bh 78

mental state - individual struggles to distinguis external world from his perceptions; brain disease that disrupts perceptions, thinking, feelings, and behaviors

1

• affective disturbance
• autism
• associative looseness
• ambivalence

inappropriate blunted flat affect

preoccupation w the self w little concern for external reality

stringing together of unrelated topics

simultaneous opposite feelings

• better prognosis
• onset is acute
• high dopamine
• delusions, manic type s/s
• excitement, elevation-exaggeration above norm
• persecution feelings
• grandiosity
• hallucinations and hostility
• illusions and insomnia
• suspiciousness
• responds better to meds

• poor prognosis
• chronic onset
• low dopamine; brain anatomy changes
• depressed type s/s
• alogia
• anergia
• anhedonia
• asocial behavior
• attention deficits
• avolition
• blunted affect
• poor communication
• difficulty w abstractions
• passive social withdrawel
• poor grooming
• ventricular brain ratio; brn smaller; vesicles larger

lack of poverty of speech, short, monosyllabic answers

absence of energy

loss of pleasure in previously enjoyed activities

lack of movement

alterations in personal relationships: decreased attention to appearance, hostility, withdrawel.

alterations of activity: psychomotor agitation, echoprexia, stereotypy

• altered perceptions: hallucinations, illusions, paranoid thinking
• alterations of thought: retardation, autism, blocking, delusions.
• altered consciousness: confusion, clouding, incoherent speech
• alterations of affect: inappropriate, apathy, ambicalence

• paranoid
• disorganized
• catatonic
• undifferentiated
• residual

suspicious/mistrustful

alterations in thoughts, speech, behaviors

immobility

none of the above

chronic, lesser sx

dopamine level alterations

brain atrophy, decrease cerebral bld flow, VBR changes

maternal influenza, birth during late winter or early spring, prenatal exposure to lead, maternal starvation, prenatal exposure to cats, OB complications

lack of care/nurturing by or severe conflicts w the mothering one

VBR : ventricles enlarged/brain smaller; ventricular bld flow is slower

ventricular brain ratio

compulsion to drink excess water (4-10L/d) the desire to drink probably occurs bc of thirst and osmotic dys-regulation

hyponatremia

strict I&O w possible fluid restrictions, monitor wts, monitor labs r/t F&E balance, esp na & k

• depression & suicide (most fatal)
• substance abuse
• difficulty maintaining job
• difficulty w family relations
• relapse is common
• med non-compliance
• stress triggers cause stable pt to decompensate

• do not argue abt delusions
• do not reinforce hallucinations (enforce safety & distract)
• focus on real ppl and real events
• be diligent in attempting to understand pts
• attempt to balance siding w inappropriate behavior and crushing a fragile ego
• set limits on disruptive behavior
• freq. observe escalating pts
• modify environment to remove potentially harmful objects

• Haldol, Navane, Thorazine
• 1st developed

• primarily to treat psychotic d/o's
• specifically schizo, bipolar d/o, and other chronic mental illnesses

• anticholinergic
• antiadrenergic
• cardiac
• sexual
• GI
• endocrine

dry mouth, blurred vision, urinary retention, constipation

orthostatic hypotension

arrhythmias

wt gain, CHO craving

increased prolactin levels, insulin resistance

neuroleptic malignant syndrome

similar to serotonin syndrome, except affects dopamine (causing depletion)

onset is rare but usually within one wk of starting rx (eg. Haldol)

• hyperthermia (high fever)
• change in LOC (agitation, confusion, restless)
• muscle rigidity

• d/c drug immediately 
• administer dantrium or Parlodel as ordered & cont. it for 8-12 days until after improvement is noted, restart antipsychotics 2 wks after complete resolution

extrapyramidal s/e

• -antipsychotic drugs should not be used for non-approved indications (ex. do not use for common anxiety)
• -dose for certain groups should be limited (older adults are more susceptable)
• -low dose should be given (start low; go slow)

• akathisia
• akinesia/bradykinesia
• dystonia
• parkinsonism
• tardive dyskinesia
• pisa syndrome

restlessness

absent/slowed movements

abnormal postures

tremors, shuffling gait, rigidity, pill rolling

starts around mouth, tongue protrusion, lip smacking, puckering, teeth grinding, movements stop w sleep

leaning to one side

• -Cogentin, Benadryl may be ordered 
• -antipsychotics are contraindicated in pts w glaucoma, BPH, & CV disease
• -Decanote form is long acting by injection & given at 2-4 wk+ intervals
• -abuse potential--etoh & substance drugs overall

pregnant- 1st trimester drugs pass thru placenta

elderly- start low and go slow

• tendency to become anxious/paranoid abt potential s/e
• simple written description of benefits & s/e
• how to cope w s/e
• info in written format helps to be in control & collaborate w tx

• avoid immersions in hot water (hypotension-falls)
• avoid abrupt withdrawal of med (EPSE)
• sunscreen (sunburn)
• immediately report signs of sore throat, malaise, fever, or bleeding (dyscrasia)
• dress appropriately in hot weather & drink plenty of water (heatstroke)

risperdal, zyprexa, seroquel, geodon

most freq prescribed

• decrease risk of epse 
• increase cost if no generic

2

aggregate of the individuals physical and mental qualities as these interact characteristally w the persons environment; thus personality is expressed thru behavior. characteristic combinations of behavior distinguish one ind from another and endow inds w their own unique identity; OR traits and characteristics that make us unique and interesting

• characteristic that describes our personality
• (ex. outgoing, shy)

exaggerated, pathologic behavior patterns destructive to the ind and others

odd, eccentric behaviors

• paranoid
• schiziod
• schizotypal

• suspicious
• mistrust
• interprets actions of others as personal threats
• on the offensive
• blunt affect; cold
• holds grudges
• easily angered

• maintain hope
• set firm limits and consistency
• encourage group therapy
• praise them for what they do good

• psychotic episodes infreq and less severe than w schizophrenia
• problems in thinking, perceiving and communicating
• eccentric
• sensitive to behaviors of others
• feel they are different and do not fit in
• fantasies about imaginary friendships
• uncomfy around ppl but interested in others
• social situations uncomfy and cause anx
• lose dose of antipsych drugs decrease severity of sxs in psych state

• include them in interventions offering support, kindness, and gentle suggestions to help them become involved in activities w others
• help pt improve interpersonal relationships, social skills, & appropriate behaviors
• vocational counseling & asisstance w job placement
• low dose of antipsych drugs

• trust
• honesty
• no intrusiveness
• clear, simple explanations and requests

dramatic, emotional, erratic behaviors

• antisocial
• borderline
• histrionic
• narcissistic

no sense of remorse

• impulsiveness, disregard safety
• main feature- pattern of disregard for the rights of others 
• behaviors are dx'd as conduct d/o before age 15
• promiscuous and feel no guilt, lying, cheating, stealing
• criminal behavior places them in prisons instead of mental health facilities
• dx based on hx of disordered life functioning rather than on mental illness
• do not behave as responsible, mature, and independent adults

• set firm limits
• must be steadfast & consistent in confronting behaviors and enforcing rules and policies
• set consequences of behavior and make sure pt is aware of them
• pnt out the effects that the pts behavior has on others
• avoid moralizing
• assist pt in identifying and verbalizing feeling that might reflect anx and depression
• offer membership pin in group to make pt feel accepted
• encourage pt to join in a group w ppl of same dx

• anger, impulsivity
• self image disturbances
• abandonment fears
• manipulation
• dependency
• mood shifts/disturbances
• projective identification
• self mutilation, suicidal
• unstable and intense relationships
• impairment in occupational funct

• conduct a suicide assessment
• provide a safe environment to decr self-harm & contain impulses
• work w pt to find less destructive ways to handle anger, rage, and psychic pain
• allow for venting & discussion punching pillows, foam mats
• discuss w pt a safe alternative method to handle feelings
• use a bahavioral contract
• have pt write in notebook
• consistency, limit setting, & supportive confrontation

thrive on action

• behavior is silly and colorful, frivolous and seductive
• shallow, rapidly, shifting emotions
• uses physical appearance to draw attention
• easily influenced by others
• exaggerates degree in intimacy w others
• dissociation common defense to avoid feelings

• positive reinforcement in form of attention, recognition, or praise
• provide support to facilitate independent problem solving and daily funct
• help clarify pts feelings and help them learn appropriate way to express them
• patience

• grandiose behavior that is based on reality, but embellished and distorted
• feelings of superiority and entitlement
• arrogant, self-centered, self-absorbed
• pt overvalues self
• needs and feelings of others ignored, feels it is "all about me"
• needs to be admired

anxious, fearful behaviors

avoidant, dependent, ocd

• preoccupied w what others think
• socially withdrawn, shy, uncomfortable
• avoids situations where they might feel disappointment or rejection
• afraid to ask questions or speak in public
• hypersensitivity to criticism
• low self confidence

• help pt gradually confront his fears
• discuss the pts feelings and fears before and after doing something they are afraid to do
• support and direct pt in accomplishing sml goal
• help pt be assertive and develop social skills
• use relaxation techs
• give positive feedback

• pervasive need to be taken care of
• submissive, clinging behaviors w fear of seperation
• extreme helplessness, want others to make decisions for them
• do for others to foster attachments
• fear of being left alone, in fact will even stay in an abusive relationship
• unable to make day to day decisions wo help

• work on decision
• manage anx
• teach assertiveness

• perfectionist and inflexible
• overly strict
• sets standards too high
• work never good enough
• preoccupied w rules, trivial details
• difficult to express warm emotions
• little give and take interactions
• rigid, controlling, cold
• fun and pleasure diff bc so serious
• afraid to make mistakes
• affect is constrictive
• unable to discard worn out objects

• support in exploring feelings & attempting new experiences 
• help pt w decision making & follow thru
• at times needs to confront pt procrastination and intellectualization
• teach pt importance of leisure activities
• teach pt he is human and its ok to make mistakes
• help decr irrational beliefs about necessity to be perfect

first to note s/s of schizo, calling it "dementia praecox" (precocious senility)

studied schizo intensely, believing that it was brought on by neuropathologic causes that led to deterioration

consistant staff

• paranoid, schizoid, schizotypal
• antisocial, borderline, histrionic, narcissistic
• avoidant, dependent, ocd

• pers. d/o NOS
• not otherwise specified

schizoid pers. d/o