3320 Flashcards
(283 cards)
1
Q
Students come into nursing with mental health concern experience
Students belive they are in recovery
Nursing school threatens recovery
Nursing students with mental health feel advantaged
A
Findings
2
Q
12 determinations of health
A
Income/status Social support Education Working condition Social environment Physical environment Coping/personal health Healthy child develop Bio/genetic Services Gender Culture
3
Q
Recovery CHIME
A
Connectedness Hope and optimism Identity Meaning Empowerment
4
Q
Mental health definition
A
“a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”
Not just absence of disease
5
Q
Mental health and illness are…
A
Relative concepts
6
Q
A person is mentally healthy when they
A
Meet basic needs Assume responsibility for behavior and self growth Learned to integrate thoughts, feelings, actions Can resolve conflicts Maintain relationships Communicate Respect others Adapts to change
7
Q
Incidence - new cases
Prevelance - total cases
A
Note
8
Q
Promote / prevent Recovery / rights Access to services Disparities / diversity First nation's Lead / collab
A
2009 health commission directives
9
Q
APA definition of mental disorder
A
A clinically significant behavior in an individual that results in distress or disability woth an increased risk for suffering death, pain or loss of freedom
Not an expected response go a loss such as death of a loved one
10
Q
Healthy
Reacting
Injured
Ill
A
Model #1
Mental health continuum model
11
Q
Nature vs nurture
A
Germ theory (something in environ) Lead to isolating affected
12
Q
Psychological ocus in 1952 due to
A
Calming effects of chlorpromazine
13
Q
Mental health continuum
A
Mental illness refers to disorders diagnose able by DSM-5
Subjective feeling of well being can exist within health and illness
14
Q
Individual group and environment factors that work together effectively ensuring subjective well being, optimal development and use of mental abilities achievements of goals
A
Optimal mental health
15
Q
Individual group and environmental factors that conflict producing subjective distress; impairment or underdevelopement of mental ability, failure to achieve goals, destructive behavior
A
Minimal mental health
16
Q
Optimal health
Minimum health
Absence of MD
Presence of MD
A
Model #2
17
Q
First highlighted important of mental health
A
EPP report 1988
Framework created in 2009
18
Q
Genetic predisposition
Stress
A
Dicthesis stress model
19
Q
4 quadrants
Optimal mental ———-poor mental
Serious illness————no illness
1) max MHD, optimal MH
2) no MHD, optional MH
3) no MHD, min MH
4) max MHD, Min MH (mostly BPD)
A
Flourishing and languishing mental health models (Corey keyes)
20
Q
Process/outcome of complex cultural systems not independent. Capacity to overcome adversity
Not unaffected my stressors
A
Resilience
21
Q
Mental health is defined my culture and determined my social norms
A
Note
22
Q
Feeling good
Low functioning
A
Settling
23
Q
Feeling good
Functioning well
A
Flourishing
24
Q
Not feeling good
Low functioning
A
Languishing
25
Not feeling good
| Functioning
Striving
26
Nervous affection (usually woman) where emotion and reflex are exaggerated leads to loss of control
Helped with sexual outlets
Thought to be caused by sexual deprivation
Hysteria
27
Adverse factors
- Low self esteem
- Cognitive/emotional immaturity
- Difficulty communicating
- Medical illness/ substance use
Protective factors
- self esteem
- problem Solving/ stress management
- communication skills
- physical health
Individual attributes
28
Adverse factors
- loneliness/bereavement
- neglect/family conflict
- exposure to violence
- low income
- difficult schooling
- work stress
- no services
Protective factors
- social support
- good parenting
- physical security
- economic security
- school achievement
- success at work
- basic services
Social circumstances
29
Adverse factors
- injustice/discrimination
- social and gender inequality
- war or disaster
Protective factors
- social justice
- equality
- physical security
Environmental factors
30
Do we need to diagnose to help mental health
No
31
Dsm 5
Classifies disorders not people
| Also international classification of disease ICD
32
Mental health affects all
20% will experience a personal concern at some point
33 3% with experience a concern
Canadian stats
33
10-20% affected (most disabling group)
5% male 12% female (12-19) experienced MDD
3.2 million (12-19)
Suicide third highest 4,000 die prematurely
Second highest hospital expenses
1/5 received care
Youth stats
34
5mill use services every year
Woman 25-39 most often
1/4 over 80 overuse
Largest increase 10-14
Boys under 18 more likely
More stats
35
Primitive society
Shamans
36
Medieval (middle ages) 5th - 15th century
Western Europe religion dictated
Demonic possession
Inhuman so immune to human discomfort
37
Early civilization
Severe mental illness from disordered physiological condition
Major faith traditions (Christian, Judaism, Islam, Hinduism, Buddhism
38
First Asylums
8th century middle east society with first asylums compassionate peaceful environment
39
Renaissance 1400-1700
Bedlam
40
18th -19th custodial care
Assistance with adls
41
Dorothea dix
Advocate for improved care in public
42
First asylum in canada
Beauport
43
Salpetriere asylum (France)
Philipe pinel (1802) (Moral therapy)
Asylems could cure madness
44
What are asylems
Retreats from society with early intervention and lots of rest would cure
45
19th C
```
Alcohol sedatives
Blood worms
Pinning (spin in chair)
Hydrotherapy (forced baths)
Insulin shock (comas)
```
Mid 20th
ECT
Lobotomy
Treatment
46
Holistic
Individual lost equilibrium with cosmos
Healing at community level
Aboriginal
47
```
Colonialism caused more asylems
Demonic possession (bloodletting, purging, restore humours)
```
Canada
48
1878 William wundt
```
Talk therapy
Psychoanalysis
Behaviorist
Cognitive science
Radical therapy (ECT, insulin, lobotomy)
```
49
```
1950 chlorpromazine
1955 meprobamate (miltown)
1960 choriozepoxide (first anti psychotic)
```
20th psychopharmacology
50
Nurse pt relationship
Empathetic linkage
Self system (from sulluvans work)
The self is an anxiety system (bio needs from sociocultural)
Nurses help identify needs
Hildegard Peplau (1909-1999)
51
Weir report - change Nursing environ
Nurses and deinstitutionalization
Note
52
```
Lived experience
Value voice
Respect language
Curiosity
Personal wisdom
Transparent
Tools that worked
Time used
Change is constant
```
Phil Baker Todal Model
53
Acculturizstion - adopting new beliefs
Somatizations- distress from physical problems
Note
54
Involuntary admission
Suffering from mental
Harm to self or others
Unsuitable as formal pt
A person unfit to stand trial may be detailed in mental facilities
55
Mental health act (under 16)
Informal pt (need consent from other to get tx)
Substitute decision maker
Not mentally capable of consent
56
Application by physician for psychological assessment
Holding for 72h
Must be seen within 7days before form
Form 1
57
Order of exam
Filled by justice of peace (anyone)
Detection long enough for exam
Form 2
58
Certificate of involuntary admission
Filled by physician
72h from start of detention under form 1
Valid for 2wk
Can contest
Form 3
59
Certificate of renewal
Filled my physician
Before expiration of form 3 or 4
Valid for 30, 60, 90 days
Form 4
60
Involuntary to voluntary
By physician
Whenever
No expiration or renewal
Form 5
61
Order to return
By officer in charge of facilities
Whenever absence becomes known
Expires 1month after becomes known
Form 9
62
Certificate of incompetence
Notice to pt
Physician must inform rights advisor
Form 30
63
Notice to person
Signed by physician
Given when detained under form 1
Form 42
64
Mental health legislation reform
Memory of brain Smith
Provide for early intervention
Community tx orders and new criteria for involuntary admission
Brian's law (2000) bill 68
65
Community tx orders
For serious reoccurring
Plan of community less restrictive care
Expire 6mo after made
Form 45
66
Right to less restricted care (restraints
Rights to confidentiality
- duty to warn
- duty to protect
- reporting abuse
- confidentiality of communicable diseases
- confidentiality after death
Patient rights under law
67
Elements of providing culturally sensitive care
Establish common goals
- culture preservation
- accommodation (re-patterning)
Self reflection
Cultural knowledge
Facilitate client choice
Communication
68
Historical trauma
Transmission
PTSD of a nation of people
"Cumulative emotional wounding across generations from massive tragedy"
69
Residential school
1870-1950 full scale operation remained open until 1990
Ages 5-15
Denied language, culture
70
Sixties scoop
Important for NSG: high suicide rate
1940s - advocacy for care of aboriginal
1951 - indiact act revised for child welfare
1960 - 1980 : aboriginal taken placed in adoption
71
Stigma
Mark of disgrace
Epidemiological paradox
- must raise profile of suffering for help
- perpetuates racist stereotypes
72
Treating intergenerational trauma
Use story telling to instill trust
Uncover contextual ways of
- explaining the world
- explaining how and why good and bad things happen (social Det, cultural teaching)
73
Nurse client relationship
Safe, confidential, reliable, consistent
Clear boundaries
74
Social relationship vs therapeutic
Social for friendship, socialization, mutual needs met
Therapeutic focus on pt, personal insight outcome. Nurses needs met outside
75
Goal and function of nurse pt relationship
Facilitate communication of distressing thought
Assist pt with problem solving
Help pt examine self defeating behavior and find alternatives
Promote self care and independence
76
Nurse pt relationship (Peplau)
Orientation: get to know eachother, develops trust (minutes - months)
The working phase: pt examines their difficulty and learns new ways of approaching them
Termination phase: from when issue is resolved to end of relationship (discharge)
77
CNO
Trust - fragile
Professional intimacy
Power - unequal
Respect
78
Boundaries
Personal space
Location and service of delivery
TX planning and delivery
No friendship etc
Can have relationship one year IF
- would not have negative impact on pt for future
- not based on trust and professional intimacy
79
Blurring boundaries
Slips into social context
Nurses needs and met by pt
80
Blurring of roles
Boredom, rescue, overinvolved, overidentify, misuse honesty, anger, help/hopelessness
Transference- client displaces onto nurse feelings and behavior related to past
Conterferance- vice versa
81
Factors that encouraxe client growth and empowerment
Genuine
Empathy
Attending
Suspending judgement
Help develop reasourses
Positive regard - attitudes, actions
82
RNAO client centered care beliefs
Respect
Human dignity
Pt expert of own life
Clients as leaders
Pt goals coordinate care
83
Problem focused approach vs solution focused
Past - future
What's wrong - was right
Blame - progress
Control - influence
Expert knows best - collab
Deficits - resources
Complications - simplicity
Definition - actions
84
Solution focused is strength based
All persons gave strengths
Respect strengths
Motivation increase by focusing on strengths
Focus on helping process
(Not dx, deficits, symptoms, weakness)
Help relationship - collab, mutually
Each person responsible for recovery
85
5 primary intervention questions
Exceptions questions
Miracle questions
Scaling questions
Relationship questions
Coping questions
86
MSE
Systematic assesment
Reflects observations
Finding subjective
87
MSE ASEPTIC
```
Appearance
Speech
Emotion
Perception
Thoughts
Cognition
```
88
Mental hygiene
Science of establishment and maintenance of health
No official health recommendations for mental health
89
Default mode network
Medial prefrontal cortex to posterior cingulate cortex
More active at rest (task negative)
Mind wandering
90
Task positive network
Attention network
Lateral prefrontal cortex to insula to posterior parietal
91
Cognitive patterns with DMN (default mode network)
Rumination
Self referential (internal narrative)
Mind wandering
Non practical past / future thought
92
Hyperconnectivity of DMN associated with
```
MDD
Anxiety
PTSD
OCD
phobias
Stress
```
93
DMN and happiness
Inversely related
Higher quality of life = decreased connectivity
More resilient
94
TPN (task positive network)
Central executive
Goal orientated activity
Associated with focus state
95
Dominance of DMN over TPN
Associated with depressive states
96
Decrease DMN
```
Mental training
Mindfulness
Meditation
Mental excersise
Journaling
Breathing
Nature
Tasanama chant
```
97
Kirwan Kriya chant
Evidence based
Non symbolic sounds (TA-SA-NA-MA)
Chanting, finger touching, visualize (top of head out)
Decreased intensity then increased to normal
98
Think thought not about
About (worrying, wandering, no solution, distraction)
Through (reflection, concentration, solution, clear and relaxed mind)
99
Coordinated breathing and walking
3 in 4 out
100
```
treat based off diagnosis
balance risk and benefit
treat symptoms
monitoring
compliance
concurrent disorders
social, interpersonal and personality disorders
history of medication use
```
principles of psychopharm
101
not compliance due to
stigma, denial, side effects, delayed onset, cognition, cost, misinformation
102
medications effect serotonin and NE, some dopamine
clinical response delay of several weeks
all effective depends of mechanism of action and side effects
treating depression
onset: initial response 1-2wk (increased apatite, sleep and energy)
peak response: 6-8wk up to 12 (mood, interest)
103
1987 - fluoxetine (Prozac)
MOA: blocks serotonin reuptake
SE: nausea, diarrhea, anxiety, headache, insomnia, sweating
SSRI
for MDD, BPD, PTSD, OCD, PMS, bulimia, smoking cessation
104
SSRI and sexual dysfucntion
decreased libido, anorgasmia, vaginal dryness, ED, delayed erection
m>w
tx: reduce dose, change to non serotonergic (bupropin, mitazapine)
105
SSRI discontinuation syndrome
with abrupt stop, depends on medication half-life
flu like, insomnia, n/v/d, imbalance, sensory electric shock sensation, hyperarousal
taper slowly
106
Serotonin syndrome (life threatening)
```
discontinue medication, address myoclonus
BP control (propranolol, lorazepam)
```
delirium, agitation, fever, sweating, myoclonus, hyperflexia, tremor, HT, diahhrea, incoordination
107
SNRI (serotonin NE) uses
MDD, anxiety, fibromyalgia, OCD, chronic fatigue, hot flashes, migraine, tension headaches
108
SNRI side effects
dose increase and HT
serotonin syndrome
discontinuation syndrome
109
SNRI venlafaxine (effexor)
```
small dose (serotonin)
med dose (NE)
high dose (dopamine)
```
110
NDRI (NE, dopamine) uses
MDD, BPD, smoking cessation, SAD, chronic fatigue, ADHD, sexual dysfunction
111
NDRI side effects
headache, agitation, seizures, sleep disturbance, decreased apatite/weight loss, sweating
112
NaSSA (Noradrenaline serotonin specific) uses
MOA: increases NE/A and serotonin
MDD, insomnia, weight loss, anxiety, sedative lower dose (tolerance builds)
113
NaSSA side effects
rare: serotonin syndrome, SIADH, hepatoxicity
weight gain
anticholinergic (constipation, urinary retention, dry mouth, blurred vision, drowsy, tachy)
take at bedtime
114
TCA (tricyclic ad) uses
MOA: block NE and 5-HT reuptake
depression, anxiety, pain, migraine, PTSD
115
TCA side effects
narrow therapeutic index
```
weight gain (blocks histamine)
sedation (blocks histamine)
dizziness (alpha-adrenergic)
orthostatic HT (alpha-adrenergic)
anticholinergic (muscarinic)
cardiac conduction (NA)
```
116
Anticholinergic Effects
red as beet, dry as bone, blind as bat, mad as hatter, hot as hare, bowel and bladder lose tone, heart goes off alone
warm skin, dry mouth, blurred vision, confusion, fever, drowsy, urinary retention, constipation, sinus tachy
ice, candy, increase fluids, laxatives, tears, pilocarpine eye drops, shower daily, talcum powder
117
MAOI
Monoamine oxidase breaks down hormones (5-HT, NE, DA)
originally tb med found to decrease depression
| first antidepressant
118
MAOI special diet
avoid tyramines (aged cheese, wine, beer)
119
MAOI side effects
weight gain (orthostatic HT, edema)
rare: SS, HT crisis, teratogenicity
HT crisis- NE not broken down increase BP
120
limitations of MAOI and TCA
delay up to 10days
toxic (5-10 therapeutic range)
adverse effects "dumb bomb"
watch for added effects of tramodol, meperidine, dextro
121
SARI (trazodone) (serotonin antagonist and reuptake) uses
150mg/day depression
below 150 sedative
not used for PTSD much
122
suicide and antidepressants
make more agitated, restless
| more likely to commit suicide
123
Mood stabilizers
```
lithium
valporic acid
lamotrigine
carbamazepine
oxcarbazepine
topimate
```
124
BPD
lithium (toxicity with no sodium diet)
narrow therapeutic (0.8-1.4)
polyuria, goiter
125
Lithium side effects
tremors, hypothyroid, weight gain, GI, increased thirst, lethargy
126
lithium toxicity
tremor, ataxia, confusion, n/v/d, arrhythmia, poly urea/dipsia, edema, goiter, hypothyroidism, myoclonus, hyperflexia, coma, seizures
127
valproic acid uses and side effects
BPD, epilepsy, migraine
sedation, tremor, acne, blood dyscrasias, elevated ammonia, mensural irregularities
128
Lamotrigine uses and side effects
BPD, epilepsy, neuropathic pain
rash, ataxia, cognitive slow, sleep disturbance
129
antipsychotics uses and MOA
schizophrenia, manic, depression, short term dementia
```
blocks DA (all)
blocks serotonin (atypical)
```
130
haldol
loxapine
chlorpromazine
long acting injections (flupenthixol, flupehanzine, haldol, zuclopenthixol)
First generation antipsychotics (typical)
older drugs, work well ,cheaper
131
SGA/TGA (second/third atypical)
block D2 and 5-HT
less EPS more FGA
may be more effective for negative effects of schizophrenia
132
SGA/TGA side effects
weight gain, sedation, hyperglycemia, akathisia, dizzy, photosensitive, agranulocytosis (clozapine), seizure (clozapine)
133
Clozapine (first atypical antipsychotic)
side effects: agranulocytosis, myocarditis, seizures, sialorrhea (drool), metabolic syndrome
other: QT long, arrhythmia, sudden death
```
1960
came off because agranulocytosis
for tx resistant
CBC, ECG
must have 2 other trials first
```
134
neuroleptic malignant syndrome
tx: stop meds
fever, rigid, elevated wbc/ck, change in mental status, autonomic instability (HT, tachy)
135
Acute EPS
seen first 3mo
due to blocked DA receptors
parkinsonism (reduce dose, anticholinergic)
dystonia (reduce dose, IM benztropine)
akathisia (reduce dose, propranolol, benzodiazepine)
136
Chronic EPS
tardive dystonia (sustained abn posture)
tardive dyskinesia (usu oral-facial)
- use over 90 days
- cumulative antipsychotics
- increased age
137
sedatives anxiolytics
MOA: binds to GABA
```
short term hypnotic
prevent panic attacks
alcohol withdrawal
mania
agitation
```
138
anxiolytics side effects
confusion, memory decline, drowsy, withdrawal, dizzy, sleep apnea
hostility, disinhibition (esp elderly)
139
stimulants
ADHD, narcolepsy, tx resistant depression
side effects: HT, tachy, insonmia, irritable, headaches, anorexia, child growth slowed
140
stress as kids sensitizes stress in furture
note
141
1920s Walter Cannon
Body responds: sympathetic stimulates adrenals, triggers catecholamines (NE, adrenaline)
Increase HR, BP, RR
Body returns in 20-60min
triggers real or imaginary
acute stress response: fight or flight
142
GAS: general adaptation syndrome
Alarm
resistance
exhaustion
143
human response to prolonged stress feels no control
endocrine and corticosteroids
can cause damage to physical and psychological health
Chronic stress response
144
Coping styles
health sustaining
life satisfaction
social support
healthy responses
145
Role of oxytocin in bonding
increased sensitivity to social cues
if positive/safe (adaptive responses)
if negative/unsafe (distress responses)
146
Stress
response to a threat
from pressures in life. releases adrenaline extended releases can cause anxiety, depression etc
147
Anxiety
reaction to stress
stress after stressor is gone
fear, impending doom, uneasiness, cause known/not
148
Anxiety responses can be
physical
affective (terror, guilt, isolation)
cognitive (flashbacks)
behavioral (restless, inhibition)
149
tensions of daily living, person alert, perceptual field increased
motivated learning, growth, creativity
s/s: restless, irritable, impatient
Relieving: finger tapping, fidgeting
anticipation and mild anxiety
150
focus on immediate concerns, narrowing of perceptual field (hears, sees, grasps less)
voice tremor, concentration, pacing, increase VS, frequency, headache
moderate anxiety
151
significant reduction of perceptual field
focus on specific details and nothing else
all activity to decrease anxiety focus on self, environment blocked out, sense of dread
inability to process, make decisions, purposeless activity, hyperventilate
Severe anxiety
152
sense of terror
unable to do anything
disorganized, no rational thought
unable to communicate or function
terror, dilated pupils, pallor, mute or unintelligent speech, tremors, hallucinations, withdrawal, out of control agitation
Panic
153
Distinguishing Anxiety (3 fields)
perceptual field
ability to learn
physical/other
154
Contructive means to cope
talking
breathing
express feeling
avoid or withdrawal
155
Altruism - dedication to others
Compensation - cover shortcomings
Conversion - anxiety to physical symptom
Denial - Ignore what's happening
identification - associate with a group
introjection - outside world absorbed into self
intellectual - facts not emotion
projection - "what say...what are"
156
Splitting - good or bad
sublimation - mature for immature
suppression - deny feelings
undoing - children, atonement
Displacement - feeling onto others
rationalize - justify with other reasons
reaction formation - anxiety thoughts opposite
regression - simple behaviors
157
repression - block memory
| dissociation - disrupt function
note
158
50% panic
40% GAD
20% phobias
OCD strong link
Anxiety theories: Genetic
159
Anxiety theories: biochemical
amygdala / hippocampus
sensitivity to CO2
GABA, 5-HT, DA, Epi etc
160
Other anxiety theories
```
psychodynamic
interpersonal (family)
behavioral
trauma
medical conditions
```
161
anxious, tension, fear, insomnia, intellecual, depressed, muscular, sensory, CV, respiratory, GI, GU, ANS, behavior
Hamilton anxiety rating scale (0-4)
162
difficult to differentiate from worries
excessive worry for more days than not for 6mo
diagnosis of exclusion
GAD 4%
NSG - relaxation, awareness of stressors, exercise, CBT, ask questions to dispute illogical thinking, sleep hygiene and avoid stimulants at bed time
163
Intervention for GAD
benzodiazepines (no longer because addiction)
SSRI, SSNRI tx of choice
Gabapentin
164
OCD Obsession vs complusions
unwanted thoughts that cause anxiety
behaviors to prevent and release anxiety
165
Intervention for OCD
harm reduction, accept behaviors
Biological: gauge type and severity (open question "how long to get ready")
Psych: thought block, present and ask to refrain, relaxation, cognitive restructure
social: SES, explain routine, assist with schedule, recognize rituals
166
OCD tx
```
CBT
deep brain simulation
SSRI
Venlafaxine (SNRI) less side effects
Clomipramine (TCA)
```
167
reexperiencing
avoidance
numbing
heightened arousal
PTSD 8% normal 20% cars 80% war
from trauma, fatigue, grief, moral injury
168
PTSD tx
psychosocial tx (exposure, coping skills)
SSRI, TCA, antipsychotics, mood stabilizers, service animals
169
similar s/s as PTSD (different duration 1mo)
| dissociative symptoms
acute stress disorder
170
Abrupt peak in minutes
palpations, sweat, tremble, SOB, chest pain, choking, nausea, depersonalization, derealization
depression and substance use
genetics
Panic disorders
can lead to phobias
171
NSG assessment panic disorder
determine effects, suicidal assessment, thought patterns
distract, positive talk, CBT, exposure, desensitization
172
panic tx
breath, relax, nutrition, physical activity, sleep hygiene
SSRI (First) benzodiazepines
173
emergency care for panic
```
stay with
reassure
clear directions
minimal stimulation
PRN anxiolytic
venting
```
174
fear of social
fear of judgement
general/specific
Social phobia 14%
| specific (10%)
175
caused by substance
| BT tx
substance induced anxiety
176
anxiety in physical symptoms
somatization disorder (W80%, 20% M)
177
impaired physical function de to psychological conflict
| "la belle indifference" or distress
conversion/functional neuro disorder (2x W)
178
Hypochondriasis/illness anxiety
misinterpret physicals sensations
tx; stress management, build trust, distraction, antipsychotics, antidepressants
179
Somatoform vs factitious disorder (Munchausen syndrome)
malingering's - faking symptoms to benefit
should not be confused a person consistently produce physically and psychological symptoms
180
rethink
reboot
reconnect
revitalize
note
181
skills for stress management
```
exercise
relax
lifestyle change
reframe (thoughts)
laughter and humor
memory bank (positive)
```
182
```
trust more
fewer fatal accidents
strong memory
better testing
good friends
not appearing anxious
human race needs more apparently
```
advantages of anxiety
183
schizophrenia is
treatable
a neurological disorder
psychosis is one element
184
Epidemiology
1% worldwide (no bias yet doctor bias present)
185
Schizophrenia co-morbidity
substance use (nicotine, alcohol, cannabis)
anxiety, depression and suicide
physical illness
polydipsia
186
social realities of schizophrenia
caregiver stress
stigma and isolation
homelessness
187
Psychological realities of schizophrenia
```
difficult relating, decisions
affective blunting
decrease stress response and coping
self concept changes
self stigma
```
188
Creativity and schizophrenia
90% higher chance
189
Schizophrenia and dopamine
```
positive symptoms (overactive mesolimbic)
negative symptoms (mesocortical dysfunction)
```
both are dopaminergic important role in motivation, cognition and significance of stimuli
190
High levels of D2 receptors impaired grasp of reality, emotional dysregulation
mesolimbic
191
reduction of D2 can cause decline in neurocognitive fx, memory, attention, problem solving, social traits
Prefrontal cortex
192
Role of glutamate and schizophrenia
activated NMDA (forms connections in brain cells, for brain development, learning and memory
low NMDA - schizophrenia later in life?
193
theories of etiology schizophrenia
vulnerability stress theory
early causes
vulnerability
drugs
stress and infection
194
Phases of schizophrenia
recovery (maintenance and health promotion)
```
Prodrome phase
acute (onset/exacerbation)
Stabilization (diminishing, previous level)
maintenance (at/near baseline)
health promotion
```
195
Prodromal phase
a year before episode
most common symptoms (reduced concentration, reduces motivation, depressed, sleep disturb, anxiety, social withdrawal, suspicious, deteriorating roles, irritable)
196
hallucinations, delusions, racing thoughts, disorganized speech/behavior, disturbed/bizarre behavior
positive symptoms
197
Positive symptoms: alterations in perceptions
hallucinations (auditory, command, visual)
depersonalization (detach from self)
derealization (detach from surrounding)
198
Positive symptoms: alterations in thought content
```
delusions
concrete thinking (literal answers, no abstract thought)
```
199
clang - rhyme
word salad - meaningless
neologisms - made up words
echolalia - repeating
circumstantiality - explain unneeded detail
flight of ideas
thought insertion
through broadcasting (everyone knows thoughts)
ideas of reference (special significance)
Positive symptoms: Alteration in speech (associative looseness)
200
```
motor retardation/agitation (slow) (fast)
catatonia (^/v movement)
waxy flexibility (posture maintained)
echopraxia (mimic movements)
boundary impairment (self end other start)
impaired impulse
gesturing/posturing
Automatic obe (robot)
negativism (does opposite)
```
Positive symptoms: Alteration in behavior
201
```
avolition (decreased motivation)
affective flattening (decreased expression)
alogia (decreased speaking)
anhedonia (decreased pleasure)
anosognosia (doesn't know ill)
```
negative symptoms
202
assessment for depression
| relapse, substances use, increased suicide risk, each psychotic break impair functioning
Affective symptoms (symptoms with emotion/expression)
203
difficult attention, memory, information processing, cognitive flexibility, executive functions
cognitive symptoms
204
outcomes with schizophrenia
1/3 improve
1/3 relapse
1/3 disabled
sustained remission with psychosocial support
205
early detection and schizophrenia
earlier better
once symptoms and fear are addressed recovery begins
important to recognize other diseases (Huntington's, Wilson's, epilepsy, tumor, encephalitis, meningitis, MS)
206
SPI-A must have 2/9 symptoms
```
inability to divide attention
thought inference
thought blockage
disturbed receptive speech
disturbed expressive speech
disturbed abstract thinking (concretism)
ideas of reference (subject centrism)
captivated attention by details of visual field
```
207
First episode psychosis
3% of population
1/3 only have one episode
each acute episode prognosis worsens (toxic storm)
treatable
208
Acute phase intervention
self care deficit
prevent water intoxication (polydipsia)
medications
209
FGA-Typical antipsychotics
EPS (extrapyramidal side effects
thorazine, haloperidol, stelazine, loxipine, chlorpromazine
depot-fluphenazine, haldol, flupenthixol, zuclopenthixol
traditional (tranquilizer)
first generation (typical)
- lowers dopamine (D2 antagonist)
- acute dystonia (sustained contraction) chronic
- akathesia (restless)
- psudoparkinsoniasm
- tardive dyskinesia (invol contractions) chronic
210
SGA- atypical
rispiridone, olanzapine, quintiapine, ziprasidone, amisulpride, clozapine (final choice)
block D2 and 5-HT
negative and positive symptoms
minimal EPS or tardive dyskinesia
disadvantage - weight gain, blood monitoring required
se: sedation, hyperglycemia, akathisia, dizzy, photosensitivity
211
Clozapine
```
SGA
for tx resistant
registration, blood work, ECG, CBC
7 day supply to start
must have two other trial medicines first
```
212
Clozapine side effects
```
agranulocytosis
myocardidis
seizure
sialorrea (drool)
weight gain (hyperglycemia)
metabolic syndrome (central obesity, high BP, high TG, low HDL, insulin resistance
```
213
TGA
aripiprazole (abilify)
dopamine stabilizer
| improves positive and negative symptoms (little risk of EPS and tardive dyskinesia)
214
iloperidone (fanapt)
lurasidone (latuda)
asenapine (saphris)
paliperidone (invega)
newest atypical antipsychotics
215
Dangerous responses to antipsychotics
agranulocytosis
anticholinergic toxicity
neuroleptic malignant syndrome
216
anticholinergic toxicity (toxidrome)
blind bat, mad hatter, red beet, dry bone, hot hare, stuffed pipe, myoclonus
```
blurred vision
confuses, dec. LOC, seizures, delirium, psychosis
flushed, VD, tachy, dysrhythmia
hyperthermia
urinary and bowel retention
```
217
NMS (FARM)
fever
autonomic changes
rigid muscles
mental status changes
218
Adjunts to antipsychotics
Anti depressants
| mood stabilizers
219
general health of schizophrenia
more diabetes
more HIV
higher asthma
modifiable risk factors
220
```
1-2% experience (3% in usa)
equal among cultures, ages and genders
2/3 have family history
6th leading cause of disability
9.2yr off lifespan
```
BPD stats
221
BPS definition
shifts in mood, energy and ability to function
75% have concurrent anxiety disorder
222
Mania don't recognize behavior is problematic
| can turn into hallucinations or delusions
note
223
BPD 1
one or more manic episodes with a major depressive occurrence
224
BPD 2
periods of major depression with at least one episode of hypomania
underdiagnosed and usually mistaken for BPD
more common in woman (says slides)
females more depression
males more mania
225
4 changes in 12mo
poor functioning, high reactivity, resist tx
Severe form of BPD
rapid cycling
226
depressive and hypomanic episodes don't meet BP 1/2 criteria
milder form BPD
tend to have irritable hypomanic
substance use to self medicate
cyclothymic disorder
227
Mania definition
over the top euphoria or irritability
228
Hypomania definition
lower level less dramatic mania
at least 4 days
at least 3 manic behaviors
psychosis not present
229
BPD neuroendocrine
woman low estrogen (improve with supplement)
| HPTA and inflammation
230
BPD neurobio
NE, D2, 5HT increase (mania) decrease (MD)
receptor insensensitivity
prefrontal cortex dysfunction on FMRI
grey matter loss
231
Chronic cyclic disorder
mean age onset 21-30
episodes accelerate over time
Clinical course BPD
232
initial presentation usually depression
intense range (3h straight)
symptoms reflect developmental stage
maybe mistaken for ADHD or conduct disorders
Children BDP considerations
233
abnormalities and cognitive disturbances (confusion)
older adults BPD considerations
234
Increase BPD with increase IQ
| 15-30% genetic
note
235
Manic episode priorities
```
protection
poor judgement, impulsivity
risk taking
supernatural powers
devastation by actions
```
236
Depressive episode priorities
protection of pt
suicidal
self care deficits
237
BDP assesment
mood
cognition
thought disturbances
risk assessment (injury, suicide, violence, abuse)
238
psychoses during acute mania
| stress and coping (stress trigger, negative coping)
BPD thought disturbances
239
```
injury prevention
hospitalization helpful
symptom management and stabilization
antipsychotics or benzodiazepines
serum monitoring (1-2weeks/2months) (3-6weeks/after)
```
BPD acute phase (depression, mania or hypomania onset)
240
lasts 4-9months (2-9mo after acute)
relapse prevention or cycling
continue stabilizers
BPD continuation phase
241
prevention
decrease severity of future episodes
medication adherence
maintenance phase BPD
242
Nsg assessment BPD
```
changes in sleep/weight
electrolytes, WBC, thyroid
use of substances
STI, pregnant
medication adherence
```
243
encourage rest (min stimulation)
sleep aid
hydration/nutrition
monitor for withdrawal of substances
Mania interventions
once mood stabilizes (teaching routine and triggers)
244
600-1200 start (max 1800mg)
supplemented with olanzapine
narrow therapeutic (0.4-1.0mEq/L)
fluid and Na important (low Na increase seizures, dehydration, thiazide diuretics, NSAIDS, ACE inhibitors
Lithium carbonate
245
anticonvulsant (BPD, epilepsy, migraine)
better for acute mania (prevent future mania)
SE: dizzy, confusion, hallucination, headache, ataxia, sedation, tremor, acne, blood dyscraias, elevated ammonia, mensural irregularities, PCOS, weight gain, pancreatic, hyper-ammonic encephalopathy
divalproex (valproic acid)
broad spectrum
loading dose
liver function needs to be normal
246
Third life antipsychotic
| effects estrogen levels
tamoxifen
247
n/v/d, fatigue, hyperreflexia, ataxia, delirium, myoclonus, coma, renal impairment
toxicity (arrhythmias, blackouts, tremors, seizures)
contradictions (heart, brain, renal, thyroid issues, graves disease)
Lithium toxicity
248
Normal SE of lithium
```
fine tremors
hypothyroidism
weight gain
GI symptoms
thirst
lethargy
```
249
```
anticonvulsant with mood stabilizing effects
better with rapid cycling and dysphoria
for unresponsive to Li
incremental dosing decrease SE
monitor blood and liver function
drug interactions and contraceptives
```
Carbamazepine (tegretol)
250
First line for BPD
for BDP, epilepsy and neuropathic pain
SE: rash, hyponatremia, blood dyscrais, hepatotoxicity, teratogenicity, ataxia, cognitive slow, sleep disturbance
Lamotrgine
251
Milieu Method
restrains and seclusion
252
education (warning signs, medication adherence, health teaching, weight management
psychotherapy CBT
environment (roommates, peer support)
Other nsg interventions
253
persistent depressive disorder (dysthymia)
depression most days
254
pre-mensural dysmorphic disorder
last week before period
| interfere with work and interactions
255
Mood disorders (Affective disorders)
alterations in emotions and mood that result in depression or mania
interfere with life
depression (unipolar)
BP (manic depressive)
SAD
256
persuasive and sustained emotion that colors ones perception of the world and how they function in it
mood
257
reoccurring disturbances in mood that cause stress and behavioral impairment
alterations in mood not thought or perceptions
mood disturbances
258
Mood disorder epidemiology
```
3million Canadians at some point
2x as many woman
co-occur with other disorders
unrelated to race
culture can influence experience and communication of symptoms
```
259
changes in apatite, weight, sleep, activity, recurrent thoughts, psychotics features, impaired functioning)
depressed mood 2weeks min
single or reoccurring (20% become chronic)
MDD (unipolar depression)
260
Mood disorders behavioral factors
```
NT
endocrine disorders
family/genetics
psychoimmunology
sleep dysfunction
```
261
Mood disorders psychological factors
```
stressful life events
behavioral factors (cognitive, psychodynamic)
```
262
Mood disorders social factors
support
| woman 2x men mood disordersw
263
Biological theory NT dysfunction and mood disorders
low 5HT (depression)
D2 (high-mania) (low-depression)
NE (modulated attention)
Acetylcholine and GABA
264
Biological: endocrine dysfunction (hypothalamic-pituitary-adrenal-cortical-axis)(HPAC)
depression specifically:
elevated cortisol
malfunction thyroid
dysregulation of GH
265
Diathesis stress model
early signs ^CNS activity CRF
causes sensitization under mild stress
biology and life events
| psychosocial stressors and interpersonal events can trigger neuro-physical changes in the brain
266
psychological factors
Beck's triad (negative self, world, future)
cognitive theory
persons thoughts drive emotions
negative thoughts perpetuate depression
negative schema in childhood = negativity
267
CBT
thought, behaviors and emotions to change perceptions
268
Psychological: stressful events
meaning more important than actual event
BP stressful events linked to episodes not future
50-80% don't develop mood disorders after stress
269
psychological: Behavioral
learned helplessness (Sligmans rats and dogs)
linked to lack of control
lack of positive reinforcement (withdrawal)
270
Psychological: psychodynamic
depression rooted in deficit of caregiver relationship
adult relations reflect childhood loss
loss triggers depression
271
Brown and Harris social support
woman with stressful events
those friend <10% depressed
without >37%
272
Goals of nsg and mood disorders
```
symptom control
improve occupational/psychosocial function
build coping skills
reduce relapse
safety priority (suicide)
```
273
nsg assessment mood disorders
```
MSE
suicide risk
symptoms review
changes
decreased energy
```
274
atypical (over eat/sleep)
melancholic (apathy, weight loss, guilt, worse in morning)
psychotic (delusions, hallucinations)
catatonic (nonresponsive)
Types of MDD (4/8 total)
275
postpartum (4weeks post, rumination, delusions)
SAD (anergia, hypersomnia, over eat, weight gain)
substance induced
dysthymic
Types of MDD (4/8)
276
less likely psychosis
more likely anxiety and somatic
irritable rather than sad
suicide risk (mortality increase through adolescence)
nsg assessment MDD children
277
```
most don't meet criteria for depression
8-20%
37% in primary care
tx successful yet response slower
highest suicide rate (over 80)
```
MDD assessment elderly
278
SIGECAPS assessment
sleep, interest, guilt, energy, concentration, apatite, psychomotor, suicidal ideation
279
SAD PERSONS - suicide risk assessment
sex, age, depression, previous attempts, ETOH/alcohol, rational thinking, social support, organized plan, no spouse, sickness
280
suicide rare <10yo
| can they understand the finality of death
prepubescent children suicide
281
male 3x more likely
40x more if Inuit
suffocation
20-1 attempts-suicide
pre-adolescents suicide
| adolescent suicide
282
highest in midlife
single, divorced, widowed
other risk factors
marriage is protective
adults suicide
283
parasuicide definition
an apparent attempt at suicide not resulting in death
