Week 1 Flashcards
(115 cards)
1
Q
What does mental health allow an individual to do?
A
Recognize own potential, cope with stress, productivity, contribute to society, rational thought, appropriate communication, able to learn, grow emotionally, healthy self-esteem, resilience
Resilience is the ability to acquire resources needed to support well-being, optimism, sense of mastery, and competence.
2
Q
What is resilience?
A
Ability to acquire resources needed to support well-being, optimism, sense of mastery, competence
Resilience is essential to recovery.
3
Q
What model combines biological predisposition and environmental stressors in understanding mental illness?
A
Diathesis Stress Model
This is currently the most widely accepted explanation for mental illness.
4
Q
What are the cultural perceptions of mental health treatment among Asian-Canadian individuals?
A
Shame, stigma, blame; low treatment seeking
Only ¼ seek treatment.
5
Q
What is the DSM-5?
A
A manual that provides definable diagnoses for mental disorders.
6
Q
What are the significant dysfunctions considered in diagnosing mental illness?
A
- Developmental
- Biological
- Physiological
- Social
- Spiritual
- Culturally defined
7
Q
What is the focus of psychoanalytic theories in mental health?
A
Id, ego, superego; psychosexual stages of development; transference; countertransference.
8
Q
What does Erik Erikson’s theory describe?
A
Eight stages of psychosocial development from infancy to old age.
9
Q
What is the goal of Maslow’s Hierarchy of Needs?
A
To achieve self-actualization once basic needs are met.
10
Q
What is the focus of cognitive behavioral therapy (CBT)?
A
Test distorted beliefs and change ways of thinking.
11
Q
Which theory recognizes the importance of interpersonal relationships in mental health?
A
Interpersonal Theory / Psychotherapy (Sullivan).
12
Q
Fill in the blank: The _______ model addresses the whole person and environment in mental health.
A
BIOPSYCHOSOCIAL
13
Q
What are some implications of behavioral therapies?
A
- Classical Conditioning (Pavlov)
- Behaviorism (Watson)
- Operant conditioning (Skinner)
- Modelling
- Systematic Desensitization
- Aversion Therapy
- Biofeedback
14
Q
What is the significance of documenting patient condition in mental health nursing?
A
Changes in patient condition, informed consents, reaction to medication, documentation of symptoms, safety concerns.
15
Q
True or False: The moral model views substance use as a result of weak character.
A
True
16
Q
What are the key components of addiction theories?
A
- Genetic / Biological
- Psychodynamic
- Moral Model
- Environmental / Social Learning
17
Q
What contributes to stigma in mental health as illustrated by media?
A
Misrepresentations that reinforce fear and discrimination.
18
Q
What is a challenge for Indigenous populations regarding mental health?
A
Lack of connectedness with culture/tradition and access to services.
19
Q
What is the role of documentation in the nursing process for mental health?
A
To record changes in patient condition, informed consents, reactions to medications, and safety concerns.
20
Q
What is the primary focus of the nursing process in mental health?
A
To ensure a focus on the client’s holistic needs.
21
Q
Attributes of mental health
A
- accurately appraise reality
- be able to love and experience joy
- be able to deal with conflicting emotions
- be able to live without fear, guilt or anxiety
- be able to take responsibility for ones actions
- be able to control ones own behaviour
- think clearly
- relate to others
- attain self define spirituality
- negotiate each developmental task
- be able to work and be productive
- maintain a healthy self concept and self value
- be able to play and laugh
22
Q
The mental health continuum: Healthy
A
Normal functioning
- normal mood functions
- takes things in stride
- consistent performance
- normal sleep patterns
- physically and socially active
- usual self confidence
- comfortable with others
23
Q
The mental health continuum: Reacting
A
Common and reversible distress
- irritable/ impatient
- nervousness, sadness, increased worrying
- procrastination, forgetfulness
- trouble sleeping
- lowered energy
- intrusive thoughts
- difficulty in relaxing
- decreased social activity
24
Q
The mental health continuum: injured
A
Significant functional impairment
- anger, anxiety, lingering sadness
- fearfulness, hopelessness, worthlessness
- preoccupation, decreased performance in academics or at work
- significantly disturbed sleep
- avoidance of social situations
- withdrawal
25
The mental health continuum: ill
Clinical disorder, severe & persistent functional impairment
- significant difficulty with emotions
- thinking high level of anxiety
- panic attacks
- depressed mood, feeling overwhelmed
- constant fatigue
- disturbed contact with reality
- significant disturbances in thinking
- suicidal thouhghts/ intent. Behaviour
26
Diathesis stress model
Diathesis = biological predisposition or trauma
Stress = environmental factors
Nature plus nurture
- combination of negatve environmental factors and genetic vulnerability
- currently the most widely accepted explanation for mental illness
27
Epidemiology; mental health
Definition: the study of patterns of risk and resiliency (protective) factors
- identification of high risk groups/factors
- incidence
- prevalence
Clinical epidemiology
- individuals with specific disorders are studied for:
—> natural hx of illness
—> diagnostic screening Tests
—> interventions
- results describe the frequency of disorders and symptoms that appear together
28
Psychoanalytic theories
Psychoanalytic (Freud)
- id, ego, superego
- psychosexual stages of development
- transference *
- countertransference *
Psychodynamic
Ego theory (Erickson)
- 8 stages of development
29
Biological theories
Focus on neurological, chemical, biological, genetic interactions
How the body and brain interact to create
- emotions
- memories
- perceptual experiences
Consider social, environmental, cultural, economic spiritual
30
Eriksons eight stages of development
1. Trust vs mistrust (0-1.5)
2. Autonomy vs shame and doubt (1.5-3)
3. Initiative vs guilt (3-6)
4. Industry vs inferiority (6-12)
5. Identity vs role confusion (12-20)
6. Intimacy vs isolation (20-35)
7. Generatively vs self absorption (35-65)
8. Integrity vs despair (65+)
31
Humanistic theories
Hierarchy of Needs (Maslow)
- when basic needs are met, higher needs can emerge
- goal is to achieve self actualization
- emphasis on human potential and client strengths
- prioritizing nursing actions in the nurse patient relationship is build on this hierarchy
32
Interpersonal theories
Interpersonal theory/ psychotherapy (Sullivan)
- needs are met through interpersonal interactions
Interpersonal relationships in nursing (peplau)
- the art of nursing
—> provide care, compassion, advocacy
—> enhance comfort and well being
- the science of nursing
- appply knowledge to a board range of human problems a psychosocial phenomenon
- intervene in reliving suffering and promote growth
33
Cognitive theories
Rational-emotive (Ellis)
- recognition of irrational beliefs and inaccurate thoughts
Cognitive behaviour (CBT) (Beck)
- test distorted beliefs and change way of thinking
Dialectical behaviour (DBT_ (lineman)
- combines cognitive and behavioural techniques with mindfulness (becoming aware of thoughts and shaping them)
- increases tolerance to stress
34
Behavioural theories
Classical conditioning (Pavlov)
Behaviourism (Watson)
Operant conditioning (skinner)
- modelling
- operant conditioning
- systematic desensitization
- aversion therapy
- biofeedback
35
Cognitive therapies: implications for nursing
- recognizing interplay between events, negative thinking, and negative responses can be beneficial
- workbooks to aid in process of identifying cognitive distortions
- challenge the negative thoughts that are not based on facts and then replace them with more realistic appraisals
- Brie therapy modalities
36
Therapies (traditional/ western approaches)
- pharmacotherapy
- group therapy
- family therapy
- cognitive therapy
- behavioural therapy
- electroconvulsive therapy
37
Addiction theories: genetic/ biological
Genetic predisposition
- behaviour vs biology encoded
- connection to race (hypersensitive to alcohol)
- gender link (males inherit)
Introduction of a substance to the body on a regular basis will inevitability lead to addiction
Metabolic adjustments in the body result in tolerance
- requires higher doses to avoid withdrawal
38
What are the main interactions that the Biological Theory of Mental Illness focuses on?
Neurological, chemical, biological, genetic interactions
## Footnote
These interactions explain how the body and brain create emotions, memories, and perceptual experiences.
39
What are the effects of increased dopamine levels?
Linked to positive symptoms of schizophrenia (hallucinations, paranoia)
## Footnote
Decreased levels are associated with Parkinson-like symptoms, rigidity, and depression.
40
What is the role of serotonin in mental health?
Mood control, temperature regulation, impulsivity, aggression
## Footnote
Increased levels can elevate mood and decrease anxiety, while decreased levels can lead to anxiety, depression, and obsessive-compulsive behaviors.
41
What is the function of norepinephrine?
Arousal, dreaming, depressed mood, attention
## Footnote
Increased levels are linked to positive symptoms of schizophrenia, while decreased levels are associated with depression.
42
What does an increase in gamma-amino butyric acid (GABA) lead to?
Decrease in anxiety
## Footnote
Not having enough GABA can lead to increased anxiety.
43
What effects does acetylcholine have on cognition?
Learning, memory, alertness
## Footnote
Increased levels are linked to depression, while decreased levels can lead to dementia.
44
What is an action potential?
Occurs when a neuron sends information down the axon, away from the cell
## Footnote
It is a fundamental process for neuronal communication.
45
Define 'Full Agonist' in the context of neurotransmitters.
Mimics the effect of the neurotransmitter
46
What does a 'Partial Agonist' do?
Mimics the effect of the neurotransmitter to a lesser extent
47
What is the role of the Parasympathetic Nervous System?
Controls homeostasis, often referred to as 'rest and digest'
48
What is the primary indication for lithium carbonate?
First-line mood stabilizer for bipolar disorder
49
What is the therapeutic level of lithium?
0.6-1.2 mmol/L
50
What are the signs of early lithium toxicity?
Nausea, vomiting, diarrhea, abdominal cramping, thirst, lethargy, slurred speech, muscle weakness, fine hand tremor
51
What is the mechanism of action for lithium?
Alters sodium transport, modulates neurotransmitter signaling (↑ GABA, ↓ dopamine/glutamate)
52
What are common side effects of H₁ receptor blockade?
Sedation, weight gain, hypotension
53
What are the effects of selective serotonin reuptake inhibitors (SSRIs)?
Decrease depression and anxiety
54
What is the use of benzodiazepines?
Treatment for anxiety and insomnia
55
What is the pathway result of D₂ receptor blockade in antipsychotic pharmacology?
Decrease positive symptoms (ex. hallucinations, delusions)
56
What does the term 'Inverse Agonist' refer to?
Produces opposite effect of the neurotransmitter
57
What is the result of 5-HT₂ reuptake inhibition?
Decrease depression, decrease anxiety, but may cause GI/sexual effects
58
What are the effects of increased norepinephrine?
Linked to positive symptoms of schizophrenia (hallucinations, paranoia)
## Footnote
Decreased levels are associated with depression.
59
Fill in the blank: The Sympathetic Nervous System is responsible for the ______ response.
fight or flight
60
What are the key therapeutic effects of antipsychotic medications?
Decrease positive symptoms, decrease hostility, increase impulse control
## Footnote
These effects are primarily due to D₂ receptor blockade.
61
Addiction theories: Psychodynamic
- self medicating
- symptoms of underlying phsychological problems
- maladaptive coping strategy
- address the underlying issues and addiction will be resolved
62
Addiction theories: environmental/social learning
Emotional
- stress; lack of coping
Socially
- peer pressure, observational learning
Spirituality
- absence of hope, love, compassion
Environmental
- advertising, laws, social norms
63
Addiction theories: moral model
Substance use as a result of weak, sinful character
64
Agnosognosia
Neurological condition that prevents people from recognizing or acknowledging their psychiatric or neurological deficits
(Lack of awareness or insight into their own mental illness)
65
Addiction theories: biophychosocial
- all previous models have some element of truth
- address the whole person and enviroment
- mallows hierarchy
66
Transference
The unconscious redirection of feelings and behaviours from past relationships, typically those from childhood, onto a new person, often the therapist or nurse in our case
67
Countertransference
Referers to a therapists unconscious emtioional reactions to a client, often a response to the clients transference
68
Complementary and alternative approaches
- whole medical systems
- mind-body- spirit approaches
- biological based practices
- manipulative approaches
Energy therapies
69
Neurotransmitters for Shizophrenia
Dopamine
70
Action Potential Definition
Occurs when a neuron sends information down the axon, away from the cell
71
Full agonist definition
Mimics effect of the neurotransmitter
72
Partial Agonist Definition
Mimics (to a LESSER extent) the effect of the neurotransmitter
73
Antagonist definition
Blocks effect of the neurotransmitter
74
Inverse agonist
Produces opposite effect of the neurotransmitter
75
Parasympathetic Nervous System
“Rest and digest”, controls homeostasis
76
Sympathetic nervous System
Fight or flight, response to perceived threat
77
Tri/Tetracyclic TCA Antidepressants
- earliest developed
- increased NE and 5-HT
- blocks acetylcholine
- cardio toxicity
—> a weeks work of this medication is lethal
- highly lethal in overdose
- discontinuation syndrome
78
SSRI & SNRI (Antidepressents)
FIRST LINE
- most common prescribed
- blocks serotonin/ NE reputable
- better side effect profile
- less lethal in overdose
- risk of serotonin syndrome
79
MAOI (Antidepressants)
- inhibits monoamine breakdown
- food and drink interactions
- drug-drug interactions
- risk of hypertensive crisis
80
81
Therapeutic effects of Antidepressants
Pathway
- DA reputake inhibitaion
- NE reputake inhibition
- 5-HT2 reuptake inhibition
Result
- decrease depression, increase motivation, decease psychomotor slowing
- decrease depression, decrease tremors, may increase HR
- decrease de[ression, decrease anxiety, but may cause GI/sexual effects
82
Side effects by receptor blockade
Receptor blocked
- H1 (histamine)
- ACh (acetylcholine)
-a1 (adrenergic)
-a2 (adrenergic)
5-HT2 (serotonin)
Key side effects
-Sedation, weight gain, hypotension
-dry mouth, constipation, blurred vision, urinary retention
- postural hypotension, dizziness, memory issues
- priapism
- sexual dysfunction, hypotension
83
Different types of SSRIs
Prozac - Fluoxetine
Paxil - Paroxetine
Celexa - Citalopram
Cipralex - escitalopram
Zoloft - sertraline
84
S/E of ACh blocks
- blurred vision
-dry mouth
- constipation
- sinus tachycardia
- urinary retention
85
S/E of a2 blocks
Priapism
86
S/E of a1 block
- Postural hypotension
- dizziness
- reflex tachycardia
- memory dysfunction
87
S/E of NE reuptake inhibition
- reduced depression
- tremors
- tachycardia
- erectile/ Ejaculatory dysfunction
88
5-HT2 reuptake inhibition
- reduced depression
- anti-anxiety effects
- GI disturbances
- sexual disturbances
89
S/E of 5-HT2 block
- reduced depression
- reduced sucidal behaviour
- antipsychotic effects
- hypotension
- Ejaculatory dysfunction
90
S/E of DA reuptake inhibition
- decreased depression
- psychomotor activation
- anti-parkinsonian effects
91
Mood stabilizer pharmacology
-lithium
- valproate
- lamotrigine
- others
—> anticonvulsants: topiramate, gabapentin, oxycarbazepine
—> Antipsychotics: olanzapine, quetiapaine, lurasidone, arpiprazole
92
S/E for H1 blocks
- sedation/drowsiness
- hypotension
- weight gain
93
Mood stabilizer Pharmacology - Lithium
- first line Tx for bipolar
- influence NE and 5-HT reuptake *
- alters cation transport
- narrow therapeutic index *
- risk for lithium toxicity **
94
Valproate
- most commonly prescribed
- blocks neuronal NA and Ca
- increases GABA
- monitor therapeutic index
- risk for hepatoxicity and pancreatitis
95
Mood stabilizer pharmacology: Lamotrigine
- first line for maintenance therapy
- blocks neuronal NA and Ca
- moderates glutamate and aspartate
Risk of SJS ****
96
Lithium Carbonate
Indication: first line mood stabilizer for bipolar disorder
Mechanism: alters sodium transport, modulates neurotransmitter signalling (increase GABA, decrease dopamine/glutamate)
Therapeutic level: 0.6-1.2mmol/L
Onset of effect: ~ 1-3 weeks
Nursing monitoring
- serum lithium levels: baseline, then q5-7days, then q3months
- kidney function (eGFR, creatinine,) thyroid (TSH) every 6-12 months
- assess hydration, sodium intake
-hold dose and notify provider if symptoms appear
Patient teaching
- maintaine consistent salt and fluid intake
- avoid NSAIDA, dehydration and diuretics
- report vomiting, diarrhea, or confusion immediately
97
Lithium Toxicity early
Early toxicity (<1.5mmol/L): Nausea, vomiting, diarrhea, abd cramping, thirst, lethargy, slurred speech, muscle weakness, fine hand tremor
98
Lithium toxicity: Advanced
Advanced: 1.5-2.0 mmol/L
- coarse tremor, persistent GI upset, confusion, disorientation, myoclonic jerks
99
Lithium Toxicity severe
Severe toxicity: 2.0-2.5mmol/L
- seizures, stupor, decreased level of consciousness (LOC), hypotension, arrhythmias, dilute polyuria, coma
100
What is the therapeutic range for lithium
0.6-1.2mmol/L
101
Lithium toxicity- Critical toxicity
Critical toxicity (>2.5mmol/L)
- generalized seizures, oliguria or anuria, coma, possible cardiovascular collapse or death
102
Anxiety disorders
Symptoms
- agitation
- irritability
- irrational fear
- obsessions/compulsions
Neurotransmitters
- GABA (gamma-amniobutyric acid)
- seratonin
Treatment
- antidepressants
—> increased seratonin
- atypical antipsychotics
—> low doses Boost seratonin
-anxiolytics
-potentials effects of GABA
103
Depression and Mood disorders
Symptoms
- sadness
-decreased energy
- anhedonia
- suicidality
Neurotransmitters
- serotonin
- norepinephrine
Treatment
- antidepressants and mood stabilizers
—> increase seratonin
—> stabilize mood swings in bipolar
- atypical antipsychotics
—> adjunct therapy
—> boosts effect of antidepressants
104
Anxiolytic Pharmacolgoy
- Benzodiazepines
- Antidepresants
- Antipsychotics
105
Anxiolytic Pharmacology: Benzodiazepines
- enhances effects of GABA
- fast, intermediate or long acting
- also used for alcohol withdrawal
- can cause physical dependence
- recommended brief use (<4months)
106
Anxiolytic pharmacology: antipsychotics
- off label use
- usually atypical
- increase serotonin**
107
Anxiety and insomnia medications: Short acting sedative-hypnotic sleep agents (Z-hypnotics)
- zopiclone (imovane)
- zolpidem Tartrate (sublinox)
108
Anxiolytic Pharmacology: Antidepressants
- usually SSRI
- block serotonin reuptake **
- risk of serotonin syndrome
109
Drugs to treat anxiety and insomnia: melatonin report agonists
- buspirone hydrochloride (Buspar)
110
Drugs to treat anxiety and insomnia: use of antidepressants
- selective serotonin reuptake inhibitors (SSRIs)
111
Drugs to treat anxiety and insomnia: benzodiazepines
- lorazepam (Ativan)
- flurazepam (dalmane)
- temazepam (restoril)
- triazolam (halcion)
- nitrazepam (mogadon)
- oxazepam (serax)
112
Schizophrenia Specutrum disorders
Symptoms
- hallucinations
- delusions
- paranoia
- decreased motivation
Neurotransmitters
- dopamine
-serotonin
Treatment
- typical antipsychotics
- —> block dopamine
- aypitical antipsychotics
—> block dopamine
—> block serotonin
113
Antipsychotic pharmacology: Typical (1st gen)
- earliest developed
- block dopamine (D2)**
- movement related s/e
114
Antipsychotic pharmacology: atypical (2nd gen)
- most commonly prescribed
- block dopamine D2
- block serotonin (5HT2)
- metabolic related S/E
115
Antipsychotic pharmacology: partial Ag (3rd gen)
- block d2 receptor and partial agonists at D2
- block serotonin (5HT2)
- adjunctive therapy (depression)
