Mental Health Chapter 13 & 14

Autism Medications - CNS Stimulants

1. Amphetamine (Adderall) 2. Methylphenidate (Ritalin) 3. Dextroamphetamine (Dexedrine)

Autism Medications - Antipsychotics

1. Risperidone (Risperdal) 2. Clozapine (Clozaril) 3. Olanzapine (Zyprexa) 4. Quetiapine (Seroquel) Approved for FDA for treatment of autism Can get side effects of anti-psychotics

cyclothymic disorder episodes

4 episodes - Adult = 2yrs 4 episodes - Child = 1 year

Visual Motor Deficit

A disorder that affects the understanding of information that a person sees, or the ability to draw or copy.

dyscalculia

A specific disability that affects a person's ability to understand and learn math facts.

affect

Appearance of observable emotions

labile

Changing rapidly and often

What should family watch for in a patient with manic episodes?

Driving, money, are they taking there medications

Age-appropriate behaviors for a 4-year-old

wanting to please and be like friends showing increased independence being able to distinguish fantasy from reality being demanding at times, cooperative at times

Which statement would show acceptance of a depressed, mute patient?

"I would like to sit with you for 15 minutes now and again this afternoon." Spending time with the patient without making demands is a good way to show acceptance.

Lithium lab values:

0.5-1.2 mEq/L

Dysgraphia

A learning disability that involves difficulty in handwriting.

Dyslexia

A specific learning disability that affects reading and related language-based processing skills.

Language Processing Disorders

A specific type of Auditory Processing Disorder in which there is difficulty attaching meaning to sound groups that form words, sentences and stories.

Dysthymia cannot be diagnosed unless it has existed for

At least two years Dysthymia is a chronic condition that by definition has to have existed for longer than two years.

Kawasaki disease

B/L conjunctivitis Unilateral cervical LAD Strawberry tongue Rash of hands and feet ***Tx with ASA***

A patient with depression was prescribed fluvoxamine. On regular examination, the nurse identifies that the patient is having serotonin syndrome. Which symptoms in the patient support the nurse's assumption? Select all that apply.

Hyperactivity Altered mental states Abnormally high fever Fluvoxamine is a selective serotonin reuptake inhibitor. It can cause potential side effects such as serotonin syndrome due to overactivation of central serotonin receptors. Serotonin syndrome is characterized by hyperactivity, altered mental state, and hyperpyrexia characterized by excessively high fever. It is also characterized by elevated blood pressure and increased heart rate.

Bipolar 2

major depression and hypomania

MAOIS and tyramine interaction

since MAO metabolizes tyramine if have an inhibitor of this enzyme tyramine will accumulate which will elevate BP and may cause HYPERTENSIVE CRISIS

The most common side effects of methylphenidate for ADHD?

sleeplessness nervousness reduced appetite headache abdominal pain tachycardia changes in blood pressure and heart rate.

resilient children

children who rebound from serious early life traumas to construct successful adult lives

Cyclothymic Disorder (Cyclothymia)

chronic but less severe form of bipolar disorder

ADHD signs and symptoms

-Fidgeting, interrupts others, easily distracted, can't focus, no complete tasks, follow instructions (girls internalize symptoms)

Autism treatment

-In some cases, FOOD is the only Reinforcement that works in the initial stages of Treatment -Structured Therapies (Therapist tried to engage the child in CONVERSATION while the child PLAYS with toys) -Behavioral Treatment: Applied Behavioral Analysis (Based on Operant Conditioning - Behaviors that are REINFORCED should INCREASE and Behaviors that are NOT REINFORCED should DIMINISH)

How long does it take for symptoms to improve when taking antidepressants?

1-3 weeks

Three Main Types of Autism Spectrum Disorders

1. Autistic Disorder 2. Asperger's Syndrome 3. PDD - Not Otherwise Specified (PDD-NOS)

Autism Medications - Serotonin Reuptake Inhibitors/Antidepressants

1. Clomipramine (Anafranil) 2. Fluvoxamine (Luvox) 3. Fluoxetine (Prozac) Studies have shown these drugs to reduce the frequency and intensity of repetitive behaviors, may decrease irritability, tantrums, and aggressive behaviors Some children have also shown improvements in eye contact and responsiveness If you give too much, very lethargic

Autism Medications - Benzodiazepines

1. Diazepam (Valium) 2. Lorazepam (Ativan) 3. Alprazolam (Xanax) Studies show reduction in anxiety, repetitive behaviors, and aggression If you give too much, very lethargic

autism spectrum disorders

1. Individuals with autism are unable to filter extraneous stimuli -- cannot narrow focus; anything that is going on cannot filter and it is overstimulation 2. Autism is referred to as a spectrum disorder due to the fact that there is a very large range to which an individual's level of involvement is affected 3. Autism is a lifelong condition 4. There is no cure

Autism Treatments

1. No one method is effective in treating autism 2. Treatment involves a variety of psychosocial, behavioral, and pharmacological interventions 3. Treatment team generally includes: individual with autism, family, psychiatrist, teacher, speech/language pathologist, behavior analysis, and occupational therapist 4. Early diagnosis and intervention result in better outcomes

Executive Functioning

An inefficiency in the cognitive management systems of the brain that affects a variety of neuropsychological processes such as planning, organization, strategizing, paying attention to and remembering details, and managing time and space.

A nurse will prepare teaching materials for the parents of a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which medication will the information focus on?

Methyphenidate (Ritalin)

Which individual has the highest risk for major depression?

55-year-old single female recently diagnosed with rheumatoid arthritis The correct response incorporates the most risk factors for depression. Primary risk factors include female gender, being unmarried, low socioeconomic class, early childhood trauma, a negative life event (especially loss and humiliation), family history of depression, ineffective coping ability, postpartum time period, medical illness, absence of social support, and alcohol or substance abuse.

ADHD

A disorder that includes difficulty staying focused and paying attention, difficulty controlling behavior and hyperactivity.

Dyspraxia

A disorder that is characterized by difficulty in muscle control, which causes problems with movement and coordination, language and speech, and can affect learning.

Non-Verbal Learning Disabilities

A disorder which is usually characterized by a significant discrepancy between higher verbal skills and weaker motor, visual-spatial and social skills.

Given a choice of the following entrees, the patient prescribed a monoamine oxidase inhibitor (MOA) can safely eat

A fruit and cottage cheese plate Fruit and cottage cheese do not contain tyramine. Avocados, fermented food such as sauerkraut, processed meat, and organ meat contain tyramine. Monoamine oxidase inhibitors inhibit the breakdown of tyramine, which can lead to high blood pressure, hypertensive crisis, and eventually a cerebrovascular accident.

A child diagnosed with attention deficit hyperactivity disorder (ADHD) shows hyperactivity, aggression, and impaired play. The health care provider prescribed amphetamine salts (Adderall). The nurse should monitor for which desired behavior?

Improved abilities to participate in cooperative play with other children

Neuroleptic Malignant Syndrome

Adverse reaction to antipsychotics with severe "lead pipe" rigidty, FEVER, and mental status changes

A patient says to the nurse, "Life doesn't have any joy in it anymore. Things I once did for pleasure aren't fun." What term would the nurse use to document this complaint?

Anhedonia Anhedonia is a common finding in many types of depression. It refers to feelings of a loss of pleasure in formerly pleasurable activities. Dysthymic disorder is characterized by chronic low-level depression while euphoria is an extreme sense of joy. Psychomotor retardation is related to physical movement not emotion.

What statements regarding depression is true?

Depression can be seen in association with other mental and physical disorders. Social relationships can suffer when an individual is depressed. Depression can range from mild to severe in its effect on individuals. Depression can exist alone or in conjunction with other disorders and illnesses. Depression can present differently in different populations and different age groups and can be manifested on a continuum from mild to severe. One thing is consistent; depression results in significant pain and suffering that disrupts social relationships, performance at school or on the job, and the ability for a person to live a full and happy life. Depression also has a negative impact on physical well-being and the course of other medical diagnoses. This chapter includes basic information and therapeutic tools that will facilitate the care of patients with depression.

A patient hospitalized for major depression has been taking sertraline for the past week and has verbalized increased energy and improved sleep. What is the highest priority question the nurse should ask?

"Are you having any thoughts of harming yourself?" The patient is starting to experience increased energy, but suicidal thoughts may still remain. The patient may now have the energy for self-harm. It is important to assess for other side effects, such as appetite changes and depression, but suicide is the highest priority.

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed patients on the unit are older than 60 years." The reply by the nurse that clarifies the prevalence of this disease is

"Depression is seen in people of all ages, from childhood to old age." Depression can occur at any age. Children, adolescents, adults, and the elderly may all experience depression.

Tardive dyskinesia (TD)

potentially disabling motor disorder that may occur following regular use of antipsychotic drugs

Which statements are associated directly with Beck's cognitive triad?

"I'm not worth much; I can't do anything right." "Things will only get worse; they never get better." "I'll never find anyone who loves or values me." Three assumptions constitute Beck's cognitive triad: (1) a negative, self-deprecating view of self; (2) a pessimistic view of the world; and (3) the belief that negative reinforcement (or no validation for the self) will continue in the future. Statements such as "I don't think other people are worthless" and "Good luck happens to good people" lack the negative assumptions associated with the cognitive triad.

A patient has been taking citalopram for two years for depression. The patient's outcomes have been achieved and the patient wants to discontinue the medication. Which information should the nurse provide?

"It's important for you to gradually stop taking this drug over two to four weeks." Selective serotonin reuptake inhibitors (SSRIs) should be tapered off gradually over a period of two to four weeks to avoid a withdrawal syndrome. Symptoms of the withdrawal syndrome include headache, gastrointestinal upset, dizziness, insomnia, anxiety, and flulike symptoms. Serotonin syndrome is a potentially life-threatening consequence of drug interactions with SSRIs.

A nurse is caring for a patient with severe depression. After 4 months of treatment, the nurse tells the patient, "Depression is an illness that is beyond a person's voluntary control." In which phase of treatment is this an appropriate statement by the nurse?

Continuation Phase There are three phases of treatment for depression: the acute phase, the continuation phase, and the maintenance phase. After 4 to 9 months of treatment patients are in the continuation phase, during which they are educated about depression in hopes that they will better adhere to the treatment plan and avoid relapse. Explaining depression is beyond a person's control is an example of this teaching. The other stages of treatment have different goals, such as the acute phase (the initial 12 weeks) in which the patient is given interventions to simply reduce symptoms of depression. After 1 year of treatment, patients are typically in the maintenance phase, where they may already be well educated about depression and the treatment focuses on avoiding further complications due to relapse of the illness. The orientation phase is not one of the three phases of the treatment. It is a part of the group development phase in which patients are encouraged to interact with each other.

A young adult patient reports to the nurse that her premenstrual symptoms have worsened. She has read about premenstrual dysphoric disorder (PMDD) and thinks she may have the condition. Which statement about the disorder is true?

Fluoxetine is one potential treatment option. Fluoxetine can be used to treat PMDD. PMDD does not necessarily mean a patient will always have severe depression. The disorder can manifest as long as a woman is menstruating, including during the postnatal period. Symptoms generally decrease after menopause unless the patient receives hormone replacement therapy.

A patient diagnosed with depression begins a new prescription for phenelzine. Which food is safe for this patient to consume?

Fresh Fish Phenelzine is a monoamine oxidase inhibitor antidepressant medication. It is important to avoid foods high in tyramines. Fresh fish is safe. Pepperoni and chocolate are foods high in tyramines, which may cause a hypertensive crisis. Guacamole is made from avocados.

A patient who has been assessed by the nurse as moderately depressed is given a prescription for daily doses of a selective serotonin reuptake inhibitor. The patient mentions that he or she will take the medication along with the St. John's wort he or she uses daily. The nurse should

Explain the high possibility of an adverse reaction Serotonin malignant syndrome is a possibility if St. John's wort is taken with other antidepressants.

What is the recommended starting dose of selective serotonin reuptake inhibitors in geriatric patients with depression?

Half the lowest adult dose Geriatric patients with depression must be prescribed selective serotonin reuptake inhibitors as a first line treatment. They must be administered half the lowest adult dose to avoid adverse effects due to drug accumulation. In geriatric patients the concentration of these drugs in the blood is high due to low glomerular filtration rate and reduced clearance of the drug. This is caused by impaired renal function, which can be caused by polypharmacy. The lowest adult dose, normal adult dose, and half the normal adult should not be administered to geriatric patients. These doses would cause severe toxic effects in geriatric patients.

A nurse is teaching a group of nursing students about antidepressants that act by increasing the availability time of noradrenaline and serotonin at the postsynaptic receptors. Which medication would you expect to see prescribed?

Imipramine Imipramine belongs to the class of tricyclic antidepressants that act by increasing the availability time of noradrenaline and serotonin at the postsynaptic receptors. An increase in the serotonin and norepinephrine levels can cause mood elevation. Bupropion belongs to norepinephrine dopamine reuptake inhibitors. It blocks the synaptic reuptake of norepinephrine and dopamine. Vilazodone is a selective serotonin reuptake inhibitor and serotonin receptor agonist. It acts by blocking the synaptic reuptake of serotonin and activated serotonin receptors. Sertraline is a selective serotonin reuptake inhibitor. It blocks the synaptic reuptake of serotonin.

A depressed patient tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can identify this cognitive distortion as an example of

Learned helplessness Learned helplessness results in depression when the patient feels no control over the outcome of a situation.

The nurse cares for an adult who repeatedly says, "My dead relatives try to talk to me and penetrate my body." This comment is most associated with which of the following disorders?

Major depressive disorder with psychosis Depressive disorders are classified according to symptoms or the situations under which they occur. During a major depressive episode, the person's ability to think clearly is negatively affected and evidence of delusional thinking may be seen. Delusional thinking is an aspect of psychosis. Seasonal affective disorder is characterized by marked seasonal differences in mood associated with decreased daylight. Substance-induced depressive disorder applies when symptoms of a major depressive episode arise in association with drug or alcohol intoxication or withdrawal. Disruptive mood dysregulation disorder relates to children and refers to situations in which a person has frequent temper tantrums, resulting in verbal or behavioral outbursts out of proportion to the situation.

Which food is safe for a patient taking monoamine oxidase inhibitors (MAOIs)?

Pineapple Patients taking MAOIs must avoid foods containing tyramine. Most fruits, like pineapple, are safe to eat while taking MAOIs, as they have low levels of tyramine. Avocados, especially overripe ones, are high in tyramine. Almost all dairy products like cheddar cheese contain tyramine. Chocolate is also a food to avoid.

What is the nurse's priority focused assessment for side effects in a child taking methylphenidate (Ritalin) for attention deficit hyperactivity disorder (ADHD)?

Sleep disturbances and weight loss

A desired outcome for a 12-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) is to improve relationships with other children. Which treatment modality should the nurse suggest for the plan of care?

Social Skills Group

What is the major reason for hospitalization for depressed patients?

Suicidal Ideation Suicidal thoughts are a major reason for hospitalization for patients with major depression. It is imperative to intervene with such patients to keep them safe from self-harm. Inability to go to work, loss of appetite, and psychomotor agitation describe symptoms of major depression but are not by themselves the major reason for hospitalization.

A patient who had undergone a hysterectomy has low self-esteem and avoids taking food. Which appropriate method does the nurse choose to reduce anorexia?

The nurse allows family members to remain with the patient during meals. Low self-esteem and reduced food intake are symptoms of depression. Patients can be encouraged to take food in the presence of their family members as it increases their self-esteem. Taking food rich in fiber helps reduce constipation. Small amounts of high-calorie and high-protein food should be given frequently to meet the patient's nutritional demands. The patient must not be given tea or coffee frequently as they cause insomnia.

A nurse caring for a patient with depression instructs the patient to rest after group activity. The nurse provides warm milk to the patient in the morning and at night. What change does the nurse find in the patient after implementation of this these interventions?

The patient sleeps properly. Depressive patients often have insomnia. The nurse should ensure that patients rest adequately after group activity. This helps to reduce fatigue, which can intensify the symptoms of depression. The patient can be given warm milk at night to induce sleep. Encouraging the patient to interact with the nurse or practice good hygiene or improving the patient's appetite may be treatment goals but they are not directly related to the nurse's intervention with warm milk.

A depressed male patient tells the nurse he is in the 'acute phase' of his treatment for depression. The nurse recognizes that the client has been in treatment

To reduce depressive symptoms The acute phase of depression therapy (6-12 weeks) is directed toward the reduction of symptoms and restoration of psychosocial and work function and may require some hospitalization.

Stereotypic Movement Disorder

a disorder in which the individual voluntarily repeats nonfunctional behaviors, such as rocking or head banging, that can be damaging to his or her physical well-being

toxic lithium levels

above 1.5 mEq/L

Lithium toxicity symptoms

acute: GI disturbances: nausea, vomiting, diarrhea neuro finding can occur later chronic- neurologic ataxia, confusion, tremors

Tourette's Disorder

developmental disorder featuring multiple dysfunctional motor and vocal tics

Bipolar 1

full manic and major depressive episodes

Seratonin syndrome

may start 2-72 hours after- can be LETHAL confusion, fever, agitation, anxiety, hallucination, hyperflexia, diaphoresis, tremors, hypertension

MAOIs

monoamine oxidase inhibitors; increase serotonin and norepinephrine at the synaptic cleft by inhibiting the enzyme monoamine oxidase which breaks down serotonin and NE--less enzyme, more neurotransmitter, less depression; dangerous; parnate, nardil, marplan; dry mouth, blurred vision, urinary retention, orthostatic hypotension--no tyramines (cheese, wine, etc): could produce hypertensive crisis