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Psych Final Exam Flashcards

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1
Q

Epidemiology of eating/feeding disorders

A

More common in women
Binge eating more common
Trauma
ED is their one sense of control
Onset teens to early 20s
Anorexia may start earlier 7 -12
Often comorbid mood or anxiety disorder, (adolescents ODD may be accompanying), increase incidence of personality disorder (OC, Borderline)

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2
Q

Biological of anorexia

A

Genetic-60% heritability, no single gene

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3
Q

Neurobiological of anorexia

A

Role of tryptophan-only in diet-essential to serotonin synthesis (need to gain 90% optimal weight for antidepressants to be effective
Altered serotonin function, positive feedback loop of euphoria with calorie restriction eventually leads to dysphoria
If we don’t eat, it causes a deficit in serotonin. We need them to eat so they can have serotonin synthesis
Self serving disorder, very complicated cycle

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4
Q

fMRI in anorexia

A

↓ gray & white matter in CNS
Exhibit ↓ in size and/or function of:
Hypothalamus, basal ganglia, & somatosensory cortex
Regions of the insula, amygdala, & dorsolateral prefrontal cortex appear larger or experience ↑ activation
Insula associated with awareness/sensation of fullness

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5
Q

Anorexia

A

Intense fear of weight gain
Distorted body image (restricting vs binge purge)
Extremely thin, maybe cachectic, more dangerous for this patient to binge purge
Restricted calories with significantly low BMI

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6
Q

Subtypes of anorexia

A

Restricting (no consistent bulimic features)
Binge/eating/purging type (primarily restriction, some bulimic behaviors)

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7
Q

General assessment of anorexia

A

perception of problem
eating habits
hx of dieting
methods of weight control
value of weight to them
Interpersonal and social functioning
MSE and physiological parameters (thyroid, cardiac, electrolytes)

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8
Q

When is hospitalization necessary for anorexia nervosa?

A

Weight loss >30% over 6 months
Inability to gain weight outpatient (want them to gain 1-2 pounds a week during treatment)
Hypothermia (lower than 96.8)
Heart rate < 40 bpm
Systolic BP < 70 mm Hg
Hypokalemia (<3 mEq/L)
EKG abnormalities (arrhythmias)
Suicidal
Severe depression
Psychosis/delirium/confusion
Non-compliance outpatient treatment

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9
Q

Acute care for anorexia

A

Suicidal ideation first
Psychosocial interventions
Pharmacological interventions-none approved, though SSRI-Fluoxetine (Prozac) ↓ OC behaviors
Integrative medicine
Health teaching and health promotion
Safety and teamwork

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10
Q

Refeeding syndrome

A

Seen in anorexia when someone eats a lot all of a sudden after being anorexic
Body is used to no micronutrients. Now you’re eating regular food. When you lose weight your body breaks down muscle and fat for energy. When you eat normally again, your body pulls micronutrients from blood

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11
Q

Effects of refeeding syndrome

A

Hypokalemic, hypophosphatemia, hypomagnesemia, heart attacks when not proper. Small frequent meals
Double vision, swallowing problems, trouble breathing, kidney dysfunction, muscle weakness, confusion and disorientation, seizures, cardiomyopathy (heart weakness), N/V, hypotension)

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12
Q

Advance practice interventions for anorexia

A

Psychotherapy
Individual therapy
Group therapy
Family therapy
Journaling
Family communication and conflict resolution
Meal planning

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13
Q

Relapse of anorexia

A

Relapse rate is high up to 50% first year
Up to 40% meet criteria for 4 years
Goal-restore weight and establish healthful eating habits

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14
Q

Bulimia assessment

A

Appear well
At or near ideal body weight (maybe a few pounds over)
Episodes of binge eating (1500-5000 cals within 2 hour period followed by compensatory behavior)
Eating when they’re alone
Trying to lose the calories every day by vomiting, laxatives, etc

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15
Q

Physical signs of bulimia

A

Enlarged parotid glands, inflamed and scarred fingers from vomiting, dental erosion, and caries if the patient has been inducing vomiting.

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16
Q

Emotional and relationship signs of bulimia

A

Impulsivity and compulsivity more than anorexia. No breakdown of muscle and fat since they’re eating, normal electrolytes and stuff
Chaotic, non-nurturing family relationships more than anorexia
Familial and/ or social instability
Difficult interpersonal relationships

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17
Q

Acute interventions for bulimia

A

Teamwork and safety
Pharmacological interventions-FDA approval-SSRI Fluoxetine (Prozac). TCAs & Topamax (anticonvulsant for BD, weight neutral)
Counseling-establish rapport–patient sees it as a problem
Health teaching and health promotion-Healthy diet, coping skills, cognitive distortions, relaxation techniques, yoga!!

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18
Q

Cardiac output in bulimia

A

Decreased

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19
Q

Outcomes in bulimia

A

Electrolytes in balance; adequate cardiac output; satisfaction with body image; effective coping; verbalizes confidence; makes informed life decisions; expresses independent decision-making; willingness to call others for assistance; develops sense of belonging

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20
Q

Binge eating disorder

A

Weight significantly over ideal weight
Dysfunctional eating pattern (response to internal cues)
Sedentary lifestyle
Gastric bypass surgery (can’t eat the same as before, you’ll still gain weight)
Embarrassment due to weight, body dissatisfaction
Loss of control of eating, shame and guilt
Eats normally around others, will binge somewhere else, sometimes they replace food
Fear reactions of others
Feelings of dread

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21
Q

Outcome identification for binge eating

A

The nurse will need to help these patients manage dysregulation of the entire gastrointestinal tract.
Remember, eating is not about the food, it is about coping with emotions

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22
Q

Pharm acute care for binge eating

A

Pharmacological interventions-BMI >30 or >27 if accompanied by health problem
Belviq/lorcaserin
Qsymia
Vyvanse (Lisdexamfetamine dimesylate)

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23
Q

Other acute interventions for binge eating

A

Surgical interventions: bariatric surgery (for obesity), sometimes other things recommended like meal plan or exercise
Psychosocial interventions-CBT and Interpersonal Therapy, along with behavioral weight loss programs
Health teaching and health promotion-GI problems such as heartburn, dysphagia, pain , bowel changes associated with binging

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24
Q

Pica

A

Persistently eating nonfood items (dirt, paint) well past toddlerhood
Not part of other illness
Begins in early childhood & lasts for a few months
Can be in any age

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25
Q

Rumination disorder

A

Regurgitation with rechewing, re swallowing, or spitting out
No medical or mental reason
Infants 3-12 mos., but can happen at any age

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26
Q

Interventions for rumination disorder

A

Reposition infants and children while eating so there’s not much regurgitation
Make mealtimes pleasant (don’t yell during mealtime)
Improve communication between caregiver and child
Distract the child when the behavior starts
Family therapy if needed (not preferred)

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27
Q

Avoidant/restrictive food intake

A

Starts in infancy & early childhood
Note: 40% of “picky” eaters resolve on their own
Low BMI
No distorted body image
Prematurity, FTT, and autism (usually in boys)

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28
Q

Diagnostic criteria for binge eating

A

…

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29
Q

Biological factors of neuro disorders in children

A

Genetic-increased risk
Neurobiological-brain developing rapidly (finishes at 25)
Children are great at learning languages at this point
FTT or family conflict/environment, synapses prune back and aren’t being used. Causes delays. Pruned synapses are normal but not much

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30
Q

psychological factors of neuro disorders in children

A

Temperament-coping style
Resilience-inborn strength & success handling stress

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31
Q

Environmental factors of neuro disorders in children

A

Impact of trauma-Witnessing violence
Role of caregivers/parents-Neglect and abuse
Challenges in family environment (one or both parents, maybe one parent won’t speak up)
Not only socioeconomically driven, also seen in rich ppl
Being poor can definitely contribute but not always
Bullying

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32
Q

Cultural factors of neuro disorders in children

A

Cultural expectations
Presence of stressors
Lack of support

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33
Q

Assessment of psych disorders in children

A

History of present illness (child doesn’t speak, parent speaks for them)
Developmental history (deficits)
Developmental assessment
Neuro assessment
Medical history
Family history
MSE

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34
Q

Interventions for psych disorders in children

A

Family therapy–child does the talking
Group therapy or play therapy for young kids
Behavioral therapy
CBT
Disruptive Behavior Management
Creative expression: art/music
Bibliotherapy–books
Journaling
Psychopharmacology

35
Q

Restraints for children

A

Office of mental health is huge, bigger than joint commission, we DON’T restrain a child, also adolescent but specifically children
Can’t even hold child for more than 4 minutes, that’s a restraint

36
Q

Group therapy for children

A

Younger children: uses play and ideas
Grade-school children: combines play, learning skills, and talk
Adolescents: identifying emotions, modifying responses, learning skills and talking, focusing largely on peer relationships and addressing specific problems

37
Q

CBT for children

A

Replacing negative, self-defeating thoughts with more realistic and accurate appraisals to improve functioning

38
Q

Neurodevelopmental disorders of children and adolescents

A

Communication disorders
Motor disorders
Specific learning disorder
Intellectual developmental disorder
Autism Spectrum Disorder (ASD)
Attention Deficit Hyperactivity Disorder (ADHD)- predominantly inattentive or predominantly hyperactive

39
Q

Speech disorders in children

A

Problems making sounds

40
Q

Language disorders in children

A

Receptive language disorder-difficulty understanding or in using words in context and appropriately
May be evident by inability to follow directions
Expressive language disorder
Social communication disorder
Child onset fluency disorder

41
Q

developmental coordination disorder in children

A

Impairments in motor skill development
Coordination below the child’s developmental age
Ie: delayed sitting, walking, jumping, shoelace tying

42
Q

stereotypic movement disorder

A

Repetitive, purposeless movements for 4 weeks or more, ie: rocking, head banging, hand waving

43
Q

Tic disorders

A

Sudden, nonrhythmic and rapid motor movements or vocalizations
Tourette’s disorder
Persistent motor or vocal tic disorder
Provisional tic disorder

44
Q

Treating tic disorders

A

Behavioral techniques-CBITS-comprehensive behavior interventions-habit reversal
Deep brain stimulation (DBS)- a fine wire in brain, connected to a device under collarbone. Pacemaker for the brain. Pt controls it

45
Q

Meds for tic disorder

A

Haldol, Orap (1st gen psy.), Abilify (2nd gen psy.), Risperdal, Clonodine, Klonopin & Botox

46
Q

Specific learning disorders

A

Dyslexia (reading)
Dyscalculia (math)
Dysgraphia (written expression)
Screening is crucial for early intervention
Supported by the Disabilities Education Improvement Act
IEP

47
Q

Intellectual development disorder

A

Deficits in intellectual, social, or daily functioning

48
Q

nursing process in intellectual developmental disorders

A

Assess: delays or neglect/abuse
Diagnosis: impairments range from mild to severe
Outcome ID: Nursing outcome classification (NOC)
Implementation: psychosocial interventions
Evaluation

49
Q

ASD

A

Deficits in social relatedness and relationships
Stereotypical repetitive speech
Obsessive focus on specific objects
Over adherence to routines or rituals
Hyper- or hypo-reactivity to sensory input
Extreme resistance to change
Appears in early childhood

50
Q

Implementation in ASD

A

Psychosocial interventions-early intervention program
Psychobiological interventions-pharmacology/Abilify & Risperdal FDA appr for 5-6 & older-improve associated agitation, Off label-SSRI’s-improve mood & anxiety, Stimulants-↓ hyperactivity, impulsivity or inattention.
Evaluation

51
Q

ADHD

A

Inappropriate degree of
Inattention
Impulsiveness
Hyperactivity
Symptoms present in at least 2 settings, before age 12

52
Q

Assessment of ADHD

A

Level of physical activity, attention span, talkativeness
Social skills
Comorbidity

53
Q

Implementation in ADHD

A

CBT-recognize ineffective coping
Psychobiological interventions
Psychopharmacology-stimulants-Methylphenidate (Ritalin), Adderall & Non-stimulating- Atomoxetine (Strattera)
Medications for aggressive behaviors-mood stabilizers, antipsychotics

54
Q

Center for Quality Assessment and Improvement in Mental Health Measures

A

Access to child specialty care for treatment of depression
Family involvement in the treatment of ADHD
Stimulant medication treatment for ADHD
Antipsychotic treatment for childhood psychoses
Completion of treatment for substance use disorders
Referral to post-detoxification treatment services

55
Q

Intermittent explosive disorder

A

after the age of six, during teenage years/young adults

56
Q

Biological factors of impulse control disorders

A

Genetic-familial risk
Neurobiological-brain differences

57
Q

Cognitive factors of impulse control disorders

A

Negative reinforcement methods
Low self esteem

58
Q

Environmental factors of impulse control disorders

A

ACEs, family distress, inadequate parenting, abuse, attachment issues, socioeconomic status

59
Q

Oppositional defiant disorder

A

Angry and irritable mood
Defiant and vindictive behavior (twice within prev. 6 mo.)
social difficulties
Conflicts with authority
Academic problems

60
Q

Risk factors for ODD

A

Genetic component; family history of mental illness
Numerous neurobiological causes identified
Environment: family dysfunction can play a role

61
Q

Treatment of ODD

A

Psychosocial interventions-manage anger, improve problem solving, reduce impulsivity & improve social interactions
Psychobiological interventions-No meds FDA approved-Off label use of Divalproex sodium (Depakote) for reactive aggression & irritability

62
Q

Intermittent Explosive Disorder

A

Pattern of behavioral outbursts seen as:
Inability to control aggressive impulses
Begins in childhood-adult under age 50
Leads to problems with interpersonal relationships, occupational difficulty, and criminal difficulty

63
Q

Comorbidities with intermittent explosive disorder

A

Depressive, anxiety, and substance use disorders
Antisocial and borderline personality disorders

64
Q

Risk factors of intermittent explosive disorder

A

Neurobiological abnormalities
Conflict or violence in family of origin

65
Q

Treatment of Intermittent Explosive Disorder

A

Psychosocial-individual & group CBT
Pharmacologic-off label-SSRI’s (serotonergic dysfunction), antipsychotics, & bets-blockers

66
Q

Conduct disorder

A

Behavior is usually abnormally aggressive-before age 13
Rights of others are violated and societal norms or rules are disregarded; lack of remorse
Childhood-onset conduct disorder-before age 10
Adolescent-onset conduct disorder-after age 10

67
Q

Complications of conduct disorder

A

Academic failure, school suspensions and dropouts, juvenile delinquency, drug and alcohol abuse, and juvenile court involvement

68
Q

Epidemiology and comorbidity of conduct disorder

A

Epidemiology-4x more common with prev. dx. ODD
Comorbidity-ADHD & ODD

69
Q

Risk factors of conduct disorder

A

Genetic
Neurobiological factors
Adolescents have reduced gray matter in cortex &
amygdala-structural
Children reduced ability to empathize-functional-MRI
reduced blood flow to region
Environmental factors

70
Q

Treatment approaches of conduct disorder

A

Psychosocial interventions-anger management, dysfunctional parent-child relationship
Need parental participation
Pharmacologic treatment-No FDA approved, but off label use-antidepressants, mood stabilizers, antipsychotics, & anticonvulsants

71
Q

Two problems related to impulse control disorders

A

Pyromania
Kleptomania

72
Q

pyromania

A

repeated deliberate fire setting

73
Q

Kleptomania

A

repeated failure to resist urges to steal objects not needed for personal use or monetary value

74
Q

Assessment in impulse control disorders

A

Suicide risk

75
Q

Diagnoses and outcomes in impulse control disorders

A

Risk for suicide
Impaired impulse control
Risk for other-directed violence
Defensive coping related to impulse control
Aggressive behavior

76
Q

Common negative attitudes in impulse control disorder

A

A belief that the patient is choosing not to get better.
A belief that concerns for safety may be exaggerated

77
Q

Nurses’ ethical and professional responsibility

A

Provide equal care to all people
Empathy
Consider the patient’s environment of origin and history of constant negative responses

78
Q

Implementation in impulse control disorders

A

Psychosocial
Pharmacological interventions-aimed at symptoms
Health teaching and health promotion
Teamwork and safety
Seclusion and restraint

79
Q

CBT for impulse control disorders

A

feelings, thoughts, behaviors

80
Q

Psychodynamic psychotherapy for impulse control disorders

A

underlying feelings & motivations

81
Q

Dialectical behavioral therapy (DBT) for impulse control disorders

A

Impulse control

82
Q

Parent-child interaction therapy (PCIT) for impulse control disorders

A

coaching through one way mirror & ear audio devices

83
Q

Parent management training (PMT) for impulse control disorders

A

parent provided with positive behaviors & short neg consequences for bad behavior

84
Q

Multisystemic therapy (MST) for impulse control disorders

A

violent juvenile offenders

Psych (6 decks)

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