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Terms in this set (86)
Freud Defense Mechanisms: unconscious processes, relieve anxiety
1. Compensation
2. Denial
3. Displacement
4. Identification
5. Intellectualization
6. Introjection
7. Isolation
8. Projection
9. Rationalization
10. Regression
11. Sublimation
12. Suppression
13. Undoing1. Compensation: strengthen one to hide another
2. Denial: refuse to face negative behavior
3. Displacement: take it out on someone else
4. Identification: attach to something positive
5. Intellectualization: focus on intellectual component, not emotions
6. Introjection: conform feelings for approval
7. Isolation: accepting reality without emotional response
8. Projection: projecting your own thoughts/feelings onto someone else
9. Rationalization: excuse and justify mistakes
10: Regression: act younger to feel better
11. Sublimation: divert negative energy into positive behavior
12. Suppression: suppress thoughts from being conscious
13. Undoing: attempt to undo thought/actionTherapy focused on the past
Interpretation
Free AssociationPsychodynamic Psychotherapy (Freud)
Interpretation: discussing meaning of behavior
Free Association: divulge thoughts/behavior immediately without censorshipDevelopmental Stages
Birth to 3yo
Focus on separation-individuationObject Relations Theory (Mahler)Internalization of experiences with othersKlein & Fairburn"Good enough Mother"
Allows children to develop their true selvesWinnicottPeople seek confidence, self esteem and order to build their self-esteemKohutLooks at how people attach to each otherRelational ModelsSupportive Psychotherapy vs. Expressive PsychotherapySupportive: focus on problem solving, support, for moderate-severe mental illness
Expressive: dealing with defense mechanisms (best for BPD)For patients with mature (and primitive) defense mechanisms and some object constancyPsychoanalytic PsychotherapyInterpersonal relationships determine our sense of security, who we are
Good Me
Bad Me
Not MeInterpersonal Theory (Sullivan)
Good Me: positive feedback, pleasure, contentment
Bad Me: negative feedback, anxiety, discomfort
Not Me: intense feelings, horror, dread, loathingCoping Strategies Interpersonal Theory
1. Security Operations
2. Selective Inattention
3. Dissociation1. Security Operations: measures to decrease anxiety
2. Selective Inattention: not paying attention to details that cause anxiety
3. Dissociation: not acknowledging things that cause anxiety1-3. Ego States (PAC)
4. Strokes
5. Structural Analysis
6. Transactional Analysis
7. Family Modeling
8. Analysis of Games & Rackets
9. Script AnalysisTransactional Analysis (Berne)
1. Parent: shoulds, oughts
2. Adult: objective, not emotional or judgmental
3. Child: feelings, impulsive acts
4. Strokes: feedback
5. Structural Analysis: patient becomes aware of ego states
6. Transactional Analysis: social interactions are analyzed to determine ego states
7. Family Modeling: imagining past situations, influence of significant others in interactions
8. Analysis of Games & Rackets: understanding transactions with others
9. Script Analysis: life patterns are evaluatedStrokes (Transactional Analysis)
1. Positive Strokes
2. Negative Strokes
3. Unconditional Strokes
4. Conditional Strokes
5. Games
6. Rackets
7. Life Scripts5. Games: repetitive, unconscious transactions between people where both parties end up experiencing rackets
6. Rackets: substitute feelings instead of authentic feelings
7. Life Scripts: life story we made up as childrenIndividual is responsible for his/her own environment
Must accept personal responsibility
Increased awareness of self
Focused on PRESENTGestalt TherapyUnconditional Positive Regard
Every patient has the ability to become aware of their problem and solve it
Therapist helps the patient find their own path, not about probing
Therapist Qualities: genuineness, warmth, empathy, active listening, reflectionPerson-Centered Therapy (Carl Rogers)Used for substance use disorders
Collaborative
Support clients in making change
1. Relational Component
2. Technical ComponentMotivational Interviewing
1. Relational Component: empathy
2. Technical Component: reinforcement of change talkTypes of Motivation
1. Amotivation
2. Extrinsic
3. Intrinsic1. Helpless
2. Activities with pay off
3. Self-rewardingOARSOpen-ended questions
Affirmations
Reflective listening
SummariesStages of Change Model
1. Pre-contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
6. Relapse1. Pre: not considering change
2. Contemplation: ambivalent about change
3. Preparation: commit and plan
4. Action: implement and revise
5. Maintenance: integrate change into lifestyle
6. RelapseChange
1. Preparatory Phase
2. Predictive Phase
(DARN-CAT)1. Preparatory Phase: desire, ability, reason, need
2. Predictive Phase: commitment, activation, taking stepsCBT
1. Schemas
2. Primary Thinking
3. Secondary Thinking
4. Socratic Dialogue
5. Downward Arrow
6. Labeling Distortions
7. Assertiveness Training
8. Cognitive Restructuring1. Schemas: world views, all encompassing
2. Primary Thinking: negative and irrational
3. Secondary Thinking: positive and rational
4. Socratic Dialogue: lead the patient to discovering and idea
5. Downward Arrow: if this is true, then what happens?
6. Labeling Distortions: all or nothing, catastrophizing
7. Assertiveness Training: help patients express needs/wants (helpful in family/couples therapy)
8. Cognitive Restructuring: alter dysfunctional thinking, improve feelings/behaviorAll behavior is a result of its consequences
Encourage/discourage specific behavior using reinforcement, reinforcement comes after behaviorApplied Behavioral Analysis/Operant ConditioningSomething of monetary value in exchange for not using drugsContingency ManagementInvoluntary behavior is based on neutral stimulus (learned)
Stimulus comes before behaviorStimulation-Response Model/Classical ConditioningIndividual experiences, actions of others, and environment influence behaviorSocial Cognitive Theory (Pavlov)All psychopathology has similar irrational beliefs rooted in childhood
Examine validity of beliefsRational Emotive Therapy (Ellis)Change and acceptance
Pt always does the best they can
Pt cannot fail - therapist/treatment fails
Therapist qualities: oriented to change, acceptanceDBT4 Elements of DBT1hr weekly therapy
group skills training weekly
skills coaching PRN
team consultation to ensure treatment fidelityStages of DBT (1-4)1. focus on therapy engaging/interfering and life-threatening behaviors, diary cards are essential
2. non-traumatizing therapy, regulation of emotions
3. skills, self-awareness, dealing with trauma, exposure therapy
4. self-efficacy, interdependence, self-fulfillment, decreasing therapy sessionsHildegard Peplau's 6 Nursing Subroles
***PMHNP main role1. Mother-Surrogate: provide basic needs
2. Technician
3. Manager: manage environment
4. Socializing Agent
5. Health Teacher
6. Counselor/Psychotherapist: PMHNP main roleStages of Therapy
1. Pretreatment
2. Beginning
3. Middle
4. End Phase/Termination
5. F/u1. Pretreatment: patient identifies goals, expected time for resolution
2. Beginning: develop therapeutic alliance, ID issues, set limits, contract for number of sessions/payment
3. Middle: increase awareness, clarify, confront, interpret resistance, monitor progress
4. End Phase/Termination
5. F/u PRNPhases of Therapeutic Relationship
1. Orientation
2. Working Phase
3. Termination1. Orientation: 1+ meetings, establish relationship, work on communication, ID roles
2. Working Phase: gather info, positive change, work through resistance, discuss termination
3. Termination: goals are met, review accomplishments, discuss guidelines for future communicationIndividuals learn how to differentiate themselves within a family
1. Fusion
2. Cutoffs
3. Emotional Reactivity
4. TrianglesFamily Systems Therapy
1. Fusion: people borrow/lend one another
2. Cutoffs: immature separation
3. Emotional Reactivity: react without separating thoughts, feelings
4. Triangles: person A focuses on person C to manage anxiety with person B (de-triangulation allows for differentiation)Strategies families have developed to deal with issues becomes a problemStrategic Family TherapyFamily therapy with:
1. Subsystems
2. Boundaries
3. Enmeshment
4. DisengagementStructural Family Therapy
1. Subsystems: subgroups within a family connect
2. Boundaries: emotional walls
3. Enmeshment: not enough boundaries
4. Disengagement: rigid boundariesShort term (10-15 sessions) family therapy that uses multiple different theoriesEmotionally Focused Family TherapyRecovery is the most important goal
Individuals improve their health/wellness, live.a self-directed life, strive to reach full potential
Adherence to treatment is a predictor of recovery
1. Concordance
2. Person-Centered
3. Exchange-Centered
4. Community-CenteredRecovery Model of Care
1. Concordance: partnership with pt, not authoritative, communication is key
2. Person-Centered: sense of hope, self-determination
3. Exchange-Centered: taking on social roles
4. Community-Centered: social connections, community integrationL-a-acetylmethadol (LAAM)alt to methadone effective for up to 36hrs, dosed three times per weekRisk for ETOH use disorder in amount consumed per week or per day
Men
WomenMen: 14 drinks per week, 4 drinks per day
Women: 7 per week, 3 per daySBIRT
CAGE
AUDITSBIRT: Screening, Brief Intervention and Referral Tool (for substance use)
AUDIT: Alcohol Use Disorders Identification TestETOH Withdrawal Onset of
1. Seizures
2. DT's1. Seizures: 7-48hrs
2. DT's: 48-72hrsCIWA Score
>15
8-14
0-8>15: immediate pharm intervention
8-14: initiate pharm intervention
0-8: supportive treatment, continue monitoringTreatment for:
1. Wernicke's Encephalopathy
2. Alcohol Deterrent1. Prophylactic: IV Thiamine 250mg daily X3-5 days
Treatment: IV Thiamine 500mg daily X3-5 days, then 250mg X3-5 days
(Healthy drinkers PO Thiamine 300mg daily during detox)
2. Disulfiram (Antabuse)
Acamprosate (Campral)COWS Score (treatment)
0-14
>150-14: Clonidine
>15: Clonidine +/- Phenobarbital, methadoneFDA approved meds for mood dysregulation in childrenFluoxetine, Fluvox, Sertraline (7+)
Depakote (3+)
Lithium (7+)
Olanzapine (Zyprexa), Quetiapine, Abilify, Arsenapine (Saphris), Lurasidone (10+)
Carbamazepine (13+)Palilalia
Echolalia
CoprolaliaPalilalia: repeating one's own sound/words
Echolalia: repeating the last heard word/phrase
Coprolalia: saying socially unacceptable wordsPharm Treatments for TourettesPimizide (Orap)
Haldol
ClonidinePharm Treatment EnuresisImipramine (OD can cause cardiac arrhythmia)
Desmopressin (DDAVP): nocturnal enuresis
Oxybutynin: daytime incontinenceLow Na
Low K
Low Cl
Elevated CO2
Metabolic AlkalosisAnorexia /BulimiaSigns of AnorexiaVery low BMI
Lanugo
Hypothermia
Bradycardia
Loss of SubQ tissue, pubic/scalp hair
Pigmentation of chest/abdomen
Distended abdomenSigns of BulimiaFull facies: parotid/submaxillary swelling
Tachycardia
Orthostatic hypotension
Russell's Sign: scratches/calluses over knuckles
petechiae, subconjunctival hemorrhage
abdominal tendernessIncidence of anxiety in the US12-25%1. Moderate Anxiety
2. Severe Anxiety1. Moderate: inability to concentrate, impaired learning, perceptual distortions, restless, muscle tension
2. Severe (pathologic): limited attention/concentration, increased somatic symptoms, behavior aimed at relieving anxiety, response not proportional to threat, response continued beyond threat, impaired functioning1. Medicare A
2. Medicare B
3. Medicare C
4. Medicare D1. A: inpatient, SNF, home health, hospice
2. B: physician services, outpatient hospital services, labs, diagnostic procedures, medical equipment
3. A + B = C
4. D: Rx coverageIncident to Billing- Billing under a licensed physician (or other health care provider), can be billed at 100% of physician fee (80% of bill is payed by Medicare, 20% by patient, NP is payed 85%)
- physician must be present in the office
- physician must perform initial eval and subsequent intermittent evalsSteps of Quality Improvement-Conducting an assessment
-Setting specific goals for improvement
-Identifying ideas for changing current practice
-Deciding how improvements in care will be measured
-Rapidly testing practice changes
-Measuring improvements in care
-Adopting the practice change as a new standard of careRoot Cause Analysisfollows sentinel event (death or serious injury)
experts analyze underlying cause and effect through why questions
identify risks
determine potential improvementsLACE ModelLicensure
Accreditation
Certification
Educationmeta-analysis vs. meta-synthesisAnalysis: uses quantitative studies to test hypothesis
Synthesis: uses qualitative studies to build new theoriesPICOTPatient
Intervention
Comparison
Outcome
Timeframe1. Level of significance (p-value)
2. Confidence Interval1. p-value = <.05 is statistically significant
2. Confidence Interval: smaller interval is more preciseInternal Validity vs. External ValidityInternal: treatment lead to outcome
External: generalizability of resultsProstate CA Screening40: 1+ first degree relative with prostate CA at early age
45: African American, 1+ first degree relative with prostate CA <65yo
50: avg risk, expected to live >10 yearsDepression NT and part of brainSerotonin
Locus CoreolusAnxiety NT and part of brainElevated Serotonin, Norepinephrine
Decreased GABA
Raphe Nuclei, AmygdalaPsychosis NT and part of brainElevated Dopamine
Basal Ganglia1. frontal lobe
2. parietal lobe
3. occipital lobe
4. temporal lobe1. Frontal: Personality, decision making, movement, sense of smell, Broca's Area (speech)
2. Parietal: identify objects, spacial relations, pain/touch, Wernicke's Area (understanding language)
3. Occipital: vision
4. Temporal: short term memory, speech, musical rhythmErickson
1. Trust vs. Mistrust
2. Autonomy vs. Shame and Doubt
3. Initiative vs. Guilt
4. Industry vs. Inferiority
5. Identity vs. Role Confusion1. infancy. Goal: develop trust. Failure: difficulty giving/receiving
2. 18mo to 3yo. Goal: gain self control, willpower. Failure: lack of confidence
3. 3yo to 6yo. Goal: identify and direct activities. Failure: inadequacy, guilt
4. 6yo to 12yo. Goal: self confidence, peer recognition. Failure: low self esteem, poor interpersonal skills
5. 12yo to 20yo. Goal: develop identity. Failure: lack of direction, self confidenceClozaril Monitoring, Dosing12.5, 25-50, max 900
>2000, 1500, 1000NMS Treatment
Hot, stiff and out of itDantrolene, Amantadine
BromocriptineSerotonin Syndrome TreatmentCyproheptadine
Dantrolene2C19
1A2
2D6
3A42C19 - Asians 20%, AA 19%
1A2 - Cigarettes
2D6 - Caucasians
3A4 - all meds, grapefruit juice, carbamazepineLithium Tox
Monitoring>1.2
5-7 days after dose change, initiationDoxepin ClassTCACauses side effect/contraindication of liver toxPhenobarbital, Depakote, CarbamazepineSelegilineAnti-parkinson med and MAOI
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