Week 7 - Exam 2 Flashcards
Psychosis occurs when clients lose touch with ______________. They may experience hallucinations and __________________.
reality, delusions
What causes psychosis?
- __________ - Conditions like schizophrenia, bipolar disorder, and major depressive disorder can cause psychosis.
2._____________ illnesses include CNS infections, brain tumors, strokes, Parkinson’s disease, and liver disease.
- ________________ can cause psychosis. Antiparkinsonian agents and corticosteroids are two common examples.
- _______________ can cause psychosis. Clients who abuse alcohol, amphetamines, marijuana, or LSD may experience psychosis
- mental disorders
- physical
- medications
- drug abuse
The three main categories of schizophrenia are:
1.
2.
3.
- positive symptoms
- negative symptoms
- cognitive symptoms
Positive symptoms include:
1.
2.
3.
4.
- hallucinations
- delusions
- bizarre behaviors
- altered speech
______________ are sensory perceptions of things that are not present or real
hallucinations
The most common type of hallucination associated with schizophrenia is __________________
auditory hallucinations
______________ hallucinations are rare in schizophrenia. When clients do experience these hallucinations, they often describe them as unclear or “shadowy.”
____________ are false, bizarre beliefs that clients hold onto firmly.
delusions
Examples of common delusions include:
1.
2.
3.
4.
5.
- delusions of control or influence
- delusions of grandeur
- delusions of persecution
- delusion of reference
- somatic delusions
Delusions of ______________ or influence - Belief that people control the thoughts or actions of the client (e.g., “The CIA has planted a tracking device in my brain that controls my thoughts and movements.”).
control
Delusions of ________________ - Fantastical belief about one’s identity, power, achievements, wealth, knowledge, etc. (e.g., “I am the Virgin Mary and I have God inside my womb.”).
grandeur
Delusions of ______________________ - Belief that others are trying to harm the client (e.g., “The FBI has sent an assassin to kill me.”).
persecution
Delusions of __________________ - Belief that neutral events have special, personal meanings to the client (e.g., “The meteorologist sends me coded messages during the evening news.”).
reference
______________ delusions - False, bizarre beliefs about the client’s body (e.g., “I have a third eye on my forehead. I cannot allow others to see or they might die.”).
somatic
Bizarre speech pattern example include:
1.
2.
3.
4.
5.
6.
- claim associations
- echolalia
- loose association
- neologism
- perseveration
- word salad
__________ associations - Choosing words based on sound rather than meaning (e.g., “I’m so bored. I’ve got to cut the cord so I can buy a new Ford and sharpen my sword.”).
claim
______________ is repeating the words or phrases of others for no apparent reason.
Loose associations - Extreme shifts to unrelated topics while speaking, greatly obscuring the client’s meaning (e.g., I came to the hospital when all the little birds and fishes kept singing their praises.”).
echolalia
Neologisms - Using newly invented __________ that have no meaning to others (e.g., “My new boss is a hankybroom.”).
words
____________ is persistently repeating the same word or idea no matter the topic of conversation (e.g., “I am Groot!”).
perseveration
_____________ - An extreme version of loose association. Spoken words have no connection to each other (e.g., “Fellow harp chairs easily told unto times past fountain head finishing.”).
word salad
Schizophrenia bizarre behaviors include:
1.
2.
3.
- catatonia
2.incongruent affect - repetitive or stereotyped behavior
______________ - Rigid or bizarre body postures (e.g., sitting in a statue-like state for long periods).
catatonia
Incongruent affect - Displaying an affect that doesn’t __________ the current situation (e.g., laughing hysterically when told one’s mother died).
match
________________ - Repeatedly performing an unusual behavior (e.g., twirling one’s hair in a dramatic fashion).
repetitive or stereotyped behaviors
Schizophrenia negative symptoms include:
1.
2.
3.
4.
5.
- affective flattening
- alogia
- anergy
- anhedonia
- avolition
Decreased emotional expression is ?
affective flattening
Decreased __verbal__________ communication is?
alogia
Lack of energy to carry out daily tasks is?
anergy
Loss of interest in pleasurable activities is?
anhedonia
Decreased motivation to engage in purposeful behavior is?
avolition
Schizophrenia often causes significant cognitive impairment. Clients may exhibit disordered thoughts/speech (loose associations, word salad), decreased ability to think abstractly (________________ thinking), attention deficits, and memory loss.
concrete
If symptoms have been present for less than one month, the diagnosis is?
brief psychotic disorder
If symptoms have been present for more than one month but less than six months, the diagnosis is?
schizophreniform disorder
It’s only after these disturbances have been present for ______ months that the diagnosis becomes schizophrenia.
6 months or greater
If a client has a primary diagnosis of schizophrenia and subsequently develops a mood disorder, the diagnosis is?
schizoaffective disorder
Some clients have delusions but lack all the other symptoms of schizophrenia. This is called?
delusional disorder
The lifetime prevalence of schizophrenia is 0.7%. _________ are at a slightly higher risk.
males
Bipolar disorder has a strong genetic basis. Excessive levels of the neurotransmitter ________________ play a major role in schizophrenia.
dopamine
Stabilized schizophrenic clients often benefit from social and independent living skills training. Modified ______ and family-based education are also important.
CBT
________ and __________-generation antipsychotics are the primary agents. A common side effect of first-generation antipsychotics is extrapyramidal symptoms
first, second
______________ hallucinations can easily lead to dangerous behaviors if the client has poor insight or believes the commands must be obeyed. In general, you should consider command hallucinations a potential psychiatric emergency. ⭐
command
Show empathy, but do not __________________ the hallucinations. For example, you might say, “That must be frightening for you to hear that. I do not hear those voices.” ⭐
reinforce
Assess for ________________ ideation. About 33% of clients with schizophrenia will attempt suicide at some point. About 10% will succeed.
suicidal
Individuals with personality disorders have difficulty ________________ to the needs of the moment
adapting
Inflexibility in clients with personality disorder causes significant ________________ to themselves and others. These problems cause them to ramp up these maladaptive thoughts, emotions, and behaviors, creating a vicious cycle.
distress
Schneider’s for Es of personality disorder
1.
2.
3.
4.
- early
- enduring
- egosyntonic
- externalization
Personality disorder clients have poor ______________. They believe others are the source of their distress. If they seek treatment, it is usually for a comorbidity (e.g., depression).
insight
The DSM-5-TR identifies ______ specific personality disorders that are organized into 3 clusters (A,B,C)
10
Cluster A disorders are characterized by odd or eccentric behaviors. They are sort of like mild, functional versions of __________________________.
schizophrenia
Cluster A Disorders include:
1.
2.
3.
- paranoid personality disorder
- schizoid personality disorder
- schizotypal personality disorder
_________________ clients are highly suspicious of others—even close companions. They stay on the alert lest someone try to sabotage them or take advantage. They are private and reveal little about themselves—someone could use personal information against them.
paranoid personality disorder
_______________ clients are reclusive and have very limited social interaction. They are not lonely or fearful of rejection. Rather, they have little interest in others. They prefer solitude. Others find them to be awkward and strange.
schizoid personality disorder
_______________ clients have disorganized speech and behavior. They are odd and eccentric. They do not have hallucinations or delusion, but they may engage in magical thinking and experience illusions (e.g., UFO sightings).
schizotypal personality disorder
Cluster B disorders are characterized by dramatic, emotional, and erratic behaviors. These clients have trouble respecting personal ____________________ and can cause significant distress to others. Antisocial and borderline personality disorders are the focus of this lesson.
boundaries
________________ clients are dramatic and love the spotlight. They usually dress _______seductively_____ and can be very flirtatious. Relationships are intense, but shallow and short-lived.
histrionic personality disorder
Cluster B disorders include:
1.
2.
- histrionic personality disorder
- narcissistic personality disorder
Cluster C disorders:
1.
2.
3.
- avoidant personality disorder
2.dependent personality disorder - obsessive compulsive personality disorder
___________________ clients are very _proud______ and outspoken about their talents and achievements. They are very preoccupied with themselves. Their interest in someone can be strong if they believe that person may help them get what they want. Just as quickly, their interest will vanish when that person is no longer needed. They are entitled.
narcissistic personality disorder
Cluster C disorders are characterized by ______________ emotions and behaviors.
anxious
Avoidant personality disorder - clients crave relationships but feel too awkward or inept to pursue them. They fear __________________ so much, they find it easier to avoid new relationships. Their only relationships are with a few old friends.
rejection
Dependent personality disorder - clients feel a desperate need to be __________ for and nurtured by someone else. They are needy, unassertive, and overly submissive. They have few interests of their own and view the world through other people’s eyes. They require lots of input or assistance when making ordinary __________________.
cared, decisions
Obsessive-compulsive personality disorder - clients are overly concerned with rules, order, and routines. They are true ____________________________ and have trouble delegating. They are usually stingy with money and have trouble throwing things away. They are inflexible in relationships; it’s their way or the highway.
perfectionist
Antisocial personality disorder clients had serious behavior problems starting in childhood (i.e., ______________ disorder).
conduct
Antisocial clients are charming when trying to ____________________ others. However, they have a low tolerance for frustration. If kindness doesn’t work, they quickly become violent and aggressive
manipulate
Sometimes the term ____________ is used to describe a more severe version of this antisocial disorder. These clients are extremely cold, predatory, and have no remorse for their terrible deeds. They prey on the weak, poor, elderly, and intellectually disabled.
psychopath
Psychotherapy is generally ineffective. ________ may help those with mild versions of antisocial personality disorder, who have good insight and are motivated to change.
CBT
__________ generation antipsychotics can treat severe aggression but there is no effective medication for antisocial personality disorder
second
Anti PD intervention: Remember to convey unconditional positive regard. Maintain the attitude that it is not the person but his or her ________________ that is unacceptable.
behaviors
Anti PD intervention:
Set clear ____________ on unacceptable and manipulative behavior. Remember to use a calm, matter-of-fact tone. Use clear, understandable terminology. Explain what the consequence will be if the limits are broken. Ensure consistency among staff in explaining and enforcing these limits.
limits
Anti PD intervention:
Clients with antisocial personality disorder often misuse the ego defense mechanism of ________________________. Help clients realize this and recognize the real source of their anger.
displacement
Anti PD intervention:
Ensure sufficient staff is available to present a “show of strength” if necessary. Remember to use the __________ restrictive means necessary.
least
BPD clients have intense fears of ______________________. Clients cling tightly to relationships.
abandonment
__________________ in BPD is a common ego defense mechanism. Clients handle feelings of rejection by vilifying the person that offended them.
splitting
BPD clients have high emotional ________________ (instability). Depression, self-mutilation, and suicide are common. They have poor impulse control. Substance abuse, gambling, promiscuity, and reckless driving are common.
lability
____________ behavioral therapy is the primary therapy for this disorder.
dialectical
BPD med such as _____________ can help treat depression. _____________ and mood stabilizers can treat emotional instability, impulsivity, and aggression.
antidepressant, antipsychotics
BPD intervention:
Clients with borderline personality disorder can be difficult to care for. Don’t allow yourself to have personal “triggers.” Monitor your thoughts and emotions. Watch out for _____________________.
contertransference
BPD intervention:
Remember that clients who have borderline personality disorder have strong fears of ______________________. They often exhibit clinging and distancing behaviors. Help these clients understand that you are available but do not promote dependent, clinging behaviors. Consider rotating staff members.
abandonment
BPD intervention:
Splitting is a primary ego defense mechanism of clients with borderline personality disorder. These clients tend to see people as either all ________ or all ________. One day someone may be the client’s favorite caregiver; the next day that same person may be the client’s sworn enemy.
good, evil
BPD intervention:
Encourage clients who engage in self-____________________ behaviors to seek out a team member if the urge returns. Remove dangerous objects and frequently monitor the client. Remember on exam questions that goals related to safety and injury are usually the ______________ priority.
mutilation, highest
BPD intervention: Encourage clients to __________________ painful emotions.
express
BPD intervention:
If self-mutilation occurs, do not __________________ the behavior by giving lots of sympathy or showing lots of interest in the wounds. Instead, matter-of-factly treat the wounds and encourage the client to discuss the emotions that preceded the self-injury.
reinforce
The DSM-5-TR describes three groups of neurocognitive disorders:
1.
2.
3.
- delirium
- mild neurocognitive disorder
- major neurocognitive disorder (dementia)
Delirium has a __________ onset and the duration is usually __________ (three to seven days).
rapid, short
Delirious clients are disoriented to time and place. They often have trouble focusing their attention, and they can become easily ____________________ by environmental stimuli such as noises or movements. Perceptual distortions (i.e., illusions or hallucinations) are common. Emotions are very labile. These impairments increase clients’ risk of self-harm.
distracted
Delirium requires prompt ______________ treatment. Most clients have a full recovery. Some, however, can experience permanent brain damage or die.
medical
Delirium is extremely common in ____________________ settings
healthcare
The first thing to examine when clients become delirious is their ___________.
medications
Many medical illnesses can precipitate delirium. Examples include ____________________ (e.g., urinary tract, meningitis, pneumonia, sepsis), metabolic disorders (e.g., hypoxia, hypoglycemia, ketoacidosis, electrolyte imbalances, thiamine deficiency), hepatic failure, and brain tumors.
infection
Intoxication and ____________ from drugs like alcohol, amphetamines, cocaine, marijuana, etc. can also cause delirium.
withdrawal
Delirium intervention:
Risk for self-harm is high; safety is paramount. Keep clients’ beds in a low position. Assign them rooms near the nurse’s ______________. Assist with ambulation and remove fall hazards
station
Delirium intervention: Ensure adequate ________________. Have clients wear their eyeglasses and hearing aids. ⭐
lighting
Delirium intervention: Assign ____________________ caregivers. This may help minimize confusion.
consistent
Alzheimer’s disease is the number one cause of dementia; it accounts for 50-60% of cases. The cause of Alzheimer’s disease is unknown, but it is associated with a build-up of beta-amyloid ______________ and neurofibrillary tangles in the brain.
plaques
Clients with Alzheimer’s disease experience a devastating cognitive decline in 3 stages which are:
mild
moderate
severe
clients experience short-term memory loss and confusion. Frequently misplacing objects is common. They may get lost in familiar environments. Executive function begins to fade is what stage?
mild stage
clients have significant difficulty with activities of daily living. ___wondering______ and emotional instability are common—both of which increase clients’ risk for self-injury. Clients begin to lose their ability to recognize family and friends. Clients may also unconsciously fill in memory gaps with imaginary events (confabulation) is what stage?
moderate
clients experience profound deficits in cognitive function. They lose their ability to eat, speak, understand language, ambulate, and control elimination. They require total care in what stage?
severe
frontotemporal lobe dementia (Pick’s disease) is caused by damage to the frontal and temporal lobes of the brain. Clients with this disorder experience a significant decline in executive function and language comprehension. Damage to these brain areas may also cause socially __________________________ speech and behavior.
inappropriate
___________ infection (especially type 1) can confusion, behavior changes, and psychosis. Newer treatments for this (antiretroviral therapy) have helped reduce this problem.
HIV
Huntington’s disease is an __________________ disease. It has an earlier age of onset (30-50 years). It initially presents as incoordination and involuntary, jerky movements of the extremities (chorea)
inherited
Lewy body dementia is similar to Alzheimer’s disease except it tends to progress more rapidly. Visual ____________________________ and Parkinson’s symptoms are also common. It is named for a type of protein deposit (Lewy bodies) that can be seen in the brain upon autopsy
hallucinations
Damage to the substantia nigra causes the motor dysfunction we commonly associate with Parkinson’s disease. About _______% of the clients will also experience damage to other regions of the brain, resulting in dementia.
75
Severe trauma to the head can cause a sudden onset of dementia. Also, repeated head injuries (e.g., from boxing or football) can lead to a more progressive onset called ______________ ?
traumatic brain injury
Vascular dementia is the second most common form of dementia. It’s caused by multiple small ______________. Symptoms vary greatly depending on which areas of the brain are damaged.
strokes
Each form of dementia has its own prevalence rate. For Alzheimer’s disease, 10% of people over the age of 65 have Alzheimer’s disease. Two out of three people who have Alzheimer’s disease are __________.
women
Clients with Alzheimer’s disease require extensive supportive care. Many family members can benefit from _________ care.
respite
______________ inhibitors (e.g., donepezil) and memantine can sometimes provide temporary symptom relief. __________-generation antipsychotics can treat psychosis and aggression.
anticholinesterase, second
Neurocog intervention:
The risk for self-harm is high; ____________ is paramount. Keep clients’ beds in a low position. Assign them rooms near the nurse’s station. Assist with ambulation and remove fall hazards.
safety
Neurocog intervention:
Refer family members to home health agencies for ______________ care.
respite
Neurocog intervention: Ensure a __________ environment. Have clients wear their eyeglasses and hearing aids. ⭐
well-lit
Neurocog intervention: Unlike other disorders, it’s not always therapeutic to ________________ clients with advanced dementiaIf a client is looking for their deceased spouse, it’s best just to redirect them and engage them in conversation. For example, you might talk to the client about activities they enjoyed with their partner. ⭐
reorient
Neurocog invention:
Allow the client to have as many ________________ objects as possible.
familiar
Utilize ___________ therapy (i.e., discussion of past events using tangible objects such as photographs). ⭐
reminiscence
