Exam 1 : Key Terms Flashcards
Preinteraction Phase
begins before the nurse’s first contact with the patient. The nurse’s self-analysis in the Preinteraction phase is a necessary task.
Other tasks in this phase include gathering data about the patient if information is available and planning for the first interaction with the patient.
Introductory, or Orientation Phase-
it is during the introductory phase that the nurse and patient first meet.
One of the nurse’s primary concerns is to find out why the patient sought help. The reason for seeking help forms the basis of the nursing assessment, helps the nurse focus on the patient’s problem, and determines the patient’s motivation for treatment.
It is important for the nurse to realize that help-seeking varies among different cultures, social, and ethnic groups.
Another task is for the patient and the nurse to establish their partnership and agree on the nature of the problem and the patients’ treatment goal.
Working Phase
Most of the therapeutic work is carried out during the working phase.
The nurse and the patient explore stressors and promote the development of insight in the patient by linking perceptions, thoughts, feelings, and actions. The nurse helps the patient master anxieties, increase independence and self-responsibility, and develop constructive coping mechanisms.
Actual behavioral change is the focus of this phase.
Termination Phase
is one of the most difficult but most important phases of the therapeutic nurse-patient relationship.
It is a time to exchange feelings and memories and to evaluate mutually the patient’s progress and goal attainment.
Levels of trust and intimacy are heightened, reflecting the quality of the relationship and the sense of loss experienced by both nurse and patient.
Together the nurse and the patient review the progress made in treatment and the attainment of specified goals. Successful termination requires that the patient work through feelings related to separation from emotionally significant people.
Helping the patient work and grow through the termination process is an essential goal of each relationship.
o Transference
is an unconscious response in which patients experience feelings and attitudes toward the nurse that were originally associated with other significant figures in their life.
Transference is characterized by the inappropriate intensity of the patient’s response.
o Countertransference
is a therapeutic impasse created by the nurse’s specific emotional response to the qualities of the patient. This response is inappropriate to the content and context of the therapeutic relationship and inappropriate in the degree of intensity of emotion.
Countertransference is transference applied to the nurse.
o Listening
an active process of receiving information and examining reaction to the message received. The first rule of a therapeutic relationship is to listen to the patient. It is an active, not passive, process.
o Informing
the skill of information giving. Is an essential nursing technique in which the nurse shares simple facts or information with the patient.
o Broad Openings
encouraging the patient to select topics for discussion. Broad openings let the patient know that the nurse is accessible and following what the patient is saying.
o Focusing
questions or statements that help the patient expand on a topic of importance. It can help the patient become more specific, move from vagueness to clarity, and focus on reality.
o Restating
repeating the main thought the patient expressed. Restating shows that the nurse is listening.
o Sharing Perceptions
asking the patient to verify the nurse’s understanding of what the patient is thinking or feeling.
o Theme Identification
underlying issues or problems experienced by the patient that emerge repeatedly during the course of the nurse-patient relationship.
o Clarification
attempting to put into words vague ideas or unclear thoughts of the patient to enhance the nurse’s understanding or asking the patient to explain what he means.
o Reflection
directing back the patient’s ideas, feelings, questions, or content.
o Silence
lack of verbal communication for a therapeutic reason. Silence allows the patient time to think and to gain insights.
o Humor
the discharge of energy through the comic enjoyment of the imperfect. It is a constructive coping behavior.
o Suggesting
presentation of alternative ideas for the patient’s consideration relative to problem solving.
o Sympathy
is a feeling of pity or sense of compassion; it is when you feel bad for someone else who’s going through something hard.
o Genuineness
means that the nurse is an open, honest, sincere person who is actively involved in the relationship. Genuineness means that the nurse’s response is sincere.
o Empathy
is the ability to enter into the life of another person, to accurately perceive the person’s current feelings and their meanings, and to communicate this understanding to the patient. Empathy is an essential part of the therapeutic process.
o Immediacy
involves focusing on the current interaction of the nurse and the patient relationship. It is significant dimension because the patient’s behavior and functioning in the nurse-patient relationship reflect functioning in other interpersonal relationships.
o Amines
are neurotransmitters that are synthesized from amino acid molecules such as tyrosine, tryptophan, and histidine. Found in various regions of the brain, amines affect learning, emotions, motor control and other activities.
Monoamine
• Norepinephrine (NE)
levels fluctuate with sleep and wakefulness. Plays a role in changes in levels of attention and vigilance. Involved in attributing a rewarding value to a stimulus and in regulation of mood. Plays a role in affective and anxiety disorders. Antidepressants block reuptake of NE into presynaptic cell or inhibit monoamine oxidase from metabolizing it. Excitatory or Inhibitory.
Monoamine
• Dopamine (DA)
Involved in control of complex movements, motivation, and cognition and in regulating emotional responses. Many drugs of abuse (e.g., cocaine, amphetamines) cause DA release, suggesting a role in sensation of pleasure. Involved in movement disorders seen in Parkinson disease and in many of the deficits seen in schizophrenia and other forms of psychosis. Antipsychotic drugs block DA receptors in postsynaptic cells. Usually Excitatory.
Monoamine
• Serotonin (5-HT)
Levels fluctuate with sleep and wakefulness, suggesting a role in arousal and modulation of general activity levels of CNS, particularly onset of sleep. Plays a role in mood and probably in delusions, hallucinations, and withdrawal symptoms of schizophrenia. Involved in temperature regulation and pain-control system of body. The hallucinogenic drug LSD acts at 5-HT receptor sites. Plays a role in affective and anxiety disorders. Antidepressants block its reuptake into presynaptic cells. Mostly Inhibitory.
Melatonin
induces pigment-lightening effects on skin cells and regulates reproductive and immune function.
• Acetylcholine
mediates cognitive functioning directly or by modulating another neurotransmitter indirectly. Plays a role in sleep-wakefulness cycle. Signals muscles to become active. Alzheimer disease is associated with degeneration in acetylcholine neurons. Myasthenia gravis (weakness of the skeletal muscles) results from reduction in acetylcholine receptors.
Amino Acids
• Glutamate
Excitatory. Implicated in schizophrenia; glutamate receptors control the opening of ion channels that allow calcium (essential to neurotransmission) to pass into nerve cells, propagating neural electrical impulses. Its major receptor, NMDA, helps regulate brain development. This receptor is blocked by drugs (e.g., PCP) that cause schizophrenia-like symptoms. Over-exposure to glutamate is toxic to neurons and may cause cell death in stroke and Huntington disease.
Amino Acids
• Gamma-aminobutyric acid (GABA)
Inhibitory. Drugs that increase GABA function, such as benzodiazepines, are used to treat anxiety and epilepsy and induce sleep.
Histamine
May play a role in alertness and learning. Is being investigated as potential mechanism for side effects commonly associated with psychotropic medications (weight gain, hyperlipidemia). Same substance as involved with immunological/allergic responses.
Peptides
chains of amino acids found throughout the body. New peptides are continually being identified, with 100 neuropeptides active in the brain, but their role as neurotransmitters is not well understood. Although they appear in very low concentrations in the CNS, they are very potent. They also appear to a play a “second messenger” role in neurotransmission; that is, they modulate messages of nonpeptide neurotransmitters through G protein-linked receptors.
• Endorphins & Enkephalin
widely distributed in CNS; Inhibitory.
• Substance P
significant in the raphe system and spinal cord; Excitatory.
o Cerebral Cortex
critical in decision making and higher order thinking, such as abstract reasoning.
o Limbic System
involved in regulating emotional behavior, memory and learning.
o Basal Ganglia
coordinate involuntary movements and muscle tone.
o Hypothalamus
regulates pituitary hormones; temperature; and desires such as hunger, thirst and sex drive.
o Locus Ceruleus
makes norepinephrine, a neurotransmitter involved in the body’s response to stress.
o Raphe Nuclei
make serotonin, a neurotransmitter involved in the regulation of sleep, behavior, and mood.
o Substantia Nigra
makes dopamine, a neurotransmitter involved in complex movements, thinking, and emotions.
o Reuptake
After release into the synapse and communication with receptor cells, the neurotransmitters are transported back from the synapse into the axon.
o Depolarization
- the destruction, neutralization, or change in direction of polarity. This change triggers a cascade of chemical and electrical processes that are caused by a variety of chemicals within the cell itself known as second messengers.
o Neurotransmission
communication of neurons through electrical impulses, chemical messengers.
o Synaptic Pruning
during adolescence the efficiency of the brain is refined by eliminating unneeded circuits, called synaptic pruning, and strengthening others. This process allows humans to have a brain that accommodates both its genetic potential and the environmental influences surrounding it.
o Formal Mental Status Examination
describes sum total of clinician’s observations and impressions of patient at the time of the interview. Whereas the patient’s history remains stable, the MSE can change from day to day or hour to hour.
Appearance
(How the patient looks) Grooming, posture, apparent age, attitude toward the interviewer
Behavior
mannerisms, gestures, tics, restlessness, psychomotor agitation or retardation, Echopraxia (imitating others movements), gait
Speech
physical characteristics of speech (e.g., rate, volume, amount, characteristics)
• Mood
a pervasive and sustained emotion that colors the person’s perception of the world. The patient’s self report of one’s emotional state and reflects the patient’s life situation.
• Affect
patient’s present emotional responsiveness; may or may not be congruent with mood. Is the patient’s apparent emotional tone.
• Hallucinations
false sensory perception occurring in the absence of any relevant external stimulation of the sensory modality involved; may be auditory, visual, tactile, gustatory or olfactory; auditory most common
• Illusion
perceptual misinterpretation of a real external stimulus
Thought process
the “how” of the patients thinking
Thought content
the “what” of the patients self-expression
Orientation
to person, place and time
Memory
• Remote
recall of events, information, and people from the distant past.
Memory
• Recent
recall of events, information, and people from the past week or so.
Memory
• Immediate
recall of information, or data to which a person was just exposed.
Judgment
making decisions that are constructive and adaptive
Insight
patients understanding of the nature of one’s problem or illness
o Informal Mental Status Examination
observations made while caring for a patient (more unstructured)
o Primary Prevention
is lowering the incidence of a mental disorder by reducing the rate at which new cases of a disorder develop. Ex: Teaching social effects of alcohol to elementary students.
o Secondary Prevention
involves decreasing the prevalence of a mental disorder by reducing the number of existing cases through early case findings, screening, and prompt, effective treatment. Ex: early detecting in treatment, crisis intervention, suicide hotlines
o Tertiary Prevention
attempts to reduce the severity of a mental disorder and its associated disability through rehabilitation activities. Ex: help someone after they’ve developed the disorder/disease, psychosocial rehabilitation
o Maturational Crisis
are developmental events requiring role changes. Ex: different developmental stages in life, marriage, midlife
o Situational Crisis
occur when a life event upsets an individuals or groups psychological equilibrium. Ex: Disaster, loss of a job, unwanted pregnancy, loss of a loved one.
o Neurosis
describes a mental disorder characterized by anxiety that involves NO distortion of reality. Behavior does not violate social norms. Ex: PTSD, Anxiety
o Psychosis
is disintegrative and involves a significant distortion of reality. Ex: great difficulty in functioning, gross impairment in reality.
o Axis I
Clinical Syndromes. Ex: Major depression, bipolar, schizophrenia
o Axis II
Personality Disorders & Specific Developmental Disorders. Ex: Antisocial personality disorder, mental retardation
o Axis III
General Medical Conditions. Ex: Diabetes, Hypertension, Cancer
o Axis IV
Psychosocial & Environmental Problems. Ex: Housing problems, economic problems, problems with the legal system
o Axis X
Global Assessment of Functioning (GAF): (score rating overall functioning): Scale of 0 to 100.
o Voluntary Admission
any citizen of lawful age may apply in writing for admission to a public or private psychiatric hospital. The person agrees to receive treatment and abide by hospital rules. They can sign out at any time.
o Involuntary Admission
The patient did not request hospitalization and may have opposed it or was indecisive and did not resist it. Most laws permit commitment of the mentally ill on one or more of the following:
- Dangerous to self or others
- Mental ill and in need of treatment
- Unable to provide for own basic needs
• Issues of informed consent
o A clinician must give the patient a certain amount of information about the proposed treatment and must obtain the patients consent, which must be informed, competent, and voluntary. Even if the patient is psychotic, the clinician must still attempt to obtain informed consent for treatment. For patients not able to consent and for minors, informed consent should be obtained from a substitute decision maker.
o Right to communicate with people outside the hospital
allows patient to visit and hold telephone conversations in privacy and send unopened letters to anyone they wish.
o Right to keep personal effects
patient may bring clothing or personal items to the hospital.
o Right to enter into contractual relationship
- the court considers contracts valid if the person understands the circumstances of the contract and its consequences.
o Right to education
many patients exercise the right to education on behalf of their emotionally ill or mentally retarded children.
o Right to Habeas Corpus
is an important constitutional right for all patients. It provides for the speedy release of any person who claims to be detained illegally.
o Right to privacy
implies the person’ right to keep some personal information completely secret or confidential.
o Right to informed consent
clinician must give the patient a certain amount of information about the proposed treatment and must obtain patients consent.
o Right to treatment
to all mentally ill or mentally retarded people who were involuntary hospitalized.
o Right to refuse treatment
includes the right to refuse involuntary hospitalization.
o Right to treatment in the least restrictive setting
evaluating the needs of each patient and maintaining the greatest amount of personal freedom, autonomy, dignity, and integrity in determining treatment.
Under: Right of Privacy:
Circle of Confidentiality
within the circle, patient information may be shared. (Patient, staff supervisors, health care students and faculty, involved health care consultants, treatment team members) Those outside the circle require the patient’s permission to receive information. (Family, outside therapist, reimburses uninvolved health care students and trainers, lawyers, law enforcement agency, regulators, uninvolved health care professionals and support staff).
o Major Depressive Disorder
May involve a single episode or a recurrent depressive illness but does not include a manic episode.
• Accounts for more “bed days” than any other “physical” disorder except CV disorders.
• It is more costly to the economy than chronic illness (resp, diabetes, arthritis, HTN).
• Psychotherapy alone mostly helps those with Mild to Moderate symptoms.
• Depression can be treated successfully by antidepressant medications in 65% of cases.
• Success rate of treatment increases to 85% when alternative or adjunctive medications are used or psychotherapy is combined with medications.
• Diagnostic Criteria for Major Depression
- Must have at least one of these major symptoms: depressed mood and/or anhedonia (inability to experience joy and pleasure in activities)
- Five or more of the following symptoms occurring in the same two week period.
- Weight gain or loss (at least 5% of their weight within a month)
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue
- Feelings of worthlessness
- Impaired concentration
- Thoughts of suicide or death (with or without a plan)
• Specifiers of major depression
- With anxious distress: they have difficulty concentrating, they feel like they’re going to lose control, they feel like the end of the world is coming for them.
- With mixed features: major depression and bipolar
- With melancholic features: the depressed mood, often tend to have depression when they wake up early. Depression is worse in the morning.
- With atypical features: Don’t have the melancholic mood. Will respond normal to stimuli. But will have a “heavy” feeling in legs and feet (leaden paralysis).
- With psychotic features: They have a rigid posture. They can also all of the sudden have purposeless activity. Not in response to an obvious stimuli. Waxy flexibility (where they stand in a goofy position). They can also be mute.
- With seasonal pattern: get depressed in fall and winter when there is less sunlight.
- With peripartum onset: they have depression during pregnancy or within months to a year after pregnancy.
o Bipolar I Disorder
one or more manic episodes and often one or more major depressive episodes. They are not better explained by other psychiatric disorders and are not the direct result of a substance or other medical condition.
• Criteria for Manic Episode
Need to have at least three of these symptoms.
• Period of abnormally persistent, elevated and expansive, or irritable mood, lasting at least ONE WEEK.
• Inflated self-esteem or grandiosity
• Decreased need for sleeping
• More talkative than usual or pressure to keep talking
• Flight of ideas or subjective experience that thoughts are racing
• Distractibility
• Increase in goal-directed activity
• Excessive involvement in pleasurable activities that have high potential for painful consequences.
• Behaviors associated with Mania
- Elevated, euphoric or expansive moods
- Irritability
- Sleep disturbances
- Excessive spending
- Sexual overactivity
- Flamboyant dress (bright busy patterns, strange jewelry or makeup)
- Hyperactive, intrusive.
- Grandiosity
- Verbosity
- Flight of ideas
- Rapid, pressured speech.
o Bipolar II Disorder
Presence or history of one or more major depressive episodes with a presence or history of at least ONE hypomanic episode.
• Has never had a manic episode
• Symptoms are not from a substance or general medical condition.
• When diagnosing be careful to not miss the hypomania.
• Other psychiatric disorders are ruled out.
• Symptoms cause significant distress or impair social, occupational, or other functioning.
• Hypomania
- Persistently elevated, expansive, or irritable mood that is clearly different from usual for at least 4 days.
- Has many of the symptoms of mania EXCEPT no psychotic features
- Function has changed, which others have observed
- No marked impairment in social, occupational, or other functioning.
- Hospitalization NOT required.
o Cyclothymia
for at least 2 years has had NUMEROUS periods with HYPOMANIC SYMPTOMS that do not meet criteria for a hypomanic episode and NUMEROUS periods with DEPRESSIVE SYMPTOMS that do not meet the criteria for major depressive episode.
• Has not been without symptoms for more than 2 months at a time.
• “the highs aren’t as high, the lows aren’t as low”
• Has had no manic, hypomanic, or major depressive episodes during the 2 year period.
• Other psychiatric disorders do not better account for the symptoms
• Symptoms are not the direct result of a substance or other medical condition
• Symptoms significantly impair functioning or cause significant distress.
o Rapid Cycling
Four or more mood episodes in the previous 12 months that meet the criteria for manic, hypomanic, or major depressive episode.
• Episodes are marked by either partial or full remission for at least 2 months or a switch to an episode of opposite polarity.
• Differences between mania, hypomania
Mania
Bipolar I
Characterized by an elevated, expansive, or irritable mood.
Hypomania
Bipolar II
Is a clinical syndrome that is similar to but not as severe as mania. NO psychosis. NO hospitalization needed.
• Psychomotor agitation
This is more often seen in anxiety but can also occur in depression. This is a series of unintentional and purposeless motions that stem from mental tension and anxiety of an individual. This includes pacing around a room, wringing one’s hands, uncontrolled tongue movement, pulling off clothing and putting it back on and other similar actions.
• Psychomotor retardation
a behavioral issue. This is the slowing down of thoughts and physical movement. Someone can be so depressed that they are unable to care for themselves in the daily living.
o Beck Depression Inventory (BDI)
• Self-rating depression screening tool
o Center for Epidemiological Studies – Depression Scale (CES-D)
• Self-rating depression screening tool
o Zung Self-Rating Depression Scale (Zung SDS)
• Clinician administered depression screening tool
o Hamilton Depression Rating Scale (HDRS)
• Clinician administered depression screening tool
Mesocortical pathway
: innervates the frontal lobe
• Function: insight, judgment, social consciousness, inhibition, and highest level of cognitive activities (reasoning, motivation, planning, decision making)
• Abnormal function-negative symptoms.
Mesolimbic pathway
innervates the limbic system
• Function: associated with memory, smell, automatic visceral effects and emotional behavior
• Abnormal function: positive symptoms
Tuberinfundibular pathway
originates in the hypothalamus and projects to the pituitary
• Function: endocrine function, hunger, thirst, metabolism, temp control, digestion, sexual arousal, and circadian rhythms
• Abnormal function: implicated in some endocrine abnormalities see in schizophrenia and some of the SE of antipsychotic drugs, such hyperprolactinemia. Prolactic is under tonic dopaminergic control of this pathway. Antipsychotics increase prolactin levels. Hyperprolactinemia has direct action on brain and indirect action through suppression of sex hormones. Concern is development of hypogonadism. Short term consequences of hyperprolactinemia: amenorrhea, galactorrhea, gynecomastia (mainly from Risperdal), sexual dysfunction (ED, vaginal dryness, decreased libido), behavioral effects. Long term consequences of hyperprolactinemia: CV/atherosclerosis, osteoporosis/decreased bone mineral density, breast cancer, prostate cancer, immunosuppression.
Nigrostriatal pathway
: originate in the substantia nigra and terminates in the caudate nucleus- putamen complex (neostriatum)
• Function: innervates the motor and EPS
• Abnormal function: implicated in some of the movement SE of antipsychotic drugs such as tardive dyskinesia, akathisia and dystonia reactions.
o Cataplexy
fixed rigidity of posture, similar to posturing
o Waxy flexibility
if you lift their arm it stays up
o Mutism
don’t speak
o Posturing
similar to cataplexy
o Mannerism
a particular action that the patient performs
o Stereotypy
repetitive, ritualistic movement
o Agitation
– Motor
such as pacing, inability to sit still, clenching or pounding fists, and tightening of jaw or facial muscles.
o Agitation
– Verbal
such as threats to real or imagined objects, intrusive demands for attention or swearing.
Speech may be loud and pressured, and posture may become threatening.
o Grimacing
contortion of the face in response to something contemptuous or painful
o Echolalia
imitating the words of others
o Echopraxia
imitating the movement of others
o Alexithymia
difficulty naming and describing emotions
• Neuroleptic Malignant Syndrome
a rare but potentially fatal (14-30% mortality) side effect of antipsychotic drugs, sx include fever over 100.4F, confused or altered consciousness, tachycardia, sweating, muscle rigidity, tremor, incontinence, elevated creatinine phosphokinase (CPK), renal failure, and stupor. NMS in an emergency and can lead to death if untreated. Treatment includes stopping the drug and initiating supportive care. Treat the hyperthermia aggressively, such as with cooling blankets or ice packs to the axilla and groin. Many cases require intensive care and circulatory and ventilatory support. Benzos, dantrolene and dopaminergic agents can be used for treatment. If it is recognized early enough, NMS is not fatal.
• EPS, Tardive Dyskinesia
side effects of typical antipsychotics, most EPS SE are common and are often painful and disabling. They are also stigmatizing but usually can be prevented or minimized and effectively treated. Drug strategies to treat EPS include lowering the dose of the drug, changing to a drug with a lower incidence of that EPS or administering. EPS sx are divided into two categories: dyskinesias (movement disorders such as tongue thrusts or fly catching, lip smacking, finger movements, eye blinking, movement of the arms or legs) and dystonias (muscle tension disorders).Tardive dyskinesia can occur after use (usually long use) of conventional antipsychotics; stereotyped involuntary movements (tongue protrusion, lip smacking, chewing, blinking, grimacing, choreiform movements of trunk and limbs, foot tapping), if using typical antipsychotics, use preventative measures and assess often, consider changing to an atypical antipsychotics; there is no treatment for TD. The symptoms for TD are more likely to be permanent even after the medication is stopped.
o Definition of schizophrenia (DSM-V)
a disturbance that lasts for at least 6 months and includes at least a month of active-phase symptoms” meaning 2 or more of the following: delusion (false beliefs), hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms. They have positive, negative, mood and cognitive symptoms. Mood symptoms include dysphoria, suicidality, hopelessness. Cognitive symptoms include: attention, memory, executive functions (abstraction, concept formation, problem solving, decision making) problems. These all lead to a social/occupational dysfunction with work/activities, interpersonal relationships, self-care and mortality/morbidity. It must exclude schizoaffective and mood disorders w/psychotic features and exclude underlying medical conditions such as withdrawal of substances. Consider the relationship to autism spectrum disorder, patient must meet the criteria for schizophrenia and must have delusions and hallucinations for at least a month.
o Schizoaffective disorder
patient has schizo and mood disorder symptoms
o Schizophreniform disorder
symptoms of schizophrenia but lasts 1-6 months, functioning is not impaired
o Brief psychotic disorder
has schizophrenia symptoms for 1 day-1 month, functioning is not impaired
o Delusional disorder
patient has one or more delusion, but not the other symptoms, functioning is not impaired. No hallucinations, catatonia, disorganized speech.
o Ertomanic
pt believes someone is in love w/them, may try to contact them
o Grandiose
pt believes they have made some important discovery
o Jealous
suspects infidelity with no evidence to show for
o Persecutory
believes they’re being followed, cheated, poisoned, w/o evidence of it
o Somatic
beliefs of the body, think they omit foul body odor or that parasites are crawling in their skin
o Mixed
more than one theme
o Unspecified
the theme cannot be identified
o Positive symptoms of schizophrenia
: an exaggeration or distortion of normal brain function; usually responsive to all categories of antipsychotic drugs
o Delusions: false belief that is firmly maintained even though it is not shared by others and is contradicted by social reality- a celebrity loves me
o Hallucinations: false sensory impressions or experiences. 70% are auditory, 20% visual, 10% are gustatory, olfactory, tactile, kinesthetic (feel their body is moving but it isn’t), cenesthetic (feel the blood moving through your body and your food digesting, internal body feelings)
o thought disorder: loose associations, word salad, tangentiality, illogicality, circumstantiality, pressured speech, poverty of speech, distractible speech and clanging
o disorganized speech
o bizarre behavior
o inappropriate affect
o Negative symptoms of schizophrenia
a diminution or loss of normal brain function; usually unresponsive to traditional antipsychotics and more responsive to atypical antipsychotics
o affective flattening: limited range and intensity of emotional expression
o alogia : shortage if speech or language, don’t say much, very concrete answers, poverty of speech, protracted silence
o avolition/apathy: inability to begin, engage in and finish goal directed activity/inability to initiate an activity
o anhedonia/asociality: inability to experience pleasure/don’t want to socialize
o attentional deficit
• Review the purpose of the AIMS assessment
it records the occurrence of tardive dyskinesia in patients receiving neuroleptic medications. It is used to detect TD and follow the severity over time. It is a 12 point anchored scale that the clinician administers and scores, items 1-10 are rated on a 5 pt anchored scale.
Items 1-4 assess orofacial movements.
Items 5-7 deal with extremity and truncal dyskinesia.
Items 8-10 deal with global severity as judged by the examiner and the patient’s awareness of the movements and the distress associated with them.
Items 11-12 are yes-no questions concerning problems with teeth and/or dentures because such problems can lead to a mistaken diagnosis of dyskinesia.
Maladaptive Behaviors:
Appearance inappropriate for environment
disheveled, dirty clothes, poor or absent personal grooming, lack of personal hygiene, this is often the first set of symptoms to occur and is a signal to the family that something is happening to their loved one
Maladaptive Behaviors:
Aggression/agitation/violence
these terms are usually used to describe schizophrenics but people experiencing psychoses are not typically violent. Those that do is usually due to med non-compliance or substance abuse. It is common for those living with a chronic illness to experience agitation as there is no cure. It is important to identify and document things that trigger the behavior.
Maladaptive Behaviors:
Repetitive or stereotyped behaviors
: appears similar to OCD but are related to a private meaning rather than thoughts. Ex: having to eat food a certain way, wearing only certain clothes, walking four steps forward and one step back or only being able to drink ½ glass of water at a time
Maladaptive Behaviors:
Avolition
lack of drive and energy, may be due to frustration with inability to accomplish tasks that required little effort in the past, it causes most people with schizophrenia to be labeled as “lazy, disinterested, and unmotivated”
Maladaptive Behaviors:
In General:
Lack of persistence at work or school typically accompanies deterioration in appearance. As problems in the brain function begin to appear, the cognitive skills seem to “short circuit” and the person can no longer perform routine tasks.
o Maladaptive Movements
o Catatonia, waxy flexibility, posturing
o Extrapyramidal side effects of psychotropic medications
o Abnormal eye movements: following a moving target, absence or avoidance of eye contact, decreased or rapid eye blinking and frequent starting. These common oculomotor symptoms are found in 40-80% of pts
o Grimacing: abnormal facial movements that are beyond the patient’s control and are not caused by psychotropic medications.
o Apraxia/echopraxia: difficulty carrying out a purposeful, organized task that is somewhat complex such as dressing/ purposeless imitation of movements made by other people. Although purposeless it can illustrate a delusion. “I thought the nurse was my mirror and I had to do what the mirror showed me, so I copied everything she did. As long as I coud see her I could feel connected to myself and my surroundings.”
o Abnormal gait: staggering, intentional stepping, walking with toes
o Mannerisms: gestures that seem contrived and are not appropriate to the situation, such as stopping mid-sentence to whirl 2 fingers around.
Catatonia
Characteristics may include confusion and purposeless agitation/excitement, along with the following symptoms: Stupor Catalepsy Waxy flexibility Mutism Negatism Posturing Mannerism Stereotypy Agitation Grimacing Echolalia Echopraxia
The meaning of Resistance
The patient’s reluctance to look at and examine troubling aspects of oneself; if resistance occurs, it is usually during the working phase of the nurse/patient relationship
Anticholinergic Side Effects of Antipsychotic Meds
Benztropine (Cogentin)
Trihexyphenidyl (Artane)
Biperiden (Akineton)
Symptoms: constipation, dry mouth, blurred vision, orthostatic hypotension, tachycardia, urinary retention, nasal congestion;
