Week 10: Psych Flashcards
1
Q
Hippocrates “four humors”
A
- Irritable and hostile (yellow bile)
- Pessimistic and melancholic (black bile)
- Overly optimistic and extraverted (blood)
- Apathetic (phlegm)
2
Q
“Moral Insanity”
A
1801: Irrational behavior with an intact intellect
3
Q
The Healthy Personality- Positive Relationships
A
- Closeness with others
- Maintain separate identities
- Open communication of feelings
- Valued but separate relationships
- Empathic acceptance
4
Q
Adaptive/Maladaptive Social Response continuum
A
Adaptive Response
- Solitude
- Autonomy
- Mutuality
- Interdependence
Middle of the Road
- Loneliness
- Withdrawal
- Dependence
Maladaptive Social Response
- Manipulation
- Impulsivity
- Narcissism
5
Q
Personality Disorder (definition)
A
- Set of patterns/traits that hinder the ability to maintain meaningful relationships, feel fulfilled and enjoy life (Stuart, 2012)
- Enduring pattern of inner experience and behavior that is pervasive and inflexible
- Prevalence estimates 4%-22% population
- Not exclusive to one gender
- Often comorbid with substance use disorders
- Continuous rather than episodic
- Frequently not diagnosed
- Few strategies for relating to others
- Infrequently treated as primary illness
- Problems with impulse control, judgment, reality testing, self-perception, mood, social and interpersonal functioning
- Approach to relationships is inflexible and maladaptive
- Behaviors provoke negative reactions from others
- Adaptation is tenuous- low resilience in stressful situations
- Inflexible and pervasive
6
Q
Etiology Personality disorder Biological
A
- Genetic influences
- Disturbances in neurotransmitters
7
Q
Etiology Personality Disorder Sociocultural
A
- Cultural influences
- High levels of crime and violence
- Immediate gratification
- Displaced aggression
8
Q
Etiology of Personality Disorders: Psychodynamic origins
A
ego development and object-relations
- difficulty with separation-individuation stage of development (1.5 -3 yrs)
- issues with abandonment, dependency, control and authority
- Most widely accepted theory
9
Q
Personality disorders 3 clusters
A
- Cluster A: ECCENTRIC: paranoid, schizoid, or schizotypal (not schizophrenic, personality styles in which people are essentially withdrawn from others, interact with people in a very odd and incomfortable way)
- Cluster B: ERRACTIC: (most frequent) antisocial (there are rules for other people but not for me), borderline (most frequently occuring), histrionic (very wide range of expressive behaviors. Makes a mountian out of a molehill), narcissistic
- Cluster C: FEARFUL (absolutely avoids others): avoidant, dependent (unable to functionwithout the support and guidance of somebody else), o_bsessive-compulsive_ (personality style in which the person’s obsessions or compulsions occupy a significant amount of time, not associated with anxiety)
10
Q
Borderline Personality Disorder
A
Pervasive instability with 5 or more:
- Efforts to avoid abandonment
- Unstable interpersonal relationships
- Unstable self image
- Impulsivity that is potentially damaging
- Recurrent self-mutilating behavior
- Affective instability
- Chronic feelings of emptiness
- Inappropriate anger
- Transient paranoia
11
Q
Interaction Patterns- Assessment (borderline personality disorder)
A
- Poor impulse control (ex: decide to cut at the drop of a hat because their friend cancelled a lunch date. Can’t handle potential or actual abandonment)
- Affective instability
- Judgment
- Projection
- Distorted self-perception
- Clinging and distancing
- Expert in “splitting”
- Expert in manipulation
- Acting out behaviors
12
Q
Case study Multi-Axial Dx
- 29 year old single woman
- Suicidal after her boyfriend broke up with her w 2 weeks ago after a very stormy year together
- History of on and off, very good or very bad relationships
- Drinking many martinis and using diazepam (Valium)
- Began stalking ex, threw a rock through his window
- Agitated and screaming “I just want to die” then ran into the street in front of an oncoming car
- Taken to emergency department and admitted with pelvic and femur fractures and various lacerations
A
Multi-Axial Diagnosis
Axis I
Substance use disorder
Axis II
Borderline personality disorder
Axis III
Pelvic fracture, femur fracture, lacerations
Axis IV
Problems with primary support group (boyfriend)
History of unstable relationships
Axis V
Current GAF 30, highest in last year, 60
13
Q
Concept Mapping for this individual
- 29 year old single woman
- Suicidal after her boyfriend broke up with her w 2 weeks ago after a very stormy year together
- History of on and off, very good or very bad relationships
- Drinking many martinis and using diazepam (Valium)
- Began stalking ex, threw a rock through his window
- Agitated and screaming “I just want to die” then ran into the street in front of an oncoming car
- Taken to emergency department and admitted with pelvic and femur fractures and various lacerations
A
#1 Risk for self harm
- Related to: parental emotional deprivation, history of unsatisfying relationships
- As evidenced by: recent history of self harming episode
Goal: The patient will not harm herself during this shift.
Interventions
- Frequent observation
- Contract
- Self harm episodes are dealt with in a matter of fact manner
- Discuss feelings as they occur
- Act as a role model
- Environmental vigilance
Evaluation:
Outcome: there will be no self harming behaviors during this shift
- No harm has occurred
- Seeks out staff when desire for self mutilation occurs
#2 Impaired social interaction
- Related to: fears of abandonment
- As evidenced by: lack of close friendships, staff splitting, blaming and recent breakup
Goal: The patient will engage in therapeutic interaction with the nurse for ten minutes twice during this shift
Nursing Intervention
- Examine and identify clinging/distancing behaviors
- Reinforce availability for 1:1 interaction
- Reinforce independent functioning
- Skilled staff members
- Explore abandonment
- Discourage dependency behaviors
Evaluation
Outcome: no clinging/distancing behaviors
- Independent with ADL
- Interacts with more than one staff member
- Fewer or no manipulative behaviors
- Accepts feedback and changes behavior
Nursing Concerns
- Risk for violence, directed at others, self
- Self-esteem disturbance
- Noncompliance with milieu structure
- Personal identity disturbance
- Substance abuse diagnoses
- Care for the nurse
14
Q
Limit Setting
A
- Specific boundaries so that significance of deviations
- can be immediately processed
- Contracting defines limits
- Designated team member delivers communications
15
Q
Medicines and borderline personality disorder
A
- aren’t medicines to fix, but can treat symptoms
- Depressed: anti-depressants
- Mood Stabilizers: Depakote, Lamictal
- Antipsychotics: Most usually inappropriate because these aren’t psychotic symptoms
- Anxiolytic Drugs: Very often used, can spell trouble because of the addiction. Would recommend Benzo’s such as Ativan or *Klonapin (long acting and least abuseable, helpful in small doses).
16
Q
4 Big problems of Older Adults
A
- Depressive Disorders
- Dementia
- Delirium
- Dying
17
Q
Depression
A
- Often comorbid with other physical illness
- Depressed persons frequently diagnosed and treated by primary care providers, cases are undertreated, or untreated (Wang, 2005)
- 58% of older adults believe depression is a normal event for this demographic
- Resistant to seeking treatment due to stigma
- Insidious problem
- Neurovegetative signs (undereating, no energy, no sleep, inability to concentrate) interfere with general health and influence other health problems
- Depression can mimic dementia
- Symptoms include lack of interest, social withdrawal, anxiety, chronic aches and pains, increased dependency
- Evidence points to depression as etiologic in stroke, cancer, epilepsy
18
Q
Depression is not
A
- Part of “normal” aging
- Inevitable
- Untreatable
19
Q
Suicide in Older Adults
A
- Older adults account for 15.7% completed suicides
- Males >75 have the highest suicide frequency: 14.7 per 100,000
- Individuals who complete suicide have seen a primary care giver within 6 weeks prior
- Firearms are the most common means (71.9%)
20
Q
Older Adult Suicide Risk Factors
A
- Recent death of a loved one
- Physical illness- fear of prolonged illness
- Uncontrolled pain
- Perceived poor health
- Social isolation
- Major changes in family, social, or occupational roles
21
Q
Depression Assesment Instruments
A
Assessment instruments specifically for older adult depression diagnosis
*Two-Question Screen for Depression: Patient Health Questionnaire 2 (PHQ-2)
- During the last 2 weeks have you been often bothered
- By having little interest or pleasure in doing things yes, no
- By feeling down, sad or hopeless yes, no
22
Q
Interventions for Older Adult Depression
A
- Most often provided by primary care professionals
- Most often treated with medication alone
- Medication alone is less effective treatment than when combined with psychotherapy
- One major episode after age 60 = treatment for life is indicated
23
Q
Nursing Interventions for Older Adult Depresssion
A
- Therapeutic alliance
- Support system
- Suicide assessment- ask the question
- Community services
- Health assessment
- Monitoring of medications- depressogenics
- Psychotherapy
- Living arrangements
- Maximize autonomy
24
Q
Dementia in Older Adults
A
- Not part of normal aging
- From the Latin “demens”
- Umbrella term for chronic condition
- Chronic and progressive in nature
- Alzheimer’s type
- Traumatic Brain Injury
- Multi-Infarct
25
Q
Alzheimer’s Dementia
A
- Chronic, progressive, irreversible
- Current treatment is not curative, but minimally effective in slowing progression
- Loss of premorbid cognitive and intellectual abilities- slowly insidious
- Disorientation, memory loss, impaired judgment, decreased social functioning, personality change, labile mood
- Diagnosis at autopsy, prior to that dx is “Dementia- most probably of the Alzheimer’s type”
26
Q
Depressogenic Medications
A
- Antihypertensives
- Analgesics
- CNS depressants
- Antiparkinsons drugs
- Sulfonamides
- Cardiovascular agents (digitalis)
- Long Term Steroids
27
Q
Multi Infarct Dementia
A
- Stepwise downward progression
- Secondary to vascular disease or co morbid illness
28
Q
Traumatic Brain Injury
A
- As a result of accident or violence
- Specific impairments dependent on injury site
- Improvements are possible
29
Q
Dementia/Assessment
A
Standardized screening instruments administered by nurses-
- Folstein Mini Mental Status Examination (old gold standard. Don’t use much anymore bc it’s copywritten. Score out of 30)
- Clock Drawing Test
- Montreal Cognitive Assessment (This is the new gold standard. Score of 27 or less deonstrates some impairment)
30
Q
Symptoms/Changes you see in dimensia
A
- Attention
- New learning
- Memory
- Language
- Visual perception
- Emotional Regulation
31
Q
Nimenda
A
Effects neurotransmitters in the synapse to help slow the progression of dimensia. Left on unless we have to stop: Can’t tolerate due to side effect (agitation, sleeplessness, bad stomach upset), Running out of Money. If medicine is stoped, you might see a steep functional decline.
32
Q
Dementia/Intervention
A
- Accommodate physical impairments
- Create therapeutic alliance
- Integrate verbal and nonverbal communication
- Use all the senses
- Involve significant others
- Facilitate story
- Clarify, verify, and revisit
- Community agencies
- Assess use of medications
- Living situation
33
Q
“Elderspeak”
A
- Over accommodation
- Monosyllabic wording
- Exaggerated intonation
- High pitch
- Volume
- Diminutives
34
Q
Common Errors when dealing with dimentia patients
A
- Arguing
- I know more than you know
- Criticizing
- Labeling
- I know what would be best
- Everything will be just fine
35
Q
Delirium
A
- Syndrome of disturbed consciousness, attention, cognition, and perception
- Complex interaction of physical health condition, cognitive functioning, and behavior
- Frequently 1st symptom of underlying illness
- Contributes to increased morbidity and mortality and longer illness episodes
- “House of cards” for frail older adults
- Acute onset syndrome
- Contributes to increased morbidity and mortality of older adults
- Longer hospital stays- complications of physical illness
- Occurs more frequently in older adults than in younger adults- possibly due to “frail brain” of the older adult
36
Q
Identification of delerium
A
- must understand baseline of pt. cognitive status
- Instruments designed to assess for delerium include Confusion Assessment Method: Onset is acute, inattention, someone who is disorganized, and has an altered level of conciousness)
37
Q
Delerium Acronym
A
- Drug- review meds
- Electrolyte imbalance
- Low oxygen (hypoxia)
- Infection
- Reduced sensory input
- Intracranial problem
- Urinary or fecal retention
- Myocardial problem
38
Q
Nursing Interventions for Delerium
A
Environment
- Close observation
- Lighting, noise
- Minimize stimulation, intervention
- Restraints, as a last resort
Physical/Sensory
- Touch
- Physical presence
- ADL
- Sensory aids
Cognitive
- Orientation, reorientation
- Explanation, reassurance
- Cueing/coaching
- “Making sense” of it
39
Q
Hope
A
- Meaning of hope
- “Fifth” vital sign
- Meaning of relief
- Resilience
40
Q
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