phases of schizophrenia
prodromal phase
acute phase
maintenance phase
stabilization phase
104
Sx begin about a month to a year before the first break, Sx include social withdraw, depression, perceptual disturbances, magical thinking
prodromal phase
105
psychotic Sx are present (post., neg., and cognitive Sx)
acute phase
106
acute Sx decrease in severity, particularly positive Sx
maintenance phase
107
done by maintaining Rx and decrease stress, Sx remain in remission, may be mild persistent Sx
Stabilization phase
108
criteria for schizophrenia
at least 2 of the following:
delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative Sx are present
*continue for at least 6 months
109
what reflects a loss of normal functions
| -show structural brain abnormalities and respond poorly to Tx
Negative Sx
110
what reflects an excess of distortion of normal functions, have better outcome with Tx
Positive Sx
111
Examples of positive Sx
alterations in:
| thinking (delusions), speech, perception (hallucinations), behavior
112
feels threatened and believes others are out to harm, usually scan the environment
delusions of persecution
113
exaggerated feeling of importance, power, knowledge
delusions of grandeur
114
false idea about the functioning body
somatic delusions
115
has a false idea that ones mate is unfaithful, may have so-called proof
jealousy delusion
116
misconstruing trivial events and remarks and giving them personal significance
delusions of ideas of reference
117
believes certain objects or persons have control over him
delusion of control or influence
118
delusion
fixed false belief
119
over emphasis on specific details and impairment in the ability to use abstract concepts
concrete thinking
120
ideas shift from one unrelated subject to another, unaware that the topics are unrelated
associative looseness
121
invents new words, meaningless to others,
neologisms
122
repeating of another's words by imitation and is often seen in people with catatonia
echolalia
123
mimicking another's movements
echopraxia
124
choice of words is governed by sounds, thakes form of rhyming
clang association
125
a group of words that are put together randomly, without logical connection,
word salad
126
what hallucination is most common
auditory
127
command hallucination
voices that try to get the schizophrenia to do or say something usually negative
128
lack of sense of where their bodies end in relationship to where others begin
personal boundary difficulties
129
loss of his/her identity
depersonalization
130
false perception that the environment has changed
derealization
131
what alterations in behavior may you see in a schizophrenic
extreme motor agitation, automatic obedience (robot), sterotyped behaviors, waxy flexibility, stupor
132
examples of negative Sx
affective blunting, poverty of speech, anergia, anhedoina (inability to experience pleasure), avolition (lack of motivation), thought blocking,
133
irrational suspicion, ideas of reference, usually later onset
paranoid
134
extreme abnormal behavior, either agitation or retardation
catatonic
135
most regressed and socially impaired, often homeless, bizarre mannerisms, extreme social withdraw, incoherent speech
most severe
disorganized
136
does not meet the criteria for paranoid catatonic or disorganized type
early onset, insidious
undifferentiated
137
active phase sx are not present, 2 or more residual sx are present (social withdraw, inability to work or study, lack of content of speech, odd beliefs)
residual
138
4-10 L/day, thirst and osmotic dysregulation,
psychosis induced polydipsia
139
what is the most common form of abuse is an addiction to
nicotine
140
Tx positive Sx and disorganization Sx , do little to affect negative Sx
major effect is to decrease hallucinations, delusions, and psychotic thinking
antipsychotic Rx
141
how do conventional antipsychotics work
blocking dopamine receptors in the brain
142
Mesolimbic pathway
starts in brain stem and goes to limbic system, any chemical that decreases dopamine in the limbic system decreases psychotic Sx
143
mesocortical pathway
starts in brain stem and goes to the surface of the frontal lobe of the brain
dopamine in the frontal cortex stimulates behavior, thought, expression, and motivation
144
nigrostriatal pathway
starts in brain stem and ends at the basal ganglion of the brain
control system for the extrapyramidal motor system (motor movements)
145
Extrapyramidal side effects
when dopamine is blocked, tremor, sudden muscle spasms, motor restlessness.
all are Txable except for tardive dyskinesia
146
typical/conventional antipsychotics
predominantly dopamine antagonists in both the limbic and motor centers, blocking postsynaptic D2 receptors, decrease positive Sx
Ex:Haldol, stelazine, prolixin, loxitane, moban, triafon, thorazine, mellaril
147
SE of typical/conventional antipsychotics
extrapyramidal, weight gain, DM
148
include sudden often dramatic spasms of muscles of head neck lips and tongue
acute dystonia reactions
| Tx with anticholinergic Rx
149
tapping of foot, rocking, shifting weight, nervousness, caffeine makes it worse,
akathisia
| Tx antiparkinsonian, beta blocker, valium
150
stiff and stooped posture, masklike face, drooling, shuffling gate, tremor
```
pseudoparkinsonism
Tx anticholinergic (Cogentin), give towel
```
151
protruding and rolling tongue, blowing, lip smacking, licking, spastic facial distortion
it can be permanent
tardive dyskinesia
| no known Tx
152
anticholinergic Sx
dry mouth, urinary retention, constipation, burred vision, block sweating, interfere with memory, ortho static Hypotension
Serious effects: blood dyscrasias, agranulocytosis
153
Atypical antipsychotic Rx block what
both D2 and serotonin 5Ht2a receptors
154
produce minimal to no EPS or tardive dyskinesia, effective for both post. and neg. sx, more expensive
atypical antipsychotics
155
Clozapine (clozaril)
associated with fatal heat stroke, most effective antipsychotic Rx available, weight gain
156
Risperidone (Risperdal)
2nd generation atypical antipsychotic, works for ppl who have not responded to traditional antipsychotics, decreases both post and neg sx
also have IM version
157
Olanzapine (zyprexa)
3rd generation atypical antipsychotic, weight gain, increase in liver enzymes, zyprexa zydis:oral disintegrating
158
Quetiapine (Seroquel)
no EPS side effects, does not increase prolactic levels, orthostatic hypotension
159
Aripiprazole (abilify)
blocks but partially stimulates dopamine receptors, allows for more normal brain function, no weight gain,
160
Asenapine (saphris)
antipsychotic, also used tx of manic or mixed epiosed of bipolar disorder
sublingual tablets
161
best antipsychotic rx
zyprexa zydis: bc oral and dissolves, cant tongue meds
162
characterized by opposite poles, mania and depression
bipolar disorder
163
etiology of bipolar
genetics, neurotransmitter (excess levels of norepinephrine and dopamine with decreased levels of serotonin)
164
Bipolar I
at least one epidose of mania alternating with major depression, psychosis may accompany the manic episode
165
Bipolar II
hypomanic episode alternating with major depression, psychosis not present
166
Cyclothymic disorder
hypomanic episode alternating with minor depressive episodes (at least 2 years duration) tend to have irritable hypomanic episodes
167
Rapid cycling
four or more mood episodes in a 12 month period, severe Sx
168
Manic episode
hyperactivity, invovlement in pleasurable activities, push limits, loud, rapid speech, talkative
169
Dx criteria for manic episode
elevated expansive or irritable mood lasting at least 1 week, and three or more of the following:
inflated self esteem, decreased need for sleep, more talkative, flight of ideas, distractability, inccrease goal directed, increase pleasure in activiites
170
hypomanic episode
life of party, talks in sexual nature, pressured speech, very social, judgement may be poor, grandious plans
171
phase 1 of bipolar
acute phase
| keep well hydrated, maintain stable cardiac status, tissue integrity, sufficient sleep and rest
172
phase 2 of bipolar
relaspse prevention
173
phase 3 of bipolar
maintenance of Tx
| focus of relapse prevention
174
Lithium
medication of choice, less effective in people with rapid cycyling, takes 7-14 days or longer usually a antipsychotic agent or benzodiazepine needed for immediate action
175
Ex of lithium
eskalith, lithobid, lithonate, lithotabs
176
therapeutic level of lithum
0.4-1.0 mEq
177
#1 reason why ppl wont take lithium
weight gain
178
severe toxicity 2.0 mEq of above
ataxia, confusion, EEG changes, large dilute urine output, seizures coma
179
protocol for lithium
check blood levels for lithium weekly or biweekly initially, after 6 months to one year every 3 months
Blood to be drawn 8-12 hours after last dose
180
lithium is closely related to what
sodium, if sodium reduced, lithium is reabsorbed by the kidneys
181
what labs need to be checked with lithium
thyroid and renal
182
what effects on the kidneys does lithium
nephrogenic diabetes insipidous
183
anticonvulsants
Ex. valproic acid, tegretol, lamictal
| useful is treating lithium nonresponders
184
Tegretol
anticonvulsant Rx, for rapid cycling and severly paranoid patients
185
what is a potentially life threatening rash with Lamictal (anticonvulsants Rx)
SJS
186
Electroconvulsive therapy
used for severe manic behavior, Tx for resistant mania, rapid cycling, paranoid features
used as last resort
