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Flat Affect
- 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
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Inappropriate Affect
- affect does not match the feeling or the topic being discussed
- ex. person laughs when speaking of being afraid
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Labile Affect
- affect rapidly changes from one mood to another
- ex. during the course of a conversation the person laughs and then cries.
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Blocking
- involuntarily interrupting speach or train of thought
- ex. patient begins to answer question but pauses at odd points while speaking
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circumtantiality
- 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
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Compulsion
- 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
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Confabulation
- 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.
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Delusion
- 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.
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echolalia
- Automatic but meaningless repitition of anoher person's words
- ex. In response to "Are you afraid of the dark?" patient answers: "afraid, afraid, afraid."
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Echopraxia
- Imitation of another person's body movements.
- Patient sits opposite the interviewer and copies the hand positionand leg movements of the interviewer.
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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."
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hallucination
- 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.
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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.
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Illusion
- Misinterpretation of an external sensory stimulus, usually visual or auditory
- ex. Person sees clothing on a chair and thinks it is a cat.
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Loose Associations
- 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.
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Neologism
- 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.
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Obsession
- Involuntary preoccupation with a particular thought or idea that seems irrational.
- ex. A thin patient is preoccupied with fear of getting fat.
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Perseveration
- Involuntary persistence or repitition of an idea or response.
- Patient keeps repeating one phrase over and over.
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Tangentially
- 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."
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Dissociative Amnesia
Partialized or total inability of the client to recall or identify past experiences
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Localized
Client blocks out all memories about a specific period
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Selective amnesia
client recalls some but not all memories
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Generalized Amnesia
loss of all memory about past life.
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Dissociaive Fugue
- 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.
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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.
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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
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Depersonalization Disorder
- loss of sense of self in environment, from the outside looking in.
- feelings of detatchment
- intact reality testing
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First choice antidepressants
SSRI's`
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SSRI's
- prozac, Zoloft, Paxil, Celesta
- prescribed for mild and moderate depression, and chronic anxiety.
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TCA's
- Elavil, Tofranil, Norpramin, Pamelor, Sinequin
- Used for moderate and severe depression.
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Atypical's
- Effexor, Wellbutrin, Serzone
- High evidence of seizure activity
- Must take at the same time EVERY DAY
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MAOI's
- Marplan, Parnate, Nardil
- used infrequently because of interaction with tyramine causes hypertensive crisis
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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
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Bipolar Disorder
Characterized by episodes of mania and depression with periods of normal mood and activity in between, Involves mood swings and depression, and mania
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BiPolar Medications:
- 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
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Characteristics of Manic Phase
- restlessness
- 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
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Priority interventions for Manic Phase
- high calorie FINGER FOODS
- physical activities and outlets for tension
- protection from injury
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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.
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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
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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
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Uses for ECT
- Catatonic schizophrenia
- Major Depression
- Marked psychomotor retardation
- Manics who don't do well on Lithium
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Indications for ECT
- ineffective antideressants
- Rapid Response, ex. homicidal or suicidal.
- extreme agitation
- past effective use
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Preprocedure ECT
- Informed consent
- NPO
- Have pt void
- Baseline Vitals
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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
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Postprocedure ECT
- reorient
- continur VS's
- Assess for gag reflex before giving fluids
- Memory usuallly recovers completely
- Decreased Mental function is a side effect but is RARE
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Schizophrenia
group of mental disorders characterized by psychotic features, inability to trust others, disordered thought processes and dirupted interpersonal relationships
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Hard or Positive symptoms of schizoprenia (More responsive to treatment)
- Delusions
- hallucinations
- Disorganized speech and behavior
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Soft or negative symptoms of schizophrenia. (more resistant to treatment)
- Flat affect
- Avolition
- Social withdrawal or discomfort
- Apathy
- Alogia: an absence of speech, speaks very little
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Anhedonia
A person who finds no pleasure in life
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Religiosity
Excessive demonstration of obsession with religious Idea
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Paranoia
Extreme suspiciousness of others
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Magical thinking
The idea that if one thinks something it will be true
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Associative Looseness
Shift of ideas from one topic to another, Might be related to topic
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Concrete Thinking
Literal interpretations of the environment
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Clang associations
Choice of words is governed by sound (often rhyming). ex. like Dr. Seuss
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Word Salad
a group of words put together in a random fashion. (Mikes youtube video)
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Mutism
Inability or refusal to speak
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Schizophrenic Paranoia
- persecutory or grandiose delusions and hallucination
- sometimes excessive religiosity
- hostile and aggressive behavior
- easiest to treat
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Disorganized Schizophrenic
grossly inappropriate or flat affect, incoherence, loose associations, EXTREMELY DISORGANIZED BEHAVIOR.
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Catatonic Schizophrenic
marked psychomotor disturbance, motionless excessive motor activity, extreme negativism, muism, peculiarities of voluntary movement (echolalia, echopraxia)
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Undifferentiated Schizophrenic
Mixed schizophrenic symptoms along with disturbances of thought, affect, behavior
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Residual Schizophrenia
at least one previous psychotic episode but not currently; socially withdrawn
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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
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Schizoid personality disorder
inability to form warm, close social relationships. no thoughts or behaviors.
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Paranoid personality disorders
Suspiciousness and mistrust of others
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Histrionic personality disorder
orverly dramatic and intensely expressive behavior. Drama Queen
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Narcissisic personality disorder
increased sense of self importance
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Avoidant personality disorder
Social withdrawal and extreme sensitivity to potential rejection
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Dependent personality disorder
individual lacks self-confidence and abiliy to function independently
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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
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Antisocial personality disorder
pattern of irresponsible and antisocial behavior
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Borderline personality disorder
Instability in interpersonal relationships, moode and self-image
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Passive-aggressive personality diorder
passively expressing covert aggression rather than dealing with it directly
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Changes in elderly
- slower reactiontime
- easily confused
- decreased visual acuity
- decreased hearing
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difference in delerium and dementia
- Delerium is a sudden fast onset
- Dementia is a slow steady onset
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