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Psych Final Exam Flashcards

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

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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 or very depressed
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

Low potassium, phosphate, and magnesium
heart attacks from electrolyte imbalance
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
Rumination disorder
Regurgitation with rechewing, re swallowing, or spitting out No medical or mental reason Infants 3-12 mos., but can happen at any age
26
Interventions for rumination disorder
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)
27
Avoidant/restrictive food intake
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)
28
Diagnostic criteria for binge eating
...
29
Biological factors of neuro disorders in children
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
30
psychological factors of neuro disorders in children
Temperament-coping style Resilience-inborn strength & success handling stress
31
Environmental factors of neuro disorders in children
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
32
Cultural factors of neuro disorders in children
Cultural expectations Presence of stressors Lack of support
33
Assessment of psych disorders in children
History of present illness (child doesn't speak, parent speaks for them) Developmental history (deficits) Developmental assessment Neuro assessment Medical history Family history MSE
34
Interventions for psych disorders in children
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
Restraints for children
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
Group therapy for children
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
CBT for children
Replacing negative, self-defeating thoughts with more realistic and accurate appraisals to improve functioning
38
Neurodevelopmental disorders of children and adolescents
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
Speech disorders in children
Problems making sounds–wabbit Can be hard to make friends because you talk funny
40
Language disorders in children
Receptive language disorder-difficulty understanding or in using words in context and appropriately Expressive language disorder–know what they wanna say and what you’re saying, can’t say their own thoughts. Don’t follow directions Social communication disorder–very anxious and can’t communicate. Also seen in writing, can’t write a card with friends Child onset fluency disorder–a form of stuttering
41
developmental coordination disorder in children
Impairments in motor skill development Coordination below the child’s developmental age Ie: delayed sitting, walking, jumping, shoelace tying
42
stereotypic movement disorder
Repetitive, purposeless movements for 4 weeks or more, ie: rocking, head banging, hand waving Needs early intervention Naltrexone (opioid antagonist, euphoria from behavior so this blocks euphoric effect which makes them stop)
43
Tic disorders
Sudden, nonrhythmic and rapid motor movements or vocalizations Tourette’s disorder
44
Treating tic disorders
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
Meds for tic disorder
Haldol, Orap (1st gen psy.), Abilify (2nd gen psy.), Risperdal, Clonodine, Klonopin (trying to steer away because it’s sedating/addictive) & Botox (muscle relaxant)
46
Specific learning disorders
Dyslexia (reading) Dyscalculia (math) Dysgraphia (written expression) Screening is crucial for early intervention Supported by the Disabilities Education Improvement Act IEP Plans can go in place as early as Kindergarten Psychology and social work work together
47
Intellectual development disorder
now called intellectual disability Deficits in intellectual (reasoning, prefrontal cortex, multi-faceted), social (impaired communication and social cues), or daily functioning Teachers notice very early on, parents deny it
48
nursing process in intellectual developmental disorders
Assess: delays (get frustrated and impulsive bc can't do what others can, can they have civil conversations, etc) or neglect/abuse (malnourished, doesn't have to be neuro) Outcome ID: Nursing outcome classification (NOC) Strength based, how can we strengthen what the child needs? Implementation: psychosocial, Strength based, how can we strengthen what the child needs?
49
ASD
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 Complex neurobiological AND biological
50
Implementation in ASD
Psychosocial interventions-early intervention program Psychobiological interventions-pharmacology: atypical like 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
ADHD
Inappropriate degree of Inattention–previously ADD, now primarily ADHD with inattention Impulsiveness-ADHD with impulsivity and hyperactivity Hyperactivity Symptoms present for at least 6 months in at least 2 settings, before age 12
52
Assessment of ADHD
Level of physical activity, attention span, talkativeness Social skills-how do they perceive it Comorbidity If they get admitted, ask school if teachers know, if social work is involved, how they behave in school, etc
53
Implementation in ADHD
CBT-recognize ineffective coping Psychobiological interventions Psychopharmacology-stimulants-Methylphenidate (Ritalin), Adderall & Non-stimulating- Atomoxetine (Strattera, watch for liver dx) Medications for aggressive behaviors-mood stabilizers, antipsychotics
54
Intermittent explosive disorder and age
after the age of six, during teenage years/young adults IED is also a type of explosive if that helps you remember that these people blow up
55
Biological factors of impulse control disorders
Genetic-familial risk Neurobiological-brain differences
56
Cognitive factors of impulse control disorders
Negative reinforcement methods Low self esteem
57
Environmental factors of impulse control disorders
ACEs, family distress, inadequate parenting, dysfunctional families, abuse, attachment issues, socioeconomic status (also seen in very affluent communities)
58
Oppositional defiant disorder
Angry and irritable mood Defiant and vindictive behavior (twice within prev. 6 mo.) social difficulties but they don't care or need friends Conflicts with authority Academic problems Pretty much seen in childhood
59
Risk factors for ODD
Genetic component; family history of mental illness Numerous neurobiological causes identified Environment: family dysfunction can play a role
60
Treatment of ODD
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/depakene) for reactive aggression & irritability. Also works in bipolar for reactivity
61
Intermittent Explosive Disorder
Pattern of behavioral outbursts seen as: Inability to control aggressive impulses (verbal or physical, aggressive towards others and property, not as much themselves) Begins in childhood-adult under age 50 Leads to problems with interpersonal relationships, occupational difficulty, academic issues, and criminal difficulty
62
Comorbidities with intermittent explosive disorder
Depressive (low self esteem, driving factor), anxiety, and substance use disorders Antisocial and borderline personality disorders Diabetes and HTN seen for some reason
63
Risk factors of intermittent explosive disorder
Neurobiological abnormalities Conflict or violence in family of origin
64
Treatment of Intermittent Explosive Disorder
Psychosocial-individual & group CBT Pharmacologic-off label-SSRI’s (serotonergic dysfunction), antipsychotics, & beta-blockers Inderal used to be given for anxiety Atypicals work well for depression
65
Conduct disorder
Precursor for antisocial personality disorder 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
66
Complications of conduct disorder
Academic failure, school suspensions and dropouts, juvenile delinquency, drug and alcohol abuse (even though IED is more criminality), and juvenile court involvement
67
Epidemiology and comorbidity of conduct disorder
Epidemiology-4x more common with prev. dx. ODD Comorbidity-ADHD & ODD
68
Risk factors of conduct disorder
Genetic Neurobiological factors Adolescents have reduced gray matter in cortex (decisions and reasoning)& amygdala (emotion)- structural Children reduced ability to empathize-functional-MRI reduced blood flow to region (dysfunction in folds of the brain) Environmental factors
69
Treatment approaches of conduct disorder
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 Therapy works very well! For the tremendous aggression and lack of remorse Callousness in antisocial goes away Have to stay in therapy to prevent risk and family needs to be involved
70
Two problems related to impulse control disorders
Pyromania Kleptomania
71
pyromania
repeated deliberate fire setting
72
Kleptomania
repeated failure to resist urges to steal objects not needed for personal use or monetary value–might steal for others
73
Assessment in impulse control disorders
Suicide risk r/t low self esteem, depression, and anxiety Self assessment (they’re okay with how they’re living, see no problem, so they don’t adhere to treatment))
74
Diagnoses and outcomes in impulse control disorders
Risk for suicide Impaired impulse control Risk for other-directed violence Defensive coping related to impulse control Aggressive behavior Impaired parenting
75
Common negative attitudes in impulse control disorder
A belief that the patient is choosing not to get better. A belief that concerns for safety may be exaggerated (child says I'm gonna kill sibling and nobody believes it. Also kid gets jealous)
76
Nurses' ethical and professional responsibility
Provide equal care to all people Empathy Consider the patient’s environment of origin and history of constant negative responses
77
Implementation in impulse control disorders
Psychosocial Pharmacological interventions-aimed at symptoms–divalproex sodium (depakote), atypical antipsychotics like aripiprazole (abilify), risperidone (risperdal), SSRIs, mood stabilizers, beta-blockers, avoid benzodiazepines (addictive properties)
78
CBT for impulse control disorders
feelings, thoughts, behaviors
79
Psychodynamic psychotherapy for impulse control disorders
underlying feelings & motivations for adolescents, they love to talk
80
Dialectical behavioral therapy (DBT) for impulse control disorders
Impulse control
81
Parent-child interaction therapy (PCIT) for impulse control disorders
Parent plays with child with ear piece and on the other side of the glass is someone watching also with an ear piece. The other person can see the parent and child, parent and child can’t see other person. Other person coaches parent. Several weeks to months, changes interaction pattern, very effective
82
Parent management training (PMT) for impulse control disorders
parent provided with positive behaviors & short neg consequences for bad behavior
83
Multisystemic therapy (MST) for impulse control disorders
violent juvenile offenders
84
What can cause communication disorders in children
substance, brain injury (intellectual disabilities, neurodevelopmental disorders, cleft palate, hearing loss). Want early diagnosis and intervention, picked up in preschools which is good
85
Tourette's disorder
multiple motor tics and at least one vocal tic, has to be seen for at least a year, usually seen from ages 2-7 but can be later and go on into adulthood
86
Persistent motor or vocal tic disorder
single or multiple of one or the other for more than one year (NOT BOTH)
87
Provisional tic disorder
either or, LESS than one year
88
When are communication disorders seen
Happens in childhood but can be seen later
89
Family and communication disorders
Difficult for family to work with child, affects socialization and academic performance
90
Levels of ASD and savant
Level 1: not much support Level 2: some support Level 3: maximum support Savant syndrome: GENIUS in one area
91
Assessment in ASD
Functioning, deficits, etc Ability to cooperate with others Very concrete in what they say
92
Biological pharmacotherapy for ASD
Used to improve relatedness and decrease anxiety, compulsive behaviors, or agitation
93
ABA for ASD
Applied behavior analysis Encourages positive behaviors and discourages negative behaviors (don’t reinforce them, but don’t ignore them, just move onto something positive)
94
Why are stimulants annoying
they’re taken at like 8AM and they run out of energy around 4PM so they take another dose and have energy until 3AM which is bad especially for school-age children 2nd dose should be between 12-3 the latest
95
Concerta
For ADHD Side effects: Nervousness, trouble sleeping, loss of appetite, weight loss, dizziness, N/V, headache. If ant of these effects last or get worse, talk to your doctor Children may complain of upper abdominal GI discomfort An empty tablet shell may appear in your stool. This is harmless because your body already absorbed the medication
96
Jornay
Taken at night, delayed release so it doesn’t start working until early morning. Covered all day No spikes which is nice JorNAYYY covers you all DAYYYY
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EIBI for ASD
Early intensive behavioral intervention Improves language and cognitive skills
99
ESDM for ASD
Early start Denver model One to one interactions, joint play, and activity routines with the adult and child

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