x Mental Health (Grant) Flashcards
1
Q
Behavior
A
the manner in which a person performs any or all ADLs
2
Q
Mental Health
A
ones ability to cope with and adjust to recurrent stresses of everyday living
3
Q
Maladaptive Behaviour
A
- inhibits pts ability to deal w situation
- response to anxiety
- result in Dfx and non-productive outcomes
- avoidance, substance abuse
4
Q
SS of Mental Illness
A
- poor self concept
- feeling of inadequacy (abused ppl)
- dependent behavior
- need constant permission
- poor judgement
- inability to cope
- irresponsibility
- inability to accept responsibility for ones actions (personality disorder)
- avoid probs
- inability to recognize own talents
- inability to recognize ones limitations
- *** -inability to perceive reality (PSYCHOSIS)
- demands or seeks immed gratification
- inability to establish meaningful relationships
5
Q
5 Dimensions of a Person
A
1) Physical (Biological, Physiological)
2) Cognitive (ability to formulate thoughts, process info, solve probs)
3) Affective (ability to experience/express feelings and emotions. the External manifestations of feelings/emotions, facial express, tone, body lang)
4) Behavioral (individuality, involving integration of physical, cognitive and affective dimensions) (*behaviour is learned and has meaning)
5) Social (skills in living as a member of a family and community)
6
Q
Mental Illness: CAUSE
A
1) Envt factors (lack, loving parents, trauma, stress, moving)
2) Cultural Factors (racism, discrimination, poverty (2-3x more likely to develop), violence)
3) Biological (chem, hormones)
4) Genetics (no preference to race/sex etc.)
7
Q
Personality
A
attitudes/behaviors specific to certain situations
8
Q
Erik Erickson (1902-94)
A
provided framework for understanding personality development (if a given task not mastered, then a set of behaviors can be predicted
- knows for Developmental stages Birth - Death
- believed personality traits in opposite (follower/leader)
- many traits inborn
- other charecteristics like feeling, incompetent/inferior are learned and based on challenges and support received growing up.
- loved Sioux Indians. aware of influence of culture on hehaviour
- course of develpment buld on Body/Mind/Cultural influences
9
Q
Erickson’s 8 Stages of Life
A
1) Infancy: Birth - 18 mos, Trust vs Mistrust
2) Early Childhood: 18 mos - 3 yrs, Autonomy vs Shame
3) Play: 3 - 5 yrs. Initiative vs Guilt
4) School Age: 6-12 yrs, Industry vs Inferiority
5) Adolescence: 12 - 18 yrs, Identity vs Role Confusion
6) Young Adulthood: 18 - 35yrs, Intimacy/Solidarity vs Isolation
7) Middle Adulthood: 35 - 55/65, Generativity vs Self Absorption/Stagnation
8) Late Adulthood: 55/65 - Death, Integrity vs Despair
10
Q
- Infancy
A
- Birth - 18 mos,
- Trust vs Mistrust
- emphasis on visual contact, touch.
- If fail to experience TRUST, you start to develop MISTRUST
11
Q
- Early Chilhood
A
- 18 mos - 3 yrs
- Autonomy vs Shame
- learn to master skills i.e. walking, talking, feeding, fine motor, toilet train
- this is where you learn to build self esteem and autonomy
- learn right from wrong
- terrible 2s, learn NO
- acquire new skills
- if you don’t learn toilet training, this is where you develop SHAME
12
Q
- Play
A
3-5 yrs
- Initiative vs Guild
- start to copy adults around you
- Take initiative in creating play situations.
- if you get FRUSTRATED, you start to experience GUILT
13
Q
- School Age
A
- 6-12 yrs
- Industry vs Inferiority
- capable of learning, creating and accomplishing numerous new skills and knowledge. -Develop Industry.
- if experience inadequacies (poor student), you experience INFERIORITY
- start to pick up incompetence and low self esteem
- kids won’t consider parents ultimate authority
14
Q
- Adolescence
A
- 12 - 18 yrs
- Identity vs Role Confusion
- Your development dependent on what has been done to you. now going toward it, we try to find our identity. Ife more complex.
- struggle w social interactions
- grapple w moral issues
- discover separate from family, own identity
- if unsuccessful in this stage => ROLE CONFUSION
- most important relationships = PEERS
15
Q
- Young Adulthood
A
- 18 - 35yrs
- Intimacy/Solidarity vs Isolation
- seeking partner, satisfying relationship
- build families
- if successful, experience INTIMACY, if not, ISOLATION
16
Q
- Middle Adulthood
A
- 35 - 55/65
- Generativity vs Self Absorption/Stagnation
- Work is most crucial
- mid age, occupied w meaningful, creative work, family issues
- in charge, role you have long envied
- most important tasks –> perpetuate culture and transmit values to our families
- strength through care of others
- children leave home
- relationships/goals change
- mid life crisis, divorce, retirement
- struggle for new meaning/purpose
- if not successful, become SELF ABSORBED and STAGNANT
17
Q
- Late Adulthood
A
- 55/65 - death
- Integrity vs Despair
- much of life prep for mid-adult
- late adulthood, recovering from it.
- one can look back on life w fulfillment, happiness, content, deep sense that life has meaning, INTEGRITY
- accepting death as completion of life
- some reach this step w DESPAIR because perceive life as failure.
- fear death as they discover purpose for life
18
Q
Freud’s Personality Development (3 Parts)
A
- ID: Innate Drive / Pleasure Principal. constant gratification. encompasses entire personality at birth. NOT changed by experience, because ID is NOT in contact w EXTERNAL world
- EGO: Mediator. Reason/Good Sense. Reality factor that helps person perceive conditions accurately. helps decide how and when to act. PORTION of psyche in contact w external reality.
- SUPEREGO: Angel on Shoulder. Parental/Societal value system. Develop @5 yrs. Morality. Strive for perfection. Derived from EGO. 3 Fx’s.
19
Q
Freud’s 3 Fx’s of Super Ego
A
- Conscience
- Self Observation
- Formation of Ideas
20
Q
Freud’s Psychosexual Stages of Development
A
- Oral Stage, birth - 1yr
- Anal Stage, 1-3yrs,
- Phallic Stage, 3-6yrs
- Latency Stage, 6-11yrs
- Genital Stage, adolescent - adult
21
Q
Freud’s: Oral Stage
A
- Oral Stage, birth - 1yr
- sex instinct center around mouth (suck breast/bottle)
- if oral needs not met, develop habits i.e. thumb sucking, nail biting, pencil chew.
- can develop in adulthood to over eating, smoking
22
Q
Freud’s: Anal Stage
A
- Anal Stage, 1-3yrs,
- Toddlers enjoy holding and releasing urine and feces.
- toilet training become major issue. If parent insists before ready, or if make too few demands, there is conflict about anal control.
- child may become extremely orderly/clean or very messy/disorderly
23
Q
Freud’s: Phallic Stage
A
- Phallic Stage, 3-6yrs
- Pre-Schoolers love genital stim.
- Oedipus vs Electra Complex (boys love mom, hostile to dad)
- child feels sexual desire towards opp sex parent and hostility towards same sex.
- boys mimic dad our of fear of being punished by dad
- SUPER EGO formed
24
Q
Freud’s: Latency Stage
A
- Latency Stage, 6-11yrs
- sex instincts begin to die.
- SUPER EGO develops further.
- child begins to aquire new social values from adults and sam sex peers
- if stage NOT met, SEXUAL UNFULFILLMENT
25
Freud's: Genital Stage
5. Genital Stage, adolescent - adult
- Puberty
- Sex impulses of phallic stage re-appear
- if stage successful during early stages, w lead to marriage, sex maturity and birth/rearing of kids
- if NOT successful, IMPOTENCE, FRIGIDITY, UNSATIS RELATIONSHIPS
26
Self-Concept
- framework or reference one uses for all he/she knows and experiences
- perceptions, behaviors, interactions
- over time, one accumulates and processes info that helps form basic perception of who he is, how he looks, how others react to him.
27
Stress
- non specific response of the body to any demand made on it.
- an individual's response to stressful situation or events is often result of learned/conditioned behavior.
- chronic stress - -> disease
28
Stressors
- physical
- social
- spiritual
- economics
- chemical
(Mental Health nursing concerns itself w person's response to stressors)
29
Prolonged Stress leads to
- depression
- heart disease
- CA
- disorders (mental/physical)
- LO immune system
- colds/flu
- asthma
- PTSD
- Eczema
- Stomach ulcers
30
General Adaptation Syndrome (GAS)
SEE PIC (phys response to stress)
- 3 Levels when one encounters stress
1. Alarm Reaction: body prepares for Fight or Flight (Sympathetic NS)
2. Resistance Stage: body attempts to resist or adapt to stress (Parasymp NS),
- adapt LO HR, dilation BV, hormones level return to norm
3. Exhaustion Stage: leads to recovery of death. exhausted after all stress
31
Coping w Stress
- mental health provider
- stay in touch w people to provide emotional support
- DEC work load
- LOOK triggers to stress/reactions to stress
- set priorities
- don't dwell
- exercise, 30min/d
- schedule activities you enjoy
- yoga
- taichi
32
Stress SS
- insomnia
- relationship changes
- physica changes
- HA
- Nausea
- drinking
- easily angered
- low energy
- exhaustion
33
Hans Selye
father of stress research
| -Hungarian Endocrinologist, 1907-1982
34
Anxiety
- vague feeling of apprehension that results from perceived threat to self
- mild forms ready body to meet stressful demands
- severe forms: immobilized coping skills d/t emotional chaos.
- Fear overcomes all emotions, apprehension, worry
- Group of Disorders: Phobias, Gen Anx Dis, OCD
35
Degree of Anxiety influenced by
- how person views stressor
- number of stressors being handled at a time
- previous experience w similar situation
- magnitude of change event represents
36
*** Degrees of Anxiety (see pic)
1. Mild
2. Moderate
3. Severe
4. Panic
37
Mild Anxiety and Moderate Anxiety
MILD
-person alert. perceptual field UP
NI
-assist pt to identify effect coping mech
-active listening
-therapeutic comm tech (open ended questions)
-calm presence, recognize pt stress
-explore options
-encourage pos act for stress relief (yoga, walk)
-UP motivation
```
MODERATE
-focusing on immediate concerns, perceptual field narrow
SS: HA, Diarhea, N/V, low back pain, UP pulse, UP VS
NI
-give simple directions, info.
-validate understanding
-be willing to repeat instructions
-limit choices
-ensure quiet envt (min stim)
```
38
Severe Anxiety and Panic
```
SEVERE
-perceptual field STRONGLY REDUCED, focuses on specific detail (sometimes details distorted d/t/ anxiety)
-may be unable to take direction
SS: UP VS
NI
-admin MED (calming)
-restraints last resort
-reality orientation
-limit setting
```
PANIC
-markedly disturbed behaviours associated w dread and terror
-involves disorganization of personality and can be life threatening
-may be unable to follow commands
SS: UP anxiety, reality distorted, trembling, chest pain, overwhelming anxiety
NI:
-ensure safety
-coach in relaxation techniques
-limit physical contact, may misinterpret touch
-never leave pt alone, may harm self/others
-CAN give MED against will
39
Motivation
the gathering of personal resources or inner drive to complete a task or reach a goal.
maybe generated by:
.perceived reward
.perceived threat of punishment
Motivation in care helps pt through recovery
40
Frustration
anything that interferes w goad-drected activity
41
Conflict
mental struggle, opposing thoughts
42
Adaptation
one's individual ability to adjust to changing life situation using various strategies.
43
Coping Responses
```
.overeating
.drinking
.smoking
.withdrawal
.seeking company
.yelling
.exercise
.fighting
.pacing
.listening to music
```
mostly conscious
44
Defense Mechanisms
UNCONSCIOUS intra-psychic reactions that offer protection to self from stress situation.
1. Denial
2. Displacement
3. Intellectualizing (focus on flowers in casket not body)
4. Projection (placing feelings onto others)
5. Rationalization
6. Reaction/Formation (hide true feelings d/t anxiety from telling truth)
7. Regression
8. Repression
9. Sublimation (acting out unacceptabe in acceptable way, person who loves to fight become boxer)
10. Suppression
11. Compensation
12. Dissasociation
45
Phases of Crisis
1. Confusion/disbelief/hi anxiety
2. denial
3. reality (anger, remorse)
4. Sadness/Crying
5. Reconciliation, Adaptation
46
Crisis NI:
- provide accurate info that aids in realistic perception of situation
- encourage venting feelings, empathy
- identify fam supp and coping mech
- touch
- silence
- clergy (permission first)
- active listening
47
DSM V
Diagnostic and Statistic Manual of Mental Disorders
- Bible of Psychiatry
- manual of standard classifications of mental disorders. used by MH profs in US.
- contains all Dx codes for record keeping/billing
- gives criteria to meet in order to classify w certain diseases
- used Multi-axial/Multidimensional approach to Dx
48
DSM V: Multi Axial System
Axis 1: Main Dx, represents acute SS that need Tx (paranoid schitz, Maj Dep Dis)
Axis 2: Personality / Developmental (MR, Autism) Dxs
Axis 3: Medical & Neuro Dx, especially ones that can influence psych disorder (i.e. D.M.)
Axis 4: Recent Psychosocial stressors (divorce, death, job loss)
Axis 5: Patient level of Fx, scale 0 - 100 (GAF scale, Global Assess of Fxs)
49
DSM V: Conducting an Interview
- in a safe place (quiet area, where others can see u)
- open ended question (how can we help you? What's been happening w you?)
- If hallucinating, can ask more focused questions.
- closed ended questions (are you feeling suicidal? how many packs smoke? What MEDS on? do you drink ETOH?)
- Prior to interview, nurse would have overview from admitting party. Are they calm? Cooperative?
50
DSM V vs Nursing Dx
Nursing Dx specifically describes the pts actual or potential reaction to a physiological or MH problem that the nurse is licensed and skilled to treat.
i. e. pt w Schiz:
- disturbed sensory perception
- rsk for violence
- social isolation
- self care deficit
51
Mental Status Exam
focuses on cognitive Fx @ time of eval
- personal info
- appearance (neat?)
- Behavior
- Speech
- Affect/Mood
- Thought process
- Perceptual Disturbances (hallucinations)
- Cognition (oriented?)
52
MSE: Psycho-social Assess
- Previous hospitalization
- Educ/occ background
- Social patterns (typical day?)
- Sex patterns
- Activity Orientation
- Substance Abuse
- Spiritual
53
MSE: 3 Phases of
| Nurse/Pt Relationship
1. Orientation
2. Working
3. Termination
54
MSE: Nurse/Pt: Orientation
4 Issues Addressed
1. Parameters of relationship (professional here to help)
2. Formal/Informal Contract (rules, schedule)
3. Confidentiality (explore pt needs, set goals, trust bld, consistency)
4. Termination
55
MSE: Nurse/Pt: Working
.Data Collection
.promote self esteem/prob solv
.supporting them as they try coping skills
.be aware of transference + counter transference (pt or nurse remind one of another person in their lives, so they treat the new person according to old feelings)
.Testing behaviors by pt (testing limits)
56
MSE: Nurse/Pt: Termination
discuss discharge upon admission
57
Milieu Therapy
a form of psychotherapy that involves use of therapeutic communities. Patients join group of ~30, for 9 - 18 mos. During stay, patients encouraged to take responsibility for themselves and others within unit, based on hierarchy of collective consequences.
- entitled to comfortable/secure envt
- 24hr support
- staff exhibit model behavior
- encourage self care
- treat everyone fairly
- work w people of other disciplines
- promote feelings of self worth, hope and being cared about
58
*** Mental Illness Continuum
| see pic
L (to 50%): Well Being/Occasional-Mild Stress/NO impairment
MID (50-80%): Emotional Probs & Concerns/Still Healthy w some distress/Mild Mod stress / Mild Temp Impairment
R (80-100%): Mental Illness/Marked distress/MOD DISABLING CHRON impairment
59
pt w a Psychiatric Disorder does NOT...
lose touch with reality.
DOES NOT lose touch with reality
anxiety, compulsions, OCD, phobias, sex dyfx
60
Delerium
rapid change in consciousness over short time
61
Delerium: Cause
- illness (F, Hrt fail, PNA, azotemia, malnutrition)
- Drug Intox
- Anesthesia
62
Delerium: SS
- lo awerensss and attention to surroundings
- disorganized thinking
- irrelevant speech
- poor sleep
- sundowning syndrome
Tx: treat cause
63
Dementia
-SLOW progressive loss of brain fx, irreversible
64
Dementia: Cause
-cerebral disease:
alzheimer's (most common)
vascular dementia)
65
Dementia: SS
- impaired memory, judgement
- personality changes
- DEC cognitive fx
- impaired orientation
66
Dementia: MEDS
Agitation: Lorazepam (ATIVAN), Haldol
lo doses, sedating, esp in elderly, RSK fall
Dementia: Cognex, Aricept
67
Dementia: NI
- finger foods/freq feed
- Safety: remove stove knobs at night. dbl lock doors, 1:1 supervision
- Reality Orientation (clock, calendar, open windows, calm, supportive)
- DEC sensory stimulation
- side rails up
- night light
68
Schizophrenia
| Separate slides
bizarre, non-reality based thinking
CAUSE: brain tissue changes
SS:hallucinations, apathy, social withdrawal, flat affect, delusions
69
Mood Disorders (Affective Disorders)
psychotic disorders characterized by
- severe/innapp emotional response
- prolonged and persistent dirsturbances of mood
- deprssion/manic SS
70
Mood Disorders: Cause
- Hx (60-80%)
| - Biologic (envt, trauma, depression (lo norepi/serotonin), mania (hi norepi)
71
Depression: SS
mood disturbances w exaggerated feelings of
- sadness
- depair
- lo self esteem,
- loss of interest,
- pessimistic thoughts
- neglect of appearance
- diff concentrating
- c/o phys probs
- change in eating pattern
- feel helplessness, hopelessness
- extreme anxiety/panic
72
Type of Depression
-UniPolar
major depress episodes lasting more than 2 years
-Disthymic Disorder
daily moderate depression lasting more than 2 years (can still fx at work)
73
Mania: type/levels
- persistent abnormal activity and an euphoric state
- hypomanic: ss not severe
- Bipolar: manic / depressive
- Cyclothymic: repeated mood swings of hypomania and depression
74
BiPolar & Cause
Manic/Depressive, severe shift in person'a mood, energy and ability to fx
Equal Men/Women, onset early 20s
```
CAUSE:
Gx factors
trauma
severe stress
steroids
anti depress
amphetemines
narcotics
```
75
BiPolar: Tx
-Antidepressants (UP Norepi, Seratonin, Dopamine)
PROZAC (Fluoxetine), DESYREL (trazodone), ELAVIL (amitriptyline), EFFEXOR (venlafaxine)
-Lithium (effetive in acute)
-ECT
-Phsychotherapy
76
BiPolar: SS
Depression - Manic - Depression
Adolscent: if mania develops
phychotic SS, truancy, substance abuse
While MANIC-
- grandiosity
- impulsive
- pressured rapid speech
- euphoria
- UP phys energy
- insomnia
- hypersexuality
- racing thoughts
77
Anxiety
normal response to threat or stress
- state of feeling of apprehension, uneasiness, agitation, uncertainty, fear resulting from anticipation of threat/danger
- late onset associated w DEPRSSION
78
Anxiety Traits
- Signal Anxiety: learned response to ie. test taking
- FreeFloating Anxiety: feelings of dread that can not be identified
- Anxiety Train: learned, anxious reactions to relatively nonstressful events
79
GAD
Generalized Anxiety Disorder
-hi degree of anxiety and/or avoidance behavior
```
TYPES:
Panic
Agoraphobia
OCD
PTSD
```
NI:
- provide safe envt
- stay w pt during attack
- focus deep breathing
- relaxation techniques
80
Panic Attack
acute, intense, overwhelming anxiety, 15 - 30 min rapid, intense, escalating anxiety.
75% have NO envt trigger
SS
- Great emotional fear
- physiological SS:
- palpitations
- N
- tremors
- SOB
- Diaphoresis
- abd distress
- dizziness
- chills
- parethesis
- suffocating feeling
- chest pain
81
Agorphobia
Hi anxiety brought on by possible situation such as people, places or events
82
OCD
recurrent, intrusive, and senseless thoughts and behaviours that are performed in response to the obsessive thoughts
83
PTSD
Post-traumatic stress disorder:
response to intense trauma experience that is beyond normal experience
-flashbacks that may be stimulated by stimulus that resembles the experience or anniversary of an event (i.e. illusions (visual, auditory)
SS: Avoidance Behaviour
84
Panic Dis: Tx
- block attacks w MEDS
- educate
- better coping mech
85
PTSD: Tx
- MEDS (Antidepress, Antiseizure)
- cognitive therapy (focus on breaking neg thought pattern)
- behavioural therapy (break up conditional response until no longer automatic)
- immediate debriefing is effective in preventing PTSD
86
Avoidance Behaviours
common w PTSD
- emotional detachment
- survivors guilts
- amnesia
- insomnia
- diff concentrating
- depression
- substance abuse
87
Lithium (BiPolar)
* drug of choice for mania
- abort manic episodes in 10-21 days (60-80% pts)
- not as effective in w rapid recycling (manic/depres over and over again)
- NOT addictive
- eat normal diet
Lithium effects
- rsk hyponatremia (Li, DEC Na reabsorption)
- LO euphoria, grandiosity, pressured speech, insomnia, hypersex
- must reach THERAPEUTIC level in for 7-14 days
- regular blood work to monitor therapeutic level
* *THERAPEUTIC RANGE 0.4 - 1.3meq/L
88
Lithium: NI
yes 0.4 - 1.3meq/L
avoid Lithium toxicity SS
EARLY (1.5 and lower)
- NV
- Diarrhea
- Thirst
- Polyurea
- Slurred speech
- Muscle wkn
(2. 0 and up)
- life threatening
- gastric lavage
- treat w Urea, Manitol, Aminophylline to get rid of Li
89
Antidepressants (BiPolar)
```
Antidepressants
UP Norepi (fight/flight)
UP Serotonin (sleep/mood/emotion)
UP Dopamine (thought/pleasure)
```
SSRIs: Selective Seratonin Reuptake Inhibitor
- Monitor for UP Seratonin (Seratonin Syndrome)
- ensure not on any other Serotonin containing meds
- slowly DEC dosage of drug
used for OCD as well.
PROZAC (Fluoxetine), DESYREL (trazodone), ELAVIL (amitriptyline), EFFEXOR (venlafaxine)
90
Serotonin Syndrome
- altered mental status
- autonomic dfx (labile HTN)
- tachycardia
- hyperthermia
- pupil dilation
- neuro musc ss (akithesia, dystonia, dyskinesia, sz, tremors)
91
neuro musc ss
Akathisia: a state of agitation, distress, and restlessness that is an occasional side-effect of antipsychotic and antidepressant drugs.
Dystonia: Involuntary muscle contractions that cause repetitive or twisting movements.
Dyskinesia: abnormality or impairment of voluntary movement.
92
***Atypical AntiDepressants
often used w other anti-dep when ineffective or causing adverse SEs.
- Wellbutrin
- Cymbalta
- Pristique
- Remeron
- Effexor
- Desyrel
93
ECT
Eletroconvulsive Therapy. LAST RESORT
- used for severe depression/manic behaviour not responding to LI.
- used for RAPID CYCLING
- for the acutely suicidal
- short acting anesthetic used - BREVATOL (muscle paralyzing, safe for pt)
- when done, Grand Mal sz induced.
- 10-15 min procedure
- PT signs informed consent (guardian if involuntary)
94
ECT: Post Opp
- confused/disoriented
- short term mem loss (few days - 2 wks)
- tired
- may incontinent of urine
- if out pt, must have someone w. bring change clothes
- maintenance of Li
- may need repeat visit
95
Agoraphobia
difficulty leaving home
- cant work, shop
- intense anxiety
- always worrying
- occurs late in life, 50s
- onset d/t illness
96
Agoraphobia: Tx
Tx anxiety
-MEDS: AntiAnxiety/Anxiolytic
-Positive reframing: turning neg messages into pos ones
("my heart is pounding, think i am going to die" to " heart is pounding, i can handle this")
-Decastrophizing: teach pt to realistically appraise situation "what is worst that can happen?"
-Assertiveness Training: teach techniques to foster self esteem/self assuredness
97
.
.
98
AntiAnxiety/Anxiolytic
-can be addictive
-use only for 1 month
-titrated off
-use w caution in elderly d/t rsk fall
(SSRIs used to Tx anxiety in elderly)
- Ativan(Lorazepam) short act, addictive, aggressive, anti agitation
- Librium (Chlordiazepoxide) ETOH wd/Sz/Panic
- Klonopin (Clonazepam) long act, 2p/d, addictive
- Xanax (Alprazolam) short acting, addictive, nasty wd
99
OCD:Obsessive Compulsive Dissorder
-OBSESSIONS (thoughts, impulses, images that cause real, marked anxiety and interfere w interpersonal, social and occupational fx
-person knows thought unreasonable but believe then have no control over it
COMPULSIONS (repetitive behaviours or mental acts)
an attempt to neutralize the anxiety (i.e. repetitive hand washing protects against Obsession of germs
in order to neutralize blasphemy, we pray constantly
Childhood (MALE)
20s (FEMALE)
Rx:
MED: SSRIs
Behavioral therapy
100
Personality Disorders (finish..)
- Abusive personality
- Dependent personality
- Paranoid personality
- Borderline personality
- Antisocial personality
101
Sexual Disorders
-Adaptive Sex Behaviour:
in private, satisfying, not forced
-Maladaptive Sex Behaviour:
harmful to self/others, performed publicly and sometime s w/out consent
102
Sexual Dysfunction
```
A disturbance during sexual response
psychological or physiological
-Dyspareunia (painful intercourse)
-Hypoactive sexual desire
-premature ejaculation
```
103
Paraphilias
group of sexually gratifying activities that are NOT common to gen pub and illegal in some areas
- Pedophilia
- Exhibitionism (flashing)
- Voyeurism (sex grat by observing others during sex or seeing genitals)
- Frotteurism (sex arousal by rubbing on non-consenting adult)
- Fetishism (using object, usually article of clothing, to attain sex arousal)
- Transvestic Fetishism (cross dress)
- Sexual sadism (arousal inflicting pain)
- Masochism (arousal receiving mental/phy abuse)
104
Gender Dysphoria
conflict of biological sex identitity and gender perception
- person believes he/she was born in the body of the incorrect sex
- Transexualizm: persistenet desire ot have body of opposite sex.
NI: nurse should be careful of attitude towards patient
105
Psychosomatic Illness
physical disorder brought on by a psychological trigger
106
Somatization
recurrent, multiple physical complaints and ss for which there is no organic cause
-feelings, needs, conflicts manifestd physiologically
Dx made by r/o possible physical causes, drug, toxic, mental illness
-Briquet's Syndrome
107
Anorexia Nervosa
White females
- sever form of self starvation that leads to death
- adolescent girls above average intelligence
- intense fear or obesity, bizarre attitudes toward food, disturbed self image
- not about food, about self control/willpower
108
Anorexia Nervosa: NI
- develop trusting relationship
- educate better nutrition (stress free meal time, frequent small meals)
- set limits to decrease manipulation / proscrast (15-20min)
- encourage express feelings
- offer unconditional acceptance of both negative and positive feelings expressed
109
Bulemia Nervosa
-episodes of over eating followed by purging
close relate to anorexia nervosa
White Females, mid - upper class, well educated
110
Bulemia Nervosa: SS
- low self esteem
- lack of control
- guilt/anxiety/depression
PHYSICAL signs
- hoarseness
- esophagitis
- dental erosion
- palate lacerations
- weakness or fatigue
- electrolyte imabalance
111
Anorexia/Bulemia Nervosa: Tx
-behaviour mod
-individual psychotherapy
-family therapy
-MEDs: SSRIs (Fluoxetine (Prozac), Sertraline (Zoloft)
(anorexia, bulemia, ocd)
112
Antidepressants (SSRIs)
```
SSRI's (look out Serotonin Syndrome)
Fluoxetine (Prozac)
Sertraline (Zoloft)
Venlafaxibe (Effexor)
Citalopram (Celexa)
Porexitine (Paxil),
```
TRICYCLICS:
Amitriptyline (Elavil), amoxapine (Ascendin), desipramine HCL (Norpramin), imipramine HCL (Tofranil), nortriptyline HCL (Aventyl, Pamelor)
```
MAOIs:
phenelzine sulfate (Nardil)
Tranylcypromin sulfate (Parnate)
```
TRIAZOLOPYRIDINES:
Trazodone (Desyrel)
Bupropoion (Wellbutrin)
113
Tardive Dyskenesia
```
Perm
late SE, involuntary muscle mvnt.
-snake like mvmt
-lip smacking
-tongue protrusions
-blinking/grimacing
-tonic mvmnts (snake like mvts)
-stop ASAP if you see mouth mvmts.
```
AMES test to confirm. First sign of mouth/lip mvnt, STOP
114
Anti-Anxiety meds are habit forming?
YES
115
Antipsychotics
NOT a cure, only RELIEVE SS
Major tranquilizers
Schizophrenia, psychosis, bipolar manic phase,
SEs:
Extrapyramidal SS
-pseudoparkinsonians, akathisia, dystonias, dyskinesia, tardive dyskinesia
116
Paranoid Personality
suspicious people, secretive. Always think someone is out to get them. no one has their best interest in mind
117
Antisocial Personality
- difficulty w personal relationships
- don't learn form previous experiences/punishments
- no loyalty, manipulative, deceitful, intimidating, hostile, aggressive
NI:
Strict limit setting and rules of behavior. sometimes must be aggressive w them.
118
Narcissistic Personality
-very grandiose. Need for admiration. lack empathy. starts in childhood. self centered. unrealistic self image, superior to others, sense of entitlement
119
Schizophrenia
- most severe of all illnesses
- devastating brain disorder. affects thinking. language, emotions, social behavior, ability to perceive reality accurately
- onset, late teens, early 20s
- doesn't discriminate, everyone can get
- Duration: 6mos
120
Schizophrenia: Dx
2 or more grossly disorganized, catatonic, or neg bahaviour
- r/o schizoaffective and mood do
- r/0 substance abuse and/or MED condition
- CT scan to r/o tumor
- drug screen
121
Schizophrenia: SS
- hallucinations
- delusions
- disorganized behavior
- disorganized speech
- catatonia
- dec self care
- unable to hold job
122
Schizophrenia: Comlications
- incaceration
- homelessness
- suicide
- hiv
123
Other Psychotic Disorders
Schizophreniform: ss for 1mos 1day,
124
Shchizoaffective DO
- Schiz behaviors and Mood
- depression
- mania
- bizarre behaviour
- hallucinations/delusions
- anxiety
125
Schizophrenia: Types
Paranoid: guarded, suspicious, hostile, agressive, less regression of mental fx. behaviour not as bizarre as other types. ONSET, late 20s-30s. SS intermittent during fir 5 yrs
Disorganized (hebaphrenic):w talk circles around you. answer other than question asked. inappropriate affect. if any delusions, not prominent.
Catatonic: not common anymore d/t better meds. SS Motor immobility, waxy flexibility (if you lift their arm, it will stay that way)
Undifferentiated (Mixed): not only 1 clinical behavior dominates. mixture. SS hallucination, delusions, bizarre behaviour
Residual: no longer has active SS of schiz, but w still have some NEG SS isolative, withdrawn, excentric behaviour, odd beliefs, poor hygiene, lack of interest
126
Schizophrenia: Causes
Neurobiological: UP Dopamine and Ceratonin
Neuroanatomical: actual structural abnormalities in brain., SS INC cerebral ventricles, Atrophy of Cerebellar and frontal lobe (prob solving, insight, reasoning), DEC volume gray matter
Genetic: 1 parent Schiz = 12% chance, 2 parents Schiz = 46% change. Identical Twins, 40-50%, Fraternal Twins, 15-17%
Preg/Birth Comp: Prenatal RSK, Viral, lo nutrition, starvation, exp to toxins, lo O2
Stress: can precipitate illness in vulnerable person. common breaks happen on college campuses
127
Pre Psychotic Early SS
- deterioration in pre-morbid fx
- anxiety
- dissociative symptoms (wandering mind, less concentration)
- misinterpretation of envt (mystical, spiritual meaning to ordinary events)
- emotional/physical withdrawal (inability to trust or relate to others
- pre-occupation with mysticism and religion
- speech (make up words, rambling)
- sex pre-occupation (homo themes, exaggerated needs and fear of intimacy)
128
Schiz: Bleuler's 4 As
Paul Bleuler, swiss psychiatrist, born 1900s, coined term Schizophrenia
Fundamental Aspects of Disease
1. Affect: observable feelings/emotions (bizarre, blunted, flat, innapropriate)
2. Associative Looseness: speech/reasoning. confused thinking, jumbled, illogical speech and reasoning. LOA, Looseness of Association. Word salad, thought disorders
3. Autism: thinking not connected to reality. Delusions and Hallucinations. Neologisms (new words), social withdrawal. prefer fantasy world over reality.
4. Ambivalence: hold 2 opposing emotions. can be paralyzing. type of person w vacillate a lot. make no decisions. lack of motivation.
129
Association: Types
Loose Associations: person's thinking haphazard, illogical, confusion
Flight of Ideas: rapid association of ideas. rapid shifting of ideas. rambling one subject to another, Manic phase.
Thought blocking: thoughts blocked by intruding thoughts like hallucinations. hard time carrying on convo.
Tangential speech: follows series of related thoughts but never get to the point
Circumstantial speech: w reach conclusion after much unnecessary detail
Perseveration: when people repeat work or phrase over and over again.
130
Association: more Types
Echolalia: repeating someone else's words
Echopraxia: imitate movements of another
World Salad: jumble of words that mean nothing
Clang: meaningless rhyming of words
Cryptic Speech: pieces of sentences
Neologism: made up words w importance to speaker
131
Other SS
- unmet physical needs
- psychomotor over-activity/retardation (all over the place, can't get out of bed)
- poor social skill
- non compliance to meds (biggest reason for relapse)
132
Schiz: POS SS (Behavioural)
appear early. First phase of illness. Precipitate hospitalization
- disorganized
- bizarre (visible in dress, grooming, rituals)
- motor agitation (excitable, physical behaviour, constantly moving around d/t inner/ourter stimul)
- sterotyped (patterns that originally had meaning but are now robotic, mechanical)
- Automatic obedience: catatonic pts w sometimes respond to simple commands
- Negative/Resistance: doing opposite of what asked to do.
- Stupor: motionless for long periods of time almost appear as i a coma.
- Waxy flexibility: maintain posture for long periods of time. if someone lifts pts arm, it stays that way.
133
Schiz: POS SS (Thinking)
- Thinking
- Delusions (75% Schizo experience falst believes. can't be corrected by any reason)
- Persecution: belief that they are al powerful and important
- Grandeur: they believe they are all powerful and important
- Control or Influence: they have control and are very influential
- Somatic: false beliefs that body is changing in an unusual way
- Nihilistic: belief that the self or part of the self didn't exist
134
Schiz: more POS SS (Thinking)
Ideas of reference: misconstruing coincidences, trivial events and giving them personal significance
Thought broadcasting: they feel their thoughts can be heard
Thought insertion: they think other people thoughts are being inserted into their heads
Thought withdrawal: someone is taking their thoughts
Concrete thinking: great difficulty with abstract thinking (what brought you to the hospital....a car)
135
Schiz: POS SS (Perceptions)
Hallucinations: (90% of pts)
Auditory: hearing voices/sounds. ***if someone tells you they are hearing voices, ask what they are saying. ensure they are not going to hurt themselves/others
Visual:
Tactile: bodily sensations/feelings. (electrical impulses controlling their body)
Gustatory: taste (taste food and think it's poison)
Olfactory: smell odors no one else smells
136
Schiz: NEG SS
- Flat inappropriate Affect
- Restricted thought/speech:
- Anhedonia: inability to experience pleasure in activities/life. Barron emotions (common in Clinical Depression)
- Social Withdrawal
- Restriction of goal directed behaviour
- Alogia (poverty of speech, not much to say, won't hold convo)
137
Schiz: NEG SS more
Anergia: lack of energy, passive
Avolition: lack to motivation. can not initiate any task
Poverty of Speech: nothing much to say
Thought blocking:
Poor memory, attention span, problem solving
138
Schiz: NI
```
.Nusing Dx
.Interventions - protection
.establish trust
.reality orientation
.improve interpersonal relationships
.ADLs
.Encourage expression of feeling
.decrease anxiety
.client/family teaching
```
139
Hallucinations: NI
.keep lights on
.ask directly "what are you afraid of?
.watch for cues
.don't react, argue, just acknowledge what they see and let them know you don't see it
.focus on reality/diversion: you are safe, no one is going to hurt you
.assess anxiety
140
Delusions: NI
```
.honesty/matter of fact
.ask them to describe
.no arguing
.focus on feelings
.set time limits
.assess triggers
.validate if part is real
```
141
Loose Association: NI
.don't pretend you understand
.look for themes
.reality based activities
.re-enforce clear communication
142
Therapy: NI
```
.Individual
.social skills training
.group therapy
.family therapy
.cognitive
```
143
Addictive Personaltiy
person who exhibits a pattern of compulsive and habitual use of a substance or practice to cope with psychic pain from conflict and anxiety
```
SS:
.low stress tolerance
.dependency
.neg self image
.feelings of insecurity
.depression
```
144
Stages of dependence
Early: recovery may occur w/out tx
Mid: few recover w'out tx
Late: NEED Rx/Tx to recover
145
Fetal Alchohol Syndrome
seen in newborns whose mothers drank heavily during preg
```
SS:
.mental retardation
.growth disorder
.wide set eyes
malformed body parts
.spontaneous abortion/stillborn
```
146
Alchohol Withdrawal Syndrome
seen in pt who has developed physiologic dependence and quits drinking
```
RSK:
.older adults
.malnourished
.pt w other acute illness
.pt w DTs in past
```
ETOH = LO levels of B12, B1, Folic Acid
SS:
.6-48hrs after last drink
.last for 3-5d
.diaphoresis, tachycardia, HTN, tremors, N/V, anorexia, restlessness, disorientation, hallucinations
147
Delerium Tremens
acute psychotic reaction to wd or ETOH after excessive consumption over long period of time
```
SS:
. 1-4 days after last drink
.last 2d - 1wk
.extreme agitation
.disorientation
.fear/panic
.hallucinations
.HI temp
```
MED: Librium
148
Korsakoff's Psychosis
. sl 13
149
Werrnicke's Encephalopathy
. sl 14
150
ETOH: Interview: Subjective
.sl 16
151
ETOH: Interview: Objective
.sl 17
152
ETOH: Dx
.blood/urine for toxins
.poppy can cause false pos
.liver enzymes, hypoglycemia, albumin, Mg
.Hep, HIV
153
ETOH DETOX
MED:
Lithium (Chlordiazepoxide)
Naltrexone (Narcan)
154
3 Types of Opiod Abusers (Heroine, Morphine, Methadone)
1. street abusers (illicit)
2. medical abusers (rx abuse)
3. Methadone abusers
.Abstinence reverses tolerance
.Drugs act on Lymbic system
155
Cannibus
around for 1000s yrs
.sched 1 drug d/t high use
.used as Analgesic, Antiemtic, Antispamatic
SS:
- distorted perception
- diff prob solving
- poor memory
- uncontrollable laughter
- panic attacks
```
CHRONIC users:
.stuffy nose
.asthma
.bronchitis
.lo immune sys
.lung CA
.lo sleeping/eating
.lo testosterone/sperm count
```
156
Opiod OD
- severe resp depression
- pin point pupils
- stupor or coma
MED: LAAM (Orlaam)
long acting compound of methadone
RESCUE drug for opiods
SEs: dysrythmias (QT wave)
157
Opiod Withdrawal
```
.flu like ss
.body aches
.watery eyes
.V
.cramps
.diaphoresis
.runny nose
```
MED: Clonodine (Catapress?)
158
Methadone
synthetic opiod
159
Cocaine
- used as topical/local/regional anesthetic
- vasoconstrictor for some SXs
- rush lasts 30sec, then crash w intense craving for more. mod/severe depression
- hard to quit. can have cravings months after abstinence
160
Crack
- cocaine w baking soda
- strong CNS stimulang
- chronic use erodes septum = chronic sinusitis/rhinitis
161
Crack/Coacaine: SEs
- cardiac distress
- sz
- MED: Parlodel and Symetrel. help Lower cravings
crack babies need to be tightly swaddled, LO envt stimuli, minimal handling
162
Meth
potent, addictive amphetamin
- HI levels of Dopamine released
- Dopamine can be depleted then start to exhibit Parkinsonian traits.
- Perm brain cell damage
SS: hallucinations, paranoia, weidht loss/anorexia
CHRONIC users: flat affect, diff concentrating, forgetfullness
163
PCP:SS
Low-Mod Dose:
- generalized numbness
- poor coor
- UP BF
- flushing/sweating
HI Dose:
- LO respiration, Pulse, BP
- loss of balance
- blurred vision
OD:
Violent
psychotic
164
LSD
popular in 60s, potent hallucinogen, LONG ACTING (more than 12hrs)
```
RSK:
.flashbacks
.lingering mental disorder
.severe DEP/SCHIZ
.general impaired mental fx
```
```
SS:
.dilated pupils
.sweating
.loss appetite
.dry mouth
.sleeplessness
.tremors
.crossover sensory perception
.flashbacks (days to 1yr after use)
```
165
MDMA (Ecstasy)
80s club drug
.ceratonin release until depleted (mood/sex)
.euphoria for 6 + hours
```
SS:
.altered growth, develop in adolesc
.BRUXISM (grinding teeth)
.N
.blurred vision
.chills
.sweating
.malignant hyperthermia (in HU doses)
.muscle contractions
.maybe kidney/heart fail
```
SEs: lasting psych effects, poor concentration, anxiety, parkinson's tremor
166
Ketamine
date rape drug, snort, IM
human and vet use. mostly vet.
-anesthetic
-induces dream like state (hallucinations)
SS: Hi Dose
- amnesia
- impaired motor fx
- delerium
167
Mescaline / Psilocybin
Mescalin (peyote buttons)
| Psilocybin (mushrooms)
