Transcript MH 3.1 Personality Disorders, Schizophrenia, Bipolar

Judith Wikel RN BSN MEd
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What is MOOD?
◦ An emotion is a feeling—a nonintellectual
responses. Emotions are reactions to various stimuli
based on individual points of view.
◦ Your book defines mood as a “prolonged emotional
state that influences one’s whole personality and
life functioning”.
◦ Think about MOOD! What type of
Mood are you in right now?
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Think back to your teenage years!
Were you in a good mood?
Please refer to page 226 and read the Emotions of
Adolescence section.
During our teenage years we are struggling with identity, how
to gain control over, and express our emotions.
Moods of adolescents commonly swing from feeling
vulnerable to dependent to knowing that they are the
smartest on in their family. (remember? I do!)
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Theories
◦ Psychoanalytical theories see mood disorders as
anger turned inward.
◦ Behaviorist or Behavioral theory view depression as
a group of learned responses.
◦ Social theorists consider depression the result of
faulty social interactions.
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Major Depressive Disorder
◦ When depression is severe and last more than 2
weeks, it is called a major depressive episode.
◦ Severe depression encompasses one’s whole
being—every realm of human functioning.
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Behaviors associated with severe depression.
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Paralysis to agitation
Feelings of worthlessness
Guilt
Despair expressed in every thought, every
movement, every activity
Physical appearance declines
Eating and sleeping become distasteful chores
Poor concentration
Inability to follow through on tasks lead to feelings
of powerlessness and helplessness.
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Major Depressive Disorder
◦ Persons with major depressive disorders have a
high mortality rate.
◦ Suicide is a risk with Major Depressive Disorder.
◦ Frequent assessment is required and safeguards
must be in place to prevent or reduce the risk of
suicide.
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Therapeutic Interventions
◦ Psychotherapies
◦ Electroconvulsive Therapy
◦ Antidepressants
Read and understand the nursing actions,
interventions, patient teaching, and when to notify
the physician related to therapies listed above.
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Daily moderate depression that last for more
than 2 years is called?
◦ DYSTHYMIC DISORDER
Hint – read and understand all
sections in book related to ppt
slides.
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Seasonal affective disorder
◦ Also known as winter depression
◦ Levels of mild and moderate depression are
experienced during long winter days.
What is the treatment for Seasonal affective disorder?
Read, Read, Read this section in Textbook!
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Tricyclic antidepressants
Monoamine oxidase inhibitors (MAOIs)
Selective serotonin reuptake inhibitors (SSRIs)
All other antidepressants
Mood-stabilizing drugs
◦ All above listed medications are discussed on pages
232 & 233 of text book. Don’t get crazy and try to
memorize all the drugs be familiar with the drug
classes and nursing actions and interventions.
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Focus on signs to report to physician.
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Bipolar Disorders
◦ The hallmark of a bipolar disorder is sudden and
dramatic shifts in emotional extremes. Persons with
bipolar disorders live in a world that seesaws
between the emotional extremes of mania and
depression.
◦ Thoughts, moods, and behaviors swing from
normal to grandiose, to depressed.
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Hypomania
◦ An exaggerated sense of cheerfulness, begins the
cycle. Soon cheerfulness progresses to the unstable
“high” of mania
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Behaviors related to Mania
◦ Read about Kevin in Case study 21-1 on page 229
and identify his behaviors related to Bipolar
disorder.
 Confidence
 Vigor
 Unstable
 Pressured
Think about how he would have looked, spoke,
smelled…
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Trust
◦ When needs for food, comfort, safety, and
socialization are consistently met, a sense of trust
and self-worth develops.
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Paranoid Personality Disorder
◦ Paranoia is a suspicious system of thinking that
includes delusions of persecutions and grandeur.
◦ Men are diagnosed more often than women with
Paranoia.
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Theories
◦ Biological theories
◦ Psychoanalytical theories
◦ Behavioral theories
◦ Sociocultural theories
Read and understand theories on pages 334 & 335.
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Psychopaths
◦ The hallmark of psychopaths is a lack of
conscience.
◦ Psychopaths use charm, manipulation, intimidation,
and violence to control others and satisfy their own
selfish needs.
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Narcissistic Personality Disorder
◦ Grandiose, no empathy, needs to be admired, seeks
attention.
◦ Look at me!
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Dependent Personality Disorder
◦ This disorder is associated with separation and
abandonment. Individuals with this problems carry
a deep fear of rejection, which expresses itself as
the need to be cared for.
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Schizotypal Personality Disorder
◦ Odd, strange, or peculiar actions.
◦ These individuals often have ideas of reference.
◦ Ideas of reference are incorrect perceptions of
causal evens as having great or significant meaning.
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Drugs Used to Treat Personality Disorders
◦ Relax! Read through Table 30-2 on page 340 and
pay close attention to side effects. No need to
memorize specific drugs to specific side effects.
◦ Understand these medications can cause
Extrapyramidal side effects (EPSEs).
◦ Understand and be ready to answer questions
related to EPSEs.
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Erratic Cluster
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Antisocial
Borderline
Histrionic
Narcissistic
Tip: Be able to identify the above listed Personality
Disorders as erratic.
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Psychosis
◦ The inability to recognize reality, relate to others, or
cope with life’s demands.
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Biological Theories
◦ Read the sections on all the different theories of
how Schizophrenia develops, and understand most
theorist believe different areas of the brain have
trouble communicating causing problems with the
brain and its activities.
◦ Page 346-347.
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Schizophrenia
◦ Subtypes
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Catatonic
Disorganized
Paranoid
Undifferentiated
Residual
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Akathisia
◦ An inability to sit still.
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Families of Schizophrenics need treat and
support.
◦ Read and understand
the nurse’s role in
assisting with support of
families.
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Use this PowerPoint presentation to guide you
along in studying for MH 3.1 exam.
As always, reading the chapters and
understanding the objectives is also
important.
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Question –
a 49y/o nursing instructor is found dancing
down her street at 3am, laughing and singing loudly. She is
wearing a clown's wig, a tank top, and men’s boxer shorts.
She has on bright red lipstick and above her lips as well as on
her cheeks. It is 40 degrees outside, and she is barefoot.
When the police arrive, she quickly jumps on the younger
officer and wraps her legs around his, attempting to kiss him.
She slaps his partner when the officer tries to get her off him.
She then offers him $2 million to leave her alone. What mood
disorder does this woman most likely have? What terms can
be used to describe the behaviors that she is displaying?
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Answer -
This individual is most likely having a manic
episode. She is awake in the middle of the night experiencing
insomnia and hyperactivity. She is initially euphoric, which is
shown by her singing, dancing, and laughing. She exhibits
increased motor activity. She is dressed inappropriately in a
bizarre outfit, with excessive makeup. She is uninhibited and
sexually driven. She becomes easily irrigated with the officer
with a brief period of anger. She has grandiose delusions of
being a millionaire.
Recognize her unstable effect and pressured speech…
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Question -
The chief feature of a paranoid personality
disorder is
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A) unwarranted suspicion and mistrust of others.
B) detachment from social relationships
C) cognitive and perceptual eccentricities.
D) impulsivity
◦ A-is the correct answer.
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Question -
Psychotherapy for clients with schizophrenia
is more difficult than for other clients because of:
◦ A) family problems associated with schizophrenia
◦ B) anxiety problems associated with schizophrenia
◦ C) communication problems associated with
schizophrenia
◦ D)mood problems associated with schizophrenia
◦ Answer is C! But, remember families of
schizophrenics need lots of education and support.
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Question -
Tardive dyskinesia involves involuntary muscle
movements that most often are associated with the:
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A) mouth, lips, and tongue
B) extremities
C) trunk
D) head
Answer – A – Hint: review extrapyramidal
movements.
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Again, remember the PowerPoint is a study
outline.
Read through assigned reading.
Answer objectives.
Study
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Do well on the test.
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Judith Wikel RN
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