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125 Cards in this Set
- Front
- Back
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Bipolar disorder is:
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A brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.
Patients tend to alternate between extreme manic and depressive states |
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Bipolar I is classified/diagnosed by:
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1. AT LEAST 1 MANIC EPISODE W/O HAVING A DEPRESSIVE EPISODE
2. HYPOMANIC STATE WITH AT LEAST ONE PREVIOUS MANIC OR MIXED EPISODE, OR 3. CURRENT MANIC EPISODE WITH AT LEAST ONE MAJOR DEPRESSIVE EPISODE |
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Bipolar II is classified/diagnosed by:
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Presence or history of one or more depressive episodes with at least one manic or hypomanic episode
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What distinguishes a bipolar disorder from a unipolar disorder?
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The presence of mania
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Hypomania is defined as:
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Same symptoms of having a manic episode but not severe enough to cause marked impairment in social or occupational functioning (not delusional).
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What is a manic episode?
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An abnormally and persistently elevated, expansive or irritable mood lasting 1 week.
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Symptoms that can be present during a manic episode:
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Grandiosity
Hyperverbal and pressured speech Flight of Ideas Distractability Insomnia or decreased need for sleep Increased goal directed activity Psychomotor agitation Excessive involvement in pleasurable activities that have high potential for painful consequences Impairment in occupational functioning or in social activities/relationships |
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During the nursing assessment what may the nurse expect to see in a patient having a manic episode?
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Very poor social judgment
Impulsive Violence Substance abuse Intrusive |
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What is a common disorder associated with anxiety?
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Depression
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What nursing interventions would the nurse implement for a bipolar patient with manic episodes?
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Decrease stimuli
Set limits Avoid competition Redirect violent behavior Use firm calm approach and short concise explanations Be neutral Listen to legitimate complaints Be consistent Protect patient from consequences of poor judgment |
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What is limit setting?
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The ability to contain or diminish inappropriate behavior in a positive professional manner maintains self esteem & establishes personal boundaries.
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What medications is given as the first line mood stabilizer?
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Lithium
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What is important to monitor when administering lithium & why?
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Blood levels of lithium, because it has a narrow therapeutic window (0.5-1.5)
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What are the signs and symptoms of lithium toxicity?
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Confusion, slurred speech, ataxia (primary indicator)
Cardiovascular collapse & liver failure Course tremors Moderate diarrhea |
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What are common side effects associated with lithium?
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• Fine intentional tremors
• Thirst • Polyuria • Weight gain & edema • Mild diarrhea • Muscle weakness • Abdominal discomfort |
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What should the nurse include when teaching about lithium?
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Adequate fluid intake (3L per day)
Awareness of heavy sweating to replace fluids & electrolytes Take with food or milk Don't change salt intake (lithium is a salt) S/S of toxicity |
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What kinds of drugs interact with Lithium?
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Any drug that affects sodium levels
(e.g. diuretics, low salt-diet, NSAIDS, Haldol, Aminophlline) |
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18. The nurse is preparing to administer lithium (eskalith) to a client w/ bipolar disorder. The client complains of nausea and muscle weakness and his speech is slurre.d His lithium level is 1.6 mEq/L. What is the best action for the nurse to take ?
• Chart the clients symptoms after giving the lithium • Explain that these are common s/e • Withhold the client’s lithium • Administer a PRN antiparkinsonian drug |
Withhold the client’s lithium
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What is defined as uncomfortable feeling that occurs in response to the fear of being hurt or losing something valued?
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Anxiety
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To protect against anxiety, people use:
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coping behaviors
ineffective coping behaviors physical activity |
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Unconscious attempts to manage anxiety are referred to as:
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Defense mechanisms
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What disorder is characterized by persistent anxiety, excessive worrying about everyday concerns, and other symptoms like sleep disturbances, muscle tension, overall fatigue and irritability?
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Generalized anxiety disorder
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The highest level of anxiety, characterized by disorganized thinking, feelings of terror and helplessness, non-purposeful behavior. Person believes he/she is about to die, losing control, about to “go crazy”.
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Panic attack
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Symptoms of a panic attack include:
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SOB, choking or smothering sensation, sweating
Hypotension, dizziness, chest pain, palpitations, chills, hot flashes Nausea Agitation, poor motor coordination, involuntary movements, entire body trembling, facial expression of terror Feeling of losing control, fear of dying Completely disrupted perceptual field |
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When is someone diagnosed with a panic disorder?
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When there are recurrent panic attacks, which are often related to stressful events, as well as other psychiatric symptoms include:
widespread catastrophic thinking phobia like avoidance anxiety depression obsession |
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What is the variation of the panic disorder in which panic attacks awaken person and usually occur within one to four hours after falling asleep, usually during non REM sleep?
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Nocturnal panic
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If avoidance of physical dangers is generalized to situations other than realistic dangers, and the person demonstrates
o Unreasonable behavioral response o Persistent fears o Avoidance behavior o Disabling behavior they are said to have: |
Phobia
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Fear of being away from home and of being alone in public places when assistance might be needed and where escape might be difficult.
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Agoraphobia
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Persons with this disorder often exhibit hyperalertness, resulting from a need to constantly search the environment for danger. They may feel detached from other, develop a socially-isolated lifestyle and may experience flashbacks
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PTSD (Post traumatic stress disorder)
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The condition experienced by sufferers of PTSD and abuse in which the sense of self is shattered or not developed at all
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Self-devaluation
**Being treated like an object leads to feelings of dehumanization Repetitive childhood trauma interferes with developmental organization of the personality |
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The severity of which disorder is classified as follows:
o Mild: less than 1 hr/day o Moderate: 1-3 hrs/day o Severe: 3-8 hrs/day o Extreme: nearly constant |
Obsessive-Compulsive Disorder
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What are defined as unwanted, repetitive thoughts that lead to feelings of fear, anxiety, or guilt, such as the thought of killing someone?
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Obsessions
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What are defined as behaviors (freq. hand washing) or thoughts (silently counting) used to decrease the fear of guilt associated with obsessions?
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Compulsions
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Prior to being diagnosed with PTSD, a person may be diagnosed with what preliminary disorder that begins within a month of traumatic event, lasts at least 2 days, goes away within 4 weeks (> 4 weeks, diagnosis is upgraded to PTSD)
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Acute stress disorder
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A person who has difficulty parting with possessions, resulting in extreme stress and functional impairments has:
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Hoarding disorders
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Anxiety disorders are much more likely to occur in:
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Women
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The disorder that has equal prevalence in both men an women is:
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Obsessive-compulsive disorder
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Anxiety, OCD, trauma, and stressor related disorders all have:
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Genetic and Neurobiological links
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The type of anxiety is related to current use of a chemical substance, or to withdrawal effects from a substance, such as alcohol:
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Substance-induced anxiety
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This therapy helps the patient identify negative thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace negative self-talk.
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Cognitive behavioral therapy
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Behavioral therapy technique that involves exposing the patient to a great deal of an undesirable stimulus in an attempt to turn off the anxiety.
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Flooding
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Behavioral therapy technique that allows a patient to see a demonstration of appropriate behavior in a stressful situation
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Modeling
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Therapy for clients who have PTSD that encourages eye focus on a separate stimuli while thinking of or talking about the traumatic event.
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Eye Movement Desensitization and Reprocessing Therapy
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The origin of this disorder is usually severe, sadistic, and often sexual, child abuse. It is characterized by alteration in conscious awareness of behavior, affect, thoughts and memories, and identity, particularly in the consistency of personality, and sufferers usually display defense mechanisms of repression and dissociation.
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Dissociative disorder
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Persons who suffer with these types of disorders are often obsessively interested in bodily processes and diseases, and demonstrate hypochondriasis. Individually, they include pain disorder, conversion disorder, body dismorphic disorder, and somatization disorder
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Somatoform disorders
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The most severe and chronic form of this disorder is Munchausen Syndrome; sufferers are extremely vague and inconsistent about their medical histories and will produce physical/psychological symptoms in order to assume the sick role.
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Factitious
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When person intentionally produces false physical or psychological symptoms; motivation is external incentives: sick leave from work, financial compensation, obtaining drugs…
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Malingering
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With comorbid disorders, there is a high correlation between what two disorders?
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Anxiety and substance-abuse
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What condition typically follows the onset of anxiety?
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Depression
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Some medical conditions, such as COPD and restless leg syndrome are associated with
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High levels of anxiety
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What disorder may be related to streptococcal infections, autoimmune diseases such as rheumatic fever and lupus, brain tumors, or head trauma.
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Obsessive-compulsive disorders
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Heritability for anxiety disorders:
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30-40%
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which gene takes NE and DA back into presynaptic neurons, is found on chromosome 16, and plays into social phobia.
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Norepinephrine transporter gene
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Which disorder has a significant genetic component estimated at 51%. The more severe the disorder, the stronger the genetic influence
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Social phobia
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People with this disorder have low cortisol levels and an overabundance of epinephrine and NE
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PTSD
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people who are __________ have an overly responsive autonomic nervous system related to dysfunction of serotonin, NE, DA, and GABA
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anxious
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For people with these types of disorders, stressful life events are disowned and kept out of conscious awareness by amnesia.
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Dissociative
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A disproportionate number of women experience this disorder, having been reinforced to behave dependently, passively, submissively.
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agoraphobia
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Which medications are mainstay for pharmacological treatment of anxiety disorders?
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Antidepressants
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Which Serotonin Non-reuptake inhibitor (SNRI) antidepressants, are FDA approved for Generalized Anxiety Disorder (GAD)?
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Venlafaxine
Escitalopram |
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Which antipsychotic can be added to the patient's drug regimen if SNRIs are not effective enough alone?
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Zyprexa (olanzapine)
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What nonbenzodiazepine antianxiety agent is more effective than benzos in managing GAD, by blocking norepinephrine receptors and causing minimal sedation? It is great for those who may be addicts or self medicate.
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Buspirone
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The most effective tricyclic antidepressant used for GAD:
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imipramine
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SSRIs (Selective Serotonin reuptake inhibitors) are becoming the first line of defense medication for treating:
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Panic disorders
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Which beta blockers are given to treat social phobias severe enough to interfere with occupational functioning?
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Propranolol and Atenolol
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What antibiotic as been shown to reduce fear in people who suffer from specific phobias?
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Cycloserine
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Fluoxetine
Sertraline Fluvoxamine Citalopram and Paroxetine are all SSRIs used to treat: |
Obsessive Compulsive Disorder
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Which antihypertensive seems to counteract the excessive brain activity in PTSD?
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Prazosin
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What must children and adolescents be carefully assessed for when taking antidepressants?
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Suicidal thoughts
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Benzodiazepines are not recommended for what age group?
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Older adults
***Celexa is drug of choice for older adults with anxiety disorders |
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Type of cognitive behavioral therapy in which clients are exposed in reality or in their mind, to feared situations or objects for about 30 minutes. This is followed by instructions to try and refrain from or delay usual phobic/ritualistic response for 2 more hours.
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Exposure and response prevention
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The symptoms of PTSD have been shown to improve with:
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Repetitive Transcranial Magnetic Stimulation
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When performing an assessment on a patient with anxiety, dissociative, or somatoform disorder what should the nurse remember?
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Pt may not reveal information unless nurse asks direct, specific questions.
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Children with this disorder may follow parent around house, needing to be close at all times. May refuse to go to school.
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Separation Anxiety Disorder
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Children with this disorder have steady failure to speak in specific social situations in which speaking is expected; may be unable to speak face to face, but can speak over the phone.
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Selective mutism
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Children with this disorder are developmentally inappropriate in social situations; it results from parental inexperience, extreme poverty, or prolonged institutionalization of child.
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Reactive attachment disorder
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Children with this disorder may obsessively redo school work out of an excessively high standard of achievement and is unrealistic.
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Generalized Anxiety Disorder
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In children, this disorder is preceded by or comorbid with separation anxiety disorder and is often accompanied by phobias, such as fear of dark, monsters, bugs…etc
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Panic disorder
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Can manifest in children who experience natural disasters, war, unexpected personal tragedies, ongoing interpersonal violence.
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PTSD
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Postmenopausal women can suffer from:
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Panic attacks
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In older adults, anxiety is often associated with
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medical illness
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When experiencing this level of anxiety, people are agreeable with a pleasant increase in tension. Helps people deal constructively with stress. Motivates learning.
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Mild anxiety
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When experiencing this level of anxiety HR increases, BP rises, SOB, pupils dilate, sweating, fearful facial expression, tense muscles, restlessness. People experience dry mouth, stiff neck, fatigue, inability to relax, diarrhea, constipation, urinary hesitancy.
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Severe
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When experiencing this level of anxiety, the person may become pale, hypotensive, quavering voice, agitation, poor motor coordination, body trembling, face of terror, dilated pupils, lightheadedness, n/v, chest pain, smothering sensation…
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Panic
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The major defense mechanism for people with somatoform disorders is:
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Denial
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Persons with phobias or OCD realize that their responses are unreasonable and irrational; are of, or pertaining to, aspects of one's behavior or attitudes viewed as inconsistent with one's fundamental beliefs and personality. This type of cognition is called:
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Egodystonic
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Therapeutic methods used to uncover abuse and trauma of DID. Goal is to have patient discover that the various personalities are real and distinct, but are not separate individuals.
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Individual psychotherapy and hypnosis
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Theorists view which condition as a learned response to anticipatory anxiety.
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Obsessive-Compulsive
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Women are more likely to suffer from this condition, although currently, men are more likely to be diagnosed:
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PTSD
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For people suffering from PTSD, high levels of adrenaline and stress hormones cause:
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Memory traces to be deeply imprinted
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This part of the brain is releases stress hormones and intensifies stressful memories in persons with PTSD, whenever traumatic events are recalled
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Amygdala
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Persons with OCD have been shown to have a neurobiological abnormality in the pathway that links which two parts of the brain?
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Orbitofrontal cortex and Basal Ganglia
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People with this disorder have a higher than normal glucose metabolism in portions of sensory cortex in temporal, parietal, occipital lobes
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Depersonalization disorder
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The central nervous system's physiological and emotional response to a vague sense of threat or danger
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Anxiety
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The neurotransmitter gammaamnobutyric acid, whose low activity has been linked to generalized anxiety disorder
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GABA
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A neurotransmitter whose abnormal activity is linked to panic disorders and depression
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Norepinephrine
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A neurotransmitter whose abnormal activity is linked to depression, ocd, and eating disorders
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Serotonin
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An ego defense mechanism wherby a person unconsciously cancels out an unacceptable desire or act by performing another act
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Undoing
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When is anxiety considered a disorder?
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when symptoms interfere with a person's ability to sleep or otherwise function. Generally speaking, anxiety occurs when a reaction is out of proportion with what might be normally expected in a situation.
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Alert, tense, restless, and selective inattention
Narrowing of perceptual field Focus on present Selective inattention - blocking out of extraneous sensory stimuli Twitching eyelid, trembling lips, mild GI symptoms, SOB Uses ego-defense mechanisms |
Moderate anxiety
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Personality is made up of:
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Temperament and character
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Personality component that is Influenced by genetics, is highly stable over time, and whose features may be present since birth:
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Temperament
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Personality component that is influenced by environment, has enduring traits and behavior patterns, and is composed of traits that are products of learning and interacting with environment
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Character
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Personality disorders occur:
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When personality patterns are exaggerated, inflexible, and maladaptive
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When do personality disorders typically manifest?
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Before or during adolescence
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The amount of the population estimated to suffer from personality disorders:
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6 - 18%
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Group of personality disorders that are least likely to show improvement with treatment/medications over time
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Cluster A personality disorders
Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder |
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Cluster A Personality Disorder in which the person is secretive and hyperalert, looks for hidden meaning, has a chronic state of tension, has great difficulty with intimate relationships, and perceives the actions of others as threatening
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Paranoid Personality Disorder
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Cluster A Personality Disorder in which the person appears indifferent to praise or criticism, is a loner who prefers solitary activities, has no close friends, poverty of thought and blunted or flat affect.
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Schizoid Personality Disorder
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Expected assessment findings for Schizoid Personality Disorder
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Cold, aloof, indifferent
Lack of close relationships Seclusive and withdrawn Lack of social skills Excessive daydreaming |
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Expected assessment findings for Paranoid Personality Disorder
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Hypersensitive, Unable to accept criticism
Distrustful, argumentative Pathologic jealousy Cold, aloof, fearful, secretive Guarded, tense Blaming, critical of others Exaggerate difficulties |
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Cluster A personality disorder in which the person prefers solitary activities, has odd thinking and speech, has excessively suspicious thinking, displays an inappropriate affect, fears intimacy, and has difficulty in making decisions
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Schizotypal Personality disorder
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Expected assessment findings for Schizotypal personality disorder
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Magical thinking
Ideas of reference Social isolation and anxiety Odd speech Cold, Aloof, Suspicious |
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Cluster B Personality Disorder that manifests by the age of 15, but is not formally diagnosed until the person is at least 18
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Antisocial Personality Disorder
**Before age 18, diagnosis is Conduct disorder |
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People who have family histories of abuse (physical/sexual), are exposed to violent tempers and cruelty as children, are deserted as children, or are unwanted as children are more likely to develop which personality disorder?
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Antisocial Personality Disorder (Cluster B)
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Expected assessment findings for Antisocial Personality Disorder
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Lack of trust
Cold, Insensitive, Poor interpersonal relationships Social extroversion, Charming, Seductive “Con artist”, Deceitful Verbally abusive, Hostile, Low frustration tolerance No sense of guilt |
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Neurobiologically, persons with Antisocial Personality Disorder are often found to have defect in the:
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Hypothalamus
**They also have EEG differences and neurochemical differences |
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Persons with Antisocial Personality Disorder have no desire to change and assume no responsibility for their actions; have behaviors, values, feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one's ideal self-image. This trait is called:
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Egosyntonic
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People with panic disorder and agoraphobia have a higher incidence of:
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Mitral valve prolapse
**Typically have higher cholesterol level as well |
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GAD does not have:
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Panic attacks or phobias
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When providing care/interviewing someone with an anxiety disorder, the nurse should focus on:
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The present. (not the past or future)
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Anticonvulsant that is a mood stabilizer which is contraindicated for women on birth control medications. It reduces the rate of impulse transmission that may reduce mania, panic, and anxiety. It used primarily to treat epilepsy and bipolar
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Carbamazepine (Tegral)
**May increase effectiveness of lithium when combined. Also has antiaggressive properties |
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This medication is contraindicated with MAOIs but is a commonly used OTC decongestant and/or antihypertensive (depends on formulation).
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Coricidian (Coricidan, Coricidan HBG)
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Criteria for binge eating disorder
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Eating an amount of food that is definitely larger than most
Marked distress regarding binge eating is present Binge eating occurs, on average, at least once a week for 3 months Not associated with a compensatory behavior |
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Prevalence of Eating Disorders-Anorexia
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0.5 - 4% of women
More common in women More common in western cultures Higher in athletes |
