psych week 1 Flashcards
Peplau (Peplau was aware)
Peplau (Nurse vs. friend roles) - be aware of your thoughts and feelings about patients. be empathetic, not sympathetic. focus on the patient - don’t tell them about your break up - focus on them.
one of the best ways to demonstrate respect is
with empathy
information giving
listener determines that client would benefit from concrete data thatthe listener has.
information giving can be useful
can be used to explain technical procedures, lab results, etc.
can be used to communicate resources the client mayfind useful, e.g. clinics, childcare centers, etc.
be careful not tso turn time with client into a lecture.
schizo - after 10 years
after 10 years, 25% fully recover, 25% improve, 25% need extensive help, 15% in and out of hospital. 10% die - cause of death is suicide.w
when does schizo develop for men and women?
Males - late teens, women late 20s early 30s.
Schizophrenia results in disturbances in (PTA is schizo)
thought processes, perception, and affect.
how many ppl develop schizo?
Approximately 1 percent of the population will develop schizophrenia over the course of a lifetime.
4 phases of schizo (just numbers)
I - IV
phase 1 - schizo - and what else?
The Prodromal (Prepsychotic) Phase: In this phase, the individuals are socially withdrawn, and have behavior that is peculiar or eccentric. Whether or not to intervene here pharmacologically is a hot area of research. Possible profalycitic meds.
phase 2 - schizo (and what is a big concern here?)
Acute: In the active phase of the disorder, psychotic symptoms are prominent. These include delusions, hallucinations, and impairment in work, social relations, and self-care. Often, safety is a big concern.
phase 3 - schizo
Stabilization: Symptoms are diminishing and pt is recovering. May be living at an ADU or L-facility.
phase 4 - schizo
Maintenance Phase: Pt is at baseline. Symptoms are greatly reduced, similar to the prodromal phase, or have disappeared. May be living independently.
schizo - Genetic Influences - what % is genetic?
A growing body of knowledge indicates that genetics play an important role (65-80%) in the development of schizophrenia. something turns on the genes - marijauna now bc it’s so much stronger. a little more common in males. females do a little better. may be more developmental for males, and more degenerative for females. hormones play a part.
schizo - Biochemical Influences (what hormones)
One theory suggests that schizophrenia may be caused by an excess of dopamine dependent neuronal activity in the brain. Abnormalities in the neurotransmitters norepinephrine, serotonin, acetylcholine, and gamma-aminobutyric acid, glutamate and cholecystokinine have also been suggested.s
schizo - Physiological Influences.
Several physiological factors have been implicated, including viral infection, brain abnormalities, and birth trauma.
schizo - Psychological Influences - when do first breaks happen?
“First breaks” (from reality) and relapses often occur during times of increased stress (e.g. leaving home to go to college).
schizo - Environmental Influences (your income is your environment)
Factors associated with lower SES (chronic poverty, high crime) have been linked to the development of schizophrenia…“downward drift” theory? (ppl who are schizo are more likely to be poor)
schizo - The Stress-Diathesis Model (stress the combo)
Schizophrenia is likely the result of a combination of psychological and environmental influences on an individual who is biologically vulnerable to the illness (could be starvation – concentration camp)
Schizotypal Personality Disorder.(frank is not typical)
Bizarre behavior and suspiciousness, but no frank psychosis. To be discussed more during lecture on Personality Disorders.
Delusional Disorder (delusional break in)
Nonbizarre delusions, without other sxs. they have dilusions, just not that bizarre. ie - house is being broken into, live in a bad neighborhood.
Brief Psychotic Disorder - how long do they last? (briefly one month)
Sudden onset of psychotic symptoms following a severe psychosocial stressor. Symptoms last less than one month, and the individual returns to the full premorbid level of functioning. ***not uncommon to go onto develop schizophrenia. higher risk for schizo.
Substance-Induced Psychotic Disorder - what drugs (and the weird one)
The presence of prominent hallucinations and delusions that are judged to be directly attributable to the physiological effects of a substance. drugs, alcohol, or medication. steroids. malaria drugs. stimulants. marjiuana, more than even psychedelics.
Schizophreniform Disorder (formed in 1 - 6 months)
same symptoms as schizophrenia with the exception that the duration of the disorder has been at least 1 month but less than 6 months. schizophrenia is more than 6 months.
Schizoaffective Disorder
Schizophrenic symptoms accompanied by a strong element of symptomatology associated with the mood disorders, either mania or depression (and psychotic symptoms).
euthymic
(normal mood)
Psychosis or Catatonia Associated with other medical conditions - what diseases (WALE on the psychosis)
Symptoms of this disorder include prominent hallucinations and delusions that can be directly attributed to a general medical condition. ie - wilson’s disease, autoimmune, lupus, encephalitis.
Psychosis or Catatonic Disorder Not Otherwise Specified - what is the prognosis? and how does it resolve?
Psychotic and/or catatonic symptoms that don’t yet meet diagnostic criteria for any of the above disorders. more likely to spontaneously resolve.
POSITIVE SYMPTOMS - and treatment?
reflect an excess or distortion of normal functions, such as AH, delusions and disorganized thinking, and are thought to have a relatively good response to treatment. outwardly obvious, hallucinations.
Thought Content
Thought Content (what a person is thinking)
thought content - dilusions - how many ppl have them?
Delusions (false personal beliefs) 75% of people with schizophrenia experience delusions
thought content - Erotomanic
The individual believes that someone, usually of a higher status (famous person), is in love with him or her.
thought content - Grandiose - common with what disorder? (I’m effectively grandiose)
Irrational ideas regarding own worth, talent, knowledge, or power. (common w/ schizoaffective disorder) you know someone famous.
thought content - Jealous.
Irrational idea that the person’s sexual partner is unfaithful.
thought content - Persecutory.
most common*** The individual believes he or she is being malevolently treated in some way.
thought content - Somatic (somatic pregnancy)
(body) The individual has an irrational belief that he or she has some physical defect, disorder or disease. convinced you have HIV. pregnant when they’re not - older women or males.
thought content - Religiosity
(excessive demonstration or obsession with religious ideas and behavior). this would cause an impairment of function.
thought content - Paranoia
(extreme suspiciousness of others) really common.
thought content - Ideas of Reference (they’re referencing me)
(false belief that one is the subject of attention by other people or the media).
Thought Process/Form (and abbreviation)
(how a person is thinking) abbreviated TP**
Thought Process - Associative looseness (and another term for it)
(shift of ideas from one topic to another) LOA - abbreviation. person is shifting as they are talking, one topic to another. also referred to as derailment. very common with schizo. don’t pretend like you understand when you don’t. pick out one part that did make sense. I’m having a hard time following, but I don’t understand. You mentioned…
Thought Process - Neologisms (Neo is made up)
(made-up words that have meaning only to the individual who invents them) rare.
Thought Process - Concrete thinking (concrete, but not sarcastic)
(literal interpretations of the environment). common with schizo and autism. can’t understand sarcasm. can’t understand abstract.
Thought Process - Clang associations
(choice of words is governed by sound, often rhyming)
Thought Process - Word salad
(a group of words put together in a random fashion)
Thought Process - Circumstantiality (these details are circumstantial)
(a delay in reaching the point of a communication due to unnecessary and tedious details). goes off on extra details, but do get to the point.
Thought Process - Tangentiality
(unable to get to the point of communication due to introduction of many new topics). loose association and tang interchangeable.
Thought Process - Mutism
(inability or refusal to speak)
Thought Process - Perseveration (perseveration is persistent)
(persistent repetition of the same word or idea in response to different questions)***common w/ alzheimers. asking for coffee over and over.
Thought Process - Thought blocking (Al is blocking)
(abrupt halt in the train of thinking, often because of hallucinations). specific to schizo. stop talking suddenly, usually due to internal voices.
Thought Process - Echolalia (Parrots echo for a long time) and common with what type of schizo?
(parroting words just spoken by another). common w/ longterm schizo.
Thought Process - Thought insertion (inserting thoughts in my head)
(feeling like someone or something else is putting thoughts in your head)
Thought Process - Thought withdrawal (don’t withdraw my thoughts)
(feeling like someone or something else is stealing/taking your thoughts away)
Thought Process - Thought broadcasting
(feeling like you can broadcast/send/transmit your thoughts to other people) the internet, X-ray machines.
Thought Process - Alogia (Al can’t speak)
(loss of speech)
Thought Process - agnosinosia (Agnes doesn’t know she’s sick)
poor insight, don’t recognize they have an illness.
Perception
the interpretation of stimuli through the senses
perception - hallucinations - how many ppl have them?
(false sensory perceptions not associated with real external stimuli) most common is auditory*** can have olfactory or gustatory (taste) visual and tactile is withdrawal. 60% of people with schizophrenia have hallucinations
perception - illusions (the illusion is real)
misperceptions of real external stimuli) real things but misinterpreting.
perception - Depersonalization and Derealization
(feelings of unreality). living outside your body, your in a movie, the surroundings aren’t real.
Alterations in Behavior - Echolalia (repeat the echo)
(repeating words that are heard).
Alterations in Behavior - Echopraxia (prax is a mime)
(repeating movements that are observed). miming. not as common.
Alterations in Behavior - Catatonia
(extreme motor retardation (“stupor”) or agitation). ppl can hear you when they are catatonic.
Alterations in Behavior - Waxy flexibility
(passive yielding of all moveable parts of the body to any efforts made at placing them in certain position)
Alterations in Behavior - Posturing (boxing posture) OR WHAT ELSE
(voluntary assumption of inappropriate or bizarre postures or expressions) shadowboxing, frozen in a pose.
Alterations in Behavior - Pacing and rocking - can be caused by what?
(pacing back and forth and rocking of the body). can be from acathesia (medication side effect). can be self soothing.
NEGATIVE SYMPTOMS
reflect a diminution or loss of normal functions, such as diminished emotional expression and apathy, and are less likely than the positive symptoms to respond to treatment. may be caused by some medications.
may try reality orientation, but it can agitate people. they’re ready when they start asking questions or voice doubt.
negative symptoms - Affect/Emotional Tone
Inappropriate affect
Flat
Apathy
negative symptoms - Avolition (the aviator has no goal)
(impairment in the ability to initiate goal directed activity) stay in bed all day
negative symptoms - Anergia
(a deficiency of energy) common w/ many disorders
negative symptoms - Anhedonia
(inability to experience pleasure)
Associated Features - negative symptoms - autism
negative symptoms, autism - actually referrs to focus inward on a fantasy world. internally preoccupied.
Autism
(the focus inward on a fantasy world, while distorting or excluding the external environment)
Deteriorated appearance
(personal grooming and self-care activities are impaired)
Regression - usually happens during which phase?
(retreat to an earlier level of development) - act younger than they are, usually in acute phase. laughing and childlike.
COGNITIVE SYMPTOMS - what does treatment help do?
one of the biggest predictors of disability. ppl who get through college before symptoms tend to do better than those diagnosed at 15. tends to get worse over time. treatment helps plateau cognitive decline. prevent relapse. d
Expected Outcomes
may just take a shower, hallucinations reducing, thought process more organized, etc.
usually ppl who are hallucinating are the ones who are most likely to be hallucinating.
Antipsychotics - Typicals (older) (typicalHal tries malaria)
Haldol, Trilafon, Mellaril
typicals - antipsychotics - issues
higher risk for EPS (extra paramatal symptoms) and TD (tardiv dysconensia) = movement disorders
cheaper
antipsychotics - Atypicals (newer)
. Clozaril, Zyprexa, Risperdal,
antipsychotics - Atypicals - issues
better treatment of negative sxs
high risk of weight gain and DM
Informal admission
Informal admission is the least restrictive of all admissions. person does not pose a substantial threat of harm to self or others.
voluntary admission
Voluntarily admitted patients have the right to request and obtain release. Before being released, reevaluation may be necessary
Emergency commitment (confused or ill by the emergency)
(1) for people who are so confused they cannot make decisions on their own or (2) for people who are so ill they need emergency admission
consider this before using restraints
- Verbally intervening (e.g., asking the patient for cooperation) * Reducing stimulation
- Actively listening
- Providing diversion
- Offering as needed (PRN) medications
restraint times
Adults 18 years or older are limited to 4 hours; children and adolescents 9 to 17 years old are limited to 2 hours; and children under 9 years old have a 1 hour limit. assess pt. every 15 to 30 min
tort
harming - The injury can be to person, property, or reputation.
intentional torts
assault, battery, and false imprisonment.
assault
threat
battery
the actual harmful or offensive touching of another person
Unintentional torts
negligence
malpractice
negligence - 1. Duty
2. Breach of duty
3. Cause in fact
4. Proximate cause 5. Damages
MSE
mental status examination
life expectancy for schizo
15-25 years less life expectancy. 1-5 ppl in jail have mental illness.
illnesses associated w/ schizo
Various physical conditions, such as epilepsy, systemic lupus erythematosus,
schizo and IQ
lose IQ points over time
Inappropriate affect
emotions are incongruent with the circumstances, laughing for no reason
Flat
weak emotional tone
Apathy
disinterest in the environment
illnesses associated with schizo (just 2)
myxedema (hypothyroidism), Parkinsonism
is circumstaniality more or less severe?
less severe thought process.
atypicals (a typical Sarah is able to geo)
Seroquel, Geodon, Abilify,
atypicals (a typical sapphire in Vegas with latitude)
Invega, Latuda, Saphris
Peplau
mutual collaboration. not heirarchy, form a rapport.
benzos increase
gaba
babies born between jan and april
have higher risk for schizo - viruses. mostly end of 2nd and 3rd trimester.
treatment for schizo that is not responsive to normal meds
steroids - it could be autoimmune
low birth weight
a little higher chance of schizo
personality disorders ARE
lifelong and fixed
dilusions usually stem
from something that did happen in the past
usually don’t see negative symtpoms when someone is
psychotic
command auditory hallucinations
really dangerous
interventions for hallucinations
Nursing care includes calling the patient by name, speaking simply and loudly enough to be understood during auditory hallucinations, presenting in a supportive manner, maintaining eye contact, and redirecting the patient’s focus to your conversation as needed (
interventions for delusions
It is true the doctor wants to see you as he talks with all patients about their treatment.
Would you feel more comfortable if I stayed with you during your meeting?
Focusing on activities and events occurring in the present keeps the focus on reality and provides opportunities to distinguish what is real.
if someone is paranoid -
“seems like youre really worried about what’s going on right now.” don’t let them to go on about their delusion.
if someone is paranoid = you need to
build trust, they won’t tolerate much eye contact. too nice makes them suspicious.
atypical better for
negative symptoms that typical.
acathesia
hard time sitting still - caused by antipsychotics
