psych final exam Flashcards
science of nursing
finding the evidacne for the practive
art of nursing
finding the skills for the practice
EBP model
its a medical model focuses on the sciences
recovery model
consumer and family driven based on the rehabilitation and recovery of the pt -goal is empowerment and finding meaning to ones life
5 A’s of EBP
ask questionacquire literatureappraise litereatureapply evidanceasses performance
resources for best EBP
internet mental health resources- provide info for treatment, provisions, and results of rescent clinical studies (there are also self test for pt)clinical prctive guidelines- identify, summarise and appraise the best EBP, diagnosis, prognosis and therpay. Are based on literature reviewclinical algortihms- step by step guidelines prepared in flow chart such as in helping with what med clinical pathways- most often used for hospitalised pts and target a specific audience such as suecidal, bipolar, manic. serve as a map for treatements to occur in a specific time frame
three areas in nursing care
attending-presence, human connection, touching, sensescaringpts advocacy-speasks up for pt
healthy mental healthis is to be resilient
to bounce back after a stressful situationcharacterised by optimism, sense of mastery, competence
diasthesis stress model
explains mental ilness occurs from:environmental stress or traumadiasthesis-biological gentetic predisposition
DSM5
guidebook for diagnosing mental health problems in the US-discuses cultural variations in each disorder-describes culture bound syndromes-outline assists docs. to evaluate and report the impact of an individuals cultural context
characteristics that imfluence a group
content- whats said in a groupproccess-whats acctually going on, underlying dynamics
therapeudic factors in groups
instilation of hopeuniversalityaltruism-helpful of others which in turn makes u happycatharsis- release of emotion
group types
content oriented group- task group- discusses goals and tasks and is short termprocess oriented- discusses interpersonal relation, can go longer mid-range- combines contet and process groups, self help groups and psychoeducational
heterogeneous group
variety of backgrounds
homogenous group
same traits (alchohol, drugs)
closed group
membership restricted
open group
new members can come and go
subgroup
smaller groups developed out of bigger groups
overt norms
rules are explictly states (schedule, leaving)
covert norms
implied or unspoken rules
phases of group development
orientation phaseworking phasetermination phase
autocratic leader
has lots of control
democratic middle
middle control
laisez faire leader
no rules or boundaries
basic level RN groups
symptom managment groupstress managment grouptherapeudic community groupssupport groups
advaned practive Rn groups
group psychotherapypsychodrama groups-pts use role playing or drama playingbehavioral treatment groups
task orienterd
a group memeber frequenty reminds others of groups main purpose
freuds psychoanalytic theory
levels of awareness-concious-what were aware of-preconcious-info stored0unconcious-supresses memories,
freuds personality structure
id- pleasure principles-hungry thirsty tiredego-problem solver, reality tester(keeps things in check)superego-strives for perfection-maintain ego intergory
feud said that defense mechanisms
operate on an unconcious level
ferud said that expericnes
during childhood determine us as a person
trasnference
when something a health care provider does reminds a patient about something in their life
countertransference
if a pt. reminds a healthcare provider of something
eriksons ego theory
8 stages of development and personaility continues to develop throughout old age-you can work on more than one level at a time
sullivans interpersonal theory
purpose of behaviour is to1.get needs met2.lower anxiety
Peplaus theory
was based on sulivans theory1.Rn is observer in care of pt. to provide care, empathy, comfort, advocay and bring scientific knowlegeLEVELS OF ANXIETY OF PEPLAU- mild moderate severe panicPeplau helped create interventions to lower anxietyINFLUENCES PROFESSIONAL PRACTICE OF PSYCHIATRIC NURSING
behaviour theory
pavlovs conditioning theory-one action can give a specific reactionwatsons behaviour theory- all behaviors are acquired through conditioning. skinners operant conditionsing- rawards and punishment
5 types of behaviour therapy
biofedback- pt can have voluntary controlaversion theroapy- meds for chronic drinker, if they drink they get negative reaction (causes unplesant sensation)systemic desensitization- overcome phobiasoperant conditioning- rewards and punishments for behavior.modeling
cognitive therapy
interplay between individuals and environment-thoughts come before feelings and actions
rational emotive behaviour therapy (ellis)cognitive therapy
aims to eredicate irrational beliefsfocuses on feelings, painful thoughts and dysfunctional behaviours
cognitive bahavioural therapy (beck)
change way of thinking to change way of acting *schemas-automatic thoughts and unique assumptions(change this thinking)
maslows hiarchy of needs
when lower needs are met higher needs can emerge-to strive for selft actualization you need to fulfil basic needs firt then go on ti higher ones
fear
reaction to a specific danger
anxiety
feeling of uneasing, dread, uncertain
learning and behavioural theory related to ANXIETY
anxiety is learned response from modeling from parents or peers
cognitive theory on ANXIETY
anxiety is caused by distortions of thikning
OCD
obessesions- theoughts impulses or images that cant come off ur mindcompulsions- ritualistic behaviours
panic disorder
allow pt to crydont touch the pt stay with pt dont leave aloneif hyperventilating use brown bag
OCD
give pt time to perform rituals, never take away a ritual
*buspar
for anxiety, not a cns depressant s/e- dizziness, nausea, headeache, nervousnesss-not for PRN pts. bcuz can take weeks to start working
antidepresants
selective serotonin reuptake inhibitos- first line therapy for anxiety and OCD
antianxiety drugs
benzospotetial for dependance s/e- sedation ataxia, decreased mental functioning
crisis
acute and time limitred, do short term interventions
types of crises
maturational-developmental(menopause, child growing up, puberty, college, having babay)situational-arise from events, divorce, loss of life/job, ilnessadventitions-unplanned accidentail, crime, violence, natural disaster
phases of crisis
phase1- pt confronted by confliced which causes increased anxietyphase2- if threat persists anxiety ecalerates(trial-error)phase3- if trial error faild anxiety can go to panicphase4- if problem not solved can lead to illness
in time of crises
make pt feel safe-evaluate ANXIETY SUICIDAL HOMICIDAL Thoughts
levels of crises intervetnion
primary-preventsecondary- during actual event, treat symptomstertiary-after event takes placegoal- to gt pt ack to pre crisis stage, crises are usually self limiting and solve within 4-6 weeks
eustress
good stress
distress
bad stress
PTSD
occurs after a traumatic event, not acute, develops over time. causes depression, helplesness, poweless, flashbacks, numbing, avoidance to stimuli psychotherpay treatment of choice if pt is experencing flashback- stay with them and ensure them they are safe
traumatic brain injury (sports)
psychotherapy
benzodiazepines
for acute violence
antiepilepitc beta blockers
litheum - for long standing agression`
phases of nurse pt relationship
pre orientation phase- gather data, asses situationorientation phase- establish report, terms, confidentialityworking phase- gather further data, use of language, work termination phase- summarise, discuss, review
empathy
understand feelings of others
sympathy
we feel the feelings of others
positive regard
display respect
set boundaries
blurring boundaries- when nurse pt relationship turns into social relationship, may be result of trasnference or countertransference
Paplaus communiaction
clarity- continuety-connection of ideas
relationshop factors
symmetrical relationship-friends, same levelunsymetrical- unequal in status of power
double message
pt may be happy but crying
double bind message
intent to create confusion
false notes
inconsistent with what pt is saying and doing
ethics
right or wrong
bioethics
ethichal dilemmas in healthcare
autonomy
respectiong rights of others
justice
equality
fidelity
loyalty and commitment
veracity
truth
informal admision
sought by pt
voluntary admision
sought by pt or guardian
temporary admision
pt confused or demered so ill that he or shee needs emergency admission
involuntary admision
without pts consentfor acute 1-5 days
long term admision
needs to be reviewd by court60-180 dayspt has right to attorney
to be admitted
danger to self or othersso ill cant take care of self
ECT elecrocunvulsion therapy
needs informed consent state laws regarding refusal
conditional release
pt gets dischared but told to dollow up
restraint
never keep pt on one restraint always on 4 3 2
soft restraint
cuffs
hard restraint (behavioural restaarints)
vinyl restraints that lock, make sure you keep key with u at all times, asses pt every 15 min
seclusion
no access outside of the room
only force med
if pt becomes violent to self or otherst
tarasoff law
duty to warn and protect third parties even if its breaking confidentiality
m’naghten rule (insanity defense)
pts state of mind when they commited the crime
specialty treamtnet settings
eatting disorders
assertive community treatment ACT
keep chronically ill pts out of acute care facilities
therapeudic miely
safe environment
consumers
those who use mental services
grassroots groups
confront stigma
MSe mental status exam
to evaluate current cognitive thought processsubjective-what pt saysobjective-what u findA-apperanceB-behaviourC-cognition
mood- how pt tells u they feel
affect- how pt appears to feelblunted-mood and affect the samelabile-mood instability
if pt is intoxicated
do not do psych assesment
psych assesment for adolescents
H-home environemtne-education emplymentA-activietesD-drugs alchojol smokingS- sexualityS- suicideS-savagery- exposure to violence
suicidal ideation
thoughts about killing yourself
compleated suicide
successfull suicide attempt
copycat suicide
do it how someone else has done it
risk factors for suicide
adolescencts, native americans, those in chronic pain, previous suicide atempts, mental disorders, drug abuse. age, no social support, family has had suicide attempts
risk factors scale SAD PERSONS
Sex- male is more at riskAgeDepressionPrevious sucide attemptSeparated, divorcedOrganised plan No social supportStated future intent 0-5 score is safe to discharge6-8 requires psychological assessment>8 requires admission
neurobiologic aspects of suicide
strong association exists between suicide and serotonin, biological responses to stress may be risk factors
noradrenergic systems
overactivity of norepinephrine is associated with anxiety, aggitation, and suicide - neurotransmitter most responsible for vigilant concentration
hypothalamic pituitary adrenal axis (HPA)
is associated with memory dysfunction. most suicide victims have HPA axis abnormalities -a major part of the neuroendocrine system that controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality and energy storage and expenditure.
sigmund freug theory
suicide is a unacceptable murderous on self
karl menninger theory
you have 3 emotions, revenge, guilt, depression
edwin shneidman theory
unbarable psychological pain, there is no way out-you d self destructive behaviours such as drugs, gambling, harm which is called SUBINTENTIONED SUICIDE which is slowly killing yourself
% of suicide
affective illness(depression & bipolar) 50%drugs & alchohol 25%schicophrenia 10%personality disorders 5%
sudden behavioural changes
giving away prized possesionswriting farewell notesmaking willglobal insomnia- fall asleep longer periods *exhibits sudden improvements in moodneglecting personal hygene
overt statements
i cant take it anymorelife isnt worth livingi wish i were deadeveryone would be better off if i was deadliving is useless
covert statements
its ok now everything will be finei wont be a problem much longernothing feels good anymorei want to give my body to medical science
during suicidal crisis you should tell pt
crisis is temporarycan be survivedhelp is availableyou are not alone
three main elements of a PLAN
specifil plan, lethality, access
low risk lethality
slashing wriststaking pillsinhaling gasees
primary intervention
activities that provide support, information and education to prevent suicide (suicide awareness)
secondary intervention
tretment of the actual suicidal crisis
tertiary intervention (postprevention)
interventions with a circle of survivors left by individuals who completed suicide to reduce the traumatic afterefects
parasuicide
deliberate direct attempt to cause bodily harmbut does not result into suicide-cutting, biting, hitting, picking,
depression
is unipolar males higher to commit suicide women higher to get depression
cognitive theory on depression (Beck)
negative interpretation on lifepessimistic view of the would-belief that negative reinforcement (or no validation for self) will continue in the future
Major depressive disorder (to be dignosed with depression)- no manic episodes in hx
has to have 1 of the following-depressed for a minimum of 2 weeks-anhadonia-lack of interest on previously pleasurable activitieshas to have 4 of the following-significant weight loss or gain (5% of body weigh in 1m)-insomnia or hypersomnia-psychomotor aggitation or retardation-fatigue or loss of energy-feeling of worthlessnes or guilt- diminished ability to concentrate or think-recurrent thoughts on death and suicinde
persistent depressive disorder (diagnosis)- no manic episodes
depressed mood for most of day for at least 2 yrs (in children or adolescents mood can be irratable for 1 year)has to have presence of 2 of the following - poor appetite or overeatting-insomnia or hyperinsomnia-fatigue-low self esteem-poor concentration and thinking-feeling of hopelesnessmood doesnt change from usual behaviour
affect
how the patient looks
mood in depressed patients
guilt, wortlesness, anger, irritation,anxiety, delusional thinking or psychosis, psychomotor retardation and agitation and anergia
psychomotor retardation (depresion)
involves a slowing-down of thought and a reduction of physical movements in an individual.
psychomotor agitation (depression)
is a series of unintentional and purposeless motions that stem from mental tension and anxiety of an individual. This includes pacing around a room, wringing one’s hands
anergia(depression)
abnormal lack of energy.
vegetative signs of depression
impairs activities needed to support physical life and growth -anorexia-insomnia-changes in bowel movements-decreased libido-may take longer to process words
avioid platitude
false reassurance
what to do for insomnia
stay out of bed during the day
mileu therapy
psychotherapy that involves the use of therapeudic communities where patient joins the group and is in a safe environment
mbct MINFULNESS BASED COGNITIVE THERAPY
DESIGNED TO PREVENT THE RELAPE FOR THOSE WITH DEPRESSION (MEDITATION AND COGNITIVE THERAPY)
depression hapens because of
a depletion of neurotransmmitteresit is a pysical disorder, pts can not just snap out of it.
*TRICYCLICS (elavil,tofranil) TCS
increases norepinephrine,s/e include anticholenergic effects (dry mouth, diplopia, tachycardia, urinary retention, confusion, agitation, weight gain, postural hypotension)DO NOT GIVE TO PTS WITH HEART CONDITIONS
*SSRI selective serotonin inhibirots
block uptake of serotonin therfore increase serotonin, not sedating, anticholinergic sideefects but fewer than tricyclis and n/v, agitation, anxiety, sleep disturabance, sexual dysfunction, headache, dizzy-for depression, anxiety, OCD, panic do, bulimiadrugs (prozac, paxil, zoloft-may increase suicidal thoughts)
serotonin syndrome
if pt. is switched from ssri to maor you have to wait some weeks for the ssris to get out of the system first before you give the other drug because it can cause toxticity (overstimulation of serotonin, life thretning)
*serotonin and noradrenoline disinhibitors (SNDI)
increases serotoning and norepinephrine-antidepressant, antianxiety, antiemetic drug-s/e weight gain and sedation meds(remeron, wekkbutrin, desyrel)
*MAOIS
Monoamine oxidase inhibitors are chemicals which inhibit the activity of the monoamine oxidase enzyme family.s/e- abdominal pain, diareah, sweating, tachycardia, high BP, delirium, exesively high temp (hyperpyrexia), shock, apnea
black box warning for SSRI
SSRIS may increase suicidal thoughts in children and adolescnets with MDD-do not stop SSRI abruptly bcuz it makes withdrawl symptoms (flu like symptoms) and brain zaps
MAOIs warning
tyramine is elevated causing HYPERTENSIVE CRISIS which may lead to intercranial hemmorage, hyperpyrexia, and death(causes headache, stiff neck, n.v)-IMMEDIATELY give antihypertensive meds, blankets and ice packs-give MAOIs to reliable pts because they have to adhere to a strict diet such as to avoid foods that contrain tyramine, (cheese, beer, wine, yeast, chocolate, ginseng, aged meats, coffe, chinese food, )
ECT electrocunvulsive therapy
muscle relaxent is given to prevent muscle distress during shock-used when all meds have faild-causes breif seizures
bipolar disorder
two poles (mania and depresion)-pts experience dificulties even during remission-causes highest suicide rates than any other psych disorders
types of biplolar disorders
- bipolar I disorder- severe2. bipolar II disorder- no psychosis (milder3. cyclothmya- mild depression4. bipolar disorder unspecified5. rapid cycling specifier- sever episodes of mania
bipolar I disorder
-pt has at least 1 episode of mania alternating with major depressive disorder-psychosis acompanied by manic episoded, very severe-alterations in mood such as elation- feeling or state of great joy or pridegrandiosity, hyperactivity, agitation, reduced sleep, elevated mood, euphoric mania- feels wonderful in begining but declines to loss of control and confusiondysphoric mania- mixed stated or agitated depresion
bipolar II disorder
hypomanic (low level mania)tends to be euphoric mania with increased functioning-not serious-NO PSYCHOSIC but can present during depressive phase
cyclothymic depressive disorder
hypomanic episodes with mild and moderate depressive episodes -symptoms present for 2 ore more years-may cause social or ocupational impairment but not severe-usualy begins in early adulthood or adolescence
bipolar disorder unspecified
Bipolar disorder is difficult to diagnose.[2] If a person displays some symptoms of bipolar disorder but not others, the clinician may diagnose bipolar NOS. The diagnosis of bipolar NOS is indicated when there is a rapid change (days) between manic and depressive symptoms and can also include recurring episodes of hypomania. Bipolar NOS may be diagnosed when it is difficult to tell whether bipolar is the primary disorder due to another general medical condition, such as substance abuse.[3]-not quite bipolar disorder but cant be specified
rapid cyclin bipolar disorder
4 or more manic episodes within 1 year-can occur in course of a month or even days-mania and depresion may present simutaneously -Episodes must last for some minimum number of days in order to be considered distinct episodes.
what causes bipolar disorder
GENETICSneurotransmiter dysregulationneuroendocrine alterations childhood abuse-those who are genteticaly predisposed if they dont go throught a stressful event they may neber become symptomatic
manic and depressive phases
uring a manic phase, symptoms include:heightened sense of self-importanceexaggerated positive outlooksignificantly decreased need for sleeppoor appetite and weight lossracing speech, flight of ideas, impulsivenessideas that move quickly from one subject to the nextpoor concentration, easy distractibilityincreased activity levelexcessive involvement in pleasurable activitiespoor financial choices, rash spending spreesexcessive irritability, aggressive behaviorDuring a depressed phase, symptoms include:feelings of sadness or hopelessnessloss of interest in pleasurable or usual activitiesdifficulty sleeping; early-morning awakeningloss of energy and constant lethargysense of guilt or low self-esteemdifficulty concentratingnegative thoughts about the futureweight gain or weight losstalk of suicide or death
in manic episodes of bipolar disorders
flight or ideasclang asociation- words that rhyme but arent asociatedgranduositydelusions-false beliefshalucination pt may be demanding and manipulative (SET LIMITS
bipolar disprder
as disease progreses cognitive fuctioning may decline
phases of biplar disoders
acute phase- prevent injurycontinuation phase- prevent relapsemaintanace phase- limit severity and duration of future episodes
****lithium cardonate (lithane, eskalith, lothonate)
mood stabilizerfor acute mania and hypomanic episodes, depresive episodes and prevention of future episodesnot as effective with mixed mania, rapid cycling and atypical featureeffective with-eleation, granduosity, flight of ideas, irritablity, manitpulation,anxiety paranoua, agitation and destractility NEEDS TO REACH THERAPEUDIC LEVELS, doesnt work right away
flight of ideas in biploar disorder
This is where thoughts are moving so quickly that it is impossible to speak
lithium therapeudic plasma level
for acute mania 0.6-1.2maintanace therpay 0.4-1.best time to draw blood- 12 hrs after last doses.e may include hand tremors, polyuria,, thirst, naurse, weight gain
interventions with lithium
lithium decreses sodium absorbtion in kidnets, therfore increases lithium retention(PUSH FLUIDS AND DONT TAKE DIURETICS)-contraindicated with EKG changes, renal disease, thyroid disease, myasthenia gravis, pregnant, )
st johns wart
used as an anidepresant
anticonvulsants
1.valproate/divaloprex(depakore)- monitor blood levels2. carbamezepine(tegretol) monitor blood levels, may cause anemia3. lamotrigine(lamictal)for depresion and bipolasr also for alchohol and benzo withdrawl
antianxiety drugs
help with acute mania and psychomotor agitation clanazepam and lorazepam
Three qualities are needed to guide a persontoward effective social and interpersonalfunctioning:
Stable and realistic sense of selfSystem for interpreting social situations andunderstanding of relational motives and actions ofothersCapacity to serve self and others
Personality traits
peculiarities that people bring to social relationshipssuch as shyness, seductiveness, rigidity
personality
is the style of how a person deals withthe world(personality traits are FELXIBLE and ADAPTIVE)
personality disorer theory
geneticsNeurobiologic factors-Dysregulation of neurotransmitters may effect impulsive & aggressive behaviors and affective instabilityPsychologic Influences-Childhood neglect andChildhood trauma:Personality traits are present from infancy Disorder emerges in adolescence
personality disorder traits
Patients do not see behavior as a problemThey blame others Fail to accept responsibility and consequences of behaviorPatients believe they are normal; it is the others who have the problem(they dont belive problem exists)Try to change environment instead of self
cluster A PD ((paranoid, schicophrenic))
odd or eccentric behaviorsRelated to schizophrenia1.Schizoid personality disorder- is a mental health condition in which a person has a lifelong pattern of indifference to others and social isolation.lack of emotion2.Schizotypal personality disorder- is a mental health condition in which a person has trouble with relationships and disturbances in thought patterns, appearance, and behavior.(magical thinking, ilusions.,)pt doesnt benifit from mileu therapy bcuz may feel threatened
cluster B PD (anitsocial personality disorder)
dramatic, emotional, or erraticManipulation is common defense mechanismTendency to blame others for one’s problems(antisocial, narsicistic, )pt. benifits from mielau therapy
Cluster B( borderline personality disorder)
Four main characteristics:1. Difficulties in relationships with others, inflexibility, misinterpretation of cues, fear of abandonment2. Little connection with own identity, not knowing who she really is;3. An inability to control impulses4. An inner emotional experience that is chaotic and intense SAFETY IS KEY, encourage journal writing to help undersand self,
Cluster B PD (histrionic personality disorder)
histrionic- Histrionic personality disorder is a mental health condition in which people act in a very emotional and dramatic way that draws attention to themselvesatention seeking, seducation, flamboyant, atentive to phsycial appearnce, .
Cluster B PD( Narcissistic Personality Disorder)
granduosity, belives they are speical
cluster C PD
anxious or fearful behaviorsRelated to anxiety disordersInternalize blame for problems in life(1.avoidant, 2.dependant, 3.obsesive cumpolsive)
cluster C PD (avoidant PD)
Believes self to be socially inept, unappealing, or inferiorto others; fears of disapproval or rejection-asist in confrontin their fears, give + feedback ,teach relaxation techniques)
cluster C PD(dependant )
Seldom disagrees with others because of fear of loss of support or approvalUnable to function independentlyUnable to make daily decisions without much advice &
cluster C PD( Obsesive compulsive)
Fears losing control but not as ritual focused
personality disroder traits
People with PDs are excessively dependent, demanding,manipulative, stubborn, or may self-destructively refusetreatment.
Dialectic Behavioral Therapy(DBT)
Uses dialogue to rework destructive ways to deal withcrisisTeaches there are choices to decrease suicidal thoughts and emotionally reactive patternsPatients learn new patterns of thinking and behavingHas been very successful with patients with Borderline Personality Disorder
treamtnet for PD
no meds per say but treating symptomsBenzodiazepines (maintenance dosing) for anxiety arenot appropriate because of the potential for abuse and overdose; they may be used in emergency situationsSelective serotonin reuptake inhibitors (SSRIs)treatco-morbid depression and panic attacks Trazodone and venlafaxine have low toxicity in overdoseCarbamazepine targets impulsivity and self-harm. Lithium, anticonvulsants, SSRIs?minimize aggressionAtypical antipsychotics?help with psychotic features
anorexia nervosa
fear of gaining weight-they ether 1.restrict calories or 2. binge eat and purgesigns- cold extremities, lanugo- (growing fine white hairs on body), amenoreah- (absence of periods)
bulimia nervosa
binge eating then uncontrolled purging, laxatives, diureticssigns- dental problems, parotid swelling, arythmias, muslce weakness, esophageal tears by vomitings,
psychical criteria for admiting pts with eatting disorders
Weight loss over 30% over 6 monthsRapid weight loss/declineInability to gain weight in out-pt. treatmentHypothermia ? temp. lower than 96.7 degrees FHeart rate < 40 beats/minuteSystolic BP < 70 mm Hg
Cognitive Distortions Related toEating Disorders
overgeneralization- Splitting (also called black and white thinking or all-or-nothing thinking) is the failure in a person’s thinking to bring together both positive and negative qualities of the self and others into a cohesive, realistic whole. It is a common defense mechanism used by many people.[1] The individual tends to think in extremes (i.e., an individual’s actions and motivations are all good or all bad with no middle ground.)catosrophizing situations
schizophrenia
Schizophrenia is a devastating brain disease that most often targets young people in their teens and early twenties, at the beginning of their productive lives-contains psychosis- Psychosis refers to a total inability torecognize reality (e.g., delusions andhallucinations)polydipsia- fatal water intoxication; occurs in upto 20% of people with Schizophrenia
Prodromal phase of schizo
Forewarning- a month or up to a year before firstpsychotic break or full-blown manifestations occurOften described as a loner (social withdrawal), awkward, odd, eccentricAs anxiety increases- change in school/work functioning, poor memory & concentration, routine stimuli may overwhelm, events may be misinterpreted
phases of schizo
Phase I- AcuteOnset or exacerbation of symptomsPhase II-StabilizationSymptoms diminishing Movement toward previous level of functioningPhase III - MaintenanceAt or near baseline functioningMilder symptoms may remain
groups of schizo
Positive symptomsNegative symptomsCognitive symptomsAffective symptoms
+ symptoms
ALTERATIONS IN THINKING, false fixed belifes, Hallucinations,Delusions, Disorganized speech (associative looseness) Bizarre Behavior, magical thinking, alogia-Concrete thinking - Inability to think abstractly-Clang associations- words sound same-Associative looseness- jumbled and illogical speech and impaired reasoning-Word salad- mixture of phrases that is meaningless to the listener that can include neologisms.-Neologisms-made up words that have meaning for the patient but a different or non-existent meaning to others.-Echolalia- pathological repeating of another’s words by imitation, often seen with catatonia-catatonia-is a state of apparent unresponsiveness to external stimuli in a person who is apparently awake.-echopraxia-the mimicking of movements of another, also often seen in catatonia
- symptoms
Blunted affect, Poverty of thought (alogia), Loss of motivation (avolition), Inability to experience, pleasure or joy (anhedonia), Affect (outward expression of internal emotional state)Flat- immobile of blank facial expressionBlunted- reduced or minimal emotional responseInappropriate-incongruent with actual emotionalstate or situationBizarre- odd, illogical, grossly inappropriate, unfounded Ex. giggling, grimacing
cognitive symptoms
Inattention, easily distracted, Impaired memory, Poor problem-solving skills,Poor decision-making skills,Illogical thinking, Impaired judgment
Affective Symptoms
DysphoriaSuicidalityHopelessness
first generation antipsychotics (for + symptoms)
Dopamine antagonists (D2 receptor antagonists)Common - Thorazine (Chlorpromazine), Haldol (Haloperidol), Prolixin (Fluphenazine), TrilafonAdvantage-Less expensive than second generation Disadvantages-Extrapyramidal side effects (EPS),Tardive dyskinesia,Anticholinergic side effects,Weight gain, sexual dysfunction, endocrine disturbances-opisthotonos- is a condition in which the body is held in an abnormal position-oculogyric crisis-rotating of eyeballs-Akathisia-Akathisia is… psychomotor restlessness evident as pacing or fidgetinn-Pseudoparkinsonism
second generaion antipsychotics (for both +&- symptoms)
Minimal to no extrapyramidal side effects (EPS) or tardive dyskinesiaDisadvantage ? tendency to cause significant weight gainMETABOLIC SYNDROME!*Clozaril ? Agranulocytosis!Monitor White Blood Count and signs of infectionLiver Function Tests
hallucinations
Auditory-s a form of hallucination that involves perceiving sounds without auditory stimulusCommand-telling to do somethingVisual -seeing thingsOlfactory-smellingGustatory- the sensation of tasting something that isn’t really thereTactile-is the false perception of tactile sensory input that creates a hallucinatory sensation of physical contact with an imaginary object
Anosognosia
lack of awareness
Transinstitutionalization
the mentally ill are alternately and repeatedly routed between the mental health and criminal justice systems.
alchoholism
Genes ALDH2 and ALDH3 influence predisposition toalcoholism
situational theory on substance abuse
Situational: Peer influences, social norms, family systemsupporting addiction, role modeling, age when beginning to consume alcohol, education and employment levels
environmental theory on substance abuse
Access to & cost of substance, policy & policyenforcement, severity of punishment for use of illegal selling to minors, community risk factors (poverty), poor reimbursement for drug and alcohol Rx
biologic theory on substance abuse
Genetics & Family History
Socio-cultural Theories on subsatance abuse
Social forces, role models, adaptiveresponses, cultural aspects
Psychological Theories on subsatance abuse
Personality traits (<self-esteem, frequentdepression, passivity)
family theories on subsatnace abuse
Dysfunctional family systems, socialisolation, financial/legal problems, poorcommunication, codependency/enabling,poor behavior patterns
Three stages of use:
1.Preoccupation/anticipation-Impulsivity and pleasure2.Binge/intoxication3.Withdrawal/negative effectCompulsivity and avoiding pain
4 C’s of addiction
Compulsive behavior-centered on drug use and drug-seeking behaviorCravings- behavior motivated by drug cravingsChronic, relapsing brain disorder- despite negative consequencesCognitive impairment
intoxication
a transient condition following the administration of alcohol or other psychoactive substance, resulting disturbances in the level of consciousness, cognition, perception, affect or behavior, or other psychophysiological functions or responses,
tolerance
need for higher and higher doses of a substance to achieve the desired effect and/or to prevent withdrawal symptoms.
flashbacks
transitory recurrences of perceptual disturbances caused by earlierhallucinogenic drug us; occur during drug-free state
synergistic effect
intense or prolonged effect when two or more drugs are taken together
antagonist effect
combining drugs to weaken or inhibit the effect of oneof the drugs
dual diagnoses
coexistence of a substance use/abuse along with one or more other mental health disorders; either may occur first
codependence
cluster of behaviors involving families/significant others of substance abusers
Pseudoaddiction
Patients become medically addicted for legitimate medical reasons (chronic pain conditions) but no addiction lifestyle present
Non-Dependence-Producing Drugs
Patients continue to use when medically unnecessary; nodependence/withdrawal symptoms present
Polysubstance Abuse (PSA):
use of multiple substances; dependence develops to a variety of drugs
nystagmus- alchohol s/e
Nystagmus is a term to describe fast, uncontrollable movements of the eyes that may be
withdrawl
Withdrawal begins within a few hours after last drink; peaks in 24-48 hours & lasts 4-5 daysAWS includes increased hand tremor, diaphoresis, > HR and B/P, elevated temperature, insomnia, agitation/anxiety, nausea and vomiting, transient hallucinations or illusions, headache, convulsions (delirium tremens) or alcoholic withdrawal delirium is marked by severe tremors, increasing severe disorientation, frightening visual hallucinations (visual, tactile), delusions, autonomic hyperactivity, seizures Peaks 2-3 days after cessation/reduction
Complications of Alcohol (Wernicke’s encephalopathy)
An acute disease of the brain caused by a deficiency of thiamine, usually associated with chronic alcoholism and characterized by loss of muscular coordination, abnormal eye movements, and confusion.
Complications of Alcohol (Korsakoff’s Syndrome)
Korsakoff’s syndrome- is a neurological disorder caused by a lack of thiamine (vitamin B1) in the brain. Its onset is linked to chronic alcohol abuse or severe malnutrition, or both. (brain damage)
Complications of Alcohol (Marchiafave BignamiDisease
brain disease from alchohol
detoxification
tapering of drug over a period of timeGastric Lavage and dialysis may be necessary
CAGE AID screning tool
C?Have you ever felt you ought to Cut down on your drinking (or drug use)?A?Have people Annoyed you by criticizing your drinking (drug use)?G?Have you ever felt bad or Guilty about your drinking (drug use)?E?Have you ever had a drink (used drugs) first thing in the morning (Eye-opener) to steady your nerves or get rid of a hangover?AID?Adapted to Include Drugs
walkers study on violnce
three phases1.tension building2. acute battering3.honeymoon
overindulgence
is child neglect
resiliance
to spring back into shape
Intelectual disability disorder
deficits such as reasoning, problem solving, thinking, judgment, learning etc-deficits in general dailt activities such as comunicationg, school , work,
AUtism (must have two of the following)
- repetitive speach, motor movements, echoalia, 2. routines, rituals, resistance to change3. fixated interests4. hypoacitve/hyperactive sense of joy, and senses
echoalia
the automatic repetition of vocalizations made by another perso
ADHD atention deficit hypractivity disorder- scans show undeveloped frontal lobes
3 symptoms1. inattention2. hyperactivity3. impulsivityUSE OF TIME OUT
tourettes disorder
rapid, involuntary movements coprolalia- uttering of obsenitiesclonidine and guaneficeine are good drugs for tourettes
oppositional defiant disorder
angry irritableblames others
conduct disorder
violence breaking rulesno guilt or remorseencoporesis- Encopresis is the voluntary or involuntary passage of stools in a child who has been toilet trained stealingkilling animals for fun
