Pysch Flashcards
Mental Health
relative not absolute; successful mental functioning
Mental Health
influenced by cultural factors; maladaptive stress response; outside societal norms; interfere with functioning
Kubler Ross Stages of Grief
Denial
Anger
Bargaining
Depression
Acceptance
Erik Erikson= Psychosocial theory
Developmental task at each stage.
Trust vs. Mistrust (infancy)
Autonomy vs. Shame and Doubt (toddlerhood)
Initiative vs. Guilt (preschool)
Industry vs. Inferiority (school-age)
Identity vs. Role Confusion (adolescence)
Intimacy vs. Isolation (young adulthood)
Generativity vs. Stagnation (middle adulthood)
Ego Integrity vs. Despair (late adulthood).
Sigmund Fraud
Psychosexual development
Id= pleasure
Ego= reality
Super Ego= conscience
Lawrence Kohlberg
Moral Development
Harry Sullivan
Interpersonal Development
Hildegard Peplau
Nurse-client relationship
Murray Bowen
Family Systems Theory
Compensation
Focusing on achievement in one area of life in order to distract attention away from the inadequacy or fear of inadequacy in another area of life.
Denial
an individual refuses to recognize or acknowledge objective facts or experiences
Displacement
Transferring one’s emotional burden or emotional reaction from one entity to another.
Identification
The internalization or reproduction of behaviors observed in others
Intellectualization
people reason about a problem to avoid uncomfortable or distressing emotions.
Introjection
a person unconsciously absorbs experiences and makes them part of their psyche.
Isolation
Avoiding the experience of an emotion associated with a person, idea, or situation.
Projection
unwanted feelings are displaced onto another person, where they then appear as a threat from the external world.
Rationalization
people justify difficult or unacceptable feelings with seemingly logical reasons and explanations.
Reaction formation
which people express the opposite of their true feelings, sometimes to an exaggerated extent.
Regression
which people seem to return to an earlier developmental stage.
Repression
Subconsciously blocking ideas or impulses that are undesirable.
Sublimation
channeling unwanted or unacceptable urges into an admissible or productive outlet.
Suppression
Consciously choosing to block ideas or impulses that are undesirable
Undoing
a person tries to cancel out or remove an unhealthy, destructive or otherwise threatening thought or action by engaging in contrary behavior.
Maslow’s Hierarchy of Needs
Least Important to Most
Self-Actualization
(Pursue Talent, Creativity, Fulfillment)
Self-Esteem
(Achievement, Mastery, Recognition)
Belonging
(Friends, Family, Community)
Safety
(Security, shelter)
Physiological
(Food, Water, Warmth)
Theoretical Perspective: Kantianism
deontological, revolving entirely around duty rather than emotions or end goals
Theoretical Perspective: Utilitarianism
Utilitarianism promotes “the greatest amount of good for the greatest number of people.”
Theoretical Perspective: Christian ethics
it is possible for humans to know and recognize truth and moral good through the application of both reason and revelation.
Theoretical Perspective: Natural law theory
believes that our civil laws should be based on morality, ethics, and what is inherently correct.
Theoretical Perspective: Ethical Egoism
claims that I morally ought to perform some action if and only if, and because, performing that action maximizes my self-interest.
Autonomy
providing adequate information to allow patients to make their own decisions based on their beliefs and values, even if they aren’t the ones the nurse chooses.
Beneficence
an act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation.
Nonmaleficence
a core principle of medical ethics stating that a physician has a duty to ‘do no harm’ to a patient.
Justice
impartiality regarding a patient’s age, ethnicity, economic status, religion, or sexual orientation.
Veracity
requires nurses to provide honest and accurate information, even if the news is difficult for patients to hear.
Milieu therapy
a safe, structured, group treatment method for mental health issues.
How can therapeutic communication be created?
Rapport
Trust
Respect
Genuineness
Empathy
Body Language (SOLER)
S-sit squarely, face the patient
O-open posture
L-lean forward
E-eye contact
R-relax
Interventions Before Seclusion and Restraints
Prevention
De-escalation
Reduction in stimuli
*Psychosis: set of symptoms evidencing disorganization in mental processes
*Symptoms reflect behavior, emotional response, and thought processes of the person who has lost contact with reality:
Perceptual disturbances
Disorganized thinking
Behavior alterations
*Tends to withdraw from society into own unreal world
Hallucinations
false sensory perceptions, unrelated to reality and unsupported by actual environmental stimuli
Visual (seeing)
Auditory (hearing)
Olfactory (smelling)
Tactile (feeling)
Gustatory (tasting)
Illusions
sensory stimuli misinterpreted
Delusions
fixed, false ideas or beliefs without appropriate external stimuli which are inconsistent with reality and cannot be changed by reasoning
Depressive
Somatic
Grandiose
Persecution
Delusions of reference
Thought: broadcasting; insertion; withdrawal
Disorganized thinking
Loose association or derailment
Alogia (poverty of speech)
Word salad
Neologisms (new words)
Clang associations
Catatonic behaviors
Decreased reaction to surroundings
Waxy flexibility
Remains in one position until someone changes it
Schizophrenia S/S
*Positive symptoms
Acute symptoms (evidenced early in disease)
Alterations in thinking
Alterations in perception
Alterations in behaviors
*Negative symptoms: develop slowly over time
Affect
Avolition
Anergia
Anhedonia
Common: substance abuse, suicide, violence
Depression with suicidal end
Paranoid Schizophrenia
prominent hallucinations, delusions
Disorganized Schizophrenia
disorganized/unintelligible speech, bizarre behavior, flat affect
Catatonic Schizophrenia
severe decrease in motor activity, responsiveness to environment
Major depressive disorder
experience depressed mood/loss of interest in activities most of each day for 2 weeks; single or recurrent episodes
Persistent depressive disorder (dysthymia)
recurrent state of depression ≥2 years
Common signs and symptoms: lifetime struggle with depression symptoms
Bipolar and related disorders
brain dysfunction causing abnormal, erratic shifts in mood, energy, and functional ability; possible genetic factor
Episode ranges: labile
High manic (euphoria, high energy) to low depressive periods
Frequency of mood swings: unpredictable; variable (from person to person)
Severity of symptoms: mild to severe
Bipolar II/cyclothymic disorder
Episodic severity, duration
Cyclothymic disorder:
chronic mood disturbance with fluctuating periods of hypomanic symptoms + periods of depression
Treatment of Bipolar and Related Disorders
*Drug of choice: mood-stabilizing agents
Alone or in combination with selected antipsychotics
Used in conjunction with psychotherapy
*Specific medications
Lithium carbonate: effective on mania; not on lows
Serum level measurement + clinical response
Anticonvulsants
Generalized Anxiety Disorder (GAD)
Characterized by chronic, unrealistic, and excessive anxiety and worry which have occurred on more days than not for at least 6 months and cannot be contributed to specific organic factors (substances, medications, medical conditions such as hyperthyroidism)
Symptoms are intense enough to cause clinically significant impairment in social, occupational, or other areas of living.
Panic Disorder
Characterized by recurrent panic attacks, the 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
May or may not be accompanied by agoraphobia
Symptoms of panic attack:
Sweating, trembling, shaking
Shortness of breath, chest pain or discomfort
Nausea or abdominal distress
Dizziness, chills, or hot flashes
Numbness or tingling sensations
Derealization or depersonalization
Fear of losing control or “going crazy”
Fear of dying
Agoraphobia
“fear of the market place”
Substance-Induced Anxiety Disorder
May be associated with intoxication or withdrawal from any of the following substances:
Alcohol
sedatives
hypnotics
anxiolytics
Amphetamines or cocaine
Hallucinogens
Caffeine
Cannabis
Others
Obsessive-Compulsive Disorder (OCD)
Recurrent obsessions or compulsions (or both) that are severe enough to be time-consuming or to cause marked distress or significant impairment
Body Dysmorphic Disorder
Characterized by the exaggerated belief that the body is deformed or defective in some specific way
Trichotillomania (Hair-Pulling Disorder )
The recurrent pulling out of one’s own hair that results in noticeable hair loss
Post-Traumatic Stress Disorder (PTSD)
A reaction to an extreme trauma, which is likely to cause pervasive distress to almost anyone, such as natural or man-made disasters, combat, serious accidents, witnessing the violent death of others, being the victim of torture, terrorism, rape, or other crimes
Acute Stress Disorder (ASD)
Similar to PTSD in terms of precipitating traumatic events and symptomatology
Symptoms: are time limited- up to 1 month following the trauma.
Somatic Symptom Disorders
Characterized by: multiple somatic symptoms that cannot be explained medically and is associated with psychosocial distress and long-term seeking of assistance from health-care professionals
Illness Anxiety Disorder
Unrealistic or inaccurate interpretation of physical symptoms or sensations, leading to preoccupation and fear of having a serious disease
Conversion Disorder
A loss of or change in voluntary motor or sensory function that cannot be explained by any known medical disorder or pathophysiological mechanism.
Factitious Disorder
Conscious, intentional feigning of physical and/or psychological symptoms. Individual pretends to be ill to receive emotional care and support commonly associated with the role of “patient.”
3 Clusters of Personality Disorders
*Cluster A: The odd, eccentric, cluster
Includes: Paranoid Personality Disorder, Schiziod Personality Disorder, Schizotypical Disorder
Cluster B: The Dramatic, unpredicable cluster
Includes: Antiosocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, Narcissistic Personality Disorder
*Cluster C: The Anxious, Fearful Cluster
Includes: Aviodant Personality Disorder, Dependent Personality Disorder, Obsessive-compulsive Personality Disorder.
PARANOID PERSONALITY DISORDER
These patients are constantly on guard, hypervigilant, tense and irritable. They are insensitive to other’s feelings and avoid interactions with other people. They feel that others are trying to take advantage of them. They do not trust anybody and are constantly testing the honesty of others. They attribute their shortcomings to others and do not take responsibility for their own actions.
SCHIZOID PERSONALITY DISORDER
People with schizoid personality disorder often times appear cold and indifferent towards others. They spend their time doing solitary activities or engaging with animals more than people. When in the presence of others, they appear shy or anxious. Their affect is usually constricted.
SCHIZOTYPAL PERSONALITY DISORDER
People with this disorder are generally cold and distant and behave in an apathetic manner. These individuals have magical thinking, ideas of reference and illusions. When under stress, these people decompensate rapidly and have psychotic symptoms – delusional thoughts, hallucinations and bizarre behaviors. These patients will laugh at their own problems or at a situation that others would consider sad.
ANTISOCIAL PERSONALITY DISORDER
People with antisocial personality disorder have a disregard for the rights of others. They manipulate others for their own personal gain. More likely to have a substance use disorder.
BORDERLINE PERSONALITY DISORDER
People with this disorder are impulsive and self destructive and lack a clear sense of identity.
HISTRIONIC PERSONALITY DISORDER
People with this disorder have a hard time maintaining long-lasting relationships. They are attention-seeking and seductive. When they do not get the attention that they want, they become overly anxious.
NARCISSISTIC PERSONALITY DISORDER
People with this disorder lack empathy and are hypersensitive to the evaluation of others. They believe that they have rights to receive special treatment. Their mood is optimistic, relaxed, cheerful and carefree. Their mood is rapidly changing due to their low self esteem. They seek positive feedback and if they do not get it, they will become enraged.
AVOIDANT PERSONALITY DISORDER
People with this disorder are awkward and uncomfortable in social situations. Their speech is typically slow and constrained. They are often lonely and have feelings of being unwanted. They want close relationships but avoid them because of their fear of being rejected.
DEPENDENT PERSONALITY DISORDER
People with this disorder have an extreme reliance on others to take responsibility for them – to the point that they cannot be left alone for even brief moments of time. They allow others to mistreat and demean them. They will assume the passive and submissive role in a relationship. They avoid positions of responsibility and are very anxious when forced into them.
OBSESSIVE COMPULSIVE PERSONALITY DISORDER
People with this disorder are overly disciplined, perfectionistic and preoccupied with the rules. They are very inflexible about the way in which things must be done. They have an intense fear of making mistakes and this leads to difficulty with making decisions.
Phases of Substance Dependency
*Phase one: first use
User experiences “high”; regulates amount of substance and opportunities for use
*Phase two: user experiences hangover effects
Begins to feel guilty for behaviors during use
*Phase three: dependent lifestyle begins
User can no longer predict outcome; engages in compromising behaviors; loses insight
*Phase four: user demonstration of dependency/addiction
Periods of blackout, paranoia, helplessness
Wernicke–Korsakoff syndrome:
encephalopathy, psychosis
Nutritional disease of CNS, found in alcoholics
Progressive memory loss; disorientation with emotional lability and apathy; weakness; fatigue
Delirium tremens (DTs):
profound confusion, delusion and withdrawal symptoms
Anxiety, tremors, seizures, hallucinations
Lasts 72 to 80 hours, 5–15% fatality rate
Autism spectrum disorder:
range of complex neuro-developmental disorders involving delayed development of various basic skills
Communication; socializing with others
Processing, understanding external input
Autistic disorder: severe abnormal development of external social interaction and communication
Signs and symptoms: Symptoms usually appear ≤3 y.o.; lack of language development; unresponsive to interaction; nonverbal behaviors; inflexible, consistent routines
Attention-deficit/hyperactivity disorderADHD
Persistent pattern of inattention, hyperactivity, or impulsive behaviors; greater frequency than age-appropriate
Signs and symptoms: must be present ≥6 months
Continual, often destructive physical activity
Low tolerance of frustration
Anorexia nervosa:
intense fear of weight gain; significant self-image disturbance (DSM-5)
Maintenance of subnormal weight levels for age
Bulimia nervosa
binge eating with repeated attacks, self-induced destructive methods to prevent weight gain (DSM-5); purging; nonpurging
Weight typically WNL for height/age
