•Excessive and unreasonable cued
by the presence or anticipation of a specific object or situation
•Defense mech commonly used
include repression and displacement
•Fear of social performance
situations in which the person is exposed to unfamiliar people or to possible
scrutiny by others
OBSESSION COMPULSION
•Recurrent and persistent
thoughts, impulses, or images are experienced during the disturbance as
intrusive and inappropriate
•Cause anxiety or distress
•Px
knows that these are just product of one’s own mind.
•Px feels driven to perform
repetitive behaviors or mental acts in
response to obsession or according to the rules that one deems must be applied
rigidly.
•Aimed at reducing anxiety
OBSESSION COMPULSION
•Fear
of dirt & germs
•Fear
of burglary or robbery
•Worries
about discarding something important
•Concerns
about contracting a serious illness
•Worries
that things must be symmetrical or matching
•Excessive
hand washing
•Repeated
checking of door and window locks
•Counting
and recounting of objects in everyday life
•Hoarding
of objects
•Excessive
straightening, ordering, or of arranging things
•Repeating
words or prayers silently
POST
TRAUMATIC STRESS SYNDROME
•Person has experienced, witnessed
or been confronted with an event that involved actual or threatened death or
serious injury, or a threat to physical integrity
•Person reexperiences these in the
mind
•Involves intense fear,
helplessness, or horror and numbing of general responsiveness (PSYCHIC NUMBING)
ACUTE GENERALIZED
STRESS ANXIETY
•Meets the criteria for exposure
to a traumatic event and person experiences 3 of the ff sx:
–sense
of detachment,
–reduced
awareness of one’s surroundings,
–derealization,
–depersonalization,
–dissociated
amnesia
•Excessive anxiety or worry,
occurring in more days than not for at least 6 mos, about a number of events or
activities
•Finds it difficult to control the
worry
MOOD/
AFFECTIVE DISORDERS
•BIPOLAR D/O
–BIPOLAR I: current or past
experience of manic episode, lasting at least a week, that is severe enough to
cause extreme impairment in social or occupational functioning.
•MANIA: hyperactivity
•DEPRESSED: extreme sadness or
withdrawal
•MIXED
–BIPOLAR II: hx of 1 or more mj
depressive episodes & at least 1 hypomanic episode; no mania
•MAJOR DEPRESSIVE D/O
– @ least 5 sx of same 2- wk period with one
being either depressed mood or loss of interest or pleasure.
–Single episode or recurrent
–Other sx: wt loss, insomnia,
fatigue, recurrent thoughts of death, diminished ability to think, psychomotor
agitation or retardation, feelings of worthlessness.
•CYCLOTHYMIC D/O
–Hx of 2 yrs of hypomania with
numerous periods of abnormally elevated, expansive or irritable moods.
–Does not meet the criteria of
mania or depression.
•DYSTHYMIC D/O
–@ least 2 yrs of usually
depressed mood and at least 1 of the sx of mj depression without meeting the
criteria for it
•SEASONAL AFFECTIVE D/O
–Depression that comes with
shortened daylight in fall and winter that disappears during spring and summer.
Dealing with
Inappropriate Behaviors
AGGRESSIVE
BEHAVIOR
•Assist the client in identifying
feelings of frustration and aggression
•Encourage the client to talk out
instead of acting out feelings of frustration
•Assist the client in identifying
precipitating events or situations that lead to aggressive behavior
•Describe the consequences of the
behavior on self and others
•Assist in identifying previous
coping mechanisms
•Assist the client in the
problem-solving techniques to cope with frustration or aggression
DEESCALATION
TECHNIQUES
•Maintain safety
•Maintain large personal space and
use nonaggressive posture
•Use calm approach and communicate
with a calm, clear tone of voice (be assertive not aggressive
•Determine what the client
considers to be his or her need
•Avoid verbal struggles
•Provide clear options that deal
with behavior
•Assist with problem-solving and
decision making regarding the options
MANIPULATIVE
BEHAVIORS
•Set clear, consistent, realistic,
and enforceable limits and communicate expected behaviors
•Be clear about consequences
associated with exceeding set limits
•Discuss behavior in nonjudgmental
and nonthreatening manner
•Avoid power struggles
•Assist in developing means of
setting limits on own behavior
SCHIZOPHRENIA
•characterized by impairments in
the perception or expression of reality and by significant social or
occupational dysfunction.
•Once considered as a deadly
disease
•There is lack of insight in
behavior
•Dx: late adolescence and early
adulthood
–15-25
y.o. (men); 25-35 y.o. (women)
•Obsolete term: dementia praecox =
“cognitive deterioration early in life”
•Eugene Bleuler: schiz “split”;
phren “mind”
Risk
factors
•Genetics:
identical twins 50%, 15% for fraternal twins
•Biochemical
factors
–Dopamine hypothesis: overactive
–Serotonin imbalance
–Decreased brain volume, enlarged
ventricles, deeper fissures, and loss or underdeveloped brain tissue
•Psychoanalytic
–lack of trust during the early
stages
–Weak ego
–Defenses: REPRESSION, REGRESSION,
PROJECTION
•Environment
influences: poverty, lack of social support, hostile home environment,
isolation, unsatisfactory housing, disruption in interpersonal relationships (divorce
or death), job pressure or unemployment
Subtypes
•Catatonic type
–prominent psychomotor
disturbances are evident. Symptoms can include catatonic stupor and waxy
flexibility
•Disorganized type
–where thought disorder and flat
affect are present together
•Paranoid type
–where delusions and
hallucinations are present but thought disorder, disorganized behavior, and
affective flattening are absent
•Residual type
–where positive symptoms are
present at a low intensity only
•Undifferentiated type
–psychotic symptoms are present
but the criteria for paranoid, disorganized, or catatonic types has not been
met
Symptoms
According
to Bleuler: 4 A’s
–Affect is inappropriate
–Associative looseness
–Autistic thinking
–Ambivalence
Symptoms
•Positive symptoms
–delusions, auditory
hallucinations and thought disorder and are typically regarded as
manifestations of psychosis.
•Negative symptoms
–considered to be the loss or
absence of normal traits or abilities
–E.G. flat, blunted or constricted
affect and emotion, poverty of speech and lack of motivation.
Symptoms
•Social isolation
•Catatonic behavior
•Hallucinations
•Incoherence (marked looseness of
association)
•Zero/ lack of interest, energy and
initiative
•Obvious failure to attain expected level
of dev’t
•Peculiar behavior
•Hygiene and grooming impaired
•Recurrent illusions and unusual
perception experiences
•Exacerbations and remissions are common
•No organic factors accounts for the
symptoms
•Inability to return to baseline
functioning after relapse
•Affect is inappropriate
Nsg
Dx: Abnormal thought process
•BLOCKING: sudden cessation of a
thought in the middle of a sentence, unable to continue the train of thought
•CIRCUMSTANTIALITY: before getting
to the point of answering a question, the individual gets caught up in
countless details and explanations
•CONFABULATION
•LOOSENESS OF ASSOCIATION
•NEOLOGISM
•WORD SALAD
Interventions
•Assess physical needs
•Set limits
•Maintain safety
•Initiate one-on-one interaction
& progress to small groups
•Spend time with clients
•Monitor for altered thought process
•Maintain ego boundaries, avoid
touching
•Limit time of interaction
•Be neutral
•Do not make promises that can’t
be kept
•Establish daily routines
•Do not “go along” with the
client’s delusions or hallucinations
•Provide simple complete
activities
•Reorient
•Speak to the client in simple
direct and concise manner
–Preoccupied with rules &
regulations, overly concerned about trivial detail, excessively devoted to
their work
–Depression is common
–Men are more affected than women
UNDER
STUDY PERSONALITY D/O
•PASSIVE-AGGRESSIVE: sullen and
argumentative, resents others, resists fulfilling responsibilities, complains
of being unappreciated
•DEPRESSIVE: gloomy, brooding
pessimistic, guilt-prone, highly critical of self and others, cheerless.
Interventions
•Maintain safety against
self-destructive behaviors
•Allow the client to make choices
and be as independent as possible
•Encourage the client to discuss
feelings rather than act them out
•Provide consistency in response
to the client’s acting out
•Discuss expectations and
responsibilities with the client
•Inform the client that harm to
self, others, and property is unacceptable
•Identify splitting behavior
•Assist the client to deal
directly with anger
•Develop a written contract with
the client
•Encourage the client to
participate in group activities, and praise nonmanipulative behavior
•Set and maintain limits
•Remove the client from group
situations in which attention-seeking behaviors occur
•Provide realistic praise for
positive behaviors in social situations
PSYCHOLOGICAL
SEXUAL D/O
•Hypoactive sexual disorder
(asexuality)
•Sexual aversion disorder
(avoidance of or lack of desire for sexual intercourse)
•Female sexual arousal d/o
(failure of normal lubricating arousal response)
•Male erectile d/o
•Female orgasmic disorder
•Male orgasmic disorder
•Premature ejaculation
•Vaginismus
•Secondary sexual dysfxn
•Paraphilias
•Gender identity d/o
•PTSD due to genital mutilation or
childhood sexual abuse
Other
sexual problems
•Sexual dissatisfaction (non-specific)
•Lack of sexual desire
•anorgasmia
•Impotence
•STD
•Infidelity
•Delay or absence of ejaculation,
despite adequate stimulation
•Inability to control timing of
ejaculation
•Inability to relax vaginal
muscles enough to allow intercourse
•Inadequate vaginal lubrication
preceding and during intercourse
•Burning pain on the vulva or in
the vagina with contact to those areas
•Unhappiness or confusion related
to sexual orientation
•Persistent sexual arousal
syndrome
•Sexual addict
•hypersexuality
•Post Ejaculatory Guilt Syndrome,
the feeling of guilt after the male orgasm
SEXUAL
EXPRESSION
•HETEROSEXUALITY
•HOMOSEXUALITY
•BISEXUALITY
•TRANSVESTISM
PARAPHILIAS
•EXHIBITIONISM: the recurrent urge
or behavior to expose one's genitals to an unsuspecting person.
•FETISHISM: the use of non-sexual
or nonliving objects or part of a person's body to gain sexual excitement. Partialism
refers to fetishes specifically involving nonsexual parts of the body.
•FROTTEURISM: the recurrent urges
or behavior of touching or rubbing against a nonconsenting person.
•SEXUAL MASOCHISM: the recurrent
urge or behavior of wanting to be humiliated, beaten, bound, or otherwise made
to suffer.
•SEXUAL SADISM: the recurrent urge
or behavior involving acts in which the pain or humiliation of the victim is
sexually exciting.
•TRANSVESTIC FETISHISM: a sexual
attraction towards the clothing of the opposite gender.
•PEDOPHILIA: the sexual attraction
to prepubescent or peripubescent children.
•VOYEURISM: the recurrent urge or
behavior to observe an unsuspecting person who is naked, disrobing or engaging
in sexual activities, or may not be sexual in nature at all.
•Other paraphilias not otherwise
specified ("Sexual Disorder NOS")
–telephone scatalogia (obscene
phone calls)
–necrophilia (corpses)
–partialism (exclusive focus on
one part of the body)
–zoophilia(animals)
–coprophilia (feces)
–klismaphilia (enemas)
–urophilia (urine)
SOMATOFORM
D/O
•SOMATIZATION D/O: hx of many
physical complaints beginning before the age of 30 occurring over a pd of
several yrs resulting in ttt being sought or significant occupational or social
fxning.
•CONVERSION D/O: 1 or more sx of
deficits affecting voluntary motor or sensory function suggesting a
neurological or general medical condition; preceded by conflicts or stressors;
can’t be explained and sanctioned by cultural behavior.
–Most
common: blindness, deafness, paralysis, inability to talk
–“La
belle indifference”
•HYPOCHONDRIASIS: preoccupation
with fears of having, or ideas that one has, a serious dse based on the person’s
misinterpretation of bodily sx and persist despite appropriate medical eval and
reassurance and has existed for @ least 6 mos. (e.g.:extensive use of home
remedies)
•PAIN D/O: pain in 1 or more
anatomical sites severe enough to warrant clinical attention and causes
clinically significant distress or impairment in fxning.
Interventions
•Do not reinforce the sick role
•Discourage verbalization about
physical symptoms by not responding with positive reinforcement
•Explore with the client the needs
being met by the physical symptoms
•Convey understanding that the
physical symptoms are real to the client
•Report and assess any new
physical complaint
»next
EATING
DISORDER BEHAVIORS
•BINGE: rapid consumption of large
quantities of food in a discrete period of time. (A: hundrends of Cal; B: thousands of Cal at a sitting)
•PURGE: Maladaptive eating
regulation response that includes excessive exercise, forced vomiting, OCD Rx
diuretics, diet pills, laxatives and steroids.
•FAST/ RESTRICT: Includes
vegetarian diet eliminating all meat without substituting nonanimal sources of
protein, OC about food choices, and eating habits.
ANOREXIA BULIMIA
•Rare
vomiting or diuretic/laxative abuse
•More
severe wt loss
•Slightly
younger
•More
introverted
•Hunger
denied
•Eating
behavior may be considered normal and a source of esteem
•Sexually
inactive
•Obsessional
and perfectionist features dominate
•Frequent
•Less
wt loss
•Slightly
older
•More
extroverted
•Hunger
experienced
•Eating
behavior considered foreign and source of distress
•More
sexually active
•Avoidant,
dependent, or borderline features as well as obsessional features
ANOREXIA BULIMIA
complications
•Death from starvation (or
suicide, in chronically ill)
•Amenorrhea
•Fewer behavioral problems (these
increase with level of severity)
•Death from hypokalemia or suicide
•Menses irregular or absent
•Drug and alcohol abuse,
self-mutilation, and other behavioral problems
DELIRIUM
•The
medical dx term that describes an organic mental disorder characterized by a
cluster of cognitive impairments with an acute onset with a specific
precipitating factor.
•Sx:
diminished awareness of the environment, disturbances in psychomotor activity
and sleep-wake cycle.
•COGNITIVE:
the mental process characterized by knowing, thinking, and judging.
–COGNITIVE DISSONANCE: arises when
2 opposing beliefs exists at the same time.
–COGNITIVE DISTORTIONS: (+) or (-)
distortions of reality that might include errors of logic, mistakes in
reasoning, or individualized view of the world that do not reflect reality.
–Term: confusion = cognitive
impairment
»See dementia
DEMENTIA
•The medical dx term that
describes an organic mental d/o characterized by a cluster of cognitive
impairments of generally gradual onset and irreversible without identifiable
precipitating stressors.
•Types:
–VASCULAR
or MULTI-INFARCT
–VASCULAR
WITH ALZHEIMER’S DSE
–AD:
most common
–DEMENTIA
WITH LEWY BODIES: 2nd most common; neurofilament material
–PARKINSONIAN
DEMENTIA
–AIDS
DEMENTIA COMPLEX
–FRONTAL LOBE DEMENTIA or PICK’S
DSE: cytoplasmic collections; 3rd most common; loss of expressive
language & comprehension
–CREUTZFELDT-JAKOB DSE: prion (proteinaceous
infectious particles) = spongy brain; related to TSE
& BSE in mad cow dse
–CORTICOBASAL DEGENERATION or HUNTINGTON’S DSE/CHOREA:
jerky mov’ts
–SUPRANUCLEAR PALSY: clumping of
protein tau = slow mov’t, weak eye mov’t (esp. downward), impaired walking
&balance
•Reversible Causes:
–Subdural
hematoma
–Tumor
(meningioma)
–Cerebral
vasculitis
–Hydrocephalus
•Terms: disorientation, memory
loss (sensory, primary, secondary,
tertiary, working memory), confabulation, confusion
•Disturbing behaviors
–Aggressive
psychomotor
–Nonaggressive
psychomotor
–Verbally
aggressive
–Passive
–Functionally
impaired: loss of ability to do self-care
DELIRIUM vs.
DEMENTIA
•Rapid onset w/ wide fluctuations
•Hyperalert to difficult to arouse
LOC
•Fluctuating affect
•Disoriented, confused
•Attention & sleep disturbed
•Memory impaired
•Disordered reasoning
•Gradual, chronic with continuous
decline
•Normal LOC
•Labile affect
•Disoriented, confused Attention
intact, sleep usually normal
•Memory impaired
•Disordered reasoning &
calculation
DELIRIUM vs.
DEMENTIA
•Incoherent, confused, delusional,
stereotyped
•Illusions, hallucinations
•Poor judgment
•Insight may be present in lucid
moment
•Poor but variable in MSE
»next
•Disorganized, rich in content,
delusional, paranoid
•No change in perception
•Poor judgment
•No insight
•Consistently poor &
progressively worsens in MSE
ALZHEIMER’S
DEMENTIA
•Most common type of dementia
•Stages:
–MILD: impaired memory, insidious
loses in ADL, subtle personality changes, socially normal
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