3400 FINAL EXAM

thoughts about mental health in the 19th century

the mentally ill were feared and most communities felt like they needed to be protected from the mentally ill.

community mental health act of 1963 lead to

deinstitutionalization = the process of replacing long-stay mental institutions with less isolated community mental health services for those diagnosed with mental disorder or developmental disability

projection

seeing the inside in the outside, paranoid behavior

rationalization

why the unacceptable is OK in this instance, justification, string of reasons

denial

saying it is not so, substance abuse, reaction to death

regression

returning to an earlier stage of development, enuresis, primitive behaviors

voluntary commitment

occurs when a client consents to admission in the hospital. Recognizes the need for treatment. Signs document stating such

involuntary admission

made without the client's consent. It is necessary when a person is a danger to self or others, needs psychiatric treatment, or is unable to meet own basic needs. Commitment is for a specified period of time.(usually 72 hours)

patient rights

→ access to care (psychiatric patients have the right to refuse meds)

→ treated with dignity and have right to care regardless of race, financial status, sexual orientation or disability

security

they should be treated in the least restrictive environment

feedback

filing a complaint or grievance is within the rights of psychiatric patients

restraints

behavioral restraint and seclusion are authorized as an intervention : Assist client to gain control

when restraints should be used

1-when the behavior is physically harmful to the client or third party, 2-when the disruptive behavior presents a danger to the facility, 3- when alternative or less restrictive means are insufficient in protecting the client from others from harm, 4-when decrease in sensory over stimulation.

assessment of a mental health patient

clinical interviewing, interview and observe skills of practitioners because theres no laboratory test, tissue diagnosis or imaging method to confirm a psychiatric diagnosis

mood

sustained emotion, the type of emotion the patient describes, positive or negative

affect

the physical expression of emotions and feelings expressed (individuals interaction w stimuli)

depression

alteration in mood that can be expressed by feelings of sadness, despair, and pessimism, loss of interest in daily enjoyable activities seen

MDD

depressed mood or loss of interest or pleasure in usual activities, impaired social and occupational functioning for at least 2 weeks (single episode or recurrent)

5 or more of the following must be present during the same 2-week period presenting depressed mood or loss of interest or pleasure

dysthymic

depressed mood for at least 2 years accompanied by MDD symptoms for at least 2 years

post partum depression

severe depression during the postpartum period. maternity blues

bipolar disorder

mood swings from profound depression to extreme euphoria (mania) with intervening periods of normalcy

must have 3 or more symptoms

bipolar 1

experience manic episodes or has a history of one or more manic episodes and psychotic features maybe present

bipolar 2

recurrent bouts of depression with s/s of hypomania (milder degree of hypermania)

drug of choice for bipolar disorder

lithium. maintenance : 0.6 to 1.2 mEq/L

self destructive behavior examples

self harm, parasuicide

risk factors for self destructive behavior/suicide

marital status (higher in single individuals/divorced men), gender (women), age 45-64 and 85+, socioeconomic class (either higher or low class)

schizophrenia positive symptoms

most individuals do not normally experience but are present in people with schizophrenia. Delusions, disordered thoughts and speech, tactile auditory, visual, olfactory, gustatory hallucinations. Respond well to meds

schizophrenia negative symptoms

deficits of normal emotional responses or of other thought processes and respond less well to medication. Flat or blunted affect and emotion, inability to experience pleasure, lack of desire to form relationships. Can equal poor quality of life, functional disability, burden on others

schizophrenia treatment

Antipsychtics:Thorazine (chlorpromazine), Mellaril (thioridazine), Haldol (haloperidol), Prolixin (Fluphenazine Decanoate)

extrapyramidal side effects

tardive dyskinesia, neuroleptic malignant syndrome. treat with benadryl and cogentin

anxiety disorder

occurs when the anxiety becomes chronic and permeates major proportions of a person's life. The person experiences functional impairment and distress

panic disorder

Characterized by recurrent panic attacks. Onset is usually unpredictable and manifested by severe fear, terror or apprehension when exposed to phobic stimulus

panic disorder treatment

antidepressants ( SSRIs): Prozac, Zoloft, paxil

anxiolytics: Ativan, Xanax, Klonopin ( effective treatment -short term basis) Buspar for longer term treatment

Antihypertensives : clonidine

GAD

Characterized by persistent, unrealistic and excessive anxiety and worry occurring more days than not for over a period of 6 months. interferes with daily functioning/relationships

GAD treatment

long term treatment (buspar) or psychotherapy ( coping skills, relaxation techniques)

behavior therapy

refraiming, decatastrophizing, assertiveness

phobias

Illogical, intense, persistent fear of a specific object or social situation

social anxiety disorder

fear of situations where individual does something embarrassing or evaluated negatively by others

OCD obsession

intrusive thoughts that are recurrent and stressful

OCD compulsion

repetitive ritualistic behaviors performed to reduce anxiety associated with obsessive thoughts.

OCD treatment

exposure therapy

PTSD

Reaction to an extreme trauma ( man made, natural, combat, serious accidents, victim or torture/assult, witnessing tragic event)

PTSD treatment

cognitive behavior therapy

phases of crisis development 1

individual is exposed to stressor, problem solving techniques employed

phases of crisis development 2

problem solving techniques do not relieve stressor, anxiety increases

phases of crisis development 3

internal and external resources are employed to resolve problem and relieve discomfort

phases of crisis development 4

resolution does not occur, tension mounts beyond breaking point, pt may reach panic mode, cognitive functioning distorted, labile emotions and psychotic thinking may occur

phases of crisis intervention

assessment, planning intervention, intervention, evaluation

agitation

emotion expressed by verbal abuse, lack of cooperation, violation of rules or norms, and threatening behavior

agression

behavior intended to threaten or injure the victim's

abuse

the intense desire to use increasing amounts of a particular substance or substances

dependence

the body's physical need, or addiction, to a specific agent. Results in physical harm, behavior problems, social isolation and association with people who also abuse substances. When tolerance develops, the amount required to achieve the desired effect increases

opiods

Exert sedative and analgesic effect. Popular because they desensitize and individual to both psychological and physiological pain and induce euphoria.

hallucinogens

produce symptoms similar to psychotic break including hallucinations usually visual. Pt may become belligerent/aggressive

inhalants

gas, glue, paint, paint thinner, and other compounds with esters. Very common in the younger/teenage population-why they are readily available, legal and inexpensive

paranoid personality disorder

Feel others are always trying to take advantage of them, or hurt them, they trust no one

schizotypal personality disorder

Magical thinking/illusions are part of everyday life

antisocial personality disorder

Shows a general disregard for others; lack of remorse for actions, Frequently breaks law, Deceitful, conning, exploits others for personal gain, manipulative

narcissistic personality disorder

xaggerated sense of self worth, right to have anything they want "superior to anyone else", Lack empathy, humility overly critical/ judgmental of others, Exploit others to fulfill desires, Fragile self esteem/insecure ; need constant praise

borderline personality disorder

Intense/chaotic relationships, low self esteem, instability and fluctuating attitudes towards others, Fear of abandonment or rejection, Aggressive, Prone to self-harm ( attention seeker)

histrionic personality disorder

colorful/dramatic behavior, center of attention

avoidant personality disorder

extremely sensitive to rejection ( socially withdrawn life) similar to social phobia, extreme shyness

obsessive compulsive personality disorder

Overly disciplined, very serious, perfectionistic, preoccupied with rules, inflexible, lack spontaneity, Can not work well with others, constant need for control, meticulous, rigid and stubborn

dependent personality disorder

Lack of self confidence and extreme reliance on others to take responsibility and make decisions, Low self worth, Difficulty expressing disagreement