Rasmussen: Mental Health Exam 2 Study Guide with complete solutions.

What are the common symptoms of Depression? 1. Anergia - lack of energy 2. Feelings of worthlessness 3. Lack of self-esteem 4. Guilt 5. Helplessness 6. Hopelessness 7. Anger and irritability 8. Changes in eating patterns 9. Changes in sleep patterns 10. Insomnia or hypersomnia 11. Changes in bowel habits (constipation) 12. No interest in sex 13. Chronic pain 14. Lack of concentration 15. Indecisiveness Beck's Cognitive Triad (p. 199) Beck believed that three automatic negative thoughts (cognitive triad) is responsible for the development of depression. What are the three negative thoughts of Beck's Cognitive Triad? 1. A negative, self-deprecating view of self: "I really never do anything well; everyone else seems smarter." 2. A pessimistic view of the world: "Once you're down, you can't get up. Look around, poverty, homelessness, sickness, war, and despair are every place you look." 3. The belief that negative reinforcement (or no validation for the self) will continue: "It doesn't matter what you do; nothing ever gets better. I'll be in this stupid job the rest of my life." What questions should you ask to assess for the risk of suicide? 1. Ask directly - "Are you thinking of, or have you been thinking of killing yourself?" 2. Ask if the person has a plan - "When you think about suicide, do you have a way that you might do this?" 3. Determine the lethality of the plan (How detailed is the plan? How lethal is the proposed method? Does the person have a gun?) 4. Gather information about risk factors (patient's age, sex, medical problems, psychiatric problems, unemployment, lives alone) 5. Is there is a history of a suicide attempt? 6. Consult with one or more professionals and collaboratively develop a safety plan 7. If outpatient, assess the following - Is there someone that can stay with the patient? Does the significant other have knowledge of the signs of potential suicidal ideation? Is there a provision of safety resources? High level of risk Risks/ Protective factor: - Psychiatric disorder with severe symptoms of acute precipitating event protective factors not relevant Suicidality: - Potentially lethal suicide attempt or persistent ideation with strong intent or suicide rehearsal Possible Interventions: - Admission generally indicated unless a significant change reduces risk. Suicide precautions Moderate risk level for suicide Risks/ Protective factor: - Multiple risk factors, few protective factors Suicidality: - Suicidal ideation with plan, but no intent or behavior Possible Interventions: - Admission may be necessary depending on risk factors. Develop crisis plan. Give emergency/crisis numbers Low level of risk for suicide Risks/ Protective factor: - Modified risk factors, strong protective factors Suicidality: - Thoughts of death, no plan, intent or behavior Possible Interventions: - Outpatient referral, symptom reduction. Give emergency/ crisis numbers what are the most popular antidepressants? SSRIs What medications are Selective serotonin reuptake inhibitors (SSRIs) (Can Lucy Play Like Pal Zoe)? Celexa, Lexapro, Prozac, Luvox, Paxil, Zoloft Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Paroxetine (Paxil, Pexeva) Sertraline (Zoloft) Vilazodone (Viibryd) What are the side effects of SSRIs? 1. A headache 2. Nausea 3. Sleeplessness 4. Tremors or dizziness 5. Sexual problems 6. Agitation, jitteriness, nervousness 7. Serotonin syndrome 8. Suicidal ideation 9. Weight gain What are the tricyclic antidepressants (ends in "il)? 1. Elavil 2. Anafranil 3. Norpramin 4. Sinequan 5. Tofranil 6. Ludiomil 7. Vivactil 8. Surmontil 9. Asendin What are the side effects of tricyclic antidepressants? 1. Anticholinergic side effects: Dry mouth, constipation, urinary retention, blurred vision 2. Drowsiness 3. Sexual problems What medications are MAOIs? Isocarboxazid (Marplan) Phenelzine (Nardil) Selegiline (Emsam) Tranylcypromine (Parnate) What are the common side effects of MAOIs? 1. Hypotension 2. Sedation, weakness, fatigue 3. Insomnia 4. Changes in cardiac rhythm 5. Muscle cramps 6. Sexual impotence 7. Urinary hesitancy or constipation 8. Weight gain When are MAOIs used? Used in depressions that are resistant to other medications and treatments. What are patients at risk for when taking MAOIs? Hypertensive crisis What are the symptoms of an MAOI hypertensive crisis? 1. A severe headache 2. Stiff, sore neck 3. Flushing: cold clammy skin 4. Tachycardia 5. Severe nosebleeds 6. Dilated pupils 7. Chest pain, stroke, coma, death 8. Nausea and vomiting What should be given in a hypertensive crisis related to MAOIs? Oral chlorpromazine, IV phentolamine, Nifedipine What foods should be avoided when taking MAOIs? Foods that are high in tyramine. What foods contain tyramine? 1. Avocados 2. Figs 3. Fermented meats: Smoked, cured 4. Sausages: Bologna, pepperoni, salami 5. Milk, milk products 6. Fish: Pickled herring, smoked salmon 7. Beer, wine 8. Foods with yeast Electroconvulsive therapy (ECT) remains one of the most effective treatments for major depression with psychotic symptoms and for treatment of patients with life-threatening psychiatric conditions (e.g., self-harm). - The usual course of ECT for a depressed patient is 2 or 3 treatments per week to a total of 6 to 12 treatments. Light therapy is the first-line treatment for seasonal affective disorder with or without medication. - Full-spectrum wavelength light is the specific type of light used. - Exposure to light suppresses the nocturnal secretion of melatonin, which seems to have a therapeutic effect on people with seasonal affective disorder. - Treatments consist of exposure to light balanced to replicate the effects of sunlight for 30 to 60 minutes a day. What are the signs and symptoms of bipolar disorders? 1. Excessive and constant motor activity 2. Poor judgment 3. Lack of rest and sleep 4. Poor nutritional intake 5. Loud, profane, hostile, combative, aggressive behaviors 6. Rage reaction 7. Manipulative 8. Impulsive speech and actions 9. Property destruction or lashing out at others 10. Racing thoughts, grandiosity, poor judgment 11. Giving away valuables, making impulsive major life changes 12. Continuous pressured speech jumping from topic to topic 13. Taunting others 14. Provocative behaviors 15. Failure to perform ADLs and eat 16. Inability to sleep What are the nursing diagnosis for bipolar disorders? 1. Risk for injury 2. Impaired mood regulation 3. Imbalanced nutrition 4. The risk for self-directed violence 5. Labile emotional control 6. Risk for suicide 7. Interrupted family processes 8. Ineffective coping 9. Ineffective impulse control 10. Defensive coping 11. Ineffective coping 12. Disturbed thought process 13. Ineffective coping 14. Interrupted family processes 15. Caregiver role strain 16. Impaired verbal communication 17. Impaired social interaction 18. Self-care deficit 19. Disturbed sleep pattern 20. The risk for activity intolerance What medication is commonly used to treat bipolar disorders? Lithium What should be monitored the first 2-3 days when starting Lithium? Serum levels so that it stays in the therapeutic levels. What are the therapeutic levels of lithium? 0.4-1.0 mEq/L What are the side effects of lithium? 1. Fine hand tremor 2. Polyuria 3. Mild thirst 4. Mild nausea 5. General discomfort 6. Weight gain 7. Renal damage 8. Goiter 9. GI irritation - take with meals What are the signs of lithium toxicity? 1. Coarse hand tremor 2. GI upset 3. Mental confusion 4. Ataxia 5. EEG changes 6. Blurred vision 7. Clonic movements 8. Tinnitus 9. Stupor 10. Seizures 11. Severe hypotension What does lithium do to the kidneys? It decreases sodium reabsorption in the kidneys which can lead to a sodium deficiency. It is important to eat a normal diet with normal salt and fluid intake. What can happen if sodium levels drop while taking Lithium? It leads to a relative increase in lithium retention which can lead to toxicity. What anticonvulsants are used to treat bipolar disorder? 1. Depakote (Valproic acid) 2. Carbamazepine (Tegretol) 3. Lamotrigine (Lamictal) 4. Topiramate (Topamax) 5. Oxcarbazepine (Trileptal) What are the side effects of anticonvulsants? 1. Dizziness. 2. Drowsiness. 3. Fatigue. 4. Nausea. 5. Tremor. 6. Rash. 7. Weight gain. How does a manic episode affect communication? 1. Patient talks and jokes incessantly and gets irritated when not the center of attention 2. Patient treats everyone with familiarity and confidentiality; often borders on crude 3. Talk is often sexual 4. Talk is fresh; flits from one topic to the next; pressured speech (rapid talking, loud, and difficult to interrupt How does a manic episode affect thinking? Persistently elevated, expansive and irritable mood Schizophrenia (positive symptoms) Hallucinations - Auditory - Olfactory - Visual Bizarre Behavior Positive Formal Thought Disorder and Speech Patterns - Clang associations - Derailment - Incoherence Delusions - Religious - Grandios - Jealous - Being watched