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178 Cards in this Set
- Front
- Back
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Sub types of schizophrenia
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Disorganized
Catatonic Paranoid Undifferentiated Residual |
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Disorganized Schizophrenia
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Characterizeed by schizophrenic symptomsl marked incoherence, affect which is flat, incongruous or silly, Prognosis is poor
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Catatonic Schizophtenia
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Characterized by schizophrenic symptoms plus at least two of the following
Catatonic stupor, Extreme negativism, catatonic excitement, catatonic posturing, Echolalia or Echopraxia |
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Paranoid Schizophrenia
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Characterized by schizophrenic symptoms plus suspiciousness, delusions and hallucinations with themes of grandiosity , persecution, possibly jealousy. client can be very angry
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Undifferentiated Schizophrenia
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Characterized by schizophrenic symptoms; psychotic symptoms are prominent, but does not fit with one of the other types, or may be more than one of the other types
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Residual Schizophrenia
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This term is used when the client is over his psychosis, but some signs of illness persistent - emotional blunting, social withdrawal, eccentric behavior, mild thought disorder, small amount of delusion of hallucination, it is associated with chronic course of the disease
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Delusional Disroder
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Not a schizophrenia, less dramatically impaired. Characterized by persistent persecutory delusions or delusions of jealousy. Apart from the non-bizarre delusions, function is not markedly impaired and behavioris not obviously odd or bizarre. This is insidious development of a chronic and unshakable paranoid delusion. Emotion and behavior are consistent with the delusional system. Clear and ordered thinking is preserved. Age of onset is later than schizophrenia
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Schizophreniform Disorder
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Psychotic disorder with the features of schizophrenia except that the illness lasts at least one month but less than six months
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Schizoaffective
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Characterized by the presence of both active-phase symptoms of schizophrenia and symptoms of depression or mania
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Brief Psychotic Disorder
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A psychosis that resolves within one month of less, with recovery to normal level of function. Onset may be due to sever stress
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Shared Psychotic Disroder
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Delusional system develops because of close relationship with a person who already hsa a psychotic disorder with delusions
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Psychotic Disorder Due to a General Medical Condition
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Prominent hallucinations or delusions that are judged to be due to the direct physiological effects of a general medical condition (huntington's, CVA, Neoplasms)
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Substance-Induced Psychotic Disroder
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Psychotic symptoms are judged to be directed physiological consequences of abuse, a medication, or toxin exposure
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Psychotic Disorder Not Otherwise Specified
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Includes psychotic symptomatoloty that do not meet the criteria for specific psychotic disorders or about which there is inadequate or contradictory information
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Stages of Relapse
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1. Overxtension
2. Restricted Consciousness (Stage 1 and 2 do not involve symptoms of psychosis. critical time to intervine) 3. Disinhibition 4. Psychotic Disorganization 5. Psychotic Resolution |
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Alcohol Addiction Signs
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Signs of use: red eys, unsteady gait, slurred speech
Signs of withdrawal: tremors, diaphoresis, watery eyes and nose Wernicke’sEncephaolphathy: reversible delirium associated with thiamine deficiency Korsakoff’s Syndrome: coplication of wernicke’s encephalopathy affects memory and ability to retain or gain new information Effects of alcohol: brain atrophy, dementia, esophageal varices, cardiomyopathy, testicular atrophy, thiamine deficiencies * Alcohol poses the greatest withdrawal danger* |
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Alcohol Addiction Drugs
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Librium
Valium Vivitrolone time a month injection Campral: alcohol abstinence Anatabuse: alchol abstinence, get really sick if drink |
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Opioid Addiction
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Methadone,
Buphrenophine clonidine -suppresses opioid withdrawal Narcanoverdose |
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Methamphetamine
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Physical effects:increase BP, sensory acuity, enery, Decrease appetite, sleep and reaction
Psychological effects: increase alertness, confidence, mood, sex Decrease bored and lonely |
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Adolescents and medications
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SSRI’s,
NO BENZOs Lithium good Psychostimulants-ADHD Antipsychotics--psychosis Depression: fluoxetine |
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Abuse and Violence
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Passive: subordinate own rights to their perception to the rights of others
Assertive: self assurance, clear respect for others, good to teach |
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Theories on Aggression
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1. Psychological: importance of developmental experiences, reject violence, poor bonding
2. Sociocultural: Single parent, Unemployment, roadrageect… 3. Biological: limbic system, hypothalamus releases steroids ect.. |
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Aggression Meds
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-Anxiety, Sedative-Hypnotics, SSRIs, Mood stabilizers, and antipsychotics
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Child Abuse
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Physical, emotional and sexual abuse
Child may exhibit: Sexual acting out, excessive masturbation, STD’s, pregnancy, bleeding Social withdrawal, low self esteem Disturbed sleep, poor school performance *any suspicions report to CPS Parent may: have Hx of abuse Harsh discipline, seldom touches child, isolated from friends, Misuses drugs and alcohol, Doesn’t want to leave child’s side, suspicious |
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Elder Abuse
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most likely dependent, white, female, living with family, a relative
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Sexual Assault
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any type of sexual activity that victim does not want or agree to
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Rape
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expression of anger, wanting to humiliate, need for power and control
Acute Phase (Disorganization Phase): right after assault shock and disbelief Long term Reorganization phase: 2 or more wks after, integrates rape into life Psychological emergency, important for nurse to listen and provide support |
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Panic Disorder
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sudden panic attacks, women suffer more
With agoraphobia: increase when being in places where they can’t escape Without agoraphobia: recurrent or unexpected attacks Tx: BB, Benzos, Paxil, Gradual desensitation |
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Phobias
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irrational fear that produces intense anxiety and avoidance behavior
Social Phobia Tx: with BB and Neurontin SSRI, Rehersal, CBT |
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Obsessive Compulsive Disorder
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Obsessions: persistent thoughts or impulses
Compulsions: repetitive, ritualistic behaviors that attempt to relieve anxiety Tx: SSRI (Luvox) TCA (anafranil) Takes up to 1 hr each day |
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Generalized Anxiety Disorder
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Uncontrollable worrying, irritability, sleep disturbance
Tx:CBT + SSRIs, Buspar, Depaken, TCA’s |
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Post traumatic Stress Disorder
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s/s that develop after a traumatic or overwhelming situation
3 main s/s: Intrusive thoughts or flashbacks, Depersonalization, emotional numbing Tx:Desesitation, EMDR, SSRIs, BB, Tegretol |
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Acute Stress Disorder
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One month after a traumatic event, must show one of these
Detachment, reduced awareness of surrondings, derealizaiton, depersonalization, dissociateive amnesia Resolves in about 4wks |
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Somatoform Disorders
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Group of disorders which have severe recurring , multiple complaints
Somatization Disorder Hypochohdriasis Pain Disorder Body Dysmorphic Disroder Conversion Disorder |
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Somatization Disorder
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Certain number of s/s that cause function impairment, pain dysphagia
Tx: CBT |
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Hypochondriasis
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fear they have a serious disease, misinterpret physical sensations real to the patient, chronic and relapsing
Tx: Procide reassurance its not a serious illness, believe pt dont usually respond to medical treatment |
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Pain Disorder
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Organic cause ruled out, chronic pain gets expesive
Tx: excessive use of narcotics and sedatives Suicide risk |
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Body Dysmorphic Disorder
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Chronic and debilitating, they imagine defect in apperance.
No relief from surgery |
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Conversion Disorder
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Most Common, unexplained physical s/s affecting voluntary motor or sensory function that suggest neuro or medical condition
Tx: SSRI, relaxation techniques |
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Dissociative Disorders
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* Separation of thoughts, feelings or experiences from normal stream of consciousness and memory
Depersonalization, Dissociative Amnesia, Dissociative Fugue, Dissociative Identity disorder |
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Depersonalization
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Experience of self reality or self environment is changed, verbalize discomfort can feel it happen
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Dissociative Amnesia
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Inability to recall significant personal info (most common)
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Dissociative Fugue
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Identity and memory disturbances
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Dissociative Identity disorder
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Multiple personality disorder (most serious) having two or more personalities that have own behaviors and attitudes, use different voices and clothes
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Eating Disorders
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Bulimia
Anorexia |
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Bulimia
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Binge eating followed by self induced vomiting, preoccupied with weight and body shape
take laxatives, diuretics, excessive exercise to control Tx: Prozac to help with mood |
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Anorexia
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Self induced starvation, fear of fatness, must monitor K+
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Personality Disorders Characteristics
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1.Maladaptive response to stress
2. Disability in working and loving 3.Interpersonal conflict and trouble with boundaries 4. Take no responsibility, gets under the skin of others |
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Cluster A PD
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Odd/Eccentric Behaviors
Paranoid Schizotypal Schiziod |
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Cluster B PD
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Dramatic / Emotional Behavior
Antisocial Borderline Histeronic Narcissistic |
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Antisocial
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Risky behavior, illegal activity, poor planning, lack of guilt, needs limits and structure
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Borderline
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Sees people as all good or all bad, self mutilation, angry, emptiness, suicide risk, clingy, don't like to be alone
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Hsteronic
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Dramatic, attention seekers, seductive, vain, shallow, manipulative
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Narcissistic
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Grandiose, extremely self centered, feel the are privleged and special, expect favors from others
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Paranoid
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Suspicious, argumentative, jealous, tendency to blame others
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Schizoid
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Indifferent to others, loner, unable to form close relationships
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Scociopath
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Breaks laws, takes advantage of others for own gain, little remorse, charming on surface
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Schizotypal
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indifferent, aloof, magical thinking, superstitious, unusual words and peculiar ideas
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Compulsive
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perfectionists, preoccupied wiht detail, more concerned about work than pleasure, cannot express tender feelings
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Passive-Aggressive
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indirect express anger by being forgetful or stubborn, procrastinates, cannot admit to feeling angry, habitually late
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Cluster C PD
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Avoidant
Dependent Obsessive-Compulive PD |
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Avoidant
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Fear of criticism, disapproval, rejection, Negative self esteem, withhold thoughts or feelings
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Dependent
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Submissive, clinging, unable to make decision, cannot express negative emotions, Difficulty following through, want reassurance
Most common PD seen in clinics |
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Obsessive-Compulsive PD
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Preoccupation with perfection, organization, abandonment of projects due to dissatisfaction, preoccupation with logic and intelect, rule conscious behavior, excessive devotion to work, self-criticism, Difficulty relaxing
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Sexual Disorders
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Gender Identity
Gender Dysphoria Transsexualism Hermaphrodite DSM IV - Sexual dysfunction, gender identity, paraphilias, sexual disorders, NOS |
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Sexual Dysfunction
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Disturbance in sexual response cycle or pain on sexual intercourse
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Gender Identity Disorder
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Strong and Persistent cross-gender identification
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Paraphilias types
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Umbrella term for variations in sexual behavior
Fetishism Pedophilia Exhibitionism Voyeurism Transvestic Fetishism Sexual sadism Sexual masochism Frotteurism Paraphilia, NOS |
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Fetishism
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Sexual focus on object
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Pedophilia
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sexual activity with prepubuscent child (usually under 13)
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Exhibitionism
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Intentional display of genitals to unsuspecting person, followed by sexual arousal
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Voyeurism
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Viewing of other people in intimate setting
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Transvestic Fetishism
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Dressing in clothing of opposite gender
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Sexual sadism
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Sexual satisfaction from physical or psychological suffering, including humiliation, on nonconsenting person
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Sexual Masochism
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Sexual satisfaction achieved from being beaten, humiliation, bound
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Frotteurism
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Touching of another to achieve orgasm in a busy place where individual can't escape, rubbing up against a nonconsenting person to heighten sexual arousal
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Paraphilia NOS
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Not meet criteria for other categories
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Sexual disorder interventions
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Set limits
confront cognitive disorders identify triggers teach safe sex monitor compliance |
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Sexual Disorde Tx
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find out what works
punishment or treatment break down denial Depe-Provera Depo-Lupron Both decrease libido |
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Bipolar Disorder and meds
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Decrease in Serotonin
Manic Depressive Disorder, unusual shifts in mood Rx: Lithium and Depakote, Clozaril, Zyprexa, risperidal, Lamictol |
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Bipolar I
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at least one episode of mania and depression
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Bipolar II
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Hypomanic episode and Major Depression
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Cyclothymia
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Hypomanic episode and Major depression
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Types of Schizophrenia
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Disorganized, Catatonic, Paranoid, Undifferentiated, Residual
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Disorganized Schizophrenia
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s/s of incoherence, flat affect, poor prognosis
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Catatonic Schizophrenia
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s/s of schizo + 2 of catatonic: stupor, extreme negativism, Catatonic posturing, echolalia or echopraxia, apparently purposless stereotyped movements
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Meds for Schizophrenia
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Typical Antipsychotics: Thorazine, Haldol
Atypical Antipsychotics: Clozapine, Risperidal, zyprexa, Seroquel, Geodon |
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CBT
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Problem focused, goal oriented, deals with here and now. Pt is the primary decision maker
CBT + Meds = best treatment Feelings influence thinking and thinking influence feelings. Alter behavior by dealing with feelings and beliefs |
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ECT Criteria
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sever depression, depression with psychotic symptoms, Psychomotor retardation, Neuronegative changes: sleep or appetite or energy disturbance, other interventions have proven to be ineffective, bipolar-maina, schizophrenia, some PD, some Anxiety disorders
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ECT nusing role
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assess mood, evidence of suicidal ideation, level of fear associated with ECT treatment, meds list, base line vitals, ensure NPO, ADL's,
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prior to ECT
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4 hours NPO, recent labs, consult physician besides attending physician, Atropine Robinal, encourage a positive attitude
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During ECT
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Physician, Anesthesiologist, Nurse, supine on table, muscle relaxant, electrodes on temples, monitor and recored seizure activity and vitals
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Post ECT
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Monitor Vitals 15 mins for 1st hour, position PT on side, orient PT to time and place minimize confusion
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Crisis intervention
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have ateam and identify leader who will say when it is OK to restrain. Notify security and clear room of all other PTs. Secure limbs and attempt to get PT to cooperate, Administer IM meds if ordered, Process events with PT and staff, Gradually integrate PT back into mileu
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Rehab
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Multidiciplinary team focus on improvement in symptoms, work and educate, peer relationships, family relationships, community reintegration, personal hygiene, spiritual life, housing
Maximize natural support and self help through encouragement, active participation in treatment plans, advocate needs with assistance from families |
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Assertive Community Treatment
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Provide intensive community support to individuals who have serious mental illnesses. Goal is to prevent hospitalization and support individual
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Residential Services
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Supervised living situations, group homes, supervised apartments
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Mental Status Exams
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Consists of psychosocial assessment
Present problems / Precipitating event History (family, medical, socail) Apperance Speech Pattern, motor ability Orientation Affect, thought process and content Attention, impulse control and mood Memory, calculation Insight, judgment |
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Behaviors of Schizophrenia
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4 A's
autism loose association Ambivalence Affect |
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Autism
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the person lives according to own private thoughts and ideas which are derived from needs and hopes. Others reality is pushed aside
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Loose Association
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logical connections between a person's successive thoughts are absent or nor discernable to the observer
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ambivalence
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The existence within the individual of opposing emotions impulses or desires
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Affect
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Sustained feeling, mood, and emotional responce
flat - lack of normal emotion Inappropriate affect - the person's affect doesn't match appropriately with his behavior Apathy - lack of interest of feeling response in situations that usually provide such reactions |
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Hallucinations
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Sensory perception without external stimuli
auditory, visual, tactile, somatic, olfactory, gustatory |
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Delusions
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Fixed false beliefs (not held by PT culture) which cannot be changed by the use of logic.
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Idea of reference
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a belief that a event, conversation, or actions of others have reference to one's self, when no relationship exists
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Idea of influence
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A belief that someone or something is controlling one's mind
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Concrete thinking
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Person has trouble with the abstract( how do you feel....with my hand)
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Thought blocking
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a disturbance in the flow of thought. A person may stop hi speech, unable to finish thought
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Depersonalization
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feeligs of unreality or strangeness concerning either the environment or the self or both. Goes with loose ego boundaries
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Derealization
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false perception by a person that environment has changed. Familiar seems strange
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Perseveration
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Involuntary repetition of sam thought, phrase, or motor response; associated with brain damage
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Flight of Ideas
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Continuous flow of speech in which the person jumps rapidly form on topic to another
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Confabulation
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filling in of a memory gap with a detailed fantasy believed by teller. Purpose to maintain self-esteem. Seen in Korsakoff's psychosis
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Thought broadcasting
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belief that one's thoughts are being aired to the outside world
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Though insertion
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belief that thoughts of others are being inserted into one's mind
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Thought withdrawal
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belief that thoughts have been removed from one's mind by an outside agency
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Alogia
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poverty of speech, content of speech
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anergia
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lack or energy
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Anhedonia
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inability to experience pleasure
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Avolition
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Lack of motiviation
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Tangential Communication
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Person wanders from topic to topic
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Circumstantial Communication
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Speaker's inclusion of many irrelevant and nonessential details in speech before able to cone to the central idea
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Mutisim
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Person doesn't speak
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Neologism
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A newly coined word. person may have his won names for things
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Word Salad
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speech, thoughts seem totally disconnected. Disturbance is often seen in catatonic excitment
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Clanging
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Rhyming words, using the sound of the words in speech patterns
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Echolalia
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repetition of what someone else says
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Echopraxia
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copying the actions of others
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Waxy flexibility
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A phenomenon associated with catatonic, in which the body, especially an extremity, will be held for long periods of time in position selected by the examiner
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Negativism
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a generalized resistance to suggestion from outside one's self, and a tendency to behave in th opposite way from what is requested or expected
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EPS
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EPS is tardive dyskinesia (involuntary, irregular muscle movements, usually in the face). Other common EPS include akathisia (restlessness), dystonia (muscular spasms of neck - torticollis, eyes - oculogyric crisis, tongue, or jaw; more frequent in children), drug-induced parkinsonism (muscular lead-pipe rigidity, bradykinesia/akinesia, resting tremor, and postural instability; more frequent in adults and the elderly).
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EPS Cause
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From taking Antipsychotic Meds
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NMS
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Neuroleptic Malignant Syndrome
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NMS S/S
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Increased Body Temp >100.4 degrees
Confused or Altered Consciousness Diaphoresis "sweat shock" Rigid Muscles Autonomic Imbalance |
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Typical Antipsychotics
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Thorazine
Prolixin Trilafon Mellaril Stelazine Haldol Navane |
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Typical Antipsychotics
Action |
Block Dopamine
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Typical Antipsychotics
SE |
dry mouth, muscle stiffness, muscle cramping, tremors, EPS and weight-gain. EPS is a cluster of symptoms consisting of akathisia, parkinsonism, dystonias
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Atypical Antipsychotics
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Clozaril
Leponex Risperdal Zyprexa Seroquel Geodon Abilify Invega |
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Atypical Antipsychotics
Action |
Block Dopamine and Serotonin
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Atypical Antipsychotic
SE |
Dizziness, drowsiness, constipation,
insomnia, hypotension, EPS, NMS * hopefully less SE than Typical Antipsychotics |
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Anti ESP Drugs
Anticholinergics |
Used to reduce SE of Antipsychotics
Cogentin Benadryl Artane |
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Anti ESP
Anticholinergic Action |
Restores natural balance of neurotransmitters
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Anti ESP
Anticholinergic SE |
Blurred vision, dry mouth, drowsiness, anorexia,
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Anti ESP Drugs
Dopaminergics |
Symmetrel
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Anti ESP
Dopaminergics Action |
Potentiates the action of dopamine in CNS
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Anti ESP
Dopaminergics SE |
Ataxia, Dizziness, insomnia
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Lithium
action, SE, indicaion |
alters cation transport in nerve and muscle
abd pain, diarrhea, nausea, anorexia, bloating |
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Anticonvulsants
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Tegretol
Depakote Lamictal Trileptal Neurontin |
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Anticonvulsants
Action |
inhibit sodium channels
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Anticonvulsants
SE |
ataxia, dizziness, nausea, vomiting, confusion, seizures,
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Propanolol (Inderal)
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Beta Blocker
Anxiety Fatigue, weakness, pulmonary edema, impotence |
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Antidepressants
Tricyclics |
Elavil
Norpramine Tofranil Anafranil |
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Antidepressant
Tricyclics Action |
inhibit reuptake of norepinepherin and serotonin
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Antidepressant
Tricyclics SE |
Sedation, Orthostatic hypotension,
Anticholinergic effects Avoid alcohol & prolonged exposure to sun blurred vision, dry mouth, consptipation |
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Antidepressant
Tetreacyclic |
Remeron
Potentiates the effect of serotonin and norepinephrine SE Drowsiness, weight gain, agranulocytosis, dry mouth |
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SSRI
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Prozac
Zoloft Paxil Luvox Celexa Lexapro |
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SSRI
SE |
Headache, anxiety, insomnia, nausea,
vomitting, diarrhea, sedation, hypertension, sexual dysfunction |
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SARI
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Desyrel
Drowsiness, confusion, hypotension, dry mouth Serotonin antagonist reuptake inhibitor |
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SNRI (serotonin and norepinepherin reuptake inhibitor)
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Effexor
Cymbalta Pristiq |
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SNRI
SE |
anxiety, nausea, insomnia, tachcardia
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Wellbutrin
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Antidepressant
Diminish reuptake of dopamine, serotonin, norepinephrine SE: Agitation, HA, Dry mouth, N/V Tremor |
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Symbyax
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Depression / Bipolar
inhibits reuptake of serotonin SE: astheneia, increased appetite, edema, abnormal thinking, somnolence |
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MAOI (monoamine oxidase inhibitor)
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Nardil
Parnate Marplan |
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MAOI
SE |
Dizziness, insomina, restlessness, orthostatic hypotension, arrthymias
diarrhea |
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Benzodiazepine - antianxiety
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Xanax
Klonopin Librium Tranxene Valium Ativan Serx |
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Benzodiazepine
SE |
CNS Depression (Drowsiness, Sedation, Lethargy),
Paradoxical confusion, agitation, delirium (elderly) TDM, Monitor LFT & Renal Addictive, Contraidicated in pregnancy |
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Nonbenzodiazepine
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BuSpar
Aciton: reduces serotonin turnover SE: N/V dizziness, tachycardia, drowsiness |
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Benzodiazepine - Sedative/hypnotic
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Restoril
Halcion *used for insomnia |
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Benzodiazepine - Sedative / hypnotic
SE |
Drowsniess, daytime sedation, confusion, nightmares, HA, N/V, Weakness
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Non-benzodiazepine - Sedative / hypnotic
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Amien
Sonata Lunesta Rozarem Prosom |
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non-benzodiazapine Sedative hypnotic
Se |
Drowsness, daytime sedation, confusion, weakness, nightmares, HA
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Antihistamines - sedative hypnotic
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Benadryl
Atarax |
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Antihisamines - sedative hypnotic
SE |
sedation, drowsiness, seizure, dry mouth, nausea, vertigo
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Drugs for Chemical Dependency
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Revia
Campral Antabuse Methadone Subutex Chantix |
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Stimulants
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Adderall
Stattera Ritalin, Concerta, Metadate Focalin Provigil |
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Stimulants
SE |
insomnia, HA, tachcardia, dry mouth, restlessness, nervousness
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Cognitive Enhancers
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Aricept
Namenda Razadyne |
