PWB: pysch illness (class 10)

Question 1

psychosocial changes & fears in elderly

Answer 1

loss of family & friends. physical & functional changes. major life changes.. health problems. decreased hearing, vision, taste. fear of future. loss of independence. fixed incomes healthcare costs. age discrimination. fear of future.

Question 2

behaviors with anxiety

Answer 2

muscle tension, restlessness, avoidances of activities, excessive worry, procrastination in behavior or decision-making, repeatedly seeking reassurance from others, sleep disturbance, difficulty concentrating “mind goes blank”

Question 3

non-pharm interventions for anxiety

Answer 3

maintain calm nonthreatening approach. use simple words and brief messages, low stimuli, teach relaxation techniques, stay with the person, be honest keep all promises, provide with glasses, hearing aids, include in decision making, encourage social activities.

Question 4

risk factors for depression

Answer 4

marital status; single people double risk.
gender: women attempt more than men
age: white males > 80
religion: non-religious higher.
socioeconomic status: highest & lowest higher risk.
ethnicity: 1. caucasion, 2. native americans, 3. african americans, 4. hispanics, 5 asians.
diagnosed mental disorder.
family history.
healthcare workers.

Question 5

depressive behaviors in older adults

Answer 5

I-ideation
S- substance abuse

P-purposelessnes
A- anxiety
T- trapped
H- hopelessness

W-withdrawal
A-anger
R-recklessness
M- mood changes`

Question 6

warning signs of suicide

Answer 6

talks about it withdraws from friends or social activites. prepares for death by writing a will, gives away prized possessions, takes unecessary risks, seems preoccupied with death, loses interest in personal appearance, increase alcohol or drug use.

Question 7

things to consider with antidepressant meds in elderly

Answer 7

can cause confusion, blurred vision, constipation, dry mouth, dizziness, difficulty urinating.

Question 8

SSRIs

Answer 8

usually 1st line drug tx for depression in elderly r/t less side effects.
(celexa, prozac, zoloft, lexapro, paxil).

Question 9

SNRI’s

Answer 9

bupropion, remeron, trazodone, cymbalta, effexor.

Question 10

MAOIs

Answer 10

nardil, marplan, parnate, fatal adverse reactions may occur.

Question 11

tricyclic

Answer 11

elavil, sinequan, tofranil.

contraindicated in acute recovery phase of post MI and glaucoma.

hyperpyretic crisis and death may occur. hypertensive crisis with clonidine.
side effects: blurred vision, urinary retention, orthostatic hypotension, reduction of seizure threshold, photosensitivity, weight gain.

Question 12

side effects of SSRIs and SNRIs

Answer 12

insomnia, agitation- avoid caffeine.
headache-analgesics.
weight loss
sexual dysfunction.

Question 13

serotonin syndrome

Answer 13

change in mental status, restlessness, hyperreflexia, shivering, tremors, diaphoresis, labile BP.

Question 14

benzodiazepines

Answer 14

least toxic and most effective in elderly for anxiety

Question 15

benzos

Answer 15

side effects sedations, dizziness, ataxia, dependence.

Question 16

lorazepam

Answer 16

druge of choice r/t shorter half-life less side effects.

Question 17

bipolar disorder

Answer 17

mood swings from profound depression to extreme mania. effects ability to carry out day-to-day activities. onset late teens to early adult. causes: unknown may have genetic tendencies.
substance abuse often associated with behiors of bipolar disorder.

Question 18

bipolar symptoms

mania

Answer 18

elevated mood/irritability, psychotic features may be present, excessive motor activity, racing thoughts, impulsive, poor sleep, engages in high risk activity, unrealistic beliefs in abilities.

Question 19

bipolar symptoms depression

Answer 19

loss of interest in activities, sadness for long period of time, change in eating, sleeping or other habits, hopelessness, difficulty concentrating & decisions, feeling tired or slow, thoughts of death or suicide attempts.

Question 20

bipolar mnemonic

Answer 20

D-distractibility
I-indiscretion
G-grandiosity
F-flight of ideas
A-activity increase
S-sleep defecit
T-talkativeness

Question 21

schizophrenia

Answer 21

a serious mental illness characterized by incoherent or illogical thoughts, bizarre behavior and speech, and delusions or hallucinations, such as hearing voices.

Question 22

delusions

Answer 22

false beliefs that are not part of the persons culture and do not change. believing that neighbors can control their behavior with magnetic waves.

Question 23

hallucinations

Answer 23

things a person sees, hears, smells, or feels that no one else can
voices are the most common type of hallucination in schizophrenia.

Question 24

extrapyramidal symptoms

Answer 24

pseudoparkinsonism (tremor, shuffling gait, drooling, rigidity). may appear 1-5 days of initiation.
akinesia (muscular weakness)
akathisia ( continuous restlessness and fidgeting)
dystonia (involuntary muscular movements of face, arms, legs, and neck.)

Question 25

tardive dyskinesia

Answer 25

bizarre facial and tongue movements, stiff neck, and difficulty swallowing. symptoms are potentially irreversible, drug should be stopped at the first sign; tongue movement.

Question 26

neuroleptic malignant syndrome

Answer 26

rare but potentially fatal complication of treatment with antipsychotic medications.
onset: hours to years of drug initiaiton. rapid progression of s/s over 24-72 hrs of onset.

manifestations: very high fever hyperpyrexia.
muscle rigidity (lead pipe rigidity)
unstable blood pressure (fluctuations)
rapid deterioration of mental status to stupor to coma.

Question 27

neuroleptic treatment

Answer 27

discontinue antipsychotic med, monitor vital signs, degree of muscle rigidity, LOC, I&O, lower body temperature-implement cooling measures.
physician may order: dantrolene to treat muscle rigidity, IVF- to manage CV, renal failure potential complications.