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mental health1 Flashcards

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1
Q

obsessions are defines by

A

recurrent and persistent thoughts, urges, or images that are experiences, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress
the individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action

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2
Q

compulsions are defined by

A

repetitive behaviours or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
the behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation, however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive

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3
Q

DSM V criteria for ocd

A

presence of obsessions, compulsions, or both
the obsessions or compulsions are time consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
the obsessive compulsive symptoms are not attributable to the physiological effects of a substance
the disturbance is not better explained by the symptoms of another mental disorder

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4
Q

prevalence of ocd

A

About 1.2 % will develop OCD over a lifetime

Early onset predicts poorer treatment outcomes

Females are diagnosed slightly more than males

Higher rates among individuals who are
Young, divorced or separated, and unemployed

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5
Q

prevalence of ocd across the lifespan

A

Children & Adolescence
1-3%
More males than females
Young children are more difficult to diagnose

Older Adult
Late onset is more likely to occur in females
Increased occurrence of PTSD

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6
Q

comorbidities of ocd

A

Mood disorders
Particularly depression and bipolar disorder

Anxiety and panic disorders

Impulse control disorders
Eating disorders

Tourette syndrome
Frequently occurs with OCD

Personality disorders
Occurs in about 80% of individuals diagnosed with OCD

Somatic Disorder

Substance disorders
Occurs in about 1/3 of individuals diagnosed with OCD

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7
Q

genetics and ocd

A

Genetic
Strong Heritability

First degree relatives

Increased prevalence if relatives also have Tourette’s syndrome, an anxiety disorder, or a mood disorder

Polygenic disease

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8
Q

neuropathological and ocd

A

Neuropathological

Hyperactivity of the

orbitofrontal cortex
Has the most dopamine receptors
anterior cingulated cortex
Part of the limbic system
caudate nucleus 
Part of the basal ganglia where GABA mediates dopamine

Increased cerebral glucose metabolism

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9
Q

biochemical and ocd

A

Biochemical

The most studied neurotransmitter in conjunction with OCD is Serotonin

This is based on the effectiveness of Serotonin specific reuptake inhibitors (SSRI)

Serotonin is one of the transmitters that
Initiates the fight or flight response
Influences how emotions are prioritized in the amygdala
Influences how meaning is connected to memories in the pre-frontal cortex

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10
Q

psychodynamic and ocd

A

Psychodynamic
Arise form unconscious defense mechanisms
Isolation – separation of affect from thoughts and impulse
Undoing – performing a behavior to avoid the consequences of another behavior
Reaction formation – a behavior or attitude that opposes another behavior or attitude

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11
Q

behavioral and ocd

A

Behavioral
Conditioned stimuli
Behaviors that would typically be considered neutral, provoke anxiety
To manage anxiety individuals begin to perform other behaviors
The more a behavior decreases anxiety the more frequently an individual will engage in the behavior

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12
Q

assessments for ocd

A

MSE

Risk Assessment

Physical Assessment

Family

SEDoHs

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13
Q

mental status exam for ocd

A 
General Appearance
Affect & Mood
Speech & Language
Thought Process
Thought Content
Perceptual Functioning
Cognitive Functioning
Insight
Judgment
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14
Q

risk assessment for ocd

A

Assess both the obsession and compulsion for
Type
Severity

Inquire about
Access to means
Protective factors

It is importance to:
Allow enough time for the assessment
Gather collateral information

Consider insight and judgment
Is there increased impulsivity? Does the patient feel the need to punish themselves?

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15
Q

physical assessment for ocd

A 
Dermatological
Includes assessments of skin and hair
Behaviors include:
Repetitive hand washing
Excessive cleaning (skin breakdown also due to cleaning agents)
Skin picking
Pulling out hair

Dental Care
Behaviors include:
Excessive teeth brushing (leads to decreased tooth enamel)

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16
Q

possible outcomes of physical assessment for ocd

A 
Possible Outcomes
Osteoarthritis
Trichotillomania
Body dysmorphic disorder
Infection 
Electrolyte imbalances
Particularly if there have been changes in nutrition due to decreased enamel.

*These outcomes would require additional assessment

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17
Q

family assessment for ocd

A

Individuals are more likely
To remain single
Have higher rates of celibacy

Evaluate the families understanding of OCD
Is education required?
Is the family ready to change their behaviors?
How much is the family able to adapt?
Is the family enabling the patient’s compulsions?
Does the family need assistance caring for the patient?

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18
Q

impact of sedohs and ocd

A 
Impact of SEDoHs
Financial 
Can the patient work?
Is the patient safe alone or is constant caregiving required ?
Is funding required and/or available

Outside supports
Does the patient have social supports (friends, volunteer groups, etc.)?

Education
What education has the patient completed?
How does this impact employment?
How does this impact peer groups?

Social Functioning
Is it awkward to participate in social activities?

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19
Q

consequences of ocd on the patient

A

Alienation from family and friends

Lack of intimate relationships

Additional health problems
Co-morbid conditions
Con-current conditions

Legal
Acting on obsessions

Financial
Unable to work

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20
Q

body image definition

A

a mental picture of how one’s own body looks

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21
Q

body image distortion definition

A

an individual perceives his/her own body different than the world perceives it

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22
Q

interoceptive awareness definition

A

describes the sensory response to emotional and visceral cues, such as hunger

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23
Q

purge definition

A

purposeful evacuation of stomach or bowel contents through artificial means such as vomiting or laxatives

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24
Q

DSM V criteria for anorexia nervosa

A

restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than minimally expected
intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight
disturbance in the way in which one’s own body weight or shape is experienced, undue influence of body weight or shape on self evaluation, or persistent lack of recognition of the seriousness of the current low body weight

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25
prevalence of anorexia
About 0.5 – 1% Onset is in early Adolescence (age 14-16) Females 10x more likely than males Early menses (age 10/11) is an important predictor Usually a chronic condition with relapses Precipitated by distorted body image Impacted by Culture SEDoHs (Decreased socioeconomic status, Decreased education
26
anorexia across the lifespan
Most often begin in childhood and adolescence May have serious dieting before the signs of starvations are noticeable
27
comorbidities of anorexia
Anxiety disorders OCD predates anorexia nervosa by 5 years Perfectionism Depression Co-morbidities seem to resolve when the anorexia is successfully treated
28
changes in the orbitofrontal cortex and striatum and anorexia
The orbitofrontal cortex has the most dopamine receptors in the brain Decreased dopamine may decrease the pleasure an individual experiences with eating
29
genetics and anorexia
Strong Heritability | First degree relatives account for 50-80% of heritability
30
neuroendocrine and neurotransmitter and anorexia
Increase in endogenous opioids Patients exercise excessively Decreased thyroid function Related to malnutrition and chronic stress this puts on the body systems Decreased serotonergic functioning Decreased weight
31
history and anorexia
It has been thought that the underlying psychological factors have been related to unresolved conflict in developing autonomy. Dieting and weight control were a means to defend against feelings of inadequacy
32
internalization of peer pressure and anorexia
learned from peers | Reflect: How is a therapeutic environment created on an in-patient child/adolescent psychiatric unit?
33
body dissatisfaction and anorexia
Comparison with others (especially in the media) results in a struggle to develop his/her own identity Implications when the individual falls short of the ideal Reflect: Why is it important for nurses to educate adolescents and families about normal growth and development patterns, in particular the increased weight gain that supports changes that occur in puberty?
34
societal theories and anorexia
Societal messages Appearance Roles What roles are women most likely to pursue? If a women is in a significant leadership role, are there expectations for how they will look and behave? Achievements Do we have expectations for what successful people looks like? Confusion between character and appearance “It doesn’t matter what is on the outside. It’s what’s on the inside that matters?” Does this align with values and beliefs about equity? Do we live out these values and beliefs? Awareness of obesity Media awareness of plus sized models Dedicated clothing stores for particular sizes
35
risk factors for anorexia
Puberty Low self-esteem Dieting/Attitudes about healthy eating Feelings of inadequacy Athleticism SEDoHs
36
assessments for anorexia
MSE Risk Assessment Physical Assessment Family SEDoHs
37
general appearance for anorexia
Dry skin, sunken facial features, Wears baggy clothing, long sleeve shirts, long pants, layers May look older than actual age May have difficulties with balance
38
affect and mood for anorexia
Blunted affect May be unable to describe mood Ambivalence (affect incongruent with context)
39
speech and language for anorexia
``` Speech generally at normal rate, volume, and rhythm Circumstantial speech (talking around the core problem – around the circumstance) ```
40
thought process for anorexia
Obsessional thinking Irrelevant details May eventually get to the point
41
thought content for anorexia
*Especially important to listen for strengths Often hopelessness and helplessness are present Depressive or anxious cognitions (may be about talking about the subject or other concerns or worries)
42
perceptual functioning for anorexia
Maybe altered due to physical functioning (significantly altered electrolytes)
43
cognitive functioning for anorexia
Maybe altered due to physical functioning and physical changes in the brain Decreased ability to remember, concentrate
44
insight for anorexia
May not acknowledge there is a problem even thought they become physically unwell
45
judgement for anorexia
Poor. Continue to want to loose weight
46
risk assessment for anorexia
7% - 10 % mortality rate ``` Suicide is the leading cause of death Use highly lethal means Inquire about A plan (time/date/place) Access to means (even if there is no plan as insight and judgment are usually impaired) Protective factors ``` Collaborative information
47
physical assessment for anorexia
Multiple physical systems are compromised by starvation
48
musculoskeletal and anorexia
Loss of muscle mass, fat (leads to osteoporosis)
49
metabolic and anorexia
Hypothyroidism Hypoglycemia Decreased insulin sensitivity
50
cardiac and anorexia
Bradycardia and ventricular tachycardia Arrhythmias (atrial and ventricular premature contractions) Hypotension Loss/diminished cardiac muscle Prolonged QT interval (consider potentiated effect with antidepressants like Remron) Sudden death syndrome
51
gastrointestinal and anorexia
Delayed gastric emptying Bloating Constipation/diarrhea (outcome of continued laxative use and poor nutrition) Abdominal pain
52
reproductive and anorexia
Irregular menses to Amenorrhea Low levels of luteinizing hormone Low levels of follicle-stimulating hormone
53
dermatological and anorexia
Dry, cracking skin & brittle nails (dehydration) Lanugo (fine baby –like hair) over the whole body Edema Bluish hands and feet (result of poor nutrition and dehydration –decreased blood volume and decreased iron to carry oxygen) Thinning hair
54
hematological and anorexia
Leukopenia anemia, Thrombocytopenia Increased cholesterol
55
neuropsychiatric and anorexia
``` Abnormal taste sensation (related to zinc deficiency) Depression Apathy Sleep disturbances (decreased serotonin) Fatigue (but will continue to exercise) ```
56
psychological symptoms and anorexia
``` Decreased interoceptive awareness Sexuality conflict or fears Maturity fears Ritualistic behaviors Difficulty expressing negative emotions Low self esteem Perfectionism Body dissatisfaction ```
57
family assessment and anorexia
There is no evidence that family interactions are the primary cause of eating disorders.
58
Behaviors which may contribute to an individual’s need to control eating and weight
Unrealistic attitudes (weight, shape and size) Decreased affection, communication and time spent together Inability to manage conflict Enmeshment (Erikson's stages of development – low autonomy, excessive lack of boundaries intrudes privacy) Overprotectiveness (decreases the development of autonomy) Rigidity (maintaining the status quo; change and conflict are avoided)
59
consequences of anorexia for patient
Alienation from family and friends Lack of intimate relationships Additional health problems Co-morbid conditions Con-current conditions Financial Unable to work Death
60
DSM V criteria for bulimia
recurrent episodes of binge eating (eating in a discrete period of time, an amount of food that is definitely larger than what most individuals would in a similar period of time or circumstance. a sense of lack of control over eating during the episode) recurrent inappropriate compensatory behaviors in order to prevent weight gain such as self induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, excessive exercise the binge eating an inappropriate compensatory behaviours occur both at least once a week for 3 months self evaluation is unduly influenced by body weight and shape the disturbance does not occur exclusively during episodes of anorexia
61
prevalence of bulimia
About 1% – 2.3% Onset is between 15-24 years old Females 10x more likely than males Influenced also by Culture SEDoHs
62
comorbidities of bulimia
Anxiety disorders Depression Substance abuse Borderline and avoidant personality History of childhood sexual abuse
63
biological factors of bulimia
Genetic Strong Heritability ``` Biochemical Decreased serotonin Contributes to vegetative shifts which can contribute to weight gain Decreased plasma tryptophan Can lead to depressed mood ```
64
cognitive perspective and bulimia
Cognitive distortions form the basis of binge eating (i.e. all or nothing thinking, discounting positive changes, fortune telling) Psychological triggers can cause physiological responses and therefore are currently seen as an explanation for continuation of the behavior (bulimia nervosa) not as a cause
65
psychological triggers and bulimia
Increased stress Negative emotions Both physical and emotional trigger the opioid system in the anterior cingulate cortex (ACC) to release endogenous opioids. Our bodies do not make an endless supply of endogenous opioids and these can be depleted over a prolonged experience of pain. Environmental cues Environmental stimuli can be linked to memories in the hippocampus In this way, these cues trigger neurochemicals to respond in a way similar to when the initial event was experienced. As a result, even a visual or the smell of a desired food can cause a increase in dopamine levels.
66
separation-individuation process and bulimia
Moving between developmental stages Usually occurs between adolescence and adulthood Individuals are unprepared for emotional separation Blurred boundaries Individuals may feel guilt about making their own decisions
67
additional risk factors for bulimia
Societal perceptions Dietary restraint Low self-esteem History of sexual abuse Feelings of inadequacy
68
assessments for bulimia
MSE Risk Assessment Physical Assessment Family SEDoHs
69
general appearance with bulimia
Wears baggy clothing, long sleeve shirts, long pants May look older than actual age May look overweight, but may also appear an appropriate weight or under weight
70
affect and mood with bulimia
May be unable to describe mood | Ambivalence (affect incongruent with context)
71
speech and language with bulimia
``` Speech generally at normal rate, volume, and rhythm Circumstantial speech (talking around the core problem – around the circumstance) ```
72
thought process with bulimia
Obsessional thinking Irrelevant details May eventually get to the point
73
thought content with bulimia
*Especially important to listen for strengths May perseverate on weight, size or shape of their body Depressive or anxious cognitions (may be about talking about the subject or other concerns or worries)
74
perceptual functioning with bulimia
no negative changes
75
cognitive functioning with bulimia
Decreased ability to remember, concentrate due to perseveration
76
insight with bulimia
May not acknowledge there is a problem even thought they become physically unwell
77
judgement with bulimia
Poor. Continue the binge-purge cycle
78
risk assessment for bulimia
High suicide risks Independent of other co-morbid/con-current disorders High risk for self-mutilation Increased impulsivity Legal and Financial difficulty Related to increased impulsivity Inquire about A plan (date/time/location) Access to means (even if there is no plan) Protective factors
79
metabolic and bulimia
``` Electrolyte abnormalities (hypokalemia, hypomagnesemia Increased blood urea nitrogen levels (possible kidney damage) ```
80
cardiac and bulimia
Ipecac-related cardiomyopathy arrhythmias Ipecac syrup is used to induce vomiting Chronic vomiting can alter sodium and calcium levels
81
gastrointestinal and bulimia
Salivary gland and pancreatic inflammation and enlargement (increased serum amylase) Esophageal and gastric erosion/rupture Dysfunctional bowel syndrome
82
dental and bulimia
Dental Erosion of dental enamel (front teeth) Decay *Both 1 & 2 occur because of increased acid in the mouth when the individual is vomiting.
83
integument and bulimia
Fingers and knuckles may be dry and cracked which is the result of the acidity of the vomit
84
neuropsychiatric and bulimia
``` Seizures Due to the fluid shift and electrolyte disturbances Mild neuropathies Fatigue Weakness ```
85
psychological assessment and bulimia
Decreased interoceptive awareness Sexuality conflict or fears Related to their perception of their body Maturity fears Difficulties with taking responsibility and being accountable Fear of failure Low self-esteem Body dissatisfaction Could be related to weight, size, and shape
86
Behaviors which may contribute to an individual’s need to control eating and weight
Inability to manage conflict Enmeshment Erikson's stages of development - excessive boundaries intrudes privacy which may lead to sneaking behavior; lack of boundaries may lead to decreased sense of the individual’s own identity Overprotectiveness Impedes the development of autonomy Rigidity Maintaining the status quo – change and conflict are avoided
87
consequences of bulimia on patient
Alienation from family and friends Lack of healthy relationships Additional health problems Co-morbid conditions Con-current conditions Financial and legal implications

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