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unconscious refusal to accept an unacceptable idea or behavior.
open rejection of an obvious truth.
explaining away an unacceptable behavior in a way that superficially makes sense, but actually avoids the true explanation for the behavior.
voluntary exclusion of anxiety-provoking thoughts
unconscious forgetting of painful events
an attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual process of logic, reasoning and analysis.
an attempt to increase self-worth by acquiring certain attributes and characteristics of an individual one admires.
feelings or impulses unacceptable to one's self are attributed to another person
beliefs and values of another individual are internalized and symbolically become a part of the self, to the extent that the feeling of separateness or distinctness is lost
involves overachieving in one area to compensate for failures or inadequacies in another
preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors
feelings are transferred from one target to another that is considered less threatening or neutral
an unconscious physical response to anxiety, involving one of the senses
engaging in behavior to atone or make up for an undesirable behavior
the separation of a thought or memory from the feeling, tone, or emotions associated with it
re-channeling of drives or impulses that are personally or socially unacceptable into activities that are more tolerable and constructive
a retreat to an earlier level of development and the comfort measures associated with that level of functioning
associated with normal phases of growth and development
occur in response to an event which can range from job change to catastrophic events
step 1: assessment of the patient and the problem.
step 2: planning and intervention
step 3: implementation
step 4: evaluation
aware that they are experiencing distress, aware that behavior are maladaptive, unaware of any possible psychological causes of the distress, feel helpless to change their situation, no loss of contact with reality.
ex. phobias, generalized anxiety disorder, post traumatic stress disorder, obsessive-compulsive disorder, panic disorder.
fears, such as fear of snakes, common
afraid of being in a crowd and not able to get out
characterized by unreasonable thoughts and fears that lead to repetitive behaviors
repeated, persistent, and unwanted ideas, thoughts, images, or impulses.
-fear of contamination or dirt.
-preoccupation with order and symmetry.
-thoughts of violence and harming loved ones.
-fear of intruders.
unwanted repetitive behavior patterns or mental acts.
-repeating words silently
-washing and cleaning
manifested by intense apprehension, fear or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort
chronic, unrealistic, and excessive anxiety and worry
generalized anxiety disorder
develops after a terrifying ordeal that involved physical harm or the threat of physical harm to self or to others
post traumatic stress disorder
disturbances in thought process and perception of reality, disturbances of affect or mood, disturbances in communication
exhibit minimal distress (emotional tone is flat, bland, inappropriate), unaware that behavior is maladaptive, unaware of any psychological problems, exhibiting a flight from reality into a less stressful world or into one which they are attempting to adapt
most likely due to a combination of biological, psychological, and environmental factors.
may be due to problems with certain naturally occurring brain chemicals, including the neurotransmitters dopamine and glutamate
4 A's of Schizophrenia
affect and thought content are incongruent or contradictory
blunt, restricted, little or no affective expression, void of emotional tone,lacking overt expression of feelings
unpredictable train of thought, incoherence, not clear what the link or association is between words and ideas
social withdrawal and loss of contact with reality
contradictory feelings about self and others,
coexistence of opposite emotions toward the same object, person, or situation
false personal beliefs, not consistent with a person's intelligence or cultural background
misperception of real external stimuli
false sensory perceptions not associated with real external stimuli.
auditory, tactile, visual, olfactory,gustatory
the belief that casual events, people's remarks, etc. are referring to one self when, in fact, they are not
ideas of reference
extreme suspiciousness that results in persecutory delusions and hallucinations of a threatening nature
a state in which the individual ceases to perceive the reality of the self or environment. the patient feels that his or her body is unreal, is unchanging, or is dissolving; or that he or she is outside of the body.
withdrawal into unreal world of fantasy
the person believes that his or her thoughts or behaviors have control over specific situations or people
describes the behavior associated with an individual's state or emotional tone
inability to experience pleasure
passivity, lack of energy
lack of motivation, inability to initiate tasks
thinking is characterized by speech in which ideas shift from one unrelated subject to another
inability or refusal to speak
invents new words that are meaningless to others but have symbolic meaning to the psychotic person
repeat the words that he or she hears
a group of words strung together in a random fashion, without any logical connection
choice of words is governed by sounds; dr.seuss
literal interpretations of the environment; inability to think in the abstract.
ex. what brought you here to the hospital?
-the cab (answers are literal)
persistently repeats the same word or idea in response to different questions
lack of speech due to poverty of thought, lack of energy, or slowed processing
-avoid touching the patient without warning.
-reinforce and focus on reality.
-use same staff as much as possible.
-avoid laughing, whispering, or talking when patient can see but cant hear what is being said.
-have an attitude of acceptance.
-try to distract the patient from the hallucination.
therapeutic responses to delusions and hallucinations
- successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms.
-a state of well-being in which the individual realized his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.
maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and interfere with the individual's social, occupational, or physical functioning.
-psychological mechanisms or coping mechanisms, aimed at reducing anxiety.
-safeguard the mind against feelings and thoughts that are too difficult for the conscious mind to cope with.
-used in response to mild to moderate anxiety.
-fear of losing control
-fear of dying
symptoms of panic disorder, must have 4 of this symptoms to be considered a true panic attack
-excessive anxiety and worry about a number of events that the individual finds difficult to control.
-restlessness or feelings keyed up or on edge.
-difficulty concentrating or mind "going blank".
-sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
symptoms of generalized anxiety disorder
-flashbacks and nightmares
-hyper vigilance or sleep difficulties
-avoiding things that remind one of the trauma, and feeling detached or estranged from others.
re-experiencing symptoms, hyperarousal symptoms, avoidance and numbning symptoms of PTSD
treatments for anxiety disorders
-cognitive part helps people change the thinking that support their fears.
-behavioral part helps people change the way they react to anxiety-provoking situations.
with these disorders, there is a significant deficit in cognition and/or memory.
a significant change occurs in the patient's level of functioning.
delirium, dementia, and amnestic disorders
disturbance of consciousness and a change in cognition that develops rapidly
loss of previous levels of cognition, executive, and memory function in a state of full alertness
inability to learn new information (short term deficit) despite normal attention, and an inability to recall previously learned information (long term)
-knowing what to expect
-provide family with information about the disease process.
-provide information on support groups
collaborative management of delirium, dementia, and amnestic disorders
an individual's sustained emotional tone, which significantly influences behavior, personality and perception
characterized by depress mood or loss of interest or pleasure in usual activities. symptoms cant be attributed to use of substances or general medical condition
major depressive disorder
-characterized by mood swings from profound depression to extreme euphoria (mania) with intervening periods of normalcy
-delusions and hallucinations may not be a part of the clinical picture, onset of symptoms may reflect a seasonal pattern
types of mania
-perception and cognition
-activity and behavior
characteristics of mania
-cheerful and expansive (mood)
-perception of self is exalted; ideas of great worth and ability (cognition/perception)
-exhibit increased motor activity; perceived as extroverted and sociable. (activity/behavior)
-is euphoric and elated (mood)
-rapid thinking proceeds to racing and disjointed thoughts; hallucinations and delusions common (cognition/perception)
-excessive psychomotor behavior, poor impulse control, excessive spending, sexually uninhibited, may go for days without sleep, neglect personal appearance (activity/behavior)
-labile, rapid shifts from merriment and ecstasy to irritability and indifference; panic anxiety may be evident(mood)
-extremely distractible and incoherent; may demonstrate religiosity, delusions of grandeur or persecution, auditory or visual hallucinations (cognition/perception)
-psychomotor activity is frenzied, agitated, purposeless. (activity/behavior)
-educate the patient and their family on symptoms of the disease
-provide education on medication
-teach anger management
-link the patient to support groups
-assess severity of symptoms/needs for intervening
collaborative management of patients with mood disorders
-high level of anxiety
-hopelessness, helplessness, withdrawal
-use of destructive coping mechanisms
-previous suicide attempt
risk factors for suicide
-overindulgence in and dependence on a chemical substance
-can occur in nurses, physicians, and other medical professionals
-does not discriminate
-involves both legal and illegal substance
-excessive use of a chemical substance and the resulting physical and psychological dependence that interferes with life's activities
-women usually abuse more than one drug
-stressors in the environment
-lack of quality support
risk factors of substance abuse
-crime (gangs, theft, homicide)
-motor vehicle crashes
effects of substance abuse on society
condition that causes a habitual, compulsive, and uncontrollable urge to use a substance
use of chemicals for reasons other than their intended action
taking a chemical for pleasure without dependence, recreational
negative outcomes after abusers stop using substances
symptoms that may result if the drug is eliminated suddenly
alcohol, nicotine, opioids (narcotics), stimulants, hallucinogens, depressants
commonly abused substance categories
- begin 4-12 hours after cessation or reduction in heavy and prolonged use.
-tremor of hands, tongue, or eyelids; n/v, weakness, tachycardia, sweating, elevated BP, anxiety, depression, irritability, headache, insomnia, transient hallucination
-starts 2nd-3rd day
-have auditory, visual, and tactile hallucinations, extreme disorientation, restlessness, and hyperactivity of the autonomic nervous system
delirium tremens "DT's"
-sedation with benzodiazepines
-airway protection (intubation if needed)
-correct any fluid and electrolyte imbalances (potassium especially)
medical treatment for delirium tremens