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mental health
15 16
| Question | Answer |
|---|---|
| OCD = | Intrusive thoughts- unwanted thoughts interferes with daily life function anxiety-obsession-compulsion- temp relief |
| obsessions = | intrusive thoughts |
| compulsions= | repetitive behaviors |
| common compulsions | checking, counting, washing, praying |
| begins- | childhood, or adolescnce chronic, waxing/wanning insight usually present |
| biologic- | gentic predisposition neurochecmical imbalance |
| cognitive thinking | if i think it- it will happen inflated responsibility perfectionism |
| enviromental | stress triggers exacerbations |
| OCD RELATED disorders | trichotillomania - hairpulling dermatillomania- skin picking nail biting - onchyophagia |
| reward seeking 'dopamine' | kleptomania compulsive buying -oniomania- hoarding |
| body image disorders | body dysmorphic disorder true OCD reated disorders- they have to 'fix it' or cant cope (plastic surgery) |
| body identiy disorder- | feels they need to get rid of body part |
| PCD treatment | SSRI'S (first line) helpful = sertine/zoloft- flufloxime antipsychotics- adjunct |
| THERAPY | EXPOSURE + RESPONSE PREVENTION (ERP) |
| Nuring interventions | DO NOT stop abruptly reduce anxiety FIRST ENCOURAGE gradual DELAY OF RITUALS (# OF TIMES OR RITUALS GRADUALY REDUCE MAINTAIN STRUCTURED ROUTINE- focus on something therapeutic communication - do not ask 'why do you'- chastise/family education- |
| schizophrenia definiton | severe psychotic disorder afecting : thought, perception , behavior SYMPTOMS DIFF FOR EVERYONE |
| ONSET | MALES TEENS EARLY 20'S FEMALES - 20-30'S AVERAGE - can be sooner or late |
| prevalence | 1% of population symptoms dif for everyone |
| schizophrenia - pos vs neg symptoms | positive ADDED behaviors - shouldnt be there negative LOSS of normal self - should be there |
| core positive symptoms | hallucinations- most common- auditor (command dang) delisons- fixed false beliefs (paranoid, grandisoe,etc - idea of refernce) disorganzied thinking - loose associations- word salad |
| positive symptoms | disorganzied speech - (incoherent or illogical conversation - circumstantial- tangenation ) disorganzied or bizarre behavior (agitiation, innappropriate actions - child like) catatonia in some cases (immobility or excessive movemnt ) |
| medications that respond well for POSTIIVE symptoms | 1st generation - antipsychotic meds |
| Negitive symptoms (loss of normal function ) | FLAT affect - no emtional epression Avolition - LACK of motivaton Anhedonia - inability to feel plesusre |
| neg symptoms | latenecy - delayed response answers 5minlate social withdrawl - (isolationm avoidence of others,) decreased attention/ cognitive impairment |
| neg symptoms are | harder to treat and often long lasting 2nd gen anitpsychotivs can help control |
| comparison - pos/neg | postive- hallucinations, delusions, disorganzied speech , bizarre behavior Negitive- flat affect, lack of motiviaton , social withdrawl , NO please (anhedonia), cognitive impairment |
| to be DX with schizto | 2 positive symptoms - dillusions/ hallutionation ONE is req and 1 neg symtoms 3 total |
| To be DX with | 1st sign is neg symptoms 6 motnhs with symot, one of the motnhs req symtoms happens for long time |
| multifactorial | genetics neurochemical (dopamine increase) rx perscribed to lower decreas dopamine can cause parkisopns symptoms brain structure changes enviromental stressors - presentation in symptoms |
| course | rrelapse is commons medication adhenernce critical - long acting injectables (haldol etc) |
| comminication | DO NOT ARGUE WITH DELUSIONS FOCUS ON REALITY VALIDATE FEELINGS NOT BELIEFS |
| SAFTEY | ASSESS FOR coommand hallucinations risk to self or others ( increas risk for sucide 'anadonic' |
| care strategies | clear, simple communication consistency promote social skills (job skills , integrate to society ) |
| SCITZO AFFECTIVE DISORDER | FORMAL dx bipolar/depressive type condtion with mood and psychotic disorder mentally sick- not physically depressive mood-bipoloar- manic |
| antipsychotics | purpose to TREAT psychosis ( hallucinations, delusions) used in : schizophrenia bipolar disorder (mania) sever agitation |
| first generation typical | example - chloropromazine (thorazine) haloperidol (haldol) ^most common BIPOLAR CHRONIC/SCHIZO TXT HALUCINATION/DELUSIONS |
| Main effect | strong dopamine blockade movenment disorder- parkisos like disorder best for positive symptoms |
| big down side | high risk of movement disordes EPS - extra paramidal symptoms |
| second gen atypical | example: risperidone - risperdal olanzapine- zyprexia quetiapine- seroquuel zlozapine- clozaril |
| 'fun fact' | chlorpromazine same faily as phenothiazine |
| benifits | treat positive and some negative symptoms lower EPS RISK |
| BIG DOWNSIDE | METABOLIC ISSUES (WT GAIN, DIABETES) |
| CLORAZILE - | TX SEVER NUERTOPNEA - LOW BLOOD CELLS - RISK OF INFECTION NUTROPHIL, BLOOD CELL CHECK 1CE WEEK SIGNS OF INFECTION = CHECK IMMIDIATLY EVEN LOW FEVER |
| MAJOR SIDE EFFECTS | HIGH YIELD |
| EXTRAPYRAMIDAL SYMPTIOMS EPS | Caused by dopamine blockade |
| types : | acute dystonia - poor tone , muscle spasm,NECK, FACE,TOUNGE (zofran side affct) akathisia- restlesness (cant sit still ) parkinsonism- tremor suffling, gait |
| treatment | benztropine (cogentin) diphenhydramine (endryl) |
| anticholergenic = | lowers secretions |
| TD- tardive dyskinesia | late often irreverable lip smacking, tounge movements |
| if you see TD | HOLD MEDICINE AND NOTIFY PROVIDER |
| NEUROLEPTIC MALIGNANT SYNDROME (NMS) | MEDICAL EMERGENCY |
| SYMPTOMS OF NMS | HIGH FEVER SEVER MUSCLE RIGIDITY CONFUSION UNSTABLE BP |
| ACTION : | STOP DRUG IMMEDIATLY ICU LEVAL CARE |
| OTHER SIDE AFFECTS (OF ANTI PSYCHOTIC) | SEDATION ORTHOSTATIC HYPOTENSION - RISE SLOWLY ANTICHOLINERGIC EFFECTS (dRY MOUTH, CONSTIPATION ) PHOTOSENSITVTY |
| MONITOR (ANTIPSYCHOTICS) | MOVMENT CHANGES- SHOULD BE BETTER / COULD BE WORSE VITAL SIGNS WT/ MEABOLIC LABS |
| EDUCATE | CHANGE POSITIONS SLOWLY AVOID ALCOHOL WEAR SUNSCREEN |
| ASSESS | MEDICATION ADHERANCE SYMPTOM MPROVMENT |
| LITHIUM (MOOD STABIIZIER ) | BI POPLAR(MANIA) / AGRESSION STABILIZES MOOD / NOT A SEDITIVE |
| THERAPUTIC LEVAL | 0.6-1.2 (0.5-1.2) |
| LITHIUM TOXICITY EARLY SIGNS >1.5 | N/V Diarrhea tremors lethargy |
| moderate 2.0+ | confusion ataxia slurred speech |
| severe >2.5 | seizires coma death |
| priority | hold lithium and notify provider immediatly |
| why toxxicty happens | dehydration low soidum kidney probelms OD LITHIUM AND SODIUM are closley linked |
| monitoring | serum levals (routine) kidney function thyroid function |
| patient teaching | maiting constant salt intake drink 2-3L fluid/day avoid dehydration (heat,illness) do not stop abruptly |
| watch for | GI symptoms tremors confusion |
| medication/ treats/ big risk | antipsychotics/ psychosis / EPS/NMS LIthium/ mania/tioxixicty |
| EPS GIVE | BENZTROPINE (COGINTIN, BENDRYL) |
| NMS = | STOP DRUG IMMEDIDIATLY |
| LITHIUM TOXIXITY | HOLD + CALL PORVIDER |
| ATYPICAL ANITPSYCHOTICS= | METOBOLIC SYNDROME RISK - DIABETES / WT GAIN |
| EPS= | Extra problems with movemnt |
| lithium= | low sodium = danger |
| NMS | no movement sever fever |
| lithium therptuitic | 0.6-1.2 |
| toxic lithium = | 1.5> |
| toxic signs | vomiting tremors confusion |
| anytispychotics | treat positive symtoms |
| major s/a | EPS tardive dyskinsia neuroleptic malignant syndrome |
| nursing priorities | monitor labs - nuetrophils watch for side efects educate on adherance avoid alcohol |
| OCD | INSIGHT PRESENT |
| SCHIZO | LOSS OF REALITY |
| IF PT HAS- HALUCINATIONS- | ASSES SAFTEY FIRST |
| LITHIUM - TOXIXICTY | HOLD AND NOTIFY PROVIDER |
| EPS | GIVE BENZTROPINE |
| SSRI's = | OCD first line |
| antipsychotics = | schitzo |
| lithium= | mania |
| red flags : NMS = | FEVER + RIGIDTY/ EMERGECY |
| red flags : TD | irreversible |
| red flags : lithium toxiicty = | GI + nero |
| OCD = | CANT STOP THINKING , MUST ACT |
| SCHITZO | LOST TOUCH WITH REALITY |
| WHEN TALKING TO SCHIZTO | DONT SAY, THATS NOT REAL SAY: I UNDERSTAND THAT FEEL REAL TO YOU BUT.... |
Created by:
mmishue