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88 Cards in this Set
- Front
- Back
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regulates skeletal muscle coordination and the maintenance of equilibrium.
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cerebellum
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Parietal cortex: sensory and motor
Temporal cortex: sound Occipital cortex: vision Frontal lobe: thought processes Basal ganglia: regulation of movement Amygdala and hippocampus: emotions, learning, memory, basic drives |
cerebrum
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Midbrain
Papillary reflex Eye movement Pons Processing station in auditory pathways Medulla oblongata Reflex centers control Balance, heart rate, respirations, coughing Swallowing, sneezing, blood pressure, vomiting |
brainstem
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FINDINGS
Schizophrenia Cortical; atrophy Third ventricle enlargement Cognitive disorders Abnormalities MRI |
CT
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FINDINGS
Schizophrenia Enlarged ventricles Reduction in temporal lobe and prefrontal lobe |
MRI
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FINDINGS
Schizophrenia Increased D2, D3 receptors in caudate nucleus Abnormalities in limbic system Mood disorder Abnormalities in temporal lobes Adult attention deficit hyperactivity disorder Decreased utilization of glucose |
PET
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DA, NE, 5-HT, Histamine
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Monoamines
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GABA
Glutamate |
Amino acids
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SP
SRIF NT |
peptides
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Effects
Fine muscle movement Integration of emotions and thoughts Decision making Stimulates hypothalamus to release hormones (sex, thyroid, adrenal) Decrease Parkinson’s Disease Depression Increase Schizophrenia- excess amount of dopamine Mania |
monoamine: dopamine
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Inhibits release of prolactin from the anterior pituitary gland
Leads to increased pituitary secretion of prolactin In women Amenorrhea (absence of menses) Galactorrhea (milk flow) In men Gynecomastia (development of male mammary glands) |
dopamine
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is a neurotransmitter found in areas of the brain responsible for decision making and integrating thoughts and emotions.
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dopamine
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Receptors
A1, A2, B1, B2 Effects Level in brain affects mood Stimulates sympathetic branch of ANS for “fight or flight” in response to stress. Decrease Depression Increase Mania Anxiety states Schizophrenia |
monoamine (norephrine) NE
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Receptors
5-HT1, 5HT2, 5HT3, 5HT4 Effects Plays a role in sleep regulation, hunger, mood states, and pain perception Plays a role in aggression and sexual behavior Decrease Depression, causes aggresion Increase Anxiety states |
monoamine serotonin
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Receptors
H1, H2 Effect Alertness Inflammatory response Stimulates gastric secretions Decrease Depression Sedation Weight gain |
monoamine histamine
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Effect
Plays a role in inhibition; reduces aggression, excitation, and anxiety May play a role pain perception Has anticonvulsant and muscle relaxing properties Decrease Anxiety Disorders Schizophrenia Huntington’s Chorea Increase Reduction of Anxiety * Clients with medications that potentiate the action of ___ is expected to experience reduced anxiety |
amino acid GABA
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NMDA, AMPA
Effects Is excitatory Plays a role in memory Decrease (NMDA) Psychomimetic state that resembles schizophrenia Increase (AMPA) Improvement of cognitive performance in behavioral tasks |
glutamate Amino acid
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Receptors
Nicotinic, Muscarinic (M1, M2, M3) Effects Plays a role in learning, memory Regulates mood; mania, sexual aggression Affects sexual and aggressive behavior Stimulates parasympathetic nervous system Decrease Alzheimer’s disease Huntington Chorea Increase Depression |
cholinergic acetycholine
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The nurse could anticipate that the treatment plan for a client with memory difficulties might include orders to administer medications to prevent destruction of acetylcholine by _____ resulting in higher levels of acetycholine, with potential for improved memory
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anticholinesterase
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Drugs
(Tacrine (Cognex), Donepezil (Aricept), Memantine (Namenda, Ebixa) Be aware of side effects |
anticholinesterase drugs
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Substance P (SP)
Somatostatin (SRIF) Neurotensin NT |
peptides neuromodulators
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Effects
Centrally active SP antagonist has antidepressant and antianxiety effects in depression Involved in regulation of mood and anxiety Role in pain management Promotes and reinforces memory Enhances sensitivity to pain receptors to activate |
substance p (SP)
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Altered levels associated with cognitive disease
Decrease Alzheimer’s disease Decreased levels of SRIF found in spinal fluid of some depressed clients Increase Huntington’s chorea |
somatostatin (SRIF)
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Endogenous antipsychotic-like properties
Decreased levels found in spinal fluid of schizophrenic clients |
Neurotensin (NT)
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Deficiency of norepinephrine
Deficiency of serotonin Deficiency of both |
DEPRESSION
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Excess transmission of dopamine
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schizophrenia
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Deficiency of g-aminobutyric acid (GABA
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anxiety
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These drugs also act as antagonists at muscarinic receptors for acetylcholine, 1 receptors for norepinephrine, and H1 receptors for histamine.
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1st gen antipsychotics
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Blocking ___ reduces the positive symptoms of schizophrenia such as delusions and hallucinations
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dopamine
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These drugs are strong antagonists of the D2 receptors for dopamine.
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1st gen. antipsychotics
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blockade gives rise to motor disturbances, including parkinsonism, akinesia, akathisia, dyskinesia, and tardive dyskinesia (p.408-9).
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dopamine
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effects such as blurred vision, dry mouth, constipation, and urinary hesitancy
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Muscarinic receptor blockage leads to anticholinergic
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is responsible for vasodilation and a consequent orthostatic hypotension, and for ejaculatory failure as well.
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Blockade of 1 receptors for norepinephrine
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contributes to sedation and substantial weight gain.
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Blockade of H1 receptors
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Bind to dopamine receptors in the limbic system
Preferentially over dopamine receptors in the limbic system Decrease motor side effects |
atypical antipsychotics
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Possibly fatal side effects
Agranulocytosis, convulsions, myocarditis May induce agranulocytosis, so frequent white blood cell (WBC) counts are required. It may also induce convulsions in a small percentage of clients. Common side effects are drowsiness, hypersalivation, tachycardia, and dizziness. Danger of agranulocytosis removes it from first-line usage. Other side effects Drowsiness, sedation, hypersalivation, tachycardia, dizziness Side effects Motor difficulties, orthostatic hypertension, sedation |
Clozapine
atypical antipsychotics |
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Reduces delusions and hallucinations. Blocks 1 and H1 receptors and can cause orthostatic hypotension and sedation.
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Risperidone
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Broad receptor binding profile produces sedation and weight gain along with symptoms associated with muscarinic and 1 blockade.
Extrapyramidal symptoms are few. |
Quetiapine Seroquel
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Same profile as clozapine but without agranulocytosis. Major disadvantage is weight gain.
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Olanzapine/ zyprexa
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A serotonin-norepinephrine reuptake inhibitor. The major side effects are hypotension and sedation. One major safety concern is prolongation of the QTc interval, which can be fatal if a client has a history of cardiac arrhythmia.
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Ziprasidone
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A unique atypical known as a dopamine system stabilizer.
Side effects include sedation, hypotension, and anticholinergic effects. No weight gain no increase in sugar/triglycerides |
Aripiprazole/abilify
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Lithium
Antiepileptic drugs Carbamazepine (Tegretol) Divalproex (Depakote) Lamotrigine (Lamictal) Gabapentin (Neurontin) Topiramate (Topamax) Clonazepam (Klonopin) |
mood stabilizers
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The mechanism of action is unknown but is probably related to affecting electrical conductivity in neurons.
It may interact with sodium and potassium at the cell membrane to stabilize electrical activity. Such a mechanism of action would explain its ability to induce cardiac dysrhythmias, convulsions, and tremor. ___ can also create fluid balance disturbances. For these reasons it has a low therapeutic index (ratio of lethal dose to effective dose) and requires close monitoring of serum |
lithium
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These alter electrical conductivity in membranes and reduce the firing rate of very-high-frequency neurons in the brain.
This action may account for their use in reducing mood swings in bipolar clients. Drugs in this group include carbamazepine (Tegretol), divalproex sodium (Depakote), and clonazepam (Klonopin), which has strong sedating properties. |
antiepileptic drugs
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is structurally similar to the tricyclic antidepressants. It treats unipolar depression.
It is particularly effective in conditions such as trigeminal neuralgia. The efficacy of the drug as an analgesic may be related to its ability to reduce the firing rate of overexcited neurons as well as to its ability to calm the accompanying psychological agitation associated with the pain. Some common side effects include nausea, sedation, and ataxia. The therapeutic blood level is monitored regularly. |
Carbamazepine (Tegretol)
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is an anticonvulsant.
It is structurally different from other anticonvulsants and psychiatric drugs. It is effective in treating manic depression. Common side effects include hair loss, tremor, weight gain and sedation. A baseline of liver function tests and CBC are done before an individual is started on this medication and periodically. Monitoring of the therapeutic blood level is done regularly as well. |
Divalproex (Depakote)
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is structurally a benzodiazepine, a type of antianxiety medication.
It has strong sedating properties, which may account for its ability to calm a patient in the manic phase of a bipolar disorder. It may be used with lithium to increase the time between mood cycles, and it may also be used as part of a multiple-drug regimen to treat clients who show a mixture of anxious and depressive symptoms concomitantly . The serious drawback with _____ is that clients can develop tolerance and dependence. Baseline lab studies include CBC, liver function, and renal function tests. |
Clonazepam (Klonopin)
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a transmission deficiency of norepinephrine or serotonin or both within the limbic system.
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Antidepressants
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Tricyclic antidepressants (TCAs)
Amitriptyline (Elavil) Imipramine (Tofranil Nortriptyline (Pamelor) |
anti depressants
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act primarily by blocking reuptake of norepinephrine and, to a lesser degree, serotonin; thus norepinephrine is not degraded by monoamine oxidase (MAO), and more stays at the synapse.
____ block muscarinic receptors, giving anticholinergic effects. Some ___ block H1 receptors in the brain, producing drowsiness. Figure 3-13 identifies the types of side effects that a person may experience when specific transmitters are blocked or bound (p. 55) (patient |
Amitriptyline, imipramine, and nortriptyline—tricyclic antidepressants (TCAs)
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Fluoxetine (Prozac)
Sertraline (Zoloft) Paroxetine (Paxil) Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine, sertraline, paroxetine, and citalopram block the reuptake of serotonin with little or no effect on the other monoamine transmitters. These drugs have less ability to block muscarinic and H1 receptors than do the tricyclics (TCAs). |
Selective serotonin reuptake inhibitors (SSRIs
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Isocarboxazid (Marplan)
Phenelzine (Nardil) Tranylcypromine (Parnate) Phenelzine and tranylcypromine: Monoamine neurotransmitters, as well as any monoamine food substance or drug, are degraded by the enzyme MAO. |
Monoamine oxidase inhibitors (MAOIs)
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These drugs act by inhibiting the enzyme ___, interfering with the destruction of monoamine neurotransmitters and increasing the synaptic level of the transmitters.
In the presence of ____ tyramine is not destroyed in the liver, resulting in hypertensive crisis. Thus when ___ are taken, the client must observe a tyramine-free diet. |
MAOIs
Monoamines (norepinephrine, epinephrine, dopamine, tyramine) Monoamine oxidase Monoamine oxidase inhibitors |
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is a weak antagonist of muscarinic receptors so produces few anticholinergic effects.
However, it blocks 1 and H1 receptors, causing orthostatic hypotension and sedation. |
Trazodone
anti dep |
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blocks reuptake of both norepinephrine and serotonin, but does not block muscarinic, 1, or H1 receptors.
It may produce feelings of anxiety, nausea, vomiting, and dizziness |
Venlafaxine anti dep
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acts on 5-HT2 and 2 presynaptic norepinephrine receptors, accounting for its antidepressant effect.
Side effects of sedation, weight gain, dry mouth, and constipation are related to its actions as an antagonist at H1 and muscarinic receptors. |
Mirtazapine
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Benzodiazepines
Diazepam (Valium) Clonazepam (Klonopin) Alprazolam (Xanax) Flurazepam (Dalmane) Triazolam (Halcion) |
Antianxiety/Anxiolytic Drugs
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reduces anxiety without strong sedative-hypnotic effects. Its action is unclear, but it may block presynaptic 5-HT1 receptors, preventing negative feedback and allowing more transmitter to be released.
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Buspirone (BuSpar)
Buspirone |
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Tacrine (Cognex)
Donepezil (Aricept) Memantine (Namenda) |
alzeiherms
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Major concerns
Potential long-term effects Nerve damage Kidney damage Liver damage Possibility of adverse chemical reactions With other substances With conventional medications |
herbal medicines
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To provide a standardized nomenclature and language for all mental health professionals
To present defining characteristics or symptoms that differentiate specific diagnoses To assist in identifying the underlying causes of the disorder |
DSM-IV-TR
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identifies all major psychiatric disorders except mental retardation and personality disorders.
Examples include depression, schizophrenia, anxiety, and substance-related disorders. |
axis 1
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s for reporting mental retardation and personality disorders (examples: antisocial PD, dependent PD, Obsessive compulsive PD, etc.) as well as prominent maladaptive personality features and defense mechanisms
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axis 2
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(are diagnosed when a personality traits become inflexible and maladaptive and significantly interfere with how a person functions in society or cause the person emotional distress).
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axis 2
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is for reporting current medical conditions that are potentially relevant to understanding or managing the person’s mental disorder as well as medical conditions that might contribute to understanding the person.
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axis 3
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is for reporting psychosocial and environmental problems that may the diagnosis, treatment, and prognosis of mental disorders.
Included are problems with primary support group, social environment, education, occupation, housing, economics, access to health care, and legal system. |
axis 4
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presents a Global Assessment of Functioning (GAF), which rates the person’s overall psychological functioning on a scale of 0-100. This represents the clinician’s assessment of the person’s current level of functioning; the clinician also may give a score for prior functioning (for instance, highest GAF 6 months ago).
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axis 5
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is the unconscious transformation of anxiety into a physical symptom with no organic cause.
Often the symptom functions to gain attention or as an excuse Adaptive Use A student is unable to take the final examination because of a terrible headache Maladaptive Use A man becomes blind after seeing his wife flirt with other men |
conversion
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is used to make up for perceived deficiencies and cover shortcomings related to these deficiencies to protect the conscious mind from recognizing them.
Adaptive A shorter-than-average man becomes assertively verbal and excels in business Maladaptive An individual drinks alcohol when self-esteem is low to temporarily diffuse discomfort. |
compensation
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is the process by which the outside world is incorporated or absorbed into a person’s view of self.
Adaptive Use After his wife’s death, a man has transient complaints of chest pains and difficulty breathing-the symptoms his wife has before she died. Maladaptive Use A Young child whose parents were overcritical and belittling grows up thinking that she is no good. She has taken on her parents’ evaluation o her as part of her self-image. |
introjection
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is the first-line psychological defense anxiety.
It is the temporary or long-term exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness. This happens at an unconscious level. Adaptive Use A man forget his wife’s birthday after a marital fight. Maladaptive Use A woman is unable to enjoy sex after having pushed out of awareness a traumatic sexual incident from childhood. |
repression
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involves escaping unpleasant, anxiety-causing thoughts feelings, wishes, or needs by ignoring their existence
Adaptive Use A man reacts to news of death of a loved one by saying “No, I don’t believe you. The doctor said he was fine.” Maladaptive Use A woman whose husband died 3 years earlier still keeps his clothes in the closet and talks about him in the presence tense. |
denial
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refers to the unconscious rejection of emotionally unacceptable features and attributing them to other people, objects, or situations.
You can remember this defense through childhood retort of “What you say is what you are.” Adaptive Use A man who is unconsciously attracted to other women teases his wife about flirting. Maladaptive Use A woman who has repressed an attraction toward other women refuses to socialize. She fears another woman will make homosexual advances toward her. |
projection
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is the transference of emotions associated with a particular person, object, or situation onto another person, object, or situation that is nonthreatening
Adaptive Use A patient criticizes a nurse after his family fails to visit Maladaptive Use A child who is unable to acknowledge fear of his father becomes fearful of animals |
displacement
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is a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment.
It may result in a separation between feeling and thought. This can also manifest itself in compartmentalizing uncomfortable or unpleasant aspects of oneself. Adaptive Use An art student is able to mentally separate herself from the noisy environment as she becomes absorbed in her work. Maladaptive Use As the result of an abusive childhood and the need to separate from its realities, a woman finds herself perpetually in a world where she feels disconnected from reality |
dissociation
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formation is when unacceptable feelings or behaviors are controlled and kept out awareness by developing the opposite behavior or emotion
Adaptive Use A recovering alcoholic constantly preaches about the evils of drink Maladaptive Use A woman who has an unconscious hostility toward her daughter is overprotective and hovers over her to protect her from harm, interfering with her normal growth and development |
reaction
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is a process in which events are analyzed based on remorse, cold facts and without passion, rather than incorporating feeling and emotion into the processing.
Adaptive Use Despite the fact that a man has lost his farm to a tornado, he analyzes his options and leads his child to safety. Maladaptive Use A man responds to the death of his wife by focusing on the details of day care and operating the household, rather than processing the grief with his children. |
Intellectualization
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is attributing to oneself the characteristics of another person or group.
This may be done consciously or unconsciously. Adaptive Use An 8-year-old girl dresses up like her teacher and puts together a pretend classroom for her friends. Maladaptive Use A young boy thinks a neighborhood pimp with money and drugs is someone to look up to. |
identification
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is an unconscious process of substituting mature, constructive, and socially acceptable activity for immature, destructive, and unacceptable impulses.
Often these impulses are sexual or aggressive. Adaptive Use A woman who is angry with her boss writes a short story about a heroic woman. Maladaptive Use The use of sublimation is always constructive |
Sublimation
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is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image.
Aspects of the self and of others tend to alternate between two poles, for example, either good, loving, worthy, and nurturing or bad, hateful, destructive, rejecting, and worthless. Adaptive Use A toddler views her parents a superhuman and want to be like them. Maladaptive. A 26-year-old woman has difficulty maintaining close relationships. Despite the fact that she can initially find many positive qualities about new acquaintances, eventually she becomes disillusioned when they turn out to be flawed. |
splitting
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is most commonly seen in children.
It is when a person makes up for an act or communication Adaptive Use After flirting with her male secretary, a woman brings her husband tickets to a concert he want to see. Maladaptive Use A man with rigid, moralistic beliefs and repressed sexuality is driven to wash his hands to gain composure when around attractive women |
undoing
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is the conscious denial of a disturbing situation or feeling. For example, Jessica has been studying for the state board examination for a week solid.
She say’s “I won’t worry about paying my rent until after my examination tomorrow.” Adaptive Use A businessman who is preparing to make an important speech later in the day is told by his wife that she wants a divorce. Although visibly upset, he puts the incident aside until after his speech, when he can give the matter his total concentration. Maladaptive A woman feels a lump in her breast shortly before leaving for a 3-week vacation puts the information in the back of her mind until after returning from her vacation. |
suppresion
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consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener.
Adaptive Use An employee say’s “ I didn’t get the raise because the boss doesn’t like me.” Maladaptive Use A man who thinks his son was fathered by another man excuses his malicious treatment of the boy by saying, “He is lazy and disobedient.” when that is not the case. |
Rationalization
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is reverting to an earlier, more primitive and childlike pattern of behavior that may or may not have been previously exhibited.
Adaptive Use A 4-year old boy with a new baby brother starts sucking his thumb and wanting a bottle. Maladaptive Use A man who loses a promotion starts complaining to others, hands in sloppy work, misses appointments, and comes in late for meetings |
Regression
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Use a low-pitched voice; speak slowly.
Reinforce reality if distortions occur(e.g.) seeing objects that are not there or hearing voices when no one is present. Listen for themes in communication. Attend to physical and safety needs as necessary(e.g., need for warmth, fluids, elimination, pain relief, family contact). KNOW RATIONALES |
Interventions for Severe to Panic Anxiety
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Maintain a calm manner.
Always remain with the patient person experiencing an acute severe to panic level of anxiety. Minimize environmental stimuli. Move to a quieter setting and stay with the client. |
Interventions for Severe to Panic Anxiety
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Ask questions to clarify what is being said.
Help the patient identify thoughts or feelings before the onset of anxiety. Encourage problem solving with the patient. Assist in developing alternative solutions to a problem. Explore behaviors that have worked off excess energy (e.g., walking, playing ping-pong, dancing, exercising). |
Interventions for Mild to Moderate
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Help the patient identify anxiety.
Anticipate anxiety provoking situations. Use nonverbal language to demonstrate interest. Encourage the patient to talk about his or her feelings. Avoid closing off avenues of communication that are important for the client. |
Interventions for Mild to Moderate
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