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Psych Essentials of Psychiatric Mental Health Nursing 3rd Edition

Question Answer
Loss of Cortical Tissue has been associated with which disease? Schizophrenia
The cerebral cortex is divided into four lobes that control what? Sensory and Motor Function
What does the Prefrontal Cortex (PFC) coordinate? complex cognitive function, planning and execution of goals
The Hippocampus interacts with the PFC to ..? make new memories
Amygdala processes fear and anxiety
Chronic Stess Triggers shrink of the hippocampus and gay matter in the PFC/ Vulnerability to stress related disorders
Anxiolytics Anti-Anxiety Drugs ( slow limbic system)
Extra-Pyramidal Symptoms abnormal involuntary motor symptoms
Movement is regulated by Basal Ganglia
Brainstem controls vital life function
RAS controls level of conciousness and cycle of sleep
Cerebellum controls motor control, cognitive processing
Injury to the Cerebellum may cause disturbance in coordination, balance, gait, attention, and emotional control
Thalamus Function Filters sensory information before it reaches the cerebral cortex
Hypothalamus Function Regualates temp, BP, perspiration, libido, hunger, thirst, and circadian ryhthm
5 A's of EBP Ask a Question
Aquire Literature
Appraise Literature
Apply Evidence
Assess Performance
Clinical Practice Guidelines statements based on EBP that appraise and summarize the best evidence to guide clinicians in making informed decisions
Clinical Algorithms step by step guidelines prepared in trial and error format
Clincal Pathways map for specified treatments and interventions
Recovery Model emphasis on rehab and recovery
trauma informed care recognizes trauma as almost universally found in the histories of mental patients
5 Axis' of diagnosis I Psych Dx
II Personality Disorders and Mental Retardation
III Med Dx
IV pyschsocial stressors
V GAF Score
Global Assessment of Functioning Score scale from 1 – 100 ; higher the score, higher level of functioning
Biologically bases Mental Illness caused by neurotransmitter dysfunction, abnormal brain structure, or genetic factors
Psychobiological Disorders Schixophenia
Bipolar Disorder
Major Depression
OCD
PTSD
Autism
Anorexia
ADHD
Culture bound syndromes appear only in particular cultures but do not appear globally
Running Amok someone runs around engaging in violent behavior
Pibloktoq uncontrollable desire to remove clothing and expose oneself to winter weather
Psychoanalytic Theory (Freud) Psychoanalysis to learn unconcious thoughts
Interpersonal Theory (Sullivan) Focus on here and now
Behavioral Theory(Pavlov, Watson, Skinner) Behavioral modification addresses maladaptive behaviors by rewarding adaptive behavior
Cognitive Theory (Beck) identification of negative thought patterns and replacing them with rational ones
Biological Theory neurochemical imbalances are corrected through medication and talk therapy
Systematic Desensitization learned responses can be reversed by first promoting relaxation and then gradually facing a particular anxiety provoking stimulus
Aversion Therapy eradicate unwanted habits by associating unpleasant consequences with them
Biofeedback using relaxation techniques to control physiological responses
Schemata unique assumptions about ourselves, others, and the world around us
Automatic Thoughts rapid unthinking responses based of schemata
Cognitive Distortions irrational automatic thoughts
Overgeneralization using a bad outcome as evidence that nothing will ever go right again
Mental Filter Focusing on small negative details
Disqualifying the Positive maintaining a negative view by rejecting info that supports positive view
Catastrophizing the very worst is assumed to be probable outcome
Emotional Reasoning drawing conclusion based on emotional state
ABC's of irrational belief A – Activating Event
B- Belief
C- Consequence
Electroconvulsive Therapy (ECT) electrical current used to induce a seizure
Cognitive Development care should be tailored to met patients cognitive level
Group Content actual dialog between members in the group
Autocratic Leader exerts control over the group and does not encourage interaction between members
Democratic Leader Supports extensive interaction between members in problem solving
Lassiez Faire Leader allows members to act in whatever way they seem fit and does not control direction of the group
Altruism giving appropropriate help to other members
cohesiveness feeling connected to other members and belonging to the group
interpersonal learning learning from other members of the group
guidance recieveing help and advice
catharsis releasing feelings and emotions
identification modeling after another member or leader
family re-enactment testing new behaviors in a safe enviornment
self-understanding gaining personal insights
instillation of hope feeling hopeful about ones life
universality feeling that one is not alone
Existential Factors coming to understand what life is about
double bind no win situation
Differentiation ability to develop a strong identity and sense of self while staying connected with family and place of origin
Sociocultural Context the framework for viewing the family in terms of the influence of gender, race, ethnicity, religion, economic class, and sexual orientation
Multigeneration Issues reptitition of themes or toxic issues
theraputic milieu healthy enviornment
corticotropin-releasing hormone released in response to stress, stimulates the adrenal cortex to release cortisol
thyroid hormones are used to treat patients with depression or rapid cycling bipolar disorder
dopamine inhibits the release of prolactin
Frontal Lobe Function Thought Processes
Temporal Lobe Function Auditory
Occipital Lobe Function Vision
Parietal Lobe Function Sensory and Motor
Midbrain Function pupillary reflex and eye movement
Pons Function major processing station in auditory pathways
Medulla Oblongata Function Reflex centers
Cerebellum Function regulates skeletal muscle coordination and contraction
PET Scan / SPECT use ionizing radiation to localize brain regions associated with perceptional, cognitive, emotional, and behavioral functions
MRI used to exclude neuro disorders
CT can detect lesions, abrasions, areas of infarct
Monoanamine Neurotransmitters implicated in neuropsychiatric disorders
Amino Acid Neurotransmiters balance brain activity
Peptide neurotransmitters adjust brain function
Dopamine controls emotional responses, stimulates the heart, increases blood flow to vital organs
Dopamine Hypothesis of Schizophrenia drugs that stimulate dopamine activity can induce psychotic symptoms, drugs that block dopamine receptors have antipsychotic properties
Acetylcholine plays role in skeletal muscle movement, arousal, and sleep/wake cycle
Acetylcholinesterase Inhibitors prescribed to delay cognitive function decline in Alzheimers
Norephinephrine low levels are linked to low arousal and depression
high levels linked to hyperarousal
Serotonin helps regulate mood, arousal, attention, behavior, and body temp
Serotonin Syndrome high levels of serotonin cause restlessness, shivering diarrhea (mild), muscle rigidity, fever, seizures
Histamine regulates alertness, inflammatory response, gastric secretion
Aminobutyric Acid (GABA) modulates neuronal excitability (anxiety, paranoia)
glutamate a potent excitatory neurotransmitter in which any disruption (high or low) can cause neuropsychiatric symptoms
Psychotropic Drugs work my mechanisms not fully understood
Pharmacakinetic Interactions one drug alters the absorption, distribution, metabolism, or elimination of another thereby affecting plasma concentrations
Pharmacodynamic Interactions drugs act at the same or interrelated receptor sites resulting in synergistic or antagonistic effects
Monoanamine Hypothesis suggests a lack of three monoanamines in various brain regions accounts for depression
Monoanamine Receptor Hypothesis low levels of neurotransmitters cause increased receptor sensitivity over time, therefore it may take several weeks for patients to feel better on antidepressants
Monoanamines type of organic compound, including the neurotransmitters, that are further divided into subgroups
Monoamine Oxidase (MAO) an enzyme that destroys monoanamines
Monoanamine Oxidase Inhibitors (MAOI's) drugs that increase monoanamines by inhibiting action of MAO
Tricyclic Antidepressants (TCA's) act primarily by blocking the presynaptic transporter protein receptors for norepinephrine and serotonin
TCA's Treat depression and chronic pain
TCA's are called dirty drugs because of many side effects
Selective Serotonin Reuptake Inhibitors (SSRI) inhibit reuptake of serotonin in the synapse
Serotonin-Norepinephrine Reuptake Inhibitors (SNRI) block reuptake of both serotonin and norepinephrine
Serotonin- Norephinephrine Disinhibitors (SNDI) block presynaptic noradrenergic receptors
Norephinephrine- Dopamine Reuptake Inhibitors (NDRI) inhibits dopamine-norepinephrine reuptake, inhibits nicotinic acetylcholine receptors to reduce the addictive action of nicotine
Serotonin Antagonist/Reuptake Inhibitors (SARI's) high doses are needed for serotonergic effect, at low doses it can be used for insomnia
Selective Norephinephrine Reuptake Inhibitors (NRI's) block presynaptic norepinephrine transporters thereby inhibiting reuptake of norepinephrine
Benzodiazepines most common anti-anxiety agents. high risk for tolerance and withdrawal
Benzo's when combined with other CNS depressants can cause respiratory depression
Buspar reduces anxiety, has high affininty for serotinin receptors
Lithium appears to exert therputic actions through second messenger systems causing alterations in electrical conductivity
Depakote anticonvulsant that inhibits enzymes involved in GABA catabolism thereby inhibiting neuronal excitabillity
Lamictal treats b-polar by inhibiting release of glutamate and aspartate
Tegretol treats rapid cycling bipolar by making neurons less excitable and stabilizes the inactive state of sodium channels in neurons
first generation antipsychotic cause significant neurological effects, also bing to dopamine receptors which reduces dopamine transmission
dopamine blockade may cause dystonia, akathiaia, tardive diskinesia, drug induced parkinsonism, and neuroleptic malignant syndrome
neuroleptic malignant syndrome muscle rigidity, confusion, agitation, and increased temperature, pulse, and blood pressure caused by dopamine blockade
Clozapine (Clozaril) firts of the atypicals is several times more potent in blocking histamine receptors and dopamine receptors
clozapine may supress bone marrow resulting in agranulocytosis
Olanzapine (Zyprexa) derivitive of Clozaril, sedating effects
Metabolic Monitoring is recommended for all patients using SGA (atypicals)
Olanzapine Pamoate (Zyprexa Relprevv) extended release atypical injection which requires 3 hrs observation for sedation/delerium
Risperidone (Risperdal) Atypical blocks a1 and h1 receptors which may cause orthostatic hypotension, sedation, and EPS
Paliperidone risperidone XR
Quetiapine (Seroquel) Atypical with strong blockage of histamine receptors which may cause sedation
Ziprasidone (Geodon) SSRI that binds to many receptors which may cause dizziness, sedation, and prolonged QT interval
EKG is recommended for patients before taking Ziprasidone (Geodon)
Aripiprazole (abilify) dopamine-serotonin stabilizer which may cause akathisia
Abilify Maintena once a month intramuscular injection for schizophrenia
Iloperidone (Fanapt) atypical with high affinity to D3 and noradrenergic receptors which may cause orthostatic hypotension
Lurasidone Hydrochloride (Latuda) atypical used for MDD or Bipolar 1 disorder
Cariprazine ( Vraylar) atypical which works primarily of D3 receptors used in schizophrenia and bipolar disorder
Pyschoneuroimmunology (PNI) research field that focuses on the interaction between the immune system and the nervous system
Cross-Cultural Psychopharmacology explores different responses that exist among ethnic groups and the reasons for them
anosognosia the inability to recognize the need for care
Most Common Mental Illness Depression
Major Depressive Disorder Syptoms cause change from usual functioning, increased mortality rate, increased potential for pain and physical illness
Melancholic Depression loss of pleasure in life, inability to feel better, early morning awakenings, loss of weight, slow moving
Anhedonia loss of pleasure in life,
Seasonal Depression episodes during fall or winter, responds to light therapy
Anxious Depression Significant amount of anxiety along with depression, restlessness, difficulty concentrating
catatonic depression characterized by abnormalities of movement behavior
mixed depression characterized by hypomanic symptoms (inflated self-esteem)
atypical depression rejection sensitivity that is present throughout life and may cause impairment, hypersomnia, hyperphagia, fatigue
psychotic depression common with bipolar disorder, may experience delusions, psychosis will match current mood
Persisting depressive disorver (dysthymic disorder) less severe but chronic depressed mood more days than not, lasting for at least 2 years
Prementrual Dysphoric Disorder severe depression, irritability, and other mood disturbances. Onset 10 – 14 days before menses and improves within a few days
Twin Studies identical twins have a greater concordance rate for depression disorders than fraternal twins
Adoptive Studies risk for development of depression in children born to parents with depressive illness is unchanged when adopted by a nondepressive family
masked depression patients present with severe pain or other symptoms
the stress diathesis model early life trauma may result in permanant neuronal damage leaving the patient more vulnerable to depression later in life
Somatic Symptom Disorder umbrella group of disorders characterized by the presance of one or more physical symptoms accompanied by abnormal thoughts, feelings, and behavioral reactions
Dissociative Disorders umbrella group of disorders characterized by varying degrees of mental detatchment from conscious awareness
illness anxiety disorder patient preoccupied with having or eventually developing a serious illness
how long do symptoms last in order for patient to be diagnosed with illness anxiety disorder more than 6 mo
Conversion Disorder one or more symptoms of impaired motor or sensory function
la belle indifference lack of emotional concern
factitious disorder imposed on self deliberate fabrication of symptoms or self-injury without obvious external reward or gain
malingering deliberate fabrication of symptoms or self injury to recieve external rewards
factious disorder imposed on another deliberate fabrication of symptoms or injury on someone else to recieve attention
other specified somatic symptom and related disorders used when the symptoms and impairment do not meet the full criteria for any specific disorder
secondary gains benefits derived from the symptoms alone
assertiveness training form of behavior therapy designed to help people stand up for themselves
depersonalization/derealization disorder recurrent period of feeling unreal, detatched, outside of the body, numb, dreamlike, distorted sense of time, or visual perception
dissociative disorder the inability to recall specific information about the self, usually of traumatic nature
fugue patient flees normal life to another location and starts a new life
Dissociative identity disorder disruption of identity by two or more distinct personality states
Personality disorders personality traits tend to be inflexible and unpredictable, coping strategies tend to be more primitive and immature