w2 Flashcards

Question

Physiological treatments: Transcranial magnetic stimulation (TMS) - invasive? - Magnetic pulses stimulate focal areas in cerebral cortex - Contraindication – _______ Adverse reactions - h/a and __________ - seizures – rare - mild s/e – scalp _________, discomfort at admin site - neurological deficits or memory problems?

Answer 1

Transcranial magnetic stimulation (TMS) - Noninvasive - Magnetic pulses stimulate focal areas in cerebral cortex - Contraindication – metal Adverse reactions - h/a and lightheaded - seizures – rare - mild s/e – scalp tingling, discomfort at admin site - NO neurological deficits or memory problems

Answer 2

Negative symptoms Symptoms that should be there but are not More difficult to treat compared to positive symptoms - Affective blunting – reduced affect (without affect) - Alogia – reduction in speech, poverty of speech (without speech) - Anhedonia – reduced ability to experience pleasure or joy (without joy) - Apathy – decreased interest in activities/beliefs that would usually be interesting/important (without interest) - Asociality – decreased desire for social interactions, social withdrawal (without social interactions) - Avolition – decreased goal directed behavior, difficulty beginning or sustaining goal directed activities (without goals) o Flat – blank face o Blunted minimal emotional response o Constricted – reduced range (shows only sadness or anger) o Inappropriate – incongruent with the actual emotional situation o Bizarre – odd, illogical, inappropriate, or unfounded, includes grimacing

Answer 3

3 behavior theories led to behavioral therapy - classical conditioning theory - behavioral theory - operant conditioning theory

Answer 4

Challenging member behavior Monopolizing member - Remind group of equal chances to contribute - Speak directly to member in private if necessary Demoralizing member - Listen objectively - Ask in private about cause of anger - Empathize Silent member - Determine cause - Require responses to ease group discomfort - Provide extra time for members to think about a response and come back to them

Answer 5

Neuroleptic malignant syndrome - Prompt detection is vital, difficult to diagnose in emergent situation, history is critical - Immediately stop all antipsychotics - Treat symptoms – hydration, monitor vitals, complications - ICU hospitalization required - Meds – dantrolene sodium, bromocriptine mesylate, lorazepam (for agitation)

Answer 6

Affective symptoms Altered experience and expression of emotions Mood may be unstable, erratic, labile, incongruent/inappropriate

Answer 7

warning signs

Answer 8

- Extrapyramidal side effects (EPS) o Acute dystonic reactions o Akathisia o Pseudoparkinsonism o Tardive dyskinesia (TD) - Anticholinergic s/e - Neuroleptic malignant syndrome - Metabolic syndrome

Answer 9

risk factors biological - neurotransmitters (serotonin, dopamine, norepinephrine) may play a role cognitive - form of self punishment - painful actions make up for acts that caused harm to others - positive reinforcement (rewards) may support self injurious acts environmental - cultural differences may play a role societal - may be a social phenomenon - learned from peers engaging in behavior

Answer 10

- 9. Labeling – Labeling is an extreme form of all-or-nothing thinking. Instead of saying “I made a mistake,” you attach a negative label to yourself: “I’m a loser.” You might also label yourself “a fool” or “a failure” or “a jerk.” Labeling is quite irrational because you are not the same as what you do. Human beings exist, but “fools,” “losers” and “jerks” do not. These labels are just useless abstractions that lead to anger, anxiety, frustration and low self-esteem. - You may also label others. When someone does something that rubs you the wrong way, you may tell yourself: “He’s an S.O.B.” Then you feel that the problem is with that person’s “character” or “essence” instead of with their thinking or behavior. You see them as totally bad. This makes you feel hostile and hopeless about improving things and leaves very little room for constructive communication. - 10. Personalization and Blame - Personalization comes when you hold yourself personally responsible for an event that isn’t entirely under your control. - Ex: When a woman received a note that her child was having difficulty in school, she told herself, “This shows what a bad mother I am,” instead of trying to pinpoint the cause of the problem so that she could be helpful to her child. When another woman’s husband beat her, she told herself, “If only I was better in bed, he wouldn’t beat me.” Personalization leads to guilt, shame and feelings of inadequacy.

Answer 11

Positive symptoms

Answer 12

Disorganized or alterations in behavior - Boundary impairment – cant sense where one’s body ends and another’s begins - Catatonia – increase or decrease in the rate and amount of movement, excessive motor activity is purposeless - Echopraxia – involuntary imitation of anothers movements - Gesturing or posturing – posture held in fixed position - Impaired impulse control - Motor retardation – slowing of movement - Motor agitation – excited behavior, running or pacing, in response to internal/external stimuli - Negativism – tendency to resist or oppose the requests of others - Stereotyped behaviors – repetitive purposeless movement that are peculiar to the person and serve no purpose

Answer 13

- Pseudoparkinsonism – temporary symptoms that resemble parkinson’s disease o Stiff and stooped posture o Shuffling gait o Bradykinesia o Pill rolling fingers o Resting tremors in hands and arms o Dysphagia or reduction in spontaneous swallowing, drooling

Answer 14

Deep brain stimulation (DBS) - Most invasive - (2) surgically implanted electrodes - Treats Parkinson’s disease - Now being investigated as treatment for depression - Stimulates regions identified as underactive in depression

Answer 15

observation

Answer 16

2. Types of groups Psychoeducational – groups to increase knowledge or skills about a specific psychological or somatic subject - Medication or health education - Dual diagnosis - Symptom management - Goal setting/review - Recreational activity - Interpersonal skills Therapeutic community meeting group – where unit happenings are processed. Every interaction occurring on an inpatient milieu has the potential to be therapeutic Support and self-help groups – structure to provide patients opportunity to maintain/enhance personal/social functioning through cooperation and shared understanding of life’s challenges Ex – AA, cancer survivors, bereavement Group psychotherapy – specialized group intervention requiring skilled leaders and expertise such as an advanced practice nurse to bring about personality change

Answer 17

6. Yaloms therapeutic factors Instillation of hope - The leader shares optimism about the successes of group treatment, and members share their improvements. Ex - Testimonials from peers at Alcoholics Anonymous meetings provide firsthand stories of successfully dealing with recovery methods and inspire hope among members of the group. Universality - Members realize that they are not alone with their problems, feelings, or thoughts. Ex - Members of sexual abuse support groups may be struggling with shame. Being with peers who feel or have felt the same way makes them feel less alone and less ashamed. Imparting of information - Participants receive formal teaching by the leader or advice from peers. Ex - Leaders of groups for patients with HIV often incorporate medical material and information related to correcting fears and misconceptions about the transmission of infection. Altruism - Members gain or profit from giving support to others, leading to improved self-esteem. Ex - A patient says that she will never get over the loss of her husband. A second group member nods and responds, “I felt like that, too, after my husband died.” The second group member feels pleased to have helped another person.

Answer 18

Types of talk therapies Can be alone or with psychopharmacology Interpersonal therapy – focuses on interpersonal relationships by improving functioning and communication patterns - Techniques include: - Identification of emotion – help identify what their emotion is and where it is coming from - Expression of emotion – help person express emotion in healthy way - Dealing with emotional baggage – looking at how past relationships affect current relationships

Answer 19

Cognitive BT – based on cognitive psychology + behavioral theory - Thoughts cause feelings and behaviors, not external things - Benefit = change the way we think to feel/act better (situation does not change) - Brief, time limited, structure (16 sessions) - Homework and self counseling skills - Collaborative effort between therapist and pt - Goals identified by the patient Ex: seeing someone you know in public but they apparently ignore you Unhelpful thoughts = they ignored me, they don’t like me CBT helpful thoughts = They were wrapped up in themselves and didn’t notice me Rational emotive therapy – (type of CBT) focuses on irrational thinking or beliefs - Identify activating situations and negative emotions, leading to irrational beliefs - Stop using useless words like – must, should, ought, or have to - Desired outcome is within clients control of behavior and thinking - A change in thinking = positive change in behavior - Activating event  beliefs  emotional consequences Dialectic BT – (type of CBT) combines cognitive and behavioral techniques with mindfulness - Developed to treat chronically suicidal individual commonly with borderline personality disorder - Emotional regulation - Interpersonal effective ness - Distress tolerance - Mindfulness – being in the present moment, notice what is going on now and accepting it. Controlling the mind from wandering to the past and future. - Self management skills

Answer 20

Types of behavioral therapies - Modeling - Operant conditioning - Systemic desensitization - Aversion therapy - Biofeedback Types of talk therapies - Interpersonal therapy - Cognitive BT - Dialectic BT - Challenging stinkin’ thinkin’ and cognitive distortions

Answer 21

long acting injectable medications - indicated for pts at risk for nonadherence - admin only 1x per 2-4 weeks - must have transportation to receive injection - typical antipsychotic injectables: o fluphenazine decanoate o haloperidol decanoate - atypical antipsychotic injectables: o risperidone microspheres o paliperidone palmitate o olanzapine pamoate o aripiprazole

Answer 22

behavioral theories - personality is learned behaviors - behavior is influenced by conditioning - conditioning – pairing behavior with condition that reinforces or decreases occurrence of behavior

Answer 23

- 7. Emotional Reasoning – You assume that your negative emotions necessarily reflect the way things really are - Ex: “I feel terrified about going on airplanes. It must be very dangerous to fly.” Or, “I feel guilty. I must be a rotten person.” Or, “I feel angry. This proves that I’m being treated unfairly.” Or, “I feel so inferior. This means I’m a second rate person.” Or, “I feel hopeless. I must really be hopeless.” - 8. “Should” statements – You tell yourself that things should be the way you hoped or expected them to be. - Ex: After playing a difficult piece on the piano, a gifted pianist told herself, “I shouldn’t have made so many mistakes.” This made her feel so disgusted that she quit practicing for several days. “Musts,” “oughts” and “have tos” are similar offenders. - “Should statements” that are directed against yourself lead to guilt and frustration. Should statements that are directed against other people or the world in general, lead to anger and frustration: “He shouldn’t be so stubborn and argumentative!” - Many people try to motivate themselves with shoulds and shouldn’ts, as if they were delinquents who had to be punished before they could be expected to do anything. “I shouldn’t eat that doughnut.” This usually doesn’t work because all these shoulds and musts make you feel rebellious and you get the urge to do just the opposite. Dr. Albert Ellis has called this ” must erbation.” I call it the “shouldy” approach to life.

Answer 24

Vagal nerve stimulation (VNS) - Invasive - Originally used to treat epilepsy – decreases seizures - Treats resistant depression – improves mood - Electrical stimulation boosts neurotransmitters s/e - Voice alterations - Neck pain - Cough - Paresthesia - Dyspnea

Answer 25

schizophrenia: Cognitive symptoms - Anosognosia – inability to realize one is ill, may see resistance to treatment, often combined with paranoia - Concrete thinking – impaired ability to think abstractly, interprets things literally - Impaired information processing – delayed responses, misperceptions, difficulty understanding others - Impaired executive functioning – difficulty reasoning, setting priorities, comparing options, planning - Impaired memory – short term memory and ability to learn is impacted

Answer 26

Hallucinations – alterations in perception that involve errors in how one interprets perceptions or perceives reality. Person receives a sensory experience for which no external source exists - Auditory – hearing voices or sounds o Command – an auditory hallucination that instructs the person to act a certain way, ranges from not harmful to dangerous, like harm to self or others - Visual – seeing people or things - Olfactory – smelling odors - Gustatory – experiencing taste - Tactile – feeling body sensations

Answer 27

Agranulocytosis clozapine WBCs

Answer 28

Functional roles of group members Task roles - Initiator/contributor – suggests new ideas regarding problem/goal - Information seeker – clarifies group roles - Information giver – provides facts/shares experiences as an authority figure - Coordinator – shows clarifies how ideas can work - Orienteer – notes the groups progress - Recorder – keeps notes Building and maintenance roles - Encourager – praise and seeks input - Harmonizer – reconciles differences among members - Gatekeeper – facilitates the contributions of others to keep communication open - Group observer – notes/reports what is occurring to the group process - Follower – goes along with others, audience role Informal roles of group members - Aggressor - Criticizes and attacks others’ ideas and feelings - Blocker/oppositional - Disagrees with and halts group issues - Recognition seeker - Seeks attention by boasting and discussing achievements - Play person - Dominator

Answer 29

Schizophrenia a psychosis characterized by abnormalities in perception, content of thought, thought processes, and extensive withdrawal of one’s interest from individuals and the outside world (Psychosis - A state in which the individual is experiencing hallucinations, delusions, or disorganized thoughts, speech, behaviors.) Mental illness that interferes with a person’s ability to - Think clearly - Manage emotions - Make decisions - Relate to others

Answer 30

Disorganized or alterations in speech - Circumstantiality – extremely detailed and lengthy conversations about a topic, but eventually gets to the point - Clang association – choosing words based on their sound instead of meaning, may involve rhyming or similar beginning sounds - Echolalia – repetition of another’s words - Flight of ideas – topic of conversation changes repeatedly and rapidly with only superficial associative connections, making it difficult for others to follow - Looseness of association – absence of normal connectedness of thoughts, ideas, and topics - Neologisms – made up words - Pressured speech – urgent or intense speech, reluctance to allow comments from others - Tangentiality – wandering off topic or going off on tangents, never reaching the point - Word salad – string of words totally unconnected, jumble of words meaningless to listener - Symbolic speech – using words based on what they symbolize, not what they mean (sharp pain described as demons sticking needles in me)

Answer 31

Building and maintenance roles - Encourager – praise and seeks input - Harmonizer – reconciles differences among members - Gatekeeper – facilitates the contributions of others to keep communication open - Group observer – notes/reports what is occurring to the group process - Follower – goes along with others, audience role

Answer 32

Types of behavioral therapies - Modeling – role playing, demonstrating desired behaviors for the client to observe and practice. - Operant conditioning - Using positive reinforcement or tokens to increase or decrease target behaviors. - Systemic desensitization - Gradually exposing the client to anxiety-provoking stimuli in a controlled manner to reduce fear responses. - Aversion therapy - Associating an unwanted behavior with an unpleasant stimulus to suppress that behavior. - Biofeedback – control of body, Using instrumentation to provide feedback about physiological functions like muscle tension, allowing clients to gain self-regulation skills.

Answer 33

Pharmacotherapy: antipsychotic meds Used to treat psychotic disorders – such as schizophrenia Takes 2-6 weeks to become effective

Answer 34

Atypical antipsychotics

Answer 35

unacceptable terms - completed suicide - committed suicide !!- suicide attempt interrupted by self or other - successful suicide - failed suicide attempt - non-fatal suicide attempt !!- suicide/death by suicide - suicidal gesture - suicidality

Answer 36

Neuroleptic malignant syndrome

Answer 37

Documentation: hallucinations - Type, content, characteristics - Use pts own words - Behavior prior to and during episode - Any actions taken to help the pt with episode Teaching: hallucinations - Manage stress and stimulation - Use other sounds to compete with hallucinations - Check with others to find out what is/isn’t real - Do activities that distract from hallucinations - Self talk – tell self voices aren’t real, tell voices to go away, tell self you’re safe - Make eye contact with others - Develop a coping plan

Answer 38

- Akathisia – motor restlessness manifested as excessive pacing, inability to remain still, rocking while seating, shifting from one foot to the other while standing o Can be severe and distressing o Can be mistaken for anxiety or agitation – may lead to more drug being administered, making it worse o Tardive (delayed) form can persist despite treatment

Answer 39

Epidemiology - Found in all of world’s population regardless of race, ethnicity, economic background. - Schizophrenia one of US leading causes of disability - More frequently diagnosed in males and urban areas - Peak onset 15-35 (men 15-25 and women 25-35) - New cases rare before 10 and after 40

Answer 40

Phases of schizophrenia Prodromal - Mild changes in thinking, reality testing and mood, insufficient to meet DSM-5 criteria - Speech or though changes - Anxiety, obsessive thoughts, compulsive behavior - Can’t concentrate, distressing thoughts occur with performance and social functions, paranoia, memory impairments - s/s occur 1-2 months before the first full episode of the illness acute - s/s vary from few and mild to many and disabling - hallucinations, delusions, apathy, social withdrawal, diminished affect, anhedonia, disorganized behavior, impaired judgement and cognition result in functional impairment - difficulty coping with worsening symptoms which becomes apparent to others - can last several months even with treatment - increased support and hospitalization may be required stabilization - s/s are stabilizing and diminishing and there is no movement toward a previously level of functioning - may require care in outpatient mental health center or partial hospitalization program maintenance or residual - condition stable and new baseline established - positive symptoms absent or significantly diminished - negative and cognitive symptoms remain

Answer 41

Schizophrenia in children Early s/s: Developmental problems - Language delays - Late or unusual crawling - Late walking - Motor behaviors – rocking or arm flapping Later s/s: - Hallucinations – esp auditory - Delusions - Lack of emotion - Inappropriate emotions - Social withdrawal - Poor school performance - Decreased ability to do self care - Strange eating habits - Incoherent speech - Illogical thinking - Agitation Treatment - Meds = risperidone and aripiprazole - Individual and family psychotherapy - Social and academic skills training - Hospitalization

Answer 42

Physiological treatments Phototherapy/light therapy - noninvasive - First line treatment for depression with a seasonal onset (formerly known as SAD) - Efficacy d/t influence of light on melatonin - Effective as medication - Negative s/e – h/a and jitteriness

Answer 43

Physiological treatments: Electroconvulsive therapy (ECT) Process - Anesthesia and muscle relaxant used - Process includes applying electricity to temporal regions of the brain to induce brief seizure - Can be unilateral (electrodes on one side of brain) or bilateral (both sides) - 2-3 treatments/week for total of 6-12 treatments - Must reorient patient for several hours after treatment

Answer 44

Assessment: hallucinations - Important to keep staff and pt safe - Ask direct question to assess type and content of hallucinations - Ask when they began, and how they are experienced - In initial assessment – ask if command hallucinations occur and if it makes pt fearful or distressed o What do you hear? Are they voices telling you to do something? Do you believe what you hear is real? - Ask about other types of hallucinations (5 senses) - Do not respond to hallucinations as if they are real - Do not deny the person experience - Offer your own perception, convey empathy, present reality - After hallucination – help identify triggers, what makes worse/better, pt response, how do they cope

Answer 45

2 types Bipolar type - Combination of symptoms from schizophrenia and bipolar disorder - Depressive and manic episodes + schizophrenia symptoms Depressive type - Psychotic symptoms of schizophrenia + depressed moods/major depressive disorder - long periods of intense depression - No highs or lows

Answer 46

NSSI - non suicidal self injury

Answer 47

antipsychotic meds Side effects treatment Akathisia - Dosage reduction or change in meds - Give Anticholinergic (benztropine) - Add meds for short term use only (propranolol, lorazepam, diazepam - Relaxation exercises

Answer 48

epidemiology - prevalence is difficult to determine - more common in female - rate declines after 29 comorbidity - depression - anxiety - eating disorders - substance use disorder - borderline personality disorder

Answer 49

Styles of leadership Autocratic leader – exerts control over the group and doesn’t encourage much interaction Democratic leader – supports extensive group interaction in the process of problem solving Laissez-faire leader – allows the group members to behave any way they choose and doesn’t attempt to control the direction

Answer 50

clozapine: atypical antipsychotics - effective in treating refractory schizophrenia - decreased negative symptoms - increased impulse control - reduced violence to self and others - improved quality of life - !! potentially fatal s/e – agranulocytosis

Answer 51

environemental

Answer 52

Medications to know Typical antipsychotics - Chlorpromazine - Haloperidol Atypical antipsychotics - Clozapine - Olanzapine - Quetiapine - Risperidone - Aripiprazole typical Antipsychotic long acting injections - Haloperidol decanoate atypical Antipsychotic long acting injections - Risperidone - Paliperidone palmitate Anticholinergics - Benztropine - Trihexyphenidyl

Answer 53

NSSI - non suicidal self injury

Answer 54

treatment and management: safety #1 - re-assessment following identified suicide risk - re-screen if there is a change in patient condition - safety planning intervention for all pts with identified risk - sitter – inform them of suicide risk and to be vigilant, observe pt in bathroom - hand-off communication between care providers - rounding for safety at regular intervals - inform all unit staff of pts risk - maintain RN hourly rounding even if the pt has a sitter - place pt close to nursing station - implement suicide precautions and elopement precautions per hospital policy - monitor medication ingestion and cheeking - teach coping and problem solving skills - assess access to lethal means at home before d/c - involve social support persons throughout hospitalization - provide community resources

Answer 55

Intervening: delusions - Remain calm, acknowledge and accept patients experience and feeling (delusions can feel very real and frightening to pt) - Encourage pt to express feelings and show empathy is pt is fearful - Reassure patient your intentions and present reality - Focus – help patient feel safe by addressing underlying theme of fear o Don’t focus on delusion o Focus on fear, cause of fear, what can help pt feel more safe Ex: pt thinks you are part of FBI plot to destroy them Nurse: it seems people want to hurt you, that must be scary. I will not hurt you. We can work together to help you feel safe.

Answer 56

Intervening: hallucinations - Approach pt in non-threatening and calm manner (hallucinations are very real to person experiencing them, may be distracting, can provoke varying reactions, anxiety or distress, may be episodic or constant, may attribute sound from a specific source like a parent or god) - Introduce self to pt to gain rapport, trust, and develop relationship - Reassure the pt they are safe - Suicidal/homicidal themes or commands require immediate safety measures During hallucination - Call pt by name, speak clear and loud, short sentences - Convey support, maintain eye contact, redirect focus to conversation with nurse - Assess for intensifying hallucinations or command hallucination – increasing signs of anxiety - Engage in reality based activities like card games or listening to music

Answer 57

risk factors

Answer 58

components of evidence based comprehensive suicide risk screenings, re-assessments and safety planning C-SSRS (Columbia suicide severity rating scale) - screening - risk factors - protective factors - re-assessment recognizing cues - verbal and nonverbal cues o overt statements o covert statements - assessment of the lethality of suicide plan - self-assessment

Answer 59

symptom assessment (4) positive symptms negative symptoms cognitive symptoms affective symptoms

Answer 60

6. Yaloms therapeutic factors: Group cohesiveness - This factor arises in a mature group when members feels connected to one another, the leader, and the group as a whole. Ex - A group develops norms that include nonjudgmental acceptance and inclusion, helping members learn to trust one another, disclose information about themselves, receive empathetic feedback, and feel accepted. Catharsis - A genuine expression of feelings that can be interpreted by both the patient and the group. Overexpression of feelings can be detrimental to group processes. Ex - Individuals in a group for women with early breast cancer are able to express emotions and needs within the context of the mutually supportive group. Existential factors - Members examine aspects of life—such as loss, meaning, and mortality—that affect everyone in constructing meaning. Ex - Individuals in a grief support group express positive thoughts and feelings in regard to the loss of a loved one and can also safely share negative thoughts and feelings.

Answer 61

Paranoia - irrational fear, mild to profound, deep mistrust or suspicion of others - can develop into delusional thoughts - May result in dangerous defensive action (harming person)

Answer 62

6. Yaloms therapeutic factors: Corrective recapitulation of the primary family group - Members repeat patterns of behavior in the group that they learned in their families; from the safety of the group with feedback from the leader and peers, they learn about their own behavior. Ex - A group member expresses frustration that other members are more appreciated, and she resents having to share time with the group. Group members note that she said the same thing about her siblings and suggest that she is appreciated. Development of socializing techniques - Members learn new social skills based on others’ feedback and modeling. Ex - A man knew that others were avoiding social engagement with him but he was not sure why. Through a member’s direct feedback, he learned that his tendency to obsessively insert irrelevant details in his communication created discomfort in others. Imitative behavior - Members may copy the behavior of the leader or peers and thus can adopt healthier habits. Ex - Patients with psychotic symptoms in a cognitive behavioral therapy group learn how to reduce the intensity of auditory hallucinations by watching the group leader and other members use cognitive behavioral strategies. Interpersonal learning - The group itself is a laboratory for trying out new interpersonal skills. Members gain insight from others’ feedback and from trying out new behaviors in the group. Ex - Patients in the parent support group for children with attention-deficit/hyperactivity disorder role play responses to challenging behaviors of their children. Afterward, the group provides feedback to support the patients’ learning.

Answer 63

Comorbidity Individuals with schizophrenia often experience comorbid conditions such as: - Substance use disorder - Nicotine dependence - Anxiety, depression, suicide - Diabetes - CV disease - Obesity - Malignant neoplasm - HIV/AIDS - Osteoporosis - Hep C

Answer 64

Challenging stinkin’ thinkin’ and cognitive distortions - 1. All-or-nothing thinking – You see things in black-or-white categories. If a situation falls short of perfect, you see it as a total failure. - Ex: When a young woman on a diet ate a spoonful of ice cream, she told herself, “I’ve blown my diet completely.” This thought upset her so much that she gobbled down an entire quart of ice cream. - 2. Overgeneralization – You see a single negative event, such as a romantic rejection or a career reversal, as a never-ending pattern of defeat by using words such as “always” or “never” when you think about it. - Ex: A depressed salesman became terribly upset when he noticed bird dung on the window of his car. He told himself, “Just my luck! Birds are always crapping on my car!” - 3. Mental Filter – You pick out a single negative detail and dwell on it exclusively, so that your vision of reality becomes darkened, like the drop of ink that discolors a beaker of water. - Example: You receive many positive comments about your presentation to a group of associates at work, but one of them says something mildly critical. You obsess about his reaction for days and ignore all the positive feedback.

Answer 65

3. Advantages and disadvantages of working with groups Adv - Multiple pts in treatment at same time - Benefits from feedback, knowledge, and experience of others - Safe setting to try out new behaviors and communication skills - Promotes a feeling of belonging Dis adv - Time constraints, someone may feel cheated for participation time - Concern for confidentiality - Disruptive members - Not all pts benefit from group treatment

Answer 66

Herbal treatments St johns wort - Flower processed into tea or tablet - May increase serotonin, norepinephrine, dopamine - May treat mild – moderate depression Ginseng - Stress and fatigue Valerian root or chamomile - Insomnia, depression, stress/anxiety SamE - Depression Exercise - Biological, social, and psychological effects - Dampens HPA axis – though to be overly active in depression - Alters levels of serotonin, dopamine, and norepinephrine Other - Pet therapy - Aromatherapy - Acupuncture

Answer 67

Disorganized or alterations in thought - Thought blocking – reduction or stopping thoughts - Thought insertion – believing that someone else has inserted thoughts into patients brain - Thought deletion – believing that thoughts have been taken or are missing

Answer 68

Risks and adverse reactions - Stress on heart at seizure onset and up to 10 mins after - Stress on brain – increased cerebral oxygen, blood flow and ICP. Contraindicated for brain tumors and subdural hematomas - Confused and disoriented several hours after – must reorient frequently - Retrograde amnesia – loss of memory of events leading up to an including treatment

Answer 69

suicide prevention - know risk factors and warning signs - screen individuals for suicide risk – ask directly - identify protective factors, develop safety plan, reduce access to lethal means - provide individuals with resources for suicide prevention - create community based systems to response to suicide risk

Answer 70

Delusions - false beliefs despite lack of evidence to support them and aren’t corrected with reasoning - Persecutory – believes they are being watched, potted against, ridiculed - Referential – believes events are somehow related to them even though they really have no connection to them - Grandiose – believe they are a powerful important person - Erotomanic – believes another person romantically desires them - Nihilistic – delusion of nonexistence, believes mind, body, world, no longer exist - Somatic – believes that their body is changing in unusual ways - Control – believes that another person or external force controls their thoughts, feelings, impulses, behaviors - Religion – believes they have a special relationship with God, or on a mission for God, or that they are sinners

Answer 71

Informal roles of group members 5. Informal roles of group members - Aggressor - Criticizes and attacks others’ ideas and feelings - Blocker/oppositional - Disagrees with and halts group issues - Recognition seeker - Seeks attention by boasting and discussing achievements - Play person - Dominator

Answer 72

metabolic syndrome is associated with all antipsychotics and are a disadvantage, of the whole classification of medications. atypical antipsychotics have the same potential side effects as the typical antipsychotics, but atypical antipsychotic side effects are usually fewer, milder, and better tolerated. For example, both atypical and typical antipsychotics have the potential to cause EPS, but patients taking atypical antipsychotics are less likely or are at a lower risk for developing EPS than patients taking typical antipsychotics.

w2 Flashcards

(108 cards)