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151 Cards in this Set
- Front
- Back
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What are the causitive theories of Anorexia and Bulimia?
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Neurobiological
Psychological and Sociocultural Biopsychosocial Family Theory |
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What is the neurobiological theory of Anorexia and Bulimia?
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Anorexia and Bulimia is caused by an imbalance in Neurotransmitters (similar to mood disorders). Decreased levels impact satiety.
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What role do endorphins play in the neurobiological causative theory of eating disorders?
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Starvation is thought to cause the release of endorphins causing one to feel good while actually starving to death.
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Is there a genetic predisposition to develop an eating disorder?
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57% concordance with zygotic twins.
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What is the psychological and sociocultural causative theory of Anorexia and Bulimia?
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Maladaptive response to the developmental taks of adolescence
Affective instability and poor impulse control Cultural influences |
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What are two biopsychosocial theories of eating disorders?
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Genetic vulnerability
Concurrent disorders |
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What does the family theory of eating disorders teach?
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eating disorders are caused by unconscious intrapersonal and interpersonal conflicts in the family.
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What type of family would a person with anorexia have under the family systems theory?
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Enmeshed or overly rigid
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What type of amily would a bulimic person have according to the family systems theory?
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Disengaged or abivalent
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What are three types of eating disorders?
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Anorexia, Bulimia, and Binge-eating disorder
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Define anorexia nervosa
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a potentially life-threatening disorder characterized by extreme perfectionism, weight fear, significant weight loss, body image disturbances, strenuous exercising, peculiar food handling patterns, reductions in heart rate, blood pressure, metabolic rate, and the production of estrogen or testosterone.
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What is the DSM-IV-TR criteria for anorexia?
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1. Refusal to maintain body weight
2. intense fear of gaining weight 3. disturbance in the way in which one's body image or shape is experienced 4. ammenorrhea in postmenarcheal females |
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What are the two types of anorexia nervosa?
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Restricting type and binge-eating/purging type
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What is the restrictive form of anorexia nervosa?
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during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior
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What is the binge-eating/purging form of anorexia nervosa?
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During the current episode of anorexia nervosa, the person has regularly engaged in binge-eating or purging behavior.
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What is bulimia nervosa?
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a disorder characterized by binge eating followed by purging
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What is binge eating?
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eating large quantities of food in a short period of time
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What is purging?
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self-induced vomiting and/or use of large doses of laxatives and diuretics
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What is the DSM-IV-TR criteria for bulimia nervosa?
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1. recurrent episodes of binge eating
2. recurrent inappropriate conpensatory behavior in order to prevent weight gain 3. both 1 and 2 occur at least 2x a week for 3 months 4. self evaluation is unduly influenced by body shape and weight 5. the disturbance does not occur exclusively during episodes of anorexia nervosa |
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What are the two types of bulimia?
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Purging type and nonpurging type
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What is the purging type of bulimia?
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during the current episode of bulimia nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
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What is the non-purging type of bulimia?
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use of stric dieting, fasting, vigorous exercise, but does not regularly engage in purging
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Characteristics of anorexia
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denial of food related problems
turns away from food rejection of femininity, not sexually involved confident over mastery of food dependency and social withdraw pathological self-control angelic child egosyntonic behavior |
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Characteristics of bulimia
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person sees eating pattern as abnormal
turns toward food oriented towards traditional feminitity, sexually involved afraid of food independent; socially outgoing difficulty with self-control hellion child egodystonic behavior |
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Define egosyntonic behavior
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one's behavior is consistent with the perons beliefs
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Define egodystonic behavior
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A person's behavior is unacceptable to them because it is not compatible with their values or worldview
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Define binge-eating disorder
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repeated episodes of uncontrolled eating, sometimes called compulsive overating. Individuals are often obese
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DSM-IV-TR criteria for binge-eating disorder
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1. recurrent episodes of binge eating
2. marked distress regarding binge eating 3. binge eating occurs on average at least 2 days a week for 6 months 4. no associated with purging 5. have 3 of the following: eating more rapidly, eating until feeling too full, eating when not hungry, eating alone out of embarassement, feeling disgusted with oneself b/c of overeating |
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Physical symptoms of anorexia
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emanciated with sunken eyes and a skeletal appearance, lanugo growth on face, extremities, and trunk, bradycardia, hypotension, arrhythmias, delayed gastric motility, hypothyroid like state with dry skin, listlessness, and dry, falling out hair; peripheral edema; osteoporosis and increased risk of fracture
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What will the labs for a person with anorexia look like?
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leukopenia, anemia, low serum potassium, elevated blood urea nitrogen, high serum calcium levels indicate osteoporosis is occuring
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Physical symptoms of bulimia
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hoarseness, esophagitis, dental enamel erosion, enlarged parotid glands, abrasions or calluses on knucles, amenorrhea in 40% of cases, concentrated urine, decreased urine output, hypotension, elevated temperature, poor skin turgor, weakness, arrythmias
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Lab test results for bulimics
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low potassium, increased toxicity if using ipecac
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What are some pharmacological treatments for eating disorders?
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- Imipramine
- Prozac - for severe problems use IV's, hyperal, appetite stimulation **never use wellbutrin** -acomplia - new med coming out |
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What therapy should be implemented in eating disorder clients?
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help identify underlying fears, feelings, and any secondary gains they achieve from the behaviors. Help to develop alternative behaviors that are adaptive. Involve the family in treatment
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What is the difference between REM and NON-REM sleep?
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non-REM - quiet state
REM - most active dreaming, almost total paralysis, like waking state |
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Define cataplexy
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sudden collapse of muscle tone in a person with a dyssomnia
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What are circadian rhythm sleep disorders?
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24 hour sleep wake schedule is distrubed
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What are examples of circadian rhythm sleep disorders?
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Jet lag, shift work, delayed sleep hase, advanced sleep phase
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What is somnambulism
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sleep walking
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What is there a deficit of, in terms of stages of sleep, for individuals with schizophrenia?
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Reduced REM sleep and no REM rebound. Stage 4 sleep is limited
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What disorder is related to melatonin level variation?
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Seasonal affective disorder
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What effect does acute alcohol intoxication have on sleep
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increased sleepiness for 3-4 hours then fragmented sleep
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What is RLS and who usually experiences it?
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Restless leg syndrome is usually experienced by individuals greater than 60 years of age.
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What is primary insomnia?
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difficulty initiating or maintaining sleep, or nonrestorative sleep that lasts for at least a month and does not occur exclusively in association with another sleep disorder or mental disorder
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What is primary hypersomnia?
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prolonged sleep and excessive sleepiness so severe as to interfere with function which is not better explained by another sleep disorder or a mental disorder.
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What are 3 breathing related sleep disorders?
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sleep apnea r/t dementia
obstructive sleep apnea central sleep apnea |
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What medication is currently being directly advertised to consumers for RLS
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Requip
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What do nurses need to work with individuals who have sexual disorders?
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extensive background and experience
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What is gender identity?
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personal sense of being male or female related to genetic and environmental influences
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What is an example of incongruence of gender identity and anatomical sex?
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MTF - born physically male but are emtionally and psychologically female
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This individual's life becomes unmanageable, they often lead a double life, there is often a progression to relieve pain
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someone with a sexual addiction
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What is flexibility in gender roles called?
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androgyny
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What is frotteurism
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rubbing up against others for sexual gratification
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What is pedohilia?
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Adult sexually aroused by and engaging in sexual behavior with children
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What is auterotic asphyxia?
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a noncoercive but often fatal sexual behavior that is copulsive and unconventional
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What are paraphilias?
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sexual disorders that have a strong obsessive-compulsive behavioral component. Usually can be males that feel compelled to engage in hisparticular sexual behavior
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What is hypoactive sexual desire disorder?
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deficiency or absence of sexual fantasies and persistently low interest in sexual activity.
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What can contribute to problems with sexual arousal?
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fatigue, pain, meds, substance abuse, menopause, fear of intimacy, conflict, fear of losing control, anger
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What is spectatoring?
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detached appriasal of sexual performance or the body during a sexual act
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What is the difference between transsexuals and cross dressers?
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transexuals want to be a member of the opposite sex and cross-dressers simply dress that way
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What is a fetish?
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A fetish is a paraphilis that is characterized by an early association of a particular object or body part with a sexual arousal condition. The person begins to respond sexually to that stimulus.
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What is autism?
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abnormal development in social interaction, communication, and restricted involvement in activities and interests
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What are some symptoms of autism?
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- impaired nonverbal communication - lack of interest in shared activities - delay or lack of spoken languge - motor mannerisms - stereotyped, repetitive, or idosyncratic language - preoccupation with parts of objects - like structure - very anxious - aversion to being held
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What is the etiology of autism?
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Genetics
Structural brain and neurotransmitter abnormalities Mre boys than girls onset before 3 years |
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What is the treatment for autism?
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- luvox and anafril
- behavioral and family therapy - special diet - educational approaches |
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Age of onset of schizophrenia in children
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between 5-10 years of age
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What is the etiology of schizophrenia in children
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genetics and structural and functional brain changes
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What are the signs and symtpoms of schizophrenia in children?
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delusions, hallucinations, regressive behaviors, cognitive problems
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Treatment of schizophrenia in children
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atypical anti-psychotics
individual and fmaily therapy behavior modifications |
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What is asperger's disorder?
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Has some but not all of the features of autism. Children show same problems with social interaction adn restricte, repetitive behavior but there is no delay in language, cognitive development, in age appropriate self-help and adaptive kills, or in curiousity about the environment.
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Symptoms of attention deficit disorder
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6 or more of the following:
1. doesn't give close attention to details 2. difficulty sustaining attention 3. does not listen when spoke to directly 4. doesn't follow instructions 5. doesn't like activities requiring a lot of mental effort 6. easily distracted by extraneious stimuli 7. forgetful in daily activities |
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Symptoms of attention deficit hyperactivity disorder
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Six or more of the following
1. fidgets with hands or feet and squirms in chir 2. leave set in classroom 3. runs or climbs excessivly in inappropriate situations 4. can't play in quiet activities 5. described as driven by a motor 6. talks excessively 7. blurts out answers before question is done being asked 8. difficulty awaiting turn 9. interrupts or intrudes on others |
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Differences between ADHD and bipolar disorder in children
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ADHD: gory dreams, slow and irritable in morning, excessive physical energy boosts, regression during anger, intentional destructiveness, family history positive, enjoys danger, dysphoric mood changes, treat with a stimulant
Bipolar disorder: no gory dreams, quick and fully charged in the morning, always on with excessive energy, less regression ssen during anger, accidental destructiveness, family history positive, oblivious to danger, no dysphoric mood changes, treat with mood stabilizers |
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What meds are given to treat ADHD
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Ritalin (most common)
Concerta (longer acting) Adderall (amphetamine mixture) Cylert (not a true stimulant) Straterra (non-stimulant) |
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Why are stimulants gien to children with ADHD
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they have a idosyncratic effect, help inattentive and hyperactive peopel slow down and focus.
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What are the short term side effects of ADHD meds?
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weight loss
sleep disturbance tics |
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what are some long term side effects of ADHD meds?
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arrythmias
inhibit growth |
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What psychopathologies are unique to adolescents?
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Oppositionaly defiant disorder
Conduct disorder |
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What the features of ODD and CD in adolescents?
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challenging, severity and duration of symptoms defines illness according to DSMIV standards, pattern change from baseline, must differentiate between normal defiance and abnormal defiance
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Define oppositional defiant disorder
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recurrent and hostile pattern of behavior toward authority figures.
Most common in children 11+ years of age |
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Define conduct disorder
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repetitive and resistent behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated
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Criteria for diagnosing Oppositional defiant disorder
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These four behaviors must last longer than 6 months:
1. negativisitic behavior 2. defiant behavior 3. disobedient behavior 4. hosilt behavior Also: behavior must occur more frequently in this individual than others the same age and the person must have significant impairment in social, academic, or occupational functioning |
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Examples of behaviors exibited by persons with oppositional defiant disorder
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- loss of temper
- arguing with adults - actively defying - refusing to comply with rules of adults - deliberately annoying others - blaming others for mistakes - easily annoyed by others - being angry - being resentful |
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Symptoms of Conduct Disorder
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- repetitive, persistent behavior
- rights of others are violated - age apropriate societal norms are violated - agressive conduct - non agressive conduct |
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Examples of non agressive conduct in persons with CD
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causes property damage or loss
deceitfulness theft serious violations of rules |
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Examples of agressive conduct in persons with CD
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causes or threatens physical harm toward people or animals
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Future prospect of persons with CD
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- end up in legal system
- develop anti-social personality disorder - substance abuse often develops |
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How should children and adolescents with CD or ODD be treated with medications
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- adult meds at smaller doses
- long term effects are unknown - research is showing protection of brain with antipsychotic meds in children |
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How should mental health nurses care for children and adolescents with psychopatholigies?
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1. screening
2. know developmental level of child 3. establish a connection with the child 4. set limits 5. educate on boundaries 6. be an authority figure 7. be consistent 8. make sure adult signs the child into the unit 9. family therapy 10. gather family history |
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Psychopathologies in older adults
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Depression
Anxiety disorders High rates of suicide |
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What might be a cause of depression in adults over the age of 65?
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physical conditions that are difficult for their bodies to handle (asthma, CHF, chronic infection, anemia, rheumatoid arthritis, thyroid function problems)
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What does dementia in older adults look like?
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memory impairment, impaired ability to learn new information, short term memory is greatly impaired
Symptoms may come on gradually or abruptly |
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What are the symptoms of dementia in older adults
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- aphraxia
- aphasia - agnosia - disturbance in executive functioning |
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What are the two types of demential in the elderly population
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Early onset <65 years of age
Late onset >65 years of age |
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Define apraxia
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Total or partial loss of the ability to perform coordinated movements or manipulate objects in the absence of motor or sensory impairment.
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Define aphasia
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Partial or total loss of the ability to articulate ideas or comprehend spoken or written language, resulting from damage to the brain caused by injury or disease.
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Define agnosia
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Loss of the ability to interpret sensory stimuli, such as sounds or images.
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Compare and contrast dementia with psuedodementia
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Dementia: family history, confabulate answers, disoriented to time and place, good at compensating, minimize impairment, LT memory intact, sundowners syndrome, cognitive then mood changes, behavior changes such as wandering and agitation, usually more gradual onset
Psuedodementia: no family history, depression may cause dementia, "i don't know answers", exaggerate impairment, LT and ST memory changes, early morning awakenings, rapid onset, mood change then dementia, usually no behavior change |
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What meds are used to treat elders with dementia
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Namenda - for severe AD
Atypical anti-psychotics for agitation - abilify, geodon, risperadol Antidepressant for dysphoria and agitation vitamin E - to slow dementia NSAIDS Ginko biloba |
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What is anticholinergic syndrome?
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Antipsychotics all possess anticholinergic side effects - they interfere with the normal transmission of nerve impulses.
Elderly people with this syndrome will look confused Other meds that can cause this are benzodiazepines, anti-depressants, and antihistamines |
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What are some symptoms of anticholinergic syndrome
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Skin flushing, dry mucous membranes, blurred vision, motor incoordination, confusion, agitation, hallucinations, delirium
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What are the stages of loss?
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Denial, anger, bargaining, depression, acceptance
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What interventions can nurses use with care of elders with dementia and depression
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- understand elders may act out feelings they can't express
- elders may become irritable with depression - go elder's pace -use simple, direct language - use diagrams and signs - start meds at small doses and increase slowly - maintain optimal level of functioning |
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DSM-IV-TR criteria for Schizophrenia
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-2 or more of the following symptoms every day for at least 1 month:
delusions hallucination dizorganized speech disorganized behavior negative symptoms -social/occupational dysfunction -duration -r/o schizoaffective and mood disorder -r/o substance/general medical condition -relationship to pervasive developmental disorder |
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What are the positive symptoms of schizophrenia?
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delusions
hallucinations disorganized speech catatonia |
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What are the negative symptoms of schizophrenia
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affective flattening
alogia avolition anhedonia |
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Cognitive symptoms of schizoprenia
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attention
memory executive function |
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Mood symptoms of schizoprenia
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dysphoria
Suicidal hopelessness |
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What are delusions?
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false personal beliefs
inconsistent with IQ continue despite proof that they are not reality based con be very bright and persuasive you are unable to realize with these people |
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What are the common delusional themes
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persecution - people are out to get them
grandeur - they can do anything control of influence - ability to control others thougts somatic - something is going on in their body nihilistic - world is ending |
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What are hallucinations?
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breaks from reality
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What types of hallucinations exist?
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Auditory - temporal lobe
Visual - occipital lobe Tactile - parietal lobe Olfactory - parietal lobe Gustatory - parietal lobe |
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What are the stages of hallucinations?
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comforting - help at first
condemning - become intrusive and negative controlling - caustic and negative, commanding conquering - eventually may kill person or another |
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What is disorganized speech?
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speech is loose and incoherent, lack of goal directed actions, difficult to manage basic daily activities
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What is Catatonia
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- motor immobility
- waxy infelxibility - purposeless motor activity - mutism - won't be able to talk - posturing - echolalia - says last word over and over - person slows down til they can't move anymore |
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What is affective flattening
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blank or flat looks on their face all the time
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What is alogia?
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poverty of speech, don't initiate conversations
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What is avolition?
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Lack of attention of ability to finish things
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What is anhedonia?
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Lack of pleasure in activities they used to enjoy
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What is dysphoria?
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feeling sad or bad all the way to full blown depression
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What are the four types of schizophrenia?
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Disorganized
Catatonic Paranoid Undifferentiated |
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Describe disorganized schizophrenia
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Sz that has disorganized thought as the most pronounced symptom
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What is catatonic Sz?
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the individual becomes immobilized with bursts of activity
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What is paranoid Sz?
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Sz with a strong paranoid or delusional process going on
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what is Undifferentiated Sz?
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Sz that has symptoms of all types of Sz and doesn't fit just one specifically
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What are other forms of psychotic disorers?
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Schizoaffective Disorder
Brief psychotic disorder Delusional disorder Shared psychotic disorder Substance-induced psychotic disorder |
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What are some comorbities common with schizophrenia
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uni or bipolar disorder
substance-dependence or addictions anxiety disorders personality disorders |
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What is the etiology of schizophrenia?
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genetic influence
biochemical influences (too much dopamine) Physiological influences Environmental influences (toxins that peopel are exposed to, types of immunizations, stress people are in) Transactional model (combination of all of the above) Older theories (double blind communication or split personality) |
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What treatments are used for schizophrenia?
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medications
long-term supportive therapy group therapy family support milieu therapy |
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Treatment considerations for schizophrenic clients
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1. be supportive in nature, not intensive one to one psychotherapy
2. social skills oriented, focus on reintegration into the community 3. vocational rehabilitation - part time jobs 4. goal is to optimize level of functioning |
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Nursing interventions for schizophrenia
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1. safety
2. administer and monitor meds 3. clear communication and boundaries 4. anxiety reduction 5. decode delusion or hallucination themes 6. encourage reintegration into community 7. educate person and family 8. include and support family |
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5 points that are important to remember when interrupting hallucinations
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1. build a trusting relationship
2. look and listen for cues of hallucinations 3. ask if they are experiencing hallucinations 4. tell them you don't hear what they hear in a nonjudgmental manner 5. teach distraction methods |
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What are short-term anti-psychotic meds used for?
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exacerbations of schizophrenia
actue mania brief periods of loss of control psychotic symptoms <3mo |
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What are long-term anti-psychotic meds used for?
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schizophrenia
bipolar paranoia long lasting psychotic symptoms |
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What considerations should the nurse think about when selecting an anti-psychotic med for a person.
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select according to side effect profile
start with a low dose consider cost non-addictive - don't want them addicted to psychotic agents |
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Characteristics of anti-psychotic meds
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**metabolized in liver (20-40 hours)
**With paranoid patients - liquid concentrates or IM administration is important **7up or diet 7up is universal mixer with meds |
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Types of anti-psychotics
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High-potency/broad spectrum - wide range of side effects
Moderate potency Low potency Atypical - more dopamine specific, fewer side effects, very specific to dopamine Dopamine system stabilizer - new and will be on market soon |
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Frequently seen antipsychotics
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Risperdal (benzisoxazole derivative) - newest, longer acting, 500-650 per week
Abilify (dopamine stabilizer) Geodon (benzisothiazolyl piperazine derivative) Clozaril - 900-1000 per month (dibenzodiazepines) |
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What are some different side effects seen with anti-psychotics
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-anticholinergic
-orthostatic BP changes -sedation -weight gain -increased photosensitivity -decreased tolerance to alcohol and sedatives -problems with sexual functioning -agranulocytosis -GI distress -extrapyramidal side effects |
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Examples of extrapyramidal side effects
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parkinsonism
dystonic reactions akathisia tardive dyskinesia |
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What are dystonic reactions?
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abnormal tonic contractions of muscle groups
-trunk, neck, and face -oculogyric crisis - eyes won't do what you want them to do |
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What is akathisia?
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Motor restlessness perceived subjectively by the client and experienced as an urge to pace, an need to shift weight from one foot to another, or an inability to sit or stand still
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What is tardive dyskinesia?
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characterized by coordingated, arrythmic, involuntary movements (lip smaking, tongue protrusion, rocking, foot tapping)
can be reversible, risperadol can be helpful atypicals cause less TD and Risperdal can reverse TD to some degree |
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What meds can be used to fight the effects of antipsychotic medications
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Cogentin
Artane Benadryl Ativan (for dystonic reactions) |
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What tools can be used to assess tardive dyskinesia?
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Measure with DISCUS scale
Abnormal involuntary movements scale (AIMS) Use same tool over time |
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What is neuroleptic malignant syndrome?
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a severe and potentially life-threatening side effect of all psychotropic medications.
It a result of dopamine blockade and is not an allergic or toxic reaction |
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What are symptoms of Neuroleptic malignant syndrome
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fever
diaphoresis muscle rigidity increased CPK increased heart rate and BP changes change in sensorium-increase confusion results in delirium |
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What is the treatment for Neuroleptic malignant syndrome?
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hold the antipsychotic and contact MD
Supportive care - safety and hydration Dopamine agonist - Bromocriptine or symmetrel for sometimes meds do not help |
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What is the definition of severe and persistently mentally ill
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severity = impairs one's ability to function socially, occupationally, ADL's, etc
duration = symptoms are pronounced nearly every day for 6 months to 2 years |
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What are common reasons people with SPMI
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- felt better and stopped taking meds
- ran out of meds, didn't have money to buy more - did not want to stop drinking and drugging -did not like side effects |
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Concerns for people with SPMI
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- stigma
- parity in Kansas - disability and the limited number of work hours - self-determination |
