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Definition
| The external manifestation of feelings or emotion which is manifested in facial expression, tone of voice, and body language. for example, a patient may be said to have a flat affect, meaning that there is an absence or a near absence of facial expression. The term may be used loosely to describe a feeling, emotion or mood. |
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| Symptoms involving emotions and their expression. |
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| Regular rhythmic movements, usually of the lower limbs; constant pacing may also be seen; often noticed in people taking antipsychotic medications. |
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| The holding, at the same time, of two opposing emotions, attitudes, ideas, or wishes toward the same person, situation, or object. |
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| A patient's inability to realize that he or she is ill; caused by the illness itself. |
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| A disturbance of thinking in which ideas shift from one subject to another in an oblique or unrelated manner. |
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| A classification of antipsychotic medications, also known as second-generation antipsychotics, which commonly interact with serotonin as well as dopamine receptors, They are considered the first line of treatment for psychosis and have a low profile for extrapyramidal side effects. |
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| A state in which thinking is not bound to reality but reflects the private perceptual world of the individual. |
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| The meaningless rhyming of words, often in a forceful manner. |
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| Abnormalities in how a person things. |
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| "Voices" that direct the person to take action. |
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| Thinking grounded in immediate experience rather than abstraction. There is an over emphasis on specific detail as opposed to general and a abstract concepts. |
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| Conventional antisychotics |
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Definition
| The original classification of antipsychotic medications, also known as typical antipsychotics and first-generation antipsychotics,which work by D2 receptor antagonism. They are accompanied by a variety of side effects, including extrapyramidal symptoms. Effective in the treatment of positive symptoms (e.g. delusions, hallucinations, disorganized though) but not negative symptoms (e.g. depression, avolition, anhedonia) |
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| A flase belief held to be true even with evidence to the contrary (e.g. the false belief that one is being singled out for harm by others.) |
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| A phenomenon whereby a person experiences a sense of unreality of or estrangement from the self. For example, one may feel that limbs or extremities have changed, that one is seeing self and events from a distance, or that one is in a dream. |
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| The false perception by a person that his or her environment has changed. For example, everything seems bigger or smaller, or familiar objects appear strange and unfamiliar. |
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Definition
| Abnormal muscle tonicity resulting in impaired voluntary movement. May occur as an acute side effect of neuroleptic (antipsychotic) medication, in which it manifests as muscle spasms of the face, head, neck, and back. |
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| Repeating of the last words spoken by another; mimicry or imitation of the speech of another person. |
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Definition
| Mimicry or imitation of the movements of another person. |
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| EPS-Extrapyramidal side effects |
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Definition
| A variety of signs and symptoms that are aften side effects of the use of certain psychotropic drugs, particularly the phenothiazines. Three reversible extrapyramidal side effects are acute dytonia, akatisia, and pseudoparkinsonism. A fourth, tardive dyskinesia, is the most serious and is not reversible. |
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| A sense perception (seeing, hearing, tasting, smelling, or touching) for which no external stimulus exists (e.g. hearing voices when none are present.) |
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| The false impression that outside events have special meaning for oneself. |
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| An error in the perception of a sensory stimulus. For example, a person may mistake polka dots on a pillow for hairy spiders. |
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Definition
| Weight gain, dyslipidemia, and altered glucose metabolism caused by atypical antipsychotic changes. |
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Definition
| The absence of something that should be present (e.g. apathy, lack of motivation, anhedonia, poor thought processes.) |
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| A word a person makes up that has meaning only for that person; often part of a delusional system. |
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| Neuroleptic malignant syndrome |
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Definition
| A rare and sometimes fatal reaction to high-potency neuroleptic drugs. Symptoms include muscle rigidity, fever, and elevated white blood cell count. It is thought to result from dopamine blockage at the basal ganglia and hypothalamus. |
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Definition
| A state characterized by the presence of intense and strongly defended irrational suspicions. These ideas cannot be corrected by experience and cannot be be modified by facts or reality. |
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| The presence of something that is not normally present (e.g. hallucinations, delusions, bizarre behavior, paranoia.) |
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| A medication-induced temporary constellation of symptoms associated with Parkinson's disease: tremor, reduced accessory movements, impaired gait, and stiffening of muscles. |
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| Conceptual model of psychiatric illness that stresses hope, living a full and productive life, and eventual recovery. |
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| A motor pattern that originally had meaning to the person (e.g. sweeping the floor or washing windows) but has now become mechanical and lacks purpose. |
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| A serious and irreversible side effect of the phenothiazines and related drugs; consists of involuntary tonic muscle spasms typically involving the tongue, fingers, toes, neck, trunk, or pelvis. |
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Definition
| A mixture of words meaningless to the listener and to the speaker as well. |
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| The wife of a patient with schizophrenia is worried about her 17 year old daughter and asks the nurse what symptoms mark the prodromal stage of schizophrenia. The nurse should respond by listing behaviors such as: |
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Definition
Withdrawal, poor concentration, phobic or obsessive behavior, oddities of speech.
Prodromal symptoms of schzophrenia are those that are present before the development of florid symptoms and can be subtle and nonspecific. The include social withdrawl, reduced concentration, phobic or obsessive behavior, oddities of speech or thinking, and decreased functioning in school or other roles. The other options each list the positive symptoms of schizophrenia that might be apparent during the later stage of the illness. |
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| The nurse is sitting with a patient diagnosed as having schizophrenia, disorganized type, who starts to laugh uncontrollably, although nothing funny has occurred. The nurse should say: |
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Definition
"You're laughing. Tell me what's happening."
The patient is likely laughing in response to inner stimuli such as hallucinations or fantasy. Focusing on this clue to internal stimuli and exploring the patient's experience of this stimuli (e.g., the content of the hallucination) shows an interest in the patient and provides potentially valuable assessment data, enabling the nurse to better understand the patient. The other options are less useful in eliciting a response, since no joke may be involved, and the patient is probably not focusing on what the nurse said in the first place. "Why are you laughing?" implies that the behavior is wrong or unacceptable, diminishing the patient's self-esteem and hampering the therapeutic relationship. |
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| A patient's nursing care plan includes assessment for auditory halluciantions. Indicators that suggest the patient may be hallucinating include: |
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Definition
Darting eyes, distracted, and mumbling to self.
Clues to hallucinations include eyes looking around the room as though to find the speaker, appearing preoccupied or distracted, and grimacing, mumbling, or talking aloud as though responding conversationally to someone. Mood changed, ritualistic behavior, and aloofness are not indicators of hallucinations. |
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| A patient received maintenance doses of fluphenazine decanoate (prolixin decanoate) 25 mg IM every 2 weeks for 2 years. The clinic nurse notes the patient is grimacing and seems to be constantly smacking her lips. On the next clinic visit, the patient's neck and shoulders twist in a slow, snakelike motion. The nurse should suspect the presence of ___________and should____________. |
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Definition
Tardive dyskinesia...administer the abnormal involuntary movement scale.
Tardive dyskinesia is a neurological condition induced by antipsychotic medications and involves involuntary rhythmic movements of the face, trunk, and limbs, including tongue thrusting, licking, blowing, rocking, and pill-rolling of the fingers. These symptoms usually persist even when the drug is discontinued. The scenario is not consistent with the other disorders mentioned: Agranulocytosis does not involve abnormal movements, the movements in Tourette’s syndrome are intermittent (tics) rather than persistent and rhythmic, and anticholinergic effects include dry mouth, blurred vision, constipation, and dry eyes and mucous membranes (which could explain the lip smacking but not the other motor changes). |
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| A catatonic patient admitted in a stuporous condition begins to demonstrate increased motor activity. During his assessment, the psychiatrist raises the patient’s arm above his head and releases it. The patient maintains the position his arm was placed in, immobile in that position for 15 minutes, moving only when the nurse gently lowers his arm. The symptom demonstrated is called echopraxia. |
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Definition
False.
The demonstrated is called waxy flexibility. Waxy flexibility is the ability to hold distorted postures for extended periods of time, as though the patient were molded in wax. Echopraxia involves the patient assuming the positions or postures he observes in others. |
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| A salesman has had difficulty holding a job because he accuses co-workers of conspiring to take his sales. Today, he argued with several office mates and threatened to kill one of them. The police were called, and he was brought to the mental health center for evaluation. He has had previous admissions to the unit for stabilization of paranoid schizophrenia. When the nurse meets him, he points at staff in the nursing station and states loudly, “They’re all plotting to destroy me. Isn’t that true?” Which would be the most appropriate response? |
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Definition
“Thinking that people want to destroy you must be very frightening.”
The patient is expressing paranoid delusions. By definition, a delusion is a persistent irrational belief held despite evidence to the contrary. Therefore, stating that his belief is untrue will not make sense to him and may reinforce his belief that people are set against him. Similarly, because the delusion is believed firmly regardless of the evidence, providing more evidence that the belief is wrong or guiding the patient to look at the evidence are unlikely to be helpful and may reinforce his delusion. The most therapeutic response is the one which focuses on the feeling associated with the belief rather than the belief itself. It conveys empathy and interest in the patient’s concerns, helping to build trust in the staff and giving him an opportunity to work through the fear he is experiencing. |
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| A patient receiving risperidone (Risperdal) reports severe muscle stiffness midmorning. During lunch he has difficulty swallowing food and speaking, and when vital signs are taken 30 minutes later, he is noted to be stuporous and diaphoretic, with a temperature of 38.8° C, pulse of 110 beats/min, and blood pressure of 150/90 mm Hg. The nurse should suspect _________ and should ______________. |
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Definition
neuroleptic malignant syndrome…place him in a cooling blanket and transfer to ICU.
Neuroleptic malignant syndrome is a life-threatening reaction to antipsychotic medications that presents with increasing muscular stiffness (leading to rigidity), hyperpyrexia, autonomic nervous system instability, diminished level of consciousness, and other symptoms. Emergency cooling measures are indicated for hyperpyrexia, and because this is a dangerous medical emergency, care in a medical unit (preferably intensive care unit) is required stat. Anticholinergic toxicity includes hyperpyrexia and elevated and unstable vital signs but includes hot, dry skin and does not include motor rigidity. A simple relapse would not include the physical changes noted here. Agranulocytosis would present with symptoms suggesting infection, not the severe symptoms noted here. |
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| A patient moving from chair to chair in the day room and pacing in the hallway repeatedly, rapidly, and for extended periods is likely demonstrating _________ , and the nurse should __________. |
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Definition
akathisia…administer PRN diphenhydramine (Benadryl) PO.
Marked, persistent psychomotor restlessness suggests akathisia, an often distressing and intense form of psychomotor restlessness. Acute dystonic reactions involve painful contractions of the tongue, face, neck, and back. Anxiety often presents as motor restlessness but the inability to remain at rest is seen as frequent changes in position or location. Tardive dyskinesia involves involuntary rhythmic muscular contractions that involve the tongue, fingers, toes, neck, trunk, or pelvis that usually appear after extended treatment and do not respond to antiparkinsonian drugs. |
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Term
| When assessing a patient’s plan for suicide, the priority areas to consider include availability of means and lethality of method. |
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Definition
True.
If a person has definite plans that include choosing a method of suicide readily available to the person and if the method is one that is lethal (i.e., will cause the person to die with little probability for intervention), the suicide risk is considered high. |
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| A patient is noted to be bending over backward in the group room. A peer asks what he is doing, and he replies, “People say they are bending over backwards to help me, so I am bending over backwards to help myself.” This is an example of: |
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Definition
concrete thinking.
Abstract thinking is the ability to think in a nonliteral way and is essential for tasks such as understanding symbolism and abstract concepts such as love or time. Concrete thinking is the absence of abstract thinking, or literal thinking, and is seen here in the patient’s interpreting the expression literally and actually bending over to help himself. Impaired reality testing is an inability to figure out whether a perception or thought is based in reality. Boundary impairment is difficulty telling where one’s self begins or ends or how one is distinct from others or one’s surroundings. |
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