Week 4: CH 26,27 Flashcards
Understanding psychopathology requires the following standards…
- Knowledge should be organized.
- Operational definitions should be formed.
- Criteria for diagnosis should be developed.
What are the 5 axes?
Axis I: Clinical disorders
Axis II: Personality or developmental disorders
Axis III: General medical conditions
Axis IV: Psychosocial and environmental problems
Axis V: Global assessment of functioning
How can the behaviors be presented?
EIther observed directly or reported by the patient.
What is the etiology?
Mental disorders arise from nature or from nurture.
What are the guidelines for psychotherapeutic management?
Provide support for patients. Strengthen patients' self-esteem. Treat adult patients as adults. Prevent failure or embarrassment. Treat patients as individuals. Provide reality testing. Handle hostility therapeutically. Be calm and matter of fact about norms and limits.
What is psychosis?
A mental state in which individual struggles to distinguish external world from internally generated perceptions Common symptoms: -Hallucinations -Delusions -Disorganized thinking
What are the 3 inescapable facts about schizophrenia?
- High probability it will become apparent in late adolescence or early adulthood
- Stress plays a role in onset and relapse
- Antipsychotic drugs therapeutically effective
What are the elements of recovery?
Hope Secure base Supportive relationships Empowerment and inclusion Coping strategies Coping with loss Meaning
What are the 10 keys to recovery from schizophrenia?
- Family relationships
- Substance abuse
- Duration of untreated psychosis
- Initial response to medication
- Adherence to treatment
- Supportive therapy
- Cognitive abilities
- Social skills, negative symptoms…
- Personal history
- Access to care
What is schizophrenia?
Major psychotic disorder Characterized by disturbances in: -Perception -Feeling -Thought processes -Reality testing -Attention -Motivation
What are the types of schizophrenia?
Positive (type I)
-Related to hyperdopaminergic process
-Has favorable response to typical antipsychotics
Negative (type II)
-Related to structural changes in the brain and hypodopaminergic process
-Responds best to atypical antipsychotics
What are the objective signs of schizophrenia?
Alterations in personal relationships
Alterations in activity
What are the subjective signs of schizophrenia?
Altered perceptions
Alterations of thought
Altered consciousness
Alterations of affect
Explain the etiology; the biologic theories.
Dopamine hypothesis: excessive dopaminergic activity in limbic areas cause acute positive symptoms of schizophrenia.
Drugs that increase dopamine can cause a psychotic state.
Explain the etiology; the neurostructural theories.
Increased ventricular brain ratios: enlarged ventricles. Not all patients have abnormally enlarged ventricles.
Brain atrophy: brain cell loss. Anatomic pathology in cortical and subcortical areas. changes in limbic, hippocampus, thalamus, temporal lobes, amygdala, substantial nigra.
Decreased cerebral blood flow: decrease in metabolic activity (organizing, planning, learning from experience, problem solving, introspection, and critical judgement are compromised).
Explain the etiology; genetic theories.
Relatives with schizophrenia have a greater incidence of the disorder than chance alone would allow. Almost every chromosome has been linked to schizophrenia.Monozygotic twins have shown a higher concordancy rate.
Explain the etiology; perinatal risk factors.
Prenatal exposure to influenza, birth during the winter, prenatal exposure to lead, minor malformations developing in early gestation, exposure to viruses from house cats, and complications of delivery, especially during labor and delivery.
Explain the etiology; psychodynamic theories.
Focus on the individual’s response to life events.
Explain the etiology; developmental theories- Freud
Seeds of mental health and illness are sown in childhood. Events early in life can cause problems that are as severe as schizophrenia.
Explain the etiology; developmental theories- Erikson
The first step of trust vs. mistrust in crucial to later interpersonal relationships.One is is deprived or neglected of a nurturing, loving environment or is neglected or rejected is vulnerable to mental disturbances. Inadequate passage through the first stage = mistrust, isolative behaviors, and other asocial behaviors.
Explain the etiology; developmental theories- Sullivan
Absence of warm, nurturing attention, during the early years blocks the expression of these same affective responses in later years.
Explain the etiology; family theories
The family is significant to the development of mental health or illness. Lack of a loving and nurturing primary caregiver, inconsistent family behaviors, and faulty communication patterns.
Explain the etiology; vulnerability-stress model
Recognizes that both biologic and psychodynamic predispositions, when coupled with stressful life events can precipitate a schizophrenic process.
What is the continuum of care for people with schizophrenia?
- Acute symptoms—Hospitalization
- Treatment-resistant—Long-term hospitalization
- Stable but chronic—Day treatment
- Some level of supervision—Supportive housing for those who cannot live with family
What is the psychotherapeutic management?
Aimed at helping patients become stronger than their symptoms
- Psychotherapeutic nurse-patient relationship
- Psychopharmacology
- Milieu management
Developing a Therapeutic Nurse-Patient Relationship
- Be calm
- Accept patients as they are
- Keep promises
- Be consistent
- Be honest
- Do not reinforce hallucinations or delusions
- Orient patients to time, person, and place, if indicated
- Do not touch without warning
- Avoid whispering or laughing when patient cannot hear
- Reinforce positive behavior
- Avoid competitive activities
- Do not embarrass patients
- Begin with one-to-one interactions
- Allow and encourage verbalization of feelings
Psychopharmacology
Antipsychotics are the drugs of choice.
Note– Asians and Hispanics might need less antipsychotic meds than Caucasians to achieve desired blood level
Nursing interventions to increase compliance
- Observe patients for side effects and intervene accordingly. Akathisia is a troubling side effect that patients cannot tolerate.
- When giving tablets or pills, make sure patients do not check the medications (hide them) to spit them out or hoard them for later.
- Teach patients and their families about drugs, including side effects, potential interactions, and dosage schedules when discharged.
- Depot drugs are effective for patients who do not comply with drug therapy.
What are the neurotransmitters and related mental disorders?
increase in dopamine=schizophrenia
decrease in norepinephrine=depression
decrease in serotonin=depression
decrease in acetylcholine=Alzheimer’s disease
decrease in GABA=Anxiety
increase in glutamate=excitotoxicity-neuronal death
decrease in glutamate=psychotic thinking
What are the results of activiating and antagonizing serotonin receptors?
Activation: antidepressant effect, anxiety, migraine headaches, nausea, vomiting, other GI disturbances, sexual dysfunction, decrease in penile erection capability, reduced appetite and weight loss, insomnia, movement disorders, temperature dysregulation, psychotic thinking.
Antagonist: depression, dysthymia, suicidality, aggressiveness, obsessive thinking, sleep-wake cycle disruption, pain, compulsive behavior, anxiety, migraine headaches, panic.
What are the results of activating and antagonizing acetylcholine receptors?
Activation: pupil contraction, decreased heart rate, constriction of bronchi, increased respiratory secretions, increased voiding, salivation, increase gastric secretions, increased defecation, sweating, enhancement of cognitive processes.
Antagonist: dilated pupils, increased heart rate, dilation of bronchi, decreased respiratory secretions, decreased voiding, dry mouth, decreased gastric secretions, constipation, decreased sweating, cognitive slowing
What are the results of activating and antagonizing norepinephrine receptors?
Activation: antidepressant effect, vasoconstriction, increased heart rate, bronchial dilation, other physical effects.
Antagonist: depressive effect, vasodilation, decreased heart rate, sexual dysfunction, other physical effects
What are milieu management principles for disruptive patients?
- Set limits
- Decrease stimuli
- Observe for escalating behavior
- Minimize potential weapons
- Be judicious when developing consequences
- Invoke consequences when violations occur
- Provide for patient safety when restraints are necessary
What are the milieu management principles for withdrawn patients?
- Arrange nonthreatening activities
- Arrange furniture around a table so patient must sit with someone
- Assist with decision making as appropriate
- Reinforce appropriate grooming and hygiene
- Provide psychosocial rehabilitation
What are the milieu management principles for people with hallucinations?
- Use distraction
- Discourage talking about the hallucinations
- Monitor TV selections
- Monitor command hallucinations
- Have staff members available to talk with patient about “real” things
What are the other psychotic disorders?
Schizoaffective and delusional disorder
Schizoaffective disorder: affective and schizophrenic symptoms, with substantial loss of occupational and social functioning. Either extremely depressed or elated.
Delusional disorder: Delusions have a basis in reality. Patients have never met the criteria for schizophrenia. Behavior of these patients is relatively normal except in relation to their delusions. If mood episodes have occurred concurrently with delusions, their total duration has been relatively brief. Symptoms are NOT direct result of a substance induced or medical condition.
What are the other psychotic disorders?
Brief psychotic and Schizophreniform disorder
Brief psychotic disorder: last less than 1 month and are not related to a mood disorder, a general medical condition, or a substance-induced disorder. Must contain 1 of the following: delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior.
Schizophreniform disorder: symptoms typical of schizophrenia and last at least 1 month but no longer than 6 months.
