Psych Exam 2

What are some postive (acute) symptoms of schizophrenia?

Are “add on” symptoms, sometimes called florid symptoms and are usually associated with acute onset of illness and likely to diminish with antipsychotic medication.

-Hallucinations, delusions, bizarre behavior, paranoia, cataonia, formal thought disorder

What are some negative (chronic) symptoms of schizophrenia?

Are “deficit” symptoms that reflect thoughts and behaviors the individual no longer demonstrates, are harder to treat and adversely affect quality of life

-Apathy, lack of initiative, anhedonia, blunted or flat affect, poverty and speech

Compare and contrast the positive and negative symptoms of schizophrenia.

-Negative symptoms develop insidiously over a long period of time
-Negative symptoms are difficult to assess during an acute psychotic episode
-Negative symptoms are header to treat whereas positive symptoms are likely to diminish with proper antipsychotic medication
-Negative symptoms adversely affect quality of life

What are some nursing interventions for a patient who is experiencing hallucinations?

-Watch patients for cues that they might be hallucinating ( eyes dart to one side, muttering, staring sideways, changes in facial expressions)

-Ask patients directly if they are hallucinating (“Are you hearing voices?” or “What are you hearing the voices say to you?”
If voices are telling patients to self harm or others:
If in the community notify proper authority (police)
If inpatient keep patient on close observation

-Document what the patient says, if they are threat to self or others, and who wa notified and when

-Accept the fact that the voices are real to patients but explain that you do not hear the voices. Refer to the voices as “your voices” or the “voices you hear”

-Present a calm demeanor and stay with patients while they are hallucinating. At times you can tell patients to tell the “voices they hear” to go away

-Maintain a calm milieu free of over stimulating activities

-Keep patients focused on simple, basic, reality-based topics and activities. Help patients focus on one idea at a time

-Help patients identify times and situations when hallucinations are the most prevalent and intense

-Assess for signs of increased anxiety, fear, or agitation and intervene as soon as possible

What are some nursing interventions for a patient who is experiencing parnoia?

-Place yourself by the patient, not face to face

-Avoid direct eye contact

-Use matter of face or business-like approach

-A paranoid patient might not eat or drink, thinking the food is poisoned. Offer food and fluids in closed containers, such as a carton of milk, a carton of yogurt, unpeeled fruit, or a hardboiled egg

-After understanding the patient's underlying feelings (fear, helplessness, etc.) engage the patient in reality-based activities, such as cards or crafts.

-If the patient is paranoid, intellectual functioning is often higher, and the patient may respond better to more intellectually taxing, non competitive activities

-Observe for events that trigger delusions

-If anxiety escalates and the patient loses control, use least restrictive interventions (one-one therapy, prn medications, leas-resort seclusion). Always follow unit protocol and provide detailed documentation

What are some nursing interventions for a patient who is experiencing delusions?

-Asses if external controls are needed; if patient is agitated and believes someone is going to inflict harm, the patient may harm someone else to survive; use safety measures

-Be aware that the patient’s delusions represent the way that person is experiencing reality

-Identify feelings:
If the patient believes there is an attempt to “get” the patient, then the patient is experiencing fear
If the belief is that someone is controlling the patient;s thoughts then the patient is expiring helplessness

-Engage the individual in yoga, exercise, walking, etc.

-Do not argue with the patient’s beliefs or ty to correct false beliefs with logic or fact

-Do not touch the patient; use gestures very carefully, particular if the patient is paranoid

What are some nursing interventions for schizophrenia in general?

-Lowering the patient’s anxiety

-Decreasing defensive patterns

-Encouraging participation in therapeutic and social events

-Raising feelings of self-worth

-Increasing medication compliance

What medications are used to treat schizophrenia?

-Second-generation antipsychotic (atypical agents)

-First-generation antiphsycotic (conventional drugs)

-Adjuncts to antipyschotic drug therapy (benzodiazepines and antidepressants)

What are some examples of Second Generation Antipyschotics?

-Clozapine (Clozaril)
-Amisulpride (Solian)
-Aripiprazole (Abilify)
-Asenapine (Saphris)
-Iloperidone (Fanapt)
-Lurasidone (Latuda)
-Olanzapine (Zyprexa)
-Paliperidone (Invega)
-Quetiapine (Seroquel)
-Risperidone (Risperdal)
-Sertindole (Serdolect)
-Ziprasidone (Geodon)
-Brexpiprazole (Rexutli)
-Carprazine (Vraylar)

What are some side effects of second generation antipyschotics?

**Anticholinergic: urinary retention, constipation, dry mouth, blurry vision, tachycardia

-Cardiovascular events: QTc interval prolongation and sudden death, myocarditis and cardiomyopathy, orthostatic hypotension

***Extrapyramidal side effects (EPS): dsytonias, akathisia, parkinsonian symptoms, tardive dyskinesia (TD)

-Metabolic syndrome: central or abdominal obesity, increased triglycerides, increased HDL, increased blood pressure, increase fasting blood glucose

-Other: sezuires, sedation, sexual problems, neasua and vomiting, increased risk for suicde

****Neuroleptic malignant syndrome

What are some examples of first generation antipsychotics?

-Haloperidol (Haldol)
-Trifluoperazine (Stelazine)
-Fluphenazine
-Loxapine (Loxitane)
-Perphenazine
-Chlorpromazine (Thorazine)
-Thiordazine (Mellaril)

What are some side effects of first generation antipsychotics?

**Anticholinergic: urinary retention, constipation, dry mouth, blurry vision, tachycardia

-Cardiovascular events: QTc interval prolongation and sudden death, myocarditis and cardiomyopathy, orthostatic hypotension

***Extrapyramidal side effects (EPS): dsytonias, akathisia, parkinsonian symptoms, tardive dyskinesia (TD)

-Other: weight gain, drug induced liver disease, cataracts, photophobia, sezuires, sedation, sexual problems, nausea and vomiting

****Neuroleptic malignant syndrome

What are some extrapyramidal side effects?

Dsytonias, akathisia, parkinsonian symptoms, tardive dyskinesia (TD)

What is dsytonias? What is its onset?

-Severe spasms of the muscles of the tongue, head, and neck; fixed upward direction of the eyes; and severe back spasms that arch the trunk forward and thrust the head and lower limbs backward

-Usually tongue and jaw happen first

-Opisthotonos: tetanic heightening of entire body, head and belly up

-Oculogyric crisis: eyes locked upward

-Onset: A few hours to 5 days

What is akathisia? What is its onset?

-Distressing motor inner-driven restlessness

-Examples: tapping foot incessantly, rocking forward and backward in a chair, shifting weight from side to side)

-Onset: 2 hours to 60 days

What is parkinsonian symptoms (pseudoparkinsonism)? What is its onset?

-Masklike facies, stiff and stopped posture, shuffling gait, drooling, tremor, "pill-rolling" phenomenon

-Onset 5 hours to 30 days

What is Tardive Dyskinesia (TD)? What is its onset?

-Is an EPS that appears after prolonged treatment. It consists of involuntary tonic muscular spasms of the face and jaw

-Early symptoms include tiny involuntary movements of the tongue or lip smacking

-Facial: Protruding and rolling tongue, blowing, smacking, licking, spastic facial distortion

-Limbs:
Choreic: rapid, purposeless, and irregular movements,
Athetoid: slow, complex, and serpentine movements

-Trunk: neck and shoulder movements, dramatic hip jerks and rocking, twisting pelvic thrusts

-Onset: Months to years

What are some treatments and nursing measures for someone who is experiencing EPSE?

-Alert medical staff

-Take pateint to quiet area and stay until relief of symptoms

-Reduce dosage (try a low-potency antipsychotic or an atypical antipsychotic)
(Discontinuing drug may only help if in the early stages)

-Use Abnormal Involuntary Movement Scale (AIMS) to help detect TD in early stages

***Use Ingrezza (valbenazine) for TD

**Medications to adminsiter that are beneifcal: (Give anticholinergics, dopamine agonist, antiparkinsonian drugs

- Trihexyphenidyl (Artane) -anticholinergic/ antiparkinsonian
- Benztropine (Cogentin) - anticholinergic/ antiparkinsonian
-Diphenhydramine hydrochloride (Bendadryl) -antihistamine
-Biperiden (Akineton) and amatadine (Symmetrel) -antiparkinsonian

What is Neuroleptic Malignant Syndrome (NMS)?

-It is somewhat rare but is potentially fatal

-Is charcterized by greatly increased muscle rigidity

-Can occur in first 1-4 weeks of drug therapy; may occur at anytime during treatment

-Rapid progression over 2-3 days after intial symptoms

Memory Tool: FEVER

-Fever
-Elevated CPK/WBC
-Vital sign instability (fluctuating BP, pallor, tachycardia, excessive sweating, tremors
-Encephalopathy (confusion, agiation, altered level of consciousness
-(Muscle) Rigidty

What are some interventions and treatments for NMS?

-Stop drug immediately
-Reduce patients temperature
-Monitior fluid balances
**Administer:
-Bromocriptine (Parlodel) (used for mild cases and is a dopamine agonist)

-Dantrolene (Dantrium) (used for severe cases and is a muscle relaxant

What are the life threatening side effect risk associated with clozapine (Clozaril)?

-Can lead to neutropenia and agranulocytosis, which can lead to serious infection or sudden death

-Beginning symptoms include: fever, chills, sore throat, mouth ulcers, bleeding gums, ad weakness

***Do a CBC to verfiy WBC and ANC have been measured and are in acceptable ranges before giving medication

-Increase risk of seziures and myocarditis

What are some psychotherapies used for patients who have schizophrenia?

-Program of Assertive Community Treatment: aims to prevent relapse , maximize socail and vocational functioning, and keep the indivdual in the community

-Family Therapy/pyschoeducation: seeks to include family members as partners, complementing interventions by clinicians by teaching speacialized interactions and coping skills

-Cognitive Behavioral Therapy: Targets distressing and disturbing thoughts and corrects them

-Cognitive Remediation: is an intervention that uses specfic learning activities to imporve cognitive skill

-Social Skills Training: helps people improve their social interactions, social preception and understanding, self-management, and workplace skills

What are the different types of child abuse?

-Physical Abuse
-Neglect
-Sexual Abuse
-Emotional or Psychological Abuse

What are the physical indicators of physical abuse? What are the behavioral indicators?

Phyiscal Indicators:
-Bruises, wounds, injuries in differening stages of healing
-Patterning of abuse, such as marks in shapes such as a coat hanger or cigarette burns, or hidden under clothing where they are harder to discern
-Bald patches on scalp
-Subdural hematoma (child younger than two)
-Retinal hemorrhage

Behavioral Indicators:
-Excessive fear of parents or constant effort to please
-Wary of adult contact
-Nightmares or anxiety
-Obvious attempts to hide bruises or injuries
-Withdrawn, depressed, aggressive, or disruptive behavior at home or school
-Regressive behavior

What are the physical indicators of neglect? What are the behavioral indicators?

Physical Indicators:
-Malnourished
-Underweight, poor growth pattern
-Inadequately supervised
-Poor hygiene
-Unattended phyiscal problems
-Inappropriate dress

Educational Neglect:
-School problems or failure
-Not enrolled in mandatory school for age of child

Behavioral Indicators:
-Soiled clothing, poor hygiene
-Begging, stealing food
-Emaciated or has distended belly
-Arrives early or stays late at school
-Psychomatic complaints
-Delinquency
-Alcohol or drug abuse
-Chronic truancy
-Special educational needs not being attended

What are the physical indicators of sexual abuse? What are the behavioral indicators?

Physical Indicators:
-Difficulty in walking or sitting
-Itching in private areas
-Urinary tract infections, painful urination
-Torn, stained, or bloody underclothing
-Bruises or bleeding in external genitalia, vaginal, or anal areas
-Sexually transmitted infection, espically in preteens
-Swollen private areas or discharge
-Objects in vagina, rectum, or urethra

Behavioral Indicators:
-Mistrust of adults
-Abnormal or distorted view of sex
-Advanced or unusual sexual behavior or knowledge for age
-Phobias: fear of the dark, men, strangers, leaving the house
-Delinquency or running away
-Self-injury or suicidal thoughts or behaviors
-Mental disorders may develop including posttraumatic stress disorder, depression, dissociative disorder, eating disorders, conduct disorders, mood swings and anxiety

What are the physical indicators of emotional abuse? What are the behavioral indicators?

Physical Indicators:
-Speech disorders
-Lag in physical development

Behavioral Indicators:
-Difficulty in learning and living up to potential
-Lack of self-confidence
-Inappropriate adultlike behavior or infantile behavior
-Poor social skills
-Dramatic behavior changes such as aggressiveness, durg use, change in friends or clothing, self-harm behaviors, compulsiveness, and a needy pursuit of attention

What are the assessments associated with child abuse/neglect?

-Reassure children that they did not do anything wrong.
- Children should not feel pressured to talk.
- Experience should be nonthreatening and supportive.
- Interview should not resemble trial or inquisition.
- Children may express experiences through playing out the incident
with dolls or drawings.
- Do not suggest answers.
- Do not promise that everything is confidential (abuse must be
reported).
- Do not react with shock to anything; do not force a child to undress
or be examined.
-Understand that children do not want to betray their parents.
- Provide (or have a physician provide) a complete physical
assessment of the child.

Open-ended questions are best. Possible questions include:
- How did this happen to you?
- Who takes care of you?
- What do you do after school?
- Who are your friends?
- What happens when you do something wrong?

Signs and charcteristics associated with partner abuse?

Signs:
-Physical: burns, bruises, scars, wounds in various stages, fractures of limbs, jaw, ribs, conussions, perforated eardrums, abdominal injruies, eye injruies, and strangulation marks on the neck, cigarette burns, patterning of injuries (injuries in the shapes of object such as coat hangers, cords, irons, handprints, fly swatters, rope burns, bite marks, or belt buckles
-Presenting signs might include high anxiety, stress, and the complaint of insomnia, chest pain, back pain, dizziness, stomach upset, trouble eating, and severe headache, among others.
-Assessment for posttraumatic stress disorder (PTSD) should be part of the evaluation.
-Brief history may reveal a series of falls, “accidents,” and recent ED visits.

Characteristics:
-Eventually believes that if they say or do the right thing the abuse will stop
-If they do not do anything wrong the abuse will not occur
-Becomes psychologically devastated and begins to believe partner's words
-Lowered self-esteem
-Unhealthy bond with others
-Overtime becomes unable to accurately assess the situation without validation from supportive network
-In constant fear or terror that becomes cumulative and oppressive
-Contemplates suicide, contemplates homicide
-May complete suicide or homicide
-May have depression
-High risk for secret drug or alchol abuse
-Unable to save money and leave
-Looses sense of self

What are the assessments associated with partner abuse?

-Most often seen in ED
-If injury does not match the explanation or if the patient minimizes the
abuse, then suspect IPV.
-If IPV is suspected, then complete a physical history, including an x-ray
study and a neurologic examination.
-Rape may be part of the abuse—test for STIs and forensic collection of evidence, give "morning after pill" to prevent unwanted pregnancy
-Physical exam: look for signs of partner abuse injuries listed above
***Should always be seen alone and partner should not be present

Questions to ask:
-Is someone hitting or hurting you? (either past or current partner)
-Do you feel safe in your current relationship?
-Are your children being harmed?

What are the signs and assessments associated with elder abuse?

-Age-related syndromes often result in frailty, making older adults more at
risk for abuse and neglect
-Elder abuse is most often diagnosed in patients with depression, alcohol or
drug abuse, dementia, or psychiatric illness, which compounds the person’s
vulnerability and draws attention to their vulnerable situation

-Fear of being alone with caregiver
-Obvious malnutrition
-Bedsores or skin lesions
-Begging for food
-Needs medical and/or dental care
-Left unattended for long periods
-Reports of abuse and neglect
-Passive, withdrawn, and emotionless
-Concern over finances and missing valuables
-Appears overmedicated
-Vaginal ot rectal pain, tears, bleeding, or STIs

What are the reasons victims of domestic violence and domestic abuse don’t leave?

-Fear that attacks will become even more violent
-Fear that the woman and child could be murdered if they leave and are found by the batterer
-They were abused as a child and abuse seems normal and familar
-Lack finacial support
-Lack of support system
-Depression or low self-esteem
-Religous values against divorce
-Belief that they deserve the abuse
-Staying for the sake of the children
-Think they cannot survive without the
partner
-Think they will loose custody of children

****The cycle of violence

Describe the components of the cycle of violence.

1. Tension-building phase
-Abuser: edgy, has minor explosions. May become verbally abuseive; minor hitting and slapping
-Victim: Feels tense and afraid "walking on eggshells". Feels helpless, becomes complaint, accepts blame

2. Serious battering phase or acute battering
-The tension becomes unbearable; the victim may provoke an incidcent to get it over with
-Serious battering incident
-The victim may try to cover up the injury or may look for help

3. Honeymoon phase
-Abuser: loving behavior, such as bringing gifts and flowers and doing special things for the victim. Contrite, sorry, make promises to change.
-Victim: trusting, hoping for change, wants to believe partner's promises

Cycle Repeats

What is the power dynamic in domestic violence?

-An abusive relationship is all about instilling fear and wanting
to have power and control in the relationship

The battered partner:
-Has feelings of powerlessness and low self-esteem
-Lives in terror

What actions does the batterer do to their partner?

-Denial and blame: Denies that the abuse occurs; shifts the
responsibility to the partner

-Emotional abuse: Belittles, criticizes, insults, uses name calling,
and undermines

-Control through isolation: Limit contact with the family or friends,
controls activities and social events, tracks the time or mileage on
the car, monitors activities, stalks the partner at work, takes the
partner to and from work or school, and may demand permission to
leave house

-Control through intimidation:
Instills fear through threats. Breaks things, destroys property, abuses pets, displays
weapons, threatens children, and threatens homicide or suicide. Increases physical, sexual, and psychological abuse

-Control through economic abuse: Controls the money. If the
partner works, the batterer calls excessively and forces the partner
to miss work.

-Control through power: Makes all the decisions, defines the role in
the relationship, treats the partner like a servant, and takes charge
of the home and social life.

What is a basic safety plan for someone who is dealing with intimate partner violence?

-Move to a room with more than one exit:
-Avoid rooms with potential weapons (e.g., kitchen knives).
-Know the quickest route out of the home.

-Know the quickest route out of the workplace.
-Find out resources that protect employees.

-Tell the neighbors about the abuse and ask them to call the police when they hear a disturbance.

-Have a code word to use with the kids, family, and
friends.

-Have a safe place selected in case you have to leave.

-Pack a bag beforehand with:
-Essential clothes and valuables.
-Prepaid phone card, cell phone, address book, and a 1-month supply of medications.
-Keep this packed bag hidden but easy to grab quickly.
- Include legal documents:
-Birth certificates, social security card, drivers liscense, passports, etc.

What are the different kind of clusters of personality disorders?

Cluster A, Cluster B, and Cluster C

What are cluster A disorders?

-Seen as “odd” or eccentric; have unusual beliefs
-Avoid interpersonal relationships; often indifferent
-Schizoid Personality
-Schizotypal Personality Disorder
-Paranoid Personality Disorder

What are some symptoms and behaviors associated with schizoid personality disorder?

-Flat affect, appearing indifferent to both praise and criticism (never animated)
***Unable to establish relationships, prefer to be alone (NO INTEREST!!!)
-Restricted range of interpersonal emotions, unempathic
-Invest little energy in human relationships; conversely, may
invest enormous energy in nonhuman interests (e.g.,
mathematics, astronomy, etc.); often connect more with
animals
-Often creative, original thinkers
-Choose solitary activties
-Emotional coldness
-Take pleasure in few things
(My dumb example of who this reminds me of: Elon Musk)

What are some symptoms and behaviors associated with schizotypal personality disorder?

-Resembles schizophrenia but with ***NO psychosis
-Odd, eccentric behavior and speech
-Cognitive perceptual distortions without psychosis
-May display magical thinking and rituals
-Give-and-take conversations difficult
-Genuinely ****unhappy about lack of relationships****
-Social anxiety and unhappiness may increase over time
-Magical thinking and rituals (ex: tossing a coin into a fountain or crossing your fingers)
-Weird figures of speech, odd thinking and beliefs
-Trouble with give and take conversations (no eye contact) do not read social cues
(My dumb example: Kramer from Seinfeld)

What are some symptoms and behaviors associated with paraniod personality disorder?

-Pervasive, persistent, inappropriate suspiciousness and distrust
of others (unjustified)
-Present as hostile, irritable, injustice collectors; jealous, lacking
warmth
-May appear businesslike and efficient, but generate fear and
conflict in others
-Find malice in benign comments and behaviors (ideas of
reference)
-Think that others are expoiliting or deceiving them
(My dumb example: Andre's grandmom from Victorious)

What are cluster B disorders?

-Emotional reactivity, poor impulse control, manipulation
-Unclear sense of identity
-Narcissistic Personality Disorder
-Histrionic Personality Disorder
-Borderline Personality Disorder
-Antisocial Personality Disorder

What are some symptoms and behaviors associated with narcissistic personality disorder?

***Grandiose sense of personal achievement, shallow, superficial
-Haughty sense of entitlement, arrogant
***Lack of empathy; exploiting others to meet own needs
-Increasing attention seeking over time
-Exploit, blame, and envy others
-Use of splitting, tantrums
-Can be sadistic, with paranoid tendencies
(My dumb example: literally any celebrity, a spoiled child)

What are some symptoms and behaviors associated with histrionic personality disorder?

-Manipulative, insensitive
-****Dramatic, rapidly shifting, charming, flamboyant, and sexually
seductive behaviors
-Need to become and remain the **center of attention, love, and
admiration
-Constant, sudden emotional shifts and lability (rapid change in mood)
-Somatic complaints are common
-Superficial, shallow, short-lived relationships
-Lack insight into cause of relationship failures
(My dumb example: every dumb person on 90 day like No Neck Ed) (any reality star)

What are some symptoms and behaviors associated with borderline personality disorder?

-Unstable, intense relationships
-Instability of affect; unstable, frequent mood changes (shifting
from anxiety, to irritability, etc.)
-Separation insecurity, fear feelings of **abandonment
-**Poor impulse control; uncontrolled anger, self-destructive;
**suicide-prone, **self-mutlations or gestures
-Chronic depression
-Lack a clear sense of identify; projected identification
-Excessive demands, ****manipulation, **splitting behavior
(My dumb example: Harley Quinn, Suicide Squad)

What are some symptoms and behaviors associated with antisocial personality disorder?

-Persistent ***disregard for others
-Persistent violation of others’ rights
-****Absence of remorse for hurting others (callousness)
-Sense of entitlement
-Deceitfulness, aggression
-Impulsiveness; risky behaviors to “feel alive”
-**Lack remorse (no guilt)
-Superficially charming
-Pattern of behavior (breaking the law, unstable employment, unstable relationships, often end up in prisons a lot)
(My dumb example: Ted Bundy)

What are Cluster C disorders?

-High anxiety and outward signs of fear
-Inhibited, internalizing blame, even when not to blame
-Aviodant Personality Disorder
-Obsessive-Compulsive Personality Disorder
-Dependent Personality Disorder
-Passive Agressive Traits

What are some symptoms and behaviors associated with avoidant personality disorder?

-Feelings of low self-worth
-**Hypersensitive to criticism or rejection
-**Avoid situations requiring socialization; withdrawal
-Fearful of **disappointment or ridicule
-Inhibited, reluctant to express irritation or anger, even when
justified
-Social phobia
-Afraid of
(My dumb example: Elsa from Frozen)

What are some symptoms and behaviors associated with Obsessive-Compulsive personality disorder?

-Orderliness, stubbornness, **attention to detail; devotion to
productivity at the exclusion of personal pleasure; indecisiveness
-Emotional constriction; stinginess
-Pervasive pattern of perfection and inflexibility
-Perseveration (persistent pursuit of an action even in the face of
repeated failures)
-High achieving
-Superficial, rigidly controlled intimacy
-Rank-conscious; ingratiating with authority figures but autocratic and
condemnatory with subordinates
-**Rigid perfectionism**
(My dumb example: The white rabbit from Alice in Wonderland)

**Different from Obessive Compulsive Disorder becasue they do not have compulsive rituals (ex: excessive handwashing) or unwanted obessions

What are some symptoms and behaviors associated with Dependent personality disorder?

-**Belief in inability to survive if left alone
-Excess need to be taken care of
-Solicit caretaking through clinging and submission
-Perversely, excessively submissive
-***Intense fear of separation and being alone
-Tolerant of poor, even abusive relationships
-If relationship does end, the individual has an urgent need to get into
another
-***Inability to make decisions without excessive reassurance
(My dumb example: Bella from Twilight)

What are Passive Agressive Traits?

**Although not a DSM-5 PD diagnosis, passive-aggressive personality traits are disruptive to interpersonal relationships.

-Characteristic of these traits is the tendency to engage in indirect
***expression of hostility through acts such as subtle insults, sullen behavior,
stubbornness, or a deliberate failure to accomplish required tasks.

-The work of those with these traits is often characterized by procrastination and intentional inefficiency.

-People with passive-aggressive behavioral traits are more likely to express their negative/hostile feelings indirectly, such as being chronically late or “forgetting” to do something.

-Although they may openly agree to another’s demands or requests, they rarely complete those demands or requests.

What are some characteristics all personality disorders have in common?

***Inflexibility of personality, (cannot adapt to situations aka being dramatic all the time). ***All cause problems in relationships.
-Display significant challenges in self-management, often having
difficulty regulating painful emotions in ways that are healthy
**Are genuinely unaware that their personality traits are causing the problems
(blaming)
-Believe they are normal; it is the others who have the problem. (NO INSIGHT)
-Tend to evoke intense interpersonal conflict.
-Lack individual accountability
-Are often insensitivity to others’ needs.
-Capacity to “get under the skin.”

What are some assessments associated with all personality disorders?

***Assess suicidal and homicidal thoughts. If these are present, the patient
will need immediate attention. Safety is a priority.

-Determine whether the patient has a medical disorder or another
psychiatric disorder.

-View the assessment of personality functioning from within ethnic,
cultural, and social backgrounds.

-Ascertain recent and important losses. Problematic behaviors associated
with PDs are often exacerbated after the loss of a significant supporting
person or as the result of a disruptive social situation.

-Evaluate for changes in personality in middle adulthood or later as this
may signal an unrecognized substance use disorder.

-Be aware of strong negative emotions that patients evoke in you as a
caregiver.

What are some good implementations for patients with personality disorder?

-Acts in a suspicious manner:
Institute behaviors to help the person feel safe emotionally.
Explain reasons for actions in a matter-of-fact manner.

-Lacks the ability to trust:
Give the patient a sense of control over what is happening by giving the patient
choices when possible (e.g., appointment in the morning or afternoon) to facilitate
adherence to treatment.

-Is hypersensitive to criticism yet has no strong sense of autonomy:
Teach/model new interpersonal skills by building on existing skills.

-Falsely attributes malevolent intentions to the nurse or others:
Discuss these cognitive distortions and present facts in a matter-of-fact manner.

-Insults or threatens the nurse or caregiver:
Ignore insults or sarcasm but set limits on abusive language or threats of violence
while continuing to provide care.

-Reports feeling hurt or rejected by others:
Allow the person to discuss the situation.
Listen to understand the situation and offer empathy. Acknowledge the distress.
Help educate the person regarding how people, systems, families, and relationships
work.

What are some good communication guidelines for Cluster A personality disorders?

-Develop a trusting relationship by being genuine, respectful, and punctual and doing what you say you will do.

-Use a business-like approach that is not overly warm to reduce suspiciousness.

-Acknowledge patient concerns and perceptions of circumstances without debate or agreement; avoid confrontation.

-Respect the patient’s need for interpersonal distance by maintaining a professional demeanor without withdrawing from the patient.

What are some good communication guidelines for Cluster B personality disorders?

-Develop a trusting relationship by demonstrating respect and positive regard, expressing empathy, and following through on promises.

-Avoid the use of “why” questions to decrease defensiveness.

-Maintain interpersonal professional boundaries; do not “punish” or reject the person for maladaptive behaviors (e.g., angry outbursts), and gently resist the patient’s attempt to establish an overly familiar relationship.

-Give the patient an opportunity to describe current stressors that lead to the suicidal or self-harm behaviors to help identify triggers.

-Support the patient to talk to staff to discuss sad and angry feelings or when thinking of hurting himself or herself, instead of acting on impulses.

-Assign only one or two staff members to the patient to minimize splitting behaviors.

-Implement a clear and structured plan of care that is closely followed by the patient and all members of the treatment team.

-Consider the use of a behavioral contract to concretely spell out acceptable behaviors and support personal safety.

-Set limits on manipulative behavior in a calm, nonaccusatory manner.

-Use objective and specific language to describe the problematic behavior, and discuss the more adaptive behaviors that can be substituted.

What are some good communication guidelines for Cluster C personality disorders?

-Develop a trusting relationship by providing empathy for the person’s distress.

-Avoid unnecessary power struggles, especially with the person with OCPD.

-Encourage the patient to assume responsibility for thoughts and behaviors without blame or shame.

-Initiate collaborative problem solving to facilitate anxiety reduction and improved coping.

What are some interventions for Manipulation?

-Assess you own reactions toward patient. If you feel angry, discuss with peers ways to reframe your thinking to defray feelings of anger

-Assess patient's interactions for a short period before labeling as manipulative

-Set limits on ANY manipulative behaviors such as: arguing, begging, flattery, seductivenesss, instilling guilt, clinging, constantly seeking attention, pitting on person against another, frequently disregarding the rules, constant engangement in power struggles, angry demanding behaviors

-Intervene in manipulative behavior
Set limits in a calm and nonputive way
Be consistent, all limits adhered to by staff
Behaviors should be documented objectively
Provide clear boundaries and consequences
Enforce the consequences

-Be vigilant AVOID:
Discussing yourself or other staff members with the patient
Promising to keep a secret for the patient
Accepting gifts from the patient
Doing special favors for the patient

What are some interventions for Impulsive Behaviors?

-Identify and discuss what precedes impulsive acts.
-Explore effects on self and others.
-Recognize cues.
-Identify triggers.
-Discuss alternative behaviors.
-Teach coping skills training.
-Discuss previous impulsive acts

What are two therapies associated with PD?

Milieu Therapy and Dialectical Behavior Therapy

What is Milieu Therapy?

-Short-term hospitalization occurs when an individual is assessed to be suicidal or self-harms or is a harm to others. (**promotes a safe enviroment)

-Patients with a diagnosis of BPD requiring hospital admission for attempted suicide have an increased risk of adverse outcomes and require careful clinical monitoring.

-Hospitalization is of unproven value for long-term suicide prevention among patients with BPD because those with this disorder may be chronically suicidal.

-***The primary therapeutic goal of milieu therapy is affect management in a group context.

-Community meetings, problem-solving groups, coping skills groups, and socializing groups are all areas in which patients can interact with peers, consider relationship problems, delegate and take responsibility for certain tasks, **discuss goals, collectively deal with problems that arise in the milieu, and **learn problem-solving skills.

What is Dialectical Behavior Therapy?

-Is an evidence-based type of cognitive-behavioral therapy

-Primary focus is stabilizing patient, achieving behavioral control, regulating emotions, developing distress tolerance skills, and constantly using crisis interventions

-Target behaviors include decreasing:
Life-threatening suicidal behaviors; therapy-interfering behaviors; and quality-of-life
interfering behaviors

-Four concepts of DBT
Mindfulness—living in the moment
Interpersonal effectiveness—skills that maximize the chance of achieving a goal without damaging a relationship or one’s self-respect
Distress tolerance—learning to bear emotional pain skillfully by accepting self and the
current situation
Emotional regulation—recognizing and coping with negative emotions in a healthy manner.

What are some Pharmacologic Therapies for PD?

-Specific medications are not available for the treatment of PDs per se. but treating the symptoms is helpful.

-Benzodiazepines (maintenance dosing) for anxiety are not appropriate because of the potential for abuse and overdose; they may be used in emergency situations.

Because of their propensity for suicidal gestures and self-harm, medications with low toxicity are recommended for patients with borderline PD.

-Selective serotonin reuptake inhibitors (SSRIs)—treat co-morbid depression
and panic attacks.

-Trazodone and venlafaxine—have low toxicity in overdose.

-Carbamazepine—targets impulsivity and self-harm.

-Lithium, anticonvulsants, SSRIs—stabilize mood, minimize aggression.

-Atypical antipsychotics—help with psychotic features in BPD under stress

What are some symptoms and behaviors of anorexia nervosa?

-AKA starvation
-Terror of gaining weight
-Preoccupation with thoughts of food
-View of self as fat even when emaciated
-Peculiar handling of food:
Cutting food into small bits
Pushing pieces of food around plate
-Possible development of rigorous exercise regimen
-Possible self-induced vomiting; use of laxatives and diuretics
-Cognitive distortions: individual judges own self-worth by weight
-Controls eating to feel powerful to overcome feelings of helplessness

What are some health complications as a result of anorexia?

-Orthostatic changes
-Bradycardia
-Cardiac murmur
-Sudden cardiac arrest
-Prolonged QT interval
-Acrocyanosis
-Symptomatic hypotension
-Leukopenia
-Lymphocytosis
-Carotenemia
-Hypokalemic alkalosis
-***Electrolyte imbalances
-Osteoporosis
-Fatty degeneration of liver
-Elevated cholesterol levels
-**Amenorrhea (one of the first signs)
-Abnormal thyroid functioning
-Hematuria
-Proteinuria
*Most life threateninng: anything related to the heart and electrolye imbalance (poatassuim)
*Imblanced nutrition*

What are some assessment features of anorexia?

-**Malnutrition**, including poor circulation, dizziness, palpitations, fainting, or pallor
-Menstrual or other endocrine disturbances
-Unexplained gastrointestinal symptoms
-Cachectic appearance (severely underweight with muscle wasting)
-Lanugo (a growth of fine, downy hair on the face and back)

What are some symptoms and beahviors of bulima?

-Binge-eating behaviors
-Binging may occur after attempts to fast to prevent weight gain
-Compensatory behavior, often self-induced vomiting (or laxative or diuretic
use) after bingeing
-History of anorexia nervosa in one-fourth to one-third of individuals
-Depressive signs and symptoms
-Problems with:
Interpersonal relationships
Self-concept
Impulsive behaviors; reports feeling “out of control” at times
-Increased levels of anxiety and compulsivity
-Possible comorbid substance use disorder
-Bingeing may be motivated by feelings of emptiness or attempts to feel less depressed

What are some health complications as a result of bulima?

-Cardiomyopathy (ipecac toxicity)
-Cardiac dysrhythmias
-Sinus bradycardia
-Sudden cardiac arrest
-Orthostatic changes in pulse and blood pressure
-Electrolyte imbalances
-Metabolic acidosis
-Hypochloremia
-Hypokalemia
-Dehydration and renal loss of potassium as a result of self-induced vomiting
-Attrition and **erosion of teeth
-**Loss of dental arch
-Diminished chewing ability
-**Parotid gland enlargement (from throwing up so much)
-Esophageal tears as a result of self-induced vomiting
-Gastric dilation
-Russell sign (calloused fingers from inducing vomiting)
*Decreased cardiac output, impulse issues, high anxiety* (possible susbtance abuse issues)

What are some assessment features of bulima?

-Prominent parotid glands because of hyperstimulation from repeated vomiting
-Atypical dental erosion and caries related to vomiting
-Severe electrolyte imbalance because of purging or misuse of laxatives or diuretics

Anorexia nervosa vs. Bulimia

Anorexia Nervosa

-Terror of gaining weight
-Preoccupation with food
-Views self as fat even when emaciated
-Peculiar handling of food:
Cutting food into small bits
Pushing food around the plate
-Maintaining a rigorous exercise regimen
-Self-induced vomiting; use of laxatives and diuretics
-Judge self-worth by weight
-Controls what they eat to feel powerful to overcome feelings of helplessness
-Lanugo
-Cachectic
-Prominent parotid glands, if purging


Bulima

-Self-concept
-Impulsive and compulsive
-Anxiety
-Possible chemical dependency and shoplifting
-Undoes weight after bingeing
-Prominent parotid glands, if purging
-Self-induced vomiting
-Laxative and diuretic abuse
-History of anorexia nervosa in one quarter to one third of individuals
-Depressive signs and symptoms
-Problems with interpersonal relationships

What are some priority health issues with both bulima and anorexia?

Nutrition (1st) and Suicide Risk (2nd)

What is the SCOFF questionnaire?

-Screening tool available to primary care providers to assess for eating disorders

-S ick: Do you make yourself sick or vomit after a meal because you feel uncomfortably full?
-C ontrol: Do you fear loss of control over how much you eat?
-O ne stone: Has the patient lost 14 lb in a 3-month period? (A stone is a unit of weight in Great Britain equivalent to 14 lb.)
- F at: Do you believe you are fat even when others tell you that you are too thin?
-F ood: Does food dominate your life?

What are some questions to ask in a Psychosocial Assessment if someone is suspected to have anorexia or bulima?

The person’s perception of the problem
-Eating habits, especially ritualistic eating patterns
-History of dieting or restrictive eating
-Methods used to achieve weight control (restricting, purging, exercising)
-Exercise might include long periods (hours) of daily excessive exercise, further compromising physiologic safety.
-Value attached to a specific shape and weight
-Comorbid mental health issues, including depression, anxiety, and obsessive-compulsive traits
-Alcohol or substance misuse
-Self-harm and suicidal ideation
-Interpersonal and social functioning (e.g., Does the person participate in high-risk activities associated with eating disorders, like modeling or professional sports?)
-Avoidance of social functions and interpersonal withdrawal

What are some interventions for anorexia?

-Acknowledge the emotional and physical difficulity the patient is experiencing
-Assess for suicidal thoughts/self injurous behaviors
-Monitor physiological parameters (vital signs, electrolytes)
-Weigh patient wearing only undergarments on a routine basis (same time of day, after voiding and before drinking)
-Monitor patient during and after meals to prevent throwing away food and or purging
-Recognize the patient's distorted image/overvalued ideas of body shape and size without minimizing or challenging the patient's perceptions
-Educate the patient about the ill effects of low weight and reslutant impaired health
-Work with patients to identify strengths

What are some interventions for bulima?

-Assess mood and presence of suicidal thoughts/behaviors and self harm
-Monitor phsiological parameters (vital signs, electrolyte) as needed
-Monitor the patient's weight as needed
-Explore dysfunctional thoughts that maintain the binge-purge cycle
-Educate the patient that fasting can lead to continuation of bingeing and the bine-purge cycle, emphasizing its self-perpetuating nature
-Monitor the patient during and after meals to prevent throwing away food and or purging
-Acknowledge the patient's overvalued ideas of body shape and size without minimizing or challenging the patient's perceptions
-Encourage the patient to keep a journal of thoughts and feelings

What are some psychotherapy interventions related to anorexia and bulima?

-Cognitive-Behavioral Therapy: is used to diminish distortions in patient's thinking that result in problematic attitudes and eating-disordered beahviors

*Cognitive Distortions that are related too eating disorders
-Overgeneralization: a single event affects unrelated situations ("he didn't ask me out becasue I'm fat")

-All-or-nothing thinking: Reasoning is absolute and extreme, in mutually exclusive terms of black or white, good or bad ("If I allow myself to gain weight, I'll blow up like a balloon")

-Catastrophizing: The consequences of an event are magnified ("If I gain weight I'll ruin my weekend")

-Personalization: Events are overinterpreted as having personal signficance ("I know everybody is watching me eat")

-Emotional reasoning: Subjective emotions determine reality ("I know I'm fat because I feel fat")

What are some psychotherapy interventions related to anorexia and bulima? (Continued)

-Enhanced CBT: is a structured, time limited treatment specfically for eating disorders. The primary focus is to establish a regular pattern of stable flexible eating and to address factors that reinforce the eating problem

-Dialectical behavioral therapy: is a form of CBT adapted to address emotional dysregulation. (More effective with bulima patients)

-Interpersonal psychotherapy: is an evidence-based therapy that focuses on resolving interpersonal stressors that may trigger feelings of loss, bodily changes, interpersonal duties and or isolation

-Maudsley anorexia nervosa treatment for adults (MANTRA): covers nutrion, symptom management, and behavior change. Motoivation and encouraging the person to work collaboratively with the practitioner are emphasized

-Specailist supportive clinical management: therapy focuses on education and support while allowing the person to decide what else should be included as part of the therapy

-Maudsley/family-based therapy: has consistently been shown to be the best treatment for children and adolescents with AN and BN

-Group therapy

What are some Pharmacologic Therapies used to treat Anorexia Nervosa and Bulima?

-Olanzapine (Zyprexa), a second-generation antipsychotic
medication, affects weight gain and improves cognition and body image.

-Fluoxetine (Prozac), a selective serotonin reuptake inhibitor
(SSRI), has shown mixed results in maintaining weight and
preventing relapse.
-More effective for Bulima becuase it SIGNIFICANTLY decreases purging and bingeing
behaviors
-Less effective for anorexia but it helps with the co-mobiid depression that
is often associated with anorexia
***Risk for suicide is increased with this medication

-Mood stablizer drugs like Topiramate may help people with Bulima to supress the urge to binge and preoccupation with eating and weight

What are some symptoms and behaviors associated with Intelluctual Disorder?

-Conceptual: Academic learning, speech (ability to verbalize needs)
-Social: Interactions with other (potential for aggression)
-Practical: Ability for self-care and life management (potential for
independence)

What are some causes of ID?

-Heredity (Tay-Sachs disease, fragile X syndrome)
-Alterations in early embryonic development (Down syndrome, fetal alcohol syndrome)
-Pregnancy or perinatal problems (fetal malnutrition, prematurity, hypoxia, infections)
-Other factors such as trauma or poisoning

What are the different levels of severity associated with intelluctual disorder?

-Mild 85% of cases:develop communication and social skills with minimal sensorimotor impairment and are often indistuigishabke drom children with normal rnage IQs. They are able to perform self care and independent living.

- Moderate 10% of cases. They develop communication, social, and academic skills slowly. Commonly read at a 1st-3rd grade level. May not interpret social cues correctly.

- Severe 3-4% of cases. Speech may be delayed or absnet. Use single word phrases or gestures. Need help with living skills. They do not marry or have children. Self harm may be present.

-Profound 1-2% of cases: Mostly non verbal and do not learn how to read. Have sensory and phyiscal impairments. Life expectancy is significantly reduced.

What are the different interventions and treatments associated with Intelluctual disorder?

-Individual and family counselling
-Appropriate schooling
-Individualized Educational Plan (IEP)
-Focus is on strengths and realistic goals

What are some types of communication disorders?

-Language
-Speech Sound Disorder
-Childhood-Onset Fluency Disorder [stuttering]
-Social Communication Disorder

What are some interventions or treatments for communication disorders?

-Referral to a speech therapist or school psychologist may be made by the parent, health care provider, or teacher.
-Speech therapy, often for several years, is provided in the school or in private settings.
-Supportive counselling may be needed to address self-esteem issues.

What are some symptoms and behaviors of Specific Learning Disorder?

-Difficulty in learning and academic skills, often in a specific area
(Reading, Written Expression, Math), e.g., dyslexia, dyscalculia
-Onset in Elementary school years (5% to 15%)
-Teacher or parents may report problems
-More common in boys than girls

What are some symptoms and behaviors of Developmental coordination disorder?

-Delayed coordinated motor skills: clumsiness, slowness, difficulty with handwriting or riding a bike

What are some symptoms and behaviors of Autism Spectrum Disorders?

-Characterized by a withdrawal of the child into the self and into a fantasy world of his or her own creation.
-Present with deficits in social and communication interactions, as well as repetitive patterns of behavior, interests, or activities
-Severity (Levels 1, 2, and 3) based on functional ability, social deficits, as well as communication
-Have self-stimulatory or "Stimming" behaviors such as: twirling, walk on their toes, falp their arms, rocking, tapping fingers on legs, banging head on floor, or biting
-May be loners and dislike social interaction
-May dislike physical affection (ex: hates to cuddle)
-Occurs more in boys than girls

*Must demonstrate two or more of the following: (DSM-5)
-Stereotyped or repetitive speech, motor movements, and echolalia, and the repetitive use of objects
-Excessive adherence to routines, rituals, or excessive resistance to change
-Fixated interests that are abnormal in intensity
-Hyporeactive or hyperreactive to the sense of joy or unusual interest in sensory aspects of the environment (e.g., indifference to pain, heat, cold)

What are the different leves of sevrity of Austism Spectrum disorder?

Level 1: There is a noticeable social deficit. Language and speech are normal. Individuals have diffculity switching between activities. Struggle with organization and planning.

Level 2: Noticeable deficit in social and communication skills. Social impairments and repetitive behaviors are obvious to others. These indivdiuals do not tend to initiate social interactions and changes in routine causes distress.

Level 3: Social deficits are severe with communication being limited and needs-based. Individuals may be nonverbal, speak in few word sentences, be difficult to understand, make odd noises, echo a word or sentence over and over again, or use overly literal language. Repetitive and restricitve behaviors markedly interfere with functioning in all spheres. Changing focus, action, or routine causes great distress. Agression toward self or others is more common at this level.

What are some treatments or interventions for Austim Spectrum Disorder?

-Behavioral management
-Cognitive therapies
-Early intervention
-Educational and school-based therapies
-Joint therapy
-Sometimes atypical antipsychotics, SSRIs, or beta blockers

Nursing interventions for the child with ASD are aimed at
-Protection of the child from self-harm
-Improvement in social functioning
-Improvement in verbal communication
-Enhancement of personal identity

Pharmacological interventions include
-Risperidone (Risperdal)
-Aripiprazole (Abilify
-Both are antipsychotics
-Targeted for the following symptoms
Aggression
Deliberate self-injury
Temper tantrums
Quickly changing moods
*Dosage is based on weight of the child and the clinical response.
-May take SSRIs like Fluoxetine (Prozac) and Sertraline (Zoloft) to improve anxiety or obsessive traits

What are the desired outcomes for a patient with Austim Spectrum Disorder?

-Exhibits no evidence of self-harm
-Interacts appropriately with at least one staff member
-Demonstrates trust in at least one staff member
-Is able to communicate so that he or she can be understood by at least one staff member
-Demonstrates behaviors that indicate he or she has begun the separation/individuation process

What are some symptoms and beahviors of ADHD (Attention Deficit Hyperactivity Disorder)?

-Essential features of ADHD include developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity.
-Diagnosed as combined presentation, predominantly inattentive presentation (formerly called ADD), predominantly hyperactive or impulsive presentation.

-Symptoms: Problems with concentration and focus, easily distracted, appearing not to listen when spoken too, lack of follow-through, organizational and time-management challenges, and forgetfulness

-Misplace items, tend to be messy, may fidget, squirm, leave their seat at school, run or climb when not appropriate, blurt out answers or comments, interrupt, talk excessively

-Impulsive, extremely limited attention span, low frustration tolerance and temper outbursts, difficulty in performing age-appropriate tasks

What are some treatments or interventions of ADHD?

Nursing interventions for the child with ADHD are aimed at
-Ensuring that client remains free of injury
-Encouraging appropriate interactions with others
-Increasing feelings of self-worth
-Fostering motivation for compliance with tasks

Pharmacological interventions include
***Pharmacological intervention for ADHD is most effective when it is combined with other therapy, such as
-Behavioral therapy
-Individual counseling or psychotherapy
-Family therapy
Central nervous system (CNS) stimulants
-Examples:
Dextroamphetamine (Dexedrine Spansule, Zenzedi, ProCentra)
Methamphetamine (Desoxyn)
***Lisdexamfetamine (Vynase)
***Methylphenidate (Ritalin)
Dexmethylphenidate (FocalinXR, Focalin)
***Dextroamphetamine/Amphetamine mixture (Adderall)

What are the side effects associated with ADHD medications?

-Side effects: Insomnia, anorexia, weight loss, tachycardia, decrease in rate of growth and development
***Must have full cardiac work before starting stimulants

What are the desired outcomes for a patient who has ADHD?

-Has experienced no physical harm
-Interacts with others appropriately
-Verbalizes positive aspects about self
-Demonstrates fewer demanding behaviors
-Cooperates with staff in an effort to complete assigned tasks

What are the symptoms and beahviors of Tourette's Disorder?

-The essential feature of Tourette’s disorder is the presence of multiple motor tics and one or more vocal tics.
-Onset may be as early as 2 years but occurs most commonly around age 6 or 7.
-The disorder is more common in boys than in girls

-Simple motor tics include eye blinking, neck jerking, shoulder shrugging, and facial grimacing.
-Complex motor tics include squatting, hopping, skipping, tapping,
and retracing steps.
-Vocal tics include words or sounds such as squeaks, grunts, barks, sniffs,
snorts, coughs, and, in rare instances, a complex vocal tic involving the uttering of obscenities.
-Palilalia (repetition of one's of words)
-Echolalia (repetition of words spoken by others)

What are some interventions and treatments associated with Tourette's disorder?

Nursing care of the client with Tourette’s disorder is aimed at
-Safety of client and others
-Encouraging interpersonal interaction using appropriate behaviors
-Promoting increased feelings of self-worth

 Pharmacological interventions include
**Pharmacological intervention for Tourette’s disorder is most effective when it is
combined with other therapy, such as
-Behavioral therapy
-Individual counseling or psychotherapy
-Family therapy
Common medications used for Tourette’s disorder
-Antipsychotics (haloperidol (Haldol), risperidone (Risperdal), pimozide (Orap), aripiprazole (Abilify))
*Can help control tics
-Alpha agonists

What are the desired outcomes for a patient who has Tourette's Disorder?

-Has not harmed self or others
-Interacts with staff and peers in an appropriate manner
-Demonstrates self-control by managing tic behavior
-Follows rules without becoming defensive
-Verbalizes positive aspects about self

What are symptoms and behaviors of Oppositional Defiant Disorder (ODD)?

-Is characterized by a persistent pattern of angry mood and defiant/headstrong behavior that occurs more frequently than is usually observed in individuals of comparable age and developmental level and interferes with social, educational, or vocational activities.

-Almost all children show symptoms found in ODD. However, for ODD to be diagnosed, the behaviors need to occur “more persistently and frequently.”

-Is more likely to occur if: If power and control are issues for parents, or if they exercise authority for their own needs, a power struggle can be established between the parents and the child, which sets the stage for the development of ODD.

*Characterized by passive-aggressive behaviors
-Stubbornness, procrastination
-Disobedience, negativism
-Carelessness, testing of limits
-Resistance to directions
-Unwillingness to cooperate
-Running away
-School avoidance and underachievement
-Temper tantrums, fighting, and argumentativeness
-Impaired interpersonal relationships
-Vindictive
-Blames others for problems
-Deliberately annoys others

**Usually, these children do not see themselves as being oppositional, but view the problem as arising from other people that they believe are making unreasonable demands on them.

What are some interventions associated with ODD?

Nursing care of the client with ODD is aimed at:
-Encouraging cooperation with therapy
-Helping client accept responsibility for own behaviors
-Promoting increased feelings of self-worth
-Assisting in the development of socially appropriate behaviors in interactions with others

What are the desired outcomes for a patient who has ODD?

-Complies with treatment by participating in therapies without negativism
-Accepts responsibility for his or her part in the problem
-Takes direction from staff without becoming defensive
-Does not manipulate other people
-Verbalizes positive aspects about self
-Interacts with others in an appropriate manner