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Mental Health > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Adrenaline

A

Fight or flight
Produced in stressful situations
Increased HR and blood flow, leading to physical boost and heightened awareness

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2
Q

GABA

A

Calming
Calms firing nerves in the central nervous system
High levels improve focus, low levels cause anxiety
Also contributes to motor control and vision

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3
Q

Noradrenaline

A

Concentration
Affects attention and responding actions in the brain
Contracts blood vessels, increasing blood flow

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4
Q

Acetylcholine

A

Learning
Involved in thought, learning, and memory
Activates muscle action in the body
Also associated with attention and awakening

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5
Q

Dopamine

A

Pleasure
Feelings of pleasure, also addiction, movement, and motivation
People repeat behaviors that lead to dopamine release

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6
Q

Glutamate

A

Memory
Most common neurotransmitter
Involved in learning and memory
Regulates development and creation of nerve contacts

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7
Q

Serotonin

A

Mood
Contributes to well-being and happiness
Helps sleep cycle and digestive system regulation
Affected by exercise and light exposure

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8
Q

Endorphins

A

Euphoria
Released during exercise, excitement, and sex, producing well-being and euphoria, reducing pain

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9
Q

Anticholenergic side effects

A

Dry mouth
Constipation
Urinary retention/hesitance
Blurred vision
Photophobia
Nasal congestion
Decreased memory
Tachycardia

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10
Q

Extrapyramidal symptoms

A
  • Antipsychotic side effects
    Dystonia
    Akathisia
    Pseudoparkinson
    Tardive Dyskinesia
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11
Q

Dystonia

A

Involuntary muscle spasms
Men, people less than 25
Emergent
Tx: Cogentine (benztropine)

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12
Q

Akathisia

A

Motor restlessness/fidgeting
More common in women

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13
Q

Pseudoparkinsons

A

Tremors, shuffling gait, drooling
Women, elderly, dehydrated

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14
Q

Tardive Dyskinesia

A

Bizarre face and tongue movements
Irreversible

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15
Q

Tardive dyskinesia tx

A

Austedo (deutrabenazine) and Ingrezza (valbenazine)

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16
Q

Supplements and vitamins that help control movement (tardive dyskinesia)

A

Ginko biloba
Melatonin
Vitamin B6
Vitamin E

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17
Q

Meds to treat Extrapyramidal sx

A

Cogentin
Benadryl
Artane
Symmetrel

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18
Q

Neuroleptic malignant syndrome

A

Rare but fatal complication from all antipsychotic drugs
Seen more with 1st gen drugs
Severe muscle rigidity

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19
Q

Serotonin syndrome

A

May begin 2-72 hrs after the start of treatment
Too much serotonin

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20
Q

Serotonin syndrome s/sx

A
  • Mental confusion
  • Difficulty concentrating
  • Agitation
  • Fever
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21
Q

Expected action of antipsychotics

A

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

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22
Q

Examples of low potency antipsychotics

A

chlorpromazine (Thorazine)
thioridazine (Mellaril)

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23
Q

Examples of high potency antipsychotics

A

haloperidol (Haldol)
fluphenazine (Prolixin)

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24
Q

Therapeutic uses for antipsychotics

A

Acute/chronic psychosis
Schizophrenia
Bipolar disorder
Tourette’s syndrome
Delusional and schizoaffective disorder
Dementia

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25
Q

Typical antipsychotic drug AE

A

Extrapyramidal side effects (EPS)
Orthostatic hypotension
Sedation
Neuroendocrine effects (Gynecomastia, galatorrhea, menstrual irregularities)
Sexual dysfunction
Agranulocytosis
Neuroleptic malignant syndrome
Skin effects - photosensitivity, contact dermatitis

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26
Q

Neuroleptic malignant syndrome characteristics

A

Sudden high fever, BP fluctuations, dysrhythmias, muscle rigidity, changes in LOC, coma

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27
Q

Contraindication for antipsychotics

A

Pt with coma, severe depression, Parkinson’s disease, prolactin-dependent breast cancer, dementia, and severe hypotension

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28
Q

Use precautions with antipsychotics for pt with

A

Glaucoma, paralytic ileus, prostate enlargement, heart disorders, liver/kidney disorders, seizures

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29
Q

Antipsychotic drug interactions

A

Concurrent use with other anticholinergic drugs, CNS depressants, levodopa

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30
Q

Teaching with antipsychotic drugs

A

Administer anticholinergic, beta-blockers, benzodiazepines - to control EPS effects
Take as prescribed/regular schedule
Therapeutic effects take 2-4 weeks to several months

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31
Q

Advantages of atypical drugs

A

Relieves both positive and negative symptoms
Fewer EPS effects
Fewer anticholinergic effects
Decrease in affective symptoms (depression) and suicidal behaviors
Improvement in cognition

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32
Q

Atypical antipsychotic examples

A

risperidone (Risperdal)
clozapine (Clozaril)
quetiapine (Serpquel)
aripiprazole (Abilify)
olanzapine (Zyprexa)
ziprasidone (Geodon)

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33
Q

Atypical antipsychotic drug uses

A

Positive and negative symptoms of schizophrenia
Bipolar disorders
Levodopa (Parkinson’s med) induced psychosis

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34
Q

Atypical antipsychotics AE

A

Low WBC count - agranulocytosis
New onset diabetes or loss of glucose control
Weight gain
Hypercholesterolemia
Orthostatic hypotension
Anticholinergic effects
Mild EPS effects

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35
Q

Lithium action

A

May stabilize electrical activity in the neurons and block serotonin receptors
- Gold Standard treatment

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36
Q

Lithium use

A

Mood stabilizer
Treatment of bipolar disorders (controls acute mania)

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37
Q

Lithium nursing consideration

A

Has the lowest therapeutic index of psychiatric drugs
- Easy to become toxic

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38
Q

Lithium AE

A

GI distress (N/V early sign of toxicity)
Fine hand tremors
Polyuria, mild thirst
Weight gain
Nephrotoxicity
Goiter and hypothyroidism (long term tx)
Bradydysrhythmias
Hypotension
Electrolyte imbalances (Esp. K+ and Na)

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39
Q

Normal lithium range

A

0.6-1.2 mEq/L
Monitor frequently

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40
Q

Lithium toxicity s/sx

A

N/V, weakness, delirium, seizures

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41
Q

Lithium pregnancy category

A

X or D (teratogenic)

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42
Q

How long does Lithium take to reach therapeutic levels

A

1-3 weeks

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43
Q

Anticonvulsant examples

A

carbamazepine (Tegretol)
valporic acid (Depakote)
lamotrigine (Lamictal)

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44
Q

Anticonvulsant action

A

Potentiating the inhibitory effects of GABA (Gamma-aminobutyric acid)

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45
Q

Anticonvulsant uses

A

Tx of bipolar disorders, especially mixed episodes

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46
Q

Anticonvulsants AE

A

CNS effects (nystagmus, double vision, vertigo, staggering gait, H/A)
Blood dyscrasias (Leukopenia, anemia, thrombocytopenia)
Hepatotoxicity
Serious skin rashes (Stevens-Johnson syndrome)
Teratogenic

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47
Q

MAOI examples

A

phenelzine (Nardil)
isocarboxazid (Marplan)
tranylcypromine (Parnate)
selegline (Emsam) patch

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48
Q

MAOI’s action

A

Prevents the destruction of serotonin, norepinephrine, dopamine, and tyramine
- Increases in the brain

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49
Q

MAOI’s uses

A

Atypical depression
Bulimia nervosa
Obsessive compulsive disorder

50
Q

MAOI adverse effects

A

Orthostatic hypotension
Hypertensive crisis - due to intake of dietary tyramine
CNS stimulation (anxiety, agitation)

51
Q

Tyramine containing foods

A

Aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein, beers, red wine

52
Q

MAOI interactions

A

Concurrent use with TCA’s (HTN crisis)
Concurrent use with SSRI’s (serotonin syndrome)
Concurrent use with vasopressors/caffeine (hypertension)
Concurrent use with OTC decongestants/cold remedies (HTN crisis)

53
Q

Tricyclic antidepressant examples

A

amitriptyline (Elavil)
imipramiine (Tofranil)
doxepin (Sinequan)
nortriptyline (Aventyl) (Pamelor)
amoxapine (Asendin)

54
Q

Tricyclic antidepressant actions

A

Block the reuptake of norepinephrine and serotonin in the synaptic space

55
Q

Tricyclic antidepressant uses

A

Depression
Bipolar disorders (depressive)

56
Q

Tricyclic antidepressant AE

A

Orthostatic hypotension
Anticholinergic effects
Sedation
Excessive sweating

57
Q

Tricyclic antidepressant contraindications

A

Clients with seizure disorder
Caution in clients with CAD, DM, liver/kidney/resp disorders, urinary retention, glaucoma, BPH, hyperthyroidism
Avoid concurrent use with MAOI’s, antihistamines, CNS depressants

58
Q

SSRI examples

A

fluoxetine (Prozac)
citalopram (Celexa)
escitalopram (Lexapro)
paroxetine (Paxil)
sertraline (Zoloft)

59
Q

SSRI actions

A

Blocks the reuptake of serotonin in the synaptic space (high concentration of serotonin in synaptic cleft)
Affects mood, relieving depression

60
Q

SSRI uses

A

Major depression
OCD
Bulimia nervosa
Panic and PTSD disorders

61
Q

SSRI AE

A

Sexual dysfunction
CNS stimulation
Serotonin syndrome
Withdrawal syndrome
GI bleeding

62
Q

SSRI contraindications

A

Increase risk of birth defects
Concurrent use with MAOI’s and TCAs

63
Q

SSRI interactions

A

Increase risk of serotonin syndrome with St. John’s wort
Increase warfarin levels with Coumadin

64
Q

Atypical antidepressant examples

A

bupropion (Wellbutrin)
duloxetine (Cymbalta)
mirtazapine (Remeron)
venlafaxine (Effexor)

65
Q

Atypical antidepressant action

A

Bupropion inhibits dopamine uptake
Others block the reuptake of serotonin and norepinephrine

66
Q

Atypical antidepressant uses

A

Depression
Quit smoking aid

67
Q

Atypical antidepressant AE

A

Suppression of appetite
HA, dry mouth, GI distress, constipation, tachycardia, insomnia, seizures

68
Q

Atypical antidepressant contraindication/precautions

A

Cautious use with seizure disorders
Concurrent use with MAOI’s is contraindicated

69
Q

Benzodiazepine examples

A

diazepam (Valium)
alprazolam (Xanax)
lorazepam (Ativan)
choloridizepoxide (Librium)
clorazepate (Tranxene)

70
Q

Benzodiazepine action

A

Enhances the inhibitory effects of GABA in the CNS

71
Q

Benzodiazepine uses

A

Generalized anxiety disorder
Seizure disorders
Insomnia

72
Q

Benzodiazepine AE

A

CNS depression - sedation, lightheadedness, ataxia
Withdrawal symptoms

73
Q

Benzodiazepine contraindications

A

Schedule 4
Do not use with sleep apnea or respiratory depression
Hx of substance abuse
Concurrent use with other CNS depressants

74
Q

Atypical antianxiety examples

A

buspirone (BuSpar)

75
Q

Atypical antianxiety action

A

Unknown; does bind to serotonin and dopamine receptors

76
Q

Atypical antianxiety uses

A

Panic disorder
OCD
PTSD

77
Q

Atypical antianxiety AE

A

CNS depression
Paradoxical worsening of anxiety

78
Q

Atypical antianxiety interactions

A

Grapefruit juice increases the effects of buspirone

79
Q

Stimulant examples

A

methylphenidate (Ritalin)
amphetamine (Adderall)

80
Q

Stimulant expected action

A

Raise levels of norepinephrine, serotonin, and dopamine into the CNS

81
Q

Stimulant uses

A

ADHD
Conduct disorder

82
Q

Stimulant AE

A

CNS stimulation
Weight loss
CV effects - dysrhythmias, chest pain, HTN
Development of psychotic symptoms
Withdrawal reaction

83
Q

Stimulant interactions

A

Concurrent use with MAOI’s may cause HTN crisis
Dilantin, Coumadin and phenobarbital may increase serum levels with concurrent use

84
Q

Models of psychotherapy include

A

Psychoanalysis and Psychoanalytic Psychotherapy
Interpersonal psychotherapy
Reality Therapy
Cognitive behavioral therapy
Dialectical behavioral therapy

85
Q

What is the goal for Psychoanalysis?

A

For client to gain insight about current relationships and behavior patterns by confronting unconscious conflicts

86
Q

Psychoanalytic psychotherapy

A

A briefer version of psychoanalysis that is focused on specific conflicts

87
Q

Who developed interpersonal psychotherapy and why

A

Sullivan for MDD tx

88
Q

Interpersonal psychotherapy

A

Considered a brief psychotherapy
Assumes that symptoms of depression are correlated with difficulties in interpersonal relationships

89
Q

Interpersonal psychotherapy goal

A

To improve interpersonal skills through specific interventions targeted at resolving identified problems

90
Q

Reality therapy developed by who

A

Glasser

91
Q

Reality therapy

A

Belief that individuals behave in ways to fulfill 5 basic needs: power, belonging, freedom, fun, and survival
Suggests that all individuals are responsible for what they choose to do

92
Q

Reality therapy goal

A

Therapist helps the client to identify needs that are not being met and change behavior to more effectively meet needs

93
Q

Cognitive behavioral therapy (CBT) was developed by (and for what)

A

Beck for tx of mood disorders

94
Q

CBT is used for what disorders

A

Schizophrenia, PTSD, substance use disorder, and personality disorders

95
Q

Goal of CBT

A

Change automatic thought patterns that contribute to mood and thought disturbances

96
Q

Who developed dialectical behavioral therapy and why

A

Linehan as tx for borderline personality disorder and suicidal ideation

97
Q

Dialectical behavioral therapy

A

Similar foundation to CBT
Focuses on regulating troubling emotions by learning nonjudgmental self-acceptance, distress tolerance, interpersonal effectiveness, and structuring the environment to reinforce progress

98
Q

Milieu therapy

A

Therapeutic community
Scientific structuring of the environment to effect behavioral changes and to improve the psychological health and functioning of the individual

99
Q

“Assumptions” of Milieu therapy

A

The health in each individual is to be realized and encouraged to grow
Every interaction is an opportunity for therapeutic intervention
The individual owns their environment
Each individual owns their behavior
Peer pressure is a useful and powerful tool
Inappropriate behaviors are dealt with as they occur
Restrictions and punishments are to be avoided

100
Q

Nurse’s role in Milieu therapy

A

Medication administration
Development of a one-to-one relationship
Setting limits on unacceptable behavior
Client education

101
Q

Methods of relaxation therapy

A

Deep-breathing exercises
Progressive relaxation
Meditation
Mental imagery
Biofeedback

102
Q

Goal of assertiveness training

A

Teaching clients to express what they feel and need without becoming defensive or violating the rights of others

103
Q

Seven practices to encourage spiritual growth

A

Transform motivation
Cultivate emotional wisdom
Live ethically
Concentrate and calm your mind
Awaken your spiritual vision
Cultivate spiritual intelligence
Express spirit in action

104
Q

Conditions that promote a therapeutic community

A

Containment
Structure
Involvement
Support
Validation

105
Q

6 principles of a therapeutic milieu

A

Contagious calmness
Respect for inherent human dignity
Nurse’s care for self and one another
Intellectual engagement
Caritas
Safe and restorative physical surroundings

106
Q

Crisis

A

A sudden life event during which the usual coping mechanisms cannot resolve the problem
Disturbs homeostasis

107
Q

Dispositional crisis

A

Lack of information causes crisis (not knowing what job to take, what medical treatment to seek, options for living arrangements)

108
Q

Crisis of anticipated life transitions

A

Normative, common crisis
Ex. Midlife career change, getting married, becoming a parent, divorce, onset of chronic illness, changing schools

109
Q

Crisis resulting from traumatic stress

A

Crisis precipitated by an unexpected external stressor over which the individual has little/no control and as a result feels emotionally overwhelmed and defeated

110
Q

Maturational/developmental crisis

A

Crisis that occur in response to failed attempts to master developmental tasks associated with transitions in the life cycle

111
Q

Crisis reflecting psychopathology

A

A crisis that is influenced or triggered by pre-existing psychopathology
Ex. Personality disorders, anxiety disorders, bipolar disorders, and schizophrenia

112
Q

A major difference between anger and aggression is

A

Intent

113
Q

Anger characteristics

A

Frowning, clenched fists, low-pitched voice, yelling, shouting, easily offended, flushed face, intense eye contact, defensive, emotional, passive-aggressive, discomfort

114
Q

Aggression characteristics

A

Pacing, restless, verbal threats, threats of homicide/suicide, loud voice, tense facial/body language, suspiciousness, increased agitation with stimuli, panic anxiety -> misinterpreting environment, disturbed thought processes, angry mood (disproportionate)

115
Q

Roberts’ seven stage crisis intervention model (in order)

A
  1. Psychosocial and lethality assessment
  2. Rapidly establish rapport
  3. Identify the major problems or precipitating factors
  4. Deal with feelings/emotions
  5. Generate and explore alternatives
  6. Implement action plan
  7. Follow up
116
Q

Suicide protective factors

A

Family
Pregnancy
Religion/culture
Social support
Coping skills
Medical care

117
Q

Suicide risk factors

A

Marital status
Gender/age
Religion
Socioeconomic status
Ethnicity
Biological
Cultural/societal
Psychological
Impulsive/aggression
Family history
Incarcerated
Chronic illness

118
Q

Suicide developmental risk factors

A

Substance abuse
Aggression
Disruptive behaviors
Depression
Social isolation

119
Q

Suicide statistics (for over 65 and young adults/adolescents)

A

Third leading cause of death for 14-24
65+ have highest rate of suicide

120
Q
A

Mental Health (3 decks)

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