Psych Exam 1 Flashcards
Cultural relativity
The “normality” of behavior is determined by the culture
Incomprehensibility
The inability of the general population to understand the motivation behind the behavior
Alarm reaction stage
Fight or flight syndrome is initiated.
Stage of resistance
Individual uses the physiological responses of the first stage as a defense to adapt to the stressor. If adaption occurs, third stage is prevented or delayed.
Stage of exhaustion
Prolonged exposure to the stressor to which the body had become adjusted.
The immediate response
The hypothalamus stimulates the sympathetic nervous system
Sustained stress response
Promotes susceptibility to diseases of adaptation
Anxiety & grief
Two major primary psychological response patterns to stress
Anxiety
A diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness.
Mild anxiety
Seldom a problem, can provide motivation for survival, still function at optimal level
Moderate anxiety
Perceptual field diminishes, may still attend to needs, less alert
Severe anxiety
Perceptual field is so finished that concentration centers on one detail only or on many extraneous details, much difficulty completing a task
Panic
The most intense state of anxiety, unable to focus on even one detail within the environment, hallucinations.
Defense mechanisms
Used at the mild to moderate state of anxiety
Repressed severe anxiety can cause
Psychoneurotic patterns of behaving like anxiety and somatoform disorders
Anxiety disorders
Symptoms are anxiety and avoidance of behavior
Somatoform disorders
Physical symptoms for which there is no demonstrable organic pathology (hypochondriac & pain disorder)
Extended periods of panic can lead to
Psychotic behavior such as schizophrenia, schizoaffective, and delusional disorder.
Grief
Subjective star of emotional, physical, and social responses to the loss of a valued entity; the loss may be real or perceived
Stages of grief
DABDA; Denial, Anger, Bargaining, Depression, Acceptance
Anticipatory grief
Experiencing of grief process before the actual loss occurs
Resolution
Length of the grief process is entirely individual. It can last from a few weeks to years and it is influenced by a number of factors; thought to occur when a person can look back on the relationship and accept both the pleasures and the disappointments of the association.
Prolonged response
Intense preoccupation with memories of the lost entity for many years after the loss has occurred. Behaviors of denial and anger are exhibited.
Delayed/inhibited response
The individual because fixed in the denial stage of grieving.
Distorted response
Fixed in the anger stage of grieving. All behaviors are exaggerated.
Axis I
Clinical disorders and other conditions that may be a focus of clinical attention; “why are they in the ward?” Includes all disorders except personality and MR patients.
Axis II
Personality disorders and mental retardation- usually begin in childhood and are stable into adulthood.
Axis III
General medical conditions that are relevant to understanding the management of the individual’s mental disorder
Axis IV
Psychosocial and environmental problems; “what happened in life to cause illness?” These are problems that may affect diagnosis, treatment, and prognosis of mental disorders named on axes I and II.
Axis V
The measurement of an individual’s psychological, social, and occupational functioning on the Global Assessment of Functioning Scale
Personality
Influenced by temperament (inborn personality characteristics) and the environment
Personality disorders
Occur when personality traits become inflexible and maladaptive, causing either significant functional impairment or subjective distress
When did Freud believe that basic character was formed?
Age 5
Id
The pleasure principle, impulsive and may be irrational, present at birth
Ego
Rational self, mediator, develops between 4-6 months
Superego
Perfection principle, develops between 3-6 years, assists ego in control of id impulses
Conscious
Memories that remain in your awareness, smallest of the three
Preconscious
Suppress unpleasant or nonessential memories from consciousness
Unconscious
All memories that you’re unable to bring to conscious awareness, largest of three
Psychic energy
Force required for mential functioning , also called libido
Oral stage
Birth-18 months, relief through oral gratification
Anal stage
18 months-3 years, learning independence and control, with focus on excretory function
Phallic stage
3-6 years, Identification with parent of same fender, development of sexual identity, focus on gentian organs
Latency stage
6-12 years, sexuality repressed
Genital stage
13-20 years, libido reawakened, opposite gender
Trust vs mistrust
Birth-18 months
Autonomy vs shame & doubt
18 months-3 years, Self control and independence within the environment, self control and self-confidence
Initiative vs guilt
3-6 years, sense of purpose and initiate own activities
Industry vs inferiority
6-12 years, self confidence by learning, performing successfully, and receiving recognition from peers
Identity vs role confusion
12-20 years, integrate tasks mastered in previous stages into secure self
Intimacy vs isolation
20-30 years, form a relationship with person, cause, or institution
Generativity vs stagnation
30-65 years, achieve life goals and consider well being for future generations
Ego integrity vs despair
65 years-death, review life and either feel happy or sad about it
Legislation
Determines what is right or good within a society
Ethics
Deals with rightness and wrongness of actions
Bioethics
Term applied to ethics within the concept of medicine, nursing, and allied health
Absolute right
When there is no restriction whatsoever on the individual’s entitlement
Legal right
A right on which society has agreed and formalized as a law
Utilitarianism
Ethical theory that promotes actions based on the end results that produce the most good (happiness) for the most people
Kantianism
Suggests that decisions and actions are bound by a sense of duty
Christian ethics
Do unto others as you would have them do to you
Natural law theories
Do good and avoid evil
Ethical egoism
Decisions are based on what is best for the individual making the decision
Beneficence
One’s duty to benefit or promote the good of others
Nonmaleficence
Abstaining from negative acts toward another; acting carefully to avoid harm
Veracity
Tell the truth
Statutory law
Made from legislative systems
Common law
Derived from decisions made from previous cases
Civil law
Protects the private and property of individuals and businesses- torts & contracts
Tort
Violation of a civil law in which an individual has been wronged
Intentional- touching
Unintentional- malpractice & negligence
Criminal law
Provides protection from conduct deemed injurious to the public welfare
HIPPA
Individuals have right to med records, corrections made to records, and who had knowledge of records
Privileged communication
May refuse to reveal info about and communications with clients (psych and attorneys)
Duty to warn
Threat, Identification of intended victim, ability to intervene in a feasible meaningful way to protect intended victim
Involuntary commitment
Emergent, mentally I’ll, involuntary outpatient commitment, gravely disabled
Malpractice
Professional negligence
Existence of a duty, failure to care, Injury, close casual connection between nurse’s conduct and patient’s injury
Defamation
Info is detrimental to client’s reputation
Libel
Written defamation
Slander
Spoken defamation
territoriality
tendency to own space
density
number of people within a given environment
distance
the space used to communicate
social organization
groups within which individuals are acculturated, acquiring knowledge and internalizing values; families, religious groups, ethnic groups
northern European americans
less value is placed on marriage, future-oriented
African americans
about 31% of households are run by females, some have a “granny” that practice folk medicine
native americans
touch is not highly regarded, silent and reserved, uncomfortable expressing emotions, present-time oriented, medicine man is called shaman, TB, alcoholism, and nutritional deficiencies
asians
soft spoken, not very touchy, past and present oriented, psychiatric illness is thought as behavior that is out of control
latinos
present-oriented, use hot and cold technique
western European americans
warm and affectionate, present-oriented, strong allegiance to culture
arabs
conversations are very close together, speech is loud and expressive, time is present-oriented, women value modesty, no pork
jews
time orientation is past, present, then future, children are highly grateful for parents
antipsychotics
block dopamine (psychosis)
atypicals
block specific serotonin receptor (depression)
benzos
facilitate transmission of GABA (anxiety)
case management
manager is assigned to negotiate with multiple providers to obtain diverse services; elderly, disabled, handicapped.
managed care
strategy used by purchasers of health services who make determinations about various types of services in order to maintain quality and control costs
case manager
individual responsible for negotiating with multiple health care providers to obtain a variety of services for the cleint
critical pathways of care (CPCs)
tools for provision of care in a case management system, outcomes have designated length of time, used by entire interdisciplinary team, case managers responsible for CPCs carrying through, standardized (protocol for clients with problems that can have a designated outcome)
Problem oriented recording
SOAPIE
focus charting
DAR
PIE method
APIE
who can facilitate therapy?
masters degree
who can facilitate a group?
RN
deinstitutionalization
closing of mental hospitals and discharging of individuals with mental illness; began in 1960s
primary prevention
reducing the incidence of mental disorders in the population; targeting groups at risk and providing education
secondary prevention
reducing the prevalence of psychiatric illness by shortening the course; early identification
tertiary prevention
reducing residual defects that are associated with severe or chronic mental illness; preventing complications of existing illness
community as a client: primary prevention
identify stressful life events and target relevant populations at high risk or prevent or minimize harmful consequences
situational crises
poverty, high rate of life change events, environmental conditions, trauma
community as a client: secondary prevention
early detection and intervention with those individuals experiencing mental illness symptoms; populations at risk: individuals experiencing maturational or situational crises
adolescence: secondary prevention
parents can no longer cope with situation, disruptive and age-inappropriate behaviors become norm
marriage: secondary prevention
substance abuse
parenthood: secondary prevention
sexual abuse of child, birth of child with special needs, diagnosis of terminal illness in a child, death of child
community as a client: tertiary prevention
individuals with severe and persistent mental illness
community mental health centers
treatment alternative- improves coping ability and prevent exacerbation of acute symptoms & case management is used frequently
program of assertive community treatment (PACT)
treatment alternative- provides comprehensive, locally based treatment to people with serious and persistent mental illnesses; provides services to people who are unable on their own to receive treatment from a traditional model of case management
day-evening treatment
treatment alternative- prevent institutionalization or to ease transition from inpatient to community living
community residential facilities
treatment alternative- may provide food, shelter, housekeeping, counseling, medical care, etc.
psychiatric home health care
treatment alternative- for the individual with serious mental illness who no longer lives in a structured, supervised setting, this service can help keep patient living independently; an acute psychiatric diagnosis is not enough to qualify for this service; client must show that he/she is unable to leave home without assistance
homeless shelters
resource available for homeless- temporary accommodations
health-care centers and storefront clinics
resource available for homeless- can provide meds, assess vital signs, screen for TB, immunizations, etc.
mobile outreach units
resource available for homeless- reach out to homeless in their environment in an effort to provide health care. Teams will drive or walk around and seek out homeless individuals who are in need of assistance.
pre-interaction phase
gather info about client and recognize one’s own feelings about client
orientation phase
gather assessment data, formulate diagnosis, set goals, create trust and rapport
working phase
promote client’s insight about perception of reality, continuously evaluate progress toward goal
termination phase
progress has been made, a plan of action for more adaptive coping has been established
concrete thinking
many patients experience this- focuses thought process on specifics and immediate issues, rather than generalities and eventual outcomes
transference
client unconsciously transfers to the nurse feelings formed toward a person from his/her past
countertransference
nurse’s behavioral and emotional response to client
intimate distance
0 to 18 inches- closest distance
personal distance
18 to 40 inches- conversations with friends or colleagues
social distance
4 to 12 feet- conversations with strangers or acquaintances
public distance
> 12 feet- speaking in public or yelling to someone some distance away
SOLER
sit squarely facing the client, observe an open posture, lean forward toward the client, establish eye contact, relax
feedback is useful when…
descriptive rather than evaluative, focused on behavior rather than client, specific and not general, directed toward behavior that the client can modify
milieu therapy
therapeutic community- client is expected to learn adaptive coping, interaction, and relationship skills that can be generalized to other aspects of his or her life
therapeutic community is based on:
health in each individual is realized and encouraged to grow, every interaction is an opportunity for therapeutic intervention, client owns their environment & behavior, peer pressure is a useful tool, inappropriate behavior is dealt with as it occurs, restrictions and punishment are avoided
what makes a hospital environment therapeutic?
physiological needs are met, facilities are conductive to achievement of the goals of therapy, democratic form of government exists, responsibilities are assigned according to client abilities, structured program, community and family are included
camaraderie
individuals receive joy and pleasure from interactions with significant others
group therapy
sound theoretic base and leaders generally have advanced degrees
therapeutic groups
focus is on group relations, interactions among group members
altruism
individuals provide assistance and support one another, thereby helping to create a positive self-image and promote self-growth
catharsis
members express both positive and negative feelings
autocratic
focus is on leader, members are dependent, production is high, but morale is low
democratic
focus is on members, production is somewhat lower than autocratic, but morale is higher
laissez-faire
no focus, goals are undefined, productivity and morale are low
psychodramatists
education is higher than master’s degree
group psychotherapists
minimum master’s degree
allopathic medicine
also known as science-based medicine
acupuncture/acupressure
healing energy (qi) flows through the body along specific pathways called meridians, which connects a series of acupoints
subluxations
displacements of vertebrae and to restore these back to normal, the vertebrae are minipulated
massage is contraindicated
high BP, acute infection, osteoporosis, phlebitis, skin conditions, varicose veins, and over the site of a recent burn, bruise, or injury
psychoanalysis
the major goal is for the client to gain insight and understanding about current relationships and behavior patterns by confronting the unconscious conflicts
abreaction
the individual relives the painful experience
interpersonal therapy (IPT)
time-limited for treatment of major depression
reality therapy
all individuals are responsible for what they do & concept of responsibility is emphasized; humans are born with the needs for power, belonging, freedom, fun, and survival
biofeedback
use of instrumentation to become aware of processes in the body that usually go unnoticed and to help bring them under voluntary control
aggressiveness
defending one’s own rights by violating basic rights of others
passive-aggressive
defending one’s own rights by expressing resistance to social and occupational demands
cognitive therapy
commonly used in treatment of mood disorders & teaches ways to control though distortions that may be a factor in the development and maintenance of mood disorders
goals of cognitive therapy
obtain symptom relief as quickly as possible, assist the client in identifying dysfunctional patterns of thinking, guide client to logic that tests the validity of the dysfunctional thinking
personalizing
automatic thought- thinking you’re the only one something is happening to
all or nothing
automatic thought- thoughts such as “I’m a COMPLETE failure” or “EVERYTHING I do is great”
mind reading
automatic thought- assuming thoughts of others
discounting positives/negatives
automatic thought- disregarding either the good that you did or the bad that you did
Therapeutic interpersonal relationship
Nurse provides care for clients in need of psychosocial intervention
Interpersonal communication techniques
Tools of psychosocial intervention
Transactional model
Both participants perceive each other, listen to each other, and simultaneously engage in the process of creating meaning in a relationship
Giving recognition
Acknowledging, indicating awareness- ex. I see you made your bed
Offering general leads
Encourages client to continue- ex. Go on
Encouraging description of perceptions
Asking client to verbalized what is being perceived- ex. What are the voices saying
Reflecting
Direct questions or feelings back to client so that they may be recognized and accepted- ex. What do YOU think you should do?
Exploring
Delving further into subject- ex. Please explain your situation more
Requesting an explanation
Asking “why” implies the client most defend their behavior
Indicating the existence of an external source of power
Encourages client I project blame for his or her thoughts on others- ex. What makes you say that?
Belittling feelings expressed
Causes client to feel unimportant- ex. Everybody gets down in the dumps sometimes. I feel that way sometimes!
Dorthea Dix
In 1841, started a campaign that resulted in establishment of a number of hospitals for the mentally ill
Community Mental Health Centers Act
1963; attempt to improve care for mentally ill
1980s
federal funding was reduced and number of community health centers was diminished due to recession
