Mental Health Unit 1

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Mental Health Unit 1
2012-02-09 23:36:05
Schizophrenia anxiety disorders

terms, symptoms, side effects
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  1. Type of Schizophrenia?
    - usually before age 25
    - course chronic
    - contact with reality extremely poor
    - affect is flat or grossly inappropriate often with periods of silliness and incongrous giggling
    - facial grimaces and bizarre mannerisums
    - communication consistently incoherent
    - personal appearance neglected
    - social impairment is extreme
    Disorganized schizophrenia
  2. Type of Schizophrenia?
    - abnormalities in motor behavior (stupor or excitement)
    - stupor- extreme psychomotor retardation, decrease in spontaneous movements
    - mutism (no speech) and negativism (an apparently motiveless resistance to instruction)
    - waxy flexibility- posturing or voluntary assumption of bizarre positions
    - excitement- state of extreme psychomotor agition
    - movements purposeless and usually accompanied by continuous incoherent verbalizations and shouting
    - often destructive and violent to others or injure themselves
    Catatonic Schizophrenia
  3. Type of Schizophrenia?
    - presence of delusions of persecution or grandeur and auditory hallucinations related to a single theme
    - tense, suspicious, and guarded, and may be argumentative, hostile, and aggressive
    - onset usually later 20s or 30s
    Paranoid Schizophrenia
  4. Type of Schizophrenia?
    - do not meet the criteria for any of the subtypes, or they may meet the criteria for more than 1 subtype
    - behavior is psychotic; evidence of delusions, hallucinations, incoherence, and bizarre behavior
    Undifferentiated schizophrenia
  5. Type of Schizophrenia?
    - individual has history of at least 1 previous episode of chizophrenia with prominent psychotic symptoms
    - acute episode
    - no prominent psychotic symptoms
    - symptoms may be social isolation, eccentric behavior, impairment in personal hygiene and grooming, blunted or inappropriate affect, poverty of or overly elaborate speech, illogical thinking, or apathy
    Residual Schizophrenia
  6. type of schizophrenia?
    - manifested by schizophrenia behaviors with a strong element of symptomatology associated with mood disorders (depression and mania)
    - depressed, psychomotor retardation and suicidal ideation, or euphoria, grandiosity and hyperactivity
    - bizarre delusions, prominent hallucinations, incoherent speech, catatonic behavior, or blunted or inappropreate affect
    Schizoaffective Disorder
  7. Type of schizophrenia?
    - sudden onset of psychotic symptoms that may or may not be preceded by a severe psychosocial stressor
    - last at least 1 day but less than 1 month
    - full return to premorbid level of functioning
    - impaired reality testing may include incoherent speech, delusions, hallucinations, bizarre behavior and disorentation
    Brief Psychotic disorder
  8. Type of schizophrenia?
    - identical to schizophrenia
    - duration, including parodromal, active, and residual phases, is at least 1 month but less than 6 months
    - good prognosis if individuals affect is not blunted or flat
    Schizophreniform disorder
  9. Type of Schizophrenia?
    - presence of 1 or more nonbizarre delusions that persist for at least 1 month
    - hallucinations are not prominent
    - behavior is not bizarre
    - 5 subtypes
    Delusional disorder
  10. type of delusional disorder?
    - individuals believes that someone, usually of higher status, is in love with him/her
    Erotomatic type
  11. type of delusional disorder?
    - irrational ideas regarding their own worth, talent, knowledge, or power
    - may believe they have special relationship with famous person or even assume the identity of a famous person
    Grandiose type
  12. Type of delusional disorder?
    - centers on idea that person's sexual partner is unfaithful
    - idea is irrationanal and without cause but searches for evidence to justify
    Jealous type
  13. type of delusional disorder?
    - most common type
    - idividuals believe they are bing malevolently treated in some way
    - themes include being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed
    Persecutory type
  14. type of delusional disorder?
    - believe they have some physical defect, siorder, or disease
    Somatic type
  15. Type of Schizophrenia?
    - delusional system that develops in a second person as a result of a close relationship with another person who already has a psychotic disorder with prominent delusions
    - chronic
    - more common in women
    Shared psychotic disorder
  16. Type of Schizophrenia?
    - prominent hallucinations and delusions that can be directly attributed to a general medical condition
    Psychotic disorder due to a general medical condition
  17. Type of schizophrenia?
    - presence of prominent hallucinations and delusions that are judged to be directly attributable to the phyilogical effects of a substance
    Substance-Induced psychotic disorder
  18. - reflect an excess or distortion of normal functions
    - relatively good response to treatment
    symptoms include
    1. delusions
    2. religiosity
    3. paranoia
    4. magical thinking
    5. associative looseness
    6. neologisms
    7. concrete thinking
    8. clang associations
    9. word salad
    10. circumstantiality
    11. tangentiality
    12. mutism
    13. perseveration
    14. hallucinations
    15. illusions
    16. echolalia
    17. echopraxia
    18. identification and imitation
    19. depersonalization
    Positive symptoms
  19. - reflect a diminution or loss of normal function
    - difficult to treat and respond less to neuroleptics
    - most destructive because they render patient inert and unmotivated
    Symptoms include
    1. inappropriate affect
    2. bland or flat affect
    3. apathy
    4. emotional ambivalence
    5. autism
    6. deteriorated appearance
    7. anergia
    8. waxy flexability
    9. posturing
    10. pacing and rocking
    11 anhedonia
    12. regression
    Negative symptoms
  20. excessive demonstration of or obsession with religious ideas and behavior
    • religiosity
    • positive symptoms
  21. extreme suspiciousness of others
    • paranoia
    • positive symptoms
  22. believes that his/her thoughts or behaviors have control over specific situations or people
    • magical thinking
    • positive symptoms
  23. ideas shift from one unrelated subject to another
    - unaware topics are unconnected
    • associative loosness
    • positive symptoms
  24. invents new words meaningless to others but have meaning to psychotic patient
    • neologisms
    • positive symptoms
  25. literal interpretations of the environment, represents a regression to earlier level of cognitive functioning
    • concrete thinking
    • positive symptoms
  26. take from of rhyming
    • clang associations
    • positive symptoms
  27. group of words that are put together randomly
    • word salad
    • positive symptoms
  28. individual delays in reaching the point of a communication because of unnecessary and tedious details
    • circumstantiality
    • positive symptoms
  29. person never really gets to the point of the communication
    • tangentiality
    • positive symptoms
  30. inability or refusal to speak
    • mutism
    • positive symptoms
  31. repeats same word or idea in response to different questions
    • perseveration
    • positive symptoms
  32. false sensory perceptions not associated with real external stimuli
    types: auditory, visual, tactile, gustatory, olfactory
    • hallucinations
    • positive symptoms
  33. misperceptions or misinterpretations of real external stimuli
    • illusions
    • positive symptoms
  34. repeat words that he or she hears
    • echolalia
    • positive symptom
  35. purposelessly imitate movements made by others
    • echopraxia
    • positive symptom
  36. behavior often takes on the form of that which they see in the other person
    • identification and imitation
    • positive symptom
  37. feelings of unrality (feeling that one's extremities have changed in size; or sense of seeing oneself from a distance)
    • depersonalization
    • positive symptom
  38. individuals emotional tone is incongruent with the circumstances
    • inappropriate affect
    • negative symptom
  39. 1. very weak affect
    2. void of emotional tone
    • 1. balnd
    • 2. flat
    • negative symptoms
  40. indefferent to or disinterest in the environment
    • apathy
    • negative symptom
  41. impairment in ability to initiate goal directed activity
    • volition
    • negative symptom
  42. opposite emotions toward same object, person, or situation interfere with ability to make very simple decision
    • emotional ambivalence
    • negative symptom
  43. condition created by the person with schizophrenia who focuses inward on a fantasy world, while distorting or excluding the external environment
    • autism
    • negative symptom
  44. personal grooming and selfcare activities may be neglected
    deteriorated appearance
  45. dificincy of energy
    • anergia
    • negative symptoms
  46. body parts in bizarre or uncomfortable positions
    • waxy flexability
    • negative symptoms
  47. voluntary assumption of inappropreate or bizarre postures
    • posturing
    • negative symptoms
  48. inability to experience pleasure
    • anhedonia
    • negative symptoms
  49. retreat to earlier level of development
    • regression
    • negative symptoms
  50. type of therapy?
    - reality oriented individual therapy
    - focus: decrease anxiety and increase trust
    individual psychotherapy
  51. type of therapy?
    - focus: real-life plans, problems, and relationships
    - social interaction, sense of cohesiveness, identification, and reality testing
    - supportive environment
    group therapy
  52. type of therapy?
    - reducing the frequency of bizarre, disturbing, and deviant behaviors
    behavior therapy
  53. type of therapy?
    - nonverbal, paraliguistic, verbal content, interactive balance
    - role play
    - emphasis placed on functional skills that are relevant to activities of daily living
    social skills training
  54. - Action- work by blocking postsynaptic dopamine receptors in basal ganglia, hypothalamus, limbic system, brainstem and medulla
    - chlorpromazine (thorazine)
    - fluphenazine (prolixin)
    - haloperidol (haldol)
    - precautions- contraindicated in pts with known hypersensitivity
    - should not be in comatose state or when CNS depression is evident
    - when blood dyscrasias exist
    - in pts with parkinson's disease or narrow angle glaucoma
    - pts with liver, renal, cardiac insufficiency
    - poorly controlled seizure disorder
    - caution when giving to elderly, severely ill, or debilitate and to diabetic pts or pts with respiratory insufficiency, prostatic hypertrophy or intestinal obstruction
    Typical antipsychotics
  55. - action- weaker dopamine receptor antagonists, but are more potent antagonists of serotonin type 2A receptors
    - aripiprazole (abilify)
    - clozapine (clozaril)
    - olanzapine (zyprexa)
    - risperidone (risperdal)
    - ziprasidone (geodon)
    - precautions- contraindicated in hypersensitivity, comatose, or severely depressed pts, pts with dementia related psychosis and lactation
    - Ziprasidone and risperidone contraindicated for pts with history of cardiac arrhythmias, uncompensated heart failure
    - clozapine containdicated inpts with myeloproliferative disorders, with history of clozapine induced agranulocytosis or severe granulocytopenia, and uncontrolled epilepsy
    - caution with elderly or debilitated pts, pts with cardiac, hepatic, or renal insufficiency, history of seizures, diabetes or risk factors for diabetes, under conditions that cause hypotension
    Atypical antipsychotics
  56. - Clozapine causes this side effect
    - sore throat, fever, malaise
    - WBC drop extremely low- need to be at least 3,500/mm3
  57. - administer antiparkisonian drug - administer Cogentin
    - more common in typical antipsychotic
    - pseudoparkinsonism- tremor, suffling gait, drooling
    - akinesia- muscle weakness
    - akathisia- restlessness and fidgeting
    - dystonia- involuntary muscular movements of face, arms, legs, and neck
    - oculogyric crisis- uncontrolled rolling back of eye
  58. bizarre facial and tongue movements, stiff neck and difficulty swallowing
    - more common with typical
    - irreversable
    Tardive dyskinesia
  59. - common with typical antipsychotics
    - fatal
    - observe for parkinsonian symptoms
    - muscle rigidity, high fever, tachycardia, tachypenea, fluctuation in BP, diaphorisis, rapid deterioration of mental status to stupor or coma
    Neuroleptic malignant syndrome
  60. - recurrent panic attacks, the onset is unpredictable and manifested by intense apprehension, fear, or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort.
    - unexpectedly
    - at least 4 symptoms
    1. palpitations, pounding heart
    2. sweating
    3. trembling
    4. SOB
    5. choking feeling
    6. chest pain
    7. nausea
    8. dizzy
    9. derealization
    10. fear dying
    11. chills or hot flashes
    - attacks usually last minutes
    Panic disorder
  61. - characterized by symptoms described for panic disorder
    - fear of bing in plces or situations from which escape might be difficutl or in which help might not be avialable
    - nearly or completely house bound
    - being outside house alone, being in crowd or standing in line, being on a bridge, traveling in bus, train, car
    panic disorder with agoraphobia
  62. - chronic, unrealistic, and excessive anxiety and worry
    - 6 months or longer
    - symptoms must have occured more day than not for at least 6 months and must cause clinically significant distress or impairment in social, occupational functioning
    - depressive symptoms
    - somatic complaints
    - chronic
    1. excessive anxiety and worry about things pt finds difficult to control
    2. restlessness or feeling keyed up or on edge
    3. easliy fatigued
    4. difficult concentrating
    5. irritability
    6. muscle tension
    7. sleep disturbances
    general anxiety disorder
  63. - fear cued by presence oranticipation of a specific object or situation, exposure to which almost invariably provokes an immediate anxiety response or panic attack, even though the subject recognizes that the fear is excessive or unreasonable
  64. - excessive fear of situations in which person might do something embarrassing or be evaluated negatively by others
    - fear of speaking or eating in public, fear of using public restroom, fear of writing in presence of others
    - feeling of panic anxiety, with tachycardia, sweating, dyspnea
    - onset late childhood or early adolescence and runs as a chronic course
    social phobia
  65. - recurrent obsession or compulsions that are severe enough to be time consuming or to cause distress or impairment
    - begins in adolescence or early adulthood
    - single people more affected than married
    obsessive-compulsive disorder
  66. - following exposure to extreme traumatic stressor involving a personal threat to physical integrity or to physical integrity of others
    - after learning about unexpected or violent death, serious harm, or threat of death or injury of a family member of close associatie
    -symptoms: re-experiencing traumatic event, a sustained high level of anxiety or arousal, or general numbing of responsiveness
    - intrusive recollections or nightmares of events
    - depression common
    - full symtom picture must be present for more than 1 month and cuase significant interference with social, occupational, and other areas of functioning
    Post-Traumatic stress disorder
  67. - multiple somatic symptoms
    - symptoms may be vague, dramatized or exaggerated in their presentation
    - chronic
    - pain in 4 different sites
    - 2 different gastro symptoms (nausea, vomit)
    - 1 sexual symptom
    - 1 pseudoneuroligical (paralysis, blindness, deaf)
    - anxiety and depression frequently manifested and suicidal threats and attempts are not uncommon
    - drug abuse and dependence are common complications
    - symptoms heightened emotionality, impressionistic thought and speech, seductiveness, strong dependency needs, and preoccupation with symptoms and oneself
    somatization disorder
  68. - characterized by physical symptoms suggesting medical disease but without demonstrable organic pahtology or known pathophysiology mechanisms to account for them
    somatoform disorders
  69. - severe and prolonged pain that causes clinically significant distress or impairment in social, occupaitonal, or other important areas of functioning
    - primary gain- pain enables pt to avoid some unpleasant activity
    - secondary gain- pain promotes eimotioanl support or attention that pt might not otherwise receive
    - characteristic behaviors- frequent vistits to physician in an effort to obtain relief, excessive use of analgesics, and requests for surgery
    - symptoms of depression are common
    - dependence on addictive substances is common complication
    pain disorder
  70. - unrealistic or incaccurate interpretation of physical symptoms or senstations, leading to preoccupation and fear of having serious disease
    - fear becimes disableing and persists despite appropriate reassurance that no orgainic pathology can be detected
    - symtoms are excessive in relation to degree of pathology
    - profoundly preoccupied with their bodies and are totally aware of even the slightest change in feeling or sensation
    - hitory of "doctor shopping" and are convinced that they are not receiving proper care
    - anxiety and depression common
    - OCD frequently accompany disorder