Psych----C.

Dodson stand one foot over the other legal involuntary holds, HIPPA, pt rights---have right to refuse treatment (meds), issue of labeling people, stigma----ex. say person has a schizophrenia not that are schizophrenic; y y y y y y y y y y y y y y y labeling can lead to depersonalization marginalizing them discrimination increase fear treatment changes decrease seeking help there is no equaty-insurance is very different for types of illnesses no beds sometimes get treatment in ER and let go with no follow u; get lucky if gets psych med before leaving think how long they have been suffering and how long it led to poor treatment we are numb to tragedy and to violence watch for sudden change in patient s attitude very positive-can mean they have a plan and they made a decision parents may be afraid to seek help for a child as they afraid child will be labeled exhausting to have someone who has mental illness some insurances require certain conditions to meet the criteria such as no antidepressants ever prescribed-can be the reason why some people may not seek for help in order to get insurance or to keep insurance

milieu---the environment as a nurse redirect that pt to a safest area ; has to be managed by the staff want to role model and help manage the environment group therapy important pt tr s: y y y y y y y y diet exercise sleep creative outlet yoga, meditation talk therapy---talk to someone support system stress interacts with all neurotransmitters and creates imbalance

med is the last resort---when really depressed, suicidal

delusions fixed false belief illusion-misinterpret something that s real hallucinations-auditory, visual, gustatory, olfactory psychosis-loss of touch w/reality y y s/s:hallucinations, delusions, illusions psychotic features can be seen in schizophrenia, bi-polar mania, depressions, substance withdrawl, post-partum depression, brief psychotic episode can get med and might go away and never come back

if pt agitated short sentences, keep distance, same tone of voice, easy commands, not okay to touch as can be misinterpreted aware of pt s body language: y y y culture shame fear

is a reason to be afraid: can be unpredictable, paranoid, afraid of everything, sense of persecution, can be grandiose-->work for CIA;can be impulsive, increase for violence, voices r/t fear/hallucinations triggering events for schizophrenia:person w/schizophrenia has high dopamine y y y y y y y y y deeper sulci larger ventricles age at diagnoses genetic birth-have baby in winter months, baby more likely later to develop schezophrenia viruses substance abuse neurotransmitters theory:dopamine too much-agitated, too little in prefrontal cortex-can t concentrate; parkinsons not enough dopamine amphetamine users- end up w/ s/s of schizophrenia

events that trigger s/s of schizophrenia for boys: y y y leaving home going to college military

for women happens later: pregnant, getting married-->stress-->hormones make change in the brain positive s/s of schizophrenia:observed, added y y y y y y y hallucinations inappropriate aspect delusions illusions bizarre behavior thinking disordered/disorganized dopamine

negative s/s:look like depressed y y y flat affect apathy, amotivation, attention deficit, powerty of speech

cognitive: y y y y mood: y y y suicide depression anxiety hopeless decision making impaired ability to reason problem solving organization

feel good-I don t need meds if can get back on meds in 2-3 weeks-preserve brain cells can start decrease meds to see if still be stable to recognize if it is a an illness or just an episode

y y

need to monitor closely to see effects of drugs and progression combination of positive s/s needed to be diagnosed w/schizophrenia

Monday, January 23, 2012 y y y Schizoeffective disorder schizophreniphorm s/s last >1 months , <6 months schizophrenia + s/s: o halluc o paranoia o illusions o delusions o disorganized thinking - s/s o flat o anhedonic o amotivation

Phases of schizophrenia: y y y acute phase-hospitalization stabilization supportive, keep them taking medications maintenance phase-taking meds

cognitive mood comorbid disorders SIsigarette smoking, carb craving is common Atypical antipsychotics---SE: weight gain, diabetes, metabolic syndrome--->mainly from eating sugar Dual diagnoses---two psych disorders, one psychiatric and another is substance abuse causes of schizophrenia: PTSD, stress, life events, Nursing Dg: Safety---boundaries, distance, body position-stay at 45 degree angle to someone, keep one foot in front of the other, repeat yourself, short sentences---5 words or less, change the topics that agitating, no touching

y y y y y y y y y y y y y y

Echopraxia repeat a move of another person echolalia repeat words of another catatonic schezoph waxy flexibility -->hold body position akathesia- fidgeting, motor restlessness , beyond pacing dyskinesia- odd little ticks tangential- they go in a tengine, but never come back to what you asked circumstantial speech big circle take on really long ride before they bring you back to what the question was neologism- new words that have meaning to them flight of ideas jump from one thing to the next to the next lockin, block of thought-stop all of the sudden and can t continue because train of thought was interrupted and they can t get back confabulation-story that is not true, make up the answer perseverate-stuck on one topic word salad- words in different order that makes no sense clang association-making sentences that all rhyme

Depression: Observe in pt: y y y y y y y y y y y y y y y y y y y quiet lack of eye contact sad easily agitated lack of hygiene slumped posture frequent bouts of weeping insomnia or sleeping too much hopelessness poor eating overeating or undereating flat affect anergia odor---don t wash hair, stay in pj s all day, keep dark at home, symptoms: lack of energy feel anxious constipations sleeping too much(vegetative depression)or not sleeping diet: eat a lot or eat a little no sex drive

y y

feel hopeless feel suicidal --------------------------mania severe major depression<------------------------------------------------------>mania ----------------------euthamia normal

--------------------dysthymia --- ------------------------severe depression

If have one episode of hypomania or mania---you have bipolar mania: y y y y y y y y y y y y y euphoria---or agitated and angry decreased sleep labile hypersexuality--->STD, pregnant impaired judgement pressured speech grandiose high energy do thing in manic state and may have no memory dangerous/impaired decision making out of normal schedule stressors--->anxious, excited, no sleep can ruin their credit and empty their bank account, loose house, compromise marriage

HAD FULL BLOWN MANIA, loose touch w/reality, or have been hospitalized bipolar I CyCLIC: y one episode of mania and then mostly depression

zyprexa atypical antipsychotic serotonin transporter genes can be long or short if long longhave more resilience gainst mental illness and depression, long short maybe okay or not, short short not so good amygdala-emotional memories are stored amygdala is hypersensitive and reactive short short serotonin genes-PTSD, depression, -->MORE LIKELY TO HAVE PROBLEMS y y y y y HYPOMANIA-s/s less severe than mania dysthymia-feeling of sadness, low level cyclothymia between depression and dysthimia rapid cycling 4 x year between depression and hypomania, can cycle in a day mixed state-depression and mania at the same time

some antipsychotics work really well w/severe depression nursing Dg: safety for others and for themselves high risk for suicide (15-20% higher chance), don t eat --give finger food, cup that can take with them -decrease stimuli if agitated -medication-->to get them out of that manic phase-----very important -take possessions away in the hospital so they don t give it away bipolar III-because induced by meds -STEROIDS can cause psychosis, sometimes if take off steroids and psychosis can go away Pt treatment----> y y y y y y y y y y sleep exercise stress social support meds-can help jump start vit D look at thyroid levels can remove s/s of depression fish oil creative talk therapy

y y

talk therapy, meds and exercise-->best combo mindfulness therapy---meditating, bringing intentional of what they think o positive psychology o teach them to think of themselves in a different way o processing

depressive brain----decreased metabolism, decreased blood flow---brain looks blue of scan women in exercise group did a lot better, brain looked better when put on antidepressants first risk is observe for suicide because all of sudden now they have energy to do things abut still depressed wine and benzodiazepine --->not a good combination Monday, January 30, 2012 Anticholinergics because on antipsychotics : -seroquel can give extrapyramidal side effects

SNRIs : y y y y effexor is hard to get off of it discontinuation syndrome to taper down open capsule and sprinkle some med out every other day less adherent---is better term to use for non-copliant

bipolar 1-mania and major depression, can become psychotic (hallucinations, delusions) ---lithium is a gold standard if all other meds didn t work bipolar 2-hypomania mania: y y y y y y y pressured speech talk really fast loud hypersexual risky behaviors don t sleep poor decisions impulsive give money away, think can fly

y y y

changes clothes euphoric can be angry and agitated

Bulimia: causes: y y y y y y y y y y y y self-esteem media peer pressure control issues hx of abuse neurotransmitter imbalance serotonin occupation-ballet, modeling, gymnastics, wrestlers personality disorders neuroendocrine and genetic theory anger issues and anxiety issues sense of accomplishment cultural---in some cultures if thick mean rich, if thin means poor

anorexia: no appetite, may feel hunger but it is all about control; have distorted body image; see themselves as fat y y y y y y y y y y y y y y y y pushing food around the plate and they don t eat it, rituals around food excessive exercise body image issues phobia of weight gain seem all together at first may be perfectionist big baggy cloth can purge; go to the bathroom after eating obsessive about weight measuring food in scales body mass if less than 85% BMI rapid weight loss >30% for any physical reason amenorrhea lanugo <40 Bmp T<36

y y y y

EKG changes electrolytes changes (K);often die from dysrhythmias pancytopenia constipation, osteoporosis, FVD,

Acute: y y y y y family therapy, nutr counceling, meds correct her electrolytes nutrition-careful the way reefed, maybe TPN small frequent meals after getting them stable inpatient eating disorder clinic which works around psychological aspect of it, all about group therapy, counseling, have rules (can t talk about food or sports, watch when go to the bathroom) try keep focus on psychological and inner growth instead of appearence, weight and food permanent physical changes can happen when in severe stage some have purging, some restrict calorie intake

y y y

Bulimia: warning signs: y y y y y y y y y y y leave and go to the bathroom excessive working out laxative abuse and certain meds take out own trash broken blood vessels in their eyes large amounts of food missing, large caloric intake eating in secrecy , eating alone not thin, don t look anorexic an emotional hunger----talk like they have hall that needs to feel this feeling /hall up eat certain foods of color so when throw up and see it means all came out sense of shame kid who is shamed and humiliated by a parent is worse than for the child who has been bitten it is ongoing outpatient mostly psychological support, group therapy correcting underlying things electrolytes keep a log of triggers :measuring cups, talk about food, scales

y y y y y

purging and non-purging: y y teeth erosion varices

shame about who you are guilt-about your behavior Anxiety y y y 40 million people affected 3-5 times more likely to go to a doctor types: o OCD  anxiety OCD  personality OCD  obsession-thought..im afraid of germs  compulsion-clean hands  something bad is going to happen so needs to do something to prevent it  counting, checking,  germ phobia  stepping on something  taking away compulsions will raise anxiety o PTSD o Phobia o social anxiety o GAD  unsettled  something wrong  fidgets  control environ  predict  cleaning-activities anxiety-to press tight, emotional and very subjective o mild anxiety-hightens your awareness;jump start to do your test o moderate anxiety-thinking not clear, phidgiting, harder to learn and think, frontal lobe is not working well, awareness

cause of anxiety: y triggers, stressor

y y y y meds: y y y y

illness thoughts-not tended to chemical imbalance-serotonin, gabba, norepinephrine brain differences-ganglia differences

benzodiazepam SSRI s buspar betablockers-indural

PTSD: y y y y y y y y y y flashback-there is a trigger that leads to it; they releave the experience recurrent >6 months; starts 3 months greater and lasts more than 1 months increased arousal-hypervigilent insomnia/terrible nightmares environment is very important dissosociation stare off or look in the corner; purpose of dissociation is to protect herself, decrease anxiety if dissociate call gently person s name, if bring up abruptly can make them very anxious avoidance anger COUNSELING for PTSD helps to intervene