Mental Health 2 Flashcards

How do neurons communicate

They send and receive electrochemical messages through neurotransmitters.

What happens at a synapse?

The presynaptic neuron releases a neurotransmitter, it binds to a receptor on the postsynaptic neuron, then it is taken back by reuptake or inactivated by an enzyme.

What is the simple synapse memory chain?

SEND → BIND → CLEAN UP.

What does dopamine control?

Emotional responses, complex movement, cognition, pleasure, and reward.

How is dopamine connected to schizophrenia?

Schizophrenia manifestations and antipsychotic treatment are related to regulation of dopamine transmission

What does serotonin regulate?

Emotion, sexual behavior, temperature, sleep, and pain

How do many antidepressants increase serotonin activity?

They block serotonin reuptake so it has more time to bind to postsynaptic receptors.

What does norepinephrine regulate?

Learning, sleep, mood, memory, and attention

What may low norepinephrine cause?

Anxiety, social withdrawal, depression, and memory loss.

What does histamine do in the brain?

It helps regulate alertness and wakefulness.

Why can histamine-antagonist medications cause sedation and weight gain?

They block histamine activity.

What is GABA?

An inhibitory neurotransmitter that helps reduce anxiety and promote sleep.

How do benzodiazepines affect GABA?

They enhance GABA binding and produce a strong inhibitory or calming effect.

What is glutamate?

An excitatory neurotransmitter involved in motor, emotional, and cognitive functions

Why is excess glutamate dangerous?

In excess, especially after head injury or stroke, it becomes toxic to neurons and can cause permanent damage.

What does acetylcholine regulate?

The sleep-wake cycle and muscle functioning; it can be excitatory or inhibitory

How is acetylcholine connected to Alzheimer disease?

Alzheimer disease involves fewer acetylcholine-secreting neurons, so medications may increase acetylcholine concentration.

What factors interact in mental illness?

Neurobiological, genetic, and environmental factors.

What can psychiatric pharmacogenomic testing help predict?

Which psychotropic medication may work and how severe its side effects may be based on the client’s genes.

What is psychoimmunology?

The study of how psychosocial stress affects the immune system and may influence mental illness

What is neuroplasticity?

The brain’s ability to change synaptic connections and form new pathways after stress, learning, injury, or medication.

What is the neuroplasticity sequence?

Chemical change → structural change → functional change.

Why can antidepressants take weeks to work?

The brain needs time for neuroplastic changes; improvement is not produced by one dose.

What are common benzodiazepines?

Alprazolam, chlordiazepoxide, diazepam, and lorazepam.

What is the benzodiazepine mechanism?

They bind to GABA receptors, causing chloride to enter the neuron and producing a strong inhibitory effect.

Why can benzodiazepines cause dependence?

They produce CNS inhibition and a dopamine reward effect in the limbic system with repeated use.

What is buspirone used for?

Chronic anxiety.

How does buspirone differ from benzodiazepines?

It acts on serotonin and dopamine, does not affect GABA, and takes a few weeks to work.

What are common buspirone effects?

Sedation, nausea, headache, and dizziness.

How do diazepam and lorazepam differ?

Diazepam has quick onset and a half-life up to 100 hr; lorazepam has moderately slow onset and a half-life up to 20 hr.

What are common benzodiazepine adverse effects?

Sedation, drowsiness, poor concentration, and impaired memory.

What is next-day sedation?

Sedation that continues for hours after a long-half-life benzodiazepine was given.

What is a paradoxical benzodiazepine response?

The opposite effect, such as increased agitation, hallucinations, or seizures.

What safety precaution may benzodiazepines require?

Fall precautions and assessment of the client’s ability to complete ADLs.

What reverses benzodiazepine toxicity?

Flumazenil

What is the major danger of flumazenil?

It may cause seizures, especially with a seizure history or TCA use.

What must be avoided with benzodiazepines?

Alcohol because benzodiazepines strengthen its CNS-depressant effect.

How should long-term benzodiazepines be stopped?

Slowly tapered, never abruptly discontinued.

What are the five main antidepressant groups?

MAOIs, TCAs, SSRIs, SNRIs, and neurosteroid antidepressants.

How do MAOIs such as phenelzine work?

They block monoamine oxidase so serotonin and dopamine remain available longer.

How do TCAs such as amitriptyline work?

They block serotonin and norepinephrine reuptake.

How do SSRIs such as fluoxetine work?

They selectively block serotonin reuptake.

How do SNRIs such as venlafaxine work?

They selectively block serotonin and norepinephrine reuptake.

How long can SSRIs take to work?

About 4–6 weeks.

How long can TCAs take to work?

About 2–4 weeks.

What major adverse effects occur with MAOIs?

Weight gain, daytime sedation, sexual dysfunction, and insomnia.

What adverse effects are common with TCAs?

Anticholinergic effects and orthostatic hypotension

What are anticholinergic effects?

Dry mouth, constipation, blurry vision, and urinary retention

What adverse effects are common with SSRIs?

Nausea, agitation, and sexual dysfunction.

What adverse effect is distinctive for SNRIs in the attachment?

ppetite suppression.

What must be monitored when starting or increasing any antidepressant?

Worsening depression, unusual behavior, and increased suicide risk.

Why should clients taking MAOIs avoid tyramine?

MAOIs prevent tyramine breakdown, creating a high risk of hypertensive crisis.

What high-tyramine foods are listed?

Aged cheese, cured or smoked meat, fermented sauces, dried or overripe fruit, red wine, beer, chocolate, avocado, tofu, raisins, prunes, and bananas.

What medications should not be combined with an MAOI?

TCAs and over-the-counter drugs containing ephedrine.

What is important about bupropion?

It carries a higher seizure risk.

What is zuranolone used for?

Postpartum depression; it is taken once daily for 14 days and may begin helping in about 3 days.

Why must antidepressants be tapered?

Abrupt stopping after more than a month can cause antidepressant discontinuation syndrome.

What are signs of antidepressant discontinuation syndrome?

Trouble sleeping, anxiety, depression, flu-like symptoms, and electric-shock-like sensations in the hea

What can happen if an MAOI is stopped abruptly?

Manifestations of psychosis.

How do first-generation antipsychotics work?

They strongly block dopamine receptors.

What are examples of first-generation antipsychotics?

Haloperidol, fluphenazine, loxapine, and chlorpromazine.

How do second-generation antipsychotics work?

They block dopamine less strongly and inhibit serotonin reuptake.

What are the major second-generation antipsychotic risks?

Metabolic effects: increased blood glucose, blood pressure, and cholesterol.

Which drugs are described as dopamine stabilizers?

Aripiprazole, brexpiprazole, and cariprazine.

What is a depot antipsychotic injection?

A long-term intramuscular maintenance medication.

What common antipsychotic effects can improve after a few weeks

Anticholinergic effects such as dry mouth, constipation, blurred vision, and orthostatic hypotension.

How can the nurse reduce antipsychotic-related dry mouth and constipation?

Offer water, hard candy, or sugarless gum and encourage fluids and fiber.

What teaching is needed for antipsychotic photosensitivity?

Wear sunscreen in direct sunlight.

What can increased prolactin cause?

Breast enlargement, decreased sex drive, menstrual irregularities, and weight gain.

What labs are important with second-generation antipsychotics?

Blood glucose and lipid levels.

What must be monitored with clozapine?

WBC and absolute neutrophil count because of agranulocytosis risk.

What are agranulocytosis warning signs

Flu-like symptoms, sore throat, fatigue, fever, and muscle aches.

When should the provider be contacted about WBC with clozapine?

Immediately when WBC is below 3,500/mm³.

What is neuroleptic malignant syndrome?

A dangerous antipsychotic reaction with fever, encephalopathy, unstable vital signs, elevated creatine kinase, and rigidity.

What is the NMS memory trick?

FEVER: Fever, Encephalopathy, Vital-sign instability, Elevated CK, Rigidity.

What is the first action for NMS?

Immediately stop the antipsychotic.

How is NMS treated in the attachment?

stop the drug, monitor fluids/electrolytes, cool the client, use cardiac monitoring, and give prescribed bromocriptine or dantrolene.

What are the four extrapyramidal symptoms?

Acute dystonia, akathisia, pseudoparkinsonism, and tardive dyskinesia.

What is acute dystonia?

sudden muscle rigidity or spasm, trouble opening the mouth, fixed gaze, or oculogyric crisis.

What is akathisia?

Severe restlessness that is not relieved by movement; it can lead to medication discontinuation or suicidal thoughts.

What is pseudoparkinsonism?

Slumped posture, shuffling gait, drooling, tremor, and pill-rolling movements.

What is tardive dyskinesia?

Permanent involuntary movements such as lip smacking, tongue thrusting, head tilting, or limb movements.

What are early lithium toxicity findings above 1.5 mEq/L?

Poor coordination, confusion, sedation, nausea, coarse tremor, vomiting, and diarrhea.

What causes lithium toxicity in the attachment?

Dehydration, overdose, and concurrent loop-diuretic use.

What does the nurse do for early lithium toxicity?

Withhold lithium and contact the provider.

What occurs at lithium levels of 2.0–2.5 mEq/L?

Seizures, stupor, very diluted urine, blurred vision, respiratory problems, tinnitus, and jerking movements

What occurs above lithium 2.5 mEq/L?

Coma, severe respiratory problems, rapid deterioration, and possible death; hemodialysis is needed.

What are common sedative-hypnotic medications?

Zolpidem, zaleplon, eszopiclone, and the melatonin agonist ramelteon.

What dangerous sedative-hypnotic effects require monitoring?

Sleep-driving or walking, amnesia, hallucinations, and suicidal thoughts.

What teaching is essential for sedative-hypnotics?

Do not drive after taking them, avoid alcohol/CNS depressants, and continue good sleep hygiene.

What are common CNS stimulants?

Methylphenidate, amphetamine, and dextroamphetamine.

What are stimulants used for?

ADHD and narcolepsy.

What must be monitored with stimulants?

Nausea, dry mouth, palpitations, irritability, appetite/weight loss, growth, and sleep.

What stimulant teaching concerns food and timing?

Avoid caffeine, support adequate intake, and do not take sustained-release medication after midday.

What can cause serotonin syndrome?

Too much serotonin from overdose, combined antidepressants, migraine/pain drugs, LSD/ecstasy, or St. John’s wort.

What are serotonin syndrome findings?

Restlessness, dilated pupils, tachycardia, high BP, muscle rigidity, sweating, and poor coordination

How is serotonin syndrome treated?

Stabilize vital signs, sedate with benzodiazepines, and give a serotonin antagonist such as cyproheptadine.

What is activation syndrome?

Early antidepressant effects of irritability, anxiety, impulsivity, aggression, agitation, and increased suicidal thoughts.

What behaviors may show a client has decided to complete a suicide plan?

Giving away valued belongings, saying goodbye, or requesting to write a living will.

How does chronic alcohol use change GABA and glutamate?

It decreases GABA function and increases glutamate function as an adaptation.