Depression
What are the two required symptoms for a diagnosis of MDD? (Hint: these are the first two questions in the PHQ-9)
--Feeling down, depressed, hopeless
--Lack of interest in usual activities (anhedonia)
How is bipolar disorder different from depressive disorders?
Presence of mania, which can include irritability in addition to elevated mood.
What is the hallmark symptom of generalized anxiety disorder?
Excessive worry or fear that causes impairment in function.
What differentiates PTSD from anxiety?
Re-experiencing of traumatic event.
Name two of the three psychotic symptoms of which one is required to diagnose schizophrenia.
Hallucinations
Delusions
Disorganized speech
Define affect
External expression of the person's internal state.
Define staff splitting.
A manipulation technique by which a patient attempts to get an advantage by putting staff against each other, ie--by telling a staff member that they are nice and another staff member is mean or saying that a nice staff member allowed them to have access to a contraband item.
At what anxiety level is the person unable to think rationally and may have limited ability to process sensory input?
Panic
What is the difference between depersonalization and derealization?
Depersonalization: Extremely uncomfortable feeling of being observer of one’s own body or mental process. Disconnected from self.
Derealization: Recurring feeling that one’s surroundings are unreal or distant. Detached from body. Can be like watching a movie.
What is prodrome/prodromal symptoms?
Warning signs or early symptoms of schizophrenia.
True/False: A patient with only one episode of mania can be correctly diagnosed as having MDD.
False.
You are the RN on an inpatient psychiatric unit. A patient diagnosed with bipolar disorder tells you "well, once I am out of here, no one will need to worry about me any more." What do you do?
Concern for suicidality. Complete suicide assessment. Investigate potential reason for change in mood. Assess for need for further intervention to maintain safety. Report to care team.
Name an intervention appropriate for a moderately anxious patient.
Reduce disruption to other patients. Refocus patient. Use up excess energy. Reduce sensory input. PRN medications.
What are the key components of dissociative disorders?
Occur after significant adverse experiences/traumas
Individuals respond to stress with severe interruption of consciousness
Unconscious defense mechanism
Protects individual against overwhelming anxiety through emotional separation
Define alogia. What category of symptoms is it (positive, negative, affective, cognitive)?
Negative symptom
A co-worker tells you a patient cannot be depressed because they are not sleeping and are pacing in the unit. What do you tell them?
Both insomnia and hypersomnia are criteria for MDD. As are psychomotor agitation AND psychomotor retardation.
True/False: You want to avoid pointing out a patient's behavior when they are experiencing symptoms of bipolar disorder.
False. Pointing out behavior can help patient.
Name a comorbidity for anxiety.
Depression.
Substance Use Disorder
You are caring for a patient who has been diagnosed with dissociative identity disorder. She was hospitalized after coming to the emergency department with deep cuts on her arms with no memory of how this occurred. The priority nursing intervention for this patient is:
A. Assist in recovering memories of abuse
B. Maintain 1:1 observation
C. Teach coping skills and stress management techniques
D. Refer for integrative therapy
B. Maintain 1:1 observation
True/False: You should challenge a patient's delusion.
False. What should you do?
Name a key component of the recovery model of mental health care.
Focus on patient’s strengths
Treatment goals mutually developed
Based on patient’s personal needs and values
What is goal for maintenance phase for bipolar disorder?
Prevent relapse
True/False: Chronic anxiety has no physical effect on the person experiencing it.
False: Remember HPA axis and effects of inflammatory processes.
A nurse assesses a patient diagnosed with dissociative identity disorder. Which finding would likely be part of the patient’s history?
A. Travel to a foreign country
B. Thyroid dysfunction
C. Eating disorder
D. Physical or sexual abuse
D. Physical or sexual abuse
You are working on the acute unit of an inpatient psychiatric facility. A patient who had been sitting alone in the quiet room complains to you that there should not be anyone talking to her while she is in the quiet room. You realize this could be a sign the patient is experiencing
A. Asociality
B. Thought insertion
C. Hallucinations
D. Delusions
C. Hallucinations