Mental Illness Flashcards

1
Q

What is Dysthymia?

A

Persistent depressive disorder is characterized by depressive symptoms that last for at least TWO YEARS, with depressed mood present for most of the day, and for more days than not. Dysthymic disorder, a chronic form of MDD, is seen more commonly in the older adult and is associated with symptoms of MDD but lasts for more than 2 years.

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2
Q

Dysthymia is characterized by two of the following factors…?

A
  1. Decreased or increased appetite
  2. Insomnia or hypersomnia
  3. Low energy
  4. Poor self-esteem
  5. Poor concentration
  6. Hopelessness
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3
Q

Major depressive disorder manifests with 5 or more of the follow s/s…

A
  1. Depressed mood**
  2. Loss of interest or pleasure in most or all activities**
  3. Insomnia or hypersomnia
  4. Change in appetite or weight
  5. Psychomotor retardation or agitation
  6. Low energy
  7. Poor concentration
  8. Thoughts of worthlessness or guilt
  9. Recurrent thoughts about death or suicide
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4
Q

What are the clinical RED FLAGS for depression?

A
  1. Insomnia
  2. Fatigue
  3. Chronic pain
  4. Recent life changes or stressors
  5. Fair or poor self-rated health
  6. Unexplained physical symptoms
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5
Q

What enzyme tends to be elevated in people with depression?

A

Cortisol

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6
Q

What are somatic symptoms

A

Depression accompanied by (headache, abdominal or pelvic pain, back pain, or other physical complaints)

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7
Q

What population typically has somatic symptoms with depression

A

pregnant women, older adults, incarcerated individuals, some cultural ethnicities, patients with low incomes, and patients with co-existing medical conditions.

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8
Q

For treatment what age should SSRI’s be avoided and why?

A

18-29: Avoid SSRI’s because of suicidal risk

> 65: Avoid SSRIs because of Upper GI risk

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9
Q

Difference between anxiety disorder and normal anxiety?

A

Anxiety disorder effects a person’s functioning and anxiety is present without anxiety producing issue.

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10
Q

What are S/S of a panic attack?

A

Symptoms may resemble an acute cardiac event with sweating, palpitations, shortness of breath, choking sensation, chest pain, nausea, and lightheadedness.

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11
Q

How is a panic attack characterized?

A

characterized by recurrent, unexpected panic attacks followed by at least 1 month of persistent concern about having another.

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12
Q

What is a phobia?

A

A persistent, irrational fear of a particular object, place, or situation referred to as a phobic stimulus. Exposure therapy is usually effective.

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13
Q

Are patient’s aware of OCD?

A

Although aware of the irrational nature of the thoughts and behaviors, people with OCD feel helpless to interrupt the cycle.

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14
Q

How is OCD manifested?

A

Patients may experience either obsessions, compulsions, or both. The thoughts or obsessions cause anxiety, which is partly relieved by the compulsive, ritualistic behavior.

The patient may spend great amounts of time carrying out rituals or may go to great lengths to avoid situations associated with the obsessions.

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15
Q

What is social phobia or social anxiety disorder?

A

Refers to a fear of social or performance situations (such as public speaking) in which embarrassment may occur, resulting in an immediate anxiety response. The fear relates to being judged or humiliated. It can be distinguished from shyness based on the degree of discomfort and social/work impairment that results.

Social phobias are self-reinforcing in that the anxiety about performing interferes with performance—leading to embarrassment—which further reinforces the fear of performing.

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16
Q

How does PTSD Manifest itself?

A

Follows a traumatic event. The event does not have to be personally experienced or witnessed to have a traumatic effect. Sometimes the patient develops anxiety related to an event that was experienced by someone else and then made known to them.

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17
Q

S/S of PTSD

A

depression, anxiety, sleep disturbances, sexual dysfunction, or even psychosis.
Intense re-experiencing through traumatic memories is most common and can involve flashbacks or hallucinations.

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18
Q

What are the time frames for PTSD and ASD?

A

In PTSD, symptoms appear more than 1 month after exposure. If the symptoms appear within 1 month after the traumatic event, a diagnosis of acute stress disorder (ASD) may apply. If unresolved, ASD can progress to PTSD.

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19
Q

Criteria for GAD

A

Uncontrollable anxiety over a period of at least 6 months.

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20
Q

What has been linked to GAD?

A

GAD has been linked to heart disease, GI disturbances, and pain disorders. EARLY CHILDHOOD TRAUMA IS A SIGNIFICANT ENVIRONMENTAL FACTOR IN THE DEVELOPMENT OF ANXIETY DISORDERS

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21
Q

s/s of GAD

A
  1. Symptoms include restlessness
  2. Fatigue
  3. Difficulty concentrating
  4. Irritability
  5. Difficulty sleeping
  6. Muscle tension
  7. Primary care setting pt may present with unexplained physical symptoms
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22
Q

What are the diagnostic tests for GAD?

A

New onset of anxiety includes a physical exam, a mental status exam, a medical and psychiatric history, family history of anxiety or mood disorders, and a basic lab profile.

complete blood cell count
chemistry profile
thyroid function tests
urinalysis
urine drug screen

Anxiety symptoms can be related to the physiologic effects of caffeine, abusive drugs, and TOC medications. ALL PATIENTS SHOULD BE ASSESSED FOR DEPRESSION, SUICIDAL, AND HOMICIDAL IDEATION.

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23
Q

What is Schizophrenia?

A

Mental disorder often characterized by abnormal social behavior and failure to realize what is real. These individuals experience auditory and visual hallucinations, disorganized speech, flat affect, impairment in cognition including attention.

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24
Q

How is a dx made for Schizophrenia?

A

A diagnosis is based on the presence of such symptoms, coupled with social or occupational dysfunction for at least six months in the absence of another diagnosis that would better account for the presentation.

25
Q

What are some positive symptoms?

A

Hallucination

  1. Delusions
  2. Disorganization
26
Q

What are some negative symptoms

A

Decreased expressiveness

  1. Apathy
  2. flat affect
  3. lack of energy
27
Q

What are some neurological disturbances those with schizophrenia experience?

A

Examples of neurological soft signs are right-left confusion, agraphesthesia (the inability to recognize letters or numbers traced on the skin, usually on the palm of the hand), and astereognosia (the inability to identify familiar objects by touch alone).

28
Q

Antipsychotic medication + Antidepressants=?

A

Significant QTc prolongation

29
Q

What is Hyperprolactinemia?

A

An elevation in prolactin levels in the blood that has numerous side effects. Antipsychotic-induced suppression of dopamine indirectly increases pituitary prolactin production, and may present as MENSTRUAL IRREGULARITY, AMENORRHEA, OR GALACTORRHEA in women and GYNECOMASTIA AND SEXUAL DYSFUNCTION in men. *May promote growth of breast and prostate tumors.

30
Q

Myocarditis+Clozapine?

A

S/S of myocarditis include unexplained fatigue, dyspnea, tachypnea, fever, chest pain, palpitations, and symptoms of heart failure, or abnormal ECG findings such as ST abnormalities and T-wave inversion. If myocarditis is suspected, an ECG, white blood cell count and serum troponin level or CK-MB should be evaluated. If evidence of myocarditis is found, clozapine should be stopped and the patient referred urgently to a cardiologist.

31
Q

What is some preventative measures that a schizophrenic patient can undergo?

A

Nicotine interferes with the metabolism of some antipsychotic medications, the effects of those medications should be more closely monitored in patients who are quitting or starting.

Monitor for an increase in BMI+Waist circumference

32
Q

What is Bipolar?

A

Bipolar is a disorder that is characterized by episodes of mania, hypomania, and major depression.

33
Q

How is Bipolar I diagnosed?

A

Patients with BIPOLAR I disorder experience manic episodes and nearly always experience major depressive and hypomanic episodes

34
Q

How is Bipolar II diagnosed?

A

BIPOLAR II disorder is marked by at least one hypomanic episode, at least one major depressive episode, and the absence of manic episodes

35
Q

Risk factors for Bipolar

A

FAMILY HX IS AN INDICATOR, BIPOLAR II CAN PEAK 45-54 YEARS OF AGE.

36
Q

What are some prodromal S/S of bipolar?

A

irritability, anxiety, mood lability, agitation, aggressiveness, sleep disturbance, and hyperactivity may precede onset of diagnosable bipolar disorder

37
Q

What is mania and the presenting S/S?

A

Clinically significant changes in mood behavior, energy, sleep and cognition. Abnormally elevated, irritable, and labile mood. Euphoric disinhibition, disregard for social boundaries, and relentless pursuit of stimulation and social activities. Decreased need for sleep. Flight of ideas+manic speech such as loud, speech that is accelerated and difficult to interrupt.

THESE PATIENTS BENEFIT FROM BEING HOSPITALIZEDD TO PROTECT THEMSELVES FROM DAMAGING BEHAVIOR

38
Q

What is hypomania?

A

Hypomanic episodes are characterized by changes in mood, behavior, energy, sleep, and cognition, similar to those of mania but less severe.

39
Q

S/S of hypomania?

A
  1. Hypomania is often quick and creative, and leads to productive increases in goal-directed activities.
  2. Thought form is more organized in hypomania
  3. Risk-taking behavior in hypomania is mild to moderate, but in mania is severe
  4. Psychosocial functioning in hypomania is either improved or mildly impaired
  5. Hypomanic speech can be loud and rapid, but easier to interrupt than manic speech
40
Q

What is major depression in regards to bipolar?

A

Generally characterized by dysphoria, as well as slowing in the pace of mental and physical activity. Interest in pleasurable activities is minimal, energy is low, appetite is diminished and accompanied by weight loss. Patients are agitated, and sleep disturbances exist.

41
Q

Mixed feature requires three of the following criteria…

A

●Diminished interest or pleasure in most activities

  1. ●Psychomotor retardation
  2. ●Low energy
  3. ●Excessive guilt or thoughts of worthlessness
  4. ●Recurrent thoughts about death or suicide, or suicide attempt
42
Q

What are some common substances that induce manic symptoms?

A

Common substances that may induce manic symptoms include stimulants, corticosteroids, sympathomimetics, decongestants, caffeine, and antidepressant medications.

43
Q

What are some common substances that induce a depressed mood include?

A

Substances that may lead to depressed mood include CNS depressants, such as alcohol and benzodiazepines.

44
Q

What are the most common condition for manic symptoms?

A

The most common conditions for manic symptoms are head injuries, multiple sclerosis, CNS tumors, and HIV/syphilis.

45
Q

What questionnaire should the NP use for screening?

A

Mood Disorder Questionnaire for screening mania in clinical practice

46
Q

Metabolic syndrome and BPD

A

BPD patients are twice as likely to have metabolic syndrome than the general population

47
Q

Mood stabilizers and women?

A

All women of childbearing age need consistent contraception due to increased risks of congenital abnormalities.

48
Q

Risks of taking mood stabilizers?

A

Lithium tox is serious concern. S/S include delirium, mental status changes, severe tremors, ataxia, diarrhea, n/v, high sedation.

Anti-inflammatory agents, ACEI, and diuretics increase lithium plasma blood levels. Caffeine and high sodium intake decrease lithium levels. Pt’s need to avoid low sodium dietary regimens and situations where excessive sodium depletion can occur, such as heavy exercise with excessive sweating, due to a possible increased lithium concentration and lithium toxicity.

49
Q

Alcohol misuse and AST, ALT, GGT, and CDT

A

AST, ALT, GGT, and CDT are biomarkers that are altered in the consumption of alcohol.

ALT is distributed mainly in the liver; therefore, its serum elevation may be indicative of hepatic injury or inflammation. AST may also indicate liver injury but has been linked to muscle inflammation and MI as well. AST and ALT are elevated in the presence of liver disease whether IT’S ALCOHOL OR NOT.

50
Q

GGT and alcohol misuse

A

GGT-increased levels may result from increased cell membrane permeability and cell necrosis. Elevations occur in DM TYPE 2, HTN, CAD, stroke, and obesity. 50-72% of elevated GGT levels are due to alcohol intake. Normal levels can occur over 4-8 weeks of abstaining from alcohol consumption.

51
Q

What are potent opioid Agonists?

A

Opioid Agonists: (HELPS WEEN) Buprenorphine (Suboxone)-Can prevent potential life threatening respiratory depression in cases of abuse. Methadone and Suboxone are equally as effective at opioid replacement therapy.

52
Q

What are potent opioid Antagonists?

A

Opioid Antagonist: antagonist of mu opioid receptors and can block the effects of opioid agonists. Can prevent the impulsive use of opioids in patients receiving naltrexone, and can provide time for the patient to consider the consequences of relapse and to seek support.

53
Q

What is Ecstasy and S/S?

A

MDMA acts as both a stimulant and a psychedelic that creates an energizing effect combined with distortions in perception and enhanced enjoyment from tactile experiences.

54
Q

What is GHB and S/S?

A

In ↓ concentrations GHB stimulates dopamine release, whereas in ↑ doses dopamine release in inhibited. Withdrawal symptoms range from mild to short-lived. Agitation, anxiety, and insomnia, tachycardia, delirium, hallucinations and seizures.

55
Q

What is Rohypnol and S/S?

A

preoperative anesthesia as a sedative-hypnotic. Acts as a muscle relaxant and at high doses, can cause a lack of muscle control and loss of consciousness. Date rape pill causes sedation, inhibition, confusion, hypotension, and amnesia.

56
Q

Treatment for Rohypnol overdose?

A

Overdose may be treated cautiously with FLUMAZENIL, the benzodiazepine antagonist

57
Q

What is Ketamine and S/S?

A

Rapid-acting anesthetic. The patient becomes psychologically disconnected from his or her body. Lower dose intoxication results in impaired attention, memory, and learning ability. Overdoses of ketamine cause delirium, amnesia, impaired motor function, and hypertension

58
Q

Treatment for Ketamine?

A

TREATMENT IS SUPPORTIVE GENERALLY REQUIRING MECH VENTILATION+CARDIOVASCULAR SUPPORT.