NRS 211 Exam 2

Countertransference

the total emotional reaction of the treatment provider to the patient

Cognitive interventions for depression

thought stopping; positive self-talk

What lab testing to run in bipolar patient

thyroid function, electrolytes

What is the bon bon sign? In what disorder is it found?

tongue rolls around in the mouth and protrudes into the cheek tardive dyskinesia

Catatonic excitement

very hyperactive; running up and down hallway, over and over again; if you ask them to stop, they won't; they have to want to stop on their own; and when they do, it's all of a sudden

Parasuicide

voluntary, apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death

Club drug a/e

Hyperpyrexia

What are you concerned with during opioid detox?

fluid & electrolyte balance because the person has lack of appetite, vomiting, diaphoresis. detox doesn't have to be done in hospital (like alcohol)

Nicotine effects

increased alertness, concentration, attention, and appetite suppression

What does it mean for a patient to become refractory to their medication?

it doesn't have the same effect as it used to. So it may need to be changed.

Psychoanalytic Paradigm

How ind'l views themselves. Low self-esteem, non-assertive (anorexia)

What is serotonin syndrome?

(person has too much serotonin)— autonomic instability (BP increase or decrease [HTN more common]), tachycardia, fever, diaphoresis, muscle rigidity, tremors, confusion, coma, death.

Alcohol withdrawal medications

*Benzos* (drugs of choice: chlordiazepoxide [librium]). Specific protocol for alcohol withdrawal depending on institution). Other benzos used: diazepam (valium), lorazepam (ativan). Person would get these round the clock, maybe up to 5 days, gradually decreasing doses. Others used in combo w/ benzos: •Sleep medications, antidepressants (SSRIs), antipsychotics. Carbamazepine (anticonvulsant). Clonidine/catapress (used to control cardiac symptoms)

Three medications used for opioid addiction treatment

*Buprenorphine:* Also an opiate but don't get an intense high (like you would with heroine) *Suboxone:* Designer drug that doesn't à intense high like in heroine. *Methadone* is also opioid, but not as extreme a high and not as lethargic as heroine, oxycodone, fentanyl.

Issues with TCAs

*Lethal if OD*. *Liver & kidney failure*. Controlled substance (prescribed for 30 days and then need new prescription). *Withdrawal symptoms* if stopped abruptly.

AD Stages 1-3 signs

*Stage 1:* No signs *Stage 2:* Mild cognitive decline, but still may not know person has issues because it may be normal for age-related *Stage 3:* Cognitive decline; person may feel sad, depressed, anxious. Starting to avoid social situations, withdrawing from social activities. Hoarding (because they don't remember where they put things). Cognition: Lack of familiar words/repeat words. Are aware of their behavior and become frustrated.

AD Stage 4-5 signs

*Stage 4:* Moderate cognitive decline. *Stage 5:* Moderate-severe cognitive decline. Need help w/ activities. May over/under eat (majority don't eat). Change in sleep (less sleep).

What other antidepressants are used in depression treatment?

*Wellbutrin (buproprion):* good antidepressive agent; lowers seizure threshold *Remeron:* Decreased sexual side effect *Trazedone:* Can cause priapism

What are negative symptoms in schizophrenia?

*diminished emotional expression and avolition* (lack of interest or motivation in goal-directed behavior, such as getting dressed, going to work or to school) §Affective blunting §Alogia §Anhedonia §Avolition §Attentional impairment

Lithium therapeutic levels

0.6-1.4 mEq/L

How long does it take lithium to reach therapeutic levels?

2-3 weeks

When do delirium tremens typically occur?

24-96h (1-3 days) after last drink

What is the max weekly weight gain you want to see w/ anorexics?

2lb over 1 week the psychological impact of gaining too much weight too fast is unhealthy emotionally for them

How long do TCAs take

4-6 weeks to reach therapeutic effect (up to 8 weeks)

How long should a depressed patient be kept on SSRIs after recovery?

6-12 mo If you take them off too early (sooner than 6 mo), risk of suicide; because they're feeling better, they have energy. When take them off, taper the dose

Alcohol withdrawal syndrome usually occurs how long after abrupt alcohol cessation?

6-12h

How many stages of AD are there?

7

Dependent personality disorder nursing management

: Assessment (increasing self-worth), interpersonal relationship, social behavior, try to promote therapeutic relationship, assertiveness training. Try to help pt have more insight into what's going on (recognize dependent patterns)

Common anorexia nervosa comorbidities

OCD, phobia, panic disorder, & depression

Negativism

A type of thinking where the person says or does the opposite of what you want on purpose

In schizophrenia, what class of medications are often given for odd motor movements?

Anticholinergics (e.g. benztropine)

Tacrine (use, contraindication)

AD Contraindicated in liver dysfunction. Must monitor liver enzymes

Galantamine (use, contraindication)

AD Contraindicated in patient's with liver or renal disease

Memantine (use, a/e)

AD Nausea, diarrhea, insomnia

What is the AIMS scale? Why is it important?

Abnormal Involuntary Movement Scale Records the occurence of tardive dyskinesia in patients receiving neuroleptic medications as soon as you notice ANY movements, report it. They'll evaluate med dosage and probably lower it or maybe give drug holiday or switch medications.

Donepazil (use, a/e)

Alzheimer's a/e: Irregular heartbeat

Name some TCAs used in depression

Amitriptylene, impipromene, desipromene, clomipromene

Methylphenidate (Ritalin)

Amphetamine

Personality disorder definition

An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture §The individual has difficulty adjusting to life §Exhibit inner distress & behavioral problems §Medications have limited role in treatment

NCLEX tip on suicide

Any words that relate to harming oneself is the best type of communication w/ person if you think they're suicidal (ask them directly).

Stilted language

Artificial form of language; inappropriate

Paranoid personality disorder nursing management

Assess quality of interpersonal relationship. Try to develop therapeutic relationship, reinforce personal strengths & assertiveness, try to assist w/ making decisions

Circumstantiality

Ask the person something and they talk in a circle. They talk in details. But they do come around and complete the circle and answer.

How long do antipsychotics take to start working?

At least 3-4 weeks

What dietary restrictions do SSRIs have?

Avoid grapefruit juice

Mild stage of Alzheimer's Disease

Behavior & Mood: •Feeling sad, depressed, or anxious •Avoiding social situations •Hoarding Cognition: •Speech - lack of familiar words, repeats words •Memory problems •Misplaces articles •Aware of behavior •Frustrated

Jealousy delusions

Believe someone is jealous of you

Thought insertion delusions

Believe someone is putting thoughts in their head

Nihilistic delusions

Believe they're dead

How is dystonia treated?

Benzodiazepine (need something that will act quickly; IV) and/or diphenhydramine.

What medication classes are used in bipolar disorder?

Benzos (clonazepam administered upon admission) mood stabilizers, antipsychotics, antidepressants (MAYBE)

Why are benzodiazepines used in bipolar disorder? And when?

Benzos used upon admission to help with acute mania. Put on this along with one of the others (e.g. lithium). May be on it for a month until mood stabilizer takes effect. Clonazepam: Used for acute mania—works fast.

Lamotrigine (lamactil) - use, a/e

Bipolar Stevens-Johnson syndrome (dermatological effect causing rash, epidural necrosis, ataxia, dizziness, moves inside body --> multi-organ failure --> death if untreated

Carbamazepine (tegretol) - use, a/e

Bipolar Watch for *bone marrow suppression* & *agranulocytosis* (increased risk for infection), *thrombocytopenia*.

What does it mean when a schizophrenic is "blocking"?

Blocking is another sign they are experiencing hallucinations. Another sign: they're talking to you then turn away for a few seconds (responding to the other voices) then turn back to you and continue to answer questions. Or, maybe they're in the corner, lips moving.

Opioid signs of withdrawal

Body aching, diarrhea, tachycardia, HTN, fever, rhinorrhea, sneezing, diaphoresis, yawning, nausea, vomiting, nervousness, restlessness, irritability, shivering/trembling, abdominal cramps, weakness, chills, substance craving, lacrimation, piloerection.

Medications for nicotine "detox"

Bupropion and varenicline tartrate (Chantix)

Anorexia nervosa symptoms

Can be life-threatening, electrolyte imbalances are primary issue, esophageal varices, purging behaviors (caused by food coming back up esophagus), GI bleeding, cavities/caries and wasting of enamel (caused by acidic foods coming back up esophagus), decrease in serum Ca levels (<8.5), bradycardia, hypotension, person is susceptible to the cold, Amenorrhea, lanugo (on shoulder blades; fine, long, dark hairs), cardiac arrhythmias (r/t potassium), electrolyte imbalance (Na, K, Ca, BUN, Cr, low sp. gravity [1.002-1.030], WBC [normal: ~4,000], CPK [normal: 10-120], Cl-), thin hair that falls out dual diagnosis (may turn to substance maybe because they're unhappy with body part and think if they take substance [e.g. cocaine] they'll lose weight [and they will, on cocaine]... or alcohol, opiates, etc. It may make them feel good temporarily, but effects and treatment of dual diagnosis are HARDER). 50% are diagnosed w/ depression during illness (or major depression).

Does carbonation of alcohol increase or decrease absorption in body?

Carbonation increases alcohol absorption

What to be concerned with after ECT?

Cardiac arrhythmias

Caffeine stimulates what part of brain?

Cerebral cortex

What was the 1st drug used for schizophrenia? What was an expected s/e?

Chlorpromazine (thorazine)— turns the urine a dark color (expected)

What medications are commonly associated with dystonic reactions?

Chlorpromazine, Haloperidol, and Fluphenazine

Mutism

Choosing not to speak

Selective Abstraction

Choosing to ignore some information I can only be happy 10 lb lighter

Wernicke's encephalopathy symptoms

Confusion, impaired LT, ST memories, shuffling gait, ataxia, neuropathy, vision impairment, hypotension

Why is disordered water balance an issue in schizophrenic patients?

Clients taking in a high fluid volume (4-10 L) experience a drop in serum sodium levels which can result in neurologic signs that can range from ataxia to coma. High fluid intake leads to hyponatremia and low sp gravity

MDMA (ecstasy)

Club drug

Sundowning

Cognitive functioning decreases as sun goes down (increased confusion when dark) - can also happen w/ delirium AD

Club drug physical drug properties

Colorless, odorless, tasteless (can be put in drink and person won't even know they've taken them). Effects are like a blackout (person is awake but they don't remember what happens for short period of time—major safety risk)

Echopraxia

Copy the movements of someone else. E.g. you reach out your hand to them, they reach out their hand to you. You touch your head, they touch their head. Opposed to echolalia: copy the voice of someone

Regressed behavior

Could be childlike behaviors. E.g. throwing a tantrum

Aphasia

Decrease in productive language. *Receptive aphasia:* Person can't receive messages. *Expressive aphasia:* Person cannot express themselves in speech (they take in the message properly, but can't express themselves). AD

Which of the following would the nurse be least likely to assess in a patient experiencing neuroleptic malignant syndrome? A.Diaphoresis B.Muscle rigidity C.Incontinence D.Unreactive dilated pupils

D. Unreactive dilated pupils would suggest anticholinergic crisis. Diaphoresis, muscle rigidity, and incontinence would be associated with neuroleptic malignant syndrome.

What is the danger with schizoaffective disorder?

Danger is risk for suicide because mood is so predominant. Higher risk for suicide with this disorder, even higher than schizophrenia.

Anergia

Decreased energy

Cannabis long-term use effects

Decreased motivation

Does incidence of bipolar *mania* increase or decrease with age?

Decreases in older adults

Alzheimer's Disease

Degenerative, progressive neuropsychiatric disorder Chronic course ◦Cognitive impairment ◦Emotional and behavioral changes ◦Physical and functional decline ◦Ultimately, death

Delusional disorder

Delusion for short period of time and it goes away

Why would antipsychotics be used in AD?

Delusions

Major depressive disorder dx

Depressed or anhedonic in nearly all activities for >=2 weeks 4+ additional symptoms: ◦Disruption in sleep, appetite (or weight), decreased concentration, anergia, indecisiveness ◦Psychomotor agitation or retardation ◦Excessive guilt or feelings of worthlessness/hopelessness ◦Suicidal ideation

BPD primary cognitive therapy

Dialectical Behavior Therapy (DBT)

Korsakoff's syndrome symptoms

Difficulty acquiring new information, retrieving new memories. Confabulation (making up stories). Visual impairment. Attention deficiet disorientation.

Acetylcholinesterase inhibitors used in AD

Donepezil, Galantamine, Rivastigmine

Cocaine affects which neurotransmitters?

Dopamine, norephinephrine, serotonin (all increase)

Neuropeptides r/t depression

Dopamine, norepinephrine, serotonin

Barbiturate effects (ST, LT)

Drowsiness, decreased attention, memory, judgment, and delayed reaction time •Long-term effects: Dependence and addiction

Anticholinergic effects

Dry mouth, blurry vision, urinary retention, decreased lacrimation, photophobia

Dual diagnosis

Dx w/ mental illness and substance abuse. Dual dx is harder to treat than just primary mental illness

Before starting TCAs, what must you do?

EKG and cardiac hx review

What are dystonic reactions?

Emergency situation that can occur if *severe muscle spasm in the neck that blocks the airway*. Eyeballs roll back into head (oculogyric crisis), person has difficulty breathing (due to severe spasms). painful muscular reaction to neuroleptics airway concern

Signs of fetal alcohol syndrome (FAS)

Female who are drinking whilst pregnant & dangers r/t that. Alcohol passes to fetus. P retardation, slowed development, flat nose bridge, ears lower than eyes

Bulimia nervosa diagnostic criteria

Episodes occurring at least twice a week for at least 3 months

Hallucinogen effects

Euphoria or dysphoria, altered body image, distorted or sharpened visual and auditory perception, confusion, incoordination, and impaired judgment and memory

What are positive symptoms in schizophrenia?

Excess or distortion of normal functions *Delusions and hallucinations*

Avoidant personality disorder etiology

Experience aversive stimuli more intensely and frequently than others; may be r/t limbic system

What are some common a/e of 1st gen antipsychotics (schizophrenia)?

Extrapyramidal symptoms (parkinsonism, anticholinergic effects, dystonic reactions, akathisia [Inner & outer restlessness], tardive dyskinesia)

Oculogyric crisis

Eyeballs roll back into head

What are delusions?

False beliefs grandiose, somatic, persecutory, nihilistic, paranoid, jealousy, being controlled, mind reading, reference, erotomanic, religious, guilt or sin, thought broadcasting, thought insertion, withdrawal

Lithium toxicity 2.5+ mEq/L a/e

Fatal; severe EKG changes, arrhythmias, large output of dilute urine, coma, death

Lanugo

Fine, soft hair. Found in anorexics & infants

What is the drug of choice for eating disorders?

Fluoxetine

Substance/Medication-Induced Psychotic Disorder (SIPD)

From medication. Depends on what the medication is. E.g. some hallucinogens (e.g. LSD, ketamine) can bring on hallucinations

How to manage opioid withdrawal safely? What medications?

Gradual reduction in opioid dose, can use methadone or clonidine (must monitor BP carefully). Avoid giving analgesics for pain (sometimes pt gets motrin).

What is the ideal age for eating disorder prevention teaching?

Grammar school age (10-14?)

Severe stage of alcohol withdrawal signs

HTN, tachycardia, elevated temperature, marked diaphoresis. Markedly disoriented, confused. Experiencing auditoary hallucinations (alcoholic hallucinosis: tactile hallucinations [feel things are crawling up them like bugs or snakes], visual and auditory hallucinations [walls are closing in on them], paranoid delusions), delirium tremens: most dangerous, life threatening—coarse tremors, seizures, extreme restlessness/agitation, gross tremors, convulsions, can lead to death. Their body cannot tolerate food and fluids. 15% mortality.

Hallucination vs delusion

Hallucinations involve one or more of the five senses (perception of environment) -- auditory, most common Delusions involve only thoughts - *false beliefs*

Divalproex Sodium contraindications

Hepatitis, liver failure

Amphetamine a/e

Hepatotoxicity

Why might a bipolar patient be put on antipsychotic?

If they're experiencing delusions

When should SSRIs be taken?

In the morning; can cause sleep disturbances

Agraphia

Inability to read or write (can't sign name, can't read) AD

Agnosia

Inability to recognize familiar objects, objects that one should know AD

ECT pre-procedure prep

Informed consent, full lab workup, medical clearance, CXR, EKG, baseline vitals Given muscle relaxants (e.g. succinylcholine) IV started pre- or interim procedure Given sedatives (e.g. benzos, barbs) Atropine given ~30 min pre-procedure (for secretions)

Akathisia

Inner & outer restlessness

Schizoaffective disorder (SAD) - dx criteria

Intense symptom exacerbation alternating with periods of adequate psychosocial functioning Psychosis & mood disturbance manic, or mixed Two or more of the following: •Delusions •Hallucinations •Disorganized speech •Disorganized or catatonic behavior Negative symptoms oRisk for suicide

Vagus nerve stimulation

Invasive; surgically implanted device. Electrical pulsations but implanted. Complications: Voice changes because it's placed near the larynx (dysphagia, hoarseness, etc.). Not that effective in treating depression.

Disturbance of executive functioning

Involves problem solving, prioritizing, doing things like making lists AD

Neuroleptic malignant syndrome (symptoms)

Life threatening condition! •Severe muscle rigidity, elevated temperature with a rapidly accelerating cascade of symptoms Autonomic instability: BP can go up or down (usually it goes up), tachycardia, diaphoresis, incontinence, leukocytosis. Definitive sign: Elevated CPK (creatinine phosphatase kinase. Normal is from 10-120 mEq/L. So elevated is >120)

Reference delusions

Like a 3-party delusion. Person is listening to a radio and they believe that what's being said refers to them.

Apraxia

Loss of the ability of skilled motor movements (e.g. writing, walking). Unable to use objects properly (e.g. fork, spoon). AD

Magnification

Making more out of a little I binged last night, so I can't go out with anyone.

Religious delusions

May believe they're God, Jesus, Devil... anything to do w/ religion

Catastrophic reactions (AD)

May get angry and hurt themselves or others. Generally happen when person is fatigued and there's stimulation in the environment that they can't deal with. (e.g. can occur when person feels overwhelmed at birthday party w/ lots of people, loud). Fatigue can make it worse. *Nursing/family intervention:* Remove from situation, bring back to home environment where they're most comfortable and there's less stimulation.

Tangentiality

May or may not answers question but then goes off in different direction and doesn't come back.

Brief psychotic disorder (BPD)

Maybe lasts 1 day to 1 month

NMDA antagonists used in AD

Memantine

Nicotine withdrawal

Mood changes (craving, anxiety, irritability, depression) and physiologic changes (difficulty in concentrating, sleep disturbances, headaches, gastric distress, and increased appetite

Mood vs. affect

Mood: Emotions and feelings Affect: Appearance of body related to that mood

Affective blunting

Negative symptom in schizophrenia Person not showing much emotion.

After ECT, patient may ask for food or drink. What do you do?

Must check gag reflex before giving anything. because they're NPO night before; usually must be NPO at least 4h preop

Opioid OD treatment

Narcan/Naloxone

SSRI s/e

Nausea, vomiting, weight changes (gain), sexual side effects (more males than females; delayed orgasm, impotence), photosensitivity *Serotonin syndrome* (person has too much serotonin)—autonomic instability (BP increase or decrease [HTN more common]), tachycardia, fever, diaphoresis, muscle rigidity, tremors, confusion, coma, death.

Hypermetaphorphosis

Need to touch and examine everything in the environment (behavior you see as children) AD

Severe Stage AD (stages 6-7)

Needs help with • bathing, eating, help to stand & walk, help to use bathroom •No self-care •Little/Loss of use of language •Minimal long-term memory •Must have 24 hour, 7 days/week care to ensure safety Bladder incontinence ST memory is gone. LT memory is last to go. Psychotic symptoms. They can hurt themselves or someone else.

Attentional impairment

Negative symptom in schizophrenia Decrease in attention/concentration

Avolition

Negative symptom in schizophrenia Lack of motivation

Anhedonia

Negative symptom in schizophrenia Lack of pleasure

Alogia

Negative symptom in schizophrenia Lack of speech; person may be speaking but it's not productive speech. Difficulty w/ social skills; interacting w/ others

Loose Association (LOA)

No connection to the thoughts the person is expressing. Expressing words but we can't understand it because no connection. Healthy people have connections; it's logical thinking.

Repetitive transcranial magnetic stimulation (TMS)

Non-invasive. Uses magnet placed on scalp. Pulsations to stimulate certain areas of the brain. Not used very much. But helps some patients. Pt is alert

Anticholinergic crisis (symptoms)

Nonreactive dilated pupils, may have hallucinations or delusions, may become disoriented

Cluster A psychiatric disorders

Odd or eccentric •Characterized as "odd", "different" or detached Types: •Schizoid •Paranoid •Schizotypal

What does it mean for a schizophrenic to be internally occupied?

Often they deny it but they're aware that hallucinations are abnormal. They don't want other to know it so *they hide their hallucinations*. So must look for clues (e.g. *covering their ears, pulled down hat, pencils in ears to block out voices*).

Hallucinogen severe reactions

Paranoia, fear of losing one's mind, depersonalization, illusions, delusions, hallucinations

Stereotypy

Perform a meaningless action over and over again. E.g. Have desk drawer, empty it, then put it back in the drawer; then later, take everything out again and put it back.

Neologisms

Person invents word or phrase that is not in our language (so... every writer ever)

Name some MAOIs used in depression

Phenelzine, tranelpropine

Irritable mood (mania)

easily annoyed and provoked to anger

Wernicke's encephalopathy caused by

Poor nutrition, thiamine deficiency

Nursing role in nicotine

Prevention primary: educate on nicotine dangers pre-use; secondary: screening, giving info for smokers; tertiary: encourage pt to stop)

Hyperorality

Putting things in their mouth that don't belong in mouth (behavior you see as children) AD

What is light therapy/phototherapy used for?

Seasonal affective disorder (SAD)

TCA a/e

Sedation, orthostatic hypotension (risk for safety; 20 point change in BP is significant), tachycardia. Great cardiac complication risk (can lead to arrhythmias, torsades des pointes). Anticholinergic effects (urinary retention), drowsiness, photosensitivity, constipation, weight gain.

BPD interventions

Safety assessment (how dangerous are they?), close supervision (should have 1-1 observation when they first get admitted).

What stage are most schizophrenics in? (Acute, stabilization, recovery, or relapse)

Recovery

Hypervigilance

Scanning the environment, looking for somebody watching or following you

Paliperidone (treats? available in what form?)

Schizo Available as extended release tablet

Catatonia

Refers to different psychomotor disturbances in behavior E.g. mutism (chooses not to speak). Posturing (takes on different postures; e.g. belief you are a dog, would bark, eat food like a dog). Repetitive behaviors. Stupor (in a coma-like state, not reacting, perhaps curled in fetal position).

Cannabis effects

Relaxation, euphoria, spatial misperception, time distortion, food craving Conjunctival redness

What type of group therapy is particularly good for dementia patients?

Reminiscence groups

Lurasidone (treats? benefits?)

Schizo Decrease in chances of weight gain and metabolic syndrome

Clozapine (treats? a/e)

Schizo Most common a/e is tachycardia, hypersalivation, hypotension (?), agranulocytosis (most dangerous). Person must be monitored while on drug for serum levels.

Iloperidone (treats? a/e)

Schizo Prolonged QT waves, tachycardia

Verbigeration

Repetition of words. Purposeless repetition.

Asenapine (treats? administered how?)

Schizo Taken SL

Ziprasidone (treats? a/e)

Schizo Torsades de pointes arrhythmia

What psychiatric disorder results in the highest rates of hospitalization?

Schizophrenia

Olanzapine (treats? a/e)

Schizophrenia Danger for weight gain (more so than some others). Increased risk for metabolic syndrome (e.g. if diabetes or cardiac issues such as HTN or cholesterol, this may not be the best drug to put them on)

Quetiapine (treats? a/e)

Schizophrenia Decrease in BP, sedation

Early phase alcohol withdrawal interventions

Rest is important, nutrition, hydration (alcohol is dehydration agent. Maybe forcing IV fluids)

Anorexia treatment

Restore weight - Start IV, correct fluid & electrolyte imbalances Tube feedings may be necessary

For major depressive disorder (MDD), which is more common: psychomotor agitation or retardation?

Retardation

Risperidone (treats? a/e)

Schizophrenia a/e: Increase in blood sugar, menstruation irregularities, increase in prolactin elevation (can lead to enlarged mammary glands; gynecomastia). Commonly used drug

Aripiprazole (treats? a/e)

Schizophrenia decrease in risk of weight gain

Clang association

Rhyming words. E.g. Kite might bite. Words used in a sentence

MAOI s/e & a/e

S/E: Dizziness, headache, constipation. A/E: Hypertensive crisis (real danger) -- especially if due to tyramine consumption

What does ECT cause?

Seizure

Barbiturates use

Seizures, sedation

What neurotransmitter do we associate w/ food?

Serotonin

Bulimia nervosa is associated with which neurotransmitter?

Serotonin (decreased neurotransmission)

Lithium toxicity 1.5-2.5 mEq/L a/e

Severe diarrhea, vertigo, increasing tremors

What s/e can be expected from ECT?

Short-term memory loss (expected; may last up to 6 mo, but in majority of cases, memory will come back. Small percentage that will have permanent memory loss). Headache (normal), backache (normal), ST memory loss (normal)

Schizotypal personality disorder features

Similar to schizophrenia, less severe •Cognitive perceptual symptoms: magical beliefs and perceptual aberrations •Referential thinking; paranoia •Eccentric personality •Lack friends •Constricted mood •Avoid others

Concrete thinking

Simple thinking. Seen in a lot of different types of mental illness. Difficult for person to abstract their thinking.

When people are depressed, do they typically sleep more or less? Eat?

Sleep less, eat less

Opioid a/e

Slow peristalsis, hypotension, bradycardia, miosis, dental caries

What is an illusion?

Something in the environment (real perception) but the person is viewing it a little differently—not accurate viewing. Very different from hallucinations (totally false; nothing true in environment about it). Not really concerned with illusions. Can associate illusions w/ PTSD. Don't treat illusions because there is a real stimulus. *is this different from delusions????*

Pressured speech

Speech is fast.

How do you treat serotonin syndrome?

Stop drug, notify HCP benzos in emergencies (lorazepam, alprazolam, etc.) beta-blocker (depending on vital signs)

Where is cannabis stored?

Stored for weeks in fat tissue and in the brain

MAOI medication contraindications

Sudafed, meperidine (demerol—used sometimes for surgeries & pain). Need washout period BEFORE starting on MAIOs—must be washed out of previous medications before starting; must also need washout period AFTER being taken off MAOIs before starting other medications.

Paranoia

Suspicious thinking; when guarded, don't say much about themselves; use 1-2 words to answer (closed-ended responses). Think someones after them.

Schizophreniform disorder

Symptoms like schizophrenia but not as severe. Lasts <6 months. Oftentimes can recover on own.

Early signs of alcohol withdrawal (mild)

Tachycardia, HTN, temperature elevation. Slight sweating. Person orientated. Mild anxiety. Restlessness, akathisia. Slight, fine tremor (hands or even eyes). Nausea, not hungry. No confusion.

Naltrexone (treats...)

alcoholism used w/ someone who alcohol and/or opiate addiction and mental disorder. Works by blocking effects of alcohol/opiate molecule in the body and decreases desire to drink)

What is auricular therapy

There's a pressure point in the ear that can affect nicotine addiction.

Persecutory delusions

They believe someone is going to hurt them or someone they love. Or, paranoia-type thinking (government/CIA following them)

Somatic delusions

They believe something about their body (e.g. there's something in my stomach/brain) but it's not true

During mania, would bipolar have hallucinations or delusions?

They can have either.

Referential thinking

They think people are talking about you (basically)

Wernicke's encephalopathy treatment

Thiamine injection

Autistic thinking

Thinking by private rules of logic (no one else understands the reasoning)

Flight of Ideas (FOI)

Thoughts moving very fast; thoughts spinning in head; coming out fast w/ speech. Is some connection there, but may be difficult to understand. But NOT as severe as LOA (no connection). See in mania, too.

Mini Mental Status Exam (MMSE)

Tool used in AD/dementia

Mini Cog Tool

Tool used in AD/dementia to help better assess the symptoms and what's happening w/ the individual •Used to assess executive cognitive functioning. •Few questions you ask a person

What are the treatment goals for bipolar disorder?

Treat the episodes of mania and depression and decrease the number of episodes that occur. Want to help person function in community as much as possible. Try to assist person during stressful periods which is when they may have manic episode. Try to prevent relapse

SSRIs should be taken with food: true or false?

True

Is the following statement true or false? A person with antisocial personality disorder typically must be older than the age of 18 years and have shown some evidence of a conduct disorder.

True To be diagnosed with antisocial personality disorder, a person *must be older than age 18 years* and have a *history of one or more of the characteristics of conduct disorder* before the age of 15 years.

What do MAOIs interact with (food)?

Tyramine Food and drink you have at cocktail party—red wine, beer, aged cheese (some cheese is allowed: cheddar, cottage, ricotta), fermented meats (salami, some sausage), raisins, pickled foods (pickled herrings), smoked foods (smoked salmon), avocado, bananas, yeast (caution w/ bread), fava beans, soy sauce, sauerkraut, caffeine (can have LIMITED caffeine).

Lithium toxicity at 1.5 mEq/L a/e

fine tremors, muscle weakness, nausea, polyurea, polydipsia

Other names of divalproex sodium

Valproic acid, depakote

What are the 3 main SNRIs used in depression?

Venlafaxine (also useful for women w/ menopausal symptoms) duloxetine (also used for GAD, somatic pain), desvenlafaxine

Command hallucinations

Very concerned with command hallucinations. Threatening hallucinations ("push her in front of the subway!"). Way hurt themselves or someone else. Safety risk. Have to find out when person is having hallucinations if it's a command hallucination—determines how dangerous it is.

Stage II alcohol withdrawal symptoms

Vital signs increasing, diaphoresis, intermittent confusion. Perhaps auditory/visual hallucinations. Insomnia, nightmares. Visible tremors. Anorexia, nausea, vomiting.

Echolalia

Where one echoes the words of another. Ask question? They echo the words back to you. I say: "What did you hear?" They say: "What did you hear?". They don't answer the question.

Confabulation

Where one makes up something because they forget (they don't want you to know they forgot so they make up a story) AD

How long does opioid withdrawal last?

Withdrawal last 7-10 days. First 3-4 days are the worst.

Word salad

Words mixed up

Metonymic speech

Words w/ similar meanings are used.

Waxy flexibility

You put an extremity in a certain position and keep it there for a long time. E.g. elevate arm and keep it there for an hour. If someone tells you to put it down, you won't. They will fight you. Any extremity of body. Can be dangerous to person if it's blocking circulation.

Behavior therapy for depression

activity scheduling, social skills training, problem solving

Delirium

acute cognitive impairment with multiple causes •Disturbed consciousness (impaired) •Change in cognition •Rapid onset •Usually reversible •Serious - ER situation (can be serious) •Dx r/t: impaired consciousness, problems in memory, orientation, & speech •Acute confusion = delirium Etiology:medical condition, procedures, hospitalizations, and substances

Disulfiram (treats...)

alcoholism aversion therapy; client must be onboard to not use alcohol; if they take it w/ alcohol, they'll become violently ill—includes substances like alcohol wipes, mouthwash

What is mania?

an abnormally and persistently elevated, expansive, or irritable mood

Depression

an alteration in mood that is expressed by feelings of sadness, despair, & pessimism

Fluoxetine treats...

anorexia

Trazedone (use & a/e)

antidepressant Can cause priapism

Remeron use

antidepressant Decreased sexual side effect

Wellbutrin (bupropion) use

antidepressant good antidepressive agent; lowers seizure threshold

Cluster C psychiatric disorders

anxious & fearful Characterized by inability to attain goals and fear of criticism or rejection •Obsessive-Compulsive Personality Disorder •Avoidant Personality Disorder •Dependent Personality Disorder

Overgeneralization

basing belief on insufficient considerations I didn't eat anything yesterday and did okay, so I don't think not eating for a week or two will harm me.

Dementia

chronic cognitive impairment differentiated by cause, not symptom patterns ◦Cortical dementia ◦Subcortical dementia

Common s/e of atypical antipsychotic agents

constipation, dizziness, drowsiness

Cluster B psychiatric disorders

dramatic & emotional Difficulty with establishing & maintaining close personal relations •Borderline •Narcissistic •Histrionic •Antisocial

Elevated mood (mania)

euphoria or elation

Effects of inhalant abuse

euphoria, sedation, emotional lability, and impaired judgment

Caffeine withdrawal symptoms

headache, drowsiness, fatigue, possible impaired psychomotor performance, difficulty concentrating, craving, and psychophysiologic complaints (e.g., yawning, nausea)

Expansive mood (mania)

lack of restraints in expression; overvalued self-importance, grandiosity *When one thinks they're better than they are*

Catastrophizing

more meaning I purged last night for the first time in 4 months—I'll never recover

Delirium tremens

most dangerous, life threatening—coarse tremors, seizures, extreme restlessness/agitation, gross tremors, convulsions, can lead to death. Their body cannot tolerate food and fluids. 15% mortality.

Detoxification

process for safe withdrawal

What is enmeshed

refers to strong female figure; very controlling Risk factor for disordered eating habits

Methamphetamine (neurotransmitters)

release of excess dopamine; highly addictive; use in a "binge and crash" pattern

Inhalants intoxication effects

respiratory depression, stupor, and coma

What do you die of in AD?

respiratory problems, wound infections, lack of appetite, & immobility.

Caffeine intoxication symptoms

restlessness, nervousness, excitement, insomnia, flushed face, diuresis, gastrointestinal disturbances, muscle twitching, rambling flow of thought and speech, tachycardia or arrhythmias, inexhaustibility, psychomotor agitation

Steroids LT use a/e

risk for heart attacks, strokes, and blood clotting

Opioid OD symptoms

shallow breathing, convulsions, pulmonary edema, death

Bulimia nervosa comorbidities

substance abuse (dual diagnosis), depression, and OCD

Cocaine is a CNS stimulant. What are some of its effects? BP, HR, pupil size, food intake, sleep amount...

sudden burst of mental alertness and energy, feelings of self-confidence, being in control, sociability Tachycardia, HTN, rising body temperature, mydriasis (pupil dilation). Lack of sleep. Lack of eating, anorexia. Feel energetic, alert, self-confident, sociable.

Posturing

takes on different postures; e.g. belief you are a dog, would bark, eat food like a dog

Cachexia

weakness and wasting of body

When is clozapine used for schizophrenia? Why?

when no other second-generation agent effective Don't use clozapine as much because of blood work that's needed

What foods are allowed when taking MAOIs?

white wine, hotdogs, fresh sausage, lunch meats (bologna), soy milk.

Should lithium be taken with or without food

with food; can cause stomach upset

How long is the ECT procedure?

~30 seconds to induce seizure

Anorexia psychological treatment

•*Client contract:* Could be verbal or written. "If I have the urge to purge, I will notify someone before doing so [e.g. nurse, aid]." •They use food as a means of control, so *try to give them control*. Use CBT, different techniques, and reinforcing positive behaviors in terms of control issues. •*Family Therapy:* If dysfunctional family is problem •*Assertiveness Training:* "I" communications e.g. "I feel angry when you say I am not fat." Try to teach the person to be more assertive. Verbally express if they are upset/angry in an appropriate way; don't want them holding in the angry feelings.

Tardive dyskinesia

•Abnormal involuntary, repetitive movements •Most commonly face Tongue (bon-bon sign: tongue rolls around in the mouth and protrudes into the cheek); lip smacking, puckering, tongue protrusion out of side of mouth. Worm-like movements of tongue. Chewing. Eye blinking. Worm-like movements of fingers/toes. Jerking. Food tapping. •May be dose related (may be able to decrease dose & symptoms disappear) •Non-reversible

What two groups are we most concerned with regarding suicide?

•Adolescents & young adults have high rate of completed suicides. •Older adult males, 65+, have the highest rate of completed suicides.

What are neurovegetative symptoms of depression?

•Appetite and weight changes •Sleep disturbance •Decreased energy, tiredness, and fatigue

Histrionic Personality Disorder

•Attention seeking •Dramatic/emotional •Labile affect •Sexually seductive •Easily influenced by others May be abused by someone (sexually, physically) because they are easily influenced.

Avoidant personality behavior (features)

•Avoidance of social situations •Timid, shy, hesitant, fear of criticism, & feelings of inadequacy •Extremely sensitive to negative comments and disapproval •Engagement in interpersonal relationships only when they receive unconditional approval

Alzheimer's Disease etiology

•Beta-amyloid plaques •Neurofibrillary tangles •Cell death & neurotransmitters •Genetic factors •Oxidative stress, free radicals, and mitochondrial dysfunction •Inflammation

Cannabis binds with what receptor, where, to block what neurotransmitter?

•Binds with μ-opioid receptor in the brain to block dopamine reuptake

Binge Eating Disorder

•Binge eating similar to bulimia nervosa but no purging or compensation for binges through other behaviors •Most are obese Criteria ◦Binge eating ◦Distress about the binge ◦Eating until uncomfortably full (à abdominal pain) ◦Feelings of guilt or depression afterward

What do typical antipsychotic agents do? (i.e. what do they block? where? to treat what symptoms? Issues?)

•Block dopamine at receptor site •Used to treat positive s/o •No effect negative s/o • Problem- motor side effects

Assessment scales for alcohol detox

•CIWA scale: different symptoms (Tremors, nausea, vomiting, agitation, tactile distsurbances, visual headache, etc.) •CAGE tool: Simple 4 question (?) tool

Dysthymic disorder diagnosis

•Chronic - most days for 2 years •Symptoms similar to major depression but milder •Depressed mood most of the day, nearly every day •Poor appetite or overeating •Insomnia or oversleeping •Low energy or fatigue •Low self-esteem •Poor concentration or difficulty making decisions •Feelings of hopelessness *mild but long-term form of depression*

Dependent personality disorder (Features)

•Clinging to others in a desperate attempt to keep them close; intense need to be taken care of •Total submission and disregard for themselves •Decision making difficult or nonexistent •Withdrawal from adult responsibilities •Epidemiology: prevalence of 0.49%; women > men

Disruptive, Impulse-Control and Conduct Disorders (types & treatments)

•Common characteristic is irresistible impulsivity Types: •Oppositional defiant disorder •Conduct disorder •Intermittent explosive disorder •Kleptomania •Pyromania *Treatment:* Psychopharmacologic agents (to control aggressiveness); psychotherapeutic, behavioral, and social interventions

How to reduce risk of tardive dyskinesia?

•Decrease risk: Close monitoring - AIMS (Appendix b) •Drug holidays •Lower doses antipsychotics

Schizoid Personality Disorder features

•Detachment from others •Restricted emotions Other criteria (4) •Distrust •Solitary activities •Low libido •Restricted pleasure •Lacks friends - loner •Indifference •"Emotional coldness" Don't experience pleasure Don't care, one way or the other.

Anticholinergic crisis (treatment? what is the antidote?)

•Discontinuation of medication •*Physostigmine*=antidote: inhibits anticholinesterase Gastric lavage, charcoal, catharsis for intentional overdoses

Delirium signs

•Disturbed consciousness •Disordered cognition •Decreased attention - easily distracted •Disturbed perceptions - may have hallucinations •Labile mood •Disrupted sleep (insomnia) •Psychomotor - hypoalert OR hyperalert •Asterixis - "lever flap"

Neuroleptic malignant syndrome treatment

•Dopamine agonists (bromocriptine); muscle relaxants (dantrolene or benzodiazepine)

How should the nurse react to neuroleptic malignant syndrome?

•Early recognition of symptoms; withholding of any antipsychotic medication Frequently monitor vitals

Steroid effects

•Euphoria, increased energy, sexual arousal, mood swings, distractibility, forgetfulness, and confusion

Bulimia nervosa

•Few outward signs; bingeing and purging in secret •Typically normal weight •Overwhelmed and overly committed individuals •"Social butterflies"; difficulty setting limits and appropriate boundaries in social situations (diff. from anorexia) •Shame, guilt, disgust about bingeing and eating •Also impulsivity in other aspects of life Not as severe as anorexia. Outcomes are better. More aware of their eating behaviors. Know that these behaviors are inappropriate, therefore they try and hide them.

Narcissistic Personality Disorder

•Grandiose •Sense of entitlement •Needs attention •Lacks empathy •Feelings of superiority •Self-centered •Not tolerant of criticism Sense of entitlement. May abuse someone else (be the perpetrator of abuse).

Antisocial personality disorder etiology

•H/O violence, substance abuse, physical abuse •Previous H/O Adolescent Conduct Disorder

What does cannabis cause?

•Impaired ability to form memories, recall events, and shift attention from one thing to another; disruption of coordination of movement, balance, and reaction time

Antisocial personality disorder features

•Lack of concern for others •Self-centered •unlawful behavior •lying, scamming •Impulsive •Arrogant •Reckless disregard for others •Lack of stability •Unremorseful

Schizoid personality disorder etiology

•Learned Pattern •Restricted homelife •Dysfunctional

List some mood stabilizers used in bipolar disorder

•Lithium •Divalproex sodium •Carbamazepine •Topiramate •Gabapentin/Neurontin •Lamotrigine

Anorexia nervosa

•Low body weight •Intense fear of gaining weight or becoming fat •Disturbance in experiencing body weight or shape Two types ◦Restricting [food and fluids] ◦Binge eating and purging

Signs of dementia

•Memory impairment - repeat, lose things •Problems with routine activities •Decrease socialization •Impaired reasoning •Decrease in attention •Anger - curse & hit •Disorientation to place, time, & person •Inappropriate sexual behavior

Lithium s/e & a/e (not specific to toxicity levels)

•Metallic taste is sign (initially) that you may be getting toxicity •S/E: Slurred speech, nausea, vomiting, lack of coordination, tinnitus, dizziness, dry mouth, mild/fine tremor •A/E: Fine hand tremor, hypothyroidism, myxedema (sluggishness, increased cold sensations, puffy face, constipation, brittle fingernails & hair, heavy menstruation, increase in forgetfulness), weight gain, swollen joints, rash, pruritus, electrolyte imbalances

BPD medications

•Mood stabilizers •Antidepressants •Anxiolytics

Signs of chemical dependence in nurses

•Mood swings; inappropriate behavior at work •Noncompliance with acceptable policies and procedures •Deteriorating appearance, job performance • Errors in charting •Alcohol on breath •Forgetfulness; poor judgment and concentration •Lying •Volunteering for overtime or extra duties •Onset after prescription after surgery or a chronic illness •Family history alcoholism or addiction

Moderate Stage AD

•Need help with everyday activities - bath, shower •Decrease in ADL's •Need reminders to eat Behavior & Mood: •Difficulty finding way around home &/or neighborhood •Wandering, restlessness •Get suspicious, angry, or easily upset •Change in sleep •Cognition: Disoriented to time & place •Difficulty recognizing family members •Speech: Difficulty expressing self & understanding others •Hallucinations & delusions •Catastrophic reactions •Problems with visual perception •Lack of complex motor skills •Needs frequent supervision

What are some biologic theories behind schizohprenia? (e.g. neuroanatomic findings? Neurotransmitters?)

•Neuroanatomic findings: *larger lateral and third ventricles; smaller total brain volume* •Familial patterns •Genetic associations •Neurodevelopment •Neurotransmitters, pathways, and receptors •Abnormalities in frontal, temporal, and cingulate regions •*Dopamine hyperactivity*; transmitter or neural systems •Other neurotransmitter involvement

Obsessive-compulsive personality disorders (nursing management)

•Nursing Management: Help person deal with behaviors r/t this which are more physical. If they do seek help, it's for physical symptoms (like HTN). May have cardiac symptoms because of the stress they put on themselves. Even fatigue. Interventions: Develop therapeutic nrs-pt relationship. Social skills training. Group therapy. Trying to get the person to improve their social skills.

Other s/e of antipsychotics

•Orthostatic hypotension •Hyperprolactinemia •Sedation; weight gain •New-onset diabetes •Cardiac arrhythmias Agranulocytosis

Obsessive-compulsive personality disorder features

•Preoccupied with lists and rules •Order •Control: can't delegate •Joyless mood •Perfectionist •Workaholic •Inflexible & overly righteous •Hoarding behavior •Miserly (cheap), rigid, stubborn

Characteristics of mania (bipolar)

•Pressured speech, clanging speech (rhyming words), sexually preoccupied, increased energy, neglect ADLs •Go on spending sprees (clothing, dinner, etc.) •Flight of Ideas: Racing thoughts, but there is some connection. •Lack of attention, lack of concentration. •Have grandiose view of themselves and their abilities. •Irritable, distractable. •Inappropriate dress: dress very colorfully, may mismatch clothing. •Rapid actions. Movements rapid, psychomotor agitation, impulsive behavior (do things, they don't think about consequences [e.g. take cocaine]) •Most moving, sex, spending. •In denial of illness. Have poor insight. Become dangerous during manic episodes. Hurt self (non-stop physical activity w/ lack of nutrition, dehydration leading to electrolyte imbalance and physical exhaustion or death) or others. Must treat mania.

ECT during procedure

•Put bite guard in mouth, BP cuff (one by ankle [easier to see in ankle than arm during seizure] and one on arm). •Put to sleep •Amount of electricity calculated based on weight, etc. •Place jelly then leads on forehead (sometimes 2 areas used, sometimes just 1 in forehead... depends on what psychiatris wants [either work])

Main medication categories for treating depression

•SSRIs •SNRIs •Cyclic (tricyclic) antidepressants (TCA's) •MAOIs •Other antidepressants

ECT -- when shock is given; nursing interventions/what to expect

•Short amount of electricity to induce seizure. Should happen within 30-40s after electricity initiation. Then it's over. •During seizure: O2 to drop (as low as 80%... But they will be getting some oxygen), BP may increase (200/110, maybe or higher), tachycardia, arrhythmias [2-3 PVCs in a row. Would be concerned with 6+]. •Once seizure happens, stop the electricity •Turn pt on side, check their mouth, do they need to be suctioned? Is airway clear? Even though they received atropine, may still need suctioning. Remove bite thing from mouth.

Antisocial personality disorder comorbidities

•Substance Abuse •Physical Injury •Other-directed violence

Paranoid personality disorder features

•Suspiciousness •Mistrust of others •Guarded behavior & speech (Use close-ended type answers) •Self-importance - rigid •Hostile or angry •Unforgiving - hold grudges

General nursing interventions for personality disorders

•Therapeutic relationship, independent decision making, help become confident in ability to handle situations •Reinforcement of personal strengths •Enhancing self-awareness •Assertiveness groups •Social skills training •Encourage respect for rights of others •Referral to group work/program •Help to identify strengths and limitations •Use role playing •Confront about impaired judgement •Nurse can model behaviors, like self-respect. Nurse communications must be clear. •Need for setting limits on behaviors and personal boundaries. For some of the disorders, must set limits on behavior. •Must get person to recognize and verbalize feelings, have more insight into their own feelings. •Harm reduction strategies: Contract for no harm •Assist to identify situations that may initiate self harm •Develop behavioral objectives •Remove unsafe items •Encourage to seek out staff to talk •Use a calm non-punitive approach •Avoid giving positive reinforcement for negative behaviors •Monitor impulses - set limits on inappropriate behavior •Examining belief underlying behavior; psychotherapy •Acceptance of the patient's need for order and rigidity Administering pharmacotherapy for the short term

What do atypical antipsychotics treat in schizophrenia? A/E? S/E?

•Treat both positive and negative s/o •Less abnormal motor effects - Decreased EPS and Tardive Dyskinesia •Side Effects: Weight gain, metabolic changes, diabetes, sexual s/e (esp. for males)

Schizotypal personality disorder nursing management

•Try to develop social skills, increasing self-worth/self-esteem

Borderline personality disorder etiology

•Unstable family life •lack of order violence

BPD diagnostic criteria

•Unstable interpersonal relationships •Fear of abandonment •Manipulative •Unstable self-image (identity diffusion, promiscuous behavior) •Unstable affect (Affective instability [rapid and extreme shift in mood]) e.g. When they get angry, they yell, scream, etc. When they get depressed, they may curl up in a ball, like a child. •Cognitive dysfunctions (Dichotomous thinking - splitting, Dissociation) •Behavioral dysfunctions (Impulsivity, Self-harm behaviors [e.g. self-mutilation], Poor insight) -- self-harm behaviors done for attention •Parasuicidal behavior - Suicidal gestures

How frequently is ECT done? Over how long?

•Usually done 2-3x weekly. Average number of treatments 6-12 over period of time.

When is electroconvulsive therapy (ECT) used?

•Very effective for major depression, catatonia, & sometimes for severe mania •Clients who do not respond to medications - ECT 50% effective

divalproex sodium (Depakote) - caution

•Watch for liver status (need liver provile), monitor liver enzymes, platelet bleeding times.

When are barbiturates particularly dangerous?

•when mixed with other CNS depressants (e.g. alcohol, opiates)

Amphetamine action (neurotransmitters)

◦Block reuptake of norepinephrine and dopamine, lesser effect on serotonin; peripheral nervous system effects

Cocaine intoxication

◦CNS stimulation and then depression ◦Increasing doses: restlessness ® tremors and agitation ® convulsions ® CNS depression

Neurochemicals of delirium

◦Dopamine ◦Serotonin ◦Cortisol ◦Acetylcholine ◦Glutamate ◦GABA

Alzheimer's Disease types

◦Early onset (65 years and younger): rapid progression Genetically linked, rare ◦Late onset (older than 65 years): more common Risk increases with age

Delirium treatment

◦Elimination or correction of the underlying cause ◦Symptomatic and supportive measures ◦Pay attention to life-threatening disorders ◦Rule out life-threatening illness ◦Stop all suspected medications ◦Monitor changes in vital signs, behavior, and mental status ◦The longer it takes to find out what the cause, is, the longer the symptoms can go on. Want to treat as fast as possible. ◦Monitor behavior, see if it changes.

Anorexia levels of severity (+BMI)

◦Mild: BMI > 17 kg/m2 ◦Moderate: BMI 16-16.99 kg/m2 ◦Severe: BMI ≤15-15.99 kg/m2 less than 85% of BMI

Purging vs. non-purging

◦Purging: vomiting or use of laxatives, diuretics, or emetics ◦Nonpurging: fasting or overexercising

What are the two types of anorexia nervosa?

◦Restricting type ◦Binge-eating and purging type

Cocaine withdrawal symptoms

◦Severe anxiety, restlessness, agitation, intense depression, craving ◦Long-term use: depletion of norepinephrine à "crash" and sleeping 12 to 18 hours ◦Sleep disturbances, rebound REM, anergia, ↓ libido, *depression*, suicidality, anhedonia, poor concentration, and *cocaine craving*, *paranoia*

Dichotomous Thinking

◦reasoning by extremes I've gained 2 lb, so I'll be up by 100 lb soon.

Club drugs (e.g. MDMA, ecstasy) action

◦↑ serotonin and excess dopamine release --> hallucinations, confusion, depression, sleep problems, drug craving, severe anxiety, and paranoia; possible malignant hyperthermia ◦Rohypnol, GHB, ketamine ◦(CNS Depressants)