NCLEX Mental Health

bipolar 1

dramatic mood fluctuations cycling from depression to mania

bipolar 2

mood fluctuations from depression to hypomania (less intense)

lithium mood stabilizer

narrow therapeutic index, and toxicity can be fatal, blood draws required

symptoms of lithium toxicity

gi distress, ataxia, sedation, seizures

Lithium considerations

teach client to maintain consistent sodium intake and drink 2-3L/day, starts to work in 1-3 weeks, will use benzos or atypical antipsychotics in meantime

what 3 anticonvulsants are used as mood stabilizers? and their effects?

valproate (hepatotoxicity and pancreatitis), carbamazepine and lamotrigine (monitor for rash stevens johnson syndrome)

Delirium causes THINK

toxins (drugs anticholinergics, sedatives), Hypoxemia, infection (uti, pneumonia), Nonpharm (missing hearing aids or glasses), K or (fluid and electrolyte imbalances)

The 3 S’s of serotonin syndrome

sweating (fever and increased HR), shaking (tremors muscle rigidity), strange behavior (mental status changes, confusion, agitation)

major depressive disorder

depression lasting more than 2 weeks

seasonal affective disorder

depression follows seasonal pattern

anorexia signs

low body weight, decreased HR and BP, dehydration, hypokalemia, decreased cognition and energy, amenorrhea

bulimia signs

normal body weight, dental erosion, scarring and calluses on hands, dehydration, hypokalemia

cluster a disorders

(odd and eccentric), paranoid, schizoid, schizotypal

cluster B personality disorders

(dramatic and erratic) antisocial, borderline, histrionic, narcissistic

cluster c personality disorders

(anxious and fearful) avoidant, dependant, obsessive compulsive

dialectical behavior therapy

teaches emotion regulation, distress tolerance, and interpersonal skills (borderline effective)

what is the primary treatment for personality disorders?

psychotherapy

paranoid personality disorder

suspicious of others, reads hidden meaning to remarks, easily offended, hypervigilant

antisocial personality disorder

disregards societal norms, lies, manipulates, disregards the rights of others, lacks guilt and remorse

borderline personality disorder

high risk for self-injury/suicide, unstable moods and relationships, fears abandonment, impulsive

narcissistic personality disorder

exaggerated self-importance, needs praise and admiration, lacks empathy

dependant personality disorders

struggles to function independently, fears abandonment, clings to others, lacks confidence, needs constant reassurance

positive schizophrenia symptoms

delusions, hallucinations, disorganized thinking

negative schizophrenia symptoms

anhedonia, avolition (lack of motivation), anhedonia, asocial behaviors, anergia, alogia, apathy

which first gen (typical) antipsychotics are used for schizophrenia?

haloperidol, fluphenazine, chlorpromazine

which second gen (atypical) antipsychotics are used for schizophrenia?

risperidone, ziprasidone, clozapine

EPS symptoms

akathisia, dystonia, pseudo parkinsonism, tardive dyskinesia (irreversible)

what two side effects do antipsychotics cause?

anticholinergic and orthostatic hypotension

first gen conventional antipsychotics names

chlorpromazine, fluphenazine, thioridazine, haloperidol

second gen antipsychotic names

aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone

cautions with 1st gen antipsychotics

NMS life threatening reaction characterized by fever, muscle rigidity, AMS

considerations with first gen antipsychotics

EPS akathisia, dystonia, pseudoparkinsonism

atypical antipsychotics cautions

agranulocytosis most likely to occur with CLOZAPINE, immediately report signs of infection (fever, sore throat, chills)

considerations atypical antipsychotics

metabolic syndrome teach healthy diet and exercise to manage weight

SSRI names

citalopram, fluoxetine, sertraline

SNRI names

duloxetine, venlafaxine

TCAS names

amitriptyline, imipramine, nortriptyline

MAOIs names

isocarboxazid, phenelzine, selegiline

bupropion antidepressant avoid administering to what clients?

clients with seizure disorder because of increased risk for seizures

mirtazapine antidepressant risk for?

sedation and weight gain

SSRIs considerations

sexual side effects common, take with food and drink to avoid GI effects, do not stop abruptly

SNRIs considerations

obtain baseline BP and monitor throughout treatment

TCA cautions

baseline ECG to assess for dysrhythmias, avoid alert activities, take at bedtime

TCA considerations

orthostatic hypotension, anticholinergic effects, and monitor for urinary retention

MAOI cautions

don’t combine with SSRIs or TCAs, washout period of more than 2 weeks is required to start or stop MAOI, risk for HTN crisis AVOID FOODS WITH TYRAMINE (cured meats, aged cheeses, beer, wine)