Midterm Flashcards

Question

level 3 anxiety

Answer 1

* pathologic * autonomic CNS increase triggering * perceptual field further decreased * diaphoresis * increased urinary frequency * rigid muscle * decreased problem solving ability * distorted perception of time * decreased hearing * VS increased

Answer 2

* tired, slowed down * problems concentrating, remembering, making decisions * restless or irritable * change in eating, sleeping, other habits * thinking of death/suicide, attempting suicide

Answer 3

* dysthymia * hopelessness * depressed mood * mood elevations * expansions * sleep cycle * appetite * energy * supports * physical complaints * behavioral changes

Answer 4

* having trusting, lasting relationsihps * tend to have good self-esteem * comfortable sharing feelings with friends and partners * seek out social support

Answer 5

* loss of control of something you do * preoccupation with something you want to do * doing something depsite adverse consequences

Answer 6

* 4% prevalence * decreases over time (adolescenes into adulthood) * most prevalent disorder in children under 12 yo * equally common males:females

Answer 7

not made 18 yo age of onset by Hx or observation is usually ~ 10yo

Answer 8

Short Michigan Alcoholism Screening Test - Geriatric version

Answer 9

* therapy * talk * cognitive behavior * psychodynamic * psychoanlysis * medication

Answer 10

* assess ability to give informed consent * simplify language * offer opportunities to ask questions * test patient's understanding after explanation * reeducate as often as needed * document what was disclosed, patient's understanding, competency, voluntary agreement to treatment, actual consent

Answer 11

* clinicians free from legal responsibility if they release information with patient's written and signed request * writeen consent makes clear to both parties that consent has been given * if questions arise about onsent, documentary record of it exists * should be made part of patient's permanent chart * patient's place themselves in care of others and reveal vulnerable aspects of their personal life * in return they expect high-quality care and protection of interests * thus patient-clinician relationship is intimate: * demands trust, loyalty, privacy

Answer 12

* overly long period of feeling "high" or an overly happy or outgoing mood * extreme irritability

Answer 13

* parental and family Hx of depression * vague physical symptoms * behavior issues, misdiagnosed * school phobia, excessive clinging to parents, poor academic performance and attendance

Answer 14

Alcohol Use Disorders Tdentification Test 1. how often do you drink alcohol? 2. how many drinks on a typical day? 3. how often do you have 6+? 4. how often have you started and couldn't stop drinking? 5. how often have you failed to do what was normally expected from you b/c of drinking? 6. how often have you been unable to remember the night before? 7. how often have you needed alcohol first thing in the morning after a night of heavy drinking? 8. how often do you feel guilt/remorse after drinking? 9. how often have you/others been injured from your drinking? 10. has a relative/health professional expressed concern?

Answer 15

* misunderstanding/dispute about medical issues * not being taken seriously * dissatisfaction with Tx * pain * enforced care or Tx * disputes over hospital policy

Answer 16

* escitalopram/lexapro * citalopram/celexa * fluoxetine/prozac * paroxetine/praxil * sertraline/zoloft * luvox * fluvoxamine

Answer 17

* complete, prolonged recovery w/ minimal/no negative S/Sx * partial recovery or recurrent psychotic episodes * no significant recovery of psychosis

Answer 18

* persistent and insidious onset * parallel to bipolar disorder * at least 2 yrs

Answer 19

* criteria that may justify coerced treatment * patient judged to be dangerous to self or others * must have reasonable chance of benefiting patient * patient judged to be incompetent to evaluate necessity of treatment * even if these conditions are met, patient should be informed regarding what will be done, reasons for it, probable effects

Answer 20

* almost all states permit emergency commitment for acutely ill patients * to control immediate threat to self/others * in states w.o laws, police jail acutely ill person on disordely conduct charge (criminal charge) * emergency commitment 48-72 hrs long

Answer 21

* may have problems with intimacy * invest little emotion in social and romantic relationships * unable/unwilling to share thoughts and feelings with others

Answer 22

* patients with SUD not unmotivated * motivated to engage in harmful behaviors b.c of need for reward OR * not ready to begin helpful behaviors * effective self management techniques not use after taught or voluntarily sought out * 44% SUD patients \> 12 yo completed Tx course in 2010 * high risk of relapse despite motivation * continuum * assessment * how serious is problem? 0-10 * how much do you feel the need to stop forever? 0-10 * increase motivation? * external factors - family, prison, legal factors

Answer 23

* dissociative identity dx * dissociative amnesia * depersonalization/derealization dx

Answer 24

* many people outisde circle; nurse but consider relationships * family members not automatically entitled to clinical info about adult patient * nurses may wish to engage family in therapeutic alliance but info still belongs to patient

Answer 25

* affect - (flat blunted, incongruent) - may vary by culture * depressed mood common

Answer 26

* supportive * insight-oriented * interpersonal * cognitive-behavioral * psychodynamic * individual, gorup or family

Answer 27

* tends to be one body part * muscle dysmorphia: body builders (tends to be male)

Answer 28

* community initiatives to offer pts Tx in least restrictive setting * may include court-ordered community Tx or outpatient commitment * courts can order pts committed to a course of outpatient Tx specificed by clinicians * also called mandatory outpatient Tx * Tx resources must be effective

Answer 29

* hostile/critical environment * housing difficulties * pressure to perform * changes in life events, daily patterns * interpersonal difficulties/disruptions * social isolation * lack of social support * job pressures * stigmatization * poverty

Answer 30

* heigh, weight, BMI * waist circumference * BP, HR * education about diet and exercise * evaluation of risks * lifestyle, genetic predisposition * labwork * fasting glucose, HGB 1AC, lipid panel, prolactin level

Answer 31

nondisclosure of specific information about a person to someone else, unless authorized by that person every psychiatric professional responsible for protecting patient's right to confidentiality (including knowledge that person is hospitalized or in Tx)

Answer 32

sustained response that influences behaviors - no stimulus needed

Answer 33

* 15-20% hospitalized patients have AUD * 43% trauma patients have AUD * 31% trauma patients have withdrawal

Answer 34

* don't interfere with repetitive acts initially * don't force them to confront avoided situation/phobic object * coping mechanisms keep anxiety within tolerable limits * insight may often be intact * do not argue with patients or reason them out of coping mechanism * do not reinforce phobia, ritual * negotiate limits later

Answer 35

* memory, attention, speech, decision-making, thought content, thought process * concrete thinking, difficulty with commands * executive function alteration

Answer 36

* calm * centered/balanced * empathetic/udnerstanding * present and able to listen * verbally reassuring * firm but non-intimidating * fair * non-threatening, but not "wishy washy"

Answer 37

malpractice: failure of pressionals to provide proper and competent care warranted by members of their profession; failure that results in harm to patient all nurses held to standards of care most claims filed ner law of negligent tort: civil wrong for which injured party is entitled to compensation

Answer 38

* alcohol = GABA agonist * decreased CNS excitability * sedation * cognitive dysfxn * poor muscle coordination * GABA increases neuronal inibition via chloride channel * downregulation of GABA receptors * need more alcohol for same effect * BAC 150 w. no S/Sx of intoxication = tolerance * BAC 300 = risk of death * patients awake and fxnal at very high BAC * EXTREMELY DANGEROUS

Answer 39

* lip smacking * chewing * tongue protrusion * grimacing * blinking * choreiform movements, foot tapping

Answer 40

* scratching, skin picking * most commonly begins in adolescence * females 75%

Answer 41

* most mentally ill are not violent and are often victims of violence * possible predictors of violence * previous violent behavior * psychosis * noncompliance with meds * current substance abuse * antisocial personality disorder * lack of perceived need for Tx/Tx effectiveness

Answer 42

* substantia nigra * midbrain * hypothalamic-pituitary connection

Answer 43

* two legal theories * police power: state has authority to protect community from dangerous acts of mentally ill * parens patriae powers: state can provide care for citizens who cannot care for themselves * dangerousness used as standard for commitment

Answer 44

* wanting to die, ill oneself * looking for way to kill oneself * feeling hopeless, no reason to live * feeling trapped or in unbearable pain * being a burden to others * increasing use of alcohol/drugs * acting anxious/agitated; behaving recklessly * sleeping too little, too much * withdrawn, isolated * showing rage, talking about seeking revenge * displaying extreme mood swings * preoccupation with death * suddenly happier, calmer * loss of interest in things one cares about * visiting, calling people to say goodbye * setting affairs in order * giving things away

Answer 45

* originates in substantia nigra and terminates in caudace nucleus-putamen complex (neostratum) * function: * innervates motor and extrapyramidal systems * abnormal function: * some movement side effects of antipsychotic drugs (tardive dyskinesia, akathisia, dystonic rxns)

Answer 46

* depression * mania * anxiety * obsessive-compulsive * substance abuse

Answer 47

* limbic (CNS) * endocrine * autonomic cognitive and behavioral respones can exacerbate or mediate symptoms

Answer 48

* hospitalization for indefinite time or until patient is ready for discharge * patient has right to consul lawyer at any time and requet court hearing to determine whether additional hospitalization is necessary

Answer 49

* pathologic * panic state = all of level 3 + following: * decreased hand-eye coordination * lowered BP - higher HR * possible illogical thoughts, psychosis, hallucinations

Answer 50

* may avoid parents * does not seek much comfort or contact from parents * shows little or no preference between parent and stranger

Answer 51

* pulmonary - asthma, CV disorders * endocrine disturbances * obesity * inflammatory disorders * Tx-related or Tx-caused or both? * neurologic conditions * migraines * MS

Answer 52

* decrease environmental timuli * do not focus on content of conversation * bring down the level of arousal to a safer place * respond selectively * do not answer abusive questions * explain limits and rules in authortiative but respectful tone * give choices where possible * empathaize with feelings not behavior * do not argue * give consequences of inappropriate behavior without threats/anger * represent external controls as institutional, not personal

Answer 53

* person agrees to treatment and hospital rules * people may seek help based on personal decision or advice of family or health professional * patient acknowledges problem in living, seeks help in coping, will probably actively participate in finding solutions * patient retains all civil rights

Answer 54

* talking very fast, racing thoughts * unusually distracted * increasing activities, new projects * overly restless * sleeping little, not tired * unrealistic belief in abilities * impulsive and engaging in pleasurable, high-risk behaviors

Answer 55

1. drink any alcohol? 2. smoke marijuana? 3. anything else to get high?

Answer 56

* constitutional right * speedy release of person who claims to be detained illegally * committed patient may file writ anytime on grounds of being sane and eligible for release * court hearing takes place where those who restrain patient must defend their actions * patient discharged if judged to be sane

Answer 57

1. tremulousness: 6-36 hrs after last drink 2. hallucinations: 12-48 hrs 3. seizures: 6-48 hrs 4. delirium tremens: 3-7 days

Answer 58

amygdala communicates with: * prefrontal cortex: emotional and cognitive experience of fear * locus ceruleus: NE released; HR and BP increase * NE also tones bladder: have to pee more * endocrine HPA: HPA activation * parabrachial nucleus: increased RR

Answer 59

* most states now recognize some variation of the duty to warn * clinicians must: * assess threat of violence to another * identify person being threatened * implement some alternative, preventative acts * courts extend scope of duty to protect property and persons

Answer 60

off-topic but with logical progression can't get back to the original topic/question

Answer 61

* poor nutrition * lack of sleep * circadian rhythms * fatigue * infection * CNS drugs * lack of exercise * barriers to accessing health care

Answer 62

* may not know how to talk to patient; perhaps even fear them * may need help to face problems encoutntered in additional roles of case manager, residential supervisor, legal guardian * can be emotionally painful, draining for families

Answer 63

significant hereditary component still depends on some sort of external "trigger"

Answer 64

* serotonin * GABA * DOPAMINE * NE * glutamate * voltage-sensitive ion channels

Answer 65

* 1/4 persons meet criteria for anxiety disorder in lifetime * common comorbidities: * substance use * 91% with panic disorder have other psychiatric disorder * 2/3 persons with panic d/o first experience S/Sx with onset of MDD episode

Answer 66

* waist circumference (\>40 in men, \>35 in women) * triglycerides \> 150 mg/dl * HDL cholesterol: * BP: \> 130/85 * fasting glucose: \> 100 mg/dl 3 or more = metabolis syndrome

Answer 67

* hx of sustained drinking * history of previous DT * age greater than 30 (some say 60) * presence of concurrent illness * presence of significant alcohol withdrawal in presence of elevated alcohol level (high level of tolerance) * longer period since last drink (more likely to enter DT after longer period of time)

Answer 68

* weak 5-HT uptake block, a-block, 5-HT2 antagonist * no anticholinergic actions * risks: priapsim (sustained erection), postural hypotension * better as sleep agent PRN

Answer 69

* different from transient stress/fear * persistent (6 mo duration) * most develop in childhood and persist if not treated * can develop at any age * often result of traumatic event * are excessive * made by clinician * clients can over/underestimate danger

Answer 70

a serious mental disorder with symptoms similar to those of schizophrenia. the disorder including its prodromal, active, and residual phases, lasts longer than 1 mo but less than 6 mo. unlike schizophrenia, in which prodromal symptoms may develop over several years, schizophreniform disorder has a rather rapid period from the onset of prodromal symptoms to the point at which all criteria for schizophrenia are met

Answer 71

amygdala-centered

Answer 72

* severity of trauma/nature of event * individual's coping mechanisms * psychological defense * resources * person's ego * adapts to internal and external stresses * delay or lack of treatment

Answer 73

* determine error in reality * test strength of conviction or belief * encourage discussion about belief and details surrounding belief * calmly present alternative explanations

Answer 74

binds to place on GABA receptor in limbic system to increase GABA in the brain after time the channels get looser and looser so there is less binding - why long term BZs are not recommended and why there is a high level of addiction

Answer 75

\<2wks depressed mood or marked loss of interest or pleasure in normal activities + 4 of: * significant weight change * significant sleep pattern change * agitation or retardation * fatigue/loss of energy * guilt/worthlessness (feel like burden) * can't concentrate or make decisions (indecisiveness) * thoughts of death/suicide

Answer 76

* "schizophrenia virus" * prenatal exposure to influenza may be factor in etiology * more people with schizophrenia born in winter/early spring or urban settings * high levels of toxoplasma associated w/ increased risk

Answer 77

* pathologic response * prolonged activation of autonomic system * increased endocrine HPA reactivity * cognitive perception affected

Answer 78

* seclusion and restraints of particular concern * must be therapetucially justified with good rationale for use of these practices * document event that led to: * seclusion or restraint * alternatives attempted * patient's behavior while secluded/restrained * nursing interventions * ongoing evaluation of patient

Answer 79

* information-processing overload related to faulty brain information feedback loop * dopamine = factor in overload of processing and feedback loop * abnormal gating mechanisms * decreased gating causes inability to selectively attend to stimuli

Answer 80

* teaching focuses on prevention of relapse and symptom management through engaging patient in healthy lifestyle * patient teaching methods that involve simple, clear, concrete instructions including repetition and return demonstrations are most helpful

Answer 81

* sleep disturbances * sexual disturbances * assess sleep and sexual disturbances before medicine and not just as side effect of medicine * difficulty concentrating, making decisions * fatigue * assess before medicine * appetite changes including changes in body weight * social withdrawal/isolation * increased somatic complaints * including anxiety about illness, vague body complaints

Answer 82

* working memory * declarative memory * verbal memory

Answer 83

* mesolimbic * mesocortical * nigrostriatal * tuberinfundibular * incertohypothalamic * medullary * retinal

Answer 84

1. amygdala perceives danger 2. hypothalamus releases CRH 3. pituitary releases ACTH 4. adrenal glands release cortisol 5. cortisol shuts off alarm, "fight/flight" stops and homeostasis returns

Answer 85

* dazed mutism * fever * tachycardia * sweating * muscle rigidity * tremor * stupor * renal failure * leukocytosis

Answer 86

1. somatic conern 2. anxiety 3. emotional withdrawal 4. conceptual disorganization 5. guilt feelings 6. tension 7. mannerisms and posturing 8. grandiosity 9. depressive mood 10. hostility 11. suspiciousness 12. hallucinatory behavior 13. motor retardation 14. uncooperativeness 15. unusual thought content 16. blunted affect 17. excitement 18. disorientation

Answer 87

* benzodiazepines: affect GABA receptors * most often used * long acting with active metabolites * librium (chlordiazepoxide) * valium (diazepam) * smoother course w/ less chance of withdrawal seizures * disadvantage: risk of accumulation in elderly and liver disease * fast to intermeidate * ativan (lorazepam) * serax (oxazepam) * appropriate frequency * intermediate half-life; no metabolites

Answer 88

across two or more settings (home & school/peers) * severe recurrent temper outbursts out of proportion in intensity and to situation/provocation * temper outbursts not consistent with deelopmental level * ~ 3+ times/week * mood between outbursts persistently irritable or angry and observable by others * differentiation with bipolar * when there is a behavior change, mood is not great change from usual mood * in bipolar, irritability is departure from usual mood

Answer 89

* presence of either: * cessation after heavy use * opioid antagonist after heavy use * + \>3 of: * dyspohoric mood * N/V * muscles aches * lacrimation or rhinorrhea * pupillary dilation, piloerection, sweating * diarrhea * dehydration * yawning * fever * insomnia * clinically significant distress/impairment

Answer 90

* serotonin * GABA * glutamate * corticotropin releasing factor/HPA * NE * voltage sensitive ion channels

Answer 91

* carbamazepine * lamotrigine * oxcarbazepine * valproate

Answer 92

* normal * tension, worry * increased HR, muscle tone * narrowed perceptual field * increased motivation

Answer 93

* mood, manic exclusion * no more than 1 day mania or hypomanic symptoms * behaviors do not occur exclusively during MDD * not better explained by ASD, PTSD, separation anxiety disorder, persistent depressive d/o (dysthymia)

Answer 94

* later and abrupt onset * level of premorbid functioning * prominent affective symptoms or disorganized behavior * paucity of symptoms

Answer 95

* hunger * fatigue * lack of exercise * endocrine imbalance * medication rxn * poor oxygenation * constipation * pain * withdrawal (nicotine, ETOH, caffeine)

Answer 96

* hypomania does not reach level of acute manic symptoms * depressive episodes still significant * 0.3-4.8% lifetime prevalence

Answer 97

* recovering from unconsciousness * TBIs * dementia * delirium/confusion * alcohol/drug intoxication/withdrawal * mental illness/handicap, psychiatric Hx

Answer 98

* reluctant to become close to others * worry that their partner does not love them * becomes very distraught when a relationship ends

Answer 99

* dopamine antagonist * improve positive symptoms (mesolimbic) * EPS and tardive dyskinesia

Answer 100

feeling like you need a boost (tobacco, caffeine, etc.) - negative symptom of schizophrenia

Answer 101

women and pediatric settings

Answer 102

* "insanity" defense based on humanitarian rationale that people should not be blamed for crimes if they did not know what they were doing or could not help themselves * movement from "not guilty by reason of insanity" (NGBI) to "guilty but mentally ill" (GBMI) * some states abolished insanity defense

Answer 103

* no interest in other interventions, recommendations * no interest in rehab * Rx from multiple sources * preference for specific meds

Answer 104

* N/V * tremors * sweats * anxiety * agitation * tactile dysfunction * auditory disturbance * visual disturbance * headaches * orientation

Answer 105

* personality * staff unhappiness/frustration * spillover from outside lives * poor communication * lack of cohesion * inability to deal with aggression * fear of physical injury

Answer 106

* exposure to actual or threatened death/injury, sexual violence * intrusion symptoms * spontaneous, cued memories * dreams * dissociative reactions * alterations in arousal and reactivity associated with traumatic event * distress or impairment in relationships * duration of more than 1 mo

Answer 107

* most common psychotic disorder * often results in chronic illness * nobody believes they have a medical illness * increased risk of suicide * biochemical factors * increase dopamine, NE * reward alterations * 5HT excess * GABA (inhibitory) and glutamate (excitatory) dysregulation * MRI, CT changes * large ventricles; atrophy of brain tissue

Answer 108

* median age of onset 7-11 yo * can be precipitated by traumatic event * can be connected to panic/anxiety occuring with media coverage of fearful situation

Answer 109

* develop therapeutic relationship * assess/provide safety * encourage grief of losses, expression of feelings * encourage expansion of positive coping skills * encourage adherence to treatment regimen * assess severity and readiness for change * listen, nonjudgmental, open * safety * education * promote help-seeking * treatment * medication * exercise * nutrition * sleep * comfort * relaxation * supportive relationships

Answer 110

* mobilize team resources/other staff * call security * remove patients, visitors, students, untrained staff from area * be aware of exit routes and potential weapons * important staff roles during psychiatric codes * know your role!

Answer 111

* white males 65+ yo: 3-4X * veterans/military: 2-4X * alaskan natives/american indians: 2-4X * serious mental illness: 6-12X * LBGTQ: 2-3X

Answer 112

* GGT * most specific to alcohol use (liver enzymes) * elevated in 80% of alcohol dependent patients) * MCV: mean corpuscular volume * elevated in 60% of dependent patients) * AST: * liver enzymes (also w/ certain meds) * elevated in 40% * ALT: * liver enzymes (also w certain meds) * elevated in 20%

Answer 113

circumscribed symptoms of non-bizarre delusions, but without hallucinations, thought disorder, mood disorder, or significant flattening of affect

Answer 114

* place delusion in time frame and identify triggers * assess intensity, frequency, duration * identify emotional components * observe for evidence of concrete thinking * observe speech for symptoms of thought disorder * observe for ability to accurately use cause-and-effect reasoning * distinguish between description of experience and facts of situation * question facts as presented and their meaning * discuss consequences of delusion when person is ready * promote distraction to stop focusing on delusion

Answer 115

* annual prevalence = 7% * similar prevalence in children and adults but rates decrease with age * females 2x greater in population (help seeking) * median age of onset = 13 yo * 75% between 8 and 15 yo * follows stressful/humiliating experience

Answer 116

* provides patients access to thei medical records * more control over personal health information is used and disclosed * first national, comprehensive privacy protection act * scope extensive * applies to almost any institution or individual in health care

Answer 117

can be traumautic or supportive for patient, depending on insititution, attitue of family/friends, staff response, type of admission types of admission: * voluntary * involuntary

Answer 118

* also called emotion- or ego-focused coping mechanisms * protect person from feelings of inadequacy and worthlessness and prevent awareness of anxiety * can be used to such extreme that they distort reality, interfere with relationships, and limit ability to work productively

Answer 119

* voluntary patients have the right to refuse any treatment and should not be forcibly medicated except in situations when patient is actively violent to self or others and all less restrictive means have been unsuccessful * patient's behavior should be clearly documented and all interventions recorded

Answer 120

* normal * mild muscle tone increase * increased perceptual field * helps to motivate us

Answer 121

* 2 million adolescents attempt suicid annually * 700,000 ER visits * 1,100 suicides/yr among college students * 50% colelge students report suicidal ideation at some time in life * of 1.1 mil adults who attempted suicide, 67.2% received medical attention and 51.1% stayed overnight or longer in hospital as a result of suicide attempt

Answer 122

* patient voluntarily admitted can leave when ready * patients can be discharged by staff when max benefit received * voluntary patients may request discharge * most states require written notice of desire to leave * patients may ahve to sign form if leaving against medical advice (AMA)

Answer 123

* respect and dignity * situational alliance * working with the escalated individual so they understand they are not alone in this crisis and that you are there to help * objectivity * don't allow personal agendas/values to impede ability to provide care * honesty * humor * only if you have the skill

Answer 124

no connection between one thought and another break in logic

Answer 125

patient who had been using mu opiod agonist is administered opioid antagonist also possible for partial agonist to precipiate withdrawal * affinity * intrinsic activity * dissociation

Answer 126

* new diagnosis for children * irritability/reactivity out of range of what trigger would induce * created b/c of overdiagnosis of bipolar disorder in children

Answer 127

* 0-8 = mild withdrawal * 9-15 = moderate withdrawal * \> 15 = severe withdrawal * not validated in ICU patients * altered by pain, meds, etc.

Answer 128

* bipolar mania * need antidepressant in combo * aripiprazole, asenapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone

Answer 129

* from above * thoughts of helplessness * lack of control

Answer 130

dysregulation of serotonin neurotransmission may play role in etiology of anxiety because patients experiencing these disorders may ahve hypersensitive 5HT receptors SSRIs are best "long" term Tx for anxiety disorders: no risk of addiction, less risk of OD

Answer 131

* informed, competent, voluntary * explain tx and possible complications, risks * goal: help pt make better decisions * pt must be able to consent and not be a minor and judged legally incompetent

Answer 132

* family doctor * psychiatrist * pschiatric nurse practitioner * psychotherapist can't prescribe meds * most common source of lack of response in major depression is administration of inadequate doses, or use of psychotherapy alone

Answer 133

* dangerous to self or others * mentally ill and in need of tx * unable to provide for own basic needs

Answer 134

* first line treatment * fluoxetine/prozac, fluvoxamine/luvox, sertraline/zoloft, citalopram/celexa, escitalopram/lexapro, paroxetine/paxil * gradual benefit, takes time * relatively safe and better patient acceptability * less risk for OD fatality * absence of psychomotor and cognitive impairment * preferred in prophylaxis of recurrent depression * fatigue, sexual side effects, "poop-out" syndrome (lose efficacy)

Answer 135

* document should be given to patients on admission and read/explained to them * evolution of patients' rights uneven across United States * they have the right to: * communicate with people outside hospital * keep clothing/personal effects * religious freedom * be employed, if possible * manage/dispose of property * execute wills * enter contractual relationships * make purchases * education * habeas corpus * independent psychiatric exam * civil service status * retain licenes, priviliges, permits * sue or be sued * marry/divorce * not be subject to unnecessary mechanical restraints * periodic review of status * legal representation * privacy * informed consent * Tx * refuse Tx * Tx in least restrictive setting

Answer 136

* methadone: full agonist - acts like opiate to block receptor * buprenorphine: partial agonist, antagonist - dose response with ceiling effect; occupation without full actiation * naloxone: full antagonist - used for acute intoxication opioid receptors: Mu, Delta, Kappa

Answer 137

* inntervates frontal lobes * function: * insight, judgment, social consciousness, inhibition, highest level of cognitive activities * abnormal function: * negative symptoms * affective flattening/blunting, poverty of speech, blocking, poor grooming, lack of motivation, anhedonia, social withdrawal, cognitive defects, attention deficits

Answer 138

not talking - neg. symptom of schizophrenia

Answer 139

* substance abuse dx * substance intoxication * substance withdrawal * substance induced mental dx

Answer 140

* avolition, aggression (only 10%) * perescutory delusions and command hallucinations are #1 risk factors for violence * deterioration in appearance * EPS, abnormal eye movements (medicine), unpredictable outbursts, paranoia

Answer 141

* highly prevalent * 1/5 pts seeing primary care practitioner has significant symptoms of depression * providers fail to diagnose MDD up to 50% of the time * or undertreat it with low doses

Answer 142

characterized by muscular rigidity and mental stupor, posturing, mutism, sometimes alternating with great excitement and confusion

Answer 143

to assess positive, negative, and affective symptoms of individuals with psychotic disorders (especially schizophrenia)

Answer 144

determined by a special tribunal of hearing officers

Answer 145

* diagnosis * Tx: need informed consent * consequences: * risks/benefits of proposed Tx * alternatives * prognosis * w/ Tx * w/ alternative Tx * w/o Tx

Answer 146

* standard of behavior or belief valued by an individual or group * describes what ought to be, rahter than what is; goal to which individual aspires * standards are learned through socialization, growth, experience * ethical standards not legally enforceable unless incorporated into law

Answer 147

* involuntarily committed pt lost right to leave hospital when desired * short-term/emergency commitments specify max length of detainment * long-term commitments do not have max length, but patient's status should be reviewed often * if committed patient leaves before discharge, staff has legal obligation to notify police and committing courts

Answer 148

understanding how brain processes information from senses and resulting behavioral responses * cognition * perception * emotion * behavior and movement * socialization * internal preoccupation - ok to ask/assess

Answer 149

1. little interest in doing things 2. down, depressed, hopeless 3. trouble falling asleep, staying asleep, sleeping too much 4. feeling tired, little energy 5. poor appetite or overeating 6. feeling bad about self 7. trouble concentrating 8. moving/speaking slowly or being ridgety/restless 9. thoughts of self-harm/suicide

Answer 150

* strong risk factor for other anxiety disorders and affective disorders during childhood and into adulthood * under-researched * broad models exist but not focused ones * parental cognitions have impact on risk of SAD in children * parents of anxious children had significant dysfxnal beliefs related to self, child, environment * shows need for parental involvement in Tx

Answer 151

* a difficult p;roblem with no apparent satisfactory solution * a choice between equally unsatisfactory alternatives * when moral claims conflict

Answer 152

* reactive attachment dx * disinhibited social engagement dx * PTSD * acute stress dx * adjustment dx

Answer 153

* identify critical times in schedule * identify individuals more likely to be a challenge * establish a proactive plan

Answer 154

luanzethine-fluoxetine combo (anti-mania and antidepressant combined)

Answer 155

a type of schizophrenia characterized by systematized delusions or frequent auditory hallucinations and the projection of personal conflicts, which are ascribed to the supposed hostility of others. it can progress to aggressive acts believed to be performed in self-defense or as a mission

Answer 156

corticostriatal thalamic cortical loop

Answer 157

perception-like experiences without stimulus

Answer 158

emotinal response and stress-coping patterns

Answer 159

* innerates limbic system * function: * memory, smell, automatic visceral effects, emotional behavior * abnormal function: * positive symptoms * hallucinations, delusions, disorganized speech, bizarre behavior

Answer 160

* lithium (gold standard) * same as bipolar Tx * also psychotherapy and psychoeducation * with families too

Answer 161

* structured recovery-oriented programs and "first episode psychosis" programs provide improvement in function, coping skills * promoting healthy lifestyle, encourage physical activity * help patients stop smoking; healthy diet

Answer 162

* persistent depressive disorder * insidious onset and peristent course * patient may say "I'm always depressed" * less intense than MDD but parallel * at least 2 yrs, but usually more

Answer 163

* shorter life span * high-risk lifestyle * sedentary * smoking * dietary habits * obesity, resulting in * diabetes * HTN * coronary artery disease * atypical antipsychotics may increase risk of certain medical conditions

Answer 164

* 1% * rates similar across cultures * equal prevalence between genders * men: 10-25 yo * women: 25-35 yo

Answer 165

* noise/chaos * cramped space, no privacy * long wait times, boredom * other patients * visitors * inability to smoke

Answer 166

* hallucinations * delusions * misinterpretation of what is reality

Answer 167

* silliness * agitation * difficulty in goal-directed behavior * stereotyped movements * blinking, staring * mutism, echoing of speech * catanonia, negativism * excessive motor activity

Answer 168

decision made by a judge or jury in formal hearing

Answer 169

* SNRI * faster b/c of NE * no cholinergic, adrenergic and histaminic interference * raised BP at higher doses

Answer 170

when someone has suffered a loss or event about 6 mo prior that has caused a mood/depressive issue and they are still adjusting to that problem typically of shorter span and following event or loss that is specific and has triggered mood component

Answer 171

* medication induced? * substance induces? * steroids * if confined to mood episodes, consider: * bipolar with psychosis * major depression with psychosis

Answer 172

inferred from speech

Answer 173

* prevalence 1.2-2% * 30% of individuals have lifetime tic disorder * more common in males with OCD in childhood * ask about family hx of tourettes, anxiety * evaluate level of insight * most have good insight * poor insight = worse long-term prognosis

Answer 174

* not able to take meds as prescribed * frequent requests for early med renewal * nursing: early request for PRN * reports frequent lost, stole, destroyed Rx * cannot produce meds when asked * abusing non-prescribed drugs or ETOH * withdrawal signs or symptoms in clinic

Answer 175

* distraction * fighting back * isolation * attempts to feel better * help seeking

Answer 176

* tricylic antidepresants - last in line * anticholinergic - dry mouth, bad taste, constipation, urinary retention * dysphoric state, mania, fatigue * cardiovascular * postural hypotension * arrhythmia * QT changes * risk for fatality with overdose * weight gain * seizure in children * sedation, mental confusion/delirium - elderly and youth * sweating, fine tremor

Answer 177

* negligence in preventing suicide or while assisting ECT * patient falls * failing to fllow physician orderes or established protocols * medication errors * improper use of equipment * inadequate discharge planning * failure to provide sufficient monitoring or failure to communicate

Answer 178

* increased cortisol * weakening of HPA * lack of ability to inhibit response and resume homeostasis * increased risk for diabetes

Answer 179

* ~yr w/o treatment * changes icnrease by 50% for another episode after current episode * high relapse/recurrence rates * many go on to experience chronic depression * inadequate Tx

Answer 180

ask person directly if he/she is: * having suicidal thoughts/ideas * has a plan to do so * has access to lethal means

Answer 181

mental condition that causes both a loss of contact with reality (psychosis) and mood problems

Answer 182

motor center, affecting movement and coordination

Answer 183

lack of energy week out if it's a motivation anergia r/t depression or comorbid sleep problem

Answer 184

* increase BP, HR * increase risk for MI, CVA

Answer 185

* distress with separation * worry about danger to self, significant other * fear at night * impairs functioning * 4 wk duration

Answer 186

patient who had been using mu opioid agonist stops OR decreases typical dose * heroin * onset 6-12 h * peak 36-72 hr * duration 5 days * oxy * similar to heroin * methadone * onset = 24-72 h

Answer 187

* hair picking * 2% population * 10:1 female:male * pubertal onset most common * rule out tic side effect of meds * pull and eat = trichobezoars (dangerous) * pharmacotherapy * opioid antagonists * n-acetyl cysteine = glutamate agent * SRIs * antispychotics

Answer 188

* antagonize both dopamine and serotonin * modulation of serotonin helps reduce adverse motor side effects * fewer cognitive, affective, motor side effects than typical * improve positive symptoms (mesolimbic) * improve negative symptoms (mesocorticol) * result in metabolic syndrome

Answer 189

* stable conditions can regress when: * changes in sleep * acute stress * loss * trauma * altered self care * adherence to medicine * isolation * sensory deprivation or overload

Answer 190

* median age of onset = 30 yo * females:males 2:1 * nervousness, anxious all thier lives, anxious temperament * wax and wanes, same across ages * difference is content of worries * rates of full remissions = very low * difficult to treat

Answer 191

staff and patient safety equally important

Answer 192

* leading cause of disability in U.S. ages 15-44 * affect ~12% * median age of onset = 40 * highest risk is under 20 yo and over 70 yo * also for suicidality * more prevalent in women than men (2:1) * women may seek Tx more often and could skew ratio

Answer 193

1. gather background information 2. identify ethical components 3. clarify responsibilities of ethical agents 4. explore options 5. apply nursing principles 6. form a resolution 1. social expectations 2. action 3. legal requirements

Answer 194

circles back around to original topic eventually

Answer 195

* separation anxiety disorder * selective mutism * specific phobia * social anxiety disorder * panic disorder * agoraphobia * generalized anxiety disorder

Answer 196

* plaintiff must prove * legal duty of care existed * nurses performed duty negligently * damages suffered by plaintiff * damages were substantial * nurses should have malpractice insurance

Answer 197

* acute reduction/abstinence from alcohol * \<5% of withdrawal; mortality 2-10% * hallucinations, usually tactile * disorientation * tachy * HTN * fever * agitation * diaphoresis * can persist up to 7 days

Answer 198

* primarily for diagnosis and short-term therapy; emergency situation not required * for specified time that varies state-to-state * petition can be filed for long-term commitment of patient is not ready for discharge at end of period

Answer 199

* OCD * body dysmorphic dx * hoarding dx * trichotillomania * excoriation dx

Answer 200

* interplay among patient's rights, legal role of nurse, concern for quality care * three roles: * provider of services * employee/contractor of services * private citizen

Answer 201

* estrogen impacts monoamines, GABA (inhibitory - calming effect), and glutamate (excitatory - fight/flight) * also impacts serotonergic fxns (mood, anxiety, appetite, sex drive) * significant during puberty onset, menstrual cycles, postpartum period, during menopause

Answer 202

* 8.5% in adults * 12.4% men * 4.9% women * criteria * physical - tolerance, dependence * psychological - craving * alchol withdrawal syndrome * S/Sx occur w.in hrs to a week after cessation

Answer 203

* 15-40 yo and 70-85 yo * during first 2-3 days of admission * physical assaults usually by patient * relatives more likely to assault ambulance personnel

Answer 204

* cessation or alcohol use that was heavy and prolonged * THEN: two + developing within hrs to weeks after (A) * autonomic hyperactivity (sweating, tachy) * increased hand tremor * insomnia * N/V * transient visual, tactile, auditory hallucinations/illusions * psychomotor agitation * anxiety * generalized tonic-clonic seizures * S/sx above cause clinically significant distress/impairment in social, occupational, or other important areas or functioning * S/Sx not attributable to another medical condition, mental dx, including intoxication or withdrawal from another substance

Answer 205

* difficulty communicating * loss of drive, interests * stigma

Answer 206

* may be wary of strangers * become greatly distressed when parent leaves * do not appear to be comforted by return of parent

Answer 207

* inhibitory neurotransmitter * controls activity/firing rates of neurons responsible for producing anxiety * makes postsynaptic receptor more sensitive * enhances neurotranmission and inhibits cell activity

Answer 208

patient did not request hospitalization and may have opposed it

Answer 209

* increase awareness, facilitate communicaiton, assess for command hallucinations * maintain eye contact, speak simply * call patient by name, use touch (w/ permission) * isolation not recommended * do not reinforce hallucinations, identify triggers/risks

Answer 210

1. loss of energy 2. unmotivated 3. daytime drowsiness 4. sleeping too much 5. muscles tense 6. muscles tremble 7. restless 8. need to move around 9. trouble going to/staying asleep 10. blurry vision 11. dry mouth 12. drooling 13. memory/concentration 14. constipation 15. weight changes 16. change in sexual fxn 17. menstrual/breast problems

Answer 211

emotional response to threat (perceived or real) that is short term

Answer 212

12 mo duration w/o 3 mo period w.o symptoms

Answer 213

* chronic drinking over a period of years * males 5:1 * middle-aged or older * previous hx of AWS seizures or DTs * CIWA-ar \> 8-10 * comorbid alcoholic liver dx, trauma, infections, sepsis * detectable blood alcohol on admission * use of eye opener * abnormal LFTs

Answer 214

* antabuse/disulfram * inhibits ETOH metabolism * increased acetaldehyde * sweating, N, flushing, tachy if ETOH is consumed * most stop taking prior to ETOH; can be life threatening if taken with ETOH * Naltrexone/ReVia: * blocks opioid receptors * reduces craving and reward * contraindicated with opiate use

Answer 215

false belief based on incorrect inference about external reality that is firmly held despite proof or evidence of the contrary

Answer 216

* most psychiatric records are separate; more sensitive than medical records * if patients request access: * expore reasons for request * prepare patient for review * be present to discuss questions * do not release material from other sources * do not alter/destroy record * physical record is facility/therapist's property * information belongs to patient * only copy given to patient * record can be brought into cord and contents used in lawsuit

Answer 217

* 80% likelihood of comorbid mental dx * substance abuse common * co-occurence of TBI and PTSD of US deployed in recent wars = 48% * highly associated with suicide risk * associated with mutism in children * comorbid bereavement S/Sx common

Answer 218

* more common than in general population (25-50%) * underrecognized and underdiagnosed * ageism * high suicide risk in older white males who are isolated/live alone

Answer 219

* manic or mixed episodes * acute mania + depressive episodes * depressed and not sleeping * mania and depression are intense * 0-2.4% lifetime prevalence

Answer 220

* monitor adherence * 4-6 wks for response * monitor for response vs. remission * vegetative symptoms tend to improve first, cognitive symptoms take longer * SSRIs = first line Tx for MDD * address biopsychosocial needs and maintain meds 6-12 mo

Answer 221

* asociality * avolition * anhedonia * blunted affect * alogia

Answer 222

* mood instability - depression vs. mania * depressive episodes very severe in bipolar patients * difficult diagnosis to differentiate * 31% patients misdiagnosed with unipolar depression * 35% waited 10+ yrs for accurate diagnosis * need thorough history * median age of onset = 30 yrs

Answer 223

* acute dystonic reactions: * sudden muscle spasms in neck, back, eyes that may be painful or frightening * akathisisa: * pacing, inner restlessness, leg aches relieved by movement * Parkinson syndrome: * cogwheel rigidity, fine tremor, akinesia

Answer 224

* CBT * exposure therapy * 50% report response * 12-16 sessions * medications can be helpful prior to therapy to decrease anxious symtpoms

Answer 225

* serotonin subtypes: decreased COMT reduced catecholemines = more anxiety * increased NMDA/receptors impact NE and glutamate * decreased GABA, increased glutamate * overprotective parent(s) * trauma * attachment problems

Answer 226

* becoming anxious, avoiding the person * reinforcing delusion * attempting to prove the person is wrong * setting unrealistic goals * becoming incorporated into delusional system * failing to clarify confusion surrounding delusion * being inconsistent in intervention * seeing delusion first and person second

Answer 227

1/10 women have anxiety during pregnancy which increases cortisol and increases risk of anxiety in the fetus (later in life)

Answer 228

* behavioral therapy such as cognitive behavioral therapy * interventions involving coping, family participation in maintenance phase * teaching for potential relapse * symptom management * patient engagement in decision making

Answer 229

* chronic heavy use * type * volume * frequency * drinking pattern * time of last drink * Hx of detox or withdrawal * social, financial, legal problems * Hx of alcohol-related seizures * family hx

Answer 230

hypothalamus pituitary adrenal axis responsible for endocrinologic changes when fear/stress occurs by releasing glucocorticoids and CRF

Answer 231

* in emergency, act in patient's best interests * court-ordered evaluations or reports * commitment proceedings * criminal proceedings * acting to protect third parties * child custody disputes * reports required by state law * child abuse proceedings

Answer 232

* fever, malaise * ulcerative sore throat * leukopenia * 1-2% of patients taking clozapine

Answer 233

* public reprimands * sarcasm * favoritism * inconsistency * dishonesty * threats * disrespect

Answer 234

Suicide Behaviors Questionnaire-Revised 1. lifetime suicide ideation and/or attempts 2. frequency of suicidal ideation over past 12 mo 3. threat of suicide attempt 4. self-reported likelihood of suicidal behavior in future

Answer 235

* delusions * hallucinations * disorganized thinking * grossly disorganized or abnormal motor behavior (including catatonia) * negative symptoms

Answer 236

* typical and atypical antipsychotic drugs * improve psychotic symptoms in acute phase of illness * reduce risk of future relapse * psychosocial treatments * life skills training * supported employment * cognitive behavioral psychotherapy * behavior modification * social learning/token economy programs * assertive community treatment

Answer 237

* overly long period of feeling sad, hopeless * loss of interest in activities once enjoyed, including sex

Answer 238

* sadness * tearfulness * low self-esteem * obsessive self-critical thoughts * inability to experience pleasure * loss of ambition * loss of interest * inability to focus on tasks (ADHD in children) * irritability * anger * pessimism * guilt * helplessness * loss of hope * feelings of despair, including thoughts of suicide * anxiety (90%)

Answer 239

* NDRI - inhibitor of DA and NE * non-sedative but excitant property * used in depression and cessation of smoking * seizure may be precipitated

Answer 240

C: cut down A: annoyed (you or others) G: guilty E: eye-opener

Answer 241

emotion and memory

Answer 242

* able to separate from parent * seek comfort from parents when frightened * return of parents met with positive emotions * prefers parents to strangers

Answer 243

* \>1 million suicide deaths annually * 90% with diagnosed mood disorder * highest rates in white men over 85 * 4x as many men than women die by suicide * but women attempt it 2-3X more often than men

Answer 244

C: car? R: relax? A: alone? F: forget things? F: family/friends say to cut down? T: trouble?

Answer 245

* medical * surgical * ICU

Answer 246

* NaSSA (noradrenergic and specific serotonergic antidepressant) * enhancement of NE release and specific 5-HT1 receptor action * lower doses = higher sedation * weight gain b/c it antihistaminic * avoids G1 5-HT - good for intractable nausea or anorexia * fewer sexual side effects

Answer 247

1. basically satisifed with life? 2. dropped activities/interests? 3. life is empty? 4. bored? 5. good spirits? 6. afraid something bad will happen to you? 7. happy most of the time? 8. helpless? 9. prefer to stay at home? 10. more problems with memory than most? 11. wonderful to be alive? 12. worthless? 13. full of energy? 14. situation is hopeless? 15. most people better off?

Answer 248

* delusions * hallucinations * disorganization * catatonia

Answer 249

a rare condition in which an otherwise healthy person (secondary case) shares the delusions of a person with a spychotic disorder (primary case), such as schizophrenia, who has well-established delusions

Answer 250

* clomipramine * SRI (blood levels) * if induced can have arrythmia * fluoexitine (prozac) * fluvoxamine * paroxetine * sertraline

Answer 251

* originates in hypothalamus and projects to pituitary * function: * endocrine, hunger, thirst, metabolism, temp control, digestion, sexual arousal, circadian rhythms * abnormal function: * implicated in endocrine abnormalities in schizophrenia and some side effects of antipsychotic drugs (hyperprolactinemia)

Midterm Flashcards

(276 cards)