Exam 1 - psychiatry.docx

Psychiatric / Mental Health - [Mental health]: A state of well-being in which individuals reach their own potential, cope w the normal stresses of life, work productively, and contribute to the community. - Mood: An individual's pervasive feeling state, relating with emotions/feeli...

Psychiatric / Mental Health - [Mental health]: A state of well-being in which individuals reach their own potential, cope w the normal stresses of life, work productively, and contribute to the community. - Mood: An individual's pervasive feeling state, relating with emotions/feelings. "The way a person feels". [This is subjective] - Affect: Observable response a person has to his/her own feelings. [This is objective] - Euthymia: Normal & healthy fluctuations in mood. This involves normal happiness & normal sadness. - Moods should not fluctuate so rapidly or to such extremes or for so long that functional status is disrupted. - Mood regulation depends on optimal functions of: - Neurons - Neurotransmitters (dopamine, serotonin, Norepinephrine) - Prefrontal cortex - Anterior cingulate cortex - Limbic system - [Excessive] or [insufficient] lvls of neurotransmitters are associated w mood disorders and other mental health conditions. (Neurotransmitters are chemicals that travel between neurons) - Mental disorders are caused by: 1. Media 2. Life experiences 3. Upbringing 4. Culture - Individuals suffering from mood disorders are known to be slow in seeking treatment. - Nurses are quite likely to be the first clinicians to detect the possibility. - [Motivational interviewing]: Influencing the Pt to seek care or change behavior. - 1 in 5 Americans (21%) experience mental health illness. - 18 -- 25 have highest lvl of mental illness, prevalence of 24% - Leading cause of Mental disability WORLDWIDE: Unipolar major depression (major depressive disorder) - Factitious Disorder (*Munchausen syndrome*): Pt pretends physical illness to get emotional needs met. - [Somatization (Somatic) disorder]: extreme focus on physical symptoms (pain/fatigue) that cause major emotional distress. - [Conversion Disorder]: presence of deficits in voluntary motor or sensory functions. (blindness/paralysis) - [Hypochondriasis Disorder]: Intense fear of having a serious illness and worry that minor symptoms indicate something serious. - [Body dysmorphic disorder]: Mental illness involving obsessive focus on a perceived flaw in appearance. - [Pain disorder]: No organic cause of pain, yet discomfort leads to impairment. - [Dissociative Fugue]: temporary state where a person has memory loss and ends up in an unexpected place without recalling how they got there. - [Depersonalization disorder]: Persistent/recurring feeling of being detached from one's body or mental mind. - [Dissociative Amnesia]: inability to recall important personal information, causing gaps in memory. - [Dissociative Identity Disorder] (DID): 2 or more distinct personality identities take control over behavior. - General mental status assessments: - Alertness/Orientation - General appearance - Motor activity - Mood - Affect - Speech - Nursing Diagnosis: - Anxiety - Ineffective coping - Social isolation - Hopelessness - Self-deficit - Ineffective role performance - Outcomes: - Manage anxiety - Increase self-esteem - Appropriate social interaction - Increased ability to cope - Clear sense of personal identity - DID (integration of personalities into one) - Treatment for mental health disorders: - Psychotherapy - Pharmacotherapy (combination of both is most effective \^) - Brain-stimulating therapy (mainly for mood disorders) - Psychoeducation - Support groups - Antidepressants: (for depression) - SSRI (first choice of treatment -- positive response rates & low side effect) - SNRI (mainly used for refractory depression) - NDRI - TCA - MAOI (used for refractory depression; beware for TYRAMINE foods) ( Tyramine foods: fermented foods: meat, alcohol, cheese, tofu, beans, plum, pineapple chocolate, nuts) - Antidepressants can cause Serotonin syndrome. (tachycardia, shivering, diaphoresis, dilated pupils, myoclonus (tremors/twitch), hyperreflexia, hyperthermia) - DO NOT abruptly discontinue antidepressants meds = SSRI withdrawal syndrome (Anticholinergic rebound) -\> Flu-like symptoms - Mood stabilizers: (for mania/hypomania & bipolar) - Lithium (Blood lvls 0.8-1.4, kidney function, thyroid function) - 2^nd^ gen Antipsychotics - Non-epileptic drugs (NED) - Anxiolytic (risk -- due to lethal overdose) (Check renal/hepatic) - Early signs of lithium toxicity: Diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination. (severe: ataxia, tinnitus, blurred vision) - Take steady fluids & electrolytes - Lithium should not be taken by pregnant or breast-feeding woman - DSM-5 -- Diagnostic and Statistical Manual - Identifies disorders based on specific criteria. Schizophrenia - Must have at least 1 of the first 2 symptoms for at least 1 month. - Positive Symptoms: - [Delusions] - [Hallucinations] - Disorganized speech - Disturbances in behavior - Disturbances in thought process - Negative Symptoms: - Loss of interest - Lack of emotions - Removal of normal processes - Flat affect - Avolition (decrease in motivation) - Cognitive symptoms: - Epidemiology - Affects males more than women - Mainly occurs between 15 -- 25 - Many die more than 20yrs prematurely - Treatment: - Anti-psychotics (1^st^ gen & 2^nd^ gen) (2^nd^ is first defense & most common) - ElectroConvulsive Therapy -- used if medications don't work Bipolar - Types of Bipolar: - **Bipolar I** -- Characterized by the presence/history of at least one manic episode. - **Bipolar II** -- Characterized by the presence/history of at least one hypomanic episode and one major depression - **Cyclothymia disorder** -- Bipolar-related disorder, with symptoms of hypomania and mild-moderate depression for [at least 2yrs]. - Mania: - Presence of euphoric/agitated affective state - Often caused by high lvls of dopamine - Impaired functional status - They suffer from perceptual disturbances - Often suffer from: 1. Racing thoughts 2. Grandiose delusions 3. Difficulty concentrating 4. Impulsivity 5. Lack of insight - Depressive episodes typically last longer than manic/hypomanic episodes. - Causes: - Genetic (Inherited by family history) - Neurodegeneration (thalamus, basal ganglia) - Neurotransmitter imbalance - Stressful life events - Substance abuse - Certain meds (TCA) - Hypomania: - Unstable affective state - This a lesser severe degree of mania & less impairment - Criteria for Manic episodes: (at least 1 and more than 3 symptoms) - Increased energy - Psychosis (hallucinations & delusions) - Decreased need for sleep - Inflated sense of self-worth/confidence - Unusual talkativeness/ rapid flow of speech - Racing thoughts - Increased distractibility - Participating in high-risk activities w/o regards for consequences (gambling, shopping sprees, foolish investments - Mixed episode: - Most severe - Poor prognosis - Risk for suicide is high - Criteria for hypomanic episodes: (At least 4 days with 3 or more symptoms but less severe) (it's the same as mania \^) - Pts who are manic/hypomanic are higher risk for suicide than those melancholic pole. - Early detection of bipolar -- can help diminish substance use problems, suicide, and decline in social relationships - During acute phase of mania = physical needs take priority - Genetics plays a big role in the risk of bipolar disorders - 3 things that can help Pt adhere to med regimen: 1. Support groups 2. Psychoeducation 3. Guidance for family - First line of defense = Mood stabilizers (Lithium & anti-convulsant) - Lithium treats acute mania & maintenance - Check blood lvls(0.8-1.4), kidney function, thyroid function - Treatment for Bipolar: - Mood stabilizer (lithium) - Antipsychotics - Antidepressants - Most Anti-convulsant are used for acute mania - Lamictal is used for maintenance - Antipsychotics (2^nd^ gen) are used for sedating & mood stabilizing properties. - Depression: Overwhelming sadness & despair that one feels drained of energy. - May feel so sad that he/she loses the will to live -\> SI - A mood disorder that affects the way you feel, think, act for prolonged periods. - Melancholy: Undiagnosed mood for sadness, despair, and loss of functional status. - [Depression is higher in women] than in men. - Risk factors for depression: - Early/past trauma - Stress - Neglect - Abuse - Family history - Comorbid medical & psychiatric disorders - Personality disorders - Lack of social support - Criteria for major depressive episode: (for at least 2 weeks and 5 or more symptoms, must also include at least 1 of the first 2) - Depressed mood/ feeling sad or hopelessness - Loss of interest in all activities - Significant weight gain or loss - Increase/ decrease in appetite - Insomnia or sleeping too much - Increased restlessness or unusual sluggishness - Fatigue - Feeling worthless/guilty over past mistakes - Difficulty thinking/ concentrating - Having suicidal thoughts/attempts - Blunting: An absence or diminished presence of any affect. - This is a sign of affective instability. - Anhedonia: lack of interest in normal activities - Anxiety is different from depression - Excessive & persistent worry & fear about everyday situations. Tachycardia, Tachypnea, sweating, fatigue - Medications that can cause depression: - Steroids - BP meds - Physical signs of depression: - Fatigue & Insomnia - Changes in weight/appetite - Moving/speaking more slowly - Aches & pain - Loss of libido (low sex drive) - Changes in menstrual cycles - Psychological signs of depression: - Low mood or sadness - Feeling of hopelessness - Low self-esteem - Feeling tearful, guilty, irritable - Losing motivation/interest - Difficulty making decisions - Anxiety - Thoughts of self-harm - 5 D's of depression - Distress - Dysfunction - Defeat - Distance - Disregard - Types: - **Major depressive Disorder** - Last for at least 2-week period - Experience at least 5 depressive symptoms (each day) - Average age onset: 33 - At risk: Non-Hispanic whites & women - Women are more prone than men - Leading cause of disability in US - **Persistent Depressive Disorder** (DYSTHYMIA) - Chronic - Symptoms occur most of the day, nearly everyday, for more than 2yrs - Disqualifiers = manic episodes, cannot result from substance abuse or medical conditions - **Disruptive mood dysregulation disorder** - Angry mood most of the day, nearly everday with temper outbursts or episodes of explosive rage - Applies to children 7 adolescents - Happens in 2 settings: home & school - Not more than 3 months can pass w/o symptoms - **Psychotic Depression** - Depression is so severe it causes hallucinations/delusions known as psychosis - Treatment for depression: (SSRI) -- DO NOT use in children - Fluoxetine - Paroxetine - Sertraline - Citalopram \* Can be fatal if used w MAOI - Treatment for Anxiety: "-l / pam" "benzodiazepines" - Alprazolam (Xanax) - Clonazepam (Klonopin) - Chlordiazepoxide (Librium) - Diazepam (valium) - Lorazepam (Ativan) - Nursing Diagnoses: - Risk for suicide - Hopelessness - Ineffective coping - Social isolation - Spiritual distress - Self-care deficit Therapeutic Communication Techniques - Listening: - Restating: - Broad Opening: - Clarification: - Reflection: - Sharing perception: - Suggesting: - Focusing: - Theme identification: