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Neurobiological Concepts

Terms in this set (178)

The 1990s were called the
"Decade of the Brain" with the challenge of studying the biological basis of behavior
In keeping with the "Neuro-Scientific Revolution," greater emphasis is being placed on
The organic basis of mental illness
Parietal Lobe Function (Sensory & Motor)
- Receives and identifies sensory information
- Concept formation and abstraction
- Proprioception and body awareness
- Reading & mathematics
- Right and left orientation
Frontal Lobe Function (Thought Processes)
- Formulate or select goals
- Initiates, plans, and terminates actions
- Decision making
- Insight
- Motivation
- Social judgment
- Voluntary motor ability
Temporal Lobe Function (Auditory)
- Language Comprehension
- Stores sounds into memory
- Language & speech
- Connects w/ limbic system to allow expression of emotions (sexual, aggression, and fear)
Occipital Lobe Function (Vision)
- Interprets visual images
- Visual associations
- Visual memories
- Involved w/ language formation
Limbic System (Emotional Brain)
Many areas within the cerebrum that influence primitive emotional and behavioral responses:
- The "4 F's": Feeding, fighting, fleeing, and fornicating

Supports a variety of interrelated functions: Long-term memory, emotions, and motivation
Structures of the limbic system
- Hypothalamus
- Amygdala
- Thalamus
- Hippocampus
- Pituitary gland
Hypothalamus regulates many bodily functions such as
- Sleep
- Body temperature
- Appetite, etc.
Amygdala
- Stores emotional memory & controls fear responses
Thalamus
- Integrates sensory inputs with pleasant and unpleasant feelings
Hippocampus
- Consolidates new memories into long-term memory
Pituitary gland
- Supplies hormones for vital functions (homeostasis)
What part of the brain would be suspected w/ emotional dysfunction ?
Limbic system
Endocrine Regulation: Stress responses are regulated by the
Hypothalamic—Pituitary—Adrenal (HPA) Axis
Autonomic Nervous System (ANS)
- Sympathetic Nervous System
- Parasympathetic Nervous System
Sympathetic Nervous System
- Dominates in stressful situations
- Prepares the body for "Fight or Flight"
"E" Division of the Sympathetic Nervous System
- Exercise
- Excitement
- Emergency
- Embarrassment
Parasympathetic Nervous System
- Dominates when a person is relaxed
- "Rest and Digest"
"D" Division of the Parasympathetic Nervous System
- Digestion
- Defecation
- Diuresis
Synapses
Synapse: The junction between two neurons

Synaptic Cleft: The space between neurons

Pre-Synaptic Neuron: The area of an axon where neurotransmitters are stored

Post-Synaptic Neuron: The area of a dendrite where receptor sites are located
- Electrical impulses begin the process of transmission
Neurotransmitters play an important role in
Human emotions and behavior
What is the target for the mechanism of action for psychotropic medications?
Neurotransmitters
Neurotransmitters are released into the
Synaptic Cleft between the Axon (sends) and the Dendrite (receives)
A neuron conducts
An impulse to another neuron via a change in the cell membrane effected by electrical stimulation
Neurons can release
More than one type of neurotransmitter or neuromodulator
Neurotransmitters are
Chemical messengers that release into the synapse (junction or space between two nerve cells) to conduct the nerve impulse from cell to cell
Neurotransmitters can
- Activate (stimulate) or inhibit neuron activity - they can do both
- Neurotransmitter substances are then either inactivated or returned to the axon
Neurotransmitters can remain in the synapse only for
A certain length of time, to be either used again (reuptake) or degraded
Reuptake
The re-absorption of a neurotransmitter into the pre-synaptic neuron after it has performed its function of transmitting a neural impulse

This action both recycles the neurotransmitter and prevents too much signaling
Agonist
Term for any chemical messenger or substance that stimulates the release of a chemical messenger
Studies have shown that brain neurotransmission is affected by
Many different factors such as genetics, diet, exercise, sleep, stress, connecting emotionally with another human being, learning about oneself and learning new coping behaviors
Genetics
Research has shown that all major mental illnesses seem to have a genetic base
Psychoimmunology:
Normal immune responses are decreased during periods of
- Grief
- Bereavement
- Depression
Adverse Childhood Experiences (ACEs) scores
Stressful or traumatic experiences including:
- Psychological abuse
- Physical abuse
- Sexual abuse
- Emotional neglect
- Physical neglect
- Loss of a parent
- Mother treated violently
- Substance abuse
- Mental illness
- Criminal behavior in the household
How does childhood stress affect
health & behavior?
- Lowers tolerance for emotional and physical stress, which can result in such behaviors as fighting, defiance, checking-out, or isolation

- Decreases ability to focus and concentrate, which can cause problems with learning and memory and result in problems at school or work

- Increases difficulty in making friends and maintaining relationships

- Increases stress hormones called Cortisol, which affects the body's ability to stay healthy and may cause lasting health problems
Chemical imbalance hypothesis
Schizophrenia d/t increase in dopamine

Depression d/t
- Decrease in norepinephrine
- Decrease in serotonin

Anxiety d/t decrease in GABA
MRI and CT scan
Tells us what the brain looks like
(Structural)
PET, SPECT, fMRI scans
Tells us how the brain is working
Neuroanatomical changes r/t mental disorders
Enlargement of ventricles causing,
- Schizophrenia
- Alcoholism

Atrophy of the hippocampus d/t
- Trauma
- Severe stress in early life

Decreased cerebral blood flow causing
- Schizophrenia (Prefrontal Cortex)
- Attention-deficit hyperactivity disorder (Frontal Lobe)
Psychotropic or psychoactive drugs are
Medications which affect the mind or mental state
monozygotic twins (identical)
Enlarged ventricles in schizophrenia
Main purpose of psychotropic (also called "psychoactive") medication is to
Help balance neurotransmission in the brain
"Psychotropic" or "Psychoactive" drugs:
Medications which affect the mind or mental state
Psychiatric medications increase or decrease
Neurotransmitters, which control emotions, thoughts and behaviors
Neurotransmitters that are affected by
- Serotonin
- Dopamine
- Norepinephrine
Most antidepressants increase the
Amount of serotonin in the synapse clefts by blocking their re-uptake
Antipsychotic medications act primarily by
Blocking dopamine
Action of the Psychoactive Medications
Blocking the re-uptake of the neurotransmitter in the synapse, so that there is a higher concentration of the neurotransmitter that can be absorbed (i.e. results in increased neurotransmission).

Blocking a receptor or binding to prevent absorption (receptor antagonist).

Altering a receptor (genetic structure of the receptor)

Providing chemicals that help increase availability of a substance.
Therapeutic Effects of Psychoactive Medication:
Target symptoms: each class of medications have certain symptoms they target.

Onset of Action: Varies, but usually takes 2 to 3 weeks before you get the maximum effect.

Long term maintenance: Since mental illness is often a chronic disease, like diabetes, many clients need to stay on their medications.

Client education is a great need. You may need to assess for problems with adherence to medications.
Receptors are
Protein molecules which are embedded in the plasma membrane or cytoplasm of the receiving nerve cell
What are the site of attachment (or "binding") for the neurotransmitter?
Receptors
Neurotransmitters binding to receptors elicits a
Cellular response and then the chemical is passed on to the next nerve cell
Excitation and Inhibition
When a neurotransmitter binds to the receptor, the postsynaptic neuron is either a) excited or b) inhibited, depending on the type of neurotransmitter involved
Types of neurotransmitters
- Acetylcholine
- Dopamine
- Serotonin
- Norepinephrine
- GABA
Dopamine
- Initiation of motor activity
- Control of flow of information
to the frontal lobe from other areas of the brain
- Involved in the motivation reward pleasure system and addiction
Norepinephrine
- Alertness
- Ability to focus
- Stimulation of heart rate
- Involved in "fight or flight" response
Serotonin
- Coordinates and balances the nervous system
- Is both excitatory and inhibitory
- Regulates sleeping, appetite, sexual and social behaviors
An imbalance in serotonin can cause
- Depression
- Eating disorders
- OCD
- Migraine headaches
GABA (gamma-aminobutyric acid)
- Inhibitory
- Calming
Acetylcholine
- Memory and learning, muscle contractions
- REM sleep
- Principle neurotransmitter of the ANS
Many medications cause a decrease in level of
ACh, therefore "anticholinergic side effects" are commonly experienced when taking psychotropic meds
Admission Diagnostic Tests should include complete basic labs with possible addition of
- STIs
- TB
- EKG
- Blood alcohol level
- Therapeutic drug level monitoring e.g. lithium, Depakote
- Urine Drug screen
Assessments by the team should include
- Legal Status (does the person meet voluntary or involuntary admission criteria)
- Safety Risks and contraindications for seclusion or restraint
- Psychiatric Evaluation (facilitates psychiatric diagnosis)
- Nursing Assessments (facilitate appropriate care)
- Medical Exam
- Psychosocial (done by Social worker in-depth assessment of financial, work, social history, family assessment, etc)
Treatment team updates the treatment plan on
A regular basis
Treatment plans should
- Progress toward treatment goals
- Referrals (if needed) including psychological testing
- Discharge planning-aftercare
Formal evaluations are conducted on
Admission by the psychiatrist or when in-depth assessments are needed
A formal mental status exam or mental status assessment includes
- General Appearance
- Speech
- Behavior
- Movements and Muscle Tone
- Orientation
- Memory
- Attention and Concentration
- Emotional State (Affective)
- Thought Processes
- Thought Content
- Intellectual Functioning
- Judgment
- Insight
General appearance assess for
- Attire
- Hygiene/Grooming
- Facial Expression
- Pupil dilation or constriction
- Makeup and skin adornment
- Body weight, height, nutritional status
- Relationship between appearance and age
Speech assess for
- Pace (pressured vs. normal vs. slow)
- Flow (hesitant vs. steady)
- Volume, tone and modulation ( overly loud, inaudible, whispering)
- Clarity (slurred, speech impediment)
- Amount (hyperverbal vs. poverty of speech/has few words)
Behavior assess for
- Level of engagement
- Degree of cooperation
- Attitude toward interviewer or questions asked
- Excessive or reduced body movements
- Abnormal movements (e.g. tardive dyskinesia, tremors)
- Level of eye contact (keeping cultural differences in mind)
Movements and Muscle Tone assess for
Posture
Gait and mobility
Psychomotor Movements (involuntary movements associated with neural activity)
- Amount of movement
- Repetitive movements
- Abnormal movements and postures
Sensorium (level of consciousness) assess for
- Sensorium: Alert, drowsy, stuporous
- Quality of Responses: Answers questions, follows simple instructions
Memory assess for
- Immediate, short-term/working memory, long-term
- Any deficits or use of confabulation
Confabulation
Client fills in gaps in memory with made-up content
Emotional State (Affective) assess for
Mood (inward, ongoing emotional state of client)
Affect (outward emotional expression)
- Range of emotions/emotional expression
- Appropriateness to situation
- Lability
- Congruence with non-verbal or
with mood
Lability
Rapid changes in mood or affect
Thought processes assess for
- How logical
- Organization
- Ability to have goal-directed thinking
- Associations made (connections)
- Flight of ideas
- Neologisms
- Thought blocking
- Circumstantiality
- Ability to abstract (use of concepts)
Flight of ideas
Symptom of mania that involves an abruptly switching in conversation from one topic to another
The nurse is caring for a patient who exhibits intense and frequently shifting emotional extremes. The nurse should document the patient's behaviors and expressions as a:

a) Labile affect
b) Full affect
c) Constricted affect
d) Balanced affect
a) Labile affect
Circumstantiality
Speech that is delayed in reaching the point and contains excessive or irrelevant details
Thought blocking
Interruption of a thought process before it is carried through to completion
Thought Content assess for
- What the individual is thinking about
- Themes (What is the individuals main concern(s)? e.g., failures, family, finances)
- Somatic symptoms (focuses on physical sensations or discomfort)
- Repetitive thinking (obsessions, preoccupations)
- Denial or defensive thinking
- Destructive thoughts Violence, suicide or homicide
Compare intellectual functioning
To level of education
Judgment assess for
Rated ability to evaluate situations and to problem-solve
Insight assess for
The person's level of self-awareness and understanding of illness and current situation
Hallucinations
Abnormal sensory perceptions
Delusions
Beliefs that persist despite absence of evidence
Illusions
Misperceptions or inaccurate perceptions of external stimuli
Poverty of thought
Reduced ability for thoughts and responses
Nursing MSA
Documented in short form (every shift in acute care, less frequently in longer-term settings) with nurse's notes for changes in status
Risk Assessment for Suicidal Behavior
- Risk Factors for Suicide ("What places your patient at higher risk of acting on suicidal thoughts/ ideation?" Such as family hx, hopelessness, lives alone)
- Describe Plan is a narrative entry field
- Protective Factors ("What aspects of your patient's life will help protect them from acting on suicidal thoughts/ideation?")
Safety Plan is REQUIRED on
ALL patients that have identified risk for Suicide

Drop down options include "continue to monitor", "notify staff", & "other w/ annotation"
Nursing psychosocial assessments include assessing for
- How does the individual interact on unit with peers, staff?
- Motivation for treatment offered and attendance at scheduled activities
- Motivation for self-care and recovery; health seeking
- Did the he/she have visitors?
- Coping behaviors used, strengths, support system
- Interests and recreational activities
Basic Physical Assessments that Pertain to Mental Health Environment
- VS, Meds (side effects), compliance, status relative to other illnesses/chronic conditions; is the patient in withdrawal from ETOH/drugs?
- Sleep patterns, sleep disturbances
- Nutritional status, dietary needs
Purposes of the DSM-5
- Provides diagnostic criteria for mental health treatment in America
- Reimbursement
- Research and statistics
Conventional Attire/Dress
- Customary
- Usual
- Traditional
Meticulous Attire/Dress
- Overly neat and clean
- Unusually careful of detail
Inappropriate Attire/Dress
- Eccentric
- Peculiar or unusual
- Peculiar jewelry
- Violent slogans on clothing
Seductive Attire/Dress
Inappropriate dressing to enhance sexual desirability
Disheveled Attire/Dress
- Untidy
- Rumpled/wrinkled
- In disrepair
- Dirty
Well-groomed
Clean and neat
Dirty
- Dirty Hair
- Dirty clothes and/or skin or nails Strong body odor or odor from clothing
Unkept
- Hair not combed
- Buttons/zippers undone or
incorrect
- Missing usual articles (no socks
with tie shoes)
Sad facial expressions
Downcast and gloomy expression
Happy facial expressions
- Smiling
- Laughing
Angry facial expressions
- Frowning
- Scowling
Neutral or Unremarkable facial expressions
Lack of symptoms to arouse notice
Relaxed facial expressions
- Lack of tension
- Calm
- Loose muscles
Tense facial expressions
- Muscles taunt
- Showing emotional strain
Crying facial expressions
Tearful
Suspicious facial expressions
- Looking around constantly as if worried about a threat
- Guarding information
Poor eye contact
- Not meeting eyes of interviewer when culturally appropriate
Audible/Inaudible speeh
Loud enough/not loud enough to be heard by interviewer
Clear/Slurred speech
Distinct/indistinct
Rapid/Slow Pressured speech
Speaks very rapidly and continuously
Stammering speech
Uses involuntary halts, breaks and repetitions
Mumbling speech
Speaks in low tone and without articulation
Halting speech
Uses irregular rhythm
Garbled speech
Facts and sequence confused and mixed up
Incoherent speech
Disjointed and unintelligible
Even speech
- Smooth
- Steady
- Constant
Cooperative attitude
Answers questions without needing encouragement
Hostile attitude
Angry, resentful or unfriendly
Threatening attitude
Makes verbal or physical threats
Withdrawn
Avoids interpersonal interaction Stays to self
Guarded attitude
Inappropriately defends against questions
Manipulative attitude
Attempts to get own way using indirect means
Evasive attitude
Avoids honest, overt, candid interaction
Passive attitude
- Does not initiate anything
- Accepts what's offered
Dramatic attitude
Using theatrical appearance, speech and/or behavior
Naive
Shows lack of knowledge or experience for age
Aggressive attitude
- Overly assertive
- Insists on getting own way
Negativistic attitude
Says no to reasonable requests consistently
Ingratiating attitude
Overly compliant to elicit favor and approval
Self Deprecating attitude
- Self-degrading
- Expresses feeling unworthy
Seductive attitude
- Flirtatious
- Sexual display
- Excessive intimacy
Disdainful
- Superior attitude
- Disgust for others
Retardation
Movements slower than usual
Acceleration
- Movements faster or more frequent than usual
- Slow pacing
Agitation
- Excited
- Purposeless
- Restless activity
- Rapid
- Pacing
Posturing
Holding an abnormal and exaggerated posture
Repetitive movements
- Compulsions (repetitive behaviors performed in response to an intense need)
- Bizarre movements
Stuporous
Has some moments of unconsciousness
Hypervigilant
Heightened awareness of what goes on around them
Blunted affect
Appears unperceptive and slow to respond
Flat affect
Minimal expression with restricted or no range
Congruent affect
Non-verbal and verbal expression of feelings match
Incongruent affect
Mismatch between verbal statements and non-verbal cues (laughing when talking about grief)
Word Salad
Jumble of words without coherence
Confabulation
Filling in memory gaps by guessing or making up
Perseveration
Persistent, involuntary repetition of a phrase or idea
Ambivalence
Inability to make up one's mind
Clang associations
Words or phrases are associated based on sound, rhyming or initial sounds
Concretism
- Inability to think in concepts
-,Fabrication Creates fictional fillers to bridge actual events
Somaticism
Focus on physical ailments or complaints
Delusions of persecution
Believing others are out to harm or interfere when there is no realistic basis for fear
Delusions of Grandeur
Unrealistic belief that one has unique and special status, abilities or powers
Delusions of Reference
Belief that one is the topic or reference point for conversations or activities going on around one
Delusions of Influence
Belief that one's thoughts or actions are controlled by external forces or that one can
control the thoughts and actions of others
Delusions of Somatic
Bizarre, non-reality-based belief about condition or function of one's body
Nihilistic Delusions
Denial of existence of things or oneself
Thought of Broadcasting
Belief that one can read others' minds
Neologisms
Made up words
The nurse is caring for a patient who exhibits intense and frequently shifting emotional extremes. The nurse should document the patient's behaviors and expressions as a:

a) Labile affect
b) Full affect
c) Constricted affect
d) Balanced affect
a) Labile affect
The assessment of memory during a psychiatric interview is:

a) Important because if a patient cannot remember what has happened to him/her, it is difficult to complete the assessment
b) Important because impairment of memory is often a feature of organic mental disorder
c) Not particularly important
d) Difficult because the nurse can rarely verify the patient's statements
b) Important because impairment of memory is often a feature of organic mental disorder
Which of the following are considered to be the "chemical messengers" of the brain?

a) Dendrites
b) Axons
c) Neurotransmitters
d) Synapses
c) Neurotransmitters
Antipsychotic drugs are thought to block which neurotransmitters in the brain?

a) Dopamine
b) Serotonin
c) Acetylcholine
d) Norepinephrine
a) Dopamine
An MRI is ordered for a patient with a tentative diagnosis of schizophrenia. Visualizing which structure of the brain will be of particular interest with this patient?

a) Ventricles
b) Pineal Gland
c) Brainstem
d) Fornix
a) Ventricles

More dead space in the brain
Ventricles will be larger
Gray & white matter will be constricted
More cerebrospinal fluid
The Mental Status Evaluation should be:

a) The first communication a nurse has with a patient
b) Integrated in the nurse's assessment
c) Completed by several nurses
d) Done without the patient knowing
b) Integrated in the nurse's assessment
The Mental Status Evaluation is a reflection of the patient's:

a) Current state
b) Future prognosis
c) Past experiences
d) Family history
a) Current state

performed periodically
When establishing initial rapport with a patient, the nurse needs to focus on which clinical skills in the interview process during a Mental Status Evaluation?

a) Clarification and restatement
b) Systematic inquiry and organization of data
c) Attentive listening, observations, and questions
d) Information giving and feedback
c) Attentive listening, observations, and questions
When gathering information about a patient's judgment, which question would be the most appropriate?

a) "On a scale of 1 to 10, how stressed would you rate yourself?"
b) "What brought you into the hospital?"
c) "What problem would you like to work on while you are hospitalized?"
d) "If you found yourself downtown without money or a car, how would you get home?"
d) "If you found yourself downtown without money or a car, how would you get home?"

Ask an absract question
Asking a patient what a proverb means can test for which mental function?

a) Short-term memory
b) Orientation to reality
c) Abstraction
d) Long-term memory
c) Abstraction
Posture, body movements, grooming, and hygiene are included in which part of the Mental Status Evaluation?

a) Behavior
b) Cognition
c) Appearance
d)Thought processes
c) Appearance
Hyperactive, posturing/mannerisms, psychomotor agitation, tics, and tremors are included in which part of the Mental Status Evaluation?

a) Behavior
b) Affect
c) Motor activity
d) General appearance
c) Motor activity
Suicide, phobias, paranoia, and obsessions are included in which part of the Mental Status Evaluation?

a) Thought content
b) Thought process
c) Behavior
d) Mood
a) Thought content
Confusion, circumstantial, tangential, and flight of ideas are included in which part of the Mental Status Evaluation?

a) Speech
b) Thought process
c) Behavior
d) Thought content
b) Thought process
A patient diagnosed with schizophrenia is admitted. The nurse assesses the person's mental status. Which assessment finding is most characteristic of a patient with schizophrenia?

a) Mood swings
b) Extreme sadness
c) Manipulative behavior
d) Flat affect
d) Flat affect
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