Psych Test III

Nursing diagnoses

Anxiety Fear Ineffective Coping PTSD

Treatment of Phobias:

Behavioral therapy: positive reframing; assertiveness training; systematic desensitization; flooding Medications (see Tables 14.2 and 14.3)

Anti-Anxiety MEdications

Benzodiazepines: Xanax Valium Ativan *Short-term use 3-4 months

Chronic Anxiety

Beta-Blockers Anticonvulsants

Cognitive theories

Caused by distortions in thinking and perceiving

Antianxiety/Anxiolytic: Pt teaching

Cessation needs to be weaned after 3-4 month usage DO NOT Combine with CNS Depressants Causes increased sedation

Blood-injection phobias

fear of seeing one's own or others' blood, traumatic injury, or an invasive medical procedure such as injections

Natural environmental phobias

fear of storms, water, heights, or other natural phenomena

Fear

feeling afraid or threatened by a clearly identifiable, external stimulus that represents danger to the person

Depersonalization

feelings of being disconnected from himself or herself; the client feels detached from his or her behavior

Referential delusions

or ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her

how long does it take MAOIs to reach therapeutic levels?

2-4 weeks adequate wash out periods of 5-6 weeks are recommended between times that the MAOI is discontinued and another class of antidepressant is started.

how many treatments does a client get?

6-15 treatments scheduled twice a week. usually a miminal of 6 is needed to see improvement

what does cognitive therapy focus on/

how the person thinks about the self, others, and the future and interprets his or her experiences focuses on the persons distorted thinking, which in turn influences feelings behaviors and functional abilities.

what is the difference in hypomania and mania?

hypomania episodes do not impair the persons ability to function and there are no psychotic features.

how to manage medications

increased activity and improved mood that antidepressants produce can provide the energy for suicidal clients to carry out the task. *must assess suicide risk even when clients are receiving antidepressants. - ensure that clients ingest the medication - SSRIs are rarely fatal in overdose, but MAOIs and cyclic antidepressants are potentially fatal. presciptions may need to be limited to only 1 week supply at a time. mangement of side effects. clients and family must learn to manage the medication regimen bc clients may need to take these for a long time.

what do manic episodes include?

inflated self esteem or grandiosity decreased sleep excessive and pressured speech risk taking activities with a high potential for painful consequences.

how does the nurse take an authoritarian role in a client with suicidal ideation/

intervention for suicide or suicidal ideation becomes the first priority of nursing care. Authoritarian role to help keep clients safe. Clients see few or no alternatives to resolve their problems. Nurse lets clients know their safety is the primary concern and takes precedence over other needs or wishes.

other things about lithium

is not recommended for use during pregnancy onset of action is 5-14 days; antipsychotic or antidepressant agents are used carefully in combination with lithium to reduce symptoms in acutely manic or acutely depressed clients

suicide precautions

removal of harmful items increased supervision

what patients is lithium contraindicated in?

renal failure patients

The nurse has been asked to assess a client to determine if the client has a suicide plan. Which question would assist the nurse in assessing this area? "Are you a religious person?" "Do you have people in your life who are supportive of you?" "Are you thinking about killing yourself right now?" "How do you generally cope with problems in your life?"

"Are you thinking about killing yourself right now?"

who shows symptoms earlier, males or females?

males

Psychiatric disorders at risk for suicide

- depression - bipolar disorder - schizophrenia - substance abuse - PTSD - borderline personality disorder

Separation anxiety disorder

- is excessive anxiety concerning separation from home or from persons, parents, or caregivers to whom the client is attached - it occurs when it is no longer developmentally appropriate and before 18 years of age

The nurse is conducting an interview with an adult client who is being treated for major depression. What question should the nurse prioritize in an effort to determine the client's risk for suicide? "Do you ever feel like your situation is hopeless?" "How would you describe your relationship with your parents?" "Do you feel like your antidepressant is helping your mood?" "What are your plans for the next few days?"

"Do you ever feel like your situation is hopeless?"

When conducting a focused assessment on a newly admitted client who attempted suicide, which question should the nurse include to ensure the client's safety? Select all that apply. "Do you still have a plan to harm yourself?" "Have you ever tried to hurt yourself before?" "Are you willing to tell us if you plan to harm yourself again?" "Did you really want to kill yourself?" "Is there a history of depression in your family?"

"Do you still have a plan to harm yourself?" "Have you ever tried to hurt yourself before?" "Are you willing to tell us if you plan to harm yourself again?"

A nursing instructor is teaching about different depressive disorders and identifies a need for further instruction when a student states what? "Dysthymic disorder is milder than major depression." "Dysthymic disorder is less chronic than major depression." "With dysthymic disorder, depressed mood exists for most days for at least 2 years." "Dysthymic disorder can significantly affect a patient's functioning."

"Dysthymic disorder is less chronic than major depression."

A psychiatric nurse's colleague has expressed a reluctance to assess a client's risk for suicide, stating, "The last thing I want to do is to plant the thought in the client's head and bring on a suicide attempt." What is the nurse's best response? "Evidence shows that talking about suicide with clients doesn't cause suicide attempts." "We have an ethical responsibility to assess our clients for suicide risk, even if there are risks associated with doing so." "If a client is determined to make an attempt at suicide, there's nothing you or I can do to alter that." "Could it be that you're experiencing countertransference around your own fears of suicide?"

"Evidence shows that talking about suicide with clients doesn't cause suicide attempts."

A 52-year-old client with bipolar disorder tells the nurse, "I read that there are chemicals in my brain that can cause my symptoms." Knowing that the client is referring to neurotransmitters, which would be the best response by the nurse? "Recent studies have found that neurotransmitters do not play a role in bipolar disorders." "Clients with bipolar disorder often have high levels of gamma-aminobutyric acid (GABA) in manic states." "High levels of the neurotransmitter serotonin are associated with mania." "Low levels of the neurotransmitter dopamine are associated with mania."

"High levels of the neurotransmitter serotonin are associated with mania."

During a night shift, a hospitalized client with depression tells a nurse that the client is going to kill himself or herself. The client is placed on constant observation. When the client asks to use the toilet, the nurse follows the client into the bathroom. The client says, "You don't need to follow me into the bathroom. Give me some space." Which response by the nurse is most appropriate? "You're right. I don't need to come into the bathroom with you. I will wait outside the door." "I must stay with you until we are sure you will not hurt yourself." "If you think you are going to be OK, I will check on you in 5 minutes." "I can't imagine anything dangerous is in the bathroom. Go ahead. I will wait for you in the hallway."

"I must stay with you until we are sure you will not hurt yourself."

A client has been recently diagnosed with depression and has just started taking an antidepressant medication. Which of the client's statements indicates an accurate understanding of this aspect of treatment? "I'm still trying to decide whether antidepressants will be helpful in my treatment." "I understand that I probably won't feel much better for a couple of weeks after I start the drugs." "I can tell that I get a lift each morning after I take my antidepressant." "I know that few people actually see an improvement in their mood with antidepressants, but I suppose I'll try anyhow."

"I understand that I probably won't feel much better for a couple of weeks after I start the drugs."

The nurse is interviewing a client with a diagnosis of depression and the client states, "Honestly, I know my family would be a lot better off if I wasn't around to be a burden on them. That's just between you and me, though, okay?" What is the nurse's best response? "I'm obliged to share what we talk about with the other people on your care team." "Why is it important to you that this be kept between you and I?" "In my experience, nothing good ever comes of keeping secrets." "What can I do to get your permission to share with the other members of the care team?"

"I'm obliged to share what we talk about with the other people on your care team."

A client is to receive three treatments of electroconvulsive therapy (ECT) per week for 3 weeks. After the third treatment, the client is forgetful and confused. When the client's spouse arrives to take the client home, the nurse discusses the client's condition with the spouse. Which statement is best? "Some confusion after ECT is normal. The client will regain memory in a few hours." "Confusion after ECT is not expected. Though it will resolve, the client probably will not be a candidate for ECT in the future." "Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer." "Some confusion after ECT is normal. Withhold the client's medications for today and call tomorrow to let us know how the client is doing."

"Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer."

A client is to receive three treatments of electroconvulsive therapy (ECT) per week for 3 weeks. After the third treatment, the client is forgetful and confused. When the client's spouse arrives to take the client home, the nurse discusses the client's condition with the spouse. Which statement is best? "Some confusion after ECT is normal. The client will regain memory in a few hours." "Confusion after ECT is not expected. Though it will resolve, the client probably will not be a candidate for ECT in the future." "Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer." "Some confusion after ECT is normal. Withhold the client's medications for today and call tomorrow to let us know how the client is doing."

"Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer."

A psychiatric-mental health nurse is conducting an in-service education program about suicide for a group of nurses working at a community mental health center. The nurse determines that the teaching was successful based on which statement by the group? "Suicide is more of a concern in countries other than the United States." "Suicide does not occur in affluent neighborhoods, indicating poverty is a factor." "Suicide has profound effects on those connected to the individual." "Suicide rates among older adults are low."

"Suicide has profound effects on those connected to the individual."

The spouse of a client diagnosed recently with a mood disorder calls the nurse therapist to report a change in the client's mood. The spouse states, "The client is clearly in a better mood than usual. I would say the client seems mildly elated. The client is functioning fine at work and home. The client is energetic, up and doing things at 5:00 a.m. and really confident again. It seems fantastic, but unusual. Is this something to worry about?" Which potential response by the nurse accurately assesses the situation? "It sounds as though the antidepressants are working well. Just ask the client if the client is experiencing any side effects and let me know." "I'm concerned. Sometimes depressed people seem contented when they have decided to commit suicide. Let's schedule an appointment for tomorrow." "Since the client is eating, sleeping, and not behaving inappropriately, there's nothing to worry about. Just let me know if the client starts getting irritable or has trouble sleeping." "The client sounds hypomanic. Let's schedule an appointment for this week for an evaluation. The client may need additional or different medication."

"The client sounds hypomanic. Let's schedule an appointment for this week for an evaluation. The client may need additional or different medication."

A client whose mania is related to a medical condition asks why the physician has prescribed carbamazepine instead of lithium. Which is the nurse's best response? "This drug may be preferred by your physician for many reasons." "This drug is best for clients who do not respond to lithium or whose mania is related to a medical condition, as is yours." "You will be fine taking this drug, so don't worry." "I don't know. Make sure you discuss this with your doctor as soon as you can."

"This drug is best for clients who do not respond to lithium or whose mania is related to a medical condition, as is yours."

A client comes to the emergency department reporting a severe pounding headache in the temples and a stiff neck. The client is flushed and diaphoretic, and the client's pulse is racing. The client states that the client is being treated for depression with an MAOI. Which question by the nurse would be most important to ask at this time? "When did you last have blood drawn to check your drug level?" "What have you had to eat or drink today?" "Are you having any chest pain?" "Do you use any herbal remedies?"

"What have you had to eat or drink today?"

A nurse is completing an admission assessment of a young male client who has a history of depression and who was brought to the hospital by the client's partner. In response to the nurse's question regarding suicidal ideation, the client discloses that he is thinking about killing himself. Which question would be most appropriate for the nurse to ask next? "What does your partner think about your desire to kill yourself?" "What are your spiritual beliefs about suicide?" "What will killing yourself accomplish?" "What thoughts have you had about how you would kill yourself?"

"What thoughts have you had about how you would kill yourself?"

A client has just been diagnosed with bipolar disorder and is upset with the diagnosis. The client tells the nurse, "It is probably my mother's fault, she has bipolar too." Which is the best response by the nurse? "Bipolar disorders have not been found to be genetic." "While bipolar disorders are genetic, there are other causes as well." "While bipolar disorders are genetic, the gene can only be passed on by a father." "Genetics are a minor factor in bipolar; it is more heavily influenced by psychological factors."

"While bipolar disorders are genetic, there are other causes as well."

A client has experienced a first episode of major depression and has received medication and treatment, which has led to a complete remission of the symptoms. The client asks the nurse, "How much longer will I need to take the medication?" Which response by the nurse would be most appropriate? "You'll need to continue the medication for about 6 to 12 months to see how things go." "It's probably best to continue the medication for another month, gradually decreasing the dosage over that time." "Since you have no more symptoms, you can stop taking the medications tomorrow." "The medication has eliminated your symptoms so you'll need to keep taking it for the rest of your life."

"You'll need to continue the medication for about 6 to 12 months to see how things go."

Antihistamines

(Benadryl, Hydroxyzine (Vistrailm) Atarax) Safe non-addicting alternative to Benzos

Monoamine oxidase inhibitor (MAOI) antidepressants

- isocarboxazid (Marplan) - phenelzine (Nardil) - tranylcypromine (Parnate)

Environmental factors at risk for suicide

- isolation - recent loss - lack of social support - unemployment - critical life events - family history of depression/suicide

which drugs for major depressive disorder are agonists?

- MAO-I - tricycles, SSRIs, SNRIs

antidepressants

- MOA inhibitors (prevent monoamine degradation) - tricyclic (inhibit MOA reuptake to keep them in synapse longer) - re-uptake inhibitors (SSRI is specific to serotonin)

what is the evidence that schizophrenia derives from genes imparting susceptibility?

- MZ twins have the same likelihood of developing schizophrenia even if they don't physically show schizophrenia -DZ twin shows the same likelihood as MZ twins only if they have the schizophrenia gene. if not, there is a significant decrease in susceptibility - prenatal environment of identical (MZ) twins makes a difference. monochorionic (same environment) makes them both more likely to have schizophrenia. dichorionic makes them both less likely to develop schizophrenia

what are the genes associated with depressive disorders?

- RORA : control of circadian rhythm - GRM8 - RORB

Behavioral therapy

- Relaxation training - Modeling - Systematic desensitization - Flooding - Response prevention - thought stopping

difference between ETC and TMS

- TMS is more selective in which part of the brain is stimulated - TMS does not cover as much of the brain

What is Tardive Dyskinesia

- a side effect from early antipsychotics caused by chronic usage of CPZ and D2 supersensitivity - it is a movement disorder that results in slow, faulty movements, involuntary movements of the face and neck

Three stages of reaction to stress

- alarm reaction stage - resistance stage - exhaustion stage

Negative or soft symptoms of schizophrenia

- alogia (tendency to speak very little or to convey little substance of meaning - poverty of content) - anhedonia (feeling no joy or pleasure from life or any activities or relationships) - apathy (feelings of indifference toward people, activities, and events) - Asociality (social withdrawal, few or no relationships, lack of closeness) - Blunted affect (restricted range of emotional feeling, tone, or mood) - catatonia (psychologically induced immobility occasionally marked by periods of agitation or excitement; the client seems motionless, as if in a trance - flat affect (absence of any facial expression that would indicate emotions or mood - avolition or lack of volition (absence of will, ambition, or drive to take action or accomplish tasks) - inattention (inability to concentrate or focus on a topic or activity, regardless of its importance)

Antidepressants and suicide risk

- depressed clients who begin taking an antidepressant may have a continued or increased risk for suicide in the first few weeks of therapy - they may experience an increase in energy from the antidepressant but remain depressed - this increase in energy may make clients more likely to act on suicidal ideas and able to carry them out - because antidepressants take several weeks to reach their peak effect, clients may become discouraged and act on suicidal ideas because they believe the medication is not helping them - it is extremely important to monitor the suicidal ideation of depressed clients until the risk has subsided

Positive or hard symptoms of schizophrenia

- ambivalence (holding seemingly contradictory beliefs or feelings about the same person, event, or situation) - associative looseness (fragmented or poorly related thoughts and ideas) - delusions (fixed false beliefs that have no basis in reality) - echopraxia (imitation of the movements and gestures of another person whom the client is observing) - flight of ideas (continuous flow of verbalization in which the person jumps rapidly from one topic to another) - hallucinations (false sensory perceptions or perceptual experiences that do not exist in reality) - ideas of reference (false impressions that external events have special meaning for the person) - perseveration (persistent adherence to a single idea or topic; verbal repetition of a sentence, word, or phrase; resisting attempts to change the topic) - bizarre behavior (outlandish appearance or clothing; repetitive or stereotyped, seemingly purposeless movements; unusual social or sexual behavior)

Tricyclic antidepressants

- amitriptyline (Elavil) - amoxapine (Asendin) - doxepin (Sinequan) - imipramine (Tofranil) - desipramine (Norpramine) - nortriptyline (Pamelor)

what are the results for people with long alleles for the promotor region of 5-HT?

- associated with less depression in patient - patients respond better to antidepressants - patients are more likely to respond to placebos - patients have fewer suicides *basically people with long alleles for serotonin are more resilient in stressful situations

Divalproex (Depakote)

- ataxia, drowsiness, weakness, fatigue, menstrual changes, dyspepsia, nausea, vomiting, weight gain, hair loss - monitor gait and assist as necessary, provide rest periods, give with food, establish balanced nutrition

what are delusions?

- beliefs that are contrary to fact, and are not shared by others - includes feelings of persecution, grandeur, and control (paranoia that someone else is controlling your thoughts and actions)

Anxiolytic drugs nonbenzodiazepines

- buspirone (BuSpar) - meprobamate (Miltown, Equanil)

Medication treatment of generalized anxiety disorders

- buspirone (buspar) - SSRI or SNRI antidepressants

Medical illnesses at risk for suicide

- cancer - HIV/AIDS - diabetes - CVA - head/spinal cord injuries

Anticonvulsants used as mood stabilizers

- carbamazepine (Tegretol) - divalproex (Depakote) - gabapentin (Neurontin) - lamotrigine (Lamictal) - topiramate (Topamax) - oxcarbazepine (Trileptal)

Desipramine (Norpramine)

- cardiac dysrhythmias, dizziness, orthostatic hypotension, excitement, insomnia, sexual dysfunction, dry mouth and throat, rashes - monitor cardiac function, assist client to rise slowly from sitting position, administer in AM if client is having insomnia, encourage sugar free beverages and hard candy, report rashes or sexual difficulties to physician

Nortriptyline (Pamelor)

- cardiac dysrhythmias, tachycardia, confusion, excitement, tremor, constipation, dry mouth and throat - monitor cardiac function, administer in AM if stimulated, ensure adequate fluids, encourage use of sugar free beverages and hard candy, report confusion to physician

Serotonin syndrome symptoms

- change in mental state: confusion and agitation - neuromuscular excitement: muscle rigidity, weakness, sluggish pupils, shivering, tremors, myoclonic jerks, collapse, and muscle paralysis - autonomic abnormalities: hyperthermia, tachycardia, tachypnea, hypersalivation, and diaphoresis

Depressive disorder signs/symptoms

- changes in eating habits resulting in unplanned weight gain/loss - hypersomnia or insomnia - impaired concentration, decision making, or problem solving abilities - inability to cope with daily life - feelings of worthlessness, hopelessness, guilt, or despair - thoughts of death and/or suicide - overwhelming fatigue - rumination with negative, pessimistic thinking with no hope of improvement

Catatonia disorder

- characterized by marked psychomotor disturbance, either excessive motor activity or virtual immobility and motionlessness - motor immobility may include catalepsy (waxy flexibility) or stupor - excessive motor activity is apparently purposeless and not influenced by external stimuli - other behaviors include extreme negativism, mutism, peculiar movements, echolalia, or echopraxia. - can occur with schizophrenia, mood disorders, or other psychotic disorders

What does Chlorpromazine (CPZ) do?

- classic antipsychotic that blocks D2 and D3 dopamine receptors and is a first generation antipsychotic drug - not very effective in treating neuroses or psychoses but has a dramatic effect on schizophrenia

Brief psychotic disorder

- client experiences the sudden onset of at least one psychotic symptom, such as delusions, hallucinations, or disorganized speech or behavior, which lasts from 1 day to 1 month - the episode may or may not have an identifiable stressor or may follow childbirth

Delusional disorder

- client has one or more nonbizarre delusions—that is, the focus of the delusion is believable - the delusion may be persecutory, erotomanic, grandiose, jealous, or somatic in content - psychosocial functioning is not markedly impaired, and behavior is not obviously odd or bizarre

Treatment of panic disorders

- cognitive behavioral techniques - deep breathing and relaxation - medications (benzodiazepines, SSRI antidepressants, tricyclic antidepressants, antihypertensives such as clonidine [Catapres] and propranolol [Inderal])

Panic disorder

- composed of discrete episodes of panic attacks, that is, 15 to 30 minutes of rapid, intense, escalating anxiety in which the person experiences great emotional fear as well as physiologic discomfort - palpitations, sweating, tremors, shortness of breath, sense of suffocation, chest pain, nausea, abdominal distress, dizziness, paresthesias, chills or hot flashes

why is there an excessive amount of dopamine in the striatum?

- could be due to decrease in GABA

Premenstrual dysphoric disorder

- defined as recurrent, moderate psychological and physical symptoms that occur during the week before menses and resolve with menstruation - affected by affective and/or somatic symptoms causing severe dysfunction in social or occupational functioning - symptoms include labile mood, irritability, increased interpersonal conflict, difficulty concentrating, feeling overwhelmed or unable to cope, feelings of anxiety, tension, or hopelessness

Schizoaffective disorder

- diagnosed when the client is severely ill and has a mixture of psychotic and mood symptoms - signs and symptoms include those both of schizophrenia and a mood disorder such as depression or bipolar disorder - symptoms may occur simultaneously or alternate between psychotic and mood disorder symptoms

Anxiolytic drugs benzodiazepines

- diazepam (Valium) - alprazolam (Xanax) - chlordiazepoxide (Librium) - lorazepam (Ativan) - Clonazepam (Klonopin) - oxazepam (Serax)

describe the ways in which hypofrontality disinhibits VTA and amygdala in the mesolimbic system

- disrupted Glutamate projections or receptors in PFC - decreased Dopamine projections or receptors in PFC - DISC1 mutation decreased dopamine projection to PFC - increased striatal D2 receptors disrupts GABA receptors in PFC each of these will disinhibit the VTA and and increase the DA released positive symptoms result from the lack of inhibition of the VTA from the prefrontal cortex

Oxcarbazepine (Trileptal)

- dizziness, fatigue, ataxia, confusion, nausea, vomiting, anorexia, headache, tremor, confusion, rashes - assist client to rise slowly from sitting position, monitor gait and assist as necessary, give with food, orient client and protect from injury, report rashes to physician

Topiramate (Topamax)

- dizziness, hypotension, anxiety, ataxia, incoordination, confusion, sedation, slurred speech, tremor, weakness, blurred or double vision, anorexia, nausea, vomiting - assist client to rise slowly from sitting position, monitor gait and assist as necessary, orient client, protect client from potential injury, give with food

Gabapentin (Neurontin)

- dizziness, hypotension, ataxia, coordination, sedation, headache, fatigue, nystagmus, nausea, vomiting - assist client to rise slowly from sitting position, provide rest periods, give with food

Lamotrigine (Lamictal)

- dizziness, hypotension, ataxia, coordination, sedation, headache, weakness, fatigue, menstrual changes, sore throat, flu like symptoms, blurred or double vision, nausea, vomiting, rashes - assist client to rise slowly from sitting position, monitor gait and assist as necessary, provide rest periods, monitor physical health, give with food, report rashes to physician

Carbamazepine (Tegretol)

- dizziness, hypotension, ataxia, sedation, blurred vision, leukopenia, rashes - assist client to rise slowly from sitting position, monitor gait and assist as necessary, report rashes to physycian

Amoxapine (Asendin)

- dizziness, orthostatic hypotension, sedation, insomnia, constipation, dry mouth and throat, rashes - assist client to rise slowly from sitting position, administer at bedtime if client is sedated, ensure adequate fluids, encourage use of sugar free beverages and hard candy, report rashes to physician

Doxepin (Sinequan)

- dizziness, orthostatic hypotension, tachycardia, sedation, blurred vision, constipation, dry mouth and throat, weight gain, sweating - assist client to rise slowly from sitting position, administer at bedtime if client is sedated, ensure adequate fluids and balanced nutrition, encourage use of sugar free beverages and hard candy, encourage exercise

Amitriptyline (Elavil)

- dizziness, orthostatic hypotension, tachycardia, sedation, headache, tremor, blurred vision, constipation, dry mouth and throat, weight gain, urinary hesitancy, sweating - assist client to rise slowly from sitting position, administer at bedtime, encourage use of sugar free beverages and hard candy, ensure adequate fluids and balanced nutrition, encourage exercise, monitor cardiac function

Imipramine (Tofranil)

- dizziness, orthostatic hypotension, weakness, fatigue, blurred vision, constipation, dry mouth and throat, weight gain - assist client to rise slowly from sitting or supine position, ensure adequate fluids and balanced nutrition, encourage use of sugar free beverages and hard candy, encourage exercise

Sertraline (Zoloft)

- dizziness, sedation, headache, insomnia, tremor, sexual dysfunction, diarrhea, dry mouth and throat, nausea, vomiting, sweating - administer in PM if client is drowsy, encourage use of sugar free beverages or hard candy, drink adequate fluids, monitor hyponatremia, report sexual difficulties to physician

Paroxetine (Paxil)

- dizziness, sedation, headache, insomnia, weakness, fatigue, constipation, dry mouth and throat, nausea, vomiting, diarrhea, sweating - administer with food, administer in PM if client is drowsy, encourage use of sugar free hard candy or beverages, encourage adequate fluids

Escitalopram (Lexapro)

- drowsiness, dizziness, weight gain, sexual dysfunction, restlessness, dry mouth, headache, nausea, diarrhea - check orthostatic blood pressure, assist client to rise slowly from sitting position, encourage use of sugar free beverages or hard candy, administer with food

Phenelzine (Nardil)

- drowsiness, dry mouth, overactivity, insomnia, nausea, anorexia, constipation, urinary retention, orthostatic hypotension - administer in AM

Tranylcypromine (Parnate)

- drowsiness, dry mouth, overactivity, insomnia, nausea, anorexia, constipation, urinary retention, orthostatic hypotension - administer with food, ensure adequate fluids, perform essential teaching on importance of low tyramine diet

Isocarboxazid (Marplan)

- drowsiness, dry mouth, overactivity, insomnia, nausea, anorexia, constipation, urinary retention, orthostatic hypotension - assist client to rise slowly from sitting position

Citalopram (Celexa)

- drowsiness, sedation, insomnia, nausea, vomiting, weight gain, constipation, diarrhea - monitor for hyponatremia, administer with food, administer dose at 6pm or later, promote balanced nutrition and exercise

mania

- extreme euphoria - grand plans

Agranulocytosis

- failure of the bone marrow to produce adequate white blood cells - develops suddenly and is characterized by fever, malaise, ulcerative sore throat, and leukopenia - potentially fatal side effect of clozapine - must have weekly white blood cell counts for the first 6 months of therapy and every two weeks thereafter (cell count above 3500 cells/mm cubed)

Buspirone (BuSpar)

- very slow acting - dizziness, restlessness, agitation, drowsiness, headache, weakness, nausea, vomiting, paradoxical excitement or euphoria - rise slowly from sitting position

Diazepam (Valium)

- fast acting - half life 20-100 hours - dizziness, clumsiness, sedation, headache, fatigue, sexual dysfunction, blurred vision, dry throat/mouth, constipation, high potential for abuse and dependence - avoid other CNS depressants such as antihistamines and alcohol

depression

- feelings of guilt and unworthiness

Selective serotonin reuptake inhibitor (SSRI) antidepressants

- fluoxetine (Prozac) - sertraline (Zoloft) - paroxetine (Paxil) - Citalopram (Celexa) - Escitalopram (Lexapro)

Nefazodone (Serzone)

- headache, dizziness, drowsiness, alters results of AST, ALT, LDH, cholesterol, glucose, hematocrit - administer before meal (food inhibits absorption), monitor liver and kidney functions

Fluoxetine (Prozac)

- headache, nervousness, anxiety, sedation, tremor, sexual dysfunction, anorexia, constipation, nausea, diarrhea, weight loss - administer in AM (if nervous) or PM (if drowsy), monitor for hyponatremia, encourage adequate fluids, report sexual dysfunction to physician

Desvenlafaxine (Pristiq) SNRI

- headache, sedation or insomnia, agitation, dry mouth, constipation, sweating, increased blood pressure, dizziness - administer with food, encourage use of sugar free beverages or candy, rise slowly from sitting or lying position

why is puberty a critical point for showing brain abnormalities in people with schizophrenia?

- hormones that weren't being expressed before - new neural connections may not be accomplishing anything, and too much cell death at one time can cause neural abnormalities

Early signs of schizophrenia relapse

- impaired cause and effect reasoning - impaired information processing - poor nutrition - lack of sleep - lack of exercise - fatigue - poor social skills, social isolation, loneliness - interpersonal difficulties - lack of control, irritability - mood swings - ineffective medication management - low self concept - looks and acts different - hopeless feelings - loss of motivation - anxiety and worry - disinhibition - increased negativity - neglecting appearance - forgetfulness

Behavioral factors at risk for suicide

- impulsivity - erratic/unexplained changes from usual behavior - unstable lifestyle

Duloxetine (Cymbalta) SNRI

- increased blood pressure and pulse, nausea, vomiting, drowsiness or insomnia, headache, dry mouth, constipation, lowered seizure threshold, sexual dysfunction - administer with food, ensure adequate fluids, encourage use of sugar free beverages or hard candy, give with food

Venlafaxine (Effexor) SNRI

- increased blood pressure and pulse, nausea, vomiting, headache, dizziness, drowsiness, dry mouth, and sweating; can alter many lab tests, e.g., AST, ALT, alkaline phosphatase, creatinine, glucose, and electrolytes - administer with food, ensure adequate fluids, give in PM, encourage use of sugar-free beverages or hard candy

what role do PCP and ketamine have in the frontal cortex

- indirect antagonist of glutamate NMDA receptors - suppress DA utilization

Manic episodes

- inflated self esteem or grandiosity - decreased sleep - excessive and pressured speech - flight of ideas - distractibility - increased activity or psychomotor agitation - excessive involvement in pleasure seeking or risk taking activities with a high potential for painful consequences - mood can be excessively cheerful, enthusiastic, and expansive or may be irritable when told no or to follow rules - deny problems and place blame on others for difficulties experienced - delusions/hallucinations

Lorazepam (Ativan)

- intermediate acting - half life 10-20 hours - dizziness, clumsiness, sedation, headache, fatigue, sexual dysfunction, blurred vision, dry throat/mouth, constipation, high potential for abuse and dependence

Chlodiazepoxide (Librium)

- intermediate acting - half life 5-30 hours - dizziness, clumsiness, sedation, headache, fatigue, sexual dysfunction, blurred vision, dry throat/mouth, constipation, high potential for abuse and dependence - take care with potentially hazardous activities such as driving

Alprazolam (Xanax)

- intermediate acting - half life 6-12 hours - dizziness, clumsiness, sedation, headache, fatigue, sexual dysfunction, blurred vision, dry throat/mouth, constipation, high potential for abuse and dependence - avoid caffiene

Visual hallucinations

- involve seeing images that don't exist - lights, dead person, or distortions such as seeing a monster instead of a nurse - second most common type of hallucination

Olfactory hallucinations

- involve smells or odors - may be specific scent (urine, feces) or more general scent (rotten or rancid odor) - in addition to those with schizophrenia can occur with dementia, seizures, or CVA's

Cenesthetic hallucinations

- involve the client's report he or she feels bodily functions not usually detectable - sensation of urine forming or impulses being transmitted in the brain

Gustatory hallucinations

- involves a taste lingering in the mouth or sense that food tastes like something else - taste may be metallic, bitter, or represented as a specific taste

Nonsuicidal self-injury

- involves deliberate, intentional cutting, burning, scraping, hitting, or interference with wound healing - those engaging in self injury (self mutilation) report reasons of alleviation of negative emotions, self punishment, seeking attention, or escaping a situation or responsibility

Substance induced anxiety disorder

- is anxiety directly caused by drug abuse, a medication, or exposure to a toxin - symptoms include prominent anxiety, panic attacks, phobias, obsessions, or compulsions

Anxiety disorder due to a general medical condition

- is diagnosed when the prominent symptoms of anxiety are judged to result directly from a physiologic condition - the person may have panic attacks, generalized anxiety, or obsessions or compulsions - medical conditions causing this disorder can include endocrine dysfunction, chronic obstructive pulmonary disease, congestive heart failure, and neurologic conditions

treatment resistant depression

- ketamine treatment (interferes with NDMA glutamate receptor, but not a preferred therapy due to chronic use) - electroconvulsive therapy (ECT) - transcranial magnetic stimulation (TMS) of PFC - deep brain stimulation (DBS) of subgenual anterior cingulate cortex - vagus nerve stimulation - bright light therapy - sleep deprivation

Spring onset seasonal affective disorder

- less common - insomnia - weight loss - poor appetite from late spring or early summer until early fall

which study shows evidence for sudden loss of gray matter in schizophrenics?

- looking at discordant twins, the schizophrenic twin has wider sulci and enlarged ventricles

what happens to gray matter tissue in schizophrenic subjects?

- loss of neuropil - rate of gray tissue loss is much greater than in healthy people - even if schizophrenics have the same number of neurons, they will have less developed neurons

Panic anxiety physiologic responses

- may bolt and run - may be totally immobile and mute - dilated pupils - increased BP and pulse - flight, fight, or freeze

Postpartum (maternity) blues

- mild, predictable mood disturbance occurring in the first several days after delivery of a baby - symptoms include labile mood and affect, crying spells, sadness, insomnia, anxiety - symptoms subside without treatment but mothers benefit from support/understanding of friends/family

Fall onset seasonal affective disorder (winter depression)

- most common - increased sleep, appetite, and carbohydrate cravings - weight gain - interpersonal conflict - irritability - heaviness in the extremities beginning late autumn and abating in spring or summer

Postpartum depression

- most common complication of pregnancy in developed countries - symptoms consistent with those of depression with onset within 4 weeks of delivery

Auditory hallucinations

- most common type - involves hearing sounds, most often voices talking to or about the client - may be one or multiple voices - familiar or unfamiliar person's voice may be speaking

Moderate anxiety physiologic responses

- muscle tension - diaphoresis - pounding pulse - headache - dry mouth - high voice pitch - faster rate of speech - GI upset - Frequent urination

What developmental changes occur that result in schiz

- mutation of the DISC1 gene - abnormalities in striatal dopaminergic system - hypofrontality role of D2 dopa receptors

Bupropion (Wellbutrin)

- nausea, vomiting, lowered seizure threshold, agitation, restlessness, insomnia, may alter taste, blurred vision, weight gain, headache - administer dose in AM, ensure balanced nutrition and exercise

what is epigenetics?

- not all of your genes will be expressed - external modifications (environmental factors) will either turn on or turn off DNA - methylation turns off genes - if chromosomes are wrapped too tightly around histones, then some genes are less likely to be expressed by RNA - epigenetic modification can be transmitted to offspring

Kinesthetic hallucinations

- occur when the client is motionless but reports sensation of bodily movement - bodily movement is something unusual such as floating above the ground

Panic attack symptoms

- palpitations - sweating - tremors - shortness of breath - sense of suffocation - chest pain - nausea - abdominal distress - dizziness - paresthesia - chills or hot flashes

Clients suffering anxiety disorders can demonstrate unusual behaviors such as

- panic without reason - unwarranted feat of objects or life conditions - unexplainable or overwhelming worry

describe atypical antipsychotics

- partial agonist (act as both agonist and antagonist) - high affinity and low activity - clozapine and aripiprazole

Moderate anxiety psychological responses

- perceptual field narrowed to immediate task - selectively attentive - cannot connect thoughts or events independently - increased use of automatisms

Panic anxiety psychological responses

- perceptual field reduced to focus on self - cannot process any environmental stimuli - distorted perceptions - loss of rational thought - doesn't recognize potential behavior - can't communicate verbally - possible delusions and hallucinations - may be suicidal

Severe anxiety psychological responses

- perceptual field reduced to one detail or scattered details - cannot complete tasks - cannot solve problems or learn effectively - behavior geared toward anxiety relief and is usually ineffective - doesn't respond to redirection - feels awe, dread, or horror - cries - ritualistic behavior

Meprobamate (Miltown, Equanil)

- rapid acting - dizziness, restlessness, agitation, drowsiness, headache, weakness, nausea, vomiting, paradoxical excitement or euphoria - take care with potentially hazardous activities such as driving; take with food; report persistent restlessness, agitation, excitement, or euphoria to physician

Tactile hallucinations

- refer to sensations (electricity running through body or bugs crawling on skin) - found most often in those undergoing alcohol withdrawal - rarely occurs in those with schizophrenia

Mild anxiety physiologic responses

- restlessness - fidgeting - GI butterflies - difficulty sleeping - hypersensitivity to noise

Positive sign nursing diagnoses

- risk for other-directed violence - risk for suicide - disturbed thought process - disturbed sensory perception - disturbed personal identity - impaired verbal communication

what are the main factors that contribute to the susceptibility hypothesis?

- schizophrenic-susceptible gene - shared intrauterine environment - DISC1 mutation - epigenetics - environmental factors during pregnancy - paternal age correlation with schizophrenic offspring

what are the environmental factors that can contribute to schizophrenia during pregnancy?

- season of birth & viral epidemics (in the spring, more pregnant women get the flu and children are more likely to develop brain disruptions) - vitamin D deficiency (dark skinned more likely to develop schizophrenia) - population density (urban) - prenatal malnutrition - substance abuse - interactions (urinary tract infection during pregnancy) - obstetric complications

role of zeitbgebers in affective disorders

- seasonal affective disorder (SAD): usually during winter - phototherapy (daily exposure to bright light to help relieve depressive symptoms)

Mirtazapine (Remeron)

- sedation, dizziness, dry mouth and throat, weight gain, sexual dysfunction, constipation - administer in PM, encourage use of sugar free beverages and hard candy, ensure adequate fluids and balanced nutrition, report sexual difficulties to physician

Negative sign nursing diagnoses

- self care deficits - social isolation - deficient diversional activity - ineffective health maintenance - ineffective therapeutic regimen management

treatments for schizophrenia

- serotonin can help with negative and cognitive symptoms but does not help with positive symptoms - atypical antipsychotic drugs are more useful. increases activity in PFC while decreasing dopamine in reward system - works by high affinity & low activity

Postpartum psychosis

- severe and debilitating psychiatric illness with acute onset in days following childbirth - symptoms begin with fatigue, sadness, emotional lability, poor memory, and confusion - progress to delusions, hallucinations, poor insight and judgment, loss of contact with reality - medical emergency requiring immediate treatment

Severe anxiety physiologic responses

- severe headache - nausea, vomiting, diarrhea - trembling - rigid stance - vertigo - pale - tachycardia - chest pain

Clonazepam (Klonopin)

- slow acting - half life 18-50 hours - dizziness, clumsiness, sedation, headache, fatigue, sexual dysfunction, blurred vision, dry throat/mouth, constipation, high potential for abuse and dependence - rise slowly from lying or sitting position

Oxazepam (Serax)

- slow acting - half life 4-15 hours - dizziness, clumsiness, sedation, headache, fatigue, sexual dysfunction, blurred vision, dry throat/mouth, constipation, high potential for abuse and dependence - use sugar free beverages or hard candy, drink adequate fluids, take only as prescribed, do not stop taking the drug abruptly

what is the role of neurogenesis in monoamine theory?

- stressful situations impair hippocampal neurogenesis - exercise improves neurogenesis - neurogenesis takes time - it may take weeks for SSRIs to work as antidepressants because neurogenesis needs to make up for impaired neural connections

Panic Disorder

- sudden onset of extreme apprehension/fear of impending doom; - extremely intense; -lasts few min. and then subsides; - not always necessary in response to stress; - typically unpredictable- come "out of the blue". - fear of losing one's mind or having a heart attack; - *fear so severe that normal functioning is suspended*, - perceptual field is severely limited and may misinterpret reality; - children and adolescents less able to articulate symptoms; - *avoid situations where help is not available including pleasurable and adaptive activities*; - *fear the fear*; - feel hopeless to control attacks and become depressed, - ETOH and substance abuse common in adolescents - *palpitations, chest pain, breathing difficulties, nausea, and feelings of choking, chills, and hot flashes may occur*.

Schizophreniform disorder

- the client exhibits an acute, reactive psychosis for less than the 6 months necessary to meet the diagnostic criteria for schizophrenia - if symptoms persist over 6 months, the diagnosis is changed to schizophrenia - social or occupational functioning may or may not be impaired

Resistance stage

- the digestive system reduces function to shunt blood to areas needed for defense - the lungs take in more air, and the heart beats faster and harder so it can circulate this highly oxygenated and highly nourished blood to the muscles to defend the body by fight, flight, or freeze behaviors - if the person adapts to the stress, the body responses relax, and the gland, organ, and systemic responses abate

why are antipsychotic drugs useful?

- their high affinity can compete with the naturally occurring dopamine, but they wont fully open the channels (antagonist) - this gives overall less activity in the VTA and amygdala - the same high affinity will cause receptors in the PFC to be saturated, when they normally are not (agonist)

characterize the sleep of of depressed people

- they don't have 90 minute periods in between - they have fragmented REM and shallow sleep (keep waking and falling back asleep) - early and increased REM

affective disorders and tryptophan depletion procedure

- tryptophan is necessary for making serotonin - if you remove tryptophan from patients, then they will relapse into depression - shows that lack of serotonin is critical for depression

Shared psychotic disorder (folie deux)

- two people share a similar delusion - the person with this diagnosis develops this delusion in the context of a close relationship with someone who has psychotic delusions, most commonly siblings, parent and child, or husband and wife - the more submissive or suggestible person may rapidly improve if separated from the dominant person

Generalized anxiety disorder symptoms

- uneasiness - irritability - muscle tension - fatigue - difficulty thinking - sleep alterations

describe positive symptoms

- unique to schizophrenia - includes hallucinations, delusions, and thought disorders (illogical thoughts) - an added behavior that wasn't previously present

Atypical antidepressants

- venlafaxine (Effexor) SNRI - desvenlafaxine (Pristiq) SNRI - duloxetine (Cymbalta) SNRI - bupropion (Wellbutrin) - nefazodone (Serzone) - mirtazapine (Remeron)

which studies show evidence for progressive loss of gray matter in schizophrenics?

- while everyone loses gray matter with age, schizophrenics lose more gray matter with age - longitudinal study from 1990 to 2000 shows gradual increase in ventricle size on MRI scans

Mild anxiety psychological responses

- wide perceptual field - sharpened senses - increased motivation - effective problem solving - increased learning ability - irritability

types of affective disorders

1. bipolar disorder (transitions from mania to depression) 2. major depressive disorder MDD 3. mania without depression

what is the chronological order of symptom development for schizophrenia?

1. negative symptoms 2. cognitive symptoms 3. positive symptoms

if schizophrenia is a recessive trait, then at least ___% of children from 2 schizophrenic parents should also be schizophrenic

100%

dichorionic MZ twins have ______% concordance for schizophrenia

11%

The mental health nurse appropriately provides education on light therapy to which client? 20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term 58-year-old showing signs of early Alzheimer's disease 45-year-old lawyer whose medication therapy needs an additional treatment 50-year-old farmer whose major depression has not responded to any treatment modality

20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term

viral epidemics can contribute to schizophrenic offspring during which trimester of pregnancy?

2nd trimester

what is the actual incidence of schizophrenia in people who inherit it? what does this incidence suggest?

50% this suggests that there are two possibilities for schizophrenia development. it either involves: 1) several genes 2) genes imparting a susceptibility to development of the disorder

monochorionic MZ twins have ______% concordance for schizophrenia

60%

When completing discharge medication education for the client, the client asks how long it will take before the selective serotonin reuptake inhibitor (SSRI) medication will help the client's mood improve. Which is the correct response by the nurse? 1 to 2 days 5 to 7 days 7 to 10 days 3 to 4 weeks

7 to 10 days

if schizophrenia is a dominant trait, then at least ___% of children from 2 schizophrenic parents should also be schizophrenic

75%

A client in the clinic appears to have elevated self-esteem, is more talkative than usual, and is easily distracted. This client is exhibiting symptoms of which of the following? a) Grandiosity b) Anxiety c) Anorexia d) Depression

A Grandiosity is elevated self-esteem and may range from unusual self-confidence to grandiose delusions. Speech is pressured; the person is more talkative than usual and at times is difficult to interrupt. There is often a flight of ideas or racing thoughts.

You are working with a 50-year-old woman admitted for major depressive episode. The client has remained isolated and withdrawn since her admission and is reluctant to speak. Which of the following therapeutic communication skills is most likely to encourage the client to vent her feelings? a) Silence and active listening b) Reality orientation c) Direct confrontation d) Projective identification

A Silence and active listening are powerful tools for use with a client who is depressed and withdrawn. Direct confrontation can lead to feelings of shame or embarrassment. The client who is not psychotic does not need reality orientation, and projective identification is a primitive subconscious ego defense mechanism.

When teaching prevention to the parents of a 15-year-old client who recently attempted suicide by taking an overdose of Xanax (alprazolam), the nurse describes which of the following behavioral clues? a) Giving away valued personal items b) Experiencing the loss of a boyfriend or girlfriend c) Inquiry about doses of lethal drugs d) Angry outbursts at significant others

A The suicidal individual may exhibit behaviors that provide clues to his or her intent, including the following: • Talks about death, suicide, and wanting to be dead • Talks or thinks about punishment, torture, and being persecuted • Hears voices and suddenly seems very happy after being very depressed for some time • Is very aggressive or very impulsive, and acting suddenly and unexpectedly • Shows an unusual amount of interest in getting his or her affairs in order • Gives away personal belongings

A client is to receive three treatments of electroconvulsive therapy (ECT) per week for 3 weeks. After the third treatment, the client is forgetful and confused. When the client's husband arrives to take her home, the nurse discusses his wife's condition with him. Which of the following statements is best? a) "Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer." b) "Some confusion after ECT is normal. She will regain her memory in a few hours." c) "Confusion after ECT is not expected. Though it will resolve, she probably will not be a candidate for ECT in the future." d) "Some confusion after ECT is normal. Withhold her medications for today and call tomorrow to let us know how she's doing."

A A frequent consequence of ECT is memory impairment, ranging from mild forgetfulness of details to severe confusion. This may persist for weeks or months after treatment but usually resolves.

A nurse is assessing a client with depression. During the assessment, the nurse notes that the client's emotional expression does not match what the client is saying. The nurse would document this as which type of affect? a) Inappropriate b) Labile c) Flat d) Blunted

A An inappropriate affect is a discordant affective expression accompanying the content of speech or ideation. A blunted affect is significantly reduced in intensity. A flat affect is characterized by an absent or nearly absent emotional expression. A labile affect is one that is varied, rapid, and abruptly shifts.

When teaching a client with newly diagnosed bipolar I disorder, the nurse states that the difference between bipolar I disorder and bipolar II disorder is what? a) Bipolar I disorder is often more disruptive than bipolar II disorder. b) Bipolar I disorder is characterized by hypomanic episodes. c) Bipolar I disorder more often affects women. d) Bipolar I disorder involves altered moods of anger and paranoia.

A Bipolar I disorder is often more severe, thus symptoms tend to create more disruption in functioning compared to bipolar II disorder. Bipolar I disorder is characterized by one or more manic or mixed episodes in which the individual experiences rapidly alternating moods accompanied by symptoms of a manic mood and a major depressive episode.

According to the biochemical theory of mood disorders, a client with a diagnosis of depression is likely to have alterations in the levels and function of which of the following neurotransmitters? a) Serotonin, norepinephrine, and dopamine b) Acetylcholine, adenosine, and glutamate c) Epinephrine, histamine, and melatonin d) Aspartate, GABA, and serine

A Monoamines such as serotonin, norepinephrine, and dopamine have been implicated in the etiology of mood disorders such as depression.

The nurse is caring for a client with major depressive disorder who has been admitted to a psychiatric-mental health facility. After assessing the client, the nurse has developed a nursing diagnosis of "Risk for Violence Toward Others related to agitation and low tolerance level." Which of the following would be an appropriate intervention for this client? a) Remove all dangerous items from the client's room. b) Encourage the client to act on thoughts that are leading to aggression. c) Provide antianxiety medication to prevent an incident. d) Encourage the client to engage in calming group activities.

A Establishing geographic boundaries, such as room restriction or half-hall restriction, is part of ongoing monitoring. Also, clients likely will have "as-needed" medications ordered; nurses use them if aggressive or agitated behavior escalates. Other environmental approaches include reducing stimuli and opportunities for interaction with other clients in the milieu. Nurses remove all dangerous items from the client's room and monitor closely for use of any dangerous items. Nurses help clients learn to recognize what triggers violent thoughts and behaviors. They teach clients not to act on these thoughts but to leave the situation and find a staff member to talk to about them.

A client who has liver damage is receiving lithium for treatment of bipolar disorder. The nurse understands that which of the following may occur when the client is receiving lithium? a) Increased plasma concentration b) Monitoring of plasma levels is not needed c) Decreased plasma concentration d) No alteration in plasma levels

A Hepatic and renal impairments increase plasma concentration of lithium.

The wife of a client diagnosed recently with a mood disorder calls the nurse therapist to report a change in her husband's mood. She states, "He is clearly in a better mood than usual. I would say he seems mildly elated. He's functioning fine at work and home. He's energetic, up and doing things at 5:00 AM and really confident in himself again. It seems fantastic, but unusual. Is this something to worry about?" Which of the following potential responses by the nurse accurately assesses the situation? a) "He sounds hypomanic. Let's schedule an appointment for this week for an evaluation. He may need additional or different medication." b) "It sounds as though the antidepressants are working well. Just ask him if he is experiencing any side effects and let me know." c) "Since he is eating, sleeping, and not behaving inappropriately, there's nothing to worry about. Just let me know if he starts getting irritable or has trouble sleeping." d) "I'm concerned. Sometimes depressed people seem contented when they have decided to commit suicide. Let's schedule an appointment for tomorrow."

A Hypomania is a slightly less severe subcategory of mania. Differentiating points are that hypomania has no psychotic features and does not impair functioning to a level that necessitates hospitalization. Most hypomanic episodes in bipolar II disorder occur immediately before or after a major depressive episode.

After educating a class on factors that enhance the risk of suicide, the instructor determines the need for additional education when the class identifies which of the following? a) Cautiousness b) Family member committing suicide c) Loss d) Delusions

A Impulsivity, rather than cautiousness, enhances suicide risk. Other factors include a family member having completed suicide, psychotic thoughts such as delusions, and loss.

Based on current research, the psychiatric nurse expects that a newly diagnosed bipolar client with suicidal ideations will be prescribed a) Lithium b) Clozapine (Clozaril) c) (Prozac) d) Naltrexone (ReVia)

A Lithium has been proven to lower suicide rates in clients with the diagnosis of bipolar disorder.

A client taking lithium for bipolar disorder is having mild diarrhea. The nurse informs the client that this is an example of which of the following? a) Side effect b) Desired effect c) Therapeutic effect d) Toxic effect

A Lithium has many side effects that can be handled with interventions. For diarrhea, the nurse can instruct the client to take the medication with meals and provide for fluid replacement. The nurse should tell the client to notify the prescriber if the diarrhea becomes severe--this development can be an early sign of lithium toxicity, which would warrant a change in medication. Diarrhea is not a toxic or desired effect. The therapeutic effect is the intended effect of a drug.

A nurse who works primarily with clients who have bipolar disorder identifies which group of clients as not being candidates to take lithium as treatment? a) Patients who take ACE inhibitors b) Patients who take bronchodilators c) Patients who drink decaffeinated coffee d) Patients with diabetes who take oral antidiabetic agents

A Lithium interacts with several different medications and foods. Clients who take ACE inhibitors should not take lithium, because the combination can increase the serum lithium level, leading to toxicity and impaired kidney function.

Cassandra, a 52-year-old woman with bipolar disorder, tells the nurse, "I read that there are chemicals in my brain that can cause my symptoms." Knowing that she is referring to neurotransmitters, which of the following would be the best response by the nurse? a) "Low levels of the neurotransmitter serotonin are associated with mania." b) "Clients with bipolar disorder often have high levels of GABA in manic states." c) "Recent studies have found that neurotransmitters do not play a role in bipolar disorders." d) "Low levels of the neurotransmitter dopamine are associated with mania."

A Mania has been associated with reduced serotonin and decreased sensitivity of serotonin receptors. Higher dopaminergic activity induced by reduced synaptic vesicle buffering capacity or higher dopaminergic receptor sensitivity also may be associated with mania. Clients with bipolar disorder may have low plasma levels of GABA during depressive and manic phases. (

The nurse is caring for a group of hospitalized clients with various psychiatric diagnoses. The nurse identifies which client as having the greatest risk for a suicide attempt? a) Man with major depressive disorder b) Woman with somatoform disorder c) Man with bipolar I disorder d) Woman with acute stress disorder

A Men have a higher suicide completion rate than women. For men, suicide is the eighth leading cause of death, with a rate of 17.5 per 100,000, more than four times the rate in women. White men complete 73% of all suicides; 80% of these deaths are by firearms. Men are more likely to use means that have a higher rate of success, such as firearms and hanging. Most suicide deaths occur in men with a psychiatric disorder, primarily depression, in many cases complicated by substance abuse.

The nurse working on a mental health unit is teaching a nursing student learning about depression. The student asks the nurse about what constitutes a diagnosis for major depressive disorder. What is the nurse's best response? a) "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present." b) "The physician diagnosis depression when a client has feelings of sadness several times a year." c) "Depression is a mood variation to life events." d) "Feelings of anxiety and sadness as a response to a life event are the most important qualifiers for depression."

A Normal variations in mood (such as sadness, euphoria, and anxiety) occur in response to life events; they are time limited and not usually associated with significant functional impairment. The primary diagnostic criterion for major depressive disorder is one or more major depressive episodes (either a depressed mood or a loss of interest of pleasure in nearly all activities) for at least 2 weeks. Four of seven other symptoms must be present. Thus, the best response from the nurse is "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."

While caring for a client in the hospital, you become concerned that the client may be having thoughts of suicide. Which of the following statements would be most therapeutic? a) "What is concerning you?" b) "Have you tried taking medication?" c) "Are you feeling sad?" d) "Do you have support at home?"

A Nurses start with open-ended questions that invite clients to convey what is concerning them most at this particular time. Sensitivity and empathy allow nurses to gather information, engage clients, and develop the therapeutic relationship.

People who complete suicide often have extremely low levels of which neurotransmitter? a) Serotonin b) Acetylcholine c) GABA d) Norepinephrine

A People who complete suicide often have extremely low levels of the neurotransmitter serotonin. Impairments in the serotonergic system contribute to suicidal behavior. People who make near-lethal suicide attempts have much lower levels of the neurotransmitter dopamine and omega-3. Low levels of the other neurotransmitters have not been implicated in completed suicides.

You are conducting an admission assessment with Alberto, a 45-year-old man, who has been demonstrating signs of bipolar disorder. While conducting the assessment, Alberto starts speaking in illogical rhymes and uses word associations. What is the name for this thought pattern? a) Flight of ideas b) Delusions of grandeur c) Excessive euphoric speech d) Expansive ideas

A Rapid "flights of ideas" lead to excessive and illogical rhyming, punning, and word associations, along with pressured speech.

Which of the following statements regarding suicide is correct? a) Suicide has profound effects on those connected to the individual. b) Suicide is defined as the voluntary or unintentional act of taking one's own life. c) Suicide does not occur in affluent neighborhoods, indicating poverty is a factor. d) Suicide is more of a concern in countries other than the United States.

A Suicide is a major public health concern, both in the United States and around the world. Although certain factors may increase risk for suicide, suicide knows no bounds of person, age, class, race, or gender. It is an act that profoundly affects those left in its wake. While the definition of suicide is simple (the voluntary and intentional act of taking one's own life), the processes surrounding it are complex.

Which of the following is the greatest predictor of a future suicide attempt? a) Previous attempt b) Suicide planning c) Degree of hopelessness d) Seriousness of suicidal ideation

A The greatest predictor of a future suicide attempt is a previous attempt, partly because that individual already has broken the "taboo" around suicidal behavior. Assessing for risk includes determining the seriousness of the suicidal ideation, degree of hopelessness, and suicide planning.

The monoamine hypothesis of depression ... a) holds that depression results from a deficiency in the concentrations or in metabolic dysregulation of the monoamines. b) holds that depression is caused by sociocultural and psychological factors. c) holds that depression is caused by only one of the biogenic amines. d) relates to bipolar disorders, not to depression.

A The major monoamine hypothesis about depression is that absolute concentrations of norepinephrine, 5-HT, or both are deficient.

The nurse is reviewing the medical records of several clients diagnosed with major depression. The nurse identifies which client as least likely to commit suicide? a) Married man b) Widowed woman c) Single woman d) Divorced man

A The nurse determines that the client least likely to commit suicide is the client who is married. Single, older men living in a rural area have the highest rates of suicide. Unmarried, unsociable men between the ages of 42 and 77 years with minimal social networks and no close relatives have a significantly increased risk for committing suicide. Women are less likely to complete a suicide but are more likely to attempt suicide. Marriage has been identified as a protective factor for mental disorders in older adults.

The nurse is caring for a white man age 30 years whose wife has recently died. The client has been diagnosed with clinical depression and is demonstrating insufficient coping skills. Which action by the nurse would be most important? a) Ask the client if he is thinking about killing himself. b) Refer the client for long-term psychotherapy. c) Determine the client's risk of psychosis. d) Determine if anyone in the client's family has had depression.

A The nurse should first ask if the client is thinking about killing himself, because statistics show that in young, recently widowed white men between the ages of 20 and 34 years, the suicide risk is 17 times higher than that of married men in that same age group. Social isolation and access to firearms play important roles in this group. Information related to psychosis, psychotherapy, or family history would be less of a priority at this time.

After teaching a group of nursing students about major depression, the instructor determines that the education was successful when the group identifies which age group as having the highest onset? a) Individuals in their 20's b) Individuals in their 30's c) Teens d) Middle-aged persons

A The onset of depression may occur at any age. However, the initial onset may occur in puberty; the highest onset occurs within persons in their 20s.

what are the two extreme feelings associated with major affective disorders?

mania & depression

In a therapy session, a client with a diagnosis of major depression admits to the nurse-therapist, "I actually went out driving on the interstate this morning and had every intention of getting up to speed and plowing right into the overpass by my exit. Maybe tomorrow." The nurse would recognize the client's statement as what? a) Suicidal intent b) Suicidal gesture c) Suicidal threat d) Suicidal ideation

A The specificity and concreteness of the client's plan indicates suicidal intent. Suicidal ideations, threats, and gestures are typically more vague and less rooted in time and place.

A 34-year-old client with depression is admitted to an inpatient psychiatric unit. The nurse enters her room and initiates interaction with the client. When talking with the client, which approach would be least appropriate? a) Animated and cheerful manner b) Quiet and empathetic manner c) Matter-of-fact manner d) Respectful, direct manner

A When communicating with clients who are depressed, the nurse should never use an overly enthusiastic approach. This approach can lead to irritation and block communication. Clients should be encouraged to set realistic goals to reconnect with their families and communities.

Which of the following is accurate regarding women and suicide? a) They are less likely to complete suicide than men. b) They are more likely to die from attempted suicide than men. c) They are more likely to choose a more lethal method than men. d) They attempt suicide less often than men.

A Women are less likely to complete a suicide than men, partly because they are more likely to choose a less lethal method. Women are less likely to die from an attempted suicide than men, but they attempt suicide more often.

Which individual has the highest number of risk factors for the development of depression? A 42-year-old woman who has experienced depression before but has a strong support system A 32-year-old man who has been diagnosed with cancer and has been abusing alcohol A 50-year-old woman who just lost her spouse and has a family history of depression A 62-year-old man who has had depression in the past and abuses alcohol

A 50-year-old woman who just lost her spouse and has a family history of depression

Which sleep pattern is suggestive of a manic episode? A client stays awake for several days and nights before "crashing" and sleeping for a long period. A client experiences day-night reversal, sleeping until late in the afternoon and going to bed near dawn. A client reports having fitful sleep that is characterized by frequent awakenings and nightmares. A client takes multiple short naps at varied times throughout the day and night.

A client stays awake for several days and nights before "crashing" and sleeping for a long period.

A 46-year-old client comes to the community mental health center because the client thinks they might be suffering from depression. When assessing this client, which symptom would the nurse identify as being necessary for the diagnosis of major depressive disorder to be made? Euphoria along with poor decision making ability Disregard for personal hygiene including cleanliness and appearance A loss of interest or inability to derive pleasure for previously enjoyed activities A stooped posture and nonverbal signs of a depressed mood

A loss of interest or inability to derive pleasure for previously enjoyed activities

A client was admitted to the psychiatric unit after being picked up by police officers who found her frantically running back and forth across the freeway. Her husband related that she stayed up all night, ate very little, and talked incessantly. Additional assessment findings that indicate a manic episode include what? a) Psychomotor retardation, fatigue, and apathy b) Catatonic excitement, loose associations, and recurrent illusions c) Pressured speech, combative behavior, and impaired judgment d) Self-destructive behavior, overidealization, and devaluation

A manic episode would be characterized by pressured speech, potentially combative behavior, and impaired judgment. Neither psychomotor retardation is present nor are recurrent illusions. Self-destructive behavior is not a classic symptom of mania; more often, clients may have accidents caused by their lack of judgment and psychomotor agitation.

The clinical symptom that would be included when the clinician makes this diagnosis is what? Self-report of being sad after a break up A significant decrease in appetite Demonstrated examples of unwise decisions Claims by family, friends, or coworkers that the client is depressed

A significant decrease in appetite

The community mental health nurse is providing care for a large number of clients. What client should the nurse monitor most closely for the warning signs of suicide? A young male with schizophrenia who is in danger of becoming homeless An adult female who is mourning the death of her husband 5 months ago An older adult client who has recently been diagnosed with early stage Alzheimer disease A middle-aged female client who is receiving treatment for obsessive-compulsive disorder

A young male with schizophrenia who is in danger of becoming homeless

Although its therapeutic mechanism of action is unknown, electroconvulsive therapy (ECT) is effective treatment for severe depression in some clients. The nurse is aware that ECT would be contraindicated in which of the following clients? Select all answer choices that apply. a) Patients with recent cerebrovascular accidents (CVAs) b) Patients with recent retinal detachment c) Patients with increased intracranial pressure d) Patients who had recent myocardial infarctions (MIs) e) Patients who had acute renal failure f) Patients at risk for complications of anesthesia

A, B, C, D, F ECT is contraindicated in patients who have increased intracranial pressure; who have had a recent CVA, MI, or retinal detachment; and who are at risk for complications from anesthesia.

A client taking lithium for bipolar disorder comes to the clinic and reports symptoms consistent with moderate lithium toxicity. Which of the following actions should the nurse perform? Select all that apply. a) Contact the physician. b) Push fluids. c) Withhold additional doses of lithium. d) Perform a 12-lead EKG. e) Obtain a blood sample for lithium level.

A, B, C, E If symptoms of moderate to severe toxicity to lithium are noted, the nurse should withhold the medication, obtain a blood sample to analyze the lithium level, push fluids, and contact the physician for further instructions.

A client taking an antidepressant has experienced a 12 pound weight gain in 1 month as a side effect of the medication. Which of the following are nursing interventions to help this patient with this problem? Select all that apply. a) Advocate with the physician to change the medication. b) Recommend daily exercise. c) Reassure the patient that the weight gain is not that significant. d) Recommend a nutritionally balanced diet. e) Remind the patient that weight gain is better than feeling depressed.

A, B, D To relieve the side effect of weight gain from an antidepressant, appropriate nursing interventions are to help the client explore a change in medication, promote a nutritionally balanced diet, and recommend regular exercise.

Choice Multiple question - Select all answer choices that apply. A client who has been prescribed fluoxetine for depression and has just had his dosage increased comes the emergency department. The nurse suspects serotonin syndrome based on assessment of which of the following? a) Diaphoresis b) Ataxia c) Constipation d) Fever e) Hyporeflexia f) Change in mental status

A, B, D, F The symptoms of serotonin syndrome include altered mental status, autonomic dysfunction, and neuromuscular abnormalities. At least three of the following must be present for a diagnosis: mental status changes, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, and diarrhea.

A nurse suspects that a client has overdosed on the prescribed tricyclic antidepressant. Which assessment finding would support this suspicion? Select all that apply. a) Agitated delirium b) Blurred vision c) Orthostatic hypotension d) Headache e) Warm, dry skin

A, B, E In acute overdose, almost all symptoms develop within 12 hours. Anticholinergic effects are prominent and include dry mucous membranes, warm and dry skin, blurred vision, decreased bowel motility, and urinary retention. CNS suppression (ranging from drowsiness to coma) or an agitated delirium may occur. Orthostatic hypotension and headache are side effects of MAOIs.

Pharmacotherapy is essential to the management of the client with bipolar disorder. The nurse understands that the goals for such therapy are which of the following? Select all that apply. a) Decreased frequency of manic episodes b) Cure of the disorder c) Rapid control of symptoms d) Decreased severity of manic episodes e) Prevention of future episodes

A, C, D, E Pharmacotherapy is essential to the successful management of bipolar disorder to achieve the goals of rapid control of symptoms and prevention of future episodes, or, at least, reduction in their severity and frequency.

Bipolar type I

manic episodes with at least one depressive episode

A client comes to the clinic for an evaluation of headache, fatigue, and an overall feelings of being "down." When assessing the client, which statement by the client would alert the nurse to suspect possible suicide? Select all that apply. a) "I'm so tired that all I ever want to do is sleep all the time." b) "I'm looking for a new job because my job is so stressful." c) "Most times, I feel like I'm trapped with no way out." d) "I've been going out with my friends about once or twice a week." e) "I've been drinking about three or four more beers every night."

A, C, E Warning signs for suicide include increased substance use (drinking three or four more beers every night), an inability to sleep or sleeping all the time, and feeling trapped. Social isolation or withdrawal (rather than going out with friends or looking for a new job) would suggest suicide.

A nurse is providing psycho-education to a client who has been admitted to the inpatient mental health unit for a manic episode. In order to ensure the teaching is effective, the nurse must first determine which regarding the client? Ability to concentrate and process the information Likelihood to assume responsibility for self-care Cognitive awareness and intellectual abilities Interest in learning about the disorder

Ability to concentrate and process the information

A client has just been diagnosed with a major depressive disorder following recent problems with the client's mood, work performance, and sleep quality. When planning this client's care, the nurse should anticipate what interventions? Select all that apply. Administration of a sustained serotonin reuptake inhibitor (SSRI) Administration of an monoamine oxidase inhibitor (MAOI) Phototherapy Cognitive therapy Repetitive transcranial magnetic stimulation (rTMS)

Administration of a sustained serotonin reuptake inhibitor (SSRI) Cognitive therapy

Pervasive alterations in emotions that are manifested by depression, mania, or both

Affective disorder

Which must be present in a client diagnosed with serotonin syndrome? Select all that apply. Agitation Hyporeflexia Diaphoresis Constipation Ataxia Fever

Agitation Diaphoresis Ataxia Fever

Types of Phobias

Agoraphobia Acrophobia Claustrophobia Xenophobia Zoophobia

Types of Anxiety Disorders:

Agoraphobia with or without panic disorder Panic disorder Specific phobia Social phobia Generalized anxiety disorder (GAD)

Three stages of General Adaption Syndrome:

Alarm reaction stage (preparation for defense) Resistance stage (blood shunted to areas needed for defense) Exhaustion stage (stores depleted; emotional components unresolved)

A 51-year-old client has been severely depressed and has been contemplating suicide. While feeling like the client has no other way out, the client also wishes someone would help. What is this is known as? Ambivalence Rescue syndrome Determination Vacillation

Ambivalence

Which characteristic is most common among suicidal clients? Ambivalence Psychosis Remorse Anger

Ambivalence

Lack of energy

Anergia

The nurse is seeing a 43-year-old client whose spouse just died by suicide. Which is a common emotional response that the nurse should anticipate from this client? Anger toward the loved one who committed suicide The development of a panic disorder Turning toward alcohol or drugs Unpredictable behavior and a potential for risk-taking behaviors

Anger toward the loved one who committed suicide

Anxiety: Pharmacological

Anti-Anxiety Agents Anti-Depressants Antihistamines Beta-Blockers Anti-Convulsants Kava kava

Kava kava

Anti-anxiety effects Leads to Liver damage Avoid CNS depressants & Alcohol Not FDA approved

Outcomes (NOC)

Anxiety Self-Control Coping Skills

Mental Health Promotion:

Anxiety as warning of not dealing with stress effectively "Positive events" can be stressful as well. Managing the effects of stress and anxiety in one's life is important to being healthy. The goal is effective management of stress and anxiety, not the total elimination of anxiety. While medication is important to relieve excessive anxiety, it does not solve or eliminate the problem entirely.

Anxiety Due to a Medical Condition

Anxiety directly a result from physiological medical condition Ex. Hyperthyroid leads to increased HR, thinks having Heart Attack, but just Panic (Anxiety) Attack

Cultural considerations

Anxiety is expressed differently in different cultures (somatic sx, cognitive sx, culture-bound syndromes)

Substance-induced anxiety disorder

Anxiety, panic attacks, and obsessive compulsions from Substance usage Characterized by symptoms of anxiety, panic attacks , obsessions, and compulsions that develop with use of a substance

Anti-Anxiety Medications

Anxiolytics

Benzodiazepines "Benzos"

Anxious pts w. low GABA; High in norepinephrine

A client is admitted to the psychiatric unit after taking various medications and illegal substances to get "high." In addition to the underlying diagnosis of bipolar disorder, the client is diagnosed with delirium. Currently the client is experiencing mild hallucinations and confusion. Which intervention should the nurse do first? Loosely apply a vest restraint. Obtain an order for haloperidol. Arrange for an unlicensed assistant to sit with the client. Ask a family member to stay with the client and report any concerns.

Arrange for an unlicensed assistant to sit with the client.

A 20-year-old client was admitted to the inpatient unit following a suicide attempt. The client is disheveled, disorganized, and dehydrated. The priority for the client's care during the first 24 hours of admission will be what? Assisting the client with activities of daily living, including a shower and clean clothing. Assessing the client's current suicidal ideation and putting the client on suicide precautions. Rehydrating the client by forcing fluids. Assessing the client's recent suicide attempt and identifying factors that may have contributed to it.

Assessing the client's current suicidal ideation and putting the client on suicide precautions.

Identification

Attributing to oneself the characteristics of another person or group. Done consciously or unconsciously An 8-year-old girl dresses up like her teacher and puts together a pretend classroom for her friends. A young boy thinks a neighborhood pimp with money and drugs is someone to look up to

Anxiety: Defense Mechanisms

Automatic coping styles Can be Healthy or Unhealthy

what to do/ look for in the assessment phase of a person with major depressive disorder

Ask about behavioral changes; when they started, what has happening when they began their duration and what the client has tried to do about them Assess patient history. Important to determine previous episodes of depression treatment and the clients response to treatment People look sad and sometime just look ill. Slouched posture, head down, minimal eye contact psychomotor retardation Resposnes to questions are minimal with only one to two words Latency of response is seen when clients take up to 30 minutes to respond to a question. Signs of agitation or anxiety (wringing their hands and having difficulty sitting still Increase body movements and thoughts (pacing, accelerated thinking, argumentative. Hopeless, helpless, down or anxious Say they are a burden to others or are a failure at life, or they may make similar statements Easily frustrated are angry with themselves and can be angry with others. Anhedonia- losing any sense of pleasure from activitites they formerly enjoyed. Clients may be apathetic( not caring about oneself activities or must of anything. Affect is sad or depressed or may be flat with no emotional expressions. Sit alone staring into space or lost in thought Interact minimally when addressed Overwhelmed by noise and people who might make demands on them. Withdraw from stimulation of interactions with others. slowed thinking processes negative and pessimistic in their thinking, believe they will always feel this bad, things will never get better, and nothing will help focus only on failures or negative attributes cane have delusions; believe they are responsible for all the tragedies and miseries of the world. thoughts of dying or committing suicide *important to assess for suicide ideation** nurse can ask about it directly "are you thinking about suicide?" "what suicide thoughts are you having?" oriented to person time and place memory impairment is common extreme difficulty concentrating or paying attention impaired judgement cannot make decisions or choices because of extreme apathy or negative beliefs self esteem is greatly reduced cause great strain in relationships often avoid family and social relationships because they feel overwhelmed, experience no pleasure from interactions and feel unworthy. experience pronounced weight loss bc of lack of appetite or disinterest in eating. sleep disturbances are common; cannot sleep or they feel exhausted and unrefreshed no matter how much time they spend in bed. lose interest in sexual activities and men often experience impotence neglect personal hygiene. constipation results from decreased food and fluid intake.

Jackson is a 56-year-old man who suffers from seasonal affective disorder. Which of the following treatments is the most effective type of treatment for this condition? a) Antidepressant therapy b) Phototherapy c) Electroconvulsive therapy d) Psychotherapy

B

Which of the following clients is most likely to benefit from electroconvulsive therapy (ECT)? a) A man with a diagnosis of bipolar II disorder who has recently begun experiencing a manic episode b) A woman whose major depression has not responded appreciably to antidepressants c) A client with bipolar disorder who is not compliant with the blood testing necessary for lithium therapy d) A client whose recent strange behavior has been attributed to cyclothymic disorder

B While ECT is used to treat an increasing range of psychiatric-mental health problems, individuals with major depression are often among the best candidates for the treatment. ECT would not be used as a response to noncompliance, and a person who is currently experiencing a manic episode is less commonly treated with ECT. Cyclothymic disorder is less severe than bipolar II disorder and is consequently less likely to warrant ECT

A client is happy one month and sad and depressed the next. This client has rapid shifts in moods that leave people confused. What is the client demonstrating? a) Manic episode b) Mood lability c) Expansive mood d) Irritable mood

B Mood lability is alterations in moods with little or no change in external events. It is a term used for the rapid shifts in moods that often occur in bipolar disorder.

A client with major depression is prescribed paroxetine (Paxil). The nurse develops an education plan for the client based on the understanding that this drug belongs to which class of drugs? a) Monoamine oxidase inhibitors b) Selective serotonin reuptake inhibitors c) Tricyclic antidepressants d) Serotonin norepinephrine reuptake inhibitors

B Paroxetine is a selective serotonin reuptake inhibitor. Serotonin norepinephrine reuptake inhibitors (SNRIs) include venlafaxine (Effexor), nefazodone (Serzone), duloxetine (Cymbalta), and desvenlafaxine (Pristiq). Amitriptyline is an example of a tricyclic antidepressant. Monoamine oxidase inhibitors (MAOIs) include phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), and selegiline (Emsam).

The primary nursing goal for a client who is admitted for suicidal ideation or attempt would be what? a) Develop rapport based on trust and understanding. b) Prevent self-destructive behavior. c) Assess the cause of his or her depression. d) Assist him or her in the expression of sad and helpless feelings.

B Preventing self-destructive behavior is the primary nursing goal. Other important goals, such as assisting the client in expressing feelings, assessing for causes of depression, and developing rapport, may be important for intervention after the primary goal of maintaining safety is met.

Susan was abandoned by her parents at age 3, resulting in her perception of the world as a hostile place and the subsequent development of rage against men. This statement is an example of ... a) why Susan has become lesbian at the age of 23. b) a psychodynamic interpretation of Susan's major depressive disorder. c) a feminist viewpoint of depression. d) a biophysiological explanation for Susan's depressive disorder.

B Psychodynamic theories postulate that clients with depression have unexpressed and unconscious anger about feeling helpless or dependent on others. Such anger begins in childhood when basic developmental needs are not met. They cannot express this anger toward the person or people on whom they feel dependent, so their anger turns inward.

A nursing instructor is reviewing the various biologic theories related to the etiology of depression. Which of the following would the instructor most likely include as being involved when describing psychoneuroimmunology ? a) Genetics b) Cytokines c) Hypothalmic axes d) Neurotransmitters

B Psychoneuroimmunology is a recent area of research into a diverse group of proteins known as chemical messengers between immune cells. These messengers, called cytokines, signal the brain and serve as mediators between immune and nerve cells. Neurotransmitters reflect the neurobiologic theories. Hypothalmic axes reflect the neuroendocrine and neuropeptides hypotheses. Genetics is a separate group that addresses the biologic theories for depression.

A nursing student is caring for an elderly client who is taking sertraline for depression. The instructor quizzes the student about the medication and its actions. To what classification of drugs should the student assign sertraline? a) Cyclic antidepressant b) Selective serotonin reuptake inhibitor c) Monoamine-oxidase inhibitor d) Serotonin 2 antagonist

B Sertraline is a selective serotonin reuptake inhibitor.

Which medication classification has been effective in stabilizing moods in people with bipolar disorder? a) Antianxiety b) Anticonvulsants c) Antibiotics d) Anticoagulants

B Several anticonvulsants traditionally used to treat seizure disorders have proved helpful in stabilizing the moods of people with bipolar illness.

Which of the following is a primary risk factor for suicide? a) Unemployment b) Social isolation c) Economic deprivation d) Poverty

B Social isolation is a primary risk factor for suicide. Other social factors associated with suicide risk include economic deprivation, unemployment, and poverty, especially among young people.

Suicide is the leading cause of death in which of the following patient populations? a) Personality disorders b) Schizophrenia c) Anxiety disorders d) Eating disorders

B Suicide is the leading cause of premature death in people with schizophrenia.

A 50-year-old man who has recently been diagnosed with amyotrophic lateral sclerosis (ALS) has announced to the nurse his intention to commit suicide in order to prevent future suffering. Which of the following facts should underlie the nurse's response to this client? a) The nurse must refer the client to a physician who is authorized to assist the man with a suicide. b) The nurse is obliged to protect the client from self-harm. c) The nurse is required to document the client's wishes and begin to facilitate an assisted suicide. d) The nurse is ethically obliged to inform law enforcement.

B While the nurse is not obliged to inform law enforcement, he or she is ethically obligated to protect the client from self-harm. Participation or referral for assisted suicide has not been recognized as an acceptable component of nursing practice.

A client taking a monoamine-oxidase inhibitor (MAOI) for depression should be instructed to avoid which of the following when taking the medication? Select all that apply. a) Spinach b) Red wine c) Aged cheese d) Red meat e) Beer

B, C, E If co-administered with food or other substances containing tyramine (aged cheese, beer, red wine) MAOIs can trigger a hypertensive crisis.

Which is a food that might be incorporated into the plan of care for a client diagnosed in the manic phase of bipolar disorder? Bananas Brocolli Spaghetti Steak

Bananas

Anxiety: Etiology

Biological: Genetics -Women -25 y.o.

A client is admitted to the unit in an acute manic episode. The client has had three major depressive episodes in the past 10 years and two other hospitalizations for mania. Which disorders would reflect the client's symptom profile? Bipolar II Cyclothymic disorder Bipolar I Euthymic state

Bipolar I

One or more manic or mixed episode usually accompanied by major depressive episodes (Mania, Hypomania (cyclothymia), major depression)

Bipolar I

A nursing instructor is teaching about mood disorders and informs the class that bipolar disorder is divided into several groups. Those groups include what? Select all that apply. Bipolar I Bipolar II Bipolar III Bipolar mixed Bipolar IV

Bipolar I Bipolar II Bipolar mixed

When teaching a client who is recently diagnosed bipolar I disorder, the nurse correctly tells the client that the difference between bipolar I disorder and bipolar II disorder is what? Bipolar I disorder is often more disruptive than bipolar II disorder. Bipolar I disorder more often effects women. Bipolar I disorder is characterized by hypomanic episodes. Bipolar I disorder involves altered moods of anger and paranoia.

Bipolar I disorder is often more disruptive than bipolar II disorder.

One or more major depressive episodes accompanied by at least one hypomanic episode (Hypomania, minor depression, major depression)

Bipolar II

OCD

Body Dysmorphic Disorders hoarding disorder Hair pulling disorder (Trichotillomania) Swallowing hair disorder (Trichophagia) Skin Picking Disorder (Dermotillomania)

Non-Benzodiazepine

Buspirone (BuSpar) GAD Does not cause dependnces

After being diagnosed with a chronic disease, Muriel has been feeling depressed. Which of the following diagnoses has the strongest association with an increased suicide risk? a) Chronic obstructive pulmonary disease b) Congestive heart failure c) Acquired immunodeficiency syndrome d) Coronary heart disease

C The WHO notes that chronic physical illness and certain physical illnesses contribute to higher suicide risk in some individuals. Neurologic diseases such as epilepsy and spinal and brain injury have been associated with increased suicide risk. HIV infection and AIDS also pose increased suicide risk, particularly at the time of diagnosis. Pain also has been identified as a significant contributing factor.

A client has been diagnosed with major depressive disorder. The clinical symptoms that would be included when the clinician makes this diagnosis are what? a) A significant failure in an occupational or relational setting b) Claims by family, friends, or coworkers that the client is depressed c) A significant decrease in appetite d) Demonstrated examples of unwise decisions

C Among the nine clinical symptoms of a major depressive episode is a significant increase or decrease in appetite. Failures may precipitate or exacerbate decisions and others may confirm the client's depression, but these are not diagnostic criteria. Unwise decision making is not a hallmark of depression, but indecisiveness is a diagnostic criterion.

A nursing student learning about mood disorders correctly identifies which of the following to mean exaggerated feelings of well-being? a) Irritability b) Expansiveness c) Euphoria d) Paranoia

C An elevated mood can be expressed as euphoria, which is exaggerated feelings of well-being or elation. Examples include feeling high, ecstatic, and on top of the world. An expansive mood is characterized by lack of restraint in expressive feelings. Paranoia is rooted in suspicions about others, or delusions of persecution. For some, an irritable mood is feeling easily annoyed and provoked to anger, especially when their wishes are challenged or thwarted.

A client with severe depression has experienced anhedonia for the past 3 months. The nurse caring for this client understands that this term describes which of the following? a) Feelings of hopelessness b) Loss of sexual drive c) Loss of interest or pleasure d) Feelings of sadness

C Anhedonia is the loss of interest or pleasure. The client with depression may report "not caring anymore" or not feeling any enjoyment in activities that were previously considered pleasurable.

The major difference between bipolar I and bipolar II disorder is that: a) Clients with bipolar I have no symptoms of mania, but only depression. b) The prognosis for bipolar I is much better than for bipolar II. c) Clients with bipolar II disorder do not have symptoms of mania that interfere enough to cause marked functional disturbances. d) Both disorders are the same, except that clients with bipolar I disorders have a much higher incidence of suicide.

C Bipolar II disorder is characterized by a major depressive episode (either current or past) and at least one hypomanic episode. Bipolar II disorder differs from bipolar I in that the client has never had a manic or mixed episode but may have had an episode in which he/she experienced a persistently elevated, expansive, or irritable mood. The hypomanic symptoms are not severe enough to cause marked social or occupational dysfunction.

Which of the following statements regarding depression and gender is correct? a) Depressive disorders affect young men more than older women. b) Depressive disorders equally affect men and women. c) Depressive disorders are more common in women than men. d) Depressive disorders are more common in men than women.

C Depressive disorders are more prevalent in women than in men. Genetics, sociocultural factors, hormones, and other elements may account for this disparity.

A nurse is giving a presentation on mental health promotion at a community center. A participant states, "My friend tells me I'm depressed because I don't have a lot of energy and have trouble concentrating. I had to quit my full-time job because I don't seem to have the energy to manage it. But I don't want to kill myself or anything like that." Although more data are needed for diagnosis, the nurse suspects that the client may have which of the following? a) Cyclothymic disorder b) Bipolar II disorder c) Dysthymic disorder d) Major depressive disorder

C Dysthymia is a mild depressive illness in which symptoms, such as poor appetite or overeating, insomnia or excessive sleep, low energy, fatigue, low self-esteem, poor concentration, and difficulty making decisions, are chronic but less severe than with major depression. Diagnostic criteria include depressed or irritable mood most of the day, occurring more days than not for at least 2 years.

A psychiatric-mental health nurse is conducting a refresher class for a group of psychiatric-mental health nurses returning to the field. After teaching about depressive disorders, the nurse determines a need for additional teachig when the class identifies which physical symptom as being associated with depression? Catatonia Fatigue Insomnia Worthlessness

Catatonia

After assessing a client, you develop a nursing diagnosis of "Risk for Suicide." Which of the following would be your highest priority intervention? a) Communicate a desire to help the client. b) Provide mood-stabilizing medications per physician order. c) Remove means of suicide from the client's access. d) Determine the course of the client's suicidal thoughts.

C Immediate interventions involve removing the means of suicide to reduce the risk of it happening. If the person is hospitalized, methods may include ensuring pills or medications are not available to clients or that they are not taking any measures to accumulate needed drugs. If in a community or home care setting, nurses may enlist the help of family or friends to remove the means and to provide immediate support.

Which of the following medication classifications is considered first-line drug therapy for bipolar disorder? a) Anticonvulsants b) Antipsychotics c) Mood stabilizers d) Antidepressants

C Mood stabilizers are first-line drugs for bipolar disorders. They stabilize depressive and manic cycles.

Limit setting is most appropriate in which patient population? a) Depressed b) Anxious c) Manic d) Suicidal

C Most of the time, anxious, depressed, and suicidal clients do not test the limits of the caregiver.

The mental health nurse appropriately provides education on phototherapy to a ... a) 50-year-old farmer whose major depression has not responded to any treatment modality b) 58-year-old showing signs of early Alzheimer's disease c) 20-year-old college student who reports being "too tired, sad and unfocused" to enroll for classes in the winter term d) 45-year-old lawyer whose medication therapy needs an additional treatment

C Phototherapy—-or the exposure to bright artificial light-—can markedly reverse the symptoms of seasonal affective disorder (SAD), which occurs in the fall and winter. Phototherapy would be most appropriate for a 20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term.

Robin is a 42-year-old woman who is experiencing depression. Robin's mother died by suicide 20 years ago. Which of the following statements regarding Robin's risk for suicide is correct? a) Robin's risk for suicide will increase when she reaches the age of 50. b) Robin's risk is equivalent to that of the general population. c) Robin has a greater risk for suicide than the general population. d) Robin would have a greater risk for suicide if her father had died by suicide.

C Risk for suicide increases when there is a family history of suicide. Risk of suicide is two to eight times higher in first-degree (parents, siblings, or children) relatives of people who died by suicide than in the general population.

A client who has been taking lithium for bipolar disorder is admitted to the hospital with the following symptoms: dry mouth, nausea and vomiting, blurred vision, dizziness, and muscle twitching. What should the nurse suspect? a) Interaction of lithium with another medication b) Need for an increased dose of medication c) Moderate lithium toxicity d) Common side effects of the drug

C Side effects associated with moderate lithium toxicity include severe diarrhea, dry mouth, nausea and vomiting, mild to moderate ataxia, lack of coordination, dizziness, slurred speech, tinnitus, blurred vision, increasing tremors, muscle rigidity, asymmetric deep tendon reflexes, and increased muscle tone.

The nurse is providing a presentation for a group of health professionals about suicide. Which of the following would the nurse address as a major contributing factor to the rising suicide rate among men? a) Lack of conflict resolution skills b) Parenting practices c) Substance abuse d) Media influences

C Substance abuse, aggression, hopelessness, emotion-focused coping, social isolation, and lack of purpose in life have been associated with suicidal behavior in men. In addition, just under 50% of suicide attempts in men between the ages of 42 and 77 years involve firearms. The media, lack of conflict resolution skills, and parenting practices can play a role, but are not considered major factors.

Carrie, age 20, was admitted to the inpatient unit following a suicide attempt. She is disheveled, disorganized, and dehydrated. The priority for her care during the first 24 hours of her admission is ... a) assessing Carrie's recent suicide attempt and identifying factors that may have contributed to it. b) assisting Carrie with her activities of daily living, including a shower and clean clothing. c) assessing Carrie's current suicidal ideation and putting her on suicide precautions. d) rehydrating Carrie by forcing fluids.

C The first step is to provide for Carrie's safety by assessing her risk for suicide. Because Carrie has attempted suicide, the nurse immediately places her on suicide precautions with frequent or continuous one-to-one observation and reassessment.

The genetic theory, when applied to the occurrence of depression, supports that the psychiatric nurse should ... a) Prepare the client for diagnostic genetic testing to confirm the diagnosis b) Educate the client regarding the symptoms of related physical disorders c) Assess for depression in the client's family history d) Encourage the client to seek genetic counseling before considering a pregnancy

C The genetic theory, when applied to the occurrence of depression, supports that the psychiatric nurse should assess for depression in the client's family history.

When assessing a child with major depression, which of the following would the nurse need to keep in mind? Select all that apply. a) The risk for suicide is less in children than adults. b) Children have more interaction with their peers than adults do. c) Mood may be more irritable than sad. d) Children more often have anxiety symptoms e) Somatic complaints are rarely noted.

C, D Children with depressive disorders have similar symptoms to those seen in adults with a few exceptions. They are more likely to have anxiety symptoms, such as fear of separation, and somatic symptoms, such as stomach aches and headaches. They may have less interaction with their peers and avoid play and recreational activities that they previously enjoyed. Mood may be irritable, rather than sad, especially in adolescents. The risk of suicide, which peaks during the mid-adolescent years, is very real in children and adolescents.

Which of the following would a nurse expect to assess in a patient with a panic disorder? A. Rational thinking B. Blaming of others C. Automatisms D. Organized thoughts

C. Automatism Rationale: A patient with panic disorder would demonstrate automatisms, irrational thinking, self-blame, and disorganized thoughts.

Suppression

CONSCIOUS denial of a disturbing situation or feeling. A businessman who is preparing to make an important speech is told by his wife that morning that she wants a divorce. Although visibly upset, he puts the incident aside until after his speech, when he can give the matter his total concentration. A woman who feels a lump in her breast shortly before leaving for a 3-week vacation puts the information in the back of her mind until after returning from her vacation.

A 42-year-old client with major depression is in an inpatient psychiatric hospital. The client has been taking phenelzine, a monoamine oxidase inhibitor (MAOI), for depression. The therapist writes an order to discontinue the phenelzine and begin fluoxetine. Which action by the nurse is indicated? Begin educating the client about food restrictions when taking fluoxetine. Begin educating the client about selective serotonin reuptake inhibitors. Call the therapist to discuss the need for a washout period before starting fluoxetine. Note in the medication administration record to check the client's blood pressure for the first 2 days after starting fluoxetine.

Call the therapist to discuss the need for a washout period before starting fluoxetine.

A client with bipolar disorder has been ordered a medication that is classified as an anticonvulsant. Which drug does the nurse know falls within this class of medications? Mannitol Lithium Carbamazepine Methyldopa

Carbamazepine

Elderly Pts & Benzos

Contribute to Ataxia leads to falls and broken bones (Pt is Fall Rx)

Generalized anxiety disorder:

Chronic; longer than 6 months Treatment: buspirone, SSRIs

A client who suffers from bipolar disorder is admitted to a mental health unit for a manic episode. The nurse knows that which takes priority? Phamacotherapy Client safety Cognitive-behavioral therapy Distraction therapy

Client safety

A client has just been admitted to the inpatient psychiatry unit following a suicide attempt. During the client's first 24 hours of care, what outcome should be identified? Client will express that the client feels safe on the unit Client will implement strategies for managing stress Client will participate actively in cognitive behavioral therapy Client will state that the client feels optimistic about the client's future

Client will express that the client feels safe on the unit

Panic Disorder Treatment:

Cognitive behavioral techniques Deep breathing, relaxation Benzodiazepines, SSRIs, tricyclic antidepressants, antihypertensives (clonidine, propranolol)

Treatment Options of Anxiety Disorders:

Combination of medications, therapy Medications: anxiolytics; antidepressants Cognitive-behavioral therapy Positive reframing (turning negative messages into positive ones) Decatastrophizing (making more realistic appraisal of situation) Assertiveness training (learn to negotiate interpersonal situations)

Anxiety: Defense Mechanisms

Compensation Conversion Denial Displacement Identification Intellectualization Projection Reaction Formation Regression Repression (Unconscious level) Suppression (Conscious level)

A nurse suspects that a client has overdosed on the prescribed tricyclic antidepressant. Which assessment finding would support this suspicion? Select all that apply. Confusion Hallucinations Agitation Orthostatic hypotension Headache

Confusion Hallucinations Agitation

Mild mood swings between hypomania and depression without loss of social or occupational functioning

Cyclothymic Disorder

Which of the following terms describes a nonfatal, self-inflicted destructive act with an explicit or implicit intent to die? a) Suicidal ideation b) Parasuicide c) Suicidality d) Suicide attempt

D A suicide attempt is a nonfatal, self-inflicted destructive act with explicit or implicit intent to die. Suicidal ideation is thinking about and planning one's own death. Suicidality refers to all suicide-related behaviors and thoughts of completing or attempting suicide and suicide ideation. Parasuicide is a voluntary, apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death.

The nurse is told by a client that she is having suicidal thoughts. Which of the following interventions has lowest priority? a) Determining the client's concerns and if she has a plan b) Maintaining a safe, secure environment c) Assessing the client for past history of suicidal attempts d) Administering a mental status exam to assess for psychosis

D About 50% to 80% of people who commit suicide have previously attempted suicide; the more violent and lethal the plan, the higher the potential for suicide. Assessment of past attempts and current plan (not psychosis) as well as maintaining client safety would be priorities. Maintaining a safe, secure environment is an important intervention by the nurse to prevent a suicide attempt.

When assessing a client immediately following ECT, the nurse expects which of the following? a) Long-term memory impairment b) Numbness and tingling in the extremities c) Full of energy d) Confusion

D After ECT treatment, the client may be mildly confused or briefly disoriented. He or she is very tired and often has a headache. The client will have some short-term memory impairment. Numbness and tingling in the extremities is not an expected symptom.

A patient with severe depression is being treated with medications and is told to increase activity and to exercise at least 4 times a week. Which of the following domains would these nursing interventions address? a) Spiritual b) Social c) Psychological d) Biologic

D Biologic interventions center around education, pharmacologic interventions, and other somatic interventions. Activity and exercise are directly related to the body or somatic experience.

A client with bipolar disorder has been ordered a medication whose classification is anticonvulsant. Which of the following drugs does the nurse know falls within this class of medications? a) Lithium b) Methyldopa c) Mannitol d) Carbamazepine

D Carbamazepine is an anticonvulsant with mood-stabilizing effects. Lithium is a mood stabilizer. Mannitol and methyldopa are not used in the treatment of bipolar disorder.

A client with bipolar disorder has been ordered a medication whose classification is anticonvulsant. Which of the following drugs does the nurse know falls within this class of medications? a) Methyldopa b) Mannitol c) Lithium d) Carbamazepine

D Carbamazepine is an anticonvulsant with mood-stabilizing effects. Lithium is a mood stabilizer. Mannitol and methyldopa are not used in the treatment of bipolar disorder.

Which of the following is an anticonvulsant used as a mood stabilizer? a) Bupropion (Wellbutrin) b) Phenelzine (Nardil) c) Venlafaxine (Effexor) d) Divalproex (Depakote)

D Depakote is an anticonvulsant that may be used as a mood stabilizer. Effexor, Wellbutrin, and Nardil are antidepressants.

Which mental health disorder is a major risk factor for suicide? a) Anxiety b) Mania c) Schizophrenia d) Depression

D Depression is a major risk factor of suicide. Anxiety, schizophrenia, and mania are not major risk factors for suicide.

Which of the following sleep patterns is suggestive of a manic episode? a) A client reports having fitful sleep that is characterized by frequent awakenings and nightmares. b) A client experiences day-night reversal, sleeping until late in the afternoon, and going to bed near dawn. c) A client takes multiple short naps at varied times throughout the day and night. d) A client stays awake for several days and nights before "crashing" and sleeping for a long period.

D During a manic episode, an individual will typically go several nights without sleep before collapsing from exhaustion.

Anticonvulsant

Decrease Excitatory processes in the Brain

The nurse is aware that a client taking medication that is controlling the symptoms of his or her bipolar disorder will have better treatment outcomes when which of the following is initiated? a) Independent decision-making by the patient b) Controlled decision-making by the therapist c) Decision influences from many family members d) Shared decision-making

D During acute episodes, the client's judgment may be impaired, which may compromise his or her decision-making. Once treatment begins and starts to be effective, however, and manic or depressive symptoms subside, shared decision-making actually improves treatment outcomes.

After observing James, a bipolar client on the mental health unit, the nurse determines that the client is at risk for violence. Which of the following would be an appropriate intervention? a) Tell James that if he is violent, he will be sent home. b) Ask James to sit alone and write a letter. c) Encourage James to participate in an activity with other clients. d) Restrict James to his room until he calms down.

D If clients are determined to be at risk for violence, establishing geographic boundaries, such as room or half-hall restriction, is part of ongoing monitoring. Other environmental approaches include reducing stimuli and opportunities for interaction with other clients. Nurses remove all dangerous items from client rooms and monitor closely for use of any dangerous items. A pen or pencil that is used to write a letter can be a dangerous object.

In the past year, Caitlin has experienced six manic episodes, each lasting for 3 weeks. This is known as: a) Hypomania b) Hypermania c) Cyclothymic biopolar disorder d) Rapid cycling

D In rapid cycling, clients have four or more manic episodes for at least 2 weeks in a single year. The episodes are marked by either partial or full remission for at least 2 months or a switch to an episode of opposite type.

Curtis is a psychiatric-mental health nurse who is conducting a suicide assessment with a client. Why is it important to conduct a lethality assessment? a) It may assist in evaluating the potential suicide protective factors of a client. b) It may assist in determining an individual's past suicide behaviors. c) It may assist in determining how long a client has been contemplating suicide. d) It may assist in predicting how likely a person is to die by suicide.

D Lethality assessment is part of conducting a risk assessment. Once it is determined that someone is thinking of suicide, a lethality assessment is necessary. It is an attempt to predict how likely a person is to die by suicide.

A client who has just been prescribed lithium for bipolar disorder is getting instructions from the nurse about this medication. Which of the following is important for the nurse to include in teaching? a) The higher the potassium level, the lower the lithium level will be. b) Changes in diet will not affect lithium levels. c) Lithium has few interactions with other drugs. d) The higher the sodium level, the lower the lithium level will be.

D Lithium is a salt, so the interaction between lithium and sodium levels in the body and between lithium level and fluid volume in the body are crucial issues to consider. The higher the sodium levels, the lower the lithium level will be and vice versa. The other options do not represent correct information.

A mental health nurse is caring for a depressed client, whose wife passed away 2 months ago. The client sates, "I'm going to kill myself." Which of the following is a behavioral sign of suicide? a) Hopelessness b) Guilt c) Isolation d) Making a will

D Making a will is a behavioral sign of suicide. The other options are emotional/psychological signs.

When assessing a client who reports mild symptoms of depression, the nurse expects that the diagnostic tests ordered will include a) Coagulation time b) Platelet count c) Liver function test d) Thyroid Stimulating Hormone (TSH)

D Mood is also affected by the thyroid gland. Approximately 5% to 10% of clients with abnormally low levels of thyroid hormones may suffer from a chronic mood disorder. Clients with a mild, symptom-free form of hypothyroidism may be more vulnerable to depressed mood than the average person. Thus, diagnostic testing will likely include Thyroid Stimulating Hormone (TSH), not coagulation times, platelet counts, or liver function tests.

When completing discharge medication education for the client, he asks how long it will take before the effects of his prescribed SSRI could be felt. The nurse states that it will likely take? a) 5 to 7 days b) 1 to 2 days c) 3 to 4 weeks d) 2 to 3 weeks

D Most antidepressant medications do not become effective or reach a therapeutic level for at least 2 or 3 weeks.

Psychodynamic theory attributes the development of mood disorders to which of the following? a) Loss of cultural identity b) Current situational difficulties c) Repressed sexuality d) Unexpressed and unconscious anger

D Psychodynamic theories postulate that clients with depression have unexpressed and unconscious anger about feeling helpless or dependent on others. They cannot express this anger toward the person or people on whom they feel dependent, so their anger turns inward.

A client who lost a child 6 years ago as a result of an automobile accident caused by a drunk driver is seen for counseling. During the session, the mental health nurse recognizes the priority need to ... a) Encourage the client to become an activist in organizations such as Mothers Against Drunk Driving (MADD) b) Express condolences over the loss of the child c) Assess the client for feelings regarding the driver responsible for the death d) Assess the client for suicidal ideations

D Research has shown that psychiatric-mental health nurses must assess for depression, distress, and suicidal ideation in clients who have experienced the sudden, violent death of a child. Furthermore, assessment may need to be repeated over time.

A client has been diagnosed with major depression and placed on Elavil. Which of the following is a side effect of amitriptyline (Elavil)? a) Weight loss b) Diarrhea c) Excessive salivation d) Orthostatic hypotension

D Side effects of Elavil include orthostatic hypotension, constipation, weight gain, and dry mouth.

Beta-Blocker

Decrease HR Decrease Anxiety level

Anxiety: Neurobiological

Decreased GABA Increased Norepinephrine

Mark is a 43-year-old man whose wife just died by suicide. Which of the following is a common emotional response by family members of those who die by suicide? a) Unpredictable behavior and a potential for risk-taking behaviors b) The development of a panic disorder c) Turning toward alcohol or drugs d) Anger toward the loved one who committed suicide

D Some of the emotional responses suicide survivors may experience include feelings of unreality, shock, disbelief, and emotional numbness; grief, sadness, and despair; confusion over not knowing why the loved one chose suicide; anger toward the mental health practitioner, another family member, or a friend for failing to prevent the suicide; self-anger and guilt for failing to prevent the suicide; feelings of anger toward and betrayal by the loved one who committed suicide; and social stigmatization and isolation.

A client is receiving amitriptyline. The health care provider orders a drug plasma level. The client receives a dose at 8 a.m. At which time would the nurse have the sample obtained? a) 4 p.m. b) 10 a.m. c) 12 noon d) 8 p.m.

D The TCAs, including imipramine (Tofranil), desipramine (Norpramin), amitriptyline (Elavil), and nortriptyline (Pamelor), have standardized valid plasma levels that can be useful in determining therapeutic dosages, although therapeutic plasma levels may vary from individual to individual. Blood samples should be drawn as close as possible to 12 hours away from the last dose.

Which of the following would be a priority diagnosis for the client in the manic phase of bipolar disorder who is exhibiting aggressive behavior? a) Impaired Social Interaction b) Ineffective Health Maintenance c) Disturbed Thought Processes d) Risk for Other-Directed Violence

D The priority nursing diagnosis is Risk for Other-Directed Violence. The other diagnoses are utilized for the client in the manic phase of bipolar disorder but are not the priority in this situation.

A client is receiving lithium carbonate (Eskalith) for the treatment of mania. The nurse would reinforce which teaching component regarding lithium treatment? a) Watch for low urine output. b) Give medication on an empty stomach. c) Decrease fluid intake to prevent edema. d) Obtain scheduled lithium levels.

D There is a narrow range between therapeutic lithium levels and lithium toxicity. It is important to obtain scheduled drug levels to prevent toxicity from occurring. The nurse should monitor for polyuria. Teaching includes taking the medication with food or milk after meals and ensuring an adequate daily intake of fluid (2,500 to 3,000 mL) daily.

An elderly client is admitted to the hospital with fatigue and weight loss of 20 pounds in 1 month. Upon further assessment the client is diagnosed with depression. What other thing should the nurse assess this client for based on the weight loss? a) Sleep disturbance b) Decreased energy c) Suicide d) Dehydration

D When there is a significant wight loss in older adults with moderate to severe depression, they need to be assessed for dehydration as well as weight changes. They also need to be monitored for the other things, but they are not related to nutrition and the weight loss.

Women make how many suicide attempts for every one attempt by their male counterparts? a) One b) Two c) Four d) Three

D Women make three attempts to every one attempt by men. Women are less likely to complete a suicide, partly because they are more likely to choose less lethal methods.

which depression treatments work to decrease subgenual ACC activity?

DBS, TMS, VNS, SSRI, SNRI, placebo

which gene is the "schizophrenic" gene? how does it work?

DISC1 - it normally functions in neural differentiation and growth. it is a useful gene, but if mutated, it can cause more family members to be schizophrenic

Benzos: Adverse Effect

DO NOT MIX with CNS DEPRESSANTS. Lead to life threatening CNS Depression and Respiratory Failure!! DEATH!!

Racing, often unconnected thoughts; excessive amount and rate of speech comprised of fragmented or unrelated ideas

Flight of Ideas

A nurse is preparing a presentation for family members of clients who have been diagnosed with depression. When describing the family response to depression, which would the nurse include? Family members typically can understand how disabling depression can be. Depression in one family member affects the entire family. Abuse of the depressed person is a rare occurrence in families. Families of women older than 55 years of age with depression experience the majority of problems.

Depression in one family member affects the entire family.

After teaching a group of nursing students about major depression, the instructor determines that the education was successful when the group identifies which information is accurate? Onset of depression is common in adolescence Depression is twice as common in women than in men Depression is correlated with low intellectual ability Onset of depression is most common in middle-aged persons

Depression is twice as common in women than in men

A client was admitted to the psychiatric unit 3 days ago because of suicidal ideation. The client's suicidal risk has lessened considerably, and the client currently denies having any desire to kill himself or herself. In addition, the client is able to identify reasons why the client wants to be alive. Which nursing intervention would be most appropriate at this time? Assigning nursing staff to stay with the client during the suicidal crisis Developing a personal plan for managing suicidal thoughts when they occur Advising the client to consider electroconvulsive therapy treatments Administering psychotropic drugs that decrease the client's serotonin levels

Developing a personal plan for managing suicidal thoughts when they occur

Separation Anxiety disorder

Developmentally inappropriate levels of concern over being away from a significant other; Developmentally normal ages 8-18 months Typically diagnosed prior to age 18 years after 1 month of symptoms; recently an adult form recognized Impairs social and occupational function

Panic Disorder:

Discrete episodes of panic; no stimulus for panic response Avoidance behavior Primary, secondary gain Increased risk for suicidality

Antianxiety/Anxiolytic: Pt teaching

Do NOT increase dose/frequency without Prior Approval from prescriber DO NOT Drink Alcohol DO NOT take Opiates DO NOT take CNS Depressants (Leads to Respiratory depression & DEATH) Avoid Caffiene DO NOT Breastfeed

Chronic persistent mood disturbances characterized by symptoms including insomnia, loss of appetite, decreased energy, difficulty concentrating, feelings of sadness

Dysthymic Disorder

A nurse is giving a presentation on mental health promotion at a community center. A participant states, "My friend tells me I'm depressed because I don't have a lot of energy and have trouble concentrating. I had to quit my full-time job because I don't seem to have the energy to manage it. But I don't want to kill myself or anything like that." Although more data are needed for diagnosis, the nurse suspects that the client may have what? Bipolar II disorder Cyclothymic disorder Dysthymic disorder Major depressive disorder

Dysthymic disorder

Neurotransmitter that regulate anxiety

EPE, NE, DA, ST, AND GABA

Cultural Considerations for Anxiety:

Each culture has rules for expressing, dealing with anxiety Asian cultures: often with somatic symptoms; koro Hispanics: susto (high anxiety as sadness, agitation, weight loss, weakness, heart rate changes); due to supernatural spirits or bad air from dangerous places and cemeteries invading body

A client with a diagnosis of bipolar disorder is described by a family member as "flip-flopping between being happy and loving to irritable and hostile." Which characteristic symptoms of this disorder is the family member referring to? Euthymic mood Emotional lability Manic episode Grandiosity

Emotional lability

A client has been successfully treated on the psychiatric mental health unit following a suicide attempt. In preparation for discharge, the nurse should prioritize what action? Ensuring a plan is in place for the client's community-based care Ensuring that the client has created a commitment to treatment statement Documenting the client's psychiatric advance directive Communicating with the pharmacy where the client will obtain prescribed medications

Ensuring a plan is in place for the client's community-based care

A client who has experienced the recent loss of an infant child and recent immigration to the United States is admitted to the inpatient psychiatric unit with severe symptoms of depression. The client has expressed thoughts of suicide. Which is the nurse's priority intervention for this client? Exploring the grief and loss issues concerning the baby's death. Encouraging the client to express feelings of isolation following the recent immigration. Encouraging attendance at group cognitive-behavioral therapy on the unit. Ensuring that the client is not permitted to use anything that would be potentially dangerous.

Ensuring that the client is not permitted to use anything that would be potentially dangerous.

Denial

Escaping unpleasant, anxiety-causing thoughts, feelings, wishes, or needs by ignoring their existence A man reacts to the death of a loved one by saying "No, I don't believe you" to initially protect himself from the overwhelming news. A woman whose husband died 3 years earlier still keeps his clothes in the closet and talks about him in the present tense.

A client is prescribed a selective serotonin reuptake inhibitor (SSRI) as treatment for depression. Which would the nurse most likely administer? Escitalopram Venlafaxine Maprotiline Phenelzine

Escitalopram

Neurobiolgial;

Etiology- Biological Factors Amygdala plays a role (located in temporal lobe) Amygdala Alerts brain to danger; brings about fear/anxiety to preserve the system Stores memories with emotional significance R/T phobias

Average affect and activity

Euthymic mood

Benzo/CNS Depressant Life Threatening

Ex. Heath Ledger mixed oxycodone, vicodin, benzos, and opiates LEAD TO RESPIRATORY DEPRESSION and DEATH

After several visits to the primary care provider, a client has been diagnosed with depression. Within the context of the behavioral theorists' beliefs about this disorder, which factors may underlie the client's diagnosis? Exaggerated response to stressful life event Irrational beliefs about one's self Maladaptive patterns in family interactions Early lack of love and care

Exaggerated response to stressful life event

Social phobia (social anxiety disorder)

Excessive anxiety/fear of social situations or required performance that could be evaluated negatively by others

Specific phobias

Excessive anxiety/fear of specific objects or situations

Generalized Anxiety Disorder (GAD)

Excessive worry which is out of proportion to the true impact of situations. *Exaggeration of situations*

On admission to the psychiatric unit, a client is dressed in a red leotard and exercise bra, with an assortment of chains and brightly colored scarves on the client's head, waist, wrists, and ankles. The client's first words to the nurse are, "I'll punch you, munch you, crunch you," as the client dances into the room, shadow boxing. The client shakes the nurse's hand and says cheerfully, "We need to become better acquainted. I have the world's greatest intellect, and you are probably an intellectual midget." How can the nurse document the client's mood? Belligerent and blunted. Expansive and grandiose. Anxious and unpredictable. Suspicious and paranoid.

Expansive and grandiose.

A client has been diagnosed with depression and states that the client is reluctant to receive treatment, stating that the client "would prefer to just wait this out." What is the nurse's most appropriate action? Explain to the client that untreated depression often becomes increasingly severe and frequent over time Document a nursing diagnosis of ineffective denial and choose interventions accordingly Assess the client's knowledge of depression and describe the risks of suicide Document a nursing diagnosis of noncompliance and educate the client about the benefits of treatment

Explain to the client that untreated depression often becomes increasingly severe and frequent over time

After educating a class on the etiology of bipolar disorders, a nursing instructor determines that the education was successful when the class describes the kindling theory as involving what? A dysregulation in the circadian rhythm, leading to sleep disturbance A single gene or sequence of genes causing pathologic changes Exposure to repetitive subthreshold stressors at vulnerable times "Wear and tear" on the body from mood episodes leading to increased problems

Exposure to repetitive subthreshold stressors at vulnerable times

T/F Phobias result from a past negative experience.

False Rationale: Phobias usually do not result from past negative experiences. In fact, the person may never have had contact with the object of the phobia.

T/F The neurotransmitter dopamine is associated with anxiety disorders.

False The neurotransmitters, GABA and serotonin, are thought to play a role in anxiety disorders.

Zoophobia

Fear of Animals

Claustrophobia

Fear of closed spaces

Acrophobia

Fear of heights

Agoraphobia

Fear of open spaces fear of being in places or situations from which escape might be difficult or embarrassing *Doesn't leave house*

Xenophobia

Fear of strangers

more schizophrenics are born in which 4 months?

February, March, April, May.... o.

Anxiety

Feelings of Apprehension, Uneasiness, Uncertainty, or Dread from real or Perceived Threat

Panic Disorder

Feelings of Impending doom Panic attacks key feature

The nurse knows that the most dangerous time period following a previous suicide attempt is what? First 3 months First 6 months First 9 months First year

First 3 months

SSRIs

First line of defense (Antidepressants)

Anxiety Disorder: Co-morbidity

Frequently occurs with other psychiatric and medical disorders (depression, substance abuse, eating disorders)

Other anxiety disorders:

Generalized anxiety disorder Anxiety disorder due to a general medical condition Substance-induced anxiety disorder Separation anxiety disorder

A 32-year-old client is admitted to the inpatient unit for depression with suicidal thoughts. During the nursing assessment, why it is important for the nurse to assess and explore if there is any family member who has committed suicide? Genetic predisposition Disengagement of family Lack of conflict resolution skills Terminal illness

Genetic predisposition

Anxiety Disorders: Etiology Biologic Theories:

Genetic theories Neurochemical theories (GABA, serotonin)

Comorbidity

Genetics; Etiology- Biological Factors Anxiety DO tend to cluster in families

When teaching prevention to the parents of a 15-year-old client who recently attempted suicide by taking an overdose of alprazolam, the nurse describes which behavioral clue? Angry outbursts at significant others Inquiry about doses of lethal drugs Giving away valued personal items Experiencing the loss of a boyfriend or girlfriend

Giving away valued personal items

A client in the clinic appears to have elevated self-esteem, is more talkative than usual, and is easily distracted. This client is exhibiting symptoms of what? Anorexia Grandiosity Anxiety Depression

Grandiosity

Assessment of Panic Disorder:

Hamilton Rating Scale for Anxiety (see Box 14.1) History General appearance, motor behavior (automatisms) Mood, affect (depersonalization, derealization) Thought process, content (disorganized thoughts, loss of rational thinking) Sensorium, intellectual processes (confusion, disorientation) Judgment, insight Self-concept (self-blaming) Roles, relationships (avoidance of others) Physiologic, self-care concerns (sleeping, eating)

Normal Anxiety

Healthy reaction necessary for survival It provides the energy needed to carry out the tasks involved in living and striving toward goals. Anxiety motivates people to make and survive change. It prompts constructive behaviors, such as studying for an examination, being on time for a job interview, preparing for a presentation, and working toward a promotion.

A client with bipolar disorder has a history of multiple episodes and states, "I'm so frustrated with what's happened because of these episodes." Which would the nurse encourage to help support this client's recovery? Codependence Hope Self-control Independent decision making

Hope

A period of abnormally and persistently elevated, expansive or irritable mood lasting 4 days; does not impair the ability to function and does not involve psychotic features

Hypomania

The nurse is preparing to discharge a client from the inpatient facility where the client was treated following an unsuccessful suicide attempt. The priority assessment for the nurse to make is to assess whether or not the client can do what? Identify a person to whom he or she can turn to for help after discharge. Understand the need for daily medications. Feel stigmatized by the hospitalization experience. Complete activities of daily living independently.

Identify a person to whom he or she can turn to for help after discharge.

To care for an acutely suicidal client, which is the most effective initial mode of treatment? Inpatient care Group therapy Behavioral therapy Outpatient care

Inpatient care

Phobias:

Intense illogical persistent fear out of proportion to the situation or circumstance

Anxiety Disorders: Etiology Psychodynamic theories:

Intrapsychic/psychoanalytic theories (Freud and defense mechanisms) Interpersonal theories (Sullivan, Peplau) Behavioral theory

A psychiatric-mental health nurse is conducting a suicide assessment with a client. Why is it important to conduct a lethality assessment? It may assist in determining an individual's past suicide behaviors. It may assist in determining how long a client has been contemplating suicide. It may assist in evaluating the potential suicide protective factors of a client. It may assist in predicting how likely a person is to die by suicide.

It may assist in predicting how likely a person is to die by suicide.

Environmental factors may be associated with suicidal behavior. Which is an environmental factor? Spinal cord injury HIV infection Pain Job loss

Job loss

Anxiety: Herbals

Kava kava

Elder Considerations for Anxiety Disorders:

Late-life anxiety disorders (Phobias (GAD most common))(Often associated with another condition, such as depression, dementia, physical illness, or medication toxicity or withdrawal) SSRIs as treatment of choice for anxiety disorders in the elderly

Anxiety: Behavioral Theories

Learned Anxiety

Behavior theories

Learned from response from parents and or peers

Phobia

Life becomes increasingly restricted as the phobic object is avoided; may self-mediate with ETOH/drugs

A 56-year-old client who suffers from seasonal affective disorder is being assessed by the nurse in an outpatient mental health clinic. The nurse is aware which treatment is the most effective type of treatment for this condition? Antidepressant therapy Psychotherapy Electroconvulsive therapy Light therapy

Light therapy

A client diagnosed with bipolar disorder and experiencing mania is admitted to the inpatient psychiatric setting. During the acute phase of mania, which medication(s) would the nurse expect to administer? Select all that apply. Lithium carbonate Carbamazepine Fluoxetine Paroxetine Divalproex sodium

Lithium carbonate Carbamazepine Divalproex sodium

A client with bipolar disorder is prescribed divalproex sodium as part of the treatment plan. Before administering the medication, which tests should be done? Select all that apply. Liver function tests Complete blood count Platelet count Urinalysis Blood glucose concentration

Liver function tests Complete blood count Platelet count

Severe Anxiety

Loss of Perception Perceptual field greatly reduced an distorted; focus limited to details or one specific detail; attention is scattered; unable to see connections between events/details; relief behaviors unproductive; learning/problem solving is NOT possible; Manifested by: erratic, uncoordinated and impulsive behavior; confusion; purposeless activity, feelings of dread/impending doom; intense somatic complaints, chest pain; withdrawn, loud and demanding

Implementation :

Maintain a calm manner/environment Remove from stimulating environment Use Simple, Short Statements Teamwork/Safety

Episode lasts at least 2 weeks with loss of pleasure in nearly all activities with other symptoms which may include: anhedonia, change in weight, sleep, energy, concentration, and decision making SIGE CAPS

Major Depressive Disorder

A mental health nurse is caring for a depressed client, whose spouse passed away 2 months ago. The client sates, "I'm going to kill myself." Which is a behavioral sign of suicide? Hopelessness Making a will Isolation Guilt

Making a will

A 30-year-old woman has been brought to the emergency department after causing a disturbance. She is wearing a pair of tight, pink yoga pants, high heels, a sports bra, and a bright-colored hat. The woman's care providers would recognize that the woman's dress may suggest what? Antisocial personality disorder Acute confusion Mania Chronic low self-esteem

Mania

A distinct period during which mood is abnormally and persistently elevated, expansive or irritable

Mania

Limit setting is most appropriate in which client population? Manic Anxious Depressed Suicidal

Manic

A client has been diagnosed with major depression. The client reports that the client often wakes up during the night and has trouble returning to sleep. The nurse interprets this finding as suggesting what? Initial insomnia Terminal insomnia Hypersomnia Middle insomnia

Middle insomnia

4 Levels of Anxiety:

Mild Moderate Severe Panic

Levels of Anxiety

Mild Anxiety Moderate Anxiety Severe Anxiety Panic

Implementaiton

Mild to Moderate Anxiety Severe to Panic Anxiety - Don't Leave Pt Alone

Cognitive psychotherapy is most likely to be appropriate in the care of a client who has been diagnosed with what? Anaclitic depression Moderate depression A mood disorder due to a general medical condition Postpartum psychosis

Moderate depression

A client on a medical unit has a comorbid diagnosis of depression and has been taking mirtazapine for several months prior to the current admission. When providing care to the client, which action would be most appropriate for the nurse to do? Select all that apply. Assess the client's mood immediately prior to administration and 30 minutes after. Monitor the client's mood and affect over the course of the admission. Ensure that the client is not cheeking or stockpiling the medication. Ensure that the client adheres to the necessary dietary modifications. Monitor the client for hypertensive crises.

Monitor the client's mood and affect over the course of the admission. Ensure that the client is not cheeking or stockpiling the medication.

A client in an acute manic phase is pacing the halls and talking in a loud voice with pressured speech. The client is overly involved with coclients and frequently threatens and disrupts others on the unit. After administering lithium treatment for the client, the nurse can expect the plan of care to include which additional intervention? Monitoring phototherapy response. Monitoring blood levels of the medication. Teaching the client to avoid foods with tyramine. Assessing for post-electroconvulsive therapy disorientation and confusion.

Monitoring blood levels of the medication.

Benzodiazepines

Most commonly used R/T their quick onset of action; short term use only because of potential for abuse; cause dependence; not given to patients with known substnace abuse history, monitor for SE (sediation, decreased cognitive funtion) Librium, Xanax, Valium, Ativan

describe cognitive symptoms

NOT IMPORTANT TO MEMORIZE THE SYMPTOMS BUT JUST KNOW THAT COGNITIVE MEANS THAT YOU ARE IMPAIRED IN SOME SORT OF COGNITIVE FUNCTION - not unique to schizophrenia - includes attention deficits, psychomotor slowness, learning & memory disorders, poor abstract thinking, poor problem solving

describe negative symptoms

NOT IMPORTANT TO MEMORIZE THE SYMPTOMS BUT JUST KNOW THAT NEGATIVE MEANS THAT YOU ARE LACKING IN SOME SORT OF NORMAL FUNCTION - not unique to schizophrenia - previous, robust behaviors are now diminished - includes flattened affect, poverty of speech, lack of initiative, anhedonia, social withdrawal

Self-Awareness Issues:

Need to understand how, why anxiety behaviors work Nurses as vulnerable as others to stress, anxiety Everyone occasionally suffers from stress, anxiety Avoid trying to "fix" patient's problem Use techniques to manage stress, anxiety in personal life

Panic

No longer rational, will not listen to reason unable to process what is going on in the environment and may lose touch with reality Panic Manifested by: markedly disturbed behavior; terror shouting; screaming; hallucinations/delusions; increased somatic complaints, numbness, tingling, chest pain; withdrawn; severely immobile/hyperactive

Neurotransmitter that may be deficient in depression and increase in mania

Norepinephrine

Which biogenic amines have been implicated in depression? Norepinephrine and serotonin Epinephrine and dopamine Dopamine and histamine Epinephrine and serotonin

Norepinephrine and serotonin

Which is a true statement regarding depressive disorders? They are more prevalent in men than women. Depression in older adults is easier to diagnosis. Norepinephrine, dopamine, and serotonin have been implicated. It is the leading cause of U.S. disability in clients older than 44 years of age.

Norepinephrine, dopamine, and serotonin have been implicated.

Obsessive-Compulsive Disorder (OCD)

Obsessions and Compulsions

A client with bipolar disorder is experiencing a major depressive episode. Which would the nurse expect to assess? Select all that apply. Flight of ideas Obsessive rumination Hypersomnia Widespread shopping sprees Difficulty concentrating

Obsessive rumination Hypersomnia Difficulty concentrating

Obsessive-Compulsive Related Disorders

Obsessive-compulsive Disorder Body Dysmorphic Disorder Hoarding Disorder Hair Pulling and Skin Picking Disorder

mild anxiety

Occurs in normal everyday living; person is aware of anxiety; heightened/increased perception, focus is flexible,, improves problem solving, able to work effectively; manifested by restlessness, irritable; mild-tension-relieving behaviors, easily startled

Duloxetine (Cymbalta)

type of SNRI; treats GAD

Anxiety: Cognitive Theories

Over-reactive 'Distorted Thoughts

A parent is shopping w. a 5-y.o. child in a large, busy urban mall. The parent suddenly realizes the child is missing. Which level of Anxiety would likely result?

Panic

A nurse is reviewing the medical record of a client with bipolar disorder. The nurse would most likely expect to find a history of what? Panic disorder Schizophrenia Delusional disorder Posttraumatic stress disorder

Panic disorder

Tardive Dyskinesia results in opposite symptoms of _______

Parkinson's disease

A client is admitted to a mental health unit with reports of fatigue, poor appetite, and difficulty making decisions. The client also states feeling unhappy most of the time for "as long as the client can remember." Which diagnosis should the nurse anticipate for this client? Persistent depressive disorder Bipolar disorder Rapid cycling disorder Mild depressive disorder

Persistent depressive disorder

General adaptation syndrome:

Physiologic aspects of stress; identified by Selye

A client on the inpatient psychiatric-mental health unit was discovered attempting to asphyxiate himself or herself using a blanket. Which measure should the care team prioritize in the client's immediate care? Assessing the specific motivation for the client's attempted suicide Placing the client under constant observation Teaching the client improved coping skills Managing the client's anxiety

Placing the client under constant observation

Tips for managing stress:

Positive attitude; belief in self; acceptance of lack of control over certain events Assertive communication; expression of feelings: talking, laughing, crying Realistic goals; personally meaningful activity Well-balanced diet, exercise, adequate rest/sleep Use of stress management techniques

A client with major depression and a suicide attempt is admitted to the inpatient facility. The client is started on antidepressant therapy. The next day, the client demonstrates significantly higher energy and says, "I'll feel much better." The nurse would interpret this behavior as suggesting what? Possible decision to complete a suicide attempt Effectiveness of the drug therapy An act to cover up the client's true feelings A typical response to the medication

Possible decision to complete a suicide attempt

The nurse is assessing a client who gave birth to a baby 1 week ago. She has been feeling sad, fatigued, and has been crying often. The client is most likely experiencing what? Dysthymic disorder Postpartum depression Major depression Postpartum blues

Postpartum blues

A 27-year-old woman has a 4-month-old baby. For the past 3 months, the client has been experiencing intense sadness, anxiety, and hopelessness. After having thoughts of killing her baby, she decided to seek help. What is the likely the cause of this client's experience? Dysthymic disorder Postpartum depression Major depression Postpartum blues

Postpartum depression

Anti-Anxiety Medication

Potentate Increase GABA

Benzos

Potentiate GABA activity Calming Effect Used PRN IM form

Unrelenting, rapid, often loud talking without pauses

Pressured Speech

Intellectualization

Process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feelings and emotions Despite the fact that a man has lost his farm to a tornado, he analyzes his options and leads his child to safety. A man responds to the death of his wife by focusing on the details of day care and operating the household, rather than processing the grief with his children.

Beta blockers ends w/ *lol*

Propranolol (inderal) Block nerves that stimulate heart ot beat faster, used to treat social anxiety disorders

A client with bipolar disorder is experiencing acute mania. The client is unable to sit still, moving from place to place. Medication therapy has been prescribed but not yet initiated. Which would the nurse include in the plan of care to meet the client's physical needs? Instituting a sleep hygiene program Providing high energy snacks Encouraging frequent rest periods Increasing environmental stimuli

Providing high energy snacks

A client was admitted to the psychiatric unit with major depression after a suicide attempt. In addition to the client's feelings of sadness and hopelessness, the nurse would expect to assess what? Increased focus Decreased complaints of pain Psychomotor retardation Increased energy level

Psychomotor retardation

Planning

Pt participation/Involvement Determine Primary or Secondary to Medical Condition

depressed people typically start their sleep cycles in which stage?

REM. this is very atypical

In the past year, a client's parent reports the client has experienced six manic episodes, each lasting for 3 weeks. This is best described as what? Rapid cycling Cyclothymic disorder Hypomania Hypermania

Rapid cycling

Fear

Reaction to SPECIFIC danger

Relaxation training:

Relaxation exercises for breathing or muscle groups are taught. The relaxation response is the opposite of the stress response and results in a reduced heart rate and breathing and relaxed muscles.

The nurse is caring for a client with major depressive disorder who has been admitted to a psychiatric-mental health facility. After assessing the client, the nurse has developed a nursing diagnosis of "risk for violence toward others related to agitation and low tolerance level." Which would be an appropriate intervention for this client? Encourage the client to engage in calming group activities. Remove all dangerous items from the client's room. Provide antianxiety medication to prevent an incident. Encourage the client to act on thoughts that are leading to aggression.

Remove all dangerous items from the client's room.

After assessing a client, the nurse identifies that the client is at risk for suicide. Which would be the nurse's priority intervention? Communicate a desire to help the client. Remove means of suicide from the client's access. Determine the course of the client's suicidal thoughts. Provide mood-stabilizing medications per physician order.

Remove means of suicide from the client's access.

Symptoms of generalized anxiety disorders

Restlessness or feeling keyed up or on edge; being easily fatigued, difficulty concentrating/mind going blank; irritability, muscle tension, and sleep disturbance

After observing a bipolar client on the mental health unit, the nurse determines that the client is at risk for violence. Which would be an appropriate intervention? Ask the client to sit alone and write a letter. Restrict the client to the client's room until the client can calm down. Encourage the client to participate in an activity with other clients. Tell the client that if the client is violent, the client will be sent home.

Restrict the client to the client's room until the client can calm down.

Regression

Reverting to an earlier, more primitive and childlike pattern of behavior that may or may not have been previously exhibited A 4-year-old boy with a new baby brother temporarily starts sucking his thumb and wanting a bottle. A man who loses a promotion starts complaining to others, hands in sloppy work, misses appointments, and comes in late for meetings.

A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatric unit. Which nursing diagnosis has priority? Hopelessness related to recent divorce Ineffective coping related to inadequate stress management Spiritual distress related to conflicting thoughts about suicide and sin Risk for suicide related to highly lethal plan

Risk for suicide related to highly lethal plan

Compulsions

Ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety or prevent an imagined calamity

This disorder is often treated with light therapy

SAD (seasonal affective disorder)

Anxiety Disorders: Cultural Consideration

SOMATIC Symptoms ex. Increased HR, HA, Sweating

Anxiety Tx: Anti-Depressant Medications

SSRI- 1st line drug (Prozac, Zoloft, Lexapro) TCA (Elavil) MAOIs (Nardil)

Interventions for panic disorder:

Safety, comfort Therapeutic communication Anxiety management Patient, family education

A client with bipolar disorder has a plasma lithium concentration of 2.7 mE/L. Which finding would a nurse most likely assess in this client? Select all that apply. Seizures Nystagmus Fasciculations Tinnitus Incoordination

Seizures Nystagmus Fasciculations

Moderate anxiety

Selective Attention - Escalation from normal experience; - narrowed perception; - less able to pay attention and grasp what is going on; - focus on source of anxiety; -less able to pay attention; - able to solve problems but not at original ability; - decreased productivity (selective inattention and learning) Manifested by: poor concentration; mild somatic complaints; shakiness; increased perspiration, respiration, pulse and muscle tension; increased tension-relieving behaviors (pacing, banging hands on table)

Related disorders to anxiety:

Selective mutism Anxiety disorder due to another medical condition Substance/medication-induced anxiety disorder Separation anxiety disorder

When working with anxious patients:

Self-awareness of anxiety level Assessment of person's anxiety level Use of short, simple, easy-to-understand sentences Lower person's anxiety level to moderate or mild before proceeding Low, calm, soothing voice Safety during panic level Short-term use of anxiolytics (refer to Table 14.2)

A nurse is caring for a client diagnosed with bipolar disorder. The client is experiencing a manic episode. The nurse would be especially alert for signs indicating what? Self-injury Sleep disruption Dehydration Weight loss

Self-injury

Anxiety Disorder Types

Separation Anxieties Panic Disorders Phobias

Anxiety Disorders

Separation Anxiety Panic Disorder Agoraphobia Specific Phobia Social Anxiety Disorder (Social Phobia) Generalized Anxiety Disorder

This neurotransmitter influences behavior including mood, activity, aggressiveness, irritability, cognition, and pain

Serotonin

Most calming SSRI

Sertraline (Zoloft) Paroxetine (paxil)

Kava Kava

Short-term use in mild to moderate Anxiety

A client taking lithium for bipolar disorder is having mild diarrhea. The nurse informs the client that this is an example of what? Toxic effect Side effect Desired effect Therapeutic effect

Side effect

Family education concerning the safe care of a client with a history of suicide attempts includes what? Select all that apply. Signs and symptoms that indicate a mood change that could indicate the client is suicidal Information regarding the stressors that trigger the client's suicidal ideations Techniques to help the client cope with known triggers List of emergency service telephone numbers Information on how to determine if the threat of suicide is legitimate

Signs and symptoms that indicate a mood change that could indicate the client is suicidal Information regarding the stressors that trigger the client's suicidal ideations Techniques to help the client cope with known triggers List of emergency service telephone numbers

A client with depression is admitted to an inpatient psychiatric unit. The nurse provides a unit orientation. While observing the client's unpacking, the nurse can expect the client to exhibit what? A desire to initiate conversation with roommates Expansive and dramatic movements Slow movements and flat affect Overly excited interest in the admission

Slow movements and flat affect

A client receiving lithium therapy has a plasma blood concentration of 2.2 mEq/L. Which would the nurse expect to assess? Slurred speech Fine resting hand tremor Loose stools Muscular weakness

Slurred speech

Which is a primary risk factor for suicide? Social isolation Unemployment Poverty Economic deprivation

Social isolation

Social Anxiety Disorder

Social phobia

A nurse is with an adolescent who reports nothing to live for and wishing to be dead. Which nursing action would be the priority? Going to the client's psychiatrist to report the suicidal ideation Staying with the client to explore more of the client's thoughts about suicide Putting the client in seclusion with a staff member assigned to watch the client at all times Ascertaining the client's beliefs about what happens when you die

Staying with the client to explore more of the client's thoughts about suicide

Suppression Example

Studying for an exam for a week and saying not worrying about paying rent until after the exam.

Benzos Do not use with:

Substance Abuse pts Pregnant pts

In a therapy session, a client with a diagnosis of major depression admits to the nurse-therapist, "I actually went out driving on the interstate this morning and had every intention of getting up to speed and plowing right into the overpass by my exit. Maybe tomorrow." The nurse would recognize the client's statement as what? Suicidal ideation Suicidal intent Suicidal gesture Suicidal threat

Suicidal intent

A parent of four small children lost a spouse in an automobile accident 3 months ago and is admitted to the hospital with severe depression. Since the spouse's death, the client's mood has been somber; until now, the client has refused treatment. What is this client at high risk for? Bipolar disorder Suicide Schizophrenia Dysthymic disorder

Suicide

Which would be most important to assess and document in a client with depression? Appetite Weight changes Sleep disturbance Suicide risk

Suicide risk

A client has been treated following a suicide attempt. When providing anticipatory guidance during the client's discharge education, the nurse should teach the client that: The client is likely to experience stigma around the suicide attempt from some people. The client's commitment to treatment statement will be in effect for the next 6 months. A subsequent suicide attempt will likely cause the client to be declared legally incompetent. The client's long-term recovery will be primarily dependent on the adherence to group therapy.

The client is likely to experience stigma around the suicide attempt from some people.

The nurse is working with an outpatient who has a history of depression and suicide attempts. What assessment finding should the nurse interpret as indicating a high degree of planning for a future attempt? The client recently purchased a large bottle of over-the-counter analgesics The client stopped attending a depression support group, despite initially benefiting from it The client told the nurse, "I just want to stop being a burden to my wife and kids." The client has told the nurse, "I'm pretty sure my meds aren't working."

The client recently purchased a large bottle of over-the-counter analgesics

The nurse is performing an assessment of a client with depression. It took more than four sessions to complete. What is the likely reason for needing multiple sessions? The client was unwilling to answer the nurse's questions. The client was too tired to answer all of the nurse's questions in one session. The client had an insufficient attention span to understand and answer the nurse's questions. The client had impaired cognition leading to the inability to answer the nurse's questions.

The client was too tired to answer all of the nurse's questions in one session.

When teaching a group of new mental health nurses about the major difference between bipolar I and bipolar II disorders, which would be most appropriate for the nurse to include? Unlike bipolar II, bipolar I disorder involves no symptoms of mania, but only depression. Bipolar II is more often recognized than bipolar I. The mania symptoms of bipolar II disorder have little effect on functioning. Both disorders are the same, except the risk for suicide is greater with bipolar I disorder.

The mania symptoms of bipolar II disorder have little effect on functioning.

Systematic desensitization:

The patient is gradually introduced to a feared object or experience through a series of steps, from the least frightening to the most frightening (graduated exposure). The patient is taught to use a relaxation technique at each step when anxiety becomes overwhelming. For example, a patient with agoraphobia would start with opening the door to the house to go out on the steps and advance to attending a movie in a theater. The therapist may start with imagined situations in the office before moving on to in vivo (live) exposures.

A client with major depression has been prescribed escitalopram. The nurse should address what topic in client education? The possibility of gastrointestinal upset The need to avoid food containing tyramine Strategies for preventing orthostatic hypotension The possibility of weight loss

The possibility of gastrointestinal upset

After being prescribed several medications that were ineffective, a client is diagnosed with refractory mania. The physician decides to prescribe lamotrigine, an anticonvulsant that has been found to be effective for refractory mania. Which would the nurse need to include in the client's education plan? The potential for life-threatening side effects such as Stevens-Johnson syndrome The potential for the development of addiction to the medication The need to have blood levels drawn on a monthly basis The need to avoid certain types of foods while on the medication

The potential for life-threatening side effects such as Stevens-Johnson syndrome

A nurse is developing a presentation for families who have members who have been diagnosed with bipolar disorders. When describing this condition to the group, which would the nurse most likely include? As the person ages, the episodes tend to decrease. Environmental stressors are a key cause of these disorders. The risk for suicide is high with either depression or mania. Risk-taking behaviors are more common during a depressive episode.

The risk for suicide is high with either depression or mania.

Modeling:

The therapist or significant other acts as a role model to demonstrate appropriate behavior in a feared situation, and then the patient imitates it. For example, the role model rides in an elevator with a claustrophobic patient.

Which statement most accurately describes the relationship between psychiatric illness and suicide risk? Psychiatric-mental health clients are stereotyped as being at high risk of suicide, but this is untrue. The vast majority of people who commit suicide have a diagnosed mental disorder. Clients with depression are at increased risk of suicide, but suicide rates among persons with schizophrenia equal those of the general population. According to the DSM-5, suicide is considered to be a psychiatric diagnosis in and of itself.

The vast majority of people who commit suicide have a diagnosed mental disorder.

Response prevention:

This method is used for compulsive behavior. The therapist does not allow the patient to perform the compulsive ritual (e.g., hand washing), and the patient learns that anxiety does subside even when the ritual is not completed. After trying this in the office, the patient learns to set time limits at home to gradually lengthen the time between rituals until the urge fades away.

Thought stopping:

Through this technique a negative thought or obsession is interrupted. The patient may be instructed to say "Stop!" out loud when the idea comes to mind or to snap a rubber band worn on the wrist. This distraction briefly blocks the automatic undesirable thought and cues the patient to select an alternative, more positive idea. (After learning the exercise, the patient gives the command silently.

Antihistamine

Tired/Calming effect

A 51-year-old client with a history of an alcohol use disorder and depression has committed suicide. The care team has subsequently taken steps to organize a postvention. What is the goal of a postvention? To provide a chance for the client's family and friends to reminisce about the client. To allow the client's family and other close acquaintances to express their feelings about the suicide. To identify the clues that should have been acted upon in the days leading up to the client's suicide. To teach the client's close friends and family coping skills that they will need in the months ahead.

To allow the client's family and other close acquaintances to express their feelings about the suicide.

Displacement

Transference of emotions associated with a particular person, object, or situation to another nonthreatening person, object, or situation A child yells at his teddy bear after being picked on by the school bully. A child who is unable to acknowledge fear of his father becomes fearful of animals.

T/F Anxiety and fear are considered to be two different things.

True Rationale: Anxiety is different from fear. Anxiety is a vague feeling of dread or apprehension. Fear is a feeling of being afraid or threatened by an identifiable stimulus representing danger.

Repression

UNCONSCIOUS exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness A man forgets his wife's birthday after a marital fight. A woman is unable to enjoy sex after having pushed out of awareness a traumatic sexual incident from childhood

Reaction Formation

Unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite behavior or emotion A recovering alcoholic constantly talks about the evils of drinking. A woman who has an unconscious hostility toward her daughter is overprotective and hovers over her to protect her from harm, interfering with her normal growth and development.

Sigmund Freud

Unconscious childhood conflict; anxiety results when emotions close to breaking into conscious mind Ego defense mechanisms used to manage anxiety (overuse may lead to disorders)

Projection

Unconscious rejection of emotionally unacceptable features and attributing them to others No example. This is considered an immature defense mechanism A woman who has repressed an attraction toward other women refuses to socialize. She fears another woman will make homosexual advances toward her.

Conversion

Unconscious transformation of anxiety into a physical symptom with no organic cause EX: No example. Almost always a pathological defense A man becomes blind after seeing his wife flirt with other men.

A nurse is reviewing the medical record of a patient to determine the patient's risk for suicide. Which factor would alert the nurse to an increased risk for this patient? Fear of growing older Acute illness Homosexuality issues Unemployment

Unemployment

Flooding:

Unlike systematic desensitization, this method exposes the patient to a large amount of an undesirable stimulus in an effort to extinguish the anxiety response. The patient learns through prolonged exposure that survival is possible and that anxiety diminishes spontaneously. For example, an obsessive patient who usually touches objects with a paper towel may be forced to touch objects with a bare hand for 1 hour. By the end of that period, the anxiety level is lower.

Harry Stack Sullivan

Unmet early needs or disapproval (interpersonal theory) Anxiety is contagious Security operations- reduce anxiety and enhance security

When caring for a client with mania, which would the nurse most likely assess? Unusual self-confidence Slow, repetitive speech Logical thinking Narrowed focus

Unusual self-confidence

Compensation

Used to counterbalance perceived deficiencies by emphasizing strengths EX: A shorter-than-average man becomes assertively verbal and excels in business. An individual drinks alcohol when self-esteem is low to temporarily diffuse discomfort.

MAOIS

Used to treat resistance conditons; low tyramine diet redcues risk of hypertensive crisis; contraindicated in substance abuse rt risk HTN crisis

Anxiety:

Vague feeling of dread or apprehension Different from fear (feeling afraid or threatened by identifiable stimulus representing danger)

Nursing Process: Assessment

Vitals Hamilton Rating Scale

A client taking lithium for bipolar disorder comes to the clinic and reports symptoms which the nurse interprets as consistent with moderate lithium toxicity. Which action should the nurse perform? Select all that apply. Withhold additional doses of lithium. Obtain a blood sample for lithium level. Perform a 12-lead electrocardiogram. Push fluids. Contact the physician.

Withhold additional doses of lithium. Obtain a blood sample for lithium level. Push fluids. Contact the physician.

When conducting a suicide risk assessment, the nurse understands that which method has the least lethality? Hanging Wrist slashing Overdose of benzodiazepines Jumping

Wrist slashing

A client is being screened for clinical symptoms related to depression over the past 2 weeks. Which self-assessment screening instruments would be most appropriate? Zung Self-Assessment Scale Beck Depression Inventory Hamilton Rating Scale for Depression Geriatric Depression Scale

Zung Self-Assessment Scale

define neuropil

a broad term defined as any area in the nervous system composed of mostly unmyelinated axons, dendrites and glial cell processes that forms a synaptically dense region containing a relatively low number of cell bodies

Dysthymic disorder

a chronic, persistent mood disturbance characterized by symptoms such as insomnia, loss of appetite, decreased energy, low self-esteem, difficulty concentrating, and feelings of sadness and hopelessness that are milder than those of depression

Positive reframing

a cognitive behavioral technique involving turning negative messages into positive ones

Word salad

a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener (corn, potatoes, jump up, play games, grass, cupboard)

Thought insertion

a delusional belief that others are putting ideas or thoughts into the client's head; that is, the ideas are not those of the client

Thought withdrawal

a delusional belief that others are taking the client's thoughts away and the client is powerless to stop it

Thought broadcasting

a delusional belief that others can hear or know what the client is thinking

Bipolar mixed

cycles alternate between periods of mania, normal mood, depression, normal mood, mania, and so forth

Dissociation

a disruption in consciousness, memory, identity, or perception of the environment that results in compartmentalizing uncomfortable or unpleasant aspects of oneself. An art student is able to mentally separate herself from the noisy environment as she becomes absorbed in her work. As the result of an abusive childhood and the need to separate from its realities, a woman finds herself perpetually disconnected from reality.

Mania

a distinct period during which mood is abnormally and persistently elevated, expansive, or irritable

Delusion

a fixed, false belief not based in reality

Flooding

a form of rapid desensitization in which a behavioral therapist confronts the client with the phobic object (either a picture or the actual object) until it no longer produces anxiety

Anxiety disorders

a group of conditions that share a key feature of excessive anxiety, with ensuing behavioral, emotional, cognitive, and physiologic responses

Alogia

a lack of any real meaning or substance in what the client says

Tardive dyskinesia

a late-onset, irreversible neurologic side effect of antipsychotic medications; characterized by abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet

Hypersensitive crisis

a life-threatening condition that can result when a client taking MAOIs ingests tyramine containing foods and fluids or other medications

Hypomania

a period of abnormally and persistently elevated, expansive, or irritable mood lasting 4 days; does not impair the ability to function and does not involve psychotic features

Neuroleptic malignant syndrome (NMS)

a potentially fatal, idiosyncratic reaction to an antipsychotic or neuroleptic drug

Mild anxiety

a sensation that something is different and warrants special attention; often motivates people to make changes or to engage in goal directed activity; helps students to focus on studying for an exam

what is hypofrontality

a state of decreased cerebral blood flow in the prefrontal cortex of the brain

Decatastrophizing

a technique that involves learning to assess situations realistically rather than always assuming a catastrophe will happen

Pseudoparkinsonism

a type of extrapyramidal side effect of antipsychotic medication; drug-induced parkinsonism; includes shuffling gait, mask-like facies, muscle stiffness (continuous) or cogwheeling rigidity (ratchet-like movements of joints), drooling, and akinesia (slowness and difficulty initiating movement)

Anxiety

a vague feeling of dread or apprehension; it is a response to external or internal stimuli that can have behavioral, emotional, cognitive, and physical symptoms

what are the distortions addressed by cognitive therapy?

absolute, dichotomous thinking arbitrary inference specific abstraction overgeneralization magnification and minimization personalization

___________ NDMA antagonist ketamine improves depressive symptoms, but ___________ ketamine is associated with schizophrenia

acute; chronic acute = good chronic = bad, schizophrenia

what is affinity

affinity is how much a neurotransmitter "likes" a receptor; the degree of activity associated with the receptor channel

Dopamine __________ make symptoms worse

agonists

dopamine agonists are associated with _________, where as antagonists are associated with _________

agonists - psychosis antagonists - improved condition

Categories of Phobias:

agoraphobia; specific phobia; social phobia (social anxiety disorder)

CNS Depressants

alcohol, opiates

which drug causes DA transporters to run backwards

amphetamine

Phobia

an illogical, intense, and persistent fear of a specific object or social situation that causes extreme distress and interferes with normal functioning

Severe anxiety

an increased level of anxiety when more primitive survival skills take over, defensive responses ensue, and cognitive skills decrease significantly; person with severe anxiety has trouble thinking and reasoning; muscles tighten and vital signs increase; the person paces, is restless, irritable, and angry or uses other similar emotional-psychomotor means to release tension

During assessment of a client with depression, the client states, "I just feel so sad and hopeless. I just don't care anymore. I don't even enjoy doing the crossword puzzles like I used to." The nurse documents this finding as indicative of: dysthymic disorder. anhedonia. delusion. psychosis.

anhedonia

Dopamine __________ make symptoms better

antagonist

Neuroleptics

antipsychotic medications

Anxiety Disorders Example Rule out medical before mental

ex. COPD pt can't breathe and LEADS to Anxiety

what does ECT involve?

application of electrodes to the head of the client to deliver an electrical impulse to the brain causes a seizure believed that the shock stimulates brain chemistry to correct the chemical imbalance of depression.

Grandiose delusions

are characterized by the client's claim to association with famous people or celebrities, or the client's belief that he or she is famous or capable of great feats

Somatic delusions

are generally vague and unrealistic beliefs about the client's health or bodily functions. factual information or diagnostic testing does not change these beliefs

Nihilistic delusions

are the client's belief that his or her organs aren't functioning or are rotting away, or that some body part or feature is horribly disfigured or misshapen

The genetic theory, when applied to the occurrence of depression, supports that the psychiatric nurse should ... assess for depression in the client's family history. prepare the client for diagnostic genetic testing to confirm the diagnosis. educate the client regarding the symptoms of related physical disorders. encourage the client to seek genetic counseling before considering a pregnancy.

assess for depression in the client's family history.

what are the side effects of valproic acid (Divalproex)

ataxia drowsiness weakness fatigue menstrual changes dyspepsia nausea vomiting weight gain hair loss

What is the most common kind of hallucination experienced by people with schizophrenia?

auditory - they hear voices talking to them about 25% of hallucinations are visual

Cognitive therapy

based on the belief that patients make errors in thinking that lead to mistaken negative beliefs about self and others. For example, "I have to be perfect or my boyfriend will not love me." - cognitive restructuring is used

Hoarding disorder

begin early adolescences and symptoms increase with age An obsessive accumulation of belongings that may have little or no value and that prevents people from leading normal lives.

Avoidance behavior

behavior designed to avoid unpleasant consequences or potentially threatening situations

Systematic desensitization

behavioral technique used to help overcome irrational fears and anxiety associated with a phobia

Panic attack

between 15 and 30 minutes of rapid, intense, escalating anxiety in which the person experiences great emotional fear as well as physiologic discomfort

Flight of ideas

excessive amount and rate of speech composed of fragmented or unrelated ideas; racing, often unconnected, thoughts

Overdose of MAOI and cyclic antidepressants

both the cyclic compounds and MAOIs are potentially lethal when taken in overdose; to decrease this risk, depressed or impulsive clients taking any antidepressant in these two categories may need to have prescriptions and refills in limited amounts

Anti-Anxiety Medication

buspar for Addiction pts

MAOI drug interactions

can cause potentially fatal interactions - amphetamines - ephedrine - fenfluramine - isoproterenol - meperidine - phenylephrine - phenylpropanolamine - pseudoephedrine - SSRI antidepressants - tricyclic antidepressants - tyramine

what effect do cocaine/ amphetamines have

cause the person to show similar symptoms to schizphrenia

Schizophrenia

causes distorted and bizarre thoughts, perceptions, emotions, movements, and behavior

Polydipsia

excessive water intake

Substance-induced depressive or bipolar disorder

characterized by a significant disturbance in mood that is a direct physiologic consequence of ingested substances such as alcohol, other drugs, or toxins

Cyclothymic disorder

characterized by mild mood swings between hypomania and depression without loss of social or occupational functioning

D2 receptors in the caudate nucleus and putamen become supersensitive when they are ......

chronically blocked by antipsychotic drugs

what are the two types of DA antagonists

classic antipsychotics atypical antipsychotic medications

Derealization

client senses that events are not real, when in fact, they are

Ideas of reference

client's inaccurate interpretation that general events are personally directed to him or her, such as hearing a speech on the news and believing the message has personal meaning

Psychosis

cluster of symptoms including delusions, hallucinations, and grossly disordered thinking and behavior

which drugs block DA reuptake

cocaine, methylphenidate

underactivity of prefrontal cortex is associated with _______ and _______ symptoms of schizophrenia

cognitive and negative

Defense mechanisms

cognitive distortions that a person uses unconsciously to maintain a sense of being in control of a situation, to lessen discomfort, and to deal with stress; also called ego defense mechanisms

supersensitivity is a ________ mechanism

compensatory

Rationalization

consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener. An employee says, "I didn't get the raise because the boss doesn't like me." A man who thinks his son was fathered by another man excuses his malicious treatment of the boy by saying, "He is lazy and disobedient," when that is not the case.

what effect does hypofrontality have on negative symptoms

decreased activity of prefrontal cortex

(decreased/ increased) subgenual ACC activity with DBS is associated with improved depressive symptoms

decreased subgenual ACC *after 3 months of DBS symptoms improve

which characteristic of mental disorders is prevalent in schizophrenia?

deficient or inappropriate emotions

mental disorders are characterized by what 4 possible things?

deficient or inappropriate: - social behaviors - thoughts - emotions - perceptions

SAD is mostly associated with phase (delay/ advance)?

delay

how to create a safe environment for clients who are suicidal

deny clients access to materials on cleaning carts, their own meds, sharp scissors, and pen knives. remove any item they can use to commit suicide (sharp objects, shoelaces, belts, lighters, matches, pencils, pens, and even clothing with drawstrings. obseve clients every 10 minutes if lethality is low high potential clients are on one to one supervision by staff

schizophrenia is a _______________ disorder, meaning you are born with the likelihood that you will become schizophrenic, but you do not show symptoms until later in development

developmental

Bipolar disorder

diagnosed when a person's mood fluctuates to extremes of mania and/or depression

Mixed episode (rapid cycling)

diagnosed when the person experiences both mania and depression nearly every day for at least a week

A nurse taking an admission history from a client suspects that the physician will diagnose major depression. For the physician to make this diagnosis, the client will have to demonstrate specific symptoms. What are some of these symptoms? Select all that apply. disruption in sleep disruption in appetite obsessive desire to exercise disruption in concentration excessive guilt

disruption in sleep disruption in appetite disruption in concentration excessive guilt

what is mania?

distinct period during which mood is abnormally and persistently elevated, expansive or irritable.

Command hallucinations

disturbed auditory sensory perceptions demanding that the client take action, often to harm self or others, and are considered dangerous; often referred to as "voices"

what is arbitrary inference?

drawing a specific conclusion without sufficient evidence; jumping to negative conclusions

Arbitrary inference

drawing specific conclusions without sufficient evidence (jumping to negative conclusions)

most people with seasonal affective disorder begin secreting melatonin (earlier/ later) than healthy individuals?

earlier

what do antidepressants do?

establish a blockade for the reuptake of norepinephrine and seretonin into their specific nerve terminals - increase the sensitivity of the postsynaptic receptor site.

how do you treat delayed sleep phase syndrome?

evening melatonin and morning light

tru or false - someone with the genetic composition for schizophrenia will necessarily show symptoms later in life

false

tru or false - you need to have all four characteristics of mental disorder in order to have a mental disorder

false - you can have any combination of them

Hallucinations

false sensory perceptions or perceptual experiences that do not really exist

true or false: everyone who is depressed reports less depressive symptoms when sleep deprived

false. this treatment does not work for everybody. also, some people only experience immediate and temporary symptom relief/ improved mood

Animal phobia

fear of animals or insects (usually a specific type; often this fear develops in childhood and can continue through adulthood in both men and women; cats and dogs are the most common phobic objects)

Situational phobias

fear of being in a specific situation such as on a bridge or in a tunnel, elevator, small room, hospital, or airplane

Agoraphobia

fear of being outside; from the greek fear of the marketplace

Other types of specific phobias

fear of getting lost while driving if not able to make all right (and no left) turns to get to one's destination

rats that spent six weeks in total darkness showed apoptosis (cell death) in the NE neurons, DA neurons, and 5-HT neurons. therefore, total darkness results in __________ synapses for monoamines in PFC

fewer

Monkeys treated with PCP showed _________ correct responses compared to the control when they had to complete a task by reaching around a barrier

fewer correct response - the monkeys with PCP reached toward the barrier (not around it) more than the control

Panic:

fight, flight, or freeze response; increased vital signs; dilated pupils; cognitive processes focusing on defense

The majority of suicides among men are attributed to: firearms. hanging. overdose. drowning.

firearms

Word salad

flow of unconnected words that convey no meaning to the listener

Specific abstraction

focusing on a single, often minor, detail while ignoring other, more significant aspects of the experience (concentrating on one small, negative, detail while discounting positive aspects)

Overgeneralization

forming conclusions based on too little or too narrow experience (if one experience was negative, then all similar experiences will be negative)

patients with _________ amounts of dopamine release showed greater increases in __________ symptoms

greater amounts of dopamine release showed greater increases in positive symptoms

Anhedonia

having no pleasure or joy in life; losing any sense of pleasure from activities formerly enjoyed

what is lithium?

helpful for bipolar mania and bipolar depression reduces the degree and frequency of cycling or eliminating manic episodes

depressive disorders are highly __________ with 69% concordance for MZ twins

heritable

affinity

how much a neurotransmitter likes connecting to a receptor

i didnt really hear what he said about slide 61, so if you know, then pls help cause idk

i think its this: - hyperactivity in the frontal cortex is associated with depression - subgenual ACC --> inhibits PFC --> excites amygdala - also subgenual ACC --> amygdala through direct excitation - increased subgenual ACC activity leads to worse mood/ depression - increased subgenual ACC & decreased PFC are associated with increased amygdala activity

Clang associations

ideas that are related to one another based on sound or rhyming rather than meaning (I will take a pill if I go up the hill but not if my name is Jill, I don't want to kill)

assessment phase of the nursing process with a patient who is bipolar mania.

history can be difficult to obtain, patient jumps from subject to subject psychomotor agitation and seem to be in perpetual motion; sitting still is difficult.. wear clothes that reflect the elevated mood think move and talk fast pressured speech is one of the hallmark symptoms interrupt and and cannot listen to others. ignore verbal and nonverbal cues from others periods of euphoria, exuberant activity, grandiosity and false sense of well being. all knowing and all powerful image may be an unconscious defense against underlying low self esteem some can be angry, verbally aggressive tone and are sarcastic and irritable. mood is labile. periods of loud laughter and episodes of tears. cognitive ability or thinking is confused and jumbled with thoughts racing one after another (flight of ideas) cannot connect concepts and they jump from one subject to another.unable to communicate thoughts or needs in ways to understand start many projects and never finish them. talk non stop about plans and projects to anyone and everyone some experience psychotic features during mania; expression grandiose delusions involving importance fame privilege and wealth. oriented to person and place but not time claim to have many abilities they do not possess. easily angered and irritated and strike back at what they perceive as censorship by others bc they impose no restrictions on themselves. impulsive and rarely think before acting or speaking, poor judgement.insight is limited rarely can fulfill responsibilities. trouble at work and school and are too distracted and hyperactive to pay attention to children or activities of daily living. great need to socialize invade personal space and business of others. emotions are unstable and can fluctuate. labile emotions can be become hostile go days without eating and sleeping ignore persoal hygiene as boring when they have more things to do. throw away possessions or destroy valued items. physically injure themselves and tend to ignore or be unaware of health needs.

Echopraxia

imitation of the movements and gestures of someone an individual is observing

Chronic PCP treatment (impairs/helps) cognition

impairs

what is the goal of treatment?

increase the efficacy of available neurotransmitters and the absorption by postsynaptic receptors

Psychomotor agitation

increased body movements and thoughts

how do we measure the effects of exercise on neurogenesis?

indirectly via blood volume (we cannot directly measure neurogenesis in humans). increased blood flow to brain regions implies neurogenesis

describe the model for creating a schizophrenic mouse using increased D2 receptors

infuse viral vector containing D2 receptors into striatum -> increased expression of D2 receptors -> deficit in GABA transmission in dlPFC (GABA is still active but not in a coordinated way) -> abnormal neural activity -> behavioral abnormalities characteristic of schizophrenia

Panic anxiety

intense anxiety, may be a response to a life threatening situation; the emotional-psychomotor realm predominates with accompanying fight, flight, or freeze responses; adrenaline surge greatly increases vital signs, pupils enlarge to let more light in, and the cognitive process focuses on the person's defense

Akathisia

intense need to move about; characterized by restless movement, pacing, inability to remain still, and the client's report of inner restlessness

Persecutory/paranoid delusions

involve the client's belief that "others" are planning to harm the client or are spying, following, ridiculing, or belittling the client in some way. sometimes, the client cannot define who these "others" are

Sexual delusions

involve the client's belief that his or her sexual behavior is known to others; that the client is a rapist, prostitute, or pedophile or is pregnant; or that his or her excessive masturbation has led to insanity

what role does siRNA play in relation to DISC1

it is designed to prevent DISC1 from being expressed

what does Clozapine do

its an atypical antipsychotic drug that blocks D4 receptors in the nucleus accumbens

Anergia

lack of energy

anergia

lack of energy

Depressive disorder

lasts at least 2 weeks, during which the person experiences a depressed mood or loss of pleasure in nearly all activities

positive signs for schizophrenia PEAK in _________/__________

late teens/ early 20s

A group of nursing students is reviewing information about suicide and associated concepts. The group demonstrates understanding of the information when members identify which as the probability that a person will successfully complete suicide? parasuicide suicidal ideation suicidality lethality

lethality

what is hypertensive crisis?

life threatening condition that can result when a client taking MAOIs ingest tyramine-containing foods and fluids or other medications. the tyramine- MAOI interaction produces symptoms in 20 to 60 minutes after ingestion.

what does the treatment of bipolar involve?

lifetime regimen of medications; an antimanic agent called lithium or anticonvulsant meds used as mood stabilizers. help reduce manic behavior and protect against the effects of bipolar depressive cycles.

best treatment for bipolar disorder

lithium chloride, which is best taken during the manic phase

describe the model for creating a schizophrenic mouse using siRNA for DISC1

lol that just sounds so mean siRNA for DISC1 prevents it from being expressed -> infused into the progenitor cells -> neurons in the dlPFC appear normal after birth -> abnormalities in the structure of dendritic spines in the dlPFC occur after puberty -> behavioral abnormalities are positive symptoms for schizophrenia

Waxy flexibility

maintenance of posture or position over time even when it is awkward or uncomfortable

if a client has suiidal ideation or hears voices commanding to commit suicide

measures to provide a safe environment are necessary

what drugs are used when patients are unable to take lithium?

miscellaneous anticonvulsants mechanism of action is unknown raise the brains threshold for dealing with stimulation this prevents the person from being bombarded with external and internal stimuli .

what determines monochorionic versus dichorionic?

monochorionic/ same environment - split 4 days after development dichorionic/ different environment - split before 4 days of development

during depressed phase,

mood behaviors and thoughts are the same as people with major depressive disorder if persons first episode is depressed phase, can be diagnosed with major depressive disorder

Seasonal affective disorder (SAD)

mood disorder with two subtypes; in one, most commonly called winter depression or fall-onset SAD, people experience increased sleep, appetite, and carbohydrate cravings; weight gain; interpersonal conflict; irritability; and heaviness in the extremities beginning in late autumn and abating in spring and summer; the other subtype, called spring-onset SAD, is less common and includes symptoms of insomnia, weight loss, and poor appetite lasting from late spring or early summer until early fall

what are the most common psychiatric diagnoses?

mood disorders associated with suicide

receptors become _______________ if they are inhibited for a period of time by a drug that blocks them

more sensitive

Incidence of Anxiety Disorders:

most common psychiatric disorders in the United States More prevalent: women; people under 45 years old; people who are divorced or separated; people of lower socioeconomic status Onset, clinical course are variable

Categories of specific phobia:

natural environment; blood—injection; situation; animal; other types

Hypofrontality of glutamate NMDA and DA receptors plays a role in ____________

negative and cognitive symptoms

what is the DISC1 gene normally important for

neural differentiation and growth, axon guidance, receptor assembly, formation of synapses basically cognitive abilities

____________ occurs when overcompensation occurs

neurological symptoms

Euthymic

normal or level mood

creating a support system for suicidal clients

nurse assesses support systems and the type of help each person or group can give a client. Nurse makes a list of specific names and agencies that clients can call for support. He or she obtains client consent to avoid breach of confidentiality some can be treated in the community with the help of therapy and support groups without having to be hospitalized.

Exhaustion stage

occurs when the person has responded negatively to anxiety and stress: body stores are depleted or the emotional components are not resolved, resulting in continual arousal of the physiologic responses and little reserve capacity

Serotonin syndrome

occurs when there is an inadequate washout period between taking MAOIs and SSRIs or when MAOIs are combined with meperidine

Religious delusions

often center around the second coming of Christ or another significant religious figure or prophet. these delusions appear suddenly as part of the client's psychosis and are not part of his or her religious faith or that of others

Bipolar II disorder

one or more major depressive episodes accompanied by at least one hypomaniac episode

Bipolar I disorder

one or more maniac or mixed episodes usually accompanied by major depressive episodes

Magnification and minimization

over or undervaluing the significance of a particular event (one small negative event is the end of the world or a positive experience is totally discounted)

Psychomotor retardation

overall slowed movements; a general slowing of all movements; slow cognitive processing and slow verbal interaction

Mood disorders

pervasive alterations in emotions that are manifested by depression or mania or both

What is the difference between the pharmacological explanation for schizophrenia and the dopamine hypothesis

pharmacological evidence suggests that the positive symptoms of schizophrenia are caused by abnormalities in DA neurons, where as the dopamine hypothesis suggests that it is due to overactivity of DA synapses

overactivity of VTA and amygdala are associated with ________ symptoms of schizophrenia

positive

there is a (positive/negative) correlation between the amount of dopamine releases and changes in positive symptoms

positive correlation - more DA = more positive symptoms

the amount of amphetamine-induced striatal dopamine is related to _______________

positive schizophrenic symptoms

what type of symptoms is unique to schizophrenia?

positive symptoms

What does the dopamine hypothesis state

positive symptoms are due to VTA overactivity in the nucleus accumbens and amygdala

Loss of ego boundaries

potentially bizarre or strange behaviors that includes touching others without warning or invitation, intruding into others' living spaces, talking to or caressing inanimate objects, and engaging in such socially inappropriate behaviors as undressing, masturbating, or urinating in public - may also make provocative, insulting, or sexual statements

tryptophan is a ________ to serotonin/ 5-HT

precursor

what effect does hypofrontality have on cognitive symptoms

prefrontal damage that results in poor performance on neuropsychological tests, and concentration and focused attention tasks

OCD: Body Dysmorphic Disorder

preoccupation with imagined defective body part; insight varies Example: Repeated Plastic Sx Want perfect body, never satisified (Michael Jackson)

what are nursing interventions for a patient with bipolar mania?

provide for the clients physical safety and those around set limits on the clients behavior when needed remind the client to respect distances between self and others use short simple sentences to communicate clarify the meaning of the clients communication frequently provide finger foods that are high in calories and protein promote rest and sleep protect the clients dignity when inappropriate behavior occurs channel the clients need for movement into socially acceptable motor activities.

Catatonia

psychomotor disturbance, either motionless or excessive motor

positive signs for schizophrenia often BEGIN in __________

puberty

Labile

rapidly changing or fluctuating, such as someone's mood or emotions

Bipolar type II

recurrent depressive episodes with at least one hypomaniac episode

Latency of response

refers to hesitation before the client responds to questions

Suicide precautions

removal of harmful items; increased supervision to prevent acts of self-harm

Ruminate

repeatedly going over the same thoughts

Rumination

repeatedly going over the same thoughts

what is perseveration

repeatedly making the same unsuccessful choice

Echolalia

repetition or imitation of what someone else says; echoing what is heard

Extrapyramidal side effects

reversible movement disorders induced by antipsychotic or neuroleptic medication

what does discordant mean?

same genes, different phenotype

children of discordant monozygotic twins MZ have (same/different) heritability

same! heritability is around 17% for discordant MZ twins

what is the Glutamate Hypothesis

schizophrenic patients have a reduced amount of glutamate concentrations in the cerebrospinal fluid

A client who has attempted suicide has an underlying diagnosis of depression. Which would the nurse anticipate being ordered for the client? selective serotonin reuptake inhibitor mood stabilizer tricyclic antidepressant atypical antipsychotic

selective serotonin reuptake inhibitor

When assessing risk of suicide, which are important assessment components? Select all that apply. seriousness of suicidal ideation degree of hopelessness previous attempt lethality of method Unemployment

seriousness of suicidal ideation degree of hopelessness previous attempt lethality of method

Blunted affect

showing little or a slow to respond facial expression; few observable facial expressions

Flat affect

showing no facial expression

Hair-pulling and skin picking disorder

similar to cutting behaviors; rate difficult to determing similar to cutting behaviors; Hair-pulling disorder (trichotillomania) and skin-picking disorder (dermotillomania) result in varying degrees of disability, social stigma, and altered appearance. This is what disorder?

one of the most effective treatments for depression is ________ or ___________

sleep total or selective deprivation

Moderate:

something definitely wrong; nervousness/agitation; difficulty concentrating; able to be redirected

Mild:

special attention; increased sensory stimulation; motivational (Anxiety is not bad, but rather a warning sign)

monoamine hypothesis

states that depression is a result of insufficient monoamine activity. however, depression is especially associated with low 5-HT levels. however, this theory is not sufficient enough to fully explain depression

Thought blocking

stopping abruptly in the middle of a sentence or train of thought; sometimes client is unable to continue the idea

Alarm reaction stage

stress stimulates the body to send messages from the hypothalamus to the glands (such as the adrenal gland, to send out adrenaline and norepinephrine for fuel) and organs (such as the liver, to reconvert glycogen stores to glucose for food) to prepare for potential defense needs

A nurse is providing a presentation about suicide for a group of health professionals. Which would the nurse address as a major contributing factor to the rising suicide rate among men? substance abuse media influences lack of conflict resolution skills parenting practices

substance abuse

Attempted suicide

suicidal act that either failed or was incomplete

Assertiveness training

techniques using statements to identify feelings and communicate needs and concerns to others; helps the person negotiate interpersonal situations, fosters self-assurance, and ultimately assists the person to take more control over life situations

Personalization

tendency to self reference external events without basis (believing that events are directly related to one's self, whether they are or not)

Absolute, dichotomous thinking

tendency to view everything in polar categories (all or none, black or white)

Echolalia

the client's imitation or repetition of what the nurse says (Nurse: can you tell me how you're feeling? Client: Can you tell me how you're feeling, how you're feeling?)

activity

the degree of activity associated with a receptor channel

Moderate anxiety

the disturbing feeling that something is definitely wrong; the person becomes nervous or agitated; the person can still process information, solve problems, and learn new things with assistance from others; he or she has difficulty concentrating independently but can be redirected to the topic

what are obstetric complications?

the doctor may have to do things to facilitate the birth that could cause damage to the brain. this contributes to environmental causes of schizophrenia

what does susceptibility mean?

the genes for schizophrenia have to be triggered in order for the symptoms to present themselves

affective disorders and circadian rhythms

the hypothesis is that sleep crates a depressive substance. people with depression tend to have disordered sleep. it actually improves depressive symptoms to undergo some sleep deprivation. it produces immediate results, but total sleep deprivation is impractical

Suicide

the intentional act of killing oneself

Secondary gain

the internal or personal benefits received from others because one is sick, such as attention from family members, comfort measures, and being excused from usual responsibilities or tasks

if the client has a suicide plan

the nurse ask additional questions to determine the lethality of the intent and plan

Perseveration

the persistent adherence to a single idea or topic and verbal repetition of a sentence, phrase, or word, even when another person attempts to change the topic (Nurse: "How have you been sleeping lately?" Client: "I think people have been following me." Nurse: "Where do you live?" Client: "At my place people have been following me." Nurse: "What do you like to do in your free time?" Client: "Nothing because people are following me.")

Social phobia (social anxiety disorder)

the person becomes severely anxious to the point of panic or incapacitation when confronting situations involving people

Incomplete suicide attempt

the person did not finish the act because someone recognized the suicide attempt as a cry for help and responded or the person was discovered and rescued

Generalized anxiety disorder

the person worries excessively and feels highly anxious 50% of the time for 6 months or more

what is the role of the 5-HT transporter in depression?

the promotor region either has long alleles or short alleles. the short alleles tend to be treatment resistant (antagonistic) and result in less serotonin and more depression. the long alleles are agnostic and result in more serotonin and less depression

Primary gain

the relief of anxiety achieved by performing the specific anxiety-driven behavior; the direct external benefits that being sick provides, such as relief of anxiety, conflict, or distress

positive systems are associated with the overactivity of what?

the reward pathway of the brain and the amygdala

Kindling process

the snowball-like effect seen when minor seizure activity seems to build up into more frequent and severe seizures

Verbigeration

the stereotyped repetition of words or phrases that may or may not have meaning to the listener (I want to go home, go home, go home, go home)

cognitive restructuring

the therapist helps the patient (1) identify automatic negative beliefs that cause anxiety, (2) explore the basis for these thoughts, (3) reevaluate the situation realistically, and (4) replace negative self-talk with supportive ideas.

Stress

the wear and tear that life causes on the body

What is the relationship between the number of D2 receptors in schizophrenic patients and the cause of the disorder

there is a slight increase in the number of D2 receptors in the brains of schizophrenic patients, but it is unlikely that the increase is the primary cause of the disorder

why do people with schizophrenia often express feelings of fear and persecution

there is an over activity of the VTA sending dopamine projections to the amygdala

symptoms for schizophrenia show after puberty because ___________

there is no longer increasing myelination

what effect do positive symptoms have on unusual thoughts in schizophrenia

they are being reinforced so that you think your thoughts are not unusual

Suicidal ideation

thinking about killing oneself

___________ disorders are the most commonly observed in schizophrenia

thought

schizophrenia is where _______ does not match the world

thought

Obsessions

thoughts, impulses or images that persist and recur. Can't be dismissed by pt

When assessing a client who reports mild symptoms of depression, the nurse expects that the diagnostic tests ordered will include: thyroid stimulating hormone (TSH). coagulation time. platelet count. liver function test

thyroid stimulating hormone (TSH).

Obsessive-compulsive disorder

time-consuming rituals interfere with normal routines; not due to other psych/medical problems

Abnormal Involuntary Movement Scale (AIMS)

tool used to screen for symptoms of movement disorders (side effects of neuroleptic medications)

what do atypical antipsychotic medications do

treat symptoms of schizophrenia without producing side effects

Severe:

trouble thinking and reasoning; tightened muscles; increased vital signs; restless, irritable, angry

true or false - hypofrontality has an indirect effect on positive symptoms

tru - it disinhibits the mesolithic pathway resulting in more positive symptoms

Venlafaxine (Effexor)

type of SNRI; treat several anxiety disorders

Pressured speech

unrelenting, rapid, often loud talking without pauses

Stilted language

use of words or phrases that are flowery, excessive, and pompous (Would you be so kind, as a representative of Florence Nightingale, as to do me the honor of providing just a wee bit of refreshment, perhaps in the form of some clear spring water?)

Electroconvulsive therapy (ECT)

used to treat depression in select groups such as clients who do not respond to antidepressants or those who experience intolerable medication side effects at therapeutic doses

schizophrenics have a larger _________ size implying a greater loss of the surrounding __________

ventricle size; loss of surrounding neuropil

how do ventricle sizes of schizophrenic subjects compare to those of healthy subjects?

ventricles of schizophrenic people are more than 2 times larger than those of healthy people

A nurse is developing an education plan for a client who is prescribed escitalopram. Which side effect would the nurse include in this plan? Select all that apply. weight gain decreased sexual interest sedation blurred vision urinary retention Dry mouth

weight gain decreased sexual interest Dry mouth

lethality assessment

when a client admits to having a death wish or suicidal thoughts, the next step is to determine potential lethality does the client have a plan? if so what is it? is the plan specific? are the means available to carry out this plan? if the client carries out the plan, is it likely to be lethal? has the client made preparations for death such as giving away prized possessions, writing a suicide note or talking to friends one last time. where and when does the client intend to carry out the plan? is the intended time a special date or anniversary that has meaning for the client?

Active suicidal ideation

when a person thinks about and seeks ways to commit suicide

Passive suicidal ideation

when a person thinks about wanting to die or wishes he or she were dead but has no plans to cause his or her death

when is bipolar disorder diagnosed?

when a persons mood fluctuates to extremes of mania and or depression

Neologisms

words invented by the client (I'm afraid of grittiz. If there are any grittiz here, I will have to leave. Are you a grittiz?)

Generalized anxiety disorder

worried well; difficult to control the worry; worry about everyday routine life circumstances (job, health, finances, etc.), excessive worry occurring more days than not for at least 6 months, cause clinically significant distress. impairment in important areas of functioning (social/occupational) putting things off and avoidance is the key symptom --> leads to social isolation

mild /moderate anxiety interventions

• Help the patient identify anxiety. "Are you comfortable right now?" • Anticipate anxiety-provoking situations. • Use nonverbal language to demonstrate interest (e.g., lean forward, maintain eye contact, nod your head). • Encourage the patient to talk about his or her feelings and concerns. • Avoid closing off avenues of communication that are important for the patient. Focus on the patient's concerns. • Ask questions to clarify what is being said. "I'm not sure what you mean. Give me an example." • Help the patient identify thoughts or feelings before the onset of anxiety. "What were you thinking right before you started to feel anxious?" • Encourage problem solving with the patient.* • Assist in developing alternative solutions to a problem through role play or modeling behaviors. • Explore behaviors that have worked to relieve anxiety in the past. • Provide outlets for working off excess energy (e.g., walking, playing ping-pong, dancing, exercising).

Severe to Panic Level of Anxiety

• Maintain a calm manner. • Always remain with the person experiencing an acute severe to panic level of anxiety. • Minimize environmental stimuli. Move to a quieter setting, and stay with the patient. • Use clear and simple statements and repetition. • Use a low-pitched voice; speak slowly. • Reinforce reality if distortions occur (e.g., seeing objects that are not there or hearing voices when no one is present). • Listen for themes in communication. • Attend to physical and safety needs when necessary (e.g., need for warmth, fluids, elimination, pain relief, family contact). • Because safety is an overall goal, physical limits may need to be set. Speak in a firm, authoritative voice: "You may not hit anyone here. If you can't control yourself, we will help you." • Provide opportunities for exercise (e.g., walk with nurse, punching bag, ping-pong game). • When a person is constantly moving or pacing, offer high-calorie fluids. • Assess need for medication or seclusion after other interventions have been tried and have been unsuccessful. Haldol/Ativan IM

Anticonvulsants

▲ DiVALproex Sodium (Depakote, Depakote ER) or VALproic acid (Depakene) ▲ CARbamazepine (Tegretol, Equetro) (Tegretol, depakote, neurontin) Shown benefit in management of GAD and social anxiety Work by reducing excessive output from neurons in the amygdala and hippocampus

how long can and untreated episode of depression last?

from a few weeks to months or even years, thought most episodes clear in a month.

what are mixed episodes often called?

rapid cycling

what are the neuroendocrine influences on mood disorders?

-hormonal fluctuations -thyroid, adrenal, parathyroid and pituitary glands elevated glucocorticoid activity is associated with the stress response and increased cortisol secretion - postpartum hormone alterations -thyroid dysfunction and stimulating hormone

what is bipolar II?

-one or more major depressive episodes accompanied by at least one hypomanic episode -Hypomanic episode alternating with depression -Absence of psychosis -Hypomania tends to be euphoric -Depression is a particular risk for suicide

what is bipolar I?

-one or more manic or mixed episodes usually accompanied by major depressive episodes. -1 episode of mania alternating with depression -Psychosis can occur with mania

when are tricyclic antidepressants contraindicated in?

-severe impairment of liver function and in myocardial infarction. -cannot be given concurrently with MAOIs. -must be used with caution in clients who have glaucoma, benign prostatic hypertrophy urinary retention or obstruction, diabetes mellitus, hyperthyroidism, cardiovascular disease, renal impairment or respiratory disorders

how long does a manic period last?

1 week unless a person is hospitalized and treated sooner. may be longer for some individuals.

Amoxapine (Asendin) (tetracyclic antidepressant)

Amoxapine (Asendin) may cause extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant snydrome can create tolerance in 1-3 months increases appetite and cause weight gain and cravings for sweets.

suicide

Common in people with mood disorders Men young women whites and separated and divorced people are ay increased risk for suicide. Second leading cause of death among 15-24 year olds Clients with psychiatric disorders, depression, bipolar disorder, schizophrenia, substance abuse, PTSD, and borderline personality disorder are at increased risk for suicide Environmental factors that increase suicide risk include; isolation, recent loss, lack of social support, unemployment critical care events and family history of depression or suicide. Behavioral factors that increase risk include impulsivity, erratic, or unexplained changes from usual behavior and unstable lifestyle

what is one of the important risk factors for mood disorders?

Depression

what are the side effects of carbamazepine?

Dizziness Hypotension Ataxia Sedation blurred vision Leukopenia rashes

what is suicide?

Intentional act of killing oneself

what are the nursing implications for divalproex?

Monitor gait and assist as necessary Provide rest periods Give with food Establish balanced nutrition

what are the pre op instructions for a client having ECT?

NPO after midnight remove any fingernail polish voids just before the procedure IV for administration of meds.

what may adolescents with depression do?

abuse substances join gangs engage in risky behavior be underachievers drop out of school

a person with bipolar mixed episodes

alternates between major depressive and manic episodes interspersed with periods of normal behavior. each mood can last for weeks or months before the pattern begins to descend or ascend once again.

Divalproex (valproic acid)

anticonvulsant used to treat bipolar. mechanism of action is unclear monitor therapeutic levels periodically to remain at 50-`25 baseline and on going liver function test serum ammonia levels and platelet and bleeding times

a patient who has an acute episode of depression,

antipsychotic is used in combination with an antidepressant.

what are the nursing implications for carbamazepine?

assist client to rise slowly from sitting position monitor gait and assist as necessary report rashes to physician.

how is manic episode diagnosed?

at least 1 week of unusual and incessantly heightened, grandiose or agitated mood in addition to three or more of the following symptoms; exaggerated self esteem, sleeplessness, pressured speech, flight of ideas, reduced ability to filter extraneous stimuli, distractability, increased activities with increased energy, multiple grandiose high risk activities involving poor judgement and severe consequences (spending sprees, sex with strangers, impulsive investments

how long does a major depressive episode last?

at least 2 weeks during which a person experiences a depressed mood or loss of pleasure in nearly all activities.

how to choice which antidepressant to use?

based on the clients symptoms, age, and physical health needs drugs that have or have not worked in the past or that have worked for a blood relative with depression other meds the client is taking

what should the nurse avoid?

being overly cheerful or trying to cheer up clients impossible to coax or to humor clients out of depression.

what is overgeneralization?

forming conclusions based on too little or too narrow experience; if one experience was negative then all similar experiences will be negative.

what are symptoms of major depressive disorder?

change in eating habits (unplanned weight loss or gain) hypersomnia or insomnia impaired concentration, decision making or problem solving abilities inability to cope with daily life feelings of worthlessness, hopelessness, guilt or despair thoughts of death and or suicide overwhelming fatigue and rumination with pessimistic thinking with no hope of improvement

what is the etiology of mood disorders focus on?

chemical biologic imbalances as the cause psychosocial stressors and interpersonal events appear to trigger certain physiologic and chemical changes in the brain, which alter the balance of neruotransmitters

who is at an increased rick for suicide and suicide attempts?

client with schizophrenia substance abuse antisocial and borderline personality disorders panic disorders

what groups of people is electroconvulsive therapy used to treat?

clients who do not respond to antidepressants or those who are experiencing intolerable side effects at therapeutic doses (esp. older people) safe for pregnant women. clients who are activiely suicidal if there is a concern for their safety.

how do children with depression present?

cranky have school phobia hyperactivity learning disorders failing grades antisocial behaviors

older adults who are depresses may be....

cranky and argumentative

whereas a person with major depression slowly slides into depression that can last for 6 months to 2 years, a person with bipolar disorder

cycles between depression and normal behavior (bipolar depressed) or mania and normal behavior(bipolar manic)

what are the major categories of antidepressants?

cyclic antidepressants monoamine oxidase inhibitors (MAOIs) selective seretonin reuptake inhibitors (SSRI) atypical antidepressants

when does depression increase or decrease?

depression decreases with age in women and increases with age in men. single and divorced adults have the highest incidence

what is the first priority for a client with depression?

determining if the patient is suicidal!

what is a mixed episode?

diagnosed when the person experiences both mania and depression nearly ever day for at least 1 week.

during manic phase, patients are

euphoric grandiose energetic sleepless poor judgement rapid thoughts actions and speech

what may a person with manic mood be?

excessively cheerful enthusiastic and expansive or may be irritable esp when he or she is told no or has rules to follow. deny any problems placing the blame on others for any difficulties they experience can exhibit delusions and hallucinations during a manic episode.

what does bipolar involve?

extreme mood swings from episodes of mania to episodes of depression.

what is the neurochemical theory with mood disorders?

focus on serotonin and norepinephrine as the two major biogenic amines implicated in mood disorders. -growth hormone, prolactin, and cortisol are abnormal in depression. -deficits of seretonin, tryptophan or a metabolite are serotonin found in the blood or cerebrospinal fluid occur. -reduced metabolism in the prefrontal cortex -norepinephrine levels may be deficient in depression and increased in mania -kindling may underlie the cycling of mood disorders as well as addiction. -dysregulation of acetylcholine and dopamine

what is specific abstraction

focusing on a single often minor detail while ignoring other, more significant aspects of the experience; concentrating on one small negative detail while discounting positive aspects

what are the primary mood disorders?

major depressive disorder bipolar disorder

what are selective serotonin reuptake inhibitors?

newest category effective for most clients produce few sedating, anticholinergic and cardiovascular side effects. safer to use in older adults low side effects and relative safety, people are more apt to be compliant with the treatment regimen than clients using more troublesome meds. insomnia decreases in 3-4 days, appetite returns in 5-7 days, and energy returns to a more normal state in 4-7 days,in 7-10 days mood, concentration, and interest in life improve

using therapeutic communication

nurse encourages clients to describe in detail how they are feeling the nurse should listen attentively encourage clients and validate the intensity of their experience "how are you feeling today?" I feel so awful...terrible." Tell me more. what is that like for you?" "I dont feel like myself. I dont know what to do" "that must be frightening."

what are the symptoms of hypertensive crisis?

occipital headache, hypertension nausea vomiting chills sweating restlessness nuchal rigidity dilated pupils fever and motor agitation can lead to hyperpyrexia cerebral hemorrhage and death

what are the signs of overdose with tricyclic antidepressants?

occurs over several days confusion agitation hallucinations hyperpyrexia increased reflexes seizures, coma, and cardiovascular toxicity can occur with ensuing tachycardia, decreased output, depressed contractility, and atrioventricular block.

what are cyclic antidepressants/

oldest antidepressants relieve symptoms of hopelessness, helplessness, anhedonia, inappropriate guilt, suicidal ideation, and daily mood variations -used for panic disorder, OCD, eating disorders block the activity of seretonin and norepinephrine or increasing the sensitivity of postsynaptic receptor sites. -lag period of 10-14 days before reaching a serum level that begins to alter symptoms -6 weeks to reach full effect serum half life is really long so there is a lag period of 1-4 weeks before steady plasma levels are reached and the clients symptoms begin to decrease.

what is magnification and minimization?

over or undervaluing the significance of a particular event; one small negative event is the end of the world or a positive experience is totally discounted.

how is the client when they get done with ECT

patient may be confused or briefly disoriented very tired and has a headache usually symptoms are the same as a grand mal seizure. short term memory impairment can eat an drink as soon as he or she feels hungry and sleeps for a while. treat headaches symptomatically.

what is hypomania?

period of abnormally and persistently elevated, expansive or irritable mood and some other milder symptoms of mania.

mood disorder (affective disorder)

pervasive alterations in emotions that are manifested by depression, mania, or both - interfere with a persons life, can leave a person with long term sadness agitation or elation.

what neurotransmitters are decreased in depression?

serotonin and norepinephrine

if a client is unable to communicate very well or has limited responses or interactions with the nurse, the nurse can

sit with these patients for a few minutes at intervals throughout the day -presence of the nurse conveys genuine interest and caring. silence can convery that clients are worthwhile even if not interacting.

what are manifestations of depression in an adult?

substance abuse eating disorders compulsive behaviors (workaholism and gambling) hypochondriasis

how do manic episodes begin?

suddenly with rapid escalation of symptoms over a few days and they last from a few weeks to several months tend to be briefer and tend to end more suddenly than depressive episodes adolescents are more likely to have psychotic manifestations.

when does the first manic episode usually occur?

teens, 20s or 30s.

what is personalization?

tendency to self reference external events without basis' believing that events are directly related t ones self whether they are or not.

what is absolute, dichotomous thinking?

tendency to view everything in polar categories; all or none, black or white

what is suicidal ideation?

thinking about killing oneself

when does depression result?

too few neurotransmitters are released, if they linger too briefly in synapses, if the releasing presynaptic neurons reabsorb them too quickly, if conditions in synapses do not support linkage with postsynaptic receptors or if the number of postsynaptic receptors has decreased.

what is used for hypertensive crisis?

transient antihypertensive agents (phentolamine mesylate) given to dilate the blood vessels and decrease vascular resistance.

what is the genetic theory of mood disorders?

transmission of major depression in first degree relatives who are at twice the risk for developing depression compared with the general population. -genetic overlaps between early onset bipolar disorder and early onset alcoholism. people with both problems have a higher rate of mixed and rapid cycling poor response to lithium slower rate of recovery and more hospital admissions. clients may respond better to anticonvulsants than to lithium.

what does major depression usually involve?

two or more weeks of sad mood or lack on interest in life activities with at least 4 other symptoms of depression; anhedonia and changes in weight, sleep, energy, concentration, decision making, self esteem, and goals.

what is lithiums mechanism of action?

unknown thought to work in the synapses to hasten destruction of catecholamines (dopamine and norepinephrine, inhibit neurotransmitter release and decrease the sensitivity of post synaptic receptors

Carbamazepine

used for bipolar patients. has mood stabilizing properties but the threat of agranulocytosis is of great concern! need to have drug serum levels checked regularly to monitor for toxicity and to determine whether the drug has reached therapeutic levels (4-12) need baseline and periodic lab testing to monitor for suppression of WBC

what are MAOIs?

used infrequently because of the potentially fatal side effects and interactions with numerous drugs, both prescription and over the counter preparations. - most serious side effect is hypertensive crisis

what are atyipcal antidepressants?

used when the client has an inadequate response to or side effects of SSRIs.

what are examples of atypical antidepressants?

venlafaxine (Effexor)- blocks reuptake or serotonin, norepinephrine, and dopamina. duloxetine (Cymbalta)- blocks both serotonin and norepinephrine bupropion (Wellbutrin)- inhibits the reuptake of norepinephrine, weakly inhibits the reuptake of dopamine, and has no effects on serotonin. also used for smoking cessation. nefazodone (Serzone)- inhibits the reuptake of serotonin and norepinephrine and has few side effects. half life is 4 hours can be used in clients with liver and kidney disease. increases the action of certain benzodiazepines and H2 blocker terfenadine. mirtazapine (Remeron)- inhibits the reuptake of serotonin and norepinephrine and has few sexual side effects, it uses comes in higher incidence of weight gain sedation and anticholinergic side effects.

who is at highest risk for suicide?

young men early in the course of their illness, esp. if have a hx of suicide attempts or alcohol abuse, and recently being discharged from hospital.