mental health quiz 2

maintenance phase of bipolar disorder

increased ability function treatment generally continues throughout the patient's lifetime goal: prevention of future manic episode

DSM-5 psychoactive substances

- alcohol - caffeine - cannabis - hallucinogens - inhalants - opioids - sedative, hypnotic, anti anxiety meds - stimulants - tobacco

central nervous system depressants

- alcohol - sedatives/hypnotics/anxiolytics - cannabis

depressive disorder - expected findings

- anergia (lack of energy) - anhedonia (lack of pleasure in normal activities) - anxiety - reports sluggishness or feeling unalbe to relax/sit still - vegetative findings - change in eating patterns (anorexia in MDD), increase intake in PDD or PMDD, change in bowel habits (constipation), sleep disturbances, decreased interest in sexual activity, somatic reports such as fatigue, GI changes, pain physical findings: often looks sad with blunted affect, exhibits poor grooming and lack of hygiene, psychomotor retardation (slowed physical movement, slumped posture), psychomotor agitation (restlessness, pacing, finger tapping), socially isolated, showing little or no effort to interact, slowed speech, decreased verbalization, delayed response, might seem too tired to speak and sighs often

bipolar 2 comorbidity

- anxiety disorders - 75% - before the hypomania and depressive symptom - associated with depressive side - eating disorders, specifically binge eating - 14% - associated with depressive side - substance use disorders - 37% - associated with hypomanic side

bipolar 1 comorbidity

- anxiety disorders - 75% - may experience panic attacks, social anxiety disorder and specific phobias - attention-deficit/hyperactivity disorder, disruptive, impulse-control or conduct disorders - substance use disorder - more than 50% - alcohol use disorder - more than 50% - migraines - metabolic syndrome - includes high blood pressure, high blood glucose, excess body fat around the waist, abnormal cholesterol levels, may lead to premature death due to heart disease, stroke and diabetes

psychosocial interventions for alcohol use disorder

- promoting safety and sleep are essential first-line interventions - gradually re-introducing healthy food and hydration helps support body systems and neurological functioning (many have severely compromised nutritional status due to choosing substance over sustenance) - self-care hygiene will improve self esteem in those who have neglected themselves - development of therapeutic relationship sets the sage for exploring harmful thoughts, anxiety, hopelessness and spiritual distress - understanding current coping skills and identification and testing of new coping skills in a safe space - assistance in goal setting

nursing care for suicide

- assess carefully for verbal and nonverbal clues - suicidal comments usually are made to someone that the patient perceives as supportive - overt (direct) or covert (indirect) comments - assess for potential suicide risk using SAD PERSONS scale - assess patients suicide plan: does the patient have a plan, how lethal is the plan, can the patient describe the plan exactly, does the patient have access to intended method, has the patient's mood changed? sudden change from sad/depressed to happy/peaceful _____ primary intervention: focus on suicide prevention through the use of community education and screenings to identify individuals at risk secondary intervention: focus on suicide prevention for an individual who is having an acute suicidal crisis, suicide precautions are used at this level tertiary intervention: focus on providing support and assistance to survivors of a patient who completed suicide

alternations in speech

- associative looseness - neologisms - echolalia - clang associations - word salad

types of bipolar disorder

- bipolar disorder 1 - bipolar disorder 2 - cyclothymic disorder

central nervous system stimulants

- cocaine - amphetamines - inhalants - hallucinogens - caffeine

individual psychotherapies for substance use/addictive disorders

- cognitive behavioral therapies such as relaxation techniques or cognitive reframing, can be used to decrease anxiety and change behavior - acceptance and commitment therapy (ACT) promotes acceptance of the client's experiences and promotes client commitment to positive behavior changes - relapse prevention therapy assists clients in identifying the potential for relapse and promotes behavioral self-control

depressive disorder - health teaching/health promotion

- depression is an illness beyond a person's voluntary control - although beyond voluntary control, can be managed through medication and lifestyle - chronic illness management depends in large part on understanding personal signs and symptoms of relapse - illness management depends on understand the role of meds and possible med side effects - long term management works best if the patient receives psychotherapy along with med - identifying and coping with the stress of interpersonal relationships is key to stable illness management - increasing family's understanding and acceptance of the family member with depression during the aftercare period - increase the patients use of aftercare facilities in the community - contributing to higher overall adjustment in the patient after discharge

cognitive findings of psychotic disorders

- disordered thinking - inability to make decisions - poor problem-solving ability - difficulty concentrating to perform tasks - short term memory deficits - impaired abstract thinking

alterations in behavior

- extreme agitation - stereotyped behaviors - automatic obedience - waxy flexibility - stupor - negativism - echopraxia - catatonia - motor retardation - impaired impulse control - gesturing or posturing - boundary impairment

depressive disorder risk factors

- family history and previous personal history of depression - twice as common in females than males - identical twins - nearly 50% - very common in patients over 65 y/o - neurotransmitter deficiencies - serotonin, norepinephrine, dopamine, acetylcholine, GABA, glutamate - others: stressful life situations, presence of medical illness, patient's postpartum period, comorbid anxiety disorder personality disorder or substance use disorder, trauma occurring early in life, neuroticism (negative personality trait characterized by anxiety, fear, moodiness, worry, envy, frustration, jealousy, loneliness)

depressive characteristics (bipolar)

- flat, blunted, labile affect - tearfulness, crying - lack of energy - anhedonia: loss of pleasure and lack of interest in activities, hobbies, sexual activity - physical reports of discomfort/pain - difficulty concentrating, focusing, problem-solving - self-destructive behavior, including suicidal ideation - decrease in personal hygiene - loss or increase in appetite and/or sleep, disturbed sleep - psychomotor retardation or agitation

depressive disorder - assessments/screening tools

- hamilton depression scale - beck depression inventory - geriatric depression scale (short form) - zung self-rating depression scale - patient health questionniare-9 (PHQ-9)

affective findings of psychotic disorders

- hopelessness - suicidal ideation - unstable or rapidly changing mood

manic characteristics (bipolar)

- labile mood with euphoria - agitation and irritability - restlessness - dislike of interference and intolerance of crticism - increase in talking and activity - flight ideas: rapid, continuous speech with sudden and frequent topic change - grandiose view of self and abilities (grandiosity) - impulsivity: spending money, giving away money or possessions - demanding and manipulative behavior - distractability and decreased attention span - poor judgment - attention-seeking behavior: flashy dress and makeup, inappropriate behavior - impairment in social and occupational functioning - decreased sleep - neglect of ADLs including nutrition and hydration - possible presence of delusions and hallucinations - denial of illness

suicide self-assessment (nurse)

- must determine how they prsonally feel about suicide - must become comfortable asking personal questions about suicidal ideation and following up on patients' answers - death of a patient by suicide can cause healthcare professional to experience hopelessness, helplessness, ambivalence, anger, anxiety, avoidance and denial - those who work with patients who have suicidal ideation can benefit personally by debriefing, sharing and collaborating with other health professionals

myths regarding suicide

- people who talk about suicide never commit it - people who are suicidal only want to hurt themselves, not others - there is no way to help someone who really wants to kill themselves - asking a patient about suicide will cause them to actually commit suicide - ignoring verbal threats of suicide or challenging a person to carry out suicide plans will reduce the individual's use of these behaviors - people who talk about suicide are only trying to get attention

phases of schizophrenia

- prodromal - acute - stabilization - maintenance/residual

self-assessment for depressive disorders (nurse)

- recognize unrealistic expectations of yourself or the patient - identify feelings that the patient may be experiencing - understand the roles of biology and genetics play in the precipitation and maintenance of a depressed mood - as a student, personal feelings should be recognized, named and examined - discuss with peers, staff and faculty

cyclothymic disorder comorbidity

- substance use disorders - sleep disorders - attention-deficit/hyperactivity disorder

substance use epidemiology

21 million individuals or 9% of US are estimated to have a substance use disorder 140 million or 53% of US acknowledged drinking alcohol; 60 million or 23% admit to binge drinking; 16 million or 6% report heavy drinking 27 million or 10% used illicit substances (non-medical or non-prescribed prescription drugs) in the month before survey; 12-17 y/o account for 9%, 18-25 y/o account for 22%, 26+ y/o account for 8% 22 million reported using marijuana in last 30 days 4 million reported non-medical use of prescription pain relievers use of stimulants like adder all and ritalin has doubled use in the past few years

lethality of suicide plan

3 main elements: is there a specific plan with details, how lethal is the proposed method, is there access to the planned method people who have definite plans for the time, place and means are at highest risk

bipolar 1 and 2 disorder epidemiology

4% of population. men and women have equal rates but respond differently to their condition. men have more legal problems and commit acts of violence. women abuse alcohol, commit suicide and develop thyroid disease. also women who experience severe post-partum psychosis within 2 weeks of giving birth have 4x greater chance of subsequent conversion to bipolar disorder children/adolescents: children are now being diagnosed with disruptive mood dysregulation disorder - not bipolar disorder as they are not continuing to have episodes in their adult years; 1 in 5 young people with mania plus depression will attempt suicide. young people experience nearly 2 months per year of role impairment

cognitive retardation

generalized slowing or thinking, which is represented by delays in responding to questions or difficulty finishing thoughts pathological speech patterns

psychosis

altered cognition, altered perception and/or an impaired ability to determine what is or is not real

circumstantiality

including unnecessary and often tedious details in conversation but eventually reaching the point pathological speech patterns

premenstrual dysphoric disorder (PMDD)

a depressive disorder associated with the luteal phase of the menstrual cycle- occur in the last week before the onset of period. causes problems that can be severe enough to interfere with the ability of a woman to work or interact with others. emotional manifestations can include mood swings, irritability, depression, anxiety, feeling overwhelmed, and difficulty concentrating. physical manifestations can include lack of energy, overeating, hyper or insomnia, breast tenderness, aching, bloating, and weight gain. symptoms cease after menopause treatment includes exercise, diet, relaxation therapy, acupuncture, light therapy; SSRIs (only fluoxetine, sertraline, controlled release paroxetine), diuretics for bloating

thought blocking

a reduction or stoppage of thought. interruption of thought by hallucinations can cause this pathological speech patterns

major depressive disorder (MDD)

a single episode or recurrent episodes of unipolar depression (not associated with mood swings from major depression to mania) resulting in a significant change in a client's normal functioning (social, occupational, self-care) accompanied by at least 3 of the following specific clinical findings, which must occur every day for a minimum of 2 weeks and last most of the day: - depressed mood - difficulty sleeping or excessive sleeping - indecisiveness - decreased ability to concentrate - suicidal ideation - increase or decrease in motor activity - inability to feel pleasure - increase or decrease in weight gain of more than 5% of total body weight over 1 month psychotic features: presence of auditory hallucinations or the presence of delusions postpartum onset: a depressive episode that beings within 4 weeks of childbirth and can include delusions, which can put the newborn infant at high risk of being harmed by the mother

naloxone

a specific opioid antagonist can be given IM, SQ, IV or via inhalation to reverse respiratory depression, coma and other effects of opioid toxicity

screenings for psychotic disorders

abnormal involuntary movement scale (AIMS): used to monitor involuntary movements and tardive dyskinesia in patients who take anti-psychotic meds world health organization disability assessment schedule (WHODAS): helps determine the patient's level of global functioning

negative symptoms of psychotic disorders

absence of things that are normally present; more difficulty to treat successfully than positive symptoms; can be more debilitating, respond less well to antipsychotic meds, use support groups to improve these symptoms - affect: blunted (reduced or minimal emotional response), flat (immobile or blank facial expression, doesn't changes), constricted (reduced in range or intensity), inappropriate (incongruent with the actual emotional state or situation), bizarre (odd, illogical, inappropriate or unfounded) - alogia: poverty of thought or speech > might sit with a visitor but only mumble or respond vaguely to questions - anergia: lack of energy - anhedonia: lack of pleasure or joy; indifferent to things that often makes others happy - avolition: lack of motivation in activities and hygiene; completes assigned task, but unable to start next common chore without prompting - asociality: decreased desire for, or comfort during, social interaction - apathy: decreased interest in, or attention to activities or beliefs that would otherwise be interesting or important

suicide attempt

actually carrying out an act or acts with the intention of death which may or may not prove fatal every attempt must be taken seriously even if the person has a history of multiple attempts

acute phase of bipolar disorder

acute mania risk of harm to self or others is determined. hospitalization can be required, one to one supervision can be indicated for patient safety **can lead to physical exhaustion and possible death - if patient does not stop moving, does not eat, drink or sleep -- this will become a medical emergency goal: reduction of mania and patient safety

schizophrenia planning

acute phase: hospitalization if patient is a danger to self or others, can also be used to clarify and confirm diagnosis; focuses on selecting the best strategies to ensure patient safety and control symptoms stabilization/maintenance phase: focuses on providing patient and family education, support and skills training. incorporates interpersonal, functional, coping, healthcare, shelter, educational and vocational strengths and needs, and addresses how and where these needs can best be met within the community. relapse prevention efforts are vital

patient care/treatment for depressive disorder

acute phase: severe clinical findings of depression. treatment is generally 6-12 weeks; goal is reduction of depressive manifestations. hospitalization potentially needed. assess suicide risk, implement safety precautions, one-to-one observation as needed continuation phase: increased ability to function. treatment is generally 4-9 months. goal is relapse prevention through education, medication, psychotherapy maintenance phase: remission of manifestations. can last for years. goal is prevention of future depressive episodes

schizophrenia implementation

acute: prevent harm to self or others; structure within the therapeutic milieu provides a feeling of safety and security. monitored for suicide risk and intervene promptly. medication response is monitored and side effects are addressed. RNs provide support, psychoeducation and guidance. stabilization/maintenance: relies on 4 pronged approach - medication, treatment adherence, relationships with trusted care providers and support people, community-based therapeutic services. all care is geared toward the patient's strengths, culture, personal preferences and needs. communication, continuity in care and trust relationships are essential for optimum recovery and relapse prevention

alterations in thought

aka delusions; false fixed beliefs that cannot be corrected by reasoning and are usually bizarre - ideas of reference - persecution - grandeur - somatic delusions - jealousy - being controlled - thought broadcasting - thought insertion - thought withdrawal - religiosity - magical thinking

methadone

aka dolphin, Methadose; synthetic narcotic opioid used to decrease the painful symptoms of opiate withdrawal; blocks the euphoric effect of opiate drugs; can only be dispensed through an opioid treatment program certified by SAMHSA - once a day; eventually need to be withdrawn as there's a likelihood of dependence can be used in low doses for pregnant women, neonatal withdrawal is usually mild and an be managed with paregoric side effects: difficulty/shallow breathing, feel lightheaded/faint, experience chest pain or a fast/pounding heartbeat; hives, rash, swelling of face, lips, tongue or throat; hallucinations or confusion

naltrexone

aka vivitrol; opioid antagonist; for prevention of relapse to opioid dependence, following detoxification long-acting injectable version of this drug, ReVia, given once a month blocks the euphoric and sedative effects side effects: weakness, tiredness, insomnia, increased thirst, anxiety, nervousness, restlessness, irritability, lightheadedness, fainting, muscle or joint aches, decreased sex drive, impotence and difficulty having an orgasm

self-assessment of alcohol use disorder (nurse)

alcohol use is self inflicted; assess personal thoughts, opinions and feelings as first step to remaining objective and establish a therapeutic relationship.

metabolic syndrome

all second generation antipsychotics carry this risk s/s include weight gain (abdominal area), dyslipidemia, increased blood glucose, insulin resistance significant concern and increases risk of diabetes, certain cancers, hypertension and cardiovascular disease

tricyclic antidepressants (TCAs) - depression

amitriptyline; imipramine, doxepin, nortriptyline, amoxapine, trimipramine, desipramine, clomipramine used for depressive disorders; neuropathic pain, fibromyalgia, anxiety disorders, insomnia, bipolar disorder, OCD, ADHD works by blocking reuptake of norepinephrine and serotonin in the synaptic space > intensifying the effects of these neurotransmitters 10-14 days or longer before begin to work; maximum effects might not be seen until 4-8 weeks complications: orthostatic hypotension, anticholinergic effects (dry mouth, blurred vision, photophobia, urinary hesitation or retention, constipation, tachycardia), sedation (usually diminishes over time), toxicity (results in cholinergic blockade and cardiac toxicity - dysrhythmia, mental confusion, agitation, followed by seizures, coma, death), decreased seizure threshold, excessive sweating, increased appetite contraindications: amitriptyline is pregnancy risk category c; those who have seizure disorders, coronary artery disease, diabetes, liver, kidney, respiratory disorders, urinary retention and obstruction, angle closure glaucoma, benign prostatic hypertrophy, hyperthyroidism, avoid other CNS depressants (alcohol, benzodiazepine, opioids, antihistamines), direct and indirect-acting sympathomimetics and MAOIs **can increase suicide risk client ed: change positions slowly to minimize dizziness from orthostatic hypotension; chew sugarless gum, eat foods high in fiber, increase fluid intake to 2-3 L/day to minimize anticholinergic effects

paranoia

an irrational fear, ranging from mild (wary, guarded) to profound (believing irrationally that another person intends to kill you). fear may result in defensive actions, harming another person before that person can harm the patient positive symptoms

common comorbidities with depressive disorder

anxiety disorders - 70%, prognosis is poorer, higher risk for suicide and disability psychotic disorders - schizophrenia substance use disorder - attempt to relieve manifestations of depression or self-treat mental health disorders eating disorders personality disorders

co-occuring disorders

any combination of two or more substance use disorders and mental disorders identified in the DSM-5 ex: major depressive disorder, bipolar disorder, anxiety disorder, anti-social personality disorder, conduct disorder

third generation antipsychotics

aripiprazole used to treat both positive and negative symptoms in schizophrenia nursing actions: decreased risk for EPSs or tardive dyskinesia. lower risk for weight gain and anticholinergic effects.

evaluation of alcohol use disorder

assessing the effectiveness of the treatment plan, using objective data to check whether nursing actions addressed the patient's symptoms, measuring the changes in a patient's behaviors for progress toward meeting stated goals problematic behaviors, patterns of expression or perceptions may improve or only undergo change in small increments requiring alternations in the action steps or even in the goals of the treatment plan to meet the patients needs

substance-induced depressive disorder

associated with the use of, or withdrawal from drugs and alcohol last longer than expected length of physiological effects, intoxication or withdrawal from substance. symptoms appear within 1 month of use

gesturing/posturing

assuming unusual or illogical expressions alterations in behavior

process addictions

behaviors or feelings brought about by the relevant action; compulsive actions activate the reward or pleasure pathways in the brain similar to substances

referential

belief that events or circumstances that have no connection to you are somehow related to you ex: believes songs on radio are chosen to send them a message alterations in thought

being controlled

believes that a force outside their body is controlling them alterations in thought

erotomanic

believes that another person desires you romantically ex: someone (who barely knows them) would marry them if the other person's spouse would stop interfering alterations in thought

thought insertion

believes that others' thoughts are being inserted into their mind alterations in thought/pathological speech patterns

somatic delusions

believes that their body is changing in an unusual way ex: growing a third arm alterations in thought

jealousy

believes that their partner is sexually involved with another individual even though there is not any factual basis for this belief alterations in thought

thought broadcasting

believes that their thoughts are heard by others alterations in thought

thought withdrawal

believes that their thoughts have been removed from their mind by an outside agency alterations in thought/pathological speech patterns

grandeur

believes that they are all powerful and important ex: like a god alterations in thought

magical thinking

believes their actions or thoughts are able to control a situation or affect others ex: wearing a certain hat makes them invisible to others alterations in thought/positive symptom

nicotine withdrawal from tobacco use meds

bupropion, nicotine replacement therapy (nicotine gum and patch), varenicline, bupropion

atypical antidepressants - depression

bupropion; vilazodone used for depression; alternative to SSRI for those unable to tolerate the sexual dysfunction adverse effect; aid to quit smoking, prevention of seasonal pattern depression works by inhibiting dopamine uptake therapeutic effects might be be experienced for 1-3 weeks, full effects can take 2-3 months compilations: headache, dry mouth, GI distress, constipation, increased heart rate, nausea, restlessness, insomnia, suppression of appetite > weight loss, seizures (especially at higher doses) contraindications: pregnancy risk category B; those who have seizure disorder, anorexia nervosa or bulimia nervosa, those taking MAOIs or SSRIs client ed: do not take with MAOIs or SSRIs; take med as prescribed, continue therapy after improvement - sudden discontinuation can result in relapse or major withdrawal effects; therapy continues for 6 months after resolution of manifestations and can continue for 1 year or longer __________ vilazodone: works by blocking serotonin reuptake, and partial serotonin receptor agonist **administer with food to increase absorption complications: sexual dysfunction, serotonin syndrome and neuroleptic malignant syndrome, hyponatremia, dizziness client ed: can cause dizziness - avoid driving until effects are known

imapired information processing

can lead to problems such as delayed responses, misperceptions, difficulty understanding others; may lose the ability to screen out insignificant stimuli such as background sounds or objects in one's peripheral vision leading to over stimulation

depressive disorder due to another medical condition

caused by disorders that affect the body's systems or from long-term illnesses that cause ongoing pain ex: stroke, parkinson's disease, huntington's disease, alzheimer's disease, traumatic brain injury, cushing's, hypothyroidism, arthritis, back pain, metabolic conditions, HIV, diabetes, infection, cancer, autoimmune problems

first generation/conventional antipsychotics

chlorpromazine (low potency), rest are high potency > haloperidol, loxapine, fluphenazine, thiothixene, perphenazine, trifluoperazine used for positive psychotic symptoms in schizophrenia complications: agranulocytosis, anticholinergic effects; extrapyramidal effects (EPS) such as acute dystonia, akathisia, pseudoparkinsonism, tardive dyskinesia, neuroendocrine effects, neuroleptic malignant syndrome, orthostatic hypotension, sedation, seizures, severe dysrhythmias, sexual dysfunction, skin effects, liver impairment contraindications: patients who are in a coma or have parkinson's disease, liver damage or severe hypotension, older adults who have dementia. use caution with those who have prostate enlargement, heart disorders, glaucoma, paralytic ileus, liver disease, kidney disease or seizure disorder client ed: to minimize anticholinergic effects, chew sugarless gum, eat foods high in fiber, eat/drink 2-3 L of fluid a day. indications of postural hypotension include lightheadedness and dizziness - if these occur, lie down. minimize orthostatic hypotension by getting up slowly from a lying or sitting position

opioid use disorder

chronic relapsing disorder - specifically with heroin and prescription drugs; cravings result in larger amounts and longer periods of time being devoted to the drug and increasing tolerance; results in significant impairment in life roles, interpersonal conflict and puts person in physically hazardous situations; begin usually in late teens to early 20s intoxication: exhibit psychomotor retardation, drowsiness/intense drowsiness > coma, slurred speech, altered mood, impaired memory and attention, euphoria, analgesia, calmness; physical symptoms include pupillary constriction (meiosis), bradycardia, hypotension, hypothermia, sedation, head nodding withdrawal: occur after cessation or reduction in heavy use, or after an antagonist has been administered; symptoms include mood dysphoria, nausea, vomiting, diarrhea, muscle aches, fever, insomnia, lacrimation (watery eyes), rhinorrhea (runny nose), pupillary dilation (mydriasis), yawning, piloerection (bristling of hairs) or gooseflesh, tachycardia, hypertension, hyperthermia, insomnia, diaphoresis, increased respiratory rate, muscle spasms, abdominal cramps, bone/muscle pain, anxiety ; males can experience seating and spontaneous ejaculation while awake morphine, heroin and methadone withdrawal begins 6-8 hours after last dose following a period of at least a week of use; reaches intensity on 2nd or 3rd day an subsides during the next week meperidine (demerol) withdrawal begins within 8-12 hours rom abstinence and lasts about 5 days overdose: death usually stems from respiratory arrest due to the respiratory depressant effect; symptoms include unresponsiveness, slow respiration, coma, hypothermia, hypotension, bradycardia; **three main symptoms: coma, pinpoint pupils, respiratory depression overdose treatment: promoting breathing by aspiration secretions and inserting an airway; mechanical ventilation should be used until naloxone (Narcan) can be given via IM, SQ, IV, immediate increased respirations and pupillary dilation should occur, too much Narcan may produce withdrawal symptoms, duration of action is short, so may need repeated admin treatment: individual, behavioral, cognitive behavioral & family therapy, social skills training, support groups, residential treatment and therapeutic communities can use methadone, buprenorphine, naltrexone (vivitrol)

survivors of suicide

circle of survivors of a person who has completed suicide, are the largest group of mental health casualties related to suicide may experience overwhelming guilt & shame compounded by the difficulty of discussing suicide, sadness, loneliness, abandonment and disbelief

lithium carbonate (suicide)

client ed: maintain healthy diet, exercise regularly to minimize weight gain; drink 2-3 L/day, maintain adequate sodium intake, **minimize GI effects by taking med with food or milk, comply with laboratory appointments as they are needed to monitor effectiveness and adverse effects **low therapeutic index

non-suicidal self-injury

closely related to suicidal behavior deliberate and direct attempts to inflect shallow, yet painful injuries to the surface of the body without intending to end one's life common behaviors: cutting, burning, scraping/scratching skin, biting, hitting, skin picking, interfering with wound healing usually multiple methods are used significant when they last for at least 1 year and happen repeatedly intent to either alleviate psychiatric pain or, pierce the psychic numbness, punish themselves, connect with others, get attention, escape responsibility, avoid a situation

co-dependence

cluster of behaviors originally identified through research involving the families of alcoholic patients. often exhibit overly responsible behavior - doing for others what others could just as well do for themselves. define their self-worth in terms of caring for others to the exclusion of their own self needs

depressive disorders - nursing care

cognitive-behavioral therapy: assists patient to identify and change negative behavior and thought patterns interpersonal therapy: encourages patient to focus on personal relationships that contribute to the depressive disorder group therapy family therapy

flumazenil

competitive benzodiazepine receptor antagonist can reverse sedative effects and toxicity. administered IV.

substance use disorders

complex disease of the brain characterized by craving, seeking and using regardless of consequences chronic and relapsing; result in compromised executive function circuits that mediate self-control and decision making

screening, brief intervention, and referral to treatment (SBIRT)

comprehensive, integrated pubic health approach to delivery of early intervention and treatment services 3 components: - screening: nurse or other healthcare professional assess the severity of substance use and identifies the appropriate level of treatment - brief intervention: nurse or other healthcare professional focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change - referral to treatment: nurse or other healthcare professional provides those identified as needing more extensive treatment with access to specialty care alcohol assessment

gambling disorder

compulsive activity that causes economic problems and significant disturbances in a personal, social and occupational setting preoccupied with behavior, experience an increasing desire and lie to conceal extent of problem; may try to control behavior, cut back to stop; may commit illegal acts to finance their addiction; may rely on others to help pay off debts and recoup losses usually develops over the course of years, may be regular or episodic; may be interspersed with abstinence; stress and depression may increase behavior treatment: 12 step program which involves public confession, peer pressure, peer counselors who are reformed; hospitalizations may be helpful by removing patient from environment; individual, group and family therapy; medications such as SSRIs, bupropion, mood stabilizers, anticonvulsant, second generation antipsychotics, naltrexone

maintenance/residual phase of schizophrenia

condition has stabilized and new baseline is established. positive symptoms are usually absent or significantly diminished, but negative and cognitive symptoms continue to be a concern. a pattern of recurrent exacerbation separated by periods of reduced or dormant symptoms is common. outcome: focus on maintaining and increasing symptom control and insight; includes adhering to treatment, prevention relapse, maintaining and increasing independence and achieving a satisfactory quality of life

hallucinogen use disorder

considered intoxicants, have no medical use; cause a profound disturbance in reality, associated with flashbacks, panic attacks, psychosis, delirium, mood and anxiety disorders; can be natural (plants/mushrooms) and synthetic; classified as schedule 1 controlled substances - no medical use, high abuse potential; cause a clinically significant impairment or distress within a 12 month period including craving, difficulty with role obligations, impairment and tolerance two broad categories: classic (LSD) and dissociative drugs (PCP, ketamine) intoxication: clinically significant psychological and behavioral changes - paranoia, impaired judgment, intensification of perceptions, depersonalization and derealization; illusions, hallucinations and synesthesia (hearing colors and seeing sounds); physical symptoms include pupillary dilation, tachycardia, sweating, palpitations, blurred vision, tumors and incoordination withdrawal: no official diagnosis or pattern; may re-experience of perceptual symptoms that were experienced during intoxication, symptoms can be distressing & impair the individual from normal functioning for weeks, months or years treatment: talking patient down - reassurance that the symptoms are caused by a drug and the symptoms will subside; in extreme cases, antipsychotic (haloperidol) or benzodiazepine (diazepam) can be used short term

depressive disorder - client education

continuation phase followed by maintenance phase - review manifestations of depression with patient and family in order to identify relapse - reinforce intended effects and potential adverse effects of meds - explain benefits of therapy adherence - 30 minutes of exercise daily for 3-5 days/week improve clinical findings of depression and can help prevent relapse.

nihlistic

conviction that a major catastrophe will occur ex: gives all their belongings away because a comet will hit the earth

schizoaffective disorder

criteria for both schizophrenia and depressive or bipolar disorder

CAGE

cut down - have you ever felt the need to cut down your drinking? annoyed - are people annoyed by your drinking? guilty - have you felt guilty about your drinking? eye opener - have you ever had a drink in the morning? score of 2 or more is significant, score of 1 requires further assessment alcohol assessment

care continuum for substance use disorders

detoxification: warranted when individual quits using a psychoactive substance known to cause withdrawal or when the individual is already in withdrawal; medically managed inpatient program with 24-hour medical coverage while patient's body clears itself of drugs rehabilitation: can be medically managed and medically monitored inpatient programs - usually employ 24 hour medical staff and provide intensive and specialized care for those with either biomedical or psychiatric co-morbid conditions. short term: learning lost skills; long term: learning new skills halfway houses: residential treatment in a substance-free communal or family environment that provides opportunities for independent growth. focus is on extending the period of sobriety, getting case management assistance in addressing educational, economic and social needs, integrating new life skills into a solid modeled recovery program; live in halfway homes, but work outside other housing: community reintegration in supportive housing units but not part of treatment, such as three-quarter way houses, therapeutic communities, housing programs offer drug-free living environments, peer support, classes to assist or remediate skills needed for daily living partial hospitalization programs: intensive form of outpatient programming for those who do not need a 24-hour residential treatment, but who benefit from a structured treatment setting; runs 5 days a week for about 6 hours a day with planned programing. medication management is available, but is not usually medically monitored or managed in this setting intensive outpatient programs: alternative to partial hospitalization program; nonresidential program highly structured with scheduled treatment groups and at least one individual session regularly. medication management is usually available but will not be monitored; attend at least 3 days a week for 3 hours a day outpatient treatment: least intensive form of substance use treatment; may be a mix of individual sessions and educational or psychotherapy groups determined by individuals needs and treatment goals; structured, drug free and nonresidential; no more than 5 contact hours per week; can be web-based for self-paced, anonymous collective participation alcoholics anonymous: oldest and best known 12 step programs; desire to quit drinking or using substances is welcome to attend meetings. individuals learn how to be sober through the support of other members and the 12 steps. size ranges from small (15) to large (50+). also meetings to address special needs of family - al-anon for friends and family members of alcohol abusers, alateen for teenage relatives of alcohol abusers, nar-anon for family and friends of drug users relapse prevention: identifying potential triggers to substance use, learning skills to regain abstinence in the event of use and adopting healthy coping, identity and stress management skills to address triggers before they threaten sobriety

alcohol use disorders identification test (AUDIT)

developed by WHO, effective for decades and still used today; can be administered by clinician or self-report; 10 questions with a 0-4 scale rating alcohol assessment

anticonvulsant drugs (bipolar)

developed to treat convulsions associated with epilepsy; commonly used to treat acute mania and bipolar maintenance superior for continuously cycling patients, more effective when there is no family history of bipolar disease, effective at diminishing impulsive and aggressive behavior in some nonpsychotic patients, helpful in cases of alcohol and benzodiazepines withdrawal, beneficial in controlling mania (within 2 weeks), and depression (within 3 weeks or longer) valproate: treats acute mania, helpful in preventing manic episodes; monitor liver function and platelet count carbamazepine: alternative to lithium, valproate, second generation antipsychotic; seems to work better in patients with rapid cycling and severely paranoid angry patients experiencing manias rather than in euphoric, overactive, over friendly patients experiencing mania; also more effective in dysphoric patients experiencing manias lamotrigine: FDA approved maintenance therapy medication; rare dermatological reaction - potentially life threatening rash

alcohol withdrawal meds

diazepam, carbamazepine, clonidine, chlordiazepoxide, phenobarbital, naltrexone

sedative hypnotic anxiolytics/benzodiazepine (suicide)

diazepam, lorazepam complications: CNS depression (sedation, lightheadedness, ataxia, decreased cognitive function) contraindications: avoid other CNS depressants (alcohol) and caffeine client ed: avoid hazardous activities as side effects are not quickly known; do not stop taking med suddenly - need to taper dosage over several weeks

personal boundary difficulties

disenfranchisement with one's own body, identity and perceptions - depersonalization -derealization - illusions

alcohol abstinence meds

disulfiram, naltrexone, acamprosate

negativism

doing the opposite of what's requested alterations in behavior

binge drinking

drinking too much alcohol quickly men: 5+ drinks within 2 hours women: 4+ drinks within 2 hours

heavy drinking

drinking too much, too often men: 14+ drinks in a week women: 8+ drinks in a week

assessment for bipolar

early diagnosis and treatment help suicide attempts, alcohol/substance abuse, marital/work problems, development of medical comorbidity use altman self-rating mania scale (ASRM): capturing a picture of the patient's placement on the depression to mania description. scores of 6+ suggest mania or hypomania and need for further assessment/treatment

seasonal affective disorder (SAD)

form of depression that occurs seasonally, usually during winter when there is less day light. light therapy is the first line treatment

depressive disorders - therapeutic procedures

electroconvulsive therapy: can be useful for those who are unresponsive to other treatments transcranial magnetic stimulation: stimulates focal areas of cerebral cortex; indicated for depressive disorders that are resistant to other forms of treatment vagus nerve stimulation: uses implanted device that stimulates vagus nerve; used for patients who have depression that is resistant to antidepressant meds deep brain stimulation: electrodes are surgically implanted into specific areas of the brain to stimulate those regions identified to be under-active in depression light therapy St. John's wort: herb may increase the amount of serotonin, norepinephrine and dopamine in brain; not regulated by FDA; potential for adverse reactions when taking other meds; use with caution in children or pregnancy

alcohol screenings/assessments

essential to intervene early and provide treatment for people with substance disorders and for those at risk for developing these disorders - SBIRT - AUDIT - CAGE - CAGE-AID - T-ACE instructions need to be clear and followed carefully. nonjudgmental attitudes help with objectivity regardless of what the individual reveals. important trends: appearance of progression, loss of control, tolerance and withdrawal

psychobiological interventions for alcohol use disorder

essentially pharmacological intervention disulfiram (antabuse): used for maintenance, relapse prevention, aversion therapy naltrexone (vivitrol [injectable], revia, depade): used for withdrawal, relapse prevention, decreases pleasure feelings and cravings acamprostate calcium (campral): used for relapse prevention lorazepam (ativan), chlordiazepoxide (librium), diazepam (valium): used for withdrawal anticonvulsants (tegretol) or barbiturates (phenobarbital): used for withdrawal clonidine (catapres): used for mild-moderate withdrawal

psychotic or catatonic disorder not otherwise specified

exhibits psychotic features (impaired reality testing) or bizarre behavior (psychotic) or significant change in motor activity behavior (catatonic) but does not meet criteria for diagnosis with another specific psychotic disorder

delusional disorder

experiences delusional thinking for at least 1 month. self or interpersonal functioning is not markedly impaired. do not tend to behave strangely or bizarrely. general theme includes grandiose, persecutory, somatic and referential delusions.

substance-induced psychotic disorder

experiences psychosis due to substance intoxication or withdrawal. psychotic manifestations are more severe than typically expected

delusions

false beliefs held despite lack of evidence to support them; most commonly involve persecutory, grandiose or religious ideas

persecution

feels singled out for harm by others ex: being hunted down by the FBI alterations in thought

selective serotonin reuptake inhibitors (SSRI) - depression

fluoxetine; citalopram, escitalopram, paroxetine, sertraline used for major depression; OCD, bulimia nervosa, premenstrual dysphoric disorder, panic disorders, PTSD, bipolar disorder, generalized anxiety disorder, social anxiety disorder works by blocking reuptake of the monoamine neurotransmitter serotonin in the synaptic space > intensifying the effects of serotonin **first line treatment for depression complications: sexual dysfunction (anorgasmia, impotence, decreased libido), CNS stimulation (insomnia, agitation, anxiety), weight changes (weight loss early, then weight gain in long-term), serotonin syndrome (2-72 hours after start; **can be lethal; mental confusion, difficulty concentrating, abdominal pain, diarrhea, agitation, fever, anxiety, hallucinations, hyperreflexia, incoordination, diaphoresis, tremors), withdrawal syndrome (headache, nausea, visual disturbances, anxiety, dizziness, tremors), hyponatremia, rash, sleepiness, faintness, lightheadedness, GI bleeding, bruxism (grinding teeth), dry mouth, diarrhea contraindications: fluoxetine is pregnancy risk category C; fluoxetine and paroxetine can increase risk of birth defects, late in pregnancy can increase risk of withdrawal effects or pulmonary hypertension in newborn; do not give with MAOIs, TCAs, warfarin, NSAIDs, or anticoagulants; use cautiously in those who have liver/renal dysfunction, cardiac disease, seizure disorder, diabetes, ulcers, history of GI bleeding client ed: do not use with St. John's wort; follow a healthy diet and exercise regimen due to weight gain can occur with long-term use, **take med in morning, take med with food to minimize GI disturbances, avoid caffeinated beverages

schizophrenia nursing interventions

focus on illness knowledge, management, coping and quality of life. should be consistent with recovery model which stresses hope, living a full and productive life, and eventual recovery rather than focusing on controlling symptoms and adapting to disability

planning for bipolar

focuses on medically stabilizing the patient while maintaining safety (hospital is usually the safest); nursing care is geared towards managing meds, decreasing physical activity, increasing food and fluid intake, ensuring at least 4-6 hours of sleep per night, intervening so that self-care needs are met; seclusion, restraint or electroconvulsive therapy (ECT) may be considered

hallucinations interventions

focuses on understanding the patient's experiences and responses close monitoring, helping the patient feel safe, maintaining separation of the patient and others who may be in danger calling the patient by name, speaking simply and loudly enough to be understood during auditory hallucinations, presenting in a supportive manner, maintaining eye contact, redirecting the patient's focus to your conversation as needed, promote and guide reality testing, ask about hallucination content and reaction to them, ask 'what are you hearing', address any underlying emotion, need or theme

rapid cycling

four or more episodes of hypomania or acute mania within 1 year. associated with increase recurrence rate and resistant to treatment

bipolar risk factor

genetic: concordance rate among identical twins is 70%; may be more prevalent in adults who had high intelligence quotients (IQs) neurotransmitters: over abundance of norepinephrine, dopamine, serotonin will bring on mania brain structure and function: real dysfunction in prefrontal cortical region, region associated with executive decision making, personality expression and social behavior; evident in the hippocampus (memory), amygdala (memory, decision making, emotion) > emotional lability, heightened reward sensitivity and emotional dysregulation; also may be due to gray matter loss in same areas neuroendocrine: HPTA axis, hypothyroidism is most common physical abnormalities; peripheral inflammation is increased environmental factors: stressful family life, adverse life effects; stress triggers mania and depression in adults psychological factors: mania once thought to be defense against underlying anxiety and depression; thought to help individuals tolerate loss or tragedy; faulty ego uses mania when it is overwhelmed by pleasurable impulses such as sex or feared impulses such as aggression.

risk factors for bipolar disorders

genetic: having an immediate family member who has bipolar disorder physiologic: neurobiologic and neuroendocrine disorders environmental: increased stress in the environment can trigger mania and depression and increase risk for severe manifestations in genetically-susceptible children

schizophrenia risk factors

genetics: inherited. concordance rates are 50% for identical twins, 15% for fraternal twins. multiple genes on different chromosomes interact with one another in complex ways to create vulnerability for schizophrenia neurobiological: dopamine plays a significant role in psychosis; serotonin may play a role in schizophrenia brain structure abnormalities: reduced volume in the right anterior insula, reduced volume and changes in the shape of the hippocampus, accelerated age-related decline in cortical thickness, gray matter deficits in dorsolateral prefrontal cortex area, thalamus and anterior cingulate cortex, frontaotemporal, thalamocortical and subcortical-limbic circuits, reduced connectivity among various brain regions, neuronal overgrowth in some areas, possibly due to inflammation or inadequate neural pruning, widespread white matter abnormalities; lowered rate of blood flow and glucose metabolism in the prefrontal cortex psychological and environmental factors: prenatal stress (father older than 35 at conception), psychological stress (sexual abuse, chronic poverty, trauma), environmental stress (toxins)

risk factors for substance use disorder

genetics: predisposition to developing a substance use disorder due to family history; identical twins & male twins are higher risk for alcohol use issues; adoption or foster home children; some genes may reduce res of alcohol consumption by impacting alcohol metabolism neurochemical: affects all substance use disorders except alcohol; opioid, catecholamine, GABA systems are involved in developing substance use disorders; dopaminergic neurons in the VTA are especially important to sensation of reward environmental/socioeconomic: poverty, lack of parental supervision, poor education resources, impaired support systems, chronic stress, history of trauma sociocultural: peer pressure, cultural norms, lowered self esteem, few meaningful personal relationships, few life successes

group therapy or substance use/addictive disorders

groups of clients who have similar diagnoses can meet in an outpatient setting or within mental health residential facilities

alterations in perception

hallucinations are sensory perceptios that do not have any apparent external stimulus - auditory: hearing voices or sounds; command: the voice instructs the patient to perform an action (to hurt self or others); most common - visual: seeing persons or things - olfactory: smelling odors - gustatory: experiencing tastes - tactile: feeling bodily sensations

cyclothymic disorder

has at least 2 years of repeated hypomanic manifestations that do not meet the criteria for hypomanic episodes alternating with minor depressive episodes

bipolar disorder 2

has one or more hypomanic episodes alternating with major depressive episodes

health teaching and health promotion for alcohol use disorder

health teaching is a part of school curriculum; promoting classes for developing healthy coping and stress management skills, activities for increasing self-confidence and self-efficacy would also lower risks for use

family therapy or substance use/addictive disorders

identifies codependency; families learn about use of specific substances; client and family are educated regarding issues such as family coping, problem solving, indications of relapse and availability of support groups

warning factors of suicide

immediate risk of suicide - often talking or writing about death, dying or suicide - making comments about being hopeless, helpless or worthless - expressions of having no reason for living, no sense of purpose in life, saying things like "it would be better if i wasn't here" or "i want out" - increased alcohol and/or drug misuse - withdrawal from friends, family and community - reckless behavior or more risky activities, seemingly without thinking - dramatic mood changes - talking about feeling trapped or being a burden to others

impaired memory

impacts short-term memory and teh ability to learn. repetition and verbal or visual cues may help to learn and recall needed information

boundary impairment

impaired ability to see where one person's body ends and other's begins alterations in behavior

concrete thinking

impaired ability to think abstractly > interpreting or perceiving things in a literal manner

schizotypal personality disorder

impairments of personality (self and interpersonal) functioning, not as severe as schizophrenia

anosognosia

inability to realize they are ill caused by the illness itself; may result in resisting or stopping treatment, making care challenging and frustrating to staff

sedative, hypnotic, anti anxiety med use disorder

include drugs such as benzodiazepines, benzodiazepine-like drugs, carbamates, barbiturates, barbiturate-like drugs, all prescription sleeping meds and almost all prescription anti-anxiety meds cravings are typical; brain depressants negatively affect role performance and relationships; significant tolerance and withdrawal can develop; clinically significant maladaptive behavior or psychological changes intoxication: symptoms are slurred speech, incoordination, unsteady gait, nystagmus, impaired thinking, coma, inappropriate aggression and sexual behavior, mood fluctuation, impaired judgment overdose treatment: gastric lavage, activated charcoal, careful vital sign monitoring; if awake after overdose, keeps awake to prevent a loss of consciousness; if unconscious IV line should be established, endotracheal tube and mechanical ventilation may be needed withdrawal: repeated depressing of CNS along with body's daily attempt to return to homeostasis results in rebound hyperactivity with the removal of substance; symptoms include autonomic hyperactivity, tremor, insomnia, psychomotor agitation, anxiety, grand Mal seizures; degree and timing of withdrawal syndrome is dependent on specific substance, half life is very important treatment: gradual reduction of benzodiazepines will prevent seizures and other withdrawal symptoms; barbiturate withdrawal can be aided by using long-acting barbiturate such as phenobarbital

suicide precautions

include milieu therapy within facility - initiate one-on-one constant supervision around the clock, document staff member who was responsible with specific start and stop times - document patients location, mood, quoted statements and behavior every 15 min - search patients belongs with patient present - remove all glass, metal silverware, electrical cords, vases, belts, shoelaces, metal nail files, tweezers, matches, razors, perfume, shampoo, plastic bags and any other potentially harmful items from patients room and vicinity - allow patient to use only plastic eating utensils - check the environment for possible hazards (open windows, overhead pipes that are easily accessible, non-breakaway shower rods, non-recessed shower nozzles - ensure patients hands are always visible, even when sleeping - do not assign to a private room and keep door open at all times - ensure that the patient swallows all meds - identify whether the patients current meds can be lethal with exceeding prescribed dose - restrict visitors from bringing possibly harmful items to patient

stimulant use disorder

includes amphetamine-type, cocaine; second most widely used illicit substance in US; used by long distance truckers, students styling for exams, soldiers in wartime, athletes in competition produces euphoric feeling and high energy increased use, craving and tolerance are accompanied by reduced ability to function in major roles; can occur in 1 week intoxication: feel superhuman, elated, euphoric, sociable; also hyper vigilant, sensitive, anxious, tense and angry; physical symptoms include (2 or more) chest pain, cardiac arrhythmias, high/low blood pressure, tachycardia/bradycardia, respiratory depression, dilated pupils, perspiration, chills, nausea/vomiting, weight loss, psychomotor agitation/retardation, weakness, confusion, seizures, coma short term: increased energy, decreased appetite, mental alertness, increased heart rate/pressure, dilated pupils long term: irregular heartbeat, chest pains, increased risk of heart attack, panic attacks, depression, delusions/hallucinations, "cocaine bugs" (skin sensation) withdrawal: begin within a few hours to every days; symptoms include tiredness, vivid nightmares, increased appetite, insomnia, hyper insomnia, psychomotor retardation or agitation, depression, anxiety, irritability, poor concentration, paranoia, drug cravings; functionality is impaired treatment: individual, family and group therapy amphetamines > inpatient setting & some short-term drugs can be used including antipsychotics cocaine: 1-2 week is distinct because there's no physiological disturbances, outpatient settings are tried first; can experience fatigue, mood changes, disturbed sleep, craving and depression; unschedule urine tests are usually warranted

extreme agitation

including pacing and rocking alterations in behavior

lethality of method

indicates how quickly a person would die by that mode higher risk/hard methods: using a gun, jumping off a high place, hanging, poisoning with carbon monoxide, staging a car crash lower risk/soft methods: cutting one's wrists, inhaling natural gas, ingesting pills

program of assertive community treatment (PACT) - schizophrenia

intensive case management and interprofessional team approach to assist clients with community living needs

suicide

intentional act of killing oneself by any means; believes the act is the end to problems; little concern is given to the aftermath or ramifications to those left behind long-term therapy is needed for survivors

impaired executive functioning

interferes with problem solving and can contribute to inappropriateness in social situations; includes difficulty with reasoning, setting priorities, comparing options, placing things in logical order or groups, anticipation and planning and inhibiting undesirable impulses or actions

phencyclidine (PCP)

intoxication: **medical emergency; can be belligerent, assaultive, impulsive, unpredictable; physical manifestations include nystagmus (involuntary eye movements), hypertension, tachycardia, diminished response to pain, ataxia (loss of voluntary muscle control), dysarthria (unclear speech), muscle rigidity, seizures, coma, hyperacusis (sensitivity to sound), hyperthermia treatment: primarily support individual; cannot be talked down and may require restraint and a calming med such as a benzodiazepine; mechanical cooling may be necessarily for hyperthermia

disruptive mood dysregulation disorder

introduced in 2013 in response to an alarming number of children and adolescents being diagnosed with bipolar disorder > did not develop bipolar disorder s/s in their adulthood s/s: constant and severe irritability and anger between ages 6-18, onset is before 10. temper tantrums with verbal or behavior outbursts out of proportion to the situation occur at least 3 times a week; can contain behaviors in certain settings such as school. diagnosis: must exhibit irritability, anger, temper tantrums in at least two of these settings - home, school, with peers treatment is on a symptom-based approach - depression, ADHD, etc; cognitive behavioral therapy are essential; parent training helps parent interact with child in a way to predict and reduce aggression and irritability through consistency and rewarding appropriate behavior

religiosity

is obsessed with religious beliefs alterations in thought

expected physical findings of suicide

lacerations, scratches, scars

fetal alcohol syndrome

leading cause of intellectual disability in US; alcohol during pregnancy inhibits intrauterine growth and postnatal development resulting in microcephaly, craniofacial malformations, limb and heart defects; as adults tend to have short stature facial features: low nasal bridge, minor ear abnormalities, indistinct philtrum (between nose and upper lip), micrognathia (chin), epicanthal folds (eyes), short palpebral fissures (bags under eyes), flat midface and short nose, thin upper lip

protective factors of suicide

less likely that individuals will consider, attempt or die by suicide - feelings of responsibility toward partner and children - current pregnancy - religious and cultural beliefs - overall satisfaction with life - presence of adequate social support - effective coping and problem-solving skills - access to adequate medical care

lithium (bipolar)

lithium carbonate; FDA approved for both acute mania and maintenance treatment; onset within 10-21 days - usually supplemented early faces by atypical antipsychotics, anticonvulsants, antianxiety meds effective in reducing: elation, grandiosity, expansiveness, flight of ideas, irritability and manipulation, anxiety, self-injurious behavior controls the following to a lesser extent: insomnia, psychomotor agitation, threatening or assaultive behavior, distractability, hypersexuality, paranoia therapeutic level: acute manic phase = 600-1200 mg/day in two or three divided doses, then increased every few days by 300 mg with max dose of 1800 mg/day; takes 7-14 days; blood level should reach 0.6 -1.2 mEq/L for therapeutic level; should not exceed 1.5 mEq/l to avoid serious toxicity; measured 5 days after beginning therapy;**small window between therapeutic and toxic levels; **LOW AND SLOW contraindications: before - complete renal function and thyroid status as a baseline; with cardiovascular disease, brain damage, renal disease, thyroid disease, myasthenia graivs, do not give to women who are pregnant or breastfeeding

family assessment of alcohol use disorder

living with an individual who misuses alcohol or other substances is a source of stress and requires family system adjustments helps understand process of addition from a holistic perspective

hypomania

low level and less dramatic mania; less severe episode of mania that lasts at least 4 days accompanied by three or more manifestations of mania. hospitalization is not required. patient is less impaired. can progress to mania.

neologisms

made-up words that have meaning only to the patient, may use known words differently than others understand it or can create a completely new word that others do not understand ex: "i tranged and flittled" alternations in speech

waxy flexibility

maintaining a specific position for an extended period of time alterations in behavior

positive symptoms of psychotic disorders

manifestation of things that are not normally present; usually appear early; respond well to antipsychotics - halluciniations - delusions - alternations in speech - bizarre behavior

schizophreniform disorder

manifestations similar to schizophrenia, but duration is 1 to 6 months, and social/occupational dysfunction might not be apparent

clang association

meaningless rhyming of words often forceful ex: oh fox, box and lox alterations in speech

safe drinking

men day: 4 week: 14 women/elderly day: 3 week: 7 pregnant/adolescent - NONE

opioid withdrawal meds

methadone substitution, clonidine, buprenorphine, naltrexone, levo-alpha-acetylmethadol

prodromal phase

mild changes in thinking, reality testing and mood, insufficient to meet the diagnostic criteria. symptoms appear a month to more than a year before the first full blown episode. speech and thought may be odd or eccentric. anxiety, obsessive thoughts and compulsive behaviors may be present. deterioration in concentration, school or job performance, and social functioning are accompanied by distressing thoughts, suspiciousness, memory impairment and significant disorganization speech or behavior. person may feel that "something is not right or something strange is happening"

depressive disorder - nursing care

milieu therapy: - suicide risk: assess the patient's risk for suicide and implement appropriate safety precautions - self-care: patients ability to perform ADLs and encourage independence - communication: relate therapeutically to patient who is unable or unwilling to communicate. make time to be with patient even if they don't speak, make observations rather than asking direct questions, give patient sufficient time to respond - maintain safe environment - counseling can assist with problem solving, increasing coping ability, changing negative thinking to positive, increasing self-esteem, assertiveness training, using available community resources

ideas of reference

misconstrues trivial events and attaches personal significance to them ex: believing that others who are discussing the next meal are talking about him alterations in thought

illusion

misperceptions or misinterpretations of a real experience personal boundary difficulties

national institute on drug abuse (NIDA)

mission: to advance science on the causes and consequences of drug use and abuse, and to apply that knowledge to prove individual and public health

depression

mood disorder; wide spread issue ranking high among causes of disability

screening tool for bipolar disorder

mood disorders questionnaire: places mood progression on a continuum from hypomania (euphoria) to acute mania (extreme irritability and hyperactivity) to delirious mania (completely out of touch with reality)

bipolar disorders

mood disorders with recurrent episodes of depression and mania usually emerge in early adulthood, but early onset can be diagnosed in children

bipolar meds

mood stabilizers: lithium carbonate, anticonvulsants that can act as such - valproate and carbamazepine first generation psychotics: chlorpromazine and loxapine second generation antipsychotics: olanzapine, risperidone antidepressants: SSRI (fluoxetine) used to manage a major depressive episode

general assessment for bipolar

mood: euphoric mood associated with mania is unstable because it can quickly change to irritation and anger behavior: hypomania > voracious appetites for social engagement, spending, activity, even indiscriminate sex; may pursue elaborate schemes to get rich, famous, powerful despite objections and realistic constraints; manic state > gives away money, prized possessions, expensive gifts, may throw lavish parties, visit expensive nightclubs and restaurants, **distractability, may be manipulative, profane, fault finding, skilled at detecting and then exploiting others' vulnerabilities, constantly push limits, may dress outlandish, bizarre, colorful, noticeably inappropriate thought processes/speech patterns/thought content: mania causes a person to experience disorganized thoughts and speech patterns - pressured speech, circumstantial speech, tangential speech, loose associations, flight of ideas, clang associations content of speech is often sexually explicit and ranges from grossly inappropriate to vulgar, revolve around extraordinary sexual skill, brilliant business ability, unparalleled artistic talents; mania brings disturbing ways of viewing others and the world - delusions > grandiose delusions, persecutory delusions cognitive function: high cognitive function is preceded by onset of bipolar; about 1/3 display significant and persistent cognitive problems and difficulties in psychological areas. cognitive function affects overall function, cognitive deficits correlate with a greater number of manic episodes, history of psychosis, chronicity of illness, poor functional outcome, early diagnosis and treatment are crucial to prevent illness progression, cognitive deficits and poor outcome, medicine selection should consider not only the efficacy of the drug in reducing mood symptoms but also the cognitive impact of the drug on the patient

risk factors of suicide

more likely that an individual will consider, attempt or die by suicide - females are more likely to attempt suicide - adolescent, middle and older adult males are more likely to have completed suicide - older adults: untreated depression, loss of employment and finances, feelings of isolation, powerlessness, prior attempts at suicide, change in functional ability, declining physical health, alcohol or other substance use disorder - loss of loved ones biological factors: family history of suicide, physical disorders (AIDS, cancer, cardiovascular disease, stroke, chronic kidney disease, cirrhosis, dementia, epilepsy, head injury, Huntington's disease, multiple sclerosis) psycho-social factors: sense of hopelessness, intense emotions (rage, anger, guilt), poor interpersonal relationships at home, school, work, developmental stressors (adolescence), history of trauma/abuse cultural factors: american indians and alaskan natives have the highest rate of suicide environmental factors: access to lethal methods (firearms), lack of access to adequate mental health care, unemployment

bipolar disorder 1

most severe. marked by shifts in mood, energy and ability of function. has at least 1 episode of mania alternating with major depression

alcohol intoxication

most states require a blood concentration of 80-100 mg ethanol per dL of blood (0.08 or 0.10); based on number of factors including how quickly alcohol was consumed - quicker ingestion = higher levels of blood alcohol .02 - 2 drinks - slower motor performance, decreased thinking ability, altered mood and reduced ability to multitask .05 - 3 drinks - impaired judgment, exaggerated behavior, euphoria, lower alterness .08 - 4 drinks - poor muscle coordination, altered speech and hearing, difficulty detecting dancer, impaired judgment, poor self-control, decreased reasoning .10 - 5 drinks - slurred speech, poor coordination, slowed thinking .15 - 6 drinks - vomiting (unless high tolerance), major loss of balance .20 - 8-10 drinks - memory blackouts, nausea, vomiting .30 - 10+ drinks - reduction of body temp, blood pressure, respiratory rate, sleepiness, amnesia .40 - impaired vital signs and possible death

cannabis use disorder

most widely used often illegal drug in the world, and 4th most commonly used psychoactive drug in the US; delta-9-tetrahydrocannabinol (THC) is responsible for mind-altering effects; concentrated form is known as hashish; synthetic cannabinoids of HC, Marino and Cesamet are available by prescription for nausea and vomiting associated with cancer males more likely to have this disorder symptoms include larger amounts over longer period of time, craving, tolerance, withdrawal; results in problems with work, home life, education, social and physical wellbeing intoxication: heightens users' sensations; experience brighter colors, see new details in common stimuli, time seems to go more slowly; in higher doses - experience depersonalization and derealization, motor skills are impacted for 8-12 hours; delirium is possible; physical symptoms include conjunctival injection (red eyes from vessel dilation), increased appetite, dry mouth and tachycardia withdrawal: comparatively late - 1 week of cessation; symptoms include irritability, anger, aggression, anxiety, restlessness, depressed mood; insomnia, disturbing dreams; decreased appetite; physical symptoms include abdominal pain, shakiness, sweating, fever, chills or headache treatment: drug screens can detect up to 4 weeks after use; abstinence and support are the main principles; hospitalization or outpatient care may be needed; individual, family and group therapies can provide support; anti anxiety meds are used in short-term relief; anti depressants may be used if patients have underlying anxiety or depression

caffeine

most widely used psychoactive substance in the world; not an official use disorder; can result in intoxication and withdrawal; half life in human body is 3-10 hours, peak concentration is 30-60 min intoxication: 7% in US; behavioral symptoms > restlessness, nervousness, excitement, agitation, rambling speech, inexhaustibility; physical symptoms > flushed face, diuresis, GI disturbance, muscle twitching, tachycardia, cardiac arrhythmia; extremely high does can cause grand mal seizures and respiratory failure; excessive use is associated with bipolar disorder, eating disorders and sleep disorders withdrawal: not associated with medial problems or need for intervention; results in headache, drowsiness, irritability, poor concentration; can experience nausea, vomiting, muscle aches; occurs 12-14 hours after last does, peaks at 24-28 hours, and resolves within 1 week

stupor

motionless for long periods of time, coma like alterations in behavior

stereotyped behaviors

motor patterns that had meaning to client (sweeping floor) but now are mechanical and lack purpose alterations in behavior

flight of ideas

moving rapidly from one thought to the next, often making it difficult for others to follow the conversation pathological speech patterns

depersonalization

nonspecific feeling that a patient has lost their identity. self is different or unreal personal boundary difficulties

hallucinations

occur when a person perceives a sensory experience for which no external stimulus exists

alcohol withdrawal

occurs after reducing or quitting alcohol after heavy/prolonged use; symptoms is tremulousness (shakes or jitters) begin 6-8 hours after cessation mild-moderate: agitation, lack of appetite, nausea, vomiting, insomnia, impaired cognition, mild perceptual changes, systolic and diastolic blood pressure, pulse and body temp increase psychotic and perceptual symptoms may occur in 8-10 hours. if this happens, this is a medical emergency! risk of unconsciousness, seizures and delirium Ativan or librium can be given either PO or IM and tapered over 5-7 days seizures: may occur within 12-24 hours; generalized and tonic-clonic; valium given IM is common treatment delirium: aka delirium tremens (DTs); **medical emergency that can result in death, usually a result of medical problems like pneumonia, renal disease, hepatic insufficiency or heart failure; may happen anytime in the first 72 hours; autonomic hyperactivity may result in tachycardia, diaphoresis, fever, anxiety, insomnia and hypertension; delusions, visual, tactile hallucinations are common > may result in unpredictable behaviors as patients try to protect themselves from what they believe are genuine dangers goals: detox & stabilize with patient centered approach and patient to recognize the problem and become motivated for change

neuroleptic malignant syndrome

occurs in about 0.2% to 1% of patients who take first generation antipsychotics. s/s includes reduced consciousness and responsiveness, increased muscle tone (generalized muscle rigidity), and autonomic dysfunction. can also occur in second generation antipsychotics caused by excessive dopamine receptor blockade. **medical emergency

tolerance

occurs when a person no longer responds to the drug in the way that the person initially responded takes higher dose of the drug to achieve the same level of response achieved initially

affect

outward representation of a person's internal state of being and is an objective finding based on the nurse's assessment

antidepressants - schizphrenia & depression

paroxetine used to treat depression seen in many patients who have a psychotic disorder therapeutic effects are not immediate; can take several weeks or more to reach full therapeutic benefit nursing actions: used temporarily; monitor patient for suicidal ideation because med can increase thoughts of self-harm especially when first taking it client ed: avoid abrupt cessation to avoid withdrawal effect, notify provider of any thoughts of suicide, avoid alcohol while taking, avoid hazardous activities due to potential adverse effect of sedation

substance use disorder - American Psychiatric Association

pathological use of a substance that leads to a disorder of use 4 major groupings of symptoms: 1. impaired control 2. social impairment 3. risky use 4. physical effects (intoxication, tolerance, withdrawal) consumed through swallowing, inhaling, injecting

echolalia

patient repeats the words spoken to them

derealization

perception that the environment has changed ex: patient believing that objects in their environment are shrinking personal boundary difficulties

mania

period of intense mood disturbance with persistent elevation, expansiveness, irritability and extreme goal-oriented activity or energy abnormally elevated mood, can also be described as expansive or irritable. usually requires hospitalization. last at least 1 week **considered a psychiatric emergency

systemic effects of alcohol

peripheral neuropathy: caused by lack of thiamine > damage to peripheral nervous systems; s/s: pins and needles in lower extremities, numbness, muscle weakness, sensitivity to touch, burning; discontinuation of alcohol will prevent further deterioration alcoholic myopathy: caused by binge drinking or chronic alcoholism; s/s: muscle weakness and myonecrosis (muscle damage), significant reduction in muscle mass > muscle weakness; recovery is possible if alcohol is avoided alcoholic cardiomyopathy: weaken and thin the muscles of the heart leading to enlargement and heart failure; s/s: fatigue, shortness of breath, edema of the legs and feet esophagitis: result of toxic effects of alcohol on esophageal mucosa; also related to vomiting; s/s: distended veins in esophagus or upper part of stomach > risk for bursting which is a medical emergency gastritis: mucosal stomach lining is irritated and erodes causing inflammation; s/s: nausea, vomiting, loss of appetite, belching, bloating, may lead to ulcers and bleeding pancreatitis: caused by excessive drinking for more than 5 years, results in acute attack of pancreatitis; s/s: abdominal pain, nausea, vomiting. withdrawal of alcohol in early stages will reverse condition. chronic condition > malnutrition, weight loss, diabetes mellitus alcoholic hepatitis: results in diseased and inflamed liver; only occurs in a minority of heavy users. genetic factors: how body processes alcohol, other liver disorders, malnutrition, being female. s/s: appetite changes, dry mouth, weight loss, nausea, vomiting, pain/swelling in abdomen, jaundice, fever, confusion, fatigue. cirrhosis of the liver: slowly progressing disease in which healthy liver tissue is replaced by scar tissue, eventually liver can no longer function properly because scar tissue is blocking the blood flow through liver > slows process of nutrients, hormones, drugs, naturally produced toxins. s/s: easy bleeding/bruising, pruritus, jaundice, ascites, leg edema, weight loss, confusion, spider-like blood vessels on skin, petechiae, testicular atrophy. no treatment will cure cirrhosis or repair scarring. liver transplantation may be necessary. low salt diet can help ascites. leukopenia: low white blood cells due to vitamin deficient and low protein intake; predispose individuals to infection and disease. s/s: peridontitis, gingivitis, fatigue, weakness, fever, abdominal pain. treatment: improved nutrition and alcohol cessation thrombocytopenia: complication of liver cirrhosis, characterized by low platelet count. caused by platelet pooling in an enlarged spleen and decreased thromboprotein production in liver. s/s: excessive bruising (purpura), petechiae on lower legs, prolonged bleeding from cuts. treatment: alcohol cessation > platelets increase within 2-5 days cancer: major risk factor for head and neck > oral cavity, pharynx, larnyx; also liver, breast and colorectal

monoamine oxidase inhibitor (MAOI) - depression

phenelzine; isocarboxazid, tranylcypromine, selegiline (transdermal patch) used for atypical depression, depression; bulimia nervosa, panic disorder, social anxiety disorder, generalized anxiety disorder, OCD, PTSD **first line treatment for atypical depression works by blocking MAO in the brain > increasing amount of norepinephrine, dopamine and serotonin available for transmission of impulses > increased amount of these neurotransmitters at nerve endings intensifies responses and relieves depression complications: CNS stimulation (anxiety, agitation, hypomania, mania), orthostatic hypotension, hypertensive crisis (headache, nausea and vomiting, increased heart rate, increased blood pressure, diaphoresis, change in level of consciousness), local rash associated with transdermal patch contraindications: phenelzine is pregnancy risk category c; selegiline (patch) is not for those taking carbamazepine or oxcarbazepine; those taking SSRIs or TCAs; those who have pheochromocytoma (tumor on adrenal gland), heart failure, cardiovascular and cerebral vascular disease, severe renal insufficiency; those who have diabetes or seizure disorders client ed: don't use with indirect-acting sympathomimetic meds, TCAs, SRRIs, antihypertensives, meperidine, avoid tyramine rich foods such as aged cheese, fermented or smoked meats, liver, pepperoni, salami, avocados, figs, bananas, dried, cured or smoked fish, some protein dietary supplements, some beers, red wine, avoid vasopressors including foods like caffeinated beverages, chocolate, fava beans, ginseng; stop use of MAOIs within 10-14 days before and after surgery due to general anesthetics; avoid using all OTC meds unless consulting with provider

anticholinergic toxicity

potentially life-threatening medical emergency caused by antipsychotics s/s include autonomic nervous system instability and delirium with altered mental status **medical emergency

schizophrenia epidemiology

prevalence of childhood-onset is about 1 in 40,000. affects all races and cultures equally. diagnosed more frequently in males (1.4:1) between ages 15-25, among individuals growing up in urban settings, and is associated with poorer functioning and more structural abnormality of the brain. onset in women tends to be 25-35 years old and tend who have better prognosis and experience less structural changes in the brain

persistent depressive disorder (PDD)

previously known as dysrhythmic disorder; milder form of depression that usually has an early onset (childhood/adolescence) and lasts at least 2 years for adults (1 year for children). contains at least 3 clinical findings of depression - must have depressed mood and a combination of decreased appetite/overeating, insomnia/hypersomnia, low energy, poor self-esteem, difficulty thinking, hopelessness; and can later in life become major depressive disorder

diagnosis for bipolar

primary consideration is the prevention of exhaustion, then risk for injury

outcomes for bipolar

primary outcome is injury prevention ex: be well hydrated, maintain stable cardiac status, maintain/obtain tissue integrity, get sufficient sleep and rest, demonstrate thought self-control with aid of staff or medication, make no attempt at self-harm

addiction

primary, chronic disease of brain reward, motivation, memory and related circuitry disease of dysregulation in the hedonic (pleasure-seeking) or reward pathway of the brain individuals are unable to consistently abstain from the substance or activity; also unable to recognize the extent to which its creating serious problems in functioning, interpersonal relationships and emotional responses there are cycles of relapse and remission; ultimately without treatment it's progressive and often results in disability or premature death

catatonia

pronounced decrease or increase in the amount of movement. muscular rigidity/catalepsy may be so severe that limbs remain in whatever position they are placed alterations in behavior

motor retardation

pronounced slowing of movement alterations in behavior

postvention (suicide)

providing mental healthcare and support to these survivors

advanced practice nurse interventions for alcohol use disorder

psychotherapy: cognitive behavioral therapy helps patients to explore thinking patterns so that the core belief system and any irrational core beliefs can be identified, as well as any positive and negative consequences of alcohol use are explored. motivational interviewing: approach based on the trans-theoretical or changes of change theory; uses person-centered approach to strengthen motivation for change; usually meet for an hour at a time. 5 stages: - pre-contemplation: need assistance admitting there is a problem - contemplation: acknowledged the problem, but not ready to commit to addressing it - preparation: getting ready to make a change - action: changes are taking place - maintenance: ongoing commitment to a recovery problem; without this phase, individual is likely to relapse

brief psychotic disorder

psychotic manifestations that last 1 day to one month in duration; must include one: delusions, hallucinations, disorganized speech, disorganized or catatonic behaviors

schizophrenia

psychotic thinking or behavior present for at least 6 months. areas of functioning including school or work, self-care and interpersonal relationships are significantly impaired

echopraxia

purposeful imitation of movements made by others alterations in behavior

CAGE-AID

questions are the same as CAGE, but refers to adapted to include drugs (AID) alcohol assessment

impaired impulse control

reduced ability to resist impulses alterations in behavior

concreteness

reduces one's ability to understand and respond to concepts requiring abstract reasoning such as love or humor; can make it hard to pick up social cues such as sarcasm

positive prognosis of schizophrenia

reducing frequency, intensity and duration of relapse

mood stabilizers (bipolar)

refers to class of drugs used to treat symptoms associated with bipolar disorder; treat mania and some meds treat depression ex: lithium

continuation phase of bipolar disorder

remission of manifestations treatment is generally 4-9 months goal: relapse prevention through education, education adherence and psychotherapy

automatic obedience

responding in a robot-like manner alterations in behavior

continuous substance abuse

results in actual changes in the brain structure and brain function

second-generation antipsychotics (suicide)

risperidone, olanzapine **preferred over first generation due to decreased adverse effects complications: agitation, dizziness, sedation, sleep disruption client ed: maintain healthy diet and exercise regularly to minimize weight gain

second generation/atypical antipsychotics

risperidone, olanzapine, quetiapine, ziprasidone, clozapine used for both positive and negative symptoms in schizophrenia complications: metabolic syndrome, orthostatic hypotension, anticholinergic effects, agitation, dizziness, sedation, sleep disruptions, mild EPS (tremors), elevated prolactin levels, sexual disfunction client ed: to minimize weight gain, follow healthy, low calorie diet, exercise regularly, monitor weight. adverse effects include: agitation, dizziness, sedation, sleep disruption - notify your doctor if you experience any of these. blood tests are needed to monitor agranulocytosis

DEA drug schedule

schedule 1: high potential for abuse and have no acceptable medical use; ex: heroin, LSD schedule 2: high potential for abuse, are considered dangerous, available only by prescription; ex: methadone, demerol, ritalin schedule 3: low to moderate potential for misuse, available only by prescription; ex: testosterone, Tylenol with codeine, buprenorphine (Suboxone) schedule 4: low risk drugs, available by prescription; ex: alprazolam (Xanax), lorazepam (Ativan), propoxyphene/acetaminophen (darvocet) schedule 5: limited quantities of certain narcotics for treatment of diarrhea, coughing and pain; ex: atropinedyphenoxylate (lomotil), guaifenesin and codeine (robitussin ac), pregabalin (Lyrica), OTC meds

alcohol use disorder

sedative, but creates an initial feeling of euphoria, related to decreased inhibitions DSM-5 criteria says severity is based on number of symptoms - mild (2-3), moderate (4-5), severe (6+) within a 12 month period: - alcohol is often taken in larger amounts or over a longer period than was intended - there is a persistent desire or unsuccessful efforts to cut down or control alcohol use - a great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects - craving or a strong desire or urge to use alcohol - recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school or home - continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol - important social, occupational or recreational activities are given up or reduced because of alcohol use - recurrent alcohol use in situations in which it is physically hazardous - alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol - tolerance as defined by either of the following: (a) a need for markedly increased amounts of alcohol to achieve intoxication or desired effect, (b) a markedly diminished effect with continued use of the same amount of alcohol - withdrawal as manifested by either of the following: (c) the characteristic withdrawal syndrome for alcohol, (d) alcohol (or a closely related substance such as a benzodiazepine) is taken to relieve or avoid withdrawal problems

completed suicide

self injurious acts committed by an individual results in death

substance abuse and mental health administration (SAM-HSA)

serves a dual mission of reducing the impact of substance use and mental illness on communities in US

withdrawal

set pf physiological symptoms that occur when person stops using a substance specific to the substance being used and each substance will have its own characteristic syndrome can be mild or life threatening

negative prognosis of schizophrenia

slow onset (more than 2-3 years), younger age at onset, longer duration between first symptoms and first treatment, longer periods of untreated illness, more negative symptoms

comorbidity - schizophrenia

substance use disorders: alcohol and marijuana anxiety, depression and suicide physical illnesses polydipsia which can cause hyponatremia (water intoxication)

cognitive symptoms

subtle or obvious impairment in memory, attention, thinking, judgment or problem solving

stabilization phase of schizophrenia

symptoms are stabilizing and diminishing. there is movement toward a previous level of functioning. care in outpatient mental health center or partial hospitalization may be needed. outcome: focuses on patient understanding of the illness and treatment, achieving an optimal medication and psychosocial treatment regimen and controlling and/or coping with symptoms and side effects; targets negative and cognitive symptom

affective symptoms

symptoms involving emotions and their expressions

acute phase of schizophrenia

symptoms vary from few and mild to many and disabling. s/s: hallucinations, delusions, apathy, social withdrawal, diminished affect, anhedonia, disorganized behavior, impaired judgement, cognitive regression, functional impairment. symptoms worsen has person has difficulty coping. increased support or hospitalization may be required. outcome: patient safety and stabilization

tobacco use disorder

symptoms: craving, persistent & recurrent use and tolerance; dependence happens quickly withdrawal: distressing; at least 4 of the symptoms occur: irritability, anxiety, depression, difficulty concentrating, restlessness, insomnia; within days of cessation, heart rate decreases by 5-12 beats/min, within first year 4-7 pounds gained treatment: behavioral therapy > teach to recognize cravings and respond to them appropriately; hypnosis; nicotine replacement therapies; antidepressant bupropion > reduces cravings for nicotine; clonidine > decreases sympathetic activity and reduces withdrawal symptoms; varenicline (chantix) > provides some nicotine effects to ease withdrawal symptoms and blocks the effects of nicotine if smoking is resumed

reality testing

the automatic and unconscious process by which we determine what is and is not real

therapeutic procedures for suicide

therapeutic communication: always use a follow up question if the first answer from the patient denies the thought of suicide; establish trust, limit amount of alone time for patient, involve their significant others in treatment, carry out treatment plans for patients who have a comorbid disorder electroconvulsive therapy (ECT): effective in decreasing suicidal ideation in clients who have depressive or psychotic disorder

bipolar disorder - nursing care interventions

therapeutic milieu: provide safe environment during acute phase; assess patient regularly for suicidal thought, intentions and escalating behavior; decrease stimulation without isolating the patient; follow agency protocols for providing patient protection; implement frequent rest periods; provide outlets for physical activity for limited time and does not require high level of concentration or detailed instructions; protect patient from poor judgment and impulsive behaviors maintenance of self-care: monitor sleep, fluid intake and nutrition; provide portable, nutritious food, supervise choice of clothes, give step by step reminders for hygiene and dress communication: use calm, matter of fact, specific approach, give concise explanations, provide for consistency with expectations and limit-setting, avoid power struggles - do not react personally to patient's comments, listen to and act on legitimate patient grievances, reinforce non-manipulative behaviors, use therapeutic communication techniques

suicidal ideation

thinking about personal death - the wish to be dead, considering methods of accomplishing death, formulating plans to carry the act out

T-ACE Questionnaire

tolerance annoyance cut down eye opener alcohol assessment

comorbidity

two or more disorders occurring in the same person at the same time with potential interactions and exertion (worsening) of symptoms

associative looseness

unconscious inability to concentrate on a single thought, can progress to flight of ideas in which the patient's speech moves so rapidly from one thought to another that it's incoherent alternations in speech

bereavement exclusion

until recently, clinicians were advised against diagnosing a person with depression in the first 2 months following a significant loss 1. normal mourning could be labeled pathological 2. psychiatric diagnosis could result in a life-long label 3. unnecessary meds might be prescribed **this no longer applies

pressured speech

urgent or intense speech; resists allowing comments from others pathological speech patterns

mania episode relapse

use of substances (alcohol, cocaine, caffeine) sleep disturbances can come before, be associated with, or be brought on by psychological stressors

substance use and addictive disorders expected findings

use open ended questions - type of substance or addictive behavior - pattern and frequency of substance use - amount of substance use - age at onset of substance use - changes in occupational or school performance - changes in use patterns - periods of abstinence in history - previous withdrawal manifestations - date of last substance use or addictive behavior review of systems: black out or loss of consciousness, changes in bowel movements, weight loss or gain, experience of stressful situation, sleep problems, chronic pain, concern over substance use, cutting down on consumption or behavior

buprenorphine

used to help people reduce or quit use of heroin or other opiates (pain relievers like morphine) opioid partial agonist > produces effects such as euphoria or respiratory depression but with weaker effects side effects: nausea, vomiting, constipation, muscle aches and cramps, insomnia, irritability, fever only used after abstaining from opioids for 12-24 hours and in the early stages of opioid withdrawal

symbolic speech

using symbols instead of direct communication ex: "demons are sticking needles in me" when what they mean is that they are experiencing a sharp pain pathological speech patterns

cyclothymic disorder epidemiology

usually begins in adolescence or early childhood; 15-50% risk that it will develop into bipolar 1 or 2 disoder. major risk factor is having a first degree relative - parent, sibling, child - with bipolar 1

mood stabilizing agents and benzodiazepines - schizophrenia

valproate, lamotrigine, lorazepam used to treat anxiety often found in patients who have psychotic disorders, as well as some positive and negative symptoms nursing actions: use with caution in older adults client ed: med could have sedative effects. case management needed to follow up with patient and family. group, family and individual psycho-education to improve problem solving and interpersonal skills. social skills training focuses on teaching social and ADL skills

nicotine abstinence meds

varenicline, rimonabant

serotonin norepinephrine reuptake inhibitors (SNRIs) - depression

venlafaxine, duloxetine, desvenlafaxine, levomilnacipran: increase amount of these neurotransmitters avialable in the brain for impulse transmission; have little effect on other neurotransmitters and receptors complications: headache, nausea, agitation, anxiety, dry mouth, sleep disturbances, hyponatremia (especially in older patients), weight loss, increased blood pressure, sexual dysfunction contraindications: duloxetine should not be used in patients with hepatic disease or those who consume large amounts of alcohol client ed: med should be discontinued gradually _________ mirtazapine: increases the release of serotonin and norepinephrine > increasing amount of these neurotransmitters available for impulse transmission therapeutic effect occurs sooner and with less sexual dysfunction than SSRI complications: sleepiness that is exacerbated by other CNS depressants, increased appetite, weight gain, elevated cholesterol med is usually well tolerated _____________ trazodone: moderate selective blockade of serotonin receptors > increasing amount of that neurotransmitter available for impulse transmission usually used with another antidepressant complications: sedation (can be used for patient who has insomnia caused by an SSRI - take at bedtime), nausea, insomnia, weight gain, diaphoresis, sexual dysfunction, **priapism (persistent, painful erection) contraindications: those with cardiac disease and hypertension

no-suicidal contract

verbal or written agreement made to nor harm themselves, but instead seek help - not legally binding and should only be used according to facility policy - can be beneficial but should not replace other suicide prevention strategies - can be used as a tool to develop and maintain trust between nurse and patient - is discouraged for patients who are in crisis, under the influence of substances, psychotic, very impulsive and/or very angry or agitated

inhalant use disorder

volatile hydrocarbons are toxic gases inhaled through the nose or mouth and into the bloodstream; household items include solvents for glues/adhesives, propellants found in aerosol cans, thinners (paint, white out), fuels used only for a short time; out of control use symptoms are using more and more, craving, tolerance; can cause failure in major life roles and problems in interpersonal relationships; death from cardiac arrhythmias (specifically butane and propane) intoxication: small doses result in disinhibition, euphoria; high doses result in fearfulness, illusions, auditory and visual hallucinations, distorted body image, apathy, diminished social and occupational functioning, impaired judgment, impulsive and aggressive behaviors; physical symptoms include nausea, anorexia, nystagmus, depressed reflexes, diplopia; high doses can lead to stupor, unconsciousness, amnesia, delirium, dementia and psychosis withdrawal: not considered a disorder in DSM-5, some user do develop withdrawal symptoms when ceasing treatment: does not require treatment; serious and potentially fatal responses can occur such as coma, cardiac arrhythmias, bronchospasm;

tangentiality

wandering off topic or going off on tangents and never reaching the point pathological speech patterns

alcohol induced persisting amnestic disorder

wernicke-korsakoff syndrome: short term memory disturbances; both are caused by thiamine deficency caused by poor nutrtion associated with alcohol use or by malabsorption of nutrients - wernicke's encephalopathy - acute and reversible condition - korsakoff's syndrome - chronic condition with recovery rate of only about 20% both are characterized by altered gait, vestibular dysfunction, confusion and several ocular motility abnormalities (bilateral, not necessarily symmetrical); sluggish reaction to light and anisocoria (unequal pupil size) blackouts: caused by excessive consumption of alcohol followed by episodes of amnesia; a person actively engages in behaviors, can perform complicated tasks and appears normal; due to alcohol's ability to block the consolidation of new memories into ones through the hippocampus and related temporal structure

intoxication

when people are in the process of using a substance to excess can manifest in a variety of ways depending on physiological response of the body to the substance being used terminology is under the influence, intoxicated or high; depends on substance which term to use

word salad

words jumbled together with little meaning or significance to the listener ex: "hip horray, the flip is cast and wide-sprinting in the forest"