Exam 2 Flashcards Study Guide Mental

SAD PERSONS scale - what does each letter stand for?

Sex (male); Age (teen or elderly); Depression; Previous attempts; Ethanol abuse; Rational thinking loss (psychosis); Support system lacking (family, social); Organized plan (availability, lethality); No spouse (widowed, divorced, single); Sickness (chronic, debilitating illness)

SAD PERSONS - "O" (Organized plan)?

Plan with availability of means and lethality of method

SAD PERSONS - "R" (Rational thinking loss)?

Loss of rational thinking, i.e., psychosis

SAD PERSONS - "N" (No spouse)?

Widowed, divorced, or single

Factors that increase LETHALITY risk?

Specific high-lethal plan (a gun, jumping from a height); access to means (owns a weapon, has pills stored or on them); high intent (believes plan will work and is ready to act); isolation/lack of support; history of attempts (especially recent or highly lethal)

High intent means?

The person believes the plan will work and is ready to act on it

Examples of a specific high-lethal plan?

A gun; jumping from a height

Examples of access to means?

Owns a weapon; has pills stored or on them

Risk factors for suicidal ideation?

Mental health disorders (depression, bipolar, schizophrenia, substance use); chronic pain/illness; family history of suicide; recent loss; LGBTQ+ identity (lacking support); impulsivity; exposure to others' suicide attempts/thoughts

Which mental health disorders raise risk for suicidal ideation?

Depression, bipolar, schizophrenia, and substance use disorders

Highest-priority nursing diagnosis for a suicidal patient?

RISK FOR SUICIDE (always the first assessment)

Safety interventions for a suicidal patient?

One-on-one observation; remove dangerous objects (sharps, belts, cords, electronics)

Suicide interventions (full list)?

Safety (1:1 observation, remove sharps/belts/cords/electronics); contract for safety (less reliable); encourage expression of feelings without judgment; administer prescribed medications (anxiolytics)

Contract for safety - reliability?

Less reliable than other interventions

Medication class given to suicidal patients per study guide?

Anxiolytics (prescribed)

Possible nursing diagnoses for a depressed patient?

Risk for suicide (HIGHEST PRIORITY, always first assessment); hopelessness; ineffective coping; social isolation; self-care deficit

Highest-priority nursing diagnosis for a depressed patient?

Risk for suicide

Therapeutic communication with a depressed patient?

Use simple, concrete language (impaired concentration); make observations instead of asking complex questions; spend time with the patient even if silent (presence is key); avoid false reassurance

Why use simple, concrete language with depressed patients?

Impaired concentration

Example of making an observation instead of asking a question?

"I see you haven't finished your meal"

Example of false reassurance to AVOID?

"Everything will be fine"

Nursing value of sitting silently with a depressed patient?

Presence is key - spend time with the patient even if they are silent

DSM-5 criteria for major depression?

At least 5 of 9 symptoms, present over a 2-week period; two of them must be loss of interest/pleasure AND depressed mood

How long must symptoms last for DSM-5 depression?

Over a 2-week period

The 9 DSM-5 depression symptoms?

1) loss of interest and pleasure; 2) sadness/depressed mood; 3) feelings of guilt; 4) low self-worth; 5) disturbed sleep; 6) disturbed appetite; 7) low energy; 8) poor concentration; 9) suicidal thoughts

Which 2 DSM-5 symptoms are required (plus 3 more)?

Loss of interest or pleasure and depressed mood

Dysthymia (persistent depressive disorder)?

Chronic depression, less severe than major depression; lasts at least 2 years, at least 5+ days a week; no history of manic or mixed episode; presents with 2 of 6 symptoms

Dysthymia - the 6 symptoms (need 2)?

Poor appetite/overeating; insomnia or excessive sleep; low energy/fatigue; low self-esteem; poor concentration and decision-making ability; feelings of hopelessness

Anhedonia?

Inability to experience pleasure from activities usually found enjoyable

Anergia?

Lack of energy; sluggishness

Cognitive disturbances in depression?

Absolute thinking; impaired concentration and decision-making abilities

Absolute thinking?

Viewing events as entirely good or entirely bad (e.g., "If I don't get an A I'm a total failure")

Affect changes in depression?

Flat, blunted, or sad/tearful affect; often lack of emotional reactivity

Side effects of SSRIs/SNRIs?

Sexual dysfunction; weight gain/loss; insomnia/agitation; headache; nausea

MAOI food/drug interactions?

Avoid tyramine-rich foods (aged cheese, cured meats, tap beer, soy products, overripe fruit) to prevent hypertensive crisis; also avoid antidepressants, cold medications, stimulants

Complication of MAOI + tyramine?

Hypertensive crisis

Tyramine-rich foods to avoid with MAOIs?

Aged cheese; cured meats; tap beer; soy products; overripe fruit

Priority interventions/monitoring for antidepressants?

Monitor for therapeutic effects (takes weeks), suicidal ideation, and side effects

Antidepressant dosing approach (stages of implementation)?

"Start low, go slow"; therapeutic effect takes 2-4 weeks; full effect up to 12 weeks

How long until antidepressants take therapeutic effect? Full effect?

Therapeutic effect 2-4 weeks; full effect up to 12 weeks

Serotonin syndrome - why it is an emergency?

Can progress quickly to life-threatening complications: seizure, multiple organ failure, death from drug toxicity

Serotonin syndrome - symptoms?

Mental status changes (agitation, delirium); autonomic instability (tachycardia, labile BP, fever, diaphoresis); neuromuscular abnormalities (hyperreflexia, tremor, clonus)

Serotonin syndrome - nursing action?

Stop the drug immediately and provide care

Neurotransmitters involved in depression?

Serotonin, norepinephrine, and dopamine deficiencies

Risk factors for depression?

Prior episode; family history of depressive disorder; lack of social support; lack of coping abilities; life and environmental stressors; current substance use/abuse; medical and/or mental illness comorbidity

Bipolar I - quick definition?

Mania (with or without depression); manic episode lasting ≥1 week (any duration if hospitalized)

Bipolar II - quick definition?

At least 1 hypomanic episode and 1 major depressive episode; never had a full manic episode

Bipolar I - DSM-5 criteria?

1 or more manic or mixed episodes (may be preceded/followed by hypomanic or major depressive episodes, but not required); abnormally elevated, expansive, or irritable mood plus increased goal-directed activity/energy lasting ≥1 week (any duration if hospitalized), most of the day nearly every day

Mania symptoms - how many needed?

≥3 of the symptoms (or ≥4 if mood is irritable only)

Manic/hypomanic symptom list?

Inflated self-esteem or grandiosity; decreased need for sleep; pressured speech; racing thoughts or flight of ideas; distractibility; increased activity; excess pleasurable or risky activity

Bipolar I - other criteria (must be true)?

Causes functional impairment, requires hospitalization, or has psychotic features; not due to substance misuse, a medical condition, or somatic antidepressant therapy; does not meet criteria for a mixed episode

Mixed episode criteria?

Criteria met for BOTH a manic episode and a major depressive episode during at least a 1-week period; causes impairment, hospitalization, or psychosis; not due to substances, medical condition, or somatic antidepressant therapy

Mixed bipolar - plain description?

Symptoms of mania/hypomania and depression simultaneously or in rapid succession (e.g., agitated and highly irritable while feeling hopeless)

Rapid cycling?

Four or more mood episodes (mania, hypomania, or depression) in one year

Bipolar II - hypomanic episode duration?

≥4 but <7 days

Bipolar II - hypomanic episode features?

Unambiguous change in functioning, uncharacteristic of the person, observable by others; NOT severe enough to cause marked impairment; not due to substance/medical condition; NO psychosis (if present, it is mania by definition)

Bipolar II - major depressive episode criteria?

≥5 symptoms during the same 2-week period representing a change from previous functioning; at least one is depressed mood or loss of interest/pleasure

Major depressive episode symptoms (bipolar II list)?

Depressed mood; diminished interest/pleasure; weight/appetite change; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue/loss of energy; worthlessness or excessive guilt; diminished concentration/indecisiveness; recurrent thoughts of death or suicidal ideation (with or without plan)

Mania vs hypomania vs depressed mood?

Mania: severe, marked impairment, typically >1 week, may involve psychosis/hospitalization. Hypomania: less severe, no marked impairment, typically >4 days, no psychosis. Depressed mood: severity varies; sadness, anhedonia, anergia

Mania?

Elevated, expansive, or irritable mood; marked impairment in social/occupational functioning; typically lasts more than a week; may involve psychosis; hospitalization risk

Hypomania?

Elevated, expansive, or irritable mood; NO marked impairment in functioning; typically lasts more than 4 days; no psychosis

Depressed mood (in bipolar)?

Mood and symptoms consistent with major depression (sadness, anhedonia, anergia); severity varies

Lithium - drug type?

Mood stabilizer

Lithium - therapeutic level?

0.6-1.2 mEq/L

Lithium - side effects?

Tremor; polyuria; polydipsia; weight gain; mild nausea

Lithium - what to monitor?

Kidney function (BUN/Cr); thyroid function; levels drawn 12 hours after last dose

Lithium - when are levels drawn?

12 hours after the last dose

Lithium toxicity - level and signs?

>1.5 mEq/L; GI distress, ataxia, confusion, seizures (medical emergency)

Depakote (valproate) - drug type?

Anticonvulsant/mood stabilizer

Depakote - therapeutic level?

50-100 mcg/mL

Depakote - side effects?

Tremor; weight gain; hair loss; GI distress; sedation

Depakote - what to monitor?

Liver function (LFTs); platelet count

Depakote - medical emergencies?

Pancreatitis; liver failure

Lamictal (lamotrigine) - drug type?

Anticonvulsant/mood stabilizer

Lamictal - therapeutic level?

Not routinely monitored

Lamictal - side effects?

Dizziness; ataxia; blurred vision

Lamictal - what to monitor?

Monitor for rash

Lamictal - medical emergency?

Stevens-Johnson syndrome (SJS)

Stevens-Johnson syndrome (SJS)?

Rare, life-threatening allergic reaction causing painful rash, blistering, or peeling skin; triggered by medications (Lamictal); can lead to sepsis, dehydration, organ damage, respiratory failure, death. Stop the drug immediately if a rash occurs

Which mood stabilizer needs no routine level but a rash check?

Lamictal (lamotrigine)

Which mood stabilizer requires monitoring LFTs and platelets?

Depakote (valproate)

Which mood stabilizer requires monitoring BUN/Cr and thyroid?

Lithium

Positive symptoms of schizophrenia?

Additions to normal behavior: hallucinations, delusions, thought disorder, bizarre behavior

Negative symptoms of schizophrenia?

Deficits or absence of normal function: apathy, anhedonia, alogia (poverty of speech), affective blunting, avolition (lack of motivation)

Avolition?

Lack of motivation

Alogia?

Poverty of speech

Neologisms?

Made-up words

Idea of reference?

Belief that unrelated events/cues refer directly to them (e.g., thinking a news anchor is talking directly to them)

Thought withdrawal?

Belief that thoughts are being removed from one's mind

Thought broadcasting?

Belief that one's thoughts are being transmitted to others

Thought insertion?

Belief that thoughts are being placed into one's mind

Loose associations?

Absence of a logical connection between thoughts and ideas

Echopraxia?

Repetition (imitation) of another person's movements

Echolalia?

Repetition of another person's words

Tangentiality (study guide wording)?

Moving from thought to thought without ever getting to the point

Milieu therapy - goal?

Provide a therapeutic, structured, and safe environment

Milieu therapy - focus for altered perceptions?

Low-stimulus environment to minimize triggers and anxiety (hallucinations/delusions); clear, consistent routine; structured, supportive social environment to practice healthy behaviors in a therapeutic community

EPS - cause?

Dopamine blockade, primarily with first-generation antipsychotics

Pseudo-parkinsonism?

Tremor, shuffling gait, rigidity; treat with anticholinergics (benztropine) or diphenhydramine

Tardive dyskinesia (TD)?

Involuntary repetitive movements (lip smacking, tongue protrusion, chewing movements); often irreversible; caused by long-term use