Psych Exam 1

• Consumers as partners
• Consumer and family driven
• Consumer centered and recovery oriented

• Decade of the Brain
• Scientific evidence for treatment 
• Increases gap between research and practice 
• Medical Model

• Mother of psychiatric Nursing 
• Nurse-patient relationship

• ASK a question
• ACQUIRE the literature 
• APPRAISE the literature
• APPLY the evidence
• ASSESS the performance

Provide step by step guidelines prepared in a flow chart

An ethical term, not a legal term

Frontal Lobe

The successful performance of mental functions resulting in the ability to engage in productive activities, enjoy fulfilling relationships and make changes or cope with adversity

Considered a clinically significant behavioral experience by distress, disability, or the risk of suffering disability or loss of freedom

Puts emotions at the center of skills for living

• The ability to recover from or adjust to misfortune and change
• "bouncing back"

Our tendency to automatically mimic the emotion that we see in other people

• That part of us which deals with relationships and values and addresses questions of purpose and the meaning of life
• not related with religion

The quantitative study of the distribution of disorders in human populations

• The proportion of a population with a mental disorder at a given time
• How common is a disorder in the population?

A broad field that addresses what happens to people with illnesses who are seen by clinical providers

• 1996 Mental health parity passed by congress
• Requires mental health insurers to provide M.H benefits at the same level as is provided for med surg coverage

• 1. Running amok
• 2. Pibloktoq - cold areas ; uncontrollable desire to rip clothes off in cold temps
• 3. Eating disorders - "anorexia nervosa" - seen a lot in western cultures where food is plentiful

• List particular disorders 
• Psychiatric Dx
• frequency
• mild, moderate or severe

• Lists any personality disorders and/or mental retardations 
• has to have either one or be deferred

Lists any general medical conditions believed to be relevant to the mental disorder in question

Lists any psychosocial and environmental problems that affect the diagnosis, treatment and prognosis of the mental disorder

• Global Assessment of Functioning (GAF)
• Rated on a scale of 1-100

The process of sending a message to one or more persons

• Worthwhile as long as its serving a function 
• Do not rush to fill the silence

Paying undivided attention to what the client is saying or doing

Gives both the sender and receiver the opportunity to check that a message was correctly delivered and understood

Receiver restates in different words the basic content of the clients message

Repetition of the SAME key words that the client has just spoken

• Similar to restating 
• reflecting back the feelings, not repeating the same words

• Examine what the client says more fully
• A reality check

Cannot be answered with a few short words

• Can be yes or no questions
• Used for someone in a crisis or a panic 
• Used when more direct answers are needed

• Implied questions
• use sparingly and only when the client trusts you
• avoid with paranoid client - you may come off as being sneaky or manipulative

Ability to meet person to person

Ability to see another persons perspective of the world

Implies respect

• Providing a safe environment 
• Relationship MUST be built on trust

Healthy trust but cannot keep secrets which may jeopardize the clients well-being

Helps build trust

Examine your own value system

Enhances safety

Paying attention in a culturally appropriate way

Repeat admissions over and over

• Seeking peer counseling helps to get a healthy perspective and maintain therapeutic relations
• this is why there is a need for debriefing

• Invisible lines that define the amount and kind of contact between individuals
• promotes autonomy

• Little distinction between individuals
• Loss of autonomy 
• Unclear boundaries

• A person unconsciously "transfers" unresolved feelings, attitudes and wishes into present significant relationships in an attempt to resolve them in a more satisfying way
• Reacting about past situations onto someone else

The nurse or therapist displaces onto the client, feelings related to people the the nurses past relationships

• Values also formed through the example of others
• it is powerful because it is a vivid example of values in action

• Abstract standards which represent an ideal
• Are usually culturally oriented
• Influenced by parents, peers, teachers, religious institutions, Hollywood and media

• Client relationship process
• introduced the concept of the nurse

• Before you meet your patient
• Quick auto diagnosis and self-reflection
• look at any bias and feelings to avoid counter transference

• Starting the establish trust
• Termination begins in this phase

• Maintain relationship
• Bulk of treatment happens in this phase

• Review clients plans for the future
• Provide client with agency contact info and community resources

• Serotonin Imbalances
• Decreases persons inhibition to aggressive behavior 
• More likely to be aggressive if you do not have enough serotonin

Suicide in the family history = increased risk

Frontal lobe not functioning as well

Direct or Indirect thoughts

Direct verbal or written messages of intent

• Actions resulting in minor injury
• no intent to die

Serious actions with intention to die

Death of persons who had a conscious intent to die

• Lasting 6 Months
• Active Phase symptoms at least 1 month and 2 active symptoms (hallucinations, delusions, disorganized speech, catatonic behavior and negative symptoms)

• Larger cerebral ventricles 
• Excess dopamine = positive symptoms

Anxiety

no motivation or drive

Excitatory neurotransmitter

• Inhibitory system 
• Works to calm you down
• inhibits excitement

• Positive Symptoms
• Fixed False belief that cannot be corrected by reasoning

• Positive Symptom 
• Digress from conversation and come back to original point

• Positive Symptom
• Stray away from the topic and not come back

• Positive Symptom
• "on and on..."

• Positive Symptom 
• Jump from topic to topic

• Positive Symptom
• A word that the client has made up

• Positive Symptom
• Imitation of another persons speech

• Positive Symptom 
• Say a word and associate it with another that sounds similar

• Positive Symptom
• Group of random disorganized words

• Positive Symptom 
• Sensory perception when no external stimuli exists

• Positive Symptom
• Dysfunction in recognizing where ones body ends in relation to others bodies

• Positive Symptom
• A non-specific feeling that a person has lost their identity; the self is different or unreal

• Positive Symptom 
• The false perception by a person that the environment has changed

• Positive Symptom 
• Akathesia - cant sit still

• Excessive maintenance of a position
• Seen in catatonia

• Positive Symptom
• Imitate whatever another person is doing

• Positive Symptom
• Fixed position, but easy to move

• Positive Symptom 
• Resistant to direction

Negative Symptoms

Negative Symptom

• Negative Symptom
• Lack of energy

• Negative Symptom 
• Lack of Desire

• Negative Symptom
• Mumbling
• Not much speech

• Negative Symptom 
• Speech/thought completed stops mid-sentence

• Negative Symptom
• Depressed sad mood

• Red flag for suicide
• Negative Symptom

s/s more than 1 month, less than 6 months

• Generally later in life
• severe mood swings
• some psychotic s/s

• Sudden onset
• at least 1 positive symptom lasting one day, but less than one month 
• full recovery

Involving 2 individuals and share same delusions

• Non-bizarre delusions 
• at least one month duration

Induced by meds, drugs and toxins

• Reduces POSITIVE symptoms 
• Causes movement D/O
• Blocks dopamine 
• Thorazine, HALDOL, stealzine, prolixin, navane, trilafon, mellaril,serentil

• Dry Mouth
• Urinary Retention 
• Constipation 
• Blurred Vision 
• Photosensitivity 
• Dry Eyes
• Inhibition of ejaculation or impotence
• Orthostatic Hypotension

• Extra pyramidal symptoms 
• Pseudoparkinsonism
• Opisthotonos - bend backwards in 1/2 
• Oculogyric crisis - eyes roll back

• EPS S/E
• Usually happens after being on med for along period of time
• Aims test - Observe movement for baseline of movement patterns prior to med being given

• Cogentin
• Artame
• Symmetreal
• Benadryl

• Affects POSITIVE and NEGATIVE symptoms 
• Blocks dopamine but not as much as 1st gen
• Does not affect movement
• Influences glutamate = improves cognition
• Fewer anticholinergic S/E

• Improves mood level and decreases anxiety
• Diminishes Positive and Negative Symptoms
• Weight gain, metabolic abnormalities 
• Clozaril = last resort med, can cause fatalities, any sign of infection call doctor
• Risperdal - check prolactin levels, can cause lactation - dopamine blocks the release of prolactin