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87 terms

Mental Health Quiz 1

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