Vol.3-Ch.11 "Psychiatric and Behavioral Disorders" Flashcards
Behavior Vs Behavioral Emergency
What objective factors may indicate a behavioral or psychological condition? (3x)
Behavior = A person’s observable conduct and activity
Behavioral Emergency = A situation in which a patient’s behavior becomes so unusual, bizarre, threatening, or dangerous that it alarms the pt or another person.
Objective factors may indicate a behavioral or psychological condition:
- Interfere with core life functions
- Pose a threat to the life or well-being of a pt or others
- Significantly deviate from society’s expectations of norms
(“Normal Behavior” is behavior that is readily acceptable in a society)
What are 2 common misconceptions about psychiatrics disorders?
What is the main reason intervention is needed for psychiatric patients?
1 - That people with disorders cannot live normal lives
2 - That they are dangerous and the condition is incurable
1/7 people have a psychiatrics disorder but most can live normal lives. Rarely do they need to stay institutionalized which is why Psych calls account for more medical calls than all others combined.
Failure to take meds is the main reason intervention is needed for psychiatric patients
What are the general causes of behavioral emergencies? (3x)
- Biological: aka Organic, is when the psychiatric issue is caused by physical disease processes such as infections, tumors, or structural changes in the brain from things like alcohol or drug abuse.
- Psychosocial: aka Personal, are caused by personality style, dynamics of unresolved conflict, or crisis management methods. (not contributed to substance abuse or medical conditions) This is LARGLEY in part b/c of the environment they are in or grew up in.
- Sociocultural: aka Situational, are caused by a patient’s actions and interactions within society and to factors such as socioeconomic status, social habits, social skills, and values. Typically attributed to events that changed the pt’s social space (relationships), social isolation, or otherwise have an impact on socialization. This can be things such as rape, war, death of a loved one, etc.
What are the differences in assessment of behavioral type emergency patients?
- You begin your care when you begin your assessment by building your rapport with the patient, Interpersonal skills are always important but even more so on these patients
- The focused history and physical exam ALSO include a mental status examination
What are 10 good guidelines to follow to use good interpersonal skills?
- Listen
- Spend Time (don’t go too fast)
- Be assured
- Do not threaten
- Do not fear silence
- Place yourself at the patient’s level
- Keep a safe and proper distance
- Appear comfortable
- Avoid appearing judgmental
- Never lie to the patient
What are the components of a Mental Status Examination? (12x)
- General Appearance
- Behavioral Observations
- Orientations
- Memory
- Sensorium
- Perceptual Processes
- Mood and affect (visible indicators of mood)
- Intelligence
- Thought Process
- Insight
- Judgement
- Psychomotor
What is one VERY IMPORTANT question to ask a Psychiatric patient?
Are you on any medications and have you been taking them? If no, when was the last time you took them?
Should we diagnose a specific psychiatric disorder if we think we can?
NO
Even for very skilled psychologists, it is hard to diagnose b/c the signs and symptoms can often overap between illnesses and a pt may fit into more than one category.
What are the 2 diagnostic elements that almost all psychiatric disorders have?
1 - Symptoms of the disease/disorder
2 - Indications that the disease or disorder has impaired major life functions, resulting in loss of relationships, a job, housing, or another significant social problem.
What do mental health professionals use to define specific conditions?
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition AKA “DSM-5”
What are Cognitive Disorders and what can cause them?
What are the 2 types?
Cognitive Disorders are psychiatric disorders with organic causes such as brain injury or disease.
They can be caused by metabolic disease, infections, neoplasm, endocrine disease, degenerative neurologic disease, and cardiovascular disease. OR they can be caused by physical or chemical injuries from trauma, drug abuse, or a drug allergic reaction.
The Two Types are:
- DELERIUM: Is a rapid onset of widespread disorganized thought. The major signs of this are rapid onset of hours to days and the hallmark sign is Confusion. It is often reversible and is commonly caused by medical condition, intoxication, withdrawal, or more than one of these. This may involve vivid hallucinations as well.
- DEMENTIA: Is characterized as a slow onset over months where memory impairment, cognitive disturbances, and pervasive impairment of abstract thinking and judgement. It is often irreversible and is most commonly caused by Alzheimer’s but also AIDS, head trauma, Parkinson’s disease, and substance abuse.
(Dementia qualification symptoms on a different card)
Dementia is characterized by having cognitive deficits manifested by both memory impairment and one or more of the following cognitive disturbances _____x4?
- Aphasia: impaired communication
- Apraxia: Impaired ability to use motor activities despite intact sensory function
- Agnosia: failure to recognize objects or stimuli despite intact sensory function
- Disturbances in executive functioning: impaired ability to plan, organize, or sequence
What is schizophrenia?
What are the signs/symptoms? (5x)
What are the 4 types?
Schizophrenia cause is unknown but it’s hallmark sign is a significant change in behavior and a loss of contact with reality.
The signs and symptoms include and to be diagnosed at least 2 must be present for the majority of 6 months:
- Delusions
- Hallucinations
- Disorganized Speech
- Catatonia: grossly disorganized behavior
- Flat Affect: reduced or absent emotional expressiveness
4 types of Schizophrenia according to the DSW-5:
- Paranoid
- Disorganized
- Catatonic
- Undifferentiated (pt does not fit in any of the other 3)
DO NOT REINFORCE THE PT BELIEF IN HALLUCINATIONS
What are anxiety disorders and what are the 3 types?
Anxiety disorders are characterized by a dominating apprehension and fear. Anxiety itself is loosely defined as a state of uneasiness, discomfort, apprehension, and restlessness.
- PANIC ATTACKS:
the DSM5 does not list this as a disease in and of itself. It is characterized by recurrent, extreme periods of great emotional distress and are symptoms are disease and are included among the criteria for other disorders. They are ACUTE in onset and peak in 10 minutes but can last up to an hour. In order to be considered a panic attack, at least 4 of the following must be present and develop abruptly within 10 minutes: palpitations, sweating, shaking, short breath, feeling of choking, chest pain, nausea, dizziness, derealization/depersonalization, fear of loosing control, dear of dying, paresthesia (numbness or tingling), chills/hot flashes. Often you will find this can mirror cardiac or pulmonary problems that you must try to rule out. Reduce rapid breathing, benzodiazepines or antihistamines can all be used to help calm the patient. - PHOBIAS:
An intense and irrational fear such as agoraphobia (fear of crowds) that may incite anxiety or a panic attack. - POST-TRAUMATIC STRESS DISORDER:
Often results from a reaction to an extreme, usually life threatening, stressor and is characterized by a desire to avoid similar situations, recurrent intrusive thoughts, depression, sleep disturbances, nightmares, and persistent symptoms of increase arousal.
What are Mood Disorders and what are the 2 types?
Mood disorders are “a pervasive and sustained emotion that colors a person’s perception of the world”
DEPRESSION:
- characterized as a profound sadness or feeling of melancholy. In order to be considered a major depressive disorder you must have 5 or more of the following symptoms during a 2 week period:
- depressed mood most of the day, for most days
- lack of interest in pleasure
- significant weight loss
- insomnia
- psychomotor agitation or retardation
- feelings of worthlessness or guilt
- diminished ability to think or concentrate
- recurrent thoughts of death
These issues must also be ruled out of being caused by other medical factors and at least ONE of the symptoms must be either a depressed mood or loss of interest in pleasure. It must also not include a period of Mania and depression aka a “mixed episode”
BIPOLAR DISORDER: Characterized by one or more Manic episodes (periods of elation), with or without alternating periods of depression. Although usually a person will have a manic episode after a few depressive episodes. These no not happen as rapidly as TV portrays but does occur acutely and progress over a few days. To be considered a pt must experience 3 or more of the following during an episode: - inflated sense of self-esteem - decreased need for sleep - very talkative - flight of ideas that are racing - distractibility - increase in goal-directed activity - excessive involvement in pleasurable activities that have a high potential for painful consequences - delusional thoughts
Again, like depression, they must not meet criteria for a mixed episode and symptoms must not be linked to other medical problems or substance use
What is the pneumonic for screening for a major depressive episode?
IN SAD CAGES:
- Interest
- Sleep
- Appetite
- Depressed Mood
- Concentration
- Activity
- Guilt
- Energy
- Suicide
