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PVN 123 Mental Health Nursing

Identify common subjective and objective evidence associated with common mental health disorders Anxiety Disorders Depression Bipolar Disorders Schizophrenia Personality Disorders Cognitive Disorders Substance and other dependencies Eating Disorders Identify nursing interventions, therapies, screening tools, that may be utilized in the safe care, management, and health promotion, for individuals who experience these disorders. Determine desired outcomes associated with these disorders

Panic Disorder Phobias OCD GAD Stress Related Disorders (Acute Stress Disorder & PTSD)

Anxiety Response to stress High levels result in behavior changes Tends to be persistent (often disabling) Levels of anxiety Mild (restless/irritable/increased motivation) Moderate (agitated/muscles tighten) Severe (unable to function / ritualistic behaviors / unresponsive) Panic (distorted perception / hallucinations / loss of rational thought / immobility)

Anxiety Disorders Panic Disorder Recurrent panic attacks Phobias Unreasonable fear of objects or situations Obsessive-Compulsive Disorder (OCD) Unrealistic obsessions (thoughts) Compensated for with compulsive behaviors Ex: repeatedly cleaning an object or constant hand washing Generalized Anxiety Disorder (GAD) Excessive worry (more than 6 months) Stress-related Disorders Acute Stress Disorder After exposure to traumatic event Causes numbing, detachment, amnesia about the event (no more than 4 weeks) Posttraumatic Stress Disorder (PTSD) Caused by a traumatic event Fear, horror, flashbacks, detachment, foreboding, restricted affect Impairment lasts longer than one month and can last for years

Coping and Defense Mechanisms Anxiety Disorders: Displacement Undoing, reaction formation Intellectualization Isolation Repression *** If you dont remember these from last class look them up!!!

Risk Factors Anxiety Disorders: Much more likely in women (except OCD) Precipitated by exposure to traumatic event or experience Experiencing smells or sounds associated with the event Can trigger panic attack Can be due to acute medical condition Always rule out a physical cause Can be related to current use or withdrawal from a chemical substance (ex: alcohol)

Subject/Objective Data Panic Disorder Panic episodes last 15 to 30 minutes Four or more of the following: Palpitations SOB Choking / sense of smothering Chest pain Nausea Feelings of depersonalization Fear of dying / insanity Chills and hot flashes Behavior changes / persistent worries about next attack Agoraphobia (fear of being in places or situations of previous attacks)

Subjective/Objective Data Phobias: Social Phobia (fear of embarrassment) Unable to perform in front of others Dread social situations Believe others are judging them negatively Impaired relationships Agoraphobia (fear of being outside) Impaired ability to work or perform duties Other Phobias (ex: fear of strangers, flying, the dark) Fear specific objects, experiences or situations

Subjective/Objective Data OCD Ritualistic behaviors Difficulty meeting self care needs If performing constant hand washing Skin damage Infection

Subjective/Objective Data GAD Impairment in one or more areas of functioning Ex: work-related duties, self care At least three of the following manifestations Fatigue Restlessness Trouble concentrating Irritability Muscle tension Sleep disturbance

Subjective/Objective Data Stress-Related Disorders

Standardized Screening Tools Anxiety Disorders Hamilton Rating Scale for Anxiety Modified Spielberger State Anxiety Scale (see handouts)

Nursing Care Anxiety Disorders Structured interview keep client focused During Crisis or in Acute Anxiety: Provide safety and comfort for client and staff Do not reinforce teaching unable to problem-solve Remain with client and provide reassurance THEN

Nursing Care (continued) Anxiety Disorders Provide Milieu Therapy Structured environment Monitor/protect from harm Daily activities / focus on cooperation and sharing Use therapeutic communication skills Open ended questions Help client to express, validate, and acknowledge feelings Allow client to participate in decision making Encourage relaxation techniques Mild to moderate anxiety Instill hope for good outcomes (no false reassurance) Enhance self-esteem Encourage positive statements Discuss past achievements Assist to identify interfering defense mechanisms Client Education

Other Therapies Anxiety Disorders Cognitive Reframing Behavioral Therapies Relaxation Training Modeling Systematic desensitization Flooding Response prevention Thought stopping Eye Movement Desensitization Therapy (EMDR) Unfreezes fragments or trauma Group/Family Therapy (PTSD)

Medications Anxiety Disorders Antidepressants Zoloft, Elavil Sedative hypnotic anxiolytics Valium Serotonin Norepinephrine reuptake inhibitors Effexor Non-barbiturate anxiolytics Buspar Other Medications ***( used as mood stabilizers) Beta Blockers Antihistamines Anticonvulsants Remeron (serotonin norepinephrine dis-inhibitor) Used to help clients rest when panic attack occurs during sleep

Client Outcomes! Anxiety Disorders Will verbalize decreased anxiety Will be rested upon awakening Will develop realistic goals for the future Will regularly attend support group Will demonstrate appropriate use of relaxation techniques

Quick Quiz! (answers in your book!) OCD Panic Disorder Acute Stress Disorder Agoraphobia Social Phobia PTSD Traumatic event causing symptoms for months after event takes placeA Exposure to a traumatic event, resulting in numbing, detachment, and amnesia about the event for up to 4 weeksB Fear of speaking with or interacting with others C Clinical findings including chest pain, palpitations, feelings of impending doomD Fear of being out in open spaces E Ritualistic compulsions and recurrent thoughts F

Quick Quiz! A client being evaluated in her providers office tells the nurse, I remove my old makeup and apply new makeup every hour or so because I look horrible. The nurse should understand that this behavior is characteristic of which of the following disorders? A.GAD B.Agoraphobia C.OCD D.PTSD

Quick Quiz! When collecting data from a client who states that she has been dealing with constant anxiety for the past few weeks, the nurse should use which of the following communication techniques? _____Ask open ended questions _____Provide reassurance _____Discuss the clients past achievements _____Offer advice about how to reduce anxiety _____Invite the client to participate in decision making

Dysthymic Disorder Major Depressive Disorder

I Had A Black Dog http://youtu.be/XiCrniLQGYc Watch the Video!

About Depression Mood (affective) disorder Widespread issue Ranks high among causes of disability Can be comorbid with: Anxiety disorders Schizophrenia Substance abuse Eating disorders Personality disorders Client may be at risk for suicide Personal or family history of suicide attempts Comorbid anxiety or panic attacks Comorbid substance abuse or psychosis Poor self esteem Lack of social support Chronic medical condition

Depressive Disorders - MDD Major Depressive Disorder (MDD) Single or recurrent episodes of unipolar depression Not associated with mood swings (unipolar) Change in normal functioning Social, occupational and self care deficits Plus. At least 5 of the following occurring nearly every day (for most of the day) for a minimum of 2 weeks: Depressed mood Difficulty with or excessive sleeping Indecisiveness Decreased concentration Suicidal ideation Changes in motor activity Unable to feel pleasure Increase or decrease in weight ( 5% of total body weight over one month)

Dysthymic Disorder Milder and more chronic form of depression Onset is early Childhood and adolescence Lasts at least 2 years (adults) 1 year in children At least three clinical findings of depression May become MDD later in life Clinical manifestations less severe than with MDD

MDD Specific Classifications Psychotic Features Auditory hallucinations, delusions Atypical Features Changes in appetite, wt. gain, excessive daytime sleeping Postpartum Onset Begins within 4 weeks of childbirth May include delusions Mother and infant may be at high risk Seasonal Characteristics Seasonal Affective Disorder (SAD) Occurs during winter Can be treated with light therapy Chronic Features Episode lasting more than 2 years

Phases of Depression

Depression Risk Factors Family history / previous personal history of depression Twice as common among females 15 40 years Very common among elderly More difficult to recognize May go untreated May look like dementia Memory loss Confusion Behavioral problems May seek help for somatic symptoms Other Risk Factors: Stressful events Medical illness Postpartum female Poor social network Comorbid substance abuse *May be primary disorder or response to another mental or physical disorder

Subjective Data Depression Anergia (lack of energy) Anhedonia (lack of pleasure in normal activities) Anxiety Sluggish (most common) or unable to relax or sit still Change in eating patterns Usually anorexia in MDD Increased intake with Dysthymia Change in bowel habits (usually constipation) Sleep Disturbances Decreased interest in sexual activity Somatic complaints (fatigue, GI symptoms, pain)

Objective Data Depression Sad with blunted affect Poor grooming / lack of hygiene Slowed physical movement / slumped posture Agitation (pacing/finger tapping) can also occur Little or no effort to interact / socially isolated Slowed speech Decreased verbalization Delayed responses

Standardized Screening Tools Depression Hamilton Depression Scale Beck Depression Inventory Geriatric Depression Scale Zung Self-Rating Depression Scale Confidential Screening Tool http://depressionscreen.org/ See handouts!

Medications - Depression Classification / Medication ExampleNursing Considerations Selective Serotonin Reuptake Inhibitors (SSRIs) Celexa (citalopram) Prozac (Fluoxetine) Zoloft (Sertraline) Side effects include Nausea Headache CNS stimulation (agitation/insomnia/anxiety) Sexual dysfunction may occur Weight gain with long term use (follow healthy diet) Tricyclic Antidepressants Elavil (Amitriptyline) Orthostatic hypotension Dizziness change positions slowly Monoamine Oxidase Inhibitors (MAOIs) Nardil (Phenelzine) Anticholinergic effects Sugarless gum High-fiber foods Increase fluid intake (2-3L/day) Avoid foods with tyramine! Ripe avocados Figs Fermented/smoked meats Liver Dried or cured fish Most cheeses Some beer and wine Protein dietary supplements **Combinations of medication and foods can cause hypertensive crisis / death Sedative Hypnotic Anxiolytics (Benzodiazepines) Valium (Diazepam) Ativan (Lorazepam) Watch for CNS Depression Avoid using other CNS Depressants Avoid hazardous activities Avoid caffeine (interferes with effect of medication) Serotonin norepinephrine reuptake inhibitors Effexor (Venlafaxine) Side effects include: Nausea Weight gain Sexual dysfunction Nonbarbiturate Anxiolytics Buspar (Buspirone) Therapeutic effects onset may take 2 to 4 weeks

Nursing Care Depression Milieu Therapy Self-Care Monitor abilities to perform ADLs Encourage independence Encourage participation in decision making Communication Relate therapeutically Make time to be with client Make observations rather than asking questions I notice that you were at group today Give simple concrete directions Give client time to respond Maintain a safe environment

Client Teaching for Anti-Depressant Medications Do not discontinue medications suddenly May take time for therapeutic effect 1 3 weeks for initial effect Up to 2 months for maximal response Avoid hazardous activities Driving Operating heavy equipment / machinery

Serotonin Syndrome Watch the video http://www.youtube.com/watch?v=egfXW74LMi8

Other Treatments Psychotherapy Problem solving Increasing coping abilities Changing negative thinking Increasing self-esteem Assertiveness training Using community resources Alternative Therapies St. Johns Wort Side effects (photosensitivity, skin rash, rapid heart rate, GI distress, abdominal pain) Can increase or reduce levels of medications being taken Serotonin Syndrome may occur if taken with SSRIs, MAOIs, atypical antidepressants, tricyclic antidepressants. Light Therapy First line treatment for SAD Inhibits nocturnal secretion of melatonin Expose face to 10,000-lux light box for 30 min/day Electroconvulsive Therapy (ECT) Specially trained nurse monitors the client before and after procedure Watch for cardiovascular disease, neuromuscular disorders, complicated pregnancy prior to treatment Transcranial Magnetic Stimulation (TMS) Electromagnets stimulate the brain Vagus Nerve Stimulation (VNS) Implanted device stimulates vagus nerve

Electroconvulsive Therapy (ECT) Watch the video Sherwin Nuland: How Electro-shock Therapy Changed Me http://www.ted.com/playlists/9/all_kinds_of_minds.html

Client Education and Outcomes Education after discharge Review clinical manifestations with clients and family Helps to identify relapse Reinforce intended effects and side effects of meds Explain importance and benefits of adherence to therapies Encourage Regular exercise (30 min/day 3 to 5 days/wk) Shorter intervals are helpful Outcomes The client will express increase in mood. The client will adhere to the medication regimen. The client will remain safe and notify provider of any thoughts of suicide.

Quick Quiz! A nurse is interviewing a 25 year-old client diagnosed with dysthymia. Which of the following findings should the nurse expect? A.There are wide fluctuations in mood. B.There is no evidence of suicidal ideation. C.The symptoms last for at least two years. D.There is an inflated sense of self-esteem.

Quick Quiz! A client is prescribed the SSRI paroxetine (Paxil), but wants to continue taking St. Johns Wort. What should the nurse tell the client and spouse about taking this medication concurrently with St. Johns Wort?

Bipolar I Disorder Bipolar II Disorder Cyclothymia

Watch a Movie! - EXCELLENT!! "Up/Down" Bipolar Disorder Documentary FULL MOVIE (2011) About 1 hours long Make some popcorn and get comfy! Put up the Big Screen Enjoy and learn lots!! http://www.youtube.com/watch?v=eyiZfzbgaW4

Bipolar Disorders Mood disorders Recurrent episodes of depression and mania Usually emerge in late adolescence and early adulthood Can be diagnosed in school age children Side effects of medication and clinical manifestations of bipolar disorders mimic symptoms of ADHD Children not usually diagnosed until after age 7 Periods of normal functioning alternating with illness Some clients maintain occupational and social function Care mimics the phase of the disease experienced

Bipolar Disorders and Comorbidities Bipolar Disorders Bipolar I Disorder At least one episode of mania alternating with depression Bipolar II Disorder More than one or more hypomanic episodes alternating with MDD. Differs from Bipolar I Clients do not have manic phases Cyclothymia 2 years of repeated hypomanic episodes alternating with MINOR depressive episodes Comorbidities Substance abuse More rapid cycling of mania Used for self-medication Direct impact on onset of mental health disorder Anxiety Disorders Eating Disorders ADHD

Watch a Video Laura Bain - Living with Bipolar Type II http://www.youtube.com/watch?v=8Ki9dgG3P5M

Watch a Video Understanding Bipolar Disorder http://www.youtube.com/watch?v=CDK50WQEOJc

Phases, Characteristics and Treatment Bipolar Disorders

Bipolar Behaviors Mania Abnormal elevated mood Described as expansive or irritable Normally requires inpatient treatment Hypomania Less severe than mania Lasts at least 4 days Accompanied by 3 to 4 clinical findings of mania Hospitalization may not be necessary Client is less impaired Mixed Episode Manic and major depression experienced simultaneously Impaired functioning May require hospitalization (self harm or other violence) Rapid Cycling Four or more episodes of mania in 1 year

Data Collection Bipolar Disorders Risk Factors Physical illness Substance abuse (cocaine / methamphetamine) Relapse Substance use (alcohol, drugs, caffeine) May lead to manic episode Sleep disturbances Before, associated with, or brought on by manic episode Standardized Screening Tool Mood Disorders Questionnaire (see handout)

Clinical Manifestations Bipolar Disorders Manic CharacteristicsDepressive Characteristics Persistent elevated mood (euphoria) Agitation and irritability Dislike of interference Intolerant of criticism Increased talking and activity Flight of Ideas rapid/continuous speaking with frequent topic changes Grandiose view of self and abilities Impulsive Demanding / manipulative Distracted easily Poor judgment Attention-seeking behavior Impaired social and occupational function Decreased sleep Neglect ADLs Possible delusions / hallucinations Denial of illness Flat/blunted affect Tearful Lack of energy Anhedonia (loss of pleasure/lack of interest) Discomfort or pain Difficulty concentrating / problem solving / focusing Self-destructive behavior Loss or increase of appetite Loss or increase of sleep Disturbed sleep Psychomotor retardation / agitation

Nursing Care Bipolar Disorders Based on the phase of mania clients are experiencing Acute Phase Focused on safety and maintaining physical health Therapeutic Milieu (in acute care setting) Provide safe environment Evaluate for suicidal thoughts, escalating behavior Decrease stimulation Follow protocols for restraints/observations/seclusion 1:1 if threat of self-injury or harm to others Frequent rest periods Provide physical outlets Short activities No high level concentration or detailed instructions Monitor and maintain self-care needs Monitor sleep / fluid intake / nutrition Provide nutritious foods to eat on the run Supervise clothing choices Give step-by-step reminders Encourage independence Communication Use calm and specific approach Give concise instructions and explanations Provide consistency among staff members Avoid power struggles Dont react personally to clients comments List and act on legitimate grievances Reinforce non-manipulative behaviors

Medications (examples) Bipolar Disorders Mood Stabilizers (Lithium carbonate - Eskalith) Narrow therapeutic range = potential for toxicity! (requires regular lab draws and testing) What is a safe, effective dose for one person may be toxic to another. According to the US Food and Drug Administration (FDA), in general the desirable level is 0.6 to 1.2 mEq/L. However, they point out, "Patients unusually sensitive to Lithium may exhibit toxic signs at serum levels below 1 mEq/L. Antiepileptic Agents (Depakote, Klonopin, Lamictal, Neurontin, Topamax) Act as mood stabilizers Benzodiazepine (Ativan) Short term for addressing sleep impairment related to mania Antidepressant (Prozac) Manage MDD Antipsychotic (Risperdal) Manage psychotic disturbances during mania

Other Treatment / Discharge Care Bipolar Disorders ECT Used to subdue extreme manic behavior Particularly used when medications have not worked Can also be used for suicidal client or for rapid cycling *See nursing actions related to ECT in prior slide Care after Discharge Management of continuation and maintenance phases Recommend case management to follow client Encourage group, family, and individual psychotherapy Improve problem-solving and interpersonal skills Reinforce teaching regarding Chronic nature of the disorder Need for long-term pharmacological and psychological support Factors of relapse Importance of maintaining sleep, nutrition and activity pattern Medication administration and adherence to regimen

Outcomes and Complications Bipolar Disorders Outcomes Client will refrain from self harm Client will rest 4 to 6 hours / night Client will maintain adequate fluid and nutrition intake Client will use appropriate communication skills to meet needs Client will participate in self-care Client will not experience relapse Complications True manic episode client will not stop moving, does not want to eat, drink, or sleep Episodes can last for weeks to months Greater risk for psychotic episodes when manic Can become a medical emergency Nursing actions include: Prevent harm to client or others Decrease physical activity Promote fluid and food intake Ensure 4 6 hours of sleep / night Manage medication

Quick Quiz! A client who has Bipolar I disorder is in the acute phase and unable to eat or sleep. The clients moods change rapidly from elated to agitated. If this client threatens to hit a staff member or another client, which of the following verbal response by the nurse is appropriate? A. You will be put in seclusion and kept there if you make any more threats. B. Do not hit him or me. If you cannot control yourself, we will help you. C. Thats enough! You know we do not tolerate this type of behavior. D. That will only make things worse. Why would you want to hurt someone?

Quick Quiz! A client who has Bipolar I Disorder is standing with a group of clients in the mental health unit. The client is talking excitedly and at great length about a variety of topics. The nurse can see that the other clients are becoming anxious and restless, but do not know what to do to stop the conversation. Which of the following is the first action the nurse should take? A. Give honest feedback B. Administer a sedative C. Set limits D. Use distraction

Paranoid Disorganized Catatonic Residual Undifferentiated

Schizophrenia Group of psychotic disorders Affect thinking, behavior, emotions, and ability to perceive reality May result from combination of genetic and non-genetic factors Brain injury at birth Nutritional factors Viral infection Hormonal imbalances Typical onset in late teens/ early 20s Has occurred in young children Diagnosis should not be made for children < 7 years Rule out ADHD with violent tendencies May begin later in adulthood Becomes problematic when clinical manifestations interfere with relationships, self-care, ability to work

Categories / Taxonomies Schizophrenia Type of SchizophreniaCommon Symptoms Paranoid Characterized by suspicion toward others Hallucinations (auditory hearing voices) Delusions (false/fixed beliefs) Other directed violence may occur Disorganized Characterized by o Withdrawal from society o Very inappropriate behaviors (poor hygiene / mutter to self) o Frequently seen in homeless population Loose associations Bizarre mannerisms Incoherent speech Hallucinations and delusions o Less organized than in paranoia Catatonic Characterized by abnormal motor movements Stages o Withdrawn o Excited Withdrawn Stage Psychomotor retardation may appear comatose Waxy flexibility Often have extreme self-care needs o Tube feeding unable to eat Excited Stage Constant movement / unusual posturing/ incoherent speech Self-care needs may predominate May be danger to self or others Residual Active clinical manifestations no longer present Two or more residual findings Anergia/ Anhedonia / Avolition Withdrawal from social activities Impaired role function Speech problems (Alogia) Odd behaviors (strange walking) Undifferentiated Clinical manifestations of schizophrenia but do not meet criteria for any other types Any positive or negative symptoms may be present

Other Psychotic Disorders Schizoaffective Disorder Criteria for Schizophrenia plus one of the affective disorders Depression / mania / mixed disorder Client often in acute phase of Bipolar I with psychosis characteristics Brief Psychotic Disorder Clinical manifestations last between 1 day and 1 month Schizophreniform Disorder Clinical manifestations of Schizophrenia Duration 1 to 6 months Social dysfunction may or may not be present Sometimes Dx used until further evaluation can be made Shared Psychotic Disorder One person begins to share beliefs of another with psychosis. Also called folie a`deux Secondary (induced) Psychosis Brought on by medical disorder (Ex: Alzheimers) Can be caused by use of chemical substances

Watch a Video What It's Like to Hear Voices (Schizophrenia) use headphones for best experience http://www.youtube.com/watch?v=0vvU-Ajwbok

Watch a Video I Hear Voices - A Story on Schizophrenia http://www.youtube.com/watch?v=KBRAC4acr70

Characteristics and Behaviors Schizophrenia CharacteristicsExamples of Behaviors Positive Symptoms Easily identified clinical manifestations Hallucinations Delusions Speech alterations Bizarre behavior (ex: walking backward constantly) Negative Symptoms Manifestations more difficult to treat than positive symptoms Affect (blunted) Algoia (may only respond vaguely or mumble) Avolition (lack of motivation) o Can complete a task and unable to start the next one without prompting Anhedonia (lack of pleasure or joy) Anergia (lack of energy) Cognitive Symptoms Problems thinking Makes independent living difficult Disordered thinking Unable to make decisions Poor problem-solving Difficulty concentrating Memory deficits Depressive Symptoms Hopelessness Helplessness Suicidal Ideation

Types of Delusions DelusionsExamples Ideas of Reference Misconstrue trivial events Attach personal significance to events Believing others are talking about them Persecution Feeling singled out for ham by others Grandeur Believe they are all powerful and important Somatic Delusions Believe that body is changing in unusual way o Growing a third arm Jealousy Feel spouse is involved with someone else Being Controlled Believe outside forces control them Thought Broadcasting Believe their thoughts are heard by others Thought Withdrawal Believe thoughts have been removed from their mind by someone/something else Religiosity Obsessed with religious beliefs

Examples of Alterations in Speech, Perception, Behavior Schizophrenia Flight of ideas Associative looseness May say sentence after sentence Sentences may relate to several topics Listener is unable to follow Neologisms Made up words Words only have meaning to the client Ex: I trangled and flitted Echolalia Repeating words spoken to them Clang Association Meaningless rhyming words (often forceful) Ex: Oh fox, box, and lox Word Salad Words jumbled together Little meaning or significance Ex: Hip hooray, the flip is cast and wide- sprinting in the forest Alterations in Speech Alterations in Perception Hallucinations Auditory (hearing things) Visual (seeing things) Olfactory (smelling odors) Gustatory (tasting things) Tactile (feeling sensations) Alterations in Behavior Extreme agitation Stereotyped Behaviors Automatic Obedience Wavy Flexibility Stupor Negativism Echopraxia (imitates movements of others) Personal Boundary Difficulties Depersonalization feeling of losing identity Derealization feeling the environment has changes

Screening Tools Schizophrenia Global Assessment of Function (GAF) Scale Helps determine ability to perform ADLs and function independently Scale for Assessment of Negative Symptoms (SANS) Simpson Neurological Rating Scale *** See Handouts!

Nursing Care Schizophrenia Use Milieu Therapy Promote therapeutic communication Establish trusting relationship Encourage development of social skills and friendships Encourage participation in group work and psychotherapy Determine discharge needs Relate wellness to symptom management Collaborate with client Symptom management techniques Encourage medication compliance Reinforce teaching regarding medications Communication Ask client directly about hallucinations and delusions Dont argue or agree May say: I dont hear anything, but you seem frightened (hallucination) May say: I cant imagine that the President would have a reason to kill a citizen, but it must be frightening for you to believe that (delusion) Provide safety Focus on reality based subjects Identify symptom triggers Be genuine and empathetic

Internet Moment Search this! Extrapyramidal Side Effects What did you find? Write it down and bring it to class for discussion

Medications Schizophrenia

Care after Discharge and Client Outcomes Schizophrenia After Discharge Client Outcomes Recommend case manager to follow Encourage group, family, and individual psychotherapy Improve problem-solving / interpersonal skills Reinforce teaching Need for self care to prevent relapse Medication Effects Side effects Compliance Importance and resources for support groups Drug and alcohol abstinence Journaling Monitor effectiveness of meds Journal feelings and changes in behavior Client will regularly attend support groups Client will maintain an appropriate level of self-care Client will maintain medication adherence

Quick Quiz! Positive symptoms of Schizophrenia include which of the following? _____Auditory hallucinations _____Lack of motivation _____Minimal to no energy _____Delusions of persecution _____Motor agitation _____Flat affect

Quick Quiz - Matching Answer Schizophreniform DisorderAPsychotic symptoms caused by abuse of chemical substances or physical illness Schizoaffective DisorderB An absence of active symptoms of schizophrenia with two or more persistent or lingering symptoms Shared Psychotic DisorderC Psychotic behavior lasting between 1 and 6 months that may not impair the clients ability to function at work or in social situations Residual SchizophreniaDSymptoms of schizophrenia along with symptoms of mania or major depression Induced PsychosisEOne person sharing the delusional beliefs of a person who has psychosis

Psychobiological Disorders

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Documents

alcohol slide

risk factors anxiety

traumatic event fear

mental health nursing

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fear of strangers

anxiety response

attack agoraphobia fear