Psych Nursing
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| What are the four Dissociative Disorders? | Dissociate Amnesia
Dissociate Fugue
Dissociate Identity Disorder
Depersonalization Disorder
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| 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.
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| Dissociative Amnesia may be: | Amnesia may be:
Localized (certain time period)
Selective (some recall)
Generalized (whole life)
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| 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
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| 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
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| 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)
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| 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
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| 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
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| Personality Disorder Clusters:A | Cluster A: appear odd, eccentric
Paranoid, Schizoid, Schizotypal
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| Personality Disorder Clusters:B | Cluster B: appear dramatic, emotional, erratic
Antisocial, Borderline, Histrionic, Narcissistic
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| Personality Disorder Clusters:C | Cluster C: appear anxious, fearful
Avoidant, Dependent, Obsessive-Compulsive
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| Dissociative Identity Disorder terms: | Host, alters, switching, system, integration
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| Splitting | inability to synthesize positive and negative aspects of self and others.
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| Idealization | idealizes person when needs are met
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| Devaluation | devalues (demonizes) person when needs are not met
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| Feeling of abandonment: | due to lack of object constancy
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| 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
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| 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...
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| 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
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| 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
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| 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
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| 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:
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| 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
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| 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
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| 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:
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| 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
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| 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
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| 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”
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| 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
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| 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
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| 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
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| Antisocial Personality Disorder: pt4 | lack of empathy and/or guilt
evidence of Conduct Disorder with onset before 15 years of age
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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:
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| 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
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| 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
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| 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
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| 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:
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| 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
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| 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
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| 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
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| 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:
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| Nursing Diagnosis: Paranoid, Schizoid, Schizotypal (A) | Anxiety
Ineffective coping
Social isolation
Disturbances in thought process
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| 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
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| Nursing Diagnosis: Avoidant, Dependent, Obsessive-Compulsive (C): | Anxiety
Ineffective coping
Chronic low self-esteem
Impaired social interaction
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| 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
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| 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
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| 3 Types of Anxiety | -Signal: identified stressor but repressed
- Trait: personality predisposition
- State: situation where anxiety occurred in the past
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| 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
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| 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
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| 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)
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| Specific subtypes of specific phobias | Animal Type
Natural Environment Type
Blood-Injection-Injury Type
Situational Type
Other specific stimuli
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| 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
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| 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
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| 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
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| 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
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| 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”
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| 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
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| 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
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| 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.
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| 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
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| 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
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| Impulse Control Disorders (4) | 312.3 Pathological Gambling
312.33 Pyromania
312.32 Kleptomania
312.34 Intermittent Explosive Disorder
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| Treatment Modalities | Medications
anxiolytics
SSRIs
Cognitive Behavioral Therapy (CBT)
Relaxation Techniques
Behavioral techniques
exposure
systematic desensitization, especially with Specific Phobias
Skill training
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| 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
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| Nursing diagnosis associated with Anxiety Disorders | Impairment in adjustment
Ineffective coping strategies
Disturbance in body image/self-concept
Hopelessness
Noncompliance
Powerlessness
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| 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
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| 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
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| Mood Disorders pt1 | Major Depressive Disorder
Dysthymic Disorder
Adjustment Disorder
Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder
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| Mood Disorders pt2 | Mood Disorder Due to General Medical Condition
Substance-Induced Mood Disorder
Depressive Episode with Post-Partum Onset or Psychosis
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| 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
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| 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
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| Symptoms of depression pt3 | pt3.Preoccupation with death
Suicidal ideation, plan, and/or attempt
Withdrawal from friends, family social interactions
Impacts usual functioning
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| 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
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| 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
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| 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
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| 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
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| Symptoms of Hypomania pt2 | must represent dysfunctional affective state during which patient is not in control of moods or behavior, but not marked impairment
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| 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
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| 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
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| 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
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| 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)
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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