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175 Cards in this Set

  • Front
  • Back
Plato & Aristotle convinced that the mind had a relationship with?
the brain and heart.
Hippocrates believed that depression was r/t?
an excess of black bile.
Descartes said that the mind is a ___ ___ entirely separate from ___ ____ found in the head.
nonmaterial thing

physical tissue
Freud was a ___ who focused on what?
a neurologist who focused on psychoanalysis rather than biological links to mental illness.
Behavior is ?
the proper focus of psychology.
-all behaviors are learned.
In the 1950's, what changed the tx of medical illness radically?
the introduction of meds.
What 3 meds were introduced in the 1950's?
-thorazine
-MAO inhibitors
-tricyclics
In the 1970's, what was mental illness thought to be?
diseases affecting the brain
Definition of psychobiology from the 1970's?
exploration of the biochemical foundations of thought,mood,affect & emotion.
1990's?
-decade of the brain
-from "troubled mind" to "broken brain"
-explosion of info & discovery
-focus on neurotransmitters & neuronal receptors
-improved imaging techniques
Current status of neurobiology?
-abnormalities in brain structure & function & neurochemicals identified
-searching for-but no reliable biological markers yet
-specific czs still not known
-genetic factors involved
-ongoing work to integrate findings
7 brain diseases?
-schizophrenia
-bipolar illness
-depression
-OCD
-panic disorder & other anxiety disorders
-alzheimers dz
-parkinson's,huntington's chorea
Why is neurobiology important?
-erase stigma
-educate public
-increase understanding & compassion for those w/ mental illness
Nature vs. Nurture?
-thoughts & emotions prod. chemicals
-there is evidence that repeated exposures to inescapable shock prod. neurochemical abnormalities
-so even in situations where environment seems clearly assoc. w/ "mental illness"/behavior there may be assoc biological factors involved
other terms to use instead of "Mental Illness"
-brain dysregulation
-brain malfunction
-faulty messaging machinery
-brain disorders
-hypothalmo-pituitary adrenal axis dysfunction
Functions of Dopamine(DA)?
-abstract thinking,decision making
-pleasure and reward system
-integration of thoughts & emotions
Effects of Excess Dopamine?
-disorganized thinking,loose assoc
-disabling compulsions,tics
Note:disorganized thinking & loose assoc are very char. of schizophrenia
Effects of a Dopamine deficit?
-poor impulse control
-poor spatial ability
-inability to think abstractly
-no joy,no anticipation of pleasure
-parkinson's dz/parkinson-like symptoms,movement disorders
Note:drugs which tx schizophrenia block dopamine. In blocking dopamine extrapyraminal symptoms often occur 4m insufficient dopamine.
Functions of norepinephrine(NE)?
-alertness
-ability to focus attention,ability to be oriented
-necessary for learning & memory
-primes nervous system for flight or fight
Effects of excess norepinephrine?
-hyperalertness
-anxiety,panic
-paranoia
-loss of appetite
Effects of a norepinephrine deficit?
-dullness,low energy,depression
Note: some antidepressants incr norepinephrine.
Functions of Serotonin(5-HT)?
-inhibition of activity
-calmness,contentedness
-regulation of temp & sleep
-precursor to melatonin which plays a role in circadian rhythms
Effects of excess serotonin?
-sedation
-decr. anxiety
-incr. sleep
-decr sex drive,decr orgasm
-indecision
-craving for sweets and carbs
Effects of serotonin deficit?
-depressed mood
-irritability
-hostility
-insomnia
-decr impulse control
-incr suicidal tendencies
-incr aggression
-incr sex drive
Note:antidepressant meds affect this neurotransmitter making more 5-HT available in the synapse
Functions of GABA(Gamma-Aminobutyric Acid)?
-regulates anxiety
-reduces aggression
-maintains calmness,contentedness
Effects of excess GABA?
-sedation
-impaired recent memory
-anticonvulsant properties
Effects of GABA deficits?
-high levels of tension & anxiety
-irritability
-lack of coordination
-seizures
Note:antianxiety meds affect levels of GABA
What does GABA?
Gamma-Aminobutyric Acid
Purpose of theories of mental health/illness?
-framework for understanding & practice
-no 1 theory fully explains all mental health/illness
-most practitioners draw upon several or all of the theories based on the particular client's needs
-allows comparison of tx effectiveness
What is the focus of Intrapersonal Theory?
focus is on individual,internal constructs/forces of "psyche" & unconsciousness motivation
Focus of Social Interpersonal Theory?
focus is on the effects of interpersonal & social relationships & what is observable.
False Imprisonment?
deliberate & unauthorized confinement of a person by use of verbal or physical means.
-a voluntary pt cannot be restrained.
What is anosognosia?
pt not aware the are mentally ill.
Voluntary Admission?
-pt comes to the hospital for tx on a voluntary basis.
-If pt requests discharge & doc doesn't agree,pt can sign a "Right to Release". This holds pt for 24 hrs for further assessment. Doc can then discharge the pt or initiate a BA 32.
BA 52(Baker Act-Involuntary Status)
-can be initiated to bring the pt into the hospital by police,doc,LCSW,licensed PhD, or masters psychiatric nurse. pt must meet one of the Baker Act criteria.
-dangerous to self
-dangerous to others
-refusal to care for self & is likely to suffer 4m neglect
How long does BA 52-involuntary status hold pt?
holds pt for 72 hrs so doc can assess whether or not further tx is needed.
-If further tx is needed,can initiate BA 32 or encourage pt to sign voluntary.
BA 32(Baker Act-Involuntary Status)
-can be initiated to hold a pt. who meets criteria who is already in the hospital or on a BA 52.
-a 1st or 2nd opinion is initiated & filed in probate court by the social worker. This holds the pt until the court hearing. The judge can order continued tx or release the pt. The pt can be discharged or become voluntary prior to the court hearing.
Exparte Order?
initiated by family/friends 4m Probate Court. Pt must meet criteria & is ordered to the hospital for psychiatric eval for 72 hrs. If continued stay is needed a BA 52 is initiated or voluntary.
Marchman Act?
court ordered eval/tx for acute or chronic alcohol or drug prob. Must meet criteria & is ordered to the hospital for eval for 5 days. If continued stay is needed,petition is filed w/ the court for a hearing.
Writ of Habeas Corpus?
an involuntary pt can request immediate release 4m the hospital. The social worker is responsible for seeing that the Writ is received in Probate Court on the day that it is signed by the pt. An immediate decision is made by the judge as to the release of the pt.
-Refer pt to social worker or psychiatrist if pt wants to discuss discharge or legal status.
What is the Baker Act Reform?
new law allows court-ordered outpatient tx for individuals w/ untreated severe mental illness.
What are the 5 rights under the Bill of Rights for Psychiatric pts?
-the right to appropriate tx & related services in the setting that is most supportive & least restrictive to personal freedom.
-right to informed consent
-right to refuse tx.
-right to communicate w/ others.
-right to privacy.
What is the foundation of ethical behavior?
Caring.
The concepts of Sigmund Freud fall under what theory?
Intrapersonal Theory
What are the 3 concepts of consciousness and who came up with them?
3 concepts are:
1.conscious, 2.preconscious, 3.unconscious and Sigmund Freud came up with them.
The 1st concept of consciousness, Conscious, includes?
thoughts,feelings,
experiences easily remembered
Preconscious(subconscious) includes?
thoughts,feelings & experiences that have been forgotten but can easily be brought to consciousness
Unconsciousness includes?
thoughts,feelings & experiences that are below the surface of awareness,but have an effect on us.
What are the 3 components to the personality according to Freud?
Id,Ego,Superego
Id?
constitutes the biological & psychological drives
The concepts of Sigmund Freud fall under what theory?
Intrapersonal Theory
What are the 3 concepts of consciousness and who came up with them?
3 concepts are:
1.conscious, 2.preconscious, 3.unconscious and Sigmund Freud came up with them.
The 1st concept of consciousness, Conscious, includes?
thoughts,feelings,
experiences easily remembered
Preconscious(subconscious) includes?
thoughts,feelings & experiences that have been forgotten but can easily be brought to consciousness
Unconsciousness includes?
thoughts,feelings & experiences that are below the surface of awareness,but have an effect on us.
3 components to the personality according to Freud?
Id,Ego,Superego
Id?
biological & psychological drives
-instant gratification(pleasure principle)
Ego is the component of the personality that...
mediates drive of Id w/ objective reality in a way that promotes well-being & survival
Superego is the component of the personality that...
is concerned w/ moral behavior & societal rules
What is the defense mechanism Compensation?
covering up weaknesses by emphasizing a more desirable trait or by overachievement in a more comfortable area.
What is the defense mechanism Denial?
an attempt to screen or ignore unacceptable realities by refusing to acknowledge them.
What is the defense mechanism Displacement?
the transferring or discharging of emotional rxns 4m 1 object or person to another oject or person.
What is the defense mechanism Identification?
an attempt to manage anxiety by imitating the behavior of someone feared or respected.
What is the defense mechanism *Intellectualization?
a mechanism by which an emotional response that normally would accompany an uncomfortable or painful incident is evaded by the use of rational explanations that remove from the incident any personal significance & feelings.
What is the defense mechanism Introjection?
a form of identification that allows for the acceptance of others' norms & values into oneself,even when contrary to one's previous assumptions.
What is the defense mechanism *Minimization?
not acknowledging the significance of one's behavior.
What is the defense mechanism *Projection?
a process in which blame is attached to others or the environment for unacceptable desires,thoughts,shortcomings,& mistakes.
What is the defense mechanism *Rationalization?
justification of certain behaviors by faulty logic & ascription of motives that are socially acceptable but did not in fact inspire the behavior.
What is the defense mechanism Reaction Formation?
a mechanism that czs ppl to act exactly opposite to the way they feel.
What is the defense mechanism Regression?
resorting to an earlier,more comfortable level of functioning that is characteristically less demanding & responsible.
What is the defense mechanism *Repression?
an unconsicous mechanism,by which threatening thoughts,feelings,& desires are kept from being conscious;the repressed material is denied entry into consciousness.
What is the defense mechanism Sublimation?
displacement of energy assoc w/ more primitive sexual or aggressive drives into socially acceptable activities.
What is the defense mechanism Substitution?
the replacement of a highly valued,unacceptable,or unavailable object by a less valuable, acceptable, or available object.
What is the defense mechanism Undoing?
an action or words designed to cancel some disapproved thoughts,impulses, or acts in which the person relieves guilt by making reparation.
Application of Defense Mechanisms?
-insight through psychoanalysis
-understanding use of defense mechanisms
-appreciate that ppl may have unconscious feelings,experiences,& motivations for behavior that they aren't "aware" of. Defense mechanisms may be utilized on an unconscious level.
Harry Stack Sullivan?
"We are all more alike than different."
-believed personality was an abstraction that couldn't be observed apart 4m interpersonal relationships.
Maslow's theory about personality falls under what type of theory?
Social Interpersonal Theory
Maslow viewed personality as?
self-actualizing. That is, the ideal individual is one who is at peak capacity for fulfilling his or her potential.
Who is known as the "mother of psychiatric nursing?"
Hildegard Peplau
What did Hildegard Peplau focus on? (social interpersonal theory)
focused on the importance of interpersonal interaction & the nurse-pt relationship in helping individuals improve health.
What does Feminist Theory focus on?
how gender roles in society affect psychological development of both men & women.
What is crisis?
a turning point in a person's life. Their usual coping skills no longer seem effective to them.(a subjective experience)
Crisis is not the event itself, but...
the perception of the event.
What are the 4 balancing factors that influence the potential for experiencing a crisis?
-perception of the event
-prior experience has had in coping w/stress
-usual coping abilities
-support systems available
A crisis is ___ & usually lasts about ____.
A crisis is self-limiting & usually lasts about 4-6 wks.
What is the goal of crisis intervention?
to help ppl return to previous level of functioning or move on to a higher level of functioning.
What does the application of crisis theory do?
helps us look at the impact of society,relationships,
events & support systems on mental health & illness.
How could you apply crisis therapy?
role playing,assertiveness training,family & marital therapy,group therapy
B.F. Skinner's theories are considered what?
behavioral theories
Behavioral theories focus on?
a person's actions,not thoughts & feelings,not unconscious motivation.
B.F. Skinner said that all behavior is ____ & can be modified by a ________.
all behavior is learned & can be modified by a system of rewards & punishment.
Consequences that lead to an increase in the behavior are called?
reinforcers or rewards.
Consequences that lead to a decrease in the behavior are called?
punishments.
Application of Behavioral Theories?
-behavioral contracts
-point systems(token economies)
-positive reinforcement
-smoking cessation
-weight loss
-systematic desensitization(for phobias)
Cognitive theories focus on?
how ppl think & interpret events,what they believe. Focus on how thinking about things is czing a person psychological distress rather than how events or interpersonal relationships have influenced them.
Cognitive theory according to Aaron Beck?
focuses not on what ppl do but rather on how they view themselves & their world.
What are 2 important constructs of Beck's cognitive theory?
-cognitive schemas
-cognitive triad
What are cognitive schemas?
personal controlling beliefs that influence the way ppl process data about themselves & others.
Cognitive schemas contribute to development of what?
Cognitive Triad
What is included in the cognitive theory process?
1.view self as inadequate
2.negatively misinterprets current experiences.
3.negatively view the future
What is the cognitive distortion, selective abstraction?
focusing on certain info. while ignoring contradictory info.
What is the cognitive distortion, overgeneralization?
person takes info or an impression 4m 1 event & attaches it to a wide variety of situations.
Use of what 4 words would indicate that the client is overgeneralizing?
-always
-never
-everybody
-nobody
What is the cognitive distortion, Magnification?
when ppl attribute a high level of importance to insignificant events. Clients believe that what occurs in the environment is r/t to them,even when no obvious relationship exists
What is the cognitive distortion, Superstitious thinking?
person believes that some unrelated action will magically influence a course of events.
What is the cognitive distortion, Dichotomous thinking?
an all-or-none type of reasoning that interferes w/ ppl's realistic perception of themselves.
Cognitive therapy helps ppl identify?
negative thinking patterns. Point out inconsistencies & misinterpretations.
Cognitive therapy has good outcomes with?
depression & anxiety disorders.
Neurobiologcial theories focus on?
biological czs of mental health & illness. Effect of neurochemistry,genes,structural abnormalities.
Application of neurobiological theories?
-psychopharmacology
-diagnostic tests
-genetic counseling
Neurobiologic theories states that you can't separate the ___,___,___?
mind,body,spirit.
Experiences modify ____ connections & ______.
experiences modify neural connections & neurochemistry.
Neurochemistry can modify ____,____,____,& how one_______ life.
Neurochemistry can modify thoughts,emotions,perceptions,& how one experiences life.
Exceptions to the right to refuse tx except in an emergency situation or as permitted by law?
-emergency:client in no cond to exercise judgment
-to avoid serious harm,preserve life.
-when refusing tx endangers life or health of another.
Duty to disclose/protect:
-an exception to confidentiality occurs w/ the "duty to warn" & the "duty to protect"
-obligation to warn identified individuals if the client has made a credible threat of violence
-notify local police & id'ed individuals when appropriate.
Duty to Report:
-exception to confidentiality occurs w/ the duty to report abuse
-suspicion of child abuse can be reported
-elder abuse:may include theft of money or assets,neglect,abandonment,orabuse.
-state reporting laws vary.
Review of communication process
-curriculum thread
-essential to all nursing practice
-skill you can learn & improve on
What is transference?
client's unconscious displacement of feelings for significant ppl in the past on to the nurse in the current relationship.
What is counter transference?
nurse's emotional reaction to the client based on significant relationships in the nurse's past.
The early definition of Milieu Therapy?
scientifically planned community
Milieu means?
environment
Milieu Therapy-Cummings & Cummings(1962):
environment might bring about changes in behavior. Environmen manipulated.
Milieu therapy-Kraft(1966):
social & interpersonal actions of the therapeutic community influence change
Milieu therapy-Hildegard Peplau(1952):
-described role of nurse in the therapeutic milieu
What is the therapeutic use of self according to Hildegard Peplau?
using one's personhood to provide psychiatric nursing care.
Goals of Milieu Therapy?
-clear communication
-safe environment
-activity schedule w/ therapeutic goals
-support network
Kraft's definition of milieu?
a therapeutic community in which the entire social structure of the unit or residence is designed to be part of the helping process.
Milieu therapy emphasis on:
-clients as responsible ppl
-group & social interaction
-client's right to choose a variety of txs
-informality of relationships w/ HC prof.
Milieu Therapy-Communication:
-open,honest,appropriate
-no retaliation for expression of thoughts & feelings
-staff listens w/o feeling threatened
-comm skills role-modeled by staff
-respect for dignity of all
Milieu Therapy:Safe environment
-policies,procedures,& rules ensure safety of all
-all informed of rules
-structures & controls in place for confused,anxious,suicidal,homicidal,or out of control clients
Milieu Therapy:Activities w/ Therapeutic Goals(Assignment to activity depends on level of function)
-Insight?
-Understands the goals of tx?
-In contact w/ reality?
-Motivated?
*Planned to meet needs of persons in group
Milieu therapy-activities w/therapeutic goals(balanced to provide a variety)
-daily therapeutic community meetings
-group therapy
-ADL training
-physical activity
-art/play therapy
Social microcosm of group therapy?
-members behave as they do w/ family/friends
-can see dysfunctional ways of relating
-self-reflection can lead to change
Define curative factors.
mechanisms of change w/in a group.
curative factor Altruism:
thru the group process, clients recognize that they have something to give to the other group members.
Explain the curative factor of group therapy known as corrective recapitulation of the primary family group.
therapy group is often like a family, & clients can learn more functional patterns of communication,interaction & behavior.
Explain the curative factor, development of socializing techniques.
group members give feedback about maladaptive social behavior. Clients learn more appropriate ways of socializing with others.
Explain the curative factor existential factor.
group provides opportunities for clients to explore meaning of their life and their place in the world.
Explain the curative factor catharsis.
clients learn how to express their own feelings in a goal-directed way,speak openly about what is bothering them, & express strong feelings about other members in a responsible way.
What are hallucinations?
sensory experiences w/ no external stimuli.
-often assoc w/ psychotic states.
5 types of hallucinations?
-auditory
-visual
-tactile
-olfactory
-command
3 things that hallucinations could be from?
brain tumors, drug use, electrolyte imbalance
Assessment of Hallucinations?
-ask
-talking to someone not there
-laughing inappropriately
-appears distracted
-appears to be listening to something
-difficulty attending
-can be so occupied w/ voices that response to anything in environment is impossible.
What is psychosis?
state in which a person is unable to comprehend reality & has difficulty communicating & relating to others.
What is psychosis usually characterized by?
hallucinations,delusions, and/or gross disorganization of thought or behavior.
4 cross diagnostic behaviors?
-hallucinations
-delusions
-self mutilation
-aggression
Command Hallucinations?
-potentially dangerous
-May tell the patient to do something harmful to self or others
-May be very frightening to patient
-Suicide potential
What Clients Say Is Helpful when intervening while pt having hallucinations
-having someone w/ them
-hearing a real person talk
-being able to see the person who's talking
Significance of assessing hallucinations?
-symptom of pathology
-indicator of progress
Interventions for Hallucinations?
-Keep conversation simple
-Ask for a description of what is happening
-Ask client to describe feelings
-Do not argue with patient about reality of the hallucinations
-Ok to say you don’t see or hear what patient does
-Talk aloud or to someone
-Involve in an activity
-Listen to music
-Ask about and observe for environmental triggers
-Read aloud
What are delusions?
-False beliefs that cannot be changed by logical reasoning
-Firmly fixed
-Providing evidence, logical reasoning does nothing to change the false belief
-Occur in a number of disorders
What are the 9 types of delusions?
-False beliefs that cannot be changed by logical reasoning
-Firmly fixed
-Providing evidence, logical reasoning does nothing to change the false belief
-Occur in a number of disorders
-Ideas of reference
-Thought Broadcasting
-Thought Withdrawal
-Thought Insertion
Nursing Interventions for Delusions?
-Remember that delusions are real to patient
-Reassure about safety if appropriate
-Listen, reassure, and then try to refocus patient
-Present reality, don’t argue or challenge
-Logic doesn’t work
-Talk about real people and events
-Provide diversional activities
What are erotomanic delusions?
beliefs that a person, usually someone famous and of higher status, is in love with him/her.
What are somatic delusions?
ppl believe something abnormal & dangerous is happening to their bodies.
Clients Who Self Mutilate
-Deliberate destruction of body tissue without conscious intent of suicide
-Not trying to kill themselves
examples of Self mutilation
-Cutting
-Burning
-Scratching
-Hitting
-Inserting objects
-Interfering with wound healing
examples Severe Cases of self mutilation With Psychosis
-Castration
-Eye enucleation
-Amputation of body parts
Reasons given for self mutilation
-Has meaning to patient
-Ending dissociation
-Punishing oneself
-Distraction from emotional pain
-Release of tension
-Crying for help
-Manipulation
Nursing Interventions for Self mutilation
-Nonjudgemental attitude
-Set limits
-Encourage communication
-Identify the function served
-Respond without blame or shame
-Identify triggers
-Help find other coping tools
-No harm contracts
Mental disorders assoc w/ self mutilation?
-Childhood Sexual and Physical Abuse
-Borderline Personality Disorders
-Eating Disorders
-Cognitive Impairment
-OCD
-DID
-Mental Disorders
-Hallucinations and Delusions
What is the best predictor of future violence in a pt?
history of violence
when Assessing for Potential Violence, keep in mind what situations in which violence is more likely to occur?
-Persecutory Delusion
-Command Hallucinations
-Poor Impulse Control
-Intoxication/Drug Induced
-Secondary Gains
-Peer Group
Warning signs of aggression?
-Tone of voice
-Sarcasm
-Pacing
-Gesturing
-Staring
-Fist clenching
-Body tension
Prevention of aggression?
-Talking about feelings
-Finding ways to manage anger
-Physical outlets
-Time out
-Behavioral contracts
Meds used to control aggression?
-Haldol
-Geodon
-Ativan
-Given IM
-Ativan cannot be mixed with other meds
What is seclusion?
patient removed from general milieu and put in single room with or without a locked door
Milieu Factors?
¨Crowding
¨Patient/staff ratios
¨Rigid rules and regulations
¨Noise
¨Recreation
¨One to one care
¨Medications
¨Staff Education
¨Behavioral Systems
Negative things that restraints reinforce to pt?
¨Reinforces idea that violence is a valid way of regaining control
¨Reinforces “tough” image
¨May increase likelihood of future violent confrontations
¨Does not teach coping skills for future situations
¨Fosters distrust and malice towards staff
Axis I?
-primary dx
-probs that are the focus of clinical attention such as anxiety,eating disorders,sleep disorders,adjustment probs
Axis II?
personality & developmental disorders
-if says deferred under this category, means Dr. didn't know pt well enough to dx
Axis III?
physical disorders that affect mental health
ex:cancer which czs depression
Axis IV?
psychosocial & environmental stressors
-occupational
-housing
-economic
-legal probs
-probs w/ access to HC services
*will list severity(none to catastrophic) and usually the stressor
Axis V?
-Global Assessment of Functioning:looks @ big pic of how person functioning
-uses the GAF scale of 1-100
What does the GAF look at?
psychological,social & occupational functioning on a continuum of mental health illness.