Final Exam Blueprint Psych 335 PDF

Preview

Summary

Final exam filled out blueprint...

Description

NURS 335 Spring 2020 Final Exam Study Guide (80 Multiple Choice, Select all that apply) Introduction/ History and Legal Aspects of Mental Illness (approx. 10 Questions) ● DSM definition of mental disorder/ illness ○ Characterized by clinically significant disturbance in an individual’s cognition, emotional regulation, or behavior that reflects a dysfunction in psychological, biological, or developmental processes underlying mental functioning ○ Usually associated with significant distress or disability in social, occupational, or other important activities ○ Mental disorder is NOT ■ Expectable or culturally approved response to a common stressor or loss ■ Socially deviant behavior (political, religious, or sexual) ● Major historical landmarks/ key players/advances in treatment and medicine (Pinel, Bedlam, etc) ○ Prehistoric – primitive, crude magical, religious explanations and interventions ■ Trepanning – bore a hole into the human skull to expose dura mater to treat inter cranial diseases (demons/infections) ○ Greek and roman civilizations ■ Hippocrates – era of organic explanation ■ Treatments = a balanced diet and lifestyle ■ Described - Melancholia – apathy where you don’t care about things - Mania – hyperactivity - Phobia – fears of things ■ Created the four humors based on personality traits o Sanguine – pleasure seeking and sociable o Choleric – ambitious and leaderlike o Melancholic – analytical and thoughtful o Phlegmatic – relaxed and quiet o Middle ages ● Magico-religious explanation – divine energy in combination with human energy can cause concrete changes (middle ages magic ages) ● Care of the mentally ill revolved around family/community ● Treatments – beatings, exorcisms, sudden shocks, purging, fasting, bloodletting ● Muslim, Persian, and Arabian cultured held more enlightened attitudes and established the first asylums o 15-17th century (brutal and inhumane) ● Mentally ill dumped in with “undesirables” (socially abandoned and excluded) ● Committed to asylums, workhouses, poorhouses, jails ▪ Highly unregulated ▪ Confinement, restraint, harsh treatment, chains, beating, barbaric ● Demonic possession in need of catharsis = ice bath until unconscious, vomiting, bleeding ● BEDLAM – infamous for brutal treatment, chained to walls for 12 years ▪ Mentally ill, criminals, and communicable diseases all together o Era of enlightenment? ● Strict but firm, nonviolent, nonmedical approach, “mora treatment” ● Philippe Pinel ▪ French physician turned psychiatrist after a friend suicided ▪ Thought the roots of mental illness were social and environment ▪ Big shift from magic

● Dorothea Dix ▪ American activist for indigent population of mentally ill (Dix indigent) ▪ Superintendent of the union of army nurses in the civil war ● Benjamin Rush ▪ Pennsylvania hospital – saw bad conditions and led a successful campaign to create a separate mental ward ▪ Father of American psychiatry – published first textbook on it in US ▪ Incorrectly believed that mental illness was caused by disruptions of blood circulation or sensory overload ● Treatment = improved circulation to the brain (venture fugal, spinning board, centrifuge, restraining chair, sensory deprivation) th o 20 century ● Asylums ฀ hospitals ● Inmate ฀ patient ● Lunacy ฀ mental illness ● Lines of thinking regard etiology ● Psychological and neurophysiologic explanations: Sigmund Freud ● Eugenics – bio social movement advocates practices to improve genetic composition of a population (social philosophy) (GATTACA movie) ● Mental hygiene movement – emergence of disciplines ▪ Aim is the promotion and preservation of mental health, concerned with the prevention of mental disease, defect and delinquency as general public health ● WWII ▪ US soldiers returning home ▪ Treatments: lobotomy, insulin shock therapy, electroconvulsive therapy (ECT) ▪ Walter freeman – “icepick” lobotomy first performed 1945 ● 1949 – national institutes of mental health established ● 1950s – era of psychopharmacology (antipsychotics) ● 1960s – deinstitutionalization and community mental health movements ● 1990s – decade of the brain o 21st century o Increased understanding of biological and genetic origins o Role of epigenetics, advances in brain imaging/mapping ▪ Changes in a chromosome without alterations in DNA sequence ● Voluntary admission/ Involuntary admission/72 hour notice ○ Voluntary admission – person applies in writing to enter hospital for treatment, patient gives consent to be treated ■ Discharge: typically, collaboratively determined with psychiatrist, must be provided in writing ■ Psychiatrist has 72 hours to hold client until full psychiatric evaluation can be performed ■ AMA: against medical advice (does not exist in psychiatric hospitals) ○ Civil (involuntary) commitment – set of procedures enabling system to deprive person of his liberty through detainment in a mental hospital, even though he broke no laws, because he is a danger to himself or others, or unable to care for self ■ Cannot extend beyond 72 hours without a formal hearing, this 3 day period allows patients to receive basic medical treatment, recover from a psychotic episode, and understand need for further help ■ Aka certifying ■ Court hearing to continue civil (involuntary) commitment within 8 days o Patient has right to counsel/attorney

o Judge examines evidence of need for continued hospitalization up tot 3 months, court at 3 months, then every 6 months thereafter ● Key features for admission ○ Civil (involuntary) commitment -danger to himself or others, unable to care for self ● Patient rights ○ To communicate with others (send a receive mail, visitors) ○ To keep personal effects (except if considered contraband) ○ To religious freedom ○ To execute wills ○ To manage property ○ To make purchases ○ To habeas corpus ○ To sue or be sued ○ To marry and divorce ○ To independent exam ○ To education ○ To legal representation ○ To privacy ○ To treatment ○ To refuse treatment (except in emergency situations) ○ To least restrictive setting ○ To review of status ○ To enter contracts ○ Adequate staff, least restrictive setting, in privacy, in a facility that provides a comfortable bed, adequate diet and recreational facility ● Confidentiality – pt rights ○ Right to keep personal info private (HIPAA)(PHI) ○ Must have written consent, otherwise, “I cannot confirm or deny the presence of that individual on this unit.” ○ Privileged communication ■ Legal term to describe discourse between client and his lawyer, physician, therapist, and priests ■ Cannot be divulged unless permitted by client ■ Past deeds confidential; future acts can be reported under conditions ● Confidentiality – limitations ○ Danger to self, others ○ Child abuse/elder abuse/neglect ○ Duty to warn / duty to protect ■ Tarasoff vs. Regents of U.C. – psychiatrist killed by ex-patient Nursing Process/ Groups/ Nurse-Client Relationship/ Therapeutic Communication (approx. 15 Questions) ● Safety assessment ○ Suicide/homicide assessment check for ideation ■ Plan, means, intent, risk factors

● MSE/ MMSE– all components, assessments ○ Mental Status exam (MSE) – snapshot of current functioning ■ General observations (appearance, speech, behavior, cooperativeness) ■ Thinking (thought process, thought content, perceptions) ■ Emotion (mood, affect) ■ Cognition (orientation/attention, memory, insight, judgement) ■ Level of consciousness, level of orientation, appearance, degree of cooperation, eye contact, speech, motor behavior, thought process, thought content (preoccupations, obsessions, compulsions, delusions, suicidal/homicidal ideation), mood/affect, perceptions, judgement, insight, impulse control, memory (immediate, recent, remote), attention, fund of knowledge, level of abstraction ○ Can augment with MMSE (mini-mental status exam), 30 point quiz ■ Orientation, visuospatial, registration/working memory, attention, calculation, recall, language ■ Score of 23 or less indicates cognitive disturbance ● Phases of nurse-client relationship development ○ Pre-interaction phase ■ Nurse gathers data and engages in a period of developing self-awareness and an objective perspective BEFORE MEETING PATIENT ○ Orientation (introductory phase) ■ Meet patient, establish rapport, and relationship ■ Formal/informal contract o Informal = they agree to talk to you o Formal = consent for treatment o Working phase o Maintain therapeutic relationship, gain more information, promote client insight, evaluate problems and goals, adaptive behaviors o Termination phase o Summarize goals and objectives, discuss new coping strategies, future plans ● therapeutic v. nontherapeutic communication ○ Therapeutic communication ■ Nonverbal – active listening, sit squarely, open posture, lean forward, establish eye contact, relax ■ Respond with – empathy, respect, genuineness, immediacy, warmth, open-ended ■ Techniques o Silence o General leads o Restating/paraphrasing o Reflecting o Seeking clarification/focusing o Making observations o Imparting information o Acknowledging o Presenting reality o Summarizing/planning o Giving feedback o Offering self o Confronting (in some cases)

o Nontherapeutic communication o Being a cheerleading or offering reassurance o Giving advice o being “parent” ego state, having client as “child” ego state o stereotyped comments o approving or disapproving (watch nonverbals) o techniques ▪ interrogating/probing ▪ defending ▪ requesting an explanation (“Why?”) ▪ introducing an unrelated topic ▪ belittling expressed feelings/giving unwarranted reassurance ▪ making stereotyped comments ▪ confronting (in some cases) ● Transference/Countertransference ○ Transference – patient unconsciously displaces onto nurse/therapist things that have happened to them in the past ■ May be triggered by something ■ Can also take form of overwhelming affection/dependency on nurse ○ Countertransference – nurse’s behavioral and emotional response to the patient ■ May be due to unresolved feelings towards SO from nurse’s past or may be general in response to transference feeling ■ Emotional reaction of nurse towards the patient ● Group therapy – Yalom’s curative/ therapeutic factors, leadership styles ○ Yalom’s 11 therapeutic factors ■ Instillation of hope ■ Universality – they are not alone ■ Altruism – concern for happiness for others, selflessness, helping others, feel useful ■ Corrective recapitulation of family group ■ Development of social skills ■ Imitative behavior – acting like better functioning group members ■ Interpersonal learning – finding out about themselves and others ■ Group cohesiveness ■ Catharsis – emotional release, relief of unconscious conflicts, opportunity for expression and strong affect ■ Existential factor – people in group can start to accept responsibility for their QOL ● Group member roles ○ Task Roles ■ Coordinator – clarifies ideas and suggestions, brings together to pursue common goals ■ Evaluator – examines group plans and performance, measuring against group goals ■ Elaborator – explains and expands upon group plans and ideas ■ Energizer – encourages and motivates group ■ Initiator – outlines task at hand and proposes methods for solution ■ Orienter – maintains direction within the group ○ Maintenance Roles ■ Compromiser – relieves conflict ■ Encourager – offers recognition and acceptance to others ■ Follower – listens attentively, passive participant

■ Gatekeeper – encourages acceptance and participation by all members ■ Harmonizer – minimizes tension by intervening ○ Individual (personal) roles ■ Aggressor – negative, hostile, and degrading, expressing disapproval ■ Blocker – stubbornly resists, disagreeing and opposing beyond reason ■ Dominator – tries to assert authority or superiority in manipulating the group ■ Help-seeker – calls forth a sympathy response ■ Monopolizer – dominates conversation ■ Mute/silent member ■ Recognition- seeker – seducer, works in various ways to call to attention towards self, does not want to seem inferior

● Group development/ phases ○ Phase 1 – initial/orientation phase ■ Group activities – develop rules, goals, norms ■ Leader expectations – orient members, promote trust, ensure rules are equally enforced ■ Member behaviors – fear/withholding, pleasing leader and other members o Patients try to control what is happening more in initial phase ■ Structure: introduce self and topic, introduce group members/ice breaker, establish rules ○ Phase II – middle/working phase ■ Group activities – cohesion, problem solving, sharing ■ Leader expectations – role faces, group takes more responsibility, promote conflict resolution, guide discussion as needed ■ Member behaviors – ability to give and receive feedback, can have subgroups, conflict ■ Structure – psychoeducation about the specific topic, related activities, skills building and hands on ○ Phase III – final/termination phase ■ Group activities – depending how cohesive will have sense of loss ■ Leader expectations – encourage reminiscence, review goals and outcomes, discuss loss ■ Member behaviors – sharing/appreciation, attempts to prolong the connection, anger, regression can be present ■ Structure – process group reaction, summarize ● General therapeutic factors – importance ○ Establish rapport, and trust, maintain confidentiality, demonstrate respect and empathy, establish and maintain appropriate professional boundaries Theoretical Perspectives (approx. 5 Questions) ● Interpersonal theory – key points ○ Human behavior evolves in the context of interpersonal relationships, family and SO ○ focus on the early parent-child relationship as a source of psychopathology ■ emphasis on need for sense of security, not sexual desires ○ Anxiety = result of interpersonal interactions ● Family systems – key points, terminology, implications for tx ○ Individual pathology is rooted in larger family system, members interaction influence others behavior, views family as a unit ○ Identified patient’s behavior maintains family homeostasis, redefines problem in family terms ○ Terminology

■ Genogram – visual representation of family system relationships across generations representing emotional connections between members (ex. Divorced, married) ■ Fusion vs. cutoff o Fusion = decisions depend on what others think and whether the decision will disturb the fusion of the existing relationship o Emotional cut-off = people managing their unresolved emotional issues with others by reducing or cutting off emotional contact with them ■ Triangles = smallest stable relationship system, involving a third person, two comfortable insiders and one uncomfortable outsider, getting a third person involved in your conflict ■ Boundaries = enable healthy separate lives (ex. Parents share confidences and sexual intimacy with one another that is not shared with children) ■ Loyalties, allegiances, secrets = unconsciously drives behavior between parties ○ Treatment goal: differentiation of self (separate, but related) ■ Ability to separate feelings and thoughts, thinking logically and basing their responses on that, not feelings ■ Separating own feelings from other’s, not looking to their family to define how they feel about issues, people, and experiences ● Behavioral theory “learning theory” ○ “learning theory” = assumption: all behavior is learned ○ Abnormal behavior is learned following the same principles as normal behavior ○ If all behavior is learned, behaviors can be unlearned ○ Types of learning ■ Classical conditioning o Unconditioned stimulus ฀ unconditioned response o Conditioned stimulus ฀ conditioned response o Pavlov’s dog = learned that tuning fork means food ■ Operant conditioning – any action followed by positive sensations will recur - use of reinforcers (money, food) and punishers - reinforcement increases behaviors, punishment decreases behavior ● Positive reinforcement – add something to increase behavior ● Negative reinforcement – take away something to increase behavior ● Positive punishment – add something to decrease behavior ● Negative punishment – take away something to decrease behavior ○ Goal: prediction and control of behavior ○ behavioral assessment ■ Antecedent ฀ Behavior ฀ consequence ■ Antecedent o What tends to precede or provoke the behavior? o What need might be unmet? o What might the patient be attempting to communicate? ■ Behavior o What exactly is the behavior in question? o Is it dangerous? If so, how? ■ Consequence o What follows the behavior that may serve to perpetuate it? ○ behavioral techniques ■ prolonged exposure, cognitive behavioral therapy, desensitization, aversion therapy ● Cognitive – key points, distortions, learned helplessness, triad ○ “men are not disturbed by things, but by the views which they take them”

○ Assumption: thoughts are a critical link between emotions and behaviors ○ Reality vs. perception of reality ○ Interpretation of environmental stimuli and how these transformed stimuli affect emotional functioning ○ Underlying dysfunctional beliefs are identified through surface cognitions (automatic thoughts) that are distorted – perception of situations ■ Goal: uncover and reformulate dysfunctional beliefs ○ Distortions – common thinking errors ■ Magnification ■ Minimization ■ Personalization ■ Mind-reading ■ All-or-nothing thinking ■ Generalization ○ Triad – self/world/future ■ three forms of negative thinking typical of individuals with depression: negative thoughts about the self, the world and the future. These thoughts tended to be automatic in depressed people as they occurred spontaneously ○ Learned helplessness, strong influence on depression ■ depression occurs when a person learns that their attempts to escape negative situations make no difference Biological Aspects of Mental Illness (approx. 5 Questions) ● Brain structures and responsibilities - QUIZLET ○ LOBES ■ Cerebral cortex – thin layer of gray matter covering the brain (cerebrum) ■ Parietal lobe – internal GPS, pressure, pain, temperature, proprioception, sensory integration to control movements, special mapping, visuomotor guidance o Dysfunction o Apraxia – inability to have purposeful body movement o Agnosia – inability to recognize people, objects, sounds, shapes, smell ■ Temporal lobe –memory consolidation, long term storage of sensory input and integration ■ Frontal lobe (motor cortex) – VOLUNTARY movement ■ Frontal lobe (prefrontal cortex) – cognitive functions, regulation and adaptation of our emotions to new situations, orchestration of thoughts and actions in accordance with goals, planning, decision making, motivation, multitasking, transitions, social behavior, personality o More vulnerable to brain damage ■ Occipital lobe – vision, special relationships such as distance ○ Limbic system “emotional primitive brain” ■ Mediation of emotion, can override irrational thought, regulate fear and aggression ■ Amygdala – processing novel and ambiguous emotional stimuli (fear, anxiety, panic) ■ Hippocampus – memory storage ■ Thalamus – relay sensory signals and pain perception ■ Hypothalamus – control autonomic and endocrine systems via pituitary gland ○ Forebrain = cerebrum, diencephalon ■ Processes sensory information, helps with reasoning, problem solving, regulates autonomic, endocrine and motor functions ■ Cerebrum’s surface consists of gray matter and is called cerebral cortex ○ Midbrain = mesencephalon ■ Regulates movement and processes auditory and visual information

■ Integrates visual, auditory, and righting (balance, keeping head up) reflexes ○ Hindbrain = pons, medulla, cerebellum ■ Relays sensory information, coordinates movement, maintains balance and equilibrium ■ Pons – transmits messages between various parts of nervous system, associated with sleep and dreaming ■ Medulla – regulates HR, BP, and respiration, reflex center for swallowing, sneezing, coughing, vomiting ■ Cerebellum – involuntary aspects of movement coordination, muscle tone, posture, equilibrium ○ Corpus callosum – connects right and left hemispheres by a band of nerve fibers, involved in conscious thought and language, cerebral cortex contains the hemispheres Function LEFT hemisphere RIGHT hemisphere Visual Letters, words Complex geometric patterns, facial recognition auditory

Language related sounds

Music and other non-language sounds