Exam 1 : Key Terms

Question 1

Preinteraction Phase

Answer 1

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.

Question 2

Introductory, or Orientation Phase-

Answer 2

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.

Question 3

Working Phase

Answer 3

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.

Question 4

Termination Phase

Answer 4

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.

Question 5

o Transference

Answer 5

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.

Question 6

o Countertransference

Answer 6

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.

Question 7

o Listening

Answer 7

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.

Question 8

o Informing

Answer 8

the skill of information giving. Is an essential nursing technique in which the nurse shares simple facts or information with the patient.

Question 9

o Broad Openings

Answer 9

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.

Question 10

o Focusing

Answer 10

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.

Question 11

o Restating

Answer 11

repeating the main thought the patient expressed. Restating shows that the nurse is listening.

Question 12

o Sharing Perceptions

Answer 12

asking the patient to verify the nurse’s understanding of what the patient is thinking or feeling.

Question 13

o Theme Identification

Answer 13

underlying issues or problems experienced by the patient that emerge repeatedly during the course of the nurse-patient relationship.

Question 14

o Clarification

Answer 14

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.

Question 15

o Reflection

Answer 15

directing back the patient’s ideas, feelings, questions, or content.

Question 16

o Silence

Answer 16

lack of verbal communication for a therapeutic reason. Silence allows the patient time to think and to gain insights.

Question 17

o Humor

Answer 17

the discharge of energy through the comic enjoyment of the imperfect. It is a constructive coping behavior.

Question 18

o Suggesting

Answer 18

presentation of alternative ideas for the patient’s consideration relative to problem solving.

Question 19

o Sympathy

Answer 19

is a feeling of pity or sense of compassion; it is when you feel bad for someone else who’s going through something hard.

Question 20

o Genuineness

Answer 20

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.

Question 21

o Empathy

Answer 21

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.

Question 22

o Immediacy

Answer 22

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.

Question 23

o Amines

Answer 23

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.

Question 24

Monoamine

• Norepinephrine (NE)

Answer 24

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.

Question 25

Monoamine

• Dopamine (DA)

Answer 25

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.

Question 26

Monoamine

• Serotonin (5-HT)

Answer 26

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.

Question 27

Melatonin

Answer 27

induces pigment-lightening effects on skin cells and regulates reproductive and immune function.

Question 28

• Acetylcholine

Answer 28

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.

Question 29

Amino Acids

• Glutamate

Answer 29

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.

Question 30

Amino Acids

• Gamma-aminobutyric acid (GABA)

Answer 30

Inhibitory. Drugs that increase GABA function, such as benzodiazepines, are used to treat anxiety and epilepsy and induce sleep.

Question 31

Histamine

Answer 31

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.

Question 32

Peptides

Answer 32

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.

Question 33

• Endorphins & Enkephalin

Answer 33

widely distributed in CNS; Inhibitory.

Question 34

• Substance P

Answer 34

significant in the raphe system and spinal cord; Excitatory.

Question 35

o Cerebral Cortex

Answer 35

critical in decision making and higher order thinking, such as abstract reasoning.

Question 36

o Limbic System

Answer 36

involved in regulating emotional behavior, memory and learning.

Question 37

o Basal Ganglia

Answer 37

coordinate involuntary movements and muscle tone.

Question 38

o Hypothalamus

Answer 38

regulates pituitary hormones; temperature; and desires such as hunger, thirst and sex drive.

Question 39

o Locus Ceruleus

Answer 39

makes norepinephrine, a neurotransmitter involved in the body’s response to stress.

Question 40

o Raphe Nuclei

Answer 40

make serotonin, a neurotransmitter involved in the regulation of sleep, behavior, and mood.

Question 41

o Substantia Nigra

Answer 41

makes dopamine, a neurotransmitter involved in complex movements, thinking, and emotions.

Question 42

o Reuptake

Answer 42

After release into the synapse and communication with receptor cells, the neurotransmitters are transported back from the synapse into the axon.

Question 43

o Depolarization

Answer 43

• 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.

Question 44

o Neurotransmission

Answer 44

communication of neurons through electrical impulses, chemical messengers.

Question 45

o Synaptic Pruning

Answer 45

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.

Question 46

o Formal Mental Status Examination

Answer 46

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.

Question 47

Appearance

Answer 47

(How the patient looks) Grooming, posture, apparent age, attitude toward the interviewer

Question 48

Behavior

Answer 48

mannerisms, gestures, tics, restlessness, psychomotor agitation or retardation, Echopraxia (imitating others movements), gait

Question 49

Speech

Answer 49

physical characteristics of speech (e.g., rate, volume, amount, characteristics)

Question 50

• Mood

Answer 50

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.

Question 51

• Affect

Answer 51

patient’s present emotional responsiveness; may or may not be congruent with mood. Is the patient’s apparent emotional tone.

Question 52

• Hallucinations

Answer 52

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

Question 53

• Illusion

Answer 53

perceptual misinterpretation of a real external stimulus

Question 54

Thought process

Answer 54

the “how” of the patients thinking

Question 55

Thought content

Answer 55

the “what” of the patients self-expression

Question 56

Orientation

Answer 56

to person, place and time

Question 57

Memory

• Remote

Answer 57

recall of events, information, and people from the distant past.

Question 58

Memory

• Recent

Answer 58

recall of events, information, and people from the past week or so.

Question 59

Memory

• Immediate

Answer 59

recall of information, or data to which a person was just exposed.

Question 60

Judgment

Answer 60

making decisions that are constructive and adaptive

Question 61

Insight

Answer 61

patients understanding of the nature of one’s problem or illness

Question 62

o Informal Mental Status Examination

Answer 62

observations made while caring for a patient (more unstructured)

Question 63

o Primary Prevention

Answer 63

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.

Question 64

o Secondary Prevention

Answer 64

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

Question 65

o Tertiary Prevention

Answer 65

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

Question 66

o Maturational Crisis

Answer 66

are developmental events requiring role changes. Ex: different developmental stages in life, marriage, midlife

Question 67

o Situational Crisis

Answer 67

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.

Question 68

o Neurosis

Answer 68

describes a mental disorder characterized by anxiety that involves NO distortion of reality. Behavior does not violate social norms. Ex: PTSD, Anxiety

Question 69

o Psychosis

Answer 69

is disintegrative and involves a significant distortion of reality. Ex: great difficulty in functioning, gross impairment in reality.

Question 70

o Axis I

Answer 70

Clinical Syndromes. Ex: Major depression, bipolar, schizophrenia

Question 71

o Axis II

Answer 71

Personality Disorders & Specific Developmental Disorders. Ex: Antisocial personality disorder, mental retardation

Question 72

o Axis III

Answer 72

General Medical Conditions. Ex: Diabetes, Hypertension, Cancer

Question 73

o Axis IV

Answer 73

Psychosocial & Environmental Problems. Ex: Housing problems, economic problems, problems with the legal system

Question 74

o Axis X

Answer 74

Global Assessment of Functioning (GAF): (score rating overall functioning): Scale of 0 to 100.

Question 75

o Voluntary Admission

Answer 75

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.

Question 76

o Involuntary Admission

Answer 76

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

Question 77

• Issues of informed consent

Answer 77

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.

Question 78

o Right to communicate with people outside the hospital

Answer 78

allows patient to visit and hold telephone conversations in privacy and send unopened letters to anyone they wish.

Question 79

o Right to keep personal effects

Answer 79

patient may bring clothing or personal items to the hospital.

Question 80

o Right to enter into contractual relationship

Answer 80

• the court considers contracts valid if the person understands the circumstances of the contract and its consequences.

Question 81

o Right to education

Answer 81

many patients exercise the right to education on behalf of their emotionally ill or mentally retarded children.

Question 82

o Right to Habeas Corpus

Answer 82

is an important constitutional right for all patients. It provides for the speedy release of any person who claims to be detained illegally.

Question 83

o Right to privacy

Answer 83

implies the person’ right to keep some personal information completely secret or confidential.

Question 84

o Right to informed consent

Answer 84

clinician must give the patient a certain amount of information about the proposed treatment and must obtain patients consent.

Question 85

o Right to treatment

Answer 85

to all mentally ill or mentally retarded people who were involuntary hospitalized.

Question 86

o Right to refuse treatment

Answer 86

includes the right to refuse involuntary hospitalization.

Question 87

o Right to treatment in the least restrictive setting

Answer 87

evaluating the needs of each patient and maintaining the greatest amount of personal freedom, autonomy, dignity, and integrity in determining treatment.

Question 88

Under: Right of Privacy:

Circle of Confidentiality

Answer 88

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).

Question 89

o Major Depressive Disorder

Answer 89

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.

Question 90

• Diagnostic Criteria for Major Depression

Answer 90

• 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)

Question 91

• Specifiers of major depression

Answer 91

• 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.

Question 92

o Bipolar I Disorder

Answer 92

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.

Question 93

• Criteria for Manic Episode

Answer 93

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.

Question 94

• Behaviors associated with Mania

Answer 94

• 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.

Question 95

o Bipolar II Disorder

Answer 95

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.

Question 96

• Hypomania

Answer 96

• 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.

Question 97

o Cyclothymia

Answer 97

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.

Question 98

o Rapid Cycling

Answer 98

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.

Question 99

• Differences between mania, hypomania

Answer 99

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.

Question 100

• Psychomotor agitation

Answer 100

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.

Question 101

• Psychomotor retardation

Answer 101

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.

Question 102

o Beck Depression Inventory (BDI)

Answer 102

• Self-rating depression screening tool

Question 103

o Center for Epidemiological Studies – Depression Scale (CES-D)

Answer 103

• Self-rating depression screening tool

Question 104

o Zung Self-Rating Depression Scale (Zung SDS)

Answer 104

• Clinician administered depression screening tool

Question 105

o Hamilton Depression Rating Scale (HDRS)

Answer 105

• Clinician administered depression screening tool

Question 106

Mesocortical pathway

Answer 106

: 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.

Question 107

Mesolimbic pathway

Answer 107

innervates the limbic system
• Function: associated with memory, smell, automatic visceral effects and emotional behavior
• Abnormal function: positive symptoms

Question 108

 Tuberinfundibular pathway

Answer 108

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.

Question 109

Nigrostriatal pathway

Answer 109

: 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.

Question 110

o Cataplexy

Answer 110

fixed rigidity of posture, similar to posturing

Question 111

o Waxy flexibility

Answer 111

if you lift their arm it stays up

Question 112

o Mutism

Answer 112

don’t speak

Question 113

o Posturing

Answer 113

similar to cataplexy

Question 114

o Mannerism

Answer 114

a particular action that the patient performs

Question 115

o Stereotypy

Answer 115

repetitive, ritualistic movement

Question 116

o Agitation

– Motor

Answer 116

such as pacing, inability to sit still, clenching or pounding fists, and tightening of jaw or facial muscles.

Question 117

o Agitation

– Verbal

Answer 117

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.

Question 118

o Grimacing

Answer 118

contortion of the face in response to something contemptuous or painful

Question 119

o Echolalia

Answer 119

imitating the words of others

Question 120

o Echopraxia

Answer 120

imitating the movement of others

Question 121

o Alexithymia

Answer 121

difficulty naming and describing emotions

Question 122

• Neuroleptic Malignant Syndrome

Answer 122

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.

Question 123

• EPS, Tardive Dyskinesia

Answer 123

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.

Question 124

o Definition of schizophrenia (DSM-V)

Answer 124

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.

Question 125

o Schizoaffective disorder

Answer 125

patient has schizo and mood disorder symptoms

Question 126

o Schizophreniform disorder

Answer 126

symptoms of schizophrenia but lasts 1-6 months, functioning is not impaired

Question 127

o Brief psychotic disorder

Answer 127

has schizophrenia symptoms for 1 day-1 month, functioning is not impaired

Question 128

o Delusional disorder

Answer 128

patient has one or more delusion, but not the other symptoms, functioning is not impaired. No hallucinations, catatonia, disorganized speech.

Question 129

o Ertomanic

Answer 129

pt believes someone is in love w/them, may try to contact them

Question 130

o Grandiose

Answer 130

pt believes they have made some important discovery

Question 131

o Jealous

Answer 131

suspects infidelity with no evidence to show for

Question 132

o Persecutory

Answer 132

believes they’re being followed, cheated, poisoned, w/o evidence of it

Question 133

o Somatic

Answer 133

beliefs of the body, think they omit foul body odor or that parasites are crawling in their skin

Question 134

o Mixed

Answer 134

more than one theme

Question 135

o Unspecified

Answer 135

the theme cannot be identified

Question 136

o Positive symptoms of schizophrenia

Answer 136

: 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

Question 137

o Negative symptoms of schizophrenia

Answer 137

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

Question 138

• Review the purpose of the AIMS assessment

Answer 138

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.

Question 139

Maladaptive Behaviors:

Appearance inappropriate for environment

Answer 139

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

Question 140

Maladaptive Behaviors:

Aggression/agitation/violence

Answer 140

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.

Question 141

Maladaptive Behaviors:

Repetitive or stereotyped behaviors

Answer 141

: 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

Question 142

Maladaptive Behaviors:

Avolition

Answer 142

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”

Question 143

Maladaptive Behaviors:

In General:

Answer 143

 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.

Question 144

o Maladaptive Movements

Answer 144

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.

Question 145

Catatonia

Answer 145

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

Question 146

The meaning of Resistance

Answer 146

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

Question 147

Anticholinergic Side Effects of Antipsychotic Meds

Benztropine (Cogentin)
Trihexyphenidyl (Artane)
Biperiden (Akineton)

Answer 147

Symptoms: constipation, dry mouth, blurred vision, orthostatic hypotension, tachycardia, urinary retention, nasal congestion;