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Define mental disorder
diagnosable syndrome characterized by altered thinking, mood, and/or behavior, and associated with significant distress and/or impaired functioning
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What is a syndrome?
- A cluster of symptoms or manifestations that may represent more than one underlying disease/pathology.
- Mental health is diagnosed by syndrome classification as opposed to etiology
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What is a cultural syndrome?
symptom cluster that occurs in a specific group, community, or context not recognized as an illness within the culture (e.g. attack of the nerves)
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What is a cultural idiom of distress?
The characteristic ways a cultural group talks about suffering/distress (e.g. "thinking too much")
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What are the 10 fundamental components of recovery?
- self-direction
- individual and person-centered
- empowerment
- holistic
- non-linear
- strengths-based
- peer support
- respect
- responsibility
- hope
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What are the top 3 mental health issues in the general population?
- anxiety/stress
- depression/depressive symptoms
- substance misuse and abuse
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This theory has an overarching framework for explaining and targeting hypothesized causes of mental illness
The stress-diathesis theory, which states that there is a combination between biological or environmental factors and vulnerability. "Fertile-ground"
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Who is the mother of psychiatric nursing and what two points are most important for her theory of practice?
- Hildegard Peplau
- Emphasizes interpersonal experiences and healthy relationships.
- Focuses on navigating anxiety during the nurse-patient relationship.
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What are the developmental stages of the nurse-patient relationship?
- Orientation: high anxiety; testing trustworthiness of the relationship
- Working: actively working on goals; less anxiety
- Termination/resolution: use of personal styel for "good bye" (things often seem to end how they started)
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Enahancing self-awareness requires this.
- Mindfulness; self-reflection
- See one's own "blind spots" (preconscious)
- Be aware of previously-unconscious aspects of one's self
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The Johari Window has these four areas
- My public self (known to self and others)
- My blind spots (known to others but not self)
- My hidden self (known to self but not others)
- My unconscious self (not known to self or others)
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Classifications of typical antipsychotics
- phenothiazines
- butyrophenones
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Mechanism of action of typical antipsychotics
- Dopamine (D2) receptor antagonists
- decreases post-synaptic dopamine in many areas of the brain
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Side effects of typical antipsychotics
- anticholinergic: (key s/e on another slide)
- antiadrenergic: orthostatic hypotension
- cardiac: lengthening of the QT interval
- endocrine: sexual dysfunction, menstrual dysfunction, galactorrhea, gynecomastia
- extrapyramidal: (key s/e on another slide)
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Extrapyramidal side effects (EPS)
- Pseudo-Parkinsonism
- Akethisia: sensation of not being able to sit still
- Acute dystonic reaction: spasms of large muscles can be painful
- Tardive dyskinesia:a difficult-to-treat and often incurable form of dyskinesia, a disorder resulting in involuntary, repetitive body movements.
- Neuroleptic Malignant Syndrome (NMS): medical emergency!
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What is NE?
- Norepinephrine
- excitatory NT
- involved in generating, maintinaing mood states, sleep/wake rhythms, flight-of-fight response (anxiety modulation)
- decreased in depressin
- increased in manic symptoms
- NE (noradrenergic) pathway dysfunction implicated in depression and anxiety
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What is 5-HT?
- Serotonin (also ST)
- primarily excitatory NT
- involved in emotions, cognition, sensory perceptions, essential biologic functions (sleep, appetite)
- decreased in depression, insomnia
- increased in mania
- dysfunction implicated in anxiety disorders
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Discuss histamine in mental health
- certain psychotropic meds block effects
- side effects of sedation, weight gain, hypotension
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Discuss GABA in mental health
- primarily inhibitory NT
- interconnected with other key NTs
- dysfunction associated with anxiety disorders
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Discuss glutamate in mental health
dysfunction implicated in certain neurodegenerative diseases and schizophrenia
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Typical antipsychotics are also referred to as:
- classic
- conventional
- first-generation
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What does NMS stand for?
Neuroleptic Malignant Syndrome
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Signs and symptoms of neuroleptic malignant syndrome
- hyperthermia (hyperpyrexia)
- altered consciousness
- wildly fluctuating vital signs
- severe diaphoresis
- drooling
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Symptoms of agranulocytosis
- Similar to flu symptoms with addition of:
- mouth sores
- drop in WBC
potentially life threatening!
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Key anticholinergic side effects
- dry mouth
- constipation
- urinary retention
- blurred vision
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Antidyskinesic medications
- Anticholinergic drugs
- Used to manage EPS
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Signs and symptoms of anticholinergic toxicity
- Medical emergency!
- delirium/hallucinations
- severe hypotension
- tachycardia
- extreme agitatation or coma
- flushing
- seizures
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Atypical antipsychotics are also referred to as:
- newer
- non-conventional
- second generation
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Characteristics of atypical antipsychotics
- Bind loosely with D2 receptors
- greater affinity for 5-HT receptor subtypes which indirectly enhances DA production
- lower risk of EPS and tardive dyskinesia
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People with schizophrenia have higher rates of these comorbidities
note that atypical antipsychotics can result in weight gain and metabolic changes including insulin resistance and reduce insulin secretion
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What are the common side effects of atypical antipsychotics?
- weight gain
- metabolic changes
- insulin resistance/reduced insulin secretion
- hyperprolactinemia
- erectile dysfunction/gynecomastia
- orthostatic hypotension
- decreased libido
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What is CATIE and the overall results?
- Clinical Antipsychotic Trials of Intervention Effectiveness
- older medications performed as well as newer ones and were less expensive
- consider s/e when prescribing
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Reasons for treatment nonadherence
- illness-related factors: remission of symptoms, disease features
- medication-related factors: dosing schedule, polypharmacy, expense
- environmental factors: social isolation, unsupportive SOs
- clinician-related factors: poor communication and alliance
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