Chapter 4 Pharm
Discuss the difference between a side effect and an adverse effect.
Describe the goal of milieu therapy.
The goal is to manipulate the environment so that all aspects of the patient's hospital experience are considered therapeutic.
Define 1 leadership style.
Autocratic: have personal goals from the group. The focus is on the leader.
Democratic: focus on the members of the group.
Laissez-Faire-allows people to do as they please.
List one medical diagnosis commonly associated with traumatic bereavement.
Post-traumatic stress disorder (PTSD).
List one goal of recovery.
Improve health and wellness
Live a self-directed life
Reach a person's full potential
List two EPS symptoms.
Describe two members of the interdisciplinary team in psychiatry.
Psychiatrist
Clinical Psychologist
Psychiatric Clinical Nurse Specialist or Psychiatric Nurse Practitioner
Mental Health Technician
Psychiatric Social Worker
Occupational Therapist
Recreation Therapist
Music Therapist
Art Therapist
Dietician
Chaplain
List two of the three physical conditions that influence group dynamics.
Seating: a circle of chairs is better than chairs around a table.
Size: the larger the group, the less time available to devote to individual members
Membership: Open-ended groups create discomfort, and are the most common type seen on short-term units
closed-ended groups-made of individuals with common issues or problems
Are you thinking about harming yourself right now?
In the past few weeks, have you wished you were dead?
In the past few weeks, have you felt that you or your family would be better off if you were dead?
In the past week, have you been having thoughts about killing yourself?
Have you ever tried to kill yourself?
List two aspects of the Tidal Model of Recovery.
1. Value the voice:
2. Respect the language:
3. Develop genuine curiosity:
4. Become the apprentice:
5. Use the available toolkit:
6. Craft the step beyond:
7. Give the gift of time:
8. Reveal personal wisdom:
9. Know that change is constant:
10. Be transparent:
List three food to be avoided while taking MAOI inhibitors.
List three of the five conditions of a therapeutic community environment from your text.
1. Containment
2. Structure
3. Involvement
4. Support
5. Validation
List the three phases of group development.
Phase 1. Initial or orientation phase
Phase 2. Middle or working phase
Phase 3. Final or termination phase
List one goal of crisis intervention.
■ Have positive behavioral changes occurred?
■ Has the individual developed more adaptive coping strategies? Have they been effective?
■ Has the individual grown from the experience by gaining insight into their responses to crisis situations?
■ Does the individual believe that they could respond with healthy adaptation in future stressful situations to prevent crisis development?
■ Can the individual describe a plan of action for dealing with stressors similar to the one that precipitated this crisis?
List three of the five stages of the Psychological Recovery model.
Stage 1. Moratorium: This stage is identified by dark despair and confusion. “It is called moratorium, because it seems ‘life is on hold’” (p. 47).
Stage 2. Awareness: In this stage, the individual comes to a realization that a possibility for recovery exists. Andresen and associates state, “It involves an awareness of a possible self other than that of ‘sick person’: a self that is capable of recovery” (p. 47).
Stage 3. Preparation: This stage begins with the individual’s resolve to begin the work of recovery.
Stage 4. Rebuilding: The hard work of recovery takes place in the rebuilding stage. The individual “takes the necessary steps to work towards his or her goals in rebuilding a meaningful life” (p. 87).
Stage 5. Growth: The outcome of the psychological recovery process is growth. Although it is called the final stage of the psychological recovery model, it is important to remember that this is a dynamic stage and that personal growth is a continuing life process.
List four signs or symptoms of serotonin syndrome.
Signs and symptoms include:
Severe serotonin syndrome can be life-threatening. Signs include:
List 4 automatic thoughts present in depression that can be treated through cognitive behavioral therapy.
■ Personalizing: “I’m the only one who failed.”
■ All or nothing: “I’m a failure at everything I do.”
■ Mind reading: “He thinks I’m foolish.”
■ Discounting positives: “Even though I got the promotion, it was probably because no one else wanted the job.”
List four of Sampson and Marthas' (1990) 8 functions of a group.
1. Socialization
2. Support
3. Task completion
4. Camaraderie
5. Information sharing
6. Normative influence
7. Empowerment
8. Governance
List four of the six crisis classes.
Class 1: Dispositional Crises
An acute response to an external situational stressor.
Class 2: Crises of Anticipated Life Transitions
Normal life-cycle transitions may be anticipated but the individual may feel a lack of control over them.
Class 3: Crises Resulting From Traumatic Stress
Crisis precipitated by an unexpected external stressor over which the individual has little or no control, resulting in feelings of being emotionally overwhelmed and defeated.
Class 4: Maturational and Developmental Crises
Crises that occur in response to failed attempts to master developmental tasks associated with transitions in the life cycle.
Class 5: Crises Reflecting Psychopathology
A crisis that is influenced or triggered by pre-existing psychopathology. Examples of psychopathology that may precipitate crises include personality disorders, anxiety disorders, bipolar disorder, and schizophrenia.
Class 6: Psychiatric Emergencies
Crisis situations in which general functioning has been severely impaired and the individual rendered incompetent or unable to assume personal responsibility for their behavior. Examples include acutely suicidal individuals, drug overdoses, reactions to hallucinogenic drugs, acute psychoses, uncontrollable anger, and alcohol intoxication.
List the four dimensions of recovery according to SAMHSA.
1. Health: Overcoming or managing one’s disease as well as living in a physically and emotionally healthy way
2. Home: A stable and safe place to live
3. Purpose: Meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society
4. Community: Relationships and social networks that provide support, friendship, love, and hope
List 5 considerations with lithium.
1. Therapeutic range is from 0.6-1.2 mEq/L
2. At levels over 1.5 mEq/L, side effects increase
3. Optimal range of 0.4-0.6 mEq/L. Higher levels, closer to 1.0 may be more effective for those more prone to manic episodes.
4. Lithium levels should be monitored monthly during maintenance therapy
5. Lithium is a salt and is an imperfect substitute for sodium. Anything that depletes sodium increases the risk for toxicity. Must maintain regular sodium and fluid intake.
6. Too much dietary sodium will decrease amount of available lithium
7. Weight gain is a common side effect-education is needed
8. Has a warning label-can increase suicidal thoughts and behaviors
9. Lithium toxicity:
Mild symptoms: nausea, vomiting, lethargy, tremor, and fatigue (Serum lithium concentration between 1.5-2.5 mEq/L)[33] [34].
Moderate intoxication: confusion, agitation, delirium, tachycardia, and hypertonia (serum lithium concentration between 2.5-3.5 mEq/L)[33] [34].
Severe intoxication: Coma, seizures, hyperthermia, and hypotension (serum lithium concentration (more than 3.5 mEq/L)[33] [34].
List five types of individual psychosocial therapy.
Psychoanalysis and Psychoanalytic Psychotherapy
Interpersonal Psychotherapy
Reality Therapy
Cognitive Behavioral Therapy
Dialectical Behavioral Therapy
List five of Yalom and Leszcz's (2005) 11 therapeutic factors.
1. Instillation of hope
2. Universality
3. Imparting of information
4. Altruism
5. Corrective recapitulation of the primary family group.
6. Development of socializing techniques
7. Imitative behavior
8. Interpersonal learning
9. Group cohesion
10. Catharsis
11. Existential factors
List five behaviors associated with anger or aggression.
Anger
■ Anxious, tense, frowning, or angry facial expression (affect)
■ Clenched fists
■ Low-pitched verbalizations forced through clenched teeth
■ Yelling and shouting
■ Intense eye contact or avoidance of eye contact
■ Hypersensitivity, easily offended
■ Defensive response to criticism
■ Passive-aggressive behaviors
■ Lack of control or overcontrolled emotions
■ Intense discomfort; continuous state of tension
■ Flushed face
Aggression
■ Pacing, restlessness
■ Threatening body language
■ Verbal or physical threats
■ Loud voice, shouting, use of obscenities, argumentativeness
■ Threats of homicide or suicide
■ Increase in agitation, with overreaction to environmental stimuli
■ Panic anxiety, leading to misinterpretation of the environment
■ Suspiciousness and defensive posturing
■ Angry mood, often disproportionate to the situation
■ Destruction of property
■ Acts of physical harm toward another person
List five guiding principles of recovery.
■ Recovery emerges from hope:
■ Recovery is person-driven:
■ Recovery occurs via many pathways:
■ Recovery is holistic:
■ Recovery is supported by peers and allies:
■ Recovery is supported through relationship and social networks:
■ Recovery is culturally based and influenced:
■ Recovery is supported by addressing trauma:
■ Recovery involves individual, family, and community strengths and responsibilities:
■ Recovery is based on respect