Mental Health Nursing Exam #3

Antipsychotics

Action: used to decrease agitation & psychotic symptoms of schizophrenia & other psychotic disorders -Typicals → dopaminergic blockers with various affinity for cholinergic/α-adrenergic/histaminic receptors -Atypicals → weak dopamine antagonists + potent 5HT2A antagonists + exhibit antagonism for cholinergic/histaminic/adrenergic receptors

Depression

Alteration in mood expressed by feelings of sadness/despair/pessimism

Suicide

Assessment: -Demographics: ^Age ^Gender ^Ethnicity & race ^Marital status ^Socioeconomic status & occupation ^Lethality & availability of method ^Religion ^Family history of suicide ^Military history -Presenting symptoms & medical-psychiatric diagnosis -Suicidal ideas or acts ^Seriousness of intent ^Plan ^Means ^Verbal & behavioral clues -Interpersonal support system -Analysis of suicidal crisis ^Precipitating stressor ^Relevant history ^Life-stage issues -Psychiatric/medical/family history -Coping strategies -Presenting symptoms

Histrionic personality disorder

Behavior: -Excitable -Emotional -Colorful -Dramatic -Extroverted

Depression

Biological theories r/t predisposing factors: -Genetics ^Hereditary factor may be involved -Biochemical influences ^Deficiency of norepinephrine/serotonin/dopamine has been implicated ^Excessive cholinergic transmission may also be factor -Neuroendocrine disturbances: ^Possible failure within hypothalamic-pituitary-adrenocortical axis ^Possible diminished release of thyroid-stimulating hormone -Physiological influences: ^Medication side effects ^Neurological disorders ^Electrolyte disturbances ^Hormonal disorders ^Nutritional deficiencies

Suicide

Biological theories r/t predisposing factors: -Genetics ^Twin studies have shown much higher concordance rate for monozygotic twins than for dizygotic twins -Neurochemical factors ^Number of studies have revealed deficiency of serotonin in depressed clients who attempted suicide *Support hypothesis that deficiencies in CNS serotonin = associated with suicide

PTSD

Characteristic symptoms: -Re-experiencing traumatic event -Sustained high level of anxiety or arousal -General numbing of responsiveness -Intrusive recollections or nightmares -Amnesia to certain aspects of trauma -Depression (survivor's guilt) -Substance abuse -Anger & aggression -Relationship problems

Bipolar disorder r/t another medical condition

Characterized by abnormally & persistently elevated/expansive/or irritable mood + excessive activity or energy judged to be result of direct physiological effects of another medical condition

Antidepressants

Client & family education -Continue to take medication for 4 weeks -Use caution when driving or operating dangerous machinery ^Drowsiness & dizziness can occur -Do not discontinue medication abruptly ^To do so might produce withdrawal symptoms such as nausea/vertigo/insomnia/HA/malaise/nightmares/return of symptoms for which med was prescribed -Serotonin syndrome → 2 SSRIs -Use sunblock lotion + wear protective clothing when spending time outdoors ^Skin may be sensitive to sunburn -Immediately report sore throat/fever/malaise/yellow skin/bleeding/bruising/persistent vomiting or headaches/rapid HR/seizures/stiff neck/chest pain to physician -Rise slowly from sitting or lying position to prevent sudden drop in BP -Take frequent sips of water/chew sugarless gum/suck on hard candy if dry mouth = problem ^Good oral care (frequent brushing & flossing)= very important -Avoid foods & meds high in tyramine when taking MAOIs ^Include: *Aged cheese *Wine & beer *Chocolate & colas *Coffee & tea *Sour cream & yogurt *Smoked & processed meats *Beef or chicken liver *Canned figs *Caviar *Raisins *Pickled herring *Yeast products *Broad beans *Soy sauce *Cold remedies *Diet pills -Avoid smoking while receiving tricyclic therapy ^Smoking increases metabolism of tricyclics requiring adjustment in dosage to achieve therapeutic effect -Avoid drinking alcohol while taking antidepressant therapy ^These drugs potentiate effects of each other

Bipolar disorder

Client & family education -Nature of illness: ^Causes of bipolar disorder ^Cyclic nature of illness ^Symptoms of depression ^Symptoms of mania -Management of illness: ^Medication management ^Assertive techniques ^Anger management -Support services: ^Crisis hotline ^Support groups ^Individual psychotherapy ^Legal/financial assistance

Antipsychotics

Client & family education: -Client should: ^Not stop taking drug abruptly ^Use sunscreens + wear protective clothing when spending time outdoors ^Report weekly (if receiving clozapine therapy) to have blood levels drawn + obtain weekly med supply ^Be aware of possible risks of taking antipsychotics during pregnancy ^Not drink alcohol while receiving antipsychotic therapy ^Not consume other medications (including OTC drugs) w/o physician's knowledge

Schizophrenia

Client & family education: -Nature of illness: ^What to expect as illness progresses ^Symptoms associated with illness ^Ways for family to respond to behaviors associated with illness -Management of illness: ^Connection of exacerbation of symptoms to times of stress ^Appropriate medication management ^Side effects of medications ^Importance of not stopping medications ^When to contact health-care provider ^Relaxation techniques ^Social skills training ^Daily living skills training

Schizotypal personality disorder

Clinical picture: -Aloof & isolated -Behave in bland & apathetic manner -Exhibits bizarre speech pattern -May decompensate + demonstrate psychotic symptoms when under stress -Demonstrates bland & inappropriate affect

Schizoid personality disorder

Clinical picture: -Aloof + indifferent to others -Emotionally cold -No close friends + prefers to be alone -Appears shy/anxious/or uneasy in presence of others -Inappropriately serious about everything + difficulty acting in light-hearted manner

Avoidant personality disorder

Clinical picture: -Awkward & uncomfortable in social situations -Desire close relationships but avoid them d/t fear of rejection -Perceived as timid/withdrawn/or cold & strange -Often lonely & feel unwanted -View others as critical & betraying

Paranoid personality disorder

Clinical picture: -Constantly on guard -Hypervigilant -Ready for any real or imagined threat -Trusts no one -Constantly tests honesty of others -Insensitive to feelings of others -Oversensitive -Tends to misinterpret minute cues -Magnifies & distorts cues in environment -Does not accept responsibility for his/her own behavior -Attributes shortcomings to others

Obsessive-compulsive personality disorder

Clinical picture: -Especially concerned with matters of organization & efficiency -Tend to be rigid & unbending -Socially polite & formal -Rank-conscious ^Ingratiating with authority figures ^Autocratic + condemnatory with subordinates -Appear to be very calm & controlled but underneath = great deal of: ^Ambivalence ^Conflict ^Hostility

Antisocial personality disorder

Clinical picture: -Fails to sustain consistent employment -Fails to conform to law -Exploits & manipulates others for personal gain -Fails to develop stable relationships

Borderline personality disorder

Clinical picture: -Fluctuating & extreme attitudes regarding other people -Highly impulsive -Emotionally unstable -Directly & indirectly self-destructive -Lacks clear sense of identity

Dependent personality disorder

Clinical picture: -Have notable lack of self-confidence often apparent in: ^Posture ^Voice ^Mannerisms -Overly generous & thoughtful while underplaying own attractiveness & achievements -Low self-worth + easily hurt by criticism & disapproval -Avoid positions of responsibility + become anxious when forced into them -Assume passive & submissive roles in relationships

Narcissistic personality disorder

Clinical picture: -Overly self-centered -Exploits others in effort to fulfill own desires -Mood (often grounded in grandiosity) = usually optimistic/relaxed/cheerful/care-free -D/t fragile self-esteem → mood can easily change if clients do not: ^Meet self-expectations ^Receive positive feedback that they expect -Criticism from others may cause them to respond with rage/shame/humiliation

Histrionic personality disorder

Clinical picture: -Self-dramatizing -Attention-seeking -Overly gregarious -Seductive -Manipulative -Exhibitionistic -Highly distractible -Difficulty paying attention to detail -Easily influenced by others -Difficulty forming close relationships -Strongly dependent -Somatic complaints = common

AD

Diagnoses: -Complicated grieving: disorder that occurs after death of significant other (or any other loss of significance to individual) in which experience of distress accompanying bereavement fails to follow normative expectations + manifests in functional impairment ^Goals should include helping client express anger toward lost entity + helping client verbalize behaviors associated with normal stages of grief ^Interventions include developing trusting relationship with client/assisting client in discharging pent-up anger/encouraging client to review his or her perception of loss -Risk-prone health behavior: impaired ability to modify lifestyle & behaviors in manner that improves health status ^Goals for treatment should include helping client discuss lifestyle change + formulating plan to incorporate those changes ^Interventions include encouraging client to talk about his or her lifestyle/helping with decision making/ensuring that client = knowledgeable about physiology of change in health status -Anxiety

Schizophrenia

Diagnoses: -Risk for violence: self-directed or other-directed r/t: ^Extreme suspiciousness ^Panic anxiety ^Catatonic excitement ^Rage reactions ^Command hallucinations -Ineffective health maintenance r/t disordered thinking or delusions -Impaired home-maintenance r/t: ^Regression ^Withdrawal ^Lack of knowledge or resources ^Impaired physical or cognitive functioning

Substance-induced bipolar disorder

Disturbance of mood (depression or mania) considered to be direct result of physiological effects of substance (ex. ingestion of or withdrawal from drug of abuse or med or other treatment)

Affect

Emotional reaction associated with experience

Suicide

Epidemiological factors -Second-leading cause of death among Americans 10-34 yrs of age -Fourth-leading cause of death for ages 35-54 -Eighth-leading cause of death for ages 55-64 -Tenth-leading cause of death overall

Bipolar disorder

Epidemiology: -Bipolar disorder affects approximately 5.7 million American adults -Gender incidence = roughly equal (ratio of women to men = about 1.2 to 1) -Average age at onset = early 20s -More common in single than married persons -Occurs more often in higher socioeconomic classes -Sixth leading cause of disability in middle age group

Depression

Epidemiology: -Gender prevalence ^About 21% of women + 13% of men will become clinically __________ during their lifetime ^More prevalent in women than in men by about 2 to 1 -Age ^More common in young women than in young men ^Gender difference = less pronounced b/t ages 44-65 but women = again more likely than men after age 65 -Social class ^Inverse relationship b/t social class + report of symptoms -Race ^No consistent relationship b/t race & affective disorder has been reported ^One recent survey revealed: *More prevalent in whites than in blacks *More severe & disabling in blacks *Blacks = less likely to receive treatment than whites -Marital status ^Single & divorced people = more likely to experience than married persons or persons with close interpersonal relationship (differences occur in various age groups) -Seasonality ^Affective disorders = more prevalent in spring + in fall

Depression

Evaluation: -Has self-harm to client been avoided? -Have suicidal ideations subsided? -Does client know where to seek assistance outside of hospital when suicidal thoughts occur? -Has client discussed recent loss with staff & family members? -Is he/she able to verbalize feelings & behaviors associated with each stage of grieving process + recognize own position in process? -Have obsession with & idealization of lost object subsided? -Is anger toward lost object expressed appropriately? -Does client set realistic goals for self? -Is client able to verbalize positive aspects about self/past accomplishments/future prospects? -Can client identify areas of life situation over which he/she has control?

Trauma-informed care

Generally describes philosophical approach that values awareness & understanding of trauma when assessing/planning/implementing care

Suicidal patient

Guidelines for treatment on outpatient basis: -Ensure access to support systems + tie to system of care -Develop detailed safety plan -Establish no-suicide contract with client -Enlist help of family or friends -Schedule frequent appointments -Establish rapport + promote trusting relationship -Be direct + talk matter-of-factly about suicide -Discuss current crisis situation in client's life -Identify areas of self-control -Give antidepressant meds

PTSD & AD

Historical & epidemiological data: -Post-trauma response was historically known as shell shock/battle fatigue/accident neurosis/post-traumatic neurosis -Renewed interest about disorder began in 1970s in response to problems encountered by Vietnam veterans -Diagnosis of posttraumatic stress disorder (PTSD) first appeared in third edition of DSM (DSM-3/1980) -More than half of all individuals will experience traumatic event in their lifetime but less than 10% will develop PTSD ^Traumatic event: event that = outside range of usual human experience -PTSD = more common in women than men -Individuals who have difficulties with stress reactions to more "normal" events may be diagnosed with adjustment disorder ^Adjustment disorders = quite common + can occur at any age

Bipolar disorder

Historical perspective: -Documentation of symptoms associated with bipolar disorder dates back to second century in Greece -Mania was categorized with all forms of "severe madness" in early writings -Modern concept of manic-depressive illness began to emerge in 19th century with terms such as "dual-form insanity" & "circular insanity" -Term manic-depressive was first coined in 1913 + American Psychiatric Association adopted term bipolar disorder in 1980

Nihilistic delusions

Individual has false idea that self/part of self/others/or world = nonexistent (ex. "The world no longer exists"; "I have no heart")

Learned helplessness

Individual who experiences numerous failures learns to give up trying

Suicidal patient

Information for family & friends: -Take any hint of suicide seriously -Do not keep secrets -Be good listener -Express feelings of personal worth to client -Know about suicide intervention resources -Restrict access to firearms or other means of self-harm -Acknowledge & accept person's feelings -Provide feeling of hopefulness -Do not leave him/her alone -Show love & encouragement -Seek professional help -Remove children from home -Do not judge or show anger toward person or provoke guilt in him/her

Suicide

Interpersonal-psychological theories r/t predisposing factors: -Durkheim's three social categories of suicide ^Egoistic ^Altruistic ^Anomic -Joiner's interpersonal-psychological theory ^Identifies that both interpersonal & psychological factors = critical to understanding suicide risk + his theory introduces concept that suicide ideation & suicide attempts need to be understood as distinct processes ^Proposed that low connectedness + high sense of one's being a burden interact with each other to increase suicide thoughts & desires but those features in presence of high capability for suicide = strongly associated with move from ideation to lethal attempts -Three-step theory ^Pain (usually psychological pain) when combined with hopelessness significantly increases suicide ideation (for both men & women + across age groups) ^Connectedness prevents suicide ideation from escalating in those at risk but when pain & hopelessness exceed one's sense of connectedness to others → suicide ideation becomes active ^When strong & active suicide ideation = present → leads to attempt only if one has capacity to make attempt

Suicide victims

Interventions with family & friends -Encourage him/her to talk about suicide -Discourage blaming & scapegoating -Listen to feelings of guilt & self-persecution -Talk about personal relationships with victim -Recognize differences in styles of grieving -Assist with development of adaptive coping strategies -Identify resources that provide support

PTSD & AD

Introduction: -Best predictor of PTSD after Vietnam War = severity of stressor + degree of isolation ^Feelings of guilt that precipitate social isolation ^Aggressive behavior that affects job performance ^Relationship problems ^High levels of anxiety -Overview: ^Trauma-related disorders *Post-traumatic stress disorder (PTSD) *Acute stress disorder (ASD) ^Stressor-related disorders *Adjustment disorder

Schizophrenia

Introduction: -Word = derived from Greek words skhizo (split) + phren (mind) -Probably caused by combination of factors including: ^Genetic predisposition ^Biochemical dysfunction ^Physiological factors ^Psychosocial stress -Requires treatment that = comprehensive + presented in multidisciplinary effort -Of all mental illnesses → probably causes more: ^Lengthy hospitalizations ^Chaos in family life ^Exorbitant costs to people & governments ^Fears -Four phases

Major depressive disorder

Key points: -Characterized by depressed mood -Loss of interest or pleasure in usual activities (anhedonia) -Symptoms present for at least 2 weeks -No history of manic behavior -Cannot be attributed to use of substances or another medical condition

Narcissistic personality disorder

Key points: -Characterized by exaggerated sense of self-worth -Lack of empathy -Belief in inalienable right to receive special consideration -Prevalence of disorder = estimated at about 6% -Diagnosed more often in men than women

Obsessive-compulsive personality disorder

Key points: -Characterized by inflexibility about way in which things must be done -Devotion to productivity at exclusion of personal pleasure -Relatively common -Occurs more often in men than women -Most common in oldest children within family constellation

AD

Key points: -Characterized by maladaptive reaction to identifiable stressor or stressors that results in development of clinically significant emotional or behavioral symptoms ^Symptoms = depressed mood/tearfulness/hopelessness -Symptoms occur within 3 months of stressor + last no longer than 6 mon ^Exception → "related to bereavement" subtype -Treat with psychotherapy initially to examine stressors and potential unresolved problems

Bipolar disorder

Key points: -Characterized by mood swings from profound depression to extreme euphoria (mania) with intervening periods of normalcy -Delusions or hallucinations may or may not be part of clinical picture -Onset of symptoms may reflect seasonal pattern -Somewhat milder form of mania = hypomania

Borderline personality disorder

Key points: -Characterized by pattern of intense & chaotic relationships with affective instability -Affects about 1-2% of population -More common in women than men

Dependent personality disorder

Key points: -Characterized by pattern of relying on others for emotional support -Relatively common within population -More common in women than men -More common in youngest children of family than older ones

Schizoid personality disorder

Key points: -Characterized primarily by profound defect in ability to form personal relationships -Failure to respond to others in meaningful & emotional way -Diagnosis occurs more frequently in men than women Prevalence within general population has been estimated at 3-5%

PTSD

Key points: -Definition: reaction to extreme trauma which = likely to cause pervasive distress to almost anyone (ex. natural or man-made disasters/combat/serious accidents/witnessing violent death of others/being victim of torture/terrorism/rape) -Symptoms may begin within first 3 months after trauma or may be delay of several months or even years

Adolescent depression

Key points: -Depression may be even harder to recognize in adolescent than younger child ^Feelings of sadness/loneliness/anxiety/hopelessness r/t depression may be perceived as normal emotional stresses of growing up → many young people whose symptoms = attributed to "normal adjustments" of adolescence do not get help they need -Best clue that differentiates depression from normal stormy adolescent behavior → visible manifestation of behavioral change that lasts for several weeks -Major cause of suicide among teens -Common manifestation of stress & independence conflicts r/t normal maturation process ^May also be response to death of parent/other relative/friend or to breakup with boyfriend/girlfriend *Perception of abandonment by parents or closest peer relationship = thought to be most frequent immediate precipitant to adolescent suicide

Psychopharmacology r/t bipolar disorder

Key points: -Emphasis on medication compliance -Weight gain = troubling side effect -In cases of grandeur & acute mania → lithium (mood stabilizer) + antipsychotic (like Risperdal) may be beneficial

Schizotypal personality disorder

Key points: -Graver form of pathologically less severe schizoid personality pattern -Affects approximately 3% of population

Premenstrual dysphoric disorder

Key points: -Includes: ^Depressed mood ^Anxiety ^Mood swings ^Decreased interest in activities -Symptoms begin during week prior to menses/start to improve within few days after onset of menses/become minimal or absent in week postmenses

Depression

Key points: -Oldest + one of most frequently diagnosed psychiatric illnesses -Transient symptoms = normal/healthy responses to everyday disappointments in life -Pathological form occurs when adaptation = ineffective -Appearance of mood = also called affect

Differences b/t PTSD & AD

Key points: -PTSD results from exposure to extreme traumatic event while AD results from exposure to "normal" daily events (ex. divorce/failure/or rejection) -Depression can be seen in both -Treatment → SSRIs = first choice for PTSD + AD = not commonly treated with meds

Antisocial personality disorder

Key points: -Pattern of behavior: ^Socially irresponsible ^Exploitative ^W/o remorse -Behavior reflects disregard for rights of others -Prevalence estimates in U.S. range from 2-4% in men to about 1% in women -Not often seen in most clinical settings ^Most frequently encountered in prisons/jails/rehabilitation services -Commonly way to avoid legal consequences when clients = seen ^Sometimes admitted to health-care system by court order for psychological evaluation

Childhood depression

Key points: -Precipitated by loss -Focus of therapy → alleviate symptoms + strengthen coping skills -Parental & family therapy

Dysthymic disorder

Key points: -Sad or "down in the dumps" -No evidence of psychotic symptoms -Essential feature = chronically depressed mood for: ^Most of day ^More days than not ^At least 2 yrs

ASD

Key points: -Similar to PTSD in terms of precipitating traumatic events & symptomatology -Symptoms = time limited (up to 1 month following trauma) -Diagnosis = PTSD if symptoms last longer than 1 month

Suicide prevention

Key points: -Suicide = not diagnosis or disorder (it = behavior) -More than 90% of suicides = by individuals who have diagnosed mental disorder

Lithium carbonate

Key points: -Treatment for bipolar disorder -400 mg daily = maximum dosage in adults -Therapeutic plasma range: ^Acute mania → 0.5-1.5 mEq/L ^Maintenance → 0.6-1.2 mEq/L *Therapeutic range (0.6-1.2 mEq/L) can have toxic side effects + potentially fatal when exceeded -Can cause weight gain → prescription of valproic acid for weight loss -Lithium toxicity → monitor for S/S including diarrhea/ringing of ears/blurry vision

Antipsychotics

Key points: -Used to decrease agitation & psychotic symptoms of schizophrenia & other psychotic disorders -Risperdal → positive symptom treatment of schizophrenia ^Used for clang associations/gustatory hallucinations/somatic delusions -Benztropine → muscle rigidity/tremors/EPS -Tardive dyskinesia → stop medication -Constantly assess for agranulocytosis -Note that meds elevate prolactin levels

Schizophrenia

Nature of disorder: -Severe deterioration of social & occupational functioning -Lifetime prevalence = about 1% in U.S -Causes disturbances in: ^Thought processes ^Perception ^Affect

Antidepressants

Onset of effectiveness → typically takes 4-6 weeks for med to reach full effect

PTSD & ASD

Outcome criteria -Client: ^Can acknowledge trauma + impact on his/her life ^Can demonstrate adaptive coping strategies ^Has made realistic goals for future ^Has worked through feelings of survivor's guilt ^Attends support group of individuals recovering from similar traumatic experiences ^Verbalizes desire to put trauma in past + progress with his/her life

Bipolar disorder

Outcome criteria -Client: ^Exhibits no evidence of physical injury ^Has not harmed self or others ^No longer exhibiting signs of physical agitation ^Eats well-balanced diet with snacks to prevent weight loss + maintain nutritional status *Higher calorie finger foods b/c may not want to eat when manic ^Verbalizes accurate interpretation of environment ^Verbalizes that hallucinatory activity has ceased + demonstrates no outward behavior indicating hallucinations ^Accepts responsibility for own behaviors ^Does not manipulate others for gratification of own needs ^Interacts appropriately with others ^Able to fall asleep within 30 min of retiring ^Able to sleep 6-8 hrs per night

Schizophrenia

Outcome criteria: -Client: ^Demonstrates ability to relate to others satisfactorily ^Recognizes distortions of reality ^Has not harmed self or others ^Perceives self realistically ^Demonstrates ability to perceive environment correctly ^Maintains anxiety at manageable level ^Relinquishes need for delusions & hallucinations ^Demonstrates ability to trust others ^Uses appropriate verbal communication in interactions with others ^Performs self-care activities independently

Depression

Outcome measurement criteria -Client: ^Experienced no physical harm to self ^Discusses loss with staff & family members ^No longer idealizes or obsesses about lost entity ^Sets realistic goals for self ^Attempts new activities w/o fear of failure ^Able to identify aspects of self-control over life situation ^Expresses personal satisfaction & support from spiritual practices ^Interacts willingly & appropriately with others ^Able to maintain reality orientation ^Able to concentrate/reason/solve problems

Depression

Planning & implementation -Risk for suicide: ^Be direct ^Maintain close observation at irregular intervals ^Encouraging verbalizations of honest feelings -Complicated grieving: ^Develop trusting relationship with client ^Encourage client to express emotions ^Communicate that crying = acceptable -Low self-esteem/self-care deficit: ^Be accepting of client ^Encourage client to recognize areas of change ^Encourage independence in performance of ADLs

Schizophrenia

Planning & implementation: -Disturbed thought processes: ^Do not argue or deny belief ^Reinforce + focus on reality -Risk for violence: ^Observe client's behavior ^Maintain calm attitude ^Have sufficient staff on hand -Impaired verbal communication: ^Facilitate trust & understanding ^Orient client to reality

PTSD & ASD

Predisposing factor: -Biological aspects ^Suggested that symptoms r/t trauma = maintained by production of endogenous opioid peptides produced in face of arousal + which result in increased feelings of comfort & control ^When stressor terminates → individual may experience opioid withdrawal + symptoms of which bear strong resemblance to those of PTSD ^Dysregulation of opioid/glutamatergic/noradrenergic/serotonergic/neuroendocrine pathways may also be involved in pathophysiology of PTSD

PTSD & ASD

Predisposing factor: -Learning theory ^Negative reinforcement leads to reduction in aversive experience thereby reinforcing & resulting in repetition of behavior ^Avoidance behaviors ^Psychic numbing -Cognitive theory ^Person = vulnerable to PTSD when fundamental beliefs = invalidated by experiencing trauma that cannot be comprehended + when sense of helplessness & hopelessness prevail

AD

Predisposing factor: -Psychosocial theories: ^Childhood trauma/dependency/arrested development ^Constitutional factor (birth characteristics) ^Developmental stage & timing of stressor ^Available support systems ^Dysfunctional grieving process

PTSD & ASD

Predisposing factor: -Psychosocial theory ^Seeks to explain why some individuals exposed to massive trauma develop PTSD while others do not ^Variables include characteristics that relate to: *Traumatic experience *Individual *Recovery environment

Schizophrenia

Predisposing factors -Biological influences: ^Genetics *Growing body of knowledge indicates that genetics plays important role in development of schizophrenia ^Biochemical influences *One theory suggests that schizophrenia may be caused by excess of dopamine activity in brain *Abnormalities in other neurotransmitters have also been suggested ^Physiological influences *Factors that have been implicated include: ~Viral infection ~Anatomical abnormalities ~Histological changes in brain ~Various physical conditions #Epilepsy #Huntington's disease #Birth trauma #Head injury in adulthood #Alcohol abuse #Cerebral tumor #Cerebrovascular accident #Systemic lupus erythematosus #Myxedema #Parkinsonism #Wilson's disease

Schizophrenia

Predisposing factors -Psychological influences: ^These theories no longer hold credibility *Researchers now focus their studies of schizophrenia as brain disorder ^Psychosocial theories probably developed early on out of lack of info r/t biological connection -Environmental influences: ^Sociocultural factors → poverty has been linked with development of schizophrenia ^Downward drift hypothesis: poor social conditions seen as consequence (rather than cause) of schizophrenia ^Stressful life events may be associated with exacerbation of schizophrenic symptoms + increased rates of relapse ^Studies of genetic vulnerability for schizophrenia have linked certain genes to increased risk for psychosis + particularly for adolescents who use cannabinoids

Bipolar disorder

Predisposing factors: -Biological theories: ^Genetics *Twin & family studies *Other genetic studies ^Biochemical influences *Possible excess of norepinephrine & dopamine ^Physiological influences *Brain lesions *Enlarged ventricles *Medication side effects -Psychosocial theories: ^Credibility of psychosocial theories has declined in recent years ^Viewed as disease of brain

AD

Predisposing factors: -Biological theories: ^Genetics ^Vulnerability r/t neurocognitive or intellectual developmental disorders -Transactional model of stress/adaptation: ^Interaction b/t individual & environment ^Type of stressor ^Situational factors ^Intrapersonal factors

Narcissistic personality disorder

Predisposing factors: -Fears/failures/or dependency needs were responded to with criticism/disdain/or neglect as children -Parents were often narcissistic themselves -Parents may have overindulged child + failed to set limits on inappropriate behavior

Obsessive-compulsive personality disorder

Predisposing factors: -Overcontrol by parents -Notable parental lack of positive reinforcement for acceptable behavior -Frequent punishment for undesirable behavior

Schizoid personality disorder

Predisposing factors: -Possible hereditary factor -Childhood characterized as: ^Bleak ^Cold ^Unempathic ^Notably lacking in nurturing

Histrionic personality disorder

Predisposing factors: -Possible link to noradrenergic & serotonergic systems -Possible hereditary factor -Biogenetically determined temperament -Learned behavior patterns

Substance-induced psychotic disorder

Presence of prominent hallucinations & delusions judged to be directly attributable to substance intoxication or withdrawal

Schizophrenia

Prognosis: -Return to full premorbid functioning = not common -Factors r/t positive prognosis include: ^Good premorbid functioning ^Later age at onset ^Female gender ^Abrupt onset precipitated by stressful event ^Associated mood disturbance ^Brief duration of active-phase symptoms ^Minimal residual symptoms ^Absence of structural brain abnormalities ^Normal neurological functioning ^Family history of mood disorder ^No family history of schizophrenia

Suicide

Psychological theories r/t predisposing factors: -Anger turned inward ^Freud believed that suicide was response to intense self-hatred that individual possessed ^Anger had originated toward love object but was ultimately turned inward against self ^Interpreted suicide to be aggressive act toward self that often was really directed toward others -Hopelessness & other symptoms of depression ^Hopelessness has long been identified as symptom of depression + as underlying factor in predisposition to suicide ^While many of symptoms identified in suicide assessment tools attempt to assess for seriousness of suicide ideation → current research = attempting to glean which symptoms might be more predictive of move from ideation to attempts -History of aggression & violence ^History of violent behavior or impulsive acts has been associated with increased risk for suicide although recent evidence suggests that impulsive traits = higher in individuals with suicide ideation but not necessarily associated with more attempts -Shame & humiliation ^Some individuals have viewed suicide as "face-saving" mechanism *Way to prevent public humiliation following social defeat such as sudden loss of status or income ^Individuals = often too embarrassed to seek treatment or other support systems

Schizophrenia

Psychological treatments: key point = provide adequate space (no touching when speaking with paranoid & agitated client) -Individual psychotherapy: long-term therapeutic approach + difficult d/t client's impairment in interpersonal functioning -Group therapy: some success if occurring over long-term course of illness + less successful in acute/short-term treatment -Behavior therapy: chief drawback has been inability to generalize to community setting after client has been discharged from treatment -Social skills training: use of role play to teach client appropriate eye contact/interpersonal skills/voice intonation/posture + aimed at improving relationship development

Depressive phase

Psychopharmacology: -Antidepressants ^May trigger mania

Schizophrenia

Psychopharmacology: -Antipsychotics -Antiparkinsonian agents may be prescribed to counteract EPS

Mania

Psychopharmacology: -Lithium carbonate -Anticonvulsants -Verapamil -Antipsychotics

Depression

Psychosocial theories r/t predisposing factors: -Psychoanalytical theory (Freud): loss = internalized + becomes directed against ego -Beck's Cognitive Theory → negative perception of self/future/environment -Learning theory ^Learned helplessness -Object loss

Positive symptoms

R/t schizophrenia: -Definition: add to individual's life experience (not good) -Includes: ^Content of thought *Delusions: false personal beliefs *Religiosity: excessive demonstration of obsession with religious ideas & behavior *Paranoia *Magical thinking: ideas that one's thoughts or behaviors have control over specific situations ^Form of thought *Associative looseness (AKA loose association): shift of ideas from one unrelated topic to another *Neologisms *Concrete thinking: literal interpretations of environment *Clang associations *Word salad: group of words put together in random fashion *Circumstantiality *Tangentiality *Mutism: inability or refusal to speak *Perseveration: persistent repetition of same word or idea in response to different questions ^Perception: interpretation of stimuli through senses *Hallucinations: false sensory perceptions not associated with real external stimuli ~Auditory ~Visual ~Tactile ~Gustatory ~Olfactory *Illusions ^Sense of self: uniqueness & individuality person feels *Echolalia *Echopraxia *Identification & imitation: taking on form of behavior one observes in another *Depersonalization: feelings of unreality

Negative symptoms

R/t schizophrenia: -Definition: take away from individual's life experience -Includes: ^Affect: feeling state or emotional tone *Inappropriate affect: emotions = incongruent with circumstances *Bland: weak emotional tone *Flat: appears to be void of emotional tone *Apathy: disinterest in environment ^Volition *Emotional ambivalence *Deterioration in appearance: impaired personal grooming & self-care activities ^Impaired interpersonal functioning + relationship to external world: *Impaired social interaction: clinging & intruding on personal space of others exhibiting behaviors not culturally & socially acceptable *Social isolation: focus inward on self to exclusion of external environment ^Psychomotor behavior: *Anergia: deficiency of energy *Waxy flexibility: passive yielding of all movable parts of body to any effort made at placing them in certain positions *Posturing: voluntary assumption of inappropriate or bizarre postures *Pacing & rocking: pacing back & forth + rocking body ^Associated features: *Anhedonia *Regression: retreat to earlier level of development

Suicide

Risk factors: -Marital status ^Suicide rate for single persons = twice that of married persons -Gender ^Women attempt suicide more often but more men succeed ^Men commonly choose more lethal methods than do women -Age ^Risk of suicide increases with age (particularly among men) ^White men older than 80 yrs = at greatest risk of all age/gender/race groups -Religion ^Affiliation with religious group decreases risk of suicide ^Catholics have lower rates than do Protestants or Jewish people -Socioeconomic status ^Individuals in very highest & lowest social classes have higher suicide rates than those in middle class -Ethnicity ^Whites = at highest risk for suicide followed by Native Americans/African Americans/Hispanic Americans/Asian Americans -Psychiatric illness: mood & substance use disorders = most common psychiatric illnesses that precede suicide ^Other psychiatric disorders that account for suicidal behavior include: *Schizophrenia *Personality disorders *Anxiety disorders -Severe insomnia = associated with increased risk of suicide -Use of alcohol & barbiturates -Psychosis with command hallucinations -Affliction with a chronic/painful/or disabling illness -Family history of suicide -LGBT individuals have higher risk of suicide than do their heterosexual counterparts -Having attempted suicide previously increases risk of subsequent attempt ^About half of those who ultimately commit suicide have history of previous attempt -Loss of loved one through death or separation -Bullying

Schizophreniform disorder

Same symptoms as schizophrenia with exception that duration of disorder has been at least 1 mon but less than 6 mon

Schizoaffective disorder

Schizophrenic symptoms accompanied by strong element of symptomatology associated with mood disorders (either mania or depression)

Antipsychotics

Side effects: -Anticholinergic effects -Nausea/GI upset -Skin rash -Sedation -Orthostatic hypotension -Photosensitivity -Hormonal effects -Electrocardiogram changes -Hypersalivation -Weight gain -Hyperglycemia/diabetes -Increased risk of mortality in elderly clients with dementia -Reduction in seizure threshold -Agranulocytosis -Extrapyramidal symptoms ^Pseudoparkinsonism ^Akinesia ^Akathisia ^Dystonia ^Oculogyric crisis -Tardive dyskinesia -Neuroleptic malignant syndrome

Schizophrenia

Social treatments: -Family therapy: aimed at helping family members cope with long-term effects of illness -Program of assertive community treatment: program of case management that takes team approach in providing comprehensive & community-based psychiatric treatment/rehabilitation/support to persons with serious & persistent mental illness

Bipolar disorder

Stages → symptoms may be categorized by degree of severity -Stage I: hypomania -Stage II: acute mania -Stage III: delirious mania

Childhood depression

Symptoms: - < age 3: feeding problems/tantrums/lack of playfulness & emotional expressiveness -Ages 3-5: accident proneness/phobias/excessive self-reproach -Ages 6-8: physical complaints/aggressive behavior/clinging behavior -Ages 9-12: morbid thoughts + excessive worrying

Adolescent depression

Symptoms: -Inappropriately expressed anger/aggressiveness -Running away -Delinquency -Social withdrawal -Sexual acting out -Substance abuse -Restlessness/apathy -Loss of self-esteem/sleeping & eating disturbances/psychosomatic complaints = also common

Schizotypal personality disorder

Symptoms: -Magical thinking -Ideas of reference -Illusions -Depersonalization -Superstitiousness -Withdrawal into self

Depressive

Symptoms: -Previous manic episodes -Mood: ^Dysphoric ^Depressive ^Despairing -Decreased interest in pleasure -Negative views -Fatigue -Decreased appetite & constipation -Insomnia -Decreased libido -Suicidal preoccupation -May be agitated or have movement retardation

Manic

Symptoms: psychosis may occur during manic episode → does not happen in hypomanic state (differentiates the two) -Onset before age 30 -Mood: ^Elevated ^Expansive ^Irritable -Speech: ^Loud-rapid ^Punning ^Rhyming ^Clanging ^Vulgar -May have weight loss -Grandiose -Delusions -Distracted -Hyperactive -Decreased need for sleep -Inappropriate -Flight of ideas -Begins suddenly + escalates over several days

Personality

Totality of emotional & behavioral characteristics particular to specific person + that remain somewhat stable & predictable over time

Lithium carbonate

Treatment for bipolar disorder Client & family education → key points: -Take medication regularly -Do not skimp on dietary sodium -Drink 6-8 glasses (2,500-3,000 mL) of water/day ^Avoid caffeine r/t dehydration -Notify physician if vomiting or diarrhea occur -Have serum lithium level checked every 1-2 mon or as advised by physician ^Most doctors choose 2 weeks

Verapamil

Treatment for bipolar disorder Client & family education: -Do not discontinue drug abruptly -Rise slowly from sitting or lying position to prevent sudden drop in BP -Report following symptoms to physician: ^Irregular heart beat + chest pain ^SOB + pronounced dizziness ^Swelling of hands & feet ^Profound mood swings ^Severe & persistent headache

Antipsychotics

Treatment for bipolar disorder Client & family education: -Do not discontinue drug abruptly -Use sunblock when outdoors -Rise slowly from sitting or lying position -Avoid alcohol and OTC meds -Continue to take medication (even if feeling well + as though = not needed) ^Symptoms may return if med = discontinued

Anticonvulsants

Treatment for bipolar disorder Client & family education: -Refrain from discontinuing drug abruptly -Report following symptoms to physician immediately → skin rash/unusual bleeding/spontaneous bruising/sore throat/fever/malaise/dark urine/yellow skin or eyes -Avoid using alcohol & OTC meds w/o approval from physician

Lithium carbonate

Treatment for bipolar disorder Notify physician if any of the following symptoms occur: -Persistent nausea & vomiting -Severe diarrhea -Ataxia -Blurred vision -Tinnitus -Excessive output of urine -Increasing tremors -Mental confusion

Antipsychotics

Treatment for bipolar disorder Report following symptoms to physician: -Sore throat/fever/malaise -Unusual bleeding/easy bruising/skin rash -Persistent nausea & vomiting -Severe headache + rapid HR -Difficulty urinating or excessive urination -Muscle twitching & tremors -Darkly colored urine + pale stools -Yellow skin or eyes -Excessive thirst or hunger -Muscular incoordination or weakness

PTSD & ASD

Treatment: -Cognitive therapy -Prolonged exposure therapy -Group/family therapy -Eye movement desensitization & reprocessing -Psychopharmacology ^SSRIs = first choice

AD

Treatment: -Individual psychotherapy -Family therapy -Behavior therapy -Self-help groups -Crisis intervention -Psychopharmacology ^Not commonly treated with meds *Psychoactive drugs carry potential for physiological & psychological dependence *Meds can interfere with ability to find more permanent solution to problem *Meds may mask real problem at root of diagnosis

Bipolar disorder

Treatment: -Individual psychotherapy -Group therapy ^Family therapy *Recommended for teenagers -Cognitive therapy -Recovery model -Electroconvulsive therapy (ECT) ^Episodes of mania may be treated with ECT when: *Client does not tolerate medication *Client fails to respond to medication *Client's life = threatened by dangerous behavior or exhaustion

Depression

Treatment: -Individual psychotherapy -Group therapy ^Family therapy -Cognitive therapy -Electroconvulsive therapy (ECT) -Transcranial magnetic stimulation (rTMS) -Vagal nerve stimulation (VNS) + deep brain stimulation (DBS) -Light therapy -Psychopharmacology ^Tricyclic/tetracyclic/heterocyclic antidepressants ^Selective serotonin reuptake inhibitors (SSRIs) ^Monoamine oxidase inhibitors (MAOIs) ^Serotonin-norepinephrine reuptake inhibitors (SNRIs) ^SSRI/SNRI combination drugs

Personality disorders

Treatment: -Interpersonal psychotherapy -Psychoanalytical psychotherapy -Milieu or group therapy -Cognitive/behavioral therapy -Dialectical behavior therapy -Psychopharmacology

Adolescent depression

Treatment: -Key points: ^Often conducted on outpatient basis ^Hospitalization may be required in cases of severe depression or threat of imminent suicide/when family situation = such that treatment cannot be carried out in home/when physical condition precludes self-care of biological needs/or when adolescent has indicated possible harm to self or others in family -Includes: ^Supportive psychosocial intervention ^Antidepressant medication *All antidepressants carry FDA black-box warning for increased risk of suicidality in children & adolescents ~Emphasizes need for close monitoring *Fluoxetine (Prozac) has been approved by FDA to treat depression in children & adolescents + escitalopram (Lexapro) was approved in 2009 for treatment of MDD in adolescents aged 12-17 yrs

Depressive disorders

Types: -Major depressive disorder -Dysthymic disorder -Premenstrual dysphoric disorder -Substance-induced depressive disorder ^Considered to be direct result of physiological effects of substance -Depressive disorder r/t another medical condition ^Attributable to direct physiological effects of general medical condition -Childhood depression -Senescence -Postpartum depression

AD

Types: -With depressed mood ^Most common -With anxiety -With mixed anxiety & depressed mood -With disturbance of conduct -With mixed disturbance of emotions & conduct -R/t bereavement -Unspecified

Light therapy

-Administered by 10,000-lux light box which contains white fluorescent light tubes covered with plastic screen that blocks UV rays -Individual sits in front of box with eyes open (although client should not look directly into light) -Usually begins with 10- to 15-min sessions + gradually progresses to 30-45 min -Mechanism of action believed to be r/t retinal stimulation which triggers reduction of melatonin + increase in serotonin in brain -Effective short-term treatment for seasonal affect disorder (SAD)

Mania

-Alteration in mood expressed by feelings of elation/inflated self-esteem/grandiosity/hyperactivity/agitation/accelerated thinking & speaking -Can occur as biological (organic) or psychological disorder or as response to substance use or general medical condition

Pharmacogenomics r/t depression

-B/t 30-50% of patients do not respond to first antidepressant prescription -Study = needed to identify benefits of routine testing/cost effectiveness/ability to provide timely results

Personality traits

-Characteristics with which individual = born or develops early in life -Influence way in which he/she perceives & relates to environment + quite stable over time

Bipolar II disorder

-Characterized by bouts of major depression with episodic occurrence of hypomania -Has never met criteria for full manic episode -Treatment → mood stabilizers + antidepressants

Cyclothymic disorder

-Chronic mood disturbance -At least 2-year duration -Numerous episodes of hypomania & depressed mood of insufficient severity to meet criteria for either bipolar I or II disorder -Treated with mood stabilizers

Bipolar I disorder

-Client = experiencing (or has experienced) full syndrome of manic or mixed symptoms -May also have experienced episodes of depression -Treatment → mood stabilizers

Jealous delusions

-Content centers on idea that person's sexual partner = unfaithful -Idea = irrational & w/o cause but individual with delusion searches for evidence to justify belief -Sexual partner = confronted (+ sometimes physically attacked) regarding imagined infidelity ^Imagined "lover" of sexual partner also may be object of attack -Attempts to restrict autonomy of sexual partner in effort to stop imagined infidelity = common

Hallucinations

-Definition: false sensory perceptions not associated with real external stimuli -Types: ^Auditory ^Visual ^Tactile: false perceptions of sense of touch (often of something on or under skin) *One specific type = formication (sensation that something = crawling on or under skin) ^Gustatory: false perception of taste *Most commonly described as unpleasant tastes ^Olfactory: false perceptions of sense of smell

Anhedonia

-Definition: loss of interest or pleasure in usual activities ^Inability to experience pleasure -Typically seen with major depressive disorder

Suicide

-Diagnosis & outcome identification ^Nursing diagnoses for suicidal client may include risk for suicide & hopelessness ^Outcome criteria -Evaluation ^Develop & maintain more positive self-concept ^Learn more effective ways to express feelings to others ^Achieve successful interpersonal relationships ^Feel accepted by others + achieve sense of belonging

Social categories of suicide

-Egoistic suicide: response of individual who feels separate & apart from mainstream of society ^Integration = lacking + individual does not feel part of any cohesive group (ex. family or church) -Altruistic suicide: opposite of egoistic suicide ^Individual = excessively integrated into group ^Group = often governed by cultural/religious/or political ties + allegiance = so strong that individual will sacrifice life for group -Anomic suicide: occurs in response to changes in individual's life (ex. divorce or loss of job) that disrupt feelings of relatedness to group ^Interruption in customary norms of behavior instills feelings of "separateness" + fears of being w/o support from formerly cohesive group

Delusions of reference

-Events within environment = referred by psychotic person to himself/herself (ex. "Someone is trying to get a message to me through the articles in this magazine [or newspaper or TV program]; I must break the code so that I can receive the message") + these beliefs become fixed (as with other delusions) despite evidence to contrary -Ideas of reference may have content similar to delusions of reference but = less rigidly adhered to beliefs ^When person with ideas of reference = offered alternative explanation → person = more likely able to consider that he/she has misinterpreted situation

Delusional disorder

-Existence of prominent & non-bizarre delusions -Delusions include: ^Erotomanic type ^Grandiose type ^Jealous type ^Persecutory type ^Somatic type ^Mixed type

Object loss

-Experiences loss of significant other during first 6 mon of life -Feelings of helplessness & despair -Early loss or trauma may predispose client to lifelong periods of depression

Severe depression

-Includes symptoms of major depressive disorder & bipolar depression ^Affective → feelings of total despair/worthlessness + flat affect ^Behavioral → psychomotor retardation/curled-up position/absence of communication ^Cognitive → prevalent delusional thinking with delusions of persecution & somatic delusions/confusion/suicidal thoughts ^Physiological → general slow-down of entire body

Delusions of control or influence

-Individual believes that certain objects or persons have control over his/her behavior (ex. "The dentist put a filling in my tooth; I now receive transmissions through the filling that control what I think and do") or person believes that his/her thoughts or behaviors have control over specific situations or people (ex. mother who believed that if she scolded her son in any way, he would die) -Similar to magical thinking which = common in children (ex. "The sky is raining because I'm sad")

Erotomanic delusions

-Individual falsely believes that someone (usually of higher status) = in love with him/her -Famous persons = often subjects -Sometimes delusion = kept secret but some individuals may follow/contact/otherwise try to pursue object of their delusion

Grandiose delusions

-Individual has exaggerated feeling of importance/power/knowledge/or identity -May believe that he/she has special relationship with famous person or even assume identity of famous person (believing that actual person = imposter) -Delusions of religious nature may lead to assumption of identity of deity or religious leader (ex. "I am Jesus Christ")

Somatic delusions

-Individual has false idea about functioning of his/her body -May be false belief that he/she has some type of general medical condition or that there has been alteration in body organ or its function (ex. "The doctor says I'm not pregnant, but I know I am" + "There is an alien force that is eating my brain")

Psychopharmacology r/t depression

-Key points: ^Antidepressant medication = generally considered first-line treatment for severe clinical depression but antidepressants also used in treatment of other depressive disorders ^Important to highlight that antidepressant medication can be lethal in overdose *Depressed/suicidal patients must be observed closely + suicide risk assessed frequently in use of this treatment modality -Includes: ^Tricyclic/tetracyclic/heterocyclic antidepressants ^Selective serotonin reuptake inhibitors (SSRIs) ^Monoamine oxidase inhibitors (MAOIs) ^Serotonin-norepinephrine reuptake inhibitors (SNRIs) ^SSRI/SNRI combination drugs

Senescence

-Key points: ^Bereavement overload ^High percentage of suicides among elderly ^Symptoms of depression often confused with symptoms of neurocognitive disorder -Treatment: ^Antidepressant medication ^Electroconvulsive therapy ^Psychosocial therapies

Paranoid personality disorder

-Key points: ^Characterized by pervasive/persistent/inappropriate mistrust of others ^Individuals = suspicious of others' motives + assume that others intend to exploit/harm/or deceive them ^More common in men than women -Predisposing factors: ^Possible hereditary link ^Subject to early parental antagonism & harassment

Avoidant personality disorder

-Key points: ^Characterized by: *Extreme sensitivity to rejection *Social withdrawal ^Prevalence = about 1% + equally common in men & women -Predisposing factors: ^No clear cause known ^May be combination of biological/genetic/psychosocial influences ^Primary psychosocial influence → parental rejection & censure (often reinforced by peers)

Bipolar disorder in childhood & adolescence

-Key points: ^Lifetime prevalence of pediatric & adolescent bipolar disorders = estimated at about 1% ^Diagnosis = difficult -Treatment strategies: ^Psychopharmacology *Lithium *Divalproex *Carbamazepine *Atypical antipsychotics ^ADHD = most common comorbid condition *ADHD agents may exacerbate mania + should be administered only after bipolar symptoms have been controlled ^Family interventions: *Psychoeducation about bipolar disorder *Communication training *Problem-solving skills training

Postpartum depression

-Key points: ^May last for few weeks to several months ^Associated with hormonal changes/tryptophan metabolism/or cell alterations ^Treatments → antidepressants & psychosocial therapies -Symptoms: ^Fatigue ^Irritability ^Loss of appetite ^Sleep disturbances ^Loss of libido ^Concern about inability to care for infant

Individual psychotherapy

-Key points: ^Treatment for depression ^Focuses on client's current interpersonal relations + proceeds through three phases -Phases: ^Phase I: *Client = assessed to determine extent of illness *Complete info = then given to individual regarding nature of depression/symptom pattern/frequency/clinical course/alternative treatments *Mutually agreeable therapeutic contract = negotiated ^Phase II: *Focuses on helping client resolve complicated grief reactions ~May include resolving ambivalence with lost relationship + assistance with establishing new relationships *Other areas of treatment focus may include interpersonal disputes b/t client & significant other/difficult role transitions at various developmental life cycles/correction of interpersonal deficits that may interfere with client's ability to initiate or sustain interpersonal relationships ^Phase III: *Therapeutic alliance = terminated *With emphasis on reassurance → clarification of emotional states/improvement of interpersonal communication/testing of perceptions/performance in interpersonal settings *Interpersonal psychotherapy has been successful in helping depressed persons recover enhanced social functioning

Catatonic features specifier

-May be associated with other psychotic disorders (ex. brief psychotic disorder/schizophreniform disorder/schizophrenia/schizoaffective disorder/substance-induced psychotic disorder) -Symptoms of catatonic disorder: ^Stupor & muscle rigidity or excessive & purposeless motor activity ^Waxy flexibility/negativism/echolalia/echopraxia

ECT (electroconvulsive therapy)

-Mechanism of action → thought to increase levels of biogenic amines -Side effects → temporary memory loss & confusion -Risks → mortality/permanent memory loss/brain damage ^Administer 100% oxygen during & after to prevent anoxia d/t medication-induced paralysis of respiratory muscle ^Place on side to prevent aspiration -Meds → pretreatment medication/muscle relaxant/short-acting anesthetic

Persecutory delusions

-Most common type of delusion in which individuals believe they = being persecuted or malevolently treated in some way -Frequent themes include being plotted against/cheated or defrauded/followed & spied on/poisoned/or drugged -Individual may obsess about & exaggerate slight rebuff (either real or imagined) until it becomes focus of delusional system -Repeated complaints may be directed at legal authorities -Individual feels threatened + believes that others intend harm or persecution toward him/her in some way (ex. "The FBI has 'bugged' my room & intends to kill me" + "The government put a chip in my brain to erase my memories") -May also be referred to as paranoid delusions which describes extreme suspiciousness of others + of their actions or perceived intentions (ex. "I won't eat this food. I know it has been poisoned"). -Aggression or violence may occur b/c individual believes that he/she must defend him/herself against someone or something perceived to be threat

Emotional ambivalence

-Negative symptom of schizophrenia -Coexistence of opposite emotions toward same object/person/or situation

Volition

-Negative symptom of schizophrenia -Impairment in ability to initiate goal-directed activity

rTMS

-Noninvasive procedure used to treat depression by stimulating nerve cells in brain -Involves use of very short pulses of magnetic energy to stimulate nerve cells at localized areas in cerebral cortex ^Similar to electrical activity observed with ECT -Electrical waves generated by rTMS do not result in generalized seizure activity unlike ECT

Personality disorders

-Occur when traits become rigid & inflexible + contribute to maladaptive patterns of behavior or impairment in functioning -Personality development occurs in response to number of biological & psychological influences ^Heredity ^Temperament ^Experiential learning ^Social interaction

AD

-Outcome criteria: ^Client: *Verbalizes acceptable grieving behaviors *Demonstrates reinvestment in environment *Accomplishes activities of daily living independently *Demonstrates ability to function adequately *Accepts change in health status *Sets realistic goals for future *Demonstrates ability to cope effectively with change in lifestyle -Evaluation: ^Based on accomplishment of previously established outcome criteria *Does client demonstrate progression in grief process? *Does client discuss change in health status & modification of lifestyle it will affect? *Does client set realistic goals for future?

Mood

-Pervasive & sustained emotion that may have major influence on person's perception of world -Examples: depression/joy/elation/anger/anxiety

Premorbid

-Phase I of schizophrenia -Social maladjustment -Antagonistic thoughts & behavior -Shy & withdrawn -Poor peer relationships -Doing poorly in school -Antisocial behavior

Prodromal

-Phase II of schizophrenia -Lasts from few weeks to few years -Deterioration in role functioning & social withdrawal -Substantial functional impairment -Sleep disturbance/anxiety/irritability -Depressed mood/poor concentration/fatigue -Perceptual abnormalities/ideas of reference/suspiciousness herald onset of psychosis

Schizophrenia

-Phase III of schizophrenia -Psychotic symptoms = prominent in active phase of disorder ^Delusions ^Hallucinations ^Impairment in work/social relations/self-care

Residual

-Phase IV of schizophrenia -Symptoms similar to those of prodromal phase -Flat affect + impairment in role functioning = prominent

PTSD & ASD

-Planning & implementation: ^Nursing care of client with trauma-related disorder = aimed at: *Reassurance of safety *Decrease in maladaptive symptoms *Demonstration of more adaptive coping strategies *Adaptive progression through grieving process -Evaluation: ^Evaluation of care for client = based on successful achievement of previously established outcome criteria *Can client discuss traumatic event w/o experiencing panic anxiety? *Has client learned new & adaptive coping strategies for assistance with recovery?

Clang associations

-Positive symptom of schizophrenia -Choice of words = governed by sound (often rhyming)

Circumstantiality

-Positive symptom of schizophrenia -Delay in reaching point of communication d/t unnecessary & tedious details

Paranoia

-Positive symptom of schizophrenia -Extreme suspiciousness of others

Tangentiality

-Positive symptom of schizophrenia -Inability to get to point of communication d/t introduction of many new topics

Neologisms

-Positive symptom of schizophrenia -Made-up words that have meaning only to person who invents them

Illusions

-Positive symptom of schizophrenia -Misperceptions of real external stimuli

Echopraxia

-Positive symptom of schizophrenia -Repeating observed movements

Echolalia

-Positive symptom of schizophrenia -Repeating words that = heard

EPS (extrapyramidal symptoms)

-Pseudoparkinsonism -Akinesia -Akathisia -Dystonia -Oculogyric crisis

Hypomania

-Stage 1 of bipolar disorder -Symptoms not sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization -Includes: ^Cheerful mood ^Rapid flow of ideas + heightened perception ^Increased motor activity

Acute mania

-Stage 2 of bipolar disorder -Includes: ^Elation & euphoria + continuous "high" ^Flight of ideas + accelerated & pressured speech ^Hallucinations & delusions ^Excessive motor activity ^Social & sexual inhibition ^Little need for sleep

Acute mania

-Stage 2 of bipolar disorder -Key points: ^Marked impairment in functioning + usually requires hospitalization ^Psychomotor activity = excessive ^Sexual interest = increased ^Poor impulse control/low frustration tolerance/individual who = normally discreet may become socially & sexually uninhibited ^Energy seems inexhaustible + need for sleep = diminished *May go for many days w/o sleep + still not feel tired ^Hygiene & grooming may be neglected ^Dress may be disorganized/flamboyant/or bizarre + use of excessive make-up or jewelry = common

Delirious mania

-Stage 3 of bipolar disorder -Key points: ^Grave form of disorder characterized by intensification of symptoms associated with acute mania ^Condition = rare since advent of antipsychotic medication -Includes: ^Labile mood + panic anxiety ^Clouding of consciousness & disorientation ^Frenzied psychomotor activity ^Exhaustion + possibly death w/o intervention

Brief psychotic disorder

-Sudden onset of symptoms -May or may not be preceded by severe psychosocial stressor -Lasts less than 1 mon -Return to full premorbid level of functioning

Mild depression

-Symptoms = identified as those associated with normal grieving ^Affective → anger & anxiety ^Behavioral → tearful & regression ^Cognitive → preoccupied with loss ^Physiological → anorexia & insomnia

Moderate depression

-Symptoms associated with dysthymic disorder ^Affective → helpless/powerless ^Behavioral → slowed physical movements/slumped posture/limited verbalization ^Cognitive → retarded thinking processes + difficulty with concentration ^Physiological → anorexia or overeating/sleep disturbance/headaches

Transient depression

-Symptoms at this level of continuum = not necessarily dysfunctional ^Affective → "blues" ^Behavioral → some crying ^Cognitive → some difficulty getting mind off of one's disappointment ^Physiological → feeling tired & listless

Recovery model

-Treatment for bipolar disorder -Learning how to live safe/dignified/full/self-determined life in face of enduring disability which may (at times) be r/t serious mental illness -Recovery = continuous process in bipolar disorder ^Client identifies goals ^Client & clinician develop treatment plan ^Client & clinician work on strategies to help individual manage bipolar illness ^Clinician serves as support person to help individual achieve previously identified goals -Although no cure for bipolar disorder → recovery = possible in sense of learning to prevent & minimize symptoms + successfully cope with effects of illness on mood/career/social life

Group therapy

-Treatment for depression -Groups can provide atmosphere in which individuals may discuss issues in their lives that cause/maintain/or arise out of having serious affective disorder -Element of peer support provides feeling of security b/c troublesome or embarrassing issues = discussed & resolved -Example: family therapy

Family therapy

-Treatment for depression -Indicated if disorder jeopardizes patient's marriage or family functioning or if mood disorder = promoted or maintained by family situation -Examines role of mood-disordered member in overall psychological well-being of whole family + role of entire family in maintenance of patient's symptom -Ultimate objective = resolve symptoms + initiate or restore adaptive family functioning

Cognitive therapy

-Treatment for depression -Individual = taught to control thought distortions considered to be factor in development & maintenance of mood disorders -Depression = characterized by triad of negative distortions r/t expectations of environment/self/future ^Environment & activities within it = viewed as unsatisfying/self = unrealistically devalued/future = perceived as hopeless -General goals = obtain symptom relief as quickly as possible/assist client in identifying dysfunctional patterns of thinking & behaving/guide client to evidence & logic that effectively test validity of dysfunctional thinking -Focuses on changing "automatic thoughts" that occur spontaneously + contribute to distorted affect

Auditory

-Type of hallucination -Definition: false perceptions of sound -Most commonly = of voices but individual may report clicks/rushing noises/music -Command hallucinations: "voices" that issue commands to individual ^Potentially dangerous when commands = directing violence toward self or others -Most common type in schizophrenia

Visual

-Type of hallucination -Definition: false visual perceptions that may consist of formed images (ex. people) or of unformed images (ex. flashes of light) -Occur about 27% of time in individuals with schizophrenia + 15% of time in affective psychoses) -Typically co-occur with auditory hallucinations + associated with poorer outcomes

VNS & DBS

-VNS improves mood + treatment involves implanting electronic device in skin to stimulate vagus nerve ^Mechanism of action = not known but preliminary studies have shown that many patients with chronic recurrent depression improved when treated -DBS = form of psychosurgery ^Electrode = implanted with intent of stimulating brain function *Deeper implant than used in VNS + requires craniotomy ^Procedure = reversible + stimulation levels can easily be adjusted ^Reserved for patients with severe & incapacitating depression or OCD who have not responded to any other more conservative treatments