1
Q
What are mood disorders (also known as affective disorders)?
A
Pervasive alterations in emotions, typically manifested by depression, mania, or both, that interfere with a person’s ability to live life, causing long-term sadness, agitation, or elation. They are also the most common psychiatric diagnosis associated with suicide.
2
Q
What is the most important risk factor associated with suicide among psychiatric diagnoses?
A
Depression
3
Q
What are the two primary categories of Mood Disorders?
A
Major Depressive Disorder (MDD) and Bipolar Disorder.
4
Q
What are the main biological theories contributing to mood disorders?
Genetic Theories
Neurochemical Theories
A
Genetic Theories: Involve multiple genes influencing brain function, stress response, and neurotransmission. First-degree relatives of those with depression have twice the risk, and for bipolar disorder, a tenfold risk.
Neurochemical Theories: Involve neurotransmitters like serotonin and norepinephrine (and possibly acetylcholine and dopamine). Norepinephrine is low in depression and high in mania. Depression is associated with deficits in serotonin and norepinephrine, while mania is linked to increased norepinephrine and possible dysregulation of dopamine and acetylcholine.
5
Q
What are the main biological theories contributing to mood disorders?
Neuroendocrine Influences
Kindling Theory
A
Neuroendocrine Influences: Hormonal fluctuations (e.g., in thyroid, adrenal, parathyroid, pituitary glands), high cortisol levels (especially in older adults with depression), and postpartum hormonal changes can lead to mood disturbances.
Kindling Theory: Repeated exposure to stress or stimuli can sensitize brain pathways, eventually triggering mood episodes spontaneously. Anticonvulsants are used to reduce these effects.
6
Q
What scales are used for assessing MDD?
A
Hamilton Rating Scale for Depression, Beck Depression Inventory, or Zung Self-Rating Scale.
7
Q
What are the 24 categories of the Hamilton Rating Scale for Depression?
A
- Depressed mood (sadness, hopeless, helpless, worthless)
- Feelings of guilt
- Suicide
- Insomnia early
- Insomnia middle
- Insomnia late
- Work and activities
- Retardation (slowness of thought and speech; impaired ability to concentrate; decreased motor activity)
- Agitation
- Anxiety psychic
- Anxiety somatic
- Somatic symptoms gastrointestinal
- Somatic symptoms general
- Genital symptoms
- Hypochondriasis
- Loss of weight
- Insight
- Diurnal variation
- Depersonalization and derealization
- Paranoid symptoms
- Obsessional and compulsive symptoms
- Helplessness
- Hopelessness
- Worthlessness
8
Q
How long do MDD episodes typically last?
A
Episodes last at least 2 weeks. Untreated episodes can last weeks, months, or years, with most clearing in about 6 months. Approximately 50-60% suffer recurrence, and about 20% develop chronic depression.
9
Q
What are the key characteristics of Bipolar Disorder?
A
Extreme mood fluctuations ranging from mania to depression (or hypomania to depression)
2nd only to major depression as cause of worldwide disability
10
Q
What type of people is bipolar disorder most common in?
A
Most common in highly educated people
Occurs almost equally among men and women
11
Q
What is the acronym D.I.G.F.A.S.T. for? What does it stand for?
A
Primary symptoms of a manic attack
Distractibility
Indiscretion or impulsivity
Grandiosity or inflated self-esteem
Flight of ideas or racing thoughts
Activity increase (weight lost)
Sleep decrease or need
Talkativeness or pressured speech
12
Q
What is Hypomania?
A
A period of abnormally and persistently elevated, expansive, or irritable mood with milder symptoms of mania. Hypomanic episodes do not impair the person’s ability to function and do not involve delusions or hallucinations.
13
Q
How is a manic episode diagnosed?
A
Diagnosis requires at least 1 week of unusually and incessantly heightened, grandiose, or agitated mood, in addition to three or more of the following symptoms:
- Exaggerated self-esteem
- Sleeplessness
- Pressured speech
- Flight of ideas
- Reduced ability to filter extraneous stimuli
- Distractibility
- Increased activities with increased energy
- Multiple grandiose, high-risk activities involving, poor judgment and severe consequences, such as spending sprees, sex with strangers, and impulsive investments
14
Q
What is the difference in mania and hypomania?
A
Hypomanic episodes do not impair the person’s ability to function, they may function quite well.
-No delusions or hallucinations
15
Q
What is mixed episode/rapid cycling?
A
Person experiences both mania and depression nearly every day for at least a week
16
Q
What is elevated in 40% of depressed patients?
A
Glucocorticoid activity
17
Q
What is the difference between Bipolar I and Bipolar II disorders?
A
Bipolar I Disorder: Involves one or more manic or mixed episodes, usually accompanied by major depressive episodes (more mania episodes than depressive).
Bipolar II Disorder: Involves one or more major depressive episodes accompanied by at least one hypomanic episode (more depressive episodes than mania).
18
Q
What is the primary pharmacological treatment for mania associated with bipolar disorder?
A
Lithium. Anticonvulsant agents are also used as mood stabilizers.
19
Q
What are the major categories of antidepressants?
A
Selective Serotonin Reuptake Inhibitors (SSRIs).
Atypical Antidepressants.
Tricyclic Antidepressants (TCAs).
Monoamine Oxidase Inhibitors (MAOIs).
20
Q
How are antidepressants chosen?
A
Client symptoms and age
Physical Health Needs
Drugs that have worked in past or that worked for blood relatives
Other meds client taking
21
Q
How do SSRIs work, and what are their advantages?
A
SSRIs block the reuptake of serotonin, leading to improved mood, concentration, and interest in life within 7 to 10 days. They have fewer sedating, anticholinergic, and cardiovascular side effects, making them safer for older adults.
22
Q
What are some examples of SSRIs?
A
Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Citalopram (Celexa)
Escitalopram (Lexapro)
23
Q
What are some examples of atypical antidepressants?
A
Venlafaxine (Effexor) (SNRI)
Duloxetine (Cymbalta) (SNRI)
Bupropion (Wellbutrin) (NDRI)
Nefazodone (Serzone) (serotonin 5/HT2A receptor antagonist and SNRI)
Mirtazapine (Remeron) (tetracyclic, dual action: NaSSA)
Inhibit reuptake of NE, serotonin and dopamine (weakly)
24
Q
What are some examples of TCAs?
A
Amitriptyline (Elavil)
Imipramine (Tofranil)
Desipramine (Norpramin)
Nortriptyline (Pamelor)
Doxepin (Sinequan)
25
How do TCAs work, and what are their contraindications and side effects?
TCAs are older antidepressants that block the reuptake of norepinephrine and serotonin or increase the sensitivity of postsynaptic receptor sites. They take about 6 weeks to reach full effect.
Contraindications: Severe impairment of liver function, acute recovery phase after myocardial infarction (MI), and cannot be given with MAOIs. Caution is advised with glaucoma, BPH, urinary retention, DM, hyperthyroidism, CVD, renal impairment, or respiratory disorders due to anticholinergic side effects.
Side Effects: They can be toxic in overdose, leading to confusion, agitation, hallucinations, hyperpyrexia, increased reflexes, seizures, coma, and cardiovascular toxicity.
26
What are some examples of MAOIs?
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
27
How do MAOIs work, and what kind of side effects do they cause?
Increase receptor sensitivity to NE and serotonin. Prevent degradation NE and serotonin. 2–4-week lag time before reach therapeutic level.
Cause CNS, cardiovascular and anticholinergic SE
28
What is the most serious side effect of MAOIs, and what causes it?
The most serious side effect is hypertensive crisis, which occurs when a client taking MAOIs ingests tyramine-containing foods or fluids.
29
What are the symptoms of a hypertensive crisis caused by MAOI-tyramine interaction?
Occipital headache, hypertension, nausea/vomiting, chills, sweating, restlessness, nuchal rigidity, dilated pupils, fever, and motor agitation. It can lead to hyperpyrexia, cerebral hemorrhage, and death.
30
When taking MAOIs, you should avoid foods high in tyramine. What are some examples of foods to avoid?
Foods to limit?
Foods to avoid:
Fermented foods (sauerkraut, soy sauce, ect.)
Fermented cheeses
Cured meats
Pickled foods
Very Ripe Fruit: overripe bananas & avocados. As well as overripe fava beans
Aged, Fermented, Cured, Smoked, or Pickled Meats/Fish
Canned Figs
Beer & Wine
Foods to limit:
Avocado
Bananas
Licorice
Chocolate
A large amount of caffeinated drinks
31
What is Serotonin Syndrome and when does it occur?
Serotonin syndrome is potentially life-threatening, it occurs when there is an inadequate washout period between taking MAOIs and SSRIs, or when MAOIs are combined with meperidine.
32
What are the symptoms of Serotonin Syndrome?
Changes in mental state (confusion, agitation), neuromuscular excitement (muscle rigidity, weakness, sluggish pupils, tremors, jerks, collapse, muscle paralysis), and autonomic abnormalities (hyperthermia, tachycardia, tachypnea, hypersalivation, diaphoresis).
33
How does cognitive behavioral therapy work?
Changes thought to change behavior
34
What is absolute, dichotomous thinking?
Tendency to view everything in polar categories (i.e., all or none, black or white)
35
What is arbitrary inference?
Drawing a specific conclusion without sufficient evidence (i.e. jumping to [negative] conclusions)
36
What is specific abstraction?
Focusing on a single (often minor) detail while ignoring other, more significant aspects of the experience (i.e., discounting positive aspects)
37
What is overgeneralization?
Forming conclusion based on too little or too narrow experience (i.e., if one experience was negative, then all similar experiences will be negative)
38
What is magnification and minimization?
Overvaluing or undervaluing the significance of a particular event (i.e., one small negative event is the end of the world or a positive experience is totally discounted)
39
What is personalization?
Tendency to self-reference external events without basis (i.e., believing that events are directly related to oneself, whether they are or not)
40
Which medication would be most appropriate for the treatment of mania associated with bipolar disorder?
A. Lithium
B. Fluoxetine
C. Citalopram
D. Venlafaxine
A. Lithium
Rationale: Lithium is an antimanic agent, which would be most appropriate for treating a manic client with bipolar disorder.
Fluoxetine, citalopram, and venlafaxine are antidepressants
41
What are some limits that need to be set with pt. with bipolar disorder?
Clearly identify unacceptable behavior
Identify consequences if limits are not met
Identify expected or desired behavior
42
What is suicidal ideation?
Thinking about killing oneself.
43
What is a lethality assessment for suicide?
An evaluation of the likelihood that a client will carry out a suicidal plan. It involves asking:
Does the client have a specific plan?
Are the means available to carry out this plan?
If the client carries out the plan, is it likely to be lethal?
Has the client made preparations for death (e.g., writing a will, giving away possessions)?
Where and when does the client intend to carry out the plan?
Is the intended time a special date or anniversary that has meaning for the client?
44
What are key nursing interventions for a client with suicidal ideations?
Using an authoritative role.
Providing a safe environment (e.g., suicide precautions).
Supporting the client's support system.
Approaching the patient with unconditional positive regard and a nonjudgmental tone.
Realizing that some clients may still commit suicide despite competent and caring interventions.
45
What are some common myths about suicide?
People who talk about suicide never commit suicide.
Suicidal people only want to hurt themselves, not others.
There is no way to help someone who wants to kill themself.
Do not mention the word "suicide" to a person you suspect to be suicidal because this could give them the idea to commit suicide.
Ignoring verbal threats of suicide or challenging a person to carry out their suicide plans will reduce the individual's use of these behaviors.
Once a suicide risk, always a suicide risk.
46
For pt. who have attempted suicide before, what period is the highest risk of another attempt?
First 2 years after
Especially first 3 months after
47
How should a nurse respond to at suicidal patient?
Unconditional positive regard for person
Avoid patient blame
Nonjudgmental approach, tone
Belief that one person can make a difference in another’s life
Possible devastation of staff if patient commits suicide
Nurses must realize that no matter how competent and caring interventions are, a few clients will still commit suicide
48
What is Disruptive Mood Dysregulation Disorder?
A disorder diagnosed in individuals 6-18 years old, characterized by severe recurrent temper outbursts and persistent irritable or angry mood.
49
What is anergia?
Lack of energy
50
What is euthymic mood?
Average affect and activity
51
What is Personality?
Personality is an ingrained, enduring pattern of behaving and relating to oneself, others, and the environment, encompassing perceptions, attitudes, and emotions. It manifests as behaviors and characteristics that are consistent across multiple settings and do not change easily.
52
What is the difference between Temperament and Character in forming Personality?
Temperament is an inborn, hardwired trait that a person is born with.
Character emerges from the interaction of temperament with the environment and represents a set of habits acquired through growth and maturity.
Together, temperament and character form a person's unique personality.
53
What are Personality Disorders?
Personality disorders involve traits that are inflexible and maladaptive, causing significant interference with functioning or emotional distress. Individuals with these disorders often do not recognize their behavior as the source of difficulty.
54
When are Personality Disorders typically diagnosed?
While maladaptive behaviors can be traced to early childhood or adolescence, personality disorders are usually not formally diagnosed until adulthood, specifically after 18 years of age, as personality is more completely formed by then. Antisocial Personality Disorder, by definition, cannot be diagnosed before the age of 18.
55
How are Personality Disorders categorized in the DSM-5?
They are grouped into three clusters:
Cluster A: Odd/Eccentric ("Weird")
Cluster B: Erratic/Dramatic ("Wild")
Cluster C: Anxious/Fearful ("Worried")
56
Which personality disorders belong to Cluster A (Odd/Eccentric)?
Paranoid Personality Disorder (PD): Mistrust and suspiciousness of others; guarded, restricted affect.
Schizoid PD: Detached from social relationships; restricted affect; involved with things more than people.
Schizotypal PD: Acute discomfort in relationships; cognitive or perceptual distortions; eccentric behavior.
57
Which personality disorders belong to Cluster B (Erratic/Dramatic)?
Antisocial PD: Disregard for rights of others, rules, and laws.
Borderline PD: Unstable relationships, self-image, and affect; impulsivity; self-mutilation.
Histrionic PD: Excessive emotionality and attention seeking.
Narcissistic PD: Grandiose; lack of empathy; need for admiration.
58
Which personality disorders belong to Cluster C (Anxious/Fearful)?
Avoidant PD: Social inhibitions; feelings of inadequacy; hypersensitive to negative evaluation.
Dependent PD: Submissive and clinging behavior; excessive need to be taken care of.
Obsessive-Compulsive PD: Preoccupation with orderliness, perfectionism, and control. (Note: This is different from Obsessive-Compulsive Disorder).
59
What population are personality disorders higher in?
Lower socioeconomic groups
60
What are the three dimensions of character?
Self-directedness (responsible, goal oriented)
Cooperativeness (integral part of society)
Self-transcendence (integral part of the universe)
61
Do specific medications alter personality?
No, there are no specific medications that alter personality. Therapy designed to help clients make changes is often long-term with slow progress.
62
What therapeutic approaches are used in the treatment of personality disorders?
Group and individual therapies.
Cognitive-behavioral therapy (CBT): Includes techniques like thought-stopping (to alter negative thought patterns), positive self-talk (to reframe negative thoughts), and decatastrophizing (to assess situations realistically).
Dialectical Behavior Therapy (DBT): Specifically for Borderline Personality Disorder, focusing on mindfulness.
63
Personality Disorder: Paranoid
Symptoms/Characteristics: ?
Nursing Interventions: ?
Symptoms/Characteristics: Mistrust & suspicions of others; guarded, restricted affect
Nursing Interventions: Serious, straightforward approach; teach client to validate ideas before taking action; involve client in treatment planning
64
Personality Disorder: Schizoid
Symptoms/Characteristics: ?
Nursing Interventions: ?
Symptoms/Characteristics: Detached from social relationships; restricted affect; involved with things more than people
Nursing Interventions: Improve client's functioning in the community; assist client in finding case manager
65
Personality Disorder: Schizotypal
Symptoms/Characteristics: ?
Nursing Interventions: ?
Symptoms/Characteristics: Acute discomfort in relationships; cognitive or perceptual distortions; eccentric behavior
Nursing Interventions: Develop self-care skills; improve community functioning; social skills training
66
Personality Disorder: Antisocial
Symptoms/Characteristics: ?
Nursing Interventions: ?
Symptoms/Characteristics: Disregard for rights of others, rules, and laws
Nursing Interventions: Limit setting; confrontation; teach client to solve problems effectively and manage emotions of anger or frustration
67
Personality Disorder: Borderline
Symptoms/Characteristics: ?
Nursing Interventions: ?
Symptoms/Characteristics: Unstable relationships, self-image, and affect; impulsivity; self-mutilation
Nursing Interventions: Promote safety; help client to cope and control emotions; cognitive restructuring techniques; structure time; teach social skills
68
Personality Disorder: Histrionic
Symptoms/Characteristics: ?
Nursing Interventions: ?
Symptoms/Characteristics: Excessive emotionality and attention seeking
Nursing Interventions: Teach social skills; provide factual feedback about behavior
69
Personality Disorder: Narcissistic
Symptoms/Characteristics: ?
Nursing Interventions: ?
Symptoms/Characteristics: Grandiose; lack of empathy; need for admiration
Nursing Interventions: Matter-of-fact approach; gain cooperation with needed treatment; teach client any needed self-care skills
70
Personality Disorder: Avoidant
Symptoms/Characteristics: ?
Nursing Interventions: ?
Symptoms/Characteristics: Social inhibitions; feelings of inadequacy; hypersensitive to negative evaluation
Nursing Interventions: Support and reassurance; cognitive restructuring techniques; promote self-esteem
71
Personality Disorder: Dependent
Symptoms/Characteristics: ?
Nursing Interventions: ?
Symptoms/Characteristics: Submissive and clinging behavior; excessive need to be taken care of
Nursing Interventions: Foster client's self-reliance and autonomy; teach problem-solving and decision-making skills; cognitive restructuring techniques
72
Personality Disorder: Obsessive-compulsive
Symptoms/Characteristics: ?
Nursing Interventions: ?
Symptoms/Characteristics: Preoccupation with orderliness, perfectionism, and control
Nursing Interventions: Encourage negotiation with others; assist client in making timely decisions and completing work; cognitive restructuring techniques
73
What behavior most strongly supports a diagnosis of Antisocial Personality Disorder?
Repeatedly violating the rights of others and showing no remorse.
74
What are key characteristics of Antisocial Personality Disorder?
Disregard for the rights of others, deceit, manipulation, lack of empathy, poor judgment and insight (do not consider morals/ethics), egocentricity (though self is shallow and empty), and using relationships to serve their own needs. Individuals often have a history of acts of cruelty and abusive parenting. These individuals often display false emotions and have a narrow view of the world. They are typically of average/above average IQ.
75
What is Antisocial Personality Disorder (ASPD)?
A Cluster B personality disorder characterized by a pervasive pattern of disregard for and violation of the rights of others.
76
What are appropriate nursing interventions for clients with Antisocial Personality Disorder?
Promoting accountability for their own behavior.
Limit setting: Establishing clear boundaries for behavior.
Consistent adherence to rules and treatment plan
Confrontation: Directly addressing maladaptive behaviors.
Effective problem-solving skills.
Decrease impulsivity
Expressing negative emotions such as anger or frustration
Take a time-out from stressful situations
Improve role performance
Identify barriers to role fulfillment
Decrease/eliminate use of drugs/alcohol
77
What defense mechanism might a client with Antisocial Personality Disorder use when stating, "I only hit him because he deserved it- he started it"?
Rationalization.
78
A client diagnosed with antisocial personality disorder is
observed smoking in a non-smoking area. Which initial nursing intervention is appropriate?
A. Teach Alternate Coping Skills
B. Confront the client about the behavior
C. Remind all clients of the no smoking policy
D. Tell the client’s primary nurse about the situation
B. Confront the client about the behavior
79
A client has been diagnosed with antisocial personality disorder based on a long history of difficulties with the legal system and cruelty to others. Which one of the following characteristics would you expect to assess in this client?
A. lack of guilt or wrong doing
B. feelings of emptiness and abandonment
C. social withdrawal and isolation
D. ability to learn from past experiences
A. lack of guilt or wrong doing
80
What is Borderline Personality Disorder (BPD)?
A Cluster B personality disorder characterized by pervasive instability in relationships, self-image, affect, and marked impulsivity.
81
What are some common assessment cues of borderline personality disorder?
Disturbed early relationship w/parents
Appearance and behavior can reflect their internal instability (ex. cuts, burns)
Unstable interpersonal relationships, self-image, and affect; marked impulsivity
Wide range of behavior, appearance
Dysphoric mood
Polarized extreme thinking (splitting); dissociation
Impaired judgment; safety not a concern
Threats of self-harm
Social isolation
82
Which therapeutic approach is considered most effective in treating Borderline Personality Disorder?
Dialectical Behavior Therapy (DBT)
83
A client with borderline personality disorder says to the nurse, “ I feel so comfortable talking with you. You seem to have a special way about you that really helps me.” Which would be the most appropriate response by the nurse?
A. “I’m glad you feel comfortable with me”
B. “You feel others don’t understand you?”
C. “I’m here to help you just as all the staff are.”
D. “ I cannot be your friend. You need to be clear on that”
C. “I’m here to help you just as all the staff are.”
84
When caring for a client with a personality disorder, it is important for the nurse to remember which of the following?
A. Changes in the clients behavior can be corrected easily with therapy and medication.
B. Once alerted to the behavioral problem ,the client can readily change the behavior.
C. The client could choose to control or modify his or her pattern of behavior.
D. The client’s behavior often provokes negative feelings in others.
D. The client’s behavior often provokes negative feelings in others.
85
Clients with personality disorders have greater unmet needs in what 5 areas?
Self-care (keeping clean and tidy)
Sexual expression (dissatisfaction with sex life)
Budgeting (managing daily finances)
Psychotic symptoms
Psychological distress
Providing care for the first 3 areas might result in a greater sense of well-being and improved health.
86
Children who have a greater number of “protective factors” are less likely to develop antisocial behavior as adults
What are some protective factors that care could emphasize?
school commitment or importance of school, parent and/or peer disapproval of antisocial behavior, and involvement in a religious community
87
What are appropriate nursing interventions for a client with Borderline Personality Disorder who engages in self-harm?
No self-harm contract
Strict adherence to boundaries
Long-term therapy to resolve family dysfunction/abuse
Help client cope/control emotions
Cognitive restructuring techniques
Structuring time
Teach social skills
Teach effective communication skills
Structured, with limit setting, therapeutic relationship
88
What are the core characteristics/behavior of Antisocial Personality Disorder (ASPD)?
Primarily characterized by a pervasive disregard for the rights of others, rules, and laws. Often exhibit deceit, manipulation, and a notable lack of empathy, guilt, or remorse for actions.
89
What are the core characteristics/behavior of Borderline Personality Disorder (BPD)?
Characterized by unstable relationships, self-image, and affect. Commonly experience intense emotional dysregulation, impulsivity, and a profound fear of abandonment.
90
What is the Motivation/Self-Perception of Antisocial Personality Disorder (ASPD)?
Behavior is often motivated by personal gratification, and their sense of self-esteem may come from gaining power/pleasure, often at the expense of others. May appear confident, but their self is described as shallow/empty. Don't typically recognize their behavior as problematic.
91
What is the Motivation/Self-Perception of Borderline Personality Disorder (BPD)?
While impulsive, their behaviors (like self-harm) are often driven by intense emotional pain, a desire to cope with overwhelming feelings, or a fear of abandonment, rather than a disregard for others' rights. They may struggle with identity disturbance.
92
What are some self-awareness issues for nurses working with clients with personality disorders?
Avoid client attempts to manipulate.
Maintain clear communication.
Set limits and boundaries.
Deal with frustration, as clients change slowly.
Work effectively as part of a team, ensuring consistency.
93
Antisocial personality disorder is more common in...
Men
94
Boarderline personality disorder is more common in....
Women
95
What is the maintenance level for lithium?
0.5-1
96
What is the treatment level for lithium?
Manic level?
When pt. is back to normal?
0.8-1.5
Manic: 1.0-1.2
Normal: 0.8-1.0
97
What is a toxic level of lithium?
Anything over 1.5
98
When should you call the doctor when the pt is on lithium?
-Persistent thirst and diluted urine
-Client has diarrhea, fever, flu,or any condition that leads to dehydration
99
Side Effects: Lithium
oMild nausea
oMild diarrhea
oFine hand tremor
oPolydipsia
oMetallic taste in mouth
oWeight gain/acne - later in therapy
100
Side Effects: Lithium toxicity
o Severe diarrhea
o Vomiting
o Drowsiness
o Muscle weakness
o Lack of coordination
o Can lead to renal failure, coma, and death
101
What is a good type of food for manic pt?
HIGH calorie finger foods
102
peak of lithium
30 minutes to 4 hours for regular forms and in 4 to 6 hours for the slow-release form
103
onset of lithium
is 5 to 14 days
104
contraindications for lithium
- pregnancy
- people with compromised renal function or urinary retention and those taking low-salt diets or diuretics
105
hydration with lithium
- Clients should drink adequate water (approximately 2 L/day) and continue with the usual amount of dietary table salt
- The physician should be contacted if the client has diarrhea, fever, flu, or any condition that leads to dehydration.
106
renal status with lithium
Because most lithium is excreted in the urine, baseline and periodic assessments of renal status are necessary to assess renal function
107
1.5-2 mEq/L lithium toxicity
- Nausea and vomiting, diarrhea, reduced coordination, drowsiness, slurred speech, and muscle weakness
- Withhold next dose, call physician. Serum lithium levels are ordered, and doses of lithium are usually suspended for a few days or the dose is reduced.
108
2-3 mEq/L lithium toxicity
Ataxia, agitation, blurred vision, tinnitus, giddiness, choreoathetoid movements, confusion, muscle fasciculation, hyperreflexia, hypertonic muscles, myoclonic twitches, pruritus, maculopapular rash, movement of limbs, slurred speech, large output of dilute urine, incontinence of bladder or bowel, and vertigo
- Withhold future doses, call physician, stat serum lithium level. Gastric lavage may be used to remove oral lithium; IV containing saline and electrolytes used to ensure fluid and electrolyte function and maintain renal function.
109
3 mEq/L & above lithium toxicity
- Cardiac arrhythmia, hypotension, peripheral vascular collapse, focal or generalized seizures, reduced levels of consciousness from stupor to coma, myoclonic jerks of muscle groups, and spasticity of muscles
- All preceding interventions plus lithium ion excretion is augmented with use of aminophylline, mannitol, or urea. Hemodialysis may also be used to remove lithium from the body. Respiratory, circulatory, thyroid, and immune systems are monitored and assisted as needed.
110
What is Intoxication?
Substance use that results in maladaptive behavior. It refers to the acute signs and symptoms that can occur with a regular amount of usage.
111
What is Withdrawal Syndrome?
The negative psychological and physical reactions that occur when the use of a substance ceases or dramatically decreases.
112
What is Detoxification?
The process of safely withdrawing from a substance.
113
What is Substance Abuse?
Using a drug in a way that is inconsistent with medical or social norms, despite negative consequences.
114
What is Substance (or Chemical) Dependence?
Problems associated with addiction such as tolerance, withdrawal, and unsuccessful attempts to stop using the substance. Substance use and dependence can be used interchangeably.
115
What is Polysubstance Abuse?
The abuse of more than one substance.
116
What are Designer Drugs (or Club Drugs)?
Synthetic substances, most of which are amphetamine-like.
117
What are the effects of alcohol on the body?
Alcohol acts as a CNS depressant, leading to relaxation and loss of inhibitions.
118
What are the symptoms of alcohol intoxication?
Slurred speech, unsteady gait, lack of coordination, impaired attention, memory, judgment, and aggressive or inappropriate sexual behavior; blackouts can also occur.
119
What is the average age for the first episode of alcohol intoxication?
Adolescence, typically between 12-14 years old. Some individuals may report "sipping" alcohol as early as 8 years old.
120
What is blackout? (alcohol abuse)
Refers to experiencing blackouts, a common consequence of heavy alcohol consumption where a person is conscious and performing actions but later has no memory of the events. Blackouts are a serious sign of acute intoxication and indicate significant brain impairment.
121
What is a tolerance break? (alcohol abuse)
A tolerance break typically refers to a period of abstinence or reduced use where a person's tolerance to a substance decreases. This is often followed by a return to substance use, where the person consumes the amount they used to, but with a reduced tolerance, leading to a much higher risk of overdose or severe intoxication.
Functioning becoming affected
122
What are the symptoms of alcohol overdose?
Vomiting, unconsciousness, and respiratory depression.
123
How is an alcohol overdose treated?
Treatment involves gastric lavage or dialysis to remove the drug, along with support of respiratory and cardiovascular functioning in an intensive care unit.
124
When does alcohol withdrawal typically begin and peak?
It begins 4 to 12 hours after cessation or marked reduction of alcohol intake , usually peaking on the second day and completing in about 5 days.
125
What are the symptoms of alcohol withdrawal?
Coarse hand tremors, sweating, elevated pulse and blood pressure, insomnia, anxiety, and nausea or vomiting.
126
What are the severe or untreated complications of alcohol withdrawal?
It may progress to transient hallucinations, seizures, or delirium, known as delirium tremens (DTs). Alcohol withdrawal can be life-threatening.
127
What class of medications is used for safe alcohol withdrawal (detoxification)?
Benzodiazepines, such as lorazepam (Ativan), chlordiazepoxide (Librium), and diazepam (Valium), are used to suppress withdrawal symptoms.
Vitamin B1 (thiamine) to prevent or treat Wernicke’s syndrome - Korsakoff’s syndrome
Cyanocobalamin (vitamin B12) and folic acid for nutritional deficiencies
128
A Client calls the emergency department of the local hospital reporting that after 16 years of heavy drinking, he is tired and wants to quit “cold turkey”. What would be the best response?
A. “it is not safe to stop drinking suddenly without medical observation.”
B. “you sound really motivated. You should do with sustaining from substance use.
C. “after a few days of rest, you should feel better as long as you do not drink anything”.
D. “you likely will feel anxious and get a severe headache. Treat these symptoms with acetaminophen and rest and come in if they do not get better in 3-5 days.”
A. “it is not safe to stop drinking suddenly without medical observation.”
129
What are the effects of Sedatives, Hypnotics, and Anxiolytics?
They are CNS depressants that decrease anxiety and cause disinhibition. They can produce a feeling of well-being, euphoria, and reduced inhibition.
130
What are the symptoms of intoxication from Sedatives, Hypnotics, and Anxiolytics?
Slurred speech, unsteady gait, lack of coordination, impaired attention, memory, and judgment.
131
What are the signs of an overdose from Sedatives, Hypnotics, and Anxiolytics, and what is the treatment?
Overdose can lead to respiratory depression, coma, and death. Treatment involves gastric lavage and activated charcoal, and for benzodiazepine overdose, flumazenil (Romazicon) can be used.
132
What are the symptoms of withdrawal from Sedatives, Hypnotics, and Anxiolytics?
Autonomic hyperactivity (increased pulse, blood pressure, temperature), hand tremor, insomnia, nausea/vomiting, anxiety, psychomotor agitation, and (grand mal) seizures. Withdrawal can be fatal.
133
What is the safest and most common method for withdrawal from sedatives, hypnotics, & anxiolytics?
Detoxification via drug tapering
134
What are the effects of Stimulants (e.g., amphetamines, cocaine, methamphetamine)?
They stimulate the CNS, leading to increased alertness, euphoria, and increased motor activity.
135
What are the symptoms of intoxication from Stimulants?
Tachycardia, elevated blood pressure, dilated pupils, nausea, vomiting, insomnia, and paranoia.
136
What are the signs of an overdose from Stimulants, and what is the treatment?
Overdose can lead to seizures, coma, death, hyperpyrexia, cardiovascular shock, and cerebral hemorrhage. Treatment involves chlorpromazine (Thorazine) to control hypertension, seizures, and hyperthermia.
137
What are the symptoms of withdrawal from Stimulants?
Marked dysphoria, fatigue, vivid unpleasant dreams, insomnia or hypersomnia, increased appetite, and psychomotor retardation or agitation. This is often called "crashing".
138
The following clients are waiting to be seen in the ED. Which client should the nurse assess first?
A. A cocaine abuser with chest pain
B. An intoxicated client with long history of alcoholism
C. A client who took their first dose of lithium and became nauseated.
D. A client with bipolar disorder who smoked marijuana 2 hours ago.
A. A cocaine abuser with chest pain
139
What are the effects of Cannabis (marijuana)?
Produces effects similar to alcohol, like relaxation, euphoria, and altered perceptions, but it is not a CNS depressant. It can impair motor skills for 8-12 hours.
140
What are the symptoms of intoxication from Cannabis?
Impaired motor coordination, euphoria, anxiety, sensation of slowed time, and impaired judgment. Physical symptoms include conjunctival injection (red eyes), increased appetite, dry mouth, and tachycardia.
141
What are the signs of an overdose from Cannabis?
There is no known overdose syndrome for cannabis.
142
What are the symptoms of withdrawal from Cannabis?
Irritability, anger, aggression, anxiety, sleep disturbances, decreased appetite, restless, depressed mood, abdominal pain, tremors, sweating, fever, chills, or headache.
143
What are the effects of Opioids?
Opioids act as CNS depressants, producing euphoria, pain relief, and sedation.
144
What are the symptoms of intoxication from Opioids?
Pinpoint pupils, drowsiness, slurred speech, and impaired memory.
145
What are the signs of an overdose from Opioids, and what is the treatment?
Overdose can lead to respiratory depression, stupor, coma, and death. Treatment involves naloxone (Narcan) to reverse respiratory depression and coma.
146
What are the symptoms of withdrawal from Opioids?
Nausea, vomiting, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, yawning, fever, and insomnia
Symptoms cause significant distress, but do not require pharmacologic intervention to support life or bodily functions
147
For short-acting opioid drugs (e.g. heroin) what is the onset, peak, and when does it subside?
Onset in 6 to 24 hours; peaking in 2 to 3 days and gradually subsiding in 5 to 7 days
148
For long-acting opioid drugs (e.g. methadone) what is the onset and when does it subside?
Onset in 2 to 4 days, subsiding in 2 weeks
149
What are the components of the five-point program to address the opioid crisis?
Access: Better prevention, treatment, and recovery.
Data: Better data on the epidemic.
Pain: Better pain management.
Overdoses: Better targeting of overdose-reversing drugs.
Research: Better research on pain and addiction.
150
What is the current concern regarding prescription opioids and heroin?
Prescription opioids and heroin overdose remain high and are increasingly adulterated with fentanyl.
151
What are the effects of Hallucinogens (e.g., LSD, PCP)?
They cause reality distortion and can induce flashbacks.
152
What are the symptoms of intoxication from Hallucinogens?
Paranoia, impaired judgment, anxiety, hyperthermia, seizures, tachycardia, hypertension, and rigidity.
153
What are the signs of an overdose from Hallucinogens?
Overdose can be deadly, causing convulsions, hyperthermia, and respiratory arrest. Treatment involves cooling, anticonvulsants, and haloperidol (Haldol).
154
What are the symptoms of withdrawal from Hallucinogens?
There is no specific withdrawal syndrome, but flashbacks can occur and may persist from a few months to 5 years. Some report a craving for the drug.
155
What are Inhalants, and what are their effects?
Substances that are inhaled for their psychoactive effects, causing neurological and behavioral symptoms. Examples include volatile solvents, aerosols, gases, and nitrites.
156
What are the signs of acute toxicity from Inhalants?
Can lead to anoxia, respiratory depression, vagal stimulation, and dysrhythmias.
157
What are the signs of an overdose from Inhalants, and what is the treatment?
Death is possible due to bronchospasm, cardiac arrest, suffocation, or aspiration of the compound or vomitus. Treatment is supportive, focusing on respiratory and cardiac functioning.
158
What are the symptoms of withdrawal from Inhalants?
There is no specific withdrawal syndrome, but frequent users may report cravings. Persistent dementia or inhalant-induced disorders (psychosis, anxiety, mood disorders) can occur even after discontinuing use.
159
What types of treatment settings are available for substance abuse?
Individual and group counseling, outpatient treatment, freestanding substance abuse treatment facilities, self-help programs (e.g., AA, Rational Recovery), agency-sponsored aftercare programs, and individual or family counseling.
160
What is dual diagnosis?
Substance abuse + another psychiatric illness
An estimated 75% of people with severe mental illness also have a substance use disorder.
161
What is included in successful treatment and relapse prevention strategies for dual diagnosis?
Healthy, nurturing, supportive living environments
Assisting with fundamental life changes, such as finding a job and abstinent friends
Connections with other recovering people
Treatment of co-morbid conditions
162
What is a key characteristic of substance use disorders in terms of their course?
For many, substance use is a chronic illness with remissions and relapses. Relapse rates range from 60% to 90%.
163
What is the nurse's ethical and legal responsibility regarding suspicious behavior of healthcare professionals concerning controlled substances?
Nurses have an ethical and legal responsibility to report suspicious behavior, as mandated by the nurse practice act.
164
What factors are associated with the highest rates for successful recovery from substance abuse?
Abstinence and a high level of motivation.
165
What are some community-based care options for substance abuse treatment?
Outpatient treatment, freestanding substance abuse treatment facilities, self-help programs like AA (Alcoholics Anonymous) and Rational Recovery, agency-sponsored aftercare programs, and individual or family counseling.
166
What are some general warning signs for substance use disorder in health professionals?
Poor work performance/frequent absenteeism
Unusual behavior/slurred speech
Isolation from peers
167
What are some important self-awareness issues for nurses working with clients and families with substance use problems?
Clients cannot control their substance abuse without assistance and understanding.
Examine your own beliefs and attitudes to ensure they do not interfere with client care.
Approach treatment experiences with an open and objective attitude.
Recognize that clients may be successful in their second or third treatment experience.
Recognize that substance abuse is a chronic illness with relapses and remissions.
Remain open and objective.
168
The nurse is caring for a client who abuses alcohol. What should the nurse understand about the effects of this substance
A. Alcohol is a central nervous system stimulant.
B. Alcohol is a central nervous system depressant.
C. Alcohol is a muscle relaxant.
D. Alcohol is a hallucinogen.
B. Alcohol is a central nervous system depressant.
169
How is the effectiveness of substance abuse treatment evaluated?
Heavily based on the client’s abstinence. Successful treatment should result in more stable role performance, improved interpersonal relationships, and increased satisfaction with quality of life.
170
What Benzodiazepines are used for detoxification?
Lorazepam (Ativan), chlordiazepoxide (Librium), and diazepam (Valium)
171
What drug is used to decrease the cravings for alcohol, but does not make you sick?
Acamprosate (Campral)
172
What drug makes you sick/want to die if you drink alcohol, but does not decrease craving?
(The getting sick is therapeutic)
Disulfiram (Antabuse)
173
What drug, if it is still in one's system, will prevent pain meds from being effective?
Naltrexone (ReVia)
174
When can Disulfiram (Antabuse) be started?
After a patient has been abstinent from alcohol for at least 12 hours, and preferably longer (e.g., 24-48 hours).
175
When can Acamprosate (Campral) be started?
As soon as possible after acute alcohol withdrawal symptoms have subsided
176
When can Methadone be started?
Can be started immediately, even when pt is actively opioid-dependent and experiencing withdrawal symptoms.
177
When can Buprenorphine and Naloxone (Suboxone) be started?
Only after the patient is in a state of mild-to-moderate opioid withdrawal, typically 12-24 hours after the last short-acting opioid (e.g., heroin, oxycodone) or 24-72 hours after the last long-acting opioid (e.g., methadone).
178
When can Naltrexone (ReVia) be started?
After a patient has been opioid-free for a sufficient period, typically 7-10 days for oral naltrexone and up to 14 days for extended-release injectable naltrexone
179
What does the fluid and sodium intake need to be for pt. on lithium?
Pt. need to stay hydrated (3L/day) (DO NOT DRINK TO FAST/NOT ALL AT ONCE)
Lithium is dependent on sodium, so pt. need steady sodium intake
180
What are the 2 biggest reasons why people stop taking lithium?
Acne and weight gain.
181
A client reports drinking 1-2 drinks when drinking behavior first began. Now the client reports drinking at least 6 drinks with every episode in order to have a good time. What term would best describe this phenomenon
Tolerance
182
A client is being discharged on disulfiram (Antabuse). Which instruction for Antabuse should the client receive?
A) Take disulfiram with food to avoid stomach upset.
B) Skip the daily dose of disulfiram on days when consumption of alcoholic beverages is likely.
C) Read products labels carefully to avoid all products containing alcohol.
D) Disulfiram will prevent the desire to drink alcoholic beverage
C) Read products labels carefully to avoid all products containing alcohol.
183
The client asks the nurse. "What will happen if I drink while taking Antabuse?" What should be the nurse's reply?
A) "You will not want to drink while taking Antabuse. It reduces the cravings."
B) "You will not get any effect from the alcohol you drink."
C) "Antabuse will reverse the effects of alcohol."
D) "You will experience a severe reaction, including a throbbing headache and vomiting."
D) "You will experience a severe reaction, including a throbbing headache and vomiting."
184
A client has just been diagnosed as having major depression. At which time would the nurse expect the client to be at highest risk for self-harm?
A) Immediately after a family visit
B) On the anniversary of significant life events in the client's life
C) During the first few days after admission
D) Approximately 2 weeks after starting antidepressant medication
D) Approximately 2 weeks after starting antidepressant medication
185
What kind of food options are best for patients who are manic
Finger foods are great because you can eat them while moving around.
- The foods should be as high in calories and protein as possible.
186
Which thought process would cause a client with antisocial personality disorder to want to do everything for himself?
A) Belief in his own self-worth
B) Inability to delay gratification
C) Rewards for competitive behavior
D) Sense of mistrust of others
D) Sense of mistrust of others
187
Which term describes the extent to which a person considers himself to be an integral part of the universe?
Self-transcendence
Psych NUR 162
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