Exam 3 SG Flashcards
Grandiosity Symptoms
• Experienced by Bipolar Disorders with elevated self-esteem, larger than life feelings of superiority and invulnerability.
Phenelzine (Nardil): Drug class, toxicity and nursing considerations
- Monoamine Oxidase Inhibitor Agents
- Prescribed as third line agents after SSRIs and tricyclic antidepressants
- Toxicity: headaches and palpitations
- Do NOT use within 14 days of taking SSRIs.
- Avoid anticholinergics, anesthetics, amphetamines, appetite suppressants, nasal decongestants, anti-HTN, CNS depressants (including alcohol), sympathomimetics, and cyclic and newer antidepressants because these may increase hyperpyretic crises, seizures, HTN episodes, or serotonin syndrome. Some OTC cough and cold medications contain sympathomimetics. Consult with the pharmacist when purchasing OTC medicines when taking MAOIs.
- Oral selegiline (Eldepryl) has been helpful with refractory depression
Suicidality: Psychological Factors
o Self-directed aggression/self-destruction
o Death as atonement for wrongdoings
o Death as a way to recapture lost love object
o Suicidal death as a secondary result of the major depressive process
o Suicidal ideation and parasuicidal as an abandonment anxiety
o Response to helplessness, hopelessness, guilt, and diminished self-esteem
o Suicide serves as a way to end painful feeling states
o Cognitive rigidity: inability to identify problems and solutions
o Perturbation: determination of an individual’s level of distress and rated on scale of 1 to 9
Five Level of Suicidal Behavior
(1) Suicidal ideation: Direct or indirect thoughts
(2) : Suicidal threats: Direct verbal or written messages of intent
(3) : Suicidal gestures: Actions resulting in minor injury, no intention to die
(4) : Suicidal attempts: Serious actions with intention to die
(5) : Successful suicides: Deaths of persons who had conscious intent to die
Risk Factors: SADPERSONS
Sex: Male Age: <19 or >45 years Depression or hopelessness Previous attempts or psychiatric care Excessive alcohol or drug use Rational thinking loss Separated/divorced/widowed Organized or serious attempt No social supports Stated future intent
Manic Episode
•Abnormally and persistently elevated, expansive or irritable mood for at least 1 week.
•At least 3 of the following symptoms must be present:
•Emotional Symptoms
o Excessively and persistently elevated, expansive, or irritable mood
• Cognitive Symptoms
o Thoughts of inflated self-esteem and grandiosity
o Thought-flow disturbance with racing thoughts and flight of ideas
• Behavioral Symptoms
o Increased talkativeness
o Decreased need for sleep
o Increased goal-directed behavior or agitation
o Excessive involvement in activities thought to be pleasurable, risky, or even dangerous
• Social Symptoms
o Increased sociability and sexuality
o Intrusive, interruptive, and disruptive during conversations or activities
o Fluctuations between euphoria and anger
• Perceptual Symptoms
o Distractibility
o Hallucinations
Manic Episode Emotional Symptoms
Excessively and persistently elevated, expansive, or irritable mood
Manic Episode Behavioral Symptoms
o Increased talkativeness
o Decreased need for sleep
o Increased goal-directed behavior or agitation
o Excessive involvement in activities thought to be pleasurable, risky, or even dangerous
Manic Episode Social Symptoms
o Increased sociability and sexuality
o Intrusive, interruptive, and disruptive during conversations or activities
o Fluctuations between euphoria and anger
Manic Episode Perceptual Symptoms
Distractibility
Hallucinations
Adjustment disorder
Occurs with a specific psychosocial stressor that can be identfied.
Reactions that occur as a response to a stressor.
Acute case, 3 months,
Chronic case, 6 months.
Symptoms occur as a result of hard time coping or reaction is stronger than expected.
Adjustment disorder with depressive symptoms
• Anhedonia, depressed mood and sadness, diminished ability to think, concentrate or make decisions, recurrent thoughts of death, excessive self-worthlessness and guilt, significant weight loss or gain or change in appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, sleep disturbances, withdrawal from family and social interactions, problems at work as a result of the inability to organize, initiate or complete work, financial problems.
Adjustment disorder signs and symptoms
Symptoms, such as stress, feeling sad or hopeless, and physical symptoms that can occur after you go through a stressful life event. Symptoms occur because you are having a hard time coping. Your reaction is stronger than expected for the type of event that occurred.
Personality disorders
• Pattern is manifested in two or more of the following areas:
o Cognition
o Affectivity
o Interpersonal function
o Impulse control
• Enduring pattern is inflexible and pervasive across a broad range of personal and social situation.
3 Types of Personality disorders
Cluster A - Weird
Cluster B - Wild
Cluster C- Worried
Cluster A - Weird
o Difficulty relating to others, isolate themselves and are unable to socialize comfortably.
o Paranoid, schizoid, schizotypal personality disorders
Paranoid Personality Disorder
Pervasive distrust and suspicion of others and their motives
Unjustified belief that others are trying to harm or deceive you
Unjustified suspicion of the loyalty or trustworthiness of others
Hesitancy to confide in others due to unreasonable fear that others will use the information against you
Perception of innocent remarks or nonthreatening situations as personal insults or attacks
Angry or hostile reaction to perceived slights or insults
Tendency to hold grudges
Unjustified, recurrent suspicion that spouse or sexual partner is unfaithful
Schizoid Personality Disorder
Lack of interest in social or personal relationships, preferring to be alone
Limited range of emotional expression
Inability to take pleasure in most activities
Inability to pick up normal social cues
Appearance of being cold or indifferent to others
Little or no interest in having sex with another person
Schizotypal Personality Disorder
Peculiar dress, thinking, beliefs, speech or behavior
Odd perceptual experiences, such as hearing a voice whisper your name
Flat emotions or inappropriate emotional responses
Social anxiety and a lack of or discomfort with close relationships
Indifferent, inappropriate or suspicious response to others
“Magical thinking” — believing you can influence people and events with your thoughts
Belief that certain casual incidents or events have hidden messages meant only for you
Cluster B Symptoms
Characterized as the “dramatic” and “emotional”
Overly emotional or unpredictable thinking or behavior
Permiscous/impulsive
Antisocial, borderline, histrionic, narcissistic disorders
Antisocial Personality Disorder
Disregard for others’ needs or feelings
Persistent lying, stealing, using aliases, conning others
Recurring problems with the law
Repeated violation of the rights of others
Aggressive, often violent behavior
Disregard for the safety of self or others
Impulsive behavior
Consistently irresponsible
Lack of remorse for behavior
Borderline Personality Disorder
Impulsive and risky behavior, such as having unsafe sex, gambling or binge eating
Unstable or fragile self-image
Unstable and intense relationships
Up and down moods, often as a reaction to interpersonal stress
Suicidal behavior or threats of self-injury
Intense fear of being alone or abandoned
Ongoing feelings of emptiness
Frequent, intense displays of anger
Stress-related paranoia that comes and goes
Histrionic Personality Disorder
Constantly seeking attention
Excessively emotional, dramatic or sexually provocative to gain attention
Speaks dramatically with strong opinions, but few facts or details to back them up
Easily influenced by others
Shallow, rapidly changing emotions
Excessive concern with physical appearance
Thinks relationships with others are closer than they really are
Narcissistic Personality Disorder
Belief that you’re special and more important than others
Fantasies about power, success and attractiveness
Failure to recognize others’ needs and feelings
Exaggeration of achievements or talents
Expectation of constant praise and admiration
Arrogance
Unreasonable expectations of favors and advantages, often taking advantage of others
Envy of others or belief that others envy you
Cluster C - Worried
Characterized as the “anxious” and “fearful”
Avoidant, dependent, obsessive-compulsive disorders
Avoidant Personality Disorder
Too sensitive to criticism or rejection
Feeling inadequate, inferior or unattractive
Avoidance of work activities that require interpersonal contact
Socially inhibited, timid and isolated, avoiding new activities or meeting strangers
Extreme shyness in social situations and personal relationships
Fear of disapproval, embarrassment or ridicule
Dependent Personality Disorder
Feeling the need to be taken care of
Submissive or clingy behavior toward others
Fear of having to provide self-care
Lack of self-confidence, requiring excessive advice and reassurance from others to make even small decisions
Difficulty starting or doing projects on your own due to lack of self-confidence
Difficulty disagreeing with others, fearing disapproval
Tolerance of poor or abusive treatment, even when other options are available
Urgent need to start a new relationship when a close one has ended
Obsessive-compulsive Personality Disorder
Preoccupation with details, orderliness and rules
Extreme perfectionism, resulting in dysfunction and distress when perfection is not achieved, such as feeling unable to finish a project because you don’t meet your own strict standards
Desire to be in control of people, tasks and situations, and inability to delegate tasks
Neglect of friends and enjoyable activities because of excessive commitment to work or a project
Inability to discard broken or worthless objects
Rigid and stubborn
Inflexible about morality, ethics or values
Tight, miserly control over budgeting and spending money
Freud’s psychosexual stage
Oral Anal Phallic Latency Genital
Freud’s Oral Stage
o Ability to relate to others without excess dependency or jealousy.
o Do not complete show lack of trust, self-centered, dependent and jealous.
o Paranoid, Borderline or Histrionic Personality Disorder
Freud’s Anal Stage
o Ability to manage ambivalence
o Do not complete shows difficulty making decisions, withhole friendship or share
o Antisocial, Borderline, Histrionic or Dependent Personality Disorder
Freud’s Phallic Stage
o Ability to master impulses and gains a beginning sense of relating to other people in the environment
o Do not complete shows inability to resolve conflict.
o Multiple psychiatric disorders, particularly those involve the superego function of guilt.
Freud’s Latency Stage
o Repasses the libidinal (sexual) drive and turns attention towards learning and industry.
o Experience too much or too little ability to develop inner control
o Lack of inner control: borderline personality disorder
o Excess of inner control: Obsessive-Compulsive Disorder
Freud’s Genital Stage
o Opportunity to rework earlier issues that the individual has not resolved.
o Do not complete shows compromised sense of self and ability to relate to others
o Whole range of personality disorders.
Milieu Therapy
Recreate a community setting on these units so that the patient is able to interact with other patient peers to identify and problem-solve issues that occur when relating to others.
Adolescent Suicide RF
Previous suicide attempt
History of psychiatric disorders
History of physical/sexual abuse
Exposure to violence
Asperger’s Disorder
Language and cognition are unaffected Will have sustained social impairment, and restricted repetitive patterns Obsessed with one field of area Motor skills are poorly developed More likely to live independently Diagnosis at 7/8
Reactive Attachment Disorder
Occur in kids who experiences pronounce parental physical and emotional abuse or neglect or who are institutionalize or who exposed to extreme poverty.
Reactive Attachment Disorder Clinicals
Feeding difficulties
Failure to gain weight
Detached and difficult to comfort
Shows inhibited or disinhibited type
Reactive Attachment Disorder Inhibited
Unable to socially interact in accordance with his or her developmental level due to lack of healthy bonding and intimacy
Fails to initiate or respond to social cues
Reactive Attachment Disorder Disinhibited
Lacks appropriate boundaries and is unable to differentiate between strangers and safe attachment relationship
Assessing progression of eating disorders
involves sensitivity, thoroughness, and sharp observation skills.
First impressions set the tone for the entire treatment experience
Assess for co-occuring disorders
Eating disorder Etiology
Genetic Serotonin abnormality Diet, Fitness and Fashion industry Women's movement Peer pressure Perfectionism, Social insecurity Affective insecurity Interoceptive deficits- inability to accurately identify and respond to bodily cues Alexithymic - difficulty naming and expressing emotions Low self-esteem Immaturity Compliance Sense of ineffectiveness Interpersonal distrust Enmeshment Poor conflict resolution Separation and individuation
Eating Disorder Epidemiology
Sex ratio: Female
Age of onset: before 20 years old
Cross-cultural: no differentiation in racial, ethnic, or socioeconomic group in US
Mortality: higher than any mental illness
Commonly diagnosed with depression
Anorexia Nervosa Behavioral & Physical Symptoms
Self-starvation Compulsive behaviors regarding food May use laxative/diuretics, excessive exercise & vomiting Wearing baggy clothes Weight loss 15% below ideal Amenorrhea Bradycardia, subnormal body temperature Cachexia, sunken eyes, dry skin Lanugo on face Constipation Cold sensitivity
Anorexia Nervosa Psychological Symptoms
Denial of seriousness of low weight
Body image disturbance
Irrational fear of weight gain
Constant striving for perfect body
Self-concept unduly influenced by shape & weight
Preoccupation with food, cooking
Delayed psychosexual developement (little interest in sex, relationships)
Bulimia Nervosa Behavioral & Physical Symptoms
Recurrent episode of binge eating
Purging behavior to compensate
Self-induced vomiting, use of laxatives, diuretics, enemas, fasting & excessive exercise
Fluid & electrolyte imbalances
Hypokalemia, alkalosis, dehydration, idiopathic edema,
Cardiovascular: hypotension, dysrhythmia, cardiomyopathy
Endocrine: hypoglycemia, menstrual dysfunction
GI: constipation, diarrhea, gastroparesis, esophageal reflux, esophagitis, esophageal tears, dental enamel erosion, parotid gland enlargement
Bulimia Nervosa Psychological Symptoms
Body image disturbance
Persistent over concern with weight, shape, proportions
Mood swings, irritability
Self-concept unduly influenced by weight
External (Situational) crisis
Occurs when a specific, external event, such as job loss, disturbs one’s psychologic equilibrium.
Coping with stressor
Manifests as fight-or-flight reactions or freeze reactions
Denial is common during crisis
Usually individual’s interpretation of crisis is based on the individuals perception of the event, prior learning, memory and previous outcomes to similar situations.
Internal (Subjective) crisis
Triggered by subjective perception of threat to one’s well-being that may not be obvious to the outside observer.
It results from a threat to a deeply held belief or value.
Psychiatric Emergency
Involves a sudden and serious psychologic disturbance that results in a behavioral state that requires intervention to prevent a life-threatening or psychologically damaging consequence.
3 Categories of Psychiatric Emergency
Life-threatening behavior
Life-disrupting behavior,
Life-impairing behavior
Life-threatening behavior
threatened or attempted suicide; individuals at high risk for suicide, assault, homicidal thoughts or actions, other violent acts toward the self or others; drug overdose (intentional or unintentional); acute psychoses caused by psychopathology, drug-induced intoxication, or psychosis; and uncontrollable anger.
