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

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

4. 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

5. 4.Mutism: The inability to talk.

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

7. 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:

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

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

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

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

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

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

14. 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

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

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

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

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

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

20. IV.Addictive personalities

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

22. Substance abuse Abuse Addiction Alcoholism Addictive personality

23. Drug Abuse 1970: Comprehensive Drug Abuse and Controlled Substances Act

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

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

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

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

28. Interventions Detoxification Safety IV fluids Seizure precautions Medications Reduce stimuli

29. Rehabilitation Object of treatment Treatment programs

30. Types of Treatments Group Therapy Alcoholics Anonymous Treatment Centers

31. Other Addictive Substances

32. Drug Abuse Illegal drugs Prescription drugs OTC Club drugs

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

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

35. Stimulants Caffeine Nicotine

36. Cocaine Amphetamines

37. Hallucinogens PCP: phencyclidine LSD: lysergic acid diethylamide

38. Hallucinogens con’t MDMA: Ecstasy Ketamine Mescaline and Psilocybin

39. Cannabis Sativa Marijuana Hashish THC

40. Inhalants Solvents Glues Lighter fluid Cleaning fluid Anesthetic gases

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