PsychosocialTest 6 Flashcards
define substance
drug of abuse, a medication, or a toxin
define substance abuse
- -the ingesting (by eating, drinking, injecting, or inhaling) of any chemical that affects the body.
- -includes legal, illegal, and medicinal substances
- -culturally and socially defined
define abused substances
chemicals that alter an individual’s perception by affecting the CNS
- -often called mind-altering drugs
- ability to enhance or depress moods/emotions
define substance (drug) abuse
the excessive use of a substance that differs from societal norms
define habituation
occurs when an individual depends on a substance to provided pleasure or relief
define substance (chemical) dependency
occurs when a user must take usual dose of the drug to prevent the onset of withdrawal signs/symptoms
how drugs affect pregnancy
- first trimester of pregnancy, developing fetus is highly sensitive
- -may alter the placenta
- -ability to perform life-promoting functions
Fetal alcohol syndrome
- -result of excessive alcohol use during pregnancy
- -1 child/1000 live births
- -smaller at birth
- -small heads (microcephaly)
- -fail to develop normally
- -CNS deficits, mental retardation, hyperactivity
- -irritability, poor feeding habits
- -slow growth rates, developmental delays
- -behavioral problems, intellectual impairment
- -poor judgement
- -facial features (low nasal bridge, epicanthic folds, short eyelid tissues, short nose, small midface, indistinct infranal depression, thin upper lip)
how infants are affected when exposed to cocaine in utero
sleeping and eating problems. unusual levels of irritability, high pitched cries
children of parents who use both legal and illegal chemicals are likely to:
- -do poorly in school
- -have difficulty controlling their emotions
- -exhibit low self-esteem
- -repeat the cycle of substance abuse as they age
what is most frequently abused drug of adolescents
- -alcohol
- -alcohol related accidents are the leading cause of death
adolescents experiment with drugs for what reasons
- -recreational ways
- -social setting
- -relaxation
- -intoxication
define dual diagnosis
- -people with serious mental illness who also are addicted to or use chemicals or have other mental health problems
- -estimated 75% of the mentally ill has a dual diagnosis
- -ppl with personality disorders very likely to have co-occurring mental disorder (include anxiety, mood, and impulse control disorders)
how is alcohol metabolized and excreted
metabolized by the liver
excreted by the kidneys and lungs
effects of alcohol
- -low dose=rise in PH and HR
- -large dose=cardiac irregularities, blood vessels dilate (flushing of the skin)
- -rapid loss of body heat
- -numbness of the hands and feet
- -false sense of warmth
- -can actually reduce body T
define narcotics
- -CNS depressants
- -occur naturally, semi-synthetically, synthetically
- -often called opioids or opiates
semisynthetic narcotics include:
heroin
hydromorphone
thebaine derivatives
define heroin
- -white
- -bitter tasting powder
- -put in solution and injected
- -can be white to dark brown
- -black tar heroin=processed form of heroin. made in Mexico. 80% impurities
stimulants include
caffeine cocaine certain prescription drugs (amphetamines) appetite suppressants, methylphenidate (Ritalin)
large amounts of caffeine produce:
tremors tachycardia nervousness insomnia most prominent withdrawal symptom is headache
summarize cocaine
- -potent natural stimulant
- -relieve fatigue and hunger
- -available on the street as a white, crystalline powder
- -often contaminated with anesthetics or sugar
- -either injected or snorted
- -rush of energy, vigor, feelings of well being
- -last less than 1 hour
- -mental dependency can occur trying to reach initial high
- -overstimulates the nervous system
- -can dissolve the nasal septum, resulting in collapsed nose
summarize crack
- -type of processed cocaine
- -combining cocaine with ammonia or baking soda and heating it
- -produces chips or chunks of highly addicting cocaine
- -called rocks
- -usually vaporized in a pipe or smoked
summarize amphetamines
- -originally pharmaceutically manufactured
- -treat depression, narcolepsy, hyperactivity in children, obesity
- -strong stimulants with addictive properties
- -only available by prescription
summarize hallucinogens
- -natural and synthetic substances
- -alter one’s perception of reality
- -peyote cactus contains mescaline
- -LSD=ergot fungus, orally or inhaled
- -heighten awareness of reality, distortions in time, space, and body image
- -feelings of depersonalization loss sense of reality
- -flashbacks may occur after drug has worn off
- -can lead to various mental health problems
summarize Phencyclidine (PCP)
- -developed for use as animal tranquilizer
- -produces feelings of being separated from one’s body and environment (dissociation)
- -produces mild depression with low doses
- -schizophrenic like reaction with high doses
- -dangerous, behave in unpredictable, often violent ways
signs and symptoms of heroine use
constricted pupils depression drowsiness euphoria nausea respiratory depression
signs and symptoms of heroin overdose
shall respirations
clammy skin
convulsions
coma
signs and symptoms of heroin withdrawal
watery eyes runny nose sweating muscle cramps loss of appetites nausea chills tremors panic
signs and symptoms of PCP use (physical)
increased BP increased T muscle rigidity ataxia repeated jerking agitated movements vertical and horizontal nystagmus
signs and symptoms of PCP use (psychological)
belligerence (wants to fight) bizarre behaviors hallucinations impaired/poor judgment impulsive behaviors paranoia unpredictable behaviors
summarize cannabis
- -marijuana
- hemp plant, cannabis sativa
- -grows wildly
- -used to treat pain, decreased appetite, muscle and gastrointestinal tract spasms, asthma, depression
- used as an antibiotic, topical anesthetic
- rope, clothing, paper made from hemp
forms that cannabis is available in
- -marijuana=dried tops and leaves
- -hash=dried resin that seeps from the top and leaves
- -hash oil=distilled oil of hashish
–all usually smoked, but can be eaten
marijuana and other cannabis products produce:
- -sense of well being and relaxation
- -alter time perception
- -affect short term memory and concentration
- -motivation may be decreased
- -increase in hunger occurs
- -large doses can result in feeling of anxiety
designer drugs
- -created by underground chemists who alter the molecular structures of existing drugs
- -MDMA (ecstasy) STP, ice
- -mild hallucinogen, increased feelings, empathy; confusion, memory loss, decreased consciousness, seiuzres, coma
summarize ecstasy
- -designer drug
- -suppresses the need to drink, eat, and sleep
- -promotes severe dehydration and physical exhaustion
- -hyperthermia is leading cause of death
- -kidney or liver failure can result
morphine
one of the most effective painkillers
white powder
solution for injection
hydromorphone and thebaine derivatives
- -semisynthetic narcotics made form opium
- -hydromorphone called Dilaudid
- -used as analgesic, in liquid or tablet
- -more sedating and powerful than morphine
- -Thebaine derivatives up to 1000 times more potent than morphine. used by veterinarians for large animals only
sigs and symptom of stimulant use:
changes in personality anxiety tension anger restlessness rapid speech and movement
inhalants are popular for several reason
legal
inexpensive
easily available
have a rapid onset
significant complications of inhalants
sudden death from cardiac dysrhythmia respiratory depression hyperactive motor responses loss of coordination seizures
most commonly inhaled substances
alcohol solvents gasoline glue paint thinner hairspray spray paints
huffing
inhaled directly from the container
inhalant effects
feels a high great well being excitement sexual aggressiveness lessened sense of right/wrong loss of judgment
signs and symptoms of inhalant intoxication
delusions hallucinations anxiety confusion loss of inhibition slurred speech muscle weakness damage to the CNS
nicotine
legal inhalant produces relaxation increases alertness helps to relieve feelings of hunger used as a method to control body weight
difference between substance use and abuse
use=does not affect their ability to perform the activities of daily life.
abuse=occurs when use of the chemical becomes more important than the ADLs
describe the stages of addiction
- -early stage==able to use and enjoy their substance. desire to repeat the first pleasurable experience. frequent pattern of use. prefer being high to other activities. habit of excessive use develops. ignore responsibilities and obligations. ma deny that a problem exists. ignore others comments, lie to cover up activity and to conceal problem
- -middle (crucial) stage==episodes increase as body compensates by adapting to substance. tolerance develops.
- -chronic (late) stage=tolerance of chemical is usually high. loss of one’s behavior. life is miserable without chemical. daily living becomes nightmare. all waking hours are spent focused on obtaining and using substance
define intoxication
a state of maladaptive behavioral or psychological changes resulting from exposure to certain chemicals
- -frequently belligerent (looking for a fight or an argument)
- -wide emotional swings
- -lack sound judgement
- -critical thinking ability is reduced
define tolerance (physical and psychological)
- -increased amounts of the chemical are needed to produce the same effects
- -physical=occurs when the body has adjusted to living and functioning with the substance in its system
- -psychological=develops when individuals feel that they can’t function without the use of the chemical
individuals must meet certain criteria for diagnosis of a substance-related disorder
- -must be disabling
- -lead to significant impaired functioning and distress
- -must demonstrate signs of tolerance, withdrawal, dependence
what are the 3 most commonly abused types of drugs
- -alcohol and sedative-alcohol combos
- -opiate narcotics (mainly heroin)
- -stimulants (mainly cocaine and amphetamines)
physical examination of user includes
- -CNS=orientation, balance, gait
- -head and neck=ruddy or pale complexion
- -chest=vitals, pulses
- -abdomen-bowel, bruising
- -skin=needle marks
- -nutritional status=prone to malnutrition
psychosocial assessment of user includes
- -general appearance=tidy, tattoos
- -behaviors=speech rate, memory loss
- -emotional state=depression, instability
- -social support=most important ppl
- -motivation=description of chemicals used
- -diagnostic tests=UA, CBC, chemistry panel, HIV, TV, EEG, MRI, Ct, hepatitis
disease model of treatment
states that substance abuse is a disease and should be treated as such
- has acute and chronic signs and symptoms
- certain pattern of progression
- physical pathological condition associated with continued use
- two types of treatment programs: 12 step programs and residential treatment programs
what is 12 step program
- -disease model treatment program
- -self-help, group centered
- -involves admitting one’s powerlessness to control dug use
- -seeking help from a higher power through prayer or medication, moral inventories, confessing wrongs, asking for forgiveness, and carrying the message to other
- -very effective when the individual wants them to be
medical model of treatment
- -considers addictions from a public health, chronic, and acute infectious disease perspective
- -attempts to explain substance abuse with biopsychosocial framework
- -neurotransmitters and other biochemical activities
psychiatric models of treatment
–view substance abuse as an expression of an underlying emotional conflict mental disorder
sociocultural model of treatment
state that substance abuse can be treated by changing an individual’s environment and teaching ppl how to develop new responses to their current environments
–led to the establishment of long-term residential treatment programs and therapeutic communities
the first steps in treatment for substance abuse is:
- -individual recognize the need for help
- -focus turns to uncovering and treating existing emotional or mental health problems
- -las (most difficult) assist individuals in changing their behaviors
define detoxification
- process of withdrawing from a substance under medial supervision
- -hospitalized because of potential complications: seizures, respiratory and cardiac problems
- -given methadone, phenobarbital, Dilantin, Valium
define methadone
- -drug used to treat heroin addiction
- -ease the effects of withdrawing from heroin
- -chemical relative of heroin
- -taken orally daily, prevent the symptoms of withdrawal
- -helps stabilize the lives of substance abusers
define Disulfiram (Antabuse)
- -taken daily
- -for nonpracticing (dry) alcoholics
- -causes very unpleasant physical reactions when combined with alcohol
- -induces headaches, flushing, nausea, vomiting, low BP, blurred vision
important intervention for clients, act as a therapeutic agent by:
- practice effective listening skills
- establish trust and cooperation
- learn to act as a role model
- quietly demonstrate problem solving skills
- demonstrate effective coping skills
- look beyond the addiction to see the person
key interventions for abuse and dependence problems
- -meet physical needs during detoxification
- -address physiological problems resulting from dependence
- -monitor effects of therapies used to control substance abuse
- -teach clients about the disease and its progression
- -focus on client’s strengths, help clients build on them
- -help clients problem solve the dilemmas they fear
- -encourage focus on the present and future, not past
- -behave toward client in consistent manner, nonjudgmental
- -assist client’s families by encouraging them to become involved
define gregarious
- -people are gregarious, they are sociable and in need of the company of others
- -need interactions with other ppl throughout our lives
define personality
- -composite of behavioral traits and attitudes that identify one as an individual
- -unique pattern of thoughts, attitudes, values, and behaviors
- -established during childhood
- -developed by adapting to a particular environment and its standards
- -based on one’s self concept
- -define who we are and how we present to the world
summarize personality in childhood (infants to early school years)
- -infants=do not see themselves as separate being until 18 months. environments are seen as warm, nurturing, and unconditionally accepting. sense of trust and self worth develops
- -toddlers=personality is fluid, changeable, and undefined. Btw 18 months-3 years learn to separate from caregivers, explore world around them. develop a sense of object constancy. Seek out their parents for support, encouragement, and approval.
- -early school years=learn about cooperation, competition, compromise. Peer relationships assume more importance. approval from persons outside the family is sought. conflicts with parents begin to occur. search for independence
define object constancy
knowledge that a loved person or object continues to exist, even though it is out of sight.
personality in adolescence
- -personality is well established
- -relationships with others assert their independence from parents
- -chances for sharing, clarifying values, and learning about the differences in ppl
- -support each other in struggles
- -cope with the distresses of becoming adults
- -sexual issues produce anxiety
- sexual activity is experimental and spontaneous
- -struggles continue over autonomy within the family
summarize personality in adulthood
- -self-sufficient, making decision, involved in give and take relationships
- -occupational choices are made
- -families may be started
- -self awareness grows
- -balance btw personal independence and meeting the needs of others
- -acceptance of the feelings of other persons
- -encourage independence in others
- -relationships grow and evolve
summarize personality in older adulthood
- -must cope with loss and change
- -personality remains intact as individuals age
- -life takes deeper meaning and is reviewed
- -able to cope with losses by maintaining what independence they can
- -accepting their limitations
- -A SUDDEN CHANGE IN PERSONALITY IS NOT A NORMAL SIGHN OF AGING
- -personality is deeply entrenched
define psychopath
term used to describe a gross disturbance in social behavior with no impairment in mental state
what are the four general theories of personality disorders
biological
psychoanalytical
behavioral
sociocultural
summarize biological theories of personality
- -behavior and personality have a strong genetic influence
- -temperament is genetically linked
- -cardiovascular responses, brain dysfunctions, and biochemical imbalances
- -neurophysical basis for behaviors
- -abnormalities in dopamine and serotonin is linked to maladaptive behaviors
- -brain mechanism that connects emotions and intellect may be inefficient
define temperament
the biological bases that underline moods, energy levels, and attitudes
summarize psychoanalytical theories of personality disorders
- -infants begin to discover that nature of “good/bad” and “love/hate”
- -the superego grows
- -patterns of parental responses prevent the child from developing a strong sense of self and balance among the 3 forces of the personality (ego, id, superego)
summarize behavioral theories of personality disorders
- -result of conditioned responses caused by previous events
- -occur in persons who are not able to hold a consistent, stable image of the mother when she is absent
- -result of unmet needs during critical developmental periods
summarize sociocultural theories of personality disorders
- -causes embedded in one’s culture and society
- -lack of social structure and available roles are risks
- -foundation for disorders is built on society’s social and cultural stresses
- -unemployment, homelessness, and AIDS add to the powerlessness felt by ppl
define personality disorder
long-standing, maladaptive patterns of behaving and relating.
- -characterized by continual difficulties with interpersonal relations
- -have maladaptive behaviors
- -behaviors are inflexible and maladaptive and cause significant functional impairment
- -must occur throughout a broad range of occupational, social, and personal situations
- -no medical or other mental health problem can account
personality disorders are grouped into what 3 clusters
eccentric
erratic
fearful
(Box 30-1)
Characteristics of personality disorders
- -impaired self perceptions
- -impaired thought processes
- -impaired reality testing
- -impaired judgement
- -impaired stimulus barrier
- -dysphoric feelings (depression, abandonment when significant others are absent; emptiness; fear; guilt; rage)
- -impaired object relations
- -poor impulse control
- -acting out behaviors
3 eccentric personality disorders
paranoid
schizoid
schizotypal
4 erratic personality disorders
antisocial
borderline
histrionic
narcissistic
3 fearful personality disorders
avoidant
dependent
obsessive-compulsive
eccentric clusters of personality disorders are characterized by?
odd or strange behaviors
- -find it difficult to relate to others or socialize comfortably
- -often live in isolation
- -interact only when necessary
- -paranoid, schizoid, schizotypal disorders
summarize paranoia
- -suspicious system of thinking
- -includes delusions of persecution and grandeur
- -developed a pattern of behaviors marked by suspiciousness and mistrust
- -everyone is “out to harm, deceive, or exploit” them
- -friends questioned for hostile intentions
- -search for hidden meanings
- -constantly alert for harmful intentions
- -minor event arouses intense hostility and aggression
- -short tempered and unwilling to forgive
- -feelings of tenderness or resect are nonexistent, jealousy
- -problem solving is difficult, high anxiety
- -men are diagnosed more often
- -substance abuse is common
schizoid and schizotypal personality disorders are marked by:
an inability to develop and maintain relationships with other people
summarize schizoid personality
- -lack the willingness to become involved in close relationships
- -society’s loners, prefer solitary activities and their own company
- -emotionally restricted and detached
- -unable to take pleasure in activities or social relationships
- -slightly more common in men and families with an already diagnosed member
summarize schizotypal personality
- -same pattern of avoiding ppl, few friends
- -distortions and eccentricities
- -have ideas of reference
- -commonly find special, personal messages in everyday events
- -often superstitious or believe in paranormal
- -think they have special powers
- -believe they read ppls minds, ability to control over others
- -experience perceptual alterations
- -speech is loose and vague
- -marked by suspiciousness and paranoid ideation
- -emotional expressions are inappropriate or restricted
- -style of dress or grooming, and inattention appropriate social behaviors considered odd and eccentric
- -problems relating to other ppl, very anxious
- -diagnosed more frequently in men
define ideas of reference
incorrect perceptions of casual events as having great or significant meaning
conduct disorder in children
being aggressive to animals and ppl deceive, lie, steal, destroy property break important rules may become bullies impulsive quick to anger no regard for others
adult psychopths
some signs
--gain money, power, influence at expense of others feel no guilt unable to plan ahed too impulsive inflict great pain with no remorse rationalize their own actions shrug off any responsibility for behaviors emotions are shallow
antisocial personality disorder
signs
often charming glib clever conversationalists compliment and entertaining statements inflated view of own importance
borderline personality
pattern of instability in mood, thinking, self image, behavior, personal relationships fears abandonment avoids being alone sudden dramatic changes may gamble, abuse food or drugs engage in sex with multiple partners spends money irresponsibly engages in self-mutilating or suicidal behaviors
histrionic personality
pattern of excessive emotional expression
attention seeking behavior
may be dramatic in dress, mannerisms, speech
emotionally shallow
lie in a romantic fantasy world
narcissistic personality disorder
- -characterized by pattern of grandiosity and the need to be admired
- -believe they are special, unique, or extra important
- -crave admiration
- -inflate beliefs about their accomplishments
- -take advantage of and exploit others without guilt
- -more diagnosed in men
a common characteristic of the fearful cluster is
anxiety
the three personality disorders in the fearful cluster is
avoidant
dependent
obsessive compulsive
avoidant personality
- -anxiety is related to fear of rejection and humiliation
- -narrow their interests to small range of activities
- -minimal support system
- -so afraid of reactions of others
- -do no allow new friends to come into life
- -life filled with isolation and self-pity
- -hypersensitive to criticism
- -some also suffer from general anxiety, depression, or hypochondria
dependent personality
- -associated with separation and abandonment
- -deep fear of rejection
- -need to be cared for
- -become over cooperative and docile
- -do not make demands or disagree
- -when alone, feel helpless
- -refuse to be responsible for their own actions
- -unwilling to begin a task alone
- -seek out overprotective, dominating, or abusive relationships
- -one of most commonly diagnosed personality disorders
- -equally diagnosed in men/women
obsessive compulsive personality
- -considered an anxiety disorder
- -uncertainty about the future
- -extremely orderly
- -preoccupied with details
- -accomplish very little
- -devoted to work, few leisure activities
- -need for perfection
- -2/3 are men
treatment and therapy for personality disorders are guided by:
client’s symptoms, complaints, problems
taking ginseng with MAOI antidepressants can cause
headache, tremors, mania
taking kava-kava with Alprazolam (Xanax) can cause
lethargy, disorientation
taking St. John’s wort with MAOI depressants can cause
toxicity
taking St. Johns’ wort with SSRI antidepressants can cause
serotonin syndrome, agitation, confusion. flushing, sweating, tremors
taking Valerian root with Fluoxetine (Prozac) can cause
A delirium like state
(Table 30-2 Drugs used to treat personality disorders, example, actions, and common side effects)
Antianxiety agents
- -example: Ativan, Valium, BuSpar
- -actions: reduce tension and stress
- -common side effects: fatigue, sedation, dizziness, orthostatic hypotension, dependence, monitor kidney function
(Table 30-2 Drugs used to treat personality disorders, example, actions, and common side effects)
Antidepressants
- -example: Elavil, Prozac
- -actions: Increased feelings of well-being by acting on certain neurochemicals. takes 2-4 wks before improvement
- -side effects: dry mouth, nausea, vomiting, constipation, diarrhea, anorexia, taste, tremor, dizziness, weakness, fatigue, sweating, sexual dysfunction, urinary disturbances
(Table 30-2 Drugs used to treat personality disorders, example, actions, and common side effects)
Anticonvulsants
- -example: Dilantin, phenobarbital, Tegretol
- -actions: CNS depressants that prevent seizure, also help control moods and impulses
- -common side effects: bone marrow depression most serious, GI symptoms, gum tissue growth, slurred speech, confusion
(Table 30-2 Drugs used to treat personality disorders, example, actions, and common side effects)
Antipsychotics
- -example: Haldol, Thorazine
- -actions: act on brain and CNS to help control psychotic symptoms and behaviors
- -common side effects: extrapyramidal side effects, abnormal movements, dry mouth, blurred vision, photophobia, tachycardia, hypotension
(Table 30-2 Drugs used to treat personality disorders, example, actions, and common side effects)
Lithium
- -example: Eskalith, Lithane
- -actions: helps control the exaggerated thoughts and behaviors associated mania
- -side effects: fine hand tremor, increased thirst and urination, diarrhea, constipation, vomiting, extreme hand tremor, sedation, muscle weakness, dizziness
nursing therapeutic goals of care for ppl with personality disorders are:
- -to help clients identify and then become responsible for their behaviors
- -assist clients in developing satisfactory relationships
remain nonjudgmental
define splitting
emotionally dividing the staff by complimenting one group and degrading another
short term goals of ppl with personality disorders focus on:
the discomforts and ineffective behaviors associated with daily living activities
nursing diagnoses related to personality disorders: physical realm
- risk prone health
- noncompliance
- ineffective role performance
- risk for self-mutilation
- risk for other-directed violence
nursing diagnoses related to personality disorders: psychosocial realm
- anxiety
- chronic low self-esteem
- compromised family coping
- ineffective coping
- disturbed personal identity
- risk for loneliness
- impaired social interaction
