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- Affect without any expression of feeling; unresponsive to varied topics or surroundings over time.
- ex. The patient discusses the weather and her mother's death without any change in facial expression or tone of voice
- affect does not match the feeling or the topic being discussed
- ex. person laughs when speaking of being afraid
- affect rapidly changes from one mood to another
- ex. during the course of a conversation the person laughs and then cries.
- involuntarily interrupting speach or train of thought
- ex. patient begins to answer question but pauses at odd points while speaking
- pattern of speach in which irrelevant details are included with relevant details in describing an event, but follows through on one topic.
- ex. person describes his dinner but also describes what he was wearing and a phone call
- anirresistible urge to repeatedly perform an act that may be contrary to one's usual standards due to extreme anxiety if the act is not completed.
- ex. person washes her hands five times each hour
- Fabrication of events or situations to fill in gaps in memory, usually in a plausible way.
- Patient explains his black eye with elaborate story about a fight but his wife reports that he was home all evening.
- A fixed belief that is defended intensely despite its being illogical or unrealistic; paranoid with excessive suspiciousness; or grandiose with exaggerated view of self-worth
- Patient believes the hospital food is poisoned and she only eats food in sealed containers, or patient believes that he is an alien with supernatural powers.
- Automatic but meaningless repitition of anoher person's words
- ex. In response to "Are you afraid of the dark?" patient answers: "afraid, afraid, afraid."
- Imitation of another person's body movements.
- Patient sits opposite the interviewer and copies the hand positionand leg movements of the interviewer.
Flight of Ideas
- Rapid stream of talk describing multiple topics unrelated to each other.
- ex. Patient states, "I feel fine, the trees are green , the chairs are broken."
- Sensory perception that dos not result from real, external stimulus; most commonly auditory or visual but may be tactile, olfactory.
- Patient hears voice of a relative talking about her or sees bugs on her hands.
Ideas of Reference
- Believing that statements or behaviors of others are related to oneself, even when no realistic connection exists.
- ex. Patient believes talk show host is talking about him.
- Misinterpretation of an external sensory stimulus, usually visual or auditory
- ex. Person sees clothing on a chair and thinks it is a cat.
- Pattern of speech in which the connections between ideas are so vague that, to the listener, they do not seem to follow any logical sequence.
- ex. Patient talks about medication, then switches to describe a cat, and then changes the subject again.
- Word invented by a person with a meaning specific to that person.
- A crying patient says, "My bermin hurts" but does not explain what that is.
- Involuntary preoccupation with a particular thought or idea that seems irrational.
- ex. A thin patient is preoccupied with fear of getting fat.
- Involuntary persistence or repitition of an idea or response.
- Patient keeps repeating one phrase over and over.
- In conversation, the tendency for a response to digress from the original topic.
- ex. When asked about sleep, the patient replies, "I sleep fine but my mother used to say that I sleep too much, she always criticizes me."
Partialized or total inability of the client to recall or identify past experiences
Client blocks out all memories about a specific period
client recalls some but not all memories
loss of all memory about past life.
- Assumption of a new identity in a new environment, may be sudden.
- client retreats even furtherinto his mind and wanders away from home
- develops few social relationships
- when fugue lifts, client returns home and cant remeber fugue state.
Dissociative Identity Disorder (multiple personality)
two or more fully developed distinct and unique personalities within the person; may take full control of te client one at a time. personalities may or may not be aware of eachother.
Dissociative Identity Disorder Assessment
- Inability to recall important information too extensive to be explained
- transition from one personality to the other related to stress and is sudden
- dissociation is used as a method of dstancing and depending self from anxiety and traumatizing experiences
- be sure to name the personalities and their behaviors
- loss of sense of self in environment, from the outside looking in.
- feelings of detatchment
- intact reality testing
First choice antidepressants
- prozac, Zoloft, Paxil, Celesta
- prescribed for mild and moderate depression, and chronic anxiety.
- Elavil, Tofranil, Norpramin, Pamelor, Sinequin
- Used for moderate and severe depression.
- Effexor, Wellbutrin, Serzone
- High evidence of seizure activity
- Must take at the same time EVERY DAY
- Marplan, Parnate, Nardil
- used infrequently because of interaction with tyramine causes hypertensive crisis
MAOI Diet Restricitons
- Dairy: cheese, sour cream, yogurt
- Meat: Liver, sausage, bacon, pork, salami, smoked fish, pickled fish
- Vegetables: pea pods, avocados, sauerkraut
- Beans: broad-fava, soy
- Dessert: chocolate, alcohol
- MSG, yeast, protein extracts
Characterized by episodes of mania and depression with periods of normal mood and activity in between, Involves mood swings and depression, and mania
- Lithium: regular monitoring for low sodium, must have adequate water intake. (normal level around 1, toxic around 2)
- Anticonvulsants for ther mood stablizing effects, (tegretol, depakote, lamictal, Topamax, and Neurontin, Klonipin (Benzodiazapine). SE: drowsiness, weight gain, dry mouth
Characteristics of Manic Phase
- Inabilit to eat or sleep because of involvement in more important things.
- Extroverted personality
- Delusional self-confidence
- Quickly angered
- Inappropriate dress, grandiose and persecutory delusions
- sexually promiscuous
- unlimited energy
- distracted by environmental stimuli.
- excessive talking
Priority interventions for Manic Phase
- high calorie FINGER FOODS
- physical activities and outlets for tension
- protection from injury
Psychiatric Medical Emergencies
- NMS: Neuroleptic malignant syndrome
- Serotonin Syndrome: side effect of serotonergic antidepressants, which most of ten occure between MAOI's and SSRI's.
Signs of Psych Medical emergencies
- ALOC, agitation, restlessness, tremor, shivering, lack of coordination, fever, tachycardia, N/V/D,
- EPS: frozen face, ataxic gait, pill rolling, distonia, tartive dyskinesia
ECT: Electroconvulsive Therapy
Effective treatment for depresion that consists of inducing a grand mal seizure by passing an electrical current through electrodes attached to a clients temples.NOT A CURE
Uses for ECT
- Catatonic schizophrenia
- Major Depression
- Marked psychomotor retardation
- Manics who don't do well on Lithium
Indications for ECT
- ineffective antideressants
- Rapid Response, ex. homicidal or suicidal.
- extreme agitation
- past effective use
- Informed consent
- Have pt void
- Baseline Vitals
What to do during ECT
- Maintain IV access
- Continuous HR, BP, ECT, O2, and RR monitoring
- GIVE MUSCLE RELAXANT (to decrease the whole body seizure activity)
- maintain safety and airway
- continur VS's
- Assess for gag reflex before giving fluids
- Memory usuallly recovers completely
- Decreased Mental function is a side effect but is RARE
group of mental disorders characterized by psychotic features, inability to trust others, disordered thought processes and dirupted interpersonal relationships
Hard or Positive symptoms of schizoprenia (More responsive to treatment)
- Disorganized speech and behavior
Soft or negative symptoms of schizophrenia. (more resistant to treatment)
- Flat affect
- Social withdrawal or discomfort
- Alogia: an absence of speech, speaks very little
A person who finds no pleasure in life
Excessive demonstration of obsession with religious Idea
Extreme suspiciousness of others
The idea that if one thinks something it will be true
Shift of ideas from one topic to another, Might be related to topic
Literal interpretations of the environment
Choice of words is governed by sound (often rhyming). ex. like Dr. Seuss
a group of words put together in a random fashion. (Mikes youtube video)
Inability or refusal to speak
- persecutory or grandiose delusions and hallucination
- sometimes excessive religiosity
- hostile and aggressive behavior
- easiest to treat
grossly inappropriate or flat affect, incoherence, loose associations, EXTREMELY DISORGANIZED BEHAVIOR.
marked psychomotor disturbance, motionless excessive motor activity, extreme negativism, muism, peculiarities of voluntary movement (echolalia, echopraxia)
Mixed schizophrenic symptoms along with disturbances of thought, affect, behavior
at least one previous psychotic episode but not currently; socially withdrawn
Prolixin DEPOT INJECTION
comes in a base of sesame oil which allows it to be absorbed over time. May need an injection less frequently. every 1-2 weeks
Schizoid personality disorder
inability to form warm, close social relationships. no thoughts or behaviors.
Paranoid personality disorders
Suspiciousness and mistrust of others
Histrionic personality disorder
orverly dramatic and intensely expressive behavior. Drama Queen
Narcissisic personality disorder
increased sense of self importance
Avoidant personality disorder
Social withdrawal and extreme sensitivity to potential rejection
Dependent personality disorder
individual lacks self-confidence and abiliy to function independently
Obsessive-compulsive personality disorder
Client has difficulty expressing warm and tender emotions and reflects perfectionism, stubbornness, the need to control others, and devotion to work
Antisocial personality disorder
pattern of irresponsible and antisocial behavior
Borderline personality disorder
Instability in interpersonal relationships, moode and self-image
Passive-aggressive personality diorder
passively expressing covert aggression rather than dealing with it directly
Changes in elderly
- slower reactiontime
- easily confused
- decreased visual acuity
- decreased hearing
difference in delerium and dementia
- Delerium is a sudden fast onset
- Dementia is a slow steady onset