Quiz for weeks 8 & 9 Flashcards
FRONTAL LOBES
Part of the brain where reason and emotion interact
Damage can cause impaired judgment, personality changes, problems in decision making, inappropriate conduct, aggressive outbursts
HYPOTHALAMUS
After repeated stimulation, system may respond more vigorously to all provocations
LOW LEVELS OF NEUROTRANSMITTER
may increase irritability, hypersensitivity to provocation, rage
may influence people who commit impulsive arson, suicide, homicide
Think DEADPOOL
ESCALATING BEHAVIOURS
Changes in level of consciousness may occur, including confusion, disorientation, memory impairment
NURSE’S ROLE
if patient potentially violent
Notify physician, give PRN medications as appropriate
Provide for patient and staff safety
Notify co-workers
Obtain additional security if needed
Assess environment; make necessary changes
PSYCHOPHARMACOLOGY
for
VIOLENCE
Antianxiety and sedative-hypnotics
Antidepressants
Antipsychotics
TARASOFF RULING
A duty is present by the therapist to take some action to prevent foreseeable harm to a third party injured by the client.
CATEGORIES OF
SUICIDAL BEHAVIOR
Suicide ideation: thought of self-inflicted harm
Passive: only thoughts of suicide; no plan
Active: plans of causing one’s own death
- *Suicide threat:** verbal or nonverbal warning
- *Suicide attempt**: any self-directed action that will lead to death if not stopped
SUICIDE ASSESSMENT
The most suicidal person is one who has:
Highly lethal method (e.g., gunshot to head)
Specific plan (as soon as wife goes shopping)
Means available (loaded gun in desk drawer)
Little ambivalence, as compared with someone “asking for help”
Prior suicide attempt is best predictor
Warning signs may be missed or ignored
DIRECT QUESTIONS
ABOUT SUICIDAL THOUGHTS
Direct questioning about suicidal thoughts
and plans will not cause patient to take suicidal action
SUICIDE RISK
and
ANTIDEPRESSANTS
Risk is higher during first few weeks of new medication
Energy and concentration improve before mood
Patient still feels very depressed but now he has the ability to make a suicide plan and carry it out
PROTECTIVE FACTORS
AGAINST SUICIDE
Family and community support
Supportive relationships with health care providers
Learned skills in problem-solving
Cultural and religious beliefs may give sense of hope
Strong personal relationships
TRAUMATIC
BRAIN INJURY
Disruption of normal brain function that occurs when the skull is struck, suddenly thrust out of position, or penetrated
Symptoms may appear right away or may not be present until days or weeks or months after the injury
TBI can affect a single, specific region of the brain (focal injury), be distributed throughout the brain (diffuse injury), or both
PRECIPITATING STRESSORS:
TRAUMATIC BRAIN INJURY
Open Head Injury – Occurs as a result of bullet wounds or any injury that penetrates the skull
Closed Head Injury – Occurs as a result of a fall, motor vehicle accident, explosion, or contact sports activity; there is no penetration of the skull
Deceleration Injury – Occurs with differential movement of the skull and the brain when the head is struck (Shaken Baby Syndrome)
TRAUMATIC BRAIN INJURY IS CLASSIFIED INTO THREE CATEGOREIS
BASED ON TIME OF LOST CONSCIOUSNESS
Mild – less than 30 minutes
Moderate – more than 30 minutes but less than 24 hours
Severe – more than 24 hours
FOLLOWING TRAUMATIC BRAIN INJURY
RISKS ARE
depression, generalized anxiety disorder, panic disorder, agoraphobia, posttraumatic stress disorder
Risk of suicide is 2-4 times greater in patients with TBI (even if mild)
INTERVENTIONS FOR:
TRAUMATIC BRAIN INJURY
Interventions include exercises to improve memory, problem-solving ability, attention span, speech, reading, and physical functioning and learn new adaptive coping skills
Lifestyle changes including exercise, diet, sleep, hygiene, stress reduction, relaxation training, and engaging in pleasurable activities
JUST SAY “NO” TO FOOTBALL
MEDICATIONS FOR
TRAUMATIC BRAIN INJURY
No medication has been approved for TBI
WAYS TO MANAGER ANGER
Positive self-talk; writing about feelings
Change of environment
Thinking of the consequences
Listening to music
Watching television
Deep-breathing exercises
Taking a walk
Medication
Counting to 50
Comfort wrap with a blanket
Relaxation exercises
Talking about your feelings
Reading
Being alone
EATING ICE CREAM & WATCHING STRANGER THINGS! :-)
PSYCHOPHARMACOLOGY
FOR SURVIVORS OF
CRIMES
Do not generally need meds
Antianxiety agnets (benzodiazepines) are prescribed occasionally for short-term use to decrease anxiety
Trazodone (Desyrel) is prescribed to faciliate sleep
PSYCHOPHARMACOLOGY
FOR SURVIVORS OF
TORTURE, RITUAL ABUSE, MIND CONTROL AND HUMAN TRAFFICKING
Meds are highly controversial, especially becasue drugs were often a part of the abuse as it occured.
Sometimes medications in treating PTSD, anxiety disorders, depression, sleep disturbances, and psychosis are effective.
PSYCHOPHARMACOLOGY
FOR SURVIVORS OF
RAPE and SEXUAL ASSAULT
Although rarely prescribed to rape survivors:
For Anxiety- Benzodiazepines to reduce anxiety and provide for sleep might be used on a temporary basis
For depression with sleep disturbance: antidepressant (trazodone) at bedtime
For nightmares or traumatic memories: low dose of antipsychotic, rieperidone (Risperdal), quetiapine (Seroquel) or alpha-1-adrenergic antagonist prazosin (Minipress)
PSYCHOPHARMACOLOGY
FOR SURVIVORS OF
CHILDHOOD SEXUAL ABUSE
Meds are not always needed or desirable for adult surviors of childhood sexual abuse, especially if substance abuse is a problem or potential problem.
If depressive symtoms are intefering with sleep: antidepressant such as trazodone
For reexperiencing of traumatic memoreis: Benzodiazepines or clonidine for a short-term basis
Disturbing nightmares, flashbacks: lose doses of risperidone, aripiprazole (abilityf), prazosin, quetiapine, or topiramate (Topamax)
PSYCHOPHARMACOLOGY
FOR SURVIVORS OF
PARTNER and ELDER ABUSE
Meds normally are not needed but are commonly given to survivors.
Often misprescribed meds are antidepressants, benzodiazepines, and hypnotics.
NEUROSIS
vs.
PSYCHOSIS
Neurosis is a mental disorder characterized by anxiety with no distortion of reality.
VS.
Psychosis is disintegrative and involves a significant distortion of reality.
TREATMENT OF
ANXIETY DISORDERS
Behavioral therapies: systematic desensitization
Medication: SSRIs, benzodiazepines (ADDICTIVE), buspirone, hydroxyzine
Psychotherapy & Psychoanalysis
Hypnosis
Cognitive Behavioral Therapy
BENZODIAZEPINES
“DIRTY BANDAIDS”
Informally called “tranquilizers”
Psych APNs see many patients addicted to benzos
Patients love them and won’t give them up
They are addictive (compulsive use, neuroadaptation leading to withdrawal syndrome & tolerance)
Benzos linked to Alzheimer’s Disease
ARE BENZOS THE
RIGHT
TREATMENT FOR ANXIETY??
Benzos are used a lot with inpatients
These “Bandaids” are appropriate in this type of outpatient situations:
Pre-op anxiety
Airplane phobia
Public speaking
Going to a funeral
Discrete, short-term, closed-ended situations
XANAX:
THE “CRACK”
OF BENZOS
Some university medical centers have taken Xanax out of the formulary because of its addiction potential
In 1990’s it was recommended by FDA for Panic Disorder
Short onset & short half-life make it similar in trajectory to cocaine
Can see intra- and inter-dose withdrawal; pt wants more
Tolerance & withdrawal develop
Addiction has begun
BETTER CHOICES FOR
SHORT TERM ANXIETY
Propranolol (Inderal)- Beta-blocker (stage fright drug)
Benztropine (Cogentin)- anticholinergic agent; counteracts jitteriness
Hydroxyzine (Vistaril)
Improve quality of sleep: sleep hygiene techniques
NURSING INTERVENTIONS
FOR
REDUCING ANXIETY
NURSING INTERVENTION:
- Provide a calm and quit environment
- Ask pt. to identify what and how they feel
- Enourage pt. to describe and discuss their feelings with you
- Help patients identify possible causes of their feelings
- Listen carefully for patient’s expressiosn of helplessness and hopelessness
- Ask patients whether they feel suicidal or have a plan to hurt themselves
- Plan and Involve patients in activites such as going for walks or playing recreational games.
TREATMENT FOR
GENERALIZED ANXIETY DISORDER (GAD)
Most effective Meds:
Antideprssants: selective serotonin reuptake inhibitors (SSRIs) and selective serotoni-norepinephrine reuptake inhibitors (SNRIs)
GAD is Chronic - Antidepressants better than Benzodiazepine
Benzodiazepine only used for short-term, quick acting med
Benzodiazepine is slowly tapered if necessary and discontinued.
TREATMENT FOR
PANIC DISORDER
Meds:
Long term treatment: SSRIs and SNRIs
Short term immediate treatment: Benzodiazepine like alprazolam (xanax) and lorazepam (Ativan)
TREATMENT FOR
AGORAPHOBIA
Cognitive Behavioral Therapy (CBT) is the most successful treatment for phobic patients
Meds: Clonidine and propranolol may be taken as needed before social engagements
SSRIs are used to reduce anxiety and depression if present
TREATMENT OF
OBSESSIVE-COMPULSIVE DISORDER
MEDS:
SSRIs such as
fluoxetine (Prozac)
sertraline (Zoloft)
fluvoxamine (Luvox)
paroxetine (paxil)
TREATMENT FOR
POSTTRAUMATIC STRESS DISORDER (PTSD)
AND ACUTE STRESS DISORDER (ASD)
First line treatment for PTSD: SSRIs
Paroxetine, sertraline and fluoxetine
Secondline treatmetns: Tricyclic antidepressants and monoamine oxidase inhibitors
Benzodiazepine, clonidine, propranolol also used
TREATMENT FOR
SOMATIC SYMPTOM and RELATED DISORDERS
Patients with somatoform disorders might be using too much medication and taking variety of durgs, medication for pain should be used temporarily and sparingly.
SSRIs are helpful for: anxiety, depression – also decrease sensitivity to bodily sensations
