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Mental Health > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Selective serotonin reuptake inhibitors (SSRIs)

A 
Citalopram
Fluoxetine
Sertraline 
Paroxetine
Fluvoxamine
Escitalopram
Vilazodone
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2
Q

Tricyclic antidepressants

A

Amitriptyline
Desipripramine
Imipramine
Nortiptyline

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3
Q

Monoamine oxidase inhibitors (MAOIs)

A

Phenelzine
Tranylcypromine
Isocarboxazid

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4
Q

Atypical antidepressants (heterocyclics)

A 
Bupropion 
Mirtazapine
Nefazodone
Trazodone
Deplin
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5
Q

Serotonin norepinephrine reuptake inhibitors

A

Venlafaxine
Duloxetine
Desvenlafaxine

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6
Q

Adverse effects of SSRIs

A

Nausea, headache, agitation, insomnia, anxiety, sexual dysfunction, weight gain

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7
Q

What should the client watch for when taking SSRIs?

A

Serotonin syndrome

Avoid taking st. John’s wart which can increase the risk

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8
Q

For what drug must the patient try to minimize anticholinergic effects?

A

Tricyclic antidepressants

Chew gum, eat high fiber foods, increase fluid intake

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9
Q

What foods should be avoided when taking MAOIs?

A

Foods with tyramine: smoked meats, avocados, liver, dried fish, most cheeses, some beer and wine
Avoid all medications, cold cut meats, pickled foods, chocolate

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10
Q

Side effects of atypical antidepressants?

A

Headache, dry mouth, nausea, restlessness, insomnia

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11
Q

Avoid giving atypical antidepressants to what patients?

A

Those at risk for seizures

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12
Q

Side effects of SNRIs

A

Nausea, insomnia, weight gain, diaphoresis, sexual dysfunction

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13
Q

Use caution giving SNRIs to what patients?

A

Those with history of hypertension

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14
Q

Mood stabilizers- anti seizure medications

A 
Valproic acid
Carbamazepine 
Oxcarbazepine
Levetiracetam
Gabapentin
Lamotrigine
Topiramate

Bipolar disorder

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15
Q

Antianxiety medications

A 
Lorazepam
Clonazepam
Alprazolam
Diazepam
Oxazepam 
Chlordiazepoxide
Clonazepam

Bipolar disorder

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16
Q

Mood stabilizer- antipsychotics (conventional)

A

Chlorpromazine
Haloperidol
Thiothixene
Molindone

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17
Q

What can ECT be used for?

A

Major depressive disorder
Schizophrenia (with catatonic manifestations)
Schizoaffective disorder
Acute manic episodes (bipolar with rapid cycling)

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18
Q

ECT is contraindicated when?

A

Cardiovascular disorders

Cerebrovascular disorders

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19
Q

Electroconvulsive therapy

A

Uses electric current to induce grand mal seizure activity

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20
Q

How often does the patient get ECT?

A

2-3 times per week for a total of 6 to 12 treatments

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21
Q

Medication given before ECT

A

Atropine sulfate to control secretions
Muscle relaxant
Anesthetic

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22
Q

Complications of ECT

A

Short term memory loss

Headache, nausea, muscle soreness

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23
Q

Transcranial magnetic stimulation

A

Noninvasive therapy that uses magnetic pulsation to stimulate the cerebral cortex of the brain

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24
Q

How often does a patient receive TMS?

A

Daily for 4 to 6 weeks

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25
Q

What is TMS used to treat?

A

MDD

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26
Q

Side effects of TMS

A

Tingling sensation at site of electrode
Lightheadedness
Seizures rare

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27
Q

Vagus nerve stimulation

A

Electrical stimulation through vagus nerve to the brains through a device that is surgically placed
Believed to result in increased level of neurotransmitters

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28
Q

What is VNS used for?

A

Depression that isn’t treated by pharmacological treatments or ECT
Epilepsy

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29
Q

How often does the VNS device deliver pulsations?

A

Every 5 minutes for a duration of 30 seconds

Can be turned off using a special external magnet

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30
Q

Side effects of VNS

A 
Voice changes
Hoarseness
Neck pain
Dysphagia 
Dyspnea with physical exertion (turn off device when exersizing)
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31
Q

Mood stabilizer

A

Lithium carbonate

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32
Q

What do conventional antipsychotics treat?

A

Positive signs of schizophrenia

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33
Q

Mood stabilizers- antipsychotics (atypical)

A 
Risperidone
Olanzapine
Arpiprazole
Ziprasidone
Quetiapine
Clozapine
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34
Q

What are atypical antipsychotics used for?

A

Negative symptoms of schizophrenia

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35
Q

What are SSRIs used to treat?

A

MDD

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36
Q

What are MAOIs used to treat?

A

MDD

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37
Q

What are SNRIs used to treat?

A

MDD

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38
Q

When are TCA’s used?

A

When SSRIs and SNRIs don’t work or if depression is related to alcohol/cocaine withdrawal

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39
Q

Side effects of TCAs

A

Sedation
orthostatic hypotension
Anticholinergic effects (can’t pee, see, spit, shit)
Cardiotoxicity (tachycardia)

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40
Q

When are MAOIs used?

A

When SSRIs and SNRIs don’t work

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41
Q

Side effects of MAOIs

A

Hypertensive crisis

Seizures

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42
Q

What is the first line meds for depression?

A

SSRIs

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43
Q

Side effects of SSRIs

A

GI upset
Sleep difficulty
Decreased libido

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44
Q

Side effects of SSRIs and SNRIs

A

Anticholinergic effects

Serotonin syndrome

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45
Q

Symptoms of serotonin syndrome

A 
Nausea, vomiting, diarrhea
Fever 
Sweating
Mental status change
Can progress to cardiac arrest
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46
Q

Treatment for serotonin syndrome

A

Muscle relaxants
Serotonin blocker (cyproheptadine)
Nitrates, cardiac meds

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47
Q

Side effects of benzos

A

Respiratory depression
Drowsiness
Dizziness

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48
Q

Side effects of toxicity of valproic acid

A

GI issues

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49
Q

Side effects for toxicity of carbamazepine

A

Blurred vision and drowsiness

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50
Q

Side effects of lamotrigine

A

N/V
Headache
Dizziness
Steven Johnson’s syndrome

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51
Q

What is most frequently prescribed medication for bipolar disorder?

A

Lithium carbonate

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52
Q

Therapeutic range of lithium carbonate

A

0.6-1.2

Draw levels every 6 months

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53
Q

Symptoms of toxicity of lithium carbonate

A 
Polydipsia
Polyuria
N/V
Diarrhea
Headache
Muscle pain
Rash
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54
Q

Side effects of antipsychotics

A

Neuroleptic malignant syndrome (first sign increased temp)
Extrapyramidal symptoms (EPS- increased risk for conventional antipsychotics)
Disordered water balance
Metabolic syndrome (more with atypical antipsychotics)

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55
Q

Types of EPS

A

Acute dystonia
Pseudoparkinsonism
Akathesia
Tardive dyskinesia

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56
Q

Why is clozapine heavily monitored?

A

Risk of agranulocytosis

Need to monitor WBC and infections symptoms

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57
Q

Positive signs of schizophrenia

A 
Hallucinations
Feel like things are there but they are not
Delusions
Paranoia
Agitation
Illusions
58
Q

Negative signs of schizophrenia

A

Social withdrawal
Apathy
Depression

59
Q
  1. Acute stage schizo
A

Late teens and early adulthood; brought on by stressor that can trigger a psychotic break

60
Q
  1. Stabilization stage schizo
A

Still symptomatic but symptoms lessened

More in touch with reality than acute episode

61
Q
  1. Maintenance and recovery stage schizo
A

Nurses can make significant impact during this phase - even if client fully adherent to meds, still have 50% chance of relapse

62
Q
  1. Relapse stage achizo
A

If pt stops taking meds, could develop EPS

63
Q

Bipolar disorder

A

Bouts of depression and several manic episodes

64
Q

Manic symotoms

A 
Sleep diminished 
Inflated self esteem
Difficulty concentrating
Decreased appetite 
Increased risky behaviors
Psychomotor agitation
65
Q

Hypomanic symptoms

A 
Decreased sleep
Craving more relations
Hypoactivity
Not as much reckless behavior but some experimentation with drugs and alcohol
Hyperverbal
66
Q

What is the first line treatment for seasonal affective disorder?

A

Light therapy

67
Q

Dysthmic disorder

A

Milder form of depression
Lasts 2 years
Can later become MDD

68
Q
  1. Acute phase MDD
A

Severe depression
6 to 12 weeks
Potential for hospitalization

69
Q
  1. Continuation phase MDD
A

Increased ability to function

4 to 9 months

70
Q
  1. Maintenance phase MDD
A

Remission of manifestations

Can last for several years

71
Q

What gender is more likely to develop depression?

A

Females

72
Q
  1. Acute phase bipolar
A

Acute mania
Hospitalization may be required
One to one supervision
Asses risk of harm to self or others

73
Q
  1. Continuation phase bipolar
A

Remission of manifestations

Treatment 4 to 9 months

74
Q
  1. Maintenance phase bipolar
A

Increased ability to function
Treatment continues through lifetime
Prevent future manic episodes

75
Q

How long do manic episodes last?

A

At least one week

76
Q

How long does hypomania last?

A

At least 4 days

77
Q

What is rapid cycling?

A

Four or more episodes of hypomania or acute mania within 1 year

78
Q

What symptoms can come before a manic episode?

A

Sleep disturbances

79
Q

Schizophrenia

A

Psychotic thinking or behavior for at least 6 months

80
Q

Schizophreniform disorder

A

Manifestations similar to schizophrenia but duration is 1 to 6 months

81
Q

Schizoaffective disorder

A

Disorder meets criteria for schizophrenia and depressive or bipolar disorder

82
Q

Manifestations of things that are not normally present

A

Positive symptoms

83
Q

Absence of things that are normally present

A

Negative symptoms

84
Q

What drug class is the best choice for long term anxiety?

A

Antidepressants

85
Q

How long does it take for antidepressants to work?

A

2-6 weeks

86
Q

Use caution taking NSAIDs with what drug?

A

Lithium carbonate

87
Q

What is the outcome of disordered water balance?

A

Seizures, coma, and/or death

88
Q

Signs of acute dysonia (EPS)

A 
Muscle rigidity 
Muscle rigidity
Torticollis (twisted neck)
Oculogyric crisis
Jaw pain
89
Q

What EPS will you generally see first

A

Acute dystonia

90
Q

Signs of pseudoparkinsonism (EPS)

A 
Tremor 
Slowed movement
Rigidity
Loss of facial expression
Drooling
91
Q

Signs of Akathesia (EPS)

A

Motor restlessness
Agitation
Hyperverbal/ difficulty communicating

92
Q

Signs of tardive dyskinesia (EPS)

A

Permanent movement disorder
Lip smacking, tongue protrusion, puckering
Persistent but symptoms can be minizimed

93
Q

Steps of nursing process

A 
Assess
Diagnose (nanda)
Outcome identification
Planning
Implementation
Evaluation
94
Q

Mood examples

A 
Depressed
Fearful
Hopeless
Euphoric
Anxious
Happy
Neutral
Appropriate to situation
95
Q

Affect examples

A 
Flat
Blunted
Labor
Incongruent with mood
Congruent with mood
96
Q

Premorbid stage schizo

A

Social withdrawal
Irritability
Antagonistic thoughts

97
Q

Prodromal phase schizo

A

Decline in functioning that precedes 1st psychotic episode

98
Q

Active phase schizo

A

Psychotic symptoms present

99
Q

Residual phase schizo

A

Remission of symptoms

100
Q

Erotomatic (delusional disorder)

A

Believing someone (often famous) is in love with them

101
Q

Grandiose (delusional disorder)

A

May believe they have a special relationship with someone famous
May believe themselves to be a deity or religious leader

102
Q

Persecutory (delusional disorder)

A

Believe they are being poisoned, followed, cheated, spied on
Often will contact authorities multiple times
Most common

103
Q

Somatic (delusional disorder)

A

Believe they have a medical condition

104
Q

Jealous (delusional disorder)

A

Focus on significant other being unfaithful

Can be violent towards them

105
Q

What can steroidal contraceptives cause?

A

Depression or periods of rage, irritability

106
Q

When are depressed patients at highest risk for suicide?

A

When they seem to be coming out of depression because they have the energy to carry out their plan

107
Q

(Just sit there and say nothing)

A

Using silence

Therapeutic

108
Q

“Yes I understand what you said”

A

Accepting

Therapeutic

109
Q

“Hello Jay. I see you made your bed”

A

Giving recognition

Therapuetic

110
Q

“I’ll stay with you awhile”

A

Offering self

Therapeutic

111
Q

“What would you like to talk about today?”

A

Giving broad openings

Therapuetic

112
Q

“What seemed to lead up to…”

A

Placing the event in time or sequence

Therapeutic

113
Q

“I noticed you are pacing a lot”

A

Making observations

Therapeutic

114
Q

“Yes I see. Go on”

A

Offering general leads

Therapeutic

115
Q

“What do the voices seem to be saying?”

A

Encouraging description of perceptions

Therapeutic

116
Q

Pt: “I can’t my mind is wandering”
Nurse: “ you have trouble concentrating”

A

Restating

Therapuetic

117
Q

“What helped you last time you felt this way?”

A

Encouraging comparison

Therapeutic

118
Q

Pt: “i have to do everything for my mom!”
Nurse: “you’re angry you don’t have help”

A

Reflecting

Therapeutic

119
Q

“Maybe we can discuss this further”

A

Focusing

Therapeutic

120
Q

“Please tell me more details about this situation”

A

Exploring

Therapeutic

121
Q

“I’m not sure I understand. Can you explain?”

A

Seeking clarification and validation

Therapeutic

122
Q

“I understand the voices are real to you, but I do not hear them”

A

Presenting reality

Therapeutic

123
Q

“I find that difficult to believe”

A

Voicing doubt

Therapeutic

124
Q

Pt: “this is a waste of time”
Nurse: “are you feeling like No one understands?”

A

Vandalizing the implied

Therapeutic

125
Q

“What could you do to let your anger out without hurting anyone?”

A

Formulating a plan of action

Therapeutic

126
Q

Pt: “I’m always out in the ocean”
Nurse: “you must be feeling lonely right now”

A

Attempting to translate words into feelings

Therapeutic

127
Q

“Everything will be alright. Don’t worry”

A

Giving reassurance

Non therapeutic

128
Q

“I don’t wanna hear about that”

A

Rejection

Non therapeutic

129
Q

“That’s right” or “That’s wrong”

A

Agreeing or disagreeing

Non therapeutic

130
Q

“That’s good” “That’s bad” “I’m glad you…”

A

Approving or disapproving

Non therapeutic

131
Q

“I think you should…”

A

Giving advice

Non therapeutic

132
Q

“Tell me how your mother abused you as a child”

A

Probing

Non therapeutic

133
Q

“Why did you do that?”

A

Requesting an explanation

Non therapeutic

134
Q

“None of the staff would lie to you”

A

Defending

Non therapeutic

135
Q

“What makes you say that?”

A

Indicating the existence of an external source of power

Non therapeutic

136
Q

Pt: “ I have no reason to live”
Nurse: “oh, everyone has bad days”

A

Belittling feelings expressed

Non therapeutic

137
Q

“Hang in there” “keep your chin up”

A

Making stereotypical comments

Non therapeutic

138
Q

Pt: “I’m nothing”
Nurse: “of course you’re something, everyone is”

A

Using denial

Non therapeutic

139
Q

“What you really mean is…”

A

Interpreting

Non therapeutic

140
Q

Pt: “ I have nothing to live for”
Nurse: “did you have visitors today?”

A

Introducing an unrelated topic

Non therapeutic

Mental Health (2 decks)

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