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Mental Health Nursing > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

recurrent intrusive idease, thoughts, and impulses

A

obsessions

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2
Q

ritualistic behaviors that people participate in to control thoughts

A

compulsions

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3
Q

what are two forms of OCD?

A

body dysmorphic disorder and hoarding

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4
Q

preoccupation with an imagined defective body part. these people obsessively think about it and have compulsive behaviors.

A

body dysmorphic disorder

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5
Q

why do people with body dysmorphic disorder develop emotions of disgust, shame, and depression?

A

because of their constant fear of rejection by others, perfectionism, and conviction of being disfigured

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6
Q

do people with body dysmorphic disorder respond well to reassurance?

A

no, they still believe they have the defect

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7
Q

excessive collection of items and the failure to discard these items. these people have severe distress and disruption of daily functioning and often do not believe they have a problem

A

hoarding disorder

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8
Q

what are all stress disorders related to?

A

exposure of several stressors which may include natural disasters, accidents or intentional harm

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9
Q

what are two types of stress disorders?

A

acute stress disorder and post-traumatic stress disorder

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10
Q

how quickly do acute stress disorders appear?

A

within one month of the traumatic experience

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11
Q

what are symptoms that occur with acute stress disorder?

A

numbess, detachment, derealization, depersonalization, and dissociative amnesia

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12
Q

when a person has symptoms of ASD past one month. this is accompanied by functional impairment and stress and the perosn may have flashbacks, nightmares, and sleep disturbances

A

post traumatic stress disorder

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13
Q

when is PTSD considered delayed?

A

if symptoms are delayed and do not occur until more than 6 months after the event

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14
Q

in addition to the symptoms of ASD, what are some symptoms of PTSD?

A

loss of trust, poor self esteem, feeling damaged, difficulty maintaining or building relationships, numb to emotions, increased arousal, may become more irritable, difficulty with concentration, try to avoid anything associated with the trauma they experienced

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15
Q

what biological factors play a role in anxiety and stress related disorders?

A

genetics, too much norepinephrine, too little serotonin, too little GABA

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16
Q

why do benzodiazapines work with anxiety and stress disorders?

A

they help to increase levels of GABA so that the patient calms down and feels good

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17
Q

what are psychological factors that increase a patients likelihood of developing an anxiety disorder?

A

shy and timid people, critical parents, learning anxiety through classical conditioning, social learning from parents and peers, cognitive distortions

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18
Q

what other disorders do anxiety disorders usually co-exist with?

A

depression, substance abuse, eating disorders, personality disorders, and schizophrenia

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19
Q

what are clues to look for with anxiety and stress disorders?

A

high alcohol/drug intake, history of barbiturate or benzodiazepine dependence, history of frequent use of healthcare for somatic complaints, negative outlook, distorted thinking, obsessions or compulsions, history of an eating disorder

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20
Q

why aren’t benzodiazepines used often in the outpatient setting?

A

because there is a high rate of addiction

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21
Q

what are the side effects of benzodiazepines?

A

drowsiness, sedation, ataxia, dizziness, feelings of detachment, irritability or hostility, anterograde amnesia, cognitive slowing with long-term use, tolerance, dependency, rebound insomnia/anxiety, rarely nausea, headache, confusion, depression

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22
Q

what are the withdrawal symptoms of benzodiazepines?

A

agitation, anorexia, hyperactivity, insomia, irritability, nausea, vomiting, sensitivity to light/sounds, tinnitus, tremulousness, anxiety, autonomic arousal, dizziness, generalized seizures, hallucinations, headaches

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23
Q

what drug do they use to treat benzodiazepine overdose?

A

Romazicon (flumazenil)

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24
Q

who often experience paradoxical effects of benzodiazepines?

A

children

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25
Q

what are some meds other than benzodiazepines that are used for the treatment of anxiety?

A

Buspiraone (BuSpar), antihistamines, blood pressure meds

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26
Q

will buspirone work PRN?

A

no, it generally takes several weeks for significant anti-anxiety effects

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27
Q

is buspirone (BuSpar) effective to manage drug or alcohol withdrawal or panic disorder?

A

no

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28
Q

why are antihistamines used as meds for anxiety?

A

they are used for their sedative effects, but they’re not usually as effective as other drugs, but they do not cause physical dependence

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29
Q

what blood pressure meds can be used for antianxiety?

A

propranolol (inderal) and clonidine (catapres). these are typically given lower doses than beta blockers

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30
Q

what biological aspects should you assess on a person with anxiety?

A

substance use, sleep patterns, eating patterns, sexual functions and menstrual cycles

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31
Q

what psychological factors should be assessed on a person with anxiety?

A

mood and affect, self esteem, and coping strategies

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32
Q

what anxiety disorders are blood pressure meds good to treat?

A

performance anxiety

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33
Q

what social factors should be assessed for a patient with anxiety?

A

interpersonal relationships, diversional activities, cultural expressions of anxiety

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34
Q

what are the signs and symptoms of anxiety disorders

A

heart rate increase, blood pressure increase, sweaty palms, shortness of air, lightheadedness, depression, irritability, difficulty focusing, more forgetful

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35
Q

what things do you want to look for when assessing family functions?

A

management, boundaries, communication, emotional support/availability, socialization

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36
Q

what do clear family values consist of?

A

very cohesive, good communications, general rules and expectations that are firm, yet flexible at the same time, family members are supported and nurtured, yet offered autonomy

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37
Q

what do diffuse or enmeshed family boundaries consist of?

A

families are overly involved with each other, not able to define the thoughts and feelings of each individual member, might lose some autonomy, can be emotionally involved and show warmth, but there might be a lot of hostility and meddling, child has more issues becoming an independent person

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38
Q

what do rigid or disengaged families consist of?

A

no flexibility, relationships may be cold and controlling or even withdrawn, individuals may be disengaged from each other, or as a family unit be disengaged from the rest of the society, not much negotiation and opportunities for individual development

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39
Q

what is healthy communication within a family unit?

A

clear and easy to comprehend, can help with adapting to stressors

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40
Q

what is unhealthy communication within a family unit?

A

unclear and indirect - more passive aggressive

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41
Q

what do healthy families have in emotional support/availability?

A

show affection and respect for one another, are allowed to express feelings and don’t repress someone else’s feelings

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42
Q

what do unhealthy families have in emotional support/availability?

A

will be more angry towards one another and have more conflict

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43
Q

occurs when a two system person starts to have tension and they bring in a third person to reduce the conflict between them

A

family triangles

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44
Q

how many generations should you look at when looking at multigenerational issues?

A

3-4 generations because dysfunctional systems are passed down from generation to generation

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45
Q

what are the objective factors of the family burden?

A

practical problems family members face while caring for ill relative, symptomatic behaviors like deficit behaviors when they don’t do things that they should and intrusive or acting out behaviors, care-giving, and stigma

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46
Q

what are the subjective factors of family burden?

A

negative emotions that family members experience in response to a loved ones mental illness - grief, fear, guilt, anger

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47
Q

how do traditional family therapies work?

A

working with the family as a whole. might focus on here and now or the past that lead up to where they are now.

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48
Q

how do psychoeducational family therapies work?

A

they focus on helping the family understand that mental illness and includes teaching them about side effects, medications, etc

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49
Q

how does case management work?

A

someone goes into the home and helps the family and patient handle day-to-day problems. this is a good way to keep an eye on patients in between appointments

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50
Q

what are iatrogenic family burdens caused by?

A

a dysfunctional mental health system and by the attitudes and behaviors of some mental health professionals who have outmoded theories about families

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51
Q

harsh physical or verbal action reflecting rage, hostility, and potential for destructiveness that can be directed at self or others

A

aggression

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52
Q

term uniquely associated with human beings that refers to physical aggression and is usually out of context of what the stimulus was

A

violence

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53
Q

how much more likely are patients with psychiatric disorders to be violent than those who don’t have them?

A

they are 5x more likely than those who don’t

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54
Q

which psychiatric disorders have an increased risk of violence?

A

ADHD, ODD, PTSD, dementia, paranoid delusions and personality disorders

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55
Q

which medical/neurological disorders have an increased risk of violence?

A

TBI, temporal lobe epilepsy, brain tumor, infections, intoxicated or withdrawing from drugs/alcohol

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56
Q

what neurobiological factors are related to anger and aggression?

A

limbic system, amygdala, and temporal lobe dysfunction can cause behavioral problems and violence and aggression; serotonin and GABA help regulate emotions and keep us calmer and not having enough of these can lead to aggressive or violent behaviors

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57
Q

in which communities do violent deaths occur most often in?

A

lower to lower middle class communities. it could be related to the stress of those environments

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58
Q

are men or women more likely to be aggressive?

A

men

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59
Q

what are childhood red flags to anger and aggressive behaviors?

A

animal cruelty and setting fires

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60
Q

what questions should you ask when assessing for violent behavior and aggression?

A

have you ever thought of harming someone else? have you ever seriously injured another person? what is the most violent thing you have ever done?

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61
Q

which factors should you identify when assessing for violent outcomes?

A

angry, irritable effect, hyperactivity, increasing anxiety, verbal abuse, loud voice, history of recent acts of violence, suspicious or paranoid patients, substance abuse, possessions of a weapon, milieu characteristics conductive to violence

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62
Q

what milieu characteristics are conductive to violence?

A

loud, overcrowding, staffing unconsistent, understaffing

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63
Q

what is the most important priority when assessing for a person with anger and aggression?

A

safety of the patient and others: risk for self-directed violence and risk for others-directed violence

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64
Q

what is the most important aspect in decreasing the risk of anger and violence?

A

consistency of staff response - the use of well-trained staff skilled in the use of de-escalation techniques. must include comprehensive patient, situation, enviromental, and staff assessment

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65
Q

what things can you do to ensure safety when anger and aggression are risks?

A

position self where you can get to the door, don’t be directly in front of the patient, search valuables and get anything that can be used for a weapon, work with other staff - let them know where you are going to be

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66
Q

what do you want to do in the preassaultive stage of violence?

A

de-esculation approaches, remain calm with a soft, nonjudgemental tone; try to find out what is going on and how you can help the patient, try to talk the patient through their anger

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67
Q

what should you do during the assaultive stage of the violence cycle?

A

medicaiton, seclusion, restraint; patient is being violent; have other patients go to their rooms and shut their doors

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68
Q

what should you do during the post-assaultive stage of the violence cycle?

A

seclusion and restraint, delicate reentry of the patient back onto the unit

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69
Q

what things do you want to document about violence?

A

what was going on - early behaviors and what you did about them, narrative, if there are injuries - in which case you will have to fill out an incident report

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70
Q

how can you distract a patient with a neurocognitive deficit?

A

validate things about them and then distract them - if you cannot orient them

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71
Q

what interventions can you use to keep catastrophic reactions of neurocognitively impaired patients from happening?

A

adopt a calm, unhurried manner when responding to patients agitation/aggression, might put pictures up around the room to help orient them, approach patients from the front- don’t come up behind them; tell people who you are and smile

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72
Q

what does cognitive-behavioral approaches do for anger/aggression?

A

attempt to teach anger management skills. behavioral interventions are based on social learning theory.

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73
Q

what is dialectical behavioral therapy based on? where is it commonly used?

A

based on a principle of mindfulness - thinking before you act; it is used in patients with anger issues, personality disorders and in prisons

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74
Q

what drugs are used to treat acute aggression?

A

atypical antipsychotics or high potency typical antipsychotics (haloperidol) that are used to calm and sedate the patients; benzodiazepines (adivan and lorazepam)

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75
Q

what drugs are used to treat chronic aggression?

A

anticonvulsants (carbamazepine); beta blockers (propranolol); lithium carbonate

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76
Q

what are good interventions to do when a patient is experiencing anger/aggression?

A

calm approach, stay on patient’s non-dominant side, make sure you are between the patient and the door, tell client that you expect him/her to stay in control, ask what you can do to help, suggest ways that the patient can get their needs met, clarify with a lot of reflection, don’t ask why

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77
Q

what is the definition of suicide?

A

the act of intentionally ending one’s life and opting for nonexistance

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78
Q

what things does a suicide attempt include?

A

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

79
Q

what is suicide ideation?

A

thinking about ending your life

80
Q

suicide is the ……. leading cause of death in the US

A

11th

81
Q

suicide is the …… leading cause of death in adolescence?

A

3rd

82
Q

do older age groups have increased or decreased rates of suicide?

A

increased

83
Q

every ….. minutes an American commits suicide. for every completed suicide, there are …. - ….. attempts

A

16; 10-20

84
Q

what profession tends to have higher rates of completed suicides than the general population? why?

A

nurses have higher rates than other populations because they tend to choose medications that are more lethal with overdoses. the daily stress of the nursing career may be a risk factor

85
Q

what things are included in the etiology of suicide?

A

command hallucinations or delusions - hear people saying that they should kill theirselves; no hope for the future; viewed as a relief from unbearable pain; many losses; multiple crises have drained resources; ultimate expressions of anger toward significant others - use it as a source of revenge

86
Q

how did Freud describe suicide?

A

as a murderous attack on ambivalently loved, internalized

87
Q

what are the risk factors for suicide?

A

genetics, neurotransmitter imbalances, poverty, recent divorce/separation or bereavement, homelessness, negative life events with poor social support, being a woman, psychosis, feelings of hopelessness, helplessness, and worthlessness, presence of a plan, previous suicide attempts, impulsive or aggressive tendencies, family history of suicide aggression or abuse, incarceration, exposure to suicides of others, chronic physical illness, adolescents and young adults, older adults

88
Q

what things put adolescents at an increased risk of suicide?

A

substance abuse, aggression, disruptive behaviors, depression, social isolation

89
Q

what have most older adults who commit suicide done about a month before?

A

visited a primary care physician

90
Q

what are some protective factors for suicide?

A

effective care, easy access to care, close relationships, restricted access to lethal means, ongoing relationships with care providers, good communication and problem solving skills, cultural and religious beliefs

91
Q

which race has the highest rate of suicide in the US?

A

caucasians have twice the rate of minority groups, with the exception of Native Americans who are higher - possibly because of substance abuse

92
Q

why does the rate of suicide increase with age with Asian Americans?

A

because they don’t want to express feelings feelings of fear and shame. keeping these emotions could lead to suicide.

93
Q

what is a protective factor of suicide for Asian Americans?

A

because of the belief that the individual and society are dependent

94
Q

does an improvement in mood mean that the risk of suicide is over?

A

no, sometimes antidepressants give people the energy that they need to come up with the plan and follow through with it. they may try to convince you that they are feeling better and can go home now.

95
Q

what is a good suicide assessment tool to use?

A

SADPERSONS

96
Q

what things should you assess for when assessing for suicide?

A

recognize clues (overt and covert) that the patient may give you; assess for precipitating events/risks and protective factors; assess for previous suicides of loved ones; always ask the person at risk if they are having thoughts of suicide; assess plan, including intent, lethality, availability of means, and any injury suffered; determine support systems, including community supports if the person is on an outpatient basis

97
Q

what should your lethality of plan assessment include?

A

how detailed the plan is, how lethal the proposed method is, do they have the means to access it?

98
Q

what is the “is path warm” acronym?

A

Ideation, Substance abuse, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, Mood changes

99
Q

what is planning for the patient with suicide attempts and ideations directed towards?

A

crisis/communication and intervention and long-term treatment of any co-occuring mental illness

100
Q

what should you do during the crisis period of a suicide attempt?

A

follow institutional policiy, keep accurate records of patient behavior documenting activity q 15 minutes or as per protocol, may establish a suicide contract, encourage the patient to discuss feelings/problem solving alternatives

101
Q

what should you do for the patient in the post crisis period of a suicide attempt?

A

arrange for someone to stay with them, make sure weapons/pills are removed by family and friends, encourage patient to discuss feelings, encourage patient to avoid decision making, activate links to community support (self-help groups), only give a 1-3 day supply of medications, make sure they are monitored by a responsible adult

102
Q

what things can you do to help survivors of a suicide?

A

postvention initiated 24-72 hours after death, survivors often feel they are going crazy and we need to let them know that these feelings are normal, they may have anger towards the person who committed suicide and they need to discuss these feelings. PTSD is common, we need to try and get them in self-help groups

103
Q

subjective, what a person is feeling

A

mood

104
Q

objective, what you are seeing. non-verbal communication of how a person is feeling

A

affect

105
Q

when do you have a mood disorder?

A

when mood symptoms become significant enough they impair daily functioning

106
Q

what are the biological factors in the etiology of depression?

A

genetic - 50% increase in likelihood of an unaffected twin developing it; biochemical - serotonin and norepinephrine, dopamine, GABA, and acetacoline all may play roles; alterations in brain structure - smaller frontal lobes and cauda nuclei

107
Q

what is learned helplessness?

A

person feels like everything is their fault, but they had no control over what happened

108
Q

what is major depressive disorder manifested by? (not asking for the symptoms)

A

emotional, cognitive, physical, and behavioral symptoms - occurring nearly every day for at least a 2 week period - that interferes with daily functioning

109
Q

how many symptoms of major depressive disorder does a person have to have before they are diagnosed?

A

5+

110
Q

what are the cognitive/emotional symptoms of MDD?

A

anhidonia, feelings of worthlessness of guilt, hopelessness, difficult concentration (possibly because of slowed thought processes), anger and irritability, recurrent thoughts of death or suicide

111
Q

lack of pleasure or interest

A

anhidonia

112
Q

what are the physical symptoms of MDD?

A

fatigue, somatic complaints, loss of appetite, weight loss, insomnia or excessive sleeping, increased or decreased motor activity, annergia, chronic back pain, decreased libido, changes in grooming or appearance, stooped or hunched posture, substance abuse, isolation

113
Q

according to the DSM 5, what are the specifiers for MDD?

A

psychotic features - mood congruent hallucinations; catatonic features - psycho motor retardation (feel like they can’t move very well on their own); melancholic features - not caused by stressors, comes on its own; postpartum onset - crash of hormones after pregnancy; atypical features - want to eat more, sleep all the time, younger onset; seasonal pattern

114
Q

chronic low-grade depression characterized by chronic depressive syndrome usually present for most of a day, more days than not, for at least a two year period

A

persistent depressive disorder (dysthymia)

115
Q

are people with dysthymia usually severe enough for hospitalization?

A

no, not unless there is a threat of suicide

116
Q

when does dysthymia usually begin?

A

early childhood, teenage years, or young adulthood

117
Q

depressed mood that occurs in the fall and winter, but during the spring and summer months the person has a normal mood

A

seasonal affective disorder (SAD)

118
Q

what is commonly used to treat SAD? why?

A

a light box because there is a correlation between the disorder and the amount of light and melatonin produced

119
Q

what are the biological factors that play into bipolar disoder?

A

up to 90% of a genetic link (risk is 7x higher if you have a first degree relative with it); serotonin, norepinephrine, and dopamine play roles; dysfunction in modulating stress response; reduced hippocampus and prefrontal cortex

120
Q

what psychological and environmental factors are related to bipolar disorder?

A

stressful life events can bring it on. middle to upper classes are more affected.

121
Q

what are some symptoms of the mania phase of bipolar disorder?

A

euphoria or irritability, labile (frequent shifts in mood), inflated self-esteem, pressured speech, feel like they don’t need sleep, hypersexuality, poor judgement and decision making, racing thoughts, psychomotor agitation, inappropriate dress or behavior, may exploit otheres

122
Q

how long must the mania period last for bipolar disoder?

A

7 days.

123
Q

milder form of mania that lasts for at least 4 days and does not cause marked impairment in function like mania does

A

hypomania

124
Q

type of bipolar disorder characterized by one or more manic episodes, usually alternating with depressive episodes, but in some patients no depression may be present. they may have psychosis accompanying manic episodes

A

bipolar I

125
Q

type of bipolar disorder characterized by depressive episodes and at least one hypomanic episode, typically with more severe depression than the other kind

A

bipolar II

126
Q

disorder similar to bipolar II when the patient has alternative episodes of hypomanic symptoms and minor depressive episodes (non-psychotic) for at least two years

A

cyclothymic disorder

127
Q

what things should you assess for when assessing a client with mood disorder?

A

safety first, psychosis, are there any other psychiatric conditions going on, history of onset (was there a stressor that triggered it), rule out anything physical, check support systems, assess for depressive symptoms

128
Q

what things should you assess for with the depressed client?

A

suicidal/homicidal ideations, mood and affect, thought patterns (may be negative or delusional), appetite, sleep, sexual interest, interaction with others

129
Q

what things should you do when communicated with a depressed client?

A

realize that they may require more time to respond, make observations related to the patient or situation, avoid platitudes and making judgements; listen carefully for covert messages, question directly about suicide, question underlying assumptions and beliefs, identify cognitive distortions, encourage 1:1 and group activity, encourage exercise, encourage finding a healthy support system

130
Q

what interventions should you make for the client with depression?

A

assist with personal hygiene, monitor food intake/weight, monitor sleep, maintain a safe environment, be alert to sudden lifting of mood, monitor response to meds

131
Q

what things should you assess in the client with bipolar disorder?

A

assess current mood/change in mood, assess behaviors and potential for violence towards others, thought processes, sleep, appetite, weight, signs and symptoms of physical illness, observe for inappropriate behavior

132
Q

what things should you do when communicating with someone with bipolar disorder?

A

use firm, calm approach; use short, concise statements; remain neutral; avoid power struggles; be consistent; hear and act on legitimate complaints; firmly redirect energy into appropriate channels

133
Q

what interventions should you do for a client with acute mania?

A

maintain a low-level of stimuli, provide structured solitary activities with nurse or aide, provide frequent high-calorie fluids and foods, provide frequent rest periods, redirect violent behavior through excersize, use antipsychotics and restraints when warranted, protect patient from impulses/ help maintain their dignity, limit visitors, observe for unpredictable behavior and irritability, meals in rooms, monitor bowel habits

134
Q

what are some medications used to treat depression?

A

SSRIs, SNRIs, NDRIs, TCAs, MAOIs,

135
Q

what are SSRIs and how do they work?

A

selective serotonin reuptake inhibitors. allows for more serotonin to be available in the synaptic clefts

136
Q

how often are SSRIs used to treat depression?

A

they are the 1st line of treatment for depression and anxiety. another good thing is that most are generic so they are cost efficient

137
Q

what are some SSRIs?

A

vilaxodone (Viibryd); citalopram (Celexa), escitalopram (Lexapro); fluvoxamine (Luvox); paroxetine (Paxil); sentraline (Zoloft); floxetine (Prozac)

138
Q

what are the side effects of SSRIs?

A

drowsiness, agitation, headaches, sexual dysfunction, GI distress, anticholinergic side effects

139
Q

can you used SSRIs PRN?

A

no, they take 4-8 weeks to show full effects on the body. we need to educate the patient on this so they don’t just stop taking it after the first few doses

140
Q

what things do we need to educate patients on who are taking SSRIs?

A

time to symptom relief, management of side effects, risk of increased suicidal ideations in some populations, avoid alcohol (sedative effect), risk of serotonin syndrome

141
Q

what can you do to minimize your patients chances of developing serotonin syndrome?

A

make sure they aren’t taking any OTC or herbal supplements like St. John’s wort, cough syrups, etc that contain serotonin and then make sure they have a wash out period before starting the SSRI

142
Q

what are symptoms of serotonin syndrome?

A

confusion, unusual elevation of mood, restlessness, myoclonus (jerky muscle contractions), hyperreflexia, diaphoresis, shivering and trimmers, diarrhea, high fever, seizures, loss of consciousness, irregular heart beat

143
Q

what are SNRI’s? when are they given?

A

serotonin norepinephrine reuptake inhibitors. they are often used as a 2nd line of treatment if SSRIs aren’t working

144
Q

what does NDRI stand for and what is an example of an NDRI drug?

A

norepinephrine and dopamine reuptake inhibitor; bupropion (Wellbutrin) is an example. these are often used in combination with an SSRI or SNRI for residual depressive s/s

145
Q

what is the advantage to NDRI vs SSRI and SNRI?

A

they have less sexual side effects. and it can be used as treatment for smoking cessation

146
Q

what are common side effects of SNRI and NDRIs?

A

hypertension, nausea, insomnia, sweating, agitaiotn, headache, sexual dysfunction, seizures

147
Q

why do we not want to give SNRI and NDRIs to people with a history of seizures of eating disorders?

A

they can lower the seizure threshold - can cause electrolytes to decrease which lowers the seizure threshold even farther

148
Q

what things do we need to teach patients who are taking SNRIs and NDRIs?

A

time to symptom relief, management of side effects, difficulty stopping medications - make sure they don’t stop taking them abruptly because they could have some pretty bad withdraw effects, avoid alcohol

149
Q

what are TCAs? how do they work? what are the negative aspects of them?

A

tricyclic antidepressants; they inhibit the reuptake of norepinephrine and serotonin; they are really good drugs, but they come with a high risk of overdose and a lot of side effects so they are used as a 3rd line treatment

150
Q

what are the side effects of TCAs?

A

orthostatic hypotension, anticholinergic side effects, sedation, dizziness, may be cardiotoxic (try to avoid giving them to patients with history of heart disease and MI)

151
Q

what things do you need to teach a patient about with TCAs?

A

time to symptom relief, management of drowsiness, dizziness, hypotension, avoid alcohol

152
Q

what are MAOIs and how do they work?

A

monoamine oxidase inhibitors; they increase levels of norepinephrine, serotonin, and dopamine - used as a 3rd line of treatment

153
Q

what are the side effects of MAOIs?

A

they have a lot of interactions with food. insomnia, nausea/GI distress, agitation, confusion, risk for hypertensive crisis due to tyramine levels

154
Q

what foods should someone taking MAOIs avoid

A

foods containing tyramine: aged or smoked meats, fermented meats, dry fermented sausage (bolgna, pepperoni, salami, air-dried sausages), liver, some fish, most cheese (especially hard cheese), avocados, fava beans, sauerkraut, figs and large amounts of bananas, yeast extract, some imported beers, draft beers, some wines, protein dairy supplements, soups, soy sauce, Chianti,

155
Q

what is the diagnosis of schizophrenia commonly mistaken as?

A

split personality

156
Q

what is schizophrenia?

A

a devastating brain disease affecting thinking, language, emotions, social behavior and reality perception

157
Q

why are schizophrenia disorders considered psychotic?

A

because the person is experiencing phenomena such as delusions, hallucinations, disorganized speech or behaviors

158
Q

what are Eugen Bleuler’s 4 A’s of schizophrenia

A

affect, associative looseness, autism, ambivalence

159
Q

is schizophrenia treatable?

A

yes, but its not curable so it is considered a severe mental illness

160
Q

what is a person with schizophrenia’s affect like?

A

it is more flat and is inappropriate to the situation a lot of times

161
Q

associative looseness

A

threads are missing that tie one thought to another and one concept to another, so their communication is jumbled and illogical

162
Q

why are people with schizophrenia considered to have autism?

A

because they are not bound to the same reality as everyone else in the room. they are wrapped up in their own thoughts

163
Q

someone with schizophrenia must have two or more of what symptoms?

A

delusions, hallucinations, disorganized speech and behavior, and they must have had negative symptoms for one month

164
Q

what is the criteria for schizophrenia?

A

two or more of the appropriate symptoms, significant social/occupational dysfunction, signs continue for 6+ months, other psychotic disorders are ruled out, no medical cause for their symptoms

165
Q

why do we want to rule out everything else before we say a person has schizophrenia?

A

because it has such a stigma. we don’t want to slap the patient with that until we know for sure that is what it is

166
Q

this is similar to the s/s of schizophrenia, but it only lasts for 1-6 months

A

schizophreniform

167
Q

this is a mood disorder at the same time as active symptoms of schizophrenia. these people are at higher risk for what?

A

schizoaffective are at higher risk for suicide because they have the altered thought processes coupled with depression

168
Q

when two or more people are sharing some delusional false belief

A

shared psychotic delusions

169
Q

personality disorder that looks a lot like schizophrenia - may possibly be a precursor to schizophrenia

A

schizotypal personality

170
Q

non-bizarre delusions for 1 month but over all function is not impaired. these people may be fixed on a false belief (like believing your significant other is cheating on you.)

A

delusional disorder

171
Q

what are brief psychotic disorders?

A

they last 1 day - 1 month and then return to normal function. sometimes used when people use street drugs

172
Q

when we don’t know why a person is having delusions and things we diagnose them with…

A

psychotic disorder NES (not elsewhere specified)

173
Q

which people who are diagnosed have a better rate of recovery?

A

those who are diagnosed later on in life and have higher functioning - possibly because they have more resources and better coping strategies

174
Q

do sudden breakdowns and psychosis have better prognosis than gradual?

A

yes

175
Q

what neurobiological factors could cause schizophrenia?

A

they think that these people have an excess of dopamine in several areas of the brain. a lot of times the goal of antipsychotics is to reduce the dopamine levels

176
Q

what anatomical features about the brain have been known to change in a person with schizophrenia?

A

lower brain volume, ventricles increase in size, atrophy of the frontal lobe, more CSF, lower metabolism of glucose in the brain, not as much blood flow to the brain

177
Q

what are the specifiers of schizophrenia?

A

paranoid, disorganized, catatonic, undifferentiated, residual

178
Q

these people have pretty strong delusions or fixed false beliefs that people are out to get them or do them wrong. they have a lot of auditory hallucinations and are very guarded and suspicious. they often misinterpret situations

A

paranoid schizophrenics

179
Q

is it helpful to discount what a person with paranoid schizophrenia is saying?

A

no, it just makes them more suspicious of you

180
Q

type of schizophrenia that may represent a lot of the homeless population. they have a lot of associative losseness, affect is really impaired, and they are often seen murmuring or giggling to them selves. they are very socially regressed

A

disorganized schizophrenia

181
Q

type of schizophrenia characterized by abnormal movement spectrum, and may have waxy flexibility

A

catatonic schizophrenia

182
Q

someone who is displaying symptoms of schizophrenia that won’t fit into one of the categories is..

A

undifferntiated

183
Q

type of schizophrenia that often has negative symptoms long after treatment and do not get better. they will continue to have symptoms throughout life

A

residual schizophrenia

184
Q

what is the prodromal stage of schizophrenia?

A

it is the early stage before diagnosis. it is often missed especially in younger patients and includes relationship problems, hygiene problems, etc

185
Q

symptoms that catch the attention of others. they are positive, overt, and obvious - are usually called…

A

flourid positive symptoms

186
Q

what is the difference between positive and negative symptoms of schizophrenia?

A

positive indicate a distortion or excess of normal funcitoning; they often occur as the initial symptoms of schizophrenia and may precipitate hospitalization. negative symptoms indicate a loss or lack of normal functioning; they develop over tiem and hinder the person’s ability to endure life tasks such as work and family roles

187
Q

what are some positive symptoms of schizophrenia?

A

command hallucinations, hallucinations, delusions, illusions, concrete thinking (impaired ability to use abstract), associative looseness, personality boundary difficulties - depersonalization and derealization, bizarre behaviors (extreme motor agitation, sterotyped behaviors, autonomic obedience, waxy flexibiltiy, stupor, negativism)

188
Q

what are common negative symptoms of schizophrenia?

A

changes in affect, apathy, anhedonia, poor social functioning, poverty of thought

189
Q

what things should you assess for with schizophrenia?

A

mood, affect and behavior within cultural context; hallucinations; medical history and substance abuse; physical manifestatoins; social withdraw; potential for violence; social supports; knowledge of the disease process

190
Q

how should you communicate with the patient having hallucinations and delusions?

A

approach patient in nonthreatening and nonjudgemental manner, identify feelings patient is experiencing, clarify reality of patients experience, avoid arguing/attempting to reason, interact with patient about concrete reality, distract patient’s attention from hallucinations and delusions

191
Q

what is important to know with the patient experiencing command hallucinations?

A

what they are telling the person to do. don’t dwell on the subject but we need to know if the patient is in danger

192
Q

how should you communicate with a paranoid patient?

A

be honest and consistent, avoid talking, laughing and whispering,

193
Q

should you pretend to understand the patient with associative looseness?

A

no, tell them that you are having difficulty understanding them, but put the blame on you, not them. look for recurring topics and themes to help you understand

194
Q

do people with obsessive compulsive disorder realize that their thoughts are irrational?

A

yes, but they cannot help it

Mental Health Nursing (4 decks)

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