Exam 15 - Care of the Patient with a Psych Disorder

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Questions and Answers

What is a common symptom of delirium?

Disorganized thinking and sensory misinterpretation. (correct)

Significant long-term memory loss.

Increased awareness of surroundings.

Chronically depressed mood.

Which statement best describes dementia?

It is always reversible with proper treatment.

It usually leads to a slow and progressive loss of intellectual function. (correct)

It is a sudden onset disorder typically caused by drug interactions.

It primarily causes mood swings without cognitive impairment.

Which of the following treatments is typically aimed at correcting delirium?

Sleep cycle normalization.

Routine mental health evaluations.

Immediate long-term medication therapy.

Identifying and correcting the underlying cause. (correct)

What defines positive behavior patterns in individuals with schizophrenia?

Hallucinations and delusions Signup and view all the answers

What is the prognosis for individuals exhibiting negative behavior patterns in schizophrenia?

Poor, with limited recovery options Signup and view all the answers

What typically manifests in the prodromal phase of schizophrenia?

Lack of energy or motivation and withdrawal Signup and view all the answers

Which symptom is NOT typically associated with the prepsychotic phase of schizophrenia?

Hallucinations and delusions Signup and view all the answers

Which of the following statements about bipolar disorder is accurate?

Individuals with bipolar disorder may experience euphoric episodes that can lead to dangerous behaviors. Signup and view all the answers

Which treatment for mood disorders is primarily used when other treatments are ineffective?

Electroconvulsive Therapy (ECT) Signup and view all the answers

Which of the following statements about seasonal affective disorder (SAD) is accurate?

Phototherapy is a recommended treatment option for SAD. Signup and view all the answers

What is the typical age range for the onset of anorexia nervosa?

Early to middle stages of adolescence Signup and view all the answers

Which of the following is a common behavior associated with bulimia nervosa?

Binge eating followed by purging Signup and view all the answers

What are some reported psychological effects associated with anorexia nervosa?

Depression and pronounced emotional changes Signup and view all the answers

What is a significant physical consequence of bulimia nervosa caused by repeated purging?

Tooth erosion and stomach lacerations Signup and view all the answers

Which aspect is crucial for the treatment of binge-eating disorder?

Correcting nutritional deficiencies and establishing normal eating patterns Signup and view all the answers

What is a key distinction between a normal fear and a phobia?

A phobia is an irrational fear that produces paralyzing anxiety. Signup and view all the answers

Which of the following features are indicative of obsessive-compulsive disorder (OCD)?

Compulsions that alleviate anxiety related to obsessive thoughts. Signup and view all the answers

In posttraumatic stress disorder (PTSD), which of the following is considered a common characteristic of an episode?

Emotional detachment and avoidance behavior are often present. Signup and view all the answers

Which of the following is NOT a common symptom associated with posttraumatic stress disorder (PTSD)?

Significant improvements in emotional expression. Signup and view all the answers

What is a characteristic of individuals with personality disorders?

Their behaviors are typically more troublesome to others. Signup and view all the answers

Study Notes

Neurocognitive Mental Disorders

Differ from other mental health disorders: An identifiable brain disease or dysfunction is the basis for the behavior.
Affect cognitive/intellectual abilities: Effects range from mild memory lapses to severe loss and behavioral changes.
Disorientation is a predominant characteristic.
Delirium: Rapid change in consciousness over a short time, possible at any age.
- Associated reduced awareness, disorganized thinking, sensory misinterpretation, and irrelevant speech.
- Often disturbed sleep patterns.
- Causes include: physical illnesses (fever, heart failure, pneumonia, azotemia, malnutrition), drug intoxication, anesthesia.
- Treatment: Determine and correct the cause (homeostatic imbalance or chemical agents).
- Nocturnal delirium (sundowning syndrome): Increased disorientation and agitation only at night.
Dementia: Altered mental state secondary to cerebral disease.
- Usually progressive, slow loss of intellectual function, often irreversible
- Symptoms can severely interfere with daily activities.
- Alzheimer's disease is the most common type (60-80% of cases in the US).
- 5.7 million Americans had Alzheimer's in 2018, projected to be 14 million by 2050.
- Nursing interventions include reality orientation and a safe environment.

Schizophrenia

Thought process disorders: Bizarre, non-reality-based thinking.
Defining characteristics: Gross distortion of reality, disturbed communication, social withdrawal, disorganization of thought, perception, and emotion.
One of the most disabling mental illnesses.
Onset typically in young adulthood, equal in both sexes, 1% of population experience at some point.
Chronic disorder with residual disability.
Often causes emotional and financial devastation for the family.
Stress can exacerbate episodes.
Biological basis, not poor mother-child relationship; brain tissue changes: enlarged ventricles (left larger than right), smaller cerebral cortex.
Dopamine is present in excess.
Possible pupil size differences, blinking rate changes, clumsiness, and right/left confusion.
Behaviors are categorized as positive (excessive) or negative (absent).
- Positive symptoms: Delusions (false beliefs), hallucinations (sensory experiences without stimuli), disordered thinking (loose association, concreteness).
- Negative symptoms: Apathy (avolition), social withdrawal, alogia (reduced speech), blunted affect, anhedonia.
Subtypes: Disorganized, paranoid (good prognosis with treatment), catatonic (fair prognosis), undifferentiated, residual (poor prognosis).
Stages: prodromal (adolescence, lack of motivation, withdrawal, odd beliefs), prepsychotic (passive behavior, hallucinations/delusions), acute (loss of reality contact, inability to function), residual (symptoms similar to prodromal, followed by remission).
Prognosis fair to poor, complex disorder.
Treatment: Psychotherapies, antipsychotic drug therapy, therapeutic relationship.

Major Mood Disorders

Mood disorders (affective disorders): Severe, inappropriate emotional responses, prolonged mood disturbances, thought distortions, symptoms associated with depression or mania.
Mood: A prolonged emotion affecting a person's psyche.
Extremes in mood: Depression to mania.
Hereditary factors account for 60-80% of cases.
Neurotransmitters (norepinephrine and serotonin) are deficient or excessive in mood disorders.
Imbalances can be hereditary or due to environmental factors (stress, trauma).
Depression: Exaggerated sadness, despair, low self-esteem, loss of interest, pessimism.
- 8% of Americans experience moderate/severe symptoms in a 2-week period.
- Affects all races, ethnicities, ages, socioeconomic groups.
- Women affected twice as often as men.
- Serious enough to cause suicidal thoughts/attempts.
- Suicide prevention: recognize warning signs (verbal statements, actions).
- Major depression (persistent depressive disorder): Repeated severe depressive episodes lasting over 2 years.
- Dysthymic disorder: Daily moderate depression lasting over 2 years (lifestyle, but not enjoyable).
Bipolar disorders (manic-depressive): Shifts between depression and mania.
- Mania: Persistent overactivity, euphoria; if untreated, can lead to delirium and death.
- Hypomania (early phase of mania).
Cyclothymic disorder: Repeated mood swings of hypomania and depression, milder than bipolar.
- No periods of normal function; frequently progresses to bipolar disorder
Seasonal affective disorder (SAD) and postpartum depression are other affective disorders, connected to hormonal imbalances and respond well to treatment.

Anxiety Disorders

Anxiety: Normal response to stress/threat (apprehension, uneasiness, agitation, uncertainty, fear).
- Signal anxiety (learned response to event), free-floating anxiety (no identifiable source), anxiety trait (personality aspect of frequent anxious responses), generalized anxiety disorder.
Panic attacks: Acute, intense, overwhelming anxiety (sudden symptoms peaking within 10 minutes).
- Symptoms: Heart palpitations, sweating, trembling, dyspnea, chest pain, dizziness, fear of losing control, fear of dying, paresthesia, chills.
- More common in women.
Agoraphobia: Extreme anxiety triggered by situations with potential panic attacks, avoidance of potential triggers.
- Treatment: Education, coping mechanisms, pharmaceutical blocking.
Phobias: Irrational fear, thoughts focusing on phobia object, often recognizing irrationality but not controlling anxiety.
Obsessive-Compulsive Disorder (OCD): Recurrent, intrusive, senseless thoughts (obsessions) that lead to compulsive behaviors (repetitive rituals to reduce anxiety).
Post-traumatic stress disorder (PTSD): Response to intensely traumatic experiences, reliving experience in dreams/flashbacks.
- Avoidance behaviors, guilt about survival, amnesia.
- Types: Acute (symptoms within 6 months, about 6 months duration), Chronic (symptoms lasting 6 months or longer), Delayed (symptoms starting 6 months or more after).

Personality Disorders

Inflexible, maladaptive patterns of behavior/thinking, impair functioning, typically emerge in adolescence/earlier, behaviors more troublesome to others than to the individual.
Characteristics: Lack of insight, concrete thinking, poor attention, distorted self-perception, impaired relationships, poor impulse control, inflexible behavioral responses.
10 distinct personality disorders (DSM-V), clustered into groups based on behavioral similarities (Cluster A, B, C).

Somatic Symptom Disorders

Physical disorder with a psychological trigger.
Recurrent, multiple physical complaints/symptoms with no organic cause.
Rule out other physical causes, drug reactions, mental health problems.
Includes ulcerative colitis, irritable bowel syndrome, hypertension, etc.

Eating Disorders

Anorexia nervosa: Self-imposed starvation, intense drive for thinness, fear of weight gain, distorted body image.
Bulimia nervosa: Binge eating followed by purging or compensatory behaviors (e.g., excessive exercise, dieting).
Binge-eating disorder: Frequent, recurrent binge eating without compensatory behavior.

Communication and Therapeutic Relationship

Therapeutic communication, helping-trust relationship: Maximizes patient strengths, maintains self-esteem, assists in developing coping skills.
Psychotherapy modalities: Behavior therapy, cognitive therapy, group therapy, play therapy, hypnosis, psychoanalysis.
Adjunctive therapies: Occupational therapy, recreational therapy, music therapy, art therapy, hydrotherapy.
Confidentiality limits: Duty to report child abuse/harm, duty to warn (patient expressing intent to harm).

Electroconvulsive Therapy (ECT)

Treatment for severe depression, mania, or schizoaffective disorders unresponsive to other treatments.
Brief electrical current induces a seizure.
Muscle relaxants and anesthesia used to reduce complications (fractures, contusions).
Temporary memory loss expected; confusion resolves in hours.
Outpatient procedure.
Pre-treatment tests are necessary (physical exam, blood work, EEG, X-rays).
Post-treatment care: monitor vital signs, provide reassurance, supervision.
Patient education is crucial for anxiety reduction.

Psychopharmacology

Psychotropic medications (psychoactive): Control symptoms, monitoring for effectiveness and side effects.
- Antidepressants: SSRIs/SNRIs, tricyclic agents, MAOIs.
  - Serotonin syndrome: Life-threatening, usually from SSRI interactions.
  - Symptoms: Altered mental status, autonomic dysfunction, neuromuscular abnormalities.
Antimanic agents (lithium): Mood stabilizer for mania.
- Narrow therapeutic range, requires close monitoring of blood levels, and careful diet management (sodium and fluid intake).
- Lithium toxicity signs: Nausea, vomiting, diarrhea, drowsiness.
Antipsychotic agents (neuroleptics): For schizophrenia, organic mental disorders with psychosis, and mania.
- Dose-related side effects: Postural hypotension, sedation, photosensitivity, autonomic reactions, extrapyramidal symptoms, tardive dyskinesia.
Antianxiety agents (anxiolytics): For anxiety.
- Benzodiazepines, but abuse potential.

Alternative Therapies

Herbal remedies (St. John's wort, kava, gotu kola, ginkgo, ginseng): Vary in quality and potency, potential drug interactions.
- Patient education to avoid interactions, and require clarification of any interactions with prescription drugs.
Aromatherapy: Use of scented oils, candles, incense.
- Limited effects, use often amplifies that of other therapies.

Application of the Nursing Process

Assessment, problem identification, planning, interventions, and evaluation.
LPN/LVN participation in data collection, problem formulation, plan implementation, and evaluation.
Patient teaching, health promotion interventions.
Documentation accuracy, ongoing assessment, detailed descriptions.

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Description

This quiz explores neurocognitive mental disorders, focusing on conditions like delirium and dementia. You'll learn about their characteristics, causes, and treatments, as well as the impact on cognitive abilities. Test your knowledge on how these disorders are diagnosed and managed.