Mental Health-Exam 3

What is the estimated lifetime prevalence rate for developing anorexia nervosa for women and men?

women: 1% men: 0.3%

•group of words put together in random fashion

word salad

emotions are incongruent with the circumstances

inappropriate affect

someone with paranoid personality should have what kind of therapy?

individual

Decreased sodium levels associated with schizophrenia can lead to what?

muscle twitching and irritability, seizures or even death (consume between 4 to 10 liters of fluids per day)

Inability or refusal to speak

mutism

Pervasive pattern of grandiosity, need for admiration, lack of empathy Sense of self-importance Fantasies of unlimited success, power, brilliance, beauty Believes they are "special" Requires excessive admiration Responds to criticism with indifference or rage Sense of entitlement Takes advantage of others to achieve own ends Lacks empathy Arrogant, haughty Believes others are envious of them

narcissistic

•Severe muscle rigidity, elevated temperature •elevated temperature, changes in level of consciousness, leukocytosis, elevated creatinine phosphokinase (CPK), elevated liver enzymes or myoglobinuria

neuroleptic malignant syndrome

What are these medications used for? -fluoxetine (Prozac) -sibutramine (Meridia) -topiramate (Topamax) -Lorcaserin (Belviq) -various anorexiants (CNS stimulants)

obesity associated with binge eating disorder (BED)

Preoccupation with orderliness, perfectionism and mental and interpersonal control Details, rules, lists, order, organization, schedules Devoted to work and productivity to the exclusion of leisure Overconscientious, scrupulous, & inflexible in morals, ethics, or values Reluctant to delegate tasks Unable to discard worn-out or worthless objects Miserly spending style Rigidity & stubbornness Avoids anxiety by clinging to fixed beliefs/rules

obsessive-compulsive

extreme suspiciousness of others

paranoia

Pervasive distrust and suspiciousness Suspects others are exploiting, harming or deceiving Doubts about loyalty and trustworthiness of friends and acquaintances Reluctant to confide in others Reads hidden meanings into remarks or events Bares grudges Perceives attacks on character Suspicious of fidelity of significant other

paranoid personality

•rigidity, akinesia (slow movement), and tremor, masklike face, loss of spontaneous movements

parkinsonism

What are the five A's of schizophrenia

1. affective blunting 2. alogia 3. avolition 4. anhedonia 5. ambivalence

What are the three types of bipolar disorders?

1. bipolar I disorder 2. bipolar II disorder 3. cyclothymic disorder

Anorexia nervosa typically begins between what ages?

12-30 years of age

A patient who had a stroke 3 days ago tearfully tells the nurse, "What's the use in living? I'm no good to anybody like this." Which action should the nurse employ first when caring for a patient demonstrating hopelessness? A. implement the institutional protocol for suicide risk B. support the patient to clarify and express feelings of grief C. educate the patient about the success of stroke rehabilitation D. offer the patient an opportunity to confer with the pastoral counselor

A. implement the institutional protocol for suicide risk

A parent tells the nurse about the death of a child 2 years ago. Which comment by this parent warrants the nurse's priority attention? A. "I still have some of my child's toys and clothes." B. "A parent should never live longer than their child." C. "I never returned to church again after the death of my child." D. My child has been dead a long time, but it seems like only yesterday."

B. "A parent should never live longer than their child."

Which comment by a patient diagnosed with bipolar disorder best indicates the patient is experiencing mania? A. "I have been sleeping about 6 hours each night." B. "Yesterday I made 487 posts on my social network page." C. "I am having dreams about my father's death 8 years ago." D. "My appetite is so robust that I've gained 4 pounds in the past 2 weeks."

B. "Yesterday I made 487 posts on my social network page."

The school nurse assesses four adolescents, all of whom outwardly appear healthy. Which adolescent meets one criterion for anorexia nervosa with mild severity? A. 5'2" tall, weight 104 pounds B. 5'7" tall, weight 110 pounds C. 5'5" tall, weight 114 pounds D. 5'8" tall, weight 127 pounds

B. 5'7" tall, weight 110 pounds

A mental health nurse assesses a patient diagnosed with an antisocial personality disorder. Which comorbid problem is most important for the nurse to include in the assessment? A. generalized anxiety B. alcohol use and abuse C. compulsions and phobias D. dysfunctional sleep patterns

B. alcohol use and abuse

A patient diagnosed with major depressive disorder was hospitalized for 2 weeks on an acute psychiatric unit. One day after discharge, the patient completed suicide. Recognizing likely reactions among staff, which action should the nursing supervisor implement first? A. assess each staff member individually for suicidal intent and/or plans B. provide a private setting for staff members to talk about feelings associated with the event C. remind staff members that suicide is a risk for the patient population and they are not at fault D. invite a guest speaker to conduct an educational session for staff members about suicide risk factors

B. provide a private setting for staff members to talk about feelings associated with the event

Negativistic attitudes & passive resistance to demands for adequate performance Passively resists fulfilling routine social & occupational tasks C/o being misunderstood and unappreciated by others Sullen & argumentative Criticizes & scorns others Envy & resentment toward those apparently more fortunate Voices c/o personal misfortune Alternates between hostile defiance & contrition Procrastination Manipulates others

passive-aggressive

•Sudden onset of symptoms •May or may not be preceded by a severe psychosocial stressor •Lasts less than 1 month •Return to full premorbid level of functioning

Brief psychotic disorder

A nurse assesses four adolescents diagnosed with various eating disorders. Which comment would the nurse expect from the adolescent diagnosed with anorexia nervosa? A. "I look good because whenever I overeat, I purge myself." B. "I love sweets. I make myself throw up so I can eat more." C. "I've lost 60 pounds but I'm still a size 2. I want to be a size 0." D."I've hidden my eating disorder from everyone, even my parents."

C. "I've lost 60 pounds but I'm still a size 2. I want to be a size 0."

The nurse assesses a new patient suspected of having a schizotypal personality disorder. Which assessment question is this patient most likely to answer affirmatively? A. "Do some types of situations frighten you?" B. "Do you often have episodes of prolonged crying?" C. "Is anyone in your family diagnosed with a mental illness?" D. "Is it ever very important for you to do everything correctly?"

C. "Is anyone in your family diagnosed with a mental illness?"

A patient experiencing depression says to the nurse, "my health care provider said I need 'talk' therapy but I think I need a prescription for an antidepressant mediation. What should I do? Select the nurse's best response. A. "Which antidepressant medication do you think would be helpful?" B. "There are different types of talk therapy. Most patients find it beneficial." C. "Let's consider some ways to address your concerns with your health care provider." D. "Are you willing to give 'talk therapy' a try before starting an antidepressant medication?"

C. "Let's consider some ways to address your concerns with your health care provider."

•interpretation of stimuli through the senses

perception

persistent repetition of the same word or idea in response to different questions

perseveration

•Symptoms include •Fatigue •Irritability •Loss of appetite •Sleep disturbances •Loss of libido •Concern about inability to care for infant

postpartum depression

voluntary assumption of inappropriate or bizarre postures

posturing

What does fluoxetine (Prozac) do for patients with anorexia nervosa?

prevents relapse

an early symptom indicating the development of a disease or syndrome

prodromal phase (second phase of premorbid behavior)

•Lasts from a few weeks to a few years •Deterioration in role functioning and social withdrawal •Substantial functional impairment •Sleep disturbance, anxiety, irritability •Depressed mood, poor concentration, fatigue •Perceptual abnormalities, ideas of reference, and suspiciousness herald onset of psychosis

prodromal phase (second phase of premorbid behavior)

These are all included in what category of personality disorders? Dependent Personality Disorder Avoidant Personality Disorder Obsessive-Compulsive Personality Disorder

Cluster C: anxious-fearful (WHIMPY)

what religions have higher chances of suicide?

protestants, catholics, and jews

•is not a diagnosis but a symptom of schizophrenia.

psychosis

•refers to a total inability to recognize reality (e.g., delusions and hallucinations).

psychosis

•- four or more episodes within 12 months

rapid cycling

behaving in a manner of less mature life stages: childlike and immature behavior

regressed behavior

•can occur at any time. With each ____ there is a longer period of time before recovery

relapses

excessive demonstration of obsession with religious ideas and behavior

religiosity

in order to prevent hypertensive crisis, CVA, and possible death when being treated for depression with MAOIs, what do patients need to do?

restrict intake of tyramine

a subtype of anorexia nervosa where someone loses weight dieting, fasting, or excessively exercising

restricting subtype

Pervasive pattern of detachment from social relationships Neither desires nor enjoys close relationships Chooses solitary activities Lacks close friends Little interest in having sexual experiences Takes pleasure in few, if any, activities Indifferent to praise or criticism Coldness, detachment, flattened affect Withdraws R/T fears of rejection Most never marry Solitary employment Depressive symptoms Abuse of drugs, alcohol and food to nurture self and deal with discomfort

schizoid personality

A potentially devastating brain disorder that affects: thinking, language, emotions, social behavior, and ability to perceive reality accutately

schizophrenia

•Abnormalities in other neurotransmitters •Norepinephrine •Serotonin •Acetylcholine •Gamma-aminobutyric acid •Glutamate

schizophrenia

Graver form of schizoid Aloof, isolated, behave in bland & apathetic manner Experience few pleasures Magical thinking, ideas of reference, illusions, depersonalization, superstitiousness, bizarre speech, delusions, hallucinations, & withdrawal into self

schizotypal

•Reduces overwhelming environmental stimuli. •Protects a patient from harm to self or others. •Prevents the destruction of property.

seclusion

depression is often ___ to a medical condition

secondary

•cause by medical disorders or treatment

secondary mania

What is atypical antipsychotics use in mania?

sedative properties

These should be avoided when taking what? Aged cheese Caviar Wine; beer Raisins Chocolate; colas Pickled herring Coffee; tea Yeast products Sour cream; yogurt Broad beans Smoked and processed meats Soy sauce Beef or chicken liver Cold remedies Canned figs Diet pills

MAOI's

inability to sit still, restlessness

akathisia

reduced fluency and productivity of language and thought

alogia

concurrent experience of opposite feelings, making it impossible to make a decision

ambivalence

absence of three consecutive menstrual cycles

amenorrhea

deficiency of energy

anergia

inability to experience pleasure

anhedonia

inability to express pleasure

anhedonia

General appearance and motor behavior: slow, lethargic, even emaciated; slow to respond to questions, difficulty deciding what to say, reluctant to answer questions fully; often wear baggy clothes; limited eye contact; unwilling to discuss problems or enter treatment

anorexia nervosa

Mood and affect: sad and anxious, seldom smile or laugh

anorexia nervosa

Roles and relationships: may have failing grades in school, in sharp contrast to previous high-level performance; withdrawal from peers

anorexia nervosa

Sensorium and intellectual processes: generally alert, oriented, intact; exception is the severely malnourished client with this, who may have mild confusion, slowed mental processes, and difficulty with concentration and attention

anorexia nervosa

Thought processes and content: spend most of the time thinking about food, dieting, food-related issues; body is delusional

anorexia nervosa

What are these medications used for? -fluoxetine(Prozac) -Clomipramine (Anafranil) -Cyprohiptadine (Periactin) -Chlorpromazine (Thorazine) -Olanzapine (Zyprexa)

anorexia nervosa

an eating disorder in which an irrational fear of weight gain leads people to starve themselves

anorexia nervosa

judgement and insight: very limited insight and poor judgement about health status

anorexia nervosa

paranoid ideas about their family and health care professionals being the "enemy," "trying to make them fat."

anorexia nervosa

•Orthostatic changes •Bradycardia •Cardiac murmur •Sudden cardiac arrest •Prolonged QT interval •Acrocyanosis •Symptomatic hypotension •Leukopenia •Lymphocytosis •Carotenemia •Abnormal thyroid functioning •Lanugo Edema in the extremities •Hypokalemic alkalosis •Electrolyte imbalances •Osteoporosis •Fatty degeneration of liver •Elevated cholesterol levels •Amenorrhea •Hematuria •Proteinuria

anorexia nervosa

Self-concept: low self-esteem, see themselves as powerless, helpless, and ineffective

anorexia nervosa and bulimia nervosa

•Confusion, hallucinations, •Physical signs - dilated pupils, blurred vision, facial flushing, dry mucous membranes, difficulty swallowing, fever, tachycardia, hypertension decreased bowel sounds, urinary retention, nausea, vomiting, seizures, coma •Atropine flush •Hot as a hare, blind as a bat, mad as a hatter, dry as a bone

anticholinergic crisis

Disregard for and violation of rights of other occurring since 15 y/o Failure to conform to social norms Deceitfulness and repeated lying Conning or manipulating others for personal profit Impulsivity Irritability & aggressiveness Disregard for safety of self or others Irresponsible in work and finances Lack of remorse, rationalizing bxs Cannot maintain meaningful relationships Lacks respect and loyalty Views self as tough/powerful/cunning Can appear very charming

antisocial

disinterest in the environment

apathy

•taking on the form of behavior one observes in another

identification and imitation

misperceptions of real external stimuli

illusions

What are the stages of bipolar disorder

-Stage I: hypomania -Stage II: Acute mania -Stage III: Delirious mania

On the sixth anniversary of her spouse's death a widow says, "Sometimes life does no seem worth living anymore. I wish I could go to sleep and never wake up." Which response by the nurse has priority? A. "Are you considering suicide?" B. "You still have so much to live for." C. "Grief can sometimes last for many years." D. "Why do you continue to grieve something from long ago?"

A. "Are you considering suicide?"

A patient diagnosed with bipolar disorder lives in the community and is showing early signs of mania. The patient says, "I need to go visit my daughter but she lives across the country. I will put some requests on the Internet to get a ride. I'm sure someone will take me." What is the nurse's most therapeutic response? A. "I'm concerned about your safety when meeting or riding with strangers." B."Have you asked friends and family to donate money for your airfare?" C. "You are not likely to get a ride. Let's consider some other strategies." D. "Have you asked your daughter if she wants you to come for a visit?"

A. "I'm concerned about your safety when meeting or riding with strangers."

A community mental health nurse counsels a group of patients about the upcoming flu season. What instruction does the nurse provide for patients who are prescribed lithium? A. "Stop taking your medicine and contact me if you have nausea, vomiting, and/or diarrhea." B. "Remember that lithium reduces your immunity, so you are more vulnerable to catching the flu." C. "The flue is contagious. Isolate yourself if you get the flue so that you avoid exposing others to it." D. "Because you take lithium, you may have flu symptoms that are not typically experienced by others."

A. "Stop taking your medicine and contact me if you have nausea, vomiting, and/or diarrhea."

A nurse plans care for a patient diagnosed with borderline personality disorder. Which nursing diagnosis is most likely to apply to this patient? A. ineffective relationships related to frequent splitting B. social isolation related to fear of embarrassment or rejection C. ineffective impulse control related to violence as evidenced by cruelty to animals D. disturbed thought processes related to recurrent suspiciousness of people and situations

A. ineffective relationships related to frequent splitting

What is your best intervention when you assess that a patient is responding to an auditory hallucination? A.Ask the patient, "Can you tell me what you are hearing?" B.Ask the patient, "Are you afraid of the voice you are hearing?" C.Tell the patient, "Try to ignore the voices you hear." D.Tell the patient, "The voices you hear are not real."

A.Ask the patient, "Can you tell me what you are hearing?"

•Mood: feeling unusually "high", euphoric, irritable for at least 1 week •Cognition and perception: fragmented, disjointed thinking; pressured speech; flight of ideas; hallucinations and delusions; inflated feeling of power, greatness, or importance •Activity and behavior: excessive psychomotor behavior; increased sexual interest; inexhaustible energy; goes without sleep; bizarre dress and make-up; reckless behavior-money, sex, drugs

Acute mania

These are all included in what category of personality disorders? Antisocial Personality Disorder Borderline Personality Disorder Narcissistic Personality Disorder Histrionic Personality Disorder

Cluster B: Dramatic-Erratic (WILD)

The DSM-5 identifies this condition as an eating disorder that can lead to obesity

Binge eating disorder (BED)

•Individual is experiencing, or has experienced, a full syndrome of manic or mixed symptoms •May also have experienced episodes of depression

Bipolar I disorder

∞Recurrent bouts of major depression ∞ Episodic occurrences of hypomania ∞ Has not experienced an episode that meets the full criteria for mania or mixed symptomatology

Bipolar II disorder

Shortly after hospitalization, an adolescent diagnosed with anorexia nervosa says to the nurse, "Being fat is the worst thing in the world. I hope it never happens to me." Which response by the nurse is appropriate? A. "You need to gain weight to become healthier." B. "Your world would not change if you gained a few pounds." C. "Tell my how your world would be different if you were fat." D. 'Your attractiveness is not defined by a number on the scales."

C. "Tell my how your world would be different if you were fat."

After a power outrage, a facility must serve a dinner of sandwiches and fruit to patients. Which comment is most likely from a patient diagnosed with a narcissistic personality disorder? A. "These sandwiches are probably contaminated with bacteria." B. "I suppose it's the best we can hope for under these circumstances." C. "You should have ordered a to-go meal from a local restaurant for me." D. "I would rather wait to eat until the dietary department can prepare a meal."

C. "You should have ordered a to-go meal from a local restaurant for me."

A patient has a long history of bipolar disorder with frequent episodes of mania secondary to stopping prescribed medications. The patient says, "I will use my whole check next month to buy lottery tickets. Winning will solve my money problems." Select the nurse's best action. A. educate the patient about the low odds of winning the lottery B. present reality by saying to the patient, "That is not good use of your money." C. Confer with the treatment team bout appointing a legal guardian for the patient. D. Tell the patient, "If you buy lottery tickets, your money will run out before the end of the month."

C. Confer with the treatment team bout appointing a legal guardian for the patient.

This cluster includes avoidant, dependent, and obsessive compulsive personality disorders

Cluster C personality disorders

A 28-year-old second-grade teacher is diagnosed with major depressive disorder. She grew up in Texas but moved to Alaska 10 years ago to separate from an abusive mother. Her father died by suicide when she was 12 years old. Which combination of factors in this scenario best demonstrates the stress-diathesis model? A. cold climate coupled with history of abuse B. current age of 28 coupled with family history of depression C. family history of mental illness coupled with history of abuse D. female gender coupled with the stressful profession of teaching

C. family history of mental illness coupled with history of abuse

The nurse cares for a hospitalized adolescent diagnosed with major depressive disorder. The health care provider prescribes a low-dose antidepressant. In consideration of published warnings about the use of antidepressant medications in younger patients, which action should the nurse employ? A. notify the facility's patient advocate about the new prescription. B. teach the adolescent about black box warnings associated with antidepressant medications C. monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior D. remind the health care provider about warnings associated with the use of antidepressants in children and adolescents

C. monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior

•Stupor and muscle rigidity or excessive, purposeless motor activity •Waxy flexibility, negativism, echolalia, echopraxia

Catatonic disorder

This cluster includes disorders such as: schizotypal personality disorder, schizoid personality disorder, and paranoid personality disorder

Cluster A

-Seen as "odd" or eccentric; have unusual beliefs -Avoid interpersonal relationships; often indifferent

Cluster A disorders

These are all included in what category of personality disorders? Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Key Characteristic: Eccentric

Cluster A: odd-eccentric (WEIRD)

This cluster of personality disorders is related to emotional reactivity, poor impulse control, and an unclear sense of identity

Cluster B

This cluster of personality disorders experience of high levels of anxiety and outward signs of fear

Cluster C personality disorders

•Chronic mood disturbance •At least 2-year duration •Numerous episodes of hypomania and depressed mood of insufficient severity to meet the criteria for either Bipolar I or II disorder

Cyclothymic disorder

A patient was diagnosed with bipolar disorder many years ago. The patient tells the nurse, "When I have a manic episode, there's always a feeling of gloom behind it and I know I will soon be totally depressed." What is the nurse's best response? A. "Most patients diagnosed with bipolar disorder report the same types of feeling." B."Feelings of gloom associated with depression result from serotonin dysregulation." C. "If you take your medication as it is prescribed, you will not have those experiences." D. "Your comment indicates you have an understanding and insight about your disorder."

D. "Your comment indicates you have an understanding and insight about your disorder."

A patient is hospitalized with a diagnosis of anorexia nervosa. The nurse reviews the patient's laboratory results below. Sodium: 143 mEq/L Potassium: 3.1 mEq/L Chloride: 102 mEq/L Magnesium: 2.2 mEq/L Calcium: 8.4 mg/dL Phosphate: 3.0 mg/dL The nurse should take which action next? A. measure the patient's body temperature B. inspect the patient's skin and sclera for jaundice C. assess the patient's mucous membranes for erosion D. auscultate the patient's heart rate, rhythm, and sounds

D. auscultate the patient's heart rate, rhythm, and sounds

A single adult says to the nurse, "Both of my parents died several years ago and my only sibling committed suicide 2 weeks ago. I feel so alone." After determining that the adult has no suicidal ideation, the nurse should: A. explore the adult's feeling of survivor's guilt B. assess the adult's cultural beliefs and spirituality C. refer the adult for cognitive behavioral therapy (CBT) D. refer the adult to a self-help group for suicide survivors

D. refer the adult to a self-help group for suicide survivors

A patient tells the nurse, "No matter what I do, I feel like there's always a dark cloud following me." Select the nurse's initial action. A. assess the patient's current sleep and eating patterns B. explain to the patient, "everyone feels down from time to time" C. suggest alternative activities for times when the patient feels depressed D. say to the patient, "tell me more about what you mean by 'a dark cloud'."

D. say to the patient, "tell me more about what you mean by 'a dark cloud'."

Dysfunction between brain hemispheres. Positive correlation between the degree of reality distortion and activity in the medial temporal and ventral limbic areas

Delusional disorder

•The existence of prominent, non-bizarre delusions Types: •Erotomanic type •Grandiose type •Jealous type •Persecutory type •Somatic type •Mixed type

Delusional disorder

•a selective serotonin reuptake inhibitor (SSRI), has shown mixed results in maintaining weight and preventing relapse.

Fluoxetine (Prozac),

•Symptoms similar to those of the prodromal phase •Flat affect and impairment in role functioning are prominent

Fourth phase of premorbid behavior (residual phase)

• perceptual experiences that occur without actual external sensory stimuli.

Hallucinations

•They can involve any of the five senses, but usually are visual or auditory •Auditory are more common than visual ones (ex: the patient hears voices carrying on a discussion about his or her own thoughts or behaviors)

Hallucinations

•a second-generation antipsychotic medication, affects weight gain and improves cognition and body image.

Olanzapine (Zyprexa),

•May last for a few weeks to several months •Associated with hormonal changes, tryptophan metabolism, or cell alterations

Postpartum depression

•Prominent hallucinations and delusions are directly attributable to a general medical condition

Psychotic disorder associated with another medical condition

Scarring of the Dorsum of the hand used to stimulate the gag reflex. Presents as fingers and teeth having white spots due to caroten

Russell sign

A simple and practical assessment tool to evaluate potentially suicidal patients. Sex Age Depression Previous Attempts Ethanol or Other Drugs Rational Thinking Loss Social Supports Lacking Organized Plan No Spouse Sickness

SAD PERSONS scale

S: Male sex → 1 A: Age If <19 or >45 years → 1 D: Depression or hopelessness → 2 P: Previous suicidal attempts or psychiatric care → 1 E: Excessive ethanol or drug use → 1 R: Rational thinking loss (psychotic or organic illness) → 2 S: Separated, widowed, or divorced → 1 O: Organized plan or serious attempt → 2 N: No social support → 1 S: Stated future intent (determined to repeat or ambivalent) → 1 Guidelines for Clinical Action 0-5: May be safe to discharge (depending upon circumstances) 6-8: Probably requires psychiatric consultation > 8: Probably requires hospital admission (voluntary or involuntary)

SAD PERSONS scale

Specificity (how detailed and clear is the plan?) Availability (does the client have immediate access to the planned means? Lethality (could the plan be fatal, or does the client believe it would be fatal?).

SAL (to assess for suicide risk)

LSUDDEN WITHDRAWAL OF ANY ANTI- CONVULSANT CAN CAUSE A _____

STATUS EPILEPTICUS SEIZURE

Schizophrenic symptoms accompanied by a strong element of symptomatology associated with a mood disorders, either mania or depression.

Schizoaffective disorder

______ is a devastating brain disease that targets young people in their teens and early twenties, at the beginning of their productive lives

Schizophrenia

•Same symptoms as schizophrenia with the exception that the duration of the disorder has been at least 1 month but less than 6 months

Schizophreniform disorder

the condition or process of deterioration with age

Senescence

•Bereavement overload •High percentage of suicides among elderly •Symptoms of depression often confused with symptoms of dementia •Treatment •Antidepressant medication •Electroconvulsive therapy •Psychosocial therapies

Senescence (elderly) depression

•Delusional system develops in a second person as a result of a close relationship with a person who already has a psychotic disorder with prominent delusions. Also called folie á deux.

Shared psychotic disorder

intensification of hypomanic symptoms; requires hospitalization

Stage II: acute mania

•A grave form of the disorder, characterized by severe clouding of consciousness and representing an intensification of the symptoms associated with acute mania

Stage III: Delirious mania

•Mood: labile, from ecstasy to despair •Cognition and perception: confusion, disorientation, hallucinations, delusions •Activity and behavior: frenzied psychomotor activity; agitated, purposeless movements; exhaustion and death can occur without intervention

Stage III: Delirious mania

•The presence of prominent hallucinations and delusions that are judged to be directly attributable to substance intoxication or withdrawal

Substance-induced psychotic disorder

These are side effects of what category of medication? •sedation and drowsiness •weight gain •hypotension •potentiation of CNS system drugs •blurred vision •dry mouth •constipation •urinary retention •sinus tachycardia •decreased memory

Tricyclic antidepressants

What is the estimated lifetime prevalence rate for developing bulimia nervosa for women and men?

Women: 1.5% Men: 0.5%

•the feeling state or emotional tone

affect

reduce range of emodion

affective blunting

A person shoplifts merchandise from a community cancer thrift shop. When confronted, the thief replies, "All this stuff was donated, so I can take it." This comment suggests features of which personality disorder? a. Antisocial b. Histrionic c. Borderline d. Schizotypal

a. Antisocial

inability to perform coordinated movements

ataxia

restricts thinking to the literal and immediate so the individual has private rules of logic and reasoning that make no sense to anyone else

autistic thinking

Social inhibition,feelings of inadequacy, hypersensitivity to neg evaluation Avoids occupational activities b/c fear of criticism, disapproval, or rejection Views self as socially inept, personally unappealing, & inferior Fears of being shamed, ridiculed, criticized, rejected, or embarrassed Restraint in intimate relationships Reluctant to take personal risks Low self-esteem, anxiety, & depression

avoidant

Impairment in the ability to initiate goal-directed activity

avolition

withdrawal and inability to initiate and persist in goal directed behavior

avolition

•same as manic but less than four days

hypomanic episode

a subtype of anorexia nervosa where someone engages in binge eating followed by purging

binge eating and purging subtype

This disorder differs from bulimia nervosa in that the individual does not engage in behaviors to rid the body of excess calories

binge eating disorder (BED)

These medications are used for what? •Lithium carbonate •Anticonvulsants •Verapamil •Atypical antipsychotics

bipolar disorder (mania)

physiological influences of ___ •Alterations in electrolyte transfer resulting in intracellular sodium and calcium •Brain lesions

bipolar disorder (mania)

This mental illness is characterized by two opposite poles: mania and depression

bipolar spectrum disorder

weak emotional tone

bland affect

Instability of interpersonal relationships, self-image, & affects & marked impulsivity Avoid real or imagined abandonment Unstable & intense interpersonal relationships Unstable self-image Impulsivity in 2 areas- spending, sex, substance abuse, binge eating, reckless driving Self-mutilating & recurrent suicidal bx Affective instability Chronic feelings of emptiness Intense anger Splitting -good or bad, splits staff Chronic feeling of boredom Uncertainty r/t sexual orientation Needy "help me" "fix me" Whinnes Overwhelming state of feeling bad

borderline

Dialectical behavior therapy has been extremely effective in people with what?

borderline personality disorder

General appearance and motor behavior: normal appearance, open and talkative

bulimia nervosa

Judgement and insight: insight into the pathologic nature of their eating behavior, but feel out of control and unable to change that behavior

bulimia nervosa

Mood and affect: initially cheerful but express intense emotions of guilt, shame, and embarasment when discussing binging and purging behaviors

bulimia nervosa

Onset of this occurs in late adolescence or early adulthood, with a mean age of onset of 18 years

bulimia nervosa

Roles and relationships: ashamed of binging and purging, hides it from others; the amount of time spent buying and consuming food can interfere with role perfomance

bulimia nervosa

Sensorium and intellectual processes: generally alert, oriented, intact

bulimia nervosa

What are these medications used for? -Antidepressants: desipramine (Norpramin) imipramine (Tofranil) amitriptyline (Elavil) nortriptyline (Pamelor) phenelzine (Nardil) fluoxetine (Prozac)

bulimia nervosa

•Cardiomyopathy (ipecac toxicity) •Cardiac dysrhythmias •Sinus bradycardia •Sudden cardiac arrest •Orthostatic changesin pulse and blood pressure •Electrolyte imbalances •Metabolic acidosis •Hypochloremia •Hypokalemia Gastric dilation •Russell sign •Dehydration and renal loss of potassium as a result of self-induced vomiting •Attrition and erosion of teeth •Loss of dental arch •Diminished chewing ability •Parotid gland enlargement •Esophageal tears as a result of self-induced vomiting

bulimia nervosa

___ contains the appetite regulation center within the brain

hypothalamus

While weighing patients on an eating disorders unit, the nurse overhears a psychiatric technician say, " I wish i had an eating disorder, maybe i'd lose a little weight." What is the nurse's best action? a. report the clinical observation to the nursing supervisor b. ask the psychiatric technician, "What did you mean by that comment?" c. privately discuss the importance of sensitivity with the psychiatric technician d. immediately interrupt the interaction between the patient and psychiatric technician

c. privately discuss the importance of sensitivity with the psychiatric technician

What does cyproheptadine (Periactin) do for patients with anorexia nervosa?

can promote weight gain

only ___ is approved for mania

carbamazepine

is marked by a lack of responsiveness, stupor, and a tendency to remain in a fixed posture.

catatonic disorder

• Genetic predisposition • Biochemical dysfunction • Physiological factors • Psychosocial stress

causes of schizophrenia

•Symptoms •Under age 3: feeding problems, tantrums, lack of playfulness emotional expressiveness •Ages 3 to 5: accident proneness, phobias, excessive self-reproach •Ages 6 to 8: physical complaints, aggressive behavior, clinging behavior •Ages 9 to 12: morbid thoughts and excessive worrying

childhood depression

delay in reaching the point of a communication because of unnecessary and tedious details

circumstantiality

These individuals are seen as odd or eccentric

cluster A

This cluster includes: odd or eccentric behavior, suspicious, cold, withdrawn, or irrational behavior

cluster A

This cluster includes: dramatic, emotional behavior, attention-seeking, labile, shallow, and increased rates of substance use and suicide behavior

cluster B

-Emotional reactivity, poor impulse control, manipulation -Unclear sense of identity

cluster B disorders

These disorders include antisocial, borderline, histrionic, and narcissistic personality disorders

cluster B personality disorders

This cluster includes: anxious, fearful behavior, tense, overcontrolled, and depressed behavior

cluster C

-High anxiety and outward signs of fear -Inhibited, internalizing blame, even when not to blame

cluster C disorders

What is the treatment for bulimia nervosa?

cognitive-behavioral therapy (Cognitive Restructuring)

lack of abstract thinking, inability to understand punch lines

concrete thinking

•literal interpretations of the environment

concrete thinking

Over the past 2 months a patient made eight suicide attempts with increasing lethality. The health care provider informs the patient and family that electroconvulsive therapy (ECT) is needed. The family whispers to the nurse, "Isn't this a dangerous treatment?" How should the nurse reply? a. "Our facility has an excellent record of safety associated with use of electroconvulsive therapy." b. "Your family member will eventually be successful with suicide if aggressive measures are not promptly taken." c. "Yes, there are hazards with electroconvulsive therapy. You should discuss these concerns with the health care provider." d. "Electroconvulsive therapy is very effective when urgent help is needed. Your family member was carefully evaluated for possible risks."

d. "Electroconvulsive therapy is very effective when urgent help is needed. Your family member was carefully evaluated for possible risks."

•receiving special messages through the media

ideas of reference

•Grandiose •Nihilistic •Persecutory •Somatic •Religious

delusion categories

Need to be taken care of that leads to submissive and clinging bx and fears of separation Difficulty making decisions Needs others to assume responsibility Difficulty expressing disagreement Difficulty initiating projects or doing things on his/her own Excessive lengths to obtain nurturance and support Uncomfortable or helpless when alone When relationship ends urgently seeks another Fears of being left alone to care for self Often get into abusive situations

dependent

•feelings of unreality (nihilistic thinking)

depersonalization

selective serotonin reuptake inhibitors are often used to treat what?

depression

recurrent disturbances or alterations in mood that cause psychological distress and behavioral impairment

depressive disorders

impaired personal grooming and self-care activities

deterioration

What are comorbidities associated with schizophrenia?

diabetes, water imbalance/intoxication, decreased sodium level

What is the biochemical influence related to schizophrenia

dopamine-dependent

a middle level alteration in affect

dysthymic disorder

•Sad or "down in the dumps" •Feels inadequate, empty, fatigued, and pessimistic, low self-esteem, poor appetite or overeating, insomnia or oversleeping, feeling of hopelessness, poor concentration and difficulty making decisions •No evidence of psychotic symptoms •Essential feature is a chronically depressed mood for •Most of the day •More days than not •For at least 2 years

dysthymic disorder

involuntary muscle spasms, abnormal postures, oculogyric crisis, torticollis

dystonia

•repeating words that are heard

echolalia

•repeating movements that are observed

echopraxia

Coexistence of opposite emotions toward same object, person, or situation

emotional ambivalence

Social maladjustment, shy and withdrawn, poor peer relationships, doing poorly in school, antisocial behavior, antagonistic thoughts and behaviors

first phase of premorbid behavior

appears to be void of emotional tone

flat affect

•Premorbid behavior of the client with schizophrenia can be viewed in______ phases.

four

Failing to sleep or fall asleep for more than one night in a row

global insomnia

false sensory perceptions not associated with real external stimuli

hallucinations

What does Olanzapine (Zyprexa) do for patients with anorexia nervosa?

has an affect on body image distortions

Pattern of excessive emotionality and attention seeking Uncomfortable if not center of attention Sexually seductive or provocative bx Shallow expression of emotion Uses physical appearance to draw attention to self Speech excessively impressionistic Self-dramatization, theatrical Easily influenced by others or circumstances Considers relationships to be more intimate than they actually are Overreacting to minor events Numerous marriages or sexual relationships

histrionic personality

sustained attention to external stimulus as if expecting something important of frightening to hapepn

hypervigilance

•Mood: cheerful and expansive •Cognition and perception: self-exultation; easily distracted •Activity and behavior: increased motor activity; extroverted; superficial

hypomania

Symptoms not sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization

hypomania (stage I)

•Action: uncertain, crosses cell membranes, altering sodium transport, not protein bound

lithium

•Monitor creatinine concentrations, thyroid hormones, and CBC every 6 months. • Kidney damage may be a risk. •Thyroid function may be altered usually after 6-18 months. Observe for dry skin, constipation, bradycardia, hair loss, cold intolerance. •Avoid during pregnancy •Ensure that client consumes adequate sodium and fluid in diet

lithium carbonate

•Initial symptoms of toxicity include •Blurred vision, ataxia, tinnitus, persistent nausea and vomiting, and severe diarrhea can progress to coma and death)

lithium toxicity

ideas that one's thought or behaviors have control over specific situations (thought broadcasting and thought insertion)

magical thinking

•after the condition has stabilized, the patient focuses on regaining the previous level of functioning and quality of life (note: no medication has ever cured schizophrenia)

maintenance and recovery period

a severe level of depression

major depressive disorder

•Characterized by depressed mood •Loses interest or pleasure in usual activities •Social and occupational functioning impaired for at least 2 weeks •No history of manic behavior •Cannot be attributed to use of substances or a general medical condition •Can be with or without psychotic symptoms

major depressive disorder

•criteria for both manic and depressive episodes met

mixed episodes

•Indications •Depression with personality disorders, panic, or social phobia •Side Effects •hypertensive crisis/interaction with food •sudden, severe pounding or explosive headache •Anticholinergic •Elderly - sensitive to orthostatic hypotension •Sexual dysfunction

monamine oxidase inhibitors

This medication category inhibits the enzyme responsible for the metabolism of serotonin, dopamine, norepinephrine, and tyramine

monamine oxidase inhibitors (MAOIs)

•Valporate and derivatives (divalproex sodium - Depakote) •Carbamazapine (Tegretol) •Gabapentin (Neurontin) (least side effects) •Lamotrigine (Lamictal) •Topiramate (Topamax)

mood stabilizers: antimania anticonvulsants

Monitor for side effects of anticonvulsants •Nausea and vomiting •Drowsiness; dizziness •Blood dyscrasias •Prolonged bleeding time (with valproic acid) •Risk of severe rash (with lamotrigine) •Decreased efficacy of oral contraceptives (with topiramate)

mood-stabilizing agents

•The uniqueness and individuality a person feels

sense of self

Symptoms of this include mental status changes, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, and diarrhea (serious side effect)

serotonin syndrome

•Affective: Feelings of total despair, worthlessness, flat affect, apathy, anhedonia •Behavioral: Psychomotor retardation, curled-up position, no interaction with others •Cognitive: Prevalent delusional thinking, with delusions of persecution and somatic delusions; unable to concentrate; confusion •Physiological: A general slow-down of the entire body, anorexia, insomnia, feels worse early in morning and somewhat better as the day progresses

severe depression or major depression

•after the initial diagnosis and the initial treatment, focus is on the stabilization of symptoms

stabilization period

is a person thinking of self-harm

suicidal ideation

the order of risk for this is whites, native americans, african americans

suicide

women attempt this more, while men have more success

suicide

all are willful, self-inflicted, life-threatening attempts that have not led to death

suicide attempts

The intentional ending of one's own life

suicide or completed suicide

•: inability to get to the point of communication due to introduction of many new topics

tangentially

•Irregular, repetitive involuntary movements of mouth, face, and tongue, including chewing, tongue protrusion, lip smacking, puckering of the lips, and rapid eye blinking. Abnormal finger movements are common.

tardive dyskinesia

___ regulates the body's ability to recognize when it is hungry, when it is not hungry, and when it has be sated

the hypothalamus

•In the active phase of the disorder, psychotic symptoms are prominent • Delusions • Hallucinations • Impairment in work, social relations, and self-care Changes in thoughts and behaviors become so disruptive that they can no longer be ignored.

third phase of premorbid behavior-Schizophrenia (acute illness period)

What is anxiolytics use in mania?

treatment-resistant mania psychomotor agitation

How many women are affected by bulimia nervosa?

up to 4%

passive yielding of all movable parts of the body to any effort made at placing them in certain positions

wavy flexibility