Psych study guide

PTSD diagnostic criteria

• Exposure to traum + Symptoms greater than 1 month

• Must include:

1. Intrusion ( Involuntary, distressing, and unwanted memories, flashbacks)

2. Avoidance

3. Negative mood

4. Arousal

PTSD S/S

• Intrusive memories

• Avoidance

• Negative changes in thinking and mood

• Hypervigilance

PTSD Medications

First Line: SSRIs

• Prozac ( Fluoxetine

For PTSD nightmares

• Prazosin

PTSD Nursing interventions for management and treatment

• Do not force discussion of trauma

• Trauma-focused cognitive behavioral therapy

• Exposure therapy

• Supportive therapy

• Group therapy

• Promote grounding

• maintain safety

Manage an agitated patient

1. Safety first- remove hazards

2. Calm approach

3. Set limits

4. Offer PRN meds

5. restraints ( last resort)

Social learning theory ( four stages)

1. Attention

2. Retention

3. Reproduction

4. Motivation

Attention ( Social learning theory)

You notice and pay attention to the behavior you’re watching

Retention ( Social learning theory)

You need to remember what you saw so you can use it later

Reproduction ( Social learning theory)

You can copy the behavior if you have the skills to do it

Motivation ( Social learning theory)

You want to do the behavior because it seems rewarding

Interpersonal violence ( cycle)

Phase 1- tension building

Phase 2- Use of violence

Phase 3 - Honeymoon phase

Phase 1: Tension-building

The abuser is argumentative, angry, uses yelling, criticism. Sometimes the abuser will use coercion, threats or minor fights may occur

Phase 2: Use of violence

As the tension builds, violence is likely. This is when a major act of violence occurs. Including physical and/ or sexual attack and threats to harm, as well as verbal abuse

Phase 3: Honeymoon phase

After the use of violence, the abuser feels sorry, and acts apologetic and loving

Core themes of interpersonal violence

• Power and control

• isolation tactics

• coercive control and threats

• Emotional and psychological abuse

• financial and economic abuse

• sexual assault & coercion

• victim-blaming

• developmental/ intergenerational trauma

• cultural & structural intersectionality

Generalized Anxiety disorder diagnostic

feel worried most days for at least 6 months

Generalized Anxiety disorder- S/S

• Excessive & Persistent worry about everyday things

• Fatigue

• Trouble managing words

• Muscle tension

• Poor sleep

• SOB

• Heart palpations

Medications for GAD

• SSRIs- Escitalopram, Paroxetine, Sertaline

• Serotonin- Norepinephrine reuptake inhibitors (SNRIs)- Duloxetine, Venlafaxine

• Benzodiazepines (Short term use)

• Buspirone

Management and treatment for GAD

• Psychotherapy

• Cognitive behavioral therapy (CBT)

System desensitization (Phobias)

A behavioral therapy technique that reduces fear responses by gradual exposure to fear

Flooding (phobias)

Immediate full exposure to fear

Obsessive- Compulsive disorder - S/S

• Intrusive thoughts

• repetitive behaviors

• following a strict routine

• demanding reassurance

• fear of germs or dirt

• Fear of making a mistake

Obsessive- Compulsive Disorder- Diagnostic criteria

Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)

Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)- Criteria

• Having obsessions, compulsions or both

• Spending a lot of time on things, more than an hour per day

• Feeling stressed, or having symptoms interfere with daily life

• Alcohol, addictive substances, medications or another medical condition not causing the symptoms

• Symptoms not being better explained by another mental health condition, like anxiety, and eating disorder

OCD management:

Exposure and response prevention (ERP)

Allow rituals

Gradually limit rituals

OCD medications

• SSRIs

• Luvox (Fluvoxamine)

• Sertraline

• Paroxetine

• Fluoxetine

Medications for Anxiety and Panic disorders

Benzodiazepines- used for immediate, Short- term relief. They act as sedatives to rapidly calm the nervous system

SSRIs - First line, long term treatment

Schizophrenia Postive symptoms

• Hallucinations

• Delusions

• Disorganized behavior

• Disorganized speech or thinking

Schizophrenia Negative symptoms

Anhedonia ( reduced ability to experience pleasure)

Apathy ( loss of motivation)

Flat affect

Social withdrawal

First- Generation Antipsychotics ( Typical)

• Action: Blocks the dopamine receptors in the CNS

• Best for treating: Psychosis and Schizophrenia positive symptoms

• Side effects: NMS, Extrapyramidal symptoms, constipation, Agranulocytosis, tachycardia , seizures

• Clozapine, Haloperidol, Fluphenazine

Second-Generation Antipsychotics (Atypical)

Action: block receptors like serotonin and dopamine.

Best for: positive and negative symptoms

Side effects: metabolic syndrome. lower risk of EPS and TD

Risperidone, Clozapine, Artipiprazole, Quentiapine

Extrapyramidal Symptoms

Actue Dystonia - Painful muscle spasm

Parkinsonism

Akathisia ( having to constantly move)

Extrapyramidal treatment

• Cogentin (Benzotropine)

• Diphenhydramine

Delirium

Sudden, often temporary of severe confusion

Delirium Causes

• Medications

• Alcohol or drug use or withdrawal

• Low sodium or calcium

• Infection

• Lack of sleep

Delirium Treatment

• Identify and correct underlying cause

• Low-stiumlus environment

• Reorientation

• Constant supervision

Dementia/ Alzheimers medications used to treat

• Cholinesterase inhibitors ( Donepezil, Rivastigmine, Galantamine) - for cognitive improvement

• Memantine ( for moderate to severe cases)

Start taking meds as soon as possible to slow progression

Definition-Regression

Childish behavior

Definition-Denial

Refusing reality

Definition-Projection

Blaming others

Definition-Repression

Unconsciously blocking unpleasant thoughts from conscious awareness

Definition- Displacement

Placing anger onto unwanted things

Definition- Rationalization

Creating false but plausible excuses to justify behavior or feeling

Definition- Sublimation

individuals unconsciously transform socially unacceptable impulses, emotions, or desires—such as aggression or sexual frustration—into constructive, productive, and socially acceptable actions, such as sports, art, or career success

Neuroleptic Malignant syndrome - S/S

High fever

Muscle rigidity

Confusion

Increase Creatine Kinase

Neuroleptic Malignant syndrome - Treatment

• Stop antipsychotic

• Dantrolene/ Bromocriptine

Serotonin Syndrome - S/S

• Agitation

• Hyperreflexia

• Sweating

• Diarrhea

• Insomnia

Serotonin Syndrome - Treatment

• Stop serotonergic agent

• Cyproheptadine (Antihistamine)

Hippocampus

Part of the brain responsible for memory

Extrapyramidal symptoms treatment

• Benzotropine (Cogentin) or other anticholinergic agents

Clozapine- S/E

• Neuroleptic Malignant Syndrome

• Torsades De pointes

• Seizures

• PE/DVT

• Cardiac Arrest

• Myocarditis

Clozapine- monitor

WBC/ ANC

Bowel movements

Signs and symptoms of myocarditis

Tardive Dyskinesa (Td)

Neurological condition that causes movements you can’t control

Tardive Dyskinesa (Td) - S/S

• Involuntary movements of : Tongue, Limbs, Neck, Facial and Trunk muscles

• Walking like a duck

• Making repetitive finger movements

• Inability to remain still

• Thrusting pelvis

Child Abuse - S/S

• Bruises

• Fractures

• Burns

• Head injuries

• Fear of caregivers

• Withdrawn

• Developmental regression

• Bed-wetting

• Aggression

Child Abuse Common themes :

• Neglect

• Physical Abuse

• Emotional/ Psychological Abuse

• Sexual Abuse

Child Abuse - Nursing Actions

• Establish a relation with child

• Listen & Observe

• Provide comfort

• Speak to social worker & CPS

• Examine child for abuse

• Assess behavior and mood

Anticholinergic affects

Dry mouth

Constipation

Urinary retention

Blurred Vision

Maturational Crisis

A predictable, Stressful life transition occurring during normal development that requires significant behavioral and emotional adjustments

Benzodiazepines (-Pam, -Lam)

Indictions: short term management of anxiety, insomnia, acute seizures, and alcohol withdrawal

MOA: low down the brain by enhancing the effect of an inhibitory neurotransmitter called GABA (gamma-aminobutyric acid).

Side Effects: Respiratory Depresion

Meds: Lorzapem, Alprazolam

Clozapine (clozapril)

Class: Antipsychotic (Atypical)

Indications: treating treatment-resistant schizophrenia and reducing recurrent suicidal behavior in schizophrenia or schizoaffective disorder

MOA: block receptors like serotonin and dopamine.

Side Effects: NMS, Torsades de pointes, seizures, DVT, Myocarditis

Nursing considerations: Monitor CBC, ANC, Asses respiratory, bowel movement

Fluoxetine (Prozac)

Class: Selective serotonin reuptake inhibitors (SSRIs)

Indications: major depressive disorder (MDD), GAD, panic disorder, obsessive-compulsive disorder (OCD),PTSD

MOA: Selectively inhibits the reuptake of serotonin in the CNS

Side Effects: Torsades de pointes, NMS, Serotonin syndrome, Seizures, bleeding, sucidal thoughts/behavior

Haloperidol

Class: Antipsychotic (Typical)

Indications: Psychotic disorders, Schizophrenia, Manic states, drug-induced psychosis, Aggressive behavior

MOA- blocks dopamine in brain. Also anticholinergic and alpha- adrenergic blocking activity

Side effects: NMS, TDP, seizures, Agranulocytosis, tachycardia

Nursing considerations: Monitor CBC, ANC, monitor BP, Assess cardiac and ECG at baseline

Prazosin used for

PTSD nightmares

Risperidone (RisperDAL)

Class: Antipsychotic (Atypical)

Indications: Schizophrenia, acute manic or mixed episodes associated with bipolar 1 disorder

MOA: Blocks dopamine and serotonin in the brain

S/E: NMS, Hypersensitivity, Topic epidermal neurolysis, Seizurs

Monitor for NMS, changes in mood

Fluvoxamine (Luvox)

Class: SSRI

MOA: inhibits the reuptake of serotonin in the CNS

S/E: bleeding, NMS, serotonin syndrome, sweating, edema

Assess for suicide tendencies, serotonin syndrome, bleeding