Term
Nursing interventions for psychiatric disorders are based on a number of theoretical approaches which are described according to |
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Definition
biological, psychodynamic, interpersonal, cognitive-behavioral and other theories |
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Term
assumes the mental disorders are r/t phsiologic changes within the central nervous system |
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Definition
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wiht the biologic approach mental illness is managed with |
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Definition
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Term
the psychodynamic approach is based on the theory that |
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Definition
humans function at different levels of awareness ranging form consious to unconscious, people use ego defense mechanisms such as represison, denial and projection to prevent or minimize anxiety |
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Term
the interpersonal approach ahs 3 components |
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Definition
anxieteyt is often communicated interpersonally, the patient learns new ways of coping or maturing in a therapeuti relationship, the estabilisment of trust is an important first step in working with patients |
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Term
tthe central feature of nursing practice is |
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Definition
the nurse patient relationship |
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Term
key ideas form the cognitive behavioral approach are that |
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Definition
behaivor is learned, behavior increases because of a response to that behavior from the enviorment, the way a person thinks about things influences emotional states behavior |
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Term
a range of interpersonal strategies has been found to be particularyly helpful in promoting the patient's level of comfort with the nurse they include |
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Definition
being available, listening, clarifying, sharing observations, and accepting silence |
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Term
therapeutic use of self is key to providing goood care to patients with |
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Definition
psychiatric illness, avoiding advice giving and assiisting patients at their level of comprehension |
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Term
when you are working with a patient, direct all your attention |
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Definition
completely toward that person |
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Term
to listen well you must be aware of |
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Definition
your own thoughts and feelings |
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Term
therapeutic relationships is different from social relationships in that its: |
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Definition
purpose is to benefit the patients, relationship develops purposefully, focus is on personal and emotional needs of pateint, helper has responsibilty for evaluationg the interaction and the changing behavior, relationship has some boundaries and a clear ending |
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Term
social relationships are different form therapeutic rlationships in that its" |
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Definition
purpose is to benefit both participants in relationship, relationship develops spontaneously, focus is on personal and emotional needs of both participants, participants are not formally responsible for evaluating their interaciont, relationship may or may not have clear boundaries and a clear ending |
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Term
listening is done by concentrating on the patient and by refraining form thining of responses while the patient is |
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Definition
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Term
one way of validating that you understand what the patient is saying |
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Definition
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it is helpful to avoid the word "_" when asking questions |
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Definition
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Term
sometimes it is therapeutic to allow moments of silence between you and th epatient, this is called |
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Definition
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Term
another major feature of a complete health assessment of the patient whith psychiatric problems is the |
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Definition
mental status examination |
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Term
the mental status examination is based on observations made by the nurse and patient respons to questions used to evaluate several domains of mental functioning including |
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Definition
psychomotor activity, speech, behavior, mood, emotional expression, sensorium, cognitive processing and perceptions and thinking |
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Term
the first tep in a mental status examination is to observe how a person |
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Definition
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Term
spefific data included when assessing appearance |
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Definition
appearance in relation to stated age, appropriateness of clothing in relation ot the patient's particular peer group, temp in the room or the weather, personal grooming and hygiene, unusual physical characteristics, motor activity |
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Term
note any recent change in the patient's activity level, other types of activity that are obsevered include the following |
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Definition
hyperactivity or activity at a level considerably above average purposeful activity agitaiton or purposeless activity such as wringing of hands, pacing, picking a clothing, foot tappign, psychomotor retardation or a decrease in movement, slowness, delayed actions, thougths and speach repetitive movmements that are part of a purposeful activity, repetitive movements that are not part of purposeful activity |
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Term
unusual findings in the assessment of speech include |
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Definition
mutism, long pauses before responding, minimal or very littil speech and pressured speech |
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Term
a sustained feeling state or emotion that a person experiences in several aspects of life |
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Definition
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Term
mood is assesed in terms of its |
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Definition
intesnsity,d epth, duration and fluctuation |
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Term
words that are often used to describe mood iclude |
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Definition
irritable, anxious, depressed, euphoric, labile and despairing |
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Term
describes a person's extenral presentation of afeeling state or emotional responsiveness |
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Definition
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Definition
blunted, flat and contricted to uporic, expansive and intense |
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Term
a normal affect exists when the person's body language, mannerisms and verbal responses are consistent with the person's _ and within an average range of _ |
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Definition
mood, emotional intensity |
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Term
affect is also described according ot it's |
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Definition
appropriateness and congruence |
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Term
appropriate affect exists when the person's _ mathces what he or she is saying or doing |
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Definition
outward emotional expression |
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Term
focuses on orientation interms of time, date, place person and self as well as the situation or circumstnac ein which th epatients find themselves |
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Definition
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Term
the four levels of consciousness are |
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Definition
comatose, stuporous, drowsy, alert |
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Term
assess remot memory by comparint the patient's memory of past events whith what is recalled by other |
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Definition
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Term
if you are collecting data r/t memory or the ability to recallnew information ask the patient to learn tree unrelated words and to recall thes words: |
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Definition
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Term
general intellectual functionin is estimated by detrmining the patient's: |
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Definition
vocabulary adn knowledge of current events |
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Term
perceptual disturbances may involve any one of the senses such as |
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Definition
vision, hearing, taste, touch and smell |
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Term
one type of perceptual disturbances is an _ in which a specifif stimulus such as a spot on the wall misinterpreted |
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another perceptual disturbance is _ which a sensory experience that occurs without an external stimulus |
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Definition
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Term
hallucination is sometimes referred to as |
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Definition
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Term
evidence of hallucination (internal stimuli) include |
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Definition
a person sitting alone, tlaking as if someone were present or looking around as if someone were talking ot them |
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Term
evealuatio of a person's thinking includes two parts |
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Definition
the thought process and thought content |
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Term
an inidividuals thought process refers to the individuals ability to think |
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Definition
clearly, logically and in a goal directed fashion that is coherent |
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Term
a normal thought process is then described as |
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Definition
logical, linear, goal directed and coherent |
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Term
abnomral or unusual findings r/t thought process include |
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Definition
tangetial, circumstantial, impoverished or illogical thought processes |
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Term
additional abonromal findings relative to thought process include |
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Definition
thought blocking, loose associations, word salad |
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Term
a person stops speaking before reaching the point |
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include continual shifting from one topic to another topic |
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shifting between topics to the point ofincoherence |
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Definition
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Term
refers to thoughts that the patient describes thorught the interveiw r/t descriptions of of symptoms or circumstances of their illness as wll as the presence of self injurious thoughts, suicidal ideations or homicidal thoughts |
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Definition
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thought content also refers to any _ that the patient may have |
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Definition
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Term
the presences or absencs of _ are also noted in the description of thought content |
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Definition
obssesssions, compulsions, phobias andperseverations |
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Term
another part of thought content assessment includes determining whether the patient has _ to carry out a suicid plan |
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Definition
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Term
the ability of the person to understand the correct cause or meaning of the situation |
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Definition
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Term
the ability to assess the situation accurately and determine the appropriate course of action |
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Definition
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Term
another way of evaluation judgement is if the patient expresses desire to _ and engage in trearment to achieve that outcoume |
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Definition
recover from their illness |
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Term
three main elements of suicide risk assessment in the mental status examinaiton are |
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Definition
suicidal ideations, suicide plans, intent to follow through with a suicide plan |
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Term
individuals with generalized anxiety disorder have a difficult time controlling their |
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Definition
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Term
to meet the diagnostic criteria for GAD the individual must have had anxiet occuring for more days than not for at least _ with worries and anxieties about multiple situations and events |
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Definition
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Term
when a person has GAD their thoughts and worries interfere with the ability to |
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Definition
function in their day to day activities |
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Term
what distinguishes GAD from day to day anxiety that is not pathologic is tha tworries are are _ and typically interfere significantly with these individuals perceive their concerns as _ |
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Definition
excessive, difficult to manage |
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Term
when a person has GAD their worries are more _ and are often accompanied by phsical symptoms such as feeling _ |
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Definition
pervasive, pronounced, distressing restless and tense |
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Term
treatment of GAD includes individual psychotherpay such as _ with first line agents including the _ |
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Definition
cognitive behavioral therapy and pharmocotherpay, selective serontonin reuptake inhibitors |
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Term
judicious use of _ may be helful at the beginning of treatment for GAD until the SSRI becomes effective |
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Definition
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Term
long term use of benzodiazepines hsould be avoided because of the potential for addiction |
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Definition
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Term
in panic disorder the person expereiences _ panic attacks |
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Definition
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Term
panic attacks vary in lenght but generally do no exceed _ minutes, but may prgress to the point of _ and are often accopmanied by feelings of _ |
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Definition
10 to 15, terror, impending doom |
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Term
physical symptoms of sever anxiety are |
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Definition
increased pulse, elevated blood pressur,e trembling diaphoresis, shortness of breath, chest pain, nausea, dizziness apresthesia |
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Term
pyshcologic sympomts of sever anxiety include |
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Definition
feeligns of unreality or feeling of being detached form self and fear of dying or fear of losing ocntrol or going crazy |
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Term
treatment of panic disorder includes individual psychotherapy such as _ with frist line agents including the _ |
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Definition
CBT and pharmocotherpay, SSRI's |
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Term
initially for treatment of panic disorder, short temr use of _ may be helpful but it should be noted that panic attacks are _ in their duration and byt the time an oral medicaiton is absorbed and becomes active the painc attack has usually _ |
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Definition
benzodiazepine, self limiting, subsided |
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Term
the person with _ is extremely fearful of situations outside the home |
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Definition
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Term
agoraphobia may occur by itself or |
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Definition
together with panic disorder |
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Term
a disorder in which the patient experiences a marked and persistent fear that is excessive unreasonable or both |
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Definition
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Term
obsessive compulsive and related disorders are: |
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Definition
OCD, body dysmorphic disorder, hoarding disorder, trichotillomania, excoriaon disorder and r/t diosrders |
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Term
consists of recurrent obsessions, compulsions or both tha tproduce stress, are time consuming an dinterfere with fuction with functioning |
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Definition
obsessive compulsive disorder |
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Term
obssessions r/t ocd frequently involve _ that a person cannot stop |
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Definition
intrusive thoughts about unpleasnat or violent acts |
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Term
examples of convulsions include |
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Definition
hand washing, counting and checking |
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Term
many people with OCD have considerably reduced their symptoms with a |
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Definition
tricyclic antidepressant or SSRI |
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Term
standard of treatment for ocd |
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Definition
cognitive behavioral, psychotherapy in combination with medicaion management |
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Term
persons with _ become preoccupied with one or more perceived flaws in their physical appearance |
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Definition
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Term
individuals with body dysmorphic disorder believe they look |
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Definition
unattractive, abnromal, deformed or ugly |
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Term
the flaws that people with dysmorphic disorder see are not genarlly _ to others or only appear _ to others |
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Definition
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Term
individuals with body dysmorphic disorder can become preoccupied with _ and it can sometimes lead ot comuplsive behaviors like _ which can result in skin damage, infections and even _ |
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Definition
checkng their perceived deficits, examining them directly, grooming excessively, attemptimg to camouflage thier deficits, skin picking, damaged blood vessels |
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Term
rates fo suicidal ideation and suicide attempts are higher in people with |
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Definition
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Term
persons with _ demonstrate persistent problems discarding or parting with possessions regardless of their acutal value |
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Definition
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Term
commonly saved items of pt with hoarding disorder can include |
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Definition
magazines, newspapers, old clothing and other items (virtually any item can be saved) |
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Term
persons with hoarding diorder experience _ when facing the prospect of discarding their belongs |
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Definition
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Term
demonstrate the behaior of recurrent pulling out of thier hairs resulting in hair loss |
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Definition
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Term
allthough the hair pulling may occur in any region of the person's body the most often common sites in a patient with trichotillomania are |
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Definition
scalp, eyebrows and eyelids |
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Term
the hairpulling form trichotillomania can be preceded by |
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Definition
emotional distress or psychosocial distress |
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Term
individuals with _ demonstrate the behavior of recurrent picking at their own skin |
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Definition
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Term
most common areas where the skin is picked in excoriation patients are |
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Definition
face, arms, hands, some individuals pick multiple body sites |
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Term
people with excoriation disorder pick at healthy skin or at some minor skin irregularities such as |
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Definition
pimples, calluses or scab |
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Term
a cluster of symptoms experienced after a distressing event that is outside the range of normal events and in which the person experienced intese fear, hlplessness, horror or a combination of these |
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Definition
posttraumatic stress diorder |
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Term
examples of symptoms of ptsd included |
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Definition
reexperiencing the trauma through repeated and intrusive recall of the event, avoiding situations that in some way remind the person of the event, feeling detached from othe rpeople, having a heighteded sens of arousal which is expericed as difficulty falling alseep, hypervigilance an exaggerated startle respons or a combination of these |
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Term
recommended treatment for ptsd uses |
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Definition
psychotherapy and pharmacotherpay |
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Term
evidence based pharmacotherpay for ptsd includes |
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Definition
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Term
symptoms of acute stress diorder last from |
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Definition
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Term
acute stress diorder is is characterized by |
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Definition
intrusion symptoms, negative mood, dissociative symptoms, avoidance sympotms, arousal sympomts |
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Term
manifestations of intrusion sympotms |
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Definition
recurrent distressing dreams, recurrent memories of the traumatic event, flashbacks of the event(may occurs with complete loss of awareness of present surroundings in serious cases) |
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Term
manifestations of negative mood |
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Definition
persistent inability to expereince feeling sof happiness, satisfation, or love |
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Term
manifestations of dissociative symptoms |
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Definition
feeling a sens of detachment, having a reduced awareness of ones surroundings, inability to remember aspects of the traumatic event |
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Term
manifestations of avoidance sympotms |
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Definition
avoiding distressing memories or external reminders of the traumatic event |
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Term
manifestations of arousal symptoms |
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Definition
sleep disturbances, irritability, angry outbursts, problems with concnetraiton or exaggerated startle response |
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Term
individuals with _ expericence multiple current physical sympotms that are distressing or result in significant diruption of daily life |
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Definition
somatic symptoms and r/t disorders |
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Term
persons with _ experience one or more phsycial symptoms that they experience as distressing and/or result in significant disruption in their daily life |
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Definition
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Term
in the person with somatic symptom disorder thier _ are diproportionate to the seriousness of the sympomt and are persistent |
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Definition
thoughts, feelings and behaviours |
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Term
the course of somatic sympomt disorder can be persisten with sympoms lasign _ or more and the severit can be _ |
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Definition
6 months mild, moderate or sever |
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Term
individuals are preoocupied with having or acquiring a serious underlying illness |
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Definition
illness anxiety disorder (hypochondriac) |
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Term
the person with illness anxiety disorder is convinced they have a serious medical problem despite the absence of |
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Definition
concrete medical findings |
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Term
in conversion diorder sympomts may include _ without physiologic cause |
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Definition
blindness, deafness or parlysis of th elegs |
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Term
usuall sympomts of conversion disorder are _ and can occur in response to some threatenign or truamatic event |
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Definition
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Term
dissociative disorders involve a chang in |
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Definition
identiy, memory, consciousness, motor ocntrol and behavior |
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Term
individuals feel that they are outside of themselves or floating overhead watching what is happening as if it wer happening ot someone else |
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Definition
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Term
examples of dissociative diorders are |
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Definition
amnesia or dissociative identity disorder |
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Term
characterized by a gap in memory usually of traumatic or stressful nature |
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Definition
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Term
five major types of amnesia exsit |
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Definition
localized amnesia, selective amnesia, generalized amnesia, continuous amnesia, systematized amnesia |
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Term
difficulty remembering anything about the first few hours after a profoundly disturbing event |
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Definition
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Term
the ability to remember some but not all of the events surrounding a traumatic experience |
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Definition
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Term
failure to remember one' sentire life |
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Definition
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Term
inability to recal events after a specific time up to and including the present |
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Definition
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Term
loss of memory for certain categories of information such as all memories r/t to one's family or to a particular person |
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Definition
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Term
disociative identiy diorder is a relatively rare dissociative disorder with two major components |
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Definition
presnence of two ro more disticnt personality states and possesion |
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Term
legal identity of a person with DID is retained by the |
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Definition
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Term
identities r/t DID appear as though a spirit, supernatural being or outsid eperson ahs taken control so that hte individual begins speakign or acting in a distinctly different manner |
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Definition
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Term
the category of medications used to reat the acute symptoms of anxiety is the _ category |
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Definition
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Term
the primary aniolytic medications used to treat DID are |
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Definition
benzodiazepines such as diazepam (valium, chlordiazepoxide hydrochloride (librium), lorezepam (ativan) alprazolam (xanax) clonazepam (klonopin) |
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Term
side affects of benzodiazepines are those associated with sedation such as |
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Definition
drowsiness, fatigue, dizziness, confusion |
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Term
because _ occur withdrawal form benzodiazepines must be medically supervised |
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Definition
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Term
abrupt cessation of benzodiapines may result in withdrawal sympomt sincluding |
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Definition
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Term
benzodiapines are typically used at the _ of treatment ot reduce sympoms until other medicaiton can take effect |
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Definition
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Term
antidepressants such as the SSRIs and some newer antidepressants such as _ are often useful in _ |
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Definition
venlafazine(effexor), nefazodone (dutonin, nefadar (formerly serzone, duloxetine (cymbalta)
reducing anxiety, decreasing distress and improving overal funcitoning |
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Term
a term used to refer to a gropu of very serious usually chronic thought diorders in which pychotic sympoms primarily impar theaffected person's ability to interpret the world accurately |
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Definition
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Term
schizophrenia is characterized by distrubances in |
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Definition
thinking, mood and behavior |
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Term
a state in which a person has distorted perceptions of reality |
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Definition
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Term
psychotic sympomts include |
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Definition
delusions, hallucinations , diorganized thinking, grossly diorganized or abnormal motor behavior and negative sympoms |
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Term
the sympoms of schizphrenia are characterized as eithe r |
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Definition
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Term
positive sympomts of schizophrenia appear to reflect an excess or distorion of normal funciotns nad include |
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Definition
delusions, hallucinations, problems with communicaton, and bizarre behavior |
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Term
negative sympomts of schizophrenia appear to reflect a decrease or loss of normal fucntions and include |
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Definition
diminished emotional expression, slowed thinking and speech and difficultin initiating goal directed behavior |
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Term
the range of biologic factors being investigated to cause schizphrenia includes |
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Definition
neurotransmitters and their receptors, structural abnormalities such as dgeneration of th elimbic system, elargment of the lateral and their ventricles and loss of neruons in the temporal lobe, infectinous agents and hormonal deregulation |
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Term
anxiolytic medications which are given for anxiety diroders or as an adjunct for treating schizoprhenia may have side effects such as |
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Definition
drowsiness, loss of coordinaiton, fatigue, ocnfusion, blurred vision and psychologic dependence |
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Term
the most commonly adminsiter medicaitns for people with schizophrenia are |
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Definition
antipsychotic medicaiton and antiparkinsonism medicaions |
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Term
administered at times to prevent or relieve some of the side effects of the anntipsychotics |
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Definition
antiparkinsonism medications |
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Term
_ may also be administered in conjunction with the antipsychotics to decrease agitation and akathisisa |
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Definition
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Term
a potential side effect of antipsychotics in which the patient is restles sand unable to sit still |
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Definition
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Term
tow broad categories of antipsychotics exist |
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Definition
firgeneration agents and second generation agents |
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Term
FGAs are also referred to as |
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Definition
conventional or typicla agents |
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Term
FGAs were very useful in treating the positive sympotms of schizophrenia such as _ however were not particularly useful in treating the negaitve sympomts such as |
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Definition
auditory and visual hallucinations, poverty of thougth, delayed thinking and decreased function |
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Term
one side affect that can be managed when recievign antipsychotics is |
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Definition
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Term
stem from the effect of the antipsychotic agents on the extrapyramidal tracts of the CNS |
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Definition
extrapyramidal side effects |
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Term
play a role in the control of involuntary movements |
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Definition
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Term
examples of acute dystnoic reactions that may occure afer one dose of antipsychotics r/t schizophrenia |
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Definition
sever muscle contraction involving the tongue, face, neck(torticollis) and back, laryngospasms, |
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Term
dystonic reactions are reveresed with _ given _ with |
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Definition
benztropin mesylate (cogentine), IM or IV, dphenhydramin hydrochloride (benadryl) |
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Term
_ is a medical emergency and must be treated immediatly |
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Definition
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