Exam 1 - Study Material Flashcards

Question

Define the "theme identification" therapeutic communication technique, give an example, and its value in practice.

Answer 1

* **Definition**: underlying issues or problems experienced by the patient that emerge repeatedly during the course of the nurse-patient relationship * **Example:** “I’ve noticed that in all of the relationships that you have described, you’ve been hurt or rejected by the man. Do you think this is an underlying issue?” * **Therapeutic value:** allows the nurse to best promote the patient’s exploration and understanding of important problems

Answer 2

* Definition: lack of verbal communication for a therapeutic reason * Example: sitting with a patient and nonverbally communicating interest and involvement * Therapeutic value: allows the patient time to think and gain insights, slows the pace of the interaction, and encourages the patient to initiate conversation, while conveying the nurse’s support, understanding, and acceptance.

Answer 3

* Definition: the discharge of energy through the comic enjoyment of the imperfect * Example: “That gives a whole new meaning to the word nervous,” said with shared kidding between the nurse and patient. * Therapeutic value: can promote insight by making conscious repressed material, resolving paradoxes, tempering aggression, and revealing new options; a socially acceptable form of sublimation

Answer 4

* Definition: presentation of alternative ideas for the patient's consdieration relative to problem solving * Example: “Have you thought about responding to your boss in a different way when he raises that issue with you? For example, you could ask him whether a specific problem has occurred.” * Therapeutic value: increases the patient’s perceived options or choices

Answer 5

Characteristics crucial to establish trust and open communication in a relationship and help convey a sense of hope **Examples:** 1. Genuineness 2. Respect 3. Empathic understanding 4. Concreteness

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To be an open, honest, sincere person who is actively involved in the relationship.

Answer 7

Giving someone unconditional positive regard; the patient is regarded as a person of worth

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The ability to enter into the life of another per- son, to accurately perceive the person’s current feelings and their meanings, and to communicate this understanding to the patient.

Answer 9

* The use of specific terminology rather than abstractions when discussing the patient’s feelings, experiences, and behavior. * It involves asking for examples and details rather than generalities.

Answer 10

It is an expression by the nurse of perceived discrepancies in the patient’s behavior in which the nurse attempts to make the patient aware of incongruence in feelings, attitudes, beliefs, and behaviors.

Answer 11

The process of focusing on the current interaction of the nurse and the patient in the relationship.

Answer 12

* Subjectively true, personal statements about the self, intentionally revealed to another person. * When self-disclosing, the nurse should have a par- ticular therapeutic goal in mind.

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* A process that envolves encouraging a patient to talk about things that are most bothersome * Catharsis brings fears, feelings, and experiences out into the open so that they can be examined and discussed with the nurse

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* The process of acting out a particular situation * It increases the patient’s insight into human relations and can deepen the ability to see the situation from another person’s point of view. * it helps patients practice new and more adaptive behaviors.

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They are blocks in the progress of the nurse-patient relationship

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* Resistance * Transference * Countertransference * Boundary violations

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* the patient’s reluctance or avoidance of talking about or experiencing troubling aspects of oneself. * Often caused by the patient’s unwillingness to change when the need for change is recognized (usually during the working phase)

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* An unconscious response in which patients experience feelings and attitudes toward the nurse that were originally associated with other significant figures in their life. * It is characterized by the inappropriate intensity of the patient’s response.

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* A therapeutic impasse created by the nurse’s specific emotional response to the qualities of the patient. * In such cases nurses identify the patient with individuals from their past, and personal needs interfere with their therapeutic effective- ness

Answer 20

* Occurs when a nurse goes outside the boundaries of the therapeutic relationship and establishes a social, economic, or personal relationship with a patient. * As a general rule, whenever the nurse is doing or thinking of doing something special, different, or unusual for a patient, often a boundary violation is involved

Answer 21

* She was Hildegard Peplau the mother of psych nursing; identified the heart of psych nursing as the role of counselor or psychotherapist * Differentiated between general practice nurses who worked on a psych unit and psychiatric nurses who have graduate degrees and specialize in psych nursing * Identified nursing as a significant therapeutic process

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the first American psychiatric nurse; emphasized the **physical AND emotional** needs of the patient

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* Focused on the patient’s **physical needs**, such as medications, nutrition, hygiene, and ward activities * Psych nurses had limited psych training and mostly used med-surg principles; their main qualification was being kind and more patient

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* chemical “first” messengers * Give rise to human activity, body functions, consciousness, intelligence, creativity, memory, dreams, and emotion * Neurotransmission is a key factor in understanding how various regions of the brain function and how interventions, such as medications and other therapies, affect brain activity and human behavior

Answer 25

* Involved in **control of complex movements**, motivation, and cognition and in regulating emotional responses * Dopamine plats a role in the sensation of pleasure

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* Levels fluctuate with sleep and wakefulness, plats a role in arousal and modulation of general activity levels of CNS, particularly onset of sleep * Involved in temperature regulation and pain-control system of body.

Answer 27

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

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* Plays a role in sleep-wakefulness cycle. * Signals mus- cles to become active

Answer 29

* glutamate receptors control the opening of ion channels that allow calcium (essential to neurotransmission) to pass into nerve cells, propagating neuronal electrical impulses * Found in all cells of body, where it is used to synthesize structural and functional proteins

Answer 30

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

Answer 31

* May play a role in alertness and learning * Located in diencephalon

Answer 32

The opiates morphine and heroin bind to these endogenous opioid receptors on presynaptic neurons, blocking release of neurotransmitters and thus reducing pain

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Found in pain transmission pathway. Blocking release of substance P by morphine reduces pain.

Answer 34

* At birth, an infant’s brain is almost the same size as an adult’s brain and contains most of the brain cells for one’s entire life * From birth, the brain matures from back to front. With aging, it degenerates in the opposite direction * A newborn’s brain grows about three times its size in the first year * The brains of 2-year-old children consume twice as much glucose as do adult brains * Compared to an environment with little stimulation, a stimulating environment can give a child a 25% greater ability to learn * By the age of 7 years, our brains are 95% their adult size * It is a myth that we use only 10% of our brains. In fact, we use it all * Your skin weights twice as much as your brain * The brain can live for 4-6 minutes without oxygen, and then it begins to die. No oxygen for 5-10 minutes will result in permanent brain damage

Answer 35

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

Answer 36

involved in regulating emotional behavior, memory, and learning Basal ganglia: coordinate involuntary movements and muscle tone

Answer 37

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

Answer 38

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

Answer 39

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

Answer 40

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

Answer 41

Represents a cross section of the patient’s psychological life and the nurse’s observations and impressions at one point in time

Answer 42

* The elements of the exam depend on the patient’s clinical presentation, as well as on the patient’s educational and sociocultural background * Exam itself is usually divided into several parts; they can be arranged in different ways, as long as the nurse covers all the areas * Some components of the exam are completed through simple observation of the patient, such as noting the patient’s clothing or facial expressions * Other aspects require asking specific questions, such as those related to memory or attention span * Most of all, the nurse should remember that the mental status exam does not reflect how the patient was in the past or will be in the future * The mental status exam is an evaluation of the patient’s current state * Info obtained during the exam is used along with other objective and subjective data

Answer 43

1. Appearance 2. Speech 3. Motor activity 4. Interaction during the interview 5. Affect 6. Perceptions 7. Thought content 8. Thought process 9. Level of consciousness 10. Level of concentration and calculation 11. Information and intelligence 12. Judgment 13. Insight

Answer 44

**Observe:** * apparent age, manner of dress, cleanliness, posture, gait, facial expressions, eye contact, pupil dilation or constriction, general state of health and nutrition **Clinical implications**: * Dilated pupils are sometimes associated with drug intoxication * Pupil constriction may indicate narcotic addiction * Stooped posture is often seen in patients with depression * Manic patients may dress in colorful or unusual attire

Answer 45

**Observe for:** * Rate: rapid or slow * Volume: loud or soft * Amount: paucity, muteness, pressured speech * Characteristics: stuttering, slurring of words, or unusual accents **Clinical implications:** * Speech disturbances are often caused by specific brain disturbances. For example, mumbling may occur in patients with Huntington chorea, and slurring of speech may occur in intoxicated patients

Answer 46

**Observations:** * Level of activity: lethargic, tense, restless, or agitated * Type of activity: tics, grimaces, or tremors * Unusual gestures or mannerisms: compulsive behavior **Clinical implications:** * Excessive body movement may be associated with anxiety, mania, or stimulant abuse * Little body activity may suggest depression, organic mental disorders, catatonic schizophrenia, or drug-induced stupor * Tics and grimaces may suggest medication side effects * Repeated motor movements or compulsive behavior may indicate OCD * Repeated picking of lint or dirt off of clothing is sometimes associated with delirium or toxic conditiom

Answer 47

**Observations:** * is the patient hostile, uncooperative, irritable, guarded, apathetic, defensive, suspicious, or seductive? The nurse may explore the observed behavior by asking, “You seem irritated by something. Is that true?” **Clinical implications:** * Suspiciousness may be evident in patients with paranoia * Irritability may suggest an anxiety disorder

Answer 48

**Mood is:** * a self-report of one’s emotional state and reflects the patient’s life situation **Observations:** * If the potential for suicide is suspected, the nurse should ask the patient directly about thoughts of self-harm. To judge a patient’s suicidal or homicidal risk, the nurse should assess the patients plans, the patient’s ability to carry out those plans, the patient’s attitude about death, and support systems available to the patient

Answer 49

**Affect is:** * the patient’s apparent emotional tone **Observations: affect can be described in terms of** * Range * Duration * Intensity * Appropriateness * Flat affect: the absence of emotional expression, as seen by a patient who reports significant life events without showing any emotional response * Labile affect: expression by undergoing frequent changes from one affective response to another quickly in the same conversation * The nurse should also assess whether the patient’s emotional response is congruent or in agreement with the speech content; for example, it would be incongruent if a patient reports being persecuted by the police and then laughs **Clinical observations:** * Labile affect is often seen in patients with mania * Flat affect and incongruent affect are often evident in those with schizophrenia

Answer 50

* A hallucination is a perception in the **absence of a stimulus** * They are false sensory impressions or experiences * These sensory impressions are generated by the mind rather than by any **external stimuli**, and may be seen, heard, felt, and even smelled or tasted by the patient

Answer 51

false perceptions or false responses to a sensory stimulus

Answer 52

are those that tell the patient to do something, such as kill oneself, harm another, or join someone in the afterlife

Answer 53

**Observations: hallucinations may occur in any of the five major sensory modalities:** * Auditory – sound * Visual – sight * Tactile – touch * Gustatory – taste * Olfactory – smell * Cenesthetic: feeling body functions such as blood pulsing through veins, food digesting, or urine forming * Kinesthetic: sensation of movement while actually motionless **Clinical implications:** * Auditory hallucinations suggest schizophrenia * Visual hallucinations suggest organic mental disorders * Tactile hallucinations suggest organic mental disorders, cocaine abuse, and delirium tremens

Answer 54

**Thought content:** * refers to “what” the patient is thinking **Observations: ** * Delusions: false belief that is firmly maintained even though it is not shared by others and is contradicted by social reality (may be religious, somatic, grandiose, or paranoid) * Thought broadcasting: belief that one’s thoughts are being aired to the outside world * Thought insertion: belief that thoughts are being placed into one’s mind by outside people or influences * Depersonalization: the feeling of having lost self-identity and that things around the person are different, strange, or unreal * Hypochondriasis: somatic over concern with and morbid attention to details of body functioning * Ideas of reference: incorrect interpretation of casual incidents and external events as having direct personal references * Magical thinking: belief that thinking equates with doing, characterized by lack of realistic relationship between cause and effect * Nihilistic ideas: thoughts of nonexistence and hopelessness * Obsession: an idea, emotion, or impulse that repetitively and insistently forces itself into consciousness, although t is unwelcome * Phobia: a morbid fear associated with extreme anxiety **Clinical implications:** * Obsessions and phobias are associated with anxiety disorders * Delusions, depersonalization, and ideas of reference suggest schizophrenia and other psychotic disorders * it is important that the nurse only obtain information about the patient’s thinking and not challenge or try to correct the patient’s beliefs

Answer 55

**Thought process:** * “how” of the patient’s self-expression **Observations:** * Circumstantial: thought and speech associated with excessive and unnecessary detail that is usually relevant to a question, and an answer is eventually provided * Flight of ideas: over-productive speech characterized by rapid shifting from one topic to another and fragmenting ideas * Loose associations: lack of a logical relationship between thoughts and ideas that renders speech and thought inexact, vague, diffuse, and unfocused * Neologisms: new word or words created by the patient; often a blend of other words * Perseveration: involuntary, excessive continuation or repetition of a single response, idea, or activity; may apply to speech or movement, but most often verbal * Tangential: similar to circumstantial but the person never returns to the central point and never answers the original question * Thought blocking: sudden halt in the train of thought or in the middle of a sentence * Word salad: series of words that seem totally unrelated **Clinical implications:** * Circumstantial thinking may be a sign of defensiveness or paranoid thinking * Loose associations and neologisms suggest schizophrenia or other psychotic disorders * Flight of ideas indicates mania * Perseveration is often associated with brain damage and psychotic disorders * Word salad represents at the highest level of thought disorganization

Answer 56

**Observations:** * Can be described as confused, sedated, or stuporous * In addition, the patient should be questioned regarding orientation to time, place, and person **Clinical implications:** * Patients with organic mental disorders may give grossly inaccurate answers, with orientation to person remaining intact longer than orientation to time or place * Patients with schizophrenic disorders may say that they are someone else or somewhere else or reveal a personalized orientation to the world

Answer 57

**Observations:** * Remote memory: recall of events, info, and people from the distant past * Confabulation is a possibility, because the nurse can’t tell what is true and isn’t from the past; the patient may make up stores about situations or events that cannot be remembered * Recent memory: recall of events, info, and people from the past week or so * Immediate memory: recall of info or data to which a person was just exposed **Clinical implications:** * Loss of memory occurs with organic mental disorders, dissociative disorder, and conversion disorder * Patients with Alzheimer disease retain remote memory longer than recent memory * Anxiety and depression can impair immediate retention and recent memory

Answer 58

**Concentration:** * is the patient’s ability to pay attention during the course of the interview **Calculation:** * is the person’s ability to do simple math **Observations:** * Calculation can be assessed by: * Counting from 1 to 20 rapidly * Do simple calculations * Serially subtract 7 from 100 **Clinical implications:** * Many psychiatric illnesses impair the ability to concentrate and complete simple calculations * It is particularly important to differentiate among organic mental disorder, anxiety, and depression

Answer 59

**Observations:** * The nurse should assess the patient’s last grade of schooling completed, general knowledge, and use of vocabulary **Clinical implications:** * The patient’s educational level and any learning disabilities should be carefully evaluated * Mental retardation should be ruled out whenever possible * The patient’s level of literacy may be part of a general assessment, but it also is an important factor in any health teaching or didactic information presented to the patient * the nurse should be cautious about judging intelligence after a brief and limited contact typical of the time it takes to conduct a mental status exam

Answer 60

**Judgment:** * involves making decisions that are constructive and adaptive **Observations:** * can be evaluated by exploring the patient’s involvement in activities, relationships, and vocational choices **Clinical implications:** * Judgment is impaired in organic mental disorders, schizophrenia, psychotic disorders, intoxication, and borderline or low IQ

Answer 61

**Insight:** * the patient’s understanding of the nature of one’s problem or illness **Observations:** * important for the nurse to determine whether the patient accepts or denies the presence of a problem or illness; in addition, the nurse should ask if the patient blames the problem on someone else or some external factors **Clinical implications:** * Insight is impaired in those with many psychotic illnesses, including organic mental disorders, psychosis, substance abuse, eating disorders, personality disorders, and borderline or low IQ * Whether a patient sees the need for treatment is important to the formation of the therapeutic alliance, establishment of mutual goals, and implementation of and adherence to the treatment plan * Motivational interviewing can assess the patient’s readiness to change

Answer 62

a simplified, scored form of the cognitive mental status exam with 11 questions; requires 5-10 minutes

Answer 63

1. Wechsler Adult Intelligence Scale (WAIS) 2. Wechsler Intelligence Scale for Children (WISC) * Projective tests: reflect aspects of a person’s personality, including reality testing ability, impulse control, ego defense, interpersonal conflicts, and self-concept

Answer 64

* Measure the extent of the patient’s problems * Make an accurate diagnosis * Track patient progress over time * Document the efficacy of treatment

Answer 65

lowering the incidence of a mental disorder by reducing the rate at which new cases of a disorder develop

Answer 66

involves decreasing the prevalence of a mental disorder by reducing the number of existing cases through early case finding, screening, and prompt, effective treatment

Answer 67

attempts to reduce the severity of a mental disorder and its associated disability through rehabilitative activities

Answer 68

* developmental events requiring role changes * Transitional periods during adolescence, parenthood, marriage, midlife, and retirement are key times for the onset of maturational crises

Answer 69

* occur when a life event upsets an individual’s or group’s psychological equilibrium * Examples: loss of a job, loss of a loved one, unwanted pregnancy, onset or worsening of a medical illness, divorce, school problems, witnessing a crime

Answer 70

describes a mental disorder characterized by anxiety that involves no distortion of reality; neurotic disorders are maladaptive anxiety responses associated with moderate and severe levels of anxiety

Answer 71

* disintegrative and involves a significant distortion of reality; can emerge with the panic level of anxiety * The medical diagnoses related to anxiety include panic disorder with or without agoraphobia, agoraphobia, specific phobia, social phobia, OCD, PTSD, acute stress disorder, and GAD

Answer 72

An important aspect of mental health promotion involves activities related to dispelling myths and stereotypes associated with vulnerable groups, providing knowledge of normal parameters, increasing sensitivity to psychosocial factors affecting health and illness, and enhancing the ability to give sensitive, supportive, and humanistic health care

Answer 73

* Stigma: a mark of disgrace or discredit that is used to identify and separate out people whom society sees as deviant, sinful, or dangerous; * **Three types:** * **Public –** what the public does to those with mental illness * **Self –** when individuals internalize public stigma and harm themselves * **Label avoidance -** when individuals who are not mentally ill avoid mental health care so as not to be marked with the label

Answer 74

* Makes people conceal or deny their symptoms * Results in delays in treatment * Discourages adherence to effective treatments * Isolates the individual and family * Lowers self-esteem and potential for self-care * Limits access to quality health care * Negatively affects the attitudes of health care providers * Contributes to more severe forms of illness * Limits the community’s response to illness * Stigma reduction initiatives must take place on both individual and community levels * Everyone needs to understand that no one is immune to mental illness or emotional problems and that the fear, anxiety, and even anger felt about some people who experience these problems may reflect some of our own deepest fears and anxieties

Answer 75

clinical syndromes

Answer 76

* personality disorders * Axis I and II include the entire classification of mental disorders plus conditions that are not attributable to a mental disorder but that are a focus of attention or treatment

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* general medical conditions * Axis III allows the clinician to identify any physical disorder relevant to the understanding or treatment of the individual

Answer 78

* psychosocial and environmental problems * Axis IV is for reporting psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders

Answer 79

* global assessment of functioning * Axis V is for reportingthe clinician’s judgment of the individual’s overall level of functioning

Answer 80

**Voluntary admission:** * any citizen of lawful age may apply in writing for admission to a public or private psychiatric hospital **Characteristics:** * The person agrees to receive treatment and abide by hospital rules * If someone is too ill to apply but voluntarily seeks help, a parent or legal guardian may request admission (people under the age of 16) * Voluntary admission is preferred because it is similar to a medical hospitalization and indicates that the patient acknowledges problems in living, seeks help in coping with them, and will participate in finding solutions * When voluntarily admitted, the patient retains all civil rights, including the right to vote, have a driver’s license, buy and sell property, manage personal affairs, hold office, practice a profession, and engage in a business

Answer 81

**Involuntary admission (commitment):** * Means that 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 **three grounds:** 1. Dangerous to self or others 2. Mentally ill and in need of treatment 3. Unable to provide for own basic needs * **Emergency hospitalization: most state laws limit the length of emergency commitment to 48-72 hours** *

Answer 82

**Commitment process:** * Begins with a sworn petition by a relative, friend, public official, physician, or any interested citizen stating that the person is mentally ill and needs treatment * Then, one or two physicians must assess the person’s mental status (some states require psychiatrist) * The decision of whether to hospitalize the patient is made next; the person who makes the decision determines the nature of the commitment: * Medical certification means that physicians make the decision * Court or judicial commitment is made by a judge or jury in a formal hearing * Administrative commitment is determined by a special tribunal of hearing officers

Answer 83

: used for diagnosis and short term therapy and does not require an emergency situation

Answer 84

provides for hospitalization for an indefinite time or until the patient is ready for discharge

Answer 85

1. Right to communicate 2. Right to keep personal effects 3. Right to enter into contractual relationships 4. Right to education 5. Right to habeas corpus: 6. Right to privacy:

Answer 86

Right to communicate with people outside the hospital with telephone privileges, sending letters, etc

Answer 87

patient may bring clothing and personal items to the hospital, taking into consideration the amount of storage space available

Answer 88

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

Answer 89

**Incompetence: a legal term without a precise medical meaning; the following must be shown in court:** * The person has a mental disorder * This disorder causes a defect in judgment * This defect makes the person incapable of handling personal affairs * If ruled incompetent, a person cannot vote, marry, drive, or make contracts

Answer 90

provides for the speedy release of any person who claims to be detained illegally

Answer 91

confidentiality means not disclosing information about a person to someone else unless authorized by that person

Answer 92

* Every psychiatric professional is responsible for protecting a patient’s right to confidentiality, including even the knowledge that a person is in treatment or a hospital * Clinicians are free from legal responsibility if they release information after they obtain the patient’s written and signed consent * HIPAA guarantees patients four rights related to the release of information: * To be educated about HIPAA privacy protection * To have access to their own medical records * To request correction or amendment of their health information to which they object * To require their permission for disclosure of their own personal information

Answer 93

The physical record is property of the treatment facility or therapist, but the information inside of it belongs to the patient; thus the original record should never be given to the patient; only a copy of it should be provided

Answer 94

* applies only in court related proceedings; includes communication between husband and wife, attorney and client, and clergy and church member * The right to reveal information belongs to the person who spoke, and the listener cannot disclose the information unless the speaker gives permission * Testimonial privilege between health professionals and patients exists only if established by law

Answer 95

* A model that shows with whom patient information may be shared with * Within the circle are treatment team members, staff supervisors, health care students and their faculty, and consultants who actually see the patient * All these people must be informed about the patient’s clinical condition to be able to help * The patient is also inside the circle because they can reveal any aspect of their lives, problems, treatments, and expierences to anyone

Answer 96

A mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for weeks or longer. It can occur once or repeatedly over the course of a lifetime.

Answer 97

**Five or more of the following symptoms occurring in the same two week period:** 1. Weight gain or loss 2. Insomnia or hypersomnia 3. Psychomotor agitation or retardation 4. Fatigue 5. Feelings of worthlessness 6. Impaired concentration 7. Thoughts of suicide or death **AND ****At least one major symptoms:** 1. Depressed mood 2. Anhedonia (inability to experience pleasure from activities usually found enjoyable)

Answer 98

* Both heredity and environment play an important role in severe mood disturbances; MDD and bipolar are familial disorders * The lifetime risk is 20% for relatives of people with depression and 24% for relatives of people with bipolar disorder * Identical twins has a 2-4 times greater risk than fraternal twins

Answer 99

* May involve a single episode or a recurrent depressive illness but does not include a manic episode * Behaviors associated with depression: key element of a behavioral assessment is change of the patient’s usual patterns * Anxiety often accompanies depression * Somatic complaints * Postpartum onset

Answer 100

* **Culture affects the symptomatic expression, clinical presentation, and effective treatment of depression** * A high incidence of depression is found among all patients hospitalized for medical illnesses & Depressive conditions are highly prevalent in primary care setting * **More than 50% of those who have one episode will eventually have another, and 25% of patients will have chronic, recurrent depression** * Only one third of all people with depression seek help, are accurately diagnosed, and obtain appropriate treatment

Answer 101

* Beck Depression Inventory * Zung self-Rating Depression Scale * Hamilton Depression Rating Scale * Center for Epidemiological Studies – Depression Scale

Answer 102

* Physical care, psychopharmacology, somatic therapies * **Cognitive Behavioral Therapy:** help patients explore their feelings and their view of the problem; focus on modifying the patient’s thinking; the patient can be helped to examine the accuracy of perceptions, logic, and conclusions * Be quiet, warm, and accepting * Rapport is best established with the depressed patient through shared time, even if the patient talks little, and through supportive companionship * Sleep deprivation therapy * **Express feelings of hope for patient** and that the future will be better; tell patient that expressing feelings is normal and necessary

Answer 103

**The patient will be emotionally responsive and return to a preillness level of functioning** **Goals:** * To allow recognition and continuous expression of feelings, including denial, hopelessness, anger, guilt, blame, helplessness, regret, hope, and relief, within a supportive therapeutic atmosphere * To allow for gradual analysis of stressors while strengthening the patient’s self-esteem * To increase the patient’s sense of identity, control, awareness of choices, and responsibility for behavior * To encourage healthy interpersonal ties with others * The promote understanding of maladaptive emotions and to acquire adaptive coping responses to stressors * Specific short-term goals should be developed based on the behaviors of the patient, present areas of difficulty, and relevant stressors * **The patient’s participation in setting these goals can be significant first steps in regaining mastery over life**

Answer 104

* Tricyclic antidepressants (TCA) * Monoamine oxidase inhibitors (MAOIs) * Selective serotonin reuptake inhibitors (SSRI) * Other antidepressants

Answer 105

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

Answer 106

persistent absence of emotion with undue delay in work of mourning or grieving

Answer 107

Emotions triggered by deliberate recall of circumstances surrounding loss or occurrence

Answer 108

* Assess stage in the grief process. * Help actualize the loss by talking about it. * Encourage expression of feelings.

Answer 109

It is an adaptive response, it is a self-limited process of realization that makes the fact of the loss real

Answer 110

* It is a milder form of depression lasting 2 or more years. * It is a chronic condition, and many patients with dysthymia eventually develop major depressive episodes, but there are fewer related depressive symptoms

Answer 111

* Cognitive and behavioral therapy * Phototherapy * Sleep deprivation therapy * Transcranial magnetic therapy * Vagal nerve stimulation * Electroconvusive therapy

Answer 112

* It is a method of changing patient's thought processes, behaviors, and emotions. * Has proven efficacy for both depressive and bipolar disorders * **Nurses have three major aims:** * To increase the patient’s sense of control over goals and behavior * To increase the patient’s self-esteem * To help the patient modify dysfunctional thinking patterns

Answer 113

* Light therapy; a physiological treatment in which patients are exposed to bright artificial light for a specified amount of time each day * Appears to be effective in the short-term treatment of mild to moderate SAD

Answer 114

Research indicates that depriving some depressed patients of a night’s sleep improves their clinical condition; MOA is unknown

Answer 115

* Noninvasive procedure in which a changing magnetic field is introduced into the brain to influence the brain’s activity with the goal of treating mood disorders * **Adverse effect:** potential for inducing seizures * **With TMS the brain is directly stimulated to produce neurochemical changes**

Answer 116

* It is used in the treatment of affective disorders, particularly treatment resistant depression * The left vagus is used because it is composed of mostly afferent sensory fibers that connect to the brainstem and deep brain structures * **Side effects:** hoarseness, throat pain, neck pain, headache, SOB

Answer 117

* ECT is a specific therapy for patients with severe depressions who have somatic delusions and delusional guilt accompanied by a lack of interest in the world, suicidal ideation, and weight loss * Used with depressed patients, particularly those with recurrent depressions and resistance to drug therapy

Answer 118

* Cardiovascular effects * **Systemic effects include:** headaches, nausea, muscle soreness, and drowsiness may occur * **Cognitive effects:** confusion immediately after the seizure and memory disturbance during the treatment course * **Short term memory loss** * **_AFTER ECT check vital signs and precautions from general anesthesia_**

Answer 119

* Emotional support and education * **Pretreatment nursing care:** reviewing recommended consultations, noting that any abnormalities in lab tests have been addressed, and checking that equipment and supplies are adequate and functional * **Nurse should remain with the patient throughout the treatment to provide support** * **Posttreatment care:** the area should contain oxygen, suction, pulse oximeter, vital sign monitoring, and emergency equipment * The nurse should clarify that most memory problems will pass within several weeks

Answer 120

* A condition in which people go back and forth between periods of a very good or irritable mood and depression. * The “mood swings” between mania and depression can be very quick

Answer 121

* Includes one or more manic episodes, with our without a major depressive episode * **Manic behavior, the essential feature of bipolar disorder**, is a distinct period of intense psychophysiological activation; the predominant mood is elevated or irritable * Patients may have misperceptions about their power and importance and may involve themselves in senseless, irresponsible, or risky activities * Grandiose symptoms are evident * Physical changes they experience, such as abundant energy and heightened sexual appetite, are caused by inadequate nutrition, partly because manic patients have no time to eat; serious weight loss is also related to their insomnia and overactivity * As mania intensifies, formal and logical speech is replaced by loud, rapid, and confusing language, referred to as pressured speech -\> can lead to loose associations and flight of ideas * May experience lability of mood with rapid shifts to periods of depression

Answer 122

Defined as having four or more episodes per year; four or more major depressive, manic, hypomanic, or mixed episodes within a 12 month period

Answer 123

Occurs when a patient has 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.

Answer 124

* Period of abnormally persistent, elevated, and expansive, or irritable mood, lasting at least one week. **Three or more of seven symptoms must be present:** * 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 a high potential for painful consequences

Answer 125

* **Risk factors are being female and having a family history of bipolar** * Most people start showing symptoms **in their late teens** * On average, a person is free of symptoms for about 5 **years between the first and second episodes** * Associated with increased premature mortality secondary to general medical illnesses

Answer 126

* Elevated, euphoric, or expansive moods * Irritability * Sleep disturbances * Excessive spending * Sexual overactivity * Flamboyant dress * Hyperactive, intrusive * Grandiosity * Verbosity * Flight of ideas * Rapid, pressured speech

Answer 127

* Bipolar II is similar to bipolar I disorder, with moods cycling between high and low over time. * However, in bipolar II disorder, **the "up" moods never reach full-on mania**. The less-intense elevated moods in bipolar II disorder are called **hypomanic episodes, or hypomania.**

Answer 128

* Presence or history of one or more major depressive episodes * 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 * Symptoms can cause significant distress or impair social, occupational, or other functioning * Other psychiatric disorders are ruled out

Answer 129

* 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

Answer 130

It iss a disorder resembling bipolar disorder but with **less severe symptoms**, characterized by repeated periods of nonpsychotic depression and hypomania for **at least two years**

Answer 131

* Has for at least 2 years, 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** * Has had no manic, hypomanic, or major depressive episodes during the 2 year period

Answer 132

* Patients with bipolar illness may be very talkative and need **simple explanations and concise, truthful answers to questions** * Constrictive limit setting on manic patients’ behavior is an essential part of the plan * One goal of nursing care is to **increase the patient’s self-control, and this should be kept in mind when setting limits** * Physiological treatments * Manic patients primarily need protection from themselves * Non-adherence is a major problem * Somatic therapy * Expressing feelings: these patients are often hyperverbal and need help from the nurse in pacing and moderating their expression * **Helping the patients to speak more slowly and to follow one line of thought is an important area for nursing intervention** * **Cognetive behavioral therapy:** behavior change; social skill building * Family group involvement * Education

Answer 133

* 10th leading cause of death in the US * 3rd leading killer of young people * Are most likely under-reported * Women attempt suicide three times as often as men: **men are more likely to complete a suicide** * **Highest rate of suicide is among Caucasian men over 80 years of age.** * **Guns account for half of all completed suicides**

Answer 134

* Hospitalized depressed patients * Elderly patients * Patients with alcoholism * Depressed adolescents * Patients with severe mood disturbances

Answer 135

**Nursing diagnoses:** * Maladaptive self-protective responses are risk for suicide * self-mutilation * noncompliance * risk for self-directed violence **Goals of care:** * _Patient will not physically harm himself or herself; highest priority should be given to the preservation of life_

Answer 136

* Motivational interviewing * Assess patient’s judgment, availability of a responsible family member or close friend who is willing to stay with the patient * **Protect the patient from harm!**

Answer 137

* **The highest priority nursing activity with self-destructive patients is to protect them from inflicting further harm on themselves and, if suicidal, from killing themselves** * Suicidal patients may appear to be feeling much better immediately before making an attempt * Although no suicide contracts have been used in clinical practice for many years, they have found to be NOT effective * The patient should be supervised at all times * The nurse should monitor any medications the patient receives

Answer 138

* Gun control and decreased availability of lethal weapons * Limitations on the sale and availability of alcohol and drugs * Increased public and professional awareness about depression and suicide * Less attention to and reinforcement of suicidal behavior in the media * Establishment of community-based crisis intervention clinics * Campaigns to decrease the stigma associated with psychiatric care * Increased insurance benefits for psychiatric and substance abuse disorders * Develop broad-based support for suicide prevention * Develop and implement strategies to reduce the stigma associated with being a consumer of mental health, substance abuse, or suicide prevention services * Develop and implement suicide prevention programs * Promote efforts to reduce access to lethal means and methods of self-harm * Implement training for recognition of at-risk behavior and delivery of effective treatment * Improve access to and community linkages with mental health and substance abuse services * Improve reporting and portrayals of suicidal behavior, mental illness, and substance abuse in the entertainment and news media * Promote and support research on suicide and suicide prevention * Improve and expand surveillance systems

Answer 139

Block reuptake of serotonin at the presynaptic membrane. This results in an increase of available serotonin in the synapse and therefore at postsynaptic receptors, promoting serotonin neurotransmission

Answer 140

Weight gain, lower seizure threshold, **serotonin syndrome,** agitation, anxiety, nausea, diarrhea, insomnia, sexual dysfunction **Cytochrome p-450 inhibition**

Answer 141

* Inhibits metabolism of TCAs, trazodone, barbiturates, most benzodiazepines, carbamazepine, narcotics, neuroleptics, phenytoin, valproate, verapamil * This effect can be potentially life threatening because it increases serum concentrations as well as therapeutic and toxic effects of these drugs

Answer 142

* a life-threatening emergency resulting from excess CNS 5-HTcaused by combining 5-HT enhancing drugs or administering SSRIs too close to the discontinuation of MAOIs (SSRIs) * confusion, disorientation, shivering, Dilated pupils, Headache, diarrhea, rapid heart rate, heavy sweating

Answer 143

serotonin and NE reuptake inhibition, as well as blockade of three receptors not implicated in depression: muscarinic cholinergic, histamine, and alpha-noradrenergic receptors

Answer 144

TCAs can have dangerous cardiac side effects and are lethal in overdose, sedation, weight gain, orthostatic hypotension, dizziness

Answer 145

inhibit both types of the enzyme( MAO A and MAO B) that metabolizes serotonin and norepinephrine; this inhibition is irreversible; lasting until the body is able to manufacture new MAO after the drug is discontinued

Answer 146

Dangerous elevation in blood pressure can result from high levels of NE not metabolized by MAO; avoid foods and drugs that are NE agonists, they can cause hypertensive crisis

Answer 147

* Used to treat bipolar disorder * **Side effects:** drowsiness, dizziness, ataxia, double vision, blurred vision, nausea, fatigue, GI upset, skin reactions, P450 drug, agranulocytosis (rare decrease in WBC that is permanent); lethal in overdose

Answer 148

* Used for bipolar disorder, it is a derivative of valproic acid, it has a superior therapeutic index, a better toxicity profile, and a wider range of effectiveness in subtypes of bipolar disorder * **Side effects:** GI complaints, tremor, sedation, headache, dizziness, ataxia, increased appetite/weight gain, thrombocytopenia, pancreatitis, hepatic dysfunction

Answer 149

* A severe and potentially life-threatening increase in blood pressure and can be caused by MOI's. * **Don't take foods with tiramine (no wine, cherries, cheeses, blue cheese, cheddar cheese, sour cream, alvacado, chocolates) and MAOI's at the same time** * **Symptoms include:** * flushed face, dialated pupils, headaches

Answer 150

A naturally occurring salt that is first line for patients with acute mania and for the long term prevention of recurrent episodes; exact MOA is unknown, but many neurotransmitter functions are altered by the drug

Answer 151

Because it is excreted by the kidneys, it can adversely affect the thyroid, has a narrow therapeutic index and can quickly become fatal, initial and ongoing health assessment and laboratory monitoring is required; lithium toxicity is a medical emergency requiring rapid treatment

Answer 152

0.6 – 1.4 mEq/L Lithium in the blood

Answer 153

* Decreased sodium intake * Diuretic therapy * Decreased renal functioning * Fluid and electrolyte loss, sweating, diarrhea, dehydration, fever, vomiting * Medical illness * Overdose * Nonsteroidal antiinflammatory drug therapy

Answer 154

* Assess quickly; obtain rapid history of incident, especially dosing; offer support and explanations to the patient. * **Hold all lithium doses** * **Obtain lithium blood level immediately;** obtain electrolytes, BUN, creatinine, urinalysis, CBC when possible * **Vigorously hydrate:** 5 to 6 L/day; balance electrolytes; IV line; indwelling urinary catheter * Implement osmotic diuresis with urea or mannitol * **Ensure adequate intake of sodium chloride to promote excretion of lithium**

Answer 155

A mental disorder that makes it hard to yell the difference between what is real and not real

Answer 156

**Nobody is completely sure, there are:¨** * Neurophysiological theories * Genetic theories * Environmental and developmental factors * Probably due to Abnormalities in brain structure

Answer 157

* Pre-frontal cortex * Anterior cingulate cortex * Limbic regions-hippocampus * Striatum

Answer 158

* **Astereognosis: **Inability to recognize objects by the sense of touch (e.g., differentiating a nickel from a dime) * **Agraphesthesia:** Inability to recognize numbers or letters traced on the skin * **Dysdiadochokinesia: **Impairment of the ability to perform smooth, alternating movements (e.g., turning the hand face up and face down rapidly) * Mild muscle twitches, choreiform and ticlike movements, grimacing * Impaired fine motor skills and abnormal motor tone Increased rate of eye blinking * **Abnormal smooth pursuit eye movements (SPEMs):** Diff iculty following movement of objects

Answer 159

Loss of function, weakness, diminished reflexes, paralysis caused by a cerebrovascular accident, tumor, traumatic injury, etc

Answer 160

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:** * delusions * hallucinations * disorganized speech * grossly disorganized or catatonic behavior * negative symptoms

Answer 161

¨**Peak incidence:** * Males: 15-25 years of age * Females: 25-35 years of age **Course of illness:** * Extremely variable * Often chronic * Sometimes episodic only **Prognosis:** * Intensity of psychosis diminishes with age

Answer 162

¨_Factors related to poor prognosis:_ * Early age of onset * Insidious onset * Poor premorbid adjustment * Sustained emotional withdrawal * Inappropriate affective response * Enlarged cerebral ventricles * Perinatal brain injury * Poor response to medications

Answer 163

* Delusions * Hallucinations * Though disorder * Disorganized speech * Bizarre behavior * Inappropriate affect

Answer 164

Diminished normal behaviors; diminution or loss of normal brain function; usually unresponsive to traditional antipsychotics and more responsive of atypical antipsychotics

Answer 165

They are exaggerated normal behaviors; an exaggeration or distortion of normal brain function; usually responsive to all categories of antipsychotic drugs

Answer 166

* Affective flattening * Alogia * Avolition/apathy * Anhedonia/asociality * Attentional deficit

Answer 167

**Tendencies of women compared with men:** * Late onset schizophrenia * Less severe course of illness * Exhibit more positive and less negative symptoms * More affective symptoms * Respond to lower doses of antipsychotic medication * Higher level of social functioning * Fewer structural brain abnormalities

Answer 168

* Impaired verbal communication * Disturbed sensory perception * Impaired social isolation * Disturbed personal identity

Answer 169

the patient will live, learn, and work at a maximum possible level of success, as defined by the individual

Answer 170

* Acute phase * Stabilization phase * Stable phase * Relapse

Answer 171

* Provide for patient safety * Reduction of over stimulation * Stress reduction * Establishment of therapeutic relationship * Provide psychosocial education to patient and family

Answer 172

* Psychoeducation * Psychosocial Rehabilitation

Answer 173

* Independent living skills training * Social skills training * Cognitive rehabilitation * Vocational rehabilitation

Answer 174

**Teach patient and family:** * Recognize warning signs * Get to a safe place where someone can monitor symptoms * Reduce stress demands * Take medications * Talk to a trusted person * Avoid negative people

Answer 175

False perceptual distortions that occur in maladaptive neurobiological responses, and there is no identifiable external orinternal stimuluses.

Answer 176

* Auditory * Visual * Olfactory * Gustatory * Tactile * Cenesthetic * Kinesthetic

Answer 177

Audible thoughts in which the patient **hears voices** that are speaking what the patient is thinking and commands that tell the patient to do something, sometimes harmful or dangerous

Answer 178

Visual stimuli in the form of flashes of light, geometric figures, cartoon figures, or elaborate and complex scenes or visions. Visions can be pleasant or terrifying, as in seeing monsters

Answer 179

Putrid, foul, and rancid smells such as blood, urine, or feces; occasionally the odors can be pleasant. Olfactory hallucinations are typically associated with stroke, tumor, seizures, and the dementias

Answer 180

Putrid, foul, and rancid smells such as blood, urine, or feces; occasionally the odors can be pleasant.

Answer 181

Experiencing pain or discomfort with no apparent stimuli. Feeling electrical sensations coming from the ground, inanimate objects, or other people

Answer 182

Feeling body functions such as blood pulsing through veins and arteries, food digesting, or urine forming

Answer 183

Sensation of movement while standing motionless

Answer 184

* Understanding characteristics of the hallucination and identifying the related anxiety level is important * Remember Hallucinations are very real to the person having them * Honesty, genuineness, and openness are the foundation for effective communication during hallucinations * Maintain eye contact, speak simply and in a slightly louder voice than usual, call the patient by name, use touch as appropriate (patient needs sensory validation to override the abnormal sensory processes that are occurring in the brain)

Answer 185

To help them increase awareness of these symptoms so that they can distinguish between the world of psychosis and the world of reality experienced by others without schizophrenia

Answer 186

* **Patients cope with delusions in several ways. Some adapt by learning to live with them, others seek to understand the symptom and become empowered to manage delusions when they occur** * **Development of trust is important; easier through nonverbal communication** * It is essential for the nurse to approach the patient with calmness and empathy * Patients are sensitive to rejection; nurse should not underestimate the power of delusions * Place the delusion in a time frame and identify triggers * Assess the intensity, frequency, and duration of the delusion * Identify emotional components of the delusion * Observe for evidence of concrete thinking * Observe speech for symptoms of a thought disorder * Observe for the ability to accurately use cause and effect reasoning * Distinguish between the description of the experience and the facts of the situation * Carefully question the facts as they are presented and their meaning * Discuss consequences of the delusion when the person is ready * Promote distraction as a way to stop focusing on the delusion

Answer 187

* Self awareness * Communication * Maintain safe environment * Administer psychopharmacology * Crisis management * Seclusion ## Footnote **When patient is aggressive try least restrictive measures first**

Answer 188

A rare but potentially fatal (14% to 30% mortality) side effect of antipsychotic drugs, side effects include: * fever * tachycardia * sweating * muscle rigidity * tremor * incontinence * stupor

Answer 189

Treatment for NMS includes stopping the triggering drug and initiating supportive care

Answer 190

* Cognition is the act or process of knowing * People with schizophrenia are often unable to produce complex logical thoughts or express coherent sentences, because neurotransmission in the brain’s information processing system is malfunctioning

Answer 191

* forgetfulness * disinterest * difficulty learning * lack of compliance w/ meds

Answer 192

* difficulty completing tasks * difficulty concentrating on work * distractibility

Answer 193

* may include loose associations * word salad * tangentiality - with only slight relevance to the current subject * illogicality * circumstantiality * pressured speech * poverty of speech * distractible speech * clanging

Answer 194

**These problems affect one’s:** * insight * judgment * logic * decisiveness * planning * ability to carry out decisions * abstract thought

Answer 195

* Paranoia * grandiosity * religious * nihilistic * somatic delusions * Delusions can be further complicated by thought withdrawal, thought insertion, thought control, or thought broadcasting

Answer 196

a personal belief based on an incorrect inference of external reality; false belief that is firmly maintained even though it is not shared by others and is contradicted by social reality

Answer 197

the identification and interpretation of a stimulus based on information received through sight, sound, taste, touch, and smell.

Answer 198

* Mood and affect: broad, restricted, blunted, flat, and inappropriate * Schizophrenics usually have symptoms of **hypoexpression** * **Alexithymia** * **Anhedonia** * **Apathy**

Answer 199

difficulty naming and describing emotions

Answer 200

inability or decreased ability to experience pleasure, joy, intimacy, and closeness

Answer 201

lack of feelings, emotions, interests, or concern

Answer 202

* Maladaptive behaviors in schizophrenia include deteriorated appearance, lack of persistence and work/school, avolition (lack of energy or drive), repetitive/stereotyped behavior, aggression, agitation, and negativism * Maladaptive movements include catataonia, abnormal eye movements, grimacing, apraxia/echopraxia, abnormal gait, mannerisms, and extrapyramidal side effects of psychotropic medications

Answer 203

* inability to communicate coherently * Loss of drive and interest * deterioration of social skills * poor personal hygiene * paranoia

Answer 204

* Social inappropriateness * disinterest in recreational activities * inappropriate sexual behavior * stigma-related withdrawal by friends, families and peers

Answer 205

* Aripiprazole (abilify) * Clozapine (Clozaril) * **Risperidone (Risperdal) = EPS, tardive dyskinesia** * **Quetiapine (Seroquel) = draw cbc before drug is given, no new prescriptions given until the cbc is drawn** * **Olanzapine (Zyprexa) = metabolic syndrome** * **Ziprasidone (Geodon) = prolonged qt interval**

Answer 206

block effects at the dopamine₂and serotonin₂postsynaptic receptors; thus, they are DA and 5-HT antagonists

Answer 207

* Apriprazole is unique in that it is the first of a new generation of atypical antipsychotics, a dopamine-serotonin stabilizer; it is a partial agonist at D₂and 5-HT_1A receptors and has antagonistic activity at 5-HT_2A receptors * **Atypical antipsychotics improve the positive symptoms of schizophrenia, but unlike the typical drugs, they also improve the negative symptoms** * Reported to **treat mood symptoms**, hostility, violence, suicidal behavior, difficulty with socialization, and the cognitive impairment seen in schizophrenia

Answer 208

* They can result in **metabolic syndrome** with problems related to weight gain, diabetes, and dyslipidemia, often resulting in cardiovascular disease * They **cost** considerably **more** than the typical antipsychotics

Answer 209

* Resperidone tends to elevate serum prolactin levels and may cause extrapyramidal effects at higher doses * Sedation is commonly observed in patients taking quetiapine, olanzapine, or clozapine * Zirpasidone has been associated with mild to moderate QT interval prolongation in up to 5% of patients * Clozapine is often reserved for patients with treatment resistant illness because of its side effects of agranulocytosis, seizures, and myocarditis * Severe allergic reaction can occur with Saphris

Answer 210

* **Haloperidol (Haldol)** * Loxapine (Loxitane) * Thioridazine (Mellaril) * Molindone (Moban)

Answer 211

predominantly dopamine antagonists; they block postsynaptic D₂ receptors in several DA tracts in the brain, accounting for a decrease in positive symptoms of schizophrenia

Answer 212

* Extrapyramidal symptoms and tardive dyskinesia; **result mainly from nonadherence with drug regimens** * A rare but potentially fatal side effect is neuroleptic malignant syndrome; S/S include fever, tachycardia, sweating, muscle rigidity, tremor, incontinence, and stupor * **Treatment includes stopping the triggering drug and initiating supportive care**

Answer 213

They often result in patient nonadherence with drug regimens

Answer 214

* Dyskinesias are movement disorders. * Dystonias are muscle tension disorders.

Answer 215

Dyskinesias are movement disorders and can include any of a number of repetitive, involuntary, and purposeless body or facial movements: * Tongue movements, such as “tongue thrusts” or “flycatching” movements * Lip smacking * Finger movements * Eye blinking * Movements of the arms or legs. * An individual may or may not be aware of these movements. **These movements are recognizable, and many people** **fear that others will know they are taking an antipsychotic medication due to these unusual movements**

Answer 216

* General treatment principles: * Tolerance usually develops by the third month. * Decrease dose of drug. * Add a drug to treat EPS; then taper after 3 months on the antipsychotic. * Use a drug with a lower EPS profile. * Give patient education and support.

Answer 217

* **Anticholinergics:** * Benztropine * Trihexyphenidyl * Biperiden * **Antihistamine** * Benadryl * **Dopamine agonist:** * Amantadine * **Benzodiazepines** * Diazepam * Lorazepam * Clonazepam

Answer 218

symptoms appear during long-term treatment (often after several years) with an antipsychotic. They are more likely to be permanent even after the medication is stopped.

Answer 219

* Can occur after use (usually long use) of conventional antipsychotics * stereotyped involuntary movements (tongue protrusion, lip smacking, chewing, blinking, grimacing, choreiform movements of limbs and trunk, foot tapping) * if using typical antipsychotics, use preventive measures and assess often * consider changing to an atypical antipsychotic drug * **there is no treatment at present for TD**

Answer 220

A group of problems related to weight gain, diabetes, dyslipidemia, often resulting in cardiovascular disease

Answer 221

Patient education on healthy lifestyle—eating, exercise, smoking cessation.

Answer 222

belief that one is favored by a higher being or is an instrument of that being

Answer 223

belief that one’s body or parts of one’s body are diseased or distorted

Answer 224

belief that one possesses greatness or special powers

Answer 225

excessive or irrational suspicion and distrust of others, characterized by systematized delusions that others are “out to get them” or spying on them

Answer 226

belief that one’s thoughts are being aired to the outside world

Answer 227

belief that thoughts are being placed into one’s mind by outside people or influences

Answer 228

the feeling of having lost self-identity and that things around the person are different, strange, or unreal

Answer 229

somatic overconcern with and morbid attention to details of body functioning

Answer 230

incorrect interpretation of casual incidents and external events as having direct personal references

Answer 231

belief that thinking equates with doing, characterized by lack of realistic relationship between cause and effect

Answer 232

thoughts of nonexistence and hopelessness

Answer 233

an idea, emotion, or impulse that repetitively and insistently forces itself into consciousness, although it is unwelcome

Answer 234

a morbid fear associated with extreme anxiety

Answer 235

thought and speech associated with excessive and unnecessary detail that is usually relevant to a question, and an answer is eventually provided

Answer 236

overproductive speech characterized by rapid shifting from one topic to another and fragmenting ideas

Answer 237

lack of a logical relationship between thoughts and ideas that renders speech and thought inexact, vague, diffuse, and unfocused

Answer 238

new word or words created by the patient, often a blend of other words

Answer 239

involuntary, excessive continuation or repetition of a single response, idea, or activity; may apply to speech or movement, but most often verbal

Answer 240

similar to circumstantial but the person never returns to the central point and never answers the original question

Answer 241

sudden halt in the train of thought or in the middle of a sentence

Answer 242

series of words that seem totally unrelated

Answer 243

* Gating is an electrical process involving electrolytes. It refers to inhibitory and excitatory nerve action potentials and the feedback occurring within the nervous system related to completed nerve transmissions. * Decreased gating is demonstrated by a person’s inability to selectively attend to stimuli. * For example, at a baseball game the person with schizophrenia would be unable to differentiate the noise from the crowd from the music ,the team,or the public address system

Answer 244

An increased responsiveness to low doses of stimulation overtime, resulting in seizures due to intermittent and repeated stimulating by low-level electrical impulses or low-dose chemicals such as cocaine.