ch15 pysc
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| anergia | lack of energy
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| euthymic mood | average affect & activity
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| define mood dix | aka:affective dix. pervasive alterations in emotions that are manifested by depression, mania, or both
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| what is the most common psyc Dx associated with suicide? | Mood Dix. depression is the most important risk factor for it
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| what is the primary mood dix? | Bipolar Dix; formerly known as manic-depressive illness
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| how long does a major depressive episode last? | at least 2 weeks, during which pt is depressed & has no pleasure in all activities.
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| for a Dx of depression, four of the following charectaristics must be present: | changes in appetite or weight, sleep, or psychomotor activity; dec energy, worthlessness/guilt, diff thinking/concentrating, suicudal thinking
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| Biploar Dix | when a persons mood cycles b/t extremes of mania & depression
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| define mania | distinct period where mood is abnormally & persistantly elevated, expansive, or irritable (usually 1wk)
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| 3 s/s accompanying mania | inflated self-esteem or grandiosity, dec need for sleep, pressured speech, flight of ideas, distractability, dec priorities, ^risky behavior
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| pressured speech | unrelenting, rapid, often loud talking without pauses
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| flight of ideas | racing, often unconnected, thoughts
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| hypomania | same as mania BUT they do not impair the persons ability to function & there is no psychotic features
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| mixed Bipolar episode | both mania & depresison nearly everyday for 1 week
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| Bipolar I dix | 1 or+ manic or mixed episodes usually accompanied by major depressive episodes
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| Bipolar II dix | 1 or+ major depressive episodes accompanied by at least 1 hypomanic episode
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| dysrythmic dix | 2yrs of depressed mood for more days than not w/other less severe s/s that dont meet crit for major dep episode
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| cyclothymic dix | 2yrs of numerous periods of both hypomanic s/s that dont meet crit for Bipolar
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| substance-induced mood dix | prominant & persistant mood changes that is a direct physiologic result of ETOH, other drugs, or toxins
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| Mood dix due to general medical condition | disturbance in mood that is a direct result of medical condition ie:degenerative neurologic conditions, cerebrovascular disease, metabolic or endocrine conditions etc
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| Seasonal Affective Dix | Fall or Spring: ppl experience ^sleep, appetite, carb craving, weight^, interpersonal conflict, heaviness in extremeties (FALL). insomnia, weight dec, poor appetite(SPRING)
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| Postpartum psychosis | psychotic episode onset 3wks after delivery. fatigue, sadness, lability, poor memory/confusion progressing to delusions/hallucinations. Medical emergency!
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| genetic theories | implicates that transmission of depression in 1st degree relatives are at twice the risk for developing depression. genetics alone arent only facotr
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| neurotransmitters responsible for dpresison | dec serotonin & norepinephrine
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| neuroT implicated in mania | ^ norepinephrine
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| children w/depression | often appear cranky, school phobia, hyperactivity, learning dix, failing grades, antisocial
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| adolescence w/dep | may abuse drugs, join gangs, engage in risky behaviors, underacheivers, drop out of school
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| somatic ailments that accompany dep | physiologic s/s: headache, backache, heart problems, "nerves"
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| stats of dep | ^in younger women than men but ^in older men than older women
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| untreated episode of dep | lasts 6-24months before remitting. high recurrance rate
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| is ECT safe for pregnant women? | yes. it is intended for pts who dont respond to antidepressants. Unilateral dec memory loss, bilateral results more quickly, but w/more memory loss
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| psychotherapy | interpersonal theory: relationships ie:greif reactions, role diputes, role transitions
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| cognitive therapy | focuses on how person thinks abt self, others & future & interprets experince.
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| cognitive distortion:absolute, dichotomous thinking | tendency to view everything in polar categories ie:all or none, black/white
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| cognitive distortion: arbitrary inference | drawing specific conclusion w/out sufficinet eveidence ie:jumping to negative conclusion
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| cog distortion: specific abstraction | focusing on single, small detail while ignoring the big pitcure
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| cog distortion: overgeneralization | forming conclusions based on too little or too narrow experience ie:if 1 experince was bad, all will be bad
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| magnification & minimalization | over or undervaluing significance of particular event ie:1 small negative event is world ending while 1 big positive event is nothing
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| personalization | tendancy to self-reference external events w/out basis ie:thinking everything is abt you, even if its not
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| psychomotor retardation | slow verbal comm. often 1 or 2 word answers very slowly
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| latency of response | pt takes 30seconds to respond. may answer IDK b/c there too fatigued or overwhelmed to think of an answer.
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| psychomotor agitation | ^ body m ovement & thoughts ie:pacing, accelerated thinking, argumentativeness
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| anhedonia | losing any sense of pleasure from activites they formerly enjoyed
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| apathy | not caring abt self, activities, or much of anything
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| depressed affect | sad, flat. sit alone staring into space or lost in though. minimal interaction w/few words spoken to others
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| thought process dep | appears to be in slow motion. are negative & pessamistic in thinking. self-deprecating remarks. they ruminate
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| ruminate | to repeatedly go over the same thoughts (beating themselves up)
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| sensorium in dep | some are usually oriented X3, but some may have trouble with Orientation if they are psychotic or withdrawn. memory impairment common
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| roles/relationships dep | often withdraw form familiy & social relationships. family gets frustrated often
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| depression rating scales | used to create Dx picture: self-rating: Zung slef rating Dep Scale, Beck Dep Inventory.
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| Hamilton Rating Scale for Dep | clinician rates pts behavior ie:dep mood, guilt, suicide, insomnia. also diunal variations, depersonalization, paranoid s/s, obsession
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| Dep Intervention | SAFETY!!! suicide precautions (removal of harmful items, ^supervision)
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| therapeutic comm rn-pt | can use silence as a tool if pt is not interacting. Validate feelings yet still promote participation.
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| assess ability to perform ADLs | global task, if not met, build competency by concrete instructions, if not met, assist pt.
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| reestablish balanced nutrition: | offer foods frequently & in small amts. sit quietly during meals to promote eating.
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| promote sleep | monitor amt of hours slept as well as whether they feel refreshed on awakening
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| communication | active listening, let pt share burden to provide relief, validate feelings. Do NOT attempt to "fix" problems, they belittle pt
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| education/family teaching | depression is an illness, not a lack of willpower or motivation. encourage both meds+therapy, support groups benefit
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| Biploar Dix: s/s of mania | pts are euphoric, grandiose, energetic, & sleepless, poor judgements/rapid thoughts, actions, speech.
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| onset/clinical course of Biploar dix | onset often early 20s (usually amoung highly educated ppl), but could be in 50s
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| psychopharm bipolar dix | lifetime regimen of antimanic(lithium) or anticinvulsant mood stabilizers. only dix where meds can prevent acute cycles of bipolar behavior
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| lithium | salt that competes for salt receptor sites but affects Ca, K & Mg ions as wello as glucose metabolism. stops destruction of Dop, norepi
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| lithium levels 1.5-2 s/s | N/V, diarrhea, dec coordination, drowsy, slurred speech, muscle weakness. withold next dose; call dr, serum lith level
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| lith level 2-3 s/s | ataxia, blurred vision, tinnitus, giddiness, confusion, muscle fasiculation, hyperreflexia, myoclonic twitches, incontinance. withold future doses, call dr stat serum level. gastric lavage IV saline/elec
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| lith level 3.0 & ^ | cardiac arrhythmia, hypotension, peripheral vascular collapse, seizures, dec LOC, coma. all previous interventions + lith ion excretion augmented w/aminophylline, mannitol, or urea. Dialysis
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| bipolar dix general appearance/motor behavior | may wear clothes that reflect ^mood ie: bright clothes, provocadive, flamboyant. heavy makup, shirtless guys. **pressured speech** loud speech invading personal space
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| mood/affect bipolar | often irritable or aggressive when ppl set limits to behavior. emotionally labile
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| thought process/content bipolar | flight of ideas, circumstaniality, tangentiality thinking. starts many projects at once but doesnt finish them. does not consider risks or resouces. they start projects as they occur in thought process
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| ex: bipolar thought process | shopping sprees, using credit card when broke, promiscuous unprotected sex, gambling, impulsive trips, illegl endevours, speeding. may think there God
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| sensorium bipolar | may be oriented to person/place but RARELY to time.
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| judgement/insight bipolar | easily angered when they percieve censorship form others. may say there "fine". often blame difficulties on others. rarely think beofre speaking or acting
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| self-concept bipolar | exaggerated slf-esteem may cover defensive chronic low self-esteem
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| roles/relationships bipolar | too distracted & hyper to pay attention to their kidsor ADLs. unaware of overpowering & confrontational interactions. need for social interaction leads to promiscuity, often invade ppls personal space labile emotions
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| physiologic/self-care bipolar | goes days without sleep or food & dont even realize it, even to the point of physical exhaustion. ignores personal hygiene
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| Intervention bipolar | SAFETY. then self-esteem & socialization. Provide a safe environment, assess for suicidal ideation. establish external controls empathetically & nonjudgey
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| meeting physiologic needs | dec environmental stimuli to assist relaxation ie: dark room or tepid bath. nutrition: give finger foods ^cal/protien(shakes, bars, sandwiches)
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| comm. bipolar | use short-clear sentances, break info into small segments & ask them to repeat it, printed info related to rules/expectations, rights, staff names, education. put comm responsibility on nurse not pt. explain relationships b/t topics
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| promoting appropriate behaviors | distract pt to rearrange chairs or walk. do not respond judgey to lack of clothing or inappropriate behavior. dec "competition" for RNs attention
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| is lithium metabolized? | No! its reabsorbed by proximal tubule & excreted in urine. Narrow therapeutic index
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| suicide (involves ambivolence) | higher rates for men b/c methods are more effective. women tend to take pills, men shoot themselves. separeted or divorced white women & young men are at risk
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| active suicidal ideation | thinking abt killing oneself & explores ways to do so
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| passive suicidal ideation | thinking abt it, but not developing a plan for it
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| risk factors for suicide | relative that has commited. family may feel it gives "permission" for them to do the same
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| direct vs indirect ideation suicide | the nurse NEVER ignores any suicidal ideation no matter how trivial it may seem. Direct:i want to die" indirect"i give up"
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| ***lethality assessment*** | does pt have a plan?*are means avalible to carry it out?*if they carry it out? is it lethal?*has pt made precautions for death?*where/when do they plan it?*is it intended on a specail date or anniversary?
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| Intervention for suicide | be authoritative role:keep pt safe,suicide precautions, increased supervision.
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| lethality for supervision | is lethality id low, pt should be oberved every 10 minutes, if its high, 1:1
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