Psychosis means a person has difficulty correctly understanding reality. Common features include unusual beliefs, unusual perceptions, and disorganized thinking or speech.

Delusion is a false, firmly held belief that does not change simply because evidence says otherwise.

Hallucination is a sensory experience occurring without an outside stimulus.

Illusion is different: there is a real stimulus, but it is interpreted incorrectly.

Thought blocking means the person’s train of thought suddenly stops. They may suddenly become silent.

Flight of ideas means thoughts move rapidly from one subject to another, but some connection between ideas can usually still be followed.

Loose associations means connections between ideas become weak or difficult to follow.

Neologism refers to a newly invented or made-up word.

Echolalia means repeating another person’s words or sounds.

Ideas of reference occur when a person gives a special personal meaning to ordinary events, comments, television, radio, or other media.

Thought broadcasting is a belief that other people can know, hear, or access one’s thoughts.

Thought insertion involves the belief that thoughts are being put into one’s mind by an outside source.

Thought withdrawal involves the belief that thoughts are being taken away from one’s mind.

Defense mechanisms are mainly unconscious psychological ways of dealing with anxiety or uncomfortable feelings.

Displacement means moving an emotion from the original target to a safer target.

Projection means attributing one’s own unacceptable feelings or thoughts to another person.

Regression means returning to behavior associated with an earlier developmental stage during stress.

Rationalization means creating a reasonable-sounding explanation for behavior or feelings.

Sublimation means directing an unacceptable impulse into a socially acceptable activity.

The word schizophrenia comes from Greek roots related to “split” and “mind.” It does not mean having two personalities.

Positive symptoms mean something has been added to normal experience, such as hallucinations, delusions, or disorganized thinking.

Negative symptoms mean normal functions or behaviors are reduced. Examples include reduced motivation, reduced emotional expression, and social withdrawal.

Avolition refers to reduced motivation or difficulty starting goal-directed activities.

Anxiety can range from mild to severe. As anxiety becomes more intense, the person’s ability to process information and concentrate becomes more limited.

With severe anxiety, communication should be simple, clear, and brief. Avoid giving too much information at once.

A panic attack is a sudden episode of intense fear or discomfort. Physical symptoms may include palpitations, sweating, trembling, dizziness, or shortness of breath.

Mania is a period of abnormally elevated, expansive, or irritable mood with increased energy and activity.

Common clues include rapid speech, decreased need for sleep, increased activity, distractibility, and increased goal-directed behavior.

Pressured speech is speech that is unusually rapid and difficult to interrupt.

Lithium is a classic mood stabilizer used in bipolar disorder. It has a relatively narrow therapeutic range, so monitoring and patient education are important.

Lithium levels can rise when the body loses fluid or when certain medicines and conditions affect lithium handling.

Early or concerning toxicity may involve gastrointestinal symptoms such as nausea, vomiting, or diarrhea, along with worsening tremor and weakness.

More serious toxicity can produce neurological symptoms such as confusion, poor coordination, or marked changes in consciousness.

Antipsychotic medications can cause several movement-related adverse effects. The timing and type of movement help distinguish them.

Acute dystonia: sudden painful or sustained muscle contractions, often involving the neck, eyes, jaw, or tongue.

Akathisia: intense inner restlessness with difficulty sitting still.

Tardive dyskinesia: involuntary repetitive movements that usually develop after longer exposure.

Neuroleptic malignant syndrome (NMS): a rare but serious reaction associated with severe rigidity, high temperature, altered mental status, and autonomic instability.

Clozapine is an atypical antipsychotic used in selected patients, particularly when schizophrenia has not responded adequately to other treatments.

One important safety concern is severe neutropenia, which can increase the risk of serious infection.

Therefore, blood monitoring focuses on the absolute neutrophil count (ANC).

Therapeutic communication helps the client express thoughts and feelings while maintaining a professional nurse–client relationship.

Therapeutic silence gives the client time to think, organize thoughts, and continue speaking.

Open-ended statements such as “Tell me more…” encourage the client to explain feelings instead of simply answering yes or no.

Avoid giving false reassurance, judging, comparing, changing the subject, or minimizing feelings.

Delirium is an acute disturbance in attention and awareness. It usually develops over a relatively short period and often fluctuates.

Dementia is a broader term historically used for progressive cognitive decline. The onset is generally gradual.

A sudden change in mental status should make the nurse think about an acute medical cause and assess the patient promptly.

Alcohol withdrawal occurs when a person who has been drinking heavily reduces or stops alcohol intake.

Severe withdrawal can produce autonomic hyperactivity, including sweating, tremor, increased heart rate, elevated blood pressure, agitation, and confusion.

Delirium tremens (DTs) is the severe form of alcohol withdrawal that can include marked confusion, agitation and hallucinations, often with autonomic instability.

OCD contains two important ideas: obsession and compulsion.

An obsession is an unwanted, intrusive, recurring thought, image, or urge.

A compulsion is a repetitive behavior or mental act performed in response to an obsession or according to rigid rules.

Compulsions are often performed to reduce anxiety, although the relief is usually temporary.

PTSD can develop after exposure to a traumatic event. Symptoms may include intrusive memories, nightmares, avoidance, negative mood or thinking changes, and increased arousal or reactivity.

A trigger is a person, place, sound, smell, image, situation, or other stimulus that reminds the individual of the trauma and may bring back distress.

The trigger does not have to be exactly the same as the original traumatic event.

Anorexia nervosa involves restriction of energy intake together with an intense fear of gaining weight or persistent behavior that interferes with weight gain.

A disturbed perception of body weight or shape is an important part of the disorder.

Do not confuse the word anorexia with simply having a temporary loss of appetite from an illness.

When suicide risk is suspected, the nurse should communicate calmly and directly.

Asking directly about suicidal thoughts, plans, intent, and access to means is an important part of risk assessment.

Talking about suicide does not create suicidal thoughts. Avoiding the topic may cause important safety information to be missed.

A client at significant risk requires appropriate safety precautions and observation.

When a client is acutely aggressive, the nurse’s first priority is safety.

Use a calm, confident, nonthreatening manner and maintain an appropriate amount of personal space.

Speak clearly and set simple, consistent limits when necessary. Avoid arguing, threatening, humiliating, or challenging the client unnecessarily.