Psych Flashcards
Incomprehensibility (define)
When the general public can’t understand the motive behind someone’s behavior (Horowitz)
Cultural Relativity (define)
When the “normality” of behaviors is determined by a culture (wailing in mourning vs silent coping)
Dorothea Dix
Developed the concept of asylum (sanctuary), provided food, shelter, clothing to mentally ill.
What was the unintended consequence of deinstitutionalization
Thousands of mentally ill concentrated in prisons, state hospitals, homeless, and nursing homes.
Risk factors for violence among the mentally ill
History of violence
Command Auditory Hallucinations
Drug/Alcohol Abuse
Not compliant with treatment (or out of treatment)
Peplau believed…
That the work of psych nurses is interpersonal, and that using the relationship between nurse and patient can help move them towards wellness.
What are Peplau’s five roles?
Teacher Resource Counselor Technical Expert Surrogate
Transference
When a patient takes their baggage, especially feelings about a specific significant person, and places it upon the nurse/therapist.
Countertransference
When a nurse/therapist takes their history/baggage and it colors their perspective/opinions about the patient.
Milieu Therapy: Assumptions
Every individual has the ability to be healthy/realize health.
Every interaction is an opportunity for therapeutic intervention.
The client owns his own environment.
The client is accountable for his own behavior.
Inappropriate behavior comes with logical repercussions.
Milieu Therapy: Characteristics
Meeting of the patient’s basic physical needs
Facilities are home-like
Structured program of social and work-like activities
Community and family are involved
Democratic government in which patient is encouraged to participate.
What is the role of the nurse in the psychiatric setting?
Meeting the patient’s physiological needs Provides reality orientation Medication Administration Therapeutic Interactions Teacher Provide Hope
What are the recovery models and what are their shared components?
They’re based on the idea that recovery is possible.
The desire is for the patient to manage their illness the best as they are able.
The patient is provided a safe place to live.
The patient needs to feel as though they have meaningful activities.
The patient needs a social network for support.
Tidal Model
WRAP model.
What is the Tidal Model?
Recovery Model that uses the metaphor of water.
Focuses on the patient’s story, builds on their strengths.
Recognizes that change is constant (comes in waves)
Nurse should:
- spend time with patient
- be transparent.
What is the WRAP model
Wellness Action Recovery Plan (recovery model).
Structured process with concrete steps:
- Builds a “wellness toolkit”
- involves patient identifying their triggers/early warning signs and what tools they can use if it occurs.
- making a maintenance list and reviewing it daily
- spells out how to recognize when the condition worsens
- incorporates crisis planning: how friends/family can manage so as not to call 911.
What are the four major groups of neurotransmitters?
Cholinergics
Monoamines
Neuropeptides
Amino Acids
What’s the basic physiology of neurotransmitter release?
Neurons talk to each other across the synaptic space
AP fires and the NT is released into the synaptic cleft
NT attaches to receptors on the postsynaptic membrane
AP continues to the next nerve cell
(Presynaptic neuron “reuptakes” extra/leftover NT for recycling).
What NT is the primary cholinergic? Is it excitatory or inhibitory? Where is it located? What is it synthesized from? What does it do? What disease processes are associated with it?
Acetylcholine. (Synthesized from choline)
Both excitatory and inhibitory.
Location: Mostly PNS (also brain and spinal cord) - NMJs of skeletal muscles, especially.
Coordination of movement, sleep, arousal, pain, perception, memory retention.
Increased in: depression
Decreased in: Alzheimer’s, Huntingdon’s, Parkinsons.
What are the monoamines?
Norepinephrine
Dopamine
Serotonin/5HT
Histamine
What type of NT is neuroepinephrine? What is NE synthesized from? Is it inhibitory or excitatory? Where is it synthesized? What are its functions? What disorders are associated with it?
Monoamine.
Synthesized from Tyrosine
Excitatory
Synthesized in pons, medulla, lymbic system, hippocampus (more?)
Functions: Mood, cognition, attention/vigilance, perception, cardiovascular function, sleep.
Increased in: anxiety, mania, schizophrenia
What metabolizes norepinephrine? What drugs prevent this?
Monoamine oxidase
MAO inhibitors
What kind of NT is dopamine? What is it synthesized from? Where is it located? Is it excitatory or inhibitory? What does it do? What disorders is it associated with?
Monoamine
Synthesized from Tyrosine
Located in: brainstem (mostly), especially at the substantia nigra
Usually excitatory. (Inhibits prolactin release: gynecomastia)
Controls complex movements, motivation, cognition, regulates emotional responses, involved in pleasure.
Associated with addictions, movement disorders, psychosis.
Increased in mania and schizophrenia
Decreased in depression and Parkinson’s
What kind of NT is Serotonin? What is it synthesized from? Where is it located? Is it inhibitory or excitatory? What are its jobs? What disorders is it associated with?
Monoamine
From tryptophan
Located in the brain (especially at the raphe nuclei of the brainstem)
Mostly inhibitory
Plays a role in sleep/arousal, libido, appetite, mood, aggression, pain perception, temperature regulation.
Decreased in depression
Increased in anxiety
What kind of NT is Histamine?
What does it to?
Monoamine
Plays role in mediating allergic reactions
Associated with wakefulness
What are the Amines?
What are they synthesized from?
Where are they located?
What functions are they associated with?
GABA, Glycine (Inhibitory)
Glutamate, Aspartate (Excitatory)
Synthesized from tyrosine, tryptophan, histidine
Found in the brain
Involved in learning, emotions, motor control
What type of NT are GABA and Glycine? What do they do? What are they synthesized from? Where are their receptors located? What drug class is GABA associated with? What disorders are they associated with?
Amines
GABA is the major NT of post-synaptic inhibition: it interrupts the impulse at the synaptic junction.
(Synthesized from glutamate?)
Most CNS neurons have receptors
Associated with Benzodiazepines
Decreased in Anxiety, Schizophrenia, some Epilepsy, Huntingdon’s
What type of NT are Glutamate and Aspartate? Are they excitatory or inhibitory? What do they do? Where are they located? What is the risk? What disorders are they associated with?
Amines
Excitatory
Relay sensory info and regulate motor/spinal reflexes
Synthesize structural/functional proteins
Located in the CNS
Too much can be neurotoxic
Decreased in Schizophrenia
Increased in anxiety, depression, temporal lobe epilepsy
What are Neuropeptides? Examples?
What does “second messenger” mean?
Opioid peptides (endorphins and encephalines)
Substance P
Somatostatin
They are “Second messengers”: they modulate the messages of NTs that aren’t peptides.
What type of NTs are Endorphins and Enkephalines?
Where are they located?
What do they do?
Are they inhibitory or excitatory?
Neuropeptides (opioid peptides) Located in the CNS and GI tract Endorphins help us deal with stress Enkephalines help reduce pain They’re generally inhibitory.
What is Substance P? Is it excitatory or inhibitory? What is it’s job? Where is it located? What drug interrupts its release? What disorders are associated with it?
Neuropeptide
Excitatory
Works in the transmission/regulation of pain
Located in the spinal cord, brain, sensory neurons associated with pain, GI tract, salivary glands
Interrupted by morphine
Increased in the CSF of patients with depression and PTSD.
Which NTs are most closely associated with anxiety disorders?
Serotonin (5HT), Norepinephrine, GABA
How do Monoamine Oxidase inhibitors work?
They prevent the intracellular destruction of monoamines (NE, 5HT, DA)
How do Donepezil and Rivastigmine work?
They inhibit acetylcholineesterase in the synapse, thereby increasing available acetylcholine.
How do tricyclics work?
They block the reuptake of norepinephrine and 5HT/Serotonin
How do antipsychotics work?
They block dopamine receptors on the post-synaptic neurons.
How do antianxiety drugs work (generally)
They activate GABA receptors/potentiate GABA.
How are norepinephrine and dopamine related?
Dopamine is the precursor to catecholamines.
Anxiety basics
Subjective experience detectable by objective behaviors.
SNS response to a perceived threat.
Psychological (thoughts) and physiological (NTs as well as Catecholamines).
Define Anxiety Continuum
Anxiety exists along a continuum, from mild through panic. At the mild end it can be useful and isn’t pathologic. At the panic end it is debilitating.
Mild Anxiety
Helpful/Adaptive No intervention needed Increased: -learning -alertness -perception -motivation
Moderate Anxiety
Could be appropriate (depending on the threat) Decrease in: -perceptual field -alertness -learning -attention span -concentration
Severe Anxiety
Could be appropriate if threat is severe, as well.
Greatly decreased perceptual field. Focus on very specific details.
No:
Concentration
Effective learning
Panic
NO: Focus Learning Concentration Comprehension.
Misperceptions and sense of doom.
Defense mechanisms arise at what point(s) in the anxiety continuum?
Mild-Moderate
Migraines, heart arrythmias and IBS arise from an extended time in what section(s) of the anxiety continuum?
Moderate to Severe
Chronic supression of severe anxiety can lead to:
Psycho neurotic behavior patterns
PTSD symptoms
Reliving trauma
Mental Stupor
Irritability
Nightmares
Simple Phobias
Fear of blood/snakes/elevators/flying/etc
Social Phobias
Fear of humiliation
Can manifest as fear of public speaking, fear of public toilets…
Panic Disorder symptoms
Fear of dying, sense of doom
Chest pain
Shortness of breath
Mixed anxiety/depressive disorder symptoms
Anxiety Inner tension Depression Increased Aggression Hostility
OCD symptoms
Obsessions (fears) and compulsions (to help to relieve the fears). Hallucinations.
Can be fear of germs, public toilets.
Can be sexual or murderous thoughts.
What are the four names we learned for anxiety disorders with physical manifestations?
Factitious disorder
Malingering
Somatic Symptom Disorder
Conversion Disorder
What is a factitious disorder? Is it intentional or unintentional?
Intentional production of symptoms in order to attain primary gain (usually treatment/medication/high)
What is Malingering? Is it intentional or unintentional?
Intentional production of symptoms made up for secondary gain (like a warm bed on a freezing night).
What is somatic symptom disorder? Is it intentional or unintentional?
Somatic symptoms (like a stomachache) not related to the disorder that the person believes is caused by something else (staples in the stomach). No loss of function.
What is conversion disorder? Is it intentional or unintentional?
Person actually loses function in a part of their body but no physiological cause exists. (Not intentional).
What are some anxiety screening tools? When/why are they used?
Usually used in outpatient treatment. Good for establishing a baseline and marking progress (anxiety skews perception in the moment).
GAD-7 Hamilton Anxiety Screen (HAMa) Burns Anxiety Screen Sheehan Anxiety Scale Pediatric Anxiety Scale MOCI
Behavioral Responses to Anxiety (Observable Signs)
Pacing Hand-wringing Hyper vigilance Increased motor movement Increased Startle Reflex Difficulty problem-solving Clenching jaw Increased heart rate/BP respiration’s
Physiological experience of anxiety (patient-experienced symptoms)
Palpitations Trembling, Shaky Chest pain/pressure Paresthesias (numbness/tingling) Faintness Irritability/Restlessness Derealization (doesn’t feel real) Dread/Doom Decreased concentration Decreased appetite Gut pain, IBS Dry mouth Lump in the throat
Psychological responses to anxiety (Defense mechanisms)
Denial Displacement Rationalization Intellectualization Regression Repression Suppression Dissociation Obsessions Compulsions Abreactions/Flashbacks
Define Displacement
Placing feelings (and associated actions) on someone other than the original target (yelling at the nurse because of anger at the doctor).
Define Intellectualization
Using logic, reasoning and analysis to avoid addressing actual emotions.
Define Repression
Involuntary blocking of feelings/experiences (can’t remember)
Define suppression
Voluntary blocking of feelings/experiences (“I don’t want to think about that now”).
Define Dissociation
No longer present - checked out completely.
Define Abreactions/Flashbacks
Relieving an experience and the subsequent emotional release.
Anxiolytics
Antianxiety medications. Most depress subcortical levels of the CNS (except buspirone).
SSRIs (action, names, onset, side effects)
Increase serotonin in the synapse by slowing down the reuptake and recycling by the presynaptic neuron.
Onset: slow (3-4 weeks), peak effect (6 weeks).
Side effects: sedation (paroxetine), nausea, restless legs (fluoxetine)
Paroxetine
Citalopram
Fluoxetine
Sertraline
Escitalopram
