Psych Mental Health Exam 2 - Expert Learning Guide

1. PSYCHOPHARMACOLOGY ESSENTIALS

🧠 STIMULANTS → Think: "Speed Up the Brain"

What: Methylphenidate, amphetamines
Why: ADHD, narcolepsy
Watch: Heart rate, appetite, sleep, growth (kids)
Red Flag: Don't give if heart problems

📊 AIMS SCALE → "Abnormal Involuntary Movement Scale"

Purpose: Catch tardive dyskinesia from antipsychotics
When: Baseline, then every 6 months
What to look for: Lip smacking, tongue movements, finger tapping
Memory trick: AIMS = "Am I Moving Strange?"

🔥 SEROTONIN SYNDROME → "Too Much Serotonin = Medical Emergency"

The Fatal Triad:

• Mind = Agitation, confusion
• Body = Fever, sweating, fast heart
• Muscles = Tremor, rigid, jumpy reflexes

Cause: SSRI + another serotonin drug
Action: STOP the drugs, cool the patient, get help NOW

💊 MEDICATION ADHERENCE → "Why Patients Don't Take Meds"

Top 4 Reasons:

1. Side effects suck
2. "I feel better, don't need it"
3. Can't afford it
4. Too complicated

Your Job: Educate, simplify, build trust, monitor side effects

👻 ANTIPSYCHOTICS → "Ghost Busters for Hallucinations"

1st Generation (Typical): Haloperidol - more movement problems
2nd Generation (Atypical): Risperidone, olanzapine - more weight gain
Monitor: Weight, movement, heart rhythm, blood sugar

🚨 CLOZAPINE Special Alert:

• Risk of agranulocytosis → monitor WBC weekly
• Absolute neutrophil count (ANC) must be ≥1,500 before starting
• Hold medication if ANC drops too low
• Report sore throat/fever immediately

🔥 Neuroleptic Malignant Syndrome (NMS):

• High fever, rigidity, confusion, unstable BP
• Emergency: Stop med, cool body, give IV fluids, notify provider NOW

😴 BENZODIAZEPINES → "Chill Pills with Risks"

Good: Calm anxiety fast
Bad: Drowsy, confused, addictive
Dangerous: + alcohol = stop breathing
Elderly: Fall risk, paradoxical agitation

⚖️ LITHIUM TOXICITY → "Narrow Window Between Help and Harm"

Levels to Know:

• Therapeutic: 0.6-1.2 (just right)
• Mild toxic: 1.5-2.0 (nausea, shaky hands)
• Moderate toxic: 2.0-2.5 (confused, can't walk)
• Severe toxic: 2.5+ (seizures, coma)

Critical Interactions:

• Avoid NSAIDs and thiazide diuretics (↑ lithium levels)
• Sodium intake must be consistent - low Na = ↑ lithium retention
• Triggers: Dehydration, kidney problems, too much salt loss

💊 SSRIs/SNRIs → "Serotonin Boosters"

Key Teaching:

• Takes 2-4 weeks for effect
• Do NOT stop abruptly - risk discontinuation syndrome (dizziness, insomnia, flu-like)
• Monitor for increased suicidal thoughts during first few weeks (especially young adults)

🚫 CONTRAINDICATIONS → "When NOT to Give"

Antipsychotics: Dementia patients (death risk), severe heart disease
SSRIs/SNRIs: With MAOIs (serotonin syndrome), narrow-angle glaucoma

---

🚨 PERSONALITY DISORDERS → "Pattern Problems"

Cluster A (Odd): Paranoid, Schizoid, Schizotypal
Cluster B (Dramatic): Borderline, Narcissistic, Histrionic, Antisocial
Cluster C (Anxious): Avoidant, Dependent, Obsessive-Compulsive

Borderline Personality:

• Fear of abandonment, mood swings, impulsive
• Best intervention: Set boundaries, stay consistent

Antisocial Personality:

• Disregard for others, manipulative, no remorse
• Best approach: Set firm limits, don't personalize behavior

---

2. ANXIETY DISORDERS → "Fear Factory"

The Big 5 Anxiety Disorders:

1. GAD = Worry about everything for 6+ months
2. Panic Disorder = Sudden terror attacks + fear of more attacks
3. Social Anxiety = Fear of being judged by others
4. Specific Phobias = Irrational fear of one thing
5. Agoraphobia = Fear of places you can't escape

ACEs Connection: Bad childhood = anxious adult brain

Anxiety Ladder: (Know this cold!)

1. Mild = Alert, can learn better
2. Moderate = Harder to focus, tunnel vision starts
3. Severe = Can barely function, very narrow focus
4. Panic = Total chaos, fight or flight takes over

Severe & Panic Priority: Safety & calm environment. Use short, simple phrases. Stay with patient.

Panic Disorder Special Notes:

• Key signs: Chest pain, hyperventilation, sense of impending doom
• Nursing tip: Always rule out heart attack in first episodes

---

3. SCHIZOPHRENIA → "When Reality Gets Scrambled"

POSITIVE vs NEGATIVE (Most tested concept!)

POSITIVE = ADDITIONS (things that shouldn't be there)

• Hallucinations (hearing voices)
• Delusions (false beliefs)
• Disorganized thinking
• Weird movements

NEGATIVE = SUBTRACTIONS (missing normal stuff)

• No motivation (avolition)
• Flat emotions
• Poor speech (alogia)
• No pleasure (anhedonia)
• Social withdrawal

Language Disturbances:

• Word Salad: Jumbled words without meaning
• Neologism: Made-up words
• Clang association: Rhyming words with no meaning

Talking to Hallucinating Patients:

✅ DO: "I understand you're hearing voices. That must be scary."
❌ DON'T: "There are no voices" or "What are they saying?"

🗣️ THERAPEUTIC COMMUNICATION → "The Right Words Matter"

Best Responses: Open-ended, empathetic, non-judgmental
Avoid: "Why?" questions, false reassurance, changing subject, giving advice
Example: "Tell me more about how you're feeling" vs "Why are you upset?"

Key Stats: 1% of people, starts teens/20s, chronic condition

Comorbidities: 50% use drugs/alcohol, high suicide risk

---

4. STRESS RESPONSE → "Fight, Flight, or Freeze"

What Makes Stress Worse:

• Bad genes + bad environment
• No support system
• Poor coping skills
• Past trauma

Healthy Coping = BREATHE:

Breathing exercises
Relaxation techniques
Exercise
Ask for help
Think through problems
Healthy habits
Emotion regulation

Body's Stress Signals:

• Acute: Racing heart, sweating, tense muscles
• Chronic: Sick more often, stomach problems, can't sleep

---

5. THERAPIES → "Different Tools for Different Problems"

CBT = Change thoughts to change feelings (depression, anxiety)
DBT = Learn skills to handle emotions (borderline personality)
Family Therapy = Fix family problems together
Group Therapy = Learn from others with same issues
Motivational Interviewing = Help patient explore ambivalence and build intrinsic motivation (esp. substance use)

---

6. DEMENTIA TYPES → "The Memory Thieves"

Alzheimer's (most common) = Forgets recent stuff first, gets lost
Vascular = Mini-strokes cause stepwise decline
Lewy Body = Sees things that aren't there, stiff like Parkinson's
Frontotemporal = Personality changes, inappropriate behavior

---

7. MOVEMENT DISORDERS → "When the Body Won't Cooperate"

Tardive Dyskinesia = Antipsychotic side effect, lip smacking
Parkinson's = Tremor, slow movement, rigid muscles
Huntington's = Genetic, jerky movements, dementia
Dystonia = Muscle spasms, twisting movements

---

8. LANGUAGE & LEARNING → "Communication Breakdowns"

Aphasia = Brain injury affects talking/understanding
Dyslexia = Smart but can't read well
Dysgraphia = Can't write properly
Dyscalculia = Math is impossible

---

9. AUTISM → "Different, Not Less"

Family Education:

Key Messages:

• Autism is neurological, not caused by parenting
• Early intervention (before age 3) = better outcomes
• Each child is unique, no cookie-cutter approach
• Routines and structure are crucial

Practical Tips:

• Use visual schedules and social stories
• Prepare for transitions ("5 more minutes")
• Connect with other autism families
• Know school rights (IEP/504 plans)

Signs:

• Social struggles (eye contact, relationships)
• Repetitive behaviors
• Sensory issues
• Need for sameness

---

10. ADHD → "Attention Deficit Hyperactivity Disorder"

Can't Focus: Distracted, forgetful, disorganized
Can't Sit Still: Fidgety, talks too much, interrupts
Impact: School problems, relationship issues, accidents

---

11. GRIEF → "The Price of Love"

Kübler-Ross Stages (not in order):

Denial → Anger → Bargaining → Depression → Acceptance

How to Help:

• Listen without judging
• Say "I'm sorry for your loss"
• Don't say "They're in a better place"
• Let them feel their feelings

End-of-Life Ethics:

Patient Rights: Autonomy, advance directives, informed consent
Nurse's Job: Advocate for patient wishes, manage pain, maintain dignity
Key Rule: Patient wishes beat family pressure
When Stuck: Consult ethics committee
Document: All care discussions and decisions

---

12. ERIKSON'S STAGES → "Life's Challenges"

Memory Trick - "Trust Will Push Industry Into Love Care Wisdom"

0-1: Trust vs Mistrust (can I trust caregivers?)
1-3: Will vs Shame (can I do things myself?)
3-5: Purpose vs Guilt (can I try new things?)
5-12: Industry vs Inferiority (can I learn skills?)
12-18: Identity vs Confusion (who am I?)
18-40: Love vs Isolation (can I form relationships?)
40-65: Care vs Stagnation (can I help others?)
65+: Wisdom vs Despair (was my life meaningful?)

---

13. NURSING SELF-CARE → "You Can't Pour from an Empty Cup"

Physical: Sleep, eat, exercise, see doctor
Emotional: Therapy, mindfulness, boundaries
Professional: Learn, ask for help, work-life balance
Social: Friends, family, fun activities

---

🧠 MEMORY SUPERCHARGERS

AIMS = "Am I Moving Strange?"
Serotonin Syndrome = "Hot, Agitated, Shaking"
Lithium Levels = "1.5 Mild, 2.0 Moderate, 2.5+ Severe"
Anxiety = "Mild-Moderate-Severe-Panic"
Schizophrenia = "Positive = Plus, Negative = Minus"

---

🎯 PRACTICE LIKE THE EXAM

Scenario Practice:

1. Patient has lithium level 1.8 with nausea → What's happening? (Mild toxicity)
2. Patient on SSRI gets tramadol, now agitated and hot → What's wrong? (Serotonin syndrome)
3. Schizophrenia patient won't take meds due to weight gain → How do you help? (Education, alternative meds)
4. Family angry after patient death → How do you respond? (Therapeutic communication)

Question Types to Expect:

• "What's the priority action?"
• "Which statement shows understanding?"
• "What should the nurse monitor?"
• "Which patient needs immediate attention?"

---

📚 FINAL 48-HOUR PUSH

Day 1: Review all medications and their key points
Day 2: Practice scenarios and therapeutic communication
Last Hour: Review Erikson's stages and anxiety levels

Final Hour Checklist:

• SSRI side effects + discontinuation syndrome
• Lithium interactions + sodium guidance
• Clozapine + agranulocytosis protocol
• Suicidal ideation risk ↑ when starting antidepressants
• Neuroleptic Malignant Syndrome (NMS) vs Serotonin Syndrome
• Language features of schizophrenia
• Therapeutic vs non-therapeutic statements
• Anxiety levels + best nursing interventions
• Borderline Personality: Limit setting + consistency
• Panic Attack = rule out MI + calm, simple language
• Motivational interviewing for substance use

Test Day: Trust your nursing judgment, eliminate obvious wrong answers, choose the most therapeutic response.