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mental health > week 4 > Flashcards

week 4 Flashcards

1
Q

is bipolar disorder chronic and a life threatening illness?

A

yes

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2
Q

Explain how bipolar disorder “cycles”

A

pts with bipolar disorder cycle through different periods of normal functioning, mania, hypomania, or periods of depression.

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3
Q

What are the ranges of symptoms on a continuum of bipolar disorder?

A

mania
depressive symptoms
mixed (Both)

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4
Q

at what age does bipolar disorder usually onset?

A

18

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5
Q

can bipolar disorder be induced by menopause?

A

yes

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6
Q

which gender does bipolar 1 disorder effect more?

A

both male and female equally

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7
Q

which gender does bipolar 2 disorder effect more?

A

female

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8
Q

Why does bipolar disorder occur? What are the causes?

A
  1. genetics
  2. neurobiological factors
  3. neuroendocrine factors
  4. neuroanatomical factors
  5. environmental and psychological influences
  6. cultural considerations
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9
Q

What are neuroanatomical factors of bipolar disorder?

A
  1. pts have less gray matter volume
  2. smaller amygdala
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10
Q

what are some examples of neuroendocrine factors of bipolar disorder?

A

hormones play a BIG ROLE

Women who have bipolar disorder have worse PMS symptoms

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11
Q

What can lead to a relapse of bipolar disorder?

A

sleep

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12
Q

what are some examples of environmental and psychological influences in bipolar disorder?

A
  1. stress
  2. interpersonal conflict
  3. poor sleep
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13
Q

What three diagnoses do pts with bipolar 1 disorder cycle between?

A
  1. at least one episode of mania
  2. major depressive disorder
  3. possible psychosis
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14
Q

Does a pt with bipolar disorder 1 experience psychosis? What do they experience with psychosis?

A

yes, delusions or hallucinations

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15
Q

in a pt with bipolar disorder 1, and experiencing psychosis, what “kind” of delusions do they experience?

A
  1. grandeur delusions
  2. paranoid delusions
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16
Q

What are signs of mania in bipolar 1 disorder?

A
  1. euphoria or agitation
  2. irritability or anger
  3. increased energy
  4. rapid speech
  5. flight of ideas
  6. delusions of grandeur
  7. decreased need for sleep
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17
Q

Define mania

A

when someone has a persistent or elevated or irritable mood accompanied by these changes in these activities or energy

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18
Q

What is KEY to know if someone is going through a manic episode?

A

Decreased need for sleep

they won’t sleep for days or weeks

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19
Q

What is the key difference between bipolar 1 and bipolar 2 disorder?

A

Bipolar 1 has MANIA

Bipolar 2 has HYPO mania

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20
Q

Difference between mania and hypomania?

A

someone with mania CANNOT function but someone with HYPOmania can function and can sleep

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21
Q

What do pts with bipolar disorder 2 typically cycle between?

A
  1. at least one period of mania
  2. one or more periods of depression
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22
Q

What are some depressive characteristic s of a pt with bipolar 2 disorder?

A

1.hoplessness/ sadness
2. altered sleep
3. appetite and weight changes
4. inability to concentrate
5. inability to make decisions
6. suicidal thoughts

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23
Q

what do pts with bipolar2 disorder not experience that is KEY in bipolar 1?

A

no psychosis
no hallucinations
no delusions

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24
Q

Hypomania or Mania

EX: Treats everyone with familiarity and confidentiality; often borders on crude

A

hypomania

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25
Q

hypomania or mania

EX: Becomes inappropriately demanding of peoples attention, and intrusive nature repels others

A

mania

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26
Q

Hypomania or Mania

EX: May have a voracious appetite, eat on the run, or gobble food during brief periods

A

hypomania

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27
Q

hypomania or mania

EX: no time to eat-too distracted and disorganized

A

mania

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28
Q

What “type” of foods are the best option for Mania pts?

A

finger foods because they don’t think too eat

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29
Q

Explain delirious mania

A

happens acutely, life threatening, and happens quickly and suddenly.
1. disoriented
2. psychosis
3. catatonia

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30
Q

What is cyclothymic disorder

A

When they alternate between hypomania and depression

they have multiple hypomania episodes

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31
Q

If someone is showing symptoms of mania, what are the PRIORITIES to find in your assessment?

A
  1. dehydration
  2. cardiac status
  3. sleep
  4. safety

PHYSIOLOOGICAL PRIORITIES

We want to make sure they aren’t using up too much energy that leads up to these issues

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32
Q

What can lead to cardiac collapse?

A

not getting enough sleep

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33
Q

If a patient is impulsive what is a priority?

Ex: blurting out words or making certain gestures

A

safety safety safety

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34
Q

What is a “good” amount of sleep for someone with mania?

A

4-6 hours of sleep

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35
Q

how often should you get vitals for someone with mania?

A

multiple times during the day

*attempt like around every hr or at least the HR

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36
Q

Would competitive activities be optimal for someone with bipolar disorder/mania?

A

Naurrrrr

these individuals are very competitive, they will deplete their energy

distarct them to something more solitary

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37
Q

What are some interdisciplinary treatments for those with Bipolar disorder?

A
  1. pharmacotherapy
  2. psychosocial support
  3. CBT
  4. interpersonal and social rhythm therapy
  5. family therapy
  6. support groups
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38
Q

are those with bipolar disorder able to deal with change well?

A

Naurrrrr so interpersonal and social rhythm therapy help them cope with change.

change may induce manic episodes

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39
Q

What are the pharmacological therapies?

A
  1. Mood stabilizers
  2. anticonvulsants
  3. anxiolytics
  4. second gen antipsychotics
  5. ECT
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40
Q

What is lithium used for?

A

Used as a mood stabilizer and is used as the first line of tx

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41
Q

What disorders does lithium target/help treat?

A
  1. acute mania
  2. acute BP depression
  3. Prevention of manic and depressive episodes
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42
Q

How long does it take lithium to have a full response?

A

3-6 weeks

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43
Q

What is a contraindication of lithium?

A
  1. NSAIDS
  2. caution with diuretics, lithium level might go up
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44
Q

let’s say someones sodium level goes down, what happens to the lithium level? What does this increase the risk for?

A

Sodium DOWN
Lithium UP
(Vice versa)

INCREASES RISK FOR LITHIUM TOXICITY

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45
Q

What is the therapeutic level for lithium?

A

0.5-1.2 mEq/L

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46
Q

does a level of 1.2-1.5 lithium level indicate toxicity?

A

No, its not toxic buuuuut its a red flag

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47
Q

What are the common EXPECTED side effects of someone taking lithium?

A
  1. fine hand tremors
  2. polyuria, mild thirst
  3. nausea
  4. weight gain
  5. sedation
  6. acne
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48
Q

Therapeutic level for ADVANCED signs of lithium toxicity

A

1.5-2

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49
Q

therapeutic level for SEVERE lithium toxicity

A

2+

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50
Q

If the therapeutic level of lithium is between 1.2-1.5 what should you do?

A
  1. Hold medication
  2. Call doc
  3. Get the dosage reevaluated

usually if the pt skips a dose that’s enough to get them to a safer range

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51
Q

If the therapeutic level is between 1.2-1.5, what symptoms may the pt experience?

A
  1. n/v/d
  2. slurred speech
  3. muscle weakness
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52
Q

What level is the KEY to know if the lithium level is toxic?

anything above this level is toxic

A

ANYTHING ABOVE 1.5 IS EL TOXICOOOOO

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53
Q

What are some symptoms someone will experience in advanced signs of toxicity? 1.5-2mEq/L

A
  1. coarse hand tremor
  2. GI upset
  3. Mental confusion
  4. Muscle hyper-irritability
  5. EEG changes
  6. incoordination
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54
Q

What is usually the tx for someone who has a lithium lab level of 1.5-2?

A

Give a saline bolus to bring the lithium level down

(Giving them sodium to bring that lithium level down)

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55
Q

If the lithium level is 2+, which is severe toxicity, what tx do they usually need to get rid of the lithium?

A

dialysis to get rid of the lithium in the body because it affects the kidneys at this point

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56
Q

What are some symptoms a pt will experience with lithium levels of 2+?

A
  1. ataxia
  2. Serious EEG changes
  3. Blurred vision
  4. clonic movements, seizures
  5. Stupor
  6. Coma
  7. Death
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57
Q

What are some general long term side effects of lithium?

A
  1. HYPOthyroidism, goiter
  2. kidney dysfunction
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58
Q

When someone is taking lithium, what do we usually want to get a baseline test of?

A

Baseline thyroid function test because they are susceptible to HYPOthyroidism

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59
Q

Since lithium can affect the kidneys, what do we want to monitor?

A

BUN and creatinin levels

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60
Q

What are commonly seen anticonvulsants?

all the same med

(HINT)
2 Vaginas
2 Dicks
= orgasms looks like SEIZURES lol

A
  1. Valproic acid
  2. Depakote
  3. Divalproex
  4. Valproate
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61
Q

if you see that the pt has a valproic acid level but you dont see them taking valproic acid what does that mean?

A

Valproic acid is the lab draw so their probably taking depakote or divalproex

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62
Q

What are anticonvulsants usually effective in tx of?

A
  1. Bipolar mania
  2. hypomania
  3. mixed states
  4. Rapid cycling
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63
Q

What are the side effects of anticonvulsants?

(HINT mnemonic)
Grace
Tried
Sucking
His
Weiner

buuuut didn’t like his enlarged prostate from his…

B
P
H

A

G: GI pain
T: Tremors
S: Sedation
H: Hair loss
W: Weight gain
B: Blood Dyscrasias
P: Pancreatitis
H: Hepatotoxicity

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64
Q

Since anticonvulsants can have a side effect of blood dycrasias, what should we monitor?

A

always monitor CBC

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65
Q

Why would anticonvulsants be the first line of tx for someone with kidney issues?

A

Because its Hepatotoxic not Nephrotoxic

Lithium can cause kidney dysfunction… so for someone who has kidney issues give them an anticonvusant for someone with liver issues give them lithium

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66
Q

What is the therapeutic level for anticonvulsants?

A

85-125

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67
Q

anticonvulsant toxicity symptoms

A

ataxia
confusion
somnolence
coma

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68
Q

TX for anticonvulsant toxicity

A

stop medication
give fluids

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69
Q

What is carbamazepine?

A

anticonvulsant

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70
Q

What is Carbamazepine effective in tx of?

A
  1. Rapid cycling
  2. Mixed states
  3. Acute mania
  4. Prevents relapse of mania
71
Q

What are the side effects of Carbamazepine?

A
  1. Hepatic disease
  2. Blood dycrasias
  3. fluid overload
  4. Hyponatremia
  5. life threatening dermatological reactions (SJS/rash)
72
Q

what does carbamazepine decrease the effectiveness of?

A

birth control pills

73
Q

What is the therapeutic level of Carbamazepine?

A

4-12 mcg/mL

74
Q

Symptoms of toxicity of carbamazepine?

A
  1. Fatigue, nausea
  2. Diplopia
  3. Blurred vision
  4. Ataxia
75
Q

What kind of med is Lamotrigine?

A

anticonvulsant

76
Q

What is Lamotrigine effective in tx of?

A
  1. Bipolar depression
  2. Both acute and maintenance
77
Q

What are the SERIOUS side effects of lamotrigine?

A
  1. SJS
  2. Aseptic meningitis (Monitor for stiff neck)
  3. Can lower effects of birth control
78
Q

What are anxiolytics?

A

Benzodiazepines

79
Q

What are some examples of Anxiolytics?

A

Clonazepam
Lorazepam

80
Q

When do we usually give a benzo?

A

if were concerned about them collapsing

  1. adjunctive agents
  2. acute mania
  3. Psychomotor agitation
81
Q

What are second gen antipsychotics effective in tx of?

A
  1. Acute mania
  2. Bipolar disorder
  3. Prevent relapse of mania and depression
82
Q

What is primary psychosis?

A

Ex: schizophrenia, something genetic, part of genes

83
Q

What is secondary psychosis?

A

secondary to some medications or secondary to a brain tumor

84
Q

What is the onset age for males with schizo?

A

onset: 18-25

85
Q

What is the onset age for females with schizo?

A

onset: 25-35

86
Q

what are some comorbidities of Schizo?

A
  1. Substance use disorder (up to 50% have this disorder)
  2. Tobacco use disorder (up to 50% have this disorder)
  3. Cannabis use
  4. Attempted suicide
  5. Anxiety disorders
  6. Metabolic Syndrome
  7. HIV/AID
87
Q

What are the phases of Schizo?

A
  1. Prodromal phase
  2. Acute phase
  3. Stabilization phase
  4. Maintenance phase
88
Q

Explain what happens in the prodromal phase

A

warm up phase

What happens before someone is diagnosed with shizo, socially withdrawn, deterioration in functioning, depressed, start acting strange.

very hard to catch when someone in this phase

89
Q

Explain the acute phase of schizo

A

full blown psychotic break, when they start to hallucinate or have delusions

90
Q

Explain the stabilization phase of schizo

A

When they starts to decrease in severity, symptoms are not acute or full blown but they are not 100% back to baseline

91
Q

Explain the maintenance phase of schizo

A

when the symptoms are in remission or symptoms are so mild that they aren’t really noticeable

92
Q

Is it possible for someone for someone to go from the maintenance phase back into the acute phase? What are some warning signs

A

yes they can go back.

Signs: If they start having a hard time sleeping or start having poor concentration

93
Q

What are the categorical symptoms of schizo?

A
  1. positive symptoms
  2. Negative symptoms
  3. Cognitive symptoms
  4. affective symptoms
94
Q

If someone has positive symptoms of schizo, what may they have alterations of?

A
  1. Thinking
  2. Thought process
  3. Perception
  4. Behavior
  5. Boundaries
95
Q

Define delusions

A

a false fixed belief

they believe its true but its not

96
Q

What are the different alterations of THINKING in people with schizo?

A
  1. Ideas of reference
  2. paranoid/ persecutory
  3. Grandiosity
  4. Somatic
  5. Jealousy
  6. Control
  7. Thought broadcasting
  8. Thought insertion
  9. Thought withdraws
  10. concrete thinking
97
Q

Explain idea of reference delusions

A

A specific even has a personal meaning

EX: a classroom laughs and they think those people are laughing them (no connection) or TV is talking to them

98
Q

Explain paranoid/ persecutory delusions

A

The belief that someone is out to get you

the FBI is coming to get me, the doctor is poisoning me

99
Q

Explain Grandiosity delusions

A

The belief that they are superior, they own the hospital and they’re gonna fire you because you’re a terrible nurse

100
Q

Explain somatic delusions

A

Belief that internal organs are abnormal

they may believe that their preggo but aren’t but they have a tumor or hernia

101
Q

Explain jealousy delusions

A

feeling that you’re significant other is unfaithful

102
Q

Explain control delsions

A

the belief that ones mind is being controlled by another

103
Q

Explain thought broadcasting delusions

A

belief that the thoughts are being broadcasted to the world
they can read my mind I better not think hat

104
Q

explain thought insertion delusions

A

Thoughts are being INSERTED into my mind

105
Q

explain thought withdrawal delusions

A

the belief that thoughts are being removed from your mind

106
Q

explain concrete thinking delusions

A

they can’t think abstractly, literal interpretation

when we see gardening tools but they see things with wooden handles

107
Q

What are some alternations in thought process that are altered in the way that they speak for someone with schizo?

A
  1. associative looseness
  2. circumstantiality
  3. tangential
  4. neologisms
  5. world salad
  6. echolalia
  7. clang associations
108
Q

Describe associate looseness

A

they have illogical shifts between topics

109
Q

describe circumstantiality

A

when you talk to someone and they give you way too many excessive details about the story

110
Q

describe tangential

A

when someone goes off on a tangent

111
Q

describe neologism

A

they have a made up word

112
Q

describe word salad

A

someone gets a bunch of words puts them in a bowl and throws them out (nothing makes
sense)

113
Q

describe echolalia

A

echoes

Ex: phone phone phone where’s the phone

114
Q

in positive symptoms of schizo, what are some examples of alteration in PERCEPTION

A
  1. hallucinations (5 senses)
  2. Illusions, they think a cord is a snake

*gustatory taste poison
*olfactory they smell gas its a sign of a brain tumor
*tactile if they feel bugs its meth induced

115
Q

What are some alterations in behavior in positive symptoms of schizo?

A
  1. bizarre demeanor
  2. eccentric, grooming, and rituals
  3. impaired impulse control
116
Q

describe bizarre demeanor

A

tick like movements

117
Q

what are some alterations in boundaries in positive symptoms of schizo?

A
  1. depersonalization
  2. derealization
118
Q

what are symptoms of negative symptoms of schizo

A
  1. anergia
  2. avolition
  3. anhedonia
  4. affective blunting
  5. poverty of speech
  6. social withdrawal
119
Q

describe anergia

A

loss of energy

120
Q

describe avolition

A

loss of motivation

121
Q

describe anhedonia

A

inability to experience pleasure

122
Q

describe effective blunting

A

inability to express emotions on face

123
Q

describe poverty of speech

A

no talking, or one word answers

124
Q

What are symptoms of cognitive symptoms

A
  1. memory impairment
  2. Disruption in social learning
  3. poor judgment and focus
  4. impaired insight (they dont think they have schizo)
125
Q

What are symptoms of affective symptoms

A
  1. Depression
  2. Anxiety
  3. Demoralization
  4. suicidality
  5. excitability
  6. agitation
126
Q

Describe catatonia

A
  1. extreme and abnormal motor behavior
  2. slowing-down of thought
  3. reduction in physical movements
127
Q

What is a CLASSIC sign of catatonia

A

waxy flexibility

128
Q

tx for someone with catatonia

A

HIGH level of benzos

129
Q

What are examples of other psychotic disorders?

A
  1. Schizophrenirform disorder
  2. brief psychotic disorder
  3. Schizoaffective disorder
  4. Delusional disorder
  5. substance/
    medication-induced psychotic disorder
130
Q

Describe Schizophreniform

A

You have this for 6 months then its deemed schizophrenic

131
Q

describe brief psychotic disorder

A

induced from a stressful event

**symptoms only last for a month VERY BRIEF

132
Q

describe schizoaffective

A

Schizophrenia and a mood disorder

ex: Schizo and depression or schizo and mood disorder

133
Q

Describe delusional disorder

A

when someone has a delusion

134
Q

What are some examples of outcomes for schizo?

A
  1. pt will refrain from inflicting injury
  2. pt will take meds without prompting
  3. pt will state two coping mechanisms to reduce anxiety
135
Q

What are some examples of interdisciplinary tx for schizo?

A
  1. family psychoeducation/ therapy
  2. CBT
  3. cognitive remediation
  4. social skills training
  5. pharmacological therapies
136
Q

What is important to know about first gen antipsychotics?

A
  1. traditional dopamine antagonists
  2. used less frequently (side effects are severe)
  3. minimal impact on negative symptoms
137
Q

If someone has negative symptoms what antipsychotic do you not give them?

A

NO FIRST GEN

138
Q

What are the first gen antipsychotics?

A
  1. Chlorpromazine
  2. Loxapine
  3. Fluphenazine
  4. Haloperidol
139
Q

What are symptoms of EPS? Extrapyramidal symptoms

A
  1. Psuedoparkinsonism
  2. Acute dystonia
  3. Akathisia
  4. Tardive dyskinesia
140
Q

What are symptoms of pseudo parkinsonism

A
  1. stooped posture
  2. shuffling gait
  3. Rigidity
  4. Bradykinesia
  5. tremors at rest
  6. pill-rolling motion of the hand
141
Q

what are symptoms of acute dystonia

A
  1. facial grimacing
  2. involuntary upward eye movement
  3. muscle spasms of the tongue
  4. laryngeal spams
142
Q

what are symptoms of akathisia?

A
  1. restless
  2. Trouble standing still
  3. Paces the floor
  4. feet in constant motion
143
Q

what are symptoms of tar dive dyskinesia?

A
  1. protrusion and rolling of the tongue
  2. sucking and smacking movements of the lips
  3. chewing motion
  4. facial dyskinesia
  5. involuntary movements of the body and extremities
144
Q

When someone is having EPS symptoms of acute dystonia what is most concerning?

A

Laryngeal spams, MONITOR AIRWAY

145
Q

If dosage is too high for pt what can happen?

A

PT can get acute dystonia

146
Q

tx for EPS symptom of acute dystonia

A
  1. diphenhydramine
  2. Benztropine
147
Q

Is tardrive dyskinesia reversible?

A

no its irreversible

148
Q

as soon as you see symptoms of tardrivei dyskinesia what do you do

149
Q

what is the tx for someone with tar dive dyskinesia?

A
  1. lower dosage or switch med
  2. benztropine
150
Q

For a pt with EPS symptoms of akathisia what do you monitor for?

A

monitor for suicide

151
Q

What is the tx for akathisia?

A
  1. propanolol
  2. Benzodiazepines (helps reduce restlessness)
152
Q

What is the tx for pseudo parkinsonism?

A
  1. Benztropine
  2. Trihexyphenidyl
153
Q

what are pts with pseudo
parkinsonism at risk for

154
Q

What are other side effects of antipsychotics?

A
  1. sedation
  2. orthostatic hypotension
  3. lowered seizure threshold
  4. increased prolactin
  5. prolonged QT interval
  6. Anticholinergic toxicity
  7. neuroleptic malignant syndrome
155
Q

what can increased prolactin lead to?

A
  1. sexual dysfunction
  2. galactorrhea
  3. Amernorrhea
  4. Gynecomastia
156
Q

*****What is metabolic syndrome? **

know this

A

a combination of more diseases

  1. obesity
  2. HTN
  3. Diabetes
  4. Dyslipidemia
157
Q

signs of anticholinergic toxicity

A
  1. anxiety
  2. delirium
  3. disorientation
  4. hallucinations
  5. hyperactivity
  6. seizures
158
Q

if someone is experiencing anticholinergic toxicity what should you do

159
Q

signs of neuroleptic symptoms

SEVERE

A
  1. muscle rigidity
  2. high fever
  3. fluctuating BP
  4. irregular and increased HR
  5. AMS (altered mental status)
160
Q

If someone is experiencing muscle rigidity and fluctuating BP what would you assume?

A

that when these two are paired together that the pt is experiencing NEUROLEPTIC MALIGNANT SYNDROME

161
Q

What are pts with NMS at high risk for?

A

DVT and Rhabdomyolysis

162
Q

What are the second and third gen antipsychotics?

A
  1. aripiprazole
  2. Clozapine
  3. Lurasidone
  4. Olanzipine
  5. Quetipine
  6. Risperidone
163
Q

What should be known about aripiprazole?

A

its very sedating

164
Q

what should be known about olanzapine?

A

cause weight gain

165
Q

what should be known about Quetiapine?

A

Highly abused (its seraquil)

dont give to homeless they won’t take it they will sell it

166
Q

what should be known about Risperidone?

A

places pt at higher risk for heat stroke

167
Q

Are second and third gen antipsychotics more or less likelyto cause EPS?

A

Less likely to cause EPS

they are also milder and better tolerated

168
Q

Which antipsychotic is the LAST resort med?

169
Q

Why don’t we like to give clozapine?

A

side effects are severe and common

170
Q

what are side effects of clozapine?

A
  1. agranulocytosis
  2. mycarditis
  3. Siallorhea
171
Q

Why would you not want to give clozapine to someone with a low WBC count?

A

because it causes agranulocytosis because they are at higher risk for sepsis and infection

172
Q

What is Siallorhea

A

they wake up drenched in their saliva

173
Q

what us the tx for siallorhea

A

atropine eyedrops under the tongue

174
Q

What are some long acting injectables?

A
  1. Olanzipine
  2. Plaperidone
  3. Ziprasidone
  4. Haldol
  5. Aripriprazole

mental health (14 decks)

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