Psychology: Understanding Hallucinations

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Questions and Answers

Which medication type is more likely to cause extrapyramidal symptoms (EPS)?

Selective serotonin reuptake inhibitors

Atypical antipsychotics

Typical antipsychotics (correct)

Mood stabilizers

What is one characteristic of akathisia?

Sudden muscle contractions

Rigidity and tremors

Motor restlessness (correct)

Involuntary tongue movements

Which of the following accurately describes Bipolar II disorder?

No history of hypomanic episodes

At least one major depressive episode

At least one hypomanic episode and one major depressive episode (correct)

At least one manic episode

What best describes the onset of mania in bipolar disorder?

Gradual with subtle changes in mood and behavior Signup and view all the answers

What type of movement disorder is characterized by involuntary rhythmic movements of the face and tongue?

Tardive dyskinesia Signup and view all the answers

What should be prioritized when managing violent command hallucinations?

Staff availability for safety Signup and view all the answers

Which type of hallucination involves experiencing sensations on the skin that are not there?

Tactile Signup and view all the answers

What is a recommended approach for communicating with someone experiencing hallucinations?

Offer simple and direct instructions Signup and view all the answers

In severe cases of hallucinations, what may be necessary to ensure patient safety?

Seclusion or restraints Signup and view all the answers

What type of hallucination involves hearing voices or sounds that are not present?

Auditory Signup and view all the answers

When managing delusions, what is a key intervention?

Identify and challenge delusional beliefs Signup and view all the answers

What should be avoided while interacting with a person experiencing hallucinations?

Arguing or challenging their hallucination Signup and view all the answers

Which intervention can help a person manage distress associated with delusions?

Teach coping strategies Signup and view all the answers

What is one feature commonly associated with mania?

Elevated or irritable mood Signup and view all the answers

Which nursing management strategy is essential for protecting patients with mania?

Prevent harm to self and others Signup and view all the answers

What is the therapeutic range for lithium levels?

0.6-1.2 mEq/L Signup and view all the answers

What is a common sign of lithium toxicity?

Tremor Signup and view all the answers

Which aspect is critical in therapeutic communication with manic patients?

Establishing trust and rapport Signup and view all the answers

What should be monitored in patients with bipolar disorder to ensure safety?

Signs of agitation or aggression Signup and view all the answers

Which is NOT a risk factor for suicidal ideation in patients with Major Depressive Disorder (MDD)?

High self-esteem Signup and view all the answers

Which action is NOT appropriate when managing a patient exhibiting suicidal ideation?

Encouraging isolation from others Signup and view all the answers

Which of the following is NOT a recommended nursing intervention for instilling hope in patients?

Provide strict discipline Signup and view all the answers

What signifies a high risk of suicide that may warrant inpatient hospitalization?

High suicide risk Signup and view all the answers

Which of the following is a cue for impending suicide?

Sudden mood shifts Signup and view all the answers

What is a common risk factor associated with suicide?

Previous suicide attempts Signup and view all the answers

Which intervention is crucial when assessing suicidal ideation in a patient?

Inquire about the presence of a plan Signup and view all the answers

Which of the following statements reflects an understanding of maintaining consistency with patients?

Provide a predictable environment Signup and view all the answers

Which coping mechanism should NOT be encouraged for patients?

Substance abuse Signup and view all the answers

What is considered a priority nursing intervention for a patient at risk of suicide?

Establishing a therapeutic relationship Signup and view all the answers

Which symptom is NOT associated with Neuroleptic Malignant Syndrome?

Obsession with particular thoughts Signup and view all the answers

What is the primary nursing intervention for someone diagnosed with Neuroleptic Malignant Syndrome?

Stop the causative medication immediately Signup and view all the answers

What is the average life expectancy reduction for individuals with serious mental illness compared to the general population?

10-20 years Signup and view all the answers

Which of the following is a characteristic of milieu therapy?

Creating a therapeutic environment that supports recovery Signup and view all the answers

What term describes rapid, excessive speech that is difficult to interrupt, particularly in mania?

Pressure speech Signup and view all the answers

Which of the following delusions involves a belief that another person, usually of higher status, is in love with the individual?

Erotomanic delusion Signup and view all the answers

In the context of mental health, what does tangentiality refer to?

Never answering the original question and veering off-topic Signup and view all the answers

Which medication might be administered to patients suffering from Neuroleptic Malignant Syndrome?

Bromocriptine Signup and view all the answers

Study Notes

Hallucinations

Types: Auditory (hearing things), visual (seeing things), olfactory (smelling things), gustatory (tasting things), tactile (feeling things).
Concerns: hallucinations that are persistent, frequent, distressing or command hallucinations that instruct the person to do something.
Interventions: assess the content, frequency, and impact of hallucinations. Provide reality testing, helping the person distinguish between hallucinations and reality. Teach coping strategies like distraction, relaxation, and positive self-talk.
Therapeutic communication: acknowledge the experience of the hallucination, focus on the feelings, explore coping strategies.

Management of Violent Command Hallucinations

Prioritize safety: assess the situation, ensure a safe environment, have enough staff for management.
Clear and direct communication: use a calm and firm voice, give simple directions, avoid arguing or challenging the hallucination.
Consider medication adjustments: consult with a healthcare professional to adjust medication dosage or type. Rapid tranquilization may be needed in severe cases.
Seclusion or restraints: may be necessary as a last resort to prevent harm. Use for the shortest duration and monitor closely.

CBT for Delusions

Identify and challenge delusional beliefs: explore evidence, gently challenge the logic and plausibility.
Develop alternative explanations: help the person develop alternative explanations.
Improve coping strategies: teach strategies to manage distress related to delusions.

Management of Delusions

Similar to hallucinations, focus on the feelings associated with the delusion.
Do not try to disprove the delusion or argue.
Validate the person's feelings and experiences.
Explore coping strategies.

Types of EPS and Causative Medications:

Dystonia: sustained muscle contraction, twisting posture, painful and frightening.
Akathisia: motor restlessness, unable to stay still or remain in one place, distressing and can lead to agitation.
Parkinsonism: tremor, rigidity, bradykinesia.
Tardive dyskinesia: involuntary movements of the face and tongue, can be irreversible.
Medications: Typical antipsychotics are more likely to cause EPS than atypical antipsychotics.

Bipolar I vs. II

Bipolar I: at least one manic episode. May also have hypomanic or depressive episodes.
Bipolar II: at least one hypomanic episode and one major depressive episode. No history of manic episodes.

Evolution to Mania

Gradual onset with changes in mood, sleep, and behavior.
Increased energy, decreased sleep, racing thoughts, impulsivity.
May progress to a full manic episode with psychotic symptoms.

Therapeutic Communication (Bipolar)

Similar to psychosis: establish trust & rapport with clear language. Avoid arguments or confrontations.
Be patient and understanding.
Redirect the conversation if needed.
Set clear limits on inappropriate behavior.

Safety Precautions in Bipolar I

Assess for suicide risk.
Prevent harm to self and others.
Manage impulsive behaviors.
Monitor for signs of agitation or aggression.
Provide a safe environment.

Lithium

Therapeutic range: 0.6-1.2 mEq/L
Signs of toxicity: tremor, nausea, vomiting, diarrhea, confusion, seizures, coma.
Patient teaching: regular blood tests, consistent fluids and salt intake, avoid alcohol and CNS depressants, report signs of toxicity.

MDD and Suicidal Ideation

Assessment: use a standardized suicide risk assessment tool. Ask directly about suicidal ideation, plans, and intent. Assess for risk factors like hopelessness, previous attempts, access to means.
Interventions: prioritize safety. Provide observation, remove means of self-harm, encourage expression of feelings, instill hope, encourage treatment adherence.
Therapeutic communication: empathetic and non-judgmental language. Validate feelings, express concern and offer support. Instill hope.

Assessing Suicide Risk

Risk factors: previous attempts, family history of suicide, mental health disorders, substance abuse, access to means, hopelessness, social isolation.
Suicidal ideation: frequency, intensity, and duration of thoughts, presence of a plan.
Lethality of plan: specificity of the plan, availability of means, likelihood of rescue.

Cues for Impending Suicide

Changes in behavior: withdrawal, agitation, impulsivity.
Mood changes: sudden shift from sadness to happiness.
Communication: giving away possessions, making final arrangements, saying goodbye.

Priority Nursing Interventions (Suicide)

Safety is paramount.
One-on-one observation.
Remove means of self-harm.
Establish a therapeutic relationship.
Encourage expression of feelings.
Instill hope.

Indications for Inpatient Hospitalization (Suicide)

High suicide risk.
Lack of support system.
Need for intensive treatment.
Medical or psychiatric instability.

Suicide Survivors' Management

Provide support and resources.
Address grief and trauma.
Promote healing and coping.
Encourage connection with others.

Neuroleptic Malignant Syndrome

Symptoms: high fever, muscle rigidity, altered mental status, autonomic instability (tachycardia, labile blood pressure, sweating).
Nursing interventions: stop the medication, provide supportive care (cooling measures, hydration), monitor for complications, administer medication as ordered (dantrolene or bromocriptine).

Life Expectancy with SMI

Reduced by 10-20 years compared to the general population.
Due to higher rates of physical health problems and suicide.

Types of Therapies

Psychotherapy: individual, group, family, CBT, DBT.
Milieu therapy: therapeutic environment that supports recovery. Includes safety, structure, support, and validation. Involves patients in decision-making and promotes social interaction.

Definitions

Pressured speech: rapid and excessive speech that is difficult to interrupt. Often seen in mania.
Circumstantiality: indirect speech with unnecessary details before getting to the point.
Delusions: fixed false beliefs not based on reality that are not amenable to change.
Tangentiality: similar to circumstantiality but the person never returns to the central point and never answers the original question.
Erotomanic: delusion that another person is in love with the individual.
Echolalia: pathological repeating of another's words by imitation. Often seen in catatonia.

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Description

This quiz focuses on hallucinations, covering types such as auditory and visual, as well as management strategies for violent command hallucinations. Participants will learn about therapeutic communication and interventions to help individuals cope with these experiences.