Psych Exam Flashcards
Are personality traits stable over time?
They tend to be
4 parts of personality
Cognition
Affectivity
Interpersonal behavior
Impulse control
When do personality disorders typically manifest?
Adolescence and early adulthood
Why is it difficult to determine how many people in the population have personality disorders?
They do not seek professional help
Women are at increased risk for…
Avoidant, paranoid, and dependent personality disorders
Men are at increased risk for…
Antisocial personality disorders
Chronic maladaptive pattern of perceiving, thinking, and relating that impairs social or occupational functioning causing inner distress
Personality Disorder
Personality disorders occur when personality traits become:
Inflexible, maladaptive, cause significant dysfunction and subjective distress
Theory that emphasizes importance of nurturing from immediate caregivers and loved ones for fostering positive personality traits
Psychoanalytic
Theory that stressed the influence of genetics combined with environmental exposures for the formation of personality
Biological
Theory that people acquire personality characteristics through thought and interaction with their environment
Social Learning and Cognitive Perspectives
Cluster A Personality Disorders (Odd & Eccentric)
Paranoid, Schizoid, Schizotypal
Cluster B Personality Disorders (Dramatic, Emotional, or Erratic)
Antisocial, Borderline, Histrionic, Narcissistic
Cluster C Personality Disorders (Anxious & Fearful)
Avoidant, Dependent, Obsessive-Compulsive
Distrust and suspiciousness of others
others motives are interpreted as malevolent.
Quick to take offense.
Do not acknowledge their negative feelings, and project them on others.
Paranoid Personality disorder
Patients with this disorder constantly test the honesty of others, and have little or no friends
Paranoid personality disorder
Pts with this disorder show indifference to social relationships. They fail to respond to others in a meaningful, emotional way.
Schizoid Personality Disorder
These people are intolerance of close relationships. Thought patterns are disturbed, odd behaviors.
Often skip out on ADLs and Nutritional Care.
Schizotypal Personality Disorder
Bizarre speech patterns and demonstrate psychotic symptoms when under stress (decompensation), magical thinking, delusions, and depersonalization are all commonly seen in patients with….
Schizotypal personality disorder
Similar to my ex boyfriend, these guys have aggressive and irresponsible behaviors, superficially charming, lack genuine warmth.
Patterns of: fights, stealing, substance abuse, exploitative, and manipulative
Antisocial personality disorder
Failure to sustain employment, exploiting and manipulating others for personal gain, inconsistent work performance, inability to form long lasting monogamous relationships, and failure to conform to societal norms are all commonly seen in individuals with…..
Antisocial Personality Disorder
Characterized by a patter of intense and chaotic relationships with affective instability.
View life experiences and relationships to the extremes of either very good or bad.
View themselves as victims.
Highly impulsive, mood swings, anger, anxiety
May self mutilate if they feel they’re being ignored or become aggressive for attention
Borderline Personality Disorder
Splitting
Viewing life experiences as either very good or very bad
The most common form of personality disorder
Borderline
Characterized by a long standing pattern of emotionally charged interactions and attention seeking behaviors. Strive to be center of attention, speech is superficial, lacks detail. Seductive, insecure, dependent on approval of others, naive, easily influences, low tolerance to frustration, blame disappointments on others, suppress feelings related to past events and lack insight
Histrionic Personality Disorder
These individuals are highly distractible, flamboyant in dress and speech, exhibitionistic, easily influenced by others, difficulty forming close relationships, excitable, manipulative, extroverted in behavior, seductive
Histrionic Personality Disorder
These guys have life-long patterns of self-centerness, self-absorption, inability to empathize, insensitive of others, exaggerate successes, self-esteem is fragile, oversensitive to comments, envious of others, and believe others envy them.
Narcissistic Personality Disorder
These individuals mood can easily change because of fragile self-esteem.
Criticism from others may cause them to respond with rage, shame, and humiliation.
They are everly self-centered, and sensitive to what others think. insensitive to others needs and lack empathy.
Narcissistic personality disorder
Pattern in early adulthood of social discomfort, timid, fear of rejection and negative feedback, will only form relationships if acceptance is guaranteed, self-perceived unattractiveness, inferior, feelings of shame, embarrassment, ridicule trying new activities.
Avoidant Personality Disorder
Individuals with this disorder are often awkward and uncomfortable in social situations
They desire close relationships but avoid them because of their fear of being rejected
They have inappropriate displays of anger, disassociative, paranoid ideation, and are preoccupied with being criticized and rejected
Avoidant Personality Disorder
Excessive need to be taken care of, clinging behaviors, fear of separation, difficulty making independent decisions and starting projects, lack trusts in ones judgments, relationships are based on being cared for.
Dependent Personality Disorder
These people exhibit a pattern of negative attitude and passive resistance. React badly to demands for adequate performance in social and occupational situations.
Passive Aggressive Personality Disorder
Individuals with this disorder have a notable lack of self-confidence.
They may be overly generous and thoughtful, while underplaying their own attractiveness and achievements, assume passive and submissive roles in relationships, avoid positions of responsibility
Dependent Personality Disorder
These people exhibit passive resistance, general obstructiveness, switch among the roles of martyr, disrespected, distressed, guilt-ridden, sickly, and overworked.
Able to vent anger and resentment subtly while gaining the attention reassurance and dependency they crave
Passive Aggressive Personality Disorder
Treatments for Personality Disorders (6 Things)
Interpersonal Psychotherapy Psychoanalytical psychotherapy milieu or group therapy cognitive/behavioral therapy case management psychopharmacology
Nursing Goals for Cluster A Personality Disorders
Solve immediate crisis and complete social skills training
Nursing Goals for Cluster B Personality Disorders
Prevent suicide, improve coping, gain insight into feelings and behaviors and unrealistic expectations/fears
Nursing Goals for Cluster C Personality Disorders
Enhance social functioning, solve immediate crisis, assertiveness training, cognitive reconstruction
Approaches to Guarded, Suspicious, Argumentative Behavior
Do not debate or agree with patients perception
focus attention on treatment
be respectful
Approaches to dealing with Aloof & Uninvolved patients
Demonstrate understanding and respect privacy.
Explain rationale for personal questioning,
Do not push for social interaction
Approach to dealing with Idiosyncratic, Eccentric patients (Cluster A)
Consistent approach addressing complaints and beliefs
do not challenge or reinforce perspectives
Approaches to deal with Demanding patients
Cluster B
Set limits - minimize excessive or realistic demands
Approaches to dealing with Dramatic, Emotionally Involved, Seductive Patients
(Cluster B)
Supportive attitude
maintain professional boundaries to prevent unprovoked response
Approaches to dealing with cluster B patients that feel they are superior
recognize and support strengths
show interest in opinions
demonstrate competence
Approaches to dealing with sociopathic patients (Cluster B)
set realistic limits on visits
develop treatment plan to address aggressive behaviors
Approaches to Orderly, Controlled/Controlling Cluster C’s
Clearly state treatment approaches
give as much detail as possible
avoid struggle of who is in charge.
Approaches to dealing with Anxiously Avoidant, Clinging, Dependent cluster C’s
Demonstrate patience and empathy toward fears
frequent brief encounters
forewarn of any mileu changes
Approaches to dealing with Controlling, Avoidant, Dependent Cluster C’s
Directly address concerns about behaviors
identify underlying feelings about their illness and treatment
avoid feeling resentful about “Acting Out” behaviors
Nursing Considerations for Patients with Personality Disorders
Safety, trust, hygiene and nutrition, communication and social skills, normal communication skills are compromised by emotions
A group of conditions in which the affected person experiences persistent anxiety that cannot be dismissed. Coping mechanisms are ineffective. Interferes with ADLs
Anxiety Disorder
How are Anxiety and Fear different
Anxiety is an emotional response
Fear is a cognitive response
Effects of Severe Anxiety
perceptions become increasingly distorted, scattered, and disorganized
Effects of Mild Anxiety
Heightens sensations, sight, hearing, able to learn and verbalize rationally
Effects of Panic
Perception is grossly distorted, cannot differentiate real from imaginary stimuli
Get the person to focus on ONE thing
When does anxiety require interventions
When it prevents fulfillment of professional, personal, or social roles.
Most common psychiatric illness
Anxiety Disorders
Maladaptive Coping Mechanisms for Anxiety (4)
Withdrawl or retreat from provoking situations
acting out the discharge of anxiety through aggression
physiological expression of anxiety
avoidance and evasive behaviors
Adaptive Coping Mechanism for Anxiety
Problem solving - systematic method for addressing difficult situations
Barriers to treatment of Anxiety
Lack of knowledge related to nature and prevalence
lack of knowledge of the positive response to treatments
social stigma
misdiagnosed and untreated
Intense apprehension, terror without any real threat accompanied with somatic or cognitive symptoms
Panic
Symptoms of Panic Attack
chest pain, choking, dizziness, sweating, vertigo, fainting, hot and cold flashes, fear of dying, going crazy
Disorder characterized by recurrent panic attacks, onset of which are unpredictable, and manifested by intense apprehension, fear, or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort
Panic Disorder
Agorophobia
Fear of being in places and situations from which escape might be difficult or embarrassing or help might not be available in the event that a panic attack should occur
Disorder characterized by chronic, unrealistic, and excessive anxiety and worry for at least 6 months
Generalized Anxiety Disorder
Disorder that causes so much discomfort it interferes with ADLs and relationships
Generalized Anxiety Disorder
Symptoms of Generalized Anxiety Disorder
Feeling on edge, persistent and chronic s/s of muscle tension, autonomic hyperactivity, and apprehension, unable to concentrate, chronic fatigue, impaired sleep patterns, depression
Persistent irrational fear attached to an object or situation that objectively does not pose a danger
Phobia
Characteristics of Phobias
They are always anticipated, may be simple and specific to certain situations, events or objects.
Compelling fear and desire to avoid situations that involve strangers or scrutiny from others, including fear of speaking in front of others, eating, and using public restrooms.
Social Phobia
Goals for Treating Anxiety Disorders
The client should be able to recognize signs of escalating anxiety and intervene so that it does not reach panic.
Discuss a long term plan to prevent anxiety, practice relaxation, and engage in physical exercise 3x a week
Recurrent, intrusive, persistent ideas, thoughts, impulses, cognitively invasive.
Obsessions
Ritualistic behaviors, clients are compelled to perform them, to prevent or reduce anxiety
Compulsions
Obsessive Compulsive disorder can be so uncomfortable if left untreated it leads to…
Suicide or Depression
This occurs within the first month of exposure to extreme trauma (Combat, rape, physical assault)
Acute Stress Disorder
Symptoms of Acute Distress Disorder
Dissociation, a state of detachment, dream state, poor memory, esp r/t event.
Acute Stress Disorder usually resolves in _________ days
2-28
Post-traumatic Stress Disorder
Symptoms of stress disorder continue greater that 1 month
Functional impairments of stress
Generalized Anxiety, intrusive thoughts, flashbacks, nightmares, sleep disturbances, need to avoid triggers
Clinical Signs and Symptoms of PTSD
Substance use/abuse, barbiturate and benzo dependence, chronic relationship difficulties, negative outlook, frequent healthcare services for somatic complaints, obsessive compulsive behaviors, eating disorders
Treatment for PTSD
cognitive behavior therapy, relaxation, psychopharmacology, benzodiazepines
What is Cognitive behavior therapy
recognizing thoughts that cause anxiety. gain insight and learn new responses.
1 Reason for non-adherance to psychotropic medication
Unpleasant distressing side effects
SSRI (Selective Serotonin Reuptake Inhibitors)
inhibit the reuptake of serotonin by blocking the presynaptic neuron and increase the concentration of serotonin
Tricyclic Antidepressants (TCA’s)
block norepinephrine and serotonin and acetylcholine, which controls the parasympatetic nervous system.
Alcohol with TCAs causes….
sedation and ataxia. Give elderly 1/2 dose.
TCA dose for elderly patients….
Should be 1/2 adult dose
TCA’s for suicidal patients
Bad Idea…they can overdose and die
TCA Classification Reminder
All drugs end in -ine
But some drugs that are not TCA’s end in -ine too
Monoamine oxidase inhibitors (MAOIs)
inhbit MAO, and enzyme that breaks down serotonin, nor epinephrine and others, increasing their activity
MAOI interaction with Tyramine causes….
Hypertensive crisis
MAOI’s with SSRI’s
DONT DO IT!
Onset of Lithium
5-7 days (maybe 2 weeks)
Therapeutic blood levels for Lithium
0.8 - 1.5
Lithium Toxicity happens when…
Na+ levels decrease.
Anticonvulsants
used as mood stabilizers: they reduce repetitive firing of action potentials in the nerves.
Check blood levels if taking these meds:
lithium, valproate, and carbamazepine need to have blood levels checked
Important things to teach pts taking mood stabilizers
must maintain adequate fluid intake, balanced diet, normal sodium, and discontinue if toxicity symptoms occur
Buspirone (Buspar)
Antianxiety med that binds to serotonin receptor
*Contraindicated in patients with renal or liver impairment, and lactating women
Benzodiazepines
sedation, muscle relaxant, elevate seizure threshold. *Work directly on GABA receptors to dampen neural overstimulation
Meds that end in -lam or -pam
Probably Benzo’s
also: chlordiazepoxide
Nonbenzodiazepines
Buspirone and zolpidem - no CNS depressant effects or abuse potential
Repeated use of a drug that leads to functional problems without compulsive or withdrawal indicators
Substance Abuse
Painful physical and or psychological symptoms that follow the discontinuance of the substance
Withdrawal
When a person uses a substance despite extreme negative consequences and impairments to daily living
Substance Dependence
Requiring more and more of a substance to get the desired effect
Tolerance
Do people with an addiction have a high tendency for relapse?
Yes
What percentage of people with mental illness also have substance abuse disorder at some point in their life?
50%
Theory that states specific effects on selected neurotransmitters, NIH-specific genes increase risk for addiction. Physiologic mechanisms for compulsion despite consequences
Biological Theory of Addiction
This theory suggests that addiction is a defense against anxiety, dependency, and self-medication for depression hallucinations, thought disorders, PTSD, stress response, and coping styles
Psychological Theory of Addiction
Inability to learn new information, recall remote information, unsteady gait, and myopathy
Wernicke’s encephalopathy
Gait disturbances, confabulation, disorientation, ST memory impairment
Korsakoff’s Psychosis
Wernicke’s Encephalopathy and Korsakoffs Psychosis are bother related to deficiences in what?
Thyamine (Malnutrition)
Is brain damage permanent or temporary with alcoholic dementia?
It may be permanent
When do symptoms of withdrawal peak?
24 - 48 hours (then rapidly disappear)
Signs and Symptoms of Withdrawal
Hyper-alertness, Jerky movements, Irritability, easily startled, “shaking inside”
How to reduce anxiety in patients going through withdrawal
Orient them to time and place, clarify illusions to reduce clients terror
What is withdrawal delirium
A medical emergency that can result in death
When does alcohol withdrawal delirium peak?
2 to 3 days after cessation of alcohol and lasts 2 to 3 days
Signs and Symptoms of Withdrawal delirium
Tachycardia, diaphoresis, elevated BP, disorientation and clouding or changes in level of consciousness, visual or tactile hallucinations, hyper-excitability to lethargy, paranoid delusions, agitation, fever
Dilation of pupils, darting eye movements, avoidance or intense eye contact, dry oronasal cavity, sniffling, excessive motor activity, rapid speech and flight of ideas are all common signs of the use of what 3 drugs
Cocaine, Crack, Amphetamines
Two main effects of Crack/Cocaine on the body
Anesthetic and Stimulant
The imbalance of neurotransmitters from crack/cocaine produces what?
Severe cravings
Depression, paranoia, lethargy, anxiety, insomnia, nausea, vomiting, sweating, chills are all withdrawal symptoms of what drugs?
Crack / Cocaine
Adverse effects of Ecstacy
Hyperthermia, heart failure, kidney failure, acute dehydration
Date rape drugs effects
Dis-inhibition, relaxation of voluntary muscles, anterograde amnesia loss of ability to create new memories after event, inability to recall sudden trauma
Aim of treatment for substance abuse
Self-responsibility
Challenges of Substance Abuse Treatment
Matching the client with types of treatment considering various needs
4 behaviors to be address in substance abuse treatment
Dysfunctional anger, Manipulation, Impulsiveness, Grandiosity
Primary intervention for substance abuse treatment
Health Teaching
Interventions for Substance Abuse
Dual-diagnosis principle treat concurrently, psychotherapy, relapse prevention, self-help group, 12-step programs, residential programs, intensive outpatient programs, outpatient drug-free programs, employee assistance programs
Trexan, Revia (naltrexone)
Blocks opiate receptors, interferes with mechanisms of reinforcement, reduces or eliminates alcohol cravings
Campral (acamprosate)
Helps client abstain from alcohol, mechanisms not well understood
Antabuse (disulfiram)
Works on classical conditioning principle, alcohol-disulfiram reaction causes unpleasant physical effects
Dolophine (methadone)
Synthetic opiate blocks craving for, and effects of, heroin. Only medication currently approved to treat pregnant opioid addict
LAAM (L- x - acetylmethadol)
An alternative to methadone
Naltrexone (Trexan Revia)
Antagonist that blocks euphoric effects of opioids
Clonidine (Catapres)
Nonopioid suppressor of opioid withdrawal symptoms, effective somatic treatment when combined with naltrexone.
Consistently consuming less that or more than that bodies caloric needs
Eating Disorder
Eating disorders are often accompanied by __________ & ____________
Anxiety and Guilt
Life threatening condition of disturbed body image leads to emaciation with the intense fear of becoming obese
Anorexia Nervosa
Recurrent pattern of uncontrollable consumption of large amounts of food followed by attempts to eliminate the body of excess calories (purging)
Bulimia Nervosa
Compulsive over-eating with no inappropriate compensatory behaviors, 2 days a week longer than 6 months
Binge eating disorder
With Binge eating disorders eating is associated with (3 things)
Fat consumption, eating alone, guilt
What percentage of obese individuals report binge eating?
20 - 30%
Theory that states that the etiology of eating disorders is most likely influenced by multiple factors
Transactional Model of Stress/Adaptation
Theory that eating disorders are caused by low-self esteem, self-doubts about personal worth, problems with separation, or problems with sexuality
Psychological Models
Theory that eating disorders may originate in the hypothalamic, hormonal, neurotransmitters, or biochemical disturbances
Biological Theory
OCD, anorexia, bulimia, are associated with excessive levels of ________________ which is released during physical and emotional stress
Vasopressin
Conflict avoidance
Families may promote & maintain psychosomatic symptoms, including anorexia nervosa, in an effort to avoid spousal conflict.
Parental Criticism and Eating disorders
Promotes increase in obsessive and perfectionist behavior on the part of the child, who continues to seek love, approval, and recognition
With Anorexia Nervosa weight loss is usually more than _____% of expected weight
15%
Symptoms of Anorexia
Amenorrhea, hypothermia, bradycardia, hypotension, edema, lanugo, and a variety of metabolic changes. There may by an obsession with food.
Emergencies related to Anorexia/Bulimia Nervosa
Dehydration and electrolyte imbalances, physiological disorders related to starvation, kidney and liver disorders
Eating Disorders: for the program to be successful the client must perceive that he or she is in _____________ of the treatment.
Control
Medication for binge-eating disorder with obesity
Topiramate (Topamax)
Medications used for anorexia nervosa or bulimia
Anxiety and Depression medications
Metabolic Syndrome (Syndrome X)
Collection of health-related problems representing a gene-environment interaction. Main feature is insulin resistance, apple shape body, low activity, HTN, and potentially lethal CVD
Obesity
BMI over 30
Overweight
BMI 25 - 30
SSRI’s use
Depression, OCD, Anxiety, PTSD, obesity, bulimia
SSRI Side Effects
headache, nausea, insomnia, fatigue, dizziness, diarrhea, sexual dysfunction, suicidal thoughts
Medication Contraindication with Lithium Use
Diuretics - because lithium causes sodium depletion
Lithium Use
Mood stabilizer used to control manic episodes of bipolar psychosis
Lithium Side Effects
Dizziness, hand tremors, impaired vision
Nursing Considerations for Lithium
Monitor pts blood levels 2 -3 times a week when started, and monthly while on maintenance
Antipsychotic Side effects
Extrapyramidal reactions (muscle rigidity, tremors, tongue protrusion, slowing of voluntary movement, abnormal posturing), Tardive dyskinesia, blurred vision, dry mouth
Nursing Considerations for Antipsychotics
dystonic reactions treated with IV diphenhydramine
Tricyclic Antidepressants Use
Mood elevator used to treat depression
TCA’s Adverse Effects
blurred vision, constipation, weight gain, orthostatic hypotension, insomnia, agitation, cardiac dysrhythmias, GI distress, urinary retention, seizures, tachycardia, photosensitivity, nausea, sedation, dry mouth, panic attacks
TCA Nursing Considerations
Monitor patient for suicidal behaviors. frequent oral hygiene and sips of liquid, administer with food, monitor BP, pulse rate & rhythm
MAOI side effects
Dizziness, insomnia, orthostatic hypotension, dysrhythmias, HYPERTENSIVE CRISIS
People taking MAOI’s should not consume what foods?
Aged cheese, beer, red wine, dry sausage, sauerkraut, or liver because they are high in tyramine
