MH Final Exam prep

PTSD

Distressing pattern of behavior demonstrated by someone who has experienced, witnessed, or been confronted with traumatic events

Characteristics of PTSD

- Has to be a causative trauma

- Requires longer duration of symptoms (>1 month)

- Can have dreams, intrusive thoughts

- The individual may have a lack of support

S&S of PTSD

- Reexperiencing the trauma

- Avoidance

- Negative cognition/thoughts

- Hyperarousal/being on guard

Acute Stress disorder

- Occurs 3 days to 4 weeks after trauma

- Includes reeperiencing, avoidance, hyperarousal

- Can be a precursor to PTSD

Traumatic events can be classified as:

- Intentional

- Unintentional

Intentional trauma example

Being robbed at gun point

Unintentional trauma example

- Natural disasters e.g. hurricane

- Having the house get flooded

· Because someone goes through one of these events does not mean they will automatically develop a trauma response - everyone is different. T/F?

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Trauma

- "Trauma is what happens inside of you, as a result of what happens to you"

- Trauma is the result of the traumatic or the result of what is traumatic

Dementia

A chronic, progressive decline in cognitive functioning that is severe enough to interfere with daily life and independence

What is the nature of Dementia?

- Progressive cognitive impairment

- Multiple cognitive deficits

- Chronic and progressive

Early symptom of Dementia

Memory loss

Later symptoms of Dementia

- Aphasia

- Apraxia

- Agnosia

- Impaired executive function

Aphasia

Loss of ability to understand or use language (spoken or written) due to brain dysfunction

Apraxia

Inability to carry out purposeful movements or tasks, despite having the physical ability to do so (dressing, brushing teeth, or using utensils)

Agnosia

Inability to recognize or identify objects, people, sounds, or smells despite intact sensory function

Dementia is "chronic and progressive" because

- It develops slowly

- It has stages (mild → moderate → severe)

- It worsens over time

- It leads to progressive deterioration until death

Confabulation

Making up answers to fill in gaps in the memory

Dementia: Examples of distraction techniques

- Environmental, routine structure

- Redirect to another activity

- Reminiscence

- Music therapy

- Sensory soothing activities

- Using routine and structure

Reminiscence

- Encouraging a person to talk about and remember events from their past

- Thinking about, recalling, or discussing past experiences

Delirium

A sudden, temporary change in the brain that causes confusion, trouble paying attention, and rapid shifts in alertness

Risk for Delirium

- Drug intoxication or withdrawal

- Medical history

- Physiological disturbance

- Metabolic disturbance

- Cerebral disease

Disturbance of consciousness with change in cognition. It develops over a short period, and it is temporary

Delirium

What are the causes of delirium?

- Drug intoxication

- An identifiable physiological, metabolic, or cerebral disturbance or disease

Personality Disorders

- Impairment of personality functioning

- Personality traits that are maladaptive

- Identify probkems

- Relationships are dysfunctional

Personlity disorder is relatively common. It is often described as treatment resistant. T/F?

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Personality disorders are grouped into 3 clusters:

Cluster A, B, C

Cluster A disorders

- Paranoid

- Schizoid

- Schizotypal

Cluster B disorders

- Narcissistic

- Antisocial

- Borderline

- Histrionic

Cluster C disorders

- Avoidant

- Dependent

- Obsessive-compulsive

Paranoid Personality Disorder (PPD), characteristics

- Pervasive mistrust/suspisciousness

- Use of projection

- Conflict with authority

Paranoid Personality Disorder (PPD) - ways to communicate

- Formal, business-like approach

- Involve client in plan of care

- Validate idea before action

Schizoid Personality Disorder, characteristics

- Pervasive pattern of social detachment

- Restricted affect

- Little emotion

- Usually have rich and extensive fantasy life but are reluctant to reveal

Soemone with Schizoid PD:

The person likes being alone, avoids close relationships, and seems emotionally distant or detached

Schizoid Personality Disorder, ways to communicate

- Focus on improving functioning in the community

- Client has greater chance of success if he/she can relate his/her needs to one person

Schizotypal

Odd, eccentric, magical, socially anxious, social awkward, with unsual beliefs

Schizotypal Personality Disorder, characteristics

- Pervasive pattern of social and interpersonal deficits

- Friendless, except for family

- Cognitive or perceptual distortions

- Behavioral eccentricities

- Odd beliefs, thinking, and speech

- Odd appearance

- Restricted raneg of emotions

- Reluctance in social situations, anxiuous

Schizotypal Personality Disorder, ways to communicate

- Focus is self-care and social skills

- Encourage daily routines

- Identify appropriate outlets for discussing unusual beliefs

Antisocial Personality Disorder, characteristics

- Disregard for rights of others

- Deceit and manipulation

- Displays false emotions

- Narrowed view of world

- Do not consider morals and ethics

- Appears confident (but self is shallow and empty)

- Manipulates and exploits those around them

- Will largely NOT delay gratification

Antisocial Personality Disorder, ways to communicate

- Therapeutic communication

- Promote responsible behavior (limit setting, confrontation)

Borderline Personality Disorder, characteristics

- Pervasive pattern of instability

- Hate being alone but experience soicla isolation

- Reckless behavior

- Impaired judegement and lack of concern for safety

With Borderline PD, 'pervasive pattern of instability' can manifest as

- Unstable interpersonal relationships

- Self-image

- Affect

- Marked impulsivity

Borderline Personality Disorder, ways to communicate

- Safety (no self-harm)

- Therapeutic relationship (structured, with limit setting)

- "Splitting" may occur

- Strict adherence to boundaries

- Coping, emotion control

- Reshaping thinking patterns

- Structuring of daily activities

"Splitting" with Borderline PD means

- Seeing people or situations as all good or all bad — with no in-between

- See a nurse as the best one day and the worst the next

- All good or all bad” thinking. No gray area

How do we "reshape patterns" with Borderline PD?

- Cognitive restructuring

- Thought stopping

- Positive self-talk

- Decatastrophizing

Histrionic

A person who acts very dramatic, emotional, and attention-seeking

Histrionic Personality Disorder, characteristics

- Excessive emotionality and attention seeking

- Exaggeration of closeness of relationships

- Insincere and shallow emotions

Histrionic Personality Disorder, ways to communicate

- Feedback about social interactions

- Social skills training through role-playing

- Exploration of strengths and assets

Narcissistic Personality Disorder, characteristics

- Pervasive pattern of grandiosity

- Need for admiration

- Lack of empathy

- Arrogant or haughty attitude

- Superior view

- Fragile, vulnerable self-esteem

- Ambitious

Narcissistic Personality Disorder, ways to communicate

- Self-awareness skills to avoid anger and frustration

- Matter-of-fact approach

- Limit setting

Avoidant Personality Disorder, characteristics

- Social discomfort

- Low self-esteem

- Hypersensitive to negative evaluation

Avoidant Personality Disorder, ways to communicate

- Self-affirmations

- Positive self-talk

- Reframing and decastrophizing

- Social skills training

Dependent Personality Disorder, characteristics

- Need to be taken care of

- Submissive and clinging behavior

- Frequently anxious

Dependent Personality Disorder, ways to communicate

- Expression of feelings of grief and loss

- Assistance in daily functioning

- Teaching problem-solving

Obsessive-Compulsive Personality Disorder, characteristics

- Preoccupation with perfectionism

- Formal and serious demeanor

- Constricted emotional range

- Preoccupied with orderliness

- Low self-esteem

- Harsh self-evaluations

Obsessive-Compulsive Personality Disorder, ways to communicate

- Different perspective on decision-making

- Cognitive restructuring

- Risk-taking

Antisocial personality seeks instant what?

Gratification

People with antisocial PD seek instant gratification because __________

They are impulsive, cannot delay rewards, and focus only on what they want right now — regardless of consequences

EMS brings in an intoxicated person to the ED and they ask, "where am I, how did I get here" What are they experiencing?

Blackout (memory gaps & confusion about events)

What routes can Naloxone be given?

It can be given IN, IM - commonly used routes

What situation would require a repeated dose of Naloxone?

Naloxone is used in opioid overdose and may require repeat doses because opioid effects (respiratory depression) can outlast naloxone

Are there medications that are used in the treatment of alcohol abuse?

- Disulfiram (Antabuse)

- Benzodiazepines

- Naltrexone

Disulfiram

- Used as maintenance theraoy

- It introduces a form of positive punishment

- If alcohol is ingested, the patient becomes violently ill

- Acts as a deterrent to alcohol

Signs and symptoms that a nurse might be participating in substance abuse

- Poor work perfomance/frequent absenteeism

- Unusual behavior/slurred speech

- Isolation from peers

- Questionable controlled susbstance administration

Signs and symptoms of intoxication - Alcohol:

- Relaxation

- Slurred speech

- Unsteady gait

- Impaired memory/judgment

- Aggression

- Blackouts

Signs and symptoms of Overdose - Alcohol:

- Vomiting

- Unconsciousness

- Respiratory depression

Signs and symptoms of Withdrawal - Alcohol:

- Onset 4-12 hours (peaks on day 2)

- Coarse tremors

- Sweating

- Elevated pulse/BP

- Insomnia

- Anxiety

- Severe: Hallucinations, seizures, delirium (DTs)

The nurse's immediate focus (early withdrawal stage for alcohol) is to:

- Manage symptoms

- Ensure safety

- Build trust

- Promote orientation and comfort

Signs and symptoms of intoxication -Sedatives, Hypnotics, and Anxiolytics:

- Slurred speech

- Lack of coordination

- Unsteady gait

- Labile mood

- Stupor

Barbiturate overdose

- Possibly lethal

- Coma

- Respiratory depression

- Cardiac failure

- Death

Detox sedatives, Hypnotics, and Anxiolytics by:

Tapering drug

Signs and symptoms of intoxication -Stimulants (e.g. Cocaine, Amphetamines):

- High

- Euphoric feeling

- Hyperactivity

- Hypervigilance

- Anger

- Elevated BP

- Chest pain

- Confusion

- With overdose: Seizure, coma

Signs and symptoms of Withdrawal -Stimulants (e.g. Cocaine, Amphetamines):

- Onset within hours - days

- Primary symptom: marked dysphoria

- "Crashing"

- Not treated pharmacologically

Signs and symptoms of intoxication -Cannabis (aka weed):

- Lowered inhibitions

- Relaxation

- Euphoria

- Increased appetite

- Impaired motor control and judgment

- Delirium

- Cannabis-induced psychotic disorder

- No overdose

Signs and symptoms of withdrawal -Cannabis (aka weed)

- Insomnia

- Muscle aches

- Sweating

- Anxiety

- Tremors

Signs and symptoms of intoxication - Opioids (e.g. heroin)

- CNS depression

- Apathy

- Lethargy

- Listlessness

- Impaired judgment

- Psychomotor retardation or agitation

- Constricted pupils

- Drowsiness

- Slurred speech

- Impaired attention and memory

S&S of opioid overdose

Seizure and cardiac arrhythmias

Signs and symptoms of withdrawal -Opioid:

- Nausea/vomiting

- Dysphoria

- Lacrimation

- Rhinorrhea

- Sweating

- Diarrhea

- Yawning

- Fever

- Insomnia

Rhinorrhea

Running nose or excessive nasal discharge

Signs and symptoms of intoxication - Hallucinogens e.g. PCP, LSD, mushroom, etc

- Maladaptive behavioral/psychological changes

- Anxiety

- Depression

- Paranoid ideation

No typical withdrawal symptoms with Hallucinogens. T/F?

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Examples of inhalants

gases, aerosols, paint, nitrites

Signs and symptoms of intoxication - Inhalants

- Neurologic and behavioral changes:

- Slurred speech

- Hallucinations

- Euphoria

- Dizziness

- Stumbing gait

Symptoms of Acute toxicity with Inhalants

- Anoxia

- Respiratory depression

- Vegal stimulation

- Dysrhythmias

Anoxia

Absence of oxygen

With Inhalants, ______ is possible with bronchospasm, cardiac arrest, suffocation, or aspiration

death

No withdrawal syndrome but ___________ with Inhalants

cravings may occur

Dual diagnosis

When a person is diagnosed with a substance use disorder + a mental health disorder at the same time.

Dual diagnosis examples:

- Substance use disorder + depression

- Substance use disorder + anxiety disorder

- o Substance use disorder + schizophrenia

- o Substance use disorder + bipolar disorder

Somatization

- The transference of mental experiences, states into body symptoms

- It has to do with physical symptoms without identifiable medical cause that interfere with functioning

Somatic symptoms illnesses are characterized by:

- Physical complaintss that suggest major medical illness but have no demonstrable organic basis

- Psychological factors and conflicts seem important in initiating, exacerbating, and maintaining the symptoms

- Symptoms or magnified health concerns are not under the client's control

S&S of Somatic disorders

- Symptoms are often exprienced in adolescence; diagnoses may not be made until early adulthood

- Physical complaints without organic cause

Symptoms NOT under conscious control

- High level of anxiety

- Distress about health despite reassurance

- Focus on physical symptoms

- Labile mood/exaggerated emotional response

- Preoccupation with physical health

- Functional impairment (difficulty performing daily roles)

- Limited insight

- Self-care and physiologic concerns

- Conversations dominated by physical complaints

- "Doctor shopping"

Available treatment for Somatic disorders

- Symptom management

- Improvement in quality of life

- Referral to chronic pain clinic

- Involvement in theraoy groups

- Education

- Antidepressants: SSRIs

Two major types of eating disorders

- Bulimia

- Anorexia

Bulimia characteristics

- Onset: Late adolescence - early adulthood (avg age 18-19)

- Binge-eating frequently begins during or after dieting

- May have restrictive eating in between binges

- Clients are aware the behavior is pathologic

- Clients go to great length to hide their eating behavior

- Treatment: CBT, Antidepressants

Bulimia priorities

- Establish adequate nutritional eating patterns

- Eliminate compensatory behaviors (exercise, laxatives, diuretics, purging)

- Identify emotions and develop coping strategies (self-monitoring)

- Improve self-esteem

Effects of Bulimia

- Weight is usually close to expected range

- Labile moods

- History of impulsive behavior

- Preoccupation with food or dieting

- Ashamed of bahaviors

- Low self-esteem

- Unable to fulfil roles

o What is the most common age when bulimia is diagnosed?

- Late adolescence to early adulthood

- Avg age is 18-19

What if someone living with anorexia starts asking you a question during a meal, what should you do?

- During a meal, the priority is to establish nutritional eating patterns, which must be strictly supervised

- Redirect back to the meal

- Maintain structure and focus on eating

- Avoid engaging in conversations that distracts from the meal

Bipolar disorder

Alternating episodes of Mania & Depression