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mental health 2
exam 2 study guide
| Question | Answer |
|---|---|
| CHIME-D | connectedness, hope, identity, meaning (in life), empowerment, difficulties |
| personal recovery | developed by those who have experienced mental health challenges themselves,;uses a holistic POV unique to the individual and person-centered; uses psychological, environmental and social interventions; meds not necessarily excluded; presence of strengths |
| clinical recovery | developed by mental health professionals; uses a predominant biomedical viewpoint; heavy reliance on psychopharmacology; focuses on absence of symptoms |
| stereotypes | cognitive; example "all schizophrenics are dangerous" |
| prejudice | affective; example "i'm afraid of schizophrenics" |
| discrimination | behavioral; example "i'm not renting my apartment to the schizophrenic" |
| signs and symptoms of anxiety disorders | |
| mild anxiety | heightened perception, increased alertness, able to learn and solve problems |
| moderate anxiety | narrowed perception, selective inattention, difficulty concentrating, but can be redirected |
| severe anxiety | greatly reduced perception, focus on one detail, learning and problem-solving not possible, physical symptoms (e.g. headache, nausea) |
| panic anxiety | unable to focus, may lose touch with reality, disorganized behavior, possible hallucinations or delusions |
| plan of care for a client w/ anxious behavior | assess level of anxiety and triggers; provide a calm environment and reassurance; use clear, simple communication; encourage use of relaxation techniques (deep breathing, guided imagery); monitor for safety (esp severe or panic levels) |
| plan of care for a client w/ anxious behavior (part 2) | involve the client in care planning as able; teach coping strategies and provide support for ongoing management |
| anti-anxiety medications (benzodiazepines) | diazepam (Valium), chlordiazepoxide (Librium), clonazepam, lorazepam (Ativan), temazepam (Restoril), triazolam (Halcion), flurazepam (Dalmane) |
| anti-anxiety medications (non-benzodiazepines) | buspirone (BuSpar), other meds but less effective like propranolol, clonidine (Catapres), and hydroxyzine (Vistaril) |
| side effects of benzodiazepines | most commonly reported sfx are related to central nervous system depression; drowsiness, sedation, poor coordination, and impaired memory or clouded sensorium; when used for sleep, some clients may experience next-day sedation or a "hangover" effect |
| side effects of benzodiazepines (part 2) | clients can develop a tolerance to sfx, which may decrease in intensity over time; older adults may have more pronounced sfx like increased risk of falls, worsened memory deficits, problems with urinary incontinence (esp at night) |
| side effects of benzodiazepines (part 3) | not common, but benzos are associated with physical and psychological dependence; significant discontinuation symptoms can occur if the drug is stopped abruptly, and these symptoms can resemble the OG problems that led to taking the meds, like anxiety |
| antidote to benzodiazepine overdose | flumazenil; flumazenil reverses the sedative effects of benzos, such as when a person experiences excessive sedation following procedural or diagnostic sedation, or in cases of suspected benzodiazepine overdose |
| flumazenil indication | indicated for complete or partial reversal of benzo effects when rapid awakening is necessary, or when significant respiratorry depression or CNS depression is present due to benzo use |
| flumazenil contraindication | contraindicated for cases of mixed drug overdose, especially when there is a high risk of seizures, or if the benzo was given for a potentially life-threatening condition such as status epilepticus |
| benzodiazepine nursing considerations/pt teaching | anxiolytic agents are prescribed to relieve symptoms such as anxiety or insomnia, but do not treat the underlying causes of anxiety; benzos have a high potential for physical and physiological dependence |
| benzodiazepine nursing considerations/pt teaching (part 2) | usage can be short term (ideally no longer than 4-6 wks) to prevent dependence; benzo withdrawal can be fatal, so never discontinue abruptly and taper under supervision; warn patients about decreased response time, slower reflexes and possible sedative fx |
| what should you avoid consuming while on benzos? | alcohol because benzos strongly potentiate the effects of alcohol (1 drink can have the effect of 3); other CNS depressants like barbituates, opioids, and certain antidepressants b/c they may increase the risk of respiratory depression and sedation |
| what are older clients at risk for with benzos? | falls and more severe side effects such as incontinence and memory deficits due to the CNS depressant effects |
| adverse effects of benzodiazepines | CNS depression, aka drowsiness, sedation, poor coordination, and impaired memory or clouded sensorium |
| adverse effects of buspirone | dizziness, sedation, nausea, headache |
| what should doctors you're taking if you're taking benzodiazepines | assess the level of anxiety (mild, moderate, severe, panic); evaluate symptoms, impact on functioning, coping mechanisms, and triggers; use standardized tools (e.g. Hamilton Anxiety Rating Scale) |
| psychotherapy options for anxiety | cognitive-behavioral therapy (CBT); exposure therapy; acceptance and commitment therapy; mindfulness-based interventions |
| pharmacologic interventions for anxiety | anxiolytics (e.g. benzodiazepines, buspirone); antidepressants (SSRIs, SNRIs) |
| nonpharmacologic interventions for anxiety | relaxation techniques like deep breathing, progressive muscle relaxation, guided imagery; physical activity; stress management via time management, problem-solving skills |
| signs and symptoms of obsessions in OCD | recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause marked anxiety or distress; person recognizes these thoughts as excessive or unreasonable but feels unable to control or ignore them |
| when do obsessions happen? | they tend to arise unexpectedly during daily activities and are often describes as not being in line with what the individual wants to think about; attempts to suppress or neutralize these thoughts usually make them more intense |
| common themes of obsessions | fears of contamination, aggressive thoughts about harming self or others, doubts (e.g. wondering if a door is locked), a need for symmetry or exactness, unwanted taboo thoughts involving sex, religion, or harm |
| symptoms of compulsions | ritualistic or repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession or according to rigid rules, (e.g. repeated handwashing, checking locks or appliances, counting, ordering objects, praying, repeating) |
| why do compulsions happen | to prevent or reduce the anxiety caused by obsessions or to prevent a feared event, but these behaviors are not connected in a realistic way to the feared outcome or are clearly excessive |
| compulsions are... | often time-consuming (>1hr/day), may cause distress and interfere with daily functioning; individuals know they are unreasonable but feel compelled to perform them to relieve anxiety |
| first-line medications for OCD | SSRI antidepressants such as fluvoxamine (Luvox) and sertraline (Zoloft) |
| second-line of treatment for OCD | SNRI antidepressants such as venlafaxine (effexor) |
| third-line of treatment for OCD | treatment-resistant cases may respond to second-generation antipsychotics like risperidone (Risperdal) or aripiprazole (Abilify) |
| what is exposure and response prevention therapy (ERP)? | exposure and response prevention therapy, which is when clients intentionally faces feared situations or triggers, while response prevention focuses on not allowing the associated compulsive ritual |
| what is the primary behavioral therapy for OCD? | ERP, or exposure and response prevention therapy |
| what is the most effective therapy combination for OCD? | ERP and CBT |
| specialized interventions for treatment-resistant OCD | neurosurgical procedures targeting brain circuits, deep brain stimulation, trans-cranial magnetic stimulation |
| key psychosocial treatments for schizophrenia | individual and group therapy; social skills training; cognitive adaption training; cognitive enhancement therapy (CET); family education and therapy |
| individual and group therapy for schizophrenia | therapies that offer support, social contact, and opportunities for meaningful relationships; groups often focus on medication management, use of community supports, and education about schizophrenia, social skills, and coping skills |
| social skills training for schizophrenia | helps clients improve social competence by breaking down complex social behaviors into simple steps, practicing via role-playing, and applying these skills in real-world settings |
| cognitive adaption training for schizophrenia | tailored environmental supports such as signs, calendars, hygiene supplies, and pill containers that cue clients to perform every day tasks; more effective in the client's own environment |
| cognitive enhancement therapy (CET) for schizophrenia | combines computer-based cognitive training with group sessions to practice social skills; targets deficits in attention, memory, and information processing and helps clients develop mental stamina and social problem-solving abilities |
| family education and therapy for schizophrenia | involving families in education and therapy helps reduce stress, diminishes negative effects of the illness, and lowers relapse rates; ongoing family involvement is associated with better client outcomes |
| first-generation (typical) antipsychotics | haloperidol (Haldol), chlorpromazine (Thorazine), fluphenazine (Prolixin); "HALO wears FLuorescent CHLORine" |
| most important side effect of first-generation (typical) antipsychotics | extrapyramidal symptoms (EPS) like dystonia, parkinsonism, akathisia |
| common side effects of first-generation (typical) antipsychotics | tardive dyskinesia, anticholinergic effects (dry mouth, constipation, blurred vision), sedation, orthostatic hypotension, weight gain |
| most important adverse effect of first-generation (typical) antipsychotics | Neuroleptic Malignant Syndrome (NMS), which is fever, muscle rigidity, altered mental status |
| adverse effects of first-generation (typical) antipsychotics | tardive dyskinesia (potentially irreversible) and seizures |
| nursing interventions/considerations for typical antipsychotics | monitor for EPS and TD, administer anticholinergic medications as needed, educate about orthostatic hypotension, monitor for NMS, encourage hydration and fiber intake |
| patient teaching for typical antipsychotics | report muscle stiffness, spasms, or abnormal movements; rise slowly from sitting/lying; use sugar-free candy for dry mouth; avoid alcohol |
| second-generation (atypical) antipsychotics | risperidone (Risperdal), quetiapine (Seroquel), olanzapine (Zyprexa), clozapine (Clozaril), aripiprazole (Abilify); mnemonic Rich Queens Only Clean Apartments |
| most important side effect of second-generation (atypical) antipsychotics | metabolic syndrome (hyperglycemia and dyslipidemia) |
| common side effects of second-generation (atypical) antipsychotics | weight gain, sedation, anticholinergic effects, increased prolactin (with some agents) |
| most important adverse effect of second-generation (atypical) antipsychotics | agranulocytosis (ESPECIALLY with clozapine), which is a life-threatening blood disorder characterized by a severe lack of infection-fighting WBCs |
| adverse effects of second-generation (atypical) antipsychotics | NMS, seizures, increased risk of diabetes and cardiovascular disease |
| nursing interventions/considerations for atypical antipsychotics | monitor weight, glucose, and lipid levels; monitor WBC count with clozapine; educate about infection risk; encourage healthy lifestyle |
| patient teaching of atypical antipsychotics | importance of regular blood tests (ESP with clozapine); report signs of infection; monitor for weight gain; adhere to emdiaction even if feeling better |
| clozapine is.... | great for treatment-resistant schizophrenia, but must be monitored for agranulocytosis (regular blood monitoring) |
| major depressive disorder is characterized by | at least 2 weeks of a sad mood or markedly diminished interest or pleasure in life activities (anhedonia) + at least 4 other symptoms of depression |
| symptoms of major depressive disorder (part 1) | changes in weight (gain/loss); sleep disturbances (insomnia/hypersomnia); fatigue; difficulty concentrating/making decisions; low self-esteem; feelings of hopelessness/worthlessness; inability to cope w/ daily life; thoughts of death/suicide |
| symptoms of major depressive disorder (part 2) | psychomotor retardation (slow movement, speech cognitive processing); psychomotor agitation (restlessness, wringing hands, pacing); withdrawing from social interactions; flat/sad affect; negative thinking; ruminating over failures |
| severe symptoms of major depressive disorder | delusions, hallucinations, or psychotic features |
| first priority nursing intervention for MDD | assessing the risk for suicide |
| electroconvulsive therapy for MDD | used for clients unresponsive to medication, those who cannot tolerate side effects, or when a rapid response is needed (e.g. severe suicidality, psychosis, compromised health); maintenance ECT can prevent relapse |
| transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS) | both FDA-approved alternatives for treatment-resistant depression |
| SSRIs | fluoxetine, fluvoxamine, citalopram, escitalopram, sertraline, paroxetine |
| common side effects of SSRIs | nausea/diarrhea, insomnia/drowsiness, sexual dysfunction, headache, weight changes, increased sweating |
| nursing interventions/considerations for SSRIs | monitor for increased suicidal ideation, especially in the first few weeks of therapy or in younger pts; administer in the morning to minimize insomnia; monitor for GI upset + take w/ food; assess for sexual side fx; signs of serotonin syndrome; taper |
| signs of serotonin syndrome | (hot, agitated, shaking, diarrhea); rapid heart rate, high BP |
| adverse effects of SSRIs | serotonin syndrome, increased risk of suicidal thoughts (esp in children/adolescents), severe allergic reactions |
| patient teaching for SSRIs | SSRIs may take 2-4 weeks to show full effect; take medication as prescribed and taper; avoid alcohol and consult before taking other medications |
| SNRIs | venlafaxine, desvenlaxfaxine, milnacripran, levomilnacipran, duloxetine |
| common side effects of SNRIs | nausea, vomiting, diarrhea, insomnia or sedation, dizziness, headache, increased sweating, weight gain or loss, sexual dysfunction (less common than w/ SSRIs), increased BP (esp. w/ venlafaxine), dry mouth |
| what should you monitor when on venlafaxine? | blood pressure regularly |
| what should you not take with an SSRI or SNRI? | St. John's Wort |
| adverse effects of SNRIs | increased risk of suicidality in children, adolescents, and young adults; serotonin syndrome; hypertensive crisis |
| tricyclics | amitriptyline, nortriptyline, protriptyline, imipramine, clomipramine, desipramine, trimipramine, doxepin |
| common side effects of tricyclics | anticholinergic effects ("can't see, can't pee, can't spit, can't poop"); sedation; orthostatic hypotension; weight gain; increased appetite; tachycardia |
| nursing interventions/considerations for tricyclics | monitor for orthostatic hypotension; DO NOT prescribe alongside MAOIs; monitor cardiac status; assess for anticholinergic effects (severe in older adults as delirium, ileus) |
| 3 C's for tricyclic overdose | cardiotoxicity, convulsions, coma |
| patient teaching for tricyclics | warn about delayed onset; take medication at bedtime; avoid alcohol; educate about risk for overdose |
| MAOIs | phenelzine, isocarboxazid, tranylcypromine, selegiline (also available as a transdermal patch) |
| common side effects of MAOIs | daytime sedation, insomnia, weight gain, dry mouth, orthostatic hypotension, sexual dysfunction |
| nursing interventions/considerations for MAOIs | tyramine-free diet is MANDATORY; monitor BP for HTN and orthostatic HTN; avoid OTC medications; watch for s/s of HTN crisis; limit prescription quantities for clients at risk for OD |
| adverse effects of MAOIs | hypertensive crisis when taken w/ tyramine foods or drinks; serotonin syndrome; lethal overdose |
| signs and symptoms of a hypertensive crisis from MAOI | occipital headache, HTN, nausea, vomiting, chills, sweating, restlessness, nuchal rigidity, dilated pupils, fever, motor agitation; can progress to hyperprexia, cerebral hemorrhage, and death |
| patient teaching for MAOIs | strictly avoid tyramine-rich foods (foods at a fancy wine and cheese party); do not take any rx or OTC medications not approved by provider; stop for at least 2 weeks before starting any other antidepressant to prevent serotonin syndrome |
| patient teaching for MAOIs (part 2) | delayed response for 2-4 weeks; follow prescribed washout periods between MAOIs; seek immediate help for severe headache, palpitations, stiff neck, or others |
| electroconvulsive therapy (ECT) for depression | for actively suicidal: clients who do not respond to antidepressants or experience intolerable side fx at therapeutic medication doses (esp. older adults); for adolescents for whom antidepressants are unsafe or ineffective; for pregnant people; |
| what is bipolar disorder | episodes of mania/hypomania and depression with rapid mood shifts |
| manic episode symptoms | elevated, expansive, or irritable mood lasting at least 1 wek; increased energy/activity; grandiosity; racing thoughts; more talkative or pressured speech; increased goal-directed activity; possible psychotic features |
| hypomaniac episode symptoms | similar to mania but less severe, lasting at least 4 days; no marked impairment in functioning; no psychotic features |
| depressive episode symptoms | depressed most of the day, nearly every day; loss of interest or pleasure in activities; significant weight/appetite changes; insomnia or hypersomnia; fatigue; difficulty concentrating; suicidal thoughts/attempts |
| types of medications for MDD | SSRI, SNRI, Tricyclics, and MAOIs |
| types of medications for BPD | mood stabilizers, anticonvulsants, second-generation antipsychotics, and benzodiazepines |
| what is the first-line treatment for BPD? | lithium (0.5-1.5 mEq/L) |
| psychotherapy in BPD | effective for mild depressive/normal portions, but not useful during acute mania due to short attention span and agitation; combination treatment = reduced suicide risk and supports medication adherence |
| lithium side effects | mild nausea; diarrhea; anorexia; fine hand tremor; polydipsia; polyuria; metallic taste; fatigue or lethargy; weight gain; acne |
| what helps with lithium side effects | food for nausea; propranolol for tremor |
| adverse effects of lithium (lithium toxicity) | severe diarrhea; vomiting; drowsiness; muscle weakness; lack of coordination |
| what can happen if lithium toxicity is not treated? | renal failure, coma, and death |
| can lithium toxicity appear at therapeutic doses? | yes, especially in older adults or those with impaired renal function |
| toxic lithium levels | above 1.5 mEq/L |
| what lithium levels may require dialysis? | above 3 mEq/L |
| signs and symptoms of approaching lithium toxicity | persistent thirst and dilated urine |
| nursing interventions/considerations for lithium | monitor serum lithium levels regularly (initially ever 2-3 days, then weekly, and monthly) to stay between 0.5-1.0 mEq/L for maintenance, up to 1.5 mEq/L for acute mania; adequate fluid and salt intake; baseline and ongoing renal function assessments |
| anticonvulsants used for BPD | valproic acid, carbamazepine, topiramate, and lamotrigine |
| side effects for valproic acid | drowsiness, sedation, dry mouth, blurred vision, weight gain, alopecia, hand tremor |
| side effects for cabamazepine | drowsiness, sedation, dry mouth, blurred vision, rash, orthostatic hypotension |
| side effects for topiramate | dizziness, sedation, weight loss, increased incidence of renal calculi |
| side effects for lamotrigine | serious rashes (including SJS), rarely life-threatening toxic epidermal necrolysis |
| adverse effects for valproic acid | risk of lethal hepatic failure; teratogenic effects (e.g. spina bifida); life-threatening pancreatitis; liver fx tests and serum levels are required |
| adverse effects for carbamazepine | risk of aplastic anemia and agranulocytosis; monitor hematologic status regularly |
| adverse effects for lamotrigine | rashes |
| adverse effects of anticonvulsants for BPD in general | drowsiness, sedation, risk for falls, drug interactions |
| nursing interventions/considerations for lithium/anticonvulsants | monitor serum drug levels for lithium, valproic acid, and carbamazepine (12 hr after last dose); teach about serious rashes with lamotrigine and signs of infection/bleeding with carbamazepine; monitor liver and renal function, and blood cell counts |
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