MH exam 4

Symptoms of PMDD (Premenstrual Dysphoric Disorder)

Severe mood lability, irritability/anger, depressed mood, hopelessness, anxiety, tension, decreased interest, difficulty concentrating, fatigue, appetite/sleep changes; occurs in luteal phase and resolves after menstruation.

Highest nursing priority in mood disorders

Safety: risk of harm to self or others.

Safety concern in Bipolar I

• Risky behaviors during mania.

Safety concern in DMDD (Disruptive mood dysregulation disorder)

Aggression and severe outbursts.

Safety concern in dysthymic disorder

Chronic low mood → suicide risk assessment.

Safety concern in PMDD (Premenstrual Dysphoric Disorder)

Suicidal ideation during luteal phase.

Characteristics of Bipolar I

At least one manic episode, elevated/irritable mood ≥1 week, grandiosity, ↓ need for sleep, pressured speech, racing thoughts, risky behaviors.

Features of DMDD (Disruptive mood dysregulation disorder)

Severe temper outbursts, chronic irritability, ages 6–18, symptoms ≥12 months, persistent anger between outbursts.

Symptoms of dysthymic disorder

depressed mood ≥2 years, appetite changes, insomnia/hypersomnia, low energy, low self-esteem, hopelessness.

Key characteristics of PMDD (Premenstrual Dysphoric Disorder)

Severe emotional/behavioral symptoms, interferes with functioning, cyclical pattern, not relieved by rest, treatable with SSRIs.

Definition of delusion + example

Fixed false belief; example: “The FBI implanted a chip in my brain.”

Nurse actions for suicidal ideation

Stay with client, ask about plan/means/intent, remove harmful objects, initiate suicide precautions, notify provider.

Suicide risk factors & warning signs

• Risk factors: depression, substance use, previous attempts, chronic illness, social isolation.

• Warning signs: giving away possessions, talking about death, sudden mood improvement, saying goodbye.

ECT purpose & side effects

Used for severe depression/catatonia; causes short-term memory loss and confusion.

TMS purpose

Treatment-resistant depression; noninvasive, minimal side effects.

Positive symptoms of schizophrenia

Hallucinations, delusions, disorganized speech.

Negative symptoms of schizophrenia

Flat affect, anhedonia, avolition, social withdrawal.

Common comorbidities in schizophrenia

Substance use, depression, anxiety, diabetes, cardiovascular disease.

Genetic risk factor for schizophrenia

First-degree relatives increase risk.

Types of dementia

Alzheimer’s, vascular, Lewy body, frontotemporal, secondary (TBI, HIV, prion).

Cognitive deficits in Alzheimer’s

Memory impairment, aphasia, apraxia, agnosia, executive dysfunction.

Why avoid benzodiazepines in delirium

They worsen confusion, sedation, and fall risk.

Terminal Alzheimer’s features

Severe memory loss, inability to communicate, dysphagia, incontinence, infection risk.

Behavioral signs of learning disabilities

Difficulty following directions, poor academic performance, avoidance, low self-esteem.

Autism spectrum manifestations

Impaired social communication, repetitive behaviors, restricted interests, sensory sensitivities.

Nurse action when parents oppose medication

Educate, respect autonomy, explore alternatives, advocate for least restrictive care.

Characteristics of dyslexia

Difficulty reading/spelling, letter reversal, phonetic errors, normal intelligence.

Nurse role in communication disorders

Simple language, extra response time, visual aids, collaborate with speech therapy.

Orientation phase

Establish trust, define roles, set goals, discuss confidentiality.

Exploitation phase

Client uses resources; therapeutic work occurs; encourage independence.

Termination phase

Review goals, discuss progress, address feelings about ending relationship.

Identification phase

Client expresses feelings, identifies problems, participates in care.

Features of disruptive behavioral disorders

Aggression, defiance, rule-breaking, difficulty with authority.

Nursing response for IED (Intermittent Explosive Disorder)

Acknowledge feelings, set limits, encourage coping skills, avoid reinforcement.

MIND diet

Mediterranean + DASH; supports brain health; reduces dementia risk.

Dementia variants

TBI: personality changes, impulsivity.

Prion: rapid decline, fatal.

HIV: psychomotor slowing.

Lewy body: visual hallucinations, fluctuations.

ODD (oppositional defiant disorder) risk factors

Family conflict, inconsistent discipline, ADHD.

Conduct disorder risk factors

Abuse, substance use, poverty.

ODD vs CD

ODD: argumentative, no serious violations.

CD: aggression, theft, cruelty.

Reward pathway in addiction

VTA → nucleus accumbens → prefrontal cortex; dopamine-driven.

Addiction risk factors

Genetics, stress, peer influence, mental illness.

Importance of early warning recognition

Enables early intervention, prevents progression, reduces harm.

AA/NA principles –

Abstinence, peer support, 12-step, spiritual foundation.

Bulimia nervosa characteristics

Binge–purge, normal weight, body image preoccupation; example: “If I gain weight, nobody will love me.”

Bone densitometry detects

Osteoporosis.

Why eating disorder prevalence is underreported

Stigma limits accuracy.

Therapeutic communication principles

Open-ended questions, active listening, avoid advice, validate feelings.

Nursing actions in eating disorder programs

Monitor weight, observe meals, prevent purging, structured routine.

How disorders are classified

Symptom manifestation; DSM categories.

Mental Health Parity Act

Equal insurance coverage for mental and physical health.

Therapeutic milieu

Structured environment with safety, consistency, supportive relationships.

Psychiatric advance directives

Preferences for future mental health care during incapacity.

When restraints can be removed

When calm, no longer a danger, provider discontinues order.

Ethical principles

• Autonomy, beneficence, nonmaleficence, justice, fidelity.

Client-centered care

Respect preferences, involve client in decisions, individualized care.

Therapeutic use of self

Self-awareness, empathy, boundaries, authentic presence.

Social determinants of mental health

Income, education, housing, access to care, discrimination.

Mental health promotion strategies

Stress management, sleep hygiene, coping skills.

Telehealth support actions

Ensure privacy, assist with technology, encourage adherence.

Mental health continuum

Surviving → Struggling → In Crisis → Thriving → Excelling.

Barriers to mental health care

Stigma, transportation, affordability disparity

Leininger’s transcultural nursing

Cultural awareness, respect beliefs, adapt care, avoid cultural imposition.