Busy. Please wait.
or

show password
Forgot Password?

Don't have an account?  Sign up 
or

Username is available taken
show password

why


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
We do not share your email address with others. It is only used to allow you to reset your password. For details read our Privacy Policy and Terms of Service.


Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.

Remove ads
Don't know
Know
remaining cards
Save
0:01
To flip the current card, click it or press the Spacebar key.  To move the current card to one of the three colored boxes, click on the box.  You may also press the UP ARROW key to move the card to the "Know" box, the DOWN ARROW key to move the card to the "Don't know" box, or the RIGHT ARROW key to move the card to the Remaining box.  You may also click on the card displayed in any of the three boxes to bring that card back to the center.

Pass complete!

"Know" box contains:
Time elapsed:
Retries:
restart all cards




share
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

Mental Health

Exam 2

QuestionAnswer
Psychosis The inability to distinguish reality from imagination
Schizophrenia -Delusions -Hallucinations -Disorganized speech -Disorganized catatonic behavior
Common Myths about Schizophrenia -does NOT mean split personality -are NOT unusually prone to violence -NOT caused by family dysfunction
DSM-IV Diagnostic Criteria: Schizophrenia 2 or more of the following during a 1 month period: Delusions, Hallucinations, Disorganized speech, Grossly disorganized/Catatonic behavior, Negative Symptoms
Schizophrenia Subtypes -Paranoid:Delusions of persecution/grandeur -Disorganized:Regressed,silly,inappropriate behav -Catatonic:motor immobility, stupor,excessive purposeless motor activity
Schizophrenia Subtypes -Undifferentiated:indicate schizophrenia but fail to meet criteria -Residual:no active symptoms, continues neg. symptoms
Other Psychotic Disorders -Schizophreniform Disorder: hallucinates -Schizoaffective Disorder: most popular,hard time determining if depression or schizo -Delusional Disorder -Brief Psychotic:happens once or twice and never happens again -Substance induced: cocaine/alcohol
Schizophrenia Etiology -Is a combination of inherited genetic factors and nongenetic factors -Is NOT a single disease but a syndrome involving neurobiochemical and neuroanatomical abnormalities with strong genetic links
Schizophrenia: Genetics -Overall risk: 1% -One parent: 10x higher -Both parents: 50% higher -Identical twins: 50% -Fraternal twins: 10-15%
Schizophrenia: Nongenetic Risk Factors -Birth and pregnancy complications (difficult birth, lack of O2, overmedication) -Stress may precipitate in a vulnerable person
Schizophrenia: Neuroanatomical -Decreased cerebral and cranial size -Lowered numbers of cortical neurons -Decreased volume of brain-reduced brain activity in the frontal lobe.
Dopamine Hypothesis -Increase in dopamine receptors in the brain's basal ganglia -Typical antipsychotics reduced or eliminated positive symptoms by dopamine receptor blockage
Comorbidity -Substance Abuse Disorders -Nicotine Dependence -Depressive Symptoms -Anxiety Disorders -Physical Illness (DM, obesity, vision, dental, HTN) -Polydipsia (Can lead to water intoxification)
Schizophrenia: Potential Early Symptoms -Withdrawn from others -Depressed -Anxious -Phobias -Obsessions and Compulsions -Difficulty concentrating -Preoccupation with self
Symptoms of Schizophrenia -Positive: reflects an excess or distortion of normal function, add something to personality -Negative: Reflects a lessening or loss of normal function, take something away
Positive Symptoms -Delusions (religious, ideas of reference,persecution,grandeur, somatic) -Hallucinations -Looseness of association -Echolalia -Concrete thinking -Tangentiality -Neologisms -Circumstantiality -Clang assoc -Word salad
Positive Symptoms: Alterations in Behavior -Extreme motor agitation -Catatonia -Stereotyped Behavior (do what see someone else doing) -Waxy flexibility (make movement and once start they can't stop) -Automatic obedience (no matter what anyone says, do behavior)
Negative Symptoms -Poverty of speech - limited -Affective blunting -Anhedonia -Social withdraw -Apathy -Avolition - no goals -Poor grooming -Attentional Impairment -Anergia
Outcome Criteria 1) Acute phase: stabilization of symptoms 2) Stabilization phase: prevent relapse 3) Return to previous level of functioning
Communication Guidelines -Auditory hallucinations most common -Assess if suicidal/homicidal -Avoid arguing about delusions -Don't pretend to understand associative looseness1
Typical Antipsychotics -Chlorpromazine HCL, Thoridazine, Fluphenazine, Thiothixene, Haloperidol -Block dopamine -Tx of pos symptoms, not neg -Higher incidence of EPS
Side Effects of Typical Antipsychotics -Sedation -Orthostatic Hypotension -Alt. in sex -Increase appetite -Decrease tolerance to alcohol/sedatives -Seizures -Galactorrhea/Amennorhea -Gynecomastia -Jaundice, Agranulocytosis -NMS
Neuroleptic Malignant Syndrome -Hyperthermia -Muscular rigidity (stiffness) -Altered Consciousness -Autonomic dysfunction: HTN, tachycardia, diaphoresis, incontinence -Stop drug and treat symptoms
Treatment of NMS -Withdraw med -Cooling blankets, antipyretics -Dantrolene - muscle relaxer -Bromocriptine - dopamine receptor agonist -Benzodiazepines - relieve anxiety and reduce bp, tachycardia
EPS: Acute -Pseudoparakinsonism (resting tremor, mask like face, shuffle) -Acute Dystonia (intermittent/fixed abnormal, posture of eyes,face,tongue,trunk) -Akathasia (motor restlessness, pacing, rocking,shifting, subjective sense of not being able to sit still)
EPS: Late -Tardive Dyskinesia (abonrmal dyskinetic face, mouth, jaw, movements of extremities) -Tardive dystonia (sustained postures in face, eyes, tongue) -Tardive akathsia (unabative sense of subjective/objective restlessness
Anticholinergics -Benztropine, Trihexphenidyl, Diphenhydramine -Side effects: dry mouth,blurred vision, decrease lacrimation,mydrasis,photphobia, constipation, urinary hesitancy/retention
Atypical Antipsychotics -Blocks D2 receptors(low) and serotonin blockage (high) -Less incidence of EPS -Effective in treating both of the pos and neg symptoms -Risperidone,Olanzapine,Quetiapine,Siprasidone,Apriprazole,Clozapine, Paliperidone
Atypical Antipsychotics: Side Effects -Weight gain -Glucose dysregulation -DM -Hypercholesterolemia -HTN -Decreased self esteem -Sedation -Agranulocytosis (clozapine) -Cardiac arrhythmias -Caution with ALL:risk of mortality in elderly is used for dementia
Common Problems associated with SPMI -Housing -Social network and supports -Finances and benefits -Education -Employment -Transportation -Stigma/Discrimination -Nonadherence to Medication Regimen -Comorbid medical conditions -Coexisting substance abuses
Why don't clients take their medications? -Poor insight -Side effects -Substance abuse -Inadequate discharge planning/ lack of knowledge -Poor therapeutic alliance w/ treating clinician -Attitude about taking med for rest of their life
Beautiful Minds Can Be Reclaimed -Almost 1/2 of people sig. improve/recover -Mid 1950s: meds not enough, psychosocial rehab helps, requires community system after d/c -Results are lasting
Old Treatment Model -Maintenance - hopelessness - Entitlements, Staying out of hosp
New Treatment Model -Rehabilitation - Recovery - Self-sufficiency - Employment - Community reintegration
Recovery and Rehabilitation -Recovery: what clients do -Rehabilitation: what hcp do -Each of us is/has been recovering -Use this as base for empathy
Recovery -A personal process of overcoming the negative impact of a psychiatric disability despite its continued presence -Recovery from consequences of the illness can be more difficult than recovery from the illness itself
Recovery involves recovery from: -Stigma -Institutionalization -Effects of poor/wrong tx -Lack of opportunities for self-determination -Neg. side effects of unemployment -Crushed dreams -No and/or miseducation about illness
Community Resources Adult outpatient services provide: -Long term mental health tx -Response to crisis calls -Evaluation of walk-ins for possible psychiatric services -Many have dual-dx tx programs -Psychiatric nurses make home visits
Community Resources: Psychosocial rehab -Daily structure to promote socialization and vocational skills -May be consumer-driver and involve a "clubhouse" atomostphere
Community Resources: Case Manager -Coordinates services -Provides psychosocial services -Acts as advocates for clients
Community Resources: Community Outreach Programs -Team approach used to find the mentally ill where they may be -Connect these clients to services available to meet their needs -Outreach workers are advocates in all areas of client needs
Topics for Education -Information about illness -Information on meds and methods of improving adherence -Principles of management and tx -Stress management for family members -Improvement of functioning in all family members
Psychiatric Comorbidity -50% of people with SMI have substance use disorder -Suicide risk is 3 to 4 times higher in substance abusers
Common examples of dual disorders -Major depression disorder -Alcohol with panic disorder/depression -Alcoholism and polydrugism with schizophrenia -Substance abuse with personality disorder
Alcohol and CNS -Wernike's encephalopathy -Korsakoff's psychosis
Alcohol and GI -Esophagitis -Pancreatitis -Gastritis -Hepatitis -Cirrhosis of liver
Alcohol and Pregnancy -Fetal Alcohol Syndrome
Alcohol and Cardiovascular -MI -CVA
Alcohol and Infections -TB -HIV -Bacterial endocarditis -Asbecesses
Alcohol and Respiratory -Perforated septum -Sinusitis -CA
Alcohol and Long term use -TB -Accidents -Suicide -Homicide
Medical Comorbidities: Cocaine, Crack, Narcotics (Heroin), PCP -IV - infections, sclerosed veins, AIDS, hepatitis, endocarditis, cardiac arrest, coma, seizures, PE -Intranasal - sinusitis, perforated septum -Smoking - Resp. problems
What is Addiction? -Loss of control of substance consumption -Substance use despite associated problems -Tendency to relapse
Biological Theory -Alcohol abuse 3-4 times more likely if parents alcoholic -Effects on neurotransmitters (alcohol on gaba, amphetamines on dopamine)
Psychological Theory -View abuse of substances a defense against anxious impulses form of oral regression (dependency) or self medication for depression
Sociocultural Theory -Women diagnosed with less substance abuse -NO SINGLE CAUSE OF SUBSTANCE ABUSE
Substance Abuse One or more in 12 mo -Inability to fulfill major work, home, school -Hazardous situations while impaired -Recurrent legal issues -Continued use despite recurrent social and interpersonal problems
Substance Dependence 3 or more in 12 mo -Tolerance/Withdrawal -Substance taken in larger amts for longer period -Unsuccessful desire to cut down -More time obtaining,using substance -Reduction/Absence of social/work -Continued use despite physical/psychological problem
Synergistic Effect -Refers to the intensification or prolongation of the effect of two or more drugs occurring when taken together Ex: Alcohol + Benzo = extremely drowsy
Antagonistic Effect -Refers to the weakening or inhibiting the effect of one drug by using another -Heroin OD and get narcan to block receptors
Tolerance and Withdrawal -Tolerance: need for higher and higher amounts to obtain the desired effect -Withdrawal: Occurs after a long period of continued use so stopping or reducing results in physical and psychological signs and symptoms
Blackouts -Periods of amnesia during which the person appears to function normally but later does not recall the events that transpired -Frequent blackouts can be sign of alcohol dependence/addiction
CNS Depressants -Alcohol -Barbiturates -Benzo -Sedatives
CNS Depressants: Intoxification -Slurred speech -Uncoordinated -Ataxia -Drowsy -Decreased BP -Decreased inhibitions (risk) -Impaired judgment
CNS Depressants: OD -CV depression/arrest -Coma -Shock -Convulsions -Death
CNS Depressants: Treatment of OD -Induce vomiting -Charcoal -Clear airway -IV fluids -Seizure precautions -Romazicon IV
CNS Depressants: Withdrawal -N/V -Tachycardia -Diaphoresis -Anxiety -Tremors -Insomnia -Grand mal sz -Delerium
CNS Depressants: Withdrawal Tx -Tiltrated detox with similar drug -Abrupt withdrawal can lead to death -Only withdrawal that can truly be deadly
Alcohol Withdrawal -Associated with severe morbidity and mortality unlike withdrawal from other drugs -Develop w/in a few hours after cessation (2-8h) -Peak at 24-48h after stop using -Disappear rapidly after peak
Alcohol Withdrawal Symptoms -Anxiety -Anorexia -Insomnia -Hand Tremor -"Shaking Inside" -N/V -Vivid nightmares -Illusions -Sweating -I HR/BP -Psychomotor agitation -Grand mal seizures
Alcohol Withdrawal Delirium Tremens -Medical Emergency - 10% mortality -Peak 48-72h -lasts 2-3d -Altered consciousness -Changes in cognition - memory/ language impairment,disorientation -Perceptual Disturbances - hallucinations, illusions -Fever -I pulse, BP, diaphoresis -Seizur
CNS Stimulants -Cocaine -Crack -Amphetamines -Caffeine -Nicotine -Accelerate normal body function -Dependence develops rapidly -Highs followed by deep depression
CNS Stimulants: Signs of Abuse -Pupil dilation -Dryness oronasal -Excessive motor activity -Tachycardia -I BP -Twitching -Insomnia -Anorexia -Grandiosity -Impaired judgment -Paranoid thinking -Hallucinations -Hyperpyrexia -Convulsions -Death
Cocaine, Crack Intoxication -Dilated pupils -Dryness of oronasal cavity -Excessive motor activity -N/V -Insomnia -Grandiosity -Impaired judgment -Euphoria
Amphetamine Intoxication -Paranoid -Delusions (may last for months) -Psychosis -Hallucinations -Panic level anxiety -Potential for violence
CNS: Overdose -Resp. Distress -Ataxia -Fever -Convulsions -Coma -Stroke -MI -Death
CNS: Tx of Overdose -Antipsychotics -Medical management of fever, convulsions, resp. distress and CV systems
CNS: Withdrawal -Depression -Paranoia -Craving -Lethargy -Anxiety -Insomnia -N/V -Sweating -Chills
CNS: Tx of Withdrawal -Antidepressant -Dopamine agonists -Bromocriptine
Marijuana (Cannabis Sativa) -From Indian hemp plant -THC active ingredient -Depressant/Hallucinogenic -Usually smoked -Desired effects euphoria, detachment,relaxation -Long term:lethargy,anhedonia, trouble concentrating,loss of memory,D motivation -OD&w/drawal rare
Opiates -Opium -Heroin -Demerol -Morphine -Codeine -Methadone -Fentanyl
Opiates: Intoxication -Constricted pupils -D resp. -Drowsiness -D BP -Slurred speech -Psychomotor retardation -Initial euphoria followed by dysphoria -Impaired attention, judgment, memory
Opiates: OD -Possible dilation of pupils -Resp. Depression/arrest -Coma -Shock -Convulsions -Death
Opiates: OD Tx -Narc antagonist (Narcan)
Opiates: Withdrawal -Feels like bad flu -Insomnia -Irritability -Runny nose -Panic -Sweating -Cramps -N/V -Fever -Chills
Opiates: Withdrawal Tx -Methadone: synthetic opiate -Clonodine -Buprenophine: Treat symptoms
Hallucinogens:LSD, Mescaline, Psilocybin -Trip: slowing of time, lightheadedness, images in intense colors, visions in sound -BAD trip: severe anxiety, paranoia, terror, distortions in time and distance
Hallucinogens: Phencyclidine Piperidine -PCP, angel dust, horse tranquilizer, peace pill -Route significant: Oral(1h);IV, sniffing,smoking (5 min) -Symptoms:blank stare, ataxia, musc. rigidity, violence -High dose:hyperthermia,chronic jerk of extrem. HTN, renal fail -Suicidal Ideation
Long term use of Hallucinogens -Result in dulled thinking, lethargy, loss of impulse control, poor memory, and depression
Flashbacks -Transitory recurrence of perceptual disturbance caused by a person's earlier hallucinogenic drug when he or she is in a drug free state -Examples: Club drugs - ecstasy, GHB, Rohypnol, LSD -Can happen with any drug but more common w/ hallucinogen
Hallucinogens: Intoxication and OD -Dilated pupils -Tachycardia -Sweating -Palpitations -Tremors -Uncoordinated -I temp, resp, pulse -Paranoid -Anxiety -Depression/SI -Synesthesia -Depersonalization -Hallucinations -Bizarre behavior -Labile -Violent
Hallucinogens: Tx -Minimal Stimuli -Manage symptoms
Inhalants -Volatile Solvents: spray paint, glue,cigarette lighter fluid, propellant gases used in aerosols, room deodorizers, anesthetics
Inhalants: Intoxication/OD -Excitation followed by drowsiness -Disinhibition -Lightheaded -Agitation -Enhancement of sexual pleasure -Giggling, laughter -Damage to nervous system -Death
Inhalants: Tx -Support affected systems (mostly nervous system) -B12 and folate
Club Drugs -Ecstasy (adam, yabba, XTC) -3,4 methylenedioxy-methamephetamine -Ketamine
Club Drug: Effects -Euphoria -I energy -I self-confidence -I socialability -Psychedelic effects -Dehydration -Fever -Rhabdomyolysis -Acute renal failure -Hepatotoxicity -CV collapse -Depression -Panic attacks -Psychosis -Death
Date Rape Drugs -Flunitrasepam (Rohypno) or Roofies -GHB-y-Hydroxybutyric acid -Rapidly produce: disinhibition, relaxation of voluntary muscles, retrograde amnesia -Alcohol synergistic drug
Asst. Guidelines -Most important Question: When did you last drink/use? -In last year have you ever drunk or used drugs more than you meant to? -Have you felt you wanted or needed to cut down on your drinking or drug use in the last year?
Asst. Psychological Changes -Denial (Hallmark sign) -Depression -Anxiety -Dependency -Hopelessness -Low self esteem
Quick Screening Tools (CAGE) -C - cut down on drug/drinking use? -A - annoyed with criticism -G - guilty about use -E - early morning (eye opener) to get day started -Yes, sometimes or often to 2+ of these and they may have a problem
BAL -Blood Alcohol Level -Legal limit in OH = .08 -How many drinks? 1 or 2 -Lethal BAL = .5
Defense Mechanisms -Denial -Rationalization -Projection
Planning -Abstinence is the safest tx goal for addicts
Codependency -Cluster of behaviors that prevents one individual from taking care of his or her own needs due to preoccupation with another who is addicted to a substance
Enabling Behaviors -Supporting the clients physical or psychological dependence on the drug -Encouraging denial by agreeing the clt uses drugs socially -Ignoring clues to possible dependency -Demonstrating sympathy for client's reasons for abusing substances and preachi
Dual Diagnosis -Coexistence of a substance abuse disorder and a mental health disorder -Can be more difficulty accurate assessments, setting priorities, determining appropriate treatment interventions and planning patient's discharge
Relapse Cycle -Reemerging Psychiatric Symptoms -Ineffective coping strategies -Increased anxiety -Substance abuse -Adverse consequences -Attempted abstinence -Psychiatric symptoms reappear
Epidemiology -Overall chance of a substance disorder in a patient seeking psychiatric treatment is 1 in 2 -Highest occurrence: Antisocial Personality Disorder, Bipolar, Schizophrenia, Mood
Effects of drugs on mental illness -Alcohol (increase SI) -Cocaine -Amphetamines -Marijuana (heighten paranoia) -Opiates (Increase SI)
Basic Premises -Mask or cause psychiatric symptoms or may mimic:substance use,w/drawal -Substance can initiate/exacerbate psychiatric disorder -Psychiatric&subsatnce use disorders can exist independently -Psychiatric behaviors can mimic alcohol/other drug problems
4 Manifestations of Dual Diagnosis -Primary mental illness w/subsequent substance abuse -Primary substance abuse disorder w/ psychopathologic sequelae -Dual primary diagnosis (both @ same time) -Common Etiology
Barriers to Treatment -Nature of substance abuse -Counter transference - become frustrated with patients -Misunderstandings about and the stigmatization -Health Hazards
Mood -A pervasive and sustained emotion that when extreme can markedly color the way the individual perceives the world -A prolonged emotional state that affects a persons life and personality
Affect -The external manifestation of feeling or emotion which is manifested in facial expression, tone of voice, and body language -How an individual presents feelings and mood
Major Depressive Disorder Characteristics -Symptoms interfere with usual functioning -Severe emotional, cognitive, behavioral,and physical symptoms -Hx of one or more major depressive episodes -No hx of manic or hypomanic episodes -At least 60% can expect to have 2nd episode
MDD - DSM-IV-TR Criteria -Change in previous functions -Symptoms cause clinically significant distress or impair social, occupational or other important areas of functioning -5+ occur nearly every day in 2 wk period:Depressed,anhedonia,wt loss/gain,Insomnia/hypersomnia,anergia,motor activity,guilt,indecisiveness,death SI
MDD Subtypes -Psychotic (voices, delusions) -Catatonic -Melancholic -Postpartum onset (4wks after birth) -SAD -Atypical: hypersomnia,overeating -seen in young ppl
MDD Proposed Subtypes -Premenstral dysphoric disorder -Mixed anxiety-depression -Recurrent brief depression -Minor depression
Dysthymic Disorder -Chronic depressive syndrome -Present for most of the day -More days than not -At least 2 years -Hosp. rare -Early age of onset, still able to function
Depression Epidemiology -Leading cause of disability in the US -More common in Females -Prevalence unrelated to: ethnicity, edu, income, marital status -Dominates symptom in adolescents- irritability -Depression in elderly - major problem
Depression Comorbidity -Schizophrenia - go on schizo drugs and relieve symptoms but realize they'll have to be on them for the rest of their life and become depressed -Substance abuse -Eating disorders -Anxiety disorders -Personality disorders -Medical disorders - fibromya
Depression Etiology -Biological:genetic,biochemical(serotonin, NE), Alt. in hormonal regulation, Diathesis-stress model -Psychological:Beck's Triad (neg.view of self, world, future), learned helplessness
Depression Recovery Model -Focus on patient's strengths -Treatment goals mutually developed -Based on patient's personal needs and values -Optimistic attitude
Three Phases in Treatment and Recovery -The acute phase (6-12wks): psychiatric mngt and initial tx -The continuation phase (4-9mos): tx continues to prevent relapse -The maintenance phase (1+yrs):continuation of antidepressants to prevent relapse;edu=relapse prevention
Basic Level Interventions: Depression -Counseling and communication -Health teaching and health promotion -Promotion of self-care activities -Milieu therapy
Advanced Practice Interventions Psychotherapy -Cognitive Behavioral Therapy (most common) -Interpersonal Therapy -Time-Limited focused psychotherapy -Behavior Therapy (coping and social skills) Group Therapy:important in maintenance phase
Antidepressants: SSRIs -First line therapy -Indications: Depression and dysthymic disorder -Adverse Reactions: sleep disturbance, agitation, N/V -Toxic Effects: Serotonin Syndrome - tachycardia, HTN, irritability, vascular shock
New Atypical Antidepressants -SNRI: Effexor and Cymbalta -NRI - Vestra -Serotonin Receptor Antagonist/ Agonist - Nefazodone -NDRI - Wellbutrin
TCAs -Neurotransmitter: NE and Serotonin -Indications: Depressive Disorders -Adverse Effects: anticholinergic effects, orthostatic hypotension -Contraindications: MAOIs, MI, pregnancy, seizures, glaucoma
MAOIs -Neurotransmitter: block MAO, I serotonin and NE -Indications: depression, anxiety -Adverse Effects: I BP, could result in sz or stroke -Interactions: Food (tyramine) -Contraindications: stroke, sz, other drugs
Other Treatments for Depression -Electroconvulsive Therapy (ECT) -Indications -Transcranial magnetic stimulation -Vagus Nerve Stimulation -Light therapy -St. John's wort -Exercise
ECT -Use of electrically induced sz for the tx of severe depression -Indications:Elderly,non responsive to drug therapy -80% effective -Contraindications:severe cardiac disease,HTN,lesions of brain/spinal cord -Side Effects:memory loss transient,confusion
ECT Procedure -6-12txs over 3-4wks -Admin. anticholinergic -Prebreathe O2 -Anesthetic -Air way w/ventilator assist -bilaterlly,unilaterally -Musc contraction -Tonic/Clonic phase(barely noticeable) -Spontaneous breathing w/in 60-120 sec -Regain consciousnes
Complementary Therapies -St. John's Worst -Most prevalent in Germany -As effective as antidepressants in reducing sx -Not as effective in returning to functionality -CAUTION: blocks certain metabolic pathways used in rx of other disease
Depression: Promote Physical Activity -Release energy -Increase feelings of well being -Increase feelings of control and accomplishment -Walking, jogging, swimming, aerobics, weight lifting
Phototherapy -Exposure to bright artificial broad spectrum light for a prescribed period each day -Usually in the morning before sun comes up -Usually for 30 minutes -Client must face the light
Bipolar Disorder -Bipolar I Disorder: spans whole spectrum -Bipolar II Disorder: hypomania to sever depression -Cyclothymia: hypomania to mild depression
Epidemiology -Bipolar I more common in males -Bipolar II more common in females -Cyclothymia usually begins in adolescence or early adulthood
Etiology -Biological Factors: genetic, neruobiological, neuroendocrine (adrenal, pit, thyroid) -Psychological factors - drug use -Environmental factors - upper socioeconomic status, higher incidence
Self-Assessment -Manic Patient: manipulative, aggressively demanding, splitting (see things black and white)
Bipolar: Assessment -Mood:overenergetic,agitation, very high,think indestructible, anger -Behavior:hyperactive,poor attention span,indiscriminant spending,sexually indiscreet -Flight of ideas,clang associations,gradiosity -Disorganized racing thoughts
Bipolar: Outcomes Identification -Acute Phase:Stabilization, prevent injury -Continuation Phase:relapse prevention,education -Maintenance Phase: goal limit relapse occurrence and limit periods out of normal
Bipolar: Planning -Acute Phase: Medical stabilization, maintaining safety, self-care needs -Continuation Phase: maintain, medication adherence, psychoeducational teaching, referrals -Maintenance phase: prevent relapse
Bipolar: Lithium Carbonate -Levels: Therapeutic:0.8 - 1.4; Maintenance:0.4 - 1.3; Toxic: 1.5 - 2.0 -Contraindications: Kidney Disease -Relapse: w/in wks of stopping drug, need to be on it for lifetime -Watch salt, electrolytes
Bipolar: Anticonvulsant -Valproate-can use with Li -Carbamazepine - can use with Li, used for rapid cycling -Lamotrigine
Bipolar Pharmacological Interventions -Antianxiety: Clonazepam, Lorazepam -Atypical Antipsychotics: Olanzapine, Risperidone
Bipolar: Other Treatments -Electroconvulsive Therapy: can be used for mania or depression -Milieu management -Support groups -Health teaching and health promotion
Sleep Disorders -Sleep Deprivation: not getting an optimal amount of sleep every night -Leads to: chronic fatigue, memory problems, energy deficits, mood difficulties, feeling out of sorts
Consequences of Sleep Loss -Excessive sleepiness -Serious enough to: impact social, vocational functioning, increase risk for accident/injury -Comorbidity: sleep apnea - HTN, HF - fewer antibodies can't fight infection, obesity, diabetes; addiction
Sleep Requirements -Varies from individual to individual; most adults require 7-8h each night -Long sleepers: require more than 10h each night -Short sleepers: can function effectively on few than 5h per night
Normal Sleep Cycle -Complex interaction b/w CNS and environment -Non-REM sleep:composed of 4 stages, peaceful, restful -REM Sleep: reduction and absence of skeletal muscle tone,bursts of REM, myoclonic twitches of facial and limb musc, dreaming, ANS variability
Regulation of Sleep -Complex interaction b/w 2 processes: homeostatic process or sleep drive promotes sleep; Circadian process or circadian drive promotes wakefulness -Influenced by endogenous factors (neurotransmitters, hormones) or exogenous factors (light and dark)
Sleep Disorders -Dyssomnias: problems in initiating or maintaining sleep -Parasomnias: unusual or undesirable behaviors that intrude into sleep or occur at the threshold b/w waking and sleeping
Dyssomnias -Primary insomnia -Primary hypersomnia -Narcolepsy -Breathing-related sleep disorders -Circadian rhythm disorders -Dyssomnias not otherwise specified (restless leg syndrome)
Primary Insomnia -Most common sleep complaint -Difficulty with sleep initiation -Sleep maintenance -Early awakening -Non-refreshing nonrestorative sleep
Dx of Primary Insomnia -Medical and Psychiatric Hx -Sleep-wake behavior during 24h period -Impact on daytime function -Rating Scale: Pitt. sleep quality index -2 wk sleep diary -Polysomnography measures: sleep fragmentation, prolonged sleep latency, decreased sleep effici
Sleep Hygiene -Conditions and practices that promote continuous and effective sleep -Bed used only for sleep -Sleep ritual -Reduce stimuli
Pharmacological Interventions:Primary Insomnia -Benzo (promote sleep, crisis/short term therapy) -Sonata, Ambien, Lunesta (Atypical): less addcitive, longer term -Antidepressants - sedative effects -Barbiturates - short term -Antihistamines
Herbals: Pharmacological Interventions -Melatonin -Appears to be helpful in treating insomnia in older adults and insomnia r/t circadian rhythm disruption -Risks: Not FDA approved -Forms: Natural from pineal glands of animals- risk of virus; Synthetic - no risk of virus
Parasomnias -Unusual or undesirable behaviors or events -Occur during: sleep/wake transitions, certain stages of sleep; arousal from sleep
Sleep Disorders related to other mental disorders -Insomnia related to another mental disorder -Hypersomnia related to another mental disorder: major depressive disorder, anxiety disorder, schizophrenia
Other Sleep Disorders -Sleep disorders due to a general medical condition -Substance-induced sleep disorders -In both sleep disorders, sleep disturbances maybe: insomnia, hypersomnia, parasomnia, combination
Relaxation Therapies -Hyponosis -Meditation -Deep breathing -Progressive muscle relaxation
Nonpharmacological Interventions for Sleep Disorders -Stimulus control: decrease neg. associations b/w the bed and bedroom -Sleep restriction: limiting sleep creates a mild sleep deprivation -Sleep hygiene
Created by: prettyinpink7