Psychiatric-Mental Health Nursing: Substance Use, Mood Disorders, Psychosis, and Personality Disorders

Comprehensive vocabulary flashcards covering neurobiology of addiction, withdrawal assessment scales, pharmacotherapy, mood disorders, schizophrenia spectrum disorders, psychopharmacological side effects, and personality disorder dynamics.

Addiction

A chronic, relapsing brain disorder characterized by compulsive substance use despite harm, loss of control, persistent craving, and the development of tolerance and withdrawal.

Ventral Tegmental Area (VTA)

A dopamine-producing structure within the limbic system that initiates reward signaling and marks the anatomical start of the brain's reward pathway.

Nucleus Accumbens

The primary pleasure and reward center of the limbic system situated downstream from the ventral tegmental area (VTA) that mediates the reinforcement of behavior.

Tolerance

A neurobiological state where the brain downregulates dopamine receptors and reduces dopamine production in response to chronic excess stimulation, requiring escalating doses or frequency to achieve the original effect.

Wernicke Encephalopathy

An acute neurological medical emergency caused by thiamine ($\text{vitamin B}_1$) deficiency and impaired cerebral glucose metabolism, characterized by the classic clinical triad of confusion, ataxia (gait instability), and ophthalmoplegia or nystagmus.

Korsakoff Syndrome

A chronic, often irreversible neurological disorder progressing from untreated Wernicke encephalopathy, characterized by ammonia accumulation, structural brain damage, profound anterograde amnesia, confabulation, executive dysfunction, and apathy.

Confabulation

The unconscious fabrication or distortion of memories to fill in chronological gaps in recall without the deliberate intention to deceive, classically seen in Korsakoff syndrome.

Kernicterus

Irreversible bilirubin-induced brain damage affecting the basal ganglia and brainstem nuclei in neonates with severe hyperbilirubinemia; not caused by alcohol use disorder or adult nutritional deficiencies.

Delirium Tremens (DTs)

A severe, life-threatening alcohol withdrawal complication typically manifesting $48\text{--}72$ hours after cessation, characterized by high fever, severe tachycardia, hypertension, diaphoresis, tremors, illusions, seizures, and a $5\text{--}10\%$ mortality risk.

CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, Revised)

A 10-item clinical assessment tool with a maximum score of $67$ used to balance subjective and objective signs of alcohol withdrawal and titrate symptom-triggered benzodiazepine therapy; scores above $20$ generally warrant ICU admission.

COWS (Clinical Opiate Withdrawal Scale)

An 11-item clinician-administered instrument designed to rate the objective and subjective severity of opioid withdrawal (mild: $5\text{--}12$, moderate: $13\text{--}24$, moderately severe: $25\text{--}36$, severe: $>36$) to guide medication induction.

Disulfiram (Antabuse)

An oral aversion therapy agent for alcohol use disorder that inhibits aldehyde dehydrogenase, causing toxic accumulation of acetaldehyde and producing severe flushing, throbbing headache, nausea, vomiting, sweating, and hypotension if ethanol is ingested.

Naltrexone

An opioid receptor antagonist that diminishes cravings and blocks euphoric effects in both alcohol and opioid use disorders; requires complete opioid abstinence for $7\text{--}10$ days prior to initiation to prevent precipitated withdrawal.

Methadone

A long-acting full opioid agonist administered orally through specialized treatment programs for opioid detox and maintenance; suppresses withdrawal and cravings but carries risks of sedation, respiratory depression, and QT prolongation.

Buprenorphine

A partial opioid agonist with a high receptor affinity and ceiling effect; formulated alone or with naloxone (Suboxone) and initiated only once objective moderate withdrawal is established to avoid precipitating acute withdrawal.

SBIRT

An evidence-based public health framework comprising Screening, Brief Intervention ($5\text{--}15$ minutes of nonjudgmental motivational interviewing), and Referral to Treatment for patients with hazardous substance use.

Major Depressive Disorder (MDD)

A mood disorder diagnosed when at least 5 depressive symptoms (represented by SIG E CAPS and including either depressed mood or anhedonia) persist for at least 2 consecutive weeks, causing marked functional decline.

Dysthymia (Persistent Depressive Disorder)

A chronic, milder depressive state characterized by continuous depressed mood and subclinical symptoms lasting for at least 2 years in adults (or 1 year in adolescents) without full remission.

Mood Reactivity

The defining hallmark of atypical depression wherein a person's affective state temporarily brightens and improves in response to actual or potential positive environmental events.

Learned Helplessness Theory

Martin Seligman's psychological formulation proposing that repeated exposure to inescapable, uncontrollable negative stressors fosters an enduring conviction that future events are equally unalterable, driving depressive vulnerability.

Premenstrual Dysphoric Disorder (PMDD)

A severe premenstrual mood disturbance manifesting during the luteal phase (the final week prior to menses) with profound mood swings, irritability, anxiety, and social impairment, which remits shortly following menstruation onset.

Serotonin Syndrome

A rapidly developing toxidrome caused by excessive central and peripheral serotonergic stimulation, presenting with neuromuscular hyperactivity (hyperreflexia, clonus, tremors), autonomic instability (hyperthermia, tachycardia), and altered sensorium.

Bipolar I Disorder

A mood disorder characterized by the emergence of at least one full manic episode lasting at least 7 consecutive days (or of any duration if hospitalization is required), frequently alternating with major depressive episodes.

Bipolar II Disorder

A mood disorder diagnosed by the occurrence of at least one hypomanic episode lasting a minimum of 4 consecutive days alongside at least one major depressive episode, with no history of full manic episodes.

Cyclothymic Disorder

A chronic mood disturbance persisting for at least 2 years involving fluctuating periods of hypomanic symptoms and depressive symptoms that do not meet full diagnostic criteria for hypomania or major depression.

Mania

A state of pathologically elevated, expansive, or irritable mood and energy persisting for at least 7 days (or requiring hospitalization) that causes severe functional impairment and may involve grandiosity, decreased need for sleep, pressured speech, or psychosis.

Hypomania

An episode of elevated, expansive, or irritable mood and increased goal-directed activity lasting at least 4 consecutive days that is distinct from normal baseline but lacks psychotic features and does not cause severe impairment or require hospitalization.

Lithium

A first-line mood stabilizer with antisuicidal properties and a narrow therapeutic window; requires periodic serum-level monitoring, kidney function tests (BUN, creatinine, eGFR), and thyroid panels (TSH) due to risks of nephrotoxicity and hypothyroidism.

Bupropion (Wellbutrin)

A strongly activating norepinephrine-dopamine reuptake inhibitor (NDRI) antidepressant contraindicated in patients with seizure disorders, bulimia, or anorexia nervosa due to a dose-dependent reduction in the seizure threshold.

Interpersonal and Social Rhythm Therapy (IPSRT)

A psychotherapeutic modality for bipolar disorder designed to stabilize circadian systems and biological rhythms by enforcing strict daily schedules for sleeping, waking, meals, and social interactions.

Brief Psychotic Disorder

A psychotic spectrum condition involving the acute emergence of delusions, hallucinations, or disorganized speech lasting at least 1 day but less than 1 month, followed by complete restoration of premorbid functioning.

Schizophreniform Disorder

A disorder displaying the identical clinical presentation of schizophrenia whose entire duration (including prodromal, active, and residual phases) is between 1 month and 6 months.

Schizoaffective Disorder

A psychiatric condition characterized by an uninterrupted period of illness during which a major mood episode (depressive or manic) concurrent with active symptoms of schizophrenia is accompanied by at least 2 weeks of delusions or hallucinations in the absence of prominent mood symptoms.

Positive Symptoms

Symptoms of schizophrenia driven by excessive dopamine activity in the mesolimbic pathway that reflect additions to normal experience, including auditory hallucinations, persecutory delusions, loose associations, and bizarre behavior.

Negative Symptoms

Symptoms of schizophrenia linked to dopamine hypofunction in the mesocortical pathway that denote deficits in baseline functioning, including flat affect, anhedonia, avolition, alogia, and anergia.

Mesolimbic Pathway

A dopaminergic neural tract projecting from the ventral tegmental area to the limbic system; hyperactivity in this tract produces positive psychotic symptoms.

Mesocortical Pathway

A dopaminergic tract projecting from the ventral tegmental area to the prefrontal cortex; hypofunction or blockade in this tract mediates negative symptoms and cognitive dysfunction.

Acute Dystonia

An early extrapyramidal reaction occurring within hours to days of initiating $D_2$ dopamine receptor antagonists, manifested by acute, painful muscular spasms of the tongue, jaw, neck, or eyes; treated emergently with anticholinergics like benztropine.

Akathisia

A distressing extrapyramidal symptom presenting as motor restlessness and an intense subjective drive to remain in constant motion (such as pacing or rocking); managed with propranolol or lorazepam.

Tardive Dyskinesia

A late-onset, potentially permanent motor complication of long-term dopamine blockade characterized by involuntary choreiform and athetoid movements of the tongue, face, and extremities; monitored with the AIMS scale and treated with VMAT-2 inhibitors.

Neuroleptic Malignant Syndrome (NMS)

A rare, life-threatening adverse reaction to potent $D_2$ antagonists evolving over days to weeks, characterized by the 'FARM' tetrad: Fever, Autonomic instability, lead-pipe Rigidity, and Mental status deterioration, accompanied by marked elevations in creatine kinase.

Clozapine

A second-generation atypical antipsychotic reserved for treatment-resistant schizophrenia that reduces suicide risk but mandates registration in a REMS program due to the risk of severe neutropenia and agranulocytosis (requiring an $ANC \ge 1500/\mu L$ for continuation).

Ego-syntonic

A psychological state where an individual's thoughts, impulses, coping styles, and behaviors are experienced as acceptable, natural, and fully congruent with their fundamental self-concept.

Ego-dystonic

Psychological symptoms, thoughts, or urges that are recognized as intrusive, unacceptable, irrational, and inconsistent with one's core self-image (such as obsessions in obsessive-compulsive disorder).

Cluster A Personality Disorders

A diagnostic cluster encompassing personality disorders characterized by odd, eccentric, or detached patterns of thinking and relating, comprising Paranoid, Schizoid, and Schizotypal personality disorders.

Cluster B Personality Disorders

A diagnostic category comprising personality disorders marked by dramatic, emotional, erratic, or manipulative behaviors, consisting of Antisocial, Borderline, Histrionic, and Narcissistic personality disorders.

Cluster C Personality Disorders

A diagnostic classification grouping personality disorders characterized by prominent anxiety, fearfulness, and inhibition, consisting of Avoidant, Dependent, and Obsessive-Compulsive personality disorders.

Antisocial Personality Disorder (ASPD)

A personality disorder diagnosed at age 18 or older (with evidence of conduct disorder before age 15) marked by a pervasive disregard for and violation of the rights of others, deceitfulness, impulsivity, physical aggressiveness, and lack of remorse.

Borderline Personality Disorder (BPD)

A personality disorder characterized by pervasive affective instability, intense fears of abandonment, unstable self-image, volatile interpersonal relationships, marked impulsivity, and recurrent self-harm or suicidal gestures.

Splitting

A primitive defense mechanism common in borderline personality disorder wherein individuals categorize self and others into polarized extremes of all-good or all-bad, lacking the cognitive capacity to integrate contradictory qualities.

Dialectical Behavior Therapy (DBT)

A comprehensive, trauma-informed cognitive-behavioral psychotherapy developed by Marsha Linehan for chronic suicidality and BPD that integrates acceptance and change strategies across four core skill domains: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Transference

The unconscious projection or redirection of feelings, expectations, and attitudes formed toward significant individuals from earlier developmental relationships onto the nurse or clinician.

Countertransference

The nurse's conscious or unconscious emotional reaction to a patient, typically triggered by the patient's behavior or transference and influenced by the nurse's own past unresolved experiences.

Projective Identification

An interpersonal defense mechanism wherein a patient unconsciously projects an unbearable internal emotional state onto a clinician, subsequently inducing the clinician to experience and act out those identical feelings.