Exam 2 Flashcards
(141 cards)
1
Q
Altered perception, cognition, and/or impaired ability to determine what is real:
A
psychosis
2
Q
delusional disorder:
A
false thoughts or beliefs that have lasted 1 month or longer. Usually not severe enough to impair functioning
3
Q
Schizophrenia is often preceded by this phase…
A
prodromal phase
4
Q
Milder symptoms of schizophrenia–can last months or years before the full disorder manifests:
A
prodromal phase
5
Q
Comorbidities for schizophrenia:
A
substance use disorders
anxiety
depression
suicide
physical illness - CVD and metabolic syndrome contribute to premature death
polydipsia - a contributing factor is antipsychotics that cause dry mouth
6
Q
Risk factors for developing schizophrenia:
A
-genetic
-neurobiological - use of amphetamines and cocaine enhance dopamine activity which can induce psychosis and precipitate schizophrenia
-brain structure abnormalities
-prenatal stressors
-environmental factors
7
Q
Acute Phase of Schizophrenia:
A
hallucinations, delusions, apathy, social withdrawal, anhedonia, impaired judgment and cognition, difficulty coping; symptoms become apparent to others.
–can last several months even with treatment
8
Q
Stabilization Phase of Schizophrenia:
A
movement toward previous functioning
-continued outpatient or partial hospitalization may be required
-can last several months
9
Q
Maintenance or Residual Phase of Schizophrenia:
A
a new baseline may be established
-positive symptoms are diminished or absent
-negative symptoms continue to be a concern
10
Q
Positive Symptoms:
A
presence of symptoms that SHOULD NOT be present:
hallucinations
delusions
paranoia
disorganized/bizarre thoughts, behavior and/or speech
11
Q
Negative Symptoms:
A
ABSENCE of qualities that SHOULD BE present
-anhedonia
-social discomfort
-lack of goal directed behavior
-avolition
-alogia
12
Q
Cognitive Symptoms:
A
subtle or obvious impairment in memory, attention, thinking, problem solving, impulse control
13
Q
Affective Symptoms:
A
symptoms involving emotions and their expression
14
Q
Automatic and unconscious process by which we determine what is and is not real…
A
reality testing
-this is an example of a positive symptom of schizophrenia
15
Q
false beliefs that are held despite a lack of evidence to support them:
A
delusions
16
Q
common delusions:
A
persecutory, grandiose, religious
17
Q
Term for unusual speech pattern that results from haphazard and illogical thinking where concentration is poor and thoughts are loosely connected:
A
associative looseness
18
Q
Most extreme form of associative looseness which is a jumble of words that is meaningless to the listener:
A
word salad
19
Q
Choosing words based on their sound rather than meaning (often rhyming, for example):
A
clang association
20
Q
words that have meaning for the patient but a different or nonexistent meaning for others:
A
neologisms
21
Q
poverty of thought:
A
alogia
22
Q
loss of motivation
A
avolition
23
Q
inability to experience pleasure or joy
A
anhedonia
24
Q
pathological repetition of another’s words
A
echolalia
25
conversations including unnecessary and often tedious details but eventually reaching the point
circumstantiality
26
wandering off topic or going on on tangents and never reaching the point
tangentiality
27
generalized slowing and thinking; difficulty finishing thoughts
cognitive retardation
28
urgent or intense speech; reluctance to allow comments from others
pressured speech
29
moving rapidly from one thought to the next
flight of ideas
30
reduction or stoppage of thought; cognitive disorganization or interruption of thought can cause this
thought blocking
31
often uncomfortable belief that someone else has inserted thoughts into the patient's brain
thought insertion
32
a belief that thoughts have been taken or are missing
thought deletion
33
believing that reality can be changed simply by thoughts or unrelated actions
magical thinking
34
irrational fear from mild to profound; may result in dangerous defensive actions
paranoia
35
alterations in perception (can include all five senses)
hallucinations
36
a feeling of being unreal or having lost an element of one's person or identity
depersonalization
37
a feeling that the environment has changed and everything appears strange and unfamiliar
derealization
38
pronounced increase or decrease in the rate and amount of movement
catatonia
39
muscular rigidity
catalepsy
-may be very severe and lead to exhaustion, pneumonia, blood clotting, malnutrition, dehydration
40
pronounced slowing of movement
motor retardation
41
excited behavior, such as running or pacing - can put patient at risk
motor agitation
42
mimicking of movements of another
echopraxia
43
tendency to resist or oppose the requests or wishes of others
negativism
44
assuming illogical expressions, posture, or positions
gesturing/posturing
45
impaired ability to sense where one's body ends and another's begins
boundary impairment
46
decreased desire for social interaction
asociality
47
reduced or constricted affect
affective blunting
48
Typically affects of schizophrenia:
flat
blunted
constricted
inappropriate - incongruent with actual emotional state
bizarre
49
impaired ability to think abstractly
concrete thinking
50
inability to realize one is ill (caused by the illness itself)
anosognosia
51
What does the recovery model focus on?
hope
living a full and productive life
recovery rather than focusing on controlling symptoms and adapting to disability
52
What is the overall goal of the acute phase of schizophrenia?
patient safety and stabilization
Also, that patient consistently labels hallucinations as "not real and a symptom of illness"
53
First-gen antipsychotics are _____ antagonists.
dopamine
54
Examples of first-gen antipsychotics:
haloperidol
chlorpromazine
55
First-gen antipsychotics work primarily by reducing _____ symptoms but have little effect on _____ symptoms.
positive; negative
56
Benefits of second-gen antipsychotics:
-treat positive symptoms and help negative symptoms
-fewer and better-tolerated side-effects
57
atypical antipsychotics are ____ and ____ antagonists.
serotonin; dopamine
58
Examples of atypical antipsychotics:
clozapine
risperidone
59
Side effects of first-gen antipsychotics:
-extrapyramidal side effects
--acute dystonia
--akathisia
--pseudoparkinsonism
--tardive dyskinesia
-anticholinergic side effects - dry mouth, blurred vision, constipation, urinary retention, tachycardia
Other: sedation, orthostatic hypotension, lowered seizure threshold, photosensitivity
60
sudden, sustained contraction of one or several muscle groups, usually of the head and neck
acute dystonia
61
motor restlessness that causes pacing and/or an inability to stay still
akathisia
62
temporary group of symptoms that resemble Parkinson disease
pseudoparkinsonism
63
persistent EPS involving involuntary rhythmic movements
tardive dyskinesia
(smoking, alcohol, and stimulate use increase risk)
64
Serious side effects of antipsychotic medications:
neuroleptic malignant syndrome, severe neutropenia, anticholinergic toxicity
65
Metabolic Syndrome
weight gain, abnormal lipid levels, increased insulin resistance which leads to increased risk of CVD, diabetes, etc.
66
Comorbidities of Bipolar I:
-migraines
-metabolic syndrome
-ADHD
-substance use disorder
-anxiety disorders
67
Comorbidities of Bipolar II:
-anxiety disorders
-eating disorders
-substance use disorders
68
Some people with bipolar I or II will experience _____________ and may have at least four mood episodes in a 12 month period.
rapid cycling
69
Risk factors of Bipolar Disorder:
-genetic
-neurobiological
-brain structure and function - particularly in the prefrontal cortex, hippocampus, and amygdala
-neuroendocrine - hypothyroidism
-peripheral inflammation - both manic and depressive states increase peripheral inflammation
-cognitive factors
-environmental factors
70
Mania may cause these disorganized thoughts and speech patterns:
pressured speech
circumstantial speech
tangential speech
loose association
flight of ideas
clang associations
71
Thought content related to mania:
grandiose delusions
persecutory delusions
72
Therapeutic level of lithium:
0.8-1.2mEq/L (target range for a 12-hr serum trough)
73
When should you draw the first lithium level?
every 2-3 days after beginning and after any dosage change until the therapeutic level has been reached. Then every 3-6 months.
74
What blood work should you check before starting lithium?
renal and thyroid status
75
What is valproate and valproic acid used for?
treating acute mania
76
common side effects of valproic acid:
nausea, weakness, somnolence, indigestion, diarrhea, dizziness, vomiting
77
black box warnings for valproate:
monitor LFTs, platelets (thrombocytopenia), pancreatitis
78
What anticonvulsants pose a risk of Stevens-Johnson Syndrome and patients should report any rash immediately to the HCP?
carbamazepine
lamotrigine
79
This is diagnosed when low level depression occurs most of the day, for the majority of days and last at least two years in adults. May experience decreased appetite/overeating, insomnia/hypersomnia, low energy, poor self esteem, hopelessness:
persistent depressive disorder
80
substance/medication-induced depressive disorder:
-prolonged use of/withdrawal from drugs and alcohol
-depressive symptoms are not experienced in the absence of drugs/alcohol
-symptoms appear within one month of use
81
Major depressive disorder:
-persistently depressed mood lasting for a minimum of two weeks
-depressive episode may last 5-6 months
82
Term for not diagnosing a person with depression in the first two months following a significant loss:
bereavement exclusion
83
What model of depression considers the interplay between genetic and biological predisposition toward depression and life events?
diathesis-stress model
84
What theory holds the underlying assumption that a person's thoughts will result in emotions and people with depression process information in negative ways and tend to ignore positive aspects of their lives?
cognitive theory
85
What is the most dangerous aspect of major depressive disorder?
preoccupation with death
--always evaluate for SI
86
alterations in those activities necessary to support physical life and growth (eating, elimination, sleeping, sex):
vegetative signs of depression
87
normal mood
euthymic
88
overly happy
euphoric
89
inability to feel pleasure in aspects of life that once made a person happy
anhedonia
90
How long in advance should a patient discontinue all SSRIs before starting an MAOI?
2-5 weeks
91
hyperpyrexia
fever
92
Executive functioning
planning, decision making, problem solving, abstract thinking
93
social cognition
processing, storing, and applying information about other people and social situations
94
Key points about delirium:
--affects lower level functioning
--acute
--often reversible
--disorientation, anxiety, agitation, poor memory, delusional thinking, visual hallucinations
95
Delirium is always _______
a medical emergency
96
Errors in the perception of sensory stimuli:
illusions - unlike delusions or hallucinations, you can explain and clarify illusions for the individual
97
agnosia
inability to identify familiar objects or people
98
creation of stories or answers in place of actual memories to maintain self-esteem
confabulation
99
persistent repetition of a word, phrase, or gesture that continues after the original stimulus has stopped
perseveration
100
Only occurs in AD: diminished ability and eventual inability to read or write
agraphia
101
loss of language ability
aphasia
102
loss of purposeful movement in the absence of motor or sensory impairment (ex: unable to put on clothes properly)
apraxia
103
tendency to put everything in the mouth to taste and chew
hyperorality
104
tendency for an individual's mood to deteriorate and agitation to increase in the later part of the day
sundowning
105
Cluster A: behaviors described as odd or eccentric
paranoid personality disorder
schizoid personality disorder
schizotypal personality disorder
106
Cluster B: behaviors described as dramatic, emotional, erratic
borderline personality disorder
narcissistic personality disorder
histrionic personality disorder
antisocial personality disorder
107
Cluster C: behaviors described as anxious or fearful
avoidant
dependent
obsessive-compulsive
108
long-standing distrust and suspiciousness of others based on the belief, unsupported by evidence, that other want to exploit, harm, or deceive the person.
paranoid personality disorder
109
This person exhibits a lifelong pattern of social withdrawal. They are somewhat expressionless and have a restricted range of emotional expression. Others view them as odd or eccentric because of their discomfort for social interaction.
schizoid personality disorder
110
What is the prominent feature of schizoid personality disorder?
emotional detachment
111
This person does not blend in with the crow. Their symptoms are strange and unusual. Magical thinking, odd beliefs, strange speech patterns, inappropriate affect.
schizotypal personality disorder
112
This person has severe social and interpersonal deficits and experience extreme anxiety in social situation. Tend to ramble with overly detailed and abstract content and are overly suspicious. This disorder is also the first of the schizophrenia spectrum disorders.
schizotypal personality disorder
113
This person is excitable and dramatic yet they are also high functioning.
histrionic personality disorder
114
This person has intense feelings of entitlement, exaggerated belief in one's own importance, and a lack of empathy. They also suffer from weak self-esteem and hypersensitivity to criticism.
narcissistic personality disorder
115
This person is extremely sensitive to rejection, feels inadequate, and are socially inhibited - they avoid interpersonal contact owing to fears of rejection or criticism.
avoidant personality disorder
116
Characterized by a pattern of submissive and clinging behavior related to an overwhelming need to be cared for.
dependent personality disorder
117
This person exhibits limited emotional expression, stubbornness, perseverance, indecisiveness, and has a preoccupation with orderliness, perfectionism, and control.
obsessive-compulsive personality disorder
118
Characterized by severe impairments in functioning: instability, impulsivity, identity or self-image distortions, unstable mood, unstable interpersonal relationships.
--emotional dysregulation
--emotional lability
--impulsivity
borderline personality disorder
119
What personality disorder suffers from chronic SI and self-destructive behaviors?
borderline personality disorder
120
"splitting" is a primary defense mechanism of what personality disorder?
borderline
121
Term for the inability to view both positive and negative aspects of others as part of a whole which results in viewing someone as either a wonderful or horrible person.
splitting
122
This person displays a pattern of disregard for the rights of others and their frequent violation.
--antagonistic behaviors: being deceitful and manipulative for personal gain or hostile if one's needs are blocked.
--risk taking
--disregard for responsibility and impulsivity
--most concerned with gaining personal power and pleasure
antisocial personality disorder
--often referred to as sociopaths
123
What is an ego-syntonic disorder?
an example is anorexia nervosa--the patient knows their actions are potentially harmful, but they believe that the benefits outweigh the harm
124
term for fine, downy hair on the face and back sometimes seen in patients with anorexia nervosa:
lanugo
125
Term for the potentially lethal syndrome that may occur in severely malnourished patients with anorexia nervosa as nutrients are restored:
refeeding syndrome - abnormalities in fluid balance and glucose metabolism
126
bulimia nervosa
repeated episodes of binge eating (1500-5000 calories within any 2-hr period) followed by compensatory behaviors such as self-induced vomiting, misuse of laxatives, diuretics, fasting, excessive exercise
127
What is the only FDA approved medication for bulimia nervosa?
fluoxetine
128
The patient with this disorder engages in episodes of increased intake that occur beyond the point of satiety and cause distress afterward. They do not regularly use compensatory behaviors - they may be of normal weight but repeated binge eating causes obesity.
binge-eating disorder
129
When a person is in the process of using a substance to excess:
Intoxication
130
When a person no longer responds to the drug in the way that the person initially responded:
Tolerance
131
Cannabis withdrawal symptoms
Irritability, anger, aggression, anxiety, restlessness, depressed mood
132
Physical symptoms of cannabis withdrawal:
Abdominal pain, shakiness, sweating, fever, chills, headache
133
Hallucinogens
Classic: LSD
Dissociative drugs: PCP and ketamine
134
What hallucinogen intoxication is a medical emergency?
PCP
—benzo may be administered IM or IV and mechanical cooling may be necessary for severe hyperthermia
135
Opioid withdrawal symptoms:
Mood dysphoria
Nausea, vomiting
Diarrhea
Muscle aches
Fever
Insomnia
Pupillary dilation
Yawning
136
When does opioid withdrawal syndrome begin for morphine, heroin, and methadone?
6-8 hours after the last dose following a period of at least one week of use
137
When does meperidine withdrawal begin?
8-12 hours from abstinence
138
What medication is useful for treating tremulousness and mild to moderate agitation due to alcohol withdrawal?
Chlordiazepoxide (Librium)
139
What is the common IV treatment for alcohol withdrawal seizures?
Diazepam (Valium)
140
Term for alcohol withdrawal delirium?
Delirium tremens - medical emergency - may happen any time within the first 72 hours
141
Side effects of buspirone:
Dizziness
Nausea
Headache
Nervousness
Lightheadedness
Excitement
