Week 3 Flashcards
(109 cards)
1
Q
What are the levels of disorders in the continuum of disorders?
A
MILD, MODERATE, SEVERE, PSYCHOSIS, PSYCHOPHYSIOLOGICAL
Disorders classified by presenting clinical symptoms, formerly known as neurotic disorders.
2
Q
What are some characteristics of anxiety?
A
Physiological, psychological, behavioural, and cognitive symptoms; excessive irrational fear and dread
Most common mental illness in Canada, affecting up to 1 in 4 Canadians in their lifetime.
3
Q
What defines normal anxiety?
A
Necessary for survival
It serves as a reaction to real or perceived danger.
4
Q
What are the types of anxiety disorders?
A
- Generalized Anxiety Disorder (GAD)
- Panic Disorder
- Obsessive-Compulsive Disorder (OCD)
- Social Phobia (Social Anxiety Disorder)
- Specific Phobia
- Substance-Induced Anxiety Disorder
- Separation Anxiety
- Anxiety Due to Nonpsychiatric Medical Conditions
Anxiety disorders categorized based on specific symptoms and contexts.
5
Q
What are the physiological responses to anxiety?
A
- Cardiovascular: palpitations, BP/HR changes
- Respiratory: SOB, shallow breathing
- Neuromuscular: startle reaction, pacing
- Gastrointestinal: nausea, appetite changes
- Integumentary: flushed/pale, sweating
- Urinary: frequency and urgency
Each system reacts differently under anxiety.
6
Q
What neurotransmitter mediates mood and anxiety?
A
Norepinephrine
It plays a role in stress response, attention/vigilance, and arousal.
7
Q
What are the effects of GABA in the nervous system?
A
Acts as a brake on neuron excitability; has sedative, anticonvulsant, and muscle-relaxant properties
Benzodiazepines and barbiturates bind to GABA receptors to enhance its effect.
8
Q
What pharmacological treatments are used for anxiety?
A
- Benzodiazepines
- MAOIs
- Beta-adrenergic blocking agents
- SSRIs
- Tricyclic antidepressants (TCAs)
- Non-benzodiazepines
Each treatment has different mechanisms and effects on neurotransmitters.
9
Q
What is Somatic Symptom Disorder?
A
Physical symptoms suggesting a physical disorder without supporting evidence; linked to psychological factors
Symptoms are not intentional or under the client’s control.
10
Q
What are the types of somatoform disorders?
A
- Somatic Symptom Disorder
- Illness Anxiety Disorder (formerly hypochondriasis)
- Conversion Disorder
- Factitious Disorders
Each type presents unique characteristics and implications for treatment.
11
Q
What is the role of the limbic system in anxiety?
A
Regulates unconscious response to stress and connects to the Reticular Activating System (RAS)
It influences alertness and arousal levels.
12
Q
What defines dissociative disorders?
A
Severe interruption of consciousness following significant adverse experiences or traumas
Protects against overwhelming anxiety through emotional separation.
13
Q
What are some nursing interventions for anxiety?
A
- Establish open, trusting relationship
- Assist with management of anxiety
- Provide reassurance of safety
- Identify anxiety triggers
- Promote physical health and relaxation
These interventions aim to support patients in managing their anxiety effectively.
14
Q
What is Cognitive-Behavioural Therapy (CBT)?
A
A type of cognitive therapy that focuses on changing negative thought patterns and behaviours
It is effective in treating anxiety and mood disorders.
15
Q
Fill in the blank: The _______ is a key brain structure involved in the fight or flight response.
A
Hypothalamus
It plays a critical role in the body’s response to stress.
16
Q
True or False: Secondary gain refers to the unconscious defense that causes a physical symptom.
A
False
Secondary gain is achieved from the physical symptom allowing the person to receive support.
17
Q
What assessments are used for anxiety disorders?
A
- Hamilton Rating Scale for Anxiety (HAM-A)
- Yale-Brown Obsessive-Compulsive Scale (YBOCS)
- Panic Disorder Severity Scale (PDSS)
These assessments help in evaluating the severity and presence of anxiety disorders.
18
Q
What is the purpose of milieu therapy?
A
To provide a safe and supportive environment for patients
It emphasizes community and interpersonal relationships as a therapeutic tool.
19
Q
What is fear
A
Reaction to a real or perceived danger
20
Q
Primitive defence mechanisms
A
- denial
- regression
- acting out
- dissociation
- compartmentalizations
- projection
- reaction formation
21
Q
Mid-level Defence mechanism
A
- repression
- displacement
- intellecutalization
- rationalization
- undoing
22
Q
Mature defense mechanisms
A
- sublimination
- self assertion
- suppression
- compensation
- altruism
- anticipation
- affiliation
- self-observation
23
Q
Biological causes and risk factors for anxiety
A
- genetic predisposition (family history)
- neurochemical dysregulation (ex. Seratonin)
- overactivity in the amygdala or HPA axis
24
Q
Psychological causes and risk factors for anxiety
A
- childhood adversity or insecure attachment
- low coping skills or perfectionism
- learned fear responses
25
Social/environmental causes and risk factors for anxiety
- stressful life events (e.g trauma, loss)
- substance use (alcohol, stimulants)
- chronic illness or comorbidities psychiatric disorders
26
Lambic system & anxiety: Hypothalamus
- unconscious response to stress
- fight or flight response
- connects to RAS
- if stimulated, increased alertness and arousal
- if inhibited, drowsiness and sleep induction
27
Limbic system and anxiety: Reticular activating system (RAS)
- alerts cerebral cortex, transmits information to higher brain centres
- if no signal, decreased general brain activity
28
Responses to anxiety: Cardiovascular
Palpitations, increased or decreased BP/HR, faintness, tightness/chest pain
29
Responses to anxiety: respiratory
-SOB
- pressure
- shallow breathing
- gasping
30
responses to anxiety: neuromuscular
Startle reaction, pacing, tremors, insomnia
31
Responses to anxiety: cognitive
- poor concentration
- forgetfulness
- confusion
- preoccupation
- errors in judgement
- fear of losing control
32
Responses to anxiety: behavioural
- restlessness
- inhibition
- rapid speech
- tension
- tremors
- avoidance
- hyperventilation
33
Responses to anxiety: affective
- impatience
- fright
- alarm
34
Norepinephrine and anxiety
- mediates mood and anxiety
- stress response, attention/vigilance, arousal, ability to focus/learn, feeling of reward
- fluctuates with sleep and wakefulness
35
Gamma-aminobutyric acid (GABA)
- most prevalent inhibitaory neurotransmitters
- decreased aggression, anxiety, excitation
- sedative, anticonvulsant, and muscle relaxant properties
- neuron is stimulated, gaba acts as a brake, neuon excitability
- benzodiazepines and barbiturates bind to GABA receptor —> intensifies effect of GABA
36
Serotonin and anxiety
- modulator for specific brain functioning —> affects temperature, sensory, sleep, and assertiveness areas
37
Pharm treatments: Benzodiazepines
- potentiate effects of GABA and other inhibitory neurotransmitters, decreasing anxiety
38
Pharm treatments: MAOIs
- increasing concentration of epinephrine, norepinephrine, serotonin, and dopamine
39
Pharm treatments: Beta adrenergic blocking agents
- decrease blood pressure without reflec tachycardia or bradycardia
- control irregular pulse, reduce nervous tension, sweating panic and shakiness
40
Pharm treatments: SSRI
- inhibits serotonin reuptake, no effect on norepinephrine or dopamine
41
Pharm treatments: tricyclic antidepressants (TCAs)
- block reputake of norepinephrine and serotonin and increase action of those neurotransmitters in nerve cells
42
Pharm interactions: Non-benzodiazepines
- rarely lead on dependence or tolerance, so safe to use on a daily basis (generalized anxiety disorder)
43
Types of Anxiety Disorders
- generalized anxiety disorder (GAD)
- panic disorder
- obsessive compulsive disorder (OCD)
- social phobia (social anxiety disorder)
- specific phobia
- substance induced anxiety disorder
- separation anxiety
- anxiety due to non psychiatric medical conditions
44
Assessments for Anxiety
- Hamilton rating scale for anxiety (HAM-A)
- Yale brown obsessive compulsive scale (YBOCS)
- obsessive compulsive inventory (OCI)
- panic disorder severity scale (PDSS)
45
Nursing interventions for anxiety
- establish open, trusting relationships
- assist with management of anxiety
—> be aware of and control your own feelings
- provide reassurance of safety
- assist to identify anxiety triggers
- assist to identify new adaptive coping strategies
- promote physical health, well being, relaxation response
46
Non- pharmacological treatment: cognitive therapies
- cognitive restructuring
- cognitive-behavioural therapy (CBT)
47
Non-pharmacological treatments: behaviour therapies
- relaxation
- modelling
- systematic desensitization
- flooding
- response prevention
- thought stopping
48
Non-pharmacological Treatment: integrative therapy
- mediation
Guided imagery
- yoga
- nutritional and herbal supplements
49
Somatic symptom disorder (unintentional)
- onset before age 30
- impaired social, occupational, cognitive functioning
50
Illness anxiety disorder (formerly known as hypochondriasis) (unintentional)
- preoccupation with having a serious disease
- impaired social or occupational functioning
51
Conversion disorder (unintentional)
- cannot be explained by neurological, medical or culture bound syndrome
- can display like la belle indifference
52
Münchausen syndrome (intentional)
- may have scars from exploratory surgeries
- multiple tests and procedures
53
Fictitious disorder by proxy (intentional)
- deliberate feigning or causing illness in vulnerable dependent
- attention, sympathy, excitement
54
Malingering (intentional)
- conscious act for primary or secondary gain
- intentional production of false or exaggerated symptoms
55
Primary gain
- a decrease in anxiety (gain) from an unconscious defense that causes a physical system
- e.g a person strikes someone else. The arm becomes (unconciusly) paralyzed because it was used to harm someone else, therefore the guilt is decreased
56
Secondary gain
- gain achieved from the physical symptom which allowed the person to get support that they would not ordinarily obtain
- e.g avoiding difficult situations, getting attention, emotional support or sympathy
57
Formal assessments for somatic disorders
- patient health question are somatic symptom short form (PHQ-SSS)
- dissociative experiences scales (DES)
- somatoform dissociation questionnaire (SDQ)
- dissociative disorders interview schedule (DDIS)
- BATHE technique
58
BATHE technique
- goof for engaging a patient with simultaneously assessing psychosocial factors
B- background (what’s brings you in today)
A- Affect (how do you feel about that)
T- Trouble (what bothers you the most about this situation)
H- handling (how are you handling that)
E- Empathy (this must be very difficult for you)
59
Interventions for somatic disorders
Collect throughout history to clarify the course of past and current symptoms
- self reflection/ self assessment
- identify secondary gains
- verbal and body psychotherapies
—> cognitive refraining, sensorimotor psychotherapy, dance movement therapy
60
Dissociative disorders (under trauma and stressor related disorders)
- occur after significant adverse experiences or trauma
- stress response with severe interruption of consciousness
- protects againsts overwhelming anxiety through emotional separation
Depersonalization/derealization disorder
Dissociative amnesia / fugue
Dissociative identity disorder
61
Assessments of dissociative disorders
- assess identity and memory
- assess for co-morbid conditions
- history of trauma or abuse as a child
- identify support systems
- assess mood and anxiety
- assess safety of self and others
62
Interventions for dissociative disorders
Milieu management
- safe, supportive enviroment
Provide simple and consistent routine
Support proces of disclosure of memories at patients own pace
Health teaching and promotion
- prevention of dissociation if triggers can be identities
Pharmacological
- minimal effects, may use benzodiazepines or antidepressants for comorbidities disorders
63
What is ethics
An expression of values/ beliefs that guide practice
64
Psychosis
1% prevalence of schizophrenia worldwide
3% of individuals will experience a psychotic episode in their lifetime
Onset
- males (18-25) females (25-35)
65
Key features in psychotic disorders
- delusions
- hallucinations
- disorganized thinking
- abnormal motor behaviour
- negative symptoms
66
Etiology for Schizophrenia
Biological factors
- genetics
Neurobiological
- dopamine theory/ other neurochemicals
Brain structure abnormalities
- head injury
Psychological and environmental factors
- prenatal stressors
- psychological stressors
- environmental stressors
67
Co-morbidities for schizophrenia
- substance abuse disorders
- nicotine dependence
- depression, anxiety and polydipsia (water intoxication)
- suicide
- physical illness
68
Relational ethics
Recognize the impact that relationships matter
69
Bioethics (objective moral values and duties) (belief does not = truth)
- autonomy
- nonmaleficence
- beneficence
- justice
- principle of impossibility
- fidelity
70
Patients Rights: legal Right
- right to treatment
- right to refuse treatment (UNLESS they are deemed incompetent)
- authorization of treatment (consent, competency, advance directives, involuntary, admission criteria, community treatment orders)
- least restrictive care (seclusion, restraints)
- confidentiality
71
Patients right: confidentiality
- duty to warn
- duty to protect
- reporting of abuse (child abuse, protection for the person in care act)
- confidentiality of communicable disease
- confidentiality after death
- protection of patients
72
Tort
A civil wrongful for which money damaged may be collected by the injured party from the responsible party
73
Intentional tort
Willful or intentional acts that violate another persons right or property
- assaults or battery (making contact w/o consent, can be any threats, need probable cause)
- false imprisonment
- invasion of privacy
- defamation of character
74
Unintentional tort
Unintended acts against another person that produce injury or harm
- negligence
- malpractice
75
Potential nursing liability
- pt safety
- intentional torts
- negligence/malpractice
- assault and/or battery
- false imprisonment
- defamation of character (libel, slander)
- invasion of privacy
- supervisory liability
76
How to chart
- stick to the facts
- avoid labeling
- be specific
- use neutral language
- eliminate bias
- keep the record intact
77
What to chart
- significant situations
- complete assessment data, especially baseline data on admission
- discharge instructions
78
+ symptoms of schizophrenia
- hallucinations
- 5 senses
- delusions
- fixed false belief
- disorganized thinking/ behaviours
-stupor
- Catatonia
79
Word salad
Type of disorganized speech where sentences or phrases make little sense to others, often due to lack of logical connection between words and phrases.
80
Tangential thought process
Type of thinking where ones thoughts shift away from the main topic, going off on related but irrelevant tangents, without returning to original subject
81
Circumstantial thought process
Someone provides excessive, irrelevant details before eventually getting to the main point
82
(-) symptoms of schizophrenia
- paranoia
- affective flattening
- alogia
- avolition (lack of will, inability to prompt themselves towards goal directed activities)
-asocial
83
What is ethics?
An expression of values / beliefs that guide practice.
## Footnote
Ethics encompasses various approaches, including relational ethics, deontology, and bioethics.
84
What are the key ethical principles in mental health nursing?
* Autonomy
* Nonmaleficence
* Beneficence
* Justice
* Fidelity
* Principle of impossibility
85
What are patients' legal rights in mental health care?
* Right to treatment
* Right to refuse treatment
* Authorization of treatment
* Consent
* Competency
* Advance directives
* Involuntary admission criteria
* Community treatment orders
* Least restrictive care
* Seclusion
* Restraints (chemical, physical)
* Confidentiality
86
What is the Alberta Mental Health Act?
A legal framework governing mental health treatment and patient rights in Alberta.
## Footnote
It outlines criteria for patient certification and treatment decisions.
87
What are the criteria for formal patient certification under the Mental Health Act?
* Suffering from a mental disorder
* Potential to benefit from treatment
* Likely to cause harm or substantial deterioration within a reasonable time
* Unsuitable for admission to a Designated Facility other than as a formal patient
88
Define intentional tort in nursing.
Willful or intentional acts that violate another person's rights or property.
## Footnote
Examples include assault, battery, false imprisonment, invasion of privacy, and defamation.
89
What is an unintentional tort?
Unintended acts against another person that produce injury or harm.
## Footnote
Common examples include negligence and malpractice.
90
What are the phases of schizophrenia?
* Phase I – Acute
* Phase II – Stabilization
* Phase III – Maintenance
91
What are the four main symptom groups of schizophrenia?
* Positive symptoms
* Negative symptoms
* Cognitive symptoms
* Affective symptoms
92
What is the prevalence of schizophrenia worldwide?
1%
## Footnote
Approximately 3% of individuals will experience a psychotic episode in their lifetime.
93
What are typical antipsychotics used for?
Treatment of positive symptoms of schizophrenia.
## Footnote
They act as dopamine (D2 receptor) antagonists and can cause movement-related side effects.
94
What are atypical antipsychotics used for?
Treatment of both positive and negative symptoms of schizophrenia.
## Footnote
They act as dopamine and serotonin antagonists and may have metabolic-related side effects.
95
What is anosognosia?
Lack of insight or awareness of one's own mental illness, often experienced by individuals with schizophrenia.
## Footnote
This condition can complicate treatment and recovery.
96
What are the criteria for Medical Assistance in Dying (MAiD) in Canada?
* Eligible for health insurance
* At least 18 years old and capable of making health care decisions
* Have a grievous and irremediable medical condition
* Make a voluntary request free from external pressure
* Give informed consent after being informed of all available treatments
97
What safeguards are in place for MAiD where death is not reasonably foreseeable?
* 90-day mandatory assessment period
* Second assessment by a specialist
* Information on all means to relieve suffering
* Opportunity to withdraw request
* Express consent immediately before MAiD is provided
98
What is the purpose of documentation in nursing?
To communicate among team members and ensure compliance with laws, regulations, and professional standards.
## Footnote
Documentation should be timely, accurate, and derived from assessments, treatment plans, and interventions.
99
Fill in the blank: A __________ is a civil wrong for which money damages may be collected by the injured party.
Tort
100
What is the best defense in court for a nurse?
Factual charting.
## Footnote
This requires knowing how, what, when, and who should chart.
101
True or False: A patient is considered incompetent if they can understand the subject matter of treatment decisions.
False
102
What are some nursing interventions for patients with schizophrenia?
* Establish open, trusting relationships
* Assist with management of symptoms
* Provide reassurance of safety
* Identify safety risks
* Promote physical health and relaxation
103
What is the difference between schizophrenia and schizoaffective disorder?
Schizophrenia is characterized by symptoms lasting at least six months, while schizoaffective disorder includes concurrent or consecutive symptoms of both mood disorders and schizophrenia.
104
What is psychosis associated with another condition?
Psychotic symptoms that appear due to a head injury or physical illness affecting brain function.
## Footnote
This may include conditions like encephalitis or tumors.
105
What are cognitive symptoms for schizophrenia
- inattetnion, distractibiity
- impaired memory
- poor problem-solving skills
- poor decision making skills
- illogical thinking
- impaired judgement
106
Affective symptoms for schizophrenia
- dysphoria
- suicidality
- hopelessness
107
Typical Antipsychotics (1st Generation)
- positive symptoms
- dopamine (D2 receptor) antagonists (postsynaptic)
- antagonists for acetylcholine, norepinephrine, and histamine receptors
- movement related and anticholynergic effects
108
Atypical Antipsychotics (2nd Generation)
- positive and negative symptoms
- dopamine (postsynaptic) and serotonin (presynaptic) antagonists
- metabolic related side effects
109
Complications to pharmacological treatment
- anticholinergic toxicity
- neuroleptic malignant syndrome (NMS)
- agranulocytosis
—> particularity with clozapine
- extrapyramidal symptoms (EPS)
—> tardive dyskinesia
—> dystonia
—> pseudoparkinsonism
—> AKathisia
