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Schizophrenia2 or more of the following s/s for significant
portion of time during 1-month period: delusions, hallucinations, disorganized speech,
disorganized behavior, negative symptoms. Continuous social/occupational dysfunction for
at least 6 month
types of schizophrenia
paranoid, disorganized, catatonic, or undifferentiated
Major Depression
Five s/s present for 2 > wks and represent a change form previous functioning. at least one of the /s is depressed mood or loss of pleasure.
Wt loss, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished abilityt othink or
concentrate, recurrent thoughts of death.
Bipolar I (manic Episode)
Presence of current of previous manic episode. Abnormally and persistently elevated, exansive
or irritable mood, lasting at least 1 wk. Characterized by 3 or more of the following:
inflated self-esteem, decreased need for sleep, more talkative than usual, flight of ideas,
distractibility, increased goal-directed activity, excessive involvement in pleasurable activities.
Panic disorderRecurrent, unexpected panic attacks. At least
one of the attacks has been followed by 1 month of: persistent concern aobut having additional
attacks or worrying about implications
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Personalitythe enduring pattern of inner experience and
behavior that is established in the late teens or early adulthood
Personality disorders
dianosed when people experience clinically significant distress or impairment related to
longstanding inflexible and pervasive patterns
Areas where problematic behavior is manifested for personality disorders
cognition, affectivity, interpersonal functioning and impulse control
Cognition ways of perceiving and interpreting self, othr people, and events
Affectivity the range, intensity, lability and appropriateness of emotional response
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Cluster A odd and eccentric
cluster B dramatic and emotional
Cluster C Anxious and fearful
odd and eccentric personality types
paranoid, schizoid, and schizotypal
dramatic and emotional personality types
antisocial, borderline, histrionic and narcissistic
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anxious and fearful personality types
avoidant, dependent and obsessive compulsive
Schizophrenia2 or more of the following 1> month: delusions,
hallucinations, disorganized speech, disorganized behavior, negative symptoms.
continuous social/occupational dysfuncition for at least 6 months
types of schizophrenia
paranoid, disorganized, catatonic or undifferentiated
mood disorders
major depression, dysthymia, bipolar I and Bipolar II, cyclothymia
Major Depression
5> symptoms that have been present for 2 weeks or more and represent a change from
previous functioning. At least one of the sympotoms is depressed mood or loss of
pleasure other symptoms weight loss, insomnia or hypersomnia, psychomotor agitation or
retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished
ability to think or concentrate, recurrent thoughts of death
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Bipolar I (manic episode)
Presence of current or previous manic episode. A distinct period of abnormally and peristently elevated, expansive, or irritable mood, lasting
at least one week, characterized by 3 or more of the following: inflated self-esteem, decreased
need for sleep, more talkative than usual, flight of ideas, distractibility, increased in goal-directed activity, excessive involvement in
pleasurable activities.
Panic disorderrecurrent unexpected panic attacks, at least one of the attacks has been followed by one moth of
persistent concern aobut having additional attacks and worry aobut implications.
GADexcessive anxiety and worry, occurrig more
days than not for at least 6 months. The anxiety and worry are associated with 3 or more of the
following 6 symptoms: restlessness, being easily fatigued, difficulty concentrating,
irritability, muscle tension, sleep disturbance
Phobia: specific, social or agaraphobia
marked persistent fear that is excessive or unreasonable, cued by the presence or
anticipation of a specific object or situaTION, THE PERSON RECOGNIZES THAT THE
FEAR IS EXCESSIVE AND THE STIMULUS IS AVOIDED
OCDeither obsessions or compulsions that cause
marked distress are time-consuming, and interfere with functioning
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obsessionsrecurrent and persistent thoughts, impulses or
images that are intrusive and inappropriatecompulsions
compulsions repetitive behaviors that the person feels driven to perform; aimed at anxiety reduction
PTSDperson has been exposed to a traumatic event
which is persistently re-experienced. Persistent avoidance of stimuli associated with the trauma
and numbing of general responsivenss. Persistent symptoms of increased arousal.
Duration is >1 month
substance abuseadministration of any drug in a culturally disapproved manner that causes adverse
consequences and continue use takes place despite social and interpersonal problems.
recurrent use of substance abuse causes
failure in role responsibilities, physicallyhazardous situations and legal
problems.
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Two types of substance dependence
physical and psychological dependence.
substance dependence
substance is often taken in larger amounts or over a longer period than intended. Time is spent in activiteis necessary to obtain the
substance. social, occupational, recreational activities given up because of use. Unsuccessful
efforts to cut down use.
physical dependencea physiologic state of neuro-adaptation
producded by repeated administration of a drug, necessitaiting continued administration to prevent withdrawal syndrome. Tolerance
may take place.
Tolerance need for increasing amounts for desired effect
psychological dependence
repeats use to produce pleasure or avoid discomfort. Cravings for a drug.
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Intoxicationreversible substance-speific syndrome caused by substance ingestion. Maladaptive behavior
due to substances. symptoms not due to medical conditions or other mental disorder.
Withdrawal
substance-specific syndrome caused by cessation of prolonged and heavy use. substance specific syndrome causing
impairment in social, occupational, and other areas of functioning. Symptoms not due to medical condition or accounted for other
mental disorder. Withdrawal symptoms are generally the opposite of intoxication
symptoms.
Separation anxiety disorder
developmentally inappropriate and escessive anxiety concerning separation from home or
attachment figures. repeated nightmares, repeated somatic symptoms . Persistent worry,
onset prior to age 18
AutismQualitative impairment in social interaction
and communication. restricted repeetitive and stereotyped patterns of behavior interest and acctivities. Delays or abnormal fucntioning in
at least one of the following with onset prior to age 3: social interaction, language or symbolic
or imaginative play.
ADHD
Six or more symptoms of inattention hthat have persisted for at least 6 months to a degreee tha
is maladaptive and inconsistent with developmental level. six ormore sympotms of hyperactivity-impulsivity that have persisted
for at least 6 months to a degree that is maladaptive and inconsistent with
developmental level. symptoms that cause impairment were present before age 7.
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OPPOSITIONAL DEFIANT DISORDER
A pattern of negativistic , hostile, and defiant behavior. Loses temper, argues, annoys,
blames, easily annoyed
CONDUCT DISORDER
Repetitive and persistent pattern of behavior in which the basic rights of others, or societal
norms or rules, are violated: aggression toward people or animals, destruction of property,
deceitfulness or theft and serious violations of rules.
EATING DISORDERS
Bullemia and anorexia
BULEMIArecurrent episodes of binge eating with
recurrent inappropriate compesatory behaviors at least 2 times per week for 3 months. may be
purging or nonopurging type. May be of normal weight.
ANOREXIARefusal to maintain body weight at or above
85% of expected, intense fear of gaining weight, distrbance in self-perception, ammenorrhea for
at least 2 consecutive cycles. Restricting or binge/purge types.
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Cognitive disordersdementia or
delirium
dementiaonset is grudual of multiple cognitive deficits including memory loss and at least one of the
following aphasia, apraxia, agnosia and isturbed executive funtioning. Impairment in
social or occupational functioning.
dellirium
a disturbance in consciousness that is accompanied by a change in cognition that
cannot be better accounted for by a preexisting or evolving dementia. Acute confusion.
disturbance develops over a short period of time (usually hours to days) and tends to
fluctuate during the course of the day. May demonstrate psychomotor agitation or
depression.
Acculturation problem
The focus of clinical attention is a problem involving adjustment to a different culture
Cuture bound syndromes
mental disorders particular to certain cultures i.e. Amok, brain fag, ataque de nervios, evil eye.
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Head abnormalities associated to menal d/o
progressively severe headache
Nystagmus and mental disorders
associated with substance intoxication and brain lesions
oculogyric crisis and mental disorders
neuroleptic induced dystonia
high fever and sore throat and mental disorders
agranulocytosis, greatest risk with clozapine
Thyroid enlargement hypothyroidism
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respiratory findings of anxiety hyperventiolatin, asthma, SOB
Lamothrigine amy cause rash associated with risk of Stevens-Johnson syndrome as a side effect
Lithium may cause fine motor tremors
Gait and balance disturbances association with mental disorders
encaphalopathy, intoxicaitn and cerebellar injuries
disorientation, confusion and mental disorders
delirium, anticholinergic toxicity
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weakness and numbness may be caused by
cerebrovascular events
Anxiety may be a result ofdrug intoxication or withdrawal,
stimulants or seizures
ECG changes may result from tricyclics, anticholinergics, some antipsychotics (e.g Geodon)
orthostatic hypotension may be caused by
tryicyclics, antipsychotics and antihypertensives
Tachycardia may be caused by anxiety, stimulants, anorexia
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Hypertension may be caused byantipsychotics, MAOI-induced
hypertensive crisis
Bradycardia may be caused byBeta-blockers, anorexia or
parkinson's
Anxiety may be caused by
Anemia, angina, congestive heart failure, mitral valve prolapse, tachycardia
Gi distress and nausea may be caused lithium, SSRIs
Abnormal glucose metabolism may be caused by antipsychotics
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Hyperprolactinemia may be caused by
antipsychotic dopaminergic blockade
Depression may be caused by Hypothyroidism, chronically elevated cortisol (prolonged stress response)
Anxiety may be caused by
Hyperthyroidism, hypoglycemia, premenstrual syndrome
polyuria and polydipsia may be caused by
lithium adverse affect, renal disease or drugs that reduce renal clearance, may increase
serum conctration of drugs that are excreted by the kidneys
Sexual dysfunction may be caused by
side effect from antihypertensives, antidepressants, antihistamines or
antispamodics
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Body symmetry may be affected by
dystonias, CVAs, lesions
Dystonias muscle spasms as a rsult of Parkinsonism side effects
Types of abnormal movements:dyskinesis, dystonia,
bradykinesia, akathesia
Gait disturbances may be a result
Cerebellalr dysfunction such as seen with alcoholic encephalopathy, substance use
disorders
Swallowing problems may be a result of
Parkinson's disease, advanced dementia, antipsychotic-induced dystonias
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Axis IV primary support groupdeath, health problems, abuse,
dysfunction
Axis IV social environment categories
Death of friend, living alone, discrimination
Axis IV education categoriesIlliteracy, academic problems, inadequate
school environment, discord with teachers or fellow student
Axis IV occupation categories unemployment, job dissatisfaction, job change, discord with boss or coworkers
Axis IV Hoursing categoriesHomelessness, inadequate
housing, unsafe neighborhood
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Axis IV economicsextreme poverty,
inadquate financees, insufficient welfare support
Axis IV access to healht care Inadequate or unavailable care, inadequate transportation or heatlh insurance
GAF Global Assessment of Funcitoning
Purpose of GAF
useful for documenting baseline fucntioning and tracking progress with treatment
Outcome identification may include
functional, clinical, satisfaction and financial indicators
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Good outcomes may be defined as
measurable, specific, time-lined, realistic and evidence based
Maslow's HIerarchy of needs(from bottom to top of pyramid) biological and
physiological needs, safety needs, belongingness and love needds, safety needs,
ans self actualization
Maslow defined biological and physiological needs
air food shelter warmth sex sleep
Maslow defined safety needsprotection, security, order, law,
limits, stability, etc
Maslow's belongingness and love needs
family, affection, relationships, work group
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Maslow's esteem needsachievement, status,
responsibility and reputation
maslow's self actualization personal growth and fulfillment
Nursing interventions to reduce the likelihood of harm
reduce stimulation in the millieu, remove lethal material, separate from other patients, contract
for safety, constant one-on=one monitoring, maintain safety: observe for escalation, remain
calm: defuse with least restrictive means.
descalating communication strategies
speak in a calm, low voice, respect need for personal space, avoid intense eye contact,
acknowledge the patient's feelngs and reassure that staff are ther to help, communicate
expected behavior, communicate consequences of unacceptable behavior, give opportunity for
time out
Seclusions or restraints
may only be used where preventive and de-escalating strategies have failed. It requires a team response with a designated team leader, notify security if necessary, need to remove all
other patients form the area and when the leader expresses concern for the patient's safety
and behavior. Must document the behaviors, the attempts treatments, and the rationale for
terminating the intervention
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types of inforamtion used to evaluate individual's response to treatment
physical exam findings, mental status changes, laboratory tests results, scores on rating scales
Scales used to evaluate response to nursing care or medications
AIMS, Clinical institute withdrawal Assessment for Alcohol Withdrawal, The brief psychiatric
rating scale
AIMS scale useful for quantification of presence of EPS.
AREAS OF ASSESSMENT
AIMS
movements from not to severe while sitting, standing, walking, in the tongue, mouth, rapid
finger-thumb tappping, passive flexion and extension of the arms
CIWA-Ainstrument that helps assessment of alcohol
wthdrawal and serves as a guide in the treatment of the condition during
detoxification form alcohol
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time interval for CIWA-A scores assessment
every 30 minutes until the scores are reduced to ,10 for 3 consecutive assessments or for 4
hours
The Brief Psychiatric Rating Scale
An 18-item scale measuring positive symptoms, affective symptoms, and general
psychopathology. Can be rated on observation of the patient or may be used to monitor
outcomes of treatment
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