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Psych Nursing

Somatoform disorder Presence of physical symptoms that suggest a medical condition, are not fully explained by a general medical condition, by the direct effects of a substance, or by another mental disorder No diagnosable medical dx accounts for symptoms
To qualify as Somatoform disorder, each of the following criteria must be met, occurring at any time during the disturbance: 4 pain symptoms in at least 4 sites 2 gastrointestinal symptoms 1 sexual symptom 1 pseudoneurological symptom
Body Dysmorphic Disorder Excessive preoccupation with an imagined defect in appearance Preoccupation causes clinically significant distress or impairment Usually begins in adolescence Preoccupation is not better accounted for by another mental disorder
Conversion Disorder pt1.1 or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition Symptoms cannot be fully explained by a general medical condition or direct effects of a substance
Conversion Disorder Pt2 pt2.Symptoms cause clinically significant distress or impairment in social, occupational, or other areas of functioning Symptoms usually remit within 2 weeks Often secondary gain from the symptoms
Hypochondriasis Preoccupation with fears of having, or the idea that one has, a serious disease based on the person’s misinterpretation of bodily symptoms Duration of disturbance is at least 6 months
Factitious Disorder Intentional production of physical or psychological symptoms Motivation is to assume the sick role External incentives such as in Malingering are absent Often have repeated hospitalizations in numerous cities, states, countries
Malingering Intentionally false or grossly exaggerated S&S motivated by external incentives: Avoid military duty Avoid jury duty Wanting transfer to another setting such as jail or hospital Means to obtain drugs Seeking monetary compensation
What are the four Dissociative Disorders? Dissociate Amnesia Dissociate Fugue Dissociate Identity Disorder Depersonalization Disorder
Dissociative Amnesia 1 or more episodes of inability to recall important personal information, usually traumatic or stressful, that is too extensive to be explained by ordinary forgetfulness.
Dissociative Amnesia may be: Amnesia may be: Localized (certain time period) Selective (some recall) Generalized (whole life)
Dissociative Fugue Sudden, unexplained travel away from home or customary place of work, with inability to recall one’s past Confusion about personal identity or assumption of a new identity
Dissociative Identity Disorder Presence of 2 or more distinct identities or personality states,with enduring pattern of perceiving, relating to, & thinking about the environment & self At least 2 of these identities or personality states recurrently take cntrl of the person’s behavior
Depersonalization Disorder Persistent or recurrent experiences of feeling detached from, & as if one is an outside observer of, one’s mental processes or body (feeling like in a dream, detached from self)
Personality Disorders pt1 pt1.Enduring pattern of inner experience & behavior that deviates markedly from expectations of the culture Enduring pattern is inflexible & pervasive Pattern leads to clinically significant distress or impairment in functioning
Personality Disorders pt2 pt2.Pattern is stable & of long duration Pattern is manifested in 2 or more of the following: Cognition Affectivity Interpersonal functioning Impulse control Onset in adolescence or early adulthood
Personality Disorder Clusters:A Cluster A: appear odd, eccentric Paranoid, Schizoid, Schizotypal
Personality Disorder Clusters:B Cluster B: appear dramatic, emotional, erratic Antisocial, Borderline, Histrionic, Narcissistic
Personality Disorder Clusters:C Cluster C: appear anxious, fearful Avoidant, Dependent, Obsessive-Compulsive
Dissociative Identity Disorder terms: Host, alters, switching, system, integration
Splitting inability to synthesize positive and negative aspects of self and others.
Idealization idealizes person when needs are met
Devaluation devalues (demonizes) person when needs are not met
Feeling of abandonment: due to lack of object constancy
Projective Identification: Feel bad impulse & project it onto someone else, then fear other person because of the projected impulse From need to control the other person
Paranoid personality disorder: pt1 Pervasive mistrust & suspiciousness of others such that their motives are interpreted as malevolent, present as 4 or more of the following: suspects, without sufficient basis, that others are exploiting, harming, or deceiving them cont...
Paranoid personality disorder: pt2 preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates reluctant to confide in others due to unwarranted fear that the information will be used against them
Paranoid personality disorder: pt3 reads hidden demeaning or threatening meanings into benign remarks or events persistently bears grudges, unforgiving of insults or slights perceives attacks on their character or reputation that are not apparent to others & is quick to react angrily
Paranoid personality disorder: pt4 has recurrent suspicions, without justification, regarding fidelity of spouse or partner argumentative, short-tempered, inflexible, aloof, hostile, litigious, holds negative stereotypes of others especially certain groups
Schizoid personality disorder: pt1 Pervasive pattern of detachment from social relationships & restricted range of expression of emotions in interpersonal settings, in a variety of contexts, indicated by 4 or more of the following:
Schizoid personality disorder: pt2 neither desires nor enjoys close relationships, including being part of a family almost always chooses solitary activities little, if any, interest in having sexual experiences with another person
Schizoid personality disorder: pt3 takes pleasure in few, if any, activities lacks close friends or confidants other than first-degree relatives appears indifferent to praise or criticism of others shows emotional coldness, detachment, or flattened affectivity
Schizotypal Personality Disorder pt1 Pervasive pattern of social & interpersonal deficits marked by discomfort with, & reduced capacity for, close relationships as well as cognitive or perceptual distortions & eccentricities of behavior present indicated by 5 or more of the following:
Schizotypal Personality Disorder: pt2 ideas of reference (non-delusional; incorrect interpretation of events) odd beliefs or magical thinking that influences behavior & are inconsistent with culture unusual perceptual experiences, including bodily illusions odd thinking & speech
Schizotypal Personality Disorder: pt3 suspiciousness or paranoid ideation inappropriate or constricted affect behavior or appearance that is odd, eccentric, or peculiar lack of close friends or confidants other than first-degree relatives
Schizotypal Personality Disorder: pt4 excessive social anxiety that does not diminish with familiarity & tends to be associated with paranoid fears rather then negative judgments about self feel like they “don’t fit in”
Antisocial Personality Disorder: pt1 Pervasive pattern of disregard for & violation of rights of others occurring since age 15, indicated by 3 or more of the following: failure to conform to social norms with respect to lawful behaviors, repeated acts that are grounds for arrest
Antisocial Personality Disorder: pt2 deceitfulness, indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure individual is at least 18 years of age impulsivity or failure to plan ahead irritability & aggressiveness, repeated physical fights or assault
Antisocial Personality Disorder: pt3 reckless disregard for safety of self or others consistent irresponsibility, repeated failure to sustain consistent work behavior or finances lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another
Antisocial Personality Disorder: pt4 lack of empathy and/or guilt evidence of Conduct Disorder with onset before 15 years of age
Borderline Personality Disorder: pt1 Pervasive pattern of instability of interpersonal relationships, self-image, affects, & marked impulsivity in a variety of contexts indicated by 5 or more of the following: frantic efforts to avoid real or imagined abandonment
Borderline Personality Disorder: pt2 pattern of unstable & intense demanding interpersonal relationships with extremes of idealization & devaluation persistent unstable sense of self & of self-image; think they must be “bad”; often undermine self when close to goal loose boundaries
Borderline Personality Disorder: pt3 impulsivity in at least 2 areas that are potentially self-damaging recurrent suicidal behavior, gestures, threats, or self-mutilating behavior affective instability due to marked reactivity of mood chronic feelings of emptiness
Borderline Personality Disorder: pt4 inappropriate, intense anger or difficulty controlling anger, especially at any hint of abandonment can be very sarcastic, often followed by guilt more comfortable with transitional objects (i.e.: pets) than in relationships
Histrionic Personality Disorder: pt1 Pervasive pattern of excessive emotionality & attention-seeking, in a variety of contexts, indicated by 5 or more of the following: uncomfortable in situations when not the center of attention
Histrionic Personality Disorder: pt2 interaction with others often characterized by inappropriate sexually seductive or provocative behavior displays rapidly shifting & shallow expressions of emotions consistently uses physical appearance to draw attention to self
Histrionic Personality Disorder: pt3 speech style that is excessively impressionistic & lacking in detail shows self-dramatization, theatricality, & exaggerated expression of emotion is suggestible, easily influenced by others or circumstances
Narcissistic Personality Disorder: pt1 Pervasive pattern of grandiosity ( in fantasy or behavior), need for admiration, & lack of empathy in a variety of contexts, indicated by 5 or more of the following:
Narcissistic Personality Disorder: pt2 grandiose sense of self-importance preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love believes they are “special” & unique, & can only be understood by, or should associate with, other special or high-status people
Narcissistic Personality disorder: pt3 devalues others requires excessive admiration has sense of entitlement, unreasonable expectations of especially favorable treatment or automatic compliance with their expectations
Narcissistic Personality disorder: pt4 is exploitative, takes advantage of others to achieve their own ends lacks empathy, is unwilling to recognize or identify with the feelings & needs of others often envious of others or believes that others are envious of them
Avoidant Personality Disorder: pt1 Pervasive pattern of social inhibitions, feelings of inadequacy, hypersensitivity to negative evaluation, as indicated by 4 or more of the following:
Avoidant personality Disorder: pt2 avoids occupational activities involving significant interpersonal contact because of fears of criticism, disapproval, or rejection unwilling to get involved with people unless certain of being liked
Avoidant personality Disorder: pt3 shows restraint within intimate relationships because of fear of being shamed or ridiculed preoccupied with being criticized or rejected in social situations inhibited in new interpersonal situations due to feeling inadequate
Avoidant personality Disorder: pt4 views self as socially inept, personally unappealing, or inferior to others unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing the shy, quiet, “invisible” ones who lead restricted life style
Dependent Personality Disorder: pt1 pt1.Pervasive & excessive need to be taken care of that leads to submissive & clinging behavior & fears of separation, as indicated by 5 or more of the following:
Dependent Personality Disorder: pt2 pt2.difficulty in making everyday decisions without an excessive amount of advice & reassurance from others needs others to assume responsibility for most major areas of their lives
Dependent Personality Disorder: pt3 pt3.difficulty expressing disagreements with others because of fear of loss of support or approval, fearing abandonment difficulty initiating projects or doing things on their own due to a lack of self-confidence in judgment or abilities
Dependent Personality Disorder: pt4 pt4.goes to excessive lengths to obtain nurturance & support from others, to the point of volunteering to do things that are unpleasant feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themselves
Dependent Personality Disorder: pt5 pt5.urgently seeks another relationship as a source of care & support when a close relationship ends unrealistically preoccupied with fears of being left to take care of themselves
Obsessive Compulsive Personality Disorder: pt1 pt1.Pervasive pattern of preoccupation with orderliness, perfectionism, & mental & interpersonal control, at the expense of flexibility, openness, & efficiency, as indicated by 4 or more of the following
Obsessive Compulsive Personality Disorder: pt2 pt2.preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost shows perfectionism that interferes with task completion, often missing deadlines
Obsessive Compulsive Personality Disorder: pt3 pt3.excessively devoted to work & productivity to the exclusion of leisure activities & friendships over-conscientious, scrupulous, & inflexible about matters of morality, ethics, or values unable to discard worn-out or worthless objects
Obsessive Compulsive Personality Disorder: pt4 pt4.reluctant to delegate tasks or to work with others unless they submit to exactly their own way of doing things adopts a miserly spending style toward both self & others rigid & stubborn, unwilling to consider a change in plans
Nursing Diagnosis: Paranoid, Schizoid, Schizotypal (A) Anxiety Ineffective coping Social isolation Disturbances in thought process
Nursing Diagnosis: Antisocial, Borderline, Histrionic, Narcissistic (B) Ineffective coping Disturbed personal identity Chronic low self-esteem Risk for self-injury Impaired social interactions Risk for other directed violence
Nursing Diagnosis: Avoidant, Dependent, Obsessive-Compulsive (C): Anxiety Ineffective coping Chronic low self-esteem Impaired social interaction
Common complaints to physician from a patient with anxiety disorder: Fatigue Dizziness Weight loss or gain Headache G.I S&S Various aches & pains Insomnia
4 Stages of anxiety Mild, +1, warning of danger - Moderate, +2, tension - Severe, +3, fight/flight, pupils dilated, lowered problem solving, selective attention - Panic, +4, helpless, complete disorganization
3 Types of Anxiety -Signal: identified stressor but repressed - Trait: personality predisposition - State: situation where anxiety occurred in the past
Agoraphobia Anxiety about being in places or situations where escape might be difficult or embarrassing, or where help may not be available if Panic Attack occurs Situations are avoided or endured with marked distress
Panic Disorder Presence of recurrent, unexpected Panic Attacks, followed by at least 1 month of persistent concern about having another worry about possible implications of attacks significant behavioral change related
Specific Phobia marked & persistent fear of clearly discernible objects or situations exposure to the phobic stimulus provokes immediate anxiety response patients recognize the fear is unreasonable (not always for children)
Specific subtypes of specific phobias Animal Type Natural Environment Type Blood-Injection-Injury Type Situational Type Other specific stimuli
Social Phobia Marked & persistent fear of one or more social or performance situations, usually under scrutiny of others, fear embarrassment exposure to situation almost always provokes anxiety; maybe a Panic Attack recognizes fear is excessive or unreasonable
Obsessive-Compulsive Disorder recurrent obsessions or compulsions severe enough to be time consuming, cause marked distress or significant impairment recognizes thoughts are product of own mind recognizes persistent obsessive thoughts or repetitive compulsive behaviors are excessive
Posttraumatic Stress Disorder pt1 pt1.Symptoms develop after exposure to personal experience involving actual or threatened death or serious injury to self or others, especially family or friends intense fear, helplessness, or horror; more intense if trauma is man-made
Posttraumatic Stress Disorder pt2 pt2.persistent re-experiencing of traumatic event; flashbacks, intrusive thoughts & dreams persistent avoidance of stimuli associated with the event persistent symptoms of increased arousal; hypervigilence & increased startle reflex
Posttraumatic Stress Disorder pt3 pt3.Symptoms present for more than 1 month causes significant distress or impairment in functioning specified as “acute”, “chronic”, or “delayed onset”
Acute Stress Disorder Exposure to traumatic event of actual or threatened death or serious injury, or threat to physical integrity of self or others response was intense fear, helplessness, or horror
Acute Stress Disorder pt2 3 or more dissociative symptoms within 1 month of exposure to the trauma: numbing, detachment “in a daze” derealization depersonalization dissociative amnesia Avoidance of stimuli flashbacks, intrusive dreams
Generalized Anxiety Disorder excessive anxiety& worry occurring more days than not, lasting at least 6 months - difficult to control the worry, yet recognized by patient as excessive.
Generalized Anxiety Disorder pt2 presence of at 3 of the following: restlessness, edginess, fatigue, poor concentration, irritability, muscle tension, sleep disturbances. significant distress or impairment with normal social and occupational functioning
Trichotillomania Recurrent pulling out of one’s hair resulting in noticeable hair loss An increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior Pleasure, gratification, or relief when pulling out the hair
Impulse Control Disorders (4) 312.3 Pathological Gambling 312.33 Pyromania 312.32 Kleptomania 312.34 Intermittent Explosive Disorder
Treatment Modalities Medications anxiolytics SSRIs Cognitive Behavioral Therapy (CBT) Relaxation Techniques Behavioral techniques exposure systematic desensitization, especially with Specific Phobias Skill training
Nursing Assessments for anxiety disorders Observe mental status Identify reason for seeking help Assess level of safety in present environment Observe physiological status, somatic S&S Assess level of impairment due to anxiety
Nursing diagnosis associated with Anxiety Disorders Impairment in adjustment Ineffective coping strategies Disturbance in body image/self-concept Hopelessness Noncompliance Powerlessness
Nursing Interventions for patients with Anxiety Disorders Establish a therapeutic relationship Keep patient safe Identify patient’s behaviors Modify environment Medications to help with anxiety Engage in activities as tolerated Avoid confrontation
Nursing Interventions for patients with Anxiety Disorders pt2 Help to recognize anxiety, explore feelings Help with insight into antecedents Help with coping skills/behaviors Identify supports Education patient/family about medications/anxiety Monitor elimination and eating patterns
Mood Disorders pt1 Major Depressive Disorder Dysthymic Disorder Adjustment Disorder Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder
Mood Disorders pt2 Mood Disorder Due to General Medical Condition Substance-Induced Mood Disorder Depressive Episode with Post-Partum Onset or Psychosis
Symptoms of Depression pt1 Depressed mood & sadness OR anhedonia must be present At least 5 symptoms present over 2 weeks Irritability, anger, rage Hopelessness Worthlessness (most important symptom toward suicidality) Difficulty in concentration, focus
Symptoms of Depression pt2 pt2.Difficulty in making decisions Guilt Psychomotor retardation or agitation Change in eating pattern Change in sleeping pattern Decrease in energy level Fatigue
Symptoms of depression pt3 pt3.Preoccupation with death Suicidal ideation, plan, and/or attempt Withdrawal from friends, family social interactions Impacts usual functioning
Symptoms of Mania pt1 pt1.Distinct period of abnormally & persistently elevated, expansive, or irritable mood , 3 or more of following S&S, lasting at least 1 week inflated self-esteem or grandiosity decreased need for sleep more talkative than usual, or pressured speech
Symptoms of Mania pt2 flight of ideas, and/or racing thoughts increased distractibility increased sociability may be very witty intrusive, interruptive, disruptive increase in goal-directed activity
Symptoms of Mania pt3 psychomotor agitation excessive involvement in high risk pleasurable activities marked impairment in social or occupational functioning may have psychotic features may require hospitalization
Symptoms of Hypomania pt1 Similar to manic symptoms but never reaching same severity or duration, for at least 4 days: happy congenial humorous productive must represent a change in usual functioning, but without interference in social or occupational functioning
Symptoms of Hypomania pt2 must represent dysfunctional affective state during which patient is not in control of moods or behavior, but not marked impairment
Symptoms of Mixed Episode Criteria met for both Manic Episode and Major Depressive Episode nearly every day for at least 1 week accompanied by rapidly alternating moods must be sufficiently severe to cause marked impairment in social or occupational functioning
296 Major Depressive Episode 5 or more symptoms of depression, must include either depressed mood or anhedonia, daily for at least 2 weeks Symptoms must cause significant distress Symptoms must impact functioning Symptoms are not the direct result of a medical condition
300.4 Dysthymic Disorder Similar to Depressive symptoms, but never reach same intensity Must have 2 or more depressive symptoms Never without S&S for more than 2 months at a time Must have low level of depression for at least 2 years
309. Adjustment Disorder pt1 Development of emotional or behavioral symptoms in response to an identifiable stressor(s) symptoms occur within 3 months of the onset of the stressor(s)
Adjustment Disorder pt2 symptoms are clinically significant as evidenced by either of the following: marked distress in excess of what would be expected significant impairment in social or occupational functioning
296.0 Bipolar I Disorder pt1 pt1. Characterized by occurrence of 1 or more Manic Episodes, depressive symptoms, and mood swings May also have Hypomanic, Mixed, or Major Depressive Episodes Symptoms cause clinically significant distress or impairment social, occupational functionin
296.0 Bipolar I Disorder pt2.Mood swings can last for weeks/months Cycle back and forth from Manic to Depressive & baseline S&S Cycles vary in duration Can be rapid cycling, within a day Can be weeks or months in each cycle Important to determine patient’s pattern of cycling
296.89 Bipolar II Disorder Characterized by 1 or more Major Depressive Episodes accompanied by at least 1 Hypomanic Episode Has never had a Manic or Mixed Episode Symptoms cause clinically significant distress or impairment in social, occupational, or other areas of functioning
301.13 Cyclothymic Disorder pt1. pt1.For at least 2 years, presence of numerous periods with Hypomanic symptoms cycling with Depressive symptoms Symptoms need be present for only 1 year if child or adolescent under 18 years of age
301.13 Cyclothymic Disorder pt2 pt2.Depressive symptoms never meet criteria for a Major Depressive Episode Never without symptoms for more than 2 months during the 2 years (or 1 year if under 18 years of age) Symptoms cause clinically significant distress in soc/occ. functioning
Created by: goodwinnursing