Week 4: CH 26,27

Question 1

Understanding psychopathology requires the following standards…

Answer 1

1. Knowledge should be organized.
2. Operational definitions should be formed.
3. Criteria for diagnosis should be developed.

Question 2

What are the 5 axes?

Answer 2

Axis I: Clinical disorders
Axis II: Personality or developmental disorders
Axis III: General medical conditions
Axis IV: Psychosocial and environmental problems
Axis V: Global assessment of functioning

Question 3

How can the behaviors be presented?

Answer 3

EIther observed directly or reported by the patient.

Question 4

What is the etiology?

Answer 4

Mental disorders arise from nature or from nurture.

Question 5

What are the guidelines for psychotherapeutic management?

Answer 5

Provide support for patients.
Strengthen patients' self-esteem.
Treat adult patients as adults.
Prevent failure or embarrassment.
Treat patients as individuals.
Provide reality testing.
Handle hostility therapeutically.
Be calm and matter of fact about norms and limits.

Question 6

What is psychosis?

Answer 6

A mental state in which individual struggles to distinguish external world from internally generated perceptions
Common symptoms: 
-Hallucinations
-Delusions 
-Disorganized thinking

Question 7

What are the 3 inescapable facts about schizophrenia?

Answer 7

1. High probability it will become apparent in late adolescence or early adulthood
2. Stress plays a role in onset and relapse
3. Antipsychotic drugs therapeutically effective

Question 8

What are the elements of recovery?

Answer 8

Hope
Secure base
Supportive relationships
Empowerment and inclusion
Coping strategies
Coping with loss
Meaning

Question 9

What are the 10 keys to recovery from schizophrenia?

Answer 9

1. Family relationships
2. Substance abuse
3. Duration of untreated psychosis
4. Initial response to medication
5. Adherence to treatment
6. Supportive therapy
7. Cognitive abilities
8. Social skills, negative symptoms…
9. Personal history
10. Access to care

Question 10

What is schizophrenia?

Answer 10

Major psychotic disorder 
Characterized by disturbances in:
-Perception
-Feeling
-Thought processes
-Reality testing
-Attention
-Motivation

Question 11

What are the types of schizophrenia?

Answer 11

Positive (type I)
-Related to hyperdopaminergic process
-Has favorable response to typical antipsychotics
Negative (type II)
-Related to structural changes in the brain and hypodopaminergic process
-Responds best to atypical antipsychotics

Question 12

What are the objective signs of schizophrenia?

Answer 12

Alterations in personal relationships

Alterations in activity

Question 13

What are the subjective signs of schizophrenia?

Answer 13

Altered perceptions
Alterations of thought
Altered consciousness
Alterations of affect

Question 14

Explain the etiology; the biologic theories.

Answer 14

Dopamine hypothesis: excessive dopaminergic activity in limbic areas cause acute positive symptoms of schizophrenia.
Drugs that increase dopamine can cause a psychotic state.

Question 15

Explain the etiology; the neurostructural theories.

Answer 15

Increased ventricular brain ratios: enlarged ventricles. Not all patients have abnormally enlarged ventricles.
Brain atrophy: brain cell loss. Anatomic pathology in cortical and subcortical areas. changes in limbic, hippocampus, thalamus, temporal lobes, amygdala, substantial nigra.
Decreased cerebral blood flow: decrease in metabolic activity (organizing, planning, learning from experience, problem solving, introspection, and critical judgement are compromised).

Question 16

Explain the etiology; genetic theories.

Answer 16

Relatives with schizophrenia have a greater incidence of the disorder than chance alone would allow. Almost every chromosome has been linked to schizophrenia.Monozygotic twins have shown a higher concordancy rate.

Question 17

Explain the etiology; perinatal risk factors.

Answer 17

Prenatal exposure to influenza, birth during the winter, prenatal exposure to lead, minor malformations developing in early gestation, exposure to viruses from house cats, and complications of delivery, especially during labor and delivery.

Question 18

Explain the etiology; psychodynamic theories.

Answer 18

Focus on the individual’s response to life events.

Question 19

Explain the etiology; developmental theories- Freud

Answer 19

Seeds of mental health and illness are sown in childhood. Events early in life can cause problems that are as severe as schizophrenia.

Question 20

Explain the etiology; developmental theories- Erikson

Answer 20

The first step of trust vs. mistrust in crucial to later interpersonal relationships.One is is deprived or neglected of a nurturing, loving environment or is neglected or rejected is vulnerable to mental disturbances. Inadequate passage through the first stage = mistrust, isolative behaviors, and other asocial behaviors.

Question 21

Explain the etiology; developmental theories- Sullivan

Answer 21

Absence of warm, nurturing attention, during the early years blocks the expression of these same affective responses in later years.

Question 22

Explain the etiology; family theories

Answer 22

The family is significant to the development of mental health or illness. Lack of a loving and nurturing primary caregiver, inconsistent family behaviors, and faulty communication patterns.

Question 23

Explain the etiology; vulnerability-stress model

Answer 23

Recognizes that both biologic and psychodynamic predispositions, when coupled with stressful life events can precipitate a schizophrenic process.

Question 24

What is the continuum of care for people with schizophrenia?

Answer 24

1. Acute symptoms—Hospitalization
2. Treatment-resistant—Long-term hospitalization
3. Stable but chronic—Day treatment
4. Some level of supervision—Supportive housing for those who cannot live with family

Question 25

What is the psychotherapeutic management?

Answer 25

Aimed at helping patients become stronger than their symptoms - Psychotherapeutic nurse-patient relationship - Psychopharmacology - Milieu management

Question 26

Developing a Therapeutic Nurse-Patient Relationship

Answer 26

- Be calm - Accept patients as they are - Keep promises - Be consistent - Be honest - Do not reinforce hallucinations or delusions - Orient patients to time, person, and place, if indicated - Do not touch without warning - Avoid whispering or laughing when patient cannot hear - Reinforce positive behavior - Avoid competitive activities - Do not embarrass patients - Begin with one-to-one interactions - Allow and encourage verbalization of feelings

Question 27

Psychopharmacology

Answer 27

Antipsychotics are the drugs of choice. | Note– Asians and Hispanics might need less antipsychotic meds than Caucasians to achieve desired blood level

Question 28

Nursing interventions to increase compliance

Answer 28

- Observe patients for side effects and intervene accordingly. Akathisia is a troubling side effect that patients cannot tolerate. - When giving tablets or pills, make sure patients do not check the medications (hide them) to spit them out or hoard them for later. - Teach patients and their families about drugs, including side effects, potential interactions, and dosage schedules when discharged. - Depot drugs are effective for patients who do not comply with drug therapy.

Question 29

What are the neurotransmitters and related mental disorders?

Answer 29

increase in dopamine=schizophrenia decrease in norepinephrine=depression decrease in serotonin=depression decrease in acetylcholine=Alzheimer's disease decrease in GABA=Anxiety increase in glutamate=excitotoxicity-neuronal death decrease in glutamate=psychotic thinking

Question 30

What are the results of activiating and antagonizing serotonin receptors?

Answer 30

Activation: antidepressant effect, anxiety, migraine headaches, nausea, vomiting, other GI disturbances, sexual dysfunction, decrease in penile erection capability, reduced appetite and weight loss, insomnia, movement disorders, temperature dysregulation, psychotic thinking. Antagonist: depression, dysthymia, suicidality, aggressiveness, obsessive thinking, sleep-wake cycle disruption, pain, compulsive behavior, anxiety, migraine headaches, panic.

Question 31

What are the results of activating and antagonizing acetylcholine receptors?

Answer 31

Activation: pupil contraction, decreased heart rate, constriction of bronchi, increased respiratory secretions, increased voiding, salivation, increase gastric secretions, increased defecation, sweating, enhancement of cognitive processes. Antagonist: dilated pupils, increased heart rate, dilation of bronchi, decreased respiratory secretions, decreased voiding, dry mouth, decreased gastric secretions, constipation, decreased sweating, cognitive slowing

Question 32

What are the results of activating and antagonizing norepinephrine receptors?

Answer 32

Activation: antidepressant effect, vasoconstriction, increased heart rate, bronchial dilation, other physical effects. Antagonist: depressive effect, vasodilation, decreased heart rate, sexual dysfunction, other physical effects

Question 33

What are milieu management principles for disruptive patients?

Answer 33

- Set limits - Decrease stimuli - Observe for escalating behavior - Minimize potential weapons - Be judicious when developing consequences - Invoke consequences when violations occur - Provide for patient safety when restraints are necessary

Question 34

What are the milieu management principles for withdrawn patients?

Answer 34

- Arrange nonthreatening activities - Arrange furniture around a table so patient must sit with someone - Assist with decision making as appropriate - Reinforce appropriate grooming and hygiene - Provide psychosocial rehabilitation

Question 35

What are the milieu management principles for people with hallucinations?

Answer 35

- Use distraction - Discourage talking about the hallucinations - Monitor TV selections - Monitor command hallucinations - Have staff members available to talk with patient about “real” things

Question 36

What are the other psychotic disorders? | Schizoaffective and delusional disorder

Answer 36

Schizoaffective disorder: affective and schizophrenic symptoms, with substantial loss of occupational and social functioning. Either extremely depressed or elated. Delusional disorder: Delusions have a basis in reality. Patients have never met the criteria for schizophrenia. Behavior of these patients is relatively normal except in relation to their delusions. If mood episodes have occurred concurrently with delusions, their total duration has been relatively brief. Symptoms are NOT direct result of a substance induced or medical condition.

Question 37

What are the other psychotic disorders? | Brief psychotic and Schizophreniform disorder

Answer 37

Brief psychotic disorder: last less than 1 month and are not related to a mood disorder, a general medical condition, or a substance-induced disorder. Must contain 1 of the following: delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior. Schizophreniform disorder: symptoms typical of schizophrenia and last at least 1 month but no longer than 6 months.