Mental Health Exam 4 Review

cognition

brain’s ability to process, retain, and use information

cognitive abilities

include reasoning, judgement, perception, attention, comprehension, and memory

cognitive disorder

a disruption or impairment in these higher-level functions of the brain

delirium

a syndrome that involves a disturbance of consciousness accompanied by a change in cognition.

\- usually develops over a short period, sometimes a matter of hours, and fluctuates, or changes, throughout the course of the day.

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Clients with delirium have difficulty paying attention, are easily distracted and disoriented, and may have sensory disturbances such as illusions,misinterpretations, or hallucinations.

physiological/metabolic delirium causes

Hypoxemia; electrolyte disturbances

\-renal or hepaticfailure

\- hypoglycemia or hyperglycemia

\-dehydration

\-sleep deprivation

\-thyroid or glucocorticoid disturbances

\-thiamine or vitamin B12 deficiency

\-vitamin C, niacin, or protein deficiency

\-cardiovascular shock

\-brain tumor

\-head injury; and exposure to gasoline, paint solvents, insecticides, and related substances

infection causes of delirium

Systemic: Sepsis, urinary tract infection, pneumonia; Cerebral: Meningitis, encephalitis, HIV, syphilis

drug related delirium causes

Intoxication: Anticholinergics, lithium, alcohol, sedatives, and hypnotics

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Withdrawal: Alcohol, sedatives, and hypnotics

Reactions to anesthesia, prescription medication, or illicit (street) drugs

Delirium treatment

To identify and treat and casual or contributing medical conditions

delirium medications

\-Heloperidol (Haldol) 0.5 -1 mg to decrease agitation

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\-Ativan: for treatment of sedative-hypnotic withdrawal

drugs that cause delirium

Anesthesia

\-Anticonvulsants

\-Anticholinergics

\-Antidepressants

\-Antihistamines

\-Antihypertensives,

\-Antineoplastics

\-Antipsychotics

\-Aspirin

\-Barbiturates

\-Benzodiazepines

\-Cardiac glycosides

Cimetidine (Tagamet)

Hypoglycemic agents

Insulin

Narcotics,

Propranolol (Inderal)

Reserpine, Steroids

Thiazide diuretics

dementia

a disease process marked by progressive cognitive impairment with no change in the level of consciousness. It involves multiple cognitive deficits, initially, memory impairment, and later, the following cognitive disturbances may be seen: aphasia, apraxia, agnosia, distrubance in executive functioning

aphasia

deterioration of language function

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usually begins with the inability to name familiar objects or people andthen progresses to speech that becomes vague or empty with excessive use of terms such as it or thing.

apraxia

impaired ability to execute motor functions despite intact motor abilities

agnosia

inability to recognize or name objects despite intact sensory abilities

disturbance in executive functioning

the ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior

memory impairment

the prominent early sign of dementia

echolalia

echoing what is heard

palilalia

repeating words or sounds over and over

mild dementia

Forgetfulness is the hallmark

\-It exceeds the normal, occasional forgetfulness experienced as part of the aging process. The person has difficulty finding words, frequently loses objects, and begins to experience anxiety about these losses.

Occupational and social settings are less enjoyable, and the person may avoid them.

\-Most people remain in the community during this stage

moderate dementia

\-confusion is apparent, along with progressive memory loss.

The person no longer can perform complex tasks but remains oriented to person and place.

\-He or she still recognizes familiar people.

Toward the end of this stage, the person loses the ability to live independently and requires assistance because of disorientation to time and loss of information, such as address and telephone number.

The person may remain in the community if adequate caregiver support is available, but some people move to supervised living situations

severe dementia

Personality and emotional changes occur. The person may be delusional, wander at night, forget the names of his or her spouse and children, and require assistance with ADLs.

\-Most people live in nursing facilities when they reach this stage, unless extraordinary community support is available

alzheimer disease

a progressive brain disorder that has a gradual onset but causes an increasing decline in functioning, including loss of speech, loss of motor function, and profound personality and behavioral changes such as paranoia, delusions, hallucinations, inattention to hygiene, and belligerence

lewy body dementia

is a disorder that involves progressive cognitive impairment and extensive neuropsychiatric symptoms as well as motor symptoms.

Delusions and visual hallucinations are common.

Functional impairments may initially be more pronounced than cognitive deficits.

Several risk genes have been identified, and it can occur in families, though that is less common than no family history

vascular dementia

has symptoms similar to those of Alzheimer disease, but onset is typically abrupt, followed by rapid changes in functioning

\- a plateau, or leveling-off period; more abrupt changes; another leveling-off period; and so on. Computed tomography or magnetic resonance imaging usually shows multiple vascular lesions of the cerebral cortex and subcortical structures resulting from the decreased blood supply to the brain

frontotemporal lobar degeneration

originally called Pick disease) is a degenerative brain disease that particularly affects the frontal and temporal lobes and results in a clinical picture similar to that of Alzheimer disease.

Early signs include personality changes, loss of social skills and inhibitions, emotional blunting, and language abnormalities.

Onset is most commonly 50 to 60 years of age; death occurs in 2 to 5 years. There is a strong genetic component, and it tends to run in families.

prion disease

are caused by a prion (a type of protein) that can trigger normal proteins in the brain to fold abnormally.

They are rare, and only 300 cases per year occur in the United States.

Creutzfeldt–Jakob disease is the most common prion disease affecting humans. It is a CNS disorder that typically develops in adults aged 40 to 60 years. It involves altered vision, loss of coordination or abnormal movements, and dementia that usually progresses rapidly (a few months).

parkinson disease

is a slowly progressive neurologic condition characterized by tremor, rigidity, bradykinesia, and postural instability.

It results from loss of neurons of the basal ganglia.

Dementia has been reported in approximately 25%(mild NCD) to as many as 75% (major NCD) of people with Parkinson disease and is characterized by cognitive and motor slowing, impaired memory, and impaired executive functioning

huntington disease

is an inherited, dominant gene disease that primarily involves cerebral atrophy, demyelination, and enlargement of the brain ventricles.

Initially, there are choreiform movements that are continuous during waking hours and involve facial contortions, twisting, turning, and tongue movements.

Personality changes are the initial psychosocial manifestations followed by memory loss, decreased intellectual functioning, and other signs of dementia.

The disease begins in the late 30s or early 40s and may last 10 to 20 years or more before death.

tacrine

(Cognex) is also a cholinesterase inhibitor; however, it elevates liverenzymes in about 50% of clients using it. Lab tests to assess liver function are necessary every 1 to 2 weeks; therefore, tacrine is rarely prescribed

memantine

(Namenda) is an NMDA receptor antagonist that can slow the progression of Alzheimer in the moderate or severe stages.

namzaric

(memantine and donepezil) is a newer combination of two othermedications, thereby having the actions of both cholinesterase inhibition and NMDA receptor antagonist.

lithium carbonate, carbamazepine and valproic acid

help stabilize affective lability and diminish aggressive outbursts.

benzodiazepines

are used cautiously because they may cause delirium and can worsen already compromised cognitive abilities.

pimavanserine

(Nuplazid) has been specifically FDA approved to treat delusions and hallucinations that some experience with Parkinson disease.

One 34-mg capsule per day is the recommended dose. It is known to prolong the Q-T interval.

Both conventional and atypical antipsychotics are associated with an increased risk of mortality in elderly patients treated for dementia-related psychosis

folate, vitamin B12 and betaine

are known to reduce plasmahomocysteine levels, potential therapeutic strategies using these substances may modify or diminish the risk for dementia.

personality

an ingrained, enduring pattern of behaving and relating to the self, others, and the environment; it includes perceptions, attitudes, and emotions.

personality disorders

are diagnosed when there is impairment of personality functioning and personality traits that are maladaptive.

schizoid personality disorder

is characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings.

It may affect 5% of the general population and is more common in males than females.

People with schizoid personality disorder avoid treatment as much as they avoid other relationships, unless their life circumstances change significantly.

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Clients with schizoid personality disorder display a constricted affect and little, if any, emotion. They are aloof and indifferent, appearing emotionally cold, uncaring, or unfeeling. They report no leisure or pleasurable activities because they rarely experience enjoyment. Even under stress or adverse circumstances, their response appears passive and disinterested. There is marked difficulty experiencing and expressing emotions, particularly anger or aggression

schizotypical personality disorder

is characterized by a pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and behavioral eccentricities. Incidence is about 3% of the population

\-the disorder is slightly more common in men than in women. Clients may experience transient psychotic episodes in response to extreme stress. Persons with schizotypical personality disorder may develop schizophrenia.

cluster a personality disorders

odd or eccentric behaviors

\-paranoid personality disorder

\-schizoid personality disorder

\-schizotypal personality disorder

cluster b personality disorders

erratic or dramatic behaviors

\-antisocial personality disorder

\-borderline personality disorder

\-histrionic personality disorder

\-narcissistic personality disorder

cluster c personality disorder

anxious or fearful behaviors

\-avoidant personality disorder

\-dependent personality disorder

\-obsessive personality disorder

depressive behavior

is characterized by a pervasive pattern of depressive cognitions and behaviors in various contexts.

It occurs more often in people with relatives who have major depressive disorders. People with depressive personality disorders often seek treatment for their distress

passive aggressive behaviors

is characterized by a negative attitude and a pervasive pattern of passive resistance to demands for adequate social and occupational performance.

These clients may appear cooperative, even ingratiating, or sullen and withdrawn, depending on the circumstances.

Their mood may fluctuate rapidly and erratically, and they may be easily upset or offended.

4 temperament traits

\-harm avoidance

\-novelty seeking

\-reward dependence

\-persistence

high harm avoidance

people exhibit fear of uncertainty, social inhibition, shyness with strangers, rapid fatigability and pessimistic worry in anticipation of problems

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\-these behaviors may result in maladaptive inhibition and excessive anxiety

low harm avoidance

people are carefree, energetic, outgoing and optimistic

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\-behaviors may result in unwarranted optimism and unresponsiveness to potential harm or danger

high novelty seeking temperament

results in someone who is quick-tempered, curious, easily bored, impulsive, extravagant, and disorderly.

He or she may be easily bored and distracted with daily life, prone to angry outbursts, and fickle in relationships.

low novelty seeking

is slow-tempered, stoic,reflective, frugal, reserved, orderly, and tolerant of monotony; he or she may adhere to a routine of activities.

reward dependence

defines how a person responds to social cues.

high reward dependence

are tenderhearted, sensitive, sociable, and socially dependent.

They may become overly dependent on approval from others and readily assume the ideas or wishes of others without regard for their own beliefs or desires.

low reward dependence

are practical, tough-minded, cold,socially insensitive, irresolute, and indifferent to being alone.

Social withdrawal, detachment, aloofness, and disinterest in others can result

self directedness

is the extent to which a person is responsible, reliable, resourceful, goal-oriented, and self-confident.

Self-directed people are realistic and effective and can adapt their behavior to achieve goals.

\-People low in self-directedness are blaming, helpless, irresponsible, and unreliable. They cannot set and pursue meaningful goals.

cooperativeness

refers to the extent to which a person sees him or herself as an integral part of human society.

Highly cooperative people are described as empathic, tolerant, compassionate, supportive, and principled.

People with low cooperativeness are self-absorbed, intolerant, critical, unhelpful, revengeful, and opportunistic; that is, they look out for themselves without regard for the rights and feelings of others

self transcendence

describes the extent to which a person considers him or herself to be an integral part of the universe.

\-Self-transcendent people are spiritual, unpretentious, humble, and fulfilled. These traits are helpful when dealing with suffering, illness, or death.

\-People low in self-transcendence are practical, self-conscious, materialistic, and controlling. They may have difficulty accepting suffering, loss of control, personal and material losses, and death

cognitive perceptual disturbances

include magical thinking, odd beliefs,illusions, suspiciousness, ideas of reference, and low-grade psychotic symptoms.

These chronic symptoms usually respond to low-dose antipsychotic medications.

paranoid personality disorder

is characterized by pervasive mistrust and suspiciousness of others. Clients with this disorder interpret others’ actions as potentially harmful. During periods of stress, they may develop transient psychotic symptoms

antisocial personality disorder

is characterized by a pervasive pattern of disregard for and violation of the rights of others—and by the central characteristics of deceit and manipulation.

borderline personality disorder

is characterized by a pervasive pattern of unstable interpersonal relationships, self-image, and affect as well as marked impulsivity

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Is the most common personality disorder found in clinical settings. It is three times more common in women than in men. Under stress, transient psychotic symptoms are common

autism spectrum disorder

includes disorders previously categorized as different types of a pervasive developmental disorder (PDD), characterized by pervasive and usually severe impairment of reciprocal social interaction skills, communication deviance, and restricted stereotypical behavioral patterns

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\-almost 5x more prevalent in boys than girls

\-usually identified by 18 months and no later than 3 years of age

autism treatment

goal is to reduce behavioral symptoms and to promote learning and development, particularly in the acquisition of language skills

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\-SPED, CBT and language therapy

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Pharmacologic treatment with antipsychotics, such as haloperidol (Haldol), risperidone (Risperdal), aripiprazole (Abilify), or combinations of antipsychotic medications, may be effective for specific target symptoms such as temper tantrums, aggressiveness, self-injury, hyperactivity, and stereotyped behaviors.

Other medications, such as naltrexone (ReVia), clomipramine (Anafranil),clonidine (Catapres), and stimulants to diminish self-injury and hyperactive and obsessive behaviors, have had varied but unremarkable results. There are no medications approved for the treatment of ASD itself.

tic disorders

a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization

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\-stress exacerbated, diminish during sleep and when the person is engaged in an absorbing activity

tic treatment

usually treated with risperidone (Risperdal) or olanzapine (Zyprexa), which are atypical antipsychotics

tourette disorder

involves multiple motor tics and one or more vocal tics, which occur many times a day for more than 1 year. The complexity and severity of the tics change over time, and the person experiences almost all the possible tics described previously during his or her lifetime.

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The person has significant impairment in academic, social, or occupational areas and feels ashamed and self-conscious. This rare disorder (4 or 5 in 10,000) is more common in boys and is usually identified by 7 years of age. Some people have lifelong problems; others have no symptoms after early adulthood

chronic motor or vocal tic

differs from Tourette disorder in that either the motor or the vocal tic is seen, but not both.

transient tic disorder

may involve single or multiple vocal or motor tics, but the occurrences last no longer than 12 months.

developmental coordination disorder

essential feature is impaired coordination severe enough to interfere with academic achievement or activities of daily living.

\-This diagnosis is not made if the problem with motor coordination is part of a general medical condition, such as cerebral palsy or muscular dystrophy.

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\-often coexists with a communication disorder

sterotypic movement disorder

\-Is characterized by rhythmic, repetitive behaviors, such as hand waving, rocking, head banging, and biting, that appears to have no purpose. Self-inflicted injuries are common, and the pain is not a deterrent to the behavior.

Onset is prior to age 3 years and usually persists into adolescence. It is more common in individuals with intellectual disability.

\-Comorbid disorders, such as anxiety, ADHD, OCD, and tics/Tourette syndrome, are common and often cause more functional impairment than the stereotypic behavior

communication disorder

\-Involves deficits in language, speech, and communication and is diagnosed when deficits are sufficient to hinder development, academic achievement, or activities of daily living, including socialization

language disorder

involves deficit(s) in language production or comprehension,causing limited vocabulary and an inability to form sentences or have a conversation

speech sound disorder

is difficulty or inability to produce intelligible speech, which precludes effective verbal communication

stuttering

is a disturbance of fluency and patterning of speech with sound and syllable repetitions

social communication disorder

involves the inability to observe social “rules” of conversation, deficits in applying context to conversation, inability to tell a story in an understandable manner, and inability to take turns talking and listening with another.

encopresis

is the repeated passage of feces into inappropriate places such as clothing or the floor by a child who is at least 4 years of age either chronologically or developmentally. It is often involuntary, but it can be intentional.

involuntary encopresis

is usually associated with constipation that occurs for psychological, not medical, reasons.

intentional encopresis

is often associated with oppositional defiant disorder (ODD) or conduct disorder

enuresis

is the repeated voiding of urine during the day or at night into clothing or bed by a child at least 5 years of age either chronologically or developmentally.

enuresis treatment

imipramine (Tofranil), an antidepressant with a side effect of urinary retention.

sluggish congitive tempo

is a syndrome that is not a DSM-5 diagnosis. It includes daydreaming, trouble focusing and paying attention, mental fogginess, staring, sleepiness, little interest in physical activity, and slowness in finishing tasks.

adhd

is characterized by inattentiveness, overactivity, and impulsiveness.

adhd treatment

methylphenidate (Ritalin) and an amphetamine compound (Adderall)

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Dextroamphetamine (Dexedrine) and pemoline (Cylert) are other stimulants used to treat ADHD. The most common side effects of these drugs are insomnia, loss of appetite, and weight loss or failure to gain weight

atomoxetine

(Strattera) is the only nonstimulant drug specifically developed and tested by the U.S. Food and Drug Administration for the treatment of ADHD.

It is an antidepressant, specifically a selective norepinephrine reuptake inhibitor.

The most common side effects in children during clinical trials were decreased appetite, nausea, vomiting, tiredness, and upset stomach.

In adults, side effects were similar to those of other antidepressants, including insomnia, dry mouth, urinary retention, decreased appetite, nausea, vomiting, dizziness, and sexual side effects.

In addition, atomoxetine can cause liver damage, so individuals taking the drug need to have liver function tests periodically

oppositional defiant disorder

consists of an enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures without major antisocial violations

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The disruptive, defiant behaviors usually begin at home with parents or parental figures and are more intense in this setting than settings outside the home

intermittent explosive disorder

Involves repeated episodes of impulsive, aggressive, violent behavior, and angry verbal outbursts, usually lasting less than 30 minutes.

During these episodes, there may be physical injury to others, destruction of property, and injury to the individual as well. The intensity of the emotional outburst is grossly out of proportion to the stressor or situation.

In other words, a minor issue or occurrence may result in rage, aggression, and assault of others.

The episode may occur with seemingly no warning. Afterward, the individual may be embarrassed and feel guilty or remorseful for his or her actions. But that does not prevent future impulsive, aggressive outbursts.

IED treatment

medications, such as fluoxetine (Prozac); lithium; and anticonvulsant mood stabilizers such as valproic acid (Depakote), phenytoin (Dilantin), topiramate (Topamax), and oxcarbazepine (Trileptal).

Selective serotonin reuptake inhibitor antidepressants particularly seem to reduce aggressive tendencies because serotonin deficiencies are often linked to causation

conduct disorder

Is characterized by persistent behavior that violates societalnorms, rules, laws, and the rights of others.

\-These children and adolescents have significantly impaired abilities to function in social, academic, or occupational areas.

\-Symptoms are clustered in four areas: aggression to people and animals, destruction of property, deceitfulness and theft, and serious violation of rules

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\-Frequently associated with early onset of sexual behavior, drinking, smoking, use of illegal substances, and other reckless or risky behaviors.

mild conduct disorder

The child has some conduct problems that cause relatively minor harm to others. Examples include repeated lying, truancy, minor shoplifting, and staying out late without permission

moderate conduct disorder

The number of conduct problems increases as does the amount of harm to others.

\-Examples include vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity

severe conduct disorder

The person has many conduct problems that cause considerable harm to others.

Examples include forced sex, cruelty to animals, physical fights, cruelty to peers, use of a weapon, burglary, robbery, and violation of previous parole or probation requirements

kleptomania

Is characterized by impulsive, repetitive theft of items not needed by the person, either for personal use or monetary gain.

Tension and anxiety are high prior to the theft, and the person feels relief, exhilaration, or gratification while committing the theft. The item is often discarded after it is stolen.

-Is more common in females and often has negative legal, career, family, and social consequences

pyromania

Is characterized by repeated, intentional fire-setting. The person is fascinated about fire and feels pleasure or relief of tension while setting and watching the fires.

There is neither any monetary gain or revenge or other reason, such as concealing other crimes, nor is it associated with another major mental disorder. Pyromania as a primary disorder is rare. Persons, if caught, become part of the legal rather than mental health system.

psychological abuse

\-AKA emotional abuse

\-Includes name calling, belittling, screaming, yelling, destroying property and making threats as well as subtler forms, such as refusing to speak or ignoring the victim

korkasoff syndrome

long term use of alcohol that results in dementia

alcohol intoxication

slurred speech, unsteady gait, lack of coordination, and impaired attention, memory judgement

alcohol overdose

vomiting, unconsciousness, respiratory depression

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treatment: gastric lavage or dialysis to remove the drug and support of resp/cardio functioning in an ICU

alcohol withdrawal

onset within 4-12 hours

usually peaks on the second day

complete in about 5 days

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symptoms: coarse hand tremors, sweating, elevated pulse/BP, insomnia, anxiety

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\-benzodiazepines used for safe withdrawal

stimulant intoxication and overdose

\-high or euphoric feeling, hyperactivity, hypervigilance, anger, elevated blood pressure, chest pain, confusion

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\-seizures, coma with overdose

stimulant withdrawal

onset within hours to several days

\-primary symptom is marked dysphoria, “crashing”

\-not treated pharmacologically

opioid withdrawal

\-nausea, vomiting, diarrhea, sweating, yawning, fever, insomnia, dysphoria, lacrimation, rhinorrhea

\-short acting drugs (ex: heroin) onset in 6-24 hours;peaking in 2-3 days and gradually subsiding in 5-7 days

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\-longer acting drugs (Ex: methaodone) onset in 2-4 days;subsiding in 2 weeks

tension building phase

tension builds over common domestic issues like money, children, or jobs.

Victim tries to control situation by pleasing the abuser, giving in or avoiding abuse. None stop abuse