Mental Health Disorders and Substance Use: Diagnosis, Treatment, and Prevention, Exams of Nursing

Download Mental Health Disorders and Substance Use: Diagnosis, Treatment, and Prevention and more Exams Nursing in PDF only on Docsity! symptom presentation \ n ✔affective, cognitive, physical autosomal dominant \ n ✔genetic inheritance. will present in more than one generation. 50/50 chance of passing on trait (Huningtons) autosomal recessive \ n ✔two copies must be present (cystic fibrosis prior to MSE \ n ✔assessment includes ROS, VS, heart tone, lung sounds, neuro exam, muscle tone, rigidity SLUMS \ n ✔11 items. Max 30, 27-30 normal for high school education, 21-60 mild neurocognitive disorder, 0-20 dementia MMSE \ n ✔11 components. Max 30, no impairment 24-30 Delirium/dementia 18-23 mild, 0-7 severe SLAP \ n ✔suicide assessment. Social support, Lethality, Access to means, Plan/Previous attempt Hamilton Anxiety Rating scale \ n ✔most popular anxiety scale Vanderbilt Assessment Scale \ n ✔free ADHD assessment tool Abnormal Involuntary Movement Scale (AIMS) \ n ✔total score is less important than monitoring areas of the body. 2 or more is positive. Question 7 examines trunk movements WHODAS \ n ✔36 item, measures six domains, understanding and communicating, getting around, self care, getting along with people, life activities and participation with society. 0=no disability, 100=full disability Metabolic syndrome \ n ✔abdominal obesity and any two of the following: triglycerides >150, HDL >40/50, BP >130/85, FSBS >100 or prior type 2 diabetes general screening labs \ n ✔CBC, chemistry panel, thyroid labs, hepatic panel, B12/folate and vitamin D PET scan \ n ✔localizes mental activities, primarily as experimental basis and is very expensive cranial nerves \ n ✔olfactory=smell, sensory optic=vision, sensory oculomotor=most EOM, motor trochlear=downward and inward eye movement, motor trigeminal=mastication muscles, sensation of face, both abducens=lateral eye movmement, motor facial=move face, close eyes, taste, saliva, tears, both acoustic=hearing and balance, sensory glossopharyngeal=phonation, gag, carotid, swallowing, taste, both vagus=talk, swallow, carotid, both spinal accessory=shrug shoulders, motor hypoglossal=moves the tounge, motor tender lymph node \ n ✔classic sign of infection rubbery lymph node \ n ✔classic sign of lymphoma soft lymph node \ n ✔insignificant nontender lymph node \ n ✔classic sign of potential malignancy lymph node size \ n ✔insignificant if less than 2cm, 3cm in axilla and inguinal. but if supraclavicular fossa, >1cm is significant lasts longest in the urine \ n ✔cannabis. 3 days to 4 weeks pneumococcal vaccine \ n ✔give to 19-64 year old smoker or if have asthma Pap smear \ n ✔every 3 years, HPV every 5 years. discontinue at age 65-70 if have 3 consecutive negative and no abnormal tests in 10 years prostate exam \ n ✔digital begin at age 40 and PSA at age 40 if have family history of prostate cancer or AA. ALL males 50 years and older should get screening colorectal screening \ n ✔starting at 50 years old, annual fecal occult blood test, flex sig every 5 years and colonoscopy every 10 years Medicare B screening coverage \ n ✔for cervical, breast, prostate, colorectal cancer top 4 killers of adults in US \ n ✔heart disease, cancer, lower resp disease, CVA lung cancer \ n ✔highest cancer mortality in women and men, primary prevention \ n ✔PROMOTES health PRIOR. healthy diet, exercise, avoiding things secondary prevention \ n ✔focuses on early identification and treatment of existing problems. includes REGULAR exams and screening like pap tertiary prevention \ n ✔rehab and restoration of health hepatitis A vaccine \ n ✔for military, travelers to endemic areas, men who have sex with men diabetes screening \ n ✔impaired if FSBS 100-125 diabetes if >126 on two separate occasions cholesterol screening \ n ✔evaluate serum lipid levels Total cholesterol <200 Triglycerides <150 Supportive psychotherapy \ n ✔reinforces patients healthy and adaptive thought pattresn and functional behaviors, aiming to reduce intrapsychic conflicts, minimizing symptoms of mental disorders ego strength \ n ✔deal with demands of id, super ego and reality. helps us maintain emotional stability and cope with internal and external strength intrapsychic conflicts \ n ✔class of opposing impulses, wishes, drives or external demands triangle of unconscious \ n ✔impulse-feelings/anxiety/defense triangle of feelings \ n ✔transference/current significant person/past significant person Hildegard Peplau nursing sub roles \ n ✔mother surrogate technician manager socializing agent health teacher counseor or psychotherapist phases of therapeutic relationship \ n ✔orientation working termination orientation \ n ✔establish trust and set parameters with addressing immediate issues, establishing each others roles, communicate in general therapeutic goals, contracting, establish confidentiality, termination working \ n ✔collect information, apply problem solving skills to patient situation, enhance self esteem, support positive changes in behavior, work through patient resistance to change behaviors, help patient develop adaptive coping skills, lay ground work for termination termination \ n ✔occurs when therapeutic goals are realized, review of therapeutic accomplishments, communicate methods for patient to sustain and grow his mental health, discussion of feelings concerning termination are explored, guidelines for further communication are established therapeutic milieu \ n ✔management of therapeutic environment to facilitate the therapeutic process. involves multidisciplinary team promotes therapeutic environment \ n ✔structure, involvement, containment, support, validation role of NP in the milieu \ n ✔ensure physiological needs are met, encourage independence, reality orientation, medication management, 1-1 relationship, setting limits, teaching ideal group size \ n ✔8 group membership \ n ✔open ended (can join anytime) close ended (pre-determined, fixed time frame Yaloms therapeutic/curative factors of group \ n ✔universality, hope, education, self esteem, correct maladaptive behavior, social skills, role modeling, insight, security, emotion expression, existential factors leadership styles \ n ✔autocratic, democratic, laissez-faire Family System Theory \ n ✔Murray Bowen triangles genograms focus on family relationships and not the individual Strategic Family Therapy \ n ✔Jay Haley and Milton Erickson families develop strategies to solve problems and the strategies become problems therapy involves design of strategies for eliminating problematic behavior Structural Family Therapy \ n ✔Salvador Minuchin structure, subsystems, boundaries diffuse boundaries more chaos, rigid boundaries less emotional support concordance \ n ✔a true partnership, communication is about collaboration, clinicians bring their expertise and clients bring their experiences, beliefs, wishes disorders of behavior \ n ✔behavior offers relief from tension behavior disorder serotonin metabolism \ n ✔evidence it is abnormal with low 5HT turnover and decreased CSF of serotonin metabolite disorders of behavior diagnosis \ n ✔is one of exclusion disorder of behavior characteristic \ n ✔degree of aggression is out of proportion to any provocation or precipitating psychosocial stressor that is NOT due to medical or substance. keleptomania \ n ✔failure to resist impulse to steal objects NOT needed for personal use or needs WITHOUT assistance from or collaboration of others Kleptomania family history \ n ✔ODC in first degree relatives Pyromania \ n ✔tension or affective arousal before setting fires Trichotillomania \ n ✔biopsy may be helpful to make diagnosis, best course of treatment unclear but biofeedback, hypnotherapy, SSRI, Pimozide, Naltrexone, BUSPAR feeding and eating disorders \ n ✔condition where one spends more time eating or not in response to external cues feeding and eating incidence \ n ✔1: 10 male to female ratio for anorexia nervosa and bulimia nervosa anorexia age of onset \ n ✔usually between 12-17 with a second peak in later adolescence 17-18 years old. age of bulimia is later than anorexia Anorexia symptomatology \ n ✔loss of at least 15% of total body weight pigmentation on chest and abdomen metabolic imbalances hibernation appearance bulimia vs. anorexia \ n ✔bulimia is sexually active, anorexia is not parotid hypertrophy \ n ✔binging and purging Binge Eating Disorder \ n ✔Vyvance treatment FDA indicated mortality rates eating disorders \ n ✔anorexia 4% bulimia 3.9% binge eating disorder 5.2% substance related disorder \ n ✔behavioral evidence/diagnostic criteria of pathological use type, amount, pattern of use is less significant than \ n ✔behavioral manifestations impaired control, social impairment, risky use, pharmacological criteria substance abusers \ n ✔20 times more likely to die by suicide than the general population and those who have died by suicide have had a loss within a year methadone withdrawal \ n ✔lasts longer than heroin withdrawal Impaired control behavioral manifestation \ n ✔consume larger amounts over longer period of time, unsuccessful efforts to cut down, significant amount of time spent in obtaining, using or recovering Social impairment behavioral manifestation \ n ✔failure to fulfill work, school or home obligations, continued use desptie social or interpersonal problems, other activities given up or reduced Risky use behavioral manifestation \ n ✔use in physically hazardous situations, continued use despite persistent or recurrent physical or psychological problems Pharmacological criteria substance use disorder \ n ✔tolerance, withdrawal male risk of alcohol use disorder \ n ✔consumption exceeds 14 standard drinks per week or 4 per day long term management of impulsive violence \ n ✔buspar 20-60mg/day for aggression associated with anxiety, head injury or dementia. SSRI, mood stabilizers, antipsychotics, beta blockers managing escalation depends on three skills \ n ✔observation of changes from baseline, assessment of the causes of behavioral change, modification of communication based on the cause and degree of emotional arousal Addressing the escalating patient \ n ✔with respect, avoid challenging. Give the patient an opportunity to change behavior but do not provide more than one option. Maintain the ability to stay relaxed First technique for early escalation \ n ✔offer self and use of active listening, discover the underlying emotion driving the behavior change second technique for early escalation \ n ✔supportive problem solving to alleviate distress. If frustration, identify source and practical ways to attain unmet needs. If anger, identify source and methods to reduce the sense of threat or harm late escalation \ n ✔patient fully aroused, with changes in breathing and complexion and increased muscle tension crisis communicaiton \ n ✔used in late escalation, rather than problem solving reduce words to a minimum \ n ✔in crisis communication, rely on body language and limitation. set enforceable limits, offer simple choices if fearful and anxious \ n ✔Attempt threat reduction. ask what is needed to make them feel safe. 5-8 feet away at an angle if frustrated and angry \ n ✔exert control. stand out of reach, use pointed gestures in non-aggressive posture. simple 1-2 word commands if fully aroused in a panic and striking out \ n ✔remove self and any vulnerable people out of range de-escalation \ n ✔do NOT attempt to problem solve post crisis depression \ n ✔offer self, listen, problem solve suspect abuse if \ n ✔child is wary of adult contacts, frightened of parents with constant effort to please them history of abuse in family of origin \ n ✔seen in about half of all victims elderly men are at higer risk of being abused than elderly women \ n ✔particularly if they were abusive in the past expressed style of rape trauma syndrome \ n ✔smiling, crying, agitation controlled style of rape trauma syndrome \ n ✔masked faces, subdued, distracted long range goals of abuse \ n ✔current victim will have no further injuries and family will not create any new abuse/neglect situations crisis \ n ✔when a person encounters a hazard or precipitating event that cannot be dealt with through the utilization of usual methods of problem solving, disorganization occurs and emergency methods of problem solving continue to be ineffective phases of crisis \ n ✔confrontation of hazard threatens the self concept and produces temporary disequilibrium, usual problem solving techniques fail and increase the disequilibrium, emergency problem solving resources implemented and fail, making disequilibrium worse and may cause panic, a major disruptive state or disorganization occurs whether or not a stressful event precipitates a crisis is based on \ n ✔previously learned coping mechanisms, perception of event, situational support crisis occurs \ n ✔in ALL individuals at some time and is NOT equated with psychopathology crisis intervention \ n ✔directed solely towards resolving he hazardous event goal of crisis intervention \ n ✔to return the individual to previous levels of functioning situational crisis \ n ✔arises from EXTERNAL events. loss of others, change in employment, financial or status of another, physical illness, suicide Adventitious crisis \ n ✔results from NATURAL disasters such as fire, earthquakes, riots, crimes of violence Precipitating event is NOT \ n ✔the crisis, the reaction is counseling keystones relevant to assessment of a crisis \ n ✔empathy, concreteness, confrontation, immediacy becks cognitive triad \ n ✔negative view of self, ongoing evaluation in negative way, misinterprets available data and assumes future holds no hope incidence of bipolar disorder \ n ✔lower in higher socioeconomic class limbic system \ n ✔ HPA axis \ n ✔ basal ganglia \ n ✔ somatostatin \ n ✔levels in CSF lower in patients with depression maintenance phase of depression \ n ✔50-85% of patients will have at least one lifetime recurrence, usually within 2-3 years time for maintenance treatment for depression \ n ✔9-12 months and free from recurrence bipolar and suicide \ n ✔48% will attempt suicide and 10-19% will succeed genetic risk with bipolar \ n ✔children of bipolar parents are at 4x greater risk. psychosis due to \ n ✔elevated dopamine levels in basal ganglia anxiety disorders related to \ n ✔elevated serotonin, norepi and decreased gaba Raphe nucleus most involved attention deficit hyperactivity disorder circuit \ n ✔dorsal anterior cingulte cortex, dorsal lateral prefrontal cortex and orbital frontal cortex mesolimbic dopamine pathway \ n ✔projects to nucleus accumbens, a part of the limbic system involved with pleasurable behaviors; elevated DA levels in this pathway are associated with psychosis CYP 450 1A2 \ n ✔cigarette smoking use will increase elimination of olanzapine CYP 450 2D6 \ n ✔strongly inhibitd by fluoxetine, paroxetine, buproprion. Eliminates TCA's CYP 450 3A4 \ n ✔inhibited by grapefruit juice and induced by carbamazepine and St. Johns Wort lithium toxicity \ n ✔can be caused by NSAIDS, diuretics risperidone \ n ✔NOT in pregnancy. Highest increase of prolactin weight gain with antipsychotic agent \ n ✔if >7%, change medication HDL is \ n ✔one of the strongest predictors of cardiovascular risk in metabolic syndrome neuroleptic malignant syndrome \ n ✔hot, stiff, out of it Serotonin syndrome \ n ✔Shits and SHIVERS tricyclic antidepressants \ n ✔end in -triptyline or -pramine MAOI \ n ✔unique dietary restriction. Limit tyrosine to prevent hypertensive crisis Mirtazipine side effect \ n ✔agranulocytosis state practice acts \ n ✔authorize boards of nursing in each state to develop administrative rules and regulations. specify scope of nursing practice Drug enforcement agency \ n ✔has ruled NPs may obtain registration numbers, state practice acts dictate the level of prescriptive authority allowed credentials \ n ✔establish minimal levels of acceptable performance LACE consensus model licensure \ n ✔what a person is qulaified to perform in a particular professional role. granted by state boards of nursing certification \ n ✔that a person has met certain standards in a particular profession which signify mastery of specialized knowledge and skills. Granted by ANCC or other specialty boards credentialing and privileging \ n ✔granting permission to practice in an inpatient setting by a facility patient abandonment if \ n ✔NP accepted patient assignment, formally creating practitioner-patient relationship, gave reasonable notice before termination or if reasonable arrangements could have been made to continue patient care when the adequate notice was given risk management \ n ✔systematic effort to reduce risk begins with formal written risk management plan and includes organization goals, scope, responsibility delegation, commitment by the board, articulation of certain guarantees quantitive futility \ n ✔likelihood that an intervention will benefit the patient is extremely poor qualitative futility \ n ✔quality of benefit an intervention will produce is extremely poor medical futility \ n ✔"does this intervention have any reasonable prospect of helping this patient?" competence \ n ✔legal concept. state in which a patient is able to make personal decisions about his or her care nonmaleficense \ n ✔duty to avoid harm utilitarianism \ n ✔right act is the one that produces the greatest good for the greatest number beneficence \ n ✔duty to prevent harm and promote good justice \ n ✔duty to be fair fidelity \ n ✔duty to be truthful veracity \ n ✔duty to be truthful autonomy \ n ✔duty to respect an individuals thoughts and actions reasons to d/c a patient \ n ✔abuse, refusal to pay, persistant non-adherence to recommended care. must send a certified letter with return receipt requested. specific content to letter, provide general healthcare for 15-30 days post termination deadline, obtain release of information and give them chart copy 1965 \ n ✔first NP program, Dr. Loretta Ford and Dr. Henry Silver Univ of Colorado, peds 4 roles of NP \ n ✔clinicain consultant/collaborator educator research evidence based practice \ n ✔evidence+clinical experience+patietn preferences levels of evidence \ n ✔ level 1 evidence \ n ✔meta analysis of multiple RCT qualitative methodologies \ n ✔phenomenology, ethnography, grounded theory, case studies qualitative methodologies \ n ✔phenomenology, ethnography, grounded theory, case studies descriptive statistics \ n ✔describe sample inferential statistics \ n ✔testing conclusions level of significance (p-value) \ n ✔probability level of which the results of statistical analyses are judged to indicate a statistically significant difference between results. Means its "probably true" and not due to chance t-test \ n ✔statistical test to evaluate the differences in means between two groups validity \ n ✔degree to which a study measures what it is intended to measure internal validity \ n ✔treatment (independent variable) led to outcome (dependent variable) external validity \ n ✔generalizability of results standards of care \ n ✔are used as criteria to measure whether negligence has occurred Malparctice \ n ✔must prove negligence 4 D's of medical malpractice \ n ✔ALL must be proven Duty Dereliction Damages Direct cause assault \ n ✔intentional act performed by one individual that produces apprehension in another individual (shaking fist in the air in the direction of another person, making the motion to inject someone against his will battery \ n ✔if the victim is touched serious mental illness (SMI) \ n ✔people with symptoms that interfere wtih occupational (academic) and social functioning SMI \ n ✔when an individual has been diagnosed with a major psychiatric disorder continues to have persistent physical and emotional problems within the past year. About 1/3 of mental population dementia \ n ✔100% chronic SMI SMI mortality \ n ✔die from suicide, accidents and murder at 4.6 times the general population rate non-adherence \ n ✔inability, failure and/or failure to accept recommended treatment. 75% of those who discontinue their medication relapse symptomatic with schizophrenia \ n ✔many people symptomatic for over 2 years before getting treatment and do not get appropriate treatment when first diagnosed bipolar clients \ n ✔usually not identified until they have had several manic episodes, many are misdiagnosed with schizophrenia, and get little or no treatment for mood disorder 15-30% \ n ✔of clients with SMI do not respond to the currently available medications with full remission of symptoms ask the SMI patient \ n ✔how current mood compares to how they felt before got sick or how it compares to the best period of functioning the client has had in the last several years psychosocial/environmental assesssment \ n ✔most critical for the long term management of SMI Moller-Murphy Symptom Management Assessment Tool II \ n ✔assistance in symptom and trigger identification and management Achetylcholinesteras inhibitors \ n ✔donepezil/aricept galantamine/reminyl rivastigmaine/exelon NMDA antagonist \ n ✔NaMenDA regulates glutamate in the brain Infant reflexes \ n ✔all disappear 3-4 months except grasp (6mo), pacing (1-2 mo) and babinski (12mo or walking) cerebrum lobes \ n ✔ frontal lobe responsible for \ n ✔voluntary motor activity, speaking activity, elaboration of thought, executive functions occipital loves responsible for \ n ✔initially processing visual input pariteal lobes \ n ✔receive and process sensory input temporal lobes \ n ✔emotions, memory, cognition, speech limbic system \ n ✔amygdala+hippocampus. regulates behavioral awareness, fear, social behavior, rage, sexual desire basal ganglia \ n ✔a system of subcortical structures that are important for the planning and production of movement cerebellum \ n ✔maintains balance, enhance muscle tone brain stem \ n ✔contains the sleep centers self esteem \ n ✔individuals perception of their self worth. high secure self esteem \ n ✔confident, perform well in school and sports, less risky behaviors high insecure self esteem \ n ✔confident, inauthentic, do not perform well in school or other activities, high risk behaviors, rejection sensitive with reactive anger to criticism low self esteem \ n ✔more frequent school failure, antisocial or delinquent behavior, have more health and metnal health problems with at risk health behaviors including sexual and drug use Psychosocial theory \ n ✔Erikson society and culture influence the development of the personality Cognitive theory \ n ✔Piaget based on the premise that human intelligence is an extension of biological adaptation or ones ability for psychological adaptation to the environment, how we develop schema \ n ✔mental structure of patterns of thinking assimilation \ n ✔incorporating new information into current schemas according to new environmental stimuli perceived accomodation \ n ✔adjusting to new information by creating new schemas equilibrium \ n ✔symbiosis of sensory information and accumulated knowledge equilibration \ n ✔means to compensate for external disturbance Theory of object relations \ n ✔Mahler: had a troubled sister because of parents divorce. play and love important to infants. emphasized role of relationship in producing change and individuation Ethological theories \ n ✔behavior strongly influenced by biology. is tied to evolution and is characterized by critical or sensitive phases Bonding \ n ✔Klaus & Kennell Attachment: Bowlby Ainsworth Social learning theory \ n ✔behavior is learned and development is influenced by the environment classical conditioning \ n ✔Pavlov (conditioning changes behavior) Watson (all learning is based on conditioning) Operant conditioning \ n ✔Skinner behavior modification is largely based on operant conditioning theory (influenced motivational interviewing) Piaget moral development \ n ✔nature of knowledge and how humans come to develop it Kohlberg moral development \ n ✔adapted piagets model. moral reasoning is basis for ethical behavior Tanner staging \ n ✔ development of human sexuality \ n ✔2 yr: understand gender 4 yr: heterosexual play 6 yr: homosexual play 10-13 yr: romantic interests develop 13-20: conceptualizing love, sexual feelings 20-65: intimate relationships Ecological systems model \ n ✔Bronfenbenner called attention to the large number of environmental and societal influences on child development. Head Start program enviroments \ n ✔influence children and lead to mutual accommodation and reciprocity disorders exist \ n ✔when they are not age or culturally appropriate and result in maladaptive functioning genotype \ n ✔genetic code phenotype \ n ✔human expression Asian and carbamazepine \ n ✔test for HLA-B* 1502 allele prior to prescribing due to risk of stevens johnson syndrome Intellectual disability \ n ✔general intellectual functioning is compromised, not based on IQ alone, but adaptive functioning has deficits Autism spectrum disorders \ n ✔repetitive patterns of behavior, impaired social functions 4:1 male to female 50-100 fold increase in rate of autism in first degree relatives of autistic children Rett Syndrome \ n ✔onset usually before first birthday loss of skills already acquired Childhood Disintegrative Disorder \ n ✔males > females, but females exhibit more severe, can have up to 10 years of normal development prior, deterioration in social, motor, language, bowel/bladder and intellectual function Pervasive Developmental Disorder \ n ✔diagnosis of exclusion Adolescents and mood disorders \ n ✔25% have depression at some point, lasting approx 9 months. 70% will have a recurrance within 5 years Disruptive Mood Dysregulation Disorder \ n ✔ depression in children \ n ✔appear somatic, socially withdrawn, sad, helpless with possible auditory hallucinations. children may appear irritable FDA approved meds for children 7 and older \ n ✔fluoxetine, sertraline. mood stabilizers, divalproex sodium (2 years), carbamazepine (6 yr), lithium )12+) ADHD incidence \ n ✔boys to girls 6:1 highly genetic hallmark of GAD \ n ✔excessive and persistent worry, apprehensiveness, irritability, somatic symptoms GAD goals \ n ✔reduce the overall level of autonomic arousal, reduce worry to reasonable level Panic Disorder \ n ✔spontaneous, rapidly developing episodes of intense anxiety (panic attacks) associated with autonomic arousal chest pain with panic DO \ n ✔40-60% of patients Panic DO includes \ n ✔recurrent unexpected attacks, attacks are then followed by at least one month of persistent concern/worry about future attacks or their consequences AND/OR significant maladaptive change in behavior prompted by the attacks panic DO goals \ n ✔empathetic support to reduce anxiety to minimum, encourage verbalization of feelings, identify problematic relationship dynamics, assist with development of adaptive coping skills PTSD prevalence \ n ✔3.5% among US adults PTSD diagnostic domains \ n ✔Exposure Intrusion Avoidance Negative Arousal Acute Stress Disorder vs PTSD \ n ✔ASD can only be given within the FIRST MONTH following a traumatic event Adjustment Disorder \ n ✔50% of pts receiving a hospital psychiatric consultation receive a diagnosis of adjustment disorder psychodynamic factors of adjustment disorder \ n ✔children with less mature defensive constellations as a result of trauma or greater constitutional vulnerability. as adults these children may react with substantially impaired functioning when faced with a stressor goal of treatment with adjustment DO \ n ✔gain perspective on stressor, ultimately managing themselves and stressor somatic symptom and related disorder \ n ✔first line pharmacologic intervention: TCA conversion disorder \ n ✔rule out medical two types of dissociative amnesia \ n ✔simple fugue localized dissociative amnesia \ n ✔no memory of details associated with traumatic event selective dissociative amnesia \ n ✔remembers selective details for specific time after event generalized dissociative amnesia \ n ✔recall for events of past life, personal identity lost continuous dissociative amnesia \ n ✔unable to recall events occurring after a specific time Dissociative identity disorder suicide rate \ n ✔70% depersonalization/derealization disorder prevalence \ n ✔transient symptoms present in 50% of all adults at least once in liffetime depersonalization/derealization disorder hallmark \ n ✔feeling of detachment from the environment, sense of unreality Phases of schizophrenia \ n ✔premorbid prodromal acute or psychotic stable or residual attenuated psychosis syndrome \ n ✔mild psychotic like symptoms that dont meet full criteria for schizophrenia. is under further study in DSM 5 Schizophrenia genetics \ n ✔chromosome 6/22 possibly 81% heritability stress and schizophrenia \ n ✔even when adherent to medication, stressed schizophrenic individuals become extremely vulnerable to exacerbations of illness types of schizophrenia \ n ✔ PMHNP Board Prep 1 – 12 Questions with Answers 2024 schizoaffective DO \ n ✔period of delusions or . hallucinations (for at least 2 weeks) WITHOUT prominent mood sympotms schizophreniform DO \ n ✔between 1-6 months delusional disorder \ n ✔functioning NOT markedly impaired or obviously odd or bizarre in areas other than the delusion circumstantiality \ n ✔conversational drift based on loose associations. unnecessary details to answers that deviate from topic tangentiality \ n ✔oblique, digressive, or irrelevant responses to questions. abrupt permanent deviation in subject. involves NOT answering the question perseveration \ n ✔repetition of particular response despite absence of stimuli smoking + schizophrenia \ n ✔60% smoke. Cigarette smoke impacts metabolism of drugs via CYP 1A2 (smoking will decrease the concentration of antipsychotics) instrumental activities of daily living \ n ✔activites that contribute to independent functioning activities of daily living \ n ✔basic self care activiites Dressing Eating Ambulating Transferring and toileting Hygeine Albumin \ n ✔below 3.5% indicates protein malnutrition Elderly pharmacokinetics \ n ✔how the body interacts with drugs decrase in total body water, increase in fat, incrase in muscle mass, decrease in serum albumin can lead to toxicity psych drugs are \ n ✔lipophilic and protein bound, so the increase in fat and decrease in protein can cause toxicity in elderly