N471 Exam 1

Trihexyphenidyl (Artane) and benztropine (Cogentin) - _____ drugs used to treat what? - can also treat what? - abuse of _____ drugs is a problem because they can cause an ____ altered _____

- Anticholinergic drugs used to treat Parkinson's disease - can also treat Extrapyramidal side effects - abuse of antiparkinsonian drugs is a problem because they can cause an enjoyed altered sensorium (getting high)

concrete vs abstract thinking? give an example

"The grass is always greener on the other side of the fence" Abstract thinking - abstract interpretation: it always seems we would be happier given other circumstances Concrete thinking - interpreting or perceiving things in a literal manner - difficult to recognize social cues and sarcasm - interpretation: that side gets more sun, so it's greener there

Antidepressants: Tricyclic Antidepressants (TCAs) - ____ ____ and ____ reuptake by the ____ ____ terminals - by ____ ____ mechanism, ____ and ____ levels are _____, which may ___ mood and _____ depression

- Block norepinephrine & serotonin reuptake by the adrenergic nerve terminals - By blocking reuptake mechanism, norepinephrine & serotonin levels are increased, which may elevate mood and reduce depression

Social Influences of Mental Health Care

- Consumer movement/recovery - National Alliance on Mental Illness (NAMI) - Surgeon General's report on mental health - Human Genome Project - New Freedom Commission on Mental Health - Institute of Health - Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative - Research Diagnostic Criteria (RDoC) Initiative

Mental Illness - disorders with ___ ____ - significant ____ in mental _____ r/t _____, _____, and _____ disturbances - ____ defined

Disorders with definable diagnosis Significant dysfunction in mental functioning related to ØDevelopmental ØBiological ØPhysiological disturbances Culturally defined

Antianxiety and Hypnotic Drugs: - what are the Short-acting sedative-hypnotic sleep agents called? - give one example (not on study guide)

"Z-hypnotics" ØZolpidem (Ambien) ØZaleplon (Sonata) ØEszopiclone (Lunesta)

What is the name of the class of Antianxiety and Hypnotic Drugs? List examples of drugs in this class (what is their suffix) (not on study guide)

*Benzodiazepines* (*-pam/lam*) ØDiazepam (Valium) ØClonazepam (Klonopin) ØAlprazolam (Xanax) ØLorazepam (Ativan) ØFlurazepam (Dalmane) ØTemazepam (Restoril) ØTriazolam (Halcion) ØEstazolam (ProSom) ØQuazepam (Doral)

Major Depressive Disorder Key Assessment Findings - ____ mood and ____ - _____ - _____ - psychomotor ____ or _____ - _____ signs - ____ pain

- Depressed mood and anhedonia - Anergia (abnormal lack of energy) - Anxiety - Psychomotor agitation or retardation - Vegetative signs - Comorbidity: chronic pain

Antidepressants: Serotonin & Norepinephrine Reuptake Inhibitors (SNRIs)

- Desvenlafaxine - Duloxetine (Cymbalta) - Venlafaxine (Effexor) - Levomilnacipran

First-Generation Antipsychotics - MOA? - targets what? has little effect on what? - advantage? Side Effects - _____: acute ____, _____, ____ ____, _____ - ____ side effects: urinary ____, ____ pupils, ____, _____vision, _____ - orthostatic _______, ______ - weight ____, ____ dysfunction, _____ disturbances

- Dopamine antagonists (D2 receptor antagonists) - Target positive symptoms of schizophrenia, but have little effect on negative symptoms Advantage - Less expensive than second generation Side effects - Extrapyramidal side effects (EPS): acute dystonia, pseudoparkinsonism, tardive dyskinesia, akathisia - Anticholinergic (ACh) side effects (urinary retention, dilated pupils, constipation, blurred vision, tachycardia) - orthostatic hypotension, sedation - Weight gain, sexual dysfunction, endocrine disturbances

Dangerous Side Effects to Antipsychotics - ___ ____ - _____ ______ syndrome - _____ - ____ _____ - _____ impairment

- ACh (anticholinergic) toxicity - Neuroleptic malignant syndrome (NMS) - Agranulocytosis - QT prolongation - Liver impairment

Major Depressive Disorder: Areas to Assess - ____ - _____ processes - _____ - _____ - _____ changes - _____ behavior

- Affect - Thought processes - Mood - Feelings - Cognitive changes - Physical behavior

First-Generation Antipsychotic Drugs - also referred to as ____ antipsychotics or _____ antipsychotics - these drugs are strong _____ - these drugs are most effective on what symptoms of schizophrenia? ____ of _____ receptors for: - _____ - ______ - ______ List 2 significant side effects

- Also referred to as conventional antipsychotics and typical antipsychotics - these drugs are strong antagonists (blocks the action) - these drugs are most effective on the "positive" symptoms of schizophrenia Antagonists of muscarinic receptors for ØAcetylcholine ØNorepinephrine ØHistamine Significant side effects ØWeight gain ØSedation

List 7 examples of TCAs

- Amitriptyline (Elavil) - Desipramine (Norpramin) - Doxepin (Sinequan) - Imipramine (Tofranil) - Notriptyline (Pamelor) - Clomipramine (Anafranil) - Protriptyline (Vivactil) *A*ll *D*octors *D*ress *I*n *N*ice *C*olorful *P*ants

List the primary risk factors for depression - what gender? - ____ childhood ____ - ____ life ____ - ____ family ____ with ____ _____ disorder - _____ - _____ abuse - _____, _____ disorders - ____/____ medical conditions

- Females - Adverse childhood events ("ACEs") - Stressful life events (such as death, divorce, & poverty) - Immediate family members with Major Depressive disorder - Neuroticism (Negative personality traits characterized by anxiety, fear, moodiness, worry, envy, frustration, jealousy, loneliness) - Substance abuse - Anxiety, personality disorders - Chronic/disabling medical conditions

Nontherapeutic Communication Techniques - giving ___ ___ - ____ feelings - ___ reassurance - asking ___ ___ - asking ____ ___ - giving ____ or ____ - changing the ____

- Giving premature advice - Minimizing feelings - False reassurance - asking "why" questions - asking excessive questions - giving approval or disapproval - changing the subject

symptoms of mania - inflated ____-____ or ____ - ____ need for ____ - ____ or _____ speech - ____ of ____ - _____ - _____ involvement in goal-directed activities or psychomotor ______ - _____ involvement in ____ risky activities

- Inflated self-esteem or grandiosity - Decreased need for sleep - Increased or pressured speech - Flight of ideas - Distractibility - Increased involvement in goal-directed activities or psychomotor agitation - Excessive involvement in pleasurable risky activities (i.e. unrestrained shopping sprees, sexual indiscretions)

Nursing Assessment of Bipolar Disorder: Assessing characteristics of Mania, list them - _____ - _____ - _____ processes and ____ patterns, ____ content - _____ function

- Mood - Behavior - Thought processes and speech patterns, thought content - Cognitive function

Bipolar Disorders - mood ___ from profound ___ to extreme _____ (_____) with ____ periods of normalcy - ____ or ____ may or may not be present - onset of symptoms may show _____ patterns - nearly all ____ disorders may be associated with ____ __&__

- Mood swings from profound depression to extreme euphoria (mania) with intervening periods of normalcy - Delusions or hallucinations may or may not be present - Onset of symptoms may show seasonal pattern - Nearly all anxiety disorders may be associated with bipolar 1 & 2

Transcranial Magnetic Stimulation - _____ - uses ___-strength ____ ____ to stimulate ____ areas of the ____ ____ - what is the only contraindication? - no ____ deficits or ____ problems have been ____ Adverse reactions - ____ and ____ - ____ rarely - most side effects are ____ and include ____ ____ and discomfort at the administration _____

- Noninvasive - Uses MRI-strength magnetic pulses to stimulate focal areas of the cerebral cortex - Presence of metal in area of stimulation is the only contraindication (cochlear implants, brain stimulators, medication pumps) - No neurological deficits or memory problems have been noted Adverse reactions - Headache and lightheadedness - Seizures rarely - Most side effects are mild and include scalp tingling and discomfort at the administration site

What is the role of the psychiatric nurse and the mental health worker? How do they differ?

- Psychiatric mental health RN: focus is on mental health and mental illness; may not be certified in psychiatric mental health nursing; roles: treating responses to psychiatric disorders, coordinating care, counseling, giving meds, providing education mental health worker (mental health specialists, psych technicians): include nursing assistants, function under the direction and supervision of RNs; provide assistance to pts in meeting basic needs

Third-Generation Antipsychotics - really a ___ of the _____ - ____ system ____ - may improve what symptoms? - may improve ___ function - ____ risk of ____ or tardive ____

- Really a subset of the SGAs - Aripiprazole (Abilify), brexpiprazole (Rexulti), and cariprazine (Vraylar) - Dopamine system stabilizers - May improve positive and negative symptoms and cognitive function - Little risk of EPS or tardive dyskinesia

Clinical Picture: Schizophrenia - Schizophrenia affects what percent of adults - characterized by ____ --> altered ___, ____, and _____ _____ - 75%: develop ___, presenting at __ to __ yrs of age - child-onset and late-onset are more ____

- Schizophrenia affects 1% of adults - Characterized by psychosis ØAltered cognition, perception, and reality testing (impaired ability to determine what is or not real) - 75%: Develop gradually, presenting at 15 to 25 years of age - Child-onset and late-onset are more rare

Clozapine - what class? - has the potential to suppress _____ marrow and induce _____ - regular measurement of absolute ____ count is necessary - has the potential for inducing ____ - ____ not likely

- Second-generation antipsychotic - has the potential to suppress bone marrow and induce agranulocytosis - regular measurement of absolute neutrophil count is necessary - has the potential for inducing convulsions - EPS not likely

Selective serotonin reuptake inhibitors (SSRIs) - selectively ____ ____ of ____ by ___ ____, making more ____ ____ in the ____ - an ____ _____ level may ____ the patient's ____ and ____ _____

- Selectively inhibits reuptake of serotonin by CNS neurons, making more serotonin available in the synapse - An elevated serotonin level may elevate the patient's mood and reduce depression

Schizophrenia Comorbidity - ____ abuse disorders: many pts with schizophrenia have ____ dependence - ____, _____, _____ - ____ illnesses are more common among people with schizophrenia than in the general population - ____ occurs in 20% of individuals with schizophrenia and it causes _____ (aka ____ _____)

- Substance abuse disorders: many pt's with schizophrenia have Nicotine dependence - Anxiety, depression, and suicide co-occur frequently in schizophrenia - Physical illnesses are more common among people with schizophrenia than in the general population - Polydipsia occurs in 20% of individuals with schizophrenia and causes hyponatremia (aka water intoxication)

Carbamazepine - class? - indication? - MOA? - what tests/labs need to be obtained/monitored? - common side effects: ____ effects, ____, ____, _____ - serious adverse effects: ____ ____, _____-_____ syndrome - FDA requires ____ testing before this drug is used in people of ____ descent

- class: anticonvulsant - indication: useful in treating acute mania - mechanism of action: reduces firing rate of overexcited neurons by reducing the activity of sodium channels - baseline liver function tests, CBC, EKG, and electrolyte levels should be obtained - blood levels are monitored to avoid toxicity - common side effects: anticholinergic effects (dry mouth, constipation, urinary retention, blurred vision), orthostasis, sedation, ataxia - serious adverse effects: exfoliative dermatitis, Stevens-Johnson syndrome - FDA requires genetic testing before this drug is used in people of Asian descent

Electroconvulsive Therapy (ECT) - the most ____ _____ treatment - ____ illnesses are the ____ most common ____ for ECT - pt given general ____ to induce ___ and a ____-____ agent to prevent ____ ____ and ____ ECT is the primary treatment in: - severe ____, _____, and ____ d/t lengthy ____ - ECT is often more ___ than ____ with certain ____ conditions - ____ _____ - failure of ____ medication ____ - _____ with ____ ECT improves ____-____ capacity

- The most effective depression treatment - psychotic illnesses are the second most common indication for ECT - pt given general anesthetic to induce sleep and a muscle-paralyzing agent to prevent muscle distress and fractures ECT the primary treatment in - Severe malnutrition, exhaustion, and dehydration due to lengthy depression - ECT is often more Safer than meds with certain medical conditions - Delusional depression - Failure of previous medication trials - Schizophrenia with catatonia Improves decision-making capacity

Antidepressants: list Monoamine oxidase inhibitors (MAOIs)

- Tranylcypromine (Parnate) - Isocarboxazid (Marplan) - Phenelzine (Nardil) - Selegiline (Eldepryl, EMSAM)

Therapeutic use of self - use ____ ____ and in full ____ - attempt to establish ____ - structured ____ ____ - we all have ____ ___ that we can learn to use ___ to form ____ ____ with others. the use of these ___ to promote ____ in others is referred to as the ___ use of ___

- Use personality consciously and in full awareness - Attempt to establish relatedness - Structure nursing interventions - we all have distinct gifts (unique personality traits and talents) that we can learn to use creatively to form positive bonds with others. the use of these gifts to promote healing in others is referred to as the *therapeutic use of self*

Blurring Boundaries-- name 2 circumstances in which boundaries are blurred - when the relationship ___ into a ____ ____ - when the nurse's ____ are ___ at the ____ of the patient's ____

- When the relationship slips into a social context - When the nurse's needs are met at the expense of the patient's needs

Therapeutic Milieu - ___-_____ term that recognizes the ___, the ___, the ___, and the ____ climate as ___ to ____ - a well-managed milieu offers patients a ___ of ____ and promotes ____ - structured aspects of milieu include ____, rules, _____ orientation, practices, and _____

- all-inclusive term that recognizes the people, the setting, the structure, and the emotional climate as important to healing - a well-managed milieu offers patients a sense of security and promotes healing - structured aspects of milieu include activities, rules, reality orientation practices, and environment

Second-Generation Antipsychotics - also known as what? - MOA? - target ____ and ____ symptoms of ______ - ____ to no ___ or _____ ____ - side effects: significant ____ ____, risk of ____ ____, ____, _____ dysfunction, _____ - often chosen as ____-____ antipsychotics because they are equally effective for ____ symptoms and also help ____ symptoms

- also known as atypical antipsychotics - Serotonin (5-HT2A receptor) and dopamine (D2 receptor) antagonists - Target both positive and negative symptoms of schizophrenia - minimal to no EPS or tardive dyskinesia - Side effects: significant weight gain; risk of metabolic syndrome; sedation, sexual dysfunction, seizures - Often chosen as first-line antipsychotics because they are equally effective for positive symptoms and also help negative symptoms

Extrapyramidal side effects (EPS) - blockage of __ _____ in both ____ and ____ symptoms cause EPS - EPS includes what 3 conditions?

- blockage of D2 receptors in both limbic and motor symptoms cause EPS - EPS includes: --> acute dystonia --> akathisia --> pseudoparkinsonian

how does caffeine affect mania in bipolar disorder: - caffeine is a ___ _____ that ____ needed ___ or ____ - caffeine ___ ____ - ___ of ____ can lead to ____ and ____ ____

- caffeine is a CNS stimulant that inhibits needed rest or sleep - caffeine worsens insomnia - lack of sleep can lead to exhaustion and increase mania

Major Depressive Disorder - characterized by a _____ ______ mood lasting for a _____ of ___ ____ - Chronic: lasting ___ than ___ ____ - ____ episodes common - episode not ____ to another ____ condition/_____ effects - absence of a ____ or ____ episode

- characterized by a persistently depressed mood lasting for a minimum of 2 wks - Chronic: Lasting more than 2 years - Recurrent episodes common - episode not attributed to another medical condition/physiological effects - Absence of a manic or hypomanic episode

Olanzapine (Zyprexa) - class? - MOA? - side effects: ____, weight ____, ______ w/ new onset ___, higher risk of ___ syndrome

- class: 2nd generation antipsychotic - mechanism of action: antagonist of 5-HT2 (serotonin), D2, H1, alpha-1, and muscarinic receptors - side effects: sedation, weight gain, hyperglycemia w/ new onset T2DM, higher risk of metabolic syndrome

Risperidone (Risperdal) - class? - MOA? - side effects: ____ dysfunction, _____ hypotension, ____, weight ___ - serious adverse effect: ___

- class: 2nd generation antipsychotic - mechanism of action: dopamina-2 receptor antagonist and it blocks alpha-1 and H1 receptors - side effects: sexual dysfunction, orthostatic hypotension, sedation, weight gain - serious adverse effects: EPS

Lamotrigine - class? - indication? not effective in treating what? works well in treating what? - MOA: modulates the ___ of ____ and _____ - list 1 serious adverse effect

- class: anticonvulsant - indication: maintenance therapy in bipolar disorder, not effective in acute mania. works wells in treating the depression of BPD - MOA: modulates the release of glutamate and aspartate - serious adverse effects: Stevens-Johnson syndrome

Valproate (Depakote) - class? - indication? - list 3 common side effects: ____, weight ____, ____ - list 4 serious side effects: ____, _____, ____ failure, birth ____ - what needs to be monitored?

- class: anticonvulsant - indication: mixed episodes of bipolar disorder - common side effects: tremor, weight gain, sedation - serious side effects: thrombocytopenia, pancreatitis, hepatic failure, birth defects - Baseline levels are measured for *liver function tests* and *CBC* before an individual is initiated on this med and lab monitoring is repeated periodically. In addition, therapeutic *blood level of the drug* is monitored

Lithium - class? - MOA: ___, may affect ____ ____ in ____ - adverse effects: list 11 - what needs to be monitored?

- class: mood stabilizer - mechanism of action: MOA unknown, may affect electrical conductivity in neurons - adverse effects: tremor, ataxia, convulsions, N&V, diarrhea, arrythmias, polyuria, polydipsia, edema, goiter, hypothyroidism - lithium blood levels need to be monitored on a daily basis to ensure that the drug is not accumulating and rising to dangerous levels

Side effects of antipsychotic medication - ____ mouth - urinary ____ - _____ - ___ vision - _____ toxicity - ______ - acute _____ - _____ - tardive ______ - _____/orthostatic ____ - ______ - _____ impairment - _____ _____ syndrome - _____ syndrome (no ___, no ___, no ___, no ___)

- dry mouth - urinary retention - constipation - blurred vision - anticholinergic toxicity - pseudoparkinsonism - acute dystonia - akathisia - tardive dyskinesia - hypotension/orthostatic hypotension - agranulocytosis - liver impairment - neuroleptic malignant syndrome - metabolic syndrome no see (blurred vision), no spit (dry mouth), no pee (urinary retention), no poop (constipation)

Symptoms of Serotonin Syndrome - ____ or ____ - what happens to HR? BP? temp? - ____ mental ____ - ____, ____ swings, _____ - _____ - _____, incoordination, ____ rigidity - ___ pain, ____, bloating - _____ - __&__ - _____

- hyperactivity or restlessness - tachycardia - fever - elevated blood pressure - altered mental status - irritability, mood swings, hostility - seizures - myoclonus, incoordination, tonic rigidity - abd pain, diarrhea, bloating - apnea - N&V - diaphoresis

Antidepressants: Monoamine oxidase inhibitors (MAOIs) - ____ the enzyme ____ ____, which normally ____ ____ neurotransmitters (____ and _____) - MAOI ____ ____ of ____ ____ and ____ level of these ____ in the ____ - inability to ___ down ____ _____ can result in a serious problem - ____ ____ intake can cause severe ____ ____ leading to ____ ____

- inhibits the enzyme monoamine oxidase, which normally breaks down neurotransmitters (serotonin and norepinephrine) - MAOI blocks action of monoamine oxidase and increases level of these neurotransmitters in the synapse - inability to break down tyramine sufficiently can result in a serious problem - High tyramine intake can cause severe hypertensive crisis leading to cerebrovascular accident

Major Depressive Disorder Epidemiology - leading cause of ____ in the US - depression in ___ adults is ____, but it is not a ____ result of aging - risk of depression _____ as health _____

- leading cause of disability in the US - depression in older adults is common, but it is not a normal result of aging - risk of depression increases as health deteriorates

SNRIs Side Effects and Warnings - list 7 side effects Match the following warnings to their correct SNRI medication a) discontinuation syndrome b) neonate with in uteroexposure have required respiratory support and tube feeding c) may increase effects of anticoagulants d) may reduce pain associated with depression

- nausea - headache - insomnia - dry mouth - sweating - constipation or diarrhea Warnings - Desvenlafaxine: neonate with in uteroexposure have required respiratory support and tube feeding - Duloxetine: may reduce pain associated with depression - Venlafaxine: discontinuation syndrome - Levomilnacipran: may increase effects of anticoagulants

How is DSM-V different from NANDA-I-Approved Nursing Diagnoses?

- nursing diagnosis is a clinical judgement concerning a human response to health conditions/life processes, or vulnerability for that response by an individual, family, group, or community - DSM-V is used to diagnose a psychiatric disorder - nursing diagnosis provides the framework for identifying appropriate nursing interventions for dealing with the patient's reaction to the disorder

Serotonin Syndrome - one ___ and ___-____ event associated with _____ - side effect that occurs when ____ _____ to ____ level in ___ in patients receiving a drug ____ _____ ____ or with combination of other ____

- one rare and life-threatening event associated with SSRIs - Side effect that occurs when serotonin accumulates to toxic level in CNS in patients receiving a drug inhibiting serotonin reuptake or with combination of other drugs

Bipolar Assessment: What contributes to danger to self or others: - patients may not ___ or ____, often for ___ at a time - ____ impulse ____ may result in ____ to others or ____

- patients may not sleep or eat, often for days at a time - poor impulse control may result in harm to others or self

Neuroleptic malignant syndrome (NMS) - ____ consciousness and ____ - ____ muscle ____ - _____ dysfunction - what happens to HR, T, RR, and BP? What is the mnemonic used?

- reduced consciousness and responsiveness - increased muscle tone - autonomic dysfunction - increased HR, Temp, RR - increased or decreased BP *F*ever *A*MS *L*eukocytosis *T*remors *E*levated CPK *R*igidity

Risk factors of schizophrenia: Brain Structure Abnormalities - ____ volume in right anterior ____ (may contribute to ____ symptoms) - ____ volume and changes in the shape of the _____ - ____ age-related ____ in cortical ____ - gray matter ____ in different areas of the _____ - ____ connectivity among various brain regions - neuronal _____ - widespread ____ matter abnormalities - ____ rate of blood flow and ___ metabolism in prefrontal _____

- reduced volume in right anterior insula (may contribute to negative symptoms) - reduced volume and changes in the shape of the hippocampus - accelerated age-related decline in cortical thickness - gray matter deficits in different areas of the brain - reduced connectivity among various brain regions - neuronal overgrowth - widespread white matter abnormalities - lowered rate of blood flow and glucose metabolism in prefrontal cortex

Injectable antipsychotics for schizophrenia - side effects can be ____ and ___ easily managed when medication is administered ____ - with ___-_____ injectables, some may need to be administered every __-__ wks or once every __ mo; by requiring ___ frequent medication administration, adherence is ____ and conflict about taking meds is ____ - disadvantage: lack of dosing _____; and pts may feel like they have ___ control and are _____

- side effects can be intensified and less easily managed when medication is administered IM - with long-acting injectables, some may need to be administered every 2-4 wks or once every 3 mo; by requiring less frequent medication administration, adherence is improved and conflict about taking meds is reduced - disadvantage: lack of dosing flexibility and pts may feel like they have less control and are coerced

What are the early warning signs of relapse in schizophrenia: - ____ disturbances - _____ thoughts - ____ thinking or ____ - being ___ of what is ____ - _____ voices - becoming more _____ around _____

- sleep disturbances - troubling thoughts - difficulty thinking or remembering - being unsure of what is real - hearing voices - becoming more uncomfortable around others

valbenazine capsules (Ingrezza) - medication that treats what? - ____ the severity of abnormal ____ _____ - list 2 adverse effects

- treats tardive dyskinesia in adults - reduces the severity of abnormal involuntary movements - adverse effects: sleepiness, QT prolongation

Electroconvulsive Therapy (ECT) for Bipolar Disorder - used to subdue severe ____ behavior, esp in pts with treatment-____ ____ and pts with ____ ____ - ECT seems to be far more ____ than ____-based therapy for treatment-_____ bipolar _____ - _____ episodes are an indication for this treatment

- used to subdue severe manic behavior, esp in pts with treatment-resistant mania and pts with rapid cycling (i.e. those who experience 4 or more episodes/year) - ECT seems to be far more effective than drug-based therapy for treatment-resistant bipolar depression - depressive episodes are an indication for this treatment

Therapeutic Communication Techniques - using ____ - active ____ - ____ techniques - asking ____

- using silence - active listening - clarifying techniques (reflecting, paraphrasing, exploring, etc) - asking questions

List 3 anticonvulsant drugs that are useful in the treatment of bipolar disorders

- valproate - carbamazepine - lamotrigine

Metabolic Syndrome Symptoms - wt ____ - _____ - ____ blood ____ - ____ resistance - increases risk of ____, cancers, ____, CVD

- weight gain (especially in the abdominal area) - dyslipidemia - increased blood glucose - insulin resistance - increases risk of diabetes, cancers, hypertension, CVD

Describe and give examples of Congruence and Incongruence of verbal and nonverbal communication

- when the content is congruent with the process, the communication is more clearly understood and is considered healthy - verbal and nonverbal *congruent* behavior example: a student says "it's important that I get good grades in class" (this is content). if the student has bought the books, takes good notes, and has a study buddy, that is process. therefore, the content and process are congruent and straightforward, and there is a health message - verbal and nonverbal incongruent behavior example: a student says "it's important that i get good grades in class" and does not have the bools, skips class, and does not study; the content and the process do not match (the student's verbal and nonverbal behaviors are incongruent)

how long do antidepressant drugs take to work?

1-3 weeks or longer

NAMI - what does it stand for? - this organization advocates for those with ____ ____ - educates _____ about ____ ____ - offers ____ groups

The National Alliance on Mental Illness - the organization advocates for those with mental illness - educates families about mental illnesses - offer support groups

Lethality of Suicide Plan 3 main elements to consider when evaluating lethality 1. is there a specific ___ with ____ 2. how ___ is the proposed ___ 3. is there ___ to the ___ method People who have definite ___ for the ___, ____, and ____ are at highest risk

3 main elements to consider when evaluating lethality: 1. is there a specific plan with details 2. how lethal is the proposed plan 3. is there access to the planned method People who have definite plans for the time, place, and means are at highest risk

Eric becomes anxious and says, "There are worms under my skin eating the hair follicles." How would you classify this assessment finding? A.Positive symptom B.Negative symptom C.Cognitive symptom D.Depressive symptom

A

Which assessment finding represents a negative symptom of schizophrenia? A.Apathy B.Delusion C.Motor tic D.Hallucination

A

Diathesis-Stress Model - AKA what? - Diathesis: _____ _____ - Stress: ____ stress or ____ - most accepted ____ for mental ____ - combination of ____ ____ and _____ environmental ____ - assertion: most psychiatric disorders result from a combination of ____ ____ and ____ environmental _____

AKA nature vs nurture - Diathesis—biological predisposition - Stress—environmental stress or trauma - Most accepted explanation for mental illness - Combination of genetic vulnerability and negative environmental stressors - Assertion: Most psychiatric disorders result from a combination of genetic vulnerability and negative environmental stressors

Resilience - ability and _____ to secure ____ needed to support ___-____ - characterized by: ____, sense of ____, _____ - essential to ____

Ability and capacity to secure resources needed to support well-being Characterized by ØOptimism ØSense of mastery ØCompetence Essential to recovery

Traits of Mental Health-- Ability to: - think ____ - communicate ____ - ____ - grow ____ - be ____ - have a healthy ___-____ - realistic ____ and reasonable ____ w/in the individual's ____

Ability to ØThink rationally ØCommunicate appropriately ØLearn ØGrow emotionally ØBe resilient ØHave a healthy self-esteem ØRealistic goals and reasonable function within the individual's role

Adverse reactions of SSRIs antidepressants: - ____ dysfunction - ___ effects - _____ - _____ - weight ____ - _____ syndrome Warnings of SSRIs: _____ syndrome (____, _____, _____) may occur with ____ ____; taper ____

Adverse Reactions: - Sexual dysfunction - GI effects - Insomnia - take dose early in the day - Headaches - Weight Loss - Serotonin syndrome Warnings: Discontinuation syndrome (dizziness, insomnia, nervousness) may occur with abrupt withdrawal; taper slowly

Schizophrenia: Positive Symptoms Alterations in ____ ____ - _____: false, ____ ____ held despite ____ of ____ to ____ them - alterations in ____, perception, or ______

Alterations in reality testing ØDelusions—false, fixed beliefs held despite lack of evidence to support them ØAlterations in speech, perception, or behavior

Psychobiological Interventions for Schizophrenia _____ medications - list 3 types ______ _____ - list 2 types

Antipsychotic medications ØFirst-generation ØSecond-generation ØThird-generation Injectable antipsychotics ØShort-acting ØLong-acting

Schizophrenia: Affective Symptoms Assessment for ____ is crucial because it may indicate: - an ____ ____ - _____ ____ abuse - _____ ____ risk - further impairs _____

Assessment for depression is crucial because it may indicate: ØAn impending relapse ØIncreases substance abuse ØIncreases suicide risk ØFurther impairs functioning

List 6 Suicide Risk Factors

Biological Factors Psychological Factors Environmental Factors Cultural Factors Societal Factors Other risk factors: race, religion, marriage, profession, physical health

Suicide Risk Factors: Biological Factors - _____ tendency - ____ ____ gene expression - ____ ____ levels

Biological Factors - Familial tendency - Lowered SKA2 gene expression - Low serotonin levels (are r/t depressed)

Risk Factors of Bipolar Disorder _____ factors - ____: BPD tends to run in ____; the lifetime risk for individuals with an affected ____ is __-__% greater - _____ - _____ _____ factors ______ factors

Biological Factors - genetic: BPD tends to run in families; the lifetime risk for individuals with an affected parent is 15-30% greater - neurobiological - neuroendocrine Psychological factors Environmental factors

Etiology/Risk Factors of Schizophrenia ____ factors - ______ _______ - _____ theory - other _____ hypotheses _____ structure abnormalities _____ and _____ factors - _____ stressors - _____ stressors - _____ stressors - ____ considerations

Biological factors ØGenetics Neurobiological ØDopamine theory ØOther neurochemical hypotheses Brain structure abnormalities Psychological and environmental factors ØPrenatal stressors ØPsychological stressors ØEnvironmental stressors ØPrognostic considerations

what are the 3 types of bipolar and bipolar related disorders? Match the following characteristics to their correct disorder a) Highest mortality rate of the three b) more common in males c) more common in females d) Rapid cycling possible e) Most severe form f) usually begins in adolescence or early adulthood g) symptoms so severe, it's a psychiatric emergency h) At least 1 hypomanic episode i) Alternate with symptoms of mild to moderate depression for at least 2 years (adults) j) At least 1 manic episode k) At least 1 major depressive episode l) psychosis possible (esp hearing voices)

Bipolar I disorder - Most severe form - Highest mortality rate of the three - At least 1 manic episode - psychosis possible (esp hearing voices) - symptoms so severe, it's a psychiatric emergency - more common in males Bipolar II disorder - At least 1 hypomanic episode - At least 1 major depressive episode - more common in females Cyclothymic disorder - Alternate with symptoms of mild to moderate depression for at least 2 years (adults) - Rapid cycling possible - usually begins in adolescence or early adulthood

Case Study: Eric M, 18, has always been a good student. How, however, in his second semester of college, he begins, for the first time in his life, to have trouble concentrating. When his family doesn't hear from Eric, they contact the school, only to discover that his roommate says Eric is "talking weird." Asked what he means, the roommate says, "Well, you know, he says stuff that doesn't connect, doesn't make any sense. I asked him if he was high or something, but he said no, and I believed him." On further investigation, Eric's professors say he's been missing class, after starting out so well. Eric's parents arrive on campus, and he agrees to meet with them and a campus counselor. He appears anxious. He expresses sorrow that his grades are suffering, acknowledging that his concentration "just isn't there." He says that he feels "something weird is happening to me" and describes frequent distressing thoughts. He admits to feeling suspicious of everyone he passes. Eric's parents and the counselor both notice what the roommate had described about Eric's speech. Eric agrees to see a psychiatrist and an initial assessment and history indicate that he has only been experiencing some mild changes in his thinking and mood for about a month—ever since returning from the winter holiday. The examiner confirms that his speech is sometimes disorganized and his ability to concentrate and study is diminished from his previous longstanding as a strong student. Given the evidence we have so far, if Eric has schizophrenia, which is suspected, which phase is he most likely experiencing? A.Acute B.Residual C.Prodromal D.Stabilization

C

During assessment, Eric has trouble staying on topic, zipping rapidly from one thought to the next, making it hard to follow what he's trying to say. Which speech disturbance is he exhibiting? A.Pressured speech B.Circumstantiality C.Flight of ideas D.Tangentiality

C

Eric's roommate says his speech "... doesn't connect; it doesn't make any sense. He sort of gets derailed." Which of the following symptoms is Eric displaying? A.Avolitional speech B.Delusional speech C.Disorganized speech D.Diminished emotional expression

C

Schizophrenia Epidemiology - childhood onset schizophrenia: 1 in _____ children No difference r/t - ____ - _____ ____ - ______ More frequently diagnosed: - among ____ - in ____ areas Onset ____ in women (___-___), who tend to have better _____

Childhood-onset schizophrenia: 1 in 40,000 children No difference related to ØRace ØSocial status ØCulture More frequently diagnosed: ØAmong males ØIn urban areas Onset later in women (25-35), who tend to have better prognosis

Suicide Risk Factors: Cultural, Societal, Other Risk Factors Cultural factors: ____ beliefs, ____ values, _____ orientation, gender ____, _____ behavior, and attitude toward ___, have an impact on suicide rates Societal Factors - ____ suicide - suicide ____ Other risk factors: ____, ____, marriage, ____, _____ health

Cultural Factors - cultural factors, including religious beliefs, family values, sexual orientation, gender identity, bullying behavior, and attitude toward death, have an impact on suicide rates Societal Factors - assisted suicide - suicide bombing Other risk factors: race, religion, marriage, profession, physical health

delusions vs hallucinations?

Delusions: Bizarre ideas without foundation Hallucinations: involve perceiving a sensory experience for which no external stimulus exists. (hearing voices when no one is speaking)

A person with schizophrenia can experience Alterations in Perception. Match the following definitions with their positive symptoms. A) a particularly disturbing symptom that directs the person to take an action B)A feeling that the environment has changed. C)experiencing tastes D)hearing voices or sounds E) smelling odors F) misperceptions or misinterpretations of a real experience (ex: a man sees a coat on a shadowy coat rack and believes it is a bear) G)feeling bodily sensations (ex: feeling an insect crawl on one's skin) H) A feeling of being unreal or having lost identity. Body parts do not belong or the body has drastically changed. (ex: a pt may see the fingers as being smaller or not theirs)

Depersonalization: A feeling of being unreal or having lost identity. Body parts do not belong or the body has drastically changed. (ex: a pt may see the fingers as being smaller or not theirs) (*H*) Derealization: A feeling that the environment has changed. (*B*) Hallucinations ØAuditory: hearing voices or sounds (*D*) ØVisual: seeing people or things ØOlfactory: smelling odors (*E*) ØGustatory: experiencing tastes (*C*) ØTactile: feeling bodily sensations (ex: feeling an insect crawl on one's skin) (*G*) ØCommand: a particularly disturbing symptom that directs the person to take an action. (*A*) Illusions: misperceptions or misinterpretations of a real experience (ex: a man sees a coat on a shadowy coat rack and believes it is a bear) (*F*)

Chapter 1 Mental Health and Mental Illness PPT

Describe the continuum of mental health and mental illness. Explore the role of resilience in the prevention of and recovery from mental illness and consider resilience in response to stress. Identify how culture influences the view of mental illnesses and behaviors associated with them.

Chapter 26: Crisis

Differentiate between the two types of crisis and provide an example of each. Identify six aspects of crisis that have relevance for nurses involved in crisis intervention. Develop a handout describing areas to assess during crisis. Include at least two sample questions for each area. Compare and contrast the differences among primary, secondary, and tertiary intervention, including appropriate intervention strategies.

Chapter 3: Psychobiology and Psychopharmacology

Discuss major functions of the brain and how psychotropic drugs can alter these functions. Identify how specific brain functions are altered in certain mental disorders (e.g., depression, anxiety, schizophrenia). Describe how a neurotransmitter functions as a chemical messenger. Describe how the use of imaging techniques can be helpful for understanding mental illness.

Possible effects of receptor binding of antidepressant medications. Match the following effects to their corresponding mechanism of action: a) sedation/drowsiness b) dry mouth c) constipation d) decrease/reduce depression e) hypotension f) priapism g) postural hypotension h) dizziness i) blurred vision j) antianxiety effects k) tremors l) tachycardia m) reduce suicidal behavior n) erectile/ejaculatory dysfuction o) antipsychotic effects p) psychomotor activation q) reflex tachycardia r) memory dysfunction s) urinary retention t) weight gain u) blurred vision v) GI disturbances w) sexual dysfunction x) antiparkinsonian effects y) sinus tachycardia

Dopamine reuptake inhibition - decrease depression - psychomotor activation - antiparkinsonian effects H1 Block - sedation/drowsiness - hypotension - weight gain ACh block - blurred vision - dry mouth - constipation - sinus tachycardia - urinary retention alpha-2 block - priapism alpha-1 block - postural hypotension - dizziness - reflex tachycardia - memory dysfunction NE reuptake inhibition - reduce depression - tremors - tachycardia - erectile/ejaculatory dysfunction 5-HT reuptake inhibition - reduce depression - antianxiety effects - GI disturbances - sexual dysfunction 5-HT2 block - reduce depression - reduce suicidal behavior - antipsychotic effects - hypotension - ejaculatory dysfunction

Lithium Toxicity Symptoms and Interventions Match the following characteristics to their level of toxicity a) Lithium 2.0-2.5 mEq/L b) Lithium 1.5-2.0 mEq/L c) Lithium > 2.5 mEq/L d) giddiness e) coma f) oliguria g) hand tremor h) confusion i) hyperirritability of muscles j) convulsions k) GI upset l) sedation m) severe hypotension n) blurred vision o) ataxia p) clonic movements q) death can occur r) interventions: in addition to interventions above, hemodialysis may be used is severe cases s) interventions: medication should be withheld, blood Li levels measured, and dosage reevaluated t) interventions: hospitalization is indicated. the drug is stopped, and excretion is hastened. whole bowel irrigation may be done to prevent further absorption of lithium u) incoordination v) seizures

Early Signs of Toxicity (Lithium 1.5-2.0 mEq/L) - GI upset - hand tremor - confusion - hyperirritability of muscles - sedation - incoordination - interventions: medication should be withheld, blood Li levels measured, and dosage reevaluated Advanced Signs of Toxicity (Lithium 2.0-2.5 mEq/L) - ataxia - giddiness - blurred vision - clonic movements - seizures - severe hypotension - coma - interventions: hospitalization is indicated. the drug is stopped, and excretion is hastened. whole bowel irrigation may be done to prevent further absorption of lithium Severe Toxicity (Lithium > 2.5 mEq/L) - convulsions - oliguria - death can occur - interventions: in addition to interventions above, hemodialysis may be used is severe cases

Empathy vs Sympathy

Empathy - occurs when the helping person attempts to understand the world from the patient's perspective - we understand the feelings of others Sympathy - we feel pity or sorrow for others

Suicide Risk Factors: Environmental Factors - ____-stress model: combination of ____ ____ and significant ____ - ____ suicides follows a highly ____ ___ of a public ___, an ___, or a ____ in the community --> ____ are at a high risk for ____ suicides d/t their ____ prefrontal cortex (the portion of the brain that controls the executive functions involving ____, ____ tolerance, and ____ control)

Environmental Factors - Diathesis-stress model—combination of suicidal fantasies and significant loss - Copycat suicides follows a highly publicized suicide of a public figure, an idol, or a peer in the community --> adolescents are at high risk for copycat suicides d/t their immature prefrontal cortex (the portion of the brain that controls the executive functions involving judgement, frustration tolerance, and impulse control)

Antipsychotic Drugs Strong _____: - bind to ___ receptors - ____ attachment of ____ - ____ _____ transmission

First-generation, conventional, typical of standard antipsychotic drugs Strong antagonists (blocking agents) ØBind to D2 receptors ØBlock attachment of dopamine ØReduce dopaminergic transmission

First-generation vs second-generation antipsychotics - what symptoms of schizophrenia do each target or not target?

First-generation: Target positive symptoms of schizophrenia, but have little effect on negative symptoms Second-generation: Target both positive and negative symptoms of schizophrenia

DSM-5 Criteria for Major Depressive Disorder Five or more of the following symptoms in a __-week period - ___ ____ or _____ changes - _____ disturbances - _____ - _____ or _____ - loss of ability to _____ - recurrent thoughts of ____ PLUS at least one symptom is also either - ____ mood or - loss of ____ or _____ (_____)

Five or more of the following symptoms in a 2-week period - Weight loss and appetite changes - Sleep disturbances - Fatigue - Worthlessness or guilt - Loss of ability to concentrate - Recurrent thoughts of death PLUS—at least one symptom is also either - Depressed mood or - Loss of interest or pleasure (anhedonia)

Lethality of a method: hard methods vs soft methods - list examples of each method - which is higher and lower risk?

Hard methods (higher risk) - using a gun - jumping off a high place - hanging - poisoning with carbon monoxide - staging a car crash Soft methods (lower risk) - cutting one's wrists - inhaling natural gas - ingesting pills

Chapter 12: Schizophrenia Spectrum Disorders

Identify the schizophrenia spectrum disorders. Discuss at least three of the neurobiological findings that indicate that schizophrenia is a brain disorder. Differentiate among the positive and negative symptoms of schizophrenia in terms of treatment and effect on quality of life.

In unmedicated patients with schizophrenia, PET scans may show a ____ use of ____ in the ____ lobes

In unmedicated patients with schizophrenia, PET scans may show a decreased use of glucose in the frontal lobes

Risk and Protective Factors - ____ attributes and behaviors - social and ____ circumstances - ____ factors

Individual attributes and behaviors Social and economic circumstances Environmental factors

ICD-10-CM - what does it stand for? Clinical descriptions of mental and ____ disorders - __ ___ classifications - _____

International Classification of Diseases, 10e Clinical descriptions of mental and behavior disorders Ø2 broad classifications ØSubclassifications

Mood Stabilizers - list 1 mood stabilizer - list 4 anticonvulsant drugs

Lithium (Eskalith, Lithobid) Anticonvulsant drugs ØValproate (Depakote, Depakene) ØCarbamazepine (Equetro, Tegretol) ØLamotrigine (Lamictal) ØGabapentin (Neurontin)

Schizophrenia Phase I Acute: Implementation - psychiatric, _____, and ____ evaluation - _______ treatment - support, _____, guidance - supervision and limit setting in the ____ - monitor ___ intake - working with _____ --> regularly assess for ___ and take ____ measures

ØPsychiatric, medical, and neurological evaluation ØPsychopharmacological treatment ØSupport, psychoeducation, and guidance ØSupervision and limit setting in the milieu ØMonitor fluid intake ØWorking with aggression •Regularly assess for risk and take safety measures

Types of Crisis - describe the 3 different types of crisis

Maturational Crisis - New developmental stage is reached - Old coping skills no longer effective - Leads to increased tension and anxiety Situational Crisis - arises from events that are extraordinary, external rather than internal, and often unanticipated - ex: loss or change of job, death of a loved one, divorce Adventitious Crisis - not a part of everyday life - caused by events that are unplanned and may be accidental, caused by nature or human-made - results from natural disaster, national disaster (terrorism, wars, plane crashes), crime of violence (child abuse, murder in workplace)

Anosognosia People with ______ often experience anosognosia - inability to ___ they are ____ - caused by the ____ itself - may result in ____ to or ____ of treatment - often combined with ____ so that accepting help is _____

People with schizophrenia often experience anosognosia ØInability to realize they are ill ØCaused by the illness itself ØMay result in resistance to or cessation of treatment ØOften combined with paranoia so that accepting help is impossible

Factors that affect Communication ____ factors - pts may have difficulty _____ d/t ____ disorder - ____ barriers - ____ disorders _____ factors - ____ noise - lack of ____ _____ factors - refer to the level of ____ w/in the ____ - complementary _____: ___ person has ____ ____

Personal factors: - pts may have difficulty communicating d/t a psychiatric disorder - language barriers - cognitive disorders Environmental factors - background noise - lack of privacy Relationship factors - relationship factors refer to the level of equality w/in the relationship - complementary relationship: one person has more control (i.e. nurse and patient)

Phases of Crisis Match the following descriptions to their correct phase: a) If the trial-and-error attempts fail, then anxiety can escalate to severe and panic levels. b) Person confronted by conflict that threatens self-concept responds with increased anxiety. c) If the usual defensive response fails and if threat persists, then anxiety escalates. Trial-and-error begins. d) If the problem is not solved and new coping skills are ineffective, then anxiety can overwhelm the person and lead to serious illness; assess for suicidal thoughts.

Phase 1: Person confronted by conflict that threatens self-concept responds with increased anxiety. Phase 2: If the usual defensive response fails and if threat persists, then anxiety escalates. Trial-and-error begins. Phase 3: If the trial-and-error attempts fail, then anxiety can escalate to severe and panic levels. Phase 4: If the problem is not solved and new coping skills are ineffective, then anxiety can overwhelm the person and lead to serious illness; assess for suicidal thoughts.

Phases of Schizophrenia 1. ______: ____ of schizophrenia, ____ changes 2. _____: _____ of symptoms 3. _____: symptoms _____; _____ toward ____ level of _____ 4. _____ or _____: new ____ is _____

Prodromal Ø mild changes in thinking, reality testing, and mood - onset; minimal changes Acute ØExacerbation of symptoms Stabilization ØSymptoms stabilizing and diminishing ØMovement toward previous level of functioning Maintenance or residual ØNew baseline is established

Suicide Risk Factors: Psychological Factors (list the theorists) - ____: ____ turned ____ - _____ three parts to suicide ____: --> wish to ____ --> wish to be ___ --> wish to ____ - ____ ____: central ____ factor is ____

Psychological Factors - Freud—aggression turned inward - Menninger's three parts to suicide hostility --> Wish to kill --> Wish to be killed --> Wish to die - Aaron Beck—central emotional factor is hopelessness

psychomotor agitation vs retardation Match the following characteristics to their correct term a) facial expressions are decreased b) gaze is fixed c) ex: pacing, nail biting, finger tapping d) movements are extremely slow e) patients commonly feel fidgety and are unable to relax f) may range from slowed and difficult movements to complete inactivity and incontinence

Psychomotor agitation: - patients commonly feel fidgety and are unable to relax - ex: pacing, nail biting, finger tapping Psychomotor retardation: - movements are extremely slow - facial expressions are decreased - gaze is fixed - continuum of psychomotor retardation may range from slowed and difficult movements to complete inactivity and incontinence

Vegetative Signs of Depression Refer to _____ in those activities ____ to ____ _____ life and _____ - ____: ____ loss or ____ in ____ - ____: ____ or ____ - _____ habits: _____, ____ - ____ interest: _____ - ____ and personal ____: markedly ____

Refer to alterations in those activities necessary to support physical life and growth - appetite: appetite loss or increase in eating - sleep: insomnia or hypersomnia (increased sleep) - bowel habits: constipation, diarrhea - sexual interest: declines (libido) - grooming and personal hygiene: markedly neglected

Interventions for Serotonin Syndrome Remove ____ agents Initiate symptomatic treatment - ____-receptor ____ with _____, methysergide, _____ - ____ ____, _____ for _____ - _____, ____ for muscle ____ or ____ - _____ - artificial ____ - induction of _____

Remove offending agents Initiate symptomatic treatment: - serotonin-receptor blockage with cyproheptadine, methysergide, propanolol - cooling blankets, chlorpromazine for hyperthermia - Dantrolene, diazepam for muscle rigidity or rigors - Anticonvulsants - Artificial ventilation - Induction of paralysis

DSM-V - what does it stand for? - official medical ___ of the American ____ Association for diagnosing ___ disorders - based on ____ ____ influenced by ____ clinical field ____

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition - Official medical guidelines of the American Psychiatric Association for diagnosing psychiatric disorders - Based on specific criteria influenced by multiprofessional clinical field trials - DSM-V identifies disorders based on specific criteria

Side effects and Warnings of TCAs - ____ effects - _____ - _____ toxicity - ____ Warnings - ____ often fatal/____ - all TCAs ____ cardiac ____ - all TCAs ____ ____ threshold - use cautiously in ____ adults with ____ disorders, ____ _____ pressure, urinary _____, _____, _____ disorders, and ____ or ____ dysfunction

Side Effects - anticholinergic effects (dry mouth, constipation, blurred vision, urinary retention) - hypotension - cardiac toxicty - sedation Warnings - overdose often fatal/lethal - All TCAs slow cardiac conduction - All TCAs lower seizure threshold - use cautiously in older adults with cardiac disorders, elevated intraocular pressure, urinary retention, hyperthyroidism, seizure disorders, and liver or kidney dysfunction

Monoamine oxidase inhibitors (MAOIs) Side Effects and Warnings Side effects - ____ - ____ - agitation - confusion - _____ crisis Warnings - contraindicated in people taking ____ - used cautiously in people taking ____ - ____-____ food could bring about a ____ ____ - many other strong ____ and ____ interactions

Side effects - insomnia - nausea - agitation - confusion - hypertensive crisis Warnings - contraindicated in people taking SSRIs - used cautiously in people taking TCAs - tyramine-rich food could bring about a hypertensive crisis - many other strong drug and food interactions

Epidemiology of Mental Disorders - Incidence vs Prevalence?

Study distribution of mental disorders ØIdentify high-risk groups ØIdentify high-risk factors *Incidence = number of new cases in a given time* *Prevalence = number of cases regardless of when they began* Lifetime risk = risk that one will develop a disease in the course of a lifetime

T of F: Mania may be substance induced (caused by use or abuse of a drug or substance)

TRUE

NANDA-I, NOC, and NIC - what does each stand for? Match the following descriptions with their corresponding abbreviation: a) Source of standardized outcomes, definitions of these outcomes, and measuring scales b) Provides standardized nursing diagnoses c) Identifies seven domains of nursing intervention

The North American Nursing Diagnosis Association International (NANDA-I) ØProvides standardized nursing diagnoses Nursing Outcomes Classification (NOC) ØSource of standardized outcomes, definitions of these outcomes, and measuring scales Nursing Interventions Classification (NIC) ØIdentifies seven domains of nursing intervention

As a nurse, what should you do if a patients asks you to keep a secret?

The nurse cannot make a such a promise. The information may be important to the health or safety of the patient or others. "I cannot make that promise. It might be important for me to share it with other staff."

As a nurse, what should you do if a patient asks you a personal question?

The nurse may or may not answer the patient's question. If the nurse decides to answer a natural question, the nurse answers in a word or two, then refocus back on the patient.

Lithium therapeutic blood level range?

Therapeutic blood level: 0.8 to 1.4 mEq/L

What leads First-Generation (Conventional) Antipsychotic Drugs to be involved with extrapyramidal side effects (EPS): - these drugs are ____ which results in ____-____ activity - for example, because ____ in the basal ____ plays a major role in the ____ of ____, it is not surprising that ____ _____ can lead to ____ abnormalities known as ____

These drugs are antagonists which results in receptor-blocking activity. For example, because dopamine in the basal ganglia plays a major role in the regulation of movement, it is not surprising that dopamine blockade can lead to motor abnormalities known as EPS

Concepts of the Nurse-Patient Relationship: To establish that the nurse is... - ____ - ____ - ____ - ____ Relationship with ____ _____

To establish that the nurse is - Safe - Confidential - Reliable - Consistent Relationship with clear boundaries

Blurring of Roles: define transference and countertransference

Transference: patient unconsciously and inappropriately displaces onto nurse feelings and behaviors related to significant figures in patient's past - the pt may even say "You remind me of my mother, sister, father, etc..." - Transference intensified in relationships of authority Countertransference: nurse displaces feelings related to people in nurse's past onto patient - Patient's transference to nurse often results in countertransference in nurse - Common sign of countertransference in nurse is overinvolvement with the patient

What happens when you treat bipolar disorder with an antidepressant alone?

Treatment of BPD with a common antidepressant alone increases the risk of bringing on a manic episode The risk vanishes when combining the antidepressant with a mood stabilizer

T or F: Many antidepressants have proven to be effective treatments for anxiety disorders

True

Schizophrenia DSM-V Criteria Two or more of the following for a significant portion of time in 1 month: - ____ - ______ - _____ speech - gross _____ or _____ - _____ symptoms - functional impairment of some kind Continuous disturbance for at least ___ mo

Two or more of the following for a significant portion of time in 1 month: ØDelusions ØHallucinations ØDisorganized speech ØGross disorganization or catatonia ØNegative symptoms (diminished emotional expression or avolition) ØFunctional impairment of some kind Continuous disturbance for at least 6 months

A person with schizophrenia can experience Alterations in Behavior. Match the following definitions with their positive symptoms. a) a pronounced or decrease in the rate and amount of movement b) a pronounced slowing of movement c) excited behaviors such as running or pacing rapidly, often in response to internal or external stimuli d) repetitive behaviors that do not serve a logical purpose e) maintaining a given posture inappropriately, usually seen in catatonia (ex: when the nurse raised the arm, the pt continues to hold this position in a statue-like manner) f) the mimicking of movements of another g) a tendency to resist or oppose the requests or wishes of another h) a reduced ability to resist one's impulses i) assuming unusual or illogical expressions (often grimaces) or positions j) an impaired ability to sense where one's body or influence ends and another's begins (Ex: a pt might stand too close to others or might drink another's beverage, believing that because it is near, it is theirs)

a) Catatonia b) Motor retardation c) Motor agitation d) Stereotyped behaviors e) Waxy flexibility f) Echopraxia g) Negativism h) Impaired impulse control i) Gesturing or posturing j) Boundary impairment

Schizophrenia: Match the following definitions to their correct affect negative symptom. a) Immobile or blank facial expression b) Reduced or minimal emotional response c) Reduced in range or intensity, e.g., shows sadness or anger but no other moods d) Incongruent with the actual emotional state or situation (e.g., laughing in response to a tragedy) e) Odd, illogical, inappropriate, or unfounded; includes grimacing

a) Flat affect b) Blunted affect c) constricted affect d) Inappropriate affect e) Bizarre affect

A person with schizophrenia can experience disorders or distortions of thought. Match the following definitions with their positive symptoms. a) A reduction or stoppage of thought. Interruption of thought by hallucinations can cause this. b) The uncomfortable belief that someone else has inserted thoughts into their brains. c) A belief that thoughts have been taken or are missing. d) Believing that thoughts or actions affect others' consequences. e) An irrational fear, ranging from mild (wary, guarded) to profound (believing irrationally that another person intends to kill you).

a) Thought blocking b) Thought insertion c) Thought deletion d) Magical thinking e) Paranoia

Match the following definitions to their correct Extrapyramidal side effects a) sudden, sustained contraction of one or several muscle groups, usually of the head or neck. can be frightening and painful, but unless they involve muscles affecting the airway, which is rare, they are not dangerous b) a motor restlessness that causes pacing, repetitive movements, or an inability to stay still or remain in one place. c) a temporary group of symptoms that looks like Parkinson's disease: tremor, reduced accessory movements (arms swinging when walking), gait impairment, reduced facial expressiveness, slowing of motor behavior d) a persistent EPS side effect involving involuntary rhythmic movements

a) acute dystonia b) akathisia c) pseudoparkinsonism d) tardive dyskinesia

Match the following definitions with their schizophrenia symptom a) symptoms involving emotions and their expression b) the absence of something that should be present. c) subtle or obvious impairment in memory, attention, thinking, judgement, or problem solving d) the presence of something that should not be present. e) symptoms include the social discomfort, lack of goal-directed behavior, or inability to enjoy activities f) symptoms include hallucinations, delusions, paranoia, or disorganized or bizarre thoughts, behavior, or speech

a) affective symptoms b) negative symptoms c) cognitive symptoms d) positive symptoms e) negative symptoms f) positive symptoms

Schizophrenia: Match the following definitions to their correct negative symptom. a) Loss of motivation; difficulty beginning and sustaining goal-directed activities b) Reduction in speech, sometimes called poverty of speech. c) A decreased interest in, or attention to, activities or beliefs that would otherwise be interesting or important. d) A reduced ability or inability to experience pleasure in everyday life. e) Decreased desire for, or comfort during, social interaction. f) Reduced or constricted affect.

a) avolition b) alogia c) apathy d) anhedonia e) asociality f) affective blunting

A person with schizophrenia can experience alterations in speech. Match the following definitions to their positive symptom a) Words chosen based on sound rather than their meaning (ex: "click, clack, clutch, close") b) Word salad—most extreme form; jumble of words meaningless to a listener c) meaning for the patient only; words that have meaning for the patient but a different or nonexistent meaning to others d) pathological repetition of another's words e) Including unnecessary and often tedious details in conversation, but eventually reaching the point. f) Wandering off topic or going off on tangents and never reaching the point. g) Generalized slowing of thinking, which is represented by delays in responding to questions or difficulty finishing thoughts. h) Urgent or intense and resists comments from others. i) Moving rapidly from one thought to the next, often making it difficult for others to follow the conversation. j) Using symbols instead of direct communication. For example, a patient reports "demons are sticking needles in me" when what he means is that he is experiencing a sharp pain (symbolized by "needles").

a) clang association b) associative looseness c) neologisms d) echolalia e) Circumstantiality f) Tangentiality g) Cognitive retardation h) Pressured speech i) Flight of ideas j) Symbolic speech

As a nurse, what should you do if a patient gives you: a) an expensive gift or money b) an inexpensive gift at the end of hospitalization when a relationship has developed c) an inexpensive gift given at the beginning of the relationship

a) graciously refuse b) graciously accept c) graciously refuse and explore the meaning behind the present: "Thank you, but it is our job to care for our patients. Are you concerned that some aspect of your care will be overlooked?"

Schizophrenia: Match the following definitions to their correct cognitive symptom a) Includes difficulty with reasoning, setting priorities, comparing options, placing things in logical order or groups, anticipation and planning, and inhibiting undesirable impulses or actions. b) Impaired ability to think abstractly, resulting in interpreting or perceiving things in a literal manner. Difficulty responding to concepts like love or humor. (ex: a nurse might ask what brought the pt to the hospital and the pt responds "a cab" rather than explaining a suicide attempt) c) Delayed responses, misperceptions, or difficulty understanding others; may lose the ability to screen out insignificant stimuli; can lead to overstimulation d) Impacts short-term memory and the ability to learn

a) impaired executive functioning b) concrete thinking c) impaired information processing d) impaired memory

agranulocytosis puts the pt at an increased risk for what? as the nurse, you should teach pts to report what?

a) infection b) signs of infection (fever, chills, sore throat)

Patient and Family Teaching: Lithium Therapy a) why should the patient continue to take it even when feeling good? b) fluid intake? c) dietary sodium intake? d) potential risk for medical conditions: talk to provider about having ____, ____, and ____ function checked periodically d/t risk for ____ and decreased ____ function

a) lithium is a mood stabilizer and helps *prevent relapse*. it is important to continue taking the drug even after the current episode subsides b) it is important to maintain a consistent fluid intake (1500-3000 mL/day or six 12-oz glasses of fluid) c) sodium intake can affect Li levels. high sodium intake leads to lower levels of Li and less therapeutic effects. low sodium intake leads to higher Li levels, which could produce toxicity. aim for consistency in sodium intake d) talk to provider about having thyroid, parathyroid, and renal function check periodically d/t risk for hypothyroidism, and decreased kidney function

People with schizophrenia can experience delusions. Match the following definitions to their delusion a) believing that one is being singled out for harm or prevented from making progress by others b) a belief that events or circumstances that have no connection to you are somehow r/t to you c) believing that one is a very powerful or important person d) believing that another person desires you romantically e) the conviction that a major catastrophe will occur f) believing that the body is changing in unusual ways g) believing that another person, group of individuals, or external force controls thoughts, feelings, impulses, or behavior

a) persecutory b) referential c) grandiose d) erotomanic e) nihlistic f) somatic g) control

A patient diagnosed with schizophrenia is most likely to experience which type of hallucination? a) visual b) tactile c) auditory d) olfactory

auditory

define affect

outward expression of a person's internal emotional state

define hypomania - refers to a ___-___ and ____ ____ mania - unlike ____, ____ is ____ present with hypomania

refers to a low-level and less dramatic mania unlike mania, psychosis is never present with hypomania

Schizophrenia Phase II Stabilization and Phase III Maintenance: Interventions - medication administration/_____ - relationships with ____ care ____ - community-based _____ services - ____ and safety - ____ and groups Counseling and communication techniques - intervening with _____, _____, and associative _____ - health ____ and health _____

ØMedication administration/adherence ØRelationships with trusted care providers ØCommunity-based therapeutic services ØTeamwork and safety ØActivities and groups Counseling and communication techniques Ø Intervening with Hallucinations Ø Intervening with Delusions Ø Intervening with Associative looseness ØHealth teaching and health promotion

List 7 neurotransmitters involved in psychiatric illness

ØNorepinephrine ØSerotonin ØDopamine ØGlutamate Øγ-Aminobutyric acid (GABA) ØNeuropeptides ØAcetylcholine

what is the first line of treatment for major depressive disorder? list 2 reasons why

selective serotonin reuptake inhibitors (SSRIs) - low side-effect profile compared with the older antidepressants - they do not create anthicholinergic effects making it easier for pts to take these meds as prescribed

how do Selective serotonin reuptake inhibitors affect libido: stimulation of the _____ receptors in the ____ area may ____ ____ activity in this area, leading to ___ and ___ libido

stimulation of the 5-HT2A receptors in the mesocortical area may decrease dopamine activity in this area, leading to apathy and low libido

List 10 Second-Generation Antipsychotics - suffix?

suffix: -apine or -idone - Clozapine (Clozaril) - Risperidone (Risperdal) - Quetiapine (Seroquel) - Olanzapine (Zyprexa, Zyprexa Relprevv) - Ziprasidone (Geodon) - Aripiprazole (Abilify) - Paliperidone (Invega) - Iloperidone (Fanapt) - Lurasidone (Latuda) - Asenapine (Saphris)

List 9 first generation antipsychotics - suffix?

suffix: -azine - chlorpromazine - thiodidazine - loxapine - perphenazine - fluphenazine - haloperidol - pimozide - thiothixene - trifluoperazine

Least restrictive environment: treatment options are presented in order of ____, beginning with those in the least restrictive environment, that is, the setting that provides the ____ care while allowing the ____ _____ _____

treatment options are presented in order of acuteness, beginning with those in the least restrictive environment, that is, the setting that provides the necessary care while allowing the greatest personal freedom

T or F: nonverbal cues are a better predictor of attitudes and feelings than are words

true

Antidepressant Drugs: List Selective serotonin reuptake inhibitors (SSRIs)

ØFluoxetine (Prozac) ØSertraline (Zoloft) ØParoxetine (Paxil) ØCitalopram (Celexa) ØEscitalopram (Lexapro) ØFluvoxamine (Luvox) *E*ffective: Escitalopram *F*or: Fluoxetine, Fluvoxamine *S*adness: Sertraline *P*anic: Paroxetine *C*ompulsions: Citalopram

Schizophrenia Assessment Guidelines - any ____ problems - _____ problems that mimic _____ - drug or ____ use disorders - ____ status examination - include ____ assessment - assess for _____, _____, _____ risk - assess ability to ensure personal ____ and health - assess ____ meds - assess symptoms' impact on ____ - assess family ____

•Any medical problems •Medical problems that mimic psychosis •Drug or alcohol use disorders •Mental status examination •Include cognitive assessment (e.g., reality testing) •Assess for hallucinations •Assess for delusions •Assess for suicide risk •Assess ability to ensure personal safety and health •Assess prescribed meds •Assess symptoms' impact on functioning •Assess family knowledge