Class 5: Mental Health Flashcards
Positive symptoms of pyschosis
-Delusions, hallucinations, disorganized thinking and behaviors
-Poor social functioning
-Sudden onset improved with antipsychotic medication
Negative symptoms
-Absence of thought and behavior patterns contributing to inappropriate social functioning
-Slow onset that worsens
Delusions
-aThought content, fixed false beliefs
-Cannot be corrected by reasoning or evidence
Examples of delusions
-Grandiose, persecutory, somatic & nihilistic
-GPSN
Nihilistic
Belief that they’re dead
Persecutory
Being watched
Somatic
aBodily function
Disorganized thinking
Illogical speech, impaired reasoning, loose associations
Abnormal motor behaviour
-Agitation, aggression (perceived or toward others), catatonic excitement, echopraxia, hypervigilance, mutism, rigid (could be r/t medications), waxy flexibility
Echopraxia
Imitating others behaviors
Catatonic excitement
Hyperactivity of purposeless activities and abnormal movements such as grimacing and posturing
Waxy flexibility
Posture held in an unusual position
Brief pyschotic disorder criteria rules
-2 or more of the following, presenting for 1 month. At least one of these needs to be: Delusions, hallucinations or disorganized speech
-Episode lasts at least 1 day but less than 1 month with a return to a normal level of functioning
Brief psychotic disorder criteria manifestations
Catatonic behaviour, delusions, disorganized speech and behavior, hallucinations
Brief psychotic disorder etiology
Can result from changes in physical status, major life events, drug use, and environmental changes
Prevalence of brief psychotic disorders
Onset in the mid 30s, can occur at any age, twice as common in females, more common in developing countries
Delusional disorder criteria rules
-1 or more delusions over 1 month
-Delusion criterion for schizophrenia has not been met, if hallucinations are present they are not prominent or r/t delusion
-Function is not markedly impaired
Subtypes of delusional disorder
-Jealous, somatic, erotomania (sexual), & grandiose
-JSEG
Delusional disorder prevalence
-Rarely exists on its own, comorbidities include: Mood disorders, OCD, and personality disorders (specifically paranoid, schizoid, avoidant)
-Can begin in adolescence
Delusional disorder may go..
Undiagnosed because behavior is not noticeably abnormal
If delusions are…
Somatic, individuals risk unnecessary medical investigations and legal interventions
Neurobiological etiology of delusional disorder
-Asymmetrical temporal lobes, possible neuro-degenerative component
-Sensory alterations in the nervous system associated with cortical changes
-Perceptions linked with an interpretation that has deep emotional significance but no verifiable basis
SDOH + delusional disorder etiology
Early life experiences
Schizophrenia criteria rules
-2 or more of the following over a 1 month period. Must include delusions, hallucinations, or disorganized speech
-Lasts >1 month >6 months
Schizophrenia manifestations
Delusions, disorganized speech and behavior, negative symptoms, and hallucinations
Phase I (acute) assessment of schizophrenia
-Onset of illness, loss of function abilities
-Florid, disruptive symptoms (positive or negative)
Phase II (stabilization) assessment of schizophrenia
-Period of wellness
-Move from acute care to community-based services, still require supervision
Phase III (maintenance) assessment of schizophrenia
Progress in not a linear
Prevalence of schizophrenia
-Late teens/ early adolescents
-Becomes chronic in 80% of individuals who are diagnosed, poor functioning before onset of disease
-More common in males, except in later onset
Early onset of schizophrenia
Early onset ( 18-25 yrs.): Increased brain abnormality & increased apathy
Later onset of schizophrenia
Later onset (25-35 yrs.): More likely to be female, less structural brain abnormality
Schizophrenia genetic etiology
-Heredity, polygenic disease, irregularities on chromosomes 13 and 15
-Rate increases by 10 x if you have a first degree relative with schizophrenia
Schizophrenia neurobiological etiology
-Neurotransmitters; dopamine, and serotonin, glutamate
-Dopamine & serotonin; based on the use of use of conventional antipsychotics
-Glutamate; involved in neural communication, memories, learning, regulation, CNS maturation
-GSD
Schizophrenia brain structure abnormalities + etiology
-Differences in structure of the ventricles
-Lower brain volume, increased CSF, decreased blood flow to the frontal lobe
Schizophrenia comorbidity + etiology
Obesity & diabetes
Schizophrenia etiology + prenatal risk factors
Viral infections, poor nutrition, hypoxia, toxins, birth complications, age of conception
Schizophrenia etiology + psychological stressors
-Prolonged increased stress results in aHypothalamus development
-Recreational drugs increase dopamine
-Trauma
-PRT
Schizophrenia etiology + SDOH
Adverse living conditions, migration
Across the lifespan considerations + children & adolescents
-Look for patterns
-Consider if the difficulties are r/t developmental tasks (i.e. exploration with drugs, alcohol, and sex; seeking autonomy)
Across the lifespan considerations + older adults
Presence of additional factors may increase patients’ stress and potential for secondary concerns
Delusional disorder general appearance + engagement
-No functional impairment, may become more distracted as it progresses
Delusional disorder general appearance + grooming & dress
Disrupted self-care
Delusional disorder affect
Anxiety with progression of illness
Delusional disorder thought content + delusions
Fixed false beliefs
Delusional disorder thought content + suicide, homicide, self-harm, depressive & anxious cognitions
Assess impulsivity to act in relation to the delusion
Schizophrenia general appearance positive & negative symptoms + engagement
-Positive: Engage in conversation but unmotivated to change
-Negative: Apathetic, withdrawn, anergia, anhedonia, avolition
Anergia
Lack of energy
Anhedonia
Inability to feel pleasure
Avolition
Lack of motivation
Schizophrenia general appearance positive & negative symptoms + movement
-Positive: Psychomotor agitation, repeated motor behaviours, waxy flexibility, & echopraxia
-Negative: Stuporous, psychomotor retardation, comatose
Schizophrenia general appearance + grooming
Poor maintenance of hygiene & ADLs
Schizophrenia general appearance + dress
Eccentric dress
Schizophrenia affect positive & negative symptoms
-Positive: Blunted, anxious, fearful, irritable
-Negative: Blunted, flat
Schizophrenia mood positive & negative symptoms
-Positive: Low d/t paranoia
-Negative: Low d/t lack of motivation
Schizophrenia speech
Alogia (poverty of speech), slow, hesitant, quiet
Schizophrenia language
Poverty of content, variable vocabulary, not fluent, troubles comprehending
Schizophrenia thought process
Disorganized, range from less goal directed to lack of connection between ideas
Schizophrenia thought process + range from goal directed to lack of connection between ideas
Loose associations, circumstantiality, tangentiality, neoglisms, echolalia, word salad
Loose associations
Interrupted thoughts
Circumstantiality
Inclusion of unnecssary details
Echolalia
Repeating of another’s words (often seen in catatonia and neurological disorders)
Schizophrenia thought content + delusions
-Fixed false beliefs, more common with positive symptoms
-Delusions are usually grandiose & persecutory
-Concrete thinking
Schizophrenia thought content + suicide, homicide, & self-harm
-In response to hallucinations, delusions, paranoia, impaired judgement, or self-referentiality
-Assess for alcohol or substance use
Schizophrenia thought content + depressive cognitions
-Relationship breakdowns
-Dependency
-Slow response to tx & stigma can increase sense of hopelessness, helplessness & shame
Schizophrenia thought content + anxious cognitions
Increase anxiety can be the outcome or result of a delusion
Concrete thinking
We use a similarity test where we ask patients what is similar between two objects (i.e. an apple and an orange). Improves the ability to understand concepts such as love and belonging, , problem solving processes, time, and consequences
Self-referentiality
Belief that neutral or everyday occurrences carry special meaning
Schizophrenia perceptual functioning + hallucinations
-Most common disturbance
-Assess to distinguish the cause of the hallucination
-Auditory hallucination outward observations: Turing/tilting head or moving lips silently
Schizophrenia perceptual functioning + other
Boundary impairment, depersonalization, derealization, illusions
Boundary impairment
Impaired ability to differentiate between his/her own space and what is his/her own things
Derealization
False perception that the environment has changed (bigger/smaller, a familiar environment has become unfamiliar)
Perceptual functioning
-Thought insertion, withdrawal, broadcasting
-Ideas of reference
Assessment of delusional disorder
-Somatic symptoms
-Medications
-Lab and diagnostic tests r/t somatic concerns
Assessment of schizophrenia
-Lipid panel, glucose and hormones
-Increased BP&HR, movement disorders
-BUN, GFR, creatinine, urine for protein
-Polyuria (significantly decreased Na+ levels)
Family assessment of delusional disorder
Quality of relationships
Family assessment of schizophrenia
-Who assumes the burden of care?
-Is there an acceptance of the diagnosis?
SDOH influence on delusional disorder
-Health Services; need for health services due to multiple somatic concerns
-Social environments; legal concerns related to acting on delusions
SDOH influence on schizophrenia
-Need for health care services & access
-Personal health practices & coping strategies
-Employment
Consequences of illness on patient well-being in delusional disorder
-Difficulties developing relationships
-Additional health problems, somatic & legal concerns
-Family is overwhelmed and confused
Consequences of illness on patient well-being in schizophrenia
-Isolation, family is overwhelmed and confused
-Additional health problems
-Financial; inability to maintain employment
NANDA for schizophrenia & delusional disorder
-Non-adherence with treatment plans and medications
-Compromised coping/alienate from others
-Delusions
S&S of schizophrenia & delusional disorder + NANDA
-Stops taking medication
-Loneliness, disturbed thought process
NANDA for schizophrenia
Disturbed sensory perception, social isolation, negative self-perception, lack of motivation
NANDA S&S for schizophrenia
-Auditory Hallucinations (command), uncommunicative
-Feels guilty, rejected, lonely, bad or no good
-Unable to initiate tasks
Personality disorder
-Pattern of inner experience and behavior that deviates markedly from their cultural expectations
-Patterns of coping and relating are pervasive and inflexible
-Onset in adolescence or early adulthood
-Overtime, stable maladaptive coping strategies lead to distress and inability to adapt to new situations
Personality disorder definition
-Pattern of unstable relationships, self-image, and affects
-Marked impulsivity
-Begins by early adulthood
-Indicated by 5 or more common findings
Personality disorder manifestations (1-4)
- Frantic effort to avoid real or imagined abandonment
- Patter of unstable relationships alternating between extremes of idealization & devaluation
- Unstable self-image or sense of self
- Impulsive in at least 2 areas that are self-damaging
Personality disorder manifestations (5-9)
- Recurrent suicidal behaviour, gestures, threats, or self-mutilatation
- Affective instability d/t reactivity of mood
- Chronic feelings of emptiness
- Inappropriate, intense & difficult to control anger
- Transient, stress-related paranoid ideation or dissociative symptoms
Cluster A personality disorder
-Eccentric behaviors, perceptual distortions, unusual levels of suspiciousness, magical thinking, cognitive impairment
-Includes: paranoid, schizoid, and schizotypal personality disorders
-A=Atypical..
Cluster B personality disorders
-Respond with dramatic, emotional, or erratic behavior
-Difficulties with impulse control, emotional processing and regulation, and interpersonal skills
-Includes: antisocial, borderline, histrionic and narcissistic personality disorders
-B=bad=mad!
Cluster C personality disorders
-Anxious and fearful behaviors, social shyness, rigidity, hypersensitivity, relational dependency
-Includes: avoidant, dependent , and obsessive –compulsive personality disorders
-C=Careful/cautious/caring
Personality disorder prevalence
-Often in those receiving extensive medical and psychiatric services
-Borderline, avoidant, and obsessive-compulsive personality disorders are most common
-BPD most common in women
-~ 10% of the total population
Personality disorder risk factors
-Childhood neglect and trauma
-High corticotropin-releasing hormone in response to early life stress and emotional reactivity decreases the individual’s overall stress tolerance level
Personality disorder comorbidities
-Periods of crisis and illness; strain already maladaptive coping strategies
-Mental health; mood, anxiety, disordered eating, substance abuse
-Other; homeless, incarcerated
Personality disorder etiology
Multifactorial
Personality disorder genetic factors
Potentially hyper responsive amygdala and impairment in the prefrontal lobe
Personality disorder neurochemistry etiology
Neurotransmitters may regulate temperament
Personality disorder pyschological factors + etiology
-Children learn maladaptive responses in response to crisis and trauma, as they have been role-modeled, and/or in a way of relating that feels familiar
Personality disorder environmental factors + etiology
Family dynamics, PMH, supports, education
General appearance of personality disorders + cooperation
-Dependent on the level of trust with the nurse, may not get valid information
General appearance of personality disorders + affect & mood
-Labile
-Affect and mood can be the same or different
-Affect is exaggerated and inappropriate for the context
Speech & language in personality disorders
Intense inflection, loud volume, emotional language
Thought process in personality disorder
-Goal directed; find ways to get their needs met while staying emotionally safe
-Repetitive themes; negative self-image, focus on how others have not met their needs
Thought content of personality disorder
-Distortions in self-image; inability to simultaneously hold positive and negative ideas about themselves and others
-Fear of abandonment and sensitivity to personal rejection
-Significance placed on emotions, high risk of self-harm
-Regrets actions which perpetuates distorted self-image
-*Chronic suicidal ideation, negative self-soothing habits
Perceptual function in personality disorder
May have hallucinations as result of the stress response, concurrent diagnosis or use of drugs
Cognitive function in personality disorder
Difficulties with planning, implementation, and evaluation of their choices and behavior
Insight + personality disorder
Impaired, difficulty acknowledging and taking personal ownership for their problems
Physical assessment of personality disorder
Integument; risk of self-harm
Family assessment of personality disorder
Relationships, boundaries, support, abuse
Relationship assessment in personality disorder
-Attachments
-What activities are most enjoyable for the patient? What activities might the patient avoid? Why?
Boundary assessment in personality disorder
-Do they use the same coping strategies across diverse situations?
-When are the patient’s boundaries flexible?
Consequences of well-being in personality disorder
-Withdrawal, social isolation, frustration and anger, impaired functioning, risk of suicide and self harm
NANDA for personality disorder
-Ineffective coping
-Risk for harm
-Impaired social interaction
-Nonadherence
NANDA S&S for personality disorder
-Crisis, withdrawal, depression, anxiety
-Difficulties in relationships (seen as manipulative)
-Unable to keep medical appointments, frequently arrive late
