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224 Cards in this Set

  • Front
  • Back
Specific measurable symptoms that are expected to to improve with treatment
Target symptoms
Unwanted effects of medications
Side effects
If unwanted effects have serious physiologic consequences
Adverse Reactions
Adverse reactions range from _____ to ______.
Mild; severe
Intervention for:

Blurred Vision
(generally subsides in 2 to 6 weeks)
Intervention for:

Dry mouth and lips
Frequent rinsing of mouth, good oral hygiene, sucking sugarless candies or lozenges, lip balm, lemon juice, and glycerin mouth swabs
Intervention for:

Dry Eyes
Artificial tears may be required; increase use of wetting solutions for those wearing contacts, Alert opthalmologist; no eye examination for new glasses for at least 3 wk after a stable dose
Intervention for:

High fiber diet; encourage bran , fresh fruits and vegies
Metamucil (must consume at least 16oz of fluid with dose)
Increase hydration
Exercise; increase fluids
Mild laxative
Intervention for:

Urinary hesitancy or retention
Monitor frequently for difficulty with urination,including changes in starting or stopping stream
Notify prescriber if difficulty develops
A cholinergic agonist, such as bethanichol, may be required
Intervention for:

Nasal congestion
Nose drops, moisturizer, not nasal spray
Intervention for:

Sinus Tachycardia
Assess for infections
Monitor pulse for rate and irregularities
Withhold medication and notify prescriber if resting rate exceeds 120 beats / min
Intervention for:

Decreased labido, anorgasmia, ejaculatory inhibition
Reassurance (reversible); change to another medication
Postural Hypotension
Frequent monitoring of lying-to-standing blood pressure during dosage adjustment period, immediate changes and accommodation, measure pulse in both positions; consider change to less anti-adrenergic drug
Advise pt to move slowly, avoid caffeine, increase hydration
Change meds if persists
Intervention for:

Protective clothing
Dark glasses
Use of sunblock; remember to cover all exposed areas
Intervention for:

Stop medication usage
Consider medication change; may require a systemic antihistamine
Initiate comfort measures to decrease itching
Intervention for:

Impaired psychomotorfunctions
Advise patient to avoid dangerous tasks, such as driving
Avoid alcohol, which will increase this impairment
Intervention for:

Drowsiness and sedation
Encourage activity during the day to increase accomodation
Avoid tasks that require mental alertness, such as driving
May need to adjust schedule or, if possible, give a single dose at bedtime
May need a cholinergic medication if sedation is the problem
Avoid driving or operating potentially dangerous equipment
May need to change medication
Provide quiet and decreased stimulation when sedation is the desired effect
Intervention for:

Weight gain and metabolic changes
Exercise and diet teaching
Caloric count
Intervention for:

Check fluid retention
May need a diuretic
Intervention for:

Irregular menstruation or amenorrhea
Reassurance (reversible)
May need to change class of drug
Reassurance and counseling (does not indicate lack of ovulation)
Instruct patient to continue birth control measures
Intervention for:

Vaginal dryness
Instruct use of lubricants
Is responsible for the safety, efficacy, and security of human and veterinary drugs, biologic products, medical devices, our nation's food supply, cosmetics, and products that emit radiation
Food and Drug Administration
If a medication is ordered and administered for a condition that is not approved by the FDA it is considered
Off-label use
the action or effects of drugs on living organisms
specific proteins intended to respond to a chemical
substances that initiate the same response as the chemical normally present in the body are
substances that block the response of a given receptor are
A drugs ability to interact with a given receptor type may be judged by what three properties?
- Selectivity
- Affinity
- Intrinsic activity
Psychiatric medications primarily target the CNS at the cellular, synaptic level, at what four sites?
- Receptors
- Ion channels
- Enzymes
- Carrier Proteins
The ability of a drug to be specific for a particular receptor
____ ____ drugs will interact only with its specific receptors in the areas of the body where these receptors occur and therefore not affect tissues and organs where its receptors do not occur.
Highly selective
The ___ ___ the drug, the more receptors are affected and the more likely there will be unintended effects or side effects.
Less selective
The degree attraction or strength of the bond between the drug and its biologic target
If a cell has more than one receptor to which a drug will adhere the affinity is ______.
A drug's ability to interact with a given receptor is
Intrinsic Activity
Some drugs directly block ____ _____ of the nerve cell membrane.
Ion Channels
Usually proteins that act as catalysts for physiologic reactions and can be targets for drugs
membrane proteins that transport a specific molecule across the cell membrane
recognizes sites specific for the type of molecule to be transported
Carrier Proteins
(AKA uptake receptors)
The ability of a drug to produce a response and is considered when a drug is selected
refers to the dose of drug required to produce a specific effect.
If a drug is able to produce an effect at a lower dose it is said to be _____ potent.
more potent
rapid decrease in drug effects that may develop in a few minutes of exposure to a drug
True or false

Desensitization is common in psychiatric medications.
a gradual decrease in the action of a drug at a given dose or concentration in the blood.
the point at which concentrations of the drug in the bloodstream are high enough to become harmful or poisonous to the body
the ratio of the maximum nontoxic dose to the minimum effective dose
Therapeutic index
Means there is a large range between the dose at which the drug begins to take effect and a dose that would be toxic to the body
High therapeutic Index
Therapeutic index may be changed by co-administration of drugs.

True or False
Alcohol consumption with the use of CNS-depressant drugs increases the chances of toxicity and or death
Variable rates and extent of absorption, depending on the drug
May be affected by the contents of the intestines
Disadvantages of Oral tablet Medications
Usually the most convenient route
Oral Medication
Basic prep. for most psychparmacologic agents, including antidepressants, antipsychotics, mood stabilizers, anxiolytics
Oral Tablet
Two classes of antipsychchotic drugs
Antipsychotic drugs are given for
- schizophrenia, mania, autism, psychosis
- Symptoms of psychosis
- Hallucinations, delusions
- bizarre behavior
Absorption of antipsychotics
-Varies with route
- Oral admin
Atypical drugs end in
- ole
- done
- dal
Typical drugs end in
- zine
- ixene
- dol
Exceptions to Typical ending
Both are Typical
Mood stabilizers Gold Standard
Examples of Anticonvulsant Mood Stabilizers are:
- Valproic Acid (Depakote)
- carbamazepine (Tegrol)
- Lamotrigine (Lamictal)
- Topiramate (Topamax)
- Oxacarbazepine (Trileptal)
- gabapentin (Neurontin)
Mood stabilizers include:
- Lithium
- Anticonvulsants
- Calcium channel blockers
- Adrenergic blocking agents
- Atypical antipsychotics
SSRI Antidepressants include:
- fluoxitine (Prozac)
- citalopram (Celexa)
- escitalopramoxalate (Lexapro)
- setraline (Zoloft)
- paroxetine (Paxil)
- fluoxamine (Luvox)
SNRI Serotonin Norepinephrine Reuptake Drugs include
- venlafaxine (Effexor)
- nefazodone (Serzone)
- duloxetine (Cymbalta-sleep)
- desipramine (Norpramine)
Tricylic Antidepressants (TCAs) include:
- amitryptyline (Elavil)
- clomipramine (Anafranil)
- doxepin (Sinequan)
- imipramine (Tofranil)
- trimipramine (Surmontil)
- amoxapine ( Asendin)
- desparimine (Norpramin)
- nortiptyline (Aventyl, Pamelor)
- protryptyline (Vivactil)
MAOI's (Monoamine Oxidase Inhibitors) Include:
- phenelzine (Nardil)
- trancypromine (Parnate)
- selegiline (Emsam) trans-dermal patch
Antianxiety and Sedative - Hypnotic Medications: Benzodiazepines include
- alprazolam (Xanax)
- lorazepam (Ativan)
- diazepam (Valium)
- chlordiazepoxide (Librium)
- flurazepam (Dalmane)
- triazolam ( Halcion)
- oxazepam (Serax)
Antianxiety and Sedative - Hypnotic Medications: Nonbenzodiazepines
- Busprirone (Buspar)
• Adverse reactions(serious) (side effects and allergic rxns-immunologic) include:
o Allergies(unwanted that vary in degree and consequences can be life threatening, less common) and side effects(unwanted)
o Mechanisms Causing Decreases in Medication Effects
 Change in receptors
 Loss of receptors
 Exhaustion of NT supply
 Increased metabolism of the drug
 Physiologic adaption
process by which a drug is absorbed, distributed, metabolized, and eliminated by the body
• Absorption
Drug from administration site into plasma
Factors that affect distribution
 Size of organ
 Amount of blood flow
 Perfusion within organ
 Solubility
 Plasma protein binding
 Anatomic barriers
 Blood-brain barrier
 Ability for drug to dissolve
 Psych drugs lipid soluble: blood brain barrier (to protect brain, keep things out)
o Protein Binding
 Unbound molecules can act at receptor sites
 High protein binding reduces concentration at receptor site
(process by which a drug is altered and broken down into smaller substances called metabolites)
• Metabolism/biotransformation
• Excretion
Removal of drugs from the body either unchanged or as metabolites
 Total volume of blood, serum, or plasma from which drug is completely removed per unit of time
o Clearance
Individual Variations in Drug Effects include
• Age
• Ethnopsychopharmacology
o cultural variations and differences influencing effectiveness
Complete pysch eval
Physical and history assessment
Meds are started
Closely watched
• Initiation phase
Medication being titrated
Ongoing monitoring
Looking for target signs and symptoms
Is they problem getting better
Side effects starting
 Happen in this phase
 Adding another medication
 polypharmacy
• Stabilization
Continued to prevent relapse
• Maintenance
Closely tapered
Prevent withdrawing
• Discontinuation
Antipsychotic Medications (schizophrenia, mania, autism, psychosis)• Indications:
schizophrenia; mania; autism; and the symptoms of psychosis, such as hallucinations, delusions, bizarre behavior, disorganized thinking, and agitation
Antipsychotic Medications (schizophrenia, mania, autism, psychosis • Absorption:
variable with oral administration; IM administration less variable (avoid first-pass effects); long-acting preparations (IM injection every 2–4 weeks)
Antipsychotic Medications (schizophrenia, mania, autism, psychosis • Metabolism:
Antipsychotic Medications (schizophrenia, mania, autism, psychosis • Excretion:
slow; half-life of 24 hours and metabolites with longer half-lives; high lipid solubility
Antipsychotic Medications: Side Effects
• Cardiovascular: orthostatic hypotension
• Anticholinergic
• Weight gain
• Diabetes
• Sexual side effects
• Blood disorders: agranulocytosis (Clozaril)
Decrease of granulocytes in bone
Cannot command infection
<500 cells
sudden infection
monitor labs closely
• Neuroleptic malignant syndrome (atypical meds)
Miss in high risk
 Already agitated/overly mentally ill
Muscle rigidity
Elevated temperature
o Cascade of symptom
Increase SNS
Muscle and heart issues
Usually beginning of treatment
• Photosensitivity
• Lowered seizure threshold
• Medication-related movement disorders
 Involuntary muscle spasm
 Neck to side and tongue protrusion
onset within a few days of initiating therapy
abrupt or sudden onset within first 30 days of treatment
 Rigidity
 Slow movement
o Pseudoparkinsonism:
possibly misdiagnosed as agitation or increased psychotic symptom
Restless pacing and rocking
Hardness to treat and recognize
o Akathisia:
Treatment for Akathisia:
 Propranolol/inderal
o (antipsychic med and have side effects that go untreated, more permanent, >6 months of side effects)
o (lip smacking, chewing, tongue protrusion-can’t control)
o (cannot fix)
o Long-term antipsychotic use
o Irreversible
Tardive dyskinesia
• Therapeutic blood levels:
o 0.8 to 1.4 mEq/L
Lithium (salt)
Lithium (salt)
• Indications:
mania; depressive episodes of bipolar illness
Lithium (salt)
• Side effects:
thirst, metallic taste, increased urinary frequency, fine hand tremor, drowsiness, and mild diarrhea
Lithium (salt)
• Monitoring
Blood levels for toxicity (severe diarrhea, vomiting, drowsiness, muscular weakness and lack of coordination); drug held if symptoms occur
Creatinine concentrations, thyroid hormones, and CBC every 6 months
Renal function (kidney damage possible)
Thyroid function (possible alteration after 6 to 18 months; observation for dry skin, constipation, bradycardia, hair loss, and cold intolerance
Blood for toxicity
• Reduce repetitive firing of action potentials in the nerves
• Used for elevated moods
• Used when patients have not responded to lithium(salt-weight gain-non complaint)
Mood Stabilizers: Anticonvulsants
Mood Stabilizers: Anticonvulsants
• Examples:
- Valproic acid (Depakote), carbamazepine (Tegretol-blood levels important)
- Lamotrigine (Lamictal-rashes), topiramate (Topamax)
- Oxcarbazepine (Trileptal), gabapentin (Neurontin)
• Variable absorption; peak plasma levels in 2 to 6 hours
• Side effects: dizziness, drowsiness, tremor, visual disturbances, nausea and vomiting, weight gain, alopecia
• Increased risk for aplastic anemia and agranulocytosis
• Side effects minimized by treating in low doses; nausea reduced when given with food
Mood Stabilizers: Carbamazepine
• Side effects: benign skin rash, sedation, blurred or double vision, dizziness, nausea, vomiting, and other gastrointestinal symptoms
• In rare cases, severe, life-threatening rashes occurring within 2 to 8 weeks of treatment; risk highest in children-Stephen Johnson (dermis separates from epidermis)
• Immediately discontinuation if a rash noted
Mood Stabilizers: Lamotrigine (Lamictal)
• Initial improvement with some within 7 days; complete relief of symptoms possibly taking several weeks
• Slow tapering necessary; antidepressants are not to be discontinued abruptly because of the uncomfortable symptoms that result
• Increased risk of suicidal behavior in children and adolescents
• Serotonin syndrome from overactivity of serotonin or an impairment of the serotonin metabolism
o life-threatening condition
Antidepressant Medications
o Mental status changes
o Autonomic instability
o Neuromuscular problems: hyperreflexia, incoordination
o Nausea, vomiting, diarrhea
• Serotonin syndrome can be life threatening
• Discontinuation of medication= treatment
• Symptoms of serotonin syndrome (started with confusion)
Examples: fluoxetine (Prozac), citalopram (Celexa), escitalopram oxalate (Lexapro), sertraline (Zoloft), Paroxetine (Paxil), fluvoxamine (Luvox)
Antidepressant Medications: SSRIs- Selective Serotonin Reuptake Inhibitors excitatory
SSRIs- Selective Serotonin Reuptake Inhibitors excitatory
• Action:
inhibition of reuptake of serotonin by blocking transport into presynaptic neuron
o More available for brain to bring in
SSRIs- Selective Serotonin Reuptake Inhibitors excitatory
• Side effects:
headache, anxiety, insomnia, transient nausea, vomiting, diarrhea, sedation, sexual dysfunction, diastolic hypertension, increased perspiration
Examples: venlafaxine (Effexor), nefazodone (Serzone), duloxetine (Cymbalta-sleep), desipramine (Norpramin)
Antidepressant Medications: SNRIs- Serotonin Norepinephrine Reuptake Inhibitors
Antidepressant Medications: SNRIs- Serotonin Norepinephrine Reuptake Inhibitors
• Action:
prevention of reuptake of norepinephrine and serotonin at presynaptic site
Antidepressant Medications: SNRIs- Serotonin Norepinephrine Reuptake Inhibitors
• Side effects:
similar to SSRIs; increased blood pressure
Example: bupropion (Wellbutrin, Zyban)
Antidepressant Medications: NDRI- Norepinephrine Dopamine Reuptake Inhibitors)
Antidepressant Medications: NDRI- Norepinephrine Dopamine Reuptake Inhibitors)
• Action:
inhibition of norepinephrine(excitatory) and dopamine (feel good)
Antidepressant Medications: NDRI- Norepinephrine Dopamine Reuptake Inhibitors)
• Side effects:
agitation or anxiety, insomnia, appetite suppression, psychosis
Example: trazodone (Desyrel)-
Antidepressant Medications: SARI- Serotonin- 2 Antagonist Reuptake Inhibitor)
Antidepressant Medications: SARI- Serotonin- 2 Antagonist Reuptake Inhibitor)
• Blocking of serotonin-2A receptor potently and blocking serotonin reuptake pump less potently
Antidepressant Medications: SARI- Serotonin- 2 Antagonist Reuptake Inhibitor)
• Side effects:
sedation, weight gain, nausea, vomiting, constipation, dizziness, fatigue, incoordination, tremor
before SSRI but more side effects and abused, once a day, more lethal when OD-passive to active depressive(mood elevation
Antidepressant Medications: Tricyclic Antidepressants (TCAs) )
Examples: amitriptyline (Elavil), clomipramine (Anafranil), doxepin (Sinequan), imipramine (Tofranil), trimipramine (Surmontil), amoxapine (Asendin), desipramine (Norpramin-kids and bed wetting), nortriptyline (Aventyl, Pamelor), protryptyline (Vivactil)
Tricyclic Antidepressants
Tricyclic Antidepressants
• Common side effects:
sedation, orthostatic hypotension, anticholinergic side effects
Tricyclic Antidepressants
• Other side effects:
tremors, restlessness, insomnia, nausea and vomiting, confusion, pedal edema, headache, seizures, blood disorders, cardiac changes
• Examples: phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Emsam-transdermal patch)
Antidepressants: MAOIs- (Monoamine Oxidase Inhibitors)
Antidepressants: MAOIs- (Monoamine Oxidase Inhibitors)
• Food interactions:
aged meat, cheese, beer and wine, thyme rich foods-MAOIs patches bypass stomach
Antidepressants: MAOIs- (Monoamine Oxidase Inhibitors)
• Action:
inhibition of MAO à increased serotonin and norepinephrine activity in the synapse
Antidepressants: MAOIs- (Monoamine Oxidase Inhibitors)
• Side effects:
dizziness, headache, insomnia, dry mouth, blurred vision, constipation, nausea, peripheral edema, urinary hesitancy, muscle weakness, forgetfulness, weight gain, sexual dysfunction
• Hypertensive crisis: interaction with tyramine-rich foods and certain medications
• Many food and medication restrictions needed
• Examples: alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium), flurazepam (Dalmane), triazolam (Halcion), oxazepam (Serax)
Antianxiety and Sedative– Hypnotic Medications: Benzodiazepines
Antianxiety and Sedative– Hypnotic Medications: Benzodiazepines
• Side effects:
drowsiness, intellectual impairment, memory impairment, ataxia, reduced motor coordination, sedation, “hangover” effects; tolerance or psychological dependence
• Increased CNS depression with alcohol
o Same receptor sites with alcohol
• Abrupt discontinuation possibly leading to recurrence of the target symptoms (rebound insomnia or anxiety)
• Addictive and not good for addictive personalities
• Example: buspirone (BuSpar)
Antianxiety and Sedative–Hypnotic Medications: Nonbenzodiazepine
Takes a while to get into system to be effective
• Not addictive
• Effective for treating anxiety disorders without the CNS-depressant effects or the potential for abuse and withdrawal syndromes
buspirone (BuSpar)
buspirone (BuSpar)
• Side effects:
dizziness, drowsiness, nausea, excitement, headache
• Benzodiazepines
• GABA enhancers
• Melatonergic hypnotics
• Antihistamines
are examples of :
Antianxiety and Sedative–Hypnotic Medications: Sedative-Hypnotics
Examples: Methylphenidate (Ritalin-older now too, little boost, paradoxical in adolescence), dexmethylphenidate (Focalin)
D-amphetamine (Dexedrine), amphetamine/ dextroamphetamine (Adderall)
Lisamphetamine (Vyvanse)
Stimulants and Wakefulness-Promoting Agents
• Stimulants:
o Modafinil (Provigil)
o Armodafinil (Nuvigil)
• Wakefulness-promoting agents
• St. John’s Wort
for depression, pain, anxiety, insomnia, and premenstrual syndrome (take when on another depression-can OD)
o Serotonin, dopamine, and norepinephrine modulation
o Risk of serotonin syndrome with other serotonergic drugs
for anxiety reduction
Interaction with dopaminergic transmission, inhibition of MAO-B enzyme system, and modulation of GABA receptor
Risk of severe liver injury, thrombocytopenia, leukopenia, and hearing impairment
• Kava
• Use: severe depression; mania and schizophrenia when other treatments have failed
• Generalized seizures initiated by electrical current
• Procedure repeated two or three times per week (total, six to 12 treatments)
• Rapid relief of depressive symptoms
o 2-3 times a week
o 6-8 months
o comes back when stopped
o best on elderly
o sedated (complete, no memories)
 early not sedated
Electroconvulsive Therapy (ECT)
Electroconvulsive Therapy (ECT)
• Side effects
Hypo- or hypertension, bradycardia or tachycardia, minor arrhythmias, headache, nausea, muscle pain immediately afterward
o Memory loss for months afterward
o Circadian rhythms reset
o Used for seasonal depression
• Light therapy (phototherapy)
o Alternative to ECT in managing symptoms of depression
• Transcranial magnetic stimulation (TMS)
adjunct for severe depression in adults unresponsive to four or more adequate antidepressant treatments; permanent implant
• Vagus nerve stimulation (VNS):
o Side effects (most common reason)
o Lack of awareness or denial of illness
o Stigma
o Feeling better
o Confusion about dosage or timing
o Difficulties in access to treatment
o Substance abuse
• Reasons for non-adherence
o Basic framework of rational emotive behavior therapy
The “A” in the ABCDE frame of rational emotive behavior therapy
o It represents an external or internal stimulus
o Not necessarily an actual event, it may be an emotion, thought or expectation that is interpreted according to a set of beliefs
• Activating event
o The “B” in the ABCDE framework of rational emotive behavior therapy
o Beliefs underlying thoughts and emotions are shaped by rationality which is self-constructive, and irrationality, which is self-defeating
• Belief systems
• An internal process of perception, memory, and judgment through which an understanding of oneself and the world is developed
o change or reframe an individual’s automatic thought patterns that develop over time and that interfere with the ability to function optimally
• Cognitive interventions:
o REBT (rational emotive behavioral therapy)
• Albert Ellis
o Cognitive behavioral theory
• Aaron Beck
o Solution focused grief therapy
• Steven deShazer and Insoo Kim Berg
• Used to alter distorted beliefs and problem behaviors: negative and inaccurate thoughts identified and replaced; rewards for behavior changed
Cognitive Behavioral Therapy
- Cognitive triad
 Thought of self, world, and future in own perspective
 Altered thinking and impacts negatively
 perception
- Cognitive distortions
- Schema
 Life rules and act as fixture
 Filter
 Developed in early childhood and fixed in late childhood
• Three cognitive processes involved in the development of mental disorders
o People disturbed by the perception of event, not the event
o Whenever or however the belief develops, the individual believes it
o Work and practice can modify beliefs, creating difficulties
• Assumptions of CBT
 Life rules and act as fixture
 Filter
 Developed in early childhood and fixed in late childhood
• Engagement and assessment
Establish rapport
And theme for problem management
Contract for future sessions
• Interventions
ID underlying beliefs that are framing problems
Alternative explanations
Examine implications if actually true
Months to years depending on event/trauma
• Evaluation and termination
Pt gains sense of self
Stopped or decreased with time
• Only works with pts who understand process of CBT
Does not work with psychotic pts (schizo, mania)
Implementing CBT
• Form of CBT
• Assumptions:
o People are born with the potential to be rational (self-constructive) and irrational (self-defeating)
o Irrational thinking, self-damaging habituations, wishful thinking, and intolerance are exacerbated by culture and family groups
o Change irrational beliefs that cause stress into rational beliefs
 Decrease stress
Rational Emotive Behavior Therapy
Rational Emotive Behavior Therapy Framework
activating event to trigger automatic response
Rational Emotive Behavior Therapy Framework
beliefs underlie thoughts and emotions
 Irrational beliefs
 Demand
 Absolute thinking
 Catastrophizing
 Low frustration tolerance
 Global evaluations of human worth
Rational Emotive Behavior Therapy Framework
Rational Emotive Behavior Therapy Framework
dispute or challenge with unreasonable
Rational Emotive Behavior Therapy Framework
effective outlook developed by disputing
Rational Emotive Behavior Therapy Framework
o Role-playing, assertion training, desensitization, humor, operant conditioning, suggestion, support
o Focus: developing rational beliefs to replace those that are irrational and interfere with quality of life
• Focus: solutions rather than problems; problems best understood in relation to solutions
• Emphasis on what is functional and healthful rather than on problems or symptoms
• View of the patient as an individual with a collection of strengths and successes rather than as a diagnosis and collection of symptoms
• Emphasis on the uniqueness of the individual and the capacity to make changes or deal with day-to-day lives
Solution-Focused Brief Therapy
• People with strengths and resources for problem solving
• Not necessary to know a lot about the complaint to resolve it
• “Problem defined and dissected from patient’s perspective
• Resolution of even longstanding issues
• No right way or wrong way to see things
• Change most likely when focused on what is changeable
• Therapist’s job to identify and amplify change
• The therapist and patient co-create reality
• The therapist with expectation of change and movement
Solution-Focused Brief Therapy Assumptions
• Therapist in position of curiosity; asks questions
• Interventions focus on achievement of specific, concrete, and achievable goals
Solution-Focused Brief Therapy Interventions
 Rooted in the belief that nothing is constantly present at the same level of intensity
 Helps pt to identify times when whatever bothering them is not present
Exception questions
 amplify and reinforce positive relationships
relationship questions
 affirmations of the pt
o Solution-focused therapy
 Goal and outcome based
 Shorter term
 Not reflection based
o Journaling and “homework” assignments
Use of Cognitive Therapies in Psychiatric Nursing
• Inpatient settings
o Cognitive approaches in combination with other interventions
o Primary care: CBT and SFBT
o More time when not in hospital
Use of Cognitive Therapies in Psychiatric Nursing
• Community settings
Basic framework of rational emotive behavior therapy
o The “A” in the ABCDE frame of rational emotive behavior therapy
o It represents an external or internal stimulus
o Not necessarily an actual event, it may be an emotion, thought or expectation that is interpreted according to a set of beliefs
• Activating event
o The “B” in the ABCDE framework of rational emotive behavior therapy
o Beliefs underlying thoughts and emotions are shaped by rationality which is self-constructive, and irrationality, which is self-defeating
• Belief systems
o Think or know
o Intellectual process
• Cognition
o Automatic thought generated by organizing distorted information or inaccurate interpretation of situation
• Cognitive distortions
o Interventions that aim to change or reframe an individual’s automatic thought patterns that develop over time and that interfere with the ability to function optimally
• Cognitive interventions
o Thoughts about self, world, and future
• Cognitive triad
o Affirmations of the patient
• Compliments
o Part of “C” in the ABCDE framework of rational emotive behavior therapy
o Results of the interaction between A (activating event) and B (belief system) that follow from flexible, rational beliefs
• Dysfunctional consequences
o Questions used to help the patient identify times when whatever is bothering him or her is not present or is present with less intensity based on the underlying assumption that during these times the patient is usually doing something to male things better
• Exception question
o Part of “C” in the ABCDE framework of rational emotive behavior therapy
o Results of the interaction between A (activating event) and B (belief system) that follow from flexible, rational beliefs
• Functional consequences
o Patients are asked to use their imagination in crafting their response to very specific questions about a scenario
• Miracle question
o Questions to amplify and reinforce positive responses to the other questions
• Relationship questions
o Question that quantify exceptions noted in intensity and in tracking change over time using a scale of 1 to 10
• Scaling questions
o Cognitive structure, or an individual’s life riles, that act as a filter that screens, codes, and evaluates the incoming stimuli through which the individual interprets events
• Schema
• Enhance understanding of self, conquer unwanted thoughts/feelings, learn new behaviors
• Cost effective
• Two or more people developing interactive relationships
• Sharing of at least one common goal or issue
• More than the sum of its parts
• Own personality, patterns of interaction, and rules of behavior
o Does the purpose of the group match the needs of potential members?
o Does the potential member have social skills to function comfortably in the group?
o Do other group members accept the new member?
o What is the potential of the group member to commit to attending group meetings?
o Usually it is group of convenience
Member Suitability/Selecting Members
• Criteria
new and old members
 New at disadvantage
no new members
 People can leave but dynamics change if one leaves may not be able to function
 Cost effective
 Less intense of countertransference and transference
 Best for specific problem
 smoking
 Leader control the interaction by giving directions and information and allowing little discussion
 Little or no guidance from group leader
 Free following
 Two people share responsibility
• Space and privacy important
• Absence of physical barriers (e.g., tables) to improve communication flow
• Members able to see and hear each other
• Circular arrangement enhancing group work
• Those sitting close to the group leader usually have more power in the group
Seating Arrangement

 Rapport developing
 Setting frame work
 Testing members
Beginning stage: Honeymoon

 Share ideas
 Group personality
 Norms
 Realization of purpose
 Meat of events happening
Working stage

 Grief for loss of groups closeness
 Summary and future plans
Termination stage
o Development and culmination of the session to session interactions of the members that move the group toward its goal
• Group process
 Support
 Confrontation
 Advice and suggestions
 Summarizing
 Clarification
 Probing and questioning
 Repeating
 Reflecting feelings and behaviors
Techniques in leading groups
• Facilitation of verbal and nonverbal communication
• Encouraging interaction and active listening
o Leader remains neutral
• Monitoring verbal communication
o Communication pathways
• Monitoring nonverbal communication
• Deciphering Content Themes
o Group themes
 Collective conceptual underpinnings of a group
 Members’ underlying concern regardless of group purpose
• Tracking group communication
Group Communication
• Initiator-contributor
• Information seeker
• Information giver
• Opinion giver
• Elaborator
• Coordinator
• Orienter
• Evaluator-critic
• Energizer
• Procedural technician
• Recorder
Group Members: Task Roles (keep on track)-informer
• Encourager
• Harmonizer
• Compromiser
• Gatekeeper
• Standard setter
• Group observer
• Follower
o Not always negative
Group Members: Maintenance Roles
• Aggressor
• Blocker
• Recognition seeker
• Self-confessor
• Playboy
• Dominator
• Help seeker
• Special interest pleader
Group Members: Individual Roles (disruptive)
• Monopolizer
• “Yes, but. . .”
• Disliked member
• Silent member
Challenging Group Behaviors
o Enhance knowledge, solve problems
• Psychoeducation groups
o Specific for specific activity
o Equal member
o Group cohesive
• Task groups
o Avoid group think
• Decision-making groups
o Help individuals
o Psych nurse primary role
• Supportive therapy groups
o Emotional problems
o Lots of theories
o Psychoanalytic, cognitive, behaviors
o Yaloms?
• Psychotherapy groups
o Coping with specific problems
o AA
o Essential
o Lead by members and share problems
• Self-help groups
o Age requirements
o Help group together
• Age-related groups (refer to Box 13.5)
• Instillation of hope
• Universality
• Imparting information
• Altruism
• Corrective recapitulation
• Development of socializing techniques
• Group cohesiveness
• Catharsis
o Open expression to cleanse oneself
• Existential factors
o Ultimate concerns of existence
Yalom’s Therapeutic Factos
• Medication groups (refer to Box 13.6)
o Specific to nursing
o Need cognitive ability and basic med knowledge
o Health literacy
o Don’t need specific med they are on
o Med complication
o Side effects
o Not one on one
• Symptom management groupss
• Anger management groups
• Self-care groups
• Reminiscence groups
Nursing Intervention Groups
o All members begin at once
o New members are not admitted after first meeting
• Closed group
o Ability of a group to stick together
• Cohesion
o Two people share responsibility for leading a group
• Co-leadership
o Aspect of group interaction based on interaction patterns related to who is most liked in the group, who occupies a position of power, what subgroups have formed, and who is isolated from the group
• Communication pathways
o Leader controls the interaction of the group by giving directions and information and allowing little discussion
• Direct leadership
o Group of only two people who are usually related
• Dyad
o Designated leader and members of the group
• Formal group roles
o Collective conceptual underpinnings of a group that express the members’ underlying concerns or feelings, regardless of the group’s purpose
• Group themes
o Tendency of many group to avoid conflict and adopt a normative pattern of thinking that is often consistent with the group leaders’ idea
• Groupthink
o Leader who is primarily reelections the group members’ discussion and offers little guidance tor information to the group
• Indirect leadership
o Roles that either enhance or detract from the group’s functioning but have nothing to do with either the group task or maintenance
• Individual roles
o Positions within the group with implicit rights and duties that can either help or hinder the group’s process
o No formally sanctioned
• Informal group roles
o Informal roles of group members that encourage the group to stay together
• Maintenance roles
o Group in which new members can join at any time and old members leave at different sessions
• Open group
o Group role of an individual that is concern about the purpose of the group and keeps the focus on the task of the group
• Task roles
o Group consisting of three
• Triad