Mental Health Exam 2
What medications are used for alzheimer's disease?
1. Cholinesterase inhibitors 2. NMDA receptor antagonists
what percentage of nurses have a substance use disorder?
10%
what percentage of patients with dementia have reversible illnesses if the treatment is initiated before irreversible damage takes place?
15%
what class of medication is chlorpromazine
1st gen antipsychotic
what class of medication is fluphenazine
1st gen antipsychotic
what class of medication is haloperidol
1st gen antipsychotic
what class of medication is perphenazine
1st gen antipsychotic
what class of medication is aripiprazole
2nd gen antipsychotic
what class of medication is quetiapine
2nd gen antipsychotic
what class of medication is risperidone
2nd gen antipsychotic
what class of medication is clozapine
2nd generation antipsychotic
about how many years do patients with AD normally survive?
4-8 years
what percentage of people with AD have major depression?
40%
about how many people in the United States currently have Alzheimer's Disease?
5.8 million
what percentage of patients with a neurocognitive disorder have Parkinson's Disease?
75%
What is Alzheimer's disease?
A decrease in the neurotrasmitter acetylcholine
hypomania
A mild manic state in which the individual seems infectiously merry, extremely talkative, charming, and tireless. it is not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization, and it does not include psychotic features.
What differentiates mood disorder from the typical behavior of adolescence?
A visible manifestation of behavioral change that lasts for several weeks is the best clue for a mood disorder
What is phase 3 of schizophrenia?
Active Psychotic Phase: psychotic symptoms are prominent
what are examples of a CNS Depressant?
Alcohol, benzodiazepines, and cannabis
what are the 4 A's of dementia?
Amnesia Aphasia Agnosia Apraxia
definition of aphasia
An inability to produce or understand speech
Tool to assess Delirium
CAM- Confusion Assessment Method
what do you use to diagnose Alzheimer's Disease
CT scan or MRI
what is Bipolar II Disorder?
Characterized by recurrent bouts of major depression with episodic occurrence of hypomania. May present with symptoms or history of depression or hypomania. The diagnosis may specify whether the current or most recent episode is hypomanic, depressed, or with mixed features.
what class of medication is rivastigmine
Cholinesterase inhibitor
What is cyclothymic disorder?
Chronic mood disturbance of at least 2 years duration, involving numerous periods of elevated mood that do not meet the criteria for a hypomanic episode, and number periods of depressed mood of insufficient severity or duration to meet the criteria for major depressive episode. The individual is never without the symptoms for more than 2 months.
what are examples of a CNS Stimulant?
Cocaine, amphetamines, and caffeine
what is the second most common cause of dementia in the elderly after Alzheimers?
Dementia with Lewy bodies
symptoms of delirium
Difficulty sustaining and shifting attention Extreme distractibility Disorganized thinking Speech that is rambling, irrelevant, pressured, and incoherent Impaired reasoning ability and goal-directed behavior Disorientation to time and place Impairment of recent memory Misperceptions about the environment, including illusions and hallucinations Disturbance in level of consciousness, with interruption of the sleep-wake cycle Psychomotor activity that fluctuates between agitation and restlessness and a vegetative state Emotional instability may be manifested by fear, anxiety, depression, irritability, anger, euphoria, or apathy
All patients with schizophrenia experience the same symptoms. True or False.
False
The exact cause of AD is known. T or F
False
personality change is uncommon in NCD and can be manifested by either an alteration or accentuation of premorbid characteristics. T or F.
False. Personality change is COMMON in NCD.
what is a popular OTC supplement advertised for improving cognitive impairment and symptoms of dementia?
Gingko biloba
what class of medication is isocarboxazid
MAOI
what class of medication is phenelzine
MAOI
what class of medication is selegiline
MAOI
Tools to Assess Dementia
MMSE- Mini-Mental Status Exam
what are screening tools used for substance use disorders?
Michigan Alcohol Screening Test (MAST), CAGE (q's to ask to determine how they view their substance usage), Clinical Institute Withdrawal Assessment Scale (CIWA)- determine the level of detox
what is the 4 stage of AD?
Moderate cognitive decline. The individual may forget major events in personal history, such as his or her child's birthday; experience declining ability to perform tasks, or be unable to understand current news events. He or she may deny that a problem exists by covering up memory loss with confabulation. Depression and social withdrawal are common. The individual requires some assistance to maintain safety.
what is stage 6 of AD?
Moderately severe cognitive decline. Individuals may be unable to recall the name of their spouse and may misidentify people. Disorientation to surroundings is common. The person is unable to manage ADLs without assistance. Delusions often become apparent, such as maintaining the belief that one must go to work even though the person is no longer employed. Urinary and fecal incontinence is common. Sleeping becomes a problem. SUNDOWNING. Communication becomes more difficult, with increasing loss of language skills. Institutional care is usually required at this age.
what class of medication is memantine
NMDA Receptor Antagonist
what is the first stage of AD?
No apparent symptoms. No apparent decline in memory despite changes that are beginning to occur in the brain.
what is phase 1 of schizophrenia?
Premorbid phase: the signs occur before there is clear evidence of illness and may include distinctive personality traits or behaviors. Behavioral indications may include being very shy and withdrawn, having poor peer relationships, doing poorly in school, and demonstrating asocial behavior.
Pseudodementia (depression)
Rapid onset Symptoms present for short time Lack of interest in answering questions May emphasize deficits Marked variability in performing tasks of similar difficulty Mood consistently depressed Neurologic symptoms not present
what class of medication is desvenlafacine
SNRI
what class of medication is duloxetine
SNRI
what class of medication is venlafaxine
SNRI
what class of medication is escitalopram
SSRI
what class of medication is fluoxetine
SSRI
what class of medication is fluvoxamine
SSRI
what class of medication is sertraline
SSRI
what class of medication is Amitriptyline
TCA
what class of medication is imipramine
TCA
what class of medication is nortriptyline
TCA
what is the 3rd phase of Alcohol Use Disorder?
The Crucial Phase: the individual has lost control of their use. Inability to choose whether or not to drink. Binge drinking, lasting from a few hours to several weeks is common. Anger and aggression are common manifestations. Drinking is their total focus, and they are willing to risk losing everything that was once important to maintain the addiction. It is not uncommon for the individual to have experienced the loss of job, marriage, family, friends, and self-respect.
What is the 1st phase of Alcohol Use Disorder?
The Prealcoholic Phase: characterized by the use of alcohol to relieve the everyday stress and tensions of life. Person may have had parents or other adults in their life drinking alcohol. Tolerance develops, and the amount required to achieve the desired effect steadily increases
what is the 4th phase of alcohol use disorder?
The chronic phase. Characterized by emotional and physical disintegration. Usually more intoxicated more often than they are sober. Life-threatening physical manifestations may be evident. Depression and suicidal ideation are not uncommon. Abrupt withdrawal of alcohol can be fatal.
what is the 2nd phase to Alcohol Use Disorder?
The early Alcoholic Phase: begins with blackouts- brief periods of amnesia that occur during or immediately following a period of drinking. It is now a drug that is required by the individual. The individual typically feels enormous guilt and becomes very defensive about his or her drinking. Excessive use of denial and rationalization is evident.
The etiology of depression is unclear. T or F
True
The onset of symptoms of Alzheimer's Disease is slow and insidious, and the course of the disorder is generally progressive and deteriorating. T or F
True
Can severe head injuries increases one's risk for AD or other dementias?
YES
what is schizoaffective disorder?
a condition in which the individual expresses symptoms of a mood disorder as well as symptoms of schizophrenia
what is the definition of dementia (major neurocognitive disorder)?
a disease process in which there is progressive decline in cognitive ability in the presence of clear consciousness. It involves many cognitive deficits and significantly impairs social and occupations functioning.
premenstrual dysphoric disorder
a disorder marked by repeated episodes of significant depression and related symptoms during the week before menstruation. The symptoms of this disorder are severe enough to interfere with one's ability to function socially, at work, or school and they are recurrent for the majority of menstrual cycles over the course of a year.
what is disulfiram?
a drug that can be administered as a deterrent to drinking to individuals who abuse alcohol.
what is group therapy?
a form of therapy in which a number of people meet together to work toward therapeutic goals
definition of ineffective coping
a pattern of invalid appraisal of stressors, with cognitive and/or behavioral efforts, that fails to manage demands related to well-being
definition of psychosis
a severe mental condition in which there is disorganization of the personality, deterioration in social functioning, and loss of contact with, or distortion of, reality. There may be evidence of hallucinations and delusional thinking. It can occur with or without the presence of organic impairment
definition of intoxication
a state of disturbance in cognition, perception, behavior, level of consciousness, judgment, and other functions that is directly attributable to the effects of a psychoactive drug. It may be marked by a physical and mental state of exhilaration and emotional frenzy or lethargy and stupor
what is the definition of neurocognitive?
a term used to describe cognitive functions closely linked to particular areas of the brain that have to do with thinking, reasoning, memory, learning, and speaking.
what is the onset of vascular NCD?
abrupt, and changes in the thought processes occur in noticeable "steps" downward rather than as a gradual deterioration.
what is the greatest risk factor for AD?
age
definition of mania
alteration in mood that may be expressed by feelings of elation, inflated self-esteem, gradiosity, hyperactivity, agitation, racing thoughts and accelerated speech. It can occur as part of the psychiatric disorder bipolar disorder, as part of some other medical conditions, or in response to some substances
causes delirium
always caused by something else: metabolic, electrolyte imbalances, infections, withdrawal
what is the most common neurobehavioral symptom following a head trauma?
amnesia
depression
an alteration in mood expressed by feelings of sadness, despair, and pessimism. There is a loss of interest in usual activities, and somatic symptoms may be evident. Changes in appetite, sleep patterns, and cognition are common.
what are symptoms of cannabis withdrawal?
anger, aggression, irritability, anxiety, sleep difficulty, decreased appetite, restlessness, depressed mood, abdominal pain, tremors, sweating, fevers, headache
what is the treatment for opioid overdose?
aspirate secretions, mechanical ventilation, Naloxone (Narcan), Methadone
symptoms of frontotemporal NCD
behavioral and personality changes speech and language problems
somatic
believe body is changing in an usual way
being controlled
believes a force outside of their body is in control
magical thinking
believes their actions or thoughts are able to control a situation or affect others
thought broadcasting
believes their thoughts can be heard by others
grandeur
believes they are all powerful and important
thought insertion
believes thoughts are being put into their mind
what are reversible causes of NCD?
brain tumors, subdural hematomas, medication reactions, normal pressure hydrocephalus, vitamin/nutritional deficiences, poisoning, anoxia, central nervous system infections, immune disorders.
withdrawal symptoms of stimulant use disorder
called "crashing." chills, muscle cramps, aching, depression (can last for months)
what is the psychoanalytic theory of depression?
caused by the loss of a loved object (death or rejection)
causes dementia
cerebral atrophy, neuritic plaques, neurofibrillary tangles, genetics
what is Major Depressive Disorder?
characterized by depressed mood or loss of interest or pleasure in usual activities, impaired social and occupational functioning that has existed for at least 2 weeks, no history of manic behavior, and symptoms that cannot be attributed to use of substances or a general medical condition. The presence of anxiety and severity of suicide risk may be noted.
what class of medication is donepezil
cholinesterase inhibitor
what class of medication is galantamine
cholinesterase inhibitor
what are long-term effects of alcohol consumption?
cirrhosis, pancreatitis
definition of addiction
compulsive or chronic requirement. The need is so strong as to generate distress if left unfulfilled
definition for denial
conscious or unconscious attempt to disavow the knowledge or meaning of an event to reduce anxiety and/or fear, leading to the detriment of health
what is the definition of confabulation?
creating imagery events to fill in memory gaps
confabulation
creation of answers to protect the ego
positive symptoms of schizophrenia
delusions and hallucinations, neologisms, clang associations, word salad, perservation, illusions, echopraxia
what is delusional disorder?
delusions lasts 1 month or longer. Grandiose, persecutory, somatic, and/or referential delusions. Usually not severe enough to impair occupational or daily functioning.
what is withdrawal treatment for alcohol use disorder?
diazepam, chlordiazepoxide, IV lorazepam
what are the symptoms of alcohol intoxication?
disinhibition of sexual or aggressive impulses, mood lability, impaired judgment, impaired social or occupation functioning, slurred speech, incoordination, unsteady gait, nystagmus, and flushed face.
Symptoms of inhalant intoxication
dizziness, ataxia, euphoria, excitation, disinhibition, nystagmus, blurred vision, double vision, slurred speech, hypoactive reflexes, psychomotor retardation, lethargy, generalized muscle weakness, stupor or coma
what are symptoms of opioid intoxication?
drowsiness, slurred speech, bradycardia, hypotension, pinpoint pupils, hypothermia, intense drowsiness, coma
intoxication symptoms of stimulant use disorder
elation, euphoria, sensitive, anxious, tense, hypervigilant, angry, psychotic, aggressive
The Dopamine Theory in schizophrenia?
excess of dopamine and too many dopamine receptors throughout the brain. There is excess dopamine in the limbic system and decrease in the prefrontal cortex
persecution
fees singled out for harm by others
what are interventions for delirium
find underlying cause and keep safe; decrease stimulation, have family stay with pt, verbally orient, place in room close to nurse station, place block and calendar in the room, explain events, frequent reassurance, calm structured environment, simple answers, consistent assignment of caregivers, involve family in care
what is cognitive theory of depression?
focuses on helping the individual alter mood by changing the way he or she thinks. The individual is taught to control negative thought distortions that lead to pessimism, lethary, procrastination, indecisiveness, and low self-esteem.
Predisposing Factors to Substance-Related Disorders
genetics, personality traits, cognitive factors, social learning, cultural and ethnic influences
What are examples of an opioid?
heroin and morphine
what are symptoms of cannabis intoxication?
impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgement
Common behavioral symptoms of frontotemporal NCD are
impulsive (disinhibited) or bored and listless (apathetic) and includes inappropriate social behavior; lack of social tact; lack of empathy; distractibility; loss of insight into the behaviors of oneself and others; an increased interest in sex; changes in food preferences; agitation or, conversely, blunted emotions; neglect of personal hygiene; repetitive or compulsive behavior, and decreased energy and motivation
when was the term schizophrenia coined?
in 1908 by the Swiss psychiatrist Eugen Bleuler, derived from the Greek skhizo ("split") and phren ("mind")
when does symptoms of schizophrenia generally appear?
in late adolescence or early adulthood, but can occur in middle or late adult life.
definition of apraxia
inability to carry about purposeful motor activities despite intact motor function and the inability to use objects properly
what are symptoms of depression in an adolescent?
inappropriately expressed anger, aggressiveness, running away, deliquency, social withdrawal, sexual acting out, substance abuse, restlessness, and apathy, loss of self-esteem, sleeping and eating disturbances, and psychosomatic complaints. This is very similar to the normal emotional stresses of growing up.
what is Persistent Depressive Disorder (dysthymia)?
individuals with this mood disturbance describe their mood as sad or "down in the dumps." No evidence of psychotic symptoms. The essential feature is a chronically depressed mood for most of the day, for at least 2 years.
what is the etiology of vascular NCD?
interruption of blood flow to the brain; high BP causes the small strokes in the brain
what is counseling?
it is goal-directed, one-to-one basis. The focus is on current reality, development of a working treatment relationship, and strengthening ego assets. The counselor assists the individual to accept that the use of substances causes problems in significant life areas and that he or she is not able to prevent these problems. The individual works to gain self-control and abstain from substances.
what is the cause of frontotemporal NCD?
it is unknown, but a genetic factor appears to be involved.
What does Lewy body NCD do differently than AD?
it tends to progress more rapidly, with earlier appearance of visual hallucinations and parkinsonian features
what is stage 7 of AD?
late stage AD very severe, completely dependent with ADLs, rigidity which may lead to contractures, speech severely impaired and eventually loss usually aphasic.
Dementia is...
long-term, progressive, irreversible
aphasia
loss of language ability
amnesia
loss of memory impairment
apraxia
loss of purposeful movement in the absence of motor/sensory impairment
Speech symptoms that occur in frontotemporal NCD are
loss of speech or increasing difficulty in using and understanding written and spoken language. Spatial skills and memory remain intact, but the disease progresses steadily and often rapidly
what is bipolar I disorder?
manic episodes with or without major depressive episodes, The diagnosis is further specified by the current or most recent behavioral episode experienced. Psychotic or catatonic features may also be noted.
treatment for stimulant use disorder
medical detox. To counteract CNS stimulant, use a depressant
validation therapy
meet them in their world. What the pt is saying is heard, caregiver listens and understands frustration. Not "presenting reality"
what is the definition of delirium?
mental state characterized by an acute disturbance of cognition, manifested by short-term confusion, excitement, disorientation, and clouded consciousness. Hallucinations and illusions are common.
what is the third stage of AD?
mild cognitive decline. changes in thinking and reasoning that interfere with work performance and become noticeable to coworkers. Concentration may be interrupted. There is difficulty recalling names or words, which becomes noticeable to family and close associates. A decline occurs in the ability to plan or organize.
ideas of reference
misconstrues trivial events personal significance to them
what is stage 5 of AD?
moderately severe cognitive decline. Individuals lose the ability to independently perform some ADLs, such as hygiene, dressing, and grooming. They forget adresses, phone numbers, and names of close relatives. Become disoriented to time and place, but they maintain knowledge about themselves. Withdrawal and self-absorption are common.
what class of medication is Lamotrigine
mood stabilizer
what class of medication is carbamazepine
mood stabilizer
what class of medication is lithium carbonate
mood stabilizer
what class of medication is valproic acid
mood stabilizer
Wernicke's encephalopathy
most serious form of thiamine deficiency in alcoholics. Symptoms include paralysis of the ocular msucles, diplopia, ataxia, somnolence, and stupor. If thiamine replacement therapy is not given quickly, death will ensue.
symptoms of NMS
muscle rigidity, high fever, autonomic instability and cognitive changes (delirium)
ataxia definition
muscular incoordination
what does a MRI show in the brain of an Alzheimer's patient?
numerous neurofibrillary tangles and senile plaques in the brains of clients with AD.
mood
pervasive and sustained emotion that may have a profound influence on a person's perception of the world. Examples of mood include depression, joy, elation, anger, and anxiety.
definition of withdrawal
physiological and mental readjustment that accompanies the discontinuation of an addictive substance
what is phase 2 of schizophrenia?
prodromal phase: the signs are differentiated from premorbid signs in that prodromal symptoms more clearly manifest as signs of developing schizophrenia than do premorbid signs. begins with a change from premorbid functioning and extends until the onset of frank psychotic symptoms. The individual begins to show signs of significant deterioration in function. Social withdraw is not uncommon, and signs of cognitive impairment may begin to emerge.
symptoms of EPS
pseudoparkinsonism stooped posture pill rolling foot shuffling muscle rigidity dystonia tardive dyskinesia
alcohol treatment and abstinence
recognize indications of relapse, family therapy medications: disulfiram, acamprosate, naltrexone
what is the transactional model of depression?
recognizes combined effects of genetic, biochemical, and psychosocial influences on individual's susceptibility to depression
catatonia
refers to certain motor behaviors characteristic of some people with schizophrenia.
perservation
repetition of same topic or words
what is phase 4 of schizophrenia?
residual phase: usually follows the active phase of the illness. Positive symptoms may be improved, but negative symptoms remain, and flat affect and impairment in role functioning are common during this phase.
what are types of withdrawal therapy?
rest, adequate nutritional support, and medication assisted treatment with drugs such as methadone and buprenorphine
what is the most important nursing diagnosis in patient with schizophrenia?
risk for suicide
Delirious Mania
serious form of the disorder characterized by severe clouding of consciousness and an intensification of the symptoms associated with acute mania.
delirium is...
short-term, reversible
What are the cognitive symptoms of vascular NCD caused by?
significant cerebrovascular disease
what are symptoms of alcohol intoxication?
slurred speech, altered consciousness, lack of concentration, sexual or aggressive impulses, mood lability
meds used to treat delirium
small doses of antipsychotic, antianxiety symptom management
flat affect
someone who lacks emotional expression and is often seen in severely depressed clients
what is the object loss theory of depression?
suggests that depressive illness occurs as a result of having been abandoned by or separated from a significant other during the first 6 months of life
what are symptoms of alcohol withdrawal?
symptoms: hallucinations, insomnia, lack of appetite, diaphoresis, hypertension, hallucinations Provide client safety: seizure precautions Medications: diazepam, carbamazepine, chlordiazepoxide
Korsakoff's psychosis
syndrome of confusion, loss of recent memory, and confabulation in acoholics. Treatment is parenteral or oral thiamine replacement
predisposing factors of delirium
systemic infections, febrile illness or hyperthermia, metabolic disorders (electrolyte imbalances, hypercarbia, hypoglycemia, hyponatremia), hypoxia and COPD, hepatic failure and renal failure, head trauma, seizures, migraine headaches, brain abscess or brain neoplasms, stroke, nutritional deficiency, uncontrolled pain, burns, heat stroke, orthopedic and cardiac surgeries, social isolation, emotional stress, physical restraints, admission to an intensive care unit
what are symptoms of opioid withdrawal?
tachycardia, hypertension, increased RR, dilated pupils, bone and muscle pain, enlarged pupils, runny nose, vomiting, diarrhea, diaphoresis
definition of tolerance
the amount required to achieve the desired effect continually increases
what is stage 3 to treating codependency
the core issues stage: the recovering codependent must face the fact that relationships cannot be managed by force of will. The goal of this stage is to detach from the struggles of life that exist because of prideful and willful efforts to control things that are beyond the individual power to control.
what is the first step in the treatment of delirium?
the determination and correction of the underlying causes. Additional attention must be given to fluid and electrolyte status, hypoxia, anoxia, and diabetic problems.
affect
the external, observable emotional reaction associated with an experience.
what is stage 2 for treating codependency?
the reidentification stage: occurs when the individuals are able to glimpse their true selves through a break in the denial system. They accept their limitations and are ready to face the issues of codependence
what is the 4th stage to treating codependency
the reintegration stage: this is a stage of self-acceptance and willingness to change when codependent relinquish the power over others that was not rightfully their to reclaim the personal power they do possess. Control is achieved through self-discipline and self-confidence.
what is the 1st stage in treating codependency?
the survival stage: codependent persons must begin to let go of the denial that problems exist or that their personal capabilities are unlimited. very emotional and painful period
what is the purpose of Peer Assistance Programs?
these programs strive to intervene early, reduce hazards to clients. and increase prospect for the nurse's recovery.
what is the learning theory of depression?
those who have had numerous failures (real or perceived) abandon attempts to succeed, and thus have depressive symptoms
The symptoms of delirium usually begin abruptly following a head injury or seizure. T or F
true
which condition is referred to as a mixed disorder?
vascular NCD
what is the second stage of AD?
very mild changes. individual begins to lose things or forget names of people. Individual is aware of the intellectual decline and may feel ashamed, becoming anxious and depressed. The symptoms are often not noticed by others and do not interfere with the individual's ability to plan or organize.
when are individuals considered to have a substance use disorder?
when the addiction interferes with the ability to fulfill role obligations at work, school, or home
negative symptoms of schizophrenia
withdrawn, flat affect, narrow range of expression, poverty of thought or speech (alogia), lack of motivation (avolition), lack of feeling pleasure (anhedonia), lack of energy (anergia)
