1) Autonomy

2) Nursing Must insist on what three things?

1) Self-determination, independence and shared power.

2) -control over nursing tasks.

-  the ability to eliminate, refuse or delegate non-nursing tasks.

-their right and duty to function independently within their realm of practice as described in the Nurse Practice Act. The Scope and Standards of Psychiatric-Mental Health Nursing Practice (American Nurses Association, 2000), and the Code of Ethics for Nurses (American Nurses Association, 2001), and applicable state law.

-Nurses must regard fellow-nurses with respect and trust. They must

   provide support, commitment and solidarity to one another as valued members of the same profession.

1) Define Collaboration

2) Nurses must do what three things?

1) Working effectively with interdisciplinary treatment team members

2) -be able to assertively define, describe, and defend nursing’s role and function as members of the team.

-not only be accountable for nursing practice, but insist on accountability from all other disciplines including physicians, social work, and administration.

-be able to demonstrate clinical competence and commitment to evidence based practice to other members of the team.

The nurse’s primary commitment is to the patient, not the health care

               institution. It is the nurse’s responsibility to advocate assertively for the best possible patient care and outcomes. The nurse also has a responsibility to advocate for the profession of nursing. The nurse must also advocate for his or own self-care to preserve personal integrity, dignity, and promote professional growth.

Essential Personal Qualities of the Psychiatric Nurse

(4 Qualities and their definitions)

1.      Self-Awareness: The ability for the nurse to examine his/her personal feelings, beliefs, behaviors, reactions, prejudices, and past experiences

2.      Genuineness:  A quality of the nurse characterized by openness, honesty, sincerity, and authenticity.

3.      Respect: Regarding all patients with a deep sense of worth, value and

unconditional positive regard.

4.      Empathy: The ability to view the patient’s world from his or her internal frame or reference.

Bipolar Disorder (“manic-depression”)

Two Types

Type I:  Characterized by periodic episodes of mania (elevated mood, poor sleep and appetite, rapid speech, poor judgment, impulsiveness, irritability, lability, and sometimes grandiose delusions. Patient may or may not have intermittent periods of depression.

Type II: Characterized by one or more major depressive episodes and at least one hypomanic episode. Often misdiagnosed as major depression.

Axis I

Axis II

Axis III

Axis IV

Axis V

I-Mood, anxiety and psychotic disorders; organic disorders; substance abuse disorders; disorders first noticed in childhood, (and a few others).

II-Personality disorders

III-Medical problems

IV-Psych/Social stressors

V-Global Assessment of Functioning (GAF) 

"NOS"

"Defferred"

"R/O"

NOS- Not Otherwise Specified (used on Axes I and II

Deferred- Used on Axis 2

R/O-Rule Out

1. Affect
2. Anergia
3. Anhedonia
4. Apathy
5. Behavior

1) Generally refers to a patient’s facial expression – eg. flat,blunted,broad,constricted, sad, tearful, tense, etc.

2) Lack of energy

3) Inability or decreased ability to experience pleasure, joy, intimacy, and closeness. A common symptom of depressive disorders.

4) Lack of feelings, emotions, interests, or concern.

5) Any observable, recordable, and measurable act, movement, or response.

1. Behavioral Health
2. Circumstantial
3. Cognition
4. Commitment
5. Compulsion

1) A term used to describe both mental health and addiction services.

2) Thought and speech of a person associated with excessive and unnecessary detail that is usually relevant to a question; an answer is eventually provided.

3) The mental process characterized by knowing, thinking, learning, and judging.

4) Involuntary admission in which the request for hospitalization did not originate with the patient.

5) A recurring, irresistible impulse to perform some act.

1) Concreteness

2) Confabulation

3) Congruence/incongruence

4) Coping Mechanism

5) Defense Mechanisms

1) Use of specific terminology rather than abstractions in the discussion of the patient’s feelings, experiences, and behavior.

2) A confused person’s tendency to make up a response to a question when he or she cannot remember the answer

3) how well a patient’s stated mood fits with his observable affect.

4) any effort directed at stress management. It can be problem, cognitive, or emotion focused.

5) Coping mechanisms of the ego that attempt to protect the person from feelings of inadequacy and worthlessness and prevent awareness of anxiety. They are primarily unconscious.

1) Delirium

2) Delusion

3) Dementia

4) Dual Diagnosis

1) The medical diagnostic term that describes an organic mental disorder characterized by a cluster of cognitive impairments with an acute onset and the identification of a specific precipitating stressor (i.e. medical problem).

2) A fixed, false belief that is firmly maintained even though it is not shared by others and is contraindicated by social reality.

3) The medical diagnostic term that describes an organic mental disorder characterized by cognitive impairment.

4) Simultaneous occurrence of a mental illness and a substance abuse disorder.

1) Dysphoria

2) Dysthymia

3) Electroconvulsive Therapy (ECT)

4) Euphoria

5) Euthymia

1) low mood

2) a milder form of depression lasting 2 or more years.

3) Artificial induction of a grand mal seizure by passing a controlled electrical current through electrodes applied to the patient’s head.

4) highly elevated mood often associated with mania.

5) a “normal” mood – the midpoint between dysphoria and euphoria.

1) Extrapyramidal Syndrome (EPS)

2) Grief

3) Hallucination

4) Hypomania

1) A variety of signs and symptoms, including muscular rigidity,, tremors, drooling, shuffling gait, restlessness, peculiar involuntary postures, and many other neurological disturbances. Often a side-effect of antipsychotic medications.

2) A person’s subjective response to the loss of a person, object, or concept that is highly-valued.

3) Perceptual distortion arising from any of the 5 senses.

4) A clinical syndrome that is similar to but less severe than that described by the term mania or manic episode.

1) Ideas of Reference

2) Illusions

3) Insight

4) Intellectualization

5) Lability

1) Incorrect interpretation of casual incidents and external events as having direct personal references.

2) False perceptions of or false responses to a sensory stimulus.

3) The patient’s understanding of the nature of the problem or illness.

4) Excessive reasoning or logic used to avoid experiencing disturbing feelings.

5) rapid changes in mood.

1) Limit Setting

2) Loose Associations

3) Magical Thinking

4) Malingering

5) Mania

1) nonpunitive, non-manipulative act in which the pts told what behavior is acceptable/unacceptable, & the consequences of behaving unacceptably.

2) lack of a logical relationship between thoughts and ideas that renders speech and thought inexact, vague, diffuse, and unfocused.

3) Belief that thinking equates with doing, characterized by lack of realistic understanding of cause & effect.

4) Deliberate feigning of an illness.

5) a condition characterized by a mood that is elevated, expansive, or irritable. It is a component of bipolar illness.

1) Mood

2) Neologisms

3) Neuroleptic Malignant Syndrome

4) Neurotransmitters

5) Obsession

1) the patient’s self-report of prevailing emotional state.

2) New word or words created by the patient; often a blend of other words.

3) A potentially fatal side-effect of antipsychotic medications.

4) Chemical messengers of the nervous system, manufactured in one neuron, released from the axon into the synapse, received by the dendrite of the next neuron.

5) an idea, emotion, or impulse that repetitively and insistently forces itself into consciousness; unwanted, but cannot be voluntarily excluded from consciousness.

1) Perseveration

2) Phobia

3) Polypharmacy

4) Projection

5) Psychosis

1) Involuntary, excessive continuation or repetition of a single response, idea, or activity.

2) A morbid fear associated with extreme anxiety.

3) Use of a combination of psychoactive drugs in a patient at the same time without determining whether one drug by itself is effective; can cause drug interactions and may increase the incidence of adverse reactions.

4) Attributing one’s own thoughts or impulses to another person.

5) A category of  mental health problems that are distinguished by gross impairment in reality testing

1) Recovery

2) Regression

3) Rehabilitation

4) Relapse

1) The consumer-centered rehabilitation philosophy that is characterized by awareness of mental illness and substance abuse as illnesses and what is needed to recover; management of one’s own mental health; interconnectedness with others; and client advocacy.

2) A retreat in the face of stress to behavior that is characteristic of an earlier level of development

3) The process of enabling a mentally ill person to return to the highest possible level of functioning

4) return of symptoms; also referred to as decompensation

1) Repression

2) Resistance

3) Seclusion

4) Secondary Gain

5) Self-ideal

1) Involuntary exclusion of a painful or conflictual thought, impulse or memory from awareness.

2) Attempt of the patient to remain unaware of anxiety-producing aspects within the self.

3) Separating the patient from others in a safe, contained environment with minimal stimulation.

4) A related benefit that a patient experiences as the result of one’s illness.

5) The person’s perception of how he or she should behave on the basis of certain personal standards

1) Somatization Disorder

2) Suppression

3) Tangential

4) Therapeutic Milieu

1) A disorder characterized by multiple physical complaints with no evidence of organic impairment.

2) A process that in which a person consciously excludes anxiety-producing thoughts, feelings, or memories.

3) Thought and speech of a person that strays markedly from the original discussion, yet is, in some manner, related to the original discussion  -i.e. “touches on” a topic or word within the discussion.

4) The controlled environment of treatment facilities in which patients are provided with a safe, stable, coherent, therapeutic environment.

1) Thought Blocking

2) Thought Broadcasting

3) Thought Insertion

4) Word Salad

1) sudden stopping in the train of thought or in the midst of a sentence. Often a symptom of psychosis.

2) The belief that one’s thoughts are being aired to the outside world

3) The belief that one’s thoughts are being placed into one’s mind by outside people or influences.

4) Series of words that seem totally unrelated.

1) AMA

2) AWOL

3) DTO

4) DTS

5) A/V Hallucinations

1) Patient discharged “Against Medical Advice”

2) "Absent Without Leave"-i.e. escape from a locked psychiatric facility

3) "Danger to Others"

4) "Danger to Self"

5) "Auditory or Visual Hallucinations"

1) LTM

2) R/O

3) STM

4) NOS

5) SMART

1) "Long Term Memory”

2) "Rule Out"

3) "Short Term Memory"

4) "Not otherwise Specified"-Often used in DSM diagnoses

5) S-Specific

M-Measurable

A-Achievable

R-Realistic

T-Timely

Name the various drugs under the category

ANTIDEPRESSANTS

Prozac

Effexor

Lexapro

Paxil

Zoloft

Wellbutrin

Cymbalta

Celexa

Name the various drugs under the category

ANTI-ANXIETY

Ativan

Klonopin

Valium

Xanax

Vistaril

Name the various drugs under the category

MOOD STABILIZERS

Lithium

Valproic Acid

Carbatrol

Lamictal

Neurontin

Name the various drugs under the category

TYPICAL ANTIPSYCHOTICS

Haldol

Thorazine

Stelazine

Trilafon

Name the various drugs under the category

ATYPICAL ANTIPSYCHOTICS

Seroquel

Risperdal

Geodon

Abilify

Zyprexa

Clozaril

Name the various drugs under the category

SLEEP AIDS

Ambien

Restoril

Lunesta

Rozerem

Desyrel

Name the various drugs under the category

SUBSTANCE ABUSE DETOX AGENTS

Suboxone

Methadone

Phenobarbitol

Revia

Name the various drugs under the category

FOR ANTIPSYCHOTIC SIDE EFFECTS

Cogentin

Artane

Benadryl

Name the various drugs under the category

ADD MEDICATIONS

Ritalin

Adderall

Stratera

Interventions:

1) Active Listening

2) Mutual Goal-setting

3) Education (individual and group)

4) Exercise

1) perhaps the best, most important, and most effective intervention of all.

2) devising daily and longer-term goals in conference with the patient. Use SMART criteria – just like the expected outcomes in care plans

3) illness, coping skills, medication, etc

4) an extremely effective intervention for depression.

Interventions:

5) Role-Play

6) Meditation

7) Journaling

8) Relaxation Training

5) An excellent way to practive new behaviors

6) Active awareness and breath control

7) Write down feelings

8)  Look up (pg 877-881)

Interventions

9) Support System Development

10) Social Skills Training

11) Promotion of self-care activities

12) Cognitive Behavioral Therapy and Cognitive Restructuring

9) Strong support system

10) P. 256

11) Promote self-care

12) extremely effective for depression and anxiety. You can learn the basics in 15 minutes and begin using it after that!

Interventions

13) Motivational Interviewing/Counseling

14) Milieu Therapy

15) Behavioral Contracting

16) Time-Out

17) Limit-Setting