Final Notes: Chapter 18-21

Final Chap 18: Personality Disorders Chap 19: Addiction including elder consideration. Potter and Perry (2021) Chap 14: Older Adults pp 187-188 Chap 20: Eating Disorders Chap. 21: Somatic Symptom Illnesses Chapter 18: personality disorders - about self preservation - Personality disorders are diagnosed when there is impairment of personality functioning and personality traits that are maladaptive Groups (A,B,C) Cluster A—odd or eccentric behaviors Paranoid personality disorder - certain characteristics schizophrenia but no psychotic features Schizoid personality disorder - characterized by being detached from any relationship Schizotypal personality disorder Cluster B—erratic or dramatic behaviors - attention seeking behavior Antisocial personality disorder - bring pleasure to themselves without consideration for others, no sense of remorse, enjoy seeing other people su er Borderline personality disorder - self harming behaviors - Must have good limit setting with clients with this disorder Histrionic personality disorder - lie a lot to get attention Narcissistic personality disorder Cluster C—anxious or fearful behaviors ff Avoidant personality disorder Dependent personality disorder Obsessive personality disorder - people are obsessed with perfection Chapter 19: Addiction Chapter 20: Eating Disorders - coming from bad self image - Preoccupied with self-image - Find these disorders in developed countries vs. developing countries Pica - Anemia: eating ice Anorexia Nervosa - restriction of intake to maintain minimal body weight - STRICT food intake - Lower BMI - Manifestations - Thin frame - Females: absence of menstrual period (Amenorrhea) - Rumination: chewing food then spitting it out Bulimia - recurrent cycle of binging and followed by compensatory behaviors - Ea - Lock bathrooms if unable to observe patient after meals - Maintain normal body weight/BMI Nursing Considerations - Potassium: watch potassium levels (cardiac: dysrhythmias) Treatment - SSRIs - Regulate mood and appetite - Antipsychotic Chapter 21: Somatic Disorders Disorders with no organic cause Labela Indeferens: displaying the opposite emotion contrary expected Malingering: seeking external reward Factitious Disorder: intentionally Manchausens: imposed on self Manchausens by proxy: imposed on others in order to appear heroic Treatment - SSRIs: Zoloft Okay, here are the key points discussed in the tutoring session, presented in a study reviewer bullet form, drawing on the provided source material: • • Mental health can be simpli ed to the state of your emotions. If your emotions are good, you are mentally healthy; if not, you are not. • Psychosis is de ned as being out of touch with reality. • Criteria for involuntary admission to a mental health facility: danger to self (DTS), danger to others (DTO), or gravely disabled (GD). You only need to meet one of these criteria for involuntary admission. • Patients can also be admitted to the hospital voluntarily. • Types of communication were discussed, including therapeutic communication. • Silence is a therapeutic communication technique. • In mental health, you should avoid using the word "why" because it is interrogative and can be provocative to the patient. • Different characteristics and types of the nurse-client relationship were covered, emphasizing what a perfect relationship should be. Avoid intimate or romantic relationships with patients. • The cycle of abuse was discussed, including how abuse can run in families and what to look for. • Nurses are mandated reporters. You do not need the entire evidence to report suspected abuse. • Different types or generations of psychotropic drugs were covered: rst, second, and third generation. • The most desirable classi cation of drug to use in mental health is the second fi fi fi fi generation. • First generation antipsychotics primarily treat positive symptoms of schizophrenia. • Second generation antipsychotics treat both positive and negative symptoms of schizophrenia. • People at highest risk for abuse are pregnant women, children, and the elderly. • Antidepressant medications were discussed. • Extrapyramidal Symptoms (EPS) are side effects associated with antipsychotic medication. First generation antipsychotics create more EPS than second generation. • Nursing ethical values were discussed, including autonomy, bene cence, veracity, justice, male cence, and negligence. • The difference between delirium and dementia was learned. • Delirium is reversible and has a fast onset. You can often pinpoint the exact cause of delirium. • Mental health nursing is mostly in uenced by culture. It is dif cult to de ne mental health in one word because cultures value different things differently. • Mental health involves mood, behavior, and thinking. Social culture is a signi cant factor in uencing mental health. • The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) is a diagnostic guideline for mental health. • The DSM-5 provides the de ning characteristics and criteria each disease has to meet. It does not provide treatment guidelines. • Historically, mental illness was viewed differently; in ancient times as displeasing to gods, and by Christians during the Renaissance as possession by demons. • The period of enlightenment saw the creation of asylums, the work of Dorita Dix, and Sigmoid Freud's scienti c study of mental health treatment. • Psychopharmacology emerged in the 1950s. • The rst major psychotropic medications were Thorazine, Haldol, and Lithium. • In the 21st century, the "revolving door" phenomenon occurred. This was a consequence of deinstitutionalization where patients were discharged prematurely and subsequently readmitted. • Mental illness affects homelessness, with about 30% of homeless people having a mental fi fi fi fi fl fi fi fi fl fi illness. • The Healthy People 2030 goal (set by NIH) includes incorporating mental health into treatment goals, increasing identi cation/diagnosis/treatment, decreasing suicide rates, and increasing employment for individuals with mental illness. • The cost containment/managed care movement in the 1970s led to the development of utilization review for mental health and the separation of mental health care from physical insurance. • Advanced health practitioners, not just psychiatrists, can care for people with mental illness. • Self-awareness is crucial for nurses; knowing yourself helps you better care for patients. Johari's window is a concept used to assess self-awareness. • Basic neuroanatomy (nervous system, brain) and neurotransmitters were reviewed. • Chemical or hormonal imbalances play a major role in mental health. • Major neurotransmitters involved in mental health are dopamine, serotonin, and norepinephrine. The balance between neurotransmitters is important. • Neurotransmitters can be excitatory (dopamine, epinephrine, norepinephrine, glutamate), neuromodulators (histamine), or inhibitory (serotonin, GABA). • Brain imaging (like MRI) is not common in mental health but can show enlarged brain ventricles in general brain disorders, and a deformed frontal lobe in schizophrenia. • Mental illness can have a genetic component. Psychoimmunology and infection theory were also mentioned. • Important concepts for psychotropic drugs include ef cacy, potency, and hal ife. • The two major categories are rst generation (conventional) and second generation (atypical) antipsychotics. Second generation is preferred due to less EPS. • Off-label drug use involves using a medication for a side effect rather than its intended effect (e.g., using Benadryl for drowsiness/sleep). • Examples of medications discussed include chlorpromazine ( rst generation), olanzapine/ Zyprexa and ziprasidone (second generation, speaker's favorite), and drugs like aripiprazole (Abilify) as third generation/dopamine stabilizers. Antipsychotic medications are typically used when patients exhibit psychotic features fl fi fi fi (out of touch with reality). fi • • Signi cant side effects of antipsychotics include EPS, NMS, anticholinergic effects, tardive dyskinesia, increased appetite, increased prolactin, and metabolic syndrome. • EPS symptoms include acute dystonia, pseudoparkinsonism, akathisia, and tardive dyskinesia. These can be managed with non-pharmacologic methods or medications like beta blockers or anticholinergics (Cogentin/benztropine). • Neuroleptic Malignant Syndrome (NMS) symptoms include high fever, hypore exia (corrected from hyperre exia), and hemodynamic instability. • Anticholinergic effects include dry mouth, constipation, urinary hesitancy, and urinary retention. • Tardive dyskinesia is a potential permanent side effect characterized by slow, repetitive movements, especially of the face or limbs (e.g., tongue protruding, lips smacking). • Increased prolactin can cause breast enlargement in men. • Metabolic syndrome side effects include hyperlipidemia, hyperglycemia, obesity, and weight gain. • Agranulocytosis is a serious side effect associated with clozapine, requiring WBC monitoring. • There are four major categories of antidepressants, including SSRIs and MAOIs. SSRIs like uoxetine (Prozac) and sertraline (Zoloft - speaker's favorite) were mentioned. MAOIs like propenazine (likely phenelzine/Nardil) and nardine (likely tranylcypromine/ Parnate) were mentioned. • Do not combine MAOIs with SSRIs due to the risk of serotonin syndrome. • Do not take MAOIs with tyramine-containing foods. This combination can cause a hypertensive crisis. • Foods containing tyramine include aged cheese, smoked or cured meat, chocolate, and pepperoni. • Trazodone is an antidepressant sometimes abused in jail because it can cause priapism (an erection lasting more than 4 hours). • If a dose of medication is missed, you can usually take it if it's within 3 hours; otherwise, • Mood stabilizers are speci cally used for bipolar disorder. fl Birth control is an exception where you might double or triple up missed doses. fi • fl fi fl skip it. • Lithium is a commonly used mood stabilizer with a narrow therapeutic range (0.5-1.5, desired 1.2). Levels above 1.2 may require notifying the doctor. • Other mood stabilizers include valproic acid (Vipric acid/Depakote/Depakene). • Patient teaching for lithium includes watching for signs of toxicity (tremors, diarrhea often missed, altered mental status, blurred vision) and maintaining a regular intake of salt and water. • Anti-anxiety medications like benzodiazepines can cause sedation and dependency, so they should be used cautiously. • Stimulants are used for hyperactive disorders. They work by occupying receptor sites, allowing the patient to focus and calm down. Stimulants can decrease appetite and are sometimes used off-label for weight loss. • Disul ram is an anti-alcoholic medication that causes severe illness if alcohol is consumed while taking it. • Basic theories used in mental health were mentioned, including Pavlov, Maslow, Erikson, and Freud. Focusing on Maslow's basic needs is important from this chapter. • The therapeutic relationship involves establishing trust by showing genuine interest. • It is important to be empathetic rather than sympathetic when caring for patients. Empathy is trying to understand and share the patient's feelings, while sympathy is just feeling sorry. • The therapeutic relationship progresses through phases: orientation, working, and termination. Termination should be introduced during the orientation phase. • The duty to warn was discussed, which is the obligation to warn potential victims if a patient expresses a threat. • Understanding different nurse roles (teacher, caregiver, etc.) was mentioned as helpful. • Transference and countertransference are concepts related to communication techniques. • The most important type of communication technique is nonverbal. Nonverbal communication is more accurate and less easily faked than verbal communication. • Proximics (distance zones) are important in therapeutic communication. The recommended distance for nurses in mental health is the social distance (4-12 feet), fi fi speci cally suggesting 6 feet as best. Intimate and public distances should be avoided. • Using touch in mental health is generally avoided as it can be misinterpreted. • Active listening involves providing verbal cues to show you are engaged (e.g., "continue," "go on," "tell me more"). • Other therapeutic communication techniques mentioned include focusing and restating. Here are the points discussed in the tutoring session, presented in a study reviewer bullet form, drawing on the provided sources: • • • Eating Disorders: ◦ Differentiate Bulimia Nervosa from Anorexia based on weight and BMI. ◦ How to interact with anorexic patients. ◦ Potential complications related to eating disorders (beyond electrolyte problems). ◦ Adolescence and eating disorders. Personality Disorders: ◦ Borderline personality disorder - discuss interventions. ◦ Histrionic personality disorder - symptoms. ◦ Antisocial personality disorder - characteristic mentioned (shopping?). ◦ Paranoid personality disorder - how to help someone experiencing it. ◦ De nition of personality disorders. Cognitive Disorders: ◦ Basic interventions for cognitive disorders. ◦ Differentiate Delirium from Dementia. Focus on basic interventions for someone with a cognitive disorder versus delirium. ◦ Stages of dementia (mild, moderate, severe) - how to distinguish them. ◦ How to respond to a family member asking about potential dementia in another family member. • Safety and Crisis Management: fi ◦ In mental health, the number one focus is safety. ◦ For psychotic patients, after safety check, the number one intervention is trying to bring them back to reality. ◦ • • How to help someone who has attempted suicide or feels like hurting themselves. Somatic Issues/Disorders: ◦ Clients know they have the issue but have no control. ◦ What to teach somebody about Somatic Symptom Disorder. Schizophrenia: ◦ Characteristics include problems with relationship and thinking. ◦ Desired outcome for someone with schizophrenia. ◦ Patient responding to unseen others (hallucinations). ◦ Guidelines for choosing between rst and second generation antipsychotics for schizophrenia. ◦ • Prolactin level with schizophrenia - just need to know the prolactin level. Admission Criteria: ◦ Criteria for involuntary admission (DTS, DTO, GD) - only need one [review of previous material, not in these sources]. ◦ Communication: ◦ Types of communication, including therapeutic communication [review of previous material]. ◦ Nonverbal communication is the most important. Includes facial expression, body language, eye contact. ◦ Silence is a therapeutic communication technique ("golden type"). ◦ Verbal communication techniques: Exploring, Focusing, Restating, Re ecting. ◦ Favorite verbal technique: Broad opening question, starts with "Tell me". It gives more details versus close-ended questions like "Are you in pain?". Avoid interrupting and giving advice in verbal communication. fl ◦ fi • Patients can also be admitted voluntarily. ◦ Cultural consideration in communication is important as different cultures communicate differently. Example: Eye contact (Asian vs. American culture). ◦ Assertive communication uses the word "I" and is important for setting boundaries. ◦ Proximics (distance zones) - the recommended distance for nurses in mental health is social distance (4-12 feet), suggesting 6 feet as best [review of previous material]. ◦ Generally avoid touch in mental health as it can be misinterpreted [review of previous material]. ◦ Active listening involves providing verbal cues (e.g., "continue," "go on," "tell me more") [review of previous material]. ◦ • Non-therapeutic communication - discuss things to avoid. Nurse-Client Relationship: ◦ Discussed characteristics and types, emphasizing the ideal relationship [review of previous material]. ◦ Avoid intimate or romantic relationships with patients [review of previous material]. ◦ Therapeutic relationship - establishing trust by showing genuine interest [review of previous material]. ◦ Be empathetic rather than sympathetic (Empathy: understand/share feelings; Sympathy: feel sorry) [review of previous material]. ◦ Phases: Orientation, Working, Termination. Termination should be introduced during orientation [review of previous material]. • Abuse: ◦ The cycle of abuse was discussed [review of previous material]. ◦ Abuse can run in families (intergenerational transmission). How to deal with someone who grew up in an abusive home. ◦ Nurses are mandated reporters. Do not need entire evidence to report [review of previous material]. ◦ Most vulnerable populations for abuse: women, children, and the elderly. (Pregnant women were previously mentioned, source 26 lists women, children, pregnant) [review of previous material, 26]. ◦ The abuser usually holds the power. ◦ Abuse results in physical and psychosocial injuries. ◦ Common characteristics of abuser: social isolation, alcohol and drug use. ◦ Domestic violence statistics are similar across different relationship types (malefemale, same-sex). ◦ Victim has less power and protection. ◦ Cycle of violence includes honeymoon, tension building, and violence phases. ◦ Child abuse signs: broken bones (kids are exible), markers not matching the story. Abuser is often irritable, hyper-responsive. ◦ Elderly abuse: Most common type is nancial abuse. Abusers are usually family members. Elderly are afraid to report due to fear of retaliation or losing care. Neglect signs: poor hygiene, wearing same clothes for a long time. Bullying between residents is a type of abuse. ◦ Rape is a crime of violence and humiliation, often committed by someone the victim knows. ◦ Psychotropic Drugs: ◦ Different generations: rst, second, and third generation [review of previous material]. ◦ The most desirable classi cation is the second generation [review of previous material]. ◦ First generation antipsychotics treat primarily positive symptoms of schizophrenia [review of previous material]. ◦ Second generation antipsychotics treat both positive and negative symptoms of schizophrenia [review of previous material]. ◦ fl fi Antidepressant medications were discussed [review of previous material]. fi fi • Therapeutic response and guidelines for someone who has been raped. ◦ Antipsychotic medications are typically used when patients exhibit psychotic features [review of previous material]. ◦ Guidelines for choosing between rst and second generation antipsychotics for schizophrenic patients. • ◦ Ways to minimize some side effects of antipsychotic medication. ◦ Side effects of "every single" antipsychotic medication. Side Effects of Antipsychotics (covered previously, but mentioned again as a review point): ◦ Extrapyramidal Symptoms (EPS): More common with rst generation [review of previous material]. Include acute dystonia, pseudoparkinsonism, akathisia, tardive dyskinesia [review of previous material]. ◦ Neuroleptic Malignant Syndrome (NMS): Symptoms include high fever, hypore exia (corrected from hyperre exia), hemodynamic instability [review of previous material]. ◦ Anticholinergic effects: Dry mouth, constipation, urinary hesitancy/retention [review of previous material]. ◦ Tardive dyskinesia: Potential permanent side effect (slow, repetitive movements, e.g., tongue protruding, lips smacking) [review of previous material]. ◦ Increased appetite, increased prolactin (can cause breast enlargement in men), metabolic syndrome (hyperlipidemia, hyperglycemia, obesity, weight gain) [review of previous material]. ◦ Agranulocytosis (with clozapine) requires WBC monitoring [review of previous material]. • Antidepressants (covered previously, but mentioned again as a review point): ◦ Four major categories: SSRIs, MAOIs, etc. [review of previous material]. ◦ Examples mentioned: uoxetine (Prozac), sertraline (Zoloft) - SSRIs; phenelzine (Nardil), tranylcypromine (Parnate) - MAOIs [review of previous material]. ◦ Do not combine MAOIs with SSRIs (risk of serotonin syndrome) [review of fi fl fi fl fl previous material]. ◦ Do not take MAOIs with tyramine-containing foods (risk of hypertensive crisis) [review of previous material]. Foods include aged cheese, smoked meat, chocolate, pepperoni [review of previous material]. ◦ Trazodone can cause priapism (erection > 4 hours) and is sometimes abused [review of previous material]. • Medication Administration: ◦ If a dose is missed, can usually take within 3 hours, otherwise skip it (birth control is an exception) [review of previous material]. • Mood Stabilizers: ◦ Used speci cally for bipolar disorder [review of previous material, 4]. ◦ Lithium: Common mood stabilizer with a narrow therapeutic range (0.5-1.5, desired 1.2). Notify doctor if > 1.2 [review of previous material, 3]. ◦ Patient teaching for lithium: watch for signs of toxicity (tremors, diarrhea, altered mental status, blurred vision), maintain regular intake of salt and water [review of previous material]. ◦ Other mood stabilizers: valproic acid (Depakote) [review of previous material]. ◦ Characteristics of manic vs. hypomanic phase (key difference: ability to function). ◦ At what age somebody must be diagnosed with bipolar disorder - very hard to diagnose in childhood, need to know why. • Anti-anxiety Medications: ◦ Benzodiazepines can cause sedation and dependency, use cautiously [review of previous material]. • Stimulants: ◦ Used for hyperactive disorders. Work by occupying receptor sites to help focus/ calm down [review of previous material]. ◦ Can decrease appetite, sometimes used off-label for weight loss [review of previous material]. fi • Anti-alcoholic Medication: ◦ Disul ram causes severe illness if alcohol is consumed [review of previous material]. • Theories (covered previously): ◦ Pavlov, Maslow, Erikson, Freud. Focus on Maslow's basic needs [review of previous material]. • Self-awareness: ◦ Crucial for nurses; knowing yourself helps care for patients [review of previous material]. Johari's window mentioned [review of previous material]. ◦ Self-awareness is a component of Chapter 9. Also mentioned as self-explanatory in Chapter 6 review. • Neuroanatomy and Neurotransmitters (covered previously): ◦ Basic nervous system, brain, neurotransmitters [review of previous material]. ◦ Chemical/hormonal imbalances play a major role [review of previous material]. ◦ Major neurotransmitters: dopamine, serotonin, norepinephrine. Balance is important [review of previous material]. ◦ Types: Excitatory (dopamine, epinephrine, norepinephrine, glutamate), Neuromodulators (histamine), Inhibitory (serotonin, GABA) [review of previous material]. • Brain Imaging (covered previously): ◦ Not common in mental health but can show enlarged ventricles (general disorders) or deformed frontal lobe (schizophrenia) [review of previous material]. • Causes of Mental Illness (covered previously): ◦ Genetic component [review of previous material]. Psychoimmunology and infection theory mentioned [review of previous material]. Psychotropic Drug Concepts (covered previously): fl fi fi • ◦ Ef cacy, Potency, Hal ife [review of previous material]. ◦ Off-label drug use [review of previous material]. • Historical Context (covered previously): ◦ Ancient times (displeasing to gods), Renaissance (demon possession) [review of previous material]. ◦ Enlightenment: asylums, Dorita Dix, Freud's study [review of previous material]. ◦ Psychopharmacology emerged in the 1950s [review of previous material]. ◦ First major psychotropics: Thorazine, Haldol, Lithium [review of previous material]. ◦ 21st century: "revolving door" from deinstitutionalization (premature discharge, readmission) [review of previous material]. ◦ • Mental illness affects homelessness (~30%) [review of previous material]. Goals and Healthcare System (covered previously): ◦ Healthy People 2030 goals (integrate mental health, increase diagnosis/treatment, decrease suicide, increase employment for mentally ill) [review of previous material]. ◦ Cost containment/managed care (1970s) led to utilization review and separation of mental health from physical insurance [review of previous material]. ◦ Advanced health practitioners can care for mentally ill patients [review of previous material]. • Assessment (Detailed Review): ◦ Always assess rst before intervening. ◦ Factors in uencing assessment: client status, history, understanding, nurse attitude/mood. ◦ Use open-ended questions ("tell me"). Reorient if patient cannot focus. ◦ Consider age, development, spiritual belief. ◦ Mental Status Exam (MSE) components: ▪ Appearance: hygiene, grooming, dressing appropriately. ▪ Motor Behavior: posture, eye contact, unusual movements (lip smacking, hand shaking, involuntary movements possibly indicating EPS or fi fl Parkinson's). ▪ Speech: pattern, speed, rate, volume (important for identifying mania, etc.). ▪ Mood vs. Affect: Mood is inside, Affect is outside expression. Types of Affect: Restricted (one expression), Broad (many expressions), Blunted (between at and restricted), Flat (no expression). ▪ Thought Process vs. Thought Content: Process is HOW they think. Content is WHAT they think (e.g., SI). ▪ Thought Process Concepts: Circumstantial thinking (returns to point), Tangential thinking (never returns), Delusions, Flight of ideas, etc.. ▪ Word Salad vs. Flight of Ideas: Word salad is random words, Flight of ideas is jumping topics. ▪ Suicidal/Homicidal Ideation: Ask directly, explore plan detail (how, means, time/event). ▪ Sensorium: orientation, concentration. ▪ Abstract Thinking: Proverb interpretation. ▪ Judgment vs. Insight: Judgment is choices/normal vs. abnormal distinction, Insight is accepting illness. ▪ Eating/Sleeping Pattern: Important to assess, especially in manic patients who may not sleep for days. • Legal and Ethical Issues (Detailed Review): ◦ Avoid negligence and malpractice. ◦ Patient right to least restrictive environment. ◦ Restraint: Physical and Chemical. Seclusion is a restraint because it takes away freedom. Use for shortest possible duration. ◦ Con dentiality is a big deal. ◦ Duty to Warn potential victims of threats. ◦ Insanity Law: Legal term, no medical de nition; inability to control actions/ understand wrongfulness; used in court defense. ◦ Liability: Negligence and Malpractice. Must prove 4 elements: Duty, Breach of fi fl fi Duty, Injury/Damage, Causation. ◦ Intentional Torts: Battery, Assault, False Imprisonment. Must prove 3 elements: Willful act, Intent to harm, Act caused substantial harm. ◦ Ethics: Branch dealing with value of human conduct. Principles: Bene cence, Non-male cence, Justice, Veracity (truth-telling). ◦ Ethical Dilemma: Con ict between ethical principles. Can occur in various relationships (nurse/patient, nurse/family, etc.). • Anger and Hostility: ◦ Normal emotion when expressed appropriately. ◦ Know the phases. ◦ Know signs/symptoms of rising anger (triggering phase). ◦ Intervene in the triggering phase (e.g., offer PRN medication) to prevent crisis. ◦ Managing aggressive behavior: take control, provide direction, remain calm and quiet. ◦ • Focus on safety and intervening early. PTSD and Related Disorders: ◦ PTSD develops when coping mechanisms are exhausted after trauma (war, disaster, abuse). ◦ Related disorders: Adjustment Disorders, Acute Stress Disorders, Dissociative Disorders. ◦ Key difference between Adjustment Disorder (up to 6 months after trauma) and Acute Stress Disorder (3-4 days to 4 weeks after trauma). ◦ Reactive Attachment Disorder occurs early (before age 5). ◦ PTSD symptoms: experiencing trauma, intrusive/recurrent thoughts, avoidance, negative cognition. ◦ Treatment options: Counseling, medication, CBT, Exposure Therapy, Relaxation, Adaptive Cognitive Processing Therapy, community based. ◦ Dissociative Disorders: Subconscious defense, disruption during/after event. Types: Dissociative Amnesia (forgetful), Dissociative Identity Disorder (multiple personality), Depersonalization/Derealization (choose to forget bad fi fl fi event). ◦ Dissociative Disorder treatment: group therapy, anxiety medication. Goal is not cure, but to improve quality of life, functionality, reduce symptoms. • Obsessive-Compulsive Disorder (OCD): ◦ Do NOT stop compulsions abruptly. Negotiate with the patient. Abrupt stopping can cause a crisis. ◦ Know de nitions of different phobias (fear of space, spider, water) from the OCD chapter. • Substance Use Disorders: ◦ Signs/symptoms of cocaine intoxication (pupil size mentioned). ◦ Behavior signs indicating substance use or disorders. ◦ What to look for when suspecting substance abuse in a patient with unknown history. • ◦ Onset latency for alcohol withdrawal symptoms (how many days). ◦ Alcoholism and rehabilitation. ◦ Addiction video (watched before ATI exam, on Canvas) - know what was learned. Other Disorders/Topics Mentioned: ◦ Premenstrual Dysphoric Disorders (PMS) - symptoms ( ghting husband for no reason), focus on signs and interventions. ◦ Anxiety disorders - signs/symptoms at different stages (mild, moderate, severe, generalized). Covered again later. Postpartum depression vs. maternity blues difference. ◦ Hoarding disorder - how to approach. ◦ Anxiety, Bipolar, Depression - stated you should know these well. ◦ Manic episode. Exam Information: ◦ Total 100 questions: 75 from the last two weeks, 25 are old material. ◦ No repeated questions. ◦ Study the textbook, not "wrong stuff". fi fi • ◦ ◦ • ATI retake is on Friday on campus. Meeting/Clinical Information: • ◦ Exam day meeting time: 7:30. Exam starts at 8:00. ◦ Clinical makeup submission on Canvas. ◦ Course evaluation encouraged. Key Concepts to Memorize/Differentiate: ◦ Self-ef cacy, Hardiness, Resiliency, Spirituality. ◦ Adjustment Disorders vs. Acute Stress Disorders (timeframe difference). ◦ Dissociative Amnesia vs. Dissociative Identity Disorder vs. Depersonalization/ Derealization. fi fi fi ◦ De nitions of speci c phobias (from OCD chapter).