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Sleep and wakefulness disorders can be organized into five categories: insomnia, hypersomnia, sleep-relatedbreathing disorders, circadian rhythm disorders, and parasomnias.

INSOMNIAPrimary insomnia—Difficulty initiating or maintaining sleep or nonrestorative sleep that lasts for 1 monthand causes significant distress or impairment in social, occupational, or other important areas offunctioning. Subcategories include sleep-onset insomnia, sleep-maintenance insomnia, or early morningwakening. About one third of the U.S. population suffers several bouts of insomnia per year, and about 10%of the population has a chronic problem with insomnia. Of those, as many as 40% self-medicate withalcohol, over-the-counter medications, or both. Treatment modalities include sleep hygiene measures (seeSleep Hygiene Measures box), cognitive–behavioral techniques, and medication.

Adjustment insomnia—Is a transient problem that is related to acute stress, conflict with others, or lifechanges. The sleep problems last from a week to a few months and are resolved when the stressor isremoved or resolved.

Paradoxical insomnia—Is when the individual thinks he or she is awake, or is not sleeping even thoughbrain wave activity is consistent with normal sleep. It is usually due to ruminative worrying that continuesinto sleep, but causes the individual to believe he or she is awake. An interruption of rumination anddiminished worry about not sleeping usually diminishes or eliminates the problem.

Idiopathic insomnia—A lifelong inability to obtain adequate sleep. It is thought to be a neurologic deficit inthe sleep–wake cycle, and is therefore chronic and lifelong. Treatment consists of improved sleep hygiene,relaxation therapy, and the long-term use of sleep-inducing medication.

Insomnia due to a mental disorder, medical condition, or drug or substance use—Primary treatment of theunderlying cause is helpful, but may not eliminate the insomnia altogether. So use of medications for sleep,sleep hygiene measures, and the avoidance of stimulants including caffeine and of medications that interferewith sleep are also effective.

HYPERSOMNIAPrimary hypersomnia—Excessive sleepiness for at least 1 month that involves either prolonged sleepepisodes or daily daytime sleeping that causes significant distress or impairment in functioning. Major sleepepisodes may be 8 to 12 hours long, and the person has difficulty waking up. Daytime naps leave the person

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unrefreshed on awakening. Treatment with stimulant medication is often effective.

Narcolepsy—Excessive sleepiness characterized by repeated, irresistible sleep attacks. After sleeping 10 to 20minutes, the person is briefly refreshed until the next sleep attack. Sleep attacks can occur at opportunetimes, such as during important work activities or while driving a car. People with narcolepsy may alsoexperience cataplexy (sudden episodes of bilateral, reversible loss of muscle tone that last for seconds tominutes) or recurrent intrusions of REM sleep in the sleep–wake transitions, manifested by paralysis ofvoluntary muscles or dream-like hallucinations. Treatment includes stimulant medication, modafinil(Provigil), and behavioral structuring, such as scheduling naps at convenient times.

SLEEP-RELATED BREATHING DISORDERSSleep disruption leads to excessive sleepiness or, less commonly, insomnia, caused by abnormalities inventilation during sleep. These sleep-related breathing disorders include obstructive sleep apnea (repeatedepisodes of upper airway obstruction), central sleep apnea (episodic cessation of ventilation without airwayobstruction), and central alveolar hypoventilation (hypoventilation resulting in low arterial oxygen levels).Central sleep apnea is more common in the elderly, while obstructive sleep apnea and central alveolarhypoventilation are commonly seen in obese individuals. The primary treatments for sleep-related breathingdisorders are surgical, such as tracheotomy, and use of a continuous positive airway pressure machine duringsleep.

CIRCADIAN RHYTHM DISORDERSCircadian rhythm sleep disorder (formerly sleep–wake schedule disorder)—Persistent or recurring sleep disruptionresulting from altered functioning of circadian rhythm or a mismatch between circadian rhythm and externaldemands. Subtypes include delayed sleep phase (person’s own circadian schedule is incongruent with neededtiming of sleep, such as an individual being unable to sleep or remain awake during socially acceptable hoursas a result of a work schedule or the like), jet lag (conflict of sleep–wake schedule and a new time zone), shiftwork (conflict between circadian rhythm and demands of wakefulness for shift work), and unspecified(circadian rhythm pattern is longer than 24 hours despite environmental cues, resulting in varying sleepproblems). Sleep hygiene measures (see Sleep Hygiene Measures box), melatonin, and bright light therapy canbe effective treatments. Bright light therapy consists of being exposed to bright light when wakefulness isinitiated and avoiding bright lights when sleep is desired.

PARASOMNIASParasomnias are disorders characterized by abnormal behavioral or psychological events associated with sleep,specific sleep stages, or sleep–wake transition. These disorders involve activation of physiologic systems, suchas the autonomic nervous system, motor system, or cognitive processes, at inappropriate times, as during sleep.

Nightmare disorder—Repeated occurrence of frightening dreams that lead to waking from sleep. Thedreams are often lengthy and elaborate, provoking anxiety or terror and causing the individual to havetrouble returning to sleep and to experience significant distress and, sometimes, lack of sleep. There is no

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widely accepted treatment.

Sleep terror disorder—Repeated occurrence of abrupt awakenings from sleep associated with a panickyscream or cry. Children with sleep terror disorder are confused and upset upon awakening and have nomemory of a dream either at the time of awakening or in the morning. Initially, it is difficult to fullyawaken or console the child. Sleep terror disorder tends to go away in adolescence.

Sleepwalking disorder—Repeated episodes of complex motor behavior initiated during sleep, includinggetting out of bed and walking around. Persons appear disoriented and confused and, on occasion, maybecome violent. Usually they return to bed on their own or can be guided back to bed. Sleepwalking occursmost often in children between 4 and 8 years, and it tends to dissipate by adolescence. No treatment isrequired.

Sleep disorders related to another mental disorder may involve insomnia or hypersomnia. Mood disorders,anxiety disorders, schizophrenia, and other psychotic disorders are often associated with sleep disturbances.Treatment of the underlying mental disorder is indicated to resolve the sleep disorder.

SLEEP HYGIENE MEASURES

Establish a regular schedule for going to bed and arising.

Avoid sleep deprivation, and the desire to “catch up” by excessive sleeping.

Do not eat large meals before bedtime; however, a light snack is permissible, even helpful.

Avoid daytime naps, unless necessitated by advanced age or physical condition.

Exercise daily, particularly in the late afternoon or early evening, as exercise before retiring mayinterfere with sleep.

Minimize or eliminate caffeine and nicotine ingestion.

Do not look at the clock while lying in bed.

Keep the temperature in the bedroom slightly cool.

Do not drink alcohol in an attempt to sleep; it will worsen sleep disturbances and produce poor-quality sleep.

Do not use the bed for reading, working, watching television, and so forth.

If you are worried about something, try writing it down on paper and assigning a designated time todeal with it—then, let it go.

Soft music, relaxation tapes, or “white noise” may be helpful; experiment with different methods tofind those that are beneficial for you.

Sleep disorder due to a general medical condition may involve insomnia, hypersomnia, parasomnias, or acombination of these attributable to a medical condition. These sleep disturbances may result fromdegenerative neurological illnesses, cerebrovascular disease, endocrine conditions, viral and bacterial infections,coughing, or pain. Sleep disturbances of this type may improve with treatment of the underlying medical

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condition or may be treated symptomatically with medication for sleep.

Substance-induced sleep disorder involves prominent disturbance in sleep due to the direct physiologic effectsof a substance, such as alcohol, other drugs, or toxins. Insomnia and hypersomnia are most common.Treatment of the underlying substance use or abuse generally leads to improvement in sleep.

Adapted from Sadock, B., Sadock, V. A., & Ruiz, P. (2015). Synopsis of psychiatry (11th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

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INTRODUCTIONThere are three general groups of sexual and gender problems: sexual dysfunctions (desire, arousal, orgasm,pain, and dysfunction due to a medical condition), paraphilias (exhibitionism, fetishism, frotteurism,pedophilia, masochism, sadism, transvestic fetishism, and voyeurism), and gender dysphoria. These disordersare usually identified in primary care or outpatient settings and treated with individual, couple/partner, orgroup psychotherapy. Occasionally, when the diagnosis coincides with behavior defined as criminal, that is,many of the paraphilias, individuals get involved in the legal system.

SEXUAL DYSFUNCTIONSSexual dysfunction is characterized by a disturbance in the processes of the sexual response cycle or by painassociated with sexual intercourse. The sexual response cycle consists of desire, excitement, orgasm, andresolution. Sexual dysfunction may be due to psychological factors alone or a combination of psychologicalfactors and a medical condition.

Sexual desire disorders involve a disruption in the desire phase of the sexual response cycle.

Hypoactive sexual desire disorder—Characterized by a deficiency or absence of sexual fantasies and a lack ofdesire for sexual activity that causes marked distress or interpersonal difficulty.

Sexual aversion disorder—Involves aversion to and active avoidance of genital sexual contact with a sexualpartner that causes marked distress or interpersonal difficulty. The individual reports anxiety, fear, ordisgust when confronted by a sexual opportunity with a partner.

Sexual arousal disorders are a disruption of the excitement phase of the sexual response cycle.

Female sexual arousal disorder—Persistent or recurrent inability to attain or to maintain, until completion ofthe sexual activity, an adequate lubrication–swelling response of sexual excitement, which causes markeddistress or interpersonal difficulty.

Male erectile disorder—Persistent or recurrent inability to attain or maintain, until completion of the sexualactivity, an adequate erection, which causes marked distress or interpersonal difficulty.

Orgasmic disorders are disruptions of the orgasm phase of the sexual response cycle.

Female orgasmic disorders—Persistent or recurrent delay in, or absence of, orgasm following a normal sexual

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excitement phase, which causes marked distress or interpersonal difficulty.

Male orgasmic disorder—Persistent or recurrent delay in, or absence of, orgasm following a normal sexualexcitement phase, which causes marked distress or interpersonal difficulty.

Premature ejaculation—Persistent or recurrent onset of orgasm and ejaculation with minimal sexualstimulation before, on, or shortly after penetration and before the person wishes it, causing marked distressor interpersonal difficulty.

Sexual pain disorders involve pain associated with sexual activity.

Dyspareunia—Genital pain associated with sexual intercourse causing marked distress or interpersonaldifficulties. It can occur in both males and females, and symptoms range from mild discomfort to sharppain.

Vaginismus—Persistent or recurrent involuntary contractions of the perineal muscles surrounding the outerthird of the vagina when vaginal penetration with penis, finger, tampon, or speculum is attempted, causingmarked distress or interpersonal difficulties. The contraction may range from mild (tightness and milddiscomfort) to severe (preventing penetration).

Sexual dysfunction due to a general medical condition is presence of clinically significant sexual dysfunctionthat is exclusively due to the physiological effects of a medical condition. It can include pain with intercourse,hypoactive sexual desire, erectile dysfunction, orgasmic problems, or other problems as previously described.The individual experiences marked distress or interpersonal difficulty related to the symptoms.

Substance-induced sexual dysfunction is clinically significant sexual dysfunction resulting in marked distressor interpersonal difficulty caused by the direct physiological effects of a substance (drug of abuse, medication,or toxin). It may involve impaired arousal, impaired orgasm, or sexual pain.

PARAPHILIASParaphilias are recurrent, intensely sexually arousing fantasies, sexual urges, or behaviors generally involving(1) nonhuman objects, (2) the suffering or humiliation of one’s self or partner, or (3) children or othernonconsenting persons. For pedophilia, voyeurism, exhibitionism, and frotteurism, the diagnosis is made ifthe person has acted on these urges or if the urges or fantasies cause marked distress or interpersonal difficulty.For sexual sadism, the diagnosis is made if the person has acted on these urges with a nonconsenting person orif the urges, fantasies, or behaviors cause marked distress or interpersonal difficulty. For the remainingparaphilias, the diagnosis is made if the behavior, sexual urges, or fantasies cause clinically significant distressor impairment in social, occupational, or other important areas of functioning.

Exhibitionism—Exposure of the genitals to a stranger, sometimes involving masturbation; usually occursbefore age 18 and is less severe after age 40.

Fetishism—Use of nonliving objects (the fetish) to obtain sexual excitement and/or achieve orgasm.Common fetishes include women’s underwear, bras, lingerie, shoes, or other apparel. The person mightmasturbate while holding or rubbing the object. It begins by adolescence and tends to be chronic.

Frotteurism—Touching and rubbing against a nonconsenting person, usually in a crowded place from which

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the person with frotteurism can make a quick escape, such as public transportation, a shopping mall, or a

crowded sidewalk. The individual rubs his genitals against the victim’s thighs and buttocks or fondles herbreasts or genitalia with his hands. Acts of frottage occur most often between the ages of 15 and 25;frequency declines after that.

Pedophilia—Sexual activity with a prepubescent child (generally 13 years or younger) by someone at least 16years old and 5 years older than the child. It can include an individual undressing the child and looking atthe child; exposing himself or herself; masturbating in the presence of the child; touching and fondling thechild; fellatio; cunnilingus; or penetration of the child’s vagina, anus, or mouth with the individual’s fingersor penis or with foreign objects, with varying amounts of force. Contact may involve the individual’s ownchildren, stepchildren or relatives, or strangers. Many individuals with pedophilia do not experience distressabout their fantasies, urges, or behaviors.

Sexual masochism—Recurrent, intensely sexually arousing fantasies, sexual urges, or behaviors involving theact of being humiliated, beaten, bound, or otherwise made to suffer. Some individuals act on masochisticurges by themselves, others with a partner.

Sexual sadism—Recurrent, intensely sexually arousing fantasies, sexual urges, or behaviors involving acts inwhich the psychological or physical suffering of the victim is sexually arousing to the person. It can involvedomination (caging the victim or forcing victim to crawl, beg, plead), restraint, spanking, beating, electricalshock, rape, cutting, and, in severe cases, torture and death. Victims may be consenting (those with sexualmasochism) or nonconsenting.

Transvestic fetishism—Recurrent, intensely sexually arousing fantasies, sexual urges, or behaviors involvingcross-dressing by a heterosexual male.

Voyeurism—Recurrent, intensely sexually arousing fantasies, sexual urges, or behaviors involving the act ofobserving an unsuspecting person who is naked, in the process of undressing, or engaging in sexual activity.Voyeurism usually begins before age 15, is chronic, and may involve masturbation during the voyeuristicbehavior.

GENDER DYSPHORIAGender dysphoria is diagnosed when an individual has a strong and persistent sense of incongruence betweenexperienced or expressed gender and the gender assigned at birth, usually anatomical and called natal. Theincongruence is accompanied by the persistent discomfort of his or her assigned sex or a sense ofinappropriateness in the gender role of that assigned sex. The person experiences clinically significant distressor impairment in social, occupational, or other important areas of functioning. In boys, there is apreoccupation with traditionally feminine activities, a preference for dressing in girls’ or women’s clothing,and an expressed desire to be a girl or grow up to be a woman. Girls may resist parental attempts to have themwear dresses or other feminine attire, wear boys’ clothing, have short hair, ask to be called by a boy’s name,and express the desire to grow a penis and grow up to be a man.

Adapted from Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Synopsis of psychiatry (11th ed.). Philadelphia, PA: Lippincott Williams &Wilkins.

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Drug Classification Under the Controlled Substances Act

Schedule I Drugs Schedule II Drugs Schedule III Drugs Schedule IV Drugs Schedule V Drugs

OpioidsAcetylmethadolHeroinNormethadoneMany others

OpioidsAlfentanilCodeineFentanylHydrocodone—pureHydromorphone (Dilaudid)LevorphanolMeperidineMethadoneMorphineOpium tinctureOxycodoneOxymorphoneSufentanilTapentadol (Nucynta)

OpioidsHydrocodone syrup and

compoundsParegoricBuprenorphine and

compounds (Subutex,Suboxone, Buprenex,Norspan, Butrans,Temgesic)

OpioidsPentazocinePropoxyphene

OpioidsDiphenoxylate plus atropine

(Lomotil)Cough syrups containing

codeineAntidiarrheals containing

opium or diphenoxylate

Psychedelics Psychostimulants Stimulants Stimulants Others

PsychedelicsBufoteninDiethyltryptamineDimethyltryptamine

(DMT)IbogaineD-Lysergic acid

diethylamide (LSD)Mescaline3,4-Methylenedioxy-

methamphetamine(MDMA)

PeyotePsilocinPsilocybin

AmphetamineAmphetamine salts

(Adderall)CocaineDextroamphetamine

(Dexedrine)Dextromethamphetamine

(Desoxyn)Lisdexamfetamine

(Vyvanse)MethamphetamineMethylphenidatePhenmetrazine

BenzphetaminePhendimetrazine

DiethylpropionFenfluramineMazindolPemolinePhentermine

Pregabalin (Lyrica)Lacosamide (Vimpat)Retigabine (Potiga/Trobalt)Pyrovalerone (Centroton,

Thymergix)

Cannabis Derivatives Barbiturates Barbiturates Barbiturates

HashishMarijuana

AmobarbitalPentobarbital

AprobarbitalButabarbital

MephobarbitalMethohexital

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Nembutal TalbutalThiamylalThiopental

Othersα-methyltryptamine

(dMT)Benzylpiperazine (BZP)CathinoneMethaqualoneGammahydroxybutyric

acid (GHB)

CannabinoidsDronabinol (THC)Nabilone

MiscellaneousDepressants

GlutethimideMethyprylon

BenzodiazepinesAlprazolamChlordiazepoxideClonazepamClorazepateDiazepamEstazolamFlurazepamHalazepamLorazepamMidazolamOxazepamPrazepamQuazepamTemazepamTriazolam

OthersPhencyclidine

(PCP)

Anabolic SteroidsFluoxymesteroneMethyltestosteroneNandroloneOxandroloneStanozololTestosterone

MiscellaneousDepressants

Chloral hydrateEthchlorvynolEthinamateMeprobamateParaldehyde

OthersErgineXyremKetamine

Drugs in Schedule I have a high potential for abuse and have no approved medical use in the United States. Drugs in Schedules II through V allhave approved uses and are classified based on their abuse potential. Schedule II drugs have a higher potential for abuse.

Schedule V drugs have the lowest potential for abuse.

Some individual states have or are considering laws allowing medical and/or recreational use of marijuana. It remains Schedule I in this Federallaw.

Compiled from Controlled Substances Act. http://www.deadiversion.usdoj.gov/schedules/index.html

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Canadian Drug Trade Names Sorted by Drug Class

Generic Name U.S. Trade Name Canadian Trade Name

Antipsychotics

Chlorpromazine Thorazine Chlorprom, Chlorpromanyl, Largactil, Novo-Chlorpromazine, Apo-Chlorpromazine

Clozapine Clozaril, Fazaclo Clozaril, Gen-clozapine, Rhoxal, Clozapine

Droperidol Inapsine NA

Fluphenazine Prolixin Apo-Fluphenazine, Moditen, PMS-Fluphenazine, Modecate

Haloperidol Haldol Apo-Haloperidol, Novo-Peridol, Peridol

Loxapine Loxitane Loxapac, PMS-Loxapine, Apo-Loxitane, Nu-Loxitane

Mesoridazine Serentil Serentil

Molindone Moban Moban

Olanzapine Zyprexa, Zydis Zyprexa, Zydis

Perphenazine Trilafon Apo-Perphenazine, Phenazine

Prochlorperazine Compazine, Compro Stemetil, PMS-Prochlorperazine, Nu-Prochlor, Compazine

Quetiapine Seroquel Seroquel

Risperidone Risperdal Risperdal

Thioridazine Mellaril Apo-Thioridazine, Mellaril

Thiothixene Navane Navane

Trifluoperazine Stelazine Apo-Trifluoperazine, Novo-Trifluoperazine, PMS-Trifluoperazine,Terfluzine

Ziprasidone Geodon Geodon

Antidepressants

Amitriptyline Elavil Levate, Novotriptyn

Bupropion Wellbutrin, Zyban Wellbutrin, Zyban

Citalopram Celexa Celexa

Clomipramine Anafranil Apo-Clomipramine, Gen-Clomipramine, Novo-Clopamine, Anafranil

Desipramine Norpramin, Pertofrane Apo-Desipramine, Novo-Desipramine, Nu-Desipramine, PMS-Desipramine, Norpramin, Alti-Desipramine

Duloxetine Cymbalta NA

Doxepin Sinequan, Prudoxin, Zonalon Alti-Doxepin, Apo-Doxepin, Novo-Doxepin, Triadapin, Zonalon

Escitalopram Lexapro Cipralex

Fluoxetine Prozac, Sarfem Apo-Fluoxetine, Novo-Fluoxetine, Alti-Fluoxetine, Prozac, PMS-Fluoxetine, FXT, Gen-Fluoxetine, Rhoxal-Fluoxetine

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Fluvoxamine Luvox Apo-Fluvoxamine, Luvox, Alti-Fluvoxamine, Novo-‐Fluvoxamine, Nu-Fluvoxamine, Rhoxal-fluvoxamine

Imipramine Tofranil Apo-Imipramine, Impril, Tofranil

Isocarboxazid Marplan NA

Maprotiline Ludiomil Novo-Maprotiline

Mirtazapine Remeron Remeron

Nefazodone Serzone Apo-Nefazodone, Lin-Nefazodone, Serzone 5HT

Nortriptyline Aventyl, Pamelor Apo-Nortriptyline, Norventyl, PMS-Nortriptyline,Gen-Nortriptyline, Nu-Nortriptyline, Aventyl

Paroxetine Paxil Paxil

Phenelzine Nardil Nardil

Sertraline Zoloft Apo-Sertraline, Gen-Sertraline, Novo-Sertraline, Nu-Sertraline, PMS-Sertraline, ratio-Sertraline, Zoloft

Tranylcypromine Parnate Parnate

Trazodone Desyrel Alti-Trazodone, Apo-Trazodone, Nu-Trazodone,Desyrel, Gen-Trazodone, Novo-Trazodone, PMS-Trazodone

Venlafaxine Effexor Effexor

Antimanic and Mood Stabilizers

Carbamazepine Tegretol, Epitol, Equetro Apo-Carbamazepine, Novo-Carbamaz, Nu-Carbamazepine, PMS-Carbamazepine, Taro-Carbamazepine

Gabapentin Neurontin PMS Gabapentin, Neurontin, Apo-Gabapentin,Novo-Gabapentin, Nu-Gabapentin

Lamotrigine Lamictal Apo-Lamotrigine, Lamictal, PMS-Lamotrigine,ratio-Lamotrigine

Lithium Lithane, Eskalith,Lithobid

Carbolith, Duralith, Lithizine, PMS-LithiumCarbonate, Apo-Lithium

Oxcarbazepine Trileptal Trileptal

Topiramate Topamax Topamax

Valproic acid Depakote, Valproate,Depakene

Alti-Divalproex, Deproic, Epival, Gen-Divalproex,Novo-Divalproex, Nu-Divalproex, PMS-Valproicacid, Rhoxal-valproic

Anxiolytics

Alprazolam Xanax Apo-Alpraz, Novo-Alprazol, Nu-Alpraz, Xanax TS

Buspirone BuSpar Apo-Buspirone, Buspirex, Gen-Buspirone, Lin-

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Buspirone, Novo-Buspirone, Nu-Buspirone, PMS-Buspirone, BuSpar

Chlordiazepoxide Librium Apo-Chlordiazepoxide, Corax

Clonazepam Klonopin Apo-Clonazepam, Clonapam, Gen-Clonazepam,Rivotril, Novo-Clonazepam, Nu-Clonazepam

Clorazepate Tranxene Apo-Chlorazepate, Novo-Clopate

Diazepam Valium, Diastat Apo-Diazepam, Diazemuls, Valium, Diastat

Estazolam ProSom NA

Flurazepam Dalmane Somnol

Hydroxyzine Atarax, Vistaril Apo-Hydroxyzine, Novo-Hydroxyzine

Lorazepam Ativan Apo-Lorazepam, Novo-Lorazem, Nu-Loraz, Ativan,Riva-Lorazepam

Meprobamate Miltown Apo-Meprobamate, Novo-Mepro

Midazolam Versed Apo-Midazolam

Oxazepam Serax Apo-Oxazepam, Novoxapam, Zapex, Oxpram

Temazepan Restoril Apo-Temazepam, Novo-Temazepam

Drugs Used With Dementia

Donepezil Aricept Aricept

Rivastigmine Exelon Exelon

Tacrine Cognex NA

Drugs Used for Attention Deficit Hyperactivity Disorder

Atomoxetine Strattera NA

Amphetamine Adderall NA

Amphetamine, long acting Adderall XR NA

Dexmethylphenidate Focalin NA

Dextroamphetamine Dexedrine Dexedrine

Methylphenidate Ritalin PMS-Methylphenidate, Riphenidate, Biphentin

Methylphenidate,longacting

Concerta, Metadate CD,Ritalin LA

NA

Pemoline Cylert NA

Drugs Used to Treat Side Effects

Amantadine Symmetrel Endantadine, Gen-Amantadine

Atenolol Tenormin Apo-Atenolol, Gen-Atenolol, Novo-Atenol, Tenolin

Benztropine Cogentin Apo-Benztropine, Cogentin

Biperiden Akineton Akineton

Diphenhydramine Benadryl (Multiple OTC Allerdryl, Allernix, Benadryl

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names)

Procyclidine Kemadrin PMS Procyclidine, Procyclid

Trihexyphenidyl Artane Apo-Trihex

Drugs Used in Substance Abuse

Clonidine Catapres Apo-Clonidine, Dixarit, Nu-Clonidine, Novo-Clonidine, Catapres

Disulfiram Antabuse NA

Naltrexone ReVia, Depade, Trexan ReVia

Ondansetron Zofran NA

Ondansetronhydrochloride dihydrate

Zofran NA

NA, no Canadian Trade Name is available.

Alphabetical Listing by Canadian Drug Name

Canadian Trade Name Generic Name

Allerdryl Diphenhydramine

Allernix Diphenhydramine

Alti-Desipramine Desipramine

Alti-Doxepin Doxepin

Alti-Fluoxetine Fluoxetin

Alti-Fluvoxamine Fluvoxamine

Alti-Trazodone Trazodone

Alti-Valproic Valproic acid

Anafranil Clomipramine

Apo-Alpraz Alprazolam

Apo-Atenolol Atenolol

Apo-Benztropine Benztropine

Apo-Buspirone Buspirone

Apo-Carbamazepine Carbamazepine

Apo-Clorazepate Clorazepate

Apo-Chlordiazepoxide Chlordiazepoxide

Apo-Chlorpromazine Chlorpromazine

Apo-Clomipramine Clomipramine

Apo-Clonazepam Clonazepam

Apo-Clonidine Clonidine

Apo-Desipramine Desipramine

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Apo-Diazepam Diazepam

Apo-Doxepin Doxepin

Apo-Fluoxetine Fluoxetine

Apo-Fluphenazine Moditen Fluphenazine

Apo-Fluvoxamine Fluvoxamine

Apo-Gabapentin Gabapentin

Apo-Haloperidol Haloperidol

Apo-Hydroxyzine Hydroxyzine

Apo-Imipramine Imipramine

Apo-Lamotrigine Lamotrigine

Apo-Lithium Lithium

Apo-Lorazepam Lorazepam

Apo-Loxitane Loxitane

Apo-Midazolam Midazolam

Apo-Meprobamate Meprobamate

Apo-Nefazodone Nefazodone

Apo-Nortriptyline Nortriptyline

Apo-Oxazepam Oxazepam

Apo-Perphenazine Perphenazine

Apo-Sertraline Sertraline

Apo-Temazepam Temazepam

Apo-Thioridazine Thioridazine

Apo-Trazodone Trazodone

Apo-Trifluoperazine Trifluoperazine

Apo-Trihex Trihexyphenidyl

Aricept Donepezil

Ativan Lorazepam

Aventyl Nortriptyline

Biphentin Methylphenidate

BuSpar Buspirone

Buspirex Buspirone

Carbolith Lithium

Chlorprom Chlorpromazine

Chlorpromanyl Chlorpromazine

Cipralex Escitalopram

Clonapam Clonazepam

Clozaril Clozapine

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Cogentin Benztropine

Compazine Prochlorperazine

Compro Prochlorperazine

Corax Chlordiazepoxide

Deproic Valproic acid

Desyrel Trazodone

Dexedrine Dextroamphetamine

Diastat Diazepam

Diazemuls Diazepam

Divalproex Valproic acid

Dixarit Clonidine

Duralith Lithium

Endantadine Amantadine

Effexor Venlafaxine

Epitrol Carbamazepine

Epival Valproic acid

Equetro Carbamazepine

Exelon Rivastigmine

FXT Fluoxetine

Gen-Amantadine Amantadine

Gen-Atenolol Atenolol

Gen-Buspirone Buspirone

Gen-Clomipramine Clomipramine

Gen-Clonazepam Clonazepam

Gen-Clozapine Clozapine

Gen-Divalproex Valproic acid

Gen-Fluoxetine Fluoxetine

Gen-Nortriptyline Nortriptyline

Gen-Sertraline Sertraline

Gen-Trazodone Trazodone

Geodon Ziprasidone

Impril Imipramine

Lamictal Lamotrigine

Largactil Chlorpromazine

Levate Amitriptyline

Lin-Buspirone Buspirone

Lin-Nefazodone Nefazodone

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Lithizine Lithium

Loxapac Loxapine

Luvox Fluvoxamine

Mellaril Thioridazine

Modecate Flupheazine

Moditen Fluphenazine

Nardil Phenelzine

Navane Thiothixene

Neurontin Gabapentin

Norpramin Desipramine

Norventyl Nortriptyline

Novo-Alprozol Alprazolam

Novo-Atenol Atenolol

Novo-Buspirone Buspirone

Novo-Carbamaz Carbamazepine

Novo-Chlorpromazine Chlorpromazine

Novo-Clonazepam Clonazepam

Novo-Clopamine Clomipramine

Novo-Clopate Clorazepate

Novo-Desipramine Desipramine

Novo-Divalproex Valproic acid

Novo-Doxepin Doxepin

Novo-Fluoxetine Fluoxetine

Novo-Fluvoxamine Fluvoxamine

Novo-Gabapentin Gabapentin

Novo-Hydroxyzine Hydroxyzine

Novo-Lorazem Lorazepam

Novo-Maprotiline Maprotiline

Novomepro Meprobamate

Novo-Peridol Haloperidol

Novopramine Imipramine

Novo-Sertraline Sertraline

Novo-Temazepam Temazepam

Novo-Trifluoperazine Trifluoperazine

Novo-Trazodone Trazodone

Novotriptyn Amitriptyline

Novoxapam Oxazepam

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Nu-Alpraz Alprazolam

Nu-Buspirone Buspirone

Nu-Carbamazepine Carbamazepine

Nu-Clonazepam Clonazepam

Nu-Clonidine Clonidine

Nu-Desipramine Desipramine

Nu-Divalproex Valproic acid

Nu-Fluvoxamine Fluvoxamine

Nu-Gabapentin Gabapentin

Nu-Loraz Lorazepam

Nu-Loxitane Loxitane

Nu-Nortriptyline Nortriptyline

Nu-Promchlor Prochlorperazine

Nu-Sertraline Sertraline

Nu-Trazodone Trazodone

Parnate Tranylcypromine

Paxil Paroxetine

Peridol Haloperidol

Phenazine Perphenazine

PMS Benztropine Benztropine

PMS-Buspirone Buspirone

PMS-Carbamazepine Carbamazepine

PMS-Desipramine Desipramine

PMS-Fluoxetine Fluoxetine

PMS-Fluphenazine Fluphenazine

PMS Gabapentin Gabapentin

PMS-Lamotrigine Lamotrigine

PMS-Lithium Carbonate Lithium

PMS-Loxapine Loxapine

PMS-Methylphenidate Methylphenidate

PMS-Nortriptyline Nortriptyline

PMS-Prochlorperazine Prochlorperazine

PMS Procyclidine Procyclidine

PMS-Sertraline Sertraline

PMS-Trazodone Trazodone

PMS-Trifluoperazine Trifluoperazine

PMS-Valproic acid Valproic acid

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Procyclid Procyclidine

Prozac Fluoxetine

ratio-Lamotrigine Lamotrigine

ratio-Sertraline Sertraline

Remeron Mirtazapine

Restoril Temazepam

Rhoxal-clozapine Clozapine

Rhoxal-fluoxetine Fluoxetine

Rhoxal-fluvoxamine Fluvoxamine

Rhoxal-valproic Valproic acid

Riphenidate Methylphenidate

Risperdal Risperidone

Riva-Lorazepam Lorazepam

Rivotril Clonazepam

Serentil Mesoridazine

Serzone 5HT Nefazodone

Somnol Flurazepam

Stemetil Prochlorperazine

Taro-Carbamazepine Carbamazepine

Tenolin Atenolol

Terfluzine Trifluoperazine

Tofranil Imipramine

Topamax Topiramate

Triadapin Doxepin

Trileptal Oxcarbazepine

Valium Diazepam

Vivol Diazepam

Wellbutrin Bupropion

Xanax TS Alprazolam

Zapex Oxazepam

Zoloft Sertraline

Zonalon Doxepin

Zyban Bupropion

Zydis Olanzapine

Zyprexa Olanzapine

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Mexican Drug Trade Names

Mexican Trade Name U.S. Brand or Generic Name

Abilify Aripiprazole

Actinium Oxcarbazepine

Akineton Biperiden

Alboral Diazepam

Aleval Sertraline

Altruline Sertraline

Aluprex Sertraline

Alzam Lorazepam

Anafranil Clomipramine

Anapsique Amitriptyline

Ativan Lorazepam

Aropax Paroxetine

Bapex Gabapentin

Brucarcer Effexor SR

Buspar Buspar

Carbazep Carbamazepine

Carbazina Carbamazepine

Carbolit Lithium

Citox Celexa

Clonapielep Clonazepam

Clopsine Clozapine

Clostedol Carbamazepine

Concerta Concerta

Cryoval Valproic acid

Cymbalta Cymbalta

Dehydrobenzperidol Droperidol

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Depakene Valproic acid

Dormicum Midazolam

Efexor Venlafaxine

Epival Valproic acid

Eranz Donepezil

Exelon Rivastigmine

Farmaxetina Prozac

Fluoxac Fluoxetine

Flupazine Trifluoperazine

Haldol Haloperidol

Haloperil Haloperidol

Hipokinon Trihexyphenidyl

Ifafonal Diazepam

Kenoket Clonazepam

Lambdara 12/24 Lamotrigine

Largactil Chlorpromazine

Leponex Clozapine

Leptilan Valproic acid

Leptopsique Perphenazine

Litheum Lithium

Luvox Fluvoxamine

Mellaril Thioridazine

Neugeron Carbamazepine

Neurontin Gabapentin

Neurosine Buspirone

Norispez Risperdal

Ortopsique Diazepam

Pacitran Diazepam

Paxil Paroxetine

Prozac Fluoxetine

Remeron Mirtazapine

Risperdal Risperidone

Rivotril Clonazepam

Seropram Citalopram

Seroquel Quetiapine

Sinestron Lorazepam

Siquial Fluoxetine

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Stelazine Trifluoperazine

Strattera Strattera

Taloprim Imipramine

Tasedan Estazolam

Tofranil Imipramine

Topamax Topiramate

Tranxene Chlorazepate

Trileptal Oxcabazepine

Tzoali Diphenhydramine

Valium Diazepam

Valprocid Valproic acid

Wellbutrin Bupropion

Xerenex Paxil CR

Zyprexa Olanzapine

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abnormal involuntary movement scale (AIMS) tool used to screen for symptoms of movement disorders (side effects of neurolepticmedications)

abstract messages unclear patterns of words that often contain figures of speech that are difficult to interpret

abstract thinking ability to make associations or interpretations about a situation or comment

abuse the wrongful use and maltreatment of another person

acceptance avoiding judgments of the person, no matter what the behavior

acculturation altering cultural values or behaviors as a way to adapt to another culture

acting out an immature defense mechanism by which the person deals with emotional conflicts or stressors through actions rather than throughreflection or feelings

active listening concentrating exclusively on what the client says, refraining from other internal mental activities

active observation watching the speaker’s nonverbal actions as he or she communicates

acute stress disorder diagnosis is appropriate when symptoms appear within the first month after the trauma and do not persist longer than 4weeks

adaptive disclosure combat-specific therapy for veterans with posttraumatic stress disorder (PTSD); eight sessions designed to help identifyunhelpful beliefs about the trauma and find ways to move forward

adjustment disorder a group of symptoms, such as stress, feeling sad, or hopeless, and physical symptoms that occur following a stressful lifeevent; the reaction is stronger than would be expected for the event that occurred

advocacy the process of acting on the client’s behalf when he or she cannot do so

affect the outward expression of the client’s emotional state

agnosia inability to recognize or name objects despite intact sensory abilities

agoraphobia fear of being outside; from the Greek fear of the marketplace

akathisia intense need to move about; characterized by restless movement, pacing, inability to remain still, and the client’s report of innerrestlessness

alexithymia difficulty identifying and expressing feelings

alogia a lack of any real meaning or substance in what the client says

alternative medicine therapies used in place of traditional or conventional medical practices

Alzheimer’s disease a progressive brain disorder that has a gradual onset but causes an increasing decline in functioning, including loss ofspeech, loss of motor function, and profound personality and behavioral changes such as those involving paranoia, delusions, hallucinations,inattention to hygiene, and belligerence

anergia lack of energy

anger a normal human emotion involving a strong, uncomfortable, emotional response to a real or perceived provocation

anhedonia having no pleasure or joy in life; losing any sense of pleasure from activities formerly enjoyed

anorexia nervosa an eating disorder characterized by the client’s refusal or inability to maintain a minimally normal body weight, intense fear ofgaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal toacknowledge the existence or seriousness of a problem

anticholinergic effects dry mouth, constipation, urinary hesitancy or retention, dry nasal passages, and blurred near vision; commonly seen as

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side effects of medication

anticipatory grieving when people facing an imminent loss begin to grapple with the very real possibility of the loss or death in the near future

antidepressant drugs primarily used in the treatment of major depressive illness, anxiety disorders, the depressed phase of bipolar disorder, andpsychotic depression

antipsychotic drugs also known as neuroleptics; used to treat the symptoms of psychosis such as the delusions and hallucinations seen inschizophrenia, schizoaffective disorder, and the manic phase of bipolar disorder

antisocial personality disorder characterized by a pervasive pattern of disregard for and violation of the rights of others and with the centralcharacteristics of deceit and manipulation

anxiety a vague feeling of dread or apprehension; it is a response to external or internal stimuli that can have behavioral, emotional, cognitive,and physical symptoms

anxiety disorders a group of conditions that share a key feature of excessive anxiety, with ensuing behavioral, emotional, cognitive, andphysiologic responses

anxiolytic drugs used to treat anxiety and anxiety disorders, insomnia, obsessive–compulsive disorder (OCD), depression, PTSD, and alcoholwithdrawal

aphasia deterioration of language function

apraxia impaired ability to execute motor functions despite intact motor abilities

assault involves any action that causes a person to fear being touched, without consent or authority, in a way that is offensive, insulting, orphysically injurious

assertive communication ability to express positive and negative ideas and feelings in an open, honest, and direct way

assertive community treatment (ACT) community-based programs that provide many of the services that are necessary for successfulcommunity living; includes case management, problem-solving, social skills training, support, teaching on a 24/7 basis

assertiveness training techniques using statements to identify feelings and communicate needs and concerns to others; helps the personnegotiate interpersonal situations, fosters self-assurance, and ultimately assists the person to take more control over life situations

asylum a safe refuge or haven offering protection; in the United States, the term “asylum” was used to describe institutions for the mentally ill

attachment behaviors affectional bonds with significant others

attention deficit hyperactivity disorder (ADHD) characterized by inattentiveness, overactivity, and impulsiveness

attentive presence being with the client and focusing intently on communicating with and understanding him or her

attitudes general feelings or a frame of reference around which a person organizes knowledge about the world

autism spectrum disorder neurodevelopmental disorder first seen in childhood, conceptualized across a continuum with symptoms varying frommild to severe; may include communication deficits, problems building social relationships, overdependence on routines, and high level ofsensitivity to the environment

automatism repeated, seemingly purposeless behaviors often indicative of anxiety, such as drumming fingers, twisting locks of hair, or tappingthe foot; unconscious mannerism

autonomy the person’s right to self-determination and independence

avoidance behavior behavior designed to avoid unpleasant consequences or potentially threatening situations

avoidant personality disorder characterized by a pervasive pattern of social discomfort and reticence, low self-esteem, and hypersensitivity tonegative evaluation

battery involves harmful or unwarranted contact with a client; actual harm or injury may or may not have occurred

behavior modification a method of attempting to strengthen a desired behavior or response by reinforcement, either positive or negative

behaviorism a school of psychology that focuses on observable behaviors and what one can do externally to bring about behavior changes; it doesnot attempt to explain how the mind works

beliefs ideas that one holds to be true

beneficence refers to one’s duty to benefit or to promote good for others

bereavement refers to the process by which a person experiences grief

binge eating consuming a large amount of food (far greater than most people eat at one time) in a discrete period of usually 2 hours or less

Black Box Warning medication package inserts must have a highlighted box, separate from the text, that contains a warning about the life-threatening or otherwise serious side effect(s) of the medication

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blackout an episode during which the person continues to function but has no conscious awareness of his or her behavior at the time or any latermemory of the behavior; usually associated with alcohol consumption

blunted affect showing little or a slow-to-respond facial expression; few observable facial expressions

body image disturbance occurs when there is an extreme discrepancy between one’s body image and the perceptions of others and extremedissatisfaction with one’s body image

body image how a person perceives his or her body, that is, a mental self-image

body language a nonverbal form of communication: gestures, postures, movements, and body positions

borderline personality disorder pervasive and enduring pattern of unstable interpersonal relationships, self-image, and affect; markedimpulsivity; frequent self-mutilation behavior

breach of duty the nurse (or physician) failed to conform to standards of care, thereby breaching or failing the existing duty; the nurse did notact as a reasonable, prudent nurse would have acted in similar circumstances

broad affect displaying a full range of emotional expressions

bulimia nervosa an eating disorder characterized by recurrent episodes (at least twice a week for 3 months) of binge eating followed byinappropriate compensatory behaviors to avoid weight gain such as purging (self-induced vomiting or use of laxatives, diuretics, enemas, oremetics), fasting, or excessively exercising

callous and unemotional traits personality characteristics such as lack of empathy, lack of remorse for bad behavior, shallow or superficialemotions, and no concern for problematic behaviors or issues

case management management of care on a case-by-case basis, representing an effort to provide necessary services while containing cost; in thecommunity, case management services include accessing medical and psychiatric services and providing assistance with tasks of daily livingsuch as financial management, transportation, and buying groceries

catatonia psychomotor disturbance, either motionless or excessive motor

catharsis activities that are supposed to provide a release for strong feelings such as anger or rage

causation action that constitutes a breach of duty and was the direct cause of the loss, damage, or injury; in other words, the loss, damage, orinjury would not have occurred if the nurse had acted in a reasonable, prudent manner

character consists of concepts about the self and the external world

child abuse the intentional injury of a child

circumstantial thinking term used when a client eventually answers a question but only after giving excessive, unnecessary detail

circumstantiality the use of extraneous words and long, tedious descriptions

cliché an expression that has become trite and generally conveys a stereotype

client-centered therapy focused on the role of the client, rather than the therapist, as key to the healing process

closed body positions nonverbal behavior such as crossed legs and arms folded over chest that indicate the listener may be failing to listen, maybe defensive, or not accepting

closed group structured to keep the same members in the group for a specified number of sessions

clubhouse model community-based rehabilitation; an “intentional community” based on the belief that men and women with serious andpersistent psychiatric disability can and will achieve normal life goals when given the opportunity, time, support, and fellowship

codependence a maladaptive coping pattern on the part of family members or others that results from a prolonged relationship with the personwho uses substances

cognitive restructuring therapy that focuses on changing the way one thinks about or interprets one’s self, relationships, and/or environment

cognitive therapy focuses on immediate thought processing: how a person perceives or interprets his or her experience and determines how heor she feels and behaves

cognitive–behavioral techniques techniques useful in changing patterns of thinking by helping clients to recognize negative thoughts and toreplace them with different patterns of thinking; include positive self-talk, decatastrophizing, positive reframing, and thought stopping

command hallucinations disturbed auditory sensory perceptions demanding that the client take action, often to harm self or others, and areconsidered dangerous; often referred to as “voices”

communication the processes that people use to exchange information

compassion fatigue a type of secondary trauma or stress resulting from helping others work through traumatic stress; experienced by those in thehelping professions

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compensatory behaviors for clients with eating disorders, actions designed to counteract food intake, such as purging (vomiting), excessivelyexercising, and using/abusing laxatives and diuretics

complementary medicine therapies used in conjunction with traditional or conventional medical practices

complicated grieving a response outside the norm and occurring when a person is void of emotion, grieves for prolonged periods, or hasexpressions of grief that seem disproportionate to the event

compulsions ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety

computerized tomography (CT) a diagnostic procedure in which a precise x-ray beam takes cross-sectional images (slices) layer by layer

concrete message words that are as clear as possible when speaking to the client so that the client can understand the message; concretemessages are important for accurate information exchange

concrete thinking when the client continually gives literal translations; abstraction is diminished or absent

conduct disorder characterized by persistent antisocial behavior in children and adolescents that significantly impairs their ability to function insocial, academic, or occupational areas

confabulation clients may make up answers to fill in memory gaps; usually associated with organic brain problems

confidentiality respecting the client’s right to keep private any information about his or her mental and physical health and related care

confrontation technique designed to highlight the incongruence between a person’s verbalizations and actual behavior; used to managemanipulative or deceptive behavior

congruence occurs when words and actions match

congruent message when communication content and processes agree

content verbal communication; the literal words that a person speaks

context the environment in which an event occurs; includes the time and the physical, social, emotional, and cultural environments

contract includes outlining the care the nurse will give, the times the nurse will be with the client, and acceptance of these conditions by theclient

controlled substance drug classified under the Controlled Substances Act; includes opioids, stimulants, benzodiazepines, anabolic steroids,cannabis derivatives, psychedelics, and sedatives

conversion disorder sometimes called conversion reaction; involves unexplained, usually sudden deficits in sensory or motor function related toan emotional conflict the client experiences but does not handle directly

countertransference occurs when the therapist displaces onto the client attitudes or feelings from his or her past; process that can occur whenthe nurse responds to the client based on personal, unconscious needs and conflicts

Creutzfeldt–Jakob disease a central nervous system disorder that typically develops in adults 40 to 60 years of age and involves altered vision,loss of coordination or abnormal movements, and dementia

criminalization of mental illness refers to the practice of arresting and prosecuting mentally ill offenders, even for misdemeanors, at a rate fourtimes that of the general population in an effort to contain them in some type of institution where they might receive needed treatment

crisis a turning point in an individual’s life that produces an overwhelming emotional response; life circumstance or stressor an individual isconfronting that cannot be managed through customary coping strategies

crisis intervention includes a variety of techniques, based on the assessment of the individual in crisis, to assist in resolution or management ofthe stressor or circumstance

cues (overt and covert) verbal or nonverbal messages that signal key words or issues for the client

culturally competent being sensitive to issues related to culture, race, gender, sexual orientation, social class, economic situation, and otherfactors

culture all the socially learned behaviors, values, beliefs, and customs, transmitted down to each generation, as well as a population’s ways ofthinking that guide its members’ views of themselves and the world

cycle of violence a typical pattern in domestic battering: violence; honeymoon or remorseful period; tension building; and, finally, violence; thispattern continually repeats itself throughout the relationship

date rape (acquaintance rape) sexual assault that may occur on a first date, on a ride home from a party or when the two people have knowneach other for some time

day treatment treatment programs in which clients attend during the day and return home or to the community at night

decarceration decriminalizing mental illness, allowing a shift from providing care of the mentally ill with minor legal offenses from jail and

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prison setting to treatment-focused programs

decatastrophizing a technique that involves learning to assess situations realistically rather than always assuming a catastrophe will happen

defense mechanisms cognitive distortions that a person uses unconsciously to maintain a sense of being in control of a situation, to lessendiscomfort, and to deal with stress; also called ego defense mechanisms

deinstitutionalization a deliberate shift in care of the mentally ill from institutional care in state hospitals to care in community-based facilitiesand through community-based services

delirium a syndrome that involves a disturbance of consciousness accompanied by a change in cognition

delusion a fixed, false belief not based in reality

dementia a mental disorder that involves multiple cognitive deficits, initially involving memory impairment with progressive deterioration thatincludes all cognitive functioning

denial defense mechanism; clients may deny directly having any problems or may minimize the extent of problems or actual substance use

deontology a theory that says ethical decisions should be based on whether or not an action is morally right with no regard for the result orconsequences

dependent personality disorder characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clingingbehavior and fears of separation

depersonalization feelings of being disconnected from himself or herself; the client feels detached from his or her behavior

depot injection a slow-release, injectable form of antipsychotic medication for maintenance therapy

depressive behavior characterized by a pervasive pattern of depressive cognitions and behaviors in various contexts

derealization client senses that events are not real, when, in fact, they are

Dermatillomania compulsive skin picking, often to the point of physical damage; an impulse control disorder

designer drugs synthetic substances made by altering existing medications or formulating new ones not yet controlled by the FDA;amphetamine-like effects, some also have hallucinogenic effects; called club drugs

detoxification the process of safely withdrawing from a substance

Diagnostic and Statistical Manual of Mental Disorders (DSM-5): taxonomy published by the APA; the DSM-5 describes all mental disorders andoutlines specific diagnostic criteria for each based on clinical experience and research

directive role asking direct, yes/no questions and using problem-solving to help the client develop new coping mechanisms to deal with present,here-and-now issues

disease conviction preoccupation with the fear that one has a serious disease

disease phobia preoccupation with the fear that one will get a serious disease

disenfranchised grief grief over a loss that is not or cannot be mourned publicly or supported socially

dissociation a subconscious defense mechanism that helps a person protect his or her emotional self from recognizing the full effects of somehorrific or traumatic event by allowing the mind to forget or remove itself from the painful situation or memory

dissociative disorders these disorders have the essential feature of a disruption in the usually integrated functions of consciousness, memory,identity, or environmental perception; they include amnesia, fugue, and dissociative identity disorder

distance zones amount of physical space between people during communication; in the United States, Canada, and many Eastern Europeannations, four distance zones are generally observed: intimate zone, personal zone, social zone, and public zone

distraction involves shifting the client’s attention and energy to a different topic

dopamine a neurotransmitter located primarily in the brain stem; has been found to be involved in the control of complex movements,motivation, cognition, and regulation of emotional responses

dream analysis a primary method used in psychoanalysis; involves discussing a client’s dreams to discover their true meaning and significance

dual diagnosis the client with both substance abuse and another psychiatric illness

duty existence of a legally recognized relationship, that is, physician to client, nurse to client

duty to warn the exception to the client’s right to confidentiality; when health-care providers are legally obligated to warn another person who isthe target of the threats or plan by the client, even if the threats were discussed during therapy sessions otherwise protected by confidentiality

dysphoric mood that involves unhappiness, restlessness, and malaise

dystonia extrapyramidal side effect to antipsychotic medication; includes acute muscular rigidity and cramping, a stiff or thick tongue withdifficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties; also called dystonic reactions

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echolalia repetition or imitation of what someone else says; echoing what is heard

echopraxia imitation of the movements and gestures of someone an individual is observing

education group a therapeutic group; provides information to members on a specific issue, for instance, stress management, medicationmanagement, or assertiveness training

efficacy refers to the maximal therapeutic effect a drug can achieve

ego in psychoanalytic theory, the balancing or mediating force between the id and the superego; represents mature and adaptive behavior thatallows a person to function successfully in the world

elder abuse the maltreatment of older adults by family members or caretakers

electroconvulsive therapy (ECT) used to treat depression in select groups such as clients who do not respond to antidepressants or those whoexperience intolerable medication side effects at therapeutic doses

emotion-focused coping strategies techniques to assist clients to relax and reduce feelings of stress

empathy the ability to perceive the meanings and feelings of another person and to communicate that understanding to that person

enabling behaviors that seem helpful on the surface but actually perpetuate the substance use of another; for example, a wife who calls to reporther husband has the flu and will miss work when he is actually drunk or hungover

encopresis the repeated passage of feces into inappropriate places, such as clothing or the floor, by a child who is at least 4 years of age eitherchronologically or developmentally

enmeshment lack of clear role boundaries between persons

enuresis the repeated voiding of urine during the day or at night into clothing or bed by a child at least 5 years of age either chronologically ordevelopmentally

environmental control refers to a client’s ability to control the surroundings or direct factors in the environment

epinephrine derivative of norepinephrine, the most prevalent neurotransmitter in the nervous system, located primarily in the brain stem, andplays a role in changes in attention, learning and memory, sleep and wakefulness, and mood regulation

ethical dilemma a situation in which ethical principles conflict or when there is no one clear course of action in a given situation

ethics a branch of philosophy that deals with values of human conduct related to the rightness or wrongness of actions and to the goodness andbadness of the motives and ends of such actions

ethnicity concept of people identifying with one another based on a shared heritage

euthymic normal or level mood

evolving consumer household (ECH) a group-living situation in which the residents make the transition from a traditional group home to aresidence where they fulfill their own responsibilities and function without on-site supervision from paid staff

executive functioning the ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior

exploitation phase of nurse–client relationship, identified by Peplau, when the nurse guides the client to examine feelings and responses and todevelop better coping skills and a more positive self-image; this encourages behavior change and develops independence; part of the workingphase

exposure behavioral technique that involves having the client deliberately confront the situations and stimuli that he or she is trying to avoid

externalizing behavior aggressive, angry, sometimes destructive behavior resulting from externalizing and acting out one’s environmental stressand adversity

extrapyramidal side effects reversible movement disorders induced by antipsychotic or neuroleptic medication

extrapyramidal symptoms (EPSs) neurologic side effects of antipsychotic medications that are drug and dose related; treated withanticholinergic medication; includes dystonia, pseudoparkinsonism, and akathisia

eye contact looking into the other person’s eyes during communication

fabricated and induced illness: factitious disorders characterized by physical symptoms that are feigned or inflicted on one’s self or anotherperson for the sole purpose of gaining attention or other emotional benefits; also called factitious disorder, imposed on self or others

false imprisonment the unjustifiable detention of a client, such as the inappropriate use of restraint or seclusion

family therapy a form of group therapy in which the client and his or her family members participate to deal with mutual issues

family violence encompasses domestic or partner battering; neglect and physical, emotional, or sexual abuse of children; elder abuse; and maritalrape

fear feeling afraid or threatened by a clearly identifiable, external stimulus that represents danger to the person

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fidelity refers to the obligation to honor commitments and contracts

flat affect showing no facial expression

flight of ideas excessive amount and rate of speech composed of fragmented or unrelated ideas; racing, often unconnected, thoughts

flooding a form of rapid desensitization in which a behavioral therapist confronts the client with the phobic object (either a picture or the actualobject) until it no longer produces anxiety

flushing reddening of the face and neck as a result of increased blood flow

free association a method in psychoanalysis used to gain access to subconscious thoughts and feelings in which the therapist tries to uncover theclient’s true thoughts and feelings by saying a word and asking the client to respond quickly with the first thing that comes to mind

genuine interest truly paying attention to the client, caring about what he or she is saying; only possible when the nurse is comfortable withhimself or herself and aware of his or her strengths and limitations

going along technique used with clients with dementia; providing emotional reassurance to clients without correcting their misperceptions ordelusions

grief subjective emotions and affect that are a normal response to the experience of loss

grieving the process by which a person experiences grief

grounding techniques helpful to use with the client who is dissociating or experiencing a flashback; grounding techniques remind the client thathe or she is in the present, as an adult, and is safe

group therapy therapy during which clients participate in sessions with others; the members share a common purpose and are expected tocontribute to the group to benefit others and to receive benefit from others in return

half-life the time it takes for half of the drug to be eliminated from the bloodstream

hallucinations false sensory perceptions or perceptual experiences that do not really exist

hallucinogen substances that distort the user’s perception of reality and produce symptoms similar to psychosis including hallucinations (usuallyvisual) and depersonalization

hardiness the ability to resist illness when under stress

hierarchy of needs a pyramid used to arrange and illustrate the basic drives or needs that motivate people; developed by Abraham Maslow

histrionic personality disorder characterized by a pervasive pattern of excessive emotionality and attention seeking

homeostasis a state of equilibrium or balance

hostility an emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior; also called verbalaggression

humanism focuses on a person’s positive qualities, his or her capacity to change (human potential), and the promotion of self-esteem

Huntington’s disease an inherited, dominant gene disease that primarily involves cerebral atrophy, demyelination, and enlargement of the brainventricles

hyperarousal symptoms that arise from high levels of anxiety, including insomnia, irritability, anger outbursts, watchfulness, suspiciousness, anddistrustfulness. Often seen with PTSD

hypertensive crisis a life-threatening condition that can result when a client taking monoamine oxidase inhibitors (MAOIs) ingests tyramine-containing foods and fluids or other medications

hypochondriasis see illness anxiety disorder

hypomania a period of abnormally and persistently elevated, expansive, or irritable mood lasting 4 days; does not impair the ability to functionand does not involve psychotic features

hysteria refers to multiple, recurrent physical complaints with no organic basis

id in psychoanalytic theory, the part of one’s nature that reflects basic or innate desires such as pleasure-seeking behavior, aggression, and sexualimpulses; the id seeks instant gratification; causes impulsive, unthinking behavior; and has no regard for rules or social convention

ideas of reference client’s inaccurate interpretation that general events are personally directed to him or her, such as hearing a speech on thenews and believing the message has personal meaning

illness anxiety disorder preoccupation with the fear that one has a serious disease or will get a serious disease; also called hypochondriasis

impulse control the ability to delay gratification and to think about one’s behavior before acting

inappropriate affect displaying a facial expression that is incongruent with mood or situation; often silly or giddy regardless of circumstances

incongruent message when the communication content and process disagree

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individual psychotherapy a method of bringing about change in a person by exploring his or her feelings, attitudes, thinking, and behavior; itinvolves a one-to-one relationship between the therapist and the client

inhalant a diverse group of drugs including anesthetics, nitrates, and organic solvents that are inhaled for their effects

injury or damage the client suffered some type of loss, damage, or injury

insight the ability to understand the true nature of one’s situation and accept some personal responsibility for that situation

interdisciplinary (multidisciplinary) team treatment group composed of individuals from a variety of fields or disciplines; the most usefulapproach in dealing with the multifaceted problems of clients with mental illness

intergenerational transmission process explains that patterns of violence are perpetuated from one generation to the next through role modelingand social learning

internalization keeping stress, anxiety, or frustration inside rather than expressing them outwardly

internalizing behavior isolative and withdrawn behavior, as well as somatic illness, depression, and anxiety resulting from internalizing one’senvironmental stress and adversity

intimate partner violence the mistreatment, misuse, or abuse of one person by another in the context of a close, personal, or committedrelationship

intimate relationship a relationship involving two people who are emotionally committed to each other; both parties are concerned about havingtheir individual needs met and helping each other to meet needs as well; the relationship may include sexual or emotional intimacy as well assharing of mutual goals

intimate zone space of 0 to 18 inches between people; the amount of space comfortable for parents with young children, people who mutuallydesire personal contact, or people whispering; invasion of this intimate zone by anyone else is threatening and produces anxiety

intoxication use of a substance that results in maladaptive behavior

judgment refers to the ability to interpret one’s environment and situation correctly and to adapt one’s behavior and decisions accordingly

justice refers to fairness, or treating all people fairly and equally without regard for social or economic status, race, sex, marital status, religion,ethnicity, or cultural beliefs

kindling process the snowball-like effect seen when a minor seizure activity seems to build up into more frequent and severe seizures

Korsakoff’s syndrome type of dementia caused by long-term, excessive alcohol intake that results in a chronic thiamine or vitamin B deficiency

la belle indifférence a seeming lack of concern or distress; a key feature of conversion disorder

labile rapidly changing or fluctuating, such as someone’s mood or emotions

latency of response refers to hesitation before the client responds to questions

least restrictive environment treatment appropriate to meet the client’s needs with only necessary or required restrictions

limbic system an area of the brain located above the brain stem that includes the thalamus, hypothalamus, hippocampus, and amygdala(although some sources differ regarding the structures that this system includes)

limit setting an effective technique that involves three steps: stating the behavioral limit (describing the unacceptable behavior), identifying theconsequences if the limit is exceeded, and identifying the expected or desired behavior

loose associations disorganized thinking that jumps from one idea to another with little or no evident relation between the thoughts

magnetic resonance imaging (MRI) diagnostic test used to visualize soft tissue structures; energy field is created with a magnet and radio waves,and then converted into a visual image

malingering the intentional production of false or grossly exaggerated physical or psychological symptoms

malpractice a type of negligence that refers specifically to professionals such as nurses and physicians

managed care a concept designed to purposely control the balance between the quality of care provided and the cost of that care

managed care organizations developed to control the expenditure of insurance funds by requiring providers to seek approval before the deliveryof care

mania a distinct period during which mood is abnormally and persistently elevated, expansive, or irritable

mental health a state of emotional, psychological, and social wellness evidenced by satisfying relationships, effective behavior and coping,positive self-concept, and emotional stability

mental illness a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated withpresent distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantlyincreased risk of suffering death, pain, disability, or an important loss of freedom

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metaphor a phrase that describes an object or a situation by comparing it to something else familiar

mild anxiety a sensation that something is different and warrants special attention

milieu therapy the concept involves clients’ interactions with one another, that is, practicing interpersonal relationship skills, giving one anotherfeedback about behavior, and working cooperatively as a group to solve day-to-day problems

moderate anxiety the disturbing feeling that something is definitely wrong; the person becomes nervous or agitated

mood disorders pervasive alterations in emotions that are manifested by depression or mania or both

mood refers to the client’s pervasive and enduring emotional state

mood-stabilizing drugs used to treat bipolar disorder by stabilizing the client’s mood, preventing or minimizing the highs and lows thatcharacterize bipolar illness, and treating acute episodes of mania

mourning the outward expression of grief

Munchausen’s syndrome a factitious disorder where the person intentionally causes injury or physical symptoms to self to gain attention andsympathy from health-care providers, family, and others

Munchausen’s syndrome by proxy when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnelor to be a hero for “saving” the victim

narcissistic personality disorder characterized by a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack ofempathy

negative reinforcement involves removing a stimulus immediately after a behavior occurs so that the behavior is more likely to occur again

neglect malicious or ignorant withholding of physical, emotional, or educational necessities for the child’s well-being

negligence an unintentional tort that involves causing harm by failing to do what a reasonable and prudent person would do in similarcircumstances

neologisms invented words that have meaning only for the client

neuroleptic malignant syndrome (NMS) a potentially fatal, idiosyncratic reaction to an antipsychotic (or neuroleptic) drug

neuroleptics antipsychotic medications

neurotransmitter the chemical substances manufactured in the neuron that aid in the transmission of information throughout the body

nondirective role using broad openings and open-ended questions to collect information and help the client to identify and discuss the topic ofconcern

nonmaleficence the requirement to do no harm to others either intentionally or unintentionally

nonsuicidal self-injury intentional physical damage to the body, such as cutting or burning; results from self-harm urges or thoughts; injury isnot an attempt at suicide

nonverbal communication the behavior that accompanies verbal content, such as body language, eye contact, facial expression, tone of voice,speed and hesitations in speech, grunts and groans, and distance from the listener

norepinephrine the most prevalent neurotransmitter in the nervous system

no–self-harm contract a client promises to not engage in self-harm and to report to the nurse when he or she is losing control

obsessions recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause marked anxiety and interfere withinterpersonal, social, or occupational function

obsessive–compulsive personality disorder characterized by a pervasive pattern of preoccupation with perfectionism, mental and interpersonalcontrol, and orderliness at the expense of flexibility, openness, and efficiency

off-label use a drug will prove effective for a disease that differs from the one involved in original testing and FDA approval

oniomania compulsive buying; possessions are acquired compulsively without regard for cost or need for the item

onychophagia compulsive nail biting

open group an ongoing group that runs indefinitely; members join or leave the group as they need to

operant conditioning the theory that says people learn their behavior from their history or past experiences, particularly those experiences thatwere repeatedly reinforced

opioid controlled drugs; often abused because they desensitize the user to both physiologic and psychological pain and induce a sense ofeuphoria and well-being; some are prescribed for analgesic effects but others are illegal in the United States

orientation phase the beginning of the nurse–client relationship; begins when the nurse and client meet and ends when the client begins toidentify problems to examine

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pain disorder has the primary physical symptom of pain, which generally is unrelieved by analgesics and greatly affected by psychological factorsin terms of onset, severity, exacerbation, and maintenance

palilalia repeating words or sounds over and over

panic anxiety intense anxiety, may be a response to a life-threatening situation

panic attack between 15 and 30 minutes of rapid, intense, escalating anxiety in which the person experiences great emotional fear as well asphysiologic discomfort

panic disorder composed of discrete episodes of panic attacks, that is, 15 to 30 minutes of rapid, intense, escalating anxiety in which the personexperiences great emotional fear as well as physiologic discomfort

paranoid personality disorder characterized by pervasive mistrust and suspiciousness of others

parataxic mode begins in early childhood as the child begins to connect experiences in sequence; the child may not make logical sense of theexperiences and may see them as coincidence or chance events; the child seeks to relieve anxiety by repeating familiar experiences, althoughhe or she may not understand what he or she is doing

Parkinson’s disease a slowly progressive neurologic condition characterized by tremor, rigidity, bradykinesia, and postural instability

partial hospitalization program (PHP) structured treatment at an agency or a facility for clients living in the community; designed to helpclients make a gradual transition from being an inpatient to living independently or to avoid hospital admission

participant observer this term has been coined for the therapist’s role, meaning that the therapist both participates in and observes the progressof the relationship

passive–aggressive behavior characterized by a negative attitude and a pervasive pattern of passive resistance to demands for adequate social andoccupational performance

patterns of knowing the four patterns of knowing in nursing are empirical knowing (derived from the science of nursing), personal knowing(derived from life experiences), ethical knowing (derived from moral knowledge of nursing), and aesthetic knowing (derived from the art ofnursing); these patterns provide the nurse with a clear method of observing and understanding every client interaction

personal zone space of 18 to 36 inches; a comfortable distance between family and friends who are talking

personality an ingrained, enduring pattern of behaving and relating to self, others, and the environment; includes perceptions, attitudes, andemotions

personality disorders diagnosed when personality traits become inflexible and maladaptive and significantly interfere with how a personfunctions in society or cause the person emotional distress

phenomena of concern describe the 12 areas of concern that mental health nurses focus on when caring for clients

phobia an illogical, intense, and persistent fear of a specific object or social situation that causes extreme distress and interferes with normalfunctioning

physical abuse ranges from shoving and pushing to severe battering and choking and may involve broken limbs and ribs, internal bleeding, braindamage, and even homicide

physical aggression behavior in which a person attacks or injures another person or that involves destruction of property

pica persistent ingestion of nonnutritive substances such as paint, hair, cloth, leaves, sand, clay, or soil

Pick’s disease a degenerative brain disease that particularly affects the frontal and temporal lobes and results in a clinical picture similar to that ofAlzheimer’s disease

polydipsia excessive water intake

polysubstance abuse abuse of more than one substance

positive reframing a cognitive–behavioral technique involving turning negative messages into positive ones

positive regard unconditional, nonjudgmental attitude that implies respect for the person

positive reinforcement a reward immediately following a behavior to increase the likelihood that the behavior will be repeated

positive self-talk a cognitive–behavioral technique in which the client changes thinking about the self from negative to positive

positron emission tomography (PET) a diagnostic test used to examine the function of the brain by monitoring the flow of radioactivesubstances that are injected into the bloodstream

postinjection delirium/sedation syndrome (PDSS) : cluster of symptoms, such as slurred speech, confusion, sedation, altered gait, orunconsciousness that result from accidental intravascular injection of a portion of olanzapine (Zyprexa Relprevv)

PTSD a disturbing pattern of behavior demonstrated by someone who has experienced a traumatic event; for example, a natural disaster, a

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combat, or an assault; begins three or more months following the trauma

potency describes the amount of a drug needed to achieve maximum effect

preconception the way one person expects another to behave or speak; often a roadblock to the formation of an authentic relationship

pressured speech unrelenting, rapid, often loud talking without pauses

primary gain the relief of anxiety achieved by performing the specific anxiety-driven behavior; the direct external benefits that being sickprovides, such as relief of anxiety, conflict, or distress

problem identification part of the working phase of the nurse–client situation, when the client identifies the issues or concerns causing problems

problem-focused coping strategies techniques used to resolve or change a person’s behavior or situation or to manage life stressors

process in communication, denotes all nonverbal messages that the speaker uses to give meaning and context to the message

prototaxic mode characteristic of infancy and childhood that involves brief, unconnected experiences that have no relationship to one another;adults with schizophrenia exhibit persistent prototaxic experiences

proverbs old adages or sayings with generally accepted meanings

proxemics the study of distance zones between people during communication

pseudoparkinsonism a type of extrapyramidal side effect of antipsychotic medication; drug-induced parkinsonism; includes shuffling gait,masklike facies, muscle stiffness (continuous) or cogwheeling rigidity (ratchet-like movements of joints), drooling, and akinesia (slowness anddifficulty initiating movement)

psychiatric rehabilitation services designed to promote the recovery process for clients with mental illness; not limited to medicationmanagement and symptom control; includes personal growth reintegration into the community, increased independence, and improvedquality of life

psychoanalysis focuses on discovering the causes of the client’s unconscious and repressed thoughts, feelings, and conflicts believed to causeanxiety and helping the client to gain insight into and resolve these conflicts and anxieties; pioneered by Sigmund Freud; not commonly seentoday

psychoimmunology examines the effect of psychosocial stressors on the body’s immune system

psychological abuse (emotional abuse) includes name calling, belittling, screaming, yelling, destroying property, and making threats as well assubtler forms such as refusing to speak to or ignoring the victim

psychomotor agitation increased body movements and thoughts

psychomotor retardation overall slowed movements; a general slowing of all movements; slow cognitive processing and slow verbal interaction

psychopharmacology the use of medications to treat mental illness

psychosis cluster of symptoms including delusions, hallucinations, and grossly disordered thinking and behavior

psychosocial interventions nursing activities that enhance the client’s social and psychological functioning and improve social skills,interpersonal relationships, and communication

psychosomatic used to convey the connection between the mind (psyche) and the body (soma) in states of health and illness

psychotherapy group the goal of the group is for members to learn about their behaviors and to make positive changes in their behaviors byinteracting and communicating with others as members of a group

psychotherapy therapeutic interaction between a qualified provider and a client or group designed to benefit persons experiencing emotionaldistress, impairment, or illness; therapist’s approach is based on a theory or combination of theories

psychotropic drugs drugs that affect mood, behavior, and thinking that are used to treat mental illness

public zone space of 12 to 25 feet; the acceptable distance between a speaker and an audience, between small groups, and among others atinformal functions

purging compensatory behaviors designed to eliminate food by means of self-induced vomiting

race a division of humankind possessing traits that are transmitted by descent and sufficient to identify it as a distinct human type

rape a crime of violence, domination, and humiliation of the victim expressed through sexual means

rebound temporary return of symptoms; may be more intense than original symptoms

recovery improved quality of life, beyond just symptom control, including personal growth, reintegration into the community, empowerment,increased independence, and pursuit of life goals like any other person

reframing cognitive–behavioral technique in which alternative points of view are examined to explain events

religion an organized system of beliefs about one or more all-powerful, all-knowing forces that govern the universe and offer guidelines for

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living in harmony with the universe and others

reminiscence therapy thinking about or relating personally significant past experiences in a purposeful manner to benefit the client

repressed memories memories that are buried deeply in the subconscious mind or repressed because they are too painful for the victim toacknowledge; often relate to childhood abuse

residential treatment setting long-term treatment provided in a living situation; vary according to structure, level of supervision, and servicesprovided

resilience defined as having healthy responses to stressful circumstances or risky situations

resourcefulness involves using problem-solving abilities and believing that one can cope with adverse or novel situations

response prevention behavioral technique that focuses on delaying or avoiding performance of rituals in response to anxiety-provoking thoughts

restraining order legal order of protection obtained to prohibit contact between a victim and a perpetrator of abuse

restraint the direct application of physical force to a person, without his or her permission, to restrict his or her freedom of movement

restricted affect displaying one type of emotional expression, usually serious or somber

rumination repeatedly going over the same thoughts

satiety satisfaction of appetite

schizoid personality disorder characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotionalexpression in interpersonal settings

schizotypal personality disorder characterized by a pervasive pattern of social and interpersonal deficits marked by acute discomfort with andreduced capacity for close relationships as well as by cognitive or perceptual distortions and behavioral eccentricities

seasonal affective disorder (SAD) mood disorder with two subtypes; in one, most commonly called winter depression or fall-onset SAD, peopleexperience increased sleep, appetite, and carbohydrate cravings; weight gain; interpersonal conflict; irritability; and heaviness in theextremities beginning in late autumn and abating in spring and summer; the other subtype, called spring-onset SAD, is less common andincludes symptoms of insomnia, weight loss, and poor appetite lasting from late spring or early summer until early fall

seclusion the involuntary confinement of a person in a specially constructed, locked room equipped with a security window or camera for directvisual monitoring

secondary gain the internal or personal benefits received from others because one is sick, such as attention from family members, comfortmeasures, and being excused from usual responsibilities or tasks

self-actualized describes a person who has achieved all the needs according to Maslow’s hierarchy and has developed his or her fullest potentialin life

self-awareness the process by which a person gains recognition of his or her own feelings, beliefs, and attitudes; the process of developing anunderstanding of one’s own values, beliefs, thoughts, feelings, attitudes, motivations, prejudices, strengths, and limitations and how thesequalities affect others

self-concept the way one views oneself in terms of personal worth and dignity

self-disclosure revealing personal information such as biographical information and personal experiences, ideas, thoughts, and feelings aboutoneself

self-efficacy a belief that personal abilities and efforts affect the events in our lives

self-help group members share a common experience, but the group is not a formal or structured therapy group

self-monitoring a cognitive–behavioral technique designed to help clients manage their own behavior

sense of belonging the feeling of connectedness with involvement in a social system or environment of which a person feels an integral part

serotonin a neurotransmitter found only in the brain

serotonin syndrome uncommon but potentially life-threatening disorder called serotonin or serotonergic syndrome; characterized by agitation,sweating, fever, tachycardia, hypotension, rigidity, hyperreflexia, confusion, and, in extreme cases, coma and death; most commonly resultsfrom a combination of two or more medications with serotonin-enhancing properties, such as taking MAOI and SSRI antidepressants at thesame time or too close together

severe anxiety an increased level of anxiety when more primitive survival skills take over, defensive responses ensue, and cognitive skills decreasesignificantly; person with severe anxiety has trouble thinking and reasoning

sexual abuse involves sexual acts performed by an adult on a child younger than 18 years

single photon emission computed tomography (SPECT) a diagnostic test used to examine the function of the brain by following the flow of an

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injected radioactive substance

social network groups of people whom one knows and with whom one feels connected

social organization refers to family structure and organization, religious values and beliefs, ethnicity, and culture, all of which affect a person’srole and, therefore, his or her health and illness behavior

social relationship primarily initiated for the purpose of friendship, socialization, companionship, or accomplishment of a task

social support emotional sustenance that comes from friends, family members, and even health-care providers who help a person when aproblem arises

social zone a space of 4 to 12 feet, which is the distance acceptable for communication in social, work, and business settings

socioeconomic status refers to one’s income, education, and occupation

sodomy anal intercourse

somatic symptom disorder characterized by multiple, recurrent physical symptoms in a variety of bodily systems that have no organic or medicalbasis; also called somatization disorder

somatization the transference of mental experiences and states into bodily symptoms

spirituality a client’s beliefs about life, health, illness, death, and one’s relationship to the universe; involves the essence of a person’s being andhis or her beliefs about the meaning of life and the purpose for living

spontaneous remission natural recovery that occurs without treatment of any kind

spouse or partner abuse see intimate partner violence

stalking repeated and persistent attempts to impose unwanted communication or contact on another person

standards of care authoritative statements by professional organizations that describe the responsibilities for which nurses are accountable; thecare that nurses provide to clients meets set expectations and is what any nurse in a similar situation would do

12-step program based on the philosophy that total abstinence is essential and that alcoholics need the help and support of others to maintainsobriety

stereotyped motor behavior repetitive, seemingly purposeless movements; may include waving, rocking, twirling objects, biting fingernails,banging the head, biting or hitting oneself, or picking at the skin or body orifices

stimulant drugs drugs that stimulate or excite the central nervous system

stress the wear and tear that life causes on the body

subconscious thoughts or feelings in the preconscious or unconscious level of awareness

substance abuse can be defined as using a drug in a way that is inconsistent with medical or social norms and despite negative consequences

substance dependence includes problems associated with addiction, such as tolerance, withdrawal, and unsuccessful attempts to stop using thesubstance

suicidal ideation thinking about killing oneself

suicide precautions removal of harmful items; increased supervision to prevent acts of self-harm

suicide the intentional act of killing oneself

superego in psychoanalytic theory, the part of a person’s nature that reflects moral and ethical concepts, values, and parental and socialexpectations; therefore, it is in direct opposition to the id

support group organized to help members who share a common problem to cope with it

supportive touch the use of physical touch to convey support, interest, caring; may not be welcome or effective with all clients

survivor view of the client as a survivor of trauma or abuse rather than as a victim; helps to refocus client’s view of himself or herself as beingstrong enough to survive the ordeal, which is a more empowering image than seeing oneself as a victim

syntaxic mode begins to appear in school-aged children and becomes more predominant in preadolescence; the person begins to perceivehimself or herself and the world within the context of the environment and can analyze experiences in a variety of settings

systematic desensitization behavioral technique used to help overcome irrational fears and anxiety associated with a phobia

tangential thinking wandering off the topic and never providing the information requested

tapering administering decreasing doses of a medication leading to discontinuation of the drug

tardive dyskinesia a late-onset, irreversible neurologic side effect of antipsychotic medications; characterized by abnormal, involuntarymovements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet

temperament refers to the biologic processes of sensation, association, and motivation that underlie the integration of skills and habits based on

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emotion

termination or resolution phase the final stage in the nurse–client relationship; it begins when the client’s problems are resolved and concludeswhen the relationship ends

therapeutic communication an interpersonal interaction between the nurse and the client during which the nurse focuses on the client’s specificneeds to promote an effective exchange of information

therapeutic community or milieu beneficial environment; interaction among clients is seen as beneficial, and treatment emphasizes the role ofthis client-to-client interaction

therapeutic nurse–client relationship professional, planned relationship between client and nurse that focuses on client needs, feelings,problems, and ideas; interaction designed to promote client growth, discuss issues, and resolve problems; includes the three phases oforientation: working (identification and exploitation) and termination (resolution); also called therapeutic nurse–patient relationship

therapeutic play play techniques are used to understand the child’s thoughts and feelings and to promote communication

therapeutic relationship see therapeutic nurse–client relationship

therapeutic use of self nurses use themselves as a therapeutic tool to establish the therapeutic relationship with clients and to help clients grow,change, and heal

thought blocking stopping abruptly in the middle of a sentence or train of thought; sometimes client is unable to continue the idea

thought broadcasting a delusional belief that others can hear or know what the client is thinking

thought content what the client actually says

thought insertion a delusional belief that others are putting ideas or thoughts into the client’s head; that is, the ideas are not those of the client

thought process how the client thinks

thought stopping a cognitive–behavioral technique to alter the process of negative or self-critical thought patterns

thought withdrawal a delusional belief that others are taking the client’s thoughts away and the client is powerless to stop it

tic a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization

time away involves leaving clients for a short period and then returning to them to reengage in interaction; used in dementia care

time orientation whether or not one views time as precise or approximate; differs among cultures

time-out retreat to a neutral place to give the opportunity to regain self-control

tolerance break very small amounts of a substance will produce intoxication

tolerance the need for increased amount of a substance to produce the same effect

tort a wrongful act that results in injury, loss, or damage

Tourette’s disorder involves multiple motor tics and one or more vocal tics, which occur many times a day for more than 1 year

transference occurs when the client displaces onto the therapist attitudes and feelings that the client originally experienced in otherrelationships; it is common for the client to unconsciously transfer to the nurse feelings he or she has for significant others

trichotillomania compulsive hair pulling from scalp, eyebrows, or other parts of the body; leaves patchy bald spots that the person tries toconceal

unknowing when the nurse admits she does not know the client or the client’s subjective world; this opens the way for a truly authenticencounter; the nurse in a state of unknowing is open to seeing and hearing the client’s views without imposing any of his or her values orviewpoints

utilitarianism a theory that bases ethical decisions on the “greatest good for the greatest number”; primary consideration is on the outcome ofthe decision

utilization review firms developed to control the expenditure of insurance funds by requiring providers to seek approval before the delivery ofcare

values abstract standards that give a person a sense of right and wrong and establish a code of conduct for living

vascular dementia has symptoms similar to those of Alzheimer’s disease, but onset is typically abrupt and followed by rapid changes infunctioning, a plateau or leveling-off period, more abrupt changes, another leveling-off period, and so on

veracity the duty to be honest or truthful

verbal communication the words a person uses to speak to one or more listeners

waxy flexibility maintenance of posture or position over time even when it is awkward or uncomfortable

withdrawal new symptoms resulting from discontinuation of drug or substance

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withdrawal syndrome refers to the negative psychological and physical reactions that occur when use of a substance ceases or dramaticallydecreases

word salad flow of unconnected words that convey no meaning to the listener

working phase in the therapeutic relationship, the phase where issues are addressed, problems identified, and solutions explored; nurse andclient work to accomplish goals; contains Peplau’s phases of problem identification and exploitation

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Note: Page numbers followed by “b” indicate box; those followed by “f” indicate figure; those followed by “t”indicate table.

AAbility to concentrate, 141Abnormal involuntary movement scale (AIMS), 270–271, 272bAbraham’s hierarchy of needs, 50, 50fAbsolute neutrophil count (ANC), 27Abstract messages, 101Abstract thinking, 141–142Abuse

child, 201–204. See also Child abuseclinical picture of, 196–197cycle of, 199–200elder, 203–206emotional, 198intimate partner violence, 198–201physical, 198

defined, 198in elder, 204, 205bin spouse, 198

psychological, 198in child, 202defined, 198in spouse, 198

self-awareness issues, 210sexual, 202warning signs of abused/neglected children, 203b

Acamprosate (Campral), 35, 376, 377tAcceptance, 82, 163ACCESS. See Access to Community Care and Effective Services and Support (ACCESS)Access to Community Care and Effective Services and Support (ACCESS), 70Acculturation, defined, 167Acetylcholine, 19, 19tACT. See Assertive community treatment (ACT)Acting out, 184Active listening, in therapeutic communication, 100–101Acute confusion, 468. See also DeliriumAcute dystonia, 25Acute stress disorder

PTSD, 217

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Adaptive denial, 174Adaptive disclosure, 218Addiction. See Substance abuseADHD. See Attention deficit hyperactivity disorder (ADHD)Adjustment disorder, 217Adolescents. See also Child and adolescent disorders

characteristics and behavior in, 452twith depression, 297eating disorders. See Eating disordersmental illness, 4suicidal risk, 29, 329

Adult foster care, 66, 66bAdvocacy, defined, 93Advocate, nurses as, 93Aesthetic knowing, 85, 85tAffect

in ADHD, 441in antisocial personality disorder, 344in bipolar disorder, 316blunted, 140in borderline personality disorder, 349broad, 140in conduct disorder, 458defined, 140in delirium, 469in dementia, 478in depression, 304in eating disorders, 400, 404flat, 140inappropriate, 140in OCD, 257in panic disorder, 242in psychosocial assessment, 138b, 140restricted, 140in schizophrenia, 274–275in somatic symptom illness, 419in substance abuse, 382

Affective disorders. See Mood disordersAfrican Americans

bereavement rituals of, 167cultural considerations, 127, 167

Age, in client response to illness, 120–121, 121t, 122tAggressive behavior

community-based care, 192–193cultural considerations, 185etiology, 184–185nursing care plan, 186–189nursing process, 190–192

assessment, 190data analysis, 190–191evaluation, 192intervention, 191–192

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outcome identification, 191onset and clinical course, 183phases of, 190tphysical, 182related disorder, 183–184self-awareness issues, 193treatment of, 185workplace hostility, 192

Agnosia, 472. See also DementiaAgoraphobia, 236, 238t, 240Agranulocytosis, 272AIMS. See Abnormal involuntary movement scale (AIMS)Akathisia, 25, 270, 271tAlameda Model, 10Alarm reaction stage, of stress, 231Alcohol abuse

in family violence, 197–198long term effects, 368b

Alcoholics anonymous, twelve steps of, 373bAlcoholism

clinical course, 365–366Clinical Institute Withdrawal Assessment of Alcohol Scale, 369–370bclinical vignette, 370, 374elder considerations, 384family considerations, 366, 383intoxication and overdose, 368mental health promotion, 384–385older adults and, 384parental, 383pharmacologic treatment, 376–378, 377tSimple Screening Instrument for Alcohol and Other Drugs (SSI-AOD), 381, 381bspontaneous remission, 366withdrawal and detoxification, 368

Alexithymia, defined, 406Alogia, defined, 275Alprazolam (Xanax), 33t, 234t, 238tAlternative medical systems, 57Alzheimer’s disease, 23, 473

PET of patient with, 21, 21fAmantadine (Symmetrel), 25t, 271tAmerican Indians, cultural considerations, 127American Nurses Association (ANA), 7

Code of Ethics, 156, 158, 158bstandards of care, 7

American Psychiatric Association (APA)mental disorder defined by, 2

American Psychiatric Nurses Association (APNA), 7Amitriptyline (Elavil), 28t, 300tAmnestic disorders, 474. See also Cognitive disordersAmok, 185Amoxapine (Asendin), 28t, 299, 300tAmphetamines, 34, 35t

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abuse of, 370–371Amygdala, 17ANA. See American Nurses Association (ANA)ANC. See Absolute neutrophil count (ANC)Anergia, 293Anger. See also Aggressive behavior

onset and clinical course, 183related disorders, 183–184suppression of, 183

Anger attacks, 184Anhedonia, 274, 304Anorexia nervosa, 394–396

binge eating, 391clinical vignette, 396defined, 391, 394medical management, 395nursing care plan, 397–399onset and clinical course, 394physical problems of, 391bpsychopharmacology, 395psychotherapy, 395–396purging, 395risk factors, 392ttreatment and prognosis, 394–396

Antianxiety drugs, 32–33abuse of, 368, 370benzodiazepines, 32–33, 33tCanadian drugs, 503client teaching, 33listing of, 33tmechanism of action, 32–33side effects, 33

Anticholinergic side effects, 26Anticipatory grieving, defined, 162Anticonvulsant drugs, for bipolar disorder, 315–316

aripiprazole (Abilify), 316carbamazepine (Tegretol), 315–316, 315tclonazepam (Klonopin), 316divalproex (Depakote), 315tgabapentin (Neurontin), 315t, 316lamotrigine (Lamictal), 315tas mood stabilizers, 315toxcarbazepine (Trileptal), 315ttopiramate (Topamax), 315t, 316valproic acid (Depakote), 316

Antidepressant drugs, 28t, 29–32, 30batypical, 299, 301tCanadian drugs, 502–506client teaching, 30–31cyclic, 298–299

listing of, 28toverdose, 302

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side effects, 29–30drug interactions, 30listing of, 28tmechanism of action, 29monoamine oxidase inhibitors (MAOI), 300–301, 301t

drug interactions, 30, 302food interactions, 30, 30blisting of, 28tmechanism of action, 29overdose of, 302side effects, 30

selective serotonin reuptake inhibitors (SSRI)drug interactions, 30listing of, 28t, 299tmechanism of action, 29, 298side effects, 29

side effects of, 29–30suicide risk and, 29tetracyclic, 299tricyclic, 298–299, 300t

Antimanic and mood stabilizersCanadian drugs used in, 503

Antipsychotic drugs, 23–28, 24tfor aggressive behavior, 185Canadian drugs, 502client and family education, 27–28for dementia, 475depot injection, 23mechanism of action, 23–24for schizophrenia, 266, 269tside effects, 25–27, 271t

agranulocytosis, 272akathisia, 270, 271tanticholinergic, 26blurred vision, 270, 271tclient and family education, 287constipation, 270, 271tdry mouth, 270, 271tdystonic reactions, 270, 271textrapyramidal symptoms (EPS), 25, 269t, 270, 271tneuroleptic malignant syndrome (NMS), 25–26, 270, 271t, 272orthostatic hypotension, 270, 271tphotosensitivity, 270, 271tsedation, 270, 271tseizures, 270, 271t, 272tardive dyskinesia (TD), 26, 270, 271turinary retention, 270, 271tweight gain, 26–27, 270, 271t

Antisocial behavior, in children. See Conduct disorderAntisocial personality disorder, 343–348

care plan for, 346–348client and family education, 348b

844

clinical vignette, 345defined, 343interventions, 341tnursing process, 343–348

assessment, 343–344data analysis, 344evaluation, 348interventions, 341t, 345, 348outcome identification, 344–345

symptoms, 341tAnxiety

Hamilton rating scale for, 241blevels of, 232, 233tmild, 232moderate, 232severe, 232

Anxiety disorderscare plan for, 235–236community-based care, 239cultural considerations of, 237–238defined, 230elder considerations of, 238–239etiology, 237–338generalized anxiety disorder, 245incidence, 236mental health promotion, 239onset and clinical course, 236overview of, 234, 236panic disorder, 239–244phobias, 244–245related disorders, 236–237as response to stress, 230–234, 236self-awareness issues, 245–246treatment of, 238, 238t

Anxiety levels, in therapeutic relationship, 49, 49tAnxiolytics, 234t. See also Antianxiety drugs

Canadian drugs used in, 503Aphasia, 472. See also DementiaApproval, in therapeutic communication, 105tApraxia, 472. See also DementiaArab Americans, cultural considerations, 127–128Aripiprazole (Abilify), 23, 24, 24t, 316Arousal disorder, sexual, 498ASAP. See Assaulted staff action program (ASAP)Asperger’s disorder, 432Assault, 156Assaulted staff action program (ASAP), 193Assertive communication, 114–115Assertive community treatment (ACT), 65, 68–69, 69bAssertiveness training, 238Assessment

in aggressive behavior, 190

845

of attention deficit hyperactivity disorder (ADHD), 440–441components of

general appearance, 138b, 140, 220history, 138–139, 138binterview, 137–138judgment and insight, 139b, 142, 224mood and affect, 138b, 140, 220motor behavior, 138b, 140, 220physiologic considerations, 224roles and relationships, 139b, 143, 224self-care, 139b, 143self-concept, 139b, 142–143, 224sensorium and intellectual processes, 139b, 141–142, 224sensory-perceptual alterations, 139b, 142thought process and content, 138b, 140–141, 220, 224

of conduct disorder, 457–458content of, 138–141data analysis, 143–145of delirium, 467–470of dementia, 476–479factors influencing, 136–137mental status exam, 145psychiatric diagnoses, 145psychological tests, 144, 144tself-awareness issues, 145–146of somatic symptom illness, 418–419, 419b, 423–424of suicide risk, 141–143, 141b

Assisted suicide, 327. See also SuicideAsylum, 3Asynchronous, technology, 69Atomoxetine, 34Attachment behaviors, 163Attention deficit hyperactivity disorder (ADHD), 434–443

adult, 435, 436bCanadian drugs, 504care plan for, 437–438causes of, 435–436client and family education, 443, 443bclinical vignette, 436cultural considerations, 439defined, 434drugs to treatment, 35t, 440tetiology, 435–436, 439nursing process, 440–443

assessment, 440–441data analysis, 441evaluation, 443intervention, 441b, 442–443outcome identification, 442

onset and clinical course, 435psychopharmacology, 439, 440trisk factors of, 439

846

strategies at school and home for, 439treatment of, 439

Attentive presence, 171Attitudes

defined, 83self-awareness of, 83

Atypical antidepressants, 299, 301tAuditory hallucinations, 276Autism spectrum disorder, 432–433

Asperger’s disorder, 432childhood disintegrative disorder, 432Rett’s disorder, 432

Automatisms, 140Autonomy, and ethics, 157Avoidance behavior, 240Avoidance, in therapeutic relationships, 92Avoidant personality disorder

clinical course, 356–357defined, 356interventions, 341t, 357symptoms, 341t

Axon, 17

BBailey, Harriet, 7Barbiturates

abuse of, 370Battery, 156Behavioral theories

on anxiety disorders, 237Pavlov’s classical conditioning, 51Skinner’s operant conditioning, 51–52

Behaviorism, 51Behavior modification, 51Beliefs about health, in client response to illness, 125–126Beneficence, 157Benzodiazepines, 4, 475

in aggressive behavior, 185client teaching, 33listing of, 33tmechanism of action, 32–33side effects, 33substance abuse, 370

Benztropine (Cogentin), 25t, 185, 271tBereavement, 161Best practice

abuse and violence, 210addiction, 385anger, hostility, and aggression, 193anxiety and anxiety disorders, 245assessment, 145client’s response to illness, 132

847

in cognitive disorders, 485in disruptive behavior disorders, 461in eating disorders, 408grief and loss, 179legal and ethical issues, 158in mood disorders and suicide, 329neurobiologic theories and psychopharmacology, 36in neurodevelopmental disorders, 447obsessive–compulsive and related disorders, 259–260in personality disorders, 359psychiatric–mental health nursing, 10psychosocial theories and therapy, 58in schizophrenia, 288in somatic symptom illnesses, 426therapeutic communication, 116therapeutic relationships, 94trauma and stressor-related disorders, 227treatment settings and therapeutic programs, 72–73

BIID. See Body identity integrity disorder (BIID)Binge eating disorder, 391Biologically based therapies, 57Biologic factors, 121Biologic theories

of mood disordersgenetic, 296neurochemical, 296neuroendocrine, 296

personality disorders, 337–338of somatic symptom illness, 417

Biperiden (Akineton), 25t, 271tBipolar cycles, 314fBipolar disorder, 313–323

client and family education, 322–323DSM-5 diagnostic criteria, 314bmania. See Manianursing process, 316–323

assessment of, 316–318data analysis, 319evaluation, 323intervention, 320–323outcome identification, 319–320

onset and clinical course, 313psychopharmacology, 313–316

anticonvulsant drugs, 315–316lithium, 315

psychotherapy, 316questionnaire, 313treatment, 313–316

Black box warning, 22Blackout, 366Bleuler, Eugene, 4Blunted affect, 140, 274

848

defined, 274Board and care homes, 66, 66bBody dysmorphic disorder, 251Body identity integrity disorder (BIID), 252Body image disturbance, 393Body language, in communication, 108–109Borderline personality disorder, 337, 349–354

client and family education, 354bclinical vignette, 351defined, 349DSM-5 diagnostic criteria, 337binterventions, 341tnursing care plan, 351–352bnursing process, 349–354

assessment, 349–350data analysis, 350evaluation, 354interventions, 352–354outcome identification, 352

symptoms, 341tBoufféedélirante, 185, 268Boundaries

in borderline personality disorder, 353in therapeutic communication, 99–100in therapeutic relationship, 91–92, 91t

Bowlby’s phases of grieving, 163Brain

anatomy of, 16–17, 16fstructure of, 17f

Brain imaging techniques, 19–21, 20tlimitations of, 21types of, 19–21

Brain stem, 16f, 17, 17fBreach of duty, 156Breathing-related sleep disorders, 496–497Brief Jail Mental Health Screen (BJMHS), 71Brief psychotic disorder, 267Broad affect, 140Bulimia nervosa

care plan, 402–404bclinical vignette, 400cognitive–behavioral therapy for, 396defined, 391, 396onset and clinical course, 396psychopharmacology, 400risk factors, 392ttreatment, 396, 400

Buprenorphine/naloxone (Suboxone), 377, 377tBupropion (Wellbutrin), 28t, 30, 299, 301tBuspirone (BuSpar), 30, 33t, 234t, 238t

C

849

CAM. See Complementary and alternative medicine (CAM)Cambodians, cultural considerations, 128Canadian drug names, 502–506Cannabis sativa, abuse of, 371Carbamazepine (Tegretol), 315–316, 315t

in aggressive behavior, 185as mood stabilizer, 31side effects, 32

Caregiverinternet intervention for, 58nurses as, 93

Care plan. See Nursing care planCarper’s patterns of nursing knowledge, 85, 85tCase management, 6CAT. See Computed axial tomography (CAT)Catatonia, 267, 274Catharsis, 183Causation, 156Cenesthetic hallucinations, 277Central nervous system (CNS)

brain stem, 16f, 17, 17fcerebellum, 16–17, 16f, 17fcerebrum, 16, 16f, 17flimbic system, 17

Cerebellum, 16–17, 16f, 17fCerebrum, 16, 16f, 17fChemical dependence, 365Child abuse

assessment of, 202–203clinical picture of, 202intervention of, 203treatment of, 203types of, 202

Child and adolescent disordersattention deficit hyperactivity disorder (ADHD), 434–443

adult, 435, 436bCanadian drugs, 504care plan for, 437–438causes of, 435–436client and family education, 443, 443bcultural considerations, 439defined, 434drugs to treatment, 35tetiology, 435–436, 439nursing process, 440–443onset and clinical course, 435psychopharmacology, 439, 440trisk factors of, 439strategies at school and home for, 439treatment of, 439

chronic motor disorder, 433communication disorders, 434

850

conduct disorder, 453–460care plan for, 455–456causes of, 454classification, 453–454client and family education, 460, 460bcommunity-based care for, 460cultural considerations, 457defined, 453etiology, 454, 456nursing process, 457–460onset and clinical course, 453–454treatment of, 457

elimination disorders, 434feeding and eating disorders

pica, 391rumination disorder, 304, 307, 391

learning disorders, 433motor skills disorders, 433–434oppositional defiant disorder (ODD), 451–453reactive attachment disorder, 217self-awareness issues. See Self-awareness issuesseparation anxiety disorder, 237SNAP-IV teacher and parent rating scale, 444–446btic disorders, 433Tourette’s disorder, 433

Childhood and Society, 45Chinese

bereavement rituals, 168cultural considerations, 128, 168

Chlorazepate (Tranxene), 33t, 238tChlordiazepoxide (Librium), 33, 33t, 234t, 238t, 377tChlorpromazine (Thorazine), 4Chronic motor disorder, 433Circadian rhythm sleep disorders, 497Circumstantiality, defined, 109Circumstantial thinking, 140Citalopram (Celexa), 28t, 299tClassical conditioning, 51Client and family education

for ADHD, 443for antipsychotic drugs, 27–28, 287for antisocial personality disorders, 348for borderline personality disorder, 354for community-based social support, 27for conduct disorder, 460for delirium, 470for depression, 313for eating disorders, 407for mania, 322–323for obsessive–compulsive and related disorders, 259for panic disorder, 243for schizophrenia, 285

851

for somatic symptom illness, 425in substance abuse, 383for trauma and stressor-related disorders, 219

Client-centered therapy, 50Client participation/feedback, factors influencing assessment, 136Client’s health status, factors influencing assessment, 137Clinical course, personality disorders, 337Clinical vignette

in ADHD, 436in alcoholism, 374in anger, hostility, and aggression, 186in anorexia nervosa, 396in antisocial personality disorder, 345in anxious behavior, 234in borderline personality disorder, 351in bulimia nervosa, 400in child abuse, 202in conduct disorder, 454in conversion disorder, 414in delirium, 467in dementia, 476in depression, 304in dual diagnosis, 378in elder abuse, 204in grief and loss, 166, 176in illness anxiety disorder, 419in intimate partner violence, 199in manic episode, 317in obsessive–compulsive and related disorders, 253in panic disorder, 240in posttraumatic stress disorder, 221in rape, 206in schizophrenia, 277in seclusion, 154in therapeutic communication, 100in therapeutic relationships, 81in withdrawal, 370

Clomipramine (Anafranil), 28tClonazepam (Klonopin), 31, 33t, 234t, 238t, 316Clonidine (Catapres), 32, 238t, 377t, 378Closed body positions, 108Closed groups, 56Clozapine (Clozaril), 23, 24t, 26, 27, 185

in agranulocytosis, 272in tardive dyskinesia, 270

Clubhouse modelfor psychiatric rehabilitation, 68

CNS. See Central nervous system (CNS)Cocaine, abuse of, 370–371Code of Ethics, American Nurses Association (ANA), 156, 158, 158bCodependence, 383Cognition, defined, 465

852

Cognitive disordersamnestic disorders, 474categories of, 465defined, 465delirium, 465–472

care plan, 468causes of, 466, 466bclient and family education, 470bcommunity-based care for, 472cultural considerations, 466defined, 465vs. dementia, 473tetiology of, 466nursing process, 467–471treatment of, 466–467

dementia, 472–485caregiver issues, 484–485care plan for, 477causes of, 473–474clinical course for, 472–473community-based care for, 483cultural considerations, 474–475defined, 472vs. delirium, 473tetiology of, 473–474mental health promotion, 484nursing process, 476–483related disorders, 474risk factors for, 484self-awareness issues, 485stages of, 472–473treatment of, 475types of, 472

Cognitive processing therapy, 218Cognitive restructuring, definition of, 354Cognitive therapy, 52

distortions addressed by, 303tCommand hallucinations, 276Communication. See also Therapeutic communication

disorders, 434nonverbal

body language, 108–109defined, 98eye contact, 109facial expression, 108silence, 109skills for, 107–109vocal cues, 109

verbaldefined, 98skills for, 101–107

Community-based care

853

addiction, 384in aggressive behavior, 192–193in anxiety disorders, 239current states of, 5–6for delirium, 472for dementia, 483disruptive behavior disorders, 460in eating disorders, 407in mood disorders and suicide, 328–329obsessive–compulsive disorder (OCD), 259in personality disorders, 359PTSD, 219for schizophrenics, 288for somatic symptom illness, 425–426in substance abuse, 384in therapeutic communication, 115

Community Mental Health Centers Construction Act, 4Community support services, 58Community violence, 209–210Comorbid psychiatric disorders, 391–392Compassion fatigue, 94Compensation, as ego defense mechanism, 43tComplementary and alternative medicine (CAM), 57–58Complicated grieving, 169–171

risk factors, 171susceptibility to, 170uniqueness of, 171

Compulsions, 250Computed axial tomography (CAT), 19–20Computed tomography (CT), of brain, 19–20, 20fConcentrate, ability to, 141Concrete messages, 101Conduct disorder, 453–460

care plan for, 455–456causes of, 454classification, 453–454client and family education, 460, 460bclinical vignette, 454community-based care for, 460cultural considerations, 457defined, 453etiology, 454, 456nursing process, 457–460

assessment, 457–458data analysis, 458evaluation, 460intervention, 458–460, 459boutcome identification, 458

onset and clinical course, 453–454related problems, 456–457treatment of, 457

Confrontation, definition of, 345

854

Congruence, 80Congruent message, 98Conscious, in psychoanalytic theory, 42Context, in therapeutic communication, 110Control issues, in family violence, 197, 197bControlled substances, in substance abuse, 385Conversion, as ego defense mechanism, 43tConversion disorder, 413Coping strategies, for somatic symptom illness, 425Corpus callosum, 16Correctional Mental Health Screens (CMHS), 71Cost containment, managed care and, 6–7Countertransference, 44, 45, 90Creative play, 439Creutzfeldt–Jakob disease, 474Criminalization of mental illness, 70“Crisis hostel,” concept of, 64Crisis intervention, 53Crisis phase, in aggressive behavior, 191Crisis resolution teams (CRT), 64Crisis, stages of, 53CT. See Computed tomography (CT)Cubans, cultural considerations, 128Cues, 106–107

in communication, 109covert, 107overt, 107vocal, 109

Cultural assessment, 126–127, 126bbiologic variations, 126–127communication, 126environmental control, 126physical distance, 126social organization, 126time orientation, 126

Cultural considerationsin abuse and violence, 198addiction, 367–368in ADHD, 439in anger, hostility, and aggression, 185of anxiety disorders, 237–238in client response to illness

beliefs about health, 125–126social class, 127socioeconomic status, 127

in cognitive disorders, 466in conduct disorder, 457culture-specific rituals, 167–168delirium, 466–467in dementia, 474–475in disruptive behavior disorders, 457in eating disorders, 394

855

ethnic groupAfrican Americans, 127American Indians, 127Arab Americans, 127–128Cambodians, 128Chinese, 128Cubans, 128Filipinos, 128–129Haitians, 129Japanese Americans, 129Mexican Americans, 129–130Native Americans, 127Puerto Ricans, 130Russians, 130South Asians, 130Vietnamese, 130

in grief and loss, 167–169in mental illness, 7in mood disorders and suicide, 297in neurobiologic theories and psychopharmacology, 36in neurodevelopmental disorders, 439nurse’s role and, 131–132, 168–169in obsessive–compulsive and related disorders, 253patterns and differences, 127–130in personality disorders, 338–339in psychosocial theories and therapy, 53–54in schizophrenia, 268–269of somatic symptom illness, 417–418substance abuse, 367–368in therapeutic communication, 110–111in trauma and stressor-related disorders, 218

Culturally competent nursing, 125Culture-bound syndromes, 417tCulture, defined, 120Cyanocobalamin (vitamin B12), 377t

Cyclic antidepressants, 298–299listing of, 28toverdose, 302side effects, 29–30

Cyclothymic disorder, 295Cystic fibrosis, 21

DDamage, 156Data analysis

in aggressive behavior, 190–191antisocial personality disorder, 344attention deficit hyperactivity disorder (ADHD), 441in bipolar disorder, 319borderline personality disorder, 350conduct disorder, 458for delirium, 470

856

for dementia, 479in depression, 308eating disorders, 405grieving, 174obsessive–compulsive disorder (OCD), 258posttraumatic stress disorder (PTSD), 225in schizophrenia, 281somatic symptom illness, 424substance abuse, 382–383

Date rape, defined, 206Day treatment programs, 66Decatastrophizing, 238

definition of, 354Defense mechanisms, 237Deinstitutionalization, 4Delirium

care plan for, 468causes of, 466, 466bclient and family education, 470bcommunity-based care for, 472cultural considerations, 466–467defined, 465vs. dementia, 473tdrug-induced, 466b, 467bnursing process, 467–471

assessment, 467–470data analysis, 470evaluation, 471interventions, 470–471outcome identification, 470

psychopharmacology, 466treatment of, 466–467

Delirium tremens (DT), 368Delusional disorder, 267Delusions, 140

defined, 275of grandeur, 276ftypes of, 276b

DementiaAlzheimer’s disease, 473Canadian drugs used in, 503caregiver issues, 484–485care plan for, 477causes of, 473–474community-based care for, 483Creutzfeldt–Jakob disease, 474cultural considerations, 474–475defined, 472vs. delirium, 473tdrugs used for, 475, 476bHuntington’s disease, 474mild, 472–473

857

moderate, 473nursing process, 476–483

assessment, 476–479data analysis, 479evaluation, 483intervention, 479–483outcome identification, 479

Parkinson’s disease, 474Pick’s disease, 474risk factors for, 484self-awareness issues, 485severe, 473stages of, 472–473treatment of, 475types of, 472–473vascular, 473–474

Dendrites, 17Denial, 163, 164t

as ego defense mechanism, 43tDeontology, 157Department of Health and Human Services (DHHS), 5Dependent personality disorder, 357–358

clinical course, 357defined, 357interventions, 341t, 357–358symptoms, 341t

Depersonalization, 242, 277disorder, 220

Depot injection, antipsychotic drugs, 23, 270Depression, 294

care plan for, 305–307client/family education, 313clinical course, 297electroconvulsive therapy (ECT), 302Hamilton rating scale for, 308, 309–310binvestigational treatment, 303nursing process, 303–313

assessment of, 303–304, 307–308data analysis, 308evaluation, 313intervention, 305–307, 308, 310–312, 311outcome identification, 308

psychopharmacology, 297–301, 298b, 299t, 300tpsychotherapy for, 303

medical treatments and, 302–303rating scales, 308

Depressive behavior, defined, 336Derealization, 242

disorder, 220Dermatillomania, 251Designer drugs, 365Desipramine (Norpramin), 28t, 300t

858

Desire disorders, sexual dysfunctions, 498Desvenlafaxine (Pristiq), 28t, 301tDetoxification, 365

alcohol, 368anxiolytics, 370hallucinogens, 372hypnotics, 370inhalants, 373marijuana, 371opioids, 372sedatives, 370stimulants, amphetamines and cocaine, 371

Developmental coordination disorder, 433–434Developmental theories, 45–46

Erikson’s psychosocial stages, 45–46, 46tPiaget’s cognitive stages, 46

Development stagesErikson’s psychosocial, 45–46, 46tFreud’s psychosexual, 43–44, 44tgroups, 54–55Piaget’s cognitive, 46

Dextroamphetamine (Dexedrine), 34, 35tDhat, 417tDHHS. See Department of Health and Human Services (DHHS)Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)

classification system, 2objectives of, 2

Diazepam (Valium), 25t, 33, 33t, 234t, 238t, 271tDiphenhydramine (Benadryl), 25t, 271tDirective role, in therapeutic communication, 112Disenfranchised grief, 169Disinhibited social engagement disorder (DSED), 217Displacement, as ego defense mechanism, 43tDisruptive behavior disorders

community-based care, 460conduct disorder, 453–460

care plan for, 455–456causes of, 454classification, 453–454community-based care for, 460cultural considerations, 457defined, 453etiology, 454, 456nursing process, 457–460onset and clinical course, 453–454treatment of, 457

intermittent explosive disorder, 453mental health promotion, 460–461oppositional defiant disorder (ODD), 451–453self-awareness issues, 461

Disruptive mood dysregulation disorder, 295Dissociation, 219

859

as ego defense mechanism, 44tDissociative amnesia, 219Dissociative disorders

PTSD, 219–220Dissociative identity disorder, 219–220Disulfiram (Antabuse), 35–36, 376, 377tDivalproex (Depakote), 315tDix, Dorothea, 3Dopamine, 18, 19tDopamine receptors, antipsychotics effects on, 23Dopamine system stabilizers, 23Doxepin (Sinequan), 28t, 300tDramatic play, 439Dream analysis, 43Droperidol (Inapsine), 27Drug abuse, in family violence, 197Drug alert

antidepressants and suicide risk, 329MAOI and cyclic antidepressants, 302MAOI drug interactions, 302serotonin syndrome, 302

Drug classification under the controlled substances Act, 500–501Drug interactions

antidepressant drugs and, 30DSM-5 diagnostic criteria

bipolar I disorder, 314borderline personality disorder, 337major depressive disorder, 298obsessive–compulsive disorder, 252posttraumatic stress disorder, 216–217schizophrenia, 266

DSM-V-TR. See Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)DT. See Delirium tremens (DT)Dual diagnosis

substance abuse and, 378Duchenne’s muscular dystrophy, 21Duloxetine (Cymbalta), 28t, 299, 301tDyspareunia, 498Dysphoric mood, 349Dysthymic disorder, 295Dystonia, acute, 25Dystonic reactions, 270, 271t

EEating attitudes test, 401bEating disorders, 390–409

anorexia nervosa, 394–396binge eating, 391defined, 394medical management, 395onset and clinical course, 394psychopharmacology, 395

860

psychotherapy, 395–396purging, 395risk factors, 392ttreatment and prognosis, 394–396

binge eating disorder, 391bulimia nervosa

care plan, 402–404bcognitive–behavioral therapy for, 396defined, 396onset and clinical course, 396psychopharmacology, 400risk factors, 392ttreatment, 396, 400

categories of, 391–392client and family education, 407, 407bcommunity-based care, 407cultural considerations, 394etiology, 392–394

biologic factors, 392–393developmental factors, 393family influences, 393sociocultural factors, 394

family considerations, 393medical management, 395mental health promotion, 407–408night eating disorder, 391nursing process, 400, 404–407

assessment, 400, 404–405data analysis, 405evaluation, 407interventions, 405–407, 406boutcome identification, 405

obesity, 390overview of, 390–391psychopharmacology, 395psychotherapy, 395–396risk factors for, 392tsample screening questions, 408bself-awareness issues, 408–409treatment and prognosis, 394–396

Echolalia, 274, 472Echopraxia, 274ECT. See Electroconvulsive therapy (ECT)Edema, 20Education groups, 56–57Education, nurse’s role in, 22, 22fEfficacy, of drug, 22Ego, 42, 43Ego defense mechanisms, 43, 43–44tElder abuse, 203–206

assessment of, 204–206clinical picture of, 204

861

intervention, 206treatment of, 206

Elder considerationsaddiction, 384in anxiety and anxiety disorders, 238–239in disruptive behavior disorders, 460in mood disorders and suicide, 328in obsessive–compulsive and related disorders, 259in personality disorders, 359PTSD, 219schizophrenia, 287–288

Electroconvulsive therapy (ECT), 7for depression, 302

Elimination disorders, 434Ellis, Albert, rational emotive therapy, 52, 52tE-Mental health services, 69, 72–73Emotional abuse

defined, 198in spouse, 198

Emotional support, in dementia, 481Emotion-focused coping strategies, 425Empathy, in therapeutic relationship, 81–82, 81fEmpowerment, in therapeutic communication, 113–114Encopresis, 434Energy therapies, 57–58Engel’s stages of grieving, 163Enuresis, 434Environment, in psychosocial assessment, 137Epinephrine, 18, 19tEPS. See Extrapyramidal symptoms (EPS)Erectile disorder, 498Escalation phase, in aggressive behavior, 186b, 191Escitalopram (Lexapro), 28t, 299tEthical Decision-Making, 158Ethical dilemmas, in mental health, 157–158Ethical issues, 157–158Ethics

code of, 156, 158, 158bdefined, 157principles of, 157self-awareness issues, 158

Ethnic group, cultural considerationsAfrican Americans, 127American Indians, 127Arab Americans, 127–128Cambodians, 128Chinese, 128Cubans, 128Filipinos, 128–129Haitians, 129Japanese Americans, 129Mexican Americans, 129–130

862

Native Americans, 127Puerto Ricans, 130Russians, 130South Asians, 130Vietnamese, 130

Euthymic mood, 293Evaluation, 259

in aggressive behavior, 192obsessive–compulsive disorder (OCD), 258–259

Excoriation, 251Executive functioning, 472Exhaustion stage, stress, 231Exhibitionism, 499Existential theories, 52–53, 52t

cognitive therapy, 52Gestalt therapy, 52–53, 52tlogotherapy, 52, 52trational emotive therapy, 52, 52treality therapy, 52t, 53

Exploitation phase, of therapeutic relationship, 48, 48t, 87t, 90Exposure, 253

therapy, 218Expressive language disorder, 434Externalizing behaviors, 457bExtrapyramidal symptoms (EPS), 25, 269t, 270, 271t

acute dystonia, 25akathisia, 25drugs to treatment, 25tpseudoparkinsonism, 25

Eye contact, in communication, 109

FFabricated or induced illness, 414Facial expression, in communication, 108Factitious disorders, 414Falling-out episodes, 417tFalse imprisonment, 156Family considerations

in eating disorders, 393in schizophrenia, 273in substance abuse, 366, 383

Family education, 56. See also Client and family educationFamily input, in psychosocial assessment, 137–138Family therapy, 56Family violence

characteristics of, 197–198, 197bchild. See Child abusecultural considerations, 198elder. See Elder abuseintimate partner. See Intimate partner violence

FDA. See U.S. Food and Drug Administration (FDA)Fear, 240

863

Female orgasmic disorders, 498Female sexual arousal disorder, 498Fetishism, 499Fidelity, 157Filipinos

bereavement rituals, 168cultural considerations, 128–129, 168

Fixation, as ego defense mechanism, 44tFlat affect, 140, 274Flight of ideas, 140, 294Flooding, 245

onset and clinical course, 245treatment of, 245

Fluoxetine (Prozac), 28t, 29, 238t, 298, 299t, 418tFlurazepam (Dalmane), 33, 33tFluvoxamine (Luvox), 28tFolic acid (folate), 377tFrankl, Viktor, logotherapy, 52, 52tFree association, in psychoanalytic theory, 43Freudian slip, 42Freud, Sigmund, 412

psychoanalytic theory, 42–45, 43ftreatment of mental disorders and, 3–4

Friendship-warmth touch, 100Frontal lobe, 16, 16f, 17fFrotteurism, 499Functional-professional touch, 100

GGABA. See Gamma-aminobutyric acid (GABA)Gabapentin (Neurontin), 31, 315t, 316Gamma-aminobutyric acid (GABA), 237Gender dysphoria, 499General adaptation syndrome, 231General appearance

in ADHD, 430–431in antisocial personality disorder, 344in bipolar disorder, 316in borderline personality disorder, 349in conduct disorders, 458in delirium, 467, 469in dementia, 476, 478in depression, 303–304in eating disorders, 400in OCD, 255in panic disorder, 241–242in psychosocial assessment, 138b, 140in PTSD, 220in schizophrenia, 274in somatic symptom illness, 418–419in substance abuse, 382

Generalized anxiety disorder (GAD), 236, 245

864

Genetic and heredity considerationsof anxiety disorders, 237mental illness and, 21of mood disorders, 296schizophrenia, 267

Genetic theoriesanxiety disorders, 237of mood disorders, 296

Genuine interestin therapeutic relationship, 80–81

Gestalt therapy, 52–53, 52tGhost sickness, 268Ginkgo biloba, 36Glasser, William, 52t, 53Glutamate, 19, 19tGoing along, 482–483Grandiose delusions, 276bGrief. See also Grieving

clinical vignette, 166physiologic, 167responses to

behavioral, 166cognitive, 164–165emotional, 165physiologic, 167spiritual, 165–166

Grieving, 161–179anticipatory, 162care plan for, 177–179complicated grieving, 169–171, 170f

risk factors, 171susceptibility to, 170uniqueness of, 171

cultural considerations, 167–169dimensions of, 164–169nursing process

assessment, 172–174data analysis, 174evaluation, 176interventions, 174–176, 176boutcome identification, 174

process, 162–164self-awareness issues, 179stages of, 164tsymptoms of, 172btasks of, 163–164theories of, 162–163, 164t

Grounding techniques, 225Groups, 54–57

closed, 56defined, 54development stages of, 54–55

865

leadership, 55open, 56roles in, 55therapy in, 55–57

Group therapyeducation groups, 56–57family, 56family education, 56psychotherapy, 56self-help groups, 57support groups, 57

Gustatory hallucinations, 277

HHaitians

bereavement rituals, 167–168cultural considerations, 167–168

Haldol (decanoate haloperidol), 24, 24tHalf-life, of drug, 22Hallucinations, 142, 276

abuse of, 372Haloperidol (Haldol), 4

in aggressive behavior, 185Hamilton rating scale

for anxiety, 241bfor depression, 308, 309–310b

Health Care Finance Administration, 6Health care, misconceptions

factors influencing assessment, 137Health, defined by WHO, 2Hippocampus, 17Hispanic Americans

bereavement rituals, 168cultural considerations, 168

Histamine, 19, 19tHistrionic personality disorder

clinical course, 355defined, 355interventions, 341t, 355symptoms, 341t

Hoarding disorder, 251Homelessness, mental illness and, 5, 70Homeostasis, 171Horowitz’s stages of loss and adaptation, 163Hospitalization, 63–65

case management, 65discharge planning, 65dual diagnosis, 64legal considerations

involuntary, 152mandatory outpatient treatment, 152–153release, 152

866

long stays, 64–65partial, 65–66, 66bscheduled, 64short stays, 64

Hospitalization, need for, 10Hostility, 182

onset and clinical course, 183workplace, 192

Human Genome Project, 21Humanism, 50Humanistic theories, 50

Maslow’s hierarchy of needs, 50, 50fRogers’s client-centered therapy, 50

Huntington’s disease, 21, 474Hwa-byung, 185, 417tHydroxyzine (Vistaril), 32, 238tHyperarousal, 215Hyperinsomnia, 496Hypertensive crisis, 301Hypnotics, abuse of, 368, 370Hypochondriasis

care plan for, 420–423disorder, 413

Hypomania, 294Hypothalamus, 17Hysteria, 412

IId, 42, 43fIdeas of reference, 140, 280Identification, as ego defense mechanism, 44tIdentification phase, of therapeutic relationship, 48, 48tIED. See Intermittent explosive disorder (IED)Illness anxiety disorder, 413

clinical vignette, 419Imipramine (Tofranil), 28t, 238t, 300tImmune system, mental illness and, 21–22Immunovirologic factors, schizophrenia, 268Impulse control

in aggressive behavior and, 184defined, 184

Inappropriate affect, 140Incongruent message, 98–99Indirectly acting amines, 34Individual factors, in mental health

age, 120–121, 121t, 122tdevelopment, 120–121genetics and heredity, 121growth, 120–121hardiness, 123health practices, 121–122physical health, 121–122

867

psychosocial development, 121, 121tresilience, 123–124resourcefulness, 123–124response to drugs, 122self-efficacy, 122–123spirituality, 124

Individual psychotherapy, 54Infection causes, of mental illness, 22Information and communication technology (ICT), 69Inhalants, abuse of, 372–373Injury, 156Inpatient hospital treatment. See HospitalizationInsight

in ADHD, 441in antisocial personality disorder, 344in bipolar disorder, 317in borderline personality disorder, 350in conduct disorders, 458in delirium, 469in dementia, 478in depression, 308in eating disorders, 404in OCD, 257in panic disorder, 242in posttraumatic stress disorder (PTSD), 224in psychosocial assessment, 139b, 142in schizophrenia, 277, 279in somatic symptom illness, 419in substance abuse, 382

Insomnia, 496Insulin shock therapy, 7Integrative medicine, 57Intellectual functioning, 141–142Intellectualization, as ego defense mechanism, 44tIntellectual processes

in ADHD, 441in antisocial personality disorder, 344in bipolar disorder, 317in borderline personality disorder, 349–350in conduct disorders, 458in delirium, 469in dementia, 478in depression, 307in eating disorders, 404in panic disorder, 242in psychiatric disorder related to abuse and violence, 224in psychosocial assessment, 139b, 141–142in PTSD, 224in schizophrenia, 276–277in somatic symptom illness, 419in substance abuse, 382

Intentional torts, 156

868

Interdisciplinary teams, 71, 72bIntergenerational transmission process, 198Intermittent explosive disorder (IED), 453Internalization

behavior, 457bdefined, 416in somatic symptom illness, 416

Interpersonal factorsfamily support, 125sense of belonging, 124social networks, 124–125social support, 124–125

Interpersonal Relations in Nursing, 7Interpersonal Techniques: The Crux of Psychiatric Nursing, 7Interpersonal theories, 46–49

on anxiety disorders, 237Peplau’s therapeutic relationship, 48f, 48–49, 48tSullivan’s life stages, 46–48, 47t

Interventionin aggressive behavior, 191–192obsessive–compulsive disorder (OCD), 258–259

Interview, for psychosocial assessment, 137–138Intimate partner violence

assessment of, 200clinical picture, 198–199domestic violence, 198interventions, 200–201treatment, 200–201

Intimate relationship, 86Intimate zone, 99Intoxication, 365

alcohol, 368anxiolytics, 368, 370hallucinogens, 372hypnotics, 368, 370inhalants, 373marijuana, 371opioids, 371sedatives, 368, 370stimulants, amphetamines and cocaine, 371

Intrapsychic theories, on anxiety disorders, 237Intrusion, 163Investigational treatment, for depression, 303Isocarboxazid (Marplan), 28t, 301t

JJapanese Americans

bereavement rituals, 168cultural considerations, 129, 168

JCAHO. See Joint Commission on Accreditation of Healthcare Organizations (JCAHO)Jikoshu-kyofu, 268–269The Joint Commission, 153

869

Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 192Judgment

in ADHD, 441in antisocial personality disorder, 344in bipolar disorder, 317in borderline personality disorder, 350in conduct disorders, 458in delirium, 469in dementia, 478in depression, 308in eating disorders, 404in OCD, 257in panic disorder, 242in psychosocial assessment, 139b, 142in PTSD, 224in schizophrenia, 277, 279in somatic symptom illness, 419in substance abuse, 382

Justice, 157

KKava, 36Khmer, 128Kindling, defined, 296Kinesthetic hallucinations, 277Kleptomania, 251–252, 451Knowing, patterns of, 85–86, 85tKoro, 238, 417tKorsakoff’s syndrome, 474Kraepelin, Emil, 3Kubler-Ross’s stages of grieving, 162–163

LLa belle indifférence, 413Labile, 140Lamotrigine (Lamictal), 31, 315tLanguage disorder, 434Latency of response, 274, 304Leadership

group, 55Learning disorders, 433Legal considerations

client’s rights, 152–155confidentiality, 155conservatorship and guardianship, 153duty to warn, 155hospitalization

involuntary, 152mandatory outpatient treatment, 152–153release, 152

insanity defense, 155–156least restrictive environment, 153–155malpractice, 156

870

negligence, 156nursing liability, 156release, 152restraints, 153seclusion, 154torts, 156

Levomethadyl (Orlaam), 376, 377tLewy body dementia, 473Liability

prevention of, 156steps to avoid, 156b

Libido, 43Life events checklist, 214bLife stages

Sullivan’s, 46–48, 47tLimbic system, 17Limit setting, 345Lithium, 4

in aggressive behavior, 185for bipolar disorders, 315

toxicity, 315, 322tdosage, 31mechanism of action, 31side effects, 31–32

Locura, 27Logotherapy, 52, 52tLoose associations, 140Lorazepam (Ativan), 25t, 33t, 234t, 271t, 377t

in aggressive behavior, 185Loss

types of, 162Love-intimacy touch, 100

MMADD. See Mothers Against Drunk Driving (MADD)Magnetic resonance imaging (MRI), of brain, 20Malingering, 414Managed care

cost containment and, 6–7defined, 6

Mania, 294client and family education, 322–323nursing care plan, 318–319bnursing interventions, 320

Manic episode, 294–295clinical vignette, 317diagnosis of, 313DSM-5 diagnostic criteria, 314bnursing process, 316–323

assessment of, 316–318data analysis, 319evaluation, 323

871

intervention, 320–323outcome identification, 319–320

onset and clinical course, 313psychodynamic theories, 297

Manipulative and body-based therapies, 57MAOI. See Monoamine oxidase inhibitors (MAOIs)Maprotiline (Ludiomil), 28tMarijuana, abuse of, 371Maslow, Abraham

hierarchy of needs, 50self-actualization, 50

Maslow’s hierarchy of needs, 50, 50fMaterial abuse, in elder, 205bMaternity blues, 295Medicaid, 6Medical conditions

sexual dysfunctions, 498–499sleep disorders, 497

Medicare, 6Medication. See PsychopharmacologyMedication management

for antipsychotics, 286–287for schizophrenics, 285

Medulla oblongata, 16f, 17, 17fMellow, June, 7Memory, assessment of, 141Memory impairment and dementia, 471. See also DementiaMental health

defined, 2factors, 2

Mental Health Parity Act, passed by Congress, 7Mental health promotion

in anxiety disorders, 239in cognitive disorders, 484disruptive behavior disorders, 460–461eating disorders, 407–408in mood disorders and suicide, 329neurodevelopmental disorders, 443–447in personality disorders, 359in PTSD, 219–220in schizophrenia, 288in somatic symptom illnesses, 426substance abuse, 384–385

Mental illnesscommunity-based care, 5–6cost containment and, 6–7cultural considerations, 7current state of, 4–7defined, 2factors influencing, 2future objectives, 5, 5bhistorical perspectives, 3–4

872

ancient times, 3community-based care, 4institutions, 3psychopharmacology, 4treatment, 3–4

homelessness and, 5, 70screening tool, 71

Mental status exam, 145Meperidine, 29Meprobamate (Miltown, Equanil), 234t, 238tMesoridazine (Serentil), 27Methadone (Dolophine), 376, 377tMethylphenidate, 34, 35tMexican Americans, cultural considerations, 129–130Mexican drug trade names, 507Midbrain, 16f, 17Mild anxiety, 232Milieu therapy, 63

Sullivan’s, 46–48Mind-body interventions, 57Mindfulness-based stress reduction (MBSR), 57bMirtazapine (Remeron), 28t, 299, 301tMixed receptive-expressive language disorder, 434Moderate anxiety, 232Monoamine oxidase inhibitors (MAOIs), 300–301, 301t

drug interactions, 30, 302food interactions, 30, 30blisting of, 28tmechanism of action, 29overdose of, 302side effects, 30

Moodin ADHD, 431and affect, in PTSD, 220in antisocial personality disorder, 344in bipolar disorder, 316in borderline personality disorder, 349in conduct disorders, 458defined, 140in delirium, 469in dementia, 478in depression, 304in eating disorders, 400, 404in OCD, 257in panic disorder, 242in psychosocial assessment, 138b, 140in schizophrenia, 274–275in somatic symptom illness, 419in substance abuse, 382

Mood disordersbipolar disorder, 313–323

nursing process, 316–323

873

onset and clinical course, 313psychopharmacology, 313–316psychotherapy, 316questionnaire, 313treatment, 313–316

categories of, 294–295community-based care, 328–329concept of, 293–294cultural considerations, 297elder considerations, 328etiology of, 296–297

biologic theories, 296psychodynamic theories, 296–297

major depressive disorder, 294–295, 297–303clinical course, 297DSM-5 diagnostic criteria, 298belectroconvulsive therapy (ECT), 302investigational treatment, 303medical treatments and psychotherapy, 302–303nursing process, 303–313psychopharmacology, 297–301, 298b, 299t, 300tpsychotherapy for, 303treatment and prognosis, 297–303

mental health promotion, 329related disorders, 295self-awareness issues, 330substance-induced, 295

Mood-stabilizing drugs, 31–32anticonvulsant drugs, 315–316anticonvulsants as, 31client teaching, 32dosage, 31lithium, 31–32, 315

mechanism of action, 31side effects, 31–32toxicity, 315, 322t

Mothers Against Drunk Driving (MADD), 57Motor behavior

in ADHD, 430–431in antisocial personality disorder, 344in bipolar disorder, 316in borderline personality disorder, 349in conduct disorders, 458in delirium, 467, 469in dementia, 476, 478in depression, 303–304in eating disorders, 400in OCD, 255in panic disorder, 241–242in psychosocial assessment, 138b, 140in PTSD, 220in schizophrenia, 274

874

in somatic symptom illness, 418–419in substance abuse, 382

Motor skills disorders, 433–434Mourning, 162MRI. See Magnetic resonance imaging (MRI)Munchausen’s syndrome by proxy, 414Muslim Americans

bereavement rituals, 167cultural considerations, 167

Myasthenia gravis, 19

NNaltrexone (ReVia, Trexan), 377, 377tNAMI. See National Alliance for the Mentally Ill (NAMI)Narcissistic personality disorder

clinical course, 355–356defined, 355–356interventions, 341t, 356symptoms, 341t

Narcolepsy, 496National Alliance for the Mentally Ill (NAMI), 56National Center for Complementary and Alternative Medicine (NCCAM), 57National Center for Education Statistics (NCES), 209National Human Genome Research Institute (NHGRI), 21Native Americans

bereavement rituals, 168cultural considerations, 127, 168

NCCAM. See National Center for Complementary and Alternative Medicine (NCCAM)NCES. See National Center for Education Statistics (NCES)Nefazodone (Serzone), 28, 28t, 299, 301tNeglect indicators, 204–205, 205bNeologisms, 140Nervous system

central, 16–17limbic system, 17neurotransmitters, 17–19

Neuroanatomic factorsschizophrenia, 267–268

Neurobiologic theoriesin aggressive behavior, 184about mental illness causes

genetic, 21infection, 22psychoimmunology, 21–22

Neurochemical factors, schizophrenia, 267–268Neurochemical theories

anxiety disorders, 237of mood disorders, 296

Neurodevelopmental disordersattention deficit hyperactivity disorder (ADHD), 434–443

adult, 435, 436bcare plan for, 437–438

875

causes of, 435–436client and family education, 443, 443bcultural considerations, 439defined, 434etiology, 435–436, 439nursing process, 440–443onset and clinical course, 435psychopharmacology, 439, 440trisk factors of, 439treatment of, 439

autism spectrum disorder, 432–433chronic motor disorder, 433communication disorders, 434elimination disorders, 434learning disorders, 433mental health promotion, 443, 447motor skills disorders, 433–434related disorders, 433self-awareness issues, 447SNAP-IV teacher and parent rating scale, 444–446btic disorders, 433Tourette’s disorder, 433

Neuroendocrine theories, of mood disorders, 296Neuroleptic malignant syndrome (NMS), 25–26, 270, 271t, 272Neuroleptics, 269. See Antipsychotic drugsNeurotransmitters, 17–18, 18f

abnormal, 18facetylcholine, 19defined, 17dopamine, 18epinephrine, 18functions of, 17–18gamma-aminobutyric acid (GABA), 18f, 19glutamate, 19histamine, 19norepinephrine, 18serotonin, 18–19

NHGRI. See National Human Genome Research Institute (NHGRI)Night eating disorder, 391Nightmare disorder, 497Nihilistic delusions, 276bNMS. See Neuroleptic malignant syndrome (NMS)Nonacceptance, in therapeutic relationships, 92Nonbenzodiazepine, 33tNondirective role, in therapeutic communication, 111–112Nonmaleficence, 157Nonsuicidal self-injury, 295, 349Nontherapeutic communication, techniques to avoid, 102, 105–106t, 106Nonverbal communication

defined, 98skills for, 107–109

Norepinephrine, 18, 19t

876

Nortriptyline (Pamelor), 28t, 300tNo-self-harm contracts, 327

in borderline personality disorder, 353Nurse

role ofin research and education, 22, 22fin therapeutic relationship, 48–49

Nurse’s attitude and approach, factors influencing assessment, 137Nursing care plan, 437–438

for aggressive behavior, 186–189for anorexia nervosa, 397–399for antisocial personality disorder, 346–348for anxiety disorders, 235–236for attention deficit hyperactivity disorder (ADHD), 437–438in borderline personality disorder, 351–352for bulimia nervosa, 402–404for conduct disorder, 455–456for conversion disorder, 415–416for delirium, 468for dementia, 477in depression, 305–307for dual diagnosis, 379–380for grieving, 177–179for hypochondriasis, 420–423for illness anxiety disorder, 420–423for mania, 318–319for obsessive–compulsive and related disorders, 254–255for PTSD, 221–224for schizophrenia, 278–279for substance abuse, 375–376

Nursing diagnosis. See Data analysisNursing interventions

for ADHD, 441for antisocial personality disorder, 345for anxiety and anxiety disorders, 243for borderline personality disorder, 353for conduct disorder, 459for delirium, 471for dementia, 481for depression, 311for eating disorders, 406for grief and loss, 176for mania, 320for obsessive–compulsive and related disorders, 258for schizophrenia, 282for somatic symptom illnesses, 425for substance abuse, 384for trauma and stressor-related disorders, 225

Nursing Mental Diseases, 7Nursing process

of addiction, 381–384of anger, hostility, and aggression, 190–192

877

of antisocial personality disorder, 343–345, 348of attention deficit hyperactivity disorder, 440–443of bipolar disorder, 316–323of borderline personality disorder, 349–350, 352–354of conduct disorder, 457–460of delirium, 467, 469–471of dementia, 476, 478–483of depression, 303–304, 307–308, 310–313of eating disorders, 400, 404–407of grief and loss, 171–176of obsessive–compulsive and related disorders, 255, 257–259of panic disorder, 241–244of schizophrenia, 273–277, 279–287of somatic symptom illnesses, 418–419, 423–425of trauma and stressor-related disorders, 220, 224–226

Nursing Therapy, 7Nutritional considerations

in bipolar disorder, 320in delirium, 471in dementia, 480in eating disorders, 405–406in schizophrenics, 286

OObesity, 390Observation, in therapeutic communication, 100–101Obsessions, 250Obsessive-compulsive disorder (OCD), 230

BIID, 252body dysmorphic disorder, 251care plan for, 254–255client/family education, 259bcommunity-based care, 259cultural considerations, 253data analysis, 258dermatillomania, 251DSM-5 diagnostic criteria, 252betiology, 252–253evaluation, 259hoarding disorder, 251intervention, 258–259, 258bkleptomania, 251–252nursing process

assessment, 255, 256–257b, 257–258community-based care, 259data analysis, 258elder considerations, 259evaluation, 259intervention, 258–259

oniomania, 252onset and clinical course, 251onychophagia, 251

878

related disorders, 251–252self-awareness issues, 260treatment, 253trichotillomania, 251

Obsessive-compulsive personality disorder, 358–359clinical course, 358defined, 358interventions, 341t, 358–359symptoms, 341t

Occipital lobe, 16, 16f, 17fOCD. See Obsessive-compulsive disorder (OCD)Oculogyric crisis, 25ODD. See Oppositional defiant disorder (ODD)Olanzapine (Zyprexa), 24t, 26, 36, 185Older adults, personality disorders in, 359Olfactory hallucinations, 277Oniomania, 252Onychophagia, 251Open-ended questions, for assessment, 138Open groups, 56Operant conditioning, 51–52Opioids, abuse of, 371–372Opisthotonus, 25Oppositional defiant disorder (ODD), 451–453Orgasmic disorders, 498Orientation, defined, 141Orientation phase, of therapeutic relationship, 48, 48tOrthodox Jewish Americans

bereavement rituals, 168cultural considerations, 168

Orthostatic hypotension, 270, 271tOstracism, 209Outcome identification, in aggressive behavior, 191Outcry, 163, 164tOverdose

alcohol, 368anxiolytics, 368, 370hallucinogens, 372hypnotics, 368, 370inhalants, 373marijuana, 371opioids, 371sedatives, 368, 370stimulants, amphetamines and cocaine, 371

Oxazepam (Serax), 33t, 234t, 238tOxcarbazepine (Trileptal), 31, 315t

PPain disorders, 413

management of, 418sexual dysfunctions, 498

Palilalia, 472

879

Paliperidone (Invega), 23, 24tPanic anxiety, 240Panic attacks, 171, 239–240Panic disorder, 236, 239–244

clinical course, 240nursing process

assessment, 241–242data analysis for, 242evaluation, 244intervention, 242–244outcome identification, 242

treatment of, 240Paranoid delusions, 276bParanoid personality disorder

clinical course, 340–341defined, 340interventions, 341tnursing interventions, 341–342symptoms, 341t

Paraphilias, 499Parasomnias, 497Parent surrogate, nurses as, 93Parietal lobe, 16, 16f, 17fParkinson’s disease, 474

symptoms of, 25Paroxetine (Paxil), 28t, 238t, 299t, 418tPartial hospitalization programs (PHP), 65–66, 66bPartner abuse. See also Intimate partner violence

dos and don’ts of working with victims of, 200tPassive-aggressive behavior, defined, 336PATH. See Projects for Assistance in Transition from Homelessness (PATH)Patient’s bill of rights, 152bPavlov, Ivan, classical conditioning, 51PDD. See Pervasive developmental disorder (PDD)Pedophilia, 499Peplau, Hildegard, 7

on anxiety levels, 49, 49ton therapeutic relationship, 48–49, 49t

Period of enlightenment, 3Perls, Frederick, 52, 52tPersecutory delusions, 276bPersistent depressive disorder, 295Personality

components of, 42, 43fobjective measures of, 144tprojective measures of, 144t

Personality disorders, 335–360antisocial, 343–348

care plan for, 346–348client and family education, 348bdefined, 343interventions, 341t

880

nursing process, 343–348symptoms, 341t

avoidantclinical course, 356–357defined, 356interventions, 341t, 357symptoms, 341t

borderline, 349–354interventions, 341tsymptoms, 341t

client and family education, 354bcommunity-based care, 359cultural considerations, 338–339defined, 335, 337, 349dependent, 357–358

clinical course, 357defined, 357interventions, 341t, 357–358symptoms, 341t

depressive behaviordefined, 336

elder considerations, 359etiology, 337–338histrionic, 355

clinical course, 355defined, 355interventions, 341t, 355symptoms, 341t

interventions, 341tmental health promotion, 359narcissistic, 355–356

clinical course, 355–356defined, 355–356interventions, 341t, 356symptoms, 341t

nursing process, 349–354obsessive-compulsive, 358–359

clinical course, 358definition, 358intervention, 341tinterventions, 358–359symptoms, 341t

in older adults, 359onset and clinical course, 337other behaviors, 335paranoid, 340–342

clinical course, 340–341defined, 340interventions, 341tnursing interventions, 341–342symptoms, 341t

passive-aggressive behavior

881

defined, 336psychopharmacology, 339, 340tpsychotherapy, 339–340schizoid

clinical course, 342defined, 342interventions, 341tnursing interventions, 342symptoms, 341t

schizotypalclinical course, 342–343defined, 342interventions, 341tnursing interventions, 343symptoms, 341t

self-awareness issues, 359–360symptoms, 341ttreatment, 339–340

Personal zone, 99Pervasive developmental disorder (PDD), 432PET. See Positron emission tomography (PET)Phenelzine (Nardil), 28t, 301tPhobias, 244–245

defined, 244onset and clinical course, 245treatment of, 245

Phonologic disorder, 434Photosensitivity, 270, 271tPHP. See Partial hospitalization programs (PHP)Physical abuse

defined, 198in elder, 204, 205bin spouse, 198

Physical aggression, 182Physiologic considerations

in PTSD, 224in substance abuse, 382

Physiologic loss, 162Piaget, Jean, and cognitive development stages, 46Pica, 391Pick’s disease, 474Pineal body, 16Pinel, Philippe, 3Play therapy, 439Polydipsia, 280Polysubstance abuse, 365Pons, 16f, 17, 17fPositive reframing, 238Positive regard, in therapeutic relationship, 82Positive self-talk, in borderline personality disorder, 354Positron emission tomography (PET), 20, 21fPostcrisis phase, in aggressive behavior, 192

882

Postpartum blues, 295Postpartum depression, 295Postpartum psychosis, 295Posttraumatic stress disorder (PTSD), 214–217

acute stress disorder, 217adjustment disorder, 217checklist, 215bclient and family education, 219clinical course, 215–216clinical vignette, 221community-based care, 219cultural considerations, 218defined, 214DSM-5 diagnostic criteria, 216–217belder considerations, 219etiology, 217–218mental health promotion, 219–220

dissociative disorders, 219–220interventions, 220treatment of, 220

nursing processassessment, 220, 224data analysis, 225evaluation, 226intervention, 225–226outcome identification, 225

reactive attachment disorder, 217related disorders, 217self-awareness issues, 227treatment of, 218

Potency, of drug, 22Power issues, in family violence, 197, 197bPreconscious, in psychoanalytic theory, 42Premature ejaculation, 498Premenstrual dysphoric disorder, 295Pressured speech, 294Primary gain, 240

in somatic symptom illness, 416Prisoners

mental illnessdecarceration, process of, 70

Prisoners, mental illness and, 70–71Problem-focused coping strategies, 425Problem identification, 90Problem-solving, in therapeutic communication, 113–114Procyclidine (Kemadrin), 25t, 271tProjection, as ego defense mechanism, 44tProjects for Assistance in Transition from Homelessness (PATH), 70Prolixin (decanoatefluphenazine), 23, 24tPropranolol (Inderal), 25t, 32, 238t, 271tProtriptyline (Vivactil), 28tProxemics, 99

883

Pseudoparkinsonism, 25, 270Psychiatric diagnoses, 145Psychiatric nursing

areas of practice, 8bhistorical perspectives, 7phenomena of concern, 7–8, 8bself-awareness issues, 10standards of care, 8student concerns, 8–9, 10f

Psychiatric rehabilitation, 58assertive community treatment (ACT), 68–69, 69bclubhouse model for, 68community support for, 67–68, 67bdefined, 67goals of, 67b

Psychoanalytic theoryon anxiety disorders, 237countertransference, 44, 45current practice, 45dream analysis, 43ego defense mechanisms, 43, 43–44tfree association, 43personality components, 42, 43fpsychosexual development stages, 43–44, 44tsubconscious thoughts, 42–43transference, 44

Psychodynamic theoriesof mood disorders, 296–297personality disorders, 338

Psychoimmunology, 21–22Psychological abuse

in child, 202defined, 198in elder, 204–205in spouse, 198

Psychological tests, 144Psychomotor agitation, 304Psychomotor retardation, 140, 274, 304Psychopharmacology, 22–37

antianxiety drugs, 32–33, 33tantidepressant drugs, 28–31, 28tantipsychotic drugs, 23–28, 24tbipolar disorder, 313–316cultural considerations, 36–37development of, 4disulfiram (antabuse), 35–36mood-stabilizing drugs, 31–32personality disorders, 339self-awareness issues, 36stimulants, 33–35, 35ttreatment guidelines, 23

Psychosexual development, Freud’s stages of, 43–44, 44t

884

Psychosis, 265Psychosocial abuse, in elder, 205bPsychosocial interventions, nursing, 58Psychosocial nursing, in public health and home care, 72Psychosocial rehabilitation. See Psychiatric rehabilitationPsychosocial theories, 41–60

in aggressive behavior, 184–185behavioral theories, 51–52crisis intervention, 53cultural considerations, 53–54developmental theories, 45–46, 46texistential theories, 52–53, 52thumanistic theories, 50interpersonal theories, 46–49psychoanalytic theories, 42–45, 43fself-awareness issues, 59of somatic symptom illness, 416–417

Psychosomatic, defined, 412Psychosurgery, 7Psychotherapy

bipolar disorder, 316depression, 303group, 54–57individual, 54personality disorders, 339–340

Psychotropic drugs, 4, 22PTSD. See Posttraumatic stress disorder (PTSD)Public zone, 99Puerto Ricans, cultural considerations, 130Purging disorder, 391Pyromania, 451

QQi-gong, 269Questions, in therapeutic communication, 112–113

RRape

assessment of, 207–208common myths, 208bdefined, 206dynamics of, 207intervention, 208–209treatment of, 208–209and sexual assault, 206–209

Rational emotive therapy, 52, 52tRationalization, as ego defense mechanism, 44tReaction formation, as ego defense mechanism, 44tReactive attachment disorder (RAD), 217Reality therapy, 52t, 53Recovery

defined, 67later stage, characteristics, 67–68, 67b

885

outcomes, 68culture, 67

Recovery phase, in aggressive behavior, 192Reduction of boarding, hospitalization, 10Referential delusions, 276bReframing, 479, 483Regression, as ego defense mechanism, 44tReinforcement

negative, 51in operant conditioning, 51positive, 51

Relapse, early signs of, 285bRelationships. See also Therapeutic relationship

intimate, 86social, 86therapeutic, 86types of, 8

Relationship violence, warning sign of, 208bReligious delusions, 276bReminiscence therapy, for dementia, 482Reorganization, 166Repressed memories, 220Research, nurse’s role in, 22, 22fResidential treatment settings, 66–67, 66bResistance stage, stress, 231Resolution phase, of therapeutic relationship, 48, 48t, 87t, 90Response prevention, 253Restraining order, 201Restricted affect, 140Revolving door effect, 4f, 5Richards, Linda, 7Risperidone (Risperdal), 23, 24t, 185Rogers, Carl, client-centered therapy, 50Roles and relationships

in ADHD, 441in antisocial personality disorder, 344in bipolar disorder, 317in borderline personality disorder, 350in conduct disorders, 458in delirium, 469in dementia, 478in depression, 308in eating disorders, 405in OCD, 257in panic disorder, 242in psychosocial assessment, 139b, 143in PTSD, 224in schizophrenia, 280in somatic symptom illness, 423–424in substance abuse, 382

Rumination, 304, 307, 391Russians, cultural considerations, 130

886

SSAD. See Seasonal affective disorder (SAD)Safety loss, 162Sanguedormido (sleeping blood), 417, 417tSchizoaffective disorder, 265Schizoid personality disorder

clinical course, 342defined, 342interventions, 341tnursing interventions, 342symptoms, 341t

Schizophrenia, 4career plan for, 278–279client/family education, 285, 287clinical course, 265–266clinical vignette, 277community-based care, 288cultural considerations, 268–269DSM-5 diagnostic criteria, 266elder considerations, 287–288etiology, 267–268mental health promotion, 288negative or soft symptoms, 265bnursing process, 273–287

assessment, 273–280data analysis, 281evaluation, 287intervention, 281–287outcome identification, 281

positive or hard symptoms, 265bpsychopharmacology, 269–272

drug listing, 269tmaintenance therapy, 270side effects, 270–272, 271t, 272b

psychosocial treatment, 272–273related disorders, 266–267self-awareness issues, 289treatment, 269–273types of, 265, 265bunusual speech patterns of clients with, 274b

Schizophreniform disorder, 267Schizotypal personality disorder

clinical course, 342–343defined, 342interventions, 341tnursing interventions, 343symptoms, 341t

Seasonal affective disorder (SAD), 295, 295fSecondary gain, 240

in somatic symptom illness, 416–417Security loss, 162Sedation, 270, 271t

887

Sedatives, abuse of, 368, 370Seizures, 270, 271t, 272Selective mutism, 236Selective serotonin reuptake inhibitor (SSRI), 239

drug interactions, 30listing of, 28t, 299tmechanism of action, 29, 298side effects, 29

Self-actualization, 50loss related to, 162

Self-awarenessof attitudes, 83of beliefs, 82–83cultural considerations, 83, 83bdefined, 10psychosocial theories and, 59in therapeutic relationship, 82–86of values, 82, 83f

Self-awareness issues, 210, 260in aggressive behavior, 193in anxiety disorders, 245–246assessment, 145–146child and adolescent disorders, 447in client response to illness, 132cognitive disorders, 485disruptive behavior disorders, 461with eating disorders, 408–409ethics, 158mood disorders, 330in OCD, 260with personality disorders, 359–360in psychiatric nursing, 10with psychopharmacology, 36in PTSD, 227in schizophrenics, 289somatic symptom illness, 426with substance abuse, 386suicide, 330with therapeutic communication, 116therapeutic relationship and, 94treatment settings, 73

Self carein ADHD, 441in bipolar disorder, 318in borderline personality disorder, 350in conduct disorders, 458in delirium, 470in dementia, 479in depression, 308in eating disorders, 405in OCD, 257–258in panic disorder, 242

888

in psychosocial assessment, 139b, 143in schizophrenia, 280in schizophrenics, 286in somatic symptom illness, 424and proper nutrition, for schizophrenia, 285–286

Self-conceptin ADHD, 441in antisocial personality disorder, 344in bipolar disorder, 317in borderline personality disorder, 350in conduct disorders, 458in delirium, 469–470in dementia, 478in depression, 308in eating disorders, 405in OCD, 257in panic disorder, 242in psychiatric disorder related to abuse and violence, 224in psychosocial assessment, 139b, 142in PTSD, 224in schizophrenia, 279–280in somatic symptom illness, 423in substance abuse, 382

Self-esteem loss, 162Self-help groups, 57Self-monitoring, defined, 406Self-neglect indicators, 205bSelf, therapeutic use of, 83–85Sensorium

in ADHD, 441in antisocial personality disorder, 344in bipolar disorder, 317in borderline personality disorder, 349–350in conduct disorders, 458in delirium, 469in dementia, 478in depression, 307in eating disorders, 404in panic disorder, 242in psychiatric disorder related to abuse and violence, 224in psychosocial assessment, 139b, 141–142in PTSD, 224in schizophrenia, 276–277in somatic symptom illness, 419in substance abuse, 382

Sensory experiences, in psychosocial assessment, 139bSensory-perceptual alterations, in psychosocial assessment, 142Separation anxiety disorder, 237Serotonin, 18–19, 19tSerotonin syndrome, 30, 302Sertraline (Zoloft), 28t, 238t, 299t, 418tSevere anxiety, 232

889

Sexual abuse, in child, 202Sexual arousal disorders, 498Sexual-arousal touch, 100Sexual aversion disorder, 498Sexual delusions, 276bSexual desire disorders, 498Sexual disorders

paraphilias, 499sexual dysfunctions, 498–499

Sexual dysfunctionsarousal disorders, 498desire disorders, 498orgasmic disorders, 498pain disorders, 498related to medical conditions, 498substance-induced, 499

Sexual masochism, 499Sexual pain disorders, 498Sexual sadism, 499Shared psychotic disorder, 267Shenjingshuariuo, 417, 417tSide effects

antianxiety drugs, 33anticholinergic drugs, 26antidepressant drugs, 29–30antipsychotic drugs, 25–27, 271t

agranulocytosis, 272akathisia, 270, 271tanticholinergic, 26blurred vision, 270, 271tclient and family education, 287constipation, 270, 271tdry mouth, 270, 271tdystonic reactions, 270, 271textrapyramidal symptoms (EPS), 25, 269t, 270, 271tneuroleptic malignant syndrome (NMS), 25–26, 270, 271t, 272orthostatic hypotension, 270, 271tphotosensitivity, 270, 271tsedation, 270, 271tseizures, 270, 271t, 272tardive dyskinesia (TD), 26, 270, 271turinary retention, 270, 271tweight gain, 26–27, 270, 271t

benzodiazepines, 33Canadian drugs used in, 504cyclic antidepressants, 29–30lithium, 31–32monoamine oxidase inhibitors (MAOI), 30mood-stabilizing drugs, 31–32selective serotonin reuptake inhibitors (SSRI), 29stimulants, 35

Signals, interpreting, 106–107

890

Silence, in communication, 109Simple Screening Instrument for Alcohol and Other Drugs (SSI-AOD), 381, 381bSingle photon emission computed tomography (SPECT), 20Skinner, B.F., operant conditioning, 51–52Sleep apnea, 496Sleep attacks, 496Sleep disorders

breathing-related, 496–497circadian rhythm, 497hyperinsomnia, 496insomnia, 496narcolepsy, 496nightmare disorder, 497parasomnias, 497related to medical condition, 497sleep hygiene measures, 497sleep terror disorder, 497sleepwalking disorder, 497substance-induced, 497

Sleep hygiene measures, 497Sleep terror disorder, 497Sleepwalking disorder, 497SNAP-IV teacher and parent rating scale, for child and adolescent disorders, 444–446bSocial anxiety disorder, 236Social class, in client response to illness, 127Social isolation, in family violence, 197Social phobia, 236, 245Social-polite touch, 100Social relationship, 86Social Security Disability Income (SSDI), 4Social skills, for schizophrenics, 286Social zone, 99Socioeconomic status, in client response to illness, 127Sodomy, 198Somatic delusions, 276bSomatic symptom disorder, 413Somatization disorder

defined, 413Somatoform disorders, 412–426

antidepressants drugs, 418tbiologic theories of, 417care plan for

conversion disorder, 415–416hypochondriasis, 420–423

client and family education, 425bclinical vignette, 414community-based care for, 425–426conversion disorder, 413coping strategies for, 425cultural considerations, 417–418etiology of, 416–417factitious disorder, 414

891

hypochondriasis, 413, 420–423illness anxiety disorder, 413malingering, 414mental health promotion, 426Munchausen’s syndrome, 414nursing process, 418–419, 423–425

assessment, 418–419, 419b, 423–424data analysis, 424evaluation, 425intervention, 424–425, 425boutcome identification, 424

onset and clinical course of, 413–414overview of, 413pain disorder, 413psychosocial theories of, 416–417related disorders, 414, 416self-awareness issues, 426somatic symptom disorder, 413somatization disorder, 408treatment of, 418, 418t

South Asians, cultural considerations, 130Specific phobia, 236, 244–245SPECT. See Single photon emission computed tomography (SPECT)Spiritual considerations, in therapeutic communication, 110SSDI. See Social Security Disability Income (SSDI)SSI. See Supplemental Security Income (SSI)SSI-AOD. See Simple Screening Instrument for Alcohol and Other Drugs (SSI-AOD)SSRI. See Selective serotonin reuptake inhibitor (SSRI)Stalking, 201Standards of care, 156Stereotyped motor behaviors, 432, 432bStereotypic movement disorder, 434Stigma, 71Stimulants, 33–35

abuse of, 370–371client teaching, 35dosage, 34, 35tmechanism of action, 34side effects, 35

St. John’s wort, 36Stress, 230–234

alarm reaction stage, 231anxiety, levels of, 232anxious clients, working with, 232–233exhaustion stage, 231in mental illness, 21–22related illness, 234related illness, 234resistance stage, 231

Student concerns, related to psychiatric nursing, 8–9, 10fSubconscious thoughts, in psychoanalytic theory, 42–43Substance abuse, 364–386

892

alcohol, 368Canadian drugs in, 504cannabis, 371care plan for, 375–376bclinical course, 365–366community-based care, 384cultural considerations, 367–368defined, 365dual diagnosis, 378elder considerations, 384etiology, 366–367hallucinogens, 372in health professionals, 385inhalants, 372–373marijuana, 371mental health promotion, 384–385nursing process, 381–384

assessment, 382client and family education, 383bdata analysis, 382–383evaluation, 384intervention, 383–384, 384boutcome identification, 383

in older adults, 384opioids, 371–372pharmacologic treatment, 376–378, 377trelated disorders, 366sedatives, hypnotics, and anxiolytics, 368, 370self-awareness issues, 386stimulants amphetamines and cocaine, 370–371treatment, 368–378

and prognosis, 373–378treatment programs, 374, 374btypes of, 365

Substance Abuse and Mental Health Services Administration (SAMSHA), 4Substance dependence, 365Substance-induced anxiety disorder, 236Substance-induced mood disorder, 295Substance-induced sexual dysfunction, 499Substance-induced sleep disorders, 497Substitution, as ego defense mechanism, 44tSuicidal ideation, 324, 326bSuicide, 323–328

assisted, 328attempted, 324defined, 323family response, 327–328incidence, 323legal and ethical considerations, 328myths and facts about, 324–325bnurse’s response, 328self-awareness issues, 330

893

Suicide precautions, 310, 327Suicide risk

antidepressant drugs and, 29, 329assessment of, 324–327elder considerations, 328in elders, 312interventions, 327mental health promotion, 329outcome identification, 327support system for, 327

Sullivan, Harry Stacklife stages, 46–48, 47tmilieu therapy, 46–48

Superego, 42, 43fSupplemental Security Income (SSI), 4Support groups, 58Supportive touch, for dementia, 481Support system, for suicide risk, 327Survivors, 196–197, 226Sympathy, in therapeutic relationship, 81f, 82Synapse, 17–18Synchronous, technology, 69Systematic (serial) desensitization, 51, 245

TTactile hallucinations, 277Talk therapy, 63Tangential thinking, 140Tarasoff vs. Regents of the University of California, 155bTardive dyskinesia (TD), 270, 271tTeacher, nurses as, 92Technology, treatment settings, 69–70Telemedicine Journal and e-Health, 70Telemental health, 69Telepsychiatry, 69Temazepam (Restoril), 33, 33tTemperament, 337Temporal lobe, 16, 16f, 17fTermination phase, therapeutic relationship, 87t, 89t, 90Tetracyclic antidepressants, 299Thalamus, 17Therapeutic communication, 98–116

active listening in, 100–101assertive communication, 114–115clarification, 113client’s anxiety-producing topic, 113community-based care, 115context in, 110cultural considerations, 110–111defined, 99directive role, 112distance zones in, 99

894

empowerment in, 113–114goals of, 111–112interpreting cues, 106–107meaning and, 109–110nondirective role, 111–112nonverbal communication skills, 107–109observation in, 100–101privacy in, 99–100problem-solving in, 113–114questions, 112–113self-awareness issues, 116session, 111–114spiritual considerations, 110techniques for, 101–102, 102–104ttouch in, 100verbal communication skills, 101–107

Therapeutic community, 47–48Therapeutic nurse-patient relationship, 48–49, 48tTherapeutic play, 439Therapeutic relationship, 79–94

anxiety levels in, 49, 49tbehaviors to avoid, 91–92, 91t

avoidance, 92client dependency, 92inappropriate boundaries, 91–92nonacceptance, 92sympathy, 92

components of, 80–86acceptance, 82empathy, 81–82, 81fgenuine interest, 80–81positive regard, 82self-awareness, 82–86trust, 80, 80b

confidentiality in, 88–89duty to warn in, 89methods to avoid inappropriate, 93bnurse–client contracts, 88nurse’s role in, 92–93patterns of knowing in, 85–86phases of, 48, 48t

orientation, 86–90, 87t, 89ttermination, 87t, 89t, 90working, 87t, 90

self-awareness issues, 94self-disclosure in, 89–90therapeutic use of self, 83–85transference in, 90warnings or signs of abuse, 92b

Thiamine (vitamin B1), 376, 377t

Thioridazine (Mellaril), 27Thought blocking, 140

895

defined, 275Thought broadcasting, 140, 275Thought content

in ADHD, 431in antisocial personality disorder, 344in bipolar disorder, 316–317in borderline personality disorder, 349in conduct disorders, 458defined, 140in delirium, 469in dementia, 478in depression, 304, 307in eating disorders, 404in OCD, 257in panic disorder, 242in psychosocial assessment, 138b, 140–141in schizophrenia, 275in somatic symptom illness, 419in substance abuse, 382

Thought insertion, 141, 275Thought process

in ADHD, 431in antisocial personality disorder, 344in bipolar disorder, 316–317in borderline personality disorder, 349in conduct disorders, 458defined, 140in delirium, 469in dementia, 478in depression, 304, 307in eating disorders, 404in OCD, 257in panic disorder, 242in psychosocial assessment, 138b, 140–141in PTSD, 220, 224in schizophrenia, 275in somatic symptom illness, 419in substance abuse, 382

Thought stopping, definition of, 354Thought withdrawal, 141, 274Tic disorders, 433Time away, 482TMS. See Transcranial magnetic stimulation (TMS)Tolerance break, 366Tolerance, drug, 366Topiramate (Topamax), 31, 315t, 316Torticollis, 25Torts, 156Touch

in therapeutic communication, 100types of, 100

Tourette’s disorder, 433

896

Transcranial magnetic stimulation (TMS), 303Transference, 44, 90Transitional discharge model, 67Transvestic fetishism, 499Tranylcypromine (Parnate), 28t, 301tTrazodone (Desyrel), 28, 28tTreatment Advocacy Center, 6Treatment modalities

community-based care, 54, 73complementary and alternative medicine (CAM), 57–58groups, 54–57

defined, 54development stages, 54–55leadership, 55roles in, 55therapy in, 55–57

individual psychotherapy, 54psychiatric rehabilitation, 58

Treatment settings, 63–67hospitalization, 63–65partial hospitalization, 65–66, 66bresidential, 66–67, 66bself-awareness issues, 73technology, 69–70transitional care, 67

Triazolam (Halcion), 33, 33tTrichotillomania, 251Tricyclic antidepressants, 298–299, 300tTriggering phase, 183Trihexyphenidyl (Artane), 25t, 271tTrimipramine (Surmontil), 28tTrust

in therapeutic relationship, 80trusting behaviors, 80b

UUnconscious, in psychoanalytic theory, 42Undoing, as ego defense mechanism, 44tUnintentional torts, 156Universal reactions, 167Urinary retention, 270, 271tU.S. Food and Drug Administration (FDA), 22Utilitarianism, 157Utilization review firms, 6

VVaginismus, 498Valerian, 36Valproate (Depakote), in aggressive behavior, 185Valproic acid (Depakote, Depakene), 31, 316Values clarification exercise, 84bValues clarification process, 82, 83fVascular dementia, 473–474

897

Venlafaxine (Effexor), 28, 28t, 299, 301tVeracity, 157Verbal communication

defined, 98skills for, 101–107

Vietnamesebereavement rituals, 168cultural considerations, 130, 168

Violenceclinical picture of, 196–197community, 209–210cycle of, 199–200family violence

characteristics of, 197–198, 197bcultural considerations of, 198elder. See Elder abusespouse. See Intimate partner violence

intimate partner, 199rape, 206–209sexual assault, 206–209warning signs of abused/neglected children, 203b

Visual hallucinations, 277Vocal cues, in communication, 109Voyeurism, 499

WWarning

amphetamines, 33atypical antipsychotics, 24, 476bupropion, 30carbamazepine, 32clozapine, 27disulfiram, 35droperidol, thioridazine, mesoridazine, 27geodon, 25indicators from caregiver, 205, 205blamotrigine, 31lithium, 31methylphenidate, 34nefazodone, 30pemoline, 34valproic acid and its derivatives, 32

Waxy flexibility, 140, 267, 274Weight gain, due to antipsychotics, 26–27, 270, 271tWithdrawal

alcohol, 368anxiolytics, 370hallucinogens, 372hypnotics, 370inhalants, 373marijuana, 371opioids, 372

898

sedatives, 370stimulants, amphetamines and cocaine, 371

Withdrawal syndrome, 365Word salad, 141, 274Workplace hostility, in aggressive behavior, 192World Health Organization, 58

health defined by, 2

YYale-Brown obsessive–compulsive scale, 256–257b

ZZar, 269Ziprasidone (Geodon), 24t, 25, 26Ziprasidone, Canadian drugs used in, 502–503

899