Test3-psych Flashcards
(44 cards)
1
Q
Cognitive Disorders
A
-delirium-
-dementia-
amnetic disorder-
2
Q
Delirium
A
- distrubance of consciousness and a change of cognition that develop over a short period of time
- always secondary to another physiological condition and is transient
- most frequently in older pts-surgery, intro of new meds, UTI, cerebrovascular disease, pneumonia and CHF; polypharmacy
- reduced clarity of awareness of the environment
- easily distracted by irrelevant stimuli
- especially at night
- acute onset, inattention, disorganized thinking, disturbance of consciousness
- withdrawn, agitated or psychotic
- sundowning (seen with delirium and dementia)
- drug and alcohol withdrawl (CNS stimulants-cocaine)
- metabolic (dehydration, DKA, Thiamine def (B1)=Wernicke encephalopathy,
- digitalis, anticholinergics, head trauma, seizure, tumor, sleep deprivation, pain
- illusions (errors in perception of sensory stimuli)
- hallucinations (false sensory stimuli)
- psychomotor agitation
- tachy, sweating, flushed face, dilated pupils, elevated BP
3
Q
Dementia
A
- progressive deterioration of cognitive functioning and global impairment of intellect with no change in consciousness
- difficulty with memory, thinking and comprehension
- majority are irreversible
- Alzheimer’s is the most common cause
- Primary dementia: AD, vascular dementia (both irreversible)
- Secondary: result of another pathological process (AIDS, viral encephalitis, pernicious anemia, Korsakoff’s syndrome (B1 deficiency-alcoholics), Parkinson’s, Huntington’s chorea
4
Q
Alzheimers Disease
A
- most common cause of dementia
- 1/10 >65 1/2 >85
- PET scan, CT scans reveal brain atrophy and rule out other conditions (neoplasms)
- confabulation-creation of stories or answers in place of actual memories to maintain self-esteem; not the same as lying; unconscious attmept to maintain self-esteem
- amnesia/memory impairment
- aphasia-loss of language ability
- apraxia-loss of purposeful movement in the absence of motor or sensory impairment
- agnosia-loss of sensory ability to recognize objects
- disturbances in executive functioning.
- Average duration from onset to death is 8-10 years, but ranges from 3-20 years
5
Q
Stages of Alzheimers
A
- Mild Alzheimer’s-loss of enerygy, drive, initiative, dificulty learning new things; personality and social behavior remain intact; depression may occur early-lessens as disease progresses
- Moderate AD-deterioration becomes evident; can’t rememer address or date; memory gaps that fluctuate day to day; poor hygiene; can’t dress themselves properly; labile mood-paranoia, anger, jealousy, apathy; driving is hazardous; withdrawl.
- Moderate to Severe-unable to recognize familiar objects/people (agnosia), needs simple directions repeated (apraxia), forgets where toilet is-incontinent, the world is frightening, nothing makes sense; agitation, violence, paranoia, delusions; wandering
- Late AD-agraphia (inability to read or write), hyperorality (need to chew), blunting of emotions, visual agnosia, hypermetamorphasis (touching everything in sight); ability to walk and talk are lost
- End-stage-stupor, coma, with death secondary to infection or choking.
6
Q
Tolerance
A
occurs when a person’s physiological reaction to a drug decreases with repeated administrations of the same dose.
7
Q
Withdrawal
A
Causes physiological changes to occur when blood and tissue concentratin of a drug decrease in individuals who have maintained heavy and prolonged use of a substance.
8
Q
Substance Abuse
vs. Dependence
A
Abuse: continued use despite related consequences-inability to fulfill role obligations, participation in hazardous situations while impaired, recurrent legal/interpersonal problems, continued use despite social/interpersonal problems
Dependence: severe condition or disease with physical problems, presence of tolerance, withdrawal, subs taken in higher amts, unsuccessful desire to cut down, increased time spent, reduction/absence from social, occupational, recreational activities
9
Q
Co-Dependence
A
over-responsible behavior–doing for others what they can do for themselves–valuing oneself by what one does, what one looks like and what one has, rather than by who one is
10
Q
Addiction
A
- Loss of control of substance consumption
- Substance use despite associated problems
- Tendancy to relapse
11
Q
Alcohol Withdrawal
A
- fever
- N/V
- anxiety
- visual, tactile or auditory hallucinations or illusions
- autonomic hyperactivity: sweating, tachy, HTN
- psychomotor agitation, seizures (within 7-48h)
- insomnia
- hand tremor
- long-acting benzodiazepines (prevent DTs)=Librium, Valium; short acting (if livery disfunction)=Ativan
12
Q
Alcohol Related Delirium
A
- develops within hours to days
- impaired consciousness
- change in cognition (memory, disorientation, hallucinations, illusions)
13
Q
CAGE
A
- Cut down? (feel need to)
- Annoyed by others criticizing your drinking?
- Guilty feelings about your drinking?
- Eye openner needed?
1=possible problem
2=probable problem
14
Q
Stimulants
A
relief from fatigue, grandiosity, euphoria, impaired judgement, dilated pupils, dry mouth, excessive motor activity, twitching, increased BP, HR
Most common: cocaine, amphetamines
Tolerance develops to euphoria but not wakefulness
Prolonged/excessive use can lead to psychosis almost identical to paranoid schizophrenia
15
Q
Cocaine
A
- produces physical dependence and withdrawal sx with very high relapse
- short acting euphoria 10-20 s rush, then 15-20 minutes of less intense eurphoria
- sudden death: heart attack
3 Phases of Withdrawal:
- Crash (4 days-anxiety, depression, anergia, paranoia, peak cravings)
- Prolonged Dysphoria (anhedonia, lack of motivation, intense cravings, relapse most likely)
- Intermittent Craving (support groups helpful)
16
Q
Opiates & Opioids
A
- Narcotics
- opium, morphine, meperidine (demerol), fentanyl, heroin
- Symptoms: stupor, constipated, pinpoint pupils
- Withdrawal is rarely life-threatening, very uncomfortable
- methadone
- Heroin withdrawal: subutex, clonidine (for BP), valium
- Symptoms of Withdrawal: resemble the flu-runny nose, tearing, diaphoresis, muscle cramps, chills, fever, dilated pupils
- Buprenorphine = opioid agonist/antagonist, used for pain, can cause confusion, diaphoresis, hallucinations, sedation, nausea
17
Q
Toxic Psychosis
A
- use of LSD, PCP, stimulants
- resembles paranoid schizophrenia
- LSD users can be “talked down”
- PCP/amphetamine users more lkely to strike out, panic from misconceptions; may not feel pain
- may need restraints, benzos, high-potency anti-psychotics (Haldol/Ativan cocktail)
18
Q
Drugs for Alcohol Abstinence
A
-Naltrexone (Revia), nalmefene: opiate agonists to diminish craving
-Acamprosate (Campral), citalopram or ondansetron to diminish desire
-Antibuse (disulfiram)-interupts alcohol metabolism-severe HA, N/V, flushing, hypoTN, tachy, dyspnea, diaphoresis, chest pain, palps, dizziness, confusion; effects can last 14 days after discontinuing
19
Q
Nicotine Withdrawal
A
- patch/gum, taper after 4-6 wks
- Buproprion (Zyban, Wellbutrin)-non-nicotine replacement therapy
- Clonidine (anti-hypertensive), nortriptyline (TCA)-second line
20
Q
Wernicke’s Korsakoff Syndrome
A
- Severe memory disorder resulting from thiamine deficiency secondary to alcohol abuse
- Thiamine (B1) to prevent Wernicke encephalopathy B1 needed for glucose metabolism in the brain-cell death/atrophy-nystagmus, ataxia; reversible if treated early.
- B1-Korsakoff psychosis-follows untreated Wernicke; antegrade/retrograde memory loss; confabulation
21
Q
Personality Disorders
A
- 11 of them-3 clusters
- Axis II
- Involve long term and repetitive use of maladaptive and self-defeating behaviors
- do not recognize their sx, do not seek tx
- inflexible and maladaptive response to stress
- disability in working and loving
- ability to evoke interpersonal conflict
- capacity to frustrate others
- need a lot of attention
- monopolize time
- manipulative/power struggles
- no single cause
- repeated cycles of trauma may affect brain growth and development
22
Q
Cluster A:
Odd/Eccentric
A
- Paranoid-hard to get a Hx, psychotic episodes in times of stress; nurse: straight forward explanations
- Schizoid-avoids close relationships, socially isolated, poor occupational functioning, cold, aloof, detached, loner, lacks social awareness, relationships generate fear and confusion; nurse: simplification/clarity
- Schizotypal-ideas of reference, magical thinking, odd beliefs, perceptual distortions, vague, stereotyped speech, frightened, suspicious, blunted affect, distant/strained relationships, frightened/suspicious in social situations, explanation can ease anxiety.
23
Q
Cluster B:
Dramatic/Erratic
A
- Antisocial personality disorder (ASPD)-superficial charm, violates rights of others, exploits others, lies, cheats, lacks guilt or remorse=psychopath, aggressive, manipulative, impulsive, violent; nurse: establish/adhere to a plan of care, maintain clear boundaries
- Borderline - unstable, intense relationships, identity disturbances, manipulative, impulsivity (volatile, mood swings), self-mutilation (often abused as a child), suicidal, rapid mood shifts, chronic emptiness, fear of abandonment, anger, psychotic, splitting; nurse: help with anger mgt, relationship building, safety, limit setting-atypical antipsychotics, mood stabilizers, antidepressants
- Histrionic - center of attention, flamboyant, seductive, provocative, shallow, rapidly shifting emotions, dramatic expression of emotions, overly concerned with impressing others, exaggerates degree of intimacy with others, self-aggrandizing, preoccupied with appearance, depressed when admiration of others is not given, suicide risk (less so than boderline); nurse: suicde assessment, offer support
- Narcissistic - grandiosity, fantasies of power or brilliance, need to be admired, sense of entitlement, arrogant (over compensating for low self-esteem), patronizing, rude, fragile ego, demands best, humiliated by boundaries or when corrected; nurse: help id attempts to seek and become perfect.
24
Q
Cluster C:
Anxious/Fearful
A
- Avoidant - social inhibition, inadequacy, hypersensitive to criticism, preoccupation with fear of rejection/criticism, self-perceived socially inept, social phobias, demands of workplace often overwhelming, perceive rejection where none exists; nurse: socialization skills, positive feedback, build self-esteem
- Dependent - inability to make decisions without advice/reassurance, anxious, helpless when alone, submissive, solicit care taking by clinging, fear abandonment if they are too competent, experience anxiety and co-existing depression, victims of spousal abuse
- OCDPD - preoccupied with rules, perfectionistic, too busy to have friends, rigid control, superficial relationships, fear of losing control, focused on details to point they miss the big picture, complains about others inefficiencies, gives others directions
25
Benzodiazepines
As effective as Barbituates, but safer. Sedative/hypnotic, can be addictive.
Xanax (alprazolam)
Valium (diazepam)
Ativan (lorazepam)
Librium-long half-life, used only for alcohol withdrawal
Klonopin (clonazepam)-can cause ataxia
Serax (oxazepam)
Versed (midazolam)-used for conscious sedation
NON-Benzo anti-anxiety: Buspar (buspirone)
Flumazenil = *for benzo intoxication*-causes dizziness, confusion, agitation, n/v
**Withdrawal: **N/V, tachy, diaphoresis, anxiety, irritability, tremors in hands, fingers, eyelids, marked insomnia, grand mal seizures, delerium
26
Mood Stabilizers
Lithium Carbonate
Therapeutic = 0.6-1.2 mEq/L
SE: hypothyroidism, weight gain, tremors, electrolyte/blood imbalance, impaired renal function
Toxicity above 1.5-begins as GI upset, CNS changes, death
Education: avoid excessive heat, diaphoresis, use of diuretics, decreased Na intake
Anticonvulsants: Tegretol, Depakote, Neurontin, Lamictal, Trileptal, Gabitril, Topamax
Antipsychotics: Seroquel, Risperdal, Abilify, geodone
27
Psychostimulants
- for ADD/ADHD, narcolepsy, depression (last resort)
- SE: insomnia, increased activity/restlessness, tremor, cardiac, HTN, anorexia
Ritalin
Daytrana (patch)
sustained release = Ritalin SR, Concerta
Dexedrine
Adderall
Cylert (liver damage)
Vyvanese
Intuniv
NON-stimulant: Strattera
28
PDD
(Pervasive Developmental Disorders)
* Autism
* Asperger's (Autism Spectrum Disorder)
* Rett's Disorder
* Medications: antipsychotics (Risperdal)
29
Autism
* Language delay (also logic and reasoning)
* Social impairment (lack eye contact, lack of make-believe play, failure to imitate)
* Repetitive behavior
* First observed before 3 years of age
* Rigid adherence to rituals/routines
* Preoccupation with certain activities (sand, water)
30
Asperger's
* Later onset
* No significant cognitive/language delay
* Repetitive patterns
* Socially-problems with empathy
* speech/language peculiarities
* motor clumsiness
* improves with maturity
31
Rett's Disorder
* Mostly in females
* On-set before age 4
* Caused by a gene mutation
* Neuro-developmental disorder
* 1 in 10 to 15,000 live births
* loss of manual skills
* stereotyped hand movements
* problems with coordination/gait
* severe psychomotor retardation
* problems with expressive and receptive language (can't express themselves)
* loss of interest socially
32
ADHD
* Inattention, impulsive
* Hyperactive, restless
* Difficult to diagnose bf age 4
* Talkative
* Difficulty completing tasks
* Easily frustrated
* Temper outbursts
* Labile mood
* Poor school performance
* Low self-esteem
* **Medications**: stimulants, antidepressants, methylphenidate
33
ODD
(Oppostional Defiant Disorder)
* most common in males
* before age 8
* recurrent patter: negativistic, hostile, defiant
* disobediant without serious violations of other's rights
* loses temper, argues, non-compliant
* stubborn, argumentative, tests limits, refuses to accept blame
34
Conduct Disorder
* violates rights of others
* worse than ODD
* onset prior to age 10
* physical aggression toward people and animals
* ADHD is pre-disposing factor
* causes: parental rejection, inconsistent parenting, harsh discipline, alcoholic father
* can lead to anti-social personality disorder
* destruction of property
* deceitful
* thefts
* violates rules
* **Medications:** antipsychotics, antidepressants
35
Mood Disorders in Children
* Major Depressive Disorder
* Bipolar
* Children tend to have somatic complaints
* Irritable, aggressive
* psychomotor retardation
* hypersomnia
* associated factors: abuse, neglect, death, divorce
* complications: school failure, drug/alcohol abuse, promiscuity, run-away, suicide
36
Depression in the Elderly
* Often undiagnosed
* Presents with somatic complaints
* Mistaken for cognitive decline
* SSRI's are first line of therapy-Zoloft is drug of choice
* Suicide rate is higher than any other age group, esp white males
* Sx=insomnia, change in sleep pattern, weight loss, excessive fatigue, incr concern with bodily functions, alterations in mood, expressions of aprehension/anxiety, low self-esteem, pessimism
37
Normal Aging Changes
* hypothermia
* decreased oxygen use and cardiac output, resulting in anoxia/hypoxia
* muscle wasting, weakness--decreased mobility
* limited cough reflex=risk of aspiration
* demineralization of bones
* decreased GI motility=constipation
* decreased ability to interpret painful stimuli
38
Adult Day Health Model
* medical and psychiatric nursing rehab for high risk
* psychosocial interventions with frail older adults
* requires MD referral
* goal: prevent or slow mental, physical, or social deterioration and to maximize potential
39
Maintenance Day Care Model
* for clients at risk for institutionalization
* led by psychiatrist
* clients=frail, with dementia, persistent psychiatric disorders
* goal: maintain functional abilities as long as possible
40
Chemical Restraints
Haldol
Ativan
41
Drugs for Alzheimers
* **Aricept**-(donepezil)=cholinesterase inhibitor; slows progression SE: insomnia, dizziness, H/A, N/D (may subside), less liver toxicity
* **Tacrine** (Cognex)-cholinesterase inhibitor, may delay progress, high incidence of liver SE's
* **Exelon** (rivastigmine) cholinesterase inhibitor
* **Rezadyne** (galantamine) cholinesterase inhibitor
* **Namenda** (Memantine)-NMDA receptor antagonist SE: dizzy, H/A, constipation
42
Risk Factors for Alzheimers
* apolipoprotein E (involved with amyloid depostion in the brain) E4 allele=high risk
* family history
* being female
* cardiovascular: HTN, hyperlipidemia, diabetes
* head trauma
* lower education
43
Symptoms of Alzheimers
* Orientation
* Behavior (disinhibited)
* irritable, agitated
* psychosis (paranoid delusions, later hallucinations)
* Motor symptoms=Parkinsonism, gait abnormalities, falls, no tremor
* short term memory
* executive dysfunction (prob solve, mult-task)
* language-names of objects
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