Psych Exam 1

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bminch0121
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Psych Exam 1
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2014-05-22 10:59:23
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Psych Exam 1
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  1. Recovery Model
    • Consumers as partners
    • Consumer and family driven
    • Consumer centered and recovery oriented
  2. EBP Model
    • Decade of the Brain
    • Scientific evidence for treatment 
    • Increases gap between research and practice 
    • Medical Model
  3. Hildegard Peplau
    • Mother of psychiatric Nursing 
    • Nurse-patient relationship
  4. 5 A's in EBP process
    • ASK a question
    • ACQUIRE the literature 
    • APPRAISE the literature
    • APPLY the evidence
    • ASSESS the performance
  5. Clinical Algorithms
    Provide step by step guidelines prepared in a flow chart
  6. Patient Advocacy
    An ethical term, not a legal term
  7. Lobe affected by anxiety and depression
    Frontal Lobe
  8. Mental Health
    The successful performance of mental functions resulting in the ability to engage in productive activities, enjoy fulfilling relationships and make changes or cope with adversity
  9. Mental Illness
    Considered a clinically significant behavioral experience by distress, disability, or the risk of suffering disability or loss of freedom
  10. Emotional Intelligence
    Puts emotions at the center of skills for living
  11. Resiliency
    • The ability to recover from or adjust to misfortune and change
    • "bouncing back"
  12. Emotional Contagion
    Our tendency to automatically mimic the emotion that we see in other people
  13. Spirituality
    • That part of us which deals with relationships and values and addresses questions of purpose and the meaning of life
    • not related with religion
  14. Epidemiology
    The quantitative study of the distribution of disorders in human populations
  15. Prevalence Rate
    • The proportion of a population with a mental disorder at a given time
    • How common is a disorder in the population?
  16. Clinical Epidemiology
    A broad field that addresses what happens to people with illnesses who are seen by clinical providers
  17. Mental Health Parity
    • 1996 Mental health parity passed by congress
    • Requires mental health insurers to provide M.H benefits at the same level as is provided for med surg coverage
  18. DSM V includes information specifically related to culture in these 3 areas...
    • 1. Running amok
    • 2. Pibloktoq - cold areas ; uncontrollable desire to rip clothes off in cold temps
    • 3. Eating disorders - "anorexia nervosa" - seen a lot in western cultures where food is plentiful
  19. Axis I
    • List particular disorders 
    • Psychiatric Dx
    • frequency
    • mild, moderate or severe
  20. Axis II
    • Lists any personality disorders and/or mental retardations 
    • has to have either one or be deferred
  21. Axis III
    Lists any general medical conditions believed to be relevant to the mental disorder in question
  22. Axis IV
    Lists any psychosocial and environmental problems that affect the diagnosis, treatment and prognosis of the mental disorder
  23. Axis V
    • Global Assessment of Functioning (GAF)
    • Rated on a scale of 1-100
  24. Communication
    The process of sending a message to one or more persons
  25. Use of Silence
    • Worthwhile as long as its serving a function 
    • Do not rush to fill the silence
  26. Active Listening
    Paying undivided attention to what the client is saying or doing
  27. Clarifying techniques
    Gives both the sender and receiver the opportunity to check that a message was correctly delivered and understood
  28. Paraphrasing
    Receiver restates in different words the basic content of the clients message
  29. Restating
    Repetition of the SAME key words that the client has just spoken
  30. Reflecting
    • Similar to restating 
    • reflecting back the feelings, not repeating the same words
  31. Exploring
    • Examine what the client says more fully
    • A reality check
  32. Open-ended questions
    Cannot be answered with a few short words
  33. Closed-ended questions
    • Can be yes or no questions
    • Used for someone in a crisis or a panic 
    • Used when more direct answers are needed
  34. Indirect questions
    • Implied questions
    • use sparingly and only when the client trusts you
    • avoid with paranoid client - you may come off as being sneaky or manipulative
  35. Genuineness
    Ability to meet person to person
  36. Empathy
    Ability to see another persons perspective of the world
  37. Positive Regard
    Implies respect
  38. Safety
    • Providing a safe environment 
    • Relationship MUST be built on trust
  39. Confidential
    Healthy trust but cannot keep secrets which may jeopardize the clients well-being
  40. Reliability
    Helps build trust
  41. Non-judgmental
    Examine your own value system
  42. Clear Boundaries
    Enhances safety
  43. Attending
    Paying attention in a culturally appropriate way
  44. Recidivision
    Repeat admissions over and over
  45. Clinical Solution
    • Seeking peer counseling helps to get a healthy perspective and maintain therapeutic relations
    • this is why there is a need for debriefing
  46. Boundaries
    • Invisible lines that define the amount and kind of contact between individuals
    • promotes autonomy
  47. Diffuse Boundaries
    • Little distinction between individuals
    • Loss of autonomy 
    • Unclear boundaries
  48. Transference
    • A person unconsciously "transfers" unresolved feelings, attitudes and wishes into present significant relationships in an attempt to resolve them in a more satisfying way
    • Reacting about past situations onto someone else
  49. Counter Transference
    The nurse or therapist displaces onto the client, feelings related to people the the nurses past relationships
  50. Modeling
    • Values also formed through the example of others
    • it is powerful because it is a vivid example of values in action
  51. Values
    • Abstract standards which represent an ideal
    • Are usually culturally oriented
    • Influenced by parents, peers, teachers, religious institutions, Hollywood and media
  52. Peplau's Interactive Nurse
    • Client relationship process
    • introduced the concept of the nurse
  53. Pre-orientation Phase
    • Before you meet your patient
    • Quick auto diagnosis and self-reflection
    • look at any bias and feelings to avoid counter transference
  54. Orientation Phase
    • Starting the establish trust
    • Termination begins in this phase
  55. Working Phase
    • Maintain relationship
    • Bulk of treatment happens in this phase
  56. Termination Phase
    • Review clients plans for the future
    • Provide client with agency contact info and community resources
  57. Suicide Biologic Factors
    Neurotransmitter Imbalances
    • Serotonin Imbalances
    • Decreases persons inhibition to aggressive behavior 
    • More likely to be aggressive if you do not have enough serotonin
  58. Suicide Biologic Factors
    Genetic Influences
    Suicide in the family history = increased risk
  59. Suicide Biologic Factors 
    Alt in Brain Structure assoc with Depression
    Frontal lobe not functioning as well
  60. Suicidal Indeation
    Direct or Indirect thoughts
  61. Suicidal Threats
    Direct verbal or written messages of intent
  62. Suicidal Gestures
    • Actions resulting in minor injury
    • no intent to die
  63. Suicidal Attempts
    Serious actions with intention to die
  64. Successful suicides
    Death of persons who had a conscious intent to die
  65. DSM V Criteria 
    Schizophrenia
    • Lasting 6 Months
    • Active Phase symptoms at least 1 month and 2 active symptoms (hallucinations, delusions, disorganized speech, catatonic behavior and negative symptoms)
  66. Etiology of Schizophrenia
    • Larger cerebral ventricles 
    • Excess dopamine = positive symptoms
  67. Too much Norepinephrine
    Anxiety
  68. Too little norepinephrine
    no motivation or drive
  69. Glutamate
    Excitatory neurotransmitter
  70. GABA
    • Inhibitory system 
    • Works to calm you down
    • inhibits excitement
  71. Delusions
    • Positive Symptoms
    • Fixed False belief that cannot be corrected by reasoning
  72. Circumstantiality
    • Positive Symptom 
    • Digress from conversation and come back to original point
  73. Tangeniality
    • Positive Symptom
    • Stray away from the topic and not come back
  74. Perservation
    • Positive Symptom
    • "on and on..."
  75. Associative Looseness
    • Positive Symptom 
    • Jump from topic to topic
  76. Neologisms
    • Positive Symptom
    • A word that the client has made up
  77. Echolalia
    • Positive Symptom
    • Imitation of another persons speech
  78. Clang Association
    • Positive Symptom 
    • Say a word and associate it with another that sounds similar
  79. Word Salad
    • Positive Symptom
    • Group of random disorganized words
  80. Hallucinations
    • Positive Symptom 
    • Sensory perception when no external stimuli exists
  81. Personal Boundary Difficulties
    • Positive Symptom
    • Dysfunction in recognizing where ones body ends in relation to others bodies
  82. Depersonalization
    • Positive Symptom
    • A non-specific feeling that a person has lost their identity; the self is different or unreal
  83. Derealization
    • Positive Symptom 
    • The false perception by a person that the environment has changed
  84. Extreme motor agitation
    • Positive Symptom 
    • Akathesia - cant sit still
  85. Waxy Flexibility
    • Excessive maintenance of a position
    • Seen in catatonia
  86. Echopraxia
    • Positive Symptom
    • Imitate whatever another person is doing
  87. Catalepsy
    • Positive Symptom
    • Fixed position, but easy to move
  88. Negativism
    • Positive Symptom 
    • Resistant to direction
  89. Affective Blunting
    Negative Symptoms
  90. Flat/inappropriate affect
    Negative Symptom
  91. Anergia
    • Negative Symptom
    • Lack of energy
  92. Avolition
    • Negative Symptom 
    • Lack of Desire
  93. Poverty of content of speech
    • Negative Symptom
    • Mumbling
    • Not much speech
  94. Thought Blocking
    • Negative Symptom 
    • Speech/thought completed stops mid-sentence
  95. Dysphoria
    • Negative Symptom
    • Depressed sad mood
  96. Hopelessness
    • Red flag for suicide
    • Negative Symptom
  97. Schizophreniform
    s/s more than 1 month, less than 6 months
  98. Schizoaffective
    • Generally later in life
    • severe mood swings
    • some psychotic s/s
  99. Brief psychotic d/o
    • Sudden onset
    • at least 1 positive symptom lasting one day, but less than one month 
    • full recovery
  100. Shared psychotic d/o
    Involving 2 individuals and share same delusions
  101. Delusional D/O
    • Non-bizarre delusions 
    • at least one month duration
  102. Substance/medication-induced psychotic D/O
    Induced by meds, drugs and toxins
  103. Typical 1st Generation Antipsychotics
    • Reduces POSITIVE symptoms 
    • Causes movement D/O
    • Blocks dopamine 
    • Thorazine, HALDOL, stealzine, prolixin, navane, trilafon, mellaril,serentil
  104. Anticholinergic S/S
    Typical 1st Gen Antipsych
    • Dry Mouth
    • Urinary Retention 
    • Constipation 
    • Blurred Vision 
    • Photosensitivity 
    • Dry Eyes
    • Inhibition of ejaculation or impotence
    • Orthostatic Hypotension
  105. EPS S/E
    Typical 1st Gen Antipsych
    • Extra pyramidal symptoms 
    • Pseudoparkinsonism
    • Opisthotonos - bend backwards in 1/2 
    • Oculogyric crisis - eyes roll back
  106. Tardive Dyshinesia
    • EPS S/E
    • Usually happens after being on med for along period of time
    • Aims test - Observe movement for baseline of movement patterns prior to med being given
  107. Rx for EPS symptoms
    • Cogentin
    • Artame
    • Symmetreal
    • Benadryl
  108. Atypical 2nd Generation Antipsychotics
    • Affects POSITIVE and NEGATIVE symptoms 
    • Blocks dopamine but not as much as 1st gen
    • Does not affect movement
    • Influences glutamate = improves cognition
    • Fewer anticholinergic S/E
  109. Atypical Antipsychotics
    • Improves mood level and decreases anxiety
    • Diminishes Positive and Negative Symptoms
    • Weight gain, metabolic abnormalities 
    • Clozaril = last resort med, can cause fatalities, any sign of infection call doctor
    • Risperdal - check prolactin levels, can cause lactation - dopamine blocks the release of prolactin

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