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Mental Health > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

When obtaining family history- what information would I include on relatives?

A

First degree only, parents, sibs, grandparents and children

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2
Q

Risk Factors vs/Protective factors

A

Look up in book- cut out friends or family members who tempt you to drink or use drugs and who affect your mood.

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3
Q

Anhedonia

A

inability to feel pleasure

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4
Q

Echolalia

A

parrot like repetition of someone else’s words

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5
Q

Aphasia

A

inability to understand or express speech

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6
Q

avolition

A

lack of motivation

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7
Q

clang association

A

rhyming

clang, bang, rang

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8
Q

tangenital

A

inability to get to the point of the story

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9
Q

neologisms

A

new words that an individual invents

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10
Q

CAGE Assessment or alcohol

A

Cut down, annoyed, guilty, eye opener
All questions directed at individual
Have your ever felt annoyed by your friends asking you to stop drinking

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11
Q

Example of Psychoeducation in Psychiatric-Mental Health History

A

Anger management, etc

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12
Q

When taking medical history what do we need to address prior to addressing the mental health issues

A

Rule out any medical conditions first before focusing on mental health. Could be contributor

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13
Q

Syphillis can appear like what mental health illness

A

Schizophrenia

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14
Q

CIWA-AR Assessment is for what

A

Probability for alcohol withdrawal, 40% of patients admitted to med surge unit are at risk for alcohol withdrawal

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15
Q

Common Lab tests performed and what is RPR

A

CBC, Chem panel for liver and kidney function, comprehensive metabolic panel, thyroid function, folate, RPR- Rapid plasma reagin (tests for syphilis), Urine toxicology, UHCG (pregnant).

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16
Q

Suicidal thoughts or attempts screening test

A

CSSRS- Columbia Suicide Severity Rating Scale

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17
Q

Disheveled

A

Untidy and disordered

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18
Q

Emaciated

A

Abnormally thin or weak

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19
Q

Hyperactive behavior could be described as

A

constant activity but also easily distracted

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20
Q

Apathetic Attitude

A

Showing or feeling no interest, enthusiasm, or concern

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21
Q

Speech is described in 3 categories of a patient

A

Quality Quantity and Rate

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22
Q

Monotonous speech describes

A

Quality and think monotone

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23
Q

Quantity of speech is labeled as

A

talkative, unspontaneous, normally responsive

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24
Q

Rate of Speech

A

Rapid, slow, hesitant, staccato (short choppy sentences), stuttering, pressured

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25
Q

Mood is objective or subjective

A

Subjective

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26
Q

Despairing mood

A

Showing loss of all hope

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27
Q

Expansive mood

A

larger than life behavior, brass or lavish

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28
Q

Self contemptuous mood

A

lack of admiration for oneself

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29
Q

If my mood is labile what does that mean

A

Easily altered or changeable

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30
Q

Futile mood

A

Ineffective, useless, producing no effect

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31
Q

Affect can be described as

A

Within normal range, constricted, blunt, flat

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32
Q

Constricted

A

Range and intensity of expression are reduced

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33
Q

Blunted

A

Persons expression is further reduced

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34
Q

Flat Affect

A

Virtually no signs of expression are present.

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35
Q

Affect can be congruent or Incongruent with patients reported _____. Explain

A

Mood. In line with the mood or incongruent. Doest align so bad mood but appears/acting happy

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36
Q

Types of Hallucinations

A

Auditory, visual, or tactile. Auditory is most common

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37
Q

Hallucinations are….

A

Sensory distortion in the absence of a stimulus

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38
Q

Delusions are

A

Fixed false beliefs that the patient is convinced of and hard to change their mind

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39
Q

An illusion is what

A

A sensory distortion in the presence of a stimulus. Example a child may perceive tree branches at night as if they are goblins

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40
Q

Thought disturbance that is called Ideas of reference is what

A

Misrepresentation of external incident or event that is going on and relates to them but in reality doesn’t at all. Thinking that everyone on the bus having a conversation is talking about them

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41
Q

Flight of idea thought process

A

A succession of multiple associations so that thought seems to move from idea to idea often

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42
Q

What is circumstantiality

A

Kind of like tangential except instead of not getting to the point of the story this individual over explains the trivial details which delays getting to the point of the story

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43
Q

Looseness of association Throught process

A

Sentences do not make sense. The words are spoken together but make no sense an we switch from one topic to the next

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44
Q

Perseveration

A

Persistent repetition of the same word or idea to peoples questions

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45
Q

Echolalia

A

Parrot-like repetition of the words spoken by another

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46
Q

Neologisms

A

New words the person invents that have no meaning

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47
Q

Word salad thought process

A

Group of words put together in a random fashion without any logical connection

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48
Q

Confabulation memory/cognition

A

Honest lying. False memories without the intent to deceive

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49
Q

Orientation and memory is lost in what order and regained in what order

A

Time, Place, person (sense of self last to go)

When regained it goes back and will be regained by person first, then place, then time

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50
Q

A patient with schizophrenia hears a person say that people in glass houses should not throw stones, the patient responds by saying because you can break the house. This is an example of

A

abstract thought

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51
Q

The patients mental status examination ends with what

A

The nurses/psychiatrist’s impression of the patients reliability and their capacity to report their situation accurately. Reliability includes estimate of patients veracity

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52
Q

What are protective factors in suicide

A

Preventative methods in both thought and action
(No access to lethal means, easy access to treatment, family friends and community support, support from ongoing healthcare provider relationships

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53
Q

The C-SSRS Assessment has how many questions, which ones answered yes require mental health referral vs immediate help

A

Any yes of the time 6 questions will require a mental health referral, but answering yes to 4, 5, and/or 6 requires immediate help

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54
Q

SAFE T consists of what

A
  1. Identify risk factors
  2. Identify protective factors
  3. Conduct suicide inquiry
  4. Determine risk level and implement appropriate interventions
  5. Document (risk assessment, interventions, evaluations)
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55
Q

Primary main focus for planning and intervention with patient at risk of suicide

A

Ensure the persons safety, performing those 15 minute checks in an inpatient mental health is huge

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56
Q

Crisis Prevention Plan includes 7 steps

A
  1. Identify the upsetting thoughts
  2. Write out and review rational responses to this (coping skills)
  3. Do things that help feel better for 30 minutes
  4. Repeat steps 1-3
  5. If the suicide behavior escalates, call someone in support system
  6. Cannot reach first person, call second person on list
  7. If cannot reach second person and behavior continues call suicide hotline
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57
Q

Diagnostic criteria of Schizophrenia

A

Consists of positive and negative symptoms that prevent the person from functioning in society to best of ability

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58
Q

Hallucinations and Delusions are

A

Positive symptoms

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59
Q

Grandiose delusion

A

Exceptional power

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60
Q

Nihilistic Delusion

A

Patient thinks they are dead

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61
Q

Persecutory Delusion

A

Patient thinks they are being plotted against

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62
Q

Somatic Delusion

A

Person thinks they have a bodily function abnormality

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63
Q

Hallucinations involve one of the 5 senses but ____ is the most common

A

Auditory

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64
Q

Alogia

A

Poverty of thought or speech- mumbling. Negative symptom of Schizophrenia

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65
Q

Alterations in speech and bizarre behaviors are positive or negative symptoms of schizophrenia

A

Positive

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66
Q

Negative symptoms of schizophrenia are the _____ of something that usually happens

A

absence. Anhedonia, avolition, anergia.

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67
Q

Should you allow patient to think the hallucinations are real?

A

No return to reality but ask them about what they are experiencing

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68
Q

First generation Anti-psychotic medications used to control what

A

Positive signs of schizophrenia

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69
Q

MOA of First generation anti psychotics

A

Block dopamine, histamine, AcTh, and norepinephrine receptors in the brain and in the periphery

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70
Q

Epidemiology and risk factors for developing schizophrenia

A

Possible past stressors in childhood or growing up that caused this to happen. Migrant status. Having a family relative diagnosed with schizophrenia makes it 10x more likely someone will be diagnosed.

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71
Q

Schizophrenia occurs in what age for males in compared to women

A

18-25 for males

25-35 for females but females have better outcomes

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72
Q

Comorbidity of Schizophrenia

A

Substance use, depression , diabetes, metabolic syndrome, risk for harm, obesity anxiety

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73
Q

What is a strength assessment in a mental health assessment

A

The patients stress and coping mechanisms. What gives hope about the future

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74
Q

Nursing Assessment of someone with Schizophrenia

A

Physical Check to rule out physical ailment causing these symptoms. Look at physical functioning as member of society, nutrition status, then look at the medication adherence and any substance use

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75
Q

How long do anti psychotic medications usually take to affect change in symptoms

A

1-2 weeks

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76
Q

How long should patient take anti psychotic medication before considering a change?

A

6-12 weeks

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77
Q

Injectable anti psychotics are a thing? True or false

A

True, injection every 30 days

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78
Q

Psychosocial interventions with Schizophrenic patients

A

Memory problems- make lists
Executive functioning- simulations to mimic being out in the real world and interacting with people
Behavioral issues- Positive reinforcement of performing their ADLs, focus on motivation and organization

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79
Q

In acute phase of schizophrenia, the most important intervention is

A

Promotion of safety

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80
Q

What is schizoaffective disorder

A

Also known as SAD, has psychosis and mood disturbances. Better outcome than schizophrenic patients. Like being on a emotional roller coaster with someone

81
Q

What is delusional disorder

A

Delusions for 1 month, no other symptoms

82
Q

Types of disorganized behavior

A

Disorganized thoughts, speeches or behavior

83
Q

What do you need to show in order to be diagnosed with schizophrenia

A

Positive and negative symptoms present for at least 1-6 months

84
Q

Developing therapeutic relationship with schizophrenic patient what is important

A

Approach in calm manner, develop trust, and realize that developing that trust will take time

85
Q

Schizophreniform

A

Its schizophrenia but only lasts for 6 months or less. has to occur for at least 1 month. In 2/3rds of cases it could lead to schizophrenia

86
Q

Brief Psychotic Disorder

A

At least one day but less than a month, includes one positive of schizophrenia

87
Q

Bipolar has two poles, what are they

A

Mania and depression

88
Q

Is there a gene identified for Bipolar

A

No gene but strong evidence to suggest genetic component

89
Q

Bipolar affects men more than women, true or false

A

False. It affects them both equally but women are more likely to seek treatment

90
Q

Mania is defined as what, and can it include a state of psychosis?

A

Very elevated mood for at least 1 week and yes it can include psychosis- hallucinations

91
Q

What is hypomania

A

4 days duration with the same symptoms as mania but a lighter version. Not extreme enough to have psychosis, warrant hospitalization, and cant still function at work but detrimental to close relationships. Could include mood elevation or irritable mood

92
Q

Mixed episode of Bipolar

A

Can include both mania and depression at the same time to varying degrees

93
Q

Cyclothymic Bipolar

A

Switch between hypomanic episode and depressive with rapid cycling
Symptoms have occurred for at least 2 years and without remission for more than 2 months

94
Q

Bipolar 1, is it serious? what are symptom presentation and does it include psychosis

A

Most serious
One episode of Mania, alternating with one episode of depression
May include psychosis

95
Q

Examples of mania

A

Inflated self esteem, decreased need for sleep, very talkative, easily distracted, flight of ideas, racing thoughts, too many projects, risky behavior

96
Q

Mania cannot be attributed to other causes, meds, or substances? true or false

A

true

97
Q

Bipolar 2, is it more serious or common than Bipolar 1? and what does it consist of

A

It is more common
One or more hypomanic episodes alternating with depressive episodes
There is no full mania or psychosis
Its less serious because its toned down

98
Q

When assessing between Bipolar and depression be sure to ask questions relating to what?

A

Ask questions relating to the high episodes to prevent misdiagnosis. Major depressive disorder is the most common misdiagnosis

99
Q

What mental health disorder is most commonly associated with suicide?

A

Bipolar

100
Q

Mania could often be confused for what physiological condition a px is experiencing

A

Hyperglycemia (agitation)

101
Q

In Bipolar patients always accurately assess what?

A

Assess suicide risk, doesn’t have to be recent

102
Q

For suicide risk assess what things

A

Px have plan, access to lethal means, acts of deceptiveness relating to doing it

103
Q

Nursing interventions for Bipolar Disorder

A 
Clear and concise directions 
Recommend boxed breathing 
Suicide risk is high 
Avoid arguing and debating 
Establish routines 
Ask lots of open ended questions (Tell me what its like...)
104
Q

Dual Diagnosis consists of what?

A
  1. Substance use disorder
    w/
  2. Depression or bipolar (mental health disorder of some sort)

Alcoholic with depression is dual diagnosis

105
Q

Nursing diagnosis Imbalanced eating

A

Give them food to eat on the run

106
Q

What is critical for mood disorder patients? This will prevent relapse and bad outcomes

A

Medication adherence and knowledge on their medications. Also need to know side effects

107
Q

What causes depression

A

Neurochemical imbalances- serotonin, dopamine , norepinephrine deficiencies
Genetic factors- Inherited variances in alleles and environment can play factor
Hormonal imbalances, stress, circadian rhythms.

108
Q

Can you test neurotransmitter levels?

A

No, only on autopsy

109
Q

Major depressive disorder is diagnosed by

A

Must experience 5 or more symptoms for at least 2 weeks
Depressed mood an/or feeling of hopelessness, SI, thinking of death, increased or decreased sleep, weight gain/weight loss, etc.
**Must cause significant dysfunction and this is not related to meds, substances or other mood disorders.

110
Q

When assessing for depression ask about ____ and observe ____. Remember to take notice of the 4 As

A

Mood, Affect

Anhedonia (Without joy), Anergia (No energy), Apathy (no personality) Avolution (lack of motivation

111
Q

Is major depressive disorder usually diagnosed on its own?

A

No, typically it goes along with something else, anxiety, personality, schizophrenia, etc

112
Q

What is ECT and why do we utilize it

A

Electroconvulsive Therapy
Typically used for pxs not responding to antidepressants
Electrodes attached to brain “straightens out tangles”
6-15 treatments
The shock stimulates brain chemistry to correct chemical imbalance of depression

113
Q

Patient care ECT

A

Same as an operation- remove jewlery, IV, O2
Sedation and muscle relaxant administered
Some short memory impairment, usually have headache afterwards

114
Q

What is CBT (Cognitive Behavioral Therapy)

A

Therapy to improve problem solving and interpersonal skills with the patient

115
Q

Depression Medications - what they do MOA

A

SSRIs and tricyclics act by increasing concentration of serotonin/norepinephrine/dopamine by blocking the reuptake of those neurotransmitters

Drugs-
TCA
SSRI
SNRI
MAOIs- inhibit monoamine oxidase enzymes that inactivate serotonin/norepinephrine/and dopamine in the body
116
Q

Thank TCA stands for

A

Tricycle antidepressant

117
Q

SSRI stand for

A

Selective serotonin reuptake inhibitor

118
Q

SNRI

A

Serotonin and norepinephrine reuptake inhibitor

119
Q

Blackbox warning for anti depressants

A

Taking these meds prior to age 25 can increase risk of suicide

120
Q

First choice drug for MDD

A

SSRIs

121
Q

Common side affects of Anti Depressants

A

weight gain, insomnia, agitation, sexual dysfunction

122
Q

Are SSRIs considered as effective as SSRIs? and what other therapeutic purpose can they serve?

A

Yes and they can help with pain relief (Neuralgia)

123
Q

SNRI Side effects

A

Same as SSRIs in addition to stomach pain

124
Q

What was the first antidepressant available

A

TCAs, can aggravate symptoms with person who has schizophrenia.

125
Q

Common side effects of tricyclics

A

Blurred vision, anti-cholinergic effects, weight gain, MAJOR ARRHYTHMIAS (EKG)

126
Q

Can I take MAOIs with SSRI’s?

A

No they are contraindicated- you are doubling up on something that will block the enzyme that inactivates serotonin and norepinephrine as well as drug that prevents the reuptake

127
Q

Taking MAOI and SSRI will cause what

A

Serotonin Syndrome

128
Q

MAOIs are generally the 2nd or third choice for depression due to what, name most common and the most dangerous side effect

A

Side effects
Insomnia
Hypertensive crisis (Avoid tyramine containing foods)

129
Q

Tyramine containing foods

A

Caviar, herring, soy sauce, smoked and processed meats, aged cheeses, raisins, beans, pea pods, aged cheeses, MSG and brewers yeast, corned beef, chicken, beef liver, red wines and some beers

130
Q

Citalopram

A

Celexa- SSRI

131
Q

Fluoxetine

A

Prozac SSRI

132
Q

Escitalopram

A

Lexapro SSRI

133
Q

Paroxetine

A

Paxil SSRI

134
Q

Sertraline

A

Zoloft SSRI

135
Q

Good drug for generalized anxiety disorder

A

SNRIs

136
Q

Can you take TCA with SSRIs

A

Yes, often just increases the effects

137
Q

Carbamazepine and Valproate are what, how do they work

A

Anticonvulsant drugs that treat mania and seizures.
Calms hyperactivity in the brain, are used for people with rapid cycling (4 or more episodes) of mania and depression within a year

138
Q

What is double depressive disorder

A

can be in children and adults, persistent depression for 2 years

139
Q

Anticonvulsants can treat depression but also

A

Bipolar…its manic and depression

140
Q

Isocarboxazid (Marplan), Phenelzine (Nardil), and Tranlycpromine (Parnate)

“I hardly plan to partake”

A

MAOIs

141
Q

Amitriptyline (Elavil)

A

TCA

142
Q

Doxepin (Sinequan)

A

TCA

143
Q

Imipramine (Tofranil)

A

TCA

144
Q

Nortriptyline (Pamelor)

A

TCA

145
Q

What drugs can be prescribed for Bipolar

A

Anticonvulsants, Antipsychotics (mainly second generation due to less side effects), and mood stabilizer drugs

146
Q

First sign of lithium toxicity

A

tremors especially in the hands

147
Q

Main consideration for lithium

A

Monitor levels of the drug in system to avoid toxicity

148
Q

Lithium therapeutic range

A

.6-1.2 mEq/L

149
Q

After starting someone on lithium when do we check their labs

A

Within 5 days of start, weekly, monthly, 3 month, 6-12 month mark

150
Q

Lithium- fluid status is important

A

Assess sodium and renal labs, contributor to possible toxicity

151
Q

Anti-psychotics can Treat what

A

Schizophrenia and Bipolar

152
Q

Why do we ensure adequate salt intake with lithium

A

Not enough salt, not enough 02, causing toxicity

153
Q

What do we do if the lithium level is too high

A

Hold dose and call provider

154
Q

Lithium toxicity symptoms

A

Hand tremors, blurred vision, ataxia, nausea and vomiting

155
Q

Lamotrogine (Lamictal) is what and what is a potential side effect

A

It is an anti convulsant, steven johnson syndrome (see a rash, call the provider)

156
Q

What should you do with lithium patient if dosage increases or their behavior changes

A

Draw labs!

157
Q

Take NSAIDS with Lithium?

A

No! High salt

158
Q

First generation anti-psychotics treat what

A

Control positive symptoms of psychotic disorders (Schizophrenia)

159
Q

First generation anti-psychotics MOA

A

Block dopamine, ACTH, histamine and norepinephrine receptors in the brain and periphery

160
Q

Hallucinations can be caused by dopamine hyperactivity in what part of the brain

A

Trigeminal area

161
Q

First Generation Antipsychotic side effects

A

Extrapyramidal Adverse Effects, Agranulocytosis, anti-cholinergic effects

162
Q

Command Hallucinations are what

A

Some non external stimuli that is telling you to do something

163
Q

First Generation anti-psychotics do what MOA

A

Block dopamine in the basal ganglia, hypothalamus, medulla, and brain stem

164
Q

Which medication treats acute agitation of schizophrenia

A

Haloperidol (Haldol) First generation anti-psychotic

165
Q

First or Second generation anti-psychotics have more side effects?

A

FIRST GENERATION!

166
Q

Conventional Antipsychotics are first or second generation

A

Frist generation

167
Q

Second Generation anti-psychotics are also called

A

Atypical

168
Q

Second Generation Anti Psychotics treat what symptoms of Schizophrenia

A

Positive and negative

169
Q

What is first line of treatment med for Schizophrenia or breakthrough episodes

A

Second generation anti-psychotics

170
Q

MOA of Second Generation anti-psychotics

A

Blocks SEROTONIN and dopamine, and to lesser extent histamine, norepinephrine, and ACTH

171
Q

Anti-psychotic side effect of Neuroleptic malignant syndrome

A

Fever, BP, muscle rigidity, life threatening, Stop med and monitor vitals. Wait 2 weeks to resume med or switch

172
Q

Any med that has anti-cholinergic effect should be tapered in both directions?

A

Yes, Low and slow initially and taper off gradually

173
Q

Anti- convulsants are often utilized to treat ____ _____

A

Acute mania

174
Q

Serotonin Syndrome symptoms

A

Confusion, agitation, restlessness, Bp is up , rapid HR, twitchy muscles

175
Q

Neuroleptic Malignant syndrome symptoms

A

Very high fever and muscle rigidity

176
Q

Mild lithium toxicity symptoms

A

fine tremors, nausea, and confusion

177
Q

Hypertensive crisis

A

Elevated BP, Confusion, agitation

178
Q

Off label medication used to treat mania in Bipolar

A

Antiseizure medications/Anti convulsant

179
Q

What drug is utilized when first line meds are ineffective in treating depression

A

TCAs

180
Q

What is SAD

A

Seasonal Affective disorder, people that live in Washington, Depressed because it rains all the time

181
Q

Drug treatment order for Bipolar

A

Lithium- Anti-seizure/convulsant- then the last choice is an anti-psychotic

182
Q

Second Generation Anti-psychotics do have many less anti-cholinergic and fewer to no EPS but what are some complications of them

A

Metabolic syndrome, orthostatic hypotension, anti-cholinergic effects and mild EPS

183
Q

What are Extra Pyramidal symptoms and what drugs do they involve

A

Think voluntary and involuntary muscle twitching, tremors, inability to sit still and it deals with Anti-psychotic medications

184
Q

Third generation Anti-psychotics treat and moa

A

Treat both positive and negative symptoms the MOA is stabilizing dopamine as both an agonist and antagonist.

185
Q

Third generation Anti-psychotic benefits

A

Even lower risk of anti-cholinergic effects, diabetes, weight gain, anti-cholinergic, etc

186
Q

Most dangerous side effect of hypertensive crisis associated with which drug

A

MAOI

187
Q

Potency of Haldol, Loxapine, and Fluphenazine

A

Haldol- high
Loxapine- medium
Fluphenazine- high

188
Q

Risperidone is what

A

2nd gen Anti-psychotic

189
Q

Clozapine is what

A

2nd gen anti-psychotic

190
Q

Olanzipine

A

Second gen anti-psychotic

191
Q

Aripiprazole is what

A

Third generation anti-psychotic

192
Q

EPS side effects occur with drugs that block what

A

Dopamine

193
Q

EPS side effects associated mainly with anti-psychotics, true or false

A

True

194
Q

EPS side effect of Parkinsonism

A

Mimics parkinson

195
Q

EPS side effect of dystonic reactions

A

intermittent spasm of muscles in face and neck, larynx, trunk

196
Q

Akathisia side effect of what meds and what does it look like

A

Anti psych anti depressant, cant sit still! Psychomotor restlessness

197
Q

Tardive dyskinesia associated side effect of what drugs and what does it look like

A

Facial tics, involuntary facial movements, smacking lips, tongue thrusting, rapid blinking. Associated with anti psych meds

198
Q

Definition of echopraxia

A

Purposeful imitation of movements made by others

Mental Health (3 decks)

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