Year 2 Mental Health Flashcards
What are the seven rights of medication
- right patient
- right reason
- right route
- right medication
- right time
- right documentation
- right dose
What is pharmacodynamics
how the drug affects the body
1. replace or act as a substitute fro missing chemicals
2. increase or stimulate certain cellular activites
3. depress or slow cellular activites
4. interfere with the functioning of foreign cells
What is pharmacokinetics
involves the study of absorption, distribution, metabolism and excretion of drugs
What are antipsychotics used for
used to treat psychotic disorders, including schizophrenia, they are also used to treat autism, behavioral disorders, and movement disorders with a psychological component. atypical and typical
What are common antipsychotics?
typical - haloperidol, chlorpromazine
atypical - olanzapine, risperidone, quetiapine, clozapine
What are the common side effects of antipsychotics?
weight gain
constipation
drowsiness
dizziness
What is metabolic syndrome?
A cluster of conditions that increase the risk of heart disease, stroke, and diabetes. Includes weight gain, hypertriglyceridemia along with increased insulin, glucose, and low-density lipoprotein cholesterol levels.
What is agranulocytosis
A serious condition occurs when there is an extremely low number of granulocytes (a type of white blood cell) in the blood. Granulocytes are an important part of the immune system and help the body fight infection.
What is Neuroleptic Malignant Syndrome
is a life-threatening neurologic emergency associated with the use of antipsychotic (neuroleptic) agents and characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia.
What are antidepressants used for?
the biomedical explanation for depression suggests that depression stems from a deficiency of norepinephrine, dopamine, or serotonin in the brain
What are the different types of antidepressants?
SSRI - Selective serotonin reuptake inhibitors (first-line treatment for depression, fewer side effects, block the reuptake of serotonin)
SNRI - Serotonin-noradrenaline reuptake inhibitors (ease depression by affecting chemical messengers (neurotransmitters) used to communicate between brain cells)
TCA - Tricyclic antidepressants (block the reuptake of serotonin and norepinephrine in presynaptic terminals, which leads to an increased concentration of these neurotransmitters in the synaptic cleft)
MAOI - Monoamine oxidase inhibitors
(removing the neurotransmitters norepinephrine, serotonin, and dopamine from the brain)
Common SSRI medication
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil, Pexeva)
Sertraline (Zoloft)
Common side effects from SSRI medication
blurred vision
constipation
weight loss
insomnia
What is serotonin syndrome
Serotonin syndrome is a potentially life-threatening drug reaction that results from having too much serotonin in your body.
What are common SNRI medication
Effexor (venlafaxine)
Pristiq (desvenlafaxine)
Cymbalta (duloxetine)
Common side effects of SNRI medication
dry mouth
nausea
insomnia drowsiness
headache
Common TCA medication
Amitriptyline
Doxepin
Imipramine
Nortriptyline
Common side effects of TCA medication
dry mouth
blurred vision
constipation
headache
Common MAOI medication
isocarboxazid (‘Marplan’)
phenelzine (‘Nardil’)
tranylcypromine (‘Parnate’)
Common side effects of MAOI medication
dry mouth
constipation
headache
drowsiness
What are mood stabilisers used for?
used in the treatment of bipolar affective disorder and schizoaffective disorder. used for the treatment of manic episodes and the prevention of future episodes
What are common mood stabilisers
lithium
anticonvolsants - sodium valproate, carbamazepine, lamotrigine
What are common side effects of mood stabilisers
tremor, stomach upset, polyuria, polydipsia, weight gain, dizziness, drowsiness, nausea
What are signs of lithium toxicity
blurred vision, drowsiness, confusion, slurred speech, vomiting
What are anxiolytics used for?
They act in the limbic system, making gamma-aminobutyric acid (GABA) more effective. To prevent or treat anxiety symptoms or disorders.
What are common anxiolytic medication
benzodiazepines, SSRI
diazepam, clonazepam, lorazepam, alprazolam, oxazepam
What are common side effects of anxiolytics
dizziness, drowsiness, confusion, headache, sedation, nausea
What are hypnotics used for?
Sedative-hypnotic drug products are a class of drugs used to induce and/or maintain sleep.
What are common hypnotic medications
benzos, hypnotics, barbituates
benzos - temazepam, triazolam, zopiclone
non bentos - buspirone, propanalol
What is in an MSE
Behavior/Appearance - age, ethnicity, gender, what are they wearing, (is it appropriate) build, hair, eyes, clothing, identifying factors, how they are behaving
Emotion (mood/affect) - mood, what they say, what you see, affect, and congruence
Thought form and stream - speech (rate, volume, quantity), thought steam (poverty of ideas slow or hesitant), continuity of ideas (tangential, derailment, perseveration), language (word salad, clanging, unusual words)
Thought content - delusions (grandiose), suicidal/self-harm, and homicidal ideation (current experiencing thoughts, have a plan, access to means)
Perception - hallucinations (derealisation or depersonalization)
Cognition - level of consciousness, GCS or AVPU, orientation to TPP, memory, concentration
Insight - understanding of illness, adherence to treatment/medication
Judgement - ability to make safe decisions
Risks - summary of risks
Impression - summary of symptoms
Plan - what is the next step
What is in a functional enquiry
sleep - normal bedtime and wake time, total sleep, falling asleep (how long does it take), waking (how often and why), sleep hygiene (warm, dark room), medications or routines, any changes
enjoyment - hobbies, how they spend their free time
mood - subjective,objective, congruent
motivation - are they likely to complete ADLs, do they get out of bed for work, do they do additional tasks/hobbies
appetite - how many meals do they eat, snacks, skip meals, normal meals, do they cook
ADLs - shower, bath, how often, do they appear well kempt
activity/energy - exercise, able to walk far, how far without being puffed, energy levels
concentration/memory/attention - can they focus on the interview, can they still read/watch tv, short and long-term memory
anxiety - do they currently feel anxious, is it normal, causes
other issues - AOD, what drives this, how often, impact
What is suicide
A global problem with approximately one million deaths worldwide yearly. Mental health disorders, particularly mood disorders, substance use disorders, psychotic disorders, and antisocial disorders, account for up to 70% of suicidal and suicide attempts. Suicide is when someone takes their own life
What are the 2 depressive disorders
- major depressive disorder, a condition involving seriously depressed mood and other symptoms which affect all body systems and interfere significantly with a person’s ability to carry out their daily living activities
- dysthymic disorder - chronically depressed mood for most of the day, more days than not, for at least two years
What are the different types of bipolar disorder
bipolar type 1 disorder - marked symptoms of mania with at least 1 episode of depression
bipolar type 2 disorder - recurrent bouts of major depression with episodes occurrence of hypomania
What is mania
Mania is classified as an elevation, expansive, or irritable mood for at least one week. There is also significant impairment in social or occupational functioning
What are the symptoms of mania
inflated self-esteem of grandiosity
decreased need for sleep
more talkative/pressure of speech
flight of ideas/racing thoughts
distractibility
increase in goal-directed activity
excessive involvement in pleasurable activities that may have negative consequences
What are the criteria for depression
five or more symptoms over the same 2 week period and represent a change in functioning
depressed mood most of the day, nearly every day
markedly diminished interest or pleasure
significant weight loss or gain, decrease or increase in appetite
insomnia or hyper insomnia
psychomotor agitationn or retardation
fatigue or loss of energy
feeling worthless or inappropriate guilt
lack of concentration and/or indecisiveness
recurrent thought of death or recurrent suicidal ideation
What is schizophrenia
characterised by a major disturbance in thought perception, cognition, and psychosocial functioning and is one of the most severe mental disorder
What are the positive symptoms of schizophrenia
- delusions
- thought disorder
- hallucinations
What are the negative symptoms of schizophrenia?
Anhedonia - the diminished capacity to experience pleasant emotions
Avolition - is a total lack of motivation that makes it hard to get anything done
Aphasia - is a disorder that affects how you communicate
Anergia - lack of energy
alogia - a disruption in the thought process that leads to a lack of speech and issues with verbal fluency
asociality - reduction in social initiative due to decreased interest in forming close relationships with others
What are delusions
Fixed beliefs that are not amenable to change in light of conflicting evidence.
persecutory - belief that one is going to be harmed or harassed by an individual or organization
referential - belief that certain gestures, comments, and environmental cues are directed at them
grandiose - when an individual believes that they have exceptional abilities, wealth, or fame
erotomanic - an individual believes falsely that another person is in love with them
What are hallucinations
Perception-like experiences occur without an external stimulus. They are vivid and clear with the full force and impact of normal perceptions and are not under voluntary control.
Auditory - experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the individual’s thoughts
visual - seeing something that isn’t there
What is a thought disorder
A disorder of cognitive organization, characteristic of psychotic mental illness, in which thoughts and conversation appear illogical and lacking in sequence and may be delusional or bizarre in content
What is anxiety
Excessive fear and anxiety and related behavioral disturbances. anxiety is the anticipation of future threats.
What are some different types of anxiety?
- generalized anxiety disorder
- panic disorder
- specific phobia
- social phobia
- obsessive-compulsive disorder
- acute street disorder
- post-traumatic stress disorder
- agoraphobia
What is a post-traumatic disorder
Development of characteristic symptoms following exposure to an extreme traumatic stressor involving the direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s integrity or witnessing an event that involves death, injury, or a threat to the physical integrity of another person, or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or close associate.
What is Generalised anxiety disorder (GAD)
Excessive anxiety and worry occurring more days than not for a period of at least 6 months, about a number of events or activities. The individual finds it difficult to control the worry
Obsessive-compulsive disorder (OCD)
Recurrent obsessions or compulsions that are severe enough to be time-consuming (they take more than one hour a day) or cause marked distress or significant impairments.
obsessions
compulsions
rituals
What is type 1 diabetes
Pancreases can no longer produce enough insulin to cope with increased glucose/insulin needs. no insulin is produced, and symptoms develop rapidly
Symptoms of hyperglycemia
glycosuria - the presence of reducing sugars in the urine
polyuria - excessive urination
polydipsia - increased thirst
polyphagia - increased appetite
weight loss
Symptoms of hypoglycemia
sweating
shaking
dizziness
headache
confusion
What is type 2 diabetes?
insulin resistance, the inability of the cells to respond normally to insulin and be able to access blood glucose. Reduced insulin secretion
What is gestational diabetes
glucose intolerance during pregnancy
usually resolves after the birth
increased risk of developing diabetes later in life
What is diabetic ketoacidosis (DKA)
A serious diabetes complication is where the body produces excess blood acids (ketones). results from insulin deficiency so occurs most commonly in T1D
causes
insulin withdrawal
MI,stroke, trauma or other medical stress
infection
IV fluids
Long-term complications of diabetes
Autonomic neuropathy (dizziness, syncope) - occurs when there is damage to the nerves that control automatic body functions.
Eyes - retinopathy, cataracts, glaucoma
microangiopathy - cerebral infarcts, hemorrhage
atherosclerosis - ischemic HD, MI
gastrointestinal motility - delayed gastric emptying, diarrhea, constipation
genitourinary tract - bladder stasis/infection, erectile dysfunction
nephropathy - glomerulosclerosis, CKD
peripheral vascular disease
somatic neuropathy - abnormal sensory and motor function, foot ulcers
What is addiction
Any chemical entity that is used non-medically and is generally self-administered, through any route of administration for its positive psychoactive effect
What are different types of addictive substances
alcohol
cannabinoids
opioids
depressants
stimulants
hallucinogens
What are the stages of the change model
pre-contemplation - no intention of changing behavior in the near future (6 months approx), generally appearing unmotivated and resistant to change
contemplation - individuals state their intent to change in the near future but are ambivalent about change
preparation - individual intent to actively change within the next month or so, and preparation is, therefore, a transition from contemplation to action rather than a subtle state
action - the individual is making changes or has done so recently
maintenance and recycling - individuals maintain the gains made and prevent relapse
What is a personality
The unique combination of traits makes you an individual, including characteristics, behaviors, attitudes, feelings, and ways of thinking. Our personality manifests in our moods, attitudes and opinions and is clearly expressed when we interact with others
Different types of personality disorders (cluster A)
odd, eccentric, cold, withdrawn, suspicious
1. paranoid personality disorder
2. schizoid personality disorder
3. schizotypal personality disorder
Different types of personality disorders (cluster B)
dramatic, emotional, erratic behaviors
1. antisocial personality disorder
2. borderline personality disorder
3. histrionic personality disorder
4. narcissistic personality disorder
Different type of personality disorders (cluster C)
anxious, tense, over-controlled
1. avoidant
2. dependant
3. obsessive-compulsive
4. personality change due to another medical condition
5. other personality disorder: NOS
What is borderline personality disorder and the diagnosis criteria?
a pervasive pattern of instability of interpersonal relationships, self-image and effects and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five or more of the following
1. frantic efforts to avoid real or imagined abandonment
2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. identity disturbances: markedly and persistently unstable self-image or sense of self
4. impulsivity in at least 2 areas that are potentially self-damaging
5. recurrent suicidal behavior, gestures, or threats of self-mutilating behavior
6. affective instability due to a marked reactivity of mood
7. chronic feelings of emptiness
8. inappropriate, intense anger or difficulty controlling anger
9. transient, stress-related paranoid ideation or serve dissociative symptoms
What are an antisocial personality disorder and the diagnosis criteria?
a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15yrs, as indicated by three or more of the following
1. failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3. impulsivity or failure to plan ahead
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults
5. reckless disregard for the safety of self and others
6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
the individual is at least 18 yrs
there is evidence of conduct disorder with onset before age 15yrs
What are the 9 principles of recovery?
- is borne of hope
- is a journey defined by the individual
- needs a supportive environment to thrive
- involves individuals redefining who they are in the presence of a psychiatric label
- is an active and ongoing process
- is a non-linear journey
- recovery skills can be learnt
- involves a person educating themselves about their illness
- learning to manage both internalised and external stigma an discrimination
What is stigma
a sign of shame, disgrace or disapproval, to shun or reject, ignorance, prejudice, discrimination
What is discrimination
Is the systemic, unfair treatment of people because they are different, discrimination is a behavior that says to people with mental illness or addiction issues that “we don’t want you here”
Impact of self discrimination
discrimination of families
often blamed for illness
lack of tolerance and understanding
guilt and shame
frustration
that they cant “fix it”
Impact of discrimination within families
lack of education
feeling responsible, ashamed of the reputation
more likely to wait to long before accessing services
feeling helpless to fix their loved one and frustrated with MH services cant either
The impact from the community
social avoidance and exclusion
lack of tolerance and knowledge from public services
reputations being inherited
migrant populations
The impact from mental health services
not being involved in clinical decisions
lack of consultation
exclusive treatment of individuals
assumption of ignorance
blamed for problem - child/adolescent
What is Trauma
is the lasting adverse effects on persons or collectives functioning and mental, physical, social, emotional, or spiritual wellbeing caused by events, circumstances, or intergenerational historical traumatic experiences
What is trauma-informed care?
A human service delivery framework based on knowledge and understanding of how trauma affects people.
What is the Health Practitioners Competence Assurance Act 2003
provides a framework for the regulation of health practitioners in order to protect the public where there is a risk if harm from professional practice
What is The Privacy Act 1993
Protects individuals by defining how organizations: collect personal information, hold personal information, use and disclose personal information
What is The Health Information Privacy Code 1994
Rules for agencies in the health sector. it covers health information collected, used, held, and disclosed by health agencies and takes the place of the information privacy principles for the health sector
What is the Substance Abuse Act 2018
Enable persons to recieve compulsory treatment if they have a severe substance addiction and their capacity to make decisions about treatment for that addiction is severely impaired
What is the Intellectual Disability Act 2003
To provide the courts with appropriate compulsory care and rehabilitation options for people who have an intellectual disability and who are charged with or convicted of an offence
to recognize and safeguard the special rights of individuals subject to the act
to provide for the appropriate use of different levels of care for individuals who, while no longer subject to the criminal justice system, remain subject to this act
What are the 6 ethical principles
- autonomy (individuals have a right to self-determination)
- beneficence (act for the benefit of the patient, do no harm)
- nonmaleficence (there is an obligation not to inflict harm on others.)
- justice (giving each person what he or she deserves)
- veracity (requires that healthcare providers be honest in their interactions with patients)
- fidelity (addresses a person’s responsibility to be loyal and truthful in their relationships with others)
What is the Mental Health Act
defines the rights of patients and proposed patients to provide protection for those rights, and generally to reform and consolidate the law relating to the assessment and treatment of person with a mental health illness
What are sections 8/9 about in the MHA
8 - compulsory assessment and treatment
Any person may fill out the application form
9 - Assessment examination to be arranged and conducted
What is section 11 about in the MHA
Further assessment and treatment for 5 days -If the mental health practitioner records a finding under section 10(1)(b)(ii), the mental health practitioner must require the patient to undergo further assessment and treatment throughout the first period. The mental health practitioner must give the patient written notice of this requirement.
What is section 13 about in the MHA
Further assessment and treatment for 14 days - If the responsible clinician records a finding under section 12(1)(b)(ii), the clinician must require the patient to undergo further assessment and treatment throughout the second period. The responsible clinician must give the patient written notice of this requirement.
What is section 29 about in the MHA
Community treatment orders - A community treatment order shall require the patient to attend at the patient’s place of residence or at some other place specified in the order for treatment by employees of the specified service, and to accept that treatment.
What is section 30 about in the MHA
Inpatient orders - Every inpatient order shall require the continued detention of the patient in the hospital specified in the order or (where the patient is being detained at some other hospital) the admission of the patient and his or her detention in the hospital so specified, for the purposes of treatment, and shall require the patient to accept that treatment.
What is section 111 about in the MHA
Powers of the nurse where urgent assessment required - any person who has been admitted to the hospital (not being a patient who is already subject to assessment or treatment under this Act) is acting in a manner that gives rise to a reasonable belief that he or she may be mentally disordered, or such a person is brought to a hospital; and
(b)
a nurse having immediate responsibility in the matter considers that—
(i)
there are reasonable grounds for believing that the person may be mentally disordered; and
(ii)
it may be desirable for the person to have an assessment examination urgently in the person’s own interests or the interests of any other person
What is forensic mental health?
Patients who have committed or allegedly committed a legal crime in the context of mental illness.
What is the fitness to plead
Refers to an individual being able to make a mentally competent plea in court regarding an alleged offense. The person making the plea must understand the consequences of the plea they are entering.
What are some barriers to recovery
length of custodial sentence between prison and hospital
remanded to hospital from the courts/prison
unresolved legal issues and related outcomes
index or alleged offense
helplessness
self stigma
isolation
traume
medication non adherence
What is dementia
A group of thinking and social symptoms that interfere with daily functioning. Not a specific disease, dementia is a group of conditions characterised by impairment of at least two brain function, such as memory loss and judgement.
Types of dementia
Alzeimers disease - 50-60%
Vascular dementia - 20-30%
What is delirium
It is sudden, serve confusion and rapid changes in brain function that occur with physical or mental illness. Delirium is often caused by physical or mental illness and is usually temporary and reversible. Many disorders cause delirium, including conditions that deprive the brain of oxygen or other substances
What is sundowning
Refers to a state of confusion at the end of the day and into the night. Is an increase or appearance of agitation/confusion and other behavioral symptoms in the late afternoon or early evening when the person is awake
What is an Intellectual disability, how is it determined
the abilty of a persons brain to learn, think, solve problems, and make sense of the world. IQ
whether the person has the skills he or she needs to live independently. adaptive behavior or adaptive functioning
Causes of ID
Heredity
alterations in embryonic development
complications in pregnancy
environmental and teratogenic influences
post natal medical complications
trauma and injury
