Psychiatric Disorders and Treatments, Exams of Nursing

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NSG 211 PSYCH REVIEW EXAM STUDY GUIDE 2024

 Anger: This is a normal human emotion that results when a person is frustrated, hurt, or

afraid. If handled appropriately, it can be a positive force for resolving conflicts, solving problems, and making decisions.

 Haloperidol (Haldol): It is a first generation anti-psychotic, potential adverse effect of

extrapyramidal symptoms, such as dystonia, akathisia, and pseudoparkin- sonism. It specifically targets positive symptoms of schizophrenia and is a potent dopamine antagonist. It is available as a depot injection for maintenance therapy.

 Aggression Cycle: Triggering - An event or circumstance in the environment initiates the

client's response, which is often anger or hostility. Escalation - The client's responses represent escalating behaviors that indicate movement toward a loss of control. Crisis - During an emotional and physical crisis, the client loses control. Recovery - The client regains physical and emotional control. Postcrisis - The client attempts reconciliation with others and returns to the level of functioning before the aggressive incident and its antecedents.

 Signs of Aggression: Triggering - Restlessness, anxiety, irritability, pacing, mus- cle tension,

rapid breathing, perspiration, loud voice, and anger. Escalation - Pale or flushed face, yelling, swearing, agitation, threatening, demand- ing, clenched fists, threatening gestures, hostility, and loss of ability to solve the problem or think clearly.

2 / 13 Crisis - Loss of emotional and physical control, throwing objects, kicking, hitting, spit- ting, biting, scratching, shrieking, screaming, and inability to communicate clearly. Recovery - Lowering of voice, decreased muscle tension, clearer more rational communication, and physical relaxation. Postcrisis - Remorse, apologies, crying, quiet, and withdrawn behavior.

 Intimate Partner Violence: Mistreatment or misuse of one person by another in context of

emotionally intimate relationship. Can include psychological (emotional), physical, and sexual abuse.

 Cycle of Violence: 1) Violent Episode

2) Honeymoon Period

3)Tension-Building Phase

 Child Abuse: Intentional injury of a child. Can include physical abuse or injuries; neglect or

failure to prevent harm; failure to provide adequate physical or emotional care or supervision; abandonment; sexual assault or intrusion; overt torture or maiming.

 Elder Abuse: Maltreatment of older adults. Can include physical, sexual, and psy- chological

abuse; neglect of self-neglect; financial exploitation; denial of adequate medical treatment.

 Rape and Sexual Assault: Perpetration of act of sexual intercourse with person against his or

her will and without consent.

 Atypical Antipsychotics: Decrease psychotic symptoms in patients with schiz- ophrenia,

schizoaffective disorder, and manic phase of bipolar disorder. They lessen positive and negative symptoms. Inhibit the uptake of serotonin and weaker blockers of dopamine.

3 / 13 Examples: Clozapine (Clozaril), Risperidone (Risperdal), Olanzapine (Zyprexa), Ziprasidone (Geodon), and Lurasidone (Latuda).

 Extrapyramidal Side Effects (EPS): This is a side effect of anti-psychotics (es- pecially first

generation), they are reversible and typically appear early in treatment. Acute Dystonic Reactions - Spasms of the neck, dysphagia, and oculogyric crisis. Akathisia - Restless movement Pseudoparkinsonism - Shuffling gait, muscle stiffness, and cogwheel rigidity.

 Tardive Dyskinesia: This is a side effect of anti-psychotics, it is irreversible and late

appearing. Abnormal, involuntary movements - Lip smacking, tongue protrusion, blinking, gri- macing, and choreiform movements of hands and feet.

 Neuroleptic Malignant Syndrome (NMS): This is a side effect of anti-psy- chotics, it is

serious and frequently fatal. Muscle rigidity, increased muscle enzymes - creatine phosphokinase, high fever, and leukocytosis.

 Schizophrenia: A disorder that causes distorted and bizarre thoughts, per- ceptions,

emotions, movements, and behavior. Categories of symptoms include negative and positive symptoms.

 Schizoaffective Disorder: Diagnosed when a client is severely ill and has a mixture of

psychotic and mood symptoms. The signs and symptoms include those of both schizophrenia and a mood disorder such as depression or bipolar disorder.

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 Positive or Hard Symptoms: Ambivalence - Holding seemingly contradictory beliefs or

feelings about the same person, event, or situation. Associative looseness - Fragmented or poorly related thoughts and ideas. Delusions - Fixed false beliefs that have no basis in reality. Echopraxia - Imitation of the movements and gestures of another person whom the client is observing. Flight of ideas - Continuous flow of verbalization in which the person jumps rapidly from one topic to another. Hallucinations - False sensory perceptions or perceptual experiences that do not exist in reality. Ideas of reference - False impressions that external events have special meaning for the person. Perseveration - Persistent adherence to a single idea or topic; verbal repetition of a sentence, word, or phrase; resisting attempts to change the topic. Bizarre behavior - Outlandish appearance or clothing; repetitive or stereotyped, seemingly purposeless movements; unusual social or sexual behavior.

 Negative or Soft Symptoms: Alogia - Tendency to speak little or to convey little substance of

meaning (poverty of content). Anhedonia - Feeling no joy or pleasure from life or any activities or relationships. Apathy - Feelings of indifference toward people, activities, and events. Asociality - Social withdrawal, few or no relationships, lack of closeness. Blunted affect -

5 / 13 Restricted range of emotional feeling, tone, or mood. Catatonia - Psychologically induced immobility occasionally marked by periods of agitation or excitement; the client seems motionless, as if in a trance. Flat affect - Absence of any facial expression that would indicate emotions or mood. Avolition or lack of volition - Absence of will, ambition, or drive to take action or accomplish tasks. Inattention - Inability to concentrate or focus on a topic or activity, regardless of its importance.

 Delusions: Fixed false beliefs that have no basis in reality.

 Hallucinations: False sensory perceptions or perceptual experiences that do not exist in

reality.

 Thought Insertion: The belief that others are placing thoughts in their mind against their

will.

 Thought Blocking: Client may suddenly stop talking in the middle of a sentence and remain

silent for several seconds to 1 minute.

 Olanzapine (Zyprexa): It is an atypical anti-psychotic. It lessens positive and negative

symptoms of schizophrenia. It inhibits the uptake of serotonin and is a weaker blocker of dopamine. It is available as a depot injection for maintenance therapy. Has a lower risk for extrapyramidal symptoms, but can have other adverse effects, such as weight gain, sedation, orthostatic hypotension, diabetes mellitus, and anticholinergic effects.

 Psychosis: A psychological disorder in which a person loses contact with reality,

6 / 13 experiencing irrational ideas and distorted perceptions.

 Paranoia: An irrational suspiciousness or distrust of others.

 Stress: The wear and tear that life causes on the body. The process by which we perceive

and respond to certain events, called stressors, that we appraise as threatening or challenging.

 Posttraumatic Stress Disorder (PTSD): Disturbing pattern of behavior demon- strated by

someone who has experienced, witnessed, or been confronted with a traumatic event. Response is intense fear, helplessness, and terror.

 Cognitive-Behavioral Therapy (CBT): Positive Reframing - turning negative messages into

positive ones. Decatastrophizing - making more realistic appraisal of situation. Assertiveness Training - learn to negotiate interpersonal situations. It involves exposure and anxiety management. It is a treatment option for PTSD.

 Flashback: A dissociative reaction in which the individual feels or acts as though a traumatic

event is reoccurring.

 Depersonalization: The client has a persistent or recurrent feeling of being detached

from his or her mental processes or body.

 Anxiety: A vague feeling of dread or apprehension. It is unavoidable in life and can serve

many positive functions such as motivating a person to take action to solve a problem or to resolve a crisis. Levels

7 / 13 Mild - Special attention; increased sensory stimulation; motivational. Moderate - Feeling something is definitely wrong; nervousness/agitation; difficulty concentrating; able to be redirected. Severe - Trouble thinking and reasoning; tightened muscles; increased vital signs; restless, irritable, angry. Panic - fight, flight, or freeze response; increased vital signs; enlarged pupils; cognitive processes focusing on defense.

 Selye's General Adaptation: 1) Alarm Reaction Stage - preparation for defense

2) Resistance Stage - blood shunted to areas needed for defense

3) Exhaustion Stage - stores depleted; emotional components unresolved

 Gamma-Aminobutyric Acid (GABA): The amino acid neurotransmitter be- lieved to be

dysfunctional in anxiety disorders. It is an inhibitory neurotransmitter that functions as the body's natural anti-anxiety agent by reducing cell excitability, thus decreasing the rate of neuronal firing.

 Serotonin: Affects mood, hunger, sleep, and arousal. It is a neurotransmitter usually

implicated in psychosis and mood disorders. It is believed to play a distinct role in OCD, panic disorder, and GAD. There is a deficit with depression.

 Systematic Desensitization: Therapist progressively exposes the client to the threatening

object in a safe setting until the client's anxiety decreases.

 Obsessive-Compulsive Disorder (OCD): A disorder characterized by unwant- ed repetitive

thoughts (obsessions) and/or actions (compulsions). It can be mani- fested through many behaviors, all of which are repetitive, meaningless, and difficult to conquer.

 Compulsions: Ritualistic or repetitive behaviors or mental acts that a person carries out

8 / 13 continuously in an attempt to neutralize anxiety.

 Body Dysmorphic Disorder (BDD): Preoccupation with an imagined or slight defect in

physical appearance that causes significant distress for the individual and interferes with functioning in daily life.

 Mania: Is a distinct period during which mood is abnormally and persistently elevated,

expansive, or irritable. Period lasts about 1 week. Common presentation is pressured speech (unrelenting, rapid, often loud talking without pauses) and flight of ideas (racing, often unconnected thoughts). Person often denies problems, places blame on others.

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 Antidepressants: Includes SSRIs, Tricyclic, Tetracyclic, Atypical, and MAOI. They establish a

blockade for the reuptake of norepinephrine and serotonin into their specific nerve terminals. This permits them to linger longer in synapses and to be more available to postsynaptic receptors. They also increase the sensitivity of the postsynaptic receptor sites.

 Lithium: It is a salt contained in the human body and is an antimanic agent used for the

treatment of bipolar disorder. It can be toxic and must be monitored through frequent labs. It is contraindicated for patients with renal disease.

 Suicide Assessment: Previous suicide attempts (the first 2 years after is the highest risk

period, especially the first 3 months); relative who committed suicide Warnings of suicidal intent Risky behavior Lethality assessment

 Histrionic Personality Disorder: A personality disorder in cluster B (erratic or dramatic

behavior), characterized by excessive emotionality and attention seeking; exaggeration of closeness of relationships; insincere and shallow emotions.

 Dependent Personality Disorder: A personality disorder in cluster C (anxious or fearful

behaviors), characterized by a need to be taken care of; submissive and clinging behavior; frequently anxious.

 Anorexia Nervosa: Life-threatening eating disorder characterized by the client's restriction of

nutritional intake necessary to maintain a minimally normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed percep- tion of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even

10 / 13 that one exists. Restricting subtype Binge eating and purging subtype

 Bulimia Nervosa: Eating disorder characterized by recurrent episodes of binge eating

followed by inappropriate compensatory behaviors to avoid weight gain, such as purging, fasting, or excessively exercising. Binging or purging episodes are often precipitated by strong emotions and followed by guilt, remorse, shame, or self-contempt.

 Lorazepam (Ativan): It is a benzodiazepine that can increase the calming ef- fects of the

neurotransmitter GABA. It can affect dopamine levels by creating surges of this neurotransmitter which make the drug addictive to susceptible individuals. An adverse effect is CNS depression.

 Dopamine: A neurotransmitter associated with movement, attention and learn- ing and the

brain's pleasure and reward system. Thought to play a role in mood disorders.

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 Autism Spectrum Disorder (ASD): Pervasive, usually severe impairment of reciprocal social

interaction skills, communication deviance, restricted stereotypical behavioral patterns. Previous pervasive developmental disorder (PDD) now viewed on a continuum: Rett disorder, childhood disintegrative disorder, and Asperger disorder.

 Tourette's: Multiple motor tics, one or more vocal tics, which occur many times a day for

more than 1 year. Tics, movements, or sounds that are repetitive and the individual has no control over. Treatment with antipsychotics, self-care, CBT or talk therapy to help with negative thoughts and emotions.

 Attention-Deficit/Hyperactivity Disorder (ADHD): A disorder characterized by inattentiveness,

overactivity, and impulsiveness. Fidgeting, noisy, disruptive, unable to complete tasks, failure to follow directions, blurting out answers, lost or forgotten homework.

 Frontal Lobe: Essential for attention, impulse control, organization, and sus- tained goal-

directed activity.

 Therapeutic Play: Play techniques are used to understand the child's thoughts and feelings

and to promote communication. Used with ADHD.

 Methylphenidate (Ritalin): A stimulant used in treating ADHD. It reduces hyper- activity,

impulsivity, and mood lability. May cause weight loss and growth delays due to poor nutritional intake.

 Huntington's Disease: A progressive, genetic disease in which degeneration of nerve cells in

the brain occur. Characterized by poor coordination, concentration, and choreiform movements (jerking or writhing movements). There is no cure, but treatment for symptom management and talk therapy is used.

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 Vascular Dementia: Is common in older adults with chronic hypertension, arrhythmias,

and other diseases that may impact blood flow to the brain. Has symptoms similar to those of Alzheimer's disease, but onset is typically abrupt.

 Antipsychotics: May be effective for specific target symptoms such as temper tantrums,

aggressiveness, self-injury, hyperactivity, and stereotyped behaviors for autism and tic disorders. Can be used to decrease agitation and psychotic symp- toms, as well as facilitate sleep in clients with delirium.

 Continuity of Care: Coordination of services provided to patients before they enter a

health care setting, during the time they are in the setting, and after they leave the setting.

 Delirium: A syndrome that involves a disturbance of consciousness accom- panied by a

change in cognition. Usually develops over a short period. Clients have difficulty paying attention, are easily distracted and disoriented, and may have sensory disturbances such as illusions, misinterpretations, or hallucinations.

 Echolalia: Automatic and immediate repetition of what others say.

 Palilalia: Repeating words or sounds over and over.

 Confabulation: Clients make up answers to fill in memory gaps.

 Traumatic Brain Injury (TBI): A traumatic insult to the brain that can cause dementia as a

direct pathophysiological consequence of head trauma. The degree and type of cognitive impairment and behavioral disturbance depend on the location and extent of the brain injury.

 Parkinson's Disease: A slowly progressive neurologic condition characterized by tremor,

rigidity, bradykinesia, and postural instability. It results from loss of neu- rons of the basal ganglia. Characterized by cognitive and motor slowing, impaired memory, and impaired

13 / 13 executive functioning.

 Alzheimer's Disease: A progressive brain disorder that has a gradual onset but causes an

increasing decline in functioning, including loss of speech, loss of motor function, and profound personality and behavioral changes such as paranoia, delusions, hallucinations, inattention to hygiene, and belligerence.

 Donepezil (Aricept): A cholinesterase inhibitor that has shown modest thera- peutic effects

and temporarily slows the progression of dementia. Monitor the patient for nausea, diarrhea, and insomnia. Test stools periodically for gastrointestinal bleeding.

 Reading: Considered a brain-stimulating activity that is proven to make an individual

less likely to develop Alzheimer's disease.

 Reminiscence Therapy: This is an effective intervention for clients with demen- tia. It uses

the client's remote memory, which is not affected as severely or quickly as recent or immediate memory.

 Acetylcholine (ACh): A neurotransmitter involved in learning, memory, arousal, and muscle

movement. It can speed up or slow down nerve signals. Plays a role in development of various forms of dementia.

 Amphetamine (Adderall): A stimulant used for ADHD. Often effective in de- creasing

hyperactivity, impulsiveness, and improving attention. Major adverse effect is insomnia.

 Therapeutic Communication: Verbal and nonverbal communication tech- niques that

encourage patients to express their feelings and to achieve a positive relationship.

 Safety: Involve protecting client's against injury, meeting physiological needs, and

managing risks posed by the environment. It is the priority focus of nursing interventions in mental health nursing.