w2 Flashcards
antipsychotic meds Side effects treatment
Tardive dyskinesia
- Depends on severity of symptoms
- Reduce or stop meds
- Examine and document symptoms, use AIM scale, follow up
- Symptoms may still persist
- Change to atypical or typicals?
- Meds to treat TD symptoms – ____benazine and ______benazine
Tardive dyskinesia
- Depends on severity of symptoms
- Reduce or stop meds
- Examine and document symptoms, use AIM scale, follow up
- Symptoms may still persist
- Change to atypical (reduce typicals, while increasing atypicals)
- Meds to treat TD symptoms – valbenazine and deutetrabenazine
Typical or atypical antipsychotics?
Advantages
- Less expensive
Disadvantages
- !!Extrapyramidal s/e - Acute dystonic reaction, Akathisia, Pseudoparkinsonism, Tardive dyskinesia
- !!Anticholinergic s/e
- Sedation
- Weight gain
- !!Metabolic syndrome
- !!Neuroleptic malignant syndrome
- Sexual dysfunction
- Endocrine disturbances
- Cardiovascular issues – orthostatic hypotension and arrhythmias
- Increased seizure risk
typical
RN interventions:
Coordination of care
Health teaching and promotion
Pharmacological, biological, and integrative therapies
Milieu therapy
Therapeutic relationship
RN interventions
Coordination of care
Health teaching and promotion
Pharmacological, biological, and integrative therapies
Milieu therapy
Therapeutic relationship
Types of talk therapies: Challenging stinkin’ thinkin’ and cognitive distortions
- Jumping to conclusions
- Discounting the positive
- Magnification
_________ – You reject positive experiences by insisting that they “don’t count.” If you do a good job, you may tell yourself that it wasn’t good enough or that anyone could have done as well. Discounting the positives takes the joy out of life and makes you feel inadequate and unrewarded.
__________ – You interpret things negatively when there are no facts to support your conclusion.
- Mind Reading : Without checking it out, you arbitrarily conclude that someone is reacting negatively to you.
- Fortune-telling : You predict that things will turn out badly. Before a test you may tell yourself, “I’m really going to blow it. What if I flunk?” If you’re depressed you may tell yourself, “I’ll never get better.”
_________ – You exaggerate the importance of your problems and shortcomings, or you minimize the importance of your desirable qualities. This is also called the “binocular trick.”
- Discounting the positive – You reject positive experiences by insisting that they “don’t count.” If you do a good job, you may tell yourself that it wasn’t good enough or that anyone could have done as well. Discounting the positives takes the joy out of life and makes you feel inadequate and unrewarded.
- Jumping to conclusions – You interpret things negatively when there are no facts to support your conclusion.
- Mind Reading : Without checking it out, you arbitrarily conclude that someone is reacting negatively to you.
- Fortune-telling : You predict that things will turn out badly. Before a test you may tell yourself, “I’m really going to blow it. What if I flunk?” If you’re depressed you may tell yourself, “I’ll never get better.”
- Magnification – You exaggerate the importance of your problems and shortcomings, or you minimize the importance of your desirable qualities. This is also called the “binocular trick.”
Functional roles of group members
_________ roles
- Initiator/contributor – suggests new ideas regarding problem/goal
- Information seeker – clarifies group roles
- Information giver – provides facts/shares experiences as an authority figure
- Coordinator – shows clarifies how ideas can work
- Orienteer – notes the groups progress
- Recorder – keeps notes
Functional roles of group members
Task roles
- Initiator/contributor – suggests new ideas regarding problem/goal
- Information seeker – clarifies group roles
- Information giver – provides facts/shares experiences as an authority figure
- Coordinator – shows clarifies how ideas can work
- Orienteer – notes the groups progress
- Recorder – keeps notes
antipsychotic meds s/e
Anticholinergic side effects
___ as a ___
(5)
- Can progress to anticholinergic toxicity
Anticholinergic side effects
- Mad as a hatter – drowsiness, dizzy, confusion, hallucinations
- Blind as a bat - Blurred vision
- Red as a beet – skin flushing
- Hot as a hare – tachycardia
- Dry as a bone - Dry mouth, dry eyes, constipation, urinary retention/hesitancy, decreased sweating
- Can progress to anticholinergic toxicity
Assessment: delusions
- Build rapport by being open, honest
- Ask them to describe delusion
- Validate if part of the delusion is real and then present reality
- Never debate the delusions content, breaks trust
- Asses intensity, frequency, duration of delusion
- Assess what triggered delusion
Documentation: delusions
- Type, content, characteristics
- Use pts own words
- Behavior prior to and during delusion
- Any actions taken to help the pt with delusion
Assessment: delusions
- Build rapport by being open, honest
- Ask them to describe delusion
- Validate if part of the delusion is real and then present reality
- Never debate the delusions content, breaks trust
- Asses intensity, frequency, duration of delusion
- Assess what triggered delusion
Documentation: delusions
- Type, content, characteristics
- Use pts own words
- Behavior prior to and during delusion
- Any actions taken to help the pt with delusion
antipsychotic meds s/e
Extrapyramidal side effects (EPS):
- Acute dystonic reaction
- Akathisia
- Pseudoparkinsonism
- Tardive dyskinesia
_____________ - Sudden, sustained contraction of one or several muscle groups
o Usually head or neck areas
o Can be painful, frightening, uncomfortable, causing anxiety, not dangerous (unless airway is affected, rare)
o Monitor and act on emergently
ex:
o torticollis – spasmodic and painful spasm of muscle (pulls head to one side)
o oculogyric crisis – eyes roll to back of head
o laryngeal dystonia – spasms of throat impairing breathing and swallowing
Extrapyramidal side effects (EPS)
- Acute dystonic reaction - Sudden, sustained contraction of one or several muscle groups
o Usually head or neck areas
o Can be painful, frightening, uncomfortable, causing anxiety, not dangerous (unless airway is affected, rare)
o Monitor and act on Acute dystonic reaction emergently
o torticollis – spasmodic and painful spasm of muscle (pulls head to one side)
o oculogyric crisis – eyes roll to back of head
o laryngeal dystonia – spasms of throat impairing breathing and swallowing
NSSI diagnostic features
- a desire to feel _______ from negative thoughts or feelings (anxiety, anger, distress)
- self-loathing and a belief that they are bad, defective, or deserving of ______ is common
- intent to alleviate psychic pain or ______ness
- intent to achieve a short, intense, state of ________ during or after injurious act
- may have impaired interpersonal relationships as the impetus for self injury
- considered significant if it happens repeatedly for at least a year
- majority don’t seek help
diagnostic features
- a desire to feel relief from negative thoughts or feelings (anxiety, anger, distress)
- self-loathing and a belief that they are bad, defective, or deserving of punishment is common
- intent to alleviate psychic pain or numbness
- intent to achieve a short, intense, state of euphoria during or after injurious act
- may have impaired interpersonal relationships as the impetus for self injury
- considered significant if it happens repeatedly for at least a year
- majority don’t seek help
Psychiatric mental health nursing assessment
Gathering data
- ROS
- Labs
- MSE – mental status exam
- Validating the assessment
- Using rating scales
- Psychosocial assessment
Psychiatric mental health nursing assessment
Gathering data
- ROS
- Labs
- MSE – mental status exam
- Validating the assessment
- Using rating scales
- Psychosocial assessment
Schizoaffective disorder
Chronic mental health condition characterized by
- Symptoms of _________ – hallucinations or delusions
- Symptoms of _________ – mania or depression
Uninterrupted period of illness during which there is either a ________ episode, ________ episode, or a mixed episode with symptoms of _________.
- Mood episodes subside in days or weeks
- Schizophrenia symptoms persist
Often incorrectly diagnosed at first with bipolar disorder or schizophrenia because it’s less studied, many interventions are borrowed from their treatments
Rare
Men and women experience at same rate
Men develop it earlier
Managed effectively with meds and therapy
Schizoaffective disorder
Chronic mental health condition characterized by
- Symptoms of schizophrenia – hallucinations or delusions
- Symptoms of mood disorder – mania or depression
Uninterrupted period of illness during which there is either a major depressive episode, manic episode, or a mixed episode with symptoms of schizophrenia.
- Mood episodes subside in days or weeks
- Schizophrenia symptoms persist
Often incorrectly diagnosed at first with bipolar disorder or schizophrenia because it’s less studied, many interventions are borrowed from their treatments
Rare
Men and women experience at same rate
Men develop it earlier
Managed effectively with meds and therapy
antipsychotic meds Side effects treatment
Pseudoparkinsonism
- Identify medication causing symptoms, slow and safe d/c
- Reduce dose
- Give oral anticholinergics (2) to alleviate symptoms
Pseudoparkinsonism
- Identify medication causing symptoms, slow and safe d/c
- Reduce dose
- Give oral anticholinergics (benztropine or trihexyphenidyl) to alleviate symptoms
_________ – engaging in potentially injurious behavior with the intention of death
_________ - person takes steps to injure but is stopped by self prior to fatal injury occurring
________– person takes steps to injure but is stopped by another person prior to fatal injury occurring
_________ – suicides occur closer together than normally would be expected in a given community. Increases when:
- stories about suicide increase
- story reported at length
- story placed on front page
- person broadly known and story spreads
- headline is dramatic
__________ – circle of survivors of a person who has died by suicide
_________– providing mental healthcare and support to survivors or family/friends (if person dies by suicide)
suicide attempt – engaging in potentially injurious behavior with the intention of death
suicide attempt interrupted by self or other
suicide attempt interrupted by other – person takes steps to injure but is stopped by another person prior to fatal injury occurring
cluster suicides or suicide contagion – suicides occur closer together than normally would be expected in a given community. Increases when:
- stories about suicide increase
- story reported at length
- story placed on front page
- person broadly known and story spreads
- headline is dramatic
suicide survivors – circle of survivors of a person who has died by suicide
postvention – providing mental healthcare and support to survivors or family/friends (if person dies by suicide)
NSSI treatment
- therapeutic relationship
- care for wounds
- learning healthy coping
- CBT and DBT
- Group therapy
- Psychopharmacology
treatment
- therapeutic relationship
- care for wounds
- learning healthy coping
- CBT and DBT
- Group therapy
- Psychopharmacology
Schizophrenia
_________ symptoms
o Delusions
Persecutory
Referential
Grandiose
Erotomanic
Nihilistic
Somatic
Control
Schizophrenia
Positive symptoms
o Delusions
Persecutory
Referential
Grandiose
Erotomanic
Nihilistic
Somatic
Control
suicide: __________
individual
- coping and problem solving skills
- reasons for living
- cultural identity
relationships
- strong connection and support
community
- strong connection
- availability of high quality health care
societal
- reduced access to lethal means
- strong cultural identity – culture, religion, moral objections
protective factors
Etiology: Schizophrenia
1. Etiology
- Genetics
- Environmental
- Brain chemistry
- Substance use
The vulnerability-stress model - proposes that schizophrenia develops from an interaction between ______ vulnerability and ________ stressors.
Etiology
1. Etiology
- Genetics
- Environmental
- Brain chemistry
- Substance use
The vulnerability-stress model - proposes that schizophrenia develops from an interaction between genetic vulnerability and environmental stressors.
________ – condition that may increase individuals’ risk for suicide. May be modifiable or non-modifiable. Biological, psychological, or social factors.
_________ – factors that may reduce the risk for suicidal ideation, suicide attempt, or death by suicide
_________ – behavioral or emotional clues or changes that may indicate a person is contemplating suicide or at risk for suicide
_______– thinking about death, including the wish to be dead, considering methods of accomplishing death, formulating plans to carry out the act
_________ – acts associated with suicidal intent
________ – deaths caused by self-directed injurious behavior with the intent to die as a result of the behavior
risk factor – condition that may increase individuals’ risk for suicide. May be modifiable or non-modifiable. Biological, psychological, or social factors.
protective factor – factors that may reduce the risk for suicidal ideation, suicide attempt, or death by suicide
warning sign – behavioral or emotional clues or changes that may indicate a person is contemplating suicide or at risk for suicide
suicidal ideation – thinking about death, including the wish to be dead, considering methods of accomplishing death, formulating plans to carry out the act
suicidal behaviors – acts associated with suicidal intent
suicide/death by suicide – deaths caused by self-directed injurious behavior with the intent to die as a result of the behavior
Physiological treatments:
Electroconvulsive therapy (ECT)
- invasive?
- Most effective depression treatment
- Primary treatment in severe malnutrition, Exhaustion, and dehydration d/t ______ depression
- 2nd most common treatment for ______ illnesses
- Delusional depression
- Refractory depression - previous med trials/treatment weren’t effective
- Schizophrenia with catatonia
- Safer than meds with certain medical conditions
Physiological treatments:
Electroconvulsive therapy (ECT)
- Noninvasive
- Most effective depression treatment
- Primary treatment in severe malnutrition, Exhaustion, and dehydration d/t lengthy depression
- 2nd most common treatment for psychotic illnesses
- Delusional depression
- Refractory depression - previous med trials/treatment weren’t effective
- Schizophrenia with catatonia
- Safer than meds with certain medical conditions
Schizoaffective disorder:
_________ symptoms
uncontrollable highs (manic episodes) and lows (depressive episodes) + schizophrenia symptoms
- increased energy, may feel like don’t need sleep
- euphoria, may not match circumstance
- risky behaviors
- break from reality – believe things that aren’t real
- constant tiredness, doesn’t go away with sleep
- sadness or misery
- these symptoms last for weeks before rapidly shifting to feelings on the opposite end of the emotional spectrum
_________ symptoms
no mania, just major depressive episodes + schizophrenia symptoms
- feeling lethargy, not wanting to do anything
- no pleasure from favorite activities
- inability to sleep or excessive sleep
- loss of appetite
- feeling you will never be happy again
- can be constant or ebb and flow
________ symptoms
Psychotic symptoms that are near constant
- Delusions
- Hallucinations
- Difficulty holding work or staying enrolled in school
- Problems with personal hygiene
- Difficulty communicating with other
Schizoaffective disorder: bipolar symptoms
uncontrollable highs (manic episodes) and lows (depressive episodes) + schizophrenia symptoms
- increased energy, may feel like don’t need sleep
- euphoria, may not match circumstance
- risky behaviors
- break from reality – believe things that aren’t real
- constant tiredness, doesn’t go away with sleep
- sadness or misery
- these symptoms last for weeks before rapidly shifting to feelings on the opposite end of the emotional spectrum
- + schizophrenia symptoms
depressive symptoms
no mania, just major depressive episodes + schizophrenia symptoms
- feeling lethargy, not wanting to do anything
- no pleasure from favorite activities
- inability to sleep or excessive sleep
- loss of appetite
- feeling you will never be happy again
- can be constant or ebb and flow
- + schizophrenia symptoms
Schizophrenia symptoms of schizoaffective disorder
Psychotic symptoms that are near constant
- Delusions
- Hallucinations
- Difficulty holding work or staying enrolled in school
- Problems with personal hygiene
- Difficulty communicating with others
antipsychotic meds s/e
Extrapyramidal side effects (EPS):
- Acute dystonic reaction
- Akathisia
- Pseudoparkinsonism
- Tardive dyskinesia
___________– involuntary rhythmic movement disorder
o can occur with long term antipsychotic treatment
o varies from mild to severe
o usually involves oral and facial muscles, progresses to fingers, toes, neck, trunk, pelvis
o often will see tongue protruding, lips smacking, mouth movements
o changes may be so gradual they are missed
o assess pts on antipsychotic meds using ‘abnormal involuntary movement’ scale at least every 3 months
- Tardive dyskinesia – involuntary rhythmic movement disorder
o can occur with long term antipsychotic treatment
o varies from mild to severe
o usually involves oral and facial muscles, progresses to fingers, toes, neck, trunk, pelvis
o often will see tongue protruding, lips smacking, mouth movements
o changes may be so gradual they are missed
o assess pts on antipsychotic meds using ‘abnormal involuntary movement’ scale at least every 3 months
schizophrenia: Prognosis
Many pts live with good quality of life, family, occupations, etc. with meds and psychosocial interventions
Some pts don’t respond fully to treatment, mild – severe symptoms and dysfunction/disability
Some require inpatient care r/t
- Slow onset of disease
- Younger age at onset
- Longer duration between 1st symptom and 1st treatment
- Longer periods of untreated illness
- More negative symptoms
Prognosis
Many pts live with good quality of life, family, occupations, etc. with meds and psychosocial interventions
Some pts don’t respond fully to treatment, mild – severe symptoms and dysfunction/disability
Some require inpatient care r/t
- Slow onset of disease
- Younger age at onset
- Longer duration between 1st symptom and 1st treatment
- Longer periods of untreated illness
- More negative symptoms
Schizophrenia
_________ symptoms
- Disorganized or alterations in behavior
o Boundary impairment
o Catatonia
o Echopraxia
o Gesturing or posturing
o Impaired impulse control
o Motor retardation
o Motor agitation
o Negativism
o Stereotyped behaviors
o Psychosis - Disorganized or alterations in thought
o Thought blocking
o Thought insertion
o Thought deletion
positive
antipsychotic meds s/e
_______________
- Associated with atypical and typcial antipsychotics
- Monitor weight and girth
- Initial glucose tolerance test
- Monitor blood glucose
- Provide nutrition and activity support
- Consider lifestyle
Metabolic syndrome – diabetes/hyperglycemia
- Associated with atypical antipsychotics
- Monitor weight and girth
- Initial glucose tolerance test
- Monitor blood glucose
- Provide nutrition and activity support
- Consider lifestyle
Physiological treatments:
Transcranial magnetic stimulation (TMS)
- invasive?
- Magnetic pulses stimulate focal areas in cerebral cortex
- Contraindication – _______
Adverse reactions
- h/a and __________
- seizures – rare
- mild s/e – scalp _________, discomfort at admin site
- neurological deficits or memory problems?
Transcranial magnetic stimulation (TMS)
- Noninvasive
- Magnetic pulses stimulate focal areas in cerebral cortex
- Contraindication – metal
Adverse reactions
- h/a and lightheaded
- seizures – rare
- mild s/e – scalp tingling, discomfort at admin site
- NO neurological deficits or memory problems
schizophrenia: Negative symptoms
Symptoms that should be there but are not
More difficult to treat compared to positive symptoms
- Apathy
- Affective blunting
- Anhedonia
- Avolition
- Asociality
- Alogia
________– reduced affect (without affect)
_______– reduction in speech, poverty of speech (without speech)
_________ – reduced ability to experience pleasure or joy (without joy)
________– decreased interest in activities/beliefs that would usually be interesting/important (without interest)
_________ – decreased desire for social interactions, social withdrawal (without social interactions)
_________– decreased goal directed behavior, difficulty beginning or sustaining goal directed activities (without goals)
affect descriptions:
o Flat
o Inappropriate/incongruent
o Constricted
o Blunted
o Bizarre
______– blank face
______- minimal emotional response
________ – reduced range (shows only sadness or anger)
__________– not matching facial expression with the actual emotional situation
________ – odd, illogical, inappropriate, or unfounded, includes grimacing
Negative symptoms
Symptoms that should be there but are not
More difficult to treat compared to positive symptoms
- Affective blunting – reduced affect (without affect)
- Alogia – reduction in speech, poverty of speech (without speech)
- Anhedonia – reduced ability to experience pleasure or joy (without joy)
- Apathy – decreased interest in activities/beliefs that would usually be interesting/important (without interest)
- Asociality – decreased desire for social interactions, social withdrawal (without social interactions)
- Avolition – decreased goal directed behavior, difficulty beginning or sustaining goal directed activities (without goals)
o Flat – blank face
o Blunted minimal emotional response
o Constricted – reduced range (shows only sadness or anger)
o Inappropriate – incongruent with the actual emotional situation
o Bizarre – odd, illogical, inappropriate, or unfounded, includes grimacing
3 behavior theories led to behavioral therapy
- _______ conditioning theory
- ________ theory
- _________ conditioning theory
3 behavior theories led to behavioral therapy
- classical conditioning theory
- behavioral theory
- operant conditioning theory
Challenging member behavior:
Demoralizing
Monopolizing
Silent
___________ member
- Remind group of equal chances to contribute
- Speak directly to member in private if necessary
____________ member
- Listen objectively
- Ask in private about cause of anger
- Empathize
_________ member
- Determine cause
- Require responses to ease group discomfort
- Provide extra time for members to think about a response and come back to them
Challenging member behavior
Monopolizing member
- Remind group of equal chances to contribute
- Speak directly to member in private if necessary
Demoralizing member
- Listen objectively
- Ask in private about cause of anger
- Empathize
Silent member
- Determine cause
- Require responses to ease group discomfort
- Provide extra time for members to think about a response and come back to them
s/s _______
- scars
- fresh wounds
- broken bones
- keeping sharp objects around
- wearing long sleeves even in hot weather
- claiming to have frequent accidents
- spending a lot of time alone
- pervasive difficulties in interpersonal relationships
- persistent questions about personal identity
- behavioral and emotional instability, impulsiveness
- statements of helplessness, hopelessness, etc.
NSSI
antipsychotic meds Side effects treatment
Neuroleptic malignant syndrome
- Prompt detection is vital, difficult to diagnose in emergent situation, history is critical
- Immediately stop all antipsychotics
- Treat symptoms – hydration, monitor vitals, complications
- ICU hospitalization required
- Meds – dantrolene sodium, bromocriptine mesylate, _________ (for agitation)
Neuroleptic malignant syndrome
- Prompt detection is vital, difficult to diagnose in emergent situation, history is critical
- Immediately stop all antipsychotics
- Treat symptoms – hydration, monitor vitals, complications
- ICU hospitalization required
- Meds – dantrolene sodium, bromocriptine mesylate, lorazepam (for agitation)
schizophrenia: ________ symptoms
Altered experience and expression of emotions
Mood may be unstable, erratic, labile, incongruent/inappropriate
Affective symptoms
Altered experience and expression of emotions
Mood may be unstable, erratic, labile, incongruent/inappropriate
suicide: _________
- expression of hopelessness or worthlessness
- talking about being a burden
- preoccupation with death, recklessness
- talking about feeling trapped or unbearable pain
- increased substance use
- anger, irritability, resentment
- isolation from family or friends
- extreme mood swings
- increased anxiety
- sudden uplift in mood – with out reason (could feel better b/c they have decided to die by suicide)
- sleeping too much/little
- giving away prized possessions
- looking for a way to access lethal means – making plans
warning signs
antipsychotic meds s/e
- _________ side effects
o Acute dystonic reactions
o Akathisia
o Pseudoparkinsonism
o Tardive dyskinesia (TD) - Anti_________ s/e
- Neuroleptic ________ syndrome
- __________ syndrome
- Extrapyramidal side effects (EPS)
o Acute dystonic reactions
o Akathisia
o Pseudoparkinsonism
o Tardive dyskinesia (TD) - Anticholinergic s/e
- Neuroleptic malignant syndrome
- Metabolic syndrome
NSSI
risk factors
biological
- _________ (serotonin, dopamine, norepinephrine) may play a role
cognitive
- form of self punishment
- painful actions make up for acts that caused harm to others
- positive reinforcement (rewards) may ______ self injurious acts
environmental
- cultural differences may play a role
societal
- may be a social phenomenon
- learned from peers engaging in behavior
risk factors
biological
- neurotransmitters (serotonin, dopamine, norepinephrine) may play a role
cognitive
- form of self punishment
- painful actions make up for acts that caused harm to others
- positive reinforcement (rewards) may support self injurious acts
environmental
- cultural differences may play a role
societal
- may be a social phenomenon
- learned from peers engaging in behavior
Types of talk therapies: Challenging stinkin’ thinkin’ and cognitive distortions
- Personalization and Blame
- Labeling
________– an extreme form of all-or-nothing thinking. Instead of saying “I made a mistake,” you attach a negative label to yourself: “I’m a loser.” You might also label yourself “a fool” or “a failure” or “a jerk.” Labeling is quite irrational because you are not the same as what you do. Human beings exist, but “fools,” “losers” and “jerks” do not. These labels are just useless abstractions that lead to anger, anxiety, frustration and low self-esteem.
- You may also label others. When someone does something that rubs you the wrong way, you may tell yourself: “He’s an S.O.B.” Then you feel that the problem is with that person’s “character” or “essence” instead of with their thinking or behavior. You see them as totally bad. This makes you feel hostile and hopeless about improving things and leaves very little room for constructive communication.
_________ - when you hold yourself personally responsible for an event that isn’t entirely under your control.
- Ex: When a woman received a note that her child was having difficulty in school, she told herself, “This shows what a bad mother I am,” instead of trying to pinpoint the cause of the problem so that she could be helpful to her child. When another woman’s husband beat her, she told herself, “If only I was better in bed, he wouldn’t beat me.” Personalization leads to guilt, shame and feelings of inadequacy.
- Labeling – Labeling is an extreme form of all-or-nothing thinking. Instead of saying “I made a mistake,” you attach a negative label to yourself: “I’m a loser.” You might also label yourself “a fool” or “a failure” or “a jerk.” Labeling is quite irrational because you are not the same as what you do. Human beings exist, but “fools,” “losers” and “jerks” do not. These labels are just useless abstractions that lead to anger, anxiety, frustration and low self-esteem.
- You may also label others. When someone does something that rubs you the wrong way, you may tell yourself: “He’s an S.O.B.” Then you feel that the problem is with that person’s “character” or “essence” instead of with their thinking or behavior. You see them as totally bad. This makes you feel hostile and hopeless about improving things and leaves very little room for constructive communication.
- Personalization and Blame - Personalization comes when you hold yourself personally responsible for an event that isn’t entirely under your control.
- Ex: When a woman received a note that her child was having difficulty in school, she told herself, “This shows what a bad mother I am,” instead of trying to pinpoint the cause of the problem so that she could be helpful to her child. When another woman’s husband beat her, she told herself, “If only I was better in bed, he wouldn’t beat me.” Personalization leads to guilt, shame and feelings of inadequacy.
Schizophrenia
_________ symptoms
o Hallucinations
Auditory
* Command
Visual
Olfactory
Gustatory
Tactile
o Paranoia
Positive symptoms
schizophrenia: positive symptoms
Disorganized or alterations in behavior
- Echopraxia
- Motor agitation
- Catatonia
- Negativism
- Motor retardation
- Boundary impairment
- Stereotyped behaviors
- Gesturing or posturing
__________ – cant sense where one’s body ends and another’s begins
________– increase or decrease in the rate and amount of movement, excessive motor activity is purposeless
__________– involuntary imitation of anothers movements
____________– posture held in fixed position
- Impaired impulse control
__________ – slowing of movement
___________ – excited behavior, running or pacing, in response to internal/external stimuli
__________– tendency to resist or oppose the requests of others
___________ – repetitive purposeless movement that are peculiar to the person and serve no purpose
Disorganized or alterations in behavior
- Boundary impairment – cant sense where one’s body ends and another’s begins
- Catatonia – increase or decrease in the rate and amount of movement, excessive motor activity is purposeless
- Echopraxia – involuntary imitation of anothers movements
- Gesturing or posturing – posture held in fixed position
- Impaired impulse control
- Motor retardation – slowing of movement
- Motor agitation – excited behavior, running or pacing, in response to internal/external stimuli
- Negativism – tendency to resist or oppose the requests of others
- Stereotyped behaviors – repetitive purposeless movement that are peculiar to the person and serve no purpose
antipsychotic meds s/e
Extrapyramidal side effects (EPS):
- Acute dystonic reaction
- Akathisia
- Pseudoparkinsonism
- Tardive dyskinesia
____________ – temporary symptoms that resemble parkinson’s disease
o Stiff and stooped posture
o Shuffling gait
o Bradykinesia
o Pill rolling fingers
o Resting tremors in hands and arms
o Dysphagia or reduction in spontaneous swallowing, drooling_
- Pseudoparkinsonism – temporary symptoms that resemble parkinson’s disease
o Stiff and stooped posture
o Shuffling gait
o Bradykinesia
o Pill rolling fingers
o Resting tremors in hands and arms
o Dysphagia or reduction in spontaneous swallowing, drooling
Typical or atypical antipsychotics?
Clozapine
Risperidone
Olanzapine
Quetiapine
Ziprasidone
Aripiprazole
Brexipipprazole
cariprazine
atypical
Physiological treatments:
Deep brain stimulation (DBS)
- Invasive?
- #___ surgically implanted electrodes
- Treats _________ disease
- Now being investigated as treatment for depression
- Stimulates regions identified as underactive in depression
Deep brain stimulation (DBS)
- Most invasive
- (2) surgically implanted electrodes
- Treats Parkinson’s disease
- Now being investigated as treatment for depression
- Stimulates regions identified as underactive in depression
suicide intervention: __________
- level of observation determined by provider – constant, 15 mins, 30 mins, hourly
- changes in level of observation per order
- locked inpatient psychiatric unit – observation level assigned based on acuity, higher at beginning of admit or is pt verbalizes SI
- acute care unit – constant observation by trained staff, can’t be family members
observation
- Types of groups:
Therapeutic community meeting group
Support and self-help groups
Psychoeducational
Group psychotherapy
____________– groups to increase knowledge or skills about a specific psychological or somatic subject
- Medication or health education
- Dual diagnosis
- Symptom management
- Goal setting/review
- Recreational activity
- Interpersonal skills
______________ – where unit happenings are processed. Every interaction occurring on an inpatient milieu has the potential to be therapeutic
_______________ – structure to provide patients opportunity to maintain/enhance personal/social functioning through cooperation and shared understanding of life’s challenges
Ex – AA, cancer survivors, bereavement
_____________ – specialized group intervention requiring skilled leaders and expertise such as an advanced practice nurse to bring about personality change
- Types of groups
Psychoeducational – groups to increase knowledge or skills about a specific psychological or somatic subject
- Medication or health education
- Dual diagnosis
- Symptom management
- Goal setting/review
- Recreational activity
- Interpersonal skills
Therapeutic community meeting group – where unit happenings are processed. Every interaction occurring on an inpatient milieu has the potential to be therapeutic
Support and self-help groups – structure to provide patients opportunity to maintain/enhance personal/social functioning through cooperation and shared understanding of life’s challenges
Ex – AA, cancer survivors, bereavement
Group psychotherapy – specialized group intervention requiring skilled leaders and expertise such as an advanced practice nurse to bring about personality change
- Yaloms therapeutic factors:
Universality
Altruism
Imparting of information
Instillation of hope
__________ - The leader shares optimism about the successes of group treatment, and members share their improvements.
Ex - Testimonials from peers at Alcoholics Anonymous meetings provide firsthand stories of successfully dealing with recovery methods and inspire hope among members of the group.
___________ - Members realize that they are not alone with their problems, feelings, or thoughts.
Ex - Members of sexual abuse support groups may be struggling with shame. Being with peers who feel or have felt the same way makes them feel less alone and less ashamed.
______________ - Participants receive formal teaching by the leader or advice from peers.
Ex - Leaders of groups for patients with HIV often incorporate medical material and information related to correcting fears and misconceptions about the transmission of infection.
__________ - Members gain or profit from giving support to others, leading to improved self-esteem.
Ex - A patient says that she will never get over the loss of her husband. A second group member nods and responds, “I felt like that, too, after my husband died.” The second group member feels pleased to have helped another person.
- Yaloms therapeutic factors
Instillation of hope - The leader shares optimism about the successes of group treatment, and members share their improvements.
Ex - Testimonials from peers at Alcoholics Anonymous meetings provide firsthand stories of successfully dealing with recovery methods and inspire hope among members of the group.
Universality - Members realize that they are not alone with their problems, feelings, or thoughts.
Ex - Members of sexual abuse support groups may be struggling with shame. Being with peers who feel or have felt the same way makes them feel less alone and less ashamed.
Imparting of information - Participants receive formal teaching by the leader or advice from peers.
Ex - Leaders of groups for patients with HIV often incorporate medical material and information related to correcting fears and misconceptions about the transmission of infection.
Altruism - Members gain or profit from giving support to others, leading to improved self-esteem.
Ex - A patient says that she will never get over the loss of her husband. A second group member nods and responds, “I felt like that, too, after my husband died.” The second group member feels pleased to have helped another person.
Types of talk therapies:
_________ therapy – focuses on interpersonal relationships by improving functioning and communication patterns
- Techniques include:
- Identification of emotion – help identify what their emotion is and where it is coming from
- Expression of emotion – help person express emotion in healthy way
- Dealing with emotional baggage – looking at how past relationships affect current relationships
Types of talk therapies
Can be alone or with psychopharmacology
Interpersonal therapy – focuses on interpersonal relationships by improving functioning and communication patterns
- Techniques include:
- Identification of emotion – help identify what their emotion is and where it is coming from
- Expression of emotion – help person express emotion in healthy way
- Dealing with emotional baggage – looking at how past relationships affect current relationships
Types of talk therapies:
cognitive based therapy (CBT)– based on cognitive psychology + behavioral theory
- ________ cause feelings and behaviors, not external things
- Benefit = change the way we ______ to feel/act better (situation does not change)
- Brief, time limited, structure (16 sessions)
- Homework and self counseling skills
- Collaborative effort between therapist and pt
- Goals identified by the patient
Ex: seeing someone you know in public but they apparently ignore you
Unhelpful thoughts = they ignored me, they don’t like me
CBT helpful thoughts = They were wrapped up in themselves and didn’t notice me
_______ __________ therapy – (type of CBT) focuses on irrational thinking or beliefs
- Identify activating situations and negative emotions, leading to irrational beliefs
- Stop using useless words like – must, should, ought, or have to
- Desired outcome is within clients control of behavior and thinking
- A change in thinking = positive change in behavior
- Activating event beliefs emotional consequences
_____ ______ therapy – (type of CBT) combines cognitive and behavioral techniques with mindfulness
- Developed to treat chronically suicidal individual commonly with borderline personality disorder
- Emotional regulation
- Interpersonal effective ness
- Distress tolerance
- Mindfulness – being in the present moment, notice what is going on now and accepting it. Controlling the mind from wandering to the past and future.
- Self management skills
Cognitive BT – based on cognitive psychology + behavioral theory
- Thoughts cause feelings and behaviors, not external things
- Benefit = change the way we think to feel/act better (situation does not change)
- Brief, time limited, structure (16 sessions)
- Homework and self counseling skills
- Collaborative effort between therapist and pt
- Goals identified by the patient
Ex: seeing someone you know in public but they apparently ignore you
Unhelpful thoughts = they ignored me, they don’t like me
CBT helpful thoughts = They were wrapped up in themselves and didn’t notice me
Rational emotive therapy – (type of CBT) focuses on irrational thinking or beliefs
- Identify activating situations and negative emotions, leading to irrational beliefs
- Stop using useless words like – must, should, ought, or have to
- Desired outcome is within clients control of behavior and thinking
- A change in thinking = positive change in behavior
- Activating event beliefs emotional consequences
Dialectic BT – (type of CBT) combines cognitive and behavioral techniques with mindfulness
- Developed to treat chronically suicidal individual commonly with borderline personality disorder
- Emotional regulation
- Interpersonal effective ness
- Distress tolerance
- Mindfulness – being in the present moment, notice what is going on now and accepting it. Controlling the mind from wandering to the past and future.
- Self management skills
Types of ________ therapies
- Modeling
- Operant conditioning
- Systemic desensitization
- Aversion therapy
- Biofeedback
Types of _____ therapies
- Interpersonal therapy
- Cognitive BT
- Dialectic BT
- Challenging stinkin’ thinkin’ and cognitive distortions
Types of behavioral therapies
- Modeling
- Operant conditioning
- Systemic desensitization
- Aversion therapy
- Biofeedback
Types of talk therapies
- Interpersonal therapy
- Cognitive BT
- Dialectic BT
- Challenging stinkin’ thinkin’ and cognitive distortions
suicide: __________ responsibility
- remove stigma
- learn risk factors and warning signs
- attend QPR training – learn how to recognize warning signs and what to do
- know the resources for individuals at risk of sucicide
community
long acting injectable medications
- indicated for pts at risk for nonadherence
- admin only 1x per 2-4 weeks
- must have transportation to receive injection
- typical or atypical antipsychotic injectables:
o fluphenazine decanoate
o haloperidol decanoate - atypical or typical antipsychotic injectables:
o risperidone microspheres
o paliperidone palmitate
o olanzapine pamoate
o aripiprazole
long acting injectable medications
- indicated for pts at risk for nonadherence
- admin only 1x per 2-4 weeks
- must have transportation to receive injection
- typical antipsychotic injectables:
o fluphenazine decanoate
o haloperidol decanoate - atypical antipsychotic injectables:
o risperidone microspheres
o paliperidone palmitate
o olanzapine pamoate
o aripiprazole
behavioral theories
- personality is __________ behaviors
- behavior is influenced by ____________
- ____________ – pairing behavior with condition that reinforces or decreases occurrence of behavior
behavioral theories
- personality is learned behaviors
- behavior is influenced by conditioning
- conditioning – pairing behavior with condition that reinforces or decreases occurrence of behavior
Types of talk therapies: Challenging stinkin’ thinkin’ and cognitive distortions
- Emotional Reasoning
- “Should” statements
__________ – You assume that your negative emotions necessarily reflect the way things really are
- Ex: “I feel terrified about going on airplanes. It must be very dangerous to fly.” Or, “I feel guilty. I must be a rotten person.” Or, “I feel angry. This proves that I’m being treated unfairly.” Or, “I feel so inferior. This means I’m a second rate person.” Or, “I feel hopeless. I must really be hopeless.”
____________ – You tell yourself that things should be the way you hoped or expected them to be.
- Ex: After playing a difficult piece on the piano, a gifted pianist told herself, “I shouldn’t have made so many mistakes.” This made her feel so disgusted that she quit practicing for several days. “Musts,” “oughts” and “have tos” are similar offenders.
- Emotional Reasoning – You assume that your negative emotions necessarily reflect the way things really are
- Ex: “I feel terrified about going on airplanes. It must be very dangerous to fly.” Or, “I feel guilty. I must be a rotten person.” Or, “I feel angry. This proves that I’m being treated unfairly.” Or, “I feel so inferior. This means I’m a second rate person.” Or, “I feel hopeless. I must really be hopeless.”
- “Should” statements – You tell yourself that things should be the way you hoped or expected them to be.
- Ex: After playing a difficult piece on the piano, a gifted pianist told herself, “I shouldn’t have made so many mistakes.” This made her feel so disgusted that she quit practicing for several days. “Musts,” “oughts” and “have tos” are similar offenders.
- “Should statements” that are directed against yourself lead to guilt and frustration. Should statements that are directed against other people or the world in general, lead to anger and frustration: “He shouldn’t be so stubborn and argumentative!”
- Many people try to motivate themselves with shoulds and shouldn’ts, as if they were delinquents who had to be punished before they could be expected to do anything. “I shouldn’t eat that doughnut.” This usually doesn’t work because all these shoulds and musts make you feel rebellious and you get the urge to do just the opposite. Dr. Albert Ellis has called this ” must erbation.” I call it the “shouldy” approach to life.
Physiological treatments:
Vagal nerve stimulation (VNS)
- Invasive?
- Originally used to treat _______ – decreases _____
- Treats resistant ________ – improves ______
- Electrical stimulation boosts neurotransmitters
s/e
- ________ alterations
- Neck pain
- Cough
- Paresthesia
- Dyspnea
Vagal nerve stimulation (VNS)
- Invasive
- Originally used to treat epilepsy – decreases seizures
- Treats resistant depression – improves mood
- Electrical stimulation boosts neurotransmitters
s/e
- Voice alterations
- Neck pain
- Cough
- Paresthesia
- Dyspnea
schizophrenia: Cognitive symptoms
- Impaired executive functioning
- Impaired information processing
- Anosognosia
- Concrete thinking
- Impaired memory
________ – inability to realize one is ill, may see resistance to treatment, often combined with paranoia
________– impaired ability to think abstractly, interprets things literally
________ – delayed responses, misperceptions, difficulty understanding others
_______ – difficulty reasoning, setting priorities, comparing options, planning
_______ – short term memory and ability to learn is impacted
schizophrenia: Cognitive symptoms
- Anosognosia – inability to realize one is ill, may see resistance to treatment, often combined with paranoia
- Concrete thinking – impaired ability to think abstractly, interprets things literally
- Impaired information processing – delayed responses, misperceptions, difficulty understanding others
- Impaired executive functioning – difficulty reasoning, setting priorities, comparing options, planning
- Impaired memory – short term memory and ability to learn is impacted
schizophrenia: positive symptoms
- Tactile
- Hallucinations
- Gustatory
- Olfactory
- Auditory
- Visual
- Command
________ – alterations in perception that involve errors in how one interprets perceptions or perceives reality. Person receives a sensory experience for which no external source exists
______ – hearing voices or sounds
_______ – an auditory hallucination that instructs the person to act a certain way, ranges from not harmful to dangerous, like harm to self or others
_________ – seeing people or things
_________ – smelling odors
_______ – experiencing taste
_______ – feeling body sensations
Hallucinations – alterations in perception that involve errors in how one interprets perceptions or perceives reality. Person receives a sensory experience for which no external source exists
- Auditory – hearing voices or sounds
o Command – an auditory hallucination that instructs the person to act a certain way, ranges from not harmful to dangerous, like harm to self or others
- Visual – seeing people or things
- Olfactory – smelling odors
- Gustatory – experiencing taste
- Tactile – feeling body sensations
Typical or atypical antipsychotics?
- Reduces positive symptoms
- Have little effect on negative symptoms
- Used less often
typical
_________– reduction in number of circulating granulocytes and decreased production of granulocytes that limit one’s ability to fight off infection
- Life threatening
- Associated with _______
- ______ drop to dangerous levels
- Monitor WBC weekly for 1st 18 months of treatment
- d/c if pt develops leukopenia or neutropenia
- reversible if treated early
Agranulocytosis
clozapine
WBCs
functional roles or group members (2)
informal roles of group members (1)
Functional roles of group members
Task roles
- Initiator/contributor – suggests new ideas regarding problem/goal
- Information seeker – clarifies group roles
- Information giver – provides facts/shares experiences as an authority figure
- Coordinator – shows clarifies how ideas can work
- Orienteer – notes the groups progress
- Recorder – keeps notes
Building and maintenance roles
- Encourager – praise and seeks input
- Harmonizer – reconciles differences among members
- Gatekeeper – facilitates the contributions of others to keep communication open
- Group observer – notes/reports what is occurring to the group process
- Follower – goes along with others, audience role
Informal roles of group members
- Aggressor - Criticizes and attacks others’ ideas and feelings
- Blocker/oppositional - Disagrees with and halts group issues
- Recognition seeker - Seeks attention by boasting and discussing achievements
- Play person
- Dominator
____________
a psychosis characterized by abnormalities in perception, content of thought, thought processes, and extensive withdrawal of one’s interest from individuals and the outside world
Mental illness that interferes with a person’s ability to
- Think clearly
- Manage emotions
- Make decisions
- Relate to others
(_________ - A state in which the individual is experiencing hallucinations, delusions, or disorganized thoughts, speech, behaviors.)
Schizophrenia
a psychosis characterized by abnormalities in perception, content of thought, thought processes, and extensive withdrawal of one’s interest from individuals and the outside world
(Psychosis - A state in which the individual is experiencing hallucinations, delusions, or disorganized thoughts, speech, behaviors.)
Mental illness that interferes with a person’s ability to
- Think clearly
- Manage emotions
- Make decisions
- Relate to others
schizophrenia: positive symptoms
Disorganized or alterations in speech
- Clang association
- Tangentiality
- Circumstantiality
- Looseness of association
- Echolalia
- Word salad
- Flight of ideas
- Neologisms
- Symbolic speech
- Pressured speech
_________ – extremely detailed and lengthy conversations about a topic, but eventually gets to the point
__________– choosing words based on their sound instead of meaning, may involve rhyming or similar beginning sounds
_______ – repetition of another’s words
________ – topic of conversation changes repeatedly and rapidly with only superficial associative connections, making it difficult for others to follow
________– absence of normal connectedness of thoughts, ideas, and topics
_______ – made up words
________– urgent or intense speech, reluctance to allow comments from others
__________– wandering off topic or going off on tangents, never reaching the point
_________ – string of words totally unconnected, jumble of words meaningless to listener
_________ – using words based on what they symbolize, not what they mean (sharp pain described as demons sticking needles in me)
Disorganized or alterations in speech
- Circumstantiality – extremely detailed and lengthy conversations about a topic, but eventually gets to the point
- Clang association – choosing words based on their sound instead of meaning, may involve rhyming or similar beginning sounds
- Echolalia – repetition of another’s words
- Flight of ideas – topic of conversation changes repeatedly and rapidly with only superficial associative connections, making it difficult for others to follow
- Looseness of association – absence of normal connectedness of thoughts, ideas, and topics
- Neologisms – made up words
- Pressured speech – urgent or intense speech, reluctance to allow comments from others
- Tangentiality – wandering off topic or going off on tangents, never reaching the point
- Word salad – string of words totally unconnected, jumble of words meaningless to listener
- Symbolic speech – using words based on what they symbolize, not what they mean (sharp pain described as demons sticking needles in me)
Functional roles of group members
________________ roles
- Encourager – praise and seeks input
- Harmonizer – reconciles differences among members
- Gatekeeper – facilitates the contributions of others to keep communication open
- Group observer – notes/reports what is occurring to the group process
- Follower – goes along with others, audience role
Building and maintenance roles
- Encourager – praise and seeks input
- Harmonizer – reconciles differences among members
- Gatekeeper – facilitates the contributions of others to keep communication open
- Group observer – notes/reports what is occurring to the group process
- Follower – goes along with others, audience role
Schizophrenia
_________ symptoms
- Affective blunting
- Alogia
- Anhedonia
- Apathy
- Asociality
- Avolition
negative
Types of behavioral therapies:
- Operant conditioning
- Modeling
- Biofeedback
- Systemic desensitization
- Aversion therapy
__________ – role playing, demonstrating desired behaviors for the client to observe and practice.
____________ - Using positive reinforcement or tokens to increase or decrease target behaviors.
___________ - Gradually exposing the client to anxiety-provoking stimuli in a controlled manner to reduce fear responses.
___________ - Associating an unwanted behavior with an unpleasant stimulus to suppress that behavior.
____________– control of body, Using instrumentation to provide feedback about physiological functions like muscle tension, allowing clients to gain self-regulation skills._
Types of behavioral therapies
- Modeling – role playing, demonstrating desired behaviors for the client to observe and practice.
- Operant conditioning - Using positive reinforcement or tokens to increase or decrease target behaviors.
- Systemic desensitization - Gradually exposing the client to anxiety-provoking stimuli in a controlled manner to reduce fear responses.
- Aversion therapy - Associating an unwanted behavior with an unpleasant stimulus to suppress that behavior.
- Biofeedback – control of body, Using instrumentation to provide feedback about physiological functions like muscle tension, allowing clients to gain self-regulation skills.
Pharmacotherapy: antipsychotic meds
Used to treat _______ disorders – such as schizophrenia
Takes ___ weeks to become effective
Pharmacotherapy: antipsychotic meds
Used to treat psychotic disorders – such as schizophrenia
Takes 2-6 weeks to become effective
Typical or atypical antipsychotics?
s/e
- Major weight gain
- Changes to metabolism leading to metabolic/endocrine problems including DM and hyperprolactinemia
- Cardiac dysrhythmias, cardiac death
- Sexual dysfunction
- Less likely to cause anticholinergic effects, orthostatic hypotension, seizures, EPS
Atypical antipsychotics
which are acceptable terms?
- completed suicide
- committed suicide
- suicide attempt interrupted by self or other
- successful suicide
- failed suicide attempt
- non-fatal suicide attempt
- suicide/death by suicide
- suicidal gesture
- suicidality
unacceptable terms
- completed suicide
- committed suicide
!!- suicide attempt interrupted by self or other
- successful suicide
- failed suicide attempt
- non-fatal suicide attempt
!!- suicide/death by suicide
- suicidal gesture
- suicidality
antipsychotic meds s/e
____________
- Rare but serious, potentially fatal
- Occurs early
- Early detection increases survival
- Severe muscle rigidity
- AMS
- Increased temp
- HTN
- Tachycardia
- Tachypnea
- Diaphoresis
- Incontinence
Neuroleptic malignant syndrome
Documentation: hallucinations
- Type, content, characteristics
- Use pts own words
- Behavior prior to and during episode
- Any actions taken to help the pt with episode
Teaching: hallucinations
- Manage stress and stimulation
- Use other sounds to compete with hallucinations
- Check with others to find out what is/isn’t real
- Do activities that distract from hallucinations
- Self talk – tell self voices aren’t real, tell voices to go away, tell self you’re safe
- Make eye contact with others
- Develop a coping plan
Documentation: hallucinations
- Type, content, characteristics
- Use pts own words
- Behavior prior to and during episode
- Any actions taken to help the pt with episode
Teaching: hallucinations
- Manage stress and stimulation
- Use other sounds to compete with hallucinations
- Check with others to find out what is/isn’t real
- Do activities that distract from hallucinations
- Self talk – tell self voices aren’t real, tell voices to go away, tell self you’re safe
- Make eye contact with others
- Develop a coping plan
antipsychotic meds s/e
Extrapyramidal side effects (EPS):
- Acute dystonic reaction
- Akathisia
- Pseudoparkinsonism
- Tardive dyskinesia
__________ – motor restlessness manifested as excessive pacing, inability to remain still, rocking while seating, shifting from one foot to the other while standing
o Can be severe and distressing
o Can be mistaken for anxiety or agitation – may lead to more drug being administered, making it worse
o Tardive (delayed) form can persist despite treatment
- Akathisia – motor restlessness manifested as excessive pacing, inability to remain still, rocking while seating, shifting from one foot to the other while standing
o Can be severe and distressing
o Can be mistaken for anxiety or agitation – may lead to more drug being administered, making it worse
o Tardive (delayed) form can persist despite treatment
Epidemiology: Schizophrenia
- Found in all of world’s population regardless of race, ethnicity, economic background.
- Schizophrenia one of US leading causes of disability
- More frequently diagnosed in males and urban areas
- Peak onset 15-35 (men 15-25 and women 25-35)
- New cases rare before 10 and after 40
Epidemiology
- Found in all of world’s population regardless of race, ethnicity, economic background.
- Schizophrenia one of US leading causes of disability
- More frequently diagnosed in males and urban areas
- Peak onset 15-35 (men 15-25 and women 25-35)
- New cases rare before 10 and after 40
Phases of schizophrenia
___________
- Mild changes in thinking, reality testing and mood, insufficient to meet DSM-5 criteria
- Speech or though changes
- Anxiety, obsessive thoughts, compulsive behavior
- Can’t concentrate, distressing thoughts occur with performance and social functions, paranoia, memory impairments
- s/s occur 1-2 months before the first full episode of the illness
_________
- s/s vary from few and mild to many and disabling
- hallucinations, delusions, apathy, social withdrawal, diminished affect, anhedonia, disorganized behavior, impaired judgement and cognition result in functional impairment
- difficulty coping with worsening symptoms which becomes apparent to others
- can last several months even with treatment
- increased support and hospitalization may be required
__________
- s/s are stabilizing and diminishing and there is no movement toward a previously level of functioning
- may require care in outpatient mental health center or partial hospitalization program
_____________
- condition stable and new baseline established
- positive symptoms absent or significantly diminished
- negative and cognitive symptoms remain_
Phases of schizophrenia
Prodromal
- Mild changes in thinking, reality testing and mood, insufficient to meet DSM-5 criteria
- Speech or though changes
- Anxiety, obsessive thoughts, compulsive behavior
- Can’t concentrate, distressing thoughts occur with performance and social functions, paranoia, memory impairments
- s/s occur 1-2 months before the first full episode of the illness
acute
- s/s vary from few and mild to many and disabling
- hallucinations, delusions, apathy, social withdrawal, diminished affect, anhedonia, disorganized behavior, impaired judgement and cognition result in functional impairment
- difficulty coping with worsening symptoms which becomes apparent to others
- can last several months even with treatment
- increased support and hospitalization may be required
stabilization
- s/s are stabilizing and diminishing and there is no movement toward a previously level of functioning
- may require care in outpatient mental health center or partial hospitalization program
maintenance or residual
- condition stable and new baseline established
- positive symptoms absent or significantly diminished
- negative and cognitive symptoms remain
Schizophrenia in children
Early s/s:
Developmental problems
- Language delays
- Late or unusual crawling
- Late walking
- Motor behaviors – rocking or arm flapping
Later s/s:
- Hallucinations – esp auditory
- Delusions
- Lack of emotion
- Inappropriate emotions
- Social withdrawal
- Poor school performance
- Decreased ability to do self care
- Strange eating habits
- Incoherent speech
- Illogical thinking
- Agitation
Treatment
- Meds = risperidone and aripiprazole
- Individual and family psychotherapy
- Social and academic skills training
- Hospitalization
Schizophrenia in children
Early s/s:
Developmental problems
- Language delays
- Late or unusual crawling
- Late walking
- Motor behaviors – rocking or arm flapping
Later s/s:
- Hallucinations – esp auditory
- Delusions
- Lack of emotion
- Inappropriate emotions
- Social withdrawal
- Poor school performance
- Decreased ability to do self care
- Strange eating habits
- Incoherent speech
- Illogical thinking
- Agitation
Treatment
- Meds = risperidone and aripiprazole
- Individual and family psychotherapy
- Social and academic skills training
- Hospitalization
Physiological treatments:
Phototherapy/light therapy
- invasive?
- First line treatment for what type of depression?
- Efficacy d/t influence of light on melatonin
- Effective as medication
- Negative s/e – (2)
Physiological treatments
Phototherapy/light therapy
- noninvasive
- First line treatment for depression with a seasonal onset (formerly known as SAD)
- Efficacy d/t influence of light on melatonin
- Effective as medication
- Negative s/e – h/a and jitteriness
Physiological treatments:
Electroconvulsive therapy (ECT)
Process
- ___________ used before procedure
- Process includes applying electricity to temporal regions of the brain to induce brief seizure
- Can be unilateral (electrodes on one side of brain) or bilateral (both sides)
- 2-3 treatments/week for total of 6-12 treatments
- Must __________ patient for several hours after treatment
Physiological treatments:
Electroconvulsive therapy (ECT)
Process
- Anesthesia and muscle relaxant used
- Process includes applying electricity to temporal regions of the brain to induce brief seizure
- Can be unilateral (electrodes on one side of brain) or bilateral (both sides)
- 2-3 treatments/week for total of 6-12 treatments
- Must reorient patient for several hours after treatment
Assessment: hallucinations
- Important to keep staff and pt safe
- Ask direct question to assess type and content of hallucinations
- Ask when they began, and how they are experienced
- In initial assessment – ask if command hallucinations occur and if it makes pt fearful or distressed
o What do you hear? Are they voices telling you to do something? Do you believe what you hear is real?
- Ask about other types of hallucinations (5 senses)
- Do not respond to hallucinations as if they are real
- Do not deny the person experience
- Offer your own perception, convey empathy, present reality
- After hallucination – help identify triggers, what makes worse/better, pt response, how do they cope
Assessment: hallucinations
- Important to keep staff and pt safe
- Ask direct question to assess type and content of hallucinations
- Ask when they began, and how they are experienced
- In initial assessment – ask if command hallucinations occur and if it makes pt fearful or distressed
o What do you hear? Are they voices telling you to do something? Do you believe what you hear is real?
- Ask about other types of hallucinations (5 senses)
- Do not respond to hallucinations as if they are real
- Do not deny the person experience
- Offer your own perception, convey empathy, present reality
- After hallucination – help identify triggers, what makes worse/better, pt response, how do they cope
2 types: Schizoaffective disorder
Bipolar type
- Combination of symptoms from schizophrenia and bipolar disorder
- Depressive and _________ episodes + schizophrenia symptoms
Depressive type
- Psychotic symptoms of schizophrenia + depressed moods/major depressive disorder
- long periods of intense depression - No _____ or _____
2 types
Bipolar type
- Combination of symptoms from schizophrenia and bipolar disorder
- Depressive and manic episodes + schizophrenia symptoms
Depressive type
- Psychotic symptoms of schizophrenia + depressed moods/major depressive disorder
- long periods of intense depression - No highs or lows
Deliberate and direct attempts to inflict painful injuries to the surface of the body WTHOUT intending to die
NSSI - non suicidal self injury
Schizophrenia
_________ symptoms
- Anosognosia
- Concrete thinking
- Impaired information processing
- Impaired executive functioning
- Impaired memory
Cognitive
Typical or atypical antipsychotics?
advantage
- Treats positive and negative symptoms
- Less likely to cause EPS
- s/e usually fewer, miler, and better tolerated
- Treats cognitive function
disadvantage
- weight gain
- metabolic syndrome
- more expensive (compared to typical antipsychotics)
atypical
antipsychotic meds Side effects treatment
Akathisia
- Dosage reduction or change in meds
- Give _________ (benztropine)
- Add meds for short term use only (3)
- Relaxation exercises
antipsychotic meds Side effects treatment
Akathisia
- Dosage reduction or change in meds
- Give Anticholinergic (benztropine)
- Add meds for short term use only (propranolol, lorazepam, diazepam
- Relaxation exercises
NSSI
epidemiology
- prevalence is difficult to determine
- more common in_______
- rate declines after 29
comorbidity
- depression
- anxiety
- eating disorders
- substance use disorder
- borderline personality disorder
epidemiology
- prevalence is difficult to determine
- more common in female
- rate declines after 29
comorbidity
- depression
- anxiety
- eating disorders
- substance use disorder
- borderline personality disorder
blank
blank
Typical or atypical antipsychotics?
clozapine
atypical
Styles of leadership:
Laissez-faire
Autocratic
Democratic
_________ leader – exerts control over the group and doesn’t encourage much interaction
________ leader – supports extensive group interaction in the process of problem solving
_________ leader – allows the group members to behave any way they choose and doesn’t attempt to control the direction
Styles of leadership
Autocratic leader – exerts control over the group and doesn’t encourage much interaction
Democratic leader – supports extensive group interaction in the process of problem solving
Laissez-faire leader – allows the group members to behave any way they choose and doesn’t attempt to control the direction
clozapine: atypical antipsychotics
- effective in treating _________ schizophrenia
- decreased ________ symptoms
- increased impulse control
- reduced violence to self and others
- improved quality of life
- !! potentially fatal s/e – _________
clozapine: atypical antipsychotics
- effective in treating refractory schizophrenia
- decreased negative symptoms
- increased impulse control
- reduced violence to self and others
- improved quality of life
- !! potentially fatal s/e – agranulocytosis
suicide _________ safety
- search pt and assess belongings for harmful objects
- removal any potential lethal objects and mitigate and potential ligature risk
o materials for hanging – clothes, no shoelaces
o wear hospital gown
o no razors
o no perfume bottles
o no mirrors
o no meds from home
- lock windows
- lock bed in low position
- use plastic utensils, disposable food trays
- dispose tray and implements outside pt room
- no private rooms, always keep door open
- jump proof and hang proof bathrooms
- lock doors to non-pt areas and empty pt rooms
- continuous monitoring for potentially harmful objects – ex: gifts brought in by visitors
environemental
Medications to know
Atypical or Typical antipsychotics?
- Chlorpromazine
- Haloperidol
Atypical or Typical antipsychotics
- Clozapine
- Olanzapine
- Quetiapine
- Risperidone
- Aripiprazole
Antipsychotic long acting injections: (1) typical and (2) atypical
- Risperidone
- Paliperidone palmitate
- Haloperidol decanoate
______________ (hint: treats a s/e)
- Benztropine
- Trihexyphenidyl
Medications to know
Typical antipsychotics
- Chlorpromazine
- Haloperidol
Atypical antipsychotics
- Clozapine
- Olanzapine
- Quetiapine
- Risperidone
- Aripiprazole
typical Antipsychotic long acting injections
- Haloperidol decanoate
atypical Antipsychotic long acting injections
- Risperidone
- Paliperidone palmitate
Anticholinergics
- Benztropine
- Trihexyphenidyl
Common behaviors
- cutting
- burning
- scraping/scratching skin
- biting
- hitting
- skin picking
- interfering with wound healing
- picking off scab or biting nails – not self injury
common areas
- front of thigh
- dorsal side of forearm
NSSI - non suicidal self injury
suicide treatment and management: _______ #1
- re-assessment following identified suicide risk
- re-screen if there is a change in patient condition
- safety planning intervention for all pts with identified risk
- sitter – inform them of suicide risk and to be vigilant, observe pt in bathroom
- hand-off communication between care providers
- rounding for safety at regular intervals
- inform all unit staff of pts risk
- maintain RN hourly rounding even if the pt has a sitter
- place pt close to nursing station
- implement suicide precautions and elopement precautions per hospital policy
- monitor medication ingestion and cheeking
- teach coping and problem solving skills
- assess access to lethal means at home before d/c
- involve social support persons throughout hospitalization
- provide community resources
treatment and management: safety #1
- re-assessment following identified suicide risk
- re-screen if there is a change in patient condition
- safety planning intervention for all pts with identified risk
- sitter – inform them of suicide risk and to be vigilant, observe pt in bathroom
- hand-off communication between care providers
- rounding for safety at regular intervals
- inform all unit staff of pts risk
- maintain RN hourly rounding even if the pt has a sitter
- place pt close to nursing station
- implement suicide precautions and elopement precautions per hospital policy
- monitor medication ingestion and cheeking
- teach coping and problem solving skills
- assess access to lethal means at home before d/c
- involve social support persons throughout hospitalization
- provide community resources
Intervening: delusions
- Remain calm, acknowledge and accept patients experience and feeling (delusions can feel very real and frightening to pt)
- Encourage pt to express feelings and show empathy is pt is fearful
- Reassure patient your intentions and present reality
- Focus – help patient feel safe by addressing underlying theme of fear
o Don’t focus on delusion
o Focus on fear, cause of fear, what can help pt feel more safe
Ex: pt thinks you are part of FBI plot to destroy them
Nurse: it seems people want to hurt you, that must be scary. I will not hurt you. We can work together to help you feel safe.
Intervening: delusions
- Remain calm, acknowledge and accept patients experience and feeling (delusions can feel very real and frightening to pt)
- Encourage pt to express feelings and show empathy is pt is fearful
- Reassure patient your intentions and present reality
- Focus – help patient feel safe by addressing underlying theme of fear
o Don’t focus on delusion
o Focus on fear, cause of fear, what can help pt feel more safe
Ex: pt thinks you are part of FBI plot to destroy them
Nurse: it seems people want to hurt you, that must be scary. I will not hurt you. We can work together to help you feel safe.
Intervening: hallucinations
- Approach pt in non-threatening and calm manner (hallucinations are very real to person experiencing them, may be distracting, can provoke varying reactions, anxiety or distress, may be episodic or constant, may attribute sound from a specific source like a parent or god)
- Introduce self to pt to gain rapport, trust, and develop relationship
- Reassure the pt they are safe
- Suicidal/homicidal themes or commands require immediate safety measures
During hallucination
- Call pt by name, speak clear and loud, short sentences
- Convey support, maintain eye contact, redirect focus to conversation with nurse
- Assess for intensifying hallucinations or command hallucination – increasing signs of anxiety
- Engage in reality based activities like card games or listening to music
Intervening: hallucinations
- Approach pt in non-threatening and calm manner (hallucinations are very real to person experiencing them, may be distracting, can provoke varying reactions, anxiety or distress, may be episodic or constant, may attribute sound from a specific source like a parent or god)
- Introduce self to pt to gain rapport, trust, and develop relationship
- Reassure the pt they are safe
- Suicidal/homicidal themes or commands require immediate safety measures
During hallucination
- Call pt by name, speak clear and loud, short sentences
- Convey support, maintain eye contact, redirect focus to conversation with nurse
- Assess for intensifying hallucinations or command hallucination – increasing signs of anxiety
- Engage in reality based activities like card games or listening to music
suicide: ____________
individual
- previous attempts
- hx of depression or mental illness
- alcohol or substance use disorder
- physical health, chronic illness
- legal problems
- financial problems
- adverse childhood experience
- hopelessness
relationship
- bullying
- family/friend hx of suicide
- loss of relationship
- high conflict or violent relationship
- social isolation
community
- lack of access to healthcare or mental healthcare
- suicide cluster
- stress of acculturation
- community violence
- historical trauma
- discrimination
societal
- stigma around help seeking and mental helath
- easy access to lethal means
risk factors
components of evidence based comprehensive suicide risk screenings, re-assessments and safety planning
C-SSRS (Columbia suicide severity rating scale)
- screening
- risk factors
- protective factors
- re-assessment
recognizing cues
- verbal and nonverbal cues
o _____ statements
o _____ statements
- assessment of the lethality of suicide plan
- self-assessment
components of evidence based comprehensive suicide risk screenings, re-assessments and safety planning
C-SSRS (Columbia suicide severity rating scale)
- screening
- risk factors
- protective factors
- re-assessment
recognizing cues
- verbal and nonverbal cues
o overt statements
o covert statements
- assessment of the lethality of suicide plan
- self-assessment
schizophrenia symptom assessment (4)
_______ symptoms - symptoms that exist but shouldn’t be there
______ symptoms - Symptoms that should be there but are not
________ symptoms
________ symptoms - Altered experience and expression of emotions. Mood may be unstable, erratic, labile, incongruent/inappropriate
symptom assessment (4)
positive symptms
negative symptoms
cognitive symptoms
affective symptoms
- Yaloms therapeutic factors:
Existential factors
Group cohesiveness
Catharsis
_____________ - This factor arises in a mature group when members feels connected to one another, the leader, and the group as a whole.
Ex - A group develops norms that include nonjudgmental acceptance and inclusion, helping members learn to trust one another, disclose information about themselves, receive empathetic feedback, and feel accepted.
________ - A genuine expression of feelings that can be interpreted by both the patient and the group. Overexpression of feelings can be detrimental to group processes.
Ex - Individuals in a group for women with early breast cancer are able to express emotions and needs within the context of the mutually supportive group.
_________- Members examine aspects of life—such as loss, meaning, and mortality—that affect everyone in constructing meaning.
Ex - Individuals in a grief support group express positive thoughts and feelings in regard to the loss of a loved one and can also safely share negative thoughts and feelings.
- Yaloms therapeutic factors:
Group cohesiveness - This factor arises in a mature group when members feels connected to one another, the leader, and the group as a whole.
Ex - A group develops norms that include nonjudgmental acceptance and inclusion, helping members learn to trust one another, disclose information about themselves, receive empathetic feedback, and feel accepted.
Catharsis - A genuine expression of feelings that can be interpreted by both the patient and the group. Overexpression of feelings can be detrimental to group processes.
Ex - Individuals in a group for women with early breast cancer are able to express emotions and needs within the context of the mutually supportive group.
Existential factors - Members examine aspects of life—such as loss, meaning, and mortality—that affect everyone in constructing meaning.
Ex - Individuals in a grief support group express positive thoughts and feelings in regard to the loss of a loved one and can also safely share negative thoughts and feelings.
schizophrenia: positive symptoms
___________ - irrational fear, mild to profound, deep mistrust or suspicion of others
- can develop into delusional thoughts
- May result in dangerous defensive action (harming person)
Paranoia - irrational fear, mild to profound, deep mistrust or suspicion of others
- can develop into delusional thoughts
- May result in dangerous defensive action (harming person)
- Yaloms therapeutic factors:
Interpersonal learning
Development of socializing techniques
Corrective recapitulation of the primary family group
Imitative behavior
______________ - Members repeat patterns of behavior in the group that they learned in their families; from the safety of the group with feedback from the leader and peers, they learn about their own behavior.
Ex - A group member expresses frustration that other members are more appreciated, and she resents having to share time with the group. Group members note that she said the same thing about her siblings and suggest that she is appreciated.
_______________ - Members learn new social skills based on others’ feedback and modeling.
Ex - A man knew that others were avoiding social engagement with him but he was not sure why. Through a member’s direct feedback, he learned that his tendency to obsessively insert irrelevant details in his communication created discomfort in others.
______________- Members may copy the behavior of the leader or peers and thus can adopt healthier habits.
Ex - Patients with psychotic symptoms in a cognitive behavioral therapy group learn how to reduce the intensity of auditory hallucinations by watching the group leader and other members use cognitive behavioral strategies.
_______________- The group itself is a laboratory for trying out new interpersonal skills. Members gain insight from others’ feedback and from trying out new behaviors in the group.
Ex - Patients in the parent support group for children with attention-deficit/hyperactivity disorder role play responses to challenging behaviors of their children. Afterward, the group provides feedback to support the patients’ learning.
- Yaloms therapeutic factors:
Corrective recapitulation of the primary family group - Members repeat patterns of behavior in the group that they learned in their families; from the safety of the group with feedback from the leader and peers, they learn about their own behavior.
Ex - A group member expresses frustration that other members are more appreciated, and she resents having to share time with the group. Group members note that she said the same thing about her siblings and suggest that she is appreciated.
Development of socializing techniques - Members learn new social skills based on others’ feedback and modeling.
Ex - A man knew that others were avoiding social engagement with him but he was not sure why. Through a member’s direct feedback, he learned that his tendency to obsessively insert irrelevant details in his communication created discomfort in others.
Imitative behavior - Members may copy the behavior of the leader or peers and thus can adopt healthier habits.
Ex - Patients with psychotic symptoms in a cognitive behavioral therapy group learn how to reduce the intensity of auditory hallucinations by watching the group leader and other members use cognitive behavioral strategies.
Interpersonal learning - The group itself is a laboratory for trying out new interpersonal skills. Members gain insight from others’ feedback and from trying out new behaviors in the group.
Ex - Patients in the parent support group for children with attention-deficit/hyperactivity disorder role play responses to challenging behaviors of their children. Afterward, the group provides feedback to support the patients’ learning.
all Typical or atypical antipsychotics?
Chlorpromazine
Haloperidol
Fluphenazine
Thioridazine
Perphenazine
typical
Comorbidity
Individuals with schizophrenia often experience comorbid conditions such as:
- Substance use disorder
- Nicotine dependence
- Anxiety, depression, suicide
- Diabetes
- CV disease
- Obesity
- Malignant neoplasm
- HIV/AIDS
- Osteoporosis
- Hep C
Comorbidity
Individuals with schizophrenia often experience comorbid conditions such as:
- Substance use disorder
- Nicotine dependence
- Anxiety, depression, suicide
- Diabetes
- CV disease
- Obesity
- Malignant neoplasm
- HIV/AIDS
- Osteoporosis
- Hep C
Types of talk therapies: Challenging stinkin’ thinkin’ and cognitive distortions
- Overgeneralization
- Mental Filter
- All-or-nothing thinking
__________ – You see things in black-or-white categories. If a situation falls short of perfect, you see it as a total failure.
- Ex: When a young woman on a diet ate a spoonful of ice cream, she told herself, “I’ve blown my diet completely.” This thought upset her so much that she gobbled down an entire quart of ice cream.
__________ – You see a single negative event, such as a romantic rejection or a career reversal, as a never-ending pattern of defeat by using words such as “always” or “never” when you think about it.
- Ex: A depressed salesman became terribly upset when he noticed bird dung on the window of his car. He told himself, “Just my luck! Birds are always crapping on my car!”
__________ – You pick out a single negative detail and dwell on it exclusively, so that your vision of reality becomes darkened, like the drop of ink that discolors a beaker of water.
- Example: You receive many positive comments about your presentation to a group of associates at work, but one of them says something mildly critical. You obsess about his reaction for days and ignore all the positive feedback.
Challenging stinkin’ thinkin’ and cognitive distortions
- 1. All-or-nothing thinking – You see things in black-or-white categories. If a situation falls short of perfect, you see it as a total failure.
- Ex: When a young woman on a diet ate a spoonful of ice cream, she told herself, “I’ve blown my diet completely.” This thought upset her so much that she gobbled down an entire quart of ice cream.
- 2. Overgeneralization – You see a single negative event, such as a romantic rejection or a career reversal, as a never-ending pattern of defeat by using words such as “always” or “never” when you think about it.
- Ex: A depressed salesman became terribly upset when he noticed bird dung on the window of his car. He told himself, “Just my luck! Birds are always crapping on my car!”
- 3. Mental Filter – You pick out a single negative detail and dwell on it exclusively, so that your vision of reality becomes darkened, like the drop of ink that discolors a beaker of water.
- Example: You receive many positive comments about your presentation to a group of associates at work, but one of them says something mildly critical. You obsess about his reaction for days and ignore all the positive feedback.
- Advantages and disadvantages of working with groups
- Multiple pts in treatment at same time
- Benefits from feedback, knowledge, and experience of others
- Safe setting to try out new behaviors and communication skills
- Promotes a feeling of belonging
- Time constraints, someone may feel cheated for participation time
- Concern for confidentiality
- Disruptive members
- Not all pts benefit from group treatment
- Advantages and disadvantages of working with groups
Adv
- Multiple pts in treatment at same time
- Benefits from feedback, knowledge, and experience of others
- Safe setting to try out new behaviors and communication skills
- Promotes a feeling of belonging
Dis adv
- Time constraints, someone may feel cheated for participation time
- Concern for confidentiality
- Disruptive members
- Not all pts benefit from group treatment
Physiological treatments:
Herbal treatments -
St johns wort
- Flower processed into tea or tablet
- May ___crease serotonin, norepinephrine, dopamine
- May treat mild – moderate ___________
Ginseng
- Stress and fatigue
Valerian root or chamomile
- Insomnia, depression, stress/anxiety
SamE
- Depression
Exercise -
- Biological, social, and psychological effects
- Dampens HPA axis – though to be overly active in depression
- Alters levels of serotonin, dopamine, and norepinephrine
Other -
- Pet therapy
- Aromatherapy
- Acupuncture
Herbal treatments
St johns wort
- Flower processed into tea or tablet
- May increase serotonin, norepinephrine, dopamine
- May treat mild – moderate depression
Ginseng
- Stress and fatigue
Valerian root or chamomile
- Insomnia, depression, stress/anxiety
SamE
- Depression
Exercise
- Biological, social, and psychological effects
- Dampens HPA axis – though to be overly active in depression
- Alters levels of serotonin, dopamine, and norepinephrine
Other
- Pet therapy
- Aromatherapy
- Acupuncture
schizophrenia: positive symptoms
Disorganized or alterations in thought
- Thought blocking
- Thought deletion
- Thought insertion
__________ – reduction or stopping thoughts
_________ – believing that someone else has inserted thoughts into patients brain
_________ – believing that thoughts have been taken or are missing
Disorganized or alterations in thought
- Thought blocking – reduction or stopping thoughts
- Thought insertion – believing that someone else has inserted thoughts into patients brain
- Thought deletion – believing that thoughts have been taken or are missing
suicide treatment and management: _______
- be direct – ask the question
- discuss current crisis in pts life
- therapeutic comm
- active listening
- no judgment or advice
- build trust – be open and accepting
- coping strategies – past successful or new coping
- identify protective factors
- involve social supports
- educate pt on safety plan and how to use in crisis
- provide resources and provider in community to continue care
support
Schizophrenia
_________ symptoms
- Disorganized or alterations in speech
o Circumstantiality
o Clang association
o Echolalia
o Flight of ideas
o Looseness of association
o Neologisms
o Pressured speech
o Tangentiality
o Word salad
positive
Physiological treatments:
Electroconvulsive therapy (ECT)
Risks and adverse reactions
- Stress on_______ at seizure onset and up to 10 mins after
- Stress on ________
- Confused and disoriented several hours after – must reorient frequently
- Retrograde amnesia – loss of memory of events ____________ treatment
Risks and adverse reactions
- Stress on heart at seizure onset and up to 10 mins after
- Stress on brain – increased cerebral oxygen, blood flow and ICP. Contraindicated for brain tumors and subdural hematomas
- Confused and disoriented several hours after – must reorient frequently
- Retrograde amnesia – loss of memory of events leading up to an including treatment
suicide prevention
- know _____ factors and ______ signs
- ______ individuals for suicide risk – ask directly
- identify ______ factors, develop safety plan, reduce access to lethal means
- provide individuals with ______ for suicide prevention
- create community based systems to response to suicide risk
suicide prevention
- know risk factors and warning signs
- screen individuals for suicide risk – ask directly
- identify protective factors, develop safety plan, reduce access to lethal means
- provide individuals with resources for suicide prevention
- create community based systems to response to suicide risk
schizophrenia: positive symptoms
- Persecutory
- Control
- Somatic
- Erotomanic
- Referential
- Grandiose
- Nihilistic
- Religion
- Delusions
_________ - false beliefs despite lack of evidence to support them and aren’t corrected with reasoning
________ – believes they are being watched, potted against, ridiculed
_________ – believes events are somehow related to them even though they really have no connection to them
_________– believe they are a powerful important person
________ – believes another person romantically desires them
________ – delusion of nonexistence, believes mind, body, world, no longer exist
________ – believes that their body is changing in unusual ways
________ – believes that another person or external force controls their thoughts, feelings, impulses, behaviors
________ – believes they have a special relationship with God, or on a mission for God, or that they are sinners
Delusions - false beliefs despite lack of evidence to support them and aren’t corrected with reasoning
- Persecutory – believes they are being watched, potted against, ridiculed
- Referential – believes events are somehow related to them even though they really have no connection to them
- Grandiose – believe they are a powerful important person
- Erotomanic – believes another person romantically desires them
- Nihilistic – delusion of nonexistence, believes mind, body, world, no longer exist
- Somatic – believes that their body is changing in unusual ways
- Control – believes that another person or external force controls their thoughts, feelings, impulses, behaviors
- Religion – believes they have a special relationship with God, or on a mission for God, or that they are sinners
_________ roles of group members
- Aggressor - Criticizes and attacks others’ ideas and feelings
- Blocker/oppositional - Disagrees with and halts group issues
- Recognition seeker - Seeks attention by boasting and discussing achievements
- Play person
- Dominator
Informal roles of group members
5. Informal roles of group members
- Aggressor - Criticizes and attacks others’ ideas and feelings
- Blocker/oppositional - Disagrees with and halts group issues
- Recognition seeker - Seeks attention by boasting and discussing achievements
- Play person
- Dominator
metabolic syndrome is associated with _____ antipsychotics and are a _________, of the whole classification of medications.
atypical antipsychotics have the same potential side effects as the typical antipsychotics, but _______ antipsychotic side effects are usually fewer, milder, and better tolerated.
For example, both atypical and typical antipsychotics have the potential to cause EPS, but patients taking _______ antipsychotics are less likely or are at a lower risk for developing EPS than the patients taking ________ antipsychotics.
metabolic syndrome is associated with all antipsychotics and are a disadvantage, of the whole classification of medications.
atypical antipsychotics have the same potential side effects as the typical antipsychotics, but atypical antipsychotic side effects are usually fewer, milder, and better tolerated.
For example, both atypical and typical antipsychotics have the potential to cause EPS, but patients taking atypical antipsychotics are less likely or are at a lower risk for developing EPS than patients taking typical antipsychotics.
