Psychology Chapter: Maslow's Hierarchy of Needs

Maslow's Hierarchy of Needs

• Physiological Needs: Basic fundamental needs like food, air, water, sleep, exercise, elimination, shelter, and sexual expression.

• Safety: Avoiding harm, maintaining comfort, order, structure, and freedom from fear.

• Love: Giving and receiving affection, companionship, interpersonal relationships, and belonging to a group.

• Self-Esteem: Seeking self-respect and respect from others, striving for success and recognition.

• Self-Actualization: Feeling of self-fulfillment; reaching full potential.

Mental Health

• Successful adaptation to internal or external stressors, evidenced by age-appropriate and culturally-normative thoughts, feelings, and behaviors.

Mental Illness

• Maladaptive responses to stressors, evidenced by thoughts, feelings, and behaviors incongruent with cultural norms, interfering with social, occupational, or physical functioning.

Fight or Flight Syndrome

• Immediate: Hypothalamus stimulates the sympathetic nervous system, leading to physical effects.

• Sustained: Prolonged stress; hypothalamus stimulates the pituitary gland to release hormones, causing effects.

General Adaptation Syndrome

• Alarm: Fight-or-flight response occurs.

• Resistance: Attempts to adapt to the stressor.

• Exhaustion: Prolonged exposure to the stressor; without intervention, exhaustion or death can result.

Anxiety Levels

• Mild Anxiety: Seldom a problem; sharpens senses, increases motivation, and expands awareness.

• Moderate Anxiety: Perceptual field narrows; attention span and concentration decrease.

• Severe Anxiety: Focus narrows to one detail or many extraneous details; attention span is extremely limited; behavior aims at relieving anxiety.

• Panic Anxiety: Most intense state; inability to focus, loss of contact with reality, misperceptions, and possible hallucinations or delusions; feeling of terror; can be life-threatening.

Stages of Grief

• Denial: Shock and disbelief.

• Anger: Loss displaced on environment or internalized.

• Bargaining: Promises made to delay the loss.

• Depression: Full impact of loss is felt.

• Acceptance: Resignation to the loss.

• Delayed/Inhibited Grief: Absence of grief when expected; potentially pathological; fixing on denial stage; delaying return to satisfying life.

• Distorted Grief: Exaggerated symptoms. Fixing on anger stage; can lead to depression.

• Chronic/Prolonged Grief: Intense preoccupation years after loss; caution necessary; can prevent daily activities.

Schizophrenia

• Biological factors: frontal cortex, temporal lobes, and limbic system involved; dopamine hyperactivity; decreased glutamate; decreased prolactin levels; possible correlation with antipsychotic medications and lowest prolactin levels.
• Genetics: Twin, familial, and adoption studies suggest a genetic link.

Depressive Disorders

• Biological factors: Frontal lobes, limbic system, and temporal lobes involved; decreased norepinephrine, dopamine, and serotonin; increased glutamate; increased cortisol and thyroid hormone; increased melatonin.
• Genetics: Twin, familial, and adoption studies suggest a genetic link.

Bipolar Disorder

• Biological factors: Frontal lobes, limbic system, and temporal lobes involved; increased norepinephrine and dopamine in acute mania; elevated thyroid hormones may manifest as manic symptoms; abnormal circadian rhythms correlated.
• Genetics: Twin, familial, and adoption studies suggest a genetic link.

Principles of Ethics

• Autonomy: Respecting patients' rights to determine their destinies.

• Beneficence: Duty to benefit others.

• Nonmaleficence: Avoiding harm and acting carefully.

• Justice: Treating all individuals equally and fairly.

• Veracity: Truthfulness.

Admission Types

• Voluntary Admission: Sought by patient or guardian; patient can demand release; many states require written notice of intent to leave. Patient is competent and can refuse treatment.

• Involuntary Admission: Made without patient consent; commonly due to imminently dangerous behaviors (suicidal or homicidal) or inability to care for basic needs.

• Emergency Commitment: Time-limited with court hearing scheduled within 72 hours. Individuals are clearly and imminently dangerous to themselves or others.

Patient Rights

• Right to Treatment: Medical and psychiatric care provided.

• Right to Refuse Treatment: Withholding or withdrawing consent for treatment.

• Right to Least Restrictive Treatment Alternative: Outpatient treatment preferred; hospitalization only if other methods are unsuccessful.

• Informed Consent: Essential; must be obtained to perform treatment; psychosis doesn't preclude the right.

Confidentiality

• Limits access to client information to those involved in care. Written consent required for sharing with outside parties.

• Duty to Warn: Exception to confidentiality to protect third parties.

Legal Aspects of Healthcare

• Statutory Law: Legislative enactments like nurse practice acts.

• Common Law: Principles derived from previous court decisions.

• Civil Law: Protects private rights and allows lawsuit for breach of tort or contract.

• Torts: Wrongful conduct causing harm; seeks compensation.

• Contracts: Breach of agreement; seeks compensation or performance.

• Criminal Law: Protects public welfare and punishes those who engage in injurious conduct.

Hormones

• Antidiuretic Hormone (ADH): Conserves water and maintains blood pressure.

• Oxytocin: Uterine contractions and milk release.

• Growth Hormone: Growth in children; protein synthesis in adults.

• Thyroid Stimulating Hormone (TSH): Stimulates thyroid hormone for metabolism and temperature regulation.

• Adrenocorticotropic Hormone (ACTH): Stimulates cortisol for stress response.

• Prolactin: Milk production.

• Gonadotropic Hormones: Stimulate estrogen, progesterone, and testosterone; role in ovulation and sperm production.

• Melanocyte-stimulating hormone: Stimulates melatonin secretion.

Specific Disorders

• Panic Disorder: Limbic system and midbrain, increase in norepinephrine, decreased GABA, elevated thyroid hormones, genetic link suggested.
• Anorexia Nervosa: Limbic system (hypothalamus), low norepinephrine, serotonin, and dopamine, low gonadotropins and growth hormone, high cortisol, genetic link suggested.
• Obsessive-Compulsive Disorder (OCD): Limbic system and basal ganglia; low serotonin; increased cortisol; twin studies suggest a possible genetic link.
• Alzheimer's Disease: Temporal, parietal, and occipital regions of the cortex; hippocampus; decreased acetylcholine, norepinephrine, serotonin, and somatostatin; decreased corticotropin-releasing hormone; familial predisposition, genetic markers.

Medications

• Typical Antipsychotics: (Chlorpromazine, Thioridazine, Haloperidol, Fluphenazine) Treat psychosis, schizophrenia, and others; adverse effects like EPS, hypotension, sedation; administer anticholinergic and beta blockers for EPS control.

• Atypical Antipsychotics: (Risperidone, Olanzapine, Quetiapine, Aripiprazole, Clozapine, Ziprasidone) Positive and negative symptoms of schizophrenia, bipolar disorders, and others; adverse effects like diabetes, weight gain, orthostatic hypotension, EPS. Clozapine-suppresses bone marrow, Ziprasidone-QT prolongation.

• Lithium: Bipolar disorder, alcoholism; adverse effects like GI distress, tremors, polyuria; monitor lithium levels (0.6-1.2).

• Anticonvulsants: (Carbamazepine, valproic acid, Lamotrigine) – Treat bipolar disorders; adverse effects include double vision, blood dyscrasias, hepatotoxicity, SJS.

• Benzodiazepines: (Diazepam, Alprazolam, Lorazepam, Chlordiazepoxide, Clorazepate): Anxiety, seizures, insomnia; adverse effects include sedation, lightheadedness. Schedule IV, do not use with respiratory depression or substance abuse.

• CNS Stimulants: (Methylphenidate, Amphetamine): ADHD, conduct disorder; adverse effects include abuse, CNS stimulation, weight loss, dysrhythmias, chest pain, and hypertension.

• Buspirone: Anxiety adjunct; adverse effects are minimal CNS depression; grape juice may increase effects.

• SSRIs: (Fluoxetine, Citalopram, Escitalopram, Paroxetine, Sertraline): Major depression, OCD, bulimia, PTSD; adverse effects include sexual dysfunction, serotonin syndrome, and GI bleeding.

• MAOIs: (Phenelzine, Isocarboxazid, Tranylcypromine, Selegiline): Atypical depression, bulimia, OCD; adverse effects include hypertensive crisis (monitor tyramine intake).

• TCAs: (Amitriptyline, Imipramine, Doxepin, Nortriptyline, Amoxapine): Depression; adverse effects include hypotension, anticholinergic effects, sedation, and sweating.

• Atypical Antidepressants: (Bupropion, Duloxetine, Mirtazapine, Venlafaxine): Depression, smoking cessation. Adverse effects include suppression of appetite, dry mouth, GI distress, tachycardia, insomnia, and seizures.