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Exam #2 Psych/Comm
mod 4-7
| Question | Answer |
|---|---|
| Depressive disorder quick facts | worlds oldest recognized mental illness, onset mid 20-30s, effects 19 million people more frequently women, episodes more common in spring and fall |
| Major depression is characterized by: | depressed mood, loss of interest or pleasure in usual activities, social and occupational fxing impaired for at least 2 wks, no history of manic behavior, depression can't be atributed to use of substances or gen medical condition. |
| Dysthymia is characterized by: | sad or down in the dumps (less sever than major depression), no evidence of psychotic symp, essential feature is a chronically depressed mood for 1) most of the day, 2) more days than not, 3) for at least 2 years!! |
| What are three types of antidepressants? | Tricyclic (TCAs) monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs) |
| What is something an individual would want to avoid when takingn TCAs? | Alcohol |
| What do TCAs do in the brain? | Increases levels of neurotransmitters (serotonin or norepinephrine) in synaptic cleft (area between nerve endings) (need neurotransmitter for synapse to fire). |
| Elavil, Pamelor, Trofronil, and Sinequine are common types of what anitdepressants? | TCAs |
| What are the common side effects of TCAs? | dry mouth, blurred vision (should subside ina few weeks), constipation, orthostatic hypOtension, Tachycardia, Urinary retention (contraindicated w/BPH), decreased seizure threshold (seizure precautions), weight gain |
| What type of antidepressant would you not want to give to a man with BPH? | TCAs |
| What should you inform a Pt who just started taking TCAs and is now having blurry vision? | It should subside ina few weeks. |
| Monoamine oxidase inhibitors (MAOIs) (last route to go for antidepressants). What does it do in the brain? | Prevents metabolism of neurotransmitters (MAO inactivates norepinephrine NE, serotonin and dopamine DA) |
| What is used more MAOIs or TCAs? | MAOIs |
| Name some side effects of MAOIs. | Abnormal heart rate, orthostatic hypotension, drowsy or insomina, dizzy and vertigo. |
| HTN CRISIS!!! Must know!! What is it? and what is it caused by? | MAOIs interact w/ tyramine a substance that inhibits the enzyme which breaks down tyramine. An accumulation of tyramine triggers release of norephinephrine which may cause HTN crisis. |
| HTN CRISIS what are s/s of it? | increased BP, HA, diaphoresis, dilated pupils, increased heart %, intracereberal hemorrhage. Must avoid food with TYRAMINE!! (cheese, beer, wine, chocolate) |
| What would be a extermely important issue to teach a Pt newly perscribed MAOIs? | Avoid anything containing tyramine (beer, wine, cheese, chocolate) !! could cause HTN crisis. |
| Celexa, Luvox, Lexapro, Prozac, Paxil, and Zoloft are all common antidepressants of what type? | SSRIs (first line of defense) |
| List in order of first line to last line of defense regarding antidepressants. | SSRI, Others, TCAs, MAOIs |
| If a Pt is on a MAOI they must be off the drug for how many day before starting an SSRI? | 14 days!! if not it could cause Serotonin syndrome.(rare) |
| What are the s/s of Serotonin syndrome? | confusion, delirium, agitated, irritable, ataxia, tremor, seziure, diaphoresis, N/V, diarrhea, hypotension or HTN, tachy, hyperthermia, cyanosis, coma, resp depression. |
| What are common side effects of SSRIs? | N/ diarrhea/constipation, tremor, insomnia, dry mouth, weight loss, anorexia, sexual dysfx |
| What is something important to tell an individual who just started taking a SSRI? | It may cause sexual dysfuction....if so let the doc know so the medication can be switched. |
| Facts about Bipolar Disorder.. | formerly known as manic depression, affects 5.7 million american adults, more common in higher socioeconomic classes, requires life long medications. |
| How is bipolar d/o characterized? | mood swings (High to low), mood changes may be rapid or gradual, if maina is left untreated the person may become psychotic. |
| What is Bipolar I? | has experienced depression, mania, or mixed (exhibiting mania and depression simultaneously) w/ periods of normalcy between. |
| Explain Bipolar II... | has experienced bouts of major depression and hypomania (mild mania-excessive hyperactivity). has never met the criteria for full mainia. |
| Cyclothymic is what? | doesn't meet criteria for bipolar I or II, Pts experience numerous periods of depression and hypomania but it's not severe enough to be called a major depressive episode. Chronic, Pt has had symp for at least 2yrs, alcohol n substance abuse is common. |
| What are symptoms of people experienceing mania? | (they try to dominate the group). Abnormal or excesssive elation, unusual irritability, decreased need for sleep, grandiose notions, increased talking, racing thoughts, increased sexual desire, markedly increased energy, poor judgement, loud, rapid speec |
| What is the type of medication called for bipolar d/o? | Mood stabilizers |
| Two most common mood stabilizers are? | Lithium Carbonate and Anticonvulsants: MOA unknown. |
| What substance is Lithium similiar to? | Salt |
| What is the therapeutic range for lithium? Is the range wide or narrow? | 0.6-1.2 mEq/L (for maintenance), 1.0-1.5mEq/L (acute mania). Narrow. Monitor weekly at first then monthly. 12hrs after last dose. |
| What are the toxic ranges or lithium? | 1.5-2 mEq/L- blurred vision, ataxia, tinnitus, n/v/D 2.0-3.5- increased Urinary output, tremors, confusion. 3.5 or greater - seizures, MI, coma, oliguria/anuria, giddy |
| How is Lithium processed in the body? | It is not metabolized in the body but is excreted by the kidneys |
| If decreased Na in the body then what happends to lithium? | Lithium is reabsorbed by the kidneys and can equal lithiium toxicity |
| If increased Na is in the body what is going on with lithium? | it is excreted by the kdneys and may not have therapeutic lithium level and may become manic. |
| Someone taking Lithium would need how much fluid a day? | 2500-3000 cc/day 2.5-3 liters a day |
| Tegretol, Depakote, Klonopin, Neurontin, Lamictal, Topamax are all anticonvulsants to treat what? | Bipolar disorder |
| What would be some interventions for a person suffering from SAD? | phototherapy where the pt is exposed to artificial light, pt may also be placed on an antidepressant for the duration of the season. |
| What is ECT used for? | People w/ severe depression when other treatments where unsuccessful, mania, some schizophrenia, some parkinson's. |
| What is ECT Absolutely contraindicated for in pts with? | Increased ICP |
| Some normal side effects of ECT is? | confusion, memory loss |
| How many treatments of ECT do people usually get? | 3Xwk for 6-12 treatments, then Pts begin maintenance treatment w/ longer times in bewteen treatments |
| What are the nurses responsabilities for people recieving ECT? | assure NPO 6-8 hrs, allow Pt to void, remove denture or other prosthesis, assess physical and mental status, begin IV, informed consent signed!! |
| Describe the procedurer for ECT... | Tourniquet on leg, Pt hooked to EEG and EKG, ECT leads are connected, Pt given IV brevital (anesthetic), Anectine (muscle relaxant - (after tourniquet), Atropine - decreased secretions (anticholinergic),02, bite block, seize induced, pt recover, sent home |
| suicide quick facts | suicide occurs every 18 mins in the US, 31,00 successful suicdes every year, 95% committing have a mental disorder, 11th leadin cause of death, elderly white males (12% of pop, but 18% of suicides) |
| Suicide is not a diagnosis or a disorder but .... | a behavior |
| Risk factors for suicide... | single, divorced, widowed, men rates rise in adolescents and peak at 40-50, levels off and rises after age 65, protestants commit suicde more than catholic or jewish, more common in high class than lower, caucasian, professionals, Hx of mental illness |
| What are questions to ask a pt if you think they may be sucidal? | are you having thoughts of harming yourself? do you have a plan? what is your plan? Do you have a mean to carry out your plan? |
| Immediate concern for person who may be suicidal... | sudden better mood w/depression - happy decision is made also has the energy to complete |
| Name types of abuse.. | physical, emotional, sexual, financial, identity, spirtiual, intimate partner abuse (domestic abuse) |
| Cycle of violence | Phase 1 - tension building phase (may last weeks, months or years). Phase 2 - The battering phase (most violent and shortest) Phase 3 - Honeymoon phase (batterer becomes loving, kind and contrite) |
Created by:
ashleydc1987
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