Term
| Most common disorders in women |
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Definition
anxiety disorders
mood disorders |
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Term
| most common disorders in men |
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Definition
impulse control
substance abuse |
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Term
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Definition
reduction in psychotic thinking
decreased agitation and violence
improved moods in depressed pts
improved hospital environments
increase in the number of pts able to live in community
moral and legal questions have arisen |
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Term
| impacts of deinstitutionalization |
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Definition
raised ED use
shift of cost to federal gov
commitment laws changed
revolving door effect
raised homelessness |
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Term
DSM-IV-TR multiaxial system of evaluation
axis I |
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Definition
clinical disorders
other conditions that may be a focus of clinical attention |
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Term
DSM-IV-TR multiaxial system of evaluation
axis II |
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Definition
personality disorders
mental retardation |
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Term
DSM-IV-TR multiaxial system of evaluation
axis III |
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Definition
| general medical conditions |
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Term
DSM-IV-TR multiaxial system of evaluation
axis IV |
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Definition
| psychosocial and environmental problems |
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Term
DSM-IV-TR multiaxial system of evaluation
axis V |
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Definition
| global assessment of functioning |
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Term
| therapeutic vs social relationship |
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Definition
nurse is responsible
body of knowledge required
purposeful and goal directed
time limited relationship
focus is on client
choice of who is in relationship is not an option
provider self disclosure is limited
understanding is verbalized
nurse is advocate |
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Term
| being therapeutic is communicating in a goal directed way to help benefit the client in many different settings... |
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Definition
assisting the pts to problem solve
providing feedback and validation
listening
use of appropriate verbal skills and behaviors
providing information |
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Term
therapeutic communication skills examples
minimal cues and leads |
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Definition
body actions: smiling, nodding, leaning forward
words: mm, uh huh, oh really, go on |
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Term
therapeutic communication skills examples
clarification |
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Definition
"could you describe what happened in sequence?"
"i'm not sure I understand what you ran, can you give me an example?" |
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Term
therapeutic communication skills examples
restatement |
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Definition
"are you saying that...(repeat clients words)"
you mea...(repeat clients words)" |
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Term
therapeutic communication skills examples
paraphrasing
client: i can't take this anymore...the chemo is worse than the cancer. i just want to die |
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Definition
| nurse "it sounds as though you are saying you have had enough" |
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Term
therapeutic communication skills examples
reflection |
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Definition
"it sounds as though you feel guilty bc you weren't home at the time of the accident"
"you sound really frustrated because the treatment is taking longer than you thought it would" |
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Term
therapeutic communication skills examples
summarization |
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Definition
| " before moving on, I would like to go over with you what I think we accomplished thus far" |
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Term
therapeutic communication skills examples
silence |
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Definition
| briefly disconnecting but confirming to use attending behaviors after an important idea, thought, or feeling" |
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Term
therapeutic communication skills examples
touch |
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Definition
| gently rubbing a persons arm during a painful procedure |
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Term
| responses that block communication |
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Definition
false reassurance
giving advice
false inferences
close ended questions
moralizing
value judgments
social responses (isn't that nice) |
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Term
| stages of nurse - pt relationship |
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Definition
orientation
working stage
termination stage |
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Term
nurse - pt relationship
orientation |
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Definition
building trust
beginning assessment - learn about pt and needs
pt learns about nurses' role - they help pts look at realistic options so pts can make own decisions
management of emotions
providing support
providing structure
prepare for termination - discuss time length with pt |
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Term
nurse - pt relationship
working stage |
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Definition
process of learning
stormy
in depth data collection
reality testing and cognitive restructuring (helps pts redefine how they look at things)
journal writing - allows objective analysis
promoting change - empathy, explore reason for change
supportive confrontation - aimed at contradictions in pts statements.
promoting change - help pt evaluate risk benefit ratio
teaching new skills - relaxation, stress reduction, conflict resolution, assertiveness, problem solving and social skills |
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Term
nurse - pt relationship
termination stage |
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Definition
evaluation - nurse guides pts in discussion of specific changes in thoughts, feelings, and behaviors
help ID areas that need more work
good byes
referrals
discuss termination from beginning of relationship |
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Term
| interventions for violent pts |
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Definition
stay out of striking distance
avoid touching pts without permission
change topic temp if pts behavior is escalating
suggest time out
avoid entering room alone
leave temp if pt is agitating and asking to be left alone
call for assistance |
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Term
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Definition
assess content
comment on behavior - i saw you talking into the blanket
say - "I don't hear anything, tell me what you hear"
assess hallucinations content - reveals themes
after content is known focus on here and now. focusing on hallucinations will only reinforce them
eventually hallucinations are ignored - engage in productive activity |
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Term
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Definition
assess content, clarify meaning
avoid arguing about delusions
focus on underlying themes - beautiful, power.. |
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Term
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Definition
| help pt examine effects or outcomes of their beliefs |
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Term
| incoherent speech patterns |
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Definition
avoid repeating questions more than 2x..makes demented clients more anxious
meds can decrease anxiety and help make them clearer
clarify meaning of communication
spend frequent brief time with pt |
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Term
|
Definition
definition: a means to gain attention, sympathy, control and dependence
consistency and limit setting is important
help pt to express needs directly |
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Term
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Definition
allow and encourage
avoid touching pt to allow pt to get it out
offer tissue
provide privacy
offer opportunity to talk after crying stops |
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Term
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Definition
acknowledge the inappropriateness of behavior and the consequences of the continued behavior
avoid touching pts with boundary issues
pair pts with members of the same sex |
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Term
| incompliance/denial/lack of cooperation |
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Definition
reality testing
focus on the outcomes of noncompliance
trust is often an issue - use measures to increase trust
help pt identify fear |
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Term
| depressed affect/apathy/ psychomotor retardation |
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Definition
acknowledge feelings, discourage rumination
patience, frequent contact & empathy are helpful with sadness, helplessness, and hopelessness
encourage movement
do not allow pt to stay stuck |
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Term
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Definition
communicate clearly, concisely, and congruently
clarify misinterpretation - avoid arguments |
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Term
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Definition
decrease stimulation
encourage physical activity to drain energy
speak slowly and calmly
respect personal space
be kind and firm |
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Term
| transference (when you remind the pt of their mom or someone) and countertransference (when the pt reminds you of something that effects you) |
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Definition
recognition
redirection and limit setting are important if behaviors are inappropriate
peer support for countertransference |
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Term
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Definition
help pts problem solve
avoid giving pts advice or suggesting options until pt has has opportunity to come up with options
ask questions that are open ended |
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Term
millieu management
5 environmental elements |
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Definition
safety: physical & psychological protection
structure: activities, schedule and design
norms: expectations of behavior
limit setting: regulation of pt behavior
balance: independent & dependent behaviors |
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Term
| important mental health issues/laws |
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Definition
1. right to refuse treatment, need informed consent
2. duty to warn (tarasoff law)
3. confidentiality
4. illegal confinement (false imprisonment)
5. assault and battery |
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Term
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Definition
1. least restrictive environment (most important)
2. freedom from restraint (includes meds)
3. freedom from seclusion
4. confidentiality HIPAA
5. give or refuse consent to treatment
6. provide advance directives
7. suspension of rights (when they can be suspended) |
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Term
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Definition
| everything is slowed down |
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Term
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Definition
| emotional range attached to ideas; outwardly demonstrated; feeling, mood, or emotional tone. How one shows emotion and feels |
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Term
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Definition
| emotional tone in harmony with the accompanying idea, thought, or verbalization. |
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Term
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Definition
| incongruence between the emotional feeling tone and the idea, thought, or speech accompanying it. |
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Term
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Definition
| absence or near-absence of any signs of affective expression |
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Term
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Definition
| rapid changes in emotional feeling tone, unrelated to external stimuli |
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Term
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Definition
| disturbance manifested by a severe reduction in the intensity of affect |
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Term
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Definition
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Term
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Definition
| how clear is their thinking. Oriented to place and time |
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Term
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Definition
| where you can see hallucinations |
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Term
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Definition
| speech that lacks meaning |
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Term
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Definition
| don’t think they have a pro |
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Term
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Definition
| – talk about religion all the time. Not in a productive or helpful way. |
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Term
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Definition
| false beliefs. They might say they’re sent from Jesus to save the world |
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Term
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Definition
| delusions that are related to thinking people are out to get them or harm them |
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Term
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Definition
| delusions that leads the patient to believe they are special in some way. Claiming they are a CEO of a company. They want to feel powerful. |
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Term
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Definition
| related to body of some kind. Lot of physical complaints like saying they have cancer or making up illnesses |
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Term
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Definition
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Term
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Definition
| ideas that everything going on is about them (radio, news, overhearing conversations) |
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Term
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Definition
| they think that because they think something it will happen. They think they influence people with their thoughts. |
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Term
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Definition
| see things that are in the environment but you think they’re something else. Think curtain is a ghost. |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| feeling like bugs are crawling on them |
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Term
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Definition
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Term
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Definition
| get stuck talking about one thing |
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Term
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Definition
| irrational thoughts they get stuck thinking about that they know isn’t accurate. Thinking they are dirty even though they just showered. They know they turned off curling iron but they keep thinking about it. |
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Term
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Definition
| what people actually do because of the obsessions. Showering a lot, checking repeatedly to see if curling iron is off. |
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Term
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Definition
| pts thoughts are somewhat connected but they go off on other things. Need to refocus. |
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Term
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Definition
| like flight of ideas (thoughts are somewhat connected but they go off on other things) but pts thoughts are not connected very well. |
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Term
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Definition
| give people a lot of details but don’t really get to the point |
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Term
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Definition
| go off on a different tangent or idea |
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Term
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Definition
| often seen in pts with schiztophrenia. Their thoughts are ahead of what they’re saying. If they’re hearing a voice they’ll stop mid sentence. Something is interfering with their thoughts. |
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Term
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Definition
| they can’t make good decisions. |
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Term
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Definition
| does the pt know they have a problem, do they know how to handle it |
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Term
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Definition
| difficulty in searching for words |
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Term
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Definition
| lack of feeling, interest, or emotion; indifference that is occasionally a mechanism for avoiding intense emotion |
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Term
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Definition
| inability to perform once known, purposeful, skilled activities in the absence of loss of motor function. |
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Term
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Definition
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Term
| aggression goals and principles |
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Definition
assess, defuse, & manage
use least restrictive methods
-physically restrain only if imminent danger of physical injury exists
verbal aggression is a major warning sign of impending acting out behavior |
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Term
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Definition
traumatic brain injury
ETOH or drug use and/or withdrawal
impulse-control disorders
med non-compliance
perceptual disturbances |
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Term
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Definition
trigger-stressful even occurs
escalation- movement towards loss of control
crisis- loss of control occurs
recovery - return to normal responses
post-crisis depression - reconciliation with others |
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Term
triggering
Behaviors and interventions |
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Definition
behaviors: muscle tension, irritable, pacing, suspicious
interventions: support, empathy, alternative options, ask to maintain control |
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Term
escalation
Behaviors and interventions |
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Definition
behaviors: agitation, screaming, swearing, flushed, clenched fists
interventions: take charge, use time out, oral meds |
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Term
crisis
Behaviors and interventions |
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Definition
behaviors: loss of self control, fighting, rage
interventions: seclusion & restraint, IM meds |
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Term
recovery
Behaviors and interventions |
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Definition
behaviors: accusations, decreased body tension, relaxation
interventions: continue intensive nursing care, process incident |
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Term
post-crisis
Behaviors and interventions |
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Definition
behaviors: crying, apologies, repression
interventions: decrease the extent of seclusion and restraint; facilitate re-entry into unit |
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Term
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Definition
wraps around the brainstem & sits beneath the cerebral cortex
emotion formation & processing, memory & motivation |
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Term
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Definition
amygdala buried deep in the temporal lobe; complex emotions (aggression)
hippocampus transfers information from short to long term memory; affected by thiamine deficiency |
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Term
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Definition
responsible for modulating voluntary movement
includes substantia nigra (produces and sends dopamine to basal ganglia) |
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Term
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Definition
made up of the thalamus & hypothalamus
all sensory pathways synapse in the thalamus
hypothalamus influences food & fluid intake & endocrine secretion |
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Term
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Definition
includes reticular formation
-primitive brain buried deep in brainstem
-affects motor, sensory, & visceral functions |
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Term
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Definition
receives sensory input indicating how muscles are to be directed
communicates with cerebral cortex to coordinate find motor movement
does not initiate movement
maintain equilibrium |
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Term
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Definition
many psychotropic drugs have anticholinergic properties; block the cranial nerves
effects:
dilated pupils
decreased lacrimation
dry mouth
slowing of bowel and bladder |
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Term
| neurotransmitters and mental illness |
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Definition
schizo - dopamine dysfunction
depression - serotonin & norepinephrine
anxiety disorders - GABA
anorexia nervosa - hypothalamic dysfunction |
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Term
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Definition
identify and express each members feelings
define family roles and rules
explore and try out new ways of dealing with one another
return power to the parental dyad |
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Term
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Definition
pts gain knowledge about ways to relate to others
pts gain acceptance, reassurance, and support
pts gain hopefulness about ability to recover
pts have an opportunity to test out new behaviors in a safe environment
pts can share feelings, probs, concerns, and ideas in safe place
pts gain a sense of importance and worth |
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Term
| Yalom's therapeutic factors |
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Definition
instillation of hope
universality
imparting of information
altruism
corrective recapitulation of primary fam group
development of socializing techniques
imitative behaviors
catharsis
existential factors
cohesiveness
interpersonal learning |
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Term
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Definition
| combines both task and process |
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Term
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Definition
recreation
creative expression |
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Term
| education groups or psychoeducation |
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Definition
focus on teaching
illness
medication
problem solving
stress management
social skills |
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Term
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Definition
process oriented
focus is on the relationships among members and communication styles and patterns
insight oriented
psychodrama
sociadrama |
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Term
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Definition
serious and persistent mental illness characterized by significant disturbances in the following:
perception (hallucinations)
thought (loose associations, blocking, delusions)
feeling (affect)
behavior
attention (poor concentration & focus)
motivation |
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Term
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Definition
both mood disorder and schizophrenia; hybrid
schizophrenia symptoms are dominant
may be treated with antipyschotic & mood stabilizer |
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Term
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Definition
less than 1 month duration
not related to a mood disorder, medical condition, or substance induced |
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Term
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Definition
display symptoms of shchizo
delusions are somewhat reality based
relatively normal behavior |
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Term
| schizophreniform disorder |
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Definition
| display typical symptoms for at least 1 month but less than 6 months |
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Term
| schizophrenia theory of cause |
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Definition
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Term
schizophrenia
positive symptoms |
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Definition
excess of thoughts, emotions, and behavior (excess dopamine)
hallucinations, delusions, abnormal thoughts, agitation |
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Term
schizophrenia
negative symptoms |
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Definition
deficit of thoughts, emotions, and behavior (decreased dopamine)
alogia (poverty of speech), anergia (lethargy, lack of physical activity), poor grooming, social withdrawal |
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Term
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Definition
do not reinforce hallucinations
orient to person, place, and time
focus on real people, and real events
avoid whispering and laughing
begin with 1:1 interactions
role model & teach socially acceptable behavior
reinforce positive behaviors |
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Term
| typical (traditional) antipsychotic meds |
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Definition
decrease dopamine in dopaminergic tracts of the brain
improves positive symptoms
my worsen negative symptoms
PNS anticholinergic and antiadrenergic SE may occur |
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Term
| why are typical meds the 2nd line therapy? |
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Definition
because they can cause extra pyramidal symptoms EPS like:
dystonias
akathisia
parkinsonism
tardive dyskinesia |
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Term
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Definition
| prolonged and unintentional muscular contractions of voluntary and involuntary muscles; state of abnormal tonicity |
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Term
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Definition
anticholinergics or antihistaminergics
-cogentin
-artane
-benadryl |
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Term
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Definition
| inability to sit still; motor restlessness (pacing, tapping feet) |
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Term
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Definition
| treat with benzos, beta-adrenergic antagonist or beta-adrenergic agonists; anticholinergics usually not effective |
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Term
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Definition
| triad of resting tremor, muscular rigidity, and bradykinesia, shuffling gait, slowed cognition, excessive salivation, appear 3-9 days after initiation of treatment or dose increase |
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Term
| pseudoparkinsonism treatment |
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Definition
| anticholinergics are highly effective |
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Term
| Neuroleptic malignant syndrome (NMS) |
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Definition
potentially lethal side effect of antipsychotics
less than 1% of pts will develop, 5-20% will die if untreated
medical emergency |
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Term
| Neuroleptic malignant syndrome (NMS) symptoms |
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Definition
increased temp
rigidity & autonomic dysfunction
treated with muscle relaxants and dopaminergics |
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Term
| atypical antipsychotic meds |
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Definition
selectively increases dopamine in the mesocortical and decreases dopamine in the mesolimbic tracts
decrease positive symptoms
may improve negative symptoms
less risk of EPS side effects |
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Term
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Definition
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Term
adverse effects
risperidone |
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Definition
risperidal
orthostatic hypotension
most EPS
long acting form risperdal consta |
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Term
adverse effects
olanzapine |
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Definition
zyprexa
hyperglycemia, hyperlipidemia, weight gain
most metabolic atypical drugs |
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Term
adverse effects
qualiapine |
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Definition
seroquel
high rate of sedation, appetite stimulation |
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Term
adverse effects
ziprasidone |
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Definition
geodon
prolonged QT interval |
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Term
adverse effects
apripiprazole |
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Definition
abilify
less weight gain
akathesia |
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Term
adverse effects
paliperidone |
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Definition
invega
headache, sedating, can increase prolactin levels |
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Term
| bipolar general descriptions and characteristics |
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Definition
extremes in mood polarity, very euphoric or depressed
onset most often in early 20s |
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Term
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Definition
1 or more manic or mixed episodes, usually accompanied by major depressive episodes
symptoms persist for at least 1 week
usually begins suddenly & escalates rapidly
frequent hospitalization
rapid cycling denotes 4 or more episodes of mania and depression in 1 year |
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Term
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Definition
1 or more major depressive episodes
at least one hypomanic episode
no history of manic episodes
Often misdiagnosed as major depression
at least 2 years of numerous periods of hypomanic & depressive symptoms
no symptom remission for more than 2 months |
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