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Mental Health

Exam 2

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Schizophrenia: Potential Early Symptoms -Withdrawn from others -Depressed -Anxious -Phobias -Obsessions and Compulsions -Difficulty concentrating -Preoccupation with self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