I.Therapeutic conversation A.Must be: 1.pt focused 2.non-threatening 3.goal oriented 4.based on trust *Benefits both pt and HCW*

B.Types of questions: 1.closed 2.open 3.restating 4.paraphrasing 5.reflecting 6.leading * Avoid advice giving*

C.Speech patterns by pt. 1.Flight of ideas: To shift rapidly between unrelated ideas 2.Echolalia: Repeating the last word heard. 3.Blocking: Able but not willing

4.Mutism: The inability to talk.

** Before you are going to be successful, make sure the patient can participate. ** And most important, LISTEN

II.Places for Patient Treatment A. In patient: 1.Severe mental illness 2.Threat to self or others 3.Baker Act: 4.Transportation hold 5.72 hour hold 6.Direct court hold 7.Assessment hold 8.MI and dangerous:

B.CMHC 1.Community Mental Health Act 2.Should have: a.inpatient b.outpatient c.emergency d.day/night programs

C.Home Care 1.Least disruptive 2.Allows testing of coping skills in real world

D.Residential programs 1.2 types a.Immediate crisis intervention b.Long term

III.Crisis: 1.For pt and family 2.You will see everyday 3.Phases: a.Confusion b.Denial c.Anger d.Sadness e.Reconciliation

4.You will be the one to help with coping mechanisms

III.Types of treatment A.Psychotherapy 1.Individual 2.Group: Provides support Good for addictive person- alities and grief loss

B.Therapeutic Milieu 1.Promote safe environment 2.Everyone is involved C.Behavior Modification: 1.Focus on what client does. 2.Uses influences from family and friends and the social setting

3.Works best with phobias and ETOH/smoking 4.Types: a.Operant b.Positive c.Negative d.Adverse stimulus e.Punishment f.Extinction

D.Codependency 1.Strong urge to solve other peoples problems Takes responsibility 2.Usually because trying to cover their own

E.Drugs Classifications: 1.Antipsychotics:Thorazine 2.Antidepressants:Prozac 3.Antianxiety:Xanax 4.Sedatives:Ambien 5.Antiparkinsonian:Cogentin 6.Anticonvulsant:Depakote 7.Antimanic:Lithium

Main adverse reaction: 1. TARDIVE DYSKINESIA Rhythmic facial/tongue movement

F.ECT: The induction of a seizure to inhibit certain neurotransmitters Best used for depression when meds not effective

IV.Addictive personalities

Care of the Patient with an Addictive Personality Substance Abuse Mental Health

Substance abuse Abuse Addiction Alcoholism Addictive personality

Drug Abuse 1970: Comprehensive Drug Abuse and Controlled Substances Act

Stages of Dependence Early stage: More of drug needed to reach same effect “tolerance”

Middle stage: Difficulty with stopping May use just to feel normal Late stage: Severe impairment Continuous use Need treatment

Alcohol Abuse and Alcoholism Factors contributing to development – Biologic – Genetic – Ethnicity – Personality?

Etiology Effects on brain: Frontal lobe Diuretic affect Intestinal mucosa Nutritional value

Interventions Detoxification Safety IV fluids Seizure precautions Medications Reduce stimuli

Rehabilitation Object of treatment Treatment programs

Types of Treatments Group Therapy Alcoholics Anonymous Treatment Centers

Other Addictive Substances

Drug Abuse Illegal drugs Prescription drugs OTC Club drugs

Depressants (CNS) Sedative-hypnotic drugs – Barbiturates – Benzodiazepines

Depressants con’t Opiod analgesics Opium poppy Laudanum Heroin Morphine sulfate Uses

Stimulants Caffeine Nicotine

Cocaine Amphetamines

Hallucinogens PCP: phencyclidine LSD: lysergic acid diethylamide

Hallucinogens con’t MDMA: Ecstasy Ketamine Mescaline and Psilocybin

Cannabis Sativa Marijuana Hashish THC

Inhalants Solvents Glues Lighter fluid Cleaning fluid Anesthetic gases

Chemically Impaired HCW Indicators of abuse Peer assistance programs Healthcare Integrity and Protection Data Bank (HIPDB)