Psych Test 3 Bitches….

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Psych Test 3 Bitches….
2010-08-03 00:13:32
Psych Test

Psych Test 3
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  1. In schizophrenia, these symptoms reflect an excess or distortion of normal functions. These
    active, abnormal symptoms may include:
    --Thought disorders
    --Disorganized behaviors

    Positive Symptoms
  2. These beliefs are not based in reality and usually
    involve misinterpretation of perception or experience. They are the mot common
    of schizophrenic symptoms.
  3. These usually involve seeing or hearing things that
    don't exist, although they can be in any of the senses. Hearing
    voices is the most common example among people with schizophrenia.
  4. Difficulty speaking and organizing thoughts may
    result in stopping speech midsentence or putting together meaningless words,
    sometimes known as "word salad."
    Thought disorder
  5. This may show in a number of ways, ranging from
    childlike silliness to unpredictable agitation.
    Disorganized behavior

  6. refers to a diminishment
    or absence of characteristics of normal function. They may appear months or
    years before positive symptoms. They include:

    of interest in everyday activities

    to lack emotion

    ability to plan or carry out activities

    of personal hygiene


    of motivation

    • Negative
    • symptoms

  7. Involves problems with thought processes. These symptoms may be the most
    disabling in schizophrenia, because they interfere with the ability to perform
    routine daily tasks. A person with schizophrenia may be born with these
    symptoms, but they may worsen when the disorder starts. They include:

    with making sense of information

    paying attention


    Cognitive symptoms
  8. Schizophrenia
    also can affect mood, causing depression or mood swings. In addition, people
    with schizophrenia often seem inappropriate and odd, causing others to avoid
    them, which leads to social isolation.
    • Affective
    • symptoms
  9. Homelessness & Schizophrenia
    • Mental illness is one of the main contributors to homelessness.

    • Schizophrenia and homelessness are dual conditions that plague nearly every
    • industrialized country in the world. The crisis is compounded by the fact that
    • many schizophrenics are drug addicts and/or alcoholics. Treatment is difficult,
    • if not impossible, and funding is a continuing issue. With the challenges of
    • treatment, increased legal issues, schizophrenics' tendency toward violence and
    • the fact that mentally ill homeless remain homeless longer than the general
    • homeless population , homeless schizophrenics have become modern
    • society's untouchables. According to, in 2007, approximately 200,000
    • people were schizophrenic and homeless.

  10. Domestic violence in SC

    • Attorney General

    • Henry McMaster has named domestic violence as the number one crime problem
    • in South Carolina. More than 36,000 victims annually report a domestic
    • violence incident to law enforcement agencies around the state. Over the
    • past twelve years, an average of thirty-three (33) women have been killed each
    • year by their intimate partner. Currently South Carolina ranks eighth in
    • the nation for the amount of homicides caused by criminal domestic violence
  11. One in every four women will?
    • experience domestic violence in her lifetime

  12. One in 33 men have?
    • experienced an attempted or completed rape

  13. There were 35,894 victims of domestic violence in
    South Carolina in 2005. 43% of reported domestic violence cases ended in an
  14. In South Carolina, 36% of aggravated assaults were
    domestic violence related in
  15. 1,809 forcible rapes were reported in South Carolina
  16. 28% of murders in South Carolina were domestic
    violence related in
  17. There were 32 domestic violence related homicides
  18. The most common relationship between homicide
    perpetrators and victims was boyfriend/girlfriend and the second most common
    relationship was between
  19. How long do you have to have the symptoms to classify as schizophrenia?
    Symptoms X30 days for >6Months
  20. How long for schizophrenoform DO?
    Symptoms < 6 months
  21. What is SAFD?
    Schizoaffetive Disorder….Symptoms with & without mood episode
  22. What is a delusional disorder?
    Non-bizarre delusion x 1month
  23. How long is a brief psychotic disorder?
    > 1 day <1 month
  24. What is a shared psychotic disorder?
    It takes on other delusions
  25. Some other psychotic disorders can be caused by what?
    • Medicine/drugs
    • NOS?
  26. What is the diagnosis criterion for schizophrenia?
    • 1. Positive or negative symptoms for 30 days for greater than 6 months
    • 2. Marked social/vocational dysfunction
    • 3. NOT due to:
    • …….. medical
    • …….. drugs
    • …….. SAFD
    • …….. Manic Depressive Disorder (MDD) with psychotic features
  27. What are the 4 types of POSITIVE symptoms?
    • 1. Delusions
    • 2. Hallucinations
    • 3. Disorganized Speech
    • 4. Catatonia
  28. Grandiosity, persecution, somatic, reference, thought insertion/withdrawal/broadcasting, ect?
  29. auditory, visual, tactile, olfactory, gustatory?
  30. clang, neologisms, thought block, loose assoc, perseveration?
    Disorganized Speech
  31. stupor, posture, excitation?
  32. What are the NEGATIVE symptoms of schizophrenia? *Hint-Crazy 8's*
    • - Affective blunting
    • -Anhedonia
    • -Anergia
    • -Alogia
    • -Apathy
    • - Avolition
    • - Asociality
    • -Attention problems
  33. What are the subtypes of schizophrenia?
    • •Paranoid
    • •Disorganized
    • •Catatonic
    • •Undifferentiated
    • •Residual
  34. Negative symptoms that persist inspite of resolution of positive symptoms
  35. What is the scope of schizophrenia?
    • •40 % attempt suicide within 10 yrs.
    • •10 % actually complete suicide
    • •9thleading cause of disability
    • •60-70% never marry/have children
    • •Occupy 25% of all hospital beds
    • •70%–80% are unemployed or underemployed
    • •10% of permanently disabled Americans
    • • 20%–30% of the homeless population
  36. Schizophrenia vs. Violence
    •Evidence mixed•Media sensationalized?•Schizophrenics 14% more likely to be victimrather than comit violent crime
  37. What are the demographics of Schizophrenia?
    •0.5 - 1.5 % of population•Urban > Rural•Uniform rates across racial and ethnic groupsin US, except for higher rates with racial minorities in large cities •Higher rates with maternal malnutrition
  38. What are the gender differences of Schizophrenia?
    •Male > Female (up to 20%)•Onset: male (18-25 yr); female (25-35 yr) •Second peak in onset women after 45 yrs.•Pre-morbid function females > males•Males – More positive symptoms•Females – More negative symptoms•Women have moreemotional/affectivesymptoms – misdiagnosed MDD or SAFD
  39. What are the etiological theories concerning Schizophrenia?
    •Genetic – familial ; 10% greater chance•Hormonal – onset S/P puberty, thyroid, DM•Apoptosis/Excessive pruning•Virus – selectivity; dormancy; triggered bystress/hormonal; alter cellular process without destroying cells•Neurotransmitter – drugs can either mimic or eleviatesymptoms
  40. What is the pathology behind Schizophrenia?
    •Up To 25% loss of graymatter•Enlarged ventricles •Enlarged amygdala •Neurological abnormalities•Impaired cognitive function•Decreased prefrontal brainfunction •Impaired awareness ofillness
  41. What are the 4 stages of progression when dealing with Schizophrenia?
    1. Premorbid2. Prodromal3. Psychotic4. Recovery
  42. Asymptomatic withgenetic/environmental vulnerability.
    Premorbid (0-35 yrs.)
  43. Insidious decline inwork/school/social/adaptive functioning
    Prodromal (2-5 yrs.)
  44. Abrupt onset of (+) &significant worsening of (-) symptoms. Often hospitalized due to unable to care for self.
    Psychotic (wks.-yrs.)
  45. Exacerbations & remissionswith 80% relapse rate. Degree of illness/level of functioning plateau after 10yrs.
    Recovery (yrs.)
  46. What are some ways to treat Schizophrenia without medications?
    •Supportive psychotherapy•Family therapy•Socialization/social skills training•Cognitive Behavioral Therapy•Hospitalization
  47. What are the two types of pharmacotherapeutics that treat Schizophrenia?
    1. Typicals2. Atypicals
  48. These Alleviate positive symptoms, have More side effects, but are Lessexpensive
  49. These will alleviate positive symptoms, offer some help with negative symptoms, have fewer side effects, and MIGHT have neuroprotective effects????
  50. What are the medication forms that treat Schizophrenia?
    •Pill/capsule•Elixir•Orally disintegrating tabs (ODT)•IV/IM•Deaconate
  51. What are the drug side effects for drugs that treat Schizophrenia?
    •Histaminic effects – Sedation•Adrenergic effects – Orthostasis•Anticholenergic effects – Dry mouth•Hyperprolactinemia – Sexual•Metabolic effects:- Weight gain- Hyperglycemia/diabetes- Hyperlipidemia
  52. What are the other med risks?
    •Seizures•Stroke•Sudden death (dementia)•QTcProlongation (Geodon & Melaril)•Extrapyramidal symptoms (EPS)•Tardive dyskinesia(TD)•Neuroleptic malignant disorder (NMS)•Agranulocytosis (Clozaril)
  53. What does the nurse need to monitor the patient for that is receiving treatment for Schizophrenia?
    •Vital signs – include orthostatic BP (falls)•Weight & BMI•EKG•AIMS – Abnormal Involuntary Movement Scale (TD)•Labs – CBC, renal function,lipids, glucose, HgbA1C, LFTs, TFTs, prolactin•Suicidality
  54. ASEs Typicals?
  55. ASEs Atypicals?
  56. Dopamine pathways

  57. This syndrome is probably, in part, a genetic condition. People with this syndrome have motor tics and vocal tics. Motor tics are movements of the
    muscles, blinking, head shaking, jerking of the arms, and shrugging. When a
    person with this syndrome suddenly begins shrugging, he or she may not be
    doing it on purpose. This may be a motor tic.

    Tourette's Syndrome

  58. These tics are sounds that a person with Tourette syndrome might make with his or her
    voice. Throat clearing, grunting, and humming are all common tics. A
    person with Tourette syndrome will sometimes have more than one type of tic happening
    at once.

    Vocal Tics
  59. Tics are usually worse when a person is under?
  60. Tourette syndrome is not a psychological condition, it is a ? one
  61. Tourette's Statistics
    Tourette's However, psychological factors are very important in this condition. Psychological distress can make the tics worse, and kids with Tourette syndrome might feel very upset because of the tics and the problems that go with them. Counselors and Tourette syndrome organizations can help kids learn how to explain tics to others. It affects at least 1 in 1,000 to 2,000 people and maybe more. It is believed that about 100,000 Americans have Tourette syndrome.
  62. What drugs is ADHD treated with?
    • ADHD is usually treated
    • with the aid of stimulant drugs like Ritalin. Concerta
    • and with non-stimulant Straterra
    • as well as amphetamines,
    • such as Dexedrine
    • and Adderall.
  63. Stimulants are believed to
    work by increasing ? levels in the brain. Stimulant medications boost
    concentration and focus while reducing hyperactive and impulsive behaviors.

  64. Stimulants for
    ADD / ADHD come in both short and long-acting dosages. Short-acting stimulants
    peak after several hours, and must be taken (x) times a day. Long-acting or
    extended-release stimulants last 8-12 hours, and are usually taken (y)?

    • (x)= 2-3 times
    • (y)= 1 time per day

  65. The relationship between suicide risk and
    sexual orientation: results of a population-based study.

    • G Remafedi, S

    • French, M Story, M D Resnick and R Blum
    There is evidence of a strong
    association between suicide risk and bisexuality or
    in ?

  67. RESULTS: Suicide attempts
    were reported by
    28. 1
    % of bisexual/homosexual males, 20.5% of bisexual/homosexual females, 14.5% of
    heterosexual females, and 4.2% of heterosexual


  68. Means restriction

  69. Limiting access to lethal
    means of self-harm is an ? strategy to prevent self-destructive
    behavior, including suicide.

  70. Some suicidal acts are
    ?, resulting from a combination of psychological pain or despair
    coupled with easy availability of the means to inflict self-injury: firearms,
    carbon monoxide, medications, sharp objects, tall structures.

  71. By limiting the individual's ? to the
    means of self-harm, a suicidal act may be prevented.

  72. The ? is to separate in
    time and space the individual experiencing an acute suicidal crisis from easy
    access to lethal means of self-injury and personal harm
  73. The hope is by making it
    harder for those intent on self-harm to act on that impulse, one can buy time
    for the ? to pass and for healing and recovery to occur.
  74. ? are the most common method
    of completed suicides nationwide (54%), followed by suffocation (20%),
    poisoning (17.5%), falls (2.3%), cut/pierce (1.8%), and drowning (1.2%) (CDC:
  75. This is true for men, women
    and adolescents who complete suicide. In New York, ? are also the
    predominant means of suicide, but by a much slimmer margin
  76. Suicide by firearms seems
    to be associated with their availability in the home and with victim

  77. Many homes contain guns and
    nearly half (43%) of all homicides and suicides occur in a ?. Most victims
    are shot: 67% of the homicides and 54% of the suicides in 2002 (CDC: WISQARS,
    2005). In some studies, ? pose the greatest risk.

    • home
    • handguns

  78. Asperger syndrome and interpersonal relationships

  79. The lack of
    ? is possibly the most dysfunctional aspect of Asperger

  80. Individuals
    with Asperger's Syndrome experience difficulties in basic elements of (1), which
    may include a failure to develop friendships or to seek shared enjoyments or
    achievements with others (for example, showing others objects of interest), a
    lack of social or emotional reciprocity, and impaired
    nonverbal behaviors in areas such as (2….4 items)?

    • 1= social interaction
    • 2= eye contact, facial expression, posture, and gesture

  81. Qualitative impairment in social
    interaction, as manifested by at least two of the following: (4 items)

    • (A) marked impairments in the use of

    • multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body
    • posture, and gestures to regulate social interaction
    • (B) failure to develop peer relationships

    • appropriate to developmental level
    • (C) a lack of spontaneous seeking to

    • share enjoyment, interest or achievements with other people, (e.g.. by a lack
    • of showing, bringing, or pointing out objects of interest to other people)
    • (D) lack of social or emotional

    • reciprocity

  82. (II) Restricted repetitive &
    stereotyped patterns of behavior, interests and activities, as manifested by at
    least one of the following: (4 items)

    • (A) encompassing preoccupation with one

    • or more stereotyped and restricted patterns of interest that is abnormal either
    • in intensity or focus
    • (B) apparently inflexible adherence to

    • specific, nonfunctional routines or rituals
    • (C) stereotyped and repetitive motor

    • mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body
    • movements)
    • (D) persistent

    • preoccupation with parts of objects
  83. Eating Disorders

  84. It is estimated that 8 million ? have an eating
    disorder – seven million women and one million men

    • Americans
  85. Eating disorders have the highest ? rate of any mental illness
  86. A study by the National Association of Anorexia Nervosa and
    Associated Disorders reported that 5 – 10% of anorexics die within 10 years
    after contracting the disease; 18-20% of anorexics will be dead after 20 years
    and only ? ever fully recover
    30 – 40%
  87. 20% of people suffering from anorexia will prematurely die from
    complications related to their eating disorder, including suicide and ?
    heart problems

  88. Common
    co-morbid conditions include ? (50% to
    75%), sexual abuse (20% to 50%), obsessive-compulsive disorder (25% with
    anorexia nervosa), substance abuse (12% to 18% with anorexia nervosa,
    especially the binge-purge subtype, and 30% to 37% with bulimia nervosa), and
    bipolar disorder (4% to 13%). 1-4

    major depressive disorder or dysthymia
  89. Medical Complications of Anorexia?
    • 1. Amenorrhea Bradycardia
    • 2. Orthostatic Blood Pressure Drop
    • 3. Osteoporosis
    • 4. Stress fractures
  90. Cold intolerance, constipation, cyanosis, edema, hypoglycemia, low albumin
    Amenorrhea Bradycardia
  91. What are the Structural and functional brain changes associated with anorexia?
    Thyroid dysfunction
  92. What can appetite suppressant abuse cause?
    • Anxiety, hypertension, tremors, tachycardia, Purging type reflux, parotid abnormalities, gastrointestinal

    • bleeding, hypokalemia, Dental caries, enamel erosion, dehydration, cardiac
    • arrhythmias, and Renal failure
  93. TREATING ANOREXIA involves what three components?
    • 1. Restoring the person to a healthy weight;

    • 2. Treating
    • the psychological issues related to the eating disorder
    • 3. Reducing
    • or eliminating behaviors or thoughts that lead to disordered eating, and
    • preventing relapse.

  94. · The ? in anorexia treatment is to address and
    stabilize any serious health issues. Hospitalization may be necessary to
    prevent starvation, suicide, or a medical crisis. Dangerously thin anorexics
    may also need to be hospitalized until they reach a less critical weight.
    Outpatient treatment is an option when the patient is not in immediate medical

    first priority

  95. Explores the critical and
    unhealthy thoughts underlying anorexia. The focus is on increasing
    self-awareness, challenging distorted beliefs, and improving self-esteem and
    sense of control. Also involves education about anorexia.

    • Cognitive therapy

  96. Promotes healthy eating behaviors
    through the use of rewards, reinforcements, self-monitoring, and goal
    setting. Teaches the patient to recognize anorexia triggers and deal with
    them using relaxation techniques and coping strategies.

    • Behavior therapy

  97. Examines the family dynamics that
    may contribute to anorexia or interfere with recovery. Often includes some
    therapy sessions without the anorexic patient—a particularly important
    element when the person with anorexia denies having an eating disorder.

    • Family therapy

  98. Allows people with anorexia to
    talk with each other in a supervised setting. Helps to reduce the isolation
    many anorexics may feel. Group members can support each other through
    recovery and share their experiences and advice.

    • Group therapy

  99. Presentation-2.child.ppt
  100. Genetic factors (nature) and childhood experiences (nurture) are predisposing causes for developing ?
    psychiatric illness

  101. ˜?
    combined with genetic predisposition begins to explain complexity of
    development of child psychiatric illness

  102. ˜Related
    to roles of ? and brain development

  103. Perhaps epigenetic mechanism

  104. ˜Brain
    mechanisms down-regulate stress reaction after ? has passed, returning
    brain to prior level of functioning

    and reversible during acute stress


  105. ˜If
    prolonged, severe, or repetitive stress, increased neurotransmitter activity
    often ?

  106. Resilient Children

    • ˜Resilience: ability to withstand stress
    • ØAffected
    • by individual characteristics, early life experiences
    • ˜Protective
    • factors in their environment
    • ˜Are
    • competent, realistic, flexible, assured of their own inner resources and
    • support
    • ØHave
    • strong sense of personal control
    • ØTake
    • age-appropriate responsibility
    • ØRecover
    • quickly when faced with stressors

  107. Challenges for Nurses

    • ˜Derive
    • realistic, well-defined goals
    • ˜Respond
    • to complex social needs
    • ˜Understand
    • and advocate for child
    • ˜Develop
    • comprehensive treatment plan that identifies and integrates child’s needs and
    • family resources
    • ˜Realize
    • that behavior is cultural, must be viewed from sociocultural
    • perspective

  108. Communication

    • ˜First
    • goal: to establish therapeutic alliance with child and parents
    • ˜If
    • child’s verbal communications vague or unclear, ask for more explanations
    • ˜Child
    • may not respond to problem-centered lines of communication
    • ØFirst
    • discuss more general aspects of child’s life (family members, school, friends)

  109. Strategies for

    Communicating with Children

    • ˜Understand
    • age-related development
    • ˜Convey
    • respect and authenticity
    • ˜Use
    • familiar vocabulary at child’s level of understanding
    • ˜Assess
    • child’s needs in immediate situation
    • ˜Assess
    • child’s capacity to cope with change

  110. Strategies for

    Communicating with Children

    • ˜Increase
    • coping skills by creative, unstructured play
    • ˜Use
    • indirect age-appropriate communication techniques (storytelling, picture
    • drawing, creative writing)
    • ˜Use
    • alternative communication devices for children with special needs (sign
    • language, computer aids)

  111. Ego Competency Skills

    Important to learn

    • ˜Focus
    • nursing assessment on specific skills all children need to become competent
    • adults

    • ˜Regardless
    • of medical diagnosis, assess child for mastery of these skills:

    • ØEstablishing
    • closeness and trusting relationships

    • ØHandling
    • separation/independent decision making

    • ØNegotiating
    • joint decisions and interpersonal conflictØDealing
    • with frustration/unfavorable events
    • ØCelebrating
    • good feelings and experiencing pleasure
    • ØWorking
    • for delayed gratification
    • ØRelaxing
    • and playing
    • ØCognitive
    • processing through words, symbols, images
    • ØEstablishing
    • adaptive sense of direction or purpose

  112. More common childhood
    psychiatric illnesses

    • ˜ADHD
    • ˜Depression
    • ˜Anxiety
    • ˜Conduct
    • disorder
    • ˜Autism

  113. Effective Coping

    Behaviors for Children

    • ˜Withdrawing
    • from stressful situations
    • ˜Postponing
    • immediate response
    • ˜Finding
    • more manageable situation
    • ˜Restructuring
    • (manipulating or shaping) environment
    • ˜Accepting
    • good and bad as part of life
    • ˜Working
    • toward maintaining optimal conditions of adjustment, security, comfort

  114. Treatment

    • ˜Medication:
    • improve brain functioning
    • ˜Social
    • skills training: improve socialization
    • ˜Behavior
    • management: learn impulse control
    • ˜Cognitive
    • therapy: practice problem solving and communication
    • ˜Parent
    • education: integrate new behaviors and skills into child’s life

  115. Eating Regulation Responses and Eating Disorders

  116. Adaptive Eating Responses
    • •Balanced
    • eating patterns
    • •Appropriate
    • caloric intake
    • •Body
    • weight appropriate for height
    • •Able
    • to regulate eating habits
    • •Resists
    • overuse or underuse of food
    • •Maintains
    • biological, psychological, sociocultural integrity

  117. Maladaptive Eating Responses

    • Illnesses
    • associated with maladaptive eating regulation responses
    • Anorexia nervosa
    • Bulimia nervosa
    • Binge eating disorder
    • Night eating syndrome

  118. Continuum of

    Adaptive Eating Responses

  119. Implications
    • Eating
    • disorders more common among females; males more reluctant to seek treatment
    • Sociocultural norms result in
    • distorted body image

  120. Implications

    • Eating
    • disorders can cause biological changes: altered metabolic rates, profound
    • malnutrition, possibly death
    • Eating
    • obsessions can cause psychological problems, e.g., depression, isolation,
    • emotional lability

  121. Eating Disorders: Anorexia

    • •Anorexia nervosa in approximately 0.5%-1% of females
    • •About 5%-10% of people with anorexia are male
    • •Usual onset between 13-20 years but can occur in any age

  122. Eating Disorders: Anorexia

    • •Although hungry, person with anorexia refuses to eat
    • because of distorted self-perception of fatness
    • •Starvation ensues
    • •Can become chronic illness
    • •Estimated mortality from anorexia nervosa: 5% of those
    • with the disorder

  123. Eating Disorders: Bulimia

    • •Bulimia nervosa more common
    • –Estimated in 1%-4% of
    • population, mostly females
    • –4%-15% of female high
    • school and college students
    • •Onset usually at 15-18 years old

  124. Eating Disorders: Bulimia

    • •Uncontrolled binge eating alternating with vomiting or
    • dieting
    • •Same patient may have bulimia and anorexia
    • •Bulimia usually occurs in people of normal weight but
    • people may be obese or thin

  125. Eating Disorders: Binge Eating

    • •Binge
    • eating disorder: consuming large amounts of calories in contained amount of
    • time
    • •Differs
    • from bulimia because person does not attempt to prevent weight gain
    • •Purging
    • behaviors not used
    • •Prevalence:
    • approximately 2%-4% of population

  126. Eating Disorders: Night Eating

    • Night
    • eating syndrome: pattern of awakening during night associated with food intake
    • Not yet listed as separate eating disorder in DSM-IV-TR
    • Estimated 1.5% in general population
    • Make up 27% of
    • severely obese population seeking surgical treatment

  127. Overlapping Relationships Among Eating Disorders

  128. Assessment
    • Complete
    • biological, psychological, sociocultural evaluations
    • Full
    • physical examination: vital signs; weight; skin; cardiovascular system;
    • evidence of laxatives, diet pills, diuretic abuse, and/or vomiting; dental
    • examination
    • Psychiatric
    • history: dieting and substance use, family assessment, medication

  129. Screening for Eating Disorders

    • Focus specific attention on assessment of eating
    • regulation responses

    • Several questionnaires and rating scales screen for
    • eating disorders

    • Adding these two questions may be as effective as more
    • extensive questionnaires to identify people with eating disorders:

    Are you satisfied with your eating patterns?

    • Do you ever eat in secret?

  130. Assessment: Eating Disorders

    • Actual
    • and desired weight, weight history, menstruation
    • Food
    • avoidances, restrictions, dieting, fasting patterns/unusual nutrition beliefs
    • Frequency,
    • extent, timing of binge eating, and/or purging/compulsive exercise patterns

  131. Assessment: Eating Disorders

    • Use
    • of laxatives, diuretics, diet pills, other methods of purging/chewing and
    • spitting food
    • Weight
    • or shape preoccupation/body image disturbances
    • Food
    • preferences, peculiarities
    • Impact
    • of illness on school, work, social life

  132. Behaviors: Binge Eating

    • Rapid
    • consumption of much food in discrete period
    • Emphasis
    • on patient’s perception of loss of control, perceived excessive caloric intake
    • more important than total number of calories consumed, but must assess both
    • Usually
    • binge secretively, often feel shame

  133. Behaviors: Binge Eating

    • Person
    • with bulimia typically average weight or slightly overweight with unsuccessful
    • dieting history
    • Several
    • times weekly to more than 10 times/day, or occasional binges related to
    • stressful situations

  134. Behaviors: Fasting or Restricting

    • People
    • with anorexia eat 500-700 calories (as few as 200) daily
    • Eliminate
    • all meat, poultry, fish, dairy; do not substitute nonanimal protein, nutrients
    • May
    • be obsessive-compulsive: eat same foods repeatedly, foods in predetermined
    • order, bizarre food preferences, avoid fattening food, fast for days

  135. Behaviors: Purging

    • Excessive
    • exercise

    • Forced
    • vomiting

    • Over-the-counter
    • or prescription diuretics, diet pills, laxatives, steroids

    • Laxative
    • abuse common, inefficient way to
    • lose; abuse can increase to 60 doses/week

    • Many
    • patients engage in more than one purging behavior

  136. Medical Complications of

    Eating Disorders

    • Central nervous system
    • Renal
    • Hematological
    • GastrointestinaI
    • Metabolic
    • Endocrine
    • Cardiovascular

  137. Medical Problems

    Related to Anorexia

    • Patients
    • 30% below ideal body weight often have life-threatening clinical, laboratory
    • findings
    • People
    • who vomit and use laxatives or diuretics, regardless of weight, usually have
    • health problems
    • Metabolic
    • and endocrine abnormalities result from malnutrition/starvation

  138. Medical Problems

    Related to Anorexia

    • Often
    • see amenorrhea, osteoporosis, hypometabolic symptoms (cold intolerance, bradycardia)
    • Starvation
    • may cause hypotension, constipation, acid-base, fluid-electrolyte disturbances,
    • e.g., pedal edema

  139. Medical Problems

    Related to Bulimia

    • Potassium depletion and hypokalemia from vomiting,
    • laxative or diuretic abuse
    • Symptoms of potassium depletion: muscle weakness,
    • cardiac arrhythmias, conduction abnormalities, hypotension
    • Gastric, esophageal, bowel abnormalities common in
    • patients with bulimia
    • May erode dental enamel, cause enlarged parotid glands

  140. Medical Problems

    Related to Binge Eating

    • Excess
    • weight: serious health problems
    • Increased
    • weight: exacerbate health problems
    • Medical
    • problems common
    • Excess
    • weight: hypertension, cardiac problems, sleep apnea, difficulties with
    • mobility, diabetes mellitus

  141. Co-morbid Mental Illnesses

    • Depression
    • or dysthymia in 50%-75% of people
    • with anorexia and bulimia
    • Obsessive-compulsive
    • disorder in up to 25% of patients with anorexia nervosa
    • Patients
    • with bulimia have increased rates of anxiety disorders, posttraumatic stress
    • disorder, substance abuse, mood disorders

  142. Predisposing Factors

    • Psychological: rigidity, perfectionism
    • Environmental: illnesses, sexual abuse, drug abuse,
    • media influences
    • Familial: increased risk in female relatives
    • Biological: probable relationship to serotonin and
    • dopamine levels
    • Sociocultural: shifting cultural norms for young women to face
    • multiple, ambiguous, often contradictory role expectations

  143. Sociocultural Influences

    • In
    • some cultures, thinness highly valued, culturally rewarded, associated with
    • achievement
    • Contemporary
    • U.S. ideal woman is lean, strong, graceful, feminine with emphasis on fitness,
    • health

  144. Sociocultural Influences

    • Children,
    • adolescents, young adults living where emphasis placed on weight and size often
    • develop eating disorders
    • Activities
    • or occupations that emphasize beauty or fitness also promote preoccupation with
    • weight, eating behaviors

  145. Appraisal of Stressors

    • Include
    • peer pressure, daily solitude, interpersonal rejection, loss
    • Environmental
    • pressures, stress if lacking self-concept, realistic body image
    • Rely
    • on external feedback
    • Rely
    • on external cues
    • Food
    • a replacement for deficient internal regulator

  146. Stuart Stress Adaptation Model: Eating Regulation

  147. Medical Diagnoses

    • Anorexia
    • nervosa
    • Includes intense fear of gaining weight, disturbed body
    • image
    • >15% below minimum normal weight for age/height
    • Can be restrictive type or binge eating/purge type
    • Binge
    • eating disorder
    • Bulimia
    • nervosa

  148. Short-Term Goals

    • Patient
    • will identify cognitive distortions about food, weight, body shape
    • Develop
    • nutritionally balanced menus
    • Accurately
    • describe body dimensions
    • Exercise
    • moderately only when nutritionally, medically stable

  149. Short-Term Goals

    • Demonstrate
    • positive family interactions and successful movement toward achievement of
    • separation and individuation issues
    • Describe
    • complications of eating disorder behaviors
  150. Planning
    • Nursing
    • care varies based on treatment setting of patient with maladaptive eating
    • regulation responses
    • Factors
    • affecting choice of treatment setting
    • Patient’s physical and psychological condition
    • Financial resources
    • Availability of treatment specialists
    • Patient’s preference

  151. Care Settings for Eating Disorders

    • Outpatient
    • settings: day treatment, intensive, partial hospitalization programs
    • Weekly
    • outpatient office visits
    • Reimbursement
    • for inpatient programs often difficult to obtain
    • Inpatient
    • treatment: 24-hour nursing care to ensure safety, support behavioral change,
    • monitor physiological responses

  152. Outpatient Treatment

    • Allows
    • patient greatest opportunity for self-control, autonomy
    • Requires
    • high patient motivation
    • Need
    • family’s active support, involvement
    • Need
    • ongoing physiological monitoring

  153. Evidence-Based Treatment for Bulimia Nervosa

    • Manual-based
    • CBT is treatment of choice
    • Several
    • antidepressants produced short-term reductions in binge eating, purging
    • Long-term
    • effects untested
    • CBT
    • with antidepressants may affect bulimia slightly by treating co-morbid anxiety,
    • depression

  154. Nurse-Patient Contract

    • Goal:
    • to engage in therapeutic alliance and obtain commitment to treatment process
    • Before patient admitted to eating disorder treatment
    • program, obtain cooperation with nurse-patient contract
    • By signing contract, patients show they understand
    • treatment they will be receiving
    • Assists patient to make informed decisions about
    • treatment process, ability to honor contract

  155. Implementation:

    Nutritional Stabilization

    • High
    • priority for nursing intervention

    • Set
    • healthy target weights

    • In
    • life-threatening circumstances, malnourished patients may need refeeding interventions

    • Treatment
    • programs develop specific nursing interventions to promote weight
    • stabilization, healthy eating patterns

  156. Eating Disorder Program Protocols

    • Time,
    • frequency, procedure for weighing patient and if patient may view reading

    • Time
    • and number of meals each day

    • How
    • staff will interact with patients at mealtimes to maximize therapeutic value of
    • their presence

    • Allowing
    • diet foods, condiments, or food substitutions?

  157. Eating Disorder Program Protocols

    • Amount
    • of water patient may drink each day
    • Vital
    • signs/intake and output/required laboratory work
    • Conditions
    • for bathroom privileges
    • Indications
    • for close observation by staff

  158. Eating Disorder Treatment

    • Patients
    • able to master eating their meals can move toward having more independence over
    • scheduling meals
    • Select
    • own menus with assistance is next
    • Then
    • can shop for, cook food with supervision
    • By
    • discharge, should have high level of comfort with food and its preparation

  159. Eating Disorder Treatment

    • Getting
    • patient with anorexia to gain weight is difficult
    • Nurse-patient
    • contracts can be effective
    • May
    • set goal of gaining 1 pound/week
    • If
    • fails to gain 4 pounds in 1 month, contract would stipulate that patient would
    • agree to enter hospital, day treatment program, or more intensive type of care

  160. Cognitive Behavioral Therapy (CBT)

    • Single
    • most effective treatment for patients with eating disorders
    • Must
    • work with patients regarding cognitive distortions or faulty thinking about
    • body shape, weight, food

  161. Cognitive Distortions in Maladaptive Eating

    • Magnification:
    • overestimating significance of undesirable events
    • Superstitious
    • thinking: believing in cause-effect relationship of noncontingent events
    • Dichotomous
    • or all-or-none thinking
    • Overgeneralization
    • Selective abstraction
    • Personalization and self-reference

  162. Awareness of Cognitive Distortions

    • Patient
    • to monitor and record eating, bingeing, and purging behavior and thoughts and
    • feelings regarding weight, shape, food
    • Cues that trigger eating responses
    • Thoughts, feelings, assumptions with cues
    • Connection between these and eating regulation responses
    • Consequences from eating responses

  163. Eating Regulation Responses

    • Help
    • patient solve problems and make decisions after identifying alternatives
    • Encourage
    • patient to list high-risk situations that cue maladaptive eating, purging
    • behaviors
    • May
    • benefit from assertiveness training, role-modeling sessions with nurse

  164. Body Image

    • Body
    • image distortion in eating disorders involves perceptions, attitudes, behaviors
    • Distinguish
    • body image distortion vs. body dissatisfaction
    • Body
    • image distortion: discrepancy between patient’s actual size and perceived body
    • size

  165. Body Image

    • Body
    • dissatisfaction: degree of unhappiness person feels in relation to body size
    • All
    • people may express dissatisfaction with their bodies at some point, but such
    • dissatisfaction is constant in persons with anorexia or bulimia

  166. Body Image Interventions

    • First determine if patient has problems with perception,
    • attitude, or behavior
    • Devise program targeting specific problem
    • Cognitive behavioral interventions effective, as are
    • dance therapies; enhance integration of mind and body, clarify body boundaries,
    • modulate negative feelings
    • Other therapeutic approaches: imagery and relaxation,
    • working with mirrors, art

  167. Other Interventions

    • Family
    • involvement
    • Engage families from beginning of treatment, include in
    • family meetings, treatment planning sessions
    • Group
    • therapies
    • Reality testing, support, communicating with peers
    • essential therapeutic factors provided
    • Outpatient support helps reinforce social alliances,
    • encourage to express feelings

  168. Interventions: Medication

    • Patients
    • with anorexia often resist medication; no drugs completely effective
    • Do
    • not as primary treatment for anorexia
    • Antidepressants
    • therapeutic effect on many patients with bulimia
    • May
    • decrease frequency of binge eating vomiting
    • Used
    • with other interventions

  169. Evaluation

    • Did
    • nurse provide effective role modeling, emotional support, biological
    • monitoring, reinforcement of patient’s attempts to explore and experiment with
    • new cognitive and behavior patterns?
    • Have
    • normal eating patterns been restored?

  170. Evaluation

    • Have
    • biological and psychological sequelae of malnutrition been corrected?
    • Have
    • associated sociocultural and behavioral
    • problems been resolved so that relapse does not occur?
    • Do
    • goals and evaluation together with patient