Psych Exam 2

Step 1 of Synaptic Transmission

The presynaptic neuron releases a chemical neurotransmitter into the synaptic cleft.

Step 2 of Synaptic Transmission

The neurotransmitter crosses the gap and binds to specific receptors on the postsynaptic neuron.

Step 3 of Synaptic Transmission

After the message is delivered, the neurotransmitter doesn't just hang around forever. It must be removed from the synapse. This can happen in three ways: reuptake, enzyme breakdown, or diffusion

Step 4 Synaptic Transmission

Feedback Regulation - Some neurotransmitters bind to receptors on the original neuron - like a thermostat

Reuptake

Neurotransmitter goes back into the original neuron to be reused later. (Many antidepressants work by blocking this step.)

Enzyme Breakdown

One process by which neurotransmitters are inactivated. Chemicals called enzymes interact with the transmitter molecule and change its structure so that it no longer is capable of occupying receptor sites

Diffusion of Neurotransmitter

It drifts away from the synapse.

This step is important because too much neurotransmitter activity can cause problems — and too little can also cause problems.

Function of Autoreceptors in Synapses

They act as a thermostat to regulate and adjust neurotransmitter release based on feedback.

Role of Norepinephrine

An excitatory neurotransmitter responsible for learning, sleep, mood, memory, and attention.

Role of Serotonin

An inhibitory neurotransmitter regulating emotion, sexual behavior, body temperature, sleep, and pain.

Role of Dopamine

An excitatory neurotransmitter involved in emotional responses, pleasure, complex movement, and cognition.

Role of Histamine

Regulates the release of histamine, glutamate, serotonin, and GABA

Benzodiazepine Reversal Agent

Flumazenil is used to reverse the sedative effects of _________ overdose.

Key Patient Teaching for Benzodiazepines

Taper off slowly; **avoid alcohol**, opioids, and driving; watch for fall risks and addiction, its the most prescribed anxiolytic

Benzodiazepine Role

treat anxiety (number ONE prescribed medication for anxiety)

Common Side Effects of Lithium

Diarrhea, nausea, increased thirst, fine hand tremors, and weight gain.

Monitoring Requirements for Lithium

Serum blood levels every 1-2 weeks and regular kidney and liver function tests.

Lithium Role

Treat Bipolar Disorders (mood regulation)

Mechanism of Anticonvulsants in Mood Regulation (bipolar disorder)

Inhibits the kindling process to prevent cascading neural activity associated with mania.

Onset Time for SSRI Efficacy

Typically takes 4 to 6 weeks to show full therapeutic effectiveness.

SSRI Herb Interaction Warning

Combining SSRIs (e.g., fluoxetine) with St. John's Wort increases the risk of Serotonin Syndrome.

SSRI Role

Antidepressant, anti-anxiety, and treats some symptoms of bipolar disorder

MAOI Dietary Restriction

Avoid tyramine-rich foods (aged cheeses, cured meats, soy sauce) to prevent hypertensive crisis.

St Johns Wart

antidepressant herbal supplement

education: do NOT take with tricyclic, MAOI, SSRI/SNRI

-> increase side effects and lead to serotonin syndrome

CNS Stimulant Administration Timing

Enteric-coated formulas should not be taken after midday to avoid sleep disruption.

CNS Stimulant Role

Treat ADHD & Narcolepsy

What to avoid when taking a central nervous system stimulant?

Caffeine

Major Risk Associated with Clozapine

Agranulocytosis; requires baseline WBC count and ongoing weekly blood monitoring.

Adverse Effects of FGA

- anticholinergic

- enlargement of breast tissue

- decreased sex drive

- menstrual irregularities

- weight gain

Important education when patient is taking a FGA

To continue it, if do not like side effects able to discuss dosage/other meds with the doctor

Metabolic Adverse Effects of Second-Generation Antipsychotics (SGAs)

Increased blood glucose, elevated blood pressure, and hypercholesterolemia.

Antipsychotic's (typical & atypical) Role

Schizophrenia Treatment

Clinical Manifestations of Serotonin Syndrome

Restlessness, diaphoresis, dilated pupils, tachycardia, muscle rigidity, and hyperreflexia.

Emergency Treatment for Serotonin Syndrome

Stabilize vital signs, administer benzodiazepines for sedation, and give serotonin antagonist meds like cyproheptadine.

MOA of SSRI

inhibit reuptake of serotonin

Anxiolytic Meds

Alprazolam

Chlordiazepoxide

Diazepam

Lorazepam

SSRI Meds

Fluoxetine

Sertraline

Escitalopram

Citalopram

Central Nervous System Meds

Methylphenidate

Dextroamphetamine

Amphetamine

Specific Alprazolam Teaching

Faster onset

Foods high in tyramine

- strong/aged cheese

- cured & processed meats

- sauces like teriyaki, fish, shrimp, soy

- dried/overripened fruits

- fermented foods such as beer

- wine

- soy containing products such as tofu

What happens if you mix MAOI with tyramine high foods?

hypertensive crisis

Manifestations of Early Lithium Toxicity (>1.5 mEq/L)

Coarse hand tremors, persistent GI upset (vomiting/diarrhea), sedation, and confusion.

Interventions of Early Lithium Toxicity (>1.5 mEq/L)

The nurse should withhold lithium treatment and consult with the health care provider

Manifestations of Advanced Lithium Toxicity (2.0-2.5 mEg/L)

Psychological manifestations of seizures and stupor.

(extremely diluted urine, blurred vision, respiratory complications, tinnitus, and jerking motor movements)

The rate of kidney excretion may have to be increased through the administration of urea or mannitol.

Interventions of Advanced Lithium Toxicity (2.0-2.5 mEg/L)

In the case of an intentional lithium overdose, consult with the health care provider to consider gastric lavage.

Interventions for Severe Lithium Toxicity (>2.5 mEq/L)

Immediately consult the healthcare provider to initiate hemodialysis.

Manifestations for Severe Lithium Toxicity (>2.5 mEq/L)

Rapidly deteriorate with the advent of a comatose state.

Risk of severe respiratory complications, leading to death

Antidepressant Discontinuation Syndrome (ADDS)

Clinical manifestations that may occur with sudden discontinuation of the antidepressant medication which the client has been taking. Educate on importance of talking to healthcare provider before ending & tapering meds

Antidepressant Discontinuation Syndrome (ADDS) Manifestations

Flu-like symptoms, insomnia, anxiety, and electric-shock-like head sensations after abrupt cessation.

Activation Syndrome Risk

Early antidepressant treatment can cause impulsivity and agitation, increasing suicidal ideation risk.

Neuroleptic Malignant Syndrome (NMS) Features

Life-threatening hyperthermia, muscle rigidity, altered mental status, and autonomic instability.

Pharmacological Treatment for NMS

Discontinue antipsychotic; administer dantrolene (muscle relaxant) or bromocriptine (dopamine agonist).

Acute Dystonia Definition & Treatment

Severe muscle spasms/rigidity (e.g., oculogyric crisis); treated with IM benztropine or diphenhydramine - caused by blocking dopamine in the midbrain to the brainstem

Akathisia Definition

Subjective feeling of intense motor restlessness not relieved by movement - caused by blocking dopamine in the midbrain to the brainstem

Tardive Dyskinesia Manifestations & Assessment

Involuntary lip-smacking, tongue thrusting, and grimacing; monitored using the AIMS scale - caused by blocking dopamine in the midbrain to the brainstem

Pseudoparksinson

Mimic Parkinson manifestations (shuffling gait, slumped posture, drooling, tremors, pill-rolling) - caused by blocking dopamine in the midbrain to the brainstem

Agranulocytosis

A life-threatening drop in white blood cells. This condition is sometimes produced by the atypical antipsychotic drug clozapine.

Opiate Withdrawal Symptoms

Severe muscle aches, piloerection (goosebumps/gooseflesh), diaphoresis, nausea, vomiting, and diarrhea.

The need for detoxification protocol while providing care in an interprofessional team

provide a standardized, evidence-based framework that allows an interprofessional healthcare team to safely and efficiently manage acute withdrawal symptoms. This collaborative approach minimizes clinical errors, reduces adverse events, and seamlessly bridges the gap between acute stabilization and long-term substance use disorder (SUD) recovery

Purpose of the Mental Health Continuum

Demonstrates that mental health fluctuates from well-being to illness, reducing societal stigma.

Excelling Zone on the Mental Health Continuum

peak well-being, characterized by cheerful, energetic, high-performance flow, and fully realizing potential

Thriving Zone on the Mental Health Continuum

Individual has a satisfactory level of mental well-being and is able to function without difficulty on a daily basis --> Positive, Calm, Preforming, Sleeping well, Eating Healthily, Satisfying Social Activities

Surviving Zone on the Mental Health Continuum

Characterized by an unsettled state, worry, irritability, trouble sleeping, and distraction.

Struggling Zone on the Mental Health Continuum

Signifies trouble in mental health. The individual may experience anxiety and depression, poor concentration, low energy, and struggles with work --> Anxious, Depression, Tired, Poor performance, Poor sleep , Poor appetite

What does the Crisis Zone on the Mental Health Continuum indicate?

It indicates when a person is in a state of emergency with their mental health and requires immediate help.

What are common experiences of clients in the Crisis Zone?

Clients often experience suicidal ideation, severe anxiety, and depression-- exhaustion, very poor sleep weight gain

What is a sign of social isolation in the Crisis Zone?

Absenteeism.

Crisis Stabilization Beds

Are for clients in a mental health emergency who receive treatment and monitoring of their health care needs; these beds are not located in a hospital setting. Those who require a long-term care facility typically remain there indefinitely. A stay in this setting is brief, lasting overnight or a few weeks

State Hospital Facilities

Are for clients who have a mental illness and who meet the state criteria for commitment to an inpatient facility. Often requires court-ordered hospitalization and they have no alternative setting where proper care is received, the client will remain in the state hospital

Transitional/Respite Care

Requires continuous nonmedical monitoring or support after discharge from a hospital. A stay in a transitional or respite facility is typically short, an average of two to four weeks

Long-term Facilities

Are for those clients with chronic mental health conditions who are unable to live independently in the community. Those who require a long-term care facility typically remain there indefinitely

Substance use disorder treatment centers

detoxification facilities and acute residential treatment programs

Military Veteran Care

Veterans Administration (VA) care is provided through a government health program for veterans of the military and their family members. Specific symptoms of mental illness that affect service people and their families, such as posttraumatic stress disorder and military sexual trauma, are addressed

Pediatric and Adolescent Care

are specifically designed for children or teens may be part of an inpatient hospital care unit or a separate facility dedicated to a certain client age range. Specially trained health care professionals work with clients, such as pediatric primary care mental health specialists (PMHS)

Geriatric Care

is targeted at older adults and their unique mental health needs. This can range from specialist geriatric health care providers to programs in long-term care facilities.

Forensic Care

is a type of specialty mental health care for clients convicted of a criminal offense. It is a balance between public safety and comprehensive mental health care. It aims to rehabilitate clients and decriminalize mental health disorders. May be found in jails or prison, homeless shelters, halfway houses with the aim to assist clients to integrate back into the community

Case management

helps the client to coordinate their mental health treatment, such as medications, appointments, or arrange transportation

Assertive Community Treatment (ACT)

Delivers inpatient-level psychiatric care directly into the client's home and community setting.

Telehealth

uses virtual technology such as a computer or smartphone with a camera for health care professionals to meet with clients

Mobile Mental Health Crisis Teams

specially trained mental health professionals who provide emergency psychiatric care onsite at the client's location

Day Treatment

provides mental health care and nonclinical support, such as job training

Primary Mental Health Prevention Example

Teaching parenting skills to expectant parents or offering stress-awareness education in schools, substance use prevention programs

Secondary Mental Health Prevention Example

Conducting mental health self-check screenings or early counseling interventions, resources for teens

Tertiary Mental Health Prevention Example

Medication management groups, life skills training, and home health follow-up visits.

Primary Preventions

focuses on the prevention of a mental illness by focusing on both the individual client and their environment

Secondary Prevention

involves minimizing the early symptoms of a mental illness. Early intervention may mitigate the impact of a mental health disorder

Tertiary Prevention

concentrates on reducing any long-term or debilitating effects of severe and chronic mental illness

Social Determinants of Mental Health (SDoMH)

- Economic stability

- Education (and quality)

- Healthcare access (and quality)

- Neighborhoods and built environment

- social & community context

Other factors affecting access to healthcare

- economic factors

- accessibility

- availability of treatment

Risk Factors to Abuse

History of violence

History of mental health disorder including substance use

Being the victim of a crime

Witnessing abuse or violence

Poor self-esteem and inadequate coping skills

No presence of positive role models throughout childhood

Adverse childhood experiences

Etiology of Abuse

Genetic (MAO gene deficit, X linked recessive)

Social determinants

Medical conditions (Damage to the brain's prefrontal cortex, limbic system, and amygdala, Alzheimer's, Addictive personalities)

Physical Abuse

Perpetrators of physical abuse may use force, including kicking, hitting, slapping, pushing, strangling, or biting to control how others behave and think

Signs of Physical Abuse

General appearance: Ripped or torn clothing, broken eyewear, disheveled hair and clothing

Body: Bruising, lacerations, burn marks, fractured bones, puncture wounds, wounds in various stages of healing

Emotional Abuse

The person responsible for abusing others may use threats, insults, and

intimidation to exert control

Emotional Abuse Signs

Changes in usual behavior, such as social withdrawal or non-responsive communication

Loss of self-esteem

Anxiety provoked by the presence of certain people

Claims of enduring verbal or mental mistreatment

Sexual Abuse

Any forced, inappropriate, or unwanted sexual contact.

What are some examples of sexual abuse?

Includes photographs that are sexually explicit, indecent exposure, unwanted touching, rape, forcing individuals to engage in sexual acts, or coerced nudity.

How has digital media affected sexual abuse?

Digital media and online resources have simplified the grooming, luring, and exposure of children and adolescents to unwanted sexually explicit content.

Signs of Sexual Abuse

Sudden changes in behavior such as fear of people or places

Sexually explicit behavior or sex play

Regression to younger behaviors such as bedwetting

Developmentally inappropriate interest in human sexuality

Discomfort, bruising or bleeding around the breasts, anus, or genital area

Underclothing that is damaged or contains blood stains

Unexplained or recurring sexually transmitted infections (STIs)

Neglect & Abandonment

The refusal or failure of an individual to fulfill any part of his or her duties or obligations to an older person with necessities such as food, shelter, personal safety,clothing and medicine, and needed care.