MENTAL HEALTH EXAM 2

FUNDAMENTAL SIGNS OF SCHIZOPHRENIA THE FOUR As

AFFECT

THE OUTWARD MANIFESTATION OF A PERSONS FEELINGS AND EMOTIONS; FLAT,

BLUNTED, INAPPROPRIATE, OR BIZARRE

ASSOCIATIV
E
LOOSENESS

DISORGANIZED THINKING, MANIFESTED AS JUMBLED AND ILLOGICAL SPEECH, AND

IMPAIRED REASONING IS DISPLAYED. ALSO KNOWN AS LOOSENESS OF
ASSOCIATION

AUTISM

THINKING IS NOT BOUND TO REALITY BUT REFLECTS THE PRIVATE PERCEPTUAL

WORLD OF THE INDIVIDUAL; DELUSIONS, HALLUCINATIONS, AND NEOLOGISMS

AMBIVALEN
CE

SIMULATANEOUSLY HOLDING TWO EMOTIONS, ATTITUDES, IDEAS, OR WISHES

TOWARD THE SAME PERSON, SITUATION OR OBJECT

PSYCHOTIC DISORDERS
SCHIZOPHRENI
FORM
BRIEF
PSYCHOTIC
SCHIZOAFFECTI
VE

DELUSIONAL

SHARED
PSYCHOTIC
FOLIE A
DEUX

ESSENTIAL FEATURES EXACTLY THOSE OF SCHIZOPHRENIA.

DURATION AT LEAST 1 MONTH BUT LESS THAN 6 MONTHS

IMPAIRED SOCIAL OR OCCUPATIONAL DURING SOME PART IS NOT

APPARENT BUT MAY OCCUR

MIGHT OR MIGHT NOT HAVE A GOOD PROGNOSIS

SUDDEN ONSET OF PSYCHOTIC SYMPTOMS (DELUSIONS, HALLUCINATIONS,
DISORGANIZED SPEECH) OR GROSSLY DISORGANIZED CATATONIC BEHAVIOR

LASTS AT LEAST 1 DAY BUT LESS THAN 1 MONTH

OFTEN FOLLOWS EXTREMELY STRESSFUL LIFE EVENTS

RETURNS TO PREMORBID LEVEL OF FUNCTIONING

CHARACTERIZED BY AN UNINTERRUPTED PERIOD OF ILLNESS DURING WHICH
THERE IS A MAJOR DEPRESSIVE, MANIC, OR MIXED EPISODE THAT MEETS
CRITERIA FOR SCHIZOPHRENIA

SYMPTOMS MUST NOT BE DUE TO SUBSTANCE USE/ABUSE OR GENERAL

MEDICAL CONDITION
INVOLVES NON-BIZARRE DELUSIONS OF AT LEAST 1 MONTHS DURATION AND
ABILITY TO FUNCTION IS NOT MARKEDLY IMPAIRED, NOR IS THE PERSONS
BEHAVIOR OBVIOUSLY ODD OR BIZARRE.

DELUSIONS OF GRANDEUR, PERSECUTION, OR JEALOUSY

SOMATIC OR MIXED DELUSIONS

A SHARED PSYCHOTIC DISORDER. INDIVIDUAL IN A RELATIONSHIP WITH
ANOTHER WHOM HAS A PSYCHOTIC DISORDER WITH A DELUSION. THE TWO
COME TO SHARE DELUSIONAL BELIEFS IN TOTAL OR IN PART. APART FROM THE
SHARED DELUSION, THE PERSON WHO TAKES ON THE DELUSIONAL BEHAVIOR
IS NOT OTHERWISE ODD OR UNUSUAL. IMPAIREMENT OF THE PERSON WHO
SHARES THE DELUSION IS USUALLY MUCH LESS THAN THE PERSON WITH THE
PSYCHOTIC DISORDER WITH THE DELUSION. CULT PHENOMENONS SUCH AS
WACO AND JONESTOWN ARE EXAMPLES.

BIOLOGICAL FACTORS
TYPE
GENETIC

1 | Page

INFO
GENERAL POPULATION 1%
FIRST DEGREE RELATIVE 10%
MORE COMMON WITH
RELATIVES
IDENTICAL TWINS 50%,
FRATERNAL 15%

RELEVANT
GENES ON DIFFERENT
CHROMOSOMES INTERACT IN
COMPLEX WAYS TO CREATE
VULNERABILITY TO
SCHIZOPHRENIA

MENTAL HEALTH EXAM 2

DOPAMINE THEORY

OTHER NEUROCHEMICAL
HYPOTHESIS

BRAIN STRUCTURE
ABNORMALITIES

DRUGS THAT BLOCK THE ACTION

OF DOPAMINE RECEPTORS
REDUCE SOME SYMPTONS OF
SCHIZOPHRENIA. DRUGS THAT
INCREASE ACTIVITY MAY
PRECIPITATE ONSET IN
BIOLOGICALLY SUSCEPTIBLE
PERSONS OR EXACERBATE IT
WHEN ALREADY PRESENT.

FIRST GENERATION
ANTIPSYCHOTICS (TYPICAL)
HALDOL & THORAZINE
BECAUSE DOPAMINE BLOCKING
DONT ALL SYMPTOMS THE
DOPAMINE HYPOTHESIS IS NO
LONGER CONSIDERED RELEVANT
SECOND GENERATION
ANTIPSYCHOTICS
(ATYPICAL)

BLOCK THE ACTION OF

DOPAMINE AND SEROTONIN

DETECTED WITH CT, MRI, PET

SCANS
REDUCED CORTICAL, FRONTAL
LOBE, HIPPOCAMPAL AND
CEREBELLAR VOLUMES
INCREASED SIZE OF SULCI ON
SURFACE
ENLARGED VENTRICLES /
ASSYMETRY

DISRUPTION IN THE
COMMUNICATION PATHWAYS OF
THE BRAIN. STRUCTURAL

ABNORMALITIES

PHASES OF SCHIZOPHRENIA
PHASE

ACTION

INTERVENTION

ACUTE

ONSET OR EXACERABTION OF FLORID,

DISRUPTIVE SYMPTOMS (HALLUCINATIONS,

APATHY, WITHDRAWAL) WITH RESULATANT LOSS

OF FUNCTIONAL ABILITIES; INCREASED CARE OR

HOSPITALIZATION MAY BE REQUIRED

STABILIZATI
ON

SYMPTOMS ARE DIMINISHING, MOVEMENT

TOWARD ONES PREVIOUS LEVEL OF
FUNCTIONING (BASELINE); DAY HOSPITALIZATION
OR CARE IN A RESIDENTIAL CRISIS CENTER OR A
SUPERVISED GROUP HOME MAY BE NEEDED

MAINTENAN
CE

2 | Page

OVERALL GOAL IS PATIENT

SAFETY.
PSYCHIATRIC, MEDICAL,
NEUROLOGICAL
INTERVENTION
PSYCHOPHARMACOLOGICAL TX
SUPPORT, PSYCHOEDUCATION,
AND GUIDANCE
SUPERVISION AND LIMIT
SETTING IN MILIEU (Milieu
Therapy- environment of the
patient)
THREE PRONGED APPROACH
MED ADMIN / ADHERENCE
NURSING INTERVENTION
COMMUNITY SUPPORT
FAMILY PSYCHOEDUCATION, KEY
ROLE OF NURSE. ALL
INTERVENTIONS AND
STRATEGIES GEARED TOWARD
PATIENTS STRENGTHS,
CULTURE, PERSONAL
PREFERENCES, AND NEEDS
OUTCOMES TARGET ABILITY TO
SUCCEED IN SOCIAL ,
VOCATIONAL, SELF CARE
ACTIVITIES

THE PATIENT IS AT OR NEARING BASELINE (OR

PREMORBID) FUNCTIONING; SYMPTOMS ARE
MAINTAINING ACHIEVEMENT
ABSENT OR DIMINISHED; LEVEL OF FUNCTIONING PREVENTING RELAPSE
PROMOTING INDEPENDENCE
ALLOWS THE PATIENT TO LIVE IN THE
COMMUNITY. IDEALLY, RECOVERY WITH FEW OR
AND A SATISFACTORY QUALITY
NO RESIDUAL SYMPTOMS HAS OCCURRED. MOST
OF LIFE
AT THIS PHASE LIVE IN THEIR OWN RESIDENCES.

MENTAL HEALTH EXAM 2

SYMPTOMS OF SCHIZOPHRENIA
TYPE

POSITIV
E

DEFINITION
THE PRESENCE OF
SOMETHING THAT IS
NOT NORMALLY
PRESENT

SYMPTOMS

NEGATI
VE

COGNITI
VE

AFFECTI
VE

THE ABSENCE OF
SOMETHING THAT
SHOULD BE PRESENT
BUT IS NOT

HALLUCINATIONS
DELUSIONS
BIZARRE BEHAVIOR
THOUGHT DISORDER
AND SPEECH
PATTERNS
INNAPPROPRIATE
AFFECT
AFFECTIVE FLATTENING
ALOGIA
AVOLITION
ANHEDONIA
ATTENTION DEFICITS
OTHER (INABILITY TO
READ EMOTIONS OR
INTENT

DIFFICULTY WITH:
ATTENTION
MEMORY
ABNORMALITIES IN
INFORMATION
HOW A PERSON THINKS
PROCESSING
COGNITIVE FLEXIBILITY
EXECUTIVE FUNCTIONS

SYMPTOMS INVOLVING
EMOTIONS AND THEIR
EXPRESSION

REDUCTION IN
EXPRESSION, RANGE
AND INTENSITY OF
AFFECT

BEHAVIOR
BOUNDARY DIFFICULTIES
ALTERATIONS IN
BEHAVIOR/APPEARANCE
ALTERATIONS IN SOCIAL/SEXUAL
BEHAVIOR

DISORGANIZED THINKING
DECREASED PROBLEM SOLVING
DECREASED VERBAL MEMORY

UNABLE TO:
MANAGE PERSONAL CARE
UNABLE TO HOLD A JOB
INITIATE OR MAINTAIN SUPPORT
SYSTEM
LIVE ALONE
ASSESSMENT FOR DEPRESSION
CRUCIAL
DEPRESSION
HERALDS RELAPSE
INCREASES SUBSTANCE ABUSE
INCREASES SUICIDE RISK
FURTHER IMPAIRS
FUNCTIONING

POSITIVE (HALLUCINATIONS/DELUSIONS) AND NEGATIVE

SYMPTOMS
OF SCHIZOPHRENIA
DEFINITION
HEARING VOICES OR SOUNDS THAT DO NOT EXIST IN
THE ENVIROMENT BUT ARE MISPERCEPTIONS OF THE
INNER THOUGHTS OR FEELINGS
FEELING STRANGE SENSATIONS ON THE SKIN WHERE
NO EXTERNAL OBJECTS STIMULATE SUCH FEELINGS;
COMMON IN DELIRIUM TREMENS
LACK OF ENERGY; PASSIVITY, LACK OF PERSISTENCE
AT WORK OR SCHOOL
BELIEVING ANOTHER PERSON DESIRES YOU
ROMANTICALLY
TASTING SENSATIONS THAT DO NOT EXIST
REDUCED MOTIVATION; INABILITY TO INITIATE TASKS
SUCH AS SOCIAL CONTACTS, GROOMING, AND OTHER
ADLS

3 | Page

SYMPTOM

+ OR -

AUDITORY

POSITIVE

TACTILE

POSITIVE

ANERGIA

NEGATIV
E

EROTOMANIC

POSITIVE

GUSTATORY

POSITIVE

AVOLITION

NEGATIV
E

MENTAL HEALTH EXAM 2

BELIEVING THAT ONE IS A VERY POWERFUL OR
IMPORTANT PERSON
BELIEVING THAT ANOTHER PERSON, GROUP OF
PEOPLE, OR EXTERNAL FORCE CONTROLS THOUGHTS,
FEELINGS, IMPULSES, OR BEHAVIOR
A REDUCTION IN THE EXPRESSION, RANGE AND
INTENSITY OF AFFECT
SEEING A PERSON, OBJECT, ANIMAL, COLORS, OR
VISUAL PATTERNS THAT DO NOT EXIST IN THE
ENVIRONMENT
BELIEVING THAT ONES MATE IS UNFAITHFUL
INABILITY TO EXPERIENCE PLEASURE IN ACTIVITIES
THAT USUALLY PRODUCE IT; RESULT OF PROFOUND
EMOTIONAL BARRENESS
GIVING PERSONAL SIGNIFICANCE TO TRIVIAL EVENTS;
PERCIEVING EVENTS AS RELATING TO YOU WHEN
THEY ARE NOT
REDUCED AMOUNT OF SPEECH, RESPONSES RANGE
FROM BRIEF TO ONE WORD ANSWERS
BELIEVING THAT THE BODY IS CHANGING IN AN
UNUSUAL WAY
A SUDDEN INTERRUPTION IN THE THOUGHT
PROCESSS, USUALLY DUE TO INTERNAL STIMULI
SMELLING ODORS THAT DO NOT EXIST
BELIEVING THAT ONE IS BEING SINGLED OUT FOR
HARM BY OTHERS; OFTEN MANIFEST AS A PLOT BY
PEOPLE IN POWER

GRANDEUR

POSITIVE

CONTROL

POSITIVE

AFFECTIVE
FLATTENING

NEGATIV
E

VISUAL

POSITIVE

JEALOUSY

POSITIVE

ANHEDONIA

NEGATIV
E

IDEAS OF
REFERENCE

POSITIVE

ALOGIA

NEGATIV
E

SOMATIC

POSITIVE

THOUGHT
BLOCKING
OLFACTORY

NEGATIV
E
POSITIVE

PERSECUTION

POSITIVE

ALTERATIONS IN SPEECH
NEOLOGISM
S
ECHOLALIA
ECHOPRAXI
A
CLANG
ASSOCIATIO
N
WORD
SALAD

MADE UP WORDS THAT HAVE MEANING FOR THE PATIENT BUT DIFFERENT OR
NONEXISTENT MEANING TO OTHERS
THE PATHOLOGICAL REPEATING OF ANOTHERS WORDS; OFTEN SEEN IN
CATATONIA
THE MIMICKING OF MOVEMENTS OF ANOTHER; OFTEN SEEN IN CATATONIA
THE CHOICE OF WORDS BASED UPON THEIR SOUND RATHER THAN THEIR
MEANING, OFTEN RHYMING AND SOMETIMES HAVING A SIMILAR BEGINNING
SOUND (ON THE TRACK..HAVE A BIG MAC); MAY BE SEEN IN NEUROLOGICAL
DISORDERS
A JUMBLE OF WORDS THAT IS MEANINGLESS TO THE LISTENER AND PERHAPS
THE LISTENER AS WELL BECAUSE OF AN EXTREME LEVEL OF DISORGANIZATION

ALTERATIONS IN PERCEPTION
4 | Page

MENTAL HEALTH EXAM 2

HALLUCINATIO
NS

A NONSPECIFIC FEELING THAT A PERSON HAS LOST HIS OR HER IDENTITY

AND THE SELF IS DIFFERENT OR UNREAL. BODY PARTS DONT BELONG TO
THEM OR BODY HAS DRASTICALLY CHANGED (FINGERS AS SNAKES, ARM AS
ROTTING WOOD)
A FALSE PERCEPTION THAT THE ENVIRONMENT HAS CHANGED. BIGGER,
SMALLER, FAMILIAR SURROUNDINGS HAVE BECOME STRANGE AND
UNFAMILIAR
PERCEIVING A SENSORY EXPERIENCE FOR WHICH NO EXTERNAL STIMULUS
EXISTS (VOICES)
Command hallucination-hurt themselves

ILLUSIONS

MISPERCEPTIONS OR MISINTERPRETATIONS OF A REAL EXPERIENCE (COAT

ON A RACK IS A BEAR ABOUT TO ATTACK

ANOSOGNOSIA

THE INABILITY TO REALIZE ONE IS ILL, WHICH IS CAUSED BY THE ILLNESS

ITSELF (SCHIZOPHRENIA)

DEPERSONALIZ
ATION
DEREALIZATION

PHARMACOLOGICAL INTERVENTIONS - ANTIPSYCHOTIC

GROUP

ANTAGONIZE

SYMPTOM
S TREATED

ONSET

CONVENTIONAL
(TYPICAL)

DOPAMINE RECEPTORS

POSITIVE

2-6 WEEKS

ATYPICAL

DOPAMINE & SERATONIN

RECEPTORS

POSITIVE
&
NEGATIVE

2-6 WEEKS

ATYPICAL ANTIPSYCHOTICS - SIDE EFFECTS

ISSUE

METABOLIC

SIDE EFFECTS

WEIGHT GAIN, DYSLIPIDEMIA,

ALTERED GLUCOSE
METABOLISM.
SYNDROME INCREASES RISK OF DIABETES,
HYPERTENSION,
ATHEROSCLEROTIC HEART
DISEASE

AGRANULOCYTOSIS

SUPPRESSION OF BONE
MARROW

MEDS RESPONSIBLE
ALL ATYPICALS EXCEPT:
ARIPIPRAZOLE
(ABILIFY)
ZIPRASIDONE
(GEODON)
CLOZAPINE (CLOZARIL)

THESE ATYPICAL ANTIPSYCHOTICS ARE FIRST LINE AGENTS

BECAUSE OF THEIR LOWER SIDE EFFECT PROFILE AND ARE
FREE OF HEMATOLIGICAL SIDE EFFECT OF CLOZAPINE
THE BLOCKAGE OF DOPAMINE RECEPTOR SITES IN MOTOR
AREAS CAUSES
THE MOST SEDATING AGENT THAT HAS FEWER EPSS;
CAUSES HYPOTENSION

5 | Page

ABILIFY, GEODON,
RISPERDAL, ZYPREXA,
SEROQUEL
EXTRAPYRAMIDAL SIDE
EFFECTS
THORAZINE

MENTAL HEALTH EXAM 2

MINIMAL SEDATION AND HYPOTENSION, BUT HAS HIGH
EPSS
THE THREE DEPOT (LONG ACTING) ANTIPSYCHOTICS

HALDOL
HALDOL, PROLIXIN,
RISPERDAL CONSTA

CONVENTIONAL (TYPICAL) ANTIPSYCHOTICS SEIZURE

DISORDERS
ISSUE
ACUTE DYSTONIA

AKATHISIA

PSEUDOPARKINSONI
SM

TARDIVE DYSKINESIA
(TDK)

SIDE EFFECTS
ACUTE SUSTAINED CONTRACTION
OF MUSCLES, USUALLY OF THE
TONGUE, FACE, NECK, BACK;
TETANIC HEIGHTENING OF ENTIRE
BODY, HEAD AND BELLY UP
PSYCHOMOTOR RESTLESSNESS
EVIDENT AS PACING OR
FIDGETING, SOMETIMES
PRONOUNCED AND VERY
DISTRESSING TO PATIENTS;
TAPPING FOOT, ROCKING CHAIR,
SHIFTING WEIGHT SIDE TO SIDE
A MEDICATION INDUCED
TEMPORARY CONSTELLATION OF
SYMPTOMS ASSOCIATED WITH
PARKINSONS DISEASE; STIFF
STOOPED POSTURE, PILL ROLLING,
DROOLING, TREMOR, MASKLIKE
FACIES
INVOLUNTARY TONIC MUSCLE
CONTRACTIONS THAT TYPICALLY
INVOLVE THE TONGUE, FINGERS,
TOES, NECK, TRUNK OR PELVIS.
FREQUENTLY SEEN IN WOMEN AND
OLDER PATIENTS ON LONG TERM
THERAPY

INTERVENTION
COGENTIN, BENADRYL
CONSIDER BENADRYL IM/IV
COMFORT PT, FEAR OF CHOKING
MONITOR AIRWAY

COGENTIN, BENADRYL
PROPRANOLOL, LORAZEPAM,
DIAZEPAM
MEDICATION CHANGE

COGENTIN, BENADRYL
MEDICATION CHANGE
TOWEL FOR SALIVA

STOP MEDICATIONS
NO TREATMENT
USUALLY PERMANENT
AIMS TEST

DSM-IV-TR CRITERIA FOR SCHIZOPHRENIA SUBTYPES

DISORDER
PARANOID

PRESENTATION
1.
2.
1.
2.

DISORGANIZED
3.

6 | Page

INTERVENTION

SECURE/SAFE ENVIRONMENT
DOMINANT: HALLUCINATIONS, DISTRACTING ACTIVITIES
SEALED FOODS (PARANOIA)
DELUSIONS
NO OTHERS PRESENT
COGNIZANT OF IDEAS OF
REFERENCE
DOMINANT: DISORGANIZED
SPEECH, BEHAVIOR
CLEAR, CONCISE, CONCRETE
DELUSIONS, HALLUCINATIONS
COMMUNICATION
(NOT PROMINENT OR
REPEATED REFOCUSING
FRAGMENTED).
REINFORCE ADL PATTERNS
GRIMACING, MANNERISMS,
PROVIDE FOR PRIVACY NEEDS
AND OTHER ODDITIES OF
BEHAVIOR

MENTAL HEALTH EXAM 2

1.
2.

CATATONIC

3.
4.
1.

RESIDUAL

2.

1.

UNDIFFERENTIATED

2.

MOTOR IMMOBILITY
EXCESSIVE
PURPOSELESSNESS MOTOR
ACTIVITY; AGITATION
PECULIAR VOLUNTARY
MOVEMENT
ECHOLALIA OR ECHOPRAXIS
NO LONGER HAS ACTIVE
PHASE SYMPTOMS
PERSISTENCE OF SOME
SYMPTOMS
HAS ACTIVE PHASE
SYMPTOMS
NO ONE CLINICAL
PRESENTATION DOMINATES
(PARA, DIS, CATA)

WITHDRAWN
NUTRITION FOR WITHDRAWN
ASSIST GROOMING
RETENTION OR INCONTINENCE
EXCITED PHASE
CLEAR, DIRECT, LOUD
COMMUNICATION
SIMILAR TO THAT FOR
WITHDRAWN, PARANOID, OR
DISORGANIZED
SCHIZOPHRENIA.
DICTATED BY PATIENTS
BEHAVIOR
SIMILAR TO THAT FOR
WITHDRAWN, PARANOID, OR
DISORGANIZED
SCHIZOPHRENIA.
DICTATED BY PATIENTS
BEHAVIOR

ATYPICAL ANTIPSYCHOTICS ISSUES

MED

SIDE EFFECTS

CONTRAINDICATIONS
IMMUNE COMPROMISED
PATIENTS
REGULAR BLOOD COUNTS FIRST
6 MONTHS

CLOZARIL

AGRANULOCYTOSIS
CONVULSIONS
WEIGHT GAIN

RISPERDAL

SEXUAL DYSFUNCTION
ORTHOSTASIS
WEIGHT GAIN
CVA (RARE)

ABILIFY

INSOMNIA
AKATHISIA

INVIGA

ORTHOSTASIS
SEDATION
WEIGHT GAIN

GEODON

DIZZINESS
SEDATION
QT INTERVAL ELONGATION

SEROQUEL

METABOLIC SYNDROME
WEIGHT GAIN
SEDATION
ORTHOSTASIS

ZYPREXA

METABOLIC SYNDROME
WEIGHT GAIN
SEDATION
HYPERGLYCEMIA

DM TYPE II PATIENTS
OBESE PATIENTS
HIGH CHOLESTEROL

7 | Page

OLDER ADULTS
DEMENTIA PATIENTS
HYPOTENSIVE PATIENTS

HYPOTENSIVE PATIENTS

RECENT ACUTE MYOCARDIAL

INFARC
UNCOMPENSATED HEART
FAILURE
CARDIAC PATIENTS

MENTAL HEALTH EXAM 2

WHICH WOULD YOU NOT GIVE TO DIABETES PATIENT

WHICH WOULD YOU NOT GIVE TO A CARDIAC PATIENT

ZYPREXA
GEODON

POTENTIALLY DANGEROUS RESPONSE TO ANTIPSYCHOTICS

CONDITION

MANIFESTATION

NEUROLEPTIC
MALIGNANT
SYNDROME (NMS)

REDUCED CONSCIOUSNESS,
INCREASED MUSCLE TONE,
HYPERPYREXIA, LABILE
HYPERTENSION, TACHYPNEA,
DIAPHORESIS, AND DROOLING

INTERVENTION
EARLY DETECTION
DISCONTINUANCE OF
ANTIPSYCHOTIC
FLUID BALANCE MANAGEMENT
TEMPERATURE REDUCTION
BROMOCRIPTINE / DANTROLENE
ECT IN SOME CASES
MONITORING FOR
COMPLICATIONS
AGRANULOCYTOSIS AND LIVER
IMPAIRMENT ARE SIDE
EFFECTS

SUBSTANCE ABUSE QUESTIONS

THE MAIN ORGAN OF WEAKNESS DURING SUBSTANCE
ABUSE
WHAT SUBSTANCE IN THE BRAIN IS DISRUPTED BY
SUBSTANCE ABUSE
SUBSTANCE ABUSE COMMONLY DISRUPTS THESE ASPECTS
IN INDIVIDUALS
DURING SUBSTANCE ABUSE, WHAT IS THE INDIVIDUAL
ACTUALLY ADDICTED TO
WHAT IS A COMMON COMORBIDITY DURING SUBSTANCE
ABUSE
WHAT ARE SUBSTANCES ABUSERS ALSO AT HIGH RISK
FOR?
IN ADDITION TO ENVIRONMENTAL, PHYSICAL,
DEVELOPMENTAL, AND PSYCHOSOCIAL FACTORS FOR
ADDICTION, WHAT OTHER ASPECT IS LINKED TO ADDICTIVE
PERSONALITY?

SUBSTANCE ABUSE THEORIES

8 | Page

BRAIN
NEUROTRANSMITT
ERS
SLEEP CYCLE,
NUTRITION,
JUDGEMENT,
HYGIENE
EUPHORIA
PSYCHIATRIC
DISORDERS
SUICIDE

GENETIC; FOR
CHILDREN OF
ALCOHOLICS

MENTAL HEALTH EXAM 2

PSYCHOLOGICAL

BEHAVIORAL
SOCIO-CULTURAL

STATES CERTAIN PSYCHODYNAMIC FACTORS ARE PART OF THE ADDICTIVE

PERSONALITY. SUCH AS:

LACK OF TOLERANCE, FRUSTRATION, AND PAIN

LACK OF SUCCESS IN LIFE

LACK OF AFFECTIONATE, MEANINGFUL RELATIONSHIPS

PATIENTS HAVE A LOW SELF ESTEEM, LACK OF SELF-REGARD, RISK TAKING
PROPENSITY, FREQUENT DEPRESSION, AND PASSIVITY. UNABLE TO RELAX,
DETER GRATIFICATION, AND COMMUNICATE EFFECTIVELY
STATES PATIENT DISCOVERS THE EUPHORIC STATE, ROUTINELY SEEKS IT TO
ESCAPE, AND CONTINUES TO ABUSE IN SPITE OF THE DIRE
CONSEQUENCES. TREATMENT INVOLVES IDENTIFICATION OF STRESSORS IN
THE PATIENTS LIFE.
STATES THERE IS DIFFERENCES IN THE RATE OF SUBSTANCE ABUSE AMONG
VARIOUS GROUPS. CULTURE HAS AN IMPACT. ABUSERS FIND A SENSE OF
BELONGING WITHIN THE SUBSTANCE ABUSE CULTURE.

DEFINITIONS
THE NEED FOR HIGHER AND HIGHER DOSES TO ACHIEVE
THE DESIRED EFFECT
OCCURS AFTER A LONG PERIOD OF CONTINUED USE;
STOPPING OR REDUCING USE RESULTS IN SPECIFIC
PHYSICAL AND PSYCHOLOGICAL SIGNS AND SYMPTOMS
TRANSITORY RECURRENCE OF PERCEPTUAL DISTURBANCE
CAUSED BY A PERSONS EARLIER HALLUCINOGENIC DRUG
USE. RANGE FROM MILD/PLEASANT TO FRIGHTENING
THE INTENSIFIED OR PROLONGED EFFECT WHEN DRUGS
ARE TAKEN TOGETHER
COMBINING DRUGS TO WEAKEN OR INHIBIT THE EFFECT OF
ONE OF THE DRUGS
A CLUSTER OF BEHAVIORS OFTEN MANIFESTED BY
PERSONS LIVING WITH A SUBSTANCE ABUSING INDIVIDUAL.
EXHIBIT OVER-RESPONSIBLE BEHAVIOR, DOING FOR
OTHERS WHAT THEY COULD DO FOR THEMSELVES.
NECESSARY WHEN A PERSON IS SUBSTANCE ABUSING AND
HAS A PSYCHIATRIC ILLNESS
IN THE ABOVE SITUATION IT MUST BE DETERMINED WHICH
CONDITION IS PREDOMINANT. MUST DISTINGUISH BETWEEN
PERSON WHO IS:

HOW MUST A DUAL DIAGNOSED PATIENTS CONDITIONS BE

TREATED
THE TERM FOR THE ABUSE OF TWO TYPES OF SUBSTANCES
WHICH TYPE OF DRUG IS NOT SAFE WHEN TREATING AN
ADDICTED PATIENT
ALCOHOL ABUSE IS LOW IN THIS CULTURE DUE TO A
BIOLOGICAL DEFICIENCY IN ALDEHYDE DEHYDROGENASE;
9 | Page

TOLERANCE

WITHDRAWAL

FLASHBACK

SYNERGISTIC
EFFECTS
ANTAGONISTIC
EFFECTS

CODEPENDENCE

DUAL DIAGNOSIS
MENTALLY ILLS
AND SELF
MEDICATES
DEPRESSED
ADDICT
BECAUSE OF
ALCOHOLISM
SIMULTANEOUSLY
CROSS ADDICTION
MOOD ALTERING
ASIAN

MENTAL HEALTH EXAM 2

AN ENZYME THAT BREAKS DOWN ALCOHOL
ACETALDEHYDE?
WHICH GENDER HAS LOWER SUBSTANCE ABUSE RATES?

FEMALE

SUBSTANCE ABUSE INTERVENTIONS

PRIMARY

INTERVENTION

STRATEGIES

EDUCATE YOUNG
SUPPORT
ELDERLY

SECONDARY

TERTIARY

DETOXIFICATION (3-5
DAYS)
MONITOR

CONFRONTATION
(TOUGH LOVE)
MANAGE HEALTH
TEACH PROBLEM
PROBLEMS
FAMILY EDUCATION
SOLVING
NO DENIAL OR
TECHNIQUES
ADVOCATE POSITIVE
ENABLING
INVOLVE FAMILY /
INTERPERSONAL
DISCOURAGE
RELATIONSHIPS
ADDICTION
SUPORTING
BEHAVIOR

PREVENT RELAPSE
DO NOT REJECT
TEACH NEW
COPING
STRATEGIES

RELAPSE COMMON,
EXPECT IT
NON SUBSTANCE
ABUSING FRIENDS

GENERAL CARE CONSIDERATIONS FOR PT/CLIENT

HALLMARK SIGN OF SUBSTANCE ABUSE
BAHAVIORS ASSOCIATED WITH SUBSTANCE ABUSE
COMMON IN PATIENTS WHETHER SOBER OR INTOXICATED
THE TERM FOR THE ATTEMPT TO CONTROL THE ADDICTS
BEHAVIOR

DENIAL
DYSFUNCTIONAL
ANGER
MANIPULATIVE
IMPULSIVE
DEPRESSION &
SUICIDE
CODEPENDENCY

IMPAIRED NURSE

SYMPTOMS FOR AN
IMPAIRED NURSE

10 | P a g e

MEDICATION WASTING / NOT GETTING WASTING COUNTER-SIGNED

PATIENT COMPLAINS OF INEFFECTIVE PAIN CONTROL
COMES IN EARLY / STAYS LATE
VOLUNTEERS FOR ADDITIONAL SHIFTS
USES BATHROOM A LOT
SLOPPY CHARTING
ABSENTEEISM
FREQUENT JOB CHANGES / LOSS
JOB RELATED ACCESS
CRIMINAL RECORD

MENTAL HEALTH EXAM 2

11 | P a g e

MENTAL HEALTH EXAM 2

ABUSED DRUGS
DRUG

OPIODS

PHYSICAL
EFFECTS

TYPES

HEROIN
MORPHINE
CODEINE
METHADONE

MESCALINE
PEYOTE,
MUSHROOMS,
HALLUCINOG
ANGEL TRUMPET
LSD, MDMA, PCP
ENS

PUPIL CONSTRICTION
RESPIRATORY
DEPRESSION
PSYCHOMOTOR
RETARDATION
EUPHORIA DYSPHORIA
USE TOLERANCE
PUPIL DILATION
TACHYCARDIA
DIAPHORESIS
PALPITATIONS
TREMORS
INCOORDINATION
TEMP, PULSE,
RESPIRATION
EUPHORIA
CNS DEPRESSION
VISUAL HALLUCINATIONS
/ DISORIENTATION
ENHANCEMENT SEXUAL
PLEASURE
BRAIN DAMAGE

INTERVENTIONS
METHADONE TAPERING
CLONIDINE(CATAPRES),
NALTREXONE DETOX
BUPRENORPHINE
SUBSTITUTION

ROOM WITH LIGHT / STIMULI

1 TO 1, TALK DOWN PATIENT
SPEAK SLOW, CLEAR, LOW
VOICE
DIAZEPAM / CHLORAL HYDRATE
FOR ANXIETY

INHALANTS

HAIRSPRAY
GAS
WHITEOUT
SOLVENTS
ANESTHETICS

OTC DRUGS

ANTIHISTAMINES
COUGH SYRUP
ALCOHOL EFFECTS
TREAT SYMPTOMS RELATED TO
NYQUIL COLD MED
ANTIHISTAMINE EFFECTS
MOUTHWASH
USE
MANY
VANILLA FLAVORING
SLEEP AIDS

AMPHETAMINES

NON-AMPHETAMINES
METHAMPHETAMINE
CNS

S
STIMULANTS COCAINE (MOST

POTENT)
CAFFEINE, NICOTINE

ALCOHOL

CNS
BARBITUATES

DEPRESSAN BENZODIAZEPINES
HYPNOTIC
TS
SEDATIVES

12 | P a g e

DILATED PUPILS
TACHYCARDIA
ELEVATED BP
N/V, INSOMNIA
PSYCHO-PERCEPTUAL
DISTURBANCES
PARANOIA, PSYCHOSIS
SLURRED SPEECH
ATAXIA
DECREASED BP
DROWSINESS
IMPAIRED JUDGEMENT
IMPAIRED
ATTENTION/MEMORY
DISINHIBITION OF
SEXUAL / AGGRESSIVE
DRIVES

SUPPORT AFFECTED SYSTEMS

OXYGEN, METHYLENE BLUE
B12 FOR NEUROPATHY

ANTIDEPRESSANTS
DOPAMINE AGONIST
BROMOCRIPTINE

CAREFULLY TITRATED
DETOXIFICATION WITH
SIMILAR DRUG
** ABRUPT WITHRDRAWAL
DEADLY**

MENTAL HEALTH EXAM 2

WITHRDRAWAL
DRUG

SYMPTOMS OF WITHDRAWAL

CNS DEPRESSANTS

ANXIETY
INSOMNIA
TREMORS
DELIRIUM / CONVULSIONS

OPIODS

WATERY EYES
RUNNY NOSE
LOSS OF APPETITE
IRRITABILITY
TREMORS
PANIC
CRAMPS
NAUSEA
CHILLS / SWEATING
ELEVATED BP
HALLUCINATIONS DELUSIONS

CNS STIMULANTS

APATHY
HYPERSOMULENCE
IRRITABILITY
DEPRESSION
DISORIENTATION

HALLUCINOGENS

NONE

BAC LEVEL AFFECTS / NON-TOLERANT DRINKER

BLOOD ALCOHOL
LEVEL
50 mg/dL
13 | P a g e

EFFECTS
CHANGES IN MOOD AND BEHAVIOR, IMPAIRED JUDGEMENT

MENTAL HEALTH EXAM 2

100 mg/dL

ATAXIA; LEGAL LEVEL OF IMPAIRMENT IN MOST STATES

200 mg/dL

DEPRESSED FUNCTION OF ENTIRE MOTOR AREA OF BRAIN;

ATAXIA, STAGGERING, EMOTIONAL LABILITY

300 mg/dL

CONFUSION, STUPOR

400 mg/dL

COMA

500 mg/dL

DEATH DUE TO RESPIRATORY DEPRESSION

EARLY SIGNS OF ALCOHOL WITHDRAWAL USUAL OCCUR

WHEN

COMMON SIGNS OF ALCOHOL WITHDRAWAL

FEW HOURS AFTER

CESSATION

WITHDRAWAL SIGNS USUALLY PEAK WITHIN HOW LONG

AFTER CESSATION
A WITHDRAWAL RELATED FEVER OF 100o TO 103o LEADS
TO

24-48 HOURS (2-3

DAYS)
SEIZURE

FEATURES OF ALCOHOL WIHDRAWAL DELIRIUM

HOW IS ALCOHOL WITHDRAWAL TREATED

PHARMACOLOGICALLY
WHICH BENZODIAZEPINES DONT INVOLVE THE LIVER
WHICH BENZODIAZEPINES ARE USED TO DECREASE
WITHDRAWAL SYMPTOMS, STABILIZE VITAL SIGNS, AND
PREVENT SEIZURES/DTS
IF TAKING BENZODIAZEPINES, WHAT ANTI-SEIZURE MED
14 | P a g e

HANGOVER
JERKY MOVEMENTS
IRRITABILITY
GI DISTURBANCE
SHAKING INSIDE
GRAND MAL
SEIZURES

ANXIETY, INSOMNIA
ANOREXIA
DELURIUM
AUTONOMIC
HYPERACTIVITY
SENSORIUM
DISTURBANCES
PERCEPTUAL
DISTURBANCES
FLUCTUATING LOC
DELUSIONS,
AGITATED
BEHAVIORS,
FEVER
SUBSTITUTE DRUG
(CNS DEPRESSANT)
& TITRATE DOWN
LORAZEPAM(ATIVAN
), DIAZEPAM
(VALIUM)
LORAZEPAM(ATIVAN
), DIAZEPAM
(VALIUM),
CHLORIDIAZEPOXID
E (LIBRIUM)
PHENOBARBITAL

MENTAL HEALTH EXAM 2

CANT BE USED
WHY DO WITHDRAWAL PATIENTS NEED TO BE ODED
WITH BENZODIAZEPINES DURING TREATMENT?
WHICH MULTIVITAMINS ARE GIVEN TO WITHDRAWAL
PATIENTS
WHY ARE MULTIVITAMINS GIVEN TO WITHDRAWAL
PATIENTS
THIAMIN (B1) IS GIVEN TO WITHDRAWAL PATIENTS TO
PREVENT
WHAT IS GIVEN WITH THIAMIN TO INCREASE ITS
EFFECTIVENESS, ESPECIALLY IF THE PATIENT HAS A
HISTORY OF SEIZURES
THE SCALE UTILIZED TO DETERMINE THE SEVERITY OF
WITHDRAWALS
A CIWA SCORE GREATER THAN WHAT WILL MANDATE USE
OF BENZOS
BLOOD AND URINE SCREENS ARE UTILIZED TO DETERMINE

TOLERANCE
THIAMIN (B1), FOLIC
ACID
MALNUTRITION
WERNIKEKORSAKOFF
SYNDROME
MAGNESIUM
SULFATE

CIWA SCALE
GREATER THAN 15
WHAT AND HOW
MUCH OF A DRUG IS
IN PTS SYSTEM

WHEN MUST THE SCREEN BE PERFORMED

THE CONDITION WHERE ONE DRUG IS USED TO PREVENT
THE WITHDRAWAL SYMPTOMS FOR ANOTHER DRUG
THIS DRUG WORKS ON THE CLASSICAL PRINCIPLE OF
INHIBITING IMPULSIVE DRINKING, CAUSING NEGATIVE
PHYSICAL SYMPTOMS UPON ALCOHOL INTAKE

UPON ARRIVAL

WHAT MUST THE PATIENT ON ANTABUSE BE EDUCATED

ABOUT

NEGATIVE
SYMPTOMS LAST UP
TO 2 WEEKS

THIS MEDICATION, TAKEN BY NARCOTIC AND SOMETIMES

ALCOHOL ADDICTS, BLOCKS OPIATE RECEPTORS IN THE
BRAIN THUS BLOCKING THE EUPHORIC EFFECTS
A SECOND MEDICATION USED TO TREAT ALCOHOLISM; ITS
MECHANISM OF ACTION IS NOT FULLY UNDERSTOOD
TERTIARY INTERVENTION FOR RECOVERING ADDICTS
INVOLVES

15 | P a g e

CROSSDEPENDENCE
ANTABUSE
(DISULFIRAM)

NALTREXONE
(REVIA)
ACAMPROSATE
(CAMPRAL)
RELAPSE
PREVENTION
REHAB SELF HELP
GROUPS
90 MEETINGS, 90
DAYS
PSYCHOTHERAPY

MENTAL HEALTH EXAM 2

REVIEW QUESTIONS
WITH THERAPEUTIC COMMUNICATION, WHAT IS THE
PRIORITY RESPONSE?
WITH THERAPEUTIC COMMUNICATION WHAT IS
NECESSARY TO BUILD TRUST?
WHEN PATIENTS HAVE HALLUCINATION, WHAT IS A SIGN
THERAPY IS PROGRESSING?
GIVING DIRECTION WITH SCHIZOPHRENIC PATIENTS
SHOULD OCCUR IN WHAT FORMAT?
THE PHASE OF SCHIZOPHRENIA WHERE SYMPTOMS ARE
ABSENT OR DIMINISHED; PATIENT IS AT OR NEARING
BASELINE
THE PHASE OF SCHIZOPHRENIA WHERE THERE IS ONSET
OR EXACERBATION OF FLORID, DISRUPTIVE SYMPTOMS
WITH LOSS OF FUNCTIONAL ABILITIES
THE PHASE OF SCHIZOPHRENIA WHERE SYMTOMS ARE
DIMINISHING AND THERE IS MOVEMENT TOWARDS ONES
PREVOUS LEVEL OF FUNCTIONING
THE OVERALL GOALS OF PHASE I

THE OVERALL GOALS OF PHASE II

THE OVERALL GOALS OF PHASE III

WHAT PLAYS A KEY ROLE IN IMPROVING THE PROGNOSIS
FOR SCHIZOPHRENIC PATIENTS?
16 | P a g e

SAFETY
EMPATHY
PATIENTS INFROM
NURSE OF
HALLUCINATIONS
GIVE DIRECTION,
FACILITATE
OPTIONS, ALLOW
DECISION MAKING
III MAINTENANCE

I ACUTE

II STABILIZATION
SAFETY, MEDICAL
STABILIZATION
HELP PATIENT
ADHERE TO TX,
BECOME STABILIZED
ON MEDS,
CONTROL/COPE
WITH SYMPTOMS
MAINTAIN
ACHIEVEMENT,
PREVENT RELAPSE,
INDEPENDENCE /
SATISFACTORY LIFE
EARLY ASSESSMENT

MENTAL HEALTH EXAM 2

THE FOUR MAIN SYMPTOM GROUPS OF SCHIZOPHRENIA

WHICH SYMPTOMS USUALLY APPEAR EARLY IN THE
ILLNESS
WHICH SYMPTOMS TEND TO BE PERSISTENT AND
CRIPPLING
WHICH SYMPTOMS RESPOND TO ANTIPSYCHOTIC
MEDICATION?
WHEN DOES SCHIZOPHRENIA NORMALLY DEVELOP?
WHICH GENDER IS SCHIZOPHRENIA MORE COMMON IN?
CONCRETE THINKINGS REFERS TO A PATIENTS INABILITY
TO THINK IN WHAT TERMS? THE GRASS IS ALWAYS
GREENER ON OTHER SIDE OF FENCE
IS OFFERING EVIDENCE OF REALITY TO DELUSIONAL
PATIENTS THERAPEUTIC?
THE AFFECT INVOLVING IMMOBILE OF BLANK FACIAL
EXPRESSION
THE AFFECT INVOLVING REDUCED/MINIMAL EMOTIONAL
RESPONSE
THE AFFECT INVOLVING EMOTIONAL RESPONSE
INCONGRUENT WITH THE SITUATION LAUGHING AT
DEATH
THE AFFECT INVOLVING ODD, ILLOGICAL EMOTIONAL
STATE THAT IS GROSSLY INAPPROPRIATE OR UNFOUNDED;
UNCONTROLLABLE LAUGHTER, GRIMACING, GIGGLING FOR
NO REASON
OF ALL THE SYMPTOMS OF SCHIZOPHRENIA, THESE ARE
COMMON AND INCREASE THE PATIENTS SUFFERING.
INCREASE CHANCES OF RELAPSE, SUBSTANCE ABUSE,
AND SUICIDE, FURTHER IMPAIR FUNCTIONING.
WHICH TYPE OF ABUSED SUBSTANCE IS CONSIDERED THE
LAUGHING DRUG?
WHY ARE ATYPICAL ANTIPSYCHOTIC MEDICATIONS THE
PREFERRED CHOICE?
WHY ARE TYPICAL ANTIPSYCHOTIC MEDS AVOIDED?
WHAT ARE THE THREE DECANOATE (DEPOT)
ANTIPSYCHOTIC MEDS?
AMONG THESE 3, WHICH IS THE PREFERRED? WHY?
HOW ARE DEPOT MEDS ADMINISTERED?
IN WHAT CIRCUMSTANCE ARE DEPOT MEDS UTILIZED
HOW OFTEN ARE DEPOT MED ADMINISTERED?
WHAT WOULD YOU ASSESS PRIOR TO GIVING DEPOT MEDS
17 | P a g e

POSITVE, NEGATIVE,
COGNITIVE,
AFFECTIVE
POSITIVE
NEGATIVE
POSITIVE
LATE TEENS EARLY
20S
MALE

ABSTRACT

NO
FLAT
BLUNTED

INNAPPROPRIATE

BIZARRE

AFFECTIVE

INHALANTS
TREAT POSITIVE &
NEGATIVE
SYMPTOMS
HIGHER INCIDENCE
OF EPS
HALDOL, PROLIXIN,
RISPERDAL CONSTA
RISPERDAL CONSTA,
ATYPICAL
IM
NON-COMPLAINT
PATIENTS
EVERY 1-2 WEEKS
WILL PATIENT
ACCEPT NEEDLE

MENTAL HEALTH EXAM 2

STICK

WHAT IS THE MOST COMMON REASON FOR

NONCOMPLIANCE IN MEN?
WHAT IS A COMMON COMORBITITY IN SCHIZOPHRENIA
PATIENTS?
WHAT ARE TWO SIDE EFFECT ASSOCIATED WITH CLOZARIL
WHAT IS REQUIRED PRIOR TO THE ADMINISTRATION OF
CLOZARIL?
WHAT TWO SYMPTOMS WOULD MERIT DISCONTINUATION
& MD NOTIFICATION?
WHAT ASPECT OF THE CBC MUST BE MONITORED WHEN
ON CLOZARIL
WHAT IS A NURSING PRIORITY BEFORE ADMINISTRATION
OF CLOZARIL TO A PATIENT CURRENTLY ON A REGIMEN?
WHAT MUST OCCUR REGULARLY WHEN ON A CLOZARIL
REGIMEN?
WHICH ATYPICAL MED IS CONTRAINDICATED FOR
OVERWEIGHT/DIABETIC PATIENTS?
WHICH ATYPICAL MED IS CONTRAINDICATED FOR CARDIAC
PATIENTS?
WHICH ATYPICAL MED IS GOOD FOR
OVERWEIGHT/CARDIAC PATIENTS?
EPSS CAN BE MINIMIZED BY LOWERING MED DOSES AND
ADMINSTERING
MEDS THAT ARE HELPFUL IN REDUCING AKATHISIA

ANTIPARKINSONIAN DRUGS WORSEN ANTICHOLINERGENIC

SIDE EFFECTS OF TYPICAL ANTIPSYCHOTICS, CAUSING
THESE SIDE EFFECTS
A SEDATING AGENT THAT HAS FEWER EPSS BUT CAUSES
HYPOTENSION
A LESS SEDATING AGENT, INDUCES LESS HYPOTENSION,
HIGH EPSS
NAME THREE OF THE MOST COMMON EPSS
A PERSISTENT EPS THAT USUALLY APPEARS AFTER
PROLONGED TREATMENT AND PERSISTS EVEN AFTER
MEDICATION HAS BEEN DISCONTINUED
A BRIEF TEST FOR THE DETECTION OF TDK AND OTHER
INVOLUNTARY MOVEMENTS
18 | P a g e

SEXUAL
DYSFUNCTION
DEPRESSION
AGRANULOCYTOSIS,
SEIZURES
TRIED 2 ATYPICAL
ANTIPSYCHOTICS
PRIOR
FEVER, MOUTH
SORES
WBCS
CHECK LABS
BLOOD DRAWS,
CHECK WBC COUNT
ZYPREXA
GEODON
ABILIFY
COGENTIN &
BENADRYL
LORAZEPAM
(ATIVAN), DIAZEPAM
(VALIUM),
PROPRANOLOL
(INDERAL)
DRY MOUTH/EYES,
URINARY
RETENTION,
CONSTIPATION,
BLURRED VISION,
PHOTOSENSITIVITY
THORAZINE
HALDOL
DYSTONIA,
AKATHISIA,
PSEUDOPARKINSONI
SM
TDK

AIMS

MENTAL HEALTH EXAM 2

EPS CHARACTERIZED BY SUSTAINED CONTRACTION OF
HEAD/NECK MUSCLES
EPS CHARACTERIZED BY PSYCHOMOTOR RESTLESSNESS;
PACING, ROCKING, ETC
EPS CHARACTERIZED BY TEMPORARY CONSTELLATION OF
SYMPTOMS; TREMOR, REDUCED ACCESSORY MOVEMENTS, IMPAIRED
GAIT, STIFFENING OF MUSCLES

A POSSIBLY FATAL EFFECT OF ANTIPSYCHOTIC DRUGS,

CHARACTERIZED BY REDUCED CONSCIOUSNESS,
MUSCULAR RIGIDITY, HYPERPYREXIA, LABILE
HYPERTENSION, TACHYCARDIA, TACHYPNEA,
DIAPHORESIS, AND DROOLING.
MILD CASES OF THE ABOVE CAN BE TREATED WITH
SEVERE CASES ARE TREATED WITH
SCHIZOPHRENIC DISORDER CHARACTERIZED ONLY BY
HALLUCINATIONS AND DELUSIONS
SCHIZOPHRENIC DISORDER CHARACTERIZED BY MOTOR
IMMOBILITY, EXCESSIVE PURPOSELY MOTOR ACTIVITY,
NEGATIVISM OR MUTISM, PECULIAR VOLUNTARY
MOVEMENT, AND ECHOLALIA/ECHOPRAXIS
SCHIZOPHRENIC DISORDER CHARACTERIZED BY ACTIVE
PHASE SYMPTOMS BUT NO ONE CLINICAL PRESENTATION
DOMINATES
SCHIZOPHRENIC DISORDER CHARACTERIZED BY
DISORGANIZED SPEECH/BEHAVIOR AND INAPPROPRIATE
AFFECT, DELUSIONS/HALLUCINATIONS, GRIMACING,
MANNERISMS, AND OTHER ODDITIES OF BEHAVIOR.
SCHIZOPHRENIC DISORDER THAT NO LONGER HAS ACTIVE
PHASE SYMPTOMS BUT PERSISTANCE OF SOME
SYMPTOMS IS NOTED.
NANDA FOR PSYCHOTIC DISORDERS
NANDA FOR HALLUCINATIONS
NANDA FOR DELUSIONS

ADDICTION IS CHARACTERIZED BY WHICH 3 ASPECTS

4 RISK FACTORS TIED INTO SUBSTANCE ABUSE

IF INDICATORS OF IMPAIRED PRACTICE ARE OBSERVED BY
ANOTHER NURSE, WHAT IS THE OBSERVERS
19 | P a g e

DYSTONIA
AKATHISIA
PSEUDOPARKINSONI
SM

NEUROLEPTIC
MALIGNANCY
SYNDROME (NMS)

BROMOCRIPTINE
(PARLODEL)
IV DANTROLENE
(DANTRIUM)
PARANOID

CATATONIC

UNDIFFERENTIATED

DISORGANIZED

RESIDUAL

RISK FOR INJURY

DISTURBED
SENSORY PROCESS
DISTURBED
THOUGHT PROCESS
LOSS OF
CONSUMPTION
CONTROL,
CONTINUED USE
DEPITE PROBLEMS,
TENDENCY TO
RELAPSE
BIOLOGICAL,
PSYCHOLOGICAL,
SOCIOCULTURAL,
GENETIC
GATHER DATA,
NOTIFY NURSE
MANAGER, DO NOT

MENTAL HEALTH EXAM 2

RESPONSIBILITY?
INTERVENTION IS WHOSE RESPONSIBILITY?
IF NOTIFICATION IS MADE AND THE NURSE NOTICES NO
ACTION HAS BEEN TAKEN, WHAT IS NECESSARY?

WHAT IS THE MAIN GOAL OF INTERVENTION?

THE DRUG OF CHOICE GIVEN TO DECREASE ALCOHOL
WITHDRAWAL SYMPTOMS, STABILIZE VITAL SIGNS, AND
PREVENT SEIZURES/DTS
FOR ALCOHOL WITHDRAWAL PATIENTS, WHAT DRUG IS
GIVEN TO TREAT HALLUCINATIONS (TACTILE, VISUAL,
AUDITORY, OLFACTORY)
WHAT IS ALSO GIVEN TO ALCOHOL WITHDRAWAL
PATIENTS TO ADDRESS MALNUTRITION?
WHICH DRUG, WHICH BLOCKS OPIOD RECEPTORS, IS ALSO
GIVEN TO ALCOHOL WITHDRAWAL PATIENTS TO DECREASE
THE PLEASANT, REINFORCING EFFECTS OF ALCOHOL?
WHICH DRUG, WHICH LOWERS BP, IS GIVEN IN
COMBINATION WITH THE ABOVE MED AND IS A NONOPIOD SUPPRESSOR OF WITHDRAWAL SYMPTOMS
WHICH SCALE IS UTILIZED TO IDENTIFY SYMPTOMS AND
DETERMINE SEVERITY OF ALCOHOL WITHDRAWAL?
A SCORE OF ABOVE ___ ON THE CIWA SCALE MANDATES
TREATMENT
A SCORE ABOVE ___ INDICATES SEVERE WITHDRAWALS
WHAT IS THE ONLY MEDICATION CURRENTLY APPROVED
FOR THE TREATMENT OF A PREGNANT OPIOD ADDICT
EARLY SIGNS OF ALCOHOL WITHDRAWAL APPEAR:

CONFRONT
NURSE MANAGER,
NURSING
ADMINISTRATORS
MAKE NOTIFICATION
TO NEXT LEVEL IN
CHAIN OF
COMMAND
PROTECT PATIENTS,
GET NURSE
TREATMENT,
RETURN NURSE TO
PRACTICE OF
POSSIBLE
ATIVAN
(LORAZEPAM)

HALDOL
FOLIC ACID,
THIAMIN,
MULTIVITAMINS
NALTREXONE
(REVIA)

CLONIDINE
(CATAPRES)

CIWA
15
20
METHADONE
WITHIN A COUPLE
HOURS AFTER
CESSATION

ALCOHOL WITHDRAWAL SIGNS PEAK AFTER:

24-48 HOURS

ALCOHOL WITHDRAWAL DELIRIUM PEAKS AFTER:

WITH A NEWLY ARRIVED SUBSTANCE ABUSE PATIENT,
WHAT QUESTIONS ARE THE NURSING PRIORITY WITH
REGARD TO THE SUBSTANCE?
AS A PRECAUTION, A NURSE HANDLING A WITHDRAWAL
PATIENT SHOULD MONITOR FOR WHAT PHYSICAL
REACTION?
WHICH DRUG FOR ALCOHOL ABUSE WORKS ON THE
CLASSICAL CONDITIONING PRINCIPLE OF INHIBITING

48-72 HOURS

20 | P a g e

WHAT WAS TAKEN,

WHEN LAST TAKEN,
HOW MUCH

SEIZURES
ANTABUSE
(DISULFIRAM)

MENTAL HEALTH EXAM 2

IMPULSIVE DRINKING. CAUSES UNPLEASANT PHYSICAL
EFFECTS IF ALCOHOL IS CONSUMED.
WHAT SHOULD THE PATIENT BE EDUCATED ABOUT?

HOW LONG IS ANTABUSE EFFECTIVE IN SYSTEM?

WITH REGARD TO THE PSYCHOLOGICAL SUBSTANCE

ABUSE THEORY, NAME SOME CHARACTERISTICS OF
SUBSTANCE ABUSE PATIENTS

PATIENT HAS DRY MUCOUS MEMBRANES, NON-REACTIVE

PUPILS, HOT-RED-DRY SKIN, HYPERPYREXIA WITHOUT
DIAPHORESIS, TACHY CARDIA, AGITATION, UNSTABLE V/S,
WORSENING OF PSYCHOTIC SYMPTOMS, DELIRIUM,
URINARY RETENTION, SEIZURE, REPETITIVE MOTOR
MOVEMENTS. NURSE SUSPECTS?
IS THIS CONDITION POTENTIALLY LIFE THREATENING?

NURSING INTERVENTIONS FOR THIS CONDITION.

21 | P a g e

THE NEGATIVE
EFFECTS
ASSOCIATED WITH
ALCOHOL
CONSUMPTION /
EXPOSURE
5 DAYS 2 WEEKS
AFTER LAST DOSE
LOW SELF ESTEEM
LACK OF SELFREGARD
RISK TAKING
FREQUENT
DEPRESSION
PASSIVITY
UNABLE TO RELAX
DETER
GRATIFICATION
CANT
COMMUNICATE
EFFECTIVELY

ANTICHOLINERGE
NIC TOXICITY

YES
EMERGENCY
COOLING
HOLD MEDS
CATHETERIZATION
PRN
BENZOS OR OTHER
PRNS
PHYSOSTIGMINE
MAYBE

MENTAL HEALTH EXAM 2

22 | P a g e

MENTAL HEALTH EXAM 2

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MENTAL HEALTH EXAM 2

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