MH Exam 2 PDF: Past Paper

Exam 2  🔹 🔹 Neurotransmitters (Monoamines) Feel good Booster Dopamine Functions: Cognition, motivation, movement, reward system, heart stimulat...

Exam 2  🔹 🔹 Neurotransmitters (Monoamines) Feel good Booster Dopamine Functions: Cognition, motivation, movement, reward system, heart stimulation, blood flow. Dopamine: Drug Effects: Decreases in Parkinson's disease Cocaine/Amphetamines → Increase dopamine → Can cause psychosis. and depression Increases in Schizophrenia and Antipsychotics (Haloperidol) → Block dopamine → Reduce psychosis. mania Dopamine Hypothesis: Excess dopamine = schizophrenia symptoms. Norepinephrine (Flight on fight) Function: Regulates arousal (low = sedation/depression, high = hyperarousal). Decreases in depression Receptors: α1 & α2 adrenergic receptors. Increases in Mania, anxiety, Drug Effects: schizophrenia Prazosin → Blocks α1 → Treats PTSD nightmares. FGAs (Conventional Antipsychotics) → Block α1 → Vasodilation, orthostatic hypotension, ejaculation issues. chood's sleep Stabilizes Serotonin: Function: Regulates mood, arousal, attention, behavior, and body temperature. Decreases in Depression Serotonin Syndrome: Increases in Anxiety states Mild: Restlessness, shivering, diarrhea. Severe: Muscle rigidity, fever, seizures. Cause: Excess serotonin (e.g., SSRIs + St. John’s wort/dextromethorphan). Histamine: Treatment: Muscle relaxants, serotonin blockers. Decrease: Sedation, weight gain SSRIs & SERT Blockade: Drugs: FGAs & other psychiatric meds block H1 Effect: Increases serotonin, reduces platelet aggregation. receptors. Risk: Bleeding (Caution with NSAIDs, aspirin, warfarin). Effects: Sedation → Useful for agitation. Weight Gain → Beneficial for low appetite/ weight.  🔹 🔹 Neurotransmitters (Amino Acids) calm down chemical The GAMMA-AMINOBUTYRIC Function: Inhibitory neurotransmitter, regulates neuronal excitability & ACID (GABA) anxiety. Decrease: Mania, anxiety, Drug Effects: schizophrenia Anxiolytics → Enhance GABA activity → Reduce anxiety. Increase: Reduction of anxiety Future Antipsychotics → Target GABA & dopamine for schizophrenia - treatment. Glutamate: Brain Booster Function: Excitatory neurotransmitter, activates NMDA receptors. - Decrease NMDA: psychosis Imbalance Effects: Increase NDMA: neurotoxicity, Excess glutamate → Neurotoxicity & cell death (e.g., Alzheimer’s). neurodegeneration in Alzheimer NMDA antagonists (e.g., Memantine) → Reduce excitability & disease neurotoxicity. Increase AMPA: Improve cognitive Therapeutic Advances: performance in behavioral tasks Lumateperone (Caplyta) → Targets serotonin, dopamine, & glutamate (schizophrenia). Ketamine-like drugs → Modulate NMDA & AMPA receptors (rapid depression relief).  🔹 🔹 Nuerotransmitters (Cholinergic) Function: Balances dopamine, regulates muscle movement, arousal, memory, sleep-wake cycle. Acetylcholine: Muscle memoryer ACh & Alzheimer’s: Increase: Depression Deficiency in ACh → Cognitive decline. Decrease: Alzheimer’s disease, Huntington chorea, AChE Inhibitors (e.g., Donepezil, Rivastigmine) → Delay cognitive decline. Parkinson disease Nicotinic Receptors & Schizophrenia: Nicotine stimulates ACh receptors → May help with cognition & sensory deficits. New drug research → Targets nicotine receptors without harmful effects. Peptides-Neuromodulators Substance P: Regulation of mood and anxiety - Role in pain management - Somatostatin: Nuerotransmitter Systems are Decrease: Alzheimer’s diease, affectd by these Psychotropic decreased levels of SRIF in spinal Function: Regulates cognitive function. Drugs: fluid of some depressed patients Antidepressants Increase: Huntington chorea Antianxiety agents Sedative hypnotics mood stabilizers Antipsychotic agents Neurotensin: Anticholinesterase agents Decreased levels in spinal fluid of patients with schizophrenia  Antidepressant Drugs: MAOI'S Smiley in the O uptake Selective serotonin reuptake inhinitor stops Monoamines: Organic compounds, including catecholamines (e.g., NE, Brain dopamine) and indolamines (e.g., serotonin). - - MAO: Enzyme that breaks down monoamines. -- G SSRIs: Fluoxetine (Prozac), sertraline (Zoloft), parapxetine (Paxil) - - incease serotonin, improve mood - take in take morning + ne MAOIs: Inhibit MAO, increasing monoamine concentrations. the Side effects include fewer anticholinergic effects than tricyclic agents: morning N/V Use: Treats intractable depression by increasing serotonin & NE. SSRIs & SNRIs are preferred due to fewer side effects. Serotonin-norepinephrine reuptake inhibitor (SNRIs): venlafaxine (Effexor), duloxetine (Cymbalta) Hypertensive Crisis: Caused by combining MAOIs with OTC medications with Increase serotonin and norepinephrine sympathomimetics (e.g., pseudoephedrine) or foods containing tyramine (e.g., aged/ Side effects: include fewer anticholinergic effects fermented foods, some beverages). Laged cheese Dietary Restriction: Avoid tyramine for 2 weeks after stopping MAOIs. Serotonin-norepinephrine disinhibitors (SNDIs): mirtazapine (Remeron) Increase serotonin and norepinephrine. Combined with SSRIs to augment Selegiline via patch → Lower hypertensive risk compared to oral - efficacy or counteract serotonergic side effects (serotonin syndrome s/e) MAOIs (e.g., Phenelzine, Tranylcypromine) Serotonin antagonist/reuptake inhibitors takes 1 weeks effect Norepinephrine-dopamine reuptake inhibitors (NDRIs): bupropion (Wellbutrin) (SARIs): trazodone (Desyrel): to take Do not act on serotonin system. Not the first choice for antidepressant treatment, but Inhibit nicotinic acetylcholine receptors to reduce addictive effects. useful for insomnia. Can cause priapism (a prolonged erection of the penis, usually without sexual arousal) Selective norepinephrine reuptake inhibitors cTricyclic (cyclic) antidepressants (TCAs): amitriptylene G(Elavil), nortriptyline C(Pamelor) (NRIs): atomoxetine (Strattera): Increase norepinephrine.Blocke Serotonin Treat ADHD when stimulants are not tolerated, but no significant Side effects include anticholinergic effects. constipation , Dry morth antidepressant benefits. Blurred vision Urinary retention , 🔹 Antianxiety Drugs Buspirone (Buspar): term vse) (long Reduces anxiety without the sedative and euphoric effects of benzodiazepines Melatonin-Receptor Agonist A hypnotic drug that acts similar to Enas in pam melatonin; is thought to regulate Benzodiazepines: used for anxiety (short-term use circadian rhythms - Bind to GABAA receptors, enhancing GABA activity. Types of Benzodiazepines:idote-Flumazil Ex: Ramelteon (Rozerem) Hypnotic (sleep-inducing): Flurazepam, Triazolam. Anxiolytic (reduces anxiety): Lorazepam, Alprazolam. Short-Acting Sedative-Hypnotic sleep agents Z-hypnotics (nonbensodiazepine agents) Use: Primarily for sedation (sleep-inducing) without affecting anxiety or muscle tone. Examples: Zolpidem (Ambien) Zaleplon (Sonata) Eszopiclone (Lunesta)  Mood Stabilizer: Lithium (Bipolar disorder ( Anticonvulsants: Affects multiple steps in cellular signaling Therapeutic Level: 0.5-1.5 mEq/L - C Valproate (Depakote/Depakene) Helpful in bipolar patients (increasesaba Toxic Level: >1.5 mEq/L unresponsive to lithium. - Increases the concentrations of mania Signs of Lithium Toxicity: lamotrigine (Lamictal). - decreases Early Signs (Therapeutic to Toxic): ◦ Vomiting, diarrhea, GI discomfort - - Lamotrogine (Lamictal) Levels >2 mEq/L: Effective in bipolar depression. ◦ Tremors, sedation, confusion when dose is increased to - - - May trigger a severe skin reaction Levels >3.5 mEq/L: called Stevens-Johnson syndrome. quickly ◦ Delirium, seizures, coma, death - - - Long-Term Risks: Kidney disease - Cr Carbamazepine (Tegretol) Effective for rapid cycling bipolar disorder. I decreaseranial Thyroid disease A CBC must be done periodically because of rare but - serious blood problems (e.g., aplastic anemia and - Additional Safety Issues: agranulocytosis). Hyponatremia (low sodium) Headache (HA) Dizziness, hypotension - QT prolongation Leukocytosis (increased white blood cells) - Polyuria - (increased urination  🔹 Off- Label Mood Stabilizers Oxcarbazepine (Trileptal) Off-label use: May be used as a mood stabilizer. Mechanism of action: Similar to carbamazepine (stabilizes sodium channels in neurons). Gabapentin (Neurontin) Off-label use: Sometimes used for mood stabilization. Mechanism of action: Increases GABA activity, reducing neuronal excitability. Topiramate (Topamax) Off-label use: Mood stabilization. Mechanism of action: Inhibits glutamate release and enhances GABA activity, reducing brain excitability. Antipsychotic Safety: Specific Adverse Reactions Blocking muscarinic cholinergic receptors Blurred vision, dry mouth, constipation, and urinary hesitancy Antagonism of the histamine1 receptors Sedation and weight gain Blocking α1 receptors for norepinephrine Can affect vasodilation and a consequent drop in blood pressure, or orthostatic hypotension Antagonism of either α1 receptors or 5-HT2 receptors Ejaculatory dysfunction Nonverbal behaviors include: Techniques that can obstruct communication Body behaviors, facial expressions. eye cast, voice related behaviors, observable autonomic physiological responses, personal appearance, physical characteristics Double-bind messages: When the verbal message is not reinforced by the communicator’s actions, the message is ambiguous; we call this a double-bind (or mixed) message. Incongruent- doesn't match congruent- matches  Active listening includes: Factors that can impede accurate communication Observing the patient’s nonverbal behaviors Listening and understanding the patient’s verbal Personal Factors: message Emotional: mood, personal bias Listening and understanding a person in the Social: cultural, lifestyle, and language differences social context, and listening for “false notes” Cognitive: problem solving, knowledge level “false notes” = inconsistencies or things the patient says that need more clarification Environmental factors: Providing feedback Physical factors: backgrounds noise, lack of privacy Most people want (in communication) the Societal determinants: economic factors, expectations of other person to be there for them others psychologically, socially, and emotionally. Relationship factors: Cultural Competence Symmetrical relationship: Equal friends or colleagues involves gaining knowledge about another Complementary relationship: Difference in status and power, individual’s culture and is a necessary competence such as between a nurse and patient or between a teacher when caring for a client from a diverse background. and student. Barriers Relationship is characterized by inequality (one Communication Styles – Some cultures use participant is “superior” to the other often to d/t the expressive, emotional communication, while others formal role of the relationship) prefer reserved, indirect styles. Eye Contact – In some cultures, direct eye contact is a sign of respect, while in others, it may be seen as aggressive or inappropriate. Perception of Touch – Some cultures value physical contact as a sign of warmth, while others may see it as intrusive. Cultural Filters – Personal biases and cultural backgrounds influence how we interpret information.  Telehealth Allow for establishing and maintaining therapeutic relationships Provide a live interactive mechanism Provide a way to track clinical progress Provide access to people who otherwise might not receive good medical or psychosocial help May help relieve the nursing shortage Statistically, 1:4 adults could be diagnosed with a mental health issue. Most of these mental health issues are not addressed because of: Fear of stigma Scarcity of health care providers in remote areas Problems with transportation U.S. Department of Defense (DOD) uses telehealth for: Telepsychiatry appointments Health assessments, diagnoses, treatments and interventions Clinical consultations for all DOD members Mobile apps Cell phones are the most quickly adopted consumer technology in human history. Psychiatric patients own smartphones at high rates and are interested in using them to monitor their mental health, based on published surveys. There are thousands of apps that target psychiatric conditions, however, there is less clinical research on these apps. There is growing interest in using “passive data” information.  Therapeutic Relationship Phases of the nurse patient relationship ATI chapter 5 Orientation: when the nurse and patient first meet. It sets the foundation for trust and establishes the structure of the A patient-centered partnership implies a patient’s participation in relationship. Key Aspects: his or her health care decisions. Establishing rapport and a trusting environment. The therapeutic nurse-patient relationship Defining the nurse’s role and responsibilities. Is the basis of all psychiatric nursing treatment approaches Discussing confidentiality and its limitations. regardless of the specific aim. Creating a contract (verbal or written) outlining the time, place, and duration of meetings. Identifying the patient’s main concerns and setting mutually agreed-upon goals. Is a creative process and unique to each nurse. Example Interaction: Student Nurse: “Hello, Mr. Jones. I’m a nursing student, and I’ll be spending time with you every Thursday to support you in working toward your treatment goals. Goals in a therapeutic relationship include: Facilitating communication of distressing thoughts and feelings Working: nurse and patient actively engage in addressing identified concerns. The patient may experience resistance or progress in problem-solving Assisting patients with problem solving to help facilitate ADL’s Key Aspects: Helping patients examine selfdefeating behaviors and test Exploring and addressing the patient’s thoughts, feelings, and behaviors. alternatives Encouraging problem-solving and autonomy. Using therapeutic communication to help the patient express concerns. Promoting self-care and independence Identifying and overcoming resistance or defense mechanisms. Monitoring for transference (patient projects feelings onto the nurse) and countertransference (nurse projects feelings onto the patient). Social relationship: Includes friendship and socialization. Mutual needs Example Interaction: are met. May include giving advice. Basic needs are met. Content is Patient: “I feel like nothing ever goes right for me.” Nurse: “It sounds like you’re feeling discouraged. Let’s talk about what’s making you feel this way. superficial. Roles may shift. Little evaluation of interaction occurs Therapeutic relationship: Nurse maximizes communication Termination: conclusion of the nurse–patient relationship, whether due to patient discharge, a transfer, or the end of scheduled sessions skills, understanding of human behaviors, and personal Key Aspects: strengths to enhance patient’s growth. Patient needs are Reviewing the progress the patient has made. addressed. Language is straightforward. Focus is on the Addressing feelings of loss or separation. Reinforcing coping strategies and future steps. patient’s ideas. Ensuring a smooth transition to other sources of support if needed. Example Interaction: Nurse: “Over the past six weeks, we’ve worked on managing your anxiety. How do you feel about using the coping techniques we discussed after discharge?  Boundary blurring: Empathy- Is “temporarily living in the other’s life.” The first connections between the nurse and patient are to establish an understanding that the nursing relationship is: Empathy vs sympathy: Safe, confidential, reliable, and consistent. In empathy, we understand the feelings of others. Conducted within appropriate and clear boundaries In sympathy, we feel the feelings of others; objectivity is lost. Genuineness: Clinical Interview Self-awareness of one’s feelings occurs; develops the ability to communicate when appropriate. Positive regard: Displays respect; view another person as worthy of our time. Transference: Person unconsciously and inappropriately displaces (transfers) those emotional reactions that originated from significant figures in childhood onto another individual. Countertransference: Tendency of the nurse to displace feelings related to people in his or her past onto a patient (does not have to be sexual in nature). The nurse’s transference or response to a patient that is based on the nurse’s unconscious needs, conflicts, problems, or view of the world. Frequently, the patient’s transference to the nurse evokes countertransference feelings in the nurse.  Depression Stigma: The individual is just feeling Stats: Estimated 17.3 million adults in the U.S. had at least Theory: Genetic factors down one major depressive episode Biochemical factors: Neurotransmitters involved in depression Approximately 2/3 of people with depression contemplate Monoamines, serotonin, norepinephrine, and dopamine Major Depressive Disorder (MDD) suicide Abnormalities in the number of receptor sites Medical illness that affects how 2/3 = > 11.5 million people you feel, think & behave causing persistent feelings of sadness & # loss of interest in previously * enjoyed activities Risk Factors: History of prior episodes of depression History of suicide attempts or family history of suicide Member of the LGBTQ+ community Female gender Age 40 years or younger Postpartum period Chronic medical illness Absence of social support Early life trauma, particularly hx of sexual abuse Active alcohol or substance use disorder Family hx of depressive disorder, esp. in 1st- degree relatives Nursing Concerns (priority hypothesis) Interventions: DTS Self mutilation Worthlessness Hopelessness Helplessness Self-care deficit Isolation Poor nutrition Planning: Safety is always the highest priority But we take it one step further and make it a patient specific safety Brain Stimulation Therapy: concern Brief seizures are induced by electrical current attached to one Geared toward specific symptoms or both sides of the forehead. Recognize and help patient tolerate medication side effects Facilitate a supportive nurse-patient relationship Effective for— Account for the presence of vegetative signs of depression, as well as Treatment-resistant depression, Patients with life-threatening changes in concentration, activity level, social interaction, or personal psychiatric conditions such as self-harm and acute mania, appearance Patients for whom side effects of antidepressants are too uncomfortable or have been ineffective Communication guidelines: Table 15-3 & Table 15-4 in the textbook. Educate pt— Instructions for before (i.e.., NPO) Person with depression may speak & comprehend very slowly. Include expected effects (i.e., HA, disrupted memory, general Extreme depression—Person may be mute/ selectively mute. confusion) Sitting with a patient in silence is a valuable intervention. This time spent together can be meaningful to the depressed person. Suicide Prevalence & Comorbidity Risk Factors: Suicide- The intentional ending of one’s own life. Every year approximately 800,000 people Presence of a plan Suicide attempts- Willful, self-inflicted, lifethreatening attempts around the world die by suicide. Previous suicide attempt (the greatest that have not led to death. Suicide rates differ with gender, age, race, and predictor) Suicidal ideation- A person thinking of selfharm. geography. History of mental disorder (specifically Always take an individual very seriously if some form of Of all completed suicides, 78% are male, which depression, alcohol, and drug abuse) suicidal ideation is mentioned. is 4x the rate for females. Adverse life events, recent loss Ask, “Are you thinking of harming [killing] yourself?” Middle-aged adults account for the largest Family hx of mental illness, specifically Listen very carefully to what he or she does or does not proportion of suicides. substance abuse and/or suicide say. American Indian/Alaska Natives have the highest Incarceration rates of suicide. Exposure to suicide from family, peers, White/non-Hispanics have the second highest and others "Right to die" rates Chronic physical illness and pain The issue of the “right to die with dignity” is vastly controversial & complex. Physician-assisted suicide (PAS) for the terminally ill SUICIDE IS-- The 3rd-leading cause of death among operates under strict guidelines. people ages 10 - 14 CA, CO, HI, ME, NJ, NM, OR, VT, WA, and DC The 2nd-leading cause of death for people ages 15 - 34 legalized physicianassisted suicide via legislation Of the 10 U.S. states, all of them require a patient to: Some medications contribute to symptoms of depression Be a resident of the state Antidepressant may increase the risk of suicide Be at least 18 years old Have an estimated 6 months or less to live Those who have experienced a traumatic brain injury (TBI) are at Make at least two verbal and one written request greater risk for PAS to a physician 15-23% of returning war veterans have experienced TBI Athletes in high contact sports with chronic traumatic encephalopathy (CTE)  Assessment Guidelines: Suicide Risk Adolescents & Young Adults How detailed is the plan? Strongest r/f, 14 - 24 y/o: How lethal is the proposed method? Substance abuse, aggression, depression, & social isolation Highly lethal: Guns, hanging, carbon monoxide, staging a car crash Additional r/f: Lower risk: Slashing wrists, inhaling natural gas, ingesting pills Frequent episodes of running away How available is the proposed method in carrying out the plan? Frequent expressions of rage & problems with parents Example: Does the person have a gun? Family loss, instability, & withdrawal Determine whether the patient’s age, medical condition, or Perception of failure: school, work, social psychiatric diagnosis places the patient at a higher risk. Expression of suicidal thoughts when sad or bored Difficulty dealing with sexual orientation Cause theory: Unplanned pregnancy Neurobiologic aspects of suicide: Strong association exists between suicide and low Older Adults serotonin. R/f include social isolation, solitary living arrangements, widowhood, lack of financial resources, Biological responses to stress may be a risk factor. poor health, and hopelessness/helplessness. Hypothalamic-pituitaryadrenal (HPA) axis: Most older adults who commit suicide have visited their primary care physician the month before Is associated with memory dysfunction. the suicide, sometimes that very day. Suicide victims often exhibit HPA axis abnormalities. Recognition and tx of depression in the medical setting helps prevent suicide in older adults. Genetic Factors: Suicide clusters develop in some families, resulting in a family history of suicide Psychologic factors: Psychotic tendencies result in increased risk, especially as it relates to CAH Hopelessness, helplessness, and feelings of worthlessness are evident. Cultural Considerations: Verbal clues- Always take a suicide threat seriously Overt Statements The meaning of suicide has traditionally reflected the religious “I can’t take it anymore.” beliefs of a culture. “Life isn’t worth living anymore.” Cultures historically steeped in Roman Catholic teachings “I wish I were dead.” (South America, Spain, Italy, Ireland) often have lower rates “Everyone would be better off if I died.” of suicide d/t “unforgivable.” “Living is useless.” To the contrary, people who practice the Shinto religion “Nothing matters anymore.” believe in reincarnation; therefore, suicide may be seen as an honorable solution to life’s problems. Covert/Concealed Statements- particularly reveling if you Seppuku is a form of taking one's own life that was can identify considered honorable among the feudal Japanese samurai “It’s okay now. Everything will be fine.” class. Traditionally, the act consisted of stabbing oneself in “I won’t be a problem much longer.” the abdomen with a short sword to ensure a slow and “Nothing feels good and never will again.” agonizing death. “I want to give my body to medical science.” Assessing clues: Nursing concerns Sudden behavioral changes include: Risk for suicide or DTS Giving away prized possessions Self-restraint from suicide is the hoped- Writing farewell notes for outcome. Making out a will Other possible concerns include: Putting personal affairs in order HOPELESSNESS Failing to sleep or fall asleep for more than one night in a row (global Ineffective coping insomnia) Social isolation Exhibiting sudden or unexpected improvement in mood after being Spiritual distress depressed and withdrawn Low self-esteem Neglecting personal hygiene Disturbed thought processes Safety promotions: SI long term outcomes should: Intervention during the crisis period Optimize events and environmental factors to help minimize self-destructive acts. Institutional Protocol: Ensure that suicidal individuals will be able to: Provide a safe environment. Explore alternatives and increase problem-solving skills. Document the patient’s activity—usually every 15 Show evidence of increased coping skills. minutes; include what the patient is doing and with State that feelings of isolation and loneliness are less. whom. Engage in treatment for co-occurring mental health issues (e.g., depression, substance abuse, PTSD) Maintain accurate records of nurse and physician Communication guidelines: actions. During a suicidal crisis, the following information should be conveyed to the patient in all settings: Place the patient on either suicide precaution or suicide The crisis is temporary. observation. This unbearable pain can be survived. Construct a verbal or written no-suicide contract. Help is available. Encourage the patient to talk about his or her feelings You are not alone. and alternatives. Outcome Interventions After the Crisis Period Reflect patient values, & ethical environmental situations. Be culturally appropriate. Be documented as measurable goals. Include a time estimate. Interventions for Returning War Veterans Support groups for veterans Increase coping skills Enhance problem solving Minimize isolation and loneliness