Avoidance of difficult realities by ignoring or refusing to recognize them, or minimizing the impact or effect something wil have on their life.
Attributing one’s own thoughts or impulses to another person.
Feelings, emotions and conflicts are expressed behaviorally, rather than through language.
Excessive reasoning of logic used to avoid painful emotions.
Offering a socially acceptable or apparently logical explanation to justify or make acceptable otherwise unacceptable impulses, feelings, behaviors and motives.
Voluntary psychiatric hospitalization.
Person signs themselves into the hospital and must give 72 hours notice of intent to leave.
Involuntary psychiatric hospitalization.
2 physicians determine that a person meets criteria and can be hospitalized without consent.
Emergency petition for psych evaluation.
Person can be taken to ED for evaluation.
What is Transference?
An unconscious response of patients in which they experience feelings and attitudes toward the nurse that were originally associated with significant figures in their lives- may be positive or negative
What is Counter transference?
An emotional response of the nurse that is generated by the patient’s qualities that stimulate emotions based on their own personal experience that results in behavior based that is not appropriate to the therapeutic relationship
Psychiatric medication that is extremely addicting.
Length of time by which an involuntary hospitalized patient must have a hearing.
Axis I Diagnosis
Psychiatric Clinical Disorders
Axis II Diagnosis
Personality disorders, mental retardation
Axis III Diagnosis
Axis IV Diagnosis
Psychosocial and environmental problems
Axis V Diagnosis
Global Assessment of Functioning (GAF)
What Axis is MDD?
What Axis is Schizophrenia?
What Axis is poly-substance abuse?
What Axis is obsessive compulsive personality disorder?
What Axis is alcohol and drug dependence?
What Axis is eating disorder?
How old does a person have to be to be diagnosed with a personality disorder?
At least 18 years old
What GAF score is assigned to out of control behavior or danger to themselves?
What GAF score is assigned to in control, serious problems?
What GAF score is assigned to average or above average function?
Best predictor of suicide?
Parts of the Mental Status Exam.
Thought Processes and content
Tool used to assess cognitive functioning.
Mini Mental Status Exam
Difference between Mood and Affect.
Mood is what the patient tells you
Affect is what you observe
What may waxing and waning of LOC indicate?
Four areas of memory?
Five elements of speech assessment.
Loosening of Associations (LOA)
Lack of connectedness in thoughts and ideas with sudden illogical shifts in topic without any relation to the preceding topic.
Gets off topic very easily and ends up on a totally different topic though it may have had some relation to the original topic.
Difficulty getting to the point because of lengthy unnecessary detail about the topic.
Flight of Ideas
Rapid thoughts that are often fragmented and shifting topics.
Excessive focus on a topic, activity, or idea which interferes with all interactions and activities.
FIXED FALSE BELIEFS that are outside of the norms for the patient’s social, cultural or religious background. They often have a theme and can be classified as paranoid, religious, grandiose, somatic or erotomanic.
The belief that others can read their mind or hear their thoughts.
The belief that others are putting thoughts in their head.
Ideas of influence
The belief that someone/something is controlling their behavior.
False sensory experiences. It’s not really there.
Misperceptions or misrepresentations of real external sensory stimuli. It’s there but it’s not what you perceive it to be.
Hallucinations often seen with brain tumors.
Gustatory and olfactory
Hallucinations often seen in schizophrenics.
Ability to understand cause and effect, especially concerning one’s own actions
Ability to make accurate analysis of a situation and choose appropriate actions
Person is unaware of their disability. Common in right hemisphere strokes.
Location of Broca’s area.
Left hemisphere, back of fronal lobe.
Location of Wernicke’s area.
Most people have it on left in temporal lobe.
Location in brain where executive function occurs.
Function in Precentral Gyrus
Primary motor area
Function of Prefrontal cortex
What is Executive Function?
Planning, organizing, and carrying out complex behavior
Functional areas of Parietal Lobe
Postcentral Gyrus = Primary sensory cortex
Touch, pain, temperature, proprioception
Functional areas of Temporal Lobe:
Primary auditory cortex
Connects left and right brain.
Relay station for most information going into the brain
Regulates blood pressure, body temperature and sex hormones.
Regulates heartbeat and other visceral functions, and processes the emotion fear
Helps establish long term memory in regions of the cerebral cortex.
Control of breathing, heartbeat, circulation and digestion.
Control system for movement and cognitive function.
Bradykinesia, hyperkinesia, and hypokinesia all suggest disease of, or damage to…
Neurotransmitter that regulates arousal, concentration, learning and memory, mood, stress response
Neurotransmitter that regulates stress response
Neurotransmitter that regulates arousal, concentration, learning and memory, mood, stress response
Neurotransmitter that regulates mood, appetite, eating behavior, sleep, depression and anxiety
Neurotransmitter that regulates sleep/wake
Percentage of psychiatric illness that is explained by genetics?
No more than 50-70%
What is the Diathesis Stress Model?
Genetic vulnerability + stressor → expression of psychiatric disorder
Special considerations regarding children and medication.
Have greater hepatic capacity and glomerular filtration rates, may be less able to store medication in body fat. Shorter half-life.
Special considerations regarding the elderly and medication.
GI disease may decrease absorption
Slower metabolism increases toxicity risk
May have greater sensitivity to psychotropics
Multiple medication interaction
More susceptible to adverse effects
Common side effects of Tricyclic Antidepressants
Atypical antipsychotics increase mortality among elderly patients with these conditions…
dementia and psychosis
Most psychotropics are this pregnancy category
Category C, some are Category D (anticonvulsants).
Psychotropics that pass through breast milk.
All of them.
How cholinesterase inhibitors work.
Decrease metabolism of ACh by cholinesterase
How Monoamine Oxidase Inhibitors work.
Decrease metabolism of transmitters by MOA
How antipsychotic drugs work.
Block dopamine from binding with receptors
How atypical antipsychotics and some antidepressants work.
Block specific serotonin receptor families
How benzodiazepines work.
Enhance the effects of GABA at the receptor
Receptor sensitivity changes
Receptor becomes more or less responsive
Leaves more neurotransmitter in synapse
Five key concepts of recovery.
Ragin’s Four Stages of Recovery
•SELF – RESPONSIBILITY
•A MEANINGFUL ROLE IN LIFE
10 Fundamental Components of Recovery
Individualized & Person-centered
What is a more important criterion of recovery than being symptom free?
Personal process of recovery.
The process of positive adaptation to the illness and living a satisfying life (patient’s role)
Treatment process of recovery
The external conditions that can facilitate personal recovery (practitioner’s role)
Recovery oriented services are reimburseable by…
Medical assistance. Not medicare.
Biggest barrier to recovery according to 1999 Surgeon General’s Report on Mental Health.
Percent of homeless population in US that suffers from some form of severe mental illness.
Percent of Americans that are severely mentally ill.
Third largest cause of homelessness for single adults.
What population is overrepresented in the US’s homeless population?
African American Men
How many years shorter is the life expectancy of a schizophrenic?
Percent of schizophrenics that attempt suicide? Succeed?
What changes brain development of a fetus that may increase vulnerability to schizophrenia?
Percentage of patients with schizophrenia have a co-occurring substance abuse disorder (alcohol/cannabis).
What neurobiological findings in schizophrenia can be seen with a PET scan?
Decreased blood flow to frontal lobes
Decreased size of thalamus
Increased activity of basal ganglia
What is the dysregulation hypothesis related to schizophrenia?
There are overactive dopamine pathways to the mesolimbic areas of the brain and underactive pathways to the mesocortical areas and there is an imbalance between serotonin and dopamine neurotransmitter systems.
Schizophrenia diagnosis criteria according to the DSM IV-TR:
At least two of the following signs/symptoms present for at least 6 months:
Grossly disorganized/catatonic behavior
What is schizophreniform disorder?
Meets criteria for schizophrenia and episode lasts at least one month but less than 6 months.
Positive symptoms of schizophrenia.
Negative symptoms of schizophrenia
Cognitive symptoms of schizophrenia.
Executive Functions impaired
Mood symptoms of schizophrenia.
Social/occupational dysfunction in schizophrenia.
Types of delusions:
Schneiderian 1st Ranks Symptoms:
Ideas/delusions of reference
Positive symptoms of Schizophrenia
Other odd/unusual behaviors
Some examples of disorganized thoughts:
Loosening of associations
Negative syptoms of Schizophrenia
Alogia (poverty of speech)
Cognitive Symptoms of Schizophrenia
Poor attention span
Executive function impairment
Effect of nicotine/smoking on schizophrenics
It is hypothesized that nicotine may help with cognitive functioning and negative symptoms.
Mood symptoms with schizophrenia
High risk times for suicide in schizophrenics.
1. Periods when they are very psychotic and out of touch with reality.
2. Periods when they are very depressed
3. In the first 6-9 months after they have started first taking meds
Features of paranoid schizophrenia.
Pre-occupation with 1 or more delusions or frequent auditory hallucinations. No disorganized thoughts
Features of disorganized schizophrenia.
Flat of inappropriate affect
Does not meet criteria for catatonic schizophrenia
Features of catatonic schizophrenia.
At least two of the following:
2.excessive motor activity
3.extreme negativism or mutism
4.peculiarities of voluntary movement
Feature of undifferentiated schizophrenia.
Symptoms meeting general criteria are present byt criteria for other types are not met.
Features of residual schizophrenia.
Criteria for schizophrenia are not met, nor are those for any other subtype.
Risk factors for poor outcome in people with schizophrenia.
Poor premorbid adjustment
Inappropriate affective response:
Enlarged cerebral ventricles
Reduced blinking rates
Poor response to meds
Criteria for schizoaffective disorder:
Has signs/symptoms of BOTH schizophrenia and a mood disorder and the mood and psychotics symptoms are concurrent.
Criteria for delusional disorder:
Non-bizarre delusions at least 1 month
No symptoms characteristics of schizophrenia
May function well
Criteria for Brief psychotic disorder
Psychotic symptoms for more than 1 day and less than 1 month
How do typical antipsychotics work?
Block dopamine (D2) receptors
Indications for typical antipsychotics:
Effect of typical antipsychotics on positive and negative symptoms:
Decrease positive symptoms
Can worsen negative symptoms
How long it takes for an antipsychotic medication to take effect…
Time it takes for typical antipsychotic to take full therapeutic effect….
Difference in side effects between high and low potency typical antipsychotics:
High potency = greater risk of EPS, less sedation and anticholinergic effect
Low potency = greater sedation and anticholinergic effect, lower risk of EPS