N235 Flashcards
Thalamus and hypothalamus are part of what system
Limbic system
What does the forebrain consist of
Cerebellum and diencephalon (connects cerebellum to limbic)
A few major neurotransmitter categories
Chollinergics
Monoamines
Amino acids
Neuropeptides
Chollinergics
Acetylcholine
Primary in junctions of nerves and muscles
Plays a role in most all functions
Could play a role in Parkinson’s and Alzheimer’s
Monoamines
Norepinephrine
Dopamine
Serotonin
Histamine
Monoamine
Norepinephrine
Creates activity in the post synaptic terminal of nerves in ANS
Used for fight or flight
Regulates mood, cardiovascular system, sleep.
What mood disorders can be implicated from norepinephrine
Depression
Mania
Anxiety
Schizophrenia
Monoamine
Dopamine
Functions to regulate mood
Movement/ coordination
Increased dopamine levels are seen in what mood disorders
Mania
Schizophrenia
Monoamine
Serotonin
Play a role in sleep arousal, libido, mood, agitation.
Seen in schizophrenic disorders as well as anxiety states
Monoamine
Histamine
Functions as allergic and inflammatory reactions.
Sustaining wakefulness
Shown to be associated to some depressive illness
Amino acids types
Inhibitory and excitatory amino acids
Two of the biggest inhibitory amino acids
Gamma aminobutyic acid (GABA)
Glycine
How does GABA and glycine work
They prevent excitation of postsynaptic terminal impeding the impulse of electrical current. (Stops/slows down the message signal)
What disorder has GABA been implicated to
Anxiety disorders
Movement disorders
Some forms of epilepsy
What disorders has glycine been implicated with
Spastic disorders
What are the two common excitatory amino acids
Glutamate
Aspartate
Excitatory amino acids role
Relay sensory information
Regulate motor and spinal reflexes
Excitatory amino acids are implicated in
Neurodegenerative disorders
Huntingtons disease
Temporal epilepsy
The longer you are awake for what happens to your inhibitory amino acid numbers
They increase
Three main neuropeptides
Opioid peptides
Substance P
Somatostatin
Circadian rhythm
24 hour sleep wake cycle
Abnormal circadian rhythm correlated to
Depression
Bipolar disorder
Seasonal affective disorder
Neurochemicals that effect sleep
Serotonin
Norepinephrine
Acetylcholine
Melatonin
Is there a correlation of the immune system to psych illnesses
Yes
Serotonin can be triggered by micro biome in gut.
What is the function of the limbic system
Helps stabilize emotional behavior
What was the primary psychotropic drugs before 1950
Sedatives
Amphetamines
Post 1950 psychotropic therapy
Extended to anti anxiety
Antidepressant
Antipsychotic
Used in adjunct with psychotherapy
Role of nurses with psychotropic medications
Patient education
When to take
How to take them
Side effects
Benefit time line
How do psychotropic medications work
Psychotropic medications affect neurotransmitters
How does reuptake effect neurotransmitter
Inactivation
What are the 4 kinds of psychotropic medications
Antidepressant
Antipsychotic
Benzodiazepines
Psychostimulants
Anti anxiety agents would be used in
Anxiety disorders
Alcohol withdrawal
Convulsive disorder
Skeletal muscle spasm
Pre operative sedation
Anti anxiety agent action
Depression of the central nervous system
Antagonist of GABA receptors the inhibitory neurotransmitter
Anti anxiety medications
Benzodiazepines (pams)
Atypical anxiolytic
SSRI’s
SNRI’s
Off label prescriptions
Benzodiazepines
Anti anxiety
Lorazepam
Alprazolam
Clonazepam
Diazepam
Atypical anxiolytic
Anti anxiety
Busprione
SSRI’s
Anti anxiety
Selective serotonin reuptake inhibitors
Paroxetine
Fluoxetine
Citalopram
Sertraline
SNRI’s
Anti anxiety
Venlaxafine
Duloxetine
Desvenlafaxine
Off label prescriptions for anti anxiety
Propranolol
Prazosin
Gabapentin
Pregabalin
What medication is usually prescribed for a patient PRN with anxiety symptoms
Benzodiazepines
Pams usually used as a PRN anti anxiety
Alprazolam
What is the action of anti depressant medication
Increase the concentration of
Serotonin
Dopamine
Norepinephrine
Blocks the reuptake of these neurotransmitters
Classes of anti depressants
MAOI. (Monoamine oxidase inhibitors)
Tricyclic antidepressant (TCA)
Selective serotonin reuptake inhibitors (SSRI’s)
Serotonin/norepinephrine reuptake inhibitors (SNRI’s)
Norepinephrine/dopamine reuptake inhibitors (NDRI’s). Bupropion
Common SSRI’s
Paroxetine
Fluoxetine
Citalopram
How long does it take SSRI’s to take effect
No immediate affect maybe placebo
Improvement in 4-6 weeks
Full effect in months
Feel side effects before benefits
One problem with SSRI’s
Take a while before effect side effects are seen first.
Patients might have more energy
Might be prone to commit suicide
SSRI’s nurse education
Take at same time everyday
Night time to avoid side effects
Must be tapered off
Do not double dose if missed
Suicide assessment report any new thoughts immediately
SSRI’s side effects
Nausea
Agitation
Headache
Sexual dysfunction
Etc
Sleep disorders
Appetite disorders
Serotonin syndrome
Too much serotonin in the body causing over stimulation of receptors in CNS
Hyper reflex
Tachycardia
Tremor
Hypertension
Hyper bowel sounds
Dilated pupils
Sweating
Double dose
Taking 5HTP one cleave away from serotonin same effects
MAOI action
Inactivation of norepinephrine
Serotonin dopamine enzyme leaving more left
Drug interaction with other anti depressants
What do you have to do with MAOI’s
Avoid tyramine rich foods
Can cause hypertensive crisis
Cheeses
Red wine
Smoked meats
Soy sauce
MSG
Mood stabilizing agents
Lithium
Anti convulsant
Second generation atypical antipsychotic
What is the relation between lithium and sodium
Lithium is a salt that is a imperfect substitute for sodium
What happens if your sodium goes down to lithium
More sites are available for lithium risk for lithium toxicity
Lithium side effects
Weight gain
Lethargic
Hypotension
Hyponatremea
Narrow therapeutic range
High risk for patient discontinuation
Lithium therapeutic range
0.6-1.2mEq/L
1.0-1.5 mEq/L for mania
Don’t change diet enough sodium and water intake
Lithium toxicity
Nausea vomiting diarrhea
Over 2mEq/L tremors
Over 3.5mEq/L delirium seizures coma death
ADHD medication agents can they be dependent
Yes both physically and psychologically
When would you give ADHD medication
Early in the morning to avoid insomnia and sleep disorders
Conditions that are essential to a therapeutic relationship
Rapport
Trust
Respect
Genuineness
Empathy
What are the 4 phases of the therapeutic relationship
Pre interaction
Orientation
Working
Termination
Pre Interaction phase
Obtain information
Examine own feelings
Goal is to explore one’s own self perceptions
Orientation introductory phase
Set mutually agreeable goals
Gather assessments
Create environment of trust
Working phase
Maintain trust
Goal is to promote patient change
During working phase two issues arise what are they
Transference Patient transfers feelings of someone else on to you
Countertransference Nurse emotional/ behaviors to the patient
What are some therapeutic communication techniques
Using silence :patient is able to take control
Accepting: coveys positive regard
Offering self:
Giving recognition: acknowledging indicating awareness
Giving broad opening open ended questions. : allows patient to select topic
Offering general leads
Placing events in a time sequence.
Making observations. Verbalize what you see
Encourage description of perception. Have the patient tell you what they are seeing or going through.
Restating
Reflecting
Non therapeutic communication techniques
Giving reassurance: may discourage patient from further expression of feelings
Rejecting:
Approving or disapproving:
Giving advice:
Probing:
Defending:
Depression is a risk factor for what?
Cardiovascular disease
Diabetes
Asthma
Hyperlipidemea
Dementia
1 in _ women have depression in their life
5
1 in _ men have depression in their life
10
Clients with a significant mental illness die _ sooner than the normal population
25 years
Why do you give a benzodiazepine to someone withdrawing from alcohol
They have been taking a depressor and need another depressor to wean off the withdrawals with out rebounding
AD
Alztihmiers disease
What drugs do you want to give and avoid in patients with AD
You would give drugs to help with depression such as SSRI
avoid TCA antidepressant since this will be a anticholinergic medication making condition worse
What are some causes of AD
having too much Acetylcholine enzyme in the brain or having a deficit of acetylcholine
what is the percentage of people in the workforce taht can be classified as a addiction or substance use disorder
75%
What gender is using illicit drugs more than the other
males
What is CIWA used for
This is used for alcohol withdraw score
What is one way to make sure the score is true without patients fasly boosting the score
introduce yourself and shake their hands you can usually tell right away with out being obvious if they are shaking
What are the categories of CIWA
Tremors 0-7
A&O 0-4
sweating 0-7
Auditory hallucinastions 0-7
visual hallusinations 0-7 light sensitive
headache 0-7 tight band feeling
tactile disturbance 0-7
anxiety 0-7
agitation 0-7
What are the common medication used for alcoholism
Disulfiram (antabuse) doesn’t stop drinking but will take away the good feeling from drinking. Is used in combination with life change
Thiamine to replace what is deficient in the body
Benzodiazepine – alcohol has a huge impact on GABA when you stop abruptly all of your body has been consent depressed. Using this will depress the body not allowing a deadly rebound effect after body has been suppressed for so long.
Anticonvulsants - after the depression of the brain used to help symptoms of tremors and seizures
What are the common medication used for alcoholism
Disulfiram (antabuse) doesn’t stop drinking but will take away the good feeling from drinking. Is used in combination with life change
Thiamine to replace what is deficient in the body
Benzodiazepine – alcohol has a huge impact on GABA when you stop abruptly all of your body has been consent depressed. Using this will depress the body not allowing a deadly rebound effect after body has been suppressed for so long.
Anticonvulsants - after the depression of the brain used to help symptoms of tremors and seizures
what percent of the population uses THC
8.4%
What is the effect of cannibals on the body
cardiovascular effects
respiratory effects
Depress CNS
suppress sexual function
Zolpidem
Sedative called Ambien
depresses CNS
non barbiturate hypnotics
sleep disorders
addictive
makes you dependent on it for sleep
What parts does a sedative or a hypnotic effect
They will all have effects on your
respiratory depression
body temp
Effects RAS (reticular activating system) which can cause respiratory depression
Hypotension possible
what are the pharmocological drugs used for opioid dependence
Methadone (slow long term replacement for dependence) can taper off used clinically to wean off opioid addiction.
Buprenorphine partial agonist. weaker than methadone. used for withdraw seen to be safer
Suboxone: combination drug ( naloxone and buprenorphine) this is both an agonist and an antagonist
Narcan (Naloxone) used to treat overdose very short half life
what is the estimate for nurses with a chemical dependence
10-15%
What are the four phases of schizophrenia
- premorbid ( signs of odd behavior shy and anti social poor in school)
- prodromal Can last years still doing poor with relationships
- Active psychotic symptoms are present
- Residual flat affect similar to prodromal
positive symptoms
Adding to the individual visual or auditory symptoms that are added to a patient that the normal person doesn’t have
Negative symptoms
These are symptoms that are taken away flat affect
Delusions
Fixed or false personal beliefs
common delusions that can occur
grandiose ( fantasy of greater they are president or know so and so)
persecutory
reference
control think they are in charge and can put you in jail for example
religious think that they are doing gods work.
jealous
Echopraxia
repeating movements that are being observed
Negative symptoms
affects that are taking away from one’s mood
inappropriate affect one’s emotions are in concurrent with the situation (laughing at someone’s pain)
Bland = weak emotional tone overall
Flat= appears to be absent of any emotional tone
apathy = disinterest in one’s environment
Avolition
Negative symptom in schizophrenia impairment in goal directed activity as well as ADL’s
Anergia
lack of energy
Anhedonia
inability to experience pleasure
What are other negative symptoms taht can happen
Abnormal eye movement
regression in age development stage
strange posture
Is suicide a diagnosis or a disorder
No it is a behavior
True or false 90% of suicides are from people with diagnosed mental disorders
True
Suicide risk factors
Feeling trapped
feeling helpless
feeling lonely
feels like a burden
has means to carry it out
thoughts of committing it
intoxicated
history of violence
exposure to suicide
substance abuse
out of touch with reality
If someone walks into a clinic is that protective
yes this is a protective factor just coming into talk is trying to stop doing suicide.
988
national suicide hotline
do you leave someone who is suicidal alone for a little bit to go get help?
NO!! you never leave anyone who might be suicidal alone.
You want to remove kids from the situation to avoid trauma.
What is the prevalence of depression
17% of the population will have depression
2:1 ratio for women to men experiencing depression
The older you get the more prevalent depression is at a higher rate for those 45 years or older.
Types of depression
Major depressive disorder (symptoms present for at least 2 weeks) lose interest in pleasurable things
Persistent depressive disorder (chronic)
most days rather than not most of the day for over 2 years.
premenstrual dysphoric disorder (depression, anxiety, mood swings, symptoms surrounding menses)
substance medication induced= depression associated to or lack of drugs
Hypomania
milder form of mania
What are the 3 stages of mania
hypomania
acute mania what is normally seen for mania
delirious mania (rare)
What are the different forms of bipolar disorder
Bipolar 1 more extreme shift from mania to hypo mania or depressive mood
Bipolar 2 hypomanic to depressive
cyclothymic chronic mood shifts for 2 years
Substance bipolar
What stage of mania is needing to be hospitalized
Acute mania and delusional mania
not hypomania
Signs of a mania
Changes in sleep pattern
always active
great feeling
high risk activity
easily distracted
rapid conversation
What do you want to do as a positive for the patient when going through a mania
Keep things calm and quiet
finger food so they don’t forget to eat
weight daily
daily I&O
healthy outlets for energy
medications that are used to treat OCD
SSRI’s Fluoxetine, Fluvoxamine, Sertaline
Symptoms that are a part of PTSD
Survivors guilt
depression
anger aggression
substance abuse
relationship problems
What is an acute stress disorder time line
<1month
true or false 25% of men have anorexia
false 25% of those with anorexia are men
true or false most people with bulimia are within a normal weight range
true
What are common mental health disorders that are found with people with bulimia
anxiety, depression, substance abuse are commonly found with bulimia and eating disorders.
Cluster A
Odd or eccentric
paranoid, schizoid, schizotypal
Paranoid personality disorder
Cluster A disorder
distrust others
thinks things are suspicious or going to be bad
Schizoid personality
Cluster A disorder
detachment from others and emotions have a limited range of emotions
Schizotypal personality disorder
acute discomfort with reduced capacity to hold and have a healthy relationship
Cluster B personality disorders
Dramatic/ emotional/ erratic
borderline
antisocial
narcissistic
histrionic
How many stages of mania are there?
3 stages
What is phase 1 of mania entail
Elevated mood
Hypomania
No impairment to one’s life
What phase of mania do patients get hospitalized for treatment
Phase 2 acute mania
What are the signs of phase 2 mania
Impairment with normal functioning
Racing thoughts
Flight of ideas
Risky behavior
Decreased sleep
What is another name for phase 3 of mania
Delirious mania
Having hallucinations
Rare usually doesn’t get here with medications.
What medications can start a manic episode
Antidepressants Can jump start a manic episode
What is the only medication used for manic episode control
Lithium carbonate
What does cyclothymia mean
It is a bipolar disorder with fluctuations in mood from d repression to hypo manic
The swing doesn’t take the person out to acute mania but increases and decreases mood swings can last years.
Can’t be classified as depressive or manic states
What is the most common other disorder in bipolar patients
ADHD
What is cluster C personality disorders known for
Being anxious and fearful
What are some common personality disorders in cluster C?
Dependent personality disorder
Obsessive compulsive disorder
Avoidant
If someone is being avoidant to criticism what cluster are they showing
Cluster C
What are some common traits that are shared across personality disorders
Manipulative
making conflict with others
cant maintain relationships
maladaptive responses to stress
What is DBT
Dialectical Behavior Therapy
What does Dialectical behavior therapy involve
cognitive behavioral therapy that is focused on emotional regulation
Has a validating environment
Uses mindfulness and meditation
What is one of the biggest issues with personality disorder care
Splitting of the staff (Best nurse vs worst nurse)
Resolve this by having consistent caregivers
Maintain good healthy boundaries
What percentage of adolescents 9-17 have an addiction disorder
21% of kids in this age group have an addiction or mental disorder
True or false 11% of kids have a major mental illness leading to impairment in daily life
True
True of false the most common mental disorders in kids are
Anxiety disorder
Disruptive behavior disorder
Mood disorders
Bipolar disorder
Substance use disorder
False
All are true except bipolar disorder
What are some risk factors that lead a child to have a mental illness
Social situation
family history
genetics
Biochemical
If a child Went through a adverse event such as a war
abuse (any kind)/ Neglect (any kind)
natural disaster
Are they at greater risk for health issues such as COPD, early pregnancy, mental illness, liver disease or heart disease.
Yes if a child goes through a hard time during childhood of any kind can lead to maladaptation.
Leading to addiction and unhealthy risk behaviors leading to higher stress mental illness as well as STD’s and liver or heart disease.
ASD
Autism spectrum disorder
IDD
Intellectual development disorder
What are the categories for IDD
Mild
moderate
severe
profound
What are the five forms of ASD
Asperger’s
Retts
Autistic disorder
Pervasive developmental disorder
childhood disintegrative disorder
