psych ATI

Clang associations: Words that rhyme 

( Basketball in the hall very tall)

(Me, See, Bee, Tree)

( I’m blue, so are you, and i’m leaving on a choo,choo,choo!)

(I can play the flute while wearing a suit. You are cute)



Neologisms: Made up words

(I’m feeling schmoolizious today)

(Her mannerologies are poor)



Word salad: String of words that don’t make sense 

(Option, contrary, moose, allergic)

(My dog blank a boat to supreme heights)



Echolalia: Consistent repeating of another's words by imitation. Seen in autism or tourettes



Magical thinking: Belief that thoughts have control over specific people & situations. 

 

Associative looseness: A pattern of disordered speech that reflects illogical thoughts

(A match. I like matches. They are the givers of light, the light of the world. Let your light shine on)




Manic phase of bipolar disorder

  • Manic phase of bipolar disorder → Pt is hyperactive, short attention span, seductive behaviors

  • Chlorpromazine treats manic behavior in BP, 



  • Relapse of mania: Pressured speech and weight loss.



Acute manic episodes need what kinds of nutrition?

  • High-calorie/ high protein finger foods (Ex: Chicken nuggets, crackers w/ cheese sticks, a cookie)

  • Provide decreased stimulation and encourage client to participate in quiet activities with a single staff member

  • Eliminate caffeine

  • Encourage frequent rest periods

  • Maintain adequate hydration

  • Spends excessive amounts of money

  • Speakys crassly using a loud voice

  • Protect the client from impulsive behavior



Anxiety phases

  • Mild 

  • Heightened perceptual field

  • Moderate

  • Difficulty concentrating

  • Panic

  • Stay with client and speak in a calm manner

  • Use repetition when speaking with the client

  • Never leave pt alone

  • Move pt to a quieter setting

  • Patients will not be able to express her feelings

  • SOB

  • Impending doom



  • Manic

  • Form of speech is rapid, frenetic, incoherent, false sense of urgency 



PTSD

  • Insomnia

  • Repress emotions and appear detached

  • Indecisiveness

  • Avoid situations that might trigger memories

  • Medication: Paroxetine



Rape-Trauma syndrome

  • Report of intense guilt

  • Mood Swings and intense emotions

  • Exhibits dependence toward others




Restraints

  • Document client’s behavior every 15 minutes

  • Plan for one-on-one observation by staff while the client is in restraints 

  • Ensure 2 fingers can fit b/ween the restraints



Schizophrenia manifestations

  • Positive manifestations (content of thought, form of thought, perception, sense of self) (Cognitive symptom: Memory impairment, impaired judgment, and problem-solving)

  • Hallucinations (Perception)

  • Religiosity or magical thinking

  • Delusions 

  • Paranoia

  • Disorganized speech

  • Depersonalization

  • Concrete thinking

  • Associative looseness



  • Negative manifestations (affect with the client ability to cope with and adjust to social situations)

  • Social withdrawal & impaired ability to interact w/others

  • Anergia (Lack of energy)

  • Flat affect

  • Social discomfort

  • Inability to enjoy activities

  • Lack of goal-directed behavior



Distraction techniques: Whistling or signing for schizophrenics



Types of schizophrenia delusions

  • Erotomanic delusion

  • Client believes another person desires him or her romantically after meeting only a few times

  • Ex: “I have only met jenny twice, but I know she loves me”



  • Persecutory delusion

  • Client believes he or she is being singled out for harm

  • Ex: my coworker is trying to poison me because he is afraid ill take his job



  • Nihilistic delusion

  • Client who has conviction that a major catastrophe will occur

  • Ex: I am selling my house before the earthquake hits in may



  • Control delusion

  • Client believes others or outside forces can control the clients thoughts, feelings, impulses or behaviors

  • Ex: The foil on my walls prevents the government from controlling me



Schizophrenia (Involuntary commitment)

  • A court-ordered mandate requiring admission of a client to receive mental health services at a mental facility. 

  • 2 doctors or other mental health professionals must agree to support the commitment application

  • Client has the right to treatment decisions

  • The client can challenge hospitalization following emergency treatment

  • 60 days of admission



Types of delusions

  • Somatic: believe that body parts are no longer functioning in a realistic manner

(My organs have turned to stone)

  • Reference: Believes that occurrences in the environment are because personal actions

  • Persecutory: Believes that something wants to intentionally cause harm

  • Grandiose delusion: Believes they have a superior position 

( I am the king, everyone should bow to me)




Schizophrenia Medication

Chlorpromazine 

  • Reduces hallucinations, delusions, agitation

  • Adverse effects: Sedation

Haloperidol (schizophrenia meds)

  • Adverse effects: Tardive dyskinesia (Involuntary movement of many body parts). Writhing movements of the tongue and smacking of the lips. Effects are irreversible 



Oppositional defiant disorder Manifestations

  • Ignores unit rules

  • anger/ irritability

  • Enjoys obtaining rewards

  • Has little regards for penalties or punishment (loss of privileges for negative behaviors)



Conversion disorder manifestations

  • Deficit in motor or sensory function

  • Paralysis

  • Blindness

  • Movement disorder

  • Numbness

  • Paresthesia

  • Loss of hearing

  • “Stress of losing our child caused my partner to go blind”



Borderline personality disorder

  • Self-mutilation

  • Impulsive behaviors

  • sucidie


Antisocial personality disorder

  • Lacks of remorse and lacks care for authority and rules

  • Lacks empathy

  • Sees themselves as superior to others

  • Use flattery as a form of manipulation



Lithium Carbonate

  • Drink 6-8 glasses of water p.d. 

  • Consume adequate amount of sodium to prevent toxicity

  • Weight gain

  • DO NOT take ibuprofen (NSAIDs)

  • Effectiveness: reduced aggression 

  • Adverse effect: Hypothyroidism, polyuria, weight gain 5 lbs first week, fine hand tremors



Lithium toxicity (2-2.5)

  • Blurry vision

  • Ataxia

  • Clonic twitching

  • Severe hypotension

  • Polyuria



Lithium Toxicity (1.0-1.5)

  • Nausea and frequent emesis

  • Muscle weakness

  • Fine hand tremors



Valproic acid (seizure medication)

  • Monitor liver functions due to risk of hepatotoxicity 

  • Obtain baseline levels; repeat tests every 2 months during 1st 6 months of therapy

  • Initially prescribed small dose → gradually increase dose

  • Avoid aspirin due to increased risk of spontaneous bleeding




Antidepressant medication (ONLY DRUG TO TAKE 2-3 WEEKS FOR FULL EFFECT)

  • Takes up to 6 weeks to achieve full therapeutic effects

  • Take each day at bedtime to decrease sleepiness during the day

  • Avoid drinking alcohol

  • Dizziness is expected

  • Older adults require a lower initial dose



Social anxiety medication

  • Paroxetine: Takes 4 weeks to develop. Optimal effects are seen in 8-12 weeks

  • Continue for 1 year 

  • Venlafaxine: Stopping abruptly will lead to withdrawal. Approved for long term and short term, will do little to decrease somatic manifestations

  • Venlafaxine is an antidepressant that takes several weeks to take effect

  • Benzodiazepine: Adverse effects → Sedation, tachycardia, dizziness, drowsiness. Sudden withdrawal can cause seizures. ** DO No prescribe to someone with HYPOTENSION

  • Examples of benzos: Alprazolam → drowsiness, orthostatic hypotension

  • Buspirone for anxiety: Avoid consuming grapefruit, take twice daily, peak takes several weeks to occur, can alleviate muscle spasms, seizures, and insomnia

  • adverse effect: nausea, dizzy, headache, nervousness, sedation, lightheadedness, excitement, xerostomia and dry mouth, blurred vision



OCD Medication

  • Fluoxetine: Discontinue medication slowly over 1-2 months. Adverse effect → gaining weight



Antipsychotic first-generation medication adverse effects

  • Akathisia → client is unable to rest, rocks back and forth, pacing the floor. Propranolol treats akathisia

  • Akinesia: muscular weakness. Noticeable 1-5 days after starting antipsychotics. Occurs in women, older adults, and dehydrated clients

  • Dystonia: involuntary muscular movements of the face, arms, legs, and neck. Occurs in men who are 25 and younger.



Stages of grief

1st. Denial: Protective reaction that distances client from psychological pain. Initial reaction!! 

  • EX: Client has chronic alcohol use disorder and claims that her family is exaggerating the problem

2nd. Anger

3rd. Bargaining (Client hopes for a positive outcome and attempts to strike a bargain w/ a higher power to allow more time).

4th. Depression (Client recognizes the inevitability of dying and works through depression to achieve acceptance)

5th. Acceptance



Types of grief

Disenfranchised grief: social expectations restrict an individual's ability to cope with grief

Chronic grief: maladaptive grief response which can impact clients ADLs and last a long time

Uncomplicated grief: expected reactions to loss and death

Delayed grief: Absence of an expected response; unable to accept the reality of the loss. 

Complicated grief: Client has difficulty carrying on normal activities following the loss of a partner 

Ex: I feel so empty without my wife that it’s hard to get up every morning

Maladaptive grief: when death is a result of violence, traumatic, or experienced




Types of loss

Actual loss

  • A person can no longer interact with a loved one or loses a job or an item

Perceived loss

  • Less obvious to those around an individual (being shunned by a friend)

Situational loss

  • Loss is sudden and unpredictable (losing a job or developing a disability)

Adventitious crisis

  • Unplanned and not apart of everyday life (A client who is depressed following a devastating fire in her home)

Maturational loss

  • Normal, expected life changes (child going to school or an adult moving out of state)



Defense mechanisms

  • Regression

  • Reverting to a previous child-like behavior

  • compensation

  • Counterbalance a deficiency w/ a strength

  • Example: I drink alcohol to forget the pain

  • repression

  • Unconscious act of avoiding unpleasant experiences, emotions, or ideas from consciousness

  • Suppression

  • Conscious act of avoiding stressful situations 

  • Ex: I won’t worry about losing my job until my child’s break from school is over

  • Projection

  • Blaming

  • Rejection of emotionally unacceptable feelings by attributing those feelings to others

  • Splitting

  • Inability to integrate the positive and negative qualities of oneself into a combined idea

  • Rationalization

  • Justification of unacceptable behavior

  • Ex: I didn’t get the promotion at work because my boss hates me

  • Displacement 

  • Transference of feelings for a person to a less threatening one

  • Ex: My partner yelled at me, so I made the cat go outdoors.

  • Ex: I’ve received terrible care here, and no one bothers to help me




Boundaries therapeutic relationships

Countertransference: Ex: A nurse is caring for a client who reminds her of a negative person in her past

Transference: Unconscious displacement of feelings towards the nurse



Dissociative disorders

Derealization disorder: The feeling that surroundings are unreal

Dissociative amnesia: Inability to recall important personal information. Occurs after a traumatic or stressful event

Dissociative fugue: Inability to recall all or some info from the past.

Dissociative identity disorder: presence of 2 or more personalities



Cognitive impairments

  • Confabulation: Filing in gaps in memory by fabrication

  • Preserveration: repetition of phrases exhibited by clients under stress

  • Apraxia: loss of purposeful movement in the absence of motor impairment. Tasks that were done before.

  • Agnosia: loss of the sensory ability to recognize objects



Involuntary admissions

  • Client who is a danger to self or others qualifies for involuntary admission

  • Clients retain the right to refuse medications

  • Required to remain in the facility for 60 days. After a legal review of the case will determine if continued involuntary treatment is needed.

  • Unable to leave health care facility



Anorexia Nervosa 

  • Monitor client 1 hr following meals and snacks to prevent purging

  • Weigh the client each day prior to any oral intake

  • Explain that tube feeding will be necessary if the client refuses oral intake

  • (Contraindicated: permit the client to spend quiet time alone after eating) 

  • Manifestations: Lanugo, pale or yellow skin fro, hypercarotenemia, hypoactive bowels, hypothermia, strenuous exercise regimen

Restrictive anorexia nervosa

  • Decreased caloric intake



Types of therapy

  • Systematic desensitization: Slowly exposed to increasing levels of public or frightening spaces

  • Modeling: Encourage client to watch as therapist acts as a role model in anxiety provoking environments

  • Flooding: You will start your therapy by staying in a public space until your anxiety decreases.



Reminiscence therapy: Goals → gain increased self-esteem



Behavioral techniques (relaxation techniques)

Mindfulness

  • Engages insular cortex as the person focuses on the sensations and surroundings of the present moment


Progressive relaxation

  • Focuses on tightening and relaxing muscle groups to reduce muscle tension



Cognitive refraining 

  • Reduces anxiety as the individual changes how to interpret thoughts in a positive way



Dialectical behavior treatment group is for

  • Suicidal behavior



Co-dependents support group is for

  • Family or others who are substance abusers. 

  • This group enables the substance abuser by excusing their lack of responsibility for their behavior



Dual diagnosis treatment group is for

  • People with serious mental illness along with substance use disorder




Heroin intoxication manifestations

  • Respiratory depression

  • Impaired coordination

  • Pain reduction

  • Drowsiness & sedation



Heroin withdrawal

  • Muscle aches 6-8 hrs

  • Insomnia

  • Pupillary dilation

  • Diarrhea



Assessment tools

  • AIMS: Tracks involuntary movements in pts with tardive dyskinesia

  • CAGE (Cut annoyed guilty eye-opener): Diagnose alcohol use disorder

  • Hamilton anxiety rating scale: Measure psychological distress and physical symptoms associated with anxiety

  • SAFE-T (suicide assessment five-step evaluation and triage): Assess pts risk for suicide 



ECT

  • Reorient client to the environment after

  • NPO for 6-8 hours before the procedure

  • Client should awaken 15 minutes after ECT

  • Short-acting general anesthetic & muscle relaxant is administered prior

  • Administer atropine prior → atropine decreases oral secretions and counteracts bradycardia which can occur due to vagal stimulation 

  • POTENTIAL COMPLICATION: Cardiac arrhythmia 

  • DO NOT take benzodiazepines before procedure cause ECT causes seizures 

  • ECT is prescribed 2-3 times a week for 6-12 treatments total

  • Administer oxygen 

  • Retrograde amnesia



TMS (Transcranial magnetic stimulation)

  • Seizures



Conduct disorder

  • Aggressive behavior toward others

  • Violate others rights impulsive

  • Exhibit lack of respect for authority figures/ might attempt to fight w/ or intimidate others

  • Easier angered

  • Lack of respect for rules



Alcohol withdrawal manifestations

  • Headache Occurs 4-12 horus

  • Tremors “shakes or jitters” after 6-8 hours cessation, insomnia and restlessness

  • Seizures (tonic-clonic) occur within 12-24 hours after cessation 

  • Delirium tremens occur in the first 72 hours (3 days), hallucinations and delusions can occur. medical emergency

  • Hypertension occurs after 6-8 hours of cessation

  • Increase HR (tachycardia)

  • Administer lorazepam if the client has increased blood pressure to stabilize vital signs, prevent seizures, and treat delirium. 

  • Elevated temperature

  • Nausea & vomiting

  • Sweating

  • Depression

  • Irritability

  • Slurred speech

  • insomnia



Mild alcohol withdrawal 

  • Decreased appetite

  • Insomnia



Severe alcohol withdrawal

  • Hallucinations

  • Diaphoresis

  • Hyperthermia

  • tachycardia



Alcohol medication

  • MAINTENANCE MEDICATION:Disulfiram is given for the management of alcohol dependence: avoid pure vanilla extract and alcohol containing substances

  • Disulfiram adverse reactions: hyperventilation, dizziness, vomiting, hypotension

  • Diazepam for alcohol withdrawal: This medication can be habit-forming, feelings of sedation should resolve in about 1 week

  • Lorazepam: First treatment 

  • Carbamazepine: antiepileptic medication treats alcohol withdrawal

  • Acamprosate: adverse effects: diarrhea

  • Chlordiazepoxide



Wernicke-Korsakaoff syndrome due to alcohol use disorder causes

  • Confusion

  • Stupor

  • Diplopia

  • Memory loss

  • Somnolence



Cannabis can produce effects resembling alcohol



Methamphetamine Acute manifestations

  • Increase HR and BP

  • Mental alertness

  • Reduced appetite

  • Paranoia




Cocaine intoxication manifestations

  • Dilated pupils

  • Elevated BP & temp

  • Hypervigilance 

  • hyperactivity



Inhaling cocaine (CNS stimulants) manifestations

  • Hallucinations and delirium

  • Grandiosity

  • Euphoria

  • Tachycardia



Cocaine withdrawal

  • Depressed




Opioid withdrawal

  • Rhinorrhea

  • Insomnia

  • Tachycardia

  • Hyperthermia

  • Muscle spasms

  • Hyperreflexia

  • Diarrhea

  • Increase RR



Opioid withdrawal medication

  • Methadone

  • Buprenorphine

  • Naltrexone



Nicotine withdrawal medication

  • Wareniciline

  • Rimonabant



Alzheimer's disease 

  • Impaired judgment

  • Personality change

  • Remote memory loss

  • Confusion that develops over time

  • Medication: Memantine → moderate to severe alzheimer’s disease

  • Donepezil: improves cognitive functioning during earlier stages of the disease

  • Administer at bedtime

  • NSAIDs increase bleeding

  • Take for 4-6 weeks to increase dosage




  • Stage 4 Alzheimers

  • Able to eat without assistance

  • Has difficult managing personal finances

  • Uses toilet independently

  • Able to identify names of family members



  • Stage 6

  • Unable to identify the names of family members



Delirium

  • Request prescription for antianxiety 

  • Low stimulation environment

  • Keep room well-lit

  • Limit needs to make decision



Dementia

  • Progressive deterioration of cognitive function

  • Loss of language ability