Reason: Why approach patient with open-ended questions?

This technique facilitates spontaneous responses and interactive discussion.

Reason: What is the purpose for using Clarifying techniques? What are the different types of techniques?

This is used in determining if the statement made was accurate :
1. restating- uses the clients exact words
2. reflecting-directs the focus back to the client in order for the client to examine his feelings.
3. paraphrasing-restates the clients feelings a

Defense Mechanism: Alturism

Dealing with anxiety by reaching out to others

Defense Mechanism: Sublimation

Dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression.

Defense Mechanism: Suppression

Voluntarily denying unpleasant thoughts and feelings

Defense Mechanism: Repression

Putting unacceptable ideas , thoughts and emotions out of conscious awareness.

Defense Mechanism: Reaction Formation

Overcompensating or demonstrating the opposite behavior of what is felt

Defense Mechanism: Somatization

Developing a physical symptom in place of anxiety.

Defense Mechanism: Undoing

Performing an act to make up for prior behavior

Defense Mechanism: Rationalization

Creating reasonable and acceptable explanations for unacceptable behavior.

Defense Mechanism: Passive Aggressive

Indirectly behaving aggressively but appearing to be compliant.

Defense Mechanism: Acting-out behaviors

Managing emotional conflicts through actions rather than self reflection.

Defense Mechanism: Dissociation

Temporarily blocking memories and perceptions form consciousness.

Defense Mechanism: Devaluation

Expressing negative thoughts of self or others.

Defense Mechanism: Idealization

Expressing extremely positive thoughts of self or others.

Defense Mechanism: Splitting

Demonstrating an inability to reconcile negative and positive attributes of self or others.

Defense Mechanism: Projection

Blaming others for unacceptable thoughts and feelings

Defense Mechanism: Denial

Pretending the truth is not reality to manage the anxiety of acknowledging what is real.

L.O.A. Mild : S/S

Normal experiences, like every day life. Increases one's ability to perceive reality. There is an identifiable cause of the anxiety. other symptoms include mild discomfort, impatience, and apprehension.

L.O.A. Moderate: S/S

Occurs when mild anxiety escalates. Slightly reduced perception and processing of information occurs and selective inattention may occur. concentration difficulties , tiredness, pacing, heart rate increases and respiratory rate. This patient will benefit

L.O.A. Severe: S/S

Perceptual field is greatly reduced with distorted perceptions. Learning and problem solving do not occur. Confusion is apparent, feelings of impending doom, and aimless activity. Pt is not able to take direction from others.

L.O.A. Panic: S/S

Panic level is marked by disturbed behavior. Not able to process what is occurring in the environment and may lose touch with reality. The PT experiences extreme fright and horror. Dysfunction in speech, inability to sleep, delusions, and hallucinations.

Community Setting: Assertive Community Treatment ( ACT)

ACT is done wether the PT wants the treatment or not; nontraditional case management and treatment by an interdisciplinary team for a caseload of clients with severe mental illness who are noncompliant with traditional treatment.

Community Setting: Partial Hospitalization Programs

Intense-short term treatment for pt's who are well enough to go home every night and who have responsible care at home to provide support and safe environment.

Behavioral Therapy Types : Modeling

The therapist or others serve as role models for the client , who learns important behavior by imitation.

Behavioral Therapy Types: Operant conditioning

Positive rewards are given for positive behavior (positive reinforcement).

Behavioral Therapy Types: Systemic Desensitization

This therapy is the planned, progressive, or graduated exposure to anxiety-provoking stimuli in the real-life situations, or by imaging events that cause anxiety. During the exposure, the anxiety response is suppressed through the use of relaxation techni

Behavioral Therapy Types: Aversion Therapy

A maladaptive behavior is paired with a punishment or unpleasant stimuli to change the behavior.

Phases of Group Development ( Therapy) : Initial Phase

The purpose and goals of the group are defined. Members get acquainted with each other and with the group leader. Termination is discussed.

Phases of Group Development ( Therapy): Working Phase

Problem-solving skills are promoted to facilitate behavioral changes. Power and control issues may dominate in this phase. Members take informal roles within the group, which may interfere with or favor group progress toward goals.

Phases of Group Development ( Therapy): Termination Phase

This marks the end of Group. Termination issues are discussed among members and the leader summarizes the work of group and individual contributions.

Short Term Stress: Objective/Subjective Data

Actue Stress: Apprehension, unhappiness or sorrow, decreased appetite, increase respiratory rate, heart rate, cardiac output and blood pressure, increased metabolism and glucose use , depressed immune system.

Long Term Stress: Objective/Subjective Date

Prolonged Stress: Chronic anxiety or panic attacks and depression , chronic pain, sleep disturbances, weight gain/loss, increased risk for cardiac infarction and stroke, and also poor diabetes control hypertension , fatigue, irritability, decreased abilit

General adaptation Syndrome ( GAS): is what?

The body's response to an increased demand. The first stage is the initial adaptive response, also known as the "fight or flight" mechanism. If stress is prolonged , maladaptive responses can occur.

Biofeedback

A nurse or health care professional trained in this method can assist the client to gain voluntary control of such autonomic functions as heart rate and blood pressure.

ECT Therapy

Patient must have experienced bipolar mania at least 6 times in the last year . Lasts 3x week anywhere between 6-12 treatments. Client must fast 8-12 hours before receiving the ECT therapy usually in the AM hours. Ongoing cardiac care is monitored during

Anxiety Disorders: Panic

PT experiences recurrent panic attacks

Anxiety Disorders: Phobias

PT fears a certain object or situation to an unreasonable level

Anxiety Disorders: OCD

PT experiences intrusive thoughts of unrealistic obsession and tries to control these thoughts with compulsive behaviors

Anxiety Disorders: GAD

Generalized Anxiety Disorder: uncontrolled , excessive worry for more then 6 months

Anxiety Disorders: Actue Stress Disorder

PT exposure to a traumatic event causes numbing, detachment and amnesia about the event for not more then 4 weeks following the event.

Anxiety Disorders: PTSD

PT has exposure to a traumatic event causes intense fear horror, flashbacks, feelings of detachment and foreboding, restricted affect and impairment for longer then 1 month after the event symptoms may last for years.

Antidepressant Medications

Sertraline ( Zoloft), Amitriptyline ( Elavil), Diazepam (Valium), SSRI's Venalafaxine ( Effexor) and Nonbarbituates Buspirone ( BuSpar) used to manage anxiety.

Depression: Acute

Severe symptoms of depression present. and generally treatment is 6 to 12 weeks in duration, hospitalization is usually necessary, reduction of suppressive symptoms is goal of PT, suicide potential is determined and safety precautions implemented.

Dysthymic Disorder

Is a milder form of depression that usually has an early onset such as in childhood or adolescene and lasts at least 2 years in length for adults and 1 year for children. contains at least three symptoms of depression and may later turn into MDD if gone u

MDD

Major Depressive Disorder: is a single episode of recurrent episodes of unipolar depression resulting in a significant change in a client's normal functioning accompanied by at least five of the following specific symptoms, which must occur every day for

Antidepressant Medications : SSRIs

Citalopram ( Celexa)
Fluoxetine ( Prozac)
Sertraline (Zoloft)
N/H , CNS stimulation ( agitation, insomnia, anxiety), sexual dysfunction ( notify provider if effects are intolerable), Healthy diet as weight gain can occur with long term use.

Antidepressant Medications: TCA

Tricyclic Antidepressants:
Amitryptyline( ELavil)
Tell PT to change positions slowly as orthostatic hypotension and dizziness are common with this medication.

Antidepressant Medications: MAOIs

Monoamine Oxidase Inhibitors :
Phenelzine ( Nardil)
Advise PT to minimize ANTIcholinergic effects , advise the client to chew sugarless gum, eat hard sugar free candy, eat foods high in fiber and increase fluid intake by 2 to 3 L/day from food and beverag

Antidepressant Medications: Benzodiazapines

Sedative Hypnotic Anxiolytics : Benzos
Diazempam(Valium)
Lorazepam(Ativan)
Warn PT to watch for CNS depression, such as sedation, lightheadedness, ataxia, and decreased cognitive function, avoid the use of any other CNS depressants, avoid hazardous activi

Antidepressant Medications: SNRI's

Serotonin Norepinepherine Reuptake Inhibitors:
Venalfaxine( Effexor)
Side effects include: nausea, weight gain, and sexual dysfunction.

Antidepressant Medications:
Nonbarbiuate Anxiolytics

Buspirone ( BuSpar)
may take up to 2-4 weeks to obtain therapeutic effect and and they can be used for long term management of depression and the medication does not cause CNS depression.

St. Johns Wart : Adverse RXN

Abdominal Pain, skin rash, rapid heart rate, photosensitivity, gastrointestinal upset ; can be a sign of adverse rxn associated with taking St. Johns Wart.

Characteristics of Bipolar Manic

Persistant elevated mood, agitation and irritability, dislike of interference and intolerance of criticism, increase in talking and activities, flight of ideas, rapid continuous speech with sudden and frequent topic change, grandiose view of self, impulsi

Characteristics of Bipolar Depressive

Flat, blunted labile affect, tearfulness, crying, lack of energy, anhedonia; loss of pleasure, lack of interest in activities , hobbies and sexual activity. Physical symptoms of discomfort/pain, PT will have difficulty concentrating, focusing, problem sol

Bipolar I Disorder

the client has at least one episode of mania alternating with major depression

Bipolar II Disorder

the client has one or more hypomanic episodes alternating with major depressive disorder.

Cyclothmia

the client has at least 2 years of repeated hypomanic episodes alternating with minor depressive episodes.

Mood Stabilizers : Lithium Carbonate
( Eskalith)

Side effects that need to be monitored; seizures, fatigue, dizziness, impaired memory, ataxia, arrhythmia's, ECG changes, polyuria,abdominal pain, anorexia, N/D, hypothyroidism, leukocytosis, weight gain, tremors and weight gain. * make sure that PT maint

Schizophrenia

is a group of psychotic disorders that affect thinking, behavior, emotions and the ability to perceive reality.

Schizophrenia : Paranoid

Hallucinations, such as hearing threatening voices, and delusions, such as believing oneself president of the U.S. Other directed violence may occur.

Schizophrenia: Disorganized

Loose associations, bizarre mannerisms, incoherent speech and hallucination and delusions may be present but are much less organized than those seen in the client with paranoia.

Schizophrenia: Catatonic

Withdrawn Stage:
will be present during this stage and psychomotor retardation and client may appear comatose. The client often has extreme self-care needs, such as tube feeding due to inability to eat.
Excited Stage:
PT will experience constant movement

Schizophrenia: Residual

Active symptoms are no longer present and the client is experiencing at least two or more residual symptoms; anerigia, anhedonia, avolition, withdrawal from social activities, impaired role function, speech problems . such as alogia , and odd behaviors wi

Schizophrenia: Undifferentiated

The client has symptoms of schizophrenia but does not meet criteria for any of the other types ; PT will be experiencing any negative or positive symptoms with this type.

Positive Symptoms

The most easily identified symptoms ; hallucinations, delusions, alterations in speech and bizarre behavior such as walking backward constantly.

Negative Symptoms

More difficult to treat then positive symptoms ; affect usually blunted, Alogia occurs when patient has a poverty of thought or speech , the client may sit with a visitor but may only mumble or respond vaguely to questions, Avolition is the lack of motiva

Cognitive Symptoms

Disordered thinking and inability to make decisions and poor problem-solving ability, difficulty concentrating to perform tasks and PT will experiencing memory deficits such as short term memory loss, long term memory loss and the working memory such as i

Depressive Symptoms

Hopelessness and suicidal Ideation

schizoaffective

The clients disorder meets both the criteria for schizophrenia and one of the affective disorders ( depression, mania, or a mixed disorder)

Brief Psychotic Disorder

The client has psychotic symptoms that last between 1 day and 1 month in duration.

Schizophreniform Disorder

The client has symptoms like those of schizophrenia but the duration is from 1 to 6 months and social / occupational dysfunction may or may not be present.

Depersonalization

nonspecific feeling that a person has lost her identity; self is different or unreal.

Derealization

perception that environment has changed.

Behavior Changes: Echoparaxia

Purposeful imitation of movements made by others

Behavior Changes: Negativism

Doing the opposite of what is requested.

Behavior Changes: Wavy Flexibility

Excessive maintenance of position

Atypical Antipsychotics :

medications of choice for psychotic disorders, and they are generally treat both positive/negative symptoms.
Medications:
Risperidone(Risperdal)
Olanzapine(Zyprexia)
Quetiapine(Seroquel)
Ziprasidone(Geodon)
Aripiprazole(Abilify)
Clozapine(Clozaril)
To min

Conventional Antiphsychotics:

used to treat mainly positive psychotic symptoms
Medications:
Haloperidol( Halodol)
Loxapine(Loxitane)
Chlorpormazine(Thorazine)
Fluphenazine(Prolixin)
To minimize anticholenergic effects advice the client to chew sugarless gum , sugarless candies and eat

Antidepressants

Used to treat the depression seen in many clients with schizophrenia.
Medications:
Paroxetine(Paxil)
treat temporary depression associated with schizophrenia, monitor the client for suicidal ideation, as this med can increase thoughts of self harm ( espec