Mental Health Exam Study Guide

Mental Health Exam Study Guide Schizophrenia-Ch.26 ATI 14, 22 Watch 2 videos on Blackboard Somatoform and Dissociative Ch.30, Personality Disorder Ch.34 Anxiety Ch.29 (Blackboard PDF Anxitey) ATI 4, 11, 15, 19, 20, 22-left Schizophrenia (split mind) (15?s)  Distorted and bizarre thoughts, perceptions, emotions, movements, behavior…considered a disease process Extreme cost to patient and families…high suicide rates as much as 50x average. 1 in 100≈2.5 million Americans…prospects are improving due to medications Onset average is between 15-25y.o. for men and 25-35y.o. for women Abnormal Perception  Inaccurate identification and interpretation of stimuli  Hallucinations  Experiences sensory distortion as real and responds accordingly  No identifiable external or internal stimulus  Misidentification /perception of faces  contribute to fear, aggressiveness, withdrawal from interactions, hostility Affect  Can be observed by the examiner  Describe:  Broad  Restricted  Blunted  Flat  Inappropriate  Remember cultural implications Emotional Expression  Hypo-expression of feelings…generally described as flat or blunted is typical  May say they no longer have any feelings  Alexithymia- inability to identify and describe emotions in the self  Anhedonia  Apathy  Comorbid mood disorders  Suicide risk (x50) Behaviors  Behaviors  Appearance  Aggression/agitation/violence  Sign of violence, not typical  Be proactive if present  Repetitive or stereotyped behavior  Avolition-lack of drive/goals/participation  Lack of persistence at work/school Behaviors Causing Socialization Problems  Inability to communicate coherently  Loss of drive and interest  Deterioration of social skills  Poor personal hygiene  Paranoia  Movements  Catatonia, waxy flexibility, posturing  EPS 2° to meds  Abnormal eye movements  Grimacing  Apraxia-can’t execute what would be a VOLUNTARY movement  Echopraxia-INVOLUNTARY mimicking of other’s body movements/expressions  Abnormal gait…shuffling, peculiar walk… exacerbated by meds  Mannerisms  Symptoms may prevent socializing within accepted sociocultural norms  Stigma  Loss of ego boundaries, potentially expose themselves, invade personal space, touch others without permission and display odd and socially unacceptable behaviors…protect patient and others when this occurs…keep in mind their right to privacy and dignity if they lose control…don’t cast judgment Physical Health (lack thereof)  People with schizophrenia have:  Shorter life span  High risk lifestyle: sedentary, obsessive smoking, or dietary habits; obesity resulting in diabetes, hypertension, coronary artery disease…poor self-care  Disparity of health care Types of Schizophrenia  Paranoid type  Characterized by paranoid delusions, persecutory delusions…sometimes of religious nature  Client may be argumentative, hostile, and aggressive… hostility may present, especially if they feel threatened  Disorganized type  Chronic variety with flat or inappropriate affect  Silliness and incongruous giggling common  Behavior bizarre; social interaction is often extremely impaired  Catatonic type  Catatonic stupor: characterized by extreme psychomotor retardation; patient usually mute; posturing common…waxy flexibility or statue-like…odd positions with very rigid muscles…Excitement variation displays frenzied movement and often yelling incoherent things which typically requires protecting patient from self and intervention with physical control and meds  Undifferentiated type  Bizarre behavior that does not meet the criteria outlined for the other types of schizophrenia; delusions and hallucinations prominent…mixed symptoms not easily classified to another diagnosis…frequently used  Residual type  Used to diagnose a person who has a history of at least one episode of schizophrenia with prominent psychotic symptoms, but not currently present Psychotic Disorders  Schizophrenia…as well as…  Schizophreniform Disorder o Same symptoms as schizophrenia, with exception that the duration of the disorder has been at least 1 month but fewer than 6 months  Schizoaffective Disorder-the “Bipolar-Schizo” o Schizophrenic symptoms accompanied by a strong element of symptomatology associated with mood disorders, either manic or depressive o An uninterrupted period of illness including a major depressive episode or manic episode concurrent with symptoms of schizophrenia. o During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms. o Symptoms of a mood episode are present during a substantial part of the illness.  Delusional Disorder o The existence of prominent, non-bizarre delusions…they may hold down jobs and appear to function normally to those not close to them Subtypes o Erotomanic type: the individual believes that someone, usually of a higher status, is in love with him or her o Grandiose type: person has irrational ideas regarding own worth, talent, knowledge, or power o Jealous type: person has the irrational idea that the sexual partner is unfaithful o Persecutory type: person believes he or she is being malevolently treated in some way o Somatic type: person has an irrational belief that he or she has some physical defect, disorder, or disease  Brief Psychotic Disorder o Sudden onset of psychotic symptoms usually following a severe psychosocial stressor o Symptoms persist less than 1 month; client returns to the full premorbid level of functioning. Often occurs with pregnancies I’d call it post-partum psychosis  Shared Psychotic Disorder o Delusional system develops in a second person as a result of a close relationship with a person who already has a psychotic disorder with prominent delusions; also called folie á deux.  Psychotic Disorder-due to general medical condition o Symptoms of this disorder include prominent hallucinations and delusions that can be directly attributed to a general medical conditions. Cancer is often a cause.  Substance Induced Psychotic Disorder o The presence of prominent hallucinations and delusions that are judged to be directly attributable to the physiological effects of a substance. A client is admitted with a diagnosis of schizoaffective disorder. Which symptoms are characteristic of this diagnosis? A) Strong ego boundaries and abstract thinking B) Ataxia and akinesia C) Altered mood and thought disturbances D) Substance abuse and cachexia The characteristic symptoms of schizoaffective disorder are a combination of alterations in mood (mania or depression) and thought. Clinical Course  Onset: abrupt or insidious; most with slow, gradual development of signs, symptoms  Diagnosis usually with more actively positive symptoms of psychosis  Onset may be abrupt or insidious, but most clients slowly and gradually develop signs and symptoms such as social withdrawal, unusual behavior, loss of interest in school or work, and neglected hygiene.  The diagnosis of schizophrenia usually is made when the person begins to display more actively.  Positive symptoms of delusions, hallucinations, and disordered thinking (psychosis). Regardless of when and how the illness begins and the type of schizophrenia, consequences for most clients and their families are substantial and enduring.  When and how the illness develops seems to affect the outcome. Age at onset appears to be an important factor in how well the client fares: Those who develop the illness earlier show worse outcomes than those who develop it later.  Younger clients display a poorer premorbid adjustment, more prominent negative signs, and greater cognitive impairment than do older clients.  Those who experience a gradual onset of the disease (about 50%) tend to have both poorer immediate and longterm course than those who experience an acute and sudden onset (Buchanan & Carpenter, 2005).  Approximately one third of clients with schizophrenia relapse within 1 year of an acute episode  Immediate course: two patterns  Ongoing psychosis, never fully recovering;  Episodes of psychotic symptoms alternating with episodes of relatively complete recovery  Long term course: intensity of psychosis diminishes with age; most with difficulty functioning; few with ability to live fully independent lives Nature of the Disorder-4 Phases-Premorbid, Prodromal, Schizophrenia (active), Residual ▪ Premorbid behavior of the patient with schizophrenia can be viewed in four phases. Phase I Premorbid phase ▪ Normal functioning ▪ Shy and withdrawn ▪ Poor peer relationships ▪ Doing poorly in school ▪ Antisocial behavior Phase II Prodromal phase ▪ Lasts from a few weeks to a few years ▪ Deterioration in role functioning and social withdrawal ▪ Substantial functional impairment ▪ Sleep disturbance, anxiety, irritability ▪ Depressed mood, poor concentration, fatigue ▪ Perceptual abnormalities, ideas of reference, and suspiciousness herald onset of psychosis…ideas of suspiciousness Phase III Active phase-Schizophrenia ▪ In the active phase of the disorder, psychotic symptoms are prominent ▪ Delusions ▪ Hallucinations ▪ Impairment in work, social relations, and self-care