Mental Health - Test 1 - Ch. 22, 14

Front 1

somatization disorders
-what are hallmarks symptoms of this disorder (4)

Back 1

pain
gastrointestinal symptoms
sexual symptoms
pseudoneurological symptoms

Front 2

what kind of disorder, has physical symptoms that suggest a physical disorder for which there is no demonstratable base

Back 2

somatoform disorder

Front 3

What distinguishes hypochondriasis from other somatoform and anxiety disorders?

Back 3

the extreme worry and fear associated with the possibility of having a disease

Front 4

what disorder results in the misinterpretation of innocent physical sensations as evidence of a serious illness

Back 4

-hypochondriasis:

Front 5

what disorder exhibit an over concern for their health and become preoccupied with symptoms they believe may be serious

Back 5

-hypochondriasis:

Front 6

what disorder has extreme worry and fear with the possibility of having a disease

Back 6

-hypochondriasis:

Front 7

what disorder -u have a headache and u think u have a brain tumor

Back 7

-hypochondriasis:

Front 8

-when testing rules out any organic cause for the pain, and this discomfort leads to significant impairment, what is diagnosed

Back 8

pain disorder

Front 9

A person diagnosed with pain disorder will likely complain of pain in what locations?

Back 9

pain locations often indentified include the
-back,
-head,
-lower limbs,
- temporalmandibular joint,
-pelvis

Front 10

Pain disorder

-not relieved with analgesics

T OR F

Back 10

T

Front 11

what disorder has a preoccupation with an imagined defective body part results in obsessional thinking and compulsive behavior such as mirror checking and camouflaging

Back 11

body dysmorphic

Front 12

what disorder focuses on specific body part and no way of changing your mind that your part is not malformed

Back 12

body dysmorphic

Front 13

what disorder is marked by presence of deficits in voluntary motor or sensory functions, including

-paralysis,
-blindness,
-movement disorder,
-gait disorder,
-numbness,
-paresthesia,
-loss of vision or hearing
-episodes resembling epilepsy

Back 13

conversion disorder:

Front 14

what disorder has anxiety is converted into paralysis

Back 14

conversion disorder:

Front 15

what disorder has "la bell indifference"

Back 15

conversion disorder:

many pts show a lack of emotional concern about the symptoms (person doesn’t care that they are blind or paralyzed ---defining symptom of this disorder)

Front 16

what is the difference between primary gain and secondary gain?

Back 16

primary gain- relief of anxiety

secondary gain- attention they get from others

Front 17

In which type of disorder are the symptoms intentionally induced by the patient?

Back 17

factitious disorders

Front 18

Describe the ability to express feelings and emotional needs in individuals with somatoform disorders.

Back 18

they can not verbalize feelings, especially those related to anger, guilt, and dependence.

Front 19

What is a common nursing diagnosis for individuals with somatoform disorders?

Back 19

ineffective coping

Front 20

What techniques can the nurse teach the patient experiencing a somatoform disorder that will provide the patient with direct means of getting needs met and decreasing the need for symptoms?

Back 20

assertiveness techniques

Front 21

psychoanalytic theorists believe that psychogenic complaints of
-pain,
-illness,
-loss of physical functions

are related to:

examples:
pain
hypochondriasis
conversation

Back 21

repression of a conflict (usually aggressive or sexual nature) and the transformation of anxiety into a physical symtpoms thats related to their conflict



pain- obtaining love/concern from others
or punishment for real or imagined wrong doing

hypochondriassos- anger, aggression, hostility had its source in the past
-need for help/concern from others
-defense against guilt or low self-esteem
-pt views symptoms as "deserved punishment"

conversion- symptoms allow a hidden wish/urge that wants to be expressed
-special treatment/consideration from others

Front 22

Interventions for Somatoform Disorders
-what should the nurse avoid?

Back 22

Avoid + reinforcement for symptoms by frequently assessing after initial assessment

Front 23

Interventions for Somatoform Disorders

Pharmacological Interventions
-what should the nurse monitor?
-what medications show grreat promise in treatment?

Back 23

-Monitor benzodiazepines closely because patients may use them unreliably.
-Antidepressants, especially the SSRIs, are showing the greatest promise.

Front 24

Teach / Somatoform disorders

Back 24

-How to identify and express emotions
-Assertive communication
-Identify stressors
-Stress management and relaxation techniques
-Mild physical exercise

Front 25

what disorder is considered by many doctors to have psychodynamic origins

Back 25

hypochondriasis

Front 26

what disorder- anger, aggression, or hostility has had its source in past losses or dissapointments and is expressed in a need for help and concern from others

Back 26

hypochondriasis

Front 27

What do behaviorists suggest as the cause of somatoform disorders?

Back 27

the learn methods of communication helplessness and manipulate others to care for them.

- the symptoms become more intense when they are reinforced by attention from others.

Front 28

what disorder includes motivation for the behavior to assume the sick role

Back 28

facitious disorder

Front 29

Somatoform or facitious disorder:

Symptoms are not produced intentionally

Back 29

somatoform disorder

Front 30

what disorder:

-Intentionally make up symptoms to get attention
-May even engage in self-harm

Back 30

Munchausen’s (the most severe facitious disorder)

Front 31

What disorder:

-Inflict injury or cause illness to a vulnerable dependent to gain attention, sympathy or excitement from emergency medical staff, other parents

Back 31

Factitious Disorder by proxy or Munchausen’s Disorder by Proxy

Front 32

What disorder:

-Inflict injury or cause illness to a vulnerable dependent to gain attention, sympathy or excitement from emergency medical staff, other parents

Back 32

Factitious Disorder by proxy or Munchausen’s Disorder by Proxy

Front 33

what disorder:

-Intentional fabrication of physical or psychological symptoms for personal gain

Back 33

malingering

Front 34

what disorder:


-Motivated by avoiding work, avoiding criminal prosecution, getting money, getting drugs
-When they get what they want, symptoms cease

Back 34

malingering

Front 35

Etiology of Factitious Disorders
(3)

Back 35

- Childhood hospitalizations for these patients may have been perceived as a refuge from a chaotic home life. (childhood abuse or neglect)

-patients may have a masochistic side and feel a need to be punished through painful procedures.

possible brain dysfunction (impaired information processing)

Front 36

Factitious Disorders:

General principle:
-avoid what?

Back 36

avoid confrontation which may result in the patient’s defensiveness, elusiveness, or exiting the facility

Front 37

Factitious Disorders:

Planning and Implementation
-whats a big issue?

Back 37

-Safety is a major issue
-Patients who may purposefully inflict damage to themselves or others must be carefully monitored, and suspicious activities should be reported.

Front 38

Dissociative, anxiety, somatoform disorders

uncomfortable thoughts/feelings but normal interpretation of body sensations

Back 38

anxiety

Front 39

Dissociative, anxiety, somatoform disorders

c/o somatic distress, abnormal interpretation of bodily sensations but normal patterns of thinking/feeling

Back 39

somatoform

Front 40

Dissociative, anxiety, somatoform disorders

involve disruption of integrated mental functions of consciousness, memory, and identity or perception of environment

Back 40

Dissociative disorder

Front 41

Dissociative, anxiety, somatoform disorders

Criteria:
1.Unconscious defense mechanism to protect against overwhelming anxiety
2.Disturbance in memory, identity and perception
3.Intact reality; no hallucinations or delusions

Back 41

dissociative disorder

Front 42

Types of Dissociative disorders

Response to acute distress, disruption in perception, feeling of detachment or disconnected from mind or body, reality remains intact

Back 42

1. Depersonalization

Front 43

Types of Dissociative disorders

-Inability to integrate memories usually related to trauma

Back 43

Dissociative Amnesia

Front 44

Types of Dissociative disorders

Frequently relocates and assumes a new identity while not recalling his previous identity or where he lived in the past

Back 44

Dissociative Fugue:

Front 45

Types of Dissociative disorders

Inability to maintain one’s identity-->multiple personalities or “subpersonalities

Back 45

Dissociative Identity

Front 46

Comorbidity of dissociative disorders:
-what is common?

Back 46

 Mood disorders and substance-related disorders are commonly associated with all of the dissociative disorders.

Front 47

Etiology of dissociative disorders

Etiology related to psychosocial thoughts (what the learning theory suggests)

Back 47

-The actual cause is unknown, but all are believed to be related to childhood trauma.

-Learning theory suggests dissociative disorders are learned methods for avoiding stress and anxiety, and the more often “tuning out” is used, the more likely it is to become automatic

Front 48

Interventions Dissociative disorders

What should the focus be on?
what should the nurse NOT do?

-what kind of routine should the nurse offer?

Back 48

the here and now
-don't flood with data regarding past events

-a routine that is simple and not demanding

Front 49

Interventions Dissociative disorders

-what should the nurse teach?

-how should the nruse teach prevention strategies for dissociation?

Back 49

-stress management techniques

-help them identify triggers and develop a plan to interrupt (feel the physical world, focus on the here and now, count objects in room)

Front 50

Bipolar disorders

Which anxiety disorder co-occurs the most often with all bipolar disorders, 62% of the time?

Back 50

panic attacks

Front 51

Bipolar I or II disorders

at least one episode of mania alternates with major depression. psychosis may accompany the manic episode

Back 51

bipolar i

Front 52

Bipolar I or II disorders

episode alternate with major depression. psychosis is not present. the hypomania is often euphoric and often increases functioning and the depression tends to put people at risk for suicide

Back 52

bipolar II

Front 53

Bipolar I or II disorders

requires hospitalization

Back 53

depression and mania (I)

Front 54

Bipolar I or II disorders

-no hospitalization

Back 54

depression and hypomania (II)

Front 55

-mania vs hypomanic

-which one requires hospitalization

Back 55

-mania requires hospitalization (hypomania does not require hospitalization)

Front 56

-mania

neurons firing so rapidly that it’s hard to intervene, what must you do with extreme behavior with extreme consequences

Back 56

must induce sleep (w/ benzo Ativan)

Front 57

-triggering mania is taking _____ or _____ which can cause them to flip into mania

Back 57

-triggering mania is taking SSRI or antidepressant which can cause them to flip into mania

Front 58

-mainlining a regular sleep cycle is crucial to managing symptoms of _____ and _____

Back 58

bipolar and depression

Front 59

Bipolar disorders

what has moderately extreme behaviors (hyperverbal, sending 100 emails,

Back 59

hypomania

Front 60

major symptom of mania is ______, which is apparent in ideas expressed and the patients behavior

Back 60

is grandiosity (inflated self- regard) grounded in real life situations

Front 61

Bipolar disorders

-tell me about there thought process and speech patterns

Back 61

flight of ideas (continuous flow of accelerated speech with abrupt changes from topic)

speech is rapid and can be disorganized

Front 62

Bipolar disorder

-cognitive functioning is effective

True or False

Back 62

false, it is not effective

cognitive deficits correlate with a greater number of manic episodes

Front 63

What is the first area a nurse should assess for a patient who is experiencing mania

Back 63

whether the patient is a danger to self and others

Front 64

What is the main theme in treating someone with mania and what is required for effectiveness?

Back 64

limit setting (lights out after 11 pm) is the main theme

consistency among staff is imperative if the limit setting is to be carried out effectively

Front 65

Identify the overall outcome in each of the following three phases of bipolar illness.

Acute:
Continuation:
Maintenance:

Back 65

-Acute Phase: injury prevention
-Continuation Phase (4-9months): relapse prevention
-Maintenance Phase: continue to focus on prevention of relapse and limitation of the severity and duration of future episodes

Front 66

Identify the focus of planning in each of the following three phases of bipolar illness.

Back 66

-Acute Phase: focus on medically stabilizing the pt while maintaining safety (hospital is safest)
-Continuation Phase: focuses on maintaining adherence to the medication regimen and prevention of relapse
-Maintenance Phase: planning focuses on preventing relapse and limiting the severity and duration of future episode

Front 67

-acute phase: requires hospitalization for ____

Back 67

mania

Front 68

What is the major cause of relapse of bipolar disorder?

Back 68

nonadherence to the regiment of mood stabilization medication

Front 69

What medications are the first line of treatment for a person with bipolar disorder experiencing an acute depressive episode?

Back 69

Lithium and lamotrigine (Lamictal)

Front 70

-greatest chance for relapse for mania is what?

Back 70

when the pt goes off medication

Front 71

How long does it take for lithium to reach therapeutic levels in the patient’s blood to be effective and what is given in the mean time?

Back 71

usually takes 7-14 days or longer for some pts (in the mean time an antipsychotic or benzodiazepine can be used to prevent exhaustion, coronary collapse, and death)

Front 72

Identify the therapeutic lithium level range for the acute or active phase of mania and the range for the maintenance blood level.

Back 72

therapeutic level range: 0.8-1.4 mEq/L

maintenance: 0.4-1.3 mEq/L

Front 73

To avoid toxicity, lithium blood levels should not exceed:

Back 73

above 1.5 mEq/L

Front 74

What are two long-term risks of lithium therapy?

Back 74

1)hypothyroidism
2)impairment of the kidneys ability to concentrate urine

Front 75

What are the adverse and toxic effects of the electrical conductivity of Lithium?

Back 75

a potential threat to all body functions regulated by electrical currents
-cardiac contraction
-sinus bradycardia
-extreme alteration of cerebral conductivity with overdose can lead to convulsions

Front 76

lithium has a (high or low) therapeutic index

Back 76

low
-(the ratio of the lethal does to the effective dose and its measure of overall drug safety in regards to overdose or toxicity)