Test 1-psych Flashcards
Hallucinations
sensory perceptions for which there are no external stimulus (Auditory = most common for schizophrenics.)
NURSE: What is the voice telling you to do?
Delusions
Fixed false beliefs (someone is talking about them, persecution, grandiosity, unusual bodily function, jealousy, being controlled)
Positive Symptoms of Schizophrenia
Delusions
Hallucinations
Bizarre Behavior
Paranoia
Waxy flexiblity
excessive maintenance of a posture for long periods of time
Neoglisms
newly coined words that have meaning only for the client
Echolia
pathological repeating of another’s words
Clang association
meaningless rhyming of words
Word Salad
mixture of words meaningless to the listener
Primary Prevention
Health Promotion (before any diagnosis)
Secondary Prevention
Early detection and tx of symptoms (eg. depression screening, mammogram)
Tertiary Prevention
Restorative care–goal is to restore patients to best level of functioning; keep health problems from worsening.
Axis I
Clinical Disorders (depression, bi-polar, schizophrenia)
Axis II
Personality Disorders (borderline, histrionic, narcissistic, antisocial) and mental retardation.
Axis III
General medical conditions (HTN, DM, CA, arthritis)
Axis IV
Psychosocial and Environmental problems (death, divorce, loss of job, homelessness, financial strain, stressful work schedule)
Axis V
Global Assessment of Function (0-100) Pts in acute care psych will have GAF scores ranging from 30-40, some impairment in reality testing or cognition such as hallucinations, delusions
Thought Disorder
when an individual has serious problems with thinking, feelings, and behavior. The symptoms can include false belief about self or others, paranoia, hearing or seeing non-existent things, disconnected speech or thinking, and feelings that don’t match the situation
Negative Symptoms
apathy, flat affect, lack of emotion, anhedonia (inability to derive pleasure from anything), poor social functioning, poverty of thought, speech
Prolixin
- med for schizophrenia-traditional anti-psychotic (blocks dopamine receptors in the brain)
- expect high EPS, low anticholinergic
Cogentin (benzotropine)
Treatment of EPS
Parkinsonian Reaction
rigid expressions, shuffling gait, cogwheel rigidity
Akathisia
(EPS)
restlessness, inability to sit still, motoric hyperactivity
Traditional Antipsychotics
- block dopamine receptors in the brain
- SE: sedation, anticholinergic, EPS, TD, neuroleptic malignant syndrome (NMS), hyperpyrexia, mental status changes, diaphoresis, muscle stiffness, lower seizure threshold
- (Thorazine, Prolixin, Haldol, Mellaril, Navane, long-acting (IM) Haldol D, Prolixin D)
Neuroleptic Malignant Syndrome
- severe muscular rigidity, altered consciousness, stupor, catatonia, febrile, respiratory depression
- treatment: discontinuation of meds and stabilization of symptoms
- can give bromocritpine
- occurs with both traditional and atypical antipsychotics
Atypical Antipsychotic Medications
- block dopamine and serotonin
- target both positive and negative symptoms (whereas traditional drugs target positive symptoms only)
- SE: dizziness, tachy, orthostasis, syncope, weight gain, rhinitis, sleep distrubance, agranulocytosis (Cloraril only-weekly WBCs)
- incidences of EPS and TD are much less
- increased prolactin level, increased QTC interval, hyperglycemia, type II diabetes, increased lipids
- can cause suicidal ideation
- tend to be more expensive that traditional antipsychotics
- lowers impulse control
- get baseline weight before starting
- (Clozaril, Risperdal, Invega (metabolite of risperdal), Invega Sustenna (long acting), Zyprexa, Zydis, Seroquel, Geodon, Abilify, Saphris, Fanapt, Latuda)
Zyprexa (olanzapine)
- Atypical antipsychotic
- most likely to cause hyperglycemia and weight gain
- takes 1 week to reach steady state
Dystonia
- muscle cramping of head and neck
- acute dystonic rxn-head twisted to one side, complain of thick tongue
- Nurse: give Cogentin or Artane or Benedryl (IM not PO)
Artane (trihexyphenidyl)
For treatment of EPS
EPS
Acute dystonic reactions (tonic contraction of muscles in mouth and torso)
Parkinsonian reactions
Akathisia
Tardive Dyskinesia
NMS
Tardive Dyskinesia
- EPS
- results from long-term use of traditional agents
- unusual mouth movements (lip smacking, tongue protrusion)
- choreic movements (rocking)
- NO TREATMENT for TD
Avolition
a psychological state characterized by general lack of drive, or motivation to pursue meaningful goals
Apathy
is a state of indifference, or the suppression of emotions such as concern, excitement, motivation and passion. An apathetic individual has an absence of interest in or concern about emotional, social, spiritual, philosophical and/or physical life.
Clozaril (clozapine)
- atypical antipsychotic
- restrict to sever schizophrenia resistent to traditional antipsychotic meds
- monitor WBC and ANC
- risk of seizures
- risk of myocarditis
- potentially life-threatening side effects
Schizophrenia
- a brain disorder that interferes with cognition
- social withdrawal…hallucinations….delusions
Id
At birth we are all id
- the id is the source of all drives, instincts, relexes, needs, genetic inheritance and capacity to respond, as well as all the wishes that motivate us.
- operates according to the pleasure principle
- if id is too powerful, person lacks control over impulses
- unconscious
Ego
- emerges in the 4th or 5th month bc the needs, wishes, demands of the id can’t be met through primary processes and reflex actions
- problem solver and reality tester
- follows the reality principle which says to the id, “you have to delay gratification for right now.”
- administrative leadership of the personality (id=devil, superego=angel)
how the world sees us
-mostly conscious
Superego
- last portion of the personality to develop
- moral component of the personality
- shoulds/should nots
- seeks perfection as opposed to seeking pleasure or engaging reason
- if too powerful, person may be self-critical and suffer from feelings of inferiority
- half conscious/half unconscious
Erikson
- Trust vs. Mistrust (0-1 1/2)
- Autonomy vs. shame and doubt (1 1/2 - 3)
- initiative vs. guilt (3-6)
- industry vs. inferiority (6-12)
- identity vs. role confusion (12-20)
- intimacy vs. isolation (20-35)
- generativity vs. self absorption (35-65)
- Integrity vs. despair (65 yr to death)
Preconscious
just below the surface of awareness
contains material that cn be retrieved easily through conscious effort.
Peplau’s stages of nurse-patient relationship
- Orientation
- Working
- Termination
Psychoanalysis
- developed by Freud, seldom used today
- All mental illness is caused by early intra psychic conflict
- go back to early childhood
- not inpatient-takes a long time
Cognitive Behavioral Therapy
- used for depression, eating disorders
- aims to change thought patterns
- identify automatic thoughts
- cognitive restructuring
- active, time limited, structured
- how people feel and behave is determined by the way they think about their world
- thoughts can be distorted
- empiricall (evidence) based
4 Types of Behavioral Therapy
- Modeling (role model/role playing, pt learns thru imitation)
- Operant Conditioning (reward positive behavior with more privileges)
- Systematic desensitization
- Aversion therapy (maladaptive behavior is paired with noxious stimulus)
Systematic Desensitization
- patient’s fear is broken down
- patient is incrementally exposed to the fear
- patient is instructed how to design hieracrchy
- patient practices these techniques daily
(for phobias, baby steps)
Assessment
collect and organize data
AIMS
(Abnormal Involuntary Movement Scale)
- Facial and Oral Movements
- Extremity Movements
- Trunk Movements (neck, shoulder, hips)-rocking, twisting, squirming, pelvic gyrations)
- Global Judgments-severity overall, incapactitation due to movements, pt’s awareness of abnormal movements
- Dental Status
- Do movements disappear in sleep?
Haldol
- for acute psychosis and schizophrenia
- blocks dopamine receptors
- causes CNS depression, narrow-angle glaucoma, hepatic disease
- SE: EPS (TD, Parkinsonism, Acute dystonia, akathisia), NMS, QT changes and potential dysrhythmias, anticholinergic.
NURSE: assess for involuntary movements
-poor adherence is common cause of therapeutic failure
Risperdal
- atypical antipsychotic
- highest risk of EPS among atypicals
- SE: sexual dysfunction, orthostatic hypotension, weight gain, sedation, strange dreams
- available in long-acting injectioin (Risperdal Consta)-q2wks
- can be used for autism
Assessment
- *1. Establish rapport**
2. Obtain an understanding of the current problem or chief complaint
3. Review physical status and obtain baseline vital signs
4. Assess for risk factors affecting the safety of the patient or others
5. Perform a mental status examination
6. Assess psychosocial status - *7. Identify mutual goals for treatment**
8. Formulate a plan of care
Diagnosis
- Problem
- Etiology
- Supporting Data
