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Mental Health part 2 Flashcards

1
Q

reduction in or lack of energy

A

anergia

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2
Q

an inability to find meaning or pleasure in existence

A

anhedonia

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3
Q

a classification of more recently released antidepressants affecting a variety of neurotransmitters

A

atypical antidepressants

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4
Q

a mild to moderate mood disturbance characterized by chronic depression syndrome that is usually present for at least 2 years

A

dysthymic disorder

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5
Q

an effective tx for depressio nin which a grand mal seizure is induced by passing an electrical current through electrodes that are applied to the temples. The admin of a muscle relaxant minimizes seizure activity and prevents damage to long bones and cervical vertebrae

A

Electroconvulsive therapy (ECT)

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6
Q

the spending of increased time in sleep, possibly to escape from painful feelings; however the incresed sleep is not experienced as restful or refreshing

A

hypersomina

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7
Q

inabilty to fall asleep or to stay asleep, early morning awakening or both

A

insomnia

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8
Q

a classificati nof antidepressants that inhibit monoamine oxidase, an enzyme that breaks dowm amines such as serotonin and norepinephrine. The use of this necessitates the adoption of a tryamine-free diet bc of potentially fatal interactions

A

Monoamine oxidase inhibitors (MAOI)

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9
Q

a pervasive and sustained emotion that, when extreme, can markedly color the way individual perceives the world

A

mood

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10
Q

PT may constantly pace, bite their nails, smoke, tap their fingers, or engage in some other tension relieving activity

A

psychomotor agitation

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11
Q

slowed and difficult movements to complete inactivity and incontinence

A

psychomotor retardation

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12
Q

1st line antidepressants that block the reuptake of serotonin, permitting serotonin to act for an extended period at the synaptic binding sites in the brain

A

selective serotonin reuptake inhibitors (SSRI)

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13
Q

drugs that inhibit the reuptake of norepinephrine and serotonin by presynaptic neurons in the CNS, increasing the amount of time norepinephrine and serotonin are available to the postsynaptic receptors

A

tricyclic antidepressants

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14
Q

name the 3 types of mood disorders

A

major depressive disorder
dyshymic disorder
postpartum depression

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15
Q

the primary alteratio nin depression is what

A

mood, rather than in thought or perception

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16
Q

the most common cause of depression is

A

neurobiologic (serotonin & norepinephrine)

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17
Q

serotonin does what

A

regulates sleep, apettite, mood

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18
Q

low levels of norepinephrine does what

A

no energy, cant concentrate

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19
Q

both serotonin and norepinephrine are involved in what

A

perception of pain

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20
Q

depression can occur because of medication side effects such as

A

corticosteriods, anti psycotic, anti HTN, anti parkinsons

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21
Q

depression can occur because of neurological disorders such as

A

CVA, brain tumor (temporal lobe), alzhiemers

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22
Q

depression an occur because of electrolyte disturbances such as

A

excessive amounts of sodium or calcium or a deficit in Mg

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23
Q

depression can occur because of nutritional deficiencies such as

A

deficit in B1 (thiamin), zinc, folic acid, niacin

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24
Q

what psychosocial event can cause depression

A

reactio nto life events, early life trauma

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25
Q

plays a part in the stress response, if you have a major stressor, can deplete norepinephrine stores which causes depression

A

norepinephrine

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26
Q

Sx of depression

A

mood sadness, despair, emptiness, adhedonia, low self esteem, apathy, low motivation, social withdraw

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27
Q

single or recurrant episode, experience pain an dsuffering, does not function normally, Sx persist over a minumial 2 week period

A

major depressive disorder

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28
Q

For DSM what must you hve for major depressive disorder

A

loss of ability to experience pleasure in life*
depresssed mood, anhedonia, change in weight, psychomotor agitation or retardation, fatigue, anergia, feelings of worthlessness, diminished concentration, recurrent thoughts of death or suicide
*must have this

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29
Q

Melancholic features

A

complete loss of pleasure in life and inability to feel better, feels worse in morning, weight loss, excessive guilt, has psychotic features

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30
Q

postpartum onset

A

within 4 weeks postpartum, delusional thoughts about infant signigy risk of harm to infant

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31
Q

catatonic features

A

exhopraxia, grimacing, sterotyped movements, posturing, negativism, waxy flexibilty, mutism, agitation

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32
Q

atypical features

A

mood reactivity (opp of what is expected), hypersomnia, hyperphagia, leaden paralysis, rejecction sensitivity

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33
Q

depressed mood for at least 2 years for more days than not, disorder of chronicity rather than severity

A

dysthymic disorder

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34
Q

S/Sx of dysthymic disorder

A

chronic sadness, eating too much or too little, difficulty getting to sleep, low energy, decreased pleasure, negative thinking, low self esteem, feelings of worthlessness

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35
Q

physical changes of dysthymic disorder

A

psycomotor agitation/retardation, vegatative signs

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36
Q

natural response to death, responsive to social contacts, typically does not need antidepressants

A

grief

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37
Q

an illness, persistent and can worsen, suicidal ideation, responsive to antidepressants

A

depression

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38
Q

Black box warnings

A

carefully observe for worsening symptoms of depression and suicidal thuoghts

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39
Q

nonselective inhibition of norepinephrine and serotonin.

Ex. Elavil, Sinequan, Anafrail, Pamelor, Norpramin, Asendin

A

Tricyclic Antidepressants

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40
Q

Tricyclic antidepressants

A

take 10-14 days to become effective, tapper Rx to effective dose
SE: dry mouth, blurred vision, tachycardia, constipation, urinary retention, esophageal reflux, postural orthostatic hypotension, weight gain, can trigger manic episode, agranulocytosis, nightmares

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41
Q

when are tricyclic antidepressants given

A

at night due to sedative effects

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42
Q

Tricyclic Toxic effect

A

cardiovascular: dysrhythmias, MI, Heart block, tachycardia

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43
Q

what off brand issue can tricyclic antidepressants help with

A

migraines

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44
Q

what is contraindicated in taking Tricyclic Antidepressants

A

MAOI, Lethal in overdose

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45
Q

selectivley block the reuptake of serotonin (block the reuptake process, leaving a longer period of time for the serotonin to act on the recieving cell)
Ex. Celexa, Lexapro, Prozac, Luvox, Paxil, Zoloft

A

SSRI, selective serotonin reuptake inhibitors

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46
Q

SE of SSRI

A

HA, N, insomnia, treamors, sexual dysfunction, agitation or sense of restlessness

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47
Q

overactivatio nof central serotonin receptors, rare, life threatening, usually happens when taken with MAOI

A

serotonin syndrome

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48
Q

S/Sx of serotonin syndrome

A

abdominal pain, diarrhea, piaphoresis, hyperreflexia, tachycardia, increase BP, confusion, restlessness, myoclonus (tenseness)

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49
Q

blocks the reputake of serotonin and morepinephrine, may be more effective than SSRI
Ex. Effexor, Cymbalta, Remeron

A

Selective sertotonin Norepinephrine reuptake inhibiotrs (SNRI)

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50
Q

SE of SNRI

A

HTN, N, insomina, dry mouth, sweating, agiataion, HA, sexual dysfunction

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51
Q

When take a Rx and abruptly stop, S/Sx: HA, Gi upset, dizziness, flu like Sx, insomina and anxiety

A

discontinuation syndrome

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52
Q

a form of bipolar disorder in which at least one episode of maina alternates with major depression

A

Bipolar I disorder

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53
Q

a form of bipolar disorder in which hypomanic episodes alternate with major depression

A

Bipolar II disorder

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54
Q

the meaningliess rhyming of words often in a foreful manner

A

clang associations

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55
Q

mood swing that alternates btwn hypomania and depressio nbut not major depression

A

cyclothymia

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56
Q

a continucous flow of speech in which the person jumps from one topic to another themes ofthen include grandiose and fantasized evalation of personal sexual prowess, buisness ability, artistic talents and so forth

A

flight of ideas

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57
Q

a mild form of mania marked by elation and hyperactivity, these differ in that they do not cause significant distress or impatis ones work family or social life in an obvious way while manic episodes do

A

hypomanic

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58
Q

exaggerated belief in or claims about ones importance or identity

A

grandiosity

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59
Q

known as a antimanic drug bc it can stabilize the manic phase of a bipolar disorder, it can modify future manic episodes and protect against future depressive episodes

A

lithium carbonate

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60
Q

an unstable elevated mood in which delusion, poor judgement, and other signs of impaired reality testing are evident

A

mania

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61
Q

experiencing four or more mood episodes in a 12 month period

A

rapid cycling

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62
Q

acute often painful sustained contractio nof muscles usually of the head and neck, which typicaly occur from 2-5 days after the introduction of certain antipsycotic Rxs

A

acute dystonia

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63
Q

outward manifestion of a persons feelings and emotions, schizophrenia may cause flat, blunted, inapproptiate or bizarre effect

A

affect

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64
Q

regular rhythmic movements usually of the lower limbs, constant pacing may also be seen, othen noticed in people taking antipsychotic medications

A

akathisia

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65
Q

a disturbance of thinking in which ideas shift form one subejct to another in an oblique or unrelated manner

A

associative looseness

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66
Q

classification of antipsychotic medications, also known as 2nd generation antypsychotics, which interact which sertonin as well as dopamine receptors, they are considered 1st line tx for psychosis and have a low profile for extrapyramidal side effects

A

atypical antipsychotics

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67
Q

meaningless rhyming of words, often in a forceful manner

A

clang association

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68
Q

thinking grounded in immediate experience rather than abstraction

A

concrete thinking

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69
Q

“vioces” that directs the person to take action

A

command hallucinations

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70
Q

original calssification of antipsychotic Rxs also known as typical and 1st generation antipsychotics which work by D2 receptor antagonism, they are effective in tx of positive sx but not negative sx

A

conventional antipsychotics

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71
Q

a false belief held to be true even with evidence to the contrary

A

delusions

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72
Q

repeating of the last words spoken by another, mimicry or imitation of the speech of another person

A

echolalia

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73
Q

mimicry of imitation of the movemenets of another person

A

echopraxia

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74
Q

variety of S/Sx that are often SE of the use of certain psychotic rxs particularly phenothiazines. Three reversible extrapyramidal side effects are acute dystonia, akathisia, and pseudoparkinsonism. A fourth tardive dyskinesia is the most serious and not reversible

A

extrapyramidal side effects (EPSs)

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75
Q

a sense of perception for which no external stimulus exists

A

hallucinations

76
Q

an error in the perception of a sensory stimulus

A

illusion

77
Q

absence of something that shoud be present

A

negative sx

78
Q

a word a person makes up that has meaning only for that person, often part of a delusional system

A

neologisms

79
Q

rare and sometimes fatal reactio nto high potency neuroleptic drugs, Sx: muscle rigidity, fever, elevated WBC

A

neuroleptic malignant syndrome (NMS)

80
Q

the presence of something that is not normally present

A

positive Sx

81
Q

a medication induced temporaty constellatio nof Sx associated with parkinsons disease

A

pseudoparkinsonism

82
Q

serious and irreversible side effect of the phenothiazines and related Rxs; consists of involuntary tonic muscle spasms typically involving the tongue, fingers, toes, neck or pelvis

A

tardive dyskinesia (TD or TDK)

83
Q

what type of depression medications are contraindicated in people taking MAOIs

A

atypical antidepressants

ex. Wellbutrin, Serzone, BuSpar

84
Q

MAOI

A

2nd line agent, beneficial for those who do not respond to other antidepressants or ECT

85
Q

inhibits the enzyme which normally breaks down serotonin, dopamine and norepinephrine, also inhibits the breakdown of tyramine in the liver

A

MAOI antidepressant

Ex. Nardil, Parnate, Marplan

86
Q

Problem with MAOI

A

results in increase of Tyramine level which can lead to HTN crisis, CVA, death
MUST restrict intake of Tyramine

87
Q

Food restrictions with Tyramine

A

avocados, fermented veggies/meats, aged cheese, bananas, meat tenderizer, caffeinated drinks, beer and ale, chocolate, ginsing

88
Q

HTN crisis Tx

A

Medical emergency
Procardia, Adalat
VS Q10-15 minutes

89
Q

Transdermal selegiline (emsam)

A

inhibits monoamine oxidase in CNS, avoids breakdown of tyramine in liver,

90
Q

can St. Johns wort be used for depression

A

yes

91
Q

electroconvulsive therapy

A

used for major depression with psychotic sx, tx resistant depression, usually 3x week for 8-10 txs, informed consent required, NPO night prior

92
Q

seasonal affective disorder

A

depression followed by mania (summer=mania, winter=depression)

93
Q

Tx for seasonal affective disorder

A

2-3 hours of bright light /day within 3-4 days feel better

94
Q

Maternity or baby blues

A

mildest form of postpartum, sx peak btwn postpartum days 3 and 5, resolve spontaneously within 24-72 hours, Tx supportive care and reassurance

95
Q

Postpartum psychosis

A

most severe impairment, sx: hallucinations and delusions that focus on infant dying or being divine or demonic, places mother at highest risk of infanticide or suicide

96
Q

postpartum depression

A

Sx: must be present for more than 2 weeks, dysphoric mood or anhedonia, delusions, recurrent thoughts of death or suicide, anxiety of child’s health

97
Q

what is the cause of postpartum depression

A

link btwn rapid drop in hormones after delivery and depression

98
Q

a brain disprder that affects a persons thinking, language, emotions, social behavior, and ability to perceive reality accurately

A

schizophrenia

99
Q

age of onset of schizophrenia

A

late adolescence or early adulthood

100
Q

the onset and relapse of schizophrenia almost always related to

A

stress

101
Q

etiology of schizophrenia

A

genetics, excess levels of dopamine (drug use {cocaine, Ritalin, levodopa}) early brain injury, use of street drugs

102
Q

what anatomical abnormalities are found in schizophrenia

A

ventricular enlargement, smaller cortex, temporal cortex, hippocampus. slightly larger right hemisphere, lower than normal overall activity in the left hemisphere

103
Q

phases of schizophrenia

A

prodromal phase
acute phase
maintenance phase
stabilization phase

104
Q

Sx begin about a month to a year before the first break, Sx include social withdraw, depression, perceptual disturbances, magical thinking

A

prodromal phase

105
Q

psychotic Sx are present (post., neg., and cognitive Sx)

A

acute phase

106
Q

acute Sx decrease in severity, particularly positive Sx

A

maintenance phase

107
Q

done by maintaining Rx and decrease stress, Sx remain in remission, may be mild persistent Sx

A

Stabilization phase

108
Q

criteria for schizophrenia

A

at least 2 of the following:
delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative Sx are present
*continue for at least 6 months

109
Q

what reflects a loss of normal functions

-show structural brain abnormalities and respond poorly to Tx

A

Negative Sx

110
Q

what reflects an excess of distortion of normal functions, have better outcome with Tx

A

Positive Sx

111
Q

Examples of positive Sx

A

alterations in:

thinking (delusions), speech, perception (hallucinations), behavior

112
Q

feels threatened and believes others are out to harm, usually scan the environment

A

delusions of persecution

113
Q

exaggerated feeling of importance, power, knowledge

A

delusions of grandeur

114
Q

false idea about the functioning body

A

somatic delusions

115
Q

has a false idea that ones mate is unfaithful, may have so-called proof

A

jealousy delusion

116
Q

misconstruing trivial events and remarks and giving them personal significance

A

delusions of ideas of reference

117
Q

believes certain objects or persons have control over him

A

delusion of control or influence

118
Q

delusion

A

fixed false belief

119
Q

over emphasis on specific details and impairment in the ability to use abstract concepts

A

concrete thinking

120
Q

ideas shift from one unrelated subject to another, unaware that the topics are unrelated

A

associative looseness

121
Q

invents new words, meaningless to others,

A

neologisms

122
Q

repeating of another’s words by imitation and is often seen in people with catatonia

A

echolalia

123
Q

mimicking another’s movements

A

echopraxia

124
Q

choice of words is governed by sounds, thakes form of rhyming

A

clang association

125
Q

a group of words that are put together randomly, without logical connection,

A

word salad

126
Q

what hallucination is most common

A

auditory

127
Q

command hallucination

A

voices that try to get the schizophrenia to do or say something usually negative

128
Q

lack of sense of where their bodies end in relationship to where others begin

A

personal boundary difficulties

129
Q

loss of his/her identity

A

depersonalization

130
Q

false perception that the environment has changed

A

derealization

131
Q

what alterations in behavior may you see in a schizophrenic

A

extreme motor agitation, automatic obedience (robot), sterotyped behaviors, waxy flexibility, stupor

132
Q

examples of negative Sx

A

affective blunting, poverty of speech, anergia, anhedoina (inability to experience pleasure), avolition (lack of motivation), thought blocking,

133
Q

irrational suspicion, ideas of reference, usually later onset

A

paranoid

134
Q

extreme abnormal behavior, either agitation or retardation

A

catatonic

135
Q

most regressed and socially impaired, often homeless, bizarre mannerisms, extreme social withdraw, incoherent speech
most severe

A

disorganized

136
Q

does not meet the criteria for paranoid catatonic or disorganized type
early onset, insidious

A

undifferentiated

137
Q

active phase sx are not present, 2 or more residual sx are present (social withdraw, inability to work or study, lack of content of speech, odd beliefs)

A

residual

138
Q

4-10 L/day, thirst and osmotic dysregulation,

A

psychosis induced polydipsia

139
Q

what is the most common form of abuse is an addiction to

A

nicotine

140
Q

Tx positive Sx and disorganization Sx , do little to affect negative Sx
major effect is to decrease hallucinations, delusions, and psychotic thinking

A

antipsychotic Rx

141
Q

how do conventional antipsychotics work

A

blocking dopamine receptors in the brain

142
Q

Mesolimbic pathway

A

starts in brain stem and goes to limbic system, any chemical that decreases dopamine in the limbic system decreases psychotic Sx

143
Q

mesocortical pathway

A

starts in brain stem and goes to the surface of the frontal lobe of the brain
dopamine in the frontal cortex stimulates behavior, thought, expression, and motivation

144
Q

nigrostriatal pathway

A

starts in brain stem and ends at the basal ganglion of the brain
control system for the extrapyramidal motor system (motor movements)

145
Q

Extrapyramidal side effects

A

when dopamine is blocked, tremor, sudden muscle spasms, motor restlessness.
all are Txable except for tardive dyskinesia

146
Q

typical/conventional antipsychotics

A

predominantly dopamine antagonists in both the limbic and motor centers, blocking postsynaptic D2 receptors, decrease positive Sx
Ex:Haldol, stelazine, prolixin, loxitane, moban, triafon, thorazine, mellaril

147
Q

SE of typical/conventional antipsychotics

A

extrapyramidal, weight gain, DM

148
Q

include sudden often dramatic spasms of muscles of head neck lips and tongue

A

acute dystonia reactions

Tx with anticholinergic Rx

149
Q

tapping of foot, rocking, shifting weight, nervousness, caffeine makes it worse,

A

akathisia

Tx antiparkinsonian, beta blocker, valium

150
Q

stiff and stooped posture, masklike face, drooling, shuffling gate, tremor

A 
pseudoparkinsonism
Tx anticholinergic (Cogentin), give towel
151
Q

protruding and rolling tongue, blowing, lip smacking, licking, spastic facial distortion
it can be permanent

A

tardive dyskinesia

no known Tx

152
Q

anticholinergic Sx

A

dry mouth, urinary retention, constipation, burred vision, block sweating, interfere with memory, ortho static Hypotension
Serious effects: blood dyscrasias, agranulocytosis

153
Q

Atypical antipsychotic Rx block what

A

both D2 and serotonin 5Ht2a receptors

154
Q

produce minimal to no EPS or tardive dyskinesia, effective for both post. and neg. sx, more expensive

A

atypical antipsychotics

155
Q

Clozapine (clozaril)

A

associated with fatal heat stroke, most effective antipsychotic Rx available, weight gain

156
Q

Risperidone (Risperdal)

A

2nd generation atypical antipsychotic, works for ppl who have not responded to traditional antipsychotics, decreases both post and neg sx
also have IM version

157
Q

Olanzapine (zyprexa)

A

3rd generation atypical antipsychotic, weight gain, increase in liver enzymes, zyprexa zydis:oral disintegrating

158
Q

Quetiapine (Seroquel)

A

no EPS side effects, does not increase prolactic levels, orthostatic hypotension

159
Q

Aripiprazole (abilify)

A

blocks but partially stimulates dopamine receptors, allows for more normal brain function, no weight gain,

160
Q

Asenapine (saphris)

A

antipsychotic, also used tx of manic or mixed epiosed of bipolar disorder
sublingual tablets

161
Q

best antipsychotic rx

A

zyprexa zydis: bc oral and dissolves, cant tongue meds

162
Q

characterized by opposite poles, mania and depression

A

bipolar disorder

163
Q

etiology of bipolar

A

genetics, neurotransmitter (excess levels of norepinephrine and dopamine with decreased levels of serotonin)

164
Q

Bipolar I

A

at least one epidose of mania alternating with major depression, psychosis may accompany the manic episode

165
Q

Bipolar II

A

hypomanic episode alternating with major depression, psychosis not present

166
Q

Cyclothymic disorder

A

hypomanic episode alternating with minor depressive episodes (at least 2 years duration) tend to have irritable hypomanic episodes

167
Q

Rapid cycling

A

four or more mood episodes in a 12 month period, severe Sx

168
Q

Manic episode

A

hyperactivity, invovlement in pleasurable activities, push limits, loud, rapid speech, talkative

169
Q

Dx criteria for manic episode

A

elevated expansive or irritable mood lasting at least 1 week, and three or more of the following:
inflated self esteem, decreased need for sleep, more talkative, flight of ideas, distractability, inccrease goal directed, increase pleasure in activiites

170
Q

hypomanic episode

A

life of party, talks in sexual nature, pressured speech, very social, judgement may be poor, grandious plans

171
Q

phase 1 of bipolar

A

acute phase

keep well hydrated, maintain stable cardiac status, tissue integrity, sufficient sleep and rest

172
Q

phase 2 of bipolar

A

relaspse prevention

173
Q

phase 3 of bipolar

A

maintenance of Tx

focus of relapse prevention

174
Q

Lithium

A

medication of choice, less effective in people with rapid cycyling, takes 7-14 days or longer usually a antipsychotic agent or benzodiazepine needed for immediate action

175
Q

Ex of lithium

A

eskalith, lithobid, lithonate, lithotabs

176
Q

therapeutic level of lithum

A

0.4-1.0 mEq

177
Q

1 reason why ppl wont take lithium

A

weight gain

178
Q

severe toxicity 2.0 mEq of above

A

ataxia, confusion, EEG changes, large dilute urine output, seizures coma

179
Q

protocol for lithium

A

check blood levels for lithium weekly or biweekly initially, after 6 months to one year every 3 months
Blood to be drawn 8-12 hours after last dose

180
Q

lithium is closely related to what

A

sodium, if sodium reduced, lithium is reabsorbed by the kidneys

181
Q

what labs need to be checked with lithium

A

thyroid and renal

182
Q

what effects on the kidneys does lithium

A

nephrogenic diabetes insipidous

183
Q

anticonvulsants

A

Ex. valproic acid, tegretol, lamictal

useful is treating lithium nonresponders

184
Q

Tegretol

A

anticonvulsant Rx, for rapid cycling and severly paranoid patients

185
Q

what is a potentially life threatening rash with Lamictal (anticonvulsants Rx)

A

SJS

186
Q

Electroconvulsive therapy

A

used for severe manic behavior, Tx for resistant mania, rapid cycling, paranoid features
used as last resort

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