Mental Health Quiz 1

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328- powerpoint+ major concepts, drugs, and vocab from readings

cerebrum

R, L hemispheres connected by neurons
each hemisphere has 4 lobes
cortex with folds (gyri), grooves (sulci)

frontal lobe

voluntary body movement(speaking)
thinking
judgment
expression of feelings

parietal lobes

perception&interpretation of sensory info
(touch, pain, taste, body/spatial position)
abnormal activation-> memory deficits

temporal lobes

hearing
STM
smell
express emotion-limbic system

Occipital lobes

visual reception and interpretation

thalamus

relay station to cortex
some involvement-emotions, mood

hypothalamus

controls pituitary
some control of ANS
appetite, temp regulation

Limbic system

emotional brain=
fear& anxiety
anger& aggression
love, joy, hope
sexuality
social behavior

pons

regulates respiration, muscle tone

medulla

pathway for all nerve tracts
regulates: HR, BP, RR, gag, swallowing, sneezing, coughing, vomiting

cerebellum

regulates muscle tone, coordination, posture, equilibrium

axon

carries impulses away from cell body

dendrites

carry impulses to cell body

afferent

sensory neurons (where messages interpreted)
carry messages from peripheral receptors to CNS

efferent

motor neurons
carry impulses from CNS to:
muscles (contraction)
glands (secretion)

Synapses

junction between 2 neurons (small space is synaptic cleft)

neurotransmitters

3 categories: biogenic amines, amino acids, peptides
chemicals stored in neuronal axon
released in response to electrical impulse
released into synaptic cleft
bind to receptors (specific to each NT)
more NT's= stronger message

receptor agonists

substance other than specific NT capable of stimulating receptor

biogenic amines

dopamine, serotonin, NE, epinephrine, ACh, histamine
usually involved in psychobiology of mental illness
derived from: dietary amino acids, L-tryptophan

Amino Acids

excitatory: glutamate, aspartate
Inhibitory: glycine, GABA
endogenous
primarily associated with mental health: GABA

neurohormones

chemical substances produced by cells within organ/gland
act as NT or modify NT actions
primary NH's: endorphin, DHEA, oxytocin, vasopressin, PEA

endorphin

opioid produced by brain
associated with ability to experience pleasure
protects from pain
triggered by: exercise, positive thoughts, touch
good for: depression, good substitute for those with substance abuse issues

DHEA

most plentiful hormone in body
produced by adrenals
improves cognition
protects immune system
decreases cholesterol
promotes bone growth
anti depressant
precursor to pheromones

oxytocin

from pituitary gland
promotes touching/bonding
decreases cognition
impairs memory
promotes milk letdown

vasopressin

promotes attentiveness, alertness
reduces emotional extremes
focuses us on present task at hand
antidote for: anxiety, depression

PEA

natural form of amphetamine produced in brain
amt changes in response to:
thoughts, feelings, experiences
low levels associated with: depression
high levels a/w: psychotic symptoms

3 assessment domains

cognitive (what the person's thinking)
affective (feelings they express)
behavioral

dopamine

muscle movement, thoughts, decisions, hormones
increase: schizophrenia, mania
decrease: parkinsons, depression

norepinephrine

stimulates SNS, mood, attention
increase: mania, anxiety, schizo
decrease: depression

serotonin

sleep, hunger, pain, aggression
increase: anxiety
decrease: depression

histamine

alertness, inflammation, gastric secretion
increase: hyperactivity, compulsivity, suicidal depression
decrease: sedation, weight gain, hypotension

ACh

stimulates PNS, learning, memory, mood, sex
increase: depression
decrease: Alz, huntington's, parkinson's

hippocampus

in temporal lobe
memory/learning
fails to develop: schizo, bipolar, PTSD
damaged by: alcoholism, Alz

cognitive

comprehension of words being used and thinking process of person communicating

affective

understanding the emotions involved- imparted verbally and nonverbally

behavioral

how accompanying nonverbal actions modify/enhance verbal messages

culture

personal space, acceptable body language, eye contact

paralanguage

sounds- rate of speech, tone of voice, loudness, non-words (laughing, sobbing)

characteristics of effective communicators

nonjudgemental
accepting/affirming
warmth
patience
respect
trustworthiness
authenticity
congruent
empathy

anxiety

uneasy, uncomfortable feeling in response to threat or danger to self or s/o's
accompanied by physical symptoms
FIGHT OR FLIGHT

lazarus

how a person perceives a threat highly influences how he/she will respond
past experiences/ how pt was raised
how role models respond to stressors

fear vs anxiety

fear- specific, definite referent, cognitive rxn (plan)
anxiety- nonspecific, original source uncertain, emotional rxn

cognitive symptoms of anxiety

nervousness
helpnessness
tension/can't relax
unfocused apprehension

behavioral symptoms of anxiety

hypervigilance (scanning environment)
hand/voice tremors
jumpiness/incr startle response
irritability/emotional LABILITY (unpredictable)
rapid speech, higher pitched voice
laughing uncontrollably

physiological symptoms of anxiety

increased HR, RR, BP
diaphoresis
dilated pupils
pallor
urinary frequency
cold, clammy hands
dry mouth
nausea

mild vs moderate vs severe anxiety

mild- good, motivation
moderate- narrowing perception
severe- perception narrowed to crippling degree

defense mechanisms

aka mental mechanisms, coping mechanisms
protect person from discomfort of anxiety
defend ego
problem if maladaptive
UNCONSCIOUS (generally)

nursing role during anxiety attack

get pt thru attack first, then teach/help
goal of teaching: pt recognize anxiety, find coping mechanisms
use pt description/own words- gain insight

focused assessment of anxiety attack

when symptoms 1st noticed
describe attack
triggers in life at time
attacks before, describe
how to prevent
how life is affected
family hx

OCD characteristics

certain ideas & behaviors occupy person to such degree that normal work/social activity/ADL are disrupted. repetitious.

common comorbidity of OCD

depression

nursing interventions for OCD

intervene early
interview when anxiety is lowest
allow sufficient time/privacy to complete ritual
find alternatives to coping with anxiety

Phobic D/O

dreading an object, act or situation that is not realistically dangerous
never confront patient with feared object/person/act

displacement/projection

fear or threat does not lead to anxiety
instead is displaced/projected onto object or person which is then feared
(example was girl afraid of knives when really hates her mother)

PTSD

psychological symptoms caused by exposure to dangerous or life-threatening or highly traumatic events

shortly after, or years later

military combat, rape, assault, abuse, natural/manmade disaster

"burn out"- dealing with trauma aftermath

victim of manmade disaster vs natural disaster

will recover slower in manmade disaster b/c of loss of trust

nursing assessment for PTSD

determine event
psychosocial history
interpersonal relationships
guilt, rage, frustration, emotional lability
coping strategies
sleep patterns
anxiety/depression- suicidal

nursing intervention of PTSD

talkout experience
appropriate ways to express anger
relaxation techniques
assist to resume ADLs

Dissociative disorder (multiple personality)

flight from self
all/part of personality is denied
amnesia most frequent, repression

common in children who were tortured

nursing assessment of Dissociative D/O

address each personality
care plan for each
assess pt's knowledge of each

psychogenic fugue

patient not aware of what just happened

nursing interventions for dissociative d/o

foster personal growth for each personality
nurture child personality
determine which personality at each initial contact
role model mature approach to conflicts

benzodiazepines

short term treatment only
not for pt with substance dependence problems

xanax, valium, ativan

not for PTSD or OCD

buspirone

management of anxiety disorders
or
short term relief of anxiety symptoms
use before benzo's
less sedative, less dependence/tolerance
3+ weeks to be effective

SSRI's

first line treatment for all anxiety d/o's
prozac, paxil, zoloft
work on presynaptic cleft= more serotonin in synaptic cleft

SNRI's

venlafaxine, milnacipran, duloxetine

act in 1-2 weeks

venlafaxine- only one approved for panic disorders, GAD, SAD

TCA's

2nd or 3rd line use for:
PD, GAD, SAD

"start low, go slow" (dosages)

clomipramine= OCD

beta blockers

relieve physical symptoms of anxiety (stage fright)
attaching to sensors that direct arousal messages

"-olol"

drugs/psychotherapy for OCD

SSRI's
TCA's
behavioral therapy

drugs/psychotherapy for GAD

SSRI's
Buspirone
SNRI's
Depakene
TCA's
cognitive-behavioral therapy

drugs/psychotherapy for PD

SSRIs
TCAs
MAOIs
B-blockers
Depakote
cognitive-behavioral therapy

drugs/psychotherapy for PTSD

SSRI's
TCA's
Benzo's
SNRI's
MAOI's
B-blockers
carbmazepine
cognitive-behavioral therapy
family therapy
group therapy with survivors

stress

nonspecific response of the body/mind to any kind of demand

theorist who defined stress terms

Hans Selye

adaptation

adjustment of a person to environment/interpersonal stressors

coping

process through which the human manages the demands of stressors

avolition

loss of ambition, motivation, ability to perform ADL's

anhedonia

loss of interest in usual sexual activities (including sex) and ability to experience pleasure

anergia

loss of energy

bipolar 1

at least one episode of mania (usually with psychosis) alternating with major depression

Bipolar 2

hypomanic episodes alternating with major depression
no psychosis

cyclothymia

hypomanic episodes alternating with minor depressive episodes

common comorbidities of bipolar d/o

personality d/o
substance abuse d/o
anxiety d/o
ADHD

chemical restraint for mania

antipsychotic- haldol (lots of side effects)
antianxiety- ativan (a benzo- short term only!)
cogentin/benadryl- examples of drugs to deal with haldol's SE's

bioplar disorder mood stabilizers

first line- lithium carbonate
commonly used- antiepileptics (carbamazepine, depakote, lamictal)

lithium carbonate

therapeutic blood levels take 7-14 days
0.4-1.3 mEq/L
used w/antipsychotics, antianxiety for acute mania
stop if dehydrated!
toxicity:
ataxia, ECG changes, clonic mvts, seizures, coma, death

side effects of TCA's

anticholinergic
(can't poop can't pee can't spit can't see)

toxic effects are dysrhythmias/tachy/MI/etc

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