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Mental Health > Exam #3 > Flashcards

Exam #3 Flashcards

1
Q

DSM-5 diagnostic criteria for Major Depressive Disorder

A
  • persistently depressed mood lasting for a minimum of two weeks
  • may be a single episode or recurrent
  • s/s = anhedonia (no pleasure), fatigue, sleep disturbances, changes in appetite, feelings of hopelessness or worthlessness, persistent thoughts of death or suicide, inability to concentrate or make decisions, change in physical activity
  • must have anhedonia with 5 other symptoms to be classified as major depressive disorder
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2
Q

Disruptive Mood Dysregulation Disorder

A
  • children 6-18yrs with frequent temper tantrums resulting in verbal or behavioral outbursts out of proportion to the situation
  • persistent mood between outbursts is irritable
  • no other medical or mental health diagnoses associated with the tantrums
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3
Q

Dysrhythmic Disorder

A
  • feelings of depression persist consistently for at least two years (1year in adolescents)
  • can be children, adolescents, or adults
  • difficult to live with and may cause social or occupational distress but not so severe that they need to be hospitalized
  • sometimes have periods of full-blown major depressive episodes
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4
Q

Premenstrual Dysphoric Disorder

A
  • cluster of symptoms that occur in the last week prior to the onset of woman’s period
  • s/s = physical discomfort, emotional symptoms similar to major depression and may interfere with the woman’s ability to work or interact with others
  • symptoms decrease or disappear with the once of menstruation
  • 2.5-5.5% of women have this
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5
Q

Substance Abuse Depressive Disorder

A
  • symptoms of a major depressive episode arise as a result of prolonged drug or alcohol intoxication or as the result of withdrawal from drugs and alcohol
  • would not experience these symptoms without drugs/alcohol use or withdrawal
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6
Q

Depressive Disorder Associated with Another Medical Condition

A
  • result of changes that are directly related to certain illnesses such as kidney failure, parkinson’s disease, alzheimer’s disease or use of medications
  • not considered major depressive disorder
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7
Q

Etiology of depression

A
  • leading cause of disability in the united states
  • comorbidity: can be associated with other medical conditions
  • as you age it is not normal, but more prevalant, to have depression
  • older men > depression
  • younger women > depression
  • 2x more common in women that in men
  • diathesis-stress model apply
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8
Q

Depression Assessment

A
  • 15% of people with depression will commit suicide
  • Assessment tools: Beck depression inventory, hamilton depression scale, zung depression scale, geriatric depression scale, PHQ-9 (diagnoses depression 91% of time, used at each visit to assess pts, easiest)
  • Assessment of suicide potential: increased risk with severe hopelessness, overuse of alcohol, recent loss or separation, history of suicide attempts, actual suicidal ideation. evaluate at each visit
  • Key assessment findings: depressed mood and anhedonia are key symptoms, anergia (no energy), anxiety (60-90%), psychomotor agitation (constant pacing), psychomotor retardation (very slow movements). somatic complaints (headaches, malaise), vegetative signs (change in bowels, eating, sleep, sex), pain
  • Mood and affect: Affect = outward representation of a person’s internal state of being, posture is poor, may look older than age, frequent bouts of weeping, face looks sad, hopeless, despair, no eye contact, monotone speech, flat affect, short responses, frequent sighing. Mood = pt’s subjective experience of sustained emotions or feelings, can only be assessed by asking the pt what they feel
  • Psychomotor retardation and agitation: retardation = lethargy and fatigue lead to movements that are extremely slow, facial expressions decreased, gaze is fixed. agitation = constantly pacing, bite nails, smoke, tension-relieveing activities, fidgety, unable to relax
  • Special considerations in children and elderly: children = depression is often overloooked with children, 18% of children have issues, sadness and lack of pleasure, withdrawn, irritable, negativity, isolation, loss of energy, withdraw, substance abuse. elderly = often overlooked, geriatric depression scale
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9
Q

affect

A
  • flat = no expression at all, emotionless
  • blunted = significant reduction in intensity of emotions
  • inappropriate = doesn’t match situation
  • labile = abnormal variation in affect with repeated, rapid and abrupt shifts in affective expression
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10
Q

Depression Nursing Diagnosis

A

Priority diagnoses:

  • risk for suicide = always highest priority is safety
  • hopelessness
  • ineffective coping
  • social isolation
  • spiritual distress
  • self-care deficit
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11
Q

Depression Planning

A
  • outcomes: acute and long term outcomes should be identified, SMART goals
  • Recovery: recovery model emphasizes healing is possible for all pts. attained through partnerships between patients and healthcare providers who focus on patients strengths.
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12
Q

3 phases of Depression treatment

A
  • 3 phases in treatment and recovery from major depression:
    1) acute phase: 6-12 weeks, directed at reduction of depressive symptoms and restoration of psychosocial and work function. hospitalization may be required and meds may be started
    2) continuation phase: 4-9 months, directed at prevention of relapse through pharmacology, education and depression-specific psychotherapy
    3) maintenance phase: 1yr or more, directed at prevention of further episodes of depression. meds may be phased out or continued
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13
Q

Depression nursing interventions

A
  • communication: just sit with patients, silence can be the best communication, make observations, simple/concrete words, allow time for pt to respond, avoid platitudes (things will look up)
  • Health teaching and promotion: health teaching is most important, allow pts to make
  • promotion of self-care activities: physical neglect can come with depression
  • teamwork and safety: milieu therapy, precautions, restraints
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14
Q

SSRIs

A
  • exp: celexa, lexapro, prozac, paxil, zoloft
  • block
  • first line therapy
  • mild depression
  • decreased side effects
  • faster than tricyclics
  • patient compliance is better
  • serious side effects: central serotonin syndrome (and pain, diarrhea, sweaty, fever, tacky, increased BP, altered mental state), increased SE when given with MAOIs
  • periactin: given to help with CSS
  • sansert: given for CSS
  • propanolol: beta blockker used to decrease BP
  • use cooling blanket
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15
Q

Tricyclic (TCA’s)

A
  • exp: elavil, amozapine, clomipramine
  • inhibit norepi and serotonin increasing the mat of norepi and serotonin available
  • side effects: anticholinergic effects, heart dysrhythmias, MI, heart block, tacky
  • adverse rxn: MAOIs (14 day washout period), alcohol, bentos, phenothiazines, barbituates, antibuse, BC, anticoags
  • contas: recent MI, narrow angle glaucoma, seizures, pregnancy
  • lethal if overdosed
  • neurotransmitter effects
  • start with low doses then increase
  • can take 1-3 weeks to work
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16
Q

MAOIs

A
  • exp: isocarboxazid (marplan), phenelzine (nardil), selegiine, parnate
  • increases neurotransmitters at synaptic gap
  • indicaitons: atypical depression
  • adverse effects: don’t mix with other drugs, don’t eat tyramine, give in morning (insomnia), ortho hypo, weight gain, edema, constipation, mania
  • contras: CVA, CHF, HTN, liver disease (tyramine), surgery 10-14 days, less than 16 yrs
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17
Q

ECT

A
  • electroconvulsive therapy
  • emergency tx, rapid response needed to prevent suicide
  • informed consent needed, just like surgery
  • SE: confusion, disorientation, short term memory loss
  • typically 3 X week for 3-6 weeks
  • given sedation, paralytic, EEG monitoring
  • Goal: give them a seizure, do not give bentos or anti seizure meds
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18
Q

light therapy

A
  • evidence-based
  • seasonal effective disorder
  • light on face 30 mins/day
  • helps regulate melatonin
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19
Q

St John’s wort

A
  • thought to increase saratonin, norepi, and dopamine
  • mild-moderate depression
  • mild MAOI effects, can increase CSS, hypertensive crisis
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20
Q

exercise and depression

A
  • effective for mild depression, can act like an SSRI
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21
Q

cognitive behavioral thearpy & interpersonal therapy

A
  • lead to lasting mood improvements
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22
Q

bipolar 1 disorder

A
  • one or more episodes of mania alternating with major depression
  • one week-long manic episode that results in excessive activity and energy
  • manic states may alternate with depression and agitation
  • difficulty in maintaining social connections and employment
  • presence of 3 behaviors: extreme drive and energy, infalted sense of self-importance, reduced sleep, excessive talking, acing thoughts, obsessed with goals, dangerous activities and risks
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23
Q

Bipolar II disorder

A
  • repeated hypomanic episodes alternating with major depressive episodes
  • low-level mania alternates with profound depression
  • hypomania
  • euphoric and increases function, mania
  • not severe enough to interupt with job, social
  • irritable
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24
Q

Cyclothymia

A
  • at least two years of repeated hypomanic episodes alternating with minor depressive episode
  • hypomania alternates with mild to moderate depression for at least two years in adults and one year in children
  • causes social and occupational impairment
  • disturbed sleep, irritable
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25
Q

Bipolar disorder

A
  • onset: typically adolescent but can be school aged
  • fluctuations in mood from dressed to manic
  • Paranoid, psychotic and/or bizarre behaviors can be seen during manic episodes
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26
Q

Mania

A

abnormally elevated mood. May be described as expansive or irritable.

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27
Q

hypomania

A

less severe than mania. Lasts at least four days and has three to four symptoms of mania.

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28
Q

mixed episode

A

manic and depressive episodes experienced by the client simultaneously. Marked impairment in functioning.

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29
Q

rapid cycling

A

four or more episodes of acute mania within one year

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30
Q

bipolar etiology

A
  • 5.1% in united states
  • bipolar 1 - more common in males
  • bipolar 2 - more common in females
  • cyclothymia: begins in adolescence or early adulthood, 18-20yrs,
  • coincides with anxiety, anorexia, ADHD, risk for suicicde, substance abuse
  • genetics: 5-10x more liekly
  • neurotransmitter imbalances
  • hypothyroidism is associated
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31
Q

Bipolar assessment

A
  • mood: unstable euphoric mood, enthusiastic, concoct elaborate schemes, give away money/gifts
  • behavior: manipulative, exploit vulnerabilities, profane
  • thought processes and speech patterns:
  • flight of ideas: continuous flow of accelerated speech with abrupt changes from topic to topci that are usually based on understandable associations or plays on words, accelerated speech with threaded thoughts
  • clang associations: stringing together of words because of their rhyming sounds, without regard to meaning
  • gandiosity: inflated self-regard
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32
Q

bipolar manic phase

A 
Persistent elevated mood (euphoria)
			Agitation and irritability
			Dislike of interference and intolerance of criticism
			Increase in talking and activities
			Flight of ideas
			Grandiosity
			Impulsivity
			Distractibility
			Poor judgment
			Decreased sleep
			Neglect of ADLs
			May have delusions and hallucinations
			Denial of illness
33
Q

bipolar depressive phase

A 
Affect:  flat, blunted, labile
			Lack of energy
			Anhedonia
			Physical symptoms of discomfort/pain
			Difficulty concentrating
			Self-destructive behavior
			Decrease in person hygiene
			Loss or increase in appetite and/or sleep
			Psychomotor retardation or agitation
34
Q

bipolar NANDA diagnoses

A

Ineffective coping
Risk for injury
Disturbed sleep pattern
Risk for other- or self-directed violence

35
Q

bipolar stages

A
  • stage 1: hypomania – symptoms not sufficient to cause marked impairment in social or occupational fxn or to require hospitalization
  • stage 2: acute mania – marked impairment in functioning of mood, cognition, perception and activity and behavior, usually requires hospitalization
  • stage 3: delirious mania – grave form of the disorder, characterized by severe clouding of consciousness and representing an intensification of the symptoms associated with acute mania
36
Q

bipolar internvetions

A

Therapeutic milieu (within acute care facility)
Safe environment
Decrease stimulation
Observe closely for escalating behavior
Outlets for physical activities
Maintenance of self-care needs
Provide to appropriate rest-sleep-activity
Communication (by staff)
Calm, matter of fact, specific approach
Concise explanations
Consistency
Avoid power struggles
Hear and act on legitimate complaints
Reinforce non-manipulative behaviors

37
Q

bipolar outcome identifications

A
  • acute phase: prevent injury
  • continuation phase: relapse prevention
  • maintenance phase: limit severity and duration of future episodes
38
Q

medications for bipolar manic stage

A

Lithium:

  • therapuetic level: .8-1.4
  • maintenance blood level: 0.4-1.3
  • toxic blood level: 1.5 +
  • works within 10-21 days
  • helps reduce: flight of ideas, grandiosity, anxiety, irritability, insomnia, assaltive behavior, distractibility, paranoia
  • contraindications: get baselines, renal fun, thyroid status, CV disease

Anticonvulsants:

  • depakote, tegretol, lamictal
  • help continuously cycling pts, mor effective when no family history of bipolar, diminish impulsivity, helps control mani and depression within a few weeks

Atypical antipsychotics:

  • klonopin, lorazepam (ativan)
  • used for acute mania for pts resistant to other treatment
  • avoid if substance abuse
  • zyprexa and risperdal: sedative effects, help with anxiety, agitation, insomnia

Benzodiazepines

39
Q

other tx for bipolar

A
  • ECT, support groups, health teaching and promotion, CBT, social rhythm therapy
40
Q

suicide

A
  • intentional act of killing oneself by any means
  • 10th leading cause of death
  • higher in younger ages
  • risk factors: psych disorders, alcohol/substance abuse, male, increased age, white, married with kids reduces, professionals at greater risk, physical illness
  • runs in families, associated with low serotonin levels
41
Q

suicide protective factors

A
  • african american: religion and role of extended family
  • hispanic american: roman catholic and importance of extended family
  • asian americans: adherence to religions that tend to empathize interdependence between individual and society
42
Q

suicide assessment

A
  • verbal: overt statements (I wish I were dead) and covert statements (it;s ok now, everything will be ok. things will never work out. i won’t be a problem any longer”
  • lethality of suicide: specific plan with details, how lethal is the method proposed, access to planned method
  • assessment tools: SAD PERSONS scale – male, 25-44. depression, previous attempt, ethanol use, rational thinking loss, social supports lacking, organized plan, no spouse, sickness
43
Q

suicide interventions:Primary, secondary and tertiary levels

A
  • primary: provides support, information, education to prevent suicide. schools, homes, churches, clinics, hospitals, work
  • secondary: tx for actual suicidal crisis. clinics, hospitals, jails, telephone hotlines, crisis intervention
  • tertiary/postvention: internvetions with the circle of survivors.
44
Q

suicide interventions

A
  • teamwork and safety: problem solving and positive actions
  • counseling: remain calm and listen, call 911
  • health teaching and promotion: teach about dx, meds, community resources, coping skills, communication
  • case mngmt: reconect with family, friends and community resources
  • pharmacological interventions: antidepressants
  • post-vention for surviviros
45
Q

suicide evaluation

A
  • ongoing
  • sudden changes
  • anniversary of losses increases suicide
  • outcome criteria established during planning phase
46
Q

non-suicidal self-injury

A
  • 12-23% of adolescence self harm
  • not for attention
  • parasuicide
  • a way to express psychic pain, helps them feel, self comfort
  • increased risk if parent with depression
  • increased acceptance with social media
  • may lead to death but not intentional
47
Q

Schitzophrenia terms

A
  • Affect: outward expression of internal emotion, flat, inappropriate emotions
  • Associative looseness: jumbled illogical thinking
  • Delusions: false beliefs that cannot be corrected by reasoning
  • Autism: thinking not bound to reality
  • ambivalence: simultaneously 2 emtions, ideass, wishes
  • Abstract thinking: impaired ability to think abstractly, only concrete
  • Clang associations: choosing words based on their sound rather than meaning
  • Word salad: jumbled words with meaning for patient but meaningless to person
  • Neologisms: made up words
  • Echolalia: pathological repeating of another words and is often seen in cation
  • Paranoia: irrational fear of others
  • Circumstantiality: including unnecessary details that are tedious
  • Flight of ideas: moving rapidly from one thought to the next, making it difficult for others to follow the convo
  • Depersonalization: one has lost identity or is unreal
  • Derealization: false perception of environment
  • Hallucinations: perceiving a sensory experience for which no external stimuli exists
  • Catatonia: pronounced increase or decrease in rate and amount of movement
  • Waxy flexibility: extended maintenance of posture, usuallyy seen in catatonia
  • Extrapyramidal side effects (EPS): constant moving, side effect of psych meds
  • Tardive dyskinesia: constant moving, side effect of psych meds
48
Q

schitzo comorbidities

A
  • 50% substance abuse
  • 70-90% nicotine
  • anxiety, depression, suicide
  • die younger due to hypertension, obesity, CV, diabetes, trauama
  • polydipsia: 20% of schitzos have it
49
Q

schitzo etiology

A
  • biological factors: 10 x more likely if parent of sibling has it
  • prenatal stress
  • increased cortisol
  • diathesis-stress model
50
Q

prepsychotic phase

A
  • monitor at early age
  • catching it early can decrease symptoms
  • s/s of schitzo: shy and withdrawn, poor perr relationships, doing poorly in school, antisocial behavior
  • lasts a few weeks to years
  • deterioration in role functioning and social withdrawl
  • sustancial functional impairment
  • sleep disturbance, anxiety, irritability
  • depressed mood, poor concentration, fatigue
  • family can keep it under control but then they go away and it comes out
51
Q

schitzo positive symptoms

A
  • presence of something not normally present
  • hallucinations, delusions, bizarre behavior, paranoia, abnormal movements, gross errors in thinking
  • cataonia, motor retardation, waxy flexibility
52
Q

schitzo negative symptoms

A
  • absence of something that should be present
  • interest in hygeine, motivation, ability to experience pleasure
  • flat, blunted, inappropriate, bizarre affect
53
Q

schitzo cognitive symptoms

A
  • subtle changes in memory, attention, thinking

- impaired executive functioning (ability to set priorities or make decisions)

54
Q

schitzo affective symptoms

A
  • symptoms involving emotions and their expression
55
Q

command hallucinations

A
  • direct the person to take action
56
Q

schitzo nursing diagnoses

A
  • positive symptoms: disturbed sensory perception, risk for self directed or other directed violence, impaired verbal communicaiton
  • negative symptoms: social isolation, chronic low self esteem
57
Q

hallucinatin vs delusion

A
  • delusion: false, fixed beliefs. cannot be corrected by reasoning
  • hallucination: perceive a sensory experience with no external stimulus
58
Q

schitzo assessment guidelines

A

1) medical problems: brain injury, drug intoxication
2) abuse of or dependence on alcohol or drugs
3) risk to self or others
4) command hallucinations
5) delusions
6) suicide risk
7) ability to ensure self-safety
8) medications
9) mental status exam
10) patient’s insight into illness
11) family’s knowledge of patient’s illness and symptoms

59
Q

interventions in acute, stabilization, and maintenance phases

A
  • acute: psych, medical and neuro eval, psychopharm treatment, psychoeducation, supervision and limit setting
  • stabilization and maintenance: effective long-term care relys on = medication admin/adherence, relationships with trusted providers, community-based services
  • effective care provides: protection from undue stress, structure/planned routine, limits, sense of security
60
Q

schtizo communication techniques

A
  • hallucinations: nurse needs to understand exactly what their hallucinations are
  • delusions: talk about feelings and themes but not specific delusions, focus on present and realtiy based activities
  • associative loosness: tell them if you dont understand, restate and ask pt if you understand correctly
  • health teaching and promotion: educate on causes, meds, side effects, coping strategies,
61
Q

antipsych meds

A
  • 1 yr after 1 episode
  • 2yrs after 2 episodes
  • life after 3 episodes
  • potentially dangerous responses: 1)anticholinergic toxicity: hyperthermia, delirium, tachy
    2) neuroleptic malignant syndrome: fever, tachy, hydrate, cool, antiarythmics, heparin
    3) agranulocytosis:decreased WBC
62
Q

first generation antipsychotics

A
  • examples: haldol, thorzine
  • target positive symptoms of schitzo
  • dopamine antagonist
  • advantage: less expensive thatn 2nd gen
  • disadvantages: EPS, anticholinerci side effects (dry mouth, urinary retention, blurred vision, sedation, agranulocytosis), tardive diskonesia, weight gain, sex dysfunction, endocrine dys,
63
Q

second generation antipsychotics

A
  • exp: risperidone (risperdal), olanzepine (zyprexa), serquel, clozaril (agranulocytosis)
  • less side effects than first gen
  • treats pos and neg symptoms
  • no EPS or tardive dyskinesia
  • disadvantage: tendency to cause signficant weight gain
64
Q

third generation antipsychotics

A
  • abilify (aripiprazole)
  • dopamine system stabilizer
  • improves pos and neg symptoms and cognitive function
  • little risk for EPS or tardive
65
Q

substance abuse terms

A
  • Substance abuse: pathological use of a substance that leads to a disorder of use, intoxication, and often withdrawl if the substance is taken away
  • Substance dependence:
  • Flashbacks
  • Addiction: primary, chronic disease of brain reward, motivation, memory, and related circuitry. disease of disregulation in the pleasure center
  • Intoxication: process of using a substance to excess.
  • Tolerance: needing increased amounts of a substance to receive the desired result of finding that using the same amount over time results in a much diminished effect
  • Withdrawal: physiological symptoms that begin to occur as the concentration of the chemical decreases in an individual’s bloodstream
  • Dual diagnosis: co-occuring disordersADHD
66
Q

CNS depressants

A
  • Alcohol: drowsiness, slurred speech
  • barbituates:
  • benzodiazepines
  • opioids
67
Q

CNS Stimulants

A
  • meth: increased HR, weight loss
  • cocaine
  • caffeine
68
Q

Hallucinogens

A
  • LSD
69
Q

inhalants

A

Anesthetics
Volatile nitrates
Organic solvents

70
Q

Cannabis

A

marijuana

71
Q

Nicotine

A

cigarettes

72
Q

CAGE test

A
  • CAGE (one positive responsive indicates a more in-depth assessment is necessary)
    C – has anyone ever told you that you should cut down on your drinking/drug use?
    A – have people annoyed you by criticizing you for drinking/using drugs?
    G – have you ever felt guilty for drinking/doing drugs?
    E – have you ever taken an eye-opener (morning drug or drink) to steady your nerves or to get over a hangover?
73
Q

alcohol withdrawl meds

A
  • disulfiram (antabuse): makes you nauseous when you drink while taking it
  • naltrezone (revia) also used with opioids: relapse prevention
  • acamprosate (campral): helps cliend obstain from alcohol
  • ## topamax: decreases alcohol cravings
74
Q

opioid withdrawl drugs

A
  • Methadone (Dolophine): blocks cravings and effects of heroine
  • LAAM: alternate to methodone
  • Reviva: blocks euphoric effects of opioids
  • Clonidine (Catapres): helps when combined with naltrexone
  • Buprenorphine (Subutex): blocks s/s of opioid withdrawal
  • Buprenorphine and naloxone combination (Suboxone)
75
Q

alcohol withdrawl

A
  • signs develop within a few hours of cessation
  • peaks 24-48 hours
  • alcohol withdrawal delirium: medical emergency with 10% mortality rate, DIs peak 48-72 hours after stopping, withdrawl symptoms 24-48, can take a week to fully detox off alcohol
  • s/s: slurred speech, ataxia, disinhibition, impaired memory, anxiety, anorexia, insomina, tremor, increased hr, fever, hallucinations, seizures, increased BP, diaphoresis, disorientation, LOC changes, paranoid dilusions, agitaition
76
Q

serious mental illness

A
  • extends in time byond acute stage - chronic or reoccurrent
  • associated with poverty, stigma, unemployment, inadequate housing
  • how it develops: erosion of basic coping mechanisms and compensatory processes, poor self care, poor social interactions,
77
Q

older adults and younger kids with SMI

A
  • older: pts used to become dependent on mental health acute center services and loss independence
  • younger: limited experience with formal tx, inabiity to realize illness, increased risk for problems, substance abuse, unemployment
78
Q

SMI rehab and recovery

A
  • rehab focuses on managing patients’ deficits, help them to learn with their illness
  • recovery: helps achieve goals, leads to increase productivity and meaningful lives
79
Q

issues for people with SMI

A
  • higher risk for major medical disorders
  • help them to establish a meaningful life
  • social stigma, isolation, lonliness, victimixation
  • tx issues: nonadherence, anosognosia (inability to recognize your deficits due to your illness)

Mental Health (3 decks)

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