Week 3 Flashcards
what is psychosis
- used to describe conditions that affect the mind, in which people have trouble distinguishing between what is real and what is not
describe symptoms of psychosis (4)
- affect the way a person thinks, feels, and behaves
- varies greatly from person to person
- can come on suddenly or gradually
- categorized as positive or negative
what are positive symptoms of psychosis?
- symptoms that add to or distort the peron’s normal functioning
list examples of positive symptoms of psychosis (3)
- delusions
- hallucinations
- disorganized speech, thoughts, or behaviors
what are negative symptoms of psychosis
- symptoms that involve normal functioning becoming lost or reduced
list examples of negative symptoms (5)
- restricted emotional and facial expression
- restricted speech and verbal fluency
- difficulty w generating ideas or thoughts
- reduced ability to begin tasks
- reduced socialization and motivation
what are causes and risk factors of psychosis (5)
- genetic factors
- stressful events
- substance use
- imbalance in brain chemicals
- mental and physical disorders
what is the Mental Health Act of Manitoba (MMHA)
- sets out in law the admission and treatment requirements for pts in psychiatric facilities
the Act aims to strike a balance between 2 sets of principles:
- the rights given to all citizens under the Canadian Charter or Rights and Freedoms
- society’s obligation to provide care and treatment to those individuals who, at times, may not appreciate their need for treatment due to their mental illness (may not feel they need care)
persons admitted to a psychiatric facility are either: (2)
- voluntary
2. involuntary
i am not including cards on all of the individual forms because she said we did not need to know them all for the final, just understand the general process. plus, worse comes to worse it’s an open book exam
…..
patients have the right to…
- know the reason for being detained
- communicate, via phone and mail, with the provincial ombusdsman, patient rep, and mental health advocate
- retain counsel (lawyer) without delay
- apply to the mental health review board
- appeal any decision made by the review board, by applying to a manitoba court
what are some potential issues in voluntary treatment for the patient? (10)
- trauma
- feeling like rights are taken away
- feeling coerced
- feel don’t need to be there
- feel bretrayed
- blame family or police
- anger
- embarassment
- feel part of a conspiracy, may play into their delusions
- may feel relieved
what are some potential issues in involuntary treatment for the family (5)
- guilt
- ashamed
- relieved
- feel conflicted
- frustration
what are some potential issues w involuntary treatment for HCP
- ethical dilemas
- concerns for safety
- feel conflicted
- stigma (concious or subconscious)
- frustration if pt uncooperative
what does not criminally responsible (NCR) mean
- no person is criminally responsible for an act committed or an omission made while sufferring from a mental disorder that rendered the person incapable of appreciating the nature & quality of the act or omission or of knowing it was wrong
- under the Criminal Code of Canada
if an individual is found NCR, what happens?
- become under the forensic care system
describe bill 5 - amendment to the mental health act
- strikes out “serious and immediate threat” and substitued “risk of serious harm”
- under the MHA, the medical director of a psychiatric facility may disclose info in a clinical record to any person to prevent or less a risk of serious harm to the pt’s health or safety or that of another person
what is trauma
- a traumatic event involves a single experience or enduring repeated or multiple experiences, that completely overwhelm the individual’s ability to cope or integrate the ideas & emotions involved in the experience
- it is not the event that determines whether something is traumatic, but the individuals experience and meaning they make of it
what is trauma informed care (TIC)
- a program, organization, or system that is traum-informed realizes the widespread impact of trauma & understands potential paths for recovery
- recognizes the signs and symptoms of trauma in pts, families, staff, and others involved w the system
- responds by fully integrating knowledge about trauma into policies, procedures, and practices & seeks to actively resist re-traumatization
what are the 6 broad principles of TIC
- safety
- trustworthiness & transparency
- peer support
- collaboration & mutuality
- empowerment, voice, and choice
- cultural, historical, and gender issues
describe the principle of safety r/t TIC
- is everything being done to ensure the client’s physical and emotional safety?
describe the principle of trustworthiness and transparency r/t TIC
- are expectations and interactions for everyone clear & consistent?
- boundaries, respect, non-judgemental approach
describe the principle of peer support r/t TIC
- those w lived experiences can be critical resources for support
describe the principle of collaboration & mutuality r/t TIC
- members of the organization can contribute equally
describe the principle of empowerment, voice, and choice r/t TIC
- developing plans of actions that require patient-centered approaches and empower clients
describe the principle of cultural, historical, and gender issues r/t TIC
- culturally sensitive, free of biases, and stereotypes
what type of care is done r/t TIC
- least restrictive care
why is least restrictive care important (3)
- when seclusion, restraints are used we add to the trauma experienced by the pt & may traumatize/re-traumatize a pt
- safety first: pt needs to feel safe
- many pts on psychiatric units have histories of abuse
what is TIC strategy to eliminate seclusion & restraint
- developing a personal safety plan
what is included w a personal safety plan
- triggers
- self-management
- distractions
- prevent & plan
what are some questions to ask ASAP to help develop a personal safety plan? (5)
- what helps you stay calm? what works & what doesnt?
- trauma history: how can we avoid revisiting past traumatic experiences?
- what upsets you?
- what are some signs that you are getting upset?
- would you be willing to speak to one of the staff if you were feeling upset?
what is seclusion
- voluntary or involuntary confinement of a pt alone in a room locked from the outside for care and treatment
what are the indications for seclusions/restraints (4)
- only in emergencies when danger is imminent (whether voluntary or involuntary status)
- only when the behavior of the person presents a greater risk than the risks associated w using these practices
- to help the pt re-establish behavior control
- only when all other less restrictive measures (ex. meds) have proven ineffective and should be used for the least amount of time
what is key after a restraint has been used?
- debriefing
who should be debriefed after a restraint has been used
- the person affected
- the staff
- other pts or visitors if appropriate
describe debriefing after a restraint has been used
- a chance to reflect, learn, and to modify the care plan to prevent recurrence
- important in the context of recovery
a comprehensive assessment includes:
- complete health history
- physical exam
- considers the psychological, emotional, social, spiritual, ethnic, and cultural dimensions of health
- attends to the meaning of the client’s health & illness experience
- evaluates how all of this affects the individual’s daily living
what are some sources & types of data collected during data collection (9)
- objective data
- subjective info (pt interview)
- physical exam
- mental status assessment
- pharmacological
- history of present illness
- psychiatric history
- history of substance use/abuse
- collateral info (with consent ex. family)
what is the mental status exam
- systematic assessment of the individuals affect, behavior, and cognitive processes
what is included w the mental status exam (2)
- interdisciplinary
- includes both objective and subjective data collection
why is the mental status exam important
- provides info for assessment, diagnosis, and response to treatment
what are some various approaches to conduct the mental status exam (3)
- formal interview
- use of a form
- general observations
what are the components of the mental status exam (MSE) (8)
- general observations (appearance, behavior, manner of relating)
- speech characteristics
- mood & affect
- thoughts content and process
- perception
- sensorium/cognition
- insight
- judgement
what is observed r/t general appearance in the MSE (6)
- general description (age, sex, race, body build, estimated height, hair color)
- dress (describe, is it appropriate)
- grooming/hygeine (well maintained? poor?)
- manner or attitude of relating (cooperative, friendly, hostile, suspicious?)
- distinguishing features
- lvl of alertness (alert? drowsy?)
what should be observed r/t behavior in the MSE (6)
- motor behavior
- use of eye contact
- movements, gait
- any indications that reveal mood & emotional state
- is behavior organized or disorganized? (can the pt follow thru with an activity)
- are there signs of irritability/agression/potential for physical violence?
what could be observed r/t motor behavior in the MSE (4)
- psychomotor retardation
- agitation
- catatonia
- hyperactivity
speech is assessed and describe in the MSE based on? (3)
- quantity
- rate and fluency of production
- quality
what is pressured speech
- rapid speech that is increased in amt and difficult to interpret
- seen in mania
define mood
- subjective emotion experienced by the pt
- based on self-report
how can we assess mood in the MSE
can ask directly:
- how do you feel right now?
- can you describe your mood?
- how have you been feeling over the past while?
- can you rate your mood on a scale of 1 to 10, with 1 being deeply depressed and 10 being extremely happy?
define affect
- objective assessment
- the prevailing emotional tone
- what we see
how can we assess affect (4)
consider:
- range (variation?flat?)
- intensity
- appropriateness
- stability
what is the stability of affect
the duration of an affective response
define labile affect
- rapid, extreme mood swings
how is thought assessed in the MSE
- assess thru language in terms of its content and process
what is thought content
- refers to the subject matter occupying a person’s thoughts
what is thought process
- the manner in which thoughts are formed and expressed
what should be assessed regarding thought content (8)
- risk assessment
- delusions
- poverty of thought
- obsessions
- depersonalization
- what concerns does the pt have
- ideas, preoccupations, fears?
- major themes?
what should be assessed in a risk assessment
- suicidal/deliberate self-harm
- homicial ideation
a suicide risk assessment involves garnering specific details regarding.. (3)
- suicidal ideation
- threats of suicide
- suicide attempt
what questions should be asked regarding suicide risk assessment
- do you currently think about harming or killing yourself? if yes…
- do you have a plan for how you might kill yourself? if yes ask for details
- have you ever tried to harm or kill yourself? if yes…
- do you have the things you need to carry out this plan?
- have you made preparations around your death?
- what does the future hold for you?
what questions should be asked regarding suicide risk assessment
- do you currently think about harming or killing yourself? if yes…
- do you have a plan for how you might kill yourself? if yes ask for details
- have you ever tried to harm or kill yourself? if yes…
- do you have the things you need to carry out this plan?
- have you made preparations around your death?
- what does the future hold for you?
what questions should be asked regarding homicidal ideation
- do you thoughts about harming someone? if yes
- inquire about a plan
- probe for further details
what questions might you ask to assess delusions? (5)
- is what the client talks about seem based in reality or evidence of delusional thinking?
- do you spend a lot of time thinking about 1 or 2 things?
- do you have some ideas that you hold very strongly?
- do others frequently disagree with your point of view?
- do you think someone is controlling you mind or putting thoughts in your head?
what is thought insertion
- type of delusion
- thinking that someone is putting thoughts into your mind
what is thought broadcasting
- type of delusion
- thinking that everyone can hear what you’re thinking
what are ideas of reference
- type of delusion
- personalizaing/misinterpreting
- thinking things are specifically about you
what are grandoise delusions
- an inflated belief in one’s importance
ex. thinking you are god
what are nihilism delusions
- believe that they are invisible and inaudible to people around them
- persistent beliefs that a subject does not exist or is dead
what is poverty of thought
- the mental state of being devoid of thought & having a feeling of emptiness
what are obsessions
- a repititive thought, emotion, or impulse
what is depersonalization
- the belief that one’s self or one’s body is strange or unreal
define thought processes
- involves the flow and organization of thoughts
- manner in which thoughts are formed and expression
what questions can be asked to assess the pt’s thought process (3)
- have you noticed any changes in your thinking
- have your thoughts slowed down
- are you experiencing “racing” thoughts
what are examples of thought process disturbances (10)
- loose associations
- flight of ideas
- tangentiality
- circumstantiality
- perseveration
- echolalia
- word salad
- clang association
- neologisms
- thought blocking
what are loose associations
- when there is no connection between thoughts
- shift between topics
ex. “my boss is angry w me and it isnt even my fault. i saw that movie too, Lassie. I felt rlly bad about it… etc.”
what is a flight of ideas
- when there is a form of connection between thoughts but doesnt rlly make sense
ex. i read passages, i read areas, chapters, I dont have the time. when was the last time I watched a baseball game? I’m watching you all the time”
what is tangentiality
- frequent digression —–> but does not answer
what is circumstantiality
- excessive detail —> answers eventually
what is perseveration
- a persistent response
what is echolalia
- unsolicited repetition of vocalizations made by another person
ex. you greet a new pt saying “how are you feeling today?” he replies “today? feeling today? how are YOU feeling today?”
what is word salad
- a confused or unintelligible mixture of seemingly random words and phrases,
what is clang association
- groups of words chosen because of the catchy way they sound, not because of what they mean.
ex. my feet are cold. cold, bold, told. the bell tolled for me.
what are neologisms
- made up words
what is thought blocking
- loses trains of thought
what are 2 examples of altered perception
- hallucinations
- illusions
what is a hallucination
- false sensory perception
what are examples of types of hallucinations (5)
- auditory
- visual
- olfactory
- gustatory
- tactile
what is an illusion
- misinterpreting a sensory input ( an actual object is present)
what are some questions to ask to assess perception
- do you hear anything that others do not?
- do you ever see things that others do not?
what are some observations to assess perception
- if the pt is talking/laughing to themselves
what are command hallucinations
- hallucinations (ex. voices) that tell the pt to harm themselves or others
what should be assessed regarding sensorium/cognition for the MSE (5)
- LOC
- orientation to time, person, place
- memory
- attention span & concentration
- abstract thinking
what should be assessed r/t memory in the MSE
- recent –> list 3 items, see if can remember
- remote –> ex. what highschool went to
how can attention span & concentration be assessed for cognition
- ask: do you have any difficulty concentrating
how can abstract thinking be assessed
- proverbs
ex. what does not crying over spilled milk mean
describe how to assess insight
- does the client have awareness & understanding of their present situation?
- what is their thinking around their hospitalization or situation?
describe how to assess judgement
- is the client able to make constructive/adaptive or good decisions?
- impulse control?
