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mental health > week 3 > Flashcards

week 3 Flashcards

1
Q

Are men or women more likely to self medicate? (ex: substance abuse etc)

A

men

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2
Q

Is depression considered a normal part of aging?

A

No

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3
Q

What causes depression?

A

triggers
genetics
biochemical
learned helplessness
cultural

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4
Q

Explain the “learned helplessness” phenomena

A

anxiousness or so many overwhelming factors that eventually turns into “well, I don’t even care anymore”.

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5
Q

What are the two kinds of depressive disorders learned in class?

A
  1. major depressive disorder
  2. persistent depressive disorder
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6
Q

What “state” is someone in when they have major depressive disorder?

A

constant state of unhappiness

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7
Q

What is a KEY feature of someone with Major depressive disorder?

A

loss of pleasure or not interested in things they used to enjoy

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8
Q

What are symptoms of Major Depressive Disorder?

A
  1. guilt
  2. appetite changes
  3. suicidal thoughts
  4. psychomotor retardation
  5. interest lost
    concentration diminished
  6. energy decreased
  7. Sleep disturbance (includes insomnia or hypersomnia)
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9
Q

What are symptoms of persistent depressive disorder?

A
  1. Hard to distinguish between person’s usual pattern of functioning
  2. daytime fatigue
  3. irritable
  4. able to function but not optimally
  5. eating too much or too little
  6. pessimistic thinking
  7. low self-esteem
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10
Q

What are two medical diagnoses that can mimic depression symptoms?

A
  1. vitamin D deficiency
  2. HYPOthyroidism
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11
Q

What are things you will look for in an assessment on a pt with depression?

A
  1. physical exam
  2. recognizing the common symptoms
  3. depression scale
  4. hx of previous episodes and coping skills
  5. support systems
  6. cultural factors
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12
Q

what are common symptoms to look for in a pt with depression?

A
  1. mood and affect
  2. cognition and thought content
  3. physical changes
  4. suicide and homicide assessment
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13
Q

What 3 questions do you ask in a suicide assessment?

A
  1. Do you have thoughts on harming yourself?
  2. what is your plan
  3. determine if they have the means to carry out that plan
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14
Q

what is the main difference between a suicide assessment and a homicide assessment?

A

Is there is a specific target they want to harm or anyone who walks into the room

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15
Q

What is the depression scale called?

A

PHQ-9

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16
Q

How is the PHQ-9 useful?

A

is not used to diagnose someone with depression but refer the pt to somewhere else for further eval

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17
Q

What is ALWAYS the priority for someone with depression?

A

safety safety safety

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18
Q

what therapeutic technique works BEST for someone who is depressed?

A

therapeutic silence

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19
Q

What are the interdisciplinary treatments for depression?

A
  1. milieu therapy
  2. psychotherapy
  3. mindefullness-based cognitive therapy
  4. group therapy
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20
Q

What is the first line of treatment?

A

CBT: cognitive behavior therapy

modifies any dysfunctional thoughts

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21
Q

what is mindfulness-based cognitive therapy

A

a form of CBT that is basically meditation

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22
Q

What are the different types of antidepressants?

A

SSRIs
SNRIs
Trazadone
TCAs
MAOIs
Buproprion

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23
Q

When it comes to antidepressants, they have black box warning that there is an increased risk of suicide when taking the medication, why?

A

antidepressants target mood symptoms and do not target suicidal ideation. SO if the pt has a changed mood and they have more energy they will have the energy to carry out that suicide.

INCREASED RISK OF SUICIDE

you want to make sure that when someone starts an antidepressant that you’re checking up on them

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24
Q

List the 5 SSRIs

A
  1. Citalopram
  2. Escitalopram
  3. Fluoxetine
  4. Paroxetine
  5. Sertraline
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25
Q

What are SSRIs useful for treatment in?

A
  1. Depression with anxiety
  2. Panic disorder
  3. PTSD
  4. OCD
  5. Bulimia
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26
Q

What are the side effects of SSRIs?

A
  1. Sleep disturbance
  2. Sexual dysfunction
  3. Tension headaches
  4. Reduced appetite
  5. hyponatremia (Headache is a sign of hyponatremia)
  6. Rash/SJS
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27
Q

How long does it take SSRIs to take FULL effect?

A

2-3 WEEKS for full effect

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28
Q

What does SSRI stand for and how does it work?

A

Selective Serotonin Re-uptake inhibitor

Prohibits the re-uptake of serotonin so there’s more serotonin available in the brain

**the higher the dose the higher risk there are for Serotonin Syndrome **

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29
Q

Signs of Serotonin Syndrome

hint SHIVERS

A
  1. S shivering
  2. H hyperreflexia
  3. I increased temp
  4. VS vital sign instability
  5. E Encephalopathy
  6. R restlessness
  7. S Sweating
  8. Abdominal pain
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30
Q

Why would you NOT want to give two antidepressants at the same time?

A

increased risk for serotonin syndrome

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31
Q

If a pt with ulcers or a GI bleed is taking antidepressants what are they at risk for?

A

higher risk for another GI bleed

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32
Q

What medication do you NOT want to give SSRIs with?

A

warfarin!

because of the increased bleeding tendencies

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33
Q

What are the 4 SNRIs?

A
  1. Venlafaxine
  2. Desvenlafaxine
  3. Duloxetine
  4. Levomilnacipran
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34
Q

What do SNRIs inhibit?

A

serotonin and norepinephrine

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35
Q

SNRIs are useful in treatment of what disorders?

A

Major depressive disorder and anxiety disorder

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36
Q

What is trazodone usually prescribed for?

A

Trazodone is usually prescribed for sleep, but it is classified as an anti-depressant.

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37
Q

Can trazodone be given with SSRIs?

A

yes but mostly targets sleep

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38
Q

What does trazodone block? What should be be mindful of when giving someone trazodone?

A

it blocks serotonin so we want to be mindful in looking for symptoms of serotonin syndrome

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39
Q

What is an adverse effect of trazodone?

A

Priaprism

painful erect dickkkkk

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40
Q

What are the 4 Tricyclics? (TCAs)

A
  1. Amitriptyline
  2. Doxepin
  3. Imipramine
  4. Nortriptyline
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41
Q

How long does it take for TCAs to take FULL effect?

A

4-8 weeks

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42
Q

What anticholinergic side effects do TCAs have?

A
  1. Dry mouth
  2. Blurred vision
  3. Tachycardia
  4. Constipation
  5. Urinary retention
  6. Esophageal reflux
  7. Photophobia
  8. Sexual dysfunction
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43
Q

What anticholinergic effects of TCAs is considered a medical emergency while taking this medication?

A

Constipation
Urinary retention

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44
Q

Which medication is known to be very cardiotoxic?

A

Tricyclics (TCAs)

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45
Q

Is it easy to overdose on Tricyclics (TCAs)?

A

YUH

46
Q

What medication is given for someone going through physician assisted suicide? Why?

A

Amitriptyline

This medication causes those dysrhythmias , that’s why its easy to overdose on

47
Q

What are adverse effects of Tricyclics? (TCAs)

A
  1. Orthostatic hypotension
  2. Dysrhythmias
  3. Myocardial infarction
  4. Heart block
48
Q

If someone has a seizure disorder and given TCAs, would you want to increase or decrease their dosage of their seizure medication? Why?

A

Increase because they are at higher risk for seizures when using TCAs

49
Q

What are the contraindications for TCAs?

A
  1. Recent MI
  2. Narrow-angle glaucoma
  3. BPH
  4. Seizures
  5. Preggo
50
Q

What are MAOIs?

A

Monamine Oxidase Inhibitors

51
Q

What are the 4 kinds of MAOIs?

A
  1. Phenelzine
  2. Tranylcypromine
  3. Isocarboxazid
  4. Selegiline
52
Q

What is one known side effect of MAOIs?

A

HTN Crisis

53
Q

What are the sign of a HTN crisis?

A
  1. Severe HA or blurry vision
  2. Chest pain
  3. Tachycardia
  4. SOB
  5. Diaphoresis
  6. Anxiety
  7. Mental status change
  8. Confusion
  9. N/V
54
Q

If someone is taking an SSRI and the doctor wants to switch them to an MAOI, what should the nurse be mindful of? Why?

A

There needs to be a 2-5 week wash out period before they can take a MAOI because of the increased risk of serotonin syndrome and HTN crisis

55
Q

What antidepressant medication class inhibits the breakdown of Tyramine?

A

MAOIs

56
Q

What are some tyramine foods to avoid?

A
  1. Avocados, figs
  2. Fermented, smoked, cured meats and fish
  3. bologna, pepperoni, salami
  4. almost all cheeses
  5. Yeast extract
  6. Some beers (No tap just can)
  7. Protein supps
  8. shrimp paste, soy sauce

no Chinese food, no red wine but they can have white wine, and no ripe bananas :)

57
Q

Why should pts avoid tyramine rich foods when taking a MAOI?

A

It can cause HTN crisis so always check their BP

58
Q

What are some contraindications of MAOIs

A
  1. CVD
  2. HTN
  3. CHF
  4. Liver disease
  5. recurrent or severe headaches
  6. Recent surgery
59
Q

What is Buproprion given for?

A
  1. Depression
  2. Smoking cessation
  3. Prevention of seasonal pattern depression

mostly just smoking cessation

60
Q

What are some adverse effects of Buproprion?

A
  1. Appetite suppression
  2. Seizures
61
Q

Why would you not want to give Buproprion to someone with an eating disorder?

A

Because one of the adverse effects is appetite suppression.

62
Q

What are two differences between antidepressants and ketamine?

A

Anti-depressants DO NOT target suicidal ideation buuuuut Ketamine DOES!

Ketamine is quick acting and antidepressants take a few weeks

63
Q

What specifically does ketamine target?

A

Suicidal Ideation

64
Q

How can Ketamine be given? Is it just one treatment or multiple?

A

IV or Nasal spray

It wears off after a couple of days so pts have to go in for regular treatments

65
Q

What are some side effects of Ketamine?

A
  1. Increased BP/HR
  2. Dissociation

Pts will experience withdrawal symptoms

66
Q

What are some alternative treatments for depression?

A

Light therapy
St. Johns Wort

67
Q

If someone is prescribed an SSRI, what herbal substance would you want to assess for? Why?

A

St Johns Wort

this interacts with SSRIs and can lead to serotonin syndrome

68
Q

What is electroconvulsive therapy used for?

A
  1. Major Depressive disorder
  2. Schizo
  3. Acute mania
69
Q

At what point would you use electroconvulsive therapy?

A

Last resort, when all medication options have been exhausted

70
Q

What medications are given when someone is receiving ECT? Why?

A
  1. Atropine: To prevent aspiration. when seizing
  2. Propophal: to sedate
  3. Succinylcholine: muscle relaxant
71
Q

What are some known side effects of ECT?

A
  1. Confusion
  2. Memory loss
72
Q

Why is ECT not an option for someone with a CVD or hx of stroke?

A

it puts a lot of strain on the heart

73
Q

What are some examples of Brain stimulation therapies?

A
  1. Vagus nerve stimulation
  2. Transcranial Magnetic stimulation
  3. Deep brain stimulation
74
Q

What would be considered a big outcome in a evaluation?

A

Safety!!!!
Absence of suicidal thoughts

75
Q

A client is prescribed an SSRI for depression. The client asks the nurse when should they expect to notice an improvement of their symptoms?

A.You should notice a significant improvement in 1-2 weeks of starting your medication.
B. It may take up to 6 weeks of consistent use for it to reach its full effect.
C. You should feel better after just a few days of taking the medication.
D. The improvement usually varies from person to person but it usually happens within 24 hours.

A

B. It may take up to 6 weeks of consistent use for it to reach its full effect.

76
Q

What can anxiety increase the risk for?

A
  1. Cardiovascular complications
  2. reduced immunity
  3. IBS
  4. increased risk of cancer
77
Q

What is behavioral theory?

A

Anxiety is learned but can also be unlearned

if we see someone is afraid of spiders, were going to be afraid of them too

78
Q

What is cognitive theory?

A

where we tend to have assumptions of the world and they lead to cognitive distortions or negative perceptions and these distortions lead to anxiety

79
Q

What is the difference between fear and anxiety?

A

Same feeling of uneasiness or uncertainty BUT for fear there is an actual danger in front of you

80
Q

What are the three types of anxiety

A

Normal
Acute
Pathological

81
Q

Why is normal anxiety necessary for survival?

A

It’s this energy force that makes us carry out tasks MOTIVATION

82
Q

What is acute anxiety?

A

Something that threatens your sense of security

usually something that’s triggered by a stressor

83
Q

what is pathological anxiety?

A

an emotional response that is out of proportion to a threat.

Some thing happens and their response is veryyyyy overdramatic

84
Q

What are the four different LEVELS of anxiety?

A

mild
moderate
severe
panic

85
Q

What does each level of anxiety have a difference in?

A
  1. Perceptual field (How can they view the world around them)
  2. Ability to learn (Can they follow directions
  3. Physical charactersitics
86
Q

What are specific characteristics of mild anxiety?

A

They can take in all the information that’s going on around them BUT

they may be restless. mildly irritable, nail biting

87
Q

What are some specific characteristics of moderate anxiety?

A

They have selective attention, can learn but altered ability

88
Q

What are the Physical characteristics of moderate anxiety?

A
  1. tension
  2. pounding heart
  3. increased RR,HR
  4. Somatic symptoms
  5. voice tremors
89
Q

What are some characteristics of severe anxiety?

A

They are unable to learn, feel threatened, and can’t take in any information from their external environment

90
Q

what are some physical characteristics of severe anxiety?

A
  1. Automatic behavior: they randomly start taking their clothes off (irrational behavior)
  2. Severe somatic symptoms: they feel like their having a heart attack
  3. sense of dread
91
Q

Why is panic considered an extension of severe anxiety?

A

They experience the same characteristics as severe, however they experience more PSYCHOTIC type of behavior.

Psycho form of severe anxiety

completely out of touch of reality

92
Q

As the levels of anxiety go UP…

A

Cognition goes DOWNNN

can’t think straight

93
Q

Describe a panic disorder

A

Unexpected and come out of no where (no trigger)

can last up to 30 min

94
Q

What are some physical symptoms of a panic disorder?

A

heart palpitations
hyperventilation
hot flashes

ALWAYS RULE OUT MEDICAL BEFORE ASSUMING ITS A PANIC ATTACK

95
Q

What medication class would be great for acute anxiety attacks?

A

Benzodiazepines

96
Q

Are medications effective for phobias?

A

NAUR

97
Q

What is someone afraid of when they have social anxiety disorder?

A

being evaluated or humiliated

98
Q

In order to have agoraphobia you have to have at least TWO of these phobias

A
  1. fear of using public transport
  2. Fear of being in open/closed spaces
  3. standing in line
99
Q

What are those with OCD at high risk for?

A

suicide

100
Q

Define sublimation

A

ex: somebody who has an urge to kill people becomes a butcher

They do something that is acceptable to hide unacceptable feelings

101
Q

Define displacement

A

when a person transfers emotions from one person to another person

Take you anger out on someone else

102
Q

Define undoing

A

performing an action to makeup for something

103
Q

Specificities of antidepressants

A
  1. increase risk for suicide
  2. must be tapered down
  3. long term tx
104
Q

What are 3 benzodiazepines?

A

Lorazepam
Clonazepam
Alprazolam

105
Q

What are the specificities of benzos?

A
  1. short term tx
  2. highly addictive
  3. PRN BASIS
  4. withdrawal symptoms
106
Q

What are the side effects of benzos?

A
  1. Amnesia
  2. Impaired judgment don’t drive
  3. ANTIDOTE: FLUMAZENIL
  4. long term use can lead to dementia
  5. has a paradoxical effect (its supposed to calm pt but instead it makes them agitated)
107
Q

What are the two antihistamines?

A
  1. Diphenhydramine
  2. Hydroxyzine
108
Q

What disorder benefits the best with usage of antihistamines?

A

substance use disorder because its the alternative for benzos

109
Q

Specificities of Busprione

A
  1. Non addictive
  2. long term tx
  3. 2-4 weeks for it to be effective
  4. not for acute anxiety
  5. Risk for serotonin syndrome
  6. High risk for falls due to orthostatic hypotension
  7. Can cause delirium in older adults
110
Q

What are three anticonvulsants?

A

Valproic acid
Gabapentin
Pregabalin

111
Q

What are anticonvulsants used for?

A
  1. GAD
  2. Social anxiety
  3. Panic attacks
112
Q

What are some examples of easily accessible meds?

A
  1. Kava kava: causes hepatotoxicity
  2. Valerian: effective on insomnia
  3. Lavender oil
  4. St. Johns Wort: not effective for anxiety

mental health (14 decks)

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