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Flashcards in Mental Health part 2 Deck (186):
1

reduction in or lack of energy

anergia

2

an inability to find meaning or pleasure in existence

anhedonia

3

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

atypical antidepressants

4

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

dysthymic disorder

5

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

Electroconvulsive therapy (ECT)

6

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

hypersomina

7

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

insomnia

8

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

Monoamine oxidase inhibitors (MAOI)

9

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

mood

10

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

psychomotor agitation

11

slowed and difficult movements to complete inactivity and incontinence

psychomotor retardation

12

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

selective serotonin reuptake inhibitors (SSRI)

13

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

tricyclic antidepressants

14

name the 3 types of mood disorders

major depressive disorder
dyshymic disorder
postpartum depression

15

the primary alteratio nin depression is what

mood, rather than in thought or perception

16

the most common cause of depression is

neurobiologic (serotonin & norepinephrine)

17

serotonin does what

regulates sleep, apettite, mood

18

low levels of norepinephrine does what

no energy, cant concentrate

19

both serotonin and norepinephrine are involved in what

perception of pain

20

depression can occur because of medication side effects such as

corticosteriods, anti psycotic, anti HTN, anti parkinsons

21

depression can occur because of neurological disorders such as

CVA, brain tumor (temporal lobe), alzhiemers

22

depression an occur because of electrolyte disturbances such as

excessive amounts of sodium or calcium or a deficit in Mg

23

depression can occur because of nutritional deficiencies such as

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

24

what psychosocial event can cause depression

reactio nto life events, early life trauma

25

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

norepinephrine

26

Sx of depression

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

27

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

major depressive disorder

28

For DSM what must you hve for major depressive disorder

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

29

Melancholic features

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

30

postpartum onset

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

31

catatonic features

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

32

atypical features

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

33

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

dysthymic disorder

34

S/Sx of dysthymic disorder

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

35

physical changes of dysthymic disorder

psycomotor agitation/retardation, vegatative signs

36

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

grief

37

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

depression

38

Black box warnings

carefully observe for worsening symptoms of depression and suicidal thuoghts

39

nonselective inhibition of norepinephrine and serotonin.
Ex. Elavil, Sinequan, Anafrail, Pamelor, Norpramin, Asendin

Tricyclic Antidepressants

40

Tricyclic antidepressants

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

41

when are tricyclic antidepressants given

at night due to sedative effects

42

Tricyclic Toxic effect

cardiovascular: dysrhythmias, MI, Heart block, tachycardia

43

what off brand issue can tricyclic antidepressants help with

migraines

44

what is contraindicated in taking Tricyclic Antidepressants

MAOI, Lethal in overdose

45

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

SSRI, selective serotonin reuptake inhibitors

46

SE of SSRI

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

47

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

serotonin syndrome

48

S/Sx of serotonin syndrome

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

49

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

Selective sertotonin Norepinephrine reuptake inhibiotrs (SNRI)

50

SE of SNRI

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

51

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

discontinuation syndrome

52

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

Bipolar I disorder

53

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

Bipolar II disorder

54

the meaningliess rhyming of words often in a foreful manner

clang associations

55

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

cyclothymia

56

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

flight of ideas

57

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

hypomanic

58

exaggerated belief in or claims about ones importance or identity

grandiosity

59

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

lithium carbonate

60

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

mania

61

experiencing four or more mood episodes in a 12 month period

rapid cycling

62

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

acute dystonia

63

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

affect

64

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

akathisia

65

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

associative looseness

66

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

atypical antipsychotics

67

meaningless rhyming of words, often in a forceful manner

clang association

68

thinking grounded in immediate experience rather than abstraction

concrete thinking

69

"vioces" that directs the person to take action

command hallucinations

70

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

conventional antipsychotics

71

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

delusions

72

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

echolalia

73

mimicry of imitation of the movemenets of another person

echopraxia

74

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

extrapyramidal side effects (EPSs)

75

a sense of perception for which no external stimulus exists

hallucinations

76

an error in the perception of a sensory stimulus

illusion

77

absence of something that shoud be present

negative sx

78

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

neologisms

79

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

neuroleptic malignant syndrome (NMS)

80

the presence of something that is not normally present

positive Sx

81

a medication induced temporaty constellatio nof Sx associated with parkinsons disease

pseudoparkinsonism

82

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

tardive dyskinesia (TD or TDK)

83

what type of depression medications are contraindicated in people taking MAOIs

atypical antidepressants
ex. Wellbutrin, Serzone, BuSpar

84

MAOI

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

85

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

MAOI antidepressant
Ex. Nardil, Parnate, Marplan

86

Problem with MAOI

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

87

Food restrictions with Tyramine

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

88

HTN crisis Tx

Medical emergency
Procardia, Adalat
VS Q10-15 minutes

89

Transdermal selegiline (emsam)

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

90

can St. Johns wort be used for depression

yes

91

electroconvulsive therapy

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

92

seasonal affective disorder

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

93

Tx for seasonal affective disorder

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

94

Maternity or baby blues

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

95

Postpartum psychosis

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

postpartum depression

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

what is the cause of postpartum depression

link btwn rapid drop in hormones after delivery and depression

98

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

schizophrenia

99

age of onset of schizophrenia

late adolescence or early adulthood

100

the onset and relapse of schizophrenia almost always related to

stress

101

etiology of schizophrenia

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

102

what anatomical abnormalities are found in schizophrenia

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

103

phases of schizophrenia

prodromal phase
acute phase
maintenance phase
stabilization phase

104

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

prodromal phase

105

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

acute phase

106

acute Sx decrease in severity, particularly positive Sx

maintenance phase

107

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

Stabilization phase

108

criteria for schizophrenia

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

what reflects a loss of normal functions
-show structural brain abnormalities and respond poorly to Tx

Negative Sx

110

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

Positive Sx

111

Examples of positive Sx

alterations in:
thinking (delusions), speech, perception (hallucinations), behavior

112

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

delusions of persecution

113

exaggerated feeling of importance, power, knowledge

delusions of grandeur

114

false idea about the functioning body

somatic delusions

115

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

jealousy delusion

116

misconstruing trivial events and remarks and giving them personal significance

delusions of ideas of reference

117

believes certain objects or persons have control over him

delusion of control or influence

118

delusion

fixed false belief

119

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

concrete thinking

120

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

associative looseness

121

invents new words, meaningless to others,

neologisms

122

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

echolalia

123

mimicking another's movements

echopraxia

124

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

clang association

125

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

word salad

126

what hallucination is most common

auditory

127

command hallucination

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

128

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

personal boundary difficulties

129

loss of his/her identity

depersonalization

130

false perception that the environment has changed

derealization

131

what alterations in behavior may you see in a schizophrenic

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

132

examples of negative Sx

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

133

irrational suspicion, ideas of reference, usually later onset

paranoid

134

extreme abnormal behavior, either agitation or retardation

catatonic

135

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

disorganized

136

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

undifferentiated

137

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)

residual

138

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

psychosis induced polydipsia

139

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

nicotine

140

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

antipsychotic Rx

141

how do conventional antipsychotics work

blocking dopamine receptors in the brain

142

Mesolimbic pathway

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

143

mesocortical pathway

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

nigrostriatal pathway

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

145

Extrapyramidal side effects

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

146

typical/conventional antipsychotics

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

SE of typical/conventional antipsychotics

extrapyramidal, weight gain, DM

148

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

acute dystonia reactions
Tx with anticholinergic Rx

149

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

akathisia
Tx antiparkinsonian, beta blocker, valium

150

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

pseudoparkinsonism
Tx anticholinergic (Cogentin), give towel

151

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

tardive dyskinesia
no known Tx

152

anticholinergic Sx

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

153

Atypical antipsychotic Rx block what

both D2 and serotonin 5Ht2a receptors

154

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

atypical antipsychotics

155

Clozapine (clozaril)

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

156

Risperidone (Risperdal)

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

Olanzapine (zyprexa)

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

158

Quetiapine (Seroquel)

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

159

Aripiprazole (abilify)

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

160

Asenapine (saphris)

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

161

best antipsychotic rx

zyprexa zydis: bc oral and dissolves, cant tongue meds

162

characterized by opposite poles, mania and depression

bipolar disorder

163

etiology of bipolar

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

164

Bipolar I

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

165

Bipolar II

hypomanic episode alternating with major depression, psychosis not present

166

Cyclothymic disorder

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

167

Rapid cycling

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

168

Manic episode

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

169

Dx criteria for manic episode

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

hypomanic episode

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

171

phase 1 of bipolar

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

172

phase 2 of bipolar

relaspse prevention

173

phase 3 of bipolar

maintenance of Tx
focus of relapse prevention

174

Lithium

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

Ex of lithium

eskalith, lithobid, lithonate, lithotabs

176

therapeutic level of lithum

0.4-1.0 mEq

177

#1 reason why ppl wont take lithium

weight gain

178

severe toxicity 2.0 mEq of above

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

179

protocol for lithium

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

lithium is closely related to what

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

181

what labs need to be checked with lithium

thyroid and renal

182

what effects on the kidneys does lithium

nephrogenic diabetes insipidous

183

anticonvulsants

Ex. valproic acid, tegretol, lamictal
useful is treating lithium nonresponders

184

Tegretol

anticonvulsant Rx, for rapid cycling and severly paranoid patients

185

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

SJS

186

Electroconvulsive therapy

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