Mental Health part #3 Flashcards
the habitual use of a substance that falls outside of medical necessity or social acceptance for the single purpose of altering ones mood, emotion, or state of consciousness and resulting in adverse effects to the abuser or to others
abuse
a habitual psychological and physiological dependence on the substance beyond ones voluntary control
addiction (dependence)
when the body adapts to the substance and gradually requires increasing amounts of the substance to reproduce the effects originally produced by smaller ones
tolerance
transitory recurrences of perceptual disturbance caused by a persons earlier use of a hallucinogenic drug when in a drug free state
flashback
combination of drugs can intensify or prolong the effect
synergistic effects
combination of drugs to weaken or inhibit the effect of one of the drugs
antagonistic effects
people who are co dependent often exhibit over responsible behavior (doing for others what others could just as well do for themselves)
codependence
what are some co dependent behaviors
attempting to control someone else’s drug use
finding excuses for the persons use
covering up the persons drinking/drug use
feeling responsible for the persons use
eliciting promises for change
a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring within a 12 month period
substance abuse
addiction is characterized by
loss of control and tendency to relapse
what plays a major role in all addictions
dopamine
how do drugs work in the body system
they effect the limbic system, the brain circuits allow pleasure, which increase the response to dopamine, the 1st time of use, neurons release an abnormally high amount of dopamine, eventually the user needs increase amounts to achieve the same feeling
name CNS depressants
alcohol
barbiturates
benzodiazepines
barbiturates
sedative hypnotic
slight overdose can cause coma or death
addictive
benzodiazepines
aka date rape drug
sedative hypnotic minor tranquilizer addictive produces sedation, muscle relaxation, and lowers anxiety levels combined with alcohol can be lethal
examples of benzodiazepines
versed, Xanax, Ativan, Librium, valium
over dose on benzodiazepines/barbiturates
cardiovascular or respiratory depression, coma shock, convulsion, death
withdraw effects of benzodiazepines/barbiturates
N/V, tachy, diaphoresis, anxiety, tremors, grand mal seizures, delirium
the body burns how much alcohol in an hour
0.5 oz
alcohol intoxication
slurred speech, incoordination, unsteady gait, drowsiness, decreased blood pressure
excessive etoc interferes with storage of new memories in hippocampus, lost from memory within minutes of its occurrence
alcoholic blackouts
when does alcohol withdraw develop
4-12 hours after cessation or reduction of use
when does alcohol withdraw peak
24-48 hours
S/sx of alcohol withdrawal
tachy, sweating, increase BP, tremors, insomnia, psychomotor agitation, anxiety, N/V, malaise, grand mal seizures, transient visual hallucinations
intervention for alcohol withdraw
support measures, benzo’s (Librium for WD S/SX)
if they have a Hx of WD seizures: clonodine
alcohol withdraw delirium
MEDICAL EMERGENCY
death is usually due to sepsis, MI, fat embolism, peripheral vascular collapse, electrolyte imbalance, aspiration pneumonia, or suicide
S.Sx of alcohol withdraw delirium
disorientation, tachy, diaphoresis, increase BP, perceptual disturbances, fluctuating LOC
Sx of overdose
cool or clammy skin, respirations less than 10/min, cyanosis, emesis while semiconscious, or conscious, seizure
Tx for overdose
AIRWAY
if awake induce vomiting, VS Q15 minutes
if coma clear airway, IV fluids, gastric lavage with activated charcoal
most serious form of thiamin deficiency, paralysis of ocular muscle , diplopia, ataxia
death if thiamine tx not implemented
wernickes encephalopathy
chronic use of alcohol can have effects on what organs
heart: increase BP, produces deterioration of heart muscle
liver: fatty liver, cirrhosis, portal HTN, ascites, hepatic encephalopathy
pancreas: blockage of pancreatic ducts, pancreatic insufficiency (malnutrition, weight loss, DM)
Tx used for alcoholism
Naltrexone, acamprosate, Disulfiram, acupuncture AA
Naltrexone
used for craving, blocks opiate receptors to reduce ETOH craving
Acamrosate
helps to abstain from alcohol
disulfiram
a drug that makes drinking painful
NDX for alcoholism
altered nutrition
denial
ineffective coping
CNS stimulants
cocaine, crack, amphetamines, methamphetamines
Meth
releases excessive dopamine in the brain, smoked, injected, snorted
highly addictive, destroys brain cells that contain dopamine and serotonin
Prolonged use of meth (effects)
weight loss, severe tooth decay (meth mouth), skin sores, dry mouth
amphetamines
sniffed swallowed, snorted, injected
S/Sx of meth or amphetamine
increased energy, resembles paranoid schizophrenia, paranoia with delusions, psychosis, hallucinations, panic levels of anxiety, potential for violence
cocaine
made from leaf of coca bush, fine white powder, schedule II, produces an imbalance of the neurotransmitters dopamine and norepinephrine
the high in cocaine is obtained when
snorted: 3 minutes
injected: 30 seconds
smoked: 4-6 seconds (crack)
how long does the high last with cocaine
15-30 minutes for cocaine, and 5-7 for crack
S/Sx of cocaine
tachy, dilated pupils, elevated BP, N/V, insomnia, assertiveness, grandiosity, impaired judgment, impaired social and occupational functioning
overdose Tx for stimulants
antipsychotics, manage convulsions, resp distress, cardiovascular shock
caffeine
stimulant, most commonly used psychoactive drug in the world
how much caffeine is too much
200 stimulates mental activity
300 tremors, insomnia
sources of caffeine
coffee, tea, soft drinks, choc. OTC (analgesics, stimulants, cold relief preparations
what effects does caffeine have
stimulates brain, heart, kidneys, and increases acid production in stomach
withdraw from caffeine
tiredness, HA, irritability
onset is 12-24 hours after abstinence
peaks 20-51 hours
nicotine
stimulates central, peripheral and autonomic nervous system
causes increased alertness, concentration, attention, appetite suppression
Heroin
addictive, ranges from white to dark brown, cut with other substances, can be sniffed, snorted, smoked, injected (most common)
what happens when someone becomes addicted to heroin
spend more time and energy obtaining and using the drug, may become the primary purpose in life
intoxication of heroin
constricted pupils, decrease RR/BP, slurred speech, drowsiness, psychomotor retardation, initial euphoria followed by dysphoria and impairment of judgment and momory
overdose Sx of heroin
dilation of pupils, Resp arrest, cardiac arrest, coma, shock, convulsions, death,
Tx for overdose of heroin
narcan (reverses CNS depression)
withdraw from heroin Sx
yawning, insomnia, irritability, runny nose, panic, diaphoresis, cramps, N/V, “bone pain”, fever, lacrimation, diarrhea
Tx for withdraw of heroin
methadone, trexan, clonidine
marijuana
cannabis sativa, tetrahydrocanniol, hashish (strongest form)
initial effects of marijuana takes place when
within minutes, last for 3 to 4 hours
effects of marijuana
euphoria, inappropriate laughter, grandiosity, sedation, impaired cognition/motor skills, sensation of prolonged time sequences, blood shot eye, increase appetite, tachy, dry mouth
how does marijuana work
fat soluble, absorbed rapidly after being smoked or taken orally, binds with opioid receptors in the brain, can be stored for weeks in fat tissue and in brain, dependence does develop
what can happen if you have long term use of marijuana
accumulation in frontal cortex, limbic areas, brains auditory and visual perception centers
what are the medical uses for marijuana
chemo induced nausea, decrease intraocular pressure in glaucoma, appetite stimulate in AIDS wasting syndrome
hallucinogens
LSD (acid)
effects last btwn 3-6 hours, causes confusion, depression, sleep problems, paranoia
LSD
binds to serotonin receptor sites, causing a greater than normal activation of the receptor
seeing a particular sight may cause the user to perceive a sound and hearing a sound may cause him to perceive an odor
synesthesia
expansion of consciousness
trips
what effect will the hallucinations have on mood
they usually intensify whatever mood the user is in when the drug is taken
Sx of use of hallucinations
visual hallucinations, disorientation, confusion, paranoid delusions, panic, increased pulse
what is life threatening with hallucinogens
the hallucinations
what do you need to do for overdose Tx of hallucinogens
low stimuli, attempt to talk down pt, speak slowly and clearly in low voice
Ecstasy (MDMA)
takes 20-40 minutes to take effect, table or capsule
inhalants “huffing, backing”
cause euphoria, sedation, emotional liability, impaired judgment
intoxication occurs within 5 minutes, last 60-90, large dose = death
inhaled fumes take the place of oxygen in the lungs causing suffocation
sudden sniffing death
SE of inhalants
similar to alcohol
slurred speech, euphoria, dizzy, drunkenness, violent behavior
overdose of inhalants can effect
liver and brain damage, heart failure, resp arrest, coma, death
long term use of inhalants can effect
myelin sheath of nerve fibers, muscle spasms and tremors, difficulty with basic movements
what is the active ingredient in fake cocaine
MDPV methylenediozpyrocalerone “bath salts”
an active alkaloid found in the khat plant, it is a CNS stimulant
MDPV “bath salts”
powder similar to cocaine, snorted
S/Sx of MDPV
excessive HR, HTN, sweating, prolonged panic attacks psychosis, agitation, hallucinations
what is the 10th leading cause of death nationally
suicide
what is the leading cause of premature death
schizophrenia
risk factors for suicide
previous suicide attempts, depression, substance abuse, impulsiveness, barriers to help, loss, isolation
levels of suicidal behavior
suicidal ideation suicide threat suicide gesture: cry for help suicide attempt completed suicide
SAD PERSONS scale
S: sex: 1 if male
A: age: 1 if 25-44 or over 65
D: depression: 1 if present
P: previous attempt: 1 if present
E: ethanol use: 1 if present
R: rational thinking lost: 1 if psychotic for any reason
S: social supports lacking: 1 if lacking
O: organized plan: 1 if plan with lethal method
N: no spouse: 1 if widowed, separated, etc.
S: sickness: 1 if severe or chronic
points for SAD PERSONS scale
0-2: send home with follow up
3-4: closely follow up, consider hospitalization
5-6: strongly consider hospitalization
7-10: hospitalize or commit
soft methods of suicide
inhaling gas, pills, cutting wrists
hard methods of suicide
gun, jumping, hanging, staging a car crash
NDx suicide
risk for self directed violence, ineffective coping
nursing interventions for suicide
establish a therapeutic relationship, communicate the potential for suicide, stay with the person, listen to the pt, secure a no-suicide contract, give the pt a message of hope, provide meaningful activities that release tension and anger
PT teaching for suicide
have hobbies, adapt to loss, positive attitude, focus on accomplishments, increase self-esteem, share sad feelings with support person
ADHD
misfiring in the brains executive function mediated through the prefrontal cortex
role of resilience
adapts to the environment, ability to form nurturing relationships with other adults when a parent is not available
role of temperament
genetically determined, can be modified with post. or neg. results,
general tx for disorders of children
art therapy, family therapy, milieu therapy, point system
development disorders covering a range of abilities that cause problems with social skills, communication, repeated behaviors, emotional detachment
pervasive developmental disorders
an abnormal self absorption characterized by lck of response to people and actions and limited ability to communicate, complex neurobiological and developmental disability, typically appears in 1st 3 years of life
autistic disorder or autism
what have MRI studies showed with autistic disorder
markedly decreased activity in the parietal area and corpus callosum
corpus callosum
connects the left and right hemispheres, its role is to pass information from the left hemisphere and vice versa
parietal lobe
receives and processes sensory information from the body, also have language functions
what impairments might a child show
delay/absence of language, failure to imitate, lack of spontaneous make believe play, lack of eye contact, lack of interest in others, rocking, responds catastrophically to minor changes, preoccupied with objects, toe walking
average IQ score for “normal”
100
2/3 of autistic children have an IQ of what
70 or less
unusual talents that appear at an early age, exceptional memory, lightening quick calculations, musical talent, drawing ability
savant syndrome
NDx for autistic
delayed growth and development, disturbed personal identity, ineffective impulse control, risk for injury, ineffective relationship, impaired verbal communication
Nursing intervention for autistic
1:1, protect from self mutilated behaviors, assign limited number of caregivers, positive reinforcement, anticipate needs, NO MEDICATION to Tx autism
what medications might be given to a child with autism
NO MEDICATION TO TX AUTISM
antipsychotic to tx aggression, temper tantrums
beta blockers tx lower side effects
SSRI may be used for OCD behaviors
restricted and respective patterns of behavior and idiosyncratic interest, appears to have later onset, familial pattern, problems with social relationships, no significant delay in cognitive and language development
asperger’s disorder
disorder characterized by inattention, hyperactivity, impulsivity, some may have attention deficit without hyperactivity
attention deficit hyperactivity disorder
Sx for ADHD
inattention, hyperactivity (fidgets, talks excessively, acts without thinking), impulsivity (blurts out answers, diff. waiting their turn, impatient)
Tx for ADHD
Rx for hyperactivity impulsive behaviors, inattention, behavior modification, family counseling
causes of ADHD
adverse influences during prenatal period (drugs), perinatal influences (low birth weight), postnatal period (trauma or infections)
*brain scan show underdeveloped and inactive frontal lobes
Ritalin
targets the slugglish frontal lobe, risk of abuse and misuse
SE: insomnia, HA, abd. pain, lethargy, growth retardation
Adderal
calms pt, increases motor activity, mental alertness, suppresses appetite
SE: talkativeness, increased motor activity, mild euphoria
Strattera
non stimulant selective norepinephrine reuptake inhibitor, eliminates the risk of abuse, decreases daydreaming, aggression, mood swings
SE: GI disturbance, reduced appetite, weight loss, dizzy, insomnia, fatigue, small increase in BP & HR
**Dose needs to be titrated slowly to achieve the lowest satisfactory dose
what nursing interventions need to be done with Rx given for ADHD
assess mental status, level of activity, aggressiveness, degree of stimulation, keep stimuli low, reduce anorexia by administering immediately before meals and weigh weekly, administer 6 hours prior to bedtime to prevent insomnia, avoid OTC Rx, should not be withdrawn abruptly
a persistent pattern of negativistic, disobedient, hostile, defiant behaviors toward authority figures, which happen more persistently and more frequently
oppositional defiant disorder
Sx of oppositional defiant disorder
frequent temper tantrums, annoys other people deliberately, academic difficulties, blames others for mistakes or misbehavior
oppositional defiant disorder can lead to what if not treated
conduct disorder
interventions for oppositional defiant disorder
act as a role model, redirect violent behavior, maintain calm attitude, mechanical restraints if necessary
characterized by persistent pattern of behavior in which the rights of others are violated and age appropriate societal norms or rules are disregarded
conduct disorder
complications due to conduct disorder
academic failure, school suspension or dropouts, juvenile delinquency, drug or alcohol abuse, juvenile court involvement
what psychiatric disorder may co exist with conduct disorder
anxiety, depression, ADHD, learning disabilities, substance dependency
Sx of conduct disorder
destructive behavior, deceitfulness, serious violations of rules
significantly sub average general intellectual function and deficits in adaptive behavior
mental retardation
how is mental retardation measured
IQ test
4 classifications of mental retardation
mild: 50-70
moderate: 35-40
severe: 20-34
profound: below 20
mild mental retardation
50-70, 6th grade level
moderate mental retardation
35-49, 2nd grade level, requires supervision, can perform some activities, some limitation in speech
severe mental retardation
20-34, minimal verbal skills, only able to perform simple tasks under close supervision, poor psychomotor development
profound mental retardation
below 20, no capacity for independent functioning, little if any speech, no gross or fine motor movement, constant assistance
Possible causes of mental retardation
hereditary (downs, klinefelter syndrome, tay-sacs, PKU), embryonic development
characteristics of mental retardation
sit up, crawl, walk later, hard to remember things, trouble thinking logically
an individual, person or private sense of identity as female or male
gender identity
strong and persistent cross gender identification, cross gender activity/interest, relate to opp. sex, boys prefer females and cross dress, don’t consider themselves homosexualy
gender identity disorder
biological sex differs from gender identity or feelings of unease about ones maleness or femaleness
gender dysphoria
group of psychosexual disorders characterized by unconventional sexual behaviors as defined by the dominant culture, usually male, learned to associate sexual arousal with some environmental stimulus, which triggers the unusual behavior, OCD
paraphilias
sexualization of body part or inanimate object feet, shoes, etc.
fetishism
adult who is sexually aroused by and engages in sexual activity with children, usually with a prepubescent child (13 or younger)
pedophilia
in pedophilia what is the age difference
perpetrator must be at least 16 years of age and at least 5 years older than the victim
illegal, intentional display of genitals in a public place aroused by the observers shock and disgust
exhibitionism
illegal, peeping tom, frequently addicted to porn and strip clubs
voyeurism
sexual satisfaction achieved by dressing in clothing of the opposite gender, usually heterosexual
transvestic fetishism
physical/psychological suffering inflicted upon another person
sexual sadism
rubbing or touching a non consenting person in busy places
frotteurism
obscene phone calls, don’t know victim
telephone scatologia
sex with cadaver
necrophilia
concentration of sex activity on 1 part of the body
partialism
sex with animal
zoophilia
being urinated on or urinating on someone
urophilia
altered state of consciousness 2ndary to hypoxia while experiencing orgasm
hypoxyphilia
a pattern of coercive control founded on and supported bby physical and or sexual violence or threat of violence of an intimate partner
battering
who is at the highest risk of domestic violence
females 20-40
cycling of violence
tension building phase, acute battering incident, honey moon phase
reasons why ppl stay
fear, for children, financial reasons, retaliation, religious, hopefulness
for the average victim it takes how many times being abused before leaving
7
goal of domestic abuse
educate the victim to increase awareness of available resources
children of battered women often demonstrate what problems
behavioral problems, depression, PTSD, living in secrecy
homeless are prevalence to what disorders
severe depression, bipolar disorder, schizophrenia
