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119 Cards in this Set
- Front
- Back
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What does axis 1 of the DSM IV contain
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clinical mental disorders
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Axis 2
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personality disorders and mental retardation
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Axis 3
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general medical disorders
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Axis 4
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psychosocial disorders and environmental problems
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Axis 5
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GAF global assessment of functioning
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What is schizophrenia
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a disorder with distortion of thoughts, perceptions, emotions, movements, behaviors
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What are positive symptoms of schizophrenia
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excesses, added behavior or distortions not normally seen in mentally healthy adults
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What are negative symptoms of schizophrenia
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characterized by behavioral deficits that you don't normally see in mentally healthy adults
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What is a lack of energy and inability to persist in routine activity
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avolition
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What is reduced speech
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alogia
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What does axis 1 of the DSM IV contain
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clinical mental disorders
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Axis 2
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personality disorders and mental retardation
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Axis 3
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general medical disorders
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Axis 4
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psychosocial disorders and environmental problems
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Axis 5
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GAF global assessment of functioning
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What is schizophrenia
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a disorder with distortion of thoughts, perceptions, emotions, movements, behaviors
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What are positive symptoms of schizophrenia
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excesses, added behavior or distortions not normally seen in mentally healthy adults
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What are negative symptoms of schizophrenia
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characterized by behavioral deficits that you don't normally see in mentally healthy adults
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What is a lack of energy and inability to persist in routine activity
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avolition
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What is reduced speech
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alogia
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What is experiencing no pleasure
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anhedonia
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What is impaired relationships
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asociality
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What are positive signs and symptoms of schizophrenia
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hallucinations, delusions, ambivalence, associative loosness, ideas of reference, perserveration, echolalia, echopraxia
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What is repeating words
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echolalia
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What is imitation of movement
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echopraxia
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WHat are false sensory perceptions
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hallucinations
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types of hallucinations
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auditory, visual, olfactory, tactile, gustatory
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What are the more common types of hallucinations
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auditory and visual
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What are fixed false beliefs
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delusions
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What are types of delusions
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paranoid, grandiose, religious, somatic, referential
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What are religious delusions?
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think they are Jesus, the pope, antichrist, etc.
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What are somatic delusions
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feeling that the body parts or sick, off, or missing
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What are referential delusions
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think radio or news is about them
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What are negative signs and symptoms of schizophrenia
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apathy, anhedonia, affect, avolition, alogia, catatonia
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What is apathy
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flat affect/ no emotion
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What is anhedonia
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nothing gives pleasure
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What is blunt or flat affect
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no emotion
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What is staying in a position for a long time until you move them to a new position
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catatonia
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What do you do for those with catatonia?
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help maintain physiologic integrity
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What are implications for life
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reality is distorted, judgment, thinking, insight, memory, problem solving is impaired and difficulty in relationships
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What is disorganized schizophrenia?
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flat affect/ loose association/ not cognitively aware if its day or night
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What is catatonic schizophrenia
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psychomotor disturbance
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What is undifferentiated schizophrenia
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hard to put into a category
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What is residual schizophrenia
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at least one previous episode that is not clearly fit in another category
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What involves disorganized speech and flat affect and a general disruption of behavior?
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disorganized schizophrenia
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What is prolonged motor immobility that alternates with periods of excitability
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catatonic schizophrenia
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What involves the presence of prominent delusions including persecution and grandiosity
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paranoid schizophrenia
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WHat is thinking you're famous?
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grandiose feelings
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WHat is a mood disorder (manic or depression) mixed with schizophrenia
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schizoaffective disorder
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What are some beliefs of the causes of schizophrenia
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genetic, neurobiological
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What holds that the positive symptoms of schizo result form an excessive activity of dopamine in the brain
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dopamine theory
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What do anti schizophrenia drugs do?
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block dopamine receptors
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What does the dopamine theory believe
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that positive symptoms of schizo result from excessive activity of dopamine in the brain
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How long do anti schizophrenia drugs take to work
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several weeks, even though they rapidly block dopamine receptors
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What can induce pscyhosis
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ingestion of amphetamine because it causes the release of dopamine from neurons
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What is the onset of schizo in males
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15-25
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onset of schizo in females
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25-35
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Incidence of schizo
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1%
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WHat is the initial stage of schizo
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onset usually insidious, s/s may be missed at first, diagnosis associated with positive s/s (hallucinations and delusions)
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What is the intermediate stage of schizo
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intermittent relapses with fluctuating intensities, continous with uninterrupted progession and severity of s/s may shift
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What is long term schizo
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s/s tend to somewhat diminish with increasing age, crucial to success (meds and social support)
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What are neuroleptic medications?
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conventional antipsychotics, like fluphenazine (Prolixin), thioridazine (Mellaril), and haloperidol (Haldol)
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What is no longer given as an antipsychotic due to horrible side effects
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Thorazine
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What are some atypical antipsychotics
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clozapine (Clorazil), risperidone (Risperdol), Olanzapine (Zyprexa), quetiapine (Seroquel), Ziprasidone (Geodon)
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What is given for aggression or a potential for violence?
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Geodon
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What are some side effects of antipsychotics?
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sedation, anticholinergic s/s, sexual problems, weight gain, seizures, photosensitivity and agranulocytosis, EPS and NMS
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What are anticholinergic side effects
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tachycardia, dry mouth, blurred vision, constipation, urinary retention, some confusion
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What is a disturbance in agranulocytes in WBC?
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agranulocytosis
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What are muscle spasms in the head and neck
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dystonia
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What is pseudoparkinsonism
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masklike face, drooling, pillrolling, shuffling gait, tremors
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What is akinesia
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muscle weakness or loss of muscle movement
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What is tardive dyskenia
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abnormal leg or am movement, rocking, chewing, smacking lips, tongue protrusion
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What is the inability to sit or stand still
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akathesia
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What is muscle spasms in the head and neck and the eyeballs look up and cant move (oculogyricrisis) and immediate need to give meds
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dystonia
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What is oculogyricrisis
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eyeballs look up and can't move
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What is very important in command hallucinations
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safety
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What do you say to those with command hallucinations
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i dont see/hear what you hear, can you describe the voice and what is it saying, and after that be sure that you change the topic
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What is NMS
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neuroleptic malignant syndrome and a medical emergency
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What are the signs and symptoms of NMS
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muscle rigidity, hyperthermia, ANS dysfunction, severe EPS (tachycardia, hypertension, increased pulse, sweating, respiratory problems, incontinence, diaphoresis, confusion, delirium)
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What should you ask when assessing hallucinations
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are you still having them? are they getting better?
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What are some parts of assessment
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functionality, s/s of disorder, therapeutic effect of medications, side effect of medications, response to support therapies
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What are some parts of diagnosis of schizophrenia
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altered thought processes, self care deficits, social isolation, risk for self harm, ineffective management of therapeutic regimen
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What are some acute goals for schizophrenia?
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risk for self harm: goal: patient will not harm self during this admission
self care deficit: goal: patient will perform adequate hygiene throughout the day, during hospitalization altered thought processes related to disruption in cognitive processes: goal: pt will have decreased delusional thinking by discharge family identifies willingness to take part in treatment program and meet with staff, verbalizes need for pt. to comply with med, willing to help pt. maintain med |
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What are some interventions for schizophrenia
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establish rapport (trust essential, active listening), safety issues (psychological and physical, self and others),, manage hallucinations and delusions, de-escalate anxiety, use medication as necessary, prevent escalation, family education, provide information
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What is cross diagnosis?
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problems, or symptoms not limited to a specific disorder
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What are some problems associated with cross diagnosis behavior
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hallucinations, delusions, illusions, violence against self, violence against others
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How can you tell if my patient is experiencing hallucinations
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inappropriate laughter and grinning, observe behavior (conversations with unseen people), inattention to the task at hand, listening intently with ear cocked, smelling food, body, or wrinkling nose, suddenly acting startled, refusing to eat and drink, slapping at invisible things, isolative behavior
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Why may a person with hallucinations refuse to eat or drink?
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think food may be poisoned
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What should you assess with clients experiencing hallucinations
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how they're interfering with ADLs or levels of functioning, stay with clients, talk to clients in short simple sentences, ask what is happening, identify triggers in environment, encourage description of feelings related to the hallucinations, do not argue about what is or is not occuring, teach self management techniques to help cope with hallucinations
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How can you tell if the pt is experience delusions
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behaviors are inappropriate, thinking that someone is talking about you, following you, controlling you, wanting to harm you
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What are some interventions for those experiencing delusions
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provide an opportunity to discuss delusions to lessen the fear and reassure safety, refocus convo to other real, here and now topics to distract client from delusional thoughts, monitor delusions for content, if asked, tell client that the delusion is not your experience
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Should you tell a person that the delusions are not real?
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no, tell them it is not your experience
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What are some more interventions for those experiencing delusions
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identify triggers, assist in problem solving, alleviate stressor that precipitates delusion, teach coping techniques that focus on reality, teach client that it is socially unacceptable to discuss delusions in public because of probable social isolation and rejection
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What are some parts of assessment of self mutilating behavior?
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commonly seen scratches, carving, tearing out hair, uncommonly seen, enucleation, inserting objects in body cavities, castration, imuplsive behavior liked to a stressor
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What should you do if its been two weeks and the med isn't working?
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see if the patient is taking med, if not, then switch meds
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What are some basic interventions for patients who are self mutilating
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nonjudgmental, caring, setting limits to minimize further injury, attempt to build trust, client centered goals revovled around a behavioral contract that identifies mutual expectations, client responsibility and consequences for behavior, encourage communication about self injury, decrease feelings of shame and self criticism, help identify better coping skills to address stressors and feelings rather than self mutilation behaviors
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What are some assessments for aggressive behavior?
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assess for potential for violence, history of violent behavior, co morbidity (hallucinations, poor impulse control), assess for escalation of aggression
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What are any behaviors where the patient can do harm or threaten the safety of others?
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aggressive behaviors
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What occurs if there is verbal aggression
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medicate so it doesn't get physical
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What are some interventions for clients who are aggressive?
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encourage client to talk about feelings and learn to identify triggers and teach non violent coping skills, set up a behavioral contract
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What are some interventions for aggressive clients?
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out of control (remain calm, nonauthoritarian, give client space), calm down by talking down, giving choices, administering meds, secluding in quit room under close supervision, restraints under close supervision
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Occurrence of a sight, sound, touch, smell or taste without any external stimulus to sensory organs
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hallucinations
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Extensive developed central delusional system
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systematized
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Feelings that oneself or others are nonexistent
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nihilistic
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smells something putrid or foul or poisonous
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olfactory
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feelings or thoughts are being imposed by an external force
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control
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beliefs that someone is conspiring against or trying to harm the person
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persecution
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tastes putrid, foul, or poisonous food or liquid
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gustatory
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belief that someone famous is in love with the person
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erotomanic
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false beliefs that cant be changed by logical reasoning or evidence
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delusion
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feels electrical sensations or something touching them
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tactile
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see things, people, visions
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visual
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hearing voices or sounds
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auditory
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remarks or actions by someone else that in no way refer to the person but that are interpreted as related to the person
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ideas of reference
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sensory misperception of environmental stimuli
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illusion
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exaggerated feelings of importance, power
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grandeur
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orders the person to do something harmful or frightening
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command hallucinations
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believe that something abnormal and dangerous is happening to their body
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somatic
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control =?
command=? |
delusions
hallucinations |
