Exam 3 Flashcards
(154 cards)
1
Q
Characteristics of ADHD
A
Inappropriate degree of
Inattention
Impulsiveness
Hyperactivity (can also have absence of hyperactivity. This type is called inattentive type, previously was ADD)
2
Q
Gold standard for treatment of ADHD
A
Medication
3
Q
When evaluating inattentive type ADHD, what should be focused on?
A
Academic performance
ADLs
Social relationships
Personal perception
(Pts usually have low self esteem)
4
Q
When evaluating hyperactive-impulse type ADHD (or combined type), what should be focused on?
A
Academic performance
Social skills and relationships
*Impulse control
Behavioral responses
(Focuses more on interpersonal relationships)
5
Q
What are medications for ADHD used for?
A
Increase attention and task directed behavior
For aggressive behaviors
6
Q
Psychological therapies for ADHD
A
Parent training in behavior therapy
Cognitive behavioral therapy
7
Q
Stimulants used to treat ADHD
A
Methylphenidate (Ritaline)
Mixed amphetamine salts (Adderall)
Both cause weight loss and sleep disturbances as side effects
8
Q
Nonstimulants for ADHD
A
Atomoxetine (Stratera)
No dopamine but doesn’t act as fast (takes 6 weeks)
9
Q
Alpha 2 adrenergic agonists for ADHD
A
Clonidine
Guanfacine
(Can make pts sleepy)
10
Q
Medications used to treat aggressiveness in ADHD
A
Antipsychotics
11
Q
With patients taking medications for ADHD, what needs to be monitored?
A
Vital signs
Assess kidney function
*Need to watch for Tardive dyskinesia
12
Q
Symptoms of ADHD in adults
A
Poor concentration
Stress intolerance
Antisocial behavior
Outbursts of anger
Inability to maintain a routine
13
Q
Drug therapy for ADHD in adults
A
Methylphenidate (b/c scared they will abuse adderall/ritaline
14
Q
Definition of anxiety
A
Apprehension, uneasiness, uncertainty, or dread from *unspecified or *unknown threat
15
Q
What does mild anxiety look like?
A
Everyday problem-solving leverage
Grasps more information effectively
16
Q
What does moderate anxiety look like?
A
Selective inattention
Clear thinking hampered
Problem solving not optimal
SNS symptoms begin
17
Q
What does severe anxiety look like?
A
Perceptual field greatly reduced (less aware of surroundings)
Difficulty concentrating on environment
Confused and automatic behavior
Somatic symptoms increase
18
Q
What does panic look like?
A
Markedly disturbed behavior - running, shouting, screaming, pacing
Unable to process reality
Impulsivity
19
Q
Define compensation (defense mechanism for anxiety)
A
Used to counterbalance perceived deficiencies by emphasizing strengths
20
Q
Adaptive use of compensation
A
A shorter than average man becomes assertively verbal and excels in business
21
Q
Maladaptive use of compensation
A
Woman drinking alcohol when self esteem is low to temporarily ease her discomfort
22
Q
Define denial (defense mechanism for anxiety)
A
Escaping unpleasant, anxiety-causing thoughts, feelings, wishes, or needs by ignoring their existence
23
Q
Adaptive use of denial
A
Someone saying “no I don’t believe you” when someone dies to protect themself from initial grief
24
Q
Maladaptive use of denial
A
Woman whose husband died 3 years ago still keeps his clothes in her closet and talks about him in the present tense
“No i don’t have a drinking problem”
25
Definition of projection (defense mechanism of anxiety)
Unconscious rejection of emotionally unacceptable features and attributing them to others
26
Adaptive use of projection
There is no adaptive use because this is considered an immature defense mechanism
27
Maladaptive use of projection
A kid saying they’re cold and the parent telling them to put a coat on. Putting their own feelings into something.
A woman who has a suppressed attraction to women not going out to socialize because they’re afraid women will come onto them
28
Definition of rationalization (defense mechanism of anxiety)
Justifying why something is happening
29
Adaptive use of rationalization
An employee says “I didn’t get the raise because my boss doesnt like me”
30
Maladaptive use of rationalization
A man who believes his son was fathered by another man, treating him poorly and justifying it by saying he’s lazy and doesn’t listen when that’s not true
31
Excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing
Agoraphobia
32
Outcomes for anxiety and fear
Self monitors intensity
Uses reduction techinques
33
Outcomes for difficulty coping
Identifies ineffective and effective patterns
Asks for assistance and information
Modifies as needed
34
Outcomes for impaired socialization and low self-esteem
Self-monitors anxiety and desire for avoidance
Uses techniques to reduce anxiety to maintain role performance
35
Treatments of anxiety
Biological: pharmacotherapy:
- Antidepressants
- Anti-anxiety drugs
Integrative medicine
Psychosocial therapies
- Behavioral therapy (EMDR, eye movement, etc.)
- Cognitive behavioral therapy
36
What should you make sure to ask patients who have anxiety?
What their coping mechanisms are
37
DSM-5 criteria for OCD
Obsessions, compulsions, or both
Not due to a substance or condition
Not explained by another psychiatric disorder
Time consuming (over 1 hr per day)
38
Risk factors for OCD
Child abuse and trauma
Post-infectious autoimmune syndrome
Genetics: first-degree relative = twice the risk
39
Which diseases does OCD frequently have comorbidities with?
Anxiety disorders
Eating disorders
Tic disorder
40
Biological treatments of OCD
SSRIs (FDA approved for OCD)
Clomipramine (TCA), Venlafaxine (SNRI)
Some antipsychotics
41
Psychological therapies for OCD
Exposure and response prevention (expose pt to triggers of OCD symptoms)
- first line cognitive-behavioral intervention for OCD behaviors. Shows pt that anxiety does not subside even when ritual is not completed
Flooding
(Expose pt to large amount of trigger to extinguish response)
42
What can propranolol be given for to help with psychosocial problems?
Stage fright
43
How do SSRIs treat anxiety?
Blocks reuptake of serotonin increasing levels in the brain
44
How do SNRIs treat anxiety?
Blocks both serotonin and norepinephrine in the brain
45
How do noradrenergic drugs treat anxiety?
Propranolol - blocks adrenergic receptor activity
Clonidine - stimulates adrenergic receptors
46
How do benzodiazepines treat anxiety?
Binds to benzodiazepine receptors, facilitates action of GABA, slowing neural transmission thus lowering anxiety
47
How does buspirone (BuSpar) treat anxiety?
Functions as a serotonin 5-HT(1A) receptor partial agonist resulting in anxiolytic and antidepressant effects
(Can treat the worry associated with GAD rather than the muscle tension)
48
Characteristics of PTSD in adults
Flashbacks
Avoidance of stimuli associated with trauma
Persistent symptoms of increased arousal (hypervigilance)
Alterations in mood
49
Outcomes for PTSD
Manages anxiety
Experiences enhanced self-esteem
Exhibits an enhanced ability to cope
50
Pharmacotherapy for PTSD
Antidepressants
SSRIs
51
Psychological therapies for PTSD
Components of exposure and/or cognitive restructuring and EMDR therapy
52
What is ASD?
Acute stress disorder
Immediately after a highly traumatic event
Symptoms that persist for 3 days
Diagnosis made within month and if they persist longer than than, resolution or it become PTSD
53
Treatment for ASD
Psychological therapies
- CBT
- Specialized protocols for EMDR therapy
54
What is adjustment disorder?
A milder, less specific version of ASD and PTSD
Precipitated by a stressful event
55
Symptoms of adjustment disorder
All forms of distress: guilt, depression, anxiety, anger
May be combined with other manifestations of distress:
Physical complaints, social withdrawal, impaired occupational function, academic decline
56
What are dissociative disorders?
- Occur after significant adverse experience/trauma
- Individuals respond with severe interruption of consciousness (unconscious defense mechanism)
57
What is dissociative amnesia?
Inability to recall important personal information
Often of traumatic or stressful nature
58
Subtype of dissociative amnesia characterized by sudden, unexpected travel and inability to recall one’s identity
Dissociative fugue
59
Difference between depersonalization and derealization
Depersonalization: focus on self: extremely uncomfortable feeling of being an observer of one’s own body or mental process
Derealization: focus on outside world: recurring feeling that one’s surroundings are unreal or distant. Feel like you’re walking around in a fog, bubble, or dream
60
Disorder with Presence of two or more distinct personality states
Dissociative identity disorder
61
Nursing diagnoses for dissociative disorders
Disturbed personal identity
Impaired role performance
Anxiety (specify level)
62
Phases when planning treatment of dissociative disorders
Phase 1: safety, stabilization and symptom reduction
Phase 2: confronting and integrating traumatic memories
Phase 3: identify integration and rehabilitation
63
Biological treatment for dissociative disorders
No specific medications
Medications for hyperarousal and intrusive symptoms
64
Psychological therapies for dissociative disorders
CBT
Psychodynamic psychotherapy
Exposure therapy
Modified EMDR therapy
Hypnotherapy
Neurofeedback
Ego state therapies
Somatic therapies
Medication
65
What is somatization?
Expression of stress through physical symptoms that are often manifestations of psychological and emotional distress
(Anxiety, depression, irritability)
66
4 primary somatic symptom disorders
Somatic symptom disorder
Illness anxiety disorder
Conversion disorder
Cognitive factors affecting medical condition
67
Two somatic symptom disorders that are under conscious control
Factitious disorder
Malingering
68
What is somatic symptom disorder?
Excessive thoughts, anxiety and behaviors around symptoms or health concerns without physical findings or medical diagnosis
- suffering is authentic
- high level of functional impairment
69
Comorbidities with somatic symptom disorder
Anxiety disorders
Major depressive disorders
Medical illnesses with higher degree of impairment than expected
70
Important things to remember when treating a pt with somatic symptom disorder
Avoid concentrating on psychosocial issues too early and concentrate on current bodily symptoms (but try to avoid unnecessary or repetitive diagnostics)
Focus on development of self-compassion because they tend to focus on internal locus of control (it’s my fault this is happening to me)
71
Treatment of somatic symptom disorder
Possible hypnotherapy
CBT in conjunction with medication
72
What is illness anxiety disorder?
Fear and preoccupation with having or acquiring serious illness for at least 6 months
Somatic symptoms are absent or mild
Frequent self scanning for signs of illness
*May be care-seeking or care-avoidant
(Either always going to the Dr or avoid going b/c they’re scared)
73
Treatment of illness anxiety disorder
Pharmacotherapy
CBT
ECT (very drastic)
74
Important things to remember for treating illness anxiety disorder
Discuss illness concerns, but favor other topics
Reassure them that psychiatric care will supplement medical care
Encourage socialization (loneliness associated with illness anxiety disorder)
75
What is conversion disorder?
Neurological symptoms in absence of a neurological diagnosis
Presence of deficits in voluntary motor or sensory functions
*La belle indifference versus distress (patients do not seem too concerned with symptoms)
76
Common symptoms of conversion disorder
Paralysis
Blindness
Movement and gait disorders
Numbness
Paresthesias
Loss of vision or hearing
Episodes resembling epilepsy
77
Treatment of conversion disorder
Provide reassurance and support for pts feelings and beliefs
Encourage socialization
Explore alternative and adaptive coping mechanisms
78
Treatment modalities for conversion disorder
Body oriented psychological therapy
Dialectical behavior therapy
Psychodrama
Physical therapy
79
What does psychological factors affecting medical condition mean?
Psychological factors can increase risk for medical diseases, magnify them, or interfere with their treatment
Ex: depression can lead to cardiovascular diseases and cancer which can lead to more depression
Stress also affects health
80
Treatment for psychological factors affecting medical condition
Teach importance of positive affective responses
Assess childhood experiences
Coping skills
Focus on connections to family, friends, etc.
81
Implementation for somatic symptom disorders
Coping skills
Support groups or systems
Focus on strengths and reinforce skills
*promote self-care activities
Assertiveness training
82
What is factitious disorder?
Artificially, deliberately, and dramatically fabricate symptoms or self-inflict injury
Goal of assuming a sick role, is a compulsivity
Consciously conceal true nature of illness
83
What is malingering
Condition related to factitious disorders
Conscious fabrication of illness or exaggerating symptoms for secondary gain such as insurance fraud, prescription medication, or avoidance of prison or military service
84
Types of anorexia nervosa
Restricting type
Binge-eating/purging type
85
Important consideration for treating anorexia
Refeeding syndrome p.335
86
Biological treatment for anorexia
Pharmacotherapy
Can’t treat anorexia with meds but can treat the symptoms
87
Integrative medicine for anorexia
Yoga
Massage
Acupuncture
Bright light therapy
88
Psychological therapies for anorexia
Insight-oriented individual therapy
Adolescent-focused therapy
Family therapy
CBT
89
DSM-5 criteria for bulimia nervosa
Recurrent episodes of binge eating
Recurrent episodes inappropriate with compensatory behavior
Both occur, on average, at least once a week for 3 months
Self-evaluation is unduly influenced by body shape and weight
90
Difference between anorexia and bulimia
With bulimia, it is an egodystonic disorder - the pt knows they shouldn’t be doing it but they do it anyway
91
Physical symptoms of bulimia
Appear well: at or near ideal body weight
*Enlarged parotid glands
Dental erosion and caries if pt has been vomiting
92
Emotional and relationship signs of bulimia
Impulsivity and compulsivity
Chaotic, no nurturing family relationships
Familial and/or social instability
Difficult interpersonal relationships
93
Biological treatment for bulimia
Antidepressants: fluoxetine (Prozac)
Other antidepressants
*Never Wellbutrin for pts who vomit b.c it could induce a seizure
94
Advanced practice interventions for bulimia
CBT
Mixed method approach for refractory cases
dialectical behavioral therapy
Interpersonal therapy
Acceptance and commitment therapy
95
Things to remember when implementing treatment for binge eating disorder
Binge eating is not about food, it’s about coping with emotion
Help pt track what events triggered an episode
Community or group activities
Use incremental approach in goal setting
96
Biological treatment for binge eating disorder
SSRIs (weight tends to return after treatment)
SNRIs
Lisdexamfetamine (lowered relapse risk)
Vivanse to decrease appetite
Surgical intervention: bariatric surgery
97
Psychological therapies for binge eating disorders
CBT
Dialectical behavior therapy
Interpersonal therapy
98
Short term consequences of sleep loss
Increased stress responsively
Somatic pain
Reduced quality of life
Emotional distress
Mood disorders
Cognitive, memory, and performance deficits
Safety risks
99
Long term effects of sleep loss
Cardiovascular disease
Weight related issues
Metabolic syndrome
T2DM
Colorectal cancer
All-cause mortality
Safety issues
Financial burden
100
What occurs during REM sleep?
*Reduction and absence of skeletal muscle tone
Results in *Atonia
- Bursts of rapid eye movement
- Myoclonic twitches of facial and limb muscles
- Dreaming
- Automatic nervous system variability
101
What is atonia?
* protective mechanism to prevent physical response to dreams
102
Two processes that regulate sleep
Hemostasis process or sleep drive - promotes sleep
Circadian process or circadian drive - promotes wakefulness, influenced by endogenous and exogenous factors
103
Distribution of sleep and wakefulness across the sleep period
Sleep continuity
104
Disruption of sleep stages
Sleep fragmentation
105
Ratio of sleep duration to time spent in bed
Sleep efficiency
106
The time it takes to fall asleep (associated with N1 stage)
Sleep latency
107
Homeostatic process that promotes sleep
Sleep drive
108
Process that promotes wakefulness
Circadian drive
109
Exogenous factors that help set our eternal clock to a 24 hour cycle (“time givers”)
Zeitgebers
110
SC nucleus in the hypothalamus that regulates a host of functions
Master biological clock
111
Amount of sleep necessary to feel fully awake and sustain normal levels of performance
Basal sleep requirement
112
All night test using electrodes to diagnose sleep related disorders and nocturnal seizure disorders
Polysomnography
113
Daytime nap test that measures sleepiness in a sleep conducive setting
Multiple sleep latency test (MSLT)
114
Test that evaluates ability to stay awake in a situation conducive to sleep
Maintenance of wakefulness test (MWT)
115
Test that uses a tracker to record body movement over a period of time to detect sleep patterns
Actigraphy
116
How long do adults need to sleep?
7-8 hours
117
Characteristic of insomnia disorder
Difficulty initiating sleep and maintaining sleep
Early awakening
Results in clinical distress or impairment
Symptoms 3 times per week for 3 months
118
3 factors to assess for insomnia
Predisposing factors
Precipitating factors
Perpetuating factors
119
Characteristics of hypersomnolence disorder
Excessive daytime sleepiness
Chronic - begins in young adulthood
Impairs social and vocational functioning
120
Symptoms of narcolepsy
Uncontrollable attacks of sleep
Disturbed night sleep with automatic behaviors and memory lapses
Cataplexy (atonia while awake)
Hypnagogic hallucinations (dream state while awake)
Not rested regardless of amount of sleep
121
What occurs with non rapid eye movement sleep arousal disorders?
Sleep walking (somnambulism)
Sleep terrors
122
What occurs with REM sleep behavior disorder?
Pt doesnt have atonia and starts acting out their dreams
123
What should you ask a pt if they may have restless leg syndrome?
If the symptoms start late in the evening, at bedtime
If anyone in their family has restless leg syndrome
If they take SSRIs
124
What is the number one treatment for sleep disorders?
Aggressive lifestyle management
125
General assessment for pts who have sleep disorders
Sleep patterns
2 week sleep diaries
Functioning and safety
- Pittsburgh sleep quality index
- PE worth sleepiness scale
126
List the clusters of personality disorders
Cluster A: eccentric (weird)
Cluster B: erratic (wacky)
Cluster C: anxious (worried)
127
Difference between schizophrenia and schizotypal personality disorder
With schizotypal personality disorder, the pt can be made aware of their own odd beliefs
128
Characteristics of histrionic personality disorder
Excitable, dramatic, often high functioning
Bold external behaviors
No insight into disorder or role in ruining relationships
129
Guidelines for treating narcissistic personality disorder
Remain neutral
Role model empathy
Promote a stronger patient self identity
130
Characteristics of avoidant personality disorder
Low self esteem
Shyness that increases with age
Preoccupied with rejection, humiliation, and failure, which is why they don’t socialize
131
Individual therapy focuses for pts with avoidant personality disorder
Trust building
Assertiveness training
Group therapy to enhance social skills
132
Two most challenging personality disorders
Borderline personality disorder
Antisocial personality disorder
(Both are cluster B)
133
Characteristics of borderline personality disorder
Severe impairments in functioning
Emotional lability (easily flip from hating to loving someone
Impulsivity
Self destructive behaviors
Antagonism
Splitting; think of someone or something as all good or all bad
134
Important things for treating borderline personality disorder
Avoid manipulative behaviors though teamwork and safety
Clear and consistent boundaries
Clear straightforward communication
Respond matter of factor to superficial self injuries
135
Treatment for borderline personality disorder
Psychotropics geared toward symptom relief
CBT
Dialectical behavior therapy
Schema focused therapy
136
Characteristics of antisocial personality disorder
Antagonistic behaviors
Disinhibited behaviors
Profound lack of empathy
Absence of remorse or guilt
137
Nursing diagnoses of antisocial personality disorder
Risk for other directed violence (only one with this)
Impaired impulse control
Impaired social interaction
138
Treatment for antisocial personality disorder
No specific meds
Maybe mood stabilizers for aggression
Maybe SSRIs, benzos, or Ritalin
Pts may bond with psychotherapists
CBT, MBT, DBT
139
Single biggest factor for suicide
Hopelessness
140
Environmental factors for suicide
Family conflict
Low parental monitoring
Clusters of suicides: contagion or copycat
141
Pharmacotherapy for comorbid disorders
Lithium for chronic suicidal thoughts
(Need to make sure someone else in household will distribute medication to them)
142
Negatives of lithium
Electrolyte imbalances
Frequent blood draws
Toxicity
143
7 stage model of interventions for crisis relief
Plan and conduct crisis assessment
Establish rapport and rapidly establish relationship
Identify major problems (last straw or crisis precipitants)
Deal with feelings and emotions (active listening, validation)
Generate and explore alternatives
Develop and formulate action plan (crisis resolution next)
Follow up plan and agreement
144
Types of crisis
Maturational
Situational
Adventitious
145
Characteristics of maturational crisis
New developmental stage
Old coping skills no longer effective
Leads to increased tension and anxiety
146
Characteristics of situational crisis
Arise from events that are extraordinary, external, often unanticipated
Ex: job loss, death, change in financial or marital status, psychiatric or physical illness
147
Characteristics of adventitious crises
Natural (epidemics, floods, fires, earthquakes)
Human (one on one violence, terrorism, wars, riots, shootings)
Accidental (airline crashes, structural collapses, etc)
148
Phase 1 of crisis
Increased anxiety due to stressor which stimulates usual coping and defense mechanisms
149
Phase 2 of crisis
Defense mechanisms fail so threat persists
Anxiety increases, leading to feelings of extreme discomfort
Functioning becomes disorganized and trial and error attempts at problem solving begin
150
Phase 3 of crisis
Trial and error attempts fail so anxiety escalates to severe or panic levels
Automatic relief behaviors begin (withdrawal and flight)
Compromising needs or redefining situation may begin
151
Phase 4 of crisis
Problem unsolved and coping skills ineffective
Anxiety overwhelms person leading to long term effects
152
Long term effects of crisis
Serious personality disorganization
Depression
Confusion
Violence against others
Suicidal behavior
153
Overall outcome we want for pts in crisis
To get to pre-crises level of functioning
154
When implementing the nursing process for crises:
Patient safety (remove from immediate area)
*Anxiety reduction
Appropriate level of prevention/debriefing (they can’t think straight so need to tell them what to do, be direct with short simple orders)
