Test 1 Flashcards
Prior to the ______ mental disabilities were often described in one category which included intellectual delay, mental illness, and organic brain disorders.
1800’s
Start of division of mental illness into cognitive – affective – behavioural domains
Early 1800
In _______, Eugen Bleuler coined the term schizophrenia, and positive and negative symptoms
1911
In _______, Kurt Schneider developed his concept schneiderian symptoms of schizophrenia
Become the foundation of the DSM II
1959
Audible thoughts
Experience of influences controlling the body
Thought broadcasting
Thought withdrawal
Thought insertion
Delusional perception
Scheiderian symptoms
___________ (family history) appears to be the strong predictor in the development of Schizophrenia
Genetics
_________ is not solely responsible in ½ of the cases of identical twins only one twin will experience schizophrenia
Genetics
Prenatal exposure to influenza
Prenatal exposure to lead
Prenatal exposure to toxoplasma gondii
Obstetrical complications
Prenatal and Perinatal factors
before birth
Prenatal
2 or so weeks before and after birth
Perinatal
Predispositions and vulnerabilities for schizophrenia (diatheses)
People’s vulnerabilities must interact with life stresses to trigger the onset of the illness
Vulnerability + Stress
Diathesis-stress models
Stressors can include:
Trauma
Virus
Prenatal and perinatal complications
Substance use
Diathesis-stress models
Good evidence to show that stress can trigger schizophrenia, cause relapse, and worsen symptoms.
Diathesis-stress models
Dopamine hypothesis
Glutamate hypothesis
Serotonin hypothesis
Neurotransmitters
Reduced grey matter
Low activation of frontal cortex
Ventricle enlargement
Hippocampal atrophy
Neurological changes
Schizophrenia
Schizophreniform Disorder
Schizoaffective Disorder
Schizotypal Personality Disorder
DSM 5 – Schizophrenia Spectrum
is now considered part of the schizophrenia spectrum but the disorder is described detail under the section ‘personality disorders’
Schizotypal personality disorder
Delusions
Hallucinations
Positive Symptoms
Distortions or exaggerations in language and communication
Disorganized speech
Disorganized behavior
Cognitive Symptoms
Affective flattening
Avolition
Alogia
Anhedonia
Asociality
Anosognosia
Apathy
Catatonia
Negative Symptoms
Persecutory/paranoid
Referential
Grandiose
Erotomanic
Nihilistic
Somatic
Religious
Jealous
Bizarre
Magical thinking
Types of delusions
Thought insertion
Thought broadcasting
Thought withdrawal
Delusions of control
“__________ beliefs that are not amenable to change in light of conflicting evidence” (87). – no cultural basis
Fixed false
Auditory
Visual
Olfactory
Tactile
Gustatory
Positive Symptoms: Hallucinations
Experienced as real
Not under voluntary control
Not part of religious or cultural practice
Positive Symptoms: Hallucinations
Observe through speech
thought process
lack of logical relationship between thoughts and ideas – conversation shifts from one topic to another in unrelated manner
Loose associations
takes a long time to make a point – excessive detail
Circumstantiality
speaker does not return to central point
Tangentiality
pause or interruption in train of thought (paucity of thought)
Thought blocking
creation of new words
Neologisms
rapid verbalization, jumping from one topic to another
Flight of ideas
incoherent mixture of words
Word salad
focused on a specific topic, returns to the topic even after topic has changed
Perseveration
use of words or phrases that have similar sounds (hell, bell, sell, well, swell) – not associated in meaning
Clang association
echoing the words and statements used by others
Echolalia
Agitation and retardation can both refer to either _______ symptoms or ________ symptoms.
motor; psychic
internally agitated
Psychic agitation
pacing etc
Motoric agitation
internal feeling of being slowed down
Psychic retardation
slowed movements
Motoric retardation
________ hallucinations are the most common
auditory
Psychomotor agitation
Psychomotor retardation
May not be goal directed and leads to difficulty preforming activities of daily living
Cognitive Symptoms: Disorganized Behaviours
Affective blunting or flattening
Affective flattening
a significant or severe lack of motivation or a pronounced inability to complete purposeful tasks
Avolition
a symptom that causes you to speak less, say fewer words or only speak in response to others
Alogia
the lack of interest, enjoyment or pleasure from life’s experiences
Anhedonia
lack of motivation to engage in social interaction, or a preference for solitary activities
Asociality
a neurological condition in which the patient is unaware of their neurological deficit or psychiatric condition
Anosognosia
lack of interest, enthusiasm, or concern
Apathy
Stupor
Catalepsy
Waxy flexibility
Mutism
Negativism
Posturing
Mannerism
Stereotypy
Agitation
Grimacing
Echolalia
Echopraxia
Negative Symptoms: Catatonia
Combination of cognitive, affective and motor symptoms
Catatonic symptoms
no psychomotor activity, no interaction with the environment
Stupor
a medical condition characterized by a trance or seizure with a loss of sensation and consciousness accompanied by rigidity of the body
prolonged muscular rigidity and immobility, where the individual’s limbs remain in an unnatural, fixed posture
Catalepsy
if an examiner places the patient’s arm in a position, they will maintain this position until it is moved again
Waxy flexibility
limited verbal responses
Mutism
little or no response to instructions or external stimuli
a tendency to resist external commands, suggestions, or expectations, or internal stimuli, as hunger, by doing nothing or something contrary or unrelated to the stimulus
Negativism
actively holding a posture against gravity
Posturing
carrying out odd, exaggerated actions
Mannerism
repetitive movements without an apparent reason
a repetitive or ritualistic movement, posture, or utterance
Stereotypy
Can occur for no known reason
Not being able to sit still, pacing etc.
Agitation
mimicking another person’s speech
Echolalia
mimicking another person’s movements
Echopraxia
May appear fairly sudden to others but symptoms often begin to slowly develop over six months to a year
Onset of Schizophrenia
Changes in personality
Withdrawal
Dropping out of normal activities
Prodromal Stage
Lifetime prevalence is 1% of population
Persons with a diagnosis of schizophrenia have a reduced life expectancy of 25 years
20-40% of clients have at least one known suicide attempt
5% die by suicide
Socioeconomic challenges
Schizophrenia - Prognosis
In some instances, clients experiencing schizophrenia can drink excessive amounts of water, to the point of water intoxication and even death.
Cause of ______ is unknown
Symptoms often devastating
Can be chronic
Polydipsia
Brain Injury
Seizure Disorder
Stroke
Tumor
Central Nervous System changes that look like mental illness
Self stigma
Social stigma
Provider based stigma
Types of stigma
is based on societal practices, and norms that exclude and oppress groups of people, not individual impairments
Disability
Places importance on physical, cognitive, emotional, and psychological impairments and other barriers that limit or prevent full participation in society
Disability
Emil Kraepelin coined the term dementia praecox
1897
What are the Monoamine Neurotransmitters
Dopamine (D2)
Norepinephrine (NE)
Serotonin (5-HT)
Histamine
What are the additional neurotransmitters?
Acetylcholine (ACh) (Cholinergic)
Gamma-amino-butyric acid (GABA) (Amino Acid)
Glutamate (Amino Acid)
What are the Neuroendocrinology hormones?
Antidiuretic hormone
Oxytocin
Cortisol
Thyroid stimulating hormone
Central Nervous System
Brain Injury
Seizure Disorder
Stroke
Tumor
Vitamin Deficiencies
Cardiopulmonary Disorders
Gastrointestinal
Infection
Medical conditions that can look like mental illness
Animal models
Genetics and Epigenetics
Identifying risk factors
Biological basis of behavior
A __________ must be able to make a connection between:
1. Individual’s psychiatric symptoms
2. Alterations in brain function linked to symptoms
3. Rational for treatment and care
4. Client experiences and choices
psychiatric nurse
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Positron emission tomography (PET)
Single photon emission computed tomography (SPECT)
Functional magnetic resonance imaging (fMRI)
Electroencephalography (EEG)
Types of Neuroimaging
Neuroimaging the captures brain structure
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Neuroimaging the captures brain structure & function
Positron emission tomography (PET)
Single photon emission computed tomography (SPECT)
Functional magnetic resonance imaging (fMRI)
Electroencephalography (EEG)
Shows brain structure
Neuroimaging that shows: shows damage to brain & lesions
Slices
Computed tomography (CT)
Shows brain structure
Neuroimaging that shows: 3D pulses, brain lesions
Magnetic resonance imaging (MRI)
People who come off _______:
Never the same again
Oxygen deprivation changes personality
Ventilators
scan is an imaging test that can help reveal the metabolic or biochemical function
Shows abnormalities in glucose - ADHD, stroke
Positron emission tomography (PET)
Scan show regional cerebral blood flow
Vascular dementia, depression vs dementia
Single photon emission computed tomography (SPECT)
Scan can show structure & function of brain
Used to link genes to brain function
Functional magnetic resonance imaging (fMRI)
Scan uses electrodes on head
Electrical functioning
Coma state to check brain function
Epilepsy - can see seizure activity (can see subtle symptoms)
Electroencephalography (EEG)
______ hemisphere:
Verbal language function
Temporal order & sequencing
Numeric symbols
Verbal learning & memory
Left
______ hemisphere:
Receptive nonverbal language
Spatial orientation & recognition
Tone/pitch of speech & aspects of music
Facial recognition & facial expression of emotion
Right
Primary motor area
Broca’s area
Personality
Working memory
Executive functioning
Frontal lobe
Somatosensory area
Speech and maintaining attention
Parietal Lobe
Primary auditory and olfactory areas
Wernicke’s area
Internal structures important in modulating mood and emotion
Temporal Lobe
Visual
Occipital Lobe
Hypothalamus, pituitary,
amygdala, and hippocampus
all deal with basic drives,
emotions, and memory
Limbic system
Memory processing
Hippocampus
Aggression (fight) and fear (flight)
Amygdala
Hunger, thirst, body temperature, pleasure; regulates pituitary gland (hormones)
Hypothalamus
Integrates all sensory input (except smell)
Thalamus
Regulates appetite, temperature, blood pressure, thirst, and circadian rhythms
Hypothalamus
Emotional brain
Amygdala
Hippocampus
Limbic System
_____ tend to have more positive symptoms & later onset
Hearing and vision loss are common
Women
hypothesis of schizophrenia originates from the effect of NMDA receptor blockers (ketamine, phencyclidine), which produce a withdrawn, passive state that resembles the ‘negative’ symptoms of schizophrenia (passivity and anhedonism).
glutamate
hypothesis of schizophrenia postulates that hyperactivity of neurotransmitter receptor neurotransmission in subcortical and limbic brain regions contributes to positive symptoms of schizophrenia, whereas negative and cognitive symptoms of the disorder can be attributed to hypofunctionality of neurotransmitter
Dopamine
hypothesis of schizophrenia explains the origin of positive and negative symptoms, the relationship or schizophrenia to stress, cortical atrophy, peripheral depletion of phospholipids, and the effectiveness of dopamine blockade in treating positive symptoms
Serotonin
Medical knowledge
Lived experience knowledge
Psychiatric nursing knowledge
Approaches to Psychopathology
diagnostic and statistical manual of mental disorders (DSM) clustering of symptoms into mental disorders
Medical knowledge
holistic experiences of challenges and recoveries
Lived experience knowledge
individuals’ responses to DSM disorders and recovery processes
Psychiatric nursing knowledge
DSM-I 1952
DSM-II 1968
DSM-III 1974
DSM-IV 1994
DSM-IV-TR 2000
DSM-5 2013
DSM-5-TR -2022
Diagnostical Statistic Manual
“The primary purpose of _______ is to assist trained clinicians in the diagnosis of mental disorders as part of a case formulation assessment that leads to an informed treatment plan for each individual”
DSM-5
classifies disorders - it does not classify people.
DSM-5-TR
Diagnostic inflation
Diagnostic fads
Pathologizing normal
DSM Challenegs
A coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as classified by the World Health Organization (WHO)
The International Statistical Classification of Diseases and Related Health Problems 11th Revision (ICD-11)
Language updates for gender and racial issues
Diagnostic criteria has been modified for 70 diagnoses related to research
Added ‘unspecified mood disorder’, which had been previously removed
Added a new diagnosis of ‘prolonged grief disorder’
Changes in DSM 5-TR (V - TR)
General Observation
Mood
Affect
Speech
Thought
Perception
Sensorium
Insight
Judgment
Mental Status Exam
Skin coloration
Grooming
Dress
Pupil size
Distinguishing features - tattoo
Appearance
Gait
Posture
Facial expressions
Mannerisms / gestures
Activity
Coordination
Tremor
Psychomotor Behaviour
Cooperative
Ambivalent
Hostile
Guarded
Disinterested
Suspicious
Open
Attitude
Pervasive and sustained emotion
Mood
immediate expressed or observed emotion
Affect
Quantity
Rate
Quality
Speech
subject matter
Thought content
thought formation and expression
Thought process
Loose associations
Circumstantiality
Tangentiality
Thought blocking
Neologisms
Flight of ideas
Word salad
Perseveration
Clang association
Echolalia
Though process
Level of consciousness
Orientation
Memory
Attention and concentration
Sensorium
awareness/understanding of their thoughts, feelings, and situation
Insight
ability to reach a logical decision or plan course of action
Judgment
Stress
Coping
- Emotion focused
- Problem focused
Wellbeing
Risk factors
Protective factors
Determinents of health
Role loss and role change
Family / caregiver coping
Other things to assess
Lack of information, especially about outcome
Mourning and accepting the loss an envisioned future
Feelings of guilt over cause, or not preventing
Dealing with emotional consequences of trauma or illness
Rehabilitation required a great deal of time and attention
Common Family Challenges
“manuals provide clinical descriptors that can guide diagnostic decisions, they do not inform clinicians about how to______ or use the diagnosis” (Perkins et al., 2018, p. 14)
communicate
requires a holistic approach to avoid perpetuation of stigma and discrimination
Communication
