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MENTAL HEALTH > Mental Health Exam 1 > Flashcards

Mental Health Exam 1 Flashcards

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1
Q

What are possible causes of schizophrenia

A

Genetics
Biochemical
Viral
Environmental factors

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2
Q

What are the types of schizophrenia

A

Paranoid type- These ppl can b prone to violence, thinks someone is out to get them
FBI, POISONED
Disorganized type- seen in homeless, withdrawn from society, inappropriate social behaviors
Catatonic type- withdrawn ( mute, comatose, not eating, staring @ wall) excited ( constant movement, incoherent speech)
Undifferentiated- has schizophrenia but doesn’t fit into the above categories

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3
Q

What are the 5 types of hallucinations

A 
Auditory- hearing things no one else can
Visual- seeing things that aren't there
Tactile- feeling bugs are on them
Gustatory- taste 
Olfactory- smell
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4
Q

Echopraxia

A

Imitating movements of others

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5
Q

Echolalia

A

Repeating words spoke

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6
Q

What are positive symptoms of schizophrenia

A

Hallucinations/ delusions
Content of thought
Form of thought
Perception

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7
Q

What are the negative symptoms of schizophrenia

A 
Affect
Apathy
Anhedonia
Anergia
Decreased social interaction
Posturing
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8
Q

What are nursing diagnosis related to schizophrenia

A

Risk for violence; self directed or others directed
Disturbed thought process
Social isolation
Disturbed sensory perception

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9
Q

What are nursing interventions for the patient with schizophrenia

A

Avoid touching without warning especially when agitated
Do not reinforce hallucinations
Offer distraction

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10
Q

What are contraindications of typical antipsychotics

A

Parkinson’s disease, liver, renal or cardiac insufficiency

Uncontrolled seizure disorder

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11
Q

What does typical antipsychotics target

A

Positive symptoms

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12
Q

What is the prototype typical antipsychotic

A

Chlorpromazine ( Thorazine)

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13
Q

What are other typical antipsychotics

A

Haldol
Fluphenazine
Perphenazine

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14
Q

What is the prototype atypical antipsychotic

A

Risperidone ( risperdal)

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15
Q

What does atypical antipsychotics target

A

Positive and negative symptoms

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16
Q

What is the action of typicals

A

Blocks dopamine

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17
Q

What is the action of atypicals

A

Blocks serotonin and to some degree dopamine

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18
Q

What are contraindications of atypicals

A

Severely depressed people

Elderly ppl with dementia related psychosis

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19
Q

What are commonly used atypical antipsychotics

A 
Olanzapine ( Zyprexa)
Quetiapine ( seroquel)
Aripriprazole ( Abilify)
Ziprasidone ( Geodon)
Clozapine ( clozaril)
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20
Q

What is given to ppl who don’t adhere to treatment of schizophrenia

A

Long acting IM meds are the medical regime

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21
Q

What are potential side effects of all antipsychotics

A

EPS-
Pseudoparkinsonism- tremor, shuffling gait, drooling,rigidity ( because of lowered dopamine)
Akathisia- restlessness
Akinesia-muscle weakness
Dystopia- spasms & stiffness of neck, face, arms, or legs ( usually happens @ the start of antipsychotic tx.
Oculogyric crisis- rolling back of eyes

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22
Q

What are medications reverse EPS

A

Antichloinergics such as benztropine ( cogentin) and trihexphenidyl ( Artane)

Antihistamines such as diphenhydramine ( Benadryl)

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23
Q

Tardive dyskinesia is typically seen when

A

Seen after months to years of prolonged use of antipsychotic

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24
Q

What are clinical manifestations of Tardive dyskinesia

A

Bizarre facial and tongue movements
Stiff neck
Difficulty swallowing

IREVERSIBLE

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25
What is NMS
NEUROLPETIC MALIGNANT SYNDROME Rare but life threatening Typically seen soon after initiation of antipsychotics
26
What are clinical manifestations of NMS
``` Muscle rigidity Very high fever Tachycardia Tachypnea BP instability,diaphoresis Changes in LOC ```
27
WHAT is treatment for NMS
Immediately stop antipsychotics Monitor VS IV fluids I&O
28
What is metabolic syndrome
It is seen with atypicals | It causes the pt to gain wt and as a result new onset diabetes occurs
29
What is a side effect assoc with antipsychotics
Anticholinergic effects such as dry mouth, constipation, photophobia, urinary retention.
30
What is a major side effect to watch out for with antipsychotics such as clozaril
Agranulocytosis Before initiation, a baseline WBC count and absolute neutrophil count is drawn. WBC must be at least 3500 WBC AND ABSOLUTE NEUTROPHIL ARE DRAWN WEEKLY FOR 1ST 6 MONTHS THEN WEEKLY AFTERWARDS.
31
What is the definition of bipolar
A mood disorder manifested by cycles of mania and depression
32
What is the prevalence of bipolar
It occurs equally between males and females Avg onset is early 20's Genetic predisposition
33
If a person is dehydrated who also takes lithium, what will happen to there lithium levels
They will go up
34
If a person has excessive fluid in there body and also takes lithium, what will happen to there lithium levels
Lithium levels will go down
35
What is bipolar 1
Full blown manic episodes Interferes with Q day functioning, can become severely depressed when they crash, often cycle between ups and downs Can be seasonal Should be in hospital
36
What is bipolar 2
Distinguished by bouts of MMD with hypo mania | doesn't reach mania
37
What are nursing diagnosis for bipolar disorder
1. Risk for injury 2. Risk for violence; self directed or others directed 3. Imbalanced nutrition; less than body requirements 4. Disturbed thought process 5. Insomnia
38
What are nursing interventions during the manic/ acute phase
Safety Self care Communication
39
For a person with bipolar, what type of foods should be offered
Finger foods because they can't sit down long enuf to eat
40
What are medications for bipolar disorder
Lithium carbonate
41
What are contraindications of lithium carbonate
Cardiac or renal disease | Dehydration, sodium depletion
42
What are side effects of lithium carbonate
Margarine between therapeutic levels and toxic levels is very low
43
What is the therapeutic range of lithium
0.6-1.2
44
When do levels of lithium become toxic
Above 1.5
45
What are clinical manifestations of lithium toxicity from 1.5 - 2.0
Blurred vision, ataxia,tinnitus, fine hand tremors, persistent N/V Severe diarrhea
46
What are clinical manifestations of lithium toxicity with levels from 2.5-3.5
Excessive output of dilute urine, increasing tremors, mental confusion
47
What are clinical manifestations of lithium toxicity above 3.5
``` Decreased LOC Anuria MI Seizures Coma, death ```
48
Is lithium toxicity lethal
Toxicity can be lethal
49
What is patient education of lithium carbonate
Drink 2-3 L of water daily ( by not drinking enuf, they can raise lithium levels) Maintain a sufficient level of Na, ( not more not less) Avoid use of NSAIDs Use diuretics cautiously ( because of loss of Na)
50
What class of drugs is also used to treat bipolar disorder
Anticonvulsants
51
Name a anticonvulsant drug
Valproic acid ( depakote)
52
What are contraindications of valproic acid ( depakote)
Liver disease | Pregnancy
53
What are side effects of valproic acid ( depakote)
GI upset,hepatotoxicity, prolonged bleeding time
54
What is lab work that must be monitored while on valproic acid ( depakote)
LFTs ( AST,ALT) Platelet count Valproic acid serum levels
55
What is valproic acid used to treat
Bipolar disorder
56
What are treatment modalities of bipolar disorder
Individual therapy Group therapy Family therapy ECT
57
What is the definition of schizophrenia
Psychotic disorder that affects thinking, behavior, emotions,and the ability to perceive reality.
58
What does serotonin regulate
Sleep cycle Appetite Mood regulation Circadian rhythm
59
What medications have a side effect of depression
Hormone replacement therapy Antibiotics such as sulfa drugs, tetracycline Steroids, prednisone
60
What is SAD
Seasonal affective disorder It occurs during winter months Mood lightens in the spring ( some ppl may require light therapy to relieve the depression)
61
What is MDD
Major depressive disorder Characterized by depressed mood or loss of interest in usual activities Symptoms last at least 2 weeks
62
What is subjective data of a depressed person
Anergia, anhedonia, anxiety,fatigue Somatic complaints, loss of appetite Sleep disturbances Negative thoughts
63
What is objective assessment data of a depressed person
Affect, disheveled appearance Slowed physical movements Socially isolated, Slowed thought process and speech patterns
64
What are nursing diagnosis related to depression
Risk for suicide Social isolation Self care deficit Imbalanced nutrition; less than body requirements
65
What types of therapies are there for depressed patients
Cognitive behavior therapy; it helps the person realize and change negative thoughts Group therapy, depression support groups Individual therapy
66
When should a person expect to experience relief of depression after taking depression meds
Relief is not immediate, may take 2-4 weeks to reach full therapeutic levels
67
Do antidepressants carry a black box warning
YES | All antidepressants carry a FDA black box warning for increased risk of suicide in children and adolescents
68
Do antidepressants increase risk of suicide
As antidepressants take effect the mood begins to lift, giving the patient more energy. Suicide risk increases as the level of depression decreases.
69
What are meds for depression
TCAs SSRIs MAOIs Atypical antidepressants
70
What are TCAS
Tricyclic antidepressants | Blocks the reuptake of norepinephrine and serotonin in the synaptic space
71
What were the first antidepressants used
TCAs
72
What is the prototype TCAs
Amitriptyline ( Elavil)
73
What are side effects of TCAs
Orthostatic hypotension Anticholinergic effects Sedation Decreased seizure threshold
74
What is pt education regarding TCAs such as Amitriptyline
Educate to take at bedtime | Use cautiously in someone with seizure disorder
75
What are SSRIs
Blocks the reuptake of serotonin MOST PRESCRIBED ANTIDEPRESSANT Used to treat depression and anxiety
76
What is the prototype SSRI
Fluoxetine ( Prozac)
77
What are side effects of fluoxetine ( Prozac)
Sexual dysfunction CNS stimulation Changes in weight Serotonin syndrome
78
What is pt education regarding fluoxetine ( Prozac)
Can make a person feel more alert, take in am | May cause decreased libido
79
What is serotonin syndrome
Can become life threatening May begin 2-72 hours after initiation of tx It is a side effect that can occur while taking meds concurrently that affect serotonin levels
80
What meds affect serotonin levels
``` Obviously SSRIs Warfarin Beta blockers Theophylline MAOIs ```
81
What are symptoms of serotonin syndrome
``` Mental confusion Fever Hallucinations Diaphoresis Abdominal pain with diarrhea ```
82
What are MAOIs
Blocks MAO in the brain thereby increasing norepinephrine, dopamine,and serotonin
83
What is the prototype MAOI
Phenelzine ( Nardil)
84
What are side effects of MAOIs
Serotonin syndrome | Hypertensive crisis
85
What are foods to avoid while taking phenelzine
Foods that contain tyramine because tyramine is already found in MAOIs. If you eat foods that have tyramine, tyramine levels will rise leading to hypertensive crisis
86
What are foods that contain tyramine
Aged cheese, figs, yogurt, raisens, pepperoni,
87
What are atypical antidepressants
They are an alternative to SSRIs They also help combat nicotine addiction Blocks the reuptake of dopamine
88
What is the prototype atypical antidepressant
Bupropion ( Wellbutrin)
89
What are side effects of atypical antidepressants
Weight loss! Seizures! Anticholinergic effects!
90
What is the definition of anxiety
Apprehension, uneasiness, or tension
91
What are the different types of anxiety disorders
``` Panic disorder Phobias Generalized anxiety disorder OCD Compulsions ```
92
What is panic disorder
Characterized by recurrent panic attacks
93
What symptoms may a person experience during a panic attack
Heart palpitations, sweating Trembling, shaking, chest pain GI distress, SOB, Fear of loosing control, fear of dying
94
What are phobias
A person fears a specific object or situation
95
Give examples of phobias
``` Social phobia ( also called social anxiety disorder) Agoraphobia- fear of going outside ``` Multiple others such as fear of water, heights, marriage, animals etc.....
96
What is generalized anxiety disorder
Persistent and excessive worry and anxiety
97
What is OCD
Presence of obsessions, compulsions or both
98
What are obsessions
Recurrent or persistent thoughts that are experienced as intrusive and stressful
99
What are compulsions
Repetitive ritualistic behavior
100
What is desensitization
Gradually introducing the person to the phobia
101
What are meds for anxiety disorders
Benzodiazepines ( Lorazepam, Ativan )depresses CNS, works immediately Atypical anxiolytics ( buspirone, buspar) better for long term control of anxiety relief Antihistamines ( diphenhydramine) ( hydrozyzine, vistaril) SSRIs
102
What are contraindications of benzodiazepines such as lorazepam
Do not use with other CNS depressants Pregnancy, glaucoma, Elderly and those with a history of drug abuse
103
What are nursing considerations of benzodiazepines such as lorazepam
It can cause physical and psychological dependence, drowsiness, confusion,orthostatic hypotension with dizziness Blurred vision Benzodiazepines are prescribed for PRN use
104
What are contraindications of atypical anxiolytics such as buspirone ( buspar)
Breastfeeding | Concurrent use of MAOIs can cause hypertensive crisis
105
What are side effects of atypical anxiolytics
Dizziness Headache Agitation
106
When will therapuetic effects occur with atypical anxiolytics
It may take up to 2 weeks for anxiety symptoms to diminish
107
What is Paxil
A SSRI

MENTAL HEALTH (17 decks)

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