test

• STA4T
• Speech
• Thought Process
• Attitude, appearance, activity, affect
• Though content

• Enlightenment - Asylums
• Pre-Enlightenment: Assistance, Banishment & Confinement

Scientific Study - Major scientists Frued, Krapelin and Bleuler classified mental illness and treated patients

• Psychotripic Drugs - 1950's
• Chlorpromazine (thorazine) - psychotropic
• Imipramine - antidepressant
• Lithium - Mood stablizer

Community Mental Health - Funds shifted to community. More pt rights.

• Brain - 1990's
• Increase brain research.

1880's - 1st psychiatric nurse Linda Richards --> school of psychiatric nursing

1920 - 1st psychiatric nursing textbook Harriet Bailey

1937 - Psychiatric nursing part of general nursing education cirriculum

1952 - 1st phsychiatric nursing theorist

Ability to recover from misfortune

• Recognize feelings
• Deal with feelings
• Learn from experiences

• Happiness
• Control over behavior
• Appraisal of reality
• Effectiveness in work
• Healthy self-concept
• Satisfying Relationships
• Effective coping strategies

Studies groups of ppl with defined illnesses/symptoms.

• Describes:
• * Frequency of mental disorder
• * Frequency of symptoms appearing together
• * Prevalence rate of population with mental disorders.

Classifies Mental Disorders & How to Treat them

• Axis 1 - Mental Disorders
• Axis 2 - Personality Disorders & Mental Retardation
• Axis 3 - General Medical Conditions
• Axis 4 - Psychosocial & environmental problems
• Axis 5 - Global Assessment of Functioning (GAF) Scale 1-100 higher the better

Anxiety: feeling of apprehension, uneasiness, uncertainty, or dread resulting from real or percieved threat whose acutal source is unknown or unrecognized.

Fear: Reaction to specific Danger

**These are alike in their physiological response -flight or fight-

Normal - motivating force that provides energy to carry out tasks of living

Acute or State - Anxiety that is precipitated by imminent loss or change that threatens one's security (overwhelming feeling)

Chronic or trait - axiety that persists over time (always anxious, less productive)

• Mild
• *Occurs in everyday living
• *Increases perception, improves
• problem solving
• *Restlessness, irritablity, mild tension relieving behaviors.

• Moderate
• *Escalation from normal experience
• *Descreases productivity
• *Increase HR, RR, perspiration, mild
• somatic symptoms

• Nursing actions for both
• *Open-ended statements
• *Broat openings
• *Seeking clarification
• *Exploration

• Severe
• *Greatly reduced perceptual field
• *Learning & problem solving not
• possible
• *Erratic, uncoordinated and
• impulsive behavior.

• Panic
• *Loss of reality focus
• *Disturbed behavior occurs
• *Confusion, shouting, screaming and
• withdrawl.

• Nursing Actions
• *Reduce environmental stimuli (move to quite area and remain with patient)
• *Gross motor activity to reduce tension.
• *Firm, short and simple statements.
• *Reinforce reality
• *Medications and restraints (last resort)

Help protect people from painful awareness of feelings and memories that can cause overwhelming anxiety.

Operate all the time, relatively unconscious.

• Adaptive - Healthy
• Maladaptive - Unhealthy

Altruism - Stressors are dealth with by meeting the needs of others.

Sublimation - Substituting an acceptable activity for impulses that are not acceptable. Ex. Agressive man - butcher

Humor

Supression - Consvious denial of disturbing feeling.

Repression - Exclusion of unplesant things from conscious. Ex. forgetting an ex's name.

Displacement - Taking it out on someone else.

Reaction formation - "overcompensation" ex. guy who hates kids becomes boy scout leader

Undoing - Make up for. Ex. giving a gift

Rationalization - Jusifying illogical ideas.

Passive Agression - Indirectly expression aggression towards others.

Acting-out Behaviors - Deals with emotions by actions rather that feelings.

Dissociation - Blocking things out of your memory.

Idealization - Attributing exaggerated posivite qualities to a person.

Splitting - Aspects of self and others are very opposite. "split personality"

Projection - Using a "scapegoat" to take feelings out on.

Denial - Ignoring reality.

Sudden onset of extreme apprehension or fear of imending doom.

Fear of losing one's mind or having a heart attack.

SOB, Chest Pain, Choking, Tingles

• Nursing Actions
• -Stay w/ pt & acknowledge discomfort
• -Remain calm, avoid touch
• -Short simple sentences
• -1 direction at a time
• -Treat hyperventilation
• -Allow to pace & cry
• -Communicate that your in control
• -Communicate that pt is safe
• -Encourage discussion of fears

Fear of being in places or situations from which escape is difficult or help is unavailable.

Feared places are avoided, restricts one's life.

Persistent, irrational fear of specific objects, activities or situations.

• Types
• Specific: response to specific objects
• Social: result of exposure to social situations or required perfomance.

Obession - Thoughts, impulses or images that persist and recur.

Compulsion - Ritualistic behaviors that individual feels driven to perform.

• Nursing Actions
• -Ensure basic needs are met
• -Provide time to perform rituals
• -Explain expectations, routines, changes
• -Convey acceptance & understanding
• -Simple activities
• -Assist to connect behavior & feelings.

Excessive worry about numerous things lasting at least 6 months. "worry wart"

• Symptoms
• -restlessness
• -fatigue
• -poor concentration
• -irritability
• -tension
• -sleep disorders

• Reexperience traumatic Event. Occurs around 3 months from incident.
• Ex. War

• Characterized by:
• -Recurrent dreams or flashbacks
• -Avoidance of stimuli associated w/ trauma
• -Numbing of responsiveness

**Can become chronic if not treated.

Occurs within 1 month after exposure to traumatic event.

• Characterized by at least 3 dissociative symptoms during/after event.
• -Subjective sense of numbing
• -Reductive of awareness of surroundings
• -Derealization
• -Depersonalization
• -Dissociative Amnesia

• Direct physiological result of medical conditions such as:
• Hyperthyroidism
• Pulmonary Embolism
• Cardiac Dysrhythmias
• "body can tell something is wrong"

Used as part of treatment approach for patient w/ anxiety disorder who is hospitalized. "Group Therapy"

• What goes on?
• -Structure daily routine
• -Provide daily activities to promote interaction.
• -Provide therapeutic interactions
• -Include patient in decision making

• Therapist teaches patient to:
• -Examine assumptions
• -Redefine Fears
• -Restructure Thinking
• -Make Changes
• **What's going on and how to handle.

• Most have effect on synapse by
• -changing neurotransmitter release
• -change receptors they bind to

Exact mechanism is unknown

• Sleep, hunger, mood, pain perception
• Aggression, sexual behavior

Decrease - Anxiety, panic, phobias, obsessions and compulsions, bulimia/food cravings, depression

Increase - Anxiety

Mood, Flight or fight

Decrease - impaired attention, poor concentration, poor memory, slow info processing, psychomotor retardation, fatigue and depression

Increase - mania, anxiety, schizophrenia

Fine muscle movement, integration of emotions/thoughts, decision making, hormone release

Decrease - Depression, Parkinson's

Increase - Schizophrenia, Mania

Learning, memory, mood, aggression

Decrease - Alzheimers, Parkinson's

Increase - Depression

Antipsychotics - Reduce unrealistic thinking

Antidepressants - Improve Mood

Antianxiety - Calm Mood

Drugs to improve thinking, such as ones used for Alzheimer's

Antiparkinsonian drugs: correct problems caused by antipsychotic drugs

Benzo's - short-term treatment only

Buspirone - not as addictive as benzos

Selective sertonin reuptake inhibitors

Selective norepinephrine reubtake inhibitors

Tricyclic antidepressants (TCAs)

• Other Meds
• -B Blockers
• -Antihistamines
• -Anticonvulsants

• Complementary Therapy
• -Kava Kava
• -Valerain Root
• -Gotu kola
• -St. John's wort

Cognition: process that is intellectual and perceptual and closely integrated with individuals emotional and spiritual values.

• Delirium
• Dementia
• Amnestic Disorder

• Prevalence: Delirium
• -present in 60% of nursing home residents 75 and older
• -80% of terminally ill people develop delirium before death

• Comorbidity: Delirium
• ALWAYS exists secondary to another condition

• Comorbidity: Amnestic Disorders
• ALWAYS secondary to another condition

• Prevalence: Dementia
• -Alzheimers Disease most common
• -5% by age 65 and 50% by age 85

• Comorbidity: Dementia
• -80% is irriversible
• -Reversible demenia can be secondary to other processes

• Short Term
• Has to be caused by something such as illness or surgery
• 2 subtypes - hypoactive & hyperactive

• Symptoms
• -Rapid Onset
• -Anxious, fearful, bewildered
• -Abrupt disruption in perception of environment
• -Disturbance in consciousnes x3
• -Cognitive and perceptual disturbances
• (illusions and hallucinations)
• -Impaired short term memory

• -Frequent assessment
• -One to one care
• -Private Room by nurse's station
• -Camouflage tubes
• -Keep on nomral day/night schedule
• -Night light
• -Have wear assistive devices
• -Talk with pt about meaningful things
• -Use reality orientation tools clocks, calendars, family pics ect.

• Meds
• Haldol (#1 choice)
• Risperdal
• Zyprexa
• Seroquel
• Thorazine

Progressive deterioration in intellectual functioning, memory, ability to problem solve/learn new skills, decline in ablity to perform ADLs adn impaired judgement.

• Various types Alzheimers most common
• Early onset <65 seems to be inherited
• Late onset >65 no obvious pattern

• Defensive behaviors in early dementia
• -Denial - attemp to hide memory deficits
• -Confabulation - make up stories
• -Perseveration - repeat phrases
• -Avoid questions

• 4 A's
• Amneisa - can't remember
• Aphasia - can't express thoughts
• Apraxia - can't recall info.
• Agnosia - inability of motor function

• Brain damage begins long before symptoms.
• What happens:
• -Buildup of protein (beta amyloid)
• -Neurofibrillary tangles
• -Granulovascular degeneration

Mild - forgetful, short term memory loss

Moderate - confusion, progressive memory loss, decline in ADL's, social withdrawl

Moderate to Severe - Ambulatory dementia, loss of ADL's, difficulty communicating, care usually needed

End Stage - bedbound, family recognition disappears, forgets how to eat swallow chew, can't ID self Institutional care needed.

Medications

• Mild to Moderate
• -cholinesterage inhibitors: increase availabe Ach.
• Examples: galantamine (Reminyl)
• rivastigmine (Exelon)
• donepezil (Aricept)
• Severe
• N-methyl-D-aspartarte (NMDA): also makes more Ach available
• Example: Memantine (Namenda)

Cannot stop process, only slow down.

Ppl with depression experience great pain and suffering.

All ages, races and both sexes. Women more than men.

Vulnerability can be related to genetics and life stressors.

Can have comorbidity ex. cancer

• Psychodynamic factors: stress diathesis model
• -early life trauma sensitized stress pahtways to brain increase vulnerability to depression.

• Cognitive Theory - Aaron Beck
• -Automatic negative thoughts

• Learned Helplessness - Martin Seligman
• -Individual's perception of lack of control over stressful life events leads to depression.

5 more more symptoms each day for 2 weeks

-Emotional and cognitive symptoms: depressed mood, feelings of worthlessness and guilt, anhedonia, hopelessness, decreased concentration, recurrent thoughts of death/suicide.

-Physical: weight gain or loss, insomnia or hypersomnia, increased or decreased motor activity, anergia, consipation.

• FLA2T
• Feelings
• Low Energy
• Affect, Anorexia
• Trouble Sleeping

• Three D'S
• Despair
• Dysphoric
• Down

Chronic depressive syndrome usually present for most of the day, more days than not for 2 years.

Onset usually early adulthood or younger.

• PEER
• Physical needs
• Express feelings
• Exercise & simple activities to increase
• self-esteem
• Reduce risk for suicide

• Treatments
• -Milieu Therapy: structured hospital environment

-Psychotherapy - Cognitive-behavioral )CBT) and interpersonal (IPT) therapies used

-Group Therapy - Don't feel alone

• Tricyclic Antidepressants (TCAs)
• Action: inhibit reuptake of norepinephrine, dopamine and sertononin.
• Dose: start low and increase
• Side effects: SLUDGE
• 4-6 weeks to be therapeutic

• SSRIs
• Blocks seratonin reuptake therefore increase amount of seratonin available in body.
• Side effects: agitation, anxiety, sleep disturbance, termor, sexual dysfunction, headache, weight changes impotence

• MAOIs
• Prevent enzyme monoamine oxidase from breaking down neurotransmitters
• Side effects: sedations, hypotension, insomnia, muscle cramps, SLUDGE
• Toxic Reaction: Hypertensive crisis

• Electrolyte Therapy
• 2-3 treatments a week for 6-12 weeks

Light Therapy