Cognitive, Thought and Personality Flashcards
(137 cards)
1
Q
psychotic
A
loss of contact with reality (delusions, hallucinations)
2
Q
schizophrenia
A
most common thought disorder. Group of disorders that affect thinking, behavior, emotions and ability to perceive reality
3
Q
schizoaffective thought disorder
A
meets criteria for schizophrenia AND an affective disorder (depression, mania, etc.)
4
Q
Brief thought disorder
A
psychotic manifestations that last from 1 day to 1 month
5
Q
schizophreniform thought disorder
A
clinical manifestations of schizophrenia, but duration is from 1 to 6 months and social/occupational dysfunction may or not be present
6
Q
Shared psychotic thought disorders
A
one person begins to share delusional beliefs of another person with psychosis
7
Q
Secondary (induced) thought disorders
A
manifestation od psychosis brought on by medical disorder (dementia) or chemical substances (alcohol abuse)
8
Q
Schizophrenia onset
A
late teens to early 20’s
9
Q
Schizophrenia diagnosis
A
Age 7 (rule out ADHD with violent tendencies)
10
Q
Schizophrenia interferes with
A
interpersonal relationships
self-care
ability to work
11
Q
Positive symptoms (symptoms there, but should not be there)
A
- Hallucinations
- Delusions
- Alterations in speech
- Alterations in behavior
12
Q
Hallucinations (sensory perceptions)
A
- Auditory
- Visual
- Olfactory
- Gustatory
- Tactile
13
Q
Delusions
A
alterations in thought that can’t be corrected by reasoning and are usually bizarre
14
Q
Delusions of persecution
A
feeling of being singled out for harm by agencies, other people, or supernatural beings
15
Q
Delusions of grandeur
A
believe they are powerful and important (God)
16
Q
Ideas of Reference
A
believing that events or situations are occurring because of or specifically for them (people on TV sending them messages)
17
Q
Somatic delusions
A
believe their body is changing in an unusual way
18
Q
Jealousy
A
may believe spouse is having an affair
19
Q
Being controlled
A
force outside their body is controlling them
20
Q
Thought broadcasting
A
their thoughts can be heard by others
21
Q
Thought insertion
A
others’ thoughts are being inserted into their mind
22
Q
Thought withdrawal
A
thoughts have been removed from their mind
23
Q
Religiosity
A
obsession with religious beliefs
24
Q
Depersonalization
A
nonspecific feeling that the person has lost her identity
25
Derealization
perception that the environment has changed
26
Alterations in speech (Positive symptoms)
1. Flight of ideas
2. Neologisms
3. Echolalia
4. Clang
5. Word salad
27
Flight of ideas
loose association between thoughts
28
Neologisms
made up words
29
Echolalia
repeating words spoken to him
30
Clang association
meaningless rhyming words
31
Word Salad
words jumbled together with little meaning
32
Alterations in behavior (Positive)
1. Bizarre behavior
2. Extreme agitation
3. Stereotype
4. Automatic
5. Waxy flexibility
6. Stupor
7. Negativism
8. Echopraxia
33
Bizarre behavior
like walking backwards all the time
34
Extreme agitation
pacing and rocking (give them space)
35
Stereotype behaviors
motor patterns with meaning to pt. but now are mechanical and lack purpose
36
Automatic obedience
responding in a robot-like manner
37
Waxy flexibility
excessive maintenance of position
38
Stupor
motionless for long periods of time
39
Negativism
doing opposite of what is requested
40
Echopraxia
purposeful imitation of movements made by others
41
Negative symptoms of schizophrenia
abilities or characteristics that are absent from the pt.
42
Types of Negative Symptoms
1. Affect
2. Alogia
3. Avolition
4. Anhedonia
5. Anergia
43
Affect
facial expression
blunt - narrow range
flat - never changes
44
Alogia
not many thoughts or speech (mumble)
45
Avolition
lack of hygiene and activities (must be prompted)
46
Anhedonia
lack of pleasure or joy (no fun)
47
Anergia
lack of energy
48
Cognitive (thinking) symptoms
1. Disordered thinking
2. Inability to make decision
3. Poor problem solving
4. Difficulty concentrating
5. Memory deficits (long-term or Working memory)
49
Depressive symptoms
Hopelessness
| Suicidal ideation
50
Types of Schizophrenia
1. Paranoid
2. Disorganized
3. Catatonic
4. Residual
5. Undifferentiated
51
Paranoid schizophrenia
suspicion
Hallucinations and delusions
May be violent
52
Disorganized schizophrenia
```
Homeless
withdrawal from society
inappropriate behavior
Disorganized hallucinations and delusions
Bizarre mannerisms
Incoherent speech
```
53
Catatonic schizophrenia
Abnormal motor movements
1. Withdrawn (psychomotor retardation, appear comatose, waxy flexibility, self-care needs)
2. Excited (constant movement, posturing, danger to self and others)
54
Residual schizophrenia
No clinical manifestations
2 or more residual findings
Anergia, anhedonia, avolition, withdrawal, impaired role, speech problems, odd behaviors
55
Undifferentiated
No particular type
| Any symptoms may be present
56
Schizophrenia Medications
| positive psychotic symptoms
Conventional Antipsychotics:
Haldol (Haloperidol)
Thorazine (Chlorpromazine)
57
Schizophrenia Medications
| negative and positive psychotic symptoms
```
Atypical Antipsychotics:
Risperadal
Zyprexa (Olanzapine)
Seroquel (Quetiapine)
Geodon (Ziprasidone)
Abilify
Clozaril
```
58
Schizophrenia Medications
| Depression
Antidepressants:
Paxil
Watch suicide
Avoid abrupt cessation
59
Schizophrenia Medications
| Anxiety + pos and neg
```
Anxiolytics/Benzodiazepines:
Ativan (Lorazepam)
Klonopin (Clonazepam)
Sedative effect
Monitor agranulocytosis
```
60
Medication dose
start low and gradually increased
61
Take medication on a
regular basis
62
Avoid
Alcohol
Sedatives
Haz activities
63
Teach to expect
side effects
64
Significant improvement takes
2 - 4 weeks
65
Full effect may take
several months
66
Depot preparations
IM injections every 2 -4 weeks (can't maintain schedule) Risperidal
67
Oral disintegrating tablets
pt that cheeks or pockets meds or difficulty swallowing
68
Right to refulse
unless a risk for harm to self or others (order for involuntary administration)
69
Milieu therapy
structured, safe environment that helps decrease anxiety and distracts them from continually thinking about hallucinations
70
Therapeutic communication
goal-oriented to help them learn how to manage
71
Trusting relationship
Important for nurse - never lie
72
Nurse should encourage
Development of social skills and friendships
| Participation in group work and psychotherapy
73
To address hallucinations and delusions
1. Don't argue or agree
2. Acknowledge feelings (You seem to be)
3. Offer reasonable explanations
4. Provide for safety
5. Focus conversations on reality-based (redirect)
6. Be genuine and empathetic
7. Identify symptom triggers
8. Determine discharge needs
9. Promote self-care (modelling and instruction)
10. Relate wellness to symptom mgmt. (not going away)
11. Teach and implement strategies to reduce auditory hallucinations (music, TV, say stop)
74
Personality disorders
enduring patterns of behavior for which there is no loss of contact with reality or impaired cognition
75
Personality disorders first observed
late adolescence or early childhood
76
Personality disorders co-occur with
depression and anxiety
77
Personality disorders diagnosis criteria
ongoing, inflexible pattern of behavior that is very different from the individual's culture that causes distress in social or occupational functioning. Affected areas: cognition, affect, impulse control, interpersonal functioning
78
4 Characteristics of Personality Disorders
1. Inflexible and maladaptive response to life events/stress
2. Serious difficulty in areas of personal and work relationships
3. Tendency to evoke personal conflict
4. Tendency to evoke a negative emotional responses from others
79
Risk factors of Personality Disorders
Less educated or unemployed
Single or have marital difficulties
Comorbid substance use
May commit nonviolent or violent crimes (sex)
80
Defense Mechanisms
used by people with personality disorders to "protect" themselves
81
Repression
unconscious hiding of uncomfortable thoughts
82
Suppression
conscious avoidance of uncomfortable thoughts
83
Regression
reverting to patterns of behavior used in earlier development
84
Undoing
attempting to "undo" an unhealthy or destructive thought by behaving in an opposite way
85
Splitting
inability to incorporate both pos. and neg. aspects of oneself into a whole image (common with borderline personality disorder)
86
Cluster A (Odd and Eccentric)
1. Paranoid
2. Schizoid
3. Schizotypal
87
Paranoid personality disorder (A)
distrust and suspiciousness
unfounded belief that others want to harm, exploit, or deceive them
Distort things, others trying to trick them
88
Schizoid personality disorder (A)
emotional detachment, no interest in close relationships, indifference to praise or criticism, prefers to be alone, shy, uneasy, no psychotic symptoms
89
Schizotypal personality disorder (A)
odd beliefs leading to interpersonal difficulties, eccentric appearance, magical thinking or perceptual distortions (not clear hallucinations or delusions). Ideas of reference, bizarre speech, superstitions
90
Cluster B (bouncing ball)
dramatic, emotional, or erratic traits
91
Antisocial personality disorder (B)
characterized by disregard for others with exploitation, repeated unlawful actions, deceit, and failure to accept personal responsibility (often incarcerated), playboy, no guilt, no rules HANNIBAL LECTOR
92
Borderline personality disorder (B)
instability of affect, identity, and fear of abandonment in relationships, splitting behaviors, manipulation, and impulsiveness (food, gambling, spending, substance abuse, unsafe sex). Self-mutilation, suicide.
93
Histrionic personality disorder (B)
characterized by emotional attention-seeking, in which the person needs to be the center of attention. Flirtatious, seductive, drama queen, easily influenced by others, emotional
94
Narcissistic personality disorder (B)
characterized by arrogance, grandiose views of self-importance, the need for consistent admiration, and a lack of empathy for others. Grandiosity. Tends to use others.
95
Cluster C (Scaredy cat)
anxious or fearful traits; insecurity and inadequacy
96
Avoidant personality disorder (C)
social inhibition and avoidance of all situations that require interpersonal contact, despite wanting close relationships, due to extreme fear of rejection; often very anxious in social situations (avoids situations where he/she might be criticized or ridiculed). Seen as cold and/or strange.
97
Dependent personality disorder (C)
| Most common
characterized by extreme dependency in a close relationship with an urgent search to find a replacement when one relationship ends.
Clingy and passive with low self-worth
98
Obsessive/Compulsive personality disorder (C)
characterized by perfectionism with a focus on orderliness and control to the extent that the individual may not be able to accomplish a given task. Rigid about rules. Don't repeat things in a ritual manner like OCD.
99
Self-assessment
nurses need to talk about feelings with more experienced nurses
100
Angry, hostile, and aggressive behavior
| Nursing interventions
1. Assess non-verbal cues
2. Be calm and self-assured
3. Show you care
4. Be culturally aware
5. Allow adequate personal space
6. Encourage to find quiet, safe place
7. Maintain own safety
8. Stand sideways (nonthreatening)
9. Watch exits
10. Ask for permission before touching
11. Verbalize pt.'s options
12. PRN meds
13. Allow de-escalation rime
14. Document measures before restraints
101
Manipulative behavior
| Nursing interventions
1. Set clear and realistic limits (explain and refuse negotiation)
2. Set realistic, enforceable consequences
3. Make sure whole team is aware of limits & agree
4. Document limits
5. Entire staff should decide when to discontinue the limit
102
Paranoid behavior
| Nursing Interventions
1. Assign only one or two staff
2. Make brief contact at beginning of shift
3. Do not make unnecessary demands
4. Be honest, adhere to stated schedule, and follow through (Build trust)
5. Don't touch a patient
6. Don't mix meds with food
7. Supply food in commercially wrapped pkgs
103
Communication strategies
| Nursing Interventions
1. Be firm, supportive approach and provide consistent care
2. Offer realistic choices
3. Model appropriate behavior
4. Maintain professional boundaries and communication
5. Respect the need for social isolation of some clients (safe place)
104
cognitive disorder
disruption of thinking, memory, processing, and problem solving (learning and remembering)
105
delirium
acute confusion seen by a change in overall cognition and level of consciousness
106
dementia
multiple cognitive deficits (especially memory) that tends to be chronic and appear over time
107
aphasia
impaired speech
108
anomia
difficulty remembering words
109
agraphia
inability to understand written language
110
agnosia
inability to recognize familiar objects
111
apraxia
inability to perform activity even though motor function is intact
112
illusions
misinterpretation of reality
113
hallucination
seeing or hearing something that is not there
114
delusion
belief in a false idea
115
depression
may be confused with delirium or dementia
poor personal hygiene, diff. concentrating
Quiet/withdrawn OR agitated
Logical speech, but very negative, hopeless
116
amnestic disorder
involves decreased awareness of surroundings, inability to learn new information, inability to recall previously learned info, possible disorientation to place and time. NO personality change. NO impaired cognition.
117
Dementia defense mechanisms
to avoid embarrassment
1. denial
2. confabulation
3. perseveration
118
denial
refuse to accept the truth
119
confabulation
make up stories to fill in gaps in their memories
120
perseveration
won't change their story (repeat same response)
121
JAMCO
```
helps determine depression vs. delirium vs. dementia
Judgement
Affect/Mood
Memory
Cognition
Orientation
```
122
Causes of delirium
Substance-induced
| Physical needs
123
Substance-induced delirium causes
withdrawal
intoxication
side effects
elderly - lower metabolism, liver and kidney fx
124
Alzheimer's Disease causes/risk factors
```
No known cause or cure
Risks: advanced age
female
prior head injury
family history of Alzheimer's or Down Syndrome
```
125
Stage 1 Alzheimer's
No impairment
| No memory problems
126
Stage 2 Alzheimer's
Very mild cognitive decline
| Forgetfullness
127
Stage 3 Alzheimer's
Mild cognitive decline
| Misplacing important objects, short-term memory loss, Decreased attention span, Difficulty remembering words or names
128
Stage 4 Alzheimer's
Moderate cognitive decline
Personality change
Obvious memory loss
Difficulty with money and math
129
Stage 5 Alzheimer's
Moderately severe cognitive decline
| Inability to recall important details, Can remember who you are and family. Disorientation to time and place
130
Stage 6 Alzheimer's
Severe cognitive decline
Loss of awareness of recent events and surrounding
Knows name, but not personal history
Significant personality changes
Wandering and Incontinence
Abnormal sleep/wake cycles
Violent tendencies with potential to harm self or others
131
Stage 7 Alzheimer's
Very severe cognitive decline
Loss of ability to respond to environment, speak, and control movement, Ataxia, Stupor and coma,
Death frequently by choking or infection
132
Alzheimer's meds
| Cholinesterase inhibitors:
Aricept (donepezil)
Exelon (patch)
Razadyne
S/E- N/D, bradycardia, bronchoconstriction, bleeding with NSAIDS
133
Alzheimer's meds
| Calcium channel blocker
Namenda (moderate to severe)
| S/E - dizziness, headache, confusion, constipation
134
Vascular dementia
Caused by vascular disease
Risks-hypertension, hyperlipidemia, DM, alcohol and nicotine abuse
More rapid progression
135
AIDS Dementia Complex
Possibly HIV infection of brain
Slow cognition, then incontinence, bed-bound, psychosis, mania. Treat with anti-virals and symptoms (antianxiety, depress, etc.)
136
Dementia nursing interventions
| Home
```
Scatter rugs
Door locks and alarms
Lower water heater temp.
Good lighting
Hand rails
Mattress on floor
Establish routine
Provide support and care for family/caregiver
Power of Attorney/Living will
```
137
Dementia nursing interventions
| Healthcare Setting
```
Room close to Nurse's station
Low visual/auditory stimuli
Well-lit with windows
PRN meds for anxiety or agitation
Routines with food and fluids
Limit number of choices
Introduce yourself every time
Don't argue or question
Eye contact and short, simple sentences
```
