Psych Test 1

Third generation antipsychotics (dopamine system stabilizers)

control of symptoms without some of the side effects of other antipsychotic medications

Right hemisphere

controls the left side of the body and is the center for creative thinking, intuition, and artistic abilities

Frontal lobe

controls the organization of thought, body movement, memories, emotions, and moral behavior. decision making. Abnormalities in the frontal lobes are associated with schizophrenia, attention deficit hyperactivity disorder (ADHD), and dementia.

Left hemisphere

controls the right side of the body and is the center for logical reasoning and analytic functions such as reading, writing, and mathematical tasks

Occipital lobe

coordinating language generation and visual interpretation, such as depth perception

Kleptomania

impulsive, repetitive theft of items not needed by the person, either for personal use or monetary gain. Tension and anxiety are high prior to the theft, and the person feels relief, exhilaration, or gratification while committing the theft. The item is often discarded after it is stolen. Kleptomania is more common in females

Brain Stem

includes the midbrain, pons, and medulla oblongata and the nuclei for cranial nerves III through XII. *medulla* contains vital centers for respiration and cardiovascular functions. the *pons* relays messages - primary motor pathway. *midbrain* connects the pons and the cerebellum with the cerebrum and includes most of the reticular activating system and the extrapyramidal system.

Limbic System

includes the thalamus, hypothalamus, hippocampus, and amygdala. *thalamus* regulates activity, sensation, and emotion. *hypothalamus* is involved in temperature regulation, appetite control, endocrine function, sexual drive, and impulsive behavior associated with feelings of anger, rage, or excitement. *hippocampus and amygdala* are involved in emotional arousal and memory. Disturbances in the limbic system can cause the memory loss that accompanies dementia and the poorly controlled emotions and impulses seen with psychotic or manic behavior.

NMS

major symptoms of NMS are *rigidity*; high fever; autonomic instability such as unstable blood pressure, diaphoresis, and pallor; delirium; and elevated levels of enzymes, particularly creatine phosphokinase. Clients with NMS usually are confused and often mute; they may fluctuate from agitation to stupor. most often occurs in the first 2 weeks of therapy or after an increase in dosage, but it can occur at any time. Not reversible first generation meds

Thought Content

what the client actually says. The nurse assesses whether or not the client's verbalizations make sense: that is, if ideas are related and flow logically from one to the next

Freud

"Repressed sexual impulses and desires motivate human behavior." Behavior can be explained and is influenced by subconscious. - Id: basic/primal desires. pleasure-seeking behavior, aggression, and sexual desire. "devil" - Superego: moral and ethical concepts, values, and parental and social expectations. direct opposite of the ID. "angel" - Ego: balancing or mediating force between the ID and superego. Represents mature and adaptive behavior that allows a person to function successfully. - Five Stages of Psychosexual Development: - Oral: Birth to 18 months.; fixation with mouth; sucking, swallowing, biting - Anal: 18 to 36 months. ; fixation on anus, toileting - Phallic: 3 - 5 years.; fixation on penis, females= penis envy. oedipal complex - Latency: 5 - 11 years.; sexual interests suppressed. oedipal complex stops. sexual urges into school and sports - Genital: intimate relationships; sexual desires become conscious rather than suppressed Ego Defense Mechanisms

Epinephrine

*excitatory*, controls the fight-or-flight response in the peripheral nervous system. increased heart rate, sweating, lack of digestion, etc

Dopamine

*excitatory*, located primarily in the brain stem. complex movements, motivation, cognition, and regulation of emotional responses. implicated in schizophrenia (too much) and other psychoses as well as Parkinson's disease. *PERSON IS EXPRESSING NEGATIVE SYMPTOMS OF SCHIZOPHRENIA, WHICH NEUROTRANSMITTER CAUSES THIS? DOPAMINE*

Norepinephrine

*excitatory*, most prevalent neurotransmitter in the nervous system. plays a role in changes in attention, learning and memory, sleep and wakefulness, and mood regulation. implicated in several anxiety disorders; deficits may contribute to memory loss, social withdrawal, and depression. (noradrenaline) ADHD meds

Serotonin

*inhibitory*, involved in the control of food intake, sleep and wakefulness, temperature regulation, pain control, sexual behavior, and regulation of emotions. MOOOOOD.

GABA

*inhibitory*, modulates other neurotransmitters. amino acid. major inhibitory neurotransmitter in the brain. Drugs that increase GABA function, such as benzodiazepines, are used to treat anxiety and to induce sleep.

Acetylcholine

*excitatory or inhibitory*, has been found to affect the sleep-wake cycle and to signal muscles to become active. people with Alzheimer's disease have decreased acetylcholine-secreting neurons, and people with myasthenia graves have reduced acetylcholine receptors.

Glutamate

*excitatory*, amino acid that at high levels can have major neurotoxic effects. implicated in the brain damage caused by stroke, hypoglycemia, sustained hypoxia or ischemia, and some degenerative diseases such as Huntington's or Alzheimer's.

Principles that Guide Pharmacologic Treatment

- A medication is selected based on its effect on the client's target symptoms such as delusional thinking - Many psychotropic drugs must be given in adequate dosages for some time before their full effect is realized (TCAs = 4-6 weeks) - The dosage of medication often is adjusted to the lowest effective dosage for the client - lder adults require lower dosages of medications than do younger clients to experience therapeutic effects. It also may take longer for a drug to achieve its full therapeutic effect in older adults - Psychotropic medications often are decreased gradually (tapering) rather than abruptly. This is because of potential problems with *rebound* (temporary return of symptoms), recurrence (of the original symptoms), or *withdrawal* (new symptoms resulting from discontinuation of the drug) - Follow-up care is essential - Compliance with the medication regimen often is enhanced when the regimen is as simple as possible

Terms related to thought process and content

- Circumstantial thinking: a client eventually answers a question but only after giving excessive unnecessary detail - Delusion: a fixed false belief not based in reality - Flight of ideas: excessive amount and rate of speech composed of fragmented or unrelated ideas - Ideas of reference: client's inaccurate interpretation that general events are personally directed to him or her, such as hearing a speech on the news and believing the message had personal meaning - Loose associations: disorganized thinking that jumps from one idea to another with little or no evident relation between the thoughts - Tangential thinking: wandering off the topic and never providing the information requested - Thought blocking: stopping abruptly in the middle of a sentence or train of thought; sometimes unable to continue the idea - Thought broadcasting: a delusional belief that others can hear or know what the client is thinking - Thought insertion: a delusional belief that others are putting ideas or thoughts into the client's head—that is, the ideas are not those of the client - Thought withdrawal: a delusional belief that others are taking the client's thoughts away and the client is powerless to stop it - Word salad: flow of unconnected words that convey no meaning to the listener

Motor Skills Disorders

- Developmental Coordination Disorder: impaired coordination severe enough to interfere with academic achievement or activities of daily living, not due to general medical condition such as MD. often coexists with a communication disorder. - Stereotypic movement disorder: rhythmic, repetitive behaviors, such as hand waving, rocking, head banging, biting, that appears to have no purpose. Self-inflicted injuries are common, and the pain is not a deterrent to the behavior. Onset prior to 3 years, and usually persists into adolescence. It is more common in persons with intellectual disability

Elimination Disorders

- Encopresis: repeated passage of feces into inappropriate places such as clothing or the floor by a child who is at least 4 years of age. Involuntary encopresis usually is associated with constipation that occurs for psychological, not medical, reasons. Intentional encopresis often is associated with oppositional defiant disorder (ODD) or conduct disorder. - Enuresis is the repeated voiding of urine during the day or at night into clothing or bed by a child at least 5 years of age. Most often enuresis is involuntary; when intentional, it is associated with a disruptive behavior disorder. Runs in families. More common in boys.

Levels of Anxiety

- Mild: Wide perceptual field, sharpened senses, increased motivation, effective problem solving, increased learning ability, irritability. Restlessness, fidgeting, GI "butterflies", difficulty sleeping, hypersensitivity to noise. - Moderate: Perceptual field narrowed to immediate task, Selectively attentive, Cannot connect thoughts or events independently, Increased use of automatisms. Muscle tension, Diaphoresis, Pounding pulse, Headache, Dry mouth, High voice pitch, Faster rate of speech, GI upset, Frequent urination. - Severe: Perceptual field reduced to one detail or scattered details, Cannot complete tasks, Cannot solve problems or learn effectively, Behavior geared toward anxiety relief and is usually ineffective, Doesn't respond to redirection, Feels awe, dread, or horror, Cries, Ritualistic behavior. Severe headache, Nausea, vomiting, and diarrhea, Trembling, Rigid stance, Vertigo, Pale, Tachycardia, Chest pain. - Panic: Perceptual field reduced to focus on self, Cannot process any environmental stimuli, Distorted perceptions, Loss of rational thought, Doesn't recognize potential danger, Can't communicate verbally, Possible delusions and hallucination, May be suicidal. May bolt and run Or Totally immobile and mute, Dilated pupils, Increased blood pressure and pulse, Flight, fight, or freeze.

Yellow Box Warnings

- Nefazodone = liver failure - Bupropion = can cause seizures - Lamotrigine = serious rashes, SJS - Lithium = toxicity: nausea, diarrhea - Valproic Acid = liver failure (fatal) - Carbamazepine = aplastic anemia, agranulocytosis - Amphetamines = potential for abuse is high - Methylphenidate (ritalin) = caution for the emotionally unstable such as those with alcohol or drug dependence since they may increase dosage, take after meals - Pemoline = life threatening liver failure - Disulfiram = don't drink on this (this medication is used to treat alcoholism; when taken with alcohol, severe vomiting is caused) - Droperidol, Thioridazine, Mesoridazine = QT interval lengthen, cardiac issues - Clozapine= check WBC (risk for agranulocytosis)

Maslow's Hierarchy of Needs

- Physiological: the need for food, sleep, water, air, and sex - Security: the need for safety, family, stability, and economic security - Love and belonging: the need to belong, to interact with others, to have friends, and to love and be loved - Esteem: the need for respect and recognition of others - Self-actualization: the need to realize one's potential, to grow, to be creative, and to accomplish

Autism Spectrum Disorder

- Rett's disorder, Childhood Disintegrative disorder, Asperger's - almost five times more prevalent in boys than in girls, and it is identified usually by 18 months and no later than 3 years of age - little eye contact with and make few facial expressions toward others; they use limited gestures to communicate. They can have limited capacity to relate to peers or parents. They may lack spontaneous enjoyment, express no moods or emotional affect, and may not engage in play - There can be little intelligible speech. These children engage in stereotyped motor behaviors such as hand flapping, body twisting, or head banging - genetic link, no relation with vaccines - The goals of treatment of children with autism are to reduce behavioral symptoms (e.g., stereotyped motor behaviors) and to promote learning and development, particularly the acquisition of language skills - antipsychotic medications, may be effective for specific target symptoms such as temper tantrums, aggressiveness, self-injury, hyperactivity, and stereotyped behaviors

Communication Disorders

- diagnosed when a communication deficit is severe enough to hinder development, academic achievement, or activities of daily living, including socialization - Expressive language disorder - impaired ability to communicate through verbal and sign languages - Mixed receptive-expressive language disorder includes the problems of expressive language disorder along with difficulty understanding (receiving) and determining the meaning of words and sentences - Phonologic disorder involves problems with articulation (forming sounds that are part of speech) - Stuttering is a disturbance of the normal fluency and time patterning of speech. Phonologic disorder and stuttering run in families and occur more frequently in boys than in girls. Can be present at birth or acquired from injury to brain.

Assessment of Suicide

- The nurse must determine whether the depressed or hopeless client has suicidal ideation or a lethal plan. The nurse does so by asking the client directly, "Do you have thoughts of suicide?" or "What thoughts of suicide have you had?" - Ideation: "Are you thinking about killing yourself?" - Plan: "Do you have a plan to kill yourself?" - Method: "How do you plan to kill yourself?" - Access: "How would you carry out this plan? Do you have access to the means to carry out the plan?" - Where: "Where would you kill yourself?" - When: "When do you plan to kill yourself?" - Timing: "What day or time of day do you plan to kill yourself?"

Erikson's Psychosocial Stages

- Trust VS. Mistrust (Infant). Virtue: Hope. Viewing the world as safe and reliable; relationships are seen as nurturing, stable, and dependable. - Autonomy VS. Shame and Doubt (Toddler). Virtue: Will. Achieving a sense of control and free will. - Initiative VS, Guilt (Preschool). Virtue: Purpose. Beginning development of a conscience; learning to manage conflict and anxiety. - Industry VS. Inferiority (School-age). Virtue: Competence. Emerging confidence in own abilities; taking pleasure in accomplishments. - Identity VS. Role Confusion (Adolescence). Virtue: Fidelity. Formulating a sense of self and belonging. - Intimacy VS. Isolation (Young Adult) Virtue: Love. Forming adult, loving relationships and meaningful attachments to others. - Generativity VS. Stagnation ("Midlife Crisis"). Virtue: Care. Being creative and productive; establishing the next generation. - Ego Integrity VS. Despair (Maturity, Older Adult). Virtue: Wisdom. Accepting responsibility for one's self and life accomplishments.

Intellectual Disability

- below average intellectual functioning - IQ LESS THAN 70 (taken before age 18) - Mild: IQ 50-70 - Moderate: IQ 35-50 - Severe: IQ 20-35 - Profound: IQ less than 20 - limitations in: communication, self care, social skills, work, leisure, health and safety - caused by: hereditary, maternal alcohol intake, perinatal problems and infant medical problems, and environmental influences ----- Hereditary Maternal alcohol intake Environmental influences (lead paint, rusty pipes, etc.) Usually accompanied by: self care deficits, impaired communication, home living issues

Learning Disorders

- diagnosed when a child's achievement in reading, mathematics, or written expression is below that expected for age, formal education, and intelligence - Reading and written expression disorders usually are identified in the first grade; math disorder may go undetected until the child reaches fifth grade - Low self-esteem and poor social skills are common - Early identification of the learning disorder, effective intervention, and no coexisting problems is associated with better outcomes -Dyslexia: have difficulty with reading Dyscalculia: have problem with mathematics and computation Dyspraxia: have problems with manual dexterity and coordination Dysgraphia: have problems producing written word

Additional Side Effects of Antipsychotics

- increase blood prolactin levels - may cause breast enlargement and tenderness in men and women; diminished libido, erectile and orgasmic dysfunction, and menstrual irregularities; and increased risk for breast cancer; and may contribute to weight gain. Weight gain can accompany most antipsychotic medications, most likely with the second-generation antipsychotic drugs (hyperglycemia and diabetes). - prolonged QT interval - Though rare, the lengthened QT interval can cause torsade de pointes, a rapid heart rhythm of 150 to 250 beats/minute - agranulocytosis (clozapine) develops suddenly and is characterized by fever, malaise, ulcerative sore throat, and leukopenia. This side effect may not be manifested immediately and can occur up to 24 weeks after the initiation of therapy - WBC test are needed

Tourette's Disorder

- multiple motor tics and one or more vocal tics, which occur many times a day for more than 1 year - person has significant impairment in academic, social, or occupational areas and feels ashamed and self-conscious - rare disorder (4 or 5 in 10,000), more common in boys and is usually identified by 7 years of age *MOTOR AND VOCAL*

Tic Disorder

- sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization - Stress exacerbates tics, which diminish during sleep and when the person is engaged in an absorbing activity - Common simple motor tics = blinking, jerking the neck, shrugging the shoulders, grimacing, and coughing - Common simple vocal tics = clearing the throat, grunting, sniffing, snorting, and barking - Complex vocal tics include repeating words or phrases out of context, *coprolalia* (use of socially unacceptable words, frequently obscene), *palilalia* (repeating one's own sounds or words), and *echolalia* (repeating the last-heard sound, word, or phrase) - tend to run in families - Abnormal transmission of dopamine is thought to play a part in tic disorders - treated with atypical antipsychotics - important for clients with tic disorders to get plenty of rest and to manage stress because fatigue and stress increase symptoms

Groups of antidepressants

1. Tricyclic and the related cyclic antidepressants 2. Selective serotonin reuptake inhibitors (SSRIs) 3. MAO inhibitors (MAOIs) 4. Other antidepressants such as desvenlafaxine (Pristiq), venlafaxine (Effexor), bupropion (Wellbutrin), duloxetine (Cymbalta), trazodone (Desyrel), and nefazodone (Serzone)

Metabolic Syndrome

2nd generation meds; cluster of conditions that increase the risk for heart disease, diabetes, and stroke. The syndrome is diagnosed when three or more of the following are present: Obesity Increased blood pressure High blood sugar level High cholesterol

Nursing Diagnosis

ADHD: ineffective role performance Conduct Disorder: ineffective coping

Neurotransmitters

chemical substances manufactured in the neuron that aid in the transmission of information throughout the body. They either excite or stimulate an action in the cells (excitatory) or inhibit or stop an action (inhibitory)

Medications for Alcohol Intoxication

Anxiolytic drugs - Benzodiazepines (do not consume alcohol while taking these; one dosage could be equivalent to three alcoholic drinks) - Alprazolam (xanax) - Diazepam (valium) - Lorazepam (ativan) - Disulfiram - Busiprone (BuSpar) (does not have the addictive effects of benzodiazepines; serotonin agonist)

Intentional Tort

Assault - threat Battery - physical wrongdoing False imprisonment - unlawful restraint

Off-Label Use

At times, a drug will prove effective for a disease that differs from the one involved in original testing and FDA approval. An example is some anticonvulsant drugs (approved to prevent seizures) that are prescribed for their effects in stabilizing the moods of clients with bipolar disorder (off-label use).

Externalizing vs. Internalizing Behaviors

EXTERNALIZING BEHAVIORS Lying Cheating at school Swearing Truancy Vandalism Setting fires Bragging Screaming Arguing Threatening Demanding Relentless teasing Anger outbursts INTERNALIZING BEHAVIORS Prefers to be alone Withdraws Sulks Won't talk Is secretive Overly shy Stares in lieu of verbal response Physically underactive Somatic aches and pains Dizziness Nausea, vomiting, stomach problems Fatigue, lethargy Lonely Guilt feelings Nervous Crying spells Feels worthless, unloved

A nurse is reviewing the process of neuronal transmission. The nurse demonstrates understanding of this concept by identifying which part of the neuron as carrying information into the neuron from other neurons?

Dendrite

Unintentional Tort

Malpractice: Failure by a health professional to meet accepted standards Negligence: careless neglect, often resulting in injury. something almost happened but it didn't; it's a near miss; unintentional

Client and Family Education for ADHD

Parents need to hear that neither they nor their child are at fault and that techniques and school programs are available to help. Children with ADHD qualify for special school services under the Individuals with Disabilities Education Act. Because raising a child with ADHD can be frustrating and exhausting, it often helps parents to attend support groups that can provide information and encouragement from other parents with the same problems. Parents must learn strategies to help their child improve his or her social and academic abilities, but they also must understand how to help rebuild their child's self-esteem. Parents should give positive comments as much as possible to encourage the child and acknowledge his or her strengths. One technique to help parents to achieve a good balance is to ask them to count the number of times they praise or criticize their child each day or for several days.

Meds (2) for ADHD

Stimulants: - Methylphenidate (Ritalin) - Monitor for appetite suppression or growth delays. - Sustained release (Ritalin-SR, Concerta, Metadate-CD) - Alert client that full drug effect takes 2 days. - Transdermal patch (Daytrana) - Wear patch for 9 hours—drug effects last 3 hours after removal. - Dextroamphetamine (Dexedrine) - Monitor for insomnia. - Sustained release (Dexedrine-SR) - Monitor for appetite suppression. Alert client that full drug effect takes 2 days. - Amphetamine (Adderall) - Same as dextroamphetamine - Sustained release (Adderall-XR) - Pemoline (Cylert) - Monitor for elevated liver function and appetite suppression. Alert client that drug may take 2 weeks for full effect. - Lisdexamfetamine (Vyvanse) - Same as dextroamphetamine Antidepressant (SNRI) Atomoxetine (Stratega) - Give with food. Monitor for appetite suppression. Use calorie-free beverages to relieve dry mouth. Monitor for elevated liver function. Antihypertensives - Clonidine (Kapvay) - Monitor for hypotension, dizziness, syncope, somnolence. Use calorie-free beverages to relieve dry mouth. - Guanfacine (Intuniv). Extended release. Same as clonidine

SSRIs

The SSRIs, first available in 1987 with the release of fluoxetine (Prozac), have replaced the cyclic drugs as the first choice in treating depression because they are equal in efficacy and produce fewer troublesome side effects. Prozac Weekly is the first and only medication that can be given once a week as maintenance therapy for depression after the client has been stabilized on fluoxetine. SSRIs, venlafaxine, nefazodone, and bupropion are often better choices for those who are potentially suicidal or highly impulsive because they carry no risk of lethal overdose

Medications for ADHD

The most common medications are methylphenidate (Ritalin) and an amphetamine compound (Adderall). Methylphenidate is effective in 70% to 80% of children with ADHD; it reduces hyperactivity, impulsivity, and mood lability and helps the child to pay attention more appropriately. Dextroamphetamine (Dexedrine) and pemoline (Cylert) are other stimulants used to treat ADHD. Methylphenidate is also available in a daily transdermal patch, marketed as Daytrana. Because pemoline can cause liver damage, it is the last of these drugs to be prescribed. Giving stimulants during daytime hours usually effectively combats insomnia. Eating a good breakfast with the morning dose and substantial nutritious snacks late in the day and at bedtime helps the child to maintain an adequate dietary intake. When stimulant medications are not effective or their side effects are intolerable, antidepressants are the second choice for treatment (see Chapter 2). Atomoxetine (Strattera) is the only nonstimulant drug specifically developed and tested by the U.S. Food and Drug Administration for treatment of ADHD (SNRI). Atomoxetine can cause liver damage, so individuals taking the drug need to have liver function tests periodically.

ADHD Medications

The primary stimulant drugs used to treat ADHD are methylphenidate (Ritalin), amphetamine (Adderall), and dextroamphetamine (Dexedrine). Pemoline (Cylert) is infrequently used for ADHD because of the potential for liver problems. Of these drugs, methylphenidate accounts for 90% of the stimulant medication given to children for ADHD. About 10% to 30% of clients with ADHD who do not respond adequately to the stimulant medications have been treated with antidepressants. In 2003, atomoxetine (Strattera), a selective norepinephrine reuptake inhibitor, was approved for the treatment of ADHD, becoming the first nonstimulant medication specifically designed and tested for ADHD. (PAGE 34). The most common side effects of stimulants are anorexia, weight loss, nausea, and irritability. The client should avoid caffeine, sugar, and chocolate, which may worsen these symptoms.

Histamine

chemical in brain. controls alertness, gastric secretions, cardiac stimulation, peripheral allergic responses

Black Box Warning

When a drug is found to have serious or life-threatening side effects, even if such side effects are rare, the FDA may issue a BBW. Medication package inserts must have a highlighted box, separate from the text, which contains a warning about the serious or life-threatening side effects

Tardive dyskinesia (TD)

a syndrome of permanent involuntary movements, is most commonly caused by the long-term use of conventional antipsychotic drugs. symptoms include involuntary movements of the tongue, facial and neck muscles, upper and lower extremities, and truncal musculature. Tongue thrusting and protruding, lip smacking, blinking, grimacing, and other excessive unnecessary facial movements are characteristic. After it has developed, TD is irreversible, although decreasing or discontinuing antipsychotic medications can arrest its progression

Disulfiram

agent's only use is as a deterrent to drinking alcohol in persons receiving treatment for alcoholism. Disulfiram inhibits the enzyme aldehyde dehydrogenase, which is involved in the metabolism of ethanol. shaving cream, aftershave lotion, cologne, and deodorant and OTC medications such as cough preparations contain alcohol; when used by the client taking disulfiram, these products can produce the same reaction as drinking alcohol. Other side effects reported by persons taking disulfiram include fatigue, drowsiness, halitosis, tremor, and impotence. Disulfiram also can interfere with the metabolism of other drugs the client is taking, such as phenytoin (Dilantin), isoniazid, warfarin (Coumadin), barbiturates, and long-acting benzodiazepines such as diazepam and chlordiazepoxide

Serotonin Syndrome

can result from taking an MAOI and an SSRI at the same time. It also can occur if the client takes one of these drugs too close to the end of therapy with the other. Symptoms include agitation, sweating, fever, tachycardia, hypotension, rigidity, hyperreflexia, and, in extreme reactions, even coma and death

Cerebellum

center for coordination of movements and postural adjustments. receives and integrates information from all areas of the body, such as the muscles, joints, organs. low dopamine here is associated with the lack of smooth coordinated movements in diseases such as Parkinson's disease and dementia.

Temporal lobe

center for the senses of smell and hearing and for memory and emotional expression

The brain consists of the

cerebrum, cerebellum, brainstem, limbic system

ADHD

characterized by inattentiveness, overactivity, and impulsiveness. Essential to have a thorough and accurate diagnosis. Other disorders and situations may look similar to ADHD, such as bipolar disorder or behavioral acting out in response to family stress, such as divorce, parental mental disorders, etc. Key feature of ADHD is the consistency of the child's behavior—every day, in almost all situations, and with almost all caregivers, the child demonstrates the problematic behaviors. usually identified and diagnosed when the child begins preschool or school. fidgeting, makes excessive noise by tapping or playing with pencils or other objects. Normal environmental noises, such as someone coughing, distract the child. He or she cannot listen to directions or complete tasks. Studies have shown that both teachers and peers perceive children with ADHD as more aggressive, more bossy, and less likable. definitive causes of ADHD remain unknown. There may be cortical-arousal, information-processing, or maturational abnormalities in the brain. Combined factors, such as environmental toxins, prenatal influences, heredity, and damage to brain structure and functions, are likely responsible. Prenatal exposure to alcohol, tobacco, and lead and severe malnutrition in early childhood increase the likelihood of ADHD. Brain images of people with ADHD suggest decreased metabolism in the frontal lobes. Having a first-degree relative with ADHD increases the risk of the disorder by four to five times more than that of the general population. No one treatment has been found to be effective for ADHD. The most effective treatment combines pharmacotherapy with behavioral, psychosocial, and educational interventions. *ineffective role performance*

Tarasoff v. Regents of the University of California

duty to warn

Conventional Antipsychotics (first generation, typical)

effective in treating target symptoms but also produces many extrapyramidal side effects

Antipsychotic drugs

formerly known as neuroleptics, are used to treat the symptoms of psychosis. work by blocking receptors of the neurotransmitter dopamine

Cerebral lobes

frontal, parietal, temporal, and occipital

Asseessment of Harm Toward Others

if the client is angry, hostile, or making threatening remarks about a family member, spouse, or anyone else, the nurse must ask whether the client has thoughts or plans about hurting that person. The nurse does so by questioning the client directly: - What thoughts have you had about hurting (person's name)? - What is your plan? - What do you want to do to (person's name)? - When a client makes specific threats or has a plan to harm another person, health care providers are legally obligated to warn the person who is the target of the threats or plan. The legal term for this is duty to warn.

Parietal lobe

interprets sensations of taste and touch and assist in spatial orientation

M'Naghten Rule

not criminally responsible

Anticholinergic Side Effects

often occur with the use of antipsychotics and include orthostatic hypotension, dry mouth, constipation, urinary hesitance or retention, blurred near vision, dry eyes, photophobia, nasal congestion, and decreased memory. These side effects usually decrease within 3 to 4 weeks but do not entirely remit

Beneficence

one's duty to benefit or to promote the good of others

Conduct Disorder

persistent behavior that violates societal norms, rules, laws, and the rights of others. These children and adolescents have significantly impaired abilities to function in social, academic, or occupational areas. They have little empathy for others, do not feel "bad" or guilty or show remorse for their behavior, have shallow or superficial emotions, and are unconcerned about poor performance at school or home. Onset of conduct disorder behaviors before age 10 occurs primarily in boys; onset after age 10 occurs in girls and boys. As many as 30% to 50% of these children are diagnosed with antisocial personality disorder as adults. The childhood-onset type involves symptoms before 10 years. Adolescent-onset type is defined by no behaviors of conduct disorder until after 10 years of age. genetic vulnerability, environmental adversity, and factors like poor coping interact to cause the disorder. Risk factors include poor parenting, low academic achievement, poor peer relationships, and low self-esteem.

Autonomy

person's right to self-determination and independence

Thought Process

refers to how the client thinks. The nurse can infer a client's thought process from speech and speech patterns

Second generation (atypical) antipsychotics

relatively weak blockers of D2, which may account for the lower incidence of extrapyramidal side effects

Intermittent Explosive Disorder

repeated episodes of impulsive, aggressive, violent behavior and angry verbal outbursts, usually lasting less than 30 minutes. intensity of the emotional outburst is grossly out of proportion to the stressor or situation. Afterward, the individual may be embarrassed and feel guilty or remorseful for his or her actions. But that does not prevent future impulsive, aggressive outbursts. Intermittent explosive disorder is related to childhood exposure to trauma, neglect, or maltreatment. diagnosed after 18. more common in males. serotonin imbalance. mood stabilizing anticonvulsants are last resorts. SSRIs. cognitive behavioral therapy, anger management. no alcohol or drug use.

Pyromania

repeated, intentional fire-setting. The person is fascinated about fire, and feels pleasure or relief of tension while setting and watching the fires. There is neither any monetary gain or revenge or other reason, such as concealing other crimes, for fire-setting, nor is it associated with another major mental disorder

Nonmaleficence

requirement to do no harm to others either intentionally or unintentionally

Rogers VS. Orkin

right to refuse treatment

Wyatt VS. Stickney

right to treatment

EPS

serious neurologic symptoms. They include acute dystonia (muscle rigidity), pseudoparkinsonism (drug induced, mostly reversible), and akathisia. Although often collectively referred to as EPS, each of these reactions has distinct features.. First-generation antipsychotic drugs cause a greater incidence of EPS than do second-generation antipsychotic drugs. Therapies for acute dystonia, pseudoparkinsonism, and akathisia are similar and include lowering the dosage of the antipsychotic, changing to a different antipsychotic, or administering anticholinergic medication. Dystonia is most likely to occur in the first week of treatment, in clients younger than 40 years, in males, and in those receiving high-potency drugs such as haloperidol and thiothixene. Spasms or stiffness in muscle groups can produce torticollis (twisted head and neck), opisthotonus (tightness in the entire body with the head back and an arched neck), or oculogyric crisis (eyes rolled back in a locked position). Akathisia is reported by the client as an intense need to move about. The client appears restless or anxious and agitated, often with a rigid posture or gait and a lack of spontaneous gestures. Reversible

Half Life

the time it takes for half of the drug to be removed from the bloodstream. Drugs with a shorter half-life may need to be given three or four times a day, but drugs with a longer half-life may be given once a day

ODD

uncooperative, defiant, disobedient, and hostile behavior toward authority figures without major antisocial violations. occurs more often in males; however, ODD in female adolescents has increased in recent years. Most authorities believe that genes, temperament, and adverse social conditions interact to create ODD. Children with ODD have limited abilities to make associations between their behavior and consequences of behavior. Early onset, more severe symptoms, and comorbid conditions are associated with poorer long-term outcomes. Genetic. Children with this disorder can develop conduct disorder; some will be diagnosed with antisocial personality disorder as adults. Treatment for ODD is based on parent management training models of behavioral interventions. Parents learn to ignore maladaptive behaviors rather than giving the behaviors negative attention, positive behaviors are rewarded with praise and reinforcers.

Antianxiety drugs, (anxiolytic drugs)

used to treat anxiety and anxiety disorders, insomnia, OCD, depression, posttraumatic stress disorder, and alcohol withdrawal. Benzodiazepines and Buspirone. Benzodiazepines mediate the actions of the amino acid GABA, the major inhibitory neurotransmitter in the brain. Benzodiazepines strongly potentiate the effects of alcohol: One drink may have the effect of three drinks

Mood stabilizing drugs

used to treat bipolar disorder by stabilizing the client's mood, preventing or minimizing the highs and lows that characterize bipolar illness, and treating acute episodes of mania. Lithium is the most established mood stabilizer