UTM NURS342 Mental Health Floyd Exam 2 Anger, Psychosis, Substance Abuse

Constructive anger

Expression of anger resulting in meeting one's needs or promoting one's safety; assertive communication

Destructive anger

Expression of anger that results in emotional or physical harm to self or others; aggression

Aggression

Harsh physical or verbal action that reflects rage, hostility, and potential for physical or verbal destructiveness

5x

How much more likely is it that a patient with a psychiatric disorder will display violence?

ADD, ODD

List 2 disorders that increase the likelihood of anger in children

Patient may mourn the loss of independence and reject help

Why is anger common with dementia?

Freud

Which psychologist said "Anger cannot be suppressed and will eventually express itself in some form"?

Limbic system

Which site in the brain is thought to mediate primitive emotion and behaviors that are necessary for survival (such as anger?

Temporal lobe

Which area of the brain, associated with memory and complex partial seizures, correlates CT and ECC abnormalities with high violence scores?

Hypothalamus

Anger biologically stimulates which structure, resulting in the anticipation of harm?

Both inhibitory and stimulating

What effect does serotonin have on anger?

Enhances aggression and impulsive behavior

What effect does dopamine have on anger?

Higher than normal testosterone/cortisol ratio

What hormone imbalance might one expect to see in a patient with antisocial personality disorder?

Recognize early anxiety cues before they escalate to anger

What is a priority for the nurse to prevent potential violence?

Demands, irritability, frowning, red face, pacing, twisting hands, clenching/unclenching fists, labile mood

List 4 cues that indicate a patient may be escalating toward aggression

Male, 14-24 years old, low self-esteem, and low support system

What demographic is the most at risk for aggression and violence?

Loud, overcrowded, staff inexperience, poor limit setting, staff inconsistency

List 5 milieu characteristics that are conducive to violence

Trust your instincts, keep patient one arm's length away, ensure easy withdrawal from situation, know alarm locations

List 2 specific interventions to reduce the risk of violence

Direct

The nurse states "violence is unacceptable" and describes consequences. This is an example of what type of limit setting?

Indirect

The nurse states "You have a choice, you can take your medication and join the group, or you can sit alone in your room until you feel less anxious". This is an example of what type of limit setting?

Seclusion

Involuntary confinement of a patient alone in a room

Restraint

Material or equipment attached to the patient's body to prevent movement

Use the lease restrictive means for the shortest duration of time appropriate

What is the rule of thumb for using restraints?

Assessment of behavior prior to assault, nursing interventions used, detailed description of patient behavior during assault, patient's response to interventions, who was called to assess patient, time of restraint, observation during restraint, any injury, reaction to reintegration into milieu

List the 9 points to be documented after a aggressive critical incident

10%

What percentage of schizophrenic patients commit suicide?

20-40%

What percentage of schizophrenic patients make at least one attempt at suicide?

Male, less than 45 years old, depressive symptoms, unemployment, recent hospital discharge

List 3 risk factors for schizophrenia

80-90%

What percentage of schizophrenic patients have a nicotine dependence?

Excess dopamine

What neurotransmitter imbalance is associate with schizophrenia?

Influenza

What viral infection contracted during pregnancy increases the child's risk for schizophrenia?

Smaller frontal lobe

What brain structure abnormality is associated with schizophrenia?

1% in general population, 5-10% in families

What is the likelihood of schizophrenia in the general population vs. in families with a history?

Epilepsy, neuromuscular diseases, birth trauma, head injuries, alcohol abuse, tumors, stroke, Parkinson's disease

List 4 physical conditions that are associated with a higher risk if schizophrenia

Late adolescence to early adulthood; earlier in males, later in females

When do symptoms of schizophrenia usually present?

True

T or F: A patient with schizophrenia will likely never return to a prediagnosis state

Malinger

To pretend to have an illness for secondary gains

Delusions, hallucinations, and disorganized speech

Name the three major symptoms of schizophrenia of which 1 must be present for a diagnosis

Two or more symptoms present for a significant period of time during a 1-month period. One symptom must be delusions, hallucinations, or disorganized speech

What is the DSM-V definition of schizophrenia?

Other mood/depressive disorders, medical disorders, and substance abuse that may be causing symptoms

Before making a schizophrenia diagnosis, what must be ruled out?

Schizoaffective disorder

This diagnosis is made when the patient has features of both schizophrenia and a mood disorder but does not strictly meet the diagnostic criteria for either alone

Brief psychotic disorder

A thought disorder in which a person will experience short-term, gross deficits in reality testing, manifested with at least one of the following symptoms: delusions, hallucinations, disorganized speech, or disorganized or catatonic behavior

Brief psychotic disorder lasts longer than 1 day but no longer than 1 month

What differentiates brief psychotic disorder from schizophrenia?

Folie a deux

Psychotic disorder in which two people share the same delusion or delusional system and support one another in this belief

Delusional disorder

The presence of one or more delusions with a duration of one month or longer, but the criteria for schizophrenia has never been met

If they are present, they are not prominent and they are related to the delusion

What is usually true about hallucinations in regard to delusional disorder?

Persecutory delusional disorder

Delusional disorder in which one believes they are going to be harmed by an individual, organization, or group

Referential delusional disorder

Delusional disorder in which one believes gestures, comments, or environmental cues are directed at oneself

Grandiose delusional disorder

Delusional disorder in which one believes that they have exceptional abilities, wealth, or fame

Erotomania delusional disorder

Delusional disorder in which one believes that another individual is in love with them

Nihilistic delusional disorder

Delusional disorder in which one believes that a major catastrophe will occur

Somatic delusional disorder

Delusional disorder characterized by a belief that one has a certain mental or medical disorder

Non-bizarre delusions

Delusions that could actually happen such as being followed, being loved, being deceived, etc.

Loose association

A though disorder characterized by speech in which ideas shift from one unrelated subject to another; lack of connection between ideas

Neologisms

A though disorder characterized by coining new or meaningless words

Concrete thinking

A though disorder characterized by the inability to produce abstract thought; literal interpretations

Clang associations

A though disorder characterized by rhyming; word choice is governed by sounds

Word salad

A though disorder characterized by grouping of words that appear to be put together randomly without any logical connection

Circumstantiality

A though disorder characterized by delays in reaching the point of a communication because of unnecessary and tedious details.

Tangentiality

A though disorder characterized by difficulty maintaining focus and attention resulting in veering away from the topic of discussion and not reaching the point

Perseveration

A though disorder characterized by persistently repeating the same word or idea in response to different questions. The person is stuck on a particular thought.

Mutism

A though disorder characterized by the refusal or inability to speak

Echolalia

A though disorder characterized by repeating words or phrases spoken by another

Auditory, visual, tactile, gustatory, and olfactory

What are the 5 types of hallucinations?

Illusions

Misperceptions or misinterpretations of real external stimuli

Inappropriate affect

An individual's emotional tone is incongruent with the circumstances

Bland/Flat affect

An individual's emotional tone is very weak; appears to be void of emotional tone

Apathy

Indifference or disinterest in the environment

Avolition

Lack of desire, motivation, and/or persistence; patient will not start or complete any major task

Echopraxia

Intentional mimicry or imitation of the movements of another person.

Idenitification

The unconscious taking on of another person's behavior

Imitation

The conscious, intentional taking on of another person's behavior

Depersonalization

feelings of detachment from one's mental processes or body; feelings of unreality

Anergia

Deficiency of energy

Waxy flexibility

Condition associated with catatonia in which the client with schizophrenia allows body parts to be placed in bizarre or uncomfortable positions. The client remains in this position for long periods of time.

Posturing

The voluntary assumption of inappropriate or bizarre positions

Anhedonia

Inability to experience pleasure

Positive symptoms

Addition of behaviors; excess or distortion of normal function

Negative symptoms

Diminished or loss of normal functions

Regression

Retreat to an earlier level of development; primary defense mechanism of schizophrenia

Positive

Delusions, hallucinations, disorganized speech, and catatonic behavior are all examples of what type of symptoms?

Negative

Flat affect, alogia, and avolition are what type of symptoms?

Client will:

Not harm self or others,

Eliminate delusional thinking

Define and test reality

Communicate appropriately

Identify coping strategies

Demonstrate ability to meet self-care needs independently

Name 3 appropriate goals for the client with schizophrenia

Chlorpromazine (Thorazine) in 1952

What was the first antipsychotic medication and when was it introduced?

Tranquilizers and neuroleptics

What are 2 other names for antipsychotics?

Antipsychotic drugs

Drug class used to treat acute/chronic psychosis, especially with increased psychomotor activity. Exact mechanism unknown, but thought to be a dopamine antagonist

2nd generation antipsychotics

Which generation of antipsychotics generally results in higher rates of weight gain and metabolic side effects (increased BGL and triglycerides)?

1st generation antipsychotics

Which generation of antipsychotics generally have higher rates of movement disorders but relatively fewer risks of weight gain and metabolic side effects?

Clozapine

Which antipsychotic, when prescribed, requires patients to have regular levels drawn and to join a national registry to monitor its use

Lurasidone

Which antipsychotics is indicated to be taken with food because of the significant increase in absorption that results?

Ziprasidone (Geodon)

Which antipsychotic is known to increase cholesterol and triglycerides and to cause QT interval changes?

Antipsychotics + mood stabilizers

What types of drugs would be used to treat schizoaffective bipolar type?

Neuroleptic malignant syndrome

A rare but potentially fatal complication of treatment with neuroleptic (antipsychotic) drugs.

Increased CK and WBC

What two labs abnormalities would be expected for neuroleptic malignant syndrome?

Increased temperature and parkinsonian symptoms

What are the two hallmark signs of neuroleptic malignant syndrome?

Hyperthermia, tachycardia, diaphoresis, cramps, seizure activity, hypoactive neuromuscular, hyporeflexia

List 4 symptoms that would be expected with neuroleptic malignant syndrome

Hours or years after initiation of antipsychotic therapy

What is the expected time of onset for neuroleptic malignant syndrome?

24-72 hours

What is the expected period of progression for neuroleptic malignant syndrome?

Dantrolene and bromocriptine

Name 2 drugs used to treat neuroleptic malignant syndrome

Stop causative factor (antipsychotic), administer dantrolene to relax muscles and reduce hyperthermia, and administer bromocriptine to increase dopamine levels

What are 3 ways to treat neuroleptic malignant syndrome?

CBC weekly for 6 months, every 2 weeks for 6 months, and then monthly indefinitely

What is the lab schedule associated with clozapine?