NURS 463 Mental Health Midterm Study Guide

A set of vocabulary flashcards based on the NURS 463 Midterm Study Guide covering neurotransmitters, psychopharmacology, and mental health disorders.

Dopamine

An excitatory neurotransmitter in the brain that plays several important roles in regulating mood, motivation, and reward. It is directly linked to processes such as pleasure, sensation-seeking, and the reinforcement of rewarding behaviors. Dysregulation is associated with various psychiatric conditions, including psychosis (such as schizophrenia), mood disorders (such as bipolar disorder), and addictions. Additionally, it also influences motor control and coordination, making it essential for both mental and physical health.

Too little:

• Depression and apathy

Too much:

• Psychosis and hallucinations

Serotonin

An inhibitory neurotransmitter that primarily contributes to the regulation of mood, anxiety, and emotions. This neurotransmitter plays a significant role in maintaining mood balance, and alterations in serotonin levels have been closely linked to various mental health conditions, including depression, anxiety disorders, and obsessive-compulsive disorder (OCD). It also influences bodily functions such as sleep, appetite, and digestion.

Too little:

• Depression and anxiety

Too much:

• Serotonin Syndrome

Norepinephrine

An excitatory neurotransmitter that plays a role in arousal, energy, alertness, and anxiety.

Too little:

• Depression and poor concentration

Too much:

• Anxiety and hyperarousal

GABA

An inhibitory neurotransmitter that has a calming effect on the brain.

Too little:

• Anxiety and panic

Too much:

• Sedation and depression

Glutamate

An excitatory neurotransmitter involved in cognition.

Too little:

• cognitive impairment

Too much:

• Anxiety, excitotoxicity

Neuroleptic malignant syndrome (NMS)

A potentially life-threatening reaction primarily associated with the use of antipsychotic medications, particularly the first-generation (typical) antipsychotics. It is characterized by a constellation of symptoms including severe muscle rigidity, hyperthermia (elevated body temperature), autonomic instability (which can manifest as changes in blood pressure, heart rate, and sweating), altered mental status (ranging from confusion to coma), and elevated creatine kinase levels due to muscle breakdown

Metabolic Syndrome

A cluster of conditions that increase an individual's risk of heart disease, stroke, and type 2 diabetes. This syndrome is often associated with medication use, particularly second generation antipsychotics, which can lead to adverse metabolic effects. Key features include:

1. Abdominal Obesity: Increased fat around the abdomen is a significant risk factor. It is typically defined as a waist circumference greater than 40 inches for men and 35 inches for women.

2. Insulin Resistance: This condition is characterized by reduced sensitivity of the body’s cells to insulin, leading to elevated blood glucose levels.

3. Dyslipidemia: This includes high levels of triglycerides and low levels of high-density lipoprotein (HDL) cholesterol (the 'good' cholesterol). Elevated LDL (low-density lipoprotein) cholesterol is also a concern.

4. Hypertension: High blood pressure is commonly linked to metabolic syndrome, with a reading of 130/85 mmHg or higher indicating hypertension.

5. Altered Glucose Metabolism: This may manifest as elevated fasting glucose levels and can progress to type 2 diabetes if not managed appropriately.

Agranulocytosis

A severe medical risk associated with clozapine and carbamazepine involving a dangerous drop in white blood cell counts.

Lithium

A mood stabilizer with a narrow therapeutic index that requires sodium consistency, dehydration awareness, and monitoring for toxicity.

Valproate

A mood stabilizer that requires liver monitoring and is associated with congenital risks.

Lamotrigine

A mood stabilizer specifically noted for its high-risk association with Stevens-Johnson syndrome.

Carbamazepine

A mood stabilizer that carries a specific risk for agranulocytosis.

TCAs (Tricyclic Antidepressants)

A category of antidepressants known for having high lethality in cases of overdose.

MAOIs (Monoamine Oxidase Inhibitors)

A class of antidepressants that requires strict dietary restrictions. No tyramine!

Antidepressant Black Box Warning

A required safety warning for antidepressants regarding the increased risk of suicide.

Benzodiazepines

Anxiolytics such as lorazepam, alprazolam, and clonazepam that carry a high risk of dependence.

Positive vs. Negative Symptoms

The differentiation of symptoms used to assess and treat Schizophrenia Spectrum Disorders.

Positive Symptoms: Include hallucinations (perceptions without external stimuli), delusions (false beliefs), disorganized thinking and behavior, and inappropriate emotional responses. These symptoms reflect an excess or distortion of normal functions and are typically evident during acute episodes of the disorder.

Negative Symptoms: Involve a decrease or loss of normal functions and behaviors, including flat affect (reduced emotional expression), anhedonia (inability to experience pleasure), avolition (lack of motivation), social withdrawal, and alogia (reduced speech output). These symptoms can be more debilitating than positive symptoms and may interfere significantly with daily functioning and quality of life.

Mania vs. Hypomania

The distinct levels of elevated mood used to differentiate between Bipolar I and Bipolar II disorders.

Mania: Defined by a period of abnormally elevated, expansive, or irritable mood lasting at least one week (or any duration if hospitalization is required).

• Symptoms include excessive energy, decreased need for sleep, grandiosity, racing thoughts, distractibility, and engaging in high-risk behaviors.

• Can result in significant impairment in social or occupational functioning and may necessitate hospitalization to prevent harm to self or others.

Hypomania: Characterized by a milder form of elevated mood lasting at least four consecutive days.

• Symptoms are similar to mania but are less severe and do not cause significant impairment in social or occupational functioning.

• No hospitalization is typically required, and individuals in a hypomanic state often exhibit increased productivity and creativity, although their behavior can still lead to potential negative consequences.

The distinction between mania and hypomania is crucial for accurate diagnosis and treatment planning in bipolar disorder.

OCD Compulsions

Repetitive behaviors used by patients to temporarily reduce anxiety.

Safety

The constant priority in clinical decision-making across all mental health disorders.

Psychiatry

A branch of medicine focused on the diagnosis, treatment, and prevention of mental, emotional, and behavioral disorders.

Mental Health

A person's emotional, psychological, and social well-being, affecting how they think, feel, and act.

Voluntary Admission

A process by which individuals agree to be admitted to a psychiatric facility for treatment.

Involuntary Admission

A legal process through which individuals can be admitted to a psychiatric facility against their will for treatment.

Crisis Intervention

Emergency mental health services aimed at reducing psychological distress and improving functioning.

Diagnostic and Statistical Manual of Mental Disorders (DSM)

A handbook used by healthcare professionals as the authoritative guide to the diagnosis of mental disorders.

Therapeutic Alliance

The collaborative partnership between therapist and client, crucial for effective treatment.

Dual Diagnosis

The presence of both a mental health disorder and a substance use disorder in an individual.

Psychosocial Interventions

Treatment approaches that include therapy, support, and community resources aimed at improving mental health.

Patient Confidentiality

The ethical principle that protects private information disclosed by a patient to a healthcare provider.

Histamine

A biogenic amine that plays a critical role in the immune response, functioning as a neurotransmitter and mediating allergic reactions. It’s primary functions include wakefulness, gastric secretions, and cardiac stimulations.

Too little:

• Sedation

Too much:

• Insomnia

Antidepressants

A class of medications primarily used to treat depression, anxiety disorders, and some other mental disorders. They work by altering the levels of neurotransmitters in the brain, particularly serotonin, norepinephrine, and dopamine. Common classes include SSRIs, SNRIs, TCAs, and MAOIs, each with unique mechanisms of action and side effect profiles.

Antipsychotics

Medications used to manage psychosis, particularly in disorders like schizophrenia and bipolar disorder. They are classified into typical (first-generation) and atypical (second-generation) antipsychotics, which differ in their mechanisms and side effects. Antipsychotics primarily target dopamine receptors and may also affect serotonin receptors.

Mood Stabilizers

A class of drugs used to treat mood disorders, particularly bipolar disorder. These medications help to stabilize mood shifts between mania and depression. Common mood stabilizers include lithium, valproate, and lamotrigine, each with varying mechanisms and potential side effects.

Anxiolytics

Medications that help alleviate anxiety and anxiety disorders. Benzodiazepines are the most commonly prescribed anxiolytics and work by enhancing the effect of the neurotransmitter GABA, leading to a calming effect. However, they carry a risk of dependence and withdrawal symptoms when discontinued.

Serotonin Syndrome

A potentially life-threatening condition resulting from excessive serotonergic activity caused by drugs like SSRIs, SNRIs, or MAOIs. Symptoms can range from mild agitation to severe manifestations such as hyperthermia, seizures, and rigidity. Treatment involves discontinuation of serotonin-boosting medications and supportive care.

Tardive Dyskinesia

A movement disorder characterized by involuntary, repetitive body movements, commonly associated with long-term use of antipsychotic medications. Early detection is crucial, and management may include switching medications or using treatments like valbenazine to reduce symptoms. FGA antipsychotics

Acute Dystonia

A sudden onset of muscle spasms and contractions, frequently triggered by FGA antipsychotic medications. Symptoms include neck stiffness and abnormal postures. Treatment typically involves anticholinergics or antihistamines administered promptly to alleviate symptoms.

Lithium Toxicity

Excessive lithium levels in the body due to overdose or other factors, presenting with nausea, vomiting, tremors, or confusion. Severe cases can lead to seizures or coma. Treatment requires monitoring of lithium levels and potentially hemodialysis in extreme situations.

Stevens-Johnson Syndrome (SJS)

A severe skin reaction triggered by certain medications, notably anticonvulsants (such as lamotrigine), antibiotics (such as sulfa drugs), and allopurinol, showing flu-like symptoms followed by painful blisters and skin peeling. Requires immediate cessation of the offending drug, with management involving hospitalization and supportive care.

Hepatotoxicity

Liver damage caused by certain medications, notable in psychiatric treatments like valproate. Symptoms include jaundice and elevated liver enzymes. Regular monitoring of liver function tests is essential, and any signs of injury necessitate immediate medical intervention.

Nursing Interventions for Schizophrenia

Effective nursing interventions for individuals with schizophrenia include:

1. Establishing Therapeutic Relationships: - Build trust and rapport to encourage open communication.

2. Medication Management:- Educate patients about their medications, monitor adherence, and observe for side effects.

3. Crisis Intervention: - Provide immediate support during acute episodes and ensure safety for the patient and others.

4. Psychoeducation:- Teach patients and families about the illness, management strategies, and coping mechanisms.

5. Skills Training: - Facilitate social skills training and daily living skills to improve functional abilities.

6. Monitoring for Suicidal Ideation: - Regularly assess for signs of self-harm or suicidal thoughts, especially post-discharge.

7. Encouraging Rehabilitation and Community Resources: - Assist with referrals to community programs that provide vocational training and support networks.

8. Family Involvement: - Involve family members in treatment planning and support to enhance the patient’s support system.

Bipolar I Disorder

Characterized by the occurrence of at least one manic episode, which may be preceded or followed by hypomanic or major depressive episodes. The manic episode is severe enough to cause significant impairment in personal, social, or occupational functioning, and may require hospitalization to prevent harm to self or others. Can also involve periods of depression, but depression alone does not qualify for diagnosis.

Bipolar II Disorder

Defined by at least one major depressive episode and at least one hypomanic episode, but no full manic episodes. The hypomanic episodes are less severe than the manic episodes in the other and do not cause the same level of functional impairment. Individuals often experience significant depressive symptoms that can be debilitating.

Mixed Features in Bipolar Disorder

The presence of symptoms of both mania (or hypomania) and depression simultaneously during the same episode. Individuals experiencing mixed features may exhibit high energy, racing thoughts, and irritability along with low mood, hopelessness, and feelings of worthlessness. This combination can lead to increased impulsivity and a heightened risk for suicidal thoughts and behaviors. Accurate recognition of mixed features is critical for appropriate treatment, as they can significantly affect the course and prognosis of the disorder.

Suicide Risks in Bipolar Disorder

Individuals with bipolar disorder are at a significantly higher risk for suicide compared to the general population. Factors contributing to this elevated risk include the severity and frequency of mood episodes, particularly depressive episodes, and mixed features. The impulsivity associated with manic episodes can also lead to suicidal behaviors. A history of previous suicide attempts, family history of suicide, and co-occurring mental health disorders increase the risk further. Continuous monitoring and intervention strategies are essential for ensuring the safety of individuals with bipolar disorder.

Misdiagnosis of Bipolar Disorder

Due to overlapping symptoms with other mental health conditions, particularly major depressive disorder (MDD) and attention-deficit/hyperactivity disorder (ADHD).

• In cases of misdiagnosis as depression, clinicians may overlook manic or hypomanic episodes, leading to inappropriate treatment strategies that primarily address depressive symptoms without addressing underlying mood instability.

• Misdiagnosis as ADHD may occur when symptoms of impulsivity and inattention are mistaken for hyperactivity and lack of focus associated with ADHD. This misalignment can hinder proper management and lead to ineffective treatment plans. Accurate diagnosis requires careful assessment of the patient's full mood history and symptomatology over time to ensure appropriate therapeutic interventions are utilized.

Major Depressive Disorder (MDD)

A mood disorder characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in most activities. Symptoms must be present for at least two weeks and include significant impairment in daily functioning, changes in appetite or weight, sleep disturbances, fatigue, feelings of worthlessness or excessive guilt, and difficulty concentrating or making decisions.

Persistent Depressive Disorder (Dysthymia)

A chronic form of depression characterized by a consistent low mood lasting for at least two years in adults (one year in children/adolescents). Symptoms are less severe than those of major depression but can still significantly impair daily functioning. Individuals may experience periods of major depression interspersed with less severe symptoms.

Bipolar Depression

Refers to the depressive episodes experienced by individuals with bipolar disorder. Symptoms mirror those of major depressive disorder but occur within the context of bipolar diagnosis. Treatment may differ due to the alternating mood states associated with bipolar disorder, requiring careful management to avoid inducing mania.

Seasonal Affective Disorder (SAD)

A type of depression that occurs at a specific time of year, usually in the winter months when daylight hours are shorter. Symptoms are similar to major depressive disorder and include fatigue, irritability, changes in sleep patterns, and weight gain. It is believed to be related to changes in sunlight exposure and can often be treated with light therapy.

Premenstrual Dysphoric Disorder (PMDD)

A severe form of premenstrual syndrome (PMS) characterized by significant emotional and physical symptoms that occur during the luteal phase of menstruation and improve within a few days after the onset of menstruation. Symptoms can include mood swings, irritability, depression, anxiety, and physical discomfort. Treatment may include lifestyle changes, medications, or therapy.

Generalized Anxiety Disorder (GAD)

A chronic condition characterized by excessive, uncontrollable worry about various aspects of life, such as work, health, and social interactions. Symptoms may include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances. Individuals with GAD often find it challenging to manage their anxiety despite efforts to do so.

Panic Disorder

Characterized by recurrent and unexpected panic attacks, which are sudden episodes of intense fear or discomfort that peak within minutes. Symptoms can include heart palpitations, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, dizziness, chills, and fear of losing control or dying. Individuals may develop a fear of future attacks, leading to avoidance behaviors.

Social Anxiety Disorder (Social Phobia)

An intense fear of social situations where individuals may be judged, embarrassed, or scrutinized by others. This disorder can lead to avoidance of social interactions, which can significantly impact personal and professional relationships. Symptoms may include blushing, sweating, rapid heart rate, and anxiety about being watched or evaluated.

Obsessive-Compulsive Disorder (OCD)

A condition characterized by persistent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that an individual feels driven to perform in response to the obsessions. Common obsessions include fears of contamination, harming others, or making mistakes, while compulsions often involve rituals such as excessive cleaning, counting, or checking.

Post-Traumatic Stress Disorder (PTSD)

A condition that can develop after exposure to a traumatic event, resulting in symptoms such as flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event. Individuals may also experience avoidance behaviors, numbness, and difficulty relating to others. PTSD can lead to significant distress and impairment in daily functioning.

Specific Phobias

Intense fear or anxiety about a specific object or situation, leading to avoidance behavior. Common phobias include fear of heights (acrophobia), spiders (arachnophobia), and flying (aviophobia). The fear is out of proportion to the actual danger posed, and individuals may go to great lengths to avoid encountering the feared object or situation.

Bupropion

An atypical antidepressant that primarily acts on the neurotransmitters dopamine and norepinephrine. It is often used to treat major depressive disorder and to help with smoking cessation. It is known for having a lower risk of sexual side effects compared to other antidepressants and is typically stimulating rather than sedating.

Trazodone

An atypical antidepressant that primarily functions as a serotonin antagonist and reuptake inhibitor (SARI). It is often prescribed for depression but is also commonly used off-label for insomnia due to its sedative properties. It is generally well-tolerated but can cause side effects such as dizziness and sedation.

Mirtazapine

An atypical antidepressant that acts as a noradrenergic and specific serotonergic antidepressant (NaSSAs). It improves mood and appetite and is often prescribed to individuals with major depressive disorder, particularly those who have issues with sleep or appetite. It can cause sedation and weight gain as side effects.

Vilazodone

An atypical antidepressant that functions as a selective serotonin reuptake inhibitor (SSRI) and a partial agonist at serotonin receptors. It is indicated for the treatment of major depressive disorder and may have some anxiolytic properties. It tends to have a more favorable side effect profile compared to traditional SSRIs, particularly regarding sexual side effects.

Desvenlafaxine

An atypical antidepressant that is a serotonin-norepinephrine reuptake inhibitor (SNRI). It is used to treat major depressive disorder, particularly in patients who have experienced treatment-emergent sexual dysfunction with other antidepressants. It can help alleviate depressive symptoms as well as anxiety and pain associated with depression.

Cognitive Behavioral Therapy (CBT)

A therapeutic approach that empowers individuals to recognize and modify negative thought patterns and behaviors linked to depression and anxiety. It emphasizes skill-building and coping strategies to enhance emotional regulation and alleviate symptoms.

Interpersonal Therapy (IPT)

A form of therapy that concentrates on enhancing interpersonal relationships and social functioning in order to mitigate depressive and anxiety symptoms. It addresses personal issues such as grief, conflicts in relationships, and life changes, facilitating improved communication and connection.

Dialectical Behavior Therapy (DBT)

An evidence-based treatment that combines cognitive-behavioral techniques with mindfulness practices to help individuals manage intense emotions and improve relationships. It focuses on skills such as emotional regulation, distress tolerance, and interpersonal effectiveness, making it particularly effective for those with borderline personality disorder and anxiety issues.

Light Therapy

A non-pharmacological treatment that involves exposure to specific wavelengths of light, typically used for seasonal affective disorder (SAD) and other depressive disorders. It aims to influence mood-regulating hormones and improve overall emotional well-being by simulating natural sunlight exposure.

Electroconvulsive Therapy (ECT)

A medical treatment for severe depression, psychotic depression, severe malnutrition, failure of multiple medication trials, and pregnancy when rapid response is needed and medications are not appropriate, which involves sending small electrical currents through the brain to induce a therapeutic seizure. It can quickly alleviate symptoms in individuals who have not responded to other treatments, although it is typically utilized as a last resort due to potential side effects.