MH chapters (7,21,30,31)

Therapeutic plan

- Acute treatment phase: 6 to 12 weeks, to reduce symptoms and inappropriate behaviors - Continuation phase: 4 to 9 months, to prevent relapse - Maintenance treatment phase: indefinite, to prevent recurrences

the nurse is caring for a client who has an inability to sit still. the client is feels nervous and jittery. what is this client experiencing

Akathisia

The nurse is caring for a client who states that she has never been able to experience pleasure in life. the clients condition is known as what?

Anhedonia

Antimanics (Lithium)

- Therapeutic blood levels: 0.6 - 1.2 Eq/L - Interactions between the level of lithium in the blood and common table salts - Toxicity-drowsiness, nausea, vomiting, diarrhea, muscle tremors

Goals of inpatient, short term care

-stabilize client - prevent further decline in functioning - assist the client in coping with his or her disorder

Psychoses in adolescence

-the average teen is in contact with reality -the adolescent with schizophrenia is not -changes in behavior are noted: -poor hygiene -strange, vague speech -social withdrawal -odd behaviors -bizarre thoughts and beliefs -unusual superstitions

Interpersonal psychotherapy

Assist clients in addressing specific problems. It can improve interpersonal relationships communication, role relationships, and bereavement

Priority restructuring

Assist clients to identify what requires priority such as devoting energy to pleasurable activities

Dream analysis and interpretation

Believed by Freud to be urges and impulses of the unconscious mind that played out through the dreams of clients

Second generation Atypical antipsychotic

Can cause metabolic issues. should have glucose, lipid and cholesterol levels monitored. weight gain and big round bellys also don't take with antacids can alter the digestion of the antipsychotics

Agranulocytosis

A life-threatening drop in white blood cells. This condition is sometimes produced by the atypical antipsychotic drug clozapine. Check WBC and ANC (absolute neutorphil count)

antisocial personality disorder

A personality disorder in which the person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members. May be aggressive and ruthless or a clever con artist.

tardive dyskinesia

A side effect of long-term use of traditional antipsychotic drugs causing the person to have uncontrollable facial tics, grimaces, and other involuntary movements of the lips, jaw, and tongue. Can be permanent

mot depressive responses in children are tied to:

A specific event or situation

A nurse is caring for a client with whom he has developed a therapeutic relationship and who will be discharged later in the day. The client thanks the nurse for his help during the hospitalization. Which of the following Responses should the nurse make?

A. "Aren't you excited about being discharged today B. How do you feel about being discharged C. I will send you a note in a few weeks D. I know you will do well living out in the community Answer B

What percentage of individuals with severe major depressive disorder dies by suicide?

A. 10% B. 15% C. 25% D. 40% Answer: B

Dialectical behavior therapy

Cognitive behavioral therapy for clients who have a personality disorder and Xzibit self injurious behaviors. This therapy focuses on gradual behavior changes and provides acceptance in validation for these clients

Erratic cluster B

Dramatic behavior consists of four separate disorders: Antisocial, borderline, histrionic, narcissistic

The client is taking carbabazepine (tegretol). common side effects of this medication include slurred speech, confusion and bone marrow depression. what type of drug is this medication.

A. Anti anxiety agent B. Antidepressants C. Anticonvulsants D. Antiphychotic answer : C

EPS Tardive Dyskinesia are related to which group of psychotropics

A. Antipsychotics B. Antianxiety agents C. Anti-depressants D. MAOI Answer A

A nurse is caring for a client who has begun to hyperventilate, wrong her hands, and pacing the floor continually. Which of the following actions should the nurse take first?

A. Ask the client what precipitated the anxiety B. Off the client a prescribed anti anxiety medication C. Tell the client you will remain with them D. Take the client to a quiet room Answer C

A nurse is caring for a client who reports a state of increasing anxiety and the inability to sleep and concentrate. Which of the following is an appropriate response by the nurse?

A. Everyone has trouble sleeping at times B. Have you talked to your doctor? C. Why do you think you are anxious D. Is sounds like you're having a difficult time Answer D

A nurse is discussing insomnia management techniques with a group of clients who have anxiety disorders which of the following techniques mentioned by a client requires further teaching?

A. I have stopped taking naps in the afternoon B. If I wake up at might, I go to another room and read for 20 minutes C. I watch the television in my bedroom to help me sleep D. I eat my evening meal at least 3 hours before I go to bed. Answer C

A nurse in an urgent care clinic is caring for a client who is using loud and rapid speech, and continuously repeats "I don't know why my wife left me." Which of following level of anxiety is the client experiencing

A. Mild B. Moderate C. Severe D. Panic Answer C

The nurse is admitting a client who has daily moderate depression that has lasted 3 years. The client's condition is known as what?

A. Mood disorder B. Dysthymic disorder C. Bipolar disorder D. Hypomania Answer: B

A nurse is caring for a client who has moderate anxiety disorder. The client is pacing in the hallway and stated " I am at the rope, I can't take it anymore." Which of the following should the nurse take?

A. Most clients with anxiety issues benefit from lying down B. Walk with me to an area where we can talk about how you're feeling C. Providers usually recommend relaxation exercises for clients who are upset like you. D. An antianxiety pill works best for situations like this. Let me get you one Answer B

Bipolar 1

Episodes of depression alternate with episodes of mania. more severe of the two. delusions common during periods of mania. Hallucinations may occur.

Pshchoses in childhood

Failure to thrive syndrome, slowed physical growth caused by inability to integrate the physical, emotional, and sensorimotor realms of functioning. related to neglect, envorimental problems and severe family stress.

Angergia

Fatigue, Absence of energy caused by changes in brain chemistry, anatomy, or both.

What should you give to someone if they start having respiratory failure after taking a benzodiazepine.

Flumazentil (romazicon)

Cognitive therapy

Focuses on individual thoughts and behaviors to solve current problems it treats depression anxiety eating disorders and other issues that can be improved by changing a client attitude towards life experiences

Eccentric cluster A

Includes paranoid, schizoid, and schizotypal personality disorders characterized by odd or strange behaviors. they find it difficult to relate to others or to socialize comfortably

A nurse is assisting with planning cognitive reframing techniques for a client who has an anxiety disorder which of the following techniques should the nurse include in the plan of care

A. Priority restructuring B. Monitoring thoughts C. Diaphragmatic breathing D. Meditation E. Journal keeping Answer ABE

A nurse is caring for a client who reports acute anxiety. Which of the following actions should the nurse take?

A. Remain with clients B. Provide an activity for diversion C. Encourage verbalization of feelings D. Have the client identify two coping skills Answer: A C is not correct Bc it's not the first thing you should do.

The nurse is admitting a client with suspected bipolar disorder. The client has repeated patterns of mood swings alternating between hypomania and depressive symptoms; however, they are less intense than the classic bipolar disorder disease. what is this condition know as?

A. Seasonal affective disorder B. Cyclothymic disorder C. substance-induced mood disorder D. Mild bipolar disorder Answer: B

A nurse is collecting data from a client who is experiencing moderate anxiety. Which of the following findings should the nurse expect?

A. The clients communication is difficult to understand. B. The client is unable to learn new informations C. The client expresses feelings of impending doom D. The client has a narrowed focus of attention Answer D

A nurse on an acute care mental health unit is caring for a client who has generalized anxiety disorder. The client received an upsetting telephone call and is now rapidly pacing the corridors of the unit. Which of the following actions should the nurse take?

A. Walk with the pt at a gradually slowing pace B. Allow the client to pace alone until physically tired C. Ask a small group of other clients to walk with the client D. Calmly instruct the client to stop pacing and sit in day room Answer A

A nurse is caring for a client who has an anxiety disorder. Which of the following findings should the nurse recognize as a manifestation of mild anxiety?

A. incoherent speech B. Irritability C. Chest pain D. Insomnia Answer B

You are taking the history if a patient who is suspected of having lithium toxicity. what symptoms would you expect the pt to report.

A. increased drowsiness, weakness nausea B. heart palpitations, seizures, and muscle spasms C. decreased urine output, vision loss, and irritability, D. increased mania, excessive salivation, and tachycardia A S/S of lithium toxicity are: nausea, vomiting, increased drowsiness, muscle weakness, severe hand tremors and in coordination. report immediately!!!!

All of the following are true regarding ECT Except:

A. it is the introduction of a controlled grand mal seizure B. it require 30 mins C. generally 6 to 12 treatments are administered over several weeks D. each client is evaluated for ECT on a individual basis. Answer: B

which patient would be contraindicated for benzodiazepines

A. male with history of smoking B. a male who's about to undergo surgery C. a woman who is 20 weeks pregnant D. a female with breast cancer C

A pt who has been taking a typical antipsychotic resperidone report weight gain in the last 3 months. what should you tell the pt?

A. stop this drug immediately B. weight gain can be an adverse effect of this drug C. weight gain is a expected side effect of this drug D. i will notify the provider to change your meds. B

Stimulants (methylphenidate, amphetamines)

ADHD and narcolepsy treatment drug of choice stimulates CNS (nor-epinephrine and dopamine) Causes decrease appetite, weight, height, sleep, avoid caffiene

Clients who are taking lithium must monitor their water and salt intake because

Lithium is excreted by the kidneys more rapidly then sodium

Neuroleptic Malignant Syndrome

Adverse reaction to antipsychotics with severe "lead pipe" rigidty, FEVER (103 or higher) and mental status changes and rhabdomyolysis. diaphoresis

Clients with bipolar 1, bipolar 2, or cyclothymic disorders exhibit different types of:

Mania

seasonal affective disorder

Occurs in many people October to April.

Moderate depression (dysthymia)

Persists over time Moderate depression *lasts for more than 2 years*

mild depression

Short lived, triggered by life events

delusional disorder

characterized by more than 1 month of nonbizarre fixed ideas (reality based)

Histronic Personality

emotional, overdramatic and attention seeking behaviors. flirtatious, seductive, flashy in dress and mannerism

The nurse is caring for a client who is in the process of sliding into schizophrenia. her client is withdrawn, lacks energy, and has little motivation. the client is in what phase?

Prodromal

standard treatment for mood disorders

Psychotherapy, Pharmacologic therapy, ECT

schizoaffective disorder

Psychotic disorder featuring symptoms of both depression and mania is also present with schizophrenia

the nurse is caring for a client with schizophrenia. her client has had a least one acute episode of schizophrenia and is currently free of acute psychosis but is having negative symptoms of withdrawal, emotional changes, disorganized thinking, and odd behaviors. what type of schizophrenia does the client have

Residual

Lithium

S/S vomiting, extreme hand tremor, sedation, muscle weakness, and dizziness. Lithium and salt compete. Decrease in salt intake decreases the amount of lithium excreted. Blood for determination of lithium levels should be drawn in the morning, approximately 8 to 14 hours after dose is given. Therapeutic dose .6-1.2 give next dose hold dose if 1.5 or higher 2.0 is a medical emergency. dose must be taken at same time everyday if dose is missed wait until next takes 3 weeks to see improvement.

major depressive episode

Severe and lasts longer then 2 weeks. symptoms range from paralysis to agitation. May have suicidal thoughts

Methylphenidate/amphetamine

Stimulation of central nervous system (norepinephrine and dopamine) Monitor Appetite, weight, height, sleep and avoid caffeine Treats ADHD and narcolepsy

Assertiveness training

Teach his clients to expressed feelings in problems in a non-aggressive manner.

akathia

The main sign of akathisia is a sense of restlessness and intense need to move. To relieve this feeling, you need to stay in motion.

Free association

The spontaneous uncensored verbalization avoid ever comes to a clients mind

Psychodynamic psychotherapy

This focuses more on the clients present state rather than his early life

What the the different types of antidepressants

Tricyclic, MAOI, SSRI, SNRI

The client has just been placed on anti psychotic drugs. it is important for the client to know that it may take how long for the drug to become effective and stabilize the behavior?

Weeks

Cognitive behavioral therapy

a blend of cognitive and behavioral therapeutic strategies to help with anxiety management

Dystonia

a condition of abnormal muscle tone that causes the impairment of voluntary muscle movement

dystonia

a condition of abnormal muscle tone that causes the impairment of voluntary muscle movement and muscle rigidity that control gait, posture, and eye movements

mania

a mood disorder marked by a hyperactive, wildly optimistic state, grandiose thoughts and actions, awake for several days

neologism

a new word, expression, or usage; the creation or use of new words or senses

borderline personality disorder

a personality disorder characterized by disturbances in identity, in affect, and in impulse control. chronic sense of emptiness. exhibits clinging and distancing behaviors

Foods with tyramine

avocados, bananas, bologna, pepperoni, salami, smoked fish, cheese, yeast extract, beer, wine, soy sauce, chocolate,

cyclothymic disorder

behavior of repeated mood swings alternating between hypomania and depressive symptoms

narcissistic personality disorder

characterized by exaggerated ideas of self-importance and achievements; preoccupation with fantasies of success; arrogance. no empathy to people or animals. hypersensitive to critism and need to be admired.

Tortcollis

contracted cervical muscles forcing the neck to turn sideways in a twisted position

situational depression

depressive responses tied to a specific event or situation that can be traced to a recognizable cause...

schiziod personality disorder

emotional detachment, no interest in close relationships. emotionally cold and distant. absorbed in own thoughts and feelings

Alexithymia

experienced by people with schizophrenia where they have a hard time explaining their emotion

ocular crisis

eyes roll back in head

Transference

feelings that the client has developed towards the therapist in relation to similar feelings towards significant persons in the clients early childhood. Ex: Old lady therapist - grandma

Behavioral therapy

focuses on changing behavior by identifying problem behaviors, replacing them with appropriate behaviors, and using rewards or other consequences to make the changes

Anhedonia

inability to find joy in life

Tangentiality

inability to get to the point of communication due to introduction of many new topics talks about trivial topics rather than focusing on main topic

major depressive disorder

major depressive episodes repeat more then 2 years

Bipolar 2

major episodes of depression alternate with periods of hypo-mania. often marked by 1 to 2 weeks of severe lethargy, withdrawal, ad melancholy followed by several days of mania.

seretonin syndrome

mental confusion, agitation, fever, diaphoresis, usually 2-72 hours after starting new medicine. can be lethal. How to fix it: meds to create blockade serotonin and muscle rigidity, cooling blankets, anticonvulsants, possible artificial ventilation.

post partum depression

occurs after childbirth symptoms include tearfulness, irritability, sleeplessness, impaired concentration, headache

schizotypal personality disorder

odd and eccentric behaviors, altered percerceptions

Subtypes of Schizophrenia

paranoid, disorganized, catatonic, undifferentiated, residual catatonic: motor immobility, odd voluntary movements Disorganized: unable to think, speak or behave in logical manner Paranoid: believ someone or something is out to get them residual: free of psychosis, still symptoms of disorder (negative symptom)

Idea of reference delusion

person think people on tv are talking directly to them or about them

The Four Stages of Schizophrenia

prepsychotic , prodromal, acute, residual prodromal: withdrawl, lack of energy Prepsychotic phase: quiet, passive, prefer to be alone acute phase: disturbance thought, perception, behavior, emotion Residual phase: energy, negative outlook

brief psychotic disorder

psychotic episodes with a duration of at least 1 day but less than 1 month

Verbigeration

purposeless repetition of words or phrases for days

Echoliaia

repeats last word back to person after they have finished talking

Depression in Adolescence is related to these 4 factors

self-eestem, loneliness, family strengths, parent-teen communication

Paranoid

suspicious, mistrust, think others want to harm, exploit, or deceive

Drug-induced parkinsonism

symptoms that mimic parkinsonism such as tremors, rigidity, akinesia, or absence of movement with diminished mental state. taking an antipsychotic that blocks dopamine. which increases acetycholine which causes the symptoms so you take an antiparkinsons agent to fix the problem and balance everything out. Antiparkinson meds: benztropine (cogentin), dipenhydramine (benadryl), trihexphenidlyl (artane)

dyskinesia

the distortion or impairment of voluntary movement such as in a tic or spasm

Agnosia

the inability to recognize familiar objects, people, or sounds

Bruxism

the involuntary grinding or clenching of the teeth that usually occurs during sleep and is associated with tension or stress

personality disorder fearful cluster C

three personality characteristics of the personality order is : avoidant, dependent, obsessive compulsive. Avoidant: social inhibition, avoid new situations Dependent: extreme dependency a close relationship Obsessive compulsive: perfectionism, order, rules ( Differs from OCD as is characterized obsessions/compulsions is effort to maintain control.