bh 78

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  1. schizo
    mental state - individual struggles to distinguis external world from his perceptions; brain disease that disrupts perceptions, thinking, feelings, and behaviors
  2. schizo
  3. bleulers 4 as
    • affective disturbance
    • autism
    • associative looseness
    • ambivalence
  4. affective disturbance
    inappropriate blunted flat affect
  5. autism
    preoccupation w the self w little concern for external reality
  6. associative looseness
    stringing together of unrelated topics
  7. ambivalence
    simultaneous opposite feelings
  8. type 1
    • 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
  9. type 2 negative
    • 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
  10. alogia
    lack of poverty of speech, short, monosyllabic answers
  11. anergia
    absence of energy
  12. anhedonia
    loss of pleasure in previously enjoyed activities
  13. avolition
    lack of movement
  14. objective signs of schizo
    alterations in personal relationships: decreased attention to appearance, hostility, withdrawel.

    alterations of activity: psychomotor agitation, echoprexia, stereotypy
  15. Subjective symptoms of schizo
    • 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
  16. subtypes of schizo
    • paranoid
    • disorganized
    • catatonic
    • undifferentiated
    • residual
  17. paranoid schizo
  18. disorganized schizo
    alterations in thoughts, speech, behaviors
  19. catatonic schizo
  20. undifferentiated schizo
    none of the above
  21. residual schizo
    chronic, lesser sx
  22. biochemical theory of schizo
    dopamine level alterations
  23. neurostructural theory of schizo
    brain atrophy, decrease cerebral bld flow, VBR changes
  24. perinatal theory of schizo
    maternal influenza, birth during late winter or early spring, prenatal exposure to lead, maternal starvation, prenatal exposure to cats, OB complications
  25. developmental/family theories of schizo
    lack of care/nurturing by or severe conflicts w the mothering one
  26. PET and MRI scans show
    VBR : ventricles enlarged/brain smaller; ventricular bld flow is slower
  27. VBR
    ventricular brain ratio
  28. psychosis-induced polydipsia
    compulsion to drink excess water (4-10L/d) the desire to drink probably occurs bc of thirst and osmotic dys-regulation
  29. major concern of psychosis-induced polydipsia
  30. NSG interventions
    psychosis-induced polydipsia
    strict I&O w possible fluid restrictions, monitor wts, monitor labs r/t F&E balance, esp na & k
  31. psychosocial and other problems r/t schizo
    • 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
  32. NSG interventions schizo
    • 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
  33. antipsychotics
    oldest group
    (3 drugs)
    • Haldol, Navane, Thorazine
    • 1st developed
  34. desired effects of antipsychotics
    • primarily to treat psychotic d/o's
    • specifically schizo, bipolar d/o, and other chronic mental illnesses
  35. s/e of antipsychotics
    • anticholinergic
    • antiadrenergic
    • cardiac
    • sexual
    • GI
    • endocrine
  36. anticholinergic
    antipsychotic med s/e
    dry mouth, blurred vision, urinary retention, constipation
  37. antiadrenergic
    antipsychotic med s/e
    orthostatic hypotension
  38. cardiac
    antipsychotic med s/e
  39. GI
    antipsychotic med s/e
    wt gain, CHO craving
  40. endocrine
    antipsychotic med s/e
    increased prolactin levels, insulin resistance
  41. antipsychotic med 
    adverse effects
    neuroleptic malignant syndrome
  42. neuroleptic malignant syndrome is
    similar to serotonin syndrome, except affects dopamine (causing depletion)

    onset is rare but usually within one wk of starting rx (eg. Haldol)
  43. early s/s of neuroleptic malignant syndrome
    • hyperthermia (high fever)
    • change in LOC (agitation, confusion, restless)
    • muscle rigidity
  44. tx for neuroleptic malignant syndrome
    • 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
  45. EPSE or PSE
    stands for
    extrapyramidal s/e
  46. EPSE or PSE
    • -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)
  47. AIMS assessment to evaluate NMS
    • akathisia
    • akinesia/bradykinesia
    • dystonia
    • parkinsonism
    • tardive dyskinesia
    • pisa syndrome
  48. AIMS
  49. AIMS
    absent/slowed movements
  50. AIMS
    abnormal postures
  51. AIMS
    tremors, shuffling gait, rigidity, pill rolling
  52. AIMS
    tardive dyskinesia
    starts around mouth, tongue protrusion, lip smacking, puckering, teeth grinding, movements stop w sleep
  53. AIMS
    pisa syndrome
    leaning to one side
  54. EPSE
    • -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
  55. meds use in pregnancy and in elderly
    pregnant- 1st trimester drugs pass thru placenta

    elderly- start low and go slow
  56. pt teaching antipsychotics
    • 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
  57. antisychotics teach pt and family...5
    • 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)
  58. newer atypical antipsychotics names
    risperdal, zyprexa, seroquel, geodon
  59. risperdal
    most freq prescribed
  60. newer atypical antipsychotics info
    • decrease risk of epse 
    • increase cost if no generic
  61. personality d/o
  62. personality
    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
  63. personality d/o trait
    • characteristic that describes our personality
    • (ex. outgoing, shy)
  64. personality d/o
    exaggerated, pathologic behavior patterns destructive to the ind and others
  65. Cluster A
    odd, eccentric behaviors
  66. cluster a
    • paranoid
    • schiziod
    • schizotypal
  67. paranoid personality d/o
    characteristics 7
    • suspicious
    • mistrust
    • interprets actions of others as personal threats
    • on the offensive
    • blunt affect; cold
    • holds grudges
    • easily angered
  68. paranoid personality d/o
    nsg management 4
    • maintain hope
    • set firm limits and consistency
    • encourage group therapy
    • praise them for what they do good
  69. schiziod personality d/o
    characteristics 9
    • 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
  70. schizotypal personality d/o
    nsg management 4
    • 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
  71. overall nsg interventions management for cluster A 
    • trust
    • honesty
    • no intrusiveness
    • clear, simple explanations and requests
  72. cluster B
    dramatic, emotional, erratic behaviors
  73. cluster B 
    types 4
    • antisocial
    • borderline
    • histrionic
    • narcissistic
  74. antisocial
    no sense of remorse
  75. antisocial 
    characteristics 7
    • 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
  76. antisocial 
    management 8
    • 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
  77. borderline
    characteristics 10
    • 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
  78. borderline management 8
    • 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
  79. histrionic
    thrive on action
  80. histrionic
    characteristics 6
    • 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
  81. histrionic
    management 4
    • 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
  82. narcissistic
    characteristics 6
    • 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
  83. Cluster C
    anxious, fearful behaviors
  84. cluster c
    types 3
    avoidant, dependent, ocd
  85. avoidant characteristics 6
    • 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
  86. avoidant 
    management 6
    • 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
  87. dependent 
    characteristics 6
    • 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
  88. dependent
    management 3
    • work on decision
    • manage anx
    • teach assertiveness
  89. OCD characteristics 12
    • 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
  90. OCD
    management 6
    • 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
  91. benedict morel 1860s
    first to note s/s of schizo, calling it "dementia praecox" (precocious senility)
  92. Emil Kraepelin 1870s
    studied schizo intensely, believing that it was brought on by neuropathologic causes that led to deterioration
  93. schizo milieu
    consistant staff
  94. Please stay sally! Ah, but no. (I must bid you) A Dieu
    • paranoid, schizoid, schizotypal
    • antisocial, borderline, histrionic, narcissistic
    • avoidant, dependent, ocd
  95. exhibits features of more than one or doesnt meet criteria fully?
    • pers. d/o NOS
    • not otherwise specified
  96. pathological shyness - "hermit"
    schizoid pers. d/o
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bh 78
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