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PN 3003 Variations (Mental Health) Study Guide
1. definition of mental health vs mental illness: mental health:
-state of wellbeing in one's own abilities & normal stresses of life -only in a complete state of wellbeing when physical, mental, and social well being is intact mental illness: -disturbance in a person's cognition, emotions, or behaviors
2. primary gain vs secondary gain: primary: anxiety is diverted to the physical problem (ex:
stressing over final, deciding to skip it = no more anxiety) secondary: receiving attention from another (ex: attention from teacher, classmates, etc)
3. repression vs regression: repression
-suppressing a thought or desire so it remains unconscious ex: child gets bitten by a dog & develops intense phobia of dogs later in adulthood & doesn't remember experience as a child regression -defense mechanism where person reverts back to an earlier stage of development ex: in periods of stress, person may revert to bedwetting or thumb sucking
4. define displacement: defense mechanism where it involves an individual trans- ferring negative
feelings from one person or thing to another ex: a person who is angry at their boss and may take out their anger on a family member
5. define rationalization: Making excuses for actions or feelings
ex: person is rejected by crush & rationalizes situation by saying they were not attracted to other person anyway
6. define intellectualization: defense mechanism where person avoid uncomfort- able emotions by
focusing on facts & logic ex: if person A is rude to person B, person B may think about possible reasons for person A's behavior
7. what are the stages of grief?: denial, anger, bargaining, depression, acceptance
8. describe denial stage of grief: -avoiding reality & may act like nothing happened
-allows an adjustment period to gather coping strategies for grieving
9. describe anger stage of grief: -occurs once reality is real
-expressed in many ways, like crying, expressions of self-blame and guilt -sometimes anger can turn inwards, which results in physical illness and/or psycho- logical dysfunction
10. describe bargaining stage of grief: -an attempt to postpone acceptance of reality
-frequent labile moods -continued anger & unwillingness to accept loss
11. describe depression stage of grief: -deep sense of loss as reality of what happened or
anticipated settles -may withdraw from social interaction -predominant affect is feelings or emptiness or loss -sadness & grief can be intertwined w/ good days of positive emotions -sometimes this period can be overwhelming & recovery from depth of sorrow unlikely w/o professional help
12. describe acceptance stage of grief: -person begins to experience peace & serenity
-time for letting go & allowing life to provide new experiences & relationships
13. describe psychotherapy: use of psychological methods, particularly when based on regular
personal interaction, to help a person change behavior, increase happiness, and overcome problems
16. what meds are used when performing ECT?: administered along w/ general anesthesia & muscle
relaxants to minimize any seizures impacting entire body & severe muscle contractions that can fracture or dislocate bones
17. when is ECT performed?: recommended when people who have symptoms aren't responding
to meds or psychosocial txs
18. what is contraindicated for ECT?: -lithium ’ contributes to cognitive side effects (delirium &
cognitive problems) -BP meds
19. what is important to do after ECT completed?: reorient patient (name, date, location)
20. what is psychopharmacotherapy: use of medications to treat psychological problems
21. what are the most common symptoms of psychiatric disorders as de- scribed by DSM-5?: -
mood alterations -irritability & anxiety -altered thought processes -misperceptions of environment -impaired & illogical communication or interaction patterns -disorientation & confusion
22. what are the phases of a therapeutic relationship?: Orientation, working, termination
23. describe orientation phase: pt & nurse getting to know each other
-involves explaining purpose of nurse-pt interaction for building trust, establishing roles, & identifying problems & expectations
24. describe working stage: where outcomes & interventions toward behavior change are
planned & goals are developed to improve client's well being
25. describe termination phase: allows client to depend on themselves while developing
improved adaptive skills (end of nurse-pt relationship) -important to discuss termination w/ client & respond to any feelings/concerns
26. what components are included in mental status examination?: appearance: grooming, eye contact,
posture attitude: cooperative or uncooperative, friendly, hostile speech pattern: speed, volume, slurring mood & affect LOC/LOO memory: recent or short-term perceptions: hallucinations, illusions, etc. judgement: problem-solving, decision-making abilities thought processes: speed, content, logical or illogical
27. differentiate each characteristic
empathy genuineness acceptance self awareness: empathy -seeing, understanding, & sharing others viewpoints w/o judgement genuineness -attribute of realness & concerns that fosters an honest & caring foundation for trust acceptance -ability to see the client as a person w/ worthy & dignity who isn't judged or labeled by the standards of another self-awareness -consciousness of one's own individuality & personality w/ an attitude of openness to make positive changes
33. how often do attacks occur?: can occur daily, weekly, monthly
-can last few mins or longer
34. S+S of panic disorders: -heartbeat rapid & pounding
- ‘perspiration -chilling or flushing -tingling or numbness of hands, shaking
- nausea -chest pain, SOB -fear of being out of control
- agoraphobia
- depression
35. incidence & etiology of panic disorders: -onset usually occurs between late adolescence & mid
30's -first gen bio relatives are more likely to develop panic disorders -more common in females than males
36. define agoraphobia: avoidance of specific places, situations tending to trigger panic attacks
37. what are different types of specific phobias?: PTSD, social, agoraphobia, claustrophobia,
acrophobia (fear of heights)
38. specific phobia: fear of objects or specific situations or events
39. most common types of specific phobia?: animals, height, water, storms, blood or needles,
flying, elevators, or enclosed space
40. signs & symptoms of specific phobia: -irrational & persistent fear of object or situation
-immediate anxiety on contact w/ feared object or situation -loss of control, fainting, panic response -avoidance of activities w/ feared stimulus -worry w/ anticipatory anxiety
-possible impaired social or work functioning
41. incidence & etiology of specific phobia: -affects over 6m adult Americans
-twice as common in females as males -common but not severe enough to be diagnosed -symptoms usually have an onset during childhood or adolescence & persists throughout adult life
42. describe social anxiety disorder (social phobia): excessive fear of any social situation which
embarrassment is possible
43. s+s of social anxiety disorder: - hyperventilation
- palpitations -trembling hands or voice -inability to speak correctly
- blushing
- sweating -GI symptoms -urinary urgency -muscle tension -anticipatory anxiety -fear of embarrassment or ridicule
44. incidence & etiology of social anxiety disorder: -equally common in men & women
-onset usually occurs in childhood or early adolescence -onset can be abrupt after an event occurs or it can be slow -runs in families
45. post traumatic stress disorder: an anxiety disorder has been subjected to a traumatic event
46. s+s of PTSD: -intense feeling or fear and dread following a traumatic event
-mental reruns of the event -emotional numbness following the event -avoidance of people, places, or things associated w/ event
-onset in childhood or adolescence
52. what are the treatments for anxiety disorders?: - sertraline
-buspirone (short-term, non-drowsy) -bromazepam (short-term) -Xanax (long-term)
53. describe sertraline (brand, uses, side effects, etc): brand: Zoloft class: SSRIs (helps
restore balance of serotonin in the brain) uses: tx depression, panic attacks, OCD, PTSD, SAD, & severe premenstrual syn- drome -monitor for serotonin syndrome/toxicity
54. buspirone: brand: Buspar
class: anxiolytic (affects neurotransmitters in the brain) uses: anxiety, short-term -avoid eating/drinking grapefruit
55. bromazepam: class: antianxiety
uses: anxiety, short-term (binds 5TN & dopamine receptors in the brain) -avoid grapefruit
56. alprazolam: brand: Xanax
class: benzodiazepine (acts in CNS to produce anxiolytic effect) uses: GAD, panic disorder, anxiety w/ depression -avoid grapefruit juice
57. psychotherapy for anxiety tx: -most effective: cognitive behavioral therapy
-helps individuals replace negative thoughts & behaviors w/ more positive, produc- tive thoughts
58. define mood: an emotion that is prolonged to the point it color one's entire psychological
thinking
59. define affect: facial expression displayed in association with mood
60. euphoria: excessive feeling of happiness which has the possibility of escalating to mania
61. define mania: frenzied, unstable mood, may be out of touch w/ reality
62. what is the DSM-V?: diagnostic and statistical manual of mental disorders
-list of criteria that one must meet in order to be diagnosed with psychological disorder -allows for precision and consistency in diagnosis research based -includes depressive, bipolar & related disorders
63. what are the types of mood disorders?: -major depressive disorder
-persistent depressive disorder (dysthymia)
64. depression: A prolonged feeling of helplessness, hopelessness, and sadness for a duration of
over 2 weeks or longer
65. s+s of major depressive disorders: -hopelessness, worthlessness
-guilt & self blame -crying episodes -sleep disturbances -weight & appetite changes -“sex drive -poor concentration & memory lapse
- irritability
- anxiety -‘somatic complaints -difficulty making decisions -anhedonia & anergia -thoughts of death & suicide
73. s+s of bipolar disorder: hypomania/mania
-hypo: more than 4 days -hyper: up to 1wk -delusions of grandeur or persecution (mania) -auditory & visual hallucinations (mania) -inflated self esteem -flight of ideas -“need for sleep -easily distracted -extreme irritability & moodiness -reckless & impulsive behaviors -lack of judgement -poor hygiene
74. incidence & etiology of bipolar disorder: -environmental factors, changes in neurotransmitters,
familial pattern, substance abuse & stressful events are potential causes -women are at greater risk at developing -average onset is early 20s, but can start as early as adolescence or late as age 50
75. list nursing interventions for a pt experiencing hypomania or a manic episode: -create a
safe environment -decrease environmental stimuli -assess risk for accidents to self or others -monitor own anxiety level & convey messages w/ soothing tone of voice -refrain from becoming angry w/ clients who are hostile or behaving in an appropriate in an inappropriate manner -avoid arguing w/ or being charmed by clients -educate pt about meds & give pt food w/ meds to reduce upper GI discomfort & nausea -provide nutritional finger food when pt unable to sit long enough -monitor I&O to prevent dehydration; give juices and waters in containers
-set & maintain limits like unit rules & policies -spend time w/ client so they can talk, walk etc -provide positive feedback when needed
76. cyclothymic disorder: chronic mood disturbance w/ fluctuating periods of hy- pomanic
symptoms & periods of depression
77. s+s of cyclothymic disorder: -recurrent episodes of hypomania & dysthymia (usually <2 months)
-states not as severe as in bipolar -no psychotic symptoms -functioning not severely impaired
78. incidence & etiology of cyclothymic disorder: -common in both men & women
-begins in adolescence or early adulthood -usually chronic w/ an insidious onset
79. what are tx options for mood disorders?: -antidepressants (fluoxetine, citalo- pram, sertaline,
wellbuttine) -mood-stabilizing drugs: lithium -psychotherapy (same as anxiety disorders)
80. differentiate following delusions:
depression delusion somatic delusion delusion of grandeur delusion of persecution: depression delusion: -type of major depression accompanied by psychotic symptoms somatic delusion: individual believes something is wrong w/ part or all of their body
hallucinations -false perception of objects or events involving sight, smell, touch & taste (ex: hearing voices no one else hears) delusions -belief that is clearly false (ex: thinking one is being stalked)
86. define psychosis & its 3 types: loss of contact with reality
-have hallucinations & delusions -perceptual disturbances -disorganized thinking -behavior alterations
87. describe perceptual disturbances: includes hallucinations which are false sensory experiences,
such as seeing something in the absence of an external visual stimulus
88. describe disorganized thinking: includes delusions which are fixed, false ideas/beliefs w/o
appropriate external stimuli which are inconsistent w/ reality & can't be changed by reasoning
89. describe behavior alterations: -agitated, aggressive, silly & childlike
-inappropriate, unpredictable, frenzied motor activity -unkempt appearance, sexually inappropriate -catatonic behaviors -waxy flexibility
90. Schizophrenia: A psychotic disorder involving distortions in thoughts, percep- tions, and/or
emotions -has 3 stages: prodromal, acute, residual
91. describe prodromal stage of schizophrenia: -‘ anxiety w/ inability to concen- trate
- distraction -loss of connections (destroys ability to think, learn)
- paranoia
-delusional thinking -deteriorating relationships
92. describe acute stage of schizophrenia: -contains positive symptoms
-evidenced early in disease
93. positive symptoms seen in a schizophrenic patient: - delusions
-perceptual alterations -behavior patterns -word salad -clang associations -thought insertion -loose associations
- neologism
- hallucinations
- illusions
- depersonalization
- catatonia
94. describe residual stage of schizophrenia: -looks like prodromal phase
-obvious psychosis has subsided, but pt may exhibit negative symptoms like social withdrawal, lack of emotions, anhedonia
95. negative symptoms seen in a schizophrenic patient: -blunt or flat affect
-lack of motivation -lack of emotion -substance use
- violence -depression & suicidal acts -social withdrawal -violent behavior
-often auditory & delusions of being persecuted or followed -delusions are very organized & focus on the theme
101. Describe disorganized schizophrenia: exhibits disorganized & unintelligible speech, bizarre
behavior, and a flat affect -delusions don't have a theme but are fragmented & varied in focus -unusual mannerisms and posturing are seen -demonstrates inappropriate laughter
102. describe catatonic schizophrenia: severe decrease in motor activity and responsiveness to
an environment -may be mute & suddenly started repeating words at an earlier time -no movement for hours & hours
103. Describe undifferentiated schizophrenia: exhibits a # of classic symptoms like delusions,
hallucinations, disorganized speech, strange behavior, and blunted affect
104. Describe Residual Schizophrenia: has experienced prominent psychotic symptoms w/ a
previous dx of schizophrenia but no longer has them
105. describe schizoaffective disorder: mood episode & active symptoms occur together preceded
by at least 2 weeks of delusions & hallucinations
106. what are tx options for psychotic disorders?: - psychotherapy
- hospitalization
- clozapine
- haldol
107. clozapine: brand: Clozaril
class: antipsychotic (binds to dopamine receptors in CNS) uses: schizophrenia -considered a neuroleptic drug
108. haloperidol: brand: Haldol
class: antipsychotic/butyrophenones (alters effects of dopamine in CNS) uses: schizophrenia, mania, drug induced psychoses, behavioral problems
-considered a neuroleptic drug
109. what is EPS?: extrapyramidal side effects
-long term use side effects caused by antipsychotic & other drugs -caused by blocking dopamine which irritates pyramidal tracts of the CNS that coordinates involuntary movements -these side effects include: akathisia, dystonia, tardive dyskinesia, drug-induced parkinsonism, neuroleptic malignant syndrome
110. what is akathisia?: Motor restlessness
-first symptom to appear
111. what is dystonia?: rigidity in muscles controlling posture, gait, or eye move- ment
-2nd symptom to appear
112. what is tardive dyskinesia: late appearing, irreversible movements of mouth & face
-if akathisia & dystonia first noticed, tardive can be avoided
113. drug induced parkinsonism: tremors, rigidity, akinesia, absence of move- ment w/ diminished
mental state
114. neuroleptic malignant syndrome: potentially fatal reaction, onset from 3-9 days after tx
115. what are the types of personality disorders?: Cluster A Cluster B
Cluster C
116. describe cluster A personality disorders: paranoid, schizoid, shizotypal
-people w/ these disorders tend to demonstrate odd or eccentric behaviors
117. paranoid personality disorder: persistent pattern of suspicion & mistrust in actions or motives
of others
118. s+s of paranoid personality disorder: -suspicious nature, angry or hostile outbursts
-rigid, inflexible nature, often quite efficient
