Transcript MH-PP9-3-12
26 Hours Presented by: Mrs. Mary Elizabeth Pacuska, M.S.N. Attend Class Read assigned text material Participate in class projects and discussions Complete assigned projects Unit Examinations 50% Article Critique (Required) -2 points from final grade if not completed Complete Practice Questions Chapters 62, 63, 64,and 66 in Silvestri’s Comprehensive Review for NCLEX-PN Examination -5 points from final grade if not completed Self-awareness: ability to recognize nature of one’s own attitude, emotions, and behavior Do you have any prejudices about patients with psychiatric disorders? “successful performance of mental function, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity” State in which one is responsible, displays self awareness, is self directive, reasonably worry free, and can cope Function in society, accepted in a group, and generally satisfied with their lives. Self-governance Progress toward growth Tolerance of uncertainty Self-esteem Reality Orientation Mastery of environment Stress Management Inherited Characteristics (Biologic) Nurturing during childhood (Psychological) I.Q., self-concept, emotional development Life Circumstances(Socio-cultural) i.e. family stability, ethnicity and culture, economic level, religion, values, beliefs, abuse and poor parenting Def: A clinically significant behavioral or psychological syndrome experienced and marked by distress, disability. Not dealing with problems through rational decisions. All ages, races, gender and socioeconomic levels In US 48 Million/year (1in5), 20% of children 2nd leading cause of disability in US 15% have co-occurring substance abuse or Dual diagnosis Unknown Complex set of interactions involving genetic predisposition and environmental influences Mental Health, the ability to: be flexible be successful form close relationships make appropriate judgements solve problems cope with daily stresses have a positive sense of self Mental illness: Impairment of ability to think, feel, or make sound judgements Difficulty or inability to cope with reality or to form strong personal relationships Stress Anxiety Condition that develops from a threat to one’s well-being requiring one to adjust to environment May be acute (fight or flight) or chronic Physical Response (stress reaction)- arousal of autonomic nervous system A feeling of apprehension, uneasiness, or uncertainty in response to a real or perceived threat. Automatic and unconscious biologic response to a stressor Impossible to avoid, instinctive May be present whether there is danger or not External Physical environment (noise, lights, weather, crowds) Major life events ( death, divorce, loss of job, marriage) Work related (rules, deadlines, production pressures, gossip) Social (bossy or aggressive individuals, strained friendships, marital affairs) Everyday life (schedules, household duties, family conflict) Internal Personality traits (perfectionist, workaholic, worrier, loner) Negative self talk (pessimism, irrational thinking, selfcriticism) Thinking snags (all or none approach, unrealistic and inflexible expectations) Assess situation and see if it real is what it seems to be Adaptation- successful management of stress Adaptive coping- using rational management of stress and anxiety Palliative coping- solution which temporarily relieves anxiety, problem still exists Maladaptive coping- unsuccessful attempts made to decrease anxiety Dysfunctional coping- not attempting to reduce anxiety or solve problem Positive self talk Assertiveness training Problem solving skills Communication skills Relaxation techniques meditation Support systems Practical attitude Sense of humor Self-care Faith in spiritual power and in self Differs from stress and anxietydisorganization and disarray occur as coping strategies fail or unavailable Inability to control situation or function Seeks a way out Panic- feels helpless and lost Needs intervention Threat or stressor increases anxiety and defenses begin Defense strategies fal and threat continues, functioning becomes disorganized, autonomic responses engage Temporary resolution – allows daily functioning Eventual- overwhelming anxiety causing serious disorganization of mental defenses, fear, confusion, violence, or suicidal behaviors. Deals with present situation and resolution of immediate issue Early intervention vital Decrease anxiety to tolerable level Need to define problem Determine available support Set realistic goals If suicidal- protective measures Grief- emotional process of coping with loss Feel empty, hopeless and detached from meaning in life Loss can be actual or perceived change in status of one’s relationship to a valued object or person (person, pet, home, job, etc..) Grief- feeling of profound sadness and despondency Mourning is personal (family and cultural influence) A Process- learning to accept, grow Give right to right to grieve in whatever time frame needed Anticipatory Conventional- bereavement (adapting to loss) Dysfunctional – failure to complete process and cope successfully Life becomes meaningless, continued longing for what is lost- chronic sorrow Contributing factors: suicide, homicide, missing persons, multiple losses, ambivalent feelings, unresolved grief from previous loss, guilt with regard to circumstances, survivor guilt, feelings of worthlessness, marked decrease in functioning, delusional thinking Denial Anger Bargaining Depression Acceptance If intense- clinical treatment Need to face reality of our own death Respect of clients way of grieving Avoid reassuring clichés Open ended statements Determine patients support systems Be open and honest with feelings Reassure normalcy Support groups Journaling Anger- emotion triggered in response to threats, insulting situations or anything that seriously hampers the intended actions of individual- instinctive Violence- intense feeling toward an individual starts with verbal or physical threats and assaults Abuse- the destructive action Often learned response Managing anger- we have ability to control Need to control and separate physical from emotional responsephysical activity Learn appropriate assertion techniques Use “I” statements- own our feelings and express without attacking Talking to others Forgiveness “an enduring pattern of perceiving, relating to, and thinking about oneself and the environment that is demonstrated in our social and interpersonal interrelationships.” Personality traits- unique Genetic transmission of personality traits from both parents, family patterns, society and environmental influences Psyche made up of three components: Conscious- present awareness Preconscious- below current awareness, easily retrieved Unconscious- past experiences and related emotions- contributes to emotional discomfort and disturbances Personality has three aspects: ID EGO SUPEREGO MUST BE IN BALANCE FOR REASONABLE MENTAL HEALTH Pleasure principle:“I want what I want when I want it.” Present at birth Functions in the irrational and emotional part of mind. Basic needs and feelings: hunger, aggression, sex, protection, and warmth ID too strong: self gratification and uncaring to others Rational part of mind, begins development 6-8 months, well developed by 2 years Reality principle: Grows out of knowing can’t always get what we want. Ego strength refers to how well ego copes with ID and Superego Sensations, feelings, adjustments, solutions and defenses formed here Too strong: Extremely rational, cold, boring, distant Last part of mind to develop, starts at 3-4 years, well developed by 10-11. Controls, inhibits, and regulates impulses and socially unacceptable instinctive urges Moral part of mind; parental & societal values Strives for perfection, causes anxiety Conscience Operates at conscious and unconscious level Too Strong: guilty, insufferable saintly personality Constant need for ego to reconcile conflicts between id and superego causes anxiety. Anxiety cases need to preserve sense of self. For ego to remain in control automatic psychological processes (ego defense mechanisms) are mobilized “Unconscious, protective barriers used to manage instinct and affect in stressful situations.” Sigmund Freud Therapeutic used in relation to problem solving- short term allowing us to work to realistic outcome or solution. Maladaptive DM lead to distortion of reality and selfdeception regulating the response to protect oneself Compensation Conversion Denial Displacement Dissociation Fantasy Humor Introjection Projection Rationalization Reaction-formation Regression Repression Sublimation Suppression Undoing History: “lunatics”, “the insane’, Locked in cells, beaten, starved. Late 1700’s- psychiatry 19th century- beginning of change- recognized as an illness and treatment questioned 20th century- psychiatric nursing added to all curriculums 1946- National Mental Health Act- funding for research 1956- 1st antipsychotic drugs- put end to lobotmies 1950-1980 institutionalized dropped from 500,000 to less than 100,000 Improved, more compassionate care Legislation for research, development of patient rights Stigma and lack of social awareness Access to Care: cultural disparity, cultural incompetence among mental health providers Cost of care- managed care Client rights: “Bill of Rights”, appropriate care, Informed consent, confidentiality, Use of Seclusion and restraints Nurse Accountability Inpatient: Voluntary and involuntary Outpatient- private, community, support groups, marriage and family counseling Nonpsychiatric facilities- holistic Dual diagnosis treatment facilities Correctional Facilities- antisocial thoughts and behaviors, loss of sense of self, denial that situation is due to their own choices, aggressive behaviors Therapeutic Milieu Treatment Team: psychiatrist, psychologist, psychiatric nurse, mental health technician, social worker, licensed professional counselor, case manager, religious counselor, recreation specialist, Occupational therapist, dietician Pharmacologic treatment Provide holistic care Set appropriate limits and boundaries Trust Professionalism Mutual Respect Caring, empathy, and genuineness Therapeutic communication Judgmental attitudes Excessive Probing Lack of Self Awareness Active Listening Goal directed Appropriate Flexibility and feedback Assertiveness Non-Confrontational Self Disclosure Clarifying and validating Focusing and refocusing Giving information Presenting reality Listening Neutral responses Silence Providing acknowledgement and feedback Providing nonverbal encouragement Reflecting Restating Sharing perceptions Summarizing Using broad and openended questions Asking “Why?” Being defensive Changing the subject Giving advice, disapproval or approval Stereotypical comments Making value judgments Giving false reassurance 1. “Have you shared your feelings with your family?” 2. “I think we should talk more about your anger with your family.” 3. “You’re feeling angry that your family continues to hope for you to be cured.” 4. “Well it sounds like you’re pretty pessimistic. After all, years ago people died of pneumonia.” 1. “I don’t see you as a failure.” 2. “You have everything to live for.” 3. “Feeling like this is all part of being ill.” 4 “You’ve been feeling like a failure for a while?” 1. “I hate being asked these kinds of questions too.” 2. “I am a nurse and as such I’ll have you know that all information is kept confidential.” 3. “I know that some of these questions are difficult for you, but as a nurse, I must legally respect your confidentiality.” “This is difficult for you to speak about, but I am trying to perform a complete data collection and I need this information.” 1.”If you didn’t want our care, why did you come here?” 2. “ Why are you being so difficult? I only want to help you.” 3. ”Sounds like you’re feeling pretty troubled by all of us. Let’s work together so you can do everything for yourself as you request.” 4. ”I will respect your feelings. I’ll just leave this cup for you to collect your urine in. After breakfast, I will take more blood from you.” Axis I: clinical disorders and delirium,dementia, mental disorders as the result of a general medical condition Axis II: personality disorders/mental retardation Axis III: General medical conditions Axis IV: Psychosocial and environmental problems Axis V: global assessment of functioning (GAF) Coded from 0-100 Psychological, social, and occupational functioning Axis I: 300.4 Dysthymic Disorder 315.00 Reading Disorder Axis II: No Diagnosis Axis III: 382.9 Otitis Media Axis IV: Victim of Child Neglect Axis V: GAF= 53 (current) Psychopharmacology Spirituality Complementary and Alternative Therapies Milieu Therapy Interpersonal Therapy Behavior Electroconvulsive Therapy Antipsychotics Antianxiety Agents Antidepressants Stimulants Mood Stabilizers Anticonvulsants Antiparkinson Agents Acupressure/acu puncture Aromatherapy Homeopathy Hypnotherapy Imagery Biofeedback Herbs Meditation Reiki Reflexology Art/Music Therapy Pet Therapy Yoga Goals: Decrease patient’s emotional discomfort Increase patient’s social functioning Increase the ability of the patient to behave or perform in a manner appropriate to the situation. Milieu- the physical and social environment in which an individual is receiving treatment. Safe environment Treatment team Community meetings, activity groups, physical exercise One-to-one relationship with staff Establish a contract and role clarification Supportive therapy- reinforce coping mech Re-educative therapy: learn new ways of perceiving and behaving Explores alternatives, reality therapy, cognitive restructuring and behavior modification and development of coping skills Reconstructive therapy Making major life changes with psychotherapy, may take years Principle: how an individual feels and behaves is determined by way in which they think about the world and their place in it. Based on attitudes and assumptions from previous experiences Correct dysfunctional beliefs Decreased isolation Opportunities to help others Development of coping skills Decreased transference to therapist Open groups: no boundaries Closed groups: set rules Couple Therapy Family Therapy Procedure: uses electric current to induce seizures Side Effects: headache, disorientation, memory disturbance Effects are cumulative Postictal Agitation Informed Consent Biologic Psychological Cultural Spiritual Social needs Specific data regarding a particular problem Used in crisis Assess mood, affect and behavior Brief Psychiatric Rating Scale (BPRS) Drug Attitude Inventory (DAI-10) Hamilton Rating Scale for Depression (HRSD) Appearance Affect, Emotional State Behavior, Attitude, Coping patterns Communication and Social Skills Content of Thought Orientation Memory Intellectual ability Insight Spirituality Sexuality Neurovegitative Changes Medical Issues Physical characteristics Peculiarity of dress Cleanliness Use of cosmetics Outward manifestation of one’s emotions Blunted Flat Inappropriate Labile Strange, threatening, suicidal, abusive Unusual mannerisms Friendly, fearful, angry , aggressive Overactive or underactive Ask how they normally cope with problems Impaired Communication: Blocking – sudden stoppage Circumstatiality- unnecessary detail Flight of Ideas- ideas fragmented Perseveration- same verbal response Verbigeration- meaningless repetition of specific words or phrases Neologism- self invented Mutism- refusal to speak Delusions: fixed false beliefs Hallucinations: sensory perceptions without actual stimuli Depersonalization: feeling of unreality, out of body sensation Obsessions: insistent thoughts Compulsions: insistent, repetitive, intrusive, and unwanted urges to perform acts Person, place, time Where they are, who they are, date?” Levels of orientation Ability to recall past experiences Recent memory: recall immediate past-two weeks Long-term memory: recall remote past Name past presidents Simple math problems Evaluate abstract and concrete thinking Self-understanding Do they consider themselves ill? Do they understand what’s happening? Clients beliefs, culture and religious culture Are beliefs and values helping or hindering client? Concerns about sexual identity, activity and function Does client prefer male or female clinician to discuss concerns? Changes in psychophysiologic functions: sleep patterns, eating patterns, energy levels, sexual functioning, bowel functioning Cardiovascular disease Stroke Parkinson’s Can impede medical treatment Nick Vujicic, No Arms, No Legs, No Worries! Part 1 Stress produces anxiety Anxiety: “the uncomfortable feeling of dread that is a response to extreme or prolonged periods of stress.” Mild, moderate, severe, or panic Free-floating anxiety Signal anxiety Generalized Anxiety Disorder (GAD) Panic disorder Phobia Obsessive-Compulsive Disorder Post-traumatic Stress Disorder (PTSD) DSM: related to 2 or more things and last 6 months Symptoms:Most show 6 or more to be considered anxious Behaviors: restlessness, fatigue, feeling on edge Symptoms: muscle aches shakes palpitations dry mouth nausea vomiting hot flashes chills polyuria difficulty swallowing A state of extreme fear that cannot be controlled With or without agoraphobia Episodes present quickly DSM: at least 4 symptoms Symptoms: Fear (usually of dying, losing control, or going crazy) Dissociation (feeling that it’s happening to someone else) Nausea Diaphoresis Chest pain Increased pulse Shaking Unsteadiness Most common Phobia: irrational fear 700 different phobias Subcategories: agoraphobia social phobia simple phobia Obsession: repetitive thought, urge or emotion Compulsion: repetitive act that may appear purposeful Ensure basic needs are met Identify precipitating events Show empathy Allow compulsive behaviors as long as not a danger to patient or others Implement distracters of behaviors Reinforce non-ritualistic behaviors Establish written contract to decrease frequency http://www.usanetwork.com/series/monk/w ebisodes/index.html Response to an unexpected emotional or physical trauma that could not be controlled. DSM: must have symptoms for at least one month Symptoms: Flashbacks Social withdrawal feelings of low selfesteem Changes in relationships Irritability, anger, outbursts Depression Chemical dependency Recognize anxiety Establish trust Protect client Avoid anxiety provoking situations Provide activities and creative outlets Promote relaxation Psychopharmacol ogy: Anti-anxiety : benzdiazepines, or Atarax, Catapres, Zoloft Antidepressants: MAOI’s or lithium carbonate Counseling individualized: individual therapy, group, and systematic desensitization Hypnosis, imagery relaxation exercises, biofeedback Librium, valium, Serax, Tranxene, Ativan, Xanax tranquilizing, sedation, numb emotions Adverse effects: ataxia, slurred speech, rebound phenomenon, seizures Lethal with alcohol Overdose potential Antianxiety (anxiolytics): treat daytime anxiety Hypnotics: treat insomnia Maintain a calm milieu Maintain open communication Observe for signs of suicidal thoughts Document any changes in behavior Encourage activities Disorders in which people experience extreme changes in mood (emotions) and affect (outward expression of mood). Affects all ages, ethnic groups, and socioeconomic groups Twice as many woman as men Sadness becomes depression when it lasts 2 years or more. Symptoms: Sad mood Loss of pleasure in usually pleasurable things No hallucinations or delusions and four of the following for at least two consecutive weeks: weight loss or gain sleep pattern disturbance increased fatigue increased agitation increase or decrease in normal activity feelings of guilt or worthlessness decreased ability to think, remember or concentrate suicidal thoughts Assess for suicidal ideations Provide safety Assist with ADL’s Do not push decision making Monitor sleep and nutrition Focus on strengths Respond to anger therapeutically 2 Million Americans Condition in which both extreme mania (extreme elation or agitation) and extreme depression exist Tend to cycle Change from depression to manic phase drastic and obvious Persistent sad, anxious or empty mood Feelings of hopelessness or pessimism Feelings of guilt, worthlessness, or hopelessness Loss of interest or pleasure in ordinary activities, including sex Decreased energy, a feeling of fatigue or being slowed down Difficulty concentrating, remembering, making decisions Restlessness or irritability Sleep disturbances Loss of appetite and weight loss or weight gain Chronic pain or other persistent bodily symptoms that are not caused by physical disease Thoughts of death or suicide, suicide attempts Excessive highs Sustained period of different than normal behavior Increased energy, activity, restlessness, racing thoughts, and rapid talking. Decreased need for sleep Unrealistic beliefs in one’s abilities and powers Extreme irritability and distractibility Uncharacteristically poor judgment Increased sexual drive Abuse of drugs Obnoxious, provocative, or intrusive behavior Denial that anything is wrong Remove hazards Assess client for fatigue Provide rest periods Monitor sleep patterns Private room Encourage client to express feelings Use calm, slow interactions Help client focus Ignore or distract from grandiose thinking Present reality to client Do not argue with client Reduce stimuli Supervise clothing Avoid competitive games President - Abraham LINCOLN Musician - Adam ANT Actor - Ben STILLER Actor - Burgess MEREDITH Astronaut - Buzz ALDRIN Author - Charles DICKENS Nurse - Florence NIGHTINGALE Director - Francis Ford COPPOLA Boxer - Frank BRUNO Scientist - Isaac NEWTON Actor - Jean Claude VAN DAMME Musician - Jimi HENDRIX Actor - Linda HAMILTON Composer - Ludwig Van BEETHOVEN Prime Minister - Winston CHURCHILL Music Producer - Phil SPECTOR Director - Tim BURTON Actor - Richard DREYFUSS Musician - Ray DAVIES Model - Sophie ANDERTON Musician – STING Musician - Kurt COBAIN Actor - Ned BEATTY Musician - Ozzy OSBOURNE Actor - Jim CAREY Actor - Robert DOWNEY JR Actor - Robin WILLIAMS Actor - Spike MILLIGAN Actor - Stephen FRY Artist - Vincent VAN GOGH Similar to mania but not as severe Hard to describe Need to assess extreme of mood changes, length of time in each mood, frequency of cycling, and other symptoms. Generally over 45 years Women more than men “Empty nest syndrome” Symptoms more somatic Anorexia and sleep disturbances commen Hypochondriasis No cure or relief of depression Lithium- monitor levels Valproate, Zyprexa, Tegretaol (acute manic symptoms) Antidepressants Psychotherapy Electroconvulsive therapy (ECT) Patience, patience, patience!!!! Monitor lithium level Honesty Consistency Activity Nutrition Communication Monitor for suicidal ideation and implement suicide precautions A maladaptive behavior that results from ineffective personality development. Affects the way one interprets and fits in the world we live in. Stress exacerbates manifestations May deteriorate to psychotic state Seldom seen for treatment Originate in early childhood Due to overuse of defense mechanisms Poor impulse control Feelings of abandonment and depression Rage, guilt, fear and emptiness Impaired judgment Projects own feelings on to others Rigid and inflexible Distorted self-perception; self-hate or selfidealization Concrete or diffuse thinking Cluster A (odd-eccentric) Schizoid Schizotypal Paranoid Cluster B (overemotional, erratic types) Histrionic Narcissistic Borderline Antisocial Cluster C (anxious, fearful types) Obsessive-compulsive Avoidant Dependent Don’t want involvement in interpersonal or social relationships Due to ineffective and unemotional parenting Described as“loners” Very engrossed in books Intellectual and successful in careers Appear shy and introverted Respond in very serious, factual manner that is pleasant but not warm or inviting Displays abnormal, highly unusual thoughts, perceptions, speech and behavior Suspicious Paranoid Magical thinking Odd thinking and speech Relationship deficits Suspiciousness and mistrust May seem “normal”, but feel treated unfairly Prone to filing lawsuits Difficulty maintaining eye contact Take themselves very seriously Cold and calculating in relationships Take comments and events very seriously Don’t confuse with Paranoid Schizophrenia: no hallucinations or delusions Familial Pervasive and excessive emotionality and attention seeking behavior Behavior often inappropriate Overly concerned with impressing people Excessively upset with criticism Histrionic Almost opposite of schizoid Exaggerated impression of themselves self-centered and self-important Friends chosen according to how good they make narcissist feel Seem to take criticism lightly; actually repressing deep feelings of anger and resentment PAMan http://wps.prenhall.com/chet_kneisl_contem porary_1/0,7601,680172-,00.utf8.htm Causes the greatest amount of trouble for society Requires immediate self-gratification Often in trouble with the law Difficulty handling frustration and anger Seldom feel affection, loyalty, remorse, or guilt High risk for substance abuse Family with few or inconsistent rules, no guidelines for appropriate social behavior Inability to feel or show affection Usually gregarious, intelligent and likable Very serious maladaptive behavior: serial killers Manipulative in treatment Common, more frequent in females Behavioral responses are unpredictable Moods unstable, uncertain of sexual preference or self-concept Substance abuse, suicidal tendencies Anhedonia Feel bored and empty Etiology may be ineffective nurturing by parents Conflicts between love/hate, abandonment/domination, dependency/detachment Borderline Difficulty expressing warm and tender emotions Perfectionist, stubborn and controlling Inflexible with details and rules Miserly Hoarders Ritualistic Characterized by social withdrawal Sensitive to potential rejection Feelings of inadequacy Hypersensitive to reactions of others Lack of support system DSM: A pervasive pattern of dependent and submissive behavior.” Want others to make decisions for them Feel inferior, suggestible, feelings of selfdoubt Avoid responsibility Try to satisfy and please others Inordinate amount of fear Wizard of Oz Often don’t perceive they have a problem, rarely hospitalized Often leave treatment when confronted with problem Psychotherapy, individual and group, or cognitive Therapy long; stop and start Most will not improve Medications; Prozac Maintain safety Allow client to make choices Encourage to discuss feelings not act out Discuss expectations Assist with anger management Trust Limit setting Communication Role modeling Group of disorders characterized by psychotic Disturbances in affect, mood, behavior and thought Begins about 16-25 years of age 3 Million Americans Thought disorder Quietness Withdrawal Grades drop Change in personality Change in relationships Chronic, intermittent, acute psychotic episodes,progressive downhill course Relapse rate as high as 60% in first 2 years 12 year follow-up: 78% deterioration in functioning, 3% attempt suicide Not curable High incidence in Homeless At least two of the following present for a significant portion of time during a one month period: Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior Negative symptoms Social/Occupational dysfunction Positive Symptoms Hallucinations Delusions Loose Associations Combativeness Hostility Paranoia Negative Symptoms Social & emotional withdrawal Apathy Flat affect Poor insight/judgment Amotivation Mutism or catatonia Circumstaniality Neologisms Confabulation Thought blocking Flight of ideas Word Salad Looseness of association Delusions A false fixed belief Types; Grandeur, jealousy and persecution Hallucinations A sense perception with no external stimuli Types: auditory, gustatory, olfactory, tactile, and visual Clang association Echolalia Mutism Neologism Pressured speech Verbigeration Word salad Unusual suspiciousness (main symptom) and fear Hostile and aggressive behavior Also, catatonia, incongruent affect, and loose associations in speech Delusions of persecution and grandeur Voices common Unusual behavior and facial contortions Speech bizarre and incoherent “word salad” Inappropriate emotions Disorganized auditory hallucinations Most severe, poor prognosis Less frequent Disturbed motor activity, vacillate between extreme rigidity and agitation Rigid (catatonic stupor) not move for hours or days Very suggestible Echolalia Echoprexia http://www.youtube.com/watch?v=kvdw4b7t C-8&feature=related Establish nurse-patient relationship Stress situational reality Accept the patient as he or she is Do not foster a dependency relationship Avoid stressful situations Use only therapeutic communication Hay Lo Soul, Good To Too Two 2 here from you. I thought things got so good for you that you just 4 GOT WHAT you could of remembered or could remember what you don't forgit. Where is your mind—must you watch TV all day to go to night school to be a D.A. JUST to forgit I didn't take your money when I had ALL your credit cards locked up in [continued on second page] my dreams—Rife with Con Va Lution due 2 subjewgashen. My spelling got better—see when you go to school you learn to spell—oh well I'm just playing clown words to say I didn't forgit Hellbilly—Bill we always had good days + I'm glad your gonna be a D.A. Be one who works for justice + not one who wants to win win + and don't care if people didn't do rong— anyway be as good as you are when you git a job + don't let the job make you bad you make the JOB good. Easy Charles Manson Letter Marginalia: You even typing now—Cool. A HILLBILLY that can type—FAR OUT. I know if you payed what you owe you would be brok brok in like broak ones a panter brock + that they is a crook Physical symptoms with no known organic cause Rooted in unconscious mechanisms that develop to deny, repress, and displace anxiety Dependent, emotionally needy, and frustrated, want to punish relatives Conversion disorder Hypochondriasis Dysmorphophobia Somatization disorder Somatoform pain disorder Due to overuse of conversion reaction Paralysis and blindness Very real to the patient Symptom allows person to avoid unacceptable situation or extreme anxiety; dysfunction is relieving the anxiety (primary gain), (secondary gain) extra benefits from staying ill. Malingering: conscious effort to avoid unpleasant situations, faking “Professional patients” Worried about getting “it” Intense fear of becoming seriously ill Concerned they are not being taken seriously Onset generally on teens through 30’s Excessive preoccupation with an imagined defect in one’s physical appearance Usually facial Obsessive/compulsive behaviors Onset about age 30 DSM: 35 symptoms Must have 13 of the 35 symptoms Frequent symptoms: free-floating anxiety, emotional turmoil expressed in physical symptoms, usually in loss of physical function, pain that changes location frequently, depression, suicidal ideation. Any age, mostly in adolescence and early adulthood women more than men Possible hormonal interaction with neurochemicals Level of pain not consistent with physical problem, does not change location Psychalgia: emotional pain that manifests as physical pain Assess for physical problems Discourage discussion about physical symptoms by not responding with positive reinforcement Allow specific time period for client to discuss physical complaints Help client to relate feelings and conflicts with physical symptoms Assure client physical causes have been ruled out Relaxation techniques Diversional activities Often medical unit not psychiatric unit Individualized Stress management Behavior modification Medications used sparingly Communication skills: honesty and gaining trust Therapy Support Transsexualism Exhibitionism Fetishism Pedophilia Sexual masochism Sexual sadism Voyeurism Zoophilia Frotteurism Anorexia Nervosa Bulimia Nervosa Morbid Obesity “aversion to food” Usually in adolescent girls Negative feelings towards their mothers Symptoms: Excessive weight loss Refusal to maintain normal weight Intense fear of gaining weight Obsessive thoughts Excessive exercise Shy, introvert Perfectionist Distorted body image Amenorrhea Insomnia “binge eating” Followed by forced vomiting Adolescence Binge-Purge Extreme dieting Use and abuse of laxatives Diuretics Obsession with food and eating Extreme sensitivity to body shape and weight Poor self-concept Suicidal ideation Impulsiveness Depression, guilt, worthlessness Erosion of teeth enamel Obesity: body weight greater than 15% of ideal body weight Morbid obesity: More than 100 pounds over ideal weight Fixated at oral stage Electrolyte imbalances Cardiac irregularities Edema and dehydration Gastrointestinal problems Act of killing oneself purposely. 39% of people over 65 attempt suicide Third leading cause of death in adolescents 250,000 suicide attempts annually, 30,00 succeed Depression major cause Men more violent; guns, hangings, cars, women; overdose Noticeable improvement in mood Giving away personal items Talking about death or has preoccupation Difficulty sleeping Not a mental illness Many homeless have threat to mental health Mentally ill 50% of homeless 25-50% have a psychosis 33-50% are alcoholics Schizophrenia major problem Very rare Ideas split off from personality and become buried in unconscious Severe result of overuse of DM Anxiety or severe psychological trauma Develop new personality to separate from their severe emotional pain Psychogenic amnesia: sudden inability to remember personal information due to physical or psychological trauma Psychogenic Fugue: more dramatic, leave town, new identity. Does not appear confused or disoriented. Depersonalization Disorder: Usually under 40. Oriented to person, place and time, but perception of reality has changed. “Floating” or “Out of body” 2 or more completely distinct personalities Can be different Monitor frequently Safety Medications Communication Contract Crisis Intervention