Test 1 - Alteration in Mental Health Flashcards

1
Q

What are some causes of mental illness?

A

Genetics - 50% chance of depression if parents has had depression
Biological - Coronary artery disease, Certain drugs contribute to depression by altering neurotransmitters
Personality - Shy, non-assertive persons are more predisposed to depression
Environment - Victims of crimes, physical assault, neglect, physical abuse can predispose to mental illness

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2
Q

The mental health exam is what the ______ _____ is to ______ ____________

A

physical exam is to medsurg

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3
Q

The general description of the mental status exam provides an:

A

overview or mental image of the patient

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4
Q

What are the components included in the general description of the mental status examination

A

o Appearance – shows ability to care for themselves, judgment. Note eye contact (can be a sign of culture), facial expressions, posture, gait. Can give you an idea of their general state of health – for ex. Limp when walking. Depressed may have slumped posture. Aggressive personality may stand close to you. May smell of alcohol, can tell if they’re intoxicated.
o Speech – cognitive status. Dysarthria? – Neurological disorder. Nervousness? Fidgety, speaking too quickly or slowly. Slurring their words? Intoxicated or neurological disorder. Culture – speaks with accent. Choice of words – education. Amount of speech.
o Motor activity – refers to physical movement. Fidgety? Restless? Agitated? Catatonic? Unusual gestures?
o Interaction – comfort level during interaction with others? Cooperative? Hostile? Polite?

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5
Q

What are the components included in the emotional state of the mental status examination

A

o Mood – patient’s description of how they’re feeling. Patient report of emotional state.
 Suicidal or homicidal thoughts must be addressed immediately. If they do, ask if they’ve made any plans.
o Affect – the nurse’s observation of the patient’s behavior
 Flat (emotionless)
 Euphoric (state of inappropriate elation)
 Labile (shifting emotions – quickly shifting from one affect to another. Crying one minute – laughing the next)
 Expansive (exaggerated sense of ability & importance)

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6
Q

What are the components included in the perceptions of the mental status examination:

A

o Hallucination – sensory perception that isn’t shared by others. Can be visual or auditory. Command hallucinations – receiving orders from other people. They have false perceptions that commands are made of them that they must obey.
 If they’re hearing things ask what the voices are saying.
o Illusion – misrepresentation of real stimuli. They may see lint on their clothing, but it is perceived by the person as insects

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7
Q

What are the components included in the thought content of the mental status examination:

A

o Obsession – repetitive, intrusive type of thought. Ex. Stalking
o Phobia – unreasonable fear
o Delusion – false belief(s) deeply imbedded & inconsistent with reality. Ex. Thinking you’re a celebrity.

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8
Q

The thought content of the mental status exam describes:

A

what the person is thinking about

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9
Q

The perceptions of the mental status exam describes:

A

ability to recognize and interpret your surroundings

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10
Q

The emotional state of the mental status exam describes:

A

o Mood – patient’s description of how they’re feeling. Patient report of emotional state.
o Affect – the nurse’s observation of the patient’s behavior

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11
Q

The Sensorium & Cognition of the mental status exam describes:

A

state of wakefulness

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12
Q

What are the components included in the thought content of the mental status examination:

A

o Level of consciousness
o Orientation – time/place/person
o Memory – ability to recall past experience
o Attention & concentration – level of distractibility
o Comprehension & abstract reasoning – level of intelligence
o Insight & judgment – their understanding of the problem

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13
Q

What is a psychosis?

A

It is not a disease. A symptom of mental illness. Persons with psychosis cannot comprehend reality. Thoughts and behaviors may be disorganized. Have difficulty communicating with others.

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14
Q

What does ICD-10 stand for?

A

• International Statistical Classification of Diseases and Related Health Problems, Tenth Edition

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15
Q

What does the ICD-10 include?

A

o Diseases and morbid entities

o Published by World Health Organization

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16
Q

What does DSM stand for

A

• Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-V-TR)

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17
Q

The DSM includes:

A

o Psychiatric diagnosis

o American Psychiatric Association

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18
Q

What is an anxiety disorder?

A

• A state of tension, dread, or impending doom, arising from external influences that threaten to be overwhelming

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19
Q

True or False

Anxiety disorders are one of the most common psychiatric disorders.

A

True

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20
Q

What are some examples of anxiety disorders?

A
o	Generalized Anxiety Disorder
o	Panic attack
o	Panic disorder
o	Agoraphobia 
o	Specific Phobia
o	Social Anxiety Disorder (Social Phobia)
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21
Q

o Characterized by persistent, excessive and unrealistic worry about everyday things.
o Begins in childhood and adolescence but may begin in one’s twenties
o Can be the result of stressful events
o Can develop Panic Disorder

A

Generalized Anxiety Disorder

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22
Q

o Sudden onset of fear. Comes out of nowhere. Physical symptoms accompany the fear.
 Tachycardia
 Palpitations
 Chest pain
 Numb & tingling in hands & feet (paresthesia)
 Feeling of doom

A

Panic disorder

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23
Q

o Fear of being trapped.
o Fear of wide open spaces. Fear of being trapped or having a panic attack in front of others.
o Eventually persons with panic disorder can develop this.
o Ex. Fear of crossing a bridge because the bridge could collapse and they can become trapped

A

Agoraphobia

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24
Q

o Marked and persistent fear that is excessive and unreasonable, cued by the presence or anticipation of a specific object or situation

A

Specific Phobias

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25
o Fear of situations in which an individual fears humiliation or embarrassment when under the scrutiny of others.
Social Phobias (social anxiety disorders)
26
Describe Obsessive-Compulsive and Related Disorders:
* Obsession: unwanted, repetitive thoughts that lead to feelings of fear, anxiety, or guilt. Ex. Germaphobe – obsessed with germs & viruses. Scared they will get sick. * Compulsion: behavior or thoughts used to decrease the fear or guilt associated with obsessions. Ex. Germaphobe – wash hands compulsively * Body dysmorphic disorder: Type of OCD. Obsessed with perceived flaws with their body. * Trichotillomania: compulsively pull hair out. * Excoriation: compulsively picking at their skin.
27
Describe Post-Traumatic Stress Disorder
1. Preceded by a traumatic event 2. Clusters of symptoms i. Persistent re-experience of traumatic event – flashbacks ii. Avoidance of stimuli associated with the trauma; experiences a numbing that was not present before the trauma iii. Experiences symptoms that were not present before the trauma a. Sleep disturbances b. Poor concentration c. Angry outbursts d. Hypervigilance
28
• Somatic symptoms plus abnormal thoughts, feelings, and behaviours; may or may not have a diagnosed medical condition. o Formerly called hypochondriasis o High health anxiety accompanied by somatic symptoms
Somatic Symptom (soma = body)
29
High health anxiety without somatic symptoms (no symptoms)
Illness Disorder:
30
Deliberately falsify their symptoms. Become evasive & angry when questioned. Intentional. o Munchausen syndrome  Will create own symptoms  Ex. swallowing a safety pin o Munchausen syndrome by proxy  Deliberately making someone else sick  Mother makes her child sick, nurse makes patient sick
factitious disorder
31
o Not intentional o Neurological symptoms not accounted for by neurological disease o May have involuntary tremors, paralysis, pseudoseizures
Conversion Disorder
32
o Pain in one or more anatomic sites and causes impairment in one or more areas of functioning o May be associated with: (1) psychologic factors (2) psychologic and general medical condition o May be acute or chronic
• Pain disorder
33
effects person’s feelings, behaviour
Depressive Disorders
34
*Symptoms must be present most of the day, nearly every day for at least 2 weeks. • Emotional o Depressed mood, anhedonia (do not take pleasure in things), irritability • Cognitive o Poor concentration, feelings of worthlessness, guilt, thoughts of death, negative self and world view, can become delusional • Behavioral o Change in appetite, insomnia/hypersomnia, fatigue, psychomotor agitation/retardation,↓activity, neglect hygiene • Social o Withdrawal from family and social interactions. Relationships become strained.
Major depressive Disorder, Single and Recurrent Episodes
35
*Depressed mood and three symptoms for most of the day nearly every day for at least 2 years. ``` • Emotional o Depressed mood, anhedonia, irritability • Cognitive o Poor concentration and decision-making, low self-esteem, inadequacy, guilt, brooding, pessimistic, not as productive but still functional • Behavioral o Chronic fatigue • Social o Withdrawal ```
Persistent Depressive Disorders (dysthymia)
36
True or False | Depressive disorder can be due to another medical condition or substance/medication induced
True
37
What medical conditions can induce a depressive disorder?
* Diabetes * Hyperthyroidism * Hypothyroidism * Cushing’s disease * Pancreatitis * Hepatitis * HIV * Multiple sclerosis * Pernicious anemia
38
What are the three main transmitters in CNS that play a role in depression
o Serotonin o Dopamine o Norepinephrine
39
when someone has had their first episode of depression. It changes the electrophysiology of the brain. This makes the brain more vulnerable to future episodes of depression
Kindling
40
True or False | Hormone changes can be a risk factor for depressive disorders?
True
41
True or False | Someone with a parent with depression, has a 50% chance to develop depression as well
True
42
True or False | In a Pet Scan, there is a visible decrease in brain activity
True
43
Characterized by a mood cycle that shifts from severe highs (mania) or mild highs (hypomania) to severe lows (depression).
Bipolar Disorder
44
elated, boundless energy, grandiose notions, talking incessantly, poor judgment, reckless spending.
Manic
45
Manic episodes so severe they require immediate hospitalization
Bipolar disorder I
46
More functional. Have hypomanic (cheerful, don’t need much sleep) and depressive episodes.
Bipolar disorder II
47
* Combination of disordered thinking, perceptual disturbances, behavioral abnormalities, affective disruptions, and impaired social competency * Thinking process is altered. Behaviour is abnormal because they cannot understand reality. Can be disruptive. * No cure. But can be managed so person can be functional.
Schizophrenia
48
True or False | There is a specific gene identified for schizophrenia
False | Strong genetic predisposition but cannot identify specific gene
49
True or False | Drug abuse can trigger schizophrenia
True
50
What are some negative symptoms that occur with schizophrenia
* Inability to understand sensory information * Blunted or flat affect; anhedonia * Lack of motivation, impaired problem solving * Decreased activity level, minimal self-care * Limited speech * Social Withdrawal, isolation, inadequate social and occupational skills
51
What are two positive symptoms associated with schizophrenia
* Hallucinations | * Delusions
52
True or False | Diagnosis of schizophrenia is made when person has positive symptoms.
True
53
* Disorganized thinking | * Disorganized behaviour
Neurocognitive Impairment
54
symptoms as a result of recent ingestion of the drug
• Substance-induced disorders
55
Substance-induced disorders are a result of
o Substance intoxication and withdrawal | o Substance/medication-induced mental disorders
56
Symptoms of Alcohol withdrawal
``` o Seizure o Agitation o Severe confusion o Seeing or feeling things that aren't there (hallucinations) o Fever o Can be fatal ```
57
o Wernicke-Korsakoff syndrome r/t thiamine deficiency. Helps with Vitamin B absorption which aids with nerve conduction. __________ inhibits absorption of thiamine causing neurological symptoms.  Ataxia – poor balance  Persistent memory & learning dysfunction o Dementia
Alcohol-induced disorders Alcohol inhibits......
58
Occurs when women drink during pregnancy
Fetal Alcohol Syndrome
59
Symptoms of fetal alcohol syndrome
* Flat facial bones * Thin upper lip * Flat filtrim – indentation between mouth and lip * Eyes & nose are low set * Nasal bridge is flat * Cognitively delayed
60
Symptoms of opioid withdrawal
``` o Diaphoretic o Muscle pain o Bone pain o Uncontrollable kicking motion they make o Skin is cold, diaphoretic and bumpy ```
61
True or False | Opioid withdrawal is fatal
False
62
What is the cause of death from opioid use?
respiratory depression
63
Amphetamines (cocaine), Promotes release of
dopamine and norepinephrine
64
Amphetamines are Used therapeutically for
weight loss, used for ADHD, narcolepsy
65
Amphetamines increases ____________ & ______
wakefulness & focus
66
Amphetamines affect the sympathetic nervous system by increasing
HR, RR, BP
67
Amphetamines can result in
cardiac arrest
68
“an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment”
Personality Disorders
69
Seldom seek treatment, as they do not see a problem with themselves. Do not relate well to others. Continuously have problems in their interpersonal life
Personality Disorders
70
Cluster A Disorders: Odd-eccentric | 3 types in cluster A
Paranoid Schizoid Schizotypal
71
True or False | In cluster A disorders- These people socialize well with others
False | They do not
72
True or False | In cluster A disorders- These people isolate themselves
True
73
distrust and suspicious; see others’ motives as malevolent. Difficulty problem solving. Trouble interacting with others – think people are trying to take advantage. Tough exterior. A) Paranoid B) Schizoid C) Schizotypal
A) Paranoid
74
Sensory distortions, ideas of reference in addition to emotional detachment. More stable than schizophrenia. Remain functional. May have delusions but know delusions are false. May have sensory distortions but are aware they are not real. Unable to do anything about it. Brief psychotic episodes. A) Paranoid B) Schizoid C) Schizotypal
C) Schizotypal
75
Emotionally restricted and unable to take pleasure in activities, friendships, or social relationships. More stable than schizophrenia & schizotypal. Remain functional. Aloof. Detached from others, no desire to have friends. Indifferent to praise or criticism. Do not take interest in anything or participate in activities for fun. A) Paranoid B) Schizoid C) Schizotypal
B) Schizoid
76
Cluster B Disorders: Dramatic-emotional | Includes four categories
Narcissistic Histrionic Borderline Antisocial
77
``` A “stunning lack of conscience”; deceitful, manipulative. Serial killers. Can be very charming and manipulative. Total disregard for others. Become good at being deceitful. Hair-trigger temper. A) Narcissistic B) Histrionic C) Borderline D) Antisocial ```
D) Antisocial
78
preoccupied with success, beauty; arrogant, sense of entitlement; successful. Exaggerated sense of their self-worth. No humility. Self-centered. Fragile self-esteem. Do not like to be outshone. A) Narcissistic B) Histrionic C) Borderline D) Antisocial
A) Narcissistic
79
instability in mood, thinking, self-image, and personal relationships. Go from one crisis to another. No such thing as a small problem, it is always a crisis. React emotionally to every situation and have poor coping skills. Become impulsive. Have poor relationships (bff one day, enemy the next) A) Narcissistic B) Histrionic C) Borderline D) Antisocial
C) Borderline
80
Excessive emotional expression accompanied by attention-seeking behaviours. Very dramatic. Overly outgoing (gregarious). Manipulative & exhibitionists. Desperate for attention. Friendships are superficial. A) Narcissistic B) Histrionic C) Borderline D) Antisocial
B) Histrionic
81
Cluster C Disorders: Anxious-Fearful – all have underlying anxiety What are the three sub-categories
Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder
82
fearful of criticism, disapproval or rejection, avoids social interactions, low self-esteem, withholds thoughts and feelings. Very sensitive, fear of rejection. Afraid to make friends. A) Avoidant Personality Disorder B) Dependent Personality Disorder C) Obsessive-Compulsive Personality Disorder
A) Avoidant Personality Disorder
83
preoccupation with perfection, organization, structure, excessive devotion to work, self-criticism and inability to forgive own errors, insistence on others’ conforming to own methods. Still able to function, it is not crippling. Perfectionists. Successful in their careers. Very aware of social stratification. Can also be very pompous and arrogant. Want everyone to conform to their rules. A) Avoidant Personality Disorder B) Dependent Personality Disorder C) Obsessive-Compulsive Personality Disorder
C) Obsessive-Compulsive Personality Disorder
84
unable to make decisions independently, clinging, submissive, cannot express negative emotions. Fear of separation. Need to be taken care of. No self-confidence. Put up with mistreatment from others because they have such a strong need to be accepted. A) Avoidant Personality Disorder B) Dependent Personality Disorder C) Obsessive-Compulsive Personality Disorder
B) Dependent Personality Disorder