Mental Health exam 2

tolerance

need more to get the same effect

physical dependence

body adapts; stopping causes withdrawal

withdrawal

symptoms after reducing or stopping drugs

intoxication

behavioral or physical changes from recent use

substance use disorder (SUD)

continued problematic use despite harmful consequences

alcohol withdrawal symptoms 6-12 hr

tremors, anxiety, sweating, insomnia, nausea, tachycardia, hypertension

alcohol withdrawal symptoms 12-24 hr

hallucinosis perceptual disturbances/ hallucinations

alcohol withdrawal symptoms 24-48 hr

seizures generalized/tonic-clonic seizures

alcohol withdrawal symptoms 48-96 ht

delirium tremens (DT's), severe agitation, disorientation, visual hallucinations, fever, marked tachycardia and hypertension. Medical Emergency!!

alcohol withdrawal medication

Benzodiazepines (diazepam/lorazepam) treat alcohol withdrawal

opioid intoxication/OD signs/symptoms

pinpoint pupils, slow breathing, sedation, decrease LOC, hypotension. Priority: airway and breathing

opioid withdrawal signs/symptoms

dilated pupils, yawning, runny nose, tearing, goosebumps, muscle aches, diarrhea

Naloxone (Narcan)

reverses opioid OD and respiration depression, may trigger withdrawal

Methadone

opioid agonist for withdrawals/cravings. Monitor respiration depression, sedation, and QT prolongation

Disulfiram (Antabuse)

causes flushing, nausea/vomiting, palpations, and hypotension if alcohol is consumed

Alprazolam (Xanax)

fast-acting benzodiazepine; may be used for PRN for acute anxiety

benzodiazepine safety: sedation, falls, dependence. avoid alcohol and other CNS depressants; do n

Benzodiazepine safety

sedation, falls, dependence. avoid alcohol and other CNS depressants; do not abruptly stop long-term use

Buspirone

not PRN; takes 1-2 weeks or longer for therapeutic effects; low abuse potential

SSRIs

used for anxiety and OCD; full effect takes weeks

OCD medication trick

SSRIs take 8-12 weeks for full effect in OCD. Do not expect immediate relief

Clomipramine

TCA option for OCD

eustress

positive, motivating stress

distress

negative, overwhelming stress

acute stress

sudden stressor

chronic stress

repeated or prolonged stress

toxic stress

prolonged stress with harmful biological effects

General Adaption Syndrome (GAS)

alarm: fight-or-flight response

resistance: body adapts while still alarmed

exhaustion: stress continues; increases illness risk

regression

returning to previous behavior

repression

unconsciously blocking painful memories

suppression

consciously postpones thoughts

sublimation

channels an urge into a constructive activity (exercises when angry)

acute stress disorder

symptoms from 3 days to 1 month after trauma

PTSD

symptoms lasting longer than 1 month, with distress or impaired functioning

intrusion

flashbacks, nightmares, unwanted memories

arousal/reactivity

Irritability, hypervigilance, and sleep disturbances.

depersonalization

Feeling detached from oneself.

derealization

Feeling that the world is not real/dreamlike

dissociative amnesia

inability to recall important personal information, often related to trauma

anhedonia

loss of interests or pleasures

major depressive disorder

severe symptoms; at least 2 weeks

persistent depressive disorder

depressed mood for 2+ years in adults

premenstrual dysphoric disorder

mood symptoms during luteal phase and resolved with menses

substance/medication-induced depression

associated with use, intoxication, withdrawal

permpartum-onset depression

begins in pregnancy/within 4 weeks postpartum

SSRIs class/must-know

sertraline, fluoxetine: take weeks to work; monitor early treatment for worsening suicidal thoughts/serotonin syndrome

SNRIs

venlafaxine, duloxetine: monitor BP (venlafaxine); do not stop abruptly

TCAs

amitriptyline, desipramine: dry mouth, constipation, urinary retention, orthostatic hypotension, cardiac toxicity in OD

MAOIs

phenelzine: avoid tyramine-rich foods: risk of hypertensive crisis

lithium

maintain consistent Na+ and fluid intake; monitor blood levels and toxicity

Risperidone

monitor weight, glucose, lipids, EPS, tardive dyskinesia, and neuroleptic malignant syndrome

diphenhydramine

can treat acne dystonia/EPS, may cause sedation and anticholinergic effects

What is the therapeutic range for lithium levels?

0.6-1.2 mEq/L

What lithium level is considered toxic?

>1.5 mEq/L

What are some symptoms of lithium toxicity?

Course tremor, vomiting, diarrhea, confusion, ataxia

What factors can increase the risk of lithium toxicity?

Dehydration and NSAIDs

What does lithium prefer in terms of consistency?

Fluids, sodium (Na+), and regular blood level monitoring

serotonin syndrome

life-threatening reaction from excessive serotonin activity

serotonin syndrome symptoms

Neuro: tremors, hyperreflexia, clonus, rigidity, ataxia

Autonomic: sweating, tachycardia, hypertension, hyperthermia, diarrhea

Mental Status: agitation, restlessness, confusion

MAIOs food interactions

avoid tyrone-rich: aged cheese, cured/processed meats, tab beer, red wine, soy sauce, fermented foods

flight of ideas speech

rapidly changes topics (topics fly by)

tangential speech

goes off-topic, never returns to point (takes a tangent)

circumstantial speech

excessive details and eventually answers (circles before arriving)

loose associations

illogical shifts between topics (connections loose)

word salad

nonsensical, disorganized responses

clanging

words linked by rhyme or sound (clang = sound)

neologisms

makes up new words

thought blocking

speech suddenly stops (thought and speech blocked off)

poverty of speech

limited speech content; few words

grandiose delusion

believing they have extreme importance or power

persecutory delusion

believing they are being followed, watched, or targeted

jealousy delusion

believing their partner is unfaithful

religious delusion

believing they have special status with God

somatic delusion

believing they have a physical defect or illness that is not present

ideas of reference delusion

events or environmental messages are specifically about them

thought insertion delusion

believing someone is putting thoughts into their head

thought broadcasting delusion

believing their thoughts are being broadcasted to others