180 Mental Health Exam 2 Flashcards by Alayna Johnson

Change in the brain that disrupts a person’s interpretation and/or experience of the world secondary to complex neurobiological changes

Hallucinations, delusions, and/or disorganized thinking are hallmark characteristics

Psychosis

How well did you know this?

Not at all

Perfectly

Failure to thrive syndrome

Slowed physical growth d/t the inability to integrate the physical, emotional, and sensorimotor realms of functioning

Related to neglect, environmental problems, and severe family stress

Risk factors:
* Genetic influences
* Complications during pregnancy or birth
* Biochemical imbalances
* Environmental factors

Psychosis in Childhood

How well did you know this?

Not at all

Perfectly

Schizophrenia is a seldom diagnoses

May spend the remainder of their days in long-term care facilities

Acute onset of psychotic behavior must be investigated

Psychosis in Older Adults

How well did you know this?

Not at all

Perfectly

The average teen is in contact with reality; the adolescent with schizophrenia is not.

Changes in behavior noted include:
* Poor hygiene
* Strange, vague speech
* Social withdrawal
* Odd behaviors
* Bizarre thoughts and beliefs
* Unusual superstition

Psychosis in Adolescence

How well did you know this?

Not at all

Perfectly

Onset of acute symptoms most often occurs in men during their middle twenties, while women usually present with symptoms in their late twenties

Prognosis for individuals with schizophrenia is better if adaptive interpersonal relationships and acceptable school performance and work histories were in place before the onset of symptoms.

Psychosis in Adulthood

How well did you know this?

Not at all

Perfectly

What are 5 subtypes of schizophrenia?

Catatonic

Disorganized

Paranoid (most seen)

Undifferentiated

Residual

How well did you know this?

Not at all

Perfectly

What are S/s of Psychosis-Positive Symptoms?

Delusions

Hallucinations

Disorganized thinking

Disorganized/abnormal motor behavior

How well did you know this?

Not at all

Perfectly

Visual (seeing things)

Auditory (hearing voices)

Tactile (feeling things touch your skin)

Olfactory (smelling things, or not smelling the same things as others)

Gustatory experiences (tasting things)

Hallucinations (positive sign)

How well did you know this?

Not at all

Perfectly

What are Psychosis-Negative Symptoms?

Alogia (reduction in quantity of words spoken)

Affective blunting (emotional expressions don’t show outwardly)

Asociality (reduction in social initiative due to decreased interest in forming close relationships with others)

Anhedonia (reduced experience of pleasure)

Avolition (reduced goal-directed activity due to decreased motivation)

Anosognosia (someone is unaware of their own mental health condition or that they can’t perceive their condition accurately)

How well did you know this?

Not at all

Perfectly

What is the course of schizophrenia marked by?

Episodes of acute psychosis alternating with periods of relatively normal functioning

How well did you know this?

Not at all

Perfectly

The symptoms of schizophrenia must occur for at least _______ before a diagnostic label is assigned.

A) 6 months
B) 8 Months
C) 1 year
D) 2 years

C) 1 year

How well did you know this?

Not at all

Perfectly

The slide into schizophrenia commonly occurs over what four stages?

Prodromal phase

Pre-psychotic phase

Acute phase

Remission

How well did you know this?

Not at all

Perfectly

Typical agents: Blocks action of dopamine in the brain
* Ex: Halperidol (Haldol)

Atypical agents: Blocks serotonin receptors & dopamine receptors
* Ex: Aripiprazole (Abilify), Olanzapine (Zyprexa)

Use:
* Treat psychoses associated with mental illnesses (schizophrenia, mania, psychotic depression, psychotic organic brain syndrome)

Side effects:
* Peripheral Nervous System Effects (PNS)
* Constipation, urinary retention, urinary hesitation
* Dry mouth, nasal congestion
* Blurred vision, photophobia
* Hypotension or orthostatic hypotension
* Tachycardia, sedation, weight gain.

Anti Psychotic Agents

How well did you know this?

Not at all

Perfectly

Drug induced condition that produces serious, irreversible side effect of long-term treatment

Produces involuntary, repeated movements of the muscles of the face, trunk, arms, and legs

Facial movements are usually affected first with protrusion of the tongue, puffing of cheeks or tongue in cheek, lip smacking, puckering

Difficult to treat and is irreversible except in the very early stages.

Tardive Dyskinesia

How well did you know this?

Not at all

Perfectly

unpredictable / potentially fatal extrapyramidal side effect of antipsychotic medications

Must be recognized and treated quickly
* Neurologic emergency

Occurs in men more than women.
* Can affect all individuals of all ages.

Death occurs from respiratory or kidney failure, aspiration pneumonia or pulmonary emboli

Usually associated with high-potency antipsychotics or other dopamine altering drugs
* Development can occur suddenly after a single dose or years after drug treatment

S/s:
* Sudden change in LOC
* Rapid onset of rigid muscles
* Cardinal sign is a high body temperature.

Neuroleptic Malignant Syndrome (NMS)

How well did you know this?

Not at all

Perfectly

A cardinal sign of neuroleptic malignant syndrome is:

A) low body temperature (95° F to 98.6° F).
B) high body temperature (102° F to 108° F).
C) rapid speech.
D) muscle flaccidity.

B) high body temperature (102° F to 108° F).

How well did you know this?

Not at all

Perfectly

Tardive dyskinesia involves involuntary muscle movements that most often are associated with the:

A) mouth, lips, and tongue.
B) extremities.
C) trunk.
D) head.

A) mouth, lips, and tongue.

How well did you know this?

Not at all

Perfectly

What are S/s related to Anticholinergic Effects?

Dry mouth, hot feeling

Blurred vision

Urinary retention

Photophobia

Tachycardia more serious side effect and can cause sudden death.

Blind

How well did you know this?

Not at all

Perfectly

Which is the only anxiety problem that presents with psychotic features?

A) Panic
B) severe anxiety
C) Post traumatic stress disorder
D) Substance abuse

D) Substance abuse

How well did you know this?

Not at all

Perfectly

Which of the following is an example of secondary psychosis:

A) Encephalitis
B) Schizophrenia
C) Depressive disorder
D) Personality Disorders

A) Encephalitis

How well did you know this?

Not at all

Perfectly

The nurse is caring for a patient who states that she has never been able to experience pleasure in life. The patient’s condition is known as what?

A) Perseveration
B) Alexithymia
C) Apathy
D) Anhedonia

D) Anhedonia

How well did you know this?

Not at all

Perfectly

The nurse is caring for a patient who has an inability to sit still. The patient feels nervous and jittery. What is this patient experiencing?

A) Akathisia
B) Akinesia
C) Bradykinesia
D) Dyskinesia

A) Akathisia

How well did you know this?

Not at all

Perfectly

The nurse is caring for a patient who is in the process of sliding into schizophrenia. Her patient is withdrawn, lacks energy, and has little motivation. The patient is in what phase?

A) Prodromal
B) Prepsychotic
C) Acute
D) Residual

A) Prodromal

How well did you know this?

Not at all

Perfectly

The patient has just been placed on antipsychotic drugs. It is important for the patient to know that it may take how long for the drug to become effective and stabilize the behavior?

A) Hours
B) Days
C) Weeks
D) Months

C) Weeks

How well did you know this?

Not at all

Perfectly

Ineffective coping responses Appropriate but insufficient Use or abuse of alcohol or other substances • Smoking • Overeating • Denial •Avoidance

Maladaptive Coping

After performing a screening interview on a patient, which finding should be documented as a physiological stressor? A) Dementia B) Caregiving of parent C) Divorce D)Death of friend

A) Dementia

A patient has come to the health clinic for an annual checkup. He reports increased stress at work and having to work a lot of mandatory overtime. He has not been able to do his usual daily exercise for several weeks. What is the best response by the nurse? A) "There are other ways you can reduce your stress, such as cutting back on your work hours. B) "Have you considered a medication to help you sleep at night?" C) "Including exercise in your schedule will just increase the stress from work." D) "Regular exercise would be good because it helps the body deal with stress.

D) "Regular exercise would be good because it helps the body deal with stress.

The nurse is caring for a pt diagnosed w/ a degenerative neuromuscular disease with no known cure. Which statement by the patient alerts the nurse that information about effective coping strategies is needed? A) "I have decided to take some art lessons at the community center." B) "I am sleeping much better when I have two drinks and smoke before bed." C) "I am scheduling a family reunion for the upcoming holiday. D) "I have decided to sell my house and move into an apartment with my son." Spring term

B) "I am sleeping much better when I have two drinks and smoke before bed."

Normal emotional response to a perceived threat, frustration, or distressing event Can be focused on the self or others Associated with anxiety and loss of control Can be used as a coping mechanism

Anger

forceful attitude or action that is expressed physically, symbolically, or verbally

Aggression

the ability to directly express one's feelings or needs in a way that respects the rights of other people yet retains one's dignity

Assertiveness

*Aggressive behavior that violates another person or a person's preperty* Studies have shown that assault and violence occur in a predictable pattern of ergational responses **5 stages in the assult cycle:** * Trigger * Escalation * Crisis * Recovery * Depression

Assult

Stress-producing event that brings out anger, fear, anxiety, or a similar response Client chooses coping mechanisms to achieve control * For lack of efficient coping, assaultive behavior becomes automatic Clients ability to solve problems or use nonviolent behavior decreases as aggressive feelings escalate Crisis interventions are very successful if begun early

**Trigger stage** of assult cycle

What are the 3 levels of intervention for aggressive or potentially aggressive client behaviors?

**Level 1:** Focus on the prevention of violence **Level 2:** Focus on protecting client & others from harm **Level 3:** Reserved for clients who are out of control

Defined as compulsive masculinity Characteristics: * **Attitude of male pride** * Engages in thrill seeking behavior, enjoys contact sports * **Treats women as objects or commodities** * **Egocentric (Self centered)** * *Dislikes being gentle or vulnerable* * **Displays sexist attitudes** * Unable to cooperate w/ women * Uses aggression to physically solve problems * *Agrees to sexual use & physical abuse of women*

Machismo

What are some characteristics of a dysfunctional family?

Family members are self-centered Authority is inconsistent or lacking Roles are not clearly defined Family members are unable to meet own/others needs No common goals are identified Communication is cold/indifferent Family violence is present

What are some characteristics of a women who is at risk of being abused?

Trusting nature Raised to be nonaggressive & traditional Believes that the men is master & protector of household

What are some characteristics of a man who has the potential to be an abuser of women?

Poor emotional control Superior attitude toward women Hx of substance abuse High levels of jealousy & insecurity Uses threats, punishments, & physical violence to control anothers behavior

What effects does abuse have on a pregnant woman?

Low birth weight infants Pre-term deliveries Lack of prenatal care

Most vulnerable individuals in society *Spanking & other forms of physical punishment teach children that power & violence are approved coping mechanisms* Mistreatment forms: * Physical abuse * Sexual abuse * Emotional abuse * Negelct S/s of abuse: * Little eye contact w/ adults * Withdraw from physical contact w/ adults * Fractures, bruises & welts in different healing stages

Child abuse

Vigorous shaking of an infant that leads to whiplash induced bleeding within the brain w/ no external signs of head trauma * Difficult to Dx

Shaken baby syndrome

What are examples of bullying?

**Physical**: * Choking, punching * Hitting, kicking, tripping **Verbal**: * Hate talk, mocking, threatening * Rumors, intimidating, teasing **Exclusion from activites**: * Encouraging other to stay away from * Physically barring attendence **Cyber**: * Using media to deride others through hate talk, mocking, rumrs, taunting, intimidating, teasing, threatening, & encouraging other to partake

What are the 3 leading causes of death for all adolescents?

Fatal accidents Murder Suicide

**Unwanted sexual attention** * Has a strong, lasting consequence for victims Tx: * Assess hx of abuse or victimization * Report any suspicious signs or behaviors to supervisors & required authorities

Sexual abuse

**Aggression against certain groups** Forms of aggression against members of certain groups are *quiet, subtle, & usually unspoken*

Group abuse

Developes in people who have experienced a shocking, scary, or dangerous event S/s: * *Intrusive thoughts, distressing dreams* * Fear, helplessness * **Flashbacks, emotional response** * Feel removed/detached from others * Ability to feel emotions is reduced * **Believes life will be short & wonders why they survived** Ex: * **War, military combat, bombs** * *Violent assult*, **rape**, torture * Burglary, destruction of home * Natural disaster, terrorist activities * *Witnessing assult or death*

PTSD

What are 3 types of coping mechanisms?

**Psychomotor (Physical)**: * Efforts to cope directly w/ the problem * *Ex: Confrontation, fighting, running away, negotiating* **Cognitive (Intellectual)**: * Efforts to neutralize threat by changing meaning of problem * *Ex: Making comparisons, subsituting rewards, ignoring, changing values, problem-solving behaviors* **Affective (Emotional)**: * Actions taken to reduce emotional distress * No effor to problem solve * *Ex: Denial & suppression*

What is the mnemonic for suicide risk factors?

SADPERSONS

What do the letters in SADPERSONS stand for?

**S**: Sex (male) **A**: Age (young) **D**: Depression **P**: Previous suicide attempt **E**: Ethanol & other drugs **R**: Reality testing/rational through (loss of) **S**: Social support lacking **O**: Organized suicidal plan **N**: No spouse **S**: Sickness/stated future intent

What are the following S/s related to? * Most often results of family conflict or disruption * Usually not planned * Dramatic change in attitude, behaviors, or habits following stressful event or situation A) Suicide in Adolescents B) Suicide in Children C) Suicide in Adults D) Suicide in Older Adults

B) Suicide in Children

What factors in adolescents increase their risk for suicide?

Depression Poor impulse control Emotional Isolation Dysfunctional/ disrupted family Dx w/ anorexia nervosa

What are some characteristics of suicide?

Preoccupation w/ death Sense of isolation & withdrawal Few friends or family Distraction & lack of humor/pleasure (Anhedonia) * Seem to be "in their own world" Focus of past, dwell on past losses, defeats, & anticipates no future

**Compalsive & maladaptive dependence on a substance** *(alcohol, cocaine, opiates, tobacco)* **or behavior** *(gambling, internet, pornography)* Dependency typically produces adverse psychological, physical economical, social, or legal ramifications *Related terms*: * Intoxication * Craving * Tolerance

Addiction

Caused by immediate use of a substance (intoxication) & immediate effect that ccurs when substance is discontinued (withdrawal) * Temporary & reversible Results from continued, frequent use of a substance * Cumulative effect as addiction progresses

Substance Induced Disorders

Whare are some addictions that are associated with behavior?

*Food addiction* *Gambling addiction* Gaming addiction Internet addiction Sex addictin *Shopping addiction* Cell phone addiction *Social media addiction*

What are some examples of addiction disorders?

Substance use disorder Alcohol use disorder Cocaine use disorder Heroin use disorder Inhalant use disrder Marijuana use disorder Meth use disrder Opioid use disorder

What are some risk factors for addiction?

Family hx Burnout Mood disorders, Stress Homelessness, poverty Early aggressive behavior Lack of parental supervision Drug availability

Non-emergent management of addiction **Goal is to help pt get help they need to acheive & maintain sobriety** Collaborative care is used to facilitate - Includes motivational interviewing *Relapses are common*

Recovery

What are S/s associated with heroin use?

Constricted pupils Depression Drowsiness Euphoria Resp depression Nausea

What are S/s associated with heroin overdose?

Shallow RR Clammy skin Convulsions Coma

What are S/s associated with heroin withdrawal?

Watery eyes Runny nose Sweating Muscle cramps Anorexia, Nausea Chills, tremor Panic

**0.05% - 1 or 2 alcoholic drinks (0.5-1oz)**: * *Slowed judgement / reaction time* * *More socially at ease* * Unable to do complicated tasks * *Rise in blood pressure* **0.10% - 3 or 4 alcoholic drinks (1.5oz)**: * *Debth perception altered* * Voluntary motor actions clumsy * Effected eye movement & focus * *Slower reaction time, judgement & control decreased* **0.20% - 5+ alcoholic drinks (2.5 or more oz)**: * *Entire motor area of brain effected* * May want to lie down * Staggers * *Angered easily, may weep, shout, or fight* **0.30% - 6+ alcoholic drinks (3 or more oz)**: * *Confused, unresponsive to most stimuli* * May be in stupor * Lose ability to control involuntary responses * *Decreased HR, BP, & RR* **0.40% to 0.50% - 7+ alcoholic drinks (3.5 or more oz)**: * Comatose * Medulla severely depressed * *Death d/t resp. failure* * *Death if alc. limit rises too quickly* * *Fatal at 0.50% w/o medical attention*

Blood alcohol content (BAC) *Helpful tip: Legal level 0.08%*

Result of excessive alc. intake during pregnancy **S/s**: * *Developmental delays* * *Various degress of intellectual disability* * Hyperactivity, Irritability * Poor feeding habits * Behavior problems, poor judgement * Distinctive facial characteristics **Physical features**: * *Smaller at birth, slow growth rate* * **Microcephaly (small head)** * Low nasal bridge, short nose, small midface * Short eyelid tissue * Thin upper lip

Fetal Alcohol Syndrome (FAS)

What should be assessed when triaging a suicidal pt?

**Suicide Ideation (SI):** * **Client talks about wanting to be dead or thoughts of death** * Imagines AIDS or other serious illnesses * Seems gloomy or brooding (unhappiness) **Hx of past suicide attempts:** * Client has **tried to end own life in the past** * *Possible family Hx of suicide* **Existence of suicide plan:** * More *detailed suicide plan* * More likely to carry out act **Avalibile items to carry out plan:** * **What weapons are availible?** * *How difficult will it be to obtain weapons?* **Substance use or abuse:** * Suicide rates are higher in those who abuse substances **Level of despair**: * Ask about future (despair high = hope low) **Ablility to control behavior**: * Inpatient hospitilization

What are some questions you could ask when assessing the potential for suicide?

"Are there times when death seems like an attractive option for you?" "Have things ever been so bad you have thought about escaping? If so, how?" *"Do you have access to any weapons needed to carry out your plan?"* * Guns, knives * Ropes * Enclosed garage "Have you thought about or attempted harm on yourself in the past?" **"Do you think you can control your behavior and refrain from acting on these thoughts or impulses?"** * Most important question to ask

What are some suicide precautions?

Protect client from self harm Determine if client has plan, or Hx or past suicide attempts **Remove dangerous items from room** Place in least restrictive enviornment for easier observation * **Observe closely during crisis** *Escort client everywhere the go* ## Footnote More on pg 325

**Myth or Fact:** When people show signs of improved moods, the threat of suicide is over

Myth **Fact:** Mood often improves before decision to commit suicide ## Footnote More on pg 317 box 27.1

**Myth or Fact:** Mental illness is a risk factor for suicide, not all depressed people are at risk for suicide

Fact **Myth:** Only psychotic or depressed people commite suicide

**Myth or Fact:** People who are serious about suicde show no clues

Myth **Fact:** Many people communicate warnings by tidying up affairs, giving away possessions, or being preoccupied w/ death

**Myth or Fact:** Mental illness is a risk factor for suicide, not all depressed people are at risk for suicide

Fact **Myth:** People who are serious about suicde show no clues

**Myth or Fact:** Failed suicide attempt is manipulative behavior

Myth **Fact:** Manipulation is usually not a factor

**Myth or Fact:** People who talk about suicide will not comminte suicide

Myth **Fact:** More people communicate their intent

**Myth or Fact:** Every threat should be take seriously

Fact **Myth:**Suicide threats should not be taken seriously

Act of sexual violence by one person against another * Many victims live through experience by wish they died **Surviors often feel violated, angery, frustrated, shame, guilt, loss of control, fear, or haunted by the action** *Individuals often feel need to retreat to a safe place, clean themselves off, & remove all reminders of the event* * Destroys most evidence useful in apprehending the offender **Strong support, gentle understanding, & nonjudgemental acceptance are powerful influences on how well the victim copes w/ this trauma**

Rape Trauma Syndrome

How do you treat victims of violence?

**Ensure safety** **DO NOT leave client alone** *Explain all procedures simply, & ensure cooperation before proceeding* Show respect *Allow client to be in as much control as possible* Care plan developed on type of abuse, & resources availible

What are some Physical Realm problems related to violence?

Risk-prone behavior, risk-prone health Risk for violence (self or other directed) *Noncomplience* **Rape Trauma Syndrome**

What are some Psychosocial Realm problems related to violence?

Anxiety, fear, denial Helplessness, hopelessness Ineffective coping Impaired family process, impaired social interaction Self-esteem disturbance

**Serious, irreversible CNS side effect of antipsycholtic meds** * *Anticholinergic agents will worsen* Assess for signs by using the abnormal involuntary movement scale S/s: * **Protrusion of tounge** (Flycatcher sign) * *Puffing cheeks/ tounge (Bonbon sign)* * *Lip smaking / puckering* * *Blinking/ squinting* * *Impared gag relfex* (chocking, aspiration) * **Twitching trunk, legs, arms, or face** * Toe movements, foot tapping * Impaired diaphragmatic movements (dif. breathing) *Elderyly women w/ stroke hx & young men taking large doses of high-potency antipsych. meds* **(haloperidol)** *are at risk* * Younger men may be prescribed prophylactic antiparkinsonian drugs* Interventions: * Soft food diet * Suction ready * Education on S/s * Routine assessments * Prevent injury

Tardive Dyskinesia

**Potentially fatal extrapyramidal side effects (EPSE - dystonia, akathisa) of antipsychotic meds** * Occurs often when 2+ psychotheraputic drugs are given (lithium or depot (oil based)) *Death can occur from resp. failure, kidney failure, pneumonia, or pulmonary embolism* **S/s**: * **Elveated temp (103 degress+)** * **Change in LOC** * Rigid muscles (rapid onset) * Tremors * **Resp. difficulty**, pnemonia * Inability to speak * **Tachycardia, rapid change in BP, labored RR** * Increases perspiration (diaphoresis) * *Increased WBC* * Possible kidney failure, UTI **Interventions**: * Monitor Vitals * **Report sudden fever, change in BP, or sudden change in LOC** * monitor during Tx (Onset can be rapid or gradual)

Neuroleptic Malignany Syndrome (NMS)

**Inability to sit still** * *Side effect to extrapyramidal side effects (EPSE)* S/s: * Nervous / nervous energy * jittery * Assaltive behavior if in one spot **Best Tx is to reduce dose of antipsychotic meds**

Akathisia

**Characterized by involuntary , abnormal skeletal muscle movement** * *Side effect to extrapyramidal side effects (EPSE)* Usually seen as jerking motion * interfers w/ ability to walk and perform other voluntary movements

Dyskinesia

What are some anticholinergic side effects?

Dry mouth Blurred vision Urinary retention Chlorpromazine (Thrazine) * low-potency antipsych med

Are the following drugs classified as Atypical or Typical? Aripiprazole (Abilify) Brexpiprazole (Rexulti) Clozapine (Clorzaril) Olanzapine (Zyprexa) Quetiapine (seroquel)

Atypical

*Don't react to things happening nearby or may react in ways that seem unusual* **Impaired communication, unusual movements or lack of movement, and behavior abnormalities** are the most striking features of this condition S/s: * Ridgid posture * *Echopraxia* (mimics movements) * Mute * *Echolalia* (Echos others) * *Malnutrition, dehydration* (fails to eat/drink) * *Fair prognosis*

Catatonic Schizo

Disoriented speech, thinking, w/ flat or inapproriate behaviors * Early onset S/s: * Distorted facial expressions * Giggles or cries out * Loosely organized hallucinations/delusions * *Unable to perform ADLs* * *Poor prognosis*

Disorganized schizo

**Believes someone/something is out to get them** * *late onset* S/s: * *Auditory hallucinations* * High anxiety * *Complex delusions & grandeur (belives they are special/better than others)* * *Suspicious, guarded, hostile*, angry, violent * Suicidal, withdrawn * Prognosis good w/ Tx

Paranoid schizo

**Free of psychosis but sstill has negative s/s of the disorder** * Had at least 1 acute episode of schizo S/s: * Withdrawn * Emotional changes * Disorganized thinking, odd behavior * Poor prognosis

Residual Schizo

**Rapid change intopics w/ rapid flow of speech** * Speech disturbance associated w/ schizo **Example: "The sky is blue. The dog is dead, & I have 2 eyes."**

Flight of ideas

**Expressing belief that some events have special personal meaning** * Speech disturbance associated w/ schizo **Example: " The united states are sendin satelites into space to spy on me"**

Ideas of Reference

**Thinking characterized by speech that moves from one unrelated idea to the next** * Speech disturbance associated w/ schizo **Example: "I'm hungry but the desert has no rain so it's cold outside"**

Loose associations

Refusal to speak * Speech disturbance associated w/ schizo

Mutism

**Words or expressions invented by the individual** * Speech disturbance associated w/ schizo **Example: "The Ispy is not happy when the fulgari is green"**

Neologism

**Rapid, forced speech** * Speech disturbance associated w/ schizo **Example: "I must prepare. There is no time to waste. Can't talk now"**

Pressure speech

**Random, jumbled set of words that have no connection or relationship to one another** * Speech disturbance associated w/ schizo **Example: "Hot happies are spying on me but no men have short feet"**

Word salad

What are 4 theories relating to psychosis? ## Footnote Morrison pg 371

**Possession Theory:** * Believes that the thoughts in their mind are not their own **Biopyschosocial model status:** * States schizo is a result of a combination between physical, psychological, & social factors **Stress/disease/trauma model:** * **Looks at effects of stress on the individual,** especially during prenatal period * *Viural infections & severe malnutrition* during pregnancy contribute to development of schizo **Sociocultural theories:** * *Considers effects of enviornment on psychosis* * **Poverty, homeless, unstable family, cultural differences, ect.**

**Slowed physical growth because of inability to intergrate the physical, emotional, & sensorimotor realms** of functioning **Most often related to neglect, enviornment problems, or severe family stress** Children do not have consistent opportunites to experience activities & conditions for normal growth & development

Failure to Thrive Syndrome

**Information gathered for legal purpose** Helps find & convict the perpetrator(s) of violence * **Must document throughly** **By law, HCP must report incidents to police** * *Law does not require victims of rape to report it* * All evidence must be gathered carefully

Forensic Evidence

**Most commonly used for anxiety** * Less likely to interact w/ other drugs or cause overdose **Example of drug: Lorazepam (Ativan)** * PO, IV, IM Use: * **Sedation** * Muscle relaxant * Antianxiey, anticonvulsant * *Reduce hepatic function* **Therapeutic outcome: Decreased anxiety** Interventions: * Record baseline for anxiety * **Record baseline for vitals** * Check for Hx of blood dyscrasias or hepatic disease * **Determine if pregnant or breastfeeding (Not andimisterd during first trimester, Do not breastfeed)**

Benzodiazepine

**Class: Opiate** * PO, IM Blockes the effects of opioids by competeing for binding sites at opiate receptors Use: * **Diminishes or eliminates opiate & alcohol cravings** * *Must be used w/ other therapies ( support groups or behavior therapy)* **Theraputic outcomes:** * *Improve adherence w/ substances & alcohol* Interventions: * Perform basline neuro assessment *(A&O, bilateral hand grip, motor functioning)* * Monitor vitals * **Check labs for hepatotoxicity (elevated belirubin, AST,ALP, & PT)** * *Monitor for GI sympotoms before and after* * *Obtain baseline liver function tests* before initiating tx & repeat for 6 months * **7-10 day minimum for opioids to leave system, collect UA so ensure non in system**

Naltrexone

**Used to treat alcoholism** * Used w/ other rehab therapies * PO *When ingested before consumption of alc. a unpleasent reaction occurs* * N/V, dizziness * Blurred vision * Confusion * Sweating * Throbbing headache *Blocks metabolism of alc. called acetaldehyde* **Avoid all alc. products:** * *Mouthwash, rubbing alc.* * sleeping aids, *cough / cold products* * *Aftershave lotion* * Certain sauces & vinagers **Interventions:** * Perform basline neuro assessment *(A&O, bilateral hand grip, motor functioning)* * Monitor vitals * **Check labs for hepatotoxicity, UA (elevated belirubin, AST,ALP, & PT)** * *Monitor for GI sympotoms before and after* * *Obtain baseline liver function tests* **Adverse effects:** * Hives, puritus, rash * **Hepatotoxicity (jaundice, N/V/A, hepato/splenomegaly)** * Drug interactions (warfarin, phenytoin,benzos, ect.)

Disulfiram