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Flashcards in Mental Health Deck (15):

mentally healthy person

is in contact w/ reality

can relate to ppl and situations in their environment

resolve conflicts w/in a problem-solving framework


psychiatric illness

loss of the ability to responde to the internal and external environment in ways thta are in harmony with oneself or the expectations of society


characterized by thought or behavior patterns that impair functioning and cause distress


right of involuntary admission

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  • right for informed consent
  • right to refuse tx including meds, unless a separate and specific tx is obtained from the court
    • lose right if immediate threat to self or others


Types of denfense mechanisms

See attached

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Need of pt w/ Anxiety

need to decrease stimuli and provide quiet/calm environment


panic d/o

the cause usually cannot be identified


Somatoform d/o

persistant worry or complaints regarding physical illness w/o supportive physical findings


the pt my unconsciously use somatization for secondary gains, such as increased attentention or decreased responsibilities


  • Conversion d/o: sudden onset of a physical symptom or a deficit suggesting loss of or altered body function related to psycho conflict or neuro d/o
  • Hypochriasis: preoccupaton w/ fears of having a serious illness, no evidence of physical illness
  • Somatization d/o: pt has multiple physical complaints involving numerous body systems, it's psychological

RN to allow a specific time period for the pt to discuss physical complaints b/c pt will feel less threatedend if limited rather than abrupt stopping.  avoid responding w/ positive reinforcement about physical complaints


dissociative d/o

  • dissociative identity d/o: two or more personalities
  • dissociative amnesia: can't recall important personal information b/c it provokes anxiety
  • dissociate fugue: pt assumes new identity in a new environement


Rx for bipolar d/o

traditionally lithium carbonate

  • need serium lithium levels!!
  • Need stable intake of SODIUM and FLUID (2-3L) to avoid toxicity

valproic acid (depakote)

carbamazepine (tegretol)

these reduce acute manic episodes and for maintenance therapy

olanzapine (Zyprexa)

aripiprazole (abilify)

risperidone (Risperdal)

given for sedative and mood stabilizing effects

**sidenote: RN should avoid power struggles. Just set clear, consistent enforceable limits and the consequences and follow thru


ECT (electroconvulsive therapy)

6 - 12 tx, given 2-3x/wk


  • NPO at least 4h befoe
  • baseline VS
  • void
  • Meds to relax muscles

During procedure

  • BP cuff on, IV line and ECG electrodes
  • 100% O2 by mask via positive pressure


  • Pt may be confused, frequently reorient the pt
  • assess gag reflex before given fluids, meds, food




citalopram (Celexa)

escitalopram (Lexapro)

Fluoxetine (Prozac)

Fluvoxamine (Luvox)

Paroxetine (Paxil)

Sertrraline (Zoloft)

s/e: CNS stimulation, BP changes, dizzy, photosensitivity

  • admin w/ snack or meal
  • do not stop taking abruptly 
    • d/c sydnrome: GI distress, behavioral or perceptual oddities, mvmt problems, sleep issues
  • notify HCP if priaprism occurs
  • monitor liver, kidney and WBC
  • serotonin syndrome:
    • elevated temp, muscle rigidity, elevated CPK levels
    • increased when given with MAOIs
    • OTC cold meds increase liklihood
  • prevent exposure to sun
  • do not take St.John's wort


TCAs (tricyclic antidepressants)

blocks reuptake of NE (and serotonin)

has anticholinergic effects: dry mouth, difficulty voiding, decr GI mtoitliy, constipation

  • may reduce seizure threshold
  • reduce effectiveness of antihypertensives
  • concurrent use w/ ETOH and antihistamines --> CNS depression
  • concurrent use w/ MAOIs --> hypertensive crisis
  • CV disturbances like tachycardia/drysrhythmias, ortho hypotension
  • prevent exposure to sun



inhibition of MAO increases amines, NE, and serotonin

prescribed when other tx including ECT was not effective for depression


Phenelzine (Nardil)

Tranylcypromine (Parnate)

Isocarboxazid (Marplan)

Selegiline (Emsam)

  • Hypertensive crisis --> concurrent use w/ amphetamines, antidepressants, dopamine, epinephrine, levodopa, methyldopa, nasal decongestants. NE foods w/ tyramine
    • htn, occipital h/a radiating frontally, neck stiffness/soreness, N/V, clammy skin

ANTIDOTE: phentolamine

Foods to avoid:

  1. avocados, bananas, eggplant, figs, overripe fruit, papaya
  2. raisins, red wine
  3. liver, meat extracts and tenderizers, pickled herring, sausage, bologna, pepperoni, salami
  4. sour cream, yogurt
  5. soy sauce, brewer's yeast
  6. broad beans
  7. caffeine, coffee, tea, chocolate




mood stabilizer

  • therapeutic: 0.6 - 1.2
  • mild toxicity: 1.5 mEq/L
    • apathy, lethargy, diminished conc, mild ataxia, coarse hand tremors, slight muscle weakness
  • moderate toxicity: 1.5 - 2.5
    • N/V, severe diarrhea, incoordination, slurred speech, tinnitus, blurred vision
  • severe toxicity: >2.5
    • nystagmus, DT hyperreflexia, visual/tactile hallucinations, oliguria, anuria, impaired LOC, tonic-clonic seizures or coma leading to death

Need to taper drug!!  If missed, can take 2h later only or wait for next dose.

Levels are checked in morning 12h following last dose. 



antianxiety, sedative-hypnotic, muscle relaxing and anticonvulsant action

contraindicated in pt w/ acute narrow-angle glaucoma

abrupt w/d can be life-threatening

taper gradually 2-6 weeks