MH Exam

What are the criteria for diagnosis for major depressive disorder?

must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure

How is major depressive disorder treated? (2)

• antidepressants

• CBT

What is the main difference between major depressive disorder and persistent depressive disorder (dysthymia)

PDD has fewer symptoms, but they last longer (2 years vs. 2 weeks for diagnosis)

What are the crtieria for diagnosis for persistent depressive disorder (dysthymia)?

Depressed mood present 'more days than not' over at least a 2-year period

How is persistent depressive disorder (dysthymia) treated? (2)

• antidepressants

• CBT

What is a validation tool nurses use to assess depression in adults and in children/teens?

• Beck Depression Inventory (BDI)

What are obsessions?

recurring, unwanted thoughts, ideas, or
sensations

What are compulsions?

repetitve actions to deal with obsessions

What are some treatments / interventions for OCD? (4)

• CBT

• Group therapy

• Exposure therapy

• Antidepressants

What is panic disorder?

Frequent and unexpected panic attacks. These attacks are characterized by a sudden wave of fear or discomfort or a sense of losing control even when there is no clear danger or trigger.

What physical assessment findings can be present with panic disorder? (3)

• Sweating

• Tachycardia

• Tachypnea

What is the GAD-7? What does it aim to assess?

• Screening tool for generalized anxiety disorder.

• Measures the severity of anxiety symptoms.

What are treatments / interventions for panic disorder? (4)

• Group therapy

• Psychotherapy (talk therapy)

• Mindfulness techniques

• Antidepressants

What is the continuum of bipolar disorders? (3)

• Bipolar I

• Bipolar II

• Cyclothymic disorder

What is the difference between bipolar I and bipolar II?

Bipolar II do not experience as severe highs (hypomania, not fully mania)

What is the difference between bipolar and cyclothymia?

Cyclothymic disorder is a milder form of bipolar disorder involving many "mood swings. They do not reach mania or as severe depressive episodes.

What is the diagnostic criteria for bipolar I?

Mania lasting at least 1 week

What is the diagnostic criteria for bipolar II?

at least one hypomanic episode and at least one major depressive episode, never a manic episode

What is the diagnostic criteria for cyclothymia?

many periods of elevated mood (hypomanic symptoms) and periods of depressive symptoms for at least two years

What are the phases of bipolar I, and the goals of care for each? (3)

• Acute phase - prevent injury

• Continuation phase - relapse prevention

• Maintenance phase - limit severity and duration of future episodes

What are some non-pharmacological treatments for bipolar disorders? (3)

• Electroconvulsive therapy (ECT)

• Milieu management

• Support groups

What are medications used to treat bipolar disorders? (3)

• Lithium

• Anticonvulsants

• 2nd gen antipsychotics

What can staff members do to manage splitting or manipulative behaviours?

• Set limits consistantly

What are some differences between anorexia nervosa and bulimia? (3)

• People with bulimia often have normal body weight, where people with anorexia often are underweight.

• People with anorexia experience amenorrhea and cold intolerance.

• People with bulimia experience scaly skin, and tooth / gum deterioration.

What are the similarities between anorexia nervosa and bulimia? (2)

• Obsessive desire to lose weight

• Fluid / electrolye imbalance

What are the severe 6 signs / symptoms of anorexia nervosa?

1. Extreme weight loss (less than 75% expected weight)

2. Fluid and electrolyte imbalance - hypokalemia = potassium below 3.5 (cardiac dysrhythmias)

3. Lanugo (thin hair)- rare

4. Amenorrhea (no menstruation) due to low body fat, estrogen production

5. Cold intolerance

6. 3 Low’s: Low temp, Low BP, Low HR

What is binging?

eating much larger amounts than normal in a short period of time

What is purging?

actions to compensate for excessive food intake, can include:

• self-induced vomiting

• misuse of laxatives

• excessive exercising

What evidence might be present to support a nursing diagnosis of imbalanced nutrition and risk for dehydration for eating disorders? (6)

• Electrolyte imbalance

• Skin pallor

• Poor skin turgor

• Laxative abuse

• Abnormal ECG

• Reduced caloric intake

What medications can help manage bulimia? (3)

• Fluoxetine

• Citalopram

• Sertraline

What is addiction?

A chronic, relapsing brain disorder that results from the prolonged effects of exposure of the brain to drugs

What is intoxication?

A reversible substance-specific syndrome due to ingestion or exposure to a substance

What is withdrawal?

A substance-specific maladaptive behavioral change due to stopping or reducing the consumption following heavy and prolonged substance use

What is the difference between addiction and compulsive behaviour?

Urge versus need

A compulsion is an insatiable urge to do something.

Addiction is a need to do something to experience pleasure or remove discomfort

How do opioids work? (4)

1. Attaches to proteins in the brain called opioid receptors.

2. Stops messages being sent from the body to the brain.

3. Triggers the release of endorphins.

4. Endorphins block the perception of pain and boosts feelings of pleasure.

What are the signs of opioid intoxicaiton? (5)

• Drowsiness

• Flu like symptoms

• Changes in sleep habits

• Lack of hygiene

• Isolation from family and friends

What are the signs of opioid overdose? (8)

• Difficulty walking

• Difficulty talking

• Difficulty staying awake

• Clammy and cold skin

• Confusion

• Drowsiness

• Extremely dialated pupils

• Unconciousness

What are the signs of opiod withdrawal? (7)

• Sweating

• Chills

• Anxiety

• Agitation

• Muscle aches

• Nausea / vomiting

• Stomach cramping

What is the COWS scale used for?

Clinical opiate withdrawal scale, determines the severity of opioid withdrawal.

Why are Methadone and Suboxone used? How do they differ from other opioids?

Methadone: a synthetic opioid dispensed daily from a pharmacy.

Suboxone: a synthetic opioid mixed with an opiate antagonist

What happens to neurotransmitters during addiction?

Many drugs cause dopamine to flood the reward pathway 10 times more than a natural reward. The brain remembers this surge and associates it with the addictive substance

What harm reduction techniques can nurses teach patients who use substances (4)

• Medical grade drugs instead of street drugs

• Never using alone

• Sanitary techniques

• Never mixing drugs

What is Narcan and how does it work?

Narcan reverses an opioid overdose by blocking the effects of opiates on the brain and restoring breathing

What are the guidelines for alcohol consumption?

For women:

• Limit alcohol to no more than 2 drinks per day, or 10 drinks per week.

For men:

• Limit alcohol to no more than 3 drinks per day, or 15 drinks per week.

What is considered a “drink" for beer, malt liquor, wine, and hard liquor?

• Beer (5%): 12 ounces

• Malt liquor (7%): 8-9 ounces

• Wine (12%): 5 ounces

• Hard liquor (40%): 1.5 ounces

What is CAGE and what are the questions?

Screening assessment for excessive drinking and alcoholism.

1. Have you ever felt you should CUT down on your drinking?

2. Have people ANNOYED you by criticizing your drinking?

3. Have you ever felt GUILTY about your drinking?

4. Have you ever had a drink first thing in the morning to steady your nerves or get yourself going for the day? (EYE-opener)

What pharmacological interventions are available in Canada for alcoholism? (3)

• Naltrexone

• Disulfiram

• Gabapentin

How do Naltrexone and Gabapentin work?

Naltrexone and Gabapentin decrease cravings for alcohol by decreasing the pleasurable effects of drinking.

What is the CIWA assessment?

Clinical Insitute Withdrawal Assessment for Alcohol, assesses alcohol withdrawal

What neurotransmitter is impacted in BPD?

For people with BPD, the serotonin gene 5-htt has shorter alleles, which is linked to lower levels of serotonin

What is emotional dysregulation?

trouble controlling your emotions and how you act on those feelings

What patterns would a person with BPD present with? (6)

• Intense and unstable relationships

• Rapid mood swings

• Intense fear of abandonment

• Impulsivity

• History of trauma

• Self harm

What is the mortality rate of BPD?

30%

What criteria is required for a diagnosis of PTSD?

experiencing intrusive recurring symptoms that persist longer than one month and interfere with daily life

What objective assessment findings would a nurse identify in an individual with PTSD? (6)

• Anxious, fidgeting

• Inability to sit still

• Stuttering

• Changes in speech rate and volume

• Instability in mood

• Exhaustion

What is ADHD?

A neurodevelopmental disorder that begins in early childhood, causing functional impairment across the lifespan

What is executive functioning?

brain functions that activate, organize, integrate and manage other functions. It enables individuals to account for short- and long-term consequences of their actions and to plan for those results.

What is self regulation?

the means by which an individual manages themselves in order to attain their goals

How is dopamine effected with ADHD?

inadequate dopamine decreases motivation and focus and affects learning and memory. it also effects reward processes

what is CBT?

CBT is a type of psychotherapy that involves changing unhealthy ways of thinking, feeling, and behaving. This tends to be a short-term treatment

What is DBT?

DBT is a type of talking therapy that is most commonly used for people who feel their emotions very intensely. This treatment is usually long-term.

What conditions can coexist with PTSD? (4)

• Major depressive disorders

• Substance use disorder

• Anxiety

• Suicidality

What are the 3 types of ADHD?

• Inattentive
• Hyperactive-impulsive
• Combined

What are the red flags of ADHD? (6)

• Family history of ADHD

• Poor self-regulation

• Family / marital problems

• Substance use disorder

• History of driving violations / accidents

• Difficulty managing finances

How can ADHD present in preschoolers?

behavioural disturbances

How can ADHD present in school-aged children? (3)

• difficulty with social relationships

• difficulty with academics

• negative self-esteem

How can ADHD present in adolescents? (4)

• Experimentation with drugs / alcohol

• Risky sex

• Accidents

• Academic problems

How can ADHD present in university / college? (2)

• Academic failure

• Reliance on substances

How can ADHD present in adults? (3)

• Difficulty with finances

• Difficulty with relationships

• Occupational challenges

What is the multimodal approach to treating ADHD? (4)

• Lifestyle modification (exercise, high protein, sleep hygiene)

• Counselling (behavioural psychotherapy)

• Mindfulness (yoga, meditation)

• Pharmacotherapy

What are 1st line therapy medications for ADHD? (2)

Psychostimulants:

• Methylphenidates - ex. Concerta

• Amphetamines - ex. Vyvanse

What are 2nd line therapy medications for ADHD? (2)

Non-stimulants:

• NDRI - ex. Wellbutrin

• NRI - ex. Strattera

What are common side effects of ADHD medications? (7)

• Decreased appetite / weight loss

• Nausea

• Dry mouth

• Tremors

• Mood changes

• Anxiety

• Palpitations

What are contradictions to prescribing ADHD medication? (6)

• Family history of sudden cardiac death

• History of severe hypertension

• Heart disease

• Mania / psychosis

• Substance use disorders

• Tic disorders

How do methlyphenidates act on the brain to achieve effective treatment?

Methylphenidate increases extracellular dopamine levels in the brain by blocking the dopamine transporters in the synapse

What are risk factors for the development of mental health disorders? (4)

• Parent with depression

• Parent’s inability to model effective coping stratagies

• Children who have been abused or neglected

• Exposure to intimate partner violence

What resilient behaviors can be developed in children to prevent mental health disorders? (5)

• Adaptability to changes in the environment

• Ability to form nurturing relationships with other adults

• Ability to distance self from emotional chaos

• Good social intelligence

• Good problem solving skills

What preventative programs exist in NB to help children develop resilient behaviors? (5)

• Healthy Learners Program

• Integrated Service Delivery Program

• NB Social Pediatrics

• Parent-child Assistance program

• Strengthening Families program

What are the cardinal symptoms of delirium? (4)

• Inability to direct, focus, or sustain attention

• Abrupt onset

• Clinical features fluctuate with periods of lucidity

• Disorganized thinking and poor executive functioning

Aphasia

Loss of language ability

Agnosia

Loss of sensory ability to recognize objects

Apraxia

Loss of purposeful movement