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Adventitious Crisis - ANSWER-caused by nature or humans and are not usual
parts of everyday life ->natural disaster, a national disaster, or a crime of
violence. Examples - hurricane, plane crash, school shooting, physical/sexual
assault -> often results in acute stress disorder, PTSD, major depressive
disorder
Phase 1 of crisis - ANSWER-·Conflict or problem arises
·Self-concept threatened
·Increased anxiety
·Use of problem-solving techniques and defense mechanisms (sometimes
resolves the problem)
Phase 2 of Crisis - ANSWER-Defense mechanisms fail
Threat persists
Anxiety increases
Feelings of extreme discomfort
Functioning disorganized
Trial-and-error attempt to solve problem and restore normal balance
Phase 3 of Crisis - ANSWER-Trial-and-error attempts may fail
Anxiety can escalate to severe level or panic
Automatic relief behaviors mobilized (i.e., withdrawal and flight)
Some form of resolution may be devised(i.e., compromising needs or redefining
situation)
Phase 4 of Crisis - ANSWER-Problem is unsolved and coping skills are
ineffective
Overwhelming anxiety
,Possible serious personality disorganization, depression, confusion, violence
against others, or suicidal behavior
Modalities of Crisis Treatment - ANSWER-Emergency rooms
24/7 Telephone hotlines
Peer crisis services
Crisis intervention teams (CITs)
Crisis stabilization beds
Short-term residential services
Mobile Crisis Teams
Assessment of crisis pt - ANSWER-General assessment:
•Important to assess for suicidal ideations and ask what can be done to make
sure the client feels safe
Assessment of perception of precipitating event
Assessment of situational supports
Assessment of personal coping skills
Self-assessment
Phases of Group Development - ANSWER-Orientation phase:
Rules
Expectations
Start and stop time and dates
Working phase
Termination phase
Group Leadership Responsibility - ANSWER-Initiating:
Get them going on time
Reiterate the topic or purpose of the meeting
Maintaining:
Keep them on track
Terminating:
Recapitulation
End on time
Styles of Leadership - ANSWER-Autocratic leader:
Do it my way or makes decisions independently
Democratic leader:
Decide how to do it or make decisions as a group
Laissez-faire leader:
, Don't care how you do or when you do it just have it done on time
Challenging Members - ANSWER-Monopolizing member
Complaining member who rejects help
Demoralizing member
Silent member
Bipolar 1 disorder - ANSWER-•This is the most severe bipolar disorder
•Moods fluctuate from mania to deep depression (periods of normal functioning
may alternate)
•Bipolar 1 Disorder is characterized by at least one MANIC EPISODE
Mania - ANSWER-•Hallucinations and delusions
•Extreme energy (no need to eat, sleep, etc.)
•Risk taking behavior
•Feeling euphoric and optimistic
•Lasts at least a week
•Is a psychiatric and physical emergency
Bipolar 2 disorder - ANSWER-•This is less severe than Bipolar 1 disorder
•Moods fluctuate from hypomania to deep depression (periods of normal
functioning may alternate)
•Hypomania does not include hallucinations or delusions but is similar to mania
in other symptoms to a lesser degree
•The depression, however, can be very severe and that can include psychotic
features
NI for Bipolar 1 - ANSWER-Your initial intervention is to physically stabilize:
• •Assess hydration and physical condition
• •Medicate
• Keeping an environment of decreased stimulation:
• •Clear and concise communication
• Reinforcing healthy patterns of sleep, eating and behavior:
• •Offer high calorie fluids frequently
• •Encourage frequent rest periods
• •Monitor I & O
• •Offer finger foods and high fiber foods
, NI Bipolar Disorder 2 - ANSWER-•Encourage healthy patterns of eating,
sleeping, etc.
•Referrals to therapy
•Medications as ordered
Lithium - ANSWER-•Lithium is a mood stabilizer
•It takes 10 - 21 days to work, so other drugs may be used as an adjunct during
this time
•Lithium has a narrow therapeutic window and levels need to be drawn
frequently
•Fluid and sodium balance are important - dehydration, for example, may lead
to toxicity.
•Many drugs interact with Lithium
•Long term use can cause hypothyroidism and goiter
Lithium Toxicity - ANSWER-•Normal range of Lithium: 0.6meq/L to 1.2meq/L
•Beginning toxicity Levels over: 1.5meq/L
•Severe toxicity Levels over: 2.0meq/L
•Labs are drawn in the morning 10 - 12 hours after the last dose
•Labs are monitored during initiation of Lithium and at any dose change until
therapeutic levels are reached. After that, levels are drawn monthly. After about
6 months to 1 year of stability, the lab draws may go to every 3 months.
Anticonvulsant Drugs - ANSWER-•Anticonvulsant Drugs are also used as
mood stabilizers
Valproates (Depakote and Depakene):
•Monitor liver function, pancreatic function, platelet count, CBC's and drug
levels.
•Life threatening rashes may occur
Carbamazepine (Tegretol):
•Liver enzymes need to be monitored weekly for first 8 weeks
•CBC's, pancreatic function, liver function, platelet count and drug levels need
to be monitored ongoingly
•Life threatening rashes may occur
Lamotrigine (Lamictal):
•Potential for life threatening rash
•Monitor for liver toxicity and blood dyscrasias