Chapter 7 & 12 Flashcards
What is cognitive theory?
an outgrowth of theoretic perspectives, including the behavioral and psychodynamic, that attempts to link internal thought processes with human behavior
What is transference?
Unconscious assignment to a therapist or nurse of a pts feelings and attitudes that were originally associated with important figures like parents or siblings
What is countertransference?
Therapist or nurse reaction to a pt that are based on interpersonal experiences, feelings, and attitudes. It can significantly interfere with the nurse-pt relationship
What is psychoanalysis?
Freudian concept that focuses on repairing the trauma of the original psychological theory through the process of accessing the unconscious conflicts that originate in childhood and then resolving those issues with a mature adult mind
Who are the psychoanalytic theorists?
Sigmund and Anna Freud
Sigmund Freud
Founder of psychoanalysis and believed that the unconscious can be accessed through dreams and free association. Has a theory on infantile sexuality
Anna Freud
Psychoanalytic theorist, talked about defense mechanisms in kids
Who are the Non-Freudian theorists? (I used their last names)
Adler, Jung, Rank, Fromm, Klein, Horney
Alfred Adler
Non-Freudian; 1st defected from Freud, founded school of individual psychology. He focused on inferiority and added to the understanding of human motivation. His theory is based on principles of mutual respect, responsibility, consequences, and belonging
Carl Gustav Jung
Non-Freudian; founded school of psychoanalytic psychology. He created analytical psychology. He believed in introversion and extroversion for personalities.
Otto Rank
Non-Freudian; Birth trauma
Erich Fromm
Non-Freudian; emphasized that society and individual are not separate and that desires are formed by society
Melanie Klein
Non-Freudian; devised play therapy techniques that shows how a kids interaction with toys reveals earlier infantile fantasies and anxieties. She is a pioneer in object relations identifications
Karen Horney
Non-Freudian; opposed Freuds theory of castration complex in women and his emphasis on the oedipal complex. Situational neurosis. She was the beginning of feminist analysis of psychoanalytic thought
Who was the interpersonal relations theorist?
Harry Stack Sullivan
Harry Stack Sullivan
Interpersonal relations; impulses and striving need to be understood, provided framework for the introduction of interpersonal theories in nursing
Who are the humanist theorists?
Maslow, Perls, Rogers
Abraham Maslow
Humanist; focused on needs and motivation, healthy people rather than sick, and approached from a holistic-dynamic viewpoint. Used to prioritize care
Maslows hierachy of needs
-physiologic needs (air, water, food, sleep)
-safety and security (shelter, predictable environment)
-love and belonging
-esteem
-self-actualization (development of full personal potential)
Frederick S. Perls
Humanist; developed Gestalt therapy. the root of human anxiety is frustration with the inability to express natural biologic and psychological desires in civilization. Reality, here and now
Carl Rogers
Humanist; based on the view of human potential for goodness. He used the term client instead of patient. Empathy, unconditional positive regard. never give advice and always clarify the clients feelings. Client-centered therapy
What are Freuds thoughts on the unconscious?
It is remembered in dreams
What is preconscious?
Describes unconscious material that is capable of entering consciousness
What are the 3 aspects of personality according to Freud?
ID, ego, superego
What is ID?
Formed by unconscious desires, primitive instincts, and unstructured drives including sexual and aggressive tendencies
What is ego?
Controls movement, perception, and contact with reality. The capacity to form relationships is not present at birth and is developed throughout childhood
What is superego?
Ethics, standards, self-criticism
What is object relations?
Freud; the psychological attachment to another person or object
ex: child imitates their mom, and later becomes like their mom in adulthood.
What are Freuds thoughts on anxiety and defense mechanisms?
Anxiety is the reaction to danger and is experienced as a specific state of physical unpleasantness.
Defense mechanisms are coping styles that protect a person from unwanted anxiety
Libido
Energy or psychic drive associated with sexual instinct. This is ID according to Freud
Behavior theories attempt to explain…
how people learn and act and never attempt to explain the cause of the mental disorders. They focus on normal human behaviors. Stimulus-response and reinforcement theories are important
Who are the early-stimulus response theorists?
Pavlov and Watson
What is the Pavlovian theory?
Ivan Pavlov; Dog salivated when he heard the bell instead of when he saw the food. This is classical conditioning by using an unconditioned stimuli, unconditioned response, and conditioned stimuli
What is Watsons theory?
He introduced behaviorism and believed that learning was classical conditioning called reflexes. He rejected the distinction between mind and body. He introduced the principle of frequency and recency.
What is the principle of recency?
The closer in time a response is to a particular stimulus, the more likely the response will be repeated
What is the principle of frequency?
The more often a response is made to a stimulus, the more likely the response to that stimulus will be repeated
Who were the theorists for reinforcement theories?
Thorndike and Skinner
Edward Thorndike
Experimental animal psychology; 1st person that believed in reinforcing positive behavior for learning.
B. F. Skinner
Studied operant behavior/conditioning. if a behavior is reinforced or rewarded with success, praise, money, etc. the behavior will probably be repeated. This was important for behavior modification
Who are the cognitive theorists?
Bandura, Beck, Lewin, Tolman
Albert Bandura
social cognitive theory; importance of modeling behavior. Self-efficacy is also emphasized
Aaron Beck
Cognitions are verbal or pictorial events in the stream of consciousness. Depression improved when pts started viewing themselves in a positive light. Depression is from distorted cognition.
Kurt Lewin
Developed field theory which is a system for understanding, learning, motivation, personality, and social behavior. He focused on life space and positive valences
Edward Chace Tolman
Introduced the concept of cognitions; believed that human beings act on beliefs and attitudes and strive towards goals. He focused on negative valences and cognition. He was important in identifying person’s beliefs
How are behavioral theories applied to nursing?
Patients education interventions are usually derived from them
Developmental theories explain…
normal human growth and development over time
Erik Erikson
Psychosocial development most often used in nursing. There are 8 stages: trust vs mistrust, autonomy vs shame and doubt, initiative vs guilt, industry vs inferiority, identity vs role diffusion, intimacy vs isolation, generatively vs stagnation, and ego integrity vs despair
Eriksons thoughts on identity and adolescence
When adolescence beings, childhood ways are given up, bodily changes occur, and an identity is formed
What age does basic trust vs mistrust go with and what is the long-term outcome?
Infant; drive and hope
What age and long-term outcome does autonomy vs shame and doubt go with?
Toddler; self-control and willpower
What age and long-term outcome does initiative vs guilt go with?
Preschool-aged kids; direction and purpose
What age and long-term outcome does industry vs inferiority and doubt go with?
School-aged kids; method and competence
What age and long-term outcome does identity vs role diffusion and doubt go with?
Adolescence; devotion and fidelity
What age and long-term outcome does intimacy vs isolation go with?
Young adult; affiliation and love
What age and long-term outcome does generativity vs stagnation go with?
Adulthood; production and care
What age and long-term outcome does ego integrity vs despair go with?
Maturity; renunciation and wisdom
Jean Piaget
He views intelligence as an adaptation to the environment. His theory was developed through observation of his own kids and never received formal testing. It provides a framework to recognize different levels of thinking in the assessment and intervention process
Carol Gilligan
Gender differentiation in moral development. Boys separate from their moms and girls attach. Ethic of care: pre-conventional (selfishness) to conventional (responsibility to others) to post-conventional (don’t hurt others or self)
Sensorimotor stage of Piaget
Birth to 2 yrs; characterized by reflexes, habit, insight and object permanence
Pre-operational stage of Piaget
2-7 yrs old; symbolic play, graphic imagery, reasoning, egocentrism
Concrete operations stage of Piaget
7-11 yrs; conservation of quantity, weight, height, volume, length, and time based on reversibility or reciprocity
Formal operations stage of Piaget
Variables are isolated and all possible combinations are examines, hypothetical-deductive thinking.
Jean Baker Miller
A sense of connection; female development within relationships and experiences. Focuses on connections and disconnections
How do the developmental theories apply to psychiatric nursing?
They are used in understanding childhood and adolescent experiences and their manifestations as an adult. It can be used to gauge mood and development. They don’t account for diversity in gender, lifestyle, and cultures
Family dynamics
Social theory; patterned interpersonal and social interactions that occur within the family structure over the life of a family. These are useful to nurses who are assessing family dynamics and planning interventions. Not usually used in psychiatric nursing
Formal support systems
Large organizations like hospitals or nursing homes that provide care to individuals
Informal support system
Family, friends, and neighbors. People with this system usually live longer than those without
Social distance
The degree to which values of the formal organization and primary group members differ
Role theories
Universal roles of a healer may be a nurse in one culture and a spiritual leader in another. They emphasize the importance of social interaction in either the persons choose or societies recognition of a particular role
Margaret Mead
Sociocultural perspective; She established the importance of culture in determining human behavior. Accepted in anthropology; criticized for being filled with misinterpretations
Madeleine Leininger
Transcultural health care directed toward holistic, congruent, and beneficent care.
How is social theories applied to psychiatric nursing?
You must consider the role of the patient within the family and society
Hildegarde Peplau
Nursing theory, interpersonal; empathetic linkage. Anxiety, self-system, and needs are a key concept
What is empathetic linkage?
The ability to feel in oneself the feelings experienced by another person
What are the levels of anxiety?
-Mild: awareness heightens
-Moderate: awareness narrows
-Severe: focused narrow awareness
-Panic: unable to function
Ida Jean Orlando
Identified 3 areas of nursing concern: the nurse-pt relationship, the nurses professional role, and the identity and development of knowledge that is distinctly nursing. Helpful in fall prevention
Rosemarie Rizzo Parse
Humanbecoming theory which views humans as indivisible, unpredictable, and ever-changing. Major themes are meaning, rhythmicity, and transcendence. Living a human life is illuminating, paradox, freedom, and mystery.
Jean Watson
Theory of transpersonal caring. She believes that caring is the foundation of nursing. There are 3 foundational concepts to her theory; transpersons caring, 10 caritas process, and caritas field. This model emphasizes the importance of sensitivity to self and others, helping and trusting relationships, teaching and learning. Her theory has been show to decrease pt emotional strain and increase confidence as well as increase nurse satisfaction
Imogene King
System model; developed theory of goal attainment that is based on 3 interacting systems: personal, interpersonal, and social. This process is initiated to help the patient cope with a health problem that compromises their ability to maintain social roles, functions, and ADLs
Betty Neuman
System model; key components are a client system interacting with the environment. This can be applied to prevention and treatment.
Dorothea Orem
Systems model; self-care is the focus of the general theory of nursing. It has 3 parts (self-care, self-care deficit, and nursing systems). It promotes independence of the person
According to Orem’s theory, what can nurses do to help meet self-care for the patient?
Acting or doing for, guiding, teaching, supporting, and providing an environment to promote the pts ability to meet current or future demands
Martha Rogers
Model of unitary human beings
Calista Roy
Adaptation model
T/F
Nursing theories form the conceptual basis for nursing practice and are useful is psychiatric nursing
T
Akathisia
An extrapyramidal side effect characterized by the inability to sit still/restlessness. Its more common in middle aged pt’s
What are atypical antipsychotics? (in general)
Newer antipsychotics that are equally or more effective than conventional antipsychotics but have fewer side effects
What are typical antipsychotics? (in general)
Conventional; “older” meds used to treat psychotic disorders with more side effects than “newer” atypical antipsychotics
Dystonia
Usually occurs within a few days of administering an antipsychotic. Characterized by involuntary muscle spasms, especially in head and neck. It is the 1st extrapyramidal effect to occur
Phototherapy
Light therapy; exposes pt to artificial light source during the winter months to help relieve seasonal depression
What is pseudoparkinsonism
Drug-induced Parkinsonism; presents are Parkinson’s but without the destruction of dopaminergic cells
Serotonin Syndrome
Life-threatening side effects that results from overactivity of serotonin. Symptoms are mental status changes (hallucination, agitation, coma), autonomic instability (tachycardia, hyperthermia, changes in BP), neuromuscular problems (hyperreflexia, incoordination), and GI (n/v, diarrhea)
Tardive dyskinesia
A late appearing extrapyramidal effect of antipsychotics meds that involve irregular, repetitive involuntary movements of the mouth, face, and tongue (lip smacking, chewing, tongue protrusion)
Phases of new drug testing
1: range of dosages tolerated in healthy people
2: effects of drug are studied in limited amount of people w/disorder. Defines range of clinically effective dosage
3: studies done with large amounts of pts. Ends with new drug application submitted to FDA
4: drug studies continue after FDA approval to find rare adverse reactions.
If someone has blurred vision while on a medication, what do you do?
Give reassurance, it generally subsides in 2-6 weeks
Pharmacodynamics
Action or effect of drugs on living organisms
Efficacy
Ability of a drug to produce a response
Norepinephrine reuptake inhibition
Antidepressant. Side effects are tachycardia, tremors, insomnia, erectile/ejaculation dysfunction. It interacts with guanethidine
Examples: Desipramine, Venlafaxine
Serotonin reuptake inhibitor
Antidepressant and antiobsessional. Side effects are GI distress, nausea, headache, restlessness, anorgasmia
Examples: Fluoxetine, Fluvoxamine
Dopamine reuptake inhibition
Antidepressant and antiparkinsons. Side effects are aggravation of psychosis and increase in psychomotor activities
Histamine receptor blockade
Examples: clozapine, olanzapine
Side effects: sedation, drowsiness, hypoTN, weight gain
Dopamine receptor blockade
Antipsychotic action
Side effects: extrapyramidal effects, endocrine changes
Examples: haloperidol, Ziprasidone
Pharmacokinetics
Process where drug is absorbed, distributed, metabolizes, and eliminated by the body
Pharmacogenomics
Study of how a persons genetic makeup affects their response to drugs
Phases of drug treatment
Initiation, stabilization, maintenance, and discontinuation of the medicine
Polypharmacy
Using more than 1 group from a class of medications
What types of disorders do antipsychotic medications treat?
Schizophrenia, mania, autism, psychosis (hallucinations, delusions, disorganized thinking, agitation, aggressiveness)
What 2 antipsychotic meds are approved for treating Tourette syndrome?
Typical antipsychotic: haloperidol and pimozide. They reduce the frequency and severity of vocal tics
What route are antipsychotic medications given and how are they metabolized?
PO, IM
Liver
What are the long-acting injectable atypical antipsychotics?
Risperidone, paliperidone, olanzapnie, and aripiprazole
Conventional antipsychotics are usually water or oil based?
Oil based
General side effects of antipsychotic medications
Ortho hypoTN, prolonged QT, anticholinergic s.e. (dry mouth, constipation, blurred vision), weight gain (atypical!!), diabetes, sexual side effects, blood dyscrasia (clozapine), neuroleptic malignant syndrome, photosensitivity, seizure, EPS, TD
Lorazepam (Ativan)
Benzodiazepine, it may cause drowsiness, lethargy, and general sedation or paradoxical agitation. It can be given PO/IM. Helps to treat medication-related movement disorders
What medications work in treating akathisia?
None, it is more difficult to relieve and doesn’t respond well to anticholinergic meds.
When do symptoms of tardive dyskinesia start to show?
They usually show 6 months after treatment or when the medication is reduced/withdrawn
What are mood stabilizers used for?
Antimanic; stabilizes mood swings, especially those of mania in bipolar disorders
Which drug is the gold standard for bipolar disorder, decreasing suicide, and preventing return of mania and depression?
Lithium
What types of meds are used for their mood stabilization/antimania
Anticonvulsants, CCB, adrenergic blocking agents, atypical antipsychotics
What is the action of lithium?
Uncertain, crosses all cell membranes, alters sodium transport, not protein bound
What are some side effects lithium?
Lithium toxicity, thirst, metal taste, weight gain, diarrhea, thyroid dysfunction
Lithium contraindications
Pregnancy, taking NSAIDs and diuretics
What are the lithium levels for the following:
-acute mania
-maintenance phase
-therapeutic
Acute: 0.8-1.4
Maintenance: 0.4-1
Therapeutic: 0.6-0.8 and 1.2-1.4
How often does a CBC need to be drawn when taking lithium for bipolar?
Every 6 months
What do anticonvulsants treat?
Bipolar and acts as a mood stabilizer
What are the 3 anticonvulsant drugs approved for treatment of bipolar disorder, mania, or mixed episodes?
Valproate, carbamazepine, and lamotrigine
Anticonvulsant side effects
Carbamazepine: rare aplastic anemia, agranulocytosis, rash, cardiac problems, SIADH
Valproic acid: weight gain, alopecia
Lamotrigine: rash occurring with in 2-8 weeks
What disorder is antidepressants used cautiously in?
Bipolar because it can precipitate a manic episode
Name a few antidepressant medications
SSRI (Lexapro, prozac, sertraline), Norepi dopamine RI (bupropion), trazodone (desyrel)
SSRI action and side effects
-Inhibits the reuptake of serotonin by blocking its transport to the presynaptic neuron
-Side effects: HA, anxiety, insomnia, n/v, sedation, sexual dysfunction
-examples: prozac, sertraline, lexapro
Serotonin norepinephrine reuptake inhibitor action and side effects
- prevents reuptake of serotonin and norepinephrine
-side effects: increased BP, mild sedation, dry mouth, liver failure
-examples: venlafaxine, nefazodone, desipramine (technically a tricyclic antidepressant)
Tricyclic antidepressant
Treats depression. These meds are highly bound to proteins. Side effects are cardio toxicity, anticholinergic effects, blood dyscrasias, NMS, EPS
Monoamine oxidase inhibitors (MAOI)
It increases the amount of serotonin and norepinephrine at the synapse. PO forms are phenelzine, isocarboxazid, tranylcypromine and transdermal form is selegiline. These interact with tyramine-rich foods (aged cheeses, not fresh meat, fava bean, tap beers, red wine, marmite, sauerkraut, soy sauce)
Buspirone and lorazepam (Ativan) help with what disorder?
anxiety; buspirone is an anxiolytic and lorazepam is a sedative-hypnotic
Examples of benzodiazepines
alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium), chlordiazepoxide, flurazepam, triazolam
-relieve anxiety and insomnia
Benzodiazepine side effects
Drowsy, memory impairment, ataxia, confusion, rebound insomnia/anxiety, CNS depression
Nonbenzodiazepine example
Buspirone
Buspirone
-treats anxiety but not panic disorder or OCD, lacks potential for abuse
-2-4 weeks of continual use for symptom relief
-side effects: digoxin toxicity, dizzy, drowsy,
-avoid giving to pregnant people
Antihistamines
Used to treat anxiety as a substitute for benzodiazepines
-example: hydroxyzine (itching, nausea)
-side effects: deep sleep, incoordination, sedation, hypoTN, tinnitus, dry mouth
What do sedatives do?
Reduce anxiety, nervousness, and excitability without causing sleep. When given in large doses, it can have a hypnotic effect
What do hypnotics do?
Cause drowsiness and facilitate the onset and maintenance of sleep
What medications are considered sedative-hypnotics?
Benzos, GABA enhancers, melatonergic hypnotics, antihistamines, and the orexin receptor antagonist
Stimulants and wakefulness-promoting agents are approved for what medical uses?
Narcolepsy, ADHD, and obesity unresponsive to other treatments. It can also be used as an adjunctive treatment in depression
Psychostimulant side effects
They occur within 2-3 weeks after use begins; appetite suppression, insomnia, irritability, weight loss, nausea, HA, palpitations, constipation, dry mouth. They can suppress growth and development in kids. Social withdrawal can occur.
Herbal therapies are often used in addition to or in place of ….
Antidepressants and anti anxiety medications
St. Johns wort (SJW)
Used for depression, pain, anxiety, insomnia, and PMS. It modulates serotonin, dopamine, and norepinephrine. This herbal med increases chance of serotonin syndrome, interacts with birth control, and can’t be taken with antidepressants.
Kava
Used for anxiety reduction. There is a severe liver injury associated with this as well as thrombocytopenia, leukopenia, and hearing impairment
Valerian
Used for insomnia and nervousness. Relatively safe, but can cause liver toxicity
Tryptophan
Dietary precursor for serotonin. Low levels of this can cause depression and aggressive behavior
Melatonin
Used for insomnia and to prevent jet lag
Lecithin
Used to improve memory and treat dementia
Electroconvulsive therapy (ECT)
Used for severe depression, mania, and schizophrenia. It produces seizures lasting 25-150 seconds and the pt won’t feel stimulus or recall the procedure. It can be repeated 2-3 times a week for a total of 6-12 treatments. Must be NPO after midnight.
Phototherapy
Light therapy; used for seasonal depression. Expose pt to artificial light source during the winter which will help cause a shift in the circadian rhythm. It can cause eye strain, HA, or insomnia.
Transmagnetic stimulation (TMS)
It acts as an anticonvulsant medication as well as treating depression. There is repetitive and deep TMS.
Vagus nerve stimulation
Approved for adjunctive therapy of severe depression for those who are unresponsive to 4 or more adequate antidepressant treatments because VNS is a permanent implant. It is not a cure for depression
How can adherence to medications be improved?
Engaging in psychoeducation
Antipsychotic meds are used for schizophrenia and act by blocking dopamine or serotonin postsynaptically. Older typical antipsychotics work on positive symptoms and are inexpensive but produce more side effects than newer atypical antipsychotic drugs which work on positive and negative symptoms.
Just read the front
Mood stabilizers or antimanic meds control variations in mood related to mania. Lithium and anticonvulsants are chemically unrelated and act in different ways to stabilize mood
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Newer antidepressants like SSRIs have fewer side effects and are less lethal in overdose than TCAs
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Antianxiety meds primarily consist of benzodiazepines and nonbenzos. Benzodiazepine enhances effect of GABA & can be used PRN and nonbenzo buspirone acts on serotonin & must be taken regularly.
Just read the front
Psychostimulants are used for narcolepsy and ADHD
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