Quiz for weeks 8 & 9 Flashcards Preview

Mental Health > Quiz for weeks 8 & 9 > Flashcards

Flashcards in Quiz for weeks 8 & 9 Deck (37):
1

FRONTAL LOBES

Part of the brain where reason and emotion interact

Damage can cause impaired judgment, personality changes, problems in decision making, inappropriate conduct, aggressive outbursts

2

HYPOTHALAMUS

After repeated stimulation, system may respond more vigorously to all provocations

3

LOW LEVELS OF NEUROTRANSMITTER

may increase irritability, hypersensitivity to provocation, rage

may influence people who commit impulsive arson, suicide, homicide

 

Think DEADPOOL

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4

ESCALATING BEHAVIOURS

Changes in level of consciousness may occur, including confusion, disorientation, memory impairment

5

NURSE'S ROLE

if patient potentially violent

Notify physician, give PRN medications as appropriate

Provide for patient and staff safety

Notify co-workers

Obtain additional security if needed

Assess environment; make necessary changes

 

6

PSYCHOPHARMACOLOGY 

for

VIOLENCE

Antianxiety and sedative-hypnotics

Antidepressants

Antipsychotics

7

TARASOFF RULING

A duty is present by the therapist to take some action to prevent foreseeable harm to a third party injured by the client.

8

CATEGORIES OF 

SUICIDAL BEHAVIOR

Suicide ideation: thought of self-inflicted harm
    Passive: only thoughts of suicide; no plan
    Active: plans of causing one’s own death

Suicide threat: verbal or nonverbal warning
Suicide attempt: any self-directed action that will lead to death if not stopped 

9

SUICIDE ASSESSMENT

The most suicidal person is one who has:
Highly lethal method (e.g., gunshot to head)
Specific plan (as soon as wife goes shopping) 
Means available (loaded gun in desk drawer) 
Little ambivalence, as compared with someone “asking for help”
Prior suicide attempt is best predictor
Warning signs may be missed or ignored

10

DIRECT QUESTIONS 

ABOUT SUICIDAL THOUGHTS

Direct questioning about suicidal thoughts

and plans will not cause patient to take suicidal action

11

SUICIDE RISK

and

ANTIDEPRESSANTS

Risk is higher during first few weeks of new medication
Energy and concentration improve before mood
Patient still feels very depressed but now he has the ability to make a suicide plan and carry it out

12

PROTECTIVE FACTORS

AGAINST SUICIDE

Family and community support 

Supportive relationships with health care providers

Learned skills in problem-solving

Cultural and religious beliefs may give sense of hope

Strong personal relationships

13

TRAUMATIC 

BRAIN INJURY

Disruption of normal brain function that occurs when the skull is struck, suddenly thrust out of position, or penetrated 

Symptoms may appear right away or may not be present until days or weeks or months after the injury 

TBI can affect a single, specific region of the brain (focal injury), be distributed throughout the brain (diffuse injury), or both

14

PRECIPITATING STRESSORS:

TRAUMATIC BRAIN INJURY

Open Head Injury – Occurs as a result of bullet wounds or any injury that penetrates the skull 

Closed Head Injury – Occurs as a result of a fall, motor vehicle accident, explosion, or contact sports activity; there is no penetration of the skull

Deceleration Injury – Occurs with differential movement of the skull and the brain when the head is struck  (Shaken Baby Syndrome)

15

TRAUMATIC BRAIN INJURY IS CLASSIFIED INTO THREE CATEGOREIS

BASED ON TIME OF LOST CONSCIOUSNESS


Mild – less than 30 minutes
Moderate – more than 30 minutes but less than 24 hours
Severe – more than 24 hours 

16

FOLLOWING TRAUMATIC BRAIN INJURY

RISKS ARE

depression, generalized anxiety disorder, panic disorder, agoraphobia,  posttraumatic stress disorder

Risk of suicide is 2-4 times greater in patients with TBI (even if mild)

17

INTERVENTIONS FOR:

TRAUMATIC BRAIN INJURY

Interventions include exercises to improve memory, problem-solving ability, attention span, speech, reading, and physical functioning and learn new adaptive coping skills 

Lifestyle changes including exercise, diet, sleep, hygiene, stress reduction, relaxation training, and engaging in pleasurable activities

JUST SAY "NO" TO FOOTBALL

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18

MEDICATIONS FOR 

TRAUMATIC BRAIN INJURY

No medication has been approved for TBI 

19

WAYS TO MANAGER ANGER

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Positive self-talk; writing about feelings

Change of environment

Thinking of the consequences

Listening to music

Watching television

Deep-breathing exercises

Taking a walk

Medication

Counting to 50

Comfort wrap with a blanket

Relaxation exercises

Talking about your feelings

Reading

Being alone

EATING ICE CREAM & WATCHING STRANGER THINGS! :-) 

20

PSYCHOPHARMACOLOGY 

FOR SURVIVORS OF

CRIMES

Do not generally need meds

Antianxiety agnets (benzodiazepines) are prescribed occasionally for short-term use to decrease anxiety

Trazodone (Desyrel) is prescribed to faciliate sleep

21

PSYCHOPHARMACOLOGY

FOR SURVIVORS OF

TORTURE, RITUAL ABUSE, MIND CONTROL AND HUMAN TRAFFICKING

Meds are highly controversial, especially becasue drugs were often a part of the abuse as it occured. 

Sometimes medications in treating PTSD, anxiety disorders, depression, sleep disturbances, and psychosis are effective.

22

PSYCHOPHARMACOLOGY 

FOR SURVIVORS OF

RAPE and SEXUAL ASSAULT

Although rarely prescribed to rape survivors:

For Anxiety- Benzodiazepines to reduce anxiety and provide for sleep might be used on a temporary basis

For depression with sleep disturbance: antidepressant (trazodone) at bedtime 

For nightmares or traumatic memories: low dose of antipsychotic, rieperidone (Risperdal), quetiapine (Seroquel) or alpha-1-adrenergic antagonist prazosin (Minipress)

23

PSYCHOPHARMACOLOGY 

FOR SURVIVORS OF

CHILDHOOD SEXUAL ABUSE

Meds are not always needed or desirable for adult surviors of childhood sexual abuse, especially if substance abuse is a problem or potential problem.

If depressive symtoms are intefering with sleep: antidepressant such as trazodone

For reexperiencing of traumatic memoreis: Benzodiazepines or clonidine for a short-term basis

Disturbing nightmares, flashbacks: lose doses of risperidone, aripiprazole (abilityf), prazosin, quetiapine, or topiramate (Topamax)

 

 

 

 

 

 

24

PSYCHOPHARMACOLOGY 

FOR SURVIVORS OF

PARTNER and ELDER ABUSE

Meds normally are not needed but are commonly given to survivors.

Often misprescribed meds are antidepressants, benzodiazepines, and hypnotics.

25

NEUROSIS

vs.

PSYCHOSIS

Neurosis is a mental disorder characterized by anxiety with no distortion of reality.

VS.

Psychosis is disintegrative and involves a significant distortion of reality.

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26

TREATMENT OF

ANXIETY DISORDERS

Behavioral therapies: systematic desensitization

Medication: SSRIs, benzodiazepines (ADDICTIVE), buspirone, hydroxyzine

Psychotherapy & Psychoanalysis

Hypnosis

Cognitive Behavioral Therapy

27

BENZODIAZEPINES

"DIRTY BANDAIDS"

Informally called “tranquilizers”

Psych APNs see many patients addicted to benzos

Patients love them and won’t give them up

They are addictive (compulsive use, neuroadaptation leading to withdrawal syndrome & tolerance)

Benzos linked to  Alzheimer’s Disease

28

ARE BENZOS THE

RIGHT

TREATMENT FOR ANXIETY??

Benzos are used a lot with inpatients

These “Bandaids” are appropriate in this type of outpatient situations:

Pre-op anxiety

Airplane phobia

Public speaking

Going to a funeral

Discrete, short-term, closed-ended situations

29

XANAX:

THE "CRACK"

OF BENZOS

Some university medical centers have taken Xanax out of the formulary because of its addiction potential 
In 1990’s it was recommended by FDA for Panic Disorder
Short onset & short half-life make it similar in trajectory to cocaine
Can see intra- and inter-dose withdrawal; pt wants more
Tolerance & withdrawal develop
Addiction has begun

30

BETTER CHOICES FOR

SHORT TERM ANXIETY

Propranolol (Inderal)- Beta-blocker (stage fright drug)

Benztropine (Cogentin)- anticholinergic agent; counteracts jitteriness

Hydroxyzine (Vistaril)

Improve quality of sleep: sleep hygiene techniques

31

NURSING INTERVENTIONS 

FOR

REDUCING ANXIETY

NURSING INTERVENTION:

1. Provide a calm and quit environment

2. Ask pt. to identify what and how they feel

3. Enourage pt. to describe and discuss their feelings with you

4. Help patients identify possible causes of their feelings

5. Listen carefully for patient's expressiosn of helplessness and hopelessness

6. Ask patients whether they feel suicidal or have a plan to hurt themselves

7. Plan and Involve patients in activites such as going for walks or playing recreational games.

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32

TREATMENT FOR

GENERALIZED ANXIETY DISORDER (GAD)

Most effective Meds:

Antideprssants: selective serotonin reuptake inhibitors (SSRIs) and selective serotoni-norepinephrine reuptake inhibitors (SNRIs)

GAD is Chronic - Antidepressants better than Benzodiazepine

Benzodiazepine only used for short-term, quick acting med

Benzodiazepine is slowly tapered if necessary and discontinued.

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33

TREATMENT FOR

PANIC DISORDER

Meds: 

Long term treatment: SSRIs and SNRIs

Short term immediate treatment: Benzodiazepine like alprazolam (xanax) and lorazepam (Ativan)

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34

TREATMENT FOR

AGORAPHOBIA

Cognitive Behavioral Therapy (CBT) is the most successful treatment for phobic patients

 

Meds: Clonidine and propranolol may be taken as needed before social engagements

SSRIs are used to reduce anxiety and depression if present

35

TREATMENT OF

OBSESSIVE-COMPULSIVE DISORDER

MEDS:

SSRIs such as

fluoxetine (Prozac) 

sertraline (Zoloft) 

fluvoxamine (Luvox)

paroxetine (paxil)

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36

TREATMENT FOR

POSTTRAUMATIC STRESS DISORDER (PTSD)

AND ACUTE STRESS DISORDER (ASD)

First line treatment for PTSD: SSRIs

Paroxetine, sertraline and fluoxetine

Secondline treatmetns: Tricyclic antidepressants and monoamine oxidase inhibitors

Benzodiazepine, clonidine, propranolol also used

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37

TREATMENT FOR

SOMATIC SYMPTOM and RELATED DISORDERS

Patients with somatoform disorders might be using too much medication and taking variety of durgs, medication for pain should be used temporarily and sparingly.

SSRIs are helpful for: anxiety, depression -- also decrease sensitivity to bodily sensations