Psyc Exam 2

Define obsession

recurrent, persistent unwanted urges, causes distress and individual trys to supress

Define Compulsion

repetitive behaviors that individuals feel driven to perform in response to an obsession, aimed at reducing anxiety, not realistically connected to what they are trying to prevent

Contamination OCD

Obsession: concerns about dirt + germs / Compulsion: excessive washing or cleaning

Harm-Related OCD

Obsession: concerns about harm coming to someone/ Compulsion: checking safety frequently

Forbidden thoughts OCD

Obsession: agression, sexual / Compulsion: mental rituals, praying

Symmetry OCD

Obsession: items need to be symmetrical and in order/ Compulsion: ordering straightening, counting

Hoarding OCD

Obsession: thoughts that discarding may result in something bad happening / Compulsion: excessively keeping things

Scrupulosity OCD

Obsession: religious or moral issues / Compulsion: confession, reassurance seeking, praying

When do most OCD cases present + how do they evolve

around age 14, gradual inc, can be triggered by a stressful event

Most common co-morbility adults with OCD

mood disorder

Most common co-morbility children with OCD

anxiety disorder

What drug class is first line treatment for OCD

TCA

What med classes are used for OCD

SSRI, TCA, SNRI, Antipsychotics

Neuromodulations OCD

deep brain stimulation/ ECT/ TMS

What can exposure and response prevention be used for

OCD

What is trichotillomania

chronis self distructive hair pulling with noticeable hair loss

Nursing interventions trichotillomania

monitor for hair ball (if eating hair), stomach pain/ anemia, monitor site for infection

What is excoriation disorder

repetitive compulsive picking of skin causing damage

Does medication work exoritation

no, focus on supportive care and therapy

What is body dysmorphic disorder

focus on real (slight) or imagined defect in appearance

Monitoring body dysmorphic disorder

safety (high depression and suicide risk)

What is hoarding disorder

difficulty parting with or discarding possesions

Monitoring hoarding disorder

safety of living environment (mandated report)

What is PANS/ PANDAS

dramatic onset of psyc symptoms including OCD, could be caused by infection

Key features schizotypal disorder

extreme discomfort in close relationships, distorted thinking or perceptions

Key features delusional disorder

Persistent false beliefs lasting at least one month, otherwise normal behavior and function

Key features brief psychotic disorder

sudden short episode of psychosis resolves within one month

Key features schizophreniform disorder

short term schizo like symptoms 1-6 months

Key features schizophrenia disorder

chronic mental illness causing hallucinations, delusions and disordered thinking

Key features schizoaffective disorder

combines psychotic symptoms with mood disturbances (depression/mania)

Key features catatonia

neuropsychiatric syndrome that disrupts a person’s movement, speech, and behavior, causing a lack of response or extreme agitation despite being awake

Positive symptoms psych disorders (general)

distortion and disorganization in thought and feeling, behavior

Negative symptoms psych disorders (general)

diminished ability or absence of feeling, motivation and reactivity

Positive symptoms psyc disorders

hallucinations, delusions, disorganized thoughts

Negative symptoms psyc disorders

affective flattening, asocial

Referential delusion

belive that ordinary events or random occurrences carry a hidden personal meaning

Nihilistic delusion

belife that oneself, or part of body no longer exists or has been destroyed

Tough insertion delusion

belief that an external entity has inserted thoughts into ones mind

Thought broadcasting delusion

belief that ones thoughts are projected and can be perceived by others

What is important to assess for with psychotic pts

command hallucinations (specifically suicide)

What is a command hallucinations

an auditory hallucination that instructs a person to perform a specific action, fairly common

How is disorganized thinking found in schizo

speach

s/s catatonia

stupor, catalepsy, waxy flexibility, mutism, negativism, posturing

What is the bush francis CS used for

monitoring catatonia

primary treatment catatonia

iv lorazepam, ECT

Etiology of schizo

dopanine imbalance could cause the main symptoms of psychosis or schizophrenia

NC schizo

rule out substance symptoms, nutrition, fluids, risk assessment, pharm assessment

NC priority acute stage shizo

safety and initiation of antipsychotic meds

NC long term schizo care relapse prevention

med adherence, stress management, coping skills

NC long term schizo care improving socialization

skills groups, working volunteering, group therapy

NC long term schizo care continued health promotion and prevention

aftercare services, outpatient care

Should you directly ask about hallucinations?

Yes

Should you negate a hallucination experience

No

Should you focus on reality-based diversions and distractions in hallucinations

Yes

Should you react to hallucinations as if they are real?

No

How to communication with someone with delusions

be honest, focus on feelings they generate, avoid arguing about the delusion, validate any true part

What med is most effective for positive symptoms of schizo

first gen (typical) antipsychotic

What med is most effective for both negative and positive symptoms of schizo

second gen (a- typical) antipsychotic

What med has a high risk of EPS

first gen (typical) antipsychotic

What antipsychotic med has a higher metabolic side effect

second gen (a-typical) antipsychotic

What class is NMS caused by

antipsychotics

Risk factors of NMS

dehydrates, hx, dosage inc

Early s/s of NMS

low grade fever, tachy, inc BP, diaphoresis

Classic S/S of NMS

hyperthermia, lead pipe rigidity, change in MS, autonomic changes

Pseudoparkinsosim

5-30days, stopped posture, tremors

Acute dystonia

1-5 days, facial grimace, involuntary eye and face movement

Akthisia

1-30day, restless, trouble standing

Tardive dyskinesia

months, protusion and rolling of tounge, smacking of lips, chewing motion

What is used to treat EPS

benztropine and diphenhydramine

Black box warning antipsychotics

inc mortality in elderly and dementia

black box warning abilify

compulsive uncontrollable urges to do bad acts

Addional side effects clozapine

risk of agranulocytosis

What is anticholinergic crisis

life truanting overdose to first gen antipsychotics

S/S anticholinergic crisis

hot and red, blurred vision, dry skin, confusion and delerium,

NC pt on clozaril

WBC educate on s/s of infection, monitor for aftigue and chech CRP and PRN

What drug carries the highest risk for constipation

clozapine

Black box warning for olanzapine

post-injection delirium sedation syndrome

Admin consideration olanzipine

3hr post injection monitoring

admin considerations for palliperidone

requires 4 months of invega sustenna first

S/S post-injection delirium sedation syndrome

occur 1 hour after, sedation, confusion, altered, resolve between 3-72 hours

cluster A personality disorder

schizoid, schizotypal, paranoid

What is BPD

instability with interpersonal relationships

Characteristics of BPD

Fear of abandonment, unstable interpersonal relationships, unstable self image, unstable affect

define use

ingestion, smoking, sniffing, or injection of mind-altering substance

Define abuse (substances)

uses for purposes of intoxication or beyond intended use

Define tolerance (substance use)

the bodys reduced response to a substance after repeated use (the amount needed inc with use)

Define physiological dependence

the bodys adaptation to a substance

Define psychological dependance

emotional or mental reliance on a substance

Define withdrawl

symptoms occurring when blood or tissue concentrations of a substance decline

Define detoxification

process for safe withdrawl

define relapse

recurrence of use

What is the substance reward pathway on the brain

connected to areas that control behavior and memory, the brain makes connections between activity and pleasure (makes repeated behavior)

What is the primary neurotransmitter in the brains reward pathway

dopamine

Define is impaired control (SUD symptoms)

using more of a substance or more often than intended

Define social problems (SUD symptoms)

neglecting responsibilities and relationships

Outcome of impaired control (SUD symptoms)

wanting to cut down or stop using but cant

Outcomes of social problems (SUD symptoms)

giving up activities, inable to complete tasks at home or life

Define risky use (SUD symptoms)

using in risky settings

Outcomes risky use (SUD symptoms)

continued use despite known problems