Mental Health Final

Key criteria to understand about the diagnosis of Schizophrenia

1. It is a chronic mental disorder

2. Develops in young adulthood (20s)

3. Changes brain, loss of reality, delusions, hallucinations, and decision-making issues

What does positive symptoms of schizophrenia mean

In excess, something that’s there that’s not normally there

Bizarre vs non-bizarre

Bizarre: Makes no sense

Non-bizarre: Resonable, but no evidence

Nihilistic, somatic, and erotomanic delusions

Nihilistic: Someone/something is out to get them

Somatic: Something is wrong with their body

Erotomanic: Excesssive thinking that is not evidence based

What does negative symptoms of schizophrenia mean

Absence or reduction of normal emotional and behavioral functions

Avolition, alogia, anhedonia, and asociality

Avolition: Lack of motivation or ability to initiate and persist in goal-oriented activity (personal hygiene)

Alogia: Poverty of speech; reduced verbal output or content, brief or empty replies to questions

Anhedonia: Inability to experience pleasure from activities that normally bring joy

Asociality: Lack of interest in social interactions and relationships

Echolalia

Repetition or echoing of another person’s spoken words

Negativism

Resistance to instructions or attempts to be moved, sometimes doing the opposite of what’s asked

Stupor

Marked decrease in responsiveness to the environment; patient appears unaware and immobile

Catatonic excitement

State of extreme, purposeless hyperactivity without obvious external cause

Mutism

Absence or minimal use of speech despite the ability to speak

Adverse muscle effects associated with 1st generation antipsychotics (Thorazine and Haldol). Dystonias, pseudoparkinsonism, akathisia, tardive dyskinesia

Dystonias: Sudden, involuntary muscle contractions causing twisting, repetitive movements, or abnormal postures

Pseudoparkinsonism: Drug-induced symptoms that mimic Parkinson’s disease

Akathisia: Feeling of inner restlessness with a strong urge to move; most subjective and distressing EPS

Tardive dyskinesia: Late onset, potentially irreversible movement disorder involuntary repetitive movements

Teachings when taking Olanzapine

• Significant weight gain

• Increased appetite

• Drowsiness

• Monitor blood glucose and lipid levels

• Risk of diabetes and hyperlipidemia

Teachings when taking Aripiprazole

• Akathisia

• Insomnia

• GI upset

• Take in morning

• May take several weeks

Teachings when taking Quetiapine

• Weight gain

• Dizziness

• Monitor blood glucose and lipid levels

• Get up slowly to avoid diziness

Teachings when taking Risperidone

• Increase prolactin levels

• Weight gain

• EPS at higher doses

Teachings when taking Ziprasidone

• QT prolongation

• Less weight gain

• Possible sedation

When a patient is on Clozapine, why do WBC need to be monitores

Carries serious risk of agranulocytosis, a potentially life-threatening condition in which the body produces dangerously low levels of neutrophils

Neuroleptic Malignant Syndrome, what is it and how to prevent

Results from dopamine receptor blockade in brain, leading to severe autonomic, muscular, and mental status disturbances. Early recognition, stop the offending agent, supportive care, and administering medications as ordered can help prevent

Symptoms of anger

• Clenched fists

• Low-pitched verbalizations

• Yelling and shouting

• Intense eye contact or avoidance of eye contact

• Hypersensitivity, easily offended

Signs of aggression

• Pacing, restlessness

• Threatening body language

• Verbal or physical threats

• Loud voice, shouting

Examples of violent behaviors

• Throwing items at people

• Making threats of harming oneself or others

• Gestures of harming others or oneself

Verbal de-escalation

• Active listening

• Identify yourself and your role

• Bring more staff and display professionalism

• Restating what patient has said to share understanding

• Reasonable and enforceable limits

• Redirection

Physical de-escalation

• Show force

• Offering or giving instruction to go to open quiet room

• 1:1 staff monitoring

• Patient education on use of physical restraints and why they are used.

Identify some signs that a veteran needs to seek help from a mental health professional

• Drug abuse

• Harm to self or others

• Lack of self-care

Describe these trauma-related dissociative states, dissociation, dissociative amnesia, dissociative fugue, and depersonalization

Dissociation: Group of disorders that affects the mind-body connection

Dissociative Amnesia: Forgetting the details of a traumatic event

Dissociative Fugue: Unexpected travel away from home when stressed

Depersonalization: Feeling outside of one’s body, feeling like an observer

Key characteristics of adjustment disorder

• Transitioning from a continual environment to one not as stressful

• Over-reacting to a common stressor at work

What are the following medications used for: SSRI and SNRI, Buspar or benzos, Zyprexa, Ambien

SSRI or SNRI: Antidepressant for depression

Buspar or Benzos: Anxiolytics for anxiety

Zyprexa: Antipsychotics

Ambien: Anti-insomnias, better sleep at night

Identify some of the barriers to mental health care that veterans face

• Lack of mental health care providers

• Stigma of mental health treatment in the military

• Military confidentiality

Describe post-traumatic growth and identify the outcomes

Positive personal changes that result from a struggle to deal with trauma and its consequences

• Sense of personal strength

• New appreciation of life

• Improved interpersonal relationships

List and define the 3 ways to facilitate post traumatic growth

• Veteran peer social support

• Learning and mastery of new tasks

• Information processing and story-telling

Purpose of a service dog vs a therapy dog

Service dog: Support handler with a physical and/or mental disorder

Therapy dog: Provide emotional support to people

Requirements of a service dog vs a therapy dog

Service dog: Order from a medical doctor

Therapy dog: Order from a therapist

Where can service dogs and therapy dogs go

Service dogs: American with disabilities act protects the right for them to go anywhere public

Therapy dogs: Entry into businesses and rental properties are determined by the owners

Training for service dog vs therapy dog

Service dog: Canine Good Citizen Test and service dog classes

Therapy dog: Ongoing education and certification through organizations