Midterm 1 Flashcards
Atypical Antipsychotics - Metabolic Syndrome Signs
**High fasting blood glucose: ** > 5.6
Hypertension:
>130/85
Abdominal obesity:
Waist to hip ratio (M >0.90; W > 0.85)
Waist circumference (M >102; W; 88)
Constellation (>3) of coronary artery disease risk factors. Metabolic syndrome signs
Abdominal obesity (Waist circumference M >102cm; W > 88cm)
Hypertension
Glucose intolerance/resistance (fasting glucose 100mg/dL)
Elevated triglycerides (150)
Low HDL (>40 males, >50 females)
CASE Approach
Chronological Assessment of Suicide Events
• Presenting suicidal events (how?)
•Recent suicide events (2 months)
•Past suicide events
•Immediate suicide events (now; what’s next?)
CASE Validity Techniques
Behaviour incident
Shame attenuation
Gentle assumption
Symptom amplification
Denial of the specific
Normalization
Behavioural Incident
What did they do? Ask questions about concrete behavioural fact
Example: “can you walk me through what happened the night you almost attempted suicide?”
..”what did you do next?” .. “what did you feel next?”
Shame Attenuation
Showing sincerity and wanting to understand rationalizations that shape how individuals perceive their reality.
Inquires about behaviours that individuals may be hesitant to discuss because of shame and guilt.
Enforces a stance for unconditional positive regard.
Symptom Amplification
How often/how intensely?
Example: “I only have a couple of drinks” - Clarify what “a couple” is for the client
Denial of the specific
When individuals deny generic questions.
Example:
Clinician: have you made any preparations for suicide?
Pt: No
Clinician: Have you written a will?
Pt: No
Clinician: Have you written a suicide note?
Pt: Well, yes, but only on my phone. I haven’t printed it or anything
Many people who say “no” to a general question will say “yes” when the question is asked about specifics
Functional vs Encapsulated vs Chaotic families
Functional: No preexisting family conflict or psychopathology. Suicide due to chronic physical illness
Encapsulated: Psychopathology and conflict generally observed only in deceased, not other family members
Chaotic: Clear evidence of psychopathology in multiple family members
Recovery-focused approach
Includes building relationships that fosters hope, empowerment, self-determination, and responsibility. Values address:
•Family engagement
•Respect and dignity
•Choice
•Determination
•Independence
•Family caregiver needs and sustainability
Ethical Considerations in nursing care
Competence
Privileged communication: Privilege provides relief from having to disclose info in court
Confidentiality:
Advocacy
Calgary Family Assessment Model Components
Developmental
Structural
Functional
Tidal Model
Theoretical model that recognizes individuals are in a constant state of change while negotiating their relationship with intrinsic and extrinsic influences and that growth and development occur through changes that follow patterns
Relevant to care of older adults in psych
Clinical Recovery vs Personal Recovery
Clinical Recovery: Reduction or removal of symptoms
Personal Recovery: Belief that even if they live with an illness, their life will continue and they will find a way to live well. Focus on strength/resources
4 R’s of trauma informed care
- Recognize your biases
- Regulation
- Relate (make a connection)
- Reason
First generation (typical)
vs
Second generation (atypical)
First gen: Significant neurological side effects such as EPS, dystonia(involuntary muscle contractions), neuroleptic malignant syndrome (life-threatening; fever, altered LOC, muscle rigidity)
Second gen: Metabolic syndrome. Still has neuro risks but lower risk
Extrapyramidal Symptoms (EPS)
Effects motor control and coordination.
•Tardive dyskinesia
Neuroleptic Malignant Syndrome
Life-threatening
fever
altered mental status
muscle rigidity
autonomic dysfunction
Dystonia
Neurological movement disorder. Involuntary contractions that cause slow repetitive movements or abnormal postures that can be painful
Waist / hip to waist ratio for obesity
Men:
Waist >102cm
Hip-to-waist >0.90cm
Women:
Waist >88cm
Hip-to-waist >0.85cm
Acute Stress Disorder
Symptoms appear 2-4 wks after event, resolve by 4 wks
Display of 3 dissociative symptoms during or after traumatic event and within month of experiencing trauma
PTSD
When psychological behavioural reactions persist over a month of an event
Flashbacks, nightmares, intrusive thoughts
Avoidance of situations/environments
Interventions:
CBT
Exposure
Group therapy
EMDR
Neurosequential therapeutics
Somatic centred approaches
meds
Perry’s Neurosequential Model of Therapeutics
NMT is a developmentally sensitive, neurobiology-informed approach to clinical problem solving. It’s not a specific technique or intervention.
Used for children but can be effective with adults.
Inverted triangle.
From bottom to top:
Brainstem -> Midbrain -> Limbic -> Cortical
Brainstem: Interoception (internal) and external input from world. HR, fight/flight.
Midbrain: arousal/sleep/appetite/movement
Limbic: Emotional response, memory, reward, bonding
Cortical: Creativity, empathy, self-control, values, language, time
Positive relationships develop when:
The nurse establishes credibility (knowledgeable)
The focus is on the immediate intervention need of the family
Challenges for families
Difficulty in access related to limited capacity
Poor information sharing between provider, consumer and carer
Carers not always included in decisions
Community treatment orders (CTOs)
Provide a legal framework that requires adherence to treatment in order to avoid treatment in restrictive environments such as inpatient units
Recovery Oriented Practice: How?
Focus on strengths
Belief in potential for growth
Hope
Understand that recovery is individualized process
Being supported by others
Develop connections to community and natural supports
Psychosocial Rehabilitation
Promotes personal recovery, successful community integration and satisfactory quality of life for persons who have mental illness
Phase I, Phase II and Phase II recovery outcomes
Phase I
(Acute) safety and medical stabilization
Phase II
(Stabilization) Adhere to treatment and self care
Phase III
(Maintenance) Building on success. Living more individually with more satisfaction. Prevent relapse
Recovery vs Rehabilitation
Rehabilitation
Focuses on managing deficits and helping them learn to live with illness
Recovery
•Focuses on achieving goals of patients choosing
•Collaborative, client-centred
•Focus is on person and future
Trauma Informed Care Principles
Trauma awareness/understanding
Cultural competence
Promote Safety/Stability
Compassion and dependability
Collaboration and empowerment
Belief in Resilience and recovery
PTSD Risk Factors
Biological:
•Hypothalamic-pituitary Adrenal Axis
•Deficits in arousal and sleep regulating systems
•Endogenous opioid system problems
Psychological:
•Mood disorders
•Anxiety disorders
Considerations for children with PTSD
Less likely to show distress. Express emotions through play
Sequential Engaging & processing
Builds off neurosequential model.
Remember the upside down triangle. Bottom to top: Brainstem, midbrain, limbic, cortical.
Sequential engaging and processing
Midbrain: Regulate
Limbic: Relate
Cortical: Reason and reflect
Post Traumatic Growth
Growth happens are a result of the struggle to find a new normal through emotional and cognitive processing. NOT because of the direct result of trauma
•Life appreciation
•Closer relationships
•Setting new goals and letting go of old ones
•Increased personal strengths
•Having a greater connection
Allostasis
Stress.
The adaptive processes that maintain homeostasis through the production of mediators such as adrenalin, cortisol and other chemical messengers.
Depersonalization vs Derealization
Depersonalization
A state in which one’s thoughts and feelings seem unreal or not to belong to oneself, or in which one loses all sense of identity.
Derealization
A mental state where you feel detached from your surroundings. People and objects around you may seem unreal.
Fear conditioning
The pairing of an initially neutral stimulus with a fear eliciting stimulus
Paresthesia
pins and needles sensation
Each “type” of anxiety disorder has symptoms clustered in 4 areas. What are those 4 areas?
Physical response
Thoughts
Emotions
Behaviours
Agoraphobia
Excessive anxiety or fear about being in places or situations in which escape might be difficult or embarrassing
Generalized Anxiety Disorder
Physical response: dizziness, itching, choking feeling, GI changes, blurred vision, nausea, vomiting, increased HR
Thoughts: automatic negative thoughts, catastrophizing, excessive worry
Emotions: Agitation, sadness, guilt
Behaviours: Avoidance, procrastination
Pharmacotherapy for anxiety
SSRI/SNRI are first line for long-term Tx
Benzodiazepines
Hypnotics
OTC
SSRI: Zoloft
SNRI: Effexor
Non-benzodiazepines: Buspirone (good for anxiety, not panic). Displaces digoxin, a med used for irregular HR
Zolpidem (sleep)
Hypnotics: Zopiclone (increase GABA activity), Temazepam
OTC: Antihistamines, melatonin
Benzodiazepine Side Effects
CNS depression
Autonomic effects
Paradoxical reactions
Panic disorder most closely associated with addiction to what?
Alcohol
GAD closely associated with addiction to what substances?
Cannabis, etc. Less commonly alcohol
Trauma Resiliency Model
The model is a brief, effective, body-based crisis response intervention that takes advantage of the body‘s natural propensity to self regulate, using the biological stabilization skills of tracking internal sensations of well-being
Exclusion
Major health problem globally
Impacts all populations, community, individuals
Carries mental health consequences on a mass scale, ranging from mild depression to suicide
Social Exclusion
Lack of or denial of resources, rights, and goods/services and inability to participate in normal activities available to the majority of people in a society, whether in economic, social, cultural, or political areas
Delirium tremens
Most severe form of ethanol withdrawal, manifested by altered mental status (global confusion) and sympathetic overdrive (autonomic hyperactivity), which can progress to cardiovascular collapse
Motivational Interviewing
What is the most preventable cause of death globally?
Tobacco/Nicotine use
Biologic Theories in Addiction
Interplay between stressors in the environment and genes (epigenetics). Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, and the environment and individuals life experiences
Psychological Theories in Addiction
The contribution of psychological and psychiatric factors that reflect the individuals preferences, experiences, or problems
Social Theories in Addiction
Substance availability, legislation, and other health policies. Culture is another factor influencing addiction prevalence rates
Spiritual Theories in Addiction
The relationship between an individual snd the sacred
Substance Use Disorder: Medical Model Approach
Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences
Substance Use Disorder: sociological Perspective
Looks at social influences; economic, homelessness, health inequities..
What are the 4 overarching Criteria of Substance Use Disorder?
•Impaired control (4)
•Social Impairment (3)
•Riskier use (2)
•Pharmacological Criteria (2)
Substance-Induced disorders
Intoxication, withdrawal, and other substance/medication-induced mental disorders (psychosis, anxiety, etc), caused by the effects of substances
Impacts of substance use disorder
Relationships
Economical
Public health (eg. opioid crisis)
Substance Withdrawal
Development of a substance-specific maladaptive behavioural change that is due to the cessation, or reduction, of heavy and prolonged substance use
Can be life threatening or just uncomfortable
Substance/medication-induced mental disorders
Challenges that develop when people who did not have mental health challenges before using now do
What is a standard drink?
341 ml (12 oz) bottle of regular beer
What is a standard drink?
341 ml (12 oz) bottle of regular beer
1.5 oz of 80-proof spirits
5 oz wine
Alcohol Use Disorder
A problematic pattern of alcohol use leading to clinically significant impairment or distress, manifested by at least two of the following occurring within a 12 month period:
- Alcohol is often taken in larger amounts over a longer period than was intended
- There is a persistent desire or unsuccessful efforts to cut down or control alcohol use
CAGE Questionnaire
COWS
Clinical Opiate Withdrawal Scale
CIWA
Clinical Institute Withdrawal Assessment for Alcohol
SUD assessment includes:
Standard use assessment
Comprehensive physical assessment
Collateral information assessment
Which substance are older adults more often hospitalized for?
Opioids
Family Assessment Components
Structural: Who, what connections, context
Developmental: Life cycle events/sequence
Functional: Detail behaviour toward eachother
4 Pillars of Substance Use Strategy
Prevention
Encourages people to make healthy choices, provide opportunities for people to reduce likelihood of substance use (affordable housing, employment training, jobs)
Treatment
Access to services, outpatient services, Opioid dependency program, residential treatment
Enforcement
Non criminalization, improving safety, community engagement
Harm Reduction
Pragmatism
Recognize that substance use is inevitable in society
