Mental Health Flashcards
Has insight and is reality based
Non-psychotic
Has no insight and is not reality based
Psychotic
What are psychotic symptoms
Delusions, hallucination, and illusion
A false, fixed belief or idea or thought. There is no sensory component. It is all in your head.
Delusions
What is the 3 types of delusions? Give examples
Parnoid, Grandoise, Somatic
Paranoid-People are out to get/kill me
Grandiose-“I’m Christ”…”iam teh President”…”I am the world’s smartest person”
Somatic-Body part (I have an x ray vision, there are worms inside my arm)
A sensory exaperiece
- it can be auditory visual, tactile, gustatory, olfactory
HALLUCINATION
There is a referent in reality
Referent means something to whoch a person refers when they say something
Hallucination
A misinterpretation of reality. It is sensory
ILLUSION
The pt staring at the empty wall says, “Listen, I hear demon voices.” Is that statement from the pt a hallucination and an illusion?
• There is no referent there
• This is a hallucination
The same pt overhears nurses and doctors laughing and talking at the nursing station, and says, “I hear demon voices.” Is that statement from the pt a hallucination and an illusion?
• There is actually a referent (real people) there • This is an illusion
How do you deal with these psychotic patients?
To deal with these psychotic pt, the first thing to ask is what type of psychosis the pt has?
What are 3 types of psychosis
- Functional psychosis
- Psychosis of dementia
- Psychosis of delirium
A type of psychotic that can function in everyday life
90% make up this category: Skeezo, Skeezo, Major, manics
There is a chemical imbalance in the brain
- Schizophrenia, Schizoaffective disorder, Major depression (not depression), Mania
FUNCTIONAL PSYCHOSIS
- A TYPE of psychosis that has actual damage to the brain
- due to alzheimer, stroke, organic brain syndrome
- anything that says Senile/ Dementia falls in the cateory
- no ptential to re learn reality
***nursing action: REDIRECT
PSYCHOSIS OF DEMENTIA
temporary, sudden, dramatic, episodic secondary to something else
• Loss of reality
o Due to UTI, thyroid imbalance, adrenal crisis, electrolytes, medications/drugs
PSYCHOTIC DELIRIUM
Approach to Answering Psychiatric Questions
• First thing to ask is
o Is the pt non-psychotic? Or, is the pt psychotic?
• Pt is non-psychotic
o Address pt as you would address any Med/Surg pts
Use therapeutic communication
• Pt is psychotic
o Next, ask if they are functional, demented, or delirious?
Functional = (1) Acknowledge feeling, (2) Present reality, (3) Set limits, and (4) Enforcethese limits
Demented = (1) Acknowledge their feeling, and (2) Redirect them—give them something they can do
Delirious = (1) Acknowledge feeling, (2) Reassurance about safety and temporariness of
their condition
• Schizo, mood disorders thought process, and mania (chemicals out of whack)
• This pt has the potential to learn reality (no brain damage)
• Your role as a nurse—teach reality
• Use the 4 step process to teach reality
o (1) Acknowledge feeling, (2) Present reality, (3) Set limits, and (4) Enforce these limits
FUNCTIONAL PSYCHOSIS
• They cannot learn reality … Don’t present it! They can’t learn it! Thus frustrates them, and may discourage you!
• Deal with their problems in 2 steps
o (1) Acknowledge their feeling, and (2) Redirect them—give them something they can do
Psychosis of dementia
Alzheimer lady is the lobby of waiting area of her nursing home. It is Sunday and she is all What church do you go to?” (redirecting) o Don’t tell her husband is dead!, which is presenting reality dressed up. You day to her, “Mrs. Smith, you are all dressed up.” She said, “Yeah! My husband is going to pick me up. We are going to church.” The problem is that the husband has been dead for 10 years.
o She has a false, fixed belief
o She is delusional (or she is psychotic)
o What do you say to her?
o First, acknowledge her … You say, “That sounds nice.” (acknowledging)
o Second, redirect her… You say, “Why don’t we sit down here and talk about church? … What church do you go to? (Redirecting)
*DOnt tell her her husband is dead!!, which is presenting reality
• This is temporary, sudden, dramatic, episodic, secondary loss to reality
• Usually due to some chemical imbalance in the body
• Causes—UTI, thyroid imbalance, adrenal crisis, electrolytes, medications/drugs thyroid storm
• To manage these pts, treat the underlying cause
o Acknowledge feeling o Reassure them of safety and temporariness of their condition
• They lost touch with of reality—Redirect them is futile
Example
A pt with schizoaffective disorder who points to 2 people talking across the room. The pt says, “Those people are plotting to kill me.” What would you say? What is the most important word in the vignette?
• Schizoaffective—psychosis
• I can see that would be frightening. They are not plotting., we are all safe
• We are not going to talk about that. I can see you are too ill. We are ending the conversation
PSYCHOSIS OF DELIRIUM
WHAT CAUSES DELIRIUM
Psychotic for short term*
Drugs: tagimen
Pts high on uppers: intoxication
Withdrawing from downers: delirium tremens, cocaine overdose, methanphetamin overdose
Chemical situations: temporary. Post op psychosis, particular to elderly (PCA post-op),
Occult infectiong: UTI in elderly, Thyroid storn, Adrenal crisis,
Medical Condition
Delirium msnage
Remove underlying cause and keep safe
What are symptoms of psychosis?
Loose associations
- Flight of ideas: rapid flow of thought
- Wod salad: Throw words togetyher and toss out
- Neologisms: make it up
- Narrow self- concept: When a psychotic refuse to change their clothes or leave the room *”Dont make a psychitic do something they don’t want to do”
- Idea of reference: You think everyone is talking about you
What are hallmark of dementia
Memory loss, inability to learn
